Northbay Medical Center
Northbay Medical Center in Fairfield, CA publishes cash prices for 63 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
1200 B Gale Wilson Blvd, Fairfield, CA 94533 Collected Sep 23, 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 Enterography Wiv And W Oral | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abd Pelvis W Contrast | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abd Pelvis W Contrast | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Enterography Wiv And W Oral | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Enterography Wiv And W Oral | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abd Pelvis W Contrast | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Enterography Wiv And W Oral | $16,630.00 | $16,630.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abd Pelvis W Contrast | $16,630.00 | $16,630.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Sinus Stealth W/O Contrast | $3,484.00 | $3,484.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Sinus Stealth W/O Contrast | $3,484.00 | $3,484.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Stealth W/O Contrast | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 Hd Sc W/O Cntrst | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Stealth W/O Contrast | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 Hd Sc W/O Cntrst | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Sinus Stealth W/O Contrast | $3,484.00 | $3,484.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Sinus Stealth W/O Contrast | $3,484.00 | $3,484.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hd Sc W/O Cntrst | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Stealth W/O Contrast | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Stealth W/O Contrast | $3,485.00 | $3,485.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Hd Sc W/O Cntrst | $3,485.00 | $3,485.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis W Iv & Oral Contrast | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis Oral Contrast Only | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis Oral Contrast Only | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis W Iv & Oral Contrast | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis Oral Contrast Only | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis W Iv & Oral Contrast | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis W Iv & Oral Contrast | $10,223.00 | $10,223.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis Oral Contrast Only | $10,223.00 | $10,223.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Stem W/O Dye | $198.74 | $198.74 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Stem W/O Dye | $198.74 | $198.74 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Iac W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Wo/Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Pituitary W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Iac W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Wo/Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Pituitary W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Stem W/O Dye | $198.74 | $198.74 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Stem W/O Dye | $198.74 | $198.74 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Wo/Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Wo/Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Iac W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Iac W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Pituitary W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Pituitary W/O Contrast | $6,128.00 | $6,128.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mr Neuro Brain Tumor W And W/O | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Iac W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Pituitary W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mr Brain W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mr Neuro Brain Tumor W And W/O | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Iac W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Pituitary W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 Mr Brain W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr Brain W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Pituitary W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Iac W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Iac W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Pituitary W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr Brain W/Wo Contrast | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr Neuro Brain Tumor W And W/O | $8,797.00 | $8,797.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mr Neuro Brain Tumor W And W/O | $8,797.00 | $8,797.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 Mri L-Spine Wo/Cont | $6,820.00 | $6,820.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 Mri L-Spine Wo/Cont | $6,820.00 | $6,820.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri L-Spine Wo/Cont | $6,820.00 | $6,820.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri L-Spine Wo/Cont | $6,820.00 | $6,820.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us > 14 Weeks | $446.64 | $446.64 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us > 14 Weeks | $446.64 | $446.64 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us Ob >14 Wks Single/1St Gesta | $4,774.00 | $4,774.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Us Ob >14 Wks Single/1St Gesta | $4,774.00 | $4,774.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us > 14 Weeks | $446.64 | $446.64 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us > 14 Weeks | $446.64 | $446.64 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us Ob >14 Wks Single/1St Gesta | $4,774.00 | $4,774.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Us Ob >14 Wks Single/1St Gesta | $4,774.00 | $4,774.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 Transvaginal Us Non-Ob | $378.45 | $378.45 | — |
