Grace Cottage Hospital

Price List for Shoppable Services. Effective 11-05-2021.

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 (TC)	Outpatient	753044	$1,892
CT HEAD/BRAIN W/O & W/DYE	CPT 70470 (TC)	Outpatient	753040	$2,635
CT MAXILLOFACIAL W/O DYE	CPT 70486 (TC)	Outpatient	753085	$1,917
CT MAXILLOFACIAL W/DYE	CPT 70487 (TC)	Outpatient	753083	$2,254
CT SOFT TISSUE NECK W/DYE	CPT 70491 (TC)	Outpatient	753125	$2,248
CT ANGIOGRAPHY HEAD	CPT 70496 (TC)	Outpatient	49973480	$2,772
CT ANGIOGRAPHY NECK	CPT 70498 (TC)	Outpatient	48577869	$3,294
CT THORAX DX C-	CPT 71250 (TC)	Outpatient	753151	$2,160
CT THORAX DX C+	CPT 71260 (TC)	Outpatient	753149	$2,616
CT THORAX DX C-/C+	CPT 71270 (TC)	Outpatient	753147	$3,115
CT ANGIOGRAPHY CHEST	CPT 71275 (TC)	Outpatient	1339992	$3,320
CT NECK SPINE W/O DYE	CPT 72125 (TC)	Outpatient	753133	$2,160
CT CHEST SPINE W/O DYE	CPT 72128 (TC)	Outpatient	753145	$2,182
CT LUMBAR SPINE W/O DYE	CPT 72131 (TC)	Outpatient	753139	$2,160
CT LUMBAR SPINE W/DYE	CPT 72132 (TC)	Outpatient	753137	$2,609
CT PELVIS W/O DYE	CPT 72192 (TC)	Outpatient	753106	$2,218
CT PELVIS W/DYE	CPT 72193 (TC)	Outpatient	753104	$2,454
CT UPPER EXTREMITY W/O DYE	CPT 73200 (LT,TC)	Outpatient	753167	$1,941
CT LOWER EXTREMITY W/O DYE	CPT 73700 (LT,TC)	Outpatient	753077	$1,939
CT ABDOMEN W/O DYE	CPT 74150 (TC)	Outpatient	752980	$2,194
CT ABDOMEN W/DYE	CPT 74160 (TC)	Outpatient	752052	$2,519
CT ABDOMEN W/O & W/DYE	CPT 74170 (TC)	Outpatient	752978	$2,661
CT ANGIO ABD&PELV W/O&W/DYE	CPT 74174 (TC)	Outpatient	8284945	$3,781
CT ABD & PELVIS W/O CONTRAST	CPT 74176 (TC)	Outpatient	931316	$3,143
CT ABD & PELV W/CONTRAST	CPT 74177 (TC)	Outpatient	931313	$3,781
CT ABD & PELV 1/> REGNS	CPT 74178 (TC)	Outpatient	931310	$4,510
CT ANGIO ABDOMINAL ARTERIES	CPT 75635	Outpatient	752985	$2,980
3D RENDER W/INTRP POSTPROCES	CPT 76376 (TC)	Outpatient	9352946	$394
Clinic
TANGNTL BX SKIN SINGLE LES	CPT 11102	Outpatient	49949567	$264
PUNCH BX SKIN SINGLE LESION	CPT 11104	Outpatient	49949569	$331
DESTRUCT B9 LESION 1-14	CPT 17110	Outpatient	47770384	$433
INJ TENDON SHEATH/LIGAMENT	CPT 20550	Outpatient	1353686	$111
DRAIN/INJ JOINT/BURSA W/O US	CPT 20610	Outpatient	49873985	$306
APPLICATION OF PASTE BOOT	CPT 29580	Outpatient	1479872	$108
REMOVE IMPACTED EAR WAX UNI	CPT 69209	Outpatient	5200898	$38
REMOVE IMPACTED EAR WAX UNI	CPT 69210	Outpatient	48439815	$101
PSYTX W PT W E/M 30 MIN	CPT 90833	Outpatient	1489773	$62
PSYTX W PT W E/M 45 MIN	CPT 90836	Outpatient	47796850	$98
IMMUNOTHERAPY ONE INJECTION	CPT 95115	Outpatient	1013348	$20
DEVELOPMENTAL SCREEN W/SCORE	CPT 96110	Outpatient	48162485	$75
MEDICAL NUTRITION INDIV IN	CPT 97802	Outpatient	49984414	$96
MED NUTRITION INDIV SUBSEQ	CPT 97803	Outpatient	49984415	$96
OFFICE O/P NEW SF 15-29 MIN	CPT 99202	Outpatient	47824834	$136
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	Outpatient	1349644	$205
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	Outpatient	-	$312
