Brownfield Regional Medical Center

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

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.

Billing Description	Billing Code	CDM Code	Department	Gross Charge	Cash Price	PNR
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450	440922	Outpatient	$1,155	$809	Payer Rates
CT MAXILLOFACIAL W/O DYE	CPT 70486	440962	Outpatient	$1,155	$809	Payer Rates
CT THORAX DX C-	CPT 71250	440935	Outpatient	$1,155	$809	Payer Rates
CT THORAX DX C+	CPT 71260	440930	Outpatient	$1,450	$1,015	Payer Rates
CT NECK SPINE W/O DYE	CPT 72125	440949	Outpatient	$1,155	$809	Payer Rates
CT LUMBAR SPINE W/O DYE	CPT 72131	440954	Outpatient	$1,155	$809	Payer Rates
CT PELVIS W/DYE	CPT 72193	440940	Outpatient	$1,618	$1,133	Payer Rates
CT ABD & PELVIS W/O CONTRAST	CPT 74176	441006	Outpatient	$1,042	$729	Payer Rates
CT ABD & PELV W/CONTRAST	CPT 74177	441008	Outpatient	$1,634	$1,144	Payer Rates
CT ABD & PELV W/CONTRAST	CPT 74177	441009	Outpatient	$1,634	$1,144	Payer Rates
CT ABD & PELV 1/> REGNS	CPT 74178	441007	Outpatient	$2,069	$1,448	Payer Rates
Cardiology
CARDIOVASCULAR STRESS TEST	CPT 93017	540005	Outpatient	$549	$384	Payer Rates
TTE W/DOPPLER COMPLETE	CPT 93306	280136	Outpatient	$1,289	$902	Payer Rates
Clinic
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	580021	Outpatient	$180	$126	Payer Rates
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	580022	Outpatient	$265	$186	Payer Rates
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	580023	Outpatient	$360	$252	Payer Rates
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-	-
(Not Offered) PATIENT OFFICE CONSULTATION, 60 MIN	CPT 99244	-	-	-	-	-
PREV VISIT NEW AGE 18-39	CPT 99385	580304	Outpatient	$300	$210	Payer Rates
PREV VISIT NEW AGE 40-64	CPT 99386	580294	Outpatient	$325	$227	Payer Rates
EKG
(Not Offered) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETAT ...	CPT 93000	-	-	-	-	-
ELECTROCARDIOGRAM TRACING	CPT 93005	260000	Outpatient	$290	$203	Payer Rates
ELECTROCARDIOGRAM TRACING	CPT 93005 (76)	260001	Outpatient	$290	$203	Payer Rates
RHYTHM ECG TRACING	CPT 93041	560329	Outpatient	$130	$91	Payer Rates
Emergency Room
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	130312	Outpatient	$362	$253	Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	130313	Outpatient	$362	$253	Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<	CPT 12011	130317	Outpatient	$362	$253	Payer Rates
RPR F/E/E/N/L/M 2.6-5.0 CM	CPT 12013	130318	Outpatient	$362	$253	Payer Rates
APPLY FOREARM SPLINT	CPT 29125 (LT)	130736	Outpatient	$360	$252	Payer Rates
PLACE NEEDLE IN VEIN	CPT 36000	130546	Outpatient	$123	$86	Payer Rates
INSERT TEMP BLADDER CATH	CPT 51702	130397	Outpatient	$360	$252	Payer Rates
IMMUNIZATION ADMIN	CPT 90471	130432	Outpatient	$146	$102	Payer Rates
EMERGENCY DEPT VISIT	CPT 99281	130415	Outpatient	$166	$116	Payer Rates
EMERGENCY DEPT VISIT	CPT 99282	130416	Outpatient	$308	$216	Payer Rates
EMERGENCY DEPT VISIT	CPT 99283	130417	Outpatient	$542	$379	Payer Rates
EMERGENCY DEPT VISIT	CPT 99283 (25)	130504	Outpatient	$542	$379	Payer Rates
EMERGENCY DEPT VISIT	CPT 99284	130418	Outpatient	$912	$638	Payer Rates
EMERGENCY DEPT VISIT	CPT 99284 (25)	130505	Outpatient	$912	$638	Payer Rates
EMERGENCY DEPT VISIT	CPT 99285	130419	Outpatient	$1,346	$942	Payer Rates
EMERGENCY DEPT VISIT	CPT 99285 (25)	130506	Outpatient	$1,346	$942	Payer Rates
CRITICAL CARE FIRST HOUR	CPT 99291 (25)	130500	Outpatient	$1,794	$1,256	Payer Rates
Gastro-Intestinal
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	100839	Outpatient	$2,036	$1,425	Payer Rates
