Lane Regional Medical Center

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

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.
Filtering
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450Outpatient403800428$503
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient403800031$531
CT MAXILLOFACIAL W/DYECPT 70487Outpatient403800032$572
CT SOFT TISSUE NECK W/DYECPT 70491Outpatient403800139$604
CT ANGIOGRAPHY NECKCPT 70498Outpatient701200026$967
CT THORAX DX C-CPT 71250Outpatient403800337$595
CT THORAX DX C+CPT 71260Outpatient403800345$641
CT ANGIOGRAPHY CHESTCPT 71275Outpatient403800346$893
CT NECK SPINE W/O DYECPT 72125Outpatient403800303$679
CT CHEST SPINE W/O DYECPT 72128Outpatient403800626$669
CT LUMBAR SPINE W/O DYECPT 72131Outpatient403800469$769
CT ANGIOGRAPH PELV W/O&W/DYECPT 72191Outpatient701200034$1,144
CT PELVIS W/O DYECPT 72192Outpatient403800543$628
CT PELVIS W/DYECPT 72193Outpatient403800037$847
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient403800127$498
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient403800287$586
CT ABDOMEN W/DYECPT 74160Outpatient403800170$1,045
CT ABDOMEN W/O & W/DYECPT 74170Outpatient403800295$1,439
CT ANGIO ABD&PELV W/O&W/DYECPT 74174Outpatient701200066$1,944
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient403800130$1,853
CT ABD & PELV W/CONTRASTCPT 74177Outpatient403800131$2,090
CT HRT W/O DYE W/CA TESTCPT 75571Outpatient403800075$75
CT ANGIO ABDOMINAL ARTERIESCPT 75635Outpatient403800015$1,360
Cardiology
PRQ CARD STENT W/ANGIO 1 VSLCPT 92928Outpatient701000070$5,567
PRQ CARD REVASC MI 1 VSLCPT 92941Outpatient701010091$13,455
TTE W/DOPPLER COMPLETECPT 93306Outpatient403100012$472
ECHO TRANSESOPHAGEALCPT 93312Outpatient701002001$915
L HRT ARTERY/VENTRICLE ANGIOCPT 93458Outpatient701004024$8,219
L HRT ART/GRFT ANGIOCPT 93459Outpatient701004025$8,675
R&L HRT ART/VENTRICLE ANGIOCPT 93460Outpatient701004026$8,545
HEART FLOW RESERVE MEASURECPT 93571Outpatient701002005$1,488
Clinic
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient409400037$144
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient409400039$194
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient409400138$239
OFFICE CONSULTATIONCPT 99243Outpatient409200066$118
OFFICE CONSULTATIONCPT 99244Outpatient409200067$167
PREV VISIT NEW AGE 18-39CPT 99385Outpatient815000009$44
PREV VISIT NEW AGE 40-64CPT 99386Outpatient815000249$59
HOSPITAL OUTPT CLINIC VISITHCPCS G0463Outpatient409400242$233
EEG
POLYSOM 6/> YRS 4/> PARAMCPT 95810Outpatient317100004$1,388
POLYSOM 6/>YRS CPAP 4/> PARMCPT 95811Outpatient317100006$1,538
EEG AWAKE AND DROWSYCPT 95816Outpatient403100415$340
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...CPT 93000----
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient403100209$83
Emergency Room
DRAINAGE OF SKIN ABSCESSCPT 10060Outpatient323100284$186
DRAINAGE OF SKIN ABSCESSCPT 10061Outpatient323100285$295
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001Outpatient323100292$109
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient323100293$109
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011Outpatient323100298$109
RPR F/E/E/N/L/M 2.6-5.0 CMCPT 12013Outpatient323100299$134
