Mt. Ascutney Hospital and Health Center

Price List for Shoppable Services. Effective 11-04-2021.

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 70450Outpatient70035070450$1,710
CT HEAD/BRAIN W/O DYECPT 70450Outpatient-$1,950
CT HEAD/BRAIN W/O DYECPT 70450Outpatient70035070450$1,710
CT THORAX DX C-CPT 71250Outpatient70035071250$2,173
CT THORAX DX C-CPT 71250Outpatient70035071250$2,173
CT ANGIOGRAPHY CHESTCPT 71275Outpatient70032071275$3,661
CT NECK SPINE W/O DYECPT 72125Outpatient70035072125$2,011
CT PELVIS W/DYECPT 72193Outpatient70035072193$2,986
CT PELVIS W/DYECPT 72193Outpatient-$2,986
CT PELVIS W/DYECPT 72193Outpatient70035072193$2,334
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient70035074176$3,500
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient70035074176$3,500
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient70035074176$3,500
CT ABD & PELV W/CONTRASTCPT 74177Outpatient-$3,160
CT ABD & PELV W/CONTRASTCPT 74177Outpatient70035074177$3,661
CT ABD & PELV W/CONTRASTCPT 74177Outpatient70035074177$3,661
Cancer Services
CHEMO IV INFUSION 1 HRCPT 96413Outpatient90033596413$173
CHEMO IV INFUSION ADDL HRCPT 96415Outpatient90033596415$112
IRRIG DRUG DELIVERY DEVICECPT 96523Outpatient90033596523$22
Cardiology
TTE W/DOPPLER COMPLETECPT 93306Outpatient70048093306$1,547
Clinic
DRAINAGE OF SKIN ABSCESSCPT 10060Outpatient50036010060$285
DRAINAGE OF SKIN ABSCESSCPT 10061Outpatient50036010061$486
DEB SUBQ TISSUE 20 SQ CM/<CPT 11042Outpatient50036011042$612
TRIM SKIN LESIONCPT 11055Outpatient20051011055$95
TRIM SKIN LESIONS 2 TO 4CPT 11056Outpatient20096011056$175
EXC TR-EXT B9+MARG 0.6-1 CMCPT 11401Outpatient50036011401$327
EXC TR-EXT B9+MARG 1.1-2 CMCPT 11402Outpatient50036011402$392
EXC TR-EXT B9+MARG 2.1-3CMCPT 11403Outpatient50036011403$502
EXC TR-EXT B9+MARG >4.0 CMCPT 11406Outpatient50036011406$1,094
EXC H-F-NK-SP B9+MARG 2.1-3CPT 11423Outpatient50036011423$610
EXC FACE-MM B9+MARG 1.1-2 CMCPT 11442Outpatient50036011442$437
EXC TR-EXT MAL+MARG 3.1-4 CMCPT 11604Outpatient50036011604$648
EXC TR-EXT MAL+MARG >4 CMCPT 11606Outpatient50036011606$953
EXC S/N/H/F/G MAL+MRG 3.1-4CPT 11624Outpatient50036011624$727
EXC F/E/E/N/L MAL+MRG 1.1-2CPT 11642Outpatient50036011642$566
TRIM NAIL(S) ANY NUMBERCPT 11719Outpatient20096011719$53
DEBRIDE NAIL 1-5CPT 11720Outpatient20096011720$198
DEBRIDE NAIL 6 OR MORECPT 11721Outpatient20096011721$143
REMOVAL OF NAIL BEDCPT 11750Outpatient20051011750$509
REMOVE PILONIDAL CYST EXTENCPT 11771Outpatient50036011771$1,283
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001Outpatient30098112001$327
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient30098112002$353
INTMD RPR S/A/T/EXT 2.6-7.5CPT 12032Outpatient50036012032$538
DESTRUCT B9 LESION 1-14CPT 17110Outpatient20096017110$199
PARTIAL MASTECTOMYCPT 19301Outpatient50036019301$2,861
MAST SIMPLE COMPLETECPT 19303Outpatient50036019303$4,422
INJECT TRIGGER POINTS 3/>CPT 20553Outpatient20096020553$683
DRAIN/INJ JOINT/BURSA W/O USCPT 20610Outpatient20096020610$285
EXC SHOULDER TUM DEEP 5 CM/>CPT 23073Outpatient50036023073$682
INCISION OF FOOT FASCIACPT 28008Outpatient50036028008$1,759
PARTIAL REMOVAL FOOT FASCIACPT 28060Outpatient50036028060$3,174
PARTIAL REMOVAL OF FOOT BONECPT 28122Outpatient50036028122$3,122
REPAIR OF HAMMERTOECPT 28285Outpatient50036028285$1,502
CORRJ HALUX RIGDUS W/O IMPLTCPT 28289Outpatient50036028289$2,525
CORRECTION HALLUX VALGUSCPT 28296Outpatient50036028296$2,464
FUSION OF BIG TOE JOINTCPT 28750Outpatient50036028750$4,309
AMPUTATION OF TOECPT 28820Outpatient50036028820$1,586
PARTIAL AMPUTATION OF TOECPT 28825Outpatient50036028825$1,851
APPLICATION OF PASTE BOOTCPT 29580Outpatient20096029580$290
INSERT TUNNELED CV CATHCPT 36561Outpatient50036036561$1,659
REMOVAL TUNNELED CV CATHCPT 36590Outpatient50036036590$950
BIOPSY/REMOVAL LYMPH NODESCPT 38500Outpatient50036038500$1,141
LAPAROSCOPY FUNDOPLASTYCPT 43280Outpatient50036043280$4,238
LAPAROSCOPY APPENDECTOMYCPT 44970Outpatient50036044970$2,669
COLONOSCOPY W/LESION REMOVALCPT 45384Outpatient20051045384$1,155
REMOVE INT/EXT HEM 1 GROUPCPT 46255Outpatient50036046255$1,564
LAPARO CHOLECYSTECTOMY/GRAPHCPT 47563Outpatient50036047563$2,808
RPR UMBIL HERN REDUC > 5 YRCPT 49585Outpatient50036049585$1,970
RPR UMBIL HERN BLOCK > 5 YRCPT 49587Outpatient50036049587$1,497
LAP ING HERNIA REPAIR INITCPT 49650Outpatient50036049650$1,898
LAP ING HERNIA REPAIR RECURCPT 49651Outpatient50036049651$2,186
XCAPSL CTRC RMVL CPLX WO ECPCPT 66982Outpatient50036066982$4,142
REMOVE IMPACTED EAR WAX UNICPT 69209Outpatient20051069209$181
ECHO EXAM OF EYE THICKNESSCPT 76514Outpatient20096076514$28
ECHO EXAM OF EYECPT 76519Outpatient20051076519$323
PSYCH DIAGNOSTIC EVALUATIONCPT 90791Outpatient20096090791$337
EYE EXAM NEW PATIENTCPT 92004Outpatient20096092004$261
EYE EXAM ESTABLISH PATIENTCPT 92012Outpatient20096092012$146
EYE EXAM&TX ESTAB PT 1/>VSTCPT 92014Outpatient20096092014$234
DETERMINE REFRACTIVE STATECPT 92015Outpatient20096092015$62
SPECIAL EYE EVALUATIONCPT 92020Outpatient20096092020$78
VISUAL FIELD EXAMINATION(S)CPT 92083Outpatient20096092083$170
CMPTR OPHTH IMG OPTIC NERVECPT 92133Outpatient20096092133$86
PURE TONE HEARING TEST AIRCPT 92551Outpatient20096092551$66
DEVELOPMENTAL SCREEN W/SCORECPT 96110Outpatient20096096110$27
RMVL DEVITAL TIS 20 CM/<CPT 97597Outpatient20051097597$437
RMVL DEVITAL TIS 20 CM/<CPT 97597Outpatient20051097597$437
MEDICAL SERVICES AFTER HRSCPT 99050Outpatient20096099050$64
VISUAL ACUITY SCREENCPT 99173Outpatient20096099173$42
OFFICE O/P NEW SF 15-29 MINCPT 99202Outpatient20096099202$156
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient20096099203$215
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient20096099204$330
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient20096099205$407
OFFICE O/P EST MINIMAL PROBCPT 99211Outpatient20051099211$64
OFFICE O/P EST SF 10-19 MINCPT 99212Outpatient20096099212$95
OFFICE O/P EST LOW 20-29 MINCPT 99213Outpatient20096099213$127
OFFICE O/P EST MOD 30-39 MINCPT 99214Outpatient20096099214$200
OFFICE O/P EST HI 40-54 MINCPT 99215Outpatient20096099215$305
OBSERVATION CARE DISCHARGECPT 99217Outpatient25051099217$216
INITIAL OBSERVATION CARECPT 99219Outpatient20096099219$392
INITIAL HOSPITAL CARECPT 99221Outpatient20096099221$282
INITIAL HOSPITAL CARECPT 99222Outpatient20096099222$388
INITIAL HOSPITAL CARECPT 99223Outpatient20096099223$468
SUBSEQUENT HOSPITAL CARECPT 99231Outpatient20096099231$142
SUBSEQUENT HOSPITAL CARECPT 99232Outpatient20096099232$212
SUBSEQUENT HOSPITAL CARECPT 99233Outpatient20051099233$318
HOSPITAL DISCHARGE DAYCPT 99238Outpatient20096099238$216
HOSPITAL DISCHARGE DAYCPT 99239Outpatient20096099239$298
OFFICE CONSULTATIONCPT 99242Outpatient20096099242$285
OFFICE CONSULTATIONCPT 99243Outpatient20096099243$358
OFFICE CONSULTATIONCPT 99244Outpatient20096099244$440
NURSING FACILITY CARE INITCPT 99304Outpatient20096099304$122
NURSING FACILITY CARE INITCPT 99305Outpatient20096099305$162
NURSING FACILITY CARE INITCPT 99306Outpatient20096099306$201
NURSING FAC CARE SUBSEQCPT 99307Outpatient20096099307$64
NURSING FAC CARE SUBSEQCPT 99308Outpatient20096099308$107
NURSING FAC CARE SUBSEQCPT 99309Outpatient20096099309$150