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239 (59)	100411	Outpatient	$2,036	$1,425	Payer Rates
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239 (59)	100412	Outpatient	$2,036	$1,425	Payer Rates
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	100840	Outpatient	$2,036	$1,425	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378 (73)	100829	Outpatient	$2,265	$1,586	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378	100835	Outpatient	$2,158	$1,511	Payer Rates
COLONOSCOPY AND BIOPSY	CPT 45380 (59)	100427	Outpatient	$2,158	$1,511	Payer Rates
COLONOSCOPY AND BIOPSY	CPT 45380	100837	Outpatient	$2,324	$1,627	Payer Rates
COLONOSCOPY W/LESION REMOVAL	CPT 45385	100420	Outpatient	$2,324	$1,627	Payer Rates
COLONOSCOPY W/LESION REMOVAL	CPT 45385 (59)	100425	Outpatient	$2,158	$1,511	Payer Rates
IV Therapy
HYDRATION IV INFUSION INIT	CPT 96360	130406	Outpatient	$425	$298	Payer Rates
HYDRATION IV INFUSION INIT	CPT 96360 (59)	130893	Outpatient	$425	$298	Payer Rates
HYDRATE IV INFUSION ADD-ON	CPT 96361	1003	Outpatient	$90	$63	Payer Rates
HYDRATE IV INFUSION ADD-ON	CPT 96361	130827	Outpatient	$90	$63	Payer Rates
HYDRATE IV INFUSION ADD-ON	CPT 96361	130892	Outpatient	$90	$63	Payer Rates
THER/PROPH/DIAG IV INF INIT	CPT 96365	130426	Outpatient	$474	$332	Payer Rates
THER/PROPH/DIAG IV INF INIT	CPT 96365 (59)	130895	Outpatient	$474	$332	Payer Rates
THER/PROPH/DIAG IV INF ADDON	CPT 96366	1008	Outpatient	$82	$57	Payer Rates
THER/PROPH/DIAG IV INF ADDON	CPT 96366	130626	Outpatient	$89	$62	Payer Rates
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	130625	Outpatient	$286	$200	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	1002	Outpatient	$162	$113	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	130425	Outpatient	$162	$113	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	130890	Outpatient	$162	$113	Payer Rates
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	1009	Outpatient	$425	$298	Payer Rates
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	130427	Outpatient	$425	$298	Payer Rates
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	130475	Outpatient	$425	$298	Payer Rates
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	1101	Outpatient	$257	$180	Payer Rates
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	130627	Outpatient	$257	$180	Payer Rates
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	130891	Outpatient	$257	$180	Payer Rates
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	1124	Outpatient	$135	$95	Payer Rates
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	130490	Outpatient	$135	$95	Payer Rates
Imaging
US EXAM OF HEAD AND NECK	CPT 76536	400080	Outpatient	$417	$292	Payer Rates
US EXAM ABDOM COMPLETE	CPT 76700	400001	Outpatient	$417	$292	Payer Rates
ECHO EXAM OF ABDOMEN	CPT 76705	400030	Outpatient	$380	$266	Payer Rates
OB US < 14 WKS SINGLE FETUS	CPT 76801	400050	Outpatient	$554	$388	Payer Rates
OB US >= 14 WKS SNGL FETUS	CPT 76805	400110	Outpatient	$554	$388	Payer Rates
OB US LIMITED FETUS(S)	CPT 76815	400022	Outpatient	$380	$266	Payer Rates
TRANSVAGINAL US OBSTETRIC	CPT 76817	400098	Outpatient	$554	$388	Payer Rates
FETAL BIOPHYS PROFIL W/O NST	CPT 76819	400113	Outpatient	$554	$388	Payer Rates
TRANSVAGINAL US NON-OB	CPT 76830	400097	Outpatient	$554	$388	Payer Rates
US EXAM PELVIC COMPLETE	CPT 76856	400045	Outpatient	$554	$388	Payer Rates
US EXAM SCROTUM	CPT 76870	400052	Outpatient	$554	$388	Payer Rates
(Not Offered) MAMMOGRAPHY OF ONE BREAST	CPT 77065	-	-	-	-	-
(Not Offered) MAMMOGRAPHY OF BOTH BREASTS	CPT 77066	-	-	-	-	-
(Not Offered) MAMMOGRAPHY, SCREENING, BILATERAL	CPT 77067	-	-	-	-	-
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...	DRG 216	-	-	-	-	-
