▸ Hospital · MD · CCN 210028

MedStar St. Mary's Hospital

25500 POINT LOOKOUT RD, LEONARDTOWN, MD, 20650

94 bedsAcute Care Hospitals2

Compliance grade

86/100

Procedures tracked

of 209 target codes

Payers

with negotiated rates

Rates published

1,120

last crawl 2026-05-23

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Source MRF: https://www.medstarhealth.org/-/media/project/mho/medstar/billing-and-insurance/2026/520619006_medstar_st_marys_hospital_standardcharges.csv · CSV

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
emergency
ED visit level 1	CPT	99281	0	$156.68	$153.55	—	—	—
ED visit level 2	CPT	99282	0	$151.68	$148.65	—	—	—
ED visit level 3	CPT	99283	0	$303.38	$297.31	—	—	—
ED visit level 4	CPT	99284	0	$606.74	$594.61	—	—	—
ED visit level 5	CPT	99285	0	$1,061.8	$1,040.56	—	—	—
imaging
CT head without contrast	CPT	70450	0	$61.22	$60	—	—	—
CT head with contrast	CPT	70460	0	$87.46	$85.71	—	—	—
CT head with and without contrast	CPT	70470	0	$104.95	$102.85	—	—	—
CT neck with contrast	CPT	70491	0	$137.02	$134.28	—	—	—
MRI brain without contrast	CPT	70551	0	$252.37	$247.32	—	—	—
MRI brain with contrast	CPT	70552	0	$372.82	$365.36	—	—	—
MRI brain with and without contrast	CPT	70553	0	$424.44	$415.95	—	—	—
Chest X-ray single view	CPT	71045	0	$64.6	$63.31	—	—	—
Chest X-ray 2 views	CPT	71046	0	$107.67	$105.52	—	—	—
Chest X-ray 3 views	CPT	71047	0	$150.74	$147.73	—	—	—
CT chest without contrast	CPT	71250	0	$104.95	$102.85	—	—	—
CT chest with contrast	CPT	71260	0	$137.02	$134.28	—	—	—
CT chest with and without contrast	CPT	71270	0	$169.09	$165.71	—	—	—
MRI chest without contrast	CPT	71550	0	$550.63	$539.62	—	—	—
MRI chest with contrast	CPT	71551	0	$602.25	$590.21	—	—	—
MRI chest with and without contrast	CPT	71552	0	$751.38	$736.35	—	—	—
Lumbosacral spine X-ray	CPT	72100	0	$150.74	$147.73	—	—	—
CT cervical spine without contrast	CPT	72125	0	$107.87	$105.71	—	—	—
CT thoracic spine without contrast	CPT	72128	0	$104.95	$102.85	—	—	—
CT lumbar spine without contrast	CPT	72131	0	$104.95	$102.85	—	—	—
MRI cervical spine without contrast	CPT	72141	0	$240.9	$236.08	—	—	—
MRI thoracic spine without contrast	CPT	72146	0	$240.9	$236.08	—	—	—
MRI lumbar spine without contrast	CPT	72148	0	$240.9	$236.08	—	—	—
MRI lumbar spine with and without contrast	CPT	72149	0	$372.82	$365.36	—	—	—
MRI cervical spine with and without contrast	CPT	72156	0	$424.44	$415.95	—	—	—
MRI lumbar spine with contrast	CPT	72158	0	$424.44	$415.95	—	—	—
CT pelvis without contrast	CPT	72192	0	$75.8	$74.28	—	—	—
CT pelvis with contrast	CPT	72193	0	$137.02	$134.28	—	—	—
Shoulder X-ray	CPT	73030	0	$215.34	$211.03	—	—	—
Humerus X-ray	CPT	73060	0	$129.2	$126.62	—	—	—
Hand X-ray 3 views	CPT	73130	0	$258.41	$253.24	—	—	—
MRI upper extremity joint without contrast	CPT	73221	0	$539.16	$528.38	—	—	—
MRI upper extremity joint with and without contrast	CPT	73223	0	$1,170.08	$1,146.68	—	—	—
Knee X-ray 1-2 views	CPT	73560	0	$258.41	$253.24	—	—	—
Ankle X-ray 3 views	CPT	73610	0	$258.41	$253.24	—	—	—
MRI lower extremity joint without contrast	CPT	73721	0	$539.16	$528.38	—	—	—
MRI lower extremity joint with and without contrast	CPT	73723	0	$1,170.08	$1,146.68	—	—	—
CT abdomen without contrast	CPT	74150	0	$72.88	$71.42	—	—	—
