CHI Health Good Samaritan
10 East 31st Street, Kearney, NE · Chihealth · · NPI 1336184019
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | not published | not published | $105.63 – $105.63 | 1 |
| Destroy vulva lesion extensive 56515 CPT 56515 | not published | not published | $401.94 – $401.94 | 1 |
| Destroy vulva lesion simple 56501 CPT 56501 | not published | not published | $254.27 – $254.27 | 1 |
| Destruct ben lesion 15/> 17111 CPT 17111 | not published | not published | $159.60 – $159.60 | 1 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | not published | not published | $686.64 – $686.64 | 1 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | not published | not published | $526.93 – $526.93 | 1 |
| Destruct cut vasl lesions >50cm 17108 CPT 17108 | not published | not published | $999.39 – $999.39 | 1 |
| Destruction 2-14 lesions 17003 CPT 17003 | not published | not published | $4.01 – $4.01 | 1 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $255.32 – $255.32 | 1 |
| Destruction anal lesion(s) CPT 46924 | not published | not published | $342.20 – $342.20 | 1 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | not published | not published | $261.62 – $261.62 | 1 |
| Destruction benign lesions < 14 lesions CPT 17110 | $157.99 | $259.00 | $54.39 – $240.87 | 7 |
| Destruction by injection tx of nerve 64630 CPT 64630 | not published | not published | $358.26 – $358.26 | 1 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $443.47 | $727.00 | $111.70 – $676.11 | 7 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $1,268.80 | $2,080.00 | $368.03 – $1,934.40 | 7 |
| Destruction ciliary body CPT 66700 | not published | not published | $747.08 – $747.08 | 1 |
| Destruction ciliary body CPT 66720 | not published | not published | $784.79 – $784.79 | 1 |
| Destruction ciliary body CPT 66740 | not published | not published | $747.08 – $747.08 | 1 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | not published | not published | $271.51 – $271.51 | 1 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $244.17 – $244.17 | 1 |
| Destruction les conjunctiva CPT 68135 | not published | not published | $285.05 – $285.05 | 1 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | not published | not published | $261.24 – $261.24 | 1 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | not published | not published | $318.97 – $318.97 | 1 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | not published | not published | $249.06 – $249.06 | 1 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | not published | not published | $291.90 – $291.90 | 1 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | not published | not published | $204.71 – $204.71 | 1 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $329.13 – $329.13 | 1 |
| Destruction premal lesions 15/> 17004 CPT 17004 | not published | not published | $187.51 – $187.51 | 1 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $1,315.15 – $1,315.15 | 1 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $352.07 – $352.07 | 1 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $218.84 – $218.84 | 1 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $183.67 – $183.67 | 1 |
| Determination venous press CPT 93770 | $317.20 | $520.00 | $1.32 – $483.60 | 7 |
| Device ablt adv novasure HCPCS C1886 | $7,729.38 | $12,671.10 | $367.50 – $1,627.50 | 11 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $2,783.43 | $4,563.00 | $958.23 – $4,243.59 | 11 |
| Device intraute mirena HCPCS J7298 | $666.84 | $1,093.17 | $229.57 – $1,136.90 | 9 |
| Device sut capio slim opn HCPCS C2631 | $906.15 | $1,485.48 | $138.60 – $613.80 | 11 |
| Device tiss remov myosure reach HCPCS C1782 | $1,496.94 | $2,453.99 | $179.55 – $795.15 | 11 |
| Devise bowel pouch CPT 44316 | not published | not published | $948.78 – $967.39 | 3 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $246.44 | $404.00 | $41.83 – $251.10 | 11 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $0.83 | $1.36 | $0.01 – $0.03 | 12 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $1.61 | $2.63 | $0.21 – $1.33 | 12 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $306.02 | $501.67 | $13.86 – $68.62 | 14 |
| Dextran 40 infusion HCPCS J7100 | $0.05 | $0.07 | $0.02 – $0.06 | 8 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $0.01 | $0.01 | $0.01 – $0.01 | 12 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $0.01 | $0.01 | $0.01 – $0.01 | 7 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $0.01 | $0.02 | $0.01 – $0.02 | 12 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $35.99 | $59.00 | $12.39 – $59.00 | 18 |
