Straub Clinic & Hospital
Straub Clinic & Hospital in Honolulu, HI publishes cash prices for 54 common procedures listed here, from its own machine-readable price file updated Feb 12, 2026. Click a procedure to compare it with other hospitals nearby.
888 South King Street, Honolulu HI 96813 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 ABDOMEN AND PELVIS W/CONTRAST-TECH | $2,167.80 | $3,613.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN-PELVIS(APPENDIX) W/CONTRAST-TECH | $2,388.00 | $3,980.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN AND PELVIS W/CONTRAST-TECH | $2,167.80 | $3,613.00 | 40% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN-PELVIS(APPENDIX) W/CONTRAST-TECH | $2,388.00 | $3,980.00 | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WITHOUT CONTRAST-TECH | $1,186.20 | $1,977.00 | 40% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WITHOUT CONTRAST-TECH | $1,186.20 | $1,977.00 | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS (LOWER ABD) WITH CONTRAST-TECH | $959.40 | $1,599.00 | 40% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS (LOWER ABD) WITH CONTRAST-TECH | $922.80 | $1,538.00 | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO BILAT DIAGNOSTIC 2-D W/WO CAD - TECH | $417.00 | $695.00 | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO BILAT DIAGNOSTIC 2-D W/WO CAD - TECH | $417.00 | $695.00 | 40% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO BILAT DIAGNOSTIC 2-D W/WO CAD W/SCRN-TC | $417.00 | $695.00 | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO UNILAT DIAGNOSTIC 2-D W/WO CAD - TECH | $299.40 | $499.00 | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO UNILAT DIAGNOSTIC 2-D W/WO CAD - TECH | $299.40 | $499.00 | 40% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO UNILAT DIAGNOSTC 2-D W/WO CAD W/SCRN-TC | $299.40 | $499.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR EXTREMITY (LOWER) JOINT WITHOUT CONTRAST-TECH | $1,489.20 | $2,482.00 | 40% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR EXTREMITY (LOWER) JOINT WITHOUT CONTRAST-TECH | $1,489.20 | $2,482.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR EXTREMITY (LOWER) JOINT WITHOUT & WITH CONTRAST-TECH | $1,899.00 | $3,165.00 | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR EXTREMITY (LOWER) JOINT WITHOUT & WITH CONTRAST-TECH | $1,899.00 | $3,165.00 | 40% |
| MRI of the brain, no contrast dye CPT 70551 MR BRAIN WITHOUT CONTRAST-TECH | $1,344.60 | $2,241.00 | 40% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN WITHOUT CONTRAST-TECH | $1,344.60 | $2,241.00 | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN WITHOUT & WITH CONTRAST-TECH | $1,827.00 | $3,045.00 | 40% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN WITHOUT & WITH CONTRAST-TECH | $1,827.00 | $3,045.00 | 40% |
| MRI of the lower back, no contrast dye CPT 72148 MR SPINE (LUMBAR) WITHOUT CONTRAST-TECH | $1,494.60 | $2,491.00 | 40% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR SPINE (LUMBAR) WITHOUT CONTRAST-TECH | $1,494.60 | $2,491.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE > OR =14 WEEKS, SINGLE-TECH | $145.80 | $243.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >OR=14 WEEKS SINGLE FETUS -TECH | $551.40 | $919.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE > OR =14 WEEKS, SINGLE-TECH | $145.80 | $243.00 | 40% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >OR=14 WEEKS SINGLE FETUS -TECH | $551.40 | $919.00 | 40% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO BILAT SCREENING 2-D W/WO CAD - TECH | $249.60 | $416.00 | 40% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO SELFREQUESTD BILAT SCRN 2-D W/WO CAD-TC | $249.60 | $416.00 | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SELFREQUESTD BILAT SCRN 2-D W/WO CAD-TC | $249.60 | $416.00 | 40% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO BILAT SCREENING 2-D W/WO CAD - TECH | $249.60 | $416.00 | 40% |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMO SELFREQUESTD UNILT SCRN 2-D W/WO CAD-TC | $226.80 | $378.00 | 40% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO UNILAT SCREENING 2-D W/WO CAD - TECH | $226.80 | $378.00 | 40% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY;6+YRS W/4+ ADD PARA-TECH | $2,374.80 | $3,958.00 | 40% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY;6+YRS W/4+ ADD PARA-TECH | $2,374.80 | $3,958.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 OB ULTRA TRANSVAGINAL NON-PREG-TECH | $142.80 | $238.00 | 40% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL-TECH | $420.00 | $700.