Does Valley County Health System have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Valley County Health System. In a medical emergency, call 911.

Where is Valley County Health System?

2707 L Street, Ord, NE 68862, in Valley County, Nebraska.

What is the phone number of Valley County Health System?

(308) 728-4200, as listed by Medicare (CMS).

What is the Medicare star rating of Valley County Health System?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Valley County Health System — Phone, Address & ER

Quick answers

Does Valley County Health System have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Valley County Health System. In a medical emergency, call 911.
Where is Valley County Health System?: 2707 L Street, Ord, NE 68862, in Valley County, Nebraska.
What is the phone number of Valley County Health System?: (308) 728-4200, as listed by Medicare (CMS).
What is the Medicare star rating of Valley County Health System?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[6][7]

Conditions treated^[12][13][15]

Treatments^{[9][11][12][14][15]}

Sleep study
Low-dose CT lung cancer screening
General X-ray
LSVT BIG and LSVT LOUD therapy
Genesight testing
Individual and group therapy

Procedures^[6]

Tonsillectomy
Adenoidectomy
Colonoscopy with biopsy and polypectomy
Hernia repair
Laparoscopic cholecystectomy
Appendectomy
Hemorrhoidectomy
Lumpectomy
Vasectomy
Hysterectomy
Endometrial ablation
Tubal ligation
Cataract extraction
Total knee replacement
Rotator cuff repair
Knee arthroscopy
Carpal tunnel release
Fracture repair
Bunion repair
Hammertoe repair

Programs and centers^{[5][9][12][13][15][16][17][18][19]}

Emergency Department
Low-Dose CT Lung Cancer Screening Program
Heritage Program for Seniors
LSVT BIG and LOUD Program
Sleep Program
Sterling Connection
Transportation service
VCHS Child Development
ACCESSNebraska community partner

Emergency care (hospital website)^[5][8]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Visitors welcome at any time; front doors lock at 8 p.m. After that, enter through the ER east doors^[10]
Patient portal	Patient Portal

Recognition^[8]

Basic Level Trauma Center (Nebraska Department of Health and Human Services re-designation) 2026

Doctors and clinicians (78)

78 doctors and other clinicians list Valley County Health System as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 54 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Howard County Medical Center37 mi · St Paul, NE · Critical Access Hospital
Jennie M Melham Memorial Medical Center38 mi · Broken Bow, NE · Critical Access Hospital
Boone County Health Center49 mi · Albion, NE · Critical Access Hospital
Callaway District Hospital55 mi · Callaway, NE · Critical Access Hospital
CHI Health St. Francis56 mi · Grand Island, NE · Acute Care Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Ord

Grand Island Regional Medical Center58 mi · Grand Island, NE · Acute Care Hospital

Hospitals in Valley County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Arbor Care Centers - Ord, LLC0.1 mi · Ord, NE · 1 of 5 stars
Community Memorial Health Center16 mi · Burwell, NE · 2 of 5 stars

All nursing homes in the state →

Hospice providers

VCHS Hospice0.2 mi · Ord, NE

All hospice providers in the state →

Home health agencies

VCHS Home Health0.2 mi · Ord, NE · 2.5 of 5 stars

All home health agencies in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Clinics and urgent care

VCHS Medical Clinic0.2 mi · Ord, NE · Rural health clinic
Greeley Medical Clinic21 mi · Greeley, NE · Rural health clinic
VCHS Medical Clinic22 mi · Loup City, NE · Rural health clinic

Pharmacies

Blaha & Blaha Inc0.2 mi · Ord, NE · Community/retail pharmacy

Assisted living nearby

Licensed homes from the official state license list, by straight-line distance.

Grandview Assisted Living Facility0.2 mi · Ord, NE

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Valley County Health System reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Rated the hospital 9 or 10 out of 10	80%National average: 72%
Would definitely recommend the hospital	80%National average: 71%
Nurses “always” communicated well	82%National average: 80%
Doctors “always” communicated well	77%National average: 80%
“Always” got help as soon as they wanted	89%National average: 64%
Staff “always” explained medicines before giving them	71%National average: 62%
Were given information about recovery at home	89%National average: 86%
Room and bathroom “always” clean	89%National average: 73%
Not reported to Medicare	Summary star rating (all survey topics); Overall rating of the hospital; Would recommend the hospital; Nurses communicated well; Doctors communicated well; Patients got help quickly from staff; Staff explained medicines; Information about recovery at home; Room and bathroom kept clean; Restfulness of Environment; Care Coordination; Symptoms After Stay
Completed surveys	26Response rate: 43%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: pneumonia patients	20.7%
Not reported to Medicare	Deaths within 30 days: heart attack patients; Deaths within 30 days: coronary bypass surgery (CABG); Serious complications (patient safety indicator PSI-90)
Too few cases to report	Deaths within 30 days: heart failure patients; Deaths within 30 days: COPD patients; Deaths within 30 days: stroke patients; Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	15.5%
Readmitted within 30 days: pneumonia	16.8%
Not reported to Medicare	Readmitted within 30 days: heart attack; Readmitted within 30 days: coronary bypass surgery; Readmitted within 30 days: hip or knee replacement
Too few cases to report	Readmitted within 30 days: heart failure; Readmitted within 30 days: COPD

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	94 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Not reported to Medicare	Sepsis patients who got all the recommended early care (SEP-1)

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

Not reported to Medicare: infections caught in the hospital. For these topics Medicare shows no result for this hospital (not reported, or too few cases).

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Nebraska Best hospitals in Nebraska

