Mount St. Mary's Hospital
Mount St. Mary's Hospital in Lewiston, NY publishes cash prices for 65 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
5300 Military Road, Lewiston, NY 14092 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 Abdomen & Pelvis W/Contrast Material | $531.35 | $531.35 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen & Pelvis W/Contrast Material | $531.35 | $531.35 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head/Brain W/O Contrast Material | $422.82 | $422.82 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head/Brain W/O Contrast Material | $422.82 | $422.82 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W/Contrast Material | $520.06 | $520.06 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W/Contrast Material | $520.06 | $520.06 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Dx Mammo Incl Cad Bi - Mammo Breast Diagnostic Bilateral | $58.20 | $383.00 | 85% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Diagnostic Mammography Computer-Aided Detcj Bi | $350.63 | $350.63 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Dx Mammo Incl Cad Bi - Mammo Breast Diagnostic Bilateral | $58.20 | $383.00 | 85% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Diagnostic Mammography Computer-Aided Detcj Bi | $350.63 | $350.63 | — |
| Diagnostic mammogram, one breast CPT 77065 Diagnostic Mammography Computer-Aided Detcj Uni | $277.46 | $277.46 | — |
| Diagnostic mammogram, one breast one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Left | $58.20 | $361.00 | 84% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Lt | $361.00 | $361.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Rt | $361.00 | $361.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Right | $361.00 | $361.00 | — |
| Diagnostic mammogram, one breast inpatient CPT 77065 Diagnostic Mammography Computer-Aided Detcj Uni | $277.46 | $277.46 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Left | $58.20 | $361.00 | 84% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Lt | $361.00 | $361.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Right | $361.00 | $361.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Dx Mammo Incl Cad Uni - Mammo Breast Diagnostic Rt | $361.00 | $361.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Any Jt Lower Extrem W/O Contrast Matrl | $815.69 | $815.69 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Jnt of Lwr Extre W/O Dye - MR Lower Ext Joint Rt WO IV Cont | $300.00 | $1,296.00 | 77% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Jnt of Lwr Extre W/O Dye - MR Lower Ext Joint Lt WO IV Cont | $1,296.00 | $1,296.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Any Jt Lower Extrem W/O Contrast Matrl | $815.69 | $815.69 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Jnt of Lwr Extre W/O Dye - MR Lower Ext Joint Rt WO IV Cont | $300.00 | $1,296.00 | 77% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Jnt of Lwr Extre W/O Dye - MR Lower Ext Joint Lt WO IV Cont | $1,296.00 | $1,296.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Any Jt Lower Extrem W/O & W/Contrast Matrl | $1,126.55 | $1,126.55 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Joint Lwr Extr W/O&W/Dye Bl | $4,318.00 | $4,318.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Joint Lwr Extr W/O&W/Dye Lt | $2,879.00 | $2,879.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Joint Lwr Extr W/O&W/Dye Rt | $2,879.00 | $2,879.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Any Jt Lower Extrem W/O & W/Contrast Matrl | $1,126.55 | $1,126.55 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Joint Lwr Extr W/O&W/Dye Bl | $4,318.00 | $4,318.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Joint Lwr Extr W/O&W/Dye Lt | $2,879.00 | $2,879.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Joint Lwr Extr W/O&W/Dye Rt | $2,879.00 | $2,879.00 | — |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain - MRI Brain WO Contrast | $300.00 | $1,313.00 | 77% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain Brain Stem W/O Contrast Material | $811.76 | $811.76 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain - MRI Brain WO Contrast | $300.00 | $1,313.00 | 77% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain Brain Stem W/O Contrast Material | $811.76 | $811.76 | — |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain Combo - MRI Brain W WO Contrast | $300.00 | $2,916.00 | 90% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain Brain Stem W/O W/Contrast Material | $1,121.15 | $1,121.15 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain Combo - MRI Brain W WO Contrast | $300.00 | $2,916.00 | 90% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain Brain Stem W/O W/Contrast Material | $1,121.15 | $1,121.15 | — |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI, Lumbar Spine - MRI Lumbar Spine WO Contrast | $300.00 | $1,457.00 | 79% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spinal Canal Lumbar W/O Contrast Material | $846.63 | $846.63 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI, Lumbar Spine - MRI Lumbar Spine WO Contrast | $300.00 | $1,457.00 | 79% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spinal Canal Lumbar W/O Contrast Material | $846.63 | $846.63 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC Pbb US, OB >/= 14 Wks, Sngl Fetus | $399.00 | $399.