Wahiawa General Hospital

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.
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Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
Service DescriptionService CodeDepartmentCharge CodeCash PriceRates
CT Scan
CT HEAD/BRAIN W/O DYECPT 70450Outpatient2100010$458
CT MAXILLOFACIAL W/O DYECPT 70486Outpatient2100085$607
CT MAXILLOFACIAL W/DYECPT 70487Outpatient2100093$758
CT SOFT TISSUE NECK W/O DYECPT 70490Outpatient2100119$607
CT SOFT TISSUE NECK W/DYECPT 70491Outpatient2100127$758
CT ANGIOGRAPHY HEADCPT 70496Outpatient2100530$1,011
CT ANGIOGRAPHY NECKCPT 70498Outpatient2100533$1,011
CT THORAX DX C-CPT 71250Outpatient2100143$1,011
CT THORAX DX C+CPT 71260Outpatient2100150$1,264
CT THORAX LUNG CANCER SCR C-CPT 71271Outpatient2100144$248
CT ANGIOGRAPHY CHESTCPT 71275Outpatient2100538$1,264
CT NECK SPINE W/O DYECPT 72125Outpatient2100176$1,460
CT CHEST SPINE W/O DYECPT 72128Outpatient2100200$1,460
CT LUMBAR SPINE W/O DYECPT 72131Outpatient2100234$1,460
CT PELVIS W/O DYECPT 72192Outpatient2100412$809
CT PELVIS W/DYECPT 72193Outpatient2100276$1,011
CT UPPER EXTREMITY W/O DYECPT 73200Outpatient2100291$809
CT UPPER EXTREMITY W/DYECPT 73201Outpatient2100309$1,011
CT LOWER EXTREMITY W/O DYECPT 73700Outpatient2100325$809
CT LOWER EXTREMITY W/DYECPT 73701 (RT)Outpatient2100333$1,011
CT ANGIO ABD&PELV W/O&W/DYECPT 74174Outpatient2100375$1,516
CT ABD & PELVIS W/O CONTRASTCPT 74176Outpatient2100373$2,091
CT ABD & PELV W/CONTRASTCPT 74177Outpatient2100372$2,718
CT ABD & PELV 1/> REGNSCPT 74178Outpatient2100371$3,533
Cardiology
CARDIOVASCULAR STRESS TESTCPT 93017Outpatient1000025$995
TTE W/DOPPLER COMPLETECPT 93306Outpatient1000700$2,531
Clinic
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30 MINCPT 99203----
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45 MINCPT 99204----
(N/O) NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 60 MINCPT 99205----
(N/O) PATIENT OFFICE CONSULTATION, 40 MINCPT 99243----
(N/O) PATIENT OFFICE CONSULTATION, 60 MINCPT 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 STUDYCPT 95810----
EEG AWAKE AND ASLEEPCPT 95819Outpatient1600035$995
EKG
(N/O) ELECTROCARDIOGRAM, ROUTINE, WITH INTERPRETATION AND ...CPT 93000----
ELECTROCARDIOGRAM TRACINGCPT 93005Outpatient1293005$168
ECG MONIT/REPRT UP TO 48 HRSCPT 93225Outpatient1000028$315
ECG MONIT/REPRT UP TO 48 HRSCPT 93226Outpatient1000032$315
Emergency Room
DRAINAGE OF SKIN ABSCESSCPT 10060Outpatient1210060$338
DRAINAGE OF SKIN ABSCESSCPT 10061Outpatient1210061$622
REMOVE FOREIGN BODYCPT 10120Outpatient1210120$622
PUNCTURE DRAINAGE OF LESIONCPT 10160Outpatient1210160$622
REMOVAL OF NAIL PLATECPT 11730Outpatient1211730$338
RPR S/N/AX/GEN/TRNK 2.5CM/<CPT 12001Outpatient1212001$338
RPR S/N/AX/GEN/TRNK2.6-7.5CMCPT 12002Outpatient1212002$338
