Procedures & surgery prices at Henderson Community Hospital (Henderson, NE)

243 codes. Prices are the hospital's own posted facility charges.

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Procedure	Posted cash	Posted gross	× Medicare
Adjt/Rearrgmt Scalp/Arm/Leg 10.1-30.0 Sq Cm (14021)	$1,600	$1,600	0.7×
Amp F/Th 1/2 Jt/Phalanx W/Neurect W/Dir Clsr (26951)	$1,764	$2,205	0.5×
Amputation toe interphalangeal joint (28825)	$3,355	$3,355	1.0×
Amputation toe metatarsophalangeal joint (28820)	$3,300	$3,300	1.0×
Anoscopy Control Bleeding (46614)	$3,130	$3,130	2.5×
Application cast elbow finger short arm (29075)	$250	$250	0.9×
Application finger splint static (29130)	$150	$150	1.1×
Application long arm splint shoulder hand (29105)	$227	$227	1.3×
Application short arm splint forearm-hand static (29125) range across 2 matching MRF lines	$204–$245	$204–$245	varies
Application short leg splint calf foot (29515) range across 2 matching MRF lines	$155–$245	$155–$245	varies
Apply Short Leg Cast (29405)	$200	$200	0.7×
Arterial puncture (36600)	$120	$120	0.9×
Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) range across 2 matching MRF lines	$245–$255	$245–$255	varies
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) range across 3 matching MRF lines	$245–$260	$245–$260	varies
Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) range across 2 matching MRF lines	$245–$250	$245–$250	varies
Arthrodesis great toe interphalangeal joint (28755) unusually low: confirm this is the full procedure	$2,895	$2,895	0.4×
Arthrodesis great toe metatarsophalangeal joint (28750)	$4,870	$4,870	0.6×
Arthroplasty glenohumeral joint total shoulder (23472) unusually low: confirm this is the full procedure	$9,075	$9,075	0.5×
Arthroplasty interphalangeal joint each (26535)	$2,272	$2,840	0.7×
Arthroscopy Ankle Surgical Debridement Extensive (29898)	$4,662	$4,662	1.4×
Arthroscopy ankle w/removal loose/foreign body (29894)	$4,662	$4,662	1.4×
Arthroscopy knee diagnostic w/wo synovial bx spx (29870)	$2,765	$2,765	0.8×
Arthroscopy knee synovectomy limited spx (29875)	$3,080	$3,080	0.9×
Arthroscopy shoulder distal claviculectomy (29824)	$2,500	$2,500	0.7×
Arthroscopy shoulder surgical capsulorrhaphy (29806)	$6,115	$6,115	0.8×
Arthroscopy, knee, surgical; with meniscus repair (medial or lateral) (29882)	$6,985	$6,985	2.1×
Arthroscopy, shoulder, surgical; debridement, extensive (29823)	$2,265	$2,265	0.7×
Arthroscopy, shoulder, surgical; debridement, limited (29822)	$4,400	$4,400	1.3×
Arthroscopy, shoulder, surgical; with rotator cuff repair (29827)	$5,250	$5,250	0.7×
Arthrotomy ankle w/expl drainage/removal fb (27610)	$3,695	$3,695	1.1×
Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft (27130)	$8,145	$8,145	0.6×
Arthrs aided ant cruciate ligm rpr/agmntj/rcnstj (29888)	$8,280	$8,280	1.1×
Arthrs knee debridement/shaving artclr crtlg (29877)	$4,876	$4,876	1.4×
Aspiration bladder insert suprapubic catheter (51102)	$3,980	$3,980	1.8×
Avulsion nail plate partial/complete simple 1 (11730)	$220	$220	1.1×
Bladder Irrigation (51700) range across 2 matching MRF lines	$175–$331	$175–$331	varies
