The University of Texas Southwestern Medical Center at Dallas
The University of Texas Southwestern Medical Center at Dallas in Dallas, TX publishes cash prices for 75 common procedures listed here, from its own machine-readable price file updated Mar 10, 2026. Click a procedure to compare it with other hospitals nearby.
6201 Harry Hines Blvd, Dallas, TX 75390 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 HCHG CT ABDOMEN & PELVIS WITH CONTRAST | $1,973.00 | $3,946.00 | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HCHG CT ABDOMEN & PELVIS WITH CONTRAST | $1,973.00 | $3,946.00 | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 HCHG CT HEAD W/O CONTRAST | $1,062.50 | $2,125.00 | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HCHG CT HEAD W/O CONTRAST | $1,062.50 | $2,125.00 | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST MATERIAL | $144.00 | $192.00 | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 HCHG CT PELVIS W/CONTRAST | $1,377.50 | $2,755.00 | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST MATERIAL | $144.00 | $192.00 | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HCHG CT PELVIS W/CONTRAST | $1,377.50 | $2,755.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HCHG MAMMOGRAM DIAG BILAT INCL CAD | $393.50 | $787.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $514.50 | $686.00 | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HCHG MAMMOGRAM DIAG BILAT INCL CAD | $393.50 | $787.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $514.50 | $686.00 | 25% |
| Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $405.75 | $541.00 | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 HCHG MAMMOGRAM DIAG UNILATERAL INCL CAD | $307.00 | $614.00 | 50% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $405.75 | $541.00 | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HCHG MAMMOGRAM DIAG UNILATERAL INCL CAD | $307.00 | $614.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG MRI LWR EXT JOINT W/O CONT | $1,384.50 | $2,769.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HCHG MRI LWR EXT JOINT W/O CONT | $1,384.50 | $2,769.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL | $264.75 | $353.00 | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HCHG MRI LWR EXT JOINT W&W/O CONT | $2,243.00 | $4,486.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL | $264.75 | $353.00 | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HCHG MRI LWR EXT JOINT W&W/O CONT | $2,243.00 | $4,486.00 | 50% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL | $161.25 | $215.00 | 25% |
| MRI of the brain, no contrast dye CPT 70551 HCHG MRI BRAIN W/O CONTRAST | $1,602.50 | $3,205.00 | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL | $161.25 | $215.00 | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HCHG MRI BRAIN W/O CONTRAST | $1,602.50 | $3,205.00 | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL | $2,079.00 | $2,772.00 | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 HCHG MRI BRAIN W/WO CONTRAST | $2,584.50 | $5,169.00 | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL | $2,079.00 | $2,772.00 | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HCHG MRI BRAIN W/WO CONTRAST | $2,584.50 | $5,169.00 | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL | $1,067.25 | $1,423.00 | 25% |
| MRI of the lower back, no contrast dye CPT 72148 HCHG MRI L-SPINE W/O CONT | $1,423.00 | $2,846.00 | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL | $1,067.25 | $1,423.00 | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HCHG MRI L-SPINE W/O CONT | $1,423.00 | $2,846.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $109.50 | $146.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ULTRASOUND PREG UTER AFTER FIRST TRIMESTER MORE THAN 14 WKS 0 | $336.00 | $448.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG US PREGNANCY >14 WEEKS SINGLE | $392.50 | $785.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $109.50 | $146.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ULTRASOUND PREG UTER AFTER FIRST TRIMESTER MORE THAN 14 WKS 0 | $336.00 | $448.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HCHG US PREGNANCY >14 WEEKS SINGLE | $392.50 | $785.00 | 50% |
| Screening mammogram, both breasts both sides CPT 77067 HCHG MAMMOGRAM SCRN BILAT INCL CAD | $260.00 | $520.00 | 50% |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $285.75 | $381.00 | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG MAMMOGRAM SCRN BILAT INCL CAD | $260.00 | $520.00 | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $285.75 | $381.00 | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HCHG PSG 4+ PARAMETERS | $1,587.50 | $3,175.00 | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $2,346.00 | $3,128.00 | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HCHG PSG 4+ PARAMETERS | $1,587.50 | $3,175.00 | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $2,346.00 | $3,128.00 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $77.25 | $103.00 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 PG DIAGNOSTIC ULTRASOUND | $117.75 | $157.00 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 HCHG US TRANSVAGINAL NON OB | $217.00 | $434.00 | 50% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ECHOGRAPHY | $281.25 | $375.00 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 SONO PELVIC TRANSVAG LIMITED | $281.25 | $375.00 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $77.25 | $103.00 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 PG DIAGNOSTIC ULTRASOUND | $117.75 | $157.00 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG US TRANSVAGINAL NON OB | $217.00 | $434.00 | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ECHOGRAPHY | $281.25 | $375.00 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 SONO PELVIC TRANSVAG LIMITED | $281.25 | $375.00 | 25% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $301.50 | $402.00 | 25% |
| Ultrasound of the abdomen, complete CPT 76700 HCHG US ABDOMEN CMPL | $435.50 | $871.00 | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $301.50 | $402.00 | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG US ABDOMEN CMPL | $435.50 | $871.00 | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 HCHG XR L-SPINE 4+ VIEWS | $235.00 | $470.00 | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HCHG XR L-SPINE 4+ VIEWS | $235.00 | $470.00 | 50% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BMP (BASIC METABOLIC PANEL) | $48.75 | $65.00 | 25% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL.. | $48.75 | $65.00 | 25% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL CALCIUM TOTAL | $48.75 | $65.00 | 25% |
| Basic metabolic panel (blood test) CPT 80048 HCHG BASIC METABOLIC PANEL | $68.50 | $137.00 | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL CALCIUM TOTAL | $48.75 | $65.00 | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BMP (BASIC METABOLIC PANEL) | $48.75 | $65.00 | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL.. | $48.75 | $65.00 | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HCHG BASIC METABOLIC PANEL | $68.50 | $137.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL + REFLEX DIRECT LDL | $47.25 | $63.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $47.25 | $63.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL. | $58.50 | $78.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE. | $58.50 | $78.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HCHG LIPID PANEL | $71.00 | $142.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $47.25 | $63.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL + REFLEX DIRECT LDL | $47.25 | $63.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL. | $58.50 | $78.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE. | $58.50 | $78.00 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HCHG LIPID PANEL | $71.00 | $142.00 | 50% |
| Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFFERENTIAL | $35.25 | $47.00 | 25% |
| Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFF. | $35.25 | $47.00 | 25% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $35.25 | $47.00 | 25% |
| Complete blood count (CBC) with differential CPT 85025 HCHG BLOOD COUNT CBC AUTO W/AUTO DIFF | $59.50 | $119.00 | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $35.25 | $47.00 | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFF. | $35.25 | $47.00 | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFFERENTIAL | $35.25 | $47.00 | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HCHG BLOOD COUNT CBC AUTO W/AUTO DIFF | $59.50 | $119.00 | 50% |
| Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFFERENTIAL | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM (NO DIFF). | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF. | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential CPT 85027 HCHG BLOOD COUNT CBC AUTO W/O DIFF | $55.00 | $110.00 | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFF. | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFFERENTIAL | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM (NO DIFF). | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED | $31.50 | $42.00 | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HCHG BLOOD COUNT CBC AUTO W/O DIFF | $55.00 | $110.00 | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 HCHG COMPREHENSIVE METABOLIC PANEL | $76.00 | $152.00 | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $84.75 | $113.00 | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL... | $84.75 | $113.00 | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 CMPL (COMPREHENSIVE METABOLIC PANEL) | $84.75 | $113.00 | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HCHG COMPREHENSIVE METABOLIC PANEL | $76.00 | $152.00 | 50% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMPL (COMPREHENSIVE METABOLIC PANEL) | $84.75 | $113.00 | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $84.75 | $113.00 | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL... | $84.75 | $113.00 | 25% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $39.00 | $52.00 | 25% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL.. | $60.00 | $80.00 | 25% |
