CentraState Medical Center

Price List for Shoppable Services. Effective 01-01-2022.

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 70450Outpatient7240101$142
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient7240121$142
CT SOFT TISSUE NECK W/DYECPT 70491Outpatient7242041$233
CT THORAX DX C-CPT 71250Outpatient7240181$142
CT THORAX DX C+CPT 71260Outpatient7240180$233
CT THORAX LUNG CANCER SCR C-CPT 71271Outpatient7244162$105
CT ANGIOGRAPHY CHESTCPT 71275Outpatient7240003$233
CT LUMBAR SPINE W/O DYECPT 72131Outpatient7240253$142
CT PELVIS W/DYECPT 72193Outpatient7240200$233
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient7244060$142
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient7242080$300
CT ABD & PELV W/CONTRASTCPT 74177Outpatient7242081$480
CT ABD & PELV 1/> REGNSCPT 74178Outpatient7242082$480
CT HRT W/O DYE W/CA TESTCPT 75571Outpatient7240259$105
Cancer Services
RADIATION THERAPY DOSE PLANCPT 77300Outpatient7263008$165
RADIATION TREATMENT AID(S)CPT 77334Outpatient7263032$441
RADIATION PHYSICS CONSULTCPT 77336Outpatient7263034$165
NTSTY MODUL RAD TX DLVR SMPLCPT 77385Outpatient7264405$707
NTSTY MODUL RAD TX DLVR CPLXCPT 77386Outpatient7264406$707
RADIATION TREATMENT DELIVERYCPT 77412Outpatient7264410$315
CHEMO ANTI-NEOPL SQ/IMCPT 96401Outpatient6220017$81
CHEMO IV PUSH SNGL DRUGCPT 96409Outpatient6220019$265
CHEMO IV PUSH ADDL DRUGCPT 96411Outpatient6220020$81
CHEMO IV INFUSION 1 HRCPT 96413Outpatient6220021$405
CHEMO IV INFUSION ADDL HRCPT 96415Outpatient6220022$81
CHEMO IV INFUS EACH ADDL SEQCPT 96417Outpatient6220023$81
Cardiology
INSERT HEART PM ATRIALCPT 33206Outpatient7130550$13,555
INSERT HEART PM VENTRICULARCPT 33207Outpatient7130551$13,555
INSRT HEART PM ATRIAL & VENTCPT 33208Outpatient7130552$13,555
RMVL SUBQ CAR RHYTHM MNTRCPT 33286Outpatient7130555$811
CARDIOVERSION ELECTRIC EXTCPT 92960Outpatient7142026$732
CARDIOVASCULAR STRESS TESTCPT 93017Outpatient7141103$345
TTE W/DOPPLER COMPLETECPT 93306Outpatient7142030$629
ECHO TRANSESOPHAGEALCPT 93312Outpatient7142024$629
STRESS TTE COMPLETECPT 93351Outpatient7145246$629
MYOCRD STRAIN IMG SPCKL TRCKCPT 93356Outpatient7142075$15
RIGHT HEART CATHCPT 93451Outpatient7130023$3,779
CORONARY ARTERY ANGIO S&ICPT 93454Outpatient7130038$3,779
CORONARY ART/GRFT ANGIO S&ICPT 93455Outpatient7130039$3,779
R HRT CORONARY ARTERY ANGIOCPT 93456Outpatient7130040$3,779
R HRT ART/GRFT ANGIOCPT 93457Outpatient7130041$3,779
L HRT ARTERY/VENTRICLE ANGIOCPT 93458Outpatient7130042$3,779
2D TTE W WO FOC W CON FUHCPCS C8924Outpatient7145278$480
Clinic
OFFICE O/P NEW SF 15-29 MINCPT 99202Outpatient7270008$61
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient7270011$103
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient7270014$168
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient7270017$228
OFFICE O/P EST MINIMAL PROBCPT 99211Outpatient7270020$11
OFFICE O/P EST SF 10-19 MINCPT 99212Outpatient7270023$44
OFFICE O/P EST LOW 20-29 MINCPT 99213Outpatient7270026$83
OFFICE O/P EST MOD 30-39 MINCPT 99214Outpatient7270029$123
