▸ Hospital · ND · CCN 351316

Presentation Medical Center

213 SECOND AVE N.E., ROLLA, ND, 351316

Compliance grade

78/100

Procedures tracked

106

of 209 target codes

Payers

with negotiated rates

Rates published

338

last crawl 2026-05-23

▸ Compare with other hospitals All ND hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://secure.claraprice.net/price-transparency/KPBN-1760641089324/machine-readable/450226729_smp-health---st-aloisius_standardcharges.json · JSON

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychotherapy 30 minutes	CPT	90832	0	$810	$729	—	—	—
Psychotherapy 45 minutes	CPT	90834	0	$955	$860	—	—	—
Psychotherapy 60 minutes	CPT	90837	0	$970	$873	—	—	—
emergency
ED visit level 1	CPT	99281	0	$227	$204	—	—	—
ED visit level 2	CPT	99282	0	$332	$299	—	—	—
ED visit level 3	CPT	99283	0	$584	$526	—	—	—
ED visit level 4	CPT	99284	0	$917	$825	—	—	—
ED visit level 5	CPT	99285	0	$1,431	$1,288	—	—	—
Critical care, first hour	CPT	99291	0	$2,274	$2,047	—	—	—
imaging
CT head without contrast	CPT	70450	0	$1,317	$1,185	—	—	—
CT head with contrast	CPT	70460	0	$1,382	$1,244	—	—	—
CT head with and without contrast	CPT	70470	0	$1,730	$1,557	—	—	—
CT neck with contrast	CPT	70491	0	$1,558	$1,402	—	—	—
MRI brain without contrast	CPT	70551	0	$2,477	$2,229	—	—	—
MRI brain with contrast	CPT	70552	0	$2,723	$2,451	—	—	—
MRI brain with and without contrast	CPT	70553	0	$3,664	$3,298	—	—	—
Chest X-ray single view	CPT	71045	0	$206	$185	—	—	—
Chest X-ray 2 views	CPT	71046	0	$268	$241	—	—	—
Chest X-ray 3 views	CPT	71047	0	$332	$299	—	—	—
CT chest without contrast	CPT	71250	0	$1,447	$1,302	—	—	—
CT chest with contrast	CPT	71260	0	$1,730	$1,557	—	—	—
CT chest with and without contrast	CPT	71270	0	$2,289	$2,060	—	—	—
MRI chest without contrast	CPT	71550	0	$3,218	$2,896	—	—	—
MRI chest with and without contrast	CPT	71552	0	$4,349	$3,914	—	—	—
Lumbosacral spine X-ray	CPT	72100	0	$289	$260	—	—	—
CT cervical spine without contrast	CPT	72125	0	$1,530	$1,377	—	—	—
CT thoracic spine without contrast	CPT	72128	0	$1,530	$1,377	—	—	—
CT lumbar spine without contrast	CPT	72131	0	$1,530	$1,377	—	—	—
MRI cervical spine without contrast	CPT	72141	0	$2,170	$1,953	—	—	—
MRI thoracic spine without contrast	CPT	72146	0	$2,304	$2,074	—	—	—
MRI lumbar spine without contrast	CPT	72148	0	$2,304	$2,074	—	—	—
MRI lumbar spine with and without contrast	CPT	72149	0	$2,848	$2,563	—	—	—
MRI cervical spine with and without contrast	CPT	72156	0	$3,607	$3,246	—	—	—
MRI lumbar spine with contrast	CPT	72158	0	$3,600	$3,240	—	—	—
CT pelvis without contrast	CPT	72192	0	$1,530	$1,377	—	—	—
CT pelvis with contrast	CPT	72193	0	$1,677	$1,509	—	—	—
Shoulder X-ray	CPT	73030	0	$250	$225	—	—	—
Humerus X-ray	CPT	73060	0	$250	$225	—	—	—
Hand X-ray 3 views	CPT	73130	0	$231	$208	—	—	—
MRI upper extremity joint without contrast	CPT	73221	0	$2,327	$2,094	—	—	—
MRI upper extremity joint with and without contrast	CPT	73223	0	$3,817	$3,435	—	—	—
Knee X-ray 1-2 views	CPT	73560	0	$227	$204	—	—	—
Ankle X-ray 3 views	CPT	73610	0	$231	$208	—	—	—
MRI lower extremity joint without contrast	CPT	73721	0	$2,386	$2,147	—	—	—
MRI lower extremity joint with and without contrast	CPT	73723	0	$3,806	$3,425	—	—	—
CT abdomen without contrast	CPT	74150	0	$1,384	$1,246	—	—	—
CT abdomen with contrast	CPT	74160	0	$1,677	$1,509	—	—	—
CT abdomen with and without contrast	CPT	74170	0	$2,456	$2,210	—	—	—
CT abdomen and pelvis without contrast	CPT	74176	0	$1,905	$1,715	—	—	—
