Clay County Memorial Hospital

Price List for Shoppable Services. Effective 05-17-2022.

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 70450Outpatient7319339$1,423
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient7319343$1,559
CT THORAX DX C-CPT 71250Outpatient7319349$1,429
CT THORAX DX C+CPT 71260Outpatient7319348$2,117
CT THORAX DX C-/C+CPT 71270Outpatient7319342$2,578
CT NECK SPINE W/O DYECPT 72125Outpatient7319365$1,816
CT CHEST SPINE W/O DYECPT 72128Outpatient7319372$1,764
CT LUMBAR SPINE W/O DYECPT 72131Outpatient7319373$2,129
CT PELVIS W/O DYECPT 72192Outpatient7319354$1,787
CT PELVIS W/DYECPT 72193Outpatient7319341$2,031
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient7319357$3,787
CT ABD & PELV W/CONTRASTCPT 74177 (TC)Outpatient7319350$4,536
CT ABD & PELV 1/> REGNSCPT 74178Outpatient7319359$4,627
Cardiology
TTE W/O DOPPLER COMPLETECPT 93307Outpatient7610070$1,828
Clinic
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient9200003$239
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient9200004$299
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient9200005$358
OFFICE O/P EST LOW 20-29 MINCPT 99213Outpatient9200008$358
OFFICE O/P EST MOD 30-39 MINCPT 99214Outpatient9200009$358
(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
(N/O) SLEEP STUDYCPT 95810----
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...CPT 93000----
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient7010049$170
RHYTHM ECG TRACINGCPT 93041Outpatient2000003$93
Emergency Room
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001Outpatient500043$381
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient500031$192
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011Outpatient500047$394
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient8614051$242
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient8690782$196
NEW PATIENT LEVEL ICPT 99201Outpatient9200001$119
OFFICE O/P NEW SF 15-29 MINCPT 99202Outpatient9200002$179
EMERGENCY DEPT VISITCPT 99281Outpatient500058$229
EMERGENCY DEPT VISITCPT 99282Outpatient500066$376
EMERGENCY DEPT VISITCPT 99283Outpatient500068$630
EMERGENCY DEPT VISITCPT 99284Outpatient500070$970
EMERGENCY DEPT VISITCPT 99285Outpatient500077$1,106
IV Therapy
HYDRATION IV INFUSION INITCPT 96360Outpatient8600083$248
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient8600084$80
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient8600081$584
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient8610095$242
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient8610075$90
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient96376$90
Imaging
US EXAM OF HEAD AND NECKCPT 76536Outpatient7419155$413
US EXAM ABDOM COMPLETECPT 76700Outpatient7419138$533
US EXAM ABDOM COMPLETECPT 76700Outpatient7419140$772
ECHO EXAM OF ABDOMENCPT 76705Outpatient7419143$502
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient7410088$518
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient7419139$546
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient7419151$502
OB US >= 14 WKS SNGL FETUSCPT 76805Outpatient7419148$869
TRANSVAGINAL US NON-OBCPT 76830Outpatient7419823$452
US EXAM PELVIC COMPLETECPT 76856Outpatient7419146$502
(N/O) MAMMOGRAPHY OF ONE BREASTCPT 77065----
(N/O) MAMMOGRAPHY OF BOTH BREASTSCPT 77066----
(N/O) MAMMOGRAPHY, SCREENING, BILATERALCPT 77067----
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460----
