Brownfield Regional Medical Center

Price List for Shoppable Services. Effective 07-25-2022.

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450440922Outpatient$1,155$809Payer Rates
CT MAXILLOFACIAL W/O DYECPT 70486440962Outpatient$1,155$809Payer Rates
CT THORAX DX C-CPT 71250440935Outpatient$1,155$809Payer Rates
CT THORAX DX C+CPT 71260440930Outpatient$1,450$1,015Payer Rates
CT NECK SPINE W/O DYECPT 72125440949Outpatient$1,155$809Payer Rates
CT LUMBAR SPINE W/O DYECPT 72131440954Outpatient$1,155$809Payer Rates
CT PELVIS W/DYECPT 72193440940Outpatient$1,618$1,133Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 74176441006Outpatient$1,042$729Payer Rates
CT ABD & PELV W/CONTRASTCPT 74177441008Outpatient$1,634$1,144Payer Rates
CT ABD & PELV W/CONTRASTCPT 74177441009Outpatient$1,634$1,144Payer Rates
CT ABD & PELV 1/> REGNSCPT 74178441007Outpatient$2,069$1,448Payer Rates
Cardiology
CARDIOVASCULAR STRESS TESTCPT 93017540005Outpatient$549$384Payer Rates
TTE W/DOPPLER COMPLETECPT 93306280136Outpatient$1,289$902Payer Rates
Clinic
OFFICE O/P NEW LOW 30-44 MINCPT 99203580021Outpatient$180$126Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 99204580022Outpatient$265$186Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 99205580023Outpatient$360$252Payer Rates
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243-----
(Not Offered) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244-----
PREV VISIT NEW AGE 18-39CPT 99385580304Outpatient$300$210Payer Rates
PREV VISIT NEW AGE 40-64CPT 99386580294Outpatient$325$227Payer Rates
EKG
(Not Offered) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETAT ...CPT 93000-----
ELECTROCARDIOGRAM TRACINGCPT 93005260000Outpatient$290$203Payer Rates
ELECTROCARDIOGRAM TRACINGCPT 93005 (76)260001Outpatient$290$203Payer Rates
RHYTHM ECG TRACINGCPT 93041560329Outpatient$130$91Payer Rates
Emergency Room
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001130312Outpatient$362$253Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002130313Outpatient$362$253Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011130317Outpatient$362$253Payer Rates
RPR F/E/E/N/L/M 2.6-5.0 CMCPT 12013130318Outpatient$362$253Payer Rates
APPLY FOREARM SPLINTCPT 29125 (LT)130736Outpatient$360$252Payer Rates
PLACE NEEDLE IN VEINCPT 36000130546Outpatient$123$86Payer Rates
INSERT TEMP BLADDER CATHCPT 51702130397Outpatient$360$252Payer Rates
IMMUNIZATION ADMINCPT 90471130432Outpatient$146$102Payer Rates
EMERGENCY DEPT VISITCPT 99281130415Outpatient$166$116Payer Rates
EMERGENCY DEPT VISITCPT 99282130416Outpatient$308$216Payer Rates
EMERGENCY DEPT VISITCPT 99283130417Outpatient$542$379Payer Rates
EMERGENCY DEPT VISITCPT 99283 (25)130504Outpatient$542$379Payer Rates
EMERGENCY DEPT VISITCPT 99284130418Outpatient$912$638Payer Rates
EMERGENCY DEPT VISITCPT 99284 (25)130505Outpatient$912$638Payer Rates
EMERGENCY DEPT VISITCPT 99285130419Outpatient$1,346$942Payer Rates
EMERGENCY DEPT VISITCPT 99285 (25)130506Outpatient$1,346$942Payer Rates
CRITICAL CARE FIRST HOURCPT 99291 (25)130500Outpatient$1,794$1,256Payer Rates
Gastro-Intestinal
EGD DIAGNOSTIC BRUSH WASHCPT 43235100839Outpatient$2,036$1,425Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 43239 (59)100411Outpatient$2,036$1,425Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 43239 (59)100412Outpatient$2,036$1,425Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 43239100840Outpatient$2,036$1,425Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 45378 (73)100829Outpatient$2,265$1,586Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 45378100835Outpatient$2,158$1,511Payer Rates
