SelfPayRates
Hospital Traverse City, MI

Paul Oliver Memorial Hospital

Paul Oliver Memorial Hospital in Frankfort, MI publishes cash prices for 37 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.

224 Park Ave, Frankfort, MI 49635 Collected Sep 23, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Exams $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 93077 CT ABD PELV W/ IV CONT $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT VENOGRAM ABD + PEL W/ CONTRAST $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Exams $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ENTEROGRAPHY $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93077 CT ABD PELV W/ IV CONT $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 93079 CT ABD PELV W/ IV+ORAL CONT $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD + PELVIS W/IV CONT (NO ORAL) $2,972.45 $3,497.00 15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) $2,972.45 $3,497.00 15%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST $1,257.15 $1,479.00 15%
CT scan of the head or brain, no contrast dye CPT 70450 CT STEALTH HEAD W/O CONTRAST $1,257.15 $1,479.00 15%
CT scan of the head or brain, no contrast dye CPT 70450 CT Exams $1,257.15 $1,479.00 15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT STEALTH HEAD W/O CONTRAST $1,257.15 $1,479.00 15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST $1,257.15 $1,479.00 15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Exams $1,257.15 $1,479.00 15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) $1,896.35 $2,231.00 15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) $1,896.35 $2,231.00 15%
CT scan of the pelvis, with contrast dye CPT 72193 CT Exams $1,896.35 $2,231.00 15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Exams $1,896.35 $2,231.00 15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ IV CONTRAST (NO ORAL CONT) $1,896.35 $2,231.00 15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST (ORAL + IV) $1,896.35 $2,231.00 15%
Diagnostic mammogram, both breasts both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT $416.50 $490.00 15%
Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL $404.60 $476.00 15%
Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL $404.60 $476.00 15%
Diagnostic mammogram, both breasts CPT 77066 MA MAMM 3D DIAGNOSTIC BIL $416.50 $490.00 15%
Diagnostic mammogram, both breasts CPT 77066 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL $416.50 $490.00 15%
Diagnostic mammogram, both breasts CPT 77066 MA Exams $416.50 $490.00 15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA FFD MAMM DIAGNOSTIC BILAT $416.50 $490.00 15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC W/ CONT BIL $404.60 $476.00 15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC W/ CONT BIL $404.60 $476.00 15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMM 3D DIAGNOSTIC BIL $416.50 $490.00 15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Exams $416.50 $490.00 15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL $416.50 $490.00 15%
Diagnostic mammogram, one breast CPT 77065 MA Exams $323.00 $380.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT $313.65 $369.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT $313.65 $369.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT $313.65 $369.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT $313.65 $369.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT $323.00 $380.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT $323.00 $380.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT $323.00 $380.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT $323.00 $380.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT $323.00 $380.00 15%
Diagnostic mammogram, one breast one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient CPT 77065 MA Exams $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT LT $313.65 $369.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC W/ CONT RT $313.65 $369.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT RT $313.65 $369.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC W/ CONT LT $313.65 $369.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC RT $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA MAMM 3D DIAGNOSTIC LT $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI RT $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC UNI LT $323.00 $380.00 15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT $323.00 $380.00 15%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST $3,834.35 $4,511.00 15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM $2,432.70 $2,862.00 15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR Exams $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI HIPS BILATERAL W/O CONTRAST $3,834.35 $4,511.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI INCOMPLETE JOINT LOWER EXTREM $2,432.70 $2,862.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR Exams $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST RT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP LIMITED W/O CONTRAST LT $2,556.80 $3,008.00 15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR Exams $3,490.10 $4,106.00 15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI HIPS BIL W/ + W/O CONTRAST $5,234.30 $6,158.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR Exams $3,490.10 $4,106.00 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 $5,234.30 $6,158.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 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 $3,490.10 $4,106.00 15%
MRI of the brain, no contrast dye CPT 70551 MRI INCOMPLETE BRAIN $2,512.60 $2,956.00 15%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST $2,640.10 $3,106.00 15%
MRI of the brain, no contrast dye CPT 70551 MR Exams $2,640.10 $3,106.00 15%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI INCOMPLETE BRAIN $2,512.60 $2,956.00 15%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST $2,640.10 $3,106.00 15%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Exams $2,640.10 $3,106.00 15%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST $3,476.50 $4,090.00 15%
MRI of the brain, with and without contrast dye CPT 70553 MR Exams $3,476.50 $4,090.00 15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Exams $3,476.50 $4,090.00 15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/ + W/O CONTRAST $3,476.50 $4,090.00 15%
MRI of the lower back, no contrast dye CPT 72148 MRI INCOMPLETE LUMBAR SPINE $2,184.50 $2,570.00 15%
MRI of the lower back, no contrast dye CPT 72148 MR Exams $2,295.85 $2,701.00 15%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST $2,295.85 $2,701.00 15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI INCOMPLETE LUMBAR SPINE $2,184.50 $2,570.00 15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR Exams $2,295.85 $2,701.00 15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST $2,295.85 $2,701.00 15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exams $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE- $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >=14 weeks Single Fetus 76805 $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >=14 weeks Single Fetus 76805 $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE- $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE $717.40 $844.00 15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exams $717.40 $844.00 15%