CT abdomen with contrast	CPT	74160	0	$137.02	$134.28	—	—	—
CT abdomen with and without contrast	CPT	74170	0	$157.43	$154.28	—	—	—
CT abdomen and pelvis without contrast	CPT	74176	0	$93.29	$91.42	—	—	—
CT abdomen and pelvis with contrast	CPT	74177	0	$180.75	$177.14	—	—	—
CT abdomen and pelvis with and without contrast	CPT	74178	0	$206.99	$202.85	—	—	—
MRI abdomen without contrast	CPT	74181	0	$418.71	$410.34	—	—	—
MRI abdomen with and without contrast	CPT	74183	0	$636.66	$623.93	—	—	—
Abdominal ultrasound complete	CPT	76700	0	$495.28	$485.37	—	—	—
Abdominal ultrasound limited	CPT	76705	0	$387.61	$379.86	—	—	—
Retroperitoneal ultrasound complete	CPT	76770	0	$473.75	$464.28	—	—	—
Obstetric ultrasound first trimester	CPT	76801	0	$452.21	$443.17	—	—	—
Obstetric ultrasound after first trimester	CPT	76805	0	$559.88	$548.68	—	—	—
Obstetric ultrasound with fetal anatomy	CPT	76811	0	$516.82	$506.48	—	—	—
Transvaginal ultrasound	CPT	76830	0	$538.35	$527.58	—	—	—
Pelvic ultrasound complete	CPT	76856	0	$452.21	$443.17	—	—	—
Scrotal ultrasound	CPT	76870	0	$215.34	$211.03	—	—	—
Diagnostic mammography unilateral	CPT	77065	0	$559.88	$548.68	—	—	—
Diagnostic mammography bilateral	CPT	77066	0	$732.16	$717.52	—	—	—
Screening mammography bilateral	CPT	77067	0	$602.95	$590.89	—	—	—
EKG tracing only	CPT	93005	0	$23.92	$23.44	—	—	—
Transthoracic echocardiogram complete	CPT	93306	0	$119.62	$117.23	—	—	—
Stress echocardiogram	CPT	93350	0	$119.62	$117.23	—	—	—
lab
Basic metabolic panel (BMP)	CPT	80048	0	$23.99	$23.51	—	—	—
Electrolyte panel	CPT	80051	0	$17.45	$17.1	—	—	—
Comprehensive metabolic panel	CPT	80053	0	$32.72	$32.07	—	—	—
Lipid panel	CPT	80061	0	$41.44	$40.61	—	—	—
Renal function panel	CPT	80069	0	$26.17	$25.65	—	—	—
Hepatic function panel	CPT	80076	0	$23.99	$23.51	—	—	—
Urinalysis automated	CPT	81003	0	$8.72	$8.55	—	—	—
Glucose quantitative	CPT	82947	0	$8.72	$8.55	—	—	—
Hemoglobin A1c	CPT	83036	0	$43.62	$42.75	—	—	—
Thyroid stimulating hormone (TSH)	CPT	84443	0	$32.72	$32.07	—	—	—
Complete blood count with automated differential	CPT	85025	0	$21.81	$21.37	—	—	—
Complete blood count without differential	CPT	85027	0	$17.45	$17.1	—	—	—
Urine culture bacterial	CPT	87086	0	$43.62	$42.75	—	—	—
Urine culture identification	CPT	87088	0	$21.81	$21.37	—	—	—
Tissue exam by pathologist level IV	CPT	88305	0	$130.87	$128.25	—	—	—
maternity
Fetal non-stress test	CPT	59025	0	$783.38	$767.71	—	—	—
Vaginal delivery only	CPT	59409	0	$9,713.92	$9,519.64	—	—	—
C-section delivery only	CPT	59514	0	$7,363.78	$7,216.5	—	—	—
office
Office visit, new patient, 15-29 min	CPT	99202	0	$145.89	$142.97	—	—	—
Office visit, new patient, 30-44 minutes	CPT	99203	0	$194.52	$190.63	—	—	—
Office visit, new patient, 45-59 min	CPT	99204	0	$243.15	$238.29	—	—	—
Office visit, new patient, 60-74 min	CPT	99205	0	$291.84	$286	—	—	—
Office visit, established patient, 5 min	CPT	99211	0	$97.28	$95.33	—	—	—
Office visit, established patient, 10-19 min	CPT	99212	0	$145.89	$142.97	—	—	—
Office visit, established patient, 20-29 minutes	CPT	99213	0	$194.52	$190.63	—	—	—
Office visit, established patient, 30-39 minutes	CPT	99214	0	$243.15	$238.29	—	—	—
Office visit, established patient, 40-54 min	CPT	99215	0	$291.84	$286	—	—	—

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.