North Texas Medical Center

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

Hospital Website Machine-Readable Chargemaster

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

Billing Description	Billing Code	CDM Code	Department	Gross Charge	Cash Price	PNR
Cardiology
HEART/LUNG RESUSCITATION CPR	CPT 92950	30031192	Outpatient	$625	$156	Payer Rates
CARDIOVASCULAR STRESS TEST	CPT 93017	30031213	Outpatient	$625	$156	Payer Rates
ECHO 2D COMP/COLOR/DOP W/ CON	HCPCS C8929	30306465	Outpatient	$2,136	$534	Payer Rates
Clinic
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-	-
EKG
ELECTROCARDIOGRAM TRACING	CPT 93005	30031036	Outpatient	$310	$78	Payer Rates
Emergency Room
DRAINAGE OF SKIN ABSCESS	CPT 10060	30111109	Outpatient	$425	$106	Payer Rates
DRESS/DEBRID P-THICK BURN S	CPT 16020	30112095	Outpatient	$387	$97	Payer Rates
REMOVE NASAL FOREIGN BODY	CPT 30300	30112182	Outpatient	$346	$87	Payer Rates
CONTROL OF NOSEBLEED	CPT 30901	30112188	Outpatient	$346	$87	Payer Rates
INSERT EMERGENCY AIRWAY	CPT 31500	30111500	Outpatient	$400	$100	Payer Rates
INSERT BLADDER CATHETER	CPT 51701	30111108	Outpatient	$346	$87	Payer Rates
INSERT TEMP BLADDER CATH	CPT 51702	30111702	Outpatient	$346	$87	Payer Rates
INJECT ANES AGENT FACIAL NERVE	CPT 64402	30112401	Outpatient	$634	$159	Payer Rates
NERVOUS SYSTEM SURGERY	CPT 64999	30112401	Outpatient	$634	$159	Payer Rates
REMOVE FOREIGN BODY FROM EYE	CPT 65205	30112422	Outpatient	$265	$66	Payer Rates
CLEAR OUTER EAR CANAL	CPT 69200	30112437	Outpatient	$346	$87	Payer Rates
EMERGENCY DEPT VISIT	CPT 99281	30117225	Outpatient	$263	$66	Payer Rates
EMERGENCY DEPT VISIT	CPT 99282	30117250	Outpatient	$541	$135	Payer Rates
EMERGENCY DEPT VISIT	CPT 99283	30117330	Outpatient	$811	$203	Payer Rates
EMERGENCY DEPT VISIT	CPT 99284	30117335	Outpatient	$1,073	$268	Payer Rates
EMERGENCY DEPT VISIT	CPT 99285	30117340	Outpatient	$1,329	$332	Payer Rates
CRITICAL CARE FIRST HOUR	CPT 99291	30119291	Outpatient	$3,150	$788	Payer Rates
CRITICAL CARE ADDL 30 MIN	CPT 99292	30119292	Outpatient	$788	$197	Payer Rates
CATHETERIZE FOR URINE SPEC	HCPCS P9612	30111108	Outpatient	$346	$87	Payer Rates
IV Therapy
HYDRATION IV INFUSION INIT	CPT 96360	30111158	Outpatient	$325	$81	Payer Rates
HYDRATE IV INFUSION ADD-ON	CPT 96361	30111164	Outpatient	$155	$39	Payer Rates
THER/PROPH/DIAG IV INF INIT	CPT 96365	30111176	Outpatient	$456	$114	Payer Rates
THER/PROPH/DIAG IV INF ADDON	CPT 96366	30041516	Outpatient	$87	$22	Payer Rates
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	30111173	Outpatient	$141	$35	Payer Rates
THER/DIAG CONCURRENT INF	CPT 96368	30111179	Outpatient	$63	$16	Payer Rates
THER/PROPH/DIAG INJ SC/IM	CPT 96372	30111190	Outpatient	$176	$44	Payer Rates
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	30116374	Outpatient	$449	$112	Payer Rates
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	30111182	Outpatient	$152	$38	Payer Rates
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	30041416	Outpatient	$142	$36	Payer Rates
Imaging
PERQ DEVICE BREAST 1ST IMAG	CPT 19281	30306283	Outpatient	$881	$220	Payer Rates
ULTRASOUND BREAST COMPLETE	CPT 76641	30306178	Outpatient	$475	$119	Payer Rates
US BRST UNILAT REAL TIME COMP	CPT 76645	30306178	Outpatient	$475	$119	Payer Rates
FETAL BIOPHYS PROFILE W/NST	CPT 76818	30306226	Outpatient	$656	$164	Payer Rates
FETAL BIOPHYS PROFIL W/O NST	CPT 76819	30306226	Outpatient	$656	$164	Payer Rates
UMBILICAL ARTERY ECHO	CPT 76820	30096820	Outpatient	$241	$60	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	-	-	-	-	-
Labor and Delivery
CIRCUMCISION W/REGIONL BLOCK	CPT 54150	30084150	Outpatient	$2,686	$672	Payer Rates
FETAL NON-STRESS TEST	CPT 59025	30091849	Outpatient	$664	$166	Payer Rates
OBSTETRICAL CARE	CPT 59410	30091852	Outpatient	$4,725	$1,181	Payer Rates
Laboratory
ROUTINE VENIPUNCTURE	CPT 36415	30272497	Outpatient	$42	$11	Payer Rates
CAPILLARY BLOOD DRAW	CPT 36416	30081838	Outpatient	$22	$6	Payer Rates
