Frio Regional Hospital

Price List for Shoppable Services. Effective 07-13-2022.

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	6207182	Outpatient	$1,092	$764	Payer Rates
CT MAXILLOFACIAL W/O DYE	CPT 70486	6207185	Outpatient	$1,092	$764	Payer Rates
CT MAXILLOFACIAL W/DYE	CPT 70487	6207186	Outpatient	$1,713	$1,199	Payer Rates
CT SOFT TISSUE NECK W/O DYE	CPT 70490	6207189	Outpatient	$1,092	$764	Payer Rates
CT SOFT TISSUE NECK W/DYE	CPT 70491	6207188	Outpatient	$1,713	$1,199	Payer Rates
CT ANGIOGRAPHY HEAD	CPT 70496	6207225	Outpatient	$1,070	$749	Payer Rates
CT ANGIOGRAPHY NECK	CPT 70498	6207226	Outpatient	$3,425	$2,398	Payer Rates
CT THORAX DX C-	CPT 71250	6207174	Outpatient	$1,092	$764	Payer Rates
CT THORAX DX C+	CPT 71260	6207175	Outpatient	$1,713	$1,199	Payer Rates
CT THORAX DX C-/C+	CPT 71270	6207173	Outpatient	$1,902	$1,331	Payer Rates
CT ANGIOGRAPHY CHEST	CPT 71275	6207228	Outpatient	$3,400	$2,380	Payer Rates
CT ANGIOGRAPHY CHEST	CPT 71275	6207239	Outpatient	$1,926	$1,348	Payer Rates
CT NECK SPINE W/O DYE	CPT 72125	6207198	Outpatient	$1,092	$764	Payer Rates
CT CHEST SPINE W/O DYE	CPT 72128	6207202	Outpatient	$1,092	$764	Payer Rates
CT LUMBAR SPINE W/O DYE	CPT 72131	6207204	Outpatient	$1,092	$764	Payer Rates
CT PELVIS W/O DYE	CPT 72192	6207194	Outpatient	$1,092	$764	Payer Rates
CT PELVIS W/DYE	CPT 72193	6207195	Outpatient	$1,713	$1,199	Payer Rates
CT UPPER EXTREMITY W/O DYE	CPT 73200	6207176	Outpatient	$1,092	$764	Payer Rates
CT LOWER EXTREMITY W/O DYE	CPT 73700	6207179	Outpatient	$1,092	$764	Payer Rates
CT LOWER EXTREMITY W/DYE	CPT 73701	6207180	Outpatient	$1,713	$1,199	Payer Rates
CT ABDOMEN W/O DYE	CPT 74150	6207171	Outpatient	$1,092	$764	Payer Rates
CT ABDOMEN W/O & W/DYE	CPT 74170	6207170	Outpatient	$1,902	$1,331	Payer Rates
CT ABD & PELV W/CONTRAST	CPT 74177	6207235	Outpatient	$3,977	$2,784	Payer Rates
CT ABD & PELV 1/> REGNS	CPT 74178	6207244	Outpatient	$3,400	$2,380	Payer Rates
3D RENDER W/INTRP POSTPROCES	CPT 76376	6207197	Outpatient	$351	$246	Payer Rates
Clinic
(Not Offered) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT ...	CPT 99203	-	-	-	-	-
(Not Offered) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT ...	CPT 99204	-	-	-	-	-
(Not Offered) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT ...	CPT 99205	-	-	-	-	-
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-	-
(Not Offered) PATIENT OFFICE CONSULTATION, 60 MIN	CPT 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 STUDY	CPT 95810	-	-	-	-	-
EKG
(Not Offered) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETAT ...	CPT 93000	-	-	-	-	-
ELECTROCARDIOGRAM TRACING	CPT 93005	7102007	Outpatient	$151	$106	Payer Rates
Emergency Room
DRAINAGE OF SKIN ABSCESS	CPT 10060	2900388	Outpatient	$700	$490	Payer Rates
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	2900291	Outpatient	$479	$335	Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	2900292	Outpatient	$452	$316	Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<	CPT 12011	2900286	Outpatient	$479	$335	Payer Rates
RPR F/E/E/N/L/M 2.6-5.0 CM	CPT 12013	2900287	Outpatient	$452	$316	Payer Rates
APPLY LONG ARM SPLINT	CPT 29105	2900297	Outpatient	$528	$370	Payer Rates
APPLY FOREARM SPLINT	CPT 29125	2900299	Outpatient	$528	$370	Payer Rates
APPLICATION OF FINGER SPLINT	CPT 29130	2900251	Outpatient	$301	$211	Payer Rates
APPLICATION LONG LEG SPLINT	CPT 29505	2900255	Outpatient	$528	$370	Payer Rates
APPLICATION LOWER LEG SPLINT	CPT 29515	2900256	Outpatient	$528	$370	Payer Rates
