Visits & medical services prices at CHI Health Good Samaritan

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $176.29 $289 0.8×
Analyze neurostim no prog (95970) $118.95 $195 0.9×
Appl on-body injector for timed subq injection (96377) $165.31 $271 3.4×
Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $142.13 $233 3.8×
Behavior id support assmt by 1 tech ea 15 min (97152) $206.18 $338 2.0×
Behavioral and qualitative analysis of voice and resonance (92524) $297.68 $488 2.7×
Biofeedback training any modality (90901) $122 $200 3.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $563.64 $924 1.5×
Car seat/bed test 60 min (94780) $220.21 $361 5.7×
Cardiac Stress Tst,Tracing Only (93017) $1,164.49 $1,909 5.2×
Cardiopulmonary resuscitation (92950) $852.78 $1,398 3.8×
Cardioversion (92960) $1,811.70 $2,970 2.6×
Cath Cath Place/Coronary Angio, Img Super/Interp, Bypass Angio (93455) $10,335.23 $16,943 3.1×
Cath Cath Place/Coronary Angio, Img Super/Interp,W Right Heart Cath (93456) $15,698.96 $25,736 4.7×
Cath Place/Coron Angio, Img Super/Interp, Bypass Angio,W L Hrt Ventric (93459) $16,954.95 $27,795 5.0×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $15,698.96 $25,736 4.7×
Cbt 1st hour (94644) $283.04 $464 2.0×
Chemo Hormon Antineopl Sq/Im (96402) $157.38 $258 2.1×
Chemo IV push addl drug (96411) $278.16 $456 3.7×
Chemo Iv Push Sngl Drug (96409) $439.20 $720 1.3×
Chemo prolong 8+ hrs infuse w/pump (96416) $667.95 $1,095 1.9×
Chemother, IV infusion, 1 hr (96413) $1,094.95 $1,795 3.2×
Chemother, IV infusion, ea add hr (96415) $161.04 $264 2.2×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $153.11 $251 2.0×
Chemotx Admn Cns Req Spinal Puncture (96450) $831.43 $1,363 2.4×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $417.54 $684.50 5.6×
Color/duplex Doppler, complete (93975) $932.69 $1,529 3.8×
Color/duplex Doppler, limited (93976) $550.22 $902 5.1×
Coronary artery angio s&i (93454) $11,879.75 $19,475 3.5×
Cpap initiation and management (94660) $733.83 $1,203 3.2×
Cpt initial (94667) $214.72 $352 1.6×
Critical care (99291) $1,715.93 $2,813 2.0×
Debridement Open Wound 20 Sq Cm< (97597) $292.19 $479 1.4×
Demo &/or eval,pt use,aerosol device (94664) $146.40 $240 0.6×
Dialysis other/than hemodialysis 1 phys/qhp eval (90945) $2,342.40 $3,840 5.4×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $522.16 $856 2.1×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $410.53 $673 3.8×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,053.47 $1,727 4.3×
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $927.20 $1,520 8.5×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $794.22 $1,302 3.2×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $397.11 $651 3.7×
Dup-scan xtr veins unilateral/limited study (93971) $1,216.34 $1,994 11.2×
Duplex hemodialysis access (93990) $461.16 $756 4.2×
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $1,319.43 $2,163 5.3×
Duplex scan artl infl&ven o/f hemo compl uni std (93986) $880.84 $1,444 8.1×
Duplex scan extracranial art compl bi study (93880) $1,160.22 $1,902 4.7×
Echo Heart Xthoracic,Limited (93308) $803.98 $1,318 3.2×
Echo transesophageal (93312) $1,923.94 $3,154 3.4×
Echo Transthoracic - Congenital Tte Complete (93303) $1,625.04 $2,664 2.9×
EEG awake asleep (95819) $921.71 $1,511 4.1×
EEG awake drowsy (95816) $857.05 $1,405 3.8×
EEG coma or sleep only (95822) $791.78 $1,298 3.5×
Eeg Extended Monitoring 61-119 Minutes (95813) $1,276.73 $2,093 5.7×
Eeg W/O Vid 2-12 Hr Unmntr (95705) $964.41 $1,581 4.3×
EEG w/o vid by tech ea incr 12-26hr unmonitored (95708) $2,094.13 $3,433 5.4×
EKG (93005) $297.68 $488 4.9×
EKG rhythm strip (93041) $98.82 $162 1.6×
Ekg Signal Averaging (93278) $331.84 $544 5.4×
Elec alys implt cplx cn npgt prgrmg (95977) $90.28 $148 0.9×
Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) $35.38 $58 0.9×
Electroencephalogram Extend Monitoring 41-60 Min (95812) $1,140.09 $1,869 5.1×
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $2,442.44 $4,004 1.9×
Er level 1 (99281) $211.06 $346 2.4×
Er level ii (99282) $331.84 $544 2.1×
Er level iii (99283) $588.04 $964 2.1×
Er level IV (99284) $1,009.55 $1,655 2.3×
