North Texas Medical Center

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

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Cardiology
HEART/LUNG RESUSCITATION CPRCPT 9295030031192Outpatient$625$156Payer Rates
CARDIOVASCULAR STRESS TESTCPT 9301730031213Outpatient$625$156Payer Rates
ECHO 2D COMP/COLOR/DOP W/ CONHCPCS C892930306465Outpatient$2,136$534Payer Rates
Clinic
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243-----
EKG
ELECTROCARDIOGRAM TRACINGCPT 9300530031036Outpatient$310$78Payer Rates
Emergency Room
DRAINAGE OF SKIN ABSCESSCPT 1006030111109Outpatient$425$106Payer Rates
DRESS/DEBRID P-THICK BURN SCPT 1602030112095Outpatient$387$97Payer Rates
REMOVE NASAL FOREIGN BODYCPT 3030030112182Outpatient$346$87Payer Rates
CONTROL OF NOSEBLEEDCPT 3090130112188Outpatient$346$87Payer Rates
INSERT EMERGENCY AIRWAYCPT 3150030111500Outpatient$400$100Payer Rates
INSERT BLADDER CATHETERCPT 5170130111108Outpatient$346$87Payer Rates
INSERT TEMP BLADDER CATHCPT 5170230111702Outpatient$346$87Payer Rates
INJECT ANES AGENT FACIAL NERVECPT 6440230112401Outpatient$634$159Payer Rates
NERVOUS SYSTEM SURGERYCPT 6499930112401Outpatient$634$159Payer Rates
REMOVE FOREIGN BODY FROM EYECPT 6520530112422Outpatient$265$66Payer Rates
CLEAR OUTER EAR CANALCPT 6920030112437Outpatient$346$87Payer Rates
EMERGENCY DEPT VISITCPT 9928130117225Outpatient$263$66Payer Rates
EMERGENCY DEPT VISITCPT 9928230117250Outpatient$541$135Payer Rates
EMERGENCY DEPT VISITCPT 9928330117330Outpatient$811$203Payer Rates
EMERGENCY DEPT VISITCPT 9928430117335Outpatient$1,073$268Payer Rates
EMERGENCY DEPT VISITCPT 9928530117340Outpatient$1,329$332Payer Rates
CRITICAL CARE FIRST HOURCPT 9929130119291Outpatient$3,150$788Payer Rates
CRITICAL CARE ADDL 30 MINCPT 9929230119292Outpatient$788$197Payer Rates
CATHETERIZE FOR URINE SPECHCPCS P961230111108Outpatient$346$87Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 9636030111158Outpatient$325$81Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 9636130111164Outpatient$155$39Payer Rates
THER/PROPH/DIAG IV INF INITCPT 9636530111176Outpatient$456$114Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 9636630041516Outpatient$87$22Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 9636730111173Outpatient$141$35Payer Rates
THER/DIAG CONCURRENT INFCPT 9636830111179Outpatient$63$16Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 9637230111190Outpatient$176$44Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 9637430116374Outpatient$449$112Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 9637530111182Outpatient$152$38Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 9637630041416Outpatient$142$36Payer Rates
Imaging
PERQ DEVICE BREAST 1ST IMAGCPT 1928130306283Outpatient$881$220Payer Rates
ULTRASOUND BREAST COMPLETECPT 7664130306178Outpatient$475$119Payer Rates
US BRST UNILAT REAL TIME COMPCPT 7664530306178Outpatient$475$119Payer Rates
FETAL BIOPHYS PROFILE W/NSTCPT 7681830306226Outpatient$656$164Payer Rates
FETAL BIOPHYS PROFIL W/O NSTCPT 7681930306226Outpatient$656$164Payer Rates
UMBILICAL ARTERY ECHOCPT 7682030096820Outpatient$241$60Payer Rates
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...DRG 216-----
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460-----
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...DRG 470-----
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473-----
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...DRG 743-----
Labor and Delivery
CIRCUMCISION W/REGIONL BLOCKCPT 5415030084150Outpatient$2,686$672Payer Rates
FETAL NON-STRESS TESTCPT 5902530091849Outpatient$664$166Payer Rates
