Maimonides Medical Center
Maimonides Medical Center in Brooklyn, NY publishes cash prices for 70 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
4802 Tenth Avenue, Brooklyn, NY 11219 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELV W/CONT | $880.00 | $880.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV W/CONTRAST | $2,800.00 | $2,800.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELV W/CONT | $880.00 | $880.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELV W/CONTRAST | $2,800.00 | $2,800.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST | $110.00 | $110.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CAT SCAN OF HEAD OR BRAIN | $310.00 | $310.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST | $1,700.00 | $1,700.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $1,700.00 | $1,700.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST | $110.00 | $110.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CAT SCAN OF HEAD OR BRAIN | $310.00 | $310.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $1,700.00 | $1,700.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST | $1,700.00 | $1,700.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $150.00 | $150.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CONTRAST CAT SCAN OF PELVIS | $150.00 | $150.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $2,400.00 | $2,400.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $2,400.00 | $2,400.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CONTRAST CAT SCAN OF PELVIS | $150.00 | $150.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST | $150.00 | $150.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST | $2,400.00 | $2,400.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST | $2,400.00 | $2,400.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI | $130.00 | $130.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 SCREEN TO DX MAMMO,BILAT | $787.00 | $787.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO,INCL CAD, BILAT | $787.00 | $787.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI | $130.00 | $130.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO,INCL CAD, BILAT | $787.00 | $787.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 SCREEN TO DX MAMMO,BILAT | $787.00 | $787.00 | — |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI | $105.00 | $105.00 | — |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI. | $105.00 | $105.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO,INCL CAD, UNILAT | $638.00 | $638.00 | — |
| Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI. | $105.00 | $105.00 | — |
| Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI | $105.00 | $105.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO,INCL CAD, UNILAT | $638.00 | $638.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JOINT OF LOW EXT WO/CONTR | $2,640.00 | $2,640.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI JOINT OF LOW EXT WO/CONTR | $2,640.00 | $2,640.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI WITHOUT CONTRAST MATERIAL | $280.00 | $280.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI WITHOUT CONTRAST MATERIAL. | $280.00 | $280.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LO EXT JNT WO/W | $3,740.00 | $3,740.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI WITHOUT CONTRAST MATERIAL | $280.00 | $280.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI WITHOUT CONTRAST MATERIAL. | $280.00 | $280.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LO EXT JNT WO/W | $3,740.00 | $3,740.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MAGNETIC IMAGE, BRAIN | $190.00 | $190.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRA BRAIN W/O CONTRAST | $190.00 | $190.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $4,500.00 | $4,500.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MAGNETIC IMAGE, BRAIN | $190.00 | $190.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRA BRAIN W/O CONTRAST | $190.00 | $190.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $4,500.00 | $4,500.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 IMAGING OF BRAIN W AND WO CONTRAST | $300.00 | $300.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 IMAGING OF BRAIN W AND WO CONTRAST. | $300.00 | $300.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/W/O CONTRAST | $6,564.00 | $6,564.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 IMAGING OF BRAIN W AND WO CONTRAST | $300.00 | $300.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 IMAGING OF BRAIN W AND WO CONTRAST. | $300.00 | $300.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/W/O CONTRAST | $6,564.00 | $6,564.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MAGNETIC IMAGE, LUMBAR SPINE | $195.00 | $195.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI SPINAL CANAL,LUMBAR W/O CONTRAST | $195.00 | $195.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE W/O CONTRAST | $3,512.00 | $3,512.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINAL CANAL,LUMBAR W/O CONTRAST | $195.00 | $195.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MAGNETIC IMAGE, LUMBAR SPINE | $195.00 | $195.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE W/O CONTRAST | $3,512.00 | $3,512.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ECHO OF PREGNANT UTERUS | $130.00 | $130.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ECHO EXAM OF PREGNANT UTERUS | $385.00 | $385.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PRG UTR,/M 14WKS<SG/1ST GST | $549.00 | $549.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB,US,>/=14 WKS, SING | $549.00 | $549.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS>OR=14WKS,SGL | $549.00 | $549.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ECHO OF PREGNANT UTERUS | $130.00 | $130.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ECHO EXAM OF PREGNANT UTERUS | $385.00 | $385.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS>OR=14WKS,SGL | $549.00 | $549.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB,US,>/=14 WKS, SING | $549.00 | $549.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PRG UTR,/M 14WKS<SG/1ST GST | $549.00 | $549.