Er level v (99285) $1,491.45 $2,445 2.4×
Evaluation of speech fluency (92521) $123.22 $202 0.9×
Evaluation of speech sound production (92522) $180.56 $296 1.6×
Evaluation of swallowing function (92610) $222.04 $364 2.6×
Evoked auditory test,limited (92587) $150.67 $247 0.7×
Exercise tst brncspsm (94617) $370.27 $607 2.7×
External ECG rec>48hr<7d recording (93242) $671.61 $1,101 17.3×
External ECG rec>48hr<7d scanning alys w/report (93243) $1,162.05 $1,905 8.4×
External ECG rec>7d<15d recording (93246) $671.61 $1,101 17.3×
External ECG rec>7d<15d scanning alys w/report (93247) $1,162.05 $1,905 8.4×
External Ecg Scanning Analysis Report (93226) $493.49 $809 8.1×
Group Therapeutic Procedures (97150) $72.59 $119 4.0×
Holter Monitor Recording (93225) $493.49 $809 3.6×
Icd Device Interrogate (93289) $64.66 $106 1.7×
Imaging of colon using capsule endoscope, with interpretation and report (91113) $1,726.91 $2,831 1.8×
Img Retina Detcj/Mntr Ds Rem Phys/Qhp I&R Uni/Bi (92228) $66.49 $109 1.7×
Imm Admn Sarscov2 Vaccine Single Dose (90480) $44.53 $73 1.1×
Immunization Admin (90471) $52.46 $86 0.7×
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $313.54 $514 0.8×
Ins swan ganz bedside (93503) $1,862.94 $3,054 1.1×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $153.11 $251 2.5×
IV infusion hydration each additional hour (96361) $129.93 $213 2.7×
IV infusion hydration initial 31 min-1 hour (96360) $470.31 $771 2.1×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $154.94 $254 2.1×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $612.44 $1,004 2.8×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $117.73 $193 2.4×
IV push initial (96374) $464.82 $762 2.1×
Liver elastography w/o imag w/i&r (91200) $286.70 $470 2.1×
Low frequency non-thermal us (97610) $265.35 $435 1.3×
Maintenance of spinal canal or brain drug infusion pump (95990) $525.82 $862 1.5×
Manual therapy 15 min (97140) $69.54 $114 2.5×
Massage 15 min (97124) $53.68 $88 1.8×
Maximum voluntary ventilation (94200) $220.21 $361 3.6×
Mechanical traction (97012) $121.39 $199 8.5×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $43.31 $71 1.4×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $53.68 $88 1.5×
Methacholine challenge (94070) $1,240.13 $2,033 3.2×
Mnt Group Ea 30 Min (97804) $56.73 $93 3.3×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $395.28 $648 4.3×
Multiple sleep latency test (95805) $3,075.01 $5,041 3.4×
Neg press wnd tx </=50 sq cm (97607) $342.52 $561.50 0.8×
Neg press wound tx >50 cm (97608) $373.93 $613 0.9×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $276.94 $454 1.3×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $367.22 $602 0.9×
Nerve conduction studies 13/> studies (95913) $533.75 $875 1.4×
Nerve Conduction Studies 3-4 Studies (95908) $533.75 $875 2.4×
Nerve Conduction Studies 9-10 Studies (95911) $533.75 $875 1.4×
Nerve conduction studies; 1-2 studies (95907) $533.75 $875 2.4×
Nerve conduction studies; 11-12 studies (95912) $533.75 $875 1.4×
Nerve conduction studies; 5-6 studies (95909) $533.75 $875 2.4×
Nerve conduction studies; 7-8 studies (95910) $533.75 $875 1.4×
Newborn resuscitation (99465) $745.42 $1,222 1.1×
Nitric oxide expired gas determination (95012) $139.69 $229 3.6×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $479.46 $786 3.5×
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $944.89 $1,549 4.2×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $295.24 $484 2.2×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $61 $100 1.3×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $57.95 $95 1.8×
Ot eval high complex 60 min (97167) $225.70 $370 2.2×
Ot eval low complex 30 min (97165) $225.70 $370 2.2×
Ot eval mod complex 45 min (97166) $225.70 $370 2.2×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $56.12 $92 1.1×
Ot Prosthetic Training, Each 15 Min (97761) $65.88 $108 1.6×
Ot re-eval est plan care (97168) $78.69 $129 1.1×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $320.25 $525 2.4×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $304.39 $499 2.3×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $154.33 $253 0.7×
