St. Mary's Health, Inc.
St. Mary's Health, Inc. in Evansville, IN publishes cash prices for 44 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
3700 Washington Ave Evansville, IN 47750 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN AND PELVIS W/C | $1,722.60 | $2,871.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN AND PELVIS W/C | $1,722.60 | $2,871.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN AND PELVIS W/C | $1,722.60 | $2,871.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN WO/C | $885.00 | $1,475.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN WO/C | $885.00 | $1,475.00 | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN WO/C | $885.00 | $1,475.00 | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/C | $1,680.60 | $2,801.00 | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/C | $1,680.60 | $2,801.00 | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/C | $1,680.60 | $2,801.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXTR ANY JNT W/O UNI | $1,179.00 | $1,965.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXTR ANY JNT W/O UNI | $1,179.00 | $1,965.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXTR ANY JNT W/O UNI | $1,179.00 | $1,965.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI LOW EXTR ANY JNT WO/WC BI | $4,352.40 | $7,254.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI LOW EXTR ANY JNT WO/WC BI | $4,352.40 | $7,254.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXTR ANY JNT WO/WC UNI | $2,176.20 | $3,627.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXTR ANY JNT WO/WC UNI | $2,176.20 | $3,627.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI LOW EXTR ANY JNT WO/WC BI | $4,352.40 | $7,254.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOW EXTR ANY JNT WO/WC UNI | $2,176.20 | $3,627.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO/C LIMITED | $645.00 | $1,075.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO/C LIMITED | $645.00 | $1,075.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO/C | $1,290.00 | $2,150.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO/C | $1,290.00 | $2,150.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO/C LIMITED | $645.00 | $1,075.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO/C | $1,290.00 | $2,150.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/WC | $2,176.20 | $3,627.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO/WC | $2,176.20 | $3,627.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO/WC | $2,176.20 | $3,627.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO/C | $1,287.00 | $2,145.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO/C | $1,287.00 | $2,145.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE WO/C | $1,287.00 | $2,145.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTER>=14WK SNG/1STGEST | $523.80 | $873.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTER>=14WK SNG/1STGEST | $523.80 | $873.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTER>=14WK SNG/1STGEST | $523.80 | $873.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG 6/> 4+PARAM ABORT ADULT | $1,783.80 | $2,973.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 SLP STGNG >6Y PARAM 4+ <6 HRS | $1,783.80 | $2,973.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG 6/> 4+PARAM ABORT ADULT | $1,783.80 | $2,973.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 SLP STGNG >6Y PARAM 4+ <6 HRS | $1,783.80 | $2,973.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 SLEEP STAGING 4+ PARAM 6YR/> | $3,567.60 | $5,946.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 SLEEP STAGING 4+ PARAM 6YR/> | $3,567.60 | $5,946.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 6/> 4+PARAM ABORT ADULT | $1,783.80 | $2,973.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SLP STGNG >6Y PARAM 4+ <6 HRS | $1,783.80 | $2,973.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STAGING 4+ PARAM 6YR/> | $3,567.60 | $5,946.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 ULS TRANSVAGINAL NON-OBSTETRIC | $544.20 | $907.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 ULS TRANSVAGINAL NON-OBSTETRIC | $544.20 | $907.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 ULS TRANSVAGINAL NON-OBSTETRIC | $544.20 | $907.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD B-SCAN+/OR REAL T COMP | $523.80 | $873.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD B-SCAN+/OR REAL T COMP | $523.80 | $873.00 | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD B-SCAN+/OR REAL T COMP | $523.80 | $873.00 | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL 4+ VIEWS | $310.80 | $518.00 | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL 4+ VIEWS | $310.80 | $518.00 | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMBOSACRAL 4+ VIEWS | $310.80 | $518.00 | 40% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $43.80 | $73.00 | 40% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $43.80 | $73.00 | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $43.80 | $73.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $65.40 | $109.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $65.40 | $109.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $65.40 | $109.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 #CBC+DIFF WBC;CMPLT AUTO | $27.00 | $45.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 #CBC+DIFF WBC;CMPLT AUTO | $27.00 | $45.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC+DIFF WBC; CMPLT AUTO | $48.00 | $80.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC+DIFF WBC; CMPLT AUTO | $48.00 | $80.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 #CBC+DIFF WBC;CMPLT AUTO | $27.00 | $45.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC+DIFF WBC; CMPLT AUTO | $48.00 | $80.