MercyOne Genesis Aledo Medical Center
MercyOne Genesis Aledo Medical Center in Aledo, IL publishes cash prices for 68 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.
409 NW 9th Ave, Aledo, IL 61231 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 C | $2,676.00 | $4,460.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w IV Contrast Only | $2,676.00 | $4,460.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen/Pelvis w IV Contrast Only | $2,676.00 | $4,460.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen/Pelvis w C | $2,676.00 | $4,460.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Viewpoint Head wo Contrast | $1,198.80 | $1,998.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head w/o contrast | $1,198.80 | $1,998.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head Stroke Alert | $1,198.80 | $1,998.00 | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Viewpoint Head wo Contrast | $1,198.80 | $1,998.00 | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head Stroke Alert | $1,198.80 | $1,998.00 | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head w/o contrast | $1,198.80 | $1,998.00 | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w Contrast | $1,434.00 | $2,390.00 | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w Contrast | $1,434.00 | $2,390.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mammo Bil w Tomo -CAD | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mam Implants Bil w CAD | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital Diag Mammogram Bil w CAD | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts CPT 77066 BR Digital A/V Mammogram Bil | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 BR Digital Screen/Diag Mam Bil w CAD | $159.00 | $265.00 | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 BR Digital A/V Mammogram Bil | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 BR Digital Diag Mam Implants Bil w CAD | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 BR Digital Diag Mammogram Bil w CAD | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 BR Digital Diag Mammo Bil w Tomo -CAD | $295.80 | $493.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammogram L | $123.60 | $206.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammogram R | $123.60 | $206.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram R | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammogram L w CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammogram R w CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram R w Tomo | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram L w Tomo | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammo L w Tomo -CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital Diag Mammo R w Tomo -CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast CPT 77065 BR Digital A/V Mammogram L | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mammogram R | $123.60 | $206.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mammogram L | $123.60 | $206.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Screen/Diag Mam L w CAD | $128.40 | $214.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Screen/Diag Mam R w CAD | $128.40 | $214.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital A/V Mammogram R w Tomo | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital A/V Mammogram R | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mam Implants L w CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital A/V Mammogram L | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mam Implants R w CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mammo R w Tomo -CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mammo L w Tomo -CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital A/V Mammogram L w Tomo | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mammogram R w CAD | $231.60 | $386.00 | 40% |
| Diagnostic mammogram, one breast inpatient CPT 77065 BR Digital Diag Mammogram L w CAD | $231.60 | $386.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Hips wo Contrast | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Hip Lmtd For Fracture wo Cntrst | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Hip wo Contrast- Right | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Hip wo Contrast- Left | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR Knee Bilateral | $2,627.40 | $4,379.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Ankle Joint w/o Contrast - L | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Hip Lmtd For Fracture wo Cntrst | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Knee - L | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Ankle Joint w/o Contrast - R | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Knee - R | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Hips wo Contrast | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Ankle Joint w/o Contrast - Bil | $2,627.40 | $4,379.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Knee - Bil | $2,653.20 | $4,422.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Hip wo Contrast- Left | $1,751.40 | $2,919.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Hip wo Contrast- Right | $1,751.40 | $2,919.00 | 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 | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Hips w/wo Contrast | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Ankle Joint w & w/o Contrast - R | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Hip Lmtd For Fracture w/wo Cont | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Knee w & w/o Contrast L | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Ankle Joint w & w/o Contrast - L | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Knee w & w/o Contrast - R | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Hips w/wo Contrast | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Knee w & wo Contrast Bil | $3,682.20 | $6,137.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Knee w & w/o Contrast - Bil | $3,717.00 | $6,195.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Ankle Jnt w/wo Contrast | $3,717.00 | $6,195.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Ankle Joint w & w/o Contrast- Bil | $3,717.00 | $6,195.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Hip w/wo Contrast Left | $2,454.60 | $4,091.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Hip w/wo Contrast Right | $2,454.60 | $4,091.