Grace Cottage Hospital

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

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.
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Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450 (TC)Outpatient753044$1,892
CT HEAD/BRAIN W/O & W/DYECPT 70470 (TC)Outpatient753040$2,635
CT MAXILLOFACIAL W/O DYECPT 70486 (TC)Outpatient753085$1,917
CT MAXILLOFACIAL W/DYECPT 70487 (TC)Outpatient753083$2,254
CT SOFT TISSUE NECK W/DYECPT 70491 (TC)Outpatient753125$2,248
CT ANGIOGRAPHY HEADCPT 70496 (TC)Outpatient49973480$2,772
CT ANGIOGRAPHY NECKCPT 70498 (TC)Outpatient48577869$3,294
CT THORAX DX C-CPT 71250 (TC)Outpatient753151$2,160
CT THORAX DX C+CPT 71260 (TC)Outpatient753149$2,616
CT THORAX DX C-/C+CPT 71270 (TC)Outpatient753147$3,115
CT ANGIOGRAPHY CHESTCPT 71275 (TC)Outpatient1339992$3,320
CT NECK SPINE W/O DYECPT 72125 (TC)Outpatient753133$2,160
CT CHEST SPINE W/O DYECPT 72128 (TC)Outpatient753145$2,182
CT LUMBAR SPINE W/O DYECPT 72131 (TC)Outpatient753139$2,160
CT LUMBAR SPINE W/DYECPT 72132 (TC)Outpatient753137$2,609
CT PELVIS W/O DYECPT 72192 (TC)Outpatient753106$2,218
CT PELVIS W/DYECPT 72193 (TC)Outpatient753104$2,454
CT UPPER EXTREMITY W/O DYECPT 73200 (LT,TC)Outpatient753167$1,941
CT LOWER EXTREMITY W/O DYECPT 73700 (LT,TC)Outpatient753077$1,939
CT ABDOMEN W/O DYECPT 74150 (TC)Outpatient752980$2,194
CT ABDOMEN W/DYECPT 74160 (TC)Outpatient752052$2,519
CT ABDOMEN W/O & W/DYECPT 74170 (TC)Outpatient752978$2,661
CT ANGIO ABD&PELV W/O&W/DYECPT 74174 (TC)Outpatient8284945$3,781
CT ABD & PELVIS W/O CONTRASTCPT 74176 (TC)Outpatient931316$3,143
CT ABD & PELV W/CONTRASTCPT 74177 (TC)Outpatient931313$3,781
CT ABD & PELV 1/> REGNSCPT 74178 (TC)Outpatient931310$4,510
CT ANGIO ABDOMINAL ARTERIESCPT 75635Outpatient752985$2,980
3D RENDER W/INTRP POSTPROCESCPT 76376 (TC)Outpatient9352946$394
Clinic
TANGNTL BX SKIN SINGLE LESCPT 11102Outpatient49949567$264
PUNCH BX SKIN SINGLE LESIONCPT 11104Outpatient49949569$331
DESTRUCT B9 LESION 1-14CPT 17110Outpatient47770384$433
INJ TENDON SHEATH/LIGAMENTCPT 20550Outpatient1353686$111
DRAIN/INJ JOINT/BURSA W/O USCPT 20610Outpatient49873985$306
APPLICATION OF PASTE BOOTCPT 29580Outpatient1479872$108
REMOVE IMPACTED EAR WAX UNICPT 69209Outpatient5200898$38
REMOVE IMPACTED EAR WAX UNICPT 69210Outpatient48439815$101
PSYTX W PT W E/M 30 MINCPT 90833Outpatient1489773$62
PSYTX W PT W E/M 45 MINCPT 90836Outpatient47796850$98
IMMUNOTHERAPY ONE INJECTIONCPT 95115Outpatient1013348$20
DEVELOPMENTAL SCREEN W/SCORECPT 96110Outpatient48162485$75
MEDICAL NUTRITION INDIV INCPT 97802Outpatient49984414$96
MED NUTRITION INDIV SUBSEQCPT 97803Outpatient49984415$96
OFFICE O/P NEW SF 15-29 MINCPT 99202Outpatient47824834$136
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient1349644$205
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient-$312
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient-$387
OFFICE O/P EST MINIMAL PROBCPT 99211Outpatient1361634$42
OFFICE O/P EST SF 10-19 MINCPT 99212Outpatient1489783$85
OFFICE O/P EST LOW 20-29 MINCPT 99213Outpatient1349647$137
