Munson Medical Center
Munson Medical Center in Traverse City, MI publishes cash prices for 49 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.
1105 Sixth St, Traverse City, MI 49684 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 93079 CT ABD PELV W/ IV+ORAL CONT | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 93077 CT ABD PELV W/ IV CONT | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exams | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93077 CT ABD PELV W/ IV CONT | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) | $3,167.10 | $3,726.00 | 15% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exams | $3,167.10 | $3,726.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $1,338.75 | $1,575.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Exams | $1,338.75 | $1,575.00 | 15% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT STEALTH HEAD W/O CONTRAST | $1,338.75 | $1,575.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exams | $1,338.75 | $1,575.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT STEALTH HEAD W/O CONTRAST | $1,338.75 | $1,575.00 | 15% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $1,338.75 | $1,575.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) | $2,020.45 | $2,377.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Exams | $2,020.45 | $2,377.00 | 15% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) | $2,020.45 | $2,377.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) | $2,020.45 | $2,377.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) | $2,020.45 | $2,377.00 | 15% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exams | $2,020.45 | $2,377.00 | 15% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL | $401.20 | $472.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL | $401.20 | $472.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA Exams | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD DX FOLLOW PROCEDURE BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DX FOLL PROCEDURE BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL | $401.20 | $472.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL | $401.20 | $472.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD DX FOLLOW PROCEDURE BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DX FOLL PROCEDURE BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Exams | $417.35 | $491.00 | 15% |
| Diagnostic mammogram, one breast CPT 77065 MA Exams | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MA Exams | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT | $311.10 | $366.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DX FOLL PROCEDURE LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE RT | $323.85 | $381.00 | 15% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD DX FOLLOW PROCEDURE LT | $323.85 | $381.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Exams | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Exams | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RT | $2,718.30 | $3,198.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Exams | $3,754.45 | $4,417.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI HIPS BIL W/ + W/O CONTRAST | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 15% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Exams | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 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 | $3,754.45 | $4,417.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI INCOMPLETE BRAIN | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O VENTRICLES MEASUREMENT | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN CSF FLOW STUDY W/O | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye CPT 70551 MR Exams | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR Exams | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN CSF FLOW STUDY W/O | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O VENTRICLES MEASUREMENT | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI INCOMPLETE BRAIN | $2,841.55 | $3,343.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Exams | $3,740.85 | $4,401.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN CSF FLOW STUDY W/ + W/O | $3,740.85 | $4,401.00 | 15% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST | $3,740.85 | $4,401.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN CSF FLOW STUDY W/ + W/O | $3,740.85 | $4,401.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ + W/O CONTRAST | $3,740.85 | $4,401.00 | 15% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Exams | $3,740.85 | $4,401.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MR Exams | $2,468.40 | $2,904.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,468.40 | $2,904.00 | 15% |
| MRI of the lower back, no contrast dye CPT 72148 MRI INCOMPLETE LUMBAR SPINE | $2,468.40 | $2,904.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR Exams | $2,468.40 | $2,904.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST | $2,468.40 | $2,904.00 | 15% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI INCOMPLETE LUMBAR SPINE | $2,468.40 | $2,904.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE- | $684.25 | $805.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE | $719.10 | $846.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exams | $719.10 | $846.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >=14 weeks Single Fetus 76805 | $719.10 | $846.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE- | $684.25 | $805.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >=14 weeks Single Fetus 76805 | $719.10 | $846.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exams | $719.10 | $846.00 | 15% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE | $719.10 | $846.00 | 15% |