COLONOSCOPY AND BIOPSYCPT 45380 (59)100427Outpatient$2,158$1,511Payer Rates
COLONOSCOPY AND BIOPSYCPT 45380100837Outpatient$2,324$1,627Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 45385100420Outpatient$2,324$1,627Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 45385 (59)100425Outpatient$2,158$1,511Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 96360130406Outpatient$425$298Payer Rates
HYDRATION IV INFUSION INITCPT 96360 (59)130893Outpatient$425$298Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963611003Outpatient$90$63Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 96361130827Outpatient$90$63Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 96361130892Outpatient$90$63Payer Rates
THER/PROPH/DIAG IV INF INITCPT 96365130426Outpatient$474$332Payer Rates
THER/PROPH/DIAG IV INF INITCPT 96365 (59)130895Outpatient$474$332Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661008Outpatient$82$57Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 96366130626Outpatient$89$62Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 96367130625Outpatient$286$200Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721002Outpatient$162$113Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372130425Outpatient$162$113Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372130890Outpatient$162$113Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741009Outpatient$425$298Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 96374130427Outpatient$425$298Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 96374130475Outpatient$425$298Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751101Outpatient$257$180Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375130627Outpatient$257$180Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375130891Outpatient$257$180Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963761124Outpatient$135$95Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 96376130490Outpatient$135$95Payer Rates
Imaging
US EXAM OF HEAD AND NECKCPT 76536400080Outpatient$417$292Payer Rates
US EXAM ABDOM COMPLETECPT 76700400001Outpatient$417$292Payer Rates
ECHO EXAM OF ABDOMENCPT 76705400030Outpatient$380$266Payer Rates
OB US < 14 WKS SINGLE FETUSCPT 76801400050Outpatient$554$388Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 76805400110Outpatient$554$388Payer Rates
OB US LIMITED FETUS(S)CPT 76815400022Outpatient$380$266Payer Rates
TRANSVAGINAL US OBSTETRICCPT 76817400098Outpatient$554$388Payer Rates
FETAL BIOPHYS PROFIL W/O NSTCPT 76819400113Outpatient$554$388Payer Rates
TRANSVAGINAL US NON-OBCPT 76830400097Outpatient$554$388Payer Rates
US EXAM PELVIC COMPLETECPT 76856400045Outpatient$554$388Payer Rates
US EXAM SCROTUMCPT 76870400052Outpatient$554$388Payer Rates
(Not Offered) MAMMOGRAPHY OF ONE BREASTCPT 77065-----
(Not Offered) MAMMOGRAPHY OF BOTH BREASTSCPT 77066-----
(Not Offered) MAMMOGRAPHY, SCREENING, BILATERALCPT 77067-----
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...DRG 216-----
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460-----
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...DRG 470-----
