Gaston Memorial Hospital
Gaston Memorial Hospital in Mount Holly, NC publishes cash prices for 48 common procedures listed here, from its own machine-readable price file updated May 11, 2026. Click a procedure to compare it with other hospitals nearby.
451 E Charlotte Ave, Mount Holly, NC 28120 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 HCHG CT ABD PELVIS WITH CONTRAST | $7,873.00 | $7,873.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HCHG CT ABD PELVIS WITH CONTRAST | $7,873.00 | $7,873.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 HCHG CT HEAD/BRAIN WO CONT | $2,564.00 | $2,564.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HCHG CT HEAD/BRAIN WO CONT | $2,564.00 | $2,564.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 HCHG CT PELVIS W CONTRAST | $4,218.00 | $4,218.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HCHG CT PELVIS W CONTRAST | $4,218.00 | $4,218.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 HCHG DIAG MAMMOGRAM W CAD BILAT | $415.00 | $415.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HCHG DIAG MAMMOGRAM W CAD BILAT | $415.00 | $415.00 | — |
| Diagnostic mammogram, one breast CPT 77065 HCHG DIAG MAMMOGRAM W CAD UNIL | $207.00 | $207.00 | — |
| Diagnostic mammogram, one breast inpatient CPT 77065 HCHG DIAG MAMMOGRAM W CAD UNIL | $207.00 | $207.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HCHG MRI EXTR LWR JT WO CONT LT | $5,241.00 | $5,241.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HCHG MRI EXTR LWR JT WO CONT RT | $5,241.00 | $5,241.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HCHG MRI EXTR LWR JT WO CONT LT | $5,241.00 | $5,241.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HCHG MRI EXTR LWR JT WO CONT RT | $5,241.00 | $5,241.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HCHG MRI EXTR LWR JT W/WO CONT RT | $6,780.00 | $6,780.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HCHG MRI EXTR LWR JT W/WO CONT LT | $6,780.00 | $6,780.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HCHG MRI EXTR LWR JT W/WO CONT RT | $6,780.00 | $6,780.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HCHG MRI EXTR LWR JT W/WO CONT LT | $6,780.00 | $6,780.00 | — |
| MRI of the brain, no contrast dye CPT 70551 HCHG MRI BRAIN WO CONT | $3,449.00 | $3,449.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 HCHG MRI BRAIN WO CONT | $3,449.00 | $3,449.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 HCHG MRI BRAIN W/WO CONT | $6,909.00 | $6,909.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HCHG MRI BRAIN W/WO CONT | $6,909.00 | $6,909.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 HCHG MRI LUMBAR SPINE WO CONT | $5,275.00 | $5,275.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HCHG MRI LUMBAR SPINE WO CONT | $5,275.00 | $5,275.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG US OB 14+WKS SGL GEST | $895.00 | $895.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HCHG US OB 14+WKS SGL GEST | $895.00 | $895.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 HCHG SCRN MAMMOGRAM W CAD BILAT | $573.00 | $573.00 | — |
| Screening mammogram, both breasts CPT 77067 HCHG SCRN MAMMOGRAM W CAD UNIL | $382.00 | $382.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG SCRN MAMMOGRAM W CAD BILAT | $573.00 | $573.00 | — |
| Screening mammogram, both breasts inpatient CPT 77067 HCHG SCRN MAMMOGRAM W CAD UNIL | $382.00 | $382.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 HCHG POLYSOMNOGRAM | $6,631.00 | $6,631.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 HCHG POLYSOM ATTENDED >3 CHN 6/> YRS | $6,631.00 | $6,631.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HCHG POLYSOMNOGRAM | $6,631.00 | $6,631.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HCHG POLYSOM ATTENDED >3 CHN 6/> YRS | $6,631.00 | $6,631.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 HCHG US TRANSVAGINAL NON OB | $1,057.00 | $1,057.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG US TRANSVAGINAL NON OB | $1,057.00 | $1,057.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 HCHG US ABDOMEN COMPLETE | $1,729.00 | $1,729.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG US ABDOMEN COMPLETE | $1,729.00 | $1,729.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 HCHG XR SPINE LUMBAR MIN 4 VIEWS | $742.00 | $742.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HCHG XR SPINE LUMBAR MIN 4 VIEWS | $742.00 | $742.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PNL CALCIUM TOTAL | $201.00 | $201.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 CHG BASIC METABOLIC PNL CALCIUM TOTAL | $201.00 | $201.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL | $159.00 | $159.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL | $159.00 | $159.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CHG CBC W AUTO DIFF | $152.00 | $152.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CHG CBC W AUTO DIFF | $152.00 | $152.00 | — |
| Complete blood count (CBC), no differential CPT 85027 CHG CBC AUTOMATED WO DIFF | $137.00 | $137.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 CHG CBC AUTOMATED WO DIFF | $137.00 | $137.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $229.00 | $229.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $229.00 | $229.00 | — |
| Kidney function blood test panel CPT 80069 CHG RENAL FUNCTION PANEL | $273.00 | $273.00 | — |
