Emergency visit, high (level 4) at Jefferson Community Health Center. CPT 99284.
What Jefferson Community Health Center publishes for this service, straight from its standard-charges file, last updated July 9, 2026.
Outpatient / ER
—cash price (self-pay)
$646list price
$131–$989range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Nebraska Total Care | Medicaid MCO | $323 |
| United Healthcare Medicaid | Medicaid MCO | $323 |
| Molina | Medicaid MCO | $323 |
| Aetna Medicare Advantage | Medicare Advantage | $381 |
| United Healthcare Medicare Advantage | Medicare Advantage | $381 |
| Blue Cross Medicare Advantage | Medicare Advantage | $381 |
| Blue Cross HIX | Health Exchange | $583 |
| Blue Cross HMO/PPO | HMO/PPO | $613 |
| United Healthcare HMO/PPO | HMO/PPO | $613 |
| Aetna HMO/PPO | HMO/PPO | $620 |
| Midlands Choice | HMO/PPO | $620 |
Inpatient
—cash price (self-pay)
$646list price
$236–$989range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross HIX | Health Exchange | $583 |
| Blue Cross HMO/PPO | HMO/PPO | $613 |
| United Healthcare HMO/PPO | HMO/PPO | $613 |
| Aetna HMO/PPO | HMO/PPO | $620 |
| Midlands Choice | HMO/PPO | $620 |
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