Hospital Dallas-Fort Worth-Arlington, TX

MSH Partners, LLC

MSH Partners, LLC in Dallas, TX publishes cash prices for 47 common procedures listed here, from its own machine-readable price file updated Apr 14, 2026. Click a procedure to compare it with other hospitals nearby.

2727 Lemmon Ave, Dallas, TX 75204 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 BCE CT Abd & Pelvis, w/contrast 74177	$3,394.20	$5,657.00	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast 74177	$3,394.20	$5,657.00	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Enterography 74177	$3,394.20	$5,657.00	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast 74177	$3,394.20	$5,657.00	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 BCE CT Abd & Pelvis, w/contrast 74177	$3,394.20	$5,657.00	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Enterography 74177	$3,394.20	$5,657.00	40%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast 70450	$1,330.80	$2,218.00	40%
CT scan of the head or brain, no contrast dye CPT 70450 BCE CT, Head or brain; w/o contrast 70450	$1,330.80	$2,218.00	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast 70450	$1,330.80	$2,218.00	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 BCE CT, Head or brain; w/o contrast 70450	$1,330.80	$2,218.00	40%
CT scan of the pelvis, with contrast dye CPT 72193 BCE CT Pelvis s/contrast 72193	$1,646.40	$2,744.00	40%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast 72193	$1,646.40	$2,744.00	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 BCE CT Pelvis s/contrast 72193	$1,646.40	$2,744.00	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast 72193	$1,646.40	$2,744.00	40%
Diagnostic mammogram, one breast one side CPT 77065 MA Dx Mammo+Cad Unilat Lt 77065	$624.00	$1,040.00	40%
Diagnostic mammogram, one breast one side CPT 77065 BCE MA Dx Mammo+Cad Unilat 77065	$624.00	$1,040.00	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Dx Mammo+Cad Unilat Lt 77065	$624.00	$1,040.00	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 BCE MA Dx Mammo+Cad Unilat 77065	$624.00	$1,040.00	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Ankle w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Knee w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Hip w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Signature Knee w/o contrast R 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 BCE MRI w/o contrast lower extremity 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Signature Knee w/o contrast L 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Right 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Right	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Left 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Left 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Right 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Hip w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Knee w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Ankle w/o Contrast Bilateral 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 BCE MRI w/o contrast lower extremity 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Signature Knee w/o contrast R 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Signature Knee w/o contrast L 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Left 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Right 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Right	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Contrast Left 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Contrast Right 73721	$2,043.00	$3,405.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Knee w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Ankle w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Hip w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 BCE MRI any joint of lower extremity w/ + w/o Contrast 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Ankle w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Hip w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Knee w/ + w/o Contrast Bl 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 BCE MRI any joint of lower extremity w/ + w/o Contrast 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Left 73723	$1,904.40	$3,174.00	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Contrast Right 73723	$1,904.40	$3,174.00	40%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast 70551	$1,816.80	$3,028.00	40%
MRI of the brain, no contrast dye CPT 70551 BCE MRI Brain w/o Contrast 70551	$1,816.80	$3,028.00	40%
MRI of the brain, no contrast dye inpatient CPT 70551 BCE MRI Brain w/o Contrast 70551	$1,816.80	$3,028.00	40%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast 70551	$1,816.80	$3,028.00	40%
MRI of the brain, with and without contrast dye CPT 70553 BCE MRI Brain, w/o & w/contrast 70553	$2,571.00	$4,285.00	40%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast 70553	$2,571.00	$4,285.00	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast 70553	$2,571.00	$4,285.00	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 BCE MRI Brain, w/o & w/contrast 70553	$2,571.00	$4,285.00	40%
MRI of the lower back, no contrast dye CPT 72148 BCE MRI Spine Lumbar w/o contrast 72148	$1,788.00	$2,980.00	40%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast 72148	$1,788.00	$2,980.00	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast 72148	$1,788.00	$2,980.00	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 BCE MRI Spine Lumbar w/o contrast 72148	$1,788.00	$2,980.00	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 BCE US Pregnancy After 1st Trimester 76805	$289.80	$483.00	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnancy After 1st Trimester 76805	$289.80	$483.00	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pregnancy After 1st Trimester 76805	$289.80	$483.00	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 BCE US Pregnancy After 1st Trimester 76805	$289.80	$483.00	40%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal 76830	$427.20	$712.00	40%
Transvaginal pelvic ultrasound CPT 76830 BCE US Transvaginal 76830	$427.20	$712.00	40%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$427.20	$712.00	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 BCE US Transvaginal 76830	$427.20	$712.00	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$427.20	$712.00	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal 76830	$427.20	$712.00	40%
Ultrasound of the abdomen, complete CPT 76700 BCE US Abdomen Complete 76700	$619.20	$1,032.00	40%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete 76700	$619.20	$1,032.00	40%
Ultrasound of the abdomen, complete CPT 76700 ROD 5.5MM 20MM 7291020	$964.80	$1,608.00	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 BCE US Abdomen Complete 76700	$619.20	$1,032.00	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete 76700	$619.20	$1,032.00	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 ROD 5.5MM 20MM 7291020	$964.80	$1,608.00	40%
X-ray of the lower back, 4 or more views CPT 72110 BCE XR Spine Lumbosacral Min 4 views 72110	$355.80	$593.00	40%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 V 72110	$355.80	$593.00	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 V 72110	$355.80	$593.00	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 BCE XR Spine Lumbosacral Min 4 views 72110	$355.80	$593.00	40%

