In compliance with the Hospital Pricing Transparency Rule, we have developed a table that provides guidance to individuals who do not have insurance, an additional discount for veterans (we truly appreciate your sacrifice to our country), as well as the Minimum & Maximum Negotiated Charges that we have in place contractually with insurance providers.
For those of you without insurance, we do offer financial assistance programs based on Federal Poverty Guidelines that may assist you further within regards to services and balances that you may have and work with you.
|
ChargeCode Description |
Procedure Code |
Gross Rate Charges |
Cash Option (Same Day) |
Cash Option Veteran (Same Day) |
De-Identified Minimum Negotiated Charges |
De-Identified Maximum Negotiated Charges |
|
ABDOMEN, 2 VIEWS |
74019 |
281.00 |
224.80 |
210.75 |
59.52 |
269.76 |
|
ABDOMEN, GB, BILIA
RY
TREE SINGLE QUAD |
76705 |
476.00 |
380.80 |
357.00 |
191.58 |
456.96 |
|
ABDOMINAL AORTA
ULTRASOUND (AAA) |
76706 |
476.00 |
380.80 |
357.00 |
191.58 |
456.96 |
|
ACUTE CARE-(ISOLAT
ION) |
n-a |
1,250.00 |
1,000.00 |
937.50 |
1,062.50 |
1,200.00 |
|
ACUTE HEPATITIS PA
NEL |
80074 |
557.00 |
445.60 |
417.75 |
52.08 |
534.72 |
|
AFP
(ALPHA-FETOPROTEIN: SERUM) |
82105 |
139.00 |
111.20 |
104.25 |
45.88 |
133.44 |
|
ALBUMIN; SERUM |
82040 |
59.00 |
47.20 |
44.25 |
20.46 |
56.64 |
|
ALCOHOL, (ETOH) AN
SPEC BUT BREATH |
80320 |
550.00 |
440.00 |
412.50 |
45.88 |
528.00 |
|
ALCOHOL, (ETOH) AN
SPEC BUT BREATH |
80320 |
188.00 |
150.40 |
141.00 |
45.88 |
412.50 |
|
ALKALINE PHOSPHATA
SE |
84075 |
70.00 |
56.00 |
52.50 |
20.46 |
67.20 |
|
ALT (SGPT) ALANINE
AMINO |
84460 |
86.00 |
68.80 |
64.50 |
20.46 |
82.56 |
|
AMMONIA; BLOOD |
82140 |
128.00 |
102.40 |
96.00 |
45.88 |
122.88 |
|
AMYLASE; SERUM OR
URINE |
82150 |
99.00 |
79.20 |
74.25 |
20.46 |
95.04 |
|
ANA (ANTINUCLEAR
ANTIBODIES) |
86038 |
137.00 |
109.60 |
102.75 |
47.12 |
131.52 |
|
ANKLE; COMPLETE, M
IN.
