Legacy Mount Hood Medical Center
Legacy Mount Hood Medical Center in Gresham, OR publishes cash prices for 72 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.
24800 Se Stark Street, Gresham, OR 97030 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 CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $558.35 | $859.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD & PELVIS W/CONTRAST | $1,777.10 | $2,734.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $558.35 | $859.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD & PELVIS W/CONTRAST | $1,777.10 | $2,734.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL | $197.60 | $304.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC HEAD CT LIMITED WITHOUT CONTRAST | $535.60 | $824.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC HEAD CT WITHOUT CONTRAST | $643.50 | $990.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL | $197.60 | $304.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC HEAD CT LIMITED WITHOUT CONTRAST | $535.60 | $824.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC HEAD CT WITHOUT CONTRAST | $643.50 | $990.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC PELVIS CT WITH CONTRAST | $890.50 | $1,370.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC PELVIS CT WITH CONTRAST | $890.50 | $1,370.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS BILATERAL | $369.20 | $568.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC BILATERAL | $369.20 | $568.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC BILATERAL | $369.20 | $568.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS BILATERAL | $369.20 | $568.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS UNILATERAL | $337.35 | $519.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC UNILATERAL | $337.35 | $519.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC UNILATERAL | $337.35 | $519.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS UNILATERAL | $337.35 | $519.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC LOWER EXTREMITY JOINT WITHOUT CONTRAST | $997.75 | $1,535.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY JOINT UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY HIP UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY KNEE UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC LOWER EXTREMITY JOINT WITHOUT CONTRAST | $997.75 | $1,535.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY KNEE UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY JOINT UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY HIP UNILATERAL WITHOUT CONTRAST | $1,085.50 | $1,670.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITH/WITHOUT CONT | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY KNEE UNILATERAL WITH/WITHOUT CONTRAST | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY JOINT UNILATERAL WITH/WITHOUT CONT | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY HIP UNILATERAL WITH/WITHOUT CONT | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY KNEE UNILATERAL WITH/WITHOUT CONTRAST | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY HIP UNILATERAL WITH/WITHOUT CONT | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY JOINT UNILATERAL WITH/WITHOUT CONT | $2,561.65 | $3,941.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITH/WITHOUT CONT | $2,561.65 | $3,941.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MR BRAIN WITHOUT CONTRAST | $1,183.00 | $1,820.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MR BRAIN WITHOUT CONTRAST | $1,183.00 | $1,820.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MR BRAIN WITH/WITHOUT CONTRAST | $2,408.90 | $3,706.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MR BRAIN WITH/WITHOUT CONTRAST | $2,408.90 | $3,706.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MR CINE MOTION LUMBAR | $373.10 | $574.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MR SPINE LUMBAR WITHOUT CONTRAST | $1,133.60 | $1,744.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR CINE MOTION LUMBAR | $373.10 | $574.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR SPINE LUMBAR WITHOUT CONTRAST | $1,133.60 | $1,744.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $244.40 | $376.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC OB COMPLETE >1ST TRIMESTER SINGLE GESTATION ULTRASOUND | $355.55 | $547.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $244.40 | $376.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC OB COMPLETE >1ST TRIMESTER SINGLE GESTATION ULTRASOUND | $355.55 | $547.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $234.00 | $360.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING BILATERAL | $347.10 | $534.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING UNILATERAL | $307.45 | $473.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $234.00 | $360.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING BILATERAL | $347.10 | $534.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING UNILATERAL | $307.45 | $473.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $1,143.35 | $1,759.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PSG COMPLEX PEDIATRIC AGED 6 TO 18 YEARS | $3,383.90 | $5,206.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC COMPLEX 13 CH PSG ADULT | $3,383.90 | $5,206.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PSG COMPLEX IP PORTABLE ADULT | $3,383.90 | $5,206.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $1,143.35 | $1,759.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC COMPLEX 13 CH PSG ADULT | $3,383.90 | $5,206.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PSG COMPLEX PEDIATRIC AGED 6 TO 18 YEARS | $3,383.90 | $5,206.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PSG COMPLEX IP PORTABLE ADULT | $3,383.90 | $5,206.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL | $214.50 | $330.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC TRANSVAGINAL (NON-OB) ULTRASOUND | $234.00 | $360.