Brattleboro Memorial Hospital
Brattleboro Memorial Hospital in Brattleboro, VT publishes cash prices for 60 common procedures listed here, from its own machine-readable price file updated Dec 29, 2025. Click a procedure to compare it with other hospitals nearby.
17 Belmont Ave, Brattleboro, VT 05301 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 BVT CT Abdomen/Pelvis w/ Contrast | $4,097.94 | $5,854.20 | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w/ Contrast | $4,130.91 | $5,901.30 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 BVT CT Abdomen/Pelvis w/ Contrast | $4,097.94 | $5,854.20 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen/Pelvis w/ Contrast | $4,130.91 | $5,901.30 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast | $1,204.14 | $1,720.20 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain for Stroke | $1,204.14 | $1,720.20 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain for Stroke | $1,204.14 | $1,720.20 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast | $1,204.14 | $1,720.20 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis MSK w/ Contrast | $497.56 | $710.80 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $2,159.57 | $3,085.10 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis MSK w/ Contrast | $497.56 | $710.80 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast | $2,159.57 | $3,085.10 | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat | $475.09 | $678.70 | 30% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat | $475.09 | $678.70 | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Right | $375.41 | $536.30 | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Left | $375.41 | $536.30 | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Left | $375.41 | $536.30 | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Right | $375.41 | $536.30 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Left | $2,364.11 | $3,377.30 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Right | $2,364.11 | $3,377.30 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Right | $2,364.11 | $3,377.30 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Left | $2,364.11 | $3,377.30 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left | $3,957.52 | $5,653.60 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right | $3,957.52 | $5,653.60 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right | $3,957.52 | $5,653.60 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left | $3,957.52 | $5,653.60 | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $2,364.11 | $3,377.30 | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $2,364.11 | $3,377.30 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $3,957.52 | $5,653.60 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $3,957.52 | $5,653.60 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $2,364.11 | $3,377.30 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 BVT MRI Spine Lumbar Limited | $2,364.11 | $3,377.30 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 BVT MRI Spine Lumbar Limited | $2,364.11 | $3,377.30 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $2,364.11 | $3,377.30 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 76805 Ultrasound preg uterus after 1st tri single gest | $211.40 | $302.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Complete | $653.66 | $933.80 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 76805 OB Fetal Eval Ultrasound | $703.92 | $1,005.60 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 76805 Ultrasound preg uterus after 1st tri single gest | $211.40 | $302.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Complete | $653.66 | $933.80 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 76805 OB Fetal Eval Ultrasound | $703.92 | $1,005.60 | 30% |
| Screening mammogram, both breasts CPT 77067 MA Mammogram Digital Screening | $385.00 | $550.00 | 30% |
| Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screening Left | $385.00 | $550.00 | 30% |
| Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screening Right | $385.00 | $550.00 | 30% |
| Screening mammogram, both breasts inpatient CPT 77067 MA Mammogram Digital Screening | $385.00 | $550.00 | 30% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screening Left | $385.00 | $550.00 | 30% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screening Right | $385.00 | $550.00 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 76830 US Transvaginal GYN (in office) | $150.64 | $215.20 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $653.66 | $933.80 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 BVT US Transvaginal Non-OB | $653.66 | $933.80 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 76830 US Transvaginal GYN (in office) | $150.64 | $215.20 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $653.66 | $933.80 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 BVT US Transvaginal Non-OB | $653.66 | $933.80 | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $653.66 | $933.80 | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $653.66 | $933.80 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 XR Lumbar Spine 5 Views | $664.09 | $948.70 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Lumbar Spine 5 Views | $664.09 | $948.70 | 30% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BMP Standard | $77.14 | $110.20 | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP Standard | $77.14 | $110.20 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel Standard | $98.00 | $140.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $98.00 | $140.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipoprotein Metabolism Profile MAYO | $133.49 | $190.70 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel Standard | $98.00 | $140.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $98.00 | $140.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipoprotein Metabolism Profile MAYO | $133.49 | $190.70 | 30% |