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR IAC wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Brain wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Posterior Fossa wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Skullbase wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Brain w Diffusion wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR Post Fossa wo Contrast w Diff | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR IAC wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Skullbase wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain wo Contrast TX Plan | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Post Fossa wo Contrast w Diff | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain w Diffusion wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Posterior Fossa wo Contrast | $1,509.60 | $2,516.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Pituitary w/wo contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Sella w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR IAC w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Post Fossa w/wo Contrast w Diff | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain w Perf&Diff w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain w Perf w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Skullbase w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Posterior Fossa w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain w Perf&Diff w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR IAC w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain w Perf w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Skullbase w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Pituitary w/wo contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Sella w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Post Fossa w/wo Contrast w Diff | $2,997.60 | $4,996.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Posterior Fossa w/wo Contrast | $2,997.60 | $4,996.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MR Lumbar Plexus wo Contrast | $1,179.00 | $1,965.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MR Spine Lumbar wo Contrast | $1,750.80 | $2,918.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Spinal Survey Lumbar wo Contrast | $1,179.00 | $1,965.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Lumbar Plexus wo Contrast | $1,179.00 | $1,965.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Spinal Survey Lumbar w Contrast | $1,179.00 | $1,965.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 GHS MRI SPINE LUMBAR W/O C | $1,750.80 | $2,918.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Spine Lumbar wo Contrast | $1,750.80 | $2,918.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB CompTriplet Gest more than 14wk | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Comp SingleGest more than 14wk | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Single more than 28 weeks | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB COMPLETE TWIN GESTATION >14 WKS | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB CompTwin Gest more than 14wk | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ob us >/= 14 wks sngl fetus 76805- | $299.40 | $499.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Single more than 28 weeks | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB CompTwin Gest more than 14wk | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB COMPLETE TWIN GESTATION >14 WKS | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Comp SingleGest more than 14wk | $451.80 | $753.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB CompTriplet Gest more than 14wk | $451.80 | $753.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Mammography Screen Bil w CAD | $88.20 | $147.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mammogram Bil woCAD | $153.60 | $256.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mam Implants Bil w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mam Bil w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mam Implants Bil w CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts CPT 77067 BR Digital Screen Mammogram Bil wCAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Mammography Screen Bil w CAD | $88.20 | $147.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mammogram Bil woCAD | $153.60 | $256.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam Implants L w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mammogram Bil wCAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mammogram L wCAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mammogram R wCAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam Implants Bil w CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR DIgital Screen Mam Implants L w CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR DIgital Screen Mam Implants R w CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam Implants R w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam Implants Bil w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam Bil w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam R w Tomo-CAD | $276.60 | $461.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 BR Digital Screen Mam L w Tomo-CAD | $276.60 | $461.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram, Neuro Dx | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 GHS POLYSOMNOGRAM - DISCONTINUED | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram - discontinued | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 GHS POLYSOMNOGRAM | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnogram - discontinued | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnogram, Neuro Dx | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 GHS POLYSOMNOGRAM - DISCONTINUED | $3,030.60 | $5,051.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 GHS POLYSOMNOGRAM | $3,030.60 | $5,051.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US Trans Vaginal Pelvic Complete | $336.60 | $561.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US Trans Vag Pelvic | $336.60 | $561.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US Trans Vaginal Pelvic Limited | $368.40 | $614.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal us non-ob 76830- | $265.80 | $443.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Trans Vaginal Pelvic Complete | $336.60 | $561.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Trans Vag Pelvic | $336.60 | $561.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Trans Vaginal Pelvic Limited | $368.40 | $614.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdominal Complete | $708.60 | $1,181.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US Biliary with CCK | $708.60 | $1,181.00 | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Biliary with CCK | $708.60 | $1,181.00 | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdominal Complete | $708.60 | $1,181.00 | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Spine Lumbar 5 Vws | $355.20 | $592.00 | 40% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 #BMP(8) | $28.80 | $48.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 GHS BASIC METABOLIC PANEL (BMP) | $33.00 | $55.