Penn Highlands Dubois
Penn Highlands Dubois in Dubois, PA publishes cash prices for 56 common procedures listed here, from its own machine-readable price file updated Aug 1, 2025. Click a procedure to compare it with other hospitals nearby.
100 Hospital Avenue, Dubois, PA 15801 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 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen + Pelvis w/ Contrast | $4,324.00 | $4,324.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain wo Contrast w Stealth Protocol - Report | $114.00 | $114.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain wo Contrast w Stealth Protocol - Report | $114.00 | $114.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain wo Contrast w Stealth Protocol - Report | $114.00 | $114.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain wo Contrast w Stealth Protocol - Report | $114.00 | $114.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain wo Contrast w Stealth Protocol | $1,287.00 | $1,287.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Cystogram - Report | $155.00 | $155.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Cystogram - Report | $155.00 | $155.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Cystogram - Report | $155.00 | $155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Cystogram - Report | $155.00 | $155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Cystogram | $2,155.00 | $2,155.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat - Report | $69.00 | $69.00 | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat - Report | $69.00 | $69.00 | — |
| Diagnostic mammogram, both breasts CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat - Report | $69.00 | $69.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat - Report | $69.00 | $69.00 | — |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, both breasts inpatient CPT 77066 MA Diag Digital Mammo+Tomo B/L | $1,180.00 | $1,180.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Left - Report | $55.00 | $55.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Left - Report | $55.00 | $55.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Left - Report | $55.00 | $55.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Left - Report | $55.00 | $55.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Diag Digital Mammo+Tomo LT | $927.00 | $927.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Ankle w/o Contrast Bilateral | $2,926.00 | $2,926.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Ankle w/o Contrast Bilateral | $2,926.00 | $2,926.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left - Report | $181.00 | $181.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left - Report | $181.00 | $181.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Ankle w/o Contrast Bilateral | $2,926.00 | $2,926.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI Ankle w/o Contrast Bilateral | $2,926.00 | $2,926.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left - Report | $181.00 | $181.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Contrast Left - Report | $181.00 | $181.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right - Report | $290.00 | $290.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right - Report | $290.00 | $290.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle Arthrogram Left | $4,324.00 | $4,324.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle Arthrogram Left | $4,324.00 | $4,324.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right - Report | $290.00 | $290.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Contrast Right - Report | $290.00 | $290.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle Arthrogram Left | $4,324.00 | $4,324.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle Arthrogram Left | $4,324.00 | $4,324.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast - Report | $308.00 | $308.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast - Report | $308.00 | $308.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast - Report | $308.00 | $308.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast - Report | $308.00 | $308.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast | $4,324.00 | $4,324.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast - Report | $198.00 | $198.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast | $2,926.00 | $2,926.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PC Pel OB Compl > 14 Wks | $134.00 | $134.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PC Pel OB Compl > 14 Wks | $134.00 | $134.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PC Pel OB Compl > 14 Wks | $134.00 | $134.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PC Pel OB Compl > 14 Wks | $134.00 | $134.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Pelvic OB > 14 Weeks Complete | $1,287.00 | $1,287.00 | — |
| Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screen Left - Report | $52.00 | $52.00 | — |
| Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screen Left - Report | $52.00 | $52.00 | — |
| Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screen Left | $976.00 | $976.00 | — |
| Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screen Left | $976.00 | $976.00 | — |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screen Left - Report | $52.00 | $52.00 | — |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screen Left - Report | $52.00 | $52.00 | — |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screen Left | $976.00 | $976.00 | — |
| Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screen Left | $976.00 | $976.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography | $3,145.00 | $3,145.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 PC PC Gyn Transvaginal | $93.00 | $93.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 PC PC Gyn Transvaginal | $93.00 | $93.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 PC PC Gyn Transvaginal | $93.00 | $93.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 PC PC Gyn Transvaginal | $93.00 | $93.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 PC US Abdomen Complete | $108.00 | $108.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 PC US Abdomen Complete | $108.00 | $108.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 PC US Abdomen Complete | $108.00 | $108.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 PC US Abdomen Complete | $108.00 | $108.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $1,287.00 | $1,287.00 | — |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel | $99.00 | $99.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $157.00 | $157.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC) with differential CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Auto Diff | $91.00 | $91.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram | $76.00 | $76.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $124.00 | $124.00 | — |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $102.00 | $102.00 | — |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $96.00 | $96.00 | — |
| Obstetric blood test panel CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| Obstetric blood test panel inpatient CPT 80055 Antibody Screen Gel | $562.00 | $562.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Diagnostic | $216.00 | $216.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time | $49.00 | $49.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $50.00 | $50.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone | $197.00 | $197.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 UA w/Micro | $59.00 | $59.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS | $33.00 | $33.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 pH Urine | $49.00 | $49.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Ketones Urine | $41.00 | $41.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 PC CATARACT SURG W/IOL 1 STAGE | $1,515.00 | $1,515.00 | — |
| Cataract surgery with lens implant CPT 66984 PC CATARACT SURG W/IOL 1 STAGE | $1,515.00 | $1,515.00 | — |
| Cataract surgery with lens implant inpatient CPT 66984 PC CATARACT SURG W/IOL 1 STAGE | $1,515.00 | $1,515.00 | — |
| Cataract surgery with lens implant inpatient CPT 66984 PC CATARACT SURG W/IOL 1 STAGE | $1,515.00 | $1,515.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 PC NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $280.00 | $280.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 PC NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $280.00 | $280.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PC NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $280.00 | $280.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PC NJX INTERLAMINAR LMBR/SAC W GUIDANCE | $280.00 | $280.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CT Lumbar/Sacrl Epidural inc Imag | $8,384.00 | $8,384.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 PC NJX INTERLAM LMBR/SAC WO GUIDE ANESTHESIA | $366.00 | $366.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 PC NJX INTERLAM LMBR/SAC WO GUIDE ANESTHESIA | $366.00 | $366.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PC NJX INTERLAM LMBR/SAC WO GUIDE ANESTHESIA | $366.00 | $366.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 PC NJX INTERLAM LMBR/SAC WO GUIDE ANESTHESIA | $366.00 | $366.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC WO GUIDANCE | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PC FACET BLOCK LUMBAR SACR SINGLE | $670.00 | $670.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PC FACET BLOCK LUMBAR SACR SINGLE | $670.00 | $670.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 CT Lumbar/Sacral Transforaminal LT | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 CT Lumbar/Sacral Transforaminal LT | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PC FACET BLOCK LUMBAR SACR SINGLE | $670.00 | $670.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PC FACET BLOCK LUMBAR SACR SINGLE | $670.00 | $670.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 CT Lumbar/Sacral Transforaminal LT | $10,778.00 | $10,778.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 CT Lumbar/Sacral Transforaminal LT | $10,778.00 | $10,778.00 | — |
| Prostate biopsy CPT 55700 PC Prostate Biopsy Single Multi | $666.00 | $666.00 | — |
| Prostate biopsy CPT 55700 PC Prostate Biopsy Single Multi | $666.00 | $666.00 | — |
| Prostate biopsy CPT 55700 Prostate Biopsy Single Multi | $24,800.00 | $24,800.00 | — |
| Prostate biopsy CPT 55700 Prostate Biopsy Single Multi | $24,800.00 | $24,800.00 | — |
| Prostate biopsy inpatient CPT 55700 PC Prostate Biopsy Single Multi | $666.00 | $666.00 | — |
| Prostate biopsy inpatient CPT 55700 PC Prostate Biopsy Single Multi | $666.00 | $666.00 | — |
| Prostate biopsy inpatient CPT 55700 Prostate Biopsy Single Multi | $24,800.00 | $24,800.00 | — |
| Prostate biopsy inpatient CPT 55700 Prostate Biopsy Single Multi | $24,800.00 | $24,800.00 | — |
| Removal of a breast lump, open surgery CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Removal of a breast lump, open surgery CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXCIS CYST FIBR LESION BREAST | $46,358.00 | $46,358.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $8,100.00 | $8,100.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PC EKG TRACING W/INTRP & RPT | $110.00 | $110.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PC EKG TRACING W/INTRP & RPT | $110.00 | $110.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PC EKG TRACING W/INTRP & RPT | $110.00 | $110.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PC EKG TRACING W/INTRP & RPT | $110.00 | $110.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 90847- Family therapy w/ patient (26+ mins) - BH Psychology Billing | $305.00 | $305.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 90847- Family therapy w/ patient (26+ mins) - BH Psychology Billing | $305.00 | $305.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 90847- Family therapy w/ patient (26+ mins) - BH Psychology Billing | $305.00 | $305.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 90847- Family therapy w/ patient (26+ mins) - BH Psychology Billing | $305.00 | $305.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY CONJOINT THERAPY | $828.00 | $828.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 90846- Family therapy w/o patient (26+ mins) - BH Psychology Billing | $293.00 | $293.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 90846- Family therapy w/o patient (26+ mins) - BH Psychology Billing | $293.00 | $293.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 90846- Family therapy w/o patient (26+ mins) - BH Psychology Billing | $293.00 | $293.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 90846- Family therapy w/o patient (26+ mins) - BH Psychology Billing | $293.00 | $293.00 | — |