APPLY FOREARM SPLINTCPT 29125Outpatient323100250$140
APPLICATION LOWER LEG SPLINTCPT 29515Outpatient323100253$106
INSERT EMERGENCY AIRWAYCPT 31500Outpatient323100259$219
INSERT TEMP BLADDER CATHCPT 51702Outpatient323100206$97
EMERGENCY DEPT VISITCPT 99282Outpatient323100227$174
EMERGENCY DEPT VISITCPT 99283Outpatient323100228$267
EMERGENCY DEPT VISITCPT 99284Outpatient323100229$430
EMERGENCY DEPT VISITCPT 99285Outpatient323100230$648
CRITICAL CARE FIRST HOURCPT 99291Outpatient323100850$966
IV Therapy
HYDRATION IV INFUSION INITCPT 96360Outpatient323100026$198
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient323100027$107
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient323100547$209
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient601000004$107
THER/DIAG CONCURRENT INFCPT 96368Outpatient323100905$104
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient323100402$73
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient323100409$73
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient323100425$73
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient601000010$73
IRRIG DRUG DELIVERY DEVICECPT 96523Outpatient602000093$83
Imaging
US EXAM OF HEAD AND NECKCPT 76536Outpatient405000108$203
ULTRASOUND BREAST COMPLETECPT 76641Outpatient405000382$196
ULTRASOUND BREAST LIMITEDCPT 76642Outpatient405000381$196
US EXAM ABDOM COMPLETECPT 76700Outpatient405000027$352
ECHO EXAM OF ABDOMENCPT 76705Outpatient405000043$237
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient405000103$314
OB US < 14 WKS SINGLE FETUSCPT 76801Outpatient405000129$215
(N/O) ABDOMIAL ULTRASOUND OF PREGNANT UTERUSCPT 76805----
TRANSVAGINAL US OBSTETRICCPT 76817Outpatient405000128$301
FETAL BIOPHYS PROFIL W/O NSTCPT 76819Outpatient405000332$169
TRANSVAGINAL US NON-OBCPT 76830Outpatient405000107$253
US EXAM PELVIC COMPLETECPT 76856Outpatient405000084$260
US EXAM SCROTUMCPT 76870Outpatient405000146$203
US COMPL JOINT R-T W/IMGCPT 76881Outpatient405000140$237
US GUIDE VASCULAR ACCESSCPT 76937Outpatient405000200$309
DX MAMMO INCL CAD UNICPT 77065Outpatient405200017$173
DX MAMMO INCL CAD BICPT 77066Outpatient405201127$173
SCR MAMMO BI INCL CADCPT 77067Outpatient405201103$173
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient405000274$338
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----
Labor and Delivery
CIRCUMCISION W/REGIONL BLOCKCPT 54150Outpatient321600017$1,799
Laboratory
ROUTINE VENIPUNCTURECPT 36415Outpatient401003900$7
METABOLIC PANEL TOTAL CACPT 80048Outpatient401003439$75
ELECTROLYTE PANELCPT 80051Outpatient401000716$34
COMPREHEN METABOLIC PANELCPT 80053Outpatient401004841$111
OBSTETRIC PANELCPT 80055Outpatient401004247$76
LIPID PANELCPT 80061Outpatient401002019$56
RENAL FUNCTION PANELCPT 80069Outpatient401004860$36
ACUTE HEPATITIS PANELCPT 80074Outpatient401000765$75
HEPATIC FUNCTION PANELCPT 80076Outpatient401004858$36
OBSTETRIC PANELCPT 80081Outpatient401073578$110
ASSAY CARBAMAZEPINE TOTALCPT 80156Outpatient401008081$75
DRUG ASSAY CLOZAPINECPT 80159Outpatient401004833$76
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient401007695$36
ASSAY DIPROPYLACETIC ACD TOTCPT 80164Outpatient401001300$83
