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 |
|---|---|---|---|---|
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $41.50 | $50.00 | $10.71 – $48.00 | 16 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $48.97 | $59.00 | $12.64 – $56.64 | 16 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $35.69 | $43.00 | $9.22 – $41.28 | 16 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $69.72 | $84.00 | $18.00 – $80.64 | 16 |
| Cytopath smear other source CPT 88160 | $29.88 | $36.00 | $7.72 – $34.56 | 16 |
| Cytopath smear oth prep screen & interp CPT 88161 | $97.94 | $118.00 | $25.28 – $113.28 | 16 |
| Cytopath tbs c/v manual CPT 88164 | $28.22 | $34.00 | $7.29 – $40.38 | 16 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | $8.96 | $10.80 | $2.32 – $10.37 | 16 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | $531.84 | $640.77 | $137.26 – $615.14 | 16 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | $1,283.04 | $1,545.83 | $331.12 – $1,484.00 | 16 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | $582.06 | $701.27 | $150.22 – $673.22 | 16 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $3,095.68 | $3,729.74 | $40.16 – $179.97 | 16 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | $686.41 | $827.00 | $177.15 – $793.92 | 16 |
| Dch validity tests CPT 81002 | $37.35 | $45.00 | $1.72 – $7.73 | 16 |
| Deamidated gliadin antibody iga CPT 86258 | $162.68 | $196.00 | $41.99 – $188.16 | 16 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | $722.93 | $871.00 | $35.35 – $158.40 | 16 |
| Debridement (>20 cm) charge pt CPT 97598 | $215.80 | $260.00 | $27.21 – $121.92 | 16 |
| Debridement bone <= 20 sq cm CPT 11044 | $1,612.69 | $1,943.00 | $184.22 – $825.60 | 16 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $316.23 | $381.00 | $43.06 – $192.96 | 16 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $316.23 | $381.00 | $70.69 – $316.80 | 16 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $425.79 | $513.00 | $78.40 – $351.36 | 16 |
| Debride nail1-5 11720 CPT 11720 | $92.13 | $111.00 | $19.50 – $87.36 | 16 |
| Debride nail6 or more 11721 CPT 11721 | $576.85 | $695.00 | $26.35 – $118.08 | 16 |
| Debride skin bone at fx site CPT 11012 | $1,726.40 | $2,080.00 | $385.56 – $1,728.00 | 16 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $341.13 | $411.00 | $24.21 – $108.48 | 16 |
| Debrid/rmv fgn bdy/open fx/skin/sq 11010 CPT 11010 | $1,051.61 | $1,267.00 | $140.52 – $629.76 | 16 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $635.78 | $766.00 | $164.08 – $735.36 | 16 |
| Decalcification CPT 88311 | $6.64 | $8.00 | $1.72 – $7.68 | 16 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $455.48 | $548.76 | $117.55 – $526.81 | 16 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $594.28 | $716.00 | $153.37 – $687.36 | 16 |
| Deep muscle biopsy 20205 CPT 20205 | $702.18 | $846.00 | $181.22 – $812.16 | 16 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | $39.97 | $48.15 | $6.81 – $30.49 | 16 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $578.52 | $697.01 | $95.70 – $428.88 | 16 |
| Delivery of placenta 59414 CPT 59414 | $698.86 | $842.00 | $50.34 – $225.60 | 16 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $102.92 | $124.00 | $26.57 – $119.04 | 16 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $1,625.18 | $1,958.05 | $389.67 – $1,746.41 | 16 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $684.75 | $825.00 | $58.91 – $264.00 | 16 |
| Depo-estradiol cypionate inj HCPCS J1000 | $33.87 | $40.81 | $8.75 – $39.18 | 16 |
| Dermagraft HCPCS Q4106 | $3,137.40 | $3,780.00 | $566.30 – $2,538.00 | 16 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $62.37 | $75.14 | $16.10 – $72.14 | 16 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $3,993.13 | $4,811.00 | $1,030.52 – $4,618.56 | 16 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $3,993.13 | $4,811.00 | $1,030.52 – $4,618.56 | 16 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $156.87 | $189.00 | $28.49 – $127.68 | 16 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $185.09 | $223.00 | $47.77 – $214.08 | 16 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | $795.14 | $958.00 | $60.84 – $272.64 | 16 |
| Destruction 2-14 lesions 17003 CPT 17003 | $77.19 | $93.00 | $19.93 – $89.28 | 16 |
| Destruction benign lesions < 14 lesions CPT 17110 | $170.98 | $206.00 | $44.13 – $197.76 | 16 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $3,993.13 | $4,811.00 | $1,030.52 – $4,618.56 | 16 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $3,993.13 | $4,811.00 | $1,030.52 – $4,618.56 | 16 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $378.48 | $456.00 | $97.68 – $437.76 | 16 |
