Bella Vista Hospital INC
Bella Vista Hospital INC in Mayaguez, PR publishes cash prices for 46 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
Carr 349 Km 2.7 Mayaguez, PR 00680 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 & PELVIS W CONTR | $475.00 | $475.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W CONTR | $475.00 | $475.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT PITUIT. W/O CONTRAST | $325.00 | $325.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST | $325.00 | $325.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD OR BRAIN W/O CONT | $325.00 | $325.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT PITUIT. W/O CONTRAST | $325.00 | $325.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD OR BRAIN W/O CONT | $325.00 | $325.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST | $325.00 | $325.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $390.00 | $390.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST | $390.00 | $390.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAPHY BILAT.(DIAGNOST) | $80.00 | $80.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAPHY BILAT.(DIAGNOSTIC | $90.00 | $90.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO BILAT IMAG W POT. ANOMAL | $90.00 | $90.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAPHY DIGITAL BILATERAL | $90.00 | $90.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAPHY BILAT.(DIAGNOST) | $80.00 | $80.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAPHY DIGITAL BILATERAL | $90.00 | $90.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAPHY BILAT.(DIAGNOSTIC | $90.00 | $90.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO BILAT IMAG W POT. ANOMAL | $90.00 | $90.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAPHY UNILAT.(DIAGNOST) | $40.00 | $40.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAPHY DIGITAL UNILAT | $90.00 | $90.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAPHY UNILAT.(DIAGNOSTIC | $90.00 | $90.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAPHY DIGITAL UNILAT INT | $90.00 | $90.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAPHY UNILAT.(DIAGNOST) | $40.00 | $40.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAPHY DIGITAL UNILAT INT | $90.00 | $90.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAPHY UNILAT.(DIAGNOSTIC | $90.00 | $90.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAPHY DIGITAL UNILAT | $90.00 | $90.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI KNEE LOW EXT.ANY J W/O | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI FOOT LOWER EXT.ANYJOINT WO | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI ANKLE LOW EXT.ANYJOINT W/O | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI ANY JOINT LOWER EXTREMI WO | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI FOOT LOWER EXT.ANYJOINT WO | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI ANKLE LOW EXT.ANYJOINT W/O | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI ANY JOINT LOWER EXTREMI WO | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI KNEE LOW EXT.ANY J W/O | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JNT OF LWR EXTRE W/O DYE | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXTREMITY W W/O CONT | $850.00 | $850.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT. ANY JOINT W/WO | $850.00 | $850.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI ANY JOINT LOW EXT W/WO | $1,200.00 | $1,200.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI JNT OF LWR EXTRE W/O DYE | $750.00 | $750.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXTREMITY W W/O CONT | $850.00 | $850.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT. ANY JOINT W/WO | $850.00 | $850.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI ANY JOINT LOW EXT W/WO | $1,200.00 | $1,200.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN(STEM) WO CONTRAST | $750.00 | $750.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN(STEM) WO CONTRAST | $750.00 | $750.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN(STEM) W/WO CONTRAST | $850.00 | $850.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN(STEM) W/WO CONTRAST | $850.00 | $850.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR WO CONTRAST | $750.00 | $750.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR WO CONTRAST | $750.00 | $750.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OBST. 2ND TRIMESTER(ABD) | $100.00 | $100.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OBST. 3RD TRIMESTER(ABD) | $115.00 | $115.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS AFTER FIRST TRI | $125.00 | $125.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OBST. 2ND TRIMESTER(ABD) | $100.00 | $100.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OBST. 3RD TRIMESTER(ABD) | $115.00 | $115.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS AFTER FIRST TRI | $125.00 | $125.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOG BILAT(PREVEN) | $80.00 | $80.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 MAMMOGR.BILAT SCREENIN (RUTIN) | $80.00 | $80.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMO BILAT EA BREAS | $80.00 | $80.00 | — |
| Screening mammogram, both breasts CPT 77067 MAMMOG BIL SCREENING (RUTINA) | $90.00 | $90.00 | — |