INSERT EMERGENCY AIRWAY	CPT 31500	2900394	Outpatient	$898	$629	Payer Rates
INSERT TEMP BLADDER CATH	CPT 51702	2900433	Outpatient	$278	$195	Payer Rates
CLEAR OUTER EAR CANAL	CPT 69200	2901270	Outpatient	$452	$316	Payer Rates
HEART/LUNG RESUSCITATION CPR	CPT 92950	2900442	Outpatient	$898	$629	Payer Rates
EMERGENCY DEPT VISIT	CPT 99282	2900427	Outpatient	$488	$342	Payer Rates
EMERGENCY DEPT VISIT	CPT 99283	2900428	Outpatient	$768	$538	Payer Rates
EMERGENCY DEPT VISIT	CPT 99284	2900429	Outpatient	$1,234	$864	Payer Rates
EMERGENCY DEPT VISIT	CPT 99285 (25)	2900430	Outpatient	$1,822	$1,275	Payer Rates
CRITICAL CARE FIRST HOUR	CPT 99291	2900443	Outpatient	$2,987	$2,091	Payer Rates
Gastro-Intestinal
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	2000016	Outpatient	$3,441	$2,409	Payer Rates
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239 (59)	2010017	Outpatient	$3,441	$2,409	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378	2000006	Outpatient	$3,855	$2,699	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378 (59)	2010006	Outpatient	$3,855	$2,699	Payer Rates
COLONOSCOPY AND BIOPSY	CPT 45380 (59)	2010010	Outpatient	$3,855	$2,699	Payer Rates
COLONOSCOPY W/LESION REMOVAL	CPT 45385	2000013	Outpatient	$3,816	$2,671	Payer Rates
IV Therapy
D5W INFUSION	HCPCS J7070	4104508	Outpatient	$14	$10	Payer Rates
Imaging
US EXAM OF HEAD AND NECK	CPT 76536	6808385	Outpatient	$555	$389	Payer Rates
ULTRASOUND BREAST COMPLETE	CPT 76641	6808942	Outpatient	$808	$566	Payer Rates
ULTRASOUND BREAST COMPLETE	CPT 76641 (LT)	6808943	Outpatient	$405	$284	Payer Rates
ULTRASOUND BREAST COMPLETE	CPT 76641 (RT)	6808944	Outpatient	$405	$284	Payer Rates
US EXAM ABDOM COMPLETE	CPT 76700	6808370	Outpatient	$555	$389	Payer Rates
ECHO EXAM OF ABDOMEN	CPT 76705	6808371	Outpatient	$555	$389	Payer Rates
ECHO EXAM OF ABDOMEN	CPT 76705	6808377	Outpatient	$555	$389	Payer Rates
ECHO EXAM OF ABDOMEN	CPT 76705	6808378	Outpatient	$555	$389	Payer Rates
US EXAM K TRANSPL W/DOPPLER	CPT 76776	6808382	Outpatient	$611	$428	Payer Rates
OB US < 14 WKS SINGLE FETUS	CPT 76801	6808406	Outpatient	$555	$389	Payer Rates
OB US >= 14 WKS SNGL FETUS	CPT 76805	6807362	Outpatient	$555	$389	Payer Rates
OB US >= 14 WKS SNGL FETUS	CPT 76805	6808375	Outpatient	$555	$389	Payer Rates
OB US FOLLOW-UP PER FETUS	CPT 76816	6808405	Outpatient	$361	$253	Payer Rates
TRANSVAGINAL US NON-OB	CPT 76830	6808391	Outpatient	$555	$389	Payer Rates
US EXAM PELVIC COMPLETE	CPT 76856	6808380	Outpatient	$555	$389	Payer Rates
US EXAM SCROTUM	CPT 76870	6808384	Outpatient	$555	$389	Payer Rates
ECHO EXAMINATION PROCEDURE	CPT 76999	6808392	Outpatient	$361	$253	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	3508554	Outpatient	$655	$458	Payer Rates
Laboratory
ROUTINE VENIPUNCTURE	CPT 36415	4409070	Outpatient	$19	$13	Payer Rates
METABOLIC PANEL TOTAL CA	CPT 80048	4406958	Outpatient	$124	$87	Payer Rates
GENERAL HEALTH PANEL	CPT 80050	4403349	Outpatient	$270	$189	Payer Rates
COMPREHEN METABOLIC PANEL	CPT 80053	4406043	Outpatient	$124	$87	Payer Rates
OBSTETRIC PANEL	CPT 80055	4406248	Outpatient	$89	$62	Payer Rates
LIPID PANEL	CPT 80061	4406106	Outpatient	$109	$76	Payer Rates
RENAL FUNCTION PANEL	CPT 80069	4406355	Outpatient	$112	$78	Payer Rates
HEPATIC FUNCTION PANEL	CPT 80076	4406127	Outpatient	$190	$133	Payer Rates
ASSAY OF DIGOXIN TOTAL	CPT 80162	4406067	Outpatient	$108	$76	Payer Rates
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	4406246	Outpatient	$110	$77	Payer Rates
ASSAY OF GENTAMICIN	CPT 80170	4403433	Outpatient	$134	$94	Payer Rates