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-	-
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...	DRG 470	-	-	-	-	-
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-	-
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...	DRG 743	-	-	-	-	-
Labor and Delivery
FETAL NON-STRESS TEST	CPT 59025	40022	Outpatient	$403	$282	Payer Rates
Laboratory
BIOFIRE GI PANEL	CPT 0097U	201216	Outpatient	$727	$509	Payer Rates
BIOFIRE RESP PANEL WITH COVID-19	CPT 0202U	201249	Outpatient	$834	$584	Payer Rates
ROUTINE VENIPUNCTURE	CPT 36415	200990	Outpatient	$9	$6	Payer Rates
CAPILLARY BLOOD DRAW	CPT 36416	200997	Outpatient	$9	$6	Payer Rates
WITHDRAWAL OF ARTERIAL BLOOD	CPT 36600	520398	Outpatient	$522	$365	Payer Rates
METABOLIC PANEL IONIZED CA	CPT 80047	200124	Outpatient	$70	$49	Payer Rates
METABOLIC PANEL TOTAL CA	CPT 80048	200133	Outpatient	$70	$49	Payer Rates
COMPREHEN METABOLIC PANEL	CPT 80053	200135	Outpatient	$105	$74	Payer Rates
OBSTETRIC PANEL	CPT 80055	202066	Outpatient	$413	$289	Payer Rates
LIPID PANEL	CPT 80061	200300	Outpatient	$133	$93	Payer Rates
LIPID PANEL	CPT 80061	200301	Outpatient	$133	$93	Payer Rates
RENAL FUNCTION PANEL	CPT 80069	200136	Outpatient	$105	$74	Payer Rates
ACUTE HEPATITIS PANEL	CPT 80074	200823	Outpatient	$147	$103	Payer Rates
HEPATIC FUNCTION PANEL	CPT 80076	200132	Outpatient	$70	$49	Payer Rates
DRUG ASSAY ACETAMINOPHEN	CPT 80143	200319	Outpatient	$140	$98	Payer Rates
ASSAY CARBAMAZEPINE TOTAL	CPT 80156	200848	Outpatient	$45	$31	Payer Rates
ASSAY OF DIGOXIN TOTAL	CPT 80162	200154	Outpatient	$105	$74	Payer Rates
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	200879	Outpatient	$105	$74	Payer Rates
DRUG SCRN QUAN LEVETIRACETAM	CPT 80177	200163	Outpatient	$41	$29	Payer Rates
DRUG ASSAY SALICYLATE	CPT 80179	200311	Outpatient	$105	$74	Payer Rates
ASSAY OF PHENOBARBITAL	CPT 80184	200847	Outpatient	$77	$54	Payer Rates
ASSAY OF PHENYTOIN TOTAL	CPT 80185	200251	Outpatient	$105	$74	Payer Rates
ASSAY OF TACROLIMUS	CPT 80197	201023	Outpatient	$42	$29	Payer Rates
ASSAY OF VANCOMYCIN	CPT 80202	201083	Outpatient	$119	$83	Payer Rates
ASSAY OF VANCOMYCIN	CPT 80202	201084	Outpatient	$119	$83	Payer Rates
DRUG TEST PRSMV DIR OPT OBS	CPT 80305	200721	Outpatient	$63	$44	Payer Rates
ALCOHOLS BIOMARKERS 1OR 2	CPT 80321	200310	Outpatient	$91	$64	Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPE	CPT 81000	-	-	-	-	-
URINALYSIS AUTO W/SCOPE	CPT 81001	200501	Outpatient	$35	$25	Payer Rates
URINALYSIS NONAUTO W/O SCOPE	CPT 81002	200513	Outpatient	$16	$11	Payer Rates
URINALYSIS AUTO W/O SCOPE	CPT 81003	200511	Outpatient	$14	$10	Payer Rates
URINE PREGNANCY TEST	CPT 81025	200503	Outpatient	$42	$29	Payer Rates
TEST FOR ACETONE/KETONES	CPT 82009	200806	Outpatient	$28	$20	Payer Rates
ASSAY OF SERUM ALBUMIN	CPT 82040	200324	Outpatient	$35	$25	Payer Rates
UR ALBUMIN QUANTITATIVE	CPT 82043	200089	Outpatient	$18	$13	Payer Rates
ALPHA-FETOPROTEIN SERUM	CPT 82105	200403	Outpatient	$96	$67	Payer Rates
ASSAY OF AMMONIA	CPT 82140	200829	Outpatient	$105	$74	Payer Rates
ASSAY OF AMYLASE	CPT 82150	200216	Outpatient	$49	$34	Payer Rates
BILIRUBIN TOTAL	CPT 82247	200328	Outpatient	$41	$29	Payer Rates
BILIRUBIN TOTAL	CPT 82247	200329	Outpatient	$41	$29	Payer Rates
BILIRUBIN DIRECT	CPT 82248	200323	Outpatient	$41	$29	Payer Rates
BILIRUBIN DIRECT	CPT 82248	200327	Outpatient	$41	$29	Payer Rates
VITAMIN D 25 HYDROXY	CPT 82306	200074	Outpatient	$91	$64	Payer Rates
ASSAY OF CK (CPK)	CPT 82550	200214	Outpatient	$37	$26	Payer Rates
CREATINE MB FRACTION	CPT 82553	200218	Outpatient	$49	$34	Payer Rates
