Dimmit Regional Hospital

Price List for Shoppable Services. Effective 06-29-2022.

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 704506825501Outpatient$632$379Payer Rates
CT MAXILLOFACIAL W/O DYECPT 704866825507Outpatient$632$379Payer Rates
CT SOFT TISSUE NECK W/DYECPT 704916825665Outpatient$1,245$747Payer Rates
CT THORAX DX C-CPT 712506825510Outpatient$632$379Payer Rates
CT THORAX DX C-CPT 712506825541Outpatient$632$379Payer Rates
CT THORAX DX C+CPT 712606825511Outpatient$1,245$747Payer Rates
CT ANGIOGRAPHY CHESTCPT 712756825557Outpatient$1,460$876Payer Rates
CT NECK SPINE W/O DYECPT 721256825513Outpatient$632$379Payer Rates
CT CHEST SPINE W/O DYECPT 721286825517Outpatient$632$379Payer Rates
CT LUMBAR SPINE W/O DYECPT 721316825520Outpatient$632$379Payer Rates
CT PELVIS W/O DYECPT 721926825526Outpatient$632$379Payer Rates
CT PELVIS W/DYECPT 721936825525Outpatient$1,245$747Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (LT)6950030Outpatient$632$379Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (RT)6950031Outpatient$632$379Payer Rates
CT ABDOMEN W/O DYECPT 741506825534Outpatient$632$379Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 741766825539Outpatient$1,215$729Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 741766825600Outpatient$725$435Payer Rates
CT ABD & PELV W/CONTRASTCPT 741776825537Outpatient$1,951$1,171Payer Rates
CT ABD & PELV 1/> REGNSCPT 741786825540Outpatient$1,951$1,171Payer Rates
Clinic
(Not Offered) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT ...CPT 99203-----
OFFICE O/P NEW MOD 45-59 MINCPT 99204 (GP)4225426Outpatient$304$182Payer Rates
(Not Offered) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT ...CPT 99205-----
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243-----
(Not Offered) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244-----
(Not Offered) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EV ...CPT 99385-----
(Not Offered) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EV ...CPT 99386-----
EEG
(Not Offered) SLEEP STUDYCPT 95810-----
EKG
(Not Offered) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETAT ...CPT 93000-----
ELECTROCARDIOGRAM TRACINGCPT 930057526001Outpatient$188$113Payer Rates
RHYTHM ECG TRACINGCPT 930416102028Outpatient$176$106Payer Rates
ECG MONIT/REPRT UP TO 48 HRSCPT 932257829001Outpatient$270$162Payer Rates
Emergency Room
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 120013000301Outpatient$448$269Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 120023000323Outpatient$448$269Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<CPT 120113000322Outpatient$448$269Payer Rates
REMOVAL OF BREAST LESIONCPT 191203000339Outpatient$12,426$7,456Payer Rates
PLACE NEEDLE IN VEINCPT 36000300337Outpatient$52$31Payer Rates
WITHDRAWAL OF ARTERIAL BLOODCPT 36600300352Outpatient$526$316Payer Rates
INSERT TEMP BLADDER CATHCPT 51702300335Outpatient$526$316Payer Rates
HYDRATION IV INFUSION INITCPT 963603000316Outpatient$445$267Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963613000317Outpatient$87$52Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963653000304Outpatient$552$331Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963663000305Outpatient$87$52Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963673000319Outpatient$140$84Payer Rates
THER/DIAG CONCURRENT INFCPT 963683000337Outpatient$87$52Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963723000302Outpatient$140$84Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963743000308Outpatient$445$267Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963753000306Outpatient$140$84Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963763000309Outpatient$49$29Payer Rates
EMERGENCY DEPT VISITCPT 99281 (25)3000311Outpatient$324$194Payer Rates
