OmniPoint Health

Price List for Shoppable Services. Effective 07-11-2022.

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450 (TC)3631777Outpatient$2,260$260Payer Rates
CT HEAD/BRAIN W/DYECPT 70460 (TC)3631775Outpatient$2,279$403Payer Rates
CT HEAD/BRAIN W/O & W/DYECPT 70470 (TC)3631776Outpatient$2,877$418Payer Rates
CT ORBIT/EAR/FOSSA W/O DYECPT 70480 (TC)3631779Outpatient$1,754$260Payer Rates
CT MAXILLOFACIAL W/O DYECPT 70486 (TC)3631778Outpatient$2,113$260Payer Rates
CT MAXILLOFACIAL W/O DYECPT 70486 (TC)3631849Outpatient$2,113$260Payer Rates
CT MAXILLOFACIAL W/DYECPT 70487 (TC)3631790Outpatient$2,278$403Payer Rates
CT SOFT TISSUE NECK W/O DYECPT 70490 (TC)3631783Outpatient$2,117$260Payer Rates
CT SOFT TISSUE NECK W/DYECPT 70491 (TC)3631784Outpatient$2,398$403Payer Rates
CT SOFT TISSUE NECK W/DYECPT 70491 (TC)54131784Outpatient$2,398$403Payer Rates
CT SFT TSUE NCK W/O & W/DYECPT 70492 (TC)3631785Outpatient$2,526$418Payer Rates
CT SFT TSUE NCK W/O & W/DYECPT 704923631859Outpatient$5,543$418Payer Rates
CT SFT TSUE NCK W/O & W/DYECPT 70492 (TC)3631864Outpatient$2,526$418Payer Rates
CT ANGIOGRAPHY HEADCPT 70496 (TC)3631901Outpatient$2,705$488Payer Rates
CT ANGIOGRAPHY HEADCPT 70496 (TC)3631904Outpatient$2,705$488Payer Rates
CT ANGIOGRAPHY NECKCPT 70498 (TC)3631902Outpatient$2,805$488Payer Rates
CT THORAX DX C-CPT 71250 (TC)3631771Outpatient$2,264$260Payer Rates
CT THORAX DX C+CPT 71260 (TC)3631769Outpatient$2,665$403Payer Rates
CT THORAX DX C+CPT 71260 (TC)3631856Outpatient$2,665$403Payer Rates
CT THORAX DX C+CPT 71260 (TC)3631862Outpatient$2,665$403Payer Rates
CT THORAX DX C-/C+CPT 71270 (TC)3631770Outpatient$3,017$418Payer Rates
CT THORAX DX C-/C+CPT 71270 (TC)3631860Outpatient$7,400$418Payer Rates
CT THORAX LUNG CANCER SCR C-CPT 71271 (TC)3631857Outpatient$305$264Payer Rates
CT ANGIOGRAPHY CHESTCPT 71275 (TC)3631900Outpatient$2,905$488Payer Rates
CT NECK SPINE W/O DYECPT 72125 (TC)3631786Outpatient$2,754$260Payer Rates
CT CHEST SPINE W/O DYECPT 72128 (TC)3631789Outpatient$2,483$260Payer Rates
CT LUMBAR SPINE W/O DYECPT 72131 (TC)3631788Outpatient$2,418$260Payer Rates
CT PELVIS W/O DYECPT 72192 (TC)3631782Outpatient$2,213$260Payer Rates
CT PELVIS W/DYECPT 72193 (TC)3631780Outpatient$1,906$403Payer Rates
CT PELVIS W/O & W/DYECPT 72194 (TC)3631781Outpatient$2,268$418Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (RT)3631774Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (RT)3631825Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (LT)3631826Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (RT)3631829Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (LT)3631830Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (LT)3631834Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (RT)3631841Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/O DYECPT 73200 (LT)3631842Outpatient$2,079$260Payer Rates
CT UPPER EXTREMITY W/DYECPT 73201 (TC)3631796Outpatient$2,368$403Payer Rates
CT UPPER EXTREMITY W/DYECPT 73201 (TC)3631835Outpatient$2,363$403Payer Rates
CT UPPER EXTREMITY W/DYECPT 73201 (TC)3631847Outpatient$2,363$403Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (LT)3631799Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (RT)3631800Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (LT)3631804Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (RT)3631805Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (RT)3631808Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (LT)3631809Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (RT)3631813Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (LT)3631814Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (RT)3631821Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/O DYECPT 73700 (LT)3631822Outpatient$1,959$260Payer Rates
