Arkansas Valley Regional Medical Center

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

Hospital Website Machine-Readable Chargemaster

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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.

Service Description	Service Code	Department	Charge Code	Cash Price	Rates
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450 (27)	Outpatient	3500260	$818
CT MAXILLOFACIAL W/O DYE	CPT 70486 (27)	Outpatient	3500350	$802
CT SOFT TISSUE NECK W/DYE	CPT 70491 (27)	Outpatient	3500391	$1,192
CT ANGIOGRAPHY HEAD	CPT 70496	Outpatient	3500267	$1,219
CT THORAX DX C-	CPT 71250 (27)	Outpatient	3500160	$896
CT THORAX DX C+	CPT 71260 (27)	Outpatient	3500151	$1,287
CT ANGIOGRAPHY CHEST	CPT 71275	Outpatient	3500153	$1,971
CT NECK SPINE W/O DYE	CPT 72125 (27)	Outpatient	3500170	$1,034
CT LUMBAR SPINE W/O DYE	CPT 72131 (27)	Outpatient	3500310	$925
(N/O) CT SCAN OF PELVIS WITH CONTRAST	CPT 72193	-	-	-	-
CT LOWER EXTREMITY W/O DYE	CPT 73700 (27)	Outpatient	3500270	$893
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	3500047	$2,182
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	3500048	$2,057
CT ABD & PELV 1/> REGNS	CPT 74178	Outpatient	3500049	$3,070
CT BONE DENSITY AXIAL	CPT 77078	Outpatient	3500083	$279
Cardiology
CARDIOVASCULAR STRESS TEST	CPT 93017	Outpatient	4820000	$692
TTE W/DOPPLER COMPLETE	CPT 93306	Outpatient	4000204	$1,716
Clinic
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30 MIN	CPT 99203	-	-	-	-
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45 MIN	CPT 99204	-	-	-	-
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 60 MIN	CPT 99205	-	-	-	-
(N/O) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-
(N/O) PATIENT OFFICE CONSULTATION, 60 MIN	CPT 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/> PARAM	CPT 95810	Outpatient	7400010	$1,770
EEG AWAKE AND ASLEEP	CPT 95819	Outpatient	7400017	$1,361
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...	CPT 93000	-	-	-	-
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	7300010	$129
ELECTROCARDIOGRAM REPORT	CPT 93010	Outpatient	7300011	$129
ECG MONIT/REPRT UP TO 48 HRS	CPT 93225	Outpatient	48000170	$898
ECG MONIT/REPRT UP TO 48 HRS	CPT 93226	Outpatient	4800171	$164
Emergency Room
PLACE NEEDLE IN VEIN	CPT 36000	Outpatient	4500135	$113
HEART/LUNG RESUSCITATION CPR	CPT 92950	Outpatient	2701095	$836
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	Outpatient	4500157	$14
EMERGENCY DEPT VISIT	CPT 99281	Outpatient	4500032	$242
EMERGENCY DEPT VISIT	CPT 99282	Outpatient	4500042	$410
EMERGENCY DEPT VISIT	CPT 99283	Outpatient	4500052	$734
EMERGENCY DEPT VISIT	CPT 99284	Outpatient	4500062	$2,396
EMERGENCY DEPT VISIT	CPT 99285 (25)	Outpatient	4500070	$801
IV Therapy
HYDRATION IV INFUSION INIT	CPT 96360	Outpatient	2600901	$164
HYDRATE IV INFUSION ADD-ON	CPT 96361 (59)	Outpatient	7620102	$125
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	2600081	$283
THER/PROPH/DIAG IV INF ADDON	CPT 96366	Outpatient	2600781	$113
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	Outpatient	2600082	$139
Imaging
US EXAM OF HEAD AND NECK	CPT 76536	Outpatient	4000310	$352
ULTRASOUND BREAST LIMITED	CPT 76642 (LT)	Outpatient	4000116	$157
