Mitchell County Hospital

Price List for Shoppable Services. Effective 07-19-2022.

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.

Billing Description	Billing Code	CDM Code	Department	Gross Charge	Cash Price	PNR
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450	4200001	Outpatient	$1,155	$809	Payer Rates
CT MAXILLOFACIAL W/O DYE	CPT 70486	4200004	Outpatient	$1,941	$1,359	Payer Rates
CT MAXILLOFACIAL W/O DYE	CPT 70486	4200043	Outpatient	$1,858	$1,301	Payer Rates
CT SOFT TISSUE NECK W/DYE	CPT 70491	4200007	Outpatient	$1,240	$868	Payer Rates
CT THORAX DX C-	CPT 71250	4200009	Outpatient	$2,029	$1,420	Payer Rates
CT THORAX DX C-	CPT 71250	4200026	Outpatient	$1,947	$1,363	Payer Rates
CT THORAX DX C+	CPT 71260	4200010	Outpatient	$2,453	$1,717	Payer Rates
CT ANGIOGRAPHY CHEST	CPT 71275	4200011	Outpatient	$2,470	$1,729	Payer Rates
CT NECK SPINE W/O DYE	CPT 72125	4200029	Outpatient	$1,290	$903	Payer Rates
CT LUMBAR SPINE W/O DYE	CPT 72131	4200031	Outpatient	$1,290	$903	Payer Rates
CT PELVIS W/O DYE	CPT 72192	4200015	Outpatient	$1,210	$847	Payer Rates
CT PELVIS W/DYE	CPT 72193	4200016	Outpatient	$1,375	$962	Payer Rates
CT LOWER EXTREMITY W/O DYE	CPT 73700	4200019	Outpatient	$1,969	$1,378	Payer Rates
CT ABD & PELVIS W/O CONTRAST	CPT 74176	4200024	Outpatient	$1,350	$945	Payer Rates
CT ABD & PELV W/CONTRAST	CPT 74177	4200025	Outpatient	$1,475	$1,033	Payer Rates
CT ABD & PELV 1/> REGNS	CPT 74178	4200023	Outpatient	$4,900	$3,430	Payer Rates
Cancer Services
IRRIG DRUG DELIVERY DEVICE	CPT 96523	1800004	Outpatient	$40	$28	Payer Rates
Cardiology
TTE W/DOPPLER COMPLETE	CPT 93306	4100015	Outpatient	$2,376	$1,663	Payer Rates
Clinic
INJ TENDON SHEATH/LIGAMENT	CPT 20550	5000007	Outpatient	$440	$308	Payer Rates
INJ TRIGGER POINT 1/2 MUSCL	CPT 20552	5000129	Outpatient	$720	$504	Payer Rates
REMOVE IMPACTED EAR WAX UNI	CPT 69210	5000009	Outpatient	$195	$137	Payer Rates
TB INTRADERMAL TEST	CPT 86580	5000015	Outpatient	$20	$14	Payer Rates
INFLUENZA ASSAY W/OPTIC	CPT 87804	5000016	Outpatient	$94	$66	Payer Rates
CYTOPATH C/V MANUAL	CPT 88150	5000017	Outpatient	$51	$36	Payer Rates
IM ADMIN 1ST/ONLY COMPONENT	CPT 90460	5000080	Outpatient	$15	$11	Payer Rates
IM ADMIN 1ST/ONLY COMPONENT	CPT 90460	5000082	Outpatient	$15	$11	Payer Rates
IM ADMIN EACH ADDL COMPONENT	CPT 90461	5000081	Outpatient	$10	$7	Payer Rates
IM ADMIN EACH ADDL COMPONENT	CPT 90461	5000083	Outpatient	$6	$4	Payer Rates
IMMUNIZATION ADMIN	CPT 90471	5000019	Outpatient	$15	$11	Payer Rates
IMMUNIZATION ADMIN EACH ADD	CPT 90472	5000020	Outpatient	$10	$7	Payer Rates
IMMUNOTHERAPY ONE INJECTION	CPT 95115	5000022	Outpatient	$22	$15	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	5000024	Outpatient	$22	$15	Payer Rates
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	5000004	Outpatient	$215	$151	Payer Rates
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	5000027	Outpatient	$143	$100	Payer Rates
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	5000115	Outpatient	$215	$151	Payer Rates
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	5000028	Outpatient	$157	$110	Payer Rates
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	5000029	Outpatient	$290	$203	Payer Rates
OFFICE O/P EST SF 10-19 MIN	CPT 99212	5000032	Outpatient	$116	$81	Payer Rates
OFFICE O/P EST SF 10-19 MIN	CPT 99212	5000061	Outpatient	$25	$18	Payer Rates
OFFICE O/P EST SF 10-19 MIN	CPT 99212	5000070	Outpatient	$131	$92	Payer Rates
OFFICE O/P EST LOW 20-29 MIN	CPT 99213	5000033	Outpatient	$143	$100	Payer Rates
OFFICE O/P EST LOW 20-29 MIN	CPT 99213	5000067	Outpatient	$240	$168	Payer Rates
OFFICE O/P EST MOD 30-39 MIN	CPT 99214	5000034	Outpatient	$157	$110	Payer Rates
