Hospital Lebanon-Claremont, NH-VT

Valley Regional Hospital

Valley Regional Hospital in Claremont, NH publishes cash prices for 64 common procedures listed here, from its own machine-readable price file updated Jun 6, 2026. Click a procedure to compare it with other hospitals nearby.

243 ELM STREET,CLAREMONT,NH,03743-2005 Collected Sep 23, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST $2,435.95 $4,429.00 45%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST $2,435.95 $4,429.00 45%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST $2,435.95 $4,429.00 45%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST $2,435.95 $4,429.00 45%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE $839.85 $1,527.00 45%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O $839.85 $1,527.00 45%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O $839.85 $1,527.00 45%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE $839.85 $1,527.00 45%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/C $1,338.15 $2,433.00 45%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE $1,338.15 $2,433.00 45%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/C $1,338.15 $2,433.00 45%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE $1,338.15 $2,433.00 45%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI $501.05 $911.00 45%
Diagnostic mammogram, both breasts both sides CPT 77066 MM MAMMO DX COMBO BILAT $501.05 $911.00 45%
Diagnostic mammogram, both breasts CPT 77066 MM BIL DIAGNOSTIC $501.05 $911.00 45%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI $501.05 $911.00 45%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM MAMMO DX COMBO BILAT $501.05 $911.00 45%
Diagnostic mammogram, both breasts inpatient CPT 77066 MM BIL DIAGNOSTIC $501.05 $911.00 45%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI $283.80 $516.00 45%
Diagnostic mammogram, one breast one side CPT 77065 MM UNILAT LT $283.80 $516.00 45%
Diagnostic mammogram, one breast one side CPT 77065 MM UNILAT RT $283.80 $516.00 45%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMO DX COMBO RT $283.80 $516.00 45%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMO DX COMBO LT $283.80 $516.00 45%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI $283.80 $516.00 45%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MM UNILAT RT $283.80 $516.00 45%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MM MAMMO DX COMBO LT $283.80 $516.00 45%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MM MAMMO DX COMBO RT $283.80 $516.00 45%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MM UNILAT LT $283.80 $516.00 45%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR LWR EXT JOINT RED SERVICE $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LWR EXT JOINT RT W/O $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LWR EXT JOINT LT W/O $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI JNT OF LWR EXTRE W/O DYE $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR LWR EXT JOINT RED SERVICE $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LWR EXT JOINT RT W/O $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LWR EXT JOINT LT W/O $1,685.75 $3,065.00 45%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE $3,281.30 $5,966.00 45%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LWR EXT JOINT RT W/O,W/C $3,281.30 $5,966.00 45%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LWR EXT JOINT LT W/O,W/C $3,281.30 $5,966.00 45%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE $3,281.30 $5,966.00 45%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LWR EXT JOINT LT W/O,W/C $3,281.30 $5,966.00 45%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LWR EXT JOINT RT W/O,W/C $3,281.30 $5,966.00 45%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN W/O $1,554.85 $2,827.00 45%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN RED SERVICE W/O $1,554.85 $2,827.00 45%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE $1,554.85 $2,827.00 45%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN RED SERVICE W/O $1,554.85 $2,827.00 45%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN W/O $1,554.85 $2,827.00 45%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN STEM W/O DYE $1,554.85 $2,827.00 45%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN W/O, W/C $3,051.40 $5,548.00 45%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE $3,131.70 $5,694.00 45%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN LEVEL II W/O, W/C $3,131.70 $5,694.00 45%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN W/O, W/C $3,051.40 $5,548.00 45%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE $3,131.70 $5,694.00 45%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN LEVEL II W/O, W/C $3,131.70 $5,694.00 45%
MRI of the lower back, no contrast dye CPT 72148 MR SPINE LUMBAR W/O $2,019.05 $3,671.00 45%
MRI of the lower back, no contrast dye CPT 72148 MR SPINE LUMBAR RED SERVICE W/O $2,019.05 $3,671.00 45%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE $2,019.05 $3,671.00 45%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O DYE $2,019.05 $3,671.00 45%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR SPINE LUMBAR W/O $2,019.05 $3,671.00 45%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR SPINE LUMBAR RED SERVICE W/O $2,019.05 $3,671.00 45%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OBS PREG UTERUS > 14 WEEKS $584.10 $1,062.00 45%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS $584.10 $1,062.00 45%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS SNGL FETUS $584.10 $1,062.00 45%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OBS PREG UTERUS > 14 WEEKS $584.10 $1,062.00 45%
