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 |
|---|---|---|---|---|
| X-ray pelvis 1-2 views CPT 72170 | $265.60 | $320.00 | $16.71 – $74.88 | 16 |
| X-ray pelvis complete > 3 views CPT 72190 | $350.26 | $422.00 | $90.40 – $405.12 | 16 |
| X-ray ribs 2 views left CPT 71100 | $405.87 | $489.00 | $18.85 – $84.48 | 16 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $126.16 | $152.00 | $25.71 – $115.20 | 16 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $494.68 | $596.00 | $127.67 – $572.16 | 16 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $296.31 | $357.00 | $76.47 – $342.72 | 16 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $180.11 | $217.00 | $9.64 – $43.20 | 16 |
| X-ray scapula complete (both sides) CPT 73010 | $239.87 | $289.00 | $61.91 – $277.44 | 16 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $290.50 | $350.00 | $14.36 – $64.32 | 16 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $390.93 | $471.00 | $17.14 – $76.80 | 16 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $1,591.94 | $1,918.00 | $410.84 – $1,841.28 | 16 |
| X-ray skull < 4 views CPT 70250 | $242.36 | $292.00 | $16.50 – $73.92 | 16 |
| X-ray skull > 4 views complete CPT 70260 | $407.53 | $491.00 | $105.18 – $471.36 | 16 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $869.84 | $1,048.00 | $224.49 – $1,006.08 | 16 |
| X-ray small intestine follow-through study CPT 74248 | $664.00 | $800.00 | $171.36 – $768.00 | 16 |
| X-ray spine single view CPT 72020 | $217.46 | $262.00 | $8.57 – $38.40 | 16 |
| X-ray sternum > 2 views CPT 71120 | $57.27 | $69.00 | $13.50 – $60.48 | 16 |
| X-ray surgical specimen CPT 76098 | $163.51 | $197.00 | $42.20 – $189.12 | 16 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $795.14 | $958.00 | $205.21 – $919.68 | 16 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $73.87 | $89.00 | $19.07 – $85.44 | 16 |
| X-ray thoracic spine 2 views CPT 72070 | $223.27 | $269.00 | $21.42 – $96.00 | 16 |
| X-ray thoracic spine 3 views CPT 72072 | $531.20 | $640.00 | $22.07 – $98.88 | 16 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $148.57 | $179.00 | $38.35 – $171.84 | 16 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $133.63 | $161.00 | $34.49 – $154.56 | 16 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $133.63 | $161.00 | $34.49 – $154.56 | 16 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $260.62 | $314.00 | $16.71 – $74.88 | 16 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $139.44 | $168.00 | $17.57 – $78.72 | 16 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $1,098.92 | $1,324.00 | $283.61 – $1,271.04 | 16 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $1,034.18 | $1,246.00 | $119.74 – $536.64 | 16 |
| X-ray upper gi&small intest CPT 74245 | $1,314.72 | $1,584.00 | $339.30 – $1,520.64 | 16 |
| X-ray wrist 2 views (both sides) CPT 73100 | $176.79 | $213.00 | $18.00 – $80.64 | 16 |
| Xyntha inj HCPCS J7185 | $0.95 | $1.14 | $0.18 – $0.80 | 16 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $1.11 | $1.34 | $0.29 – $1.29 | 16 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $31.79 | $38.31 | $8.21 – $36.78 | 16 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $28.44 | $34.27 | $0.05 – $0.23 | 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.