Mayo Regional Hospital
Mayo Regional Hospital in Dover Foxcroft, ME publishes cash prices for 59 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
897 W Main St., Dover Foxcroft, ME 04426 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 | $1,494.90 | $4,530.00 | 67% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen/Pelvis w/ Contrast | $1,494.90 | $4,530.00 | 67% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Stroke Study | $565.62 | $1,714.00 | 67% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast | $565.62 | $1,714.00 | 67% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Stroke Study | $565.62 | $1,714.00 | 67% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast | $565.62 | $1,714.00 | 67% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $590.04 | $1,788.00 | 67% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast | $590.04 | $1,788.00 | 67% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Diagnostic Bilateral. | $175.23 | $531.00 | 67% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammo Diagnostic 3D Bilateral. | $175.23 | $531.00 | 67% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Diagnostic Bilateral. | $175.23 | $531.00 | 67% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammo Diagnostic 3D Bilateral. | $175.23 | $531.00 | 67% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $637.89 | $1,933.00 | 67% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $637.89 | $1,933.00 | 67% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $810.48 | $2,456.00 | 67% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $810.48 | $2,456.00 | 67% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $610.17 | $1,849.00 | 67% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $610.17 | $1,849.00 | 67% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Complete | $240.57 | $729.00 | 67% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 MAYO OB Complete | $240.57 | $729.00 | 67% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 76805 ULTRASOUND >14 WEEKS | $333.96 | $1,012.00 | 67% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 MAYO OB Complete | $240.57 | $729.00 | 67% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Complete | $240.57 | $729.00 | 67% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 76805 ULTRASOUND >14 WEEKS | $333.96 | $1,012.00 | 67% |
| Screening mammogram, both breasts both sides CPT 77067 MA Mammogram Routine Screening Bilat. | $119.13 | $361.00 | 67% |
| Screening mammogram, both breasts both sides CPT 77067 MA Mammo Screening 3D Bilateral. | $119.13 | $361.00 | 67% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MA Mammogram Routine Screening Bilat. | $119.13 | $361.00 | 67% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MA Mammo Screening 3D Bilateral. | $119.13 | $361.00 | 67% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Study Diagnostic | $1,539.45 | $4,665.00 | 67% |
| Sleep study in a lab (polysomnography) CPT 95810 95810 SLEEP STUDY (DIAGNOSTIC) CHARGE | $1,539.45 | $4,665.00 | 67% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 95810 SLEEP STUDY (DIAGNOSTIC) CHARGE | $1,539.45 | $4,665.00 | 67% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Study Diagnostic | $1,539.45 | $4,665.00 | 67% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $187.77 | $569.00 | 67% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $187.77 | $569.00 | 67% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $264.99 | $803.00 | 67% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $264.99 | $803.00 | 67% |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $186.78 | $566.00 | 67% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $186.78 | $566.00 | 67% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel ALI | $63.03 | $191.00 | 67% |
| Basic metabolic panel (blood test) CPT 80048 i-STAT BMP 2 | $63.03 | $191.00 | 67% |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel Standard | $63.03 | $191.00 | 67% |