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...DRG 470----
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473----
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...DRG 743----
Laboratory
4 PLEX COMBO PCR CCMHCPT 0241UOutpatient60180010$309
ROUTINE VENIPUNCTURECPT 36415Outpatient6016113$16
METABOLIC PANEL TOTAL CACPT 80048Outpatient6000912$124
METABOLIC PANEL TOTAL CACPT 80048Outpatient6000917$124
METABOLIC PANEL TOTAL CACPT 80048Outpatient6016270$124
GENERAL HEALTH PANELCPT 80050Outpatient6016707$425
COMPREHEN METABOLIC PANELCPT 80053Outpatient6000907$226
COMPREHEN METABOLIC PANELCPT 80053Outpatient6000914$226
COMPREHEN METABOLIC PANELCPT 80053Outpatient6016706$270
(N/O) OBSTETRIC BLOOD TEST PANELCPT 80055----
LIPID PANELCPT 80061Outpatient6016703$84
LIPID PANELCPT 80061Outpatient6017962$84
LIPID PANELCPT 80061Outpatient6017963$84
RENAL FUNCTION PANELCPT 80069Outpatient6016171$190
ACUTE HEPATITIS PANELCPT 80074Outpatient6017112$391
HEPATIC FUNCTION PANELCPT 80076Outpatient6016272$109
CONTRACT URINE DRUG SCREENCPT 80100Outpatient60180000$45
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient6016643$109
ASSAY DIPROPYLACETIC ACD TOTCPT 80164Outpatient6017021$78
DRUG SCRN QUAN LEVETIRACETAMCPT 80177Outpatient6017299$117
ASSAY OF TACROLIMUSCPT 80197Outpatient6016197$77
ASSAY OF VANCOMYCINCPT 80202Outpatient6016646$83
DRUG TEST PRSMV INSTRMNTCPT 80306Outpatient6016135$109
DRUG TEST PRSMV INSTRMNTCPT 80306Outpatient6016136$109
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
URINALYSIS AUTO W/SCOPECPT 81001Outpatient6016101$59
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient6016109$44
MICROSCOPIC EXAM OF URINECPT 81015Outpatient6016103$59
MICROSCOPIC EXAM OF URINECPT 81015Outpatient6016105$59
MICROSCOPIC EXAM OF URINECPT 81015Outpatient6016110$59
URINE PREGNANCY TESTCPT 81025Outpatient6016067$50
URINALYSIS VOLUME MEASURECPT 81050Outpatient6016500$13
UR ALBUMIN QUANTITATIVECPT 82043Outpatient6016357$54
ASSAY OF BREATH ETHANOLCPT 82075Outpatient6016023$90
ASSAY OF AMYLASECPT 82150Outpatient6016009$80
ASSAY TEST FOR BLOOD FECALCPT 82274Outpatient6016070$67
VITAMIN D 25 HYDROXYCPT 82306Outpatient6016542$114
TOTAL CORTISOLCPT 82533Outpatient6017534$68
ASSAY OF CK (CPK)CPT 82550Outpatient6016030$89
CREATINE MB FRACTIONCPT 82553Outpatient6016047$45
ASSAY OF CREATININECPT 82565Outpatient6016038$64
ASSAY OF URINE CREATININECPT 82570Outpatient6017011$63
VITAMIN B-12CPT 82607Outpatient6016501$67
VITAMIN B-12CPT 82607Outpatient6017227$67
DEHYDROEPIANDROSTERONECPT 82626Outpatient6016626$138
DEHYDROEPIANDROSTERONECPT 82627Outpatient6017333$150
ASSAY OF ERYTHROPOIETINCPT 82668Outpatient6017668$106
ASSAY OF TOTAL ESTRADIOLCPT 82670Outpatient6017192$126
ASSAY OF ESTRONECPT 82679Outpatient6017178$134
ASSAY OF FERRITINCPT 82728Outpatient6016505$119
ASSAY OF FERRITINCPT 82728Outpatient6017222$119
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient6016502$161
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient6017228$161
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient6016784$64
GLUCOSE TOLERANCE TEST (GTT)CPT 82951Outpatient6016052$183
GTT-ADDED SAMPLESCPT 82952Outpatient6016051$62
ASSAY OF GDH ENZYMECPT 82965Outpatient6016669$19
ASSAY OF GGTCPT 82977Outpatient6017060$30
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient6017455$180
ASSAY OF GONADOTROPIN (LH)CPT 83002Outpatient6016779$104
H PYLORI DRUG ADMINCPT 83014Outpatient6016013$71