RPR S/N/AX/GEN/TRK7.6-12.5CMCPT 12004Outpatient1212004$338
RPR F/E/E/N/L/M 2.5 CM/<CPT 12011Outpatient1212011$338
RPR F/E/E/N/L/M 2.6-5.0 CMCPT 12013Outpatient1212013$338
DRESS/DEBRID P-THICK BURN SCPT 16020Outpatient1216020$338
DRAIN/INJ JOINT/BURSA W/O USCPT 20610Outpatient1220610$587
TREAT SHOULDER DISLOCATIONCPT 23650Outpatient1223650$430
TREAT ELBOW DISLOCATIONCPT 24640Outpatient1224640$430
TREAT FRACTURE RADIUS/ULNACPT 25605Outpatient1225605$1,350
APPLY LONG ARM SPLINTCPT 29105 (LT)Outpatient1229152$271
APPLY FOREARM SPLINTCPT 29125 (RT)Outpatient1229125$210
APPLICATION OF FINGER SPLINTCPT 29130Outpatient1229130$168
APPLICATION LONG LEG SPLINTCPT 29505 (LT)Outpatient1229514$271
APPLICATION LOWER LEG SPLINTCPT 29515 (LT)Outpatient1229519$271
CONTROL OF NOSEBLEEDCPT 30901Outpatient1230901$210
INSERT EMERGENCY AIRWAYCPT 31500Outpatient1231500$536
INSERTION OF CHEST TUBECPT 32551Outpatient1232020$1,966
INSERT NON-TUNNEL CV CATHCPT 36556Outpatient1236556$1,966
INSERT TEMP BLADDER CATHCPT 51702Outpatient1251702$210
DX LMBR SPI PNXRCPT 62270Outpatient1262270$1,630
NJX AA&/STRD TRIGEMINAL NRVCPT 64400Outpatient1264400$489
NJX AA&/STRD OTHER PN/BRANCHCPT 64450Outpatient1264450$1,087
CLEAR OUTER EAR CANALCPT 69200Outpatient1269200$210
REMOVE IMPACTED EAR WAX UNICPT 69209Outpatient1269209$112
IMMUNIZATION ADMINCPT 90471Outpatient1290471$116
HEART/LUNG RESUSCITATION CPRCPT 92950Outpatient1292950$498
HYDRATION IV INFUSION INITCPT 96360Outpatient1296360$382
HYDRATE IV INFUSION ADD-ONCPT 96361Outpatient1296361$74
MOD SED SAME PHYS/QHP 5/>YRSCPT 99152Outpatient1299152$95
EMERGENCY DEPT VISITCPT 99281Outpatient1297244$309
EMERGENCY DEPT VISITCPT 99282Outpatient1297236$561
EMERGENCY DEPT VISITCPT 99283Outpatient1297228$986
EMERGENCY DEPT VISITCPT 99284 (25)Outpatient1299284$1,600
EMERGENCY DEPT VISITCPT 99285 (25)Outpatient1299285$2,344
CRITICAL CARE FIRST HOURCPT 99291 (25)Outpatient1299291$3,301
CRITICAL CARE ADDL 30 MINCPT 99292Outpatient1299292$260
Imaging
BX BREAST 1ST LESION US IMAGCPT 19083Outpatient2203020$2,696
US EXAM OF HEAD AND NECKCPT 76536Outpatient2200026$343
ULTRASOUND BREAST COMPLETECPT 76641Outpatient2200072$229
ULTRASOUND BREAST LIMITEDCPT 76642Outpatient2200073$124
US EXAM ABDOM COMPLETECPT 76700Outpatient2200083$572
ECHO EXAM OF ABDOMENCPT 76705Outpatient2200109$458
US ABDL AORTA SCREEN AAACPT 76706Outpatient2200166$229
US EXAM ABDO BACK WALL COMPCPT 76770Outpatient2200174$572
US EXAM ABDO BACK WALL LIMCPT 76775Outpatient2203016$458
OB US < 14 WKS SINGLE FETUSCPT 76801Outpatient2200230$458
OB US >= 14 WKS SNGL FETUSCPT 76805Outpatient2200232$344
OB US LIMITED FETUS(S)CPT 76815Outpatient1276815$229
TRANSVAGINAL US OBSTETRICCPT 76817Outpatient2200229$458
TRANSVAGINAL US NON-OBCPT 76830Outpatient2203012$343
US EXAM PELVIC COMPLETECPT 76856Outpatient2200257$343
