Lee Memorial Hospital
Lee Memorial Hospital in Fort Myers, FL publishes cash prices for 68 common procedures listed here, from its own machine-readable price file updated Mar 26, 2026. Click a procedure to compare it with other hospitals nearby.
2776 CLEVELAND AVE, FORT MYERS, FL 33901-5864 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 HC CT Abd/Pelvis W/ Contrast | $2,809.60 | $14,048.00 | 80% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pelvis Dvt Protocol | $3,305.00 | $16,525.00 | 80% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pelvis W/ Contrast | $2,809.60 | $14,048.00 | 80% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pelvis Dvt Protocol | $3,305.00 | $16,525.00 | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast-Peds Shunt | $1,099.40 | $5,497.00 | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast Brainlab Protocol | $1,168.00 | $5,840.00 | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast Stealth Protocol | $1,168.00 | $5,840.00 | 80% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head W/O Contrast | $1,168.00 | $5,840.00 | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast-Peds Shunt | $1,099.40 | $5,497.00 | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast Brainlab Protocol | $1,168.00 | $5,840.00 | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast | $1,168.00 | $5,840.00 | 80% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head W/O Contrast Stealth Protocol | $1,168.00 | $5,840.00 | 80% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast | $2,172.00 | $10,860.00 | 80% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast | $2,172.00 | $10,860.00 | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 2d-Bilat | $119.60 | $598.00 | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MA Digital Diag Mammo Bilat 3d Tomosynthesis W or WO Cad | $119.60 | $598.00 | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 3d-Bilat | $119.60 | $598.00 | 80% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mam Diag Mammo W/ or W/O Cad Bilat | $126.00 | $630.00 | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 2d-Bilat | $119.60 | $598.00 | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MA Digital Diag Mammo Post Bx/Loc 3d-Bilat | $119.60 | $598.00 | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MA Digital Diag Mammo Bilat 3d Tomosynthesis W or WO Cad | $119.60 | $598.00 | 80% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mam Diag Mammo W/ or W/O Cad Bilat | $126.00 | $630.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Left | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Right | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Left | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Right | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Left | $104.60 | $523.00 | 80% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Right | $104.60 | $523.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Right | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 3d-Left | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Right | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Post Bx/Loc 2d-Left | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MA Digital Diag Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $99.60 | $498.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Right | $104.60 | $523.00 | 80% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mam Diag Mammo Uni W/ or W/O Cad Left | $104.60 | $523.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 HC MRI Lower Extremity Bilat W/O Contrast Peds Rotational | $914.00 | $4,570.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Knee W/O Cont | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Ankle W/O Cont-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Toes W/O Cont-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Toes W/O Cont-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Cont-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Knee W/O Cont-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Hip W/O Contrast-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Hip W/O Contrast-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Ankle W/O Cont-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 HC MRI Lower Extremity Bilat W/O Contrast Peds Rotational | $914.00 | $4,570.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Knee W/O Cont | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Cont-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Ankle W/O Cont-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Toes W/O Cont-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Hip W/O Contrast-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Cont-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Ankle W/O Cont-Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Knee W/O Contrast-Visionaire Protocol Right | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Ext Joint W/O Contrast-Peds Fast Msk-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Hip W/O Contrast-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Toes W/O Cont-Left | $963.80 | $4,819.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Ankle W & W/O Contrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Knee W&W/O Contrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Ankle W & W/O Contrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Knee W&W/O Contrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Knee W&W/O Contrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Toes W/ & W/O Conbtrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Knee W&W/O Contrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Ankle W & W/O Contrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Ankle W & W/O Contrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Right | $1,560.60 | $7,803.00 | 80% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Hip W/ & W/O Contrast-Left | $1,560.60 | $7,803.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast Brainlab Protocol | $966.60 | $4,833.