OFFICE O/P EST HI 40-54 MINCPT 99215Outpatient7270032$181
(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 95810Outpatient7341010$1,199
POLYSOM 6/>YRS CPAP 4/> PARMCPT 95811Outpatient7341015$1,199
EEG 41-60 MINUTESCPT 95812Outpatient7150008$345
EEG EXTND MNTR 61-119 MINCPT 95813Outpatient7150007$345
EEG AWAKE AND DROWSYCPT 95816Outpatient7150006$345
EEG AWAKE AND ASLEEPCPT 95819Outpatient7150005$345
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...CPT 93000----
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient7141100$73
ECG MONIT/REPRT UP TO 48 HRSCPT 93226Outpatient7142020$146
Gastro-Intestinal
ESOPHAGOSCOPY LESION ABLATECPT 43229Outpatient6612815$4,015
EGD REMOVE FOREIGN BODYCPT 43247Outpatient6612817$2,118
EGD GUIDE WIRE INSERTIONCPT 43248Outpatient6613005$1,055
ENDO CHOLANGIOPANCREATOGRAPHCPT 43261Outpatient6613006$4,015
ERCP REMOVE DUCT CALCULICPT 43264Outpatient6612802$4,015
ERCP LITHOTRIPSY CALCULICPT 43265Outpatient6612805$6,554
ERCP DUCT STENT PLACEMENTCPT 43274Outpatient6612810$6,554
ERCP REMOVE FORGN BODY DUCTCPT 43275Outpatient6613009$4,015
COLONOSCOPY SUBMUCOUS NJXCPT 45381Outpatient6612816$1,352
CA SCREEN;FLEXI SIGMOIDSCOPEHCPCS G0104Outpatient6613014$1,034
IV Therapy
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient6210186$265
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient6213105$81
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient6210188$81
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient6213115$265
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient6213120$52
Imaging
US EXAM OF HEAD AND NECKCPT 76536Outpatient7234050$142
ULTRASOUND BREAST COMPLETECPT 76641Outpatient7230024$142
ULTRASOUND BREAST LIMITEDCPT 76642Outpatient7230026$105
US EXAM ABDOM COMPLETECPT 76700Outpatient7231004$142
ECHO EXAM OF ABDOMENCPT 76705Outpatient7231005$142
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient7231025$142
OB US >= 14 WKS SNGL FETUSCPT 76805Outpatient7238004$142
OB US LIMITED FETUS(S)CPT 76815Outpatient7230001$142
FETAL BIOPHYS PROFILE W/NSTCPT 76818Outpatient7234016$142
TRANSVAGINAL US NON-OBCPT 76830Outpatient7234097$142
US EXAM PELVIC COMPLETECPT 76856Outpatient7234065$142
US EXAM SCROTUMCPT 76870Outpatient7231062$142
US LMTD JT/NONVASC XTR STRUXCPT 76882Outpatient7234058$142
BREAST TOMOSYNTHESIS BICPT 77063Outpatient7288159$33
DX MAMMO INCL CAD UNICPT 77065Outpatient7288242$120
DX MAMMO INCL CAD BICPT 77066Outpatient7288241$153
SCR MAMMO BI INCL CADCPT 77067Outpatient7288290$127
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
FUSION OF MID OR LOWER SPINEDRG 460Inpatient-$34,545
REPLACMENT OF HIP JOINTDRG 470Inpatient-$16,903
FUSION OF NECKDRG 473Inpatient-$22,451
PROCEDURES TO THE UTERUS, OVARIES OR TUBES WO CCDRG 743Inpatient-$10,236
VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&CDRG 768Inpatient-$10,397
CESAREAN SECTION W STERILIZATION W MCCDRG 783Inpatient-$22,134
CESAREAN SECTION W STERILIZATION W CCDRG 784Inpatient-$10,786
CESAREAN SECTION W STERILIZATION W/O CC/MCCDRG 785Inpatient-$8,859