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as Valley County Health System lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Show the prices of 82 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN NEW PT DETAILED HIS	$268	$241.20	$59.01 – $216.99
New patient office visit (about 30–44 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $70.54 Blue Cross Blue Shield of Nebraska — Commercial: $135.07 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $67.18 Great Plains — Medicare Advantage: $70.54 Humana — Medicare Advantage: $68.52 Medica — Commercial Plans/Care System Products: $135.99 Medica — Individual and Family Business Plans: $129.12 Medica — Medicare Advantage: $67.18 Molina — Dual Eligible Plan: $60.74 Molina — Managed Medicaid/CHIP: $59.59
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: BK OFFICE VISIT NEW PATIE	$224	$201.60	$59.01 – $216.99
New patient office visit (about 30–44 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $70.54 Blue Cross Blue Shield of Nebraska — Commercial: $135.07 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $67.18 Great Plains — Medicare Advantage: $70.54 Humana — Medicare Advantage: $68.52 Medica — Commercial Plans/Care System Products: $135.99 Medica — Individual and Family Business Plans: $129.12 Medica — Medicare Advantage: $67.18 Molina — Dual Eligible Plan: $60.74 Molina — Managed Medicaid/CHIP: $59.59
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: CRNA CONSULT NEW PATIENT	$274	$246.60	$59.01 – $216.99
New patient office visit (about 30–44 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $70.54 Blue Cross Blue Shield of Nebraska — Commercial: $135.07 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $67.18 Great Plains — Medicare Advantage: $70.54 Humana — Medicare Advantage: $68.52 Medica — Commercial Plans/Care System Products: $135.99 Medica — Individual and Family Business Plans: $129.12 Medica — Medicare Advantage: $67.18 Molina — Dual Eligible Plan: $60.74 Molina — Managed Medicaid/CHIP: $59.59
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN NEW PT COMP APPROX	$405	$364.50	$96.21 – $356.01
New patient office visit (about 45–59 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $115.73 Blue Cross Blue Shield of Nebraska — Commercial: $221.60 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $110.22 Great Plains — Medicare Advantage: $115.73 Humana — Medicare Advantage: $112.42 Medica — Commercial Plans/Care System Products: $223.11 Medica — Individual and Family Business Plans: $211.84 Medica — Medicare Advantage: $110.22 Molina — Dual Eligible Plan: $99.04 Molina — Managed Medicaid/CHIP: $97.15
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: BK OFFICE VISIT NEW PATIE	$341	$306.90	$96.21 – $356.01
New patient office visit (about 45–59 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $115.73 Blue Cross Blue Shield of Nebraska — Commercial: $221.60 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $110.22 Great Plains — Medicare Advantage: $115.73 Humana — Medicare Advantage: $112.42 Medica — Commercial Plans/Care System Products: $223.11 Medica — Individual and Family Business Plans: $211.84 Medica — Medicare Advantage: $110.22 Molina — Dual Eligible Plan: $99.04 Molina — Managed Medicaid/CHIP: $97.15
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE VISIT NEW PT 45-59	$169	$152.10	$96.21 – $356.01
New patient office visit (about 45–59 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $115.73 Blue Cross Blue Shield of Nebraska — Commercial: $221.60 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $110.22 Great Plains — Medicare Advantage: $115.73 Humana — Medicare Advantage: $112.42 Medica — Commercial Plans/Care System Products: $223.11 Medica — Individual and Family Business Plans: $211.84 Medica — Medicare Advantage: $110.22 Molina — Dual Eligible Plan: $99.04 Molina — Managed Medicaid/CHIP: $97.15
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN NEW PT COMP 60 MIN	$506	$455.40	$124.68 – $485.89
New patient office visit (about 60–74 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $157.95 Blue Cross Blue Shield of Nebraska — Commercial: $302.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $150.43 Great Plains — Medicare Advantage: $157.95 Humana — Medicare Advantage: $153.44 Medica — Commercial Plans/Care System Products: $304.50 Medica — Individual and Family Business Plans: $289.13 Medica — Medicare Advantage: $150.43 Molina — Dual Eligible Plan: $128.35 Molina — Managed Medicaid/CHIP: $125.91
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: BK OFFICE VISIT NEW PATIE	$433	$389.70	$124.68 – $485.89
New patient office visit (about 60–74 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $157.95 Blue Cross Blue Shield of Nebraska — Commercial: $302.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $150.43 Great Plains — Medicare Advantage: $157.95 Humana — Medicare Advantage: $153.44 Medica — Commercial Plans/Care System Products: $304.50 Medica — Individual and Family Business Plans: $289.13 Medica — Medicare Advantage: $150.43 Molina — Dual Eligible Plan: $128.35 Molina — Managed Medicaid/CHIP: $125.91
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE VISIT NEW PT 60-74	$224	$201.60	$124.68 – $485.89
New patient office visit (about 60–74 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $157.95 Blue Cross Blue Shield of Nebraska — Commercial: $302.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $150.43 Great Plains — Medicare Advantage: $157.95 Humana — Medicare Advantage: $153.44 Medica — Commercial Plans/Care System Products: $304.50 Medica — Individual and Family Business Plans: $289.13 Medica — Medicare Advantage: $150.43 Molina — Dual Eligible Plan: $128.35 Molina — Managed Medicaid/CHIP: $125.91
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOCN E7M ONLY NO PX 60-89	$339	$305.10	$67.80 – $332.22
Established patient office visit (about 20–29 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $325.44 Blue Cross Blue Shield of Nebraska — Commercial: $109.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $67.80 Great Plains — Medicare Advantage: $67.80 Humana — Medicare Advantage: $69.16 Medica — Commercial Plans/Care System Products: $325.44 Medica — Individual and Family Business Plans: $308.49 Medica — Medicare Advantage: $67.80 Molina — Dual Eligible Plan: $177.98 Molina — Managed Medicaid/CHIP: $174.59
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN EST PT EXP PROBLEM	$194	$174.60	$38.02 – $176.78
Established patient office visit (about 20–29 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $57.47 Blue Cross Blue Shield of Nebraska — Commercial: $110.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $54.73 Great Plains — Medicare Advantage: $57.47 Humana — Medicare Advantage: $55.82 Medica — Commercial Plans/Care System Products: $110.78 Medica — Individual and Family Business Plans: $105.19 Medica — Medicare Advantage: $54.73 Molina — Dual Eligible Plan: $39.13 Molina — Managed Medicaid/CHIP: $38.39
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: BK OFFICE VISIT EST PATIE	$168	$151.20	$38.02 – $176.78
Established patient office visit (about 20–29 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $57.47 Blue Cross Blue Shield of Nebraska — Commercial: $110.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $54.73 Great Plains — Medicare Advantage: $57.47 Humana — Medicare Advantage: $55.82 Medica — Commercial Plans/Care System Products: $110.78 Medica — Individual and Family Business Plans: $105.19 Medica — Medicare Advantage: $54.73 Molina — Dual Eligible Plan: $39.13 Molina — Managed Medicaid/CHIP: $38.39
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: WOCN E&M ONLY NO PX GREAT	$563	$506.70	$112.60 – $551.74
Established patient office visit (about 30–39 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $540.48 Blue Cross Blue Shield of Nebraska — Commercial: $146.70 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $112.60 Great Plains — Medicare Advantage: $112.60 Humana — Medicare Advantage: $114.85 Medica — Commercial Plans/Care System Products: $540.48 Medica — Individual and Family Business Plans: $512.33 Medica — Medicare Advantage: $112.60 Molina — Dual Eligible Plan: $295.58 Molina — Managed Medicaid/CHIP: $289.95
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN EST PT DETAILED HIS	$277	$249.30	$58.80 – $259.66
Established patient office visit (about 30–39 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $84.41 Blue Cross Blue Shield of Nebraska — Commercial: $161.62 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $80.39 Great Plains — Medicare Advantage: $84.41 Humana — Medicare Advantage: $82 Medica — Commercial Plans/Care System Products: $162.73 Medica — Individual and Family Business Plans: $154.51 Medica — Medicare Advantage: $80.39 Molina — Dual Eligible Plan: $60.53 Molina — Managed Medicaid/CHIP: $59.38
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: BK OFFICE VISIT EST PATIE	$236	$212.40	$58.80 – $259.66
Established patient office visit (about 30–39 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $84.41 Blue Cross Blue Shield of Nebraska — Commercial: $161.62 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $80.39 Great Plains — Medicare Advantage: $84.41 Humana — Medicare Advantage: $82 Medica — Commercial Plans/Care System Products: $162.73 Medica — Individual and Family Business Plans: $154.51 Medica — Medicare Advantage: $80.39 Molina — Dual Eligible Plan: $60.53 Molina — Managed Medicaid/CHIP: $59.38
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$80.40 – $82.76
Office consultation with a specialist (moderate): rates for 4 insurance plans Molina — Dual Eligible Plan: $82.76 Molina — Managed Medicaid/CHIP: $81.18 Nebraska Total Care — Managed Medicaid: $80.40 United Healthcare Community Plan — Managed Medicaid: $80.40
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$109.89 – $113.13
Office consultation with a specialist (moderate to high): rates for 4 insurance plans Molina — Dual Eligible Plan: $113.13 Molina — Managed Medicaid/CHIP: $110.97 Nebraska Total Care — Managed Medicaid: $109.89 United Healthcare Community Plan — Managed Medicaid: $109.89
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL NEW PATIENT 18-3	$232	$208.80	$46.40 – $227.36
Preventive checkup, new patient, age 18–39: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $222.72 Blue Cross Blue Shield of Nebraska — Commercial: $222.72 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $46.40 Great Plains — Medicare Advantage: $46.40 Humana — Medicare Advantage: $47.33 Medica — Commercial Plans/Care System Products: $134.40 Medica — Individual and Family Business Plans: $211.12 Medica — Medicare Advantage: $46.40 Molina — Dual Eligible Plan: $121.80 Molina — Managed Medicaid/CHIP: $119.48
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL NEW PATIENT 18-3	$232	$208.80	$211.12 – $227.36
Preventive checkup, new patient, age 18–39: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $222.72 Medica — Commercial Plans/Care System Products: $222.72 Medica — Individual and Family Business Plans: $211.12 Multiplan/PHCS — Primary/Complementary PPO: $227.36
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN NEW PT PREV VISIT A	$292	$262.80	$107.64 – $110.81
Preventive checkup, new patient, age 18–39: rates for 4 insurance plans Molina — Dual Eligible Plan: $110.81 Molina — Managed Medicaid/CHIP: $108.70 Nebraska Total Care — Managed Medicaid: $107.64 United Healthcare Community Plan — Managed Medicaid: $107.64
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL NEW PATIENT 40-6	$267	$240.30	$53.40 – $261.66
Preventive checkup, new patient, age 40–64: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $256.32 Blue Cross Blue Shield of Nebraska — Commercial: $256.32 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $53.40 Great Plains — Medicare Advantage: $53.40 Humana — Medicare Advantage: $54.47 Medica — Commercial Plans/Care System Products: $153.60 Medica — Individual and Family Business Plans: $242.97 Medica — Medicare Advantage: $53.40 Molina — Dual Eligible Plan: $140.18 Molina — Managed Medicaid/CHIP: $137.51
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL NEW PATIENT 40-6	$267	$240.30	$242.97 – $261.66
Preventive checkup, new patient, age 40–64: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $256.32 Medica — Commercial Plans/Care System Products: $256.32 Medica — Individual and Family Business Plans: $242.97 Multiplan/PHCS — Primary/Complementary PPO: $261.66
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN NEW PT PREV VISIT A	$326	$293.40	$117 – $120.45
Preventive checkup, new patient, age 40–64: rates for 4 insurance plans Molina — Dual Eligible Plan: $120.45 Molina — Managed Medicaid/CHIP: $118.15 Nebraska Total Care — Managed Medicaid: $117 United Healthcare Community Plan — Managed Medicaid: $117
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER LEVEL 3	$733	$659.70	$146.60 – $718.34
Emergency room visit (moderate): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $703.68 Blue Cross Blue Shield of Nebraska — Commercial: $703.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $146.60 Great Plains — Medicare Advantage: $146.60 Humana — Medicare Advantage: $149.53 Medica — Commercial Plans/Care System Products: $703.68 Medica — Individual and Family Business Plans: $667.03 Medica — Medicare Advantage: $146.60 Molina — Dual Eligible Plan: $384.83 Molina — Managed Medicaid/CHIP: $377.50
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: ER LEVEL 3 PROF FEE	$286	$257.40	$64.60 – $208.66
Emergency room visit (moderate): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $67.83 Blue Cross Blue Shield of Nebraska — Commercial: $129.88 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $64.60 Great Plains — Medicare Advantage: $67.83 Humana — Medicare Advantage: $65.89 Medica — Commercial Plans/Care System Products: $130.76 Medica — Individual and Family Business Plans: $124.16 Medica — Medicare Advantage: $64.60 Molina — Dual Eligible Plan: $79.17 Molina — Managed Medicaid/CHIP: $77.66
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER PRO FEE MODERATE EXPAN	$183	$164.70	$36.60 – $179.34
Emergency room visit (moderate): 10 of 15 insurance plan rates Aetna — Medicare Advantage: $175.68 Blue Cross Blue Shield of Nebraska — Commercial: $175.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $36.60 Great Plains — Medicare Advantage: $36.60 Humana — Medicare Advantage: $37.33 Medica — Individual and Family Business Plans: $166.53 Medica — Medicare Advantage: $36.60 Molina — Dual Eligible Plan: $96.08 Molina — Managed Medicaid/CHIP: $94.25 Multiplan/PHCS — Primary/Complementary PPO: $179.34
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER LEVEL 4	$1,040	$936	$208 – $1,019.20
Emergency room visit (moderately high): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $998.40 Blue Cross Blue Shield of Nebraska — Commercial: $998.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $208 Great Plains — Medicare Advantage: $208 Humana — Medicare Advantage: $212.16 Medica — Commercial Plans/Care System Products: $998.40 Medica — Individual and Family Business Plans: $946.40 Medica — Medicare Advantage: $208 Molina — Dual Eligible Plan: $546 Molina — Managed Medicaid/CHIP: $535.60
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: ER LEVEL 4 PROF FEE	$395	$355.50	$109.81 – $354.69
Emergency room visit (moderately high): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $115.30 Blue Cross Blue Shield of Nebraska — Commercial: $220.77 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $109.81 Great Plains — Medicare Advantage: $115.30 Humana — Medicare Advantage: $112.01 Medica — Commercial Plans/Care System Products: $222.28 Medica — Individual and Family Business Plans: $211.05 Medica — Medicare Advantage: $109.81 Molina — Dual Eligible Plan: $119.96 Molina — Managed Medicaid/CHIP: $117.68
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER PRO FEE HIGH SEVERITY	$308	$277.20	$61.60 – $301.84
Emergency room visit (moderately high): 10 of 15 insurance plan rates Aetna — Medicare Advantage: $295.68 Blue Cross Blue Shield of Nebraska — Commercial: $295.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $61.60 Great Plains — Medicare Advantage: $61.60 Humana — Medicare Advantage: $62.83 Medica — Individual and Family Business Plans: $280.28 Medica — Medicare Advantage: $61.60 Molina — Dual Eligible Plan: $161.70 Molina — Managed Medicaid/CHIP: $158.62 Multiplan/PHCS — Primary/Complementary PPO: $301.84
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER LEVEL 5	$1,523	$1,370.70	$304.60 – $1,492.54
Emergency room visit (high): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,462.08 Blue Cross Blue Shield of Nebraska — Commercial: $1,462.08 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $304.60 Great Plains — Medicare Advantage: $304.60 Humana — Medicare Advantage: $310.69 Medica — Commercial Plans/Care System Products: $1,462.08 Medica — Individual and Family Business Plans: $1,385.93 Medica — Medicare Advantage: $304.60 Molina — Dual Eligible Plan: $799.58 Molina — Managed Medicaid/CHIP: $784.35
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: ER LEVEL 5 PROF FEE	$588	$529.20	$159.70 – $515.83
Emergency room visit (high): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $167.69 Blue Cross Blue Shield of Nebraska — Commercial: $321.08 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $159.70 Great Plains — Medicare Advantage: $167.69 Humana — Medicare Advantage: $162.89 Medica — Commercial Plans/Care System Products: $323.26 Medica — Individual and Family Business Plans: $306.94 Medica — Medicare Advantage: $159.70 Molina — Dual Eligible Plan: $177.54 Molina — Managed Medicaid/CHIP: $174.16
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ER PRO FEE HIGH SEVERITY	$448	$403.20	$89.60 – $439.04
Emergency room visit (high): 10 of 15 insurance plan rates Aetna — Medicare Advantage: $430.08 Blue Cross Blue Shield of Nebraska — Commercial: $430.08 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $89.60 Great Plains — Medicare Advantage: $89.60 Humana — Medicare Advantage: $91.39 Medica — Individual and Family Business Plans: $407.68 Medica — Medicare Advantage: $89.60 Molina — Dual Eligible Plan: $235.20 Molina — Managed Medicaid/CHIP: $230.72 Multiplan/PHCS — Primary/Complementary PPO: $439.04

