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Chi Health St Mary's

1301 Grundman Blvd, Nebraska City, NE 68410 · (402) 873-3321

Critical Access HospitalsVoluntary non-profit - ChurchCMS rating 4/5

Price file

Prices published

File dated 2026-02-28

4,120 price rows for 51 procedures

Published prices

cash · negotiated range · list
Basic metabolic panel (blood test)

CPT 80048 · lowest of 4 lines

$24
cash
$5,104
cash
CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines

$1,908
cash
CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines

$2,643
cash
—
cash
Chlamydia test (DNA)

CPT 87491 · lowest of 2 lines

$148
cash
Colonoscopy (diagnostic)

CPT 45378 · lowest of 2 lines

$623
cash
Colonoscopy with biopsy

CPT 45380 · lowest of 2 lines

$1,045
cash
Colonoscopy with polyp removal

CPT 45385 · lowest of 2 lines

$1,087
cash
Complete blood count (CBC) with differential

CPT 85025 · lowest of 4 lines

$12
cash
Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 4 lines

$29
cash
Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 2 lines

$358
cash
$368
cash
Gallbladder removal (laparoscopic)

CPT 47562 · lowest of 2 lines

$1,477
cash
Gonorrhea test (DNA)

CPT 87591 · lowest of 2 lines

$148
cash
—
cash
—
cash
—
cash
Inguinal hernia repair (age 5 and up)

CPT 49505 · lowest of 2 lines

$1,174
cash
Lipid panel (cholesterol test)

CPT 80061 · lowest of 6 lines

$7
cash
Liver function panel

CPT 80076 · lowest of 4 lines

$23
cash
MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines

$4,014
cash
$2,491
cash
$3,117
cash
MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines

$3,349
cash
—
cash
$586
cash
New patient office visit (about 30 minutes)

CPT 99203 · lowest of 4 lines

$261
cash
New patient office visit (about 45 minutes)

CPT 99204 · lowest of 4 lines

$390
cash
New patient office visit (about 60 minutes)

CPT 99205 · lowest of 4 lines

$516
cash
PSA test (prostate)

CPT 84153 · lowest of 4 lines

$51
cash
$78
cash
$57
cash
Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 4 lines

$828
cash
Prostate biopsy

CPT 55700 · lowest of 2 lines

$786
cash
Prothrombin time (blood clotting test)

CPT 85610 · lowest of 6 lines

$10
cash
Removal of a breast lump (biopsy by excision)

CPT 19120 · lowest of 2 lines

$1,180
cash
Screening mammogram (both breasts)

CPT 77067 · lowest of 2 lines

$412
cash
Shoulder arthroscopy with decompression

CPT 29826 · lowest of 2 lines

$865
cash
Sleep study (overnight, attended)

CPT 95810 · lowest of 2 lines

$3,563
cash
—
cash
$290
cash
$403
cash
TSH test (thyroid)

CPT 84443 · lowest of 4 lines

$46
cash
Transvaginal ultrasound

CPT 76830 · lowest of 2 lines

$647
cash
Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines

$887
cash
Upper endoscopy (EGD)

CPT 43235 · lowest of 4 lines

$713
cash
Upper endoscopy with biopsy

CPT 43239 · lowest of 4 lines

$913
cash
Urinalysis with microscope

CPT 81001 · lowest of 6 lines

$8
cash
—
cash
X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 4 lines

$119
cash

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.