US EXAM ABDOM COMPLETE	CPT 76700	Outpatient	4000020	$481
ECHO EXAM OF ABDOMEN	CPT 76705	Outpatient	4000010	$376
US EXAM ABDO BACK WALL COMP	CPT 76770	Outpatient	4000050	$411
US EXAM ABDO BACK WALL LIM	CPT 76775	Outpatient	4000012	$342
OB US < 14 WKS SINGLE FETUS	CPT 76801	Outpatient	4000271	$528
(N/O) ABDOMIAL ULTRASOUND OF PREGNANT UTERUS	CPT 76805	-	-	-	-
OB US LIMITED FETUS(S)	CPT 76815	Outpatient	4000280	$281
TRANSVAGINAL US OBSTETRIC	CPT 76817	Outpatient	4000461	$321
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	4000470	$363
US EXAM PELVIC COMPLETE	CPT 76856	Outpatient	4000320	$548
US EXAM SCROTUM	CPT 76870	Outpatient	4000390	$329
US COMPL JOINT R-T W/IMG	CPT 76881	Outpatient	4000210	$353
DX MAMMO INCL CAD UNI	CPT 77065 (LT)	Outpatient	3201700	$269
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	3201690	$281
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	3201740	$201
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...	DRG 216	-	-	-	-
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...	DRG 470	-	-	-	-
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...	DRG 743	-	-	-	-
Labor and Delivery
FETAL NON-STRESS TEST	CPT 59025	Outpatient	7200090	$262
Laboratory
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	3001785	$76
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	3001320	$99
(N/O) OBSTETRIC BLOOD TEST PANEL	CPT 80055	-	-	-	-
LIPID PANEL	CPT 80061	Outpatient	3003530	$118
RENAL FUNCTION PANEL	CPT 80069	Outpatient	3004905	$163
HEPATIC FUNCTION PANEL	CPT 80076	Outpatient	3003668	$119
ASSAY CARBAMAZEPINE TOTAL	CPT 80156	Outpatient	3002045	$109
DRUG ASSAY CYCLOSPORINE	CPT 80158	Outpatient	3002170	$123
ASSAY OF DIGOXIN TOTAL	CPT 80162	Outpatient	3002270	$109
DIPROPYLACETIC ACID FREE	CPT 80165	Outpatient	3006260	$79
ASSAY OF LITHIUM	CPT 80178	Outpatient	3003665	$61
ASSAY OF PHENYTOIN TOTAL	CPT 80185	Outpatient	3004655	$127
ASSAY OF TACROLIMUS	CPT 80197	Outpatient	3005535	$200
ASSAY OF VANCOMYCIN	CPT 80202	Outpatient	3006275	$130
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	3000821	$280
DRUG SCREEN QUANTALCOHOLS	CPT 80320	Outpatient	3002495	$86
DRUG SCREEN AMPHETAMINES 1/2	CPT 80324	Outpatient	3003461	$38
ANALGESICS NON-OPIOID 1 OR 2	CPT 80329	Outpatient	3000620	$108
(N/O) URINALYSIS TEST USING MICROSCOPE	CPT 81000	-	-	-	-
(N/O) URINALYSIS TEST USING MICROSCOPE	CPT 81001	-	-	-	-
(N/O) URINALYSIS TEST	CPT 81002	-	-	-	-
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	3005725	$23
MICROSCOPIC EXAM OF URINE	CPT 81015	Outpatient	3005755	$31
URINALYSIS VOLUME MEASURE	CPT 81050	Outpatient	3005410	$25
TEST FOR ACETONE/KETONES	CPT 82009	Outpatient	3000635	$57
ASSAY OF SERUM ALBUMIN	CPT 82040	Outpatient	3000755	$50
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	3003840	$56
ALPHA-FETOPROTEIN SERUM	CPT 82105	Outpatient	3000004	$97
AMINO ACIDS SINGLE QUANT	CPT 82131	Outpatient	3003370	$225
ASSAY OF AMMONIA	CPT 82140	Outpatient	3000935	$113
ASSAY OF AMYLASE	CPT 82150	Outpatient	3000920	$53
BILIRUBIN TOTAL	CPT 82247	Outpatient	3001310	$50
BILIRUBIN DIRECT	CPT 82248	Outpatient	3001315	$29
VITAMIN D 25 HYDROXY	CPT 82306	Outpatient	3006360	$137
ASSAY OF CALCIUM	CPT 82310	Outpatient	3001565	$50
