Prices / Houston–Pasadena–The Woodlands, TX / Hospitals

Liberty Dayton Regional Medical Center

1353 N Travis St, Liberty, TX 77575 · CCN 451375

Source: the hospital's standard-charges file dated 2026-05-11 (original file, json, 7 MB), checked by us on 2026-10-06. 116 of 300 common services found in it.

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Evaluation & Management

Service	Code	Cash price	Insurers pay (min – median – max)	Gross charge
Family Psychotherapy, Including Patient, 50 Min	CPT 90847	$220.00	$188.00 – $267.00 – $298.00 6 insurers	$314.00
Family Psychotherapy, Not Including Patient, 50 Min	CPT 90846	$212.00	$182.00 – $257.50 – $288.00 6 insurers	$303.00
Group Psychotherapy	CPT 90853	$59.00	$50.00 – $71.50 – $80.00 6 insurers	$84.00
Initial New Patient Preventive Medicine Evaluation (18-39 Years)	CPT 99385	$271.00	$232.00 – $329.00 – $368.00 6 insurers	$387.00
Initial New Patient Preventive Medicine Evaluation (40-64 Years)	CPT 99386	$328.00	$281.00 – $399.00 – $446.00 6 insurers	$469.00
New Patient Office Or Other Outpatient Visit, Typically 30 Min	CPT 99203	$165.00	$141.00 – $228.50 – $329.00 6 insurers	$346.00
New Patient Office Or Other Outpatient Visit, Typically 45 Min	CPT 99204	$109.00	$93.00 – $342.00 – $633.00 6 insurers	$666.00
New Patient Office Or Other Outpatient Visit, Typically 60 Min	CPT 99205	$368.00	$316.00 – $492.50 – $614.00 6 insurers	$646.00
Patient Office Consultation, Typically 40 Min	CPT 99243	$165.00	$141.00 – $199.50 – $223.00 6 insurers	$235.00
Patient Office Consultation, Typically 60 Min	CPT 99244	$279.00	$239.00 – $339.00 – $379.00 6 insurers	$399.00
Psychotherapy, 30 Min	CPT 90832	$168.00	$144.00 – $204.00 – $228.00 6 insurers	$240.00
Psychotherapy, 45 Min	CPT 90834	$222.00	$190.00 – $269.50 – $301.00 6 insurers	$317.00
Psychotherapy, 60 Min	CPT 90837	$326.00	$279.00 – $395.50 – $442.00 6 insurers	$465.00

Laboratory & Pathology

Service	Code	Cash price	Insurers pay (min – median – max)	Gross charge
Automated Urinalysis Test	CPT 81003	$12.00	$10.00 – $14.50 – $16.00 6 insurers	$17.00
Basic Metabolic Panel	CPT 80048	$37.00	$32.00 – $50.00 – $68.00 6 insurers	$72.00
Blood Test, Clotting Time	CPT 85610	$9.00	$8.00 – $15.50 – $29.00 6 insurers	$31.00
Blood Test, Comprehensive Group of Blood Chemicals	CPT 80053	$49.00	$42.00 – $67.00 – $86.00 6 insurers	$90.00
Blood Test, Lipids (Cholesterol and Triglycerides)	CPT 80061	$92.00	$79.00 – $136.50 – $235.00 6 insurers	$247.00
Blood Test, Thyroid Stimulating Hormone (Tsh)	CPT 84443	$18.00	$15.00 – $58.00 – $125.00 6 insurers	$132.00
Coagulation Assessment Blood Test	CPT 85730	$32.00	$28.00 – $40.00 – $46.00 6 insurers	$48.00
Complete Blood Cell Count, With Differential White Blood Cells, Automated	CPT 85025	$19.00	$16.00 – $34.50 – $51.00 6 insurers	$54.00
Kidney Function Panel Test	CPT 80069	$41.00	$35.00 – $55.00 – $74.00 6 insurers	$78.00
Liver Function Blood Test Panel	CPT 80076	$39.00	$34.00 – $52.50 – $66.00 6 insurers	$69.00
Manual Urinalysis Test With Examination Using Microscope	CPT 81000	$10.00	$8.00 – $12.00 – $13.00 6 insurers	$14.00
Manual Urinalysis Test With Examination Using Microscope	CPT 81001	$22.00	$19.00 – $27.00 – $30.00 6 insurers	$32.00
Psa (Prostate Specific Antigen)	CPT 84153	$43.00	$37.00 – $62.00 – $105.00 6 insurers	$110.00
Psa (Prostate Specific Antigen)	CPT 84154	$39.00	$33.00 – $46.50 – $52.00 6 insurers	$55.00

