Wahiawa General Hospital

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	2100010	$458
CT MAXILLOFACIAL W/O DYE	CPT 70486	Outpatient	2100085	$607
CT MAXILLOFACIAL W/DYE	CPT 70487	Outpatient	2100093	$758
CT SOFT TISSUE NECK W/O DYE	CPT 70490	Outpatient	2100119	$607
CT SOFT TISSUE NECK W/DYE	CPT 70491	Outpatient	2100127	$758
CT ANGIOGRAPHY HEAD	CPT 70496	Outpatient	2100530	$1,011
CT ANGIOGRAPHY NECK	CPT 70498	Outpatient	2100533	$1,011
CT THORAX DX C-	CPT 71250	Outpatient	2100143	$1,011
CT THORAX DX C+	CPT 71260	Outpatient	2100150	$1,264
CT THORAX LUNG CANCER SCR C-	CPT 71271	Outpatient	2100144	$248
CT ANGIOGRAPHY CHEST	CPT 71275	Outpatient	2100538	$1,264
CT NECK SPINE W/O DYE	CPT 72125	Outpatient	2100176	$1,460
CT CHEST SPINE W/O DYE	CPT 72128	Outpatient	2100200	$1,460
CT LUMBAR SPINE W/O DYE	CPT 72131	Outpatient	2100234	$1,460
CT PELVIS W/O DYE	CPT 72192	Outpatient	2100412	$809
CT PELVIS W/DYE	CPT 72193	Outpatient	2100276	$1,011
CT UPPER EXTREMITY W/O DYE	CPT 73200	Outpatient	2100291	$809
CT UPPER EXTREMITY W/DYE	CPT 73201	Outpatient	2100309	$1,011
CT LOWER EXTREMITY W/O DYE	CPT 73700	Outpatient	2100325	$809
CT LOWER EXTREMITY W/DYE	CPT 73701 (RT)	Outpatient	2100333	$1,011
CT ANGIO ABD&PELV W/O&W/DYE	CPT 74174	Outpatient	2100375	$1,516
CT ABD & PELVIS W/O CONTRAST	CPT 74176	Outpatient	2100373	$2,091
CT ABD & PELV W/CONTRAST	CPT 74177	Outpatient	2100372	$2,718
CT ABD & PELV 1/> REGNS	CPT 74178	Outpatient	2100371	$3,533
Cardiology
CARDIOVASCULAR STRESS TEST	CPT 93017	Outpatient	1000025	$995
TTE W/DOPPLER COMPLETE	CPT 93306	Outpatient	1000700	$2,531
Clinic
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30 MIN	CPT 99203	-	-	-	-
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45 MIN	CPT 99204	-	-	-	-
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 60 MIN	CPT 99205	-	-	-	-
(N/O) PATIENT OFFICE CONSULTATION, 40 MIN	CPT 99243	-	-	-	-
(N/O) PATIENT OFFICE CONSULTATION, 60 MIN	CPT 99244	-	-	-	-
(N/O) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EVALUATION ...	CPT 99385	-	-	-	-
(N/O) INITIAL NEW PATIENT PREVENTATIVE MEDICINE EVALUATION ...	CPT 99386	-	-	-	-
EEG
(N/O) SLEEP STUDY	CPT 95810	-	-	-	-
EEG AWAKE AND ASLEEP	CPT 95819	Outpatient	1600035	$995
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...	CPT 93000	-	-	-	-
ELECTROCARDIOGRAM TRACING	CPT 93005	Outpatient	1293005	$168
ECG MONIT/REPRT UP TO 48 HRS	CPT 93225	Outpatient	1000028	$315
ECG MONIT/REPRT UP TO 48 HRS	CPT 93226	Outpatient	1000032	$315
Emergency Room
DRAINAGE OF SKIN ABSCESS	CPT 10060	Outpatient	1210060	$338
DRAINAGE OF SKIN ABSCESS	CPT 10061	Outpatient	1210061	$622
REMOVE FOREIGN BODY	CPT 10120	Outpatient	1210120	$622
PUNCTURE DRAINAGE OF LESION	CPT 10160	Outpatient	1210160	$622
REMOVAL OF NAIL PLATE	CPT 11730	Outpatient	1211730	$338
RPR S/N/AX/GEN/TRNK 2.5CM/<	CPT 12001	Outpatient	1212001	$338
RPR S/N/AX/GEN/TRNK2.6-7.5CM	CPT 12002	Outpatient	1212002	$338
RPR S/N/AX/GEN/TRK7.6-12.5CM	CPT 12004	Outpatient	1212004	$338
RPR F/E/E/N/L/M 2.5 CM/<	CPT 12011	Outpatient	1212011	$338
