Memorial Hospital Miramar
Memorial Hospital Miramar in Miramar, FL publishes cash prices for 52 common procedures listed here, from its own machine-readable price file updated May 27, 2026. Click a procedure to compare it with other hospitals nearby.
1901 S.W. 172nd Avenue, Miramar, FL 33029 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 HC CT Abd & Pelvis W Contrast | $7,446.60 | $10,638.00 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd & Pelvis W Contrast | $7,446.60 | $10,638.00 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC Brain Plain CT | $2,391.20 | $3,416.00 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC Brain Plain CT | $2,391.20 | $3,416.00 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Cont. | $5,901.70 | $8,431.00 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Cont. | $5,901.70 | $8,431.00 | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Diagnostic Mammo W/ Cad Unilateral | $598.50 | $855.00 | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Diagnostic Mammo W/ Cad Unilateral | $598.50 | $855.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 HC MRI Joint Low Ext Bilateral W/O Contrast | $3,740.80 | $5,344.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Joint Low Ext W/O Contrast | $3,740.80 | $5,344.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 HC MRI Joint Low Ext Bilateral W/O Contrast | $3,740.80 | $5,344.00 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Joint Low Ext W/O Contrast | $3,740.80 | $5,344.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 HC MRI Joint Low Ext Bilateral WO/W Contrast | $6,971.30 | $9,959.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Joint Low Ext WO/W Contrast | $9,475.20 | $13,536.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 HC MRI Joint Low Ext Bilateral WO/W Contrast | $6,971.30 | $9,959.00 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Joint Low Ext WO/W Contrast | $9,475.20 | $13,536.00 | 30% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $3,788.40 | $5,412.00 | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $3,788.40 | $5,412.00 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Head Brain WO/W Contrast | $9,474.50 | $13,535.00 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Head Brain WO/W Contrast | $9,474.50 | $13,535.00 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Spine Lumbar W/O Contrast | $3,823.40 | $5,462.00 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Spine Lumbar W/O Contrast | $3,823.40 | $5,462.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnancy | $1,384.60 | $1,978.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnancy Portable | $1,523.90 | $2,177.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnancy | $1,384.60 | $1,978.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnancy Portable | $1,523.90 | $2,177.00 | 30% |
| Screening mammogram, both breasts both sides CPT 77067 HC Screening Mammo W/ Cad Bilateral | $793.10 | $1,133.00 | 30% |
| Screening mammogram, both breasts one side CPT 77067 HC Screening Mammo W/ Cad & Tomo Unilateral | $815.50 | $1,165.00 | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Screening Mammo W/ Cad Bilateral | $793.10 | $1,133.00 | 30% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Screening Mammo W/ Cad & Tomo Unilateral | $815.50 | $1,165.00 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography (4+) | $7,773.50 | $11,105.00 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography (4+) - Discontinued | $7,773.50 | $11,105.00 | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography (4+) | $7,773.50 | $11,105.00 | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography (4+) - Discontinued | $7,773.50 | $11,105.00 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal | $1,274.70 | $1,821.00 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal | $1,274.70 | $1,821.00 | 30% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen | $2,135.00 | $3,050.00 | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen | $2,135.00 | $3,050.00 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Lumbar Spine W/Obls. | $1,212.40 | $1,732.00 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Lumbar Spine W/Obls. | $1,212.40 | $1,732.00 | 30% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel | $385.00 | $550.00 | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel | $385.00 | $550.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel Arup #2013716 | $11.20 | $16.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel Quest #92145 | $14.29 | $20.42 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Advanced Lipid Panel With Inflammation, Cardio Iq« Quest #94220 | $17.88 | $25.55 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel Quest #141363 Q201 | $28.09 | $40.13 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel Q200 | $32.90 | $47.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Profile | $738.50 | $1,055.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel Arup #2013716 | $11.20 | $16.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel Quest #92145 | $14.29 | $20.42 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Advanced Lipid Panel With Inflammation, Cardio Iq« Quest #94220 | $17.88 | $25.55 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel Quest #141363 Q201 | $28.09 | $40.13 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel Q200 | $32.90 | $47.00 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Profile | $738.50 | $1,055.00 | 30% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc W/Platelets | $245.00 | $350.00 | 30% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc W/Platelets Onc | $245.00 | $350.00 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc W/Platelets Onc | $245.00 | $350.00 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc W/Platelets | $245.00 | $350.00 | 30% |