OBSERVATION CARE DISCHARGECPT 99217Outpatient1349650$140
OBSERV/HOSP SAME DATECPT 99234Outpatient1349659$261
OFFICE CONSULTATIONCPT 99243Outpatient1349665$235
OFFICE CONSULTATIONCPT 99244Outpatient1491674$346
DOMICIL/R-HOME VISIT EST PATCPT 99335Outpatient4582900$191
HOME VISIT EST PATIENTCPT 99347Outpatient1353612$109
INIT PM E/M NEW PAT INFANTCPT 99381Outpatient1353616$334
INIT PM E/M NEW PAT 1-4 YRSCPT 99382Outpatient1353617$361
PREV VISIT NEW AGE 5-11CPT 99383Outpatient1353618$364
PREV VISIT NEW AGE 18-39CPT 99385Outpatient1353620$381
PREV VISIT NEW AGE 40-64CPT 99386Outpatient1353621$450
PER PM REEVAL EST PAT INFANTCPT 99391Outpatient1353622$255
PREV VISIT EST AGE 1-4CPT 99392Outpatient1353623$284
PREV VISIT EST AGE 5-11CPT 99393Outpatient1353624$284
PREV VISIT EST AGE 12-17CPT 99394Outpatient1353625$309
PREV VISIT EST AGE 18-39CPT 99395Outpatient1353626$313
PREV VISIT EST AGE 40-64CPT 99396Outpatient1353627$346
PER PM REEVAL EST PAT 65+ YRCPT 99397Outpatient48577218$381
PREVENTIVE COUNSELING INDIVCPT 99401Outpatient50394485$174
PREVENTIVE COUNSELING INDIVCPT 99402Outpatient50394486$348
PREVENTIVE COUNSELING INDIVCPT 99403Outpatient50394487$485
BEHAV CHNG SMOKING 3-10 MINCPT 99406Outpatient49984418$58
PHONE E/M PHYS/QHP 5-10 MINCPT 99441Outpatient8677020$118
PHONE E/M PHYS/QHP 21-30 MINCPT 99443Outpatient8677022$145
WORK RELATED DISABILITY EXAMCPT 99455Outpatient29108786$200
TRANS CARE MGMT 14 DAY DISCHCPT 99495Outpatient49984420$597
TRANS CARE MGMT 7 DAY DISCHCPT 99496Outpatient49984421$819
ADVNCD CARE PLAN 30 MINCPT 99497Outpatient47994858$451
COMM SVCS BY RHC/FQHC 5 MINHCPCS G0071Outpatient50419044$39
PPPS, SUBSEQ VISITHCPCS G0439Outpatient5992894$749
BEHAVIOR COUNSEL OBESITY 15MHCPCS G0447Outpatient49984417$89
DIS SITE TELE SVCS RHC/FQHCHCPCS G2025Outpatient50454044$139
OBTAINING SCREEN PAP SMEARHCPCS Q0091Outpatient1920735$152
PROGRAM INTAKE ASSESSMENTHCPCS T1023 (TM)Outpatient8677045$64
EEG
(N/O) SLEEP STUDYCPT 95810----
EKG
ELECTROCARDIOGRAM COMPLETECPT 93000Outpatient1355597$284
EXT ECG>48HR<7D REV&INTERPJCPT 93244Outpatient48809237$84
Emergency Room
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient9089574$570
DRAIN/INJ JOINT/BURSA W/O USCPT 20605Outpatient15220869$560
THER/DIAG CONCURRENT INFCPT 96368Outpatient44474134$45
EMERGENCY DEPT VISITCPT 99281Outpatient44474122$211
EMERGENCY DEPT VISITCPT 99282Outpatient44474123$326
EMERGENCY DEPT VISITCPT 99283Outpatient44474124$603
EMERGENCY DEPT VISITCPT 99284Outpatient44474125$927
EMERGENCY DEPT VISITCPT 99285Outpatient44474126$1,296
CRITICAL CARE FIRST HOURCPT 99291Outpatient44474127$1,562
CRITICAL CARE ADDL 30 MINCPT 99292Outpatient44474128$611
IV Therapy
HYDRATION IV INFUSION INITCPT 96360Outpatient44474129$147
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient44474130$141
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient44474131$240
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient44474132$115
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient44474133$131
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient44474145$98