EMERGENCY DEPT VISITCPT 99282 (25)3000312Outpatient$518$311Payer Rates
EMERGENCY DEPT VISITCPT 99283 (25)3000313Outpatient$911$547Payer Rates
EMERGENCY DEPT VISITCPT 99284 (25)3000314Outpatient$1,431$859Payer Rates
EMERGENCY DEPT VISITCPT 99285 (25)3000315Outpatient$2,055$1,233Payer Rates
CRITICAL CARE FIRST HOURCPT 99291300396Outpatient$1,701$1,021Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 96360204107Outpatient$442$265Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 96361204108Outpatient$90$54Payer Rates
THER/PROPH/DIAG IV INF INITCPT 96365204109Outpatient$442$265Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 96366204113Outpatient$89$53Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 96367204112Outpatient$141$85Payer Rates
THER/DIAG CONCURRENT INFCPT 96368204115Outpatient$49$29Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372204114Outpatient$141$85Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 96374204110Outpatient$442$265Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375204111Outpatient$90$54Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 96376204116Outpatient$49$29Payer Rates
Imaging
US EXAM OF HEAD AND NECKCPT 765366724533Outpatient$673$404Payer Rates
ULTRASOUND BREAST LIMITEDCPT 766426730124Outpatient$220$132Payer Rates
US EXAM ABDOM COMPLETECPT 767006724550Outpatient$673$404Payer Rates
ECHO EXAM OF ABDOMENCPT 767056724509Outpatient$673$404Payer Rates
ECHO EXAM OF ABDOMENCPT 767056724510Outpatient$673$404Payer Rates
US EXAM ABDO BACK WALL COMPCPT 767706724523Outpatient$673$404Payer Rates
OB US < 14 WKS SINGLE FETUSCPT 768016724500Outpatient$673$404Payer Rates
OB US < 14 WKS SINGLE FETUSCPT 768016725000Outpatient$673$404Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 768056724541Outpatient$673$404Payer Rates
OB US DETAILED SNGL FETUSCPT 768116724506Outpatient$955$573Payer Rates
OB US LIMITED FETUS(S)CPT 768156724507Outpatient$673$404Payer Rates
TRANSVAGINAL US OBSTETRICCPT 768176724544Outpatient$673$404Payer Rates
FETAL BIOPHYS PROFILE W/NSTCPT 768186724542Outpatient$555$333Payer Rates
FETAL BIOPHYS PROFIL W/O NSTCPT 768196724543Outpatient$673$404Payer Rates
TRANSVAGINAL US NON-OBCPT 768306724512Outpatient$673$404Payer Rates
US EXAM PELVIC COMPLETECPT 768566724517Outpatient$673$404Payer Rates
US EXAM SCROTUMCPT 768706724531Outpatient$673$404Payer Rates
US LMTD JT/NONVASC XTR STRUXCPT 768826724527Outpatient$451$271Payer Rates
BREAST TOMOSYNTHESIS BICPT 770636602006Outpatient$217$130Payer Rates
DX MAMMO INCL CAD UNICPT 77065 (LT)6602004Outpatient$225$135Payer Rates
DX MAMMO INCL CAD UNICPT 77065 (RT)6602005Outpatient$225$135Payer Rates
DX MAMMO INCL CAD BICPT 770666602003Outpatient$287$172Payer Rates
SCR MAMMO BI INCL CADCPT 770676602000Outpatient$251$151Payer Rates
TOMOSYNTHESIS, MAMMOHCPCS G02796602007Outpatient$218$131Payer Rates
TOMOSYNTHESIS, MAMMOHCPCS G0279 (LT)6602008Outpatient$218$131Payer Rates
TOMOSYNTHESIS, MAMMOHCPCS G0279 (RT)6602009Outpatient$218$131Payer Rates
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 590252102000Outpatient$633$380Payer Rates
OBSTETRICAL CARECPT 594093222127Outpatient$4,734$2,840Payer Rates
Laboratory
ROUTINE VENIPUNCTURECPT 364157023468Outpatient$15$9Payer Rates
METABOLIC PANEL TOTAL CACPT 800487028067Outpatient$92$55Payer Rates
GENERAL HEALTH PANELCPT 800507023474Outpatient$600$360Payer Rates
COMPREHEN METABOLIC PANELCPT 800537028066Outpatient$225$135Payer Rates
OBSTETRIC PANELCPT 800557023434Outpatient$235$141Payer Rates
LIPID PANELCPT 800617028071Outpatient$179$107Payer Rates
RENAL FUNCTION PANELCPT 800697028068Outpatient$95$57Payer Rates
ACUTE HEPATITIS PANELCPT 800747323961Outpatient$520$312Payer Rates
HEPATIC FUNCTION PANELCPT 800767028069Outpatient$89$53Payer Rates
ASSAY OF DIGOXIN TOTALCPT 801627028028Outpatient$145$87Payer Rates