OBSTETRICAL CARECPT 5941030091852Outpatient$4,725$1,181Payer Rates
Laboratory
ROUTINE VENIPUNCTURECPT 3641530272497Outpatient$42$11Payer Rates
CAPILLARY BLOOD DRAWCPT 3641630081838Outpatient$22$6Payer Rates
METABOLIC PANEL IONIZED CACPT 8004730272503Outpatient$151$38Payer Rates
METABOLIC PANEL TOTAL CACPT 8004830272506Outpatient$151$38Payer Rates
ELECTROLYTE PANELCPT 8005130272512Outpatient$93$23Payer Rates
COMPREHEN METABOLIC PANELCPT 8005330272515Outpatient$320$80Payer Rates
OBSTETRIC PANELCPT 8005530272518Outpatient$364$91Payer Rates
LIPID PANELCPT 8006130272521Outpatient$179$45Payer Rates
RENAL FUNCTION PANELCPT 8006930272524Outpatient$158$40Payer Rates
ACUTE HEPATITIS PANELCPT 8007430272527Outpatient$343$86Payer Rates
HEPATIC FUNCTION PANELCPT 8007630272530Outpatient$138$35Payer Rates
URINE DRUG SCREENCPT 8010430275242Outpatient$184$46Payer Rates
ASSAY CARBAMAZEPINE TOTALCPT 8015630272551Outpatient$139$35Payer Rates
ASSAY OF DIGOXIN TOTALCPT 8016230272560Outpatient$108$27Payer Rates
ASSAY DIPROPYLACETIC ACD TOTCPT 8016430272563Outpatient$139$35Payer Rates
DRUG SCRN QUAN LEVETIRACETAMCPT 8017730272590Outpatient$105$26Payer Rates
ASSAY OF LITHIUMCPT 8017830272593Outpatient$135$34Payer Rates
ASSAY OF PHENYTOIN TOTALCPT 8018530272611Outpatient$108$27Payer Rates
ASSAY OF TACROLIMUSCPT 8019730272629Outpatient$105$26Payer Rates
ASSAY OF TOBRAMYCINCPT 8020030272638Outpatient$116$29Payer Rates
ASSAY OF VANCOMYCINCPT 8020230273438Outpatient$173$43Payer Rates
URINE DRUG SCREENCPT 8030030275242Outpatient$184$46Payer Rates
DRUG TEST PRSMV DIR OPT OBSCPT 8030530275242Outpatient$184$46Payer Rates
DRUG TEST PRSMV CHEM ANLYZRCPT 8030730275242Outpatient$184$46Payer Rates
URINALYSIS AUTO W/SCOPECPT 8100130272680Outpatient$81$20Payer Rates
(Not Offered) URINALYSIS TESTCPT 81002-----
URINALYSIS AUTO W/O SCOPECPT 8100330272683Outpatient$61$15Payer Rates
URINE PREGNANCY TESTCPT 8102530272689Outpatient$131$33Payer Rates
F5 GENECPT 8124130272704Outpatient$439$110Payer Rates
TEST FOR ACETONE/KETONESCPT 8200930272722Outpatient$54$14Payer Rates
ASSAY OF SERUM ALBUMINCPT 8204030272731Outpatient$79$20Payer Rates
OTHER SOURCE ALBUMIN QUAN EACPT 8204230272734Outpatient$79$20Payer Rates
UR ALBUMIN QUANTITATIVECPT 8204330272737Outpatient$80$20Payer Rates
ASSAY OF AMMONIACPT 8214030272788Outpatient$139$35Payer Rates
ASSAY OF AMYLASECPT 8215030272797Outpatient$122$31Payer Rates
BILE ACIDS TOTALCPT 8223930272827Outpatient$124$31Payer Rates
BILIRUBIN TOTALCPT 8224730272830Outpatient$122$31Payer Rates
BILIRUBIN DIRECTCPT 8224830272839Outpatient$122$31Payer Rates
OCCULT BLOOD FECESCPT 8227030110003Outpatient$108$27Payer Rates
ASSAY TEST FOR BLOOD FECALCPT 8227430272851Outpatient$226$57Payer Rates
VITAMIN D 25 HYDROXYCPT 8230630272857Outpatient$250$63Payer Rates
ASSAY OF CALCIUMCPT 8231030272494Outpatient$105$26Payer Rates
ASSAY OF CALCIUMCPT 8233030272866Outpatient$99$25Payer Rates
CARCINOEMBRYONIC ANTIGENCPT 8237830272884Outpatient$153$38Payer Rates
ASSAY OF COPPERCPT 8252530272947Outpatient$73$18Payer Rates
TOTAL CORTISOLCPT 8253330272956Outpatient$175$44Payer Rates
ASSAY OF CK (CPK)CPT 8255030272968Outpatient$139$35Payer Rates
CREATINE MB FRACTIONCPT 8255330272974Outpatient$173$43Payer Rates
ASSAY OF CREATININECPT 8256530272977Outpatient$79$20Payer Rates
ASSAY OF URINE CREATININECPT 8257030272983Outpatient$105$26Payer Rates
CREATININE CLEARANCE TESTCPT 8257530272989Outpatient$241$60Payer Rates
VITAMIN B-12CPT 8260730272995Outpatient$150$38Payer Rates
DEHYDROEPIANDROSTERONECPT 8262730273004Outpatient$176$44Payer Rates
VIT D 1 25-DIHYDROXYCPT 8265230273010Outpatient$306$77Payer Rates
