Geary Community Hospital

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

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.

Service Description	Service Code	Department	Charge Code	Cash Price	Rates
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450	Outpatient	72316	$1,853
CT HEAD/BRAIN W/DYE	CPT 70460	Outpatient	72317	$1,976
CT HEAD/BRAIN W/O & W/DYE	CPT 70470	Outpatient	72318	$2,448
CT MAXILLOFACIAL W/O DYE	CPT 70486	Outpatient	72330	$1,846
CT MAXILLOFACIAL W/DYE	CPT 70487	Outpatient	72331	$2,056
CT MAXILLOFACIAL W/O & W/DYE	CPT 70488	Outpatient	72332	$2,473
CT SOFT TISSUE NECK W/O DYE	CPT 70490	Outpatient	72323	$1,671
CT SOFT TISSUE NECK W/DYE	CPT 70491	Outpatient	72324	$2,016
CT SFT TSUE NCK W/O & W/DYE	CPT 70492	Outpatient	72325	$2,423
CT ANGIOGRAPHY HEAD	CPT 70496	Outpatient	72639	$1,639
CT ANGIOGRAPHY NECK	CPT 70498	Outpatient	72640	$1,639
CT THORAX DX C-	CPT 71250	Outpatient	72307	$1,830
CT THORAX DX C+	CPT 71260	Outpatient	72308	$2,423
CT THORAX DX C-/C+	CPT 71270	Outpatient	72309	$2,907
CT ANGIOGRAPHY CHEST	CPT 71275	Outpatient	72641	$2,798
CT NECK SPINE W/O DYE	CPT 72125	Outpatient	72333	$2,685
CT NECK SPINE W/DYE	CPT 72126	Outpatient	72334	$3,436
CT NECK SPINE W/O & W/DYE	CPT 72127	Outpatient	72335	$4,123
CT CHEST SPINE W/O DYE	CPT 72128	Outpatient	72636	$1,008
CT CHEST SPINE W/DYE	CPT 72129	Outpatient	72637	$1,639
CT CHEST SPINE W/O & W/DYE	CPT 72130	Outpatient	72638	$1,967
CT LUMBAR SPINE W/O DYE	CPT 72131	Outpatient	72322	$1,008
CT LUMBAR SPINE W/DYE	CPT 72132	Outpatient	76991	$3,436
CT LUMBAR SPINE W/O & W/DYE	CPT 72133	Outpatient	76992	$4,123
CT ANGIOGRAPH PELV W/O&W/DYE	CPT 72191	Outpatient	72642	$1,639
CT PELVIS W/O DYE	CPT 72192	Outpatient	72319	$1,008
CT PELVIS W/DYE	CPT 72193	Outpatient	72320	$1,639
CT PELVIS W/O & W/DYE	CPT 72194	Outpatient	72321	$1,967
CT ANGIO UPR EXTRM W/O&W/DYE	CPT 73206	Outpatient	72643	$1,639
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	72313	$1,008
CT LOWER EXTREMITY W/DYE	CPT 73701	Outpatient	72314	$1,639
CT LWR EXTREMITY W/O&W/DYE	CPT 73702	Outpatient	72315	$1,967
CT ANGIO LWR EXTR W/O&W/DYE	CPT 73706	Outpatient	72644	$1,639
CT ABDOMEN W/O DYE	CPT 74150	Outpatient	72301	$1,008
CT ABDOMEN W/DYE	CPT 74160	Outpatient	72302	$1,639
CT ABDOMEN W/O & W/DYE	CPT 74170	Outpatient	72303	$1,967
CT ANGIO ABDOM W/O & W/DYE	CPT 74175	Outpatient	72645	$1,639
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	77090	$4,089
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	77091	$4,785
CT ANGIO ABDOMINAL ARTERIES	CPT 75635	Outpatient	72646	$1,639
CT SCAN FOR NEEDLE BIOPSY	CPT 77012	Outpatient	72338	$1,266
Clinic
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	Outpatient	170132	$191
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	Outpatient	170133	$292
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	Outpatient	170134	$369
(N/O) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-
