Jacobson Memorial Hospital Care Center — procedure prices

Published prices for 182 procedures at Jacobson Memorial Hospital Care Center (Elgin, ND), from its machine-readable file.

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ProcedureCashChargemasterInsurerMedicare
3D mammogram (tomosynthesis) $102 $136 $129 $51
Abdominal ultrasound $327 $436 $379 $100
Abscess incision and drainage $428 $571 $487 $174
Albumin blood test $26 $35 $33 $5
Aldosterone test $215 $287 $272 $41
Alkaline phosphatase test $28 $37 $35 $5
Allergy shots $34 $46 $41 $11
Alpha-fetoprotein (AFP) test $89 $119 $113 $17
ALT liver enzyme test $29 $38 $36 $5
Ammonia blood test $77 $102 $97 $15
Amylase test $34 $45 $43 $6
Antinuclear antibody (ANA) test $64 $85 $81 $12
Arterial blood gas (ABG) $130 $173 $164 $26
AST liver enzyme test $28 $37 $35 $5
Basic metabolic panel $63 $85 $80 $8
Benign skin lesion removal $932 $1,242 $1,118 $171
Bilirubin blood test $26 $35 $33 $5
Blood clotting test (PT/INR) $25 $33 $33 $4
Blood crossmatch $194 $259 $246 —
Blood glucose test $24 $32 $29 $5
Blood transfusion $3,327 $4,436 $4,214 $47
Blood type and screen $265 $353 $335 $10
Blood type test $16 $21 $20 $3
BNP (heart failure) test $247 $330 $288 $39
Bone density scan (DEXA) $195 $260 $247 $39
Breast ultrasound $257 $342 $297 $92
Breathing tube insertion (intubation) $309 $412 $391 $133
Burn treatment $271 $361 $343 $129
C-reactive protein (CRP) $28 $37 $35 $5
CA 19-9 tumor marker test $110 $146 $139 $21
CA-125 ovarian marker test $110 $146 $139 $21
Calcium blood test $28 $37 $35 $5
Cardiac rehabilitation $85 $113 $107 $26
Cardioversion $528 $704 $669 $155
Carotid artery ultrasound $714 $952 $904 $156
CEA tumor marker test $101 $134 $127 $19
Celiac disease test $23 $31 $29 $12
Central line placement $4,889 $6,519 $6,193 $238
Chest fluid drain (thoracentesis) $793 $1,057 $1,004 $311
Chest tube insertion $2,002 $2,669 $2,536 $143
Chest X-ray $94 $125 $107 $37
Clotting time test (PTT) $32 $42 $40 $6
Complete blood count (CBC) $46 $61 $55 $7
Comprehensive metabolic panel $79 $106 $100 $11
Continuous glucose monitor setup $40 $53 $50 $35
Contraceptive implant (Nexplanon) $168 $224 $213 $115
Copper blood test $65 $87 $84 $12
Cortisol test $86 $115 $109 $16
COVID-19 PCR test $134 $178 $169 $51
Creatine kinase (CK) test $34 $45 $43 $7
CT angiography of the chest $1,900 $2,533 $2,407 $281
CT angiography of the head $2,006 $2,675 $2,541 $274
CT scan of the abdomen $1,478 $1,971 $1,738 $230
CT scan of the abdomen and pelvis $2,164 $2,885 $2,541 $300
CT scan of the arm $1,274 $1,699 $1,600 $199
CT scan of the chest $1,317 $1,756 $1,543 $167
CT scan of the head $843 $1,124 $1,059 $148
CT scan of the leg $1,249 $1,665 $1,529 $166
CT scan of the lower back (lumbar spine) $1,241 $1,654 $1,509 $169
CT scan of the neck $1,138 $1,517 $1,386 $183
CT scan of the neck (cervical spine) $1,238 $1,651 $1,514 $168
CT scan of the pelvis $1,484 $1,979 $1,745 $226
CT scan of the sinuses $961 $1,281 $1,202 $152
D-dimer test $52 $69 $66 $10
DHEA-sulfate test $118 $157 $149 $22
Diagnostic mammogram $426 $569 $499 $140
Drug screen (urine) $75 $100 $95 $17
Echocardiogram $464 $619 $534 $138
Electrocardiogram (EKG) $56 $74 $71 $8
Electrolyte panel $37 $49 $47 $7
Emergency department visit $623 $831 $757 $69
Estradiol (estrogen) test $147 $196 $186 $28
Fecal occult blood (stool) test $84 $112 $106 $10
Ferritin (iron) test $71 $95 $90 $14
Fibrinogen test $48 $64 $61 $10
Flu test $83 $110 $105 $17
Folate (folic acid) test $77 $103 $98 $15
Foreign body removal (skin) $518 $690 $656 $157
Free T4 thyroid test $46 $61 $58 $9
FSH hormone test $98 $130 $124 $19
GGT liver test $38 $51 $48 $7
Glucose tolerance test $45 $60 $48 $8
Hematocrit test $13 $17 $16 $2
Hemoglobin A1c (diabetes test) $73 $97 $92 $10
Hepatitis B test $53 $70 $67 $10
Hepatitis C test $75 $100 $95 $14
HIV test $122 $163 $155 $19
Holter heart monitor $86 $114 $108 $26
Iron blood test $34 $45 $43 $6