CESAREAN SECTION W/O STERILIZATION W MCCDRG 786Inpatient-$17,694
CESAREAN SECTION W/O STERILIZATION W CCDRG 787Inpatient-$10,790
CESAREAN SECTION W/O STERILIZATION W/O CC/MCCDRG 788Inpatient-$9,352
VAGINAL DELIVERY W STERILIZATION/D&C W CCDRG 797Inpatient-$8,904
VAGINAL DELIVERY W STERILIZATION/D&C W/O CC/MCCDRG 798Inpatient-$8,904
VAGINAL DELIVERY W/O STERILIZATION/D&C W MCCDRG 805Inpatient-$10,740
VAGINAL DELIVERY W/O STERILIZATION/D&C W CCDRG 806Inpatient-$7,319
VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCCDRG 807Inpatient-$6,469
Laboratory
METABOLIC PANEL TOTAL CACPT 80048Outpatient7029350$10
COMPREHEN METABOLIC PANELCPT 80053Outpatient7028262$12
OBSTETRIC PANELCPT 80055Outpatient7029120$55
LIPID PANELCPT 80061Outpatient7020671$15
RENAL FUNCTION PANELCPT 80069Outpatient7024387$10
HEPATIC FUNCTION PANELCPT 80076Outpatient7028261$9
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81001----
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient7027140$3
UR ALBUMIN QUANTITATIVECPT 82043Outpatient7024031$7
VITAMIN D 25 HYDROXYCPT 82306Outpatient7020883$34
ASSAY OF URINE CREATININECPT 82570Outpatient7020511$6
VITAMIN B-12CPT 82607Outpatient7025010$17
ASSAY OF FERRITINCPT 82728Outpatient7020572$16
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient7025080$17
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient7020615$11
ASSAY OF IRONCPT 83540Outpatient7028259$7
IRON BINDING TESTCPT 83550Outpatient7028258$10
ASSAY OF MAGNESIUMCPT 83735Outpatient7020212$8
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient7025322$45
ASSAY OF PHOSPHORUSCPT 84100Outpatient7024370$5
ASSAY OF PSA TOTALCPT 84153Outpatient7027258$21
ASSAY OF PSA FREECPT 84154Outpatient7027268$21
ASSAY OF PROTEIN URINECPT 84156Outpatient7023218$4
ASSAY OF TOTAL THYROXINECPT 84436Outpatient7025190$8
ASSAY OF FREE THYROXINECPT 84439Outpatient7025211$10
ASSAY THYROID STIM HORMONECPT 84443Outpatient7025205$19
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient7020830$16
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient7024460$5
HEMATOCRITCPT 85014Outpatient7025082$3
HEMOGLOBINCPT 85018Outpatient7026105$3
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient7029300$9
COMPLETE CBC AUTOMATEDCPT 85027Outpatient7024165$7
PROTHROMBIN TIMECPT 85610Outpatient7028110$5
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient7026230$5
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient7023846$7
ALLG SPEC IGE CRUDE XTRC EACPT 86003Outpatient7020810$6
C-REACTIVE PROTEINCPT 86140Outpatient7025045$6
LYME DISEASE ANTIBODYCPT 86618Outpatient7020688$20
HEP B SURFACE ANTIBODYCPT 86706Outpatient7020608$12
SARS-COV-2 COVID-19 ANTIBODYCPT 86769Outpatient7026726$48
HEPATITIS C AB TESTCPT 86803Outpatient7020029$16
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient7022065$10
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient7202110$9
URINE CULTURE/COLONY COUNTCPT 87086Outpatient7022070$9
URINE BACTERIA CULTURECPT 87088Outpatient7028465$9
