Uvalde Memorial Hospital

Price List for Shoppable Services. Effective 07-27-2022.

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 704502200090Outpatient$2,174$2,065Payer Rates
CT PELVIS W/DYECPT 721932200314Outpatient$2,390$2,271Payer Rates
CT ABD & PELV W/CONTRASTCPT 741772200415Outpatient$3,433$3,261Payer Rates
Cardiology
HEART/LUNG RESUSCITATION CPRCPT 929501400766Outpatient$1,332$1,265Payer Rates
CARDIOVERSION ELECTRIC EXTCPT 929601260147Outpatient$1,973$1,874Payer Rates
CARDIOVERSION ELECTRIC EXTCPT 929601450199Outpatient$1,973$1,874Payer Rates
Clinic
(Not Offered) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EV ...CPT 99385-----
(Not Offered) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EV ...CPT 99386-----
EEG
(Not Offered) SLEEP STUDYCPT 95810-----
EKG
(Not Offered) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETAT ...CPT 93000-----
ELECTROCARDIOGRAM TRACINGCPT 930051401002Outpatient$318$302Payer Rates
ECG MONIT/REPRT UP TO 48 HRSCPT 932251401005Outpatient$1,375$1,306Payer Rates
ECG MONIT/REPRT UP TO 48 HRSCPT 932261401003Outpatient$893$848Payer Rates
ECG MONIT/REPRT UP TO 48 HRSCPT 932261401006Outpatient$720$684Payer Rates
REMOTE 30 DAY ECG REV/REPORTCPT 932701401023Outpatient$141$134Payer Rates
Emergency Room
DRESS/DEBRID P-THICK BURN SCPT 160201450212Outpatient$281$267Payer Rates
INJ TRIGGER POINT 1/2 MUSCLCPT 205521450405Outpatient$349$332Payer Rates
STRAPPING OF HAND OR FINGERCPT 292801451151Outpatient$321$305Payer Rates
CONTROL OF NOSEBLEEDCPT 309011450465Outpatient$454$431Payer Rates
INSERT EMERGENCY AIRWAYCPT 315001450193Outpatient$549$522Payer Rates
PLACE NEEDLE IN VEINCPT 360001450211Outpatient$100$95Payer Rates
DRAW BLOOD OFF VENOUS DEVICECPT 365911457982Outpatient$581$552Payer Rates
RECTUM SURGERY PROCEDURECPT 459991451192Outpatient$1,423$1,352Payer Rates
IRRIGATION OF BLADDERCPT 517001450400Outpatient$612$581Payer Rates
INSERT BLADDER CATHETERCPT 517011457986Outpatient$302$287Payer Rates
INSERT TEMP BLADDER CATHCPT 517021450185Outpatient$404$384Payer Rates
US URINE CAPACITY MEASURECPT 517981459794Outpatient$153$145Payer Rates
DX LMBR SPI PNXRCPT 622701450159Outpatient$1,095$1,040Payer Rates
REMOVE FOREIGN BODY FROM EYECPT 652051450153Outpatient$440$418Payer Rates
HYDRATION IV INFUSION INITCPT 963601450600Outpatient$397$377Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721450207Outpatient$153$145Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741450208Outpatient$331$314Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963761457984Outpatient$165$157Payer Rates
EMERGENCY DEPT VISITCPT 992811450032Outpatient$315$299Payer Rates
EMERGENCY DEPT VISITCPT 992821450024Outpatient$525$499Payer Rates
EMERGENCY DEPT VISITCPT 992831450016Outpatient$955$907Payer Rates
EMERGENCY DEPT VISITCPT 992841450050Outpatient$1,534$1,457Payer Rates
EMERGENCY DEPT VISITCPT 992851450060Outpatient$2,223$2,112Payer Rates
CRITICAL CARE FIRST HOURCPT 992911450069Outpatient$3,656$3,473Payer Rates
CRITICAL CARE ADDL 30 MINCPT 992921450070Outpatient$1,221$1,160Payer Rates
BRIEF CHECK IN BY MD/QHPHCPCS G20121457988Outpatient$53$50Payer Rates
TELEHEALTH FACILITY FEEHCPCS Q30141459795Outpatient$74$70Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 963601050322Outpatient$397$377Payer Rates
HYDRATION IV INFUSION INITCPT 963601150136Outpatient$397$377Payer Rates