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 #CBC AUTM HGB-HCT-RBC-WBC-PLTL | $21.00 | $35.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 #CBC AUTM HGB-HCT-RBC-WBC-PLTL | $21.00 | $35.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC AUTM HGB-HCT-RBC-WBC-PLTLT | $42.00 | $70.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC AUTM HGB-HCT-RBC-WBC-PLTLT | $42.00 | $70.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 #CBC AUTM HGB-HCT-RBC-WBC-PLTL | $21.00 | $35.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTM HGB-HCT-RBC-WBC-PLTLT | $42.00 | $70.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 #COMPREHENSIVE METABOLIC PANEL | $35.40 | $59.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 #COMPREHENSIVE METABOLIC PANEL | $35.40 | $59.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $66.60 | $111.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $66.60 | $111.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 #COMPREHENSIVE METABOLIC PANEL | $35.40 | $59.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $66.60 | $111.00 | 40% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $55.20 | $92.00 | 40% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $55.20 | $92.00 | 40% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $55.20 | $92.00 | 40% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $37.80 | $63.00 | 40% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $37.80 | $63.00 | 40% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $37.80 | $63.00 | 40% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $332.40 | $554.00 | 40% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $332.40 | $554.00 | 40% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $332.40 | $554.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 #PROSTATE SPECIFIC AG/PSA;FREE | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 #PROSTATE SPECIFIC AG/PSA;FREE | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC AG(PSA);FREE | $102.00 | $170.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC AG(PSA);FREE | $102.00 | $170.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 #PROSTATE SPECIFIC AG/PSA;FREE | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC AG(PSA);FREE | $102.00 | $170.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 #PROSTATE SPECIFIC AG(PSA);TTL | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 #PROSTATE SPECIFIC AG(PSA);TTL | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC AG(PSA);TTL | $90.00 | $150.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC AG(PSA);TTL | $90.00 | $150.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 #PROSTATE SPECIFIC AG(PSA);TTL | $61.80 | $103.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC AG(PSA);TTL | $90.00 | $150.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #THROMBOPLAST PTT;PLSM/WHL BLD | $52.20 | $87.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 #THROMBOPLAST PTT;PLSM/WHL BLD | $52.20 | $87.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PTT;PLASMA | $58.80 | $98.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PTT;PLASMA | $58.80 | $98.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 #THROMBOPLAST PTT;PLSM/WHL BLD | $52.20 | $87.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PTT;PLASMA | $58.80 | $98.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 #PROTHROMBIN TIME | $25.80 | $43.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 #PROTHROMBIN TIME | $25.80 | $43.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $30.60 | $51.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $30.60 | $51.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 #PROTHROMBIN TIME | $25.80 | $43.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $30.60 | $51.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 #THYROID STIMULAT HORMONE(TSH) | $76.20 | $127.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 #THYROID STIMULAT HORMONE(TSH) | $76.20 | $127.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULAT HORMONE(TSH) | $147.60 | $246.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULAT HORMONE(TSH) | $147.60 | $246.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 #THYROID STIMULAT HORMONE(TSH) | $76.20 | $127.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULAT HORMONE(TSH) | $147.60 | $246.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINALS DIPSTICK AUTO W/MICR | $40.20 | $67.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINALS DIPSTICK AUTO W/MICR | $40.20 | $67.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALS DIPSTICK AUTO W/MICR | $40.20 | $67.00 | 40% |
| Urinalysis with microscope exam, manual CPT 81000 URINALS DIPSTICK NON-AUTO W/MI | $43.80 | $73.00 | 40% |
| Urinalysis with microscope exam, manual CPT 81000 URINALS DIPSTICK NON-AUTO W/MI | $43.80 | $73.00 | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALS DIPSTICK NON-AUTO W/MI | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 #URINALYSIS DIP STICK;AUTO | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 #URINALYSIS DIP STICK;AUTO | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINALS DIPSTICK AUTO WO/MICR | $24.00 | $40.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINALS DIPSTICK AUTO WO/MICR | $24.00 | $40.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 #URINALYSIS DIP STICK;AUTO | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALS DIPSTICK AUTO WO/MICR | $24.00 | $40.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 #URINALYSIS DIP STICK;NON-AUTO | $9.60 | $16.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 #URINALYSIS DIP STICK;NON-AUTO | $9.60 | $16.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 URINALS DIPSTICK NON-AUTOWO/MI | $15.60 | $26.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 URINALS DIPSTICK NON-AUTOWO/MI | $15.60 | $26.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 #URINALYSIS DIP STICK;NON-AUTO | $9.60 | $16.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALS DIPSTICK NON-AUTOWO/MI | $15.60 | $26.00 | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST-CATARACT LASER SURGERY | $1,837.20 | $3,062.00 | 40% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST-CATARACT LASER SURGERY | $1,837.20 | $3,062.00 | 40% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 POST-CATARACT LASER SURGERY | $1,837.20 | $3,062.00 | 40% |
