CHI Health Plainview
704 N 3rd St, Plainview, NE · Chihealth · · NPI 1861765034
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 |
|---|---|---|---|---|
| Lead capillary CPT 83655 | $146.16 | $174.00 | $12.11 – $36.26 | 19 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $4,919.04 | $5,856.00 | $93.70 – $208.01 | 19 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $11,375.28 | $13,542.00 | $1,721.42 – $3,821.56 | 19 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $2,092.44 | $2,491.00 | $1,519.51 – $3,373.32 | 19 |
| Leishmania antibody CPT 86717 | $166.32 | $198.00 | $12.25 – $194.04 | 19 |
| Lens, intraocular (new tech) HCPCS C1780 | $995.40 | $1,185.00 | $91.50 – $203.13 | 19 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $415.80 | $495.00 | $20.74 – $46.05 | 19 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $2,089.50 | $2,487.50 | $39.65 – $88.03 | 19 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $733.60 | $873.33 | $51.85 – $115.11 | 19 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $331.09 | $394.15 | $60.70 – $134.75 | 19 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $4,081.14 | $4,858.50 | $276.18 – $613.12 | 19 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $20,756.07 | $24,709.60 | $5,024.27 – $11,153.87 | 19 |
| Leuprolide depot cipla 7.5mg HCPCS J1954 | $5,239.97 | $6,238.05 | $3,805.22 – $8,447.57 | 19 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $220.53 | $262.53 | $60.70 – $134.75 | 19 |
| Levetiracetam therapeutic drug level CPT 80177 | $176.40 | $210.00 | $13.25 – $205.80 | 19 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $173.67 | $206.75 | $126.12 – $279.99 | 19 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $307.57 | $366.15 | $190.29 – $422.45 | 19 |
| Liberta rc ipg HCPCS C1820 | $57,522.03 | $68,478.60 | $823.50 – $1,828.17 | 19 |
| Lidocaine injection HCPCS J2001 | $83.58 | $99.50 | $60.70 – $134.75 | 19 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $83.58 | $99.50 | $60.70 – $134.75 | 19 |
| Lidocaine therapeutic drug level CPT 80176 | $155.40 | $185.00 | $14.69 – $181.30 | 19 |
| Lift heel adj small gl60404sm HCPCS L3332 | $19.76 | $23.52 | $14.35 – $31.86 | 19 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $733.32 | $873.00 | $532.53 – $1,182.22 | 19 |
| Liletta, 52 mg HCPCS J7297 | $2,003.61 | $2,385.24 | $1,455.00 – $3,230.10 | 19 |
| Lincomycin injection HCPCS J2010 | $652.98 | $777.35 | $474.19 – $1,052.69 | 19 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $307.44 | $366.00 | $60.70 – $134.75 | 19 |
| Lipase CPT 83690 | $178.08 | $212.00 | $6.89 – $20.58 | 19 |
| Lipoprotein blood quant CPT 83704 | $444.36 | $529.00 | $34.19 – $518.42 | 19 |
| Lipoprotein direct measurement hdl CPT 83718 | $166.32 | $198.00 | $8.19 – $24.50 | 19 |
| Lipoprotein direct measurement ldl CPT 83721 | $186.48 | $222.00 | $10.50 – $28.42 | 19 |
| Lip surgery procedure CPT 40799 | $106.68 | $127.00 | $77.47 – $171.99 | 19 |
| Lithium therapeutic drug level CPT 80178 | $150.36 | $179.00 | $6.61 – $20.58 | 19 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | $2,745.96 | $3,269.00 | $1,994.09 – $4,426.88 | 19 |
| Liver Function Test CPT 80076 | $255.36 | $304.00 | $8.17 – $24.50 | 19 |
| Liver imaging CPT 78201 | $441.00 | $525.00 | $320.25 – $710.96 | 19 |
| Liver/spleen imag static only CPT 78215 | $877.80 | $1,045.00 | $637.45 – $1,415.14 | 19 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $593.04 | $706.00 | $430.66 – $956.07 | 19 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $83.58 | $99.50 | $60.70 – $134.75 | 19 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $3,116.40 | $3,710.00 | $2,263.10 – $5,024.09 | 19 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,830.80 | $3,370.00 | $2,055.70 – $4,563.66 | 19 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,639.28 | $3,142.00 | $1,916.62 – $4,254.90 | 19 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $4,349.52 | $5,178.00 | $3,158.58 – $7,012.05 | 19 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $3,918.60 | $4,665.00 | $2,845.65 – $6,317.35 | 19 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $3,918.60 | $4,665.00 | $1,903.01 – $6,317.35 | 19 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $424.20 | $505.00 | $45.75 – $101.57 | 19 |
| Lso flex no ri stays pre ots HCPCS L0628 | $520.36 | $619.47 | $62.44 – $138.61 | 19 |
| L/s ratio fetal lung CPT 83661 | $522.48 | $622.00 | $21.99 – $609.56 | 19 |
| Lung Function Test (Spirometry) CPT 94010 | $361.20 | $430.00 | $262.30 – $582.31 | 19 |
