CT Scan |
CT HEAD/BRAIN W/O DYE | CPT 70450 | Outpatient | 403800428 | $503 | |
CT MAXILLOFACIAL W/O DYE | CPT 70486 | Outpatient | 403800031 | $531 | |
CT MAXILLOFACIAL W/DYE | CPT 70487 | Outpatient | 403800032 | $572 | |
CT SOFT TISSUE NECK W/DYE | CPT 70491 | Outpatient | 403800139 | $604 | |
CT ANGIOGRAPHY NECK | CPT 70498 | Outpatient | 701200026 | $967 | |
CT THORAX DX C- | CPT 71250 | Outpatient | 403800337 | $595 | |
CT THORAX DX C+ | CPT 71260 | Outpatient | 403800345 | $641 | |
CT ANGIOGRAPHY CHEST | CPT 71275 | Outpatient | 403800346 | $893 | |
CT NECK SPINE W/O DYE | CPT 72125 | Outpatient | 403800303 | $679 | |
CT CHEST SPINE W/O DYE | CPT 72128 | Outpatient | 403800626 | $669 | |
CT LUMBAR SPINE W/O DYE | CPT 72131 | Outpatient | 403800469 | $769 | |
CT ANGIOGRAPH PELV W/O&W/DYE | CPT 72191 | Outpatient | 701200034 | $1,144 | |
CT PELVIS W/O DYE | CPT 72192 | Outpatient | 403800543 | $628 | |
CT PELVIS W/DYE | CPT 72193 | Outpatient | 403800037 | $847 | |
CT UPPER EXTREMITY W/O DYE | CPT 73200 | Outpatient | 403800127 | $498 | |
CT LOWER EXTREMITY W/O DYE | CPT 73700 | Outpatient | 403800287 | $586 | |
CT ABDOMEN W/DYE | CPT 74160 | Outpatient | 403800170 | $1,045 | |
CT ABDOMEN W/O & W/DYE | CPT 74170 | Outpatient | 403800295 | $1,439 | |
CT ANGIO ABD&PELV W/O&W/DYE | CPT 74174 | Outpatient | 701200066 | $1,944 | |
CT ABD & PELVIS W/O CONTRAST | CPT 74176 | Outpatient | 403800130 | $1,853 | |
CT ABD & PELV W/CONTRAST | CPT 74177 | Outpatient | 403800131 | $2,090 | |
CT HRT W/O DYE W/CA TEST | CPT 75571 | Outpatient | 403800075 | $75 | |
CT ANGIO ABDOMINAL ARTERIES | CPT 75635 | Outpatient | 403800015 | $1,360 | |
Cardiology |
PRQ CARD STENT W/ANGIO 1 VSL | CPT 92928 | Outpatient | 701000070 | $5,567 | |
PRQ CARD REVASC MI 1 VSL | CPT 92941 | Outpatient | 701010091 | $13,455 | |
TTE W/DOPPLER COMPLETE | CPT 93306 | Outpatient | 403100012 | $472 | |
ECHO TRANSESOPHAGEAL | CPT 93312 | Outpatient | 701002001 | $915 | |
L HRT ARTERY/VENTRICLE ANGIO | CPT 93458 | Outpatient | 701004024 | $8,219 | |
L HRT ART/GRFT ANGIO | CPT 93459 | Outpatient | 701004025 | $8,675 | |
R&L HRT ART/VENTRICLE ANGIO | CPT 93460 | Outpatient | 701004026 | $8,545 | |
HEART FLOW RESERVE MEASURE | CPT 93571 | Outpatient | 701002005 | $1,488 | |
Clinic |
OFFICE O/P NEW LOW 30-44 MIN | CPT 99203 | Outpatient | 409400037 | $144 | |
OFFICE O/P NEW MOD 45-59 MIN | CPT 99204 | Outpatient | 409400039 | $194 | |
OFFICE O/P NEW HI 60-74 MIN | CPT 99205 | Outpatient | 409400138 | $239 | |
OFFICE CONSULTATION | CPT 99243 | Outpatient | 409200066 | $118 | |
OFFICE CONSULTATION | CPT 99244 | Outpatient | 409200067 | $167 | |
PREV VISIT NEW AGE 18-39 | CPT 99385 | Outpatient | 815000009 | $44 | |
PREV VISIT NEW AGE 40-64 | CPT 99386 | Outpatient | 815000249 | $59 | |
HOSPITAL OUTPT CLINIC VISIT | HCPCS G0463 | Outpatient | 409400242 | $233 | |
EEG |
POLYSOM 6/> YRS 4/> PARAM | CPT 95810 | Outpatient | 317100004 | $1,388 | |
POLYSOM 6/>YRS CPAP 4/> PARM | CPT 95811 | Outpatient | 317100006 | $1,538 | |
EEG AWAKE AND DROWSY | CPT 95816 | Outpatient | 403100415 | $340 | |
EKG |
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ... | CPT 93000 | - | - | - | - |
ELECTROCARDIOGRAM TRACING | CPT 93005 | Outpatient | 403100209 | $83 | |
Emergency Room |
DRAINAGE OF SKIN ABSCESS | CPT 10060 | Outpatient | 323100284 | $186 | |
DRAINAGE OF SKIN ABSCESS | CPT 10061 | Outpatient | 323100285 | $295 | |
