Wise Health Surgical Hospital

Price List for Shoppable Services. Effective 07-22-2022.

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Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
Billing DescriptionBilling CodeCDM CodeDepartmentGross ChargeCash PricePNR
CT Scan
CT HEAD/BRAIN W/O DYECPT 7045012435144Outpatient$3,245$2,109Payer Rates
CT HEAD/BRAIN W/O DYECPT 7045012435164Outpatient$3,245$2,109Payer Rates
CT HEAD/BRAIN W/O DYECPT 7045040035144Outpatient$3,245$2,109Payer Rates
CT HEAD/BRAIN W/O DYECPT 7045040035164Outpatient$3,245$2,109Payer Rates
CT THORAX DX C-CPT 7125012435256Outpatient$3,245$2,109Payer Rates
CT THORAX DX C+CPT 7126012435221Outpatient$3,675$2,389Payer Rates
CT ANGIOGRAPHY CHESTCPT 7127512435276Outpatient$4,725$3,071Payer Rates
CT NECK SPINE W/O DYECPT 7212512435255Outpatient$3,245$2,109Payer Rates
CT PELVIS W/DYECPT 7219312435251Outpatient$3,785$2,460Payer Rates
CT ABD & PELVIS W/O CONTRASTCPT 7417612435257Outpatient$3,245$2,109Payer Rates
CT ABD & PELV W/CONTRASTCPT 7417712435258Outpatient$3,785$2,460Payer Rates
CT ABD & PELV W/CONTRASTCPT 7417740035258Outpatient$3,785$2,460Payer Rates
CT HRT W/O DYE W/CA TESTCPT 755711243528Outpatient$99$64Payer Rates
Cancer Services
CT SCAN FOR THERAPY GUIDECPT 7701413533302Outpatient$589$383Payer Rates
RADIATION PHYSICS CONSULTCPT 7733613533318Outpatient$333$216Payer Rates
NTSTY MODUL RAD TX DLVR SMPLCPT 7738513533323Outpatient$1,424$926Payer Rates
RADIATION TREATMENT DELIVERYCPT 7741213533344Outpatient$693$450Payer Rates
CHEMO IV INFUSION 1 HRCPT 964132043359Outpatient$688$447Payer Rates
Cardiology
TTE W/DOPPLER COMPLETECPT 9330612548331Outpatient$2,657$1,727Payer Rates
LEFT HRT CATH W/VENTRCLGRPHYCPT 9345282481106Outpatient$13,087$8,507Payer Rates
MOD SED SAME PHYS/QHP EACPT 9915382370353Outpatient$157$102Payer Rates
Clinic
HYPERBARIC OXYGEN THERAPYCPT 99183761510400Outpatient$902$586Payer Rates
OFFICE O/P EST LOW 20-29 MINCPT 9921376151013Outpatient$356$231Payer Rates
Dialysis
DIALYSIS PROCEDURECPT 909998018512Outpatient$2,602$1,691Payer Rates
EEG
POLYSOM 6/> YRS 4/> PARAMCPT 95810 (TC)8707406Outpatient$5,411$3,517Payer Rates
EKG
ELECTROCARDIOGRAM TRACINGCPT 930051287301Outpatient$341$222Payer Rates
Emergency Room
INSERT TEMP BLADDER CATHCPT 517029145052Outpatient$558$363Payer Rates
EMERGENCY DEPT VISITCPT 992829145023Outpatient$827$538Payer Rates
EMERGENCY DEPT VISITCPT 992839145022Outpatient$1,622$1,054Payer Rates
EMERGENCY DEPT VISITCPT 9928340045022Outpatient$1,575$1,024Payer Rates
EMERGENCY DEPT VISITCPT 992849145021Outpatient$2,867$1,864Payer Rates
EMERGENCY DEPT VISITCPT 9928440045021Outpatient$2,730$1,775Payer Rates
EMERGENCY DEPT VISITCPT 992859145018Outpatient$3,859$2,508Payer Rates
CRITICAL CARE FIRST HOURCPT 992919145026Outpatient$4,725$3,071Payer Rates
Hemodialysis
DIALYSIS PROCEDURECPT 90999 (G3)80082125Outpatient$2,478$1,611Payer Rates
DIALYSIS PROCEDURECPT 90999 (G3)80082127Outpatient$2,478$1,611Payer Rates
DIALYSIS PROCEDURECPT 90999 (G3)80082128Outpatient$2,602$1,691Payer Rates
DIALYSIS PROCEDURECPT 90999 (G4)80082134Outpatient$2,478$1,611Payer Rates
DIALYSIS PROCEDURECPT 90999 (G4)80082135Outpatient$2,602$1,691Payer Rates
DIALYSIS PROCEDURECPT 90999 (G4)80082136Outpatient$2,602$1,691Payer Rates
DIALYSIS PROCEDURECPT 90999 (G5)80082142Outpatient$2,478$1,611Payer Rates
DIALYSIS PROCEDURECPT 90999 (G5)80082143Outpatient$2,602$1,691Payer Rates