| Lung perfusion imaging CPT 78580 | $1,030.68 | $1,227.00 | $748.47 – $1,661.61 | 19 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $28,972.95 | $34,491.60 | $21,039.88 – $46,708.53 | 19 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $49,812.93 | $59,301.10 | $12,057.94 – $26,768.61 | 19 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $199,500.00 | $237,500.00 | $144,875.00 – $321,622.50 | 19 |
| Lymphatics/lymph node imaging CPT 78195 | $1,413.72 | $1,683.00 | $1,026.63 – $2,279.12 | 19 |
| Macroscopic exam arthropod CPT 87168 | $63.00 | $75.00 | $4.27 – $73.50 | 19 |
| Macroscopic exam parasite CPT 87169 | $66.36 | $79.00 | $4.31 – $77.42 | 19 |
| Magnesium CPT 83735 | $97.44 | $116.00 | $6.70 – $20.58 | 19 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $173.67 | $206.75 | $60.70 – $134.75 | 19 |
| Mammosite ced HCPCS C1728 | $8,454.60 | $10,065.00 | $100.95 – $224.10 | 19 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $73.92 | $88.00 | $53.68 – $119.17 | 19 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $126.00 | $150.00 | $91.50 – $203.13 | 19 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $83.58 | $99.50 | $60.70 – $134.75 | 19 |
| Manual diff wbc count b-coat CPT 85009 | $102.48 | $122.00 | $5.07 – $119.56 | 19 |
| Marker biop eviva buckle ss HCPCS A4648 | $5,292.00 | $6,300.00 | $0.58 – $1.29 | 19 |
| Mastectomy partial CPT 19301 | $3,715.32 | $4,423.00 | $1,087.63 – $2,414.54 | 19 |
| Mast mod rad CPT 19307 | $2,676.24 | $3,186.00 | $1,943.46 – $4,314.49 | 19 |
| Mastoids complete CPT 70130 | $359.52 | $428.00 | $261.08 – $579.60 | 19 |
| Mast radical CPT 19305 | $2,602.32 | $3,098.00 | $1,889.78 – $4,195.32 | 19 |
| Mast rad urban type CPT 19306 | $2,772.00 | $3,300.00 | $2,013.00 – $4,468.86 | 19 |
| Mast simple complete CPT 19303 | $2,167.20 | $2,580.00 | $1,573.80 – $3,493.84 | 19 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $8,058.96 | $9,594.00 | $465.43 – $1,033.26 | 19 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $258.72 | $308.00 | $14.46 – $301.84 | 19 |
| Mayo aathr protein s free CPT 85306 | $479.64 | $571.00 | $15.32 – $559.58 | 19 |
| Mayo activated protein c resistance assay CPT 85307 | $78.12 | $93.00 | $15.32 – $91.14 | 19 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $252.84 | $301.00 | $33.55 – $74.49 | 19 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $126.00 | $150.00 | $14.78 – $44.10 | 19 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $219.24 | $261.00 | $159.21 – $353.45 | 19 |
| Mayo alpha 1 antitrypsin CPT 82103 | $119.28 | $142.00 | $13.44 – $139.16 | 19 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $152.04 | $181.00 | $15.08 – $177.38 | 19 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $183.12 | $218.00 | $132.98 – $295.22 | 19 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $15.96 | $19.00 | $11.59 – $25.73 | 19 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $888.72 | $1,058.00 | $91.66 – $1,036.84 | 19 |
| Mayo androstenedione CPT 82157 | $243.60 | $290.00 | $29.28 – $284.20 | 19 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $170.52 | $203.00 | $14.60 – $198.94 | 19 |
| Mayo antithrombin iii antigen CPT 85301 | $231.84 | $276.00 | $10.81 – $270.48 | 19 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $136.08 | $162.00 | $15.05 – $158.76 | 19 |
| Mayo avwpr vw factor activity CPT 85397 | $278.04 | $331.00 | $30.86 – $324.38 | 19 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $208.32 | $248.00 | $151.28 – $335.85 | 19 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $84.00 | $100.00 | $10.18 – $98.00 | 19 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $165.48 | $197.00 | $12.90 – $193.06 | 19 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $148.68 | $177.00 | $13.19 – $173.46 | 19 |
| Mayo brcmg brucella antibody igm CPT 86622 | $104.16 | $124.00 | $8.93 – $121.52 | 19 |
| Mayo c1 esterase inhibitor CPT 83883 | $159.60 | $190.00 | $13.60 – $186.20 | 19 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $214.20 | $255.00 | $155.55 – $345.33 | 19 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $140.28 | $167.00 | $16.87 – $163.66 | 19 |
| Mayo ceruloplasmin CPT 82390 | $121.80 | $145.00 | $10.74 – $142.10 | 19 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $231.84 | $276.00 | $14.12 – $84.28 | 19 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $196.56 | $234.00 | $12.88 – $39.20 | 19 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $94.08 | $112.00 | $11.82 – $109.76 | 19 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $105.00 | $125.00 | $12.35 – $28.15 | 19 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $698.88 | $832.00 | $116.49 – $815.36 | 19 |
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.