Southwest Health System

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

Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.
Filtering
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450Outpatient821336$1,002
CT ANGIOGRAPHY CHESTCPT 71275Outpatient885769$1,517
CT PELVIS W/DYECPT 72193Outpatient821359$1,446
CT ABD & PELV W/CONTRASTCPT 74177Outpatient1005109$2,177
Cancer Services
CHEMO HORMON ANTINEOPL SQ/IMCPT 96402Outpatient11735335$285
Clinic
OFFICE O/P NEW LOW 30-44 MINCPT 99203Outpatient11517573$172
OFFICE O/P NEW MOD 45-59 MINCPT 99204Outpatient11517574$276
OFFICE O/P NEW HI 60-74 MINCPT 99205Outpatient11517575$300
(N/O) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243----
(N/O) PATIENT OFFICE CONSULTATION, 60 MINCPT 99244----
PREV VISIT NEW AGE 18-39CPT 99385Outpatient-$199
PREV VISIT NEW AGE 40-64CPT 99386Outpatient-$221
EEG
POLYSOM 6/> YRS 4/> PARAMCPT 95810Outpatient11517582$3,213
EKG
ELECTROCARDIOGRAM COMPLETECPT 93000Outpatient-$114
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient2423453$340
ECG MONIT/REPRT UP TO 48 HRSCPT 93225Outpatient3887159$336
Emergency Room
DRAINAGE OF SKIN ABSCESSCPT 10060Outpatient11752613$366
DEB SUBQ TISSUE 20 SQ CM/<CPT 11042Outpatient11755480$700
DEBRIDE NAIL 1-5CPT 11720Outpatient11755457$111
DEBRIDE NAIL 6 OR MORECPT 11721Outpatient27141078$103
REMOVAL OF NAIL BEDCPT 11750Outpatient11755387$753
REMOVE DRUG IMPLANT DEVICECPT 11982Outpatient2856996$660
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient11752591$387
RPR F/E/E/N/L/M 2.6-5.0 CMCPT 12013Outpatient11752599$387
INJ TENDON SHEATH/LIGAMENTCPT 20550Outpatient11752559$397
DRAIN/INJ JOINT/BURSA W/O USCPT 20600Outpatient11755184$397
DRAIN/INJ JOINT/BURSA W/O USCPT 20605Outpatient11755185$477
DRAIN/INJ JOINT/BURSA W/O USCPT 20610Outpatient11755186$365
TREAT SHOULDER DISLOCATIONCPT 23650Outpatient11755198$683
TREAT SHOULDER DISLOCATIONCPT 23655Outpatient6017158$2,433
TREAT FRACTURE RADIUS/ULNACPT 25605Outpatient11755348$1,999
APPLICATION OF FOREARM CASTCPT 29075Outpatient11752585$227
APPLY LONG ARM SPLINTCPT 29105Outpatient4287463$190
APPLY FOREARM SPLINTCPT 29125Outpatient11752567$231
APPLICATION OF FINGER SPLINTCPT 29130Outpatient11752570$231
APPLY SHORT LEG CASTCPT 29405Outpatient11752555$227
APPLICATION LONG LEG SPLINTCPT 29505Outpatient11752572$345
APPLICATION LOWER LEG SPLINTCPT 29515Outpatient11752573$330
APPLICATION OF PASTE BOOTCPT 29580Outpatient11752581$200
REMOVAL/REVISION OF CASTCPT 29705Outpatient11752590$227
CONTROL OF NOSEBLEEDCPT 30901Outpatient11752693$212
INSERT EMERGENCY AIRWAYCPT 31500Outpatient11752545$1,026
INSERT TEMP BLADDER CATHCPT 51702Outpatient11755493$151
OBSTETRICAL CARECPT 59409Outpatient11752737$3,367
NJX AA&/STRD OTHER PN/BRANCHCPT 64450Outpatient11755332$455
REMOVE IMPACTED EAR WAX UNICPT 69209Outpatient25370222$125
EMERGENCY DEPT VISITCPT 99281Outpatient25159328$211
EMERGENCY DEPT VISITCPT 99282Outpatient25159330$263
