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 |
|---|---|---|---|---|
| Hysteroscopy biopsy CPT 58558 | not published | not published | $430.21 – $430.21 | 1 |
| Hysteroscopy dx sep proc CPT 58555 | not published | not published | $282.22 – $282.22 | 1 |
| Hysteroscopy lysis CPT 58559 | not published | not published | $527.92 – $527.92 | 1 |
| Hysteroscopy remove fb CPT 58562 | not published | not published | $412.23 – $412.23 | 1 |
| Hysteroscopy remove myoma CPT 58561 | not published | not published | $664.73 – $664.73 | 1 |
| Hysteroscopy resect septum CPT 58560 | not published | not published | $581.07 – $581.07 | 1 |
| Hysterotomy abdominal 59100 CPT 59100 | not published | not published | $1,539.78 – $1,539.78 | 1 |
| Hzv zoster vacc recombinant adjuvanted im inj CPT 90750 | $111.64 | $183.01 | $38.44 – $190.33 | 9 |
| I-123 ioflupane diag HCPCS A9584 | $11,879.14 | $19,474.00 | $4,089.54 – $18,110.82 | 7 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $43.92 | $72.00 | $15.12 – $66.96 | 7 |
| I131 iodide cap, rx HCPCS A9517 | $29.89 | $49.00 | $10.29 – $45.57 | 7 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | $129.32 | $212.00 | $34.01 – $212.00 | 18 |
| Ibandronate 3 mg/3 ml intravenous syringe HCPCS J1740 | $44.64 | $73.17 | $15.37 – $68.05 | 12 |
| Ibuprofen injection HCPCS J1741 | $410.62 | $673.15 | $5.63 – $626.03 | 11 |
| Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 | $16.65 | $27.30 | $5.74 – $28.39 | 10 |
| Icatibant injection HCPCS J1744 | $203.22 | $333.15 | $69.97 – $309.83 | 9 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $49,117.20 | $80,520.00 | $12.52 – $55.43 | 11 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $39,070.50 | $64,050.00 | $1,959.93 – $8,679.69 | 11 |
| Icd crtp serena MRI HCPCS C2621 | $13,343.75 | $21,875.00 | $14.70 – $65.10 | 11 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $12,279.30 | $20,130.00 | $850.50 – $3,766.50 | 11 |
| I&d abscess posterior spine l/s/ls-22015 CPT 22015 | not published | not published | $410.86 – $1,739.14 | 4 |
| I&d abscss rtrphryngl/paraphryngl intraorl apprch CPT 42720 | not published | not published | $729.10 – $729.10 | 1 |
| Idarubicin hcl injection HCPCS J9211 | $4.05 | $6.63 | $1.40 – $6.63 | 12 |
| I&d/bursa/foot 28001 CPT 28001 | not published | not published | $184.59 – $184.59 | 1 |
| Idet 1 or more levels CPT 22527 | not published | not published | $289.23 – $289.23 | 1 |
| Idet single level CPT 22526 | not published | not published | $625.19 – $625.19 | 1 |
| I&d frarm&/wrst deep absc/hematoma CPT 25028 | not published | not published | $1,308.99 – $1,308.99 | 1 |
| I&d intramural/intramuscular/submuc abscess transanal anes CPT 46045 | not published | not published | $822.19 – $822.19 | 1 |
| I&d lacrimal gland CPT 68400 | not published | not published | $250.57 – $250.57 | 1 |
| I&d lacrimal sac CPT 68420 | not published | not published | $317.10 – $317.10 | 1 |
| I&d upper arm/elbow deep abscess/hematoma CPT 23930 | not published | not published | $402.26 – $402.26 | 1 |
| Idursulfase injection HCPCS J1743 | $637.62 | $1,045.28 | $219.51 – $1,045.28 | 14 |
| I & d vag hematoma non-ob 57023 CPT 57023 | not published | not published | $602.22 – $602.22 | 1 |
| I&d vag hemtma obst/postpart CPT 57022 | not published | not published | $342.15 – $342.15 | 1 |
| Ifosfamide 1 gram intravenous solution HCPCS J9208 | $58.38 | $95.69 | $0.32 – $1.48 | 12 |
| Igh gene rearrange amp meth CPT 81261 | $147.62 | $242.00 | $50.82 – $439.54 | 17 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $249.49 | $409.00 | $85.89 – $380.37 | 11 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $226.92 | $372.00 | $78.12 – $372.00 | 11 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $237.29 | $389.00 | $81.69 – $389.00 | 11 |
| Ileostomy/jejunostomy non-tube 44310 CPT 44310 | not published | not published | $732.24 – $746.60 | 3 |
| Iliac bone graft microvasc CPT 20956 | not published | not published | $2,434.85 – $4,859.59 | 4 |
| Iliac revasc add-on 37222 CPT 37222 | $7,067.46 | $11,586.00 | $326.38 – $10,774.98 | 7 |
| Imbrication/diaphragm/transthor/transabd 39545 CPT 39545 | not published | not published | $846.86 – $1,613.66 | 4 |
| Imetelstat 188 mg intravenous solution HCPCS J0870 | $6,210.12 | $10,180.52 | $534.48 – $2,366.98 | 7 |
| Img rta detc/mntr ds phy/qhp CPT 92228 | $66.49 | $109.00 | $22.89 – $101.37 | 7 |
| Immobilizer shldr cntor adlt HCPCS L3670 | $102.10 | $167.37 | $4.59 – $22.70 | 9 |
| Immobilizer shldr dlx str 24-36in med HCPCS L1830 | $28.22 | $46.25 | $9.72 – $48.10 | 9 |
| Immobilizer shldr sling med HCPCS L3660 | $66.23 | $108.57 | $16.29 – $80.66 | 9 |
| Immt breast prosthesis 19340 CPT 19340 | not published | not published | $1,415.06 – $1,415.06 | 1 |