| Complete blood count (CBC), no differential CPT 85027 HC Hemogram and Platelet Count | $574.70 | $821.00 | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Hemogram and Platelet Count | $574.70 | $821.00 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Panel | $527.80 | $754.00 | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Panel | $527.80 | $754.00 | 30% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $766.50 | $1,095.00 | 30% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $766.50 | $1,095.00 | 30% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $721.70 | $1,031.00 | 30% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $721.70 | $1,031.00 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Assay of Psa Free Q200 | $18.90 | $27.00 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Psa - Free | $19.60 | $28.00 | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Assay of Psa Free Q200 | $18.90 | $27.00 | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Psa - Free | $19.60 | $28.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Assay of Psa Total Q200 | $18.90 | $27.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Ref Psa - Total (A) | $19.60 | $28.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Antigen Psa | $506.10 | $723.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen-Eia | $1,010.10 | $1,443.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Assay of Psa Total Q200 | $18.90 | $27.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Ref Psa - Total (A) | $19.60 | $28.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Antigen Psa | $506.10 | $723.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen-Eia | $1,010.10 | $1,443.00 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ref a P T T | $7.70 | $11.00 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt Lupus Anticoagulation | $528.50 | $755.00 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC a P T T | $528.50 | $755.00 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ref a P T T | $7.70 | $11.00 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC a P T T | $528.50 | $755.00 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt Lupus Anticoagulation | $528.50 | $755.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Lupus Anticoagulant Prothrombin | $5.60 | $8.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $347.90 | $497.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Ptinr | $347.90 | $497.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time Onc | $382.20 | $546.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Lupus Anticoagulant Prothrombin | $5.60 | $8.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Ptinr | $347.90 | $497.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $347.90 | $497.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time Onc | $382.20 | $546.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Assay Thyroid Stim Hormone Q200 | $25.20 | $36.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Tsh-Endocrine | $46.90 | $67.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Tsh-Thyroid Stimulating Hormone | $792.40 | $1,132.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Assay Thyroid Stim Hormone Q200 | $25.20 | $36.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Tsh-Endocrine | $46.90 | $67.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Tsh-Thyroid Stimulating Hormone | $792.40 | $1,132.00 | 30% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis W/Micro | $158.20 | $226.00 | 30% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis W/Micro Onc | $211.40 | $302.00 | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis W/Micro | $158.20 | $226.00 | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis W/Micro Onc | $211.40 | $302.00 | 30% |
| Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis Man W/Micro | $179.20 | $256.00 | 30% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis Man W/Micro | $179.20 | $256.00 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 HC Routine Urinalysis Auto | $133.70 | $191.00 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis-Without Microscopic | $133.70 | $191.00 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis-Without Microscopic | $133.70 | $191.00 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Routine Urinalysis Auto | $133.70 | $191.00 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 HC POCT Urinalysis Nonauto W/O Scope | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urine Protein POCT | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urine Specific Gravity | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 HC Routine Urinalysis Non-Auto | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine Protein POCT | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Routine Urinalysis Non-Auto | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine Specific Gravity | $27.30 | $39.00 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC POCT Urinalysis Nonauto W/O Scope | $27.30 | $39.00 | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with endoscopic ultrasound CPT 45391 HC Colonoscopy W/Endoscopic US Exam | $3,703.70 | $5,291.00 | 30% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 HC Colonoscopy W/Endoscopic US Exam | $3,703.70 | $5,291.00 | 30% |