EMERGENCY DEPT VISITCPT 99283Outpatient25159331$554
EMERGENCY DEPT VISITCPT 99284Outpatient25159335$745
EMERGENCY DEPT VISITCPT 99285Outpatient25159341$1,267
CRITICAL CARE FIRST HOURCPT 99291Outpatient25159349$2,167
CRITICAL CARE ADDL 30 MINCPT 99292Outpatient25159350$1,084
IV Therapy
HYDRATION IV INFUSION INITCPT 96360Outpatient25159290$472
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient25159291$93
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient25159292$548
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient25159293$120
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient25159297$184
THER/DIAG CONCURRENT INFCPT 96368Outpatient25159298$79
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient25159299$86
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient25159306$197
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient25159311$120
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient25159312$129
Imaging
ULTRASOUND BREAST COMPLETECPT 76641Outpatient1007730$366
US EXAM ABDOM COMPLETECPT 76700Outpatient823404$572
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient1007763$456
OB US >= 14 WKS SNGL FETUSCPT 76805Outpatient1525529$510
TRANSVAGINAL US NON-OBCPT 76830Outpatient3145306$491
BREAST TOMOSYNTHESIS BICPT 77063Outpatient25644596$140
DX MAMMO INCL CAD UNICPT 77065Outpatient1240707$174
DX MAMMO INCL CAD BICPT 77066Outpatient1181457$291
SCR MAMMO BI INCL CADCPT 77067Outpatient1181460$210
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460Inpatient-$13,271
MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...DRG 470Inpatient-$24,027
CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473Inpatient-$14,575
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...DRG 743----
Laboratory
ROUTINE VENIPUNCTURECPT 36415Outpatient1189774$10
CAPILLARY BLOOD DRAWCPT 36416Outpatient796177$16
WITHDRAWAL OF ARTERIAL BLOODCPT 36600Outpatient10743234$155
METABOLIC PANEL TOTAL CACPT 80048Outpatient3675567$46
COMPREHEN METABOLIC PANELCPT 80053Outpatient3675566$57
OBSTETRIC PANELCPT 80055Outpatient13824201$226
LIPID PANELCPT 80061Outpatient25631259$43
RENAL FUNCTION PANELCPT 80069Outpatient3675565$98
ACUTE HEPATITIS PANELCPT 80074Outpatient2195160$138
HEPATIC FUNCTION PANELCPT 80076Outpatient1414277$69
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient20267092$174
ASSAY DIPROPYLACETIC ACD TOTCPT 80164Outpatient3679215$151
ASSAY OF PHENYTOIN TOTALCPT 80185Outpatient11287169$148
ASSAY OF TACROLIMUSCPT 80197Outpatient11612765$92
ASSAY OF VANCOMYCINCPT 80202Outpatient2013815$151
DRUG TEST PRSMV DIR OPT OBSCPT 80305Outpatient11218218$138
DRUG TEST PRSMV CHEM ANLYZRCPT 80307Outpatient1019620$121
DRUG SCREEN QUANTALCOHOLSCPT 80320Outpatient25552249$57
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81000----
URINALYSIS AUTO W/SCOPECPT 81001Outpatient11389839$51
(N/O) URINALYSIS TESTCPT 81002----
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient14085369$27
