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 |
|---|---|---|---|---|
| Control nosebleed pack+caut 30905 CPT 30905 | $864.03 | $1,041.00 | $214.20 – $960.00 | 16 |
| Control of nosebleed ant comp 30903 CPT 30903 | $581.00 | $700.00 | $147.80 – $662.40 | 16 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $370.18 | $446.00 | $45.84 – $205.44 | 16 |
| Control oropharyngeal hemorr/simp 42960 CPT 42960 | $961.97 | $1,159.00 | $96.39 – $432.00 | 16 |
| Contrst x-ray uppr gi tract CPT 74249 | $1,296.46 | $1,562.00 | $334.59 – $1,499.52 | 16 |
| Conv gtube to jtube CPT 44373 | $441.56 | $532.00 | $113.96 – $510.72 | 16 |
| Coombs direct CPT 86880 | $81.34 | $98.00 | $5.39 – $53.76 | 16 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | $78.85 | $95.00 | $5.72 – $91.20 | 16 |
| Coombs indirect titer reference CPT 86886 | $268.92 | $324.00 | $5.18 – $114.24 | 16 |
| Copper cu 64 dotatate diag HCPCS A9592 | $1,869.99 | $2,253.00 | $482.60 – $2,162.88 | 16 |
| Coronary thrombolysis/iv infusion 92977 CPT 92977 | $209.16 | $252.00 | $29.35 – $131.52 | 16 |
| Corrj halux rigdus without implt CPT 28289 | $897.23 | $1,081.00 | $231.56 – $1,037.76 | 16 |
| Cortisol total am CPT 82533 | $39.84 | $48.00 | $10.07 – $45.12 | 16 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | $20.88 | $25.16 | $0.01 – $0.01 | 16 |
| Co-treatment - group 15 mins, st CPT 92508 | $107.90 | $130.00 | $27.85 – $124.80 | 16 |
| Counseling smoke cess interm >10mins CPT 99407 | $26.56 | $32.00 | $6.86 – $30.72 | 16 |
| Cov-19 amp prb hgh thruput HCPCS U0003 | $148.57 | $179.00 | $38.35 – $171.84 | 16 |
| Coveredge 32 lead kit 40cm 48 HCPCS C1897 | $13,670.10 | $16,470.00 | $39.99 – $179.20 | 16 |
| Covid-19 administration immunization im inj 1st/only component CPT 90480 | $65.57 | $79.00 | $16.93 – $75.84 | 16 |
| Covid-19 lab test non-cdc HCPCS U0002 | $159.36 | $192.00 | $41.13 – $184.32 | 16 |
| C-peptide CPT 84681 | $190.07 | $229.00 | $20.81 – $219.84 | 16 |
| C-reactive protein CPT 86140 | $89.64 | $108.00 | $3.65 – $16.32 | 16 |
| C-reactive protein high sensitivity CPT 86141 | $105.41 | $127.00 | $9.00 – $40.32 | 16 |
| Creatine kinase CPT 82550 | $39.84 | $48.00 | $4.93 – $22.08 | 16 |
| Creatine kinase isoenzymes CPT 82552 | $36.52 | $44.00 | $9.43 – $42.24 | 16 |
| Creatine kinase mb CPT 82553 | $64.74 | $78.00 | $8.14 – $36.48 | 16 |
| Creatinine CPT 82565 | $58.93 | $71.00 | $3.65 – $16.32 | 16 |
| Creatinine 24 hour urine CPT 82570 | $66.40 | $80.00 | $3.86 – $17.28 | 16 |
| Creatinine clearance urine CPT 82575 | $36.52 | $44.00 | $6.86 – $30.72 | 16 |
| #creutz-prot.,western blot CPT 84182 | $120.35 | $145.00 | $21.85 – $97.92 | 16 |
| Critical care 30-74 minutes CPT 99291 | $3,778.99 | $4,553.00 | $167.94 – $752.64 | 16 |
| Critical care each additional 30 minutes CPT 99292 | $822.53 | $991.00 | $73.26 – $328.32 | 16 |
| Crotalidae poly immune fab HCPCS J0840 | $1,486.22 | $1,790.63 | $383.56 – $1,719.01 | 16 |
| Cryocautery of cervix 57511 CPT 57511 | $359.39 | $433.00 | $92.75 – $415.68 | 16 |
| Crystal identification light microscopy CPT 89060 | $78.02 | $94.00 | $5.15 – $23.04 | 16 |