RPR S/N/AX/GEN/TRNK 2.5CM/< | CPT 12001 | Outpatient | 323100292 | $109 | |
RPR S/N/AX/GEN/TRNK2.6-7.5CM | CPT 12002 | Outpatient | 323100293 | $109 | |
RPR F/E/E/N/L/M 2.5 CM/< | CPT 12011 | Outpatient | 323100298 | $109 | |
RPR F/E/E/N/L/M 2.6-5.0 CM | CPT 12013 | Outpatient | 323100299 | $134 | |
APPLY FOREARM SPLINT | CPT 29125 | Outpatient | 323100250 | $140 | |
APPLICATION LOWER LEG SPLINT | CPT 29515 | Outpatient | 323100253 | $106 | |
INSERT EMERGENCY AIRWAY | CPT 31500 | Outpatient | 323100259 | $219 | |
INSERT TEMP BLADDER CATH | CPT 51702 | Outpatient | 323100206 | $97 | |
EMERGENCY DEPT VISIT | CPT 99282 | Outpatient | 323100227 | $174 | |
EMERGENCY DEPT VISIT | CPT 99283 | Outpatient | 323100228 | $267 | |
EMERGENCY DEPT VISIT | CPT 99284 | Outpatient | 323100229 | $430 | |
EMERGENCY DEPT VISIT | CPT 99285 | Outpatient | 323100230 | $648 | |
CRITICAL CARE FIRST HOUR | CPT 99291 | Outpatient | 323100850 | $966 | |
IV Therapy |
HYDRATION IV INFUSION INIT | CPT 96360 | Outpatient | 323100026 | $198 | |
HYDRATE IV INFUSION ADD-ON | CPT 96361 | Outpatient | 323100027 | $107 | |
THER/PROPH/DIAG IV INF INIT | CPT 96365 | Outpatient | 323100547 | $209 | |
THER/PROPH/DIAG IV INF ADDON | CPT 96366 | Outpatient | 601000004 | $107 | |
THER/DIAG CONCURRENT INF | CPT 96368 | Outpatient | 323100905 | $104 | |
THER/PROPH/DIAG INJ SC/IM | CPT 96372 | Outpatient | 323100402 | $73 | |
THER/PROPH/DIAG INJ IV PUSH | CPT 96374 | Outpatient | 323100409 | $73 | |
TX/PRO/DX INJ NEW DRUG ADDON | CPT 96375 | Outpatient | 323100425 | $73 | |
TX/PRO/DX INJ SAME DRUG ADON | CPT 96376 | Outpatient | 601000010 | $73 | |
IRRIG DRUG DELIVERY DEVICE | CPT 96523 | Outpatient | 602000093 | $83 | |
Imaging |
US EXAM OF HEAD AND NECK | CPT 76536 | Outpatient | 405000108 | $203 | |
ULTRASOUND BREAST COMPLETE | CPT 76641 | Outpatient | 405000382 | $196 | |
ULTRASOUND BREAST LIMITED | CPT 76642 | Outpatient | 405000381 | $196 | |
US EXAM ABDOM COMPLETE | CPT 76700 | Outpatient | 405000027 | $352 | |
ECHO EXAM OF ABDOMEN | CPT 76705 | Outpatient | 405000043 | $237 | |
US EXAM ABDO BACK WALL LIM | CPT 76775 | Outpatient | 405000103 | $314 | |
OB US < 14 WKS SINGLE FETUS | CPT 76801 | Outpatient | 405000129 | $215 | |
(N/O) ABDOMIAL ULTRASOUND OF PREGNANT UTERUS | CPT 76805 | - | - | - | - |
TRANSVAGINAL US OBSTETRIC | CPT 76817 | Outpatient | 405000128 | $301 | |
FETAL BIOPHYS PROFIL W/O NST | CPT 76819 | Outpatient | 405000332 | $169 | |
TRANSVAGINAL US NON-OB | CPT 76830 | Outpatient | 405000107 | $253 | |
US EXAM PELVIC COMPLETE | CPT 76856 | Outpatient | 405000084 | $260 | |
US EXAM SCROTUM | CPT 76870 | Outpatient | 405000146 | $203 | |
US COMPL JOINT R-T W/IMG | CPT 76881 | Outpatient | 405000140 | $237 | |
US GUIDE VASCULAR ACCESS | CPT 76937 | Outpatient | 405000200 | $309 | |
DX MAMMO INCL CAD UNI | CPT 77065 | Outpatient | 405200017 | $173 | |
DX MAMMO INCL CAD BI | CPT 77066 | Outpatient | 405201127 | $173 | |
SCR MAMMO BI INCL CAD | CPT 77067 | Outpatient | 405201103 | $173 | |
EXTRACRANIAL BILAT STUDY | CPT 93880 | Outpatient | 405000274 | $338 | |
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 | - | - | - | - |
Labor and Delivery |
CIRCUMCISION W/REGIONL BLOCK | CPT 54150 | Outpatient | 321600017 | $1,799 | |
Laboratory |
ROUTINE VENIPUNCTURE | CPT 36415 | Outpatient | 401003900 | $7 | |
METABOLIC PANEL TOTAL CA | CPT 80048 | Outpatient | 401003439 | $75 | |
ELECTROLYTE PANEL | CPT 80051 | Outpatient | 401000716 | $34 | |