MICROSCOPIC EXAM OF URINECPT 81015Outpatient13855303$31
URINE PREGNANCY TESTCPT 81025Outpatient11389830$61
CFTR GENE COM VARIANTSCPT 81220Outpatient25552289$818
UNLISTED MOLECULAR PATHOLOGYCPT 81479Outpatient15256461$13
TEST FOR ACETONE/KETONESCPT 82009Outpatient1861593$50
ASSAY OF SERUM ALBUMINCPT 82040Outpatient633634$55
UR ALBUMIN QUANTITATIVECPT 82043Outpatient14046031$65
ALPHA-FETOPROTEIN SERUMCPT 82105Outpatient1597561$29
ASSAY OF AMMONIACPT 82140Outpatient633648$162
ASSAY OF AMYLASECPT 82150Outpatient11218220$72
BILIRUBIN TOTALCPT 82247Outpatient13763096$55
BILIRUBIN DIRECTCPT 82248Outpatient633670$55
ASSAY OF BIOTINIDASECPT 82261Outpatient14946084$31
ASSAY TEST FOR BLOOD FECALCPT 82274Outpatient18356336$87
VITAMIN D 25 HYDROXYCPT 82306Outpatient24117183$221
ASSAY OF CALCIUMCPT 82310Outpatient13924901$57
ASSAY OF CALCIUM IN URINECPT 82340Outpatient25631267$20
CARCINOEMBRYONIC ANTIGENCPT 82378Outpatient1025717$93
TOTAL CORTISOLCPT 82533Outpatient25631270$52
ASSAY OF CK (CPK)CPT 82550Outpatient25631271$22
ASSAY OF CREATININECPT 82565Outpatient633606$43
ASSAY OF URINE CREATININECPT 82570Outpatient25631273$16
VITAMIN B-12CPT 82607Outpatient633871$75
ASSAY OF TOTAL ESTRADIOLCPT 82670Outpatient25631274$81
ASSAY OF ESTRIOLCPT 82677Outpatient1550004$42
ASSAY OF FERRITINCPT 82728Outpatient2215100$68
ASSAY OF FOLIC ACID SERUMCPT 82746Outpatient7935142$71
ASSAY OF FOLIC ACID RBCCPT 82747Outpatient2687610$64
GALACTOSE TRANSFERASE TESTCPT 82776Outpatient14946080$18
ASSAY IGA/IGD/IGG/IGM EACHCPT 82784Outpatient25631275$46
BLOOD GASES ANY COMBINATIONCPT 82803Outpatient10743237$164
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient633594$44
REAGENT STRIP/BLOOD GLUCOSECPT 82948Outpatient19705216$13
GLUCOSE TESTCPT 82950Outpatient11538647$51
GLUCOSE BLOOD TESTCPT 82962Outpatient25140732$25
ASSAY OF GGTCPT 82977Outpatient633733$80
ASSAY OF GONADOTROPIN (FSH)CPT 83001Outpatient1025770$92
ASSAY OF GONADOTROPIN (LH)CPT 83002Outpatient7323141$92
H PYLORI (C-13) BREATHCPT 83013Outpatient25552304$135
HEMOGLOBIN ELECTROPHORESISCPT 83020Outpatient14946082$24
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient3343172$110
ASSAY OF HOMOCYSTINECPT 83090Outpatient25631347$82
ASSAY OF PROGESTERONE 17-DCPT 83498Outpatient14946085$49
IMMUNOASSAY NONANTIBODYCPT 83516Outpatient13924834$83
RIA NONANTIBODYCPT 83519Outpatient1763545$236
IMMUNOASSAY QUANT NOS NONABCPT 83520Outpatient14946083$26
ASSAY OF IRONCPT 83540Outpatient1137680$72
IRON BINDING TESTCPT 83550Outpatient4033177$98
ASSAY OF LACTIC ACIDCPT 83605Outpatient633768$16
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient11220729$68
ASSAY OF LIPASECPT 83690Outpatient633776$78
ASSAY OF MAGNESIUMCPT 83735Outpatient25631281$22
MASS SPECTROMETRY QUAL/QUANCPT 83789Outpatient14946086$35
ASSAY OF NATRIURETIC PEPTIDECPT 83880Outpatient853229$199
ASSAY NEPHELOMETRY NOT SPECCPT 83883Outpatient25631284$69
ASSAY OF PARATHORMONECPT 83970Outpatient25631287$96
