Ascension Via Christi Hospital Manhattan, Inc.
Ascension Via Christi Hospital Manhattan, Inc. in Manhattan, KS publishes cash prices for 41 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
1823 College Ave Manhattan KS 66502 Collected Sep 23, 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 CT ENTEROGRAPHY-SM BOWEL 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY-SM BOWEL 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 ABD/PELVIS W/CONTRAST 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 ABD/PELVIS W/CONTRAST 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY-SM BOWEL 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY-SM BOWEL 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 ABD/PELVIS W/CONTRAST 74177 | $2,256.00 | $5,640.00 | 60% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $206.00 | $515.00 | 60% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $206.00 | $515.00 | 60% |
| CT scan of the head or brain, no contrast dye CPT 70450 HEAD W/O CONTRAST 70450 | $1,061.20 | $2,653.00 | 60% |
| CT scan of the head or brain, no contrast dye CPT 70450 HEAD W/O CONTRAST 70450 | $1,061.20 | $2,653.00 | 60% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $206.00 | $515.00 | 60% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HEAD W/O CONTRAST 70450 | $1,061.20 | $2,653.00 | 60% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HEAD W/O CONTRAST 70450 | $1,061.20 | $2,653.00 | 60% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $206.00 | $515.00 | 60% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $206.00 | $515.00 | 60% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $1,253.20 | $3,133.00 | 60% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $1,253.20 | $3,133.00 | 60% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST | $206.00 | $515.00 | 60% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST | $1,253.20 | $3,133.00 | 60% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST | $1,253.20 | $3,133.00 | 60% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI 77066 | $179.60 | $449.00 | 60% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI 77066 | $179.60 | $449.00 | 60% |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI 77065 | $140.80 | $352.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HIP BIL W/O 7372150 | $2,303.60 | $5,759.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HIP BIL W/O 7372150 | $2,303.60 | $5,759.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE RT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE RT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE LT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE LT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HIP BIL W/O 7372150 | $2,303.60 | $5,759.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HIP BIL W/O 7372150 | $2,303.60 | $5,759.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP RT W/O 73721RT | $230.00 | $575.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE LT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE RT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP LT W/O 73721LT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP RT W/O 73721RT | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE LT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE RT LIM PREOP-TOTAL KNEE | $1,270.80 | $3,177.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HIP LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HIP RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE LT W & W/O 73723LT | $1,247.60 | $3,119.00 | 60% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE RT W & W/O 73723RT | $1,247.60 | $3,119.00 | 60% |
| MRI of the brain, no contrast dye CPT 70551 BRAIN W/O 70551 | $1,436.40 | $3,591.00 | 60% |
| MRI of the brain, no contrast dye CPT 70551 BRAIN W/O 70551 | $1,436.40 | $3,591.00 | 60% |
| MRI of the brain, no contrast dye inpatient CPT 70551 BRAIN W/O 70551 | $1,436.40 | $3,591.00 | 60% |
| MRI of the brain, with and without contrast dye CPT 70553 BRAIN W & W/O 70553 | $2,116.00 | $5,290.00 | 60% |
| MRI of the brain, with and without contrast dye CPT 70553 BRAIN W & W/O 70553 | $2,116.00 | $5,290.00 | 60% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 BRAIN W & W/O 70553 | $2,116.00 | $5,290.00 | 60% |
| MRI of the lower back, no contrast dye CPT 72148 L-SPINE W/O 72148 | $1,431.60 | $3,579.00 | 60% |
| MRI of the lower back, no contrast dye CPT 72148 L-SPINE W/O 72148 | $1,431.60 | $3,579.00 | 60% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 L-SPINE W/O 72148 | $1,431.60 | $3,579.00 | 60% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 L-SPINE W/O 72148 | $1,431.60 | $3,579.00 | 60% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB AFTER FIRST TRIMESTER >14WK | $555.20 | $1,388.00 | 60% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB AFTER FIRST TRIMESTER >14WK | $555.20 | $1,388.00 | 60% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB AFTER FIRST TRIMESTER >14WK | $555.20 | $1,388.00 | 60% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI W/CAD 77067 | $179.60 | $449.00 | 60% |
| Screening mammogram, both breasts CPT 77067 SCR BIL W/CAD CORP 77067 | $118.40 | $296.00 | 60% |
| Screening mammogram, both breasts one side CPT 77067 SCR MAMMO UNI RT W/CAD 77067 | $140.80 | $352.00 | 60% |