Lab tests

Procedure	Cash price	List price	Off list
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$25.80	$43.00	40%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$25.80	$43.00	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$30.00	$50.00	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$30.00	$50.00	40%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff	$10.80	$18.00	40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff	$10.80	$18.00	40%
Complete blood count (CBC), no differential CPT 85027 CBC Auto No Diff	$49.80	$83.00	40%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC Auto No Diff	$49.80	$83.00	40%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$30.00	$50.00	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$30.00	$50.00	40%
Kidney function blood test panel CPT 80069 Renal Function Panel	$49.80	$83.00	40%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$49.80	$83.00	40%
Liver function blood test panel CPT 80076 LIVER	$28.80	$48.00	40%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$30.00	$50.00	40%
Liver function blood test panel inpatient CPT 80076 LIVER	$28.80	$48.00	40%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$30.00	$50.00	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen	$133.20	$222.00	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen	$133.20	$222.00	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$171.60	$286.00	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$171.60	$286.00	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR Istat	$226.80	$378.00	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR Hemochron	$226.80	$378.00	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PT	$226.80	$378.00	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR Hemochron	$226.80	$378.00	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR Istat	$226.80	$378.00	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT	$226.80	$378.00	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$53.40	$89.00	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/ Rflx Free T4	$53.40	$89.00	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH w/ Rflx Free T4	$53.40	$89.00	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$53.40	$89.00	40%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis With Microscopy	$27.60	$46.00	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis With Microscopy	$27.60	$46.00	40%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick	$10.80	$18.00	40%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis	$30.60	$51.00	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Dipstick	$10.80	$18.00	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis	$30.60	$51.00	40%