ASSAY OF PHENYTOIN TOTALCPT 801857023744Outpatient$145$87Payer Rates
ASSAY OF VANCOMYCINCPT 802027028073Outpatient$148$89Payer Rates
DRUG TEST PRSMV CHEM ANLYZRCPT 803077028029Outpatient$130$78Payer Rates
DRUG TEST PRSMV CHEM ANLYZRCPT 803077028055Outpatient$215$129Payer Rates
ANALGESICS NON-OPIOID 1 OR 2CPT 803297028024Outpatient$221$133Payer Rates
ANALGESICS NON-OPIOID 1 OR 2CPT 803297028039Outpatient$77$46Payer Rates
URINALYSIS NONAUTO W/SCOPECPT 810007023827Outpatient$45$27Payer Rates
URINALYSIS AUTO W/SCOPECPT 810017040004Outpatient$45$27Payer Rates
URINALYSIS NONAUTO W/O SCOPECPT 810027023701Outpatient$28$17Payer Rates
(Not Offered) URINALYSIS TESTCPT 81003-----
URINE PREGNANCY TESTCPT 810257023780Outpatient$69$41Payer Rates
TEST FOR ACETONE/KETONESCPT 820097023887Outpatient$48$29Payer Rates
UR ALBUMIN QUANTITATIVECPT 820437027390Outpatient$88$53Payer Rates
ASSAY OF AMMONIACPT 821407028023Outpatient$159$95Payer Rates
ASSAY OF AMYLASECPT 821507028079Outpatient$77$46Payer Rates
BILIRUBIN TOTALCPT 822477028018Outpatient$55$33Payer Rates
BILIRUBIN DIRECTCPT 822487028019Outpatient$57$34Payer Rates
OCCULT BLOOD FECESCPT 822707323778Outpatient$36$22Payer Rates
VITAMIN D 25 HYDROXYCPT 823067028054Outpatient$160$96Payer Rates
ASSAY OF CK (CPK)CPT 825507028027Outpatient$71$43Payer Rates
CREATINE MB FRACTIONCPT 825537028043Outpatient$135$81Payer Rates
ASSAY OF CREATININECPT 825657023839Outpatient$59$35Payer Rates
ASSAY OF URINE CREATININECPT 825707023761Outpatient$56$34Payer Rates
CREATININE CLEARANCE TESTCPT 825757023971Outpatient$103$62Payer Rates
VITAMIN B-12CPT 826077323981Outpatient$107$64Payer Rates
BLOOD GASES ANY COMBINATIONCPT 828034124455Outpatient$226$136Payer Rates
ASSAY GLUCOSE BLOOD QUANTCPT 829477028005Outpatient$62$37Payer Rates
GLUCOSE TESTCPT 829507023758Outpatient$62$37Payer Rates
GLUCOSE TESTCPT 829507028080Outpatient$30$18Payer Rates
GLUCOSE TOLERANCE TEST (GTT)CPT 829517028081Outpatient$70$42Payer Rates
GTT-ADDED SAMPLESCPT 829527028082Outpatient$83$50Payer Rates
ASSAY OF GGTCPT 829777028030Outpatient$79$47Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 830367028031Outpatient$106$64Payer Rates
ASSAY OF LACTIC ACIDCPT 836057028032Outpatient$117$70Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 836157028033Outpatient$66$40Payer Rates
ASSAY OF LIPASECPT 836907028034Outpatient$75$45Payer Rates
ASSAY OF MAGNESIUMCPT 837357028035Outpatient$74$44Payer Rates
ASSAY OF MYOGLOBINCPT 838747028046Outpatient$141$85Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 838807023953Outpatient$370$222Payer Rates
ASSAY OF PARATHORMONECPT 839707028048Outpatient$223$134Payer Rates
ASSAY OF PHOSPHORUSCPT 841007028038Outpatient$59$35Payer Rates
ASSAY OF PSA TOTALCPT 841537023554Outpatient$201$121Payer Rates
ASSAY OF PSA TOTALCPT 841537028047Outpatient$100$60Payer Rates
ASSAY OF PSA FREECPT 841547323457Outpatient$201$121Payer Rates
ASSAY OF PROTEIN URINECPT 841567023920Outpatient$44$26Payer Rates
ASSAY OF TOTAL TESTOSTERONECPT 844037028050Outpatient$140$84Payer Rates
ASSAY OF TOTAL THYROXINECPT 844367028049Outpatient$75$45Payer Rates
ASSAY OF FREE THYROXINECPT 844397028044Outpatient$141$85Payer Rates
ASSAY THYROID STIM HORMONECPT 844437028052Outpatient$112$67Payer Rates
ASSAY OF TRIGLYCERIDESCPT 844787028021Outpatient$78$47Payer Rates
ASSAY OF THYROID (T3 OR T4)CPT 844797028053Outpatient$71$43Payer Rates
ASSAY OF TROPONIN QUANTCPT 844847028051Outpatient$112$67Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 845507028040Outpatient$57$34Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 847027028045Outpatient$143$86Payer Rates
CHORIONIC GONADOTROPIN ASSAYCPT 847037023915Outpatient$82$49Payer Rates
HEMATOCRITCPT 850147323762Outpatient$26$16Payer Rates
