MaineHealth
MaineHealth in Belfast, ME publishes cash prices for 45 common procedures listed here, from its own machine-readable price file updated Sep 9, 2025. Click a procedure to compare it with other hospitals nearby.
118 Northport Ave, Belfast, ME 04915 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 ABD & PELVIS W/ CONTRAST | $4,781.90 | $4,781.90 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD & PELVIS W/ CONTRAST | $4,781.90 | $4,781.90 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD OR BRAIN W/O CONTRAST | $1,715.45 | $1,715.45 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD OR BRAIN W/O CONTRAST | $1,715.45 | $1,715.45 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/ CONTRAST | $2,055.55 | $2,055.55 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/ CONTRAST | $2,055.55 | $2,055.55 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI | $503.35 | $503.35 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BI | $503.35 | $503.35 | — |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI | $418.40 | $418.40 | — |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNI | $418.40 | $418.40 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JOINT LOWER EXTREM W/O CONTRAST | $2,352.50 | $2,352.50 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI JOINT LOWER EXTREM W/O CONTRAST | $2,352.50 | $2,352.50 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI JOINT LOWER EXTREM W/O & W/CONTRAST | $3,657.70 | $3,657.70 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI JOINT LOWER EXTREM W/O & W/CONTRAST | $3,657.70 | $3,657.70 | — |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN STEM W/O CONTRAST | $2,360.60 | $2,360.60 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN STEM W/O CONTRAST | $2,360.60 | $2,360.60 | — |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN STEM W/O & W/ CONTRAST | $3,088.05 | $3,088.05 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN STEM W/O & W/ CONTRAST | $3,088.05 | $3,088.05 | — |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST | $2,440.30 | $2,440.30 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST | $2,440.30 | $2,440.30 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US SINGLE FETUS >/= 14 WKS REAL TIME | $558.75 | $558.75 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US SINGLE FETUS >/= 14 WKS REAL TIME | $558.75 | $558.75 | — |
| Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO BI INCL CAD | $383.30 | $383.30 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO BI INCL CAD | $383.30 | $383.30 | — |
| Sleep study in a lab (polysomnography) CPT 95810 HC SLEEP STUDY STANDARD | $3,829.05 | $3,829.05 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC SLEEP STUDY STANDARD | $3,829.05 | $3,829.05 | — |
| Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL | $64.75 | $64.75 | — |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB | $107.00 | $107.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL | $371.00 | $371.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB | $732.85 | $732.85 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 CHG US TRANSVAGINAL | $64.75 | $64.75 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB | $107.00 | $107.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 CHG US TRANSVAGINAL | $371.00 | $371.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB | $732.85 | $732.85 | — |
| Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMINAL COMPLETE REAL TIME | $1,159.45 | $1,159.45 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMINAL COMPLETE REAL TIME | $1,159.45 | $1,159.45 | — |
| X-ray of the lower back, 4 or more views CPT 72110 HC XRAY EXAM L-2 SPINE 4/> VIEWS | $577.60 | $577.60 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XRAY EXAM L-2 SPINE 4/> VIEWS | $577.60 | $577.60 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC METAPANEL CALCIUM TOTAL | $136.35 | $136.35 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC METAPANEL CALCIUM TOTAL | $136.35 | $136.35 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL | $50.00 | $50.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL | $137.90 | $137.90 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL | $50.00 | $50.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL | $137.90 | $137.90 | — |
| Complete blood count (CBC) with differential CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $64.00 | $64.00 | — |
| Complete blood count (CBC) with differential CPT 85025 HC COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $76.95 | $76.95 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $64.00 | $64.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $76.95 | $76.95 | — |
| Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $43.00 | $43.00 | — |
| Complete blood count (CBC), no differential CPT 85027 HC COUNT COMPLETE AUTOMATED | $51.25 | $51.25 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $43.00 | $43.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC COUNT COMPLETE AUTOMATED | $51.25 | $51.25 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METAPANEL | $159.35 | $159.35 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPREHENSIVE METAPANEL | $159.35 | $159.35 | — |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $112.00 | $112.00 | — |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL | $112.00 | $112.00 | — |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL | $159.35 | $159.35 | — |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL | $159.35 | $159.35 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $152.55 | $152.55 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $152.55 | $152.55 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING | $152.55 | $152.55 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $152.55 | $152.55 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING | $152.55 | $152.55 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $152.55 | $152.55 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMTIME PARTIAL PLASMA/WHOLE BLOOD | $170.05 | $170.05 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC THROMTIME PARTIAL PLASMA/WHOLE BLOOD | $170.05 | $170.05 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $63.00 | $63.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMTIME | $74.30 | $74.30 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $74.30 | $74.30 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME | $63.00 | $63.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMTIME | $74.30 | $74.30 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $74.30 | $74.30 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $158.00 | $158.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH | $191.65 | $191.65 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $158.00 | $158.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC ASSAY OF THYROID STIMULATING HORMONE TSH | $191.65 | $191.65 | — |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W/SCOPE | $6.00 | $6.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $6.00 | $6.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 HC URNLS DIP STICK/TAREAGENT AUTO MICROSCOPY | $35.05 | $35.05 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $6.00 | $6.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTO W/SCOPE | $6.00 | $6.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URNLS DIP STICK/TAREAGENT AUTO MICROSCOPY | $35.05 | $35.05 | — |