CT LOWER EXTREMITY W/DYECPT 73701 (LT)3631823Outpatient$1,863$403Payer Rates
CT ABDOMEN W/O DYECPT 74150 (TC)3631768Outpatient$2,372$260Payer Rates
CT ABDOMEN W/DYECPT 74160 (TC)3631767Outpatient$2,863$403Payer Rates
CT ABDOMEN W/O & W/DYECPT 74170 (TC)3631766Outpatient$3,291$418Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 741763631792Outpatient$3,885$517Payer Rates
CT ABD & PELV W/CONTRASTCPT 741773631793Outpatient$5,170$752Payer Rates
CT ABD & PELV 1/> REGNSCPT 741783631794Outpatient$5,300$765Payer Rates
Clinic
SPECIMEN HANDLING PT-LABCPT 990013411209Outpatient$30$30Payer Rates
(Not Offered) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT ...CPT 99204-----
(Not Offered) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243-----
(Not Offered) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244-----
(Not Offered) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EV ...CPT 99385-----
(Not Offered) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EV ...CPT 99386-----
EEG
POS AIRWAY PRESSURE CPAPCPT 946604231808Outpatient$785$785Payer Rates
(Not Offered) SLEEP STUDYCPT 95810-----
EKG
ELECTROCARDIOGRAM COMPLETECPT 930004231806Outpatient$155$155Payer Rates
EKG TRACING FOR INITIAL PREVHCPCS G04044231811Outpatient$145$145Payer Rates
Imaging
US EXAM ABDOM COMPLETECPT 76700 (TC)3331635Outpatient$1,090$236Payer Rates
ECHO EXAM OF ABDOMENCPT 76705 (TC)3931806Outpatient$870$236Payer Rates
ECHO EXAM OF ABDOMENCPT 76705 (TC)3931807Outpatient$870$236Payer Rates
ECHO EXAM OF ABDOMENCPT 76705 (TC)3931809Outpatient$870$236Payer Rates
US ABDL AORTA SCREEN AAACPT 767063931808Outpatient$261$236Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 76805 (TC)3331643Outpatient$578$243Payer Rates
TRANSVAGINAL US NON-OBCPT 76830 (TC)3331646Outpatient$966$243Payer Rates
US COMPL JOINT R-T W/IMGCPT 768813931816Outpatient$746$236Payer Rates
US COMPL JOINT R-T W/IMGCPT 768813931817Outpatient$746$236Payer Rates
(Not Offered) MAMMOGRAPHY OF ONE BREASTCPT 77065-----
(Not Offered) MAMMOGRAPHY OF BOTH BREASTSCPT 77066-----
(Not Offered) MAMMOGRAPHY, SCREENING, BILATERALCPT 77067-----
Inpatient Procedures
(Not Offered) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WI ...DRG 216-----
(Not Offered) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460-----
(Not Offered) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF L ...DRG 470-----
(Not Offered) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473-----
(Not Offered) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGN ...DRG 743-----
Laboratory
ROUTINE VENIPUNCTURECPT 364153411579Outpatient$25$25Payer Rates
METABOLIC PANEL TOTAL CACPT 800483030911Outpatient$264$17Payer Rates
METABOLIC PANEL TOTAL CACPT 8004834130911Outpatient$264$17Payer Rates
ELECTROLYTE PANELCPT 800513411210Outpatient$195$14Payer Rates
COMPREHEN METABOLIC PANELCPT 800533030912Outpatient$322$22Payer Rates
COMPREHEN METABOLIC PANELCPT 80053 (QW)3030913Outpatient$391$22Payer Rates
COMPREHEN METABOLIC PANELCPT 800533032041Outpatient$1,466$22Payer Rates
COMPREHEN METABOLIC PANELCPT 800533410913Outpatient$322$22Payer Rates
OBSTETRIC PANELCPT 80055 (90)3031402Outpatient$90$90Payer Rates
LIPID PANELCPT 800613030906Outpatient$177$25Payer Rates
LIPID PANELCPT 800613032053Outpatient$98$25Payer Rates
LIPID PANELCPT 800613410906Outpatient$177$25Payer Rates
RENAL FUNCTION PANELCPT 800693030937Outpatient$288$18Payer Rates
HEPATIC FUNCTION PANELCPT 800763031303Outpatient$235$15Payer Rates
HEPATIC FUNCTION PANELCPT 800763411303Outpatient$235$15Payer Rates
URINALYSIS NONAUTO W/SCOPECPT 810003031558Outpatient$65$7Payer Rates
URINALYSIS NONAUTO W/SCOPECPT 810003031560Outpatient$65$7Payer Rates
URINALYSIS NONAUTO W/SCOPECPT 810003411558Outpatient$65$7Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPECPT 81001-----