ASSAY OF TOTAL ESTRADIOLCPT 8267030273019Outpatient$202$51Payer Rates
ASSAY OF FERRITINCPT 8272830273046Outpatient$99$25Payer Rates
ASSAY OF FETAL FIBRONECTINCPT 8273130273049Outpatient$462$116Payer Rates
ASSAY OF FOLIC ACID SERUMCPT 8274630273052Outpatient$160$40Payer Rates
ASSAY IGA/IGD/IGG/IGM EACHCPT 8278430273061Outpatient$130$33Payer Rates
ASSAY OF IGECPT 8278530273094Outpatient$130$33Payer Rates
IGG 1 2 3 OR 4 EACHCPT 8278730273097Outpatient$145$36Payer Rates
BLOOD PHCPT 8280030031198Outpatient$263$66Payer Rates
BLOOD GASES ANY COMBINATIONCPT 8280330031195Outpatient$296$74Payer Rates
GLUCOSE OTHER FLUIDCPT 8294530273121Outpatient$105$26Payer Rates
ASSAY GLUCOSE BLOOD QUANTCPT 8294730273127Outpatient$63$16Payer Rates
GLUCOSE TESTCPT 8295030273130Outpatient$122$31Payer Rates
GLUCOSE TOLERANCE TEST (GTT)CPT 8295130273136Outpatient$209$52Payer Rates
GLUCOSE BLOOD TESTCPT 8296230041107Outpatient$15$4Payer Rates
ASSAY OF GGTCPT 8297730273157Outpatient$89$22Payer Rates
ASSAY OF GONADOTROPIN (FSH)CPT 8300130273163Outpatient$135$34Payer Rates
ASSAY OF GONADOTROPIN (LH)CPT 8300230273166Outpatient$213$53Payer Rates
ASSAY OF HAPTOGLOBIN QUANTCPT 8301030273172Outpatient$74$19Payer Rates
H PYLORI (C-13) BREATHCPT 8301330375812Outpatient$188$47Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 8303630273190Outpatient$158$40Payer Rates
ASSAY OF HOMOCYSTINECPT 8309030273205Outpatient$122$31Payer Rates
IMMUNOASSAY NONANTIBODYCPT 8351630273515Outpatient$67$17Payer Rates
RIA NONANTIBODYCPT 8351930273265Outpatient$189$47Payer Rates
ASSAY OF INSULINCPT 8352530273286Outpatient$99$25Payer Rates
ASSAY OF IRONCPT 8354030273307Outpatient$50$13Payer Rates
IRON BINDING TESTCPT 8355030271200Outpatient$63$16Payer Rates
ASSAY OF LACTIC ACIDCPT 8360530273316Outpatient$166$42Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 8361530273322Outpatient$168$42Payer Rates
LACTOFERRIN FECAL (QUAL)CPT 8363030273328Outpatient$141$35Payer Rates
ASSAY OF LIPASECPT 8369030273340Outpatient$122$31Payer Rates
ASSAY OF MAGNESIUMCPT 8373530273355Outpatient$115$29Payer Rates
SECOND NEWBORN SCREENINGCPT 8378830273364Outpatient$131$33Payer Rates
MASS SPECTROMETRY QUAL/QUANCPT 8378930273364Outpatient$131$33Payer Rates
ASSAY OF MYOGLOBINCPT 8387430273385Outpatient$182$46Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 8388030273391Outpatient$296$74Payer Rates
ASSAY OF BLOOD OSMOLALITYCPT 8393030273418Outpatient$83$21Payer Rates
ASSAY OF URINE OSMOLALITYCPT 8393530273421Outpatient$99$25Payer Rates
ASSAY OF PARATHORMONECPT 8397030273427Outpatient$297$74Payer Rates
ASSAY OF BLOOD PKUCPT 8403030273364Outpatient$131$33Payer Rates
ASSAY OF PHOSPHORUSCPT 8410030273460Outpatient$121$30Payer Rates
ASSAY OF SERUM POTASSIUMCPT 8413230273469Outpatient$79$20Payer Rates
ASSAY OF PREALBUMINCPT 8413430273478Outpatient$91$23Payer Rates
ASSAY OF PROLACTINCPT 8414630273490Outpatient$270$68Payer Rates
ASSAY OF PSA TOTALCPT 8415330273493Outpatient$150$38Payer Rates
ASSAY OF PSA FREECPT 8415430273496Outpatient$107$27Payer Rates
ASSAY OF PROTEIN URINECPT 8415630273505Outpatient$90$23Payer Rates
ASSAY OF PROTEIN OTHERCPT 8415730273514Outpatient$197$49Payer Rates
PROTEIN E-PHORESIS SERUMCPT 8416530273523Outpatient$138$35Payer Rates
ASSAY OF VITAMIN B-6CPT 8420730273532Outpatient$164$41Payer Rates
ASSAY OF SEX HORMONE GLOBULCPT 8427030273553Outpatient$158$40Payer Rates
ASSAY OF URINE SODIUMCPT 8430030273562Outpatient$29$7Payer Rates
ASSAY OF FREE TESTOSTERONECPT 8440230270001Outpatient$140$35Payer Rates
ASSAY OF TOTAL TESTOSTERONECPT 8440330273586Outpatient$187$47Payer Rates
ASSAY OF VITAMIN B-1CPT 8442530273595Outpatient$124$31Payer Rates