| Transvaginal pelvic ultrasound CPT 76830 Transvaginal Us Non-Ob | $378.45 | $378.45 | — |
| Transvaginal pelvic ultrasound CPT 76830 Us Gyn Transvag | $396.96 | $396.96 | — |
| Transvaginal pelvic ultrasound CPT 76830 Us Gyn Transvag | $396.96 | $396.96 | — |
| Transvaginal pelvic ultrasound CPT 76830 Endovaginal U/S | $1,647.00 | $1,647.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 Endovaginal U/S | $1,647.00 | $1,647.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal Us Non-Ob | $378.45 | $378.45 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal Us Non-Ob | $378.45 | $378.45 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Us Gyn Transvag | $396.96 | $396.96 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Us Gyn Transvag | $396.96 | $396.96 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Endovaginal U/S | $1,647.00 | $1,647.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Endovaginal U/S | $1,647.00 | $1,647.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 Abdomen Sonogram Complete | $3,277.00 | $3,277.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 Abdomen Sonogram Complete | $3,277.00 | $3,277.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Abdomen Sonogram Complete | $3,277.00 | $3,277.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Abdomen Sonogram Complete | $3,277.00 | $3,277.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 Xray Lumbar Spine Min 4 Vws | $224.54 | $224.54 | — |
| X-ray of the lower back, 4 or more views CPT 72110 Xray Lumbar Spine Min 4 Vws | $224.54 | $224.54 | — |
| X-ray of the lower back, 4 or more views CPT 72110 Lumbosacral Complete | $2,328.00 | $2,328.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 Lumbosacral Complete | $2,328.00 | $2,328.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Xray Lumbar Spine Min 4 Vws | $224.54 | $224.54 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Xray Lumbar Spine Min 4 Vws | $224.54 | $224.54 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Lumbosacral Complete | $2,328.00 | $2,328.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Lumbosacral Complete | $2,328.00 | $2,328.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $457.00 | $457.00 | — |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $457.00 | $457.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $457.00 | $457.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $457.00 | $457.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $42.00 | $42.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $42.00 | $42.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lpd Pnl W/Rflx To Direct Ldl | $79.00 | $79.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lpd Pnl W/Rflx To Direct Ldl | $79.00 | $79.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $42.00 | $42.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $42.00 | $42.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lpd Pnl W/Rflx To Direct Ldl | $79.00 | $79.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lpd Pnl W/Rflx To Direct Ldl | $79.00 | $79.00 | — |
| Complete blood count (CBC) with differential CPT 85025 Cbc With Auto Diff | $314.00 | $314.00 | — |
| Complete blood count (CBC) with differential CPT 85025 Cbc With Auto Diff | $314.00 | $314.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 Cbc With Auto Diff | $314.00 | $314.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 Cbc With Auto Diff | $314.00 | $314.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Hemogram Automated | $308.00 | $308.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Hemogram Automated | $308.00 | $308.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram Automated | $308.00 | $308.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram Automated | $308.00 | $308.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehen Metabolic Panel | $10.88 | $10.88 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehen Metabolic Panel | $10.88 | $10.88 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $504.00 | $504.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $504.00 | $504.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen Metabolic Panel | $10.88 | $10.88 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen Metabolic Panel | $10.88 | $10.88 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $504.00 | $504.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $504.00 | $504.00 | — |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $307.00 | $307.00 | — |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $307.00 | $307.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $307.00 | $307.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $307.00 | $307.00 | — |
