Penn Highlands Huntingdon
Penn Highlands Huntingdon in Huntingdon, PA publishes cash prices for 54 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
1225 Warm Springs Ave, Huntingdon, PA 16652 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 zzCT Abdomen w/ Pelvis w/ contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 zzCT Abdomen w/ Pelvis w/ contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 zzCT Abdomen w/ Pelvis w/ contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 zzCT Abdomen w/ Pelvis w/ contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast | $1,287.00 | $1,287.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast | $2,155.00 | $2,155.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Left | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Right | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Mammo+Tomo RT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Left | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Right | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Mammo+Tomo RT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Left | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Right | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Mammo+Tomo RT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Right | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Mammo+Tomo RT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Left | $927.00 | $927.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Pitiutary wo Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Pitiutary wo Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI IAC's w/o contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI IAC's w/o contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC's w/o contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Pitiutary wo Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI IAC's w/o contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Pitiutary wo Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Pituitary wo + w Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC's w/ + w/o contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Pituitary wo + w Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI IAC's w/ + w/o contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC's w/ + w/o contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Pituitary wo + w Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Pituitary wo + w Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI IAC's w/ + w/o contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PC Pel OB Compl > 14 Wks | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PC Pel OB Compl > 14 Wks | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PC Pel OB Compl > 14 Wks | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PC Pel OB Compl > 14 Wks | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Screening mammogram, both breasts CPT 77067 MA Mammogram Digital Screening | $976.00 | $976.00 | — |
| Screening mammogram, both breasts CPT 77067 MA Screen Digital Mammo+Tomo | $976.00 | $976.00 | — |
| Screening mammogram, both breasts CPT 77067 MA Screen Digital Mammo+Tomo | $976.00 | $976.00 | — |
| Screening mammogram, both breasts CPT 77067 MA Mammogram Digital Screening | $976.00 | $976.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 MA Mammogram Digital Screening | $976.00 | $976.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 MA Screen Digital Mammo+Tomo | $976.00 | $976.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 MA Mammogram Digital Screening | $976.00 | $976.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 MA Screen Digital Mammo+Tomo | $976.00 | $976.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 OCCHLTH LS XRAY 4 VIEW | $213.00 | $213.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 OCCHLTH LS XRAY 4 VIEW | $213.00 | $213.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 OCCHLTH LS XRAY 4 VIEW | $213.00 | $213.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 OCCHLTH LS XRAY 4 VIEW | $213.00 | $213.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel w/Rfx LDL Direct-Quest | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel w/Rfx LDL Direct-Quest | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel w/Rfx LDL Direct-Quest | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel w/Rfx LDL Direct-Quest | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $562.00 | $562.00 | — |
| Obstetric blood test panel CPT 80055 Hepatitis B Surface Antigen wRfx Conf | $562.00 | $562.00 | — |
| Obstetric blood test panel CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel CPT 80055 Hepatitis B Surface Antigen wRfx Conf | $562.00 | $562.00 | — |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Hepatitis B Surface Antigen wRfx Conf | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Hepatitis B Surface Antigen wRfx Conf | $562.00 | $562.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time S/O | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time S/O | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time S/O | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time S/O | $49.00 | $49.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 RHC PT/INR | $35.00 | $35.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 RHC PT/INR | $35.00 | $35.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time S/O Chrg Only | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time S/O Chrg Only | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 RHC PT/INR | $35.00 | $35.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 RHC PT/INR | $35.00 | $35.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time S/O Chrg Only | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time S/O Chrg Only | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR | $50.00 | $50.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/HAMA Treatment | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/HAMA Treatment | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/HAMA Treatment-Quest | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/HAMA Treatment-Quest | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/HAMA Treatment | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/HAMA Treatment-Quest | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/HAMA Treatment | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/HAMA Treatment-Quest | $197.00 | $197.