NURSING FAC CARE SUBSEQCPT 99310Outpatient20096099310$187
NURSING FAC DISCHARGE DAYCPT 99316Outpatient20096099316$258
INIT PM E/M NEW PAT INFANTCPT 99381Outpatient20096099381$224
PREV VISIT NEW AGE 18-39CPT 99385Outpatient20096099385$277
PREV VISIT NEW AGE 40-64CPT 99386Outpatient20096099386$315
PER PM REEVAL EST PAT INFANTCPT 99391Outpatient20096099391$170
PREV VISIT EST AGE 1-4CPT 99392Outpatient20096099392$191
PREV VISIT EST AGE 5-11CPT 99393Outpatient20096099393$188
PREV VISIT EST AGE 12-17CPT 99394Outpatient20096099394$207
PREV VISIT EST AGE 18-39CPT 99395Outpatient20096099395$234
PREV VISIT EST AGE 40-64CPT 99396Outpatient20096099396$293
PER PM REEVAL EST PAT 65+ YRCPT 99397Outpatient20096099397$291
WORK RELATED DISABILITY EXAMCPT 99455Outpatient20096099455$383
COLORECTAL SCRN; HI RISK INDHCPCS G0105Outpatient500361G0105$983
DIAB MANAGE TRN PER INDIVHCPCS G0108Outpatient200983G0108$86
COLON CA SCRN NOT HI RSK INDHCPCS G0121Outpatient500361G0121$983
PPPS, SUBSEQ VISITHCPCS G0439Outpatient200510G0439$582
COMP MULTIDISIPLN EVALUATIONHCPCS H2000Outpatient200510H2000$146
EEG
(N/O) SLEEP STUDYCPT 95810----
EKG
ELECTROCARDIOGRAM COMPLETECPT 93000Outpatient-$289
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient45073093005$290
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient45073093005$290
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient45073093005$290
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient45073093005$290
ECG RECORD/REVIEWCPT 93268Outpatient30073293268$379
ECG RECORD/REVIEWCPT 93268Outpatient30073293268$379
Emergency Room
HYDRATION IV INFUSION INITCPT 96360Outpatient30045096360$145
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient30045096361$126
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient30045096361$126
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient30045096365$118
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient30045096365$124
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient30045096365$118
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient30045096366$124
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient30045096366$124
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient30045096367$56
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient30045096367$56
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient20051096372$38
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient30045096374$111
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient30045096374$111
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient30045096375$56
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient30045096375$56
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient30045096376$54
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient30045096376$54
EMERGENCY DEPT VISITCPT 99281Outpatient30098199281$258
EMERGENCY DEPT VISITCPT 99282Outpatient30098199282$287
EMERGENCY DEPT VISITCPT 99283Outpatient30045099283$426
EMERGENCY DEPT VISITCPT 99284Outpatient30045099284$680
EMERGENCY DEPT VISITCPT 99285Outpatient30045099285$1,091
Imaging
US EXAM OF HEAD AND NECKCPT 76536Outpatient70040276536$862
ULTRASOUND BREAST LIMITEDCPT 76642Outpatient70040276642$358
ULTRASOUND BREAST LIMITEDCPT 76642Outpatient70040276642$358
US EXAM ABDOM COMPLETECPT 76700Outpatient-$957
US EXAM ABDOM COMPLETECPT 76700Outpatient70040276700$957
ECHO EXAM OF ABDOMENCPT 76705Outpatient70040276705$740
ECHO EXAM OF ABDOMENCPT 76705Outpatient70040276705$740
OB US >= 14 WKS SNGL FETUSCPT 76805Outpatient-$1,060
TRANSVAGINAL US NON-OBCPT 76830Outpatient70040276830$866
TRANSVAGINAL US NON-OBCPT 76830Outpatient-$866
TRANSVAGINAL US NON-OBCPT 76830Outpatient70040276830$866
BREAST TOMOSYNTHESIS UNICPT 77061Outpatient70040177061$126
BREAST TOMOSYNTHESIS BICPT 77063Outpatient70040377063$126
DX MAMMO INCL CAD UNICPT 77065Outpatient-$537
DX MAMMO INCL CAD UNICPT 77065Outpatient70040177065$537
DX MAMMO INCL CAD UNICPT 77065Outpatient-$537
DX MAMMO INCL CAD UNICPT 77065Outpatient70040177065$537
DX MAMMO INCL CAD UNICPT 77065Outpatient-$537
DX MAMMO INCL CAD UNICPT 77065Outpatient70040177065$537
DX MAMMO INCL CAD UNICPT 77065Outpatient-$537
DX MAMMO INCL CAD UNICPT 77065Outpatient70040177065$537
DX MAMMO INCL CAD BICPT 77066Outpatient-$537
DX MAMMO INCL CAD BICPT 77066Outpatient70040177066$537
DX MAMMO INCL CAD BICPT 77066Outpatient-$537
DX MAMMO INCL CAD BICPT 77066Outpatient70040177066$537
SCR MAMMO BI INCL CADCPT 77067Outpatient-$537
SCR MAMMO BI INCL CADCPT 77067Outpatient70040377067$537
SCR MAMMO BI INCL CADCPT 77067Outpatient-$537
SCR MAMMO BI INCL CADCPT 77067Outpatient70040377067$537
SCR MAMMO BI INCL CADCPT 77067Outpatient-$537
SCR MAMMO BI INCL CADCPT 77067Outpatient70040377067$537
SCR MAMMO BI INCL CADCPT 77067Outpatient-$537
SCR MAMMO BI INCL CADCPT 77067Outpatient70040377067$537
SCR MAMMO BI INCL CADCPT 77067Outpatient-$537
SCR MAMMO BI INCL CADCPT 77067Outpatient70040377067$537
SCR MAMMO BI INCL CADCPT 77067Outpatient-$537
SCR MAMMO BI INCL CADCPT 77067Outpatient70040377067$537
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----
Laboratory
CONTROLLED SUBSTANCE MONITORING PANEL, URINE MAYOCPT 18100 (5280307380347480364)Outpatient40030080307$346
ROUTINE VENIPUNCTURECPT 36415Outpatient40030036415$30
ROUTINE VENIPUNCTURECPT 36415Outpatient40030036415$30
ROUTINE VENIPUNCTURECPT 36415Outpatient40030036415$30
METABOLIC PANEL TOTAL CACPT 80048Outpatient40030080048$126
METABOLIC PANEL TOTAL CACPT 80048Outpatient40030080048$126
COMPREHEN METABOLIC PANELCPT 80053Outpatient40030080053$147
COMPREHEN METABOLIC PANELCPT 80053Outpatient40030080053$147
(N/O) OBSTETRIC BLOOD TEST PANELCPT 80055----
LIPID PANELCPT 80061Outpatient40030080061$139
RENAL FUNCTION PANELCPT 80069Outpatient-$106
HEPATIC FUNCTION PANELCPT 80076Outpatient40030070076$118
DRUG TEST PRSMV DIR OPT OBSCPT 80305Outpatient20030080305$34
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient40030080307$331
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient40030080307$331
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient40030080307$331
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient40030080307$331
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
URINALYSIS AUTO W/SCOPECPT 81001Outpatient40030081001$46
URINALYSIS AUTO W/SCOPECPT 81001Outpatient40030081001$46
URINALYSIS AUTO W/SCOPECPT 81001Outpatient40030081001$46
URINALYSIS NONAUTO W/O SCOPECPT 81002Outpatient-$18
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient40030081003$37
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient40030081003$37
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient40030081003$37
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient40030081003$37
MICROSCOPIC EXAM OF URINECPT 81015Outpatient40030081015$43
MICROSCOPIC EXAM OF URINECPT 81015Outpatient40030081015$43
URINE PREGNANCY TESTCPT 81025Outpatient40030081025$92
HLA II TYPING 1 LOCUS LRCPT 81376Outpatient40030081376$415
HLA II TYPING 1 LOCUS LRCPT 81376Outpatient40030081376$415
ACETONE ASSAYCPT 82010Outpatient40030082010$121
ACETONE ASSAYCPT 82010Outpatient40030082010$96
UR ALBUMIN QUANTITATIVECPT 82043Outpatient40030082043$70
UR ALBUMIN QUANTITATIVECPT 82043Outpatient40030082043$70