Screening mammogram, both breasts both sides CPT 77067 MM MAMMO SCREEN COMBO BILAT $405.90 $738.00 45%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD $405.90 $738.00 45%
Screening mammogram, both breasts both sides CPT 77067 MM BILATERAL SCREENING $405.90 $738.00 45%
Screening mammogram, both breasts one side CPT 77067 MM MAMMO SCREEN LT $203.50 $370.00 45%
Screening mammogram, both breasts one side CPT 77067 MM MAMMO SCREEN COMBO LT $203.50 $370.00 45%
Screening mammogram, both breasts one side CPT 77067 MM MAMMO SCREEN COMBO RT $203.50 $370.00 45%
Screening mammogram, both breasts one side CPT 77067 MM MAMMO SCREEN RT $203.50 $370.00 45%
Screening mammogram, both breasts inpatient both sides CPT 77067 MM MAMMO SCREEN COMBO BILAT $405.90 $738.00 45%
Screening mammogram, both breasts inpatient both sides CPT 77067 MM BILATERAL SCREENING $405.90 $738.00 45%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD $405.90 $738.00 45%
Screening mammogram, both breasts inpatient one side CPT 77067 MM MAMMO SCREEN LT $203.50 $370.00 45%
Screening mammogram, both breasts inpatient one side CPT 77067 MM MAMMO SCREEN RT $203.50 $370.00 45%
Screening mammogram, both breasts inpatient one side CPT 77067 MM MAMMO SCREEN COMBO RT $203.50 $370.00 45%
Screening mammogram, both breasts inpatient one side CPT 77067 MM MAMMO SCREEN COMBO LT $203.50 $370.00 45%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US $443.85 $807.00 45%
Transvaginal pelvic ultrasound CPT 76830 PELVIC TRANSVAGINAL W OTHER STUDY $528.55 $961.00 45%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB $528.55 $961.00 45%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US $443.85 $807.00 45%
Transvaginal pelvic ultrasound inpatient CPT 76830 PELVIC TRANSVAGINAL W OTHER STUDY $528.55 $961.00 45%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB $528.55 $961.00 45%
Ultrasound of the abdomen, complete CPT 76700 UL ABDOMEN COMPLT $692.45 $1,259.00 45%
Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE $692.45 $1,259.00 45%
Ultrasound of the abdomen, complete inpatient CPT 76700 US EXAM ABDOM COMPLETE $692.45 $1,259.00 45%
Ultrasound of the abdomen, complete inpatient CPT 76700 UL ABDOMEN COMPLT $692.45 $1,259.00 45%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS $313.50 $570.00 45%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR W/OBL(4+ VWS) $313.50 $570.00 45%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS $313.50 $570.00 45%
X-ray of the lower back, 4 or more views inpatient CPT 72110 SPINE LUMBAR W/OBL(4+ VWS) $313.50 $570.00 45%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC $64.90 $118.00 45%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PNL TOTAL CA $64.90 $118.00 45%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PNL TOTAL CA $64.90 $118.00 45%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC $64.90 $118.00 45%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL $30.25 $55.00 45%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPOPRO PROFILE $99.00 $180.00 45%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL $30.25 $55.00 45%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPOPRO PROFILE $99.00 $180.00 45%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC $57.75 $105.00 45%
Complete blood count (CBC) with differential CPT 85025 CBC WITH AUTO DIFFERENTIAL $57.75 $105.00 45%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH AUTO DIFFERENTIAL $57.75 $105.00 45%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC $57.75 $105.00 45%
Complete blood count (CBC), no differential CPT 85027 CBCSO $58.30 $106.00 45%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED $58.30 $106.00 45%
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFFERENTIAL $58.30 $106.00 45%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WITHOUT DIFFERENTIAL $58.30 $106.00 45%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED $58.30 $106.00 45%
Complete blood count (CBC), no differential inpatient CPT 85027 CBCSO $58.30 $106.00 45%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC $78.10 $142.00 45%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL $78.10 $142.00 45%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL $78.10 $142.00 45%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC $78.10 $142.00 45%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL $47.30 $86.00 45%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL $47.30 $86.00 45%
Liver function blood test panel CPT 80076 LIVER PROFILE $61.60 $112.00 45%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL $61.60 $112.00 45%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION DH $118.80 $216.00 45%
Liver function blood test panel inpatient CPT 80076 LIVER PROFILE $61.60 $112.00 45%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL $61.60 $112.00 45%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION DH $118.80 $216.00 45%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL $352.00 $640.00 45%
Obstetric blood test panel CPT 80055 PRENATAL PROFILE $352.00 $640.00 45%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL $352.00 $640.00 45%