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL	$177	$159.30	$35.40 – $173.46
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $169.92 Blue Cross Blue Shield of Nebraska — Commercial: $69 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $35.40 Great Plains — Medicare Advantage: $35.40 Humana — Medicare Advantage: $36.11 Medica — Commercial Plans/Care System Products: $169.92 Medica — Individual and Family Business Plans: $161.07 Medica — Medicare Advantage: $35.40 Molina — Dual Eligible Plan: $92.93 Molina — Managed Medicaid/CHIP: $91.16
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL	$177	$159.30	$161.07 – $173.46
Basic metabolic panel (blood test): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $169.92 Medica — Commercial Plans/Care System Products: $169.92 Medica — Individual and Family Business Plans: $161.07 Multiplan/PHCS — Primary/Complementary PPO: $173.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Doctor (professional) fee In the file: BASIC METABOLIC PNL TOTAL CA	Not listed in the file	Not listed in the file	$8.63 – $8.88
Basic metabolic panel (blood test): rates for 4 insurance plans Molina — Dual Eligible Plan: $8.88 Molina — Managed Medicaid/CHIP: $8.71 Nebraska Total Care — Managed Medicaid: $8.63 United Healthcare Community Plan — Managed Medicaid: $8.63
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC P	$199	$179.10	$39.80 – $195.02
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $191.04 Blue Cross Blue Shield of Nebraska — Commercial: $80.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $39.80 Great Plains — Medicare Advantage: $39.80 Humana — Medicare Advantage: $40.60 Medica — Commercial Plans/Care System Products: $191.04 Medica — Individual and Family Business Plans: $181.09 Medica — Medicare Advantage: $39.80 Molina — Dual Eligible Plan: $104.48 Molina — Managed Medicaid/CHIP: $102.49
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC P	$199	$179.10	$181.09 – $195.02
Comprehensive metabolic panel (blood test): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $191.04 Medica — Commercial Plans/Care System Products: $191.04 Medica — Individual and Family Business Plans: $181.09 Multiplan/PHCS — Primary/Complementary PPO: $195.02
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$10.77 – $11.09
Comprehensive metabolic panel (blood test): rates for 4 insurance plans Molina — Dual Eligible Plan: $11.09 Molina — Managed Medicaid/CHIP: $10.88 Nebraska Total Care — Managed Medicaid: $10.77 United Healthcare Community Plan — Managed Medicaid: $10.77
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	$297	$267.30	$59.40 – $291.06
Obstetric blood test panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $285.12 Blue Cross Blue Shield of Nebraska — Commercial: $185.14 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $59.40 Great Plains — Medicare Advantage: $59.40 Humana — Medicare Advantage: $60.59 Medica — Commercial Plans/Care System Products: $285.12 Medica — Individual and Family Business Plans: $270.27 Medica — Medicare Advantage: $59.40 Molina — Dual Eligible Plan: $155.93 Molina — Managed Medicaid/CHIP: $152.96
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	$297	$267.30	$270.27 – $291.06
Obstetric blood test panel: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $285.12 Medica — Commercial Plans/Care System Products: $285.12 Medica — Individual and Family Business Plans: $270.27 Multiplan/PHCS — Primary/Complementary PPO: $291.06
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$48.77 – $50.20
Obstetric blood test panel: rates for 4 insurance plans Molina — Dual Eligible Plan: $50.20 Molina — Managed Medicaid/CHIP: $49.24 Nebraska Total Care — Managed Medicaid: $48.77 United Healthcare Community Plan — Managed Medicaid: $48.77
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL	$166	$149.40	$33.20 – $162.68
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $159.36 Blue Cross Blue Shield of Nebraska — Commercial: $73.19 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $33.20 Great Plains — Medicare Advantage: $33.20 Humana — Medicare Advantage: $33.86 Medica — Commercial Plans/Care System Products: $159.36 Medica — Individual and Family Business Plans: $151.06 Medica — Medicare Advantage: $33.20 Molina — Dual Eligible Plan: $20.48 Molina — Managed Medicaid/CHIP: $85.49
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LIPID PANEL	$166	$149.40	$151.06 – $162.68
Cholesterol panel (lipid panel): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $159.36 Medica — Commercial Plans/Care System Products: $159.36 Medica — Individual and Family Business Plans: $151.06 Multiplan/PHCS — Primary/Complementary PPO: $162.68
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Doctor (professional) fee In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$13.66 – $14.06
Cholesterol panel (lipid panel): rates for 4 insurance plans Molina — Dual Eligible Plan: $14.06 Molina — Managed Medicaid/CHIP: $13.79 Nebraska Total Care — Managed Medicaid: $13.66 United Healthcare Community Plan — Managed Medicaid: $13.66
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL PANEL FUNCTION	$187	$168.30	$33.63 – $183.26
Kidney function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $179.52 Blue Cross Blue Shield of Nebraska — Commercial: $33.63 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $37.40 Great Plains — Medicare Advantage: $37.40 Humana — Medicare Advantage: $38.15 Medica — Commercial Plans/Care System Products: $179.52 Medica — Individual and Family Business Plans: $170.17 Medica — Medicare Advantage: $37.40 Molina — Dual Eligible Plan: $98.18 Molina — Managed Medicaid/CHIP: $96.31
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$25	$22.50	$5 – $33.63
Kidney function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $24 Blue Cross Blue Shield of Nebraska — Commercial: $33.63 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $5 Great Plains — Medicare Advantage: $5 Humana — Medicare Advantage: $5.10 Medica — Commercial Plans/Care System Products: $24 Medica — Individual and Family Business Plans: $22.75 Medica — Medicare Advantage: $5 Molina — Dual Eligible Plan: $13.13 Molina — Managed Medicaid/CHIP: $12.88
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL PANEL FUNCTION	$187	$168.30	$170.17 – $183.26
Kidney function panel: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $179.52 Medica — Commercial Plans/Care System Products: $179.52 Medica — Individual and Family Business Plans: $170.17 Multiplan/PHCS — Primary/Complementary PPO: $183.26
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$169	$152.10	$31.65 – $165.62
Liver function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $162.24 Blue Cross Blue Shield of Nebraska — Commercial: $31.65 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $33.80 Great Plains — Medicare Advantage: $33.80 Humana — Medicare Advantage: $34.48 Medica — Commercial Plans/Care System Products: $162.24 Medica — Individual and Family Business Plans: $153.79 Medica — Medicare Advantage: $33.80 Molina — Dual Eligible Plan: $88.73 Molina — Managed Medicaid/CHIP: $87.04
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL (L	$24	$21.60	$4.80 – $31.65
Liver function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $23.04 Blue Cross Blue Shield of Nebraska — Commercial: $31.65 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $4.80 Great Plains — Medicare Advantage: $4.80 Humana — Medicare Advantage: $4.90 Medica — Commercial Plans/Care System Products: $23.04 Medica — Individual and Family Business Plans: $21.84 Medica — Medicare Advantage: $4.80 Molina — Dual Eligible Plan: $12.60 Molina — Managed Medicaid/CHIP: $12.36
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$169	$152.10	$153.79 – $165.62
Liver function panel: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $162.24 Medica — Commercial Plans/Care System Products: $162.24 Medica — Individual and Family Business Plans: $153.79 Multiplan/PHCS — Primary/Complementary PPO: $165.62
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS DIP STICK TABL	$91	$81.90	$18.20 – $89.18
Urine test (automated, with microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $87.36 Blue Cross Blue Shield of Nebraska — Commercial: $21.94 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $18.20 Great Plains — Medicare Advantage: $18.20 Humana — Medicare Advantage: $18.56 Medica — Commercial Plans/Care System Products: $87.36 Medica — Individual and Family Business Plans: $82.81 Medica — Medicare Advantage: $18.20 Molina — Dual Eligible Plan: $47.78 Molina — Managed Medicaid/CHIP: $46.87
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA DIPSTICK/TABLET REAGEN	$11	$9.90	$2.20 – $21.94
Urine test (automated, with microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $10.56 Blue Cross Blue Shield of Nebraska — Commercial: $21.94 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2.20 Great Plains — Medicare Advantage: $2.20 Humana — Medicare Advantage: $2.24 Medica — Commercial Plans/Care System Products: $10.56 Medica — Individual and Family Business Plans: $10.01 Medica — Medicare Advantage: $2.20 Molina — Dual Eligible Plan: $5.78 Molina — Managed Medicaid/CHIP: $5.67
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS DIP STICK TABL	$91	$81.90	$82.81 – $89.18
Urine test (automated, with microscope): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $87.36 Medica — Commercial Plans/Care System Products: $87.36 Medica — Individual and Family Business Plans: $82.81 Multiplan/PHCS — Primary/Complementary PPO: $89.18
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTOMATED W	$50	$45	$10 – $49
Urine test (manual, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $48 Blue Cross Blue Shield of Nebraska — Commercial: $10.91 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $10 Great Plains — Medicare Advantage: $10 Humana — Medicare Advantage: $10.20 Medica — Commercial Plans/Care System Products: $48 Medica — Individual and Family Business Plans: $45.50 Medica — Medicare Advantage: $10 Molina — Dual Eligible Plan: $26.25 Molina — Managed Medicaid/CHIP: $25.75
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA DIP NON AUT W/0 MICROS	$12	$10.80	$2.40 – $11.76
Urine test (manual, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $11.52 Blue Cross Blue Shield of Nebraska — Commercial: $10.91 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2.40 Great Plains — Medicare Advantage: $2.40 Humana — Medicare Advantage: $2.45 Medica — Commercial Plans/Care System Products: $11.52 Medica — Individual and Family Business Plans: $10.92 Medica — Medicare Advantage: $2.40 Molina — Dual Eligible Plan: $6.30 Molina — Managed Medicaid/CHIP: $6.18
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTOMATED W	$50	$45	$45.50 – $49
Urine test (manual, without microscope): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $48 Medica — Commercial Plans/Care System Products: $48 Medica — Individual and Family Business Plans: $45.50 Multiplan/PHCS — Primary/Complementary PPO: $49
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS DIP STICK/TABL	$57	$51.30	$8.69 – $55.86
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $54.72 Blue Cross Blue Shield of Nebraska — Commercial: $8.69 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $11.40 Great Plains — Medicare Advantage: $11.40 Humana — Medicare Advantage: $11.63 Medica — Commercial Plans/Care System Products: $54.72 Medica — Individual and Family Business Plans: $51.87 Medica — Medicare Advantage: $11.40 Molina — Dual Eligible Plan: $29.93 Molina — Managed Medicaid/CHIP: $29.36
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UA DIPSTICK AUTO W/OUT MI	$8	$7.20	$1.60 – $8.69
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $7.68 Blue Cross Blue Shield of Nebraska — Commercial: $8.69 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1.60 Great Plains — Medicare Advantage: $1.60 Humana — Medicare Advantage: $1.63 Medica — Commercial Plans/Care System Products: $7.68 Medica — Individual and Family Business Plans: $7.28 Medica — Medicare Advantage: $1.60 Molina — Dual Eligible Plan: $4.20 Molina — Managed Medicaid/CHIP: $4.12
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS DIP STICK/TABL	$57	$51.30	$51.87 – $55.86
Urine test (automated, without microscope): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $54.72 Medica — Commercial Plans/Care System Products: $54.72 Medica — Individual and Family Business Plans: $51.87 Multiplan/PHCS — Primary/Complementary PPO: $55.86
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE SPECIFIC ANTIGEN	$162	$145.80	$32.40 – $158.76
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $155.52 Blue Cross Blue Shield of Nebraska — Commercial: $71.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $32.40 Great Plains — Medicare Advantage: $32.40 Humana — Medicare Advantage: $33.05 Medica — Commercial Plans/Care System Products: $155.52 Medica — Individual and Family Business Plans: $147.42 Medica — Medicare Advantage: $32.40 Molina — Dual Eligible Plan: $85.05 Molina — Managed Medicaid/CHIP: $83.43
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROSTATE SPECIFIC ANTIGEN	$162	$145.80	$147.42 – $158.76
PSA (prostate specific antigen) blood test: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $155.52 Medica — Commercial Plans/Care System Products: $155.52 Medica — Individual and Family Business Plans: $147.42 Multiplan/PHCS — Primary/Complementary PPO: $158.76
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Doctor (professional) fee In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$18.76 – $19.31
PSA (prostate specific antigen) blood test: rates for 4 insurance plans Molina — Dual Eligible Plan: $19.31 Molina — Managed Medicaid/CHIP: $18.94 Nebraska Total Care — Managed Medicaid: $18.76 United Healthcare Community Plan — Managed Medicaid: $18.76
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMO	$150	$135	$30 – $147
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $144 Blue Cross Blue Shield of Nebraska — Commercial: $61.72 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $30 Great Plains — Medicare Advantage: $30 Humana — Medicare Advantage: $30.60 Medica — Commercial Plans/Care System Products: $144 Medica — Individual and Family Business Plans: $136.50 Medica — Medicare Advantage: $30 Molina — Dual Eligible Plan: $78.75 Molina — Managed Medicaid/CHIP: $77.25
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TSH THYROID STIMULATING H	$48	$43.20	$9.60 – $61.72
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $46.08 Blue Cross Blue Shield of Nebraska — Commercial: $61.72 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $9.60 Great Plains — Medicare Advantage: $9.60 Humana — Medicare Advantage: $9.79 Medica — Commercial Plans/Care System Products: $46.08 Medica — Individual and Family Business Plans: $43.68 Medica — Medicare Advantage: $9.60 Molina — Dual Eligible Plan: $25.20 Molina — Managed Medicaid/CHIP: $24.72
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMO	$150	$135	$136.50 – $147
Thyroid stimulating hormone (TSH) test: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $144 Medica — Commercial Plans/Care System Products: $144 Medica — Individual and Family Business Plans: $136.50 Multiplan/PHCS — Primary/Complementary PPO: $147
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD COUNT; COMPLETE AUT	$131	$117.90	$26.20 – $128.38
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $125.76 Blue Cross Blue Shield of Nebraska — Commercial: $47.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $26.20 Great Plains — Medicare Advantage: $26.20 Humana — Medicare Advantage: $26.72 Medica — Commercial Plans/Care System Products: $125.76 Medica — Individual and Family Business Plans: $119.21 Medica — Medicare Advantage: $26.20 Molina — Dual Eligible Plan: $68.78 Molina — Managed Medicaid/CHIP: $67.47
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD COUNT COMPLETE (CBC	$23	$20.70	$4.60 – $47.03
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $22.08 Blue Cross Blue Shield of Nebraska — Commercial: $47.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $4.60 Great Plains — Medicare Advantage: $4.60 Humana — Medicare Advantage: $4.69 Medica — Commercial Plans/Care System Products: $22.08 Medica — Individual and Family Business Plans: $20.93 Medica — Medicare Advantage: $4.60 Molina — Dual Eligible Plan: $12.08 Molina — Managed Medicaid/CHIP: $11.85
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BLOOD COUNT; COMPLETE AUT	$131	$117.90	$119.21 – $128.38
Complete blood count (CBC) with differential: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $125.76 Medica — Commercial Plans/Care System Products: $125.76 Medica — Individual and Family Business Plans: $119.21 Multiplan/PHCS — Primary/Complementary PPO: $128.38
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD COUNT; COMPLETE AUT	$111	$99.90	$22.20 – $108.78
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $106.56 Blue Cross Blue Shield of Nebraska — Commercial: $25.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $22.20 Great Plains — Medicare Advantage: $22.20 Humana — Medicare Advantage: $22.64 Medica — Commercial Plans/Care System Products: $106.56 Medica — Individual and Family Business Plans: $101.01 Medica — Medicare Advantage: $22.20 Molina — Dual Eligible Plan: $58.28 Molina — Managed Medicaid/CHIP: $57.17
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BLOOD COUNT COMPLETE AUTO	$19	$17.10	$3.80 – $25.03
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $18.24 Blue Cross Blue Shield of Nebraska — Commercial: $25.03 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $3.80 Great Plains — Medicare Advantage: $3.80 Humana — Medicare Advantage: $3.88 Medica — Commercial Plans/Care System Products: $18.24 Medica — Individual and Family Business Plans: $17.29 Medica — Medicare Advantage: $3.80 Molina — Dual Eligible Plan: $9.98 Molina — Managed Medicaid/CHIP: $9.79
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: BLOOD COUNT; COMPLETE AUT	$111	$99.90	$101.01 – $108.78
Complete blood count (CBC), automated: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $106.56 Medica — Commercial Plans/Care System Products: $106.56 Medica — Individual and Family Business Plans: $101.01 Multiplan/PHCS — Primary/Complementary PPO: $108.78
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN	$105	$94.50	$21 – $102.90
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $100.80 Blue Cross Blue Shield of Nebraska — Commercial: $29.06 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $21 Great Plains — Medicare Advantage: $21 Humana — Medicare Advantage: $21.42 Medica — Commercial Plans/Care System Products: $100.80 Medica — Individual and Family Business Plans: $95.55 Medica — Medicare Advantage: $21 Molina — Dual Eligible Plan: $55.13 Molina — Managed Medicaid/CHIP: $54.08
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME	$13	$11.70	$2.60 – $29.06
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $12.48 Blue Cross Blue Shield of Nebraska — Commercial: $29.06 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2.60 Great Plains — Medicare Advantage: $2.60 Humana — Medicare Advantage: $2.65 Medica — Commercial Plans/Care System Products: $12.48 Medica — Individual and Family Business Plans: $11.83 Medica — Medicare Advantage: $2.60 Molina — Dual Eligible Plan: $6.83 Molina — Managed Medicaid/CHIP: $6.70
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROTHROMBIN	$105	$94.50	$95.55 – $102.90
Blood clotting time test (prothrombin time, PT): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $100.80 Medica — Commercial Plans/Care System Products: $100.80 Medica — Individual and Family Business Plans: $95.55 Multiplan/PHCS — Primary/Complementary PPO: $102.90
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTI	$105	$94.50	$21 – $102.90
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $100.80 Blue Cross Blue Shield of Nebraska — Commercial: $23.28 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $21 Great Plains — Medicare Advantage: $21 Humana — Medicare Advantage: $21.42 Medica — Commercial Plans/Care System Products: $100.80 Medica — Individual and Family Business Plans: $95.55 Medica — Medicare Advantage: $21 Molina — Dual Eligible Plan: $55.13 Molina — Managed Medicaid/CHIP: $54.08
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTI	$105	$94.50	$95.55 – $102.90
Blood clotting test (partial thromboplastin time, PTT): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $100.80 Medica — Commercial Plans/Care System Products: $100.80 Medica — Individual and Family Business Plans: $95.55 Multiplan/PHCS — Primary/Complementary PPO: $102.90
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Doctor (professional) fee In the file: THROMBOPLASTIN TIME PARTIAL	Not listed in the file	Not listed in the file	$6.13 – $6.31
Blood clotting test (partial thromboplastin time, PTT): rates for 4 insurance plans Molina — Dual Eligible Plan: $6.31 Molina — Managed Medicaid/CHIP: $6.19 Nebraska Total Care — Managed Medicaid: $6.13 United Healthcare Community Plan — Managed Medicaid: $6.13