| Immune complex assay CPT 86332 | $106.14 | $174.00 | $23.61 – $174.00 | 18 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | $5.71 | $9.36 | $1.97 – $9.74 | 14 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | $802.97 | $1,316.34 | $67.84 – $1,224.20 | 14 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | $4.58 | $7.50 | $0.77 – $3.81 | 14 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $78.69 | $129.00 | $20.17 – $129.00 | 18 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $64.05 | $105.00 | $20.17 – $105.00 | 18 |
| Immunofixation electrophoresis serum CPT 86334 | $102.48 | $168.00 | $21.64 – $168.00 | 18 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $175.07 | $287.00 | $51.45 – $227.85 | 7 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $159.21 | $261.00 | $54.81 – $261.00 | 11 |
| Immunoglobulin assay CPT 86023 | $35.38 | $58.00 | $12.08 – $58.00 | 18 |
| Implant biventricular device 33976 CPT 33976 | not published | not published | $1,558.82 – $1,589.38 | 3 |
| Implant brain electrodes CPT 61531 | not published | not published | $1,019.51 – $2,174.34 | 4 |
| Implant brain electrodes CPT 61533 | not published | not published | $1,300.13 – $1,325.63 | 3 |
| Implant brain electrodes CPT 61760 | not published | not published | $1,273.23 – $1,298.19 | 3 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $4,488.08 | $7,357.50 | $484.32 – $2,144.82 | 11 |
| Implant cochlear device CPT 69930 | not published | not published | $2,297.53 – $2,297.53 | 1 |
| Implant cochlear osia osi300 HCPCS L8690 | $1,910.17 | $3,131.42 | $602.58 – $2,668.54 | 11 |
| Implant eye drug system CPT 67027 | not published | not published | $1,612.13 – $1,612.13 | 1 |
| Implant hormone pellet(s) 11980 CPT 11980 | not published | not published | $103.99 – $103.99 | 1 |
| Implant nerve end CPT 64787 | not published | not published | $430.90 – $430.90 | 1 |
| Implant neuroelectrde addl CPT 61864 | not published | not published | $249.46 – $482.98 | 4 |
| Implant neuroelectrde addl CPT 61868 | not published | not published | $422.59 – $852.31 | 4 |
| Implant neuroelectrode CPT 61863 | not published | not published | $867.63 – $884.64 | 3 |
| Implant neuroelectrode CPT 61867 | not published | not published | $1,321.00 – $1,346.90 | 3 |
| Implant neuroelectrodes CPT 63655 | not published | not published | $1,515.53 – $1,515.53 | 1 |
| Implant neuroelectrodes CPT 64553 | not published | not published | $793.88 – $793.88 | 1 |
| Implant neuroelectrodes CPT 64555 | not published | not published | $617.13 – $617.13 | 1 |
| Implant neuroelectrodes CPT 64561 | not published | not published | $571.14 – $571.14 | 1 |
| Implant neuroelectrodes CPT 61850 | not published | not published | $830.44 – $1,747.10 | 4 |
| Implant neuroelectrodes CPT 61860 | not published | not published | $1,206.83 – $1,230.50 | 3 |
| Implant neurostim arrays CPT 61886 | not published | not published | $1,588.25 – $1,588.25 | 1 |
| Implant/replace hearing aid CPT 69710 | not published | not published | $1,182.85 – $1,206.05 | 3 |
| Implant single ventricular device 33975 CPT 33975 | not published | not published | $1,284.21 – $1,309.39 | 3 |
| Implant spinal canal cath CPT 62351 | not published | not published | $1,640.96 – $1,640.96 | 1 |
| Implant spine infusion pump CPT 62361 | not published | not published | $783.28 – $783.28 | 1 |
| Implant spine infusion pump CPT 62362 | not published | not published | $712.80 – $712.80 | 1 |
| Implant tcat pulm vlv perq CPT 33477 | not published | not published | $1,217.59 – $1,241.47 | 3 |
| Implant ureter in bowel CPT 50800 | not published | not published | $948.59 – $1,744.01 | 4 |
| Implant ureth bulk agent HCPCS L8606 | $1,398.58 | $2,292.75 | $286.88 – $1,902.99 | 11 |
| Impl neurostim electr perc CPT 63650 | not published | not published | $789.39 – $789.39 | 1 |
| Implnt bio implnt for soft tiss reinforcement 15777 CPT 15777 | not published | not published | $392.57 – $392.57 | 1 |
| Implnt spinl canal catheter 62350 CPT 62350 | not published | not published | $742.71 – $742.71 | 1 |
| Impl oi implt skull perq esp CPT 69714 | not published | not published | $937.82 – $937.82 | 1 |
| Impl/rplcmt gstr nstim eltrd CPT 43881 | not published | not published | $350.89 – $1,311.03 | 4 |
| Implt brain chemotx add-on 61517 CPT 61517 | not published | not published | $67.53 – $149.06 | 4 |
| Impltj ntrstrml crnl rng seg CPT 65785 | not published | not published | $846.03 – $846.03 | 1 |
| Impltj tot rplcmt hrt sys CPT 33927 | not published | not published | $2,272.27 – $2,316.83 | 3 |
| Impres&prep auricular prosth CPT 21086 | not published | not published | $2,449.99 – $2,449.99 | 1 |
| Impres&prep def obt prosth CPT 21080 | not published | not published | $2,520.36 – $2,520.36 | 1 |
| Impres&prep facial prosth CPT 21088 | not published | not published | $6,322.39 – $6,322.39 | 1 |
| Impres&prep intrm obt prosth CPT 21079 | not published | not published | $2,233.77 – $2,233.77 | 1 |
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.