Mitchell County Hospital

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

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 704504200001Outpatient$1,155$809Payer Rates
CT MAXILLOFACIAL W/O DYECPT 704864200004Outpatient$1,941$1,359Payer Rates
CT MAXILLOFACIAL W/O DYECPT 704864200043Outpatient$1,858$1,301Payer Rates
CT SOFT TISSUE NECK W/DYECPT 704914200007Outpatient$1,240$868Payer Rates
CT THORAX DX C-CPT 712504200009Outpatient$2,029$1,420Payer Rates
CT THORAX DX C-CPT 712504200026Outpatient$1,947$1,363Payer Rates
CT THORAX DX C+CPT 712604200010Outpatient$2,453$1,717Payer Rates
CT ANGIOGRAPHY CHESTCPT 712754200011Outpatient$2,470$1,729Payer Rates
CT NECK SPINE W/O DYECPT 721254200029Outpatient$1,290$903Payer Rates
CT LUMBAR SPINE W/O DYECPT 721314200031Outpatient$1,290$903Payer Rates
CT PELVIS W/O DYECPT 721924200015Outpatient$1,210$847Payer Rates
CT PELVIS W/DYECPT 721934200016Outpatient$1,375$962Payer Rates
CT LOWER EXTREMITY W/O DYECPT 737004200019Outpatient$1,969$1,378Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 741764200024Outpatient$1,350$945Payer Rates
CT ABD & PELV W/CONTRASTCPT 741774200025Outpatient$1,475$1,033Payer Rates
CT ABD & PELV 1/> REGNSCPT 741784200023Outpatient$4,900$3,430Payer Rates
Cancer Services
IRRIG DRUG DELIVERY DEVICECPT 965231800004Outpatient$40$28Payer Rates
Cardiology
TTE W/DOPPLER COMPLETECPT 933064100015Outpatient$2,376$1,663Payer Rates
Clinic
INJ TENDON SHEATH/LIGAMENTCPT 205505000007Outpatient$440$308Payer Rates
INJ TRIGGER POINT 1/2 MUSCLCPT 205525000129Outpatient$720$504Payer Rates
REMOVE IMPACTED EAR WAX UNICPT 692105000009Outpatient$195$137Payer Rates
TB INTRADERMAL TESTCPT 865805000015Outpatient$20$14Payer Rates
INFLUENZA ASSAY W/OPTICCPT 878045000016Outpatient$94$66Payer Rates
CYTOPATH C/V MANUALCPT 881505000017Outpatient$51$36Payer Rates
IM ADMIN 1ST/ONLY COMPONENTCPT 904605000080Outpatient$15$11Payer Rates
IM ADMIN 1ST/ONLY COMPONENTCPT 904605000082Outpatient$15$11Payer Rates
IM ADMIN EACH ADDL COMPONENTCPT 904615000081Outpatient$10$7Payer Rates
IM ADMIN EACH ADDL COMPONENTCPT 904615000083Outpatient$6$4Payer Rates
IMMUNIZATION ADMINCPT 904715000019Outpatient$15$11Payer Rates
IMMUNIZATION ADMIN EACH ADDCPT 904725000020Outpatient$10$7Payer Rates
IMMUNOTHERAPY ONE INJECTIONCPT 951155000022Outpatient$22$15Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963725000024Outpatient$22$15Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992035000004Outpatient$215$151Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992035000027Outpatient$143$100Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992035000115Outpatient$215$151Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 992045000028Outpatient$157$110Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 992055000029Outpatient$290$203Payer Rates
OFFICE O/P EST SF 10-19 MINCPT 992125000032Outpatient$116$81Payer Rates
OFFICE O/P EST SF 10-19 MINCPT 992125000061Outpatient$25$18Payer Rates
OFFICE O/P EST SF 10-19 MINCPT 992125000070Outpatient$131$92Payer Rates
OFFICE O/P EST LOW 20-29 MINCPT 992135000033Outpatient$143$100Payer Rates
OFFICE O/P EST LOW 20-29 MINCPT 992135000067Outpatient$240$168Payer Rates
OFFICE O/P EST MOD 30-39 MINCPT 992145000034Outpatient$157$110Payer Rates
OFFICE CONSULTATIONCPT 992435000099Outpatient$215$151Payer Rates
OFFICE CONSULTATIONCPT 992445000037Outpatient$305$214Payer Rates
