Prices / Houston–Pasadena–The Woodlands, TX / Hospitals
St Luke'S The Woodlands Hospital
17200 St Luke'S Way, The Woodlands, TX 77384 · CCN 450862
Source: the hospital's standard-charges file dated 2026-02-28 (original file, json, 239 MB), checked by us on 2026-10-06. 249 of 300 common services found in it.
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Evaluation & Management
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| New Patient Office Or Other Outpatient Visit, Typically 30 Min | CPT 99203 | $207.90 | $74.00 – $341.55 – $594.00 13 insurers | $594.00 |
| New Patient Office Or Other Outpatient Visit, Typically 45 Min | CPT 99204 | $238.35 | $74.00 – $412.88 – $681.00 13 insurers | $681.00 |
| New Patient Office Or Other Outpatient Visit, Typically 60 Min | CPT 99205 | $251.65 | $74.00 – $467.35 – $719.00 13 insurers | $719.00 |
Laboratory & Pathology
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Automated Urinalysis Test | CPT 81002 | $13.65 | $2.51 – $6.61 – $39.00 25 insurers | $39.00 |
| Automated Urinalysis Test | CPT 81003 | $53.90 | $1.62 – $4.28 – $154.00 25 insurers | $154.00 |
| Basic Metabolic Panel | CPT 80048 | $380.10 | $6.09 – $16.07 – $1,086.00 25 insurers | $1,086.00 |
| Blood Test, Clotting Time | CPT 85610 | $178.15 | $3.09 – $9.03 – $509.00 25 insurers | $509.00 |
| Blood Test, Comprehensive Group of Blood Chemicals | CPT 80053 | $472.85 | $7.60 – $20.06 – $1,351.00 25 insurers | $1,351.00 |
| Blood Test, Lipids (Cholesterol and Triglycerides) | CPT 80061 | $155.05 | $7.66 – $24.80 – $443.00 25 insurers | $443.00 |
| Blood Test, Thyroid Stimulating Hormone (Tsh) | CPT 84443 | $151.55 | $12.10 – $31.92 – $433.00 25 insurers | $433.00 |
| Coagulation Assessment Blood Test | CPT 85730 | $210.70 | $4.33 – $12.73 – $602.00 25 insurers | $602.00 |
| Complete Blood Cell Count, With Differential White Blood Cells, Automated | CPT 85025 | $93.80 | $5.59 – $16.47 – $268.00 25 insurers | $268.00 |
| Complete Blood Count, Automated | CPT 85027 | $174.30 | $4.66 – $14.00 – $498.00 25 insurers | $498.00 |
| Liver Function Blood Test Panel | CPT 80076 | $326.55 | $5.88 – $15.52 – $933.00 25 insurers | $933.00 |
| Manual Urinalysis Test With Examination Using Microscope | CPT 81001 | $91.70 | $2.28 – $6.72 – $262.00 25 insurers | $262.00 |
| Psa (Prostate Specific Antigen) | CPT 84153 | $126.70 | $13.24 – $34.94 – $362.00 25 insurers | $362.00 |
| Psa (Prostate Specific Antigen) | CPT 84154 | $67.90 | $13.24 – $34.94 – $194.00 25 insurers | $194.00 |
Medicine & Surgery
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Biopsy of Large Bowel Using An Endoscope | CPT 45380 | not published | $451.58 – $1,263.66 – $7,221.00 21 insurers | — |
| Biopsy of Prostate Gland | CPT 55700 | $849.80 | $655.56 – $1,700.15 – $7,221.00 26 insurers | $2,428.00 |
| Biopsy of The Esophagus, Stomach, and/Or Upper Small Bowel Using An Endoscope | CPT 43239 | not published | $352.37 – $1,004.82 – $7,221.00 21 insurers | — |
| Cardiac Valve and Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc | MS-DRG 216 | not published | $50,475.22 – $101,491.00 – $227,839.50 19 insurers | — |
| Cervical Spinal Fusion Without Cc Or Mcc | MS-DRG 473 | not published | $3,846.00 – $20,085.22 – $59,342.70 19 insurers | — |
| Diagnostic Examination of Esophagus, Stomach, and/Or Upper Small Bowel Using An Endoscope | CPT 43235 | not published | $352.37 – $967.25 – $5,160.00 21 insurers | — |
| Diagnostic Examination of Large Bowel Using An Endoscope | CPT 45378 | not published | $345.58 – $977.11 – $7,221.00 21 insurers | — |
| Injection of Substance Into Spinal Canal of Lower Back Or Sacrum Using Imaging Guidance | CPT 62322 | not published | $276.53 – $903.49 – $5,160.00 19 insurers | — |
| Injection of Substance Into Spinal Canal of Lower Back Or Sacrum Using Imaging Guidance | CPT 62323 | $1,877.75 | $276.53 – $1,137.60 – $5,365.00 25 insurers | $5,365.00 |
| Injections of Anesthetic and/Or Steroid Drug Into Lower Or Sacral Spine Nerve Root Using Imaging Guidance | CPT 64483 | $936.25 | $358.49 – $1,337.60 – $5,160.00 26 insurers | $2,675.00 |
| Insertion of Catheter Into Left Heart For Diagnosis | CPT 93452 | $4,753.35 | $1,358.10 – $6,466.00 – $28,954.00 24 insurers | $13,581.00 |
