Emergency visit, highest (level 5) at CHI Health Good Samaritan. CPT 99285.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$1,491cash price (self-pay)
$2,445list price
$333–$5,404range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial|ACO | $333 |
| Amerigroup | Medicaid|All Plans | $499 |
| Centene | Medicaid|IA Total Care | $499 |
| IAMolina | Medicaid|All Plans | $509 |
| United | Medicaid|Community Plan | $513 |
| Centene | Medicaid|NE Total Care | $519 |
| BCBS - NE | Medicare|All Plans | $580 |
| Humana | Medicare|All Plans | $580 |
| Medica | Medicare|All Plans | $580 |
| PACE | Medicare|All Plans | $580 |
| United | Medicare|All Plans | $580 |
| Centene | Medicare|All Plans | $598 |
| Amerigroup | Medicare|All Plans | $609 |
| Great Plains | Medicare|All Plans | $609 |
| Creighton University Employees | Commercial|All Plans | $1,198 |
| AMPS | Commercial|All Plans | $1,289 |
| ELAP | Commercial|All Plans | $1,418 |
| United | Commercial|All Plans | $1,858 |
| Medica | Commercial|Open Access | $1,907 |
| Midlands Choice | Commercial|Premier | $1,907 |
| Midlands Choice | Commercial|Standard | $2,249 |
| MultiPlan PHCS | Commercial|All Plans | $2,274 |
| Medica | Commercial|CHI Health | $2,275 |
| Medica | Commercial|All Other Plans | $2,673 |
| Greater Omaha Packing | Commercial|Narrow Network | $4,700 |
| Millard Public Schools | Commercial|Narrow Network | $4,700 |
| One World | Commercial|Narrow Network | $4,700 |
| Greater Omaha Packing | Commercial|Broad Network | $5,404 |
| Millard Public Schools | Commercial|Broad Network | $5,404 |
| One World | Commercial|Broad Network | $5,404 |
Inpatient
$1,491cash price (self-pay)
$2,445list price
$1,198–$2,274range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $1,198 |
| United | Commercial|All Plans | $1,858 |
| Medica | Commercial|Open Access | $1,907 |
| Midlands Choice | Commercial|Premier | $1,907 |
| Midlands Choice | Commercial|Standard | $2,249 |
| MultiPlan PHCS | Commercial|All Plans | $2,274 |
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