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Iacs W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast-3t | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Pituitary W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Pituitary W/Head W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast Stealth Protocol | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Head W/O Contrast-Peds Fast Brain | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 MRI Head W/O Contrast Etv Protocol | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI CSF Flow W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast Brainlab Protocol | $966.60 | $4,833.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI CSF Flow W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast-Peds Fast Brain | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Pituitary W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Pituitary W/Head W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Iacs W/O Contrast | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Head W/O Contrast Etv Protocol | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast-3t | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Head W/O Contrast Stealth Protocol | $1,026.20 | $5,131.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Head W & W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Pituitary W/&W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Iacs W/&W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Pituitary W/Head W&WO Cntrst | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI CSF Flow W/ W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Perfusion W/ W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Head W/W/O Contrast-3t | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Head W/W/O Contrast-3t | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Perfusion W/ W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI CSF Flow W/ W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Head W & W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Iacs W/&W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Pituitary W/&W/O Contrast | $1,654.20 | $8,271.00 | 80% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Pituitary W/Head W&WO Cntrst | $1,654.20 | $8,271.00 | 80% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar W/O Contrast | $1,375.40 | $6,877.00 | 80% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Spine Lumbar W/O Contrast-3t | $1,375.40 | $6,877.00 | 80% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar W/O Contrast | $1,375.40 | $6,877.00 | 80% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Spine Lumbar W/O Contrast-3t | $1,375.40 | $6,877.00 | 80% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC Ult Sono OB Over or Equal14wks | $248.40 | $1,242.00 | 80% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exam, Pg Uterus, Compl | $386.00 | $514.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Exam, Pg Uterus, Compl | $386.00 | $514.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC Ult Sono OB Over or Equal14wks | $248.40 | $1,242.00 | 80% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exam, Pg Uterus, Compl | $386.00 | $514.00 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Exam, Pg Uterus, Compl | $386.00 | $514.00 | 25% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mam Screen Mammo W/Orw/O Cad Bilat | $90.00 | $450.00 | 80% |
| Screening mammogram, both breasts both sides CPT 77067 HC MA Digital Screen Mammo Bilat 3d Tomosynthesis W or WO Cad | $94.60 | $473.00 | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Right | $83.00 | $415.00 | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Left | $83.00 | $415.00 | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $87.20 | $436.00 | 80% |
| Screening mammogram, both breasts one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $87.20 | $436.00 | 80% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mam Screen Mammo W/Orw/O Cad Bilat | $90.00 | $450.00 | 80% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC MA Digital Screen Mammo Bilat 3d Tomosynthesis W or WO Cad | $94.60 | $473.00 | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Right | $83.00 | $415.00 | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mam Screen Mammo Uni W/Orw/O Cad Left | $83.00 | $415.00 | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Right | $87.20 | $436.00 | 80% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MA Digital Screen Mammo Uni 3d Tomosynthesis W or WO Cad-Left | $87.20 | $436.00 | 80% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography 12 Hrs | $1,601.60 | $8,008.00 | 80% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography 12 Hrs | $1,601.60 | $8,008.00 | 80% |
| Transvaginal pelvic ultrasound CPT 76830 US Exam, Transvaginal | $333.00 | $444.00 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 US Exam, Transvaginal | $333.00 | $444.00 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 HC Ult Sono Transvaginal Non-OB | $368.60 | $1,843.00 | 80% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Exam, Transvaginal | $333.00 | $444.00 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Exam, Transvaginal | $333.00 | $444.00 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC Ult Sono Transvaginal Non-OB | $368.60 | $1,843.00 | 80% |
| Ultrasound of the abdomen, complete CPT 76700 HC Ult Sonogram Abdominal Survey | $429.60 | $2,148.00 | 80% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC Ult Sonogram Abdominal Survey | $429.60 | $2,148.00 | 80% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Rad Spine Lumbar Min 4 Views | $446.20 | $2,231.00 | 80% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Rad Spine Lumbar Min 4 Views | $446.20 | $2,231.00 | 80% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Lab Basic Metabolic Panel | $15.60 | $78.00 | 80% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Uc/Pol Only) | $15.60 | $78.00 | 80% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Uc/Pol Only) | $15.60 | $78.00 | 80% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Lab Basic Metabolic Panel | $15.60 | $78.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lab Zz Lipid Panel | $8.20 | $41.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Profile With Reflex to Direct Ldl | $24.80 | $124.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lab Lipid Profile | $24.80 | $124.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Hg Lipid Panel | $25.40 | $127.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lab Zz Lipid Panel | $8.20 | $41.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Profile With Reflex to Direct Ldl | $24.80 | $124.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lab Lipid Profile | $24.80 | $124.00 | 80% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Hg Lipid Panel | $25.40 | $127.00 | 80% |