CARCINOEMBRYONIC ANTIGEN	CPT 82378	Outpatient	3001655	$11
ASSAY OF CK (CPK)	CPT 82550	Outpatient	3001850	$43
ASSAY OF CREATININE	CPT 82565	Outpatient	3002075	$50
ASSAY OF URINE CREATININE	CPT 82570	Outpatient	3005870	$96
VITAMIN B-12	CPT 82607	Outpatient	3001145	$82
VIT D 1 25-DIHYDROXY	CPT 82652	Outpatient	3006370	$160
ASSAY OF ESTROGENS	CPT 82671	Outpatient	3002465	$90
ASSAY OF FERRITIN	CPT 82728	Outpatient	3002570	$89
ASSAY OF FOLIC ACID SERUM	CPT 82746	Outpatient	3002720	$91
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	3003396	$61
BLOOD GASES ANY COMBINATION	CPT 82803	Outpatient	3001361	$152
BLOOD GASES W/O2 SATURATION	CPT 82805	Outpatient	3001360	$166
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	3002990	$64
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	Outpatient	3002735	$84
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	3003065	$61
ASSAY OF IRON	CPT 83540	Outpatient	3002555	$35
IRON BINDING TEST	CPT 83550	Outpatient	3005500	$40
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	3003470	$121
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	3003500	$59
ASSAY OF LDH ENZYMES	CPT 83625	Outpatient	3001020	$66
ASSAY OF LIPASE	CPT 83690	Outpatient	3003650	$61
ASSAY OF BLOOD LIPOPROTEIN	CPT 83721	Outpatient	3001775	$68
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	3003830	$50
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	Outpatient	3001330	$85
ASSAY OF PARATHORMONE	CPT 83970	Outpatient	3004646	$363
ASSAY OF BLOOD PKU	CPT 84030	Outpatient	3004220	$148
ASSAY OF PHOSPHORUS	CPT 84100	Outpatient	3004205	$56
EVAL AMNIOTIC FLUID PROTEIN	CPT 84112	Outpatient	3007318	$88
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	3003455	$53
ASSAY OF PREALBUMIN	CPT 84134	Outpatient	3000760	$61
PROCALCITONIN (PCT)	CPT 84145	Outpatient	3004480	$94
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	3004520	$100
ASSAY OF PSA FREE	CPT 84154	Outpatient	3004510	$83
ASSAY OF PROTEIN URINE	CPT 84156	Outpatient	3002165	$89
PROTEIN E-PHORESIS SERUM	CPT 84165	Outpatient	3004175	$73
ASSAY OF FREE TESTOSTERONE	CPT 84402	Outpatient	3005406	$152
ASSAY OF TOTAL TESTOSTERONE	CPT 84403	Outpatient	3005405	$158
ASSAY OF TOTAL THYROXINE	CPT 84436	Outpatient	3005360	$85
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	3005365	$73
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	3005636	$116
ALANINE AMINO (ALT) (SGPT)	CPT 84460	Outpatient	3005045	$59
ASSAY TRIIODOTHYRONINE (T3)	CPT 84480	Outpatient	3005660	$96
FREE ASSAY (FT-3)	CPT 84481	Outpatient	3005350	$136
ASSAY OF TROPONIN QUANT	CPT 84484	Outpatient	3001574	$20
ASSAY OF UREA NITROGEN	CPT 84520	Outpatient	3001355	$53
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	3006140	$60
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	3000003	$137
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	Outpatient	3003275	$48
BL SMEAR W/DIFF WBC COUNT	CPT 85007	Outpatient	3001630	$11
HEMATOCRIT	CPT 85014	Outpatient	3003063	$28
HEMOGLOBIN	CPT 85018	Outpatient	3003064	$28
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	3001610	$57
COMPLETE CBC AUTOMATED	CPT 85027	Outpatient	3001621	$90
MANUAL RETICULOCYTE COUNT	CPT 85044	Outpatient	3004910	$61
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	3002200	$95