DRUG SCREEN QUAN LAMOTRIGINECPT 80175Outpatient401000644$50
DRUG SCRN QUAN LEVETIRACETAMCPT 80177Outpatient401000645$73
ASSAY OF LITHIUMCPT 80178Outpatient401002316$41
DRUG SCRN QUANT OXCARBAZEPINCPT 80183Outpatient401007939$40
ASSAY OF PHENOBARBITALCPT 80184Outpatient401008008$48
ASSAY OF PHENYTOIN TOTALCPT 80185Outpatient401008016$70
ASSAY OF TACROLIMUSCPT 80197Outpatient401004254$69
ASSAY OF VANCOMYCINCPT 80202Outpatient401000492$84
DRUG TEST PRSMV DIR OPT OBSCPT 80305Outpatient401001336$7
DRUG TEST PRSMV INSTRMNTCPT 80306Outpatient401000694$12
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient401007844$86
DRUG SCREEN QUANTALCOHOLSCPT 80320Outpatient401002050$109
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
URINALYSIS AUTO W/SCOPECPT 81001Outpatient401003041$30
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient401073516$27
URINALYSIS VOLUME MEASURECPT 81050Outpatient401008800$20
ACETONE ASSAYCPT 82010Outpatient401002035$43
ASSAY OF SERUM ALBUMINCPT 82040Outpatient401002043$20
UR ALBUMIN QUANTITATIVECPT 82043Outpatient401003125$39
ASSAY OF BREATH ETHANOLCPT 82075Outpatient401010000$12
ASSAY OF AMMONIACPT 82140Outpatient401007240$58
ASSAY OF AMYLASECPT 82150Outpatient401002068$45
OCCULT BLD FECES 1-3 TESTSCPT 82272Outpatient401000543$28
VITAMIN D 25 HYDROXYCPT 82306Outpatient401003170$65
ASSAY OF CALCIUMCPT 82310Outpatient401002100$31
CARCINOEMBRYONIC ANTIGENCPT 82378Outpatient401007737$45
ASSAY BLD/SERUM CHOLESTEROLCPT 82465Outpatient401002134$23
TOTAL CORTISOLCPT 82533Outpatient401007778$65
ASSAY OF CREATININECPT 82565Outpatient401002167$28
VITAMIN B-12CPT 82607Outpatient401007760$34
VIT D 1 25-DIHYDROXYCPT 82652Outpatient401003171$65
ASSAY OF FERRITINCPT 82728Outpatient401007802$73
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient401007786$34
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient401002191$26
GLUCOSE TESTCPT 82950Outpatient401004270$32
GLUCOSE BLOOD TESTCPT 82962Outpatient401002282$5
ASSAY OF GGTCPT 82977Outpatient401002233$27
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient401008503$54
ASSAY OF GONADOTROPIN (LH)CPT 83002Outpatient401008511$54
HEMOGLOBIN CHROMOTOGRAPHYCPT 83021Outpatient401007886$61
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient401000880$43
ASSAY OF INSULINCPT 83525Outpatient401007703$40
ASSAY OF IRONCPT 83540Outpatient401002241$29
IRON BINDING TESTCPT 83550Outpatient401002563$31
ASSAY OF LACTIC ACIDCPT 83605Outpatient401073590$45
ASSAY OF LEADCPT 83655Outpatient401007898$85
ASSAY OF LIPASECPT 83690Outpatient401002308$50
ASSAY OF MAGNESIUMCPT 83735Outpatient401007349$39
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient401000130$45
ASSAY OF PARATHORMONECPT 83970Outpatient401009277$68
ASSAY OF BLOOD PKUCPT 84030Outpatient401008453$29
ASSAY OF PHOSPHORUSCPT 84100Outpatient401002340$27
EVAL AMNIOTIC FLUID PROTEINCPT 84112Outpatient401073687$101
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient401002357$14
ASSAY OF PREALBUMINCPT 84134Outpatient401004882$41
ASSAY OF PROLACTINCPT 84146Outpatient401000393$45
ASSAY OF PSA TOTALCPT 84153Outpatient401005459$39
ASSAY OF PSA FREECPT 84154Outpatient401004338$65
ASSAY OF PROTEIN URINECPT 84156Outpatient401008360$35
