CHI Health St. Mary's
1301 GRUNDMAN BLVD, Nebraska City, NE · Chihealth · · NPI 1528016995
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 |
|---|---|---|---|---|
| Exc mal+marg tal 3.1-4 cm 11604 CPT 11604 | $1,101.41 | $1,327.00 | $284.25 – $1,273.92 | 16 |
| Exc/pilonidal cyst/sinus/simple 11770 CPT 11770 | $840.79 | $1,013.00 | $216.99 – $972.48 | 16 |
| Exc prtl bn phlnx toe CPT 28124 | $2,049.27 | $2,469.00 | $528.86 – $2,370.24 | 16 |
| Exc rect tum transanal part CPT 45171 | $1,420.96 | $1,712.00 | $366.72 – $1,643.52 | 16 |
| Exc sacral pr ulc prim sutr CPT 15931 | $1,579.49 | $1,903.00 | $407.63 – $1,826.88 | 16 |
| Exc sacral pr ulc skn flap CPT 15934 | $2,148.87 | $2,589.00 | $554.57 – $2,485.44 | 16 |
| Exc snhfg mal+mrg 1.1-2 11622 CPT 11622 | $1,101.41 | $1,327.00 | $152.30 – $682.56 | 16 |
| Exc snhfg mal+mrg 3.1-4 11624 CPT 11624 | $782.69 | $943.00 | $202.00 – $905.28 | 16 |
| Exc sq tum/leg or ankle area <3 cm 27618 CPT 27618 | $1,121.33 | $1,351.00 | $289.39 – $1,296.96 | 16 |
| Exc sq tum/neck/ant thorax 3cm/> 21552 CPT 21552 | $1,008.45 | $1,215.00 | $260.26 – $1,166.40 | 16 |
| Exc sq tumor/shoulder area 3cm/> 23071 CPT 23071 | $949.52 | $1,144.00 | $245.05 – $1,098.24 | 16 |
| Exc thrombosed hemorrhoid 46320 CPT 46320 | $502.15 | $605.00 | $129.60 – $580.80 | 16 |
| Expander breast 300cc mod hght extra proj smth natrelle HCPCS L8600 | $4,101.03 | $4,941.00 | $127.88 – $573.12 | 16 |
| Expander tiss 133s-mv-12-t 300ml natrelle smth HCPCS C1789 | $4,902.19 | $5,906.25 | $25.71 – $115.20 | 16 |
| Explore penetrating wnd/extremity 20103 CPT 20103 | $1,311.40 | $1,580.00 | $148.45 – $665.28 | 16 |
| Explore wound abdomen 20102 CPT 20102 | $1,861.69 | $2,243.00 | $374.21 – $1,677.12 | 16 |
| Explore woundchest 20101 CPT 20101 | $1,390.25 | $1,675.00 | $358.79 – $1,608.00 | 16 |
| Explore wound neck 20100 CPT 20100 | $1,358.71 | $1,637.00 | $350.65 – $1,571.52 | 16 |
| Ex sq tumor/face or scalp 2 cm/> 21012 CPT 21012 | $511.28 | $616.00 | $131.95 – $591.36 | 16 |
| Ext ecg>48hr<7d rev&interpj CPT 93244 | $58.10 | $70.00 | $15.00 – $67.20 | 16 |
| Ext ecg>7d<15d rev&interpj CPT 93248 | $63.91 | $77.00 | $16.50 – $73.92 | 16 |
| Extensive testis surgery CPT 54535 | $1,718.10 | $2,070.00 | $443.40 – $1,987.20 | 16 |
| Extensive thyroid surgery CPT 60254 | $3,780.65 | $4,555.00 | $975.69 – $4,372.80 | 16 |
| External chromosome analysis 20-25 cells CPT 88264 | $746.17 | $899.00 | $144.61 – $863.04 | 16 |
| External pretreatment of serum for use in antibody identification by dilution CPT 86976 | $33.20 | $40.00 | $8.57 – $38.40 | 16 |
| External recharg sys intern HCPCS L8689 | $4,556.70 | $5,490.00 | $1,175.96 – $5,270.40 | 16 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $732.06 | $882.00 | $143.75 – $846.72 | 16 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $86.32 | $104.00 | $17.93 – $99.84 | 16 |
| F-18 fdg pet diag HCPCS A9552 | $561.08 | $676.00 | $144.80 – $648.96 | 16 |
| Fabrication & fitting HCPCS V2628 | $182.27 | $219.60 | $47.04 – $210.82 | 16 |
| Facial bones <3 CPT 70140 | $260.62 | $314.00 | $67.26 – $301.44 | 16 |