OFFICE CONSULTATION	CPT 99243	5000099	Outpatient	$215	$151	Payer Rates
OFFICE CONSULTATION	CPT 99244	5000037	Outpatient	$305	$214	Payer Rates
PREV VISIT NEW AGE 18-39	CPT 99385	5000088	Outpatient	$100	$70	Payer Rates
PREV VISIT NEW AGE 40-64	CPT 99386	5000089	Outpatient	$100	$70	Payer Rates
PREV VISIT EST AGE 1-4	CPT 99392	5000052	Outpatient	$121	$85	Payer Rates
PREV VISIT EST AGE 5-11	CPT 99393	5000054	Outpatient	$121	$85	Payer Rates
PREV VISIT EST AGE 12-17	CPT 99394	5000055	Outpatient	$121	$85	Payer Rates
WORK RELATED DISABILITY EXAM	CPT 99455	5000043	Outpatient	$100	$70	Payer Rates
PPPS, INITIAL VISIT	HCPCS G0438	5000057	Outpatient	$225	$158	Payer Rates
CLINIC SERVICE	HCPCS T1015 (AM)	5000059	Outpatient	$143	$100	Payer Rates
EEG
(Not Offered) SLEEP STUDY	CPT 95810	-	-	-	-	-
EKG
ELECTROCARDIOGRAM COMPLETE	CPT 93000	8200001	Outpatient	$121	$85	Payer Rates
ELECTROCARDIOGRAM TRACING	CPT 93005	8200002	Outpatient	$211	$148	Payer Rates
ECG MONIT/REPRT UP TO 48 HRS	CPT 93225	8000030	Outpatient	$543	$380	Payer Rates
Emergency Room
DRAINAGE OF SKIN ABSCESS	CPT 10060	3000031	Outpatient	$492	$344	Payer Rates
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	3000063	Outpatient	$204	$143	Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	3000048	Outpatient	$386	$270	Payer Rates
RPR S/N/AX/GEN/TRK7.6-12.5CM	CPT 12004	3000049	Outpatient	$423	$296	Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<	CPT 12011	3000050	Outpatient	$204	$143	Payer Rates
RPR F/E/E/N/L/M 2.6-5.0 CM	CPT 12013	3000051	Outpatient	$230	$161	Payer Rates
TREAT SHOULDER DISLOCATION	CPT 23650	3000023	Outpatient	$466	$326	Payer Rates
APPLY FOREARM SPLINT	CPT 29125	3000054	Outpatient	$287	$201	Payer Rates
INSERT TEMP BLADDER CATH	CPT 51702	3000067	Outpatient	$58	$41	Payer Rates
IMMUNIZATION ADMIN	CPT 90471	3000034	Outpatient	$15	$11	Payer Rates
HYDRATE IV INFUSION ADD-ON	CPT 96361	3000085	Outpatient	$153	$107	Payer Rates
THER/PROPH/DIAG IV INF INIT	CPT 96365	3000076	Outpatient	$546	$382	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	3000060	Outpatient	$56	$39	Payer Rates
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	3000059	Outpatient	$100	$70	Payer Rates
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	3000071	Outpatient	$45	$31	Payer Rates
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	3000072	Outpatient	$150	$105	Payer Rates
EMERGENCY DEPT VISIT	CPT 99281	3000015	Outpatient	$156	$109	Payer Rates
EMERGENCY DEPT VISIT	CPT 99282	3000016	Outpatient	$215	$151	Payer Rates
EMERGENCY DEPT VISIT	CPT 99283	3000017	Outpatient	$274	$192	Payer Rates
EMERGENCY DEPT VISIT	CPT 99284	3000018	Outpatient	$470	$329	Payer Rates
EMERGENCY DEPT VISIT	CPT 99285	3000019	Outpatient	$780	$546	Payer Rates
CRITICAL CARE FIRST HOUR	CPT 99291	3000020	Outpatient	$850	$595	Payer Rates
Gastro-Intestinal
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	2000040	Outpatient	$1,450	$1,015	Payer Rates
COLONOSCOPY W/LESION REMOVAL	CPT 45385	2000039	Outpatient	$1,500	$1,050	Payer Rates
IV Therapy
HYDRATION IV INFUSION INIT	CPT 96360	3000068	Outpatient	$110	$77	Payer Rates
THER/PROPH/DIAG IV INF ADDON	CPT 96366	3000069	Outpatient	$192	$134	Payer Rates
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	1800007	Outpatient	$100	$70	Payer Rates
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	1800006	Outpatient	$45	$31	Payer Rates
Imaging
US EXAM OF HEAD AND NECK	CPT 76536	4100028	Outpatient	$818	$573	Payer Rates
US EXAM ABDOM COMPLETE	CPT 76700	4100004	Outpatient	$1,033	$723	Payer Rates
ECHO EXAM OF ABDOMEN	CPT 76705	4100005	Outpatient	$797	$558	Payer Rates
US EXAM ABDO BACK WALL COMP	CPT 76770	4100032	Outpatient	$869	$608	Payer Rates
OB US >= 14 WKS SNGL FETUS	CPT 76805	4100009	Outpatient	$807	$565	Payer Rates