| Major Joint Replacement Or Reattachment of Lower Extremity Without Mcc | MS-DRG 470 | not published | $3,846.00 – $16,312.05 – $48,194.68 19 insurers | — |
| Removal of 1 Or More Breast Growth, Open Procedure | CPT 19120 | $3,114.30 | $1,013.77 – $4,200.55 – $12,465.31 26 insurers | $8,898.00 |
| Removal of Cataract With Insertion of Lens | CPT 66984 | not published | $894.14 – $2,352.95 – $12,381.00 21 insurers | — |
| Removal of Gallbladder Using An Endoscope | CPT 47562 | not published | $1,732.00 – $5,902.25 – $18,992.38 21 insurers | — |
| Removal of One Knee Cartilage Using An Endoscope | CPT 29881 | not published | $1,144.86 – $3,314.87 – $10,562.08 21 insurers | — |
| Removal of Polyps Or Growths of Large Bowel Using An Endoscope | CPT 45385 | not published | $451.58 – $1,263.66 – $7,221.00 21 insurers | — |
| Removal of Recurring Cataract In Lens Capsule Using Laser | CPT 66821 | not published | $219.16 – $587.95 – $7,221.00 21 insurers | — |
| Removal of Tonsils and Adenoid Glands Patient Younger Than Age 12 | CPT 42820 | not published | $1,233.00 – $5,145.00 – $19,257.03 21 insurers | — |
| Repair of Groin Hernia Patient Age 5 Years Or Older | CPT 49505 | not published | $1,211.42 – $3,534.78 – $11,488.03 21 insurers | — |
| Routine Obstetric Care For Cesarean Delivery, Including Pre- and Post-Delivery Care | CPT 59510 | not published | $1,810.97 – $2,430.00 – $4,636.07 3 insurers | — |
| Routine Obstetric Care For Vaginal Delivery After Prior Cesarean Delivery Including Pre- and Post-Delivery Care | CPT 59610 | not published | $1,713.93 – $2,430.00 – $4,387.66 3 insurers | — |
| Routine Obstetric Care For Vaginal Delivery, Including Pre- and Post-Delivery Care | CPT 59400 | not published | $1,633.38 – $2,430.00 – $4,181.45 3 insurers | — |
| Shaving of Shoulder Bone Using An Endoscope | CPT 29826 | not published | $1,233.00 – $2,749.00 – $9,029.00 7 insurers | — |
| Sleep Study | CPT 95810 | $2,948.75 | $100.00 – $3,538.50 – $8,425.00 24 insurers | $8,425.00 |
| Spinal Fusion Except Cervical Without Mcc | MS-DRG 460 | not published | $3,846.00 – $4,639.00 – $42,725.00 3 insurers | — |
| Surgical Removal of Prostate and Surrounding Lymph Nodes Using An Endoscope | CPT 55866 | not published | $1,732.00 – $10,428.09 – $33,891.29 17 insurers | — |
| Ultrasound Examination of Lower Large Bowel Using An Endoscope | CPT 45391 | not published | $451.58 – $1,263.66 – $7,221.00 21 insurers | — |
| Uterine and Adnexa Procedures For Non-Malignancy Without Cc Or Mcc | MS-DRG 743 | not published | $7,157.17 – $12,706.00 – $32,306.66 19 insurers | — |
Radiology
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Abdominal Ultrasound of Pregnant Uterus (>= 14 Weeks 0 Days) Single Or First Fetus | CPT 76805 | $1,088.50 | $76.69 – $322.24 – $3,110.00 25 insurers | $3,110.00 |
| Ct Scan, Head Or Brain, Without Contrast | CPT 70450 | $2,399.25 | $76.69 – $667.00 – $6,855.00 25 insurers | $6,855.00 |
| Ct Scan of Abdomen and Pelvis With Contrast | CPT 74177 | $6,736.45 | $257.55 – $1,162.56 – $19,247.00 25 insurers | $19,247.00 |
| Ct Scan, Pelvis, With Contrast | CPT 72193 | $2,722.65 | $128.38 – $777.90 – $7,779.00 25 insurers | $7,779.00 |
| Mammography of Both Breasts | CPT 77066 | $680.75 | $148.00 – $1,069.75 – $1,945.00 13 insurers | $1,945.00 |
| Mammography of One Breast | CPT 77065 | $449.40 | $132.62 – $706.20 – $1,284.00 13 insurers | $1,284.00 |
| Mammography, Screening, Bilateral | CPT 77067 | $297.50 | $140.25 – $467.50 – $850.00 13 insurers | $850.00 |
| Mri Scan of Brain Before and After Contrast | CPT 70553 | $4,119.50 | $257.55 – $1,177.00 – $11,770.00 25 insurers | $11,770.00 |
| Mri Scan of Leg Joint | CPT 73721 | $2,725.80 | $174.32 – $1,023.00 – $7,788.00 25 insurers | $7,788.00 |
| Mri Scan of Lower Spinal Canal | CPT 72148 | $3,528.70 | $174.32 – $1,023.00 – $10,082.00 25 insurers | $10,082.00 |
| Ultrasound of Abdomen | CPT 76700 | $1,812.30 | $76.69 – $343.21 – $5,178.00 25 insurers | $5,178.00 |
| Ultrasound Pelvis Through Vagina | CPT 76830 | $705.25 | $76.69 – $301.37 – $2,015.00 25 insurers | $2,015.00 |
| X-Ray, Lower Back, Minimum Four Views | CPT 72110 | $926.80 | $51.45 – $219.50 – $2,648.00 25 insurers | $2,648.00 |
Inpatient (volume)