HYDRATION IV INFUSION INITCPT 963601260099Outpatient$397$377Payer Rates
HYDRATION IV INFUSION INITCPT 963601500338Outpatient$397$377Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963611050323Outpatient$149$142Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963611150137Outpatient$149$142Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963611260100Outpatient$149$142Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963611500339Outpatient$149$142Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963611450601Outpatient$149$142Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651057985Outpatient$733$696Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651150166Outpatient$733$696Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651260121Outpatient$733$696Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651500040Outpatient$733$696Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651450604Outpatient$733$696Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661057986Outpatient$149$142Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661150167Outpatient$149$142Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661260122Outpatient$149$142Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661500041Outpatient$149$142Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963661450605Outpatient$149$142Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963671057987Outpatient$217$206Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963671150168Outpatient$217$206Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963671260124Outpatient$217$206Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963671500042Outpatient$217$206Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963671450607Outpatient$217$206Payer Rates
THER/DIAG CONCURRENT INFCPT 963681057988Outpatient$676$642Payer Rates
THER/DIAG CONCURRENT INFCPT 963681150169Outpatient$676$642Payer Rates
THER/DIAG CONCURRENT INFCPT 963681260125Outpatient$676$642Payer Rates
THER/DIAG CONCURRENT INFCPT 963681450608Outpatient$676$642Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721050300Outpatient$153$145Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721150125Outpatient$153$145Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721260036Outpatient$153$145Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963721500020Outpatient$153$145Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741050310Outpatient$331$314Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741150126Outpatient$331$314Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741260037Outpatient$331$314Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963741500112Outpatient$331$314Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751050311Outpatient$223$212Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751150155Outpatient$223$212Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751260114Outpatient$223$212Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751500114Outpatient$223$212Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963751450215Outpatient$223$212Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963761057993Outpatient$165$157Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963761150172Outpatient$165$157Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963761260136Outpatient$165$157Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963761500363Outpatient$165$157Payer Rates
