Perry County Memorial Hospital
Perry County Memorial Hospital in Tell City, IN publishes cash prices for 41 common procedures listed here, from its own machine-readable price file updated Jun 8, 2026. Click a procedure to compare it with other hospitals nearby.
8885 ST ROAD 237,TELL CITY,IN,47586-2751 Collected Sep 22, 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/CONTRAST | $2,155.30 | $3,079.00 | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS WITH CONTRAST | $2,155.30 | $3,079.00 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST | $2,155.30 | $3,079.00 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS WITH CONTRAST | $2,155.30 | $3,079.00 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,043.00 | $1,490.00 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CON | $1,043.00 | $1,490.00 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE | $1,043.00 | $1,490.00 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CON | $1,043.00 | $1,490.00 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,733.20 | $2,476.00 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CO | $1,733.20 | $2,476.00 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CO | $1,733.20 | $2,476.00 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $1,733.20 | $2,476.00 | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI | $467.60 | $668.00 | 30% |
| Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAM PCHD | $140.00 | $200.00 | 30% |
| Diagnostic mammogram, both breasts CPT 77066 MAMMO DIAG DIGIT BIL | $467.60 | $668.00 | 30% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI | $467.60 | $668.00 | 30% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAM PCHD | $140.00 | $200.00 | 30% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO DIAG DIGIT BIL | $467.60 | $668.00 | 30% |
| Diagnostic mammogram, one breast CPT 77065 MAMMO ADD VW UNI 3D | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast CPT 77065 MAGSPOT 2D ONLY | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 DX MAMMO INCL CAD;UNILATERAL | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO ADD VW UNI 3D | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast inpatient CPT 77065 MAGSPOT 2D ONLY | $462.70 | $661.00 | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DX MAMMO INCL CAD;UNILATERAL | $462.70 | $661.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI LOW EXT JT BILAT | $3,630.20 | $5,186.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $2,419.20 | $3,456.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JT W/O C | $2,419.20 | $3,456.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI LOW EXT JT BILAT | $3,630.20 | $5,186.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $2,419.20 | $3,456.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXT JT W/O C | $2,419.20 | $3,456.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE | $2,808.40 | $4,012.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOW EXT JT W/W/O | $2,808.40 | $4,012.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE | $2,808.40 | $4,012.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOW EXT JT W/W/O | $2,808.40 | $4,012.00 | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE | $1,839.60 | $2,628.00 | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN/IAC NO CONT | $1,839.60 | $2,628.00 | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN STEM W/O DYE | $1,839.60 | $2,628.00 | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN/IAC NO CONT | $1,839.60 | $2,628.00 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/IAC W/WO | $2,998.10 | $4,283.00 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE | $2,998.10 | $4,283.00 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/IAC W/WO | $2,998.10 | $4,283.00 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE | $2,998.10 | $4,283.00 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE | $1,839.60 | $2,628.00 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MR LUMBA-SP W/O CON | $1,839.60 | $2,628.00 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O DYE | $1,839.60 | $2,628.00 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR LUMBA-SP W/O CON | $1,839.60 | $2,628.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS COMP | $702.80 | $1,004.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS | $702.80 | $1,004.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS SNGL FETUS | $702.80 | $1,004.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS COMP | $702.80 | $1,004.00 | 30% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD | $568.40 | $812.00 | 30% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO INCL CAD;BILATERAL | $568.40 | $812.00 | 30% |
| Screening mammogram, both breasts CPT 77067 MAMMO OCT SPECIAL DIGITAL | $257.60 | $368.00 | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD | $568.40 | $812.00 | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO INCL CAD;BILATERAL | $568.40 | $812.00 | 30% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO OCT SPECIAL DIGITAL | $257.60 | $368.00 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYS 6 HRS+4> PARAM REDUCED | $2,102.10 | $3,003.00 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $3,551.80 | $5,074.00 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLSY 6YRS, 4 OR > PARAM | $3,551.80 | $5,074.00 | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYS 6 HRS+4> PARAM REDUCED | $2,102.10 | $3,003.00 | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLSY 6YRS, 4 OR > PARAM | $3,551.80 | $5,074.00 | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM | $3,551.80 | $5,074.00 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 UL TRANSVAG NON-OB | $421.40 | $602.00 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB | $421.40 | $602.00 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 UL TRANSVAG NON-OB | $421.40 | $602.00 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB | $421.40 | $602.00 | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE | $788.90 | $1,127.00 | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE | $788.90 | $1,127.00 | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE | $788.90 | $1,127.00 | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US EXAM ABDOM COMPLETE | $788.90 | $1,127.00 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $410.20 | $586.00 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR 4 VIEWS | $410.20 | $586.00 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR 4 VIEWS | $410.20 | $586.00 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $410.20 | $586.00 | 30% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANE | $134.40 | $192.00 | 30% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA | $134.40 | $192.00 | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANE | $134.40 | $192.00 | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA | $134.40 | $192.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $105.00 | $150.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $105.00 | $150.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $105.00 | $150.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $105.00 | $150.00 | 30% |