| Kidney function blood test panel CPT 80069 HCHG RENAL FUNCTION PANEL | $69.50 | $139.00 | 50% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $39.00 | $52.00 | 25% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL.. | $60.00 | $80.00 | 25% |
| Kidney function blood test panel inpatient CPT 80069 HCHG RENAL FUNCTION PANEL | $69.50 | $139.00 | 50% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $12.00 | $16.00 | 25% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL.. | $42.00 | $56.00 | 25% |
| Liver function blood test panel CPT 80076 HCHG HEPATIC FUNCTION PANEL | $58.00 | $116.00 | 50% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $12.00 | $16.00 | 25% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL.. | $42.00 | $56.00 | 25% |
| Liver function blood test panel inpatient CPT 80076 HCHG HEPATIC FUNCTION PANEL | $58.00 | $116.00 | 50% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $64.50 | $86.00 | 25% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $195.75 | $261.00 | 25% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $64.50 | $86.00 | 25% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $195.75 | $261.00 | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HCHG PROSTATIC SPECIFIC ANTIGEN FREE | $68.00 | $136.00 | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $82.50 | $110.00 | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA | $82.50 | $110.00 | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HCHG PROSTATIC SPECIFIC ANTIGEN FREE | $68.00 | $136.00 | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA | $82.50 | $110.00 | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $82.50 | $110.00 | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA,POST OPERATIVE | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANT | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HCHG PROSTATIC SPECIFIC ANITGEN TOTAL SCREEN | $83.50 | $167.00 | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HCHG PROSTATIC SPECIFIC ANTIGEN TOTAL | $108.50 | $217.00 | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA,POST OPERATIVE | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANT | $78.00 | $104.00 | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HCHG PROSTATIC SPECIFIC ANITGEN TOTAL SCREEN | $83.50 | $167.00 | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HCHG PROSTATIC SPECIFIC ANTIGEN TOTAL | $108.50 | $217.00 | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLAS | $23.25 | $31.00 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HEPARINASE PLASMA TREATMENT | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT (APTT) | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT MIXING STUDY | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HCHG PARTIAL THROMBOPLASTIN TIME (PTT) | $54.00 | $108.00 | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLAS | $23.25 | $31.00 | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HEPARINASE PLASMA TREATMENT | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT (APTT) | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT MIXING STUDY | $27.75 | $37.00 | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HCHG PARTIAL THROMBOPLASTIN TIME (PTT) | $54.00 | $108.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $23.25 | $31.00 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR GROUP. | $23.25 | $31.00 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME MIXING STUDY | $28.50 | $38.00 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME + INR | $28.50 | $38.00 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HCHG PROTHROMBIN TIME (PT) | $35.50 | $71.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR GROUP. | $23.25 | $31.00 | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME | $23.25 | $31.00 | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME + INR | $28.50 | $38.00 | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME MIXING STUDY | $28.50 | $38.00 | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HCHG PROTHROMBIN TIME (PT) | $35.50 | $71.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY OF THYROID STIMULATING HORMONE TSH | $51.75 | $69.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 RE TSH - REFLEX FT4 | $51.75 | $69.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH REFLEX | $51.75 | $69.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING H | $74.25 | $99.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HCHG THYROID STIMULATING HORMONE (TSH) | $98.50 | $197.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 RE TSH - REFLEX FT4 | $51.75 | $69.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY OF THYROID STIMULATING HORMONE TSH | $51.75 | $69.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH REFLEX | $51.75 | $69.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING H | $74.25 | $99.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HCHG THYROID STIMULATING HORMONE (TSH) | $98.50 | $197.00 | 50% |
