Providence Medical Center

Wayne, NE · Critical Access Hospital

Posts prices for 47 of the 66 common shoppable procedures we track. Price file retrieved 2026-07-20.

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ProcedureCash priceGross charge× Medicare
Breast lesion removal (open) (19120) $1,207.45 $1,271 0.3×
Upper GI endoscopy (EGD), diagnostic (43235) $1,620.70 $1,706 1.7×
Upper GI endoscopy (EGD) with biopsy (43239) $2,385.45 $2,511 2.5×
Diagnostic colonoscopy (45378) $2,277.15 $2,397 2.4×
Colonoscopy with biopsy (45380) $3,654.65 $3,847 2.9×
Colonoscopy with lesion removal (45385) $3,014.35 $3,173 2.4×
Transforaminal epidural injection, lumbar/sacral (64483) $1,121.48 $1,180.50 1.2×
After-cataract laser surgery (YAG capsulotomy) (66821) $1,132.40 $1,192 2.0×
Cataract removal with lens insertion (66984) $4,258.85 $4,483 1.8×
CT head/brain without contrast (70450) $1,626.40 $1,712 15.0×
MRI brain without contrast (70551) $2,247.70 $2,366 9.1×
MRI brain with contrast (70552) $3,428.55 $3,609 9.5×
MRI brain without and with contrast (70553) $3,791.45 $3,991 10.5×
X-ray lower spine, 4+ views (72110) $423.70 $446 3.9×
MRI lumbar spine without contrast (72148) $2,210.65 $2,327 8.9×
CT pelvis with contrast (72193) $3,412.40 $3,592 18.7×
MRI lower-extremity joint without contrast (73721) $2,432 $2,560 9.8×
CT abdomen and pelvis with contrast (74177) $4,655.95 $4,901 12.9×
Ultrasound, abdomen complete (76700) $808.45 $851 7.4×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $898.70 $946 8.3×
Ultrasound, transvaginal (76830) $828.40 $872 7.6×
Mammography, one breast (diagnostic) (77065) $367.65 $387 4.3×
Mammography, both breasts (diagnostic) (77066) $410.40 $432 3.7×
Mammography, screening (bilateral) (77067) $352.45 $371 3.9×
Basic metabolic panel (80048) $133 $140 15.7×
Comprehensive metabolic panel (80053) $156.75 $165 14.8×
Lipid panel (80061) $183.35 $193 13.7×
Renal function panel (80069) $125.40 $132 14.4×
Hepatic function panel (80076) $118.75 $125 14.5×
PSA, total (84153) $155.80 $164 8.5×
Thyroid stimulating hormone (TSH) (84443) $144.40 $152 8.6×
CBC with automated differential (85025) $87.40 $92 11.2×
CBC, automated (85027) $75.05 $79 11.6×
Prothrombin time (PT) (85610) $61.75 $65 14.4×
Partial thromboplastin time (PTT) (85730) $27.55 $29 4.6×
Psychotherapy, 30 minutes (90832) $330.60 $348 1.8×
Psychotherapy, 45 minutes (90834) $319.68 $336.50 1.7×
Psychotherapy, 60 minutes (90837) $504.92 $531.50 2.7×
Family psychotherapy, without patient (50 min) (90846) $438.42 $461.50 2.4×
Family psychotherapy, with patient (50 min) (90847) $399 $420 2.2×
Group psychotherapy (90853) $343.90 $362 3.3×
Electrocardiogram (ECG), complete (93000) $220.40 $232 3.6×
Sleep study (attended polysomnography) (95810) $2,524.62 $2,657.50 2.8×
Physical therapy, therapeutic exercise (per 15 min) (97110) $95 $100 3.3×
Office visit, new patient (low complexity, ~30 min) (99203) $191.90 $202 1.4×
Office visit, new patient (moderate complexity, ~45 min) (99204) $327.75 $345 2.4×
Office visit, new patient (high complexity, ~60 min) (99205) $429.40 $452 3.1×

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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