DIALYSIS PROCEDURECPT 90999 (G5)80082144Outpatient$2,602$1,691Payer Rates
IV Therapy
HYDRATION IV INFUSION INITCPT 963609126014Outpatient$482$313Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963614126021Outpatient$88$57Payer Rates
HYDRATE IV INFUSION ADD-ONCPT 963619126015Outpatient$210$137Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963659126011Outpatient$526$342Payer Rates
THER/PROPH/DIAG IV INF INITCPT 963651322604Outpatient$526$342Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963664126012Outpatient$175$114Payer Rates
THER/PROPH/DIAG IV INF ADDONCPT 963669126038Outpatient$210$137Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 963679126050Outpatient$256$166Payer Rates
TX/PROPH/DG ADDL SEQ IV INFCPT 9636720426010Outpatient$107$70Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372412609Outpatient$337$219Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372482604Outpatient$337$219Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963729126033Outpatient$312$203Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 963722042607Outpatient$318$207Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 963749126012Outpatient$303$197Payer Rates
THER/PROPH/DIAG INJ IV PUSHCPT 9637440026032Outpatient$297$193Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963754126019Outpatient$596$387Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 963759126016Outpatient$318$207Payer Rates
TX/PRO/DX INJ NEW DRUG ADDONCPT 9637540026016Outpatient$303$197Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963764126020Outpatient$306$199Payer Rates
TX/PRO/DX INJ SAME DRUG ADONCPT 963769126047Outpatient$312$203Payer Rates
Imaging
US EXAM ABDOM COMPLETECPT 7670012540215Outpatient$1,073$697Payer Rates
ECHO EXAM OF ABDOMENCPT 7670512540234Outpatient$825$536Payer Rates
US EXAM ABDO BACK WALL COMPCPT 7677012540255Outpatient$1,074$698Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 7680512540277Outpatient$1,476$959Payer Rates
OB US >= 14 WKS SNGL FETUSCPT 7680512540278Outpatient$1,391$904Payer Rates
TRANSVAGINAL US NON-OBCPT 7683012540241Outpatient$833$541Payer Rates
TRANSVAGINAL US NON-OBCPT 76830EX12540241Outpatient$809$526Payer Rates
TRANSVAGINAL US NON-OBCPT 76830EX40040241Outpatient$809$526Payer Rates
ECHO GUIDE FOR BIOPSYCPT 769421940213Outpatient$1,383$899Payer Rates
BREAST TOMOSYNTHESIS BICPT 770631264038Outpatient$150$98Payer Rates
DX MAMMO INCL CAD UNICPT 77065 (LT)1264015Outpatient$324$211Payer Rates
DX MAMMO INCL CAD UNICPT 77065 (RT)1264016Outpatient$324$211Payer Rates
DX MAMMO INCL CAD BICPT 770661264014Outpatient$420$273Payer Rates
SCR MAMMO BI INCL CADCPT 770671264033Outpatient$301$196Payer Rates
EXTREMITY STUDYCPT 9397012592111Outpatient$1,706$1,109Payer 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-----
Laboratory
COVID FLU COMBO VIR RESP RNA 3 TRGTCPT 0240U1003001339Outpatient$232$151Payer Rates
ROUTINE VENIPUNCTURECPT 36415100300304Outpatient$31$20Payer Rates
ROUTINE VENIPUNCTURECPT 36415100300480Outpatient$3$2Payer Rates
ROUTINE VENIPUNCTURECPT 36415100300485Outpatient$12$8Payer Rates
ROUTINE VENIPUNCTURECPT 364151023001304Outpatient$13$8Payer Rates
ROUTINE VENIPUNCTURECPT 364151023001310Outpatient$11$7Payer Rates
ROUTINE VENIPUNCTURECPT 36415110300304Outpatient$32$21Payer Rates
ROUTINE VENIPUNCTURECPT 3641512330018Outpatient$28$18Payer Rates
ROUTINE VENIPUNCTURECPT 364151323001Outpatient$31$20Payer Rates
