SelfPayRates
Hospital Waco, TX

Ascension Providence

Ascension Providence in Waco, TX publishes cash prices for 39 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.

6901 Medical Pkwy Waco TX 76712 Collected Sep 23, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W CONTRAST $1,805.22 $5,014.50 64%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 *CT ABD/PELVIS W CONTRAST(2) $1,895.49 $5,265.25 64%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W CONTRAST $1,895.49 $5,265.25 64%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV PEDI APPENDICITIS $1,895.49 $5,265.25 64%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV PEDI APPENDICITIS $1,895.49 $5,265.25 64%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 *CT ABD/PELVIS W CONTRAST(2) $1,895.49 $5,265.25 64%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS W CONTRAST $1,805.22 $5,014.50 64%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 *CT ABD/PELVIS W CONTRAST(2) $1,895.49 $5,265.25 64%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELV PEDI APPENDICITIS $1,895.49 $5,265.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 OR OPERATIVE CT HEAD $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 HEAD SCAN NON-CONTRASTEIM $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 HEAD SCAN NON-CONTRASTEIM $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN LAB HEAD $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN LAB HEAD $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD OR BRAIN W/O CONTRAST $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD OR BRAIN W/O CONTRAST $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye CPT 70450 OR OPERATIVE CT HEAD $695.25 $1,931.25 64%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD OR BRAIN W/O CONTRAST $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN LAB HEAD $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HEAD SCAN NON-CONTRASTEIM $662.13 $1,839.25 64%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 OR OPERATIVE CT HEAD $695.25 $1,931.25 64%
CT scan of the pelvis, with contrast dye CPT 72193 *CT PELVIS W CONTRAST-2 $450.90 $1,252.50 64%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST $450.90 $1,252.50 64%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST $450.90 $1,252.50 64%
CT scan of the pelvis, with contrast dye CPT 72193 PELVIS CONTRAST EIM $473.49 $1,315.25 64%
CT scan of the pelvis, with contrast dye CPT 72193 PELVIS CONTRAST EIM $473.49 $1,315.25 64%
CT scan of the pelvis, with contrast dye CPT 72193 *CT PELVIS W CONTRAST-2 $473.49 $1,315.25 64%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST $450.90 $1,252.50 64%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 *CT PELVIS W CONTRAST-2 $450.90 $1,252.50 64%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 PELVIS CONTRAST EIM $473.49 $1,315.25 64%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAG IMPLANT W/CAD BILAT $180.72 $502.00 64%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAGNOSTIC W/CAD BILAT $180.72 $502.00 64%
Diagnostic mammogram, both breasts both sides CPT 77066 POST BX/NEEDLE LOC DIAG MAM BI $180.72 $502.00 64%
Diagnostic mammogram, both breasts both sides CPT 77066 POST US BX/LOC DIAG MAM BI $180.72 $502.00 64%
Diagnostic mammogram, both breasts both sides CPT 77066 POST US BX/LOC DIAG MAM BI $198.81 $552.25 64%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAG IMPLANT W/CAD BILAT $198.81 $552.25 64%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAGNOSTIC W/CAD BILAT $198.81 $552.25 64%
Diagnostic mammogram, both breasts both sides CPT 77066 POST BX/NEEDLE LOC DIAG MAM BI $198.81 $552.25 64%
Diagnostic mammogram, both breasts CPT 77066 CB MAMMO DIAGNOSTIC BIL $180.72 $502.00 64%
Diagnostic mammogram, both breasts CPT 77066 CB MAMMO DIAG IMPLANT BIL $180.72 $502.00 64%
Diagnostic mammogram, both breasts CPT 77066 CB MAMMO DIAG IMPLANT BIL $198.81 $552.25 64%
Diagnostic mammogram, both breasts CPT 77066 CB MAMMO DIAGNOSTIC BIL $198.81 $552.25 64%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 POST US BX/LOC DIAG MAM BI $180.72 $502.00 64%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 POST BX/NEEDLE LOC DIAG MAM BI $180.72 $502.00 64%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DIAGNOSTIC W/CAD BILAT $180.72 $502.00 64%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DIAG IMPLANT W/CAD BILAT $198.81 $552.25 64%
Diagnostic mammogram, both breasts inpatient CPT 77066 CB MAMMO DIAGNOSTIC BIL $198.81 $552.25 64%
Diagnostic mammogram, both breasts inpatient CPT 77066 CB MAMMO DIAG IMPLANT BIL $198.81 $552.25 64%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC W/CAD LEFT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 POST US BX/NEEDLE LOC MAM LT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 POST US BX/NEEDLE LOC MAM RT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAG IMPLANT W/CAD RIGHT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 POST BX/NEEDLE LOC DIAG MAM RT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAGNOSTIC W/CAD RIGHT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 CB MAMMO DIAG IMPLANT LT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 CB MAMMO DIAG IMPLANT RT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAG IMPLANT W/CAD LEFT $118.62 $329.50 64%
Diagnostic mammogram, one breast one side CPT 77065 POST BX/NEEDLE LOC DIAG MAM LT $130.50 $362.50 64%
Diagnostic mammogram, one breast one side CPT 77065 CB MAMMO DIAGNOSTIC LT $130.50 $362.50 64%
Diagnostic mammogram, one breast one side CPT 77065 CB MAMMO DIAGNOSTIC RT $130.50 $362.50 64%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JOINT W/O CONTRAST $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JOINT W/O CONTRAST $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE VISIONAIRE RIGHT $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE VISIONAIRE RIGHT $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE VISIONAIRE LEFT $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LEFT W/O $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE LEFT W/O $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RIGHT W/O $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LEFT W/O $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE LEFT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LEFT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE LEFT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE VISIONAIRE LEFT $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXT JOINT W/O CONTRAST $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP RIGHT W/O $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE VISIONAIRE RIGHT $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE LEFT W/O $872.37 $2,423.25 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LEFT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE VISIONAIRE LEFT $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE RIGHT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE LEFT W/O $959.58 $2,665.50 64%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXT JOINT BOTH $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXT JOINT BOTH $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE LEFT W/O W/ $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP RIGHT W/ W/O $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP RIGHT W/ W/O $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE RIGHT W/O W/ $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE RIGHT W/O W/ $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE RIGHT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE RIGHT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOW EXT JOINT BOTH $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE LEFT W/O W/ $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP RIGHT W/ W/O $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE RIGHT W/O W/ $1,327.68 $3,688.00 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE LEFT W/O W/ $1,460.43 $4,056.75 64%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE RIGHT W/O W/ $1,460.43 $4,056.