| Basic metabolic panel (blood test) inpatient CPT 80048 i-STAT BMP 2 | $63.03 | $191.00 | 67% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel ALI | $63.03 | $191.00 | 67% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel Standard | $63.03 | $191.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL W/ TRIGLYCERIDES/HDL-C QST | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel Standard | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel with Direct LDL if indicated | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HDL 2 Profile ALI | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL WITH REFLEX TO DIRECT LDL QST | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel with Direct LDL if indicated | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL W/ TRIGLYCERIDES/HDL-C QST | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL WITH REFLEX TO DIRECT LDL QST | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HDL 2 Profile ALI | $44.55 | $135.00 | 67% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel Standard | $44.55 | $135.00 | 67% |
| Complete blood count (CBC) with differential CPT 85025 CBC w/Diff Standard | $40.26 | $122.00 | 67% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/Diff Standard | $40.26 | $122.00 | 67% |
| Complete blood count (CBC), no differential CPT 85027 Hemogram Standard | $23.10 | $70.00 | 67% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram Standard | $23.10 | $70.00 | 67% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel Standard | $93.72 | $284.00 | 67% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel ALI | $93.72 | $284.00 | 67% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel Standard | $93.72 | $284.00 | 67% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel ALI | $93.72 | $284.00 | 67% |
| Kidney function blood test panel CPT 80069 Renal Function Panel Standard | $33.66 | $102.00 | 67% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel Standard | $33.66 | $102.00 | 67% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel Standard | $48.18 | $146.00 | 67% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel Standard | $48.18 | $146.00 | 67% |
| Obstetric blood test panel CPT 80055 Prenatal Panel MAYO | $160.71 | $487.00 | 67% |
| Obstetric blood test panel CPT 80055 MAYO PRENATAL PANEL | $160.71 | $487.00 | 67% |
| Obstetric blood test panel CPT 80055 Prenatal Panel Standard | $160.71 | $487.00 | 67% |
| Obstetric blood test panel inpatient CPT 80055 Prenatal Panel MAYO | $160.71 | $487.00 | 67% |
| Obstetric blood test panel inpatient CPT 80055 Prenatal Panel Standard | $160.71 | $487.00 | 67% |
| Obstetric blood test panel inpatient CPT 80055 MAYO PRENATAL PANEL | $160.71 | $487.00 | 67% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (FREE AND TOTAL) QST | $53.79 | $163.00 | 67% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free ALI | $53.79 | $163.00 | 67% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free ALI | $53.79 | $163.00 | 67% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (FREE AND TOTAL) QST | $53.79 | $163.00 | 67% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $48.51 | $147.00 | 67% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $48.51 | $147.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 zzLupus Anticoagulant Panel Reflex ALI | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Prothrombin Time/ PTT | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT Non-Heparin | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-LA W/REFLEX TO HEXAGONAL PHASE CONFIRMATION QS | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Silica Clotting Time ALI | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT ALI | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Prothrombin Time/ PTT | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 zzLupus Anticoagulant Panel Reflex ALI | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT ALI | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Silica Clotting Time ALI | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT Non-Heparin | $23.10 | $70.00 | 67% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT-LA W/REFLEX TO HEXAGONAL PHASE CONFIRMATION QS | $23.10 | $70.00 | 67% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR POC Confirm | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR ALI | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR POC (Lab) | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN/INR