Cost estimates for uninsured patients - MU Health

Cost estimates for uninsured patients

Please 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.

CT (Cat) Scan

Description

MRI X-ray

CT Head/brain w/o contrast material CT Thorax w/ contrast material (chest) CT Cervical Spine w/o contrast material CT Spine Cervical w/ contrast CT Spine Thoracic w/o contrast CT Thoracic w/ contrast CT Lumbar spine w/o contrast material CT Spine Lumbar w/ Contrast CT Abdomen & pelvis w/o contrast material CT Abdomen and Pelvis w/ contrast material

MRI Brain/Brain stem w/o w/ dye MRI Brain Stem w/o contrast MRI Spinal Canal Cervical w/o contrast MRI Spine Thoracic w/o contrast MRI Spinal Canal Lumbar w/o contrast MRI Any joint lower extremity w/o contrast MRI Any joint lower extremity w/o & w/ contrast

XR Cystography minimum 3 views RS&I

X-ray Exam Chest 2 views

X-ray Exam Spine Lumbosacral 2/3 views

X-ray Exam Pelvis ? views

X-ray Exam Shoulder Complete minimum 2 views

CPT Code

70450 71260 72125 72126 72128 72129 72131 72132 74176

74177

70553 70551 72141 72146 72148 73721

73723

74430 71046

72100 72170 73030

Hospital Fee, Discounted*

$291.60 $544.40 $354.00 $1,163.20 $355.20 $807.60 $361.20

$997.20 $632.40

$1,034.00

Physician Fee, Discounted*

$137.25 $182.25 $168.00 $177.00 $165.00 $177.00 $165.00

$177.00 $217.50

$225.00

Combined Fee, Discounted

$428.85 $726.65 $522.00 $1,340.20 $520.20 $984.60 $526.20

$1,174.20 $849.90

$1,259.00

$1,327.25 $590.40 $600.40 $652.80 $652.80 $600.40

$1,174.00

$409.50 $231.75 $231.75 $233.25 $217.50 $198.75

$311.25

$1,736.75 $822.15 $832.15 $886.05 $870.30 $799.15

$1,485.25

$406.80 $136.00 $203.20 $203.20 $147.60

$46.50 $27.75 $33.00 $29.25 $33.00

$453.30 $163.75 $236.20 $232.45 $180.60

X-ray Exam Wrist Complete minimum 3 views X-ray Exam Hand minimum 3 views

X-ray Hip Unil w Pelvis 2-3 views X-ray Exam Knee 1 / 2 views

X-ray Exam Knee 3 views X-ray Exam Knee Complete 4/more views X-ray Exam Ankle Complete minimum 3 views X-ray Exam Foot Complete Minimum 3 views+A22

X-ray Exam Abdomen 1 View

DXA Bone Density Study 1/> Sites Axial Skel Venous Duplex Bilateral

Venous Duplex Limited, Unilateral Ultrasound

US Breast Limited US Abdomen Complete US Abdominal real time w/image limited US Retroperitoneal w/image complete

Screening Mammography Screening MAMM Bilat 2 view incl CAD-BE Screening Digital Breast Tomosyn Bilateral

Laboratory Testing Glucose Blood by Monitoring Device NSFM Blood Count Complete (CBC) Auto & Auto Differential WBC Comprehensive Metabolic Panel

Urinalysis Dip Stick only

Lipid Profile

Urinalysis w/ Microscopic

Prothrombin Time

Thyroid Stimulating Hormone (TSH)

73110 73130 73502 73560 73562 73564

73610

73630

74018

77080 93970 93971

76642 76700 76705 76770

77067

77063

82962 85025 80053 81003 80061 81001 85610 84443

Common outpatient tests and procedures with self-pay discount Cardiovascular

Electrocardiogram (ECG or EKG)

Transthoracic Echo (complete Echo)

Transthoracic Echo (limited Echo) Exercise Stress Test (treadmill stress test; no echo)

93005 93306 93308

93017

$152.40 $147.20 $154.40 $131.20 $154.00 $184.40 $148.40 $153.20 $124.00 $164.40 $466.40 $224.40