IRRIG DRUG DELIVERY DEVICECPT 965231260117Outpatient$381$362Payer Rates
Imaging
US EXAM OF HEAD AND NECKCPT 765361459841Outpatient$1,009$959Payer Rates
US EXAM ABDOM COMPLETECPT 767002300396Outpatient$1,592$1,512Payer Rates
ECHO EXAM OF ABDOMENCPT 767051459801Outpatient$1,455$1,382Payer Rates
US EXAM ABDO BACK WALL LIMCPT 767751459802Outpatient$938$891Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 768052300552Outpatient$1,239$1,177Payer Rates
OB US LIMITED FETUS(S)CPT 768151500335Outpatient$902$857Payer Rates
OB US LIMITED FETUS(S)CPT 768151459804Outpatient$902$857Payer Rates
TRANSVAGINAL US NON-OBCPT 768302300391Outpatient$1,255$1,192Payer Rates
US COMPL JOINT R-T W/IMGCPT 76881 (LT)1459837Outpatient$1,068$1,015Payer Rates
US COMPL JOINT R-T W/IMGCPT 76881 (RT)1459839Outpatient$1,068$1,015Payer Rates
US LMTD JT/NONVASC XTR STRUXCPT 768821459807Outpatient$1,401$1,331Payer Rates
US GUIDE VASCULAR ACCESSCPT 769371050387Outpatient$829$788Payer Rates
US GUIDE VASCULAR ACCESSCPT 769371150213Outpatient$829$788Payer Rates
DX MAMMO INCL CAD UNICPT 770652102415Outpatient$374$355Payer Rates
DX MAMMO INCL CAD BICPT 770662102414Outpatient$464$441Payer Rates
SCR MAMMO BI INCL CADCPT 770672102413Outpatient$464$441Payer Rates
SCR MAMMO BI INCL CADCPT 770672102430Outpatient$394$374Payer 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
FETAL NON-STRESS TESTCPT 590251550160Outpatient$415$394Payer Rates
Laboratory
ROUTINE VENIPUNCTURECPT 364152000734Outpatient$22$21Payer Rates
ROUTINE VENIPUNCTURECPT 364151459793Outpatient$22$21Payer Rates
DRAW BLOOD OFF VENOUS DEVICECPT 365911057981Outpatient$581$552Payer Rates
DRAW BLOOD OFF VENOUS DEVICECPT 365911150161Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921050240Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921150171Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921260073Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921260139Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921500321Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921450998Outpatient$581$552Payer Rates
COLLECT BLOOD FROM PICCCPT 365921457987Outpatient$581$552Payer Rates
METABOLIC PANEL TOTAL CACPT 800482003157Outpatient$199$189Payer Rates
ELECTROLYTE PANELCPT 800512000213Outpatient$323$307Payer Rates
COMPREHEN METABOLIC PANELCPT 800532003981Outpatient$227$216Payer Rates
(Not Offered) OBSTETRIC BLOOD TEST PANELCPT 80055-----
LIPID PANELCPT 800612003181Outpatient$267$254Payer Rates
RENAL FUNCTION PANELCPT 800692004294Outpatient$309$294Payer Rates
HEPATIC FUNCTION PANELCPT 800762002910Outpatient$329$313Payer Rates
ASSAY CARBAMAZEPINE TOTALCPT 801562000385Outpatient$299$284Payer Rates
ASSAY OF DIGOXIN TOTALCPT 801622000518Outpatient$183$174Payer Rates
ASSAY DIPROPYLACETIC ACD TOTCPT 801642000302Outpatient$283$269Payer Rates
ASSAY OF LITHIUMCPT 801782000037Outpatient$134$127Payer Rates
ASSAY OF PHENOBARBITALCPT 801842000676Outpatient$203$193Payer Rates
ASSAY OF PHENYTOIN TOTALCPT 801852000726Outpatient$207$197Payer Rates
DRUG TEST PRSMV INSTRMNTCPT 803062001979Outpatient$75$71Payer Rates
DRUG TEST PRSMV CHEM ANLYZRCPT 803072000019Outpatient$243$231Payer Rates
DRUG TEST PRSMV CHEM ANLYZRCPT 803072001029Outpatient$221$210Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPECPT 81000-----
