Jennie Edmundson Memorial Hospital
Jennie Edmundson Memorial Hospital in Council Bluffs, IA publishes cash prices for 55 common procedures listed here, from its own machine-readable price file updated Feb 15, 2026. Click a procedure to compare it with other hospitals nearby.
933 East Pierce Street, Council Bluffs, IA 51503 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 MECT Exam | $1,641.00 | $5,470.00 | 70% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd/Pelvis w/ Contrast | $1,675.20 | $5,584.00 | 70% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exam | $1,675.20 | $5,584.00 | 70% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 MECT Exam | $1,641.00 | $5,470.00 | 70% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exam | $1,675.20 | $5,584.00 | 70% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd/Pelvis w/ Contrast | $1,675.20 | $5,584.00 | 70% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Exam | $542.70 | $1,809.00 | 70% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exam | $542.70 | $1,809.00 | 70% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Wh Body w/Cont-Pelv | $878.70 | $2,929.00 | 70% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/Contrast | $878.70 | $2,929.00 | 70% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Exam | $878.70 | $2,929.00 | 70% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Wh Body w/Cont-Pelv | $878.70 | $2,929.00 | 70% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/Contrast | $878.70 | $2,929.00 | 70% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exam | $878.70 | $2,929.00 | 70% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Mammo Digital Bilat-Diag | $100.20 | $334.00 | 70% |
| Diagnostic mammogram, both breasts CPT 77066 MM Exam | $100.20 | $334.00 | 70% |
| Diagnostic mammogram, both breasts CPT 77066 Mammo Diagnostic | $100.20 | $334.00 | 70% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Mammo Digital Bilat-Diag | $100.20 | $334.00 | 70% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Mammo Diagnostic | $100.20 | $334.00 | 70% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MM Exam | $100.20 | $334.00 | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammo Digital Unilat Lt-Diag | $81.00 | $270.00 | 70% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammo Digital Unilat Rt-Diag | $81.00 | $270.00 | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo Digital Unilat Lt-Diag | $81.00 | $270.00 | 70% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo Digital Unilat Rt-Diag | $81.00 | $270.00 | 70% |
| MRI of the brain, no contrast dye CPT 70551 MRI Exam | $900.30 | $3,001.00 | 70% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Exam | $900.30 | $3,001.00 | 70% |
| MRI of the brain, with and without contrast dye CPT 70553 MMRI Exam | $1,455.30 | $4,851.00 | 70% |
| MRI of the brain, with and without contrast dye CPT 70553 MRIME Exam | $1,455.30 | $4,851.00 | 70% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Exam | $1,455.30 | $4,851.00 | 70% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRIME Exam | $1,455.30 | $4,851.00 | 70% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Exam | $1,455.30 | $4,851.00 | 70% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MMRI Exam | $1,455.30 | $4,851.00 | 70% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Exam | $900.30 | $3,001.00 | 70% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Exam | $900.30 | $3,001.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound Pregnant Uterus after first trimester t | $98.70 | $329.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 MFM Ultrasound Pregnant Uterus Transabdominal > Fi | $148.20 | $494.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Yes - Ultrasound Level 1 Diag/Screen Charge | $259.80 | $866.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound Level 1 Diagnostic/Screening - Labor Pr | $259.80 | $866.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exam | $263.40 | $878.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound Level 1 Diagnostic/Screening | $263.40 | $878.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ultrasound Pregnant Uterus after first trimester t | $98.70 | $329.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 MFM Ultrasound Pregnant Uterus Transabdominal > Fi | $148.20 | $494.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ultrasound Level 1 Diagnostic/Screening - Labor Pr | $259.80 | $866.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Yes - Ultrasound Level 1 Diag/Screen Charge | $259.80 | $866.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exam | $263.40 | $878.00 | 70% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ultrasound Level 1 Diagnostic/Screening | $263.40 | $878.00 | 70% |
