Home › Hospitals › Ascension St. John Nowata Posts prices for 32 of the 66 common shoppable procedures we track. Price file retrieved 2026-07-29.
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Procedure Cash price Gross charge × Medicare
CT head/brain without contrast (70450) $891.79
$2,410.25
8.9×
MRI brain without contrast (70551) $870.98
$2,354
3.8×
MRI brain with contrast (70552) $985.40
$2,663.25
2.9×
MRI brain without and with contrast (70553) $1,278.91
$3,456.50
3.8×
X-ray lower spine, 4+ views (72110) $227
$613.50
2.3×
MRI lumbar spine without contrast (72148) $924.82
$2,499.50
4.0×
CT pelvis with contrast (72193) $971.25
$2,625
5.8×
MRI lower-extremity joint without contrast (73721) $976.80
$2,640
4.3×
CT abdomen and pelvis with contrast (74177) $1,187.61
$3,209.75
3.5×
Ultrasound, abdomen complete (76700) $526.79
$1,423.75
5.2×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $566.29
$1,530.50
5.6×
Ultrasound, transvaginal (76830) $378.88
$1,024
3.8×
Mammography, one breast (diagnostic) (77065) $161.69
$437
1.9×
Mammography, both breasts (diagnostic) (77066) $208.87
$564.50
1.9×
Mammography, screening (bilateral) (77067) $140.60
$380
1.5×
Basic metabolic panel (80048) $31.73
$85.75
3.8×
Comprehensive metabolic panel (80053) $40.79
$110.25
3.9×
Obstetric panel (80055) $76.04
$205.50
1.6×
Lipid panel (80061) $47.01
$127.05
3.5×
Renal function panel (80069) $26.55
$71.75
3.1×
Hepatic function panel (80076) $44.31
$119.75
5.4×
Urinalysis, non-automated, without microscopy (81002) $18.59
$50.25
5.3×
PSA, total (84153) $76.96
$208
4.2×
Thyroid stimulating hormone (TSH) (84443) $41.08
$111
2.4×
CBC with automated differential (85025) $45.33
$122.50
5.8×
CBC, automated (85027) $29.60
$80
4.6×
Prothrombin time (PT) (85610) $29.60
$80
6.9×
Partial thromboplastin time (PTT) (85730) $22.11
$59.75
3.7×
Physical therapy, therapeutic exercise (per 15 min) (97110) $33.02
$89.25
1.1×
Office visit, new patient (low complexity, ~30 min) (99203) $165.39
$447
1.3×
Office visit, new patient (moderate complexity, ~45 min) (99204) $228.20
$616.75
1.8×
Office visit, new patient (high complexity, ~60 min) (99205) $277.69
$750.50
2.2×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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