(Not Offered) URINALYSIS TESTCPT 81002-----
(Not Offered) URINALYSIS TESTCPT 81003-----
URINE PREGNANCY TESTCPT 810253411277Outpatient$161$18Payer Rates
OCCULT BLD FECES 1-3 TESTSCPT 822723411403Outpatient$58$8Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 836153411347Outpatient$178$11Payer Rates
ASSAY OF LIPASECPT 836903411356Outpatient$172$14Payer Rates
ASSAY OF MYOGLOBINCPT 838743411396Outpatient$197$25Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 838803411549Outpatient$297$77Payer Rates
ASSAY OF SERUM POTASSIUMCPT 841323411437Outpatient$71$10Payer Rates
ASSAY OF PSA TOTALCPT 841533030930Outpatient$175$35Payer Rates
ASSAY OF PSA TOTALCPT 841533412000Outpatient$175$35Payer Rates
ASSAY OF PSA FREECPT 84154 (90)3030925Outpatient$126$35Payer Rates
ASSAY OF TOTAL TESTOSTERONECPT 844033412009Outpatient$190$51Payer Rates
ASSAY OF TOTAL THYROXINECPT 844363412007Outpatient$113$14Payer Rates
ASSAY OF FREE THYROXINECPT 844393412008Outpatient$111$18Payer Rates
ASSAY THYROID STIM HORMONECPT 844433030944Outpatient$185$33Payer Rates
ASSAY THYROID STIM HORMONECPT 844433030952Outpatient$185$33Payer Rates
ASSAY THYROID STIM HORMONECPT 844433030955Outpatient$185$33Payer Rates
ASSAY THYROID STIM HORMONECPT 844433031791Outpatient$185$33Payer Rates
ASSAY THYROID STIM HORMONECPT 844433412006Outpatient$185$33Payer Rates
ASSAY OF VITAMIN ECPT 8444630301651Outpatient$103$103Payer Rates
ASSAY OF THYROID (T3 OR T4)CPT 844793412005Outpatient$108$11Payer Rates
ASSAY OF TROPONIN QUANTCPT 844843411552Outpatient$257$24Payer Rates
ASSAY OF UREA NITROGENCPT 845203411562Outpatient$68$8Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 845503411565Outpatient$87$10Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850253030864Outpatient$121$15Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850253032024Outpatient$293$15Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850253410864Outpatient$121$15Payer Rates
(Not Offered) COMPLETE BLOOD CELL COUNT (CBC), AUTOMATEDCPT 85027-----
PROTHROMBIN TIMECPT 856103030932Outpatient$90$57Payer Rates
PROTHROMBIN TIMECPT 856103412010Outpatient$90$57Payer Rates
RBC SED RATE NONAUTOMATEDCPT 856513411488Outpatient$89$7Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857303030934Outpatient$140$11Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857303412011Outpatient$140$11Payer Rates
HETEROPHILE ANTIBODY SCREENCPT 863083431308Outpatient$100$10Payer Rates
IA INFECTIOUS AGENT ANTIBODYCPT 863183411708Outpatient$85$85Payer Rates
SMEAR WET MOUNT SALINE/INKCPT 872103411510Outpatient$68$68Payer Rates
SARS-COV-2 COVID-19 AMP PRBCPT 876353412019Outpatient$161$161Payer Rates
SPUTUM SPECIMEN COLLECTIONCPT 892204040031Outpatient$99$99Payer Rates
SPECIMEN HANDLING PT-LABCPT 990013411273Outpatient$30$30Payer Rates
PSA SCREENINGHCPCS G01033412001Outpatient$155$35Payer Rates
MRI
MRI BRAIN STEM W/O & W/DYECPT 70553 (TC)4531819Outpatient$4,778$4,778Payer Rates
MRI LUMBAR SPINE W/O DYECPT 72148 (TC)4531841Outpatient$3,156$3,156Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (LT)4531831Outpatient$3,179$3,179Payer Rates
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 938803931805Outpatient$1,275$1,275Payer Rates
LOWER EXTREMITY STUDYCPT 93925 (TC)3931793Outpatient$1,297$1,297Payer Rates
LOWER EXTREMITY STUDYCPT 93926 (TC)3931795Outpatient$817$817Payer Rates
LOWER EXTREMITY STUDYCPT 93926 (TC)3931796Outpatient$817$817Payer Rates
UPPER EXTREMITY STUDYCPT 93931 (TC)3931798Outpatient$835$835Payer Rates
EXTREMITY STUDYCPT 93970 (TC)3931802Outpatient$1,460$1,460Payer Rates
EXTREMITY STUDYCPT 93970 (TC)3931812Outpatient$1,460$1,460Payer Rates
EXTREMITY STUDYCPT 93971 (TC)3931803Outpatient$939$939Payer Rates
EXTREMITY STUDYCPT 93971 (TC)3931804Outpatient$939$939Payer Rates
VASCULAR STUDYCPT 93975 (TC)3931800Outpatient$1,570$1,570Payer Rates