| Screening mammogram, both breasts CPT 77067 JEMAM Exam | $44.40 | $148.00 | 70% |
| Screening mammogram, both breasts CPT 77067 MM Exam | $100.20 | $334.00 | 70% |
| Screening mammogram, both breasts inpatient CPT 77067 JEMAM Exam | $44.40 | $148.00 | 70% |
| Screening mammogram, both breasts inpatient CPT 77067 MM Exam | $100.20 | $334.00 | 70% |
| Sleep study in a lab (polysomnography) CPT 95810 SL-All Night Polysomnogram | $1,237.80 | $4,126.00 | 70% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SL-All Night Polysomnogram | $1,237.80 | $4,126.00 | 70% |
| Transvaginal pelvic ultrasound CPT 76830 Transvaginal ultrasound | $146.40 | $488.00 | 70% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvag | $266.10 | $887.00 | 70% |
| Transvaginal pelvic ultrasound CPT 76830 MUS Exam | $266.10 | $887.00 | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal ultrasound | $146.40 | $488.00 | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 MUS Exam | $266.10 | $887.00 | 70% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvag | $266.10 | $887.00 | 70% |
| Ultrasound of the abdomen, complete CPT 76700 US Exam | $256.50 | $855.00 | 70% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Exam | $256.50 | $855.00 | 70% |
| X-ray of the lower back, 4 or more views CPT 72110 RA Exam | $89.70 | $299.00 | 70% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 RA Exam | $89.70 | $299.00 | 70% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Panel | $48.90 | $163.00 | 70% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Panel | $48.90 | $163.00 | 70% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $49.80 | $166.00 | 70% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $49.80 | $166.00 | 70% |
| Complete blood count (CBC) with differential CPT 85025 UNMC CBC | $18.60 | $62.00 | 70% |
| Complete blood count (CBC) with differential CPT 85025 Differntial (Auto) | $36.00 | $120.00 | 70% |
| Complete blood count (CBC) with differential inpatient CPT 85025 UNMC CBC | $18.60 | $62.00 | 70% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Differntial (Auto) | $36.00 | $120.00 | 70% |
| Complete blood count (CBC), no differential CPT 85027 Manual Diff - Diff Type | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential CPT 85027 Hemogram Charge | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential CPT 85027 Cellavision Diff - Diff Type | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram Charge | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Cellavision Diff - Diff Type | $27.00 | $90.00 | 70% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Manual Diff - Diff Type | $27.00 | $90.00 | 70% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $60.90 | $203.00 | 70% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $60.90 | $203.00 | 70% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $28.50 | $95.00 | 70% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $28.50 | $95.00 | 70% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $30.30 | $101.00 | 70% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $30.30 | $101.00 | 70% |
| Obstetric blood test panel CPT 80055 Prenatal Panel Charge - MH/WH/FH | $119.40 | $398.00 | 70% |
| Obstetric blood test panel inpatient CPT 80055 Prenatal Panel Charge - MH/WH/FH | $119.40 | $398.00 | 70% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $13.20 | $44.00 | 70% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $13.20 | $44.00 | 70% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total | $13.20 | $44.00 | 70% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Ultrasensitive - Post Prostatectomy | $23.70 | $79.00 | 70% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen | $68.10 | $227.00 | 70% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total | $13.20 | $44.00 | 70% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Ultrasensitive - Post Prostatectomy | $23.70 | $79.00 | 70% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen | $68.10 | $227.00 | 70% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT Inhib 1 Hr Rflx | $16.20 | $54.00 | 70% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Inhibitor Assay PTT Rflx 11 Mix | $20.40 | $68.00 | 70% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time Panel | $34.80 | $116.00 | 70% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time - MH/WH/JE | $34.80 | $116.00 | 70% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT Inhib 1 Hr Rflx | $16.20 | $54.00 | 70% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Inhibitor Assay PTT Rflx 11 Mix | $20.40 | $68.00 | 70% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time Panel | $34.80 | $116.00 | 70% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time - MH/WH/JE | $34.80 | $116.00 | 70% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Panel | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time - MH/WH/JE | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Protime - MH/WH/JE | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Protime POC - JE | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime - MH/WH/JE | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time Panel | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime POC - JE | $23.10 | $77.00 | 70% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time - MH/WH/JE | $23.10 | $77.00 | 70% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $61.80 | $206.00 | 70% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Reflex | $61.80 | $206.00 | 70% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $61.80 | $206.00 | 70% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Reflex | $61.80 | $206.00 | 70% |
| Urinalysis with microscope exam, automated CPT 81001 UA Microscopic | $18.60 | $62.00 | 70% |
| Urinalysis with microscope exam, automated CPT 81001 UA with Microscopic Charge | $18.60 | $62.00 | 70% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA with Microscopic Charge | $18.60 | $62.00 | 70% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA Microscopic | $18.60 | $62.00 | 70% |
| Urinalysis without microscope exam, automated CPT 81003 Urogram | $6.30 | $21.00 | 70% |
| Urinalysis without microscope exam, automated CPT 81003 Ketone Urine | $6.30 | $21.00 | 70% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis | $8.40 | $28.00 | 70% |
| Urinalysis without microscope exam, automated CPT 81003 UA (Culture if Positive) | $8.40 | $28.00 | 70% |
| Urinalysis without microscope exam, automated CPT 81003 UA without Microscopic Charge | $8.40 | $28.00 | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Ketone Urine | $6.30 | $21.00 | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urogram | $6.30 | $21.00 | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis | $8.40 | $28.00 | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA without Microscopic Charge | $8.40 | $28.00 | 70% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA (Culture if Positive) | $8.40 | $28.00 | 70% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with endoscopic ultrasound CPT 45391 END-Colonoscopy/ultrasound | $1,012.50 | $3,375.00 | 70% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 END-Colonoscopy/ultrasound | $1,012.50 | $3,375.00 | 70% |
| Colonoscopy with polyp removal CPT 45385 END-Colonoscopy w/Poly | $727.80 | $2,426.00 | 70% |
| Colonoscopy with polyp removal CPT 45385 COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ | $1,125.90 | $3,753.00 | 70% |
| Colonoscopy with polyp removal inpatient CPT 45385 END-Colonoscopy w/Poly | $727.80 | $2,426.00 | 70% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLSC FLX W-RMVL OF TUMOR POLYP LESION SNARE TQ | $1,125.90 | $3,753.00 | 70% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy Flex w/Biopsy Sngl or Multi | $706.50 | $2,355.00 | 70% |
| Colonoscopy with tissue sample CPT 45380 END-Colonoscopy w/ Biopsy | $727.80 | $2,426.00 | 70% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE | $1,710.60 | $5,702.00 | 70% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy Flex w/Biopsy Sngl or Multi | $706.50 | $2,355.00 | 70% |
| Colonoscopy with tissue sample inpatient CPT 45380 END-Colonoscopy w/ Biopsy | $727.80 | $2,426.00 | 70% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W-BIOPSY SINGLE-MULTIPLE | $1,710.60 | $5,702.00 | 70% |