Obstetric blood test panel inpatient CPT 80055 PRENATAL PROFILE $352.00 $640.00 45%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE $36.85 $67.00 45%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE AND TOTAL CPT#1 $36.85 $67.00 45%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE AND TOTAL CPT#1 $36.85 $67.00 45%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE $36.85 $67.00 45%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA FREE AND TOTAL CPT#2 $36.85 $67.00 45%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL $107.80 $196.00 45%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC $107.80 $196.00 45%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA ULTRASENSITIVE $122.10 $222.00 45%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA FREE AND TOTAL CPT#2 $36.85 $67.00 45%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL $107.80 $196.00 45%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC $107.80 $196.00 45%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA ULTRASENSITIVE $122.10 $222.00 45%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME FOR DH PANEL $4.95 $9.00 45%
Partial thromboplastin time (PTT) clotting test CPT 85730 VONWILLEBRANDS FACTOR ASSAY #4 $24.20 $44.00 45%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PTT $28.60 $52.00 45%
Partial thromboplastin time (PTT) clotting test CPT 85730 APS 5 $47.30 $86.00 45%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL $51.15 $93.00 45%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT $51.15 $93.00 45%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME FOR DH PANEL $4.95 $9.00 45%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 VONWILLEBRANDS FACTOR ASSAY #4 $24.20 $44.00 45%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PTT $28.60 $52.00 45%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APS 5 $47.30 $86.00 45%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT $51.15 $93.00 45%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL $51.15 $93.00 45%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME FOR DH PANEL $4.95 $9.00 45%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME 1500 $18.70 $34.00 45%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME UB $18.70 $34.00 45%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHOMBIN TIME $18.70 $34.00 45%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME $29.15 $53.00 45%
Prothrombin time (PT/INR) clotting test CPT 85610 APS 2 $33.55 $61.00 45%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME FOR DH PANEL $4.95 $9.00 45%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME UB $18.70 $34.00 45%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME 1500 $18.70 $34.00 45%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHOMBIN TIME $18.70 $34.00 45%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME $29.15 $53.00 45%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 APS 2 $33.55 $61.00 45%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID CASCADE $51.15 $93.00 45%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE $91.30 $166.00 45%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE $91.30 $166.00 45%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID CASCADE $51.15 $93.00 45%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE $91.30 $166.00 45%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE $91.30 $166.00 45%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO WITH MICRO $24.75 $45.00 45%
Urinalysis with microscope exam, automated CPT 81001 URINE AUTOMATED WITH MICROSCOPE $24.75 $45.00 45%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE $24.75 $45.00 45%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO WITH MICRO $24.75 $45.00 45%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE $24.75 $45.00 45%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINE AUTOMATED WITH MICROSCOPE $24.75 $45.00 45%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE $19.25 $35.00 45%
Urinalysis with microscope exam, manual CPT 81000 NONAUTOMATED URINE W/MICROSCOPY $19.25 $35.00 45%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTO W/SCOPE $19.25 $35.00 45%
Urinalysis with microscope exam, manual inpatient CPT 81000 NONAUTOMATED URINE W/MICROSCOPY $19.25 $35.00 45%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK ONLY AUTO $19.80 $36.00 45%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE $19.80 $36.00 45%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE $19.80 $36.00 45%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIPSTICK ONLY AUTO $19.80 $36.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE $4.95 $9.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINE HEMOGLOBIN $4.95 $9.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINE PH $9.90 $18.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINE SPECIFIC GRAVITY $10.45 $19.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK 1500 $11.00 $20.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK UB $11.00 $20.00 45%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK $11.00 $20.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE HEMOGLOBIN $4.95 $9.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE $4.95 $9.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE PH $9.90 $18.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE SPECIFIC GRAVITY $10.45 $19.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK UB $11.00 $20.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK $11.00 $20.00 45%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIPSTICK 1500 $11.00 $20.00 45%

Surgery and procedures

ProcedureCash price List priceOff list
Cesarean delivery, including prenatal and postpartum care CPT 59510 C-SECTION TOTAL CARE IPA $613.25 $1,115.00 45%
Cesarean delivery, including prenatal and postpartum care CPT 59510 C-SECTION TOTAL CARE IP $2,454.65 $4,463.00 45%