ASSAY OF SERUM SODIUMCPT 84295Outpatient401002399$23
ASSAY OF URINE SODIUMCPT 84300Outpatient401003603$23
ASSAY OF TOTAL TESTOSTERONECPT 84403Outpatient401008529$59
ASSAY OF VITAMIN B-1CPT 84425Outpatient401073348$58
ASSAY OF TOTAL THYROXINECPT 84436Outpatient401002522$37
ASSAY OF FREE THYROXINECPT 84439Outpatient401002523$57
ASSAY THYROID STIM HORMONECPT 84443Outpatient401004189$57
TRANSFERASE (AST) (SGOT)CPT 84450Outpatient401002456$23
ALANINE AMINO (ALT) (SGPT)CPT 84460Outpatient401002464$23
ASSAY OF TRANSFERRINCPT 84466Outpatient401005855$37
ASSAY OF THYROID (T3 OR T4)CPT 84479Outpatient401002514$35
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient401008010$40
FREE ASSAY (FT-3)CPT 84481Outpatient401002515$49
ASSAY OF UREA NITROGENCPT 84520Outpatient401002480$25
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient401002498$23
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient401008677$96
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient401003066$35
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient401000203$27
COMPLETE CBC AUTOMATEDCPT 85027Outpatient401008933$27
MANUAL RETICULOCYTE COUNTCPT 85044Outpatient401000153$21
COAGULATION TIME ACTIVATEDCPT 85347Outpatient401002360$24
FIBRIN DEGRADATION QUANTCPT 85379Outpatient401003596$84
FIBRINOGEN ACTIVITYCPT 85384Outpatient401000096$42
PROTHROMBIN TIMECPT 85610Outpatient401000146$30
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient401000161$16
RBC SICKLE CELL TESTCPT 85660Outpatient401000179$23
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient401000120$27
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient401007521$40
C-REACTIVE PROTEINCPT 86140Outpatient401006028$40
C-REACTIVE PROTEIN HSCPT 86141Outpatient401007910$40
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient401006051$49
IA INFECTIOUS AGENT ANTIBODYCPT 86318Outpatient401073545$71
RHEUMATOID FACTOR QUANTCPT 86431Outpatient401006077$29
TB TEST CELL IMMUN MEASURECPT 86480Outpatient401073384$64
TB INTRADERMAL TESTCPT 86580Outpatient401006523$21
SYPHILIS TEST NON-TREP QUALCPT 86592Outpatient401006069$19
HEP B SURFACE ANTIBODYCPT 86706Outpatient401003504$39
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient401073493$39
HEPATITIS C AB TESTCPT 86803Outpatient401005542$64
RBC ANTIBODY IDENTIFICATIONCPT 86870Outpatient401001714$95
COOMBS TEST DIRECTCPT 86880Outpatient401005054$35
COMPATIBILITY TEST ANTIGLOBCPT 86922Outpatient401005137$102
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient401003330$51
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient401004000$20
CULTURE SCREEN ONLYCPT 87081Outpatient401073413$26
URINE CULTURE/COLONY COUNTCPT 87086Outpatient401003256$44
DNA/RNA AMPLIFIED PROBECPT 87150Outpatient401073710$472
OVA AND PARASITES SMEARSCPT 87177Outpatient401004007$29
MICROBE SUSCEPTIBLE MICCPT 87186Outpatient401003296$22
SMEAR GRAM STAINCPT 87205Outpatient401006507$22
SMEAR WET MOUNT SALINE/INKCPT 87210Outpatient401004064$22
CLOSTRIDIUM AG IACPT 87324Outpatient401073555$33
HPYLORI STOOL AG IACPT 87338Outpatient401000020$31
HEPATITIS B SURFACE AG IACPT 87340Outpatient401007547$55
HIV-1 AG W/HIV-1&2 AB AG IACPT 87389Outpatient401001185$42
