MercyOne Genesis Davenport West Medical Center
MercyOne Genesis Davenport West Medical Center in Davenport, IA publishes cash prices for 65 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Click a procedure to compare it with other hospitals nearby.
1404 West Central Park Avenue, Davenport, IA 52804 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 IV Contrast Only | $2,381.40 | $3,969.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Enterography | $2,381.40 | $3,969.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w C | $2,381.40 | $3,969.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head Stroke Alert | $1,066.80 | $1,778.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head w/o contrast | $1,066.80 | $1,778.00 | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w Contrast | $1,276.20 | $2,127.00 | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 BR Mammography Diag BIlateral | $81.60 | $136.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Mammo A/V Bil | $81.60 | $136.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Mammography Diag Bil w CAD | $82.20 | $137.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Mammography Screen to Diag Bil w CAD | $123.00 | $205.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mammo Bil w Tomo -CAD | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital A/V Mammogram Bil w Tomo | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mammogram Bil w CAD | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital A/V Mammogram Bil | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Mammo Screen to diag Bil | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mam Implants Bil wTomo-CAD | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mam Implants Bil w CAD | $270.60 | $451.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Mammo Diag L | $70.20 | $117.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram R | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram R w Tomo | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram L w Tomo | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mam Implants L wTomo-CAD | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mam Implants R wTomo-CAD | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammo L w Tomo -CAD | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammo R w Tomo -CAD | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammogram R w CAD | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammogram L w CAD | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram L | $211.80 | $353.00 | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 BR Mammo Diag Right | $70.20 | $117.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Hips wo Contrast | $1,603.80 | $2,673.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Hip Lmtd For Fracture wo Cntrst | $1,603.80 | $2,673.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Hip wo Contrast- Right | $1,603.80 | $2,673.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Hip wo Contrast- Left | $1,603.80 | $2,673.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Hips w/wo Contrast | $2,247.60 | $3,746.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Hip Lmtd For Fracture w/wo Cont | $2,247.60 | $3,746.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Brain w Diffusion wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR IAC wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Post Fossa wo Contrast w Diff | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Gamma Knife wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Stereotatic Biopsy wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Viewpoint Brain wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Skullbase wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Posterior Fossa wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Brain wo Contrast | $1,382.40 | $2,304.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain w Perf&Diff w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Pituitary w/wo contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain w Perf w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Post Fossa w/wo Contrast w Diff | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR IAC w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Sella w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Posterior Fossa w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Skullbase w/wo Contrast | $2,745.00 | $4,575.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MR Lumbar Plexus wo Contrast | $1,079.40 | $1,799.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MR Spine Lumbar wo Contrast | $1,603.20 | $2,672.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB COMPLETE TWIN GESTATION >14 WKS | $413.40 | $689.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 GHS ED US FOCUSED 2ND/3RD TRIMESTER OB | $413.40 | $689.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 GHS PORTABLE ULTRASOUND USED ON FLOOR | $413.40 | $689.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ob us >/= 14 wks sngl fetus 76805- | $285.00 | $475.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Mammo CHC Screen Bil w CAD | $49.20 | $82.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Mammo CHC Medicare Screen Bil w CAD | $49.20 | $82.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Mammo Scrn Bil | $52.20 | $87.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Mammography Medicare Screen Bil w CAD | $52.20 | $87.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Mammography Screen Bil w CAD | $81.00 | $135.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mam Implants Bil w CAD | $253.20 | $422.