Home › Hospitals › Niobrara County Hospital District Posts prices for 24 of the 66 common shoppable procedures we track. Price file retrieved 2026-06-27.
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Procedure Cash price Gross charge × Medicare
CT head/brain without contrast (70450) $1,344
$1,680
12.6×
X-ray lower spine, 4+ views (72110) $366.40
$458
3.4×
CT pelvis with contrast (72193) $1,728.80
$2,161
9.6×
CT abdomen and pelvis with contrast (74177) $3,062.40
$3,828
8.6×
Basic metabolic panel (80048) $112.44
$140.55
13.3×
Comprehensive metabolic panel (80053) $146.50
$183.12
13.9×
Lipid panel (80061) $113.94
$142.42
8.5×
Renal function panel (80069) $79.77
$99.71
9.2×
Hepatic function panel (80076) $123.58
$154.47
15.1×
Urinalysis, non-automated, with microscopy (81000) $36
$45
9.0×
Urinalysis, non-automated, without microscopy (81002) $29.60
$37
8.5×
PSA, total (84153) $117.60
$147
6.4×
Thyroid stimulating hormone (TSH) (84443) $122.68
$153.35
7.3×
CBC with automated differential (85025) $84.44
$105.55
10.9×
CBC, automated (85027) $51.41
$64.26
7.9×
Prothrombin time (PT) (85610) $53.04
$66.30
12.4×
Partial thromboplastin time (PTT) (85730) $68.80
$86
11.4×
Electrocardiogram (ECG), complete (93000) $252
$315
4.2×
Physical therapy, therapeutic exercise (per 15 min) (97110) $84
$105
2.9×
Office visit, new patient (low complexity, ~30 min) (99203) $200
$250
1.5×
Office visit, new patient (moderate complexity, ~45 min) (99204) $336
$420
2.5×
Office visit, new patient (high complexity, ~60 min) (99205) $421.60
$527
3.1×
Preventive visit, new patient (age 18–39) (99385) $255.20
$319
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Preventive visit, new patient (age 40–64) (99386) $280
$350
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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.