Childrens Hospital of Orange County - Profit
Childrens Hospital of Orange County - Profit in Orange, CA publishes cash prices for 44 common procedures listed here, from its own machine-readable price file updated Mar 19, 2026. Click a procedure to compare it with other hospitals nearby.
1201 W La Veta Avenue, Orange, CA 92868 Collected Sep 22, 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 Enterography | $4,362.00 | $4,362.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST W CON-W PET | $4,851.00 | $4,851.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen Pelvis IV Contrast Only (No P | $6,937.00 | $6,937.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen Pelvis W Contrast | $7,423.00 | $7,423.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 ABDOMEN & PELVIS W/ CONTRAST - NM | $8,143.00 | $8,143.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 NM CT Abdomen Pelvis W Contrast | $8,551.00 | $8,551.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Enterography | $4,362.00 | $4,362.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST W CON-W PET | $4,851.00 | $4,851.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen Pelvis IV Contrast Only (No P | $6,937.00 | $6,937.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen Pelvis W Contrast | $7,423.00 | $7,423.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 ABDOMEN & PELVIS W/ CONTRAST - NM | $8,143.00 | $8,143.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 NM CT Abdomen Pelvis W Contrast | $8,551.00 | $8,551.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain Fusion Medtronic | $3,294.00 | $3,294.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CBCT CT Head W/O Contrast | $3,294.00 | $3,294.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 NM CT Brain W/O Contrast | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain Stealth Medtronic | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain W/O Contrast CODE STROKE | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain W/O Contrast W Fiducial | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain W/O Contrast Portable | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain W/O Contrast | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD BRAIN WO CON | $4,103.00 | $4,103.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CBCT CT Head W/O Contrast | $3,294.00 | $3,294.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain Fusion Medtronic | $3,294.00 | $3,294.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain W/O Contrast | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 NM CT Brain W/O Contrast | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain W/O Contrast Portable | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain W/O Contrast W Fiducial | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain W/O Contrast CODE STROKE | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain Stealth Medtronic | $3,525.00 | $3,525.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD BRAIN WO CON | $4,103.00 | $4,103.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W Contrast | $4,074.00 | $4,074.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 PELVIS W/ CONTRAST -NM | $4,569.00 | $4,569.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 PELVIS W/CON NM | $5,267.00 | $5,267.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W Contrast | $4,074.00 | $4,074.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 PELVIS W/ CONTRAST -NM | $4,569.00 | $4,569.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 PELVIS W/CON NM | $5,267.00 | $5,267.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP RIGHT W/O CON | $2,987.00 | $2,987.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP LEFT W/O CON | $2,987.00 | $2,987.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE W/O RT | $3,509.00 | $3,509.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE W/O LT | $3,509.00 | $3,509.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Hip W/O Contrast Lt | $3,864.00 | $3,864.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Hip W/O Contrast Rt | $3,864.00 | $3,864.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Knee W/O Contrast Rt | $4,542.00 | $4,542.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Knee W/O Contrast Lt | $4,542.00 | $4,542.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE W/O LT | $4,568.00 | $4,568.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE W/O RT | $4,568.00 | $4,568.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Ankle W/O Contrast Rt | $5,914.00 | $5,914.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Ankle W/O Contrast Lt | $5,914.00 | $5,914.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP RIGHT W/O CON | $2,987.00 | $2,987.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP LEFT W/O CON | $2,987.00 | $2,987.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE W/O RT | $3,509.00 | $3,509.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE W/O LT | $3,509.00 | $3,509.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Hip W/O Contrast Rt | $3,864.00 | $3,864.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Hip W/O Contrast Lt | $3,864.00 | $3,864.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Knee W/O Contrast Rt | $4,542.00 | $4,542.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Knee W/O Contrast Lt | $4,542.00 | $4,542.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE W/O RT | $4,568.00 | $4,568.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE W/O LT | $4,568.00 | $4,568.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Ankle W/O Contrast Lt | $5,914.00 | $5,914.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Ankle W/O Contrast Rt | $5,914.00 | $5,914.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE W/WO RT | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP LEFT W/WO CON | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP RIGHT W/WO CON | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE W/WO LT | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE W/WO LT | $4,713.00 | $4,713.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE W/WO RT | $4,713.00 | $4,713.