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473-----
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...DRG 743-----
Labor and Delivery
FETAL NON-STRESS TESTCPT 5902540022Outpatient$403$282Payer Rates
Laboratory
BIOFIRE GI PANELCPT 0097U201216Outpatient$727$509Payer Rates
BIOFIRE RESP PANEL WITH COVID-19CPT 0202U201249Outpatient$834$584Payer Rates
ROUTINE VENIPUNCTURECPT 36415200990Outpatient$9$6Payer Rates
CAPILLARY BLOOD DRAWCPT 36416200997Outpatient$9$6Payer Rates
WITHDRAWAL OF ARTERIAL BLOODCPT 36600520398Outpatient$522$365Payer Rates
METABOLIC PANEL IONIZED CACPT 80047200124Outpatient$70$49Payer Rates
METABOLIC PANEL TOTAL CACPT 80048200133Outpatient$70$49Payer Rates
COMPREHEN METABOLIC PANELCPT 80053200135Outpatient$105$74Payer Rates
OBSTETRIC PANELCPT 80055202066Outpatient$413$289Payer Rates
LIPID PANELCPT 80061200300Outpatient$133$93Payer Rates
LIPID PANELCPT 80061200301Outpatient$133$93Payer Rates
RENAL FUNCTION PANELCPT 80069200136Outpatient$105$74Payer Rates
ACUTE HEPATITIS PANELCPT 80074200823Outpatient$147$103Payer Rates
HEPATIC FUNCTION PANELCPT 80076200132Outpatient$70$49Payer Rates
DRUG ASSAY ACETAMINOPHENCPT 80143200319Outpatient$140$98Payer Rates
ASSAY CARBAMAZEPINE TOTALCPT 80156200848Outpatient$45$31Payer Rates
ASSAY OF DIGOXIN TOTALCPT 80162200154Outpatient$105$74Payer Rates
ASSAY DIPROPYLACETIC ACD TOTCPT 80164200879Outpatient$105$74Payer Rates
DRUG SCRN QUAN LEVETIRACETAMCPT 80177200163Outpatient$41$29Payer Rates
DRUG ASSAY SALICYLATECPT 80179200311Outpatient$105$74Payer Rates
ASSAY OF PHENOBARBITALCPT 80184200847Outpatient$77$54Payer Rates
ASSAY OF PHENYTOIN TOTALCPT 80185200251Outpatient$105$74Payer Rates
ASSAY OF TACROLIMUSCPT 80197201023Outpatient$42$29Payer Rates
ASSAY OF VANCOMYCINCPT 80202201083Outpatient$119$83Payer Rates
ASSAY OF VANCOMYCINCPT 80202201084Outpatient$119$83Payer Rates
DRUG TEST PRSMV DIR OPT OBSCPT 80305200721Outpatient$63$44Payer Rates
ALCOHOLS BIOMARKERS 1OR 2CPT 80321200310Outpatient$91$64Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPECPT 81000-----
URINALYSIS AUTO W/SCOPECPT 81001200501Outpatient$35$25Payer Rates
URINALYSIS NONAUTO W/O SCOPECPT 81002200513Outpatient$16$11Payer Rates
URINALYSIS AUTO W/O SCOPECPT 81003200511Outpatient$14$10Payer Rates
URINE PREGNANCY TESTCPT 81025200503Outpatient$42$29Payer Rates
TEST FOR ACETONE/KETONESCPT 82009200806Outpatient$28$20Payer Rates
ASSAY OF SERUM ALBUMINCPT 82040200324Outpatient$35$25Payer Rates
UR ALBUMIN QUANTITATIVECPT 82043200089Outpatient$18$13Payer Rates
ALPHA-FETOPROTEIN SERUMCPT 82105200403Outpatient$96$67Payer Rates
ASSAY OF AMMONIACPT 82140200829Outpatient$105$74Payer Rates
ASSAY OF AMYLASECPT 82150200216Outpatient$49$34Payer Rates
BILIRUBIN TOTALCPT 82247200328Outpatient$41$29Payer Rates
BILIRUBIN TOTALCPT 82247200329Outpatient$41$29Payer Rates
BILIRUBIN DIRECTCPT 82248200323Outpatient$41$29Payer Rates
BILIRUBIN DIRECTCPT 82248200327Outpatient$41$29Payer Rates
VITAMIN D 25 HYDROXYCPT 82306200074Outpatient$91$64Payer Rates
ASSAY OF CK (CPK)CPT 82550200214Outpatient$37$26Payer Rates
CREATINE MB FRACTIONCPT 82553200218Outpatient$49$34Payer Rates
ASSAY OF URINE CREATININECPT 82570200322Outpatient$16$11Payer Rates
VITAMIN B-12CPT 82607200160Outpatient$47$33Payer Rates
VIT D 1 25-DIHYDROXYCPT 82652200075Outpatient$119$83Payer Rates
ASSAY OF TOTAL ESTRADIOLCPT 82670200909Outpatient$86$60Payer Rates