(N/O) PATIENT OFFICE CONSULTATION, 60 MIN	CPT 99244	-	-	-	-
PREV VISIT NEW AGE 18-39	CPT 99385	Outpatient	170161	$338
(N/O) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EVALUATION ...	CPT 99386	-	-	-	-
INIT PM E/M NEW PAT 65+ YRS	CPT 99387	Outpatient	170163	$298
EEG
POLYSOM 6/> YRS 4/> PARAM	CPT 95810	Outpatient	66070	$4,544
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...	CPT 93000	-	-	-	-
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	65018	$296
Imaging
ULTRASOUND BREAST COMPLETE	CPT 76641	Outpatient	75020	$784
ULTRASOUND BREAST LIMITED	CPT 76642	Outpatient	78004	$558
US EXAM ABDOM COMPLETE	CPT 76700	Outpatient	75018	$784
OB US < 14 WKS SINGLE FETUS	CPT 76801	Outpatient	76973	$784
OB US >= 14 WKS SNGL FETUS	CPT 76805	Outpatient	75022	$784
OB US DETAILED SNGL FETUS	CPT 76811	Outpatient	76986	$1,631
OB US LIMITED FETUS(S)	CPT 76815	Outpatient	76815	$784
OB US FOLLOW-UP PER FETUS	CPT 76816	Outpatient	76988	$784
TRANSVAGINAL US OBSTETRIC	CPT 76817	Outpatient	76989	$784
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	75028	$784
ECHO EXAM UTERUS	CPT 76831	Outpatient	75051	$1,631
US EXAM PELVIC COMPLETE	CPT 76856	Outpatient	75023	$941
US EXAM PELVIC LIMITED	CPT 76857	Outpatient	76817	$784
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	73010	$278
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	73009	$339
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	73007	$340
BRAIN IMAGING (PET)	CPT 78608	Outpatient	72569	$5,772
PET IMAGE W/CT SKULL-THIGH	CPT 78815 (PS)	Outpatient	72564	$5,772
PET IMAGE W/CT FULL BODY	CPT 78816	Outpatient	79102	$5,772
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...	DRG 216	-	-	-	-
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-
MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...	DRG 470	Inpatient	-	$51,224
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...	DRG 743	Inpatient	-	$34,084
Laboratory
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	89620	$30
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	89936	$233
GENERAL HEALTH PANEL	CPT 80050	Outpatient	89978	$346
ELECTROLYTE PANEL	CPT 80051	Outpatient	80003	$63
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	89809	$296
OBSTETRIC PANEL	CPT 80055	Outpatient	89801	$430
LIPID PANEL	CPT 80061	Outpatient	89628	$202
RENAL FUNCTION PANEL	CPT 80069	Outpatient	89994	$78
ACUTE HEPATITIS PANEL	CPT 80074	Outpatient	87012	$428
HEPATIC FUNCTION PANEL	CPT 80076	Outpatient	80058	$313
ASSAY OF DIGOXIN TOTAL	CPT 80162	Outpatient	82643	$119
DIPROPYLACETIC ACID FREE	CPT 80165	Outpatient	800726	$121
ASSAY OF VANCOMYCIN	CPT 80202	Outpatient	89639	$121
DRUG TEST PRSMV INSTRMNT	CPT 80306	Outpatient	89702	$154
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	800973	$310
DRUG SCREEN QUANTALCOHOLS	CPT 80320	Outpatient	800415	$163
(N/O) URINALYSIS TEST USING MICROSCOPE	CPT 81000	-	-	-	-