PROTHROMBIN TIME	CPT 85610	Outpatient	3004535	$38
PROTHROMBIN TEST	CPT 85611	Outpatient	3004536	$37
RBC SED RATE NONAUTOMATED	CPT 85651	Outpatient	3002450	$37
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	3004669	$60
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	3000965	$99
C-REACTIVE PROTEIN	CPT 86140	Outpatient	3002090	$49
IMMUNOASSAY TUMOR CA 15-3	CPT 86300	Outpatient	3001505	$13
IMMUNOASSAY TUMOR CA 125	CPT 86304	Outpatient	3001490	$29
HETEROPHILE ANTIBODY SCREEN	CPT 86308 (QW)	Outpatient	3003860	$94
SERUM IMMUNOELECTROPHORESIS	CPT 86320	Outpatient	3003400	$211
RHEUMATOID FACTOR QUANT	CPT 86431	Outpatient	3004885	$57
HELICOBACTER PYLORI ANTIBODY	CPT 86677	Outpatient	3003371	$28
HIV-1ANTIBODY	CPT 86701	Outpatient	3000740	$79
HEP B CORE ANTIBODY TOTAL	CPT 86704	Outpatient	3003215	$62
HEP B SURFACE ANTIBODY	CPT 86706	Outpatient	3003245	$129
HEPATITIS A ANTIBODY	CPT 86708	Outpatient	3003200	$73
HEPATITIS A IGM ANTIBODY	CPT 86709	Outpatient	3003205	$244
MUMPS ANTIBODY	CPT 86735	Outpatient	3002710	$11
RUBELLA ANTIBODY	CPT 86762	Outpatient	3002700	$10
RUBEOLA ANTIBODY	CPT 86765	Outpatient	3002695	$11
VARICELLA-ZOSTER ANTIBODY	CPT 86787	Outpatient	3002715	$15
HEPATITIS C AB TEST	CPT 86803	Outpatient	3003290	$251
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	3900200	$77
COOMBS TEST DIRECT	CPT 86880	Outpatient	3900260	$64
BLOOD TYPING SEROLOGIC ABO	CPT 86900	Outpatient	3900101	$48
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	Outpatient	3900100	$48
COMPATIBILITY TEST SPIN	CPT 86920	Outpatient	3900310	$184
COMPATIBILITY TEST INCUBATE	CPT 86921	Outpatient	3900320	$184
COMPATIBILITY TEST ANTIGLOB	CPT 86922	Outpatient	3900300	$184
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	3007041	$122
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	Outpatient	3007065	$67
CULTR BACTERIA EXCEPT BLOOD	CPT 87075	Outpatient	3007030	$175
CULTURE AEROBIC IDENTIFY	CPT 87077	Outpatient	3003960	$43
CULTURE SCREEN ONLY	CPT 87081	Outpatient	3005170	$82
URINE CULTURE/COLONY COUNT	CPT 87086	Outpatient	3007430	$62
DNA/RNA AMPLIFIED PROBE	CPT 87150	Outpatient	3002717	$1,502
MICROBE SUSCEPTIBLE MIC	CPT 87186	Outpatient	3007355	$127
SMEAR GRAM STAIN	CPT 87205	Outpatient	3007150	$46
SMEAR WET MOUNT SALINE/INK	CPT 87210	Outpatient	3007210	$53
CLOSTRIDIUM AG IA	CPT 87324	Outpatient	3007060	$91
HPYLORI STOOL AG IA	CPT 87338	Outpatient	3003372	$50
HEPATITIS B SURFACE AG IA	CPT 87340	Outpatient	3003260	$111
RESP SYNCYTIAL VIRUS AG IA	CPT 87420	Outpatient	3007325	$82
CHYLMD TRACH DNA DIR PROBE	CPT 87490	Outpatient	3007172	$53
IADNA-DNA/RNA PROBE TQ 12-25	CPT 87507	Outpatient	3002716	$595
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	Outpatient	3003291	$507
N.GONORRHOEAE DNA DIR PROB	CPT 87590	Outpatient	3007171	$53
RESP VIRUS 12-25 TARGETS	CPT 87633	Outpatient	3002718	$836
STREP A DNA AMP PROBE	CPT 87651	Outpatient	3005160	$89
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	3004150	$86
STREP B ASSAY W/OPTIC	CPT 87802	Outpatient	3002800	$226
INFLUENZA ASSAY W/OPTIC	CPT 87804 (QW)	Outpatient	3007316	$100
STREP A ASSAY W/OPTIC	CPT 87880	Outpatient	3007315	$51
TISSUE EXAM BY PATHOLOGIST	CPT 88302	Outpatient	3100070	$68