TRANSVAGINAL US NON-OB	CPT 76830	4100011	Outpatient	$761	$533	Payer Rates
US EXAM PELVIC COMPLETE	CPT 76856	4100012	Outpatient	$888	$622	Payer Rates
US EXAM SCROTUM	CPT 76870	4100013	Outpatient	$818	$573	Payer Rates
(Not Offered) MAMMOGRAPHY OF ONE BREAST	CPT 77065	-	-	-	-	-
(Not Offered) MAMMOGRAPHY OF BOTH BREASTS	CPT 77066	-	-	-	-	-
(Not Offered) MAMMOGRAPHY, SCREENING, BILATERAL	CPT 77067	-	-	-	-	-
LOWER EXTREMITY STUDY	CPT 93925	4100031	Outpatient	$1,361	$953	Payer Rates
VASCULAR STUDY	CPT 93975	4100002	Outpatient	$995	$697	Payer Rates
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...	DRG 216	-	-	-	-	-
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-	-
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...	DRG 470	-	-	-	-	-
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-	-
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...	DRG 743	-	-	-	-	-
Laboratory
RESPIRATORY PANEL, PCR (BIOFIRE)	CPT 0202U	1000766	Outpatient	$275	$193	Payer Rates
ROUTINE VENIPUNCTURE	CPT 36415	1000115	Outpatient	$8	$6	Payer Rates
METABOLIC PANEL TOTAL CA	CPT 80048	1000121	Outpatient	$109	$76	Payer Rates
COMPREHEN METABOLIC PANEL	CPT 80053	1000120	Outpatient	$200	$140	Payer Rates
OBSTETRIC PANEL	CPT 80055	1000123	Outpatient	$195	$137	Payer Rates
LIPID PANEL	CPT 80061	1000122	Outpatient	$146	$102	Payer Rates
RENAL FUNCTION PANEL	CPT 80069	1000145	Outpatient	$130	$91	Payer Rates
ACUTE HEPATITIS PANEL	CPT 80074	1000133	Outpatient	$157	$110	Payer Rates
HEPATIC FUNCTION PANEL	CPT 80076	1000134	Outpatient	$152	$106	Payer Rates
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	1000189	Outpatient	$130	$91	Payer Rates
DRUG SCREEN QUANT GABAPENTIN	CPT 80171	1000003	Outpatient	$194	$136	Payer Rates
ASSAY OF PHENYTOIN TOTAL	CPT 80185	1000114	Outpatient	$128	$90	Payer Rates
ASSAY OF SIROLIMUS	CPT 80195	1000228	Outpatient	$360	$252	Payer Rates
ASSAY OF TACROLIMUS	CPT 80197	1000119	Outpatient	$210	$147	Payer Rates
ASSAY OF VANCOMYCIN	CPT 80202	1000194	Outpatient	$101	$71	Payer Rates
DRUG TEST PRSMV DIR OPT OBS	CPT 80305	1000246	Outpatient	$21	$15	Payer Rates
DRUG SCREEN QUANTALCOHOLS	CPT 80320	1000306	Outpatient	$110	$77	Payer Rates
ANALGESICS NON-OPIOID 1 OR 2	CPT 80329	1000182	Outpatient	$53	$37	Payer Rates
ANALGESICS NON-OPIOID 1 OR 2	CPT 80329	1000235	Outpatient	$53	$37	Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPE	CPT 81000	-	-	-	-	-
URINALYSIS AUTO W/SCOPE	CPT 81001	1000001	Outpatient	$49	$34	Payer Rates
URINALYSIS NONAUTO W/O SCOPE	CPT 81002	5000119	Outpatient	$25	$18	Payer Rates
(Not Offered) URINALYSIS TEST	CPT 81003	-	-	-	-	-
URINE PREGNANCY TEST	CPT 81025	1000090	Outpatient	$61	$43	Payer Rates
URINE PREGNANCY TEST	CPT 81025	5000011	Outpatient	$30	$21	Payer Rates
TEST FOR ACETONE/KETONES	CPT 82009	1000098	Outpatient	$55	$39	Payer Rates
TEST FOR ACETONE/KETONES	CPT 82009	1000361	Outpatient	$109	$76	Payer Rates
UR ALBUMIN QUANTITATIVE	CPT 82043	1000154	Outpatient	$131	$92	Payer Rates
UR ALBUMIN QUANTITATIVE	CPT 82043	1000155	Outpatient	$67	$47	Payer Rates
ALPHA-FETOPROTEIN SERUM	CPT 82105	1000264	Outpatient	$150	$105	Payer Rates
ASSAY OF AMMONIA	CPT 82140	1000076	Outpatient	$94	$66	Payer Rates
ASSAY OF AMYLASE	CPT 82150	1000071	Outpatient	$65	$46	Payer Rates
OCCULT BLOOD FECES	CPT 82270	1000236	Outpatient	$36	$25	Payer Rates
OCCULT BLOOD FECES	CPT 82270	1000303	Outpatient	$36	$25	Payer Rates
VITAMIN D 25 HYDROXY	CPT 82306	1000033	Outpatient	$191	$134	Payer Rates
TOTAL CORTISOL	CPT 82533	1000323	Outpatient	$133	$93	Payer Rates
TOTAL CORTISOL	CPT 82533	1000324	Outpatient	$133	$93	Payer Rates
ASSAY OF CK (CPK)	CPT 82550	1000070	Outpatient	$75	$53	Payer Rates