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient6016073$121
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient6017410$121
ASSAY OF INSULINCPT 83525Outpatient6016525$64
ASSAY OF IRONCPT 83540Outpatient6016503$39
ASSAY OF IRONCPT 83540Outpatient6017453$39
ASSAY OF LACTIC ACIDCPT 83605Outpatient6016648$83
ASSAY OF LIPASECPT 83690Outpatient6017359$96
ASSAY OF MAGNESIUMCPT 83735Outpatient6016925$115
ASSAY OF MYOGLOBINCPT 83874Outpatient6016664$70
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient6000909$209
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient6016068$209
ASSAY OF PARATHORMONECPT 83970Outpatient6017009$280
ASSAY ALKALINE PHOSPHATASECPT 84075Outpatient6084080$21
ASSAY ALKALINE PHOSPHATASESCPT 84080Outpatient6017087$21
ASSAY OF PHOSPHORUSCPT 84100Outpatient6017074$58
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient6016074$66
ASSAY OF PREALBUMINCPT 84134Outpatient6016134$47
ASSAY OF PROLACTINCPT 84146Outpatient6017644$180
ASSAY OF PSA TOTALCPT 84153Outpatient6016254$99
ASSAY OF PSA TOTALCPT 84153Outpatient6017033$99
ASSAY OF PSA TOTALCPT 84153Outpatient6017037$99
ASSAY OF PSA TOTALCPT 84153Outpatient6017842$99
ASSAY OF PSA FREECPT 84154Outpatient6017841$98
ASSAY OF PROTEIN SERUMCPT 84155Outpatient6017989$58
ASSAY OF PROTEIN URINECPT 84156Outpatient6017124$33
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient6017165$62
ASSAY OF SEX HORMONE GLOBULCPT 84270Outpatient6017269$92
ASSAY OF SERUM SODIUMCPT 84295Outpatient6016095$66
ASSAY OF FREE TESTOSTERONECPT 84402Outpatient6017440$135
ASSAY OF TOTAL TESTOSTERONECPT 84403Outpatient6017270$109
ASSAY OF VITAMIN B-1CPT 84425Outpatient6016425$51
ASSAY OF FREE THYROXINECPT 84439Outpatient6016543$41
ASSAY THYROID STIM HORMONECPT 84443Outpatient6016443$90
ASSAY THYROID STIM HORMONECPT 84443Outpatient6016444$90
ASSAY OF TRANSFERRINCPT 84466Outpatient6017188$144
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient6016480$80
FREE ASSAY (FT-3)CPT 84481Outpatient6017481$95
ASSAY OF TROPONIN QUANTCPT 84484Outpatient6016645$83
ASSAY OF TROPONIN QUANTCPT 84484Outpatient6016649$83
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient6016108$41
ASSAY OF ZINCCPT 84630Outpatient6017765$96
ASSAY OF C-PEPTIDECPT 84681Outpatient6017681$124
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient6017805$52
BL SMEAR W/DIFF WBC COUNTCPT 85007Outpatient6016042$26
BL SMEAR W/DIFF WBC COUNTCPT 85007Outpatient6016043$15
HEMATOCRITCPT 85014Outpatient6016054$32
HEMOGLOBINCPT 85018Outpatient6016055$32
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient6016031$64
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient6017919$88
COMPLETE CBC AUTOMATEDCPT 85027Outpatient6016999$63
AUTOMATED RETICULOCYTE COUNTCPT 85045Outpatient6017097$58
BLOOD SMEAR INTERPRETATIONCPT 85060Outpatient6017104$82
FIBRIN DEGRADATION QUANTCPT 85379Outpatient6017380$215
PROTHROMBIN TIMECPT 85610Outpatient6000908$61
PROTHROMBIN TIMECPT 85610Outpatient6000915$61
PROTHROMBIN TIMECPT 85610Outpatient6016079$61
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient6016090$47
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient6016115$74
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient6017311$37
ALLG SPEC IGE CRUDE XTRC EACPT 86003Outpatient6017113$27
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient6017255$50
ANTINUCLEAR ANTIBODIES (ANA)CPT 86039Outpatient6017256$46
C-REACTIVE PROTEINCPT 86140Outpatient6016140$83
