Legacy Silverton Medical Center
Legacy Silverton Medical Center in Silverton, OR publishes cash prices for 71 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
342 Fairview Street, Silverton, OR 97381 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 CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $558.35 | $859.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD & PELVIS W/CONTRAST | $622.05 | $957.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL | $558.35 | $859.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD & PELVIS W/CONTRAST | $622.05 | $957.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL | $197.60 | $304.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC HEAD CT WITHOUT CONTRAST | $256.75 | $395.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC HEAD CT LIMITED WITHOUT CONTRAST | $571.35 | $879.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL | $197.60 | $304.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC HEAD CT WITHOUT CONTRAST | $256.75 | $395.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC HEAD CT LIMITED WITHOUT CONTRAST | $571.35 | $879.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC PELVIS CT WITH CONTRAST | $622.05 | $957.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC PELVIS CT WITH CONTRAST | $622.05 | $957.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC BILATERAL | $397.15 | $611.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS BILATERAL | $456.95 | $703.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC BILATERAL | $397.15 | $611.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS BILATERAL | $456.95 | $703.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC UNILATERAL | $321.10 | $494.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS UNILATERAL | $368.55 | $567.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC UNILATERAL | $321.10 | $494.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIGITAL MAMMOGRAPHY DIAGNOSTIC RECLASS UNILATERAL | $368.55 | $567.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC LOWER EXTREMITY JOINT WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY HIP UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY KNEE UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR LOWER EXTREMITY JOINT UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC LOWER EXTREMITY JOINT WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY JOINT UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY HIP UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY KNEE UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITHOUT CONTRAST | $687.70 | $1,058.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITH/WITHOUT CONT | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY KNEE UNILATERAL WITH/WITHOUT CONTRAST | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY JOINT UNILATERAL WITH/WITHOUT CONT | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR LOWER EXTREMITY HIP UNILATERAL WITH/WITHOUT CONT | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY KNEE UNILATERAL WITH/WITHOUT CONTRAST | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY ANKLE UNILATERAL WITH/WITHOUT CONT | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY HIP UNILATERAL WITH/WITHOUT CONT | $1,237.60 | $1,904.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MR LOWER EXTREMITY JOINT UNILATERAL WITH/WITHOUT CONT | $1,237.60 | $1,904.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MR BRAIN WITHOUT CONTRAST | $934.05 | $1,437.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MR BRAIN WITHOUT CONTRAST | $934.05 | $1,437.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MR BRAIN WITH/WITHOUT CONTRAST | $1,421.55 | $2,187.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MR BRAIN WITH/WITHOUT CONTRAST | $1,421.55 | $2,187.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MR CINE MOTION LUMBAR | $398.45 | $613.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MR SPINE LUMBAR WITHOUT CONTRAST | $647.40 | $996.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR CINE MOTION LUMBAR | $398.45 | $613.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR SPINE LUMBAR WITHOUT CONTRAST | $647.40 | $996.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $244.40 | $376.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC OB COMPLETE >1ST TRIMESTER SINGLE GESTATION ULTRASOUND | $651.30 | $1,002.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION | $244.40 | $376.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC OB COMPLETE >1ST TRIMESTER SINGLE GESTATION ULTRASOUND | $651.30 | $1,002.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $234.00 | $360.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING BILATERAL | $460.20 | $708.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING UNILATERAL | $375.05 | $577.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $234.00 | $360.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING BILATERAL | $460.20 | $708.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC DIGITAL MAMMOGRAPHY SCREENING UNILATERAL | $375.05 | $577.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $1,143.35 | $1,759.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND | $1,143.35 | $1,759.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 CHG US TRANSVAGINAL | $214.50 | $330.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC TRANSVAGINAL (NON-OB) ULTRASOUND | $219.70 | $338.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 CHG US TRANSVAGINAL | $214.50 | $330.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC TRANSVAGINAL (NON-OB) ULTRASOUND | $219.70 | $338.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $210.60 | $324.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC ABDOMEN COMPLETE ULTRASOUND | $652.60 | $1,004.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION | $210.60 | $324.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC ABDOMEN COMPLETE ULTRASOUND | $652.60 | $1,004.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $94.90 | $146.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC SPINE LUMBAR MINIMUM 4 VIEWS | $178.10 | $274.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS | $94.90 | $146.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC SPINE LUMBAR MINIMUM 4 VIEWS | $178.10 | $274.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $12.35 | $19.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $12.61 | $19.40 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL | $12.61 | $19.40 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $12.35 | $19.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL | $12.61 | $19.40 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LP WITHOUT VLDL+CHOL/HDL | $8.85 | $13.61 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LP WITHOUT VLDL+CHOL/HDL | $8.85 | $13.61 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR LIPID PROFILE 80061 | $9.75 | $15.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR LIPO PROFILE PART 2 | $11.21 | $17.25 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR LIPO PROFILE PART 2 | $11.21 | $17.25 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC NMR LIPID PROFILE 80061 | $13.86 | $21.32 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE | $18.64 | $28.67 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PROFILE | $18.64 | $28.67 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL | $27.95 | $43.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LP WITHOUT VLDL+CHOL/HDL | $8.85 | $13.61 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR LIPID PROFILE 80061 | $9.75 | $15.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC NMR LIPO PROFILE PART 2 | $11.21 | $17.25 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PROFILE | $18.64 | $28.67 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL | $27.95 | $43.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $13.65 | $21.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF | $16.17 | $24.88 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC CBC W AUTO DIFF | $16.17 | $24.88 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $13.65 | $21.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC W AUTO DIFF | $16.17 | $24.88 | 35% |
| Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $4.78 | $7.36 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC AUTOMATED BLOOD COUNT | $14.46 | $22.25 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC AUTOMATED BLOOD COUNT | $55.90 | $86.00 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $4.78 | $7.36 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC AUTOMATED BLOOD COUNT | $55.90 | $86.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPRHNSV METABOLIC PANEL | $14.02 | $21.57 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $14.95 | $23.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC COMPRHNSV METABOLIC PANEL | $91.00 | $140.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $14.95 | $23.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC COMPRHNSV METABOLIC PANEL | $91.00 | $140.00 | 35% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $11.91 | $18.33 | 35% |
| Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL | $11.91 | $18.33 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC RENAL FUNCTION PANEL | $11.91 | $18.33 | 35% |
| Liver function blood test panel CPT 80076 CHG HEPATIC FUNCTION PANEL | $11.05 | $17.00 | 35% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL | $12.79 | $19.67 | 35% |
| Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL | $12.79 | $19.67 | 35% |
| Liver function blood test panel inpatient CPT 80076 CHG HEPATIC FUNCTION PANEL | $11.05 | $17.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL | $12.79 | $19.67 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $13.15 | $20.23 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC FREE PSA | $20.77 | $31.96 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC FREE PSA | $144.95 | $223.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $13.15 | $20.23 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC FREE PSA | $144.95 | $223.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA, ULTRASENSITIVE | $10.72 | $16.50 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA, ULTRASENSITIVE | $10.72 | $16.50 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA ULTRASENSITIVE | $12.62 | $19.42 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA ULTRASENSITIVE | $12.72 | $19.57 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $13.00 | $20.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA (SERIAL MONITOR) | $14.67 | $22.57 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA (SERIAL MONITOR) | $14.67 | $22.57 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN | $25.08 | $38.58 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC PROSTATE SPECIFIC ANTIGEN | $144.95 | $223.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA, ULTRASENSITIVE | $10.72 | $16.50 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA ULTRASENSITIVE | $12.62 | $19.42 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $13.00 | $20.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA (SERIAL MONITOR) | $14.67 | $22.57 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PROSTATE SPECIFIC ANTIGEN | $144.95 | $223.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC ACT PARTIAL THROMBOPLASIN TIME | $9.54 | $14.68 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC ACT PARTIAL THROMBOPLASIN TIME | $58.50 | $90.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT-LA MIX | $63.70 | $98.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC ACTIVATED PARTIAL THROMBOPLASTIN TIME | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT-LA MIX | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC ACTIVATED PARTIAL THROMBOPLASTIN TIME | $66.39 | $102.14 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC ACT PARTIAL THROMBOPLASIN TIME | $58.50 | $90.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT-LA MIX | $63.70 | $98.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC ACTIVATED PARTIAL THROMBOPLASTIN TIME | $66.39 | $102.14 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME INR | $14.95 | $23.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $15.60 | $24.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME WITH INR POC | $16.90 | $26.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME WITH INR POC | $16.90 | $26.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME INR | $26.65 | $41.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME | $15.60 | $24.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME WITH INR POC | $16.90 | $26.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME INR | $26.65 | $41.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $11.88 | $18.27 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH-THYROID STIMULATING HORMON | $35.26 | $54.25 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH-THYROID STIMULATING HORMON | $75.40 | $116.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $11.88 | $18.27 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH-THYROID STIMULATING HORMON | $75.40 | $116.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $11.70 | $18.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W MICROSCOPIC AUTO | $12.02 | $18.50 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS W MICROSCOPIC AUTO | $37.70 | $58.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $11.70 | $18.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS W MICROSCOPIC AUTO | $37.70 | $58.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $12.35 | $19.00 | 35% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY | $12.35 | $19.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINE DIPSTICK | $10.79 | $16.60 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC U DIPSTICK POCT | $10.79 | $16.60 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC URINE DIPSTICK | $10.79 | $16.60 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC U DIPSTICK POCT | $45.50 | $70.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINE DIPSTICK | $10.79 | $16.60 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC U DIPSTICK POCT | $45.50 | $70.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $9.75 | $15.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $980.20 | $1,508.00 | 35% |
| Cataract surgery with lens implant inpatient CPT 66984 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP | $980.20 | $1,508.00 | 35% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $4,915.95 | $7,563.00 | 35% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM | $4,915.95 | $7,563.00 | 35% |
| Colonoscopy with endoscopic ultrasound CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $462.80 | $712.00 | 35% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $462.80 | $712.00 | 35% |
| Colonoscopy with polyp removal CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $818.35 | $1,259.00 | 35% |
| Colonoscopy with polyp removal inpatient CPT 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $818.35 | $1,259.00 | 35% |
| Colonoscopy with tissue sample CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $779.35 | $1,199.00 | 35% |
