Ogallala Community Hospital
2601 N Spruce Street, Ogallala, NE · Banner Health · · NPI 1710915467
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 |
|---|---|---|---|---|
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,430.03 | $2,170.00 | $954.80 – $2,104.90 | 13 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,144.02 | $1,736.00 | $763.84 – $1,683.92 | 13 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $269.25 | $375.00 | $165.00 – $363.75 | 13 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $602.40 | $839.00 | $369.16 – $813.83 | 13 |
| Lower Back (Lumbar Spine) X-ray (with bending views) CPT 72114 | $611.74 | $852.00 | $374.88 – $826.44 | 13 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $190.99 | $266.00 | $117.04 – $258.02 | 13 |
| Low frequency non-thermal Ultrasound CPT 97610 | $190.50 | $300.00 | $132.00 – $291.00 | 13 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $370.40 | $587.00 | $258.28 – $569.39 | 13 |
| Lung function test (mbc/mvv) CPT 94200 | $110.42 | $175.00 | $77.00 – $169.75 | 13 |
| Lung Function Test (Spirometry) CPT 94010 | $290.89 | $461.00 | $202.84 – $447.17 | 13 |
| Lung perfusion imaging CPT 78580 | $734.34 | $1,151.00 | $506.44 – $1,116.47 | 13 |
| Lymphatics/lymph node imaging CPT 78195 | $1,081.41 | $1,695.00 | $745.80 – $1,644.15 | 13 |
| Macroscopic exam arthropod CPT 87168 | $8.93 | $13.00 | $5.72 – $12.61 | 13 |
| Macroscopic exam parasite CPT 87169 | $39.85 | $58.00 | $25.52 – $56.26 | 13 |
| Magnesium CPT 83735 | $53.94 | $88.00 | $9.24 – $20.37 | 13 |
| Magnetic image bone marrow CPT 77084 | $1,635.86 | $2,347.00 | $1,032.68 – $2,276.59 | 13 |
| Mammosite ced HCPCS C1728 | $9,240.18 | $13,895.00 | $6,113.80 – $13,478.15 | 13 |
| Marker biop eviva buckle ss HCPCS A4648 | $2,231.08 | $3,355.00 | $137.72 – $303.61 | 13 |
| Mastoids complete CPT 70130 | $235.50 | $328.00 | $144.32 – $318.16 | 13 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $73.22 | $110.10 | $48.44 – $106.80 | 13 |
| M.avium-intra dna amp prob CPT 87561 | $185.49 | $270.00 | $118.80 – $261.90 | 13 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $38.62 | $63.00 | $27.72 – $61.11 | 13 |
| Mayo aathr protein s free CPT 85306 | $39.73 | $66.00 | $26.40 – $58.20 | 13 |
| Mayo activated protein c resistance assay CPT 85307 | $39.73 | $66.00 | $29.04 – $64.02 | 13 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $96.85 | $158.00 | $48.40 – $106.70 | 13 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $82.14 | $134.00 | $26.84 – $59.17 | 13 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $34.94 | $57.00 | $25.08 – $55.29 | 13 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $74.17 | $121.00 | $53.24 – $117.37 | 13 |
| Mayo alpha 1 antitrypsin CPT 82103 | $36.17 | $59.00 | $18.04 – $39.77 | 13 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $38.01 | $62.00 | $25.96 – $57.23 | 13 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $42.91 | $70.00 | $24.64 – $54.32 | 13 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $269.00 | $365.00 | $160.60 – $354.05 | 13 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $202.67 | $275.00 | $121.00 – $266.75 | 13 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $2,564.76 | $3,480.00 | $1,531.20 – $3,375.60 | 13 |
| Mayo androstenedione CPT 82157 | $53.94 | $88.00 | $38.72 – $85.36 | 13 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $37.39 | $61.00 | $26.84 – $59.17 | 13 |
| Mayo antithrombin iii antigen CPT 85301 | $41.54 | $69.00 | $30.36 – $66.93 | 13 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $42.24 | $55.00 | $24.20 – $53.35 | 13 |
| Mayo avwpr vw factor activity CPT 85397 | $98.73 | $164.00 | $72.16 – $159.08 | 13 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $96.85 | $158.00 | $24.64 – $54.32 | 13 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $47.62 | $62.00 | $27.28 – $60.14 | 13 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $320.59 | $435.00 | $191.40 – $421.95 | 13 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $474.63 | $644.00 | $283.36 – $624.68 | 13 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $59.90 | $78.00 | $34.32 – $75.66 | 13 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $34.33 | $56.00 | $24.64 – $54.32 | 13 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $53.76 | $70.00 | $30.80 – $67.90 | 13 |
| Mayo brcmg brucella antibody igm CPT 86622 | $51.46 | $67.00 | $29.48 – $64.99 | 13 |