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	Outpatient	-	$387
OFFICE O/P EST MINIMAL PROB	CPT 99211	Outpatient	1361634	$42
OFFICE O/P EST SF 10-19 MIN	CPT 99212	Outpatient	1489783	$85
OFFICE O/P EST LOW 20-29 MIN	CPT 99213	Outpatient	1349647	$137
OBSERVATION CARE DISCHARGE	CPT 99217	Outpatient	1349650	$140
OBSERV/HOSP SAME DATE	CPT 99234	Outpatient	1349659	$261
OFFICE CONSULTATION	CPT 99243	Outpatient	1349665	$235
OFFICE CONSULTATION	CPT 99244	Outpatient	1491674	$346
DOMICIL/R-HOME VISIT EST PAT	CPT 99335	Outpatient	4582900	$191
HOME VISIT EST PATIENT	CPT 99347	Outpatient	1353612	$109
INIT PM E/M NEW PAT INFANT	CPT 99381	Outpatient	1353616	$334
INIT PM E/M NEW PAT 1-4 YRS	CPT 99382	Outpatient	1353617	$361
PREV VISIT NEW AGE 5-11	CPT 99383	Outpatient	1353618	$364
PREV VISIT NEW AGE 18-39	CPT 99385	Outpatient	1353620	$381
PREV VISIT NEW AGE 40-64	CPT 99386	Outpatient	1353621	$450
PER PM REEVAL EST PAT INFANT	CPT 99391	Outpatient	1353622	$255
PREV VISIT EST AGE 1-4	CPT 99392	Outpatient	1353623	$284
PREV VISIT EST AGE 5-11	CPT 99393	Outpatient	1353624	$284
PREV VISIT EST AGE 12-17	CPT 99394	Outpatient	1353625	$309
PREV VISIT EST AGE 18-39	CPT 99395	Outpatient	1353626	$313
PREV VISIT EST AGE 40-64	CPT 99396	Outpatient	1353627	$346
PER PM REEVAL EST PAT 65+ YR	CPT 99397	Outpatient	48577218	$381
PREVENTIVE COUNSELING INDIV	CPT 99401	Outpatient	50394485	$174
PREVENTIVE COUNSELING INDIV	CPT 99402	Outpatient	50394486	$348
PREVENTIVE COUNSELING INDIV	CPT 99403	Outpatient	50394487	$485
BEHAV CHNG SMOKING 3-10 MIN	CPT 99406	Outpatient	49984418	$58
PHONE E/M PHYS/QHP 5-10 MIN	CPT 99441	Outpatient	8677020	$118
PHONE E/M PHYS/QHP 21-30 MIN	CPT 99443	Outpatient	8677022	$145
WORK RELATED DISABILITY EXAM	CPT 99455	Outpatient	29108786	$200
TRANS CARE MGMT 14 DAY DISCH	CPT 99495	Outpatient	49984420	$597
TRANS CARE MGMT 7 DAY DISCH	CPT 99496	Outpatient	49984421	$819
ADVNCD CARE PLAN 30 MIN	CPT 99497	Outpatient	47994858	$451
COMM SVCS BY RHC/FQHC 5 MIN	HCPCS G0071	Outpatient	50419044	$39
PPPS, SUBSEQ VISIT	HCPCS G0439	Outpatient	5992894	$749
BEHAVIOR COUNSEL OBESITY 15M	HCPCS G0447	Outpatient	49984417	$89
DIS SITE TELE SVCS RHC/FQHC	HCPCS G2025	Outpatient	50454044	$139
OBTAINING SCREEN PAP SMEAR	HCPCS Q0091	Outpatient	1920735	$152
PROGRAM INTAKE ASSESSMENT	HCPCS T1023 (TM)	Outpatient	8677045	$64
EEG
(N/O) SLEEP STUDY	CPT 95810	-	-	-	-
EKG
ELECTROCARDIOGRAM COMPLETE	CPT 93000	Outpatient	1355597	$284
EXT ECG>48HR<7D REV&INTERPJ	CPT 93244	Outpatient	48809237	$84
Emergency Room
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	Outpatient	9089574	$570
DRAIN/INJ JOINT/BURSA W/O US	CPT 20605	Outpatient	15220869	$560
THER/DIAG CONCURRENT INF	CPT 96368	Outpatient	44474134	$45
EMERGENCY DEPT VISIT	CPT 99281	Outpatient	44474122	$211
EMERGENCY DEPT VISIT	CPT 99282	Outpatient	44474123	$326
EMERGENCY DEPT VISIT	CPT 99283	Outpatient	44474124	$603
EMERGENCY DEPT VISIT	CPT 99284	Outpatient	44474125	$927