| Urinalysis with microscope exam, automated CPT 81001 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $15.75 | $21.00 | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, AUTOMATED WITH MICRO. | $19.50 | $26.00 | 25% |
| Urinalysis with microscope exam, automated CPT 81001 HCHG URINALYSIS AUTO W/MICRO | $25.50 | $51.00 | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $15.75 | $21.00 | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, AUTOMATED WITH MICRO. | $19.50 | $26.00 | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HCHG URINALYSIS AUTO W/MICRO | $25.50 | $51.00 | 50% |
| Urinalysis with microscope exam, manual CPT 81000 URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $6.00 | $8.00 | 25% |
| Urinalysis with microscope exam, manual CPT 81000 ACETONE, URINE | $18.00 | $24.00 | 25% |
| Urinalysis with microscope exam, manual CPT 81000 URANALYSIS | $31.50 | $42.00 | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $6.00 | $8.00 | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 ACETONE, URINE | $18.00 | $24.00 | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URANALYSIS | $31.50 | $42.00 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $6.00 | $8.00 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS W/O MICROSCOPIC, AUTOMATED | $13.50 | $18.00 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE | $13.50 | $18.00 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 KETONES URINE | $13.50 | $18.00 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 HCHG URINE AUTO W/O MICRO | $16.00 | $32.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $6.00 | $8.00 | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS W/O MICROSCOPIC, AUTOMATED | $13.50 | $18.00 | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 KETONES URINE | $13.50 | $18.00 | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY URINE | $13.50 | $18.00 | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HCHG URINE AUTO W/O MICRO | $16.00 | $32.00 | 50% |
| Urinalysis without microscope exam, manual CPT 81002 SAD. | $8.25 | $11.00 | 25% |
| Urinalysis without microscope exam, manual CPT 81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $14.25 | $19.00 | 25% |
| Urinalysis without microscope exam, manual CPT 81002 HCHG URINALYSIS NONAUTO W/O MICRO | $16.00 | $32.00 | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 SAD. | $8.25 | $11.00 | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $14.25 | $19.00 | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HCHG URINALYSIS NONAUTO W/O MICRO | $16.00 | $32.00 | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $2,166.75 | $2,889.00 | 25% |
| Cataract surgery with lens implant inpatient CPT 66984 XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $2,166.75 | $2,889.00 | 25% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $5,564.25 | $7,419.00 | 25% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $5,564.25 | $7,419.00 | 25% |
| Colonoscopy with endoscopic ultrasound CPT 45391 COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $1,020.75 | $1,361.00 | 25% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $1,020.75 | $1,361.00 | 25% |
| Colonoscopy with polyp removal CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,401.75 | $1,869.00 | 25% |
| Colonoscopy with polyp removal CPT 45385 HCHG COLONOSCOPY REMOVE POLYP/LESION SNARE | $2,969.00 | $5,938.00 | 50% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,401.75 | $1,869.00 | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 HCHG COLONOSCOPY REMOVE POLYP/LESION SNARE | $2,969.00 | $5,938.00 | 50% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $1,244.25 | $1,659.00 | 25% |
| Colonoscopy with tissue sample CPT 45380 HCHG COLONOSCOPY BIOPSY | $2,969.00 | $5,938.00 | 50% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $1,244.25 | $1,659.00 | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 HCHG COLONOSCOPY BIOPSY | $2,969.00 | $5,938.00 | 50% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $1,041.00 | $1,388.00 | 25% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY CANCER SCREEN NON HIGH RISK PT | $1,125.00 | $1,500.00 | 25% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY CANCER SCREEN HIGH RISK PT | $1,125.00 | $1,500.00 | 25% |
| Colonoscopy, diagnostic CPT 45378 HCHG COLONOSCOPY COLORECTAL CANCER SCREENING NON-HIGH RISK | $1,287.50 | $2,575.00 | 50% |
| Colonoscopy, diagnostic CPT 45378 HCHG COLONOSCOPY COLORECTAL CANCER SCREENING HIGH RISK | $1,287.50 | $2,575.00 | 50% |