ASSAY OF ESTRIOLCPT 82677200401Outpatient$139$97Payer Rates
ASSAY OF FERRITINCPT 82728200837Outpatient$42$29Payer Rates
ASSAY OF FOLIC ACID SERUMCPT 82746200159Outpatient$45$31Payer Rates
BLOOD GASES ANY COMBINATIONCPT 82803520397Outpatient$167$117Payer Rates
ASSAY GLUCOSE BLOOD QUANTCPT 82947200302Outpatient$36$25Payer Rates
GLUCOSE TESTCPT 82950200130Outpatient$38$27Payer Rates
GLUCOSE TOLERANCE TEST (GTT)CPT 82951200333Outpatient$98$69Payer Rates
GTT-ADDED SAMPLESCPT 82952200330Outpatient$23$16Payer Rates
GLUCOSE BLOOD TESTCPT 82962200404Outpatient$36$25Payer Rates
ASSAY OF GONADOTROPIN (FSH)CPT 83001200801Outpatient$57$40Payer Rates
ASSAY OF GONADOTROPIN (LH)CPT 83002200800Outpatient$57$40Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036200838Outpatient$70$49Payer Rates
ASSAY OF IRONCPT 83540200317Outpatient$20$14Payer Rates
IRON BINDING TESTCPT 83550200318Outpatient$27$19Payer Rates
ASSAY OF LACTIC ACIDCPT 83605200405Outpatient$70$49Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 83615200213Outpatient$19$13Payer Rates
ASSAY OF LEADCPT 83655200937Outpatient$69$48Payer Rates
ASSAY OF LIPASECPT 83690200906Outpatient$56$39Payer Rates
ASSAY OF BLOOD LIPOPROTEINCPT 83721200024Outpatient$84$59Payer Rates
ASSAY OF MAGNESIUMCPT 83735200107Outpatient$49$34Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 83880201019Outpatient$194$136Payer Rates
ASSAY OF PARATHORMONECPT 83970200716Outpatient$127$89Payer Rates
ASSAY OF PHOSPHORUSCPT 84100200106Outpatient$35$25Payer Rates
ASSAY OF SERUM POTASSIUMCPT 84132200102Outpatient$36$25Payer Rates
ASSAY OF PROGESTERONECPT 84144200804Outpatient$64$45Payer Rates
PROCALCITONIN (PCT)CPT 84145201254Outpatient$68$48Payer Rates
ASSAY OF PSA TOTALCPT 84153200137Outpatient$112$78Payer Rates
ASSAY OF PSA TOTALCPT 84153200874Outpatient$106$74Payer Rates
ASSAY OF PSA FREECPT 84154201018Outpatient$112$78Payer Rates
ASSAY OF PROTEIN URINECPT 84156200731Outpatient$11$8Payer Rates
ASSAY OF PROTEIN URINECPT 84156200739Outpatient$55$39Payer Rates
ASSAY OF FREE TESTOSTERONECPT 84402200022Outpatient$147$103Payer Rates
ASSAY OF TOTAL TESTOSTERONECPT 84403200803Outpatient$80$56Payer Rates
ASSAY OF TOTAL THYROXINECPT 84436200152Outpatient$49$34Payer Rates
ASSAY OF FREE THYROXINECPT 84439200165Outpatient$77$54Payer Rates
ASSAY THYROID STIM HORMONECPT 84443200153Outpatient$105$74Payer Rates
TRANSFERASE (AST) (SGOT)CPT 84450200210Outpatient$35$25Payer Rates
ALANINE AMINO (ALT) (SGPT)CPT 84460200211Outpatient$35$25Payer Rates
ASSAY OF TRANSFERRINCPT 84466200982Outpatient$91$64Payer Rates
FREE ASSAY (FT-3)CPT 84481200064Outpatient$52$36Payer Rates
ASSAY OF TROPONIN QUANTCPT 84484200109Outpatient$84$59Payer Rates
ASSAY OF TROPONIN QUANTCPT 84484201215Outpatient$38$27Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 84550200305Outpatient$14$10Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 84702200157Outpatient$105$74Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 84702200402Outpatient$101$71Payer Rates
CHORIONIC GONADOTROPIN ASSAYCPT 84703200100Outpatient$56$39Payer Rates
HEMATOCRITCPT 85014200000Outpatient$25$18Payer Rates
HEMOGLOBINCPT 85018200008Outpatient$25$18Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 85025200018Outpatient$50$35Payer Rates
COMPLETE CBC AUTOMATEDCPT 85027200003Outpatient$50$35Payer Rates
MANUAL RETICULOCYTE COUNTCPT 85044200006Outpatient$28$20Payer Rates