COMPREHEN METABOLIC PANEL | CPT 80053 | Outpatient | 401004841 | $111 | |
OBSTETRIC PANEL | CPT 80055 | Outpatient | 401004247 | $76 | |
LIPID PANEL | CPT 80061 | Outpatient | 401002019 | $56 | |
RENAL FUNCTION PANEL | CPT 80069 | Outpatient | 401004860 | $36 | |
ACUTE HEPATITIS PANEL | CPT 80074 | Outpatient | 401000765 | $75 | |
HEPATIC FUNCTION PANEL | CPT 80076 | Outpatient | 401004858 | $36 | |
OBSTETRIC PANEL | CPT 80081 | Outpatient | 401073578 | $110 | |
ASSAY CARBAMAZEPINE TOTAL | CPT 80156 | Outpatient | 401008081 | $75 | |
DRUG ASSAY CLOZAPINE | CPT 80159 | Outpatient | 401004833 | $76 | |
ASSAY OF DIGOXIN TOTAL | CPT 80162 | Outpatient | 401007695 | $36 | |
ASSAY DIPROPYLACETIC ACD TOT | CPT 80164 | Outpatient | 401001300 | $83 | |
DRUG SCREEN QUAN LAMOTRIGINE | CPT 80175 | Outpatient | 401000644 | $50 | |
DRUG SCRN QUAN LEVETIRACETAM | CPT 80177 | Outpatient | 401000645 | $73 | |
ASSAY OF LITHIUM | CPT 80178 | Outpatient | 401002316 | $41 | |
DRUG SCRN QUANT OXCARBAZEPIN | CPT 80183 | Outpatient | 401007939 | $40 | |
ASSAY OF PHENOBARBITAL | CPT 80184 | Outpatient | 401008008 | $48 | |
ASSAY OF PHENYTOIN TOTAL | CPT 80185 | Outpatient | 401008016 | $70 | |
ASSAY OF TACROLIMUS | CPT 80197 | Outpatient | 401004254 | $69 | |
ASSAY OF VANCOMYCIN | CPT 80202 | Outpatient | 401000492 | $84 | |
DRUG TEST PRSMV DIR OPT OBS | CPT 80305 | Outpatient | 401001336 | $7 | |
DRUG TEST PRSMV INSTRMNT | CPT 80306 | Outpatient | 401000694 | $12 | |
DRUG TEST PRSMV CHEM ANLYZR | CPT 80307 | Outpatient | 401007844 | $86 | |
DRUG SCREEN QUANTALCOHOLS | CPT 80320 | Outpatient | 401002050 | $109 | |
(N/O) URINALYSIS TEST USING MICROSCOPE | CPT 81000 | - | - | - | - |
URINALYSIS AUTO W/SCOPE | CPT 81001 | Outpatient | 401003041 | $30 | |
(N/O) URINALYSIS TEST | CPT 81002 | - | - | - | - |
URINALYSIS AUTO W/O SCOPE | CPT 81003 | Outpatient | 401073516 | $27 | |
URINALYSIS VOLUME MEASURE | CPT 81050 | Outpatient | 401008800 | $20 | |
ACETONE ASSAY | CPT 82010 | Outpatient | 401002035 | $43 | |
ASSAY OF SERUM ALBUMIN | CPT 82040 | Outpatient | 401002043 | $20 | |
UR ALBUMIN QUANTITATIVE | CPT 82043 | Outpatient | 401003125 | $39 | |
ASSAY OF BREATH ETHANOL | CPT 82075 | Outpatient | 401010000 | $12 | |
ASSAY OF AMMONIA | CPT 82140 | Outpatient | 401007240 | $58 | |
ASSAY OF AMYLASE | CPT 82150 | Outpatient | 401002068 | $45 | |
OCCULT BLD FECES 1-3 TESTS | CPT 82272 | Outpatient | 401000543 | $28 | |
VITAMIN D 25 HYDROXY | CPT 82306 | Outpatient | 401003170 | $65 | |
ASSAY OF CALCIUM | CPT 82310 | Outpatient | 401002100 | $31 | |
CARCINOEMBRYONIC ANTIGEN | CPT 82378 | Outpatient | 401007737 | $45 | |
ASSAY BLD/SERUM CHOLESTEROL | CPT 82465 | Outpatient | 401002134 | $23 | |
TOTAL CORTISOL | CPT 82533 | Outpatient | 401007778 | $65 | |
ASSAY OF CREATININE | CPT 82565 | Outpatient | 401002167 | $28 | |
VITAMIN B-12 | CPT 82607 | Outpatient | 401007760 | $34 | |
VIT D 1 25-DIHYDROXY | CPT 82652 | Outpatient | 401003171 | $65 | |
ASSAY OF FERRITIN | CPT 82728 | Outpatient | 401007802 | $73 | |
ASSAY OF FOLIC ACID SERUM | CPT 82746 | Outpatient | 401007786 | $34 | |
ASSAY GLUCOSE BLOOD QUANT | CPT 82947 | Outpatient | 401002191 | $26 | |
GLUCOSE TEST | CPT 82950 | Outpatient | 401004270 | $32 | |
GLUCOSE BLOOD TEST | CPT 82962 | Outpatient | 401002282 | $5 | |
ASSAY OF GGT | CPT 82977 | Outpatient | 401002233 | $27 | |
ASSAY OF GONADOTROPIN (FSH) | CPT 83001 | Outpatient | 401008503 | $54 | |
ASSAY OF GONADOTROPIN (LH) | CPT 83002 | Outpatient | 401008511 | $54 | |