VASCULAR STUDYCPT 93978 (TC)3931790Outpatient$965$965Payer Rates
Other Procedures and Observation
OFFICE O/P NEW LOW 30-44 MINCPT 992031230138Outpatient$305$305Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 992051230146Outpatient$625$625Payer Rates
Psychiatric
(Not Offered) PSYCHOTHERAPY, 30 MINCPT 90832-----
(Not Offered) PSYCHOTHERAPY, 45 MINCPT 90834-----
(Not Offered) PSYCHOTHERAPY, 60 MINCPT 90837-----
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...CPT 90846-----
(Not Offered) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 ...CPT 90847-----
(Not Offered) GROUP PSYCHOTHERAPYCPT 90853-----
Pulmonary Function
BREATHING CAPACITY TESTCPT 940104040030Outpatient$165$165Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947614040029Outpatient$126$126Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947614040042Outpatient$120$120Payer Rates
Radiology
X-RAY EXAM OF JAW 4/> VIEWSCPT 70110 (TC)3531712Outpatient$689$205Payer Rates
X-RAY EXAM OF JAW 4/> VIEWSCPT 70110 (TC)44131712Outpatient$689$205Payer Rates
X-RAY EXAM OF JAW 4/> VIEWSCPT 70110 (TC)45131712Outpatient$689$205Payer Rates
X-RAY EXAM OF MASTOIDSCPT 70130 (TC)3531713Outpatient$260$205Payer Rates
X-RAY EXAM OF FACIAL BONESCPT 70150 (TC)3531681Outpatient$395$205Payer Rates
X-RAY EXAM OF FACIAL BONESCPT 70150 (TC)44131681Outpatient$376$205Payer Rates
X-RAY EXAM OF NASAL BONESCPT 70160 (TC)44131714Outpatient$391$158Payer Rates
X-RAY EXAM OF NASAL BONESCPT 70160 (TC)45131714Outpatient$391$158Payer Rates
X-RAY EXAM OF SINUSESCPT 70220 (TC)3531744Outpatient$460$158Payer Rates
X-RAY EXAM OF SINUSESCPT 70220 (TC)45131744Outpatient$460$158Payer Rates
X-RAY EXAM OF SKULLCPT 70250 (TC)3531745Outpatient$354$205Payer Rates
X-RAY EXAM OF SKULLCPT 70260 (TC)3531746Outpatient$649$205Payer Rates
X-RAY EXAM OF SKULLCPT 70260 (TC)44131746Outpatient$682$205Payer Rates
X-RAY EXAM OF SKULLCPT 70260 (TC)45131746Outpatient$682$205Payer Rates
X-RAY EXAM OF JAW JOINTSCPT 70330 (TC)3531758Outpatient$236$158Payer Rates
X-RAY EXAM OF JAW JOINTSCPT 70330 (TC)44131766Outpatient$236$158Payer Rates
X-RAY EXAM OF NECKCPT 70360 (TC)3531715Outpatient$359$158Payer Rates
X-RAY EXAM OF NECKCPT 70360 (TC)44131715Outpatient$342$158Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 71045 (TC)3531653Outpatient$384$154Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 71045 (TC)3531654Outpatient$384$154Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 71045 (TC)44131653Outpatient$366$154Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 71045 (TC)45131653Outpatient$366$154Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 710463531655Outpatient$420$154Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 7104644131655Outpatient$420$154Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 7104645131655Outpatient$420$154Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (TC)3531728Outpatient$427$158Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (RT)3531729Outpatient$427$158Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (LT)4513807Outpatient$427$158Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (LT)44131728Outpatient$427$158Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (RT)44131729Outpatient$427$158Payer Rates
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (LT)45131728Outpatient$427$158Payer Rates
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (TC)3531725Outpatient$501$205Payer Rates
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (TC)4411691Outpatient$501$205Payer Rates
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (TC)45131808Outpatient$501$205Payer Rates
X-RAY EXAM RIBS BIL 3 VIEWSCPT 71110 (TC)3531724Outpatient$406$205Payer Rates
X-RAY EXAM BREASTBONE 2/>VWSCPT 71120 (TC)3531757Outpatient$305$158Payer Rates