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Hip W/O + W Contrast Lt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Hip W/O + W Contrast Rt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Knee W/O + W Contrast Lt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Knee W/O + W Contrast Rt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Ankle W/O + W Contrast Rt | $6,101.00 | $6,101.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Ankle W/O + W Contrast Lt | $6,101.00 | $6,101.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HIP RIGHT W/WO CON | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HIP LEFT W/WO CON | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE W/WO RT | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE W/WO LT | $3,925.00 | $3,925.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE W/WO RT | $4,713.00 | $4,713.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE W/WO LT | $4,713.00 | $4,713.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Hip W/O + W Contrast Rt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Knee W/O + W Contrast Rt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Hip W/O + W Contrast Lt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Knee W/O + W Contrast Lt | $5,080.00 | $5,080.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Ankle W/O + W Contrast Lt | $6,101.00 | $6,101.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Ankle W/O + W Contrast Rt | $6,101.00 | $6,101.00 | — |
| MRI of the brain, no contrast dye CPT 70551 PITUITARY | $4,256.00 | $4,256.00 | — |
| MRI of the brain, no contrast dye CPT 70551 BRAIN/STEM W/O CONTRAST | $4,568.00 | $4,568.00 | — |
| MRI of the brain, no contrast dye CPT 70551 BRAIN/PITUITARY IMAGE W/O CON | $4,590.00 | $4,590.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MR Pituitary W/O Contrast | $5,511.00 | $5,511.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MR IAC W/O Contrast | $5,527.00 | $5,527.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MR Brain Stem W/O Contrast | $5,914.00 | $5,914.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MR Brain W/O Contrast CODE STROKE | $5,914.00 | $5,914.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 PITUITARY | $4,256.00 | $4,256.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 BRAIN/STEM W/O CONTRAST | $4,568.00 | $4,568.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 BRAIN/PITUITARY IMAGE W/O CON | $4,590.00 | $4,590.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Pituitary W/O Contrast | $5,511.00 | $5,511.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR IAC W/O Contrast | $5,527.00 | $5,527.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain W/O Contrast CODE STROKE | $5,914.00 | $5,914.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain Stem W/O Contrast | $5,914.00 | $5,914.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 BRAIN/ PITUITARY IMAGE W/WO CON | $7,513.00 | $7,513.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 BRAIN W/O & W/CONTRAST | $7,831.00 | $7,831.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 PITUITARY W/O & W/CONTRAST | $7,831.00 | $7,831.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MR IAC W/O + W Contrast | $9,473.00 | $9,473.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MR Pituitary W/O + W Contrast | $10,135.00 | $10,135.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MR Brain Stem W/O + W Contrast | $10,135.00 | $10,135.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 BRAIN/ PITUITARY IMAGE W/WO CON | $7,513.00 | $7,513.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 PITUITARY W/O & W/CONTRAST | $7,831.00 | $7,831.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 BRAIN W/O & W/CONTRAST | $7,831.00 | $7,831.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR IAC W/O + W Contrast | $9,473.00 | $9,473.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain Stem W/O + W Contrast | $10,135.00 | $10,135.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Pituitary W/O + W Contrast | $10,135.00 | $10,135.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 LUMBAR SPINE W/O CONTRAST | $4,519.00 | $4,519.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MR Spine Lumbar W/O Contrast | $5,848.00 | $5,848.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 LUMBAR SPINE W/O CONTRAST | $4,519.00 | $4,519.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Spine Lumbar W/O Contrast | $5,848.00 | $5,848.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB-COMPLETE/PREGNANT UTERUS | $2,753.00 | $2,753.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB-COMPLETE/PREGNANT UTERUS | $2,753.00 | $2,753.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 PSG> 6 Reduced < 7 hrs | $4,688.00 | $4,688.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography - Routin | $9,846.00 | $9,846.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography - Routine | $9,846.00 | $9,846.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG> 6 Reduced < 7 hrs | $4,688.00 | $4,688.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography - Routine | $9,846.00 | $9,846.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography - Routin | $9,846.00 | $9,846.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL SONOGRAM | $2,641.00 | $2,641.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $4,094.00 | $4,094.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US Pelvis Transvaginal | $4,094.00 | $4,094.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL SONOGRAM | $2,641.00 | $2,641.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $4,094.00 | $4,094.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Transvaginal | $4,094.00 | $4,094.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete W Duplex Limited | $2,848.00 | $2,848.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete W Duplex Complete | $2,848.00 | $2,848.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $3,247.00 | $3,247.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete W Duplex Limited | $2,848.00 | $2,848.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete W Duplex Complete | $2,848.00 | $2,848.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $3,247.00 | $3,247.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbar w Obliques | $1,577.00 | $1,577.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbar w Bending Views | $1,610.00 | $1,610.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbar w Obliques | $1,577.00 | $1,577.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbar w Bending Views | $1,610.00 | $1,610.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BMP Bill Only | $739.00 | $739.00 | — |