UR ALBUMIN QUANTITATIVECPT 82043Outpatient40030082043$70
ALPHA-FETOPROTEIN SERUMCPT 82105Outpatient40030082105$211
ALPHA-FETOPROTEIN SERUMCPT 82105Outpatient40030082105$211
ASSAY TEST FOR BLOOD FECALCPT 82274Outpatient40030082274$157
ASSAY TEST FOR BLOOD FECALCPT 82274Outpatient40030082274$157
VITAMIN D 25 HYDROXYCPT 82306Outpatient40030082306$243
VITAMIN D 25 HYDROXYCPT 82306Outpatient40030082306$243
ASSAY OF CK (CPK)CPT 82550Outpatient40030082550$94
ASSAY OF CK (CPK)CPT 82550Outpatient40030082550$98
ASSAY OF CK (CPK)CPT 82550Outpatient40030082550$98
ASSAY OF CREATININECPT 82565Outpatient40030082565$67
ASSAY OF CREATININECPT 82565Outpatient40030082565$67
VITAMIN B-12CPT 82607Outpatient40030082607$155
VITAMIN B-12CPT 82607Outpatient40030082607$155
ASSAY OF FERRITINCPT 82728Outpatient40030082728$189
ASSAY OF FERRITINCPT 82728Outpatient40030082728$189
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient40030082746$202
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient40030082746$202
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient40030082784$111
BLOOD GASES ANY COMBINATIONCPT 82803Outpatient40030082803$266
BLOOD GASES ANY COMBINATIONCPT 82803Outpatient40030082803$266
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$53
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$46
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient40030082947$46
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient40030083001$278
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient40030083001$278
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient40030083001$278
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient40030083036$140
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient40030083036$145
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient40030083036$140
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient40030083516$170
ASSAY OF IRONCPT 83540Outpatient40030083540$98
ASSAY OF IRONCPT 83540Outpatient40030083540$98
ASSAY OF IRONCPT 83540Outpatient40030083540$98
ASSAY OF IRONCPT 83540Outpatient40030083540$98
ASSAY OF IRONCPT 83540Outpatient40030083540$98
IRON BINDING TESTCPT 83550Outpatient40030083550$127
IRON BINDING TESTCPT 83550Outpatient40030083550$127
IRON BINDING TESTCPT 83550Outpatient40030083550$127
ASSAY OF LACTIC ACIDCPT 83605Outpatient40030083605$159
ASSAY OF LACTIC ACIDCPT 83605Outpatient40030083605$154
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient40030083615$87
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient40030083615$89
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient40030083615$89
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient40030083615$89
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient40030083615$70
ASSAY OF LEADCPT 83655Outpatient40030083655$180
ASSAY OF LEADCPT 83655Outpatient40030083655$180
ASSAY OF LEADCPT 83655Outpatient40030083655$180
ASSAY OF LIPASECPT 83690Outpatient40030083690$69
ASSAY OF LIPASECPT 83690Outpatient40030083690$67
ASSAY OF BLOOD LIPOPROTEINCPT 83721Outpatient40030083721$118
ASSAY OF BLOOD LIPOPROTEINCPT 83721Outpatient40030083721$118
ASSAY OF MAGNESIUMCPT 83735Outpatient40030083735$98
ASSAY OF MAGNESIUMCPT 83735Outpatient40030083735$101
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient40030083880$505
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient40030083880$489
ORGANIC ACID SINGLE QUANTCPT 83921Outpatient40030083921$269
ASSAY OF PARATHORMONECPT 83970Outpatient40030083970$502
ASSAY OF PARATHORMONECPT 83970Outpatient40030083970$502
ASSAY OF PHOSPHORUSCPT 84100Outpatient40030084100$70
ASSAY OF PHOSPHORUSCPT 84100Outpatient40030084100$68
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient40030084132$68
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient40030084132$66
ASSAY OF PSA TOTALCPT 84153Outpatient40030084153$226
ASSAY OF PSA TOTALCPT 84153Outpatient40030084153$226
ASSAY OF PSA TOTALCPT 84153Outpatient40030084153$226
ASSAY OF PSA TOTALCPT 84153Outpatient40030084153$226
ASSAY OF PSA FREECPT 84154Outpatient40030084154$273
ASSAY OF PSA FREECPT 84154Outpatient40030084154$273
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient40030084165$137
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient40030084165$137
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient40030084165$137
ASSAY OF TOTAL THYROXINECPT 84436Outpatient40030084436$80
ASSAY OF FREE THYROXINECPT 84439Outpatient40030084439$130
ASSAY OF FREE THYROXINECPT 84439Outpatient40030084439$136
ASSAY THYROID STIM HORMONECPT 84443Outpatient40030084443$205
ASSAY THYROID STIM HORMONECPT 84443Outpatient40030084443$205
ASSAY THYROID STIM HORMONECPT 84443Outpatient40030084443$205
ASSAY THYROID STIM HORMONECPT 84443Outpatient40030084443$205
FREE ASSAY (FT-3)CPT 84481Outpatient40030084481$206
FREE ASSAY (FT-3)CPT 84481Outpatient40030084481$206
ASSAY OF UREA NITROGENCPT 84520Outpatient40030084520$51
ASSAY OF UREA NITROGENCPT 84520Outpatient40030084520$52
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient40030084550$67
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient40030084550$66
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient40030084702$176
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient40030084702$176
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient40030084702$206
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient40030084703$100
HEMATOCRITCPT 85014Outpatient40030085014$36
HEMATOCRITCPT 85014Outpatient40030085014$36
HEMATOCRITCPT 85014Outpatient40030085014$35
HEMATOCRITCPT 85014Outpatient40030085014$35
HEMOGLOBINCPT 85018Outpatient40030085018$35
HEMOGLOBINCPT 85018Outpatient40030085018$36
HEMOGLOBINCPT 85018Outpatient40030085018$36
HEMOGLOBINCPT 85018Outpatient40030085018$35
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient40030085025$102
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient40030085025$102
COMPLETE CBC AUTOMATEDCPT 85027Outpatient40030085027$84
RETICYTE/HGB CONCENTRATECPT 85046Outpatient40030085046$66
FIBRIN DEGRADATION QUANTCPT 85379Outpatient40030085379$140
FIBRIN DEGRADATION QUANTCPT 85379Outpatient40030085379$151
PROTHROMBIN TIMECPT 85610Outpatient40030085610$59
PROTHROMBIN TIMECPT 85610Outpatient40030085610$53
PROTHROMBIN TIMECPT 85610Outpatient40030085610$62
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient40030085651$51
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient40030085651$52
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient40030085730$86
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient40030085730$88
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient40030085730$70
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient40030086038$167
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient40030086038$180
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient40030086038$167
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient40030086038$161
C-REACTIVE PROTEINCPT 86140Outpatient40030086140$51
C-REACTIVE PROTEINCPT 86140Outpatient40030086140$51
C-REACTIVE PROTEIN HSCPT 86141Outpatient40030086141$154
C-REACTIVE PROTEIN HSCPT 86141Outpatient40030086141$154
CCP ANTIBODYCPT 86200Outpatient40030086200$178
