Southwest Health System

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.

Service Description	Service Code	Department	Charge Code	Cash Price	Rates
CT Scan
CT HEAD/BRAIN W/O DYE	CPT 70450	Outpatient	821336	$1,002
CT ANGIOGRAPHY CHEST	CPT 71275	Outpatient	885769	$1,517
CT PELVIS W/DYE	CPT 72193	Outpatient	821359	$1,446
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	1005109	$2,177
Cancer Services
CHEMO HORMON ANTINEOPL SQ/IM	CPT 96402	Outpatient	11735335	$285
Clinic
OFFICE O/P NEW LOW 30-44 MIN	CPT 99203	Outpatient	11517573	$172
OFFICE O/P NEW MOD 45-59 MIN	CPT 99204	Outpatient	11517574	$276
OFFICE O/P NEW HI 60-74 MIN	CPT 99205	Outpatient	11517575	$300
(N/O) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-
(N/O) PATIENT OFFICE CONSULTATION, 60 MIN	CPT 99244	-	-	-	-
PREV VISIT NEW AGE 18-39	CPT 99385	Outpatient	-	$199
PREV VISIT NEW AGE 40-64	CPT 99386	Outpatient	-	$221
EEG
POLYSOM 6/> YRS 4/> PARAM	CPT 95810	Outpatient	11517582	$3,213
EKG
ELECTROCARDIOGRAM COMPLETE	CPT 93000	Outpatient	-	$114
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	2423453	$340
ECG MONIT/REPRT UP TO 48 HRS	CPT 93225	Outpatient	3887159	$336
Emergency Room
DRAINAGE OF SKIN ABSCESS	CPT 10060	Outpatient	11752613	$366
DEB SUBQ TISSUE 20 SQ CM/<	CPT 11042	Outpatient	11755480	$700
DEBRIDE NAIL 1-5	CPT 11720	Outpatient	11755457	$111
DEBRIDE NAIL 6 OR MORE	CPT 11721	Outpatient	27141078	$103
REMOVAL OF NAIL BED	CPT 11750	Outpatient	11755387	$753
REMOVE DRUG IMPLANT DEVICE	CPT 11982	Outpatient	2856996	$660
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	Outpatient	11752591	$387
RPR F/E/E/N/L/M 2.6-5.0 CM	CPT 12013	Outpatient	11752599	$387
INJ TENDON SHEATH/LIGAMENT	CPT 20550	Outpatient	11752559	$397
DRAIN/INJ JOINT/BURSA W/O US	CPT 20600	Outpatient	11755184	$397
DRAIN/INJ JOINT/BURSA W/O US	CPT 20605	Outpatient	11755185	$477
DRAIN/INJ JOINT/BURSA W/O US	CPT 20610	Outpatient	11755186	$365
TREAT SHOULDER DISLOCATION	CPT 23650	Outpatient	11755198	$683
TREAT SHOULDER DISLOCATION	CPT 23655	Outpatient	6017158	$2,433
TREAT FRACTURE RADIUS/ULNA	CPT 25605	Outpatient	11755348	$1,999
APPLICATION OF FOREARM CAST	CPT 29075	Outpatient	11752585	$227
APPLY LONG ARM SPLINT	CPT 29105	Outpatient	4287463	$190
APPLY FOREARM SPLINT	CPT 29125	Outpatient	11752567	$231
APPLICATION OF FINGER SPLINT	CPT 29130	Outpatient	11752570	$231
APPLY SHORT LEG CAST	CPT 29405	Outpatient	11752555	$227
APPLICATION LONG LEG SPLINT	CPT 29505	Outpatient	11752572	$345
APPLICATION LOWER LEG SPLINT	CPT 29515	Outpatient	11752573	$330
APPLICATION OF PASTE BOOT	CPT 29580	Outpatient	11752581	$200
REMOVAL/REVISION OF CAST	CPT 29705	Outpatient	11752590	$227
CONTROL OF NOSEBLEED	CPT 30901	Outpatient	11752693	$212
INSERT EMERGENCY AIRWAY	CPT 31500	Outpatient	11752545	$1,026
INSERT TEMP BLADDER CATH	CPT 51702	Outpatient	11755493	$151
OBSTETRICAL CARE	CPT 59409	Outpatient	11752737	$3,367
NJX AA&/STRD OTHER PN/BRANCH	CPT 64450	Outpatient	11755332	$455
REMOVE IMPACTED EAR WAX UNI	CPT 69209	Outpatient	25370222	$125
EMERGENCY DEPT VISIT	CPT 99281	Outpatient	25159328	$211
EMERGENCY DEPT VISIT	CPT 99282	Outpatient	25159330	$263
EMERGENCY DEPT VISIT	CPT 99283	Outpatient	25159331	$554