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 zzUA w/Mic | $41.00 | $41.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 zzUA w/Mic | $41.00 | $41.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 zzUA w/Mic | $41.00 | $41.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 zzUA w/Mic | $41.00 | $41.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 RHC URINALYSIS | $31.00 | $31.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 RHC URINALYSIS | $31.00 | $31.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 RHC URINALYSIS | $31.00 | $31.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 RHC URINALYSIS | $31.00 | $31.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Q-CARE URINALYSIS AUTO W/O SCOPE | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Q-CARE URINALYSIS AUTO W/O SCOPE | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 RHC URINALYSIS DIPSTICK AUTO W/O SCOPE | $15.00 | $15.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 RHC URINALYSIS DIPSTICK AUTO W/O SCOPE | $15.00 | $15.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO DIPSTICK W/O SCOPE | $16.00 | $16.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO DIPSTICK W/O SCOPE | $16.00 | $16.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 UA | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine Automated | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urine Protein Qualitative | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urine Protein Qualitative | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Routine Analysis | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 UA | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Routine Analysis | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine Automated | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Q-CARE URINALYSIS AUTO W/O SCOPE | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Q-CARE URINALYSIS AUTO W/O SCOPE | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 RHC URINALYSIS DIPSTICK AUTO W/O SCOPE | $15.00 | $15.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 RHC URINALYSIS DIPSTICK AUTO W/O SCOPE | $15.00 | $15.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO DIPSTICK W/O SCOPE | $16.00 | $16.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO DIPSTICK W/O SCOPE | $16.00 | $16.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Routine Analysis | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Protein Qualitative | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Specific Gravity Urine Automated | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Protein Qualitative | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Specific Gravity Urine Automated | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Routine Analysis | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Q-CARE URINALYSIS NO MICRO NON AUTOMATED | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Q-CARE URINALYSIS NO MICRO NON AUTOMATED | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 RHC URINALYSIS NO MICRO NON AUTOMATED | $26.00 | $26.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 RHC URINALYSIS NO MICRO NON AUTOMATED | $26.00 | $26.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NO MICRO NON AUTOMATED | $28.00 | $28.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NO MICRO NON AUTOMATED | $28.00 | $28.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 PH S/O Chrg Only | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 PH S/O Chrg Only | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Q-CARE URINALYSIS NO MICRO NON AUTOMATED | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Q-CARE URINALYSIS NO MICRO NON AUTOMATED | $3.00 | $3.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 RHC URINALYSIS NO MICRO NON AUTOMATED | $26.00 | $26.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 RHC URINALYSIS NO MICRO NON AUTOMATED | $26.00 | $26.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NO MICRO NON AUTOMATED | $28.00 | $28.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NO MICRO NON AUTOMATED | $28.00 | $28.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PH S/O Chrg Only | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PH S/O Chrg Only | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 3RD TRI MATERNITY CARE C-SECT | $3,815.00 | $3,815.00 | — |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 3RD TRI MATERNITY CARE C-SECT | $3,815.00 | $3,815.00 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 3RD TRI MATERNITY CARE C-SECT | $3,815.00 | $3,815.00 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 3RD TRI MATERNITY CARE C-SECT | $3,815.00 | $3,815.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Lumbar Spine Injection Single | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 XR Lumbar/Sacral Epidural inc. Fluoro | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 XR Lumbar/Sacral Epidural inc. Fluoro | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Lumbar Spine Injection Single | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Lumbar/Sacral Epidural inc. Fluoro | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Lumbar Spine Injection Single | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Lumbar/Sacral Epidural inc. Fluoro | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Lumbar Spine Injection Single | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 FACET BLOCK LUMBAR SACR SINGLE | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 FACET BLOCK LUMBAR SACR SINGLE | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 FACET BLOCK LUMBAR SACR SINGLE | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 FACET BLOCK LUMBAR SACR SINGLE | $10,778.00 | $10,778.00 | — |