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient44474146$141
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient44474147$141
IRRIG DRUG DELIVERY DEVICECPT 96523Outpatient9089426$159
Imaging
US EXAM OF HEAD AND NECKCPT 76536 (TC)Outpatient927052$787
US EXAM ABDOM COMPLETECPT 76700 (TC)Outpatient752050$859
ECHO EXAM OF ABDOMENCPT 76705 (TC)Outpatient753319$646
US ABDL AORTA SCREEN AAACPT 76706 (TC)Outpatient2342819$653
US EXAM ABDO BACK WALL COMPCPT 76770 (TC)Outpatient1100639$839
US EXAM ABDO BACK WALL LIMCPT 76775 (TC)Outpatient753456$653
(N/O) ABDOMIAL ULTRASOUND OF PREGNANT UTERUSCPT 76805----
TRANSVAGINAL US NON-OBCPT 76830 (TC)Outpatient753471$858
US EXAM PELVIC COMPLETECPT 76856 (TC)Outpatient753436$638
US EXAM PELVIC LIMITEDCPT 76857 (TC)Outpatient753438$564
US EXAM SCROTUMCPT 76870 (TC)Outpatient11276933$618
US LMTD JT/NONVASC XTR STRUXCPT 76882 (LT,TC)Outpatient8592961$611
(N/O) MAMMOGRAPHY OF ONE BREASTCPT 77065----
(N/O) MAMMOGRAPHY OF BOTH BREASTSCPT 77066----
(N/O) MAMMOGRAPHY, SCREENING, BILATERALCPT 77067----
EXTREMITY STUDYCPT 93970 (TC)Outpatient753419$1,067
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460----
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...DRG 470----
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473----
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...DRG 743----
Laboratory
ROUTINE VENIPUNCTURECPT 36415Outpatient816059$47
METABOLIC PANEL TOTAL CACPT 80048Outpatient633628$232
COMPREHEN METABOLIC PANELCPT 80053Outpatient633709$135
(N/O) OBSTETRIC BLOOD TEST PANELCPT 80055----
LIPID PANELCPT 80061Outpatient633777$222
RENAL FUNCTION PANELCPT 80069Outpatient819112$264
HEPATIC FUNCTION PANELCPT 80076Outpatient9706947$264
ASSAY CARBAMAZEPINE TOTALCPT 80156Outpatient9956979$215
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient9957015$215
ASSAY DIPROPYLACETIC ACD TOTCPT 80164Outpatient9974948$215
ASSAY OF LITHIUMCPT 80178Outpatient9960945$133
ASSAY OF PHENYTOIN TOTALCPT 80185Outpatient9974992$215
ASSAY OF VANCOMYCINCPT 80202Outpatient11040879$340
DRUG TEST PRSMV DIR OPT OBSCPT 80305Outpatient12968924$18
URINALYSIS NONAUTO W/SCOPECPT 81000Outpatient9708942$117
URINALYSIS AUTO W/SCOPECPT 81001Outpatient8475424$117
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient593519$31
MICROSCOPIC EXAM OF URINECPT 81015Outpatient9709000$88
URINE PREGNANCY TESTCPT 81025Outpatient742369$22
HLA II TYPING 1 LOCUS LRCPT 81376Outpatient9563051$500
ASSAY OF SERUM ALBUMINCPT 82040Outpatient633634$63
UR ALBUMIN QUANTITATIVECPT 82043Outpatient9978334$103
ASSAY OF AMMONIACPT 82140Outpatient9941215$218
ASSAY OF AMYLASECPT 82150Outpatient631567$107
BILIRUBIN DIRECTCPT 82248Outpatient633670$88
ASSAY TEST FOR BLOOD FECALCPT 82274Outpatient14476906$239
VITAMIN D 25 HYDROXYCPT 82306Outpatient48657100$487
ASSAY OF CALCIUMCPT 82310Outpatient633690$69
ASSAY OF CALCIUM IN URINECPT 82340Outpatient9956978$95
CARCINOEMBRYONIC ANTIGENCPT 82378Outpatient9956982$276
ASSAY OF BLOOD CHLORIDECPT 82435Outpatient633621$64
TOTAL CORTISOLCPT 82533Outpatient9956987$260
ASSAY OF CK (CPK)CPT 82550Outpatient633712$149
