CHI Health Good Samaritan prices
CHI Health Good Samaritan in Kearney, NE publishes its standard charges, as every US hospital must under the federal Hospital Price Transparency Rule. Below is what its own file lists for common services, next to what it has agreed to accept from insurers.
What CHI Health Good Samaritan publishes for common services
ER visit, level 3 (moderate): listed at $964. Insurers pay a median of $646, across 7 insurers.
If you were billed the list price, you may have been charged far more than insurers typically pay. See how to use these numbers below.
| Service | List price | Cash price | Insurers pay (median) |
|---|---|---|---|
| ER visit, level 1 (minor)CPT 99281, listed as "HC EMR DPT VST MAYX REQ PHY/QHP" | $346 | $211 | $170$11.72 to $322, 9 insurers |
| ER visit, level 2 (low-moderate)CPT 99282, listed as "HC EMERGENCY DEPT VISIT SF MDM" | $544 | $332 | $364$79.28 to $506, 7 insurers |
| ER visit, level 3 (moderate)CPT 99283, listed as "HC EMERGENCY DEPT VISIT LOW MDM" | $964 | $588 | $646$135 to $897, 7 insurers |
| ER visit, level 4 (high)CPT 99284, listed as "HC EMERGENCY DEPT VISIT MOD MDM" | $1,655 | $1,010 | $1,109$230 to $1,539, 7 insurers |
| ER visit, level 5 (critical)CPT 99285, listed as "HC EMERGENCY DEPT VISIT HI MDM" | $2,445 | $1,491 | $1,638$333 to $2,274, 7 insurers |
| Office visit, established patient, low complexityCPT 99213, listed as "HC OFFICE VISIT EST 20-29 MINS" | $362 | $221 | $194$76.02 to $337, 7 insurers |
| Office visit, established patient, moderate complexityCPT 99214, listed as "HC OFFICE VISIT EST 30-39 MINS" | $433 | $264 | $249$90.93 to $403, 7 insurers |
| Routine venipuncture (blood draw)CPT 36415, listed as "HC VENIPUNCTURE COLLECTION" | $34.00 | $20.74 | $9.54$7.14 to $31.62, 14 insurers |
| Vitamin B12 injectionCPT J3420, listed as "CYANOCOBALAMIN (VIT B-12) 1000 MCGM/ML INJECTION SOLUTION" | $6.40 | $3.90 | $2.81$2.81 to $5.96, 12 insurers |
| Comprehensive metabolic panelCPT 80053, listed as "HC COMPREHENSIVE PANEL" | $244 | $149 | $51.24$10.23 to $227, 18 insurers |
| Basic metabolic panelCPT 80048, listed as "HC BASIC METABOLIC PANEL" | $182 | $111 | $38.22$8.20 to $169, 18 insurers |
| CBC with differentialCPT 85025, listed as "HC CBC W AUTO DIFF" | $140 | $85.40 | $29.40$7.53 to $130, 18 insurers |
| Lipid panelCPT 80061, listed as "HC HEART CHECK LIPID" | $6.00 to $162 | $3.66 to $98.82 | $13.28$13.28 to $154, 18 insurers |
| Hepatic function panelCPT 80076, listed as "HC HEPATIC PROFILE" | $216 | $132 | $45.36$7.92 to $201, 18 insurers |
| X-ray, ankle, 3 viewsCPT 73610, listed as "HC ANKLE COMPLETE" | $541 | $330 | $170$53.17 to $503, 11 insurers |
| CT abdomen, without contrastCPT 74176, listed as "HC CT ABD PELVIS WO CONTRAST" | $4,524 | $2,760 | $864$200 to $4,207, 11 insurers |
| CT abdomen and pelvis, with contrastCPT 74177, listed as "HC CT ABDOMEN PELVIS W CONTRST" | $5,911 | $3,606 | $1,693$427 to $5,497, 11 insurers |
| CT abdomen and pelvis, with and without contrastCPT 74178, listed as "HC CT ABD PELVIS W WO CONTRAST" | $8,505 | $5,188 | $1,939$482 to $7,910, 11 insurers |
| MRI brain, without contrastCPT 70551, listed as "HC MR BRAIN WO CONTRAST" | $3,864 | $2,357 | $1,198$249 to $3,594, 11 insurers |
| MRI brain, with and without contrastCPT 70553, listed as "HC MR BRAIN W WO CONTRAST" | $4,913 | $2,997 | $2,021$416 to $4,569, 11 insurers |
| MRI pelvis, without contrastCPT 72195, listed as "HC MR PELVIS WO CONTRAST" | $3,689 | $2,250 | $2,140$315 to $3,431, 11 insurers |
| MRI pelvis, with and without contrastCPT 72197, listed as "HC MR PELVIS W WO CONTRAST" | $4,339 | $2,647 | $2,630$460 to $4,035, 11 insurers |
| Complete echocardiogram with DopplerCPT 93306, listed as "HC ECHO W PW CW CF DOPPLER" | $3,742 | $2,283 | $2,694$243 to $3,480, 11 insurers |
| Echocardiogram, completeCPT 93307, listed as "HC ECHOCARDIOGRAM" | $3,318 | $2,024 | $2,389$177 to $3,086, 11 insurers |
| Electrocardiogram, tracing only (technical component)CPT 93005, listed as "HC EKG 15 LEAD" | $467 to $509 | $285 to $310 | $364$11.55 to $364, 11 insurers |
Source: CHI Health Good Samaritan's standard charges file, which the hospital dated February 28, 2026. Read on September 28, 2026. View the hospital's file (a large data file). Hospitals must publish this file under 45 CFR § 180.
List price
The hospital's full charge (its "gross charge") before any discount. Few people pay it, but it is often the starting point on a bill.
Cash price
What the hospital says it accepts from patients paying without insurance.
Insurers pay
The median of the per-service rates the hospital has negotiated with insurers, shown only when at least 3 insurers report one. Your plan's rate may differ.
How to use these numbers
Uninsured or paying yourself? You can ask CHI Health Good Samaritan to bill you its published cash price, and ask about financial assistance, which nonprofit hospitals must offer.
Insured, and the hospital is in your network? Your share should be based on your plan's negotiated rate, not the list price. If your bill or explanation of benefits shows the list price, ask the billing office why.
These figures summarize what the hospital publishes. They are not a quote, and they don't include separate physician bills.
Check your CHI Health Good Samaritan bill for errors
The free check looks for duplicate charges, unbundling, upcoding and surprise billing. Its price comparison uses national reference pricing, separate from the hospital's published prices above.
BillMender is a document-preparation tool, not a law firm, and does not provide legal advice. We don't guarantee any outcome or dollar amount. Estimates are based on public reference pricing, not your hospital's actual contract rates.