CCP ANTIBODYCPT 86200Outpatient40030086200$178
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient40030086308$151
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient40030086308$78
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient40030086308$78
IMMUNOFIX E-PHORESIS SERUMCPT 86334Outpatient40030086334$322
IMMUNOFIX E-PHORESIS SERUMCPT 86334Outpatient40030086334$331
PARTICLE AGGLUT ANTBDY SCRNCPT 86403Outpatient40030089055$118
RHEUMATOID FACTOR QUANTCPT 86431Outpatient40030086431$85
RHEUMATOID FACTOR QUANTCPT 86431Outpatient40030086431$85
TB TEST CELL IMMUN MEASURECPT 86480Outpatient40030086480$673
TB TEST CELL IMMUN MEASURECPT 86480Outpatient40030086480$673
LYME DISEASE ANTIBODYCPT 86617Outpatient40030086617$222
LYME DISEASE ANTIBODYCPT 86617Outpatient40030086617$214
LYME DISEASE ANTIBODYCPT 86618Outpatient40030086618$185
LYME DISEASE ANTIBODYCPT 86618Outpatient40030086618$167
LYME DISEASE ANTIBODYCPT 86618Outpatient40030086618$185
LYME DISEASE ANTIBODYCPT 86618Outpatient40030086618$185
LYME DISEASE ANTIBODYCPT 86618Outpatient40030086618$232
LYME DISEASE ANTIBODYCPT 86618Outpatient40030086618$232
EPSTEIN-BARR NUCLEAR ANTIGENCPT 86664Outpatient40030086664$206
EPSTEIN-BARR NUCLEAR ANTIGENCPT 86664Outpatient40030086664$206
HIV-1/HIV-2 1 RESULT ANTBDYCPT 86703Outpatient40030086703$158
HEP B CORE ANTIBODY TOTALCPT 86704Outpatient40030086704$180
HEP B CORE ANTIBODY TOTALCPT 86704Outpatient40030086704$180
HEP B CORE ANTIBODY TOTALCPT 86704Outpatient40030086704$180
HEP B SURFACE ANTIBODYCPT 86706Outpatient40030086706$154
HEP B SURFACE ANTIBODYCPT 86706Outpatient40030086706$154
HEPATITIS A ANTIBODYCPT 86708Outpatient40030086708$183
HEPATITIS A ANTIBODYCPT 86708Outpatient40030086708$183
MUMPS ANTIBODYCPT 86735Outpatient40060086735$189
RUBELLA ANTIBODYCPT 86762Outpatient40030086762$191
RUBELLA ANTIBODYCPT 86762Outpatient40030086762$191
RUBELLA ANTIBODYCPT 86762Outpatient40030086762$215
RUBEOLA ANTIBODYCPT 86765Outpatient40030086765$184
RUBEOLA ANTIBODYCPT 86765Outpatient40030086765$191
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient40030086787$191
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient40030086787$191
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient40030086787$184
HEPATITIS C AB TESTCPT 86803Outpatient400300868$158
RBC ANTIBODY SCREENCPT 86850Outpatient40030086850$157
RBC ANTIBODY SCREENCPT 86850Outpatient40030086850$130
RBC ANTIBODY SCREENCPT 86850Outpatient40030086850$130
RBC ANTIBODY SCREENCPT 86850Outpatient40030086850$103
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient40030087040$114
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient40030087040$114
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient40030087040$114
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient40030087040$114
FECES CULTURE AEROBIC BACTCPT 87045Outpatient40030087045$111
STOOL CULTR AEROBIC BACT EACPT 87046Outpatient40030087046$118
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient40030087101$129
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient40030087045$134
CULTR BACTERIA EXCEPT BLOODCPT 87075Outpatient40030087075$137
CULTR BACTERIA EXCEPT BLOODCPT 87075Outpatient40030087075$141
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient40030087077$121
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient40030087077$118
URINE CULTURE/COLONY COUNTCPT 87086Outpatient40030087086$68
SKIN FUNGI CULTURECPT 87101Outpatient40030087101$102
SKIN FUNGI CULTURECPT 87101Outpatient40030087101$104
CULTURE TYPE IMMUNOLOGICCPT 87147Outpatient40030087147$78
DNA/RNA AMPLIFIED PROBECPT 87150Outpatient40030087150$304
MICROBE SUSCEPTIBLE MICCPT 87186Outpatient40030087186$155
SMEAR GRAM STAINCPT 87205Outpatient40030087205$65
SMEAR GRAM STAINCPT 87205Outpatient40030087205$62
CRYPTOSPORIDIUM AG IACPT 87328Outpatient40030087328$165
CRYPTOSPORIDIUM AG IACPT 87328Outpatient40030087328$134
CRYPTOSPORIDIUM AG IACPT 87328Outpatient40030087328$170
GIARDIA AG IACPT 87329Outpatient40030087329$169
GIARDIA AG IACPT 87329Outpatient40030087329$134
HEPATITIS B SURFACE AG IACPT 87340Outpatient40030087340$154
HEPATITIS B SURFACE AG IACPT 87340Outpatient40030087340$150
HEPATITIS B SURFACE AG IACPT 87340Outpatient40030087340$154
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient40030087491$304
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient40030087491$304
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient40030087491$304
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient40030087491$304
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient40030087491$304
INFLUENZA DNA AMP PROBECPT 87502Outpatient40030087502$657
INFLUENZA DNA AMP PROBECPT 87502Outpatient40030087502$657
HEPATITIS C REVRS TRNSCRPJCPT 87522Outpatient40030087522$635
HEPATITIS C REVRS TRNSCRPJCPT 87522Outpatient40030087522$635
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient40030087591$381
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient40030087591$381
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient40030087591$381
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient40030087591$304
N.GONORRHOEAE DNA AMP PROBCPT 87591Outpatient40030087591$381
HPV HIGH-RISK TYPESCPT 87624Outpatient40030087624$237
RESP VIRUS 3-5 TARGETSCPT 87631Outpatient40030087631$314
STREP A DNA AMP PROBECPT 87651Outpatient40030087651$304
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$304
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$304
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$304
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$304
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$311
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
DETECT AGENT NOS DNA AMPCPT 87798Outpatient40030087798$388
AGENT NOS ASSAY W/OPTICCPT 87899Outpatient40030087899$288
AGENT NOS ASSAY W/OPTICCPT 87899Outpatient40030087899$288
AGENT NOS ASSAY W/OPTICCPT 87899Outpatient40030087899$288
AGENT NOS ASSAY W/OPTICCPT 87899Outpatient40030087899$288
AGENT NOS ASSAY W/OPTICCPT 87899Outpatient40030087899$288
AGENT NOS ASSAY W/OPTICCPT 87899Outpatient40030087899$120
CYTOPATH C/V THIN LAYERCPT 88142Outpatient40030088142$301
TISSUE EXAM BY PATHOLOGISTCPT 88304Outpatient40030088304$567
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient40030088305$766
IMMUNOHISTO ANTB 1ST STAINCPT 88342Outpatient40030088342$690
LEUKOCYTE ASSESSMENT FECALCPT 89055Outpatient40030089055$65
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient400300P9016$555
MRI
MRI BRAIN STEM W/O DYECPT 70551Outpatient70061070551$3,595
MRI BRAIN STEM W/O DYECPT 70551Outpatient70061070551$3,595
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient-$6,767
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient70061070553$5,103
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient-$6,767
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient70061070553$5,103
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient-$6,767
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient70061070553$5,103
MRI LUMBAR SPINE W/O DYECPT 72148Outpatient-$4,378
MRI LUMBAR SPINE W/O DYECPT 72148Outpatient70061072148$3,298
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient-$4,775
