Providence St Joseph Medical Center
Providence St Joseph Medical Center in Polson, MT publishes cash prices for 68 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.
6 13th Ave E, Polson, MT 59860 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 HC CT ABDOMEN & PELVIS W CONTRAST | $2,883.20 | $3,604.00 | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,883.20 | $3,604.00 | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN WO CONTRAST | $829.60 | $1,037.00 | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN WO CONTRAST | $829.60 | $1,037.00 | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $1,429.60 | $1,787.00 | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $1,429.60 | $1,787.00 | 20% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI | $314.40 | $393.00 | 20% |
| Diagnostic mammogram, both breasts CPT 77066 HC MAMMO DIAG BIL W CAD | $314.40 | $393.00 | 20% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BI | $314.40 | $393.00 | 20% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 HC MAMMO DIAG BIL W CAD | $314.40 | $393.00 | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI | $246.40 | $308.00 | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC MAMMO DIAG UNI W CAD | $246.40 | $308.00 | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNI | $246.40 | $308.00 | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC MAMMO DIAG UNI W CAD | $246.40 | $308.00 | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST | $1,724.00 | $2,155.00 | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXTREMITY JOINT WO CONTRAST | $1,724.00 | $2,155.00 | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXTREMITY JOINT WO & W CONTRAST | $2,171.20 | $2,714.00 | 20% |
| 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 | $2,171.20 | $2,714.00 | 20% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O DYE | $1,764.00 | $2,205.00 | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O DYE | $1,764.00 | $2,205.00 | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/O & W/DYE | $2,816.80 | $3,521.00 | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/O & W/DYE | $2,816.80 | $3,521.00 | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O DYE | $1,956.80 | $2,446.00 | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O DYE | $1,956.80 | $2,446.00 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC PR 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION RHC | $200.00 | $250.00 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS | $710.40 | $888.00 | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB AFTER 1ST TRIMEST 1/1ST FETUS | $710.40 | $888.00 | 20% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD | $283.20 | $354.00 | 20% |
| Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD | $283.20 | $354.00 | 20% |
| Screening mammogram, both breasts CPT 77067 HC MAMMO SCREEN BIL W CAD | $283.20 | $354.00 | 20% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD | $283.20 | $354.00 | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN BIL W CAD | $283.20 | $354.00 | 20% |
| Screening mammogram, both breasts inpatient CPT 77067 HC MAMMO SCREEN UNIL/BIL W CAD | $283.20 | $354.00 | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PR 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND RHC | $933.60 | $1,167.00 | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE | $1,616.80 | $2,021.00 | 20% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMNOGRAPHY 4 OR MORE | $1,616.80 | $2,021.00 | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC PR 76830 TRANSVAGINAL US NON-OB RHC | $175.20 | $219.00 | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON-OB | $457.60 | $572.00 | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON-OB | $457.60 | $572.00 | 20% |
| Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE | $431.20 | $539.00 | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE | $431.20 | $539.00 | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS | $330.40 | $413.00 | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBOSACRAL MIN 4 VIEWS | $330.40 | $413.00 | 20% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $85.60 | $107.00 | 20% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL | $85.60 | $107.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR-CHOLESTEROL TOTAL | $90.40 | $113.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $90.40 | $113.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL LAB | $90.40 | $113.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL | $90.40 | $113.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR-CHOLESTEROL TOTAL | $90.40 | $113.00 | 20% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL LAB | $90.40 | $113.00 | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB | $40.80 | $51.00 | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC WITH DIFF AUTO | $64.00 | $80.00 | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $64.00 | $80.00 | 20% |
| Complete blood count (CBC) with differential CPT 85025 HC ABSOLUTE LYMPH COUNT | $103.20 | $129.00 | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC LAB | $40.80 | $51.00 | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $64.00 | $80.00 | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC WITH DIFF AUTO | $64.00 | $80.00 | 20% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC ABSOLUTE LYMPH COUNT | $103.20 | $129.00 | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB | $62.40 | $78.00 | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC CBC WITH NO DIFFERENTIAL | $62.40 | $78.00 | 20% |
