Arkansas Valley Regional Medical Center

Price List for Shoppable Services. Effective 04-25-2022.

Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.
Filtering
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450 (27)Outpatient3500260$818
CT MAXILLOFACIAL W/O DYECPT 70486 (27)Outpatient3500350$802
CT SOFT TISSUE NECK W/DYECPT 70491 (27)Outpatient3500391$1,192
CT ANGIOGRAPHY HEADCPT 70496Outpatient3500267$1,219
CT THORAX DX C-CPT 71250 (27)Outpatient3500160$896
CT THORAX DX C+CPT 71260 (27)Outpatient3500151$1,287
CT ANGIOGRAPHY CHESTCPT 71275Outpatient3500153$1,971
CT NECK SPINE W/O DYECPT 72125 (27)Outpatient3500170$1,034
CT LUMBAR SPINE W/O DYECPT 72131 (27)Outpatient3500310$925
(N/O) CT SCAN OF PELVIS WITH CONTRASTCPT 72193----
CT LOWER EXTREMITY W/O DYECPT 73700 (27)Outpatient3500270$893
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient3500047$2,182
CT ABD & PELV W/CONTRASTCPT 74177Outpatient3500048$2,057
CT ABD & PELV 1/> REGNSCPT 74178Outpatient3500049$3,070
CT BONE DENSITY AXIALCPT 77078Outpatient3500083$279
Cardiology
CARDIOVASCULAR STRESS TESTCPT 93017Outpatient4820000$692
TTE W/DOPPLER COMPLETECPT 93306Outpatient4000204$1,716
Clinic
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30 MINCPT 99203----
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45 MINCPT 99204----
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 60 MINCPT 99205----
(N/O) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243----
(N/O) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244----
(N/O) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EVALUATION ...CPT 99385----
(N/O) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EVALUATION ...CPT 99386----
EEG
POLYSOM 6/> YRS 4/> PARAMCPT 95810Outpatient7400010$1,770
EEG AWAKE AND ASLEEPCPT 95819Outpatient7400017$1,361
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...CPT 93000----
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient7300010$129
ELECTROCARDIOGRAM REPORTCPT 93010Outpatient7300011$129
ECG MONIT/REPRT UP TO 48 HRSCPT 93225Outpatient48000170$898
ECG MONIT/REPRT UP TO 48 HRSCPT 93226Outpatient4800171$164
Emergency Room
PLACE NEEDLE IN VEINCPT 36000Outpatient4500135$113
HEART/LUNG RESUSCITATION CPRCPT 92950Outpatient2701095$836
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient4500157$14
EMERGENCY DEPT VISITCPT 99281Outpatient4500032$242
EMERGENCY DEPT VISITCPT 99282Outpatient4500042$410
EMERGENCY DEPT VISITCPT 99283Outpatient4500052$734
EMERGENCY DEPT VISITCPT 99284Outpatient4500062$2,396
EMERGENCY DEPT VISITCPT 99285 (25)Outpatient4500070$801
IV Therapy
HYDRATION IV INFUSION INITCPT 96360Outpatient2600901$164
HYDRATE IV INFUSION ADD-ONCPT 96361 (59)Outpatient7620102$125
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient2600081$283
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient2600781$113
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient2600082$139
Imaging
US EXAM OF HEAD AND NECKCPT 76536Outpatient4000310$352
ULTRASOUND BREAST LIMITEDCPT 76642 (LT)Outpatient4000116$157
US EXAM ABDOM COMPLETECPT 76700Outpatient4000020$481
ECHO EXAM OF ABDOMENCPT 76705Outpatient4000010$376
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient4000050$411
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient4000012$342
OB US < 14 WKS SINGLE FETUSCPT 76801Outpatient4000271$528
(N/O) ABDOMIAL ULTRASOUND OF PREGNANT UTERUSCPT 76805----
OB US LIMITED FETUS(S)CPT 76815Outpatient4000280$281
TRANSVAGINAL US OBSTETRICCPT 76817Outpatient4000461$321