Peripheral arterial disease rehab per session (93668) $187.27 $307 3.1×
Phy/qhp op pulm rhb w/mntr (94626) $188.49 $309 3.1×
Phy/qhp op pulm rhb w/o mntr (94625) $188.49 $309 3.1×
Plethysmography (94726) $655.14 $1,074 1.7×
Pm device eval in person (93288) $42.70 $70 1.1×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,486.15 $5,715 3.9×
Prq card revasc chronic 1vsl (92943) $9,690.46 $15,886 0.8×
Prq Card Stent W/Angio 1 Vsl (92928) $16,707.90 $27,390 1.4×
Prq Card Stent/Ath/Angio (92933) $19,214.39 $31,499 1.0×
Prq revasc byp graft 1 vsl (92937) $11,862.67 $19,447 1.0×
Prq trluml coronary angio/atherect one art/brnch (92924) $20,383.76 $33,416 1.7×
Prq trluml coronary angioplasty one art/branch (92920) $3,341.58 $5,478 0.6×
Psychiatric diagnostic evaluation (90791) $185.44 $304 1.0×
Pt Electric Current Therapy (97033) $70.76 $116 3.7×
Pt Electrical Stimulation (97032) $56.12 $92 3.8×
Pt eval high complex 45 min (97163) $200.08 $328 2.0×
Pt eval low complex 20 min (97161) $200.08 $328 2.0×
Pt Gait Training Therapy (97116) $71.98 $118 2.5×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $64.66 $106 2.0×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $200.08 $328 2.0×
Pt re-evaluation (97164) $78.08 $128 1.2×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $88.45 $145 2.7×
Pt Ultrasound Therapy (97035) $49.41 $81 3.4×
Pt Whirlpool Therapy (97022) $54.90 $90 3.5×
Pulm function test by gas (94727) $294.63 $483 1.3×
Pulmonary stress testing (94618) $444.69 $729 3.2×
R & l hrt cath w/njx l ventriculog img s&i (93453) $12,633.71 $20,711 3.8×
R & L Hrt Cath Winjx Hrt Art& L Ventr Img (93460) $19,623.70 $32,170 5.8×
R hrt art/grft angio (93457) $12,716.06 $20,846 3.8×
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $20,722.31 $33,971 6.2×
Refill/maint, portable pump (96521) $508.74 $834 2.3×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $328.79 $539 8.5×
Right heart cath (93451) $8,257.57 $13,537 2.5×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $136.64 $224 0.7×
Rom meas&reprt hand w/wo comparison normal sid (95852) $93.94 $154 4.4×
Rt Chest Wall Manipulation,Subsequent (94668) $218.99 $359 1.6×
Sc Ther Infusion Reset Pump (96371) $89.06 $146 1.2×
Sleep study unattended (95806) $373.32 $612 1.7×
Speech group therapy (92508) $42.70 $70 1.8×
Speech sound lang comprehen (92523) $269.62 $442 1.2×
Spirometry (94010) $258.03 $423 1.2×
Standardized Cognitive Performance Testing (96125) $165.92 $272 1.6×
Stress echo (93350) $1,794.01 $2,941 3.2×
Stress Tte Complete (93351) $1,559.77 $2,557 2.7×
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $84.79 $139 1.7×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $333.06 $546 1.5×
Surfactant Admin Thru Tube (94610) $117.73 $193 0.5×
Temp transcutaneous pacing (92953) $533.75 $875 0.8×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $86.01 $141 3.8×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $86.01 $141 4.1×
Ther/Proph/Diag Inj Sc/Im (96372) $215.94 $354 2.9×
Therapeutic Activities (97530) $89.06 $146 2.5×
Therapeutic phlebotomy (99195) $247.05 $405 1.8×
Transcran Doppler Intracran Art - Transcranial Doppler (93886) $616.10 $1,010 2.5×
Transcranial Doppler Limited (93888) $322.69 $529 3.0×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $2,282.62 $3,742 4.0×
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $2,023.98 $3,318 8.2×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $252.54 $414 3.3×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $222.04 $364 2.6×
Tx/Pro/Dx Inj New Drug Addon (96375) $183 $300 3.8×
Unlisted Cardiovascular Service/Procedure (93799) $2,182.58 $3,578 16.3×
Unlisted pulmonary service/procedure (94799) $107.97 $177 0.8×
Vasc Duplex Extrem Venous,Bilat (93970) $1,265.75 $2,075 5.1×
Vasc Duplex Scan Extracranial,Limited (93882) $336.72 $552 3.1×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $1,002.23 $1,643 4.5×
Ventilation assist & mgmt inpatient 1st day (94002) $1,224.88 $2,008 1.9×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $914.39 $1,499 1.4×
Vital capacity total (94150) $63.44 $104 0.5×
Wheelchair Mgmt Ea 15 Min (97542) $48.19 $79 1.6×