Cesarean delivery, including prenatal and postpartum care CPT 59510 CESAREAN DELIVERY $2,454.65 $4,463.00 45%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 C-SECTION TOTAL CARE IPA $613.25 $1,115.00 45%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 C-SECTION TOTAL CARE IP $2,454.65 $4,463.00 45%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 CESAREAN DELIVERY $2,454.65 $4,463.00 45%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL $663.30 $1,206.00 45%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEX W/REM LESIONS SNARE IP $663.30 $1,206.00 45%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEX W/REM LESIONS SNARE OP $663.30 $1,206.00 45%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEX W/REM LESIONS SNARE OP $663.30 $1,206.00 45%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEX W/REM LESIONS SNARE IP $663.30 $1,206.00 45%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W/LESION REMOVAL $663.30 $1,206.00 45%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEX W/BIOPSY IP $632.50 $1,150.00 45%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEX W/BIOPSY OP $632.50 $1,150.00 45%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY $632.50 $1,150.00 45%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY $632.50 $1,150.00 45%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEX W/BIOPSY OP $632.50 $1,150.00 45%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEX W/BIOPSY IP $632.50 $1,150.00 45%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEX DIAGNOSTIC OP $512.05 $931.00 45%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEX DIAGNOSTIC IP $512.05 $931.00 45%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY $512.05 $931.00 45%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEX DIAGNOSTIC OP $512.05 $931.00 45%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEX DIAGNOSTIC IP $512.05 $931.00 45%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY $512.05 $931.00 45%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY $841.50 $1,530.00 45%
Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY LAP IP $841.50 $1,530.00 45%
Gallbladder removal, laparoscopic CPT 47562 CHOLECYSTECTOMY LAP OP $841.50 $1,530.00 45%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY $841.50 $1,530.00 45%
Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY LAP OP $841.50 $1,530.00 45%
Gallbladder removal, laparoscopic inpatient CPT 47562 CHOLECYSTECTOMY LAP IP $841.50 $1,530.00 45%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HERNIA INIT INGUINAL 5+ YRS IP $491.15 $893.00 45%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR $491.15 $893.00 45%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HERNIA INIT INGUINAL 5+ YRS OP $491.15 $893.00 45%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR $491.15 $893.00 45%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HERNIA INIT INGUINAL 5+ YRS IP $491.15 $893.00 45%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HERNIA INIT INGUINAL 5+ YRS OP $491.15 $893.00 45%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY MENISCECT MED/LAT OP $789.25 $1,435.00 45%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY MENISCECT MED/LAT IP $789.25 $1,435.00 45%
Knee arthroscopy with meniscus trim CPT 29881 ARTHRS KNE SRG MNISECTMY M/L $789.25 $1,435.00 45%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY MENISCECT MED/LAT OP $789.25 $1,435.00 45%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY MENISCECT MED/LAT IP $789.25 $1,435.00 45%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHRS KNE SRG MNISECTMY M/L $789.25 $1,435.00 45%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC $611.05 $1,111.00 45%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC $611.05 $1,111.00 45%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL $482.35 $877.00 45%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 $482.35 $877.00 45%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL $482.35 $877.00 45%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 $482.35 $877.00 45%
Removal of a breast lump, open surgery CPT 19120 BREAST EXCISIONAL BX PRO $341.00 $620.00 45%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION $523.60 $952.00 45%
Removal of a breast lump, open surgery CPT 19120 BREAST EXCISIONAL BX OP $523.60 $952.00 45%
Removal of a breast lump, open surgery CPT 19120 BREAST EXCISIONAL BX MD $523.60 $952.00 45%
Removal of a breast lump, open surgery CPT 19120 BREAST EXCISIONAL BX IP $523.60 $952.00 45%
Removal of a breast lump, open surgery inpatient CPT 19120 BREAST EXCISIONAL BX PRO $341.00 $620.00 45%
Removal of a breast lump, open surgery inpatient CPT 19120 BREAST EXCISIONAL BX MD $523.60 $952.00 45%
Removal of a breast lump, open surgery inpatient CPT 19120 BREAST EXCISIONAL BX IP $523.60 $952.00 45%
Removal of a breast lump, open surgery inpatient CPT 19120 BREAST EXCISIONAL BX OP $523.60 $952.00 45%
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION $523.60 $952.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSCP SHLDR SURG DECOM OPA $205.70 $374.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSCP SHLDR SURG DECOMP IPA $205.70 $374.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSC SHLDR DECOM SA SP W PA IP $823.90 $1,498.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSC SHLDR DECOM SA SP W PA OP $823.90 $1,498.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESSION $823.90 $1,498.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSCP SHLDR SURG DECOMP IPA $205.70 $374.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSCP SHLDR SURG DECOM OPA $205.70 $374.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHO ARTHRS SRG DECOMPRESSION $823.90 $1,498.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSC SHLDR DECOM SA SP W PA IP $823.90 $1,498.00 45%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSC SHLDR DECOM SA SP W PA OP $823.90 $1,498.00 45%
Total hip replacement CPT 27130 TOTAL HIP JOINT REPLACE OP $1,805.65 $3,283.00 45%