METABOLIC PANEL IONIZED CA	CPT 80047	30272503	Outpatient	$151	$38	Payer Rates
METABOLIC PANEL TOTAL CA	CPT 80048	30272506	Outpatient	$151	$38	Payer Rates
ELECTROLYTE PANEL	CPT 80051	30272512	Outpatient	$93	$23	Payer Rates
COMPREHEN METABOLIC PANEL	CPT 80053	30272515	Outpatient	$320	$80	Payer Rates
OBSTETRIC PANEL	CPT 80055	30272518	Outpatient	$364	$91	Payer Rates
LIPID PANEL	CPT 80061	30272521	Outpatient	$179	$45	Payer Rates
RENAL FUNCTION PANEL	CPT 80069	30272524	Outpatient	$158	$40	Payer Rates
ACUTE HEPATITIS PANEL	CPT 80074	30272527	Outpatient	$343	$86	Payer Rates
HEPATIC FUNCTION PANEL	CPT 80076	30272530	Outpatient	$138	$35	Payer Rates
URINE DRUG SCREEN	CPT 80104	30275242	Outpatient	$184	$46	Payer Rates
ASSAY CARBAMAZEPINE TOTAL	CPT 80156	30272551	Outpatient	$139	$35	Payer Rates
ASSAY OF DIGOXIN TOTAL	CPT 80162	30272560	Outpatient	$108	$27	Payer Rates
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	30272563	Outpatient	$139	$35	Payer Rates
DRUG SCRN QUAN LEVETIRACETAM	CPT 80177	30272590	Outpatient	$105	$26	Payer Rates
ASSAY OF LITHIUM	CPT 80178	30272593	Outpatient	$135	$34	Payer Rates
ASSAY OF PHENYTOIN TOTAL	CPT 80185	30272611	Outpatient	$108	$27	Payer Rates
ASSAY OF TACROLIMUS	CPT 80197	30272629	Outpatient	$105	$26	Payer Rates
ASSAY OF TOBRAMYCIN	CPT 80200	30272638	Outpatient	$116	$29	Payer Rates
ASSAY OF VANCOMYCIN	CPT 80202	30273438	Outpatient	$173	$43	Payer Rates
URINE DRUG SCREEN	CPT 80300	30275242	Outpatient	$184	$46	Payer Rates
DRUG TEST PRSMV DIR OPT OBS	CPT 80305	30275242	Outpatient	$184	$46	Payer Rates
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	30275242	Outpatient	$184	$46	Payer Rates
URINALYSIS AUTO W/SCOPE	CPT 81001	30272680	Outpatient	$81	$20	Payer Rates
(Not Offered) URINALYSIS TEST	CPT 81002	-	-	-	-	-
URINALYSIS AUTO W/O SCOPE	CPT 81003	30272683	Outpatient	$61	$15	Payer Rates
URINE PREGNANCY TEST	CPT 81025	30272689	Outpatient	$131	$33	Payer Rates
F5 GENE	CPT 81241	30272704	Outpatient	$439	$110	Payer Rates
TEST FOR ACETONE/KETONES	CPT 82009	30272722	Outpatient	$54	$14	Payer Rates
ASSAY OF SERUM ALBUMIN	CPT 82040	30272731	Outpatient	$79	$20	Payer Rates
OTHER SOURCE ALBUMIN QUAN EA	CPT 82042	30272734	Outpatient	$79	$20	Payer Rates
UR ALBUMIN QUANTITATIVE	CPT 82043	30272737	Outpatient	$80	$20	Payer Rates
ASSAY OF AMMONIA	CPT 82140	30272788	Outpatient	$139	$35	Payer Rates
ASSAY OF AMYLASE	CPT 82150	30272797	Outpatient	$122	$31	Payer Rates
BILE ACIDS TOTAL	CPT 82239	30272827	Outpatient	$124	$31	Payer Rates
BILIRUBIN TOTAL	CPT 82247	30272830	Outpatient	$122	$31	Payer Rates
BILIRUBIN DIRECT	CPT 82248	30272839	Outpatient	$122	$31	Payer Rates
OCCULT BLOOD FECES	CPT 82270	30110003	Outpatient	$108	$27	Payer Rates
ASSAY TEST FOR BLOOD FECAL	CPT 82274	30272851	Outpatient	$226	$57	Payer Rates
VITAMIN D 25 HYDROXY	CPT 82306	30272857	Outpatient	$250	$63	Payer Rates
ASSAY OF CALCIUM	CPT 82310	30272494	Outpatient	$105	$26	Payer Rates
ASSAY OF CALCIUM	CPT 82330	30272866	Outpatient	$99	$25	Payer Rates
CARCINOEMBRYONIC ANTIGEN	CPT 82378	30272884	Outpatient	$153	$38	Payer Rates
ASSAY OF COPPER	CPT 82525	30272947	Outpatient	$73	$18	Payer Rates
TOTAL CORTISOL	CPT 82533	30272956	Outpatient	$175	$44	Payer Rates
ASSAY OF CK (CPK)	CPT 82550	30272968	Outpatient	$139	$35	Payer Rates
CREATINE MB FRACTION	CPT 82553	30272974	Outpatient	$173	$43	Payer Rates
ASSAY OF CREATININE	CPT 82565	30272977	Outpatient	$79	$20	Payer Rates
ASSAY OF URINE CREATININE	CPT 82570	30272983	Outpatient	$105	$26	Payer Rates
CREATININE CLEARANCE TEST	CPT 82575	30272989	Outpatient	$241	$60	Payer Rates
VITAMIN B-12	CPT 82607	30272995	Outpatient	$150	$38	Payer Rates
DEHYDROEPIANDROSTERONE	CPT 82627	30273004	Outpatient	$176	$44	Payer Rates
VIT D 1 25-DIHYDROXY	CPT 82652	30273010	Outpatient	$306	$77	Payer Rates
ASSAY OF TOTAL ESTRADIOL	CPT 82670	30273019	Outpatient	$202	$51	Payer Rates
ASSAY OF FERRITIN	CPT 82728	30273046	Outpatient	$99	$25	Payer Rates