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	$466.00	$400.00 – $566.50 – $633.00 6 insurers	$666.00
Ct Scan, Head Or Brain, Without Contrast	CPT 70450	$664.00	$569.00 – $806.00 – $901.00 6 insurers	$948.00
Ct Scan of Abdomen and Pelvis With Contrast	CPT 74177	$1,236.00	$1,060.00 – $1,501.50 – $1,678.00 6 insurers	$1,766.00
Ct Scan, Pelvis, With Contrast	CPT 72193	$904.00	$775.00 – $1,098.00 – $1,227.00 6 insurers	$1,292.00
Mri Scan of Brain Before and After Contrast	CPT 70553	$1,775.00	$1,521.00 – $2,154.50 – $2,408.00 6 insurers	$2,535.00
Mri Scan of Leg Joint	CPT 73721	$1,269.00	$1,088.00 – $1,541.00 – $1,722.00 6 insurers	$1,813.00
Mri Scan of Lower Spinal Canal	CPT 72148	$1,269.00	$1,088.00 – $1,541.00 – $1,722.00 6 insurers	$1,813.00
Ultrasound of Abdomen	CPT 76700	$466.00	$400.00 – $566.50 – $633.00 6 insurers	$666.00
Ultrasound Pelvis Through Vagina	CPT 76830	$383.00	$328.00 – $465.00 – $520.00 6 insurers	$547.00
X-Ray, Lower Back, Minimum Four Views	CPT 72110	$239.00	$205.00 – $290.00 – $324.00 6 insurers	$341.00

Outpatient/professional (volume)

