Saint Alphonsus Medical Center - Ontario
Saint Alphonsus Medical Center - Ontario in Ontario, OR publishes cash prices for 54 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Click a procedure to compare it with other hospitals nearby.
351 SW 9th Ave, Ontario, OR 97914 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 HC CT Abdomen & Pelvis W/Contrast | $2,813.20 | $4,328.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $2,813.20 | $4,328.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,084.85 | $1,669.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,084.85 | $1,669.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,482.65 | $2,281.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $1,482.65 | $2,281.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $348.40 | $536.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $348.40 | $536.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $232.05 | $357.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $232.05 | $357.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $232.05 | $357.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $232.05 | $357.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $2,240.55 | $3,447.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $1,493.70 | $2,298.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $1,493.70 | $2,298.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $2,240.55 | $3,447.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $1,493.70 | $2,298.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $1,493.70 | $2,298.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Bl | $3,542.50 | $5,450.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Rt | $2,361.45 | $3,633.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Lt | $2,361.45 | $3,633.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Bl | $3,542.50 | $5,450.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Rt | $2,361.45 | $3,633.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Lt | $2,361.45 | $3,633.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $1,593.80 | $2,452.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $1,593.80 | $2,452.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $2,507.70 | $3,858.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $2,507.70 | $3,858.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $1,534.65 | $2,361.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $1,534.65 | $2,361.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $319.80 | $492.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $319.80 | $492.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $216.45 | $333.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $205.40 | $316.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $216.45 | $333.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $205.40 | $316.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,029.00 | $4,660.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,029.00 | $4,660.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $410.15 | $631.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $410.15 | $631.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $408.85 | $629.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $408.85 | $629.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $401.70 | $618.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $401.70 | $618.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $45.50 | $70.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $45.50 | $70.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $32.50 | $50.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Warde Lipid Panel | $48.10 | $74.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest Lipid Panel | $112.45 | $173.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Labcorp Lipid Panel | $112.45 | $173.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest 92145 Lipid Panel | $112.45 | $173.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $32.50 | $50.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Warde Lipid Panel | $48.10 | $74.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Labcorp Lipid Panel | $112.45 | $173.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest Lipid Panel | $112.45 | $173.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest 92145 Lipid Panel | $112.45 | $173.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Quest Cbc Automated/Differential Wbc Automated | $39.00 | $60.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $39.00 | $60.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Quest Cbc Automated/Differential Wbc Automated | $39.00 | $60.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $39.00 | $60.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $32.50 | $50.00 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $32.50 | $50.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $44.85 | $69.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $44.85 | $69.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $65.00 | $100.00 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $65.00 | $100.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $46.80 | $72.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $46.80 | $72.00 | 35% |
| Obstetric blood test panel CPT 80055 HC Obstetric Panel | $100.10 | $154.00 | 35% |
| Obstetric blood test panel inpatient CPT 80055 HC Obstetric Panel | $100.10 | $154.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Prostate Specific Antigen Free | $64.35 | $99.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Prostate Specific Antigen Free | $64.35 | $99.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $46.80 | $72.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Warde Prostate Specific Antigen Total Ultrasensitive | $59.80 | $92.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Arup 80206 Prostate Specific Antigen Total | $59.80 | $92.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $46.80 | $72.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Arup 80206 Prostate Specific Antigen Total | $59.80 | $92.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Warde Prostate Specific Antigen Total Ultrasensitive | $59.80 | $92.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $68.90 | $106.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 117079 Thromboplastin Time Partial (Ptt) | $74.10 | $114.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 91242 Thromboplastin Time Partial (Ptt) | $74.10 | $114.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3514930 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3500044 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3502730 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $68.90 | $106.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 117079 Thromboplastin Time Partial (Ptt) | $74.10 | $114.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 91242 Thromboplastin Time Partial (Ptt) | $74.10 | $114.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3514930 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3502730 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3500044 Thromboplastin Time Partial (Ptt) | $82.55 | $127.