EMERGENCY DEPT VISIT	CPT 99284	Outpatient	25159335	$745
EMERGENCY DEPT VISIT	CPT 99285	Outpatient	25159341	$1,267
CRITICAL CARE FIRST HOUR	CPT 99291	Outpatient	25159349	$2,167
CRITICAL CARE ADDL 30 MIN	CPT 99292	Outpatient	25159350	$1,084
IV Therapy
HYDRATION IV INFUSION INIT	CPT 96360	Outpatient	25159290	$472
HYDRATE IV INFUSION ADD-ON	CPT 96361	Outpatient	25159291	$93
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	25159292	$548
THER/PROPH/DIAG IV INF ADDON	CPT 96366	Outpatient	25159293	$120
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	Outpatient	25159297	$184
THER/DIAG CONCURRENT INF	CPT 96368	Outpatient	25159298	$79
THER/PROPH/DIAG INJ SC/IM	CPT 96372	Outpatient	25159299	$86
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	Outpatient	25159306	$197
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	Outpatient	25159311	$120
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	Outpatient	25159312	$129
Imaging
ULTRASOUND BREAST COMPLETE	CPT 76641	Outpatient	1007730	$366
US EXAM ABDOM COMPLETE	CPT 76700	Outpatient	823404	$572
US EXAM ABDO BACK WALL LIM	CPT 76775	Outpatient	1007763	$456
OB US >= 14 WKS SNGL FETUS	CPT 76805	Outpatient	1525529	$510
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	3145306	$491
BREAST TOMOSYNTHESIS BI	CPT 77063	Outpatient	25644596	$140
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	1240707	$174
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	1181457	$291
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	1181460	$210
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...	DRG 216	-	-	-	-
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	Inpatient	-	$13,271
MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...	DRG 470	Inpatient	-	$24,027
CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	Inpatient	-	$14,575
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...	DRG 743	-	-	-	-
Laboratory
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	1189774	$10
CAPILLARY BLOOD DRAW	CPT 36416	Outpatient	796177	$16
WITHDRAWAL OF ARTERIAL BLOOD	CPT 36600	Outpatient	10743234	$155
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	3675567	$46
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	3675566	$57
OBSTETRIC PANEL	CPT 80055	Outpatient	13824201	$226
LIPID PANEL	CPT 80061	Outpatient	25631259	$43
RENAL FUNCTION PANEL	CPT 80069	Outpatient	3675565	$98
ACUTE HEPATITIS PANEL	CPT 80074	Outpatient	2195160	$138
HEPATIC FUNCTION PANEL	CPT 80076	Outpatient	1414277	$69
ASSAY OF DIGOXIN TOTAL	CPT 80162	Outpatient	20267092	$174
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	Outpatient	3679215	$151
ASSAY OF PHENYTOIN TOTAL	CPT 80185	Outpatient	11287169	$148
ASSAY OF TACROLIMUS	CPT 80197	Outpatient	11612765	$92
ASSAY OF VANCOMYCIN	CPT 80202	Outpatient	2013815	$151
DRUG TEST PRSMV DIR OPT OBS	CPT 80305	Outpatient	11218218	$138
DRUG TEST PRSMV CHEM ANLYZR	CPT 80307	Outpatient	1019620	$121
DRUG SCREEN QUANTALCOHOLS	CPT 80320	Outpatient	25552249	$57
(N/O) URINALYSIS TEST USING MICROSCOPE	CPT 81000	-	-	-	-
URINALYSIS AUTO W/SCOPE	CPT 81001	Outpatient	11389839	$51
(N/O) URINALYSIS TEST	CPT 81002	-	-	-	-