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 CHG US TRANSVAGINAL | $214.50 | $330.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC TRANSVAGINAL (NON-OB) ULTRASOUND | $234.00 | $360.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $210.60 | $324.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC ABDOMEN COMPLETE ULTRASOUND | $475.80 | $732.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $210.60 | $324.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC ABDOMEN COMPLETE ULTRASOUND | $475.80 | $732.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $94.90 | $146.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBAR MINIMUM 4 VIEWS | $291.20 | $448.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $94.90 | $146.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBAR MINIMUM 4 VIEWS | $291.20 | $448.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $12.35 | $19.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $75.40 | $116.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $12.35 | $19.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL | $75.40 | $116.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LP WITHOUT VLDL+CHOL/HDL | $8.85 | $13.61 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR LIPID PROFILE 80061 | $9.19 | $14.14 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR LIPO PROFILE PART 2 | $11.21 | $17.25 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE | $18.64 | $28.67 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL | $27.95 | $43.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LP WITHOUT VLDL+CHOL/HDL | $8.85 | $13.61 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR LIPID PROFILE 80061 | $9.19 | $14.14 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR LIPO PROFILE PART 2 | $11.21 | $17.25 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE | $18.64 | $28.67 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL | $27.95 | $43.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $13.65 | $21.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF | $16.17 | $24.88 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $13.65 | $21.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC W AUTO DIFF | $16.17 | $24.88 | 35% |
| Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $4.78 | $7.36 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC AUTOMATED BLOOD COUNT | $14.46 | $22.25 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $4.78 | $7.36 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC AUTOMATED BLOOD COUNT | $14.46 | $22.25 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPRHNSV METABOLIC PANEL | $14.02 | $21.57 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $14.95 | $23.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPRHNSV METABOLIC PANEL | $14.02 | $21.57 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $14.95 | $23.00 | 35% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $11.91 | $18.33 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL | $11.91 | $18.33 | 35% |
| Liver function blood test panel CPT 80076 CHG HEPATIC FUNCTION PANEL | $11.05 | $17.00 | 35% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL | $12.79 | $19.67 | 35% |
| Liver function blood test panel inpatient CPT 80076 CHG HEPATIC FUNCTION PANEL | $11.05 | $17.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL | $12.79 | $19.67 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $13.15 | $20.23 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC FREE PSA | $20.77 | $31.96 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $13.15 | $20.23 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC FREE PSA | $20.77 | $31.96 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA, ULTRASENSITIVE | $10.72 | $16.50 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA ULTRASENSITIVE | $12.62 | $19.42 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $13.00 | $20.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA (SERIAL MONITOR) | $14.67 | $22.57 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN | $144.30 | $222.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA, ULTRASENSITIVE | $10.72 | $16.50 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA ULTRASENSITIVE | $12.62 | $19.42 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $13.00 | $20.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA (SERIAL MONITOR) | $14.67 | $22.57 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN | $144.30 | $222.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC ACTIVATED PARTIAL THROMBOPLASTIN TIME | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT-LA MIX | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC ACT PARTIAL THROMBOPLASIN TIME | $83.85 | $129.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT-LA MIX | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC ACTIVATED PARTIAL THROMBOPLASTIN TIME | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC ACT PARTIAL THROMBOPLASIN TIME | $83.85 | $129.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $15.60 | $24.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME WITH INR POC | $16.90 | $26.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME INR | $66.95 | $103.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME | $15.60 | $24.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME WITH INR POC | $16.90 | $26.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME INR | $66.95 | $103.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $11.88 | $18.27 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH-THYROID STIMULATING HORMON | $142.35 | $219.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $11.88 | $18.27 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH-THYROID STIMULATING HORMON | $142.35 | $219.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $11.70 | $18.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W MICROSCOPIC AUTO | $12.02 | $18.50 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $11.70 | $18.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W MICROSCOPIC AUTO | $12.02 | $18.50 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $12.35 | $19.00 | 35% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $12.35 | $19.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC U DIPSTICK POCT | $44.85 | $69.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINE DIPSTICK | $46.80 | $72.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC U DIPSTICK POCT | $44.85 | $69.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINE DIPSTICK | $46.80 | $72.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS NON-AUTOMATED W/O MICRO | $53.95 | $83.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINALYSIS NON-AUTOMATED W/O MICRO | $53.95 | $83.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $980.20 | $1,508.00 | 35% |