TRANSVAGINAL US NON-OBCPT 76830Outpatient4000470$363
US EXAM PELVIC COMPLETECPT 76856Outpatient4000320$548
US EXAM SCROTUMCPT 76870Outpatient4000390$329
US COMPL JOINT R-T W/IMGCPT 76881Outpatient4000210$353
DX MAMMO INCL CAD UNICPT 77065 (LT)Outpatient3201700$269
DX MAMMO INCL CAD BICPT 77066Outpatient3201690$281
SCR MAMMO BI INCL CADCPT 77067Outpatient3201740$201
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460----
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...DRG 470----
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473----
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...DRG 743----
Labor and Delivery
FETAL NON-STRESS TESTCPT 59025Outpatient7200090$262
Laboratory
METABOLIC PANEL TOTAL CACPT 80048Outpatient3001785$76
COMPREHEN METABOLIC PANELCPT 80053Outpatient3001320$99
(N/O) OBSTETRIC BLOOD TEST PANELCPT 80055----
LIPID PANELCPT 80061Outpatient3003530$118
RENAL FUNCTION PANELCPT 80069Outpatient3004905$163
HEPATIC FUNCTION PANELCPT 80076Outpatient3003668$119
ASSAY CARBAMAZEPINE TOTALCPT 80156Outpatient3002045$109
DRUG ASSAY CYCLOSPORINECPT 80158Outpatient3002170$123
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient3002270$109
DIPROPYLACETIC ACID FREECPT 80165Outpatient3006260$79
ASSAY OF LITHIUMCPT 80178Outpatient3003665$61
ASSAY OF PHENYTOIN TOTALCPT 80185Outpatient3004655$127
ASSAY OF TACROLIMUSCPT 80197Outpatient3005535$200
ASSAY OF VANCOMYCINCPT 80202Outpatient3006275$130
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient3000821$280
DRUG SCREEN QUANTALCOHOLSCPT 80320Outpatient3002495$86
DRUG SCREEN AMPHETAMINES 1/2CPT 80324Outpatient3003461$38
ANALGESICS NON-OPIOID 1 OR 2CPT 80329Outpatient3000620$108
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81001----
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient3005725$23
MICROSCOPIC EXAM OF URINECPT 81015Outpatient3005755$31
URINALYSIS VOLUME MEASURECPT 81050Outpatient3005410$25
TEST FOR ACETONE/KETONESCPT 82009Outpatient3000635$57
ASSAY OF SERUM ALBUMINCPT 82040Outpatient3000755$50
UR ALBUMIN QUANTITATIVECPT 82043Outpatient3003840$56
ALPHA-FETOPROTEIN SERUMCPT 82105Outpatient3000004$97
AMINO ACIDS SINGLE QUANTCPT 82131Outpatient3003370$225
ASSAY OF AMMONIACPT 82140Outpatient3000935$113
ASSAY OF AMYLASECPT 82150Outpatient3000920$53
BILIRUBIN TOTALCPT 82247Outpatient3001310$50
BILIRUBIN DIRECTCPT 82248Outpatient3001315$29
VITAMIN D 25 HYDROXYCPT 82306Outpatient3006360$137
ASSAY OF CALCIUMCPT 82310Outpatient3001565$50
CARCINOEMBRYONIC ANTIGENCPT 82378Outpatient3001655$11
ASSAY OF CK (CPK)CPT 82550Outpatient3001850$43
ASSAY OF CREATININECPT 82565Outpatient3002075$50
ASSAY OF URINE CREATININECPT 82570Outpatient3005870$96
VITAMIN B-12CPT 82607Outpatient3001145$82
VIT D 1 25-DIHYDROXYCPT 82652Outpatient3006370$160
ASSAY OF ESTROGENSCPT 82671Outpatient3002465$90
ASSAY OF FERRITINCPT 82728Outpatient3002570$89
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient3002720$91
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient3003396$61
BLOOD GASES ANY COMBINATIONCPT 82803Outpatient3001361$152
BLOOD GASES W/O2 SATURATIONCPT 82805Outpatient3001360$166
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient3002990$64
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient3002735$84
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient3003065$61
ASSAY OF IRONCPT 83540Outpatient3002555$35
IRON BINDING TESTCPT 83550Outpatient3005500$40
ASSAY OF LACTIC ACIDCPT 83605Outpatient3003470$121
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient3003500$59