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 OB ULTRA TRANSVAGINAL NON-PREG-TECH | $142.80 | $238.00 | 40% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL-TECH | $420.00 | $700.00 | 40% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN, COMPLETE-TECH | $507.60 | $846.00 | 40% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN, COMPLETE-TECH | $507.60 | $846.00 | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 XR SPINE, LUMBAR, 4+ VIEWS-TECH | $340.80 | $568.00 | 40% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE, LUMBAR, 4+ VIEWS-TECH | $340.80 | $568.00 | 40% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $56.40 | $94.00 | 40% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $56.40 | $94.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 2 W/RFX DLDL | $91.20 | $152.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE PANEL | $95.40 | $159.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $27.60 | $46.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL, SPECTROPHOTOMETRY | $28.20 | $47.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 2 W/RFX DLDL | $91.20 | $152.00 | 40% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE PANEL | $95.40 | $159.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC FOR FLOW CYTOMETRY | $42.60 | $71.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC AUTO W/PLATELET,AUTO DIFF | $42.60 | $71.00 | 40% |
| Complete blood count (CBC) with differential CPT 85025 CBC PLT W/AUTO DIFF | $44.40 | $74.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC FOR FLOW CYTOMETRY | $42.60 | $71.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTO W/PLATELET,AUTO DIFF | $42.60 | $71.00 | 40% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC PLT W/AUTO DIFF | $44.40 | $74.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 HPC CELL COUNT | $31.20 | $52.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC AUTO | $36.60 | $61.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC/PLT AUTO W/O DIFF | $36.60 | $61.00 | 40% |
| Complete blood count (CBC), no differential CPT 85027 CBC/PLT W/O DIFF/HEMOGRAM | $38.40 | $64.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HPC CELL COUNT | $31.20 | $52.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC/PLT AUTO W/O DIFF | $36.60 | $61.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO | $36.60 | $61.00 | 40% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC/PLT W/O DIFF/HEMOGRAM | $38.40 | $64.00 | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $68.40 | $114.00 | 40% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL | $68.40 | $114.00 | 40% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $56.40 | $94.00 | 40% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $56.40 | $94.00 | 40% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $54.00 | $90.00 | 40% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $54.00 | $90.00 | 40% |
| Obstetric blood test panel CPT 80055 OB PANEL | $393.00 | $655.00 | 40% |
| Obstetric blood test panel inpatient CPT 80055 OB PANEL | $393.00 | $655.00 | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE | $69.60 | $116.00 | 40% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE | $69.60 | $116.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC AG, ULTRASENSATIVE | $51.00 | $85.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC AG W/RFLX FREE PSA | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC ANTIGEN-SCREENING | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN, FREE | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN-DX | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC AG, ULTRASENSATIVE | $51.00 | $85.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN-DX | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC AG W/RFLX FREE PSA | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC ANTIGEN-SCREENING | $66.60 | $111.00 | 40% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN, FREE | $66.60 | $111.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $15.60 | $26.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PTT;PLASMA/WHOLE BLD | $22.80 | $38.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTICOAGULANT | $24.60 | $41.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, PLASMA/WHOLE BLD | $27.60 | $46.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT (PARTIAL THROMBOPLASTIN) | $38.40 | $64.