| Screening mammogram, both breasts both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts CPT 77067 MA MAMM 3D SCREENING BIL | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts CPT 77067 MA Exams | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING RT | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING LT | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN RT UNI | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN LT UNI | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 MA Exams | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient CPT 77067 MA MAMM 3D SCREENING BIL | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING RT | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING LT | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN RT UNI | $322.15 | $379.00 | 15% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN LT UNI | $322.15 | $379.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810 | $3,115.25 | $3,665.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG Study Reduced Serv (C) | $3,115.25 | $3,665.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM 95810 | $3,996.70 | $4,702.00 | 15% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG Study (C) | $3,996.70 | $4,702.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG Study Reduced Serv (C) | $3,115.25 | $3,665.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6/> Yrs 4/> par RDC 95810 | $3,115.25 | $3,665.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM 95810 | $3,996.70 | $4,702.00 | 15% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG Study (C) | $3,996.70 | $4,702.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 4611 US TRANSVAGINAL NON OB | $663.85 | $781.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER | $697.85 | $821.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB | $697.85 | $821.00 | 15% |
| Transvaginal pelvic ultrasound CPT 76830 US Exams | $697.85 | $821.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 4611 US TRANSVAGINAL NON OB | $663.85 | $781.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER | $697.85 | $821.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Exams | $697.85 | $821.00 | 15% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB | $697.85 | $821.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $904.40 | $1,064.00 | 15% |
| Ultrasound of the abdomen, complete CPT 76700 US Exams | $904.40 | $1,064.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Exams | $904.40 | $1,064.00 | 15% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $904.40 | $1,064.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 GD Exams | $586.50 | $690.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4 V | $586.50 | $690.00 | 15% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT | $586.50 | $690.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 GD Exams | $586.50 | $690.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4 V | $586.50 | $690.00 | 15% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT | $586.50 | $690.00 | 15% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $113.90 | $134.00 | 15% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $113.90 | $134.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $90.95 | $107.00 | 15% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $90.95 | $107.00 | 15% |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential | $74.80 | $88.00 | 15% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential | $74.80 | $88.00 | 15% |
| Complete blood count (CBC), no differential CPT 85027 CBC without Differential | $45.05 | $53.00 | 15% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential | $45.05 | $53.00 | 15% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $146.20 | $172.00 | 15% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $146.20 | $172.00 | 15% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $122.40 | $144.00 | 15% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $122.40 | $144.00 | 15% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $105.40 | $124.00 | 15% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $105.40 | $124.00 | 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 | $65.45 | $77.00 | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free and Total | $65.45 | $77.00 | 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 and Total | $65.45 | $77.00 | 15% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $65.45 | $77.00 | 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 | $56.95 | $67.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4727 | $56.95 | $67.00 | 15% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4140 | $56.95 | $67.00 | 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 PSA Diagnostic | $56.95 | $67.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4727 | $56.95 | $67.00 | 15% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4140 | $56.95 | $67.00 | 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 Heparin Protocol | $58.65 | $69.00 | 15% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $58.65 | $69.00 | 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 | $58.65 | $69.00 | 15% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time Heparin Protocol | $58.65 | $69.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 4867 | $4.25 | $5.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 4832 | $8.27 | $9.72 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 4844 | $12.75 | $15.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 PROTHROMBIN TIME/INR | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CMDIN PROTHROMBIN TIME/INR | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME BCE | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 INR (POCT) | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test CPT 85610 85610 4850 | $77.35 | $91.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 4867 | $4.25 | $5.00 | 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 85610 4844 | $12.75 | $15.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 PROTHROMBIN TIME/INR | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR (POCT) | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME BCE | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CMDIN PROTHROMBIN TIME/INR | $38.25 | $45.00 | 15% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610 4850 | $77.35 | $91.00 | 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 Function Cascade | $120.70 | $142.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with Reflex to FT4 | $120.70 | $142.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $120.70 | $142.00 | 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 | $120.70 | $142.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with Reflex to FT4 | $120.70 | $142.00 | 15% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $120.70 | $142.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Microscopic | $32.30 | $38.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Dipstick auto w/ Micro POC | $32.30 | $38.00 | 15% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis with Culture if Indicated | $32.30 | $38.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Microscopic | $32.30 | $38.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Dipstick auto w/ Micro POC | $32.30 | $38.00 | 15% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis with Culture if Indicated | $32.30 | $38.00 | 15% |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Dipstick non-auto with Micro POC | $36.55 | $43.00 | 15% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Dipstick non-auto with Micro POC | $36.55 | $43.