RPR F/E/E/N/L/M 2.6-5.0 CM	CPT 12013	Outpatient	1212013	$338
DRESS/DEBRID P-THICK BURN S	CPT 16020	Outpatient	1216020	$338
DRAIN/INJ JOINT/BURSA W/O US	CPT 20610	Outpatient	1220610	$587
TREAT SHOULDER DISLOCATION	CPT 23650	Outpatient	1223650	$430
TREAT ELBOW DISLOCATION	CPT 24640	Outpatient	1224640	$430
TREAT FRACTURE RADIUS/ULNA	CPT 25605	Outpatient	1225605	$1,350
APPLY LONG ARM SPLINT	CPT 29105 (LT)	Outpatient	1229152	$271
APPLY FOREARM SPLINT	CPT 29125 (RT)	Outpatient	1229125	$210
APPLICATION OF FINGER SPLINT	CPT 29130	Outpatient	1229130	$168
APPLICATION LONG LEG SPLINT	CPT 29505 (LT)	Outpatient	1229514	$271
APPLICATION LOWER LEG SPLINT	CPT 29515 (LT)	Outpatient	1229519	$271
CONTROL OF NOSEBLEED	CPT 30901	Outpatient	1230901	$210
INSERT EMERGENCY AIRWAY	CPT 31500	Outpatient	1231500	$536
INSERTION OF CHEST TUBE	CPT 32551	Outpatient	1232020	$1,966
INSERT NON-TUNNEL CV CATH	CPT 36556	Outpatient	1236556	$1,966
INSERT TEMP BLADDER CATH	CPT 51702	Outpatient	1251702	$210
DX LMBR SPI PNXR	CPT 62270	Outpatient	1262270	$1,630
NJX AA&/STRD TRIGEMINAL NRV	CPT 64400	Outpatient	1264400	$489
NJX AA&/STRD OTHER PN/BRANCH	CPT 64450	Outpatient	1264450	$1,087
CLEAR OUTER EAR CANAL	CPT 69200	Outpatient	1269200	$210
REMOVE IMPACTED EAR WAX UNI	CPT 69209	Outpatient	1269209	$112
IMMUNIZATION ADMIN	CPT 90471	Outpatient	1290471	$116
HEART/LUNG RESUSCITATION CPR	CPT 92950	Outpatient	1292950	$498
HYDRATION IV INFUSION INIT	CPT 96360	Outpatient	1296360	$382
HYDRATE IV INFUSION ADD-ON	CPT 96361	Outpatient	1296361	$74
MOD SED SAME PHYS/QHP 5/>YRS	CPT 99152	Outpatient	1299152	$95
EMERGENCY DEPT VISIT	CPT 99281	Outpatient	1297244	$309
EMERGENCY DEPT VISIT	CPT 99282	Outpatient	1297236	$561
EMERGENCY DEPT VISIT	CPT 99283	Outpatient	1297228	$986
EMERGENCY DEPT VISIT	CPT 99284 (25)	Outpatient	1299284	$1,600
EMERGENCY DEPT VISIT	CPT 99285 (25)	Outpatient	1299285	$2,344
CRITICAL CARE FIRST HOUR	CPT 99291 (25)	Outpatient	1299291	$3,301
CRITICAL CARE ADDL 30 MIN	CPT 99292	Outpatient	1299292	$260
Imaging
BX BREAST 1ST LESION US IMAG	CPT 19083	Outpatient	2203020	$2,696
US EXAM OF HEAD AND NECK	CPT 76536	Outpatient	2200026	$343
ULTRASOUND BREAST COMPLETE	CPT 76641	Outpatient	2200072	$229
ULTRASOUND BREAST LIMITED	CPT 76642	Outpatient	2200073	$124
US EXAM ABDOM COMPLETE	CPT 76700	Outpatient	2200083	$572
ECHO EXAM OF ABDOMEN	CPT 76705	Outpatient	2200109	$458
US ABDL AORTA SCREEN AAA	CPT 76706	Outpatient	2200166	$229
US EXAM ABDO BACK WALL COMP	CPT 76770	Outpatient	2200174	$572
US EXAM ABDO BACK WALL LIM	CPT 76775	Outpatient	2203016	$458
OB US < 14 WKS SINGLE FETUS	CPT 76801	Outpatient	2200230	$458
OB US >= 14 WKS SNGL FETUS	CPT 76805	Outpatient	2200232	$344
OB US LIMITED FETUS(S)	CPT 76815	Outpatient	1276815	$229
TRANSVAGINAL US OBSTETRIC	CPT 76817	Outpatient	2200229	$458
TRANSVAGINAL US NON-OB	CPT 76830	Outpatient	2203012	$343
US EXAM PELVIC COMPLETE	CPT 76856	Outpatient	2200257	$343
US EXAM SCROTUM	CPT 76870	Outpatient	2200349	$229
US LMTD JT/NONVASC XTR STRUX	CPT 76882	Outpatient	2200316	$229
US GUIDE VASCULAR ACCESS	CPT 76937	Outpatient	2200356	$245
