Hansford County Hospital District

Price List for Shoppable Services. Effective 05-24-2022.

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 704504250164Outpatient$780$585Payer Rates
CT ORBIT/EAR/FOSSA W/O DYECPT 704804250263Outpatient$804$603Payer Rates
CT THORAX DX C-CPT 712504250052Outpatient$953$715Payer Rates
CT THORAX DX C-CPT 71250 (0)4250404Outpatient$953$715Payer Rates
CT THORAX DX C+CPT 712604250051Outpatient$1,127$845Payer Rates
CT NECK SPINE W/O DYECPT 721254250322Outpatient$953$715Payer Rates
CT LUMBAR SPINE W/O DYECPT 721314250326Outpatient$953$715Payer Rates
CT PELVIS W/DYECPT 721934250271Outpatient$950$713Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 741764250030Outpatient$1,005$754Payer Rates
CT ABD & PELV W/CONTRASTCPT 741774250029Outpatient$1,155$866Payer Rates
Cardiology
TTE W/DOPPLER COMPLETECPT 933065051034Outpatient$1,280$960Payer Rates
Clinic
DRAINAGE OF SKIN ABSCESSCPT 100607010060Outpatient$250$188Payer Rates
SHAVE SKIN LESION 0.6-1.0 CMCPT 113017011301Outpatient$200$150Payer Rates
IMPLANT HORMONE PELLET(S)CPT 119807011984Outpatient$350$263Payer Rates
IMPLANT HORMONE PELLET(S)CPT 119807011985Outpatient$750$563Payer Rates
IMPLANT HORMONE PELLET(S)CPT 119807011986Outpatient$250$188Payer Rates
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 120017012001Outpatient$274$206Payer Rates
DESTRUCT PREMALG LESIONCPT 170007017000Outpatient$125$94Payer Rates
DESTRUCT PREMALG LES 2-14CPT 170037017003Outpatient$20$15Payer Rates
DESTRUCT B9 LESION 1-14CPT 171107017110Outpatient$180$135Payer Rates
INJ TENDON SHEATH/LIGAMENTCPT 205507020550Outpatient$110$83Payer Rates
INJ TENDON ORIGIN/INSERTIONCPT 205517020551Outpatient$109$82Payer Rates
INJ TRIGGER POINT 1/2 MUSCLCPT 205527020552Outpatient$100$75Payer Rates
DRAIN/INJ JOINT/BURSA W/O USCPT 206007020600Outpatient$100$75Payer Rates
DRAIN/INJ JOINT/BURSA W/O USCPT 206057020605Outpatient$110$83Payer Rates
DRAIN/INJ JOINT/BURSA W/O USCPT 206107020610Outpatient$137$103Payer Rates
APPLY FOREARM SPLINTCPT 291257029125Outpatient$118$89Payer Rates
REMOVE IMPACTED EAR WAX UNICPT 692097069209Outpatient$20$15Payer Rates
IMMUNOTHERAPY ONE INJECTIONCPT 951157095115Outpatient$14$11Payer Rates
IMMUNOTHERAPY INJECTIONSCPT 951177095117Outpatient$14$11Payer Rates
BRIEF EMOTIONAL/BEHAV ASSMTCPT 961277096127Outpatient$15$11Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963727096372Outpatient$63$47Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963727096373Outpatient$14$11Payer Rates
OSTEOPATH MANJ 1-2 REGIONSCPT 989257098925Outpatient$55$41Payer Rates
OFFICE O/P NEW SF 15-29 MINCPT 992027099202Outpatient$105$79Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992037099203Outpatient$145$109Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 992047099204Outpatient$200$150Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 992057099205Outpatient$240$180Payer Rates
OFFICE O/P EST SF 10-19 MINCPT 992127099212Outpatient$75$56Payer Rates
OFFICE O/P EST LOW 20-29 MINCPT 992137099213Outpatient$100$75Payer Rates
OFFICE O/P EST MOD 30-39 MINCPT 992147099214Outpatient$137$103Payer Rates
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243-----
(Not Offered) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244-----
NURSING FAC CARE SUBSEQCPT 993087099308Outpatient$90$68Payer Rates
NURSING FAC CARE SUBSEQCPT 993097099309Outpatient$105$79Payer Rates