HEMOGLOBIN CHROMOTOGRAPHY | CPT 83021 | Outpatient | 401007886 | $61 | |
GLYCOSYLATED HEMOGLOBIN TEST | CPT 83036 | Outpatient | 401000880 | $43 | |
ASSAY OF INSULIN | CPT 83525 | Outpatient | 401007703 | $40 | |
ASSAY OF IRON | CPT 83540 | Outpatient | 401002241 | $29 | |
IRON BINDING TEST | CPT 83550 | Outpatient | 401002563 | $31 | |
ASSAY OF LACTIC ACID | CPT 83605 | Outpatient | 401073590 | $45 | |
ASSAY OF LEAD | CPT 83655 | Outpatient | 401007898 | $85 | |
ASSAY OF LIPASE | CPT 83690 | Outpatient | 401002308 | $50 | |
ASSAY OF MAGNESIUM | CPT 83735 | Outpatient | 401007349 | $39 | |
ASSAY OF NATRIURETIC PEPTIDE | CPT 83880 | Outpatient | 401000130 | $45 | |
ASSAY OF PARATHORMONE | CPT 83970 | Outpatient | 401009277 | $68 | |
ASSAY OF BLOOD PKU | CPT 84030 | Outpatient | 401008453 | $29 | |
ASSAY OF PHOSPHORUS | CPT 84100 | Outpatient | 401002340 | $27 | |
EVAL AMNIOTIC FLUID PROTEIN | CPT 84112 | Outpatient | 401073687 | $101 | |
ASSAY OF SERUM POTASSIUM | CPT 84132 | Outpatient | 401002357 | $14 | |
ASSAY OF PREALBUMIN | CPT 84134 | Outpatient | 401004882 | $41 | |
ASSAY OF PROLACTIN | CPT 84146 | Outpatient | 401000393 | $45 | |
ASSAY OF PSA TOTAL | CPT 84153 | Outpatient | 401005459 | $39 | |
ASSAY OF PSA FREE | CPT 84154 | Outpatient | 401004338 | $65 | |
ASSAY OF PROTEIN URINE | CPT 84156 | Outpatient | 401008360 | $35 | |
ASSAY OF SERUM SODIUM | CPT 84295 | Outpatient | 401002399 | $23 | |
ASSAY OF URINE SODIUM | CPT 84300 | Outpatient | 401003603 | $23 | |
ASSAY OF TOTAL TESTOSTERONE | CPT 84403 | Outpatient | 401008529 | $59 | |
ASSAY OF VITAMIN B-1 | CPT 84425 | Outpatient | 401073348 | $58 | |
ASSAY OF TOTAL THYROXINE | CPT 84436 | Outpatient | 401002522 | $37 | |
ASSAY OF FREE THYROXINE | CPT 84439 | Outpatient | 401002523 | $57 | |
ASSAY THYROID STIM HORMONE | CPT 84443 | Outpatient | 401004189 | $57 | |
TRANSFERASE (AST) (SGOT) | CPT 84450 | Outpatient | 401002456 | $23 | |
ALANINE AMINO (ALT) (SGPT) | CPT 84460 | Outpatient | 401002464 | $23 | |
ASSAY OF TRANSFERRIN | CPT 84466 | Outpatient | 401005855 | $37 | |
ASSAY OF THYROID (T3 OR T4) | CPT 84479 | Outpatient | 401002514 | $35 | |
ASSAY TRIIODOTHYRONINE (T3) | CPT 84480 | Outpatient | 401008010 | $40 | |
FREE ASSAY (FT-3) | CPT 84481 | Outpatient | 401002515 | $49 | |
ASSAY OF UREA NITROGEN | CPT 84520 | Outpatient | 401002480 | $25 | |
ASSAY OF BLOOD/URIC ACID | CPT 84550 | Outpatient | 401002498 | $23 | |
CHORIONIC GONADOTROPIN TEST | CPT 84702 | Outpatient | 401008677 | $96 | |
CHORIONIC GONADOTROPIN ASSAY | CPT 84703 | Outpatient | 401003066 | $35 | |
COMPLETE CBC W/AUTO DIFF WBC | CPT 85025 | Outpatient | 401000203 | $27 | |
COMPLETE CBC AUTOMATED | CPT 85027 | Outpatient | 401008933 | $27 | |
MANUAL RETICULOCYTE COUNT | CPT 85044 | Outpatient | 401000153 | $21 | |
COAGULATION TIME ACTIVATED | CPT 85347 | Outpatient | 401002360 | $24 | |
FIBRIN DEGRADATION QUANT | CPT 85379 | Outpatient | 401003596 | $84 | |
FIBRINOGEN ACTIVITY | CPT 85384 | Outpatient | 401000096 | $42 | |
PROTHROMBIN TIME | CPT 85610 | Outpatient | 401000146 | $30 | |
RBC SED RATE NONAUTOMATED | CPT 85651 | Outpatient | 401000161 | $16 | |
RBC SICKLE CELL TEST | CPT 85660 | Outpatient | 401000179 | $23 | |
THROMBOPLASTIN TIME PARTIAL | CPT 85730 | Outpatient | 401000120 | $27 | |
ANTINUCLEAR ANTIBODIES | CPT 86038 | Outpatient | 401007521 | $40 | |
C-REACTIVE PROTEIN | CPT 86140 | Outpatient | 401006028 | $40 | |
