Emergency visit, high (level 4) at CHI Health St. Mary's. CPT 99284.
What CHI Health St. Mary's publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$284cash price (self-pay)
$682list price
$73.26–$981range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid|All Plans | $146 |
| IAMolina | Medicaid|All Plans | $149 |
| BCBS - NE | Medicare|All Plans | $247 |
| Humana | Medicare|All Plans | $247 |
| Medica | Medicare|All Plans | $247 |
| PACE | Medicare|All Plans | $247 |
| United | Medicare|All Plans | $247 |
| Centene | Medicare|All Plans | $252 |
| Amerigroup | Medicare|All Plans | $260 |
| Great Plains | Medicare|All Plans | $260 |
| Centene | Medicaid|NE Total Care | $280 |
| United | Medicaid|Community Plan | $280 |
| AMPS | Commercial|All Plans | $549 |
| BCBS - NE | Commercial|BluePrint | $616 |
| Medica | Commercial|All Other Plans | $621 |
| Medica | Commercial|CHI Health | $621 |
| BCBS - NE | Commercial|All Other Plans | $648 |
| MultiPlan PHCS | Commercial|All Plans | $648 |
| Greater Omaha Packing | Commercial|Broad Network | $655 |
| Greater Omaha Packing | Commercial|Narrow Network | $655 |
| Medica | Commercial|ACO | $655 |
| Medica | Commercial|Open Access | $655 |
| Midlands Choice | Commercial|Premier | $655 |
| Midlands Choice | Commercial|Standard | $655 |
| Millard Public Schools | Commercial|Broad Network | $655 |
| Millard Public Schools | Commercial|Narrow Network | $655 |
| One World | Commercial|Broad Network | $655 |
| One World | Commercial|Narrow Network | $655 |
| Timpte | Commercial|Broad Network | $655 |
| United | Commercial|All Plans | $655 |
Inpatient
$284cash price (self-pay)
$682list price
$309–$981range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS - NE | Commercial|BluePrint | $616 |
| Medica | Commercial|All Other Plans | $621 |
| Medica | Commercial|CHI Health | $621 |
| BCBS - NE | Commercial|All Other Plans | $648 |
| MultiPlan PHCS | Commercial|All Plans | $648 |
| Greater Omaha Packing | Commercial|Broad Network | $655 |
| Greater Omaha Packing | Commercial|Narrow Network | $655 |
| Medica | Commercial|ACO | $655 |
| Medica | Commercial|Open Access | $655 |
| Midlands Choice | Commercial|Premier | $655 |
| Midlands Choice | Commercial|Standard | $655 |
| Millard Public Schools | Commercial|Broad Network | $655 |
| Millard Public Schools | Commercial|Narrow Network | $655 |
| One World | Commercial|Broad Network | $655 |
| One World | Commercial|Narrow Network | $655 |
| Timpte | Commercial|Broad Network | $655 |
| United | Commercial|All Plans | $655 |
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