NURSING FAC CARE SUBSEQCPT 993107099310Outpatient$140$105Payer Rates
INIT PM E/M NEW PAT INFANTCPT 99381 (XC1)7099381Outpatient$130$98Payer Rates
PREV VISIT NEW AGE 18-39CPT 993857099385Outpatient$225$169Payer Rates
PREV VISIT NEW AGE 40-64CPT 99386 (XC1)7099386Outpatient$225$169Payer Rates
PER PM REEVAL EST PAT INFANTCPT 99391 (XC1)7099391Outpatient$120$90Payer Rates
PREV VISIT EST AGE 1-4CPT 99392 (XC1)7099392Outpatient$130$98Payer Rates
PREV VISIT EST AGE 5-11CPT 99393 (XC1)7099393Outpatient$135$101Payer Rates
PREV VISIT EST AGE 12-17CPT 99394 (XC1)7099394Outpatient$145$109Payer Rates
PREV VISIT EST AGE 18-39CPT 99395 (XC1)7099395Outpatient$205$154Payer Rates
PREV VISIT EST AGE 40-64CPT 99396 (XC1)7099396Outpatient$205$154Payer Rates
DOT/PRE-EMPLOYMENTHCPCS EMPPH7000110Outpatient$140$105Payer Rates
PPPS, SUBSEQ VISITHCPCS G04397000010Outpatient$165$124Payer Rates
CCM/BHI BY RHC/FQHC 20MIN MOHCPCS G05117000021Outpatient$90$68Payer Rates
SPORT PHYSICALHCPCS SPRTP7000108Outpatient$35$26Payer Rates
EKG
(Not Offered) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETAT ...CPT 93000-----
ELECTROCARDIOGRAM TRACINGCPT 930053005000Outpatient$72$54Payer Rates
ECG MONIT/REPRT UP TO 48 HRSCPT 932253005004Outpatient$375$281Payer Rates
Emergency Room
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001100114Outpatient$319$239Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002100118Outpatient$358$269Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011100110Outpatient$276$207Payer Rates
APPLY FOREARM SPLINTCPT 29125100012Outpatient$198$149Payer Rates
INSERT TEMP BLADDER CATHCPT 51702100019Outpatient$134$101Payer Rates
THER/PROPH/DIAG IV INF INITCPT 96365100085Outpatient$370$278Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 96367100094Outpatient$360$270Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372100069Outpatient$87$65Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 96374100068Outpatient$170$128Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375100083Outpatient$170$128Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 96376100084Outpatient$170$128Payer Rates
MOD SED SAME PHYS/QHP 5/>YRSCPT 99152100091Outpatient$38$29Payer Rates
EMERGENCY DEPT VISITCPT 99282100040Outpatient$220$165Payer Rates
EMERGENCY DEPT VISITCPT 99282 (25)100041Outpatient$220$165Payer Rates
EMERGENCY DEPT VISITCPT 99283100042Outpatient$350$263Payer Rates
EMERGENCY DEPT VISITCPT 99283 (25)100043Outpatient$350$263Payer Rates
EMERGENCY DEPT VISITCPT 99284100044Outpatient$635$476Payer Rates
EMERGENCY DEPT VISITCPT 99284 (25)100045Outpatient$635$476Payer Rates
CRITICAL CARE FIRST HOURCPT 99291 (25)100049Outpatient$1,210$908Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 96360100082Outpatient$370$278Payer Rates
HYDRATION IV INFUSION INITCPT 96360200015Outpatient$370$278Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 96361100081Outpatient$83$62Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 96361200013Outpatient$83$62Payer Rates
THER/PROPH/DIAG IV INF INITCPT 96365200016Outpatient$390$293Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 96366200017Outpatient$75$56Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375200014Outpatient$162$122Payer Rates
Imaging
US EXAM OF HEAD AND NECKCPT 765365051092Outpatient$317$238Payer Rates
US EXAM ABDOM COMPLETECPT 767005050974Outpatient$367$275Payer Rates
ECHO EXAM OF ABDOMENCPT 767055050975Outpatient$333$250Payer Rates