C-REACTIVE PROTEIN HS | CPT 86141 | Outpatient | 401007910 | $40 | |
HETEROPHILE ANTIBODY SCREEN | CPT 86308 | Outpatient | 401006051 | $49 | |
IA INFECTIOUS AGENT ANTIBODY | CPT 86318 | Outpatient | 401073545 | $71 | |
RHEUMATOID FACTOR QUANT | CPT 86431 | Outpatient | 401006077 | $29 | |
TB TEST CELL IMMUN MEASURE | CPT 86480 | Outpatient | 401073384 | $64 | |
TB INTRADERMAL TEST | CPT 86580 | Outpatient | 401006523 | $21 | |
SYPHILIS TEST NON-TREP QUAL | CPT 86592 | Outpatient | 401006069 | $19 | |
HEP B SURFACE ANTIBODY | CPT 86706 | Outpatient | 401003504 | $39 | |
VARICELLA-ZOSTER ANTIBODY | CPT 86787 | Outpatient | 401073493 | $39 | |
HEPATITIS C AB TEST | CPT 86803 | Outpatient | 401005542 | $64 | |
RBC ANTIBODY IDENTIFICATION | CPT 86870 | Outpatient | 401001714 | $95 | |
COOMBS TEST DIRECT | CPT 86880 | Outpatient | 401005054 | $35 | |
COMPATIBILITY TEST ANTIGLOB | CPT 86922 | Outpatient | 401005137 | $102 | |
BLOOD CULTURE FOR BACTERIA | CPT 87040 | Outpatient | 401003330 | $51 | |
CULTURE AEROBIC IDENTIFY | CPT 87077 | Outpatient | 401004000 | $20 | |
CULTURE SCREEN ONLY | CPT 87081 | Outpatient | 401073413 | $26 | |
URINE CULTURE/COLONY COUNT | CPT 87086 | Outpatient | 401003256 | $44 | |
DNA/RNA AMPLIFIED PROBE | CPT 87150 | Outpatient | 401073710 | $472 | |
OVA AND PARASITES SMEARS | CPT 87177 | Outpatient | 401004007 | $29 | |
MICROBE SUSCEPTIBLE MIC | CPT 87186 | Outpatient | 401003296 | $22 | |
SMEAR GRAM STAIN | CPT 87205 | Outpatient | 401006507 | $22 | |
SMEAR WET MOUNT SALINE/INK | CPT 87210 | Outpatient | 401004064 | $22 | |
CLOSTRIDIUM AG IA | CPT 87324 | Outpatient | 401073555 | $33 | |
HPYLORI STOOL AG IA | CPT 87338 | Outpatient | 401000020 | $31 | |
HEPATITIS B SURFACE AG IA | CPT 87340 | Outpatient | 401007547 | $55 | |
HIV-1 AG W/HIV-1&2 AB AG IA | CPT 87389 | Outpatient | 401001185 | $42 | |
RESP SYNCYTIAL VIRUS AG IA | CPT 87420 | Outpatient | 401005897 | $70 | |
NOS EACH ORGANISM AG IA | CPT 87449 | Outpatient | 401073556 | $55 | |
IADNA-DNA/RNA PROBE TQ 12-25 | CPT 87507 | Outpatient | 401073577 | $227 | |
INFLUENZA ASSAY W/OPTIC | CPT 87804 | Outpatient | 401000676 | $32 | |
HIV W/HIV1&2 ANTB W/OPTIC | CPT 87806 | Outpatient | 401005601 | $44 | |
STREP A ASSAY W/OPTIC | CPT 87880 | Outpatient | 401005731 | $59 | |
TISSUE EXAM BY PATHOLOGIST | CPT 88304 | Outpatient | 401073336 | $29 | |
TISSUE EXAM BY PATHOLOGIST | CPT 88305 | Outpatient | 401073337 | $40 | |
TISSUE EXAM BY PATHOLOGIST | CPT 88307 | Outpatient | 401073338 | $88 | |
IMMUNOHISTO ANTB 1ST STAIN | CPT 88342 | Outpatient | 401008220 | $73 | |
BODY FLUID CELL COUNT | CPT 89051 | Outpatient | 401000518 | $27 | |
LEUKOCYTE ASSESSMENT FECAL | CPT 89055 | Outpatient | 401001938 | $26 | |
EIA HIV-1/HIV-2 SCREEN | HCPCS G0432 | Outpatient | 401073677 | $56 | |
ONE-WAY ALLOW PRORATED MILES | HCPCS P9603 | Outpatient | 401003916 | $1 | |
Language Pathology |
SPEECH/HEARING THERAPY | CPT 92507 | Outpatient | 408100002 | $92 | |
SPEECH SOUND LANG COMPREHEN | CPT 92523 | Outpatient | 608000062 | $189 | |
ORAL FUNCTION THERAPY | CPT 92526 | Outpatient | 608000013 | $74 | |
EVALUATE SWALLOWING FUNCTION | CPT 92610 | Outpatient | 408100019 | $106 | |
MOTION FLUOROSCOPY/SWALLOW | CPT 92611 | Outpatient | 408100005 | $146 | |
THER IVNTJ 1ST 15 MIN | CPT 97129 | Outpatient | 608000004 | $43 | |
MRI |
MRI BRAIN STEM W/O DYE | CPT 70551 | Outpatient | 405100015 | $867 | |
MRI BRAIN STEM W/O & W/DYE | CPT 70553 | Outpatient | 405100017 | $1,148 | |