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Acute Myocardial Infarction, Discharged Alive With Cc | MS-DRG 281 | not published | $1,990.00 – $9,771.00 – $25,901.01 19 insurers | — |
| Acute Myocardial Infarction, Discharged Alive With Mcc | MS-DRG 280 | not published | $1,990.00 – $17,399.00 – $42,547.83 19 insurers | — |
| Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc | MS-DRG 897 | not published | $719.00 – $8,456.44 – $24,984.93 19 insurers | — |
| Bronchitis and Asthma With Cc/Mcc | MS-DRG 202 | not published | $5,968.19 – $10,247.00 – $26,939.71 19 insurers | — |
| Cardiac Arrhythmia and Conduction Disorders With Cc | MS-DRG 309 | not published | $1,990.00 – $7,837.00 – $21,679.16 19 insurers | — |
| Cardiac Arrhythmia and Conduction Disorders With Mcc | MS-DRG 308 | not published | $1,990.00 – $12,783.00 – $32,473.22 19 insurers | — |
| Cardiac Arrhythmia and Conduction Disorders Without Cc/Mcc | MS-DRG 310 | not published | $1,990.00 – $5,931.00 – $17,519.78 19 insurers | — |
| Cellulitis With Mcc | MS-DRG 602 | not published | $8,543.47 – $15,574.00 – $38,564.24 19 insurers | — |
| Cellulitis Without Mcc | MS-DRG 603 | not published | $5,527.96 – $9,336.00 – $24,952.56 19 insurers | — |
| Chest Pain | MS-DRG 313 | not published | $1,990.00 – $7,562.00 – $21,080.02 19 insurers | — |
| Chronic Obstructive Pulmonary Disease With Cc | MS-DRG 191 | not published | $5,416.74 – $9,106.00 – $24,450.57 19 insurers | — |
| Chronic Obstructive Pulmonary Disease With Mcc | MS-DRG 190 | not published | $6,769.21 – $11,904.00 – $30,555.46 19 insurers | — |
| Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc | MS-DRG 286 | not published | $12,356.94 – $23,315.13 – $55,777.84 19 insurers | — |
| Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc | MS-DRG 287 | not published | $6,598.55 – $11,551.00 – $29,785.12 19 insurers | — |
| Cirrhosis and Alcoholic Hepatitis With Mcc | MS-DRG 432 | not published | $11,054.18 – $20,746.29 – $49,897.32 19 insurers | — |
| Combined Anterior and Posterior Spinal Fusion With Cc | MS-DRG 454 | not published | $3,846.00 – $4,639.00 – $69,101.00 3 insurers | — |
| Craniotomy and Endovascular Intracranial Procedures With Mcc | MS-DRG 025 | not published | $23,934.18 – $47,030.50 – $108,036.21 19 insurers | — |
| Degenerative Nervous System Disorders Without Mcc | MS-DRG 057 | not published | $7,852.63 – $14,145.00 – $35,445.87 19 insurers | — |
| Diabetes With Cc | MS-DRG 638 | not published | $5,714.50 – $9,722.00 – $25,794.60 19 insurers | — |
| Diabetes With Mcc | MS-DRG 637 | not published | $8,477.36 – $15,437.00 – $38,265.83 19 insurers | — |
| Endovascular Cardiac Valve Replacement and Supplement Procedures With Mcc | MS-DRG 266 | not published | $31,716.40 – $62,999.00 – $143,164.29 19 insurers | — |
| Endovascular Cardiac Valve Replacement and Supplement Procedures Without Mcc | MS-DRG 267 | not published | $25,125.21 – $49,474.50 – $113,412.39 19 insurers | — |
| Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders With Mcc | MS-DRG 391 | not published | $7,596.89 – $13,616.00 – $34,291.50 19 insurers | — |
| Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders Without Mcc | MS-DRG 392 | not published | $5,012.90 – $8,271.00 – $22,627.64 19 insurers | — |
| Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc | MS-DRG 981 | not published | $25,377.36 – $49,992.00 – $114,550.58 19 insurers | — |
| Fractures of Hip and Pelvis Without Mcc | MS-DRG 536 | not published | $5,169.72 – $8,596.00 – $23,335.52 19 insurers | — |
| Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh Without Mcc | MS-DRG 563 | not published | $5,594.58 – $9,474.00 – $25,253.28 19 insurers | — |
| Gastrointestinal Hemorrhage With Cc | MS-DRG 378 | not published | $6,066.59 – $10,451.00 – $27,383.89 19 insurers | — |
| Gastrointestinal Hemorrhage With Mcc | MS-DRG 377 | not published | $10,332.07 – $19,273.00 – $46,637.80 19 insurers | — |
| Gastrointestinal Obstruction With Cc | MS-DRG 389 | not published | $5,122.06 – $8,497.00 – $23,120.37 19 insurers | — |
| Gastrointestinal Obstruction With Mcc | MS-DRG 388 | not published | $8,547.05 – $15,581.00 – $38,580.43 19 insurers | — |
| Gastrointestinal Obstruction Without Cc/Mcc | MS-DRG 390 | not published | $3,818.27 – $5,816.74 – $17,235.24 19 insurers | — |
| Heart Failure and Shock With Mcc | MS-DRG 291 | not published | $1,990.00 – $13,831.00 – $34,761.13 19 insurers | — |