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient70061073721$3,474
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient-$4,775
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient70061073721$3,474
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient-$4,775
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient70061073721$3,474
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient-$4,775
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient70061073721$3,474
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient-$4,775
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient70061073721$3,474
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient-$4,775
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient70061073721$3,474
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient70040293880$731
EXTREMITY STUDYCPT 93971Outpatient70092193971$588
EXTREMITY STUDYCPT 93971Outpatient70092193971$588
EXTREMITY STUDYCPT 93971Outpatient70092193971$588
EXTREMITY STUDYCPT 93971Outpatient70092193971$588
VASCULAR STUDYCPT 93976Outpatient70092193976$747
SLP STDY UNATTENDEDCPT 95800Outpatient80096095800$199
MUSC TST DONE W/NERV TST LIMCPT 95885Outpatient20096095885$522
MUSC TEST DONE W/N TEST COMPCPT 95886Outpatient20096095886$736
NRV CNDJ TST 5-6 STUDIESCPT 95909Outpatient20096095909$742
NRV CNDJ TEST 7-8 STUDIESCPT 95910Outpatient20096095910$885
NRV CNDJ TEST 9-10 STUDIESCPT 95911Outpatient20096095911$1,194
HOME SLEEP TEST/TYPE 3 PORTAHCPCS G0399Outpatient800960G0399$520
HOME SLEEP TEST/TYPE 3 PORTAHCPCS G0399Outpatient800960G0399$520
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 36430Outpatient90038036430$564
CARDIAC REHAB/MONITORCPT 93798Outpatient90094393798$286
PHLEBOTOMYCPT 99195Outpatient90094099195$146
PULMONARY REHAB W EXERHCPCS G0424Outpatient800960G0424$175
PULMONARY REHAB W EXERHCPCS G0424Outpatient800960G0424$185
PULMONARY REHAB W EXERHCPCS G0424Outpatient800960G0424$185
PULMONARY REHAB W EXERHCPCS G0424Outpatient800960G0424$185
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient400300P9016$555
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient400300P9016$555
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient400300P9016$555
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient400300P9016$555
Psychiatric
PSYTX W PT 30 MINUTESCPT 90832Outpatient20096090832$168
PSYTX W PT 45 MINUTESCPT 90834Outpatient20096090834$222
PSYTX W PT 60 MINUTESCPT 90837Outpatient20096090837$335
FAMILY PSYTX W/O PT 50 MINCPT 90846Outpatient20096090846$270
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MINCPT 90847----
(N/O) GROUP PSYCHOTHERAPYCPT 90853----
Pulmonary Function
EVALUATION OF WHEEZINGCPT 94060Outpatient80046094060$618
EVALUATION OF WHEEZINGCPT 94060Outpatient80046094060$618
EVALUATION OF WHEEZINGCPT 94060Outpatient80046094060$318
PULM FUNCT TST PLETHYSMOGRAPCPT 94726Outpatient80046094726$334
CO/MEMBANE DIFFUSE CAPACITYCPT 94729Outpatient80046094729$259
CO/MEMBANE DIFFUSE CAPACITYCPT 94729Outpatient80046094729$504
CO/MEMBANE DIFFUSE CAPACITYCPT 94729Outpatient80046094729$259
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient70032071045$306
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient70032071045$306
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient70032071046$393
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient70032071046$393
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient70032071046$393
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient70032072050$768
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient70032072050$768
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient70032072070$414
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient70032072100$600
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient-$822
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient70032072110$822
X-RAY EXAM OF SHOULDERCPT 73030Outpatient70032073030$430
X-RAY EXAM OF SHOULDERCPT 73030Outpatient70032073030$430
X-RAY EXAM OF HANDCPT 73130Outpatient70032073130$489
X-RAY EXAM OF HANDCPT 73130Outpatient70032073130$489
X-RAY EXAM OF HANDCPT 73130Outpatient70032073130$489
X-RAY EXAM OF HANDCPT 73130Outpatient70032073130$489
X-RAY EXAM OF HANDCPT 73130Outpatient70032073130$489
X-RAY EXAM OF FINGER(S)CPT 73140Outpatient70032073140$507
X-RAY EXAM OF FINGER(S)CPT 73140Outpatient70032073140$507
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$882
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$882
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$882
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$935
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$882
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$935
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$620
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$882
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient70032073502$882
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient70032073560$439
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient70032073560$439
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient70032073560$439
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient70032073560$439
X-RAY EXAM OF KNEE 3CPT 73562Outpatient70032073562$550
X-RAY EXAM OF KNEE 3CPT 73562Outpatient70032073562$550
X-RAY EXAM OF KNEE 3CPT 73562Outpatient70032073562$550
X-RAY EXAM OF KNEE 3CPT 73562Outpatient70032073562$550
X-RAY EXAM OF ANKLECPT 73610Outpatient70032073610$496
X-RAY EXAM OF ANKLECPT 73610Outpatient70032073610$496
X-RAY EXAM OF FOOTCPT 73630Outpatient70032073630$482
X-RAY EXAM OF FOOTCPT 73630Outpatient70032073630$482
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient70032074018$334
X-RAY EXAM COMPLETE ABDOMENCPT 74022Outpatient70032074022$679
X-RAYS AT SURGERY ADD-ONCPT 74301Outpatient70032074301$479
X-RAYS AT SURGERY ADD-ONCPT 74301Outpatient70032074301$479
DXA BONE DENSITY AXIALCPT 77080Outpatient70032077080$687
Respiratory
AIRWAY INHALATION TREATMENTCPT 94640Outpatient80096094640$155
AIRWAY INHALATION TREATMENTCPT 94640Outpatient80096094640$155
AIRWAY INHALATION TREATMENTCPT 94640Outpatient80096094640$155
AIRWAY INHALATION TREATMENTCPT 94640Outpatient80096094640$155
AIRWAY INHALATION TREATMENTCPT 94640Outpatient80096094640$155
Surgical Procedures
REMOVAL OF BREAST LESIONCPT 19120Outpatient-$1,042
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826----
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPECPT 29881----
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...CPT 42820----
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient20096043235$3,989
EGD BIOPSY SINGLE/MULTIPLECPT 43239Outpatient20096043239$6,934
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient20051045378$983
COLONOSCOPY AND BIOPSYCPT 45380Outpatient20096045380$7,471
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient20096045385$7,100
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562Outpatient50036047562$25,916
PRP I/HERN INIT REDUC >5 YRCPT 49505Outpatient50036049505$21,296
BIOPSY OF PROSTATECPT 55700Outpatient-$3,877
(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----
NJX INTERLAMINAR LMBR/SACCPT 62323Outpatient50036162323$2,770
NJX AA&/STRD TFRM EPI L/S 1CPT 64483Outpatient50036164483$1,561