US EXAM SCROTUMCPT 76870Outpatient2200349$229
US LMTD JT/NONVASC XTR STRUXCPT 76882Outpatient2200316$229
US GUIDE VASCULAR ACCESSCPT 76937Outpatient2200356$245
ECHO GUIDE FOR BIOPSYCPT 76942Outpatient2200401$852
BREAST TOMOSYNTHESIS UNICPT 77061Outpatient1876087$44
BREAST TOMOSYNTHESIS BICPT 77062Outpatient1876085$67
BREAST TOMOSYNTHESIS BICPT 77063Outpatient1876084$44
DX MAMMO INCL CAD UNICPT 77065Outpatient1800044$539
DX MAMMO INCL CAD BICPT 77066Outpatient1800040$678
SCR MAMMO BI INCL CADCPT 77067Outpatient1800049$583
Inpatient Procedures
(N/O) CARDIAC VALVE OR CARDIOTHORACIC PROCEDURE WITH CARDI ...DRG 216----
(N/O) SPINAL FUSION EXCEPT CERVICAL WITHOUT MCCDRG 460----
(N/O) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXT ...DRG 470----
(N/O) CERVICAL SPINAL FUSION WITHOUT CC OR MCCDRG 473----
(N/O) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WIT ...DRG 743----
Laboratory
ROUTINE VENIPUNCTURECPT 36415Outpatient1493377$24
METABOLIC PANEL TOTAL CACPT 80048Outpatient1420992$84
COMPREHEN METABOLIC PANELCPT 80053Outpatient1420950$104
(N/O) OBSTETRIC BLOOD TEST PANELCPT 80055----
LIPID PANELCPT 80061Outpatient1420976$83
RENAL FUNCTION PANELCPT 80069Outpatient1421008$54
ACUTE HEPATITIS PANELCPT 80074 (90)Outpatient1401801$294
HEPATIC FUNCTION PANELCPT 80076Outpatient1420968$50
ASSAY OF DIGOXIN TOTALCPT 80162Outpatient1420414$82
ASSAY DIPROPYLACETIC ACD TOTCPT 80164Outpatient1420106$84
DRUG SCRN QUAN LEVETIRACETAMCPT 80177 (90)Outpatient1405529$82
ASSAY OF LITHIUMCPT 80178 (90)Outpatient1400198$41
ASSAY OF PHENYTOIN TOTALCPT 80185Outpatient1420422$82
ASSAY OF VANCOMYCINCPT 80202Outpatient1400061$84
DRUG SCREEN QUANTALCOHOLSCPT 80320Outpatient1420232$167
URINALYSIS NONAUTO W/SCOPECPT 81000Outpatient1410019$39
(N/O) URINALYSIS TEST USING MICROSCOPECPT 81001----
URINALYSIS NONAUTO W/O SCOPECPT 81002Outpatient1492900$17
URINALYSIS AUTO W/O SCOPECPT 81003Outpatient1410027$14
URINE PREGNANCY TESTCPT 81025Outpatient1410084$43
ASSAY OF SERUM ALBUMINCPT 82040Outpatient1420224$31
OTHER SOURCE ALBUMIN QUAN EACPT 82042Outpatient1420303$39
UR ALBUMIN QUANTITATIVECPT 82043 (90)Outpatient1400147$36
ALPHA-FETOPROTEIN SERUMCPT 82105 (90)Outpatient1400106$104
ASSAY OF AMMONIACPT 82140Outpatient1420258$90
ASSAY OF AMYLASECPT 82150Outpatient1420265$40
BILIRUBIN TOTALCPT 82247Outpatient1420281$31
BILIRUBIN DIRECTCPT 82248Outpatient1420299$31
OCCULT BLD FECES 1-3 TESTSCPT 82272Outpatient1410077$21
VITAMIN D 25 HYDROXYCPT 82306 (90)Outpatient1476556$183
CARCINOEMBRYONIC ANTIGENCPT 82378 (90)Outpatient1400428$117
TOTAL CORTISOLCPT 82533 (90)Outpatient1400255$101
ASSAY OF CK (CPK)CPT 82550Outpatient1420365$80
CREATINE MB FRACTIONCPT 82553Outpatient1420372$114
ASSAY OF CREATININECPT 82565Outpatient1420380$32
ASSAY OF URINE CREATININECPT 82570 (90)Outpatient1493416$32
VITAMIN B-12CPT 82607 (90)Outpatient1400244$93