| Hip and Femur Procedures Except Major Joint With Cc | MS-DRG 481 | not published | $4,590.00 – $21,839.33 – $52,576.16 19 insurers | — |
| Hip and Femur Procedures Except Major Joint With Mcc | MS-DRG 480 | not published | $4,590.00 – $30,681.00 – $72,611.99 19 insurers | — |
| Hip Replacement With Principal Diagnosis of Hip Fracture Without Mcc | MS-DRG 522 | not published | $11,817.80 – $22,252.18 – $53,344.20 19 insurers | — |
| Hypertension Without Mcc | MS-DRG 305 | not published | $1,990.00 – $7,957.00 – $21,942.90 19 insurers | — |
| Infectious and Parasitic Diseases With O.R. Procedures With Cc | MS-DRG 854 | not published | $11,254.05 – $21,140.67 – $50,799.52 19 insurers | — |
| Infectious and Parasitic Diseases With O.R. Procedures With Mcc | MS-DRG 853 | not published | $26,645.27 – $52,594.00 – $120,273.76 19 insurers | — |
| Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours | MS-DRG 065 | not published | $6,225.46 – $10,779.00 – $28,101.00 19 insurers | — |
| Intracranial Hemorrhage Or Cerebral Infarction With Mcc | MS-DRG 064 | not published | $11,208.44 – $21,050.91 – $50,593.63 19 insurers | — |
| Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc | MS-DRG 066 | not published | $4,541.40 – $7,296.00 – $20,499.38 19 insurers | — |
| Kidney and Ureter Procedures For Non-Neoplasm With Cc | MS-DRG 660 | not published | $7,881.33 – $14,204.00 – $35,575.41 19 insurers | — |
| Kidney and Urinary Tract Infections With Mcc | MS-DRG 689 | not published | $7,011.62 – $12,405.00 – $31,649.67 19 insurers | — |
| Kidney and Urinary Tract Infections Without Mcc | MS-DRG 690 | not published | $5,127.18 – $8,508.00 – $23,143.51 19 insurers | — |
| Laparoscopic Cholecystectomy Without C.D.E. With Cc | MS-DRG 418 | not published | $9,513.11 – $17,579.00 – $42,941.08 19 insurers | — |
| Major Gastrointestinal Disorders and Peritoneal Infections With Cc | MS-DRG 372 | not published | $6,289.01 – $10,911.00 – $28,387.88 19 insurers | — |
| Major Small and Large Bowel Procedures With Cc | MS-DRG 330 | not published | $13,127.73 – $24,856.50 – $59,257.09 19 insurers | — |
| Major Small and Large Bowel Procedures With Mcc | MS-DRG 329 | not published | $24,547.12 – $48,288.50 – $110,802.97 19 insurers | — |
| Major Small and Large Bowel Procedures Without Cc/Mcc | MS-DRG 331 | not published | $9,475.18 – $17,501.00 – $42,769.91 19 insurers | — |
| Medical Back Problems Without Mcc | MS-DRG 552 | not published | $5,953.32 – $10,216.00 – $26,872.63 19 insurers | — |
| Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes With Mcc | MS-DRG 640 | not published | $7,819.82 – $14,077.00 – $35,297.80 19 insurers | — |
| Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes Without Mcc | MS-DRG 641 | not published | $5,018.53 – $8,283.00 – $22,653.09 19 insurers | — |
| Organic Disturbances and Intellectual Disability | MS-DRG 884 | not published | $719.00 – $14,626.30 – $43,214.05 19 insurers | — |
| Other Cerebrovascular Disorders With Cc | MS-DRG 071 | not published | $6,415.08 – $11,171.00 – $28,956.95 19 insurers | — |
| Other Cerebrovascular Disorders With Mcc | MS-DRG 070 | not published | $9,925.15 – $18,431.00 – $44,801.03 19 insurers | — |
| Other Circulatory System Diagnoses With Mcc | MS-DRG 314 | not published | $1,990.00 – $22,594.62 – $54,394.44 19 insurers | — |
| Other Digestive System Diagnoses With Cc | MS-DRG 394 | not published | $5,838.01 – $9,978.00 – $26,352.11 19 insurers | — |
| Other Digestive System Diagnoses With Mcc | MS-DRG 393 | not published | $9,500.81 – $17,554.00 – $42,885.57 19 insurers | — |
| Other Disorders of Nervous System With Cc | MS-DRG 092 | not published | $6,439.68 – $11,222.00 – $29,067.97 19 insurers | — |
| Other Kidney and Urinary Tract Diagnoses With Cc | MS-DRG 699 | not published | $6,240.84 – $10,811.00 – $28,170.42 19 insurers | — |
| Other Kidney and Urinary Tract Diagnoses With Mcc | MS-DRG 698 | not published | $9,628.42 – $17,818.00 – $43,461.60 19 insurers | — |
| Other Vascular Procedures With Mcc | MS-DRG 252 | not published | $2,221.00 – $28,408.26 – $83,933.50 19 insurers | — |
| Percutaneous and Other Intracardiac Procedures Without Mcc | MS-DRG 274 | not published | $17,008.85 – $32,820.50 – $76,776.02 19 insurers | — |
| Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/ | MS-DRG 321 | not published | $15,603.59 – $29,698.00 – $70,432.83 18 insurers | — |
| Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc | MS-DRG 322 | not published | $10,285.95 – $19,178.00 – $46,429.60 18 insurers | — |
| Peripheral Vascular Disorders With Cc | MS-DRG 300 | not published | $1,990.00 – $11,348.00 – $29,343.28 19 insurers | — |
| Permanent Cardiac Pacemaker Implant With Cc | MS-DRG 243 | not published | $3,358.00 – $23,548.82 – $56,691.61 19 insurers | — |
| Poisoning and Toxic Effects of Drugs With Mcc | MS-DRG 917 | not published | $9,417.27 – $17,327.00 – $42,508.51 19 insurers | — |
| Psychoses | MS-DRG 885 | not published | $719.00 – $12,585.86 – $37,185.50 19 insurers | — |
| Pulmonary Edema and Respiratory Failure | MS-DRG 189 | not published | $7,355.51 – $13,116.00 – $33,201.94 19 insurers | — |
| Pulmonary Embolism With Mcc Or Acute Cor Pulmonale | MS-DRG 175 | not published | $8,235.46 – $14,936.00 – $37,173.93 19 insurers | — |
| Pulmonary Embolism Without Mcc | MS-DRG 176 | not published | $5,188.17 – $8,634.00 – $23,418.82 19 insurers | — |
| Red Blood Cell Disorders With Mcc | MS-DRG 811 | not published | $8,224.18 – $14,913.00 – $37,123.03 19 insurers | — |
| Red Blood Cell Disorders Without Mcc | MS-DRG 812 | not published | $5,743.71 – $9,783.00 – $25,926.46 19 insurers | — |
| Renal Failure With Cc | MS-DRG 683 | not published | $5,569.46 – $9,422.00 – $25,139.92 19 insurers | — |
| Renal Failure With Mcc | MS-DRG 682 | not published | $8,711.05 – $15,920.00 – $39,320.71 19 insurers | — |
| Respiratory Infections and Inflammations With Cc | MS-DRG 178 | not published | $6,098.36 – $10,516.00 – $27,527.31 19 insurers | — |
| Respiratory Infections and Inflammations With Mcc | MS-DRG 177 | not published | $9,298.37 – $17,135.00 – $41,971.80 19 insurers | — |
| Respiratory System Diagnosis With Ventilator Support <=96 Hours | MS-DRG 208 | not published | $14,768.22 – $28,222.50 – $66,662.09 19 insurers | — |
| Revision of Hip Or Knee Replacement With Cc | MS-DRG 467 | not published | $3,846.00 – $28,367.55 – $83,813.21 19 insurers | — |
| Seizures With Mcc | MS-DRG 100 | not published | $11,188.45 – $21,011.17 – $50,503.41 19 insurers | — |
| Seizures Without Mcc | MS-DRG 101 | not published | $5,737.56 – $9,770.00 – $25,898.70 19 insurers | — |
| Septicemia Or Severe Sepsis With Mv >96 Hours | MS-DRG 870 | not published | $36,665.55 – $73,154.50 – $165,504.21 19 insurers | — |
| Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc | MS-DRG 871 | not published | $11,069.55 – $20,776.70 – $49,966.71 19 insurers | — |
| Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc | MS-DRG 872 | not published | $6,297.72 – $10,929.00 – $28,427.20 19 insurers | — |
| Signs and Symptoms Without Mcc | MS-DRG 948 | not published | $5,085.67 – $8,422.00 – $22,956.15 19 insurers | — |
| Simple Pneumonia and Pleurisy With Cc | MS-DRG 194 | not published | $5,216.35 – $8,692.00 – $23,546.03 19 insurers | — |
| Simple Pneumonia and Pleurisy With Mcc | MS-DRG 193 | not published | $7,767.04 – $13,968.00 – $35,059.54 19 insurers | — |
| Syncope and Collapse | MS-DRG 312 | not published | $1,990.00 – $9,236.00 – $24,732.80 19 insurers | — |
| Transient Ischemia Without Thrombolytic | MS-DRG 069 | not published | $5,114.37 – $8,481.00 – $23,085.70 19 insurers | — |
Outpatient/professional (volume)
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| 3d Radiographic Procedure | CPT 76376 | $505.05 | $18.80 – $901.88 – $2,156.00 14 insurers | $1,443.00 |
| Advance Care Planning, First 30 Minutes | CPT 99497 | $66.15 | $51.03 – $122.43 – $301.11 24 insurers | $189.00 |
| Aspiration and/Or Injection of Fluid From Large Joint | CPT 20610 | $1,723.75 | $23.28 – $966.47 – $5,160.00 26 insurers | $4,925.00 |
| Calculation of Radiation Therapy Dose | CPT 77300 | $1,705.90 | $50.52 – $2,064.41 – $4,874.00 25 insurers | $4,874.00 |
| Complete Ultrasound Scan Behind Abdominal Cavity | CPT 76770 | $1,124.20 | $76.69 – $333.47 – $3,212.00 25 insurers | $3,212.00 |
| Critical Care, Each Additional 30 Minutes | CPT 99292 | $70.35 | $20.10 – $130.65 – $5,857.00 16 insurers | $201.00 |