ECHO EXAM OF ABDOMENCPT 767055050976Outpatient$333$250Payer Rates
US EXAM ABDO BACK WALL LIMCPT 767755051061Outpatient$317$238Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 768055051075Outpatient$414$311Payer Rates
TRANSVAGINAL US NON-OBCPT 768305051078Outpatient$333$250Payer Rates
ECHO EXAMINATION PROCEDURECPT 769995051099Outpatient$201$151Payer Rates
(Not Offered) MAMMOGRAPHY OF ONE BREASTCPT 77065-----
(Not Offered) MAMMOGRAPHY OF BOTH BREASTSCPT 77066-----
(Not Offered) MAMMOGRAPHY, SCREENING, BILATERALCPT 77067-----
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...DRG 216-----
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460-----
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...DRG 470-----
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473-----
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...DRG 743-----
Laboratory
ROUTINE VENIPUNCTURECPT 364154000927Outpatient$10$8Payer Rates
METABOLIC PANEL TOTAL CACPT 800484000236Outpatient$99$74Payer Rates
GENERAL HEALTH PANELCPT 800504000493Outpatient$263$197Payer Rates
COMPREHEN METABOLIC PANELCPT 800534000343Outpatient$173$130Payer Rates
(Not Offered) OBSTETRIC BLOOD TEST PANELCPT 80055-----
LIPID PANELCPT 800614000639Outpatient$92$69Payer Rates
RENAL FUNCTION PANELCPT 800694000791Outpatient$240$180Payer Rates
ACUTE HEPATITIS PANELCPT 800744000016Outpatient$380$285Payer Rates
HEPATIC FUNCTION PANELCPT 800764000544Outpatient$108$81Payer Rates
ASSAY OF TACROLIMUSCPT 801974000976Outpatient$109$82Payer Rates
QUANTITATIVE ASSAY DRUGCPT 802994000221Outpatient$615$461Payer Rates
DRUG TEST PRSMV CHEM ANLYZRCPT 803074000431Outpatient$145$109Payer Rates
DRUG SCREEN QUANTALCOHOLSCPT 80320 (M*)4000450Outpatient$71$53Payer Rates
ANALGESICS NON-OPIOID 1 OR 2CPT 803294000815Outpatient$31$23Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPECPT 81000-----
URINALYSIS AUTO W/SCOPECPT 810014000900Outpatient$35$26Payer Rates
URINALYSIS NONAUTO W/O SCOPECPT 810027081002Outpatient$45$34Payer Rates
URINALYSIS AUTO W/O SCOPECPT 810034000899Outpatient$30$23Payer Rates
URINE PREGNANCY TESTCPT 810254000242Outpatient$40$30Payer Rates
URINE PREGNANCY TESTCPT 810254000963Outpatient$40$30Payer Rates
URINE PREGNANCY TESTCPT 810257081025Outpatient$50$38Payer Rates
UR ALBUMIN QUANTITATIVECPT 820434000911Outpatient$71$53Payer Rates
ASSAY OF AMMONIACPT 821404000185Outpatient$63$47Payer Rates
ASSAY OF AMYLASECPT 821504000188Outpatient$40$30Payer Rates
OCCULT BLOOD FECESCPT 822704000697Outpatient$25$19Payer Rates
VITAMIN D 25 HYDROXYCPT 823064000937Outpatient$165$124Payer Rates
TOTAL CORTISOLCPT 825334000363Outpatient$69$52Payer Rates
ASSAY OF CK (CPK)CPT 825504000368Outpatient$58$44Payer Rates
CREATINE MB FRACTIONCPT 825534000329Outpatient$139$104Payer Rates
ASSAY OF URINE CREATININECPT 825704000373Outpatient$24$18Payer Rates
ASSAY OF URINE CREATININECPT 825704000917Outpatient$42$32Payer Rates
VITAMIN B-12CPT 826074000932Outpatient$85$64Payer Rates
ASSAY OF TOTAL ESTRADIOLCPT 826704000445Outpatient$120$90Payer Rates
ASSAY OF FERRITINCPT 827284000465Outpatient$60$45Payer Rates
ASSAY OF FOLIC ACID SERUMCPT 827464000468Outpatient$63$47Payer Rates
ASSAY IGA/IGD/IGG/IGM EACHCPT 827844000592Outpatient$39$29Payer Rates
BLOOD GASES ANY COMBINATIONCPT 828034000224Outpatient$160$120Payer Rates
GLUCOSE BLOOD TESTCPT 829627082962Outpatient$55$41Payer Rates
ASSAY OF GGTCPT 829774000495Outpatient$33$25Payer Rates