ASSAY OF CREATININECPT 82565Outpatient633606$64
ASSAY OF URINE CREATININECPT 82570Outpatient9978335$98
VITAMIN B-12CPT 82607Outpatient9974944$193
ELECTROPHORETIC TESTCPT 82664Outpatient9551104$500
ASSAY OF TOTAL ESTRADIOLCPT 82670Outpatient9957026$460
ASSAY OF FERRITINCPT 82728Outpatient9957028$176
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient9957029$222
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient9563050$232
BLOOD GASES ANY COMBINATIONCPT 82803Outpatient32529798$683
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient633594$64
REAGENT STRIP/BLOOD GLUCOSECPT 82948 (QW)Outpatient607617$34
ASSAY OF GGTCPT 82977Outpatient633733$120
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient9957034$460
ASSAY OF GONADOTROPIN (LH)CPT 83002Outpatient9960942$262
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient9957041$176
ASSAY OF HOMOCYSTINECPT 83090Outpatient9957053$425
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient9504994$230
ASSAY OF INSULINCPT 83525Outpatient9959021$218
ASSAY OF IRONCPT 83540Outpatient9959022$56
IRON BINDING TESTCPT 83550Outpatient9959023$130
ASSAY OF LACTIC ACIDCPT 83605Outpatient12858923$215
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient633770$135
LACTOFERRIN FECAL (QUAL)CPT 83630Outpatient14666854$326
ASSAY OF LEADCPT 83655Outpatient9959026$190
ASSAY OF LIPASECPT 83690Outpatient633776$90
ASSAY OF MAGNESIUMCPT 83735Outpatient633781$135
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient872048$420
ORGANIC ACID SINGLE QUANTCPT 83921Outpatient9504220$677
ASSAY OF URINE OSMOLALITYCPT 83935Outpatient9960971$137
ASSAY OF PARATHORMONECPT 83970Outpatient9974974$680
ASSAY OF PHOSPHORUSCPT 84100Outpatient633803$81
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient633616$63
ASSAY OF PREALBUMINCPT 84134Outpatient9974983$253
ASSAY OF PROGESTERONECPT 84144Outpatient9974982$303
ASSAY OF PROLACTINCPT 84146Outpatient9974981$337
ASSAY OF PSA TOTALCPT 84153Outpatient9974975$267
ASSAY OF PSA FREECPT 84154Outpatient9563231$282
ASSAY OF PROTEIN SERUMCPT 84155Outpatient10051083$81
ASSAY OF PROTEIN URINECPT 84156Outpatient10583000$81
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient10051202$98
PROTEIN E-PHORESIS/URINE/CSFCPT 84166Outpatient10583001$262
ASSAY OF SERUM SODIUMCPT 84295Outpatient633611$88
ASSAY OF URINE SODIUMCPT 84300Outpatient9974967$97
ASSAY OF TOTAL TESTOSTERONECPT 84403Outpatient9974960$437
ASSAY OF TOTAL THYROXINECPT 84436Outpatient9974963$134
ASSAY OF FREE THYROXINECPT 84439Outpatient9974962$173
ASSAY THYROID STIM HORMONECPT 84443Outpatient633844$303
TRANSFERASE (AST) (SGOT)CPT 84450Outpatient633633$70
ALANINE AMINO (ALT) (SGPT)CPT 84460Outpatient633632$87
ASSAY OF TRANSFERRINCPT 84466Outpatient9974953$202
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient9974964$252
FREE ASSAY (FT-3)CPT 84481Outpatient9974965$317
ASSAY OF TROPONIN QUANTCPT 84484Outpatient940718$228
ASSAY OF UREA NITROGENCPT 84520Outpatient633605$63
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient633858$80
ASSAY OF VITAMIN ACPT 84590Outpatient9505007$380