ASSAY OF URINE CREATININE	CPT 82570	200322	Outpatient	$16	$11	Payer Rates
VITAMIN B-12	CPT 82607	200160	Outpatient	$47	$33	Payer Rates
VIT D 1 25-DIHYDROXY	CPT 82652	200075	Outpatient	$119	$83	Payer Rates
ASSAY OF TOTAL ESTRADIOL	CPT 82670	200909	Outpatient	$86	$60	Payer Rates
ASSAY OF ESTRIOL	CPT 82677	200401	Outpatient	$139	$97	Payer Rates
ASSAY OF FERRITIN	CPT 82728	200837	Outpatient	$42	$29	Payer Rates
ASSAY OF FOLIC ACID SERUM	CPT 82746	200159	Outpatient	$45	$31	Payer Rates
BLOOD GASES ANY COMBINATION	CPT 82803	520397	Outpatient	$167	$117	Payer Rates
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	200302	Outpatient	$36	$25	Payer Rates
GLUCOSE TEST	CPT 82950	200130	Outpatient	$38	$27	Payer Rates
GLUCOSE TOLERANCE TEST (GTT)	CPT 82951	200333	Outpatient	$98	$69	Payer Rates
GTT-ADDED SAMPLES	CPT 82952	200330	Outpatient	$23	$16	Payer Rates
GLUCOSE BLOOD TEST	CPT 82962	200404	Outpatient	$36	$25	Payer Rates
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	200801	Outpatient	$57	$40	Payer Rates
ASSAY OF GONADOTROPIN (LH)	CPT 83002	200800	Outpatient	$57	$40	Payer Rates
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	200838	Outpatient	$70	$49	Payer Rates
ASSAY OF IRON	CPT 83540	200317	Outpatient	$20	$14	Payer Rates
IRON BINDING TEST	CPT 83550	200318	Outpatient	$27	$19	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	200405	Outpatient	$70	$49	Payer Rates
LACTATE (LD) (LDH) ENZYME	CPT 83615	200213	Outpatient	$19	$13	Payer Rates
ASSAY OF LEAD	CPT 83655	200937	Outpatient	$69	$48	Payer Rates
ASSAY OF LIPASE	CPT 83690	200906	Outpatient	$56	$39	Payer Rates
ASSAY OF BLOOD LIPOPROTEIN	CPT 83721	200024	Outpatient	$84	$59	Payer Rates
ASSAY OF MAGNESIUM	CPT 83735	200107	Outpatient	$49	$34	Payer Rates
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	201019	Outpatient	$194	$136	Payer Rates
ASSAY OF PARATHORMONE	CPT 83970	200716	Outpatient	$127	$89	Payer Rates
ASSAY OF PHOSPHORUS	CPT 84100	200106	Outpatient	$35	$25	Payer Rates
ASSAY OF SERUM POTASSIUM	CPT 84132	200102	Outpatient	$36	$25	Payer Rates
ASSAY OF PROGESTERONE	CPT 84144	200804	Outpatient	$64	$45	Payer Rates
PROCALCITONIN (PCT)	CPT 84145	201254	Outpatient	$68	$48	Payer Rates
ASSAY OF PSA TOTAL	CPT 84153	200137	Outpatient	$112	$78	Payer Rates
ASSAY OF PSA TOTAL	CPT 84153	200874	Outpatient	$106	$74	Payer Rates
ASSAY OF PSA FREE	CPT 84154	201018	Outpatient	$112	$78	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	200731	Outpatient	$11	$8	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	200739	Outpatient	$55	$39	Payer Rates
ASSAY OF FREE TESTOSTERONE	CPT 84402	200022	Outpatient	$147	$103	Payer Rates
ASSAY OF TOTAL TESTOSTERONE	CPT 84403	200803	Outpatient	$80	$56	Payer Rates
ASSAY OF TOTAL THYROXINE	CPT 84436	200152	Outpatient	$49	$34	Payer Rates
ASSAY OF FREE THYROXINE	CPT 84439	200165	Outpatient	$77	$54	Payer Rates
ASSAY THYROID STIM HORMONE	CPT 84443	200153	Outpatient	$105	$74	Payer Rates
TRANSFERASE (AST) (SGOT)	CPT 84450	200210	Outpatient	$35	$25	Payer Rates
ALANINE AMINO (ALT) (SGPT)	CPT 84460	200211	Outpatient	$35	$25	Payer Rates
ASSAY OF TRANSFERRIN	CPT 84466	200982	Outpatient	$91	$64	Payer Rates
FREE ASSAY (FT-3)	CPT 84481	200064	Outpatient	$52	$36	Payer Rates
ASSAY OF TROPONIN QUANT	CPT 84484	200109	Outpatient	$84	$59	Payer Rates
ASSAY OF TROPONIN QUANT	CPT 84484	201215	Outpatient	$38	$27	Payer Rates
ASSAY OF BLOOD/URIC ACID	CPT 84550	200305	Outpatient	$14	$10	Payer Rates
CHORIONIC GONADOTROPIN TEST	CPT 84702	200157	Outpatient	$105	$74	Payer Rates
CHORIONIC GONADOTROPIN TEST	CPT 84702	200402	Outpatient	$101	$71	Payer Rates
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	200100	Outpatient	$56	$39	Payer Rates