$191.20 $275.20 $232.00 $269.60

$112.80

$16.00

$10.16 $21.76 $45.40

$7.78 $44.18

$7.74 $14.56 $55.44

$108.40 $1,034.40

$740.80 $443.60

$24.75 $24.75 $30.75 $26.25 $27.75 $33.00

$24.75

$24.75

$23.25

$33.00 $66.00 $43.50

$67.50 $116.25

$84.75 $108.00

$83.25

$60.00

$3.00

$7.50 $10.50

$2.25 $20.25

$3.00 $3.75 $16.50

$177.15 $171.95 $185.15 $157.45 $181.75 $217.40

$173.15

$177.95

$147.25

$197.40 $532.40 $267.90

$258.70 $391.45 $316.75 $377.60

$196.05

$76.00

$13.16

$29.26 $55.90 $10.03 $64.43 $10.74 $18.31 $71.94

$29.25 $173.25 $114.00

$110.25

$137.65 $1,207.65

$854.80

$553.85

Exercise Stress Echo (treadmill exercise stress test with limited echo; includes 93320, 93325, 93350) Tilt Table Evaluation Holter Hook-up (up to 48 hours) Holter Scan and Analysis Ears Nose and Throat (ENT) Tonsillectomy & Adenoidectomy less than age 12 Tonsillectomy, Age 12 or Older Create Eardrum Opening Endoscopy/Gastrointestinal (GI) EGD Biopsy single/multiple EGD Diagnostic Brush Wash Colonoscopy and Biopsy Diagnostic Colonoscopy Neurology EEG Awake and Drowsy EEG Awake and Asleep Sleep Study, Unattended (at home) Sleep Study - Polysom 6/> YRS 4/> PARAM Sleep Study - Polysom 6/>YRS CPAP 4/> PARM Urology Fragmenting of Kidney Stone Urology/Gynecological Hysteroscopy Biopsy Cystoscopy and Treatment Cystoscopy Gynecology (IUD) IUD placement

Copper IUD (PARAGARD)

Levonorgestrel 13.5 MG IUD (SKYLA)

Levonorgestrel 52 MG IUD (MIRENA)

Levonorgestrel 52 MG IUD (Liletta)

IUD removal

Insert drug implant device (Nexplanon)

Remove drug implant device (Nexplanon) Ophthalmology

Cataract Surgery W/IOL 1 Stage Cataract Surgery Complex General Surgery Laparoscopic Inguinal Hernia Repair Init Laparoscopic Cholecystectomy Orthopedic

93017 93660 93225 93226

42820 42826 69436

43239 43235 45380 45378

95816 95819 G0399 95810

95811

50590

58558 52332 52000

58300 J7300 J7301

J7298

J7297 58301 11981 J7307 11982

66984 66982

49650 47562

$1,760.80 $455.60 $262.40

$2,454.88 $2,791.75 $2,084.32

$1,034.46 $553.00

$1,068.24 $541.80

$405.60 $427.20 $204.00 $1,360.00 $1,724.80

$2,697.49

$6,184.21 $6,163.60 $4,481.18

$181.20 $270.00 $319.20

$762.81

$605.67 $152.00

$74.40 $378.18

$3,745.23 $4,100.75

$9,253.26 $7,715.78

$450.00 $307.50

$203.25

$2,210.80 $763.10 $262.40 $203.25

$1,428.00 $1,439.25

$777.75

$3,882.88 $4,231.00 $2,862.07

$818.25 $457.50 $971.25 $648.75

$1,852.71 $1,010.50 $2,039.49 $1,190.55

$109.50 $128.25 $198.00 $305.25

$406.50

$515.10 $555.45 $402.00 $1,665.25

$2,131.30

$2,201.25 $4,898.74

$1,356.00 $801.00 $869.25

$7,540.21 $6,964.60 $5,350.43

$164.25 $0.00 $0.00

$0.00

$0.00 $157.50 $247.50 $260.25

$345.45 $270.00 $319.20

$762.81

$605.67 $309.50 $321.90 $638.43

$2,172.00 $2,247.00

$5,917.23 $6,347.75

$1,525.12 $2,790.00

$10,778.38 $10,505.78

Knee Arthroscopy/Surgery Arthroscopy Rotator Cuff Repair Carpal Tunnel Surgery Incise Finger Tendon Sheath (trigger finger)

29881 29827 64721 26055

$7,248.32 $14,056.03

$4,601.48 $4,287.20

Common physical and occupational therapy fees with self-pay discount

PT Evaluation: Moderate Complexity

97162

$122.80

PT Reevaluation

97164

$94.80

OT Evaluation: Moderate Complexity

97166

$128.80

OT Reevaluation

97168

$88.80

$2,358.75 $3,432.00 $1,787.25 $1,463.25

$9,607.07 $17,488.03

$6,388.73 $5,750.45

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