X-RAY EXAM BREASTBONE 2/>VWSCPT 71120 (TC)44131757Outpatient$305$158Payer Rates
X-RAY EXAM OF SPINE 1 VIEWCPT 72020 (TC)3531770Outpatient$357$158Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 720403531748Outpatient$446$158Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 7204044131748Outpatient$446$158Payer Rates
X-RAY EXAM NECK SPINE 2-3 VWCPT 7204045131748Outpatient$446$158Payer Rates
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050 (TC)3531749Outpatient$710$205Payer Rates
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050 (TC)44131749Outpatient$676$205Payer Rates
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050 (TC)45131749Outpatient$676$205Payer Rates
X-RAY EXAM THORAC SPINE 2VWSCPT 72070 (TC)3531750Outpatient$442$205Payer Rates
X-RAY EXAM THORAC SPINE 2VWSCPT 72070 (TC)44131750Outpatient$442$205Payer Rates
X-RAY EXAM THORAC SPINE 2VWSCPT 72070 (TC)45131750Outpatient$442$205Payer Rates
X-RAY EXAM THORAC SPINE4/>VWCPT 72074 (TC)3531751Outpatient$606$205Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 721003531737Outpatient$459$205Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 721003531753Outpatient$482$205Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 7210044131737Outpatient$482$205Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 7210044131753Outpatient$482$205Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 7210045131737Outpatient$482$205Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 7210045131753Outpatient$482$205Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110 (TC)3531754Outpatient$788$205Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110 (TC)44131754Outpatient$750$205Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110 (TC)45131754Outpatient$750$205Payer Rates
X-RAY EXAM OF PELVISCPT 72170 (52)3531721Outpatient$404$205Payer Rates
X-RAY EXAM OF PELVISCPT 72170 (TC)3531722Outpatient$385$205Payer Rates
X-RAY EXAM OF PELVISCPT 72170 (52)44131721Outpatient$405$205Payer Rates
X-RAY EXAM OF PELVISCPT 72170 (52)45131721Outpatient$405$205Payer Rates
X-RAY EXAM OF PELVISCPT 72170 (TC)45131722Outpatient$356$205Payer Rates
X-RAY EXAM SI JOINTS 3/> VWSCPT 72202 (TC)44131730Outpatient$324$205Payer Rates
X-RAY EXAM SI JOINTS 3/> VWSCPT 72202 (TC)45131730Outpatient$324$205Payer Rates
X-RAY EXAM SACRUM TAILBONECPT 72220 (52)3531674Outpatient$404$158Payer Rates
X-RAY EXAM SACRUM TAILBONECPT 72220 (TC)3531731Outpatient$404$158Payer Rates
X-RAY EXAM SACRUM TAILBONECPT 72220 (52)44131674Outpatient$404$158Payer Rates
X-RAY EXAM SACRUM TAILBONECPT 72220 (TC)44131731Outpatient$404$158Payer Rates
X-RAY EXAM OF COLLAR BONECPT 73000 (TC)3531673Outpatient$380$158Payer Rates
X-RAY EXAM OF COLLAR BONECPT 7300044131673Outpatient$380$158Payer Rates
X-RAY EXAM OF SHOULDER BLADECPT 73010 (LT)3531734Outpatient$207$158Payer Rates
X-RAY EXAM OF SHOULDER BLADECPT 73010 (RT)3531735Outpatient$227$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73020 (RT)3531739Outpatient$375$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)3531740Outpatient$395$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)3531741Outpatient$395$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)3531742Outpatient$395$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)3531743Outpatient$395$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)44131740Outpatient$412$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)44131741Outpatient$412$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)44131742Outpatient$377$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)44131743Outpatient$377$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)45131740Outpatient$412$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (RT)45131743Outpatient$377$158Payer Rates