| Complete blood count (CBC), no differential CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED | $62.40 | $78.00 | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED LAB | $62.40 | $78.00 | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC WITH NO DIFFERENTIAL | $62.40 | $78.00 | 20% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC BLOOD COUNT COMPLETE AUTOMATED | $62.40 | $78.00 | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHEN METABOLIC PANEL | $113.60 | $142.00 | 20% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHEN METABOLIC PANEL | $113.60 | $142.00 | 20% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL CDM | $88.80 | $111.00 | 20% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL CDM | $88.80 | $111.00 | 20% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL CDM | $76.80 | $96.00 | 20% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL CDM | $76.80 | $96.00 | 20% |
| Obstetric blood test panel CPT 80055 HC OBSTETRIC PANEL LAB | $325.60 | $407.00 | 20% |
| Obstetric blood test panel inpatient CPT 80055 HC OBSTETRIC PANEL LAB | $325.60 | $407.00 | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB | $149.60 | $187.00 | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE | $149.60 | $187.00 | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE | $149.60 | $187.00 | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PROSTATE SPECIFIC ANTIGEN FREE | $149.60 | $187.00 | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE LAB | $149.60 | $187.00 | 20% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE | $149.60 | $187.00 | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | $143.20 | $179.00 | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC FREE PSA PSA TOTAL | $158.40 | $198.00 | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | $158.40 | $198.00 | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL LAB | $143.20 | $179.00 | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL CDM | $158.40 | $198.00 | 20% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC FREE PSA PSA TOTAL | $158.40 | $198.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PART THROMBOPLASTIN TIME | $20.00 | $25.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL | $40.80 | $51.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB | $40.80 | $51.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT (LUPUS ANTICOAG) PLASMA | $62.40 | $78.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC APTT | $62.40 | $78.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD CDM | $62.40 | $78.00 | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PARTIAL THROMBOPLASTIN-TIME | $114.40 | $143.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PART THROMBOPLASTIN TIME | $20.00 | $25.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD LAB | $40.80 | $51.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL | $40.80 | $51.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT (LUPUS ANTICOAG) PLASMA | $62.40 | $78.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD CDM | $62.40 | $78.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC APTT | $62.40 | $78.00 | 20% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PARTIAL THROMBOPLASTIN-TIME | $114.40 | $143.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TM | $13.60 | $17.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME 85610 | $15.20 | $19.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PT COAG PANEL | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME CDM | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PT INR CONFIRMATION | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME LAB | $74.40 | $93.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTIME (LUPUS ANTICOAG) | $74.40 | $93.00 | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $114.40 | $143.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TM | $13.60 | $17.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME 85610 | $15.20 | $19.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTIME | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME CDM | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT COAG PANEL | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PT INR CONFIRMATION | $59.20 | $74.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTIME (LUPUS ANTICOAG) | $74.40 | $93.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME LAB | $74.40 | $93.00 | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $114.40 | $143.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH | $73.60 | $92.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB | $73.60 | $92.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE TSH | $73.60 | $92.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH REFLEX TO FT4 | $136.00 | $170.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORMONE (TSH) | $136.00 | $170.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH | $73.60 | $92.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE TSH | $73.60 | $92.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH LAB | $73.60 | $92.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORMONE (TSH) | $136.00 | $170.00 | 20% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH REFLEX TO FT4 | $136.00 | $170.00 | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | $52.80 | $66.00 | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | $57.60 | $72.00 | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY LAB | $52.80 | $66.00 | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY CDM | $57.60 | $72.00 | 20% |
| Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS BY DIPSTICK | $19.20 | $24.00 | 20% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS BY DIPSTICK | $19.20 | $24.00 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB | $40.00 | $50.00 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC PROTEIN URINE QUALITATIVE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC SPECIFIC GRAVITY URINE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTO W/O SCOPE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC KETONE URINE QUALITATIVE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY LAB | $40.00 | $50.00 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC SPECIFIC GRAVITY URINE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC PROTEIN URINE QUALITATIVE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS AUTO W/O SCOPE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC KETONE URINE QUALITATIVE | $44.00 | $55.00 | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC PR 81002 URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC PR 81002 URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM | $10.40 | $13.00 | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC DIP UA IF NOT SENT TO LAB | $25.60 | $32.00 | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC PR 81002 URINALYSIS NONAUTO W/O SCOPE | $7.20 | $9.00 | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP CDM | $10.40 | $13.00 | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC DIP UA IF NOT SENT TO LAB | $25.60 | $32.00 | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR | $3,296.80 | $4,121.00 | 20% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR | $3,296.80 | $4,121.00 | 20% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 HC PR 59510 TOTAL OB/CESAREAN DELIVERY/PP CAR | $3,296.80 | $4,121.00 | 20% |
| Colonoscopy with polyp removal CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | $369.60 | $462.00 | 20% |
| Colonoscopy with polyp removal CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | $686.40 | $858.00 | 20% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC PR 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ CDM | $369.60 | $462.00 | 20% |
| Colonoscopy with tissue sample CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM | $291.20 | $364.00 | 20% |
| Colonoscopy with tissue sample CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM | $660.00 | $825.00 | 20% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC PR 45380 COLONOSCOPY FLEXIBLE W/BIOPSY SINGLE/MULTIPLE CDM | $291.20 | $364.00 | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $268.00 | $335.00 | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM | $321.60 | $402.00 | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $512.00 | $640.00 | 20% |
| Colonoscopy, diagnostic CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM | $614.40 | $768.00 | 20% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC PR 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD CDM | $268.00 | $335.00 | 20% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC PR 45378 DX COLONOSCOPY FLEXIBLE W/COLLTN SPEC WHEN PFRMD CDM | $321.60 | $402.00 | 20% |
| Gallbladder removal, laparoscopic CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $980.80 | $1,226.00 | 20% |
| Gallbladder removal, laparoscopic CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $980.80 | $1,226.00 | 20% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 HC PR 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $980.80 | $1,226.00 | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE | $776.80 | $971.00 | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE | $776.80 | $971.00 | 20% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC PR 49505 REPAIR INGUINAL HERNIA INITIAL BLOCK >5 YR REDUCIBLE | $776.80 | $971.00 | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | $960.00 | $1,200.00 | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | $960.00 | $1,200.00 | 20% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 HC PR 29881 KNEE ARTHROSCOPY/SURGERY MENISECTOMY | $960.00 | $1,200.00 | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC PR 62323 INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $138.40 | $173.00 | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $872.00 | $1,090.00 | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC PR 62323 INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $138.40 | $173.00 | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ W/NDL OR CATH PLCMNT EPIDRL L/S W/IMG | $872.00 | $1,090.00 | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC PR 62322 INJ INTERLAMINAR LMBR/SAC W/O IMG | $180.00 | $225.00 | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC PR 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN RHC | $196.00 | $245.00 | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $841.60 | $1,052.00 | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC PR 62322 INJ INTERLAMINAR LMBR/SAC W/O IMG | $180.00 | $225.00 | 20% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $841.60 | $1,052.00 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC PR 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL RHC | $362.40 | $453.00 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ FORAMEN EPIDURAL L/S | $916.00 | $1,145.00 | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ FORAMEN EPIDURAL L/S | $916.00 | $1,145.00 | 20% |