| Liver function blood test panel CPT 80076 Liver Panel | $528.00 | $528.00 | — |
| Liver function blood test panel CPT 80076 Liver Panel | $528.00 | $528.00 | — |
| Liver function blood test panel inpatient CPT 80076 Liver Panel | $528.00 | $528.00 | — |
| Liver function blood test panel inpatient CPT 80076 Liver Panel | $528.00 | $528.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt-La W/Rflx To Hex Phs Conf | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt-La W/Rflx To Hex Phs Conf | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $360.00 | $360.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $360.00 | $360.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt-La W/Rflx To Hex Phs Conf | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt-La W/Rflx To Hex Phs Conf | $15.00 | $15.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $360.00 | $360.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $360.00 | $360.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $230.00 | $230.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $230.00 | $230.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $230.00 | $230.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $230.00 | $230.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $54.00 | $54.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $54.00 | $54.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh, Third Generation | $257.00 | $257.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh, Third Generation | $257.00 | $257.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyr/Stim/Hormone | $284.00 | $284.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyr/Stim/Hormone | $284.00 | $284.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $54.00 | $54.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $54.00 | $54.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh, Third Generation | $257.00 | $257.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh, Third Generation | $257.00 | $257.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyr/Stim/Hormone | $284.00 | $284.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyr/Stim/Hormone | $284.00 | $284.00 | — |
| Urinalysis with microscope exam, automated one side CPT 81001 Urinalysis Rt, Auto W/ Micro | $426.00 | $426.00 | — |
| Urinalysis with microscope exam, automated one side CPT 81001 Urinalysis Rt, Auto W/ Micro | $426.00 | $426.00 | — |
| Urinalysis with microscope exam, automated inpatient one side CPT 81001 Urinalysis Rt, Auto W/ Micro | $426.00 | $426.00 | — |
| Urinalysis with microscope exam, automated inpatient one side CPT 81001 Urinalysis Rt, Auto W/ Micro | $426.00 | $426.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 Ua W/ Micro | $9.00 | $9.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 Ua W/ Micro | $9.00 | $9.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Nonauto W/Scope | $11.00 | $11.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Nonauto W/Scope | $11.00 | $11.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Ua W/ Micro | $9.00 | $9.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Ua W/ Micro | $9.00 | $9.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Nonauto W/Scope | $11.00 | $11.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Nonauto W/Scope | $11.00 | $11.00 | — |
| Urinalysis without microscope exam, automated one side CPT 81003 Urinalysis Rt, Auto W/O Micro | $236.00 | $236.00 | — |
| Urinalysis without microscope exam, automated one side CPT 81003 Urinalysis Rt, Auto W/O Micro | $236.00 | $236.00 | — |
| Urinalysis without microscope exam, automated inpatient one side CPT 81003 Urinalysis Rt, Auto W/O Micro | $236.00 | $236.00 | — |
| Urinalysis without microscope exam, automated inpatient one side CPT 81003 Urinalysis Rt, Auto W/O Micro | $236.00 | $236.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ua W/O Micro | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ua W/O Micro | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ua Wo Micro | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ua Wo Micro | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Specific Gravity,Urine | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Specific Gravity,Urine | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Acetone Urine Ql | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Acetone Urine Ql | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual one side CPT 81002 Urinalysis Rt, Non-Auto W/O Mi | $271.00 | $271.00 | — |
| Urinalysis without microscope exam, manual one side CPT 81002 Urinalysis Rt, Non-Auto W/O Mi | $271.00 | $271.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ua W/O Micro | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ua W/O Micro | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ua Wo Micro | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ua Wo Micro | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Specific Gravity,Urine | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Acetone Urine Ql | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Specific Gravity,Urine | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Acetone Urine Ql | $298.00 | $298.00 | — |