SARSCOV CORONAVIRUS AG IACPT 87426Outpatient7026741$48
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient7025286$40
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient7025279$40
SARS-COV-2 COVID-19 AMP PRBCPT 87635Outpatient7026736$59
PSA SCREENINGHCPCS G0103Outpatient7027269$22
SCREEN CERV/VAG THIN LAYERHCPCS G0123Outpatient7028135$23
COVID-19 LAB TEST NON-CDCHCPCS U0002Outpatient7026735$59
COV-19 TEST NON-CDC HGH THRUHCPCS U0004Outpatient7026740$86
Language Pathology
SPEECH/HEARING THERAPYCPT 92507Outpatient7380020$97
SPEECH SOUND LANG COMPREHENCPT 92523Outpatient7380047$291
ORAL FUNCTION THERAPYCPT 92526Outpatient7381040$108
EVALUATE SWALLOWING FUNCTIONCPT 92610Outpatient7381010$108
THER IVNTJ 1ST 15 MINCPT 97129Outpatient7381055$28
MRI
(N/O) MRI SCANCPT 70553----
(N/O) MRI SCAN OF LOWER SPINAL CANALCPT 72148----
(N/O) MRI SCAN OF LEG JOINTCPT 73721----
Nuclear Medicine
THYROID IMAGING W/BLOOD FLOWCPT 78014Outpatient7222025$492
PARATHYRD PLANAR W/WO SUBTRJCPT 78071Outpatient7221065$492
HEPATOBIL SYST IMAGE W/DRUGCPT 78227Outpatient7220801$638
GASTRIC EMPTYING IMAG STUDYCPT 78264Outpatient7223025$492
BONE IMAGING WHOLE BODYCPT 78306Outpatient7223005$492
HT MUSCLE IMAGE SPECT MULTCPT 78452Outpatient7220031$1,702
K FLOW/FUNCT IMAGE W/DRUGCPT 78708Outpatient7221070$638
Other Diagnostic
BIS XTRACELL FLUID ANALYSISCPT 93702Outpatient7371010$182
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient7231075$300
UPR/LXTR ART STDY 3+ LVLSCPT 93923Outpatient7231083$182
LOWER EXTREMITY STUDYCPT 93925Outpatient7233001$300
EXTREMITY STUDYCPT 93970Outpatient7231048$300
EXTREMITY STUDYCPT 93971Outpatient7231080$142
CONT GLUC MNTR PT PROV EQPCPT 95249Outpatient6092079$73
SLEEP STUDY UNATT&RESP EFFTCPT 95806Outpatient7341008$182
Other Procedures and Observation
FNA BX W/US GDN 1ST LESCPT 10005Outpatient7233513$811
DEB SUBQ TISSUE 20 SQ CM/<CPT 11042Outpatient7440038$451
DEB BONE 20 SQ CM/<CPT 11044Outpatient7440040$1,834
DEBRIDE NAIL 1-5CPT 11720Outpatient7440047$73
SKIN SUB GRAFT TRNK/ARM/LEGCPT 15271Outpatient6601002$2,236
SKIN SUB GRFT T/ARM/LG CHILDCPT 15273Outpatient6601004$4,591
SKIN SUB GRAFT FACE/NK/HF/GCPT 15275Outpatient6601006$2,236
SKN SUB GRFT F/N/HF/G CHILDCPT 15277Outpatient6601008$2,236
CHEM CAUT OF GRANLTJ TISSUECPT 17250Outpatient7440052$234
BX BREAST 1ST LESION STRTCTCCPT 19081Outpatient7281819$1,834
INJ TRIGGER POINT 1/2 MUSCLCPT 20552Outpatient7377055$340
CORE NDL BX LNG/MED PERQCPT 32408Outpatient7243009$1,834
ASPIRATE PLEURA W/ IMAGINGCPT 32555Outpatient7218673$706
PERICARDIOCENTESIS W/IMAGINGCPT 33016Outpatient7170455$1,833
INSERT TUNNELED CV CATHCPT 36558Outpatient7170005$3,730
INSERT TUNNELED CV CATHCPT 36561Outpatient7217063$3,730
INSJ PICC RS&I <5 YRCPT 36572Outpatient7211846$706
INSJ PICC RS&I 5 YR+CPT 36573Outpatient7211857$1,833
REMOVAL TUNNELED CV CATHCPT 36590Outpatient7217062$1,833
DECLOT VASCULAR DEVICECPT 36593Outpatient6216905$405
INJ W/FLUOR EVAL CV DEVICECPT 36598Outpatient7217049$265
INTRO CATH DIALYSIS CIRCUITCPT 36901Outpatient7172500$1,833