Bladder Scan (51798)	$210	$210	3.4×
Blood Transfusion Service (36430) range across 5 matching MRF lines	$885–$1,340	$885–$1,340	varies
Bone Graft Any Donor Area Minor/Small (20900) unusually low: confirm this is the full procedure	$3,510	$3,510	0.5×
Bx/exc lymph node open superficial (38500)	$3,300	$3,300	0.8×
Capsul mttarphlngl jt w/wo tenorrhaphy ea jt spx (28270)	$2,000	$2,000	0.6×
Carpal Tunnel Surgery (64721)	$3,225	$3,225	1.6×
Change Cystostomy Tube Simple (51705)	$215	$215	0.8×
Chest tube placement (32551)	$1,357	$1,357	0.8×
Closed Tx Bimalleolar Ankle Fracture W Manip (27810)	$800	$1,000	0.5×
Closed Tx Nasal Bone Fx W/Mnpj W/O Stabilization (21315)	$500	$500	0.3×
Closed tx patellar dislocation w/anesthesia (27562)	$428	$535	1.7×
Closed tx patellar dislocation w/o anesthesia (27560)	$700	$700	2.7×
Closed tx radial head/neck fx w/manipulation (24655)	$412	$515	0.2×
Closed tx radial shaft fracture w/manipulation (25505) range across 2 matching MRF lines	$800–$1,000	$1,000	varies
Closed Tx Radial&Ulnar Shaft Fractures W/Manj (25565)	$1,060	$1,060	0.6×
Clsd tx shoulder dislc w/manipulation w/o anes (23650) range across 2 matching MRF lines	$781–$840	$781–$840	varies
Cltx dstl fibular fx lat malls w/manj (27788) range across 2 matching MRF lines	$492–$1,132.80	$615–$1,416	varies
Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605) range across 3 matching MRF lines	$988–$1,400	$1,235–$1,400	varies
Cltx iphal jt dislc w/manj w/o anes (26770)	$528.80	$661	2.1×
Cltx phlngl fx prox/middle px/f/t w/manj ea (26725)	$365	$365	1.4×
Cltx phlngl fx prox/middle px/f/t w/o manj ea (26720)	$320	$400	1.2×
Cltx post hip arthrp dislc req anes (27266) range across 2 matching MRF lines	$880–$1,000	$1,000–$1,100	varies
Cltx prox humrl fx w/manj w/wo skeletal tracj (23605) range across 2 matching MRF lines	$500–$740	$500–$925	varies
Cltx rdl head sublxtj chld nursemaid elbw w/manj (24640) range across 3 matching MRF lines	$272–$360	$340–$360	varies
Cltx trimalleolar ankle fx w/manipulation (27818) range across 2 matching MRF lines	$800–$835	$835–$1,000	varies
Collect Blood From Catheter Venous Nos (36592)	$185	$185	1.3×
Collection of venous blood by venipuncture (36415)	$32	$32	3.4×
Colonoscopy w/ablation (45388) range across 2 matching MRF lines	$1,457–$2,230	$1,457–$2,230	varies
Colonoscopy w/submucosal inj (45381)	$2,630	$2,630	2.1×
Colposcopy Cervix Uppr/Adjcnt Vagina W/Cervix Bx (57455)	$405	$405	1.3×
Colsc flx w/removal lesion by hot bx forceps (45384) range across 2 matching MRF lines	$1,470–$2,500	$1,470–$2,500	varies
Combined anteroposterior colporrhaphy; (57260)	$4,500	$4,500	0.9×
Control Nasal Hemorrhage Anterior Simple (30901) range across 3 matching MRF lines	$290–$310	$290–$310	varies
Correction hammertoe (28285)	$2,500	$2,500	0.7×
Corrj hallux valgus w/sesmdc w/dist metar osteot (28296)	$3,844	$4,805	1.1×
Corrj Hlx Vlgs Bncty Sesmdc Joint Arthrodesis (28297) unusually low: confirm this is the full procedure	$4,230	$4,230	0.3×
Cysto calibration dilat urtl strix/stenosis (52281)	$2,240	$2,240	1.0×
Cysto w/insert ureteral stent (52332)	$3,510	$3,510	1.0×