POC | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR ALI | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN/INR POC | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR POC Confirm | $15.51 | $47.00 | 67% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR POC (Lab) | $15.51 | $47.00 | 67% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/ Reflex to Free T4 | $52.80 | $160.00 | 67% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $52.80 | $160.00 | 67% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $52.80 | $160.00 | 67% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/ Reflex to Free T4 | $52.80 | $160.00 | 67% |
| Urinalysis with microscope exam, manual CPT 81000 URINE DIPSTICK AND MICROSCOPY POC | $8.91 | $27.00 | 67% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINE DIPSTICK AND MICROSCOPY POC | $8.91 | $27.00 | 67% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick Only Standard | $12.21 | $37.00 | 67% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis with Culture, if indicated Standard | $12.21 | $37.00 | 67% |
| Urinalysis without microscope exam, automated CPT 81003 URINE DIPSTICK - AUTOMATED POC | $12.21 | $37.00 | 67% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE DIPSTICK - AUTOMATED POC | $12.21 | $37.00 | 67% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis with Culture, if indicated Standard | $12.21 | $37.00 | 67% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick Only Standard | $12.21 | $37.00 | 67% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis | $8.91 | $27.00 | 67% |
| Urinalysis without microscope exam, manual CPT 81002 Reducing Substance Ur ALI | $8.91 | $27.00 | 67% |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK POC | $8.91 | $27.00 | 67% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis | $8.91 | $27.00 | 67% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK POC | $8.91 | $27.00 | 67% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Reducing Substance Ur ALI | $8.91 | $27.00 | 67% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 59510 C-SECTION CHARGE | $3,978.81 | $12,057.00 | 67% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 59510 C-SECTION CHARGE | $3,978.81 | $12,057.00 | 67% |
| Colonoscopy with polyp removal CPT 45385 45385 COLON W/REMOVAL OF TUMOR,POLYP, OR OTHER LES BY SNARE | $461.67 | $1,399.00 | 67% |
| Colonoscopy with polyp removal inpatient CPT 45385 45385 COLON W/REMOVAL OF TUMOR,POLYP, OR OTHER LES BY SNARE | $461.67 | $1,399.00 | 67% |
| Colonoscopy with tissue sample CPT 45380 45380 COLONOSCOPY WITH BIOPSY | $413.16 | $1,252.00 | 67% |
| Colonoscopy with tissue sample inpatient CPT 45380 45380 COLONOSCOPY WITH BIOPSY | $413.16 | $1,252.00 | 67% |
| Colonoscopy, diagnostic CPT 45378 45378 COLONOSCOPY | $344.19 | $1,043.00 | 67% |
| Colonoscopy, diagnostic CPT 45378 G0121 SCREENING COLONOSCOPY | $380.16 | $1,152.00 | 67% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $380.16 | $1,152.00 | 67% |
| Colonoscopy, diagnostic CPT 45378 G0105 Colonoscopy Screen, High Risk Profee | $380.16 | $1,152.00 | 67% |
| Colonoscopy, diagnostic inpatient CPT 45378 45378 COLONOSCOPY | $344.19 | $1,043.00 | 67% |
| Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY | $380.16 | $1,152.00 | 67% |
| Colonoscopy, diagnostic inpatient CPT 45378 G0105 Colonoscopy Screen, High Risk Profee | $380.16 | $1,152.00 | 67% |
| Colonoscopy, diagnostic inpatient CPT 45378 G0121 SCREENING COLONOSCOPY | $380.16 | $1,152.00 | 67% |
| Gallbladder removal, laparoscopic CPT 47562 47562 LAP CHOLECYSTECTOMY | $625.35 | $1,895.00 | 67% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 47562 LAP CHOLECYSTECTOMY | $625.35 | $1,895.00 | 67% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 49505 REP INGU HERN 5 UP W | $374.55 | $1,135.00 | 67% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 49505 REP INGU HERN 5 UP W | $374.55 | $1,135.00 | 67% |
| Knee arthroscopy with meniscus trim CPT 29881 29881 Arthro W/Menis Med Or Lat | $601.26 | $1,822.00 | 67% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 29881 Arthro W/Menis Med Or Lat | $601.26 | $1,822.00 | 67% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 64483 TRANSFORAMINAL INJ LUM/SAC PRO | $182.16 | $552.00 | 67% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 64483 TRANSFORAMINAL INJ LUM/SAC PRO | $182.16 | $552.00 | 67% |
