Munson Healthcare Otsego Memorial Hospital
Munson Healthcare Otsego Memorial Hospital in Gaylord, MI publishes cash prices for 45 common procedures listed here, from its own machine-readable price file updated Apr 17, 2026. Click a procedure to compare it with other hospitals nearby.
825 N Center Ave, Gaylord, MI 49735 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 CT ABD + PELVIS W/IV CONT (NO ORAL) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 93077 CT ABD PELV W/ IV CONT | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exams | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exams | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93077 CT ABD PELV W/ IV CONT | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) | $3,065.95 | $3,607.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) | $3,065.95 | $3,607.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Exams | $1,319.20 | $1,552.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $1,319.20 | $1,552.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT STEALTH HEAD W/O CONTRAST | $1,319.20 | $1,552.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT STEALTH HEAD W/O CONTRAST | $1,319.20 | $1,552.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $1,319.20 | $1,552.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exams | $1,319.20 | $1,552.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Exams | $1,728.90 | $2,034.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) | $1,728.90 | $2,034.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) | $1,728.90 | $2,034.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) | $1,728.90 | $2,034.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) | $1,728.90 | $2,034.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exams | $1,728.90 | $2,034.00 | 15% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC BIL | $330.65 | $389.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL | $365.50 | $430.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL | $365.50 | $430.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA Exams | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DX FOLL PROCEDURE BIL | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD DX FOLLOW PROCEDURE BIL | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC BIL | $330.65 | $389.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL | $365.50 | $430.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL | $365.50 | $430.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Exams | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DX FOLL PROCEDURE BIL | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD DX FOLLOW PROCEDURE BIL | $384.20 | $452.00 | 15% |
| Diagnostic mammogram, one breast CPT 77065 MA Exams | $299.20 | $352.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MA Exams | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT | $297.50 | $350.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT | $312.80 | $368.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT | $312.80 | $368.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Exams | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Exams | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST LT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT | $2,427.60 | $2,856.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI HIPS BIL W/ + W/O CONTRAST | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Exams | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST RT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/ + W/O CONTRAST LT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI HIPS BIL W/ + W/O CONTRAST | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Exams | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST LT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/ + W/O CONTRAST RT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST RT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/ + W/O CONTRAST LT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST RT | $3,627.80 | $4,268.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/ + W/O CONTRAST LT | $3,627.80 | $4,268.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI INCOMPLETE BRAIN | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O VENTRICLES MEASUREMENT | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MR Exams | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O VENTRICLES MEASUREMENT | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Exams | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI INCOMPLETE BRAIN | $2,350.25 | $2,765.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Exams | $4,063.00 | $4,780.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST | $4,063.00 | $4,780.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ + W/O CONTRAST | $4,063.00 | $4,780.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Exams | $4,063.00 | $4,780.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MRI INCOMPLETE LUMBAR SPINE | $2,327.30 | $2,738.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,327.30 | $2,738.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MR Exams | $2,327.30 | $2,738.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI INCOMPLETE LUMBAR SPINE | $2,327.30 | $2,738.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Exams | $2,327.30 | $2,738.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,327.30 | $2,738.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exams | $702.10 | $826.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE | $702.10 | $826.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE- | $702.10 | $826.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 Wks Single Fetus 76805 READ | $703.80 | $828.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >=14 weeks Single Fetus 76805 | $703.80 | $828.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE- | $702.10 | $826.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exams | $702.10 | $826.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE | $702.10 | $826.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >= 14 Wks Single Fetus 76805 READ | $703.80 | $828.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >=14 weeks Single Fetus 76805 | $703.80 | $828.00 | 15% |