URINALYSIS AUTO W/SCOPECPT 810012001250Outpatient$104$99Payer Rates
URINALYSIS NONAUTO W/O SCOPECPT 810022005311Outpatient$11$10Payer Rates
URINALYSIS AUTO W/O SCOPECPT 810032005318Outpatient$69$66Payer Rates
TEST FOR ACETONE/KETONESCPT 820092000021Outpatient$80$76Payer Rates
ASSAY OF SERUM ALBUMINCPT 820402000070Outpatient$101$96Payer Rates
ALPHA-FETOPROTEIN SERUMCPT 821052000008Outpatient$132$125Payer Rates
ASSAY OF AMMONIACPT 821402000120Outpatient$207$197Payer Rates
ASSAY OF AMYLASECPT 821502000138Outpatient$194$184Payer Rates
BILIRUBIN TOTALCPT 822472000040Outpatient$74$70Payer Rates
BILIRUBIN DIRECTCPT 822482000179Outpatient$78$74Payer Rates
OCCULT BLD FECES 1-3 TESTSCPT 82272 (QW)2000815Outpatient$49$47Payer Rates
ASSAY OF CALCIUMCPT 823102000237Outpatient$76$72Payer Rates
ASSAY BLOOD CARBON DIOXIDECPT 823742000252Outpatient$68$65Payer Rates
CARCINOEMBRYONIC ANTIGENCPT 823782001748Outpatient$236$224Payer Rates
TOTAL CORTISOLCPT 825332001888Outpatient$160$152Payer Rates
ASSAY OF CK (CPK)CPT 825502000443Outpatient$154$146Payer Rates
CREATINE MB FRACTIONCPT 825532003199Outpatient$287$273Payer Rates
ASSAY OF CREATININECPT 825652000450Outpatient$102$97Payer Rates
ASSAY OF URINE CREATININECPT 825702000013Outpatient$87$83Payer Rates
ASSAY OF FERRITINCPT 827282000106Outpatient$35$33Payer Rates
ASSAY OF FOLIC ACID RBCCPT 827472000020Outpatient$236$224Payer Rates
ASSAY IGA/IGD/IGG/IGM EACHCPT 827842000029Outpatient$138$131Payer Rates
ASSAY IGA/IGD/IGG/IGM EACHCPT 827842000031Outpatient$138$131Payer Rates
ASSAY IGA/IGD/IGG/IGM EACHCPT 827842000032Outpatient$138$131Payer Rates
ASSAY OF IGECPT 827852000030Outpatient$199$189Payer Rates
GLUCOSE OTHER FLUIDCPT 829452000014Outpatient$79$75Payer Rates
ASSAY GLUCOSE BLOOD QUANTCPT 829472000617Outpatient$76$72Payer Rates
GLUCOSE TESTCPT 829502001359Outpatient$142$135Payer Rates
ASSAY OF GGTCPT 829772000619Outpatient$127$121Payer Rates
ASSAY OF GONADOTROPIN (FSH)CPT 830012002407Outpatient$193$183Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 830362003424Outpatient$109$104Payer Rates
ASSAY OF IRONCPT 835402000708Outpatient$112$106Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 836152000732Outpatient$146$139Payer Rates
ASSAY OF LEADCPT 836552000034Outpatient$143$136Payer Rates
ASSAY OF LIPASECPT 836902000740Outpatient$199$189Payer Rates
ASSAY OF MAGNESIUMCPT 837352000148Outpatient$132$125Payer Rates
ASSAY OF URINE OSMOLALITYCPT 839352000155Outpatient$132$125Payer Rates
ASSAY OF PHOSPHORUSCPT 841002000856Outpatient$89$85Payer Rates
ASSAY OF SERUM POTASSIUMCPT 841322000898Outpatient$81$77Payer Rates
ASSAY OF PROGESTERONECPT 841442003420Outpatient$177$168Payer Rates
ASSAY OF PROLACTINCPT 841462000163Outpatient$271$257Payer Rates
ASSAY OF PSA TOTALCPT 841532000369Outpatient$182$173Payer Rates
(Not Offered) TOTAL PROSTATE-SPECIFIC ANTIGEN (PSA) TESTCPT 84154-----
ASSAY OF PROTEIN SERUMCPT 841552000948Outpatient$68$65Payer Rates
PROTEIN E-PHORESIS/URINE/CSFCPT 841662000043Outpatient$156$148Payer Rates
ASSAY OF SERUM SODIUMCPT 842952001052Outpatient$79$75Payer Rates
ASSAY OF TOTAL THYROXINECPT 844362001698Outpatient$102$97Payer Rates
ASSAY THYROID STIM HORMONECPT 844432001714Outpatient$204$194Payer Rates
TRANSFERASE (AST) (SGOT)CPT 844502001193Outpatient$88$84Payer Rates