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN HEAD/BRAIN W/O CO	$2,415	$2,173.50	$483 – $2,366.70
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,318.40 Blue Cross Blue Shield of Nebraska — Commercial: $1,405.45 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $483 Great Plains — Medicare Advantage: $483 Humana — Medicare Advantage: $492.66 Medica — Commercial Plans/Care System Products: $2,318.40 Medica — Individual and Family Business Plans: $2,197.65 Medica — Medicare Advantage: $483 Molina — Dual Eligible Plan: $1,267.88 Molina — Managed Medicaid/CHIP: $1,243.73
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT SCAN HEAD/BRAIN W/O CO	$2,415	$2,173.50	$2,197.65 – $2,366.70
CT scan of the head or brain, without contrast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $2,318.40 Medica — Commercial Plans/Care System Products: $2,318.40 Medica — Individual and Family Business Plans: $2,197.65 Multiplan/PHCS — Primary/Complementary PPO: $2,366.70
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$99.39 – $321.03
CT scan of the head or brain, without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $104.36 Blue Cross Blue Shield of Nebraska — Commercial: $195.73 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $99.39 Great Plains — Medicare Advantage: $104.36 Humana — Medicare Advantage: $101.38 Medica — Commercial Plans/Care System Products: $201.19 Medica — Individual and Family Business Plans: $191.03 Medica — Medicare Advantage: $99.39 Molina — Dual Eligible Plan: $249.08 Molina — Managed Medicaid/CHIP: $244.34
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN W/WO CONTRAST	$4,647	$4,182.30	$929.40 – $4,554.06
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $4,461.12 Blue Cross Blue Shield of Nebraska — Commercial: $4,461.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $929.40 Great Plains — Medicare Advantage: $929.40 Humana — Medicare Advantage: $947.99 Medica — Commercial Plans/Care System Products: $4,461.12 Medica — Individual and Family Business Plans: $4,228.77 Medica — Medicare Advantage: $929.40 Molina — Dual Eligible Plan: $2,439.68 Molina — Managed Medicaid/CHIP: $2,393.21
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI BRAIN W/WO CONTRAST	$4,647	$4,182.30	$4,228.77 – $4,554.06
MRI of the brain, before and after contrast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $4,461.12 Medica — Commercial Plans/Care System Products: $4,461.12 Medica — Individual and Family Business Plans: $4,228.77 Multiplan/PHCS — Primary/Complementary PPO: $4,554.06
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$295.39 – $954.11
MRI of the brain, before and after contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $310.16 Blue Cross Blue Shield of Nebraska — Commercial: $581.71 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $295.39 Great Plains — Medicare Advantage: $310.16 Humana — Medicare Advantage: $301.30 Medica — Commercial Plans/Care System Products: $597.93 Medica — Individual and Family Business Plans: $567.74 Medica — Medicare Advantage: $295.39 Molina — Dual Eligible Plan: $673.77 Molina — Managed Medicaid/CHIP: $660.94
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RAD EXAM CHEST 2 VIEWS	$448	$403.20	$89.60 – $439.04
Chest X-ray, 2 views: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $430.08 Blue Cross Blue Shield of Nebraska — Commercial: $430.08 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $89.60 Great Plains — Medicare Advantage: $89.60 Humana — Medicare Advantage: $91.39 Medica — Commercial Plans/Care System Products: $430.08 Medica — Individual and Family Business Plans: $407.68 Medica — Medicare Advantage: $89.60 Molina — Dual Eligible Plan: $235.20 Molina — Managed Medicaid/CHIP: $230.72
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RAD EXAM CHEST 2 VIEWS	$448	$403.20	$407.68 – $439.04
Chest X-ray, 2 views: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $430.08 Medica — Commercial Plans/Care System Products: $430.08 Medica — Individual and Family Business Plans: $407.68 Multiplan/PHCS — Primary/Complementary PPO: $439.04
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Doctor (professional) fee In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$30.70 – $99.16
Chest X-ray, 2 views: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $32.24 Blue Cross Blue Shield of Nebraska — Commercial: $60.46 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $30.70 Great Plains — Medicare Advantage: $32.24 Humana — Medicare Advantage: $31.31 Medica — Commercial Plans/Care System Products: $62.14 Medica — Individual and Family Business Plans: $59.01 Medica — Medicare Advantage: $30.70 Molina — Dual Eligible Plan: $54.69 Molina — Managed Medicaid/CHIP: $53.65
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RAD EXAM SPINE LUMBOSACRA	$538	$484.20	$107.60 – $527.24
X-ray of the lower spine, at least 4 views: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $516.48 Blue Cross Blue Shield of Nebraska — Commercial: $516.48 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $107.60 Great Plains — Medicare Advantage: $107.60 Humana — Medicare Advantage: $109.75 Medica — Commercial Plans/Care System Products: $516.48 Medica — Individual and Family Business Plans: $489.58 Medica — Medicare Advantage: $107.60 Molina — Dual Eligible Plan: $282.45 Molina — Managed Medicaid/CHIP: $277.07
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RAD EXAM SPINE LUMBOSACRA	$538	$484.20	$489.58 – $527.24
X-ray of the lower spine, at least 4 views: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $516.48 Medica — Commercial Plans/Care System Products: $516.48 Medica — Individual and Family Business Plans: $489.58 Multiplan/PHCS — Primary/Complementary PPO: $527.24
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$49.42 – $159.63
X-ray of the lower spine, at least 4 views: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $51.89 Blue Cross Blue Shield of Nebraska — Commercial: $97.32 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $49.42 Great Plains — Medicare Advantage: $51.89 Humana — Medicare Advantage: $50.41 Medica — Commercial Plans/Care System Products: $100.04 Medica — Individual and Family Business Plans: $94.99 Medica — Medicare Advantage: $49.42 Molina — Dual Eligible Plan: $58.23 Molina — Managed Medicaid/CHIP: $57.12
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE WITHOUT	$3,971	$3,573.90	$794.20 – $3,891.58
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $3,812.16 Blue Cross Blue Shield of Nebraska — Commercial: $2,003.17 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $794.20 Great Plains — Medicare Advantage: $794.20 Humana — Medicare Advantage: $810.08 Medica — Commercial Plans/Care System Products: $3,812.16 Medica — Individual and Family Business Plans: $3,613.61 Medica — Medicare Advantage: $794.20 Molina — Dual Eligible Plan: $2,084.78 Molina — Managed Medicaid/CHIP: $2,045.07
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI LUMBAR SPINE WITHOUT	$3,971	$3,573.90	$3,613.61 – $3,891.58
MRI of the lower back (lumbar spine), without contrast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $3,812.16 Medica — Commercial Plans/Care System Products: $3,812.16 Medica — Individual and Family Business Plans: $3,613.61 Multiplan/PHCS — Primary/Complementary PPO: $3,891.58
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$178.84 – $577.65
MRI of the lower back (lumbar spine), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $187.78 Blue Cross Blue Shield of Nebraska — Commercial: $352.19 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $178.84 Great Plains — Medicare Advantage: $187.78 Humana — Medicare Advantage: $182.42 Medica — Commercial Plans/Care System Products: $362.01 Medica — Individual and Family Business Plans: $343.73 Medica — Medicare Advantage: $178.84 Molina — Dual Eligible Plan: $462.76 Molina — Managed Medicaid/CHIP: $453.94
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN PELVIS W/CONTRAST	$3,038	$2,734.20	$607.60 – $2,977.24
CT scan of the pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,916.48 Blue Cross Blue Shield of Nebraska — Commercial: $2,916.48 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $607.60 Great Plains — Medicare Advantage: $607.60 Humana — Medicare Advantage: $619.75 Medica — Commercial Plans/Care System Products: $2,916.48 Medica — Individual and Family Business Plans: $2,764.58 Medica — Medicare Advantage: $607.60 Molina — Dual Eligible Plan: $1,594.95 Molina — Managed Medicaid/CHIP: $1,564.57
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT SCAN PELVIS W/CONTRAST	$3,038	$2,734.20	$2,764.58 – $2,977.24
CT scan of the pelvis, with contrast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $2,916.48 Medica — Commercial Plans/Care System Products: $2,916.48 Medica — Individual and Family Business Plans: $2,764.58 Multiplan/PHCS — Primary/Complementary PPO: $2,977.24
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$209.67 – $677.23
CT scan of the pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $220.15 Blue Cross Blue Shield of Nebraska — Commercial: $412.90 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $209.67 Great Plains — Medicare Advantage: $220.15 Humana — Medicare Advantage: $213.86 Medica — Commercial Plans/Care System Products: $424.41 Medica — Individual and Family Business Plans: $402.99 Medica — Medicare Advantage: $209.67 Molina — Dual Eligible Plan: $338.02 Molina — Managed Medicaid/CHIP: $331.58
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LOWER EXTREMITY JOINT	$3,300	$2,970	$660 – $3,234
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $3,168 Blue Cross Blue Shield of Nebraska — Commercial: $1,521.76 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $660 Great Plains — Medicare Advantage: $660 Humana — Medicare Advantage: $673.20 Medica — Commercial Plans/Care System Products: $3,168 Medica — Individual and Family Business Plans: $3,003 Medica — Medicare Advantage: $660 Molina — Dual Eligible Plan: $1,732.50 Molina — Managed Medicaid/CHIP: $1,699.50
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI LOWER EXTREMITY JOINT	$3,300	$2,970	$3,003 – $3,234
MRI of a leg joint (such as the knee), without contrast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $3,168 Medica — Commercial Plans/Care System Products: $3,168 Medica — Individual and Family Business Plans: $3,003 Multiplan/PHCS — Primary/Complementary PPO: $3,234
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI JNT OF LWR EXTRE W/O DYE	Not listed in the file	Not listed in the file	$190.43 – $615.09
MRI of a leg joint (such as the knee), without contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $199.95 Blue Cross Blue Shield of Nebraska — Commercial: $375.01 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $190.43 Great Plains — Medicare Advantage: $199.95 Humana — Medicare Advantage: $194.24 Medica — Commercial Plans/Care System Products: $385.47 Medica — Individual and Family Business Plans: $366.01 Medica — Medicare Advantage: $190.43 Molina — Dual Eligible Plan: $457.98 Molina — Managed Medicaid/CHIP: $449.26
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT SCAN-ABDOMEN & PELVIS	$5,448	$4,903.20	$1,089.60 – $5,339.04
CT scan of the abdomen and pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $5,230.08 Blue Cross Blue Shield of Nebraska — Commercial: $2,789.35 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,089.60 Great Plains — Medicare Advantage: $1,089.60 Humana — Medicare Advantage: $1,111.39 Medica — Commercial Plans/Care System Products: $5,230.08 Medica — Individual and Family Business Plans: $4,957.68 Medica — Medicare Advantage: $1,089.60 Molina — Dual Eligible Plan: $2,860.20 Molina — Managed Medicaid/CHIP: $2,805.72
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT SCAN-ABDOMEN & PELVIS	$5,448	$4,903.20	$4,957.68 – $5,339.04
CT scan of the abdomen and pelvis, with contrast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $5,230.08 Medica — Commercial Plans/Care System Products: $5,230.08 Medica — Individual and Family Business Plans: $4,957.68 Multiplan/PHCS — Primary/Complementary PPO: $5,339.04
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$279.65 – $903.27
CT scan of the abdomen and pelvis, with contrast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $293.63 Blue Cross Blue Shield of Nebraska — Commercial: $550.71 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $279.65 Great Plains — Medicare Advantage: $293.63 Humana — Medicare Advantage: $285.24 Medica — Commercial Plans/Care System Products: $566.07 Medica — Individual and Family Business Plans: $537.49 Medica — Medicare Advantage: $279.65 Molina — Dual Eligible Plan: $557.26 Molina — Managed Medicaid/CHIP: $546.64
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULTRASOUND ABDOMINAL COMP	$952	$856.80	$190.40 – $932.96
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $913.92 Blue Cross Blue Shield of Nebraska — Commercial: $711.01 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $190.40 Great Plains — Medicare Advantage: $190.40 Humana — Medicare Advantage: $194.21 Medica — Commercial Plans/Care System Products: $913.92 Medica — Individual and Family Business Plans: $866.32 Medica — Medicare Advantage: $190.40 Molina — Dual Eligible Plan: $499.80 Molina — Managed Medicaid/CHIP: $490.28
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ULTRASOUND ABDOMINAL COMP	$952	$856.80	$866.32 – $932.96
Ultrasound of the abdomen, complete: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $913.92 Medica — Commercial Plans/Care System Products: $913.92 Medica — Individual and Family Business Plans: $866.32 Multiplan/PHCS — Primary/Complementary PPO: $932.96
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$106.37 – $343.58
Ultrasound of the abdomen, complete: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $111.69 Blue Cross Blue Shield of Nebraska — Commercial: $209.47 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $106.37 Great Plains — Medicare Advantage: $111.69 Humana — Medicare Advantage: $108.50 Medica — Commercial Plans/Care System Products: $215.31 Medica — Individual and Family Business Plans: $204.44 Medica — Medicare Advantage: $106.37 Molina — Dual Eligible Plan: $138.71 Molina — Managed Medicaid/CHIP: $136.06
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULS PREG UTERUS >OR=14WKS	$1,040	$936	$208 – $1,019.20
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $998.40 Blue Cross Blue Shield of Nebraska — Commercial: $998.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $208 Great Plains — Medicare Advantage: $208 Humana — Medicare Advantage: $212.16 Medica — Commercial Plans/Care System Products: $998.40 Medica — Individual and Family Business Plans: $946.40 Medica — Medicare Advantage: $208 Molina — Dual Eligible Plan: $546 Molina — Managed Medicaid/CHIP: $535.60
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN US OB, ABDOMEN>14 W	$375	$337.50	$126.39 – $408.24
Pregnancy ultrasound (after the first trimester): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $132.71 Blue Cross Blue Shield of Nebraska — Commercial: $248.90 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $126.39 Great Plains — Medicare Advantage: $132.71 Humana — Medicare Advantage: $128.92 Medica — Commercial Plans/Care System Products: $255.84 Medica — Individual and Family Business Plans: $242.92 Medica — Medicare Advantage: $126.39 Molina — Dual Eligible Plan: $153.75 Molina — Managed Medicaid/CHIP: $150.82
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ULS PREG UTERUS >OR=14WKS	$1,040	$936	$946.40 – $1,019.20
Pregnancy ultrasound (after the first trimester): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $998.40 Medica — Commercial Plans/Care System Products: $998.40 Medica — Individual and Family Business Plans: $946.40 Multiplan/PHCS — Primary/Complementary PPO: $1,019.20
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULTRASOUND TRANSVAGINAL N	$787	$708.30	$157.40 – $771.26
Transvaginal ultrasound: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $755.52 Blue Cross Blue Shield of Nebraska — Commercial: $755.52 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $157.40 Great Plains — Medicare Advantage: $157.40 Humana — Medicare Advantage: $160.55 Medica — Commercial Plans/Care System Products: $755.52 Medica — Individual and Family Business Plans: $716.17 Medica — Medicare Advantage: $157.40 Molina — Dual Eligible Plan: $413.18 Molina — Managed Medicaid/CHIP: $405.31
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ULS TRANSVAGINAL FOLLICUL	$328	$295.20	$65.60 – $321.44
Transvaginal ultrasound: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $314.88 Blue Cross Blue Shield of Nebraska — Commercial: $314.88 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $65.60 Great Plains — Medicare Advantage: $65.60 Humana — Medicare Advantage: $66.91 Medica — Commercial Plans/Care System Products: $314.88 Medica — Individual and Family Business Plans: $298.48 Medica — Medicare Advantage: $65.60 Molina — Dual Eligible Plan: $172.20 Molina — Managed Medicaid/CHIP: $168.92
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN US VAGINAL/GYN PRO	$328	$295.20	$109.15 – $352.55
Transvaginal ultrasound: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $114.61 Blue Cross Blue Shield of Nebraska — Commercial: $214.95 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $109.15 Great Plains — Medicare Advantage: $114.61 Humana — Medicare Advantage: $111.33 Medica — Commercial Plans/Care System Products: $220.94 Medica — Individual and Family Business Plans: $209.79 Medica — Medicare Advantage: $109.15 Molina — Dual Eligible Plan: $115.34 Molina — Managed Medicaid/CHIP: $113.15
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY UN	$403	$362.70	$80.60 – $394.94
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $386.88 Blue Cross Blue Shield of Nebraska — Commercial: $386.88 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $80.60 Great Plains — Medicare Advantage: $80.60 Humana — Medicare Advantage: $82.21 Medica — Commercial Plans/Care System Products: $386.88 Medica — Individual and Family Business Plans: $366.73 Medica — Medicare Advantage: $80.60 Molina — Dual Eligible Plan: $211.58 Molina — Managed Medicaid/CHIP: $207.55
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY UN	$403	$362.70	$366.73 – $394.94
Diagnostic mammogram, one breast: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $386.88 Medica — Commercial Plans/Care System Products: $386.88 Medica — Individual and Family Business Plans: $366.73 Multiplan/PHCS — Primary/Complementary PPO: $394.94
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$115.32 – $372.48
Diagnostic mammogram, one breast: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $121.09 Blue Cross Blue Shield of Nebraska — Commercial: $227.10 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $115.32 Great Plains — Medicare Advantage: $121.09 Humana — Medicare Advantage: $117.63 Medica — Commercial Plans/Care System Products: $233.43 Medica — Individual and Family Business Plans: $221.65 Medica — Medicare Advantage: $115.32 Molina — Dual Eligible Plan: $157.89 Molina — Managed Medicaid/CHIP: $154.88
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY BI	$454	$408.60	$90.80 – $444.92
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $435.84 Blue Cross Blue Shield of Nebraska — Commercial: $435.84 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $90.80 Great Plains — Medicare Advantage: $90.80 Humana — Medicare Advantage: $92.62 Medica — Commercial Plans/Care System Products: $435.84 Medica — Individual and Family Business Plans: $413.14 Medica — Medicare Advantage: $90.80 Molina — Dual Eligible Plan: $238.35 Molina — Managed Medicaid/CHIP: $233.81
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: DIAGNOSTIC MAMMOGRAPHY BI	$454	$408.60	$413.14 – $444.92
Diagnostic mammogram, both breasts: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $435.84 Medica — Commercial Plans/Care System Products: $435.84 Medica — Individual and Family Business Plans: $413.14 Multiplan/PHCS — Primary/Complementary PPO: $444.92
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$145.96 – $471.45
Diagnostic mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $153.26 Blue Cross Blue Shield of Nebraska — Commercial: $287.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $145.96 Great Plains — Medicare Advantage: $153.26 Humana — Medicare Advantage: $148.88 Medica — Commercial Plans/Care System Products: $295.45 Medica — Individual and Family Business Plans: $280.54 Medica — Medicare Advantage: $145.96 Molina — Dual Eligible Plan: $200.30 Molina — Managed Medicaid/CHIP: $196.48
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCREENING MAMMOGRAM BILAT	$399	$359.10	$79.80 – $391.02
Screening mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $383.04 Blue Cross Blue Shield of Nebraska — Commercial: $242.32 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $79.80 Great Plains — Medicare Advantage: $79.80 Humana — Medicare Advantage: $81.40 Medica — Commercial Plans/Care System Products: $383.04 Medica — Individual and Family Business Plans: $363.09 Medica — Medicare Advantage: $79.80 Molina — Dual Eligible Plan: $209.48 Molina — Managed Medicaid/CHIP: $205.49
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCREEN MAMMOGRAM UNILATER	$399	$359.10	$79.80 – $391.02
Screening mammogram, both breasts: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $383.04 Blue Cross Blue Shield of Nebraska — Commercial: $242.32 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $79.80 Great Plains — Medicare Advantage: $79.80 Humana — Medicare Advantage: $81.40 Medica — Commercial Plans/Care System Products: $383.04 Medica — Individual and Family Business Plans: $363.09 Medica — Medicare Advantage: $79.80 Molina — Dual Eligible Plan: $209.48 Molina — Managed Medicaid/CHIP: $205.49
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: SCREENING MAMMOGRAM BILAT	$399	$359.10	$363.09 – $391.02
Screening mammogram, both breasts: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $383.04 Medica — Commercial Plans/Care System Products: $383.04 Medica — Individual and Family Business Plans: $363.09 Multiplan/PHCS — Primary/Complementary PPO: $391.02