HEMOGLOBINCPT 850187023762Outpatient$26$16Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850257040003Outpatient$85$51Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850257040033Outpatient$52$31Payer Rates
(Not Offered) COMPLETE BLOOD CELL COUNT (CBC), AUTOMATEDCPT 85027-----
FIBRIN DEGRADJ D-DIMERCPT 853807027107Outpatient$134$80Payer Rates
PROTHROMBIN TIMECPT 856107023795Outpatient$57$34Payer Rates
RBC SED RATE AUTOMATEDCPT 856527023806Outpatient$45$27Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857307023942Outpatient$46$28Payer Rates
C-REACTIVE PROTEINCPT 861407028026Outpatient$56$34Payer Rates
HETEROPHILE ANTIBODY SCREENCPT 863087323775Outpatient$56$34Payer Rates
RHEUMATOID FACTOR TEST QUALCPT 864307023804Outpatient$62$37Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 865927023800Outpatient$45$27Payer Rates
HELICOBACTER PYLORI ANTIBODYCPT 866777323662Outpatient$182$109Payer Rates
RUBELLA ANTIBODYCPT 867627323482Outpatient$157$94Payer Rates
VARICELLA-ZOSTER ANTIBODYCPT 867877023682Outpatient$213$128Payer Rates
RBC ANTIBODY SCREENCPT 868507123329Outpatient$176$106Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 869007023521Outpatient$259$155Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 869007023721Outpatient$42$25Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 869017323722Outpatient$40$24Payer Rates
COMPATIBILITY TEST SPINCPT 869207123403Outpatient$45$27Payer Rates
COMPATIBILITY TEST ANTIGLOBCPT 869227123363Outpatient$85$51Payer Rates
BLOOD CULTURE FOR BACTERIACPT 870407023710Outpatient$113$68Payer Rates
BLOOD CULTURE FOR BACTERIACPT 870407023719Outpatient$113$68Payer Rates
FECES CULTURE AEROBIC BACTCPT 870457027329Outpatient$109$65Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870707023404Outpatient$72$43Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870707023740Outpatient$94$56Payer Rates
CULTURE AEROBIC IDENTIFYCPT 870777023410Outpatient$112$67Payer Rates
URINE BACTERIA CULTURECPT 870887023405Outpatient$88$53Payer Rates
CULTURE TYPE IMMUNOLOGICCPT 87147 (59)7040023Outpatient$28$17Payer Rates
DNA/RNA DIRECT PROBECPT 871497323998Outpatient$219$131Payer Rates
MICROBE SUSCEPTIBLE MICCPT 871867323710Outpatient$97$58Payer Rates
SMEAR WET MOUNT SALINE/INKCPT 872107023987Outpatient$47$28Payer Rates
RESPIRATORY SYNCYTIAL AG IFCPT 872807023493Outpatient$131$79Payer Rates
CLOSTRIDIUM AG IACPT 873247023456Outpatient$131$79Payer Rates
E COLI 0157 AG IACPT 873357023308Outpatient$131$79Payer Rates
HIV-1 AG W/HIV-1&2 AB AG IACPT 873897027218Outpatient$150$90Payer Rates
INFLUENZA A/B EACH AG IACPT 874007023663Outpatient$248$149Payer Rates
ROTAVIRUS AG IACPT 874257023898Outpatient$131$79Payer Rates
CHYLMD TRACH DNA AMP PROBECPT 874917023443Outpatient$383$230Payer Rates
M.PNEUMON DNA AMP PROBECPT 875817028089Outpatient$114$68Payer Rates
N.GONORRHOEAE DNA AMP PROBCPT 875917023327Outpatient$383$230Payer Rates
RESP VIRUS 12-25 TARGETSCPT 876337028086Outpatient$1,350$810Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 876357328012Outpatient$207$124Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 876357328013Outpatient$207$124Payer Rates
DETECT AGENT NOS DNA AMPCPT 877987028087Outpatient$114$68Payer Rates
DETECT AGENT NOS DNA AMPCPT 87798 (59)7028088Outpatient$114$68Payer Rates
HIV W/HIV1&2 ANTB W/OPTICCPT 878067024004Outpatient$164$98Payer Rates
STREP A ASSAY W/OPTICCPT 878807023797Outpatient$131$79Payer Rates
CYTOPATH C/V THIN LAYERCPT 88142 (TC)7400005Outpatient$83$50Payer Rates
TISSUE EXAM BY PATHOLOGISTCPT 88307 (TC)7400015Outpatient$620$372Payer Rates
SPECIMEN COLLECT COVID-19HCPCS G20237028090Outpatient$24$14Payer Rates
Language Pathology
SPEECH/HEARING THERAPYCPT 92507 (GN)4400001Outpatient$189$113Payer Rates
EVALUATE SPEECH PRODUCTIONCPT 92522 (GN)4400005Outpatient$221$133Payer Rates
