Geary Community Hospital

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 70450Outpatient72316$1,853
CT HEAD/BRAIN W/DYECPT 70460Outpatient72317$1,976
CT HEAD/BRAIN W/O & W/DYECPT 70470Outpatient72318$2,448
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient72330$1,846
CT MAXILLOFACIAL W/DYECPT 70487Outpatient72331$2,056
CT MAXILLOFACIAL W/O & W/DYECPT 70488Outpatient72332$2,473
CT SOFT TISSUE NECK W/O DYECPT 70490Outpatient72323$1,671
CT SOFT TISSUE NECK W/DYECPT 70491Outpatient72324$2,016
CT SFT TSUE NCK W/O & W/DYECPT 70492Outpatient72325$2,423
CT ANGIOGRAPHY HEADCPT 70496Outpatient72639$1,639
CT ANGIOGRAPHY NECKCPT 70498Outpatient72640$1,639
CT THORAX DX C-CPT 71250Outpatient72307$1,830
CT THORAX DX C+CPT 71260Outpatient72308$2,423
CT THORAX DX C-/C+CPT 71270Outpatient72309$2,907
CT ANGIOGRAPHY CHESTCPT 71275Outpatient72641$2,798
CT NECK SPINE W/O DYECPT 72125Outpatient72333$2,685
CT NECK SPINE W/DYECPT 72126Outpatient72334$3,436
CT NECK SPINE W/O & W/DYECPT 72127Outpatient72335$4,123
CT CHEST SPINE W/O DYECPT 72128Outpatient72636$1,008
CT CHEST SPINE W/DYECPT 72129Outpatient72637$1,639
CT CHEST SPINE W/O & W/DYECPT 72130Outpatient72638$1,967
CT LUMBAR SPINE W/O DYECPT 72131Outpatient72322$1,008
CT LUMBAR SPINE W/DYECPT 72132Outpatient76991$3,436
CT LUMBAR SPINE W/O & W/DYECPT 72133Outpatient76992$4,123
CT ANGIOGRAPH PELV W/O&W/DYECPT 72191Outpatient72642$1,639
CT PELVIS W/O DYECPT 72192Outpatient72319$1,008
CT PELVIS W/DYECPT 72193Outpatient72320$1,639
CT PELVIS W/O & W/DYECPT 72194Outpatient72321$1,967
CT ANGIO UPR EXTRM W/O&W/DYECPT 73206Outpatient72643$1,639
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient72313$1,008
CT LOWER EXTREMITY W/DYECPT 73701Outpatient72314$1,639
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient72315$1,967
CT ANGIO LWR EXTR W/O&W/DYECPT 73706Outpatient72644$1,639
CT ABDOMEN W/O DYECPT 74150Outpatient72301$1,008
CT ABDOMEN W/DYECPT 74160Outpatient72302$1,639
CT ABDOMEN W/O & W/DYECPT 74170Outpatient72303$1,967
CT ANGIO ABDOM W/O & W/DYECPT 74175Outpatient72645$1,639
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient77090$4,089
CT ABD & PELV W/CONTRASTCPT 74177Outpatient77091$4,785
CT ANGIO ABDOMINAL ARTERIESCPT 75635Outpatient72646$1,639
CT SCAN FOR NEEDLE BIOPSYCPT 77012Outpatient72338$1,266
Clinic
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient170132$191
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient170133$292
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient170134$369
(N/O) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243----
(N/O) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244----
PREV VISIT NEW AGE 18-39CPT 99385Outpatient170161$338
(N/O) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EVALUATION ...CPT 99386----
INIT PM E/M NEW PAT 65+ YRSCPT 99387Outpatient170163$298
EEG
POLYSOM 6/> YRS 4/> PARAMCPT 95810Outpatient66070$4,544
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...CPT 93000----
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient65018$296
