Home › Hospitals › Plains Memorial Hospital Posts prices for 38 of the 66 common shoppable procedures we track. Price file retrieved 2026-07-18.
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Procedure Cash price Gross charge × Medicare
Transforaminal epidural injection, lumbar/sacral (64483) $2,101
$2,801
2.4×
CT head/brain without contrast (70450) $449
$598.50
4.3×
MRI brain without contrast (70551) $1,316
$1,755
5.5×
MRI brain with contrast (70552) $1,463
$1,950
4.2×
MRI brain without and with contrast (70553) $1,086.50
$1,448.50
3.1×
X-ray lower spine, 4+ views (72110) $143.50
$191
1.4×
MRI lumbar spine without contrast (72148) $827
$1,103
3.5×
CT pelvis with contrast (72193) $678
$904
3.8×
MRI lower-extremity joint without contrast (73721) $837.50
$1,117
3.5×
CT abdomen and pelvis with contrast (74177) $1,101.50
$1,468
3.1×
Ultrasound, abdomen complete (76700) $286
$381.50
2.7×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $319.50
$426
3.0×
Ultrasound, transvaginal (76830) $385
$513
3.7×
Basic metabolic panel (80048) $41
$55
4.8×
Lipid panel (80061) $68
$90
5.1×
Renal function panel (80069) $42
$56
4.8×
Hepatic function panel (80076) $40
$53
4.9×
Urinalysis, non-automated, with microscopy (81000) $16
$21
4.0×
Urinalysis, non-automated, without microscopy (81002) $13
$17
3.7×
PSA, total (84153) $88
$117
4.8×
Thyroid stimulating hormone (TSH) (84443) $80
$107
4.8×
CBC with automated differential (85025) $38
$51
4.9×
CBC, automated (85027) $32
$42
4.9×
Prothrombin time (PT) (85610) $20
$26
4.7×
Partial thromboplastin time (PTT) (85730) $29
$39
4.8×
Psychotherapy, 30 minutes (90832) $285
$380
1.6×
Psychotherapy, 45 minutes (90834) $285
$380
1.6×
Psychotherapy, 60 minutes (90837) $285
$380
1.6×
Family psychotherapy, without patient (50 min) (90846) $108
$144
0.6×
Family psychotherapy, with patient (50 min) (90847) $112
$149
0.6×
Group psychotherapy (90853) $26
$35
0.3×
Electrocardiogram (ECG), complete (93000) $75
$100
1.3×
Physical therapy, therapeutic exercise (per 15 min) (97110) $72
$96
2.5×
Office visit, new patient (low complexity, ~30 min) (99203) $155
$206.50
1.2×
Office visit, new patient (moderate complexity, ~45 min) (99204) $205
$273.50
1.5×
Office visit, new patient (high complexity, ~60 min) (99205) $222
$296
1.7×
Preventive visit, new patient (age 18–39) (99385) $147
$196
—
Preventive visit, new patient (age 40–64) (99386) $179
$239
—
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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