Cysto w/removal of lesions small (52224)	$2,550	$2,550	0.7×
Cysto W/Simple Removal Stone & Stent (52310)	$1,950	$1,950	0.9×
Cystourethroscopy (52000)	$1,755	$1,755	2.4×
Deb Musc/Fascia 20 Sq Cm/< (11043)	$150	$150	0.2×
Debride nail 1-5 (11720)	$70	$70	1.1×
Debride nail 6 or more (11721)	$90	$90	1.5×
Debridement Bone Muscle &/Fascia 20 Sq Cm/< (11044)	$210	$210	0.1×
Debridement subcutaneous tissue 20 sq cm/< (11042)	$260	$260	0.6×
Destruct B9 Lesion 1-14 (17110)	$270	$270	1.3×
Dilation & curettage dx&/ther nonobstetric (58120)	$3,100	$3,100	0.9×
Dise Dyn Eval Sleep Disordered Breathing Flx Dx (42975)	$2,035	$2,035	1.1×
Draw Blood Off Venous Device (36591)	$175	$175	1.3×
Egd Balloon Dilation Esophagus <30 Mm Diam (43249) range across 2 matching MRF lines	$1,800–$2,625	$1,800–$2,625	varies
Egd cautery tumor polyp (43250)	$2,525	$2,525	1.3×
Egd Flexible Foreign Body Removal (43247) range across 2 matching MRF lines	$1,100–$2,266	$1,100–$2,266	varies
Egd place gastrostomy tube (43246)	$2,000	$2,000	1.0×
Egd remove lesion snare (43251) range across 2 matching MRF lines	$1,101–$2,990	$1,101–$2,990	varies
Endometrial Biopsy (58100)	$275	$275	1.3×
Episiotomy or vaginal repair (59300)	$2,000	$2,000	0.6×
Evacuation of subungual hematoma (11740)	$95	$95	0.7×
Exc arm/elbow les sc < 3 cm (24075)	$1,200	$1,200	0.7×
Exc H-F-Nk-Sp B9+Marg 0.5/< (11420)	$410	$410	0.2×
Exc Lesion Tendon Sheath/Capsule W/Synvct Foot (28090)	$2,941	$2,941	1.8×
Exc Shoulder Tum Deep 5 Cm/> (23073)	$3,326	$3,326	1.1×
Exc thigh/knee les sc 3 cm/> (27337) range across 2 matching MRF lines	$1,680–$2,030	$2,030–$2,100	varies
Exc Tr-Ext B9+Marg 1.1-2 Cm (11402)	$375	$375	0.5×
Exc tumor soft tissue leg/ankle subq <3cm (27618)	$4,560	$4,560	2.7×
Excision lesion meniscus/capsule knee (27347)	$2,720	$2,720	0.8×
Excision of ganglion, wrist (dorsal or volar); primary (25111)	$1,984	$2,480	1.2×
Excision Pilonidal Cyst/Sinus Extensive (11771)	$5,255	$5,255	1.7×
Excision tumor soft tis back/flank subq 3 cm/> (21931)	$2,300	$2,300	1.3×
Excision tumor soft tis foot/toe subq 1.5 cm/> (28039)	$2,890	$2,890	1.0×
Excision tumor soft tissue foot/toe subq <1.5cm (28043)	$2,710	$2,710	1.6×
Excision tumor soft tissue shoulder subq 3 cm/> (23071)	$1,425	$1,425	0.8×
Excision, interdigital (morton) neuroma, single, each (28080)	$1,688	$2,110	1.0×
Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater (27632)	$4,630	$4,630	1.5×
Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); 5 cm or greater Facility (27045)	$3,000	$3,000	1.0×
Explo/Drain Breast Abscess (19020)	$3,565	$3,565	2.1×
Fasciotomy Plantar Fascia Radical Spx (28062) range across 2 matching MRF lines	$880–$2,268	$1,100–$2,835	varies
Fetal non-stress test (59025)	$390	$390	1.9×
Fna bx w/us gdn 1st les (10005)	$1,250	$1,250	1.7×
Gastrocnemius recession (27687)	$3,505	$3,505	1.0×
Hemorrhoidectomy, internal and external, 2 or more columns/groups; (46260)	$4,075	$4,075	1.4×
Hemorrhoidectomy, internal, by rubber band ligation(s) (46221) range across 2 matching MRF lines	$700–$950	$700–$950	varies
Hysteroscopy Endometrial Ablation (58563)	$3,500	$3,500	0.7×