Imaging
ULTRASOUND BREAST COMPLETECPT 76641Outpatient75020$784
ULTRASOUND BREAST LIMITEDCPT 76642Outpatient78004$558
US EXAM ABDOM COMPLETECPT 76700Outpatient75018$784
OB US < 14 WKS SINGLE FETUSCPT 76801Outpatient76973$784
OB US >= 14 WKS SNGL FETUSCPT 76805Outpatient75022$784
OB US DETAILED SNGL FETUSCPT 76811Outpatient76986$1,631
OB US LIMITED FETUS(S)CPT 76815Outpatient76815$784
OB US FOLLOW-UP PER FETUSCPT 76816Outpatient76988$784
TRANSVAGINAL US OBSTETRICCPT 76817Outpatient76989$784
TRANSVAGINAL US NON-OBCPT 76830Outpatient75028$784
ECHO EXAM UTERUSCPT 76831Outpatient75051$1,631
US EXAM PELVIC COMPLETECPT 76856Outpatient75023$941
US EXAM PELVIC LIMITEDCPT 76857Outpatient76817$784
DX MAMMO INCL CAD UNICPT 77065Outpatient73010$278
DX MAMMO INCL CAD BICPT 77066Outpatient73009$339
SCR MAMMO BI INCL CADCPT 77067Outpatient73007$340
BRAIN IMAGING (PET)CPT 78608Outpatient72569$5,772
PET IMAGE W/CT SKULL-THIGHCPT 78815 (PS)Outpatient72564$5,772
PET IMAGE W/CT FULL BODYCPT 78816Outpatient79102$5,772
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460----
MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...DRG 470Inpatient-$51,224
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473----
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...DRG 743Inpatient-$34,084
Laboratory
ROUTINE VENIPUNCTURECPT 36415Outpatient89620$30
METABOLIC PANEL TOTAL CACPT 80048Outpatient89936$233
GENERAL HEALTH PANELCPT 80050Outpatient89978$346
ELECTROLYTE PANELCPT 80051Outpatient80003$63
COMPREHEN METABOLIC PANELCPT 80053Outpatient89809$296
OBSTETRIC PANELCPT 80055Outpatient89801$430
LIPID PANELCPT 80061Outpatient89628$202
RENAL FUNCTION PANELCPT 80069Outpatient89994$78
ACUTE HEPATITIS PANELCPT 80074Outpatient87012$428
HEPATIC FUNCTION PANELCPT 80076Outpatient80058$313
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient82643$119
DIPROPYLACETIC ACID FREECPT 80165Outpatient800726$121
ASSAY OF VANCOMYCINCPT 80202Outpatient89639$121
DRUG TEST PRSMV INSTRMNTCPT 80306Outpatient89702$154
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient800973$310
DRUG SCREEN QUANTALCOHOLSCPT 80320Outpatient800415$163
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
URINALYSIS AUTO W/SCOPECPT 81001Outpatient81000$98
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient89686$20
URINALYSISCPT 81005Outpatient800410$19
MICROSCOPIC EXAM OF URINECPT 81015Outpatient800069$27
URINE PREGNANCY TESTCPT 81025Outpatient82996$77
OTHER SOURCE ALBUMIN QUAN EACPT 82042Outpatient86623$70
UR ALBUMIN QUANTITATIVECPT 82043Outpatient86947$52
ALPHA-1-ANTITRYPSIN TOTALCPT 82103Outpatient86763$120
ALPHA-FETOPROTEIN SERUMCPT 82105Outpatient89816$150
ASSAY OF AMYLASECPT 82150Outpatient82150$58
BILIRUBIN TOTALCPT 82247Outpatient82251$45
BILIRUBIN DIRECTCPT 82248Outpatient89678$45
OCCULT BLOOD FECESCPT 82270Outpatient89599$39
OCCULT BLD FECES 1-3 TESTSCPT 82272Outpatient89604$38
VITAMIN D 25 HYDROXYCPT 82306Outpatient89797$266
ASSAY OF CALCIUMCPT 82310Outpatient82310$46
ASSAY BLOOD CARBON DIOXIDECPT 82374Outpatient82374$43