| Complete blood count (CBC) with differential CPT 85025 Complete Blood Count Standard | $71.12 | $101.60 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count Standard | $71.12 | $101.60 | 30% |
| Complete blood count (CBC), no differential CPT 85027 Complete Blood Count (No Differential) | $56.98 | $81.40 | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Complete Blood Count (No Differential) | $56.98 | $81.40 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMP | $97.09 | $138.70 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMP Standard | $97.09 | $138.70 | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP Standard | $97.09 | $138.70 | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP | $97.09 | $138.70 | 30% |
| Liver function blood test panel CPT 80076 Hepatic Panel1 | $73.64 | $105.20 | 30% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $73.64 | $105.20 | 30% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $73.64 | $105.20 | 30% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Panel1 | $73.64 | $105.20 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 .Prostate Health Index Reflex (PHi 13) MAYO | $54.67 | $78.10 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE | $156.87 | $224.10 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 84154 | $156.87 | $224.10 | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 .Prostate Health Index Reflex (PHi 13) MAYO | $54.67 | $78.10 | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 84154 | $156.87 | $224.10 | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE | $156.87 | $224.10 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Ultrasensitive MAYO | $42.00 | $60.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index (phi), S MAYO | $109.20 | $156.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total and Free MAYO | $133.49 | $190.70 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Diagnostic | $133.49 | $190.70 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA | $156.87 | $224.10 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Ultrasensitive MAYO | $42.00 | $60.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index (phi), S MAYO | $109.20 | $156.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total and Free MAYO | $133.49 | $190.70 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Diagnostic | $133.49 | $190.70 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA | $156.87 | $224.10 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Lupus Anticoagulant Profile MAYO | $54.67 | $78.10 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 APTT | $54.67 | $78.10 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 85730 | $71.12 | $101.60 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT | $54.67 | $78.10 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lupus Anticoagulant Profile MAYO | $54.67 | $78.10 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 | $71.12 | $101.60 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POC | $21.07 | $30.10 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Anticoagulation Management POC | $21.07 | $30.10 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Protime/INR with MELD Score | $30.38 | $43.40 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 | $32.06 | $45.80 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT | $36.40 | $52.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610(2) | $118.79 | $169.70 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POC | $21.07 | $30.10 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Anticoagulation Management POC | $21.07 | $30.10 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime/INR with MELD Score | $30.38 | $43.40 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 | $32.06 | $45.80 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT | $36.40 | $52.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610(2) | $118.79 | $169.70 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $150.85 | $215.50 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Cascade | $150.85 | $215.50 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Cascade | $150.85 | $215.50 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $150.85 | $215.50 | 30% |
