| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Chi Health Schuyler | 1721 Colfax St, Schuyler | G0109 | $30 [source] | 3 years ago |
| Chi Health Plainview | 704 N 3Rd St, Plainview | G0109 | $30 [source] | 3 years ago |
| Chi Health Lakeside | 17201 Wright St, Omaha | G0109 | $55 [source] | 3 years ago |
| Chi Health Midlands | 11111 S 84Th St, Papillion | G0109 | $55 [source] | 3 years ago |
| Chi Health Creighton University Medical Center - Bergan Mercy | 7500 Mercy Rd, Omaha | G0109 | $55 [source] | 3 years ago |
| Chi Health Immanuel | 7101 Newport Ave, Omaha | G0109 | $55 [source] | 3 years ago |
| Chi Health St. Elizabeth | 555 S. 70Th St., Lincoln | G0109 | $73 [source] | 3 years ago |
| Chi Health Good Samaritan | 10 E 31St St, Kearney | G0109 | $73 [source] | 3 years ago |
| Chi Health St. Francis | 2116 W Faidley Ave, Grand Island | G0109 | $73 [source] | 3 years ago |
| Chi Health St. Mary | 1301 Grundman Blvd, Nebraska City | G0109 | $94 [source] | 3 years ago |