| Critical Care, First 30-74 Minutes | CPT 99291 | $1,868.30 | $533.80 – $1,866.65 – $6,672.00 25 insurers | $6,672.00 |
| Ct Guidance For Insertion of Radiation Therapy Fields | CPT 77014 | $1,665.65 | $108.74 – $2,928.20 – $4,759.00 14 insurers | $4,759.00 |
| Ct Scan of Abdomen and Pelvis Before and After Contrast | CPT 74178 | $7,343.00 | $257.55 – $1,162.56 – $20,980.00 25 insurers | $20,980.00 |
| Ct Scan of Abdomen and Pelvis Without Contrast | CPT 74176 | $5,658.80 | $174.32 – $800.00 – $16,168.00 25 insurers | $16,168.00 |
| Ct Scan of Blood Vessels of Abdomen and Pelvis With Contrast | CPT 74174 | $4,027.10 | $257.55 – $1,149.50 – $11,506.00 25 insurers | $11,506.00 |
| Ct Scan of Blood Vessels of Chest With Contrast | CPT 71275 | $3,421.25 | $128.38 – $792.66 – $9,775.00 25 insurers | $9,775.00 |
| Ct Scan of Blood Vessels of Head With Contrast | CPT 70496 | $3,731.00 | $128.38 – $792.66 – $10,660.00 25 insurers | $10,660.00 |
| Ct Scan of Blood Vessels of Neck With Contrast | CPT 70498 | $3,731.00 | $128.38 – $792.66 – $10,660.00 25 insurers | $10,660.00 |
| Ct Scan of Chest With Contrast | CPT 71260 | $3,540.25 | $128.38 – $792.66 – $10,115.00 25 insurers | $10,115.00 |
| Ct Scan of Chest Without Contrast | CPT 71250 | $2,796.85 | $76.69 – $667.00 – $7,991.00 25 insurers | $7,991.00 |
| Ct Scan of Face Without Contrast | CPT 70486 | $2,256.80 | $76.69 – $644.80 – $6,448.00 25 insurers | $6,448.00 |
| Ct Scan of Leg Without Contrast | CPT 73700 | $1,767.50 | $76.69 – $559.00 – $5,050.00 25 insurers | $5,050.00 |
| Ct Scan of Lower Spine Without Contrast | CPT 72131 | $3,471.65 | $76.69 – $667.00 – $9,919.00 25 insurers | $9,919.00 |
| Ct Scan of Upper Spine Without Contrast | CPT 72125 | $2,851.10 | $76.69 – $667.00 – $8,146.00 25 insurers | $8,146.00 |
| Design and Construction of Complex Radiation Treatment Device | CPT 77334 | $3,342.50 | $101.03 – $3,338.25 – $9,550.00 25 insurers | $9,550.00 |
| Destruction of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Single Facet Joint | CPT 64635 | not published | $694.26 – $1,985.27 – $11,090.00 19 insurers | — |
| Destruction of Precancer Skin Growth, 2-14 Growths | CPT 17003 | not published | $807.00 – $2,430.00 – $2,749.00 4 insurers | — |
| Dexamethasone, Lacrimal Ophthalmic Insert, 0.1 Mg | HCPCS J1096 | $888.47 | $73.19 – $863.08 – $2,538.47 25 insurers | $2,538.47 |
| Diagnostic Digital Breast Tomosynthesis, Unilateral Or Bilateral (List Separately In Addition To 77065 Or 77066) | HCPCS G0279 | $55.30 | $15.80 – $86.90 – $243.00 15 insurers | $158.00 |
| Diagnostic Exam of Bladder and Urethra Using An Endoscope | CPT 52000 | $1,101.80 | $250.53 – $1,049.06 – $30,902.00 26 insurers | $3,148.00 |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine | CPT 77080 | $416.50 | $38.09 – $159.76 – $1,190.00 25 insurers | $1,190.00 |
| Emergency Department Visit With High Level of Medical Decision Making | CPT 99285 | $1,760.15 | $442.14 – $1,604.34 – $7,146.00 25 insurers | $5,029.00 |
| Emergency Department Visit With Low Level of Medical Decision Making | CPT 99283 | $962.15 | $30.82 – $742.23 – $3,983.00 25 insurers | $2,749.00 |
| Emergency Department Visit With Moderate Level of Medical Decision Making | CPT 99284 | $1,372.00 | $307.09 – $1,240.20 – $5,609.00 25 insurers | $3,920.00 |
| Established Patient Office Or Other Outpatient Visit With High Level of Medical Decision Making, If Using Time, 40 Minutes Or More | CPT 99215 | $174.65 | $74.00 – $320.10 – $499.00 13 insurers | $499.00 |
| Established Patient Office Or Other Outpatient Visit With Low Level Od Decision Making, If Using Time, 20 Minutes Or More | CPT 99213 | $148.40 | $74.00 – $243.80 – $424.00 13 insurers | $424.00 |
| Established Patient Office Or Other Outpatient Visit With Moderate Level of Decision Making, If Using Time, 30 Minutes Or More | CPT 99214 | $168.70 | $74.00 – $277.15 – $482.00 13 insurers | $482.00 |
| Established Patient Office Or Other Outpatient Visit With Straightforward Medical Decision Making, If Using Time, 10 Minutes Or More | CPT 99212 | $118.65 | $37.89 – $194.93 – $339.00 13 insurers | $339.00 |
| Evaluation of Fine Needle Aspirate With Interpretation and Report | CPT 88173 | $186.20 | $38.53 – $216.68 – $532.00 24 insurers | $532.00 |