Total hip replacement CPT 27130 TOTAL HIP JOINT REPLACE IP $1,805.65 $3,283.00 45%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY $1,805.65 $3,283.00 45%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY $1,805.65 $3,283.00 45%
Total hip replacement inpatient CPT 27130 TOTAL HIP JOINT REPLACE OP $1,805.65 $3,283.00 45%
Total hip replacement inpatient CPT 27130 TOTAL HIP JOINT REPLACE IP $1,805.65 $3,283.00 45%
Total knee replacement CPT 27447 TOTAL KNEE REPLACEMENT OP $1,928.85 $3,507.00 45%
Total knee replacement CPT 27447 TOTAL KNEE REPLACEMENT IP $1,928.85 $3,507.00 45%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY $1,928.85 $3,507.00 45%
Total knee replacement inpatient CPT 27447 TOTAL KNEE REPLACEMENT IP $1,928.85 $3,507.00 45%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY $1,928.85 $3,507.00 45%
Total knee replacement inpatient CPT 27447 TOTAL KNEE REPLACEMENT OP $1,928.85 $3,507.00 45%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER ENDOSCOPY W/BX OP $513.70 $934.00 45%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE $513.70 $934.00 45%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER ENDOSCOPY W/BX IP $513.70 $934.00 45%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER ENDOSCOPY W/BX OP $513.70 $934.00 45%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER ENDOSCOPY W/BX IP $513.70 $934.00 45%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE $513.70 $934.00 45%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER ENDOSCOPY OP $402.60 $732.00 45%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER ENDOSCOPY IP $402.60 $732.00 45%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH $402.60 $732.00 45%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER ENDOSCOPY IP $402.60 $732.00 45%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER ENDOSCOPY OP $402.60 $732.00 45%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH $402.60 $732.00 45%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 VBAC TOTAL CARE IP $2,244.00 $4,080.00 45%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 VBAC DELIVERY $2,244.00 $4,080.00 45%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 VBAC DELIVERY $2,244.00 $4,080.00 45%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 VBAC TOTAL CARE IP $2,244.00 $4,080.00 45%
Vaginal delivery, including prenatal and postpartum care CPT 59400 OBSTETRICAL CARE $2,104.30 $3,826.00 45%
Vaginal delivery, including prenatal and postpartum care CPT 59400 VAGINAL DELIVERY TOTAL CARE IP $2,104.30 $3,826.00 45%
Vaginal delivery, including prenatal and postpartum care CPT 59400 VAGINAL DELIVERY TOTAL CARE OP $2,104.30 $3,826.00 45%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 VAGINAL DELIVERY TOTAL CARE IP $2,104.30 $3,826.00 45%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 VAGINAL DELIVERY TOTAL CARE OP $2,104.30 $3,826.00 45%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE $2,104.30 $3,826.00 45%

Doctor visits and therapy

ProcedureCash price List priceOff list
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PRIORITY CARE EKG $73.15 $133.00 45%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE $73.15 $133.00 45%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE 1500 ONLY $83.60 $152.00 45%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE UB ONLY $83.60 $152.00 45%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE MD $83.60 $152.00 45%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE $73.15 $133.00 45%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PRIORITY CARE EKG $73.15 $133.00 45%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE MD $83.60 $152.00 45%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE 1500 ONLY $83.60 $152.00 45%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE UB ONLY $83.60 $152.00 45%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY THERAPY W/PT 50 MINS $141.35 $257.00 45%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/PT 50 MIN $141.35 $257.00 45%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY THERAPY W/PT 50 MINS $141.35 $257.00 45%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYTX W/PT 50 MIN $141.35 $257.00 45%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN FAC $47.30 $86.00 45%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN PRO $88.00 $160.00 45%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN $135.30 $246.00 45%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN MD $135.30 $246.00 45%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN FAC $47.30 $86.00 45%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN PRO $88.00 $160.00 45%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN MD $135.30 $246.00 45%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN $135.30 $246.00 45%
Group psychotherapy session CPT 90853 GROUP THERAPY PROCESS NON-FAMILY $33.55 $61.00 45%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY $33.55 $61.00 45%
Group psychotherapy session inpatient CPT 90853 GROUP THERAPY PROCESS NON-FAMILY $33.55 $61.00 45%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY $33.55 $61.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 FAC $39.05 $71.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 UB FAC $39.05 $71.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 FAC $39.05 $71.00 45%