| Cataract surgery with lens implant inpatient CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $980.20 | $1,508.00 | 35% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $4,915.95 | $7,563.00 | 35% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $4,915.95 | $7,563.00 | 35% |
| Colonoscopy with endoscopic ultrasound CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $462.80 | $712.00 | 35% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $462.80 | $712.00 | 35% |
| Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $818.35 | $1,259.00 | 35% |
| Colonoscopy with polyp removal inpatient CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $818.35 | $1,259.00 | 35% |
| Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $779.35 | $1,199.00 | 35% |
| Colonoscopy with tissue sample inpatient CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $779.35 | $1,199.00 | 35% |
| Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $615.55 | $947.00 | 35% |
| Colonoscopy, diagnostic inpatient CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $615.55 | $947.00 | 35% |
| Gallbladder removal, laparoscopic CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,219.40 | $1,876.00 | 35% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,219.40 | $1,876.00 | 35% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $968.50 | $1,490.00 | 35% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $968.50 | $1,490.00 | 35% |
| Knee arthroscopy with meniscus trim CPT 29881 PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG | $1,011.40 | $1,556.00 | 35% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG | $1,011.40 | $1,556.00 | 35% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PR POST-CATARACT LASER SURGERY | $1,028.30 | $1,582.00 | 35% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 PR POST-CATARACT LASER SURGERY | $1,028.30 | $1,582.00 | 35% |
| Left heart catheterization, diagnostic one side CPT 93452 HC CD CATH LT HT W/ LV GRAM | $6,848.40 | $10,536.00 | 35% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC CD CATH LT HT W/ LV GRAM | $6,848.40 | $10,536.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $180.70 | $278.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAMINAR LMBR/SAC W/ FLUORO | $2,056.60 | $3,164.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $180.70 | $278.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAMINAR LMBR/SAC W/ FLUORO | $2,056.60 | $3,164.00 | 35% |
| Lower-back epidural injection, without imaging guidance CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $239.85 | $369.00 | 35% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $239.85 | $369.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 HC AN INJ SEL ROOT BLOCK LUMB/SACR SNGL LVL BILAT | $1,827.80 | $2,812.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $443.95 | $683.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC AN INJ SEL ROOT BLOCK LUMB/SACR SNGL LVL | $1,560.65 | $2,401.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 HC AN INJ SEL ROOT BLOCK LUMB/SACR SNGL LVL BILAT | $1,827.80 | $2,812.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $443.95 | $683.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC AN INJ SEL ROOT BLOCK LUMB/SACR SNGL LVL | $1,560.65 | $2,401.00 | 35% |
| Prostate biopsy CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH | $438.10 | $674.00 | 35% |
| Prostate biopsy CPT 55700 HC BIOPSY PROSTATE | $2,451.80 | $3,772.00 | 35% |
| Prostate biopsy inpatient CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH | $438.10 | $674.00 | 35% |
| Prostate biopsy inpatient CPT 55700 HC BIOPSY PROSTATE | $2,451.80 | $3,772.00 | 35% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING | $2,173.60 | $3,344.00 | 35% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING | $2,173.60 | $3,344.00 | 35% |
| Removal of a breast lump, open surgery CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $958.75 | $1,475.00 | 35% |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $958.75 | $1,475.00 | 35% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $313.30 | $482.00 | 35% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $313.30 | $482.00 | 35% |
| Tonsil and adenoid removal, child under 12 CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $540.15 | $831.00 | 35% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $540.15 | $831.00 | 35% |
| Total hip replacement CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $2,366.00 | $3,640.00 | 35% |
| Total hip replacement inpatient CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $2,366.00 | $3,640.00 | 35% |
| Total knee replacement CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $2,362.75 | $3,635.00 | 35% |