ASSAY OF TOTAL THYROXINECPT 8443630273601Outpatient$58$15Payer Rates
ASSAY OF FREE THYROXINECPT 8443930273604Outpatient$175$44Payer Rates
ASSAY THYROID STIM HORMONECPT 8444330273613Outpatient$275$69Payer Rates
ASSAY OF VITAMIN ECPT 8444630273619Outpatient$150$38Payer Rates
ASSAY OF TRIGLYCERIDESCPT 8447830273634Outpatient$150$38Payer Rates
ASSAY TRIIODOTHYRONINE (T3)CPT 8448030273643Outpatient$161$40Payer Rates
FREE ASSAY (FT-3)CPT 8448130273646Outpatient$208$52Payer Rates
ASSAY OF UREA NITROGENCPT 8452030273655Outpatient$79$20Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 8455030273664Outpatient$150$38Payer Rates
ASSAY OF VITAMIN ACPT 8459030273685Outpatient$150$38Payer Rates
ASSAY OF VITAMIN KCPT 8459730273688Outpatient$205$51Payer Rates
ASSAY OF ZINCCPT 8463030273697Outpatient$67$17Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 8470230273706Outpatient$254$64Payer Rates
CHORIONIC GONADOTROPIN ASSAYCPT 8470330273709Outpatient$114$29Payer Rates
BL SMEAR W/DIFF WBC COUNTCPT 8500730271202Outpatient$43$11Payer Rates
HEMATOCRITCPT 8501430273724Outpatient$55$14Payer Rates
HEMOGLOBINCPT 8501830273727Outpatient$55$14Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 8502530273730Outpatient$109$27Payer Rates
COMPLETE CBC AUTOMATEDCPT 8502730273440Outpatient$134$34Payer Rates
AUTOMATED PLATELET COUNTCPT 8504930273748Outpatient$42$11Payer Rates
FIBRIN DEGRADE SEMIQUANTCPT 8537830273808Outpatient$205$51Payer Rates
FIBRIN DEGRADATION QUANTCPT 8537930273808Outpatient$205$51Payer Rates
FIBRINOGEN ACTIVITYCPT 8538430273811Outpatient$90$23Payer Rates
PROTHROMBIN TIMECPT 8561030273835Outpatient$87$22Payer Rates
RBC SED RATE AUTOMATEDCPT 8565230273856Outpatient$94$24Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 8573030273868Outpatient$115$29Payer Rates
ALLG SPEC IGE CRUDE XTRC EACPT 8600330273907Outpatient$40$10Payer Rates
ANTINUCLEAR ANTIBODIESCPT 8603830273937Outpatient$155$39Payer Rates
C-REACTIVE PROTEINCPT 8614030273946Outpatient$139$35Payer Rates
C-REACTIVE PROTEIN HSCPT 8614130273949Outpatient$150$38Payer Rates
CCP ANTIBODYCPT 8620030274015Outpatient$130$33Payer Rates
NUCLEAR ANTIGEN ANTIBODYCPT 8623530274024Outpatient$137$34Payer Rates
IMMUNOASSAY TUMOR CA 19-9CPT 8630130274105Outpatient$150$38Payer Rates
IMMUNOASSAY TUMOR CA 125CPT 8630430274108Outpatient$150$38Payer Rates
IMMUNOASSAY INFECTIOUS AGENTCPT 8631730274114Outpatient$152$38Payer Rates
IMMUNOASSAY INFECTIOUS AGENTCPT 8631730274135Outpatient$110$28Payer Rates
IMMUNOFIX E-PHORESIS SERUMCPT 8633430274144Outpatient$162$41Payer Rates
IMMUNFIX E-PHORSIS/URINE/CSFCPT 8633530274150Outpatient$227$57Payer Rates
MICROSOMAL ANTIBODY EACHCPT 8637630274195Outpatient$105$26Payer Rates
PARTICLE AGGLUT ANTBDY SCRNCPT 8640330274204Outpatient$81$20Payer Rates
RHEUMATOID FACTOR QUANTCPT 8643130274210Outpatient$105$26Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 8659230274216Outpatient$115$29Payer Rates
BARTONELLA ANTIBODYCPT 8661130274243Outpatient$131$33Payer Rates
COCCIDIOIDES ANTIBODYCPT 8663530274294Outpatient$67$17Payer Rates
CMV ANTIBODYCPT 8664430274303Outpatient$160$40Payer Rates
CMV ANTIBODY IGMCPT 8664530274309Outpatient$160$40Payer Rates
EPSTEIN-BARR CAPSID VCACPT 8666530274339Outpatient$152$38Payer Rates
HERPES SIMPLEX NES ANTBDYCPT 8669430274381Outpatient$147$37Payer Rates
HISTOPLASMA ANTIBODYCPT 8669830274396Outpatient$73$18Payer Rates
HIV-1/HIV-2 1 RESULT ANTBDYCPT 8670330274402Outpatient$105$26Payer Rates
HEP B CORE ANTIBODY TOTALCPT 8670430274405Outpatient$89$22Payer Rates
MUMPS ANTIBODYCPT 8673530274435Outpatient$95$24Payer Rates
RUBELLA ANTIBODYCPT 8676230274135Outpatient$110$28Payer Rates