| Complete blood count (CBC) with differential CPT 85025 CBC COMPLETE BLD CT | $75.60 | $108.00 | 30% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $75.60 | $108.00 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $75.60 | $108.00 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC COMPLETE BLD CT | $75.60 | $108.00 | 30% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $54.60 | $78.00 | 30% |
| Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFFERENTIAL | $54.60 | $78.00 | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFFERENTIAL | $54.60 | $78.00 | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED | $54.60 | $78.00 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $146.30 | $209.00 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPRE METABOLIC PAN | $146.30 | $209.00 | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPRE METABOLIC PAN | $146.30 | $209.00 | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL | $146.30 | $209.00 | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $266.00 | $380.00 | 30% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION | $266.00 | $380.00 | 30% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $266.00 | $380.00 | 30% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION | $266.00 | $380.00 | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCT PROF | $288.40 | $412.00 | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $288.40 | $412.00 | 30% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $288.40 | $412.00 | 30% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCT PROF | $288.40 | $412.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA | $137.90 | $197.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $137.90 | $197.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA REFLEX | $217.00 | $310.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA | $137.90 | $197.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL | $137.90 | $197.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA REFLEX | $217.00 | $310.00 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $75.60 | $108.00 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $75.60 | $108.00 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $75.60 | $108.00 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $75.60 | $108.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $57.40 | $82.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $57.40 | $82.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $110.60 | $158.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $110.60 | $158.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE | $110.60 | $158.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $110.60 | $158.00 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS | $66.50 | $95.00 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $66.50 | $95.00 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE | $66.50 | $95.00 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS | $66.50 | $95.00 | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 AFTER CATARACT LASER SURGERY | $1,033.90 | $1,477.00 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 YAG CAPSULOTOMY | $1,033.90 | $1,477.00 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 AFTER CATARACT LASER SURGERY | $1,033.90 | $1,477.00 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 YAG CAPSULOTOMY | $1,033.90 | $1,477.00 | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY THERAPY W/PT 1 HOUR | $217.70 | $311.00 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY THERAPY W/PT 1 HOUR | $217.70 | $311.00 | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY THERAPY W/O PT 1 HOUR | $207.20 | $296.00 | 30% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY THERAPY W/O PT 1 HOUR | $207.20 | $296.00 | 30% |
| Group psychotherapy session CPT 90853 GROUP THERAPY 1 HOUR | $174.30 | $249.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 GROUP THERAPY 1 HOUR | $174.30 | $249.00 | 30% |
| New patient office visit, about 30 minutes CPT 99203 PHYS NEW INTERMEDIAT | $240.10 | $343.00 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PHYS NEW INTERMEDIAT | $240.10 | $343.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 PHYS NEW EXTENDED | $405.30 | $579.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PHYS NEW EXTENDED | $405.30 | $579.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 PHYS NEW COMPLEX | $526.40 | $752.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PHYS NEW COMPLEX | $526.40 | $752.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 BETTER BREATHERS<6 VISITS PER MONTH | $21.00 | $30.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 BETTER BREATHERS >7 VISITS PER MONTH | $28.00 | $40.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERA PROC EA 15M | $114.10 | $163.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAEX EA 15 MIN | $121.80 | $174.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERA PROC EA 30 MINUTES | $224.70 | $321.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAEX 30 MIN | $244.30 | $349.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERA PROC EA 45 MINUTES | $338.10 | $483.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPY EXERCISE 45 | $368.20 | $526.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 BETTER BREATHERS<6 VISITS PER MONTH | $21.00 | $30.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 BETTER BREATHERS >7 VISITS PER MONTH | $28.00 | $40.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERA PROC EA 15M | $114.10 | $163.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAEX EA 15 MIN | $121.80 | $174.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERA PROC EA 30 MINUTES | $224.70 | $321.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAEX 30 MIN | $244.30 | $349.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERA PROC EA 45 MINUTES | $338.10 | $483.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPY EXERCISE 45 | $368.20 | $526.00 | 30% |
| Psychotherapy session, 30 minutes CPT 90832 INDIVIDUAL THERAPY 16-27 MINUTES | $145.60 | $208.00 | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 INDIVIDUAL THERAPY 16-27 MINUTES | $145.60 | $208.00 | 30% |
| Psychotherapy session, 45 minutes CPT 90834 INDIVIDUAL THERAPY 38-52 | $193.20 | $276.00 | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 INDIVIDUAL THERAPY 38-52 | $193.20 | $276.00 | 30% |
| Psychotherapy session, 60 minutes CPT 90837 INDIVIDUAL THERAPY 53+ MINS | $282.80 | $404.00 | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 INDIVIDUAL THERAPY 53+ MINS | $282.80 | $404.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PHYS CONSULT INTER | $298.20 | $426.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PRQ CARD REVASC CHRONIC 1 VSL | $1,312.50 | $1,875.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PHYS CONSULT INTER | $298.20 | $426.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PRQ CARD REVASC CHRONIC 1 VSL | $1,312.50 | $1,875.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PHYS CONSULT EXTEND | $479.50 | $685.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PHYS CONSULT EXTEND | $479.50 | $685.00 | 30% |