ASSAY FOR CALPROTECTIN FECALCPT 83993Outpatient1549542$58
ASSAY OF BLOOD PKUCPT 84030Outpatient14946073$10
ASSAY OF PHOSPHORUSCPT 84100Outpatient633803$51
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient633616$50
ASSAY OF PROGESTERONECPT 84144Outpatient633808$115
ASSAY OF PROLACTINCPT 84146Outpatient633809$95
ASSAY OF PSA TOTALCPT 84153Outpatient25631292$55
ASSAY OF PSA FREECPT 84154Outpatient25631293$55
ASSAY OF PROTEIN SERUMCPT 84155Outpatient25631363$11
ASSAY OF PROTEIN URINECPT 84156Outpatient14607365$18
PROTEIN E-PHORESIS SERUMCPT 84165Outpatient25631295$52
ASSAY OF URINE SODIUMCPT 84300Outpatient25631296$15
ASSAY OF FREE TESTOSTERONECPT 84402Outpatient25631300$83
ASSAY OF TOTAL TESTOSTERONECPT 84403Outpatient25631301$83
ASSAY OF VITAMIN B-1CPT 84425Outpatient2781166$97
ASSAY OF TOTAL THYROXINECPT 84436Outpatient1281223$77
ASSAY OF NEONATAL THYROXINECPT 84437Outpatient14946081$11
ASSAY OF FREE THYROXINECPT 84439Outpatient857849$92
ASSAY THYROID STIM HORMONECPT 84443Outpatient15256455$31
TRANSFERASE (AST) (SGOT)CPT 84450Outpatient633633$57
ALANINE AMINO (ALT) (SGPT)CPT 84460Outpatient633632$61
ASSAY OF TRIGLYCERIDESCPT 84478Outpatient633852$65
ASSAY TRIIODOTHYRONINE (T3)CPT 84480Outpatient633833$69
FREE ASSAY (FT-3)CPT 84481Outpatient633834$83
ASSAY OF UREA NITROGENCPT 84520Outpatient633605$46
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient633858$50
ASSAY OF ZINCCPT 84630Outpatient783592$49
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient13924892$62
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient13887475$78
BL SMEAR W/DIFF WBC COUNTCPT 85007Outpatient11220890$39
BL SMEAR W/O DIFF WBC COUNTCPT 85008Outpatient17858841$28
HEMATOCRITCPT 85014Outpatient25631304$28
HEMOGLOBINCPT 85018Outpatient25631305$28
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient11220888$37
COMPLETE CBC AUTOMATEDCPT 85027Outpatient3343185$31
AUTOMATED RETICULOCYTE COUNTCPT 85045Outpatient11287170$46
BLOOD SMEAR INTERPRETATIONCPT 85060Outpatient15332437$14
FIBRIN DEGRADATION QUANTCPT 85379Outpatient633718$90
PROTHROMBIN TIMECPT 85610Outpatient11389991$27
RBC SED RATE AUTOMATEDCPT 85652Outpatient633830$31
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient25631308$18
ALLG SPEC IGE CRUDE XTRC EACPT 86003Outpatient25631309$11
WBC ANTIBODY IDENTIFICATIONCPT 86021Outpatient25631310$48
ANTINUCLEAR ANTIBODIESCPT 86038Outpatient25552261$61
ANTINUCLEAR ANTIBODIES (ANA)CPT 86039Outpatient25631311$53
C-REACTIVE PROTEINCPT 86140Outpatient633716$57
C-REACTIVE PROTEIN HSCPT 86141Outpatient8733141$36
COMPLEMENT ANTIGENCPT 86160Outpatient2195002$61
CCP ANTIBODYCPT 86200Outpatient783619$92
NUCLEAR ANTIGEN ANTIBODYCPT 86235Outpatient25631315$73
IMMUNOASSAY TUMOR CA 15-3CPT 86300Outpatient1025710$81
IMMUNOASSAY TUMOR CA 19-9CPT 86301Outpatient1025711$102
IMMUNOASSAY TUMOR CA 125CPT 86304Outpatient1025709$102
HETEROPHILE ANTIBODY SCREENCPT 86308Outpatient11287167$57