RUBEOLA ANTIBODYCPT 8676530274474Outpatient$93$23Payer Rates
VARICELLA-ZOSTER ANTIBODYCPT 8678730274492Outpatient$75$19Payer Rates
WEST NILE VIRUS AB IGMCPT 8678830274498Outpatient$144$36Payer Rates
WEST NILE VIRUS ANTIBODYCPT 8678930274504Outpatient$144$36Payer Rates
HEPATITIS C AB TESTCPT 8680330274522Outpatient$150$38Payer Rates
HLA TYPING A B OR CCPT 8681230274528Outpatient$187$47Payer Rates
RBC ANTIBODY SCREENCPT 8685030274531Outpatient$125$31Payer Rates
RBC ANTIBODY IDENTIFICATIONCPT 8687030274537Outpatient$301$75Payer Rates
COOMBS TEST DIRECTCPT 8688030274558Outpatient$90$23Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 8690030274573Outpatient$65$16Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 8690130274579Outpatient$65$16Payer Rates
BLOOD TYPING RBC ANTIGENSCPT 8690530274597Outpatient$301$75Payer Rates
COMPATIBILITY TEST SPINCPT 8692030274606Outpatient$114$29Payer Rates
COMPATIBILITY TEST INCUBATECPT 8692130274609Outpatient$170$43Payer Rates
COMPATIBILITY TEST ANTIGLOBCPT 8692230274612Outpatient$114$29Payer Rates
SPECIMEN INFECT AGNT CONCNTJCPT 8701530274627Outpatient$63$16Payer Rates
BLOOD CULTURE FOR BACTERIACPT 8704030274630Outpatient$144$36Payer Rates
FECES CULTURE AEROBIC BACTCPT 8704530274633Outpatient$161$40Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 8707030274651Outpatient$150$38Payer Rates
CULTR BACTERIA EXCEPT BLOODCPT 8707530274687Outpatient$138$35Payer Rates
CULTURE AEROBIC IDENTIFYCPT 8707730274699Outpatient$95$24Payer Rates
CULTURE SCREEN ONLYCPT 8708130274978Outpatient$158$40Payer Rates
URINE CULTURE/COLONY COUNTCPT 8708630274711Outpatient$150$38Payer Rates
MYCOBACTERIA CULTURECPT 8711630274744Outpatient$218$55Payer Rates
MACROSCOPIC EXAM PARASITECPT 8716930278330Outpatient$53$13Payer Rates
MICROBE SUSCEPTIBLE ENZYMECPT 8718530274777Outpatient$48$12Payer Rates
MICROBE SUSCEPTIBLE MICCPT 8718630274780Outpatient$155$39Payer Rates
SMEAR GRAM STAINCPT 8720530274804Outpatient$98$25Payer Rates
SMEAR FLUORESCENT/ACID STAICPT 8720630274816Outpatient$103$26Payer Rates
SMEAR WET MOUNT SALINE/INKCPT 8721030274828Outpatient$53$13Payer Rates
GIARDIA AG IACPT 8732930274876Outpatient$87$22Payer Rates
HPYLORI STOOL AG IACPT 8733830274882Outpatient$133$33Payer Rates
HEPATITIS B SURFACE AG IACPT 8734030274885Outpatient$120$30Payer Rates
HISTOPLASMA CAPSUL AG IACPT 8738530274894Outpatient$67$17Payer Rates
STREP A AG IACPT 8743030274912Outpatient$120$30Payer Rates
CHYLMD TRACH DNA AMP PROBECPT 8749130274924Outpatient$252$63Payer Rates
C DIFF AMPLIFIED PROBECPT 8749330274927Outpatient$252$63Payer Rates
HEPATITIS C REVRS TRNSCRPJCPT 8752230274948Outpatient$368$92Payer Rates
N.GONORRHOEAE DNA AMP PROBCPT 8759130274975Outpatient$252$63Payer Rates
DETECT AGENT NOS DNA AMPCPT 8779830274984Outpatient$252$63Payer Rates
INFLUENZA ASSAY W/OPTICCPT 8780430274999Outpatient$149$37Payer Rates
RSV ASSAY W/OPTICCPT 8780730275002Outpatient$116$29Payer Rates
AGENT NOS ASSAY W/OPTICCPT 8789930275011Outpatient$158$40Payer Rates
BILIRUBIN TOTAL TRANSCUTCPT 8872030081846Outpatient$52$13Payer Rates
BODY FLUID CELL COUNTCPT 8905030275068Outpatient$72$18Payer Rates
BODY FLUID CELL COUNTCPT 8905130275074Outpatient$127$32Payer Rates
Language Pathology
SPEECH SOUND LANG COMPREHENCPT 92523 (GN)30461746Outpatient$508$127Payer Rates
EVALUATE SWALLOWING FUNCTIONCPT 9261030467255Outpatient$234$59Payer Rates
EVALUATE SWALLOWING FUNCTIONCPT 92610 (GN)30467255Outpatient$234$59Payer Rates
MOTION FLUOROSCOPY/SWALLOWCPT 92611 (GN)30467258Outpatient$387$97Payer Rates
Medical and Surgical Supplies
SCREW LOCKING 3.5X16MMHCPCS C171330109617Outpatient$451$113Payer Rates