CREATINE MB FRACTION	CPT 82553	1000040	Outpatient	$70	$49	Payer Rates
ASSAY OF CREATININE	CPT 82565	1000072	Outpatient	$53	$37	Payer Rates
VITAMIN B-12	CPT 82607	1000249	Outpatient	$132	$92	Payer Rates
VIT D 1 25-DIHYDROXY	CPT 82652	1000285	Outpatient	$121	$85	Payer Rates
ASSAY OF TOTAL ESTRADIOL	CPT 82670	1000276	Outpatient	$190	$133	Payer Rates
ASSAY OF FERRITIN	CPT 82728	1000200	Outpatient	$130	$91	Payer Rates
ASSAY OF FOLIC ACID SERUM	CPT 82746	1000158	Outpatient	$35	$25	Payer Rates
BLOOD GASES ANY COMBINATION	CPT 82803	8000023	Outpatient	$223	$156	Payer Rates
BLOOD GASES W/O2 SATURATION	CPT 82805	8000022	Outpatient	$239	$167	Payer Rates
GLUCOSE BLOOD TEST	CPT 82962	5000120	Outpatient	$20	$14	Payer Rates
ASSAY OF GGT	CPT 82977	1000042	Outpatient	$99	$69	Payer Rates
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	1000267	Outpatient	$152	$106	Payer Rates
H PYLORI (C-13) BREATH	CPT 83013	1000351	Outpatient	$313	$219	Payer Rates
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	1000165	Outpatient	$39	$27	Payer Rates
IMMUNOASSAY NONANTIBODY	CPT 83516	1000191	Outpatient	$107	$75	Payer Rates
IRON BINDING TEST	CPT 83550	1000149	Outpatient	$28	$20	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	1000340	Outpatient	$136	$95	Payer Rates
LACTATE (LD) (LDH) ENZYME	CPT 83615	1000057	Outpatient	$62	$43	Payer Rates
ASSAY OF LEAD	CPT 83655	1000166	Outpatient	$66	$46	Payer Rates
ASSAY OF LIPASE	CPT 83690	1000171	Outpatient	$37	$26	Payer Rates
ASSAY OF BLOOD LIPOPROTEIN	CPT 83721	1000245	Outpatient	$121	$85	Payer Rates
ASSAY OF MAGNESIUM	CPT 83735	1000253	Outpatient	$44	$31	Payer Rates
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	1000322	Outpatient	$135	$95	Payer Rates
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	1000400	Outpatient	$228	$160	Payer Rates
ASSAY OF PARATHORMONE	CPT 83970	1000205	Outpatient	$151	$106	Payer Rates
ASSAY OF PARATHORMONE	CPT 83970	1000316	Outpatient	$120	$84	Payer Rates
ASSAY OF PHOSPHORUS	CPT 84100	1000077	Outpatient	$31	$22	Payer Rates
ASSAY OF SERUM POTASSIUM	CPT 84132	1000062	Outpatient	$51	$36	Payer Rates
ASSAY OF PROGESTERONE	CPT 84144	1000234	Outpatient	$108	$76	Payer Rates
ASSAY OF PROLACTIN	CPT 84146	1000272	Outpatient	$115	$81	Payer Rates
ASSAY OF PSA TOTAL	CPT 84153	1000175	Outpatient	$147	$103	Payer Rates
ASSAY OF PSA FREE	CPT 84154	1000295	Outpatient	$73	$51	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	1000037	Outpatient	$237	$166	Payer Rates
ASSAY OF FREE TESTOSTERONE	CPT 84402	1000011	Outpatient	$153	$107	Payer Rates
ASSAY OF TOTAL TESTOSTERONE	CPT 84403	1000012	Outpatient	$168	$118	Payer Rates
ASSAY OF VITAMIN B-1	CPT 84425	1000075	Outpatient	$120	$84	Payer Rates
ASSAY OF TOTAL THYROXINE	CPT 84436	1000100	Outpatient	$84	$59	Payer Rates
ASSAY OF FREE THYROXINE	CPT 84439	1000150	Outpatient	$113	$79	Payer Rates
ASSAY THYROID STIM HORMONE	CPT 84443	1000117	Outpatient	$153	$107	Payer Rates
ASSAY OF THYROID (T3 OR T4)	CPT 84479	1000031	Outpatient	$53	$37	Payer Rates
FREE ASSAY (FT-3)	CPT 84481	1000222	Outpatient	$144	$101	Payer Rates
ASSAY OF TROPONIN QUANT	CPT 84484	1000041	Outpatient	$70	$49	Payer Rates
ASSAY OF TROPONIN QUANT	CPT 84484	1000770	Outpatient	$185	$130	Payer Rates
ASSAY OF UREA NITROGEN	CPT 84520	1000048	Outpatient	$46	$32	Payer Rates
ASSAY OF BLOOD/URIC ACID	CPT 84550	1000049	Outpatient	$51	$36	Payer Rates
CHORIONIC GONADOTROPIN TEST	CPT 84702	1000270	Outpatient	$158	$111	Payer Rates
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	1000382	Outpatient	$61	$43	Payer Rates
HEMATOCRIT	CPT 85014	1000064	Outpatient	$27	$19	Payer Rates
HEMOGLOBIN	CPT 85018	1000038	Outpatient	$28	$20	Payer Rates
HEMOGLOBIN	CPT 85018	1000065	Outpatient	$28	$20	Payer Rates
