ASCENSION VIA CHRISTI HOSPITAL ST. TERESA, INC.
Acute Care Hospitals
29
Procedure Prices at ASCENSION VIA CHRISTI HOSPITAL ST. TERESA, INC.
BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC
CPT 85025
$6.54
EKG Interpretation
CPT 93010
$10.41
COMPREHENSIVE METABOLIC PANEL
CPT 80053
$16.33
Mechanical Traction
CPT 97012
$16.89
EKG Tracing
CPT 93005
$19.08
Therapeutic Exercises
CPT 97110
$25.65
Therapeutic Activities
CPT 97530
$26.02
EKG
CPT 93000
$31.61
OFFICE OUTPATIENT VISIT 15 MINUTES
CPT 99213
$40.84
Chest X-Ray (1 view)
CPT 71045
$42
Chest X-Ray (2 views)
CPT 71046
$42
Thoracic Spine X-Ray
CPT 72072
$44.28
ER Visit — Low-Moderate Complexity
CPT 99283
$57.44
Diagnostic Mammogram (unilateral)
CPT 77065
$62.06
Screening Mammogram (bilateral)
CPT 77067
$73.06
Diagnostic Mammogram (bilateral)
CPT 77066
$78.34
ER Visit — Moderate Complexity
CPT 99284
$90.35
Abdominal Ultrasound — Limited
CPT 76705
$97.61
PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
CPT 90837
$102
OB Ultrasound
CPT 76805
$116.17
Retroperitoneal Ultrasound
CPT 76770
$129.57
Abdominal Ultrasound
CPT 76700
$134.07
ER Visit — High Complexity
CPT 99285
$138.76
CT Abdomen & Pelvis
CPT 74177
$156.86
Echocardiogram
CPT 93307
$261.66
NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL
CPT 64483
$280.88
Upper GI Endoscopy w/ Biopsy
CPT 43239
$294.37
Colonoscopy
CPT 45378
$294.37
CT Chest
CPT 71250
$314.25
Colonoscopy w/ Biopsy
CPT 45380
$346.62
Echocardiogram w/ Doppler
CPT 93306
$366.85
MRI Brain w/o Contrast
CPT 70551
$451.37
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$503.7
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$503.7
MRI Joint of Lower Extremity
CPT 73721
$556.43
Laparoscopic Cholecystectomy
CPT 47562
$569.12
Inguinal Hernia Repair
CPT 49505
$569.12
Laparoscopic Hernia Repair
CPT 49650
$569.12
Knee Arthroscopy
CPT 29881
$588.74
Recurrent Inguinal Hernia Repair
CPT 49520
$608.37
Appendectomy
CPT 44950
$654.16
Cataract Surgery — Complex
CPT 66982
$850.41
Cataract Surgery
CPT 66984
$850.41
ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR
CPT 29827
$862.62
MRI Brain w/ Contrast
CPT 70553
$994.8
Knee Replacement
CPT 27447
$1,095.82
TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
CPT 27245
$1,098.97
Vaginal Delivery
CPT 59400
$1,428.54
C-Section
CPT 59510
$1,568.87
VBAC Delivery
CPT 59610
$1,736
Hip Replacement
CPT 27130
$9,731.21
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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.