ASSAY OF FERRITINCPT 82728Outpatient1420040$84
ASSAY OF FOLIC ACID SERUMCPT 82746 (90)Outpatient1400269$91
BLOOD GASES ANY COMBINATIONCPT 82803Outpatient1491504$130
GLUCOSE OTHER FLUIDCPT 82945Outpatient1420794$24
ASSAY GLUCOSE BLOOD QUANTCPT 82947Outpatient1420703$24
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036Outpatient1493342$60
IMMUNOASSAY QUANT NOS NONABCPT 83520 (90)Outpatient1400317$86
ASSAY OF IRONCPT 83540Outpatient1420038$40
IRON BINDING TESTCPT 83550Outpatient1420039$54
ASSAY OF LACTIC ACIDCPT 83605Outpatient1420464$106
LACTATE (LD) (LDH) ENZYMECPT 83615Outpatient1420472$37
ASSAY OF LIPASECPT 83690Outpatient1420935$68
ASSAY OF BLOOD LIPOPROTEINCPT 83721Outpatient1493343$59
ASSAY OF MAGNESIUMCPT 83735Outpatient1420505$66
ASSAY OF BLOOD OSMOLALITYCPT 83930 (90)Outpatient1400463$41
ASSAY OF URINE OSMOLALITYCPT 83935 (90)Outpatient1400464$42
ASSAY PH BODY FLUID NOSCPT 83986Outpatient1492710$22
ASSAY OF PHOSPHORUSCPT 84100Outpatient1420588$47
ASSAY OF SERUM POTASSIUMCPT 84132Outpatient1420604$28
ASSAY OF PREALBUMINCPT 84134 (90)Outpatient1404947$90
ASSAY OF PSA TOTALCPT 84153 (90)Outpatient1400505$114
ASSAY OF PSA TOTALCPT 84153Outpatient-$114
(N/O) TOTAL PROSTATE-SPECIFIC ANTIGEN (PSA) TESTCPT 84154----
ASSAY OF PROTEIN SERUMCPT 84155 (90)Outpatient1400218$23
ASSAY OF PROTEIN URINECPT 84156 (90)Outpatient1400216$23
ASSAY OF PROTEIN OTHERCPT 84157Outpatient1420653$23
PROTEIN E-PHORESIS SERUMCPT 84165 (90)Outpatient1493010$66
PROTEIN E-PHORESIS/URINE/CSFCPT 84166 (90)Outpatient1493011$110
ASSAY OF SERUM SODIUMCPT 84295Outpatient1420687$30
ASSAY OF URINE SODIUMCPT 84300Outpatient1492908$30
ASSAY OF VITAMIN B-1CPT 84425 (90)Outpatient1400330$131
ASSAY OF FREE THYROXINECPT 84439Outpatient1420178$56
ASSAY THYROID STIM HORMONECPT 84443Outpatient1420094$104
ASSAY OF TRIGLYCERIDESCPT 84478Outpatient1420836$35
ASSAY TRIIODOTHYRONINE (T3)CPT 84480 (90)Outpatient1400438$88
ASSAY OF BLOOD/URIC ACIDCPT 84550Outpatient1420869$28
CHORIONIC GONADOTROPIN TESTCPT 84702Outpatient1492761$93
CHORIONIC GONADOTROPIN ASSAYCPT 84703Outpatient1492751$46
HEMATOCRITCPT 85014Outpatient1431252$15
HEMOGLOBINCPT 85018Outpatient1431253$15
COMPLETE CBC W/AUTO DIFF WBCCPT 85025Outpatient1431031$96
COMPLETE CBC AUTOMATEDCPT 85027Outpatient1431049$80
MANUAL RETICULOCYTE COUNTCPT 85044Outpatient1431163$27
AUTOMATED PLATELET COUNTCPT 85049Outpatient1431130$28
FIBRIN DEGRADATION QUANTCPT 85379Outpatient1420121$63
PROTHROMBIN TIMECPT 85610Outpatient1431148$39
RBC SED RATE NONAUTOMATEDCPT 85651Outpatient1431171$22
THROMBOPLASTIN TIME PARTIALCPT 85730Outpatient1431197$37
WBC ANTIBODY IDENTIFICATIONCPT 86021 (90)Outpatient1404702$74
ANTINUCLEAR ANTIBODIESCPT 86038 (90)Outpatient1400467$75
ANTISTREPTOLYSIN O TITERCPT 86060 (90)Outpatient1400402$45
C-REACTIVE PROTEINCPT 86140 (90)Outpatient1400403$32