X-RAY EXAM OF SHOULDERCPT 73030 (LT)45131777Outpatient$412$158Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (LT)3531702Outpatient$354$158Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (RT)3531703Outpatient$354$158Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (LT)44131702Outpatient$371$158Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (RT)44131703Outpatient$371$158Payer Rates
X-RAY EXAM OF HUMERUSCPT 73060 (RT)45131703Outpatient$371$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (LT)3531677Outpatient$357$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (RT)3531678Outpatient$357$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (LT)44131677Outpatient$357$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (RT)44131678Outpatient$357$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73070 (LT)45131677Outpatient$357$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (RT)3531777Outpatient$441$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (LT)3531778Outpatient$441$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (RT)44131778Outpatient$441$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (LT)44131779Outpatient$441$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (LT)45131765Outpatient$441$158Payer Rates
X-RAY EXAM OF ELBOWCPT 73080 (LT)45131766Outpatient$441$158Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (LT)3531692Outpatient$377$158Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (RT)3531693Outpatient$377$158Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (LT)44131692Outpatient$377$158Payer Rates
X-RAY EXAM OF FOREARMCPT 73090 (RT)44131693Outpatient$377$158Payer Rates
X-RAY EXAM OF WRISTCPT 73100 (LT)3531761Outpatient$207$158Payer Rates
X-RAY EXAM OF WRISTCPT 73100 (RT)3531783Outpatient$207$158Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)3531762Outpatient$405$158Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (RT)3531763Outpatient$405$158Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)44131762Outpatient$405$158Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (RT)44131763Outpatient$405$158Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)45131762Outpatient$405$158Payer Rates
X-RAY EXAM OF WRISTCPT 73110 (LT)45131778Outpatient$405$158Payer Rates
X-RAY EXAM OF HANDCPT 73120 (RT)3531695Outpatient$315$205Payer Rates
X-RAY EXAM OF HANDCPT 73120 (LT)44131694Outpatient$315$205Payer Rates
X-RAY EXAM OF HANDCPT 73120 (RT)44131695Outpatient$315$205Payer Rates
X-RAY EXAM OF HANDCPT 73120 (RT)45131695Outpatient$315$205Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)3531696Outpatient$388$158Payer Rates
X-RAY EXAM OF HANDCPT 73130 (RT)3531697Outpatient$388$158Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)44131696Outpatient$388$158Payer Rates
X-RAY EXAM OF HANDCPT 73130 (RT)44131697Outpatient$388$158Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)45131696Outpatient$388$158Payer Rates
X-RAY EXAM OF HANDCPT 73130 (LT)45131773Outpatient$388$158Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (LT)3531687Outpatient$331$158Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (RT)3531779Outpatient$331$158Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (LT)44131687Outpatient$331$158Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (RT)44131804Outpatient$315$158Payer Rates
X-RAY EXAM OF FINGER(S)CPT 73140 (RT)45131804Outpatient$315$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)3531700Outpatient$798$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)3531701Outpatient$798$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)3531775Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)3531776Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)44131700Outpatient$798$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)44131701Outpatient$798$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)44131772Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)44131773Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)44131802Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)44131803Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (LT)45131802Outpatient$394$158Payer Rates