Screening mammogram, both breasts both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL $328.95 $387.00 15%
Screening mammogram, both breasts CPT 77067 MA Exams $328.95 $387.00 15%
Screening mammogram, both breasts CPT 77067 MA MAMM 3D SCREENING BIL $328.95 $387.00 15%
Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING LT $328.95 $387.00 15%
Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN LT UNI $328.95 $387.00 15%
Screening mammogram, both breasts one side CPT 77067 MA FFD MAMM SCREEN RT UNI $328.95 $387.00 15%
Screening mammogram, both breasts one side CPT 77067 MA MAMM 3D SCREENING RT $328.95 $387.00 15%
Screening mammogram, both breasts inpatient both sides CPT 77067 MA FFD MAMM SCREEN BILATERAL $328.95 $387.00 15%
Screening mammogram, both breasts inpatient CPT 77067 MA MAMM 3D SCREENING BIL $328.95 $387.00 15%
Screening mammogram, both breasts inpatient CPT 77067 MA Exams $328.95 $387.00 15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN RT UNI $328.95 $387.00 15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA FFD MAMM SCREEN LT UNI $328.95 $387.00 15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING LT $328.95 $387.00 15%
Screening mammogram, both breasts inpatient one side CPT 77067 MA MAMM 3D SCREENING RT $328.95 $387.00 15%
Transvaginal pelvic ultrasound CPT 76830 4611 US TRANSVAGINAL NON OB $697.85 $821.00 15%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER $697.85 $821.00 15%
Transvaginal pelvic ultrasound CPT 76830 US Exams $697.85 $821.00 15%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB $704.65 $829.00 15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB W/ DOPPLER $697.85 $821.00 15%
Transvaginal pelvic ultrasound inpatient CPT 76830 4611 US TRANSVAGINAL NON OB $697.85 $821.00 15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Exams $704.65 $829.00 15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB $704.65 $829.00 15%
Ultrasound of the abdomen, complete CPT 76700 US Exams $842.35 $991.00 15%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE $842.35 $991.00 15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE $842.35 $991.00 15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Exams $842.35 $991.00 15%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT $621.35 $731.00 15%
X-ray of the lower back, 4 or more views CPT 72110 GD Exams $621.35 $731.00 15%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR MIN 4 V $621.35 $731.00 15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 GD Exams $621.35 $731.00 15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR AP + LAT W/ FLEX + EXT $621.35 $731.00 15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR MIN 4 V $621.35 $731.00 15%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel $111.35 $131.00 15%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel $111.35 $131.00 15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel $89.25 $105.00 15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel $89.25 $105.00 15%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential $73.95 $87.00 15%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential $73.95 $87.00 15%
Complete blood count (CBC), no differential CPT 85027 CBC without Differential $42.50 $50.00 15%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential $42.50 $50.00 15%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel $142.80 $168.00 15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel $142.80 $168.00 15%
Kidney function blood test panel CPT 80069 Renal Function Panel $118.15 $139.00 15%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel $118.15 $139.00 15%
Liver function blood test panel CPT 80076 Hepatic Function Panel $102.85 $121.00 15%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel $102.85 $121.00 15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free $53.55 $63.00 15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free and Total $56.10 $66.00 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 inpatient CPT 84154 PSA Free $53.55 $63.00 15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free and Total $56.10 $66.00 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, 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 84153 4140 $56.10 $66.00 15%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic $56.10 $66.00 15%
PSA (prostate-specific antigen) blood test, total CPT 84153 84153 4727 $56.10 $66.00 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 4727 $56.10 $66.00 15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 84153 4140 $56.10 $66.00 15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Diagnostic $56.10 $66.00 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 $56.95 $67.00 15%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time $56.95 $67.00 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 $56.95 $67.00 15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time $56.95 $67.00 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 $34.85 $41.00 15%
Prothrombin time (PT/INR) clotting test CPT 85610 INR (POCT) $36.55 $43.00 15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME $36.55 $43.00 15%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR $36.55 $43.00 15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME BCE $36.55 $43.00 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 $34.85 $41.00 15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME BCE $36.55 $43.00 15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR $36.55 $43.00 15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR (POCT) $36.55 $43.00 15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME $36.55 $43.00 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 $116.45 $137.00 15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Function Cascade $116.45 $137.00 15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH with Reflex to FT4 $116.45 $137.00 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 Stimulating Hormone $116.45 $137.00 15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Function Cascade $116.45 $137.00 15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH with Reflex to FT4 $116.45 $137.00 15%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Dipstick auto w/ Micro POC $28.90 $34.00 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 $28.90 $34.00 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 $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 - UC $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 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 Ketones Urine $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 pH Urine $17.00 $20.00 15%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick auto POC $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 Dipstick auto POC $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 Dipstick (POCT) $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 POC Urinalysis Dipstick auto - UC $17.00 $20.00 15%
Urinalysis without microscope exam, manual CPT 81002 DIPSTICK URINE BCE $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 Urinalysis Dipstick non-auto POC $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 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%