I&d abscess simple (10060) range across 3 matching MRF lines	$240–$1,150	$240–$1,150	varies
Implant Neuroelectrodes (64561) unusually low: confirm this is the full procedure	$3,000	$3,000	0.5×
Implant Periph/Gastric Neurostim/Receiver (64590) likely a partial charge, not the full procedure	$800	$800	0.0×
Incise finger tendon sheath (26055)	$2,505	$2,505	1.5×
Incision & drainage abscess complicated/multiple (10061) range across 3 matching MRF lines	$400–$1,185	$400–$1,185	varies
Incision & removal foreign body subq tiss simple (10120)	$275	$275	0.7×
Incision bone cortex foot (28005)	$576	$720	0.2×
Incision of eardrum (69420)	$425	$425	1.7×
Incision of rectal abscess (46040)	$2,415	$2,415	1.9×
Injection 1 tendon sheath/ligament aponeurosis (20550) range across 2 matching MRF lines	$156–$180	$156–$180	varies
Injection Aa&/Strd Sciatic Nerve W/Img Gdn (64445)	$600	$600	0.8×
Injection single tendon origin/insertion (20551) range across 3 matching MRF lines	$108–$215	$135–$215	varies
Injection, anesthetic agent; brachial plexus, single (64415)	$950	$950	1.0×
Injection, anesthetic agent; femoral nerve, single (64447)	$900	$900	1.2×
Injection, anesthetic agent; other peripheral nerve or branch (64450) range across 2 matching MRF lines	$480–$600	$480–$600	varies
Insert Drug Implant Device (11981)	$340	$340	2.5×
Insert Temp Bladder Cath (51702)	$200	$200	1.4×
Insert tunneled cv cath (36561)	$3,655	$3,655	1.1×
Insert,Non-Indwelling Bladder Catheter (51701)	$180	$180	1.3×
Insj prph cvc w/o subq port/pmp age 5 yr/> (36569)	$2,320	$2,320	1.4×
Intmd Rpr Face/Mm 12.6-20 Cm (12055) range across 2 matching MRF lines	$525–$950	$525–$950	varies
Intranasal Biopsy (30100)	$1,230	$1,230	0.8×
Intubation endotracheal emergency procedure (31500) range across 2 matching MRF lines	$450–$735	$450–$735	varies
Laparo-vag hyst incl t/o (58552)	$7,250	$7,250	0.7×
Laparoscopy Enterolysis Separate Procedure (44180)	$7,210	$7,210	1.1×
Laparoscopy Surg Rpr Initial Inguinal Hernia (49650)	$5,460	$5,460	0.9×
Laparoscopy, surgical, appendectomy (44970)	$5,990	$5,990	1.0×
Laparoscopy, surgical; cholecystectomy with cholangiography (47563)	$6,000	$6,000	1.0×
Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding) (44186)	$4,865	$4,865	0.8×
Laparoscopy, surgical; repair recurrent inguinal hernia (49651)	$3,855	$3,855	0.6×
Laryngoscopy flexible diagnostic (31575)	$425	$425	2.1×
N Block Inj Plantar Digit (64455)	$155	$155	0.5×
Nasal Endoscopy Dx (31231)	$180	$180	0.9×
Nasal/sinus ndsc w/partial ethmoidectomy (31254) unusually low: confirm this is the full procedure	$2,350	$2,350	0.3×
Neuroplasty and/or transposition; ulnar nerve at elbow (64718)	$3,225	$3,225	1.6×
Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn (62326)	$1,110	$1,110	1.2×
Nsl/sinus ndsc max antrost w/rmvl tiss max sinus (31267) unusually low: confirm this is the full procedure	$2,875	$2,875	0.4×
Open Tx Distal Fibular Fracture Lat Malleolus (27792)	$4,400	$4,400	0.6×
Open Tx Distal Tibiofibular Joint Disruption (27829)	$4,156	$4,156	0.6×
Osteotomy calcaneus w/wo internal fixation (28300)	$5,090	$5,090	0.7×
Part remv talus or calcaneus (28120)	$3,425	$3,425	1.0×