| Screening mammogram, both breasts CPT 77067 MAMMOGRAPHY SCREENING DIGITAL | $90.00 | $90.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMO BILAT EA BREAS | $80.00 | $80.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMOGR.BILAT SCREENIN (RUTIN) | $80.00 | $80.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOG BILAT(PREVEN) | $80.00 | $80.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMOGRAPHY SCREENING DIGITAL | $90.00 | $90.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 MAMMOG BIL SCREENING (RUTINA) | $90.00 | $90.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL PROBE | $125.00 | $125.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US ENDOVAGINAL | $125.00 | $125.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US ENDOVAGINAL | $125.00 | $125.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL PROBE | $125.00 | $125.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $180.00 | $180.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $180.00 | $180.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR 3 VIEWS | $64.25 | $64.25 | — |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR 5 VIEWS | $87.25 | $87.25 | — |
| X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBOSAC.MINIMUN 4 VIEWS | $96.00 | $96.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR 3 VIEWS | $64.25 | $64.25 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR 5 VIEWS | $87.25 | $87.25 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBOSAC.MINIMUN 4 VIEWS | $96.00 | $96.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL(SMA 7) | $20.00 | $20.00 | — |
| Basic metabolic panel (blood test) CPT 80048 SMA(MEDICARE CON MODIFICADOR) | $20.00 | $20.00 | — |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $25.00 | $25.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL(SMA 7) | $20.00 | $20.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 SMA(MEDICARE CON MODIFICADOR) | $20.00 | $20.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $25.00 | $25.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL(HDL,TRI,CHOL) | $26.00 | $26.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 NMR LIPO PROFILE | $64.18 | $64.18 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL(HDL,TRI,CHOL) | $26.00 | $26.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 NMR LIPO PROFILE | $64.18 | $64.18 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC HEMOGRAM & PLATE COUNT DIF | $9.00 | $9.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC AUTOMATED COMPLETE DIFF | $20.00 | $20.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC(MEDICARE CON MODIFICADOR) | $20.00 | $20.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC HEMOGRAM & PLATE COUNT DIF | $9.00 | $9.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTOMATED COMPLETE DIFF | $20.00 | $20.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC(MEDICARE CON MODIFICADOR) | $20.00 | $20.00 | — |
| Complete blood count (CBC), no differential CPT 85027 CBC HEMOGRAM & PLATE COUNT | $9.00 | $9.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC HEMOGRAM & PLATE COUNT | $9.00 | $9.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPRE METABOLIC PANEL | $21.00 | $21.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC(SMA12) | $35.00 | $35.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 SMA 12/6O (OLD) | $35.00 | $35.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC(SMA18) | $38.00 | $38.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC(SMA20) | $40.00 | $40.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC(SMA24) | $50.00 | $50.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPRE METABOLIC PANEL | $21.00 | $21.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 SMA 12/6O (OLD) | $35.00 | $35.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC(SMA12) | $35.00 | $35.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC(SMA18) | $38.00 | $38.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC(SMA20) | $40.00 | $40.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC(SMA24) | $50.00 | $50.00 | — |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $21.00 | $21.00 | — |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $21.00 | $21.00 | — |
| Liver function blood test panel CPT 80076 HEPATIC OR LIVER PROFILE | $16.00 | $16.00 | — |
| Liver function blood test panel CPT 80076 HEPATIC FUCT TEST | $30.00 | $30.00 | — |
| Liver function blood test panel CPT 80076 LIVER PROFILE | $32.00 | $32.00 | — |
| Liver function blood test panel CPT 80076 HEPATIC PROF OLD | $40.00 | $40.00 | — |
| Liver function blood test panel inpatient CPT 80076 HEPATIC OR LIVER PROFILE | $16.00 | $16.00 | — |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUCT TEST | $30.00 | $30.00 | — |
| Liver function blood test panel inpatient CPT 80076 LIVER PROFILE | $32.00 | $32.00 | — |
| Liver function blood test panel inpatient CPT 80076 HEPATIC PROF OLD | $40.00 | $40.00 | — |
| Obstetric blood test panel CPT 80055 PRENATAL PROFILE | $58.00 | $58.00 | — |
| Obstetric blood test panel inpatient CPT 80055 PRENATAL PROFILE | $58.00 | $58.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE & TOTAL | $20.00 | $20.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE | $38.00 | $38.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE & TOTAL | $20.00 | $20.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE | $38.00 | $38.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL | $20.00 | $20.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPEC. AG-PSA | $25.00 | $25.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIF AG(PSA) TOTAL | $29.00 | $29.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL | $20.00 | $20.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPEC. AG-PSA | $25.00 | $25.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIF AG(PSA) TOTAL | $29.00 | $29.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT(THROMBOPLAST.PARTIAL TIME) | $9.00 | $9.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $9.00 | $9.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $9.00 | $9.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT(THROMBOPLAST.PARTIAL TIME) | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $8.00 | $8.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PT(PROTHROMBIN TIME) | $8.00 | $8.