ORAL FUNCTION THERAPYCPT 92526 (GN)4400008Outpatient$207$124Payer Rates
EVALUATE SWALLOWING FUNCTIONCPT 92610 (GN)4400016Outpatient$175$105Payer Rates
MOTION FLUOROSCOPY/SWALLOWCPT 92611 (GN)4400017Outpatient$211$127Payer Rates
MRI
MRI BRAIN STEM W/O DYECPT 705517226615Outpatient$1,029$617Payer Rates
MRI BRAIN STEM W/O & W/DYECPT 705537226617Outpatient$1,600$960Payer Rates
MRI NECK SPINE W/O DYECPT 721417226621Outpatient$1,029$617Payer Rates
MRI CHEST SPINE W/O DYECPT 721467226623Outpatient$1,029$617Payer Rates
MRI LUMBAR SPINE W/O DYECPT 721487226625Outpatient$1,029$617Payer Rates
MRI JOINT UPR EXTREM W/O DYECPT 732217226636Outpatient$1,029$617Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 737217226643Outpatient$1,029$617Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 938806724532Outpatient$573$344Payer Rates
LOWER EXTREMITY STUDYCPT 939256730060Outpatient$573$344Payer Rates
EXTREMITY STUDYCPT 939706730030Outpatient$573$344Payer Rates
EXTREMITY STUDYCPT 939716730080Outpatient$404$242Payer Rates
Other Procedures and Observation
WITHDRAWAL OF ARTERIAL BLOODCPT 366004124459Outpatient$526$316Payer Rates
BIOPSY OF PROSTATECPT 55700650025Outpatient$3,881$2,329Payer Rates
TREAT SPINAL CANAL LESIONCPT 622827922896Outpatient$7,725$4,635Payer Rates
IMMUNIZATION ADMINCPT 904718931056Outpatient$140$84Payer Rates
OFFICE O/P EST MINIMAL PROBCPT 99211 (25)3300002Outpatient$168$101Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 364307127013Outpatient$1,426$856Payer Rates
RED BLOOD CELLS UNITHCPCS P9021 (BL)7127014Outpatient$455$273Payer Rates
RED BLOOD CELLS UNITHCPCS P9021 (BL)7127017Outpatient$455$273Payer Rates
RED BLOOD CELLS UNITHCPCS P9021 (BL)7127018Outpatient$455$273Payer 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
VENT MGMT INPAT INIT DAYCPT 940024124440Outpatient$1,121$673Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947604124460Outpatient$15$9Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947614124465Outpatient$75$45Payer Rates
CARBON DIOXIDE EXP GAS DETER INFRARED ANCPT 947704124472Outpatient$576$346Payer Rates
Radiology
NJX AA&/STRD TFRM EPI L/S 1CPT 64483650008Outpatient$1,479$887Payer Rates
X-RAY EXAM OF NASAL BONESCPT 701606923075Outpatient$287$172Payer Rates
X-RAY EXAM OF SINUSESCPT 702106924190Outpatient$287$172Payer Rates
X-RAY EXAM OF NECKCPT 703606923134Outpatient$287$172Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 710456923013Outpatient$287$172Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 710456923176Outpatient$287$172Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 710466923014Outpatient$287$172Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (RT)6923086Outpatient$172$103Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (LT)6923099Outpatient$287$172Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 720406923101Outpatient$287$172Payer Rates
X-RAY EXAM NECK SPINE 4/5VWSCPT 720506923102Outpatient$454$272Payer Rates
X-RAY EXAM THORAC SPINE 2VWSCPT 720706923103Outpatient$287$172Payer Rates
X-RAY EXAM ENTIRE SPI 2/3 VWCPT 720826924194Outpatient$454$272Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 721006923105Outpatient$287$172Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 721106923107Outpatient$454$272Payer Rates
X-RAY EXAM L-S SPINE BENDINGCPT 721146924223Outpatient$454$272Payer Rates
X-RAY EXAM OF PELVISCPT 721706923130Outpatient$287$172Payer Rates