| Colonoscopy, diagnostic CPT 45378 HCHG COLONOSCOPY W/WO BRUSH OR WASH | $2,182.00 | $4,364.00 | 50% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $1,041.00 | $1,388.00 | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY CANCER SCREEN HIGH RISK PT | $1,125.00 | $1,500.00 | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY CANCER SCREEN NON HIGH RISK PT | $1,125.00 | $1,500.00 | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG COLONOSCOPY COLORECTAL CANCER SCREENING NON-HIGH RISK | $1,287.50 | $2,575.00 | 50% |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG COLONOSCOPY COLORECTAL CANCER SCREENING HIGH RISK | $1,287.50 | $2,575.00 | 50% |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG COLONOSCOPY W/WO BRUSH OR WASH | $2,182.00 | $4,364.00 | 50% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,923.00 | $2,564.00 | 25% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,923.00 | $2,564.00 | 25% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $1,423.50 | $1,898.00 | 25% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $1,423.50 | $1,898.00 | 25% |
| Knee arthroscopy with meniscus trim CPT 29881 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | $2,160.75 | $2,881.00 | 25% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG | $2,160.75 | $2,881.00 | 25% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST-CATARACT LASER SURGERY | $985.50 | $1,314.00 | 25% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 POST-CATARACT LASER SURGERY | $985.50 | $1,314.00 | 25% |
| Left heart catheterization, diagnostic CPT 93452 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | $826.50 | $1,102.00 | 25% |
| Left heart catheterization, diagnostic one side CPT 93452 HCHG CATH LEFT HEART W/ VENTRICULOGRAPY | $7,501.00 | $15,002.00 | 50% |
| Left heart catheterization, diagnostic inpatient CPT 93452 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I | $826.50 | $1,102.00 | 25% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HCHG CATH LEFT HEART W/ VENTRICULOGRAPY | $7,501.00 | $15,002.00 | 50% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $499.50 | $666.00 | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HCHG INJ INTERLAMINAR LUMB/SACR W IMAGE GUIDE | $751.00 | $1,502.00 | 50% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $499.50 | $666.00 | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG INJ INTERLAMINAR LUMB/SACR W IMAGE GUIDE | $751.00 | $1,502.00 | 50% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $318.75 | $425.00 | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HCHG INJ INTERLAMINAR LUMB/SACR WO IMAGE GUIDE | $631.00 | $1,262.00 | 50% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $318.75 | $425.00 | 25% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HCHG INJ INTERLAMINAR LUMB/SACR WO IMAGE GUIDE | $631.00 | $1,262.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $739.50 | $986.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANES/STEROID EPIDUR; LUMB/SAC 1 LEVE | $750.75 | $1,001.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG INJECT EPIDURAL LUMBAR/SACRAL SGL | $1,422.00 | $2,844.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $739.50 | $986.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANES/STEROID EPIDUR; LUMB/SAC 1 LEVE | $750.75 | $1,001.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HCHG INJECT EPIDURAL LUMBAR/SACRAL SGL | $1,422.00 | $2,844.00 | 50% |
| Prostate biopsy CPT 55700 HCHG PROSTATE BIOPSY NDL/PUNCH SNGL OR MULTI | $594.00 | $1,188.00 | 50% |
| Prostate biopsy CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $720.00 | $960.00 | 25% |
| Prostate biopsy inpatient CPT 55700 HCHG PROSTATE BIOPSY NDL/PUNCH SNGL OR MULTI | $594.00 | $1,188.00 | 50% |
| Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $720.00 | $960.00 | 25% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT | $5,540.25 | $7,387.00 | 25% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT | $5,540.25 | $7,387.00 | 25% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,231.50 | $1,642.00 | 25% |
| Removal of a breast lump, open surgery CPT 19120 HCHG EXC CYST/LESN BREAST | $1,580.50 | $3,161.00 | 50% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,231.50 | $1,642.00 | 25% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HCHG EXC CYST/LESN BREAST | $1,580.50 | $3,161.00 | 50% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $2,100.75 | $2,801.00 | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $2,100.75 | $2,801.00 | 25% |
| Tonsil and adenoid removal, child under 12 CPT 42820 TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $779.25 | $1,039.00 | 25% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $779.25 | $1,039.00 | 25% |
| Total hip replacement CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $4,188.00 | $5,584.00 | 25% |
| Total hip replacement inpatient CPT 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $4,188.00 | $5,584.00 | 25% |
| Total knee replacement CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $5,202.75 | $6,937.00 | 25% |
