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 |
|---|---|---|---|---|
| Tympanic membrane repair CPT 69610 | not published | not published | $544.38 – $544.38 | 1 |
| Tympanolysis transcanal 69450 CPT 69450 | not published | not published | $1,042.73 – $1,042.73 | 1 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | not published | not published | $252.76 – $252.76 | 1 |
| Tympp antrt/mastoidotomy prosthesis torp 69637 CPT 69637 | not published | not published | $2,655.01 – $2,655.01 | 1 |
| Tympp antrt/mastoid without ossic chain recnst 69635 CPT 69635 | not published | not published | $2,405.89 – $2,405.89 | 1 |
| Ua w/micro/comp poc CPT 81000 | $39.04 | $64.00 | $3.90 – $59.52 | 18 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | $1,064.71 | $1,745.42 | $366.54 – $1,623.25 | 7 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $187.88 | $308.00 | $64.68 – $286.44 | 7 |
| Ultrasound breast complete CPT 76641 | $491.66 | $806.00 | $128.84 – $749.58 | 11 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $491.66 | $806.00 | $99.83 – $749.58 | 11 |
| Ultrasound chest CPT 76604 | $406.26 | $666.00 | $56.95 – $619.38 | 11 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $265.35 | $435.00 | $39.94 – $404.55 | 11 |
| Ultrasound encephalogram CPT 76506 | $596.58 | $978.00 | $155.32 – $909.54 | 11 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $709.43 | $1,163.00 | $211.03 – $1,081.59 | 11 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $529.48 | $868.00 | $93.11 – $807.24 | 11 |
| Ultrasound guidance for vascular access CPT 76937 | $603.90 | $990.00 | $46.24 – $920.70 | 11 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $761.28 | $1,248.00 | $53.17 – $1,160.64 | 11 |
| Ultrasound guide intraoperative CPT 76998 | $1,211.46 | $1,986.00 | $85.47 – $1,846.98 | 7 |
| Ultrasound guide tissue ablation CPT 76940 | $350.75 | $575.00 | $110.33 – $534.75 | 7 |
| Ultrasound hips infant dynamic CPT 76885 | $421.51 | $691.00 | $145.11 – $691.00 | 11 |
| Ultrasound infant hips ltd without stress CPT 76886 | $395.89 | $649.00 | $133.27 – $603.57 | 11 |
| Ultrasound joint complete left CPT 76881 | $691.74 | $1,134.00 | $20.39 – $1,054.62 | 11 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $571.57 | $937.00 | $58.21 – $871.41 | 11 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $576.45 | $945.00 | $77.76 – $878.85 | 11 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $604.51 | $991.00 | $39.73 – $921.63 | 11 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $395.28 | $648.00 | $131.99 – $602.64 | 11 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $421.51 | $691.00 | $95.42 – $642.63 | 11 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $645.38 | $1,058.00 | $108.02 – $983.94 | 11 |
| Ultrasound retroperitoneal limited CPT 76775 | $522.77 | $857.00 | $61.38 – $797.01 | 11 |
| Ultrasound scrotum and contents CPT 76870 | $719.19 | $1,179.00 | $132.64 – $1,096.47 | 11 |
| Ultrasound spinal canal and contents CPT 76800 | $511.18 | $838.00 | $175.98 – $779.34 | 11 |
| Ultrasound transvaginal non obstetric CPT 76830 | $651.48 | $1,068.00 | $163.74 – $993.24 | 11 |
| Umbilical artery cath newborn 36660 CPT 36660 | $253.76 | $416.00 | $67.74 – $386.88 | 9 |
| Umbilical cord occlud w/us CPT 59072 | not published | not published | $919.70 – $919.70 | 1 |
| Umbilicoplasty 15847 CPT 15847 | not published | not published | $906.65 – $906.65 | 1 |
| Unlisted fluoroscopic px CPT 76496 | $958.92 | $1,572.00 | $83.94 – $1,461.96 | 7 |
| Unlisted mr procedure CPT 76498 | $655.75 | $1,075.00 | $146.60 – $999.75 | 7 |
| Unlisted procedure spine CPT 22899 | $3,536.17 | $5,797.00 | $1,217.37 – $5,391.21 | 7 |
| Unlisted procedure urinary 58750 CPT 58750 | not published | not published | $785.43 – $1,706.54 | 4 |
| Unlisted px biliary tract CPT 47999 | $2,411.33 | $3,953.00 | $830.13 – $3,676.29 | 7 |
| Unlisted px casting/strpg CPT 29799 | $214.72 | $352.00 | $73.92 – $327.36 | 7 |
| Unlisted px external ear CPT 69399 | $187.88 | $308.00 | $64.68 – $286.44 | 7 |
| Unlisted px hands/fingers CPT 26989 | $184.83 | $303.00 | $63.63 – $281.79 | 7 |
| Unlisted px leg/ankle CPT 27899 | $473.36 | $776.00 | $162.96 – $721.68 | 7 |
| Unlisted px pelvis/hip joint CPT 27299 | $430.66 | $706.00 | $148.26 – $656.58 | 7 |
| Unlisted px small intestine CPT 44799 | $2,292.38 | $3,758.00 | $789.18 – $3,494.94 | 7 |
| Unlisted px tongue flr mouth CPT 41599 | $161.65 | $265.00 | $55.65 – $246.45 | 7 |