| Urinalysis with microscope exam, manual CPT 81000 Urine Dipstick and Microscopy POC | $16.94 | $24.20 | 30% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urine Dipstick and Microscopy POC | $16.94 | $24.20 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick Standard | $9.73 | $13.90 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick Standard | $16.45 | $23.50 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 UA w Culture if Ind | $16.45 | $23.50 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick Standard | $9.73 | $13.90 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA w Culture if Ind | $16.45 | $23.50 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick Standard | $16.45 | $23.50 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick POC Charge | $4.34 | $6.20 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick POC | $4.34 | $6.20 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 81002 URINE DIPSTICK/BIRTH CTR CHARGE | $6.09 | $8.70 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick POC Charge | $6.09 | $8.70 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick POC | $4.34 | $6.20 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick POC Charge | $4.34 | $6.20 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick POC Charge | $6.09 | $8.70 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 81002 URINE DIPSTICK/BIRTH CTR CHARGE | $6.09 | $8.70 | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpartum Care | $3,184.02 | $4,548.60 | 30% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 59510-80 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care | $3,184.02 | $4,548.60 | 30% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care | $3,816.05 | $5,451.50 | 30% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpartum Care | $3,184.02 | $4,548.60 | 30% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 59510-80 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care | $3,184.02 | $4,548.60 | 30% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care | $3,816.05 | $5,451.50 | 30% |
| Colonoscopy with polyp removal CPT 45385 Lesion removal colonoscopy | $745.43 | $1,064.90 | 30% |
| Colonoscopy with polyp removal inpatient CPT 45385 Lesion removal colonoscopy | $745.43 | $1,064.90 | 30% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple | $568.40 | $812.00 | 30% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple | $568.40 | $812.00 | 30% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $555.59 | $793.70 | 30% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic colonoscopy | $674.45 | $963.50 | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY | $555.59 | $793.70 | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic colonoscopy | $674.45 | $963.50 | 30% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy, Surgical; Cholecystectomy | $1,154.65 | $1,649.50 | 30% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy, Surgical; Cholecystectomy | $1,154.65 | $1,649.50 | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Prp i/hern init reduc >5 yr | $769.09 | $1,098.70 | 30% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Prp i/hern init reduc >5 yr | $769.09 | $1,098.70 | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 Knee arthroscopy/surgery w/meniscectomy | $761.25 | $1,087.50 | 30% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Knee arthroscopy/surgery w/meniscectomy | $761.25 | $1,087.50 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Retinal Detachment Charge | $1,081.08 | $1,544.40 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Subretinal Neovascularization Charge | $1,081.08 | $1,544.40 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Capsulotomy Charge | $1,081.08 | $1,544.40 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Capsulotomy | $1,134.84 | $1,621.20 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Subretinal Neovascularization | $1,134.84 | $1,621.20 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Capsulotomy Charge | $1,081.08 | $1,544.40 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Subretinal Neovascularization Charge | $1,081.08 | $1,544.40 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Retinal Detachment Charge | $1,081.08 | $1,544.40 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Capsulotomy | $1,134.84 | $1,621.20 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Subretinal Neovascularization | $1,134.84 | $1,621.20 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 XR Epidural Lumbal Sacral Caudal | $3,534.44 | $5,049.20 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 BVT XR Epid Lumbr/Scrl Cdl 1 Lvl w ImgGd | $3,856.93 | $5,509.90 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Epidural Lumbal Sacral Caudal | $3,534.44 | $5,049.20 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 BVT XR Epid Lumbr/Scrl Cdl 1 Lvl w ImgGd | $3,856.93 | $5,509.90 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR Inj Epidural Lumbar/Sacral | $4,515.77 | $6,451.10 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR Inj Epidural Lumbar/Sacral | $4,515.77 | $6,451.10 | 30% |
| Prostate biopsy CPT 55700 Biopsy of prostate | $373.10 | $533.00 | 30% |
| Prostate biopsy inpatient CPT 55700 Biopsy of prostate | $373.10 | $533.00 | 30% |
| Removal of a breast lump, open surgery CPT 19120 Exc. of cyst, fibroadenoma,benign or malignant tumor,breast tiss,nipple,areolar,M/F, 1+lesion | $829.29 | $1,184.70 | 30% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Exc. of cyst, fibroadenoma,benign or malignant tumor,breast tiss,nipple,areolar,M/F, 1+lesion | $829.29 | $1,184.70 | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Repair of ruptured musculotendinous cuff open; chronic | $945.63 | $1,350.90 | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Repair of ruptured musculotendinous cuff open; chronic | $945.63 | $1,350.90 | 30% |