AFTER CATARACT LASER SURGERYCPT 66821Outpatient20096066821$4,766
XCAPSL CTRC RMVL W/O ECPCPT 66984Outpatient50036066984$14,112
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
ULTRASOUND THERAPYCPT 97035Outpatient90042097035$64
ULTRASOUND THERAPYCPT 97035Outpatient90042097035$64
THERAPEUTIC EXERCISESCPT 97110Outpatient90042097110$160
THERAPEUTIC EXERCISESCPT 97110Outpatient90042097110$160
NEUROMUSCULAR REEDUCATIONCPT 97112Outpatient90042097112$167
NEUROMUSCULAR REEDUCATIONCPT 97112Outpatient90042097112$167
AQUATIC THERAPY/EXERCISESCPT 97113Outpatient90042097113$218
AQUATIC THERAPY/EXERCISESCPT 97113Outpatient90042097113$218
AQUATIC THERAPY/EXERCISESCPT 97113Outpatient90042097113$204
GAIT TRAINING THERAPYCPT 97116Outpatient90042097116$142
MANUAL THERAPY 1/> REGIONSCPT 97140Outpatient90042097140$149
MANUAL THERAPY 1/> REGIONSCPT 97140Outpatient90042097140$149
PT EVAL LOW COMPLEX 20 MINCPT 97161Outpatient90042097161$300
PT EVAL MOD COMPLEX 30 MINCPT 97162Outpatient90042097162$364
OT EVAL LOW COMPLEX 30 MINCPT 97165Outpatient90043097165$300
OT EVAL MOD COMPLEX 45 MINCPT 97166Outpatient90043097166$364
THERAPEUTIC ACTIVITIESCPT 97530Outpatient90042097530$174
THERAPEUTIC ACTIVITIESCPT 97530Outpatient90042097530$174
SELF CARE MNGMENT TRAININGCPT 97535Outpatient90043097535$174
SELF CARE MNGMENT TRAININGCPT 97535Outpatient90043097535$174
WHEELCHAIR MNGMENT TRAININGCPT 97542Outpatient90042097542$152
WHEELCHAIR MNGMENT TRAININGCPT 97542Outpatient90042097542$152
Uncategorized
AMPUTATION TOE & METATARSALCPT 28810Outpatient-$1,035
X-RAY EYE FOR FOREIGN BODYCPT 70030Outpatient-$417
X-RAY EXAM OF JAW 4/> VIEWSCPT 70110Outpatient-$566
X-RAY EXAM OF MASTOIDSCPT 70120Outpatient-$538
X-RAY EXAM OF FACIAL BONESCPT 70140Outpatient-$426
X-RAY EXAM OF FACIAL BONESCPT 70150Outpatient-$620
X-RAY EXAM OF NASAL BONESCPT 70160Outpatient-$507
X-RAY EXAM OF EYE SOCKETSCPT 70200Outpatient-$629
X-RAY EXAM OF SINUSESCPT 70210Outpatient-$461
X-RAY EXAM OF SINUSESCPT 70220Outpatient-$550
X-RAY EXAM OF SKULLCPT 70250Outpatient-$634
X-RAY EXAM OF SKULLCPT 70260Outpatient-$518
X-RAY EXAM OF JAW JOINTSCPT 70330Outpatient-$749
MAGNETIC IMAGE JAW JOINTCPT 70336Outpatient-$4,206
X-RAY EXAM OF NECKCPT 70360Outpatient-$398
SPEECH EVALUATION COMPLEXCPT 70371Outpatient-$1,106
CT HEAD/BRAIN W/DYECPT 70460Outpatient-$2,527
CT HEAD/BRAIN W/O & W/DYECPT 70470Outpatient-$3,116
CT ORBIT/EAR/FOSSA W/O DYECPT 70480Outpatient-$3,172
CT ORBIT/EAR/FOSSA W/O DYECPT 70480Outpatient-$3,172
CT ORBIT/EAR/FOSSA W/DYECPT 70481Outpatient-$3,747
CT ORBIT/EAR/FOSSA W/DYECPT 70481Outpatient-$3,747
CT ORBIT/EAR/FOSSA W/O&W/DYECPT 70482Outpatient-$4,302
CT ORBIT/EAR/FOSSA W/O&W/DYECPT 70482Outpatient-$4,302
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient-$2,597
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient-$2,597
CT MAXILLOFACIAL W/DYECPT 70487Outpatient-$3,174
CT MAXILLOFACIAL W/DYECPT 70487Outpatient-$3,174
CT MAXILLOFACIAL W/O & W/DYECPT 70488Outpatient-$3,961
CT MAXILLOFACIAL W/O & W/DYECPT 70488Outpatient-$3,961
CT SOFT TISSUE NECK W/O DYECPT 70490Outpatient-$2,444
CT SOFT TISSUE NECK W/DYECPT 70491Outpatient-$3,048
CT SFT TSUE NCK W/O & W/DYECPT 70492Outpatient-$3,816
CT ANGIOGRAPHY HEADCPT 70496Outpatient-$10,497
MRI ORBIT/FACE/NECK W/O DYECPT 70540Outpatient-$4,823
MRI ORBIT/FACE/NECK W/DYECPT 70542Outpatient-$5,327
MRI ORBT/FAC/NCK W/O &W/DYECPT 70543Outpatient-$6,949
MR ANGIOGRAPHY HEAD W/O DYECPT 70544Outpatient-$5,425
MR ANGIOGRAPH HEAD W/O&W/DYECPT 70546Outpatient-$8,534
MR ANGIOGRAPHY NECK W/O DYECPT 70547Outpatient-$5,413
MR ANGIOGRAPHY NECK W/DYECPT 70548Outpatient-$3,938
MR ANGIOGRAPH NECK W/O&W/DYECPT 70549Outpatient-$8,540
MRI BRAIN STEM W/O DYECPT 70551Outpatient-$4,944
MRI BRAIN STEM W/O DYECPT 70551Outpatient-$4,944
MRI BRAIN STEM W/DYECPT 70552Outpatient-$5,437
CT ANGIO NECK W/ CONTRASTCPT 70998Outpatient-$10,705
XR CHEST 2 VIEWS W/ FLUOROSCOPYCPT 71023Outpatient-$1,040
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient-$306
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient-$417
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient-$393
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient-$393
X-RAY EXAM CHEST 3 VIEWSCPT 71047Outpatient-$518
X-RAY EXAM CHEST 3 VIEWSCPT 71047Outpatient-$518
X-RAY EXAM CHEST 4+ VIEWSCPT 71048Outpatient-$643
X-RAY EXAM CHEST 4+ VIEWSCPT 71048Outpatient-$643
X-RAY EXAM CHEST 4+ VIEWSCPT 71048Outpatient-$643
X-RAY EXAM CHEST 4+ VIEWSCPT 71048Outpatient-$643
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100Outpatient-$447
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100Outpatient-$447
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101Outpatient-$545
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101Outpatient-$545
X-RAY EXAM RIBS BIL 3 VIEWSCPT 71110Outpatient-$573
X-RAY EXAM RIBS/CHEST4/> VWSCPT 71111Outpatient-$768
X-RAY EXAM BREASTBONE 2/>VWSCPT 71120Outpatient-$461
X-RAY STRENOCLAVIC JT 3/>VWSCPT 71130Outpatient-$550
CT THORAX DX C-CPT 71250Outpatient-$2,524
CT THORAX DX C-CPT 71250Outpatient-$2,524
CT THORAX DX C+CPT 71260Outpatient-$3,146
CT THORAX DX C+CPT 71260Outpatient-$3,146
CT THORAX DX C-/C+CPT 71270Outpatient-$3,958
CT THORAX DX C-/C+CPT 71270Outpatient-$3,958
CT ANGIOGRAPHY CHESTCPT 71275Outpatient-$7,860
MRI CHEST W/O DYECPT 71550Outpatient-$5,490
MRI CHEST W/O & W/DYECPT 71552Outpatient-$8,090
X-RAY EXAM OF SPINE 1 VIEWCPT 72020Outpatient-$334
X-RAY EXAM OF SPINE 1 VIEWCPT 72020Outpatient-$334
X-RAY EXAM OF SPINE 1 VIEWCPT 72020Outpatient-$334
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040Outpatient-$566
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient-$768
X-RAY EXAM NECK SPINE 6/>VWSCPT 72052Outpatient-$1,013
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient-$474
X-RAY EXAM THORACOLMB 2/> VWCPT 72080Outpatient-$518
X-RAY EXAM ENTIRE SPI 2/3 VWCPT 72082Outpatient-$1,072
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient-$600
X-RAY EXAM L-S SPINE BENDINGCPT 72114Outpatient-$1,154
CT NECK SPINE W/O DYECPT 72125Outpatient-$2,544
CT NECK SPINE W/DYECPT 72126Outpatient-$3,154
CT CHEST SPINE W/O DYECPT 72128Outpatient-$2,538
CT CHEST SPINE W/DYECPT 72129Outpatient-$3,158
CT CHEST SPINE W/O & W/DYECPT 72130Outpatient-$3,958
CT LUMBAR SPINE W/O DYECPT 72131Outpatient-$2,527
CT LUMBAR SPINE W/DYECPT 72132Outpatient-$3,151
CT LUMBAR SPINE W/O & W/DYECPT 72133Outpatient-$3,954
MRI NECK SPINE W/O DYECPT 72141Outpatient-$4,309
MRI NECK SPINE W/DYECPT 72142Outpatient-$5,441
MRI CHEST SPINE W/O DYECPT 72146Outpatient-$4,386
MRI CHEST SPINE W/DYECPT 72147Outpatient-$4,799
MRI NECK SPINE W/O & W/DYECPT 72156Outpatient-$6,650
MRI CHEST SPINE W/O & W/DYECPT 72157Outpatient-$6,172
MRI LUMBAR SPINE W/O & W/DYECPT 72158Outpatient-$6,635
X-RAY EXAM OF PELVISCPT 72170Outpatient-$346
X-RAY EXAM OF PELVISCPT 72190Outpatient-$634
CT PELVIS W/O DYECPT 72192Outpatient-$2,390
CT PELVIS W/O & W/DYECPT 72194Outpatient-$3,996
MRI PELVIS W/O DYECPT 72195Outpatient-$4,917
MRI PELVIS W/O & W/DYECPT 72197Outpatient-$7,018
X-RAY EXAM SI JOINTS 3/> VWSCPT 72202Outpatient-$524
X-RAY EXAM SACRUM TAILBONECPT 72220Outpatient-$430
MYELOGRAPHY THORACIC SPINECPT 72255Outpatient-$1,892