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/STEALTH W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN PIT W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O (MS PROTOCOL) $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O(STEALTH MARKERS) $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/IACS W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/ORBITS W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/TRIGEMINAL W/O CONT $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/TRIGEMINAL W/O CONT $445.95 $1,238.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/STEALTH W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN PIT W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/ORBITS W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O (MS PROTOCOL) $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O(STEALTH MARKERS) $490.59 $1,362.75 64%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/IACS W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O(STEALTH MARKERS) $445.95 $1,238.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/IACS W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN PIT W/O $445.95 $1,238.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/TRIGEMINAL W/O CONT $445.95 $1,238.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/STEALTH W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST $490.59 $1,362.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/ORBITS W/O $490.59 $1,362.75 64%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O (MS PROTOCOL) $490.59 $1,362.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN TRIGEM NEURAL W W/O $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/W CONTRAST $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/W CONTRAST $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BOTH STEALTH MARKERS $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ W/O $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BOTH (MS PROTOCOL) $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/IACS W/O W/ $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/ORBITS W/O W/ $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/PITUITARY W/O W $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/PITUITARY W/O W $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN TRIGEMINAL W/O W $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN TRIGEMINAL W/O W $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ W/O $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BOTH STEALTH MARKERS $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BOTH (MS PROTOCOL) $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/IACS W/O W/ $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/ORBITS W/O W/ $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN TRIGEM NEURAL W W/O $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/O W/ $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/O W/ $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN TRIGEM NEURAL W W/O $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN BOTH STEALTH MARKERS $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ W/O $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO/W CONTRAST $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/ORBITS W/O W/ $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN BOTH (MS PROTOCOL) $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/PITUITARY W/O W $1,327.68 $3,688.00 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/O W/ $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN TRIGEMINAL W/O W $1,460.43 $4,056.75 64%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/IACS W/O W/ $1,460.43 $4,056.75 64%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR W/O $872.37 $2,423.25 64%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR W/O CONTRAST $872.37 $2,423.25 64%
MRI of the lower back, no contrast dye CPT 72148 MRI THORACOLUMBAR W/O $872.37 $2,423.25 64%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE VERTEBROPLASTY-LTD $872.37 $2,423.25 64%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR W/O CONTRAST $959.58 $2,665.50 64%
MRI of the lower back, no contrast dye CPT 72148 MRI THORACOLUMBAR W/O $959.58 $2,665.50 64%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE VERTEBROPLASTY-LTD $959.58 $2,665.50 64%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR W/O $959.58 $2,665.50 64%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINE VERTEBROPLASTY-LTD $872.37 $2,423.25 64%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR W/O CONTRAST $872.37 $2,423.25 64%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR W/O $959.58 $2,665.50 64%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI THORACOLUMBAR W/O $959.58 $2,665.50 64%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB>=14 WKS,SINGLE FETUS $261.27 $725.75 64%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB>=14 WKS,SINGLE FETUS $261.27 $725.75 64%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREGNANCY > 14 WEEKS $287.37 $798.25 64%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREGNANCY > 14 WEEKS $287.37 $798.25 64%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB>=14 WKS,SINGLE FETUS $261.27 $725.75 64%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREGNANCY > 14 WEEKS $287.37 $798.25 64%
Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMO W/CAD BILAT $150.30 $417.50 64%
Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMO W/CAD BILAT $150.30 $417.50 64%
Screening mammogram, both breasts CPT 77067 SCREEN MAMMO IMPLANT W/CAD BIL $136.62 $379.50 64%
Screening mammogram, both breasts CPT 77067 SCREEN MAMMO IMPLANT W/CAD BIL $150.30 $417.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING IMPLANT UNI LT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING IMPLANT UNI RT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING IMPLANT UNI LT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING IMPLANT UNI RT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO W/CAD RT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREEN MAMMO IMPLANT W/CAD LT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO W/CAD RT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREEN MAMMO IMPLANT W/CAD LT $118.62 $329.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREEN MAMMO IMPLANT W/CAD RT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO UNI LT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO UNI RT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREEN MAMMO IMPLANT W/CAD RT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO W/CAD LT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO UNI RT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO UNI LT $130.50 $362.50 64%