Surgery and procedures

ProcedureCash price List priceOff list
Lower-back epidural injection, without imaging guidance CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC $1,270.75 $1,495.00 15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 62322 NJX INTERLAMINAR LMBR/SAC $1,270.75 $1,495.00 15%

Doctor visits and therapy

ProcedureCash price List priceOff 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 $215.90 $254.00 15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram (ECG) Routine 12-Lead Tracing and I&R (Global) 93000 $215.90 $254.00 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 $215.90 $254.00 15%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG - UC 93000 $215.90 $254.00 15%
New patient office visit, about 30 minutes CPT 99203 Office Visit Level 3 New 99203 $115.60 $136.00 15%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit Level 3 New 99203 $115.60 $136.00 15%
New patient office visit, about 45 minutes CPT 99204 Office Visit Level 4 New 99204 $115.60 $136.00 15%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit Level 4 New 99204 $115.60 $136.00 15%
New patient office visit, about 60 minutes CPT 99205 Office Visit Level 5 New 99205 $115.60 $136.00 15%
New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit Level 5 New 99205 $115.60 $136.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 ST 97110 ST THER EX FACE 15 MIN $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 COTA Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THERAPEUTIC EXERCISE IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 ST THER EX FACE 15 MIN IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - PT MMC $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PTA Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise 15 min - OT $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 OT IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 COTA Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THERAPEUTIC EXERCISE IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - OT $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 OT THERAPEUTIC EX 15 MIN CO $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISES EA 15 PT IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PTA Therapeutic Exercise 15min $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise 15 min - PT MMC $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 PT THERAPEUTIC EX 15 MIN CQ $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT 97110 PTM THERAPEUTIC EX 15 MIN $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 ST THER EX FACE 15 MIN IP $96.90 $114.00 15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 ST 97110 ST THER EX FACE 15 MIN $96.90 $114.00 15%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8138/381415623_paul-oliver-memorial-hospital_standardcharges.csv