| Hemodialysis Procedure With Physician Evaluation | CPT 90935 | $1,450.40 | $100.00 – $1,864.80 – $4,144.00 24 insurers | $4,144.00 |
| Imaging For Evaluation of Swallowing Function | CPT 74230 | $1,078.70 | $124.96 – $347.61 – $3,082.00 25 insurers | $3,082.00 |
| Immunologic Analysis Technique On Serum (Immunofixation) | CPT 86334 | $138.60 | $16.08 – $42.45 – $396.00 25 insurers | $396.00 |
| Injection of Anesthetic Agent and/Or Steroid Into Thigh Nerve (Femoral Nerve) | CPT 64447 | $291.20 | $36.27 – $693.64 – $5,160.00 26 insurers | $1,629.00 |
| Injection of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Level | CPT 64493 | $449.05 | $346.41 – $891.73 – $5,160.00 26 insurers | $1,283.00 |
| Insertion of Artery Tube For Blood Sampling Or Infusion Through Skin | CPT 36620 | $204.75 | $58.50 – $380.25 – $2,749.00 14 insurers | $585.00 |
| Insertion of Non-Tunneled Central Venous Tube For Infusion (5 Years Or Older) | CPT 36556 | $2,965.55 | $807.00 – $3,310.23 – $10,245.95 26 insurers | $8,473.00 |
| Insertion of Tube In Left Lower Heart Chamber and Coronary Artery For Diagnosis With Review By Radiologist | CPT 93458 | $8,642.55 | $2,319.57 – $7,704.22 – $28,954.00 24 insurers | $24,693.00 |
| Limited Ultrasound Scan of 1 Breast | CPT 76642 | $754.95 | $63.50 – $253.16 – $2,157.00 25 insurers | $2,157.00 |
| Limited Ultrasound Scan of Abdomen | CPT 76705 | $1,069.25 | $76.69 – $305.50 – $3,055.00 25 insurers | $3,055.00 |
| Low Dose Ct Scan of Chest For Lung Cancer Screening | CPT 71271 | $127.05 | $36.30 – $199.65 – $2,156.00 25 insurers | $363.00 |
| Microscopic Genetic Analysis of Tumor, Manual | CPT 88360 | $249.55 | $123.58 – $323.15 – $713.00 24 insurers | $713.00 |
| Mri Scan of Abdomen Before and After Contrast | CPT 74183 | $4,936.05 | $257.55 – $1,183.74 – $14,103.00 25 insurers | $14,103.00 |
| Mri Scan of Brain Without Contrast | CPT 70551 | $1,647.80 | $174.32 – $1,015.00 – $4,708.00 25 insurers | $4,708.00 |
| Mri Scan of Upper Spinal Canal Without Contrast | CPT 72141 | $2,950.15 | $174.32 – $1,023.00 – $8,429.00 25 insurers | $8,429.00 |
| Nuclear Medicine Studies of Heart Muscle At Rest and With Stress and Spect | CPT 78452 | $4,876.90 | $438.05 – $1,961.38 – $13,934.00 25 insurers | $13,934.00 |
| Nuclear Medicine Study From Skull Base To Mid-Thigh With Ct Scan | CPT 78815 | $4,104.45 | $1,051.88 – $3,334.00 – $11,727.00 25 insurers | $11,727.00 |
| Pathology Examination of Tissue Using A Microscope, Intermediate Complexity | CPT 88305 | $408.10 | $38.53 – $253.78 – $1,166.00 24 insurers | $1,166.00 |
| Pathology Examination of Tissue Using A Microscope, Moderately High Complexity | CPT 88307 | $534.80 | $259.42 – $718.16 – $1,528.00 24 insurers | $1,528.00 |
| Pathology Examination of Tissue Using A Microscope, Moderately Low Complexity | CPT 88304 | $322.70 | $38.53 – $248.94 – $922.00 24 insurers | $922.00 |
| Preparation of Tissue For Examination By Removing Any Calcium Present | CPT 88311 | $127.05 | $13.15 – $199.65 – $363.00 13 insurers | $363.00 |
| Protein Measurement, Serum | CPT 84165 | $91.70 | $7.73 – $20.41 – $262.00 25 insurers | $262.00 |
| Removal of Fingernails Or Toenails, 6 Or More Nails | CPT 11721 | $58.10 | $41.26 – $99.60 – $2,749.00 25 insurers | $166.00 |
| Removal of Skin and Tissue, 20.0 Sq Cm Or Less | CPT 11042 | $778.05 | $150.52 – $880.09 – $7,221.00 26 insurers | $2,223.00 |
| Removal of Skin and Tissue, Each Additional 20.0 Sq Cm Or Less | CPT 11045 | $336.00 | $36.00 – $624.00 – $2,749.00 15 insurers | $960.00 |
| Replacement of Knee Joint, Both Sides of Knee | CPT 27447 | not published | $1,997.00 – $12,887.66 – $41,884.89 17 insurers | — |
| Replacement of Thigh Bone and Hip Joint With Prosthesis | CPT 27130 | not published | $1,997.00 – $12,887.66 – $41,884.89 17 insurers | — |
| Screening 3d Breast Mammography | CPT 77063 | $64.75 | $18.50 – $101.75 – $243.00 15 insurers | $185.00 |
| Special Stained Specimen Slides To Examine Tissue, Each Additional Procedure | CPT 88341 | $187.60 | $94.18 – $316.24 – $536.00 13 insurers | $536.00 |
| Special Stained Specimen Slides To Examine Tissue Including Interpretation and Report | CPT 88313 | $187.25 | $47.70 – $193.67 – $535.00 24 insurers | $535.00 |
| Special Stained Specimen Slides To Examine Tissue, Initial Procedure | CPT 88342 | $272.30 | $123.58 – $334.54 – $778.00 24 insurers | $778.00 |