| Basic metabolic panel (blood test) CPT 80048 BMP | $739.00 | $739.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP | $739.00 | $739.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP Bill Only | $739.00 | $739.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Bill Only | $410.00 | $410.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Battery | $410.00 | $410.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Bill Only | $410.00 | $410.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Battery | $410.00 | $410.00 | — |
| Complete blood count (CBC) with differential CPT 85025 WBC W PART DIFF | $248.00 | $248.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFFERENTIAL | $410.00 | $410.00 | — |
| Complete blood count (CBC) with differential CPT 85025 Auto Diff Perf | $410.00 | $410.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 WBC W PART DIFF | $248.00 | $248.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFFERENTIAL | $410.00 | $410.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 Auto Diff Perf | $410.00 | $410.00 | — |
| Complete blood count (CBC), no differential CPT 85027 CELL COUNT-BLOOD | $279.00 | $279.00 | — |
| Complete blood count (CBC), no differential CPT 85027 CBC / Man Diff | $357.00 | $357.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 CELL COUNT-BLOOD | $279.00 | $279.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC / Man Diff | $357.00 | $357.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Neonatal CMP | $927.00 | $927.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 CMP | $927.00 | $927.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $927.00 | $927.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP | $927.00 | $927.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $927.00 | $927.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Neonatal CMP | $927.00 | $927.00 | — |
| Kidney function blood test panel CPT 80069 Renal W/ R Alb | $742.00 | $742.00 | — |
| Kidney function blood test panel CPT 80069 Renal Func Pan | $850.00 | $850.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal W/ R Alb | $742.00 | $742.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Func Pan | $850.00 | $850.00 | — |
| Liver function blood test panel CPT 80076 Neo Hepatic Function Panel | $656.00 | $656.00 | — |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $702.00 | $702.00 | — |
| Liver function blood test panel inpatient CPT 80076 Neo Hepatic Function Panel | $656.00 | $656.00 | — |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $702.00 | $702.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 QD-Prostate specific antigen Free | $16.37 | $16.37 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 QD-Prostate specific antigen Free | $16.37 | $16.37 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Total | $16.37 | $16.37 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 QD-PSA ULTRASENSITIVE | $31.00 | $31.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen | $198.00 | $198.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Total | $16.37 | $16.37 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 QD-PSA ULTRASENSITIVE | $31.00 | $31.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen | $198.00 | $198.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT Mixing Study 3 | $60.00 | $60.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $289.00 | $289.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 APTT | $319.00 | $319.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT Mixing Study 3 | $60.00 | $60.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $289.00 | $289.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT | $319.00 | $319.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT SUBSTITUTION (MX BF/PT 1:1) 2 | $45.00 | $45.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $268.00 | $268.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time (iStat PT INR) | $287.00 | $287.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME QUICK | $294.00 | $294.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT SUBSTITUTION (MX BF/PT 1:1) 2 | $45.00 | $45.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $268.00 | $268.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time (iStat PT INR) | $287.00 | $287.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME QUICK | $294.00 | $294.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 NP-THYROID STIM HORMONE (NBS) | $32.14 | $32.14 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH RIA | $486.00 | $486.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE | $654.00 | $654.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 NP-THYROID STIM HORMONE (NBS) | $32.14 | $32.14 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH RIA | $486.00 | $486.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE | $654.00 | $654.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS-RTN WITH MICRO | $246.00 | $246.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS-RTN WITH MICRO | $246.00 | $246.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 UA dip only | $13.00 | $13.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 UA dip only | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 ONC Urinalysis W/O Micro (UAD) | $108.00 | $108.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 ONC Urinalysis W/O Micro (UAD) | $108.00 | $108.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 OP URINE DIPSTICK | $31.00 | $31.