IMMUNOASSAY TUMOR CA 19-9CPT 86301 (90)Outpatient1400210$129
HETEROPHILE ANTIBODY SCREENCPT 86308 (90)Outpatient1400694$32
RHEUMATOID FACTOR QUANTCPT 86431 (90)Outpatient1400426$35
SYPHILIS TEST NON-TREP QUALCPT 86592 (90)Outpatient1400695$26
HEP B SURFACE ANTIBODYCPT 86706 (90)Outpatient1400500$66
MUMPS ANTIBODYCPT 86735 (90)Outpatient1400723$81
RUBELLA ANTIBODYCPT 86762 (90)Outpatient1400427$89
RUBEOLA ANTIBODYCPT 86765 (90)Outpatient1400722$80
VARICELLA-ZOSTER ANTIBODYCPT 86787 (90)Outpatient1400721$80
HEPATITIS C AB TESTCPT 86803 (90)Outpatient1400542$88
RBC ANTIBODY SCREENCPT 86850Outpatient1441311$224
BLOOD TYPING SEROLOGIC ABOCPT 86900Outpatient1441345$525
BLOOD TYPING SEROLOGIC RH(D)CPT 86901Outpatient1441352$159
BLOOD TYPE ANTIGEN DONOR EACPT 86902 (90)Outpatient1500232$431
COMPATIBILITY TEST SPINCPT 86920Outpatient1441336$646
COMPATIBILITY TEST ANTIGLOBCPT 86922Outpatient1441337$646
SPECIMEN INFECT AGNT CONCNTJCPT 87015 (90)Outpatient1493305$41
BLOOD CULTURE FOR BACTERIACPT 87040Outpatient1451740$64
FECES CULTURE AEROBIC BACTCPT 87045 (90)Outpatient1476222$58
CULTURE OTHR SPECIMN AEROBICCPT 87070 (90)Outpatient1487070$53
CULTR BACTERIA EXCEPT BLOODCPT 87075 (90)Outpatient1400621$58
CULTURE AEROBIC IDENTIFYCPT 87077 (90)Outpatient1400639$50
CULTURE SCREEN ONLYCPT 87081 (90)Outpatient1400617$41
URINE CULTURE/COLONY COUNTCPT 87086 (90)Outpatient1400626$50
URINE BACTERIA CULTURECPT 87088 (90)Outpatient1400638$50
MYCOBACTERIA CULTURECPT 87116 (90)Outpatient1493207$67
CULTURE TYPE IMMUNOLOGICCPT 87147 (90)Outpatient1400890$32
OVA AND PARASITES SMEARSCPT 87177 (90)Outpatient1420115$55
MICROBE SUSCEPTIBLE MICCPT 87186 (90)Outpatient1493021$53
SMEAR GRAM STAINCPT 87205 (90)Outpatient1487205$26
SMEAR FLUORESCENT/ACID STAICPT 87206 (90)Outpatient1400612$33
SMEAR COMPLEX STAINCPT 87209 (90)Outpatient1420117$111
SMEAR WET MOUNT SALINE/INKCPT 87210Outpatient1451724$29
HEPATITIS B SURFACE AG IACPT 87340 (90)Outpatient1400495$64
HIV-1 AG W/HIV-1&2 AB AG IACPT 87389 (90)Outpatient1475688$149
NOS EACH ORGANISM AG IACPT 87449 (90)Outpatient1451010$74
CHYLMD TRACH DNA AMP PROBECPT 87491 (90)Outpatient1400484$217
C DIFF AMPLIFIED PROBECPT 87493Outpatient1487493$217
INFLUENZA DNA AMP PROBECPT 87502Outpatient1404991$315
HSV DNA AMP PROBECPT 87529Outpatient1406256$117
N.GONORRHOEAE DNA AMP PROBCPT 87591 (90)Outpatient1400479$217
STREP A DNA AMP PROBECPT 87651Outpatient1407651$117
DETECT AGENT NOS DNA AMPCPT 87798Outpatient1407798$117
INFLUENZA ASSAY W/OPTICCPT 87804Outpatient1404969$83
STREP A ASSAY W/OPTICCPT 87880 (QW)Outpatient1451849$83
TISSUE EXAM BY PATHOLOGISTCPT 88304Outpatient1462135$224
TISSUE EXAM BY PATHOLOGISTCPT 88305Outpatient1462143$224
BODY FLUID CELL COUNTCPT 89051Outpatient1492785$34
LEUKOCYTE ASSESSMENT FECALCPT 89055Outpatient1451726$26