ASSAY OF FETAL FIBRONECTIN	CPT 82731	30273049	Outpatient	$462	$116	Payer Rates
ASSAY OF FOLIC ACID SERUM	CPT 82746	30273052	Outpatient	$160	$40	Payer Rates
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	30273061	Outpatient	$130	$33	Payer Rates
ASSAY OF IGE	CPT 82785	30273094	Outpatient	$130	$33	Payer Rates
IGG 1 2 3 OR 4 EACH	CPT 82787	30273097	Outpatient	$145	$36	Payer Rates
BLOOD PH	CPT 82800	30031198	Outpatient	$263	$66	Payer Rates
BLOOD GASES ANY COMBINATION	CPT 82803	30031195	Outpatient	$296	$74	Payer Rates
GLUCOSE OTHER FLUID	CPT 82945	30273121	Outpatient	$105	$26	Payer Rates
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	30273127	Outpatient	$63	$16	Payer Rates
GLUCOSE TEST	CPT 82950	30273130	Outpatient	$122	$31	Payer Rates
GLUCOSE TOLERANCE TEST (GTT)	CPT 82951	30273136	Outpatient	$209	$52	Payer Rates
GLUCOSE BLOOD TEST	CPT 82962	30041107	Outpatient	$15	$4	Payer Rates
ASSAY OF GGT	CPT 82977	30273157	Outpatient	$89	$22	Payer Rates
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	30273163	Outpatient	$135	$34	Payer Rates
ASSAY OF GONADOTROPIN (LH)	CPT 83002	30273166	Outpatient	$213	$53	Payer Rates
ASSAY OF HAPTOGLOBIN QUANT	CPT 83010	30273172	Outpatient	$74	$19	Payer Rates
H PYLORI (C-13) BREATH	CPT 83013	30375812	Outpatient	$188	$47	Payer Rates
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	30273190	Outpatient	$158	$40	Payer Rates
ASSAY OF HOMOCYSTINE	CPT 83090	30273205	Outpatient	$122	$31	Payer Rates
IMMUNOASSAY NONANTIBODY	CPT 83516	30273515	Outpatient	$67	$17	Payer Rates
RIA NONANTIBODY	CPT 83519	30273265	Outpatient	$189	$47	Payer Rates
ASSAY OF INSULIN	CPT 83525	30273286	Outpatient	$99	$25	Payer Rates
ASSAY OF IRON	CPT 83540	30273307	Outpatient	$50	$13	Payer Rates
IRON BINDING TEST	CPT 83550	30271200	Outpatient	$63	$16	Payer Rates
ASSAY OF LACTIC ACID	CPT 83605	30273316	Outpatient	$166	$42	Payer Rates
LACTATE (LD) (LDH) ENZYME	CPT 83615	30273322	Outpatient	$168	$42	Payer Rates
LACTOFERRIN FECAL (QUAL)	CPT 83630	30273328	Outpatient	$141	$35	Payer Rates
ASSAY OF LIPASE	CPT 83690	30273340	Outpatient	$122	$31	Payer Rates
ASSAY OF MAGNESIUM	CPT 83735	30273355	Outpatient	$115	$29	Payer Rates
SECOND NEWBORN SCREENING	CPT 83788	30273364	Outpatient	$131	$33	Payer Rates
MASS SPECTROMETRY QUAL/QUAN	CPT 83789	30273364	Outpatient	$131	$33	Payer Rates
ASSAY OF MYOGLOBIN	CPT 83874	30273385	Outpatient	$182	$46	Payer Rates
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	30273391	Outpatient	$296	$74	Payer Rates
ASSAY OF BLOOD OSMOLALITY	CPT 83930	30273418	Outpatient	$83	$21	Payer Rates
ASSAY OF URINE OSMOLALITY	CPT 83935	30273421	Outpatient	$99	$25	Payer Rates
ASSAY OF PARATHORMONE	CPT 83970	30273427	Outpatient	$297	$74	Payer Rates
ASSAY OF BLOOD PKU	CPT 84030	30273364	Outpatient	$131	$33	Payer Rates
ASSAY OF PHOSPHORUS	CPT 84100	30273460	Outpatient	$121	$30	Payer Rates
ASSAY OF SERUM POTASSIUM	CPT 84132	30273469	Outpatient	$79	$20	Payer Rates
ASSAY OF PREALBUMIN	CPT 84134	30273478	Outpatient	$91	$23	Payer Rates
ASSAY OF PROLACTIN	CPT 84146	30273490	Outpatient	$270	$68	Payer Rates
ASSAY OF PSA TOTAL	CPT 84153	30273493	Outpatient	$150	$38	Payer Rates
ASSAY OF PSA FREE	CPT 84154	30273496	Outpatient	$107	$27	Payer Rates
ASSAY OF PROTEIN URINE	CPT 84156	30273505	Outpatient	$90	$23	Payer Rates
ASSAY OF PROTEIN OTHER	CPT 84157	30273514	Outpatient	$197	$49	Payer Rates
PROTEIN E-PHORESIS SERUM	CPT 84165	30273523	Outpatient	$138	$35	Payer Rates
ASSAY OF VITAMIN B-6	CPT 84207	30273532	Outpatient	$164	$41	Payer Rates
ASSAY OF SEX HORMONE GLOBUL	CPT 84270	30273553	Outpatient	$158	$40	Payer Rates
ASSAY OF URINE SODIUM	CPT 84300	30273562	Outpatient	$29	$7	Payer Rates
ASSAY OF FREE TESTOSTERONE	CPT 84402	30270001	Outpatient	$140	$35	Payer Rates
ASSAY OF TOTAL TESTOSTERONE	CPT 84403	30273586	Outpatient	$187	$47	Payer Rates
ASSAY OF VITAMIN B-1	CPT 84425	30273595	Outpatient	$124	$31	Payer Rates
