▸ Hospital · ND · CCN 351314

Jacobson Memorial Hospital Care Center

601 EAST STREET NORTH, ELGIN, ND, 58533-

25 bedsCritical Access Hospitals2

Compliance grade

100/100

Rates published

1,944

last crawl 2026-05-23

Procedures tracked

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All ND hospitals JSON

Source MRF: https://www.jacobsonhospital.org/jacobson_memorial_hospital_standard_charges_new.json · JSON

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
emergency
ED visit level 1	CPT	99281	15	$264.15	$198.11	$158.49	$237.73	$369.81
ED visit level 2	CPT	99282	15	$475.08	$356.31	$285.05	$427.57	$665.11
ED visit level 3	CPT	99283	15	$830.67	$623	$498.4	$747.6	$1,162.94
ED visit level 4	CPT	99284	15	$1,277.46	$958.1	$766.48	$1,149.71	$1,788.44
ED visit level 5	CPT	99285	15	$1,839.3	$1,379.48	$1,103.58	$1,655.37	$2,575.02
Critical care, first hour	CPT	99291	15	$2,527.83	$1,895.87	$1,516.7	$2,275.05	$3,538.96
imaging
CT head without contrast	CPT	70450	15	$1,059.15	$794.36	$635.49	$953.23	$1,482.81
CT head with contrast	CPT	70460	15	$1,124	$843	$674.4	$1,011.6	$1,573.6
CT head with and without contrast	CPT	70470	15	$1,400	$1,050	$840	$1,260	$1,960
CT neck with contrast	CPT	70491	15	$1,517	$1,137.75	$910.2	$1,365.3	$2,123.8
MRI brain without contrast	CPT	70551	15	$1,492	$1,119	$895.2	$1,342.8	$2,088.8
MRI brain with and without contrast	CPT	70553	15	$3,842.15	$2,881.61	$2,305.29	$3,457.93	$5,379.01
Chest X-ray single view	CPT	71045	15	$104.65	$78.49	$62.79	$94.18	$146.51
Chest X-ray 2 views	CPT	71046	15	$144.9	$108.67	$86.94	$130.41	$202.86
CT chest without contrast	CPT	71250	15	$1,359.3	$1,019.47	$815.58	$1,223.37	$1,903.02
CT chest with contrast	CPT	71260	15	$1,756.05	$1,317.04	$1,053.63	$1,580.44	$2,458.47
CT chest with and without contrast	CPT	71270	15	$1,881	$1,410.75	$1,128.6	$1,692.9	$2,633.4
MRI chest without contrast	CPT	71550	15	$3,309	$2,481.75	$1,985.4	$2,978.1	$4,632.6
MRI chest with and without contrast	CPT	71552	15	$4,512	$3,384	$2,707.2	$4,060.8	$6,316.8
Lumbosacral spine X-ray	CPT	72100	15	$155	$116.25	$93	$139.5	$217
CT cervical spine without contrast	CPT	72125	15	$1,491.55	$1,118.66	$894.93	$1,342.39	$2,088.17
CT thoracic spine without contrast	CPT	72128	15	$1,293	$969.75	$775.8	$1,163.7	$1,810.2
CT lumbar spine without contrast	CPT	72131	15	$1,480.05	$1,110.04	$888.03	$1,332.05	$2,072.07
MRI cervical spine without contrast	CPT	72141	15	$2,281.6	$1,711.2	$1,368.96	$2,053.44	$3,194.24
MRI thoracic spine without contrast	CPT	72146	15	$2,117	$1,587.75	$1,270.2	$1,905.3	$2,963.8
MRI lumbar spine without contrast	CPT	72148	15	$2,434.55	$1,825.91	$1,460.73	$2,191.09	$3,408.37
MRI cervical spine with and without contrast	CPT	72156	15	$3,282	$2,461.5	$1,969.2	$2,953.8	$4,594.8
MRI lumbar spine with contrast	CPT	72158	15	$3,277	$2,457.75	$1,966.2	$2,949.3	$4,587.8
CT pelvis without contrast	CPT	72192	15	$1,143	$857.25	$685.8	$1,028.7	$1,600.2
CT pelvis with contrast	CPT	72193	15	$1,979	$1,484.25	$1,187.4	$1,781.1	$2,770.6
Shoulder X-ray	CPT	73030	15	$136	$102	$81.6	$122.4	$190.4
Humerus X-ray	CPT	73060	15	$130	$97.5	$78	$117	$182
Hand X-ray 3 views	CPT	73130	15	$151	$113.25	$90.6	$135.9	$211.4
MRI upper extremity joint without contrast	CPT	73221	15	$2,461	$1,845.75	$1,476.6	$2,214.9	$3,445.4
MRI upper extremity joint with and without contrast	CPT	73223	15	$3,473	$2,604.75	$2,083.8	$3,125.7	$4,862.2
Knee X-ray 1-2 views	CPT	73560	15	$142	$106.5	$85.2	$127.8	$198.8
Ankle X-ray 3 views	CPT	73610	15	$152	$114	$91.2	$136.8	$212.8
MRI lower extremity joint without contrast	CPT	73721	15	$2,523.1	$1,892.32	$1,513.86	$2,270.79	$3,532.34