CATHETER INTRATHECALHCPCS C17553010010012Outpatient$915$229Payer Rates
BARRIER ADHESION 3X4 SMHCPCS C176530100085Outpatient$1,114$279Payer Rates
PUMP PAIN PROMETRA IIHCPCS C17723010010008Outpatient$28,365$7,091Payer Rates
AUTOPLEX W/HV CEMENT KITHCPCS C177630100203Outpatient$2,900$725Payer Rates
LENS BASE CHARGEHCPCS C178030109999Outpatient$504$126Payer Rates
MESH MACROPOROUS 11X6CMHCPCS C178130100112Outpatient$480$120Payer Rates
PORT LOW PROFILE 8FR TITANIUMHCPCS C178830107712Outpatient$1,890$473Payer Rates
CAPPED VERTIFLEX INTERSPINOUSHCPCS C182130100077Outpatient$36,000$9,000Payer Rates
IPG KIT (NIPG1500)HCPCS C182230100246Outpatient$74,000$18,500Payer Rates
KIT LEAD TRIAL (TLEAD1058-50B)HCPCS C189730100256Outpatient$3,100$775Payer Rates
POST CHMBR INTRAOCULAR LENSHCPCS V263230107933Outpatient$504$126Payer Rates
LENS ADD ON 1155.00 ASTIGMATISHCPCS V2787GY (GY)30109996Outpatient$1,155$289Payer Rates
LENS ADD ON 630.00 ASTIGMATISMHCPCS V2787GY (GY)30109998Outpatient$600$150Payer Rates
LENS ADD ON 1050.00 PRESBYOPIAHCPCS V2788GY (GY)30109997Outpatient$1,100$275Payer Rates
Other Diagnostic
AEP SCR AUDITORY POTENTIALCPT 9265030081831Outpatient$417$104Payer Rates
POLYSOM <6 YRS 4/> PARAMTRSCPT 9578230375782Outpatient$9,850$2,463Payer Rates
POLYSOM 6/> YRS 4/> PARAMCPT 9581030375810Outpatient$9,850$2,463Payer Rates
POLYSOM 6/>YRS CPAP 4/> PARMCPT 9581130375811Outpatient$9,850$2,463Payer Rates
Other Procedures and Observation
INSJ PICC 5 YR+ W/O IMAGINGCPT 3656930041255Outpatient$2,214$554Payer Rates
COLLECT BLOOD FROM PICCCPT 3659230041238Outpatient$250$63Payer Rates
WITHDRAWAL OF ARTERIAL BLOODCPT 3660030031126Outpatient$90$23Payer Rates
EPIDURAL STERIOD INJECTIONCPT 6231130041188Outpatient$829$207Payer Rates
EPIDURAL STERIOD INJECTIONCPT 6231130041188Outpatient$829$207Payer Rates
NJX INTERLAMINAR LMBR/SACCPT 6232230041188Outpatient$829$207Payer Rates
IRRIG DRUG DELIVERY DEVICECPT 9652330071777Outpatient$207$52Payer Rates
OFFICE O/P EST SF 10-19 MINCPT 9921230099212Outpatient$190$48Payer Rates
OFFICE O/P EST LOW 20-29 MINCPT 9921330099213Outpatient$235$59Payer Rates
OFFICE O/P EST MOD 30-39 MINCPT 9921430099214Outpatient$280$70Payer Rates
HOSPITAL OBSERVATION PER HRHCPCS G037830061291Outpatient$114$29Payer Rates
DIRECT REFER HOSPITAL OBSERVHCPCS G037930061294Outpatient$533$133Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 3643030041789Outpatient$1,477$369Payer Rates
CARDIAC REHAB/MONITORCPT 9379830436991Outpatient$303$76Payer Rates
ULTRAVIOLET LIGHT THERAPYCPT 9690030081855Outpatient$134$34Payer Rates
MEDICAL NUTRITION INDIV INCPT 9780230700001Outpatient$200$50Payer Rates
MED NUTRITION INDIV SUBSEQCPT 9780330700002Outpatient$150$38Payer Rates
BEHAV CHNG SMOKING 3-10 MINCPT 9940630031069Outpatient$51$13Payer Rates
PULMONARY REHAB W EXERHCPCS G042430436916Outpatient$212$53Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P901630275221Outpatient$686$172Payer Rates
PLASMA 1 DONOR FRZ W/IN 8 HRHCPCS P901730275227Outpatient$188$47Payer Rates
PLATELET PHERES LEUKOREDUCEDHCPCS P903530275230Outpatient$1,494$374Payer Rates
RBC LEUKOREDUCED IRRADIATEDHCPCS P904030275233Outpatient$1,040$260Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MINCPT 90832-----
(Not Offered) PSYCHOTHERAPY, 45 MINCPT 90834-----
(Not Offered) PSYCHOTHERAPY, 60 MINCPT 90837-----
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...CPT 90846-----
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...CPT 90847-----
(Not Offered) GROUP PSYCHOTHERAPYCPT 90853-----
Pulmonary Function