CARCINOEMBRYONIC ANTIGENCPT 82378Outpatient89515$170
ASSAY OF CK (CPK)CPT 82550Outpatient82550$58
ASSAY OF CREATININECPT 82565Outpatient82565$46
CREATININE CLEARANCE TESTCPT 82575Outpatient89764$85
VITAMIN B-12CPT 82607Outpatient82607$234
ASSAY OF TOTAL ESTRADIOLCPT 82670Outpatient89950$251
ASSAY OF FERRITINCPT 82728Outpatient82730$221
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient82746$132
ASSAY OF IGECPT 82785Outpatient89888$148
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient89538$35
GLUCOSE TESTCPT 82950Outpatient89750$42
GTT-ADDED SAMPLESCPT 82952Outpatient89756$35
H PYLORI (C-13) BREATHCPT 83013Outpatient800497$606
H PYLORI DRUG ADMINCPT 83014Outpatient86526$239
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient89548$132
ASSAY OF INSULINCPT 83525Outpatient89832$102
ASSAY OF IRONCPT 83540Outpatient83540$58
IRON BINDING TESTCPT 83550Outpatient89557$78
ASSAY OF LACTIC ACIDCPT 83605Outpatient89974$104
ASSAY OF LEADCPT 83655Outpatient800154$108
ASSAY OF LIPASECPT 83690Outpatient83690$149
ASSAY OF LIPOPROTEIN(A)CPT 83695Outpatient80198$128
ASSAY OF LIPOPROTEINCPT 83718Outpatient83718$73
ASSAY OF MAGNESIUMCPT 83735Outpatient83735$143
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient80158$353
ASSAY ALKALINE PHOSPHATASECPT 84075Outpatient84075$46
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient84132$42
ASSAY OF URINE POTASSIUMCPT 84133Outpatient800496$42
ASSAY OF PREALBUMINCPT 84134Outpatient800030$131
ASSAY OF PSA TOTALCPT 84153Outpatient80301$165
ASSAY OF PSA FREECPT 84154Outpatient800475$165
ASSAY OF PROTEIN URINECPT 84156Outpatient84180$33
ASSAY OF PROTEIN OTHERCPT 84157Outpatient84175$36
ASSAY OF TOTAL THYROXINECPT 84436Outpatient89605$61
ASSAY OF FREE THYROXINECPT 84439Outpatient89802$192
ASSAY THYROID STIM HORMONECPT 84443Outpatient89609$236
TRANSFERASE (AST) (SGOT)CPT 84450Outpatient84450$46
ASSAY OF TRANSFERRINCPT 84466Outpatient800087$114
ASSAY OF TRIGLYCERIDESCPT 84478Outpatient84478$51
ASSAY OF THYROID (T3 OR T4)CPT 84479Outpatient84439$58
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient800356$127
FREE ASSAY (FT-3)CPT 84481Outpatient89963$152
ASSAY OF TROPONIN QUANTCPT 84484Outpatient89745$202
ASSAY OF UREA NITROGENCPT 84520Outpatient84520$35
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient84550$40
ASSAY OF URINE/URIC ACIDCPT 84560Outpatient86124$45
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient89544$269
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient89573$133
AUTOMATED DIFF WBC COUNTCPT 85004Outpatient86716$58
HEMATOCRITCPT 85014Outpatient89546$64
HEMOGLOBINCPT 85018Outpatient89550$70
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient89772$172
COMPLETE CBC AUTOMATEDCPT 85027Outpatient800388$116
AUTOMATED RETICULOCYTE COUNTCPT 85045Outpatient85044$87
AUTOMATED LEUKOCYTE COUNTCPT 85048Outpatient89615$22
AUTOMATED PLATELET COUNTCPT 85049Outpatient85590$40
FIBRIN DEGRADATION QUANTCPT 85379Outpatient800378$186
PROTHROMBIN TIMECPT 85610Outpatient85610$129
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient85730$159
