Home › Hospitals › Niobrara Valley 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) $3,355
$3,355
3.6×
Upper GI endoscopy (EGD) with biopsy (43239) $3,297
$3,297
3.5×
Diagnostic colonoscopy (45378) $2,416
$2,416
2.5×
Colonoscopy with biopsy (45380) $2,902
$2,902
2.3×
Colonoscopy with lesion removal (45385) $3,310.50
$3,310.50
2.7×
CT head/brain without contrast (70450) $2,651.50
$2,651.50
24.4×
MRI brain without contrast (70551) $3,591
$3,591
14.5×
MRI brain with contrast (70552) $3,587
$3,587
9.9×
MRI brain without and with contrast (70553) $5,140
$5,140
14.2×
X-ray lower spine, 4+ views (72110) $672
$672
6.2×
MRI lumbar spine without contrast (72148) $4,714.50
$4,714.50
19.0×
CT pelvis with contrast (72193) $3,281.50
$3,281.50
18.0×
MRI lower-extremity joint without contrast (73721) $3,439
$3,439
13.9×
CT abdomen and pelvis with contrast (74177) $6,274
$6,274
17.3×
Ultrasound, abdomen complete (76700) $1,228.50
$1,228.50
11.3×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $1,102.50
$1,102.50
10.2×
Ultrasound, transvaginal (76830) $892.50
$892.50
8.2×
Mammography, screening (bilateral) (77067) $499
$499
5.5×
Basic metabolic panel (80048) $231
$231
27.3×
Comprehensive metabolic panel (80053) $262.50
$262.50
24.9×
Lipid panel (80061) $168
$168
12.5×
Renal function panel (80069) $298
$298
34.3×
Hepatic function panel (80076) $194.50
$194.50
23.8×
Urinalysis, non-automated, without microscopy (81002) $15.50
$15.50
4.5×
PSA, total (84153) $168
$168
9.1×
Thyroid stimulating hormone (TSH) (84443) $160.50
$160.50
9.6×
CBC with automated differential (85025) $109
$109
14.0×
CBC, automated (85027) $105
$105
16.2×
Prothrombin time (PT) (85610) $96.50
$96.50
22.5×
Partial thromboplastin time (PTT) (85730) $130
$130
21.6×
Physical therapy, therapeutic exercise (per 15 min) (97110) $149
$149
5.1×
Office visit, new patient (low complexity, ~30 min) (99203) $65
$65
0.5×
Office visit, new patient (moderate complexity, ~45 min) (99204) $77
$77
0.6×
Office visit, new patient (high complexity, ~60 min) (99205) $115
$115
0.8×
Preventive visit, new patient (age 18–39) (99385) $274
$274
—
Preventive visit, new patient (age 40–64) (99386) $298
$298
—
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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