ASSAY OF LITHIUM	CPT 80178	4406109	Outpatient	$58	$41	Payer Rates
ASSAY OF PHENYTOIN TOTAL	CPT 80185	4406068	Outpatient	$108	$76	Payer Rates
ASSAY OF TACROLIMUS	CPT 80197	4409092	Outpatient	$278	$195	Payer Rates
ASSAY OF VANCOMYCIN	CPT 80202	4409011	Outpatient	$110	$77	Payer Rates
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	4406069	Outpatient	$91	$64	Payer Rates
ANALGESICS NON-OPIOID 1 OR 2	CPT 80329	4406151	Outpatient	$66	$46	Payer Rates
BENZODIAZEPINES1-12	CPT 80346	4403315	Outpatient	$227	$159	Payer Rates
METHYLENEDIOXYAMPHETAMINES	CPT 80359	4403324	Outpatient	$227	$159	Payer Rates
OPIATES 1 OR MORE	CPT 80361	4403322	Outpatient	$227	$159	Payer Rates
URINALYSIS NONAUTO W/SCOPE	CPT 81000 (91)	4416169	Outpatient	$32	$22	Payer Rates
URINALYSIS AUTO W/SCOPE	CPT 81001	4403539	Outpatient	$37	$26	Payer Rates
URINALYSIS AUTO W/SCOPE	CPT 81001	4406169	Outpatient	$37	$26	Payer Rates
URINALYSIS NONAUTO W/O SCOPE	CPT 81002	4406202	Outpatient	$23	$16	Payer Rates
URINALYSIS AUTO W/O SCOPE	CPT 81003	4403560	Outpatient	$19	$13	Payer Rates
TEST FOR ACETONE/KETONES	CPT 82009	4406974	Outpatient	$39	$27	Payer Rates
UR ALBUMIN SEMIQUANTITATIVE	CPT 82044	4409098	Outpatient	$112	$78	Payer Rates
ALPHA-FETOPROTEIN SERUM	CPT 82105	4406233	Outpatient	$137	$96	Payer Rates
ASSAY OF AMMONIA	CPT 82140	4406014	Outpatient	$120	$84	Payer Rates
ASSAY OF AMYLASE	CPT 82150	4406015	Outpatient	$67	$47	Payer Rates
BILIRUBIN TOTAL	CPT 82247	4409200	Outpatient	$57	$40	Payer Rates
BILIRUBIN DIRECT	CPT 82248	4409201	Outpatient	$57	$40	Payer Rates
OCCULT BLOOD FECES	CPT 82270	4406116	Outpatient	$31	$22	Payer Rates
CARCINOEMBRYONIC ANTIGEN	CPT 82378	4406038	Outpatient	$152	$106	Payer Rates
TOTAL CORTISOL	CPT 82533	4406300	Outpatient	$133	$93	Payer Rates
ASSAY OF CK (CPK)	CPT 82550	4406059	Outpatient	$67	$47	Payer Rates
CREATINE MB FRACTION	CPT 82553	4406060	Outpatient	$112	$78	Payer Rates
ASSAY OF CREATININE	CPT 82565	4406057	Outpatient	$56	$39	Payer Rates
ASSAY OF URINE CREATININE	CPT 82570	4406061	Outpatient	$44	$31	Payer Rates
VITAMIN B-12	CPT 82607	4409080	Outpatient	$124	$87	Payer Rates
ASSAY OF TOTAL ESTRADIOL	CPT 82670	4409101	Outpatient	$227	$159	Payer Rates
ASSAY OF FERRITIN	CPT 82728	4406940	Outpatient	$111	$78	Payer Rates
ASSAY OF FOLIC ACID SERUM	CPT 82746	4406917	Outpatient	$121	$85	Payer Rates
BLOOD GASES ANY COMBINATION	CPT 82803	4403444	Outpatient	$162	$113	Payer Rates
BLOOD GASES ANY COMBINATION	CPT 82803	4406312	Outpatient	$162	$113	Payer Rates
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	4406160	Outpatient	$44	$31	Payer Rates
REAGENT STRIP/BLOOD GLUCOSE	CPT 82948	4403725	Outpatient	$29	$20	Payer Rates
GTT-ADDED SAMPLES	CPT 82952	4406255	Outpatient	$40	$28	Payer Rates
ASSAY OF GGT	CPT 82977	4406911	Outpatient	$61	$43	Payer Rates
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	4406825	Outpatient	$150	$105	Payer Rates
ASSAY OF GONADOTROPIN (LH)	CPT 83002	4406984	Outpatient	$150	$105	Payer Rates
H PYLORI (C-13) BREATH	CPT 83013	4403640	Outpatient	$522	$365	Payer Rates
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	4406088	Outpatient	$80	$56	Payer Rates
ASSAY OF INSULIN	CPT 83525	4406232	Outpatient	$94	$66	Payer Rates
ASSAY OF IRON	CPT 83540	4406101	Outpatient	$64	$45	Payer Rates
ASSAY OF IRON	CPT 83540	4409030	Outpatient	$54	$38	Payer Rates