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 #BMP(8) | $28.80 | $48.00 | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 GHS BASIC METABOLIC PANEL (BMP) | $33.00 | $55.00 | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC | $55.20 | $92.00 | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $55.20 | $92.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 WS Lipid Panel | $19.80 | $33.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel (eldridge) | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Profile | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel - Aledo | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel w/ Reflex Direct LDL | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel DCH | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 #NMR LIPO-LIPID PROFILE | $46.20 | $77.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $53.40 | $89.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 WS Lipid Panel | $19.80 | $33.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel w/ Reflex Direct LDL | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Profile | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel - Aledo | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel (eldridge) | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel DCH | $39.60 | $66.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 #NMR LIPO-LIPID PROFILE | $46.20 | $77.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $53.40 | $89.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 Bill only - CBC, platelet, automated differential | $34.80 | $58.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS CBC (COMPLETE BLOOD COUNT) | $36.00 | $60.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 GHS CBC WITH MANUAL DIFF | $53.40 | $89.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Bill only - CBC, platelet, automated differential | $34.80 | $58.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 GHS CBC (COMPLETE BLOOD COUNT) | $36.00 | $60.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 GHS CBC WITH MANUAL DIFF | $53.40 | $89.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 #CBCPltNoDiff | $21.60 | $36.00 | 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 Bill only - Hemogram w/platelet | $34.80 | $58.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS HEMOGRAM | $36.00 | $60.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 GHS CBC(NO DIFFERENTIAL, HEMOGRAM) | $398.40 | $664.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 #CBCPltNoDiff | $21.60 | $36.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM (CBC, PLT, W/O DIFF) | $33.00 | $55.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Bill only - Hemogram w/platelet | $34.80 | $58.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 GHS HEMOGRAM | $36.00 | $60.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 GHS CBC(NO DIFFERENTIAL, HEMOGRAM) | $398.40 | $664.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $102.00 | $170.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL (CMP) | $108.00 | $180.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 GHS COMPREHENSIVE METABOLIC PANEL (CMP) | $108.00 | $180.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel - Obstetric | $110.40 | $184.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $102.00 | $170.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL (CMP) | $108.00 | $180.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 GHS COMPREHENSIVE METABOLIC PANEL (CMP) | $108.00 | $180.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel - Obstetric | $110.40 | $184.00 | 40% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $28.20 | $47.00 | 40% |
| Kidney function blood test panel CPT 80069 #RenalPnl(10) | $29.40 | $49.00 | 40% |
| Kidney function blood test panel CPT 80069 GHS RENAL FUNCTION PANEL | $57.60 | $96.00 | 40% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $28.20 | $47.00 | 40% |
| Kidney function blood test panel inpatient CPT 80069 #RenalPnl(10) | $29.40 | $49.00 | 40% |
| Kidney function blood test panel inpatient CPT 80069 GHS RENAL FUNCTION PANEL | $57.60 | $96.00 | 40% |
| Liver function blood test panel CPT 80076 Hepatic Function | $58.20 | $97.00 | 40% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel - Obstetric | $59.40 | $99.00 | 40% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function | $58.20 | $97.00 | 40% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel - Obstetric | $59.40 | $99.00 | 40% |
| Obstetric blood test panel CPT 80055 Bill only - Obstetric Panel | $84.00 | $140.00 | 40% |
| Obstetric blood test panel CPT 80055 Obstetric Panel | $84.00 | $140.00 | 40% |
| Obstetric blood test panel inpatient CPT 80055 Bill only - Obstetric Panel | $84.00 | $140.00 | 40% |
| Obstetric blood test panel inpatient CPT 80055 Obstetric Panel | $84.00 | $140.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 _%fPSA Reflex-Sendout | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free - Aledo | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 #PSA T+F-PSA FREE | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE | $64.80 | $108.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 _%fPSA Reflex-Sendout | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 #PSA T+F-PSA FREE | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free - Aledo | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE | $64.80 | $108.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Bill Only - PSA | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total w/reflx to PSA Free (Diag or Non-Medicare) -Quest | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total w/o Reflex - Aledo | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 #PSA T+F-PSA TOT. | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Screen w/o Reflex - Aledo | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC ANTIGEN | $66.00 | $110.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen - DCH | $66.00 | $110.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Ag - Sendout | $67.80 | $113.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 GHS PSA (PROSTATE SPECIFIC ANTIGEN) | $82.20 | $137.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total w/reflx to PSA Free (Diag or Non-Medicare) -Quest | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Screen w/o Reflex - Aledo | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total w/o Reflex - Aledo | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 #PSA T+F-PSA TOT. | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Bill Only - PSA | $64.20 | $107.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC ANTIGEN | $66.00 | $110.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen - DCH | $66.00 | $110.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Ag - Sendout | $67.80 | $113.