| Cta abdomen without & /or w/contrast CPT 74175 | $3,376.44 | $4,068.00 | $871.37 – $3,905.28 | 16 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $2,138.91 | $2,577.00 | $552.00 – $2,473.92 | 16 |
| Cta neck without &/or w/contrast CPT 70498 | $3,473.55 | $4,185.00 | $896.43 – $4,017.60 | 16 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $7,183.65 | $8,655.00 | $1,853.91 – $8,308.80 | 16 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $3,665.28 | $4,416.00 | $945.91 – $4,239.36 | 16 |
| CT Angiogram of the Head CPT 70496 | $3,422.09 | $4,123.00 | $883.15 – $3,958.08 | 16 |
| CT angio pelvis CPT 72191 | $3,228.70 | $3,890.00 | $833.24 – $3,734.40 | 16 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $105.41 | $127.00 | $27.21 – $121.92 | 16 |
| CT limited or localized follow-up study CPT 76380 | $880.63 | $1,061.00 | $227.27 – $1,018.56 | 16 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $2,775.52 | $3,344.00 | $716.29 – $3,210.24 | 16 |
| CT lower extremity without contrast (both sides) CPT 73700 | $2,332.30 | $2,810.00 | $601.91 – $2,697.60 | 16 |
| CT lwr extremity w/o&w/dye CPT 73702 | $2,915.79 | $3,513.00 | $752.49 – $3,372.48 | 16 |
| CT neck soft tissue w/contrast CPT 70491 | $2,621.97 | $3,159.00 | $676.66 – $3,032.64 | 16 |
| CT neck soft tissue without contrast CPT 70490 | $1,940.54 | $2,338.00 | $500.80 – $2,244.48 | 16 |
| CT neck soft tissue without & w/contrast CPT 70492 | $2,936.54 | $3,538.00 | $757.84 – $3,396.48 | 16 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $2,579.64 | $3,108.00 | $665.74 – $2,983.68 | 16 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $2,402.02 | $2,894.00 | $619.90 – $2,778.24 | 16 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $2,333.13 | $2,811.00 | $602.12 – $2,698.56 | 16 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $872.33 | $1,051.00 | $74.12 – $332.16 | 16 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $6,073.11 | $7,317.00 | $1,567.31 – $7,024.32 | 16 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $5,103.67 | $6,149.00 | $1,317.12 – $5,903.04 | 16 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $3,980.68 | $4,796.00 | $1,027.31 – $4,604.16 | 16 |
| CT thoracic spine w/contrast CPT 72129 | $2,330.64 | $2,808.00 | $601.48 – $2,695.68 | 16 |
| CT thoracic spine without contrast CPT 72128 | $2,177.92 | $2,624.00 | $562.07 – $2,519.04 | 16 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $345.28 | $416.00 | $89.11 – $399.36 | 16 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $2,468.42 | $2,974.00 | $637.04 – $2,855.04 | 16 |
| CT upper extremity without contrast (both sides) CPT 73200 | $2,109.86 | $2,542.00 | $544.50 – $2,440.32 | 16 |
| Culture aerobic additional method definitive id each CPT 87077 | $107.07 | $129.00 | $5.79 – $25.92 | 16 |
| Culture afb any source CPT 87116 | $211.65 | $255.00 | $10.80 – $244.80 | 16 |
| Culture anaerobic additional method definitive id each CPT 87076 | $151.89 | $183.00 | $5.79 – $25.92 | 16 |