(Not Offered) COMPLETE BLOOD CELL COUNT (CBC), WITH DIFFER ...	CPT 85025	-	-	-	-	-
COMPLETE CBC AUTOMATED	CPT 85027	1000067	Outpatient	$80	$56	Payer Rates
COMPLETE CBC AUTOMATED	CPT 85027	1000369	Outpatient	$80	$56	Payer Rates
FIBRIN DEGRADATION QUANT	CPT 85379	1000017	Outpatient	$158	$111	Payer Rates
PROTHROMBIN TIME	CPT 85610	1000018	Outpatient	$70	$49	Payer Rates
RBC SED RATE NONAUTOMATED	CPT 85651	1000080	Outpatient	$51	$36	Payer Rates
THROMBOPLASTIN TIME PARTIAL	CPT 85730	1000079	Outpatient	$53	$37	Payer Rates
ANTINUCLEAR ANTIBODIES	CPT 86038	1000309	Outpatient	$134	$94	Payer Rates
C-REACTIVE PROTEIN	CPT 86140	1000162	Outpatient	$20	$14	Payer Rates
DNA ANTIBODY NATIVE	CPT 86225	1000026	Outpatient	$95	$67	Payer Rates
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	1000022	Outpatient	$69	$48	Payer Rates
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	1000262	Outpatient	$120	$84	Payer Rates
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	1000327	Outpatient	$60	$42	Payer Rates
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	1000416	Outpatient	$111	$78	Payer Rates
HETEROPHILE ANTIBODY SCREEN	CPT 86308	1000081	Outpatient	$48	$34	Payer Rates
MICROSOMAL ANTIBODY EACH	CPT 86376	1000221	Outpatient	$107	$75	Payer Rates
RHEUMATOID FACTOR TEST QUAL	CPT 86430	1000255	Outpatient	$39	$27	Payer Rates
RHEUMATOID FACTOR QUANT	CPT 86431	1000025	Outpatient	$17	$12	Payer Rates
SYPHILIS TEST NON-TREP QUAL	CPT 86592	1000261	Outpatient	$54	$38	Payer Rates
HELICOBACTER PYLORI ANTIBODY	CPT 86677	1000066	Outpatient	$49	$34	Payer Rates
HEP B SURFACE ANTIBODY	CPT 86706	1000212	Outpatient	$34	$24	Payer Rates
SARS-COV-2 COVID-19 ANTIBODY	CPT 86769	1000424	Outpatient	$50	$35	Payer Rates
RBC ANTIBODY SCREEN	CPT 86850	1000307	Outpatient	$100	$70	Payer Rates
BLOOD TYPING SEROLOGIC ABO	CPT 86900	1000136	Outpatient	$42	$29	Payer Rates
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	1000085	Outpatient	$77	$54	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	1100010	Outpatient	$127	$89	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	1100012	Outpatient	$66	$46	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	1100013	Outpatient	$127	$89	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	1100014	Outpatient	$127	$89	Payer Rates
FECES CULTURE AEROBIC BACT	CPT 87045	1000101	Outpatient	$139	$97	Payer Rates
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	1000092	Outpatient	$111	$78	Payer Rates
CULTR BACTERIA EXCEPT BLOOD	CPT 87075	1000201	Outpatient	$82	$57	Payer Rates
URINE CULTURE/COLONY COUNT	CPT 87086	1000108	Outpatient	$24	$17	Payer Rates
BLOOD FUNGUS CULTURE	CPT 87103	1000103	Outpatient	$81	$57	Payer Rates
BLOOD FUNGUS CULTURE	CPT 87103	1000304	Outpatient	$81	$57	Payer Rates
OVA AND PARASITES SMEARS	CPT 87177	1000226	Outpatient	$41	$29	Payer Rates
MICROBE SUSCEPTIBLE MIC	CPT 87186	1000091	Outpatient	$88	$62	Payer Rates
MICROBE SUSCEPTIBLE MIC	CPT 87186	1000358	Outpatient	$89	$62	Payer Rates
SMEAR GRAM STAIN	CPT 87205	1000109	Outpatient	$34	$24	Payer Rates
SMEAR WET MOUNT SALINE/INK	CPT 87210	1000110	Outpatient	$34	$24	Payer Rates
SMEAR WET MOUNT SALINE/INK	CPT 87210	1000311	Outpatient	$42	$29	Payer Rates
HPYLORI STOOL AG IA	CPT 87338	1000225	Outpatient	$263	$184	Payer Rates
HIV-1 AG W/HIV-1&2 AB AG IA	CPT 87389	1000386	Outpatient	$104	$73	Payer Rates
RESP SYNCYTIAL VIRUS AG IA	CPT 87420	1000188	Outpatient	$44	$31	Payer Rates
SARSCOV CORONAVIRUS AG IA	CPT 87426	1000750	Outpatient	$100	$70	Payer Rates
SARSCOV CORONAVIRUS AG IA	CPT 87426	1000772	Outpatient	$100	$70	Payer Rates
STREP A AG IA	CPT 87430	1000132	Outpatient	$78	$55	Payer Rates
CHYLMD TRACH DNA AMP PROBE	CPT 87491	1000298	Outpatient	$186	$130	Payer Rates