| Total knee replacement inpatient CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $2,362.75 | $3,635.00 | 35% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $670.80 | $1,032.00 | 35% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $670.80 | $1,032.00 | 35% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $518.70 | $798.00 | 35% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $518.70 | $798.00 | 35% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $4,635.80 | $7,132.00 | 35% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $4,635.80 | $7,132.00 | 35% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $4,425.85 | $6,809.00 | 35% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $4,425.85 | $6,809.00 | 35% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $26.00 | $40.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $26.00 | $40.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 HC CONJNT PSYCH TX 30MIN | $160.55 | $247.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $193.05 | $297.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 HC CSW FAMILY COG BEHAV THER W/PT | $233.35 | $359.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 HC CONJNT PSYCH TX 60MIN | $288.60 | $444.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC CONJNT PSYCH TX 30MIN | $160.55 | $247.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $193.05 | $297.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC CSW FAMILY COG BEHAV THER W/PT | $233.35 | $359.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC CONJNT PSYCH TX 60MIN | $288.60 | $444.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYCH TX 30MIN | $161.20 | $248.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $185.25 | $285.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 HC CSW FAMILY COG BEHAV THER W/O PT | $200.85 | $309.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PSY FAMILY PSYCH TX 60MIN | $206.70 | $318.00 | 35% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYCH TX 30MIN | $161.20 | $248.00 | 35% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $185.25 | $285.00 | 35% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC CSW FAMILY COG BEHAV THER W/O PT | $200.85 | $309.00 | 35% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PSY FAMILY PSYCH TX 60MIN | $206.70 | $318.00 | 35% |
| Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY | $52.65 | $81.00 | 35% |
| Group psychotherapy session CPT 90853 HC PSY PSYCH GROUP TX 30 MIN | $72.80 | $112.00 | 35% |
| Group psychotherapy session CPT 90853 HC GROUP THERAPY 30 MIN PSYCH IP | $120.90 | $186.00 | 35% |
| Group psychotherapy session CPT 90853 HC PSY PSYCH GROUP TX 60 MIN | $143.00 | $220.00 | 35% |
| Group psychotherapy session CPT 90853 HC PSY PSYCH GROUP TX 90 MINUTES | $183.30 | $282.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 PR GROUP PSYCHOTHERAPY | $52.65 | $81.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC PSY PSYCH GROUP TX 30 MIN | $72.80 | $112.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC GROUP THERAPY 30 MIN PSYCH IP | $120.90 | $186.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC PSY PSYCH GROUP TX 60 MIN | $143.00 | $220.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC PSY PSYCH GROUP TX 90 MINUTES | $183.30 | $282.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $204.75 | $315.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 HC PHZ SP DETAILED/LOW-NEW MIN 30 MINUTES | $410.80 | $632.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 HC PHY NEW PT LIMITED VISIT MIN 30 MINUTES | $562.25 | $865.00 | 35% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $204.75 | $315.00 | 35% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC PHZ SP DETAILED/LOW-NEW MIN 30 MINUTES | $410.80 | $632.00 | 35% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC PHY NEW PT LIMITED VISIT MIN 30 MINUTES | $562.25 | $865.00 | 35% |
| New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $306.80 | $472.00 | 35% |
| New patient office visit, about 45 minutes CPT 99204 HC PHZ SP COMPREHEN MOD-NEW MIN 45 MINUTES | $609.05 | $937.00 | 35% |
| New patient office visit, about 45 minutes CPT 99204 HC PHY NEW PT COMPLEX VISIT MIN 45 MINUTES | $720.85 | $1,109.00 | 35% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $306.80 | $472.00 | 35% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC PHZ SP COMPREHEN MOD-NEW MIN 45 MINUTES | $609.05 | $937.00 | 35% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC PHY NEW PT COMPLEX VISIT MIN 45 MINUTES | $720.85 | $1,109.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $405.60 | $624.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 HC PHY NEW PT COMPREHNSV VST MIN 60 MINUTES | $776.75 | $1,195.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 HC PHZ SP COMPLEX/HIGH-NEW MIN 60 MINUTES | $781.95 | $1,203.00 | 35% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $405.60 | $624.00 | 35% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC PHY NEW PT COMPREHNSV VST MIN 60 MINUTES | $776.75 | $1,195.00 | 35% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC PHZ SP COMPLEX/HIGH-NEW MIN 60 MINUTES | $781.95 | $1,203.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE PT | $70.85 | $109.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE PT VV | $70.85 | $109.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE OT VV | $81.90 | $126.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE OT | $81.90 | $126.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT | $96.20 | $148.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT VV | $96.20 | $148.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT | $100.75 | $155.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT VV | $100.75 | $155.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC NICU PT TREATMENT 15M | $109.85 | $169.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXER 1:1 EA 15M PT PR VV | $114.40 | $176.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXER 1:1 EA 15M PT PR | $114.40 | $176.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC TREATMENT OP 3 OT | $181.35 | $279.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC TREATMENT OT 3 OP | $195.00 | $300.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) one side CPT 97110 HC TREATMENT RT IP MNCV | $81.90 | $126.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE PT | $70.85 | $109.