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	14085369	$27
MICROSCOPIC EXAM OF URINE	CPT 81015	Outpatient	13855303	$31
URINE PREGNANCY TEST	CPT 81025	Outpatient	11389830	$61
CFTR GENE COM VARIANTS	CPT 81220	Outpatient	25552289	$818
UNLISTED MOLECULAR PATHOLOGY	CPT 81479	Outpatient	15256461	$13
TEST FOR ACETONE/KETONES	CPT 82009	Outpatient	1861593	$50
ASSAY OF SERUM ALBUMIN	CPT 82040	Outpatient	633634	$55
UR ALBUMIN QUANTITATIVE	CPT 82043	Outpatient	14046031	$65
ALPHA-FETOPROTEIN SERUM	CPT 82105	Outpatient	1597561	$29
ASSAY OF AMMONIA	CPT 82140	Outpatient	633648	$162
ASSAY OF AMYLASE	CPT 82150	Outpatient	11218220	$72
BILIRUBIN TOTAL	CPT 82247	Outpatient	13763096	$55
BILIRUBIN DIRECT	CPT 82248	Outpatient	633670	$55
ASSAY OF BIOTINIDASE	CPT 82261	Outpatient	14946084	$31
ASSAY TEST FOR BLOOD FECAL	CPT 82274	Outpatient	18356336	$87
VITAMIN D 25 HYDROXY	CPT 82306	Outpatient	24117183	$221
ASSAY OF CALCIUM	CPT 82310	Outpatient	13924901	$57
ASSAY OF CALCIUM IN URINE	CPT 82340	Outpatient	25631267	$20
CARCINOEMBRYONIC ANTIGEN	CPT 82378	Outpatient	1025717	$93
TOTAL CORTISOL	CPT 82533	Outpatient	25631270	$52
ASSAY OF CK (CPK)	CPT 82550	Outpatient	25631271	$22
ASSAY OF CREATININE	CPT 82565	Outpatient	633606	$43
ASSAY OF URINE CREATININE	CPT 82570	Outpatient	25631273	$16
VITAMIN B-12	CPT 82607	Outpatient	633871	$75
ASSAY OF TOTAL ESTRADIOL	CPT 82670	Outpatient	25631274	$81
ASSAY OF ESTRIOL	CPT 82677	Outpatient	1550004	$42
ASSAY OF FERRITIN	CPT 82728	Outpatient	2215100	$68
ASSAY OF FOLIC ACID SERUM	CPT 82746	Outpatient	7935142	$71
ASSAY OF FOLIC ACID RBC	CPT 82747	Outpatient	2687610	$64
GALACTOSE TRANSFERASE TEST	CPT 82776	Outpatient	14946080	$18
ASSAY IGA/IGD/IGG/IGM EACH	CPT 82784	Outpatient	25631275	$46
BLOOD GASES ANY COMBINATION	CPT 82803	Outpatient	10743237	$164
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	633594	$44
REAGENT STRIP/BLOOD GLUCOSE	CPT 82948	Outpatient	19705216	$13
GLUCOSE TEST	CPT 82950	Outpatient	11538647	$51
GLUCOSE BLOOD TEST	CPT 82962	Outpatient	25140732	$25
ASSAY OF GGT	CPT 82977	Outpatient	633733	$80
ASSAY OF GONADOTROPIN (FSH)	CPT 83001	Outpatient	1025770	$92
ASSAY OF GONADOTROPIN (LH)	CPT 83002	Outpatient	7323141	$92
H PYLORI (C-13) BREATH	CPT 83013	Outpatient	25552304	$135
HEMOGLOBIN ELECTROPHORESIS	CPT 83020	Outpatient	14946082	$24
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	3343172	$110
ASSAY OF HOMOCYSTINE	CPT 83090	Outpatient	25631347	$82
ASSAY OF PROGESTERONE 17-D	CPT 83498	Outpatient	14946085	$49
IMMUNOASSAY NONANTIBODY	CPT 83516	Outpatient	13924834	$83
RIA NONANTIBODY	CPT 83519	Outpatient	1763545	$236
IMMUNOASSAY QUANT NOS NONAB	CPT 83520	Outpatient	14946083	$26
ASSAY OF IRON	CPT 83540	Outpatient	1137680	$72
IRON BINDING TEST	CPT 83550	Outpatient	4033177	$98
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	633768	$16
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	11220729	$68
ASSAY OF LIPASE	CPT 83690	Outpatient	633776	$78
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	25631281	$22
MASS SPECTROMETRY QUAL/QUAN	CPT 83789	Outpatient	14946086	$35
ASSAY OF NATRIURETIC PEPTIDE	CPT 83880	Outpatient	853229	$199
ASSAY NEPHELOMETRY NOT SPEC	CPT 83883	Outpatient	25631284	$69