C-REACTIVE PROTEINCPT 86140Outpatient86140$116
IMMUNOASSAY TUMOR CA 15-3CPT 86300Outpatient89964$187
IMMUNOASSAY TUMOR CA 19-9CPT 86301Outpatient89831$187
IMMUNOASSAY TUMOR CA 125CPT 86304Outpatient86959$187
RHEUMATOID FACTOR TEST QUALCPT 86430Outpatient86430$55
TB TEST CELL IMMUN MEASURECPT 86480Outpatient87044$557
SYPHILIS TEST NON-TREP QUALCPT 86592Outpatient89612$38
SYPHILIS TEST NON-TREP QUANTCPT 86593Outpatient87151$39
WEST NILE VIRUS ANTIBODYCPT 86789Outpatient80220$129
HEPATITIS C AB TESTCPT 86803Outpatient89694$128
COOMBS TEST DIRECTCPT 86880Outpatient86031$48
BLOOD TYPING SEROLOGIC RH(D)CPT 86901Outpatient86901$75
URINE CULTURE/COLONY COUNTCPT 87086Outpatient87086$197
FUNGI IDENTIFICATION YEASTCPT 87106Outpatient80187$92
CHLAMYDIA CULTURECPT 87110Outpatient89845$176
PINWORM EXAMCPT 87172Outpatient89742$38
OVA AND PARASITES SMEARSCPT 87177Outpatient87177$80
VARICELLA ZOSTER AG IFCPT 87290Outpatient87159$120
CLOSTRIDIUM AG IACPT 87324Outpatient800361$107
CYTOMEGALOVIRUS AG IACPT 87332Outpatient800320$107
HPYLORI STOOL AG IACPT 87338Outpatient800027$129
STREP A AG IACPT 87430Outpatient89598$151
NOS EACH ORGANISM AG IACPT 87449Outpatient800203$107
C DIFF AMPLIFIED PROBECPT 87493Outpatient800536$335
HEPATITIS B DNA AMP PROBECPT 87516Outpatient80071$315
HEPATITIS C PROBE&RVRS TRNSCCPT 87521Outpatient80243$315
HSV DNA AMP PROBECPT 87529Outpatient86501$315
HIV-1 PROBE&REVERSE TRNSCRPJCPT 87535Outpatient80166$315
RESP VIRUS 3-5 TARGETSCPT 87631Outpatient800972$427
RESP VIRUS 6-11 TARGETSCPT 87632Outpatient800998$654
RESP VIRUS 12-25 TARGETSCPT 87633Outpatient800979$1,250
SARS-COV-2 COVID-19 AMP PRBCPT 87635Outpatient800644$235
STREP B DNA AMP PROBECPT 87653Outpatient800533$105
CYTOPATH SMEAR OTHER SOURCECPT 88161Outpatient800617$103
PSA SCREENINGHCPCS G0103Outpatient800375$173
MRI
MAGNETIC IMAGE JAW JOINTCPT 70336Outpatient72602$2,097
MRI ORBT/FAC/NCK W/O &W/DYECPT 70543Outpatient76240$4,123
MRI BRAIN STEM W/O DYECPT 70551Outpatient72604$2,748
MRI BRAIN STEM W/DYECPT 70552Outpatient72605$3,436
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient72606$4,123
MRI CHEST W/O DYECPT 71550Outpatient72607$2,097
MRI CHEST W/DYECPT 71551Outpatient76237$2,516
MRI CHEST W/O & W/DYECPT 71552Outpatient76238$3,436
MRI NECK SPINE W/O DYECPT 72141Outpatient72610$2,097
MRI NECK SPINE W/DYECPT 72142Outpatient72611$3,436
MRI CHEST SPINE W/O DYECPT 72146Outpatient72613$2,097
MRI CHEST SPINE W/DYECPT 72147Outpatient72614$3,436
MRI LUMBAR SPINE W/O DYECPT 72148Outpatient72616$2,097
MRI LUMBAR SPINE W/DYECPT 72149Outpatient72617$3,436
MRI NECK SPINE W/O & W/DYECPT 72156Outpatient72612$4,123
MRI CHEST SPINE W/O & W/DYECPT 72157Outpatient72615$4,123
MRI LUMBAR SPINE W/O & W/DYECPT 72158Outpatient72618$4,123
MRI PELVIS W/O DYECPT 72195Outpatient76236$2,097
MRI PELVIS W/DYECPT 72196Outpatient72620$3,436
MRI PELVIS W/O & W/DYECPT 72197Outpatient76235$4,123
MRI UPPER EXTREMITY W/O DYECPT 73218 (LT)Outpatient76245$2,097
MRI UPPR EXTREMITY W/O&W/DYECPT 73220Outpatient76229$2,338