ASSAY OF GONADOTROPIN (FSH)CPT 830014000470Outpatient$78$59Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 830364000508Outpatient$64$48Payer Rates
IMMUNOASSAY NONANTIBODYCPT 835164000884Outpatient$100$75Payer Rates
ASSAY OF INTRINSIC FACTORCPT 835284000801Outpatient$83$62Payer Rates
ASSAY OF IRONCPT 835404000616Outpatient$30$23Payer Rates
IRON BINDING TESTCPT 835504000615Outpatient$39$29Payer Rates
ASSAY OF LACTIC ACIDCPT 836054000627Outpatient$99$74Payer Rates
ASSAY OF LIPASECPT 836904000638Outpatient$30$23Payer Rates
ASSAY OF MAGNESIUMCPT 837354000653Outpatient$46$35Payer Rates
ASSAY OF MYOGLOBINCPT 838744000682Outpatient$116$87Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 838804000267Outpatient$173$130Payer Rates
ASSAY OF PARATHORMONECPT 839704000712Outpatient$174$131Payer Rates
ASSAY OF PHOSPHORUSCPT 841004000584Outpatient$21$16Payer Rates
ASSAY OF PREALBUMINCPT 841344000746Outpatient$36$27Payer Rates
ASSAY OF PROGESTERONECPT 841444000752Outpatient$90$68Payer Rates
PROCALCITONIN (PCT)CPT 841454000751Outpatient$690$518Payer Rates
ASSAY OF PROLACTINCPT 841464000754Outpatient$84$63Payer Rates
ASSAY OF PSA TOTALCPT 841534000768Outpatient$121$91Payer Rates
ASSAY OF PSA TOTALCPT 841534000989Outpatient$200$150Payer Rates
ASSAY OF PSA FREECPT 841544000766Outpatient$129$97Payer Rates
ASSAY OF PSA FREECPT 841544000767Outpatient$108$81Payer Rates
ASSAY OF PROTEIN URINECPT 841564000760Outpatient$60$45Payer Rates
ASSAY OF TOTAL TESTOSTERONECPT 844034000859Outpatient$111$83Payer Rates
ASSAY OF TOTAL THYROXINECPT 844364000855Outpatient$30$23Payer Rates
ASSAY OF FREE THYROXINECPT 844394000854Outpatient$69$52Payer Rates
ASSAY THYROID STIM HORMONECPT 844434000891Outpatient$116$87Payer Rates
ASSAY OF TRANSFERRINCPT 844664000883Outpatient$39$29Payer Rates
FREE ASSAY (FT-3)CPT 844814000851Outpatient$123$92Payer Rates
ASSAY OF TROPONIN QUANTCPT 844844000889Outpatient$139$104Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 845504000905Outpatient$21$16Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 847024000243Outpatient$50$38Payer Rates
BL SMEAR W/DIFF WBC COUNTCPT 850074000946Outpatient$20$15Payer Rates
HEMATOCRITCPT 850144000531Outpatient$16$12Payer Rates
HEMOGLOBINCPT 850184000532Outpatient$16$12Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850254090004Outpatient$53$40Payer Rates
COMPLETE CBC AUTOMATEDCPT 850274000302Outpatient$44$33Payer Rates
BLOOD SMEAR INTERPRETATIONCPT 850604000718Outpatient$72$54Payer Rates
FIBRIN DEGRADE SEMIQUANTCPT 853784000415Outpatient$120$90Payer Rates
PROTHROMBIN TIMECPT 856104000765Outpatient$53$40Payer Rates
PROTHROMBIN TIMECPT 856104090009Outpatient$53$40Payer Rates
RBC SED RATE NONAUTOMATEDCPT 856514000819Outpatient$30$23Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857304000773Outpatient$53$40Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857304000774Outpatient$175$131Payer Rates
ALLG SPEC IGE CRUDE XTRC EACPT 860034000471Outpatient$28$21Payer Rates
ANTINUCLEAR ANTIBODIESCPT 860384000191Outpatient$54$41Payer Rates
ANTINUCLEAR ANTIBODIES (ANA)CPT 860394000190Outpatient$125$94Payer Rates
C-REACTIVE PROTEINCPT 861404000269Outpatient$30$23Payer Rates
COMPLEMENT ANTIGENCPT 861604000350Outpatient$127$95Payer Rates
COMPLEMENT ANTIGENCPT 861604000352Outpatient$127$95Payer Rates