| Prostate biopsy CPT 55700 55700 BIOPSY PROSTATE NEEDLE/PU | $330.33 | $1,001.00 | 67% |
| Prostate biopsy inpatient CPT 55700 55700 BIOPSY PROSTATE NEEDLE/PU | $330.33 | $1,001.00 | 67% |
| Removal of a breast lump, open surgery CPT 19120 19120 EXC OF LESION BREAST | $401.94 | $1,218.00 | 67% |
| Removal of a breast lump, open surgery inpatient CPT 19120 19120 EXC OF LESION BREAST | $401.94 | $1,218.00 | 67% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 29826 SHOULDER ARTHROSCOPY/SURGERY-SC PF | $526.02 | $1,594.00 | 67% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 29826 SHOULDER ARTHROSCOPY/SURGERY-SC PF | $526.02 | $1,594.00 | 67% |
| Total hip replacement CPT 27130 27130 Total Hip Arthroplasty | $916.74 | $2,778.00 | 67% |
| Total hip replacement inpatient CPT 27130 27130 Total Hip Arthroplasty | $916.74 | $2,778.00 | 67% |
| Total knee replacement CPT 27447 27447 Total Knee Replacement | $1,280.73 | $3,881.00 | 67% |
| Total knee replacement inpatient CPT 27447 27447 Total Knee Replacement | $1,280.73 | $3,881.00 | 67% |
| Upper endoscopy (EGD) with biopsy CPT 43239 43239 EGD WITH BIOPSY | $331.98 | $1,006.00 | 67% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 EGD WITH BIOPSY | $331.98 | $1,006.00 | 67% |
| Upper endoscopy (EGD), diagnostic CPT 43235 43235 EGD | $214.17 | $649.00 | 67% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 43235 EGD | $214.17 | $649.00 | 67% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 59610 TOTAL OB/VBAC | $1,716.99 | $5,203.00 | 67% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 59610 TOTAL OB/VBAC | $1,716.99 | $5,203.00 | 67% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 59400 OB CARE COMPL 59400 | $3,619.44 | $10,968.00 | 67% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 59400 OB CARE COMPL 59400 | $3,619.44 | $10,968.00 | 67% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG 12 LEAD, INTERP/REPORT ONLY CHARGE | $30.36 | $92.00 | 67% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG POC | $48.18 | $146.00 | 67% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG 12 LEAD, INTERP/REPORT ONLY CHARGE | $30.36 | $92.00 | 67% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG POC | $48.18 | $146.00 | 67% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WIT | $147.84 | $448.00 | 67% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WIT | $147.84 | $448.00 | 67% |
| New patient office visit, about 30 minutes CPT 99203 99203 NEW OUTPATIENT VISIT-INT CHARGE | $83.16 | $252.00 | 67% |
| New patient office visit, about 30 minutes CPT 99203 99203 INITIAL ONCOLOGY VISIT LEVEL 3 CHARGE | $144.87 | $439.00 | 67% |
| New patient office visit, about 30 minutes CPT 99203 99203 OV NEW PT 3 Facility | $144.87 | $439.00 | 67% |
| New patient office visit, about 30 minutes CPT 99203 99203 Office/OP New Visit Level 3 | $144.87 | $439.00 | 67% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 NEW OUTPATIENT VISIT-INT CHARGE | $83.16 | $252.00 | 67% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 OV NEW PT 3 Facility | $144.87 | $439.00 | 67% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office/OP New Visit Level 3 | $144.87 | $439.00 | 67% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 INITIAL ONCOLOGY VISIT LEVEL 3 CHARGE | $144.87 | $439.00 | 67% |
| New patient office visit, about 45 minutes CPT 99204 99204 NEW OUTPATIENT VISIT-EXT CHARGE | $125.07 | $379.00 | 67% |
| New patient office visit, about 45 minutes CPT 99204 99204 Office/OP New Visit Level 4 99204 | $209.22 | $634.00 | 67% |
| New patient office visit, about 45 minutes CPT 99204 99204 OV NEW PT 4 Facility | $209.22 | $634.00 | 67% |
| New patient office visit, about 45 minutes CPT 99204 99204 INITIAL ONCOLOGY VISIT LEVEL 4 CHARGE | $209.22 | $634.00 | 67% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 NEW OUTPATIENT VISIT-EXT CHARGE | $125.07 | $379.00 | 67% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 OV NEW PT 4 Facility | $209.22 | $634.00 | 67% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 INITIAL ONCOLOGY VISIT LEVEL 4 CHARGE | $209.22 | $634.00 | 67% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office/OP New Visit Level 4 99204 | $209.22 | $634.00 | 67% |