| Removal of a breast lump, open surgery CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Removal of a breast lump, open surgery CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 3RD TRI MATERNITY CARE VAG | $3,815.00 | $3,815.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 3RD TRI MATERNITY CARE VAG | $3,815.00 | $3,815.00 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 3RD TRI MATERNITY CARE VAG | $3,815.00 | $3,815.00 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 3RD TRI MATERNITY CARE VAG | $3,815.00 | $3,815.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 OCCHLTH EKG W/INTERPRETATION | $65.00 | $65.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 OCCHLTH EKG W/INTERPRETATION | $65.00 | $65.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 OCCHLTH EKG W/INTERPRETATION | $65.00 | $65.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 OCCHLTH EKG W/INTERPRETATION | $65.00 | $65.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 90847 Family Psychotherapy with Patient | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 90847 Family Psychotherapy with Patient | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 RHC FAMILY PSYTX W/PT 50 MIN | $1,133.00 | $1,133.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 RHC FAMILY PSYTX W/PT 50 MIN | $1,133.00 | $1,133.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Family Psychotherapy with Patient | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 Family Psychotherapy with Patient | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 RHC FAMILY PSYTX W/PT 50 MIN | $1,133.00 | $1,133.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 RHC FAMILY PSYTX W/PT 50 MIN | $1,133.00 | $1,133.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY MED RX WO PATIENT | $828.00 | $828.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY MED RX WO PATIENT | $828.00 | $828.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 RHC FAMILY PSYTX W/O PT 50 MIN | $1,121.00 | $1,121.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 RHC FAMILY PSYTX W/O PT 50 MIN | $1,121.00 | $1,121.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY MED RX WO PATIENT | $828.00 | $828.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY MED RX WO PATIENT | $828.00 | $828.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 RHC FAMILY PSYTX W/O PT 50 MIN | $1,121.00 | $1,121.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 RHC FAMILY PSYTX W/O PT 50 MIN | $1,121.00 | $1,121.00 | — |
| Group psychotherapy session CPT 90853 90853 Group Psychotherapy | $477.00 | $477.00 | — |
| Group psychotherapy session CPT 90853 GROUP THERAPY | $477.00 | $477.00 | — |
| Group psychotherapy session CPT 90853 GROUP THERAPY | $477.00 | $477.00 | — |
| Group psychotherapy session CPT 90853 90853 Group Psychotherapy | $477.00 | $477.00 | — |
| Group psychotherapy session CPT 90853 RHC GROUP PSYCHOTHERAPY | $560.00 | $560.00 | — |
| Group psychotherapy session CPT 90853 RHC GROUP PSYCHOTHERAPY | $560.00 | $560.00 | — |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY | $477.00 | $477.00 | — |
| Group psychotherapy session inpatient CPT 90853 90853 Group Psychotherapy | $477.00 | $477.00 | — |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY | $477.00 | $477.00 | — |
| Group psychotherapy session inpatient CPT 90853 90853 Group Psychotherapy | $477.00 | $477.00 | — |
| Group psychotherapy session inpatient CPT 90853 RHC GROUP PSYCHOTHERAPY | $560.00 | $560.00 | — |
| Group psychotherapy session inpatient CPT 90853 RHC GROUP PSYCHOTHERAPY | $560.00 | $560.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Q-CARE OV PROB DETAILED NEW L3 | $146.00 | $146.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Q-CARE OV PROB DETAILED NEW L3 | $146.00 | $146.00 | — |
| New patient office visit, about 30 minutes CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes CPT 99203 RHC OV PROB DETAILED NEW L3 | $526.00 | $526.00 | — |
| New patient office visit, about 30 minutes CPT 99203 RHC OV PROB DETAILED NEW L3 | $526.00 | $526.00 | — |
| New patient office visit, about 30 minutes CPT 99203 99203 Office Visit Level 3 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes CPT 99203 OV PROB DETAILED NEW L3 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes CPT 99203 99203 Office Visit Level 3 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes CPT 99203 OV PROB DETAILED NEW L3 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Q-CARE OV PROB DETAILED NEW L3 | $146.00 | $146.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Q-CARE OV PROB DETAILED NEW L3 | $146.00 | $146.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 RHC OV PROB DETAILED NEW L3 | $526.00 | $526.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 RHC OV PROB DETAILED NEW L3 | $526.00 | $526.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office Visit Level 3 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office Visit Level 3 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 OV PROB DETAILED NEW L3 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 OV PROB DETAILED NEW L3 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Q-CARE OV PROB COMPREHEN NEW L4 | $209.00 | $209.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Q-CARE OV PROB COMPREHEN NEW L4 | $209.00 | $209.00 | — |
| New patient office visit, about 45 minutes CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes CPT 99204 RHC OV PROB COMPREHEN NEW L4 | $647.00 | $647.00 | — |
| New patient office visit, about 45 minutes CPT 99204 RHC OV PROB COMPREHEN NEW L4 | $647.00 | $647.00 | — |
| New patient office visit, about 45 minutes CPT 99204 99204 Office Visit Level 4 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes CPT 99204 OV PROB COMPREHEN NEW L4 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes CPT 99204 99204 Office Visit Level 4 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes CPT 99204 OV PROB COMPREHEN NEW L4 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Q-CARE OV PROB COMPREHEN NEW L4 | $209.00 | $209.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Q-CARE OV PROB COMPREHEN NEW L4 | $209.00 | $209.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 RHC OV PROB COMPREHEN NEW L4 | $647.00 | $647.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 RHC OV PROB COMPREHEN NEW L4 | $647.00 | $647.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office Visit Level 4 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office Visit Level 4 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 OV PROB COMPREHEN NEW L4 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 OV PROB COMPREHEN NEW L4 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Q-CARE OV PROB COMPLEX NEW L5 | $252.00 | $252.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Q-CARE OV PROB COMPLEX NEW L5 | $252.00 | $252.00 | — |