X-RAY EXAM SACRUM TAILBONECPT 722206923088Outpatient$287$172Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)6923094Outpatient$287$172Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)6923095Outpatient$287$172Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)6923122Outpatient$287$172Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)6923129Outpatient$287$172Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (RT)6923058Outpatient$287$172Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (LT)6950023Outpatient$287$172Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (RT)6923029Outpatient$287$172Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (LT)6950001Outpatient$287$172Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (RT)6923046Outpatient$287$172Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (LT)6950014Outpatient$287$172Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (RT)6923116Outpatient$287$172Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)6950017Outpatient$287$172Payer Rates
X-RAY EXAM OF HANDCPT 73130 (RT)6923071Outpatient$287$172Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)6950028Outpatient$287$172Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (RT)6923040Outpatient$287$172Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (LT)6950027Outpatient$287$172Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)6923047Outpatient$287$172Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)6923054Outpatient$287$172Payer Rates
X-RAY EXAM HIPS BI 2 VIEWSCPT 735216960050Outpatient$287$172Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (RT)6923036Outpatient$287$172Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT)6923037Outpatient$287$172Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (LT)6923062Outpatient$287$172Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (RT)6945018Outpatient$287$172Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)6923039Outpatient$287$172Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (50)6940511Outpatient$287$172Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (LT)6950024Outpatient$287$172Payer Rates
X-RAY EXAM KNEE 4 OR MORECPT 73564 (LT)6923124Outpatient$287$172Payer Rates
X-RAY EXAM KNEE 4 OR MORECPT 73564 (RT)6960030Outpatient$287$172Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (RT)6923065Outpatient$287$172Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)6923068Outpatient$287$172Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)6923125Outpatient$287$172Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)6950033Outpatient$287$172Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (RT)6923044Outpatient$287$172Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (LT)6950012Outpatient$287$172Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (RT)6923153Outpatient$287$172Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)6950013Outpatient$287$172Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 740186923004Outpatient$287$172Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 740186923060Outpatient$287$172Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 740196923010Outpatient$287$172Payer Rates
X-RAY EXAM ABDOMEN 3+ VIEWSCPT 740216924201Outpatient$287$172Payer Rates
X-RAY XM SWLNG FUNCJ C+CPT 742306924208Outpatient$509$305Payer Rates
X-RAY NOSE TO RECTUMCPT 760106924214Outpatient$287$172Payer Rates
ULTRASOUND BREAST COMPLETECPT 766416730123Outpatient$266$160Payer Rates
ULTRASOUND BREAST COMPLETECPT 76641 (50)6730126Outpatient$266$160Payer Rates
DXA BONE DENSITY AXIALCPT 770806600001Outpatient$437$262Payer Rates
Respiratory
AIRWAY INHALATION TREATMENTCPT 946404124452Outpatient$452$271Payer Rates
AIRWAY INHALATION TREATMENTCPT 946404124456Outpatient$316$190Payer Rates
POS AIRWAY PRESSURE CPAPCPT 946604124415Outpatient$318$191Payer Rates
CHEST WALL MANIPULATIONCPT 946674124432Outpatient$251$151Payer Rates
CHEST WALL MANIPULATIONCPT 946684124461Outpatient$126$76Payer Rates
THERAPEUTIC PROCD STRG ENDURHCPCS G02374124414Outpatient$126$76Payer Rates
Surgical Procedures
DRAINAGE OF SKIN ABSCESSCPT 100603222017Outpatient$854$512Payer Rates
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826-----