| New patient office visit, about 60 minutes CPT 99205 99205 NEW OUTPATIENT VISIT-COMP CHARGE | $164.34 | $498.00 | 67% |
| New patient office visit, about 60 minutes CPT 99205 99205 TELEMEDICINE VISIT NEW LEVEL 5 | $297.66 | $902.00 | 67% |
| New patient office visit, about 60 minutes CPT 99205 99205 INITIAL ONCOLOGY VISIT LEVEL 5 CHARGE | $312.51 | $947.00 | 67% |
| New patient office visit, about 60 minutes CPT 99205 99205 OV NEW PT 5 Facility | $312.51 | $947.00 | 67% |
| New patient office visit, about 60 minutes CPT 99205 Office/OP New Visit Level 5 99205 | $312.51 | $947.00 | 67% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 NEW OUTPATIENT VISIT-COMP CHARGE | $164.34 | $498.00 | 67% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 TELEMEDICINE VISIT NEW LEVEL 5 | $297.66 | $902.00 | 67% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 INITIAL ONCOLOGY VISIT LEVEL 5 CHARGE | $312.51 | $947.00 | 67% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 OV NEW PT 5 Facility | $312.51 | $947.00 | 67% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/OP New Visit Level 5 99205 | $312.51 | $947.00 | 67% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PTA THERAPEUTIC EXERCISES (TIMED PER 15 MINS | $43.56 | $132.00 | 67% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PTA THERAPEUTIC EXERCISES (TIMED PER 15 MINS | $43.56 | $132.00 | 67% |
| Preventive checkup, new patient aged 18–39 CPT 99385 99385 PHY PHP 1-39 | $66.99 | $203.00 | 67% |
| Preventive checkup, new patient aged 18–39 CPT 99385 99385 PREVENTIVE MEDICINE 18-39 YEARS NEW | $114.51 | $347.00 | 67% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 PHY PHP 1-39 | $66.99 | $203.00 | 67% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 99385 PREVENTIVE MEDICINE 18-39 YEARS NEW | $114.51 | $347.00 | 67% |
| Preventive checkup, new patient aged 40–64 CPT 99386 99386 PHY PHP 40-64 | $80.19 | $243.00 | 67% |
| Preventive checkup, new patient aged 40–64 CPT 99386 99386 PREVENTIVE MEDICINE 40-64 YEARS NEW | $137.61 | $417.00 | 67% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 PHY PHP 40-64 | $80.19 | $243.00 | 67% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 99386 PREVENTIVE MEDICINE 40-64 YEARS NEW | $137.61 | $417.00 | 67% |
| Psychotherapy session, 30 minutes CPT 90832 90832 PSYCHOTHRPY 30 MIN W/ PATIENT AND/OR FAMILY | $113.85 | $345.00 | 67% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes with patient and/or family member | $113.85 | $345.00 | 67% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy, 30 minutes with patient and/or family member | $113.85 | $345.00 | 67% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832 PSYCHOTHRPY 30 MIN W/ PATIENT AND/OR FAMILY | $113.85 | $345.00 | 67% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes with patient and/or family member | $174.24 | $528.00 | 67% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy, 45 minutes with patient and/or family member | $174.24 | $528.00 | 67% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes with patient | $281.16 | $852.00 | 67% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy, 60 minutes with patient | $281.16 | $852.00 | 67% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 DETAILED OP/ER CONSULTATIONS | $102.30 | $310.00 | 67% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINU | $151.14 | $458.00 | 67% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 DETAILED OP/ER CONSULTATIONS | $102.30 | $310.00 | 67% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINU | $151.14 | $458.00 | 67% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 Outpt Comp/Mod Consult60Min | $144.21 | $437.00 | 67% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULTATION LEVEL 4 - 99244 | $213.51 | $647.00 | 67% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 99244 Outpt Comp/Mod Consult60Min | $144.21 | $437.00 | 67% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE CONSULTATION LEVEL 4 - 99244 | $213.51 | $647.00 | 67% |
Source file: https://northernlighthealth.org/NLH/media/Price-Transparency/843689003_Mayo-hospital_standardcharges.csv