METABOLIC PANEL IONIZED CACPT 80047100301900Outpatient$365$237Payer Rates
METABOLIC PANEL TOTAL CACPT 800481003011235Outpatient$11$7Payer Rates
METABOLIC PANEL TOTAL CACPT 800481003011306Outpatient$11$7Payer Rates
METABOLIC PANEL TOTAL CACPT 8004810030120Outpatient$349$227Payer Rates
METABOLIC PANEL TOTAL CACPT 80048100301642Outpatient$202$131Payer Rates
COMPREHEN METABOLIC PANELCPT 800531003011301Outpatient$20$13Payer Rates
COMPREHEN METABOLIC PANELCPT 80053100301582Outpatient$520$338Payer Rates
(Not Offered) OBSTETRIC BLOOD TEST PANELCPT 80055-----
LIPID PANELCPT 8006110030191Outpatient$324$211Payer Rates
RENAL FUNCTION PANELCPT 80069 (QW)100301585Outpatient$115$75Payer Rates
HEPATIC FUNCTION PANELCPT 800761003011297Outpatient$11$7Payer Rates
HEPATIC FUNCTION PANELCPT 80076100301790Outpatient$323$210Payer Rates
HEPATIC FUNCTION PANELCPT 80076100301976Outpatient$219$142Payer Rates
DRUG ASSAY SALICYLATECPT 80179100301557Outpatient$274$178Payer Rates
ASSAY OF VANCOMYCINCPT 80202100301758Outpatient$131$85Payer Rates
(Not Offered) URINALYSIS TEST USING MICROSCOPECPT 81000-----
URINALYSIS AUTO W/SCOPECPT 810011003071262Outpatient$5$3Payer Rates
URINALYSIS AUTO W/SCOPECPT 81001100307722Outpatient$166$108Payer Rates
URINALYSIS AUTO W/SCOPECPT 81001EX100307722Outpatient$174$113Payer Rates
URINALYSIS AUTO W/O SCOPECPT 81003 (QW)10030720Outpatient$49$32Payer Rates
URINE PREGNANCY TESTCPT 810251003071208Outpatient$23$15Payer Rates
URINE PREGNANCY TESTCPT 81025100307514Outpatient$166$108Payer Rates
ASSAY OF AMMONIACPT 82140100301116Outpatient$98$64Payer Rates
ASSAY OF AMYLASECPT 82150 (QW)100301113Outpatient$225$146Payer Rates
ASSAY TEST FOR BLOOD FECALCPT 82274 (QW)100301472Outpatient$68$44Payer Rates
ASSAY CARBOXYHB QUANTCPT 8237520230189Outpatient$131$85Payer Rates
ASSAY OF CK (CPK)CPT 82550100301318Outpatient$238$155Payer Rates
ASSAY OF CREATININECPT 82565 (QW)100301329Outpatient$166$108Payer Rates
ASSAY OF CREATININECPT 82565 (QW)100301883Outpatient$164$107Payer Rates
ASSAY OF URINE CREATININECPT 82570 (QW)100301163Outpatient$57$37Payer Rates
VITAMIN B-12CPT 82607100301749Outpatient$83$54Payer Rates
ASSAY OF FERRITINCPT 82728100301801Outpatient$195$127Payer Rates
ASSAY OF FOLIC ACID SERUMCPT 82746100301377Outpatient$105$68Payer Rates
BLOOD GASES W/O2 SATURATIONCPT 8280520230162Outpatient$233$151Payer Rates
ASSAY GLUCOSE BLOOD QUANTCPT 82947 (QW)100301395Outpatient$29$19Payer Rates
GLUCOSE BLOOD TESTCPT 82962100301397Outpatient$33$21Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036 (QW)100301100Outpatient$253$164Payer Rates
BLOOD METHEMOGLOBIN ASSAYCPT 8305020230190Outpatient$71$46Payer Rates
ASSAY OF IRONCPT 83540EX100301457Outpatient$32$21Payer Rates
IRON BINDING TESTCPT 83550EX100301456Outpatient$78$51Payer Rates
ASSAY OF LACTIC ACIDCPT 83605 (QW)100301724Outpatient$242$157Payer Rates
LACTATE (LD) (LDH) ENZYMECPT 83615100301446Outpatient$226$147Payer Rates
ASSAY OF LIPASECPT 83690100301454Outpatient$210$137Payer Rates
ASSAY OF MAGNESIUMCPT 83735100301461Outpatient$197$128Payer Rates
ASSAY OF MYOGLOBINCPT 83874EX10030124Outpatient$351$228Payer Rates
ASSAY OF NATRIURETIC PEPTIDECPT 83880 (QW)100301715Outpatient$195$127Payer Rates
ASSAY OF PARATHORMONECPT 83970100301653Outpatient$228$148Payer Rates
ASSAY OF BLOOD PKUCPT 84030100301559Outpatient$168$109Payer Rates
ASSAY OF PHOSPHORUSCPT 84100100301498Outpatient$53$34Payer Rates