| Culture anaerobic except blood CPT 87075 | $113.71 | $137.00 | $6.65 – $29.76 | 16 |
| Culture bact stool aero addl path ea CPT 87046 | $61.42 | $74.00 | $6.65 – $29.76 | 16 |
| Culture body fluid CPT 87070 | $111.22 | $134.00 | $6.22 – $27.84 | 16 |
| Culture fungi definitive id mold CPT 87107 | $29.05 | $35.00 | $7.50 – $33.60 | 16 |
| Culture fungi definitive id yeast CPT 87106 | $132.80 | $160.00 | $10.32 – $153.60 | 16 |
| Culture fungi other (except blood) CPT 87102 | $216.63 | $261.00 | $8.41 – $250.56 | 16 |
| Culture fungi skin/hair/nail CPT 87101 | $101.26 | $122.00 | $7.71 – $117.12 | 16 |
| Culture screening strep group a CPT 87081 | $80.51 | $97.00 | $4.93 – $22.08 | 16 |
| Culture typing immunologic CPT 87147 | $72.21 | $87.00 | $3.65 – $16.32 | 16 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $134.46 | $162.00 | $34.71 – $155.52 | 16 |
| Culture urine each isolate CPT 87088 | $26.56 | $32.00 | $5.79 – $25.92 | 16 |
| Cutter lead HCPCS C1773 | $7,138.83 | $8,601.00 | $12.44 – $55.73 | 16 |
| Cv stress test i&r only 93018 CPT 93018 | $51.46 | $62.00 | $13.29 – $59.52 | 16 |
| Cv stress test/supervision only 93016 CPT 93016 | $51.46 | $62.00 | $13.29 – $59.52 | 16 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $5.31 | $6.40 | $1.38 – $6.15 | 16 |
| Cyclic citrullinated peptide antibody CPT 86200 | $134.46 | $162.00 | $9.00 – $40.32 | 16 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | $289.62 | $348.93 | $10.77 – $48.24 | 16 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | $5.69 | $6.85 | $0.33 – $1.46 | 16 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | $10.60 | $12.77 | $2.74 – $12.26 | 16 |
| Cyclosporine 2 hour CPT 80158 | $276.39 | $333.00 | $18.05 – $319.68 | 16 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | $3.41 | $4.11 | $0.58 – $2.60 | 16 |
| Cyclosporine oral 100 mg HCPCS J7502 | $11.97 | $14.42 | $0.84 – $3.73 | 16 |
| Cylinder pump set 20cm titan zero angl HCPCS C1813 | $22,069.87 | $26,590.20 | $272.04 – $1,219.20 | 16 |
| Cystatin c CPT 82610 | $72.21 | $87.00 | $18.52 – $83.52 | 16 |
| Cystine urine quantitative CPT 82131 | $9.13 | $11.00 | $2.36 – $24.42 | 16 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $502.15 | $605.00 | $129.60 – $580.80 | 16 |
| Cystoscopy and treatment CPT 52277 | $738.70 | $890.00 | $190.64 – $854.40 | 16 |
| Cystoscopy (Bladder Scope) CPT 52000 | $1,308.91 | $1,577.00 | $147.80 – $662.40 | 16 |
| Cystoscopy & ureter catheter CPT 52005 | $2,698.33 | $3,251.00 | $186.57 – $836.16 | 16 |
| Cytarabine 20 mg/ml injection solution HCPCS J9100 | $0.78 | $0.93 | $0.08 – $0.34 | 16 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $141.93 | $171.00 | $14.39 – $164.16 | 16 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $141.93 | $171.00 | $16.85 – $164.16 | 16 |
| Cytopath fl nongyn filter CPT 88106 | $48.97 | $59.00 | $12.64 – $56.64 | 16 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $43.16 | $52.00 | $11.14 – $49.92 | 16 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $136.12 | $164.00 | $15.21 – $68.16 | 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.