| Diabetes (HbA1c) Test CPT 83036 | $56.73 | $93.00 | $9.40 – $93.00 | 18 |
| Diab manage trn ind/group HCPCS G0109 | $53.07 | $87.00 | $11.00 – $80.91 | 14 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $321.30 – $321.30 | 1 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $604.67 – $604.67 | 1 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $176.42 – $176.42 | 1 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $233.63 – $233.63 | 1 |
| Diagnostic anoscopy spx 46600 CPT 46600 | not published | not published | $77.53 – $77.53 | 1 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $53.68 | $88.00 | $18.48 – $81.84 | 7 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $53.68 | $88.00 | $18.48 – $81.84 | 7 |
| Diagnostic laryngoscopy 31505 CPT 31505 | not published | not published | $94.06 – $94.06 | 1 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $342.82 | $562.00 | $118.02 – $522.66 | 7 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $274.50 | $450.00 | $94.50 – $418.50 | 9 |
| Diagnostic Mammogram (one breast) CPT 77065 | $244.61 | $401.00 | $66.57 – $294.81 | 9 |
| Diagnostic radio unlisted proc CPT 76499 | $32.94 | $54.00 | $11.34 – $50.22 | 7 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $904.63 | $1,483.00 | $311.43 – $1,379.19 | 7 |
| Dialysis one evaluation CPT 90945 | $2,342.40 | $3,840.00 | $147.11 – $3,571.20 | 11 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.08 | $0.13 | $0.02 – $0.05 | 8 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $10.07 | $16.50 | $0.77 – $3.66 | 12 |
| Dicyclomine injection HCPCS J0500 | $23.45 | $38.44 | $8.08 – $35.75 | 12 |
| Diffusing capacity CPT 94729 | $480.68 | $788.00 | $90.38 – $732.84 | 7 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $328.13 – $328.13 | 1 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $70.53 | $115.62 | $6.09 – $46.53 | 12 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $2,927.95 | $4,799.91 | $1,007.99 – $4,844.18 | 14 |
| Digoxin total therapeutic drug level CPT 80162 | $76.86 | $126.00 | $12.87 – $126.00 | 18 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $27.90 | $45.73 | $9.61 – $45.73 | 12 |
| Dilate biliary duct/ampulla CPT 47542 | $203.74 | $334.00 | $70.14 – $310.62 | 7 |
| Dilate esophagus CPT 43453 | not published | not published | $162.73 – $162.73 | 1 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $150.00 – $150.00 | 1 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | not published | $491.72 – $620.15 | 4 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | not published | $310.09 – $501.36 | 4 |
| Dilate ic vasospasm init CPT 61640 | not published | not published | $491.72 – $882.48 | 4 |
| Dilate tear duct opening CPT 68801 | not published | not published | $152.65 – $152.65 | 1 |
| Dilate urethra stricture CPT 53600 | not published | not published | $119.13 – $119.13 | 1 |
| Dilate urethra stricture CPT 53601 | not published | not published | $100.17 – $100.17 | 1 |
| Dilate urethra stricture CPT 53605 | not published | not published | $119.74 – $119.74 | 1 |
| Dilate urethra stricture CPT 53621 | not published | not published | $134.84 – $134.84 | 1 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $78.46 – $78.46 | 1 |
| Dilation of anal sphincter CPT 45905 | $2,048.38 | $3,358.00 | $319.81 – $3,122.94 | 7 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $90.34 – $90.34 | 1 |
| Dilation of rectal stricture 45910 CPT 45910 | $2,875.54 | $4,714.00 | $363.01 – $4,384.02 | 7 |
| Dilation of salivary duct CPT 42660 | not published | not published | $159.01 – $159.01 | 1 |
| Dilation of urethra CPT 53661 | not published | not published | $75.98 – $75.98 | 1 |
| Dilation of urethra CPT 53665 | not published | not published | $71.17 – $71.17 | 1 |
| Dilation of vagina CPT 57400 | not published | not published | $243.05 – $243.05 | 1 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $111.99 – $111.99 | 1 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $163.51 – $163.51 | 1 |
| Dilator fascial 10fx20cm HCPCS C2627 | $592.92 | $972.00 | $37.71 – $166.99 | 11 |
| Dilat xst trc ndurlgc px CPT 50436 | not published | not published | $279.83 – $279.83 | 1 |
| Dilat xst trc new access rcs CPT 50437 | not published | not published | $465.02 – $465.02 | 1 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $8.15 | $13.35 | $2.81 – $13.89 | 14 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $1.68 | $2.75 | $0.07 – $0.29 | 12 |
| Disability dlco CPT 94727 | $294.63 | $483.00 | $62.01 – $449.19 | 7 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.