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK EC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK PC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK HPC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC URINE DIPSTICK LOT NUMBER HPC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK HC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIP STICK -GEN CLINIC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK CC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK MC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK GIC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 OP URINE DIPSTICK UNC | $37.00 | $37.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick CAC | $39.00 | $39.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC DIPSTICK W/UA | $78.00 | $78.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC DIPSTICK W/O UA | $78.00 | $78.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC uGK Dipstick Nursing Unit: 3W | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-Hematology/Oncology | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-SSU | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-2E | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-SSU | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 HEMOGLOBIN-QUAL URINE | $126.00 | $126.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-NICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC SG10 Urine Dipstick Post Op Obs | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Point of Care Test - OPI | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 SG10 Urine Testing - OPI | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-Hematology/Oncology | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-5W Medical | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC SG10 Urine Dipstick Nursing Unit 5E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-2E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-4W | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC SG10 Dipstick:POC SG10 Urine Dipstick Nursing | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC SG10 Urine Dipstick Nursing Unit: 3W | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-NICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-PICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-PICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-4E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-4E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-3E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 uGK Dipstick-3E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-7S | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick-4W | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick | $137.00 | $137.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 POC uGK Dipstick Nursing Unit:CVICU | $139.00 | $139.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 REDUCING SUBSTANCE-URINE | $146.00 | $146.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY-URINE | $296.00 | $296.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 OP URINE DIPSTICK | $31.00 | $31.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC URINE DIPSTICK LOT NUMBER HPC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK EC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK GIC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK MC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIP STICK -GEN CLINIC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK HC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK HPC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK PC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK CC | $34.00 | $34.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 OP URINE DIPSTICK UNC | $37.00 | $37.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick CAC | $39.00 | $39.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC DIPSTICK W/UA | $78.00 | $78.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC DIPSTICK W/O UA | $78.00 | $78.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-SSU | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-SSU | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-Hematology/Oncology | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC uGK Dipstick Nursing Unit: 3W | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-2E | $122.00 | $122.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HEMOGLOBIN-QUAL URINE | $126.00 | $126.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-4W | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-4E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC SG10 Urine Dipstick Post Op Obs | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-NICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC SG10 Urine Dipstick Nursing Unit: 3W | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC SG10 Dipstick:POC SG10 Urine Dipstick Nursing | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-2E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC SG10 Urine Dipstick Nursing Unit 5E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-5W Medical | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-3E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-3E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-7S | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-4W | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-Hematology/Oncology | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 SG10 Urine Testing - OPI | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Point of Care Test - OPI | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-NICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-PICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 uGK Dipstick-PICU | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick-4E | $129.00 | $129.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick | $137.00 | $137.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC uGK Dipstick Nursing Unit:CVICU | $139.00 | $139.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 REDUCING SUBSTANCE-URINE | $146.00 | $146.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAVITY-URINE | $296.00 | $296.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Left heart catheterization, diagnostic one side CPT 93452 LEFT HEART CATH W / LV | $23,008.00 | $23,008.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HEART CATH W / LV | $23,008.00 | $23,008.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR CT Inj Lumbar/Sac W Guidance | $2,385.00 | $2,385.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 IR CT Cisternogram | $2,385.00 | $2,385.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ EPI LUMB/SACRAL W IMAGING | $2,933.00 | $2,933.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR CT Inj Lumbar/Sac W Guidance | $2,385.00 | $2,385.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 IR CT Cisternogram | $2,385.00 | $2,385.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ EPI LUMB/SACRAL W IMAGING | $2,933.00 | $2,933.00 | — |