New patient office visit, about 30 minutes CPT 99203 IND PREP INTERMEDIATE EXAM $52.25 $95.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 PRO $72.60 $132.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 PRO $72.60 $132.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 PRO $72.60 $132.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 MD $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 IP $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 1500 ONLY $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPATIENT VISIT, NEW LEV 3 $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 UB ONLY $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW INTERMEDIATE EVALUATION $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 OP $111.65 $203.00 45%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT DET/LOW 30 MD $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 FAC $39.05 $71.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 FAC $39.05 $71.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 UB FAC $39.05 $71.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 IND PREP INTERMEDIATE EXAM $52.25 $95.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 PRO $72.60 $132.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 PRO $72.60 $132.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 PRO $72.60 $132.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 IP $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 1500 ONLY $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 MD $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 MD $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPATIENT VISIT, NEW LEV 3 $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW INTERMEDIATE EVALUATION $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30 MIN $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 UB ONLY $111.65 $203.00 45%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT DET/LOW 30 OP $111.65 $203.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 UB FAC $57.20 $104.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 FAC $57.20 $104.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 FAC $57.20 $104.00 45%
New patient office visit, about 45 minutes CPT 99204 DOT-PHYSICAL EXAM $82.50 $150.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 PRO $106.15 $193.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 PRO $106.15 $193.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 OP $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 IP $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 MD $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPATIENT VISIT, NEW LEV 4 $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW EXTENDED EVALUATION $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 UB ONLY $163.35 $297.00 45%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT COM/MOD 45 1500 ONLY $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 UB FAC $57.20 $104.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 FAC $57.20 $104.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 FAC $57.20 $104.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 DOT-PHYSICAL EXAM $82.50 $150.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 PRO $106.15 $193.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 PRO $106.15 $193.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 MD $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45 MIN $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW EXTENDED EVALUATION $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPATIENT VISIT, NEW LEV 4 $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 OP $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 UB ONLY $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 IP $163.35 $297.00 45%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT COM/MOD 45 1500 ONLY $163.35 $297.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 FAC $73.15 $133.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 FAC $73.15 $133.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 UB FAC $73.15 $133.00 45%
New patient office visit, about 60 minutes CPT 99205 IND PREMP COMP EXAM $88.00 $160.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 PRO $135.85 $247.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 PRO $135.85 $247.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 PRO $135.85 $247.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 MD $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 OP $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 IP $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 1500 ONLY $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 UB ONLY $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT COM/HIGH 60 OP $209.00 $380.00 45%
New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPATIENT VISIT, NEW LEV 5 $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 FAC $73.15 $133.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 UB FAC $73.15 $133.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 FAC $73.15 $133.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 IND PREMP COMP EXAM $88.00 $160.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 PRO $135.85 $247.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 PRO $135.85 $247.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 PRO $135.85 $247.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 UB ONLY $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 1500 ONLY $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE O/P NEW HI 60 MIN $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 MD $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 OP $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPATIENT VISIT, NEW LEV 5 $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 IP $209.00 $380.00 45%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT COM/HIGH 60 OP $209.00 $380.00 45%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HH THER EX 15 $63.80 $116.00 45%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXERCISE 15 MINUTES $78.10 $142.00 45%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE 15 MIN $78.10 $142.00 45%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES $78.10 $142.00 45%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HH THER EX 15 $63.80 $116.00 45%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXERCISE 15 MINUTES $78.10 $142.00 45%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE 15 MIN $78.10 $142.00 45%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES $78.10 $142.00 45%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39 $150.70 $274.00 45%
