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 |
|---|---|---|---|---|
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $1,035.84 | $1,248.00 | $244.19 – $1,094.40 | 16 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $1,171.96 | $1,412.00 | $267.33 – $1,198.08 | 16 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $1,226.74 | $1,478.00 | $297.53 – $1,333.44 | 16 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $1,345.43 | $1,621.00 | $316.59 – $1,418.88 | 16 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | $1,588.62 | $1,914.00 | $324.95 – $1,456.32 | 16 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | $1,588.62 | $1,914.00 | $366.29 – $1,641.60 | 16 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $163.51 | $197.00 | $8.60 – $189.12 | 16 |
| Ghs mbp CPT 83873 | $80.51 | $97.00 | $17.20 – $93.12 | 16 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $18.26 | $22.00 | $4.72 – $21.12 | 16 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $156.87 | $189.00 | $40.49 – $181.44 | 16 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $128.65 | $155.00 | $33.21 – $148.80 | 16 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $42.33 | $51.00 | $4.72 – $21.12 | 16 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $97.94 | $118.00 | $25.28 – $113.28 | 16 |
| Ghs musc test done w/n test comp CPT 95886 | $363.54 | $438.00 | $61.27 – $274.56 | 16 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $412.51 | $497.00 | $39.42 – $176.64 | 16 |
| Ghs musc tst done w/n tst non ext CPT 95887 | $204.18 | $246.00 | $52.70 – $236.16 | 16 |
| Ghs myocardial strain img spckl track CPT 93356 | $434.09 | $523.00 | $112.03 – $502.08 | 16 |
| Ghs nailbed repair/nail removal CPT 11760 | $441.56 | $532.00 | $84.61 – $379.20 | 16 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $1,292.31 | $1,557.00 | $91.25 – $408.96 | 16 |
| Ghs nerve blk intercostal, single level CPT 64420 | $987.70 | $1,190.00 | $254.90 – $1,142.40 | 16 |
| Ghs nerve block brachial plexus CPT 64415 | $210.82 | $254.00 | $54.41 – $243.84 | 16 |
| Ghs nerve block interscaline CPT 64510 | $1,302.27 | $1,569.00 | $336.08 – $1,506.24 | 16 |
| Ghs ng placement w fluoro guidance CPT 43752 | $295.48 | $356.00 | $76.26 – $341.76 | 16 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | $126.16 | $152.00 | $32.56 – $145.92 | 16 |
| Ghs opcc repair cvp without subq port CPT 36575 | $1,362.86 | $1,642.00 | $92.11 – $412.80 | 16 |
| Ghs opcc repair cvp w subq port CPT 36576 | $1,362.86 | $1,642.00 | $212.06 – $950.40 | 16 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $70.55 | $85.00 | $18.21 – $81.60 | 16 |
| Ghs pacing - transcutaneous CPT 92953 | $1,008.45 | $1,215.00 | $0.43 – $1.92 | 16 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $1,147.06 | $1,382.00 | $296.03 – $1,326.72 | 16 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $996.00 | $1,200.00 | $54.84 – $245.76 | 16 |
| Ghs peritonsillar abscess i andd CPT 42700 | $449.03 | $541.00 | $100.46 – $450.24 | 16 |
| Ghs phenylketonurid CPT 84030 | $59.76 | $72.00 | $5.50 – $69.12 | 16 |
| Ghs plngl fx pm cl CPT 26725 | $794.31 | $957.00 | $121.88 – $546.24 | 16 |
| Ghs ppd (tb intradermal) CPT 86580 | $88.19 | $106.25 | $3.43 – $15.36 | 16 |
| Ghs pr without cont pulse ox CPT 94625 | $225.76 | $272.00 | $38.56 – $172.80 | 16 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $276.39 | $333.00 | $71.33 – $319.68 | 16 |
| Ghs quinidine CPT 80194 | $5.81 | $7.00 | $1.50 – $15.54 | 16 |
| Ghs removal intranasal foreign body CPT 30300 | $496.34 | $598.00 | $53.98 – $241.92 | 16 |
| Ghs removal pharyngeal foreign body CPT 42809 | $585.98 | $706.00 | $122.31 – $548.16 | 16 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $1,417.64 | $1,708.00 | $94.47 – $423.36 | 16 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $3,411.30 | $4,110.00 | $292.82 – $1,312.32 | 16 |
| Ghs reticulocyte count CPT 85044 | $44.82 | $54.00 | $4.31 – $51.84 | 16 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $80.51 | $97.00 | $8.14 – $36.48 | 16 |
| Ghs sedimentation rate CPT 85651 | $40.67 | $49.00 | $2.36 – $10.56 | 16 |
| Ghs sensitivity (per antimicro) CPT 87184 | $63.91 | $77.00 | $5.15 – $23.04 | 16 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $405.87 | $489.00 | $102.82 – $460.80 | 16 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $504.64 | $608.00 | $117.39 – $526.08 | 16 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $474.76 | $572.00 | $112.03 – $502.08 | 16 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $477.25 | $575.00 | $87.61 – $392.64 | 16 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $406.70 | $490.00 | $85.04 – $381.12 | 16 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $388.44 | $468.00 | $77.76 – $348.48 | 16 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $439.90 | $530.00 | $101.75 – $456.00 | 16 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $533.69 | $643.00 | $117.39 – $526.08 | 16 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $499.66 | $602.00 | $128.95 – $577.92 | 16 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $146.91 | $177.00 | $37.92 – $169.92 | 16 |