URINALYSIS AUTO W/SCOPE	CPT 81001	Outpatient	81000	$98
(N/O) URINALYSIS TEST	CPT 81002	-	-	-	-
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	89686	$20
URINALYSIS	CPT 81005	Outpatient	800410	$19
MICROSCOPIC EXAM OF URINE	CPT 81015	Outpatient	800069	$27
URINE PREGNANCY TEST	CPT 81025	Outpatient	82996	$77
OTHER SOURCE ALBUMIN QUAN EA	CPT 82042	Outpatient	86623	$70
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	86947	$52
ALPHA-1-ANTITRYPSIN TOTAL	CPT 82103	Outpatient	86763	$120
ALPHA-FETOPROTEIN SERUM	CPT 82105	Outpatient	89816	$150
ASSAY OF AMYLASE	CPT 82150	Outpatient	82150	$58
BILIRUBIN TOTAL	CPT 82247	Outpatient	82251	$45
BILIRUBIN DIRECT	CPT 82248	Outpatient	89678	$45
OCCULT BLOOD FECES	CPT 82270	Outpatient	89599	$39
OCCULT BLD FECES 1-3 TESTS	CPT 82272	Outpatient	89604	$38
VITAMIN D 25 HYDROXY	CPT 82306	Outpatient	89797	$266
ASSAY OF CALCIUM	CPT 82310	Outpatient	82310	$46
ASSAY BLOOD CARBON DIOXIDE	CPT 82374	Outpatient	82374	$43
CARCINOEMBRYONIC ANTIGEN	CPT 82378	Outpatient	89515	$170
ASSAY OF CK (CPK)	CPT 82550	Outpatient	82550	$58
ASSAY OF CREATININE	CPT 82565	Outpatient	82565	$46
CREATININE CLEARANCE TEST	CPT 82575	Outpatient	89764	$85
VITAMIN B-12	CPT 82607	Outpatient	82607	$234
ASSAY OF TOTAL ESTRADIOL	CPT 82670	Outpatient	89950	$251
ASSAY OF FERRITIN	CPT 82728	Outpatient	82730	$221
ASSAY OF FOLIC ACID SERUM	CPT 82746	Outpatient	82746	$132
ASSAY OF IGE	CPT 82785	Outpatient	89888	$148
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	89538	$35
GLUCOSE TEST	CPT 82950	Outpatient	89750	$42
GTT-ADDED SAMPLES	CPT 82952	Outpatient	89756	$35
H PYLORI (C-13) BREATH	CPT 83013	Outpatient	800497	$606
H PYLORI DRUG ADMIN	CPT 83014	Outpatient	86526	$239
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	89548	$132
ASSAY OF INSULIN	CPT 83525	Outpatient	89832	$102
ASSAY OF IRON	CPT 83540	Outpatient	83540	$58
IRON BINDING TEST	CPT 83550	Outpatient	89557	$78
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	89974	$104
ASSAY OF LEAD	CPT 83655	Outpatient	800154	$108
ASSAY OF LIPASE	CPT 83690	Outpatient	83690	$149
ASSAY OF LIPOPROTEIN(A)	CPT 83695	Outpatient	80198	$128
ASSAY OF LIPOPROTEIN	CPT 83718	Outpatient	83718	$73
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	83735	$143
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	Outpatient	80158	$353
ASSAY ALKALINE PHOSPHATASE	CPT 84075	Outpatient	84075	$46
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	84132	$42
ASSAY OF URINE POTASSIUM	CPT 84133	Outpatient	800496	$42
ASSAY OF PREALBUMIN	CPT 84134	Outpatient	800030	$131
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	80301	$165
ASSAY OF PSA FREE	CPT 84154	Outpatient	800475	$165
ASSAY OF PROTEIN URINE	CPT 84156	Outpatient	84180	$33
ASSAY OF PROTEIN OTHER	CPT 84157	Outpatient	84175	$36
ASSAY OF TOTAL THYROXINE	CPT 84436	Outpatient	89605	$61
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	89802	$192
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	89609	$236