ASSAY OF ZINCCPT 84630Outpatient9505026$253
ASSAY OF C-PEPTIDECPT 84681Outpatient9503972$397
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient9957040$428
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient10339149$173
BL SMEAR W/DIFF WBC COUNTCPT 85007Outpatient9202971$78
HEMATOCRITCPT 85014Outpatient633742$57
HEMOGLOBINCPT 85018Outpatient633741$30
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient-$62
COMPLETE CBC AUTOMATEDCPT 85027Outpatient8475377$125
AUTOMATED RETICULOCYTE COUNTCPT 85045Outpatient9974972$145
FIBRIN DEGRADATION QUANTCPT 85379Outpatient633718$99
PROTHROMBIN TIMECPT 85610Outpatient633793$49
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient904651$88
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient9974973$97
ALLG SPEC IGE CRUDE XTRC EACPT 86003Outpatient10734645$80
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient9956942$190
C-REACTIVE PROTEINCPT 86140Outpatient9956993$115
C-REACTIVE PROTEIN HSCPT 86141Outpatient9957050$235
COMPLEMENT ANTIGENCPT 86160Outpatient9956973$319
CCP ANTIBODYCPT 86200Outpatient9956981$288
NUCLEAR ANTIGEN ANTIBODYCPT 86235Outpatient9504025$77
IMMUNOASSAY TUMOR CA 15-3CPT 86300Outpatient9503929$373
IMMUNOASSAY TUMOR CA 19-9CPT 86301Outpatient9503930$373
IMMUNOASSAY TUMOR CA 125CPT 86304Outpatient9956975$288
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient10339210$102
IMMUNOFIX E-PHORESIS SERUMCPT 86334Outpatient10051203$307
IMMUNFIX E-PHORSIS/URINE/CSFCPT 86335Outpatient10582999$417
MICROSOMAL ANTIBODY EACHCPT 86376Outpatient10051392$237
RHEUMATOID FACTOR QUANTCPT 86431Outpatient9974971$130
TB TEST CELL IMMUN MEASURECPT 86480Outpatient49984708$988
TB INTRADERMAL TESTCPT 86580Outpatient1013339$41
ASPERGILLUS ANTIBODYCPT 86606Outpatient11673530$267
LYME DISEASE ANTIBODYCPT 86618Outpatient9960947$237
CMV ANTIBODYCPT 86644Outpatient9551611$273
CMV ANTIBODY IGMCPT 86645Outpatient9551612$273
EPSTEIN-BARR NUCLEAR ANTIGENCPT 86664Outpatient9551624$340
EPSTEIN-BARR CAPSID VCACPT 86665Outpatient9551623$252
EHRLICHIA ANTIBODYCPT 86666Outpatient9551010$363
HERPES SIMPLEX TYPE 1 TESTCPT 86695Outpatient9551641$213
HERPES SIMPLEX TYPE 2 TESTCPT 86696Outpatient9551642$283
HIV-1/HIV-2 1 RESULT ANTBDYCPT 86703Outpatient9957051$218
HEP B CORE ANTIBODY IGMCPT 86705Outpatient9957045$193
HEP B SURFACE ANTIBODYCPT 86706Outpatient9957046$125
HEPATITIS A ANTIBODYCPT 86708Outpatient9957044$193
PROTOZOA ANTIBODY NOSCPT 86753Outpatient9551011$363
RUBELLA ANTIBODYCPT 86762Outpatient9974970$275
RUBEOLA ANTIBODYCPT 86765Outpatient9974969$273
TREPONEMA PALLIDUMCPT 86780Outpatient9974966$193
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient9974947$258
THYROGLOBULIN ANTIBODYCPT 86800Outpatient10051391$205
HEPATITIS C AB TESTCPT 86803Outpatient9957048$313
RBC ANTIBODY SCREENCPT 86850Outpatient9004146$115
BLOOD TYPING SEROLOGIC ABOCPT 86900Outpatient2548611$58
BLOOD TYPING SEROLOGIC RH(D)CPT 86901Outpatient2200640$58
COMPATIBILITY TEST SPINCPT 86920Outpatient9004141$84
SPECIMEN INFECT AGNT CONCNTJCPT 87015Outpatient10051116$148
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient8463198$121