| Screening mammogram, both breasts one side CPT 77067 SCR MAMMO UNI LT W/CAD 77067 | $140.80 | $352.00 | 60% |
| Screening mammogram, both breasts inpatient one side CPT 77067 SCR MAMMO UNI LT W/CAD 77067 | $140.80 | $352.00 | 60% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAM TECHNICAL COMP | $1,174.40 | $2,936.00 | 60% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAM TECHNICAL COMP | $1,174.40 | $2,936.00 | 60% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAM TECHNICAL COMP | $1,174.40 | $2,936.00 | 60% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAM TECHNICAL COMP | $1,174.40 | $2,936.00 | 60% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ECHO 76830 | $404.40 | $1,011.00 | 60% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ECHO 76830 | $404.40 | $1,011.00 | 60% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ECHO 76830 | $404.40 | $1,011.00 | 60% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ECHO 76830 | $404.40 | $1,011.00 | 60% |
| Ultrasound of the abdomen, complete CPT 76700 ABDOMEN COMPLETE 76700 | $713.20 | $1,783.00 | 60% |
| Ultrasound of the abdomen, complete CPT 76700 ABDOMEN COMPLETE 76700 | $713.20 | $1,783.00 | 60% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMEN COMPLETE 76700 | $713.20 | $1,783.00 | 60% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMEN COMPLETE 76700 | $713.20 | $1,783.00 | 60% |
| X-ray of the lower back, 4 or more views CPT 72110 L-SPINE MIN 4 VIEWS 72110 | $109.20 | $273.00 | 60% |
| X-ray of the lower back, 4 or more views CPT 72110 L-SPINE MIN 4 VIEWS 72110 | $109.20 | $273.00 | 60% |
| X-ray of the lower back, 4 or more views CPT 72110 BACK X-RAYS | $127.60 | $319.00 | 60% |
| X-ray of the lower back, 4 or more views CPT 72110 BACK X-RAYS | $127.60 | $319.00 | 60% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 L-SPINE MIN 4 VIEWS 72110 | $109.20 | $273.00 | 60% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 BACK X-RAYS | $127.60 | $319.00 | 60% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 L-SPINE MIN 4 VIEWS 72110 | $454.80 | $1,137.00 | 60% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $34.80 | $87.00 | 60% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $34.80 | $87.00 | 60% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $34.80 | $87.00 | 60% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $34.80 | $87.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIP PROFILE | $30.40 | $76.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIP PROFILE | $30.40 | $76.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $88.00 | $220.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $88.00 | $220.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIP PROFILE | $30.40 | $76.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $88.00 | $220.00 | 60% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $88.00 | $220.00 | 60% |
| Complete blood count (CBC) with differential CPT 85025 CBC | $70.80 | $177.00 | 60% |
| Complete blood count (CBC) with differential CPT 85025 CBC | $70.80 | $177.00 | 60% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC | $70.80 | $177.00 | 60% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC | $70.80 | $177.00 | 60% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM | $35.20 | $88.00 | 60% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM | $35.20 | $88.00 | 60% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM | $35.20 | $88.00 | 60% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM | $35.20 | $88.00 | 60% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $115.60 | $289.00 | 60% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $115.60 | $289.00 | 60% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL | $56.80 | $142.00 | 60% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL | $115.60 | $289.00 | 60% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $44.80 | $112.00 | 60% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $44.80 | $112.00 | 60% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $44.80 | $112.00 | 60% |
| Liver function blood test panel CPT 80076 LIVER PROFILE | $66.40 | $166.00 | 60% |
| Liver function blood test panel CPT 80076 LIVER PROFILE | $66.40 | $166.00 | 60% |
| Liver function blood test panel inpatient CPT 80076 LIVER PROFILE | $66.40 | $166.00 | 60% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC AG FREE | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC AG FREE | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC AG FREE | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC AG FREE | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC AG TOTAL | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC AG TOTAL | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROST SPECIFIC ANTIGEN | $74.40 | $186.00 | 60% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROST SPECIFIC ANTIGEN | $74.40 | $186.00 | 60% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC AG TOTAL | $61.20 | $153.00 | 60% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROST SPECIFIC ANTIGEN | $74.40 | $186.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLAS TIME (PTT) | $12.40 | $31.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLAS TIME (PTT) | $12.40 | $31.