EMERGENCY DEPT VISIT	CPT 99285	Outpatient	44474126	$1,296
CRITICAL CARE FIRST HOUR	CPT 99291	Outpatient	44474127	$1,562
CRITICAL CARE ADDL 30 MIN	CPT 99292	Outpatient	44474128	$611
IV Therapy
HYDRATION IV INFUSION INIT	CPT 96360	Outpatient	44474129	$147
HYDRATE IV INFUSION ADD-ON	CPT 96361	Outpatient	44474130	$141
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	44474131	$240
THER/PROPH/DIAG IV INF ADDON	CPT 96366	Outpatient	44474132	$115
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	Outpatient	44474133	$131
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	Outpatient	44474145	$98
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	Outpatient	44474146	$141
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	Outpatient	44474147	$141
IRRIG DRUG DELIVERY DEVICE	CPT 96523	Outpatient	9089426	$159
Imaging
US EXAM OF HEAD AND NECK	CPT 76536 (TC)	Outpatient	927052	$787
US EXAM ABDOM COMPLETE	CPT 76700 (TC)	Outpatient	752050	$859
ECHO EXAM OF ABDOMEN	CPT 76705 (TC)	Outpatient	753319	$646
US ABDL AORTA SCREEN AAA	CPT 76706 (TC)	Outpatient	2342819	$653
US EXAM ABDO BACK WALL COMP	CPT 76770 (TC)	Outpatient	1100639	$839
US EXAM ABDO BACK WALL LIM	CPT 76775 (TC)	Outpatient	753456	$653
(N/O) ABDOMIAL ULTRASOUND OF PREGNANT UTERUS	CPT 76805	-	-	-	-
TRANSVAGINAL US NON-OB	CPT 76830 (TC)	Outpatient	753471	$858
US EXAM PELVIC COMPLETE	CPT 76856 (TC)	Outpatient	753436	$638
US EXAM PELVIC LIMITED	CPT 76857 (TC)	Outpatient	753438	$564
US EXAM SCROTUM	CPT 76870 (TC)	Outpatient	11276933	$618
US LMTD JT/NONVASC XTR STRUX	CPT 76882 (LT,TC)	Outpatient	8592961	$611
(N/O) MAMMOGRAPHY OF ONE BREAST	CPT 77065	-	-	-	-
(N/O) MAMMOGRAPHY OF BOTH BREASTS	CPT 77066	-	-	-	-
(N/O) MAMMOGRAPHY, SCREENING, BILATERAL	CPT 77067	-	-	-	-
EXTREMITY STUDY	CPT 93970 (TC)	Outpatient	753419	$1,067
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...	DRG 216	-	-	-	-
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...	DRG 470	-	-	-	-
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...	DRG 743	-	-	-	-
Laboratory
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	816059	$47
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	633628	$232
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	633709	$135
(N/O) OBSTETRIC BLOOD TEST PANEL	CPT 80055	-	-	-	-
LIPID PANEL	CPT 80061	Outpatient	633777	$222
RENAL FUNCTION PANEL	CPT 80069	Outpatient	819112	$264
HEPATIC FUNCTION PANEL	CPT 80076	Outpatient	9706947	$264
ASSAY CARBAMAZEPINE TOTAL	CPT 80156	Outpatient	9956979	$215
ASSAY OF DIGOXIN TOTAL	CPT 80162	Outpatient	9957015	$215
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	Outpatient	9974948	$215
ASSAY OF LITHIUM	CPT 80178	Outpatient	9960945	$133
ASSAY OF PHENYTOIN TOTAL	CPT 80185	Outpatient	9974992	$215
ASSAY OF VANCOMYCIN	CPT 80202	Outpatient	11040879	$340
DRUG TEST PRSMV DIR OPT OBS	CPT 80305	Outpatient	12968924	$18
URINALYSIS NONAUTO W/SCOPE	CPT 81000	Outpatient	9708942	$117
URINALYSIS AUTO W/SCOPE	CPT 81001	Outpatient	8475424	$117