ASSAY OF PARATHORMONE	CPT 83970	Outpatient	25631287	$96
ASSAY FOR CALPROTECTIN FECAL	CPT 83993	Outpatient	1549542	$58
ASSAY OF BLOOD PKU	CPT 84030	Outpatient	14946073	$10
ASSAY OF PHOSPHORUS	CPT 84100	Outpatient	633803	$51
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	633616	$50
ASSAY OF PROGESTERONE	CPT 84144	Outpatient	633808	$115
ASSAY OF PROLACTIN	CPT 84146	Outpatient	633809	$95
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	25631292	$55
ASSAY OF PSA FREE	CPT 84154	Outpatient	25631293	$55
ASSAY OF PROTEIN SERUM	CPT 84155	Outpatient	25631363	$11
ASSAY OF PROTEIN URINE	CPT 84156	Outpatient	14607365	$18
PROTEIN E-PHORESIS SERUM	CPT 84165	Outpatient	25631295	$52
ASSAY OF URINE SODIUM	CPT 84300	Outpatient	25631296	$15
ASSAY OF FREE TESTOSTERONE	CPT 84402	Outpatient	25631300	$83
ASSAY OF TOTAL TESTOSTERONE	CPT 84403	Outpatient	25631301	$83
ASSAY OF VITAMIN B-1	CPT 84425	Outpatient	2781166	$97
ASSAY OF TOTAL THYROXINE	CPT 84436	Outpatient	1281223	$77
ASSAY OF NEONATAL THYROXINE	CPT 84437	Outpatient	14946081	$11
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	857849	$92
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	15256455	$31
TRANSFERASE (AST) (SGOT)	CPT 84450	Outpatient	633633	$57
ALANINE AMINO (ALT) (SGPT)	CPT 84460	Outpatient	633632	$61
ASSAY OF TRIGLYCERIDES	CPT 84478	Outpatient	633852	$65
ASSAY TRIIODOTHYRONINE (T3)	CPT 84480	Outpatient	633833	$69
FREE ASSAY (FT-3)	CPT 84481	Outpatient	633834	$83
ASSAY OF UREA NITROGEN	CPT 84520	Outpatient	633605	$46
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	633858	$50
ASSAY OF ZINC	CPT 84630	Outpatient	783592	$49
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	13924892	$62
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	Outpatient	13887475	$78
BL SMEAR W/DIFF WBC COUNT	CPT 85007	Outpatient	11220890	$39
BL SMEAR W/O DIFF WBC COUNT	CPT 85008	Outpatient	17858841	$28
HEMATOCRIT	CPT 85014	Outpatient	25631304	$28
HEMOGLOBIN	CPT 85018	Outpatient	25631305	$28
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	11220888	$37
COMPLETE CBC AUTOMATED	CPT 85027	Outpatient	3343185	$31
AUTOMATED RETICULOCYTE COUNT	CPT 85045	Outpatient	11287170	$46
BLOOD SMEAR INTERPRETATION	CPT 85060	Outpatient	15332437	$14
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	633718	$90
PROTHROMBIN TIME	CPT 85610	Outpatient	11389991	$27
RBC SED RATE AUTOMATED	CPT 85652	Outpatient	633830	$31
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	25631308	$18
ALLG SPEC IGE CRUDE XTRC EA	CPT 86003	Outpatient	25631309	$11
WBC ANTIBODY IDENTIFICATION	CPT 86021	Outpatient	25631310	$48
ANTINUCLEAR ANTIBODIES	CPT 86038	Outpatient	25552261	$61
ANTINUCLEAR ANTIBODIES (ANA)	CPT 86039	Outpatient	25631311	$53
C-REACTIVE PROTEIN	CPT 86140	Outpatient	633716	$57
C-REACTIVE PROTEIN HS	CPT 86141	Outpatient	8733141	$36
COMPLEMENT ANTIGEN	CPT 86160	Outpatient	2195002	$61
CCP ANTIBODY	CPT 86200	Outpatient	783619	$92
NUCLEAR ANTIGEN ANTIBODY	CPT 86235	Outpatient	25631315	$73
IMMUNOASSAY TUMOR CA 15-3	CPT 86300	Outpatient	1025710	$81
IMMUNOASSAY TUMOR CA 19-9	CPT 86301	Outpatient	1025711	$102
IMMUNOASSAY TUMOR CA 125	CPT 86304	Outpatient	1025709	$102