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $8.00 | $8.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT(PROTHROMBIN TIME) | $8.00 | $8.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $27.00 | $27.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE(TSH) | $27.00 | $27.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH-BASAL & TSH POST | $30.00 | $30.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIM HORMONE(TSH) | $27.00 | $27.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $27.00 | $27.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH-BASAL & TSH POST | $30.00 | $30.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W MICROSCOPY | $20.00 | $20.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W MICROSCOPY | $20.00 | $20.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 GLUCOSE URUNE BY STRIP | $5.00 | $5.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 CLINITEST TOLERANCE 3HRS | $15.00 | $15.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 CLINITEST TOLERANCE 5HRS | $21.00 | $21.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 GLUCOSE URUNE BY STRIP | $5.00 | $5.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CLINITEST TOLERANCE 3HRS | $15.00 | $15.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CLINITEST TOLERANCE 5HRS | $21.00 | $21.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 URINALYS (WITHOUT MIC) ROUTINE | $15.00 | $15.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYS (WITHOUT MIC) ROUTINE | $15.00 | $15.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 METABOLIC SCREENING URINE | $90.00 | $90.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 METABOLIC SCREENING URINE | $90.00 | $90.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY W/ENDOSCOPY ULTR E | $4,000.00 | $4,000.00 | — |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY W/ENDOSCOPY ULTR E | $4,000.00 | $4,000.00 | — |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY LESION REMOVAL | $500.00 | $500.00 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY LESION REMOVAL | $500.00 | $500.00 | — |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W BIOPSY SING/MULT | $538.99 | $538.99 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W BIOPSY SING/MULT | $538.99 | $538.99 | — |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $819.00 | $819.00 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $819.00 | $819.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 LEFT HEART CATH | $2,300.00 | $2,300.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HEART CATH | $2,300.00 | $2,300.00 | — |
| Prostate biopsy CPT 55700 BIOPSY PROSTATE | $650.00 | $650.00 | — |
| Prostate biopsy inpatient CPT 55700 BIOPSY PROSTATE | $650.00 | $650.00 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPAROSCOPY,PROSTATECTOMY RADI | $906.00 | $906.00 | — |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPAROSCOPY,PROSTATECTOMY RADI | $906.00 | $906.00 | — |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST,FIBROADENOMA OTH BENI | $1,700.00 | $1,700.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST,FIBROADENOMA OTH BENI | $1,700.00 | $1,700.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 GASTROSCOPY | $200.00 | $200.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 GASTROINTESTINAL ENDO W BIOPSY | $241.00 | $241.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 GASTROSCOPY | $200.00 | $200.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 GASTROINTESTINAL ENDO W BIOPSY | $241.00 | $241.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 UGIE INCLUDING ESOPHAGUS ECT | $146.00 | $146.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 GASTROJEJUNOSTOMY W/O SPECIM | $224.00 | $224.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UGIE INCLUDING ESOPHAGUS ECT | $146.00 | $146.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 GASTROJEJUNOSTOMY W/O SPECIM | $224.00 | $224.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT OFFICE VISIT | $88.50 | $88.50 | — |
| New patient office visit, about 30 minutes CPT 99203 E&M NEW PT-(INTERMEDIATE) | $332.99 | $332.99 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT OFFICE VISIT | $88.50 | $88.50 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 E&M NEW PT-(INTERMEDIATE) | $332.99 | $332.99 | — |
| New patient office visit, about 45 minutes CPT 99204 E&M NEW PT-(EXTENDED) | $456.96 | $456.96 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 E&M NEW PT-(EXTENDED) | $456.96 | $456.96 | — |
| New patient office visit, about 60 minutes CPT 99205 E&M NEW PT-(COMPLEX) | $618.45 | $618.45 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 E&M NEW PT-(COMPLEX) | $618.45 | $618.45 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT PROC THERPTC EXERCISE O/P 1 | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PHYSICAL THERAPHY | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERPTC EX. O/P 15M MFD | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT PROC THERPTC EXERCISE 15M | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT PROC THERAPTC EXERCISE O/P | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT PROC THERPTC EXERCISE 15M | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT PROC THERPTC EXERCISE 15M | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT PROC THERAPTC EXERCISE O/P | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PHYSICAL THERAPHY | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT PROC THERPTC EXERCISE O/P 1 | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERPTC EX. O/P 15M MFD | $35.00 | $35.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT PROC THERPTC EXERCISE 15M | $35.00 | $35.00 | — |
Source file: https://www.bvhpr.org/assets/files/660204776_bella-vista-hospital,-inc_standardcharges.csv