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EKG W/ AT LEAST 12 LEADS,	$41	$36.90	$8.20 – $40.18
Electrocardiogram (ECG/EKG) with reading: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $39.36 Blue Cross Blue Shield of Nebraska — Commercial: $39.36 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $8.20 Great Plains — Medicare Advantage: $8.20 Humana — Medicare Advantage: $8.36 Medica — Individual and Family Business Plans: $37.31 Medica — Medicare Advantage: $8.20 Molina — Dual Eligible Plan: $21.53 Molina — Managed Medicaid/CHIP: $21.12 Multiplan/PHCS — Primary/Complementary PPO: $40.18
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EKG W/ AT LEAST 12 LEADS,	$41	$36.90	$37.31 – $40.18
Electrocardiogram (ECG/EKG) with reading: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $39.36 Medica — Commercial Plans/Care System Products: $39.36 Medica — Individual and Family Business Plans: $37.31 Multiplan/PHCS — Primary/Complementary PPO: $40.18
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$14.25 – $54.69
Electrocardiogram (ECG/EKG) with reading: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $14.96 Blue Cross Blue Shield of Nebraska — Commercial: $28.65 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $14.25 Great Plains — Medicare Advantage: $14.96 Humana — Medicare Advantage: $14.54 Medica — Commercial Plans/Care System Products: $28.84 Medica — Individual and Family Business Plans: $27.39 Medica — Medicare Advantage: $14.25 Molina — Dual Eligible Plan: $54.69 Molina — Managed Medicaid/CHIP: $53.65
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$790.10 – $2,597.47
Left heart catheterization (diagnostic): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $844.38 Blue Cross Blue Shield of Nebraska — Commercial: $1,616.78 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $804.17 Great Plains — Medicare Advantage: $844.38 Humana — Medicare Advantage: $820.25 Medica — Commercial Plans/Care System Products: $1,627.80 Medica — Individual and Family Business Plans: $1,545.61 Medica — Medicare Advantage: $804.17 Molina — Dual Eligible Plan: $813.34 Molina — Managed Medicaid/CHIP: $797.85
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$209.15 – $675.55
Left heart catheterization (diagnostic): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $219.61 Blue Cross Blue Shield of Nebraska — Commercial: $420.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $209.15 Great Plains — Medicare Advantage: $219.61 Humana — Medicare Advantage: $213.33 Medica — Commercial Plans/Care System Products: $423.36 Medica — Individual and Family Business Plans: $401.99 Medica — Medicare Advantage: $209.15 Molina — Dual Eligible Plan: $249.04 Molina — Managed Medicaid/CHIP: $244.30
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$595.01 – $1,921.88
Left heart catheterization (diagnostic): 10 of 12 insurance plan rates Aetna — Medicare Advantage: $624.76 Blue Cross Blue Shield of Nebraska — Commercial: $1,196.27 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $595.01 Great Plains — Medicare Advantage: $624.76 Humana — Medicare Advantage: $606.91 Medica — Commercial Plans/Care System Products: $1,204.42 Medica — Individual and Family Business Plans: $1,143.61 Medica — Medicare Advantage: $595.01 Multiplan/PHCS — Primary/Complementary PPO: $1,921.88 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $612.86
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$785.23 – $2,536.29
Heart rhythm study (electrophysiology evaluation): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $824.49 Blue Cross Blue Shield of Nebraska — Commercial: $1,578.70 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $785.23 Great Plains — Medicare Advantage: $824.49 Humana — Medicare Advantage: $800.93 Medica — Commercial Plans/Care System Products: $1,589.46 Medica — Individual and Family Business Plans: $1,509.21 Medica — Medicare Advantage: $785.23 Molina — Dual Eligible Plan: $1,079.66 Molina — Managed Medicaid/CHIP: $1,059.10
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$340.31 – $1,099.20
Heart rhythm study (electrophysiology evaluation): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $357.33 Blue Cross Blue Shield of Nebraska — Commercial: $684.19 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $340.31 Great Plains — Medicare Advantage: $357.33 Humana — Medicare Advantage: $347.12 Medica — Commercial Plans/Care System Products: $688.86 Medica — Individual and Family Business Plans: $654.08 Medica — Medicare Advantage: $340.31 Molina — Dual Eligible Plan: $719.78 Molina — Managed Medicaid/CHIP: $706.07
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$316.25 – $1,021.49
Heart rhythm study (electrophysiology evaluation): 10 of 12 insurance plan rates Aetna — Medicare Advantage: $332.06 Blue Cross Blue Shield of Nebraska — Commercial: $635.82 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $316.25 Great Plains — Medicare Advantage: $332.06 Humana — Medicare Advantage: $322.58 Medica — Commercial Plans/Care System Products: $640.15 Medica — Individual and Family Business Plans: $607.83 Medica — Medicare Advantage: $316.25 Multiplan/PHCS — Primary/Complementary PPO: $1,021.49 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $325.74
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$715.99 – $2,312.65
Heart rhythm study with ablation for atrial fibrillation: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $751.79 Blue Cross Blue Shield of Nebraska — Commercial: $1,439.50 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $715.99 Great Plains — Medicare Advantage: $751.79 Humana — Medicare Advantage: $730.31 Medica — Commercial Plans/Care System Products: $1,449.31 Medica — Individual and Family Business Plans: $1,376.13 Medica — Medicare Advantage: $715.99 Molina — Dual Eligible Plan: $772.56 Molina — Managed Medicaid/CHIP: $757.84
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOMNOGRAPHY W/4 + PAR	$4,290	$3,861	$858 – $4,204.20
Sleep study (overnight, in a sleep lab): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $4,118.40 Blue Cross Blue Shield of Nebraska — Commercial: $4,118.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $858 Great Plains — Medicare Advantage: $858 Humana — Medicare Advantage: $875.16 Medica — Commercial Plans/Care System Products: $4,118.40 Medica — Individual and Family Business Plans: $3,903.90 Medica — Medicare Advantage: $858 Molina — Dual Eligible Plan: $2,252.25 Molina — Managed Medicaid/CHIP: $2,209.35
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: POLYSOMNOGRAPHY W/4 + PAR	$4,290	$3,861	$3,903.90 – $4,204.20
Sleep study (overnight, in a sleep lab): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $4,118.40 Medica — Commercial Plans/Care System Products: $4,118.40 Medica — Individual and Family Business Plans: $3,903.90 Multiplan/PHCS — Primary/Complementary PPO: $4,204.20
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$480.12 – $2,015.46
Sleep study (overnight, in a sleep lab): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $655.18 Blue Cross Blue Shield of Nebraska — Commercial: $1,254.51 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $623.98 Great Plains — Medicare Advantage: $655.18 Humana — Medicare Advantage: $636.46 Medica — Commercial Plans/Care System Products: $1,263.06 Medica — Individual and Family Business Plans: $1,199.29 Medica — Medicare Advantage: $623.98 Molina — Dual Eligible Plan: $494.25 Molina — Managed Medicaid/CHIP: $484.83