TISSUE EXAM BY PATHOLOGIST	CPT 88304	Outpatient	3100080	$88
TISSUE EXAM BY PATHOLOGIST	CPT 88305	Outpatient	3100010	$117
SPECIAL STAINS GROUP 1	CPT 88312	Outpatient	3100400	$78
SPECIAL STAINS GROUP 2	CPT 88313	Outpatient	3007265	$60
Language Pathology
SPEECH EVAL SND W/COMPR & EXP	CPT 92506	Outpatient	4400010	$208
SPEECH/HEARING THERAPY	CPT 92507 (GN)	Outpatient	4400000	$112
ORAL FUNCTION THERAPY	CPT 92526 (GN)	Outpatient	4400005	$127
EVALUATE SWALLOWING FUNCTION	CPT 92610	Outpatient	4400007	$341
MOTION FLUOROSCOPY/SWALLOW	CPT 92611 (GN)	Outpatient	4400400	$190
MRI
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	6100210	$1,848
MRI BRAIN STEM W/O & W/DYE	CPT 70553 (27)	Outpatient	6100215	$2,482
MRI NECK SPINE W/O DYE	CPT 72141 (27)	Outpatient	6100110	$1,849
MRI LUMBAR SPINE W/O DYE	CPT 72148 (27)	Outpatient	6100300	$1,552
MRI JOINT UPR EXTREM W/O DYE	CPT 73221 (RT)	Outpatient	6100545	$1,611
MRI LOWER EXTREMITY W/O DYE	CPT 73718 (LT)	Outpatient	6100287	$1,354
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	96100285	$145
Nuclear Medicine
HEPATOBIL SYST IMAGE W/DRUG	CPT 78227 (27)	Outpatient	3400140	$1,069
HT MUSCLE IMAGE SPECT MULT	CPT 78452	Outpatient	3400380	$2,734
Other Diagnostic
WITHDRAWAL OF ARTERIAL BLOOD	CPT 36600	Outpatient	2700008	$86
VISUAL FIELD EXAMINATION(S)	CPT 92083	Outpatient	5100905	$140
OPHTHALMIC BIOMETRY	CPT 92136	Outpatient	5100910	$163
EXTRACRANIAL BILAT STUDY	CPT 93880	Outpatient	4000120	$667
UPR/LXTR ART STDY 3+ LVLS	CPT 93923	Outpatient	4000102	$322
EXTREMITY STUDY	CPT 93970	Outpatient	4000215	$601
SLEEP STUDY UNATT&RESP EFFT	CPT 95806	Outpatient	7400019	$879
POLYSOM 6/>YRS CPAP 4/> PARM	CPT 95811	Outpatient	7400012	$3,053
Other Procedures and Observation
PURE TONE HEARING TEST AIR	CPT 92551	Outpatient	4700175	$73
Other Therapeutic
CLEARANCE OF AIRWAYS	CPT 31720	Outpatient	4100182	$266
BLOOD TRANSFUSION SERVICE	CPT 36430	Outpatient	2600035	$605
INSJ PICC 5 YR+ W/O IMAGING	CPT 36569	Outpatient	1200026	$2,160
IMMUNIZATION ADMIN	CPT 90471	Outpatient	2609047	$79
THER/PROPH/DIAG INJ SC/IM	CPT 96372	Outpatient	2600782	$103
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	Outpatient	2600784	$140
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	Outpatient	2600900	$127
MEDICAL NUTRITION INDIV IN	CPT 97802	Outpatient	5100480	$32
PHLEBOTOMY	CPT 99195	Outpatient	3900340	$121
Psychiatric
(N/O) PSYCHOTHERAPY, 30 MIN	CPT 90832	-	-	-	-
(N/O) PSYCHOTHERAPY, 45 MIN	CPT 90834	-	-	-	-
(N/O) PSYCHOTHERAPY, 60 MIN	CPT 90837	-	-	-	-
(N/O) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, 50 MIN	CPT 90846	-	-	-	-
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MIN	CPT 90847	-	-	-	-
(N/O) GROUP PSYCHOTHERAPY	CPT 90853	-	-	-	-
Pulmonary Function
BREATHING CAPACITY TEST	CPT 94010	Outpatient	4100038	$146
EVALUATION OF WHEEZING	CPT 94060	Outpatient	4600020	$385
LUNG FUNCTION TEST (MBC/MVV)	CPT 94200	Outpatient	4600034	$130
RESPIRATORY FLOW VOLUME LOOP	CPT 94375	Outpatient	4600032	$136
PULM FUNCT TST PLETHYSMOGRAP	CPT 94726	Outpatient	4600037	$130
CO/MEMBANE DIFFUSE CAPACITY	CPT 94729	Outpatient	4600031	$156
MEASURE BLOOD OXYGEN LEVEL	CPT 94760	Outpatient	4100092	$49
MEASURE BLOOD OXYGEN LEVEL	CPT 94761	Outpatient	4100120	$119