ASSAY OF TOTAL THYROXINE	CPT 84436	30273601	Outpatient	$58	$15	Payer Rates
ASSAY OF FREE THYROXINE	CPT 84439	30273604	Outpatient	$175	$44	Payer Rates
ASSAY THYROID STIM HORMONE	CPT 84443	30273613	Outpatient	$275	$69	Payer Rates
ASSAY OF VITAMIN E	CPT 84446	30273619	Outpatient	$150	$38	Payer Rates
ASSAY OF TRIGLYCERIDES	CPT 84478	30273634	Outpatient	$150	$38	Payer Rates
ASSAY TRIIODOTHYRONINE (T3)	CPT 84480	30273643	Outpatient	$161	$40	Payer Rates
FREE ASSAY (FT-3)	CPT 84481	30273646	Outpatient	$208	$52	Payer Rates
ASSAY OF UREA NITROGEN	CPT 84520	30273655	Outpatient	$79	$20	Payer Rates
ASSAY OF BLOOD/URIC ACID	CPT 84550	30273664	Outpatient	$150	$38	Payer Rates
ASSAY OF VITAMIN A	CPT 84590	30273685	Outpatient	$150	$38	Payer Rates
ASSAY OF VITAMIN K	CPT 84597	30273688	Outpatient	$205	$51	Payer Rates
ASSAY OF ZINC	CPT 84630	30273697	Outpatient	$67	$17	Payer Rates
CHORIONIC GONADOTROPIN TEST	CPT 84702	30273706	Outpatient	$254	$64	Payer Rates
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	30273709	Outpatient	$114	$29	Payer Rates
BL SMEAR W/DIFF WBC COUNT	CPT 85007	30271202	Outpatient	$43	$11	Payer Rates
HEMATOCRIT	CPT 85014	30273724	Outpatient	$55	$14	Payer Rates
HEMOGLOBIN	CPT 85018	30273727	Outpatient	$55	$14	Payer Rates
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	30273730	Outpatient	$109	$27	Payer Rates
COMPLETE CBC AUTOMATED	CPT 85027	30273440	Outpatient	$134	$34	Payer Rates
AUTOMATED PLATELET COUNT	CPT 85049	30273748	Outpatient	$42	$11	Payer Rates
FIBRIN DEGRADE SEMIQUANT	CPT 85378	30273808	Outpatient	$205	$51	Payer Rates
FIBRIN DEGRADATION QUANT	CPT 85379	30273808	Outpatient	$205	$51	Payer Rates
FIBRINOGEN ACTIVITY	CPT 85384	30273811	Outpatient	$90	$23	Payer Rates
PROTHROMBIN TIME	CPT 85610	30273835	Outpatient	$87	$22	Payer Rates
RBC SED RATE AUTOMATED	CPT 85652	30273856	Outpatient	$94	$24	Payer Rates
THROMBOPLASTIN TIME PARTIAL	CPT 85730	30273868	Outpatient	$115	$29	Payer Rates
ALLG SPEC IGE CRUDE XTRC EA	CPT 86003	30273907	Outpatient	$40	$10	Payer Rates
ANTINUCLEAR ANTIBODIES	CPT 86038	30273937	Outpatient	$155	$39	Payer Rates
C-REACTIVE PROTEIN	CPT 86140	30273946	Outpatient	$139	$35	Payer Rates
C-REACTIVE PROTEIN HS	CPT 86141	30273949	Outpatient	$150	$38	Payer Rates
CCP ANTIBODY	CPT 86200	30274015	Outpatient	$130	$33	Payer Rates
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	30274024	Outpatient	$137	$34	Payer Rates
IMMUNOASSAY TUMOR CA 19-9	CPT 86301	30274105	Outpatient	$150	$38	Payer Rates
IMMUNOASSAY TUMOR CA 125	CPT 86304	30274108	Outpatient	$150	$38	Payer Rates
IMMUNOASSAY INFECTIOUS AGENT	CPT 86317	30274114	Outpatient	$152	$38	Payer Rates
IMMUNOASSAY INFECTIOUS AGENT	CPT 86317	30274135	Outpatient	$110	$28	Payer Rates
IMMUNOFIX E-PHORESIS SERUM	CPT 86334	30274144	Outpatient	$162	$41	Payer Rates
IMMUNFIX E-PHORSIS/URINE/CSF	CPT 86335	30274150	Outpatient	$227	$57	Payer Rates
MICROSOMAL ANTIBODY EACH	CPT 86376	30274195	Outpatient	$105	$26	Payer Rates
PARTICLE AGGLUT ANTBDY SCRN	CPT 86403	30274204	Outpatient	$81	$20	Payer Rates
RHEUMATOID FACTOR QUANT	CPT 86431	30274210	Outpatient	$105	$26	Payer Rates
SYPHILIS TEST NON-TREP QUAL	CPT 86592	30274216	Outpatient	$115	$29	Payer Rates
BARTONELLA ANTIBODY	CPT 86611	30274243	Outpatient	$131	$33	Payer Rates
COCCIDIOIDES ANTIBODY	CPT 86635	30274294	Outpatient	$67	$17	Payer Rates
CMV ANTIBODY	CPT 86644	30274303	Outpatient	$160	$40	Payer Rates
CMV ANTIBODY IGM	CPT 86645	30274309	Outpatient	$160	$40	Payer Rates
EPSTEIN-BARR CAPSID VCA	CPT 86665	30274339	Outpatient	$152	$38	Payer Rates
HERPES SIMPLEX NES ANTBDY	CPT 86694	30274381	Outpatient	$147	$37	Payer Rates
HISTOPLASMA ANTIBODY	CPT 86698	30274396	Outpatient	$73	$18	Payer Rates
HIV-1/HIV-2 1 RESULT ANTBDY	CPT 86703	30274402	Outpatient	$105	$26	Payer Rates
HEP B CORE ANTIBODY TOTAL	CPT 86704	30274405	Outpatient	$89	$22	Payer Rates
MUMPS ANTIBODY	CPT 86735	30274435	Outpatient	$95	$24	Payer Rates
RUBELLA ANTIBODY	CPT 86762	30274135	Outpatient	$110	$28	Payer Rates