| Left heart catheterization, diagnostic CPT 93452 LHC/LV/IMAGING | $12,046.20 | $20,077.00 | 40% |
| Left heart catheterization, diagnostic CPT 93452 LHC/LV/IMAGING | $12,046.20 | $20,077.00 | 40% |
| Left heart catheterization, diagnostic inpatient CPT 93452 LHC/LV/IMAGING | $12,046.20 | $20,077.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ DX/TX LAMINAR LUM/SACRL+IM | $2,448.00 | $4,080.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ DX/TX LAMINAR LUM/SACRL+IM | $2,448.00 | $4,080.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DX/TX LAMINAR LUM/SACRL+IM | $2,448.00 | $4,080.00 | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PF EKG ROUTINE COMPLETE | $285.60 | $476.00 | 40% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PF EKG ROUTINE COMPLETE | $285.60 | $476.00 | 40% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PF EKG ROUTINE COMPLETE | $285.60 | $476.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/ PATIENT | $246.00 | $410.00 | 40% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/ PATIENT | $246.00 | $410.00 | 40% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYTX W/ PATIENT | $246.00 | $410.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PATIENT | $213.00 | $355.00 | 40% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PATIENT | $213.00 | $355.00 | 40% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PATIENT | $213.00 | $355.00 | 40% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $201.60 | $336.00 | 40% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $201.60 | $336.00 | 40% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $201.60 | $336.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 OP VISIT LEVEL 3 NEW W/PROC | $225.00 | $375.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 OP VISIT LEVEL 3 NEW | $225.00 | $375.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 OP VISIT LEVEL 3 NEW | $225.00 | $375.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 OP VISIT LEVEL 3 NEW W/PROC | $225.00 | $375.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OP VISIT LEVEL 3 NEW W/PROC | $225.00 | $375.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OP VISIT LEVEL 3 NEW | $225.00 | $375.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 OP VISIT LEVEL 4 NEW W/PROC | $255.00 | $425.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 OP VISIT LEVEL 4 NEW W/PROC | $255.00 | $425.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 OP VISIT LEVEL 4 NEW | $255.00 | $425.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 OP VISIT LEVEL 4 NEW | $255.00 | $425.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OP VISIT LEVEL 4 NEW W/PROC | $255.00 | $425.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OP VISIT LEVEL 4 NEW | $255.00 | $425.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 OP VISIT LEVEL 5 NEW W/PROC | $285.00 | $475.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 OP VISIT LEVEL 5 NEW W/PROC | $285.00 | $475.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 OP VISIT LEVEL 5 NEW | $285.00 | $475.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 OP VISIT LEVEL 5 NEW | $285.00 | $475.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OP VISIT LEVEL 5 NEW | $285.00 | $475.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OP VISIT LEVEL 5 NEW W/PROC | $285.00 | $475.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT TX EXERCISES EA 15MIN | $82.80 | $138.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT TX EXERCISES EA 15MIN | $82.80 | $138.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PF PT TX EXERCISES EA 15MIN | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PF OT THER EXERCISES 1-15 | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PF OT THER EXERCISES 1-15 | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PF PT TX EXERCISES EA 15MIN | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISES 1-15 | $97.80 | $163.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISES 1-15 | $97.80 | $163.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT TX EXERCISES EA 15MIN | $82.80 | $138.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PF PT TX EXERCISES EA 15MIN | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PF OT THER EXERCISES 1-15 | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISES 1-15 | $97.80 | $163.00 | 40% |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT&/FAMILY 30 MINUTES | $196.80 | $328.00 | 40% |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT&/FAMILY 30 MINUTES | $196.80 | $328.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT&/FAMILY 30 MINUTES | $196.80 | $328.00 | 40% |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT&/FAMILY 45 MINUTES | $327.60 | $546.00 | 40% |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT&/FAMILY 45 MINUTES | $327.60 | $546.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT&/FAMILY 45 MINUTES | $327.60 | $546.00 | 40% |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX PT&/FAMILY 60 MINUTES | $393.00 | $655.00 | 40% |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX PT&/FAMILY 60 MINUTES | $393.00 | $655.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX PT&/FAMILY 60 MINUTES | $393.00 | $655.00 | 40% |