ASSAY OF LDH ENZYMESCPT 83625Outpatient3001020$66
ASSAY OF LIPASECPT 83690Outpatient3003650$61
ASSAY OF BLOOD LIPOPROTEINCPT 83721Outpatient3001775$68
ASSAY OF MAGNESIUMCPT 83735Outpatient3003830$50
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient3001330$85
ASSAY OF PARATHORMONECPT 83970Outpatient3004646$363
ASSAY OF BLOOD PKUCPT 84030Outpatient3004220$148
ASSAY OF PHOSPHORUSCPT 84100Outpatient3004205$56
EVAL AMNIOTIC FLUID PROTEINCPT 84112Outpatient3007318$88
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient3003455$53
ASSAY OF PREALBUMINCPT 84134Outpatient3000760$61
PROCALCITONIN (PCT)CPT 84145Outpatient3004480$94
ASSAY OF PSA TOTALCPT 84153Outpatient3004520$100
ASSAY OF PSA FREECPT 84154Outpatient3004510$83
ASSAY OF PROTEIN URINECPT 84156Outpatient3002165$89
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient3004175$73
ASSAY OF FREE TESTOSTERONECPT 84402Outpatient3005406$152
ASSAY OF TOTAL TESTOSTERONECPT 84403Outpatient3005405$158
ASSAY OF TOTAL THYROXINECPT 84436Outpatient3005360$85
ASSAY OF FREE THYROXINECPT 84439Outpatient3005365$73
ASSAY THYROID STIM HORMONECPT 84443Outpatient3005636$116
ALANINE AMINO (ALT) (SGPT)CPT 84460Outpatient3005045$59
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient3005660$96
FREE ASSAY (FT-3)CPT 84481Outpatient3005350$136
ASSAY OF TROPONIN QUANTCPT 84484Outpatient3001574$20
ASSAY OF UREA NITROGENCPT 84520Outpatient3001355$53
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient3006140$60
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient3000003$137
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient3003275$48
BL SMEAR W/DIFF WBC COUNTCPT 85007Outpatient3001630$11
HEMATOCRITCPT 85014Outpatient3003063$28
HEMOGLOBINCPT 85018Outpatient3003064$28
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient3001610$57
COMPLETE CBC AUTOMATEDCPT 85027Outpatient3001621$90
MANUAL RETICULOCYTE COUNTCPT 85044Outpatient3004910$61
FIBRIN DEGRADATION QUANTCPT 85379Outpatient3002200$95
PROTHROMBIN TIMECPT 85610Outpatient3004535$38
PROTHROMBIN TESTCPT 85611Outpatient3004536$37
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient3002450$37
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient3004669$60
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient3000965$99
C-REACTIVE PROTEINCPT 86140Outpatient3002090$49
IMMUNOASSAY TUMOR CA 15-3CPT 86300Outpatient3001505$13
IMMUNOASSAY TUMOR CA 125CPT 86304Outpatient3001490$29
HETEROPHILE ANTIBODY SCREENCPT 86308 (QW)Outpatient3003860$94
SERUM IMMUNOELECTROPHORESISCPT 86320Outpatient3003400$211
RHEUMATOID FACTOR QUANTCPT 86431Outpatient3004885$57
HELICOBACTER PYLORI ANTIBODYCPT 86677Outpatient3003371$28
HIV-1ANTIBODYCPT 86701Outpatient3000740$79
HEP B CORE ANTIBODY TOTALCPT 86704Outpatient3003215$62
HEP B SURFACE ANTIBODYCPT 86706Outpatient3003245$129
HEPATITIS A ANTIBODYCPT 86708Outpatient3003200$73
HEPATITIS A IGM ANTIBODYCPT 86709Outpatient3003205$244
MUMPS ANTIBODYCPT 86735Outpatient3002710$11
RUBELLA ANTIBODYCPT 86762Outpatient3002700$10
RUBEOLA ANTIBODYCPT 86765Outpatient3002695$11
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient3002715$15
HEPATITIS C AB TESTCPT 86803Outpatient3003290$251
RBC ANTIBODY SCREENCPT 86850Outpatient3900200$77
COOMBS TEST DIRECTCPT 86880Outpatient3900260$64
BLOOD TYPING SEROLOGIC ABOCPT 86900Outpatient3900101$48
BLOOD TYPING SEROLOGIC RH(D)CPT 86901Outpatient3900100$48
COMPATIBILITY TEST SPINCPT 86920Outpatient3900310$184
COMPATIBILITY TEST INCUBATECPT 86921Outpatient3900320$184
COMPATIBILITY TEST ANTIGLOBCPT 86922Outpatient3900300$184