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 POC Urinalysis Dipstick auto - UC | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 POC Urine Dip (nsg) Automated Task - UC Only | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Auto W/O Scope (N) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick (POCT) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Ketones Urine | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis by dip stick or tablet reagent for bilirubin glucose hemoglobin ketones leukocytes nitr | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC - UC | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC Urine Dip (nsg) Automated Task - UC Only | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC - UC | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis by dip stick or tablet reagent for bilirubin glucose hemoglobin ketones leukocytes nitr | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Ketones Urine | $17.00 | $20.00 | 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 pH Urine | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Auto W/O Scope (N) | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick auto POC | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC Urinalysis Dipstick auto - UC | $17.00 | $20.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dipstick non-auto POC - UC | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 DIPSTICK URINE BCE | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 N-AUTOM URINALYS WO MICRO | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 81002 URINALYSIS NONAUTO W/O SCOP BCE | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Dipstick non-auto POC - UC | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 DIPSTICK URINE BCE | $21.25 | $25.00 | 15% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 N-AUTOM URINALYS WO MICRO | $21.25 | $25.00 | 15% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Left heart catheterization, diagnostic CPT 93452 LT HT CATH W/VENTRCLGRPHY PNL | $9,967.10 | $11,726.00 | 15% |
| Left heart catheterization, diagnostic one side CPT 93452 PNL 93452 LEFT HRT CATH W/VENTRCLGRP | $9,967.10 | $11,726.00 | 15% |
| Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY | $10,472.00 | $12,320.00 | 15% |
| Left heart catheterization, diagnostic inpatient CPT 93452 LT HT CATH W/VENTRCLGRPHY PNL | $9,967.10 | $11,726.00 | 15% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 PNL 93452 LEFT HRT CATH W/VENTRCLGRP | $9,967.10 | $11,726.00 | 15% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY | $10,472.00 | $12,320.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC W/IMG (PC-2600) | $1,640.50 | $1,930.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Epidural Interlaminar Lumbar/Sacral | $1,977.10 | $2,326.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 GD Exams | $2,077.40 | $2,444.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection with imaging guidance 62323 | $2,077.40 | $2,444.00 | 15% |
| Lower-back epidural injection, with imaging guidance CPT 62323 CISTERNOGRAM INJECTION (NM) | $2,077.40 | $2,444.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC W/IMG (PC-2600) | $1,640.50 | $1,930.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Epidural Interlaminar Lumbar/Sacral | $1,977.10 | $2,326.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CISTERNOGRAM INJECTION (NM) | $2,077.40 | $2,444.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 GD Exams | $2,077.40 | $2,444.00 | 15% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection with imaging guidance 62323 | $2,077.40 | $2,444.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTER LMBR/SAC MAT BCE | $1,282.65 | $1,509.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC | $1,282.65 | $1,509.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 1808 INJECT LUMBAR DIAGNOSTIC/1 | $1,723.80 | $2,028.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJECT LUMBAR DIAGNOSTIC/1 | $1,723.80 | $2,028.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection w/o imaging guidance 62322 | $1,811.35 | $2,131.00 | 15% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC (PC-2600) | $2,368.10 | $2,786.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTER LMBR/SAC MAT BCE | $1,282.65 | $1,509.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC | $1,282.65 | $1,509.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECT LUMBAR DIAGNOSTIC/1 | $1,723.80 | $2,028.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 1808 INJECT LUMBAR DIAGNOSTIC/1 | $1,723.80 | $2,028.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Injection w/o imaging guidance 62322 | $1,811.35 | $2,131.00 | 15% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC (PC-2600) | $2,368.10 | $2,786.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 (PC-2600) | $1,215.50 | $1,430.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Epidural Transforaminal Lumbar/Sacral 1st Level | $1,473.90 | $1,734.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Foramen Epidural L/S 64483 | $1,547.85 | $1,821.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 RPS 64483 NJX AA&STRD TFRM EPI LS1 | $1,547.85 | $1,821.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 BIL (PC-2600) | $2,547.45 | $2,997.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 (PC-2600) | $1,215.50 | $1,430.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Epidural Transforaminal Lumbar/Sacral 1st Level | $1,473.90 | $1,734.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj Foramen Epidural L/S 64483 | $1,547.85 | $1,821.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 RPS 64483 NJX AA&STRD TFRM EPI LS1 | $1,547.85 | $1,821.00 | 15% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 BIL (PC-2600) | $2,547.45 | $2,997.00 | 15% |
| Prostate biopsy CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700 | $1,904.85 | $2,241.00 | 15% |
| Prostate biopsy inpatient CPT 55700 Prostate Biopsy Needle/Punch-1 or more 55700 | $1,904.85 | $2,241.00 | 15% |
| Removal of a breast lump, open surgery CPT 19120 Biopsy 19120 | $5,710.30 | $6,718.00 | 15% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Biopsy 19120 | $5,710.30 | $6,718.00 | 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 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 | $234.60 | $276.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG - UC 93000 | $234.60 | $276.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE | $131.75 | $155.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 | $234.60 | $276.00 | 15% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - UC 93000 | $234.60 | $276.00 | 15% |