SARS-COV-2 COVID-19 AMP PRB	CPT 87635	1000422	Outpatient	$189	$132	Payer Rates
SARS-COV-2 COVID-19 AMP PRB	CPT 87635 (90)	1000771	Outpatient	$141	$99	Payer Rates
CLOSTRIDIUM TOXIN A W/OPTIC	CPT 87803	1000089	Outpatient	$26	$18	Payer Rates
INFLUENZA ASSAY W/OPTIC	CPT 87804	1000130	Outpatient	$94	$66	Payer Rates
STREP A ASSAY W/OPTIC	CPT 87880	5000012	Outpatient	$81	$57	Payer Rates
SPECIMEN HANDLING PT-LAB	CPT 99001	1000060	Outpatient	$20	$14	Payer Rates
PSA SCREENING	HCPCS G0103	1000247	Outpatient	$116	$81	Payer Rates
MRI
MRI BRAIN STEM W/O DYE	CPT 70551	4300003	Outpatient	$1,500	$1,050	Payer Rates
MRI BRAIN STEM W/O & W/DYE	CPT 70553	4300005	Outpatient	$2,000	$1,400	Payer Rates
MRI NECK SPINE W/O DYE	CPT 72141	4300019	Outpatient	$1,500	$1,050	Payer Rates
MRI LUMBAR SPINE W/O DYE	CPT 72148	4300006	Outpatient	$1,500	$1,050	Payer Rates
MRI LUMBAR SPINE W/O DYE	CPT 72148	4300022	Outpatient	$1,500	$1,050	Payer Rates
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	4300015	Outpatient	$2,880	$2,016	Payer Rates
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	4300027	Outpatient	$2,880	$2,016	Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDY	CPT 93880	4100038	Outpatient	$1,248	$874	Payer Rates
EXTREMITY STUDY	CPT 93970	4100018	Outpatient	$1,381	$967	Payer Rates
EXTREMITY STUDY	CPT 93971	4100019	Outpatient	$937	$656	Payer Rates
Other Procedures and Observation
IMPLANT HORMONE PELLET(S)	CPT 11980	1800049	Outpatient	$385	$270	Payer Rates
IMPLANT HORMONE PELLET(S)	CPT 11980	1800051	Outpatient	$350	$245	Payer Rates
THER/PROPH/DIAG IV INF INIT	CPT 96365	1800053	Outpatient	$546	$382	Payer Rates
THER/PROPH/DIAG IV INF ADDON	CPT 96366	1800054	Outpatient	$192	$134	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	1800047	Outpatient	$158	$111	Payer Rates
CHEMO ANTI-NEOPL SQ/IM	CPT 96401	1800058	Outpatient	$302	$211	Payer Rates
OFFICE O/P EST MINIMAL PROB	CPT 99211	1800059	Outpatient	$145	$102	Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	1100007	Outpatient	$100	$70	Payer Rates
CARDIAC REHAB/MONITOR	CPT 93798	1700002	Outpatient	$110	$77	Payer Rates
PHLEBOTOMY	CPT 99195	1000137	Outpatient	$66	$46	Payer Rates
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	1700003	Outpatient	$148	$104	Payer Rates
RBC LEUKOCYTES REDUCED	HCPCS P9016	1100009	Outpatient	$352	$246	Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MIN	CPT 90832	-	-	-	-	-
(Not Offered) PSYCHOTHERAPY, 45 MIN	CPT 90834	-	-	-	-	-
(Not Offered) PSYCHOTHERAPY, 60 MIN	CPT 90837	-	-	-	-	-
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...	CPT 90846	-	-	-	-	-
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...	CPT 90847	-	-	-	-	-
(Not Offered) GROUP PSYCHOTHERAPY	CPT 90853	-	-	-	-	-
Pulmonary Function
BREATHING CAPACITY TEST	CPT 94010	8000014	Outpatient	$247	$173	Payer Rates
EVALUATION OF WHEEZING	CPT 94060	8000015	Outpatient	$453	$317	Payer Rates
Radiology
X-RAY EXAM OF FACIAL BONES	CPT 70150	4000003	Outpatient	$212	$148	Payer Rates
X-RAY EXAM CHEST 1 VIEW	CPT 71045	4000011	Outpatient	$88	$62	Payer Rates
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	4000012	Outpatient	$366	$256	Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100	4000013	Outpatient	$184	$129	Payer Rates
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101	4000014	Outpatient	$383	$268	Payer Rates
X-RAY EXAM RIBS BIL 3 VIEWS	CPT 71110	4000015	Outpatient	$132	$92	Payer Rates
X-RAY EXAM RIBS/CHEST4/> VWS	CPT 71111	4000016	Outpatient	$503	$352	Payer Rates
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	4000018	Outpatient	$142	$99	Payer Rates
X-RAY EXAM NECK SPINE 6/>VWS	CPT 72052	4000019	Outpatient	$537	$376	Payer Rates