ASSAY OF SERUM POTASSIUMCPT 84132100301518Outpatient$63$41Payer Rates
PROCALCITONIN (PCT)CPT 84145100301895Outpatient$412$268Payer Rates
ASSAY OF PSA TOTALCPT 84153100301522Outpatient$413$268Payer Rates
ASSAY OF PSA FREECPT 84154100301713Outpatient$104$68Payer Rates
ASSAY OF PROTEIN URINECPT 841561003011206Outpatient$32$21Payer Rates
ASSAY OF FREE THYROXINECPT 84439100301649Outpatient$306$199Payer Rates
ASSAY THYROID STIM HORMONECPT 84443 (QW)100301697Outpatient$364$237Payer Rates
ASSAY THYROID STIM HORMONECPT 84443 (QW)EX100301697Outpatient$347$226Payer Rates
ASSAY OF TROPONIN QUANTCPT 84484100301640Outpatient$347$226Payer Rates
ASSAY OF TROPONIN QUANTCPT 84484100301893Outpatient$364$237Payer Rates
ASSAY OF TROPONIN QUANTCPT 84484EX10030125Outpatient$253$164Payer Rates
ASSAY OF TROPONIN QUANTCPT 84484EX10030126Outpatient$375$244Payer Rates
CHORIONIC GONADOTROPIN TESTCPT 84702100301437Outpatient$320$208Payer Rates
CHORIONIC GONADOTROPIN ASSAYCPT 84703 (QW)100301510Outpatient$197$128Payer Rates
BL SMEAR W/DIFF WBC COUNTCPT 85007100305400Outpatient$53$34Payer Rates
BL SMEAR W/O DIFF WBC COUNTCPT 85008100300311Outpatient$67$44Payer Rates
HEMATOCRITCPT 85014 (QW)EX100305426Outpatient$28$18Payer Rates
HEMOGLOBINCPT 85018 (QW)100305431Outpatient$27$18Payer Rates
HEMOGLOBINCPT 85018 (QW)EX100305431Outpatient$28$18Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 85025 (QW)1003051230Outpatient$8$5Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 85025 (QW)1003051337Outpatient$11$7Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 85025 (QW)10030520Outpatient$154$100Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 85025 (QW)100305305Outpatient$151$98Payer Rates
COMPLETE CBC AUTOMATEDCPT 85027100305379Outpatient$151$98Payer Rates
COAGULATION TIME ACTIVATEDCPT 85347100305404Outpatient$157$102Payer Rates
FIBRIN DEGRADATION QUANTCPT 85379100305337Outpatient$333$216Payer Rates
PROTHROMBIN TIMECPT 85610 (QW)100305187Outpatient$123$80Payer Rates
PROTHROMBIN TIMECPT 85610 (QW)10030522Outpatient$126$82Payer Rates
PROTHROMBIN TIMECPT 85610 (QW)100305538Outpatient$114$74Payer Rates
RBC SED RATE AUTOMATEDCPT 85652100305561Outpatient$127$83Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 85730100305539Outpatient$125$81Payer Rates
C-REACTIVE PROTEINCPT 86140100302536Outpatient$125$81Payer Rates
MYCOPLASMA ANTIBODYCPT 8673810030264Outpatient$90$59Payer Rates
RBC ANTIBODY SCREENCPT 868501003021346Outpatient$197$128Payer Rates
BLOOD TYPING SEROLOGIC ABOCPT 86900EX1003021370Outpatient$165$107Payer Rates
BLOOD TYPING SEROLOGIC RH(D)CPT 86901EX1003021360Outpatient$112$73Payer Rates
COMPATIBILITY TEST ELECTRICCPT 869231003021382Outpatient$382$248Payer Rates
BLOOD CULTURE FOR BACTERIACPT 87040100306323Outpatient$90$59Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 87070100306333Outpatient$428$278Payer Rates
CULTURE OTHR SPECIMN AEROBICCPT 87070100306633Outpatient$408$265Payer Rates
CULTR BACTERIA EXCEPT BLOODCPT 87075100306118Outpatient$405$263Payer Rates
URINE BACTERIA CULTURECPT 87088100306735Outpatient$84$55Payer Rates
MICROBE SUSCEPTIBLE MICCPT 87186100306146Outpatient$83$54Payer Rates
SMEAR GRAM STAINCPT 872051003061354Outpatient$160$104Payer Rates
LEGION PNEUMOPHILIA AG IFCPT 87278100306218Outpatient$50$33Payer Rates
HEPATITIS B SURFACE AG IACPT 87340100306429Outpatient$296$192Payer Rates
INFLUENZA A/B EACH AG IACPT 87400100306740Outpatient$261$170Payer Rates