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 GHS PSA (PROSTATE SPECIFIC ANTIGEN) | $82.20 | $137.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total (Reflex To Free)-Sendout | $125.40 | $209.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS MIXING STUDY, PTT (INHIBITOR ASSAY) | $23.40 | $39.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #APTT MIX-APTT | $33.00 | $55.00 | 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 | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 GHS PTT | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #THROMBOSIS- APTT | $47.40 | $79.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #THROM VKA-APTT | $78.00 | $130.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #VONWILL SCRN- APTT | $98.40 | $164.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 #APSPROF-PTT | $16.20 | $27.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 GHS MIXING STUDY, PTT (INHIBITOR ASSAY) | $23.40 | $39.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 #APTT MIX-APTT | $33.00 | $55.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME | $37.20 | $62.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 GHS PTT | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 #THROMBOSIS- APTT | $47.40 | $79.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 #THROM VKA-APTT | $78.00 | $130.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 #VONWILL SCRN- APTT | $98.40 | $164.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (INR) | $31.20 | $52.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 GHS PROTHROMBIN TIME (INR) | $31.20 | $52.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 #THROMBOSIS-PROTHROMBIN TIME | $47.40 | $79.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 #APSPRO-PT | $11.40 | $19.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $31.20 | $52.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR - POC | $31.20 | $52.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (INR) | $31.20 | $52.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 GHS PROTHROMBIN TIME (INR) | $31.20 | $52.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 #THROMBOSIS-PROTHROMBIN TIME | $47.40 | $79.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH-Sendout | $56.40 | $94.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Rfx on Abnormal to Free T4 - Sendout | $56.40 | $94.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/Reflex Free T4 | $62.40 | $104.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/Thyroid Function Reflexes | $62.40 | $104.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $63.00 | $105.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone, sensitive | $66.60 | $111.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Sensitive STH | $66.60 | $111.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE | $82.20 | $137.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS THYROID STIM HORMONE | $82.20 | $137.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 GHS TSH W/FT4 REFLEX | $82.20 | $137.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascade Profile - Sendout | $52.80 | $88.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Rfx on Abnormal to Free T4 - Sendout | $56.40 | $94.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH-Sendout | $56.40 | $94.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/Reflex Free T4 | $62.40 | $104.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/Thyroid Function Reflexes | $62.40 | $104.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $63.00 | $105.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Sensitive STH | $66.60 | $111.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid stimulating hormone, sensitive | $66.60 | $111.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 GHS TSH W/FT4 REFLEX | $82.20 | $137.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 GHS THYROID STIM HORMONE | $82.20 | $137.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIM HORMONE | $82.20 | $137.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 UA w/microscopic, bill-only | $21.00 | $35.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 GHS URINALYSIS, WITH MICROSCOPIC | $27.00 | $45.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 Urine Reflex Micro | $27.60 | $46.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 UA Routine w/ Micro & Culture if Indicated (IRIS) | $27.60 | $46.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Microscopic | $27.60 | $46.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA Auto w/Micro/Comp POC | $20.40 | $34.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/microscopic, bill-only | $21.00 | $35.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 GHS URINALYSIS, WITH MICROSCOPIC | $27.00 | $45.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA Routine w/ Micro & Culture if Indicated (IRIS) | $27.60 | $46.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Microscopic | $27.60 | $46.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urine Reflex Micro | $27.60 | $46.00 | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 UA w/Micro/Comp POC | $8.40 | $14.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 UA Routine w/ Reflex - Aledo | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 UA Routine - Aledo | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 U Macro Only | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 GHS ROUTINE URINALYSIS | $21.00 | $35.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 GHS URINE, DIP STICK ONLY | $21.00 | $35.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Specific Gravity Urine | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Single Component Glucose | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Macroscopic with Reflex | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA macroscopic, bill-only | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA Routine w/ Reflex - Aledo | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA Routine - Aledo | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 U Macro Only | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Single Component Protein | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Single Component Ketones | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Single Component pH | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA Macroscopic (dipstick-no reflex) | $17.40 | $29.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 GHS URINE, DIP STICK ONLY | $21.00 | $35.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 GHS ROUTINE URINALYSIS | $21.00 | $35.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 DCH VALIDITY TESTS | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 Validity Test - Aledo | $15.00 | $25.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 DCH VALIDITY TESTS | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dip without Micro POC | $9.60 | $16.