IV infusion therapy $1,056 $1,408 $1,043 $44
Joint aspiration (small/intermediate) $407 $543 $516 $57
Kidney ultrasound $339 $452 $421 $84
Knee joint injection $407 $543 $516 $69
Lactate test $57 $76 $72 $12
LDH test $32 $43 $41 $6
LDL cholesterol test $55 $73 $69 $11
Leg vein ultrasound (Doppler) $644 $859 $745 $150
LH hormone test $98 $130 $124 $19
Lipase test $37 $49 $47 $7
Lipid (cholesterol) panel $100 $134 $127 $13
Liver function panel $44 $58 $55 $8
Magnesium blood test $37 $50 $45 $7
MRA of the brain $2,277 $3,036 $2,884 $226
MRA of the neck $1,839 $2,453 $2,208 $245
MRI of the abdomen $1,145 $1,527 $1,451 $300
MRI of the ankle $2,364 $3,152 $2,718 $261
MRI of the brain $2,000 $2,667 $2,197 $269
MRI of the chest $2,933 $3,911 $3,347 $371
MRI of the knee $2,263 $3,017 $2,578 $315
MRI of the lower back (lumbar spine) $2,142 $2,856 $2,446 $270
MRI of the mid-back (thoracic spine) $1,721 $2,294 $2,294 $271
MRI of the neck (cervical spine) $2,086 $2,782 $2,406 $274
MRI of the pelvis $2,380 $3,174 $2,762 $268
MRI of the shoulder $2,225 $2,967 $2,546 $313
MRI of the wrist $2,509 $3,346 $2,901 $330
Nebulizer breathing treatment $61 $81 $77 $9
Occupational therapy evaluation $316 $421 $394 $101
Pap smear (cervical screening) $123 $165 $143 $20
Parathyroid hormone (PTH) test $218 $290 $276 $41
Pelvic ultrasound $323 $431 $409 $78
Phosphorus blood test $26 $34 $32 $5
Physical therapy evaluation $293 $391 $368 $98
Platelet count $24 $32 $30 $4
Pregnancy blood test (hCG) $14 $19 $18 $8
Pregnancy ultrasound $339 $453 $400 $126
Procalcitonin test $142 $189 $180 $27
Prolactin test $102 $136 $129 $19
Prostate test (PSA) $97 $129 $123 $18
Scoliosis spine X-ray $175 $233 $208 $58
Screening mammogram $395 $527 $501 $126
Scrotal ultrasound $337 $449 $427 $99
Sedimentation rate (ESR) test $22 $29 $28 $3
Sex hormone binding globulin test $114 $152 $144 $22
Simple wound stitches $270 $360 $342 $127
Skin biopsy $518 $690 $625 $121
Skin cancer lesion removal $932 $1,242 $1,123 $240
Skin lesion freezing (cryotherapy) $137 $183 $113 $36
Skin tag removal $271 $361 $343 $92
Soft tissue ultrasound $135 $180 $171 $64
Speech therapy $261 $348 $331 $76
Strep throat test $83 $110 $105 $17
Swallow study $292 $389 $370 $85
T3 thyroid test $75 $100 $95 $14
Testosterone test $136 $181 $172 $26
Thyroid test (TSH) $126 $168 $160 $17
Thyroid ultrasound $362 $483 $459 $109
Total IgE allergy test $87 $116 $110 $16
Total protein test $19 $25 $24 $4
Transvaginal ultrasound $369 $492 $467 $118
Trigger point injection $407 $543 $516 $56
Triglycerides test $31 $41 $39 $6
Troponin (heart) test $94 $125 $118 $12
Uric acid (gout) test $24 $32 $30 $5
Urinalysis $14 $19 $17 $3
Urine microalbumin test $28 $37 $37 $5
Urine pregnancy test $44 $58 $55 $9
Vaccine administration $51 $68 $55 $19
Vitamin B12 test $80 $106 $101 $15
Vitamin D test $193 $257 $244 $30
Wart removal $275 $366 $347 $121
Wound debridement $518 $690 $656 $186
X-ray of the abdomen $95 $127 $114 $36
X-ray of the ankle $114 $152 $144 $37
X-ray of the collarbone $98 $130 $124 $33
X-ray of the elbow $95 $127 $121 $33
X-ray of the facial bones $116 $155 $138 $39
X-ray of the foot $107 $142 $135 $34
X-ray of the forearm $86 $115 $109 $29
X-ray of the hand $113 $151 $143 $38
X-ray of the hip $145 $193 $174 $49
X-ray of the knee $127 $169 $152 $42
X-ray of the lower back (lumbar spine) $135 $181 $155 $47
X-ray of the lower leg $95 $127 $121 $31
X-ray of the mid-back (thoracic spine) $103 $138 $123 $36
X-ray of the neck (cervical spine) $138 $184 $157 $47
X-ray of the pelvis $109 $146 $130 $36
X-ray of the ribs $112 $149 $140 $42
X-ray of the shoulder $102 $136 $129 $36
X-ray of the skull $118 $157 $145 $40
X-ray of the upper arm $98 $130 $124 $32
X-ray of the wrist $130 $173 $164 $43
Zinc blood test $61 $81 $77 $11

Source: this hospital’s machine-readable price file (45 CFR §180). Medicare from CMS fee schedules. Estimates — confirm with the hospital. Report an incorrect price.