3 VIEWS |
73610 |
220.00 |
176.00 |
165.00 |
59.52 |
211.20 |
|
ANTI-MITOCHONDRIAL
AB |
83516 |
117.00 |
93.60 |
87.75 |
47.12 |
112.32 |
|
ANTIB EHRILICHIA |
86666 |
31.30 |
25.04 |
23.48 |
23.16 |
51.84 |
|
ANTIBO PROTOZOA |
86753 |
31.31 |
25.05 |
23.48 |
23.17 |
51.84 |
|
ANTIBODY SCREEN,RB
C,EA
SERUM TECHNIQ |
86850 |
62.00 |
49.60 |
46.50 |
45.88 |
107.08 |
|
ANTIBODY; RUBEOLA |
86765 |
113.00 |
90.40 |
84.75 |
47.12 |
108.48 |
|
ANTIMICROSOMAL
ANTIBODY |
86376 |
139.00 |
111.20 |
104.25 |
47.12 |
133.44 |
|
ANTITHROMBIN
III,ANTIGEN ASSAY |
85301 |
84.25 |
67.40 |
63.19 |
24.18 |
80.88 |
|
APP OF MODALITY
VASOPNEUMATIC DEVICES |
90716 |
25.00 |
20.00 |
18.75 |
18.50 |
228.47 |
|
APPT, PARTIAL
(PTT);PLASMA OR WHOLE |
85730 |
70.00 |
56.00 |
52.50 |
24.18 |
67.20 |
|
AST (SGOT) |
84450 |
71.00 |
56.80 |
53.25 |
20.46 |
68.16 |
|
AUTO ANTIBODIES TO
SSA
& SSB |
86235 |
50.40 |
40.32 |
37.80 |
37.30 |
124.13 |
|
B.U.N. (UREA
NITROGEN); QUANTITATIVE |
84520 |
56.00 |
44.80 |
42.00 |
20.46 |
53.76 |
|
BARTONELLA |
86611 |
84.00 |
67.20 |
63.00 |
47.12 |
80.64 |
|
BASIC METABOLIC
PANEL(BUN,CREAT,GLUC |
80048 |
168.00 |
134.40 |
126.00 |
52.08 |
161.28 |
|
BETA hCG; QUALITATIVE |
84703 |
113.00 |
90.40 |
84.75 |
20.46 |
108.48 |
|
BETA hCG; QUANTITATIVE |
84702 |
142.00 |
113.60 |
106.50 |
47.12 |
136.32 |
|
BILIRUBIN; DIRECT |
82248 |
53.00 |
42.40 |
39.75 |
20.46 |
50.88 |
|
BILIRUBIN; TOTAL |
82247 |
69.00 |
55.20 |
51.75 |
20.46 |
66.24 |
|
BK-VIRUS(DETECTION
)POLYMERASE
CHAIN |
87798 |
240.00 |
192.00 |
180.00 |
68.82 |
230.40 |
|
BLOOD COUNT;
HEMOGLOBIN |
85018 |
23.00 |
18.40 |
17.25 |
17.02 |
36.15 |
|
BLOOD COUNT;
HEMOGRAM/PLATELET COUNT |
85027 |
88.00 |
70.40 |
66.00 |
32.86 |
84.48 |
|
BLOOD COUNT; MANUAL
DIFF. W/PLATELET |
85007 |
46.00 |
36.80 |
34.50 |
32.86 |
44.16 |
|
BLOOD COUNT; WBC
(WHITE BLOOD CELL) |
85048 |
58.00 |
46.40 |
43.50 |
32.86 |
55.68 |
|
BLOOD GASES; ABG
pH,pCO2,pO2,CO2,HCO |
82803 |
212.00 |
169.60 |
159.00 |
45.88 |
203.52 |
|
BLOOD LEAD |
83655 |
101.00 |
80.80 |
75.75 |
37.20 |
96.96 |
|
BLOOD SMEAR,
PERIPHERAL; INT. BY DR. |
85060 |
61.75 |
49.40 |
46.31 |
45.70 |
67.52 |
|
BLOOD TYPING; ABO
GROUP |
86900 |
48.00 |
38.40 |
36.00 |
35.52 |
107.08 |
|
BLOOD TYPING; RH(D
) |
86901 |
47.00 |
37.60 |
35.25 |
31.00 |
45.12 |
|
BNP-NATRIURETIC
PEPTIDE |
83880 |
230.00 |
184.00 |
172.50 |
102.92 |
220.80 |
|
BONE DENSITY ,DXA,
1OR
MORE SITES, |
77080 |
322.00 |
257.60 |
241.50 |
238.28 |
309.12 |
|
