Home › Hospitals › Fillmore County Hospital Posts prices for 36 of the 66 common shoppable procedures we track. Price file retrieved 2026-07-20.
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Procedure Cash price Gross charge × Medicare
Upper GI endoscopy (EGD), diagnostic (43235) $2,330
$2,330
2.5×
Upper GI endoscopy (EGD) with biopsy (43239) $2,699
$2,699
2.9×
Diagnostic colonoscopy (45378) $2,560
$2,560
2.7×
Colonoscopy with biopsy (45380) $2,867
$2,867
2.3×
Colonoscopy with lesion removal (45385) $3,108
$3,108
2.5×
Epidural injection, lumbar/sacral (with imaging) (62322) $35
$35
0.0×
Transforaminal epidural injection, lumbar/sacral (64483) $1,906
$1,906
2.1×
CT head/brain without contrast (70450) $2,150
$2,150
19.8×
MRI brain without contrast (70551) $3,460
$3,460
14.0×
MRI brain with contrast (70552) $3,207
$3,207
8.9×
MRI brain without and with contrast (70553) $4,200
$4,200
11.6×
X-ray lower spine, 4+ views (72110) $440
$440
4.1×
MRI lumbar spine without contrast (72148) $3,400
$3,400
13.7×
CT pelvis with contrast (72193) $2,613
$2,613
14.3×
MRI lower-extremity joint without contrast (73721) $2,700
$2,700
10.9×
CT abdomen and pelvis with contrast (74177) $4,800
$4,800
13.2×
Ultrasound, abdomen complete (76700) $839
$839
7.7×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $694
$694
6.4×
Ultrasound, transvaginal (76830) $769
$769
7.1×
Mammography, one breast (diagnostic) (77065) $380
$380
4.4×
Mammography, both breasts (diagnostic) (77066) $437
$437
4.0×
Mammography, screening (bilateral) (77067) $400
$400
4.4×
Basic metabolic panel (80048) $150
$150
17.7×
Comprehensive metabolic panel (80053) $180
$180
17.0×
Lipid panel (80061) $130
$130
9.7×
Renal function panel (80069) $175
$175
20.2×
Hepatic function panel (80076) $159
$159
19.5×
PSA, total (84153) $157
$157
8.5×
Thyroid stimulating hormone (TSH) (84443) $95
$95
5.7×
CBC with automated differential (85025) $105
$105
13.5×
CBC, automated (85027) $90
$90
13.9×
Prothrombin time (PT) (85610) $60
$60
14.0×
Partial thromboplastin time (PTT) (85730) $95
$95
15.8×
Physical therapy, therapeutic exercise (per 15 min) (97110) $110
$110
3.8×
Office visit, new patient (low complexity, ~30 min) (99203) $130
$130
0.9×
Office visit, new patient (moderate complexity, ~45 min) (99204) $140
$140
1.0×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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