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mammogram Bil wCAD | $253.20 | $422.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mam Bil w Tomo-CAD | $253.20 | $422.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mam Implants Bil w Tomo-CAD | $253.20 | $422.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 GHS POLYSOMNOGRAM - DISCONTINUED | $1,451.40 | $2,419.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 GHS POLYSOMNOGRAM | $2,722.80 | $4,538.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram, Neuro Dx | $2,722.80 | $4,538.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram - discontinued | $2,722.80 | $4,538.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US Trans Vag Pelvic | $337.20 | $562.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal us non-ob 76830- | $253.20 | $422.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US Biliary with CCK | $648.60 | $1,081.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdominal Complete | $648.60 | $1,081.00 | 40% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $49.20 | $82.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 GHS BASIC METABOLIC PANEL (BMP) | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 #BMP(8) | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 GHS BASIC METABOLIC PANEL(BMP)-NEONATAL | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 GHS PRE BASIC METABOLIC PANEL | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 GHS POST BASIC METABOLIC PANEL | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC | $55.20 | $92.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel - Aledo | $37.20 | $62.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Profile | $37.20 | $62.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel DCH | $50.40 | $84.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel (eldridge) | $50.40 | $84.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 NMR LIPIDS | $63.00 | $105.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 GHS INFECTIOUS AGENT AB Q EA | $63.00 | $105.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 #NMR LIPO-LIPID PROFILE | $63.00 | $105.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Cardiac Risk Assessment | $63.00 | $105.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $63.00 | $105.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel w/ Reflex Direct LDL | $63.00 | $105.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 GHS LIPID PROFILE | $91.80 | $153.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 Bill only - CBC, platelet, automated differential | $41.40 | $69.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS CBC (COMPLETE BLOOD COUNT) | $41.40 | $69.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS PRE CBC | $41.40 | $69.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS MID CBC | $41.40 | $69.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS CBC AUTOMATED DIFF | $41.40 | $69.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS CBC WITH MANUAL DIFF | $50.40 | $84.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 #CBCPltNoDiff | $32.40 | $54.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 Bill only - Hemogram w/platelet | $33.00 | $55.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM (CBC, PLT, W/O DIFF) | $33.00 | $55.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS HGB, HCT, & PLATELET COUNT | $33.60 | $56.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS PRE HEMOGRAM | $34.20 | $57.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS POST HEMOGRAM | $34.20 | $57.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS HEMOGRAM | $34.20 | $57.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS MID HEMOGRAM | $34.20 | $57.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS POST CBC | $37.20 | $62.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS COMPLETE CBC AUTOMATED | $48.00 | $80.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS CBC(NO DIFFERENTIAL, HEMOGRAM) | $357.60 | $596.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 GHS COMPREHENSIVE METABOLIC PANEL (CMP) | $96.60 | $161.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel - Obstetric | $99.00 | $165.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 GHS POST COMPREHENSIVE METABOLIC PANEL | $99.00 | $165.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL (CMP) | $99.00 | $165.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $99.00 | $165.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 GHS PRE COMPREHENSIVE METABOLIC PANEL | $99.00 | $165.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 GHS CMP (360) | $99.00 | $165.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 GHS COMP METABOLIC PANEL(CMP)-NEONATAL | $99.00 | $165.00 | 40% |
| Kidney function blood test panel CPT 80069 #RenalPnl(10) | $33.00 | $55.00 | 40% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $33.00 | $55.00 | 40% |
| Kidney function blood test panel CPT 80069 GHS RENAL FUNCTION PANEL | $54.60 | $91.00 | 40% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel - Obstetric | $69.00 | $115.00 | 40% |
| Liver function blood test panel CPT 80076 GHS HEPATIC FUNCT PANEL A (HFP) | $69.00 | $115.00 | 40% |
| Liver function blood test panel CPT 80076 Hepatic Function | $69.00 | $115.00 | 40% |