(N/O) URINALYSIS TEST	CPT 81002	-	-	-	-
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	593519	$31
MICROSCOPIC EXAM OF URINE	CPT 81015	Outpatient	9709000	$88
URINE PREGNANCY TEST	CPT 81025	Outpatient	742369	$22
HLA II TYPING 1 LOCUS LR	CPT 81376	Outpatient	9563051	$500
ASSAY OF SERUM ALBUMIN	CPT 82040	Outpatient	633634	$63
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	9978334	$103
ASSAY OF AMMONIA	CPT 82140	Outpatient	9941215	$218
ASSAY OF AMYLASE	CPT 82150	Outpatient	631567	$107
BILIRUBIN DIRECT	CPT 82248	Outpatient	633670	$88
ASSAY TEST FOR BLOOD FECAL	CPT 82274	Outpatient	14476906	$239
VITAMIN D 25 HYDROXY	CPT 82306	Outpatient	48657100	$487
ASSAY OF CALCIUM	CPT 82310	Outpatient	633690	$69
ASSAY OF CALCIUM IN URINE	CPT 82340	Outpatient	9956978	$95
CARCINOEMBRYONIC ANTIGEN	CPT 82378	Outpatient	9956982	$276
ASSAY OF BLOOD CHLORIDE	CPT 82435	Outpatient	633621	$64
TOTAL CORTISOL	CPT 82533	Outpatient	9956987	$260
ASSAY OF CK (CPK)	CPT 82550	Outpatient	633712	$149
ASSAY OF CREATININE	CPT 82565	Outpatient	633606	$64
ASSAY OF URINE CREATININE	CPT 82570	Outpatient	9978335	$98
VITAMIN B-12	CPT 82607	Outpatient	9974944	$193
ELECTROPHORETIC TEST	CPT 82664	Outpatient	9551104	$500
ASSAY OF TOTAL ESTRADIOL	CPT 82670	Outpatient	9957026	$460
ASSAY OF FERRITIN	CPT 82728	Outpatient	9957028	$176
ASSAY OF FOLIC ACID SERUM	CPT 82746	Outpatient	9957029	$222
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	9563050	$232
BLOOD GASES ANY COMBINATION	CPT 82803	Outpatient	32529798	$683
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	633594	$64
REAGENT STRIP/BLOOD GLUCOSE	CPT 82948 (QW)	Outpatient	607617	$34
ASSAY OF GGT	CPT 82977	Outpatient	633733	$120
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	Outpatient	9957034	$460
ASSAY OF GONADOTROPIN (LH)	CPT 83002	Outpatient	9960942	$262
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	9957041	$176
ASSAY OF HOMOCYSTINE	CPT 83090	Outpatient	9957053	$425
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	9504994	$230
ASSAY OF INSULIN	CPT 83525	Outpatient	9959021	$218
ASSAY OF IRON	CPT 83540	Outpatient	9959022	$56
IRON BINDING TEST	CPT 83550	Outpatient	9959023	$130
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	12858923	$215
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	633770	$135
LACTOFERRIN FECAL (QUAL)	CPT 83630	Outpatient	14666854	$326
ASSAY OF LEAD	CPT 83655	Outpatient	9959026	$190
ASSAY OF LIPASE	CPT 83690	Outpatient	633776	$90
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	633781	$135
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	Outpatient	872048	$420
ORGANIC ACID SINGLE QUANT	CPT 83921	Outpatient	9504220	$677
ASSAY OF URINE OSMOLALITY	CPT 83935	Outpatient	9960971	$137
ASSAY OF PARATHORMONE	CPT 83970	Outpatient	9974974	$680
ASSAY OF PHOSPHORUS	CPT 84100	Outpatient	633803	$81
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	633616	$63
ASSAY OF PREALBUMIN	CPT 84134	Outpatient	9974983	$253