PREV VISIT NEW AGE 18-39CPT 993855000088Outpatient$100$70Payer Rates
PREV VISIT NEW AGE 40-64CPT 993865000089Outpatient$100$70Payer Rates
PREV VISIT EST AGE 1-4CPT 993925000052Outpatient$121$85Payer Rates
PREV VISIT EST AGE 5-11CPT 993935000054Outpatient$121$85Payer Rates
PREV VISIT EST AGE 12-17CPT 993945000055Outpatient$121$85Payer Rates
WORK RELATED DISABILITY EXAMCPT 994555000043Outpatient$100$70Payer Rates
PPPS, INITIAL VISITHCPCS G04385000057Outpatient$225$158Payer Rates
CLINIC SERVICEHCPCS T1015 (AM)5000059Outpatient$143$100Payer Rates
EEG
(Not Offered) SLEEP STUDYCPT 95810-----
EKG
ELECTROCARDIOGRAM COMPLETECPT 930008200001Outpatient$121$85Payer Rates
ELECTROCARDIOGRAM TRACINGCPT 930058200002Outpatient$211$148Payer Rates
ECG MONIT/REPRT UP TO 48 HRSCPT 932258000030Outpatient$543$380Payer Rates
Emergency Room
DRAINAGE OF SKIN ABSCESSCPT 100603000031Outpatient$492$344Payer Rates
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 120013000063Outpatient$204$143Payer Rates
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 120023000048Outpatient$386$270Payer Rates
RPR S/N/AX/GEN/TRK7.6-12.5CMCPT 120043000049Outpatient$423$296Payer Rates
RPR F/E/E/N/L/M 2.5 CM/<CPT 120113000050Outpatient$204$143Payer Rates
RPR F/E/E/N/L/M 2.6-5.0 CMCPT 120133000051Outpatient$230$161Payer Rates
TREAT SHOULDER DISLOCATIONCPT 236503000023Outpatient$466$326Payer Rates
APPLY FOREARM SPLINTCPT 291253000054Outpatient$287$201Payer Rates
INSERT TEMP BLADDER CATHCPT 517023000067Outpatient$58$41Payer Rates
IMMUNIZATION ADMINCPT 904713000034Outpatient$15$11Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963613000085Outpatient$153$107Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963653000076Outpatient$546$382Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963723000060Outpatient$56$39Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963743000059Outpatient$100$70Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963753000071Outpatient$45$31Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963763000072Outpatient$150$105Payer Rates
EMERGENCY DEPT VISITCPT 992813000015Outpatient$156$109Payer Rates
EMERGENCY DEPT VISITCPT 992823000016Outpatient$215$151Payer Rates
EMERGENCY DEPT VISITCPT 992833000017Outpatient$274$192Payer Rates
EMERGENCY DEPT VISITCPT 992843000018Outpatient$470$329Payer Rates
EMERGENCY DEPT VISITCPT 992853000019Outpatient$780$546Payer Rates
CRITICAL CARE FIRST HOURCPT 992913000020Outpatient$850$595Payer Rates
Gastro-Intestinal
EGD DIAGNOSTIC BRUSH WASHCPT 432352000040Outpatient$1,450$1,015Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 453852000039Outpatient$1,500$1,050Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 963603000068Outpatient$110$77Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963663000069Outpatient$192$134Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741800007Outpatient$100$70Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751800006Outpatient$45$31Payer Rates
Imaging
US EXAM OF HEAD AND NECKCPT 765364100028Outpatient$818$573Payer Rates
US EXAM ABDOM COMPLETECPT 767004100004Outpatient$1,033$723Payer Rates
ECHO EXAM OF ABDOMENCPT 767054100005Outpatient$797$558Payer Rates
US EXAM ABDO BACK WALL COMPCPT 767704100032Outpatient$869$608Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 768054100009Outpatient$807$565Payer Rates
TRANSVAGINAL US NON-OBCPT 768304100011Outpatient$761$533Payer Rates
