University of Missouri Health Care



Cost estimates for uninsured patientsPlease note: We cannot give you an exact total cost of care prior to a visit as it depends on the kind, severity and number of problems you address with your doctor privately in the office visit. However, we can give you some general information and definitions. Terms to knowCost estimate for common office visits with self-pay discountCost estimate for common outpatient tests with self-pay discountCT (Cat) ScanDescriptionCPT CodeHospital Fee, Discounted*Physician Fee, Discounted*Combined Fee, DiscountedCT Head/brain w/o contrast material70450$247.60 $137.25 $384.85 CT Thorax w/ contrast material (chest)71260$518.40 $182.25 $700.65 CT Cervical Spine w/o contrast material72125$247.60 $168.00 $415.60 CT Spine Cervical w/ contrast72126$997.20 $177.00 $1,174.20 CT Spine Thoracic w/o contrast72128$247.60 $165.00 $412.60 CT Thoracic w/ contrast72129$555.20 $177.00 $732.20 CT Lumbar spine w/o contrast material72131$247.60 $165.00 $412.60 CT Spine Lumbar w/ Contrast72132$997.20 $177.00 $1,174.20 CT Abdomen & pelvis w/o contrast material74176$507.60 $217.50 $725.10 CT Abdomen and Pelvis w/ contrast material74177$960.40 $225.00 $1,185.40 MRIMRI Brain/Brain stem w/o w/ dye70553$1,166.85 $409.50 $1,576.35 MRI Brain Stem w/o contrast70551$507.60 $231.75 $739.35 MRI Spinal Canal Cervical w/o contrast72141$507.60 $231.75 $739.35 MRI Spine Thoracic w/o contrast72146$645.60 $233.25 $878.85 MRI Spinal Canal Lumbar w/o contrast72148$507.60 $217.50 $725.10 MRI Any joint lower extremity w/o contrast 73721$507.60 $198.75 $706.35 MRI Any joint lower extremity w/o & w/ contrast 73723$1,003.60 $311.25 $1,314.85 X-rayXR Cystography minimum 3 views RS&I74430$406.80 $46.50 $453.30 X-ray Exam Chest 2 views 71046$128.40 $27.75 $156.15 X-ray Exam Spine Lumbosacral 2/3 views72100$203.20 $33.00 $236.20 X-ray Exam Pelvis ? views72170$203.20 $29.25 $232.45 X-ray Exam Shoulder Complete minimum 2 views73030$147.60 $33.00 $180.60 X-ray Exam Wrist Complete minimum 3 views73110$145.20 $24.75 $169.95 X-ray Exam Hand minimum 3 views73130$143.20 $24.75 $167.95 X-ray Hip Unil w Pelvis 2-3 views73502$145.60 $30.75 $176.35 X-ray Exam Knee 1 / 2 views73560$131.20 $26.25 $157.45 X-ray Exam Knee 3 views73562$154.00 $27.75 $181.75 X-ray Exam Knee Complete 4/more views73564$184.40 $33.00 $217.40 X-ray Exam Ankle Complete minimum 3 views73610$131.20 $24.75 $155.95 X-ray Exam Foot Complete Minimum 3 views+A2273630$153.20 $24.75 $177.95 X-ray Exam Abdomen 1 View74018$124.00 $23.25 $147.25 DXA Bone Density Study 1/> Sites Axial Skel77080$157.60 $33.00 $190.60 Venous Duplex Bilateral93970$369.20 $66.00 $435.20 Venous Duplex Limited, Unilateral93971$180.40 $43.50 $223.90 UltrasoundUS Breast Limited76642$191.20 $67.50 $258.70 US Abdomen Complete76700$236.40 $116.25 $352.65 US Abdominal real time w/image limited76705$225.20 $84.75 $309.95 US Retroperitoneal w/image complete76770$236.40 $108.00 $344.40 Screening MammographyScreening MAMM Bilat 2 view incl CAD-BE77067$112.80 $83.25 $196.05 Screening Digital Breast Tomosyn Bilateral77063$16.00 $60.00 $76.00 Laboratory TestingGlucose Blood by Monitoring Device NSFM82962$9.22 $3.00 $12.22 Blood Count