MYELOGRAPHY L-S SPINECPT 72265Outpatient-$2,002
MYELOGPHY 2/> SPINE REGIONSCPT 72270Outpatient-$3,085
X-RAY EXAM OF COLLAR BONECPT 73000Outpatient-$426
X-RAY EXAM OF COLLAR BONECPT 73000Outpatient-$426
X-RAY EXAM OF SHOULDER BLADECPT 73010Outpatient-$439
X-RAY EXAM OF SHOULDER BLADECPT 73010Outpatient-$439
X-RAY EXAM OF SHOULDERCPT 73020Outpatient-$334
X-RAY EXAM OF SHOULDERCPT 73020Outpatient-$334
X-RAY EXAM OF SHOULDERCPT 73030Outpatient-$430
X-RAY EXAM OF SHOULDERCPT 73030Outpatient-$430
CONTRAST X-RAY OF SHOULDERCPT 73040Outpatient-$1,666
CONTRAST X-RAY OF SHOULDERCPT 73040Outpatient-$1,666
X-RAY EXAM OF SHOULDERSCPT 73050Outpatient-$566
X-RAY EXAM OF HUMERUSCPT 73060Outpatient-$426
X-RAY EXAM OF HUMERUSCPT 73060Outpatient-$426
X-RAY EXAM OF ELBOWCPT 73070Outpatient-$426
X-RAY EXAM OF ELBOWCPT 73070Outpatient-$426
X-RAY EXAM OF ELBOWCPT 73080Outpatient-$530
X-RAY EXAM OF ELBOWCPT 73080Outpatient-$530
CONTRAST X-RAY OF ELBOWCPT 73085Outpatient-$1,456
CONTRAST X-RAY OF ELBOWCPT 73085Outpatient-$1,456
X-RAY EXAM OF FOREARMCPT 73090Outpatient-$411
X-RAY EXAM OF FOREARMCPT 73090Outpatient-$411
X-RAY EXAM OF ARM INFANTCPT 73092Outpatient-$466
X-RAY EXAM OF ARM INFANTCPT 73092Outpatient-$466
X-RAY EXAM OF WRISTCPT 73100Outpatient-$454
X-RAY EXAM OF WRISTCPT 73100Outpatient-$454
X-RAY EXAM OF WRISTCPT 73100Outpatient-$454
X-RAY EXAM OF WRISTCPT 73100Outpatient-$454
X-RAY EXAM OF WRISTCPT 73110Outpatient-$573
X-RAY EXAM OF WRISTCPT 73110Outpatient-$573
CONTRAST X-RAY OF WRISTCPT 73115Outpatient-$1,679
CONTRAST X-RAY OF WRISTCPT 73115Outpatient-$1,679
X-RAY EXAM OF HANDCPT 73120Outpatient-$404
X-RAY EXAM OF HANDCPT 73120Outpatient-$404
X-RAY EXAM OF HANDCPT 73120Outpatient-$404
X-RAY EXAM OF HANDCPT 73130Outpatient-$489
X-RAY EXAM OF HANDCPT 73130Outpatient-$489
X-RAY EXAM OF HANDCPT 73130Outpatient-$977
X-RAY EXAM OF HANDCPT 73130Outpatient-$489
X-RAY EXAM OF FINGER(S)CPT 73140Outpatient-$507
X-RAY EXAM OF FINGER(S)CPT 73140Outpatient-$507
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient-$2,458
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPER EXTREMITY W/DYECPT 73201Outpatient-$3,051
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
CT UPPR EXTREMITY W/O&W/DYECPT 73202Outpatient-$4,074
MRI UPPER EXTREMITY W/O DYECPT 73218Outpatient-$5,018
MRI UPPER EXTREMITY W/O DYECPT 73218Outpatient-$5,018
MRI UPPER EXTREMITY W/O DYECPT 73218Outpatient-$5,018
MRI UPPER EXTREMITY W/O DYECPT 73218Outpatient-$5,018
MRI UPPER EXTREMITY W/DYECPT 73219Outpatient-$5,338
MRI UPPER EXTREMITY W/DYECPT 73219Outpatient-$5,338
MRI UPPER EXTREMITY W/DYECPT 73219Outpatient-$5,338
MRI UPPER EXTREMITY W/DYECPT 73219Outpatient-$5,338
MRI UPPR EXTREMITY W/O&W/DYECPT 73220Outpatient-$7,050
MRI UPPR EXTREMITY W/O&W/DYECPT 73220Outpatient-$7,050
MRI UPPR EXTREMITY W/O&W/DYECPT 73220Outpatient-$7,050
MRI UPPR EXTREMITY W/O&W/DYECPT 73220Outpatient-$7,050
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$4,671
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$4,671
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$5,018
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$5,018
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$4,671
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$4,671
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$4,671
MRI JOINT UPR EXTREM W/O DYECPT 73221Outpatient-$4,671
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,018
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,018
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,338
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,338
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,018
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,018
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,018
MRI JOINT UPR EXTREM W/DYECPT 73222Outpatient-$5,018
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$6,635
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$6,635
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$7,050
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$7,050
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$6,635
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$6,635
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$6,635
MRI JOINT UPR EXTR W/O&W/DYECPT 73223Outpatient-$6,635
X-RAY EXAM HIP UNI 1 VIEWCPT 73501Outpatient-$339
X-RAY EXAM HIP UNI 1 VIEWCPT 73501Outpatient-$339
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient-$620
X-RAY EXAM HIPS BI 5/> VIEWSCPT 73523Outpatient-$566
CONTRAST X-RAY OF HIPCPT 73525Outpatient-$1,498
CONTRAST X-RAY OF HIPCPT 73525Outpatient-$1,498
X-RAY EXAM OF FEMUR 2/>CPT 73552Outpatient-$404
X-RAY EXAM OF FEMUR 2/>CPT 73552Outpatient-$404
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient-$878
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient-$439
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient-$439
X-RAY EXAM OF KNEE 3CPT 73562Outpatient-$1,102
X-RAY EXAM OF KNEE 3CPT 73562Outpatient-$550
X-RAY EXAM OF KNEE 3CPT 73562Outpatient-$550
X-RAY EXAM KNEE 4 OR MORECPT 73564Outpatient-$629
X-RAY EXAM KNEE 4 OR MORECPT 73564Outpatient-$629
X-RAY EXAM OF KNEESCPT 73565Outpatient-$502
CONTRAST X-RAY OF KNEE JOINTCPT 73580Outpatient-$2,131
CONTRAST X-RAY OF KNEE JOINTCPT 73580Outpatient-$2,131
X-RAY EXAM OF LOWER LEGCPT 73590Outpatient-$398
X-RAY EXAM OF LOWER LEGCPT 73590Outpatient-$398
X-RAY EXAM OF LEG INFANTCPT 73592Outpatient-$474
X-RAY EXAM OF LEG INFANTCPT 73592Outpatient-$474
X-RAY EXAM OF ANKLECPT 73600Outpatient-$417
X-RAY EXAM OF ANKLECPT 73600Outpatient-$417
X-RAY EXAM OF ANKLECPT 73610Outpatient-$496
X-RAY EXAM OF ANKLECPT 73610Outpatient-$496
X-RAY EXAM OF FOOTCPT 73620Outpatient-$404
X-RAY EXAM OF FOOTCPT 73620Outpatient-$404
X-RAY EXAM OF FOOTCPT 73630Outpatient-$482
X-RAY EXAM OF FOOTCPT 73630Outpatient-$482
X-RAY EXAM OF HEELCPT 73650Outpatient-$411
X-RAY EXAM OF HEELCPT 73650Outpatient-$411
X-RAY EXAM OF TOE(S)CPT 73660Outpatient-$474
X-RAY EXAM OF TOE(S)CPT 73660Outpatient-$474
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient-$2,390
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LOWER EXTREMITY W/DYECPT 73701Outpatient-$3,087
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT LWR EXTREMITY W/O&W/DYECPT 73702Outpatient-$4,094
CT ANGIO LWR EXTR W/O&W/DYECPT 73706Outpatient-$7,929
CT ANGIO LWR EXTR W/O&W/DYECPT 73706Outpatient-$7,929
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient-$4,900
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient-$4,900
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient-$4,900
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient-$4,900
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient-$4,900
MRI LOWER EXTREMITY W/O DYECPT 73718Outpatient-$4,900
MRI LOWER EXTREMITY W/DYECPT 73719Outpatient-$5,322
MRI LOWER EXTREMITY W/DYECPT 73719Outpatient-$5,322
MRI LOWER EXTREMITY W/DYECPT 73719Outpatient-$5,322
MRI LOWER EXTREMITY W/DYECPT 73719Outpatient-$5,322
MRI LOWER EXTREMITY W/DYECPT 73719Outpatient-$5,322
MRI LOWER EXTREMITY W/DYECPT 73719Outpatient-$5,322
MRI LWR EXTREMITY W/O&W/DYECPT 73720Outpatient-$7,061
MRI LWR EXTREMITY W/O&W/DYECPT 73720Outpatient-$7,061
MRI LWR EXTREMITY W/O&W/DYECPT 73720Outpatient-$7,061