ECHO GUIDE FOR BIOPSY	CPT 76942	Outpatient	2200401	$852
BREAST TOMOSYNTHESIS UNI	CPT 77061	Outpatient	1876087	$44
BREAST TOMOSYNTHESIS BI	CPT 77062	Outpatient	1876085	$67
BREAST TOMOSYNTHESIS BI	CPT 77063	Outpatient	1876084	$44
DX MAMMO INCL CAD UNI	CPT 77065	Outpatient	1800044	$539
DX MAMMO INCL CAD BI	CPT 77066	Outpatient	1800040	$678
SCR MAMMO BI INCL CAD	CPT 77067	Outpatient	1800049	$583
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...	DRG 216	-	-	-	-
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC	DRG 460	-	-	-	-
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...	DRG 470	-	-	-	-
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCC	DRG 473	-	-	-	-
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...	DRG 743	-	-	-	-
Laboratory
ROUTINE VENIPUNCTURE	CPT 36415	Outpatient	1493377	$24
METABOLIC PANEL TOTAL CA	CPT 80048	Outpatient	1420992	$84
COMPREHEN METABOLIC PANEL	CPT 80053	Outpatient	1420950	$104
(N/O) OBSTETRIC BLOOD TEST PANEL	CPT 80055	-	-	-	-
LIPID PANEL	CPT 80061	Outpatient	1420976	$83
RENAL FUNCTION PANEL	CPT 80069	Outpatient	1421008	$54
ACUTE HEPATITIS PANEL	CPT 80074 (90)	Outpatient	1401801	$294
HEPATIC FUNCTION PANEL	CPT 80076	Outpatient	1420968	$50
ASSAY OF DIGOXIN TOTAL	CPT 80162	Outpatient	1420414	$82
ASSAY DIPROPYLACETIC ACD TOT	CPT 80164	Outpatient	1420106	$84
DRUG SCRN QUAN LEVETIRACETAM	CPT 80177 (90)	Outpatient	1405529	$82
ASSAY OF LITHIUM	CPT 80178 (90)	Outpatient	1400198	$41
ASSAY OF PHENYTOIN TOTAL	CPT 80185	Outpatient	1420422	$82
ASSAY OF VANCOMYCIN	CPT 80202	Outpatient	1400061	$84
DRUG SCREEN QUANTALCOHOLS	CPT 80320	Outpatient	1420232	$167
URINALYSIS NONAUTO W/SCOPE	CPT 81000	Outpatient	1410019	$39
(N/O) URINALYSIS TEST USING MICROSCOPE	CPT 81001	-	-	-	-
URINALYSIS NONAUTO W/O SCOPE	CPT 81002	Outpatient	1492900	$17
URINALYSIS AUTO W/O SCOPE	CPT 81003	Outpatient	1410027	$14
URINE PREGNANCY TEST	CPT 81025	Outpatient	1410084	$43
ASSAY OF SERUM ALBUMIN	CPT 82040	Outpatient	1420224	$31
OTHER SOURCE ALBUMIN QUAN EA	CPT 82042	Outpatient	1420303	$39
UR ALBUMIN QUANTITATIVE	CPT 82043 (90)	Outpatient	1400147	$36
ALPHA-FETOPROTEIN SERUM	CPT 82105 (90)	Outpatient	1400106	$104
ASSAY OF AMMONIA	CPT 82140	Outpatient	1420258	$90
ASSAY OF AMYLASE	CPT 82150	Outpatient	1420265	$40
BILIRUBIN TOTAL	CPT 82247	Outpatient	1420281	$31
BILIRUBIN DIRECT	CPT 82248	Outpatient	1420299	$31
OCCULT BLD FECES 1-3 TESTS	CPT 82272	Outpatient	1410077	$21
VITAMIN D 25 HYDROXY	CPT 82306 (90)	Outpatient	1476556	$183
CARCINOEMBRYONIC ANTIGEN	CPT 82378 (90)	Outpatient	1400428	$117
TOTAL CORTISOL	CPT 82533 (90)	Outpatient	1400255	$101
ASSAY OF CK (CPK)	CPT 82550	Outpatient	1420365	$80
CREATINE MB FRACTION	CPT 82553	Outpatient	1420372	$114
ASSAY OF CREATININE	CPT 82565	Outpatient	1420380	$32
ASSAY OF URINE CREATININE	CPT 82570 (90)	Outpatient	1493416	$32
VITAMIN B-12	CPT 82607 (90)	Outpatient	1400244	$93
ASSAY OF FERRITIN	CPT 82728	Outpatient	1420040	$84
ASSAY OF FOLIC ACID SERUM	CPT 82746 (90)	Outpatient	1400269	$91
BLOOD GASES ANY COMBINATION	CPT 82803	Outpatient	1491504	$130