Surgery and procedures

Procedure	Cash price	List price	Off list
Cataract surgery with lens implant CPT 66984 EXTRACAPSULAR CATARACT REMOVAL W/INSERTION OF INTRAOCULAR LENS PROSTHESIS REG. 66984	$2,646.00	$4,410.00	40%
Cataract surgery with lens implant inpatient CPT 66984 EXTRACAPSULAR CATARACT REMOVAL W/INSERTION OF INTRAOCULAR LENS PROSTHESIS REG. 66984	$2,646.00	$4,410.00	40%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEXIBLE; WITH REMOVAL OF TUMOR/POLYP/LESION BY SNARE TECHNIQUE 45385	$2,863.20	$4,772.00	40%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEXIBLE; WITH REMOVAL OF TUMOR/POLYP/LESION BY SNARE TECHNIQUE 45385	$2,863.20	$4,772.00	40%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEXIBLE; WITH BIOPSY; SINGLE OR MULTIPLE 45380	$1,575.60	$2,626.00	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEXIBLE; WITH BIOPSY; SINGLE OR MULTIPLE 45380	$1,575.60	$2,626.00	40%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE; DIAGNOSTIC; INCL. COLLECTION OF SPECIMENS 45378	$2,265.60	$3,776.00	40%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE; DIAGNOSTIC; INCL. COLLECTION OF SPECIMENS 45378	$2,265.60	$3,776.00	40%
Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY LAPAROSCOPIC 47562	$1,575.60	$2,626.00	40%
Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY LAPAROSCOPIC 47562	$1,575.60	$2,626.00	40%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INITIAL HERNIA INGUINAL-AGE 5 YEARS OR OLDER-REDUCIBLE 49505	$1,575.60	$2,626.00	40%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR INITIAL HERNIA INGUINAL-AGE 5 YEARS OR OLDER-REDUCIBLE 49505	$1,575.60	$2,626.00	40%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCECTOMY 29881	$2,646.00	$4,410.00	40%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY KNEE W/MEDIAL OR LATERAL MENISCECTOMY 29881	$2,646.00	$4,410.00	40%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 DISCISSION OF SECONDARY MEMBRANEOUS CATARACT;LASER SURGERY 66821	$1,071.00	$1,785.00	40%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 DISCISSION OF SECONDARY MEMBRANEOUS CATARACT;LASER SURGERY 66821	$1,071.00	$1,785.00	40%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/IMAGE 62323	$1,071.60	$1,786.00	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/IMAGE 62323	$1,071.60	$1,786.00	40%
Lower-back epidural injection, without imaging guidance CPT 62322 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/O IMAGE 62322	$1,071.60	$1,786.00	40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECTION DIAG./THER. SUB. W/NEEDLE OR CATH. LUMBAR/SACRAL W/O IMAGE 62322	$1,071.60	$1,786.00	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483	$627.60	$1,046.00	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483	$627.60	$1,046.00	40%
Prostate biopsy CPT 55700 BIOPSY PROSTATE;NEEDLE OR PUNCTURE 55700	$1,071.00	$1,785.00	40%
Prostate biopsy inpatient CPT 55700 BIOPSY PROSTATE;NEEDLE OR PUNCTURE 55700	$1,071.00	$1,785.00	40%
Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPARASCOPIC PROSTATECTOMY RETROPUBIC RADICAL 55866	$2,078.40	$3,464.00	40%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPARASCOPIC PROSTATECTOMY RETROPUBIC RADICAL 55866	$2,078.40	$3,464.00	40%
Removal of a breast lump, open surgery CPT 19120 EXCISION LIPOMA BREAST 19120	$1,071.00	$1,785.00	40%
Removal of a breast lump, open surgery inpatient CPT 19120 EXCISION LIPOMA BREAST 19120	$1,071.00	$1,785.00	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSCOPY SHOULDER W/SUBACROMIAL DECOMPRESSION/ACROMIOPLASTY 29826	$3,591.60	$5,986.00	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSCOPY SHOULDER W/SUBACROMIAL DECOMPRESSION/ACROMIOPLASTY 29826	$3,591.60	$5,986.00	40%
Tonsil and adenoid removal, child under 12 CPT 42820 TONSILLECTOMY AND ADENOIDECTOMY UNDER AGE 12 42820	$1,071.00	$1,785.00	40%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 TONSILLECTOMY AND ADENOIDECTOMY UNDER AGE 12 42820	$1,071.00	$1,785.00	40%
Total hip replacement CPT 27130 ARTHROPLASTY ACETABULAR & PROXIMAL FEMORAL PROSTHETIC REPLACEMENT 27130	$3,591.60	$5,986.00	40%
Total hip replacement inpatient CPT 27130 ARTHROPLASTY ACETABULAR & PROXIMAL FEMORAL PROSTHETIC REPLACEMENT 27130	$3,591.60	$5,986.00	40%
Total knee replacement CPT 27447 ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL AND LATERAL 27447	$3,591.60	$5,986.00	40%
Total knee replacement inpatient CPT 27447 ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL AND LATERAL 27447	$3,591.60	$5,986.00	40%
Upper endoscopy (EGD) with biopsy CPT 43239 ESOPHAGOGASTRODUODENOSCOPY W/BIOPSY 43239	$2,187.60	$3,646.00	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ESOPHAGOGASTRODUODENOSCOPY W/BIOPSY 43239	$2,187.60	$3,646.00	40%
Upper endoscopy (EGD), diagnostic CPT 43235 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE DIAGNOSTIC 43235	$1,071.00	$1,785.00	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE DIAGNOSTIC 43235	$1,071.00	$1,785.00	40%

Doctor visits and therapy

Procedure	Cash price	List price	Off list
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 BCE OT Therapeutic Exercise 97110	$60.00	$100.00	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Charges	$60.00	$100.00	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges - PTA	$65.40	$109.00	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$65.40	$109.00	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT Therapeutic Exercise Charges	$60.00	$100.00	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 BCE OT Therapeutic Exercise 97110	$60.00	$100.00	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges - PTA	$65.40	$109.00	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges	$65.40	$109.00	40%

Source file: https://mrfs.hyvehealthcare.com/USPI/752829613_msh-partners,-llc_standardcharges.json