NUCLEAR ANTIGEN ANTIBODYCPT 86235Outpatient6016235$101
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient6016750$60
IMMUNOFIX E-PHORESIS SERUMCPT 86334Outpatient6017334$91
MICROSOMAL ANTIBODY EACHCPT 86376Outpatient6017047$70
RHEUMATOID FACTOR QUANTCPT 86431Outpatient6017099$44
TB INTRADERMAL TESTCPT 86580Outpatient8600099$75
SYPHILIS TEST NON-TREP QUALCPT 86592Outpatient6017592$30
EPSTEIN-BARR NUCLEAR ANTIGENCPT 86664Outpatient6017675$70
EPSTEIN-BARR CAPSID VCACPT 86665Outpatient6017677$77
HEP B SURFACE ANTIBODYCPT 86706Outpatient6017706$45
MUMPS ANTIBODYCPT 86735Outpatient6017197$55
RUBELLA ANTIBODYCPT 86762Outpatient6017202$61
RUBEOLA ANTIBODYCPT 86765Outpatient6017266$54
HEPATITIS C AB TESTCPT 86803Outpatient6017243$60
BLOOD TYPING SEROLOGIC ABOCPT 86900Outpatient6017108$26
BLOOD TYPING SEROLOGIC RH(D)CPT 86901Outpatient6017086$26
COMPATIBILITY TEST SPINCPT 86920Outpatient6016116$287
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient6017038$104
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient6017039$104
FECES CULTURE AEROBIC BACTCPT 87045Outpatient6017101$40
FECES CULTURE AEROBIC BACTCPT 87045Outpatient6017115$40
STOOL CULTR AEROBIC BACT EACPT 87046Outpatient6017103$40
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient6017712$52
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient6017905$36
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient6017711$126
CULTR BACTERIA EXCEPT BLOODCPT 87075Outpatient6017076$97
CULTURE ANAEROBE IDENT EACHCPT 87076Outpatient6017358$55
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient6017357$55
URINE CULTURE/COLONY COUNTCPT 87086Outpatient6017054$97
URINE CULTURE/COLONY COUNTCPT 87086Outpatient6017482$97
URINE BACTERIA CULTURECPT 87088Outpatient60161063$70
CULTURE TYPE IMMUNOLOGICCPT 87147Outpatient6017772$55
OVA AND PARASITES SMEARSCPT 87177Outpatient6017116$79
OVA AND PARASITES SMEARSCPT 87177Outpatient6016128$79
MICROBE SUSCEPTIBLE MICCPT 87186Outpatient6017774$63
SMEAR GRAM STAINCPT 87205Outpatient6017061$26
SMEAR COMPLEX STAINCPT 87209Outpatient6017131$37
CLOSTRIDIUM AG IACPT 87324Outpatient6017180$50
HIV-1 AG W/HIV-1&2 AB AG IACPT 87389Outpatient6017026$182
SARSCOV CORONAVIRUS AG IACPT 87426 (QW)Outpatient60180006$309
SARSCOV CORONAVIRUS AG IACPT 87426 (QW)Outpatient60180007$309
SHIGA-LIKE TOXIN AG IACPT 87427Outpatient6017107$90
SARSCOV & INF VIR A&B AG IACPT 87428Outpatient6017961$232
NOS EACH ORGANISM AG IACPT 87449Outpatient6017179$67
NOS EACH ORGANISM AG IACPT 87449Outpatient6017211$253
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient6017187$120
HEPATITIS C REVRS TRNSCRPJCPT 87522Outpatient6017768$240
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient6017189$108
SARS-COV-2 COVID-19 AMP PRBCPT 87635Outpatient60180009$300
INFLUENZA ASSAY W/OPTICCPT 87804Outpatient6074000$72
INFLUENZA ASSAY W/OPTICCPT 87804Outpatient6074001$72
RSV ASSAY W/OPTICCPT 87807Outpatient6016191$66
STREP A ASSAY W/OPTICCPT 87880Outpatient6016751$65
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient6017999$221
SPECIMEN HANDLING PT-LABCPT 99001Outpatient6016333$41
PSA SCREENINGHCPCS G0103Outpatient6017031$99
DRUG TEST DEF 1-7 CLASSESHCPCS G0480Outpatient6017326$515
DRUG TEST DEF 1-7 CLASSESHCPCS G0480Outpatient6017401$515
DRUG TEST DEF 1-7 CLASSESHCPCS G0480Outpatient6017414$515
DRUG TEST DEF 1-7 CLASSESHCPCS G0480Outpatient6017416$515
COV-19 AMP PRB HGH THRUPUTHCPCS U0003Outpatient60180003$300
COV-19 AMP PRB HGH THRUPUTHCPCS U0003Outpatient60180005$300