HETEROPHILE ANTIBODY SCREEN	CPT 86308	Outpatient	11287167	$57
IMMUNOASSAY INFECTIOUS AGENT	CPT 86317	Outpatient	2195108	$51
IMMUNOFIX E-PHORESIS SERUM	CPT 86334	Outpatient	1200258	$69
INHIBIN A	CPT 86336	Outpatient	25072744	$54
MICROSOMAL ANTIBODY EACH	CPT 86376	Outpatient	25631355	$71
RHEUMATOID FACTOR QUANT	CPT 86431	Outpatient	11202737	$15
TB TEST CELL IMMUN MEASURE	CPT 86480	Outpatient	26975004	$237
SYPHILIS TEST NON-TREP QUAL	CPT 86592	Outpatient	25631316	$20
SYPHILIS TEST NON-TREP QUANT	CPT 86593	Outpatient	25631317	$31
HEP B CORE ANTIBODY TOTAL	CPT 86704	Outpatient	1025783	$61
MUMPS ANTIBODY	CPT 86735	Outpatient	1549636	$51
RUBELLA ANTIBODY	CPT 86762	Outpatient	25631330	$47
RUBEOLA ANTIBODY	CPT 86765	Outpatient	798811	$53
VARICELLA-ZOSTER ANTIBODY	CPT 86787	Outpatient	25631362	$63
THYROGLOBULIN ANTIBODY	CPT 86800	Outpatient	25631361	$68
HEPATITIS C AB TEST	CPT 86803	Outpatient	1025787	$69
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	12153886	$80
COOMBS TEST DIRECT	CPT 86880	Outpatient	1137992	$53
BLOOD TYPING SEROLOGIC ABO	CPT 86900	Outpatient	10419560	$155
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	Outpatient	14424296	$34
COMPATIBILITY TEST SPIN	CPT 86920	Outpatient	13853672	$191
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	850752	$115
FECES CULTURE AEROBIC BACT	CPT 87045	Outpatient	1151516	$106
STOOL CULTR AEROBIC BACT EA	CPT 87046	Outpatient	14122294	$46
CULTURE OTHR SPECIMN AEROBIC	CPT 87070	Outpatient	858005	$97
CULTURE ANAEROBE IDENT EACH	CPT 87076	Outpatient	10636433	$79
CULTURE AEROBIC IDENTIFY	CPT 87077	Outpatient	11519861	$35
CULTURE SCREEN ONLY	CPT 87081	Outpatient	25552301	$67
URINE BACTERIA CULTURE	CPT 87088	Outpatient	850756	$59
OVA AND PARASITES SMEARS	CPT 87177	Outpatient	25631337	$44
MICROBE SUSCEPTIBLE ENZYME	CPT 87185	Outpatient	634025	$34
MICROBE SUSCEPTIBLE MIC	CPT 87186	Outpatient	294946	$97
SMEAR GRAM STAIN	CPT 87205	Outpatient	15704202	$48
SMEAR COMPLEX STAIN	CPT 87209	Outpatient	25631338	$44
SMEAR WET MOUNT SALINE/INK	CPT 87210	Outpatient	11389829	$47
CLOSTRIDIUM AG IA	CPT 87324	Outpatient	26789240	$164
GIARDIA AG IA	CPT 87329	Outpatient	11287161	$135
HPYLORI STOOL AG IA	CPT 87338	Outpatient	2195087	$135
HEPATITIS B SURFACE AG IA	CPT 87340	Outpatient	2195150	$50
HIV-1 AG W/HIV-1&2 AB AG IA	CPT 87389	Outpatient	22489168	$78
INFLUENZA A/B EACH AG IA	CPT 87400	Outpatient	15225548	$29
RESP SYNCYTIAL VIRUS AG IA	CPT 87420	Outpatient	11389876	$135
CHYLMD TRACH DNA AMP PROBE	CPT 87491	Outpatient	25631340	$50
CYTOMEG DNA QUANT	CPT 87497	Outpatient	2687625	$170
HEPATITIS C REVRS TRNSCRPJ	CPT 87522	Outpatient	25737176	$212
DETECT AGENT NOS DNA QUANT	CPT 87799	Outpatient	1549537	$140
STREP A ASSAY W/OPTIC	CPT 87880	Outpatient	11287172	$63
CYTOPATH CONCENTRATE TECH	CPT 88108	Outpatient	3663146	$111
SURGICAL PATH GROSS	CPT 88300	Outpatient	2939440	$43
TISSUE EXAM BY PATHOLOGIST	CPT 88304	Outpatient	2939442	$187
TISSUE EXAM BY PATHOLOGIST	CPT 88305	Outpatient	2939443	$188
SPECIAL STAINS GROUP 2	CPT 88313	Outpatient	4511340	$125
IMMUNOHISTO ANTB 1ST STAIN	CPT 88342	Outpatient	14166355	$319
BILIRUBIN TOTAL TRANSCUT	CPT 88720	Outpatient	2612739	$13
BODY FLUID CELL COUNT	CPT 89051	Outpatient	11218221	$62