RUBEOLA ANTIBODY	CPT 86765	30274474	Outpatient	$93	$23	Payer Rates
VARICELLA-ZOSTER ANTIBODY	CPT 86787	30274492	Outpatient	$75	$19	Payer Rates
WEST NILE VIRUS AB IGM	CPT 86788	30274498	Outpatient	$144	$36	Payer Rates
WEST NILE VIRUS ANTIBODY	CPT 86789	30274504	Outpatient	$144	$36	Payer Rates
HEPATITIS C AB TEST	CPT 86803	30274522	Outpatient	$150	$38	Payer Rates
HLA TYPING A B OR C	CPT 86812	30274528	Outpatient	$187	$47	Payer Rates
RBC ANTIBODY SCREEN	CPT 86850	30274531	Outpatient	$125	$31	Payer Rates
RBC ANTIBODY IDENTIFICATION	CPT 86870	30274537	Outpatient	$301	$75	Payer Rates
COOMBS TEST DIRECT	CPT 86880	30274558	Outpatient	$90	$23	Payer Rates
BLOOD TYPING SEROLOGIC ABO	CPT 86900	30274573	Outpatient	$65	$16	Payer Rates
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	30274579	Outpatient	$65	$16	Payer Rates
BLOOD TYPING RBC ANTIGENS	CPT 86905	30274597	Outpatient	$301	$75	Payer Rates
COMPATIBILITY TEST SPIN	CPT 86920	30274606	Outpatient	$114	$29	Payer Rates
COMPATIBILITY TEST INCUBATE	CPT 86921	30274609	Outpatient	$170	$43	Payer Rates
COMPATIBILITY TEST ANTIGLOB	CPT 86922	30274612	Outpatient	$114	$29	Payer Rates
SPECIMEN INFECT AGNT CONCNTJ	CPT 87015	30274627	Outpatient	$63	$16	Payer Rates
BLOOD CULTURE FOR BACTERIA	CPT 87040	30274630	Outpatient	$144	$36	Payer Rates
FECES CULTURE AEROBIC BACT	CPT 87045	30274633	Outpatient	$161	$40	Payer Rates
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	30274651	Outpatient	$150	$38	Payer Rates
CULTR BACTERIA EXCEPT BLOOD	CPT 87075	30274687	Outpatient	$138	$35	Payer Rates
CULTURE AEROBIC IDENTIFY	CPT 87077	30274699	Outpatient	$95	$24	Payer Rates
CULTURE SCREEN ONLY	CPT 87081	30274978	Outpatient	$158	$40	Payer Rates
URINE CULTURE/COLONY COUNT	CPT 87086	30274711	Outpatient	$150	$38	Payer Rates
MYCOBACTERIA CULTURE	CPT 87116	30274744	Outpatient	$218	$55	Payer Rates
MACROSCOPIC EXAM PARASITE	CPT 87169	30278330	Outpatient	$53	$13	Payer Rates
MICROBE SUSCEPTIBLE ENZYME	CPT 87185	30274777	Outpatient	$48	$12	Payer Rates
MICROBE SUSCEPTIBLE MIC	CPT 87186	30274780	Outpatient	$155	$39	Payer Rates
SMEAR GRAM STAIN	CPT 87205	30274804	Outpatient	$98	$25	Payer Rates
SMEAR FLUORESCENT/ACID STAI	CPT 87206	30274816	Outpatient	$103	$26	Payer Rates
SMEAR WET MOUNT SALINE/INK	CPT 87210	30274828	Outpatient	$53	$13	Payer Rates
GIARDIA AG IA	CPT 87329	30274876	Outpatient	$87	$22	Payer Rates
HPYLORI STOOL AG IA	CPT 87338	30274882	Outpatient	$133	$33	Payer Rates
HEPATITIS B SURFACE AG IA	CPT 87340	30274885	Outpatient	$120	$30	Payer Rates
HISTOPLASMA CAPSUL AG IA	CPT 87385	30274894	Outpatient	$67	$17	Payer Rates
STREP A AG IA	CPT 87430	30274912	Outpatient	$120	$30	Payer Rates
CHYLMD TRACH DNA AMP PROBE	CPT 87491	30274924	Outpatient	$252	$63	Payer Rates
C DIFF AMPLIFIED PROBE	CPT 87493	30274927	Outpatient	$252	$63	Payer Rates
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	30274948	Outpatient	$368	$92	Payer Rates
N.GONORRHOEAE DNA AMP PROB	CPT 87591	30274975	Outpatient	$252	$63	Payer Rates
DETECT AGENT NOS DNA AMP	CPT 87798	30274984	Outpatient	$252	$63	Payer Rates
INFLUENZA ASSAY W/OPTIC	CPT 87804	30274999	Outpatient	$149	$37	Payer Rates
RSV ASSAY W/OPTIC	CPT 87807	30275002	Outpatient	$116	$29	Payer Rates
AGENT NOS ASSAY W/OPTIC	CPT 87899	30275011	Outpatient	$158	$40	Payer Rates
BILIRUBIN TOTAL TRANSCUT	CPT 88720	30081846	Outpatient	$52	$13	Payer Rates
BODY FLUID CELL COUNT	CPT 89050	30275068	Outpatient	$72	$18	Payer Rates
BODY FLUID CELL COUNT	CPT 89051	30275074	Outpatient	$127	$32	Payer Rates
Language Pathology
SPEECH SOUND LANG COMPREHEN	CPT 92523 (GN)	30461746	Outpatient	$508	$127	Payer Rates
EVALUATE SWALLOWING FUNCTION	CPT 92610	30467255	Outpatient	$234	$59	Payer Rates
EVALUATE SWALLOWING FUNCTION	CPT 92610 (GN)	30467255	Outpatient	$234	$59	Payer Rates
MOTION FLUOROSCOPY/SWALLOW	CPT 92611 (GN)	30467258	Outpatient	$387	$97	Payer Rates
Medical and Surgical Supplies