IMMUNOASSAY INFECTIOUS AGENTCPT 86317Outpatient2195108$51
IMMUNOFIX E-PHORESIS SERUMCPT 86334Outpatient1200258$69
INHIBIN ACPT 86336Outpatient25072744$54
MICROSOMAL ANTIBODY EACHCPT 86376Outpatient25631355$71
RHEUMATOID FACTOR QUANTCPT 86431Outpatient11202737$15
TB TEST CELL IMMUN MEASURECPT 86480Outpatient26975004$237
SYPHILIS TEST NON-TREP QUALCPT 86592Outpatient25631316$20
SYPHILIS TEST NON-TREP QUANTCPT 86593Outpatient25631317$31
HEP B CORE ANTIBODY TOTALCPT 86704Outpatient1025783$61
MUMPS ANTIBODYCPT 86735Outpatient1549636$51
RUBELLA ANTIBODYCPT 86762Outpatient25631330$47
RUBEOLA ANTIBODYCPT 86765Outpatient798811$53
VARICELLA-ZOSTER ANTIBODYCPT 86787Outpatient25631362$63
THYROGLOBULIN ANTIBODYCPT 86800Outpatient25631361$68
HEPATITIS C AB TESTCPT 86803Outpatient1025787$69
RBC ANTIBODY SCREENCPT 86850Outpatient12153886$80
COOMBS TEST DIRECTCPT 86880Outpatient1137992$53
BLOOD TYPING SEROLOGIC ABOCPT 86900Outpatient10419560$155
BLOOD TYPING SEROLOGIC RH(D)CPT 86901Outpatient14424296$34
COMPATIBILITY TEST SPINCPT 86920Outpatient13853672$191
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient850752$115
FECES CULTURE AEROBIC BACTCPT 87045Outpatient1151516$106
STOOL CULTR AEROBIC BACT EACPT 87046Outpatient14122294$46
CULTURE OTHR SPECIMN AEROBICCPT 87070Outpatient858005$97
CULTURE ANAEROBE IDENT EACHCPT 87076Outpatient10636433$79
CULTURE AEROBIC IDENTIFYCPT 87077Outpatient11519861$35
CULTURE SCREEN ONLYCPT 87081Outpatient25552301$67
URINE BACTERIA CULTURECPT 87088Outpatient850756$59
OVA AND PARASITES SMEARSCPT 87177Outpatient25631337$44
MICROBE SUSCEPTIBLE ENZYMECPT 87185Outpatient634025$34
MICROBE SUSCEPTIBLE MICCPT 87186Outpatient294946$97
SMEAR GRAM STAINCPT 87205Outpatient15704202$48
SMEAR COMPLEX STAINCPT 87209Outpatient25631338$44
SMEAR WET MOUNT SALINE/INKCPT 87210Outpatient11389829$47
CLOSTRIDIUM AG IACPT 87324Outpatient26789240$164
GIARDIA AG IACPT 87329Outpatient11287161$135
HPYLORI STOOL AG IACPT 87338Outpatient2195087$135
HEPATITIS B SURFACE AG IACPT 87340Outpatient2195150$50
HIV-1 AG W/HIV-1&2 AB AG IACPT 87389Outpatient22489168$78
INFLUENZA A/B EACH AG IACPT 87400Outpatient15225548$29
RESP SYNCYTIAL VIRUS AG IACPT 87420Outpatient11389876$135
CHYLMD TRACH DNA AMP PROBECPT 87491Outpatient25631340$50
CYTOMEG DNA QUANTCPT 87497Outpatient2687625$170
HEPATITIS C REVRS TRNSCRPJCPT 87522Outpatient25737176$212
DETECT AGENT NOS DNA QUANTCPT 87799Outpatient1549537$140
STREP A ASSAY W/OPTICCPT 87880Outpatient11287172$63
CYTOPATH CONCENTRATE TECHCPT 88108Outpatient3663146$111
SURGICAL PATH GROSSCPT 88300Outpatient2939440$43
TISSUE EXAM BY PATHOLOGISTCPT 88304Outpatient2939442$187
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient2939443$188
SPECIAL STAINS GROUP 2CPT 88313Outpatient4511340$125
IMMUNOHISTO ANTB 1ST STAINCPT 88342Outpatient14166355$319
BILIRUBIN TOTAL TRANSCUTCPT 88720Outpatient2612739$13
BODY FLUID CELL COUNTCPT 89051Outpatient11218221$62
PSA SCREENINGHCPCS G0103Outpatient1019535$127