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME,PTT;PLASMA/WHOLE BLD | $38.40 | $64.00 | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PART THROMB TIME (PTT) | $39.60 | $66.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT | $15.60 | $26.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PTT;PLASMA/WHOLE BLD | $22.80 | $38.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTICOAGULANT | $24.60 | $41.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, PLASMA/WHOLE BLD | $27.60 | $46.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME,PTT;PLASMA/WHOLE BLD | $38.40 | $64.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT (PARTIAL THROMBOPLASTIN) | $38.40 | $64.00 | 40% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PART THROMB TIME (PTT) | $39.60 | $66.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $11.40 | $19.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME(PROTIME) ANTICOAG (HB) | $21.60 | $36.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $30.60 | $51.00 | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT (PROTIME) | $32.40 | $54.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME | $11.40 | $19.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME(PROTIME) ANTICOAG (HB) | $21.60 | $36.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $30.60 | $51.00 | 40% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT (PROTIME) | $32.40 | $54.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH TO ESOTERIX | $63.60 | $106.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE | $79.20 | $132.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH WITH REFLEX FT4 | $82.80 | $138.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH TO ESOTERIX | $63.60 | $106.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE | $79.20 | $132.00 | 40% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH WITH REFLEX FT4 | $82.80 | $138.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINE DIPSTICK, AUTOMATED W/MICROSCOPY | $6.60 | $11.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINE MICRO RFX CULTURE | $19.80 | $33.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS MICRO, REFLEXED | $19.80 | $33.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, COMPLETE | $22.20 | $37.00 | 40% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/REFLEX TO CULTURE AND SEN | $22.20 | $37.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINE DIPSTICK, AUTOMATED W/MICROSCOPY | $6.60 | $11.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS MICRO, REFLEXED | $19.80 | $33.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINE MICRO RFX CULTURE | $19.80 | $33.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, COMPLETE | $22.20 | $37.00 | 40% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/REFLEX TO CULTURE AND SEN | $22.20 | $37.00 | 40% |
| Urinalysis with microscope exam, manual CPT 81000 URINE DIPSTICK, NONAUTOMATED W/MICROSCOPY | $6.60 | $11.00 | 40% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS ROUTINE (MANUAL) | $19.20 | $32.00 | 40% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS W/REFLEX MANUAL | $19.20 | $32.00 | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINE DIPSTICK, NONAUTOMATED W/MICROSCOPY | $6.60 | $11.00 | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS ROUTINE (MANUAL) | $19.20 | $32.00 | 40% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS W/REFLEX MANUAL | $19.20 | $32.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINE MACRO CHARGE | $15.00 | $25.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 URINE MACROSCOPIC ONLY | $16.20 | $27.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY, URINE, MANUAL | $18.00 | $30.00 | 40% |
| Urinalysis without microscope exam, automated CPT 81003 POCT URINE DIPSTICK,AUTOMATED W/O MICROSCOPY | $25.20 | $42.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE DIPSTICK, AUTOMATED W/O MICROSCOPY | $4.80 | $8.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE MACRO CHARGE | $15.00 | $25.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINE MACROSCOPIC ONLY | $16.20 | $27.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY, URINE, MANUAL | $18.00 | $30.00 | 40% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POCT URINE DIPSTICK,AUTOMATED W/O MICROSCOPY | $25.20 | $42.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK, NONAUTOMATED W/O MICROSCOPY | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 TEEN URINE DIPSTICK, NONAUTO W/O MICROSCOPY | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 MANUAL URINE MACRO BILL ONLY | $16.20 | $27.