HEMATOCRIT	CPT 85014	200000	Outpatient	$25	$18	Payer Rates
HEMOGLOBIN	CPT 85018	200008	Outpatient	$25	$18	Payer Rates
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	200018	Outpatient	$50	$35	Payer Rates
COMPLETE CBC AUTOMATED	CPT 85027	200003	Outpatient	$50	$35	Payer Rates
MANUAL RETICULOCYTE COUNT	CPT 85044	200006	Outpatient	$28	$20	Payer Rates
FIBRIN DEGRADE SEMIQUANT	CPT 85378	200023	Outpatient	$56	$39	Payer Rates
FIBRIN DEGRADATION QUANT	CPT 85379	200021	Outpatient	$25	$18	Payer Rates
PROTHROMBIN TIME	CPT 85610	200011	Outpatient	$61	$43	Payer Rates
RBC SED RATE NONAUTOMATED	CPT 85651	200005	Outpatient	$28	$20	Payer Rates
THROMBOPLASTIN TIME PARTIAL	CPT 85730	200012	Outpatient	$41	$29	Payer Rates
ALLG SPEC IGE CRUDE XTRC EA	CPT 86003	200767	Outpatient	$35	$25	Payer Rates
ALLG SPEC IGE CRUDE XTRC EA	CPT 86003	201070	Outpatient	$27	$19	Payer Rates
ANTINUCLEAR ANTIBODIES	CPT 86038	200709	Outpatient	$37	$26	Payer Rates
C-REACTIVE PROTEIN	CPT 86140	200757	Outpatient	$16	$11	Payer Rates
CCP ANTIBODY	CPT 86200	200002	Outpatient	$40	$28	Payer Rates
HETEROPHILE ANTIBODY SCREEN	CPT 86308	200704	Outpatient	$35	$25	Payer Rates
IMMUNOASSAY INFECTIOUS AGENT	CPT 86317	200818	Outpatient	$91	$64	Payer Rates
IA NFCT AB SARSCOV2 COVID19	CPT 86328	201252	Outpatient	$130	$91	Payer Rates
INHIBIN A	CPT 86336	200406	Outpatient	$89	$62	Payer Rates
RHEUMATOID FACTOR TEST QUAL	CPT 86430	200703	Outpatient	$56	$39	Payer Rates
SYPHILIS TEST NON-TREP QUAL	CPT 86592	200706	Outpatient	$49	$34	Payer Rates
SYPHILIS TEST NON-TREP QUANT	CPT 86593	200975	Outpatient	$49	$34	Payer Rates
HELICOBACTER PYLORI ANTIBODY	CPT 86677	200928	Outpatient	$154	$108	Payer Rates
HERPES SIMPLEX TYPE 1 TEST	CPT 86695	200930	Outpatient	$133	$93	Payer Rates
HIV-1/HIV-2 1 RESULT ANTBDY	CPT 86703	201237	Outpatient	$38	$27	Payer Rates
MUMPS ANTIBODY	CPT 86735	200031	Outpatient	$40	$28	Payer Rates
RUBELLA ANTIBODY	CPT 86762	200719	Outpatient	$44	$31	Payer Rates
RUBEOLA ANTIBODY	CPT 86765	200899	Outpatient	$40	$28	Payer Rates
TREPONEMA PALLIDUM	CPT 86780	200694	Outpatient	$37	$26	Payer Rates
VARICELLA-ZOSTER ANTIBODY	CPT 86787	200972	Outpatient	$40	$28	Payer Rates
HEPATITIS C AB TEST	CPT 86803	200911	Outpatient	$44	$31	Payer Rates
RBC ANTIBODY SCREEN	CPT 86850	240003	Outpatient	$193	$135	Payer Rates
COOMBS TEST DIRECT	CPT 86880	240052	Outpatient	$36	$25	Payer Rates
BLOOD TYPING SEROLOGIC ABO	CPT 86900	240001	Outpatient	$189	$132	Payer Rates
BLOOD TYPING SEROLOGIC ABO	CPT 86900	240050	Outpatient	$23	$16	Payer Rates
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	240009	Outpatient	$57	$40	Payer Rates
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	240051	Outpatient	$23	$16	Payer Rates
BLOOD TYPE ANTIGEN DONOR EA	CPT 86902	240053	Outpatient	$147	$103	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	240035	Outpatient	$225	$158	Payer Rates
BLOOD CULTURE FOR BACTERIA	CPT 87040	200603	Outpatient	$32	$22	Payer Rates
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	200632	Outpatient	$27	$19	Payer Rates
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	200643	Outpatient	$27	$19	Payer Rates
CULTR BACTERIA EXCEPT BLOOD	CPT 87075	200601	Outpatient	$29	$20	Payer Rates
CULTURE AEROBIC IDENTIFY	CPT 87077	200400	Outpatient	$70	$49	Payer Rates
CULTURE AEROBIC IDENTIFY	CPT 87077	200634	Outpatient	$77	$54	Payer Rates
URINE CULTURE/COLONY COUNT	CPT 87086	200633	Outpatient	$25	$18	Payer Rates
URINE BACTERIA CULTURE	CPT 87088	200637	Outpatient	$63	$44	Payer Rates
FUNGI IDENTIFICATION YEAST	CPT 87106	200056	Outpatient	$67	$47	Payer Rates
DNA/RNA AMPLIFIED PROBE	CPT 87150	200664	Outpatient	$108	$76	Payer Rates