ALANINE AMINO (ALT) (SGPT)CPT 844602001201Outpatient$72$68Payer Rates
ASSAY OF TRIGLYCERIDESCPT 844782001219Outpatient$152$144Payer Rates
ASSAY OF THYROID (T3 OR T4)CPT 844792001680Outpatient$151$143Payer Rates
ASSAY TRIIODOTHYRONINE (T3)CPT 844802001706Outpatient$195$185Payer Rates
ASSAY OF UREA NITROGENCPT 845202001235Outpatient$96$91Payer Rates
ASSAY OF BLOOD/URIC ACIDCPT 845502001243Outpatient$106$101Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 847022001797Outpatient$224$213Payer Rates
CHORIONIC GONADOTROPIN ASSAYCPT 847032000922Outpatient$206$196Payer Rates
BLEEDING TIME TESTCPT 850022000187Outpatient$146$139Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850252000401Outpatient$136$129Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850252005180Outpatient$136$129Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 850252005848Outpatient$165$157Payer Rates
COMPLETE CBC AUTOMATEDCPT 850272004173Outpatient$102$97Payer Rates
AUTOMATED RETICULOCYTE COUNTCPT 850452000989Outpatient$99$94Payer Rates
FIBRINOGEN ACTIVITYCPT 853842000567Outpatient$169$161Payer Rates
PROTHROMBIN TIMECPT 856102000963Outpatient$87$83Payer Rates
RBC SED RATE NONAUTOMATEDCPT 856512001037Outpatient$97$92Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857302001177Outpatient$130$124Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 857302005735Outpatient$263$250Payer Rates
ANTINUCLEAR ANTIBODIESCPT 860382000009Outpatient$186$177Payer Rates
COMPLEMENT ANTIGENCPT 861602000010Outpatient$238$226Payer Rates
COMPLEMENT ANTIGENCPT 861602000080Outpatient$195$185Payer Rates
HETEROPHILE ANTIBODY SCREENCPT 863082000799Outpatient$107$102Payer Rates
RHEUMATOID FACTOR TEST QUALCPT 864302001003Outpatient$129$123Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 865922001300Outpatient$126$120Payer Rates
SYPHILIS TEST NON-TREP QUALCPT 865922003423Outpatient$46$44Payer Rates
HELMINTH ANTIBODYCPT 866822000041Outpatient$259$246Payer Rates
HEPATITIS C AB TESTCPT 868032000026Outpatient$76$72Payer Rates
BLOOD CULTURE FOR BACTERIACPT 870402000104Outpatient$295$280Payer Rates
FECES CULTURE AEROBIC BACTCPT 870452000042Outpatient$263$250Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870702000476Outpatient$262$249Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 870702003116Outpatient$213$202Payer Rates
CULTR BACTERIA EXCEPT BLOODCPT 870752000007Outpatient$332$315Payer Rates
CULTURE AEROBIC IDENTIFYCPT 870772000914Outpatient$151$143Payer Rates
URINE CULTURE/COLONY COUNTCPT 870862001342Outpatient$161$153Payer Rates
MYCOBACTERIA CULTURECPT 871162000047Outpatient$202$192Payer Rates
OVA AND PARASITES SMEARSCPT 871772001128Outpatient$200$190Payer Rates
SMEAR GRAM STAINCPT 872052000633Outpatient$115$109Payer Rates
TISSUE EXAM FOR FUNGICPT 872202001425Outpatient$150$143Payer Rates
HEPATITIS B SURFACE AG IACPT 873402000024Outpatient$54$51Payer Rates
RESP SYNCYTIAL VIRUS AG IACPT 874202003108Outpatient$169$161Payer Rates
STREP A ASSAY W/OPTICCPT 87880 (QW)2000767Outpatient$159$151Payer Rates
BODY FLUID CELL COUNTCPT 890512000278Outpatient$99$94Payer Rates
DRUG TEST DEF 1-7 CLASSESHCPCS G04802000544Outpatient$243$231Payer Rates
DRUG TEST DEF 1-7 CLASSESHCPCS G04802001102Outpatient$303$288Payer Rates
CATHETERIZE FOR URINE SPECHCPCS P96121457985Outpatient$162$154Payer Rates
MRI