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 POCT URINE DIPSTICK,NONAUTOMTD W/O MICROSCOPY | $26.40 | $44.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 PH, URINE, QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 KETONE, URINE, QUAL | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 NITRITE, URINE, QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 GLUCOSE, URINE,QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 PROTEIN, URINE, QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 OCCULT BLOOD,URINE QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual CPT 81002 BILIRUBIN,URINE QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK, NONAUTOMATED W/O MICROSCOPY | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 TEEN URINE DIPSTICK, NONAUTO W/O MICROSCOPY | $5.40 | $9.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 MANUAL URINE MACRO BILL ONLY | $16.20 | $27.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POCT URINE DIPSTICK,NONAUTOMTD W/O MICROSCOPY | $26.40 | $44.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 GLUCOSE, URINE,QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 BILIRUBIN,URINE QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 OCCULT BLOOD,URINE QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 NITRITE, URINE, QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 KETONE, URINE, QUAL | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PROTEIN, URINE, QUALITATIVE | $43.80 | $73.00 | 40% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PH, URINE, QUALITATIVE | $43.80 | $73.00 | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Laser treatment of clouding after cataract surgery (YAG) inpatient both sides CPT 66821 DISCISSION 2ND CATARACT LASER SURG BILAT | $772.80 | $1,288.00 | 40% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 DISCISSION 2ND CATARACT LASER SURG | $515.40 | $859.00 | 40% |
| Left heart catheterization, diagnostic one side CPT 93452 LEFT HEART CATH WITH VENTRICULOGRAPHY - TECH | $4,191.00 | $6,985.00 | 40% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HEART CATH WITH VENTRICULOGRAPHY - TECH | $4,191.00 | $6,985.00 | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL W/IMG | $335.40 | $559.00 | 40% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL W/IMG | $335.40 | $559.00 | 40% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL WO IMG | $136.20 | $227.00 | 40% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL WO IMG | $136.20 | $227.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANES;LUMBAR/SACRAL,1 LEVEL W/IMAGING-TECH | $1,204.20 | $2,007.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 INJ ANES;LUMBAR/SACRAL,1 LEVEL W/IMAG BILAT | $455.40 | $759.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 INJ ANES,LUMBAR/SACRAL 1LVL W/IMAG BILAT-TECH | $1,900.20 | $3,167.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANES;LUMBAR/SACRAL,1 LEVEL W/IMAGING | $303.60 | $506.00 | 40% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANES;LUMBAR/SACRAL,1 LEVEL W/IMAGING-TECH | $1,204.20 | $2,007.00 | 40% |
| Removal of a breast lump, open surgery inpatient both sides CPT 19120 EXCISION CYST ABERRANT BREAST OPN 1+LES BILAT | $548.40 | $914.00 | 40% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXCISION CYST ABERRANT BREAST OPN 1+LESIONS | $366.60 | $611.00 | 40% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD,BIOPSY SINGLE/MULTIPLE-TECH | $1,869.00 | $3,115.00 | 40% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD,BIOPSY SINGLE/MULTIPLE | $388.20 | $647.00 | 40% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD,BIOPSY SINGLE/MULTIPLE-TECH | $1,869.00 | $3,115.00 | 40% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD,DX W/COLLEC SPECIMEN BY BRUSH/WASH | $274.80 | $458.00 | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes inpatient CPT 90847 TELEHEALTH-PSYCHOTHERAPY,FAMILY W/PT 50MINS | $42.00 | $70.00 | 40% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCHOTHERAPY,FAMILY W/PATIENT 50MINS | $42.00 | $70.00 | 40% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 TELEHEALTH-PSYCHOTHERAPY,FAMILY W/O PT 50MINS | $37.80 | $63.00 | 40% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PSYCHOTHERAPY,FAMILY W/O PATIENT 50MINS | $37.80 | $63.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OP CONSULT LOW LVL MDM 30+MINS | $75.00 | $125.00 | 40% |