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient3007041$122
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient3007065$67
CULTR BACTERIA EXCEPT BLOODCPT 87075Outpatient3007030$175
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient3003960$43
CULTURE SCREEN ONLYCPT 87081Outpatient3005170$82
URINE CULTURE/COLONY COUNTCPT 87086Outpatient3007430$62
DNA/RNA AMPLIFIED PROBECPT 87150Outpatient3002717$1,502
MICROBE SUSCEPTIBLE MICCPT 87186Outpatient3007355$127
SMEAR GRAM STAINCPT 87205Outpatient3007150$46
SMEAR WET MOUNT SALINE/INKCPT 87210Outpatient3007210$53
CLOSTRIDIUM AG IACPT 87324Outpatient3007060$91
HPYLORI STOOL AG IACPT 87338Outpatient3003372$50
HEPATITIS B SURFACE AG IACPT 87340Outpatient3003260$111
RESP SYNCYTIAL VIRUS AG IACPT 87420Outpatient3007325$82
CHYLMD TRACH DNA DIR PROBECPT 87490Outpatient3007172$53
IADNA-DNA/RNA PROBE TQ 12-25CPT 87507Outpatient3002716$595
HEPATITIS C REVRS TRNSCRPJCPT 87522Outpatient3003291$507
N.GONORRHOEAE DNA DIR PROBCPT 87590Outpatient3007171$53
RESP VIRUS 12-25 TARGETSCPT 87633Outpatient3002718$836
STREP A DNA AMP PROBECPT 87651Outpatient3005160$89
DETECT AGENT NOS DNA AMPCPT 87798Outpatient3004150$86
STREP B ASSAY W/OPTICCPT 87802Outpatient3002800$226
INFLUENZA ASSAY W/OPTICCPT 87804 (QW)Outpatient3007316$100
STREP A ASSAY W/OPTICCPT 87880Outpatient3007315$51
TISSUE EXAM BY PATHOLOGISTCPT 88302Outpatient3100070$68
TISSUE EXAM BY PATHOLOGISTCPT 88304Outpatient3100080$88
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient3100010$117
SPECIAL STAINS GROUP 1CPT 88312Outpatient3100400$78
SPECIAL STAINS GROUP 2CPT 88313Outpatient3007265$60
Language Pathology
SPEECH EVAL SND W/COMPR & EXPCPT 92506Outpatient4400010$208
SPEECH/HEARING THERAPYCPT 92507 (GN)Outpatient4400000$112
ORAL FUNCTION THERAPYCPT 92526 (GN)Outpatient4400005$127
EVALUATE SWALLOWING FUNCTIONCPT 92610Outpatient4400007$341
MOTION FLUOROSCOPY/SWALLOWCPT 92611 (GN)Outpatient4400400$190
MRI
MRI BRAIN STEM W/O DYECPT 70551Outpatient6100210$1,848
MRI BRAIN STEM W/O & W/DYECPT 70553 (27)Outpatient6100215$2,482
MRI NECK SPINE W/O DYECPT 72141 (27)Outpatient6100110$1,849
MRI LUMBAR SPINE W/O DYECPT 72148 (27)Outpatient6100300$1,552
MRI JOINT UPR EXTREM W/O DYECPT 73221 (RT)Outpatient6100545$1,611
MRI LOWER EXTREMITY W/O DYECPT 73718 (LT)Outpatient6100287$1,354
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient96100285$145
Nuclear Medicine
HEPATOBIL SYST IMAGE W/DRUGCPT 78227 (27)Outpatient3400140$1,069
HT MUSCLE IMAGE SPECT MULTCPT 78452Outpatient3400380$2,734
Other Diagnostic
WITHDRAWAL OF ARTERIAL BLOODCPT 36600Outpatient2700008$86
VISUAL FIELD EXAMINATION(S)CPT 92083Outpatient5100905$140
OPHTHALMIC BIOMETRYCPT 92136Outpatient5100910$163
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient4000120$667
UPR/LXTR ART STDY 3+ LVLSCPT 93923Outpatient4000102$322
EXTREMITY STUDYCPT 93970Outpatient4000215$601
SLEEP STUDY UNATT&RESP EFFTCPT 95806Outpatient7400019$879
POLYSOM 6/>YRS CPAP 4/> PARMCPT 95811Outpatient7400012$3,053
Other Procedures and Observation
PURE TONE HEARING TEST AIRCPT 92551Outpatient4700175$73
Other Therapeutic
CLEARANCE OF AIRWAYSCPT 31720Outpatient4100182$266
BLOOD TRANSFUSION SERVICECPT 36430Outpatient2600035$605
INSJ PICC 5 YR+ W/O IMAGINGCPT 36569Outpatient1200026$2,160
IMMUNIZATION ADMINCPT 90471Outpatient2609047$79
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient2600782$103
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient2600784$140
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient2600900$127