EVALUATION OF WHEEZINGCPT 9406030031114Outpatient$622$156Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 9476030031066Outpatient$164$41Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 9476130031067Outpatient$656$164Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 9476230031063Outpatient$296$74Payer Rates
CO2 BY INFRARED ANALYZERCPT 9477030031033Outpatient$622$156Payer Rates
Radiology
X-RAY CHEST 1 VIEWCPT 7101030305668Outpatient$218$55Payer Rates
X-RAY CHEST 2 VIEWSCPT 7102030305674Outpatient$291$73Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 7104530305668Outpatient$218$55Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 7104630305674Outpatient$291$73Payer Rates
X-RAY EXAM OF HANDCPT 73120 (RT)30306616Outpatient$235$59Payer Rates
X-RAY EXAM OF HANDCPT 73120 (RT)30306616Outpatient$235$59Payer Rates
X-RAY EXAM HIP UNI 1 VIEWCPT 73501 (RT)30306616Outpatient$235$59Payer Rates
X-RAY EXAM HIP UNI 1 VIEWCPT 73501 (LT)30306643Outpatient$160$40Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)30306640Outpatient$277$69Payer Rates
HIP 2 VIEWS - RIGHTCPT 73510 (RT)30306640Outpatient$277$69Payer Rates
HIP LT INTRAOPERATIVECPT 73530 (LT)30306643Outpatient$160$40Payer Rates
FEMUR LEFT 2 VIEWSCPT 73550 (LT)30306649Outpatient$191$48Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT)30306649Outpatient$191$48Payer Rates
X-RAY KUB KIDNEY-URIN BLADDERCPT 7400030305941Outpatient$220$55Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 7401830305941Outpatient$220$55Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 7401930305944Outpatient$324$81Payer Rates
ABDOMEN 2 VIEWSCPT 7402030305944Outpatient$324$81Payer Rates
Respiratory
VENT MGMT INPAT INIT DAYCPT 9400230031108Outpatient$982$246Payer Rates
VENT MGMT INPAT SUBQ DAYCPT 9400330031111Outpatient$982$246Payer Rates
AIRWAY INHALATION TREATMENTCPT 9464030031150Outpatient$432$108Payer Rates
AIRWAY INHALATION TREATMENTCPT 94640 (76)30031150Outpatient$432$108Payer Rates
CBT 1ST HOURCPT 9464430031138Outpatient$346$87Payer Rates
POS AIRWAY PRESSURE CPAPCPT 9466030031087Outpatient$432$108Payer Rates
POS AIRWAY PRESSURE CPAPCPT 94660 (76)30031087Outpatient$432$108Payer Rates
EVALUATE PT USE OF INHALERCPT 9466430031135Outpatient$177$44Payer Rates
CHEST WALL MANIPULATIONCPT 9466730031096Outpatient$432$108Payer Rates
CHEST WALL MANIPULATIONCPT 9466830031093Outpatient$138$35Payer Rates
CHEST WALL MANIPULATIONCPT 94668 (76)30031093Outpatient$138$35Payer Rates
CHEST WALL MANIPULATIONCPT 9466830031093Outpatient$138$35Payer Rates
THERAPEUTIC PROCD STRG ENDURHCPCS G023730031117Outpatient$138$35Payer Rates
Surgical Procedures
FNA BX W/US GDN 1ST LESCPT 1000530300001Outpatient$1,347$337Payer Rates
DRAIN/INJ JOINT/BURSA W/O USCPT 2061030305359Outpatient$378$95Payer Rates
INJECTION FOR SHOULDER X-RAYCPT 2335030305371Outpatient$648$162Payer 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 GLANDCPT 55700-----
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...CPT 55866-----
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...CPT 59610-----
INJ ANES AGNT/CATH INFUS INTERCPT 6231030181642Outpatient$829$207Payer Rates
NJX INTERLAMINAR CRV/THRCCPT 6232030181642Outpatient$829$207Payer Rates
NJX INTERLAMINAR LMBR/SACCPT 6232330305346Outpatient$1,198$300Payer 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 YRSCPT 9915130113021Outpatient$199$50Payer Rates
MOD SED SAME PHYS/QHP 5/>YRSCPT 9915230113022Outpatient$199$50Payer Rates
MOD SED SAME PHYS/QHP EACPT 9915330111021Outpatient$107$27Payer Rates
Therapy
ELECTRIC STIMULATION THERAPYCPT 9701430467060Outpatient$80$20Payer Rates
ELECTRIC STIMULATION THERAPYCPT 9701430467060Outpatient$80$20Payer Rates
