Supplies, drugs & other prices at CHI Health Good Samaritan

Kearney, NE · every code in this section with a posted price and a Medicare benchmark.

63 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2d tee w or w/o fol w/con,in (C8925) $3,790.54 $6,214 4.7×
2d tte w or w/o fol w/con,fu (C8924) $1,396.29 $2,289 3.9×
Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) $5,256.98 $8,618 2.6×
Abltj perc cryoabltj img gdn nrv plex/trncl nrv (0442T) $5,256.98 $8,618 0.6×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $5,256.98 $8,618 2.6×
Adm tocilizu covid-19 1st (M0249) $294.02 $482 0.6×
Catheterize for urine spec (P9612) $126.27 $207 13.5×
Covid-19 lab test non-cdc (U0002) $100.65 $165 2.0×
Diab manage trn per indiv (G0108) $109.80 $180 2.0×
Diab manage trn ind/group (G0109) $53.07 $87 3.3×
Direct refer hospital observ (G0379) $153.11 $251 0.2×
Elec stim other than wound (G0283) $68.93 $113 5.4×
Ephys eval ccm-d ld 1st impl (0930T) $207.36 $339.92 0.2×
Ephys eval ccm-d ld separate (0931T) $207.36 $339.92 0.2×
Facility svs dental rehab (G0330) $2,068.51 $3,391 0.6×
Fecal blood scrn immunoassay (G0328) $76.86 $126 4.3×
Histotripsy mal hepatocellular tiss w/img gdn (0686T) $9,222.59 $15,119 0.5×
Inj for sacroiliac jt anesth (G0260) $783.24 $1,284 1.1×
Insertion perm ccm-d system pulse generator only (0916T) $19,169.05 $31,424.67 0.8×
Insj Perm Ccm-D Sys 1 Transvns Lead Only (0917T) $7,067.69 $11,586.37 0.8×
Insj Perm Ccm-D Sys Dual Transvns Leads Only (0918T) $7,067.69 $11,586.37 0.8×
Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) $27,380.59 $44,886.21 0.8×
Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) $25,498 $41,800 1.1×
Interrog dev eval impl ccm-d system in person (0927T) $6.37 $10.44 0.2×
Mra w/o cont, pelvis (C8919) $1,358.47 $2,227 5.5×
Mri w/cont, breast, bi (C8906) $2,827.96 $4,636 7.8×
Mri w/cont, breast, uni (C8903) $2,190.51 $3,591 12.0×
Mri w/o fol w/cont, breast, (C8908) $2,883.47 $4,727 8.0×
Mri w/o fol w/cont, brst, un (C8905) $2,440 $4,000 6.7×
N-invs det hrt fail aug echo (0932T) $51.24 $83.99 0.2×
Oth resp proc, group (G0239) $151.89 $249 3.9×
Oth resp proc, indiv (G0238) $98.21 $161 3.3×
Pemivibart infusion (M0224) $439.81 $721 1.0×
Perc d-e cor revasc chro sin (C9607) $11,194.72 $18,352 0.6×
Perc d-e cor revasc t cabg s (C9604) $16,207.09 $26,569 1.4×
Perc d-e cor stent ather s (C9602) $18,545.83 $30,403 1.0×
Perc drug-el cor stent sing (C9600) $16,707.90 $27,390 1.4×
Perq Sacral Augmt Bilat Inj (0201T) $9,076.19 $14,879 1.2×
Perq Sacral Augmt Unilat Inj (0200T) $6,527.61 $10,701 0.9×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T)
unusually low: confirm this is the full procedure
$4,869.10 $7,982.13 0.4×
Programming device eval impl ccm-d sys in person (0926T) $6.37 $10.44 0.2×
Prolonged iv inf, req pump (C8957) $354.41 $581 1.6×
Psa screening (G0103) $87.84 $144 4.5×
Quan CT tiss charac i&r w/cncrnt CT exam (0722T) $1,291.37 $2,117 2.0×
Quan CT tiss charac w/o CT (0721T) $1,291.37 $2,117 2.0×
Relocation skin pocket implanted ccm-d pg (0925T) $1,562.17 $2,560.92 0.7×
Removal perm ccm-d system pulse generator only (0919T) $3,107.97 $5,095.02 0.8×
Repositioning prev impl ccm-d transvns eltrd/ld (0924T) $528 $865.56 0.8×
Revasc intra lithotrip-ather (C9766) $22,444.95 $36,795 1.2×
Revasc intra lithotrip-stent (C9765) $23,647.87 $38,767 1.2×
Revasc lithotrip-stent-ather (C9767) $24,716.59 $40,519 1.3×
Rmvl Perm Ccm-D Sys 1 Transvns Dfb Lead Only (0921T) $3,107.97 $5,095.02 0.8×
Rmvl perm ccm-d sys 1 transvns pacing lead only (0920T) $3,107.97 $5,095.02 0.8×
Rmvl Perm Ccm-D Sys Dual Transvns Leads Only (0922T) $3,107.97 $5,095.02 0.8×
Rmvl&Rplcmt Permanent Ccm-D Pulse Generator Only (0923T) $19,169.05 $31,424.67 0.8×
Tcat Implt Wrls L Atr Prs Snr L-T L Atr Prs Mntr (0933T) $549.38 $900.61 0.2×
Therapeutic procd strg endur (G0237) $98.21 $161 3.3×
Trauma respons w/hosp criti (G0390) $3,922 $6,429.50 2.8×
Trluml peripheral atherectomy iliac artery ea (0238T) $18,709.92 $30,672 1.0×
Tte w or w/o contr, cont ecg (C8930) $2,214.30 $3,630 2.7×
Tte w or w/o fol w/con,stres (C8928) $2,214.30 $3,630 2.7×
Tte w or wo fol wcon,doppler (C8929) $2,168.55 $3,555 2.7×
Unsched dialysis esrd pt hos (G0257) $888.16 $1,456 1.2×