Service	Code	Cash price	Insurers pay (min – median – max)	Gross charge
3d Radiographic Procedure	CPT 76376	$165.00	$141.00 – $199.50 – $223.00 6 insurers	$235.00
Annual Wellness Visit, Includes A Personalized Prevention Plan of Service (Pps), Subsequent Visit	HCPCS G0439	$251.00	$215.00 – $306.50 – $344.00 6 insurers	$362.00
Aspiration and/Or Injection of Fluid From Large Joint	CPT 20610	$98.00	$84.00 – $167.50 – $842.00 6 insurers	$886.00
Critical Care, Each Additional 30 Minutes	CPT 99292	$232.00	$199.00 – $283.00 – $318.00 6 insurers	$335.00
Critical Care, First 30-74 Minutes	CPT 99291	$463.00	$397.00 – $1,075.00 – $2,409.00 6 insurers	$2,536.00
Ct Scan of Abdomen and Pelvis Before and After Contrast	CPT 74178	$1,336.00	$1,145.00 – $1,622.00 – $1,813.00 6 insurers	$1,908.00
Ct Scan of Abdomen and Pelvis Without Contrast	CPT 74176	$904.00	$775.00 – $1,098.00 – $1,227.00 6 insurers	$1,292.00
Ct Scan of Blood Vessels of Abdomen and Pelvis With Contrast	CPT 74174	$1,217.00	$1,043.00 – $1,478.00 – $1,652.00 6 insurers	$1,739.00
Ct Scan of Blood Vessels of Chest With Contrast	CPT 71275	$1,217.00	$1,043.00 – $1,478.00 – $1,652.00 6 insurers	$1,739.00
Ct Scan of Blood Vessels of Head With Contrast	CPT 70496	$1,217.00	$1,043.00 – $1,478.00 – $1,652.00 6 insurers	$1,739.00
Ct Scan of Blood Vessels of Neck With Contrast	CPT 70498	$1,217.00	$1,043.00 – $1,478.00 – $1,652.00 6 insurers	$1,739.00
Ct Scan of Chest With Contrast	CPT 71260	$904.00	$775.00 – $1,099.00 – $1,230.00 6 insurers	$1,295.00
Ct Scan of Chest Without Contrast	CPT 71250	$657.00	$563.00 – $798.50 – $894.00 6 insurers	$941.00
Ct Scan of Face Without Contrast	CPT 70486	$664.00	$569.00 – $806.00 – $901.00 6 insurers	$948.00
Ct Scan of Leg Without Contrast	CPT 73700	$664.00	$569.00 – $806.00 – $901.00 6 insurers	$948.00
Ct Scan of Lower Spine Without Contrast	CPT 72131	$664.00	$569.00 – $806.00 – $901.00 6 insurers	$948.00
Ct Scan of Upper Spine Without Contrast	CPT 72125	$664.00	$569.00 – $806.00 – $901.00 6 insurers	$948.00
Destruction of Precancer Skin Growth, 2-14 Growths	CPT 17003	$13.00	$11.00 – $16.00 – $18.00 6 insurers	$19.00
Emergency Department Visit With High Level of Medical Decision Making	CPT 99285	$383.00	$328.00 – $811.50 – $1,747.00 6 insurers	$1,839.00
Emergency Department Visit With Low Level of Medical Decision Making	CPT 99283	$157.00	$134.00 – $356.00 – $789.00 6 insurers	$831.00
Emergency Department Visit With Moderate Level of Medical Decision Making	CPT 99284	$263.00	$226.00 – $561.50 – $1,213.00 6 insurers	$1,277.00
Established Patient Office Or Other Outpatient Visit With High Level of Medical Decision Making, If Using Time, 40 Minutes Or More	CPT 99215	$243.00	$208.00 – $330.00 – $513.00 6 insurers	$540.00
Established Patient Office Or Other Outpatient Visit With Low Level Od Decision Making, If Using Time, 20 Minutes Or More	CPT 99213	$95.00	$81.00 – $150.00 – $259.00 6 insurers	$273.00
Established Patient Office Or Other Outpatient Visit With Moderate Level of Decision Making, If Using Time, 30 Minutes Or More	CPT 99214	$172.00	$148.00 – $234.00 – $366.00 6 insurers	$385.00
Established Patient Office Or Other Outpatient Visit With Straightforward Medical Decision Making, If Using Time, 10 Minutes Or More	CPT 99212	$60.00	$52.00 – $88.50 – $160.00 6 insurers	$168.00
Hospital Discharge Day Management, 30 Minutes Or Less	CPT 99238	$170.00	$146.00 – $206.50 – $231.00 6 insurers	$243.00