| Kidney function blood test panel inpatient CPT 80069 CHG RENAL FUNCTION PANEL | $273.00 | $273.00 | — |
| Liver function blood test panel CPT 80076 CHG HEPATIC FUNCTION PANEL | $157.00 | $157.00 | — |
| Liver function blood test panel inpatient CPT 80076 CHG HEPATIC FUNCTION PANEL | $157.00 | $157.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 CHG PSA FREE | $114.00 | $114.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 CHG PSA FREE | $114.00 | $114.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 CHG PROSTATE SP AG TOTAL | $138.00 | $138.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG PROSTATE SP AG TOTAL | $138.00 | $138.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 CHG LC PART THROMBO (PTT) | $22.00 | $22.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 CHG PART THROMBO (PTT) | $121.00 | $121.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG LC PART THROMBO (PTT) | $22.00 | $22.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG PART THROMBO (PTT) | $121.00 | $121.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG LC PROTHROMBIN TIME | $16.00 | $16.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $89.00 | $89.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME (POC) | $112.00 | $112.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG LC PROTHROMBIN TIME | $16.00 | $16.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME | $89.00 | $89.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME (POC) | $112.00 | $112.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG TSH | $138.00 | $138.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG TSH | $138.00 | $138.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 CHG URINALYSIS AUTOMATED W MICRO | $109.00 | $109.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URINALYSIS AUTOMATED W MICRO | $109.00 | $109.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 CHG URINE KETONES AUTOMATED | $75.00 | $75.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URINE KETONES AUTOMATED | $75.00 | $75.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 HCHG ASC REMV EXTRA CATAR W/IOL INSERT | $8,033.00 | $8,033.00 | — |
| Cataract surgery with lens implant inpatient CPT 66984 HCHG ASC REMV EXTRA CATAR W/IOL INSERT | $8,033.00 | $8,033.00 | — |
| Colonoscopy with endoscopic ultrasound CPT 45391 HCHG COLON W ENDOSCOPIC U/S | $5,708.00 | $5,708.00 | — |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 HCHG COLON W ENDOSCOPIC U/S | $5,708.00 | $5,708.00 | — |
| Colonoscopy with polyp removal CPT 45385 HCHG ASC COLON W/REM TUM/POLYP SNARE | $4,627.00 | $4,627.00 | — |
| Colonoscopy with polyp removal CPT 45385 HCHG COLONSCPY W POLYP REMVL SNARE | $5,422.00 | $5,422.00 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 HCHG ASC COLON W/REM TUM/POLYP SNARE | $4,627.00 | $4,627.00 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 HCHG COLONSCPY W POLYP REMVL SNARE | $5,422.00 | $5,422.00 | — |
| Colonoscopy with tissue sample CPT 45380 HCHG ASC COLON W/BX SGL/MULTI COLD | $3,351.00 | $3,351.00 | — |
| Colonoscopy with tissue sample CPT 45380 HCHG COLONOSCOPY W BIOPSY (COLD) | $4,880.00 | $4,880.00 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 HCHG ASC COLON W/BX SGL/MULTI COLD | $3,351.00 | $3,351.00 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 HCHG COLONOSCOPY W BIOPSY (COLD) | $4,880.00 | $4,880.00 | — |
| Colonoscopy, diagnostic CPT 45378 HCHG ASC COLONOSCOPY DX/SCREENING | $3,437.00 | $3,437.00 | — |
| Colonoscopy, diagnostic CPT 45378 HCHG COLONOSCOPY FLEX DIAG/SCREEN | $4,027.00 | $4,027.00 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG ASC COLONOSCOPY DX/SCREENING | $3,437.00 | $3,437.00 | — |
| Colonoscopy, diagnostic inpatient CPT 45378 HCHG COLONOSCOPY FLEX DIAG/SCREEN | $4,027.00 | $4,027.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 HCHG ASC LAP CHOLECYSTECTOMY | $13,055.00 | $13,055.00 | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 HCHG ASC LAP CHOLECYSTECTOMY | $13,055.00 | $13,055.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 HCHG LT HEART CATH | $23,536.00 | $23,536.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HCHG LT HEART CATH | $23,536.00 | $23,536.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HCHG INJ INTRLAMNR EPIDURAL L/S + GUID | $3,354.00 | $3,354.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HCHG L/S EPIDURAL INJ + IMAG GUID | $3,449.00 | $3,449.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG INJ INTRLAMNR EPIDURAL L/S + GUID | $3,354.00 | $3,354.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HCHG L/S EPIDURAL INJ + IMAG GUID | $3,449.00 | $3,449.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 HCHG L/S EPIDURAL INJ WO IMAG GUID | $3,113.00 | $3,113.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 HCHG INJ INTRLAMNR EPIDURAL L/S WO GUID | $3,113.00 | $3,113.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HCHG INJ INTRLAMNR EPIDURAL L/S WO GUID | $3,113.00 | $3,113.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HCHG L/S EPIDURAL INJ WO IMAG GUID | $3,113.00 | $3,113.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 HCHG INJ ANES/STER BILAT EPID L/S 1LEV+GUIDE | $3,845.00 | $3,845.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG INJ ANES/STER UNIL EPID L/S 1LEV WGUID | $1,533.00 | $1,533.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG INJ ANES/STEROID EPID L/S 1LEV UNIL+GUID | $1,543.00 | $1,543.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG INJ ANES/STEROID EPID L/S 1LEV BIL+GUID | $2,804.00 | $2,804.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 HCHG INJ ANES/STER BILAT EPID L/S 1LEV+GUIDE | $3,845.00 | $3,845.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HCHG INJ ANES/STER UNIL EPID L/S 1LEV WGUID | $1,533.00 | $1,533.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HCHG INJ ANES/STEROID EPID L/S 1LEV UNIL+GUID | $1,543.00 | $1,543.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HCHG INJ ANES/STEROID EPID L/S 1LEV BIL+GUID | $2,804.00 | $2,804.00 | — |