DRUG TEST DEF 1-7 CLASSESHCPCS G0480Outpatient27109390$103
Language Pathology
SPEECH/HEARING THERAPYCPT 92507Outpatient1230484$126
MOTION FLUOROSCOPY/SWALLOWCPT 92611Outpatient1230493$141
DEVELOPMENTAL SCREEN W/SCORECPT 96110Outpatient4811572$21
MRI
MRI BRAIN STEM W/O DYECPT 70551Outpatient821402$2,272
MRI BRAIN STEM W/O & W/DYECPT 70553Outpatient821398$3,150
MRI LUMBAR SPINE W/O DYECPT 72148Outpatient821445$1,986
MRI JNT OF LWR EXTRE W/O DYECPT 73721Outpatient821420$2,370
Medical and Surgical Supplies
CATH W/DRAINAGE 2-WAY SILCNEHCPCS A4315Outpatient12331701$38
3DMAX MESH LEFT LIGHTHCPCS C1781Outpatient13745780$351
POST CHMBR INTRAOCULAR LENSHCPCS V2632Outpatient13745914$395
Nuclear Medicine
TC99M TETROFOSMINHCPCS A9502Outpatient10472999$345
TC99M DISOFENINHCPCS A9510Outpatient10472968$208
Other Diagnostic
FETAL NON-STRESS TESTCPT 59025Outpatient12196274$379
SLEEP STUDY UNATT&RESP EFFTCPT 95806Outpatient11517583$524
POLYSOM 6/>YRS CPAP 4/> PARMCPT 95811Outpatient11517569$3,286
Other Procedures and Observation
DRAW BLOOD OFF VENOUS DEVICECPT 36591Outpatient11735358$80
HOSPITAL OBSERVATION PER HRHCPCS G0378Outpatient12638889$46
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 36430Outpatient11755350$1,131
IMMUNIZATION ADMIN EACH ADDCPT 90472Outpatient11519849$78
CARDIAC REHAB/MONITORCPT 93798Outpatient11517611$173
IMMUNOTHERAPY ONE INJECTIONCPT 95115Outpatient11735362$31
IMMUNOTHERAPY INJECTIONSCPT 95117Outpatient11735363$55
IRRIG DRUG DELIVERY DEVICECPT 96523Outpatient11735355$122
MEDICAL NUTRITION INDIV INCPT 97802Outpatient12328800$35
MED NUTRITION INDIV SUBSEQCPT 97803Outpatient12328801$31
PHLEBOTOMYCPT 99195Outpatient15134572$130
DIAB MANAGE TRN PER INDIVHCPCS G0108Outpatient12328807$41
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient2874238$311
Psychiatric
(N/O) PSYCHOTHERAPY, 30 MINCPT 90832----
(N/O) PSYCHOTHERAPY, 45 MINCPT 90834----
(N/O) PSYCHOTHERAPY, 60 MINCPT 90837----
(N/O) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, 50 MINCPT 90846----
(N/O) FAMILY PSYCHOTHERAPY, INCLUDING PATIENT, 50 MINCPT 90847----
(N/O) GROUP PSYCHOTHERAPYCPT 90853----
Pulmonary Function
BREATHING CAPACITY TESTCPT 94010Outpatient12770944$171
EVALUATION OF WHEEZINGCPT 94060Outpatient12770952$477
PULM FUNCTION TEST BY GASCPT 94727Outpatient12770956$285
CO/MEMBANE DIFFUSE CAPACITYCPT 94729Outpatient12770951$285
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient823510$90
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient823512$143
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100Outpatient823610$143
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101Outpatient3619145$172
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040Outpatient823635$155
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient3125337$225
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient823647$148
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient823641$167