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PR Prothrombin Time | $13.49 | — | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Prothrombin Time | $21.45 | $33.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $21.45 | $33.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Warde 3500044 Prothrombin Time | $35.10 | $54.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PR Prothrombin Time | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Prothrombin Time | $21.45 | $33.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $21.45 | $33.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Warde 3500044 Prothrombin Time | $35.10 | $54.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $62.40 | $96.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest 19537 Thyroid Stimulating Hormone Hama Treated | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC External Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest 7444 Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Warde 3400781 Thyroid Stimulating Hormone Hama Treated | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest 19537 Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Warde 3400781 Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $62.40 | $96.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest 19537 Thyroid Stimulating Hormone Hama Treated | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest 19537 Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Warde 3400781 Thyroid Stimulating Hormone Hama Treated | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest 7444 Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC External Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Warde 3400781 Thyroid Stimulating Hormone | $76.05 | $117.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $16.25 | $25.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $16.25 | $25.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis With Microscopy Nonautomated | $6.50 | $10.00 | 35% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis With Microscopy Nonautomated | $6.50 | $10.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 PR Urinalysis Without Microscopy Automated | $10.00 | — | — |
| Urinalysis without microscope exam, automated CPT 81003 HC POCT Urinalysis Without Microscopy Automated | $13.00 | $20.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $13.00 | $20.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PR Urinalysis Without Microscopy Automated | $5.00 | $5.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC POCT Urinalysis Without Microscopy Automated | $13.00 | $20.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $13.00 | $20.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $16.90 | $26.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $16.90 | $26.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $984.00 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $1,022.00 | $1,022.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $692.63 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $804.00 | $804.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $570.56 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $739.00 | $739.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,876.04 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $2,598.00 | $2,598.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,383.42 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $2,059.00 | $2,059.00 | — |
| Knee arthroscopy with meniscus trim CPT 29881 PR Arthroscopy Knee Surg W/ Meniscectomy Incl Debr/Shvi Artc Cartilage | $1,448.55 | — | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR Arthroscopy Knee Surg W/ Meniscectomy Incl Debr/Shvi Artc Cartilage | $2,315.00 | $2,315.00 | — |
| Removal of a breast lump, open surgery CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,470.27 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,263.00 | $1,263.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR Arthroscopy Shoulder Decompr Subacromial Space W/Part Acromioplasty | $1,025.03 | — | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR Arthroscopy Shoulder Decompr Subacromial Space W/Part Acromioplasty | $1,488.00 | $1,488.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 PR Tonsillectomy & Adenoidectomy Younger Than Age 12 | $850.90 | — | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 PR Tonsillectomy & Adenoidectomy Younger Than Age 12 | $1,163.00 | $1,163.00 | — |
| Total hip replacement CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $4,091.76 | — | — |
| Total hip replacement inpatient CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $5,868.00 | $5,868.00 | — |
| Total knee replacement CPT 27447 PR Arthroplasty Knee Condyle&Plateau Med/Lat Cpts W/WO Patella Resurfacing | $4,019.70 | — | — |
| Total knee replacement inpatient CPT 27447 PR Arthroplasty Knee Condyle&Plateau Med/Lat Cpts W/WO Patella Resurfacing | $6,272.00 | $6,272.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $445.68 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $554.00 | $554.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $400.65 | — | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $491.00 | $491.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR Ecg 12 Lead Interpretation & Report | $107.00 | — | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR Ecg 12 Lead Interpretation & Report | $32.00 | $32.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $181.00 | $181.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $181.00 | $181.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $181.00 | $85.00 | -113% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $181.00 | $181.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $295.00 | $295.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $295.00 | $295.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $295.00 | $295.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $295.00 | $157.00 | -88% |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $475.00 | $475.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $475.00 | $522.00 | 9% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $475.00 | $475.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $475.00 | $522.00 | 9% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $64.35 | $99.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $64.35 | $99.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $64.35 | $99.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $64.35 | $99.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $85.15 | $131.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $294.00 | — | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $85.15 | $131.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $209.00 | $209.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $86.45 | $133.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $341.00 | — | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $86.45 | $133.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $240.00 | $240.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $105.95 | $163.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $105.95 | $163.00 | 35% |
Source file: https://hpt.trinity-health.org/271789847_saint-alphonsus-medical-center-ontario_standardcharges.zip