Home › Hospitals › Page Memorial Hospital Posts prices for 33 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-30.
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Procedure Cash price Gross charge × Medicare
Epidural injection, lumbar/sacral (with imaging) (62322) $1,251.60
$1,788
1.5×
Transforaminal epidural injection, lumbar/sacral (64483) $920.50
$1,315
1.1×
CT head/brain without contrast (70450) $938
$1,340
9.2×
MRI brain without contrast (70551) $2,046.80
$2,924
8.8×
MRI brain with contrast (70552) $2,475.90
$3,537
7.3×
MRI brain without and with contrast (70553) $4,581.50
$6,545
13.5×
X-ray lower spine, 4+ views (72110) $210.70
$301
2.1×
MRI lumbar spine without contrast (72148) $2,289
$3,270
9.8×
CT pelvis with contrast (72193) $1,360.10
$1,943
7.9×
MRI lower-extremity joint without contrast (73721) $2,046.80
$2,924
8.8×
CT abdomen and pelvis with contrast (74177) $2,738.40
$3,912
8.0×
Ultrasound, abdomen complete (76700) $604.80
$864
5.9×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $388.50
$555
3.8×
Ultrasound, transvaginal (76830) $408.10
$583
4.0×
Mammography, one breast (diagnostic) (77065) $423.50
$605
4.9×
Mammography, both breasts (diagnostic) (77066) $548.10
$783
5.0×
Mammography, screening (bilateral) (77067) $449.40
$642
4.9×
Basic metabolic panel (80048) $77.70
$111
9.2×
Comprehensive metabolic panel (80053) $89.60
$128
8.5×
Obstetric panel (80055) $195.30
$279
4.1×
Lipid panel (80061) $120.40
$172
9.0×
Renal function panel (80069) $65.80
$94
7.6×
Hepatic function panel (80076) $74.20
$106
9.1×
PSA, total (84153) $154
$220
8.4×
Thyroid stimulating hormone (TSH) (84443) $126.70
$181
7.5×
CBC with automated differential (85025) $65.10
$93
8.4×
CBC, automated (85027) $51.10
$73
7.9×
Prothrombin time (PT) (85610) $32.20
$46
7.5×
Partial thromboplastin time (PTT) (85730) $48.30
$69
8.0×
Sleep study (attended polysomnography) (95810) $2,492
$3,560
3.0×
Physical therapy, therapeutic exercise (per 15 min) (97110) $60.20
$86
2.1×
Office visit, new patient (low complexity, ~30 min) (99203) $270.20
$386
2.1×
Office visit, new patient (moderate complexity, ~45 min) (99204) $387.80
$554
3.0×
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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