Ascension Saint Thomas DeKalb
520 W Main St, Smithville, TN · Ascension · · NPI 1649659582
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Unlisted px abdomen muscskel CPT 22999 | not published | not published | $203.78 – $2,225.50 | 22 |
| Unlisted px accessory sinus CPT 31299 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px ant segment eye CPT 66999 | not published | not published | $376.09 – $2,225.50 | 4 |
| Unlisted px arthroscopy CPT 29999 | not published | not published | $203.78 – $2,225.50 | 22 |
| Unlisted px biliary tract CPT 47999 | not published | not published | $796.46 – $2,225.50 | 22 |
| Unlisted px casting/strpg CPT 29799 | not published | not published | $45.00 – $2,225.50 | 22 |
| Unlisted px conjunctiva CPT 68399 | not published | not published | $149.18 – $2,225.50 | 22 |
| Unlisted px diaphragm CPT 39599 | not published | not published | $2,118.00 – $2,225.50 | 3 |
| Unlisted px exc pressure ulc CPT 15999 | not published | not published | $189.28 – $2,225.50 | 22 |
| Unlisted px external ear CPT 69399 | not published | not published | $45.00 – $2,225.50 | 22 |
| Unlisted px extraocular musc CPT 67399 | not published | not published | $253.94 – $2,225.50 | 22 |
| Unlisted px foot/toes CPT 28899 | not published | not published | $84.55 – $2,225.50 | 22 |
| Unlisted px forearm/wrist CPT 25999 | not published | not published | $84.55 – $2,225.50 | 22 |
| Unlisted px hands/fingers CPT 26989 | not published | not published | $84.55 – $2,225.50 | 22 |
| Unlisted px inner ear CPT 69949 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px lacrimal system CPT 68899 | not published | not published | $149.18 – $2,225.50 | 22 |
| Unlisted px leg/ankle CPT 27899 | not published | not published | $84.55 – $2,225.50 | 22 |
| Unlisted px male genital sys CPT 55899 | not published | not published | $56.62 – $2,225.50 | 22 |
| Unlisted px mediastinum CPT 39499 | not published | not published | $2,118.00 – $2,225.50 | 3 |
| Unlisted px med radj physics CPT 77399 | not published | not published | $53.24 – $336.54 | 23 |
| Unlisted px middle ear CPT 69799 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px neck/thorax CPT 21899 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px palate uvula CPT 42299 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px pelvis/hip joint CPT 27299 | not published | not published | $84.55 – $2,225.50 | 22 |
| Unlisted px posterior segmnt CPT 67299 | not published | not published | $376.09 – $2,225.50 | 4 |
| Unlisted px salivry glnd/dux CPT 42699 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px small intestine CPT 44799 | not published | not published | $796.46 – $2,225.50 | 22 |
| Unlisted px temporal bone CPT 69979 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px ther rad tx plng CPT 77299 | not published | not published | $53.24 – $336.54 | 23 |
| Unlisted px tongue flr mouth CPT 41599 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted px vestibule mouth CPT 40899 | not published | not published | $64.86 – $2,225.50 | 22 |
| Unlisted reprod med lab proc CPT 89398 | not published | not published | $5.52 – $70.60 | 21 |
| Unlisted resp px dx nuc med CPT 78599 | not published | not published | $100.20 – $938.21 | 24 |
| Unlisted spec derm svc/px CPT 96999 | not published | not published | $13.56 – $262.57 | 19 |
| Unlisted surgical path px CPT 88399 | not published | not published | $5.52 – $155.56 | 25 |
| Unlisted transfusion med px CPT 86999 | not published | not published | $7.40 – $60.80 | 25 |
| Unlisted ultrasound procedure CPT 76999 | not published | not published | $31.15 – $166.77 | 24 |
| Unlisted vasc endoscopy px CPT 37501 | not published | not published | $525.22 – $2,225.50 | 22 |
| Unlstd hematop ret/endo lymp CPT 78199 | not published | not published | $126.65 – $938.21 | 24 |
| Unlstd laps px mat care&dlvr CPT 59898 | not published | not published | $1,508.47 – $2,225.50 | 4 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | $1,508.47 – $2,225.50 | 4 |
| Upgrade pm system CPT 33214 | not published | not published | $4,746.73 – $6,935.50 | 4 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $1,383.93 | $4,613.10 | $264.35 – $991.82 | 34 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | not published | not published | $215.74 – $873.31 | 34 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $976.83 | $3,256.10 | $167.52 – $560.44 | 34 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $1,093.16 | $3,643.85 | $372.80 – $1,238.94 | 22 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $1,093.16 | $3,643.85 | $372.80 – $1,246.50 | 22 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $2,118.00 – $2,225.50 | 3 |