Hospital Discharge Day Management, More Than 30 Minutes	CPT 99239	$240.00	$206.00 – $291.50 – $326.00 6 insurers	$343.00
Immunologic Analysis Technique On Serum (Immunofixation)	CPT 86334	$30.00	$26.00 – $139.50 – $468.00 6 insurers	$493.00
Initial Hospital Care With Moderate Level of Medical Decision Making, If Using Time, At Least 75 Minutes	CPT 99223	$440.00	$377.00 – $534.00 – $597.00 6 insurers	$628.00
Initial Hospital Care With Straightforward Or Low-Level Medical Decision Making, If Using Time, At Least 55 Minutes	CPT 99222	$297.00	$254.00 – $360.50 – $403.00 6 insurers	$424.00
Initial Hospital Care With Straightforward Or Low Level of Medical Decision Making, Per Day, If Using Time, At Least 40 Minutes	CPT 99221	$220.00	$188.00 – $267.00 – $298.00 6 insurers	$314.00
Initial Nursing Facility Care With High Level of Medical Decision Making, Per Day, If Using Time, 50 Minutes Or More	CPT 99306	$383.00	$328.00 – $465.00 – $520.00 6 insurers	$547.00
Initial Nursing Facility Care With Moderate Level of Medical Decision Making, Per Day, If Using Time, At Least 35 Minutes	CPT 99305	$283.00	$242.00 – $343.50 – $384.00 6 insurers	$404.00
Insertion of Non-Tunneled Central Venous Tube For Infusion (5 Years Or Older)	CPT 36556	$181.00	$155.00 – $2,668.50 – $8,062.00 6 insurers	$8,486.00
Limited Ultrasound Scan of Abdomen	CPT 76705	$359.00	$308.00 – $436.00 – $487.00 6 insurers	$513.00
Low Dose Ct Scan of Chest For Lung Cancer Screening	CPT 71271	$228.00	$196.00 – $277.50 – $310.00 6 insurers	$326.00
Mri Scan of Abdomen Before and After Contrast	CPT 74183	$1,775.00	$1,521.00 – $2,154.50 – $2,408.00 6 insurers	$2,535.00
Mri Scan of Brain Without Contrast	CPT 70551	$1,269.00	$1,088.00 – $1,541.00 – $1,722.00 6 insurers	$1,813.00
Mri Scan of Upper Spinal Canal Without Contrast	CPT 72141	$1,248.00	$1,070.00 – $1,515.50 – $1,694.00 6 insurers	$1,783.00
Nursing Facility Discharge Management, More Than 30 Minutes	CPT 99316	$276.00	$236.00 – $335.00 – $374.00 6 insurers	$394.00
Pathology Examination of Tissue Using A Microscope, Intermediate Complexity	CPT 88305	$172.00	$148.00 – $264.50 – $466.00 6 insurers	$491.00
Protein Measurement, Serum	CPT 84165	$24.00	$20.00 – $80.00 – $203.00 6 insurers	$214.00
Psychiatric Diagnostic Evaluation With Medical Services	CPT 90792	$433.00	$371.00 – $525.50 – $587.00 6 insurers	$618.00
Removal of Fingernails Or Toenails, 6 Or More Nails	CPT 11721	$99.00	$85.00 – $121.00 – $135.00 6 insurers	$142.00
Removal of Skin and Tissue, 20.0 Sq Cm Or Less	CPT 11042	$130.00	$111.00 – $320.50 – $1,139.00 6 insurers	$1,199.00
Subsequent Hospital Care With Moderate Levelof Medical Decision Making, If Using Time, At Least 35 Minutes	CPT 99232	$166.00	$142.00 – $201.50 – $225.00 6 insurers	$237.00
Subsequent Hospital Care With Moderate Levelof Medical Decision Making, If Using Time, At Least 50 Minutes	CPT 99233	$250.00	$214.00 – $303.50 – $339.00 6 insurers	$357.00
Subsequent Hospital Care With Straightforward Or Low Level of Medical Decision Making, Per Day, If Using Time, At Least 25 Minutes	CPT 99231	$105.00	$90.00 – $128.00 – $143.00 6 insurers	$150.00
Subsequent Nursing Facility Care With High Level of Medical Decision Making, Per Day, If Using Time, At Least 45 Minutes	CPT 99310	$323.00	$277.00 – $393.00 – $439.00 6 insurers	$462.00