| Total hip replacement CPT 27130 Total hip arthroplasty | $1,990.87 | $2,844.10 | 30% |
| Total hip replacement inpatient CPT 27130 Total hip arthroplasty | $1,990.87 | $2,844.10 | 30% |
| Total knee replacement CPT 27447 Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or Without Patella Res | $2,547.79 | $3,639.70 | 30% |
| Total knee replacement inpatient CPT 27447 Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or Without Patella Res | $2,547.79 | $3,639.70 | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 43239 Upper GI Endoscopy Biopsy | $240.66 | $343.80 | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 43239 Upper GI Endoscopy Biopsy | $240.66 | $343.80 | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by | $450.17 | $643.10 | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by | $450.17 | $643.10 | 30% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Routine OB Care, Antepartum/Vaginal Delivery After Cesarean/Postpartum Charge | $3,016.23 | $4,308.90 | 30% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Routine OB Care, Antepartum/Vaginal Delivery After Cesarean/Postpartum Charge | $3,016.23 | $4,308.90 | 30% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Routine OB Care, Antepartum/Vaginal Delivery/Postpartum | $2,560.67 | $3,658.10 | 30% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Routine OB Care, Antepartum/Vaginal Delivery/Postpartum | $2,560.67 | $3,658.10 | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG 12 Lead | $42.14 | $60.20 | 30% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | $42.14 | $60.20 | 30% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG 12 Lead | $42.14 | $60.20 | 30% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | $42.14 | $60.20 | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 90847: FAMILY PSYCHOTHERAPY W/ PT PRESENT | $163.66 | $233.80 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 90847: FAMILY PSYCHOTHERAPY W/ PT PRESENT | $163.66 | $233.80 | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 90846: FAMILY PSYCHOTHERAPY W/ PT PRESENT | $157.50 | $225.00 | 30% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 90846: FAMILY PSYCHOTHERAPY W/ PT PRESENT | $157.50 | $225.00 | 30% |
| New patient office visit, about 30 minutes CPT 99203 99203 Office or other outpatient visit for the evaluation and mgmt of a new patient, 30 min level 3 | $147.14 | $210.20 | 30% |
| New patient office visit, about 30 minutes CPT 99203 NEW PAT VST/ONC/LOW COMPLEXITY | $159.53 | $227.90 | 30% |
| New patient office visit, about 30 minutes CPT 99203 99203 Office visit - new patient, level 3 | $166.46 | $237.80 | 30% |
| New patient office visit, about 30 minutes CPT 99203 NEW PAT SIGNIF SEP E&M-L3 | $175.98 | $251.40 | 30% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT E&M,LVL III | $175.98 | $251.40 | 30% |
| New patient office visit, about 30 minutes CPT 99203 99203 PBS NEW PT VISIT LVL 3 | $176.33 | $251.90 | 30% |
| New patient office visit, about 30 minutes CPT 99203 99203 Office or other outpatient visit for the evaluation and mgmt of a new patient, 30 min level 3 | $178.64 | $255.20 | 30% |
| New patient office visit, about 30 minutes CPT 99203 Office otpt visit eval mgmnt of new pt.Physician spends 30-44 min face to face with pt and or fam | $245.21 | $350.30 | 30% |
| New patient office visit, about 30 minutes CPT 99203 99203 NON-PBS VISIT LVL 3 | $286.09 | $408.70 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office or other outpatient visit for the evaluation and mgmt of a new patient, 30 min level 3 | $147.14 | $210.20 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PAT VST/ONC/LOW COMPLEXITY | $159.53 | $227.90 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office visit - new patient, level 3 | $166.46 | $237.80 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PAT SIGNIF SEP E&M-L3 | $175.98 | $251.40 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT E&M,LVL III | $175.98 | $251.40 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 PBS NEW PT VISIT LVL 3 | $176.33 | $251.90 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office or other outpatient visit for the evaluation and mgmt of a new patient, 30 min level 3 | $178.64 | $255.20 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office otpt visit eval mgmnt of new pt.Physician spends 30-44 min face to face with pt and or fam | $245.21 | $350.30 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 99203 NON-PBS VISIT LVL 3 | $286.09 | $408.70 | 30% |
| New patient office visit, about 45 minutes CPT 99204 99204 Office visit - new patient, level 4 | $180.67 | $258.10 | 30% |
| New patient office visit, about 45 minutes CPT 99204 99204 Office visit - new patient, level 4 | $219.38 | $313.40 | 30% |
| New patient office visit, about 45 minutes CPT 99204 99204 Office or other outpatient visit for the evaluation and mgmt of a new patient, 45 min level 4 | $262.63 | $375.18 | 30% |
| New patient office visit, about 45 minutes CPT 99204 99204 WC PBS VISIT LVL 4 | $265.30 | $379.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 NEW PAT VST/ONC/MODERATE COMPLEXITY | $272.23 | $388.90 | 30% |
| New patient office visit, about 45 minutes CPT 99204 99204 Office or other outpatient visit for the evaluation and mgmt of a new patient, 45 min level 4 | $297.69 | $425.27 | 30% |