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient823643$230
X-RAY EXAM L-S SPINE BENDINGCPT 72114Outpatient1008092$299
X-RAY EXAM OF PELVISCPT 72170Outpatient823608$117
X-RAY EXAM SACRUM TAILBONECPT 72220Outpatient823617$134
X-RAY EXAM OF COLLAR BONECPT 73000Outpatient823516$119
X-RAY EXAM OF SHOULDERCPT 73030Outpatient1284694$134
X-RAY EXAM OF HUMERUSCPT 73060Outpatient823588$130
X-RAY EXAM OF ELBOWCPT 73070Outpatient823520$117
X-RAY EXAM OF ELBOWCPT 73080Outpatient1007932$148
X-RAY EXAM OF FOREARMCPT 73090Outpatient823562$119
X-RAY EXAM OF WRISTCPT 73100Outpatient823685$122
X-RAY EXAM OF WRISTCPT 73110Outpatient823681$143
X-RAY EXAM OF HANDCPT 73120Outpatient823568$117
X-RAY EXAM OF HANDCPT 73130Outpatient823572$134
X-RAY EXAM OF FINGER(S)CPT 73140Outpatient3125217$116
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502Outpatient823578$127
X-RAY EXAM HIP UNI 4/> VIEWSCPT 73503Outpatient25059816$150
X-RAY EXAM OF FEMUR 2/>CPT 73552Outpatient1007940$106
X-RAY EXAM OF KNEE 1 OR 2CPT 73560Outpatient823596$125
X-RAY EXAM OF KNEE 3CPT 73562Outpatient823592$125
X-RAY EXAM KNEE 4 OR MORECPT 73564Outpatient1007996$167
X-RAY EXAM OF KNEESCPT 73565Outpatient1008002$113
X-RAY EXAM OF LOWER LEGCPT 73590Outpatient2214290$122
X-RAY EXAM OF ANKLECPT 73610Outpatient823492$97
X-RAY EXAM OF FOOTCPT 73620Outpatient823554$80
X-RAY EXAM OF FOOTCPT 73630Outpatient823558$91
X-RAY EXAM OF TOE(S)CPT 73660Outpatient3125343$88
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient823483$116
X-RAY EXAM ABDOMEN 2 VIEWSCPT 74019Outpatient823486$158
X-RAY EXAM COMPLETE ABDOMENCPT 74022Outpatient2214245$203
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient3125259$382
NEEDLE LOCALIZATION BY XRAYCPT 77002Outpatient25141979$261
Respiratory
AIRWAY INHALATION TREATMENTCPT 94640Outpatient11735244$276
POS AIRWAY PRESSURE CPAPCPT 94660Outpatient2425534$326
Surgical Procedures
REMOVAL OF BREAST LESIONCPT 19120Outpatient-$860
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826----
KNEE ARTHROSCOPY/SURGERYCPT 29881Outpatient-$6,141
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...CPT 42820----
EGD DIAGNOSTIC BRUSH WASHCPT 43235Outpatient3005152$868
EGD BIOPSY SINGLE/MULTIPLECPT 43239Outpatient2972988$1,959
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient-$1,056
COLONOSCOPY AND BIOPSYCPT 45380Outpatient3005157$1,547
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient-$1,418
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562Outpatient3005159$3,209
PRP I/HERN INIT REDUC >5 YRCPT 49505Outpatient-$1,251
CIRCUMCISION W/REGIONL BLOCKCPT 54150Outpatient12153990$2,512
(N/O) BIOPSY OF PROSTATE GLANDCPT 55700----
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...CPT 55866----
OBSTETRICAL CARECPT 59400Outpatient-$2,987
(N/O) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510----
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (POST DELIV ...CPT 59610----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322----
