Emergency visit, moderate (level 3) at CHI Health Good Samaritan. CPT 99283.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$588cash price (self-pay)
$964list price
$135–$1,702range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial|ACO | $135 |
| United | Medicaid|Community Plan | $202 |
| Centene | Medicaid|NE Total Care | $204 |
| Amerigroup | Medicaid|All Plans | $226 |
| Centene | Medicaid|IA Total Care | $226 |
| IAMolina | Medicaid|All Plans | $230 |
| BCBS - NE | Medicare|All Plans | $262 |
| Humana | Medicare|All Plans | $262 |
| Medica | Medicare|All Plans | $262 |
| PACE | Medicare|All Plans | $262 |
| United | Medicare|All Plans | $262 |
| Centene | Medicare|All Plans | $270 |
| Amerigroup | Medicare|All Plans | $275 |
| Great Plains | Medicare|All Plans | $275 |
| Creighton University Employees | Commercial|All Plans | $472 |
| ELAP | Commercial|All Plans | $559 |
| AMPS | Commercial|All Plans | $582 |
| United | Commercial|All Plans | $733 |
| Medica | Commercial|Open Access | $752 |
| Midlands Choice | Commercial|Premier | $752 |
| Medica | Commercial|CHI Health | $880 |
| Midlands Choice | Commercial|Standard | $887 |
| MultiPlan PHCS | Commercial|All Plans | $897 |
| Medica | Commercial|All Other Plans | $1,034 |
| Greater Omaha Packing | Commercial|Narrow Network | $1,480 |
| Millard Public Schools | Commercial|Narrow Network | $1,480 |
| One World | Commercial|Narrow Network | $1,480 |
| Greater Omaha Packing | Commercial|Broad Network | $1,702 |
| Millard Public Schools | Commercial|Broad Network | $1,702 |
| One World | Commercial|Broad Network | $1,702 |
Inpatient
$588cash price (self-pay)
$964list price
$472–$897range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $472 |
| United | Commercial|All Plans | $733 |
| Medica | Commercial|Open Access | $752 |
| Midlands Choice | Commercial|Premier | $752 |
| Midlands Choice | Commercial|Standard | $887 |
| MultiPlan PHCS | Commercial|All Plans | $897 |
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