RESP SYNCYTIAL VIRUS AG IACPT 87420100306549Outpatient$112$73Payer Rates
SARSCOV CORONAVIRUS AG IACPT 87426 (QW)1003021381Outpatient$58$38Payer Rates
STAPH A DNA AMP PROBECPT 87640EX100306944Outpatient$329$214Payer Rates
MR-STAPH DNA AMP PROBECPT 87641EX100306943Outpatient$329$214Payer Rates
STREP A DNA AMP PROBECPT 87651 (QW)1003061357Outpatient$147$96Payer Rates
AGENT NOS ASSAY W/OPTICCPT 87899 (QW)100306214Outpatient$85$55Payer Rates
TISSUE EXAM BY PATHOLOGISTCPT 88304100310657Outpatient$107$70Payer Rates
TISSUE EXAM BY PATHOLOGISTCPT 88305100310658Outpatient$147$96Payer Rates
Language Pathology
SPEECH/HEARING THERAPYCPT 92507 (GN)752440206Outpatient$336$218Payer Rates
ORAL FUNCTION THERAPYCPT 92526 (GN)742440212Outpatient$411$267Payer Rates
EVALUATE SWALLOWING FUNCTIONCPT 92610 (GN)742440200Outpatient$281$183Payer Rates
MRI
MRI BRAIN STEM W/O DYECPT 7055112761133Outpatient$3,245$2,109Payer Rates
MRI BRAIN STEM W/O & W/DYECPT 7055312761135Outpatient$4,326$2,812Payer Rates
MRI NECK SPINE W/O DYECPT 721411276123Outpatient$3,245$2,109Payer Rates
MRI LUMBAR SPINE W/O DYECPT 721481276129Outpatient$3,245$2,109Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (RT)12761461Outpatient$3,245$2,109Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (LT)12761462Outpatient$3,245$2,109Payer Rates
MRI JNT OF LWR EXTRE W/O DYECPT 73721 (50)12761467Outpatient$4,326$2,812Payer Rates
Other Procedures and Observation
DEB SUBQ TISSUE 20 SQ CM/<CPT 11042761761137Outpatient$339$220Payer Rates
APPLY MULTLAY COMPRS LWR LEGCPT 29581761761292Outpatient$361$235Payer Rates
COLLECT BLOOD FROM PICCCPT 365924176113Outpatient$234$152Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 99203761761119Outpatient$345$224Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 99204761761120Outpatient$571$371Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 99205761761121Outpatient$820$533Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 99205 (25)761761126Outpatient$820$533Payer Rates
OFFICE O/P EST MOD 30-39 MINCPT 99214761761130Outpatient$1,751$1,138Payer Rates
OFFICE O/P EST HI 40-54 MINCPT 99215761761131Outpatient$2,513$1,633Payer Rates
Other Therapeutic
CARDIAC REHAB/MONITORCPT 937987639432Outpatient$297$193Payer Rates
MEDICAL NUTRITION INDIV INCPT 9780239423Outpatient$126$82Payer Rates
MED NUTRITION INDIV SUBSEQCPT 9780339424Outpatient$202$131Payer Rates
RBC LEUKOCYTES REDUCEDHCPCS P901610038114Outpatient$1,054$685Payer Rates
Psychiatric
PSYTX W PT 45 MINUTESCPT 908348129143Outpatient$209$136Payer Rates
PSYTX W PT 60 MINUTESCPT 908378129419Outpatient$525$341Payer Rates
FAMILY PSYTX W/PT 50 MINCPT 908478129167Outpatient$749$487Payer Rates
GROUP PSYCHOTHERAPYCPT 908538129154Outpatient$386$251Payer Rates
GROUP PSYCHOTHERAPYCPT 908538129155Outpatient$386$251Payer Rates
Pulmonary Function
MEASURE BLOOD OXYGEN LEVELCPT 9476020246038Outpatient$94$61Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 9476120246039Outpatient$204$133Payer Rates
MEASURE BLOOD OXYGEN LEVELCPT 9476220246037Outpatient$1,002$651Payer Rates
Radiology
X-RAY EXAM CHEST 1 VIEWCPT 7104512032433Outpatient$410$267Payer Rates
X-RAY EXAM CHEST 1 VIEWCPT 7104512032434Outpatient$422$274Payer Rates
X-RAY EXAM CHEST 2 VIEWSCPT 7104612032435Outpatient$548$356Payer Rates
X-RAY EXAM L-S SPINE 2/3 VWSCPT 72100120320133Outpatient$615$400Payer Rates