| Removal of a breast lump, open surgery CPT 19120 HCHG ASC EXCISE BREAST LESION 1 + | $4,955.00 | $4,955.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 HCHG ASC EXCISE BREAST LESION 1 + | $4,955.00 | $4,955.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 HCHG ASC T&A UNDER AGE 12 | $5,060.00 | $5,060.00 | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 HCHG ASC T&A UNDER AGE 12 | $5,060.00 | $5,060.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HCHG ASC EGD FLEX/ORAL W BX SGL/MULT | $2,923.00 | $2,923.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HCHG ER EGD WITH BIOPSY SGL/MULT | $3,702.00 | $3,702.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HCHG EGD FLEX/ORAL W BX SGL/MULT | $3,968.00 | $3,968.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG ASC EGD FLEX/ORAL W BX SGL/MULT | $2,923.00 | $2,923.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG ER EGD WITH BIOPSY SGL/MULT | $3,702.00 | $3,702.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG EGD FLEX/ORAL W BX SGL/MULT | $3,968.00 | $3,968.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 HCHG ASC EGD FLEX/TRANSORAL DX | $2,645.00 | $2,645.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 HCHG EGD FLEX/TRANSORAL DX | $3,169.00 | $3,169.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HCHG ASC EGD FLEX/TRANSORAL DX | $2,645.00 | $2,645.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HCHG EGD FLEX/TRANSORAL DX | $3,169.00 | $3,169.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 HCHG LACTATION NP LVL3 LOW MDM/30+ MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes CPT 99203 HCHG NP OV LVL3 LOW MDM/30+MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes CPT 99203 HCHG NP VISIT LVL3 LOW MDM/30+MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes CPT 99203 HCHG NP OV LVL3 LOW MDM/30+MIN &PROC | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes CPT 99203 HCHG NP VISIT LV3 LOW MDM/30+MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG NP OV LVL3 LOW MDM/30+MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG NP OV LVL3 LOW MDM/30+MIN &PROC | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG LACTATION NP LVL3 LOW MDM/30+ MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG NP VISIT LV3 LOW MDM/30+MIN | $685.00 | $685.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HCHG NP VISIT LVL3 LOW MDM/30+MIN | $685.00 | $685.00 | — |
| New patient office visit, about 45 minutes CPT 99204 HCHG NP VISIT LVL4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes CPT 99204 HCHG LACTATION NP LVL4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes CPT 99204 HCHG NP OV LVL4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes CPT 99204 HCHG NP VISIT LV4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes CPT 99204 HCHG NP OV LVL4 MOD MDM/45+MIN &PROC | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG NP VISIT LV4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG NP OV LVL4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG NP OV LVL4 MOD MDM/45+MIN &PROC | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG NP VISIT LVL4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HCHG LACTATION NP LVL4 MOD MDM/45+MIN | $849.00 | $849.00 | — |
| New patient office visit, about 60 minutes CPT 99205 HCHG NP OV LVL5 HIGH MDM/60+MIN &PROC | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes CPT 99205 HCHG NP VISIT LV5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes CPT 99205 HCHG NP VISIT LVL5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes CPT 99205 HCHG NP OV LVL5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes CPT 99205 HCHG LACTATION NP LVL5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG LACTATION NP LVL5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG NP OV LVL5 HIGH MDM/60+MIN &PROC | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG NP VISIT LVL5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG NP OV LVL5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HCHG NP VISIT LV5 HIGH MDM/60+MIN | $1,140.00 | $1,140.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG OT THERAPEUTIC EXERCISE 15 MIN | $149.00 | $149.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG PT EMPLOYEE SCREENINGS | $149.00 | $149.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG OT THER EXER 1 OR > AREA EA 15M | $157.00 | $157.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG PT THER EXER 1 OR > AREA EA 15M | $157.00 | $157.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT EMPLOYEE SCREENINGS | $149.00 | $149.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE 15 MIN | $149.00 | $149.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THER EXER 1 OR > AREA EA 15M | $157.00 | $157.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THER EXER 1 OR > AREA EA 15M | $157.00 | $157.00 | — |