| Screening mammogram, both breasts both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts CPT 77067 MA MAMM 3D SCREENING BIL | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts CPT 77067 MA Exams | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING RT | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING LT | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN RT UNI | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN LT UNI | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 MA MAMM 3D SCREENING BIL | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 MA Exams | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN LT UNI | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING LT | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING RT | $330.65 | $389.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN RT UNI | $330.65 | $389.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810 | $2,907.00 | $3,420.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810 | $2,907.00 | $3,420.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Exams | $557.60 | $656.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB | $557.60 | $656.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Pelvis Complete 76856 READ | $558.45 | $657.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Pelvis Non-OB 76830 | $558.45 | $657.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 4611 US TRANSVAGINAL NON OB | $583.10 | $686.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER | $583.10 | $686.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB | $557.60 | $656.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Non-OB 76830 | $558.45 | $657.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Pelvis Complete 76856 READ | $558.45 | $657.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Exams | $583.10 | $686.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER | $583.10 | $686.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 4611 US TRANSVAGINAL NON OB | $583.10 | $686.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 US Exams | $751.40 | $884.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $751.40 | $884.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Exams | $751.40 | $884.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $751.40 | $884.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 GD Exams | $411.40 | $484.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4 V | $411.40 | $484.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT | $411.40 | $484.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT | $411.40 | $484.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4 V | $411.40 | $484.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 GD Exams | $411.40 | $484.00 | 15% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $85.00 | $100.00 | 15% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $85.00 | $100.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $85.85 | $101.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $85.85 | $101.00 | 15% |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential | $68.00 | $80.00 | 15% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential | $68.00 | $80.00 | 15% |
| Complete blood count (CBC), no differential CPT 85027 CBC without Differential | $40.80 | $48.00 | 15% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential | $40.80 | $48.00 | 15% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $119.00 | $140.00 | 15% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $119.00 | $140.00 | 15% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $106.25 | $125.00 | 15% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $106.25 | $125.00 | 15% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $122.40 | $144.00 | 15% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $122.40 | $144.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate Health Index Rflx, Serum | $57.35 | $67.47 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $70.55 | $83.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free and Total | $70.55 | $83.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate Health Index Rflx, Serum | $57.35 | $67.47 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $70.55 | $83.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free and Total | $70.55 | $83.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index Reflex, Serum | $10.66 | $12.53 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate-Specific Antigen (PSA) Ultrasensitive, Serum | $34.81 | $40.95 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic | $57.80 | $68.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4727 | $57.80 | $68.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4140 | $57.80 | $68.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index Reflex, Serum | $10.66 | $12.53 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate-Specific Antigen (PSA) Ultrasensitive, Serum | $34.81 | $40.95 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4140 | $57.80 | $68.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4727 | $57.80 | $68.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic | $57.80 | $68.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 85730 6787 | $39.24 | $46.16 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $50.15 | $59.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time Heparin Protocol | $50.15 | $59.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 6787 | $39.24 | $46.16 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time Heparin Protocol | $50.15 | $59.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $50.15 | $59.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 4832 | $8.27 | $9.72 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR POC | $8.93 | $10.50 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 PROTHROMBIN TIME/INR | $9.35 | $11.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CMDIN PROTHROMBIN TIME/INR | $9.35 | $11.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME BCE | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR (POCT) | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 4832 | $8.27 | $9.72 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR POC | $8.93 | $10.50 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CMDIN PROTHROMBIN TIME/INR | $9.35 | $11.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 PROTHROMBIN TIME/INR | $9.35 | $11.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME BCE | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $37.40 | $44.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR (POCT) | $38.25 | $45.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum | $28.25 | $33.23 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Function Cascade | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with Reflex to FT4 | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum | $28.25 | $33.23 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Function Cascade | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with Reflex to FT4 | $112.20 | $132.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $112.20 | $132.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Dipstick auto w/ Micro POC | $22.95 | $27.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic | $30.60 | $36.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Culture if Indicated | $30.60 | $36.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Dipstick auto w/ Micro POC | $22.95 | $27.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic | $30.60 | $36.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Culture if Indicated | $30.60 | $36.00 | 15% |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Dipstick non-auto with Micro POC | $35.70 | $42.00 | 15% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Dipstick non-auto with Micro POC | $35.70 | $42.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick (POCT) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC | $20.40 | $24.