MRI JOINT UPR EXTREM W/O DYECPT 73221 (LT)Outpatient72623$2,097
MRI JOINT UPR EXTREM W/DYECPT 73222 (RT)Outpatient76335$2,767
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient72622$3,436
MRI LOWER EXTREMITY W/O DYECPT 73718 (LT)Outpatient72624$2,097
MRI LOWER EXTREMITY W/DYECPT 73719 (LT)Outpatient76211$2,767
MRI LWR EXTREMITY W/O&W/DYECPT 73720 (RT)Outpatient76331$3,436
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (LT)Outpatient72626$2,199
MRI JOINT OF LWR EXTR W/DYECPT 73722 (LT)Outpatient76212$2,749
MRI JOINT LWR EXTR W/O&W/DYECPT 73723 (RT)Outpatient76337$3,436
MRI ABDOMEN W/O DYECPT 74181Outpatient72629$2,097
MRI ABDOMEN W/DYECPT 74182Outpatient76214$3,436
MRI ABDOMEN W/O & W/DYECPT 74183Outpatient72628$4,123
Nuclear Medicine
THYROID IMAGING W/BLOOD FLOWCPT 78013Outpatient72540$1,472
PARATHYROID PLANAR IMAGINGCPT 78070Outpatient79082$1,472
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----
Radiology
X-RAY EXAM OF FACIAL BONESCPT 70150Outpatient72136$560
X-RAY EXAM OF NECKCPT 70360Outpatient72191$399
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient72121$399
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient72122$478
X-RAY EXAM CHEST 3 VIEWSCPT 71047Outpatient77098$574
X-RAY EXAM CHEST 4+ VIEWSCPT 71048Outpatient76945$689
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101Outpatient72177$560
X-RAY EXAM RIBS BIL 3 VIEWSCPT 71110Outpatient77008$560
X-RAY EXAM BREASTBONE 2/>VWSCPT 71120Outpatient72194$399
X-RAY STRENOCLAVIC JT 3/>VWSCPT 71130Outpatient72193$478
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040Outpatient72226$478
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient72118$560
X-RAY EXAM NECK SPINE 6/>VWSCPT 72052Outpatient72119$672
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient72131$560
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient72163$560
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient72161$672
X-RAY EXAM L-S SPINE BENDINGCPT 72114Outpatient72162$806
X-RAY EXAM OF PELVISCPT 72170Outpatient72174$448
X-RAY EXAM OF PELVISCPT 72190Outpatient72236$560
X-RAY EXAM SACRUM TAILBONECPT 72220Outpatient72179$399
X-RAY EXAM OF COLLAR BONECPT 73000 (RT)Outpatient76322$399
X-RAY EXAM OF SHOULDER BLADECPT 73010Outpatient72181$560
X-RAY EXAM OF SHOULDERCPT 73020 (RT)Outpatient76303$399
X-RAY EXAM OF SHOULDERCPT 73030 (LT)Outpatient72184$478
CONTRAST X-RAY OF SHOULDERCPT 73040 (LT)Outpatient72108$1,145
X-RAY EXAM OF HUMERUSCPT 73060 (LT)Outpatient72151$399
X-RAY EXAM OF ELBOWCPT 73070 (LT)Outpatient72260$319
X-RAY EXAM OF ELBOWCPT 73080 (RT)Outpatient76320$399
X-RAY EXAM OF FOREARMCPT 73090 (LT)Outpatient72144$399
X-RAY EXAM OF WRISTCPT 73100 (LT)Outpatient72238$319
X-RAY EXAM OF WRISTCPT 73110 (LT)Outpatient72203$399
CONTRAST X-RAY OF WRISTCPT 73115Outpatient76018$1,909
X-RAY EXAM OF HANDCPT 73120 (LT)Outpatient76944$560
X-RAY EXAM OF HANDCPT 73130 (RT)Outpatient76314$672
X-RAY EXAM OF FINGER(S)CPT 73140 (LT)Outpatient72140$399
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient73968$478