MRI BRAIN STEM W/O & W/DYECPT 705532250009Outpatient$4,041$3,839Payer Rates
MRI LUMBAR SPINE W/O DYECPT 721482250022Outpatient$3,594$3,414Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 737212250101Outpatient$2,849$2,707Payer Rates
Other Diagnostic
AEP SCR AUDITORY POTENTIALCPT 926501100226Outpatient$492$467Payer Rates
Other Procedures and Observation
INSERT EMERGENCY AIRWAYCPT 315001400770Outpatient$549$522Payer Rates
PLACE NEEDLE IN VEINCPT 360001500377Outpatient$100$95Payer Rates
DX LMBR SPI PNXRCPT 622701100117Outpatient$1,095$1,040Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992032370200Outpatient$330$314Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 992042370201Outpatient$425$404Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 992052370202Outpatient$541$514Payer Rates
OFFICE CONSULTATIONCPT 992432370163Outpatient$257$244Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631260095Outpatient$285$271Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550034Outpatient$297$282Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550035Outpatient$372$353Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550040Outpatient$394$374Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550045Outpatient$503$478Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550120Outpatient$503$478Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550130Outpatient$297$282Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550140Outpatient$394$374Payer Rates
HOSPITAL OUTPT CLINIC VISITHCPCS G04631550150Outpatient$372$353Payer Rates
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 364301050325Outpatient$1,664$1,581Payer Rates
BLOOD TRANSFUSION SERVICECPT 364301150129Outpatient$1,664$1,581Payer Rates
BLOOD TRANSFUSION SERVICECPT 364301250136Outpatient$1,664$1,581Payer Rates
BLOOD TRANSFUSION SERVICECPT 364301260015Outpatient$1,664$1,581Payer Rates
BLOOD TRANSFUSION SERVICECPT 364301500030Outpatient$1,664$1,581Payer Rates
BLOOD TRANSFUSION SERVICECPT 364301450197Outpatient$1,664$1,581Payer Rates
PHLEBOTOMYCPT 991951050397Outpatient$266$253Payer Rates
PHLEBOTOMYCPT 991951150187Outpatient$266$253Payer Rates
PHLEBOTOMYCPT 991952001417Outpatient$266$253Payer Rates
Psychiatric
PSYTX W PT 30 MINUTESCPT 908323230015Outpatient$234$222Payer Rates
PSYTX W PT 45 MINUTESCPT 908343230097Outpatient$371$352Payer Rates
PSYTX W PT 60 MINUTESCPT 908373230020Outpatient$372$353Payer Rates
(Not Offered) FAMILY PSYCHOTHERAPY, NOT INCLUDING PATIENT, ...CPT 90846-----
FAMILY PSYTX W/PT 50 MINCPT 908473230010Outpatient$391$371Payer Rates
GROUP PSYCHOTHERAPYCPT 908533230025Outpatient$152$144Payer Rates
GROUP PSYCHOTHERAPYCPT 908533230030Outpatient$305$290Payer Rates
GROUP PSYCHOTHERAPYCPT 908533230086Outpatient$305$290Payer Rates
Pulmonary Function
BREATHING CAPACITY TESTCPT 940101400410Outpatient$609$579Payer Rates
EVALUATION OF WHEEZINGCPT 940601400428Outpatient$1,058$1,005Payer Rates
PULMONARY STRESS TESTINGCPT 946181401026Outpatient$317$301Payer Rates
CO/MEMBANE DIFFUSE CAPACITYCPT 947291400516Outpatient$620$589Payer Rates
Radiology
X-RAY EXAM L-2 SPINE 4/>VWSCPT 721102100945Outpatient$907$862Payer Rates
Respiratory
VENT MGMT INPAT INIT DAYCPT 940021400576Outpatient$869$826Payer Rates
VENT MGMT INPAT SUBQ DAYCPT 940031400287Outpatient$946$899Payer Rates
AIRWAY INHALATION TREATMENTCPT 946401400337Outpatient$474$450Payer Rates