| Colonoscopy, diagnostic CPT 45378 END-Colonoscopy Spl Flex | $1,081.50 | $3,605.00 | 70% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD | $1,710.60 | $5,702.00 | 70% |
| Colonoscopy, diagnostic inpatient CPT 45378 END-Colonoscopy Spl Flex | $1,081.50 | $3,605.00 | 70% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLX DX W-COLLJ SPEC WHEN PFRMD | $1,710.60 | $5,702.00 | 70% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY | $2,681.10 | $8,937.00 | 70% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surgical Cholecystectomy | $4,231.50 | $14,105.00 | 70% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY | $2,681.10 | $8,937.00 | 70% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy Surgical Cholecystectomy | $4,231.50 | $14,105.00 | 70% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN REDUCIBL | $1,710.60 | $5,702.00 | 70% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 END-Repair Initial Inguinal Hernia > age 5 yrs | $2,566.50 | $8,555.00 | 70% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 END-Repair Inguinal Hernia | $2,566.50 | $8,555.00 | 70% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 RPR 1ST INGUN HRNA AGE 5 YRS-GREATER THAN REDUCIBL | $1,710.60 | $5,702.00 | 70% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 END-Repair Initial Inguinal Hernia > age 5 yrs | $2,566.50 | $8,555.00 | 70% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 END-Repair Inguinal Hernia | $2,566.50 | $8,555.00 | 70% |
| Knee arthroscopy with meniscus trim CPT 29881 ARTHRS KNEE SURG W-MENISCECTOMY MED-LAT W-SHVG | $1,710.60 | $5,702.00 | 70% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRS KNEE SURG W-MENISCECTOMY MED-LAT W-SHVG | $1,710.60 | $5,702.00 | 70% |
| Left heart catheterization, diagnostic CPT 93452 LHC /- LV | $5,107.80 | $17,026.00 | 70% |
| Left heart catheterization, diagnostic inpatient CPT 93452 LHC /- LV | $5,107.80 | $17,026.00 | 70% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inject diag/therapeutic substance w/needle or cath | $660.90 | $2,203.00 | 70% |
| Lower-back epidural injection, with imaging guidance CPT 62323 MECT Exam | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance CPT 62323 L/S Spinal Inj | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance CPT 62323 SP Limited Exam | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection diagnostic or therapeutic substance not | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX DX-THER SBST INTRLMNR LMBR-SAC W-IMG GDN | $898.20 | $2,994.00 | 70% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inject diag/therapeutic substance w/needle or cath | $660.90 | $2,203.00 | 70% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 SP Limited Exam | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 MECT Exam | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection diagnostic or therapeutic substance not | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 L/S Spinal Inj | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX DX-THER SBST INTRLMNR LMBR-SAC W-IMG GDN | $898.20 | $2,994.00 | 70% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection diagnostic or therapeutic substance not | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Intrathecal Injection | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX DX-THER SBST INTRLMNR LMBR-SAC W-O IMG GDN | $898.20 | $2,994.00 | 70% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Intrathecal Injection | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Injection diagnostic or therapeutic substance not | $680.70 | $2,269.00 | 70% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX DX-THER SBST INTRLMNR LMBR-SAC W-O IMG GDN | $898.20 | $2,994.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Foramen Epidura L/S-CT | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 MSP Exam | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Foramen Epidural L/S | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT Exam | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AAAND-STRD TFRML EPI LUMBAR-SACRAL 1 LEVEL | $898.20 | $2,994.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 CT Exam | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj Foramen Epidural L/S | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj Foramen Epidura L/S-CT | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 MSP Exam | $568.20 | $1,894.00 | 70% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AAAND-STRD TFRML EPI LUMBAR-SACRAL 1 LEVEL | $898.20 | $2,994.00 | 70% |