X-RAY EXAM L-2 SPINE 4/>VWSCPT 72110120320136Outpatient$829$539Payer Rates
X-RAY EXAM ABDOMEN 1 VIEWCPT 740181203208Outpatient$390$254Payer Rates
DXA BONE DENSITY AXIALCPT 770801263201Outpatient$686$446Payer Rates
Respiratory
WITHDRAWAL OF ARTERIAL BLOODCPT 3660020241012Outpatient$88$57Payer Rates
VENT MGMT INPAT SUBQ DAYCPT 94003202410102Outpatient$1,338$870Payer Rates
VENT MGMT INPAT SUBQ DAYCPT 9400320241052Outpatient$1,338$870Payer Rates
AIRWAY INHALATION TREATMENTCPT 94640 (76)202410109Outpatient$192$125Payer Rates
AIRWAY INHALATION TREATMENTCPT 9464020241059Outpatient$192$125Payer Rates
AIRWAY INHALATION TREATMENTCPT 9464020241092Outpatient$192$125Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 992037634105Outpatient$345$224Payer Rates
BEHAV CHNG SMOKING 3-10 MINCPT 9940620241055Outpatient$42$27Payer Rates
HBOT, FULL BODY CHAMBER, 30MHCPCS G0277761413162Outpatient$994$646Payer Rates
Surgical Procedures
NJX INTERLAMINAR LMBR/SACCPT 623221937022Outpatient$1,287$837Payer Rates
Therapy
HOT OR COLD PACKS THERAPYCPT 97010 (GP)7504203Outpatient$99$64Payer Rates
HOT OR COLD PACKS THERAPYCPT 97010 (GP)75042035Outpatient$99$64Payer Rates
HOT OR COLD PACKS THERAPYCPT 97010 (GO)751430158Outpatient$104$68Payer Rates
HOT OR COLD PACKS THERAPYCPT 97010 (GO)751430159Outpatient$104$68Payer Rates
MECHANICAL TRACTION THERAPYCPT 97012 (GP)75042036Outpatient$138$90Payer Rates
ELECTRIC STIMULATION THERAPYCPT 97014 (GP)75042068Outpatient$115$75Payer Rates
VASOPNEUMATIC DEVICE THERAPYCPT 97016 (GP)75042037Outpatient$253$164Payer Rates
VASOPNEUMATIC DEVICE THERAPYCPT 97016 (GO)751430197Outpatient$265$172Payer Rates
PARAFFIN BATH THERAPYCPT 97018 (GO)751430157Outpatient$102$66Payer Rates
ULTRASOUND THERAPYCPT 97035 (GP)75042027Outpatient$138$90Payer Rates
ULTRASOUND THERAPYCPT 97035 (GO)751430164Outpatient$142$92Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GP)74042029Outpatient$203$132Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GO)741430154Outpatient$199$129Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GO)741430182Outpatient$209$136Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GP)75042029Outpatient$203$132Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GO)751430154Outpatient$199$129Payer Rates
THERAPEUTIC EXERCISESCPT 97110 (GO)751430182Outpatient$199$129Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GP)75042032Outpatient$192$125Payer Rates
NEUROMUSCULAR REEDUCATIONCPT 97112 (GO)751430174Outpatient$196$127Payer Rates
AQUATIC THERAPY/EXERCISESCPT 97113 (GP)75042046Outpatient$232$151Payer Rates
GAIT TRAINING THERAPYCPT 97116 (GP)74042033Outpatient$111$72Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GP)75042022Outpatient$153$99Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GO)751430167Outpatient$149$97Payer Rates
MANUAL THERAPY 1/> REGIONSCPT 97140 (GO)751430169Outpatient$158$103Payer Rates
GROUP THERAPEUTIC PROCEDURESCPT 97150 (GP)75042323Outpatient$276$179Payer Rates
PT EVAL LOW COMPLEX 20 MINCPT 97161 (GP)7504241Outpatient$411$267Payer Rates
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)7404242Outpatient$493$320Payer Rates
PT EVAL MOD COMPLEX 30 MINCPT 97162 (GP)7504242Outpatient$493$320Payer Rates
PT RE-EVAL EST PLAN CARECPT 97164 (GP)75042434Outpatient$218$142Payer Rates
OT EVAL LOW COMPLEX 30 MINCPT 97165 (GO)74143486Outpatient$391$254Payer Rates
OT EVAL LOW COMPLEX 30 MINCPT 97165 (GO)75143486Outpatient$391$254Payer Rates