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Preg Uterus After 1st Trimest 1/1st Gestation | $503.89 | $503.89 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Preg Uterus After 1st Trimest 1/1st Gestation | $503.89 | $503.89 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC Pbb US, OB >/= 14 Wks, Sngl Fetus | $399.00 | $399.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Preg Uterus After 1st Trimest 1/1st Gestation | $503.89 | $503.89 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Preg Uterus After 1st Trimest 1/1st Gestation | $503.89 | $221.48 | -128% |
| Screening mammogram, both breasts both sides CPT 77067 HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Left | $58.20 | $376.00 | 85% |
| Screening mammogram, both breasts both sides CPT 77067 HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Bilateral | $58.20 | $376.00 | 85% |
| Screening mammogram, both breasts both sides CPT 77067 Screening Mammography Bi 2-View Breast Inc Cad | $282.37 | $282.37 | — |
| Screening mammogram, both breasts both sides CPT 77067 HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Right | $376.00 | $376.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Left | $58.20 | $376.00 | 85% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Bilateral | $58.20 | $376.00 | 85% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening Mammography Bi 2-View Breast Inc Cad | $282.37 | $282.37 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Scr Mammo Bi Incl Cad - Mammo Breast Screening Right | $376.00 | $376.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/>Yrs Sleep 4/> Addl Param Attnd | $1,153.18 | $1,153.18 | — |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography | $2,673.00 | $2,673.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/>Yrs Sleep 4/> Addl Param Attnd | $1,153.18 | $1,153.18 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography | $2,673.00 | $2,673.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal | $518.45 | $518.45 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal | $518.45 | $518.45 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdominal Real Time W/Image Documentation | $250.45 | $250.45 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdominal Real Time W/Image Documentation | $250.45 | $250.45 | — |
| X-ray of the lower back, 4 or more views CPT 72110 HC Pbb X-Ray Lumbar Spine 4 Vw | $301.00 | $301.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 Radex Spine Lumbosacral Minimum 4 Views | $347.53 | $347.53 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Pbb X-Ray Lumbar Spine 4 Vw | $301.00 | $301.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Radex Spine Lumbosacral Minimum 4 Views | $347.53 | $347.53 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel (BMP) that includes total calcium | $7.25 | $19.00 | 62% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel (BMP) that includes total calcium | $7.25 | $19.00 | 62% |
| Complete blood count (CBC) with differential CPT 85025 Blood Count Complete Auto&Auto Difrntl Wbc | $36.10 | $36.10 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 Blood Count Complete Auto&Auto Difrntl Wbc | $36.10 | $36.10 | — |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD COUNT - POINT-OF-CARE device | $16.00 | $16.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Blood Count Complete Automated | $17.00 | $17.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE BLOOD COUNT - POINT-OF-CARE device | $16.00 | $16.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Blood Count Complete Automated | $17.00 | $17.00 | — |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel - Bundled Charge | $8.68 | $21.00 | 59% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel - Bundled Charge | $8.68 | $21.00 | 59% |
| Obstetric blood test panel CPT 80055 Obstetric Panel - Bundled Charge | $81.00 | $81.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Obstetric Panel - Bundled Charge | $81.00 | $81.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Assay of Psa, Free | $18.39 | $45.00 | 59% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Assay of Psa, Free | $18.39 | $45.00 | 59% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen,Total - Psa | $18.39 | $45.00 | 59% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen,Total - Psa | $18.39 | $45.00 | 59% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplas Time Partial - APTT | $6.01 | $15.00 | 60% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplas Time Partial - Additional Charge | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplas Time Partial - PTT CRRT System | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplas Time Partial - APTT | $6.01 | $15.00 | 60% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplas Time Partial - Additional Charge | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplas Time Partial - PTT CRRT System | $15.00 | $15.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time - Protime-Inr | $3.91 | $10.00 | 61% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $9.61 | $9.61 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time - Protime-Inr | $3.91 | $10.00 | 61% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $9.61 | $9.61 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid-Stimulating Hormone (TSH) Test | $9.00 | $68.00 | 87% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid-Stimulating Hormone (TSH) Test | $9.00 | $68.00 | 87% |