| Prostate biopsy CPT 55700 HC PR 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH RHC | $358.40 | $448.00 | 20% |
| Removal of a breast lump, open surgery CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS | $616.80 | $771.00 | 20% |
| Removal of a breast lump, open surgery CPT 19120 HC PR 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION RHC | $771.20 | $964.00 | 20% |
| Removal of a breast lump, open surgery CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS | $771.20 | $964.00 | 20% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC PR 19120 REMOVAL OF BREAST LESION 1 OR MORE LESIONS | $616.80 | $771.00 | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC PR 29826 SHOULDER ARTHROSCOPY/SURGERY SUBACRMIAL DCMP | $253.60 | $317.00 | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 HC PR 29826 SHOULDER ARTHROSCOPY/SURGERY SUBACRMIAL DCMP | $253.60 | $317.00 | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 HC PR 29826 SHOULDER ARTHROSCOPY/SURGERY SUBACRMIAL DCMP | $253.60 | $317.00 | 20% |
| Tonsil and adenoid removal, child under 12 CPT 42820 HC PR 42820 REMOVAL OF TONSILLS AND ADENOIDS/YOUNGER THAN 12 YRS | $427.20 | $534.00 | 20% |
| Tonsil and adenoid removal, child under 12 CPT 42820 HC PR 42820 REMOVAL OF TONSILLS AND ADENOIDS/YOUNGER THAN 12 YRS | $427.20 | $534.00 | 20% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 HC PR 42820 REMOVAL OF TONSILLS AND ADENOIDS/YOUNGER THAN 12 YRS | $427.20 | $534.00 | 20% |
| Total hip replacement CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $1,886.40 | $2,358.00 | 20% |
| Total hip replacement CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $1,886.40 | $2,358.00 | 20% |
| Total hip replacement CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY | $1,886.40 | $2,358.00 | 20% |
| Total hip replacement CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY | $1,886.40 | $2,358.00 | 20% |
| Total hip replacement inpatient CPT 27130 HC PR 27130 TOTAL HIP ARTHROPLASTY | $1,886.40 | $2,358.00 | 20% |
| Total hip replacement inpatient CPT 27130 HC PR 27130 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $1,886.40 | $2,358.00 | 20% |
| Total knee replacement CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY | $1,884.00 | $2,355.00 | 20% |
| Total knee replacement CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY | $1,884.00 | $2,355.00 | 20% |
| Total knee replacement inpatient CPT 27447 HC PR 27447 TOTAL KNEE ARTHROPLASTY | $1,884.00 | $2,355.00 | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE | $200.80 | $251.00 | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE | $577.60 | $722.00 | 20% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC PR 43239 EGD BIOPSY SINGLE/MULTIPLE | $200.80 | $251.00 | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | $178.40 | $223.00 | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | $451.20 | $564.00 | 20% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC PR 43235 EGD DIAGNOSTIC BRUSH WASH | $178.40 | $223.00 | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 HC PR 59610 TOTAL OB/VBAC/PP CARE | $3,066.40 | $3,833.00 | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 HC PR 59610 TOTAL OB/VBAC/PP CARE | $3,066.40 | $3,833.00 | 20% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 HC PR 59610 TOTAL OB/VBAC/PP CARE | $3,066.40 | $3,833.00 | 20% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE | $2,908.80 | $3,636.00 | 20% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE | $2,908.80 | $3,636.00 | 20% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 HC PR 59400 TOTAL OB/VAGINAL DELIVERY/PP CARE | $2,908.80 | $3,636.00 | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC PR 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R RHC | $21.60 | $27.00 | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $145.60 | $182.00 | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $146.40 | $183.00 | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 PSYTX FAMILY W PT 50 MIN RHC | $146.40 | $183.00 | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PR 90847 FAMILY PSYTX W/PATIENT | $158.40 | $198.00 | 20% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PR 90847 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $145.60 | $182.00 | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $140.00 | $175.00 | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $141.60 | $177.00 | 20% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PR 90846 PSYTX FAMILY WO PT 50 MIN RHC | $141.60 | $177.00 | 20% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PR 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $140.00 | $175.00 | 20% |
| Group psychotherapy session CPT 90853 HC PR 90853 GROUP PSYCHOTHERAPY 120 MIN | $34.40 | $43.00 | 20% |
| Group psychotherapy session CPT 90853 HC PR 90853 GROUP PSYCHOTHERAPY 120 MIN | $39.20 | $49.00 | 20% |
| Group psychotherapy session CPT 90853 HC PR 90853 PSYTX GROUP RHC | $39.20 | $49.00 | 20% |