| Total knee replacement inpatient CPT 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $5,202.75 | $6,937.00 | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,278.00 | $1,704.00 | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HCHG EGD BIOPSY | $2,594.00 | $5,188.00 | 50% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,278.00 | $1,704.00 | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG EGD BIOPSY | $2,594.00 | $5,188.00 | 50% |
| Upper endoscopy (EGD), diagnostic CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $783.75 | $1,045.00 | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HCHG EGD W OR WO COLL SPECIMEN BY BRUSH OR WASH | $1,525.50 | $3,051.00 | 50% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $783.75 | $1,045.00 | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HCHG EGD W OR WO COLL SPECIMEN BY BRUSH OR WASH | $1,525.50 | $3,051.00 | 50% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $6,765.75 | $9,021.00 | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $6,765.75 | $9,021.00 | 25% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $5,519.25 | $7,359.00 | 25% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $5,519.25 | $7,359.00 | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $99.00 | $132.00 | 25% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $99.00 | $132.00 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HCHG PSYCH THERAPY FAMILY W PT 50MIN | $192.50 | $385.00 | 50% |
| Family therapy with the patient, 50 minutes CPT 90847 SPECIAL FAMILY THERAPY - PSYCHOLOGIST | $331.50 | $442.00 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $331.50 | $442.00 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT) | $331.50 | $442.00 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (W/PATIENT PRESENT) | $340.50 | $454.00 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HCHG PSYCH THERAPY FAMILY W PT 50MIN | $192.50 | $385.00 | 50% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $331.50 | $442.00 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT) | $331.50 | $442.00 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 SPECIAL FAMILY THERAPY - PSYCHOLOGIST | $331.50 | $442.00 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (W/PATIENT PRESENT) | $340.50 | $454.00 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $279.00 | $372.00 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY THERAPY W/O PATIENT PRESENT-PSYCHOLOGIST | $279.00 | $372.00 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY THERAPY W/O PT PRESENT SOCIAL WORKER | $279.00 | $372.00 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY (W/O PATIENT PRESENT) | $286.50 | $382.00 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY THERAPY W/O PT PRESENT SOCIAL WORKER | $279.00 | $372.00 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY THERAPY W/O PATIENT PRESENT-PSYCHOLOGIST | $279.00 | $372.00 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $279.00 | $372.00 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY (W/O PATIENT PRESENT) | $286.50 | $382.00 | 25% |
| Group psychotherapy session CPT 90853 GROUP THERAPY - PSYCHOLOGIST | $97.50 | $130.00 | 25% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $104.25 | $139.00 | 25% |
| Group psychotherapy session CPT 90853 HCHG GROUP THERAPY PATIENTS ONLY | $140.00 | $280.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY - PSYCHOLOGIST | $97.50 | $130.00 | 25% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $104.25 | $139.00 | 25% |
| Group psychotherapy session inpatient CPT 90853 HCHG GROUP THERAPY PATIENTS ONLY | $140.00 | $280.00 | 50% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MIN | $271.50 | $362.00 | 25% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $271.50 | $362.00 | 25% |
| New patient office visit, about 30 minutes CPT 99203 HCHG VISIT NEW LEVEL III | $309.50 | $619.00 | 50% |
| New patient office visit, about 30 minutes CPT 99203 HCHG VISIT NEW LEVEL III W/PROC | $309.50 | $619.00 | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MIN | $271.50 | $362.00 | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $271.50 | $362.00 | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG VISIT NEW LEVEL III W/PROC | $309.50 | $619.00 | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG VISIT NEW LEVEL III | $309.50 | $619.00 | 50% |
| New patient office visit, about 45 minutes CPT 99204 TRAVEL OFF/OP NEW MODERATE MDM 45 MINS | $75.00 | $100.00 | 25% |
| New patient office visit, about 45 minutes CPT 99204 PG INITIAL CONSULT | $214.50 | $286.00 | 25% |
| New patient office visit, about 45 minutes CPT 99204 HCHG VISIT NEW LEVEL IV | $378.50 | $757.00 | 50% |