IRON BINDING TEST	CPT 83550	4409076	Outpatient	$73	$51	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	4403722	Outpatient	$100	$70	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	4403723	Outpatient	$100	$70	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	4403724	Outpatient	$100	$70	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	4406185	Outpatient	$100	$70	Payer Rates
LACTATE (LD) (LDH) ENZYME	CPT 83615	4406103	Outpatient	$64	$45	Payer Rates
ASSAY OF LIPASE	CPT 83690	4406105	Outpatient	$58	$41	Payer Rates
ASSAY OF MAGNESIUM	CPT 83735	4406241	Outpatient	$57	$40	Payer Rates
ASSAY OF MYOGLOBIN	CPT 83874	4409171	Outpatient	$105	$74	Payer Rates
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	4406506	Outpatient	$417	$292	Payer Rates
ASSAY NEPHELOMETRY NOT SPEC	CPT 83883	4403284	Outpatient	$114	$80	Payer Rates
ASSAY OF PARATHORMONE	CPT 83970	4406228	Outpatient	$333	$233	Payer Rates
ASSAY OF PHOSPHORUS	CPT 84100	4406122	Outpatient	$46	$32	Payer Rates
ASSAY OF SERUM POTASSIUM	CPT 84132	4406130	Outpatient	$41	$29	Payer Rates
ASSAY OF PREALBUMIN	CPT 84134	4403311	Outpatient	$158	$111	Payer Rates
ASSAY OF PROLACTIN	CPT 84146	4406929	Outpatient	$157	$110	Payer Rates
(Not Offered) TOTAL PROSTATE-SPECIFIC ANTIGEN (PSA) TEST	CPT 84153	-	-	-	-	-
(Not Offered) TOTAL PROSTATE-SPECIFIC ANTIGEN (PSA) TEST	CPT 84154	-	-	-	-	-
ASSAY OF PROTEIN SERUM	CPT 84155	4406137	Outpatient	$34	$24	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	4403285	Outpatient	$53	$37	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	4406139	Outpatient	$53	$37	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	4406163	Outpatient	$50	$35	Payer Rates
PROTEIN E-PHORESIS SERUM	CPT 84165	4406134	Outpatient	$89	$62	Payer Rates
ASSAY OF SERUM SODIUM	CPT 84295	4406158	Outpatient	$42	$29	Payer Rates
ASSAY OF FREE TESTOSTERONE	CPT 84402	4409009	Outpatient	$261	$183	Payer Rates
ASSAY OF VITAMIN B-1	CPT 84425	4409073	Outpatient	$222	$155	Payer Rates
ASSAY OF TOTAL THYROXINE	CPT 84436	4406209	Outpatient	$58	$41	Payer Rates
ASSAY OF FREE THYROXINE	CPT 84439	4406162	Outpatient	$128	$90	Payer Rates
ASSAY THYROID STIM HORMONE	CPT 84443	4406217	Outpatient	$137	$96	Payer Rates
ASSAY OF TRIGLYCERIDES	CPT 84478	4406166	Outpatient	$70	$49	Payer Rates
ASSAY OF THYROID (T3 OR T4)	CPT 84479	4406227	Outpatient	$108	$76	Payer Rates
FREE ASSAY (FT-3)	CPT 84481	4403297	Outpatient	$251	$176	Payer Rates
ASSAY OF TROPONIN QUANT	CPT 84484	4409173	Outpatient	$82	$57	Payer Rates
ASSAY OF TROPONIN QUANT	CPT 84484	4409179	Outpatient	$82	$57	Payer Rates
ASSAY OF UREA NITROGEN	CPT 84520	4406167	Outpatient	$43	$30	Payer Rates
ASSAY OF BLOOD/URIC ACID	CPT 84550	4406168	Outpatient	$42	$29	Payer Rates
CHORIONIC GONADOTROPIN TEST	CPT 84702	4406928	Outpatient	$176	$123	Payer Rates
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	4406131	Outpatient	$63	$44	Payer Rates
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	4406208	Outpatient	$63	$44	Payer Rates
HEMATOCRIT	CPT 85014	4406093	Outpatient	$27	$19	Payer Rates
HEMOGLOBIN	CPT 85018	4406094	Outpatient	$27	$19	Payer Rates
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	4406051	Outpatient	$66	$46	Payer Rates
(Not Offered) COMPLETE BLOOD CELL COUNT (CBC), AUTOMATED	CPT 85027	-	-	-	-	-
MANUAL RETICULOCYTE COUNT	CPT 85044	4406147	Outpatient	$39	$27	Payer Rates
BLOOD SMEAR INTERPRETATION	CPT 85060	4403415	Outpatient	$80	$56	Payer Rates
FIBRIN DEGRADATION QUANT	CPT 85379	4409192	Outpatient	$106	$74	Payer Rates
PROTHROMBIN TIME	CPT 85610	4406141	Outpatient	$44	$31	Payer Rates
PROTHROMBIN TIME	CPT 85610	4416141	Outpatient	$43	$30	Payer Rates