Screening mammogram, both breasts one side CPT 77067 SCREENING MAMMO W/CAD LT $130.50 $362.50 64%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMO W/CAD BILAT $150.30 $417.50 64%
Screening mammogram, both breasts inpatient CPT 77067 SCREEN MAMMO IMPLANT W/CAD BIL $150.30 $417.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING IMPLANT UNI RT $118.62 $329.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING IMPLANT UNI LT $118.62 $329.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING MAMMO W/CAD RT $118.62 $329.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREEN MAMMO IMPLANT W/CAD LT $118.62 $329.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING MAMMO W/CAD LT $130.50 $362.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREEN MAMMO IMPLANT W/CAD RT $130.50 $362.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING MAMMO UNI LT $130.50 $362.50 64%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING MAMMO UNI RT $130.50 $362.50 64%
Sleep study in a lab (polysomnography) CPT 95810 6 AND OLDER PSG $2,684.07 $7,455.75 64%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL $241.47 $670.75 64%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ULTRASOUND $241.47 $670.75 64%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ULTRASOUND $241.47 $670.75 64%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL $265.59 $737.75 64%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL $241.47 $670.75 64%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ULTRASOUND $241.47 $670.75 64%
Ultrasound of the abdomen, complete CPT 76700 ABDOM COMP Q70 $360.09 $1,000.25 64%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE $360.09 $1,000.25 64%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE $360.09 $1,000.25 64%
Ultrasound of the abdomen, complete CPT 76700 ABDOM COMP Q70 $396.09 $1,100.25 64%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE $360.09 $1,000.25 64%
Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOM COMP Q70 $396.09 $1,100.25 64%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR W/OBLIQUES 5 V E4H $236.52 $657.00 64%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL MINIMUM 4 $236.52 $657.00 64%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR W/OBLIQUES 5 V E4H $236.52 $657.00 64%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL MINIMUM 4 $236.52 $657.00 64%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMBOSACRAL MINIMUM 4 $236.52 $657.00 64%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR W/OBLIQUES 5 V E4H $236.52 $657.00 64%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC $96.03 $266.75 64%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC $96.03 $266.75 64%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC $96.03 $266.75 64%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 NMR LIPOPROFILE+LIPIDS 80061 $55.08 $153.00 64%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 NMR LIPOPROFILE+LIPIDS 80061 $57.87 $160.75 64%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID SCREEN $91.08 $253.00 64%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID SCREEN $95.67 $265.75 64%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 NMR LIPOPROFILE+LIPIDS 80061 $55.08 $153.00 64%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID SCREEN $95.67 $265.75 64%
Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFF $44.10 $122.50 64%
Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFF $44.10 $122.50 64%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFF $44.10 $122.50 64%
Complete blood count (CBC), no differential CPT 85027 CBC NO DIFF $30.33 $84.25 64%
Complete blood count (CBC), no differential CPT 85027 CBC NO DIFF $30.33 $84.25 64%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC NO DIFF $30.33 $84.25 64%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC $115.38 $320.50 64%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC $115.38 $320.50 64%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC $115.38 $320.50 64%
Kidney function blood test panel CPT 80069 RENAL FUNCTION $94.50 $262.50 64%
Kidney function blood test panel CPT 80069 RENAL FUNCTION $94.50 $262.50 64%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION $94.50 $262.50 64%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION $44.91 $124.75 64%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION $47.16 $131.00 64%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION $47.16 $131.00 64%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE $44.37 $123.25 64%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE $46.62 $129.50 64%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE $44.37 $123.25 64%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (DIAGNOSTIC) $54.90 $152.50 64%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (DIAGNOSTIC) $57.69 $160.25 64%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA - ULTRA SENSITIVE $57.69 $160.25 64%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA - ULTRA SENSITIVE $60.57 $168.25 64%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (DIAGNOSTIC) $57.69 $160.25 64%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA - ULTRA SENSITIVE $57.69 $160.25 64%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT $49.05 $136.25 64%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT $51.48 $143.00 64%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT $51.48 $143.00 64%
Prothrombin time (PT/INR) clotting test CPT 85610 PT INHIBITOR SCREEN $22.68 $63.00 64%
Prothrombin time (PT/INR) clotting test CPT 85610 PT INHIBITOR SCREEN $23.85 $66.25 64%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME $40.41 $112.25 64%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME $42.39 $117.75 64%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT INHIBITOR SCREEN $22.68 $63.00 64%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME $40.41 $112.25 64%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH $69.93 $194.25 64%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH $73.44 $204.00 64%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH $73.44 $204.00 64%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS $33.66 $93.50 64%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS $33.66 $93.50 64%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS $33.66 $93.50 64%
Urinalysis without microscope exam, automated CPT 81003 PROTEIN URINE $13.77 $38.25 64%
Urinalysis without microscope exam, automated CPT 81003 PROTEIN URINE $13.77 $38.25 64%
Urinalysis without microscope exam, automated inpatient CPT 81003 PROTEIN URINE $13.77 $38.25 64%
Urinalysis without microscope exam, manual CPT 81002 PH URINE $16.65 $46.25 64%
Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAV URINE $16.65 $46.25 64%
Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAV URINE $16.65 $46.25 64%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIP PROTEIN/GLUCOSE $16.65 $46.25 64%
Urinalysis without microscope exam, manual CPT 81002 PH URINE $16.65 $46.25 64%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIP PROTEIN/GLUCOSE $17.46 $48.50 64%
Urinalysis without microscope exam, manual inpatient CPT 81002 PH URINE $16.65 $46.25 64%
Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAV URINE $16.65 $46.25 64%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS DIP PROTEIN/GLUCOSE $17.46 $48.50 64%