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THERAPY PROCEDURE, EXERCI	$115	$103.50	$23 – $112.70
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $110.40 Blue Cross Blue Shield of Nebraska — Commercial: $73.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $23 Great Plains — Medicare Advantage: $23 Humana — Medicare Advantage: $23.46 Medica — Commercial Plans/Care System Products: $110.40 Medica — Individual and Family Business Plans: $104.65 Medica — Medicare Advantage: $23 Molina — Dual Eligible Plan: $60.38 Molina — Managed Medicaid/CHIP: $59.23
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THERAPEUTIC PROCEDURE, EX	$111	$99.90	$22.20 – $108.78
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $106.56 Blue Cross Blue Shield of Nebraska — Commercial: $73.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $22.20 Great Plains — Medicare Advantage: $22.20 Humana — Medicare Advantage: $22.64 Medica — Commercial Plans/Care System Products: $106.56 Medica — Individual and Family Business Plans: $101.01 Medica — Medicare Advantage: $22.20 Molina — Dual Eligible Plan: $58.28 Molina — Managed Medicaid/CHIP: $57.17
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THERAPY PROCEDURE, EXERCI	$115	$103.50	$104.65 – $112.70
Physical therapy: therapeutic exercise (each 15 minutes): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $110.40 Medica — Commercial Plans/Care System Products: $110.40 Medica — Individual and Family Business Plans: $104.65 Multiplan/PHCS — Primary/Complementary PPO: $112.70
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVAL LOW	$215	$193.50	$43 – $210.70
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $206.40 Blue Cross Blue Shield of Nebraska — Commercial: $206.40 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $43 Great Plains — Medicare Advantage: $43 Humana — Medicare Advantage: $43.86 Medica — Commercial Plans/Care System Products: $206.40 Medica — Individual and Family Business Plans: $195.65 Medica — Medicare Advantage: $43 Molina — Dual Eligible Plan: $112.88 Molina — Managed Medicaid/CHIP: $110.73
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVAL LOW	$215	$193.50	$195.65 – $210.70
Physical therapy evaluation (low complexity): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $206.40 Medica — Commercial Plans/Care System Products: $206.40 Medica — Individual and Family Business Plans: $195.65 Multiplan/PHCS — Primary/Complementary PPO: $210.70
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$74.58 – $304.98
Physical therapy evaluation (low complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $99.14 Blue Cross Blue Shield of Nebraska — Commercial: $189.83 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.42 Great Plains — Medicare Advantage: $99.14 Humana — Medicare Advantage: $96.31 Medica — Commercial Plans/Care System Products: $191.12 Medica — Individual and Family Business Plans: $181.48 Medica — Medicare Advantage: $94.42 Molina — Dual Eligible Plan: $76.78 Molina — Managed Medicaid/CHIP: $75.31
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVAL MOD	$345	$310.50	$69 – $338.10
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $331.20 Blue Cross Blue Shield of Nebraska — Commercial: $331.20 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $69 Great Plains — Medicare Advantage: $69 Humana — Medicare Advantage: $70.38 Medica — Commercial Plans/Care System Products: $331.20 Medica — Individual and Family Business Plans: $313.95 Medica — Medicare Advantage: $69 Molina — Dual Eligible Plan: $181.13 Molina — Managed Medicaid/CHIP: $177.68
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVAL MOD	$345	$310.50	$313.95 – $338.10
Physical therapy evaluation (moderate complexity): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $331.20 Medica — Commercial Plans/Care System Products: $331.20 Medica — Individual and Family Business Plans: $313.95 Multiplan/PHCS — Primary/Complementary PPO: $338.10
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$74.58 – $304.98
Physical therapy evaluation (moderate complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $99.14 Blue Cross Blue Shield of Nebraska — Commercial: $189.83 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.42 Great Plains — Medicare Advantage: $99.14 Humana — Medicare Advantage: $96.31 Medica — Commercial Plans/Care System Products: $191.12 Medica — Individual and Family Business Plans: $181.48 Medica — Medicare Advantage: $94.42 Molina — Dual Eligible Plan: $76.78 Molina — Managed Medicaid/CHIP: $75.31
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVAL HIG	$383	$344.70	$76.60 – $375.34
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $367.68 Blue Cross Blue Shield of Nebraska — Commercial: $367.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $76.60 Great Plains — Medicare Advantage: $76.60 Humana — Medicare Advantage: $78.13 Medica — Commercial Plans/Care System Products: $367.68 Medica — Individual and Family Business Plans: $348.53 Medica — Medicare Advantage: $76.60 Molina — Dual Eligible Plan: $201.08 Molina — Managed Medicaid/CHIP: $197.25
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVAL HIG	$383	$344.70	$348.53 – $375.34
Physical therapy evaluation (high complexity): rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $367.68 Medica — Commercial Plans/Care System Products: $367.68 Medica — Individual and Family Business Plans: $348.53 Multiplan/PHCS — Primary/Complementary PPO: $375.34
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$74.58 – $304.98
Physical therapy evaluation (high complexity): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $99.14 Blue Cross Blue Shield of Nebraska — Commercial: $189.83 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.42 Great Plains — Medicare Advantage: $99.14 Humana — Medicare Advantage: $96.31 Medica — Commercial Plans/Care System Products: $191.12 Medica — Individual and Family Business Plans: $181.48 Medica — Medicare Advantage: $94.42 Molina — Dual Eligible Plan: $76.78 Molina — Managed Medicaid/CHIP: $75.31
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY INDIVIDUAL	$239	$215.10	$47.80 – $234.22
Psychotherapy, 30 minutes: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $229.44 Blue Cross Blue Shield of Nebraska — Commercial: $229.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $47.80 Great Plains — Medicare Advantage: $47.80 Humana — Medicare Advantage: $48.76 Medica — Commercial Plans/Care System Products: $188.16 Medica — Individual and Family Business Plans: $217.49 Medica — Medicare Advantage: $47.80 Molina — Dual Eligible Plan: $102.90 Molina — Managed Medicaid/CHIP: $123.09
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY INDIVIDUAL	$239	$215.10	$217.49 – $234.22
Psychotherapy, 30 minutes: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $229.44 Medica — Commercial Plans/Care System Products: $229.44 Medica — Individual and Family Business Plans: $217.49 Multiplan/PHCS — Primary/Complementary PPO: $234.22
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$68.93 – $222.64
Psychotherapy, 30 minutes: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $72.38 Blue Cross Blue Shield of Nebraska — Commercial: $138.58 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $68.93 Great Plains — Medicare Advantage: $72.38 Humana — Medicare Advantage: $70.31 Medica — Commercial Plans/Care System Products: $139.53 Medica — Individual and Family Business Plans: $132.48 Medica — Medicare Advantage: $68.93 Multiplan/PHCS — Primary/Complementary PPO: $222.64 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $71
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 45 MIN W/PT	$258	$232.20	$51.60 – $252.84
Psychotherapy, 45 minutes: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $247.68 Blue Cross Blue Shield of Nebraska — Commercial: $247.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $51.60 Great Plains — Medicare Advantage: $51.60 Humana — Medicare Advantage: $52.63 Medica — Commercial Plans/Care System Products: $247.68 Medica — Individual and Family Business Plans: $234.78 Medica — Medicare Advantage: $51.60 Molina — Dual Eligible Plan: $135.45 Molina — Managed Medicaid/CHIP: $132.87
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 45 MIN W/ P	$472	$424.80	$94.40 – $462.56
Psychotherapy, 45 minutes: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $453.12 Blue Cross Blue Shield of Nebraska — Commercial: $453.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.40 Great Plains — Medicare Advantage: $94.40 Humana — Medicare Advantage: $96.29 Medica — Individual and Family Business Plans: $429.52 Medica — Medicare Advantage: $94.40 Molina — Dual Eligible Plan: $247.80 Molina — Managed Medicaid/CHIP: $243.08 Multiplan/PHCS — Primary/Complementary PPO: $462.56
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY 45 MIN W/ P	$472	$424.80	$429.52 – $462.56
Psychotherapy, 45 minutes: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $453.12 Medica — Commercial Plans/Care System Products: $453.12 Medica — Individual and Family Business Plans: $429.52 Multiplan/PHCS — Primary/Complementary PPO: $462.56
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY INDIVIDUAL	$472	$424.80	$94.40 – $462.56
Psychotherapy, 60 minutes: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $453.12 Blue Cross Blue Shield of Nebraska — Commercial: $453.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.40 Great Plains — Medicare Advantage: $94.40 Humana — Medicare Advantage: $96.29 Medica — Commercial Plans/Care System Products: $365.76 Medica — Individual and Family Business Plans: $429.52 Medica — Medicare Advantage: $94.40 Molina — Dual Eligible Plan: $247.80 Molina — Managed Medicaid/CHIP: $243.08
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY INDIVIDUAL	$472	$424.80	$429.52 – $462.56
Psychotherapy, 60 minutes: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $453.12 Medica — Commercial Plans/Care System Products: $453.12 Medica — Individual and Family Business Plans: $429.52 Multiplan/PHCS — Primary/Complementary PPO: $462.56
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$134.22 – $433.53
Psychotherapy, 60 minutes: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $140.93 Blue Cross Blue Shield of Nebraska — Commercial: $269.85 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $134.22 Great Plains — Medicare Advantage: $140.93 Humana — Medicare Advantage: $136.90 Medica — Commercial Plans/Care System Products: $271.69 Medica — Individual and Family Business Plans: $257.97 Medica — Medicare Advantage: $134.22 Multiplan/PHCS — Primary/Complementary PPO: $433.53 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $138.25
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/O	$488	$439.20	$97.60 – $478.24
Family psychotherapy, without the patient: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $468.48 Blue Cross Blue Shield of Nebraska — Commercial: $468.48 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $97.60 Great Plains — Medicare Advantage: $97.60 Humana — Medicare Advantage: $99.55 Medica — Individual and Family Business Plans: $444.08 Medica — Medicare Advantage: $97.60 Molina — Dual Eligible Plan: $256.20 Molina — Managed Medicaid/CHIP: $251.32 Multiplan/PHCS — Primary/Complementary PPO: $478.24
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/O	$488	$439.20	$444.08 – $478.24
Family psychotherapy, without the patient: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $468.48 Medica — Commercial Plans/Care System Products: $468.48 Medica — Individual and Family Business Plans: $444.08 Multiplan/PHCS — Primary/Complementary PPO: $478.24
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$98.06 – $316.73
Family psychotherapy, without the patient: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $102.96 Blue Cross Blue Shield of Nebraska — Commercial: $197.15 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $98.06 Great Plains — Medicare Advantage: $102.96 Humana — Medicare Advantage: $100.02 Medica — Commercial Plans/Care System Products: $198.49 Medica — Individual and Family Business Plans: $188.47 Medica — Medicare Advantage: $98.06 Multiplan/PHCS — Primary/Complementary PPO: $316.73 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $101
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY FAMILY =>50	$258	$232.20	$51.60 – $252.84
Family psychotherapy, with the patient: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $247.68 Blue Cross Blue Shield of Nebraska — Commercial: $247.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $51.60 Great Plains — Medicare Advantage: $51.60 Humana — Medicare Advantage: $52.63 Medica — Commercial Plans/Care System Products: $247.68 Medica — Individual and Family Business Plans: $234.78 Medica — Medicare Advantage: $51.60 Molina — Dual Eligible Plan: $135.45 Molina — Managed Medicaid/CHIP: $132.87
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/	$472	$424.80	$94.40 – $462.56
Family psychotherapy, with the patient: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $453.12 Blue Cross Blue Shield of Nebraska — Commercial: $453.12 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $94.40 Great Plains — Medicare Advantage: $94.40 Humana — Medicare Advantage: $96.29 Medica — Individual and Family Business Plans: $429.52 Medica — Medicare Advantage: $94.40 Molina — Dual Eligible Plan: $247.80 Molina — Managed Medicaid/CHIP: $243.08 Multiplan/PHCS — Primary/Complementary PPO: $462.56
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/	$472	$424.80	$429.52 – $462.56
Family psychotherapy, with the patient: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $453.12 Medica — Commercial Plans/Care System Products: $453.12 Medica — Individual and Family Business Plans: $429.52 Multiplan/PHCS — Primary/Complementary PPO: $462.56
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY PROC	$394	$354.60	$78.80 – $386.12
Group psychotherapy: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $378.24 Blue Cross Blue Shield of Nebraska — Commercial: $378.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $78.80 Great Plains — Medicare Advantage: $78.80 Humana — Medicare Advantage: $80.38 Medica — Individual and Family Business Plans: $358.54 Medica — Medicare Advantage: $78.80 Molina — Dual Eligible Plan: $206.85 Molina — Managed Medicaid/CHIP: $202.91 Multiplan/PHCS — Primary/Complementary PPO: $386.12
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY SUBSE	$394	$354.60	$78.80 – $386.12
Group psychotherapy: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $378.24 Blue Cross Blue Shield of Nebraska — Commercial: $378.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $78.80 Great Plains — Medicare Advantage: $78.80 Humana — Medicare Advantage: $80.38 Medica — Individual and Family Business Plans: $358.54 Medica — Medicare Advantage: $78.80 Molina — Dual Eligible Plan: $206.85 Molina — Managed Medicaid/CHIP: $202.91 Multiplan/PHCS — Primary/Complementary PPO: $386.12
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY SUBSQ	$394	$354.60	$78.80 – $386.12
Group psychotherapy: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $378.24 Blue Cross Blue Shield of Nebraska — Commercial: $378.24 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $78.80 Great Plains — Medicare Advantage: $78.80 Humana — Medicare Advantage: $80.38 Medica — Individual and Family Business Plans: $358.54 Medica — Medicare Advantage: $78.80 Molina — Dual Eligible Plan: $206.85 Molina — Managed Medicaid/CHIP: $202.91 Multiplan/PHCS — Primary/Complementary PPO: $386.12