US EXAM PELVIC COMPLETECPT 768564100012Outpatient$888$622Payer Rates
US EXAM SCROTUMCPT 768704100013Outpatient$818$573Payer Rates
(Not Offered) MAMMOGRAPHY OF ONE BREASTCPT 77065-----
(Not Offered) MAMMOGRAPHY OF BOTH BREASTSCPT 77066-----
(Not Offered) MAMMOGRAPHY, SCREENING, BILATERALCPT 77067-----
LOWER EXTREMITY STUDYCPT 939254100031Outpatient$1,361$953Payer Rates
VASCULAR STUDYCPT 939754100002Outpatient$995$697Payer Rates
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...DRG 216-----
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460-----
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...DRG 470-----
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473-----
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...DRG 743-----
Laboratory
RESPIRATORY PANEL, PCR (BIOFIRE)CPT 0202U1000766Outpatient$275$193Payer Rates
ROUTINE VENIPUNCTURECPT 364151000115Outpatient$8$6Payer Rates
METABOLIC PANEL TOTAL CACPT 800481000121Outpatient$109$76Payer Rates
COMPREHEN METABOLIC PANELCPT 800531000120Outpatient$200$140Payer Rates
OBSTETRIC PANELCPT 800551000123Outpatient$195$137Payer Rates
LIPID PANELCPT 800611000122Outpatient$146$102Payer Rates
RENAL FUNCTION PANELCPT 800691000145Outpatient$130$91Payer Rates
ACUTE HEPATITIS PANELCPT 800741000133Outpatient$157$110Payer Rates
HEPATIC FUNCTION PANELCPT 800761000134Outpatient$152$106Payer Rates
ASSAY DIPROPYLACETIC ACD TOTCPT 801641000189Outpatient$130$91Payer Rates
DRUG SCREEN QUANT GABAPENTINCPT 801711000003Outpatient$194$136Payer Rates
ASSAY OF PHENYTOIN TOTALCPT 801851000114Outpatient$128$90Payer Rates
ASSAY OF SIROLIMUSCPT 801951000228Outpatient$360$252Payer Rates
ASSAY OF TACROLIMUSCPT 801971000119Outpatient$210$147Payer Rates
ASSAY OF VANCOMYCINCPT 802021000194Outpatient$101$71Payer Rates
DRUG TEST PRSMV DIR OPT OBSCPT 803051000246Outpatient$21$15Payer Rates
DRUG SCREEN QUANTALCOHOLSCPT 803201000306Outpatient$110$77Payer Rates
ANALGESICS NON-OPIOID 1 OR 2CPT 803291000182Outpatient$53$37Payer Rates
ANALGESICS NON-OPIOID 1 OR 2CPT 803291000235Outpatient$53$37Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPECPT 81000-----
URINALYSIS AUTO W/SCOPECPT 810011000001Outpatient$49$34Payer Rates
URINALYSIS NONAUTO W/O SCOPECPT 810025000119Outpatient$25$18Payer Rates
(Not Offered) URINALYSIS TESTCPT 81003-----
URINE PREGNANCY TESTCPT 810251000090Outpatient$61$43Payer Rates
URINE PREGNANCY TESTCPT 810255000011Outpatient$30$21Payer Rates
TEST FOR ACETONE/KETONESCPT 820091000098Outpatient$55$39Payer Rates
TEST FOR ACETONE/KETONESCPT 820091000361Outpatient$109$76Payer Rates
UR ALBUMIN QUANTITATIVECPT 820431000154Outpatient$131$92Payer Rates
UR ALBUMIN QUANTITATIVECPT 820431000155Outpatient$67$47Payer Rates
ALPHA-FETOPROTEIN SERUMCPT 821051000264Outpatient$150$105Payer Rates
ASSAY OF AMMONIACPT 821401000076Outpatient$94$66Payer Rates
ASSAY OF AMYLASECPT 821501000071Outpatient$65$46Payer Rates
OCCULT BLOOD FECESCPT 822701000236Outpatient$36$25Payer Rates
OCCULT BLOOD FECESCPT 822701000303Outpatient$36$25Payer Rates
VITAMIN D 25 HYDROXYCPT 823061000033Outpatient$191$134Payer Rates
TOTAL CORTISOLCPT 825331000323Outpatient$133$93Payer Rates
TOTAL CORTISOLCPT 825331000324Outpatient$133$93Payer Rates
ASSAY OF CK (CPK)CPT 825501000070Outpatient$75$53Payer Rates
CREATINE MB FRACTIONCPT 825531000040Outpatient$70$49Payer Rates
ASSAY OF CREATININECPT 825651000072Outpatient$53$37Payer Rates