GLUCOSE OTHER FLUID	CPT 82945	Outpatient	1420794	$24
ASSAY GLUCOSE BLOOD QUANT	CPT 82947	Outpatient	1420703	$24
GLYCOSYLATED HEMOGLOBIN TEST	CPT 83036	Outpatient	1493342	$60
IMMUNOASSAY QUANT NOS NONAB	CPT 83520 (90)	Outpatient	1400317	$86
ASSAY OF IRON	CPT 83540	Outpatient	1420038	$40
IRON BINDING TEST	CPT 83550	Outpatient	1420039	$54
ASSAY OF LACTIC ACID	CPT 83605	Outpatient	1420464	$106
LACTATE (LD) (LDH) ENZYME	CPT 83615	Outpatient	1420472	$37
ASSAY OF LIPASE	CPT 83690	Outpatient	1420935	$68
ASSAY OF BLOOD LIPOPROTEIN	CPT 83721	Outpatient	1493343	$59
ASSAY OF MAGNESIUM	CPT 83735	Outpatient	1420505	$66
ASSAY OF BLOOD OSMOLALITY	CPT 83930 (90)	Outpatient	1400463	$41
ASSAY OF URINE OSMOLALITY	CPT 83935 (90)	Outpatient	1400464	$42
ASSAY PH BODY FLUID NOS	CPT 83986	Outpatient	1492710	$22
ASSAY OF PHOSPHORUS	CPT 84100	Outpatient	1420588	$47
ASSAY OF SERUM POTASSIUM	CPT 84132	Outpatient	1420604	$28
ASSAY OF PREALBUMIN	CPT 84134 (90)	Outpatient	1404947	$90
ASSAY OF PSA TOTAL	CPT 84153 (90)	Outpatient	1400505	$114
ASSAY OF PSA TOTAL	CPT 84153	Outpatient	-	$114
(N/O) TOTAL PROSTATE-SPECIFIC ANTIGEN (PSA) TEST	CPT 84154	-	-	-	-
ASSAY OF PROTEIN SERUM	CPT 84155 (90)	Outpatient	1400218	$23
ASSAY OF PROTEIN URINE	CPT 84156 (90)	Outpatient	1400216	$23
ASSAY OF PROTEIN OTHER	CPT 84157	Outpatient	1420653	$23
PROTEIN E-PHORESIS SERUM	CPT 84165 (90)	Outpatient	1493010	$66
PROTEIN E-PHORESIS/URINE/CSF	CPT 84166 (90)	Outpatient	1493011	$110
ASSAY OF SERUM SODIUM	CPT 84295	Outpatient	1420687	$30
ASSAY OF URINE SODIUM	CPT 84300	Outpatient	1492908	$30
ASSAY OF VITAMIN B-1	CPT 84425 (90)	Outpatient	1400330	$131
ASSAY OF FREE THYROXINE	CPT 84439	Outpatient	1420178	$56
ASSAY THYROID STIM HORMONE	CPT 84443	Outpatient	1420094	$104
ASSAY OF TRIGLYCERIDES	CPT 84478	Outpatient	1420836	$35
ASSAY TRIIODOTHYRONINE (T3)	CPT 84480 (90)	Outpatient	1400438	$88
ASSAY OF BLOOD/URIC ACID	CPT 84550	Outpatient	1420869	$28
CHORIONIC GONADOTROPIN TEST	CPT 84702	Outpatient	1492761	$93
CHORIONIC GONADOTROPIN ASSAY	CPT 84703	Outpatient	1492751	$46
HEMATOCRIT	CPT 85014	Outpatient	1431252	$15
HEMOGLOBIN	CPT 85018	Outpatient	1431253	$15
COMPLETE CBC W/AUTO DIFF WBC	CPT 85025	Outpatient	1431031	$96
COMPLETE CBC AUTOMATED	CPT 85027	Outpatient	1431049	$80
MANUAL RETICULOCYTE COUNT	CPT 85044	Outpatient	1431163	$27
AUTOMATED PLATELET COUNT	CPT 85049	Outpatient	1431130	$28
FIBRIN DEGRADATION QUANT	CPT 85379	Outpatient	1420121	$63
PROTHROMBIN TIME	CPT 85610	Outpatient	1431148	$39
RBC SED RATE NONAUTOMATED	CPT 85651	Outpatient	1431171	$22
THROMBOPLASTIN TIME PARTIAL	CPT 85730	Outpatient	1431197	$37
WBC ANTIBODY IDENTIFICATION	CPT 86021 (90)	Outpatient	1404702	$74
ANTINUCLEAR ANTIBODIES	CPT 86038 (90)	Outpatient	1400467	$75
ANTISTREPTOLYSIN O TITER	CPT 86060 (90)	Outpatient	1400402	$45
C-REACTIVE PROTEIN	CPT 86140 (90)	Outpatient	1400403	$32
IMMUNOASSAY TUMOR CA 19-9	CPT 86301 (90)	Outpatient	1400210	$129
HETEROPHILE ANTIBODY SCREEN	CPT 86308 (90)	Outpatient	1400694	$32
RHEUMATOID FACTOR QUANT	CPT 86431 (90)	Outpatient	1400426	$35