TRANSFERASE (AST) (SGOT)	CPT 84450	Outpatient	84450	$46
ASSAY OF TRANSFERRIN	CPT 84466	Outpatient	800087	$114
ASSAY OF TRIGLYCERIDES	CPT 84478	Outpatient	84478	$51
ASSAY OF THYROID (T3 OR T4)	CPT 84479	Outpatient	84439	$58
ASSAY TRIIODOTHYRONINE (T3)	CPT 84480	Outpatient	800356	$127
FREE ASSAY (FT-3)	CPT 84481	Outpatient	89963	$152
ASSAY OF TROPONIN QUANT	CPT 84484	Outpatient	89745	$202
ASSAY OF UREA NITROGEN	CPT 84520	Outpatient	84520	$35
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	84550	$40
ASSAY OF URINE/URIC ACID	CPT 84560	Outpatient	86124	$45
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	89544	$269
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	Outpatient	89573	$133
AUTOMATED DIFF WBC COUNT	CPT 85004	Outpatient	86716	$58
HEMATOCRIT	CPT 85014	Outpatient	89546	$64
HEMOGLOBIN	CPT 85018	Outpatient	89550	$70
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	89772	$172
COMPLETE CBC AUTOMATED	CPT 85027	Outpatient	800388	$116
AUTOMATED RETICULOCYTE COUNT	CPT 85045	Outpatient	85044	$87
AUTOMATED LEUKOCYTE COUNT	CPT 85048	Outpatient	89615	$22
AUTOMATED PLATELET COUNT	CPT 85049	Outpatient	85590	$40
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	800378	$186
PROTHROMBIN TIME	CPT 85610	Outpatient	85610	$129
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	85730	$159
C-REACTIVE PROTEIN	CPT 86140	Outpatient	86140	$116
IMMUNOASSAY TUMOR CA 15-3	CPT 86300	Outpatient	89964	$187
IMMUNOASSAY TUMOR CA 19-9	CPT 86301	Outpatient	89831	$187
IMMUNOASSAY TUMOR CA 125	CPT 86304	Outpatient	86959	$187
RHEUMATOID FACTOR TEST QUAL	CPT 86430	Outpatient	86430	$55
TB TEST CELL IMMUN MEASURE	CPT 86480	Outpatient	87044	$557
SYPHILIS TEST NON-TREP QUAL	CPT 86592	Outpatient	89612	$38
SYPHILIS TEST NON-TREP QUANT	CPT 86593	Outpatient	87151	$39
WEST NILE VIRUS ANTIBODY	CPT 86789	Outpatient	80220	$129
HEPATITIS C AB TEST	CPT 86803	Outpatient	89694	$128
COOMBS TEST DIRECT	CPT 86880	Outpatient	86031	$48
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	Outpatient	86901	$75
URINE CULTURE/COLONY COUNT	CPT 87086	Outpatient	87086	$197
FUNGI IDENTIFICATION YEAST	CPT 87106	Outpatient	80187	$92
CHLAMYDIA CULTURE	CPT 87110	Outpatient	89845	$176
PINWORM EXAM	CPT 87172	Outpatient	89742	$38
OVA AND PARASITES SMEARS	CPT 87177	Outpatient	87177	$80
VARICELLA ZOSTER AG IF	CPT 87290	Outpatient	87159	$120
CLOSTRIDIUM AG IA	CPT 87324	Outpatient	800361	$107
CYTOMEGALOVIRUS AG IA	CPT 87332	Outpatient	800320	$107
HPYLORI STOOL AG IA	CPT 87338	Outpatient	800027	$129
STREP A AG IA	CPT 87430	Outpatient	89598	$151
NOS EACH ORGANISM AG IA	CPT 87449	Outpatient	800203	$107
C DIFF AMPLIFIED PROBE	CPT 87493	Outpatient	800536	$335
HEPATITIS B DNA AMP PROBE	CPT 87516	Outpatient	80071	$315
HEPATITIS C PROBE&RVRS TRNSC	CPT 87521	Outpatient	80243	$315
HSV DNA AMP PROBE	CPT 87529	Outpatient	86501	$315
HIV-1 PROBE&REVERSE TRNSCRPJ	CPT 87535	Outpatient	80166	$315
