Bob Wilson Memorial Hospital

415 N Main Street, Ulysses, KS 67880 · (620) 356-1266

Critical Access HospitalsVoluntary non-profit - ChurchPart of Commonspirit Mountain Region · 13 hospitals

Price file

Prices published

File dated 2026-02-03

891 price rows for 62 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines

$44

cash

$11 to $105

20 negotiated rates

$110

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · lowest of 2 lines

$2,044

cash

$337 to $4,854

20 negotiated rates

$5,110

list

CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines

$1,006

cash

$337 to $2,389

20 negotiated rates

$2,514

list

CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines

$1,049

cash

$337 to $2,492

20 negotiated rates

$2,623

list

Cataract surgery with lens implant

CPT 66984

—

cash

$3,612 to $3,612

1 negotiated rates

—

list

Cesarean section hospital stay, no complications

MS-DRG 788

—

cash

$5,490 to $10,649

2 negotiated rates

—

list

Chlamydia test (DNA)

CPT 87491 · lowest of 2 lines

$73

cash

$44 to $174

20 negotiated rates

$184

list

Colonoscopy (diagnostic)

CPT 45378

—

cash

$1,763 to $1,763

1 negotiated rates

—

list

Colonoscopy with biopsy

CPT 45380

—

cash

$1,820 to $1,820

1 negotiated rates

—

list

Colonoscopy with polyp removal

CPT 45385

—

cash

$1,984 to $1,984

1 negotiated rates

—

list

Complete blood count (CBC) with differential

CPT 85025 · lowest of 2 lines

$50

cash

$10 to $118

20 negotiated rates

$124

list

Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines

$84

cash

$13 to $199

20 negotiated rates

$209

list

Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 2 lines

$112

cash

$90 to $267

20 negotiated rates

$281

list

Established patient office visit (about 40 minutes)

CPT 99215

—

cash

$355 to $355

1 negotiated rates

—

list

Family psychotherapy with the patient

CPT 90847

—

cash

$170 to $170

1 negotiated rates

—

list

Gallbladder removal (laparoscopic)

CPT 47562

—

cash

$9,172 to $9,172

1 negotiated rates

—

list

Gonorrhea test (DNA)

CPT 87591 · lowest of 2 lines

$71

cash

$44 to $168

20 negotiated rates

$176

list

Group psychotherapy

CPT 90853

—

cash

$40 to $40

1 negotiated rates

—

list

Hip or knee replacement, no major complications

MS-DRG 470

—

cash

$28,883 to $28,883

1 negotiated rates

—

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

—

cash

$9,350 to $9,350

1 negotiated rates

—

list

Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—

cash

$13,322 to $13,322

1 negotiated rates

—

list

Inguinal hernia repair (age 5 and up)

CPT 49505

—

cash

$5,500 to $5,500

1 negotiated rates

—

list

Knee arthroscopy with meniscus repair

CPT 29881

—

cash

$4,798 to $4,798

1 negotiated rates

—

list

Laser treatment after cataract surgery (YAG)

CPT 66821

—

cash

$1,215 to $1,215

1 negotiated rates

—

list

Left heart catheterization

CPT 93452

—

cash

$8,171 to $8,171

1 negotiated rates

—

list

Lipid panel (cholesterol test)

CPT 80061 · lowest of 2 lines

$58

cash

$17 to $138

20 negotiated rates

$145

list

Liver function panel

CPT 80076 · lowest of 2 lines

$39

cash

$10 to $92

20 negotiated rates

$96

list

MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines

$1,634

cash

$543 to $3,880

20 negotiated rates

$4,084

list

MRI of the knee or other lower joint, no contrast

CPT 73721 · lowest of 2 lines

$1,298

cash

$543 to $3,084

20 negotiated rates

$3,246

list

MRI of the lower back (lumbar spine), no contrast

CPT 72148 · lowest of 2 lines

$1,298

cash

$543 to $3,084

20 negotiated rates

$3,246

list

MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines

$1,298

cash

$543 to $3,084

20 negotiated rates

$3,246

list

Neck (cervical) spinal fusion, no complications

MS-DRG 473

—

cash

$28,610 to $28,610

1 negotiated rates

—

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · lowest of 2 lines

$1,360

cash

$919 to $3,231

20 negotiated rates

$3,401

list

New patient office visit (about 30 minutes)