DNA ANTIBODY NATIVECPT 862254000428Outpatient$60$45Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862354000684Outpatient$50$38Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862354000818Outpatient$78$59Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862354000830Outpatient$50$38Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862354000839Outpatient$50$38Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862354000840Outpatient$50$38Payer Rates
HETEROPHILE ANTIBODY SCREENCPT 863084000557Outpatient$35$26Payer Rates
MICROSOMAL ANTIBODY EACHCPT 863764000865Outpatient$43$32Payer Rates
MICROSOMAL ANTIBODY EACHCPT 863764000868Outpatient$60$45Payer Rates
RHEUMATOID FACTOR TEST QUALCPT 864304000799Outpatient$36$27Payer Rates
TB INTRADERMAL TESTCPT 865807086580Outpatient$51$38Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 865924000809Outpatient$25$19Payer Rates
HELICOBACTER PYLORI ANTIBODYCPT 866774000520Outpatient$139$104Payer Rates
HIV-2 ANTIBODYCPT 867024000559Outpatient$44$33Payer Rates
RESPIRATORY VIRUS ANTIBODYCPT 867564000810Outpatient$69$52Payer Rates
RESPIRATORY VIRUS ANTIBODYCPT 86756 (*C*)7086756Outpatient$40$30Payer Rates
SARS-COV-2 COVID-19 ANTIBODYCPT 867694000210Outpatient$175$131Payer Rates
RBC ANTIBODY SCREENCPT 868504000203Outpatient$75$56Payer Rates
RBC ANTIBODY SCREENCPT 868504000204Outpatient$75$56Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 869004000255Outpatient$45$34Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 869014000256Outpatient$45$34Payer Rates
COMPATIBILITY TEST SPINCPT 869204000345Outpatient$158$119Payer Rates
BLOOD CULTURE FOR BACTERIACPT 870404000249Outpatient$60$45Payer Rates
FECES CULTURE AEROBIC BACTCPT 870454000390Outpatient$42$32Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870704000385Outpatient$50$38Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870704000388Outpatient$50$38Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870704000959Outpatient$50$38Payer Rates
URINE BACTERIA CULTURECPT 870884000392Outpatient$33$25Payer Rates
SMEAR GRAM STAINCPT 872054000509Outpatient$37$28Payer Rates
CLOSTRIDIUM AG IACPT 873244000334Outpatient$35$26Payer Rates
HPYLORI STOOL AG IACPT 873384000570Outpatient$112$84Payer Rates
HEPATITIS B SURFACE AG IACPT 873404000539Outpatient$45$34Payer Rates
INFLUENZA A/B EACH AG IACPT 874004000604Outpatient$87$65Payer Rates
SARSCOV CORONAVIRUS AG IACPT 87426 (QW)4000835Outpatient$125$94Payer Rates
SARSCOV CORONAVIRUS AG IACPT 874267087426Outpatient$125$94Payer Rates
SARSCOV & INF VIR A&B AG IACPT 87428 (BC)4090010Outpatient$160$120Payer Rates
SARSCOV & INF VIR A&B AG IACPT 874287087428Outpatient$160$120Payer Rates
STREP A AG IACPT 874304000845Outpatient$72$54Payer Rates
CHYLMD PNEUM DNA AMP PROBECPT 874864000318Outpatient$143$107Payer Rates
M.PNEUMON DNA AMP PROBECPT 875814000652Outpatient$143$107Payer Rates
N.GONORRHOEAE DNA AMP PROBCPT 875914000484Outpatient$150$113Payer Rates
RESP VIRUS 12-25 TARGETSCPT 876334000796Outpatient$1,700$1,275Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 87635 (QWCS)4000366Outpatient$175$131Payer Rates
DETECT AGENT NOS DNA AMPCPT 87798 (QW)4000259Outpatient$200$150Payer Rates
INFLUENZA ASSAY W/OPTICCPT 87804 (*C*)7087804Outpatient$40$30Payer Rates
INFLUENZA ASSAY W/OPTICCPT 87804 (*C*)7087805Outpatient$40$30Payer Rates
STREP A ASSAY W/OPTICCPT 878807087880Outpatient$37$28Payer Rates
SPECIMEN HANDLING PT-LABCPT 990014000430Outpatient$25$19Payer Rates
Language Pathology