OVA AND PARASITES SMEARS	CPT 87177	200620	Outpatient	$27	$19	Payer Rates
MICROBE SUSCEPTIBLE MIC	CPT 87186	200638	Outpatient	$50	$35	Payer Rates
SMEAR GRAM STAIN	CPT 87205	200610	Outpatient	$13	$9	Payer Rates
SMEAR GRAM STAIN	CPT 87205	200615	Outpatient	$35	$25	Payer Rates
RESPIRATORY SYNCYTIAL AG IF	CPT 87280	200898	Outpatient	$98	$69	Payer Rates
CLOSTRIDIUM AG IA	CPT 87324	200856	Outpatient	$77	$54	Payer Rates
HEPATITIS B SURFACE AG IA	CPT 87340	200853	Outpatient	$32	$22	Payer Rates
INFLUENZA A/B EACH AG IA	CPT 87400	201010	Outpatient	$66	$46	Payer Rates
INFLUENZA A/B EACH AG IA	CPT 87400 (91)	201011	Outpatient	$66	$46	Payer Rates
NOS EACH ORGANISM AG IA	CPT 87449	200843	Outpatient	$77	$54	Payer Rates
CHYLMD PNEUM DNA AMP PROBE	CPT 87486	201221	Outpatient	$108	$76	Payer Rates
CHYLMD TRACH DNA AMP PROBE	CPT 87491	201049	Outpatient	$108	$76	Payer Rates
IADNA-DNA/RNA PROBE TQ 6-11	CPT 87506	201234	Outpatient	$657	$460	Payer Rates
M.PNEUMON DNA AMP PROBE	CPT 87581	201220	Outpatient	$108	$76	Payer Rates
N.GONORRHOEAE DNA AMP PROB	CPT 87591	201050	Outpatient	$108	$76	Payer Rates
RESP VIRUS 12-25 TARGETS	CPT 87633	201218	Outpatient	$1,286	$900	Payer Rates
SARS-COV-2 COVID-19 AMP PRB	CPT 87635	201247	Outpatient	$85	$59	Payer Rates
SARS-COV-2 COVID-19 AMP PRB	CPT 87635	201258	Outpatient	$128	$90	Payer Rates
DETECT AGENT NOS DNA AMP	CPT 87798	201219	Outpatient	$108	$76	Payer Rates
STREP A ASSAY W/OPTIC	CPT 87880	200640	Outpatient	$70	$49	Payer Rates
SPECIMEN HANDLING PT-LAB	CPT 99001	200298	Outpatient	$38	$27	Payer Rates
SPECIMEN HANDLING PT-LAB	CPT 99001	200999	Outpatient	$41	$29	Payer Rates
SPECIMEN HANDLING PT-LAB	CPT 99001	201025	Outpatient	$26	$18	Payer Rates
MRI
MRI BRAIN STEM W/O DYE	CPT 70551	380004	Outpatient	$2,049	$1,434	Payer Rates
MRI BRAIN STEM W/O & W/DYE	CPT 70553	380006	Outpatient	$2,974	$2,082	Payer Rates
MRI NECK SPINE W/O DYE	CPT 72141	380009	Outpatient	$2,049	$1,434	Payer Rates
MRI CHEST SPINE W/O DYE	CPT 72146	380011	Outpatient	$2,049	$1,434	Payer Rates
MRI LUMBAR SPINE W/O DYE	CPT 72148	380013	Outpatient	$2,049	$1,434	Payer Rates
MRI JOINT UPR EXTREM W/O DYE	CPT 73221 (RT)	380022	Outpatient	$2,049	$1,434	Payer Rates
MRI JOINT UPR EXTREM W/O DYE	CPT 73221 (LT)	380113	Outpatient	$2,049	$1,434	Payer Rates
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721 (RT)	380025	Outpatient	$2,049	$1,434	Payer Rates
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721 (LT)	380094	Outpatient	$2,049	$1,434	Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDY	CPT 93880	280018	Outpatient	$826	$578	Payer Rates
UPR/L XTREMITY ART 2 LEVELS	CPT 93922	280008	Outpatient	$581	$407	Payer Rates
LOWER EXTREMITY STUDY	CPT 93925	280105	Outpatient	$826	$578	Payer Rates
LOWER EXTREMITY STUDY	CPT 93926 (RT)	280010	Outpatient	$554	$388	Payer Rates
EXTREMITY STUDY	CPT 93970	280014	Outpatient	$826	$578	Payer Rates
EXTREMITY STUDY	CPT 93971 (RT)	280015	Outpatient	$554	$388	Payer Rates
POLYSOM 6/> YRS 4/> PARAM	CPT 95810 (26)	9001	Outpatient	$1,639	$1,147	Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	10039	Outpatient	$857	$600	Payer Rates
BLOOD TRANSFUSION SERVICE	CPT 36430	100871	Outpatient	$838	$587	Payer Rates
CARDIAC REHAB/MONITOR	CPT 93798	540003	Outpatient	$261	$183	Payer Rates
PULMONARY REHAB W EXER	HCPCS G0424	540007	Outpatient	$288	$202	Payer Rates
RBC LEUKOCYTES REDUCED	HCPCS P9016	240017	Outpatient	$461	$323	Payer Rates
RBC LEUKOCYTES REDUCED	HCPCS P9016 (BL)	240025	Outpatient	$537	$376	Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MIN	CPT 90832	-	-	-	-	-
(Not Offered) PSYCHOTHERAPY, 45 MIN	CPT 90834	-	-	-	-	-