Subsequent Nursing Facility Care With Moderate Level of Medical Decision Making, Per Day, If Using Time, At Least 30 Minutes	CPT 99309	$227.00	$194.00 – $275.50 – $308.00 6 insurers	$324.00
Subsequent Nursing Facility Care With Straightforward Level of Medical Decision Making, Per Day, If Using Time, 20 Minutes Or More	CPT 99308	$158.00	$135.00 – $191.50 – $214.00 6 insurers	$225.00
Subsequent Nursing Facility Care With Straightforward Level of Medical Decision Making, Per Day, If Using Time, At Least 10 Minutes	CPT 99307	$97.00	$83.00 – $117.50 – $131.00 6 insurers	$138.00
Test To Determine Lung Volumes Using Sensors	CPT 94726	$654.00	$560.00 – $794.00 – $887.00 6 insurers	$934.00
Test To Examine How Well The Lungs Exchange Gases	CPT 94729	$105.00	$90.00 – $128.00 – $143.00 6 insurers	$150.00
Test To Measure Expiratory Airflow and Volume Changes Before and After Medication Administration	CPT 94060	$654.00	$560.00 – $794.00 – $887.00 6 insurers	$934.00
Ultrasonic Guidance For Blood Vessel Access	CPT 76937	$155.00	$133.00 – $189.50 – $214.00 6 insurers	$225.00
Ultrasonic Guidance For Needle Placement	CPT 76942	$54.00	$46.00 – $65.50 – $73.00 6 insurers	$77.00
Ultrasound of Both Sides of Head and Neck Blood Flow	CPT 93880	$511.00	$438.00 – $621.00 – $694.00 6 insurers	$730.00
Ultrasound of Heart With Color-Depicted Blood Flow, Rate, Direction and Valve Function	CPT 93306	$1,155.00	$990.00 – $1,403.00 – $1,568.00 6 insurers	$1,650.00
Ultrasound Scan of Head and Neck Soft Tissue	CPT 76536	$359.00	$308.00 – $436.00 – $487.00 6 insurers	$513.00
Ultrasound Study of Arm Or Leg Veins With Compression and Maneuvers	CPT 93970	$566.00	$485.00 – $687.00 – $768.00 6 insurers	$808.00
Ultrasound Study of One Arm Or Leg Veins With Compression and Maneuvers	CPT 93971	$412.00	$353.00 – $501.00 – $560.00 6 insurers	$589.00
Use of A Drug To Induce Depression of Consciousness By Physician Performing A Procedure (5 Years Or Older), Initial 15 Minutes	CPT 99152	$27.00	$23.00 – $33.00 – $38.00 6 insurers	$40.00
X-Ray of Abdomen, 1 View	CPT 74018	$186.00	$160.00 – $226.50 – $253.00 6 insurers	$266.00
X-Ray of Ankle, Minimum of 3 Views	CPT 73610	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Chest, 1 View	CPT 71045	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Chest, 2 Views	CPT 71046	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Foot, Minimum of 3 Views	CPT 73630	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Hand, Minimum of 3 Views	CPT 73130	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Hip, 2-3 Views	CPT 73502	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Knee, 1-2 Views	CPT 73560	$186.00	$160.00 – $226.50 – $253.00 6 insurers	$266.00
X-Ray of Knee, 3 Views	CPT 73562	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Knee, 4 Or More Views	CPT 73564	$237.00	$203.00 – $288.50 – $324.00 6 insurers	$341.00
X-Ray of Lower and Sacral Spine, 2-3 Views	CPT 72100	$239.00	$205.00 – $290.00 – $324.00 6 insurers	$341.00
X-Ray of Lower Leg, 2 Views	CPT 73590	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Pelvis, 1-2 Views	CPT 72170	$239.00	$205.00 – $290.00 – $324.00 6 insurers	$341.00
X-Ray of Shoulder, Minimum of 2 Views	CPT 73030	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Thigh Bone, Minimum 2 Views	CPT 73552	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00
X-Ray of Wrist, Minimum of 3 Views	CPT 73110	$195.00	$167.00 – $237.00 – $265.00 6 insurers	$279.00