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Macroscopic w/Reflex to C&S | $12.00 | $20.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Validity Test - Aledo | $15.00 | $25.00 | 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 | $4,721.40 | $7,869.00 | 40% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy w/ endoscopic US 45391 | $554.40 | $924.00 | 40% |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy w/lesion removal snare 45385 | $377.40 | $629.00 | 40% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy and biopsy 45380 | $337.80 | $563.00 | 40% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic colonoscopy 45378 | $516.00 | $860.00 | 40% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparascopic Cholecystectomy 47562 | $1,407.60 | $2,346.00 | 40% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Repair ing/hern init reduc >5 yr 49505 | $977.40 | $1,629.00 | 40% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Knee arthroscopy/surgery 29881 | $755.40 | $1,259.00 | 40% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 GHS YAG LASER BOTH EYES | $1,017.00 | $1,695.00 | 40% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient one side CPT 66821 GHS YAG LASER RT EYE | $678.00 | $1,130.00 | 40% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient one side CPT 66821 GHS YAG LASER LEFT EYE | $678.00 | $1,130.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS RACZ CAUDEL STEROID AND ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS LUMBAR EPIDURAL STEROID AND ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS RACZ CAUDEL-STEROID INJECTION | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS CAUDEL EPIDURAL STEROID | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS CAUDEL EPIDURAL STEROID AND ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS INJ EPIDURAL STEROID LUMBAR | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GHS INJ LUMBAR EPIDURAL ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj diag/thera sub lumbar/sacral w/imag 62323 | $188.40 | $314.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS INJ EPIDURAL STEROID LUMBAR | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS LUMBAR EPIDURAL STEROID AND ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS CAUDEL EPIDURAL STEROID | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS CAUDEL EPIDURAL STEROID AND ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS INJ LUMBAR EPIDURAL ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS RACZ CAUDEL STEROID AND ANESTH | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GHS RACZ CAUDEL-STEROID INJECTION | $639.60 | $1,066.00 | 40% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Inj diag/ther sub lumb/sacral w/o imag 62322 | $164.40 | $274.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 GHS INJ TRANSFORAMINAL LUMB SINGLE UNI | $1,231.80 | $2,053.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Bilateral Inj Foramen Epidural L/S 64483 | $462.60 | $771.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 GHS INJ TRANSFORAMINAL LUMB SINGLE UNI | $1,231.80 | $2,053.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 GHS INJ TRANSFORAMINAL LUMB SINGLE BIL | $1,848.00 | $3,080.00 | 40% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Exc of breast lesion open 1/> 19120 | $913.80 | $1,523.00 | 40% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 T & A < 12 yrs 42820 | $576.60 | $961.00 | 40% |
| Total hip replacement inpatient CPT 27130 Total hip arthroplasty 27130 | $1,771.80 | $2,953.00 | 40% |
| Total knee replacement inpatient CPT 27447 Revision of thigh muscles 27447 | $1,770.00 | $2,950.00 | 40% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Upper Gi Endoscopy Biopsy 43239 | $204.60 | $341.00 | 40% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD/flex/transoral/diag 43235 | $181.20 | $302.00 | 40% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Vbac Delivery 59610 | $4,470.60 | $7,451.00 | 40% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Obstetrical Care 59400 | $4,263.60 | $7,106.00 | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 12 lead ECG w/interp/report 93000 | $94.80 | $158.00 | 40% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG POC | $94.80 | $158.00 | 40% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy with Patient 50 min 90847 | $174.00 | $290.00 | 40% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Therapy W/O Pt 50min 90846 | $114.00 | $190.00 | 40% |
| Group psychotherapy session inpatient CPT 90853 Group psychotherapy 90853 | $36.60 | $61.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office Visit Level 3 New | $145.80 | $243.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office Visit Level 4 New | $223.20 | $372.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office Visit Level 5 New | $277.80 | $463.00 | 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 | $69.00 | $115.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges | $91.20 | $152.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic exercise/ea 15 min 97110 | $52.20 | $87.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS HAND REHAB (REHAB) | $56.40 | $94.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS Therapeutic Exercise Charges, OT | $69.00 | $115.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS PT - INTERDISCIPLINARY CO-TREAT/15 MIN | $69.00 | $115.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges, OT | $69.00 | $115.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS OT THERAPEUTIC EX - KX | $69.00 | $115.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS PT THERAPEUTIC EX - KX | $91.20 | $152.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Ex, PT - KX | $91.20 | $152.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS OT THER EXERCISE | $91.20 | $152.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges | $91.20 | $152.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 GHS PT THERAPEUTIC EXERCIS\15 MIN | $91.20 | $152.00 | 40% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 Initial Comp Preventive Med 18 to 39 years New | $174.60 | $291.00 | 40% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 Initial Comp Preventive Med 40 to 64 years New | $229.20 | $382.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 Minutes 90832 | $58.80 | $98.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 Minutes 90834 | $114.00 | $190.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy (Add-on to 90837) | $146.40 | $244.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Level 3 99243 | $183.00 | $305.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Level 4 99244 | $273.60 | $456.00 | 40% |
Source file: https://trinityhealth.pt.panaceainc.com/MRFDownload/trinityhealth/genesismedicalcenter