(Not Offered) PSYCHOTHERAPY, 60 MIN	CPT 90837	-	-	-	-	-
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...	CPT 90846	-	-	-	-	-
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...	CPT 90847	-	-	-	-	-
(Not Offered) GROUP PSYCHOTHERAPY	CPT 90853	-	-	-	-	-
Pulmonary Function
CLEARANCE OF AIRWAYS	CPT 31720	520018	Outpatient	$383	$268	Payer Rates
EVALUATION OF WHEEZING	CPT 94060	520020	Outpatient	$553	$387	Payer Rates
LUNG FUNCTION TEST (MBC/MVV)	CPT 94200	520225	Outpatient	$236	$165	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94760	520399	Outpatient	$81	$57	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94761	520001	Outpatient	$267	$187	Payer Rates
PHYSICIAN STANDBY SERVICES	CPT 99360	520017	Outpatient	$57	$40	Payer Rates
Radiology
X-RAY EXAM OF SKULL	CPT 70250	300147	Outpatient	$268	$188	Payer Rates
X-RAY EXAM CHEST 1 VIEW	CPT 71045	300020	Outpatient	$167	$117	Payer Rates
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	300021	Outpatient	$197	$138	Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100 (RT)	300131	Outpatient	$197	$138	Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100 (LT)	301031	Outpatient	$197	$138	Payer Rates
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	300151	Outpatient	$268	$188	Payer Rates
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	300154	Outpatient	$268	$188	Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	300156	Outpatient	$268	$188	Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	300157	Outpatient	$342	$239	Payer Rates
X-RAY EXAM OF PELVIS	CPT 72170	300121	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73030 (RT)	300145	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73030 (LT)	301024	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF HUMERUS	CPT 73060 (RT)	300076	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73070 (RT)	301007	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73070 (LT)	301013	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF FOREARM	CPT 73090 (RT)	300060	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF FOREARM	CPT 73090 (LT)	301014	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF WRIST	CPT 73110 (RT)	300181	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF WRIST	CPT 73110 (LT)	301030	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF HAND	CPT 73130 (RT)	300070	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF HAND	CPT 73130 (LT)	301016	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF FINGER(S)	CPT 73140 (RT)	300054	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF FINGER(S)	CPT 73140 (LT)	301009	Outpatient	$197	$138	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	300073	Outpatient	$197	$138	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	301018	Outpatient	$197	$138	Payer Rates
X-RAY EXAM HIPS BI 2 VIEWS	CPT 73521	300074	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF FEMUR 2/>	CPT 73552	300052	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (RT)	300083	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (LT)	301022	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF KNEE 3	CPT 73562 (RT)	300996	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF LOWER LEG	CPT 73590 (RT)	300090	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF LOWER LEG	CPT 73590 (LT)	301026	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73610 (RT)	300003	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73610 (LT)	301006	Outpatient	$268	$188	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630 (RT)	300056	Outpatient	$197	$138	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630 (LT)	301012	Outpatient	$197	$138	Payer Rates