MRI LWR EXTREMITY W/O&W/DYECPT 73720Outpatient-$7,061
MRI LWR EXTREMITY W/O&W/DYECPT 73720Outpatient-$7,061
MRI LWR EXTREMITY W/O&W/DYECPT 73720Outpatient-$7,061
MRI JOINT OF LWR EXTR W/DYECPT 73722Outpatient-$5,107
MRI JOINT OF LWR EXTR W/DYECPT 73722Outpatient-$5,107
MRI JOINT OF LWR EXTR W/DYECPT 73722Outpatient-$5,107
MRI JOINT OF LWR EXTR W/DYECPT 73722Outpatient-$5,107
MRI JOINT OF LWR EXTR W/DYECPT 73722Outpatient-$5,107
MRI JOINT OF LWR EXTR W/DYECPT 73722Outpatient-$5,107
MRI JOINT LWR EXTR W/O&W/DYECPT 73723Outpatient-$6,620
MRI JOINT LWR EXTR W/O&W/DYECPT 73723Outpatient-$6,620
MRI JOINT LWR EXTR W/O&W/DYECPT 73723Outpatient-$6,620
MRI JOINT LWR EXTR W/O&W/DYECPT 73723Outpatient-$6,620
MRI JOINT LWR EXTR W/O&W/DYECPT 73723Outpatient-$6,620
MRI JOINT LWR EXTR W/O&W/DYECPT 73723Outpatient-$6,620
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient-$334
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient-$559
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient-$559
X-RAY EXAM ABDOMEN 3+ VIEWSCPT 74021Outpatient-$559
X-RAY EXAM ABDOMEN 3+ VIEWSCPT 74021Outpatient-$559
X-RAY EXAM COMPLETE ABDOMENCPT 74022Outpatient-$679
CT ABDOMEN W/O DYECPT 74150Outpatient-$2,370
CT ABDOMEN W/DYECPT 74160Outpatient-$3,418
CT ABDOMEN W/O & W/DYECPT 74170Outpatient-$4,691
CT ABDOMEN W/O & W/DYECPT 74170Outpatient-$4,691
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient-$1,657
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient-$1,657
CT ABD & PELV 1/> REGNSCPT 74178Outpatient-$4,179
CT ABD & PELV 1/> REGNSCPT 74178Outpatient-$4,179
CT ABD & PELV 1/> REGNSCPT 74178Outpatient-$446
MRI ABDOMEN W/O DYECPT 74181Outpatient-$4,319
MRI ABDOMEN W/O & W/DYECPT 74183Outpatient-$7,036
MRI ANGIO ABDOM W ORW/O DYECPT 74185Outpatient-$5,147
X-RAY XM ESOPHAGUS 1CNTRSTCPT 74220Outpatient-$1,393
X-RAY XM UPR GI TRC 1CNTRSTCPT 74240Outpatient-$1,603
XR UPPER GI + KUBCPT 74241Outpatient-$1,757
X-RAY XM UPR GI TRC 2CNTRSTCPT 74246Outpatient-$1,920
XR UPPER GI W/ AIR CONTRAST + KUBCPT 74247Outpatient-$2,213
XR UPPER GI W/ AIR W/ SMALL BOWELCPT 74249Outpatient-$3,020
X-RAY XM SM INT 1CNTRST STDCPT 74250Outpatient-$1,722
XR DUODENOGRAPHY HYPOTONICCPT 74260Outpatient-$1,221
X-RAY XM COLON 1CNTRST STDCPT 74270Outpatient-$2,460
X-RAY XM COLON 1CNTRST STDCPT 74270Outpatient-$2,460
X-RAY XM COLON 2CNTRST STDCPT 74280Outpatient-$3,385
X-RAY BILE DUCTS/PANCREASCPT 74300Outpatient-$956
X-RAY BILE/PANC ENDOSCOPYCPT 74330Outpatient-$656
UROGRAPHY IV +-KUB TOMOGCPT 74400Outpatient-$1,814
UROGRAPHY RTRGR +-KUBCPT 74420Outpatient-$1,370
CONTRAST X-RAY BLADDERCPT 74430Outpatient-$938
X-RAY URETHRA/BLADDERCPT 74455Outpatient-$1,520
X-RAY FEMALE GENITAL TRACTCPT 74740Outpatient-$1,251
CT ANGIO ABDOMINAL ARTERIESCPT 75635Outpatient-$8,729
ABSCESS DRAINAGE UNDER X-RAYCPT 75989Outpatient-$974
ABSCESS DRAINAGE UNDER X-RAYCPT 75989Outpatient-$974
ABSCESS DRAINAGE UNDER X-RAYCPT 75989Outpatient-$734
ABSCESS DRAINAGE UNDER X-RAYCPT 75989Outpatient-$1,698
ABSCESS DRAINAGE UNDER X-RAYCPT 75989Outpatient-$1,651
ABSCESS DRAINAGE UNDER X-RAYCPT 75989Outpatient-$734
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient-$1,429
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient-$1,429
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient-$1,429
XR C-ARM > 1 HRCPT 76001Outpatient-$882
X-RAY NOSE TO RECTUMCPT 76010Outpatient-$361
X-RAY EXAM OF FISTULACPT 76080Outpatient-$734
X-RAY EXAM SURGICAL SPECIMENCPT 76098Outpatient-$214
X-RAY EXAM SURGICAL SPECIMENCPT 76098Outpatient-$214
3D RENDER W/INTRP POSTPROCESCPT 76376Outpatient-$778
3D RENDER W/INTRP POSTPROCESCPT 76377Outpatient-$682
US EXAM OF HEAD AND NECKCPT 76536Outpatient-$862
US EXAM CHESTCPT 76604Outpatient-$1,261
ULTRASOUND BREAST COMPLETECPT 76641Outpatient-$1,429
ULTRASOUND BREAST COMPLETECPT 76641Outpatient-$1,429
ULTRASOUND BREAST COMPLETECPT 76641Outpatient-$1,429
ECHO EXAM OF ABDOMENCPT 76705Outpatient-$740
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient-$922
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient-$922
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient-$785
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient-$785
OB US < 14 WKS SINGLE FETUSCPT 76801Outpatient-$1,686
OB US < 14 WKS SINGLE FETUSCPT 76801Outpatient-$1,686
OB US < 14 WKS ADDL FETUSCPT 76802Outpatient-$600
OB US >= 14 WKS ADDL FETUSCPT 76810Outpatient-$1,026
OB US LIMITED FETUS(S)CPT 76815Outpatient-$821
TRANSVAGINAL US OBSTETRICCPT 76817Outpatient-$1,378
TRANSVAGINAL US OBSTETRICCPT 76817Outpatient-$1,378
ECHO EXAM UTERUSCPT 76831Outpatient-$1,863
US EXAM PELVIC COMPLETECPT 76856Outpatient-$862
US EXAM PELVIC COMPLETECPT 76856Outpatient-$862
US EXAM PELVIC LIMITEDCPT 76857Outpatient-$1,694
US EXAM SCROTUMCPT 76870Outpatient-$873
US COMPL JOINT R-T W/IMGCPT 76881Outpatient-$817
US COMPL JOINT R-T W/IMGCPT 76881Outpatient-$817
US LMTD JT/NONVASC XTR STRUXCPT 76882Outpatient-$426
US LMTD JT/NONVASC XTR STRUXCPT 76882Outpatient-$426
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient-$1,136
FLUOROGUIDE FOR VEIN DEVICECPT 77001Outpatient-$1,969
NEEDLE LOCALIZATION BY XRAYCPT 77002Outpatient-$993
NEEDLE LOCALIZATION BY XRAYCPT 77002Outpatient-$993
NEEDLE LOCALIZATION BY XRAYCPT 77002Outpatient-$993
FLUOROGUIDE FOR SPINE INJECTCPT 77003Outpatient-$679
FLUOROGUIDE FOR SPINE INJECTCPT 77003Outpatient-$679
CT SCAN FOR NEEDLE BIOPSYCPT 77012Outpatient-$1,341
CT SCAN FOR NEEDLE BIOPSYCPT 77012Outpatient-$1,341
CT SCAN FOR NEEDLE BIOPSYCPT 77012Outpatient-$1,341
CT SCAN FOR NEEDLE BIOPSYCPT 77012Outpatient-$1,341
CT SCAN FOR NEEDLE BIOPSYCPT 77012Outpatient-$1,341
X-RAY STRESS VIEWCPT 77071Outpatient-$446
X-RAY STRESS VIEWCPT 77071Outpatient-$446
X-RAYS FOR BONE AGECPT 77072Outpatient-$292
X-RAYS BONE LENGTH STUDIESCPT 77073Outpatient-$502
X-RAYS BONE SURVEY COMPLETECPT 77075Outpatient-$1,575
X-RAYS BONE SURVEY INFANTCPT 77076Outpatient-$1,371
DXA BONE DENSITY AXIALCPT 77080Outpatient-$687
DXA BONE DENSITY/PERIPHERALCPT 77081Outpatient-$388
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient-$56
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient-$290
RHYTHM ECG TRACINGCPT 93041Outpatient-$18
ECG MONIT/REPRT UP TO 48 HRSCPT 93226Outpatient-$118
TTE W/DOPPLER COMPLETECPT 93306Outpatient-$1,547
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient-$731
LOWER EXTREMITY STUDYCPT 93926Outpatient-$884
EXTREMITY STUDYCPT 93970Outpatient-$607
EXTREMITY STUDYCPT 93970Outpatient-$607
EXTREMITY STUDYCPT 93971Outpatient-$588
EXTREMITY STUDYCPT 93971Outpatient-$588
EXTREMITY STUDYCPT 93971Outpatient-$588
EXTREMITY STUDYCPT 93971Outpatient-$588
IMMUNOTHERAPY INJECTIONSCPT 95117Outpatient20096095117$133
ADMIN INFLUENZA VIRUS VACHCPCS G0008Outpatient200771G0008$74
ADMIN PNEUMOCOCCAL VACCINEHCPCS G0009Outpatient200771G0009$37
MA MAMMOGRAM LEFTHCPCS G0202Outpatient-$477
MA MAMMOGRAM RIGHTHCPCS G0202Outpatient-$477
MA MAMMOGRAM DIGITAL DIAGNOSTIC BILAT.HCPCS G0204Outpatient-$477
IR INTRAPERITONEAL CATH INSERTHCPCS G0206Outpatient-$477
IR INTRAVASC STENT PLACE W/ EMBOLIC PROTECTHCPCS G0206Outpatient-$477
MA MAMMOGRAM DIGITAL DIAGNOSTIC LEFT.HCPCS G0206Outpatient-$331
ZZ MA MAMMOGRAM DIGITAL DIAGNOSTIC RIGHT.HCPCS G0206Outpatient-$331