| New patient office visit, about 45 minutes CPT 99204 NEW PAT SIGNIF SEP E&M L4 | $360.64 | $515.20 | 30% |
| New patient office visit, about 45 minutes CPT 99204 NEW PAT E&M,LEVEL IV | $360.64 | $515.20 | 30% |
| New patient office visit, about 45 minutes CPT 99204 Office otpt visit eval mgmnt of new pt.Physician spends 45-59 min face to face with pt and or fam | $367.55 | $525.06 | 30% |
| New patient office visit, about 45 minutes CPT 99204 99204 NON-PBS WC VISIT LVL 4 | $434.35 | $620.50 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office visit - new patient, level 4 | $180.67 | $258.10 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office visit - new patient, level 4 | $219.38 | $313.40 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office or other outpatient visit for the evaluation and mgmt of a new patient, 45 min level 4 | $262.63 | $375.18 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 WC PBS VISIT LVL 4 | $265.30 | $379.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PAT VST/ONC/MODERATE COMPLEXITY | $272.23 | $388.90 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office or other outpatient visit for the evaluation and mgmt of a new patient, 45 min level 4 | $297.69 | $425.27 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PAT E&M,LEVEL IV | $360.64 | $515.20 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PAT SIGNIF SEP E&M L4 | $360.64 | $515.20 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office otpt visit eval mgmnt of new pt.Physician spends 45-59 min face to face with pt and or fam | $367.55 | $525.06 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 99204 NON-PBS WC VISIT LVL 4 | $434.35 | $620.50 | 30% |
| New patient office visit, about 60 minutes CPT 99205 99205 Office or other outpatient visit for the evaluation and mgmt of a new patient, 60 min level 5 | $287.07 | $410.10 | 30% |
| New patient office visit, about 60 minutes CPT 99205 99205 Office visit - new patient, level 5 | $300.79 | $429.70 | 30% |
| New patient office visit, about 60 minutes CPT 99205 99205 WC PBS VISIT LVL 5 | $320.95 | $458.50 | 30% |
| New patient office visit, about 60 minutes CPT 99205 99205 Office or other outpatient visit for the evaluation and mgmt of a new patient, 60 min level 5 | $348.53 | $497.90 | 30% |
| New patient office visit, about 60 minutes CPT 99205 NEW PAT VST/ONC/HIGH COMPLEXITY | $351.96 | $502.80 | 30% |
| New patient office visit, about 60 minutes CPT 99205 Office otpt visit eval mgmnt of new pt. Physician spends 60-74 min face to face with pt and or fam | $484.66 | $692.37 | 30% |
| New patient office visit, about 60 minutes CPT 99205 NEW PAT E&M,LEVEL V | $494.20 | $706.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 NEW PAT SIGNIF SEP E&M L5 | $494.20 | $706.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 99205 NON-PBS WC VISIT LVL 5 | $505.47 | $722.10 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office or other outpatient visit for the evaluation and mgmt of a new patient, 60 min level 5 | $287.07 | $410.10 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office visit - new patient, level 5 | $300.79 | $429.70 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 WC PBS VISIT LVL 5 | $320.95 | $458.50 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office or other outpatient visit for the evaluation and mgmt of a new patient, 60 min level 5 | $348.53 | $497.90 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PAT VST/ONC/HIGH COMPLEXITY | $351.96 | $502.80 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office otpt visit eval mgmnt of new pt. Physician spends 60-74 min face to face with pt and or fam | $484.66 | $692.37 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PAT SIGNIF SEP E&M L5 | $494.20 | $706.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PAT E&M,LEVEL V | $494.20 | $706.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 99205 NON-PBS WC VISIT LVL 5 | $505.47 | $722.10 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Units | $96.25 | $137.50 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges | $96.25 | $137.50 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges | $96.25 | $137.50 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Units | $96.25 | $137.50 | 30% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Preventive Medicine 18-39 years New - 99385 | $173.53 | $247.90 | 30% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive Medicine 18-39 years New - 99385 | $173.53 | $247.90 | 30% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Preventive Medicine 40-64 years New - 99386 | $203.56 | $290.80 | 30% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive Medicine 40-64 years New - 99386 | $203.56 | $290.80 | 30% |
| Psychotherapy session, 30 minutes CPT 90832 90832: Psychotherapy Time W/O MM 16-37 Min | $97.79 | $139.70 | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832: Psychotherapy Time W/O MM 16-37 Min | $97.79 | $139.70 | 30% |
| Psychotherapy session, 45 minutes CPT 90834 90834: Psychotherapy W/O MM 38-52 Mins | $130.20 | $186.00 | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 90834: Psychotherapy W/O MM 38-52 Mins | $130.20 | $186.00 | 30% |
| Psychotherapy session, 60 minutes CPT 90837 90837: Psychotherapy W/O MM 53+ Minutes | $195.58 | $279.40 | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 90837: Psychotherapy W/O MM 53+ Minutes | $195.58 | $279.40 | 30% |