| New patient office visit, about 60 minutes CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes CPT 99205 RHC OV PROB COMPLEX NEW L5 | $760.00 | $760.00 | — |
| New patient office visit, about 60 minutes CPT 99205 RHC OV PROB COMPLEX NEW L5 | $760.00 | $760.00 | — |
| New patient office visit, about 60 minutes CPT 99205 99205 Office Visit Level 5 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes CPT 99205 OV PROB COMPLEX NEW L5 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes CPT 99205 OV PROB COMPLEX NEW L5 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes CPT 99205 99205 Office Visit Level 5 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Q-CARE OV PROB COMPLEX NEW L5 | $252.00 | $252.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Q-CARE OV PROB COMPLEX NEW L5 | $252.00 | $252.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 RHC OV PROB COMPLEX NEW L5 | $760.00 | $760.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 RHC OV PROB COMPLEX NEW L5 | $760.00 | $760.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 OV PROB COMPLEX NEW L5 | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office Visit Level 5 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office Visit Level 5 New | $1,527.00 | $1,527.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 OV PROB COMPLEX NEW L5 | $1,527.00 | $1,527.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT GE THERAPEUTIC EXERC STRENGTH 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 RHC THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT GE THERAPEUTIC EXERC STRENGTH 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 RHC THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 RHC THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT GE THERAPEUTIC EXERC STRENGTH 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT GE THERAPEUTIC EXERC STRENGTH 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 RHC THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $167.00 | $167.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREVENTIVE MED 18-39YRS NEW | $82.00 | $82.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREVENTIVE MED 18-39YRS NEW | $82.00 | $82.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 RHC PREVENTIVE MED 18-39 YRS NEW | $247.00 | $247.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 RHC PREVENTIVE MED 18-39 YRS NEW | $247.00 | $247.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREVENTIVE MED 18-39YRS NEW | $82.00 | $82.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREVENTIVE MED 18-39YRS NEW | $82.00 | $82.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 RHC PREVENTIVE MED 18-39 YRS NEW | $247.00 | $247.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 RHC PREVENTIVE MED 18-39 YRS NEW | $247.00 | $247.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE MED 40-64YR NEW | $95.00 | $95.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE MED 40-64YR NEW | $95.00 | $95.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 RHC PREVENTIVE MED 40-64 YRS NEW | $286.00 | $286.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 RHC PREVENTIVE MED 40-64 YRS NEW | $286.00 | $286.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREVENTIVE MED 40-64YR NEW | $95.00 | $95.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREVENTIVE MED 40-64YR NEW | $95.00 | $95.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 RHC PREVENTIVE MED 40-64 YRS NEW | $286.00 | $286.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 RHC PREVENTIVE MED 40-64 YRS NEW | $286.00 | $286.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 90832 Psychotherapy, 30 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 90832 Psychotherapy, 30 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 RHC PSYTX W PT 30 MINUTES | $1,061.00 | $1,061.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 RHC PSYTX W PT 30 MINUTES | $1,061.00 | $1,061.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psychotherapy, 30 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832 Psychotherapy, 30 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 RHC PSYTX W PT 30 MINUTES | $1,061.00 | $1,061.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 RHC PSYTX W PT 30 MINUTES | $1,061.00 | $1,061.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 90834 Psychotherapy, 45 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 90834 Psychotherapy, 45 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 RHC PSYTX W PT 45 MINUTES | $1,135.00 | $1,135.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 RHC PSYTX W PT 45 MINUTES | $1,135.00 | $1,135.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Psychotherapy, 45 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 90834 Psychotherapy, 45 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 RHC PSYTX W PT 45 MINUTES | $1,135.00 | $1,135.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 RHC PSYTX W PT 45 MINUTES | $1,135.00 | $1,135.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 90837 Psychotherapy, 60 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 90837 Psychotherapy, 60 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 RHC PSYTX W PT 60 MINUTES | $1,283.00 | $1,283.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 RHC PSYTX W PT 60 MINUTES | $1,283.00 | $1,283.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Psychotherapy, 60 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 90837 Psychotherapy, 60 Minutes | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 RHC PSYTX W PT 60 MINUTES | $1,283.00 | $1,283.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 RHC PSYTX W PT 60 MINUTES | $1,283.00 | $1,283.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 RHC OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 RHC OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 RHC OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 RHC OV CONSULT PROB DETAILED L3 | $185.00 | $185.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 RHC OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 RHC OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 RHC OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 RHC OV CONSULT PROB COMPREHEN L4 | $260.00 | $260.00 | — |
Source file: https://www.phhealthcare.org/download/?id=15373