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 |
|---|---|---|---|---|
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | $2,713.27 | $3,269.00 | $700.22 – $3,138.24 | 16 |
| Liver Function Test CPT 80076 | $134.46 | $162.00 | $6.00 – $26.88 | 16 |
| Liver/spleen imag static only CPT 78215 | $1,689.88 | $2,036.00 | $436.12 – $1,954.56 | 16 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $2.09 | $2.51 | $0.01 – $0.01 | 16 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,431.07 | $2,929.00 | $627.40 – $2,811.84 | 16 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,133.10 | $2,570.00 | $550.50 – $2,467.20 | 16 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,927.56 | $4,732.00 | $1,013.60 – $4,542.72 | 16 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,992.15 | $3,605.00 | $772.20 – $3,460.80 | 16 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $3,116.65 | $3,755.00 | $804.33 – $3,604.80 | 16 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $244.85 | $295.00 | $22.50 – $100.80 | 16 |
| Lso flex no ri stays pre ots HCPCS L0628 | $514.17 | $619.47 | $132.70 – $594.70 | 16 |
| L/s ratio fetal lung CPT 83661 | $87.15 | $105.00 | $21.99 – $100.80 | 16 |
| Lung Function Test (Spirometry) CPT 94010 | $345.28 | $416.00 | $89.11 – $399.36 | 16 |
| Lung perfusion imaging CPT 78580 | $1,208.48 | $1,456.00 | $311.88 – $1,397.76 | 16 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $5,725.61 | $6,898.32 | $1,477.63 – $6,622.39 | 16 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $9,843.99 | $11,860.22 | $846.83 – $3,795.29 | 16 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $39,425.00 | $47,500.00 | $10,174.50 – $45,600.00 | 16 |
| Macroscopic exam parasite CPT 87169 | $28.22 | $34.00 | $4.31 – $32.64 | 16 |
| Magnesium CPT 83735 | $126.99 | $153.00 | $5.15 – $23.04 | 16 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $2.68 | $3.23 | $0.01 – $0.02 | 16 |
| Mammosite ced HCPCS C1728 | $8,353.95 | $10,065.00 | $35.45 – $158.87 | 16 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $249.83 | $301.00 | $64.48 – $288.96 | 16 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $249.83 | $301.00 | $64.48 – $288.96 | 16 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $0.10 | $0.12 | $0.03 – $0.12 | 16 |
| Manual diff wbc count b-coat CPT 85009 | $40.67 | $49.00 | $5.07 – $47.04 | 16 |
| Marker biop eviva buckle ss HCPCS A4648 | $5,229.00 | $6,300.00 | $0.35 – $1.55 | 16 |
| Mastectomy partial CPT 19301 | $1,479.89 | $1,783.00 | $381.92 – $1,711.68 | 16 |
| Mast mod rad CPT 19307 | $2,644.38 | $3,186.00 | $682.45 – $3,058.56 | 16 |
| Mastoids complete CPT 70130 | $205.84 | $248.00 | $53.13 – $238.08 | 16 |
| Mast radical CPT 19305 | $2,571.34 | $3,098.00 | $663.60 – $2,974.08 | 16 |
| Mast rad urban type CPT 19306 | $2,739.00 | $3,300.00 | $706.86 – $3,168.00 | 16 |
| Mast simple complete CPT 19303 | $2,141.40 | $2,580.00 | $552.64 – $2,476.80 | 16 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $7,963.02 | $9,594.00 | $163.44 – $732.48 | 16 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $15.77 | $19.00 | $4.07 – $32.10 | 16 |
| Mayo aathr protein s free CPT 85306 | $261.45 | $315.00 | $15.32 – $302.40 | 16 |
| Mayo activated protein c resistance assay CPT 85307 | $174.30 | $210.00 | $15.32 – $201.60 | 16 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $131.14 | $158.00 | $33.85 – $151.68 | 16 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $107.07 | $129.00 | $10.71 – $48.00 | 16 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $224.93 | $271.00 | $58.05 – $260.16 | 16 |
| Mayo alpha 1 antitrypsin CPT 82103 | $15.77 | $19.00 | $4.07 – $29.84 | 16 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $146.91 | $177.00 | $15.08 – $169.92 | 16 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $99.60 | $120.00 | $25.71 – $115.20 | 16 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $27.39 | $33.00 | $7.07 – $73.26 | 16 |
| Mayo androstenedione CPT 82157 | $17.43 | $21.00 | $4.50 – $46.62 | 16 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $18.26 | $22.00 | $4.72 – $32.41 | 16 |
| Mayo antithrombin iii antigen CPT 85301 | $141.93 | $171.00 | $10.81 – $164.16 | 16 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $59.76 | $72.00 | $15.05 – $69.12 | 16 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $15.77 | $19.00 | $4.07 – $18.24 | 16 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $93.79 | $113.00 | $10.18 – $108.48 | 16 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $78.02 | $94.00 | $12.90 – $90.24 | 16 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $157.70 | $190.00 | $13.19 – $182.40 | 16 |