| Group psychotherapy session inpatient CPT 90853 HC PR 90853 GROUP PSYCHOTHERAPY 120 MIN | $34.40 | $43.00 | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC NEW PT VISIT - LEVEL 3 | $115.20 | $144.00 | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 CDM | $115.20 | $144.00 | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $121.60 | $152.00 | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $163.20 | $204.00 | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC PR 99203 OFFICE OUTPATIENT NEW RHC | $167.20 | $209.00 | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC L&D TRIAGE NEW PATIENT LVL 3 CDM | $115.20 | $144.00 | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW PT VISIT - LEVEL 3 | $115.20 | $144.00 | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC PR 99203 NEW PT VISIT - LEVEL 3 | $121.60 | $152.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $196.00 | $245.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 CDM | $231.20 | $289.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC NEW PT VISIT - LEVEL 4 | $242.40 | $303.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $243.20 | $304.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 HC PR 99204 OFFICE OUTPATIENT NEW RHC | $251.20 | $314.00 | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC PR 99204 NEW PT VISIT - LEVEL 4 | $196.00 | $245.00 | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC L&D TRIAGE NEW PATIENT LVL 4 CDM | $231.20 | $289.00 | 20% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PT VISIT - LEVEL 4 | $242.40 | $303.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC NEW PT VISIT - LEVEL 5 | $255.20 | $319.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 CDM | $260.00 | $325.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $266.40 | $333.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $321.60 | $402.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 HC PR 99205 OFFICE OUTPATIENT NEW RHC | $331.20 | $414.00 | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC NEW PT VISIT - LEVEL 5 | $255.20 | $319.00 | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC L&D TRIAGE NEW PATIENT LVL 5 CDM | $260.00 | $325.00 | 20% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC PR 99205 NEW PT VISIT - LEVEL 5 | $266.40 | $333.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM | $68.00 | $85.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN | $68.00 | $85.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISES PX 1 OR MORE AREAS EACH 15 MIN | $68.00 | $85.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC CRISIS TELEH 97110 THERAPEUTIC EXERCISES EA 15 MIN CDM | $68.00 | $85.00 | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39 | $140.80 | $176.00 | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | $140.80 | $176.00 | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 DOT PHYSICAL AGE 18-39 NEW PT RHC | $191.20 | $239.00 | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39 | $191.20 | $239.00 | 20% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | $193.60 | $242.00 | 20% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PR 99385 PREV VISIT NEW AGE 18-39 | $140.80 | $176.00 | 20% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC | $140.80 | $176.00 | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64 | $170.40 | $213.00 | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | $170.40 | $213.00 | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64 | $220.80 | $276.00 | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 DOT PHYSICAL AGE 40-64 NEW PT RHC | $223.20 | $279.00 | 20% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | $223.20 | $279.00 | 20% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PR 99386 PREV VISIT NEW AGE 40-64 | $170.40 | $213.00 | 20% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PR 99386 PREVENTIVE VISIT NEW 40-64 RHC | $170.40 | $213.00 | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $99.20 | $124.00 | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $112.00 | $140.00 | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PR 90832 PSYTX W PT 30 MIN RHC | $112.00 | $140.00 | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PR 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES | $99.20 | $124.00 | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $130.40 | $163.00 | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $148.00 | $185.00 | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PR 90834 PSYTX W PT 45 MIN RHC | $148.00 | $185.00 | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PR 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES | $130.40 | $163.00 | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $191.20 | $239.00 | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $216.80 | $271.00 | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PR 90837 PSYTX W PT 60 MIN RHC | $216.80 | $271.00 | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES | $191.20 | $239.00 | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $137.60 | $172.00 | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES RHC | $168.00 | $210.00 | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $174.40 | $218.00 | 20% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC PR 99243 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES CDM | $137.60 | $172.00 | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $219.20 | $274.00 | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES RHC | $239.20 | $299.00 | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $260.00 | $325.00 | 20% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES CDM | $219.20 | $274.00 | 20% |
Source file: https://pricetransparency.providence.org/wamt/live/810463482_providence-st-joseph-medical-center_standardcharges.json