RBC SED RATE AUTOMATED	CPT 85652	4406152	Outpatient	$39	$27	Payer Rates
THROMBOPLASTIN TIME PARTIAL	CPT 85730	4406120	Outpatient	$52	$36	Payer Rates
THROMBOPLASTIN TIME PARTIAL	CPT 85730	4416120	Outpatient	$49	$34	Payer Rates
ANTINUCLEAR ANTIBODIES	CPT 86038	4406019	Outpatient	$99	$69	Payer Rates
C-REACTIVE PROTEIN	CPT 86140	4406056	Outpatient	$49	$34	Payer Rates
COMPLEMENT ANTIGEN	CPT 86160	4409060	Outpatient	$106	$74	Payer Rates
FLUORESCENT ANTIBODY TITER	CPT 86256	4409058	Outpatient	$110	$77	Payer Rates
HETEROPHILE ANTIBODY SCREEN	CPT 86308	4406115	Outpatient	$44	$31	Payer Rates
RHEUMATOID FACTOR TEST QUAL	CPT 86430	4406149	Outpatient	$47	$33	Payer Rates
TB TEST CELL IMMUN MEASURE	CPT 86480	4403485	Outpatient	$502	$351	Payer Rates
SYPHILIS TEST NON-TREP QUAL	CPT 86592	4406144	Outpatient	$39	$27	Payer Rates
HELICOBACTER PYLORI ANTIBODY	CPT 86677	4409036	Outpatient	$184	$129	Payer Rates
HEP B SURFACE ANTIBODY	CPT 86706	4409096	Outpatient	$120	$84	Payer Rates
HEPATITIS A ANTIBODY	CPT 86708	4408520	Outpatient	$127	$89	Payer Rates
MUMPS ANTIBODY	CPT 86735	4406998	Outpatient	$106	$74	Payer Rates
RUBELLA ANTIBODY	CPT 86762	4406150	Outpatient	$119	$83	Payer Rates
SARS-COV-2 COVID-19 ANTIBODY	CPT 86769	4403693	Outpatient	$230	$161	Payer Rates
SARS-COV-2 COVID-19 ANTIBODY	CPT 86769	4403694	Outpatient	$230	$161	Payer Rates
VARICELLA-ZOSTER ANTIBODY	CPT 86787	4409067	Outpatient	$139	$97	Payer Rates
HEPATITIS C AB TEST	CPT 86803	4406969	Outpatient	$124	$87	Payer Rates
COOMBS TEST DIRECT	CPT 86880	4406052	Outpatient	$46	$32	Payer Rates
COOMBS TEST INDIRECT QUAL	CPT 86885	4406053	Outpatient	$57	$40	Payer Rates
COOMBS TEST INDIRECT QUAL	CPT 86885	5008027	Outpatient	$53	$37	Payer Rates
BLOOD TYPING SEROLOGIC ABO	CPT 86900	4406031	Outpatient	$44	$31	Payer Rates
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	4406032	Outpatient	$30	$21	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	5008014	Outpatient	$151	$106	Payer Rates
COMPATIBILITY TEST INCUBATE	CPT 86921	5008016	Outpatient	$148	$104	Payer Rates
COMPATIBILITY TEST ANTIGLOB	CPT 86922	5008015	Outpatient	$257	$180	Payer Rates
BLOOD CULTURE FOR BACTERIA	CPT 87040	4406029	Outpatient	$86	$60	Payer Rates
FECES CULTURE AEROBIC BACT	CPT 87045	4409082	Outpatient	$78	$55	Payer Rates
CULTURE SCREEN ONLY	CPT 87081	4403501	Outpatient	$162	$113	Payer Rates
URINE CULTURE/COLONY COUNT	CPT 87086	4406063	Outpatient	$72	$50	Payer Rates
OVA AND PARASITES SMEARS	CPT 87177	4406118	Outpatient	$73	$51	Payer Rates
MICROBE SUSCEPTIBLE MIC	CPT 87186	4409079	Outpatient	$73	$51	Payer Rates
SMEAR GRAM STAIN	CPT 87205	4406922	Outpatient	$42	$29	Payer Rates
SMEAR WET MOUNT SALINE/INK	CPT 87210	4406175	Outpatient	$39	$27	Payer Rates
CLOSTRIDIUM AG IA	CPT 87324	4409150	Outpatient	$155	$109	Payer Rates
HPYLORI STOOL AG IA	CPT 87338	4406078	Outpatient	$273	$191	Payer Rates
HEPATITIS B SURFACE AG IA	CPT 87340	4406970	Outpatient	$86	$60	Payer Rates
CHYLMD TRACH DNA AMP PROBE	CPT 87491	4406111	Outpatient	$306	$214	Payer Rates
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	4409142	Outpatient	$677	$474	Payer Rates
RESP VIRUS 12-25 TARGETS	CPT 87633	4403742	Outpatient	$1,389	$972	Payer Rates
TRICHOMONAS VAGINALIS AMPLIF	CPT 87661	4403404	Outpatient	$267	$187	Payer Rates
INFLUENZA ASSAY W/OPTIC	CPT 87804	4403447	Outpatient	$94	$66	Payer Rates
INFLUENZA ASSAY W/OPTIC	CPT 87804	4403448	Outpatient	$94	$66	Payer Rates
HIV W/HIV1&2 ANTB W/OPTIC	CPT 87806	4406963	Outpatient	$153	$107	Payer Rates
RSV ASSAY W/OPTIC	CPT 87807	4406991	Outpatient	$99	$69	Payer Rates