ELECTRICAL STIMULATIONCPT 97032 (GP)30467060Outpatient$80$20Payer Rates
ELECTRICAL STIMULATIONCPT 97032 (GP)30467060Outpatient$80$20Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)30467120Outpatient$92$23Payer Rates
GAIT TRAINING THERAPYCPT 97116 (GP)30467123Outpatient$84$21Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GO)30467444Outpatient$141$35Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)30467049Outpatient$202$51Payer Rates
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)30467052Outpatient$224$56Payer Rates
PT EVAL HIGH COMPLEX 45 MINCPT 97163 (GP)30467053Outpatient$247$62Payer Rates
OT EVAL LOW COMPLEX 30 MINCPT 97165 (GO)30467347Outpatient$279$70Payer Rates
OT EVAL MOD COMPLEX 45 MINCPT 97166 (GO)30467349Outpatient$279$70Payer Rates
OT EVAL HIGH COMPLEX 60 MINCPT 97167 (GO)30467350Outpatient$279$70Payer Rates
PT ESTIM UNATTENDED NON WOUNDHCPCS G0283GP (GP)30467060Outpatient$80$20Payer Rates
PT ESTIM UNATTENDED NON WOUNDHCPCS G0283GP (GP)30467060Outpatient$80$20Payer Rates
Uncategorized
REMOVAL OF BREAST LESIONCPT 19120-Outpatient$2,744$686Payer Rates
SHO ARTHRS SRG DECOMPRESSIONCPT 29826-Outpatient$4,219$1,055Payer Rates
KNEE ARTHROSCOPY/SURGERYCPT 29881-Outpatient$8,385$2,096Payer Rates
EGD DIAGNOSTIC BRUSH WASHCPT 43235-Outpatient$4,434$1,109Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 43239-Outpatient$4,087$1,022Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 45378-Outpatient$3,811$953Payer Rates
COLONOSCOPY AND BIOPSYCPT 45380-Outpatient$4,087$1,022Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 45385-Outpatient$1,773$443Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562-Outpatient$8,259$2,065Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 49505-Outpatient$8,625$2,156Payer Rates
OBSTETRICAL CARECPT 59400-Outpatient$5,189$1,297Payer Rates
NJX AA&/STRD TFRM EPI L/S 1CPT 64483-Outpatient$2,400$600Payer Rates
XCAPSL CTRC RMVL W/O ECPCPT 66984-Outpatient$2,625$656Payer Rates
CT HEAD/BRAIN W/O DYECPT 70450-Outpatient$2,002$501Payer Rates
MRI BRAIN STEM W/O & W/DYECPT 70553-Outpatient$4,311$1,078Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110-Outpatient$600$150Payer Rates
MRI LUMBAR SPINE W/O DYECPT 72148-Outpatient$2,665$666Payer Rates
CT PELVIS W/DYECPT 72193-Outpatient$252$63Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721-Outpatient$2,583$646Payer Rates
CT ABD & PELV W/CONTRASTCPT 74177-Outpatient$2,525$631Payer Rates
US EXAM ABDOM COMPLETECPT 76700-Outpatient$950$238Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 76805-Outpatient$686$172Payer Rates
TRANSVAGINAL US NON-OBCPT 76830-Outpatient$747$187Payer Rates
DX MAMMO INCL CAD UNICPT 77065-Outpatient$175$44Payer Rates
DX MAMMO INCL CAD BICPT 77066-Outpatient$223$56Payer Rates
SCR MAMMO BI INCL CADCPT 77067-Outpatient$134$34Payer Rates
URINALYSIS NONAUTO W/SCOPECPT 81000-Outpatient$109$27Payer Rates
IMMUNIZATION ADMINCPT 9047130110471Outpatient$141$35Payer Rates
ELECTROCARDIOGRAM COMPLETECPT 93000-Outpatient$40$10Payer Rates
THERAPEUTIC EXERCISESCPT 97110-Outpatient$186$47Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 99203-Outpatient$282$71Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 99204-Outpatient$336$84Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 99205-Outpatient$390$98Payer Rates
OFFICE CONSULTATIONCPT 99244-Outpatient$462$116Payer Rates
PREV VISIT NEW AGE 18-39CPT 99385-Outpatient$250$63Payer Rates
PREV VISIT NEW AGE 40-64CPT 99386-Outpatient$250$63Payer Rates
TRAUMA RESPONS W/HOSP CRITIHCPCS G039030117302Outpatient$2,334$584Payer Rates
TRAUMA RESPONS W/HOSP CRITIHCPCS G039030117302Outpatient$2,334$584Payer Rates