| Complete blood count (CBC) with differential CPT 85025 HC Lab Cbc With Automated Diff | $13.80 | $69.00 | 80% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Lab Cbc With Automated Diff | $13.80 | $69.00 | 80% |
| Complete blood count (CBC), no differential CPT 85027 HC Lab Cbc (No Diff)* | $12.80 | $64.00 | 80% |
| Complete blood count (CBC), no differential CPT 85027 HC Lab Cbc (No Diff) | $12.80 | $64.00 | 80% |
| Complete blood count (CBC), no differential CPT 85027 HC Lab Cbc, Automated | $13.80 | $69.00 | 80% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Lab Cbc (No Diff) | $12.80 | $64.00 | 80% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Lab Cbc (No Diff)* | $12.80 | $64.00 | 80% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Lab Cbc, Automated | $13.80 | $69.00 | 80% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Bmp to Cmp Add On | $22.00 | $110.00 | 80% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel (Uc/Pol Only) | $22.00 | $110.00 | 80% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Lab Comprehensive Metabolic Panel | $23.60 | $118.00 | 80% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Bmp to Cmp Add On | $22.00 | $110.00 | 80% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel (Uc/Pol Only) | $22.00 | $110.00 | 80% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Lab Comprehensive Metabolic Panel | $23.60 | $118.00 | 80% |
| Kidney function blood test panel CPT 80069 HC Lab Renal Panel | $18.00 | $90.00 | 80% |
| Kidney function blood test panel inpatient CPT 80069 HC Lab Renal Panel | $18.00 | $90.00 | 80% |
| Liver function blood test panel CPT 80076 HC Liver Profile (Uc/Pol Only) | $14.80 | $74.00 | 80% |
| Liver function blood test panel CPT 80076 HC Lab Liver Profile | $14.80 | $74.00 | 80% |
| Liver function blood test panel inpatient CPT 80076 HC Lab Liver Profile | $14.80 | $74.00 | 80% |
| Liver function blood test panel inpatient CPT 80076 HC Liver Profile (Uc/Pol Only) | $14.80 | $74.00 | 80% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Lab Psa, Ultrasensitive | $11.40 | $57.00 | 80% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Lab Psa | $27.80 | $139.00 | 80% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Lab Psa, Ultrasensitive | $11.40 | $57.00 | 80% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Lab Psa | $27.80 | $139.00 | 80% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt, Activated (15540) | $8.40 | $42.00 | 80% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Lab Aptt | $13.80 | $69.00 | 80% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Lab Heparin Absorbed Aptt | $17.00 | $85.00 | 80% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt, Activated (15540) | $8.40 | $42.00 | 80% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Lab Aptt | $13.80 | $69.00 | 80% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Lab Heparin Absorbed Aptt | $17.00 | $85.00 | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Pain Prothrombin Time | $10.40 | $52.00 | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Hg Prothrombin Time POCT | $10.40 | $52.00 | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Lab Prothrombin Time | $10.40 | $52.00 | 80% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $12.00 | $16.00 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $12.00 | $16.00 | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Hg Prothrombin Time POCT | $10.40 | $52.00 | 80% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Lab Prothrombin Time | $10.40 | $52.00 | 80% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Pain Prothrombin Time | $10.40 | $52.00 | 80% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $12.00 | $16.00 | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $12.00 | $16.00 | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Lab Tsh, Neonate (< 30 Days) | $11.40 | $57.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Cascade | $28.80 | $144.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Lab Tsh With Reflex to Free T4 | $28.80 | $144.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Lab Tsh | $28.80 | $144.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Lab Tsh, Neonate (< 30 Days) | $11.40 | $57.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Lab Tsh With Reflex to Free T4 | $28.80 | $144.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Lab Tsh | $28.80 | $144.00 | 80% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Cascade | $28.80 | $144.00 | 80% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopic | $12.20 | $61.00 | 80% |
| Urinalysis with microscope exam, automated CPT 81001 HC Lab *Urinalysis With Microscopy | $12.20 | $61.00 | 80% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopic | $12.20 | $61.00 | 80% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Lab *Urinalysis With Microscopy | $12.20 | $61.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Leukocyte Esterase Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Nitrite Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Specific Gravity Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Protein Qual Random Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Ph Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Io Urine Dip � Automated | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Bilirubin Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Blood Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Glucose Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Urobilinogen Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Ketones Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis, Auto, W/O Scope | $7.00 | $9.00 | 22% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis, Auto, W/O Scope | $7.00 | $9.00 | 22% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis (No Microscopic) | $8.20 | $41.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Urinalysis Routine | $8.20 | $41.00 | 80% |