| Family therapy with the patient, 50 minutes CPT 90847 Psych THPY 50 Min PO 90837 | $277.95 | $327.00 | 15% |
| Family therapy with the patient, 50 minutes CPT 90847 Family Therapy 50 Min 90847 | $291.55 | $343.00 | 15% |
| Family therapy with the patient, 50 minutes CPT 90847 PHP Family Therapy 50m | $291.55 | $343.00 | 15% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Psych THPY 50 Min PO 90837 | $277.95 | $327.00 | 15% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy 50 Min 90847 | $291.55 | $343.00 | 15% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PHP Family Therapy 50m | $291.55 | $343.00 | 15% |
| Family therapy without the patient, 50 minutes CPT 90846 Fam Psych w/o PT 26-50 Min PO 90846 | $300.05 | $353.00 | 15% |
| Family therapy without the patient, 50 minutes CPT 90846 PHP Fam Psych w/o Pt 26-50 Min | $314.50 | $370.00 | 15% |
| Family therapy without the patient, 50 minutes CPT 90846 Fam Psych w/o PT 26-50 Min 90846 | $314.50 | $370.00 | 15% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Fam Psych w/o PT 26-50 Min PO 90846 | $300.05 | $353.00 | 15% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Fam Psych w/o PT 26-50 Min 90846 | $314.50 | $370.00 | 15% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PHP Fam Psych w/o Pt 26-50 Min | $314.50 | $370.00 | 15% |
| Group psychotherapy session CPT 90853 PHP Group Therapy 90853 | $195.50 | $230.00 | 15% |
| Group psychotherapy session CPT 90853 PHP Group Therapy | $195.50 | $230.00 | 15% |
| Group psychotherapy session inpatient CPT 90853 PHP Group Therapy 90853 | $195.50 | $230.00 | 15% |
| Group psychotherapy session inpatient CPT 90853 PHP Group Therapy | $195.50 | $230.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 Office Outpatient Visit New L3 | $116.45 | $137.00 | 15% |
| New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New 99203 | $116.45 | $137.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Outpatient Visit New L3 | $116.45 | $137.00 | 15% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New 99203 | $116.45 | $137.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New 99204 | $116.45 | $137.00 | 15% |
| New patient office visit, about 45 minutes CPT 99204 Office Outpatient Visit New L4 | $116.45 | $137.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New 99204 | $116.45 | $137.00 | 15% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Outpatient Visit New L4 | $116.45 | $137.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 Office Outpatient Visit New L5 | $116.45 | $137.00 | 15% |
| New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New 99205 | $116.45 | $137.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New 99205 | $116.45 | $137.00 | 15% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Outpatient Visit New L5 | $116.45 | $137.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THER EX FACE 15 MIN IP | $90.10 | $106.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE IP | $90.10 | $106.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 ST 97110 ST THER EX FACE 15 MIN | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise 15min | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - OT | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise 15min | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - PT MMC | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 COTA Therapeutic Exercise 15min | $102.00 | $120.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA Therapeutic Exercise 15min | $102.00 | $120.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THER EX FACE 15 MIN IP | $90.10 | $106.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE IP | $90.10 | $106.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - OT | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise 15min | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 ST 97110 ST THER EX FACE 15 MIN | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - PT MMC | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise 15min | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO | $94.35 | $111.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA Therapeutic Exercise 15min | $102.00 | $120.00 | 15% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 COTA Therapeutic Exercise 15min | $102.00 | $120.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 VIDEO Psychotherapy 30 Mins 90832 | $186.15 | $219.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 Psych THPY 30 Min PO 90832 | $186.15 | $219.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 Psych Thpy 30 Min 90832 | $199.75 | $235.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy 30 Mins 90832 | $199.75 | $235.00 | 15% |
| Psychotherapy session, 30 minutes CPT 90832 PHP Psych Thpy 30 Min | $199.75 | $235.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 VIDEO Psychotherapy 30 Mins 90832 | $186.15 | $219.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psych THPY 30 Min PO 90832 | $186.15 | $219.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy 30 Mins 90832 | $199.75 | $235.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PHP Psych Thpy 30 Min | $199.75 | $235.00 | 15% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psych Thpy 30 Min 90832 | $199.75 | $235.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psych THPY 45 Min PO 90834 | $227.80 | $268.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 VIDEO Psychotherapy 45 Mins 90834 | $227.80 | $268.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psych Thpy 45 Min 90834 | $239.70 | $282.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 PHP Psych Thpy 45 Min | $239.70 | $282.00 | 15% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy 45 Mins 90834 | $250.75 | $295.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 VIDEO Psychotherapy 45 Mins 90834 | $227.80 | $268.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psych THPY 45 Min PO 90834 | $227.80 | $268.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PHP Psych Thpy 45 Min | $239.70 | $282.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psych Thpy 45 Min 90834 | $239.70 | $282.00 | 15% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy 45 Mins 90834 | $250.75 | $295.00 | 15% |
| Psychotherapy session, 60 minutes CPT 90837 VIDEO Psychotherapy 60 Mins 90837 | $228.65 | $269.00 | 15% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy 60 Mins 90837 | $240.55 | $283.00 | 15% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 VIDEO Psychotherapy 60 Mins 90837 | $228.65 | $269.00 | 15% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy 60 Mins 90837 | $240.55 | $283.00 | 15% |