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	4000021	Outpatient	$121	$85	Payer Rates
X-RAY EXAM THORAC SPINE 3VWS	CPT 72072	4000107	Outpatient	$494	$346	Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	4000023	Outpatient	$165	$115	Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	4000024	Outpatient	$673	$471	Payer Rates
X-RAY EXAM OF PELVIS	CPT 72170	4000025	Outpatient	$135	$95	Payer Rates
X-RAY EXAM SACRUM TAILBONE	CPT 72220	4000028	Outpatient	$210	$147	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73020 (LT)	4000031	Outpatient	$93	$65	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73030 (LT)	4000032	Outpatient	$124	$87	Payer Rates
X-RAY EXAM OF SHOULDER	CPT 73030 (RT)	4000061	Outpatient	$125	$88	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73070 (LT)	4000034	Outpatient	$120	$84	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73070 (RT)	4000065	Outpatient	$120	$84	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73080	4000094	Outpatient	$413	$289	Payer Rates
X-RAY EXAM OF ELBOW	CPT 73080	4000095	Outpatient	$413	$289	Payer Rates
X-RAY EXAM OF FOREARM	CPT 73090 (LT)	4000035	Outpatient	$120	$84	Payer Rates
X-RAY EXAM OF FOREARM	CPT 73090 (RT)	4000067	Outpatient	$120	$84	Payer Rates
X-RAY EXAM OF WRIST	CPT 73110 (LT)	4000036	Outpatient	$125	$88	Payer Rates
X-RAY EXAM OF WRIST	CPT 73110 (RT)	4000069	Outpatient	$125	$88	Payer Rates
X-RAY EXAM OF HAND	CPT 73130 (LT)	4000038	Outpatient	$313	$219	Payer Rates
X-RAY EXAM OF HAND	CPT 73130 (RT)	4000072	Outpatient	$192	$134	Payer Rates
X-RAY EXAM OF HAND	CPT 73130	4000073	Outpatient	$363	$254	Payer Rates
X-RAY EXAM OF FINGER(S)	CPT 73140	4000039	Outpatient	$88	$62	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502 (RT)	4000074	Outpatient	$130	$91	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502 (LT)	4000088	Outpatient	$130	$91	Payer Rates
X-RAY EXAM HIPS BI 2 VIEWS	CPT 73521	4000089	Outpatient	$101	$71	Payer Rates
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (RT)	4000075	Outpatient	$145	$102	Payer Rates
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	4000092	Outpatient	$360	$252	Payer Rates
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	4000093	Outpatient	$360	$252	Payer Rates
X-RAY EXAM OF KNEE 3	CPT 73562 (LT)	4000041	Outpatient	$389	$272	Payer Rates
X-RAY EXAM OF KNEE 3	CPT 73562 (RT)	4000077	Outpatient	$389	$272	Payer Rates
X-RAY EXAM OF KNEE 3	CPT 73562	4000078	Outpatient	$389	$272	Payer Rates
X-RAY EXAM OF LOWER LEG	CPT 73590 (LT)	4000045	Outpatient	$105	$74	Payer Rates
X-RAY EXAM OF LOWER LEG	CPT 73590 (RT)	4000080	Outpatient	$105	$74	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73610 (LT)	4000046	Outpatient	$110	$77	Payer Rates
X-RAY EXAM OF ANKLE	CPT 73610 (RT)	4000082	Outpatient	$110	$77	Payer Rates
X-RAY EXAM OF FOOT	CPT 73620	4000101	Outpatient	$364	$255	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630 (LT)	4000047	Outpatient	$153	$107	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630 (RT)	4000084	Outpatient	$153	$107	Payer Rates
X-RAY EXAM OF FOOT	CPT 73630	4000085	Outpatient	$306	$214	Payer Rates
X-RAY EXAM OF TOE(S)	CPT 73660	4000049	Outpatient	$115	$81	Payer Rates
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	4000050	Outpatient	$185	$130	Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	4000051	Outpatient	$210	$147	Payer Rates
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	4000053	Outpatient	$315	$221	Payer Rates
DXA BONE DENSITY AXIAL	CPT 77080	4000087	Outpatient	$564	$395	Payer Rates
Respiratory
WITHDRAWAL OF ARTERIAL BLOOD	CPT 36600	8000005	Outpatient	$32	$22	Payer Rates
VENT MGMT INPAT INIT DAY	CPT 94002	8000006	Outpatient	$1,129	$790	Payer Rates