| Urinalysis without microscope exam, manual inpatient one side CPT 81002 Urinalysis Rt, Non-Auto W/O Mi | $271.00 | $271.00 | — |
| Urinalysis without microscope exam, manual inpatient one side CPT 81002 Urinalysis Rt, Non-Auto W/O Mi | $271.00 | $271.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 Cataract Surg W/Iol 1 Stage | $4,025.00 | $4,025.00 | — |
| Cataract surgery with lens implant CPT 66984 Cataract Surg W/Iol 1 Stage | $4,025.00 | $4,025.00 | — |
| Cataract surgery with lens implant inpatient CPT 66984 Cataract Surg W/Iol 1 Stage | $4,025.00 | $4,025.00 | — |
| Cataract surgery with lens implant inpatient CPT 66984 Cataract Surg W/Iol 1 Stage | $4,025.00 | $4,025.00 | — |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Pf Routine Ob Care Incl Ap C-S | $6,694.76 | $6,694.76 | — |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Pf Routine Ob Care Incl Ap C-S | $6,694.76 | $6,694.76 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Pf Routine Ob Care Incl Ap C-S | $6,694.76 | $6,694.76 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Pf Routine Ob Care Incl Ap C-S | $6,694.76 | $6,694.76 | — |
| Colonoscopy with endoscopic ultrasound CPT 45391 Pf Colonoscopy W/Endoscope Us | $755.51 | $755.51 | — |
| Colonoscopy with endoscopic ultrasound CPT 45391 Pf Colonoscopy W/Endoscope Us | $755.51 | $755.51 | — |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Pf Colonoscopy W/Endoscope Us | $755.51 | $755.51 | — |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Pf Colonoscopy W/Endoscope Us | $755.51 | $755.51 | — |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy W/Lesion Removal | $1,379.91 | $1,379.91 | — |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy W/Lesion Removal | $1,379.91 | $1,379.91 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy W/Lesion Removal | $1,379.91 | $1,379.91 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy W/Lesion Removal | $1,379.91 | $1,379.91 | — |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample CPT 45380 Pf Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample CPT 45380 Pf Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 Pf Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 Pf Colonoscopy And Biopsy | $1,344.25 | $1,344.25 | — |
| Colonoscopy, diagnostic CPT 45378 Diagnostic Colonoscopy | $1,027.04 | $1,027.04 | — |
| Colonoscopy, diagnostic CPT 45378 Diagnostic Colonoscopy | $1,027.04 | $1,027.04 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic Colonoscopy | $1,027.04 | $1,027.04 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic Colonoscopy | $1,027.04 | $1,027.04 | — |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Cholecystecomy | $1,891.13 | $1,891.13 | — |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Cholecystecomy | $1,891.13 | $1,891.13 | — |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopic Cholecystectomy | $17,689.00 | $17,689.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopic Cholecystectomy | $17,689.00 | $17,689.00 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy Cholecystecomy | $1,891.13 | $1,891.13 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopy Cholecystecomy | $1,891.13 | $1,891.13 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopic Cholecystectomy | $17,689.00 | $17,689.00 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopic Cholecystectomy | $17,689.00 | $17,689.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Pf Prp I/Hern Init Reduc 5+ Yr | $1,507.82 | $1,507.82 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Pf Prp I/Hern Init Reduc 5+ Yr | $1,507.82 | $1,507.82 | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Pf Prp I/Hern Init Reduc 5+ Yr | $1,507.82 | $1,507.82 | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Pf Prp I/Hern Init Reduc 5+ Yr | $1,507.82 | $1,507.82 | — |
| Knee arthroscopy with meniscus trim CPT 29881 Pf Knee Arthroscopy/Surgery | $1,617.23 | $1,617.23 | — |
| Knee arthroscopy with meniscus trim CPT 29881 Pf Knee Arthroscopy/Surgery | $1,617.23 | $1,617.23 | — |
| Knee arthroscopy with meniscus trim one side CPT 29881 Arthro Knee W Mnsc Md/Lt W/Shv | $10,383.00 | $10,383.00 | — |
| Knee arthroscopy with meniscus trim one side CPT 29881 Arthro Knee W Mnsc Md/Lt W/Shv | $10,383.00 | $10,383.00 | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Pf Knee Arthroscopy/Surgery | $1,617.23 | $1,617.23 | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Pf Knee Arthroscopy/Surgery | $1,617.23 | $1,617.23 | — |
| Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Arthro Knee W Mnsc Md/Lt W/Shv | $10,383.00 | $10,383.00 | — |
| Knee arthroscopy with meniscus trim inpatient one side CPT 29881 Arthro Knee W Mnsc Md/Lt W/Shv | $10,383.00 | $10,383.00 | — |
| Left heart catheterization, diagnostic CPT 93452 Lft Hrt Cath W/Ventrclgrphy | $12,819.00 | $12,819.00 | — |
| Left heart catheterization, diagnostic CPT 93452 Lft Hrt Cath W/Ventrclgrphy | $12,819.00 | $12,819.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath W/Ventrclgrphy | $2,937.46 | $2,937.46 | — |
| Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath W/Ventrclgrphy | $2,937.46 | $2,937.46 | — |