| Colonoscopy with polyp removal CPT 45385 HC Colonoscopy Rem Lesions (Snare) | $4,388.30 | $6,269.00 | 30% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC Colonoscopy Rem Lesions (Snare) | $4,388.30 | $6,269.00 | 30% |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy W/Biopsies | $4,388.30 | $6,269.00 | 30% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC Colonoscopy W/Biopsies | $4,388.30 | $6,269.00 | 30% |
| Colonoscopy, diagnostic CPT 45378 HC Colonoscopy Diagnostic | $3,591.70 | $5,131.00 | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC Colonoscopy Diagnostic | $3,591.70 | $5,131.00 | 30% |
| Left heart catheterization, diagnostic one side CPT 93452 HC Left Hrt Cath W/Ventrclgrphy | $6,877.50 | $9,825.00 | 30% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Left Hrt Cath W/Ventrclgrphy | $6,877.50 | $9,825.00 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection Diag Interlaminar Lumbar or Sacral W/ Imag Guid | $3,570.00 | $5,100.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection Diag Interlaminar Lumbar or Sacral W/ Imag Guid | $3,570.00 | $5,100.00 | 30% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC Injection Diag Interlaminar Lumbar or Sacral W/O Imag Guid | $6,363.70 | $9,091.00 | 30% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC Injection Diag Interlaminar Lumbar or Sacral W/O Imag Guid | $6,363.70 | $9,091.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Transforaminal Epi L/S Sngl Uni | $3,424.40 | $4,892.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Transforaminal Epi L/S Sngl Bil | $6,848.80 | $9,784.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Transforaminal Epi L/S Sngl Uni | $3,424.40 | $4,892.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Transforaminal Epi L/S Sngl Bil | $6,848.80 | $9,784.00 | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Upper Endo With Biopsies | $3,409.70 | $4,871.00 | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC Upper Endo With Biopsies | $3,409.70 | $4,871.00 | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC Upper Endo Diagnostic | $3,409.70 | $4,871.00 | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC Upper Endo Diagnostic | $3,409.70 | $4,871.00 | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy 40-50 Mins. W/Pat Bh | $194.60 | $278.00 | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy 40-50 Mins. W/Pat | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy 40-50 Mins. W/Pat (Global) | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Mh Iop Family Psychotherapy With Patient | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Sa Iop Family Psychotherapy With Patient | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy 40-50 Mins. W/Pat Bh | $194.60 | $278.00 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy 40-50 Mins. W/Pat (Global) | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Mh Iop Family Psychotherapy With Patient | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Sa Iop Family Psychotherapy With Patient | $610.40 | $872.00 | 30% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy 40-50 Mins. W/Pat | $610.40 | $872.00 | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy 40-50 Min.W/O Pat | $571.20 | $816.00 | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Sa Iop Family Therapy W/O the Patient Present | $571.20 | $816.00 | 30% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy 40-50 Min.W/O Pat | $571.20 | $816.00 | 30% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Sa Iop Family Therapy W/O the Patient Present | $571.20 | $816.00 | 30% |
| Group psychotherapy session CPT 90853 HC Group Psychotherapy Bh | $109.20 | $156.00 | 30% |
| Group psychotherapy session CPT 90853 HC O/P Group Psychotherapy Bh | $147.00 | $210.00 | 30% |
| Group psychotherapy session CPT 90853 HC Aftercare Group Therapy | $319.20 | $456.00 | 30% |
| Group psychotherapy session CPT 90853 HC Sa Iop Group Therapy | $343.70 | $491.00 | 30% |
| Group psychotherapy session CPT 90853 HC Group Psychotherapy | $343.70 | $491.00 | 30% |
| Group psychotherapy session CPT 90853 HC Group Psychotherapy-Psychcare (Global) | $343.70 | $491.00 | 30% |
| Group psychotherapy session CPT 90853 HC Group Psychotherapy-Psychcare | $343.70 | $491.00 | 30% |
| Group psychotherapy session CPT 90853 HC Mh Iop Group Therapy | $343.70 | $491.00 | 30% |
| Group psychotherapy session CPT 90853 HC O/P Group Psychotherapy | $590.80 | $844.00 | 30% |