MEASURE BLOOD OXYGEN LEVEL	CPT 94762	Outpatient	4100110	$148
PULMONARY SERVICE/PROCEDURE	CPT 94799	Outpatient	4100045	$130
Radiology
X-RAY EXAM OF SKULL	CPT 70250 (27)	Outpatient	3202509	$195
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	3200641	$134
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	3200650	$178
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101 (27)	Outpatient	3202141	$194
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040 (27)	Outpatient	3200610	$151
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	3200643	$289
X-RAY EXAM NECK SPINE 6/>VWS	CPT 72052 (27)	Outpatient	3200630	$343
X-RAY EXAM THORAC SPINE 3VWS	CPT 72072 (27)	Outpatient	3202711	$283
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100 (27)	Outpatient	3201630	$191
(N/O) X-RAY OF LOWER BACK	CPT 72110	-	-	-	-
X-RAY EXAM L-S SPINE BENDING	CPT 72114 (27)	Outpatient	3201650	$414
X-RAY EXAM OF PELVIS	CPT 72170 (27)	Outpatient	3202090	$139
X-RAY EXAM SACRUM TAILBONE	CPT 72220 (52)	Outpatient	3200580	$201
X-RAY EXAM OF COLLAR BONE	CPT 73000 (27)	Outpatient	3200560	$211
X-RAY EXAM OF HUMERUS	CPT 73060 (27)	Outpatient	3201370	$145
X-RAY EXAM OF ELBOW	CPT 73070 (27)	Outpatient	3200835	$157
X-RAY EXAM OF ELBOW	CPT 73080 (27)	Outpatient	3200830	$195
X-RAY EXAM OF FOREARM	CPT 73090 (27)	Outpatient	3201090	$155
X-RAY EXAM OF WRIST	CPT 73100	Outpatient	3202852	$158
X-RAY EXAM OF WRIST	CPT 73110	Outpatient	3201920	$174
X-RAY EXAM OF FINGER(S)	CPT 73140 (27)	Outpatient	3200990	$146
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	3201311	$286
X-RAY EXAM HIPS BI 3-4 VIEWS	CPT 73522	Outpatient	3201320	$235
X-RAY EXAM OF FEMUR 2/>	CPT 73552	Outpatient	3200940	$178
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (27)	Outpatient	3201520	$136
X-RAY EXAM KNEE 4 OR MORE	CPT 73564 (27)	Outpatient	3201500	$209
X-RAY EXAM OF KNEES	CPT 73565 (27)	Outpatient	3209525	$119
X-RAY EXAM OF LOWER LEG	CPT 73590 (50)	Outpatient	3201593	$188
X-RAY EXAM OF HEEL	CPT 73650 (27)	Outpatient	3201230	$126
X-RAY EXAM OF TOE(S)	CPT 73660 (27)	Outpatient	3202670	$115
KUB	CPT 74000 (27)	Outpatient	3201550	$127
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018 (27)	Outpatient	3200010	$127
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	Outpatient	3200015	$151
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022 (27)	Outpatient	3200040	$323
X-RAY XM SWLNG FUNCJ C+	CPT 74230 (27)	Outpatient	3200881	$279
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	3200460	$227
US GUIDE VASCULAR ACCESS	CPT 76937	Outpatient	3709001	$559
Respiratory
VENT MGMT INPAT INIT DAY	CPT 94002	Outpatient	4100015	$1,057
VENT MGMT INPAT SUBQ DAY	CPT 94003	Outpatient	4100016	$527
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	4100086	$76
CBT 1ST HOUR	CPT 94644	Outpatient	4100161	$170
CHEST WALL MANIPULATION	CPT 94667	Outpatient	4100145	$95
CHEST WALL MANIPULATION	CPT 94668	Outpatient	4100150	$62
Surgical Procedures
(N/O) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN PROCEDURE	CPT 19120	-	-	-	-
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 29826	-	-	-	-
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE	CPT 29881	-	-	-	-