MRI NECK SPINE W/O DYE | CPT 72141 | Outpatient | 405100018 | $862 | |
MRI LUMBAR SPINE W/O DYE | CPT 72148 | Outpatient | 405100029 | $846 | |
MRI LOWER EXTREMITY W/O DYE | CPT 73718 | Outpatient | 405100023 | $819 | |
MRI JNT OF LWR EXTRE W/O DYE | CPT 73721 | Outpatient | 405100061 | $819 | |
Medical and Surgical Supplies |
EMERGE 2.0 X 12 | HCPCS C1725 | Outpatient | 701010376 | $243 | |
CATH,INF,PER/CENT/MIDLINE | HCPCS C1751 | Outpatient | 325009950 | $60 | |
ANGIO TRAY SUPPLY TRAY | HCPCS C1757 | Outpatient | 701011193 | $79 | |
MYNX 6FR ORDER BY EA | HCPCS C1760 | Outpatient | 701011431 | $358 | |
J WIRE 260 CM 502-455 | HCPCS C1769 | Outpatient | 701011395 | $15 | |
DRILL PIN SET 86-4192 | HCPCS C1776 | Outpatient | 325081571 | $152 | |
SECURESTRAP STRAP25R | HCPCS C1781 | Outpatient | 325081830 | $258 | |
EBU 3.5 6FR 1/EA | HCPCS C1887 | Outpatient | 701011294 | $75 | |
GLIDESHEATH 6FR 10CM 80-1060 | HCPCS C1894 | Outpatient | 701011334 | $89 | |
Nuclear Medicine |
HEPATOBIL SYST IMAGE W/DRUG | CPT 78227 | Outpatient | 406000075 | $659 | |
GASTRIC EMPTYING IMAG STUDY | CPT 78264 | Outpatient | 406000008 | $503 | |
BONE IMAGING WHOLE BODY | CPT 78306 | Outpatient | 406000026 | $522 | |
LUNG VENTILAT&PERFUS IMAGING | CPT 78582 | Outpatient | 406000175 | $558 | |
TC99M MEDRONATE | HCPCS A9503 | Outpatient | 405900043 | $108 | |
TC99M MEBROFENIN | HCPCS A9537 | Outpatient | 405900052 | $121 | |
TC99M MAA | HCPCS A9540 | Outpatient | 405900051 | $121 | |
TC99M SULFUR COLLOID | HCPCS A9541 | Outpatient | 405900053 | $121 | |
TECHNETIUM TC-99M AEROSOL | HCPCS A9567 | Outpatient | 405900050 | $91 | |
Other Diagnostic |
EVOKED AUDITORY TEST LIMITED | CPT 92587 | Outpatient | 408100145 | $88 | |
UPR/LXTR ART STDY 3+ LVLS | CPT 93923 | Outpatient | 405000109 | $281 | |
LOWER EXTREMITY STUDY | CPT 93926 | Outpatient | 405000110 | $229 | |
EXTREMITY STUDY | CPT 93970 | Outpatient | 405000315 | $462 | |
EXTREMITY STUDY | CPT 93971 | Outpatient | 405000115 | $246 | |
VASCULAR STUDY | CPT 93975 | Outpatient | 405000340 | $424 | |
Other Procedures and Observation |
DEB SUBQ TISSUE 20 SQ CM/< | CPT 11042 | Outpatient | 409400003 | $346 | |
SKIN SUB GRAFT TRNK/ARM/LEG | CPT 15271 | Outpatient | 409400129 | $1,607 | |
SKIN SUB GRAFT FACE/NK/HF/G | CPT 15275 | Outpatient | 409400133 | $1,607 | |
CHEM CAUT OF GRANLTJ TISSUE | CPT 17250 | Outpatient | 409400136 | $155 | |
APPLICATION OF PASTE BOOT | CPT 29580 | Outpatient | 409400034 | $229 | |
FETAL NON-STRESS TEST | CPT 59025 | Outpatient | 319100047 | $166 | |
RMVL DEVITAL TIS 20 CM/< | CPT 97597 | Outpatient | 409400032 | $155 | |
RMVL DEVITAL TIS ADDL 20CM/< | CPT 97598 | Outpatient | 409400033 | $110 | |
OFFICE O/P EST SF 10-19 MIN | CPT 99212 | Outpatient | 409400052 | $118 | |
OFFICE O/P EST LOW 20-29 MIN | CPT 99213 | Outpatient | 409400054 | $131 | |
OFFICE O/P EST MOD 30-39 MIN | CPT 99214 | Outpatient | 601000024 | $171 | |
Other Therapeutic |
BLOOD TRANSFUSION SERVICE | CPT 36430 | Outpatient | 601000031 | $397 | |
MEDICAL NUTRITION INDIV IN | CPT 97802 | Outpatient | 506200021 | $23 | |
MED NUTRITION INDIV SUBSEQ | CPT 97803 | Outpatient | 506200070 | $20 | |
RBC LEUKOCYTES REDUCED | HCPCS P9016 | Outpatient | 401003725 | $222 | |
PLASMA 1 DONOR FRZ W/IN 8 HR | HCPCS P9017 | Outpatient | 401003769 | $82 | |
Psychiatric |
PSYTX W PT 30 MINUTES | CPT 90832 | Outpatient | 801000001 | $81 | |