(N/O) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62323----
NJX AA&/STRD TFRM EPI L/S 1CPT 64483Outpatient-$1,234
(N/O) REMOVAL OF RECURRING CATARACT IN LENS CAPSULE USING ...CPT 66821----
XCAPSL CTRC RMVL W/O ECPCPT 66984Outpatient-$1,181
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
ULTRASOUND THERAPYCPT 97035Outpatient691311$21
THERAPEUTIC EXERCISESCPT 97110Outpatient691306$51
NEUROMUSCULAR REEDUCATIONCPT 97112Outpatient691316$53
GAIT TRAINING THERAPYCPT 97116Outpatient692247$46
PHYSICAL MEDICINE PROCEDURECPT 97139Outpatient11200076$15
MANUAL THERAPY 1/> REGIONSCPT 97140Outpatient691319$48
GROUP THERAPEUTIC PROCEDURESCPT 97150Outpatient1230185$28
PT EVAL LOW COMPLEX 20 MINCPT 97161Outpatient25434283$120
PT EVAL MOD COMPLEX 30 MINCPT 97162Outpatient25434285$120
OT EVAL LOW COMPLEX 30 MINCPT 97165Outpatient25433994$137
OT EVAL MOD COMPLEX 45 MINCPT 97166Outpatient25433996$137
THERAPEUTIC ACTIVITIESCPT 97530Outpatient691304$57
SELF CARE MNGMENT TRAININGCPT 97535Outpatient691327$57
RMVL DEVITAL TIS 20 CM/<CPT 97597Outpatient11517510$61
WOUND(S) CARE NON-SELECTIVECPT 97602Outpatient11516928$26
ELEC STIM OTHER THAN WOUNDHCPCS G0283Outpatient11517505$22
Uncategorized
TRIM SKIN LESIONCPT 11055Outpatient11752539$304
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001Outpatient2856998$556
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011Outpatient2858686$385
INJ TRIGGER POINT 1/2 MUSCLCPT 20552Outpatient25373828$146
INJECT SACROILIAC JOINTCPT 27096Outpatient26037506$258
STRAPPING OF SHOULDERCPT 29240Outpatient25373946$87
NASAL/OROGASTRIC W/TUBE PLMTCPT 43752Outpatient607675$179
ABD PARACENTESIS W/IMAGINGCPT 49083Outpatient25374050$498
IMMUNIZATION ADMINCPT 90471Outpatient11755514$48
OFFICE O/P NEW SF 15-29 MINCPT 99202Outpatient11517572$122
OFFICE O/P EST SF 10-19 MINCPT 99212Outpatient11517576$70
OFFICE O/P EST LOW 20-29 MINCPT 99213Outpatient11517577$93
OFFICE O/P EST MOD 30-39 MINCPT 99214Outpatient11517578$135
OFFICE O/P EST HI 40-54 MINCPT 99215Outpatient11517579$200
OBSERVATION CARE DISCHARGECPT 99217Outpatient11924319$410
INITIAL OBSERVATION CARECPT 99219Outpatient3005181$634
INITIAL OBSERVATION CARECPT 99220Outpatient11924308$886
INITIAL HOSPITAL CARECPT 99221Outpatient11519883$287
INITIAL HOSPITAL CARECPT 99222Outpatient11519884$510
INITIAL HOSPITAL CARECPT 99223Outpatient11519886$844
SUBSEQUENT OBSERVATION CARECPT 99225Outpatient11924310$294
SUBSEQUENT HOSPITAL CARECPT 99231Outpatient11519888$234
SUBSEQUENT HOSPITAL CARECPT 99232Outpatient11519890$386
SUBSEQUENT HOSPITAL CARECPT 99233Outpatient11519894$655
HOSPITAL DISCHARGE DAYCPT 99238Outpatient11519895$120
HOSPITAL DISCHARGE DAYCPT 99239Outpatient11519897$431
GROUND MILEAGEHCPCS A0425Outpatient6921644$28
ALS1-EMERGENCYHCPCS A0427Outpatient6921646$1,306
BLS-EMERGENCYHCPCS A0429Outpatient6921648$1,116
TRAUMA RESPONS W/HOSP CRITIHCPCS G0390Outpatient14720462$2,486