RESP SYNCYTIAL VIRUS AG IACPT 87420Outpatient401005897$70
NOS EACH ORGANISM AG IACPT 87449Outpatient401073556$55
IADNA-DNA/RNA PROBE TQ 12-25CPT 87507Outpatient401073577$227
INFLUENZA ASSAY W/OPTICCPT 87804Outpatient401000676$32
HIV W/HIV1&2 ANTB W/OPTICCPT 87806Outpatient401005601$44
STREP A ASSAY W/OPTICCPT 87880Outpatient401005731$59
TISSUE EXAM BY PATHOLOGISTCPT 88304Outpatient401073336$29
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient401073337$40
TISSUE EXAM BY PATHOLOGISTCPT 88307Outpatient401073338$88
IMMUNOHISTO ANTB 1ST STAINCPT 88342Outpatient401008220$73
BODY FLUID CELL COUNTCPT 89051Outpatient401000518$27
LEUKOCYTE ASSESSMENT FECALCPT 89055Outpatient401001938$26
EIA HIV-1/HIV-2 SCREENHCPCS G0432Outpatient401073677$56
ONE-WAY ALLOW PRORATED MILESHCPCS P9603Outpatient401003916$1
Language Pathology
SPEECH/HEARING THERAPYCPT 92507Outpatient408100002$92
SPEECH SOUND LANG COMPREHENCPT 92523Outpatient608000062$189
ORAL FUNCTION THERAPYCPT 92526Outpatient608000013$74
EVALUATE SWALLOWING FUNCTIONCPT 92610Outpatient408100019$106
MOTION FLUOROSCOPY/SWALLOWCPT 92611Outpatient408100005$146
THER IVNTJ 1ST 15 MINCPT 97129Outpatient608000004$43
MRI
MRI BRAIN STEM W/O DYECPT 70551Outpatient405100015$867
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient405100017$1,148
MRI NECK SPINE W/O DYECPT 72141Outpatient405100018$862
MRI LUMBAR SPINE W/O DYECPT 72148Outpatient405100029$846
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient405100023$819
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient405100061$819
Medical and Surgical Supplies
EMERGE 2.0 X 12HCPCS C1725Outpatient701010376$243
CATH,INF,PER/CENT/MIDLINEHCPCS C1751Outpatient325009950$60
ANGIO TRAY SUPPLY TRAYHCPCS C1757Outpatient701011193$79
MYNX 6FR ORDER BY EAHCPCS C1760Outpatient701011431$358
J WIRE 260 CM 502-455HCPCS C1769Outpatient701011395$15
DRILL PIN SET 86-4192HCPCS C1776Outpatient325081571$152
SECURESTRAP STRAP25RHCPCS C1781Outpatient325081830$258
EBU 3.5 6FR 1/EAHCPCS C1887Outpatient701011294$75
GLIDESHEATH 6FR 10CM 80-1060HCPCS C1894Outpatient701011334$89
Nuclear Medicine
HEPATOBIL SYST IMAGE W/DRUGCPT 78227Outpatient406000075$659
GASTRIC EMPTYING IMAG STUDYCPT 78264Outpatient406000008$503
BONE IMAGING WHOLE BODYCPT 78306Outpatient406000026$522
LUNG VENTILAT&PERFUS IMAGINGCPT 78582Outpatient406000175$558
TC99M MEDRONATEHCPCS A9503Outpatient405900043$108
TC99M MEBROFENINHCPCS A9537Outpatient405900052$121
TC99M MAAHCPCS A9540Outpatient405900051$121
TC99M SULFUR COLLOIDHCPCS A9541Outpatient405900053$121
TECHNETIUM TC-99M AEROSOLHCPCS A9567Outpatient405900050$91
Other Diagnostic
EVOKED AUDITORY TEST LIMITEDCPT 92587Outpatient408100145$88
UPR/LXTR ART STDY 3+ LVLSCPT 93923Outpatient405000109$281
LOWER EXTREMITY STUDYCPT 93926Outpatient405000110$229
EXTREMITY STUDYCPT 93970Outpatient405000315$462
EXTREMITY STUDYCPT 93971Outpatient405000115$246
VASCULAR STUDYCPT 93975Outpatient405000340$424
Other Procedures and Observation
DEB SUBQ TISSUE 20 SQ CM/<CPT 11042Outpatient409400003$346
SKIN SUB GRAFT TRNK/ARM/LEGCPT 15271Outpatient409400129$1,607
SKIN SUB GRAFT FACE/NK/HF/GCPT 15275Outpatient409400133$1,607
CHEM CAUT OF GRANLTJ TISSUECPT 17250Outpatient409400136$155