| Ghs strapping shoulder - 29240 CPT 29240 | $71.38 | $86.00 | $18.43 – $82.56 | 16 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $699.69 | $843.00 | $83.54 – $374.40 | 16 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $410.02 | $494.00 | $105.82 – $474.24 | 16 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,533.01 | $1,847.00 | $187.00 – $838.08 | 16 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $742.85 | $895.00 | $140.31 – $628.80 | 16 |
| Ghs urine, porphyrins quant CPT 84120 | $180.11 | $217.00 | $14.71 – $208.32 | 16 |
| Ghs vaginal delivery only CPT 59409 | $1,754.62 | $2,114.00 | $131.95 – $591.36 | 16 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $678.94 | $818.00 | $175.22 – $785.28 | 16 |
| Ghs windowing of cast CPT 29730 | $145.25 | $175.00 | $35.56 – $159.36 | 16 |
| Gi inhouse confirmation CPT 87045 | $104.58 | $126.00 | $6.65 – $29.76 | 16 |
| Gi trc img intral colon i&r CPT 91113 | $1,051.61 | $1,267.00 | $271.40 – $1,216.32 | 16 |
| Glassia injection HCPCS J0257 | $0.52 | $0.62 | $0.14 – $0.60 | 16 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $212.56 | $256.09 | $20.11 – $90.11 | 16 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $163.22 | $196.64 | $24.18 – $108.33 | 16 |
| Glucose 1 hr post dose CPT 82950 | $24.90 | $30.00 | $4.75 – $28.80 | 16 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $114.54 | $138.00 | $1.50 – $7.28 | 16 |
| Glucose blood quantitative CPT 82947 | $43.16 | $52.00 | $3.93 – $29.76 | 16 |
| Glucose body fluid CPT 82945 | $42.33 | $51.00 | $3.93 – $48.96 | 16 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $140.27 | $169.00 | $36.20 – $162.24 | 16 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $37.35 | $45.00 | $4.93 – $28.57 | 16 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $38.18 | $46.00 | $3.92 – $44.16 | 16 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $400.12 | $482.07 | $103.26 – $462.79 | 16 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $83.00 | $100.00 | $18.58 – $96.00 | 16 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $77.19 | $93.00 | $18.52 – $89.28 | 16 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $2,423.62 | $2,920.02 | $212.67 – $953.11 | 16 |
| Graft axiofill 1000mg HCPCS J3590 | $1,618.50 | $1,950.00 | $1.37 – $6.13 | 16 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $795.97 | $959.00 | $82.47 – $369.60 | 16 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $36,061.73 | $43,447.86 | $87.03 – $390.01 | 16 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $5,313.04 | $6,401.25 | $147.54 – $661.20 | 16 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $29,289.67 | $35,288.75 | $48.14 – $215.72 | 16 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $5,395.00 | $6,500.00 | $213.75 – $957.97 | 16 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $3,227.04 | $3,888.00 | $832.81 – $3,732.48 | 16 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $5,810.00 | $7,000.00 | $447.68 – $2,006.40 | 16 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $2,511.79 | $3,026.25 | $648.23 – $2,905.20 | 16 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $38,680.71 | $46,603.26 | $843.42 – $3,780.00 | 16 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $7,351.48 | $8,857.20 | $178.13 – $798.34 | 16 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $25,732.49 | $31,003.00 | $7.70 – $34.49 | 16 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $3,022.62 | $3,641.70 | $11.22 – $50.26 | 16 |
| Granisetron hcl injection HCPCS J1626 | $12.60 | $15.18 | $0.41 – $1.80 | 16 |
| Great toe with reduction 28495 CPT 28495 | $417.49 | $503.00 | $106.25 – $476.16 | 16 |
| Gstrst open wo constj tube CPT 43830 | $1,579.49 | $1,903.00 | $407.63 – $1,826.88 | 16 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,702.33 | $2,051.00 | $403.99 – $1,810.56 | 16 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $7,728.17 | $9,311.04 | $0.30 – $1.35 | 16 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $3,557.59 | $4,286.25 | $3.11 – $13.92 | 16 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $2,115.88 | $2,549.25 | $18.00 – $80.64 | 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.