| Group psychotherapy session CPT 90853 HC O/P Group Psychotherapy (Global) | $754.60 | $1,078.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Group Psychotherapy Bh | $109.20 | $156.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC O/P Group Psychotherapy Bh | $147.00 | $210.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Aftercare Group Therapy | $319.20 | $456.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Group Psychotherapy-Psychcare (Global) | $343.70 | $491.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Sa Iop Group Therapy | $343.70 | $491.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Group Psychotherapy | $343.70 | $491.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Group Psychotherapy-Psychcare | $343.70 | $491.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC Mh Iop Group Therapy | $343.70 | $491.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC O/P Group Psychotherapy | $590.80 | $844.00 | 30% |
| Group psychotherapy session inpatient CPT 90853 HC O/P Group Psychotherapy (Global) | $754.60 | $1,078.00 | 30% |
| New patient office visit, about 30 minutes CPT 99203 HC New Patient-Level 3 | $371.00 | $530.00 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC New Patient-Level 3 | $371.00 | $530.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 HC New Pt Psy Eva -MD/Arnp(1500) 45-59 Min | $179.90 | $257.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 HC New Pt Psych Eva -MD/Arnp 45-59 Min | $361.90 | $517.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 HC New Patient-Level 4 | $539.70 | $771.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 HC New Pt Psy Eva -MD/Arnp 1500 45-59 Min | $539.70 | $771.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 HC New Pt Mh Eva -MD/Arnp 45-59 Min | $539.70 | $771.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt Psy Eva -MD/Arnp(1500) 45-59 Min | $179.90 | $257.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt Psych Eva -MD/Arnp 45-59 Min | $361.90 | $517.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt Mh Eva -MD/Arnp 45-59 Min | $539.70 | $771.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC New Patient-Level 4 | $539.70 | $771.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt Psy Eva -MD/Arnp 1500 45-59 Min | $539.70 | $771.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Psy Eva -MD/Arnp(1500) 60-74 Min | $218.40 | $312.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Psy Eva -MD/Aprn(1500) 60-74 Min | $218.40 | $312.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Psych Eva -MD/Arnp 60-74 Min | $444.50 | $635.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Psy Eva -MD/Arnp 60-74 Min | $635.60 | $908.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Psy Eva -MD/Arnp 1500 60-74 Min | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Patient-Level 5 | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Mh Eva -MD/Arnp 60-74 Min | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HC New Pt Sa Eva -MD/Arnp 60-74 Min | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Psy Eva -MD/Aprn(1500) 60-74 Min | $218.40 | $312.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Psy Eva -MD/Arnp(1500) 60-74 Min | $218.40 | $312.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Psych Eva -MD/Arnp 60-74 Min | $444.50 | $635.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Psy Eva -MD/Arnp 60-74 Min | $635.60 | $908.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Mh Eva -MD/Arnp 60-74 Min | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Psy Eva -MD/Arnp 1500 60-74 Min | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Patient-Level 5 | $659.40 | $942.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt Sa Eva -MD/Arnp 60-74 Min | $659.40 | $942.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Incontinence Therapy-Exercise 15 Min | $178.50 | $255.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Therapeutic Exercise 15 Min Ot | $178.50 | $255.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Exercise 15 Min | $178.50 | $255.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Tele Therapeutic Exercise 15 Min Ot | $211.40 | $302.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Tele Pt Therapeutic Exercise 15 Min | $211.40 | $302.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Tele Interactive Metronome Ot | $211.40 | $302.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Incontinence Therapy-Exercise 15 Min | $178.50 | $255.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Therapeutic Exercise 15 Min Ot | $178.50 | $255.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Exercise 15 Min | $178.50 | $255.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Tele Interactive Metronome Ot | $211.40 | $302.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Tele Pt Therapeutic Exercise 15 Min | $211.40 | $302.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Tele Therapeutic Exercise 15 Min Ot | $211.40 | $302.00 | 30% |
| Psychotherapy session, 30 minutes CPT 90832 HC Sa Psychotherapy Supportive Therapy 16-37 Minutes | $571.20 | $816.00 | 30% |
| Psychotherapy session, 30 minutes CPT 90832 HC Mh Psychotherapy Supportive Therapy 16-37 Minutes | $571.20 | $816.00 | 30% |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Supportive Therapy 16-37 Minutes | $571.20 | $816.00 | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Supportive Therapy 16-37 Minutes | $571.20 | $816.00 | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Mh Psychotherapy Supportive Therapy 16-37 Minutes | $571.20 | $816.00 | 30% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Sa Psychotherapy Supportive Therapy 16-37 Minutes | $571.20 | $816.00 | 30% |
| Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy Supportive Therapy 38-52 Minutes | $590.80 | $844.00 | 30% |
| Psychotherapy session, 45 minutes CPT 90834 HC Mh Psychotherapy Supportive Therapy 38-52 Minutes | $590.80 | $844.00 | 30% |
| Psychotherapy session, 45 minutes CPT 90834 HC Sa Psychotherapy Supportive Therapy 38-52 Minutes | $590.80 | $844.00 | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy Supportive Therapy 38-52 Minutes | $590.80 | $844.00 | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Sa Psychotherapy Supportive Therapy 38-52 Minutes | $590.80 | $844.00 | 30% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Mh Psychotherapy Supportive Therapy 38-52 Minutes | $590.80 | $844.00 | 30% |
| Psychotherapy session, 60 minutes CPT 90837 HC Psychotherapy Supportive Therapy 53 Minutes or More | $893.20 | $1,276.00 | 30% |
| Psychotherapy session, 60 minutes CPT 90837 HC Mh Psychotherapy Supportive Therapy 53 Minutes or More | $893.20 | $1,276.00 | 30% |
| Psychotherapy session, 60 minutes CPT 90837 HC Sa Psychotherapy Supportive Therapy 53 Minutes or More | $893.20 | $1,276.00 | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Mh Psychotherapy Supportive Therapy 53 Minutes or More | $893.20 | $1,276.00 | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Sa Psychotherapy Supportive Therapy 53 Minutes or More | $893.20 | $1,276.00 | 30% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psychotherapy Supportive Therapy 53 Minutes or More | $893.20 | $1,276.00 | 30% |
Dental
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Porcelain crown CDT D2740 HC Crown D-Ul-6 1st Pri Mol Upr 500-9444 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Ul-3 Sec Prim Mol Upr 500-9246 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn D-UR-5 Bell 1st Prim Mol 500-9378 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Lwr 5009584 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crown E-UR-4 Sec Pri Mol Upr 500-9337 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 7 Cspd 1st Prim Mol Upr 5009527 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-UR-6 Bell Sec Prim Mol 07-500-9493 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crown D-Ul-5 1st Pri Mol Upr 500-9360 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crown E-Lr-3 Sec Pri Mol Lwr 500-9279 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crown E-UR-2 Sec Pri Mol Up 500-9170 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crown E-Lr-4 Sec Pri Mol Lwr 500-9352 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Ll-2 Sec Prim Mol Lwr 75009188 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Lr-5 Sec Prim Mol Lwr 500-9436 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Ll-5 Sec Prim Mol Lwr 500-9428 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Lr-2 Sec Prim Mol Lwr 5009196 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crown E-Ll-6 Sec Pri Mol Lwr 500-9501 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn D-Lr-3 1st Prim Mol Lwr 5009238 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Lwr 5009147 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Lwr 5009154 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 5009121 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 5009139 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 7 Cspd 1st Prim Mol Upr 5009535 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Lwr 5009592 | $10.50 | $15.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Ll-7 Cspd Sec Prim Mol 7777892 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn D-UR-7 Cspd 1st Prim Mol 7777814 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn D-UR-3 Cspd 1st Prim Mol 7776446 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn D-Lr-3 Cspd 1st Prim Mol 7775656 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Upr 7770625 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 7770793 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn D-Lr-2 Cspd 1st Prim Mol 7774911 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd Sec Prim Mol Lwr 7771992 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 7775159 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-UR-7 Cspd Sec Prim Mol 7770697 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Ul-6 Cspd Sec Prim Mol 7773333 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn E-Lr-7 Cspd Sec Prim Mol 7779526 | $11.90 | $17.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 3 Thk Prll Wl Cspd Sec 504--0746 | $12.60 | $18.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 4 Thn Cntr Prim Ant Upr 7773944 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 4 Thn Cntr Prim Ant Upr 7778207 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 4 Cntr Prim Ant Upr Rlat 7778797 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 3 Thn Cntr Prim Ant Upr 7778583 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 3 Thn Cntr Prim Ant Upr 7778006 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 2 Thn Cntr Prim Ant Upr 7778520 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 1 Cntr Prim Ant Upr Rlat 7778296 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 1 Cntr Prim Ant Upr L/L 7777656 | $14.70 | $21.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Upr 5009576 | $48.30 | $69.00 | 30% |