| Urinalysis with microscope exam, manual CPT 81000 HC URINLS DIP STICK/TAREAGNT NON-AUTO MICRSCPY | $54.80 | $54.80 | — |
| Urinalysis with microscope exam, manual CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $56.00 | $56.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINLS DIP STICK/TAREAGNT NON-AUTO MICRSCPY | $54.80 | $54.80 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $56.00 | $56.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $21.00 | $21.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 HC URNLS DIP STICK/TARGNT AUTO W/O MICROSCOPY | $21.55 | $21.55 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $21.00 | $21.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URNLS DIP STICK/TARGNT AUTO W/O MICROSCOPY | $21.55 | $21.55 | — |
| Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $21.00 | $21.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 HC URNLS DIP STICK/TARGNT NON-AUTO W/O MICRSCP | $21.05 | $21.05 | — |
| Urinalysis without microscope exam, manual CPT 81002 HC URINE DIP STICK | $21.05 | $21.05 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $21.00 | $21.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URINE DIP STICK | $21.05 | $21.05 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC URNLS DIP STICK/TARGNT NON-AUTO W/O MICRSCP | $21.05 | $21.05 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAMINAR LMBR/SAC W/ IMG GUIDE | $507.50 | $507.50 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAMINAR LMBR/SAC W/ IMG GUIDE | $507.50 | $507.50 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ INTERLAMINAR LMBR/SAC W/O IMG GUIDE - ER RATE | $338.80 | $338.80 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ INTERLAMINAR LMBR/SAC W/O IMG GUIDE | $693.75 | $693.75 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ INTERLAMINAR LMBR/SAC W/O IMG GUIDE - ER RATE | $338.80 | $338.80 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ INTERLAMINAR LMBR/SAC W/O IMG GUIDE | $693.75 | $693.75 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $467.00 | $467.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC TRANSFORAM L/S SGL | $546.60 | $546.60 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $467.00 | $467.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC TRANSFORAM L/S SGL | $546.60 | $546.60 | — |
| Prostate biopsy CPT 55700 HC BIOPSY OF PROSTATE | $1,398.30 | $1,398.30 | — |
| Prostate biopsy inpatient CPT 55700 HC BIOPSY OF PROSTATE | $1,398.30 | $1,398.30 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OUTPT NEW LEV 3 - WOUND CARE CENTER | $64.75 | $64.75 | — |
| New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES - WOUND CARE | $222.70 | $222.70 | — |
| New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OUTPT NEW LEV 3 | $233.50 | $233.50 | — |
| New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $441.30 | $441.30 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE/OUTPT NEW LEV 3 - WOUND CARE CENTER | $64.75 | $64.75 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES - WOUND CARE | $222.70 | $222.70 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE/OUTPT NEW LEV 3 | $233.50 | $233.50 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $441.30 | $441.30 | — |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OUTPT NEW LEV 4 - WOUND CARE CENTER | $161.95 | $161.95 | — |
| New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES - WOUND CARE | $341.45 | $341.45 | — |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OUTPT NEW LEV 4 | $355.00 | $355.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $680.20 | $680.20 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE/OUTPT NEW LEV 4 - WOUND CARE CENTER | $161.95 | $161.95 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES - WOUND CARE | $341.45 | $341.45 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE/OUTPT NEW LEV 4 | $355.00 | $355.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $680.20 | $680.20 | — |
| New patient office visit, about 60 minutes CPT 99205 HC OFFICE/OUTPT NEW LEV 5 - WOUND CARE CENTER | $145.80 | $145.80 | — |
| New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES - WOUND CARE | $427.85 | $427.85 | — |
| New patient office visit, about 60 minutes CPT 99205 HC OFFICE/OUTPT NEW LEV 5 | $446.75 | $446.75 | — |
| New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $857.05 | $857.05 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE/OUTPT NEW LEV 5 - WOUND CARE CENTER | $145.80 | $145.80 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES - WOUND CARE | $427.85 | $427.85 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC OFFICE/OUTPT NEW LEV 5 | $446.75 | $446.75 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $857.05 | $857.05 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISES 1/> AREAS EA 15 MIN | $159.45 | $159.45 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISES 1/> AREAS EA 15 MIN | $159.45 | $159.45 | — |
| Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $118.75 | $118.75 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $118.75 | $118.75 | — |
| Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $157.90 | $157.90 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $157.90 | $157.90 | — |
| Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $232.15 | $232.15 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $232.15 | $232.15 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC OFFICE/OP CONSULT LEVEL III | $103.90 | $103.90 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $225.40 | $225.40 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC OFFICE/OP CONSULT LEVEL III | $103.90 | $103.90 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $225.40 | $225.40 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC OFFICE/OP CONSULT LEVEL IV | $159.35 | $159.35 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $336.00 | $336.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC OFFICE/OP CONSULT LEVEL IV | $159.35 | $159.35 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $336.00 | $336.00 | — |