Lane Regional Medical Center

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

Hospital Website Machine-Readable Chargemaster

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Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.

Service Description	Service Code	Department	Charge Code	Cash Price	Rates
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450	Outpatient	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