INTRO CATH DIALYSIS CIRCUITCPT 36902Outpatient7172501$6,461
PRIM ART M-THRMBC 1ST VSLCPT 37184Outpatient7172818$13,090
INS ENDOVAS VENA CAVA FILTRCPT 37191Outpatient7171039$6,218
REM ENDOVAS VENA CAVA FILTERCPT 37193Outpatient7171040$3,730
FEM/POPL REVASC W/STENTCPT 37226Outpatient7170312$13,090
DX BONE MARROW BX & ASPIRCPT 38222Outpatient7240031$3,089
NEEDLE BIOPSY LYMPH NODESCPT 38505Outpatient7231066$1,834
NEEDLE BIOPSY OF LIVERCPT 47000Outpatient7218513$1,834
ABD PARACENTESIS W/IMAGINGCPT 49083Outpatient7233002$1,055
PLACE GASTROSTOMY TUBE PERCCPT 49440Outpatient7218810$2,118
REPLACE G/C TUBE PERCCPT 49450Outpatient7218811$1,055
REPLACE DUOD/JEJ TUBE PERCCPT 49451Outpatient7211769$1,055
MYELOGRAPHY LUMBAR INJECTIONCPT 62304Outpatient7211182$932
DX LMBR SPI PNXR W/FLUOR/CTCPT 62328Outpatient7211720$827
ANALYZE SPINE INFUS PUMPCPT 62367Outpatient7454132$355
ANALYZE SP INF PUMP W/REPROGCPT 62368Outpatient7454131$355
ANAL SP INF PMP W/REPRG&FILLCPT 62369Outpatient7454133$355
DESTROY NERVE FACE MUSCLECPT 64612Outpatient7454177$340
CHEMODENERV MUSC MIGRAINECPT 64615Outpatient7454179$340
CHEMODENERV MUSC NECK DYSTONCPT 64616Outpatient7454180$340
CHEMODENERV 1 EXTREMITY 1-4CPT 64642Outpatient7454182$827
CHEMODENERV 1 EXTREM 5/> MUSCPT 64644Outpatient7454184$827
CHEMODENERV TRUNK MUSC 1-5CPT 64646Outpatient7454186$827
CHEMODENERV TRUNK MUSC 6/>CPT 64647Outpatient7454187$827
NEG PRESS WOUND TX <=50 CMCPT 97605Outpatient7440070$234
NEG PRESS WOUND TX >50 CMCPT 97606Outpatient7440071$451
Other Therapeutic
CARDIAC REHABCPT 93797Outpatient6450012$151
CARDIAC REHAB/MONITORCPT 93798Outpatient7140010$151
MEDICAL NUTRITION INDIV INCPT 97802Outpatient6092087$41
MED NUTRITION INDIV SUBSEQCPT 97803Outpatient6092088$35
PHLEBOTOMYCPT 99195Outpatient6220041$146
DIAB MANAGE TRN PER INDIVHCPCS G0108Outpatient6092055$70
DIAB MANAGE TRN IND/GROUPHCPCS G0109Outpatient6092060$19
PULMONARY REHAB W EXERHCPCS G0424Outpatient7427210$73
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 94010Outpatient7369004$182
EVALUATION OF WHEEZINGCPT 94060Outpatient7369005$345
RESPIRATORY FLOW VOLUME LOOPCPT 94375Outpatient7341006$345
HAST W/REPORTCPT 94452Outpatient7427250$146
HAST W/OXYGEN TITRATECPT 94453Outpatient7427251$146
PULMONARY STRESS TESTINGCPT 94618Outpatient7427223$146
PULM FUNCTION TEST BY GASCPT 94727Outpatient7427260$182
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient7210101$105
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient7210102$105
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient7214020$142
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient7214035$142
X-RAY EXAM OF SHOULDERCPT 73030Outpatient7211524$105
X-RAY EXAM OF HANDCPT 73120Outpatient7213011$105
X-RAY EXAM OF HANDCPT 73130Outpatient7211500$105
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient7211054$105
X-RAY EXAM OF KNEE 3CPT 73562Outpatient7210016$105
X-RAY EXAM OF ANKLECPT 73610Outpatient7211533$105
X-RAY EXAM OF FOOTCPT 73630Outpatient7211530$105
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient7210150$105