VITAMIN B-12CPT 826071000249Outpatient$132$92Payer Rates
VIT D 1 25-DIHYDROXYCPT 826521000285Outpatient$121$85Payer Rates
ASSAY OF TOTAL ESTRADIOLCPT 826701000276Outpatient$190$133Payer Rates
ASSAY OF FERRITINCPT 827281000200Outpatient$130$91Payer Rates
ASSAY OF FOLIC ACID SERUMCPT 827461000158Outpatient$35$25Payer Rates
BLOOD GASES ANY COMBINATIONCPT 828038000023Outpatient$223$156Payer Rates
BLOOD GASES W/O2 SATURATIONCPT 828058000022Outpatient$239$167Payer Rates
GLUCOSE BLOOD TESTCPT 829625000120Outpatient$20$14Payer Rates
ASSAY OF GGTCPT 829771000042Outpatient$99$69Payer Rates
ASSAY OF GONADOTROPIN (FSH)CPT 830011000267Outpatient$152$106Payer Rates
H PYLORI (C-13) BREATHCPT 830131000351Outpatient$313$219Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 830361000165Outpatient$39$27Payer Rates
IMMUNOASSAY NONANTIBODYCPT 835161000191Outpatient$107$75Payer Rates
IRON BINDING TESTCPT 835501000149Outpatient$28$20Payer Rates
ASSAY OF LACTIC ACIDCPT 836051000340Outpatient$136$95Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 836151000057Outpatient$62$43Payer Rates
ASSAY OF LEADCPT 836551000166Outpatient$66$46Payer Rates
ASSAY OF LIPASECPT 836901000171Outpatient$37$26Payer Rates
ASSAY OF BLOOD LIPOPROTEINCPT 837211000245Outpatient$121$85Payer Rates
ASSAY OF MAGNESIUMCPT 837351000253Outpatient$44$31Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 838801000322Outpatient$135$95Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 838801000400Outpatient$228$160Payer Rates
ASSAY OF PARATHORMONECPT 839701000205Outpatient$151$106Payer Rates
ASSAY OF PARATHORMONECPT 839701000316Outpatient$120$84Payer Rates
ASSAY OF PHOSPHORUSCPT 841001000077Outpatient$31$22Payer Rates
ASSAY OF SERUM POTASSIUMCPT 841321000062Outpatient$51$36Payer Rates
ASSAY OF PROGESTERONECPT 841441000234Outpatient$108$76Payer Rates
ASSAY OF PROLACTINCPT 841461000272Outpatient$115$81Payer Rates
ASSAY OF PSA TOTALCPT 841531000175Outpatient$147$103Payer Rates
ASSAY OF PSA FREECPT 841541000295Outpatient$73$51Payer Rates
ASSAY OF PROTEIN URINECPT 841561000037Outpatient$237$166Payer Rates
ASSAY OF FREE TESTOSTERONECPT 844021000011Outpatient$153$107Payer Rates
ASSAY OF TOTAL TESTOSTERONECPT 844031000012Outpatient$168$118Payer Rates
ASSAY OF VITAMIN B-1CPT 844251000075Outpatient$120$84Payer Rates
ASSAY OF TOTAL THYROXINECPT 844361000100Outpatient$84$59Payer Rates
ASSAY OF FREE THYROXINECPT 844391000150Outpatient$113$79Payer Rates
ASSAY THYROID STIM HORMONECPT 844431000117Outpatient$153$107Payer Rates
ASSAY OF THYROID (T3 OR T4)CPT 844791000031Outpatient$53$37Payer Rates
FREE ASSAY (FT-3)CPT 844811000222Outpatient$144$101Payer Rates
ASSAY OF TROPONIN QUANTCPT 844841000041Outpatient$70$49Payer Rates
ASSAY OF TROPONIN QUANTCPT 844841000770Outpatient$185$130Payer Rates
ASSAY OF UREA NITROGENCPT 845201000048Outpatient$46$32Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 845501000049Outpatient$51$36Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 847021000270Outpatient$158$111Payer Rates
CHORIONIC GONADOTROPIN ASSAYCPT 847031000382Outpatient$61$43Payer Rates
HEMATOCRITCPT 850141000064Outpatient$27$19Payer Rates
HEMOGLOBINCPT 850181000038Outpatient$28$20Payer Rates
HEMOGLOBINCPT 850181000065Outpatient$28$20Payer Rates
(Not Offered) COMPLETE BLOOD CELL COUNT (CBC), WITH DIFFER ...CPT 85025-----
COMPLETE CBC AUTOMATEDCPT 850271000067Outpatient$80$56Payer Rates
COMPLETE CBC AUTOMATEDCPT 850271000369Outpatient$80$56Payer Rates