SCREW LOCKING 3.5X16MM	HCPCS C1713	30109617	Outpatient	$451	$113	Payer Rates
CATHETER INTRATHECAL	HCPCS C1755	3010010012	Outpatient	$915	$229	Payer Rates
BARRIER ADHESION 3X4 SM	HCPCS C1765	30100085	Outpatient	$1,114	$279	Payer Rates
PUMP PAIN PROMETRA II	HCPCS C1772	3010010008	Outpatient	$28,365	$7,091	Payer Rates
AUTOPLEX W/HV CEMENT KIT	HCPCS C1776	30100203	Outpatient	$2,900	$725	Payer Rates
LENS BASE CHARGE	HCPCS C1780	30109999	Outpatient	$504	$126	Payer Rates
MESH MACROPOROUS 11X6CM	HCPCS C1781	30100112	Outpatient	$480	$120	Payer Rates
PORT LOW PROFILE 8FR TITANIUM	HCPCS C1788	30107712	Outpatient	$1,890	$473	Payer Rates
CAPPED VERTIFLEX INTERSPINOUS	HCPCS C1821	30100077	Outpatient	$36,000	$9,000	Payer Rates
IPG KIT (NIPG1500)	HCPCS C1822	30100246	Outpatient	$74,000	$18,500	Payer Rates
KIT LEAD TRIAL (TLEAD1058-50B)	HCPCS C1897	30100256	Outpatient	$3,100	$775	Payer Rates
POST CHMBR INTRAOCULAR LENS	HCPCS V2632	30107933	Outpatient	$504	$126	Payer Rates
LENS ADD ON 1155.00 ASTIGMATIS	HCPCS V2787GY (GY)	30109996	Outpatient	$1,155	$289	Payer Rates
LENS ADD ON 630.00 ASTIGMATISM	HCPCS V2787GY (GY)	30109998	Outpatient	$600	$150	Payer Rates
LENS ADD ON 1050.00 PRESBYOPIA	HCPCS V2788GY (GY)	30109997	Outpatient	$1,100	$275	Payer Rates
Other Diagnostic
AEP SCR AUDITORY POTENTIAL	CPT 92650	30081831	Outpatient	$417	$104	Payer Rates
POLYSOM <6 YRS 4/> PARAMTRS	CPT 95782	30375782	Outpatient	$9,850	$2,463	Payer Rates
POLYSOM 6/> YRS 4/> PARAM	CPT 95810	30375810	Outpatient	$9,850	$2,463	Payer Rates
POLYSOM 6/>YRS CPAP 4/> PARM	CPT 95811	30375811	Outpatient	$9,850	$2,463	Payer Rates
Other Procedures and Observation
INSJ PICC 5 YR+ W/O IMAGING	CPT 36569	30041255	Outpatient	$2,214	$554	Payer Rates
COLLECT BLOOD FROM PICC	CPT 36592	30041238	Outpatient	$250	$63	Payer Rates
WITHDRAWAL OF ARTERIAL BLOOD	CPT 36600	30031126	Outpatient	$90	$23	Payer Rates
EPIDURAL STERIOD INJECTION	CPT 62311	30041188	Outpatient	$829	$207	Payer Rates
EPIDURAL STERIOD INJECTION	CPT 62311	30041188	Outpatient	$829	$207	Payer Rates
NJX INTERLAMINAR LMBR/SAC	CPT 62322	30041188	Outpatient	$829	$207	Payer Rates
IRRIG DRUG DELIVERY DEVICE	CPT 96523	30071777	Outpatient	$207	$52	Payer Rates
OFFICE O/P EST SF 10-19 MIN	CPT 99212	30099212	Outpatient	$190	$48	Payer Rates
OFFICE O/P EST LOW 20-29 MIN	CPT 99213	30099213	Outpatient	$235	$59	Payer Rates
OFFICE O/P EST MOD 30-39 MIN	CPT 99214	30099214	Outpatient	$280	$70	Payer Rates
HOSPITAL OBSERVATION PER HR	HCPCS G0378	30061291	Outpatient	$114	$29	Payer Rates
DIRECT REFER HOSPITAL OBSERV	HCPCS G0379	30061294	Outpatient	$533	$133	Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	30041789	Outpatient	$1,477	$369	Payer Rates
CARDIAC REHAB/MONITOR	CPT 93798	30436991	Outpatient	$303	$76	Payer Rates
ULTRAVIOLET LIGHT THERAPY	CPT 96900	30081855	Outpatient	$134	$34	Payer Rates
MEDICAL NUTRITION INDIV IN	CPT 97802	30700001	Outpatient	$200	$50	Payer Rates
MED NUTRITION INDIV SUBSEQ	CPT 97803	30700002	Outpatient	$150	$38	Payer Rates
BEHAV CHNG SMOKING 3-10 MIN	CPT 99406	30031069	Outpatient	$51	$13	Payer Rates
PULMONARY REHAB W EXER	HCPCS G0424	30436916	Outpatient	$212	$53	Payer Rates
RBC LEUKOCYTES REDUCED	HCPCS P9016	30275221	Outpatient	$686	$172	Payer Rates
PLASMA 1 DONOR FRZ W/IN 8 HR	HCPCS P9017	30275227	Outpatient	$188	$47	Payer Rates
PLATELET PHERES LEUKOREDUCED	HCPCS P9035	30275230	Outpatient	$1,494	$374	Payer Rates
RBC LEUKOREDUCED IRRADIATED	HCPCS P9040	30275233	Outpatient	$1,040	$260	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
EVALUATION OF WHEEZING	CPT 94060	30031114	Outpatient	$622	$156	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94760	30031066	Outpatient	$164	$41	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94761	30031067	Outpatient	$656	$164	Payer Rates
MEASURE BLOOD OXYGEN LEVEL	CPT 94762	30031063	Outpatient	$296	$74	Payer Rates
CO2 BY INFRARED ANALYZER	CPT 94770	30031033	Outpatient	$622	$156	Payer Rates
Radiology