| Urinalysis without microscope exam, automated CPT 81003 HC Lab Urinalysis W/C&S if Indicated | $8.20 | $41.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Leukocyte Esterase Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Protein Qual Random Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Urobilinogen Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Nitrite Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Bilirubin Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Io Urine Dip � Automated | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Ketones Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Specific Gravity Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Glucose Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Blood Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Ph Urine | $5.80 | $29.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis, Auto, W/O Scope | $7.00 | $9.00 | 22% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis, Auto, W/O Scope | $7.00 | $9.00 | 22% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis (No Microscopic) | $8.20 | $41.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Urinalysis Routine | $8.20 | $41.00 | 80% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Lab Urinalysis W/C&S if Indicated | $8.20 | $41.00 | 80% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urine Dips | $9.00 | $45.00 | 80% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine Dips | $9.00 | $45.00 | 80% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 Remv Cataract Extracap,Insert Lens | $4,293.54 | $21,467.71 | 80% |
| Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy W/Endoscope US | $4,018.85 | $20,094.23 | 80% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy,Remv Lesn,Snare | $2,533.83 | $12,669.17 | 80% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy,Biopsy | $2,638.18 | $13,190.91 | 80% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy,Diagnostic | $2,244.92 | $11,224.60 | 80% |
| Gallbladder removal, laparoscopic CPT 47562 Lap,Cholecystectomy | $12,257.38 | $61,286.88 | 80% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC Repair Ing Hernia 5+Y/O Reducibl | $1,498.00 | $7,490.00 | 80% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair Ing Hernia,5+Y/O,Reducibl | $8,151.04 | $40,755.20 | 80% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC Repair Ing Hernia 5+Y/O Reducibl | $1,498.00 | $7,490.00 | 80% |
| Knee arthroscopy with meniscus trim CPT 29881 Knee Scope,Med/Lat Menisectomy | $6,822.48 | $34,112.38 | 80% |
| Left heart catheterization, diagnostic CPT 93452 HC Lhc WO Cors W-WO Lv Gram | $5,571.20 | $27,856.00 | 80% |
| Left heart catheterization, diagnostic inpatient CPT 93452 HC Lhc WO Cors W-WO Lv Gram | $5,571.20 | $27,856.00 | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Rad Xr Lumbar Puncture W/ Injection | $757.20 | $3,786.00 | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC IR Epidural Inject, Lumbr or Sacrl, W/ Imaging | $757.20 | $3,786.00 | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC CT Epidural Inject, Lumbr or Sacrl, W/ Imaging | $804.00 | $4,020.00 | 80% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Rad Xr Lumbar Puncture W/ Injection | $975.06 | $4,875.30 | 80% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC IR Epidural Inject, Lumbr or Sacrl, W/ Imaging | $757.20 | $3,786.00 | 80% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Rad Xr Lumbar Puncture W/ Injection | $757.20 | $3,786.00 | 80% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC CT Epidural Inject, Lumbr or Sacrl, W/ Imaging | $804.00 | $4,020.00 | 80% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn | $4,070.20 | $20,351.01 | 80% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj,Foramen,L/S,1 Level | $994.66 | $4,973.30 | 80% |
| Prostate biopsy CPT 55700 HC CT Biopsy Prostate | $423.80 | $2,119.00 | 80% |
| Prostate biopsy CPT 55700 Biopsy of Prostate,Needle/Punch | $8,353.74 | $41,768.70 | 80% |
| Prostate biopsy inpatient CPT 55700 HC CT Biopsy Prostate | $423.80 | $2,119.00 | 80% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Lap,Prostatectomy,Radical,W/Nerve Spare | $31,031.53 | $155,157.63 | 80% |
| Removal of a breast lump, open surgery CPT 19120 Excise Breast Cyst | $5,197.69 | $25,988.47 | 80% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shldr Arthroscop,Part Acromioplas | $18,182.93 | $90,914.65 | 80% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Remove Tonsils/Adenoids,<12 Y/O | $4,173.44 | $20,867.18 | 80% |
| Total hip replacement CPT 27130 Total Hip Arthroplasty | $21,598.72 | $107,993.58 | 80% |
| Total knee replacement CPT 27447 Total Knee Arthroplasty | $21,504.95 | $107,524.74 | 80% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Upper GI Endoscopy,Biopsy | $3,056.04 | $15,280.18 | 80% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Upper GI Endoscopy,Diagnosis | $2,213.66 | $11,068.28 | 80% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Rout OB Care,Vag Deliv,Prev C-Sec | $6,660.00 | $8,880.00 | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Rout OB Care,Vag Deliv,Prev C-Sec | $6,660.00 | $8,880.00 | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Rout OB Care,Vag Deliv,Prev C-Sec | $6,660.00 | $8,880.00 | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Rout OB Care,Vag Deliv,Prev C-Sec | $6,660.00 | $8,880.00 | 25% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Full Rout Obste Care,Vaginal Deliv | $4,514.00 | $6,018.00 | 25% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Full Rout Obste Care,Vaginal Deliv | $4,514.00 | $6,018.00 | 25% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Full Rout Obste Care,Vaginal Deliv | $4,514.00 | $6,018.00 | 25% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Full Rout Obste Care,Vaginal Deliv | $4,514.00 | $6,018.00 | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, Complete | $47.00 | $63.00 | 25% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, Complete | $47.00 | $63.00 | 25% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram, Complete | $47.00 | $63.00 | 25% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram, Complete | $47.00 | $63.00 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy W/Pt | $230.00 | $1,150.00 | 80% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy W/Pt | $230.00 | $1,150.00 | 80% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy Without Pt | $194.60 | $973.00 | 80% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy Without Pt | $194.60 | $973.00 | 80% |