| Left heart catheterization, diagnostic inpatient CPT 93452 Lft Hrt Cath W/Ventrclgrphy | $12,819.00 | $12,819.00 | — |
| Left heart catheterization, diagnostic inpatient CPT 93452 Lft Hrt Cath W/Ventrclgrphy | $12,819.00 | $12,819.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath W/Ventrclgrphy | $2,937.46 | $2,937.46 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath W/Ventrclgrphy | $2,937.46 | $2,937.46 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inj Interlaminar Lmbr/Sac W Im | $819.73 | $819.73 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inj Interlaminar Lmbr/Sac W Im | $819.73 | $819.73 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Njx Intrlamnr Lmbr/Sac W/Img | $4,563.00 | $4,563.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Njx Intrlamnr Lmbr/Sac W/Img | $4,563.00 | $4,563.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj Interlaminar Lmbr/Sac W Im | $819.73 | $819.73 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj Interlaminar Lmbr/Sac W Im | $819.73 | $819.73 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Intrlamnr Lmbr/Sac W/Img | $4,563.00 | $4,563.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Intrlamnr Lmbr/Sac W/Img | $4,563.00 | $4,563.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 Inj Interlaminar Lmbr/Sac Wo I | $466.72 | $466.72 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 Inj Interlaminar Lmbr/Sac Wo I | $466.72 | $466.72 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 Njx Intrlamnr Lmbr/Sac W/O Img | $7,946.00 | $7,946.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 Njx Intrlamnr Lmbr/Sac W/O Img | $7,946.00 | $7,946.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Inj Interlaminar Lmbr/Sac Wo I | $466.72 | $466.72 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Inj Interlaminar Lmbr/Sac Wo I | $466.72 | $466.72 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx Intrlamnr Lmbr/Sac W/O Img | $7,946.00 | $7,946.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx Intrlamnr Lmbr/Sac W/O Img | $7,946.00 | $7,946.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrm Epi L/S 1 | $750.87 | $750.87 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrm Epi L/S 1 | $750.87 | $750.87 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa/Strd Tfrm Epil L/S 1 | $4,990.00 | $4,990.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa/Strd Tfrm Epil L/S 1 | $4,990.00 | $4,990.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrm Epi L/S 1 | $750.87 | $750.87 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrm Epi L/S 1 | $750.87 | $750.87 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa/Strd Tfrm Epil L/S 1 | $4,990.00 | $4,990.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa/Strd Tfrm Epil L/S 1 | $4,990.00 | $4,990.00 | — |
| Prostate biopsy CPT 55700 Pf Biopsy Of Prostate | $774.18 | $774.18 | — |
| Prostate biopsy CPT 55700 Pf Biopsy Of Prostate | $774.18 | $774.18 | — |
| Prostate biopsy CPT 55700 Biopsy Prostate | $7,379.00 | $7,379.00 | — |
| Prostate biopsy CPT 55700 Biopsy Prostate | $7,379.00 | $7,379.00 | — |
| Prostate biopsy inpatient CPT 55700 Pf Biopsy Of Prostate | $774.18 | $774.18 | — |
| Prostate biopsy inpatient CPT 55700 Pf Biopsy Of Prostate | $774.18 | $774.18 | — |
| Prostate biopsy inpatient CPT 55700 Biopsy Prostate | $7,379.00 | $7,379.00 | — |
| Prostate biopsy inpatient CPT 55700 Biopsy Prostate | $7,379.00 | $7,379.00 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laparo Radical Prostatectomy | $4,198.33 | $4,198.33 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laparo Radical Prostatectomy | $4,198.33 | $4,198.33 | — |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Laparo Radical Prostatectomy | $4,198.33 | $4,198.33 | — |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Laparo Radical Prostatectomy | $4,198.33 | $4,198.33 | — |
| Removal of a breast lump, open surgery CPT 19120 Removal Of Breast Lesion | $1,207.10 | $1,207.10 | — |
| Removal of a breast lump, open surgery CPT 19120 Removal Of Breast Lesion | $1,207.10 | $1,207.10 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 Removal Of Breast Lesion | $1,207.10 | $1,207.10 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 Removal Of Breast Lesion | $1,207.10 | $1,207.10 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Pf Shoulder Arthroscopy/Surger | $499.17 | $499.17 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Pf Shoulder Arthroscopy/Surger | $499.17 | $499.17 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthr Sho W/Prt Acro W/Rls | $10,813.00 | $10,813.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthr Sho W/Prt Acro W/Rls | $10,813.00 | $10,813.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Pf Shoulder Arthroscopy/Surger | $499.17 | $499.17 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Pf Shoulder Arthroscopy/Surger | $499.17 | $499.17 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthr Sho W/Prt Acro W/Rls | $10,813.00 | $10,813.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Arthr Sho W/Prt Acro W/Rls | $10,813.00 | $10,813.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 Rem Tonsils Adenoids 12 Yrs | $857.22 | $857.22 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 Rem Tonsils Adenoids 12 Yrs | $857.22 | $857.22 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 Rem Tonsils Adenoids <12 Yrs | $11,074.00 | $11,074.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 Rem Tonsils Adenoids <12 Yrs | $11,074.00 | $11,074.00 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Rem Tonsils Adenoids 12 Yrs | $857.22 | $857.22 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Rem Tonsils Adenoids 12 Yrs | $857.22 | $857.22 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Rem Tonsils Adenoids <12 Yrs | $11,074.00 | $11,074.00 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Rem Tonsils Adenoids <12 Yrs | $11,074.00 | $11,074.00 | — |