(Not Offered) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOS ...CPT 29881-----
DENTAL SURGERY PROCEDURECPT 418993222055Outpatient$450$270Payer Rates
(Not Offered) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIE ...CPT 42820-----
EGD DIAGNOSTIC BRUSH WASHCPT 432353222010Outpatient$2,151$1,291Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 432393222092Outpatient$1,912$1,147Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 453783222011Outpatient$2,150$1,290Payer Rates
COLONOSCOPY AND BIOPSYCPT 453803222029Outpatient$2,366$1,420Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 453853222249Outpatient$2,215$1,329Payer Rates
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...CPT 45391-----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 475623222013Outpatient$11,711$7,027Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 495053222069Outpatient$8,345$5,007Payer Rates
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...CPT 55866-----
OBSTETRICAL CARECPT 594003222072Outpatient$6,634$3,980Payer Rates
CESAREAN DELIVERYCPT 595103222025Outpatient$7,383$4,430Payer Rates
CESAREAN DELIVERY ONLYCPT 595143222118Outpatient$2,446$1,468Payer Rates
VBAC DELIVERYCPT 596103222089Outpatient$5,823$3,494Payer Rates
VBAC DELIVERY ONLYCPT 596123222141Outpatient$4,734$2,840Payer Rates
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323-----
(Not Offered) REMOVAL OF RECURRING CATARACT IN LENS CAPSUL ...CPT 66821-----
(Not Offered) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984-----
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...CPT 93452-----
Therapy
HOT OR COLD PACKS THERAPYCPT 97010 (GP)4200171Outpatient$16$10Payer Rates
HOT OR COLD PACKS THERAPYCPT 97010 (GP)4202169Outpatient$15$9Payer Rates
WHIRLPOOL THERAPYCPT 97022 (GP)4202006Outpatient$78$47Payer Rates
ELECTRICAL STIMULATIONCPT 97032 (GP)4200010Outpatient$64$38Payer Rates
ELECTRICAL STIMULATIONCPT 97032 (GP)4202010Outpatient$64$38Payer Rates
ULTRASOUND THERAPYCPT 97035 (GP)4202013Outpatient$43$26Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GO)450009Outpatient$105$63Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GP)4200016Outpatient$107$64Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GP)4202016Outpatient$107$64Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)4200017Outpatient$94$56Payer Rates
GAIT TRAINING THERAPYCPT 97116 (GP)4200019Outpatient$94$56Payer Rates
MASSAGE THERAPYCPT 97124 (GP)4200020Outpatient$89$53Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GP)4202022Outpatient$89$53Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)4200178Outpatient$125$75Payer Rates
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)4202177Outpatient$171$103Payer Rates
PT RE-EVAL EST PLAN CARECPT 97164 (GP)4200181Outpatient$184$110Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)4200024Outpatient$116$70Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)4202024Outpatient$116$70Payer Rates
SLINGSHCPCS A45656102012Outpatient$21$13Payer Rates
SLINGSHCPCS A45656140009Outpatient$36$22Payer Rates
SLINGSHCPCS A45656140010Outpatient$36$22Payer Rates
SLINGSHCPCS A45656140011Outpatient$36$22Payer Rates
LT COMPRES BAND <3"/YDHCPCS A64486102002Outpatient$4$2Payer Rates
LT COMPRES BAND >=3" <5"/YDHCPCS A64496102004Outpatient$6$4Payer Rates
CRUTCHES MEDIUM - MDSV80535HCPCS E01146102123Outpatient$64$38Payer Rates
ANKLE SPLINT MEDIUMHCPCS L19026140006Outpatient$96$58Payer Rates
Uncategorized
IMMUNIZATION ADMINCPT 904713000335Outpatient$140$84Payer Rates
CRUTCHES LARGE - MDSV80534HCPCS E01146103123Outpatient$77$46Payer Rates
BED PANHCPCS E02756102249Outpatient$4$2Payer Rates
URINAL 1000MLHCPCS E03256100711Outpatient$3$2Payer Rates
CASIRIVI AND IMDEVI INFUSIONHCPCS M0243204118Outpatient$928$557Payer Rates