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD | $100.00 | $100.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 SCREEN MAMMO,BILAT, INCL CAD | $633.00 | $633.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD | $100.00 | $100.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREEN MAMMO,BILAT, INCL CAD | $633.00 | $633.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY,SLEEP STAGING, 4 OR MORE PARAMETERS | $1,815.00 | $1,815.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM AGE 6<;,4 OR<PARAM,ATT | $7,858.00 | $7,858.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY,SLEEP STAGING, 4 OR MORE PARAMETERS | $1,815.00 | $1,815.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM AGE 6<;,4 OR<PARAM,ATT | $7,858.00 | $7,858.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 ECHO TRANSVAGINAL | $90.00 | $90.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 ECHO EXAM, TRANSVAGINAL | $340.00 | $340.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US, TRANSVAGINAL | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAG US, NON OB | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US,TRANSVAGINAL(NON-OBSTETRIC) | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 ECHO TRANSVAGINAL | $90.00 | $90.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 ECHO EXAM, TRANSVAGINAL | $340.00 | $340.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US,TRANSVAGINAL(NON-OBSTETRIC) | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAG US, NON OB | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US, TRANSVAGINAL | $765.00 | $765.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US | $765.00 | $765.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 ECHO OF ABDOMEN | $105.00 | $105.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 ECHO EXAM OF ABDOMEN | $335.00 | $335.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 ABD US,B SCAN W/IMAGE DOC,COMP | $640.00 | $640.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ECHO OF ABDOMEN | $105.00 | $105.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ECHO EXAM OF ABDOMEN | $335.00 | $335.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ABD US,B SCAN W/IMAGE DOC,COMP | $640.00 | $640.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBOSACRAL SPINE - 2 VIEWS | $150.00 | $150.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE AP/LATE PELV. | $660.00 | $660.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBOSACRAL SPINE - 2 VIEWS | $150.00 | $150.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE AP/LATE PELV. | $660.00 | $660.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $42.00 | $42.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $42.00 | $42.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $68.00 | $68.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $68.00 | $68.00 | — |
| Complete blood count (CBC) with differential CPT 85025 AUTOMATED COMPLETE CBC W/DIFF | $41.00 | $41.00 | — |
| Complete blood count (CBC) with differential CPT 85025 BLD CNT COMP W/AUTO DIFF | $41.00 | $41.00 | — |
| Complete blood count (CBC) with differential CPT 85025 BLD CNT COMP W/AUTO DIFF POC | $41.00 | $41.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 AUTOMATED COMPLETE CBC W/DIFF | $41.00 | $41.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLD CNT COMP W/AUTO DIFF POC | $41.00 | $41.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLD CNT COMP W/AUTO DIFF | $41.00 | $41.00 | — |
| Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF | $34.00 | $34.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFF | $34.00 | $34.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE MP 1AGR CC | $55.00 | $55.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANE | $55.00 | $55.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $58.00 | $58.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANE | $55.00 | $55.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE MP 1AGR CC | $55.00 | $55.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL | $58.00 | $58.00 | — |
| Kidney function blood test panel CPT 80069 RFP | $44.00 | $44.00 | — |
| Kidney function blood test panel inpatient CPT 80069 RFP | $44.00 | $44.00 | — |
| Liver function blood test panel CPT 80076 HEPATIC PANEL | $42.00 | $42.00 | — |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION | $42.00 | $42.00 | — |
| Liver function blood test panel inpatient CPT 80076 HEPATIC PANEL | $42.00 | $42.00 | — |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION | $42.00 | $42.00 | — |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL (PNTL) | $146.00 | $146.00 | — |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL (PNTL) | $146.00 | $146.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA; FREE | $78.00 | $78.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA; FREE | $78.00 | $78.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL | $91.00 | $91.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA/TOTAL | $91.00 | $91.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA/TOTAL | $91.00 | $91.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL | $91.00 | $91.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 TO PTT (LUPPNL) | $32.00 | $32.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL | $32.00 | $32.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL | $32.00 | $32.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 TO PTT (LUPPNL) | $32.00 | $32.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POC | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMIN TIME (LUPPNL/MIXPT) | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 POC PT | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR POC | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMIN TIME (LUPPNL/MIXPT) | $21.00 | $21.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 POC PT | $21.00 | $21.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $88.00 | $88.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE (TSH) | $88.00 | $88.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIM HORMONE (TSH) | $88.00 | $88.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE | $88.00 | $88.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 URINALY AUTO W/ MICRO | $17.00 | $17.