| Detect agent nos dna dir CPT 87797 | $53.95 | $65.00 | $13.93 – $66.67 | 16 |
| Device ablt adv novasure HCPCS C1886 | $10,517.02 | $12,671.10 | $422.09 – $1,891.68 | 16 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $3,787.29 | $4,563.00 | $977.40 – $4,380.48 | 16 |
| Device intraute mirena HCPCS J7298 | $907.34 | $1,093.17 | $234.16 – $1,049.45 | 16 |
| Device sut capio slim opn HCPCS C2631 | $1,232.95 | $1,485.48 | $141.38 – $633.60 | 16 |
| Device tiss remov myosure reach HCPCS C1782 | $2,036.82 | $2,453.99 | $183.15 – $820.80 | 16 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $238.21 | $287.00 | $61.48 – $275.52 | 16 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $1.13 | $1.36 | $0.01 – $0.03 | 16 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $2.18 | $2.63 | $0.31 – $1.37 | 16 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $416.39 | $501.67 | $14.14 – $63.35 | 16 |
| Dextran 40 infusion HCPCS J7100 | $0.06 | $0.07 | $0.02 – $0.06 | 16 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $0.01 | $0.01 | $0.01 – $0.01 | 16 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $0.01 | $0.01 | $0.01 – $0.01 | 16 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $0.02 | $0.02 | $0.01 – $0.02 | 16 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $16.60 | $20.00 | $4.29 – $44.40 | 16 |
| Diabetes (HbA1c) Test CPT 83036 | $99.60 | $120.00 | $7.07 – $31.68 | 16 |
| Diag laparo separate proc 49320 CPT 49320 | $738.70 | $890.00 | $190.64 – $854.40 | 16 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $298.80 | $360.00 | $73.69 – $330.24 | 16 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $45.65 | $55.00 | $11.79 – $52.80 | 16 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $46.48 | $56.00 | $12.00 – $53.76 | 16 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $213.31 | $257.00 | $41.35 – $185.28 | 16 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $302.12 | $364.00 | $70.69 – $316.80 | 16 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $357.73 | $431.00 | $92.33 – $413.76 | 16 |
| Diagnostic Mammogram (one breast) CPT 77065 | $316.23 | $381.00 | $81.62 – $365.76 | 16 |
| Dialysis one evaluation CPT 90945 | $3,480.19 | $4,193.00 | $898.15 – $4,025.28 | 16 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.11 | $0.13 | $0.02 – $0.05 | 16 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $13.70 | $16.50 | $0.79 – $3.52 | 16 |
| Dicyclomine injection HCPCS J0500 | $31.91 | $38.44 | $8.24 – $36.91 | 16 |
| Diffusing capacity CPT 94729 | $491.36 | $592.00 | $126.81 – $568.32 | 16 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $95.97 | $115.62 | $10.72 – $48.03 | 16 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $3,983.93 | $4,799.91 | $1,028.15 – $4,607.92 | 16 |
| Digoxin total therapeutic drug level CPT 80162 | $120.35 | $145.00 | $9.86 – $44.16 | 16 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $37.96 | $45.73 | $9.80 – $43.91 | 16 |
| Dilate esophagus 1/mult pass CPT 43450 | $1,177.77 | $1,419.00 | $115.89 – $519.36 | 16 |
| Dilate urethra stricture CPT 53600 | $399.23 | $481.00 | $53.13 – $238.08 | 16 |
| Dilate urethra stricture CPT 53601 | $303.78 | $366.00 | $50.77 – $227.52 | 16 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $2,524.03 | $3,041.00 | $104.53 – $468.48 | 16 |
| Dilator fascial 10fx20cm HCPCS C2627 | $806.76 | $972.00 | $38.46 – $172.37 | 16 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $11.08 | $13.35 | $2.86 – $12.82 | 16 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $2.28 | $2.75 | $0.07 – $0.28 | 16 |
| Disaccharidases CPT 82657 | $200.86 | $242.00 | $18.85 – $84.48 | 16 |
| Dise eval slp do brth flx dx CPT 42975 | $226.59 | $273.00 | $58.48 – $262.08 | 16 |
| Dna antibody native/double stranded CPT 86225 | $87.15 | $105.00 | $9.64 – $43.20 | 16 |
| Dna gardnerella CPT 87510 | $53.95 | $65.00 | $9.00 – $44.51 | 16 |
| Dna probe chlamydia CPT 87490 | $53.95 | $65.00 | $13.93 – $62.40 | 16 |
| Dna probe gc CPT 87590 | $53.95 | $65.00 | $13.93 – $62.40 | 16 |
| Dna trichomonas CPT 87660 | $53.95 | $65.00 | $9.00 – $44.51 | 16 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $0.29 | $0.35 | $0.01 – $0.03 | 16 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $53.00 | $63.86 | $1.79 – $8.02 | 16 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $0.52 | $0.63 | $0.02 – $0.05 | 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.