CBT 1ST HOURCPT 946441400470Outpatient$498$473Payer Rates
CBT EACH ADDL HOURCPT 946451400577Outpatient$109$104Payer Rates
POS AIRWAY PRESSURE CPAPCPT 946601400352Outpatient$384$365Payer Rates
POS AIRWAY PRESSURE CPAPCPT 946601400644Outpatient$918$872Payer Rates
CHEST WALL MANIPULATIONCPT 946671400261Outpatient$473$449Payer Rates
CHEST WALL MANIPULATIONCPT 946681400262Outpatient$151$143Payer Rates
Surgical Procedures
FNA BX W/O IMG GDN 1ST LESCPT 100211260018Outpatient$462$439Payer Rates
(Not Offered) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN P ...CPT 19120-----
INJECT SACROILIAC JOINTCPT 270961260165Outpatient$2,423$2,302Payer Rates
(Not Offered) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826-----
(Not Offered) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOS ...CPT 29881-----
PLACE NEEDLE IN VEINCPT 360001050373Outpatient$100$95Payer Rates
PLACE NEEDLE IN VEINCPT 360001260085Outpatient$100$95Payer Rates
INSERT NON-TUNNEL CV CATHCPT 365561150143Outpatient$2,425$2,304Payer Rates
REMOVAL TUNNELED CV CATHCPT 365891057997Outpatient$1,445$1,373Payer Rates
REMOVAL TUNNELED CV CATHCPT 365891150192Outpatient$1,445$1,373Payer Rates
REMOVAL TUNNELED CV CATHCPT 365891260135Outpatient$1,445$1,373Payer Rates
DECLOT VASCULAR DEVICECPT 365931050361Outpatient$756$718Payer Rates
DECLOT VASCULAR DEVICECPT 365931150151Outpatient$756$718Payer Rates
INSERTION CATHETER ARTERYCPT 366201150177Outpatient$613$582Payer Rates
INSERTION CATHETER ARTERYCPT 366201459842Outpatient$613$582Payer Rates
(Not Offered) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIE ...CPT 42820-----
(Not Offered) DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH OR SMA ...CPT 43235-----
(Not Offered) BIOPSY EXAM OF ESOPHAGUS, STOMACH OR SMALL B ...CPT 43239-----
RPLC GTUBE NO REVJ TRCCPT 437621459822Outpatient$871$827Payer Rates
(Not Offered) DIAGNOSTIC EXAM OF LARGE BOWEL USING AN ENDO ...CPT 45378-----
(Not Offered) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOP ...CPT 45380-----
(Not Offered) REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL ...CPT 45385-----
(Not Offered) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL ...CPT 45391-----
(Not Offered) REMOVAL OF GALLBLADDER USING AN ENDOSCOPECPT 47562-----
(Not Offered) REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS O ...CPT 49505-----
IRRIGATION OF BLADDERCPT 517001050362Outpatient$612$581Payer Rates
IRRIGATION OF BLADDERCPT 517001150214Outpatient$612$581Payer Rates
INSERT TEMP BLADDER CATHCPT 517021050341Outpatient$404$384Payer Rates
INSERT TEMP BLADDER CATHCPT 517021150139Outpatient$404$384Payer Rates
INSERT TEMP BLADDER CATHCPT 517021260080Outpatient$404$384Payer Rates
INSERT BLADDER CATH COMPLEXCPT 517031050371Outpatient$510$485Payer Rates
INSERT BLADDER CATH COMPLEXCPT 517031150140Outpatient$510$485Payer Rates
INSERT BLADDER CATH COMPLEXCPT 517031450079Outpatient$510$485Payer Rates
CHANGE OF BLADDER TUBECPT 517051450985Outpatient$603$573Payer Rates
US URINE CAPACITY MEASURECPT 517981057999Outpatient$155$147Payer Rates
US URINE CAPACITY MEASURECPT 517981150195Outpatient$155$147Payer Rates
CIRCUMCISION W/REGIONL BLOCKCPT 541501100225Outpatient$4,665$4,432Payer Rates
BIOPSY OF PROSTATECPT 557002300375Outpatient$4,201$3,991Payer Rates