APPLICATION OF PASTE BOOTCPT 29580Outpatient409400034$229
FETAL NON-STRESS TESTCPT 59025Outpatient319100047$166
RMVL DEVITAL TIS 20 CM/<CPT 97597Outpatient409400032$155
RMVL DEVITAL TIS ADDL 20CM/<CPT 97598Outpatient409400033$110
OFFICE O/P EST SF 10-19 MINCPT 99212Outpatient409400052$118
OFFICE O/P EST LOW 20-29 MINCPT 99213Outpatient409400054$131
OFFICE O/P EST MOD 30-39 MINCPT 99214Outpatient601000024$171
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 36430Outpatient601000031$397
MEDICAL NUTRITION INDIV INCPT 97802Outpatient506200021$23
MED NUTRITION INDIV SUBSEQCPT 97803Outpatient506200070$20
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient401003725$222
PLASMA 1 DONOR FRZ W/IN 8 HRHCPCS P9017Outpatient401003769$82
Psychiatric
PSYTX W PT 30 MINUTESCPT 90832Outpatient801000001$81
PSYTX W PT 45 MINUTESCPT 90834Outpatient801000002$117
PSYTX W PT 60 MINUTESCPT 90837Outpatient801000023$176
FAMILY PSYTX W/O PT 50 MINCPT 90846Outpatient801000003$121
FAMILY PSYTX W/PT 50 MINCPT 90847Outpatient801000004$129
GROUP PSYCHOTHERAPYCPT 90853Outpatient801000005$154
Pulmonary Function
VITAL CAPACITY TESTCPT 94150Outpatient317100210$43
PULM FUNCTION TEST BY GASCPT 94727Outpatient317100634$186
PULMONARY SERVICE/PROCEDURECPT 94799Outpatient317100050$70
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient404000168$88
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient404000176$102
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101Outpatient404000234$159
X-RAY EXAM OF SPINE 1 VIEWCPT 72020Outpatient404100002$89
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040Outpatient404001265$197
X-RAY EXAM NECK SPINE 6/>VWSCPT 72052Outpatient404000846$295
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient404002179$56
X-RAY EXAM THORAC SPINE 3VWSCPT 72072Outpatient404000853$218
X-RAY EXAM ENTIRE SPI 1 VWCPT 72081Outpatient404001299$232
X-RAY EXAM ENTIRE SPI 2/3 VWCPT 72082Outpatient404001240$223
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient404001307$197
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient404000879$298
X-RAY EXAM OF PELVISCPT 72170Outpatient404000895$97
X-RAY EXAM SACRUM TAILBONECPT 72220Outpatient404000937$109
X-RAY EXAM OF SHOULDERCPT 73030Outpatient404002101$188
X-RAY EXAM OF HUMERUSCPT 73060Outpatient404000630$165
X-RAY EXAM OF ELBOWCPT 73080Outpatient404002022$182
X-RAY EXAM OF FOREARMCPT 73090Outpatient404000655$162
X-RAY EXAM OF WRISTCPT 73110Outpatient404002049$157
X-RAY EXAM OF HANDCPT 73120Outpatient404002079$156
X-RAY EXAM OF HANDCPT 73130Outpatient404002080$179
X-RAY EXAM OF FINGER(S)CPT 73140Outpatient404001360$124
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient404002052$171
X-RAY EXAM HIPS BI 3-4 VIEWSCPT 73522Outpatient404002054$245
X-RAY EXAM OF FEMUR 2/>CPT 73552Outpatient404002026$171
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient404002082$153
X-RAY EXAM OF KNEE 3CPT 73562Outpatient404002087$191
X-RAY EXAM KNEE 4 OR MORECPT 73564Outpatient404002083$218
X-RAY EXAM OF LOWER LEGCPT 73590Outpatient404002032$173
X-RAY EXAM OF ANKLECPT 73600Outpatient404002004$167
X-RAY EXAM OF ANKLECPT 73610Outpatient404002003$181
X-RAY EXAM OF FOOTCPT 73620Outpatient404002075$93
X-RAY EXAM OF FOOTCPT 73630Outpatient404002006$107