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/MICRO | $17.00 | $17.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALY AUTO W/ MICRO | $17.00 | $17.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/MICRO | $17.00 | $17.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-AUTOMATED W/O MICROSCOPY | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O MICRO | $12.00 | $12.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-AUTOMATED W/O MICROSCOPY | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICRO | $12.00 | $12.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPTICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTCK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIP STICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 UA, NON AUTO, WO MICRO | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS, DIPSTICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK,POCT | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK,WO/MICROSCOPY | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 UA WO MICRO | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS WITHOUT MICROSCO | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 UA,WO/MICRO, NON AUTOMATED | $14.00 | $14.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA WO MICRO | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTCK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS WITHOUT MICROSCO | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK,POCT | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA, NON AUTO, WO MICRO | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK,WO/MICROSCOPY | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPTICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIP STICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS, DIPSTICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK | $13.00 | $13.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 UA,WO/MICRO, NON AUTOMATED | $14.00 | $14.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL W/O ECP | $5,600.00 | $5,600.00 | — |
| Cataract surgery with lens implant inpatient CPT 66984 XCAPSL CTRC RMVL W/O ECP | $5,600.00 | $5,600.00 | — |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 CESAREAN DELIVERY | $8,110.00 | $8,110.00 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 CESAREAN DELIVERY | $8,110.00 | $8,110.00 | — |
| Colonoscopy with endoscopic ultrasound CPT 45391 COLONSCOPY W/ENDOSCOPIC ULTRASOUND EXAM | $720.00 | $720.00 | — |
| Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY W/ EUS | $4,510.00 | $4,510.00 | — |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONSCOPY W/ENDOSCOPIC ULTRASOUND EXAM | $720.00 | $720.00 | — |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY W/ EUS | $4,510.00 | $4,510.00 | — |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY TO CECUM FOR POLYPECTOMY | $715.00 | $715.00 | — |
| Colonoscopy with polyp removal CPT 45385 COLON W/ REM POLYP/TUM,SNARE | $4,090.00 | $4,090.00 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY TO CECUM FOR POLYPECTOMY | $715.00 | $715.00 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 COLON W/ REM POLYP/TUM,SNARE | $4,090.00 | $4,090.00 | — |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY TO CECUM FOR BRUSHING OR BIOPSY | $570.00 | $570.00 | — |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W/ BIOPSY(s) | $4,090.00 | $4,090.00 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY TO CECUM FOR BRUSHING OR BIOPSY | $570.00 | $570.00 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W/ BIOPSY(s) | $4,090.00 | $4,090.00 | — |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY TO CECUM | $525.00 | $525.00 | — |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEX,DX | $3,630.00 | $3,630.00 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY TO CECUM | $525.00 | $525.00 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEX,DX | $3,630.00 | $3,630.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY | $1,985.00 | $1,985.00 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY | $1,985.00 | $1,985.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INGUINAL HERNIA. | $1,575.00 | $1,575.00 | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR INGUINAL HERNIA. | $1,575.00 | $1,575.00 | — |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 LASERING, SECONDARY CATARACT | $875.00 | $875.00 | — |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 OST-CATARACT LASER SURGERY | $4,000.00 | $4,000.00 | — |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 LASERING, SECONDARY CATARACT | $875.00 | $875.00 | — |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 OST-CATARACT LASER SURGERY | $4,000.00 | $4,000.00 | — |
| Left heart catheterization, diagnostic CPT 93452 LHC INCL.VENT INJ & IMAG | $15,950.00 | $15,950.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W / VENTRCLGRPHY | $2,495.00 | $2,495.00 | — |
| Left heart catheterization, diagnostic inpatient CPT 93452 LHC INCL.VENT INJ & IMAG | $15,950.00 | $15,950.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HRT CATH W / VENTRCLGRPHY | $2,495.00 | $2,495.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ EPIDURAL LUMB/SACR W/ IMAG | $4,155.00 | $4,155.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ EPIDURAL LUMB/SACR W/ IMAG | $4,155.00 | $4,155.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC- | $220.00 | $220.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 LUMBAR EPIDURAL BLOCK | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ SINGLE,LUMBAR/SACRAL | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 SPINAL, SGL BLOCKLUM/SAC | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 CAUDAL BLOCK | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ,SGL,EPIDURAL/SUBARA,LUM/SA | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ EPIDURAL LUMB/SACR WO IMAG | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ DX/THERAP LUMBAR/CAUDAL | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC- | $220.00 | $220.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ DX/THERAP LUMBAR/CAUDAL | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ EPIDURAL LUMB/SACR WO IMAG | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ,SGL,EPIDURAL/SUBARA,LUM/SA | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 CAUDAL BLOCK | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 LUMBAR EPIDURAL BLOCK | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 SPINAL, SGL BLOCKLUM/SAC | $4,400.00 | $4,400.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ SINGLE,LUMBAR/SACRAL | $4,400.00 | $4,400.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANESTH/STEROID EPIDURAL, L | $2,978.00 | $2,978.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ EPIDURAL LUMB/SACR SGL LEV | $3,190.00 | $3,190.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANESTH/STEROID EPIDURAL, L | $2,978.00 | $2,978.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ EPIDURAL LUMB/SACR SGL LEV | $3,190.00 | $3,190.00 | — |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE | $365.00 | $365.00 | — |
| Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE | $365.00 | $365.00 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAP PROSTATECTOMY | $3,385.00 | $3,385.00 | — |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAP PROSTATECTOMY | $3,385.00 | $3,385.00 | — |
| Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION | $1,260.00 | $1,260.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION | $1,260.00 | $1,260.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS | $855.00 | $855.00 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REMOVE TONSILS AND ADENOIDS | $855.00 | $855.00 | — |
| Total hip replacement CPT 27130 TOTAL HIP JOINT REPLACEMENT | $3,795.00 | $3,795.00 | — |
| Total hip replacement inpatient CPT 27130 TOTAL HIP JOINT REPLACEMENT | $3,795.00 | $3,795.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY, BIOPSY | $390.00 | $390.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD W/ BIOPSY | $3,585.00 | $3,585.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD W/BIOPSY | $3,585.00 | $3,585.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY, BIOPSY | $390.00 | $390.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD W/ BIOPSY | $3,585.00 | $3,585.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD W/BIOPSY | $3,585.00 | $3,585.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY,DIAGNOSIS | $350.00 | $350.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD | $3,520.00 | $3,520.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GI ENDOSCOPY,DIAGNOSIS | $350.00 | $350.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD | $3,520.00 | $3,520.00 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 VAGINAL DEL TOTAL,POST CSECTION | $7,655.00 | $7,655.00 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 VAGINAL DEL TOTAL,POST CSECTION | $7,655.00 | $7,655.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OBSTETRICAL CARE | $7,245.00 | $7,245.00 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE | $7,245.00 | $7,245.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM, ROUTINE ECG COMPLETE | $45.00 | $45.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM, ROUTINE ECG COMPLETE | $45.00 | $45.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCH-INDIVID | $285.00 | $285.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHTHERAPY W PT PRESE | $587.00 | $587.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHTX W/PT 50MIN | $587.00 | $587.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCH-INDIVID | $285.00 | $285.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHTX W/PT 50MIN | $587.00 | $587.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHTHERAPY W PT PRESE | $587.00 | $587.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCH-W/O PT | $270.00 | $270.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY,W/O PT PR | $587.00 | $587.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHTX WO/ PT 50MIN | $587.00 | $587.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCH-W/O PT | $270.00 | $270.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHTX WO/ PT 50MIN | $587.00 | $587.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY,W/O PT PR | $587.00 | $587.00 | — |
| Group psychotherapy session CPT 90853 SPECIAL GROUP THERAPY | $70.00 | $70.00 | — |
| Group psychotherapy session CPT 90853 GROUP THERAPY | $328.00 | $328.00 | — |
| Group psychotherapy session CPT 90853 GROUP PSYCHO TX | $328.00 | $328.00 | — |
| Group psychotherapy session inpatient CPT 90853 SPECIAL GROUP THERAPY | $70.00 | $70.00 | — |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY | $328.00 | $328.00 | — |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHO TX | $328.00 | $328.00 | — |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30-44 MIN | $230.00 | $230.00 | — |
| New patient office visit, about 30 minutes CPT 99203 NP LEVEL 3 | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes CPT 99203 NEW PT LEVEL 3 | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes CPT 99203 NP LEVEL 3 WITH MODIFIER 25 | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes CPT 99203 NP LEVEL III | $603.00 | $603.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30-44 MIN | $230.00 | $230.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 NP LEVEL 3 WITH MODIFIER 25 | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT LEVEL 3 | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 NP LEVEL 3 | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30 MIN | $468.00 | $468.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 NP LEVEL III | $603.00 | $603.00 | — |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45-59 MIN | $375.00 | $375.00 | — |
| New patient office visit, about 45 minutes CPT 99204 NP LEVEL IV | $497.00 | $497.00 | — |
| New patient office visit, about 45 minutes CPT 99204 NP LEVEL 4 | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes CPT 99204 NP LEVEL 4 WITH MODIFIER 25 | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes CPT 99204 NEW PT LEVEL 4 | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45-59 MIN | $375.00 | $375.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 NP LEVEL IV | $497.00 | $497.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT LEVEL 4 | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45 MIN | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 NP LEVEL 4 WITH MODIFIER 25 | $528.00 | $528.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 NP LEVEL 4 | $528.00 | $528.00 | — |