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$323.11 – $1,178.53
Removal of breast growth (open surgery): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $383.11 Blue Cross Blue Shield of Nebraska — Commercial: $733.57 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $364.87 Great Plains — Medicare Advantage: $383.11 Humana — Medicare Advantage: $372.17 Medica — Commercial Plans/Care System Products: $738.57 Medica — Individual and Family Business Plans: $701.28 Medica — Medicare Advantage: $364.87 Molina — Dual Eligible Plan: $332.61 Molina — Managed Medicaid/CHIP: $326.27
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,047.84 – $3,384.52
Total hip replacement: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,100.23 Blue Cross Blue Shield of Nebraska — Commercial: $2,106.68 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,047.84 Great Plains — Medicare Advantage: $1,100.23 Humana — Medicare Advantage: $1,068.80 Medica — Commercial Plans/Care System Products: $2,121.04 Medica — Individual and Family Business Plans: $2,013.95 Medica — Medicare Advantage: $1,047.84 Molina — Dual Eligible Plan: $2,107.21 Molina — Managed Medicaid/CHIP: $2,067.08
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,046.35 – $3,379.71
Total knee replacement: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,098.67 Blue Cross Blue Shield of Nebraska — Commercial: $2,103.69 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,046.35 Great Plains — Medicare Advantage: $1,098.67 Humana — Medicare Advantage: $1,067.28 Medica — Commercial Plans/Care System Products: $2,118.02 Medica — Individual and Family Business Plans: $2,011.08 Medica — Medicare Advantage: $1,046.35 Molina — Dual Eligible Plan: $2,463.83 Molina — Managed Medicaid/CHIP: $2,416.90
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$133.24 – $998.50
Shoulder arthroscopy: shaving of shoulder bone: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $139.90 Blue Cross Blue Shield of Nebraska — Commercial: $267.88 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $133.24 Great Plains — Medicare Advantage: $139.90 Humana — Medicare Advantage: $135.90 Medica — Commercial Plans/Care System Products: $269.70 Medica — Individual and Family Business Plans: $256.09 Medica — Medicare Advantage: $133.24 Molina — Dual Eligible Plan: $998.50 Molina — Managed Medicaid/CHIP: $979.48
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$468.44 – $1,513.06
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $491.86 Blue Cross Blue Shield of Nebraska — Commercial: $941.80 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $468.44 Great Plains — Medicare Advantage: $491.86 Humana — Medicare Advantage: $477.81 Medica — Commercial Plans/Care System Products: $948.22 Medica — Individual and Family Business Plans: $900.34 Medica — Medicare Advantage: $468.44 Molina — Dual Eligible Plan: $998.50 Molina — Managed Medicaid/CHIP: $979.48
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: TONSILLECTOMY&ADENOIDECTO	$1,229	$1,106.10	$240.61 – $777.17
Removal of tonsils and adenoids (under age 12): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $252.64 Blue Cross Blue Shield of Nebraska — Commercial: $483.75 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $240.61 Great Plains — Medicare Advantage: $252.64 Humana — Medicare Advantage: $245.42 Medica — Commercial Plans/Care System Products: $487.04 Medica — Individual and Family Business Plans: $462.45 Medica — Medicare Advantage: $240.61 Molina — Dual Eligible Plan: $395.50 Molina — Managed Medicaid/CHIP: $387.97
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$102.92 – $332.43
Upper GI endoscopy (diagnostic): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $108.07 Blue Cross Blue Shield of Nebraska — Commercial: $206.92 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $102.92 Great Plains — Medicare Advantage: $108.07 Humana — Medicare Advantage: $104.98 Medica — Commercial Plans/Care System Products: $208.33 Medica — Individual and Family Business Plans: $197.81 Medica — Medicare Advantage: $102.92 Molina — Dual Eligible Plan: $138.06 Molina — Managed Medicaid/CHIP: $135.43
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$115.14 – $371.90
Upper GI endoscopy with biopsy: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $120.90 Blue Cross Blue Shield of Nebraska — Commercial: $231.49 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $115.14 Great Plains — Medicare Advantage: $120.90 Humana — Medicare Advantage: $117.44 Medica — Commercial Plans/Care System Products: $233.07 Medica — Individual and Family Business Plans: $221.30 Medica — Medicare Advantage: $115.14 Molina — Dual Eligible Plan: $144.13 Molina — Managed Medicaid/CHIP: $141.39
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY DX FLEXIBLE C	$2,581	$2,322.90	$152.70 – $493.22
Colonoscopy (diagnostic): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $160.34 Blue Cross Blue Shield of Nebraska — Commercial: $307 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $152.70 Great Plains — Medicare Advantage: $160.34 Humana — Medicare Advantage: $155.75 Medica — Commercial Plans/Care System Products: $309.10 Medica — Individual and Family Business Plans: $293.49 Medica — Medicare Advantage: $152.70 Molina — Dual Eligible Plan: $187.81 Molina — Managed Medicaid/CHIP: $184.24
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee · modifier 53 In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$76.41 – $246.80
Colonoscopy (diagnostic): 10 of 12 insurance plan rates Aetna — Medicare Advantage: $80.23 Blue Cross Blue Shield of Nebraska — Commercial: $153.62 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $76.41 Great Plains — Medicare Advantage: $80.23 Humana — Medicare Advantage: $77.94 Medica — Commercial Plans/Care System Products: $154.67 Medica — Individual and Family Business Plans: $146.86 Medica — Medicare Advantage: $76.41 Multiplan/PHCS — Primary/Complementary PPO: $246.80 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $78.70
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY WITH BIOPSY S	$2,581	$2,322.90	$165.29 – $533.89
Colonoscopy with biopsy: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $173.55 Blue Cross Blue Shield of Nebraska — Commercial: $332.32 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $165.29 Great Plains — Medicare Advantage: $173.55 Humana — Medicare Advantage: $168.60 Medica — Commercial Plans/Care System Products: $334.58 Medica — Individual and Family Business Plans: $317.69 Medica — Medicare Advantage: $165.29 Molina — Dual Eligible Plan: $243.92 Molina — Managed Medicaid/CHIP: $239.27
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$208.43 – $673.23
Colonoscopy with removal of polyps (snare): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $218.85 Blue Cross Blue Shield of Nebraska — Commercial: $419.05 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $208.43 Great Plains — Medicare Advantage: $218.85 Humana — Medicare Advantage: $212.60 Medica — Commercial Plans/Care System Products: $421.90 Medica — Individual and Family Business Plans: $400.60 Medica — Medicare Advantage: $208.43 Molina — Dual Eligible Plan: $311.22 Molina — Managed Medicaid/CHIP: $305.29
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$211.11 – $681.89
Ultrasound of the lower bowel by endoscope: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $221.67 Blue Cross Blue Shield of Nebraska — Commercial: $424.44 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $211.11 Great Plains — Medicare Advantage: $221.67 Humana — Medicare Advantage: $215.33 Medica — Commercial Plans/Care System Products: $427.33 Medica — Individual and Family Business Plans: $405.75 Medica — Medicare Advantage: $211.11 Molina — Dual Eligible Plan: $291.76 Molina — Managed Medicaid/CHIP: $286.21
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$152.83 – $493.64
Screening colonoscopy (not high risk): 10 of 12 insurance plan rates Aetna — Medicare Advantage: $160.47 Blue Cross Blue Shield of Nebraska — Commercial: $307.26 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $152.83 Great Plains — Medicare Advantage: $160.47 Humana — Medicare Advantage: $155.89 Medica — Commercial Plans/Care System Products: $309.36 Medica — Individual and Family Business Plans: $293.74 Medica — Medicare Advantage: $152.83 Multiplan/PHCS — Primary/Complementary PPO: $493.64 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $157.41
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$76.41 – $246.80
Screening colonoscopy (not high risk): 10 of 12 insurance plan rates Aetna — Medicare Advantage: $80.23 Blue Cross Blue Shield of Nebraska — Commercial: $153.62 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $76.41 Great Plains — Medicare Advantage: $80.23 Humana — Medicare Advantage: $77.94 Medica — Commercial Plans/Care System Products: $154.67 Medica — Individual and Family Business Plans: $146.86 Medica — Medicare Advantage: $76.41 Multiplan/PHCS — Primary/Complementary PPO: $246.80 Nebraska Total Care — Medicare Advantage/Dual Needs Plan/MMP Plan: $78.70
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAP CHOLE TECH FEE	$1,232	$1,108.80	$246.40 – $1,207.36
Gallbladder removal by laparoscope: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,182.72 Blue Cross Blue Shield of Nebraska — Commercial: $1,182.72 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $246.40 Great Plains — Medicare Advantage: $246.40 Humana — Medicare Advantage: $251.33 Medica — Commercial Plans/Care System Products: $1,182.72 Medica — Individual and Family Business Plans: $1,121.12 Medica — Medicare Advantage: $246.40 Molina — Dual Eligible Plan: $646.80 Molina — Managed Medicaid/CHIP: $634.48
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: LAP CHOLE PROF FEE	$710	$639	$560.81 – $1,811.42
Gallbladder removal by laparoscope: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $588.85 Blue Cross Blue Shield of Nebraska — Commercial: $1,127.51 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $560.81 Great Plains — Medicare Advantage: $588.85 Humana — Medicare Advantage: $572.03 Medica — Commercial Plans/Care System Products: $1,135.19 Medica — Individual and Family Business Plans: $1,077.88 Medica — Medicare Advantage: $560.81 Molina — Dual Eligible Plan: $1,199.49 Molina — Managed Medicaid/CHIP: $1,176.64
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAP CHOLE TECH FEE	$1,232	$1,108.80	$1,121.12 – $1,207.36
Gallbladder removal by laparoscope: rates for 4 insurance plans Blue Cross Blue Shield of Nebraska — Commercial: $1,182.72 Medica — Commercial Plans/Care System Products: $1,182.72 Medica — Individual and Family Business Plans: $1,121.12 Multiplan/PHCS — Primary/Complementary PPO: $1,207.36
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: REPAIR INITIAL INGUINAL H	$506	$455.40	$451.42 – $1,458.09
Groin (inguinal) hernia repair, age 5 or older: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $473.99 Blue Cross Blue Shield of Nebraska — Commercial: $907.58 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $451.42 Great Plains — Medicare Advantage: $473.99 Humana — Medicare Advantage: $460.45 Medica — Commercial Plans/Care System Products: $913.76 Medica — Individual and Family Business Plans: $867.63 Medica — Medicare Advantage: $451.42 Molina — Dual Eligible Plan: $635.41 Molina — Managed Medicaid/CHIP: $623.30
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: MPFS	Not listed in the file	Not listed in the file	$54.40 – $56
Prostate biopsy: rates for 4 insurance plans Molina — Dual Eligible Plan: $56 Molina — Managed Medicaid/CHIP: $54.93 Nebraska Total Care — Managed Medicaid: $54.40 United Healthcare Community Plan — Managed Medicaid: $54.40
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,003.23 – $3,240.43
Prostate removal by laparoscope (radical prostatectomy): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $1,053.39 Blue Cross Blue Shield of Nebraska — Commercial: $2,016.99 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,003.23 Great Plains — Medicare Advantage: $1,053.39 Humana — Medicare Advantage: $1,023.29 Medica — Commercial Plans/Care System Products: $2,030.74 Medica — Individual and Family Business Plans: $1,928.21 Medica — Medicare Advantage: $1,003.23 Molina — Dual Eligible Plan: $1,685.78 Molina — Managed Medicaid/CHIP: $1,653.67
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: OBGYN HYSTEROSCOPY W/ POL	$811	$729.90	$186.03 – $600.88
Hysteroscopy with biopsy of the uterus lining: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $195.33 Blue Cross Blue Shield of Nebraska — Commercial: $374.01 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $186.03 Great Plains — Medicare Advantage: $195.33 Humana — Medicare Advantage: $189.75 Medica — Commercial Plans/Care System Products: $376.56 Medica — Individual and Family Business Plans: $357.55 Medica — Medicare Advantage: $186.03 Molina — Dual Eligible Plan: $215.94 Molina — Managed Medicaid/CHIP: $211.83
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: CRNA EPIDURAL LMBR/SAC W/	$1,465	$1,318.50	$87.94 – $1,318.50
Spinal injection, lower back (epidural), with imaging guidance: rates for 2 insurance plans Aetna — Medicare Advantage: $87.94 Multiplan/PHCS — Primary/Complementary PPO: $1,318.50
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: CRNA TRANSFORAMINAL EPIDU	$2,101	$1,890.90	$98.21 – $1,890.90
Nerve root injection, lower back, with imaging guidance: rates for 2 insurance plans Aetna — Medicare Advantage: $98.21 Multiplan/PHCS — Primary/Complementary PPO: $1,890.90
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$385.06 – $1,243.74
Carpal tunnel release: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $404.31 Blue Cross Blue Shield of Nebraska — Commercial: $774.16 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $385.06 Great Plains — Medicare Advantage: $404.31 Humana — Medicare Advantage: $392.76 Medica — Commercial Plans/Care System Products: $779.44 Medica — Individual and Family Business Plans: $740.09 Medica — Medicare Advantage: $385.06 Molina — Dual Eligible Plan: $542.45 Molina — Managed Medicaid/CHIP: $532.12
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$258.04 – $833.47
Laser treatment of clouding after cataract surgery: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $270.94 Blue Cross Blue Shield of Nebraska — Commercial: $518.79 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $258.04 Great Plains — Medicare Advantage: $270.94 Humana — Medicare Advantage: $263.20 Medica — Commercial Plans/Care System Products: $522.32 Medica — Individual and Family Business Plans: $495.95 Medica — Medicare Advantage: $258.04 Molina — Dual Eligible Plan: $386.41 Molina — Managed Medicaid/CHIP: $379.05
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$435.90 – $1,815.45
Cataract removal with lens implant: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $457.70 Blue Cross Blue Shield of Nebraska — Commercial: $876.38 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $435.90 Great Plains — Medicare Advantage: $457.70 Humana — Medicare Advantage: $444.62 Medica — Commercial Plans/Care System Products: $882.35 Medica — Individual and Family Business Plans: $837.80 Medica — Medicare Advantage: $435.90 Molina — Dual Eligible Plan: $1,815.45 Molina — Managed Medicaid/CHIP: $1,780.87