X-RAY EXAM HIPS BI 2 VIEWSCPT 73521Outpatient73971$560
X-RAY EXAM HIPS BI 3-4 VIEWSCPT 73522Outpatient73967$672
CONTRAST X-RAY OF HIPCPT 73525Outpatient77000$1,909
X-RAY EXAM OF FEMUR 1CPT 73551 (LT)Outpatient73972$399
X-RAY EXAM OF FEMUR 2/>CPT 73552 (RT)Outpatient76341$478
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (LT)Outpatient72202$399
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (50)Outpatient76307$399
X-RAY EXAM OF KNEE 3CPT 73562 (RT)Outpatient76311$478
X-RAY EXAM OF KNEESCPT 73565Outpatient73021$399
CONTRAST X-RAY OF KNEE JOINTCPT 73580Outpatient72106$1,909
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)Outpatient72160$399
X-RAY EXAM OF LEG INFANTCPT 73592Outpatient76993$399
X-RAY EXAM OF ANKLECPT 73600 (LT)Outpatient72227$319
X-RAY EXAM OF ANKLECPT 73610 (RT)Outpatient76326$399
X-RAY EXAM OF FOOTCPT 73620 (LT)Outpatient72183$319
X-RAY EXAM OF FOOTCPT 73630 (RT)Outpatient76317$399
X-RAY EXAM OF TOE(S)CPT 73660 (LT)Outpatient72196$399
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient72102$560
X-RAY EXAM ABDOMEN 3+ VIEWSCPT 74021Outpatient72206$672
X-RAY EXAM COMPLETE ABDOMENCPT 74022Outpatient74022$560
X-RAY XM ESOPHAGUS 1CNTRSTCPT 74220Outpatient72133$911
X-RAY XM SWLNG FUNCJ C+CPT 74230Outpatient72205$911
X-RAY XM UPR GI TRC 1CNTRSTCPT 74240Outpatient72198$911
X-RAY XM UPR GI TRC 2CNTRSTCPT 74246Outpatient72199$1,237
X-RAY XM SM INT 1CNTRST STDCPT 74250Outpatient72190$911
X-RAY XM COLON 1CNTRST STDCPT 74270Outpatient72110$1,114
X-RAY BILE DUCTS/PANCREASCPT 74300Outpatient72125$719
CONTRAST X-RAY BLADDERCPT 74430Outpatient72128$1,909
X-RAY URETHRA/BLADDERCPT 74455Outpatient72130$1,165
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient72141$1,165
NEEDLE LOCALIZATION BY XRAYCPT 77002Outpatient71036$680
CT BONE DENSITY AXIALCPT 77078Outpatient79112$555
DXA BONE DENSITY AXIALCPT 77080Outpatient72291$560
DXA BONE DENSITY STUDYCPT 77085Outpatient77112$560
Surgical Procedures
REMOVAL OF BREAST LESIONCPT 19120Outpatient120283$917
SHO ARTHRS SRG DECOMPRESSIONCPT 29826Outpatient120145$455
KNEE ARTHROSCOPY/SURGERYCPT 29881Outpatient120156$2,638
REMOVE TONSILS AND ADENOIDSCPT 42820Outpatient-$8,442
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient120336$653
EGD BIOPSY SINGLE/MULTIPLECPT 43239Outpatient120337$873
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient120357$886
COLONOSCOPY AND BIOPSYCPT 45380Outpatient120358$1,033
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient120301$1,125
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562Outpatient120362$1,546
PRP I/HERN INIT REDUC >5 YRCPT 49505Outpatient120366$1,350
(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----
NJX INTERLAMINAR LMBR/SACCPT 62323Outpatient77123$2,250
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...CPT 64483----
AFTER CATARACT LASER SURGERYCPT 66821Outpatient17078$1,520
(N/O) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984----
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
THERAPEUTIC EXERCISESCPT 97110Outpatient-$59