SPEECH/HEARING THERAPYCPT 92507 (GN)5300012Outpatient$100$75Payer Rates
SPEECH SOUND LANG COMPREHENCPT 92523 (GN)5300009Outpatient$200$150Payer Rates
ORAL FUNCTION THERAPYCPT 92526 (GN)5300013Outpatient$86$65Payer Rates
EVALUATE SWALLOWING FUNCTIONCPT 92610 (GN)5300008Outpatient$200$150Payer Rates
MRI
MRI BRAIN STEM W/O DYECPT 705514350560Outpatient$1,767$1,325Payer Rates
MRI BRAIN STEM W/O & W/DYECPT 705534350558Outpatient$3,927$2,945Payer Rates
MRI NECK SPINE W/O DYECPT 721414350931Outpatient$1,767$1,325Payer Rates
MRI LUMBAR SPINE W/O DYECPT 721484350934Outpatient$1,964$1,473Payer Rates
MRI JOINT UPR EXTREM W/O DYECPT 73221 (RT)4350919Outpatient$1,767$1,325Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (LT)4350805Outpatient$1,573$1,180Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (RT)4350808Outpatient$1,573$1,180Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 938805050997Outpatient$774$581Payer Rates
EXTREMITY STUDYCPT 939705051017Outpatient$759$569Payer Rates
EXTREMITY STUDYCPT 93971 (RT)5051020Outpatient$517$388Payer Rates
EXTREMITY STUDYCPT 93971 (LT)5051045Outpatient$517$388Payer Rates
PERCUT ALLERGY SKIN TESTSCPT 95004200020Outpatient$15$11Payer Rates
POLYSOM 6/> YRS 4/> PARAMCPT 958105780001Outpatient$2,600$1,950Payer Rates
Other Procedures and Observation
INSERT EMERGENCY AIRWAYCPT 315005700011Outpatient$432$324Payer Rates
CLEARANCE OF AIRWAYSCPT 317205700020Outpatient$144$108Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 96367200019Outpatient$360$270Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372200008Outpatient$87$65Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 96374200007Outpatient$162$122Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 96376200027Outpatient$162$122Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 36430200003Outpatient$670$503Payer Rates
ANTIGEN THERAPY SERVICESCPT 95165200024Outpatient$30$23Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P9016 (BL)4000253Outpatient$730$548Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P9016 (BL)4000254Outpatient$75$56Payer Rates
PLATELETS, PHERESISHCPCS P90344000736Outpatient$2,049$1,537Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MINCPT 90832-----
(Not Offered) PSYCHOTHERAPY, 45 MINCPT 90834-----
(Not Offered) PSYCHOTHERAPY, 60 MINCPT 90837-----
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...CPT 90846-----
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...CPT 90847-----
(Not Offered) GROUP PSYCHOTHERAPYCPT 90853-----
Pulmonary Function
EVALUATION OF WHEEZINGCPT 940605700018Outpatient$238$179Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947605700016Outpatient$45$34Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947615700014Outpatient$196$147Payer Rates
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 710454151167Outpatient$152$114Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 710464151163Outpatient$152$114Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 711004100055Outpatient$132$99Payer Rates
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (RT)4151266Outpatient$132$99Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 720404151295Outpatient$132$99Payer Rates
X-RAY EXAM THORAC SPINE 3VWSCPT 720724151307Outpatient$132$99Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 721004151300Outpatient$152$114Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 721104151303Outpatient$264$198Payer Rates