| Mayo brcmg brucella antibody igm CPT 86622 | $56.44 | $68.00 | $8.93 – $65.28 | 16 |
| Mayo c1 esterase inhibitor CPT 83883 | $146.08 | $176.00 | $13.60 – $168.96 | 16 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $99.60 | $120.00 | $25.71 – $115.20 | 16 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $35.69 | $43.00 | $8.57 – $38.40 | 16 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $126.99 | $153.00 | $26.78 – $146.88 | 16 |
| Mayo ceruloplasmin CPT 82390 | $7.47 | $9.00 | $1.93 – $19.98 | 16 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $31.54 | $38.00 | $8.14 – $36.48 | 16 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $188.41 | $227.00 | $9.00 – $40.32 | 16 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $53.12 | $64.00 | $11.82 – $61.44 | 16 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $53.12 | $64.00 | $4.07 – $28.15 | 16 |
| Mayo chromium CPT 82495 | $28.22 | $34.00 | $7.29 – $45.02 | 16 |
| Mayo coccidioides antibody CPT 86635 | $52.29 | $63.00 | $11.47 – $60.48 | 16 |
| Mayo cocou cortisone urine CPT 82542 | $35.69 | $43.00 | $9.22 – $53.48 | 16 |
| Mayo cortisol free CPT 82530 | $36.52 | $44.00 | $9.43 – $42.24 | 16 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $91.30 | $110.00 | $23.57 – $105.60 | 16 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $36.52 | $44.00 | $9.43 – $42.24 | 16 |
| Mayo csmpu opiod/analogs definitive assay >=5 urine CPT 80364 | $102.92 | $124.00 | $26.57 – $119.04 | 16 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $34.86 | $42.00 | $9.00 – $40.32 | 16 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $9.96 | $12.00 | $2.58 – $26.64 | 16 |
| Mayo efpo chloride stool CPT 82438 | $26.56 | $32.00 | $5.00 – $30.72 | 16 |
| Mayo estriol CPT 82677 | $67.23 | $81.00 | $13.71 – $61.44 | 16 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $77.19 | $93.00 | $16.34 – $89.28 | 16 |
| Mayo everolimus therapeutic drug level CPT 80169 | $159.36 | $192.00 | $13.73 – $184.32 | 16 |
| Mayo factor ii CPT 85210 | $217.46 | $262.00 | $12.98 – $251.52 | 16 |
| Mayo factor v CPT 85220 | $315.40 | $380.00 | $17.65 – $364.80 | 16 |
| Mayo factor vii CPT 85230 | $103.75 | $125.00 | $17.90 – $120.00 | 16 |
| Mayo factor viii vw factor antigen CPT 85246 | $44.82 | $54.00 | $11.57 – $51.84 | 16 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $27.39 | $33.00 | $7.07 – $50.93 | 16 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $328.68 | $396.00 | $22.94 – $380.16 | 16 |
| Mayo factor x CPT 85260 | $255.64 | $308.00 | $17.90 – $295.68 | 16 |
| Mayo fat/lipids feces quantitative CPT 82710 | $6.64 | $8.00 | $1.72 – $17.76 | 16 |
| Mayo fbl culture fungi blood CPT 87103 | $90.47 | $109.00 | $20.46 – $104.64 | 16 |
| Mayo ffspg allergen clam igg CPT 86001 | $14.11 | $17.00 | $3.65 – $17.36 | 16 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $57.27 | $69.00 | $14.78 – $66.24 | 16 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $386.78 | $466.00 | $99.82 – $447.36 | 16 |
| Mayo hemosiderin qualitative urine CPT 83070 | $62.25 | $75.00 | $4.75 – $72.00 | 16 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $52.29 | $63.00 | $13.50 – $60.48 | 16 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $96.28 | $116.00 | $24.85 – $111.36 | 16 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $106.24 | $128.00 | $8.89 – $122.88 | 16 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $67.23 | $81.00 | $17.36 – $77.76 | 16 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $176.79 | $213.00 | $9.64 – $43.20 | 16 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $52.29 | $63.00 | $13.50 – $60.48 | 16 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $141.93 | $171.00 | $14.36 – $64.32 | 16 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $135.29 | $163.00 | $20.81 – $156.48 | 16 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $93.79 | $113.00 | $16.07 – $108.48 | 16 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $425.79 | $513.00 | $11.98 – $492.48 | 16 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | $190.07 | $229.00 | $35.09 – $219.84 | 16 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | $163.51 | $197.00 | $35.09 – $189.12 | 16 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $244.85 | $295.00 | $35.09 – $283.20 | 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.