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)45131803Outpatient$394$158Payer Rates
X-RAY EXAM OF FEMUR 1CPT 73551 (TC)45131683Outpatient$399$158Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT)3531684Outpatient$419$158Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (TC)3531685Outpatient$419$158Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT)44131684Outpatient$419$158Payer Rates
X-RAY EXAM OF FEMUR 2/>CPT 73552 (TC)44131685Outpatient$419$158Payer Rates
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (TC)3531704Outpatient$349$158Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (LT)3531706Outpatient$390$158Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)3531707Outpatient$390$158Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (LT)44131706Outpatient$390$158Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)44131707Outpatient$390$158Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (LT)45131706Outpatient$390$158Payer Rates
X-RAY EXAM OF KNEE 3CPT 73562 (RT)45131707Outpatient$390$158Payer Rates
X-RAY EXAM KNEE 4 OR MORECPT 73564 (RT)3531771Outpatient$527$205Payer Rates
X-RAY EXAM KNEE 4 OR MORECPT 73564 (LT)3531772Outpatient$527$205Payer Rates
X-RAY EXAM KNEE 4 OR MORECPT 73564 (LT)44131776Outpatient$527$205Payer Rates
X-RAY EXAM KNEE 4 OR MORECPT 73564 (RT)44131777Outpatient$527$205Payer Rates
X-RAY EXAM OF KNEESCPT 73565 (TC)3531708Outpatient$345$158Payer Rates
X-RAY EXAM OF KNEESCPT 73565 (TC)44131708Outpatient$362$158Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)3531710Outpatient$393$158Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (RT)3531711Outpatient$393$158Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)44131710Outpatient$393$158Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (RT)44131711Outpatient$393$158Payer Rates
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)45131710Outpatient$393$158Payer Rates
X-RAY EXAM OF ANKLECPT 73600 (LT)3531660Outpatient$320$158Payer Rates
X-RAY EXAM OF ANKLECPT 73600 (RT)3531661Outpatient$320$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)3531662Outpatient$390$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)3531663Outpatient$390$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)3531664Outpatient$427$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)3531665Outpatient$427$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)44131662Outpatient$390$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)44131663Outpatient$390$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)44131774Outpatient$427$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)44131775Outpatient$427$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (LT)45131774Outpatient$427$158Payer Rates
X-RAY EXAM OF ANKLECPT 73610 (RT)45131775Outpatient$427$158Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (LT)3531688Outpatient$330$158Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (RT)3531689Outpatient$330$158Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (LT)44131688Outpatient$315$158Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (RT)44131689Outpatient$315$158Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (LT)45131688Outpatient$315$158Payer Rates