FIBRIN DEGRADATION QUANTCPT 853791000017Outpatient$158$111Payer Rates
PROTHROMBIN TIMECPT 856101000018Outpatient$70$49Payer Rates
RBC SED RATE NONAUTOMATEDCPT 856511000080Outpatient$51$36Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857301000079Outpatient$53$37Payer Rates
ANTINUCLEAR ANTIBODIESCPT 860381000309Outpatient$134$94Payer Rates
C-REACTIVE PROTEINCPT 861401000162Outpatient$20$14Payer Rates
DNA ANTIBODY NATIVECPT 862251000026Outpatient$95$67Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862351000022Outpatient$69$48Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862351000262Outpatient$120$84Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862351000327Outpatient$60$42Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 862351000416Outpatient$111$78Payer Rates
HETEROPHILE ANTIBODY SCREENCPT 863081000081Outpatient$48$34Payer Rates
MICROSOMAL ANTIBODY EACHCPT 863761000221Outpatient$107$75Payer Rates
RHEUMATOID FACTOR TEST QUALCPT 864301000255Outpatient$39$27Payer Rates
RHEUMATOID FACTOR QUANTCPT 864311000025Outpatient$17$12Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 865921000261Outpatient$54$38Payer Rates
HELICOBACTER PYLORI ANTIBODYCPT 866771000066Outpatient$49$34Payer Rates
HEP B SURFACE ANTIBODYCPT 867061000212Outpatient$34$24Payer Rates
SARS-COV-2 COVID-19 ANTIBODYCPT 867691000424Outpatient$50$35Payer Rates
RBC ANTIBODY SCREENCPT 868501000307Outpatient$100$70Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 869001000136Outpatient$42$29Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 869011000085Outpatient$77$54Payer Rates
COMPATIBILITY TEST SPINCPT 869201100010Outpatient$127$89Payer Rates
COMPATIBILITY TEST SPINCPT 869201100012Outpatient$66$46Payer Rates
COMPATIBILITY TEST SPINCPT 869201100013Outpatient$127$89Payer Rates
COMPATIBILITY TEST SPINCPT 869201100014Outpatient$127$89Payer Rates
FECES CULTURE AEROBIC BACTCPT 870451000101Outpatient$139$97Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870701000092Outpatient$111$78Payer Rates
CULTR BACTERIA EXCEPT BLOODCPT 870751000201Outpatient$82$57Payer Rates
URINE CULTURE/COLONY COUNTCPT 870861000108Outpatient$24$17Payer Rates
BLOOD FUNGUS CULTURECPT 871031000103Outpatient$81$57Payer Rates
BLOOD FUNGUS CULTURECPT 871031000304Outpatient$81$57Payer Rates
OVA AND PARASITES SMEARSCPT 871771000226Outpatient$41$29Payer Rates
MICROBE SUSCEPTIBLE MICCPT 871861000091Outpatient$88$62Payer Rates
MICROBE SUSCEPTIBLE MICCPT 871861000358Outpatient$89$62Payer Rates
SMEAR GRAM STAINCPT 872051000109Outpatient$34$24Payer Rates
SMEAR WET MOUNT SALINE/INKCPT 872101000110Outpatient$34$24Payer Rates
SMEAR WET MOUNT SALINE/INKCPT 872101000311Outpatient$42$29Payer Rates
HPYLORI STOOL AG IACPT 873381000225Outpatient$263$184Payer Rates
HIV-1 AG W/HIV-1&2 AB AG IACPT 873891000386Outpatient$104$73Payer Rates
RESP SYNCYTIAL VIRUS AG IACPT 874201000188Outpatient$44$31Payer Rates
SARSCOV CORONAVIRUS AG IACPT 874261000750Outpatient$100$70Payer Rates
SARSCOV CORONAVIRUS AG IACPT 874261000772Outpatient$100$70Payer Rates
STREP A AG IACPT 874301000132Outpatient$78$55Payer Rates
CHYLMD TRACH DNA AMP PROBECPT 874911000298Outpatient$186$130Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 876351000422Outpatient$189$132Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 87635 (90)1000771Outpatient$141$99Payer Rates