| Prostate biopsy CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $1,125.90 | $3,753.00 | 70% |
| Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $1,125.90 | $3,753.00 | 70% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPS SURG PRST8ECT RPBIC RAD W-NERVE SPARING | $2,681.10 | $8,937.00 | 70% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPS SURG PRST8ECT RPBIC RAD W-NERVE SPARING | $2,681.10 | $8,937.00 | 70% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST-ABERRANT BREAST TISSUE OPEN 1-GREATER THA | $1,710.60 | $5,702.00 | 70% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST-ABERRANT BREAST TISSUE OPEN 1-GREATER THA | $1,710.60 | $5,702.00 | 70% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SURGICAL ARTHROSCOPY SHO W-CORACOACRM LIGM RLS | $2,285.70 | $7,619.00 | 70% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SURGICAL ARTHROSCOPY SHO W-CORACOACRM LIGM RLS | $2,285.70 | $7,619.00 | 70% |
| Total hip replacement CPT 27130 ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT | $2,285.70 | $7,619.00 | 70% |
| Total hip replacement inpatient CPT 27130 ARTHRP ACETBLR-PROX FEM PROSTC AGRFT-ALGRFT | $2,285.70 | $7,619.00 | 70% |
| Total knee replacement CPT 27447 ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMEN | $2,285.70 | $7,619.00 | 70% |
| Total knee replacement inpatient CPT 27447 ARTHRP KNE CONDYLEANDPLATU MEDIALANDLAT COMPARTMEN | $2,285.70 | $7,619.00 | 70% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD with biopsy | $1,081.50 | $3,605.00 | 70% |
| Upper endoscopy (EGD) with biopsy CPT 43239 END-Esophogogastroscopy w/Bx | $1,081.50 | $3,605.00 | 70% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD TRANSORAL BIOPSY SINGLE-MULTIPLE | $2,681.10 | $8,937.00 | 70% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD with biopsy | $1,081.50 | $3,605.00 | 70% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 END-Esophogogastroscopy w/Bx | $1,081.50 | $3,605.00 | 70% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD TRANSORAL BIOPSY SINGLE-MULTIPLE | $2,681.10 | $8,937.00 | 70% |
| Upper endoscopy (EGD), diagnostic CPT 43235 END-Esophagogastroduoden Diagnostic | $779.70 | $2,599.00 | 70% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Upper GI Endoscopy w/w-o Specimen Collection | $779.70 | $2,599.00 | 70% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Upper GI Endoscopy w/w-o Specimen Collection | $779.70 | $2,599.00 | 70% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 END-Esophagogastroduoden Diagnostic | $779.70 | $2,599.00 | 70% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 IOP PSY - Family Therapy w/Pt Present | $108.90 | $363.00 | 70% |
| Family therapy with the patient, 50 minutes CPT 90847 IOP CD - Family Therapy w/Pt Present | $108.90 | $363.00 | 70% |
| Family therapy with the patient, 50 minutes CPT 90847 Family Therapy w/Pt Present | $108.90 | $363.00 | 70% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 IOP PSY - Family Therapy w/Pt Present | $108.90 | $363.00 | 70% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 IOP CD - Family Therapy w/Pt Present | $108.90 | $363.00 | 70% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy w/Pt Present | $108.90 | $363.00 | 70% |
| Family therapy without the patient, 50 minutes CPT 90846 Family Therapy w/o Pt Present | $37.80 | $126.00 | 70% |
| Family therapy without the patient, 50 minutes CPT 90846 IOP CD - Family Therapy w/o Pt Present | $37.80 | $126.00 | 70% |
| Family therapy without the patient, 50 minutes CPT 90846 IOP PSY - Family Therapy w/o Pt Present | $37.80 | $126.00 | 70% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 IOP CD - Family Therapy w/o Pt Present | $37.80 | $126.00 | 70% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 IOP PSY - Family Therapy w/o Pt Present | $37.80 | $126.00 | 70% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Therapy w/o Pt Present | $37.80 | $126.00 | 70% |
| Group psychotherapy session CPT 90853 Group Therapy | $61.80 | $206.00 | 70% |
| Group psychotherapy session CPT 90853 IOP PSY - Group Psychotherapy | $61.80 | $206.00 | 70% |
| Group psychotherapy session CPT 90853 IOP CD - Group Psychotherapy | $61.80 | $206.00 | 70% |