STREP A ASSAY W/OPTIC	CPT 87880	4406199	Outpatient	$62	$43	Payer Rates
CYTOPATH C/V AUTO FLUID REDO	CPT 88175	4403641	Outpatient	$205	$144	Payer Rates
TISSUE EXAM BY PATHOLOGIST	CPT 88302	4403450	Outpatient	$77	$54	Payer Rates
TISSUE EXAM BY PATHOLOGIST	CPT 88305	4403409	Outpatient	$152	$106	Payer Rates
TISSUE EXAM BY PATHOLOGIST	CPT 88307	4403410	Outpatient	$892	$624	Payer Rates
SPECIAL STAINS GROUP 1	CPT 88312	4403571	Outpatient	$152	$106	Payer Rates
IMMUNOHISTO ANTB ADDL SLIDE	CPT 88341	4403625	Outpatient	$333	$233	Payer Rates
IMMUNOHISTO ANTB 1ST STAIN	CPT 88342	4406951	Outpatient	$457	$320	Payer Rates
COVID-19 SPECIMEN COLLECTION FEE	HCPCS C9803	4403698	Outpatient	$123	$86	Payer Rates
Language Pathology
SPEECH/HEARING THERAPY	CPT 92507 (GN)	8909710	Outpatient	$411	$288	Payer Rates
SPEECH SOUND LANG COMPREHEN	CPT 92523 (GN)	8907711	Outpatient	$1,034	$724	Payer Rates
ORAL FUNCTION THERAPY	CPT 92526 (GN)	8909713	Outpatient	$452	$316	Payer Rates
EVALUATE SWALLOWING FUNCTION	CPT 92610 (GN)	8909712	Outpatient	$372	$260	Payer Rates
MRI
(Not Offered) MRI SCAN	CPT 70553	-	-	-	-	-
(Not Offered) MRI SCAN OF LOWER SPINAL CANAL	CPT 72148	-	-	-	-	-
(Not Offered) MRI SCAN OF LEG JOINT	CPT 73721	-	-	-	-	-
Other Diagnostic
EXTRACRANIAL BILAT STUDY	CPT 93880	7710009	Outpatient	$864	$605	Payer Rates
EXTREMITY STUDY	CPT 93970	7710010	Outpatient	$1,130	$791	Payer Rates
EXTREMITY STUDY	CPT 93970	7710017	Outpatient	$1,130	$791	Payer Rates
EXTREMITY STUDY	CPT 93971	7710011	Outpatient	$797	$558	Payer Rates
EXTREMITY STUDY	CPT 93971	7710014	Outpatient	$797	$558	Payer Rates
Other Procedures and Observation
OFFICE O/P EST MINIMAL PROB	CPT 99211	3508452	Outpatient	$314	$220	Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	2901252	Outpatient	$1,453	$1,017	Payer Rates
BLOOD TRANSFUSION SERVICE	CPT 36430	3508465	Outpatient	$1,437	$1,006	Payer Rates
RED BLOOD CELLS UNIT	HCPCS P9021	5006955	Outpatient	$847	$593	Payer Rates
RED BLOOD CELLS UNIT	HCPCS P9021	5008017	Outpatient	$847	$593	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
MEASURE BLOOD OXYGEN LEVEL	CPT 94760	8001569	Outpatient	$114	$80	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94760	80000760	Outpatient	$114	$80	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94760	80008154	Outpatient	$114	$80	Payer Rates
Radiology
X-RAY EXAM CHEST 1 VIEW	CPT 71045	5607042	Outpatient	$257	$180	Payer Rates
X-RAY EXAM CHEST 1 VIEW	CPT 71045	5607058	Outpatient	$257	$180	Payer Rates
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	5607059	Outpatient	$257	$180	Payer Rates
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	5607100	Outpatient	$257	$180	Payer Rates
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	5607101	Outpatient	$430	$301	Payer Rates
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	5607103	Outpatient	$257	$180	Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	5607105	Outpatient	$257	$180	Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	5607125	Outpatient	$430	$301	Payer Rates
X-RAY EXAM OF PELVIS	CPT 72170	5607088	Outpatient	$257	$180	Payer Rates
X-RAY EXAM SACRUM TAILBONE	CPT 72220	5607066	Outpatient	$257	$180	Payer Rates