EXAM SYNOVIAL FLUID CRYSTALSCPT 89060Outpatient1492868$44
Language Pathology
SPEECH/HEARING THERAPYCPT 92507 (GN)Outpatient3000020$91
SPEECH SOUND LANG COMPREHENCPT 92523 (GN)Outpatient3092523$367
ORAL FUNCTION THERAPYCPT 92526 (GN)Outpatient3000040$284
EVALUATE SWALLOWING FUNCTIONCPT 92610 (GN)Outpatient3000030$586
MOTION FLUOROSCOPY/SWALLOWCPT 92611 (GN)Outpatient3000066$379
MRI
(N/O) MRI SCANCPT 70553----
(N/O) MRI SCAN OF LOWER SPINAL CANALCPT 72148----
(N/O) MRI SCAN OF LEG JOINTCPT 73721----
Medical and Surgical Supplies
SPECIAL SUPPLIES PHYS/QHPCPT 99070Outpatient1341404$98
STERILE WATER/SALINE, 500 MLHCPCS A4217Outpatient1335019$7
INFUSION SUPPLIES WITH PUMPHCPCS A4222Outpatient1300202$23
CATH IMPL VASC ACCESS PORTALHCPCS A4300Outpatient1342972$287
CATH W/DRAINAGE 2-WAY LATEXHCPCS A4314Outpatient1340312$41
CATH INSERTION TRAY W/BAGHCPCS A4354Outpatient1340313$27
SURGICAL SUPPLIESHCPCS A4649Outpatient1300065$25
FOAM DRG <=16 SQ IN W/BORDERHCPCS A6212Outpatient1305153$20
TRANSPARENT FILM <= 16 SQ INHCPCS A6257Outpatient1300042$19
BLANKET BAIR HUGGER LOWER BODYHCPCS E0215Outpatient1302091$21
Nuclear Medicine
HEPATOBILIARY SYSTEM IMAGINGCPT 78226Outpatient2400322$1,048
HEPATOBIL SYST IMAGE W/DRUGCPT 78227Outpatient2400323$1,359
HT MUSCLE IMAGE SPECT MULTCPT 78452Outpatient2400943$3,608
LUNG VENTILAT&PERFUS IMAGINGCPT 78582Outpatient2400605$1,359
TC99M SESTAMIBIHCPCS A9500Outpatient2401640$223
TC99M MEDRONATEHCPCS A9503Outpatient2401751$81
TC99M PERTECHNETATEHCPCS A9512Outpatient2401431$4
TC99M MEBROFENINHCPCS A9537Outpatient2401763$84
TC99M MAAHCPCS A9540Outpatient2401758$119
TECHNETIUM TC-99M AEROSOLHCPCS A9567Outpatient2401761$91
Other Diagnostic
EXTRACRANIAL BILAT STUDYCPT 93880Outpatient2200299$697
LOWER EXTREMITY STUDYCPT 93925Outpatient2200372$697
EXTREMITY STUDYCPT 93970Outpatient2200373$697
EXTREMITY STUDYCPT 93971 (LT)Outpatient2200377$343
VASCULAR STUDYCPT 93976Outpatient2200308$229
Other Procedures and Observation
BL DRAW <3 YRS OTHER VEINCPT 36406Outpatient1400001$24
WITHDRAWAL OF ARTERIAL BLOODCPT 36600Outpatient1000999$210
Other Therapeutic
BLOOD TRANSFUSION SERVICECPT 36430Outpatient1236430$1,126
PLASMA FRESH FROZENCPT 86927Outpatient1441493$1,078
THER/PROPH/DIAG IV INF INITCPT 96365Outpatient1296365$382
THER/PROPH/DIAG IV INF ADDONCPT 96366Outpatient1296366$191
TX/PROPH/DG ADDL SEQ IV INFCPT 96367Outpatient1296367$343
THER/DIAG CONCURRENT INFCPT 96368Outpatient1296368$343
THER/PROPH/DIAG INJ SC/IMCPT 96372Outpatient1296372$116
THER/PROPH/DIAG INJ IV PUSHCPT 96374Outpatient1296374$287
TX/PRO/DX INJ NEW DRUG ADDONCPT 96375Outpatient1296375$191
TX/PRO/DX INJ SAME DRUG ADONCPT 96376Outpatient1296376$191
RBC LEUKOCYTES REDUCEDHCPCS P9016Outpatient1500019$294
PLASMA 1 DONOR FRZ W/IN 8 HRHCPCS P9017Outpatient1500059$121
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
