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 |
|---|---|---|---|---|
| Slp ther svc non-spch gen CPT 92606 | $89.99 | $106.00 | $46.64 – $102.82 | 13 |
| Small Bowel Barium X-ray (Follow-Through) CPT 74250 | $432.95 | $603.00 | $265.32 – $584.91 | 13 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $46.72 | $68.00 | $25.08 – $55.29 | 13 |
| Smear gram stain CPT 87205 | $59.42 | $91.00 | $4.27 – $12.61 | 13 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $12.37 | $18.00 | $7.92 – $17.46 | 13 |
| Smear wet mount CPT 87210 | $36.41 | $53.00 | $23.32 – $51.41 | 13 |
| Sodium 24 hour urine CPT 84300 | $44.14 | $72.00 | $7.04 – $15.52 | 13 |
| Sodium serum/plasma/whole blood CPT 84295 | $27.59 | $45.00 | $13.64 – $30.07 | 13 |
| Specific gravity body fluid CPT 84315 | $6.13 | $10.00 | $4.40 – $9.70 | 13 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $339.60 | $400.00 | $176.00 – $388.00 | 13 |
| Speech Therapy Session (one-on-one) CPT 92507 | $163.86 | $193.00 | $84.92 – $187.21 | 13 |
| Spine X-ray (single view, one level) CPT 72020 | $236.94 | $330.00 | $145.20 – $320.10 | 13 |
| Sputum specimen collection CPT 89220 | $224.63 | $344.00 | $16.71 – $333.68 | 13 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $322.62 | $380.00 | $167.20 – $368.60 | 13 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $217.34 | $256.00 | $112.64 – $248.32 | 13 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $29,129.66 | $43,804.00 | $261.36 – $576.18 | 13 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $6,161.23 | $9,265.00 | $73.04 – $161.02 | 13 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $23,304.26 | $35,044.00 | $261.36 – $576.18 | 13 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $6,161.23 | $9,265.00 | $621.72 – $1,370.61 | 13 |
| St evaluate speech sound production CPT 92522 | $236.87 | $279.00 | $122.76 – $270.63 | 13 |
| Stimulants synthetic CPT 80371 | $98.08 | $160.00 | $70.40 – $155.20 | 13 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $1,370.42 | $2,148.00 | $945.12 – $2,083.56 | 13 |
| Strep b dna amp probe CPT 87653 | $72.82 | $106.00 | $46.64 – $102.82 | 13 |
| Stress test pulmonary CPT 94618 | $364.72 | $578.00 | $254.32 – $560.66 | 13 |
| Str markers specimen anal CPT 81265 | $1,051.70 | $1,427.00 | $308.00 – $679.00 | 13 |
| Sulfonylurea screen qn-sendout CPT 80377 | $109.11 | $178.00 | $78.32 – $172.66 | 13 |
| Surgical pathology level 1 gross examination only CPT 88300 | $31.35 | $50.00 | $14.65 – $48.50 | 13 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $49.53 | $79.00 | $29.61 – $76.63 | 13 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $67.72 | $108.00 | $38.16 – $104.76 | 13 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $67.72 | $108.00 | $47.52 – $104.76 | 13 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $450.19 | $718.00 | $257.97 – $696.46 | 13 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,011.98 | $1,614.00 | $386.79 – $1,565.58 | 13 |
| Susceptibility agar dilution per agent CPT 87181 | $175.18 | $255.00 | $112.20 – $247.35 | 13 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $38.47 | $56.00 | $24.64 – $54.32 | 13 |
| Susceptibility mic per plate CPT 87186 | $130.60 | $200.00 | $8.65 – $25.22 | 13 |
| Suscept studies macrobroth dilution ea CPT 87188 | $39.85 | $58.00 | $25.52 – $56.26 | 13 |
| Swallowing Evaluation (Bedside) CPT 92610 | $136.30 | $233.00 | $102.52 – $226.01 | 13 |
| Swallowing Therapy Session CPT 92526 | $180.84 | $213.00 | $93.72 – $206.61 | 13 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $39.94 | $52.00 | $22.88 – $50.44 | 13 |
| System pacing micra av HCPCS C1786 | $20,115.26 | $35,044.00 | $7,708.80 – $16,994.40 | 13 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $62,855.30 | $109,504.00 | $7,708.80 – $16,994.40 | 13 |
| T3 (triiodothyronine) free CPT 84481 | $43.52 | $71.00 | $23.76 – $52.38 | 13 |
| T3 (triiodothyronine) total CPT 84480 | $26.36 | $43.00 | $18.92 – $41.71 | 13 |
| T4 (thyroxine) free CPT 84439 | $40.46 | $66.00 | $12.32 – $27.16 | 13 |
| T4 (thyroxine) total CPT 84436 | $34.33 | $56.00 | $24.64 – $54.32 | 13 |
| Tacrolimus therapeutic drug level CPT 80197 | $39.23 | $64.00 | $25.08 – $55.29 | 13 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $228.32 | $318.00 | $139.92 – $308.46 | 13 |