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$1,890.26 – $6,289.23
Vaginal delivery, with care before and after: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,044.49 Blue Cross Blue Shield of Nebraska — Commercial: $3,914.70 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $1,947.13 Great Plains — Medicare Advantage: $2,044.49 Humana — Medicare Advantage: $1,986.07 Medica — Commercial Plans/Care System Products: $3,941.38 Medica — Individual and Family Business Plans: $3,742.38 Medica — Medicare Advantage: $1,947.13 Molina — Dual Eligible Plan: $1,945.86 Molina — Managed Medicaid/CHIP: $1,908.80
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$2,152.13 – $6,951.38
Cesarean delivery (C-section), with care before and after: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,259.74 Blue Cross Blue Shield of Nebraska — Commercial: $4,326.86 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,152.13 Great Plains — Medicare Advantage: $2,259.74 Humana — Medicare Advantage: $2,195.17 Medica — Commercial Plans/Care System Products: $4,356.34 Medica — Individual and Family Business Plans: $4,136.39 Medica — Medicare Advantage: $2,152.13 Molina — Dual Eligible Plan: $2,432.33 Molina — Managed Medicaid/CHIP: $2,386
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$2,024.36 – $6,538.68
Vaginal delivery after a previous C-section, with care before and after: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2,125.58 Blue Cross Blue Shield of Nebraska — Commercial: $4,069.98 Blue Cross Blue Shield of Nebraska — Medicare Advantage: $2,024.36 Great Plains — Medicare Advantage: $2,125.58 Humana — Medicare Advantage: $2,064.85 Medica — Commercial Plans/Care System Products: $4,097.71 Medica — Individual and Family Business Plans: $3,890.82 Medica — Medicare Advantage: $2,024.36 Molina — Dual Eligible Plan: $2,335.03 Molina — Managed Medicaid/CHIP: $2,290.56

Source: Valley County Health System’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on June 15, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Critical Access Hospital
Address	2707 L Street, Ord, NE 68862
County	Valley County
State	Nebraska
Phone	(308) 728‑4200
Emergency services	Yes
Ownership	Government - Local
Medicare overall rating	Not rated by CMS
CMS Certification Number	281353
Name in Medicare records	VALLEY COUNTY HEALTH SYSTEM
Profile level	Medicare data + hospital website
Official website	valleycountyhealthsystem.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Our Facilities - Valley County Health System — valleycountyhealthsystem.org
Emergency Care - Valley County Health System — valleycountyhealthsystem.org
Surgery - Valley County Health System — valleycountyhealthsystem.org
Specialty Clinic - Valley County Health System — valleycountyhealthsystem.org
Welcome to Valley County Health System - Valley County Health System — valleycountyhealthsystem.org
Low-Dose CT Lung Cancer Screening Program - Valley County Health System — valleycountyhealthsystem.org
Guest Services - Valley County Health System — valleycountyhealthsystem.org
General Radiology - Valley County Health System — valleycountyhealthsystem.org
LSVT BIG and LOUD Program - Valley County Health System — valleycountyhealthsystem.org
Heritage Program for Seniors - Valley County Health System — valleycountyhealthsystem.org
Our Services - Valley County Health System — valleycountyhealthsystem.org
Sleep Program - Valley County Health System — valleycountyhealthsystem.org
Sterling Connection - Valley County Health System — valleycountyhealthsystem.org
Transportation - Valley County Health System — valleycountyhealthsystem.org
VCHS Child Development - Valley County Health System — valleycountyhealthsystem.org
ACCESSNebraska - Valley County Health System — valleycountyhealthsystem.org

Valley County Health System

Summary

Profile from official sources

At a glance