RESP VIRUS 3-5 TARGETS	CPT 87631	Outpatient	800972	$427
RESP VIRUS 6-11 TARGETS	CPT 87632	Outpatient	800998	$654
RESP VIRUS 12-25 TARGETS	CPT 87633	Outpatient	800979	$1,250
SARS-COV-2 COVID-19 AMP PRB	CPT 87635	Outpatient	800644	$235
STREP B DNA AMP PROBE	CPT 87653	Outpatient	800533	$105
CYTOPATH SMEAR OTHER SOURCE	CPT 88161	Outpatient	800617	$103
PSA SCREENING	HCPCS G0103	Outpatient	800375	$173
MRI
MAGNETIC IMAGE JAW JOINT	CPT 70336	Outpatient	72602	$2,097
MRI ORBT/FAC/NCK W/O &W/DYE	CPT 70543	Outpatient	76240	$4,123
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	72604	$2,748
MRI BRAIN STEM W/DYE	CPT 70552	Outpatient	72605	$3,436
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	72606	$4,123
MRI CHEST W/O DYE	CPT 71550	Outpatient	72607	$2,097
MRI CHEST W/DYE	CPT 71551	Outpatient	76237	$2,516
MRI CHEST W/O & W/DYE	CPT 71552	Outpatient	76238	$3,436
MRI NECK SPINE W/O DYE	CPT 72141	Outpatient	72610	$2,097
MRI NECK SPINE W/DYE	CPT 72142	Outpatient	72611	$3,436
MRI CHEST SPINE W/O DYE	CPT 72146	Outpatient	72613	$2,097
MRI CHEST SPINE W/DYE	CPT 72147	Outpatient	72614	$3,436
MRI LUMBAR SPINE W/O DYE	CPT 72148	Outpatient	72616	$2,097
MRI LUMBAR SPINE W/DYE	CPT 72149	Outpatient	72617	$3,436
MRI NECK SPINE W/O & W/DYE	CPT 72156	Outpatient	72612	$4,123
MRI CHEST SPINE W/O & W/DYE	CPT 72157	Outpatient	72615	$4,123
MRI LUMBAR SPINE W/O & W/DYE	CPT 72158	Outpatient	72618	$4,123
MRI PELVIS W/O DYE	CPT 72195	Outpatient	76236	$2,097
MRI PELVIS W/DYE	CPT 72196	Outpatient	72620	$3,436
MRI PELVIS W/O & W/DYE	CPT 72197	Outpatient	76235	$4,123
MRI UPPER EXTREMITY W/O DYE	CPT 73218 (LT)	Outpatient	76245	$2,097
MRI UPPR EXTREMITY W/O&W/DYE	CPT 73220	Outpatient	76229	$2,338
MRI JOINT UPR EXTREM W/O DYE	CPT 73221 (LT)	Outpatient	72623	$2,097
MRI JOINT UPR EXTREM W/DYE	CPT 73222 (RT)	Outpatient	76335	$2,767
MRI JOINT UPR EXTR W/O&W/DYE	CPT 73223	Outpatient	72622	$3,436
MRI LOWER EXTREMITY W/O DYE	CPT 73718 (LT)	Outpatient	72624	$2,097
MRI LOWER EXTREMITY W/DYE	CPT 73719 (LT)	Outpatient	76211	$2,767
MRI LWR EXTREMITY W/O&W/DYE	CPT 73720 (RT)	Outpatient	76331	$3,436
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721 (LT)	Outpatient	72626	$2,199
MRI JOINT OF LWR EXTR W/DYE	CPT 73722 (LT)	Outpatient	76212	$2,749
MRI JOINT LWR EXTR W/O&W/DYE	CPT 73723 (RT)	Outpatient	76337	$3,436
MRI ABDOMEN W/O DYE	CPT 74181	Outpatient	72629	$2,097
MRI ABDOMEN W/DYE	CPT 74182	Outpatient	76214	$3,436
MRI ABDOMEN W/O & W/DYE	CPT 74183	Outpatient	72628	$4,123
Nuclear Medicine
THYROID IMAGING W/BLOOD FLOW	CPT 78013	Outpatient	72540	$1,472
PARATHYROID PLANAR IMAGING	CPT 78070	Outpatient	79082	$1,472
Psychiatric
(N/O) PSYCHOTHERAPY, 30 MIN	CPT 90832	-	-	-	-
(N/O) PSYCHOTHERAPY, 45 MIN	CPT 90834	-	-	-	-
(N/O) PSYCHOTHERAPY, 60 MIN	CPT 90837	-	-	-	-
(N/O) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, 50 MIN	CPT 90846	-	-	-	-
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MIN	CPT 90847	-	-	-	-