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient8463223$105
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient11222949$76
CULTURE SCREEN ONLYCPT 87081Outpatient9006955$63
URINE CULTURE/COLONY COUNTCPT 87086Outpatient8463221$65
MICROBE SUSCEPTIBLE DISKCPT 87184Outpatient10837037$94
SMEAR FLUORESCENT/ACID STAICPT 87206Outpatient10582975$107
SMEAR COMPLEX STAINCPT 87209Outpatient10583005$293
GIARDIA AG IFCPT 87269Outpatient10051120$187
CLOSTRIDIUM AG IACPT 87324Outpatient10582596$207
HPYLORI STOOL AG IACPT 87338Outpatient9504153$430
HEPATITIS B SURFACE AG IACPT 87340Outpatient9957047$236
NOS EACH ORGANISM AG IACPT 87449Outpatient10582595$207
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient9978925$312
NFCT AGENT DETECTION GICPT 87505Outpatient48334418$322
HEPATITIS C REVRS TRNSCRPJCPT 87522Outpatient9504287$1,317
HSV DNA AMP PROBECPT 87529Outpatient50031852$51
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient9978926$330
HPV HIGH-RISK TYPESCPT 87624Outpatient40608134$145
DETECT AGENT NOS DNA AMPCPT 87798Outpatient21528791$1,285
INFLUENZA ASSAY W/OPTICCPT 87804 (QW)Outpatient9448061$97
TRICHOMONAS ASSAY W/OPTICCPT 87808Outpatient35832719$85
STREP A ASSAY W/OPTICCPT 87880 (QW)Outpatient1000600$89
CYTOPATH C/V AUTO FLUID REDOCPT 88175Outpatient40608132$158
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient816035$56
BODY FLUID CELL COUNTCPT 89050Outpatient17336853$128
PSA SCREENINGHCPCS G0103Outpatient11223342$139
SPECIMEN COLLECT COVID-19HCPCS G2023Outpatient50432984$67
COV-19 AMP PRB HGH THRUPUTHCPCS U0003Outpatient50433409$89
MRI
(N/O) MRI SCANCPT 70553----
(N/O) MRI SCAN OF LOWER SPINAL CANALCPT 72148----
(N/O) MRI SCAN OF LEG JOINTCPT 73721----
Other Diagnostic
PURE TONE HEARING TEST AIRCPT 92551Outpatient1014598$54
EXTREMITY STUDYCPT 93971 (LT,TC)Outpatient753421$942
Other Procedures and Observation
US URINE CAPACITY MEASURECPT 51798Outpatient651591$94
HOSPITAL OBSERVATION PER HRHCPCS G0378Outpatient990676$70
Pharmacy
METHYLPREDNISOLONE 80 MG INJHCPCS J1040Outpatient15559135$47
Psychiatric
PSYCH DIAG EVAL W/MED SRVCSCPT 90792Outpatient1479945$307
PSYTX W PT 30 MINUTESCPT 90832Outpatient47794427$130
PSYTX W PT 45 MINUTESCPT 90834Outpatient47794429$171
(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 NECKCPT 70360 (TC)Outpatient753807$222
X-RAY EXAM CHEST 1 VIEWCPT 71045 (TC)Outpatient751376$229
X-RAY EXAM CHEST 2 VIEWSCPT 71046 (TC)Outpatient689607$331
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (LT,TC)Outpatient1457770$324
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (LT,TC)Outpatient931894$514
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040 (TC)Outpatient13762860$317
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050 (TC)Outpatient47904619$325
X-RAY EXAM THORAC SPINE 2VWSCPT 72070 (TC)Outpatient753897$311
X-RAY EXAM THORAC SPINE 3VWSCPT 72072 (50,TC)Outpatient1713017$407
X-RAY EXAM THORACOLMB 2/> VWCPT 72080 (TC)Outpatient1405815$341
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100 (TC)Outpatient1713011$350
