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Petersburg Medical Center

Petersburg, AK · CMS ID: 021304

This hospital has pricing data for 35 procedures ranging from $15 to $6,669.

Procedures (35)

Bacterial culture for aerobic isolates

87077
Cash Price
(No Insurance)
$171
Gross Charge
$214
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$214

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope

43239
Cash Price
(No Insurance)
$3,210
Gross Charge
$4,013
Insurance Negotiated Rates
AETNA - ALL PLANS$2,108

Biopsy of Large Bowel

45380
Cash Price
(No Insurance)
$4,211
Gross Charge
$5,264
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$5,264

Blood test, lipids (cholesterol and triglycerides)

80061
Cash Price
(No Insurance)
$216
Gross Charge
$270
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$270

Blood test, thyroid stimulating hormone (TSH)

84443
Cash Price
(No Insurance)
$225
Gross Charge
$281
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$281

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count

85025
Cash Price
(No Insurance)
$206
Gross Charge
$258
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$258

Complete ultrasound scan of abdomen

76700
Cash Price
(No Insurance)
$1,161
Gross Charge
$1,451
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$1,451

Complete ultrasound scan of pelvis

76856
Cash Price
(No Insurance)
$1,150
Gross Charge
$1,438
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$1,438

Comprehensive metabolic panel

80053
Cash Price
(No Insurance)
$228
Gross Charge
$285
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$285

CT scan of abdomen and pelvis with contrast

74177
Cash Price
(No Insurance)
$5,526
Gross Charge
$6,907
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$6,907

CT scan of abdomen and pelvis without contrast

74176
Cash Price
(No Insurance)
$4,764
Gross Charge
$5,955
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$5,955

CT scan of chest with contrast

71260
Cash Price
(No Insurance)
$3,486
Gross Charge
$4,358
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$4,358

Daptomycin 500 mg Vial

J0878
Cash Price
(No Insurance)
$83
Gross Charge
$104
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$104

Diagnostic Digital Breast Tomosynthesis, Unilateral or Bilateral

G0279
Cash Price
(No Insurance)
$110
Gross Charge
$138
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$138

Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope

43235
Cash Price
(No Insurance)
$3,210
Gross Charge
$4,013
Insurance Negotiated Rates
AETNA - ALL PLANS$1,592

Diagnostic exam of large bowel using a flexible endoscope

45378
Cash Price
(No Insurance)
$3,232
Gross Charge
$4,040
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$4,040

Diagnostic mammography of 1 breast

77065
Cash Price
(No Insurance)
$630
Gross Charge
$787
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$787

Diagnostic mammography of both breasts

77066
Cash Price
(No Insurance)
$518
Gross Charge
$648
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$648

Emergency department visit with high level of medical decision making

99285
Cash Price
(No Insurance)
$637
Gross Charge
$796
Insurance Negotiated Rates
AETNA - ALL PLANS$557

Emergency department visit with low level of medical decision making

99283
Cash Price
(No Insurance)
$258
Gross Charge
$323
Insurance Negotiated Rates
AETNA - ALL PLANS$199

Emergency department visit with moderate level of medical decision making

99284
Cash Price
(No Insurance)
$438
Gross Charge
$548
Insurance Negotiated Rates
AETNA - ALL PLANS$377

Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more

99213
Cash Price
(No Insurance)
$101
Gross Charge
$126
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$126

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more

99214
Cash Price
(No Insurance)
$126
Gross Charge
$158
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$158

Fetal test

59025
Cash Price
(No Insurance)
$482
Gross Charge
$603
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$603

Hemoglobin A1C level

83036
Cash Price
(No Insurance)
$171
Gross Charge
$214
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$198

Injection, Carboplatin, 50 mg

J9045
Cash Price
(No Insurance)
$15
Gross Charge
$19
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$19

Low Dose CT Scan of Chest for Lung Cancer Screening

71271
Cash Price
(No Insurance)
$1,290
Gross Charge
$1,612
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$1,612

Removal of Polyps or Growths of Large Bowel

45385
Cash Price
(No Insurance)
$4,211
Gross Charge
$5,264
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$5,264

Screening mammography

77067
Cash Price
(No Insurance)
$630
Gross Charge
$787
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$540

Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina

76830
Cash Price
(No Insurance)
$552
Gross Charge
$690
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$690

Vaginal Delivery with Care Before and After Delivery

59400
Cash Price
(No Insurance)
$6,669
Gross Charge
$8,336
Insurance Negotiated Rates
AETNA - ALL PLANS$10,483

X-ray of Chest - 1 View

71045
Cash Price
(No Insurance)
$229
Gross Charge
$286
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$286

X-ray of Chest - 2 Views

71046
Cash Price
(No Insurance)
$506
Gross Charge
$633
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$633

X-ray of Knee - 1-2 Views

73560
Cash Price
(No Insurance)
$405
Gross Charge
$506
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$506

X-ray of shoulder, minimum of 2 views

73030
Cash Price
(No Insurance)
$534
Gross Charge
$667
Insurance Negotiated Rates
PREMERA FIRST-ALL PLANS$667