X-RAY EXAM OF FOOTCPT 73620 (RT)45131689Outpatient$315$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)3531690Outpatient$393$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (RT)3531691Outpatient$393$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (TC)4411690Outpatient$393$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)44131690Outpatient$393$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (RT)44131691Outpatient$393$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)45131690Outpatient$393$158Payer Rates
X-RAY EXAM OF FOOTCPT 73630 (LT)45131768Outpatient$393$158Payer Rates
X-RAY EXAM OF HEELCPT 73650 (TC)3531718Outpatient$294$158Payer Rates
X-RAY EXAM OF HEELCPT 73650 (RT)3531719Outpatient$294$158Payer Rates
X-RAY EXAM OF HEELCPT 73650 (LT)44131718Outpatient$294$158Payer Rates
X-RAY EXAM OF HEELCPT 73650 (RT)44131719Outpatient$294$158Payer Rates
X-RAY EXAM OF TOE(S)CPT 73660 (LT)3531759Outpatient$293$158Payer Rates
X-RAY EXAM OF TOE(S)CPT 73660 (RT)3531760Outpatient$308$158Payer Rates
X-RAY EXAM OF TOE(S)CPT 73660 (LT)44131759Outpatient$308$158Payer Rates
X-RAY EXAM OF TOE(S)CPT 73660 (RT)44131760Outpatient$308$158Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018 (TC)3531709Outpatient$350$158Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018 (TC)44131709Outpatient$350$158Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018 (TC)45131709Outpatient$350$158Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019 (TC)3531657Outpatient$487$158Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019 (TC)44131657Outpatient$487$158Payer Rates
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019 (TC)45131657Outpatient$487$158Payer Rates
X-RAY EXAM ABDOMEN 3+ VIEWSCPT 74021 (TC)3531658Outpatient$543$158Payer Rates
X-RAY EXAM COMPLETE ABDOMENCPT 74022 (TC)3531659Outpatient$526$205Payer Rates
Respiratory
VENT MGMT INPAT INIT DAYCPT 940024040007Outpatient$1,295$1,295Payer Rates
VENT MGMT INPAT SUBQ DAYCPT 940034040008Outpatient$1,895$1,895Payer Rates
AIRWAY INHALATION TREATMENTCPT 946404040005Outpatient$84$84Payer Rates
EVALUATE PT USE OF INHALERCPT 946644040004Outpatient$152$152Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 947624040040Outpatient$219$219Payer Rates
Surgical Procedures
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826-----
(Not Offered) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOS ...CPT 29881-----
REMOVE TONSILS AND ADENOIDSCPT 428202030753Outpatient$1,636$1,636Payer Rates
(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 VAGINAL DELIVERYCPT 59400-----
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...CPT 59610-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322-----
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323-----
(Not Offered) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE ...CPT 64483-----
(Not Offered) REMOVAL OF RECURRING CATARACT IN LENS CAPSUL ...CPT 66821-----
(Not Offered) REMOVAL OF CATARACT WITH INSERTION OF LENSCPT 66984-----
(Not Offered) INSERTION OF CATHETER INTO LEFT HEART FOR DI ...CPT 93452-----
Therapy
THERAPEUTIC EXERCISESCPT 97110 (GP)1197110Outpatient$135$107Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GP)2197110Outpatient$135$107Payer Rates
Uncategorized
REMOVAL OF BREAST LESIONCPT 19120630167Outpatient$1,415$1,415Payer Rates
EGD DIAGNOSTIC BRUSH WASHCPT 43235630110Outpatient$1,820$1,820Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 43239630102Outpatient$969$969Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 45378630100Outpatient$393$393Payer Rates
COLONOSCOPY AND BIOPSYCPT 45380630087Outpatient$975$975Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 45385630097Outpatient$971$971Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562630095Outpatient$942$942Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 49505630127Outpatient$4,550$4,550Payer Rates
HEPATIC FUNCTION PANELCPT 800763031304Outpatient$235$15Payer Rates
NON-COVERED ITEM OR SERVICEHCPCS A92705532003Outpatient$23$23Payer Rates