X-RAY EXAM OF PELVISCPT 721704151257Outpatient$132$99Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)4151282Outpatient$284$213Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)4151283Outpatient$284$213Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)4151285Outpatient$284$213Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)4151286Outpatient$284$213Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (LT)4151232Outpatient$132$99Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (LT)4151178Outpatient$132$99Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (LT)4151218Outpatient$132$99Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (RT)4151219Outpatient$132$99Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)4151350Outpatient$132$99Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (RT)4151351Outpatient$132$99Payer Rates
X-RAY EXAM OF HANDCPT 73120 (RT)4151222Outpatient$132$99Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)4151224Outpatient$152$114Payer Rates
X-RAY EXAM OF HANDCPT 73130 (RT)4151225Outpatient$152$114Payer Rates
X-RAY EXAM OF FINGER(S)CPT 731404100022Outpatient$132$99Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)4151229Outpatient$152$114Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)4151230Outpatient$152$114Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT)4151194Outpatient$132$99Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (RT)4151195Outpatient$132$99Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (RT)4151238Outpatient$132$99Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (LT)4151240Outpatient$152$114Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)4151241Outpatient$152$114Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)4151314Outpatient$132$99Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (RT)4151315Outpatient$132$99Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)4151155Outpatient$152$114Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)4151156Outpatient$152$114Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)4151215Outpatient$152$114Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (RT)4151216Outpatient$152$114Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 740184151146Outpatient$132$99Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 740194151143Outpatient$132$99Payer Rates
X-RAY EXAM COMPLETE ABDOMENCPT 740224151148Outpatient$264$198Payer Rates
DXA BONE DENSITY STUDYCPT 770854102083Outpatient$347$260Payer Rates
Respiratory
VENT MGMT INPAT INIT DAYCPT 940025700021Outpatient$483$362Payer Rates
AIRWAY INHALATION TREATMENTCPT 94640 (76)5700009Outpatient$77$58Payer Rates
AIRWAY INHALATION TREATMENTCPT 946405700010Outpatient$77$58Payer Rates
AIRWAY INHALATION TREATMENTCPT 946405790002Outpatient$77$58Payer Rates
AIRWAY INHALATION TREATMENTCPT 946405790003Outpatient$77$58Payer Rates
AIRWAY INHALATION TREATMENTCPT 946405790004Outpatient$77$58Payer Rates
AIRWAY INHALATION TREATMENTCPT 946407094640Outpatient$25$19Payer Rates
CBT 1ST HOURCPT 946445700007Outpatient$207$155Payer Rates
POS AIRWAY PRESSURE CPAPCPT 946605790005Outpatient$285$214Payer Rates
CHEST WALL MANIPULATIONCPT 946685700004Outpatient$70$53Payer Rates
Surgical Procedures
(Not Offered) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN P ...CPT 19120-----
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 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) DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH OR SMA ...CPT 43235-----