X-RAY CHEST 1 VIEW	CPT 71010	30305668	Outpatient	$218	$55	Payer Rates
X-RAY CHEST 2 VIEWS	CPT 71020	30305674	Outpatient	$291	$73	Payer Rates
X-RAY EXAM CHEST 1 VIEW	CPT 71045	30305668	Outpatient	$218	$55	Payer Rates
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	30305674	Outpatient	$291	$73	Payer Rates
X-RAY EXAM OF HAND	CPT 73120 (RT)	30306616	Outpatient	$235	$59	Payer Rates
X-RAY EXAM OF HAND	CPT 73120 (RT)	30306616	Outpatient	$235	$59	Payer Rates
X-RAY EXAM HIP UNI 1 VIEW	CPT 73501 (RT)	30306616	Outpatient	$235	$59	Payer Rates
X-RAY EXAM HIP UNI 1 VIEW	CPT 73501 (LT)	30306643	Outpatient	$160	$40	Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502 (RT)	30306640	Outpatient	$277	$69	Payer Rates
HIP 2 VIEWS - RIGHT	CPT 73510 (RT)	30306640	Outpatient	$277	$69	Payer Rates
HIP LT INTRAOPERATIVE	CPT 73530 (LT)	30306643	Outpatient	$160	$40	Payer Rates
FEMUR LEFT 2 VIEWS	CPT 73550 (LT)	30306649	Outpatient	$191	$48	Payer Rates
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (LT)	30306649	Outpatient	$191	$48	Payer Rates
X-RAY KUB KIDNEY-URIN BLADDER	CPT 74000	30305941	Outpatient	$220	$55	Payer Rates
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	30305941	Outpatient	$220	$55	Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	30305944	Outpatient	$324	$81	Payer Rates
ABDOMEN 2 VIEWS	CPT 74020	30305944	Outpatient	$324	$81	Payer Rates
Respiratory
VENT MGMT INPAT INIT DAY	CPT 94002	30031108	Outpatient	$982	$246	Payer Rates
VENT MGMT INPAT SUBQ DAY	CPT 94003	30031111	Outpatient	$982	$246	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640	30031150	Outpatient	$432	$108	Payer Rates
AIRWAY INHALATION TREATMENT	CPT 94640 (76)	30031150	Outpatient	$432	$108	Payer Rates
CBT 1ST HOUR	CPT 94644	30031138	Outpatient	$346	$87	Payer Rates
POS AIRWAY PRESSURE CPAP	CPT 94660	30031087	Outpatient	$432	$108	Payer Rates
POS AIRWAY PRESSURE CPAP	CPT 94660 (76)	30031087	Outpatient	$432	$108	Payer Rates
EVALUATE PT USE OF INHALER	CPT 94664	30031135	Outpatient	$177	$44	Payer Rates
CHEST WALL MANIPULATION	CPT 94667	30031096	Outpatient	$432	$108	Payer Rates
CHEST WALL MANIPULATION	CPT 94668	30031093	Outpatient	$138	$35	Payer Rates
CHEST WALL MANIPULATION	CPT 94668 (76)	30031093	Outpatient	$138	$35	Payer Rates
CHEST WALL MANIPULATION	CPT 94668	30031093	Outpatient	$138	$35	Payer Rates
THERAPEUTIC PROCD STRG ENDUR	HCPCS G0237	30031117	Outpatient	$138	$35	Payer Rates
Surgical Procedures
FNA BX W/US GDN 1ST LES	CPT 10005	30300001	Outpatient	$1,347	$337	Payer Rates
DRAIN/INJ JOINT/BURSA W/O US	CPT 20610	30305359	Outpatient	$378	$95	Payer Rates
INJECTION FOR SHOULDER X-RAY	CPT 23350	30305371	Outpatient	$648	$162	Payer Rates
(Not Offered) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIE ...	CPT 42820	-	-	-	-	-
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...	CPT 45391	-	-	-	-	-
(Not Offered) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-	-
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...	CPT 55866	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-	-
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...	CPT 59610	-	-	-	-	-
INJ ANES AGNT/CATH INFUS INTER	CPT 62310	30181642	Outpatient	$829	$207	Payer Rates
NJX INTERLAMINAR CRV/THRC	CPT 62320	30181642	Outpatient	$829	$207	Payer Rates
NJX INTERLAMINAR LMBR/SAC	CPT 62323	30305346	Outpatient	$1,198	$300	Payer Rates
(Not Offered) REMOVAL OF RECURRING CATARACT IN LENS CAPSUL ...	CPT 66821	-	-	-	-	-
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...	CPT 93452	-	-	-	-	-
MOD SED SAME PHYS/QHP <5 YRS	CPT 99151	30113021	Outpatient	$199	$50	Payer Rates
MOD SED SAME PHYS/QHP 5/>YRS	CPT 99152	30113022	Outpatient	$199	$50	Payer Rates
MOD SED SAME PHYS/QHP EA	CPT 99153	30111021	Outpatient	$107	$27	Payer Rates
Therapy
ELECTRIC STIMULATION THERAPY	CPT 97014	30467060	Outpatient	$80	$20	Payer Rates
ELECTRIC STIMULATION THERAPY	CPT 97014	30467060	Outpatient	$80	$20	Payer Rates