| Urinalysis with microscope exam, automated CPT 81001 Urnls Dip Stick/Tablet Reagent Auto Microscopy | $5.00 | $5.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urnls Dip Stick/Tablet Reagent Auto Microscopy | $5.00 | $5.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy | $6.00 | $6.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy | $6.00 | $6.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urine Sample to Detect Abnormalities | $5.00 | $5.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy | $13.92 | $13.92 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy | $13.92 | $13.92 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Sample to Detect Abnormalities | $5.00 | $5.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy | $13.92 | $13.92 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urnls Dip Stick/Tablet Rgnt Auto W/O Microscopy | $13.92 | $13.92 | — |
| Urinalysis without microscope exam, manual CPT 81002 HC Pbb Urinalysis Nonauto W/O Scope | $2.00 | $6.00 | 67% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Nonauto W/O Scope - POCT Urinalysis | $6.00 | $6.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp | $6.00 | $6.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Pbb Urinalysis Nonauto W/O Scope | $2.00 | $6.00 | 67% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urnls Dip Stick/Tablet Rgnt Non-Auto W/O Micrscp | $6.00 | $6.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Nonauto W/O Scope - POCT Urinalysis | $6.00 | $6.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 OB Antepartum Care Cesarean Dlvr & Postpartum | $4,869.62 | $4,869.62 | — |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 OB Antepartum Care Cesarean Dlvr & Postpartum | $4,869.62 | $4,869.62 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 OB Antepartum Care Cesarean Dlvr & Postpartum | $4,869.62 | $4,869.62 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 OB Antepartum Care Cesarean Dlvr & Postpartum | $4,869.62 | $4,869.62 | — |
| Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq | $1,054.78 | $1,054.78 | — |
| Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq | $1,054.78 | $1,054.78 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq | $1,054.78 | $1,054.78 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq | $1,054.78 | $1,054.78 | — |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple | $922.38 | $922.38 | — |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple | $922.38 | $922.38 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy W/Biopsy Single/Multiple | $922.38 | $877.38 | -5% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy W/Biopsy Single/Multiple | $922.38 | $922.38 | — |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd | $762.00 | $762.00 | — |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd | $762.00 | $762.00 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd | $762.00 | $762.00 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd | $762.00 | $721.84 | -6% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy | $1,862.87 | $1,862.87 | — |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy | $1,862.87 | $1,862.87 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy Surg Cholecystectomy | $1,862.87 | $1,862.87 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy Surg Cholecystectomy | $1,862.87 | $1,862.87 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible | $1,193.00 | $1,193.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible | $1,193.00 | $1,193.00 | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible | $1,193.00 | $1,193.00 | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible | $1,193.00 | $1,193.00 | — |
| Knee arthroscopy with meniscus trim CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg | $1,869.25 | $1,869.25 | — |
| Knee arthroscopy with meniscus trim CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg | $1,869.25 | $1,869.25 | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg | $1,869.25 | $1,869.25 | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg | $1,869.25 | $1,869.25 | — |