| New patient office visit, about 45 minutes CPT 99204 HCHG VISIT NEW LEVEL IV W/PROC | $378.50 | $757.00 | 50% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MIN | $417.00 | $556.00 | 25% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $417.00 | $556.00 | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 TRAVEL OFF/OP NEW MODERATE MDM 45 MINS | $75.00 | $100.00 | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PG INITIAL CONSULT | $214.50 | $286.00 | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG VISIT NEW LEVEL IV | $378.50 | $757.00 | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG VISIT NEW LEVEL IV W/PROC | $378.50 | $757.00 | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MIN | $417.00 | $556.00 | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $417.00 | $556.00 | 25% |
| New patient office visit, about 60 minutes CPT 99205 TRAVEL OFF/OP NEW HIGH MDM 60 MINS | $75.00 | $100.00 | 25% |
| New patient office visit, about 60 minutes CPT 99205 PG INITIAL CONSULT | $214.50 | $286.00 | 25% |
| New patient office visit, about 60 minutes CPT 99205 HCHG VISIT NEW LEVEL V | $447.00 | $894.00 | 50% |
| New patient office visit, about 60 minutes CPT 99205 HCHG VISIT NEW LEVEL V W/PROC | $447.00 | $894.00 | 50% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MIN | $519.75 | $693.00 | 25% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $519.75 | $693.00 | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 TRAVEL OFF/OP NEW HIGH MDM 60 MINS | $75.00 | $100.00 | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PG INITIAL CONSULT | $214.50 | $286.00 | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG VISIT NEW LEVEL V | $447.00 | $894.00 | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG VISIT NEW LEVEL V W/PROC | $447.00 | $894.00 | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MIN | $519.75 | $693.00 | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $519.75 | $693.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PROCEDURE, EACH 15 MINUTES | $86.25 | $115.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $117.75 | $157.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG EXERCISE THERAPEUTIC 15 MIN | $119.50 | $239.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PROCEDURE, EACH 15 MINUTES | $86.25 | $115.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $117.75 | $157.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG EXERCISE THERAPEUTIC 15 MIN | $119.50 | $239.00 | 50% |
| Preventive checkup, new patient aged 18–39 CPT 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $339.75 | $453.00 | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $339.75 | $453.00 | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $394.50 | $526.00 | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $394.50 | $526.00 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HCHG PSYCHOTHERAPY 30MIN W PT | $84.00 | $168.00 | 50% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $187.50 | $250.00 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | $228.75 | $305.00 | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HCHG PSYCHOTHERAPY 30MIN W PT | $84.00 | $168.00 | 50% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $187.50 | $250.00 | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | $228.75 | $305.00 | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HCHG PSYCHOTHERAPY 45MIN W PT | $105.00 | $210.00 | 50% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES | $249.75 | $333.00 | 25% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $249.75 | $333.00 | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HCHG PSYCHOTHERAPY 45MIN W PT | $105.00 | $210.00 | 50% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES | $249.75 | $333.00 | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $249.75 | $333.00 | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HCHG PSYCHOTHERAPY 60MIN W PT | $156.00 | $312.00 | 50% |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES | $362.25 | $483.00 | 25% |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $375.75 | $501.00 | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HCHG PSYCHOTHERAPY 60MIN W PT | $156.00 | $312.00 | 50% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES | $362.25 | $483.00 | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $375.75 | $501.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFIC.CONS NEW/ESTAB MODERATE SEVERITY 40 MIN | $351.00 | $468.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $364.50 | $486.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFIC.CONS NEW/ESTAB MODERATE SEVERITY 40 MIN | $351.00 | $468.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $364.50 | $486.00 | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $538.50 | $718.00 | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $538.50 | $718.00 | 25% |
Dental
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Dental implant, surgical placement CDT D6010 ENDOSTEAL IMPLANT SURGICAL PLACEMENT | $1,932.00 | $2,576.00 | 25% |
| Dental implant, surgical placement inpatient CDT D6010 ENDOSTEAL IMPLANT SURGICAL PLACEMENT | $1,932.00 | $2,576.00 | 25% |
| Porcelain crown CDT D2740 CROWN PORCELAIN/CERAMIC SUBS | $978.00 | $1,304.00 | 25% |
| Porcelain crown inpatient CDT D2740 CROWN PORCELAIN/CERAMIC SUBS | $978.00 | $1,304.00 | 25% |