| Mayo c1 esterase inhibitor CPT 83883 | $44.14 | $72.00 | $24.20 – $53.35 | 13 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $51.49 | $84.00 | $24.64 – $54.32 | 13 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $70.50 | $115.00 | $22.44 – $49.47 | 13 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $71.42 | $93.00 | $40.92 – $90.21 | 13 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $270.48 | $367.00 | $161.48 – $355.99 | 13 |
| Mayo ceruloplasmin CPT 82390 | $32.49 | $53.00 | $23.32 – $51.41 | 13 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $42.91 | $70.00 | $30.80 – $67.90 | 13 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $78.34 | $102.00 | $28.60 – $63.05 | 13 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $62.21 | $81.00 | $26.84 – $59.17 | 13 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $46.85 | $61.00 | $26.84 – $59.17 | 13 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $197.75 | $350.00 | $154.00 – $339.50 | 13 |
| Mayo chromium CPT 82495 | $37.39 | $61.00 | $26.84 – $59.17 | 13 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | $91.34 | $149.00 | $24.64 – $54.32 | 13 |
| Mayo coccidioides antibody CPT 86635 | $50.69 | $66.00 | $24.20 – $53.35 | 13 |
| Mayo cocou cortisone urine CPT 82542 | $557.22 | $909.00 | $32.12 – $70.81 | 13 |
| Mayo cortisol free CPT 82530 | $33.71 | $55.00 | $24.20 – $53.35 | 13 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $97.54 | $127.00 | $55.88 – $123.19 | 13 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $43.78 | $57.00 | $25.08 – $55.29 | 13 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $30.72 | $40.00 | $17.60 – $38.80 | 13 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $46.59 | $76.00 | $33.44 – $73.72 | 13 |
| Mayo dihydrotestosterone CPT 82642 | $53.94 | $88.00 | $38.72 – $85.36 | 13 |
| Mayo efpo chloride stool CPT 82438 | $35.55 | $58.00 | $6.60 – $14.55 | 13 |
| Mayo estriol CPT 82677 | $44.75 | $73.00 | $32.12 – $70.81 | 13 |
| Mayo estrone CPT 82679 | $45.98 | $75.00 | $33.00 – $72.75 | 13 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $65.59 | $107.00 | $47.08 – $103.79 | 13 |
| Mayo everolimus therapeutic drug level CPT 80169 | $36.78 | $60.00 | $26.40 – $58.20 | 13 |
| Mayo factor ii CPT 85210 | $38.53 | $64.00 | $28.16 – $62.08 | 13 |
| Mayo factor v CPT 85220 | $45.15 | $75.00 | $33.00 – $72.75 | 13 |
| Mayo factor vii CPT 85230 | $45.75 | $76.00 | $33.44 – $73.72 | 13 |
| Mayo factor viii vw factor antigen CPT 85246 | $44.55 | $74.00 | $32.56 – $71.78 | 13 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $41.54 | $69.00 | $30.36 – $66.93 | 13 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $52.37 | $87.00 | $32.56 – $71.78 | 13 |
| Mayo factor x CPT 85260 | $45.75 | $76.00 | $33.44 – $73.72 | 13 |
| Mayo factor xi CPT 85270 | $45.75 | $76.00 | $33.44 – $73.72 | 13 |
| Mayo fat/lipids feces quantitative CPT 82710 | $31.26 | $51.00 | $22.44 – $49.47 | 13 |
| Mayo fbl culture fungi blood CPT 87103 | $47.40 | $69.00 | $30.36 – $66.93 | 13 |
| Mayo ffspg allergen clam igg CPT 86001 | $83.71 | $109.00 | $47.96 – $105.73 | 13 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $47.20 | $77.00 | $33.88 – $74.69 | 13 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $221.10 | $300.00 | $22.44 – $49.47 | 13 |
| Mayo hemosiderin qualitative urine CPT 83070 | $31.88 | $52.00 | $22.88 – $50.44 | 13 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $74.20 | $108.00 | $47.52 – $104.76 | 13 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | $83.81 | $122.00 | $53.68 – $118.34 | 13 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $52.22 | $68.00 | $27.72 – $61.11 | 13 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $59.90 | $78.00 | $34.32 – $75.66 | 13 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $58.37 | $76.00 | $33.44 – $73.72 | 13 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $66.82 | $87.00 | $38.28 – $84.39 | 13 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $50.27 | $82.00 | $36.08 – $79.54 | 13 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $398.45 | $650.00 | $22.88 – $50.44 | 13 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $109.06 | $142.00 | $22.44 – $49.47 | 13 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $48.38 | $63.00 | $27.72 – $61.11 | 13 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $57.60 | $75.00 | $33.00 – $72.75 | 13 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $44.66 | $65.00 | $28.60 – $63.05 | 13 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $104.42 | $152.00 | $66.88 – $147.44 | 13 |
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.