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	300000	Outpatient	$167	$117	Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	300001	Outpatient	$268	$188	Payer Rates
DXA BONE DENSITY AXIAL	CPT 77080	300415	Outpatient	$325	$227	Payer Rates
Respiratory
AIRWAY INHALATION TREATMENT	CPT 94640	520115	Outpatient	$383	$268	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640 (76)	520116	Outpatient	$383	$268	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640	520901	Outpatient	$383	$268	Payer Rates
POS AIRWAY PRESSURE CPAP	CPT 94660	521000	Outpatient	$383	$268	Payer Rates
EVALUATE PT USE OF INHALER	CPT 94664	520117	Outpatient	$383	$268	Payer Rates
CHEST WALL MANIPULATION	CPT 94667	520219	Outpatient	$236	$165	Payer Rates
CHEST WALL MANIPULATION	CPT 94668	520226	Outpatient	$129	$90	Payer Rates
Surgical Procedures
REMOVAL OF BREAST LESION	CPT 19120 (RT)	100481	Outpatient	$5,920	$4,144	Payer Rates
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 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 CHOLECYSTECTOMY	CPT 47562	100421	Outpatient	$10,322	$7,225	Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562 (73)	100459	Outpatient	$9,640	$6,748	Payer Rates
PRP I/HERN INIT REDUC >5 YR	CPT 49505 (LT)	100423	Outpatient	$7,307	$5,115	Payer Rates
(Not Offered) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-	-
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...	CPT 55866	-	-	-	-	-
HYSTEROSCOPY BIOPSY	CPT 58558	101017	Outpatient	$5,337	$3,736	Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-	-
OBSTETRICAL CARE	CPT 59409	100574	Outpatient	$4,930	$3,451	Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-	-
CESAREAN DELIVERY ONLY	CPT 59514	100433	Outpatient	$2,840	$1,988	Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...	CPT 59610	-	-	-	-	-
NJX INTERLAMINAR LMBR/SAC	CPT 62322	100476	Outpatient	$1,835	$1,285	Payer Rates
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62323	-	-	-	-	-
(Not Offered) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE ...	CPT 64483	-	-	-	-	-
AFTER CATARACT LASER SURGERY	CPT 66821	100832	Outpatient	$1,212	$848	Payer Rates
(Not Offered) REMOVAL OF CATARACT WITH INSERTION OF LENS	CPT 66984	-	-	-	-	-
ANESTHESIA FOR COLONOSCOPY	INPATIENT 812	120002	Outpatient	$686	$480	Payer Rates
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...	CPT 93452	-	-	-	-	-
Therapy
THERAPEUTIC EXERCISES	CPT 97110 (GP)	530300	Outpatient	$77	$54	Payer Rates
THERAPEUTIC EXERCISES	CPT 97110 (CQ)	530416	Outpatient	$77	$54	Payer Rates
NEUROMUSCULAR REEDUCATION	CPT 97112 (GP)	530220	Outpatient	$88	$62	Payer Rates
NEUROMUSCULAR REEDUCATION	CPT 97112 (CQ)	530417	Outpatient	$88	$62	Payer Rates
GAIT TRAINING THERAPY	CPT 97116 (GP)	530405	Outpatient	$76	$53	Payer Rates
GAIT TRAINING THERAPY	CPT 97116 (CQ)	530418	Outpatient	$76	$53	Payer Rates
PT EVAL LOW COMPLEX 20 MIN	CPT 97161 (GP)	530121	Outpatient	$189	$132	Payer Rates
PT EVAL LOW COMPLEX 20 MIN	CPT 97161 (GP)	530170	Outpatient	$211	$148	Payer Rates
PT EVAL MOD COMPLEX 30 MIN	CPT 97162 (GP)	530115	Outpatient	$210	$147	Payer Rates
PT EVAL MOD COMPLEX 30 MIN	CPT 97162 (GP)	530171	Outpatient	$211	$148	Payer Rates
THERAPEUTIC ACTIVITIES	CPT 97530 (CQ)	530421	Outpatient	$101	$71	Payer Rates
THERAPEUTIC ACTIVITIES	CPT 97530 (GP)	530808	Outpatient	$101	$71	Payer Rates
WHEELCHAIR MNGMENT TRAINING	CPT 97542 (GP)	530809	Outpatient	$84	$59	Payer Rates
Uncategorized
BASIC SUPPORT ROUTINE SUPPLS	HCPCS A0382	480113	Outpatient	$33	$23	Payer Rates
TRAUMA RESPONS W/HOSP CRITI	HCPCS G0390	130901	Outpatient	$2,429	$1,700	Payer Rates