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.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × 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× |
| Electrophysiologic eval ccm-d leads at 1st impl (0930T) | $207.36 | $339.92 | 0.2× |
| Electrophysiologic eval ccm-d leads 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) range across 2 matching MRF lines |
$771.04–$795.44 | $1,264–$1,304 | varies |
| 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-Invas Detcj Heart Failure Drv Augmnt Alys 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) range across 6 matching MRF lines |
$1,081.53–$6,083.53 | $1,773–$9,973 | varies |
| Trluml Perip Athrc Iliac Art (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× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.