| Group psychotherapy session CPT 90853 PC GROUP THERAPY | $83.00 | $83.00 | — |
| Group psychotherapy session CPT 90853 PC GROUP THERAPY | $83.00 | $83.00 | — |
| Group psychotherapy session inpatient CPT 90853 PC GROUP THERAPY | $83.00 | $83.00 | — |
| Group psychotherapy session inpatient CPT 90853 PC GROUP THERAPY | $83.00 | $83.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PC OV PROBLEM DETAILED NEW L3 | $232.00 | $232.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PC OV PROBLEM DETAILED NEW L3 | $232.00 | $232.00 | — |
| New patient office visit, about 30 minutes CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PC OV PROBLEM DETAILED NEW L3 | $232.00 | $232.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PC OV PROBLEM DETAILED NEW L3 | $232.00 | $232.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 BHS BC HMO OV PROB DETAILED NEW L3 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PC OV PROBLEM COMPREHEN NEW L4 | $377.00 | $377.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PC OV PROBLEM COMPREHEN NEW L4 | $377.00 | $377.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 BHS BC HMO OV PROB COMPREHEN NEW L4 | $297.00 | $297.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PC OV PROBLEM COMPREHEN NEW L4 | $377.00 | $377.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PC OV PROBLEM COMPREHEN NEW L4 | $377.00 | $377.00 | — |
| New patient office visit, about 60 minutes CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PC OV PROBLEM COMPLEX NEW L5 | $513.00 | $513.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PC OV PROBLEM COMPLEX NEW L5 | $513.00 | $513.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 BHS BC HMO OV PROB COMPLEX NEW L5 | $297.00 | $297.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PC OV PROBLEM COMPLEX NEW L5 | $513.00 | $513.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PC OV PROBLEM COMPLEX NEW L5 | $513.00 | $513.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PC PT THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PC PT THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PC PT THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PC PT THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT GE THERAPEUTIC EXERCISE 15 MIN | $167.00 | $167.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 PC PREVENTIVE MED 18-39 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 PC PREVENTIVE MED 18-39 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PC PREVENTIVE MED 18-39 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PC PREVENTIVE MED 18-39 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PC PREVENTIVE MED 40-64 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PC PREVENTIVE MED 40-64 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PC PREVENTIVE MED 40-64 NEW | $57.00 | $57.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PC PREVENTIVE MED 40-64 NEW | $57.00 | $57.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 90832- Psychotherapy (30 mins) - BH Psychology Billing | $233.00 | $233.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 90832- Psychotherapy (30 mins) - BH Psychology Billing | $233.00 | $233.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832- Psychotherapy (30 mins) - BH Psychology Billing | $233.00 | $233.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 90832- Psychotherapy (30 mins) - BH Psychology Billing | $233.00 | $233.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX PT FAMILY 30 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 90834- Psychotherapy (45 mins) - BH Psychology Billing | $307.00 | $307.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 90834- Psychotherapy (45 mins) - BH Psychology Billing | $307.00 | $307.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 90834- Psychotherapy (45 mins) - BH Psychology Billing | $307.00 | $307.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 90834- Psychotherapy (45 mins) - BH Psychology Billing | $307.00 | $307.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX PT FAMILY 45 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 90837- Psychotherapy (60 mins) - BH Psychology Billing | $455.00 | $455.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 90837- Psychotherapy (60 mins) - BH Psychology Billing | $455.00 | $455.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 90837- Psychotherapy (60 mins) - BH Psychology Billing | $455.00 | $455.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 90837- Psychotherapy (60 mins) - BH Psychology Billing | $455.00 | $455.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX W PT 60 MINUTES | $828.00 | $828.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PC OV CONSULT PROB DETAIL GLOBAL | $373.00 | $373.00 | — |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PC OV CONSULT PROB DETAIL GLOBAL | $373.00 | $373.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PC OV CONSULT PROB DETAIL GLOBAL | $373.00 | $373.00 | — |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 PC OV CONSULT PROB DETAIL GLOBAL | $373.00 | $373.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PC OV CONSULT PROB COMPREHEN L4 | $243.00 | $243.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PC OV CONSULT PROB COMPREHEN L4 | $243.00 | $243.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PC OV CONSULT PROB COMPREHEN L4 | $243.00 | $243.00 | — |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 PC OV CONSULT PROB COMPREHEN L4 | $243.00 | $243.00 | — |
Source file: https://www.phhealthcare.org/download/?id=15370