| Obstetric blood test panel CPT 80055 Obstetric Panel | $90.60 | $151.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 _%fPSA Reflex-Sendout | $73.80 | $123.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE | $73.80 | $123.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 #PSA T+F-PSA FREE | $73.80 | $123.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 GHS FREE PSA | $84.00 | $140.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total w/reflx to PSA Free (Diag or Non-Medicare) -Quest | $60.60 | $101.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC ANTIGEN | $62.40 | $104.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total w/o Reflex - Aledo | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen - DCH | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Ag - Sendout | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Bill Only - PSA | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 #PSA T+F-PSA TOT. | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 GHS PROSTATE SPECIFIC ANTIGEN, TOTAL (302150) | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Screen w/o Reflex - Aledo | $75.60 | $126.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 GHS PSA (PROSTATE SPECIFIC ANTIGEN) | $78.00 | $130.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 GHS % FREE PSA (REFLEX ONLY) | $84.00 | $140.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 GHS PSA W/% FREE PSA REFLEX | $84.00 | $140.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS MIXING STUDY, PTT (INHIBITOR ASSAY) | $22.20 | $37.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS LUPUS-LIKE ANTICOAGULANT | $31.80 | $53.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS APTT-LUPUS | $31.80 | $53.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #APTT MIX-APTT | $31.80 | $53.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS LUPUS LIKE ANTICOAG | $31.80 | $53.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS APTT MAYO BO | $31.80 | $53.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS PRE PTT | $34.80 | $58.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS POST PTT | $34.80 | $58.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS MID PTT | $34.80 | $58.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS ACTIVATED PTT SUBSTITUTION | $37.20 | $62.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $37.20 | $62.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME | $37.20 | $62.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $37.20 | $62.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS PTT | $37.20 | $62.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS LIPEMIC PATIENT PTT | $37.80 | $63.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS THROMBOPLATIN TIME, PART | $40.80 | $68.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #THROMBOSIS- APTT | $45.00 | $75.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #THROM VKA-APTT | $73.80 | $123.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS APTT/COAG CONSULT-THROMBOSIS | $77.40 | $129.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #VONWILL SCRN- APTT | $93.60 | $156.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS APTT SUBSTITUTION | $117.60 | $196.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PT MAYO BO | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS CANCER CLINIC INR POC | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PROTHROMBIN TIME (INR) | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PRE INR | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS MID INR | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS POST INR | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (INR) | $27.60 | $46.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 #THROMBOSIS-PROTHROMBIN TIME | $45.00 | $75.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PT/COAG CONSULT/THROMB | $76.80 | $128.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PROTHROMBIN TIME | $82.20 | $137.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PT-PROLONGED CLOTTING TIMES | $117.60 | $196.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone, sensitive | $59.40 | $99.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Sensitive STH | $59.40 | $99.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH-Sendout | $74.40 | $124.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Rfx on Abnormal to Free T4 - Sendout | $74.40 | $124.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS INMS-TSH | $74.40 | $124.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/Reflex Free T4 | $74.40 | $124.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $74.40 | $124.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/Thyroid Function Reflexes | $74.40 | $124.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS THYROID STIM HORMONE | $78.00 | $130.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS TSH W/FT4 REFLEX | $78.00 | $130.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE | $78.00 | $130.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS S-TSH MAYO | $111.60 | $186.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS THIRD GENERATION TSH | $116.40 | $194.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS THYROID STIM HORMONE (MAYO) | $118.80 | $198.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 UA w/microscopic, bill-only | $24.60 | $41.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 GHS URINALYSIS, WITH MICROSCOPIC | $25.20 | $42.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 GHS UA W/MICRO C/S IF INDICATED | $26.40 | $44.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA Auto w/Micro/Comp POC | $19.20 | $32.00 | 40% |