| Left heart catheterization, diagnostic one side CPT 93452 Left Heart Cath w/ Ventriculography | $6,959.00 | $6,959.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Heart Cath w/ Ventriculography | $6,959.00 | $6,959.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn | $481.00 | $481.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn | $1,499.00 | $1,499.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn | $481.00 | $481.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn | $1,499.00 | $1,499.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection into Lumbar or Sacral Interlaminar Space w/o Imaging Guidance | $1,926.00 | $1,926.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Injection into Lumbar or Sacral Interlaminar Space w/o Imaging Guidance | $1,926.00 | $1,926.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $393.00 | $393.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level | $565.42 | $1,926.00 | 71% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level Lt | $1,926.00 | $1,926.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level Rt | $1,926.00 | $1,926.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $393.00 | $393.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level | $565.42 | $1,926.00 | 71% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level Lt | $1,926.00 | $1,926.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC Inject Anes/Steroid Foramen Lumbar/Sacral W Img Guide ,1 Level Rt | $1,926.00 | $1,926.00 | — |
| Prostate biopsy CPT 55700 Prostate Needle Biopsy Any Approach | $372.74 | $372.74 | — |
| Prostate biopsy inpatient CPT 55700 Prostate Needle Biopsy Any Approach | $372.74 | $372.74 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laps Surg Prst8ect Rpbic Rad W/Nerve Sparing | $2,664.74 | $2,664.74 | — |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Laps Surg Prst8ect Rpbic Rad W/Nerve Sparing | $2,664.74 | $2,664.74 | — |
| Removal of a breast lump, open surgery CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion | $864.00 | $864.00 | — |
| Removal of a breast lump, open surgery CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion | $864.00 | $864.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion | $864.00 | $736.50 | -17% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion | $864.00 | $864.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls | $3,086.99 | $3,086.99 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls | $3,086.99 | $3,086.99 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & Adenoidectomy <Age 12 | $720.91 | $720.91 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Tonsillectomy & Adenoidectomy <Age 12 | $720.91 | $720.91 | — |
| Total hip replacement CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft | $5,463.15 | $5,463.15 | — |
| Total hip replacement CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft | $5,463.15 | $5,463.15 | — |
| Total hip replacement inpatient CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft | $5,463.15 | $5,463.15 | — |
| Total hip replacement inpatient CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft | $5,463.15 | $5,463.15 | — |
| Total knee replacement CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments | $4,138.30 | $4,138.30 | — |
| Total knee replacement CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments | $4,138.30 | $4,138.30 | — |
| Total knee replacement inpatient CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments | $4,138.30 | $4,138.30 | — |
| Total knee replacement inpatient CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments | $4,138.30 | $4,138.30 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple | $729.88 | $729.88 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple | $729.88 | $729.88 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Transoral Biopsy Single/Multiple - Egd | $772.60 | $2,029.00 | 62% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Transoral Biopsy Single/Multiple | $729.88 | $729.88 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Transoral Biopsy Single/Multiple | $729.88 | $613.88 | -19% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC Egd Transoral Biopsy Single/Multiple - Egd | $772.60 | $2,029.00 | 62% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic | $546.53 | $546.53 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic | $546.53 | $546.53 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC Esophagogastroduodenoscopy Transoral Diagnostic | $772.60 | $2,029.00 | 62% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic | $546.53 | $546.53 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic | $546.53 | $546.53 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC Esophagogastroduodenoscopy Transoral Diagnostic | $772.60 | $2,029.00 | 62% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Routine OB Care Vag Dlvry & Postpartum Care Vb | $4,457.00 | $4,457.00 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Routine OB Care Vag Dlvry & Postpartum Care Vb | $4,457.00 | $4,457.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OB Care Antepartum Vag Dlvr & Postpartum | $4,665.94 | $4,665.94 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OB Care Antepartum Vag Dlvr & Postpartum | $4,665.94 | $4,665.94 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB Care Antepartum Vag Dlvr & Postpartum | $4,665.94 | $4,665.94 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB Care Antepartum Vag Dlvr & Postpartum | $4,665.94 | $4,665.94 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Ecg Routine Ecg W/Least 12 Lds W/I&R | $154.25 | $154.25 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Ecg Routine Ecg W/Least 12 Lds W/I&R | $154.25 | $154.25 | — |