SYPHILIS TEST NON-TREP QUAL	CPT 86592 (90)	Outpatient	1400695	$26
HEP B SURFACE ANTIBODY	CPT 86706 (90)	Outpatient	1400500	$66
MUMPS ANTIBODY	CPT 86735 (90)	Outpatient	1400723	$81
RUBELLA ANTIBODY	CPT 86762 (90)	Outpatient	1400427	$89
RUBEOLA ANTIBODY	CPT 86765 (90)	Outpatient	1400722	$80
VARICELLA-ZOSTER ANTIBODY	CPT 86787 (90)	Outpatient	1400721	$80
HEPATITIS C AB TEST	CPT 86803 (90)	Outpatient	1400542	$88
RBC ANTIBODY SCREEN	CPT 86850	Outpatient	1441311	$224
BLOOD TYPING SEROLOGIC ABO	CPT 86900	Outpatient	1441345	$525
BLOOD TYPING SEROLOGIC RH(D)	CPT 86901	Outpatient	1441352	$159
BLOOD TYPE ANTIGEN DONOR EA	CPT 86902 (90)	Outpatient	1500232	$431
COMPATIBILITY TEST SPIN	CPT 86920	Outpatient	1441336	$646
COMPATIBILITY TEST ANTIGLOB	CPT 86922	Outpatient	1441337	$646
SPECIMEN INFECT AGNT CONCNTJ	CPT 87015 (90)	Outpatient	1493305	$41
BLOOD CULTURE FOR BACTERIA	CPT 87040	Outpatient	1451740	$64
FECES CULTURE AEROBIC BACT	CPT 87045 (90)	Outpatient	1476222	$58
CULTURE OTHR SPECIMN AEROBIC	CPT 87070 (90)	Outpatient	1487070	$53
CULTR BACTERIA EXCEPT BLOOD	CPT 87075 (90)	Outpatient	1400621	$58
CULTURE AEROBIC IDENTIFY	CPT 87077 (90)	Outpatient	1400639	$50
CULTURE SCREEN ONLY	CPT 87081 (90)	Outpatient	1400617	$41
URINE CULTURE/COLONY COUNT	CPT 87086 (90)	Outpatient	1400626	$50
URINE BACTERIA CULTURE	CPT 87088 (90)	Outpatient	1400638	$50
MYCOBACTERIA CULTURE	CPT 87116 (90)	Outpatient	1493207	$67
CULTURE TYPE IMMUNOLOGIC	CPT 87147 (90)	Outpatient	1400890	$32
OVA AND PARASITES SMEARS	CPT 87177 (90)	Outpatient	1420115	$55
MICROBE SUSCEPTIBLE MIC	CPT 87186 (90)	Outpatient	1493021	$53
SMEAR GRAM STAIN	CPT 87205 (90)	Outpatient	1487205	$26
SMEAR FLUORESCENT/ACID STAI	CPT 87206 (90)	Outpatient	1400612	$33
SMEAR COMPLEX STAIN	CPT 87209 (90)	Outpatient	1420117	$111
SMEAR WET MOUNT SALINE/INK	CPT 87210	Outpatient	1451724	$29
HEPATITIS B SURFACE AG IA	CPT 87340 (90)	Outpatient	1400495	$64
HIV-1 AG W/HIV-1&2 AB AG IA	CPT 87389 (90)	Outpatient	1475688	$149
NOS EACH ORGANISM AG IA	CPT 87449 (90)	Outpatient	1451010	$74
CHYLMD TRACH DNA AMP PROBE	CPT 87491 (90)	Outpatient	1400484	$217
C DIFF AMPLIFIED PROBE	CPT 87493	Outpatient	1487493	$217
INFLUENZA DNA AMP PROBE	CPT 87502	Outpatient	1404991	$315
HSV DNA AMP PROBE	CPT 87529	Outpatient	1406256	$117
N.GONORRHOEAE DNA AMP PROB	CPT 87591 (90)	Outpatient	1400479	$217
STREP A DNA AMP PROBE	CPT 87651	Outpatient	1407651	$117
DETECT AGENT NOS DNA AMP	CPT 87798	Outpatient	1407798	$117
INFLUENZA ASSAY W/OPTIC	CPT 87804	Outpatient	1404969	$83
STREP A ASSAY W/OPTIC	CPT 87880 (QW)	Outpatient	1451849	$83
TISSUE EXAM BY PATHOLOGIST	CPT 88304	Outpatient	1462135	$224
TISSUE EXAM BY PATHOLOGIST	CPT 88305	Outpatient	1462143	$224
BODY FLUID CELL COUNT	CPT 89051	Outpatient	1492785	$34
LEUKOCYTE ASSESSMENT FECAL	CPT 89055	Outpatient	1451726	$26
EXAM SYNOVIAL FLUID CRYSTALS	CPT 89060	Outpatient	1492868	$44
Language Pathology
SPEECH/HEARING THERAPY	CPT 92507 (GN)	Outpatient	3000020	$91
SPEECH SOUND LANG COMPREHEN	CPT 92523 (GN)	Outpatient	3092523	$367