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE PT VV | $70.85 | $109.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE OT | $81.90 | $126.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE OT VV | $81.90 | $126.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT | $96.20 | $148.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT VV | $96.20 | $148.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT | $100.75 | $155.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT VV | $100.75 | $155.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC NICU PT TREATMENT 15M | $109.85 | $169.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXER 1:1 EA 15M PT PR VV | $114.40 | $176.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXER 1:1 EA 15M PT PR | $114.40 | $176.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC TREATMENT OP 3 OT | $181.35 | $279.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC TREATMENT OT 3 OP | $195.00 | $300.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient one side CPT 97110 HC TREATMENT RT IP MNCV | $81.90 | $126.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $237.25 | $365.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $237.25 | $365.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $273.00 | $420.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $273.00 | $420.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC PATIENT ED 30 MIN DT | $130.65 | $201.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC CSW COG BEHAV THERAPY 30 MIN | $138.45 | $213.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSY IND PSYCH TX 30MIN IP | $143.00 | $220.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $148.20 | $228.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC IND TREATMENT 30 MIN | $153.40 | $236.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC IND TREATMENT 30 MIN VV | $153.40 | $236.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSY IND TREATMENT 30 MIN VV | $166.40 | $256.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSY IND TREATMENT 30 MIN | $166.40 | $256.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PATIENT ED 30 MIN DT | $130.65 | $201.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC CSW COG BEHAV THERAPY 30 MIN | $138.45 | $213.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSY IND PSYCH TX 30MIN IP | $143.00 | $220.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $148.20 | $228.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC IND TREATMENT 30 MIN | $153.40 | $236.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC IND TREATMENT 30 MIN VV | $153.40 | $236.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSY IND TREATMENT 30 MIN | $166.40 | $256.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSY IND TREATMENT 30 MIN VV | $166.40 | $256.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC CSW COG BEHAV THERAPY 45 MIN | $176.80 | $272.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSY IND TREATMENT 45 MIN | $182.65 | $281.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSY IND TREATMENT 45 MIN VV | $182.65 | $281.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $195.65 | $301.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC IND TREATMENT 45 MIN VV | $208.65 | $321.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC IND TREATMENT 45 MIN | $208.65 | $321.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC CSW COG BEHAV THERAPY 45 MIN | $176.80 | $272.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSY IND TREATMENT 45 MIN VV | $182.65 | $281.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSY IND TREATMENT 45 MIN | $182.65 | $281.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $195.65 | $301.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC IND TREATMENT 45 MIN VV | $208.65 | $321.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC IND TREATMENT 45 MIN | $208.65 | $321.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC CSW COG BEHAV THERAPY 60 MIN | $226.20 | $348.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSY IND PSYCH TX 60MIN IP | $234.00 | $360.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC IND TREATMENT 60 MIN VV | $248.95 | $383.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC IND TREATMENT 60 MIN | $248.95 | $383.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSY IND TREATMENT 60 MIN VV | $272.35 | $419.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSY IND TREATMENT 60 MIN | $272.35 | $419.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $289.90 | $446.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC CSW COG BEHAV THERAPY 60 MIN | $226.20 | $348.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSY IND PSYCH TX 60MIN IP | $234.00 | $360.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC IND TREATMENT 60 MIN | $248.95 | $383.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC IND TREATMENT 60 MIN VV | $248.95 | $383.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSY IND TREATMENT 60 MIN VV | $272.35 | $419.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSY IND TREATMENT 60 MIN | $272.35 | $419.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $289.90 | $446.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $205.40 | $316.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PHY CONSULT DETAILED | $429.00 | $660.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $205.40 | $316.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC PHY CONSULT DETAILED | $429.00 | $660.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $292.50 | $450.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PHY CONSULT OUTPATIENT | $670.80 | $1,032.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $292.50 | $450.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC PHY CONSULT OUTPATIENT | $670.80 | $1,032.00 | 35% |
Source file: https://www.legacyhealth.org/-/media/Files/JSON/930591528_legacy-mount-hood-medical-center_standardcharges.json