ASSAY OF PROGESTERONE	CPT 84144	Outpatient	9974982	$303
ASSAY OF PROLACTIN	CPT 84146	Outpatient	9974981	$337
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	9974975	$267
ASSAY OF PSA FREE	CPT 84154	Outpatient	9563231	$282
ASSAY OF PROTEIN SERUM	CPT 84155	Outpatient	10051083	$81
ASSAY OF PROTEIN URINE	CPT 84156	Outpatient	10583000	$81
PROTEIN E-PHORESIS SERUM	CPT 84165	Outpatient	10051202	$98
PROTEIN E-PHORESIS/URINE/CSF	CPT 84166	Outpatient	10583001	$262
ASSAY OF SERUM SODIUM	CPT 84295	Outpatient	633611	$88
ASSAY OF URINE SODIUM	CPT 84300	Outpatient	9974967	$97
ASSAY OF TOTAL TESTOSTERONE	CPT 84403	Outpatient	9974960	$437
ASSAY OF TOTAL THYROXINE	CPT 84436	Outpatient	9974963	$134
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	9974962	$173
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	633844	$303
TRANSFERASE (AST) (SGOT)	CPT 84450	Outpatient	633633	$70
ALANINE AMINO (ALT) (SGPT)	CPT 84460	Outpatient	633632	$87
ASSAY OF TRANSFERRIN	CPT 84466	Outpatient	9974953	$202
ASSAY TRIIODOTHYRONINE (T3)	CPT 84480	Outpatient	9974964	$252
FREE ASSAY (FT-3)	CPT 84481	Outpatient	9974965	$317
ASSAY OF TROPONIN QUANT	CPT 84484	Outpatient	940718	$228
ASSAY OF UREA NITROGEN	CPT 84520	Outpatient	633605	$63
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	633858	$80
ASSAY OF VITAMIN A	CPT 84590	Outpatient	9505007	$380
ASSAY OF ZINC	CPT 84630	Outpatient	9505026	$253
ASSAY OF C-PEPTIDE	CPT 84681	Outpatient	9503972	$397
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	9957040	$428
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	Outpatient	10339149	$173
BL SMEAR W/DIFF WBC COUNT	CPT 85007	Outpatient	9202971	$78
HEMATOCRIT	CPT 85014	Outpatient	633742	$57
HEMOGLOBIN	CPT 85018	Outpatient	633741	$30
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	-	$62
COMPLETE CBC AUTOMATED	CPT 85027	Outpatient	8475377	$125
AUTOMATED RETICULOCYTE COUNT	CPT 85045	Outpatient	9974972	$145
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	633718	$99
PROTHROMBIN TIME	CPT 85610	Outpatient	633793	$49
RBC SED RATE NONAUTOMATED	CPT 85651	Outpatient	904651	$88
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	9974973	$97
ALLG SPEC IGE CRUDE XTRC EA	CPT 86003	Outpatient	10734645	$80
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	9956942	$190
C-REACTIVE PROTEIN	CPT 86140	Outpatient	9956993	$115
C-REACTIVE PROTEIN HS	CPT 86141	Outpatient	9957050	$235
COMPLEMENT ANTIGEN	CPT 86160	Outpatient	9956973	$319
CCP ANTIBODY	CPT 86200	Outpatient	9956981	$288
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	Outpatient	9504025	$77
IMMUNOASSAY TUMOR CA 15-3	CPT 86300	Outpatient	9503929	$373
IMMUNOASSAY TUMOR CA 19-9	CPT 86301	Outpatient	9503930	$373
IMMUNOASSAY TUMOR CA 125	CPT 86304	Outpatient	9956975	$288
HETEROPHILE ANTIBODY SCREEN	CPT 86308	Outpatient	10339210	$102
IMMUNOFIX E-PHORESIS SERUM	CPT 86334	Outpatient	10051203	$307
IMMUNFIX E-PHORSIS/URINE/CSF	CPT 86335	Outpatient	10582999	$417