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOSIS PANEL-PTT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOSIS PANEL-LUPUS ANT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOSIS PANEL-LUPUS ANT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOSIS PANEL-PTT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PTT | $33.20 | $83.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PTT | $33.20 | $83.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTICOAGULADT APTT | $39.20 | $98.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTICOAGULADT APTT | $39.20 | $98.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLAS TIME (PTT) | $12.40 | $31.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLAS TIME (PTT) | $12.40 | $31.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOSIS PANEL-LUPUS ANT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOSIS PANEL-PTT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOSIS PANEL-PTT | $14.40 | $36.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PTT | $33.20 | $83.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PTT | $33.20 | $83.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTICOAGULADT APTT | $39.20 | $98.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTICOAGULADT APTT | $39.20 | $98.00 | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 THROMBOSIS PANEL-PT | $11.60 | $29.00 | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 THROMBOSIS PANEL-PT | $11.60 | $29.00 | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT) | $14.40 | $36.00 | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT) | $14.40 | $36.00 | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $22.40 | $56.00 | 60% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $22.40 | $56.00 | 60% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 THROMBOSIS PANEL-PT | $11.60 | $29.00 | 60% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 THROMBOSIS PANEL-PT | $11.60 | $29.00 | 60% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT) | $14.40 | $36.00 | 60% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT) | $14.40 | $36.00 | 60% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME | $22.40 | $56.00 | 60% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $101.20 | $253.00 | 60% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $101.20 | $253.00 | 60% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $101.20 | $253.00 | 60% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $101.20 | $253.00 | 60% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, NON-AUTO, W/MI | $22.00 | $55.00 | 60% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, NON-AUTO, W/MI | $22.00 | $55.00 | 60% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS | $56.80 | $142.00 | 60% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS | $56.80 | $142.00 | 60% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, NON-AUTO, W/MI | $22.00 | $55.00 | 60% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS | $56.80 | $142.00 | 60% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS | $56.80 | $142.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 URINE BLOOD-QUAL | $16.00 | $40.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 URINE BLOOD-QUAL | $16.00 | $40.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 UA W/O MICROSCOPY | $16.80 | $42.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 UA W/O MICROSCOPY | $16.80 | $42.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 SP. GRAVITY URINE | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 ACETONE UA | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 ACETONE UA | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, automated CPT 81003 SP. GRAVITY URINE | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE BLOOD-QUAL | $16.00 | $40.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE BLOOD-QUAL | $16.00 | $40.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA W/O MICROSCOPY | $16.80 | $42.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA W/O MICROSCOPY | $16.80 | $42.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 ACETONE UA | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 SP. GRAVITY URINE | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 ACETONE UA | $22.80 | $57.00 | 60% |
| Urinalysis without microscope exam, manual CPT 81002 UA W/O MICROSCOPY (REFERRED) | $15.60 | $39.00 | 60% |
| Urinalysis without microscope exam, manual CPT 81002 UA W/O MICROSCOPY (REFERRED) | $15.60 | $39.00 | 60% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA W/O MICROSCOPY (REFERRED) | $15.60 | $39.00 | 60% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC | $1,198.00 | $2,995.00 | 60% |
| Lower-back epidural injection, with imaging guidance CPT 62323 EPI INJ SPN LUMB/SACL W/IMAG | $1,198.00 | $2,995.00 | 60% |