| Target gsa panel hmtlmph neop CPT 81450 | $1,765.12 | $2,395.00 | $1,002.76 – $2,210.63 | 13 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $6,455.38 | $8,759.00 | $3,853.96 – $8,496.23 | 13 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $230.40 | $300.00 | $132.00 – $291.00 | 13 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $142.85 | $186.00 | $81.84 – $180.42 | 13 |
| Tc-99m labeled rbc HCPCS A9560 | $289.54 | $467.00 | $205.48 – $452.99 | 13 |
| Tc-99m maa HCPCS A9540 | $149.42 | $241.00 | $106.04 – $233.77 | 13 |
| Tc-99m mebrofenin HCPCS A9537 | $168.02 | $271.00 | $119.24 – $262.87 | 13 |
| Tc-99m medronate HCPCS A9503 | $219.67 | $354.30 | $155.89 – $343.67 | 13 |
| Tc-99m pentetate dtpa HCPCS A9539 | $350.30 | $565.00 | $248.60 – $548.05 | 13 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $6.82 | $11.00 | $4.84 – $10.67 | 13 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $136.40 | $220.00 | $96.80 – $213.40 | 13 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $172.30 | $277.90 | $122.28 – $269.56 | 13 |
| Tc-99m sulfur colloid HCPCS A9541 | $150.04 | $242.00 | $106.48 – $234.74 | 13 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $108.29 | $141.00 | $62.04 – $136.77 | 13 |
| T cells total count CPT 86359 | $87.55 | $114.00 | $50.16 – $110.58 | 13 |
| Telehealth original site facility fee HCPCS Q3014 | $21.56 | $88.00 | $26.00 – $85.36 | 13 |
| Testicular imaging w/vasc flow CPT 78761 | $586.96 | $920.00 | $404.80 – $892.40 | 13 |
| Test stress cardiovascular tracing only CPT 93017 | $1,046.46 | $1,630.00 | $717.20 – $1,581.10 | 13 |
| Theophylline therapeutic drug level CPT 80198 | $26.36 | $43.00 | $18.92 – $41.71 | 13 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $60.33 | $95.00 | $41.80 – $92.15 | 13 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $80.64 | $127.00 | $55.88 – $123.19 | 13 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $36.85 | $49.00 | $21.56 – $47.53 | 13 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $34.59 | $46.00 | $20.24 – $44.62 | 13 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $198.17 | $276.00 | $121.44 – $267.72 | 13 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $189.51 | $349.00 | $102.52 – $226.01 | 13 |
| Thoracotomy w/expl CPT 32100 | $917.13 | $1,689.00 | $743.16 – $1,638.33 | 13 |
| Three-Phase Bone Scan (Nuclear Medicine) CPT 78315 | $1,769.17 | $2,773.00 | $1,220.12 – $2,689.81 | 13 |
| Thrombin time CPT 85670 | $33.71 | $56.00 | $7.92 – $17.46 | 13 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $62.01 | $103.00 | $45.32 – $99.91 | 13 |
| Thyroglobulin antibody CPT 86800 | $73.73 | $96.00 | $25.08 – $55.29 | 13 |
| Thyroid imaging CPT 78013 | $620.14 | $972.00 | $427.68 – $942.84 | 13 |
| Thyroid mets imag whole body CPT 78018 | $1,419.55 | $2,225.00 | $979.00 – $2,158.25 | 13 |
| Thyroid (TSH) Test CPT 84443 | $68.04 | $111.00 | $48.84 – $107.67 | 13 |
| Thyroid Ultrasound CPT 76536 | $788.56 | $931.00 | $409.64 – $903.07 | 13 |
| Thyroid uptake measurement CPT 78012 | $386.63 | $606.00 | $266.64 – $587.82 | 13 |
| Thyroxine binding globulin (tbg) CPT 84442 | $27.59 | $45.00 | $19.80 – $43.65 | 13 |
| Tilt table study CPT 93660 | $900.32 | $1,655.00 | $728.20 – $1,605.35 | 13 |
| Tissue culture skin/biopsy CPT 88233 | $238.99 | $423.00 | $186.12 – $410.31 | 13 |
| Tissue exam koh skin/hair/nails CPT 87220 | $147.71 | $215.00 | $28.16 – $62.08 | 13 |
| Tissue transglutaminase iga CPT 86364 | $45.31 | $59.00 | $15.40 – $33.95 | 13 |
| Tobramycin peak therapeutic drug level CPT 80200 | $30.04 | $49.00 | $21.56 – $47.53 | 13 |
| Toe X-ray (both feet) CPT 73660 | $184.53 | $257.00 | $113.08 – $249.29 | 13 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $43.79 | $56.00 | $24.64 – $54.32 | 13 |
| Tomosynthesis breast screen bilateral CPT 77063 | $38.47 | $49.00 | $21.56 – $47.53 | 13 |
| Tonsillectomy (age 12+) CPT 42826 | $235.04 | $520.00 | $228.80 – $504.40 | 13 |
| Tonsillectomy (child under 12) CPT 42825 | $245.44 | $543.00 | $238.92 – $526.71 | 13 |
| Total tau CPT 84394 | $276.46 | $451.00 | $198.44 – $437.47 | 13 |
| Toxoplasma antibody igg CPT 86777 | $48.38 | $63.00 | $26.40 – $58.20 | 13 |
| Toxoplasma antibody igm CPT 86778 | $46.08 | $60.00 | $19.36 – $42.68 | 13 |
| Tpmt gene com vrnts CPT 81335 | $386.92 | $525.00 | $231.00 – $509.25 | 13 |
| Tracheobrnchsc thru est trachs incisn CPT 31615 | $107.12 | $237.00 | $104.28 – $229.89 | 13 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $102.27 | $136.00 | $59.84 – $131.92 | 13 |
| Transferrin CPT 84466 | $23.91 | $39.00 | $17.16 – $37.83 | 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.