ELECTRICAL STIMULATION	CPT 97032 (GP)	30467060	Outpatient	$80	$20	Payer Rates
ELECTRICAL STIMULATION	CPT 97032 (GP)	30467060	Outpatient	$80	$20	Payer Rates
NEUROMUSCULAR REEDUCATION	CPT 97112 (GP)	30467120	Outpatient	$92	$23	Payer Rates
GAIT TRAINING THERAPY	CPT 97116 (GP)	30467123	Outpatient	$84	$21	Payer Rates
MANUAL THERAPY 1/> REGIONS	CPT 97140 (GO)	30467444	Outpatient	$141	$35	Payer Rates
PT EVAL LOW COMPLEX 20 MIN	CPT 97161 (GP)	30467049	Outpatient	$202	$51	Payer Rates
PT EVAL MOD COMPLEX 30 MIN	CPT 97162 (GP)	30467052	Outpatient	$224	$56	Payer Rates
PT EVAL HIGH COMPLEX 45 MIN	CPT 97163 (GP)	30467053	Outpatient	$247	$62	Payer Rates
OT EVAL LOW COMPLEX 30 MIN	CPT 97165 (GO)	30467347	Outpatient	$279	$70	Payer Rates
OT EVAL MOD COMPLEX 45 MIN	CPT 97166 (GO)	30467349	Outpatient	$279	$70	Payer Rates
OT EVAL HIGH COMPLEX 60 MIN	CPT 97167 (GO)	30467350	Outpatient	$279	$70	Payer Rates
PT ESTIM UNATTENDED NON WOUND	HCPCS G0283GP (GP)	30467060	Outpatient	$80	$20	Payer Rates
PT ESTIM UNATTENDED NON WOUND	HCPCS G0283GP (GP)	30467060	Outpatient	$80	$20	Payer Rates
Uncategorized
REMOVAL OF BREAST LESION	CPT 19120	-	Outpatient	$2,744	$686	Payer Rates
SHO ARTHRS SRG DECOMPRESSION	CPT 29826	-	Outpatient	$4,219	$1,055	Payer Rates
KNEE ARTHROSCOPY/SURGERY	CPT 29881	-	Outpatient	$8,385	$2,096	Payer Rates
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	-	Outpatient	$4,434	$1,109	Payer Rates
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	-	Outpatient	$4,087	$1,022	Payer Rates
DIAGNOSTIC COLONOSCOPY	CPT 45378	-	Outpatient	$3,811	$953	Payer Rates
COLONOSCOPY AND BIOPSY	CPT 45380	-	Outpatient	$4,087	$1,022	Payer Rates
COLONOSCOPY W/LESION REMOVAL	CPT 45385	-	Outpatient	$1,773	$443	Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562	-	Outpatient	$8,259	$2,065	Payer Rates
PRP I/HERN INIT REDUC >5 YR	CPT 49505	-	Outpatient	$8,625	$2,156	Payer Rates
OBSTETRICAL CARE	CPT 59400	-	Outpatient	$5,189	$1,297	Payer Rates
NJX AA&/STRD TFRM EPI L/S 1	CPT 64483	-	Outpatient	$2,400	$600	Payer Rates
XCAPSL CTRC RMVL W/O ECP	CPT 66984	-	Outpatient	$2,625	$656	Payer Rates
CT HEAD/BRAIN W/O DYE	CPT 70450	-	Outpatient	$2,002	$501	Payer Rates
MRI BRAIN STEM W/O & W/DYE	CPT 70553	-	Outpatient	$4,311	$1,078	Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	-	Outpatient	$600	$150	Payer Rates
MRI LUMBAR SPINE W/O DYE	CPT 72148	-	Outpatient	$2,665	$666	Payer Rates
CT PELVIS W/DYE	CPT 72193	-	Outpatient	$252	$63	Payer Rates
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	-	Outpatient	$2,583	$646	Payer Rates
CT ABD & PELV W/CONTRAST	CPT 74177	-	Outpatient	$2,525	$631	Payer Rates
US EXAM ABDOM COMPLETE	CPT 76700	-	Outpatient	$950	$238	Payer Rates
OB US >= 14 WKS SNGL FETUS	CPT 76805	-	Outpatient	$686	$172	Payer Rates
TRANSVAGINAL US NON-OB	CPT 76830	-	Outpatient	$747	$187	Payer Rates
DX MAMMO INCL CAD UNI	CPT 77065	-	Outpatient	$175	$44	Payer Rates
DX MAMMO INCL CAD BI	CPT 77066	-	Outpatient	$223	$56	Payer Rates
SCR MAMMO BI INCL CAD	CPT 77067	-	Outpatient	$134	$34	Payer Rates
URINALYSIS NONAUTO W/SCOPE	CPT 81000	-	Outpatient	$109	$27	Payer Rates
IMMUNIZATION ADMIN	CPT 90471	30110471	Outpatient	$141	$35	Payer Rates
ELECTROCARDIOGRAM COMPLETE	CPT 93000	-	Outpatient	$40	$10	Payer Rates
THERAPEUTIC EXERCISES	CPT 97110	-	Outpatient	$186	$47	Payer Rates
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	-	Outpatient	$282	$71	Payer Rates
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	-	Outpatient	$336	$84	Payer Rates
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	-	Outpatient	$390	$98	Payer Rates
OFFICE CONSULTATION	CPT 99244	-	Outpatient	$462	$116	Payer Rates
PREV VISIT NEW AGE 18-39	CPT 99385	-	Outpatient	$250	$63	Payer Rates
PREV VISIT NEW AGE 40-64	CPT 99386	-	Outpatient	$250	$63	Payer Rates
TRAUMA RESPONS W/HOSP CRITI	HCPCS G0390	30117302	Outpatient	$2,334	$584	Payer Rates
TRAUMA RESPONS W/HOSP CRITI	HCPCS G0390	30117302	Outpatient	$2,334	$584	Payer Rates