Language Pathology
SPEECH/HEARING THERAPYCPT 92507 (GN)Outpatient2800082$193
ORAL FUNCTION THERAPYCPT 92526 (GN)Outpatient2800083$210
MRI
MRI BRAIN STEM W/O DYECPT 70551Outpatient7519711$2,005
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient7519713$3,127
MRI NECK SPINE W/O DYECPT 72141Outpatient7519730$2,005
MRI LUMBAR SPINE W/O DYECPT 72148Outpatient7519715$2,005
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient7519707$2,005
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient7519729$2,005
INJ PROHANCE MULTIPACKHCPCS A9576Outpatient7519731$379
Medical and Surgical Supplies
WOUND CLOSURE BY ADHESIVEHCPCS G0168Outpatient5000034$101
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient7410078$1,787
LOWER EXTREMITY STUDYCPT 93925Outpatient7410080$1,072
EXTREMITY STUDYCPT 93970Outpatient7410082$1,787
EXTREMITY STUDYCPT 93971Outpatient7410084$1,215
Other Procedures and Observation
DEB SUBQ TISSUE 20 SQ CM/<CPT 11042Outpatient500051$496
DEB SUBQ TISSUE ADD-ONCPT 11045Outpatient500700$496
US URINE CAPACITY MEASURECPT 51798Outpatient3000003$69
RMVL DEVITAL TIS 20 CM/<CPT 97597Outpatient1500005$251
RMVL DEVITAL TIS ADDL 20CM/<CPT 97598Outpatient1502000$42
CASIRIVI AND IMDEVI INFUSIONHCPCS M0243Outpatient8610201$929
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 36430Outpatient6036430$1,344
CARDIAC REHAB/MONITORCPT 93798Outpatient2000007$246
NEG PRESS WOUND TX <=50 CMCPT 97605Outpatient1500004$1,411
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient6016118$715
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
MEASURE BLOOD OXYGEN LEVELCPT 94760Outpatient2600025$43
MEASURE BLOOD OXYGEN LEVELCPT 94760Outpatient2600031$23
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient7119013$184
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient7119014$187
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100Outpatient7119066$214
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040Outpatient7119305$298
X-RAY EXAM NECK SPINE 6/>VWSCPT 72052Outpatient7119097$361
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient7119081$214
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient7119082$242
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient7119555$286
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient7119098$370
X-RAY EXAM OF PELVISCPT 72170Outpatient7119060$170
X-RAY EXAM OF SHOULDERCPT 73030 (RT)Outpatient7119073$206
X-RAY EXAM OF SHOULDERCPT 73030 (LT)Outpatient7119076$206
X-RAY EXAM OF SHOULDERCPT 73030 (LT)Outpatient7119080$206
X-RAY EXAM OF SHOULDERCPT 73030Outpatient7119325$194
X-RAY EXAM OF ELBOWCPT 73070 (RT)Outpatient7119025$176
X-RAY EXAM OF ELBOWCPT 73070 (LT)Outpatient7119026$176
X-RAY EXAM OF FOREARMCPT 73090 (RT)Outpatient7119036$185
X-RAY EXAM OF FOREARMCPT 73090 (LT)Outpatient7119037$185
X-RAY EXAM OF WRISTCPT 73110 (LT)Outpatient7119092$214
X-RAY EXAM OF WRISTCPT 73110 (RT)Outpatient7119093$214
X-RAY EXAM OF HANDCPT 73130 (RT)Outpatient7119039$204
X-RAY EXAM OF HANDCPT 73130 (LT)Outpatient7119040$204
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)Outpatient7119042$214
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)Outpatient7119045$214
X-RAY EXAM HIPS BI 2 VIEWSCPT 73521Outpatient7119313$307
X-RAY EXAM OF KNEE 3CPT 73562 (LT)Outpatient7119046$215
X-RAY EXAM OF KNEE 3CPT 73562 (RT)Outpatient7119047$215
X-RAY EXAM OF ANKLECPT 73610 (RT)Outpatient7119006$204