(N/O) GROUP PSYCHOTHERAPY	CPT 90853	-	-	-	-
Radiology
X-RAY EXAM OF FACIAL BONES	CPT 70150	Outpatient	72136	$560
X-RAY EXAM OF NECK	CPT 70360	Outpatient	72191	$399
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	72121	$399
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	72122	$478
X-RAY EXAM CHEST 3 VIEWS	CPT 71047	Outpatient	77098	$574
X-RAY EXAM CHEST 4+ VIEWS	CPT 71048	Outpatient	76945	$689
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101	Outpatient	72177	$560
X-RAY EXAM RIBS BIL 3 VIEWS	CPT 71110	Outpatient	77008	$560
X-RAY EXAM BREASTBONE 2/>VWS	CPT 71120	Outpatient	72194	$399
X-RAY STRENOCLAVIC JT 3/>VWS	CPT 71130	Outpatient	72193	$478
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	Outpatient	72226	$478
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	72118	$560
X-RAY EXAM NECK SPINE 6/>VWS	CPT 72052	Outpatient	72119	$672
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	Outpatient	72131	$560
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	Outpatient	72163	$560
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	Outpatient	72161	$672
X-RAY EXAM L-S SPINE BENDING	CPT 72114	Outpatient	72162	$806
X-RAY EXAM OF PELVIS	CPT 72170	Outpatient	72174	$448
X-RAY EXAM OF PELVIS	CPT 72190	Outpatient	72236	$560
X-RAY EXAM SACRUM TAILBONE	CPT 72220	Outpatient	72179	$399
X-RAY EXAM OF COLLAR BONE	CPT 73000 (RT)	Outpatient	76322	$399
X-RAY EXAM OF SHOULDER BLADE	CPT 73010	Outpatient	72181	$560
X-RAY EXAM OF SHOULDER	CPT 73020 (RT)	Outpatient	76303	$399
X-RAY EXAM OF SHOULDER	CPT 73030 (LT)	Outpatient	72184	$478
CONTRAST X-RAY OF SHOULDER	CPT 73040 (LT)	Outpatient	72108	$1,145
X-RAY EXAM OF HUMERUS	CPT 73060 (LT)	Outpatient	72151	$399
X-RAY EXAM OF ELBOW	CPT 73070 (LT)	Outpatient	72260	$319
X-RAY EXAM OF ELBOW	CPT 73080 (RT)	Outpatient	76320	$399
X-RAY EXAM OF FOREARM	CPT 73090 (LT)	Outpatient	72144	$399
X-RAY EXAM OF WRIST	CPT 73100 (LT)	Outpatient	72238	$319
X-RAY EXAM OF WRIST	CPT 73110 (LT)	Outpatient	72203	$399
CONTRAST X-RAY OF WRIST	CPT 73115	Outpatient	76018	$1,909
X-RAY EXAM OF HAND	CPT 73120 (LT)	Outpatient	76944	$560
X-RAY EXAM OF HAND	CPT 73130 (RT)	Outpatient	76314	$672
X-RAY EXAM OF FINGER(S)	CPT 73140 (LT)	Outpatient	72140	$399
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	73968	$478
X-RAY EXAM HIPS BI 2 VIEWS	CPT 73521	Outpatient	73971	$560
X-RAY EXAM HIPS BI 3-4 VIEWS	CPT 73522	Outpatient	73967	$672
CONTRAST X-RAY OF HIP	CPT 73525	Outpatient	77000	$1,909
X-RAY EXAM OF FEMUR 1	CPT 73551 (LT)	Outpatient	73972	$399
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (RT)	Outpatient	76341	$478
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (LT)	Outpatient	72202	$399
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (50)	Outpatient	76307	$399
X-RAY EXAM OF KNEE 3	CPT 73562 (RT)	Outpatient	76311	$478
X-RAY EXAM OF KNEES	CPT 73565	Outpatient	73021	$399