Partial removal of toe (28160)	$3,915	$3,915	1.2×
Partical Excision Bone Phalanx Toe (28124)	$3,211	$3,211	0.9×
Phalangectomy toe each toe (28150)	$4,200	$4,200	1.2×
Prtl exc b1 tarsal/metar b1 xcp talus/calcaneus (28122) range across 3 matching MRF lines	$560–$4,610	$700–$4,610	varies
Punch biopsy skin single lesion (11104)	$120	$120	0.3×
Puncture aspiration abscess hematoma bulla/cyst (10160)	$250	$250	0.6×
Rdctj torsion tstis w/wo fixj clat testis (54600)	$7,303	$7,303	2.0×
Removal Foreign Body Foot Subcutaneous (28190) range across 2 matching MRF lines	$368–$1,170	$460–$1,170	varies
Removal Foreign Body Muscle/Tendon Sheath Simple (20520)	$500	$500	0.3×
Removal impacted cerumen irrigation/lvg unilat (69209)	$45	$45	0.7×
Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210) range across 2 matching MRF lines	$50–$170	$50–$170	varies
Removal Implant Deep (20680)	$2,525	$2,525	0.8×
Removal of adenoids (42830)	$2,370	$2,370	0.7×
Removal of nail bed (11750)	$420	$420	1.0×
Removal of sesamoid bone (28315)	$3,540	$3,540	1.0×
Removal of tonsils (42825) unusually low: confirm this is the full procedure	$2,675	$2,675	0.4×
Removal of tunneled intraperitoneal catheter (49422)	$2,080	$2,080	0.6×
Removal skn tags mlt fibrq tags any area upw/15 (11200)	$180	$180	0.9×
Remove drug implant device (11982)	$510	$510	1.1×
Remove foreign body from eye (65205)	$111	$111	0.8×
Remove Intrauterine Device (58301)	$186	$186	0.6×
Remove Tendon Sheath Lesion (26160)	$1,932	$2,415	1.2×
Repair Achilles Tendon (27650) unusually low: confirm this is the full procedure	$3,585	$3,585	0.5×
Repair Collat Ankle Ligmnt,Secondary (27698) unusually low: confirm this is the full procedure	$3,337	$3,337	0.4×
Repair extensor tendon finger w/o graft each (26418) range across 2 matching MRF lines	$580–$1,200	$725–$1,500	varies
Repair Flexor Tendon Leg Primary W/O Graft Each (27658)	$3,840	$3,840	1.1×
Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051)	$537	$537	1.3×
Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm (12052)	$611	$611	1.4×
Repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm (12053) range across 2 matching MRF lines	$510–$694	$510–$694	varies
Repair intermediate f/e/e/n/l&/muc 7.6-12.5 cm (12054)	$725	$725	1.7×
Repair intermediate n/h/f/xtrnl gent 2.5cm/< (12041) range across 3 matching MRF lines	$335–$452	$335–$452	varies
Repair intermediate n/h/f/xtrnl gent 7.6-12.5cm (12044) range across 2 matching MRF lines	$645–$715	$645–$715	varies
Repair intermediate s/a/t/e 2.5 cm/< (12031)	$408	$408	1.0×
Repair intermediate s/a/t/e 2.6-7.5 cm (12032)	$510	$510	1.2×
Repair intermediate s/a/t/e 7.6-12.5 cm (12034) range across 3 matching MRF lines	$540–$675	$540–$675	varies
Repair Tendon Extensor Foot 1/2 Each Tendon (28208)	$4,680	$5,850	1.4×
Repair, primary, disrupted ligament, ankle; collateral (27695)	$4,685	$4,685	0.6×
Revision of foot (28116)	$4,435	$4,435	1.3×
Rmvl fb xtrnl eye corneal w/o slit lamp (65220)	$130	$130	0.3×
Rmvl tun ctr vad w/subq port/pmp ctr/prph insj (36590)	$2,100	$2,100	1.3×
Rmvl Tun Cvc W/O Subq Port/Pmp (36589)	$470	$470	0.7×
Rpr Aa Hernia 1st < 3 Cm Reducible (49591)	$3,780	$3,780	1.0×