X-RAY EXAM OF TOE(S)CPT 73660Outpatient404001358$128
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient404000467$152
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient404000283$190
X-RAY EXAM COMPLETE ABDOMENCPT 74022Outpatient404000052$259
X-RAY XM ESOPHAGUS 1CNTRSTCPT 74220Outpatient404000317$277
X-RAY XM SWLNG FUNCJ C+CPT 74230Outpatient404000031$210
X-RAY XM SM INT 1CNTRST STDCPT 74250Outpatient404000366$203
CONTRAST EXAM ABDOMINL AORTACPT 75625Outpatient701001007$1,356
ARTERY X-RAYS ARMS/LEGSCPT 75716Outpatient701001018$1,472
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient404001166$253
DXA BONE DENSITY AXIALCPT 77080Outpatient404100001$151
Respiratory
CLEARANCE OF AIRWAYSCPT 31720Outpatient317100584$165
WITHDRAWAL OF ARTERIAL BLOODCPT 36600Outpatient317100823$29
HEART/LUNG RESUSCITATION CPRCPT 92950Outpatient317100196$296
VENT MGMT INPAT INIT DAYCPT 94002Outpatient317100105$463
VENT MGMT INPAT SUBQ DAYCPT 94003Outpatient317100031$380
AIRWAY INHALATION TREATMENTCPT 94640Outpatient317100428$51
POS AIRWAY PRESSURE CPAPCPT 94660Outpatient317100716$331
CHEST WALL MANIPULATIONCPT 94668Outpatient317100767$38
MEASURE BLOOD OXYGEN LEVELCPT 94760Outpatient317100019$21
HBOT, FULL BODY CHAMBER, 30MHCPCS G0277Outpatient409200030$140
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----
INSJ PICC 5 YR+ W/O IMAGINGCPT 36569Outpatient302100342$693
INSJ PICC RS&I 5 YR+CPT 36573Outpatient601000151$693
INTRVASC US NONCORONARY 1STCPT 37252Outpatient701010211$1,410
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...CPT 42820----
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient318900305$445
EGD BIOPSY SINGLE/MULTIPLECPT 43239Outpatient318900313$592
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient318900263$905
COLONOSCOPY AND BIOPSYCPT 45380Outpatient318900289$905
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient318900297$905
(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----
MOD SED SAME PHYS/QHP 5/>YRSCPT 99152Outpatient318900582$141
MOD SED SAME PHYS/QHP EACPT 99153Outpatient318900583$141
MOD SED OTH PHYS/QHP 5/>YRSCPT 99156Outpatient601000089$141
MOD SED OTHER PHYS/QHP EACPT 99157Outpatient601000119$200
COLORECTAL SCRN; HI RISK INDHCPCS G0105Outpatient318900586$905
Therapy
ELECTRICAL STIMULATIONCPT 97032Outpatient607000011$48
THERAPEUTIC EXERCISESCPT 97110Outpatient607000003$46
NEUROMUSCULAR REEDUCATIONCPT 97112Outpatient607000020$43
GAIT TRAINING THERAPYCPT 97116Outpatient409102068$36
MANUAL THERAPY 1/> REGIONSCPT 97140Outpatient709101325$80
GROUP THERAPEUTIC PROCEDURESCPT 97150Outpatient606000055$60
PT EVAL LOW COMPLEX 20 MINCPT 97161Outpatient409102180$137
PT EVAL MOD COMPLEX 30 MINCPT 97162Outpatient409102181$137
PT EVAL HIGH COMPLEX 45 MINCPT 97163Outpatient409102182$137
OT EVAL LOW COMPLEX 30 MINCPT 97165Outpatient409302180$137
OT EVAL MOD COMPLEX 45 MINCPT 97166Outpatient409302181$137
OT EVAL HIGH COMPLEX 60 MINCPT 97167Outpatient409302182$137
THERAPEUTIC ACTIVITIESCPT 97530Outpatient606000050$33
SELF CARE MNGMENT TRAININGCPT 97535Outpatient409300103$44
Uncategorized
IMMUNIZATION ADMINCPT 90471Outpatient323100401$42
CHEMO IV INFUSION 1 HRCPT 96413Outpatient602000036$238