| Porcelain crown CDT D2740 HC Crwn 6 Cspd Sec Prim Mol Upr 5009485 | $51.80 | $74.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 2 Sm Med Lat Incsr Lt 171-3486 | $9.80 | $14.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 7 1st Pri Mol Lwr Rt Ss 500-9550 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 6 1st Pri Mol Lwr Lt Ss 500-9469 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 3 1st Pri Mol Lwr Lt Ss 500-9220 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 6 1st Pri Mol Upr Rt Ss 500-9451 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 6 1st Pri Mol Lwr Rt Ss 500-9477 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 Sec Pri Mol Upr Rt Ss 504-0779 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 1st Pri Mol Upr Rt Ss 500-9295 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 1st Pri Mol Upr Lt Ss 500-9287 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 5 Sec Prim Mol Lwr Lt Ss 504-0845 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 1st Pri Mol Lwr Rt Ss 500-9311 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 3 Sec Mol Upr Rt Espe 500-9253 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 6 Sec Pri Mol Upr Lt Ss 504-0860 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 2 Sec Prim Mol Up Lt Ss 500-9162 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 1st Pri Mol Lwr Lt Ss 500-9303 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 5 1st Pri Mol Lwr Lt Ss 500-9386 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 5 Sec Pri Mol Upr Rt Ss 500-9410 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 5 1st Pri Mol Lwr Rt Ss 500-9394 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 Sec Pri Mol Lwr Lt Ss 500-9345 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 6 Sec Pri Mol Lwr Lt Ss 504-0886 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 4 Sec Pri Mol Upr Lt Ss 500-9329 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 5 Sec Pri Mol Upr Lt Ss 500-9402 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 7 1st Pri Mol Lwr Lt Ss 500-9543 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 3 Sec Mol Lwr Lt Espi 500-9261 | $10.50 | $15.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crown 3 Sec Pri Mol Upr Rt Ss 504-0738 | $11.20 | $16.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 5 Sec Prim Mol Lwr Rt Ss 504-0837 | $11.90 | $17.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 4 Cntr Prim Ant Upr Lt 7777523 | $14.70 | $21.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 3 Cntr Prim Ant Upr Rt 7773300 | $14.70 | $21.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 2 Cntr Prim Ant Upr Rt 7773039 | $14.70 | $21.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 2 Cntr Prim Ant Upr Lt 7776339 | $14.70 | $21.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 1 Cntr Prim Ant Upr Lt 7770661 | $14.70 | $21.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 3 Cntr Upr Lt Cntr Prim 7771549 | $14.70 | $21.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn E1 Form Cspd Lt Pref 1713635 | $39.90 | $57.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 2 Cntr Prim Ant Upr Rt 5042775 | $52.50 | $75.00 | 30% |
| Porcelain crown one side CDT D2740 HC Crwn 3 Cntr Prim Ant Upr Rt 5042783 | $52.50 | $75.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Ll-5 Sec Prim Mol Lwr 500-9428 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown D-Ul-6 1st Pri Mol Upr 500-9444 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown E-Ll-6 Sec Pri Mol Lwr 500-9501 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn D-UR-5 Bell 1st Prim Mol 500-9378 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown E-Lr-4 Sec Pri Mol Lwr 500-9352 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown E-UR-2 Sec Pri Mol Up 500-9170 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Ul-3 Sec Prim Mol Upr 500-9246 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Lr-5 Sec Prim Mol Lwr 500-9436 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown E-UR-4 Sec Pri Mol Upr 500-9337 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown D-Ul-5 1st Pri Mol Upr 500-9360 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crown E-Lr-3 Sec Pri Mol Lwr 500-9279 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-UR-6 Bell Sec Prim Mol 07-500-9493 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 7 Cspd 1st Prim Mol Upr 5009527 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Lwr 5009584 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Lr-2 Sec Prim Mol Lwr 5009196 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn D-Lr-3 1st Prim Mol Lwr 5009238 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Lwr 5009592 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 7 Cspd 1st Prim Mol Upr 5009535 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 5009139 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 5009121 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Lwr 5009154 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Lwr 5009147 