| Colonoscopy with tissue sample inpatient CPT 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $779.35 | $1,199.00 | 35% |
| Colonoscopy, diagnostic CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $615.55 | $947.00 | 35% |
| Colonoscopy, diagnostic inpatient CPT 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $615.55 | $947.00 | 35% |
| Gallbladder removal, laparoscopic CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,219.40 | $1,876.00 | 35% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR LAPAROSCOPY SURG CHOLECYSTECTOMY | $1,219.40 | $1,876.00 | 35% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $968.50 | $1,490.00 | 35% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $968.50 | $1,490.00 | 35% |
| Knee arthroscopy with meniscus trim CPT 29881 PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG | $1,011.40 | $1,556.00 | 35% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG | $1,011.40 | $1,556.00 | 35% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 PR POST-CATARACT LASER SURGERY | $1,028.30 | $1,582.00 | 35% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 PR POST-CATARACT LASER SURGERY | $1,028.30 | $1,582.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $180.70 | $278.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $180.70 | $278.00 | 35% |
| Lower-back epidural injection, without imaging guidance CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $239.85 | $369.00 | 35% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN | $239.85 | $369.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $443.95 | $683.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC AN INJ SEL ROOT BLOCK LUMB/SACR SNGL LVL | $802.10 | $1,234.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $443.95 | $683.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC AN INJ SEL ROOT BLOCK LUMB/SACR SNGL LVL | $802.10 | $1,234.00 | 35% |
| Prostate biopsy CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH | $438.10 | $674.00 | 35% |
| Prostate biopsy CPT 55700 HC BIOPSY PROSTATE | $1,187.55 | $1,827.00 | 35% |
| Prostate biopsy inpatient CPT 55700 PR PROSTATE NEEDLE BIOPSY ANY APPROACH | $438.10 | $674.00 | 35% |
| Prostate biopsy inpatient CPT 55700 HC BIOPSY PROSTATE | $1,187.55 | $1,827.00 | 35% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING | $2,173.60 | $3,344.00 | 35% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING | $2,173.60 | $3,344.00 | 35% |
| Removal of a breast lump, open surgery CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $958.75 | $1,475.00 | 35% |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $958.75 | $1,475.00 | 35% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $313.30 | $482.00 | 35% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS | $313.30 | $482.00 | 35% |
| Tonsil and adenoid removal, child under 12 CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $540.15 | $831.00 | 35% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12 | $540.15 | $831.00 | 35% |
| Total hip replacement CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $2,366.00 | $3,640.00 | 35% |
| Total hip replacement inpatient CPT 27130 PR ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT | $2,366.00 | $3,640.00 | 35% |
| Total knee replacement CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $2,362.75 | $3,635.00 | 35% |
| Total knee replacement inpatient CPT 27447 PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS | $2,362.75 | $3,635.00 | 35% |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $670.80 | $1,032.00 | 35% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $670.80 | $1,032.00 | 35% |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $518.70 | $798.00 | 35% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $518.70 | $798.00 | 35% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $4,635.80 | $7,132.00 | 35% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB | $4,635.80 | $7,132.00 | 35% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $4,425.85 | $6,809.00 | 35% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM | $4,425.85 | $6,809.00 | 35% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $26.00 | $40.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R | $26.00 | $40.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $193.05 | $297.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS | $193.05 | $297.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $185.25 | $285.00 | 35% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS | $185.25 | $285.00 | 35% |
| Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY | $52.65 | $81.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 PR GROUP PSYCHOTHERAPY | $52.65 | $81.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $204.75 | $315.00 | 35% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES | $204.75 | $315.00 | 35% |
| New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $306.80 | $472.00 | 35% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES | $306.80 | $472.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $405.60 | $624.00 | 35% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES | $405.60 | $624.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE PT VV | $46.80 | $72.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE PT | $46.80 | $72.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT VV | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXER 1:1 EA 15M PT PR | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXER 1:1 EA 15M PT PR VV | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE OT VV | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE OT | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT | $63.05 | $97.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT VV | $63.05 | $97.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE PT | $46.80 | $72.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE PT VV | $46.80 | $72.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXER 1:1 EA 15M PT PR | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXER 1:1 EA 15M PT PR VV | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE PT VV | $51.35 | $79.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE OT | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE OT VV | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES | $53.95 | $83.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT VV | $63.05 | $97.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISE ACUTE OT | $63.05 | $97.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $237.25 | $365.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS | $237.25 | $365.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $273.00 | $420.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS | $273.00 | $420.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $148.20 | $228.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES | $148.20 | $228.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $195.65 | $301.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES | $195.65 | $301.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $289.90 | $446.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES | $289.90 | $446.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $205.40 | $316.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES | $205.40 | $316.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $292.50 | $450.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES | $292.50 | $450.00 | 35% |
Source file: https://www.legacyhealth.org/-/media/Files/JSON/930281321_legacy-silverton-medical-center_standardcharges.json