| Uppr gi scope w/submuc inj CPT 43236 | $1,093.16 | $3,643.85 | $372.80 – $1,246.50 | 22 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $1,337.72 – $1,985.50 | 4 |
| Urea nitrogen CPT 84520 | $32.96 | $109.85 | $2.77 – $15.80 | 36 |
| Urea nitrogen 24 hour urine CPT 84540 | $32.96 | $109.85 | $3.34 – $18.06 | 36 |
| Urea nitrogen clearance CPT 84545 | not published | not published | $4.63 – $25.96 | 36 |
| Ureteral embolization/occl CPT 50705 | not published | not published | $2,118.00 – $2,225.50 | 3 |
| Ureteral reflux study CPT 78740 | not published | not published | $60.04 – $589.01 | 34 |
| Ureter endoscopy CPT 50970 | not published | not published | $274.47 – $1,004.50 | 4 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $954.50 – $1,042.43 | 4 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $613.48 – $1,004.50 | 4 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $274.47 – $1,004.50 | 4 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $954.50 – $1,042.43 | 4 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $954.50 – $1,042.43 | 4 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $613.48 – $1,004.50 | 4 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $954.50 – $1,042.43 | 4 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $2,118.00 – $2,225.50 | 3 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $2,118.00 – $2,225.50 | 3 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | not published | not published | $41.49 – $456.86 | 34 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $1,254.79 – $2,225.50 | 4 |
| Urethrocystography void s&i CPT 74455 | $254.57 | $848.55 | $44.71 – $372.86 | 34 |
| Uric acid blood CPT 84550 | $42.81 | $142.70 | $3.17 – $18.06 | 36 |
| Uric acid urine CPT 84560 | $57.39 | $191.30 | $3.34 – $18.06 | 36 |
| Urinalysis microscopic only CPT 81015 | not published | not published | $2.14 – $11.28 | 36 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $1.52 – $7.90 | 36 |
| Urinalysis (with microscopy) CPT 81001 | $48.14 | $160.45 | $2.22 – $12.42 | 36 |
| Urinalysis (without microscopy) CPT 81003 | $34.80 | $116.00 | $1.57 – $9.01 | 36 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $41.49 – $192.70 | 15 |
| Urinary reflex study CPT 51792 | not published | not published | $43.37 – $2,225.50 | 24 |
| Urine Culture Test CPT 87086 | $36.56 | $121.85 | $5.66 – $31.60 | 36 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $4.67 – $2,225.50 | 24 |
| Urine pregnancy test CPT 81025 | not published | not published | $4.44 – $27.07 | 36 |
| Urography, antegrade CPT 74425 | not published | not published | $36.83 – $610.96 | 34 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $55.12 – $291.55 | 34 |
| Use 1st target lesion CPT 76982 | not published | not published | $49.23 – $179.33 | 32 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $275.10 | $917.00 | $178.02 – $244.58 | 5 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $275.10 | $917.00 | $178.02 – $222.50 | 5 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $247.16 | $823.85 | $159.94 – $235.87 | 5 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $165.50 | $551.65 | $107.09 – $132.81 | 5 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $370.74 | $1,235.80 | $79.97 – $99.18 | 5 |
| Vaccine dtap < 7 years im CPT 90700 | not published | not published | $32.47 – $49.68 | 7 |
| Vaccine dtap-hep b-ipv im CPT 90723 | not published | not published | $42.06 – $168.98 | 6 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $105.35 – $180.21 | 5 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $270.13 – $439.49 | 5 |
| Vaccine dtap-ipv/hib im CPT 90698 | not published | not published | $160.64 – $207.08 | 5 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $43.31 – $58.56 | 7 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | not published | not published | $18.64 – $20.79 | 7 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | not published | not published | $81.13 – $140.26 | 7 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | not published | not published | $156.35 – $217.66 | 7 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | not published | not published | $40.58 – $65.56 | 7 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $36.55 – $36.55 | 2 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $12.11 – $118.69 | 8 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | not published | not published | $29.86 – $118.69 | 8 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.