| Unlisted transfusion med px CPT 86999 | $73.81 | $121.00 | $25.41 – $112.53 | 7 |
| Unlisted ultrasound procedure CPT 76999 | $387.35 | $635.00 | $133.35 – $590.55 | 7 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $888.16 | $1,456.00 | $305.76 – $1,354.08 | 7 |
| Upgrade pm system CPT 33214 | $7,632.93 | $12,513.00 | $862.64 – $11,637.09 | 7 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,075.83 | $3,403.00 | $419.31 – $3,164.79 | 11 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,501.00 | $4,100.00 | $372.02 – $3,813.00 | 11 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $1,650.66 | $2,706.00 | $238.14 – $2,516.58 | 11 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | $229.87 – $229.87 | 1 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | $259.52 – $259.52 | 1 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $265.55 – $327.26 | 4 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $259.52 – $259.52 | 1 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $1,210.31 – $1,210.31 | 1 |
| Urea nitrogen CPT 84520 | $40.87 | $67.00 | $3.83 – $62.31 | 18 |
| Urea nitrogen 24 hour urine CPT 84540 | $47.58 | $78.00 | $5.39 – $72.54 | 18 |
| Ureteral embolization/occl CPT 50705 | $203.74 | $334.00 | $70.14 – $310.62 | 7 |
| Ureter endoscopy CPT 50970 | not published | not published | $691.95 – $691.95 | 1 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $658.41 – $658.41 | 1 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $882.38 – $882.38 | 1 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $668.26 – $668.26 | 1 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $661.79 – $661.79 | 1 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $592.85 – $592.85 | 1 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $870.07 – $870.07 | 1 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $664.88 – $664.88 | 1 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $1,080.05 – $2,082.11 | 4 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $1,078.48 – $1,099.62 | 3 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $739.32 | $1,212.00 | $93.72 – $1,127.16 | 7 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $1,408.24 – $1,408.24 | 1 |
| Urethrocystography void s&i CPT 74455 | $755.79 | $1,239.00 | $167.31 – $1,152.27 | 11 |
| Uric acid blood CPT 84550 | $14.64 | $24.00 | $4.38 – $24.00 | 18 |
| Uric acid urine CPT 84560 | $35.38 | $58.00 | $4.93 – $54.74 | 18 |
| Urinalysis microscopic only CPT 81015 | $6.71 | $11.00 | $2.31 – $11.00 | 18 |
| Urinalysis (with microscopy) CPT 81001 | $51.24 | $84.00 | $3.07 – $69.75 | 18 |
| Urinalysis (without microscopy) CPT 81003 | $33.55 | $55.00 | $2.18 – $35.34 | 18 |
| Urinary reflex study CPT 51792 | not published | not published | $413.64 – $413.64 | 1 |
| Urine Culture Test CPT 87086 | $67.10 | $110.00 | $7.82 – $102.30 | 18 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $10.29 – $10.29 | 1 |
| Urine pregnancy test CPT 81025 | $74.42 | $122.00 | $8.34 – $113.46 | 18 |
| Urine shunt to intestine CPT 50815 | not published | not published | $1,271.84 – $1,296.78 | 3 |
| Urography, antegrade CPT 74425 | $680.76 | $1,116.00 | $212.08 – $1,037.88 | 7 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $47.48 | $77.83 | $10.94 – $72.39 | 14 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $17,160.02 | $28,131.18 | $134.29 – $22,497.47 | 14 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $226.92 | $372.00 | $72.76 – $322.19 | 7 |
| Vaccine dtap < 7 years im CPT 90700 | $34.53 | $56.61 | $9.30 – $41.18 | 8 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $80.15 | $131.39 | $27.60 – $122.20 | 9 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $58.76 | $96.32 | $20.23 – $89.58 | 7 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $34.28 | $56.19 | $11.80 – $52.26 | 8 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $7.77 | $12.73 | $2.68 – $11.84 | 8 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $41.53 | $68.09 | $11.91 – $52.72 | 8 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $34.11 | $55.91 | $11.75 – $52.00 | 8 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $27.82 | $45.60 | $6.81 – $35.37 | 14 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $25.86 | $42.38 | $7.38 – $34.30 | 14 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $78.34 | $128.43 | $25.69 – $119.44 | 14 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $18.37 | $30.10 | $6.02 – $28.00 | 14 |
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.