VENT MGMT INPAT SUBQ DAY	CPT 94003	8000009	Outpatient	$927	$649	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640	8000003	Outpatient	$247	$173	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640	8000025	Outpatient	$247	$173	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640	8000027	Outpatient	$247	$173	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94761	8000020	Outpatient	$151	$106	Payer Rates
Surgical Procedures
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 29826	-	-	-	-	-
(Not Offered) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOS ...	CPT 29881	-	-	-	-	-
(Not Offered) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIE ...	CPT 42820	-	-	-	-	-
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	2000042	Outpatient	$2,155	$1,509	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378	2000037	Outpatient	$1,500	$1,050	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378	2000082	Outpatient	$2,466	$1,726	Payer Rates
COLONOSCOPY AND BIOPSY	CPT 45380	2000038	Outpatient	$1,500	$1,050	Payer Rates
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...	CPT 45391	-	-	-	-	-
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562	2000049	Outpatient	$8,053	$5,637	Payer Rates
PRP I/HERN INIT REDUC >5 YR	CPT 49505	2000028	Outpatient	$3,200	$2,240	Payer Rates
BIOPSY OF PROSTATE	CPT 55700	2000089	Outpatient	$2,587	$1,811	Payer Rates
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...	CPT 55866	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...	CPT 59610	-	-	-	-	-
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62322	-	-	-	-	-
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 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 LENS	CPT 66984	-	-	-	-	-
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...	CPT 93452	-	-	-	-	-
Therapy
THERAPEUTIC EXERCISES	CPT 97110 (GP)	1500002	Outpatient	$28	$20	Payer Rates
NEUROMUSCULAR REEDUCATION	CPT 97112 (GP)	1500008	Outpatient	$58	$41	Payer Rates
GAIT TRAINING THERAPY	CPT 97116 (GP)	1500006	Outpatient	$56	$39	Payer Rates
MANUAL THERAPY 1/> REGIONS	CPT 97140 (GP)	1500003	Outpatient	$39	$27	Payer Rates
PT EVAL LOW COMPLEX 20 MIN	CPT 97161 (GP)	1500010	Outpatient	$126	$88	Payer Rates
THERAPEUTIC ACTIVITIES	CPT 97530 (GP)	1500001	Outpatient	$58	$41	Payer Rates
RMVL DEVITAL TIS 20 CM/<	CPT 97597 (GP)	1500007	Outpatient	$92	$64	Payer Rates
Uncategorized
REMOVAL OF BREAST LESION	CPT 19120	2000246	Outpatient	$6,600	$4,620	Payer Rates
REMOVAL OF BREAST LESION	CPT 19120	3100177	Outpatient	$402	$281	Payer Rates
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	3100014	Outpatient	$700	$490	Payer Rates
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	3100003	Outpatient	$141	$99	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378	3100091	Outpatient	$997	$698	Payer Rates
COLONOSCOPY AND BIOPSY	CPT 45380	3100002	Outpatient	$1,102	$771	Payer Rates
COLONOSCOPY W/LESION REMOVAL	CPT 45385	3100004	Outpatient	$1,380	$966	Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562	3100007	Outpatient	$651	$456	Payer Rates
PRP I/HERN INIT REDUC >5 YR	CPT 49505	3100008	Outpatient	$1,703	$1,192	Payer Rates
IMMUNIZATION ADMIN	CPT 90471	1800002	Outpatient	$15	$11	Payer Rates
ADMIN INFLUENZA VIRUS VAC	HCPCS G0008	1800063	Outpatient	$15	$11	Payer Rates
ADMIN INFLUENZA VIRUS VAC	HCPCS G0008	5000122	Outpatient	$20	$14	Payer Rates
CASIRIVI AND IMDEVI INFUSION	HCPCS M0243	1800061	Outpatient	$774	$542	Payer Rates
BAMLAN AND ETESEV INFUSION	HCPCS M0245	1800065	Outpatient	$451	$316	Payer Rates
BAMLAN AND ETESEV INFUSION	HCPCS M0245	3000110	Outpatient	$451	$316	Payer Rates
TELEHEALTH FACILITY FEE	HCPCS Q3014	1800041	Outpatient	$58	$41	Payer Rates