| Family therapy with the patient, 50 minutes CPT 90847 Family Psychotherapy w/ Patient - 50 Minutes | $348.00 | $348.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 Family Psychotherapy W/Patient Present 50 Mins | $373.93 | $373.93 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Psychotherapy w/ Patient - 50 Minutes | $348.00 | $348.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Psychotherapy W/Patient Present 50 Mins | $373.93 | $373.93 | — |
| Family therapy without the patient, 50 minutes CPT 90846 Family Psychotherapy w/o Patient - 50 Minutes | $348.00 | $348.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 Family Psychotherapy W/O Patient Present 50 Mins | $417.46 | $417.46 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Psychotherapy w/o Patient - 50 Minutes | $348.00 | $348.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Psychotherapy W/O Patient Present 50 Mins | $417.46 | $417.46 | — |
| Group psychotherapy session CPT 90853 Group Psychotherapy | $50.71 | $50.71 | — |
| Group psychotherapy session inpatient CPT 90853 Group Psychotherapy | $50.71 | $50.71 | — |
| New patient office visit, about 30 minutes CPT 99203 Facility Fee - New Patient - 30 Minutes | $223.00 | $223.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Office/Outpatient New Low Mdm 30 Minutes | $236.00 | $236.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Facility Fee - New Patient - 30 Minutes | $223.00 | $223.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office/Outpatient New Low Mdm 30 Minutes | $236.00 | $236.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Facility Fee - New Patient - 45 Minutes | $331.00 | $331.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Office/Outpatient New Moderate Mdm 45 Minutes | $350.00 | $350.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Facility Fee - New Patient - 45 Minutes | $331.00 | $331.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office/Outpatient New Moderate Mdm 45 Minutes | $350.00 | $350.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Facility Fee - New Patient - 60 Minutes | $416.00 | $416.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Office/Outpatient New High Mdm 60 Minutes | $462.00 | $462.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Facility Fee - New Patient - 60 Minutes | $416.00 | $416.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/Outpatient New High Mdm 60 Minutes | $462.00 | $462.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Px 1/> Areas Each 15 Min Exercises | $53.00 | $53.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Exercises | $101.00 | $101.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Exercises | $101.00 | $101.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Px 1/> Areas Each 15 Min Exercises | $53.00 | $53.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Exercises | $101.00 | $101.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Exercises | $101.00 | $101.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial Preventive Medicine New Pt Age 18-39yrs | $269.00 | $192.00 | -40% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial Preventive Medicine New Pt Age 18-39yrs | $269.00 | $192.00 | -40% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Initial Preventive Medicine New Pt Age 18-39yrs | $269.00 | $192.00 | -40% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Initial Preventive Medicine New Pt Age 18-39yrs | $269.00 | $192.00 | -40% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Initial Preventive Medicine New Patient 40-64yrs | $309.00 | $223.00 | -39% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Initial Preventive Medicine New Patient 40-64yrs | $309.00 | $223.00 | -39% |
| Psychotherapy session, 30 minutes CPT 90832 Patient Psychotherapy - 30 Minutes | $122.54 | $348.00 | 65% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy W/Patient 30 Minutes | $255.72 | $255.72 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Patient Psychotherapy - 30 Minutes | $122.54 | $348.00 | 65% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy W/Patient 30 Minutes | $255.72 | $255.72 | — |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy W/Patient 45 Minutes | $300.00 | $300.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 Patient Psychotherapy - 45 Minutes | $348.00 | $348.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy W/Patient 45 Minutes | $300.00 | $300.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Patient Psychotherapy - 45 Minutes | $348.00 | $348.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy W/Patient 60 Minutes | $236.13 | $236.13 | — |
| Psychotherapy session, 60 minutes CPT 90837 Patient Psychotherapy - 60 Minutes | $348.00 | $348.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy W/Patient 60 Minutes | $236.13 | $236.13 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Patient Psychotherapy - 60 Minutes | $348.00 | $348.00 | — |
Source file: https://www.chsbuffalo.org/wp-content/uploads/2026/06/16-1523353_Mount-St-Marys-Hospital_StandardCharges.csv