FIBRIN DEGRADE SEMIQUANTCPT 85378200023Outpatient$56$39Payer Rates
FIBRIN DEGRADATION QUANTCPT 85379200021Outpatient$25$18Payer Rates
PROTHROMBIN TIMECPT 85610200011Outpatient$61$43Payer Rates
RBC SED RATE NONAUTOMATEDCPT 85651200005Outpatient$28$20Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 85730200012Outpatient$41$29Payer Rates
ALLG SPEC IGE CRUDE XTRC EACPT 86003200767Outpatient$35$25Payer Rates
ALLG SPEC IGE CRUDE XTRC EACPT 86003201070Outpatient$27$19Payer Rates
ANTINUCLEAR ANTIBODIESCPT 86038200709Outpatient$37$26Payer Rates
C-REACTIVE PROTEINCPT 86140200757Outpatient$16$11Payer Rates
CCP ANTIBODYCPT 86200200002Outpatient$40$28Payer Rates
HETEROPHILE ANTIBODY SCREENCPT 86308200704Outpatient$35$25Payer Rates
IMMUNOASSAY INFECTIOUS AGENTCPT 86317200818Outpatient$91$64Payer Rates
IA NFCT AB SARSCOV2 COVID19CPT 86328201252Outpatient$130$91Payer Rates
INHIBIN ACPT 86336200406Outpatient$89$62Payer Rates
RHEUMATOID FACTOR TEST QUALCPT 86430200703Outpatient$56$39Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 86592200706Outpatient$49$34Payer Rates
SYPHILIS TEST NON-TREP QUANTCPT 86593200975Outpatient$49$34Payer Rates
HELICOBACTER PYLORI ANTIBODYCPT 86677200928Outpatient$154$108Payer Rates
HERPES SIMPLEX TYPE 1 TESTCPT 86695200930Outpatient$133$93Payer Rates
HIV-1/HIV-2 1 RESULT ANTBDYCPT 86703201237Outpatient$38$27Payer Rates
MUMPS ANTIBODYCPT 86735200031Outpatient$40$28Payer Rates
RUBELLA ANTIBODYCPT 86762200719Outpatient$44$31Payer Rates
RUBEOLA ANTIBODYCPT 86765200899Outpatient$40$28Payer Rates
TREPONEMA PALLIDUMCPT 86780200694Outpatient$37$26Payer Rates
VARICELLA-ZOSTER ANTIBODYCPT 86787200972Outpatient$40$28Payer Rates
HEPATITIS C AB TESTCPT 86803200911Outpatient$44$31Payer Rates
RBC ANTIBODY SCREENCPT 86850240003Outpatient$193$135Payer Rates
COOMBS TEST DIRECTCPT 86880240052Outpatient$36$25Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 86900240001Outpatient$189$132Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 86900240050Outpatient$23$16Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 86901240009Outpatient$57$40Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 86901240051Outpatient$23$16Payer Rates
BLOOD TYPE ANTIGEN DONOR EACPT 86902240053Outpatient$147$103Payer Rates
COMPATIBILITY TEST SPINCPT 86920240035Outpatient$225$158Payer Rates
BLOOD CULTURE FOR BACTERIACPT 87040200603Outpatient$32$22Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 87070200632Outpatient$27$19Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 87070200643Outpatient$27$19Payer Rates
CULTR BACTERIA EXCEPT BLOODCPT 87075200601Outpatient$29$20Payer Rates
CULTURE AEROBIC IDENTIFYCPT 87077200400Outpatient$70$49Payer Rates
CULTURE AEROBIC IDENTIFYCPT 87077200634Outpatient$77$54Payer Rates
URINE CULTURE/COLONY COUNTCPT 87086200633Outpatient$25$18Payer Rates
URINE BACTERIA CULTURECPT 87088200637Outpatient$63$44Payer Rates
FUNGI IDENTIFICATION YEASTCPT 87106200056Outpatient$67$47Payer Rates
DNA/RNA AMPLIFIED PROBECPT 87150200664Outpatient$108$76Payer Rates
OVA AND PARASITES SMEARSCPT 87177200620Outpatient$27$19Payer Rates
MICROBE SUSCEPTIBLE MICCPT 87186200638Outpatient$50$35Payer Rates
SMEAR GRAM STAINCPT 87205200610Outpatient$13$9Payer Rates
SMEAR GRAM STAINCPT 87205200615Outpatient$35$25Payer Rates
RESPIRATORY SYNCYTIAL AG IFCPT 87280200898Outpatient$98$69Payer Rates
