SelfPayRates
Hospital Walla Walla, WA

Providence Health And Services - Washington

Providence Health And Services - Washington in Walla Walla, WA publishes cash prices for 46 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.

401 W Poplar St, Walla Walla, WA 99362 Collected Sep 23, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST $2,858.10 $4,083.00 30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST $3,572.80 $5,104.00 30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST $3,572.80 $5,104.00 30%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST $968.10 $1,383.00 30%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST $1,209.60 $1,728.00 30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST $1,209.60 $1,728.00 30%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST $1,451.80 $2,074.00 30%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST $1,815.10 $2,593.00 30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST $1,815.10 $2,593.00 30%
Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD $545.30 $779.00 30%
Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD $545.30 $779.00 30%
Diagnostic mammogram, one breast CPT 77065 HC MAMMO DIAG UNI W CAD $489.30 $699.00 30%
Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMO DIAG UNI W CAD $489.30 $699.00 30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JNT OF LWR EXTRE W/O DYE LIMITED $1,233.40 $1,762.00 30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST $2,258.90 $3,227.00 30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI JNT OF LWR EXTRE W/O DYE LIMITED $1,233.40 $1,762.00 30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST $2,258.90 $3,227.00 30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST $4,088.70 $5,841.00 30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST $4,088.70 $5,841.00 30%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE $1,418.20 $2,026.00 30%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O DYE LIMITED $1,418.20 $2,026.00 30%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE $1,418.20 $2,026.00 30%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O DYE LIMITED $1,418.20 $2,026.00 30%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE $2,258.20 $3,226.00 30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE $2,258.20 $3,226.00 30%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE LIMITED $2,705.50 $3,865.00 30%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE $2,940.70 $4,201.00 30%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE LIMITED $2,705.50 $3,865.00 30%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE $2,940.70 $4,201.00 30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS $672.00 $960.00 30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS $1,053.50 $1,505.00 30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS $1,053.50 $1,505.00 30%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD $336.70 $481.00 30%
Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD $428.40 $612.00 30%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD $336.70 $481.00 30%
Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD $428.40 $612.00 30%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAM REDUCED SERVICE $1,705.20 $2,436.00 30%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAM 1 ON 1 PT $3,409.70 $4,871.00 30%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE $3,409.70 $4,871.00 30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAM REDUCED SERVICE $1,705.20 $2,436.00 30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE $3,409.70 $4,871.00 30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAM 1 ON 1 PT $3,409.70 $4,871.00 30%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB $422.80 $604.00 30%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB $662.20 $946.00 30%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB $662.20 $946.00 30%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE $653.80 $934.00 30%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE $1,023.40 $1,462.00 30%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE $1,023.40 $1,462.00 30%
X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS $512.40 $732.00 30%
X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS $802.20 $1,146.00 30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS $802.20 $1,146.00 30%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL $82.60 $118.00 30%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL $82.60 $118.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB $14.70 $21.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR-CHOLESTEROL TOTAL $25.20 $36.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL CDM $71.40 $102.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL - PAML $90.30 $129.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL OF NMR $95.20 $136.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE $96.60 $138.00 30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL $116.90 $167.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB $14.70 $21.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR-CHOLESTEROL TOTAL $25.20 $36.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL CDM $71.40 $102.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL - PAML $90.30 $129.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL OF NMR $95.20 $136.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE $96.60 $138.00 30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL $116.90 $167.00 30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB $18.20 $26.00 30%
Complete blood count (CBC) with differential CPT 85025 HC CBC $18.20 $26.00 30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC CDM $63.70 $91.00 30%
Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC W/AUTO DIF WBC $91.00 $130.00 30%
Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC $121.10 $173.00 30%
Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO $121.10 $173.00 30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC $18.20 $26.00 30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB $18.20 $26.00 30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC CDM $63.70 $91.00 30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC COMPLETE CBC W/AUTO DIF WBC $91.00 $130.00 30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH DIFF AUTO $121.10 $173.00 30%
Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC $121.10 $173.00 30%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED $93.80 $134.00 30%
Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB $93.80 $134.00 30%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB $93.80 $134.00 30%
Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED $93.80 $134.00 30%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL $126.70 $181.00 30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL $126.70 $181.00 30%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM $95.20 $136.00 30%
Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM $95.20 $136.00 30%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL LAB $19.60 $28.00 30%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM $98.00 $140.00 30%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL LAB $19.60 $28.00 30%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM $98.00 $140.00 30%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL $50.40 $72.00 30%
Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL LAB $148.40 $212.00 30%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL $50.40 $72.00 30%
Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL LAB $148.40 $212.00 30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE $25.20 $36.00 30%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB $25.20 $36.00 30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE $25.20 $36.00 30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB $25.20 $36.00 30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC AG TOT(PAML) $27.30 $39.00 30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATIC SPECIFIC AG $48.30 $69.00 30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB $142.80 $204.00 30%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM $156.80 $224.00 30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC AG TOT(PAML) $27.30 $39.00 30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATIC SPECIFIC AG $48.30 $69.00 30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB $142.80 $204.00 30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM $156.80 $224.00 30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA LAB $11.20 $16.00 30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB $11.20 $16.00 30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT (LUPUS ANTICOAG) PLASMA $11.90 $17.00 30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD (RL) $17.50 $25.00 30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL $21.00 $30.00 30%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD $46.90 $67.00 30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA LAB $11.20 $16.00 30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB $11.20 $16.00 30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT (LUPUS ANTICOAG) PLASMA $11.90 $17.00 30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD (RL) $17.50 $25.00 30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL $21.00 $30.00 30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD $46.90 $67.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB $11.20 $16.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME (RT) $14.00 $20.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME (LUPUS ANTICOAG) $22.40 $32.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME $46.90 $67.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC AC PROTIME $65.10 $93.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610 $65.10 $93.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC COAGUCHECK WAIVED TESTING $70.70 $101.00 30%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN $72.80 $104.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB $11.20 $16.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME (RT) $14.00 $20.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTIME (LUPUS ANTICOAG) $22.40 $32.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME $46.90 $67.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610 $65.10 $93.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC AC PROTIME $65.10 $93.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC COAGUCHECK WAIVED TESTING $70.70 $101.00 30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN $72.80 $104.00 30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB $16.80 $24.00 30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH CDM $23.10 $33.00 30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMON $28.70 $41.00 30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4 $48.30 $69.00 30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH $180.60 $258.00 30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB $16.80 $24.00 30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH CDM $23.10 $33.00 30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY THYROID STIM HORMON $28.70 $41.00 30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4 $48.30 $69.00 30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH $180.60 $258.00 30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY $46.20 $66.00 30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM $98.70 $141.00 30%
Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB $98.70 $141.00 30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY $46.20 $66.00 30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB $98.70 $141.00 30%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM $98.70 $141.00 30%
Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS BY DIPSTICK $26.60 $38.00 30%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS BY DIPSTICK $26.60 $38.00 30%
Urinalysis without microscope exam, automated CPT 81003 HC AUTOM URINALYSIS WO MICRO (RL) $7.00 $10.00 30%
Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB $9.10 $13.00 30%
Urinalysis without microscope exam, automated CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB $26.60 $38.00 30%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE $78.40 $112.00 30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC AUTOM URINALYSIS WO MICRO (RL) $7.00 $10.00 30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB $9.10 $13.00 30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC PH URINE DIPSTICK AUTO W/O MICROSCOPY LAB $26.60 $38.00 30%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE $78.40 $112.00 30%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP $17.50 $25.00 30%
Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM $42.70 $61.00 30%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP $17.50 $25.00 30%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM $42.70 $61.00 30%