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110 (TC)Outpatient753893$508
X-RAY EXAM L-S SPINE BENDINGCPT 72114 (TC)Outpatient753891$503
X-RAY EXAM OF PELVISCPT 72170 (TC)Outpatient1066971$314
X-RAY EXAM OF PELVISCPT 72190 (TC)Outpatient1066973$408
X-RAY EXAM SI JOINTS 3/> VWSCPT 72202 (TC)Outpatient753833$404
X-RAY EXAM SACRUM TAILBONECPT 72220 (TC)Outpatient753835$318
X-RAY EXAM OF COLLAR BONECPT 73000 (LT,TC)Outpatient753601$297
X-RAY EXAM OF SHOULDERCPT 73030 (RT,TC)Outpatient753853$316
X-RAY EXAM OF HUMERUSCPT 73060 (LT,TC)Outpatient753734$318
X-RAY EXAM OF ELBOWCPT 73070 (RT,TC)Outpatient753625$276
X-RAY EXAM OF ELBOWCPT 73080 (LT,TC)Outpatient753629$318
X-RAY EXAM OF FOREARMCPT 73090 (LT,TC)Outpatient1712965$236
X-RAY EXAM OF WRISTCPT 73100 (LT,TC)Outpatient754005$286
X-RAY EXAM OF WRISTCPT 73110 (LT,TC)Outpatient754011$298
X-RAY EXAM OF HANDCPT 73120 (RT,TC)Outpatient753711$308
X-RAY EXAM OF HANDCPT 73130 (LT,TC)Outpatient753715$318
X-RAY EXAM OF FINGER(S)CPT 73140 (RT,TC)Outpatient753666$222
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT,TC)Outpatient48005097$361
X-RAY EXAM HIPS BI 2 VIEWSCPT 73521 (TC)Outpatient48005106$558
X-RAY EXAM HIPS BI 3-4 VIEWSCPT 73522 (TC)Outpatient48005109$590
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT,TC)Outpatient753644$319
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (RT,TC)Outpatient753749$287
X-RAY EXAM KNEE 4 OR MORECPT 73564 (RT,TC)Outpatient753761$418
X-RAY EXAM OF KNEESCPT 73565 (TC)Outpatient931878$190
X-RAY EXAM OF LOWER LEGCPT 73590 (RT,TC)Outpatient753920$278
X-RAY EXAM OF ANKLECPT 73600 (RT,TC)Outpatient753511$299
X-RAY EXAM OF ANKLECPT 73610 (RT,TC)Outpatient753517$316
X-RAY EXAM OF FOOTCPT 73620 (LT,TC)Outpatient753687$314
X-RAY EXAM OF FOOTCPT 73630 (RT,TC)Outpatient753695$316
X-RAY EXAM OF TOE(S)CPT 73660 (RT,TC)Outpatient753940$226
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018 (TC)Outpatient922935$277
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019 (TC)Outpatient753493$394
X-RAY EXAM COMPLETE ABDOMENCPT 74022 (TC)Outpatient753502$406
DXA BONE DENSITY AXIALCPT 77080 (TC)Outpatient931306$542
Surgical Procedures
(N/O) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN PROCEDURECPT 19120----
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826----
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPECPT 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 ENDOSCOPECPT 45378----
(N/O) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOPECPT 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 ENDOSCOPECPT 47562----
(N/O) REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS OR OLDERCPT 49505----
(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----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 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 LENSCPT 66984----
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
THERAPEUTIC EXERCISESCPT 97110Outpatient-$186
Uncategorized
REMOVE INTRAUTERINE DEVICECPT 58301Outpatient48377959$174
IMMUNIZATION ADMINCPT 90471Outpatient2187003$30
IMMUNIZATION ADMIN EACH ADDCPT 90472Outpatient2187004$30