| Group psychotherapy session inpatient CPT 90853 Group Therapy | $61.80 | $206.00 | 70% |
| Group psychotherapy session inpatient CPT 90853 IOP CD - Group Psychotherapy | $61.80 | $206.00 | 70% |
| Group psychotherapy session inpatient CPT 90853 IOP PSY - Group Psychotherapy | $61.80 | $206.00 | 70% |
| New patient office visit, about 30 minutes CPT 99203 OP Eval - New Pt Exp Focused | $88.20 | $294.00 | 70% |
| New patient office visit, about 30 minutes CPT 99203 EVM - OP VISIT NEW PATIENT LOW LEVEL 30 MIN | $91.20 | $304.00 | 70% |
| New patient office visit, about 30 minutes CPT 99203 WC-OP visit new patient low level 30-44 min | $101.10 | $337.00 | 70% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OP Eval - New Pt Exp Focused | $88.20 | $294.00 | 70% |
| New patient office visit, about 30 minutes inpatient CPT 99203 EVM - OP VISIT NEW PATIENT LOW LEVEL 30 MIN | $91.20 | $304.00 | 70% |
| New patient office visit, about 30 minutes inpatient CPT 99203 WC-OP visit new patient low level 30-44 min | $101.10 | $337.00 | 70% |
| New patient office visit, about 45 minutes CPT 99204 EVM - OP VISIT NEW PATIENT MODERATE LEVEL 45 MIN | $106.80 | $356.00 | 70% |
| New patient office visit, about 45 minutes CPT 99204 WC-OP visit new patient moderate level 45-59 min | $130.50 | $435.00 | 70% |
| New patient office visit, about 45 minutes inpatient CPT 99204 EVM - OP VISIT NEW PATIENT MODERATE LEVEL 45 MIN | $106.80 | $356.00 | 70% |
| New patient office visit, about 45 minutes inpatient CPT 99204 WC-OP visit new patient moderate level 45-59 min | $130.50 | $435.00 | 70% |
| New patient office visit, about 60 minutes CPT 99205 EVM - OP VISIT NEW PATIENT HIGH LEVEL 60 MIN | $121.80 | $406.00 | 70% |
| New patient office visit, about 60 minutes CPT 99205 WC-OP visit new patient high level 60-74 min | $177.00 | $590.00 | 70% |
| New patient office visit, about 60 minutes inpatient CPT 99205 EVM - OP VISIT NEW PATIENT HIGH LEVEL 60 MIN | $121.80 | $406.00 | 70% |
| New patient office visit, about 60 minutes inpatient CPT 99205 WC-OP visit new patient high level 60-74 min | $177.00 | $590.00 | 70% |
Dental
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Porcelain crown CDT D2740 CROWN 1 CNT UP L X_504-2726 X_PATTERSON DENTAL | $67.80 | $226.00 | 70% |
| Porcelain crown CDT D2740 CROWN 1 PR1 UR5 X_8906-125 X_DENOVO | $67.80 | $226.00 | 70% |
| Porcelain crown CDT D2740 CROWN 1 LAT UP L X_504-2809 X_PATTERSON DENTAL | $67.80 | $226.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM UR5 X_5040530 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM UR3 X_5040456 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM UL5 X_5040548 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM UL3 X_5040464 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM UR4 X_5040498 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM UL4 X_5040506 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM LR4 X_900144 X_PATTERSON DENT | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM LR3 X_900243 X_PATTERSON DENT | $69.30 | $231.00 | 70% |
| Porcelain crown CDT D2740 CROWN UNITEK SS PRIM LR3 X_900244 X_PATTERSON DENT | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN 1 PR1 UR5 X_8906-125 X_DENOVO | $67.80 | $226.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN 1 CNT UP L X_504-2726 X_PATTERSON DENTAL | $67.80 | $226.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN 1 LAT UP L X_504-2809 X_PATTERSON DENTAL | $67.80 | $226.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM LR3 X_900243 X_PATTERSON DENT | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM UL4 X_5040506 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM UL3 X_5040464 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM LR4 X_900144 X_PATTERSON DENT | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM UL5 X_5040548 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM UR5 X_5040530 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM UR4 X_5040498 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM UR3 X_5040456 X_PATTERSON DEN | $69.30 | $231.00 | 70% |
| Porcelain crown inpatient CDT D2740 CROWN UNITEK SS PRIM LR3 X_900244 X_PATTERSON DENT | $69.30 | $231.00 | 70% |
Source file: https://bestcare.org/sites/default/files/2026-02/420680355_Jennie-Edmundson-Memorial-Hospital_standardcharges.zip