MEDICAL NUTRITION INDIV INCPT 97802Outpatient5100480$32
PHLEBOTOMYCPT 99195Outpatient3900340$121
Psychiatric
(N/O) PSYCHOTHERAPY, 30 MINCPT 90832----
(N/O) PSYCHOTHERAPY, 45 MINCPT 90834----
(N/O) PSYCHOTHERAPY, 60 MINCPT 90837----
(N/O) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, 50 MINCPT 90846----
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MINCPT 90847----
(N/O) GROUP PSYCHOTHERAPYCPT 90853----
Pulmonary Function
BREATHING CAPACITY TESTCPT 94010Outpatient4100038$146
EVALUATION OF WHEEZINGCPT 94060Outpatient4600020$385
LUNG FUNCTION TEST (MBC/MVV)CPT 94200Outpatient4600034$130
RESPIRATORY FLOW VOLUME LOOPCPT 94375Outpatient4600032$136
PULM FUNCT TST PLETHYSMOGRAPCPT 94726Outpatient4600037$130
CO/MEMBANE DIFFUSE CAPACITYCPT 94729Outpatient4600031$156
MEASURE BLOOD OXYGEN LEVELCPT 94760Outpatient4100092$49
MEASURE BLOOD OXYGEN LEVELCPT 94761Outpatient4100120$119
MEASURE BLOOD OXYGEN LEVELCPT 94762Outpatient4100110$148
PULMONARY SERVICE/PROCEDURECPT 94799Outpatient4100045$130
Radiology
X-RAY EXAM OF SKULLCPT 70250 (27)Outpatient3202509$195
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient3200641$134
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient3200650$178
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (27)Outpatient3202141$194
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040 (27)Outpatient3200610$151
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient3200643$289
X-RAY EXAM NECK SPINE 6/>VWSCPT 72052 (27)Outpatient3200630$343
X-RAY EXAM THORAC SPINE 3VWSCPT 72072 (27)Outpatient3202711$283
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100 (27)Outpatient3201630$191
(N/O) X-RAY OF LOWER BACKCPT 72110----
X-RAY EXAM L-S SPINE BENDINGCPT 72114 (27)Outpatient3201650$414
X-RAY EXAM OF PELVISCPT 72170 (27)Outpatient3202090$139
X-RAY EXAM SACRUM TAILBONECPT 72220 (52)Outpatient3200580$201
X-RAY EXAM OF COLLAR BONECPT 73000 (27)Outpatient3200560$211
X-RAY EXAM OF HUMERUSCPT 73060 (27)Outpatient3201370$145
X-RAY EXAM OF ELBOWCPT 73070 (27)Outpatient3200835$157
X-RAY EXAM OF ELBOWCPT 73080 (27)Outpatient3200830$195
X-RAY EXAM OF FOREARMCPT 73090 (27)Outpatient3201090$155
X-RAY EXAM OF WRISTCPT 73100Outpatient3202852$158
X-RAY EXAM OF WRISTCPT 73110Outpatient3201920$174
X-RAY EXAM OF FINGER(S)CPT 73140 (27)Outpatient3200990$146
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient3201311$286
X-RAY EXAM HIPS BI 3-4 VIEWSCPT 73522Outpatient3201320$235
X-RAY EXAM OF FEMUR 2/>CPT 73552Outpatient3200940$178
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (27)Outpatient3201520$136
X-RAY EXAM KNEE 4 OR MORECPT 73564 (27)Outpatient3201500$209
X-RAY EXAM OF KNEESCPT 73565 (27)Outpatient3209525$119
X-RAY EXAM OF LOWER LEGCPT 73590 (50)Outpatient3201593$188
X-RAY EXAM OF HEELCPT 73650 (27)Outpatient3201230$126
X-RAY EXAM OF TOE(S)CPT 73660 (27)Outpatient3202670$115
KUBCPT 74000 (27)Outpatient3201550$127
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018 (27)Outpatient3200010$127
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient3200015$151
X-RAY EXAM COMPLETE ABDOMENCPT 74022 (27)Outpatient3200040$323
X-RAY XM SWLNG FUNCJ C+CPT 74230 (27)Outpatient3200881$279
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient3200460$227
US GUIDE VASCULAR ACCESSCPT 76937Outpatient3709001$559
Respiratory
VENT MGMT INPAT INIT DAYCPT 94002Outpatient4100015$1,057
VENT MGMT INPAT SUBQ DAYCPT 94003Outpatient4100016$527
AIRWAY INHALATION TREATMENTCPT 94640Outpatient4100086$76
CBT 1ST HOURCPT 94644Outpatient4100161$170