CLOSTRIDIUM TOXIN A W/OPTICCPT 878031000089Outpatient$26$18Payer Rates
INFLUENZA ASSAY W/OPTICCPT 878041000130Outpatient$94$66Payer Rates
STREP A ASSAY W/OPTICCPT 878805000012Outpatient$81$57Payer Rates
SPECIMEN HANDLING PT-LABCPT 990011000060Outpatient$20$14Payer Rates
PSA SCREENINGHCPCS G01031000247Outpatient$116$81Payer Rates
MRI
MRI BRAIN STEM W/O DYECPT 705514300003Outpatient$1,500$1,050Payer Rates
MRI BRAIN STEM W/O & W/DYECPT 705534300005Outpatient$2,000$1,400Payer Rates
MRI NECK SPINE W/O DYECPT 721414300019Outpatient$1,500$1,050Payer Rates
MRI LUMBAR SPINE W/O DYECPT 721484300006Outpatient$1,500$1,050Payer Rates
MRI LUMBAR SPINE W/O DYECPT 721484300022Outpatient$1,500$1,050Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 737214300015Outpatient$2,880$2,016Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 737214300027Outpatient$2,880$2,016Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 938804100038Outpatient$1,248$874Payer Rates
EXTREMITY STUDYCPT 939704100018Outpatient$1,381$967Payer Rates
EXTREMITY STUDYCPT 939714100019Outpatient$937$656Payer Rates
Other Procedures and Observation
IMPLANT HORMONE PELLET(S)CPT 119801800049Outpatient$385$270Payer Rates
IMPLANT HORMONE PELLET(S)CPT 119801800051Outpatient$350$245Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651800053Outpatient$546$382Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661800054Outpatient$192$134Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721800047Outpatient$158$111Payer Rates
CHEMO ANTI-NEOPL SQ/IMCPT 964011800058Outpatient$302$211Payer Rates
OFFICE O/P EST MINIMAL PROBCPT 992111800059Outpatient$145$102Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 364301100007Outpatient$100$70Payer Rates
CARDIAC REHAB/MONITORCPT 937981700002Outpatient$110$77Payer Rates
PHLEBOTOMYCPT 991951000137Outpatient$66$46Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992031700003Outpatient$148$104Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P90161100009Outpatient$352$246Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MINCPT 90832-----
(Not Offered) PSYCHOTHERAPY, 45 MINCPT 90834-----
(Not Offered) PSYCHOTHERAPY, 60 MINCPT 90837-----
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...CPT 90846-----
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...CPT 90847-----
(Not Offered) GROUP PSYCHOTHERAPYCPT 90853-----
Pulmonary Function
BREATHING CAPACITY TESTCPT 940108000014Outpatient$247$173Payer Rates
EVALUATION OF WHEEZINGCPT 940608000015Outpatient$453$317Payer Rates
Radiology
X-RAY EXAM OF FACIAL BONESCPT 701504000003Outpatient$212$148Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 710454000011Outpatient$88$62Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 710464000012Outpatient$366$256Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 711004000013Outpatient$184$129Payer Rates
X-RAY EXAM UNILAT RIBS/CHESTCPT 711014000014Outpatient$383$268Payer Rates
X-RAY EXAM RIBS BIL 3 VIEWSCPT 711104000015Outpatient$132$92Payer Rates
X-RAY EXAM RIBS/CHEST4/> VWSCPT 711114000016Outpatient$503$352Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 720404000018Outpatient$142$99Payer Rates
X-RAY EXAM NECK SPINE 6/>VWSCPT 720524000019Outpatient$537$376Payer Rates
X-RAY EXAM THORAC SPINE 2VWSCPT 720704000021Outpatient$121$85Payer Rates
X-RAY EXAM THORAC SPINE 3VWSCPT 720724000107Outpatient$494$346Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 721004000023Outpatient$165$115Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 721104000024Outpatient$673$471Payer Rates