OT EVAL MOD COMPLEX 45 MINCPT 97166 (GO)74143487Outpatient$484$315Payer Rates
OT EVAL MOD COMPLEX 45 MINCPT 97166 (GO)75143487Outpatient$484$315Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)74042024Outpatient$146$95Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GO)741430168Outpatient$154$100Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GP)75042024Outpatient$146$95Payer Rates
THERAPEUTIC ACTIVITIESCPT 97530 (GO)751430168Outpatient$154$100Payer Rates
SELF CARE MNGMENT TRAININGCPT 97535 (GO)741430171Outpatient$198$129Payer Rates
SELF CARE MNGMENT TRAININGCPT 97535 (GO)751430172Outpatient$198$129Payer Rates
Uncategorized
REMOVAL OF BREAST LESIONCPT 19120WSXINT19120Outpatient$1,252$814Payer Rates
SHO ARTHRS SRG DECOMPRESSIONCPT 29826WSXMSC29826Outpatient$444$289Payer Rates
KNEE ARTHROSCOPY/SURGERYCPT 29881WSXMSC29881Outpatient$1,367$889Payer Rates
REMOVE TONSILS AND ADENOIDSCPT 42820WSXDIG42820Outpatient$732$476Payer Rates
EGD DIAGNOSTIC BRUSH WASHCPT 43235WSXDIG43235Outpatient$674$438Payer Rates
EGD BIOPSY SINGLE/MULTIPLECPT 43239WSXDIG43239Outpatient$903$587Payer Rates
DIAGNOSTIC COLONOSCOPYCPT 45378WSXDIG45378Outpatient$812$528Payer Rates
COLONOSCOPY AND BIOPSYCPT 45380WSXDIG45380Outpatient$1,044$679Payer Rates
COLONOSCOPY W/LESION REMOVALCPT 45385WSXDIG45385Outpatient$1,095$712Payer Rates
COLONOSCOPY W/ENDOSCOPE USCPT 45391WSXDIG45391Outpatient$667$434Payer Rates
LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562WSXDIG47562Outpatient$1,661$1,080Payer Rates
PRP I/HERN INIT REDUC >5 YRCPT 49505WSXDIG49505Outpatient$1,314$854Payer Rates
BIOPSY OF PROSTATECPT 55700WSXMGN55700Outpatient$631$410Payer Rates
LAPARO RADICAL PROSTATECTOMYCPT 55866WSXMGN55866Outpatient$3,699$2,404Payer Rates
OBSTETRICAL CARECPT 59400WSXFGN59400Outpatient$5,264$3,422Payer Rates
CESAREAN DELIVERYCPT 59510WSXFGN59510Outpatient$5,824$3,786Payer Rates
VBAC DELIVERYCPT 59610WSXFGN59610Outpatient$5,515$3,585Payer Rates
NJX INTERLAMINAR LMBR/SACCPT 62323WSXNRV62323Outpatient$241$157Payer Rates
NJX AA&/STRD TFRM EPI L/S 1CPT 64483WSXNRV64483Outpatient$572$372Payer Rates
AFTER CATARACT LASER SURGERYCPT 66821WSXEYE66821Outpatient$854$555Payer Rates
XCAPSL CTRC RMVL W/O ECPCPT 66984WSXEYE66984Outpatient$1,616$1,050Payer Rates
METABOLIC PANEL TOTAL CACPT 80048 (QW)WLAB80048Outpatient$21$14Payer Rates
COMPREHEN METABOLIC PANELCPT 80053 (QW)WLAB80053Outpatient$20$13Payer Rates
LIPID PANELCPT 80061 (QW)WLAB80061Outpatient$20$13Payer Rates
URINALYSIS AUTO W/SCOPECPT 81001WLAB81001Outpatient$8$5Payer Rates
URINALYSIS NONAUTO W/O SCOPECPT 81002 (QW)WLAB81002Outpatient$9$6Payer Rates
URINALYSIS AUTO W/O SCOPECPT 81003 (QW)WLAB81003Outpatient$20$13Payer Rates
URINE PREGNANCY TESTCPT 81025 (QW)WLAB81025Outpatient$22$14Payer Rates
GLYCOSYLATED HEMOGLOBIN TESTCPT 83036 (QW)WLAB83036Outpatient$25$16Payer Rates
ASSAY OF PSA TOTALCPT 84153WLAB84153Outpatient$46$30Payer Rates
ASSAY THYROID STIM HORMONECPT 84443 (QW)WLAB84443Outpatient$42$27Payer Rates
COMPLETE CBC W/AUTO DIFF WBCCPT 85025 (QW)WLAB85025Outpatient$22$14Payer Rates
COMPLETE CBC AUTOMATEDCPT 85027WLAB85027Outpatient$16$10Payer Rates
PROTHROMBIN TIMECPT 85610WLAB85610Outpatient$11$7Payer Rates
THROMBOPLASTIN TIME PARTIALCPT 85730WLAB85730Outpatient$15$10Payer Rates
SARSCOV CORONAVIRUS AG IACPT 87426 (QW)WLAB87426Outpatient$75$49Payer Rates
INFLUENZA ASSAY W/OPTICCPT 87804 (QW)WLAB87804Outpatient$52$34Payer Rates