Rpr aa hernia recr 3-10 cm reducible (49615)	$4,110	$4,110	0.6×
Rpr aa hrn 1st 3-10 rdc (49593)	$4,505	$4,505	0.7×
Rpr flexor tendon leg secondary w/o graft each (27659)	$4,170	$4,170	0.6×
Septoplasty/Submucous Resecj W/WO Cartilage Grf (30520)	$3,300	$3,300	1.0×
Shave skin lesion 0.5 cm/< (11300)	$128	$160	0.3×
Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305)	$168	$210	0.8×
Shoulder Arthroscopy/Surgery (29825)	$2,930	$2,930	0.9×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm (11301)	$192	$240	0.9×
Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm (11303)	$236	$295	0.6×
Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm (11302)	$216	$270	1.0×
Sigmoidoscopy, flexible; with biopsy, single or multiple (45331)	$1,950	$1,950	2.0×
Simple repair f/e/e/n/l/m 2.5cm/< (12011) range across 2 matching MRF lines	$208–$360	$208–$360	varies
Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) range across 2 matching MRF lines	$400–$425	$400–$425	varies
Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001)	$260	$260	1.2×
Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004)	$325	$325	1.6×
Skin sub graft trnk/arm/leg (15271)	$345	$345	0.4×
Sling operation for stress incontinence (eg, fascia or synthetic) (57288)	$3,405	$3,405	0.7×
Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002)	$280	$280	1.3×
Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005)	$360	$360	0.9×
Submucous Rescj Inferior Turbinate Prtl/Compl (30140)	$2,925	$2,925	0.8×
Suture of quadriceps or hamstring muscle rupture primary (27385) unusually low: confirm this is the full procedure	$3,455	$3,455	0.5×
Synovectomy Tendon Sheath Foot Flexor (28086)	$4,505	$4,505	1.3×
Tenodesis long tendon biceps (23430)	$4,730	$4,730	0.6×
Tenolysis flxr/xtnsr tendon leg&/ankle 1 each (27680)	$3,555	$3,555	1.0×
Tenotomy Percutaneous Toe Single Tendon (28010)	$285	$285	0.2×
Tenotomy, Percutaneous, Toe; Multiple Tendons (28011) range across 2 matching MRF lines	$468–$948	$585–$1,185	varies
Tonsillectomy and adenoidectomy; age 12 or over (42821)	$3,410	$3,410	1.0×
Total Knee Arthroplasty (27447)	$8,415	$8,415	0.6×
Treatment Closed Elbow Dislocation Req Anes (24605)	$248	$310	0.1×
Treatment closed elbow dislocation w/o anes (24600) range across 2 matching MRF lines	$248–$663.20	$310–$829	varies
Trim skin lesion (11055) range across 2 matching MRF lines	$96–$135	$96–$135	varies
Trim skin lesions 2 to 4 (11056)	$160	$160	0.8×
Trim skin lesions over 4 (11057)	$170	$170	0.8×
Trimming Nondystrophic Nails Any Number (11719)	$55	$55	0.9×
Tympanostomy general anesthesia (69436)	$2,140	$2,140	1.3×
Urine Flow Measurement (51736)	$50	$50	0.4×
Vaginal delivery only (59409)	$1,160	$1,450	0.3×
Vaginal hysterectomy, for uterus 250 g or less; (58260)	$5,255	$5,255	1.0×
Vaginal hysterectomy; with removal of tube(s), and/or ovary(s) (58262)	$5,780	$5,780	1.1×
Vasectomy uni/bi spx w/postop semen exams (55250)	$2,310	$2,310	1.1×
Xfer Single Deep Low Leg Tendon (27691) range across 2 matching MRF lines	$652–$3,460	$815–$4,325	varies

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.