Preventive checkup, new patient aged 18–39 CPT 99385 PREVENTIVE NEW 18-39 YRS $150.70 $274.00 45%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREVENTIVE NEW 18-39 YRS $150.70 $274.00 45%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV VISIT NEW AGE 18-39 $150.70 $274.00 45%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64 $173.80 $316.00 45%
Preventive checkup, new patient aged 40–64 CPT 99386 PREVENTIVE NEW 40-64 YRS $173.80 $316.00 45%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREVENTIVE NEW 40-64 YRS $173.80 $316.00 45%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE 40-64 $173.80 $316.00 45%
Psychotherapy session, 30 minutes CPT 90832 PSYTX 30 MIN W/ PT FAC $33.00 $60.00 45%
Psychotherapy session, 30 minutes CPT 90832 PSYTX 30 MIN W/ PT PRO $62.15 $113.00 45%
Psychotherapy session, 30 minutes CPT 90832 PSYTX 30 MIN W/ PT MD $95.15 $173.00 45%
Psychotherapy session, 30 minutes CPT 90832 PSYTX W PT 30 MINUTES $95.15 $173.00 45%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX 30 MIN W/ PT FAC $33.00 $60.00 45%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX 30 MIN W/ PT PRO $62.15 $113.00 45%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX 30 MIN W/ PT MD $95.15 $173.00 45%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX W PT 30 MINUTES $95.15 $173.00 45%
Psychotherapy session, 45 minutes CPT 90834 PSYTX 45 MINS W/PT FAC $43.45 $79.00 45%
Psychotherapy session, 45 minutes CPT 90834 PSYTX 45 MINS W/PT PRO $81.95 $149.00 45%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES $125.40 $228.00 45%
Psychotherapy session, 45 minutes CPT 90834 PSYTX 45 MINS W/PT MD $125.40 $228.00 45%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX 45 MINS W/PT FAC $43.45 $79.00 45%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX 45 MINS W/PT PRO $81.95 $149.00 45%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX 45 MINS W/PT MD $125.40 $228.00 45%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MINUTES $125.40 $228.00 45%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES FAC $64.35 $117.00 45%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES PRO $121.00 $220.00 45%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES $185.35 $337.00 45%
Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES MD $185.35 $337.00 45%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES FAC $64.35 $117.00 45%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES PRO $121.00 $220.00 45%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES MD $185.35 $337.00 45%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES $185.35 $337.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DET/LOW 40 FAC $50.60 $92.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DETLOW 40 PRO $94.60 $172.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DET/LOW 40 OP $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30 $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DET/LOW 40 MD $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DEL/LOW 40 IP $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT DET/LOW 40 $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT OUTPATIENT 99243 $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DET/LOW 40 FAC $50.60 $92.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DETLOW 40 PRO $94.60 $172.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DET/LOW 40 $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT OUTPATIENT 99243 $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DEL/LOW 40 IP $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DET/LOW 40 OP $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFF/OP CNSLTJ NEW/EST LOW 30 $145.20 $264.00 45%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT DET/LOW 40 MD $145.20 $264.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COM/MOD 60 FAC $71.50 $130.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COM/MOD 60 PRO $133.10 $242.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COM/MOD 60 $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT OUTPATIENT 99244 $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COM/MOD 60 MD $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40 $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COM/MOD 60 IP $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT COM/MOD 60 OP $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COM/MOD 60 FAC $71.50 $130.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COM/MOD 60 PRO $133.10 $242.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40 $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT OUTPATIENT 99244 $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COM/MOD 60 $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COM/MOD 60 MD $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COM/MOD 60 IP $204.60 $372.00 45%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT COM/MOD 60 OP $204.60 $372.00 45%

Source file: https://s3.amazonaws.com/ycubaa-production-marlin-1-charge-management-public/facilities/e8ee7c31-a93d-41f9-b0b7-1df54697d98f/020222118_VALLEY-REGIONAL-HOSPITAL_standardcharges.zip