(Not Offered) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING ...CPT 55866-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400-----
ANTEPARTUM MANIPULATIONCPT 594121500371Outpatient$4,657$4,424Payer Rates
(Not Offered) OBSTETRIC CARE, PLANNED CESAREAN DELIVERYCPT 59510-----
(Not Offered) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY (PO ...CPT 59610-----
INJECT EPIDURAL PATCHCPT 622731260010Outpatient$1,548$1,471Payer Rates
INJECT EPIDURAL PATCHCPT 622731500330Outpatient$1,548$1,471Payer Rates
(Not Offered) INJECTION(S) OF THERAPEUTIC SUBSTANCECPT 62322-----
NJX INTERLAMINAR LMBR/SACCPT 623231260158Outpatient$2,365$2,247Payer Rates
NJX AA&/STRD BRACH PLEXUSCPT 644151260155Outpatient$1,813$1,722Payer Rates
NJX AA&/STRD BRACH PLEX NFSCPT 644161260152Outpatient$1,813$1,722Payer Rates
NJX AA&/STRD AXILLARY NRVCPT 644171260149Outpatient$1,813$1,722Payer Rates
NJX AA&/STRD OTHER PN/BRANCHCPT 644501260150Outpatient$1,438$1,366Payer Rates
NJX AA&/STRD TFRM EPI C/T 1CPT 644791260160Outpatient$2,365$2,247Payer Rates
NJX AA&/STRD TFRM EPI L/S 1CPT 644831260162Outpatient$2,365$2,247Payer Rates
NJX AA&/STRD TFRM EPI L/S EACPT 644841260163Outpatient$2,365$2,247Payer Rates
INJ PARAVERT F JNT C/T 1 LEVCPT 644901260168Outpatient$2,365$2,247Payer Rates
INJ PARAVERT F JNT C/T 2 LEVCPT 644911260169Outpatient$2,365$2,247Payer Rates
INJ PARAVERT F JNT C/T 3 LEVCPT 644921260175Outpatient$2,584$2,455Payer Rates
INJ PARAVERT F JNT L/S 1 LEVCPT 644931260166Outpatient$2,365$2,247Payer Rates
INJ PARAVERT F JNT L/S 2 LEVCPT 644941260167Outpatient$2,365$2,247Payer Rates
(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-----
MOD SED SAME PHYS/QHP <5 YRSCPT 991511450200Outpatient$871$827Payer Rates
MOD SED SAME PHYS/QHP 5/>YRSCPT 991521451195Outpatient$929$883Payer Rates
MOD SED SAME PHYS/QHP EACPT 991531451196Outpatient$135$128Payer Rates
MOD SED OTH PHYS/QHP 5/>YRSCPT 991561260051Outpatient$929$883Payer Rates
Therapy
(Not Offered) PHYSICAL THERAPY, THERAPEUTIC EXERCISECPT 97110-----
Uncategorized
INJECT EPIDURAL PATCHCPT 622731350774Outpatient$1,317$1,251Payer Rates
IMMUNIZATION ADMINCPT 904711100402Outpatient$146$139Payer Rates
IMMUNIZATION ADMINCPT 904711150146Outpatient$146$139Payer Rates
IMMUNIZATION ADMINCPT 904711260111Outpatient$146$139Payer Rates
IMMUNIZATION ADMINCPT 904711550180Outpatient$146$139Payer Rates
IMMUNIZATION ADMINCPT 904711450205Outpatient$146$139Payer Rates
IMMUNIZATION ADMIN EACH ADDCPT 904721100403Outpatient$116$110Payer Rates
SPECIAL ANESTHESIA SERVICECPT 991001350760Outpatient$154$146Payer Rates
EMERGENCY ANESTHESIACPT 991401350765Outpatient$154$146Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992032370209Outpatient$242$230Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 992042370210Outpatient$414$393Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 992052370211Outpatient$541$514Payer Rates
OFFICE CONSULTATIONCPT 992442380076Outpatient$368$350Payer Rates
ADMIN INFLUENZA VIRUS VACHCPCS G00081057990Outpatient$89$85Payer Rates
TRAUMA RESPONS W/HOSP CRITIHCPCS G03901450499Outpatient$3,093$2,938Payer Rates
CASIRIVI AND IMDEVI INFUSIONHCPCS M02431058002Outpatient$891$846Payer Rates
CASIRIVI AND IMDEVI INFUSIONHCPCS M02431150215Outpatient$891$846Payer Rates
CASIRIVI AND IMDEVI INFUSIONHCPCS M02431260177Outpatient$891$846Payer Rates
CASIRIVI AND IMDEVI INFUSIONHCPCS M02431450609Outpatient$891$846Payer Rates