PSA SCREENING	HCPCS G0103	Outpatient	1019535	$127
DRUG TEST DEF 1-7 CLASSES	HCPCS G0480	Outpatient	27109390	$103
Language Pathology
SPEECH/HEARING THERAPY	CPT 92507	Outpatient	1230484	$126
MOTION FLUOROSCOPY/SWALLOW	CPT 92611	Outpatient	1230493	$141
DEVELOPMENTAL SCREEN W/SCORE	CPT 96110	Outpatient	4811572	$21
MRI
MRI BRAIN STEM W/O DYE	CPT 70551	Outpatient	821402	$2,272
MRI BRAIN STEM W/O & W/DYE	CPT 70553	Outpatient	821398	$3,150
MRI LUMBAR SPINE W/O DYE	CPT 72148	Outpatient	821445	$1,986
MRI JNT OF LWR EXTRE W/O DYE	CPT 73721	Outpatient	821420	$2,370
Medical and Surgical Supplies
CATH W/DRAINAGE 2-WAY SILCNE	HCPCS A4315	Outpatient	12331701	$38
3DMAX MESH LEFT LIGHT	HCPCS C1781	Outpatient	13745780	$351
POST CHMBR INTRAOCULAR LENS	HCPCS V2632	Outpatient	13745914	$395
Nuclear Medicine
TC99M TETROFOSMIN	HCPCS A9502	Outpatient	10472999	$345
TC99M DISOFENIN	HCPCS A9510	Outpatient	10472968	$208
Other Diagnostic
FETAL NON-STRESS TEST	CPT 59025	Outpatient	12196274	$379
SLEEP STUDY UNATT&RESP EFFT	CPT 95806	Outpatient	11517583	$524
POLYSOM 6/>YRS CPAP 4/> PARM	CPT 95811	Outpatient	11517569	$3,286
Other Procedures and Observation
DRAW BLOOD OFF VENOUS DEVICE	CPT 36591	Outpatient	11735358	$80
HOSPITAL OBSERVATION PER HR	HCPCS G0378	Outpatient	12638889	$46
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	Outpatient	11755350	$1,131
IMMUNIZATION ADMIN EACH ADD	CPT 90472	Outpatient	11519849	$78
CARDIAC REHAB/MONITOR	CPT 93798	Outpatient	11517611	$173
IMMUNOTHERAPY ONE INJECTION	CPT 95115	Outpatient	11735362	$31
IMMUNOTHERAPY INJECTIONS	CPT 95117	Outpatient	11735363	$55
IRRIG DRUG DELIVERY DEVICE	CPT 96523	Outpatient	11735355	$122
MEDICAL NUTRITION INDIV IN	CPT 97802	Outpatient	12328800	$35
MED NUTRITION INDIV SUBSEQ	CPT 97803	Outpatient	12328801	$31
PHLEBOTOMY	CPT 99195	Outpatient	15134572	$130
DIAB MANAGE TRN PER INDIV	HCPCS G0108	Outpatient	12328807	$41
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	2874238	$311
Psychiatric
(N/O) PSYCHOTHERAPY, 30 MIN	CPT 90832	-	-	-	-
(N/O) PSYCHOTHERAPY, 45 MIN	CPT 90834	-	-	-	-
(N/O) PSYCHOTHERAPY, 60 MIN	CPT 90837	-	-	-	-
(N/O) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, 50 MIN	CPT 90846	-	-	-	-
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MIN	CPT 90847	-	-	-	-
(N/O) GROUP PSYCHOTHERAPY	CPT 90853	-	-	-	-
Pulmonary Function
BREATHING CAPACITY TEST	CPT 94010	Outpatient	12770944	$171
EVALUATION OF WHEEZING	CPT 94060	Outpatient	12770952	$477
PULM FUNCTION TEST BY GAS	CPT 94727	Outpatient	12770956	$285
CO/MEMBANE DIFFUSE CAPACITY	CPT 94729	Outpatient	12770951	$285
Radiology
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	823510	$90
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	823512	$143
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100	Outpatient	823610	$143
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101	Outpatient	3619145	$172
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	Outpatient	823635	$155
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	3125337	$225
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	Outpatient	823647	$148
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	Outpatient	823641	$167