CLOSTRIDIUM AG IACPT 87324200856Outpatient$77$54Payer Rates
HEPATITIS B SURFACE AG IACPT 87340200853Outpatient$32$22Payer Rates
INFLUENZA A/B EACH AG IACPT 87400201010Outpatient$66$46Payer Rates
INFLUENZA A/B EACH AG IACPT 87400 (91)201011Outpatient$66$46Payer Rates
NOS EACH ORGANISM AG IACPT 87449200843Outpatient$77$54Payer Rates
CHYLMD PNEUM DNA AMP PROBECPT 87486201221Outpatient$108$76Payer Rates
CHYLMD TRACH DNA AMP PROBECPT 87491201049Outpatient$108$76Payer Rates
IADNA-DNA/RNA PROBE TQ 6-11CPT 87506201234Outpatient$657$460Payer Rates
M.PNEUMON DNA AMP PROBECPT 87581201220Outpatient$108$76Payer Rates
N.GONORRHOEAE DNA AMP PROBCPT 87591201050Outpatient$108$76Payer Rates
RESP VIRUS 12-25 TARGETSCPT 87633201218Outpatient$1,286$900Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 87635201247Outpatient$85$59Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 87635201258Outpatient$128$90Payer Rates
DETECT AGENT NOS DNA AMPCPT 87798201219Outpatient$108$76Payer Rates
STREP A ASSAY W/OPTICCPT 87880200640Outpatient$70$49Payer Rates
SPECIMEN HANDLING PT-LABCPT 99001200298Outpatient$38$27Payer Rates
SPECIMEN HANDLING PT-LABCPT 99001200999Outpatient$41$29Payer Rates
SPECIMEN HANDLING PT-LABCPT 99001201025Outpatient$26$18Payer Rates
MRI
MRI BRAIN STEM W/O DYECPT 70551380004Outpatient$2,049$1,434Payer Rates
MRI BRAIN STEM W/O & W/DYECPT 70553380006Outpatient$2,974$2,082Payer Rates
MRI NECK SPINE W/O DYECPT 72141380009Outpatient$2,049$1,434Payer Rates
MRI CHEST SPINE W/O DYECPT 72146380011Outpatient$2,049$1,434Payer Rates
MRI LUMBAR SPINE W/O DYECPT 72148380013Outpatient$2,049$1,434Payer Rates
MRI JOINT UPR EXTREM W/O DYECPT 73221 (RT)380022Outpatient$2,049$1,434Payer Rates
MRI JOINT UPR EXTREM W/O DYECPT 73221 (LT)380113Outpatient$2,049$1,434Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (RT)380025Outpatient$2,049$1,434Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (LT)380094Outpatient$2,049$1,434Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 93880280018Outpatient$826$578Payer Rates
UPR/L XTREMITY ART 2 LEVELSCPT 93922280008Outpatient$581$407Payer Rates
LOWER EXTREMITY STUDYCPT 93925280105Outpatient$826$578Payer Rates
LOWER EXTREMITY STUDYCPT 93926 (RT)280010Outpatient$554$388Payer Rates
EXTREMITY STUDYCPT 93970280014Outpatient$826$578Payer Rates
EXTREMITY STUDYCPT 93971 (RT)280015Outpatient$554$388Payer Rates
POLYSOM 6/> YRS 4/> PARAMCPT 95810 (26)9001Outpatient$1,639$1,147Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 3643010039Outpatient$857$600Payer Rates
BLOOD TRANSFUSION SERVICECPT 36430100871Outpatient$838$587Payer Rates
CARDIAC REHAB/MONITORCPT 93798540003Outpatient$261$183Payer Rates
PULMONARY REHAB W EXERHCPCS G0424540007Outpatient$288$202Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P9016240017Outpatient$461$323Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P9016 (BL)240025Outpatient$537$376Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MINCPT 90832-----
(Not Offered) PSYCHOTHERAPY, 45 MINCPT 90834-----
(Not Offered) PSYCHOTHERAPY, 60 MINCPT 90837-----
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...CPT 90846-----
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...CPT 90847-----
(Not Offered) GROUP PSYCHOTHERAPYCPT 90853-----
Pulmonary Function
CLEARANCE OF AIRWAYSCPT 31720520018Outpatient$383$268Payer Rates
EVALUATION OF WHEEZINGCPT 94060520020Outpatient$553$387Payer Rates