MICROSOMAL ANTIBODY EACH	CPT 86376	Outpatient	10051392	$237
RHEUMATOID FACTOR QUANT	CPT 86431	Outpatient	9974971	$130
TB TEST CELL IMMUN MEASURE	CPT 86480	Outpatient	49984708	$988
TB INTRADERMAL TEST	CPT 86580	Outpatient	1013339	$41
ASPERGILLUS ANTIBODY	CPT 86606	Outpatient	11673530	$267
LYME DISEASE ANTIBODY	CPT 86618	Outpatient	9960947	$237
CMV ANTIBODY	CPT 86644	Outpatient	9551611	$273
CMV ANTIBODY IGM	CPT 86645	Outpatient	9551612	$273
EPSTEIN-BARR NUCLEAR ANTIGEN	CPT 86664	Outpatient	9551624	$340
EPSTEIN-BARR CAPSID VCA	CPT 86665	Outpatient	9551623	$252
EHRLICHIA ANTIBODY	CPT 86666	Outpatient	9551010	$363
HERPES SIMPLEX TYPE 1 TEST	CPT 86695	Outpatient	9551641	$213
HERPES SIMPLEX TYPE 2 TEST	CPT 86696	Outpatient	9551642	$283
HIV-1/HIV-2 1 RESULT ANTBDY	CPT 86703	Outpatient	9957051	$218
HEP B CORE ANTIBODY IGM	CPT 86705	Outpatient	9957045	$193
HEP B SURFACE ANTIBODY	CPT 86706	Outpatient	9957046	$125
HEPATITIS A ANTIBODY	CPT 86708	Outpatient	9957044	$193
PROTOZOA ANTIBODY NOS	CPT 86753	Outpatient	9551011	$363
RUBELLA ANTIBODY	CPT 86762	Outpatient	9974970	$275
RUBEOLA ANTIBODY	CPT 86765	Outpatient	9974969	$273
TREPONEMA PALLIDUM	CPT 86780	Outpatient	9974966	$193
VARICELLA-ZOSTER ANTIBODY	CPT 86787	Outpatient	9974947	$258
THYROGLOBULIN ANTIBODY	CPT 86800	Outpatient	10051391	$205
HEPATITIS C AB TEST	CPT 86803	Outpatient	9957048	$313
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	9004146	$115
BLOOD TYPING SEROLOGIC ABO	CPT 86900	Outpatient	2548611	$58
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	Outpatient	2200640	$58
COMPATIBILITY TEST SPIN	CPT 86920	Outpatient	9004141	$84
SPECIMEN INFECT AGNT CONCNTJ	CPT 87015	Outpatient	10051116	$148
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	8463198	$121
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	Outpatient	8463223	$105
CULTURE AEROBIC IDENTIFY	CPT 87077	Outpatient	11222949	$76
CULTURE SCREEN ONLY	CPT 87081	Outpatient	9006955	$63
URINE CULTURE/COLONY COUNT	CPT 87086	Outpatient	8463221	$65
MICROBE SUSCEPTIBLE DISK	CPT 87184	Outpatient	10837037	$94
SMEAR FLUORESCENT/ACID STAI	CPT 87206	Outpatient	10582975	$107
SMEAR COMPLEX STAIN	CPT 87209	Outpatient	10583005	$293
GIARDIA AG IF	CPT 87269	Outpatient	10051120	$187
CLOSTRIDIUM AG IA	CPT 87324	Outpatient	10582596	$207
HPYLORI STOOL AG IA	CPT 87338	Outpatient	9504153	$430
HEPATITIS B SURFACE AG IA	CPT 87340	Outpatient	9957047	$236
NOS EACH ORGANISM AG IA	CPT 87449	Outpatient	10582595	$207
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	9978925	$312
NFCT AGENT DETECTION GI	CPT 87505	Outpatient	48334418	$322
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	Outpatient	9504287	$1,317
HSV DNA AMP PROBE	CPT 87529	Outpatient	50031852	$51
N.GONORRHOEAE DNA AMP PROB	CPT 87591	Outpatient	9978926	$330
HPV HIGH-RISK TYPES	CPT 87624	Outpatient	40608134	$145
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	21528791	$1,285