| Lower-back epidural injection, without imaging guidance CPT 62322 EPIDURAL INJ SPINE LUMB/SACRAL | $750.40 | $1,876.00 | 60% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S | $750.40 | $1,876.00 | 60% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S | $750.40 | $1,876.00 | 60% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S | $750.40 | $1,876.00 | 60% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S | $750.40 | $1,876.00 | 60% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY | $81.20 | $203.00 | 60% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY | $81.20 | $203.00 | 60% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY | $81.20 | $203.00 | 60% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY | $81.20 | $203.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 PHYSICAL LEVEL 2 | $54.00 | $135.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 PHYSICAL LEVEL 2 | $54.00 | $135.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 PROF E&M NEW PT - LEVEL 3 | $70.40 | $176.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 PROF E&M NEW PT - LEVEL 3 | $70.40 | $176.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE OP NEW LEVEL III | $79.20 | $198.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE OP NEW LEVEL III | $79.20 | $198.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 E&M NEW PT - LEVEL 3 | $127.60 | $319.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 E&M NEW PT - LEVEL 3 | $127.60 | $319.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OPT VISIT NEW LEVEL 3 | $276.40 | $691.00 | 60% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OPT VISIT NEW LEVEL 3 | $276.40 | $691.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PHYSICAL LEVEL 2 | $54.00 | $135.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PROF E&M NEW PT - LEVEL 3 | $70.40 | $176.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PROF E&M NEW PT - LEVEL 3 | $70.40 | $176.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE OP NEW LEVEL III | $79.20 | $198.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE OP NEW LEVEL III | $79.20 | $198.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 E&M NEW PT - LEVEL 3 | $127.60 | $319.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OPT VISIT NEW LEVEL 3 | $276.40 | $691.00 | 60% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OPT VISIT NEW LEVEL 3 | $276.40 | $691.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE OP NEW LEVEL IV | $79.20 | $198.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE OP NEW LEVEL IV | $79.20 | $198.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 E&M NEW PT LEVEL 4 | $84.80 | $212.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 E&M NEW PT LEVEL 4 | $84.80 | $212.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 PROF E&M NEW PT - LEVEL 4 | $103.20 | $258.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 PROF E&M NEW PT - LEVEL 4 | $103.20 | $258.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 E&M NEW PT - LEVEL 4 | $282.40 | $706.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 E&M NEW PT - LEVEL 4 | $282.40 | $706.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OPT VISIT NEW LEVEL 4 | $322.40 | $806.00 | 60% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OPT VISIT NEW LEVEL 4 | $322.40 | $806.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE OP NEW LEVEL IV | $79.20 | $198.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 E&M NEW PT LEVEL 4 | $84.80 | $212.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 E&M NEW PT LEVEL 4 | $84.80 | $212.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PROF E&M NEW PT - LEVEL 4 | $103.20 | $258.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 E&M NEW PT - LEVEL 4 | $282.40 | $706.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OPT VISIT NEW LEVEL 4 | $322.40 | $806.00 | 60% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OPT VISIT NEW LEVEL 4 | $322.40 | $806.00 | 60% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE OP NEW LEVELV | $132.40 | $331.00 | 60% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE OP NEW LEVELV | $132.40 | $331.00 | 60% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OPT VISIT NEW LEVEL 5 | $432.00 | $1,080.00 | 60% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OPT VISIT NEW LEVEL 5 | $432.00 | $1,080.00 | 60% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE OP NEW LEVELV | $132.40 | $331.00 | 60% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OPT VISIT NEW LEVEL 5 | $432.00 | $1,080.00 | 60% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OPT VISIT NEW LEVEL 5 | $432.00 | $1,080.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE PER 15MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 TELE THERAP EXERCISE PER 15MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 EXERCISE I PER 15 MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 TELE EXERCISE I PER 15 MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 TELE THERAP EXERCISE PER 15MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE PER 15MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 EXERCISE I PER 15 MIN | $30.40 | $76.00 | 60% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE | $30.40 | $76.00 | 60% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHER-IND PHD 30MIN | $74.80 | $187.00 | 60% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHER-IND PHD 30MIN | $74.80 | $187.00 | 60% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHER-IND PHD 30MIN | $74.80 | $187.00 | 60% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHER-IND PHD 45 MIN | $74.80 | $187.00 | 60% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHER-IND PHD 45 MIN | $74.80 | $187.00 | 60% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHER-IND PHD 45 MIN | $74.80 | $187.00 | 60% |