(Not Offered) BIOPSY EXAM OF ESOPHAGUS, STOMACH OR SMALL B ...CPT 43239-----
(Not Offered) DIAGNOSTIC EXAM OF LARGE BOWEL USING AN ENDO ...CPT 45378-----
(Not Offered) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOP ...CPT 45380-----
(Not Offered) REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL ...CPT 45385-----
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...CPT 45391-----
(Not Offered) REMOVAL OF GALLBLADDER USING AN ENDOSCOPECPT 47562-----
(Not Offered) REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS O ...CPT 49505-----
(Not Offered) BIOPSY OF PROSTATE GLANDCPT 55700-----
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...CPT 55866-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400-----
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...CPT 59610-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323-----
(Not Offered) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE ...CPT 64483-----
(Not Offered) REMOVAL OF RECURRING CATARACT IN LENS CAPSUL ...CPT 66821-----
(Not Offered) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984-----
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...CPT 93452-----
Therapy
ULTRASOUND THERAPYCPT 97035 (GP)5100023Outpatient$40$30Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GP)5100010Outpatient$80$60Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GO)5200018Outpatient$80$60Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)5100016Outpatient$80$60Payer Rates
GAIT TRAINING THERAPYCPT 97116 (GP)5100011Outpatient$75$56Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GP)5100013Outpatient$75$56Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)5100008Outpatient$225$169Payer Rates
OT EVAL LOW COMPLEX 30 MINCPT 97165 (GO)5200005Outpatient$225$169Payer Rates
OT EVAL MOD COMPLEX 45 MINCPT 97166 (GO)5200006Outpatient$225$169Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)5100021Outpatient$80$60Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GO)5200017Outpatient$75$56Payer Rates
SELF CARE MNGMENT TRAININGCPT 97535 (GO)5200016Outpatient$75$56Payer Rates
ELEC STIM OTHER THAN WOUNDHCPCS G0283 (GP)5100006Outpatient$35$26Payer Rates
Uncategorized
IM ADMIN 1ST/ONLY COMPONENTCPT 904607090460Outpatient$40$30Payer Rates
IM ADMIN 1ST/ONLY COMPONENTCPT 904607090462Outpatient$14$11Payer Rates
IM ADMIN EACH ADDL COMPONENTCPT 904617090461Outpatient$30$23Payer Rates
IM ADMIN EACH ADDL COMPONENTCPT 904617090463Outpatient$14$11Payer Rates
IMMUNIZATION ADMINCPT 90471100007Outpatient$75$56Payer Rates
IMMUNIZATION ADMINCPT 904717090471Outpatient$50$38Payer Rates
NEBULIZER ADMINISTRATION SETHCPCS A70039800001Outpatient$6$5Payer Rates
AEROSOL MASK USED W NEBULIZEHCPCS A70159800021Outpatient$6$5Payer Rates
H/H NEBULIZER PURCHASEHCPCS E05709800012Outpatient$179$134Payer Rates
ADMIN INFLUENZA VIRUS VACHCPCS G0008200002Outpatient$75$56Payer Rates
ADMIN PNEUMOCOCCAL VACCINEHCPCS G0009300001Outpatient$75$56Payer Rates
HHCP-SVS OF CSW,EA 15 MINHCPCS G0155500026Outpatient$1$1Payer Rates
HHS/HOSPICE OF RN EA 15 MINHCPCS G0299500024Outpatient$1$1Payer Rates
HHS/HOSPICE OF LPN EA 15 MINHCPCS G0300500027Outpatient$1$1Payer Rates
HOSPICE, INPATIENT HOSPITALHCPCS Q5005500002Outpatient$900$675Payer Rates
HOSPICE, INPATIENT HOSPITALHCPCS Q5005500003Outpatient$405$304Payer Rates