INFLUENZA ASSAY W/OPTIC	CPT 87804 (QW)	Outpatient	9448061	$97
TRICHOMONAS ASSAY W/OPTIC	CPT 87808	Outpatient	35832719	$85
STREP A ASSAY W/OPTIC	CPT 87880 (QW)	Outpatient	1000600	$89
CYTOPATH C/V AUTO FLUID REDO	CPT 88175	Outpatient	40608132	$158
TISSUE EXAM BY PATHOLOGIST	CPT 88305	Outpatient	816035	$56
BODY FLUID CELL COUNT	CPT 89050	Outpatient	17336853	$128
PSA SCREENING	HCPCS G0103	Outpatient	11223342	$139
SPECIMEN COLLECT COVID-19	HCPCS G2023	Outpatient	50432984	$67
COV-19 AMP PRB HGH THRUPUT	HCPCS U0003	Outpatient	50433409	$89
MRI
(N/O) MRI SCAN	CPT 70553	-	-	-	-
(N/O) MRI SCAN OF LOWER SPINAL CANAL	CPT 72148	-	-	-	-
(N/O) MRI SCAN OF LEG JOINT	CPT 73721	-	-	-	-
Other Diagnostic
PURE TONE HEARING TEST AIR	CPT 92551	Outpatient	1014598	$54
EXTREMITY STUDY	CPT 93971 (LT,TC)	Outpatient	753421	$942
Other Procedures and Observation
US URINE CAPACITY MEASURE	CPT 51798	Outpatient	651591	$94
HOSPITAL OBSERVATION PER HR	HCPCS G0378	Outpatient	990676	$70
Pharmacy
METHYLPREDNISOLONE 80 MG INJ	HCPCS J1040	Outpatient	15559135	$47
Psychiatric
PSYCH DIAG EVAL W/MED SRVCS	CPT 90792	Outpatient	1479945	$307
PSYTX W PT 30 MINUTES	CPT 90832	Outpatient	47794427	$130
PSYTX W PT 45 MINUTES	CPT 90834	Outpatient	47794429	$171
(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 NECK	CPT 70360 (TC)	Outpatient	753807	$222
X-RAY EXAM CHEST 1 VIEW	CPT 71045 (TC)	Outpatient	751376	$229
X-RAY EXAM CHEST 2 VIEWS	CPT 71046 (TC)	Outpatient	689607	$331
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100 (LT,TC)	Outpatient	1457770	$324
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101 (LT,TC)	Outpatient	931894	$514
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040 (TC)	Outpatient	13762860	$317
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050 (TC)	Outpatient	47904619	$325
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070 (TC)	Outpatient	753897	$311
X-RAY EXAM THORAC SPINE 3VWS	CPT 72072 (50,TC)	Outpatient	1713017	$407
X-RAY EXAM THORACOLMB 2/> VW	CPT 72080 (TC)	Outpatient	1405815	$341
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100 (TC)	Outpatient	1713011	$350
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110 (TC)	Outpatient	753893	$508
X-RAY EXAM L-S SPINE BENDING	CPT 72114 (TC)	Outpatient	753891	$503
X-RAY EXAM OF PELVIS	CPT 72170 (TC)	Outpatient	1066971	$314
X-RAY EXAM OF PELVIS	CPT 72190 (TC)	Outpatient	1066973	$408
X-RAY EXAM SI JOINTS 3/> VWS	CPT 72202 (TC)	Outpatient	753833	$404
X-RAY EXAM SACRUM TAILBONE	CPT 72220 (TC)	Outpatient	753835	$318
X-RAY EXAM OF COLLAR BONE	CPT 73000 (LT,TC)	Outpatient	753601	$297
X-RAY EXAM OF SHOULDER	CPT 73030 (RT,TC)	Outpatient	753853	$316
X-RAY EXAM OF HUMERUS	CPT 73060 (LT,TC)	Outpatient	753734	$318
X-RAY EXAM OF ELBOW	CPT 73070 (RT,TC)	Outpatient	753625	$276
X-RAY EXAM OF ELBOW	CPT 73080 (LT,TC)	Outpatient	753629	$318
X-RAY EXAM OF FOREARM	CPT 73090 (LT,TC)	Outpatient	1712965	$236
X-RAY EXAM OF WRIST	CPT 73100 (LT,TC)	Outpatient	754005	$286
