| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Chi Health Good Samaritan | 10 E 31St St, Kearney | G0390 | $6,820 [source] | 3 years ago |
| Chi Health Lakeside | 17201 Wright St, Omaha | G0390 | $8,000 [source] | 3 years ago |
| Chi Health Midlands | 11111 S 84Th St, Papillion | G0390 | $8,000 [source] | 3 years ago |
| Chi Health Creighton University Medical Center - Bergan Mercy | 7500 Mercy Rd, Omaha | G0390 | $8,000 [source] | 3 years ago |
| Chi Health Immanuel | 7101 Newport Ave, Omaha | G0390 | $8,000 [source] | 3 years ago |
| Chi Health St. Francis | 2116 W Faidley Ave, Grand Island | G0390 | $8,536 [source] | 3 years ago |