| Total hip replacement CPT 27130 Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement CPT 27130 Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement CPT 27130 Pf Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement CPT 27130 Pf Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement inpatient CPT 27130 Pf Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement inpatient CPT 27130 Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement inpatient CPT 27130 Pf Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total hip replacement inpatient CPT 27130 Total Hip Arthropl | $3,951.49 | $3,951.49 | — |
| Total knee replacement CPT 27447 Pf Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement CPT 27447 Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement CPT 27447 Pf Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement CPT 27447 Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement CPT 27447 Total Knee Arthroplasty | $48,061.00 | $48,061.00 | — |
| Total knee replacement CPT 27447 Total Knee Arthroplasty | $48,061.00 | $48,061.00 | — |
| Total knee replacement inpatient CPT 27447 Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement inpatient CPT 27447 Pf Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement inpatient CPT 27447 Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement inpatient CPT 27447 Pf Tot Knee Arthroplasty | $3,946.99 | $3,946.99 | — |
| Total knee replacement inpatient CPT 27447 Total Knee Arthroplasty | $48,061.00 | $48,061.00 | — |
| Total knee replacement inpatient CPT 27447 Total Knee Arthroplasty | $48,061.00 | $48,061.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Biopsy Single/Multiple | $1,198.80 | $1,198.80 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Biopsy Single/Multiple | $1,198.80 | $1,198.80 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Biopsy Single/Multiple | $1,198.80 | $1,198.80 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Biopsy Single/Multiple | $1,198.80 | $1,198.80 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd Diagnostic Brush Wash | $890.23 | $890.23 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd Diagnostic Brush Wash | $890.23 | $890.23 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd Diagnostic Brush Wash | $890.23 | $890.23 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd Diagnostic Brush Wash | $890.23 | $890.23 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Routin Ob Care After Vag Deliv | $6,341.40 | $6,341.40 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Routin Ob Care After Vag Deliv | $6,341.40 | $6,341.40 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Routin Ob Care After Vag Deliv | $6,341.40 | $6,341.40 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Routin Ob Care After Vag Deliv | $6,341.40 | $6,341.40 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Routine Ob Care | $6,084.11 | $6,084.11 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Routine Ob Care | $6,084.11 | $6,084.11 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Routine Ob Care | $6,084.11 | $6,084.11 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Routine Ob Care | $6,084.11 | $6,084.11 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 12 Lead Ekg Global | $41.86 | $41.86 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 12 Lead Ekg Global | $41.86 | $41.86 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Pediatric 12-Lead Ekg W/Interp | $908.00 | $908.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Pediatric 12-Lead Ekg W/Interp | $908.00 | $908.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 12 Lead Ekg Global | $41.86 | $41.86 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 12 Lead Ekg Global | $41.86 | $41.86 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Pediatric 12-Lead Ekg W/Interp | $908.00 | $908.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Pediatric 12-Lead Ekg W/Interp | $908.00 | $908.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 Pf Psychi Thrpy Family W/Pt | $296.62 | $296.62 | — |
| Family therapy with the patient, 50 minutes CPT 90847 Pf Psychi Thrpy Family W/Pt | $296.62 | $296.62 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Pf Psychi Thrpy Family W/Pt | $296.62 | $296.62 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Pf Psychi Thrpy Family W/Pt | $296.62 | $296.62 | — |
| Family therapy without the patient, 50 minutes CPT 90846 Pf Psych Thrpy Family W/O Pt | $286.73 | $286.73 | — |