CT abdomen and pelvis with contrast	CPT	74177	0	$2,757	$2,481	—	—	—
CT abdomen and pelvis with and without contrast	CPT	74178	0	$3,508	$3,157	—	—	—
MRI abdomen without contrast	CPT	74181	0	$2,439	$2,195	—	—	—
MRI abdomen with and without contrast	CPT	74183	0	$3,801	$3,421	—	—	—
Abdominal ultrasound complete	CPT	76700	0	$538	$484	—	—	—
Abdominal ultrasound limited	CPT	76705	0	$412	$371	—	—	—
Retroperitoneal ultrasound complete	CPT	76770	0	$525	$473	—	—	—
Obstetric ultrasound first trimester	CPT	76801	0	$470	$423	—	—	—
Transvaginal ultrasound	CPT	76830	0	$542	$488	—	—	—
Pelvic ultrasound complete	CPT	76856	0	$481	$433	—	—	—
Scrotal ultrasound	CPT	76870	0	$490	$441	—	—	—
Diagnostic mammography unilateral	CPT	77065	0	$574	$517	—	—	—
Diagnostic mammography bilateral	CPT	77066	0	$708	$637	—	—	—
Screening mammography bilateral	CPT	77067	0	$582	$524	—	—	—
EKG tracing only	CPT	93005	0	$160	$144	—	—	—
Transthoracic echocardiogram complete	CPT	93306	0	$936	$842	—	—	—
inpatient
GI hemorrhage w CC	MS-DRG	378	0	$10	$9	—	—	—
Hospital discharge, <30 min	CPT	99238	0	$215	$194	—	—	—
Hospital discharge, >30 min	CPT	99239	0	$315	$284	—	—	—
lab
Basic metabolic panel (BMP)	CPT	80048	0	$72	$65	—	—	—
General health panel	CPT	80050	0	$321	$289	—	—	—
Electrolyte panel	CPT	80051	0	$64	$58	—	—	—
Comprehensive metabolic panel	CPT	80053	0	$107	$96	—	—	—
Lipid panel	CPT	80061	0	$122	$110	—	—	—
Renal function panel	CPT	80069	0	$72	$65	—	—	—
Hepatic function panel	CPT	80076	0	$71	$64	—	—	—
Urinalysis non-automated	CPT	81002	0	$24	$22	—	—	—
Glucose quantitative	CPT	82947	0	$37	$33	—	—	—
Hemoglobin A1c	CPT	83036	0	$87	$78	—	—	—
Thyroid stimulating hormone (TSH)	CPT	84443	0	$146	$131	—	—	—
Complete blood count with automated differential	CPT	85025	0	$68	$61	—	—	—
Complete blood count without differential	CPT	85027	0	$68	$61	—	—	—
Urine culture bacterial	CPT	87086	0	$93	$84	—	—	—
Urine culture identification	CPT	87088	0	$66	$59	—	—	—
Tissue exam by pathologist level IV	CPT	88305	0	$124	$112	—	—	—
maternity
Vaginal delivery only	CPT	59409	0	$5,892	$5,303	—	—	—
office
Office visit, new patient, 15-29 min	CPT	99202	0	$225	$203	—	—	—
Office visit, new patient, 30-44 minutes	CPT	99203	0	$318	$286	—	—	—
Office visit, new patient, 45-59 min	CPT	99204	0	$483	$435	—	—	—
Office visit, new patient, 60-74 min	CPT	99205	0	$608	$547	—	—	—
Office visit, established patient, 5 min	CPT	99211	0	$67	$60	—	—	—
Office visit, established patient, 10-19 min	CPT	99212	0	$134	$121	—	—	—
Office visit, established patient, 20-29 minutes	CPT	99213	0	$218	$196	—	—	—
Office visit, established patient, 30-39 minutes	CPT	99214	0	$320	$288	—	—	—
Office visit, established patient, 40-54 min	CPT	99215	0	$428	$385	—	—	—
preventive
Upper GI endoscopy diagnostic	CPT	43235	0	$2,765	$2,489	—	—	—
Upper GI endoscopy with biopsy	CPT	43239	0	$2,850	$2,565	—	—	—
Colonoscopy diagnostic	CPT	45378	0	$3,042	$2,738	—	—	—
Colonoscopy with biopsy	CPT	45380	0	$3,094	$2,785	—	—	—
Colonoscopy with polyp removal	CPT	45385	0	$3,258	$2,932	—	—	—
surgery
Shoulder arthroscopy with rotator cuff repair	CPT	29827	0	$13,027	$11,724	—	—	—
Knee arthroscopy with meniscectomy	CPT	29881	0	$5,885	$5,297	—	—	—
ACL reconstruction	CPT	29888	0	$29,450	$26,505	—	—	—
Laparoscopic cholecystectomy	CPT	47562	0	$2,231	$2,008	—	—	—
Open umbilical hernia repair	CPT	49560	0	$2,234	$2,011	—	—	—
Complex cataract surgery	CPT	66982	0	$5,636	$5,072	—	—	—
Cataract surgery with lens implant	CPT	66984	0	$5,636	$5,072	—	—	—