| Factor ix CPT 85250 | $145.25 | $175.00 | $19.04 – $168.00 | 16 |
| Factor ix complex HCPCS J7194 | $0.95 | $1.14 | $0.25 – $1.10 | 16 |
| Factor ix recombinant nos HCPCS J7195 | $0.85 | $1.02 | $0.22 – $0.96 | 16 |
| Factor viii CPT 85240 | $244.02 | $294.00 | $17.90 – $282.24 | 16 |
| Factor viii HCPCS J7190 | $0.77 | $0.92 | $0.20 – $0.89 | 16 |
| Factor viii recombinant nos HCPCS J7192 | $1.49 | $1.79 | $0.25 – $1.10 | 16 |
| Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution HCPCS J9358 | $2,427.32 | $2,924.48 | $626.43 – $2,807.51 | 16 |
| Fat/lipids feces qualitative CPT 82705 | $107.07 | $129.00 | $5.10 – $123.84 | 16 |
| Fecal microbiota, live-jslm 150 ml rectal suspension enema HCPCS J1440 | $49.80 | $60.00 | $12.86 – $57.60 | 16 |
| #fecal-sodium CPT 84302 | $53.95 | $65.00 | $4.86 – $62.40 | 16 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $1.68 | $2.03 | $0.01 – $0.01 | 16 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | $74.53 | $89.79 | $11.68 – $52.32 | 16 |
| Ferritin CPT 82728 | $39.01 | $47.00 | $4.29 – $30.26 | 16 |
| Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 | $8.94 | $10.76 | $2.31 – $10.33 | 16 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $576.85 | $695.00 | $148.87 – $667.20 | 16 |
| Fetal contract stress test 59020 - 26 CPT 59020 | $287.18 | $346.00 | $74.12 – $332.16 | 16 |
| Fetal fibronectin CPT 82731 | $348.60 | $420.00 | $64.41 – $403.20 | 16 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $148.57 | $179.00 | $7.73 – $171.84 | 16 |
| Fetal hemoglobin rosette CPT 85461 | $73.04 | $88.00 | $9.36 – $84.48 | 16 |
| Fetal monitor w/report CPT 59050 | $132.80 | $160.00 | $34.28 – $153.60 | 16 |
| Fetal non stress test CPT 59025 | $395.08 | $476.00 | $28.07 – $125.76 | 16 |
| Fibrin degradation d dimer quantitative CPT 85379 | $157.70 | $190.00 | $5.15 – $23.04 | 16 |
| Fibrin degradation products CPT 85362 | $84.66 | $102.00 | $6.89 – $97.92 | 16 |
| Fibrin degrade semiquant CPT 85378 | $19.92 | $24.00 | $5.15 – $23.04 | 16 |
| Fibrinogen activity CPT 85384 | $107.07 | $129.00 | $9.72 – $123.84 | 16 |
| Fibrinolytic plasminogen CPT 85415 | $57.27 | $69.00 | $14.78 – $66.24 | 16 |
| Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe HCPCS Q5110 | $130.37 | $157.07 | $16.83 – $75.39 | 16 |
| Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 | $97.15 | $117.04 | $25.07 – $112.36 | 16 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | $317.25 | $382.23 | $81.88 – $366.95 | 16 |
| Filter spider fx 3mmx320cm HCPCS C1884 | $6,721.14 | $8,097.75 | $509.27 – $2,282.40 | 16 |
| Filter vena cava fem denali HCPCS C1880 | $4,541.52 | $5,471.70 | $24.85 – $111.36 | 16 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $1,122.99 | $1,353.00 | $289.82 – $1,298.88 | 16 |
| Fine needle asp without image guide 10021 CPT 10021 | $404.21 | $487.00 | $61.27 – $274.56 | 16 |
| Finger joint sz00 swanson w/grommets HCPCS L8630 | $4,655.83 | $5,609.43 | $406.42 – $1,821.45 | 16 |
| Fl exam g/colon tube w contrast CPT 49465 | $553.61 | $667.00 | $142.88 – $640.32 | 16 |