X-RAY EXAM SACRUM TAILBONE	CPT 72220	5607159	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF COLLAR BONE	CPT 73000 (LT)	5617064	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73030 (RT)	5607095	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73030 (LT)	5617095	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF HUMERUS	CPT 73060 (RT)	5607117	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF HUMERUS	CPT 73060 (LT)	5617117	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73070 (RT)	5607068	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73070 (LT)	5617068	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73080 (RT)	5607146	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73080 (LT)	5617146	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FOREARM	CPT 73090 (RT)	5607076	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FOREARM	CPT 73090 (LT)	5617076	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF WRIST	CPT 73100 (RT)	5607112	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF WRIST	CPT 73100 (LT)	5617151	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF WRIST	CPT 73110 (RT)	5607149	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF WRIST	CPT 73110 (LT)	5617149	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF HAND	CPT 73120 (RT)	5607080	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF HAND	CPT 73120 (LT)	5617080	Outpatient	$254	$178	Payer Rates
X-RAY EXAM OF HAND	CPT 73130 (RT)	5607144	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF HAND	CPT 73130 (LT)	5617144	Outpatient	$257	$180	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	5607083	Outpatient	$257	$180	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502 (LT)	5617083	Outpatient	$257	$180	Payer Rates
X-RAY EXAM HIPS BI 2 VIEWS	CPT 73521	5607043	Outpatient	$514	$360	Payer Rates
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (RT)	5607072	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (LT)	5617072	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (RT)	5607084	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (LT)	5617084	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF KNEE 3	CPT 73562 (RT)	5607147	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF KNEE 3	CPT 73562 (LT)	5617147	Outpatient	$257	$180	Payer Rates
X-RAY EXAM KNEE 4 OR MORE	CPT 73564 (RT)	5607163	Outpatient	$396	$277	Payer Rates
X-RAY EXAM KNEE 4 OR MORE	CPT 73564 (LT)	5617163	Outpatient	$396	$277	Payer Rates
X-RAY EXAM OF LOWER LEG	CPT 73590 (RT)	5607085	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF LOWER LEG	CPT 73590 (LT)	5617085	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73600 (RT)	5607054	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73600 (LT)	5617054	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73610 (RT)	5607145	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73610 (LT)	5617145	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FOOT	CPT 73620 (RT)	5607075	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FOOT	CPT 73620 (LT)	5617075	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630 (RT)	5607153	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630 (LT)	5617153	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF TOE(S)	CPT 73660 (RT)	5607106	Outpatient	$257	$180	Payer Rates
X-RAY EXAM OF TOE(S)	CPT 73660 (LT)	5617106	Outpatient	$257	$180	Payer Rates
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	5607051	Outpatient	$257	$180	Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	5607053	Outpatient	$257	$180	Payer Rates
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	5607400	Outpatient	$430	$301	Payer Rates
Respiratory
AIRWAY INHALATION TREATMENT	CPT 94640	808102	Outpatient	$94	$66	Payer Rates
Surgical Procedures