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	Outpatient	823643	$230
X-RAY EXAM L-S SPINE BENDING	CPT 72114	Outpatient	1008092	$299
X-RAY EXAM OF PELVIS	CPT 72170	Outpatient	823608	$117
X-RAY EXAM SACRUM TAILBONE	CPT 72220	Outpatient	823617	$134
X-RAY EXAM OF COLLAR BONE	CPT 73000	Outpatient	823516	$119
X-RAY EXAM OF SHOULDER	CPT 73030	Outpatient	1284694	$134
X-RAY EXAM OF HUMERUS	CPT 73060	Outpatient	823588	$130
X-RAY EXAM OF ELBOW	CPT 73070	Outpatient	823520	$117
X-RAY EXAM OF ELBOW	CPT 73080	Outpatient	1007932	$148
X-RAY EXAM OF FOREARM	CPT 73090	Outpatient	823562	$119
X-RAY EXAM OF WRIST	CPT 73100	Outpatient	823685	$122
X-RAY EXAM OF WRIST	CPT 73110	Outpatient	823681	$143
X-RAY EXAM OF HAND	CPT 73120	Outpatient	823568	$117
X-RAY EXAM OF HAND	CPT 73130	Outpatient	823572	$134
X-RAY EXAM OF FINGER(S)	CPT 73140	Outpatient	3125217	$116
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502	Outpatient	823578	$127
X-RAY EXAM HIP UNI 4/> VIEWS	CPT 73503	Outpatient	25059816	$150
X-RAY EXAM OF FEMUR 2/>	CPT 73552	Outpatient	1007940	$106
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560	Outpatient	823596	$125
X-RAY EXAM OF KNEE 3	CPT 73562	Outpatient	823592	$125
X-RAY EXAM KNEE 4 OR MORE	CPT 73564	Outpatient	1007996	$167
X-RAY EXAM OF KNEES	CPT 73565	Outpatient	1008002	$113
X-RAY EXAM OF LOWER LEG	CPT 73590	Outpatient	2214290	$122
X-RAY EXAM OF ANKLE	CPT 73610	Outpatient	823492	$97
X-RAY EXAM OF FOOT	CPT 73620	Outpatient	823554	$80
X-RAY EXAM OF FOOT	CPT 73630	Outpatient	823558	$91
X-RAY EXAM OF TOE(S)	CPT 73660	Outpatient	3125343	$88
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	Outpatient	823483	$116
X-RAY EXAM ABDOMEN 2 VIEWS	CPT 74019	Outpatient	823486	$158
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	Outpatient	2214245	$203
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	3125259	$382
NEEDLE LOCALIZATION BY XRAY	CPT 77002	Outpatient	25141979	$261
Respiratory
AIRWAY INHALATION TREATMENT	CPT 94640	Outpatient	11735244	$276
POS AIRWAY PRESSURE CPAP	CPT 94660	Outpatient	2425534	$326
Surgical Procedures
REMOVAL OF BREAST LESION	CPT 19120	Outpatient	-	$860
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 29826	-	-	-	-
KNEE ARTHROSCOPY/SURGERY	CPT 29881	Outpatient	-	$6,141
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...	CPT 42820	-	-	-	-
EGD DIAGNOSTIC BRUSH WASH	CPT 43235	Outpatient	3005152	$868
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	Outpatient	2972988	$1,959
DIAGNOSTIC COLONOSCOPY	CPT 45378	Outpatient	-	$1,056
COLONOSCOPY AND BIOPSY	CPT 45380	Outpatient	3005157	$1,547
COLONOSCOPY W/LESION REMOVAL	CPT 45385	Outpatient	-	$1,418
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...	CPT 45391	-	-	-	-
LAPAROSCOPIC CHOLECYSTECTOMY	CPT 47562	Outpatient	3005159	$3,209
PRP I/HERN INIT REDUC >5 YR	CPT 49505	Outpatient	-	$1,251
CIRCUMCISION W/REGIONL BLOCK	CPT 54150	Outpatient	12153990	$2,512
(N/O) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...	CPT 55866	-	-	-	-
OBSTETRICAL CARE	CPT 59400	Outpatient	-	$2,987
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERY	CPT 59510	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...	CPT 59610	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62322	-	-	-	-