| Flexible Sigmoidoscopy CPT 45330 | $444.05 | $535.00 | $114.60 – $513.60 | 16 |
| Floor of mouth biopsy 41108 CPT 41108 | $1,277.37 | $1,539.00 | $329.66 – $1,477.44 | 16 |
| Flow cytometry marker each additional CPT 88185 | $131.14 | $158.00 | $33.85 – $151.68 | 16 |
| Flow cytometry one marker technical component CPT 88184 | $146.08 | $176.00 | $2.58 – $11.52 | 16 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $0.15 | $0.18 | $0.03 – $0.10 | 16 |
| Fludarabine 50 mg intravenous solution HCPCS J9185 | $103.20 | $124.33 | $21.56 – $96.59 | 16 |
| Fluidotherapy charges pt CPT 97022 | $148.57 | $179.00 | $18.00 – $80.64 | 16 |
| Fluid pressure muscle 20950 CPT 20950 | $763.60 | $920.00 | $161.08 – $721.92 | 16 |
| Fluorescent antibody titer dna CPT 86256 | $73.87 | $89.00 | $19.07 – $85.44 | 16 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $534.52 | $644.00 | $137.95 – $618.24 | 16 |
| Fluoroguide needle placement CPT 77002 | $979.40 | $1,180.00 | $243.12 – $1,089.60 | 16 |
| Fluoroscopy up to 1 hour CPT 76000 | $524.56 | $632.00 | $25.71 – $115.20 | 16 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | $0.99 | $1.19 | $0.04 – $0.18 | 16 |
| Fluphenazine decanoate 25 mg/ml injection solution HCPCS J2680 | $9.20 | $11.08 | $2.38 – $10.64 | 16 |
| Foam drg >16<=48 sq in w/bdr HCPCS A6213 | $17.46 | $21.03 | $4.51 – $20.19 | 16 |
| Foam drg <=16 sq in w/border HCPCS A6212 | $16.37 | $19.72 | $4.23 – $18.94 | 16 |
| Foam drsg <=16 sq in without bdr HCPCS A6209 | $31.59 | $38.05 | $6.01 – $26.91 | 16 |
| Folic acid CPT 82746 | $73.04 | $88.00 | $10.71 – $48.00 | 16 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | $759.12 | $914.60 | $195.91 – $878.02 | 16 |
| Fondaparinux sodium HCPCS J1652 | $180.41 | $217.35 | $9.74 – $43.66 | 16 |
| Foot X-ray CPT 73630 | $273.07 | $329.00 | $18.43 – $82.56 | 16 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | $314.57 | $379.00 | $81.19 – $363.84 | 16 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $253.99 | $306.01 | $65.55 – $293.77 | 16 |
| Foscarnet sodium injection HCPCS J1455 | $1.30 | $1.56 | $0.34 – $1.50 | 16 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $15.35 | $18.49 | $2.38 – $10.66 | 16 |
| Fracture assessment via dxa CPT 77086 | $22.41 | $27.00 | $5.79 – $25.92 | 16 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $117.86 | $142.00 | $30.42 – $136.32 | 16 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $169.32 | $204.00 | $0.01 – $0.01 | 16 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | $1,029.20 | $1,240.00 | $265.61 – $1,190.40 | 16 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | $5,362.63 | $6,461.00 | $553.71 – $2,481.60 | 16 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | $3.94 | $4.74 | $0.48 – $2.12 | 16 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | $3.71 | $4.47 | $0.28 – $1.22 | 16 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | $4.28 | $5.16 | $0.32 – $1.42 | 16 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | $10.78 | $12.99 | $2.79 – $12.48 | 16 |
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.