Salem Memorial District Hospital
Salem, MO · Critical Access Hospital
Posts prices for 37 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-15.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| Upper GI endoscopy (EGD), diagnostic (43235) | $1,943.25 | $2,591 | 2.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) | $1,943.25 | $2,591 | 2.1× |
| Diagnostic colonoscopy (45378) | $1,959 | $2,612 | 2.1× |
| Colonoscopy with biopsy (45380) | $2,529.75 | $3,373 | 2.1× |
| Colonoscopy with lesion removal (45385) | $2,529.75 | $3,373 | 2.1× |
| Obstetric care, vaginal delivery (global) (59400) | $411.47 | $548.62 | — |
| After-cataract laser surgery (YAG capsulotomy) (66821) | $1,433.25 | $1,911 | 2.6× |
| CT head/brain without contrast (70450) | $1,515.94 | $2,021.25 | 14.5× |
| MRI brain without contrast (70551) | $2,476.69 | $3,302.25 | 10.4× |
| MRI brain with contrast (70552) | $2,744.44 | $3,659.25 | 7.9× |
| MRI brain without and with contrast (70553) | $3,130.31 | $4,173.75 | 9.0× |
| X-ray lower spine, 4+ views (72110) | $305.72 | $407.62 | 2.9× |
| MRI lumbar spine without contrast (72148) | $2,476.69 | $3,302.25 | 10.4× |
| CT pelvis with contrast (72193) | $1,941.19 | $2,588.25 | 11.0× |
| MRI lower-extremity joint without contrast (73721) | $2,476.69 | $3,302.25 | 10.4× |
| CT abdomen and pelvis with contrast (74177) | $3,606.75 | $4,809 | 10.3× |
| Ultrasound, abdomen complete (76700) | $389.81 | $519.75 | 3.7× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) | $547.31 | $729.75 | 5.2× |
| Ultrasound, transvaginal (76830) | $547.31 | $729.75 | 5.2× |
| Mammography, one breast (diagnostic) (77065) | $267.76 | $357 | 3.1× |
| Mammography, both breasts (diagnostic) (77066) | $328.78 | $438.38 | 3.0× |
| Mammography, screening (bilateral) (77067) | $196.88 | $262.50 | 2.2× |
| Basic metabolic panel (80048) | $98.44 | $131.25 | 11.6× |
| Comprehensive metabolic panel (80053) | $114.19 | $152.25 | 10.8× |
| Obstetric panel (80055) | $169.32 | $225.75 | 3.5× |
| Lipid panel (80061) | $21.19 | $28.25 | 1.6× |
| Renal function panel (80069) | $102.38 | $136.50 | 11.8× |
| Hepatic function panel (80076) | $114.19 | $152.25 | 14.0× |
| Urinalysis, non-automated, with microscopy (81000) | $31.13 | $41.50 | 7.7× |
| PSA, total (84153) | $21.75 | $29 | 1.2× |
| Thyroid stimulating hormone (TSH) (84443) | $76.78 | $102.38 | 4.6× |
| CBC with automated differential (85025) | $86.63 | $115.50 | 11.1× |
| CBC, automated (85027) | $70.88 | $94.50 | 11.0× |
| Prothrombin time (PT) (85610) | $39.38 | $52.50 | 9.2× |
| Partial thromboplastin time (PTT) (85730) | $162.56 | $216.75 | 27.0× |
| Sleep study (attended polysomnography) (95810) | $1,901.72 | $2,535.62 | 2.2× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) | $149.63 | $199.50 | 5.1× |
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.
More prices at this hospital
- Imaging: 219 codes with posted prices and Medicare benchmarks
- Lab & pathology: 599 codes with posted prices and Medicare benchmarks
- Visits & medical services: 107 codes with posted prices and Medicare benchmarks
- Procedures & surgery: 279 codes with posted prices and Medicare benchmarks
- Supplies, drugs & other: 9 codes with posted prices and Medicare benchmarks
Get the raw price file
Download the machine-readable file (CSV, 82.3 MB) ↓ — captured 2026-08-15
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