LUNG FUNCTION TEST (MBC/MVV)CPT 94200520225Outpatient$236$165Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 94760520399Outpatient$81$57Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 94761520001Outpatient$267$187Payer Rates
PHYSICIAN STANDBY SERVICESCPT 99360520017Outpatient$57$40Payer Rates
Radiology
X-RAY EXAM OF SKULLCPT 70250300147Outpatient$268$188Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 71045300020Outpatient$167$117Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 71046300021Outpatient$197$138Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (RT)300131Outpatient$197$138Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (LT)301031Outpatient$197$138Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040300151Outpatient$268$188Payer Rates
X-RAY EXAM THORAC SPINE 2VWSCPT 72070300154Outpatient$268$188Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100300156Outpatient$268$188Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110300157Outpatient$342$239Payer Rates
X-RAY EXAM OF PELVISCPT 72170300121Outpatient$268$188Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)300145Outpatient$268$188Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)301024Outpatient$268$188Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (RT)300076Outpatient$197$138Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (RT)301007Outpatient$197$138Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (LT)301013Outpatient$197$138Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (RT)300060Outpatient$197$138Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (LT)301014Outpatient$197$138Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (RT)300181Outpatient$197$138Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)301030Outpatient$197$138Payer Rates
X-RAY EXAM OF HANDCPT 73130 (RT)300070Outpatient$197$138Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)301016Outpatient$197$138Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (RT)300054Outpatient$197$138Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (LT)301009Outpatient$197$138Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502300073Outpatient$197$138Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502301018Outpatient$197$138Payer Rates
X-RAY EXAM HIPS BI 2 VIEWSCPT 73521300074Outpatient$268$188Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552300052Outpatient$197$138Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (RT)300083Outpatient$197$138Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (LT)301022Outpatient$197$138Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)300996Outpatient$268$188Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (RT)300090Outpatient$197$138Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)301026Outpatient$197$138Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)300003Outpatient$268$188Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)301006Outpatient$268$188Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (RT)300056Outpatient$197$138Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)301012Outpatient$197$138Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018300000Outpatient$167$117Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019300001Outpatient$268$188Payer Rates
DXA BONE DENSITY AXIALCPT 77080300415Outpatient$325$227Payer Rates