X-RAY EXAM OF PELVISCPT 721704000025Outpatient$135$95Payer Rates
X-RAY EXAM SACRUM TAILBONECPT 722204000028Outpatient$210$147Payer Rates
X-RAY EXAM OF SHOULDERCPT 73020 (LT)4000031Outpatient$93$65Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)4000032Outpatient$124$87Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)4000061Outpatient$125$88Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (LT)4000034Outpatient$120$84Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (RT)4000065Outpatient$120$84Payer Rates
X-RAY EXAM OF ELBOWCPT 730804000094Outpatient$413$289Payer Rates
X-RAY EXAM OF ELBOWCPT 730804000095Outpatient$413$289Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (LT)4000035Outpatient$120$84Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (RT)4000067Outpatient$120$84Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)4000036Outpatient$125$88Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (RT)4000069Outpatient$125$88Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)4000038Outpatient$313$219Payer Rates
X-RAY EXAM OF HANDCPT 73130 (RT)4000072Outpatient$192$134Payer Rates
X-RAY EXAM OF HANDCPT 731304000073Outpatient$363$254Payer Rates
X-RAY EXAM OF FINGER(S)CPT 731404000039Outpatient$88$62Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)4000074Outpatient$130$91Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)4000088Outpatient$130$91Payer Rates
X-RAY EXAM HIPS BI 2 VIEWSCPT 735214000089Outpatient$101$71Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (RT)4000075Outpatient$145$102Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 735604000092Outpatient$360$252Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 735604000093Outpatient$360$252Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (LT)4000041Outpatient$389$272Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)4000077Outpatient$389$272Payer Rates
X-RAY EXAM OF KNEE 3CPT 735624000078Outpatient$389$272Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)4000045Outpatient$105$74Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (RT)4000080Outpatient$105$74Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)4000046Outpatient$110$77Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)4000082Outpatient$110$77Payer Rates
X-RAY EXAM OF FOOTCPT 736204000101Outpatient$364$255Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)4000047Outpatient$153$107Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (RT)4000084Outpatient$153$107Payer Rates
X-RAY EXAM OF FOOTCPT 736304000085Outpatient$306$214Payer Rates
X-RAY EXAM OF TOE(S)CPT 736604000049Outpatient$115$81Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 740184000050Outpatient$185$130Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 740194000051Outpatient$210$147Payer Rates
X-RAY EXAM COMPLETE ABDOMENCPT 740224000053Outpatient$315$221Payer Rates
DXA BONE DENSITY AXIALCPT 770804000087Outpatient$564$395Payer Rates
Respiratory
WITHDRAWAL OF ARTERIAL BLOODCPT 366008000005Outpatient$32$22Payer Rates
VENT MGMT INPAT INIT DAYCPT 940028000006Outpatient$1,129$790Payer Rates
VENT MGMT INPAT SUBQ DAYCPT 940038000009Outpatient$927$649Payer Rates
AIRWAY INHALATION TREATMENTCPT 946408000003Outpatient$247$173Payer Rates
AIRWAY INHALATION TREATMENTCPT 946408000025Outpatient$247$173Payer Rates