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 POC Urinalysis Dipstick auto - UC | $20.40 | $24.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC - UC | $20.40 | $24.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Ketones Urine | $22.10 | $26.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $22.10 | $26.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick (POCT) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC - UC | $20.40 | $24.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC | $20.40 | $24.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC Urinalysis Dipstick auto - UC | $20.40 | $24.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Ketones Urine | $22.10 | $26.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine | $22.10 | $26.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 DIPSTICK URINE BCE | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC - UC | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 N-AUTOM URINALYS WO MICRO | $18.70 | $22.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC - UC | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 DIPSTICK URINE BCE | $13.60 | $16.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 N-AUTOM URINALYS WO MICRO | $18.70 | $22.00 | 15% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Lower-back epidural injection, with imaging guidance CPT 62323 Epidural Interlaminar Lumbar/Sacral | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 CISTERNOGRAM INJECTION (NM) | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX Interlaminar LMBR/SAC 62323 | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection with imaging guidance 62323 | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GD Exams | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GD Exams | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Epidural Interlaminar Lumbar/Sacral | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CISTERNOGRAM INJECTION (NM) | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX Interlaminar LMBR/SAC 62323 | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection with imaging guidance 62323 | $1,827.50 | $2,150.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 1808 INJECT LUMBAR DIAGNOSTIC/1 | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJECT LUMBAR DIAGNOSTIC/1 | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection w/o imaging guidance 62322 | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTER LMBR/SAC MAT BCE | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTER LMBR/SAC MAT BCE | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 1808 INJECT LUMBAR DIAGNOSTIC/1 | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECT LUMBAR DIAGNOSTIC/1 | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Injection w/o imaging guidance 62322 | $1,267.35 | $1,491.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC | $1,267.35 | $1,491.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Foramen Epidural L/S 64483 | $1,505.35 | $1,771.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Epidural Transforaminal Lumbar/Sacral 1st Level | $1,505.35 | $1,771.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Epidural Transforaminal Lumbar/Sacral 1st Level | $1,505.35 | $1,771.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj Foramen Epidural L/S 64483 | $1,505.35 | $1,771.00 | 15% |
| Prostate biopsy CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700 | $3,717.05 | $4,373.00 | 15% |
| Prostate biopsy inpatient CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700 | $3,717.05 | $4,373.00 | 15% |
| Removal of a breast lump, open surgery CPT 19120 Biopsy 19120 | $5,503.75 | $6,475.00 | 15% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Biopsy 19120 | $5,503.75 | $6,475.00 | 15% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE | $131.75 | $155.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG - UC 93000 | $158.95 | $187.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 | $158.95 | $187.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE | $131.75 | $155.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - UC 93000 | $158.95 | $187.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 | $158.95 | $187.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New 99203 | $118.15 | $139.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 Office Outpatient Visit New L3 | $141.10 | $166.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 VIDEO OV Level 3 New 99203 | $170.85 | $201.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New 99203 | $118.15 | $139.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Outpatient Visit New L3 | $141.10 | $166.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 VIDEO OV Level 3 New 99203 | $170.85 | $201.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New 99204 | $118.15 | $139.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 Office Outpatient Visit New L4 | $192.10 | $226.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 VIDEO OV Level 4 New 99204 | $203.15 | $239.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New 99204 | $118.15 | $139.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Outpatient Visit New L4 | $192.10 | $226.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 VIDEO OV Level 4 New 99204 | $203.15 | $239.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New 99205 | $118.15 | $139.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 Office Outpatient Visit New L5 | $253.30 | $298.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 VIDEO OV Level 5 New 99205 | $284.75 | $335.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New 99205 | $118.15 | $139.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Outpatient Visit New L5 | $253.30 | $298.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 VIDEO OV Level 5 New 99205 | $284.75 | $335.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - PT MMC | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THER EX FACE 15 MIN IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 ST 97110 ST THER EX FACE 15 MIN | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 COTA Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - OT | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - OT | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 COTA Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise 15min | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 ST 97110 ST THER EX FACE 15 MIN | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THER EX FACE 15 MIN IP | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ | $130.05 | $153.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - PT MMC | $130.05 | $153.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy 30 Mins 90832 | $203.15 | $239.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 Mins 90832 | $203.15 | $239.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy 45 Mins 90834 | $215.05 | $253.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 Mins 90834 | $215.05 | $253.00 | 15% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy 60 Mins 90837 | $247.35 | $291.00 | 15% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy 60 Mins 90837 | $247.35 | $291.00 | 15% |