| Urinalysis with microscope exam, manual CPT 81000 GHS BUPRENORPHINE AND METABOLITE SCRN UR | $141.00 | $235.00 | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 UA w/Micro/Comp POC | $7.80 | $13.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 UA Routine - Aledo | $11.40 | $19.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 UA Routine w/ Reflex - Aledo | $11.40 | $19.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine | $16.20 | $27.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 GHS URINE, DIP STICK ONLY | $19.80 | $33.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 GHS UA (C/S IF CRITERIA MET) | $19.80 | $33.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 GHS ROUTINE URINALYSIS | $19.80 | $33.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 DCH VALIDITY TESTS | $13.80 | $23.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 GHS URINALYSIS (W/MICRO REFLEX) | $18.60 | $31.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dip without Micro POC | $9.00 | $15.00 | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Total Ob Care;Cesarean Delivery 59510 | $4,496.40 | $7,494.00 | 40% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy w/ endoscopic US 45391 | $528.00 | $880.00 | 40% |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy w/lesion removal snare 45385 | $359.40 | $599.00 | 40% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy and biopsy 45380 | $321.60 | $536.00 | 40% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic colonoscopy 45378 | $491.40 | $819.00 | 40% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparascopic Cholecystectomy 47562 | $1,340.40 | $2,234.00 | 40% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Repair ing/hern init reduc >5 yr 49505 | $930.60 | $1,551.00 | 40% |
| Left heart catheterization, diagnostic one side CPT 93452 GHS LT CATH/LV/NO CORS | $6,744.00 | $11,240.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS RACZ CAUDEL STEROID AND ANESTH | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS RACZ CAUDEL-STEROID INJECTION | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS INJ LUMBAR EPIDURAL ANESTH | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS INJ EPIDURAL STEROID LUMBAR | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS CAUDEL EPIDURAL STEROID AND ANESTH | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS CAUDEL EPIDURAL STEROID | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS LUMBAR EPIDURAL STEROID AND ANESTH | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 AN Lumbar/Sacral Epidural Steriod Inj | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 FL Epidural Lumbar Injection | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR INJECTION, DIAG/THERAPEUTIC | $553.80 | $923.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj diag/thera sub lumbar/sacral w/imag 62323 | $179.40 | $299.00 | 40% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Inj diag/ther sub lumb/sacral w/o imag 62322 | $156.60 | $261.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 GHS INJ TRANSFORAMINAL LUMB SINGLE UNI | $1,066.20 | $1,777.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Bilateral Inj Foramen Epidural L/S 64483 | $440.40 | $734.00 | 40% |
| Prostate biopsy CPT 55700 US BX Prostate | $865.80 | $1,443.00 | 40% |
| Prostate biopsy CPT 55700 CT BX Prostate | $865.80 | $1,443.00 | 40% |
| Removal of a breast lump, open surgery CPT 19120 GHS CBH EXCISION CYST | $1,900.80 | $3,168.00 | 40% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Exc of breast lesion open 1/> 19120 | $870.00 | $1,450.00 | 40% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 T & A < 12 yrs 42820 | $549.00 | $915.00 | 40% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Upper Gi Endoscopy Biopsy 43239 | $195.00 | $325.00 | 40% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD/flex/transoral/diag 43235 | $172.80 | $288.00 | 40% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Vbac Delivery 59610 | $4,257.60 | $7,096.00 | 40% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Obstetrical Care 59400 | $4,060.80 | $6,768.00 | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG POC | $90.00 | $150.00 | 40% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 12 lead ECG w/interp/report 93000 | $90.00 | $150.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT, 105 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT 90 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT 75 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS PSYCH TX FAMILY W PT | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT 15 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT 30 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT 45 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT 60 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 GHS FAMILY PSYCHOTHERAPY W PT, 120 MIN | $231.60 | $386.00 | 40% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy with Patient 50 min 90847 | $165.60 | $276.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT 90 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT 15 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT 30 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT 45 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT 60 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT 75 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT, 105 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 GHS FAMILY PSYCHOTHERAPY W/O PT, 120 MIN | $135.60 | $226.00 | 40% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Therapy W/O Pt 50min 90846 | $108.60 | $181.00 | 40% |
| Group psychotherapy session CPT 90853 GHS PSYCH TX GROUP 2 HOURS | $341.40 | $569.00 | 40% |
| Group psychotherapy session CPT 90853 GHS PSYCH TX GROUP PER HOUR | $341.40 | $569.00 | 40% |