| Special Stained Specimen Slides To Identify Organisms Including Interpretation and Report | CPT 88312 | $178.85 | $38.53 – $216.68 – $511.00 24 insurers | $511.00 |
| Test To Determine Lung Volumes Using Sensors | CPT 94726 | $632.80 | $100.00 – $777.44 – $1,808.00 24 insurers | $1,808.00 |
| Test To Examine How Well The Lungs Exchange Gases | CPT 94729 | $556.15 | $68.40 – $953.40 – $1,589.00 13 insurers | $1,589.00 |
| Test To Measure Expiratory Airflow and Volume Changes Before and After Medication Administration | CPT 94060 | $833.35 | $68.93 – $861.45 – $2,381.00 24 insurers | $2,381.00 |
| Ultrasonic Guidance For Blood Vessel Access | CPT 76937 | $952.70 | $27.95 – $1,497.10 – $2,722.00 13 insurers | $2,722.00 |
| Ultrasonic Guidance For Needle Placement | CPT 76942 | $1,246.35 | $35.57 – $2,029.77 – $3,561.00 14 insurers | $3,561.00 |
| Ultrasound of Both Sides of Head and Neck Blood Flow | CPT 93880 | $1,324.40 | $174.32 – $401.00 – $3,784.00 25 insurers | $3,784.00 |
| Ultrasound of Heart Blood Flow, Valves and Chambers | CPT 93320 | $687.05 | $52.09 – $1,176.00 – $1,963.00 13 insurers | $1,963.00 |
| Ultrasound of Heart Blood Flow, Valves and Chambers, Follow-Up | CPT 93321 | $336.70 | $28.94 – $625.30 – $1,176.00 13 insurers | $962.00 |
| Ultrasound of Heart, Follow-Up | CPT 93308 | $462.00 | $98.24 – $359.79 – $1,320.00 25 insurers | $1,320.00 |
| Ultrasound of Heart With Color-Depicted Blood Flow, Rate and Valve Function | CPT 93325 | $316.05 | $32.62 – $586.95 – $1,176.00 13 insurers | $903.00 |
| Ultrasound of Heart With Color-Depicted Blood Flow, Rate, Direction and Valve Function | CPT 93306 | $2,651.25 | $100.00 – $1,176.00 – $7,575.00 24 insurers | $7,575.00 |
| Ultrasound of Heart With Probe In Esophagus, With Report | CPT 93312 | $1,565.20 | $100.00 – $774.73 – $4,472.00 25 insurers | $4,472.00 |
| Ultrasound Scan of Head and Neck Soft Tissue | CPT 76536 | $1,158.15 | $76.69 – $334.86 – $3,309.00 25 insurers | $3,309.00 |
| Ultrasound Study of Arm Or Leg Veins With Compression and Maneuvers | CPT 93970 | $1,336.65 | $174.32 – $401.00 – $3,819.00 25 insurers | $3,819.00 |
| Ultrasound Study of One Arm Or Leg Veins With Compression and Maneuvers | CPT 93971 | $908.95 | $76.69 – $315.18 – $2,597.00 25 insurers | $2,597.00 |
| Use of A Drug To Induce Depression of Consciousness By Physician Performing A Procedure (5 Years Or Older), Initial 15 Minutes | CPT 99152 | $788.55 | $18.41 – $1,351.80 – $2,253.00 13 insurers | $2,253.00 |
| X-Ray of Abdomen, 1 View | CPT 74018 | $456.40 | $30.08 – $137.91 – $1,304.00 25 insurers | $1,304.00 |
| X-Ray of Ankle, Minimum of 3 Views | CPT 73610 | $542.85 | $36.75 – $155.10 – $1,551.00 25 insurers | $1,551.00 |
| X-Ray of Chest, 1 View | CPT 71045 | $436.80 | $25.73 – $137.91 – $1,248.00 25 insurers | $1,248.00 |
| X-Ray of Chest, 2 Views | CPT 71046 | $572.25 | $33.75 – $163.50 – $1,635.00 25 insurers | $1,635.00 |
| X-Ray of Foot, Minimum of 3 Views | CPT 73630 | $513.80 | $34.41 – $146.80 – $1,468.00 25 insurers | $1,468.00 |
| X-Ray of Hand, Minimum of 3 Views | CPT 73130 | $505.75 | $37.09 – $144.50 – $1,445.00 25 insurers | $1,445.00 |
| X-Ray of Hip, 2-3 Views | CPT 73502 | $560.70 | $47.11 – $160.20 – $1,602.00 25 insurers | $1,602.00 |
| X-Ray of Knee, 1-2 Views | CPT 73560 | $417.55 | $34.41 – $137.91 – $1,193.00 25 insurers | $1,193.00 |
| X-Ray of Knee, 3 Views | CPT 73562 | $504.35 | $40.76 – $144.10 – $1,441.00 25 insurers | $1,441.00 |
| X-Ray of Knee, 4 Or More Views | CPT 73564 | $579.60 | $46.78 – $173.83 – $1,656.00 25 insurers | $1,656.00 |
| X-Ray of Lower and Sacral Spine, 2-3 Views | CPT 72100 | $713.65 | $40.10 – $203.90 – $2,039.00 25 insurers | $2,039.00 |
| X-Ray of Lower Leg, 2 Views | CPT 73590 | $484.75 | $31.74 – $139.25 – $1,385.00 25 insurers | $1,385.00 |
| X-Ray of Pelvis, 1-2 Views | CPT 72170 | $457.45 | $28.06 – $169.59 – $1,307.00 25 insurers | $1,307.00 |
| X-Ray of Shoulder, Minimum of 2 Views | CPT 73030 | $558.60 | $34.75 – $159.60 – $1,596.00 25 insurers | $1,596.00 |
| X-Ray of Thigh Bone, Minimum 2 Views | CPT 73552 | $456.05 | $35.75 – $137.91 – $1,303.00 25 insurers | $1,303.00 |
| X-Ray of Wrist, Minimum of 3 Views | CPT 73110 | $462.35 | $41.10 – $139.00 – $1,321.00 25 insurers | $1,321.00 |