Respiratory
AIRWAY INHALATION TREATMENTCPT 94640520115Outpatient$383$268Payer Rates
AIRWAY INHALATION TREATMENTCPT 94640 (76)520116Outpatient$383$268Payer Rates
AIRWAY INHALATION TREATMENTCPT 94640520901Outpatient$383$268Payer Rates
POS AIRWAY PRESSURE CPAPCPT 94660521000Outpatient$383$268Payer Rates
EVALUATE PT USE OF INHALERCPT 94664520117Outpatient$383$268Payer Rates
CHEST WALL MANIPULATIONCPT 94667520219Outpatient$236$165Payer Rates
CHEST WALL MANIPULATIONCPT 94668520226Outpatient$129$90Payer Rates
Surgical Procedures
REMOVAL OF BREAST LESIONCPT 19120 (RT)100481Outpatient$5,920$4,144Payer Rates
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826-----
(Not Offered) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOS ...CPT 29881-----
(Not Offered) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIE ...CPT 42820-----
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...CPT 45391-----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562100421Outpatient$10,322$7,225Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562 (73)100459Outpatient$9,640$6,748Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 49505 (LT)100423Outpatient$7,307$5,115Payer Rates
(Not Offered) BIOPSY OF PROSTATE GLANDCPT 55700-----
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...CPT 55866-----
HYSTEROSCOPY BIOPSYCPT 58558101017Outpatient$5,337$3,736Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400-----
OBSTETRICAL CARECPT 59409100574Outpatient$4,930$3,451Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510-----
CESAREAN DELIVERY ONLYCPT 59514100433Outpatient$2,840$1,988Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...CPT 59610-----
NJX INTERLAMINAR LMBR/SACCPT 62322100476Outpatient$1,835$1,285Payer Rates
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323-----
(Not Offered) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE ...CPT 64483-----
AFTER CATARACT LASER SURGERYCPT 66821100832Outpatient$1,212$848Payer Rates
(Not Offered) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984-----
ANESTHESIA FOR COLONOSCOPYINPATIENT 812120002Outpatient$686$480Payer Rates
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...CPT 93452-----
Therapy
THERAPEUTIC EXERCISESCPT 97110 (GP)530300Outpatient$77$54Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (CQ)530416Outpatient$77$54Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)530220Outpatient$88$62Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (CQ)530417Outpatient$88$62Payer Rates
GAIT TRAINING THERAPYCPT 97116 (GP)530405Outpatient$76$53Payer Rates
GAIT TRAINING THERAPYCPT 97116 (CQ)530418Outpatient$76$53Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)530121Outpatient$189$132Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)530170Outpatient$211$148Payer Rates
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)530115Outpatient$210$147Payer Rates
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)530171Outpatient$211$148Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (CQ)530421Outpatient$101$71Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)530808Outpatient$101$71Payer Rates
WHEELCHAIR MNGMENT TRAININGCPT 97542 (GP)530809Outpatient$84$59Payer Rates
Uncategorized
BASIC SUPPORT ROUTINE SUPPLSHCPCS A0382480113Outpatient$33$23Payer Rates
TRAUMA RESPONS W/HOSP CRITIHCPCS G0390130901Outpatient$2,429$1,700Payer Rates