| Prostate biopsy CPT 55700 CT Biopsy Prostate | $2,065.00 | $2,065.00 | — |
| Prostate biopsy CPT 55700 IR CL Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy CPT 55700 IR CT Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy CPT 55700 IR MR Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy CPT 55700 IR US Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy inpatient CPT 55700 IR US Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy inpatient CPT 55700 IR CT Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy inpatient CPT 55700 CT Biopsy Prostate | $2,065.00 | $2,065.00 | — |
| Prostate biopsy inpatient CPT 55700 IR MR Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
| Prostate biopsy inpatient CPT 55700 IR CL Biopsy Prostate Ndl | $2,065.00 | $2,065.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 FMLY TX PT PRESENT 60 MIN | $375.00 | $375.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FMLY TX PT PRESENT 60 MIN | $375.00 | $375.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 FMLY TX W/O PT 60 MIN | $375.00 | $375.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FMLY TX W/O PT 60 MIN | $375.00 | $375.00 | — |
| Group psychotherapy session CPT 90853 GROUP THERAPY 90 MIN | $123.00 | $123.00 | — |
| Group psychotherapy session CPT 90853 GROUP THERAPY 60 MIN | $123.00 | $123.00 | — |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY 90 MIN | $123.00 | $123.00 | — |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY 60 MIN | $123.00 | $123.00 | — |
| New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW 30 MIN CTCC | $95.00 | $95.00 | — |
| New patient office visit, about 30 minutes CPT 99203 30 in new pt visit | $344.00 | $344.00 | — |
| New patient office visit, about 30 minutes CPT 99203 NEW VISIT 25-30 MIN LOW | $432.00 | $432.00 | — |
| New patient office visit, about 30 minutes CPT 99203 ET NEW PT LEVEL 3-OP | $915.00 | $915.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PBSC-PHYS EXAM-D3 | $2,595.00 | $2,595.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW 30 MIN CTCC | $95.00 | $95.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 30 in new pt visit | $344.00 | $344.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW VISIT 25-30 MIN LOW | $432.00 | $432.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 ET NEW PT LEVEL 3-OP | $915.00 | $915.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PBSC-PHYS EXAM-D3 | $2,595.00 | $2,595.00 | — |
| New patient office visit, about 45 minutes CPT 99204 OFC Visit New 45 Min Audio | $507.00 | $507.00 | — |
| New patient office visit, about 45 minutes CPT 99204 45 min new pt visit | $522.00 | $522.00 | — |
| New patient office visit, about 45 minutes CPT 99204 NEW VISIT 45" MODERATE | $560.00 | $560.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-IL | $915.00 | $915.00 | — |
| New patient office visit, about 45 minutes CPT 99204 ET NEW PT LEVEL 4-OP | $1,145.00 | $1,145.00 | — |
| New patient office visit, about 45 minutes CPT 99204 RADIATION THER MGMT NEW PT | $1,184.00 | $1,184.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-DE | $1,485.00 | $1,485.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-ES | $1,675.00 | $1,675.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-AM | $1,965.00 | $1,965.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-HU | $2,090.00 | $2,090.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-IT | $2,260.00 | $2,260.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-C2 | $2,600.00 | $2,600.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-D3 | $2,700.00 | $2,700.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-BE | $2,705.00 | $2,705.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-C4 | $2,875.00 | $2,875.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-CA | $3,045.00 | $3,045.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-DKMS-D1 | $3,085.00 | $3,085.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-AT | $3,210.00 | $3,210.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-GO | $3,400.00 | $3,400.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PBSC - PHYSICAL EXAM - US | $3,455.00 | $3,455.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-C1 | $3,915.00 | $3,915.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-CY | $3,915.00 | $3,915.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-AU | $3,915.00 | $3,915.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-IEM | $5,045.00 | $5,045.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-GB | $5,610.00 | $5,610.00 | — |