PSYTX W PT 45 MINUTES | CPT 90834 | Outpatient | 801000002 | $117 | |
PSYTX W PT 60 MINUTES | CPT 90837 | Outpatient | 801000023 | $176 | |
FAMILY PSYTX W/O PT 50 MIN | CPT 90846 | Outpatient | 801000003 | $121 | |
FAMILY PSYTX W/PT 50 MIN | CPT 90847 | Outpatient | 801000004 | $129 | |
GROUP PSYCHOTHERAPY | CPT 90853 | Outpatient | 801000005 | $154 | |
Pulmonary Function |
VITAL CAPACITY TEST | CPT 94150 | Outpatient | 317100210 | $43 | |
PULM FUNCTION TEST BY GAS | CPT 94727 | Outpatient | 317100634 | $186 | |
PULMONARY SERVICE/PROCEDURE | CPT 94799 | Outpatient | 317100050 | $70 | |
Radiology |
X-RAY EXAM CHEST 1 VIEW | CPT 71045 | Outpatient | 404000168 | $88 | |
X-RAY EXAM CHEST 2 VIEWS | CPT 71046 | Outpatient | 404000176 | $102 | |
X-RAY EXAM UNILAT RIBS/CHEST | CPT 71101 | Outpatient | 404000234 | $159 | |
X-RAY EXAM OF SPINE 1 VIEW | CPT 72020 | Outpatient | 404100002 | $89 | |
X-RAY EXAM NECK SPINE 2-3 VW | CPT 72040 | Outpatient | 404001265 | $197 | |
X-RAY EXAM NECK SPINE 6/>VWS | CPT 72052 | Outpatient | 404000846 | $295 | |
X-RAY EXAM THORAC SPINE 2VWS | CPT 72070 | Outpatient | 404002179 | $56 | |
X-RAY EXAM THORAC SPINE 3VWS | CPT 72072 | Outpatient | 404000853 | $218 | |
X-RAY EXAM ENTIRE SPI 1 VW | CPT 72081 | Outpatient | 404001299 | $232 | |
X-RAY EXAM ENTIRE SPI 2/3 VW | CPT 72082 | Outpatient | 404001240 | $223 | |
X-RAY EXAM L-S SPINE 2/3 VWS | CPT 72100 | Outpatient | 404001307 | $197 | |
X-RAY EXAM L-2 SPINE 4/>VWS | CPT 72110 | Outpatient | 404000879 | $298 | |
X-RAY EXAM OF PELVIS | CPT 72170 | Outpatient | 404000895 | $97 | |
X-RAY EXAM SACRUM TAILBONE | CPT 72220 | Outpatient | 404000937 | $109 | |
X-RAY EXAM OF SHOULDER | CPT 73030 | Outpatient | 404002101 | $188 | |
X-RAY EXAM OF HUMERUS | CPT 73060 | Outpatient | 404000630 | $165 | |
X-RAY EXAM OF ELBOW | CPT 73080 | Outpatient | 404002022 | $182 | |
X-RAY EXAM OF FOREARM | CPT 73090 | Outpatient | 404000655 | $162 | |
X-RAY EXAM OF WRIST | CPT 73110 | Outpatient | 404002049 | $157 | |
X-RAY EXAM OF HAND | CPT 73120 | Outpatient | 404002079 | $156 | |
X-RAY EXAM OF HAND | CPT 73130 | Outpatient | 404002080 | $179 | |
X-RAY EXAM OF FINGER(S) | CPT 73140 | Outpatient | 404001360 | $124 | |
X-RAY EXAM HIP UNI 2-3 VIEWS | CPT 73502 | Outpatient | 404002052 | $171 | |
X-RAY EXAM HIPS BI 3-4 VIEWS | CPT 73522 | Outpatient | 404002054 | $245 | |
X-RAY EXAM OF FEMUR 2/> | CPT 73552 | Outpatient | 404002026 | $171 | |
X-RAY EXAM OF KNEE 1 OR 2 | CPT 73560 | Outpatient | 404002082 | $153 | |
X-RAY EXAM OF KNEE 3 | CPT 73562 | Outpatient | 404002087 | $191 | |
X-RAY EXAM KNEE 4 OR MORE | CPT 73564 | Outpatient | 404002083 | $218 | |
X-RAY EXAM OF LOWER LEG | CPT 73590 | Outpatient | 404002032 | $173 | |
X-RAY EXAM OF ANKLE | CPT 73600 | Outpatient | 404002004 | $167 | |
X-RAY EXAM OF ANKLE | CPT 73610 | Outpatient | 404002003 | $181 | |
X-RAY EXAM OF FOOT | CPT 73620 | Outpatient | 404002075 | $93 | |
X-RAY EXAM OF FOOT | CPT 73630 | Outpatient | 404002006 | $107 | |
X-RAY EXAM OF TOE(S) | CPT 73660 | Outpatient | 404001358 | $128 | |
X-RAY EXAM ABDOMEN 1 VIEW | CPT 74018 | Outpatient | 404000467 | $152 | |
X-RAY EXAM ABDOMEN 2 VIEWS | CPT 74019 | Outpatient | 404000283 | $190 | |
X-RAY EXAM COMPLETE ABDOMEN | CPT 74022 | Outpatient | 404000052 | $259 | |
X-RAY XM ESOPHAGUS 1CNTRST | CPT 74220 | Outpatient | 404000317 | $277 | |
X-RAY XM SWLNG FUNCJ C+ | CPT 74230 | Outpatient | 404000031 | $210 | |
X-RAY XM SM INT 1CNTRST STD | CPT 74250 | Outpatient | 404000366 | $203 | |