Surgery and procedures

ProcedureCash price List priceOff list
Left heart catheterization, diagnostic CPT 93452 93452-LHC, LV $3,751.20 $10,420.00 64%
Lower-back epidural injection, with imaging guidance CPT 62323 62323-INJ EPIDRL L/S SPI W/IMG $777.78 $2,160.50 64%
Lower-back epidural injection, with imaging guidance CPT 62323 EPI L/SACRAL INJ - P $777.78 $2,160.50 64%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 64483-INJ AA&/STTFEPI L/S1L BI $1,605.87 $4,460.75 64%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NERVE BLOCK VERTEBRAL $686.61 $1,907.25 64%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483-INJ AA&/STR TFEPI L/S 1L $686.61 $1,907.25 64%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 IR EPI FORAM LUMB/S W/IMAGE $686.61 $1,907.25 64%
Prostate biopsy CPT 55700 BIOPSY PROSTATE $544.50 $1,512.50 64%

Doctor visits and therapy

ProcedureCash price List priceOff list
New patient office visit, about 30 minutes CPT 99203 99203-OFF/OUTPT NEW LOW 30 MIN $177.75 $493.75 64%
New patient office visit, about 30 minutes CPT 99203 O/P VISIT - NEW PT - INTER $195.57 $543.25 64%
New patient office visit, about 30 minutes CPT 99203 NEW PT VISIT INTERMEDIATE $195.57 $543.25 64%
New patient office visit, about 45 minutes CPT 99204 99204-OFF/OUTPT NEW MOD 45 MIN $229.77 $638.25 64%
New patient office visit, about 45 minutes CPT 99204 NEW PT VISIT EXTENDED $229.77 $638.25 64%
New patient office visit, about 45 minutes CPT 99204 O/P VISIT - NEW PT - EXTENDED $229.77 $638.25 64%
New patient office visit, about 60 minutes CPT 99205 O/P VISIT - COMPLEX $273.87 $760.75 64%
New patient office visit, about 60 minutes CPT 99205 99205-OFF/OUTPT NEW HI 60 MIN $273.87 $760.75 64%
New patient office visit, about 60 minutes CPT 99205 NEW PT VISIT COMPLEX $273.87 $760.75 64%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE $44.37 $123.25 64%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE PT $44.37 $123.25 64%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT - THER EX $44.37 $123.25 64%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EX $44.37 $123.25 64%

Source file: https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/tx-csv/741109636_ascension-providence_standardcharges.csv