Complete (CBC) Auto & Auto Differential WBC85025$18.98 $7.50 $26.48 Comprehensive Metabolic Panel80053$44.54 $10.50 $55.04 Urinalysis Dip Stick only81003$7.78 $2.25 $10.03 Lipid Profile80061$36.36 $20.25 $56.61 Urinalysis w/ Microscopic81001$7.74 $3.00 $10.74 Prothrombin Time 85610$14.56 $3.75 $18.31 Thyroid Stimulating Hormone (TSH)84443$62.26 $16.50 $78.76 Common outpatient tests and procedures with self-pay discountCardiovascularElectrocardiogram (ECG or EKG)93005$107.20$29.25$136.45Transthoracic Echo (complete Echo)93306$1,034.40$173.25$1,207.65Transthoracic Echo (limited Echo)93308$740.80$114.00$854.80Exercise Stress Test (treadmill stress test; no echo)93017$443.60$110.25$553.85Exercise Stress Echo (treadmill exercise stress test with limited echo; includes 93320, 93325, 93350)93017$1,760.80$450.00$2,210.80Tilt Table Evaluation93660$455.60$307.50$763.10Holter Hook-up (up to 48 hours)93225$262.40?$262.40Holter Scan and Analysis 93226?$203.25$203.25Ears Nose and Throat (ENT)Tonsillectomy & Adenoidectomy less than age 1242820$2,304.00$1,296.00$3,600.00Tonsillectomy, Age 12 or Older42826$2,416.00$1,307.25$3,723.25Create Eardrum Opening69436$2,930.00$777.75$3,707.75Endoscopy/Gastrointestinal (GI)EGD Biopsy single/multiple43239$1,034.46$818.25$1,852.71EGD Diagnostic Brush Wash43235$553.00$457.50$1,010.50Colonoscopy and Biopsy 45380$1,068.24$971.25$2,039.49Diagnostic Colonoscopy45378$541.80$648.75$1,190.55NeurologyEEG Awake and Drowsy95816$405.60$109.50$515.10EEG Awake and Asleep 95819$427.20$128.25$555.45Sleep Study, Unattended (at home)G0399$204.00$198.00$402.00Sleep Study - Polysom 6/> YRS 4/> PARAM 95810$1,360.00$305.25$1,665.25Sleep Study - Polysom 6/>YRS CPAP 4/> PARM 95811$1,724.80$406.50$2,131.30UrologyFragmenting of Kidney Stone50590$2,418.00$2,592.75$5,010.75Urology/GynecologicalHysteroscopy Biopsy 58558$6,393.60$1,617.00$8,010.60Cystoscopy and Treatment52332$5,528.80$996.75$6,525.55Cystoscopy 52000$4,282.00$869.25$5,151.25Gynecology (IUD)IUD placement 58300$148.80$105.60$254.40Copper IUD (PARAGARD)J7300$270.00$270.00Levonorgestrel 13.5 MG IUD (SKYLA)J7301$319.20$319.20Levonorgestrel 52 MG IUD (MIRENA)J7298$762.81$762.81Levonorgestrel 52 MG IUD (Liletta)J7297$605.67$605.67IUD removal58301$113.20$115.50$228.70Insert drug implant device (Nexplanon)11981J7307$450.98$181.50$632.48Remove drug implant device (Nexplanon)11982$139.60$190.85$330.45OphthalmologyCataract Surgery W/IOL 1 Stage66984$3,556.40$2,106.75$5,663.15Cataract Surgery Complex66982$3,999.20$2,247.00$6,246.20General SurgeryLaparoscopic Inguinal Hernia Repair Init49650$8,412.00$2,014.50$10,426.50Laparoscopic Cholecystectomy47562$6,894.80$2,724.75$9,619.55OrthopedicKnee Arthroscopy/Surgery29881$6,954.00$2,358.75$9,312.75Arthroscopy Rotator Cuff Repair 29827$14,662.00$3,497.25$18,159.25Carpal Tunnel Surgery 64721$4,460.00$1,722.00$6,182.00Incise Finger Tendon Sheath (trigger finger)26055$4,176.00$1,463.25$5,639.25Common physical and occupational therapy fees with self-pay discountPT Evaluation: Moderate Complexity97162$122.80PT Reevaluation97164$94.80OT Evaluation: Moderate Complexity97166$119.20OT Reevaluation97168$85.20 ................
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