| Family therapy without the patient, 50 minutes CPT 90846 Pf Psych Thrpy Family W/O Pt | $286.73 | $286.73 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Pf Psych Thrpy Family W/O Pt | $286.73 | $286.73 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Pf Psych Thrpy Family W/O Pt | $286.73 | $286.73 | — |
| Group psychotherapy session CPT 90853 Pf Psy/Cd Group 30 Mins | $79.52 | $79.52 | — |
| Group psychotherapy session CPT 90853 Pf Psy/Cd Group 30 Mins | $79.52 | $79.52 | — |
| Group psychotherapy session inpatient CPT 90853 Pf Psy/Cd Group 30 Mins | $79.52 | $79.52 | — |
| Group psychotherapy session inpatient CPT 90853 Pf Psy/Cd Group 30 Mins | $79.52 | $79.52 | — |
| New patient office visit, about 30 minutes CPT 99203 Fac Fee Off Visit Level Iii | $223.00 | $223.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Fac Fee Off Visit Level Iii | $223.00 | $223.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Visit New Level Iii | $256.00 | $256.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Visit New Level Iii | $256.00 | $256.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Video Visit New Pt Level Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes CPT 99203 Video Visit New Pt Level Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes CPT 99203 Office Visit New Pt Lvl Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes CPT 99203 Office Visit New Pt Lvl Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes CPT 99203 Fac Fee Visit New Level Iii | $363.00 | $363.00 | — |
| New patient office visit, about 30 minutes CPT 99203 Fac Fee Visit New Level Iii | $363.00 | $363.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Fac Fee Off Visit Level Iii | $223.00 | $223.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Fac Fee Off Visit Level Iii | $223.00 | $223.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Visit New Level Iii | $256.00 | $256.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Visit New Level Iii | $256.00 | $256.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit New Pt Lvl Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Video Visit New Pt Level Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Video Visit New Pt Level Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit New Pt Lvl Iii | $322.91 | $322.91 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Fac Fee Visit New Level Iii | $363.00 | $363.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 Fac Fee Visit New Level Iii | $363.00 | $363.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Visit New Lvel Iv | $245.00 | $245.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Visit New Lvel Iv | $245.00 | $245.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Fac Fee Off Visit Level Iv | $288.00 | $288.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Fac Fee Off Visit Level Iv | $288.00 | $288.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Visit New Level Iv | $323.00 | $323.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Visit New Level Iv | $323.00 | $323.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Fac Fee Visit New Level Iv | $381.00 | $381.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Fac Fee Visit New Level Iv | $381.00 | $381.00 | — |
| New patient office visit, about 45 minutes CPT 99204 Video Visit New Pt Level Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes CPT 99204 Office Visit New Pt Lvl Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes CPT 99204 Video Visit New Pt Level Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes CPT 99204 Office Visit New Pt Lvl Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Lvel Iv | $245.00 | $245.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Lvel Iv | $245.00 | $245.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Fac Fee Off Visit Level Iv | $288.00 | $288.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Fac Fee Off Visit Level Iv | $288.00 | $288.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Level Iv | $323.00 | $323.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Visit New Level Iv | $323.00 | $323.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Fac Fee Visit New Level Iv | $381.00 | $381.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Fac Fee Visit New Level Iv | $381.00 | $381.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit New Pt Lvl Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Video Visit New Pt Level Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit New Pt Lvl Iv | $486.52 | $486.52 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 Video Visit New Pt Level Iv | $486.52 | $486.52 | — |
| New patient office visit, about 60 minutes CPT 99205 Visit New Level V | $275.00 | $275.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Visit New Level V | $275.00 | $275.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Fac Fee Off Visit New Level V | $378.00 | $378.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Fac Fee Off Visit New Level V | $378.00 | $378.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Fac Fee Visit New Level V | $429.00 | $429.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Fac Fee Visit New Level V | $429.00 | $429.00 | — |
| New patient office visit, about 60 minutes CPT 99205 Office/Op Visit New Lvl V | $490.01 | $490.01 | — |
| New patient office visit, about 60 minutes CPT 99205 Office/Op Visit New Lvl V | $490.01 | $490.01 | — |