X-RAY EXAM OF WRIST	CPT 73110 (LT,TC)	Outpatient	754011	$298
X-RAY EXAM OF HAND	CPT 73120 (RT,TC)	Outpatient	753711	$308
X-RAY EXAM OF HAND	CPT 73130 (LT,TC)	Outpatient	753715	$318
X-RAY EXAM OF FINGER(S)	CPT 73140 (RT,TC)	Outpatient	753666	$222
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502 (RT,TC)	Outpatient	48005097	$361
X-RAY EXAM HIPS BI 2 VIEWS	CPT 73521 (TC)	Outpatient	48005106	$558
X-RAY EXAM HIPS BI 3-4 VIEWS	CPT 73522 (TC)	Outpatient	48005109	$590
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (LT,TC)	Outpatient	753644	$319
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (RT,TC)	Outpatient	753749	$287
X-RAY EXAM KNEE 4 OR MORE	CPT 73564 (RT,TC)	Outpatient	753761	$418
X-RAY EXAM OF KNEES	CPT 73565 (TC)	Outpatient	931878	$190
X-RAY EXAM OF LOWER LEG	CPT 73590 (RT,TC)	Outpatient	753920	$278
X-RAY EXAM OF ANKLE	CPT 73600 (RT,TC)	Outpatient	753511	$299
X-RAY EXAM OF ANKLE	CPT 73610 (RT,TC)	Outpatient	753517	$316
X-RAY EXAM OF FOOT	CPT 73620 (LT,TC)	Outpatient	753687	$314
X-RAY EXAM OF FOOT	CPT 73630 (RT,TC)	Outpatient	753695	$316
X-RAY EXAM OF TOE(S)	CPT 73660 (RT,TC)	Outpatient	753940	$226
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018 (TC)	Outpatient	922935	$277
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019 (TC)	Outpatient	753493	$394
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022 (TC)	Outpatient	753502	$406
DXA BONE DENSITY AXIAL	CPT 77080 (TC)	Outpatient	931306	$542
Surgical Procedures
(N/O) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN PROCEDURE	CPT 19120	-	-	-	-
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 29826	-	-	-	-
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE	CPT 29881	-	-	-	-
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...	CPT 42820	-	-	-	-
(N/O) DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH OR SMALL BOWEL ...	CPT 43235	-	-	-	-
(N/O) BIOPSY EXAM OF ESOPHAGUS, STOMACH OR SMALL BOWEL USI ...	CPT 43239	-	-	-	-
(N/O) DIAGNOSTIC EXAM OF LARGE BOWEL USING AN ENDOSCOPE	CPT 45378	-	-	-	-
(N/O) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOPE	CPT 45380	-	-	-	-
(N/O) REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ...	CPT 45385	-	-	-	-
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...	CPT 45391	-	-	-	-
(N/O) REMOVAL OF GALLBLADDER USING AN ENDOSCOPE	CPT 47562	-	-	-	-
(N/O) REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS OR OLDER	CPT 49505	-	-	-	-
(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	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62323	-	-	-	-
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...	CPT 64483	-	-	-	-
(N/O) REMOVAL OF RECURRING CATARACT IN LENS CAPSULE USING ...	CPT 66821	-	-	-	-
(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	-	$186
Uncategorized
REMOVE INTRAUTERINE DEVICE	CPT 58301	Outpatient	48377959	$174
IMMUNIZATION ADMIN	CPT 90471	Outpatient	2187003	$30
IMMUNIZATION ADMIN EACH ADD	CPT 90472	Outpatient	2187004	$30