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCE	CPT 62323	-	-	-	-
NJX AA&/STRD TFRM EPI L/S 1	CPT 64483	Outpatient	-	$1,234
(N/O) REMOVAL OF RECURRING CATARACT IN LENS CAPSULE USING ...	CPT 66821	-	-	-	-
XCAPSL CTRC RMVL W/O ECP	CPT 66984	Outpatient	-	$1,181
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSIS	CPT 93452	-	-	-	-
Therapy
ULTRASOUND THERAPY	CPT 97035	Outpatient	691311	$21
THERAPEUTIC EXERCISES	CPT 97110	Outpatient	691306	$51
NEUROMUSCULAR REEDUCATION	CPT 97112	Outpatient	691316	$53
GAIT TRAINING THERAPY	CPT 97116	Outpatient	692247	$46
PHYSICAL MEDICINE PROCEDURE	CPT 97139	Outpatient	11200076	$15
MANUAL THERAPY 1/> REGIONS	CPT 97140	Outpatient	691319	$48
GROUP THERAPEUTIC PROCEDURES	CPT 97150	Outpatient	1230185	$28
PT EVAL LOW COMPLEX 20 MIN	CPT 97161	Outpatient	25434283	$120
PT EVAL MOD COMPLEX 30 MIN	CPT 97162	Outpatient	25434285	$120
OT EVAL LOW COMPLEX 30 MIN	CPT 97165	Outpatient	25433994	$137
OT EVAL MOD COMPLEX 45 MIN	CPT 97166	Outpatient	25433996	$137
THERAPEUTIC ACTIVITIES	CPT 97530	Outpatient	691304	$57
SELF CARE MNGMENT TRAINING	CPT 97535	Outpatient	691327	$57
RMVL DEVITAL TIS 20 CM/<	CPT 97597	Outpatient	11517510	$61
WOUND(S) CARE NON-SELECTIVE	CPT 97602	Outpatient	11516928	$26
ELEC STIM OTHER THAN WOUND	HCPCS G0283	Outpatient	11517505	$22
Uncategorized
TRIM SKIN LESION	CPT 11055	Outpatient	11752539	$304
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	Outpatient	2856998	$556
RPR F/E/E/N/L/M 2.5 CM/<	CPT 12011	Outpatient	2858686	$385
INJ TRIGGER POINT 1/2 MUSCL	CPT 20552	Outpatient	25373828	$146
INJECT SACROILIAC JOINT	CPT 27096	Outpatient	26037506	$258
STRAPPING OF SHOULDER	CPT 29240	Outpatient	25373946	$87
NASAL/OROGASTRIC W/TUBE PLMT	CPT 43752	Outpatient	607675	$179
ABD PARACENTESIS W/IMAGING	CPT 49083	Outpatient	25374050	$498
IMMUNIZATION ADMIN	CPT 90471	Outpatient	11755514	$48
OFFICE O/P NEW SF 15-29 MIN	CPT 99202	Outpatient	11517572	$122
OFFICE O/P EST SF 10-19 MIN	CPT 99212	Outpatient	11517576	$70
OFFICE O/P EST LOW 20-29 MIN	CPT 99213	Outpatient	11517577	$93
OFFICE O/P EST MOD 30-39 MIN	CPT 99214	Outpatient	11517578	$135
OFFICE O/P EST HI 40-54 MIN	CPT 99215	Outpatient	11517579	$200
OBSERVATION CARE DISCHARGE	CPT 99217	Outpatient	11924319	$410
INITIAL OBSERVATION CARE	CPT 99219	Outpatient	3005181	$634
INITIAL OBSERVATION CARE	CPT 99220	Outpatient	11924308	$886
INITIAL HOSPITAL CARE	CPT 99221	Outpatient	11519883	$287
INITIAL HOSPITAL CARE	CPT 99222	Outpatient	11519884	$510
INITIAL HOSPITAL CARE	CPT 99223	Outpatient	11519886	$844
SUBSEQUENT OBSERVATION CARE	CPT 99225	Outpatient	11924310	$294
SUBSEQUENT HOSPITAL CARE	CPT 99231	Outpatient	11519888	$234
SUBSEQUENT HOSPITAL CARE	CPT 99232	Outpatient	11519890	$386
SUBSEQUENT HOSPITAL CARE	CPT 99233	Outpatient	11519894	$655
HOSPITAL DISCHARGE DAY	CPT 99238	Outpatient	11519895	$120
HOSPITAL DISCHARGE DAY	CPT 99239	Outpatient	11519897	$431
GROUND MILEAGE	HCPCS A0425	Outpatient	6921644	$28
ALS1-EMERGENCY	HCPCS A0427	Outpatient	6921646	$1,306
BLS-EMERGENCY	HCPCS A0429	Outpatient	6921648	$1,116
TRAUMA RESPONS W/HOSP CRITI	HCPCS G0390	Outpatient	14720462	$2,486