AIRWAY INHALATION TREATMENTCPT 946408000027Outpatient$247$173Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947618000020Outpatient$151$106Payer Rates
Surgical Procedures
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826-----
(Not Offered) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOS ...CPT 29881-----
(Not Offered) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIE ...CPT 42820-----
EGD BIOPSY SINGLE/MULTIPLECPT 432392000042Outpatient$2,155$1,509Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 453782000037Outpatient$1,500$1,050Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 453782000082Outpatient$2,466$1,726Payer Rates
COLONOSCOPY AND BIOPSYCPT 453802000038Outpatient$1,500$1,050Payer Rates
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...CPT 45391-----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 475622000049Outpatient$8,053$5,637Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 495052000028Outpatient$3,200$2,240Payer Rates
BIOPSY OF PROSTATECPT 557002000089Outpatient$2,587$1,811Payer Rates
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...CPT 55866-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400-----
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...CPT 59610-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323-----
(Not Offered) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE ...CPT 64483-----
(Not Offered) REMOVAL OF RECURRING CATARACT IN LENS CAPSUL ...CPT 66821-----
(Not Offered) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984-----
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...CPT 93452-----
Therapy
THERAPEUTIC EXERCISESCPT 97110 (GP)1500002Outpatient$28$20Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)1500008Outpatient$58$41Payer Rates
GAIT TRAINING THERAPYCPT 97116 (GP)1500006Outpatient$56$39Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GP)1500003Outpatient$39$27Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)1500010Outpatient$126$88Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)1500001Outpatient$58$41Payer Rates
RMVL DEVITAL TIS 20 CM/<CPT 97597 (GP)1500007Outpatient$92$64Payer Rates
Uncategorized
REMOVAL OF BREAST LESIONCPT 191202000246Outpatient$6,600$4,620Payer Rates
REMOVAL OF BREAST LESIONCPT 191203100177Outpatient$402$281Payer Rates
EGD DIAGNOSTIC BRUSH WASHCPT 432353100014Outpatient$700$490Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 432393100003Outpatient$141$99Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 453783100091Outpatient$997$698Payer Rates
COLONOSCOPY AND BIOPSYCPT 453803100002Outpatient$1,102$771Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 453853100004Outpatient$1,380$966Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMYCPT 475623100007Outpatient$651$456Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 495053100008Outpatient$1,703$1,192Payer Rates
IMMUNIZATION ADMINCPT 904711800002Outpatient$15$11Payer Rates
ADMIN INFLUENZA VIRUS VACHCPCS G00081800063Outpatient$15$11Payer Rates
ADMIN INFLUENZA VIRUS VACHCPCS G00085000122Outpatient$20$14Payer Rates
CASIRIVI AND IMDEVI INFUSIONHCPCS M02431800061Outpatient$774$542Payer Rates
BAMLAN AND ETESEV INFUSIONHCPCS M02451800065Outpatient$451$316Payer Rates
BAMLAN AND ETESEV INFUSIONHCPCS M02453000110Outpatient$451$316Payer Rates
TELEHEALTH FACILITY FEEHCPCS Q30141800041Outpatient$58$41Payer Rates