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient7210151$142
CONTRAST EXAM ABDOMINL AORTACPT 75625Outpatient7170051$3,730
DXA BONE DENSITY AXIALCPT 77080Outpatient7283100$142
Respiratory
POS AIRWAY PRESSURE CPAPCPT 94660Outpatient7341020$245
OTH RESP PROC, GROUPHCPCS G0239Outpatient7427200$44
Surgical Procedures
REMOVAL OF BREAST LESIONCPT 19120Outpatient-$4,116
SHO ARTHRS SRG DECOMPRESSIONCPT 29826Outpatient-$18,278
KNEE ARTHROSCOPY/SURGERYCPT 29881Outpatient-$3,689
INSJ SUBQ CAR RHYTHM MNTRCPT 33285Outpatient6622024$10,626
INTRO CATH DIALYSIS CIRCUITCPT 36903Outpatient6602503$13,090
REMOVE TONSILS AND ADENOIDSCPT 42820Outpatient-$6,629
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient6613002$1,055
(N/O) BIOPSY EXAM OF ESOPHAGUS, STOMACH OR SMALL BOWEL USI ...CPT 43239----
(N/O) DIAGNOSTIC EXAM OF LARGE BOWEL USING AN ENDOSCOPECPT 45378----
COLONOSCOPY AND BIOPSYCPT 45380Outpatient6612801$1,352
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient6613010$1,352
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562Outpatient-$6,596
PRP I/HERN INIT REDUC >5 YRCPT 49505Outpatient-$4,149
BIOPSY OF PROSTATECPT 55700Outpatient-$2,337
(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----
NJX INTERLAMINAR LMBR/SACCPT 62322Outpatient6625066$827
NJX INTERLAMINAR LMBR/SACCPT 62323Outpatient7211734$827
NJX AA&/STRD OTHER PN/BRANCHCPT 64450Outpatient6625063$827
NJX AA&/STRD TFRM EPI C/T 1CPT 64479Outpatient6225066$1,072
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...CPT 64483----
INJ PARAVERT F JNT C/T 1 LEVCPT 64490Outpatient6625067$1,072
DSTRJ NULYT AGT GNCLR NRVCPT 64624Outpatient6625070$2,287
INJECTION TREATMENT OF NERVECPT 64640Outpatient-$1,072
AFTER CATARACT LASER SURGERYCPT 66821Outpatient-$657
XCAPSL CTRC RMVL W/O ECPCPT 66984Outpatient-$2,710
LEFT HRT CATH W/VENTRCLGRPHYCPT 93452Outpatient7130036$3,779
Therapy
APPLY RIGID LEG CASTCPT 29445Outpatient7442073$314
APPLICATION OF PASTE BOOTCPT 29580Outpatient7440056$184
VASOPNEUMATIC DEVICE THERAPYCPT 97016Outpatient7370002$15
WHIRLPOOL THERAPYCPT 97022Outpatient7371038$23
ULTRASOUND THERAPYCPT 97035Outpatient7377025$18
THERAPEUTIC EXERCISESCPT 97110Outpatient7371092$38
NEUROMUSCULAR REEDUCATIONCPT 97112Outpatient7371068$44
AQUATIC THERAPY/EXERCISESCPT 97113Outpatient7371040$48
GAIT TRAINING THERAPYCPT 97116Outpatient7371045$38
THER IVNTJ EA ADDL 15 MINCPT 97130Outpatient7402026$28
MANUAL THERAPY 1/> REGIONSCPT 97140Outpatient7371093$35
PT EVAL LOW COMPLEX 20 MINCPT 97161Outpatient7372200$127
PT EVAL MOD COMPLEX 30 MINCPT 97162Outpatient7372201$127
PT EVAL HIGH COMPLEX 45 MINCPT 97163Outpatient7372202$127
PT RE-EVAL EST PLAN CARECPT 97164Outpatient7372210$87
OT EVAL LOW COMPLEX 30 MINCPT 97165Outpatient7402200$123
OT EVAL HIGH COMPLEX 60 MINCPT 97167Outpatient7402202$123
OT RE-EVAL EST PLAN CARECPT 97168Outpatient7402210$83
THERAPEUTIC ACTIVITIESCPT 97530Outpatient7370001$50
SELF CARE MNGMENT TRAININGCPT 97535Outpatient7370005$42
WHEELCHAIR MNGMENT TRAININGCPT 97542Outpatient7405064$41