Surgery and procedures

ProcedureCash price List priceOff list
Colonoscopy, diagnostic CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM $2,172.80 $3,104.00 30%
Colonoscopy, diagnostic inpatient CPT 45378 HC ED COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM $2,172.80 $3,104.00 30%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM $7,964.60 $11,378.00 30%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC ED RPR 1ST INGUN HRNA AGE 5 YRS OR MORE REDUCIBLE CDM $7,964.60 $11,378.00 30%
Left heart catheterization, diagnostic one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY $9,835.00 $14,050.00 30%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LEFT HRT CATH W/VENTRCLGRPHY $9,835.00 $14,050.00 30%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG $1,779.40 $2,542.00 30%
Lower-back epidural injection, with imaging guidance CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM $1,779.40 $2,542.00 30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC ED INJ EPI LUMB/SACRAL W IMAGING CDM $1,779.40 $2,542.00 30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG $1,779.40 $2,542.00 30%
Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN $2,071.30 $2,959.00 30%
Lower-back epidural injection, without imaging guidance CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM $2,071.30 $2,959.00 30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN $2,071.30 $2,959.00 30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC ED INJ EPI LUMB/SACRAL WO IMAGING CDM $2,071.30 $2,959.00 30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S $3,542.00 $5,060.00 30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S $3,542.00 $5,060.00 30%
Prostate biopsy CPT 55700 HC BIOPSY OF PROSTATE $3,922.10 $5,603.00 30%
Prostate biopsy inpatient CPT 55700 HC BIOPSY OF PROSTATE $3,922.10 $5,603.00 30%
Upper endoscopy (EGD) with biopsy CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM $2,046.10 $2,923.00 30%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC ED EGD TRANSORAL BIOPSY SINGLE/MULTIPLE CDM $2,046.10 $2,923.00 30%
Upper endoscopy (EGD), diagnostic CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM $1,983.80 $2,834.00 30%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC ED ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC CDM $1,983.80 $2,834.00 30%

Doctor visits and therapy

ProcedureCash price List priceOff list
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC ECG 12 LEAD W/INTERP & REPORT $84.00 $120.00 30%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC ECG 12 LEAD W/INTERP & REPORT $84.00 $120.00 30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN $53.20 $76.00 30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN $53.20 $76.00 30%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE CONSULTATION LEVEL 3 $105.70 $151.00 30%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC OFFICE CONSULTATION LEVEL 3 $105.70 $151.00 30%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE CONSULTATION LEVEL 4 $105.70 $151.00 30%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC OFFICE CONSULTATION LEVEL 4 $105.70 $151.00 30%

Source file: https://pricetransparency.providence.org/wamt/live/300502262_providence-st-mary-medical-center_standardcharges.json