CONTRAST X-RAY OF KNEE JOINT	CPT 73580	Outpatient	72106	$1,909
X-RAY EXAM OF LOWER LEG	CPT 73590 (LT)	Outpatient	72160	$399
X-RAY EXAM OF LEG INFANT	CPT 73592	Outpatient	76993	$399
X-RAY EXAM OF ANKLE	CPT 73600 (LT)	Outpatient	72227	$319
X-RAY EXAM OF ANKLE	CPT 73610 (RT)	Outpatient	76326	$399
X-RAY EXAM OF FOOT	CPT 73620 (LT)	Outpatient	72183	$319
X-RAY EXAM OF FOOT	CPT 73630 (RT)	Outpatient	76317	$399
X-RAY EXAM OF TOE(S)	CPT 73660 (LT)	Outpatient	72196	$399
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	Outpatient	72102	$560
X-RAY EXAM ABDOMEN 3+ VIEWS	CPT 74021	Outpatient	72206	$672
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	Outpatient	74022	$560
X-RAY XM ESOPHAGUS 1CNTRST	CPT 74220	Outpatient	72133	$911
X-RAY XM SWLNG FUNCJ C+	CPT 74230	Outpatient	72205	$911
X-RAY XM UPR GI TRC 1CNTRST	CPT 74240	Outpatient	72198	$911
X-RAY XM UPR GI TRC 2CNTRST	CPT 74246	Outpatient	72199	$1,237
X-RAY XM SM INT 1CNTRST STD	CPT 74250	Outpatient	72190	$911
X-RAY XM COLON 1CNTRST STD	CPT 74270	Outpatient	72110	$1,114
X-RAY BILE DUCTS/PANCREAS	CPT 74300	Outpatient	72125	$719
CONTRAST X-RAY BLADDER	CPT 74430	Outpatient	72128	$1,909
X-RAY URETHRA/BLADDER	CPT 74455	Outpatient	72130	$1,165
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	72141	$1,165
NEEDLE LOCALIZATION BY XRAY	CPT 77002	Outpatient	71036	$680
CT BONE DENSITY AXIAL	CPT 77078	Outpatient	79112	$555
DXA BONE DENSITY AXIAL	CPT 77080	Outpatient	72291	$560
DXA BONE DENSITY STUDY	CPT 77085	Outpatient	77112	$560
Surgical Procedures
REMOVAL OF BREAST LESION	CPT 19120	Outpatient	120283	$917
SHO ARTHRS SRG DECOMPRESSION	CPT 29826	Outpatient	120145	$455
KNEE ARTHROSCOPY/SURGERY	CPT 29881	Outpatient	120156	$2,638
REMOVE TONSILS AND ADENOIDS	CPT 42820	Outpatient	-	$8,442
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	Outpatient	120336	$653
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	Outpatient	120337	$873
DIAGNOSTIC COLONOSCOPY	CPT 45378	Outpatient	120357	$886
COLONOSCOPY AND BIOPSY	CPT 45380	Outpatient	120358	$1,033
COLONOSCOPY W/LESION REMOVAL	CPT 45385	Outpatient	120301	$1,125
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...	CPT 45391	-	-	-	-
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562	Outpatient	120362	$1,546
PRP I/HERN INIT REDUC >5 YR	CPT 49505	Outpatient	120366	$1,350
(N/O) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...	CPT 55866	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...	CPT 59610	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62322	-	-	-	-
NJX INTERLAMINAR LMBR/SAC	CPT 62323	Outpatient	77123	$2,250
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...	CPT 64483	-	-	-	-
AFTER CATARACT LASER SURGERY	CPT 66821	Outpatient	17078	$1,520
(N/O) REMOVAL OF CATARACT WITH INSERTION OF LENS	CPT 66984	-	-	-	-
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSIS	CPT 93452	-	-	-	-
Therapy
THERAPEUTIC EXERCISES	CPT 97110	Outpatient	-	$59