STREP A ASSAY W/OPTICCPT 87880 (QW)WLAB87880Outpatient$41$27Payer Rates
IM ADMIN 1ST/ONLY COMPONENTCPT 90460WVACA90460Outpatient$42$27Payer Rates
IM ADMIN 1ST/ONLY COMPONENTCPT 90460WVACA904601Outpatient$42$27Payer Rates
IM ADMIN EACH ADDL COMPONENTCPT 90461WVACA90461Outpatient$32$21Payer Rates
IMMUNIZATION ADMINCPT 904719177134Outpatient$112$73Payer Rates
PSYCH DIAGNOSTIC EVALUATIONCPT 90791WMED90791Outpatient$150$98Payer Rates
PSYTX W PT 30 MINUTESCPT 90832WTRT90832Outpatient$75$49Payer Rates
PSYTX W PT 30 MINUTESCPT 90832 (95)WTRTTH90832Outpatient$75$49Payer Rates
PSYTX W PT 45 MINUTESCPT 90834WTRT90834Outpatient$100$65Payer Rates
PSYTX W PT 45 MINUTESCPT 90834 (95)WTRTTH90834Outpatient$100$65Payer Rates
PSYTX W PT 60 MINUTESCPT 90837WTRT90837Outpatient$120$78Payer Rates
PSYTX W PT 60 MINUTESCPT 90837 (95)WTRTTH90837Outpatient$120$78Payer Rates
FAMILY PSYTX W/O PT 50 MINCPT 90846 (95)WMEDTH90846Outpatient$100$65Payer Rates
FAMILY PSYTX W/PT 50 MINCPT 90847WMED90847Outpatient$100$65Payer Rates
FAMILY PSYTX W/PT 50 MINCPT 90847 (95)WMEDTH90847Outpatient$100$65Payer Rates
GROUP PSYCHOTHERAPYCPT 90853WMED90853Outpatient$68$44Payer Rates
ELECTROCARDIOGRAM COMPLETECPT 93000WMED93000Outpatient$43$28Payer Rates
DEVELOPMENTAL SCREEN W/SCORECPT 96110WMED96110Outpatient$158$103Payer Rates
BRIEF EMOTIONAL/BEHAV ASSMTCPT 96127WTRT96127Outpatient$12$8Payer Rates
PT-FOCUSED HLTH RISK ASSMTCPT 96160WMED96160Outpatient$8$5Payer Rates
THER/PROPH/DIAG INJ SC/IMCPT 96372WMED96372Outpatient$42$27Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 99203 (95)WEM992031Outpatient$271$176Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 99203WEMFP99203Outpatient$271$176Payer Rates
OFFICE O/P NEW LOW 30-44 MINCPT 99203WEMSP99203Outpatient$271$176Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 992047635103Outpatient$411$267Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 99204 (95)WEM992041Outpatient$411$267Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 99204WEMFP99204Outpatient$411$267Payer Rates
OFFICE O/P NEW MOD 45-59 MINCPT 99204WEMSP99204Outpatient$411$267Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 992057635104Outpatient$517$336Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 99205WEMFP99205Outpatient$517$336Payer Rates
OFFICE O/P NEW HI 60-74 MINCPT 99205WEMSP99205Outpatient$517$336Payer Rates
OFFICE O/P EST SF 10-19 MINCPT 99212WEMSP99212Outpatient$113$73Payer Rates
OFFICE O/P EST LOW 20-29 MINCPT 99213WEMSP99213Outpatient$186$121Payer Rates
OFFICE O/P EST MOD 30-39 MINCPT 99214WEMFP99214Outpatient$273$177Payer Rates
OFFICE O/P EST MOD 30-39 MINCPT 99214WEMSP99214Outpatient$273$177Payer Rates
OFFICE O/P EST HI 40-54 MINCPT 99215WEMSP99215Outpatient$365$237Payer Rates
SUBSEQUENT HOSPITAL CARECPT 99232WEM99232Outpatient$183$119Payer Rates
OFFICE CONSULTATIONCPT 99243WEM99243Outpatient$247$161Payer Rates
OFFICE CONSULTATIONCPT 99244WEM99244Outpatient$272$177Payer Rates
PREV VISIT NEW AGE 18-39CPT 99385WEM99385Outpatient$698$454Payer Rates
PREV VISIT NEW AGE 40-64CPT 99386WEM99386Outpatient$725$471Payer Rates
PER PM REEVAL EST PAT INFANTCPT 99391WEM99391Outpatient$407$265Payer Rates
PREV VISIT EST AGE 1-4CPT 99392WEM99392Outpatient$446$290Payer Rates
PREV VISIT EST AGE 40-64CPT 99396WEM99396Outpatient$603$392Payer Rates
TELEHEALTH FACILITY FEEHCPCS Q30144778025Outpatient$211$137Payer Rates