ORAL FUNCTION THERAPY	CPT 92526 (GN)	Outpatient	3000040	$284
EVALUATE SWALLOWING FUNCTION	CPT 92610 (GN)	Outpatient	3000030	$586
MOTION FLUOROSCOPY/SWALLOW	CPT 92611 (GN)	Outpatient	3000066	$379
MRI
(N/O) MRI SCAN	CPT 70553	-	-	-	-
(N/O) MRI SCAN OF LOWER SPINAL CANAL	CPT 72148	-	-	-	-
(N/O) MRI SCAN OF LEG JOINT	CPT 73721	-	-	-	-
Medical and Surgical Supplies
SPECIAL SUPPLIES PHYS/QHP	CPT 99070	Outpatient	1341404	$98
STERILE WATER/SALINE, 500 ML	HCPCS A4217	Outpatient	1335019	$7
INFUSION SUPPLIES WITH PUMP	HCPCS A4222	Outpatient	1300202	$23
CATH IMPL VASC ACCESS PORTAL	HCPCS A4300	Outpatient	1342972	$287
CATH W/DRAINAGE 2-WAY LATEX	HCPCS A4314	Outpatient	1340312	$41
CATH INSERTION TRAY W/BAG	HCPCS A4354	Outpatient	1340313	$27
SURGICAL SUPPLIES	HCPCS A4649	Outpatient	1300065	$25
FOAM DRG <=16 SQ IN W/BORDER	HCPCS A6212	Outpatient	1305153	$20
TRANSPARENT FILM <= 16 SQ IN	HCPCS A6257	Outpatient	1300042	$19
BLANKET BAIR HUGGER LOWER BODY	HCPCS E0215	Outpatient	1302091	$21
Nuclear Medicine
HEPATOBILIARY SYSTEM IMAGING	CPT 78226	Outpatient	2400322	$1,048
HEPATOBIL SYST IMAGE W/DRUG	CPT 78227	Outpatient	2400323	$1,359
HT MUSCLE IMAGE SPECT MULT	CPT 78452	Outpatient	2400943	$3,608
LUNG VENTILAT&PERFUS IMAGING	CPT 78582	Outpatient	2400605	$1,359
TC99M SESTAMIBI	HCPCS A9500	Outpatient	2401640	$223
TC99M MEDRONATE	HCPCS A9503	Outpatient	2401751	$81
TC99M PERTECHNETATE	HCPCS A9512	Outpatient	2401431	$4
TC99M MEBROFENIN	HCPCS A9537	Outpatient	2401763	$84
TC99M MAA	HCPCS A9540	Outpatient	2401758	$119
TECHNETIUM TC-99M AEROSOL	HCPCS A9567	Outpatient	2401761	$91
Other Diagnostic
EXTRACRANIAL BILAT STUDY	CPT 93880	Outpatient	2200299	$697
LOWER EXTREMITY STUDY	CPT 93925	Outpatient	2200372	$697
EXTREMITY STUDY	CPT 93970	Outpatient	2200373	$697
EXTREMITY STUDY	CPT 93971 (LT)	Outpatient	2200377	$343
VASCULAR STUDY	CPT 93976	Outpatient	2200308	$229
Other Procedures and Observation
BL DRAW <3 YRS OTHER VEIN	CPT 36406	Outpatient	1400001	$24
WITHDRAWAL OF ARTERIAL BLOOD	CPT 36600	Outpatient	1000999	$210
Other Therapeutic
BLOOD TRANSFUSION SERVICE	CPT 36430	Outpatient	1236430	$1,126
PLASMA FRESH FROZEN	CPT 86927	Outpatient	1441493	$1,078
THER/PROPH/DIAG IV INF INIT	CPT 96365	Outpatient	1296365	$382
THER/PROPH/DIAG IV INF ADDON	CPT 96366	Outpatient	1296366	$191
TX/PROPH/DG ADDL SEQ IV INF	CPT 96367	Outpatient	1296367	$343
THER/DIAG CONCURRENT INF	CPT 96368	Outpatient	1296368	$343
THER/PROPH/DIAG INJ SC/IM	CPT 96372	Outpatient	1296372	$116
THER/PROPH/DIAG INJ IV PUSH	CPT 96374	Outpatient	1296374	$287
TX/PRO/DX INJ NEW DRUG ADDON	CPT 96375	Outpatient	1296375	$191
TX/PRO/DX INJ SAME DRUG ADON	CPT 96376	Outpatient	1296376	$191
RBC LEUKOCYTES REDUCED	HCPCS P9016	Outpatient	1500019	$294
PLASMA 1 DONOR FRZ W/IN 8 HR	HCPCS P9017	Outpatient	1500059	$121
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
EVALUATION OF WHEEZING	CPT 94060	Outpatient	1000051	$747
MEASURE BLOOD OXYGEN LEVEL	CPT 94761	Outpatient	1000810	$444
Radiology
X-RAY EXAM OF NASAL BONES	CPT 70160	Outpatient	1700170	$186