CONTRAST EXAM ABDOMINL AORTA | CPT 75625 | Outpatient | 701001007 | $1,356 | |
ARTERY X-RAYS ARMS/LEGS | CPT 75716 | Outpatient | 701001018 | $1,472 | |
FLUOROSCOPY <1 HR PHYS/QHP | CPT 76000 | Outpatient | 404001166 | $253 | |
DXA BONE DENSITY AXIAL | CPT 77080 | Outpatient | 404100001 | $151 | |
Respiratory |
CLEARANCE OF AIRWAYS | CPT 31720 | Outpatient | 317100584 | $165 | |
WITHDRAWAL OF ARTERIAL BLOOD | CPT 36600 | Outpatient | 317100823 | $29 | |
HEART/LUNG RESUSCITATION CPR | CPT 92950 | Outpatient | 317100196 | $296 | |
VENT MGMT INPAT INIT DAY | CPT 94002 | Outpatient | 317100105 | $463 | |
VENT MGMT INPAT SUBQ DAY | CPT 94003 | Outpatient | 317100031 | $380 | |
AIRWAY INHALATION TREATMENT | CPT 94640 | Outpatient | 317100428 | $51 | |
POS AIRWAY PRESSURE CPAP | CPT 94660 | Outpatient | 317100716 | $331 | |
CHEST WALL MANIPULATION | CPT 94668 | Outpatient | 317100767 | $38 | |
MEASURE BLOOD OXYGEN LEVEL | CPT 94760 | Outpatient | 317100019 | $21 | |
HBOT, FULL BODY CHAMBER, 30M | HCPCS G0277 | Outpatient | 409200030 | $140 | |
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 | - | - | - | - |
INSJ PICC 5 YR+ W/O IMAGING | CPT 36569 | Outpatient | 302100342 | $693 | |
INSJ PICC RS&I 5 YR+ | CPT 36573 | Outpatient | 601000151 | $693 | |
INTRVASC US NONCORONARY 1ST | CPT 37252 | Outpatient | 701010211 | $1,410 | |
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ... | CPT 42820 | - | - | - | - |
EGD DIAGNOSTIC BRUSH WASH | CPT 43235 | Outpatient | 318900305 | $445 | |
EGD BIOPSY SINGLE/MULTIPLE | CPT 43239 | Outpatient | 318900313 | $592 | |
DIAGNOSTIC COLONOSCOPY | CPT 45378 | Outpatient | 318900263 | $905 | |
COLONOSCOPY AND BIOPSY | CPT 45380 | Outpatient | 318900289 | $905 | |
COLONOSCOPY W/LESION REMOVAL | CPT 45385 | Outpatient | 318900297 | $905 | |
(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 | - | - | - | - |
MOD SED SAME PHYS/QHP 5/>YRS | CPT 99152 | Outpatient | 318900582 | $141 | |
MOD SED SAME PHYS/QHP EA | CPT 99153 | Outpatient | 318900583 | $141 | |
MOD SED OTH PHYS/QHP 5/>YRS | CPT 99156 | Outpatient | 601000089 | $141 | |
MOD SED OTHER PHYS/QHP EA | CPT 99157 | Outpatient | 601000119 | $200 | |
COLORECTAL SCRN; HI RISK IND | HCPCS G0105 | Outpatient | 318900586 | $905 | |
Therapy |
ELECTRICAL STIMULATION | CPT 97032 | Outpatient | 607000011 | $48 | |
THERAPEUTIC EXERCISES | CPT 97110 | Outpatient | 607000003 | $46 | |
NEUROMUSCULAR REEDUCATION | CPT 97112 | Outpatient | 607000020 | $43 | |
GAIT TRAINING THERAPY | CPT 97116 | Outpatient | 409102068 | $36 | |
MANUAL THERAPY 1/> REGIONS | CPT 97140 | Outpatient | 709101325 | $80 | |
GROUP THERAPEUTIC PROCEDURES | CPT 97150 | Outpatient | 606000055 | $60 | |
PT EVAL LOW COMPLEX 20 MIN | CPT 97161 | Outpatient | 409102180 | $137 | |
PT EVAL MOD COMPLEX 30 MIN | CPT 97162 | Outpatient | 409102181 | $137 | |
PT EVAL HIGH COMPLEX 45 MIN | CPT 97163 | Outpatient | 409102182 | $137 | |
OT EVAL LOW COMPLEX 30 MIN | CPT 97165 | Outpatient | 409302180 | $137 | |
OT EVAL MOD COMPLEX 45 MIN | CPT 97166 | Outpatient | 409302181 | $137 | |
OT EVAL HIGH COMPLEX 60 MIN | CPT 97167 | Outpatient | 409302182 | $137 | |
THERAPEUTIC ACTIVITIES | CPT 97530 | Outpatient | 606000050 | $33 | |
SELF CARE MNGMENT TRAINING | CPT 97535 | Outpatient | 409300103 | $44 | |
Uncategorized |
IMMUNIZATION ADMIN | CPT 90471 | Outpatient | 323100401 | $42 | |
CHEMO IV INFUSION 1 HR | CPT 96413 | Outpatient | 602000036 | $238 | |