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...	CPT 42820	-	-	-	-
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	Outpatient	9812047	$1,205
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	Outpatient	9812059	$1,205
DIAGNOSTIC COLONOSCOPY	CPT 45378	Outpatient	9812063	$1,335
COLONOSCOPY AND BIOPSY	CPT 45380	Outpatient	9812045	$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 CHOLECYSTECTOMY	CPT 47562	Outpatient	9812052	$6,826
PRP I/HERN INIT REDUC >5 YR	CPT 49505	Outpatient	9812077	$4,689
(N/O) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...	CPT 55866	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...	CPT 59610	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62322	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62323	-	-	-	-
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...	CPT 64483	-	-	-	-
AFTER CATARACT LASER SURGERY	CPT 66821	Outpatient	5100898	$1,742
(N/O) REMOVAL OF CATARACT WITH INSERTION OF LENS	CPT 66984	-	-	-	-
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSIS	CPT 93452	-	-	-	-
Therapy
MECHANICAL TRACTION THERAPY	CPT 97012	Outpatient	4200610	$64
ELECTRIC STIMULATION THERAPY	CPT 97014	Outpatient	4200292	$49
WHIRLPOOL THERAPY	CPT 97022	Outpatient	4200631	$36
ELECTRIC CURRENT THERAPY	CPT 97033	Outpatient	4300045	$57
ULTRASOUND THERAPY	CPT 97035	Outpatient	4300280	$40
THERAPEUTIC EXERCISES	CPT 97110 (GP)	Outpatient	4200450	$71
GAIT TRAINING THERAPY	CPT 97116	Outpatient	4200330	$52
MANUAL THERAPY 1/> REGIONS	CPT 97140	Outpatient	4300240	$74
PT EVAL LOW COMPLEX 20 MIN	CPT 97161	Outpatient	4200013	$110
PT EVAL MOD COMPLEX 30 MIN	CPT 97162	Outpatient	4200012	$164
PT EVAL HIGH COMPLEX 45 MIN	CPT 97163	Outpatient	4200014	$245
PT RE-EVAL EST PLAN CARE	CPT 97164	Outpatient	4200000	$74
OT EVAL LOW COMPLEX 30 MIN	CPT 97165	Outpatient	4300011	$110
OT EVAL MOD COMPLEX 45 MIN	CPT 97166	Outpatient	4300012	$164
THERAPEUTIC ACTIVITIES	CPT 97530	Outpatient	4200310	$82
SELF CARE MNGMENT TRAINING	CPT 97535	Outpatient	4300015	$62
Uncategorized
DRAINAGE OF SKIN ABSCESS	CPT 10060	Outpatient	9810400	$211
REMOVE FOREIGN BODY	CPT 10120	Outpatient	9810490	$407
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	Outpatient	9810880	$302
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	Outpatient	9810830	$332
RPR F/E/E/N/L/M 2.5 CM/<	CPT 12011	Outpatient	9810810	$313
RPR F/E/E/N/L/M 2.6-5.0 CM	CPT 12013	Outpatient	9810820	$355
TREAT SHOULDER DISLOCATION	CPT 23655	Outpatient	9810291	$2,269
APPLY LONG ARM SPLINT	CPT 29105	Outpatient	9810010	$168
APPLY FOREARM SPLINT	CPT 29125	Outpatient	9810020	$168
APPLICATION LONG LEG SPLINT	CPT 29505	Outpatient	9810040	$168
APPLICATION LOWER LEG SPLINT	CPT 29515	Outpatient	9810050	$168
X-RAY EXAM OF SHOULDER	CPT 73030	Outpatient	93202390	$22
X-RAY EXAM OF HAND	CPT 73130	Outpatient	93201260	$19
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	93201505	$22
X-RAY EXAM OF ANKLE	CPT 73610	Outpatient	93200150	$20
X-RAY EXAM OF FOOT	CPT 73630	Outpatient	93201130	$19
ECG MONIT/REPRT UP TO 48 HRS	CPT 93227	Outpatient	4800172	$61
EXTREMITY STUDY	CPT 93971	Outpatient	94000216	$50
CRITICAL CARE FIRST HOUR	CPT 99291	Outpatient	9811138	$977
CRITICAL CARE ADDL 30 MIN	CPT 99292 (Q6)	Outpatient	9811144	$313