X-RAY EXAM OF NECK	CPT 70360	Outpatient	1700287	$186
X-RAY EXAM CHEST 1 VIEW	CPT 71045	Outpatient	1702109	$187
X-RAY EXAM CHEST 2 VIEWS	CPT 71046	Outpatient	1700345	$224
X-RAY EXAM RIBS UNI 2 VIEWS	CPT 71100 (RT)	Outpatient	1700428	$186
X-RAY EXAM UNILAT RIBS/CHEST	CPT 71101 (LT)	Outpatient	1700430	$343
X-RAY EXAM NECK SPINE 2-3 VW	CPT 72040	Outpatient	1700485	$224
X-RAY EXAM NECK SPINE 4/5VWS	CPT 72050	Outpatient	1700493	$343
X-RAY EXAM NECK SPINE 6/>VWS	CPT 72052	Outpatient	1700501	$343
X-RAY EXAM THORAC SPINE 2VWS	CPT 72070	Outpatient	1700535	$343
X-RAY EXAM THORAC SPINE 3VWS	CPT 72072	Outpatient	1701970	$412
X-RAY EXAM L-S SPINE 2/3 VWS	CPT 72100	Outpatient	1700550	$343
X-RAY EXAM L-2 SPINE 4/>VWS	CPT 72110	Outpatient	1700568	$412
X-RAY EXAM L-S SPINE BENDING	CPT 72114	Outpatient	1700576	$412
X-RAY EXAM OF PELVIS	CPT 72170	Outpatient	1700592	$343
X-RAY EXAM OF PELVIS	CPT 72190	Outpatient	1700618	$515
X-RAY EXAM SACRUM TAILBONE	CPT 72220	Outpatient	1700634	$186
X-RAY EXAM OF COLLAR BONE	CPT 73000	Outpatient	1700675	$186
X-RAY EXAM OF SHOULDER	CPT 73030 (LT)	Outpatient	1700710	$280
X-RAY EXAM OF HUMERUS	CPT 73060 (LT)	Outpatient	1700740	$186
X-RAY EXAM OF ELBOW	CPT 73080 (LT)	Outpatient	1700767	$280
X-RAY EXAM OF FOREARM	CPT 73090 (RT)	Outpatient	1700774	$186
X-RAY EXAM OF WRIST	CPT 73100 (RT)	Outpatient	1700782	$186
X-RAY EXAM OF WRIST	CPT 73110 (LT)	Outpatient	1700791	$280
X-RAY EXAM OF HAND	CPT 73120 (RT)	Outpatient	1700808	$343
X-RAY EXAM OF HAND	CPT 73130 (RT)	Outpatient	1700816	$412
X-RAY EXAM OF FINGER(S)	CPT 73140 (F5)	Outpatient	1700824	$186
X-RAY EXAM HIP UNI 1 VIEW	CPT 73501 (RT)	Outpatient	1700855	$186
X-RAY EXAM HIP UNI 2-3 VIEWS	CPT 73502 (RT)	Outpatient	1700863	$280
X-RAY EXAM HIPS BI 2 VIEWS	CPT 73521	Outpatient	1700872	$343
X-RAY EXAM OF FEMUR 2/>	CPT 73552 (LT)	Outpatient	1700906	$186
X-RAY EXAM OF KNEE 1 OR 2	CPT 73560 (RT)	Outpatient	1700915	$186
X-RAY EXAM OF KNEE 3	CPT 73562 (LT)	Outpatient	1700927	$224
X-RAY EXAM KNEE 4 OR MORE	CPT 73564 (RT)	Outpatient	1700923	$268
X-RAY EXAM OF LOWER LEG	CPT 73590 (LT)	Outpatient	1700957	$186
X-RAY EXAM OF ANKLE	CPT 73600 (RT)	Outpatient	1700964	$186
X-RAY EXAM OF ANKLE	CPT 73610 (RT)	Outpatient	1700972	$280
X-RAY EXAM OF FOOT	CPT 73620 (LT)	Outpatient	1700981	$186
X-RAY EXAM OF FOOT	CPT 73630 (RT)	Outpatient	1700998	$280
X-RAY EXAM OF HEEL	CPT 73650 (LT)	Outpatient	1701011	$186
X-RAY EXAM OF TOE(S)	CPT 73660 (T5)	Outpatient	1701020	$186
X-RAY EXAM ABDOMEN 1 VIEW	CPT 74018	Outpatient	1701053	$186
X-RAY EXAM ABDOMEN 3+ VIEWS	CPT 74021	Outpatient	1701079	$343
X-RAY EXAM COMPLETE ABDOMEN	CPT 74022	Outpatient	1702036	$412
X-RAY XM ESOPHAGUS 1CNTRST	CPT 74220	Outpatient	1701095	$758
X-RAY XM SWLNG FUNCJ C+	CPT 74230	Outpatient	1701103	$343
X-RAY XM SM INT 1CNTRST STD	CPT 74250	Outpatient	1701145	$458
FLUOROSCOPY <1 HR PHYS/QHP	CPT 76000	Outpatient	1701699	$697
X-RAY NOSE TO RECTUM	CPT 76010	Outpatient	1702145	$186
FLUOROGUIDE FOR VEIN DEVICE	CPT 77001	Outpatient	1709991	$304
DXA BONE DENSITY AXIAL	CPT 77080	Outpatient	1702148	$343
Respiratory