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Ll-2 Sec Prim Mol Lwr 75009188 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-UR-7 Cspd Sec Prim Mol 7770697 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd Sec Prim Mol Lwr 7771992 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Upr 7770625 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 7775159 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn D-Lr-3 Cspd 1st Prim Mol 7775656 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn D-Lr-2 Cspd 1st Prim Mol 7774911 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn D-UR-3 Cspd 1st Prim Mol 7776446 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn D-UR-7 Cspd 1st Prim Mol 7777814 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Cspd 1st Prim Mol Upr 7770793 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Ll-7 Cspd Sec Prim Mol 7777892 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Lr-7 Cspd Sec Prim Mol 7779526 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn E-Ul-6 Cspd Sec Prim Mol 7773333 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 3 Thk Prll Wl Cspd Sec 504--0746 | $12.60 | $18.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 1 Cntr Prim Ant Upr Rlat 7778296 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 2 Thn Cntr Prim Ant Upr 7778520 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 3 Thn Cntr Prim Ant Upr 7778006 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 3 Thn Cntr Prim Ant Upr 7778583 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 1 Cntr Prim Ant Upr L/L 7777656 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 4 Thn Cntr Prim Ant Upr 7778207 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 4 Thn Cntr Prim Ant Upr 7773944 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 4 Cntr Prim Ant Upr Rlat 7778797 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 7 Cspd Sec Prim Mol Upr 5009576 | $48.30 | $69.00 | 30% |
| Porcelain crown inpatient CDT D2740 HC Crwn 6 Cspd Sec Prim Mol Upr 5009485 | $51.80 | $74.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 2 Sm Med Lat Incsr Lt 171-3486 | $9.80 | $14.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 3 Sec Mol Lwr Lt Espi 500-9261 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 1st Pri Mol Lwr Rt Ss 500-9311 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 1st Pri Mol Upr Lt Ss 500-9287 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 Sec Pri Mol Upr Rt Ss 504-0779 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 6 1st Pri Mol Lwr Rt Ss 500-9477 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 6 1st Pri Mol Upr Rt Ss 500-9451 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 3 1st Pri Mol Lwr Lt Ss 500-9220 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 6 1st Pri Mol Lwr Lt Ss 500-9469 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 7 1st Pri Mol Lwr Rt Ss 500-9550 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 7 1st Pri Mol Lwr Lt Ss 500-9543 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 5 Sec Pri Mol Upr Lt Ss 500-9402 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 5 Sec Prim Mol Lwr Lt Ss 504-0845 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 Sec Pri Mol Upr Lt Ss 500-9329 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 6 Sec Pri Mol Upr Lt Ss 504-0860 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 1st Pri Mol Upr Rt Ss 500-9295 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 1st Pri Mol Lwr Lt Ss 500-9303 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 2 Sec Prim Mol Up Lt Ss 500-9162 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 4 Sec Pri Mol Lwr Lt Ss 500-9345 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 5 1st Pri Mol Lwr Lt Ss 500-9386 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 6 Sec Pri Mol Lwr Lt Ss 504-0886 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 5 Sec Pri Mol Upr Rt Ss 500-9410 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 5 1st Pri Mol Lwr Rt Ss 500-9394 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 3 Sec Mol Upr Rt Espe 500-9253 | $10.50 | $15.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crown 3 Sec Pri Mol Upr Rt Ss 504-0738 | $11.20 | $16.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 5 Sec Prim Mol Lwr Rt Ss 504-0837 | $11.90 | $17.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 2 Cntr Prim Ant Upr Lt 7776339 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 3 Cntr Upr Lt Cntr Prim 7771549 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 4 Cntr Prim Ant Upr Lt 7777523 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 1 Cntr Prim Ant Upr Lt 7770661 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 3 Cntr Prim Ant Upr Rt 7773300 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 2 Cntr Prim Ant Upr Rt 7773039 | $14.70 | $21.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn E1 Form Cspd Lt Pref 1713635 | $39.90 | $57.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 2 Cntr Prim Ant Upr Rt 5042775 | $52.50 | $75.00 | 30% |
| Porcelain crown inpatient one side CDT D2740 HC Crwn 3 Cntr Prim Ant Upr Rt 5042783 | $52.50 | $75.00 | 30% |
Source file: https://www.mhs.net/-/media/Files/Standard%20charges/596014973memorialhospitalmiramarstandardchargescsv.zip