MRI lower extremity joint with and without contrast	CPT	73723	15	$3,511	$2,633.25	$2,106.6	$3,159.9	$4,915.4
CT abdomen without contrast	CPT	74150	15	$1,107	$830.25	$664.2	$996.3	$1,549.8
CT abdomen with contrast	CPT	74160	15	$1,971	$1,478.25	$1,182.6	$1,773.9	$2,759.4
CT abdomen with and without contrast	CPT	74170	15	$2,234	$1,675.5	$1,340.4	$2,010.6	$3,127.6
CT abdomen and pelvis without contrast	CPT	74176	15	$1,328.25	$996.19	$796.95	$1,195.42	$1,859.55
CT abdomen and pelvis with contrast	CPT	74177	15	$2,885.35	$2,164.01	$1,731.21	$2,596.82	$4,039.49
CT abdomen and pelvis with and without contrast	CPT	74178	15	$3,261.4	$2,446.05	$1,956.84	$2,935.26	$4,565.96
MRI abdomen without contrast	CPT	74181	15	$1,527	$1,145.25	$916.2	$1,374.3	$2,137.8
Abdominal ultrasound complete	CPT	76700	15	$493	$369.75	$295.8	$443.7	$690.2
Abdominal ultrasound limited	CPT	76705	15	$379	$284.25	$227.4	$341.1	$530.6
Retroperitoneal ultrasound complete	CPT	76770	15	$483	$362.25	$289.8	$434.7	$676.2
Obstetric ultrasound first trimester	CPT	76801	15	$400	$300	$240	$360	$560
Obstetric ultrasound after first trimester	CPT	76805	15	$505	$378.75	$303	$454.5	$707
Transvaginal ultrasound	CPT	76830	15	$492	$369	$295.2	$442.8	$688.8
Pelvic ultrasound complete	CPT	76856	15	$444	$333	$266.4	$399.6	$621.6
Scrotal ultrasound	CPT	76870	15	$449	$336.75	$269.4	$404.1	$628.6
Diagnostic mammography unilateral	CPT	77065	15	$499	$374.25	$299.4	$449.1	$698.6
Diagnostic mammography bilateral	CPT	77066	15	$638	$478.5	$382.8	$574.2	$893.2
Screening mammography bilateral	CPT	77067	15	$527	$395.25	$316.2	$474.3	$737.8
EKG tracing only	CPT	93005	15	$74.25	$55.69	$44.55	$66.83	$103.95
Transthoracic echocardiogram complete	CPT	93306	15	$829.15	$621.86	$497.49	$746.24	$1,160.81
lab
Basic metabolic panel (BMP)	CPT	80048	15	$84.6	$63.45	$50.76	$76.14	$118.44
General health panel	CPT	80050	15	$224	$168	$134.4	$201.6	$313.6
Electrolyte panel	CPT	80051	15	$49	$36.75	$29.4	$44.1	$68.6
Comprehensive metabolic panel	CPT	80053	15	$105.6	$79.2	$63.36	$95.04	$147.84
Lipid panel	CPT	80061	15	$133.9	$100.43	$80.34	$120.51	$187.46
Renal function panel	CPT	80069	15	$62	$46.5	$37.2	$55.8	$86.8
Hepatic function panel	CPT	80076	15	$58	$43.5	$34.8	$52.2	$81.2
Urinalysis non-automated	CPT	81002	15	$23	$17.25	$13.8	$20.7	$32.2
Urinalysis automated	CPT	81003	15	$21	$15.75	$10.2	$17	$29.4
Glucose quantitative	CPT	82947	15	$29	$21.75	$17.4	$26.1	$40.6
Hemoglobin A1c	CPT	83036	15	$97.1	$72.83	$58.26	$87.39	$135.94
Thyroid stimulating hormone (TSH)	CPT	84443	15	$168	$126	$100.8	$151.2	$235.2
Complete blood count with automated differential	CPT	85025	15	$77.7	$58.27	$46.62	$69.93	$108.78
Complete blood count without differential	CPT	85027	15	$45	$33.75	$27	$40.5	$63
Urine culture bacterial	CPT	87086	15	$80.7	$60.53	$48.42	$72.63	$112.98
Urine culture identification	CPT	87088	15	$58	$43.5	$34.8	$52.2	$81.2
Tissue exam by pathologist level IV	CPT	88305	15	$217	$162.75	$130.2	$195.3	$303.8
maternity
Vaginal delivery only	CPT	59409	15	$5,361	$4,020.75	$3,216.6	$4,824.9	$7,505.4
office
Office visit, established patient, 5 min	CPT	99211	15	$49	$36.75	$29.4	$44.1	$68.6

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 15)

Payer	Codes covered	Median rate
Aetna	78	$497.95
Blue Cross Blue Shield	78	$702.8
Cigna	78	$474.3
healthpartners	78	$474.3
Humana	78	$527
medica	78	$421.6
Medicaid	78	$377.33
Medicare	78	$619.2
Medicare Advantage	78	$474.3
Multiplan	78	$474.3
nextblue	78	$527
sanford health plan	78	$527
tlc advantage	78	$421.6
TRICARE	78	$395.25
UnitedHealthcare	78	$502

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