VENT MGMT INPAT INIT DAY	CPT 94002	Outpatient	1000226	$2,073
VENT MGMT INPAT SUBQ DAY	CPT 94003	Outpatient	1000091	$2,073
AIRWAY INHALATION TREATMENT	CPT 94640 (76)	Outpatient	1000145	$373
CBT 1ST HOUR	CPT 94644	Outpatient	1000029	$210
POS AIRWAY PRESSURE CPAP	CPT 94660	Outpatient	1000650	$1,118
CHEST WALL MANIPULATION	CPT 94668	Outpatient	1000820	$210
Surgical Procedures
(N/O) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN PROCEDURE	CPT 19120	-	-	-	-
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPE	CPT 29826	-	-	-	-
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE	CPT 29881	-	-	-	-
ASPIRATE PLEURA W/ IMAGING	CPT 32555	Outpatient	2200358	$1,225
INSJ PICC RS&I 5 YR+	CPT 36573	Outpatient	1700163	$2,949
(N/O) REMOVAL OF TONSILS AND ADENOID GLANDS, PATIENT YOUNG ...	CPT 42820	-	-	-	-
(N/O) DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH OR SMALL BOWEL ...	CPT 43235	-	-	-	-
EGD BIOPSY SINGLE/MULTIPLE	CPT 43239	Outpatient	-	$439
DIAGNOSTIC COLONOSCOPY	CPT 45378	Outpatient	-	$439
(N/O) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOPE	CPT 45380	-	-	-	-
COLONOSCOPY W/LESION REMOVAL	CPT 45385	Outpatient	-	$840
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...	CPT 45391	-	-	-	-
(N/O) REMOVAL OF GALLBLADDER USING AN ENDOSCOPE	CPT 47562	-	-	-	-
ABD PARACENTESIS W/IMAGING	CPT 49083	Outpatient	2200430	$1,487
(N/O) REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS OR OLDER	CPT 49505	-	-	-	-
(N/O) BIOPSY OF PROSTATE GLAND	CPT 55700	-	-	-	-
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...	CPT 55866	-	-	-	-
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERY	CPT 59400	-	-	-	-
(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	-	-	-	-
(N/O) INJECTION(S) OF ANESTHETIC INTO LOWER SPINE USING IM ...	CPT 64483	-	-	-	-
(N/O) REMOVAL OF RECURRING CATARACT IN LENS CAPSULE USING ...	CPT 66821	-	-	-	-
(N/O) REMOVAL OF CATARACT WITH INSERTION OF LENS	CPT 66984	-	-	-	-
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSIS	CPT 93452	-	-	-	-
Therapy
THERAPEUTIC EXERCISES	CPT 97110 (GP)	Outpatient	2801219	$99
THERAPEUTIC EXERCISES	CPT 97110	Outpatient	-	$99
NEUROMUSCULAR REEDUCATION	CPT 97112 (GP)	Outpatient	2801227	$114
GAIT TRAINING THERAPY	CPT 97116 (GP)	Outpatient	2801243	$98
MANUAL THERAPY 1/> REGIONS	CPT 97140 (GP)	Outpatient	2801800	$90
PT EVAL LOW COMPLEX 20 MIN	CPT 97161	Outpatient	2897161	$401
PT EVAL MOD COMPLEX 30 MIN	CPT 97162 (GP)	Outpatient	2897162	$364
PT RE-EVAL EST PLAN CARE	CPT 97164 (GP)	Outpatient	2897164	$186
OT EVAL LOW COMPLEX 30 MIN	CPT 97165 (GO)	Outpatient	2997165	$296
OT EVAL MOD COMPLEX 45 MIN	CPT 97166 (GO)	Outpatient	2997166	$296
THERAPEUTIC ACTIVITIES	CPT 97530 (GP)	Outpatient	2801235	$134
SELF CARE MNGMENT TRAINING	CPT 97535 (GO)	Outpatient	2901010	$113
WHEELCHAIR MNGMENT TRAINING	CPT 97542 (GP)	Outpatient	2804210	$109
ORTHOTIC MGMT&TRAING 1ST ENC	CPT 97760 (GO)	Outpatient	2902095	$156
Uncategorized
ADMIN INFLUENZA VIRUS VAC	HCPCS G0008	Outpatient	510001	$74
ADMIN PNEUMOCOCCAL VACCINE	HCPCS G0009	Outpatient	510002	$74