| New patient office visit, about 45 minutes CPT 99204 MARROW-PHYS EXAM-CH | $5,975.00 | $5,975.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFC Visit New 45 Min Audio | $507.00 | $507.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 45 min new pt visit | $522.00 | $522.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW VISIT 45" MODERATE | $560.00 | $560.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-IL | $915.00 | $915.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 ET NEW PT LEVEL 4-OP | $1,145.00 | $1,145.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 RADIATION THER MGMT NEW PT | $1,184.00 | $1,184.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-DE | $1,485.00 | $1,485.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-ES | $1,675.00 | $1,675.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-AM | $1,965.00 | $1,965.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-HU | $2,090.00 | $2,090.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-IT | $2,260.00 | $2,260.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-C2 | $2,600.00 | $2,600.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-D3 | $2,700.00 | $2,700.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-BE | $2,705.00 | $2,705.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-C4 | $2,875.00 | $2,875.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-CA | $3,045.00 | $3,045.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-DKMS-D1 | $3,085.00 | $3,085.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-AT | $3,210.00 | $3,210.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-GO | $3,400.00 | $3,400.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PBSC - PHYSICAL EXAM - US | $3,455.00 | $3,455.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-C1 | $3,915.00 | $3,915.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-AU | $3,915.00 | $3,915.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-CY | $3,915.00 | $3,915.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-IEM | $5,045.00 | $5,045.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-GB | $5,610.00 | $5,610.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 MARROW-PHYS EXAM-CH | $5,975.00 | $5,975.00 | — |
| New patient office visit, about 60 minutes CPT 99205 60 min new pt visit | $648.00 | $648.00 | — |
| New patient office visit, about 60 minutes CPT 99205 NEW VISIT 60 MIN HIGH | $656.00 | $656.00 | — |
| New patient office visit, about 60 minutes CPT 99205 ET NEW PT LEVEL 5-OP | $1,477.00 | $1,477.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 60 min new pt visit | $648.00 | $648.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW VISIT 60 MIN HIGH | $656.00 | $656.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 ET NEW PT LEVEL 5-OP | $1,477.00 | $1,477.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE - 15 MIN PT SMP | $105.00 | $105.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE - 15 MIN. OT | $165.00 | $165.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE - 15 MIN PT | $174.00 | $174.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 P.T. Therapeutic Exercises-15 minutes | $208.00 | $208.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise-15 minutes | $208.00 | $208.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT TH Therapeutic Exercises - 15 min CAC | $208.00 | $208.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE - 30 MIN PT SMP | $222.00 | $222.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE - 30 MIN OT | $350.00 | $350.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE 30 MIN - PT | $350.00 | $350.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 P.T. Therapeutic Exercises-30 minutes | $415.00 | $415.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise-30 minutes | $415.00 | $415.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE - 15 MIN PT SMP | $105.00 | $105.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE - 15 MIN. OT | $165.00 | $165.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE - 15 MIN PT | $174.00 | $174.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 P.T. Therapeutic Exercises-15 minutes | $208.00 | $208.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT TH Therapeutic Exercises - 15 min CAC | $208.00 | $208.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise-15 minutes | $208.00 | $208.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE - 30 MIN PT SMP | $222.00 | $222.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE - 30 MIN OT | $350.00 | $350.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE 30 MIN - PT | $350.00 | $350.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise-30 minutes | $415.00 | $415.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 P.T. Therapeutic Exercises-30 minutes | $415.00 | $415.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 INDIV TX NV W/MED 20-30MIN | $217.00 | $217.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 INDIV THERAPY 20-30 MIN | $217.00 | $217.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYCH DIAG EVAL W/MED SRVCS | $217.00 | $217.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCH DIAG EVAL W/MED SRVCS | $217.00 | $217.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 INDIV THERAPY 20-30 MIN | $217.00 | $217.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 INDIV TX NV W/MED 20-30MIN | $217.00 | $217.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 INDIV TX NV W/MED 45-50MIN | $318.00 | $318.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 INDIV THERAPY 45-50 MIN | $318.00 | $318.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 INDIV THERAPY 45-50 MIN | $318.00 | $318.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 INDIV TX NV W/MED 45-50MIN | $318.00 | $318.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes with patient and /or fam | $365.00 | $365.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy, 60 minutes with patient and /or fam | $365.00 | $365.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 F/U CONSULT INTERM | $313.00 | $313.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFIC CONS NEW/ESTAB MOD 40 MI | $393.00 | $393.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 F/U CONSULT INTERM | $313.00 | $313.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFIC CONS NEW/ESTAB MOD 40 MI | $393.00 | $393.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 F/U CONSULT EXT | $475.00 | $475.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 60 MINUTES-NEW CONSULT-OP | $578.00 | $578.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 F/U CONSULT EXT | $475.00 | $475.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 60 MINUTES-NEW CONSULT-OP | $578.00 | $578.00 | — |
Source file: https://choc.org/files/charges/952321786_Childrens-Hospital-of-Orange_standardcharges.csv