CHEST WALL MANIPULATIONCPT 94667Outpatient4100145$95
CHEST WALL MANIPULATIONCPT 94668Outpatient4100150$62
Surgical Procedures
(N/O) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN PROCEDURECPT 19120----
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826----
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPECPT 29881----
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...CPT 42820----
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient9812047$1,205
EGD BIOPSY SINGLE/MULTIPLECPT 43239Outpatient9812059$1,205
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient9812063$1,335
COLONOSCOPY AND BIOPSYCPT 45380Outpatient9812045$1,335
(N/O) REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ...CPT 45385----
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562Outpatient9812052$6,826
PRP I/HERN INIT REDUC >5 YRCPT 49505Outpatient9812077$4,689
(N/O) BIOPSY OF PROSTATE GLANDCPT 55700----
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...CPT 55866----
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400----
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510----
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...CPT 59610----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323----
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...CPT 64483----
AFTER CATARACT LASER SURGERYCPT 66821Outpatient5100898$1,742
(N/O) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984----
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
MECHANICAL TRACTION THERAPYCPT 97012Outpatient4200610$64
ELECTRIC STIMULATION THERAPYCPT 97014Outpatient4200292$49
WHIRLPOOL THERAPYCPT 97022Outpatient4200631$36
ELECTRIC CURRENT THERAPYCPT 97033Outpatient4300045$57
ULTRASOUND THERAPYCPT 97035Outpatient4300280$40
THERAPEUTIC EXERCISESCPT 97110 (GP)Outpatient4200450$71
GAIT TRAINING THERAPYCPT 97116Outpatient4200330$52
MANUAL THERAPY 1/> REGIONSCPT 97140Outpatient4300240$74
PT EVAL LOW COMPLEX 20 MINCPT 97161Outpatient4200013$110
PT EVAL MOD COMPLEX 30 MINCPT 97162Outpatient4200012$164
PT EVAL HIGH COMPLEX 45 MINCPT 97163Outpatient4200014$245
PT RE-EVAL EST PLAN CARECPT 97164Outpatient4200000$74
OT EVAL LOW COMPLEX 30 MINCPT 97165Outpatient4300011$110
OT EVAL MOD COMPLEX 45 MINCPT 97166Outpatient4300012$164
THERAPEUTIC ACTIVITIESCPT 97530Outpatient4200310$82
SELF CARE MNGMENT TRAININGCPT 97535Outpatient4300015$62
Uncategorized
DRAINAGE OF SKIN ABSCESSCPT 10060Outpatient9810400$211
REMOVE FOREIGN BODYCPT 10120Outpatient9810490$407
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001Outpatient9810880$302
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient9810830$332
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011Outpatient9810810$313
RPR F/E/E/N/L/M 2.6-5.0 CMCPT 12013Outpatient9810820$355
TREAT SHOULDER DISLOCATIONCPT 23655Outpatient9810291$2,269
APPLY LONG ARM SPLINTCPT 29105Outpatient9810010$168
APPLY FOREARM SPLINTCPT 29125Outpatient9810020$168
APPLICATION LONG LEG SPLINTCPT 29505Outpatient9810040$168
APPLICATION LOWER LEG SPLINTCPT 29515Outpatient9810050$168
X-RAY EXAM OF SHOULDERCPT 73030Outpatient93202390$22
X-RAY EXAM OF HANDCPT 73130Outpatient93201260$19
X-RAY EXAM OF KNEE 3CPT 73562Outpatient93201505$22
X-RAY EXAM OF ANKLECPT 73610Outpatient93200150$20
X-RAY EXAM OF FOOTCPT 73630Outpatient93201130$19
ECG MONIT/REPRT UP TO 48 HRSCPT 93227Outpatient4800172$61
EXTREMITY STUDYCPT 93971Outpatient94000216$50
CRITICAL CARE FIRST HOURCPT 99291Outpatient9811138$977
CRITICAL CARE ADDL 30 MINCPT 99292 (Q6)Outpatient9811144$313