| New patient office visit, about 30 minutes CPT 99203 TELE,CONSULT OFFICE/OP LOW LVL MDM 30+MINS | $75.00 | $125.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 TELE,CONSULT OFFICE/OP LOW LVL MDM 30+MINS | $75.00 | $125.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OP CONSULT LOW LVL MDM 30+MINS | $75.00 | $125.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OP E&M NEW LOW LEVEL 30+MINS | $87.60 | $146.00 | 40% |
| New patient office visit, about 30 minutes inpatient CPT 99203 TELEHEALTH-OFFIC/OP E&M NEW LOW LEVEL 30+MINS | $87.60 | $146.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 TELE,CONSULT OFFICE/OUTPT MOD LVL MDM 40+MINS | $101.40 | $169.00 | 40% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPT CONSULT MOD LVL MDM 40+MINS | $101.40 | $169.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPT CONSULT MOD LVL MDM 40+MINS | $101.40 | $169.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 TELE,CONSULT OFFICE/OUTPT MOD LVL MDM 40+MINS | $101.40 | $169.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 TELEHEALTH-OFFICE/OP E&M NEW MODERATE 45+MINS | $115.20 | $192.00 | 40% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OP E&M NEW MODERATE VISIT 45+MINS | $115.20 | $192.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 TELE,CONSULT OFFICE/OP HIGH LVL MDM 55+MINS | $196.20 | $327.00 | 40% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPT CONSULT HIGH LVL MDM 55+MINS | $196.20 | $327.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OP E&M NEW HIGH LEVEL 60+MINS | $144.60 | $241.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 TELEHEALTH-OFFICE/OP E&M NEW HIGH LVL 60+MINS | $144.60 | $241.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPT CONSULT HIGH LVL MDM 55+MINS | $196.20 | $327.00 | 40% |
| New patient office visit, about 60 minutes inpatient CPT 99205 TELE,CONSULT OFFICE/OP HIGH LVL MDM 55+MINS | $196.20 | $327.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE,EA 15 MIN | $96.00 | $160.00 | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXERCISE,EA 15 MIN | $96.00 | $160.00 | 40% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT PREV BREAST/PELVIC EXAM NEW PT 18-39YRS | $49.80 | $83.00 | 40% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INIT PREV BREAST/PELVIC EXAM NEW PT 40-64YRS | $49.80 | $83.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY, W/PATIENT 30MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 TELEHEALTH-PSYCHOTHERAPY W/PATIENT 30MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PHD PSYCHOTHERAPY,PATIENT 30MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 TELEHEALTH-PHD PSYCHOTHERAPY,PATIENT 30MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 TELEHEALTH-PHD PSYCHOTHERAPY,PATIENT 45MINS | $33.00 | $55.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PHD PSYCHOTHERAPY,PATIENT 45MINS | $33.00 | $55.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 TELEHEALTH-PSYCHOTHERAPY W/PATIENT 45MINS | $33.00 | $55.00 | 40% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY,W/PATIENT 45MINS | $33.00 | $55.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 TELEHEALTH-PHD PSYCHOTHERAPY,PATIENT 60MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY,W/PATIENT 60MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 TELEHEALTH-PSYCHOTHERAPY,PATIENT 60MINS | $30.60 | $51.00 | 40% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PHD PSYCHOTHERAPY,PATIENT 60MINS | $30.60 | $51.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE/OP CONSULT LOW LVL MDM 30+MINS | $75.00 | $125.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 TELE,OFF/OP CONSULT LOW LVL MDM 30MINS/+_NO ALT | $75.00 | $125.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 TELE,CONSULT OFFICE/OP LOW LVL MDM 30+MINS | $75.00 | $125.00 | 40% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFF/OP CONSULT LOW LVL MDM 30MINS/+_NO ALT | $75.00 | $125.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFF/OP CONSULT MOD LVL MDM 40MINS/+_NO ALT | $101.40 | $169.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE/OUTPT CONSULT MOD LVL MDM 40+MINS | $101.40 | $169.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 TELE,OFF/OP CONSULT MOD LVL MDM 40MINS/+_NO ALT | $101.40 | $169.00 | 40% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 TELE,CONSULT OFFICE/OUTPT MOD LVL MDM 40+MINS | $101.40 | $169.00 | 40% |
Source file: https://hph.pt.panaceainc.com/MRFDownload/hph/straub/912151670_Straub-Benioff-Medical-Center_standardcharges.csv