| New patient office visit, about 60 minutes CPT 99205 Office Visit New Pt Lvl V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes CPT 99205 Video Visit New Pt Level V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes CPT 99205 Video Visit New Pt Level V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes CPT 99205 Office Visit New Pt Lvl V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Visit New Level V | $275.00 | $275.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Visit New Level V | $275.00 | $275.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Fac Fee Off Visit New Level V | $378.00 | $378.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Fac Fee Off Visit New Level V | $378.00 | $378.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Fac Fee Visit New Level V | $429.00 | $429.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Fac Fee Visit New Level V | $429.00 | $429.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/Op Visit New Lvl V | $490.01 | $490.01 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/Op Visit New Lvl V | $490.01 | $490.01 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Video Visit New Pt Level V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit New Pt Lvl V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Video Visit New Pt Level V | $612.51 | $612.51 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office Visit New Pt Lvl V | $612.51 | $612.51 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Ea 15 Min | $93.13 | $93.13 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Ea 15 Min | $93.13 | $93.13 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot Ped-Ther Exer Ea 15M | $157.00 | $157.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot Ped-Ther Exer Ea 15M | $157.00 | $157.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Ea 15 Min | $93.13 | $93.13 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Ea 15 Min | $93.13 | $93.13 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot Ped-Ther Exer Ea 15M | $157.00 | $157.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot Ped-Ther Exer Ea 15M | $157.00 | $157.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 Pf Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 Pf Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Pf Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Pf Preventive New Pt 18-39 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 Preventive New Pt 40-64 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 Preventive New Pt 40-64 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive New Pt 40-64 Yrs | $409.80 | $409.80 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive New Pt 40-64 Yrs | $409.80 | $409.80 | — |
| Psychotherapy session, 30 minutes CPT 90832 Pf Pshcho Tx 30 Min Pt Or Fam | $199.95 | $199.95 | — |
| Psychotherapy session, 30 minutes CPT 90832 Pf Pshcho Tx 30 Min Pt Or Fam | $199.95 | $199.95 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Pf Pshcho Tx 30 Min Pt Or Fam | $199.95 | $199.95 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Pf Pshcho Tx 30 Min Pt Or Fam | $199.95 | $199.95 | — |
| Psychotherapy session, 45 minutes CPT 90834 Psych Tx 45 Min Pt Or Fam | $265.81 | $265.81 | — |
| Psychotherapy session, 45 minutes CPT 90834 Psych Tx 45 Min Pt Or Fam | $265.81 | $265.81 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psych Tx 45 Min Pt Or Fam | $265.81 | $265.81 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psych Tx 45 Min Pt Or Fam | $265.81 | $265.81 | — |
| Psychotherapy session, 60 minutes CPT 90837 Psych Tx 60 Min Pt Or Fam | $398.28 | $398.28 | — |
| Psychotherapy session, 60 minutes CPT 90837 Psych Tx 60 Min Pt Or Fam | $398.28 | $398.28 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psych Tx 60 Min Pt Or Fam | $398.28 | $398.28 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psych Tx 60 Min Pt Or Fam | $398.28 | $398.28 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult Level Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult Lvl Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult Level Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office Consult Lvl Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Level Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Lvl Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Level Iii | $322.91 | $322.91 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office Consult Lvl Iii | $322.91 | $322.91 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult Level Iv | $219.00 | $219.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult Level Iv | $219.00 | $219.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult Lvl Iv | $486.52 | $486.52 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult Lvl Iv | $486.52 | $486.52 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Level Iv | $219.00 | $219.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Level Iv | $219.00 | $219.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Lvl Iv | $486.52 | $486.52 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult Lvl Iv | $486.52 | $486.52 | — |
Source file: https://www.northbay.org/upload/941458282_northbay-vacavalley-hospital_standardcharges.csv