| Group psychotherapy session CPT 90853 HC Group Therapy Not Multi-Famil | $60.20 | $301.00 | 80% |
| Group psychotherapy session inpatient CPT 90853 HC Group Therapy Not Multi-Famil | $60.20 | $301.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Level 3 New Obt | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Ucc Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Renal Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC OB Level 3 New Obt | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Opcard Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 HC Pain Lwc Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes CPT 99203 Office/Outpt Visit,New,Levl III | $215.00 | $287.00 | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC OB Level 3 New Obt | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Level 3 New Obt | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Renal Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Pain Lwc Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Opcard Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Ucc Level 3 New | $150.00 | $750.00 | 80% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Office/Outpt Visit,New,Levl III | $154.00 | $205.00 | 25% |
| New patient office visit, about 45 minutes CPT 99204 HC Renal Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Opcard Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC OB Level 4 New Obt | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Ucc Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Level 4 New Obt | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Pain Lwc Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 HC Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes CPT 99204 Office/Outpt Visit,New,Levl IV | $317.00 | $423.00 | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Opcard Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Ucc Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Renal Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OB Level 4 New Obt | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Level 4 New Obt | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Pain Lwc Level 4 New | $178.00 | $890.00 | 80% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Office/Outpt Visit,New,Levl IV | $253.00 | $337.00 | 25% |
| New patient office visit, about 60 minutes CPT 99205 HC Renal Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Ucc Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Pain Lwc Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC OB Level 5 New Obt | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Level 5 New Obt | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 HC Opcard Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes CPT 99205 Office/Outpt Visit,New,Levl V | $410.00 | $547.00 | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Ucc Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Opcard Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC OB Level 5 New Obt | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Renal Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Level 5 New Obt | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Pain Lwc Level 5 New | $240.20 | $1,201.00 | 80% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Office/Outpt Visit,New,Levl V | $337.00 | $449.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 15 Min Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Telehealth 15 Min Ot Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Telehealth 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 15 Min Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Telehealth 15 Min Pt Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Telehealth 15 Min Ot Therapeutic Exercise | $56.00 | $280.00 | 80% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Preventive Visit,New,18-39 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Preventive Visit,New,18-39 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive Visit,New,18-39 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive Visit,New,18-39 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Preventive Visit,New,40-64 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Preventive Visit,New,40-64 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive Visit,New,40-64 | $296.00 | $395.00 | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive Visit,New,40-64 | $296.00 | $395.00 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC Psytx Pt&/Family 30 Minutes | $37.40 | $187.00 | 80% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy Patient 30 Minutes | $185.00 | $246.00 | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psytx Pt&/Family 30 Minutes | $37.40 | $187.00 | 80% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy Patient 30 Minutes | $171.00 | $228.00 | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC Psytx Pt&/Family 45 Minutes | $55.40 | $277.00 | 80% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy Patient 45 Minutes | $245.00 | $327.00 | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psytx Pt&/Family 45 Minutes | $55.40 | $277.00 | 80% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy Patient 45 Minutes | $228.00 | $304.00 | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC Psytx Pt&/Family 60 Minutes | $82.60 | $413.00 | 80% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy Patient 60 Minutes | $369.00 | $492.00 | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psytx Pt&/Family 60 Minutes | $82.60 | $413.00 | 80% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy Patient 60 Minutes | $343.00 | $457.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office/OP Consltj New/Est Pt Low Mdm 30 Minutes | $280.00 | $373.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office/OP Consltj New/Est Pt Low Mdm 30 Minutes | $280.00 | $373.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office/OP Consltj New/Est Pt Low Mdm 30 Minutes | $280.00 | $373.00 | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 Office/OP Consltj New/Est Pt Low Mdm 30 Minutes | $280.00 | $373.00 | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes | $391.00 | $521.00 | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes | $391.00 | $521.00 | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes | $391.00 | $521.00 | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes | $391.00 | $521.00 | 25% |