(Not Offered) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN P ...	CPT 19120	-	-	-	-	-
(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	-	-	-	-	-
(Not Offered) REMOVAL OF GALLBLADDER USING AN ENDOSCOPE	CPT 47562	-	-	-	-	-
PRP I/HERN INIT REDUC >5 YR	CPT 49505	2000119	Outpatient	$9,748	$6,824	Payer Rates
(Not Offered) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-	-
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...	CPT 55866	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...	CPT 59610	-	-	-	-	-
NJX INTERLAMINAR LMBR/SAC	CPT 62322	2000096	Outpatient	$3,154	$2,208	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 (RT)	2000048	Outpatient	$2,291	$1,604	Payer Rates
XCAPSL CTRC RMVL W/O ECP	CPT 66984 (RT)	2000070	Outpatient	$9,645	$6,752	Payer Rates
XCAPSL CTRC RMVL W/O ECP	CPT 66984 (LT)	2010070	Outpatient	$9,645	$6,752	Payer Rates
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...	CPT 93452	-	-	-	-	-
INJECTION, BUPIVICAINE HYDRO	HCPCS S0020	3803684	Outpatient	$23	$16	Payer Rates
Therapy
HOT OR COLD PACKS THERAPY	CPT 97010 (GP)	8907708	Outpatient	$41	$29	Payer Rates
HOT OR COLD PACKS THERAPY	CPT 97010 (GO)	8908828	Outpatient	$41	$29	Payer Rates
ELECTRIC STIMULATION THERAPY	CPT 97014 (GO)	8908802	Outpatient	$85	$59	Payer Rates
PARAFFIN BATH THERAPY	CPT 97018 (GO)	8908805	Outpatient	$60	$42	Payer Rates
ELECTRICAL STIMULATION	CPT 97032 (GO)	8908804	Outpatient	$102	$71	Payer Rates
ULTRASOUND THERAPY	CPT 97035 (GO)	8908808	Outpatient	$69	$48	Payer Rates
THERAPEUTIC EXERCISES	CPT 97110 (GP)	8907790	Outpatient	$171	$120	Payer Rates
THERAPEUTIC EXERCISES	CPT 97110 (95)	8908760	Outpatient	$171	$120	Payer Rates
THERAPEUTIC EXERCISES	CPT 97110 (GO)	8908770	Outpatient	$171	$120	Payer Rates
NEUROMUSCULAR REEDUCATION	CPT 97112 (GP)	8907791	Outpatient	$179	$125	Payer Rates
NEUROMUSCULAR REEDUCATION	CPT 97112 (GO)	8908771	Outpatient	$179	$125	Payer Rates
GAIT TRAINING THERAPY	CPT 97116 (GP)	8907792	Outpatient	$151	$106	Payer Rates
THER IVNTJ 1ST 15 MIN	CPT 97129	8907860	Outpatient	$25	$18	Payer Rates
THER IVNTJ EA ADDL 15 MIN	CPT 97130	8907861	Outpatient	$24	$17	Payer Rates
MANUAL THERAPY 1/> REGIONS	CPT 97140 (GP)	8907842	Outpatient	$160	$112	Payer Rates
MANUAL THERAPY 1/> REGIONS	CPT 97140 (GO)	8908792	Outpatient	$160	$112	Payer Rates
PT EVAL LOW COMPLEX 20 MIN	CPT 97161 (GP)	8907770	Outpatient	$400	$280	Payer Rates
PT EVAL MOD COMPLEX 30 MIN	CPT 97162 (GP)	8907771	Outpatient	$400	$280	Payer Rates
PT EVAL HIGH COMPLEX 45 MIN	CPT 97163 (GP)	8907772	Outpatient	$400	$280	Payer Rates
PT RE-EVAL EST PLAN CARE	CPT 97164 (GP)	8907774	Outpatient	$226	$158	Payer Rates
OT EVAL LOW COMPLEX 30 MIN	CPT 97165 (95)	8908811	Outpatient	$451	$316	Payer Rates
OT EVAL MOD COMPLEX 45 MIN	CPT 97166 (GO)	8908810	Outpatient	$451	$316	Payer Rates
OT EVAL HIGH COMPLEX 60 MIN	CPT 97167 (GO)	8908813	Outpatient	$451	$316	Payer Rates
OT RE-EVAL EST PLAN CARE	CPT 97168 (GO)	8908814	Outpatient	$282	$197	Payer Rates
OT RE-EVAL EST PLAN CARE	CPT 97168 (95)	8908815	Outpatient	$282	$197	Payer Rates
THERAPEUTIC ACTIVITIES	CPT 97530 (GP)	8907812	Outpatient	$186	$130	Payer Rates
THERAPEUTIC ACTIVITIES	CPT 97530 (GO)	8908830	Outpatient	$186	$130	Payer Rates
THERAPEUTIC ACTIVITIES	CPT 97530 (95)	89008860	Outpatient	$429	$300	Payer Rates
SELF CARE MNGMENT TRAINING	CPT 97535 (GP)	8907813	Outpatient	$185	$130	Payer Rates
SELF CARE MNGMENT TRAINING	CPT 97535 (GO)	8908773	Outpatient	$185	$130	Payer Rates
ELEC STIM OTHER THAN WOUND	HCPCS G0283 (GP)	8907779	Outpatient	$76	$53	Payer Rates