| Group psychotherapy session inpatient CPT 90853 Group psychotherapy 90853 | $34.80 | $58.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS MID LEVEL CLINIC - NEW | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS CBH NEW PATIENT L3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS NEW PAT EXPANDED PROBLEM/LOW COMPLEX | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS PSYCH NEW PATIENT LEVEL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS ND CLINIC NEW PATIENT LVL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS PMR CLINIC NEW PATIENT LVL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS HEADACHE CLINIC NEW PT LVL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS GI CLINIC NEW L3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS VS NEW PT LEVEL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS ID CLINIC NEW PT LVL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS NEURO SURG CLINIC NEW PT LVL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 GHS NEW PT LEVEL 3 | $91.80 | $153.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office Visit Level 3 New | $134.40 | $224.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS CBH NEW PATIENT L4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS ASSESSMENT | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS NEW PT DETAILED/MODERATE COMPLEXITY | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS ND CLINIC NEW PATIENT LVL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS PMR CLINIC NEW PATIENT LVL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS HEADACHE CLINIC NEW PT LVL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS GI CLINIC NEW L4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS VS NEW PT LEVEL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS ID CLINIC NEW PT LVL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS NEURO SURG CLINIC NEW PT LVL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS NEW PT LEVEL 4 | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 GHS HIGH LEVEL CLINIC - NEW | $151.20 | $252.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office Visit Level 4 New | $206.40 | $344.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS NEW PT COMPREHENSIVE/HIGH COMPLEXITY | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS PMR CLINIC NEW PATIENT LVL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS ND CLINIC NEW PATIENT LVL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS CBH NEW PATIENT L5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS COMPLEX LEVEL CLINIC - NEW | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS NEW PT LEVEL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS NEURO SURG CLINIC NEW PT LVL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS ID CLINIC NEW PT LVL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS VS NEW PT LEVEL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS GI CLINIC NEW L5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 GHS HEADACHE CLINIC NEW PT LVL 5 | $153.00 | $255.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office Visit Level 5 New | $256.80 | $428.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 GHS Therapeutic Exercise Charges, OT | $69.00 | $115.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges, OT | $78.60 | $131.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges | $78.60 | $131.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic exercise/ea 15 min 97110 | $49.80 | $83.00 | 40% |
| Preventive checkup, new patient aged 18–39 CPT 99385 GHS ID CLINIC ANNUAL WELLNESS INITIAL VISIT | $246.00 | $410.00 | 40% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 Initial Comp Preventive Med 18 to 39 years New | $152.40 | $254.00 | 40% |
| Preventive checkup, new patient aged 40–64 CPT 99386 GHS ID CLINIC ANNUAL WELLNESS SUBSEQUENT VISIT | $166.20 | $277.00 | 40% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 Initial Comp Preventive Med 40 to 64 years New | $200.40 | $334.00 | 40% |
| Psychotherapy session, 30 minutes CPT 90832 GHS INDIV PSYCH INTERACTIVE 20-30 MIN INPT | $74.40 | $124.00 | 40% |
| Psychotherapy session, 30 minutes CPT 90832 GHS INDIV PSYCHOTHERAPY 20-30 MIN OP | $135.60 | $226.00 | 40% |
| Psychotherapy session, 30 minutes CPT 90832 GHS PSYCH TX PT & FAM 30 MIN | $135.60 | $226.00 | 40% |
| Psychotherapy session, 30 minutes CPT 90832 GHS CBS INDIVIDUAL PSYCH THERAPY 20-30 MIN | $135.60 | $226.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 Minutes 90832 | $55.80 | $93.00 | 40% |
| Psychotherapy session, 45 minutes CPT 90834 GHS INDIV PSYCH INTERACTIVE 45-50 MIN INPT | $109.80 | $183.00 | 40% |
| Psychotherapy session, 45 minutes CPT 90834 GHS INDIV PSYCHOTHERAPY 45-50MIN OP | $161.40 | $269.00 | 40% |
| Psychotherapy session, 45 minutes CPT 90834 GHS PSYCH TX PT & FAM 45 MIN | $161.40 | $269.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 Minutes 90834 | $108.60 | $181.00 | 40% |
| Psychotherapy session, 60 minutes CPT 90837 GHS INDIV PSYCH INTERACTIVE 75-80 MIN INPT | $180.60 | $301.00 | 40% |
| Psychotherapy session, 60 minutes CPT 90837 GHS PSYCH TX PT & FAM 60 MIN | $190.80 | $318.00 | 40% |
| Psychotherapy session, 60 minutes CPT 90837 GHS INDIV PSYCHOTHERAPY 75-80 MIN OP | $190.80 | $318.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy (Add-on to 90837) | $139.20 | $232.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 GHS ID CLINIC CONSULT LVL 3 | $116.40 | $194.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 GHS RAD - SECOND OPINION LEVEL 3 | $116.40 | $194.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 GHS NEURO SURG CLINIC CONSULT LVL 3 | $116.40 | $194.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Level 3 99243 | $174.00 | $290.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 GHS NEURO SURG CLINIC CONSULT LVL 4 | $171.60 | $286.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 GHS ID CLINIC CONSULT LVL 4 | $171.60 | $286.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Level 4 99244 | $260.40 | $434.00 | 40% |
Source file: https://trinityhealth.pt.panaceainc.com/MRFDownload/trinityhealth/genesishealth-west