EVALUATION OF WHEEZINGCPT 94060Outpatient1000051$747
MEASURE BLOOD OXYGEN LEVELCPT 94761Outpatient1000810$444
Radiology
X-RAY EXAM OF NASAL BONESCPT 70160Outpatient1700170$186
X-RAY EXAM OF NECKCPT 70360Outpatient1700287$186
X-RAY EXAM CHEST 1 VIEWCPT 71045Outpatient1702109$187
X-RAY EXAM CHEST 2 VIEWSCPT 71046Outpatient1700345$224
X-RAY EXAM RIBS UNI 2 VIEWSCPT 71100 (RT)Outpatient1700428$186
X-RAY EXAM UNILAT RIBS/CHESTCPT 71101 (LT)Outpatient1700430$343
X-RAY EXAM NECK SPINE 2-3 VWCPT 72040Outpatient1700485$224
X-RAY EXAM NECK SPINE 4/5VWSCPT 72050Outpatient1700493$343
X-RAY EXAM NECK SPINE 6/>VWSCPT 72052Outpatient1700501$343
X-RAY EXAM THORAC SPINE 2VWSCPT 72070Outpatient1700535$343
X-RAY EXAM THORAC SPINE 3VWSCPT 72072Outpatient1701970$412
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100Outpatient1700550$343
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110Outpatient1700568$412
X-RAY EXAM L-S SPINE BENDINGCPT 72114Outpatient1700576$412
X-RAY EXAM OF PELVISCPT 72170Outpatient1700592$343
X-RAY EXAM OF PELVISCPT 72190Outpatient1700618$515
X-RAY EXAM SACRUM TAILBONECPT 72220Outpatient1700634$186
X-RAY EXAM OF COLLAR BONECPT 73000Outpatient1700675$186
X-RAY EXAM OF SHOULDERCPT 73030 (LT)Outpatient1700710$280
X-RAY EXAM OF HUMERUSCPT 73060 (LT)Outpatient1700740$186
X-RAY EXAM OF ELBOWCPT 73080 (LT)Outpatient1700767$280
X-RAY EXAM OF FOREARMCPT 73090 (RT)Outpatient1700774$186
X-RAY EXAM OF WRISTCPT 73100 (RT)Outpatient1700782$186
X-RAY EXAM OF WRISTCPT 73110 (LT)Outpatient1700791$280
X-RAY EXAM OF HANDCPT 73120 (RT)Outpatient1700808$343
X-RAY EXAM OF HANDCPT 73130 (RT)Outpatient1700816$412
X-RAY EXAM OF FINGER(S)CPT 73140 (F5)Outpatient1700824$186
X-RAY EXAM HIP UNI 1 VIEWCPT 73501 (RT)Outpatient1700855$186
X-RAY EXAM HIP UNI 2-3 VIEWSCPT 73502 (RT)Outpatient1700863$280
X-RAY EXAM HIPS BI 2 VIEWSCPT 73521Outpatient1700872$343
X-RAY EXAM OF FEMUR 2/>CPT 73552 (LT)Outpatient1700906$186
X-RAY EXAM OF KNEE 1 OR 2CPT 73560 (RT)Outpatient1700915$186
X-RAY EXAM OF KNEE 3CPT 73562 (LT)Outpatient1700927$224
X-RAY EXAM KNEE 4 OR MORECPT 73564 (RT)Outpatient1700923$268
X-RAY EXAM OF LOWER LEGCPT 73590 (LT)Outpatient1700957$186
X-RAY EXAM OF ANKLECPT 73600 (RT)Outpatient1700964$186
X-RAY EXAM OF ANKLECPT 73610 (RT)Outpatient1700972$280
X-RAY EXAM OF FOOTCPT 73620 (LT)Outpatient1700981$186
X-RAY EXAM OF FOOTCPT 73630 (RT)Outpatient1700998$280
X-RAY EXAM OF HEELCPT 73650 (LT)Outpatient1701011$186
X-RAY EXAM OF TOE(S)CPT 73660 (T5)Outpatient1701020$186
X-RAY EXAM ABDOMEN 1 VIEWCPT 74018Outpatient1701053$186
X-RAY EXAM ABDOMEN 3+ VIEWSCPT 74021Outpatient1701079$343
X-RAY EXAM COMPLETE ABDOMENCPT 74022Outpatient1702036$412
X-RAY XM ESOPHAGUS 1CNTRSTCPT 74220Outpatient1701095$758
X-RAY XM SWLNG FUNCJ C+CPT 74230Outpatient1701103$343
X-RAY XM SM INT 1CNTRST STDCPT 74250Outpatient1701145$458