X-RAY EXAM OF ANKLECPT 73610 (LT)Outpatient7119019$204
X-RAY EXAM OF FOOTCPT 73630 (RT)Outpatient7119035$201
X-RAY EXAM OF FOOTCPT 73630 (LT)Outpatient7119038$201
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient7119001$181
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient7119002$224
CT BONE DENSITY AXIALCPT 77078Outpatient7276075$603
Respiratory
BREATHING CAPACITY TESTCPT 94010Outpatient2600020$59
AIRWAY INHALATION TREATMENTCPT 94640Outpatient2600015$78
POS AIRWAY PRESSURE CPAPCPT 94660Outpatient2600004$27
EVALUATE PT USE OF INHALERCPT 94664Outpatient2600016$79
Surgical Procedures
REMOVAL OF BREAST LESIONCPT 19120Outpatient1100050$2,966
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826----
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPECPT 29881----
REMOVE TONSILS AND ADENOIDSCPT 42820Outpatient1100126$4,054
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient1100049$3,429
(N/O) BIOPSY EXAM OF ESOPHAGUS, STOMACH OR SMALL BOWEL USI ...CPT 43239----
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient1100046$3,429
(N/O) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOPECPT 45380----
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient1100153$4,236
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562Outpatient1100031$7,355
PRP I/HERN INIT REDUC >5 YRCPT 49505Outpatient1100048$3,688
(N/O) BIOPSY OF PROSTATE GLANDCPT 55700----
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...CPT 55866----
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400----
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510----
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...CPT 59610----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323----
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...CPT 64483----
AFTER CATARACT LASER SURGERYCPT 66821Outpatient1100308$1,277
XCAPSL CTRC RMVL W/O ECPCPT 66984Outpatient1100300$5,562
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
HOT OR COLD PACKS THERAPYCPT 97010 (GO)Outpatient2800018$34
HOT OR COLD PACKS THERAPYCPT 97010 (GP)Outpatient2800056$34
MECHANICAL TRACTION THERAPYCPT 97012 (GP)Outpatient2800057$62
ULTRASOUND THERAPYCPT 97035 (GO)Outpatient2800025$46
ULTRASOUND THERAPYCPT 97035 (GP)Outpatient2800063$46
THERAPEUTIC EXERCISESCPT 97110 (GO)Outpatient2800026$80
THERAPEUTIC EXERCISESCPT 97110 (GP)Outpatient2800064$80
NEUROMUSCULAR REEDUCATIONCPT 97112 (GO)Outpatient2800027$88
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)Outpatient2800065$88
GAIT TRAINING THERAPYCPT 97116 (GP)Outpatient2800067$82
MANUAL THERAPY 1/> REGIONSCPT 97140 (GO)Outpatient2800030$91
MANUAL THERAPY 1/> REGIONSCPT 97140 (GP)Outpatient2800069$91
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)Outpatient2800100$215
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)Outpatient2800101$215
OT EVAL LOW COMPLEX 30 MINCPT 97165 (GO)Outpatient2800104$224
OT EVAL MOD COMPLEX 45 MINCPT 97166 (GO)Outpatient2800105$224
THERAPEUTIC ACTIVITIESCPT 97530 (GO)Outpatient2800032$78
THERAPEUTIC ACTIVITIESCPT 97530 (GP)Outpatient2800071$78
SELF CARE MNGMENT TRAININGCPT 97535 (GO)Outpatient2800034$89
PT ELEC STIMULATIONHCPCS G0283GP (GP)Outpatient2800038$51
Uncategorized
IMMUNIZATION ADMINCPT 90471Outpatient8610054$93
GROUND MILEAGEHCPCS A0425Outpatient900021$25
ALS1-EMERGENCYHCPCS A0427Outpatient900016$1,350
BLSHCPCS A0428Outpatient900300$710
BLS-EMERGENCYHCPCS A0429Outpatient900004$1,137
AMBULANCE RESPONSE/TREATMENTHCPCS A0998Outpatient900034$109