CPT 99203

—

cash

$135 to $135

1 negotiated rates

—

list

New patient office visit (about 45 minutes)

CPT 99204

—

cash

$135 to $135

1 negotiated rates

—

list

New patient office visit (about 60 minutes)

CPT 99205

—

cash

$225 to $225

1 negotiated rates

—

list

PSA test (prostate)

CPT 84153 · lowest of 2 lines

$74

cash

$23 to $175

20 negotiated rates

$184

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · lowest of 2 lines

$34

cash

$8 to $80

20 negotiated rates

$84

list

Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 2 lines

$48

cash

$38 to $114

20 negotiated rates

$120

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 2 lines

$340

cash

$177 to $807

20 negotiated rates

$850

list

Prostate biopsy

CPT 55700

—

cash

$1,545 to $1,545

1 negotiated rates

—

list

Prostate removal (laparoscopic)

CPT 55866

—

cash

$16,447 to $16,447

1 negotiated rates

—

list

Prothrombin time (blood clotting test)

CPT 85610 · lowest of 2 lines

$31

cash

$5 to $73

20 negotiated rates

$77

list

Psychotherapy, 30 minutes

CPT 90832

—

cash

$112 to $112

1 negotiated rates

—

list

Psychotherapy, 45 minutes

CPT 90834

—

cash

$134 to $134

1 negotiated rates

—

list

Psychotherapy, 60 minutes

CPT 90837

—

cash

$202 to $202

1 negotiated rates

—

list

Removal of a breast lump (biopsy by excision)

CPT 19120

—

cash

$5,530 to $5,530

1 negotiated rates

—

list

Screening mammogram (both breasts)

CPT 77067 · lowest of 2 lines

$113

cash

$90 to $268

20 negotiated rates

$282

list

Shoulder arthroscopy with decompression

CPT 29826

—

cash

$5,132 to $5,132

1 negotiated rates

—

list

Sleep study (overnight, attended)

CPT 95810

—

cash

$785 to $1,410

2 negotiated rates

—

list

Spinal fusion (not neck), no complications

MS-DRG 460

—

cash

$48,402 to $48,402

1 negotiated rates

—

list

Spinal injection, lower back, no imaging guidance

CPT 62322

—

cash

$786 to $786

1 negotiated rates

—

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · lowest of 2 lines

$603

cash

$482 to $1,524

20 negotiated rates

$1,507

list

TSH test (thyroid)

CPT 84443 · lowest of 2 lines

$73

cash

$21 to $173

20 negotiated rates

$182

list

Tonsils and adenoids removal (under age 12)

CPT 42820

—

cash

$8,524 to $8,524

1 negotiated rates

—

list

Transvaginal ultrasound

CPT 76830 · lowest of 2 lines

$256

cash

$164 to $607

20 negotiated rates

$639

list

Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines

$473

cash

$202 to $1,123

20 negotiated rates

$1,182

list

Upper endoscopy (EGD)

CPT 43235

—

cash

$1,379 to $1,379

1 negotiated rates

—

list

Upper endoscopy with biopsy

CPT 43239

—

cash

$1,540 to $1,540

1 negotiated rates

—

list

Urinalysis with microscope

CPT 81001 · lowest of 2 lines

$17

cash

$4 to $41

20 negotiated rates

$43

list

Vaginal delivery hospital stay, no complications

MS-DRG 807

—

cash

$3,499 to $7,294

2 negotiated rates

—

list

X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 2 lines

$232

cash

$91 to $550

20 negotiated rates

$579

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://csdam.widen.net/content/ugisgfupgt/original/480543721-1235826454_commonspirit-kansas-inc_standardcharges.csv
Bob Wilson Memorial Grant County Hospital · parsed · tall v3.0.0 · file dated 2026-02-03 · 191.1 MB · 891 price rows read · read Nov 2026