FLUOROSCOPY <1 HR PHYS/QHPCPT 76000Outpatient1701699$697
X-RAY NOSE TO RECTUMCPT 76010Outpatient1702145$186
FLUOROGUIDE FOR VEIN DEVICECPT 77001Outpatient1709991$304
DXA BONE DENSITY AXIALCPT 77080Outpatient1702148$343
Respiratory
VENT MGMT INPAT INIT DAYCPT 94002Outpatient1000226$2,073
VENT MGMT INPAT SUBQ DAYCPT 94003Outpatient1000091$2,073
AIRWAY INHALATION TREATMENTCPT 94640 (76)Outpatient1000145$373
CBT 1ST HOURCPT 94644Outpatient1000029$210
POS AIRWAY PRESSURE CPAPCPT 94660Outpatient1000650$1,118
CHEST WALL MANIPULATIONCPT 94668Outpatient1000820$210
Surgical Procedures
(N/O) REMOVAL OF ONE OR MORE BREAST GROWTH, OPEN PROCEDURECPT 19120----
(N/O) SHAVING OF SHOULDER BONE USING ENDOSCOPECPT 29826----
(N/O) REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPECPT 29881----
ASPIRATE PLEURA W/ IMAGINGCPT 32555Outpatient2200358$1,225
INSJ PICC RS&I 5 YR+CPT 36573Outpatient1700163$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/MULTIPLECPT 43239Outpatient-$439
DIAGNOSTIC COLONOSCOPYCPT 45378Outpatient-$439
(N/O) BIOPSY EXAM OF LARGE BOWEL USING AN ENDOSCOPECPT 45380----
COLONOSCOPY W/LESION REMOVALCPT 45385Outpatient-$840
(N/O) ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL USING AN ...CPT 45391----
(N/O) REMOVAL OF GALLBLADDER USING AN ENDOSCOPECPT 47562----
ABD PARACENTESIS W/IMAGINGCPT 49083Outpatient2200430$1,487
(N/O) REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS OR OLDERCPT 49505----
(N/O) BIOPSY OF PROSTATE GLANDCPT 55700----
(N/O) SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH N ...CPT 55866----
(N/O) OBSTETRIC CARE, PLANNED VAGINAL DELIVERYCPT 59400----
(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----
(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 LENSCPT 66984----
(N/O) INSERTION OF CATHETER INTO LEFT HEART FOR DIAGNOSISCPT 93452----
Therapy
THERAPEUTIC EXERCISESCPT 97110 (GP)Outpatient2801219$99
THERAPEUTIC EXERCISESCPT 97110Outpatient-$99
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)Outpatient2801227$114
GAIT TRAINING THERAPYCPT 97116 (GP)Outpatient2801243$98
MANUAL THERAPY 1/> REGIONSCPT 97140 (GP)Outpatient2801800$90
PT EVAL LOW COMPLEX 20 MINCPT 97161Outpatient2897161$401
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)Outpatient2897162$364
PT RE-EVAL EST PLAN CARECPT 97164 (GP)Outpatient2897164$186
OT EVAL LOW COMPLEX 30 MINCPT 97165 (GO)Outpatient2997165$296
OT EVAL MOD COMPLEX 45 MINCPT 97166 (GO)Outpatient2997166$296
THERAPEUTIC ACTIVITIESCPT 97530 (GP)Outpatient2801235$134
SELF CARE MNGMENT TRAININGCPT 97535 (GO)Outpatient2901010$113
WHEELCHAIR MNGMENT TRAININGCPT 97542 (GP)Outpatient2804210$109
ORTHOTIC MGMT&TRAING 1ST ENCCPT 97760 (GO)Outpatient2902095$156
Uncategorized
ADMIN INFLUENZA VIRUS VACHCPCS G0008Outpatient510001$74
ADMIN PNEUMOCOCCAL VACCINEHCPCS G0009Outpatient510002$74