| New patient office visit, about 60 minutes CPT 99205 NP LEVEL V | $497.00 | $497.00 | — |
| New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60-74 MIN | $510.00 | $510.00 | — |
| New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN | $603.00 | $603.00 | — |
| New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL 5 | $603.00 | $603.00 | — |
| New patient office visit, about 60 minutes CPT 99205 NP LEVEL 5 WITH MODIFIER 25 | $812.00 | $812.00 | — |
| New patient office visit, about 60 minutes CPT 99205 NP LEVEL 5 | $812.00 | $812.00 | — |
| New patient office visit, about 60 minutes CPT 99205 NEW PT LEVEL 5 | $812.00 | $812.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 NP LEVEL V | $497.00 | $497.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60-74 MIN | $510.00 | $510.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT LEVEL 5 | $603.00 | $603.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60 MIN | $603.00 | $603.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT LEVEL 5 | $812.00 | $812.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 NP LEVEL 5 WITH MODIFIER 25 | $812.00 | $812.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 NP LEVEL 5 | $812.00 | $812.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES | $85.00 | $85.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES EA 15MIN | $193.00 | $193.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES | $85.00 | $85.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES EA 15MIN | $193.00 | $193.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 INITIAL E&M HEALTHY 18-39 YR | $300.00 | $300.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREV EXAM NP AGE 18-39 | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 INIT PREV MED E/M, NP 18-39YRS | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 WELL VST,NP,18-39YR,(99385) | $468.00 | $468.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INITIAL E&M HEALTHY 18-39 YR | $300.00 | $300.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV EXAM NP AGE 18-39 | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT PREV MED E/M, NP 18-39YRS | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 WELL VST,NP,18-39YR,(99385) | $468.00 | $468.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 INITIAL E&M HEALTHY 40-64YRS | $300.00 | $300.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREV EXAM NP AGE 40-64 | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 INIT PREV MED E/M, NP 40-64YRS | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 WELL VST,NP 40-64YR,(99386) | $578.00 | $578.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INITIAL E&M HEALTHY 40-64YRS | $300.00 | $300.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV EXAM NP AGE 40-64 | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INIT PREV MED E/M, NP 40-64YRS | $392.00 | $392.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 WELL VST,NP 40-64YR,(99386) | $578.00 | $578.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT AND FAMILY 30 MINUTES | $190.00 | $190.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTX 30MIN W/PT | $617.00 | $617.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT AND FAMILY 30 MINUTES | $190.00 | $190.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTX 30MIN W/PT | $617.00 | $617.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT AND FAMILY 45 MINUTES | $250.00 | $250.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTX 45MIN W/PT | $675.00 | $675.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT AND FAMILY 45 MINUTES | $250.00 | $250.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTX 45MIN W/PT | $675.00 | $675.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX PT&/FAMILY 60 MINUTES | $370.00 | $370.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTX 60MIN W/PT | $699.00 | $699.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX PT&/FAMILY 60 MINUTES | $370.00 | $370.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTX 60MIN W/PT | $699.00 | $699.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT VISIT LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULTATON PT. LEVEL3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULTATION-LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULTATION PT. LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT VST - LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT PT LEVEL 3 | $661.00 | $661.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT VISIT LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULTATION-LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULTATION PT. LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULTATON PT. LEVEL3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT VST - LEVEL 3 | $495.00 | $495.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT PT LEVEL 3 | $661.00 | $661.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULTATON PT. LEVEL4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULTATION PT. LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT PT LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT VST - LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULTATION-LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT VISIT LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT PT LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT VISIT LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULTATON PT. LEVEL4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULTATION-LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT VST - LEVEL 4 | $660.00 | $660.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULTATION PT. LEVEL 4 | $660.00 | $660.00 | — |
Dental
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Porcelain crown CDT D2740 PORCELAIN JACKET | $2,640.00 | $2,640.00 | — |
| Porcelain crown inpatient CDT D2740 PORCELAIN JACKET | $2,640.00 | $2,640.00 | — |
Source file: https://hospitalpricedisclosure.com/download.aspx?pi=zkz93A*_*EfGBBA9koWjdYHA*-*