C DIFF AMPLIFIED P
ROBE |
87493 |
79.00 |
63.20 |
59.25 |
58.46 |
75.84 |
|
C DIFF AMPLIFIED P
ROBE |
87493 |
150.00 |
120.00 |
112.50 |
68.82 |
144.00 |
|
C-REACTIVE PROTEIN
|
86140 |
107.00 |
85.60 |
80.25 |
47.12 |
102.72 |
|
CALCIUM SERUM; TOT
AL |
82310 |
81.00 |
64.80 |
60.75 |
20.46 |
77.76 |
|
CALCIUM; IONIZED |
82330 |
84.90 |
67.92 |
63.68 |
45.88 |
81.50 |
|
CALCULUS (STONE) Q
UANT |
82365 |
40.00 |
32.00 |
30.00 |
29.60 |
50.47 |
|
CANALITH REPOSITIO
NING
PROCEDURE |
95992 |
93.75 |
75.00 |
70.31 |
69.38 |
150.04 |
|
CARBON
DIOXIDE(BICARBONATE -ECO 2 |
82374 |
63.00 |
50.40 |
47.25 |
20.46 |
60.48 |
|
CARDIOLIPIN
(PHOSPHOLIPID)ANTIBODY |
86147 |
162.00 |
129.60 |
121.50 |
96.72 |
155.52 |
|
CARDIOLOGY VISIT 2
MINUTES |
99214 |
188.00 |
150.40 |
141.00 |
139.12 |
180.48 |
|
CARDIOLOGY VISIT 1
MINUTES |
99213 |
128.00 |
102.40 |
96.00 |
94.72 |
122.88 |
|
CARDIOLOGY VISIT 4
MINUTES |
99215 |
253.00 |
202.40 |
189.75 |
187.22 |
242.88 |
|
CARDIOLOGY VISIT,
10
MINUTES |
99212 |
77.00 |
61.60 |
57.75 |
56.98 |
73.92 |
|
CARDIOLOGY VISIT,
NEW
20 MINUTES |
99202 |
131.00 |
104.80 |
98.25 |
96.94 |
125.76 |
|
CARDIOLOGY VISIT,
NEW
30 MINUTES |
99203 |
190.00 |
152.00 |
142.50 |
140.60 |
182.40 |
|
CARDIOLOGY VISIT,
NEW
45 MINUTES |
99204 |
288.00 |
230.40 |
216.00 |
213.12 |
276.48 |
|
CARDIOLOGY VISIT,
NEW
60 MINUTES |
99205 |
363.00 |
290.40 |
272.25 |
268.62 |
348.48 |
|
CBC W/ AUTO DIFF.
W/PLATELET COUNT |
85025 |
112.00 |
89.60 |
84.00 |
32.86 |
107.52 |
|
CELL COUNT, W/DIFF
MISC.BODY FLUIDS |
89051 |
60.65 |
48.52 |
45.49 |
44.88 |
67.52 |
|
CERVICAL SPINE; 2-
VIEWS |
72040 |
288.50 |
230.80 |
216.38 |
59.52 |
276.96 |
|
CHEST 2 VIEWS, FRO
NT
& LAT |
71046 |
195.00 |
156.00 |
146.25 |
59.52 |
187.20 |
|
CHEST PA W/RIBS MI
N 3
VIEWS |
71101 |
212.80 |
170.24 |
159.60 |
59.52 |
204.29 |
|
CHEST, SINGLE VIEW
|
71045 |
133.00 |
106.40 |
99.75 |
59.52 |
127.68 |
|
CHLAMYDIA TRACH
AMPLIFIED PROBE |
87491 |
130.00 |
104.00 |
97.50 |
68.82 |
124.80 |
|
CHLORIDE; BLOOD |
82435 |
59.00 |
47.20 |
44.25 |
20.46 |
56.64 |
|
CLAVICLE, COMPLETE
|
73000 |
231.00 |
184.80 |
173.25 |
59.52 |
221.76 |
|
CLOSTRIDIUM DIFFIC
ILE
TOXIN; ENZYME |
87324 |
171.00 |
136.80 |
128.25 |
31.00 |
164.16 |
|
CLOTTING FACTOR II
, PROTHROMBIN,
SPECIFI |
85210 |
150.00 |
120.00 |
112.50 |
24.18 |
144.00 |
|
CMP(GLUC,BUN,CREAT
,AST,ALP,TBIL,ALT, |
80053 |
232.00 |
185.60 |
174.00 |
52.08 |
222.72 |
|
COMPLEMENT;ANTIGEN
,EA
COMPONENT |
86160 |
60.64 |
48.51 |
45.48 |
44.87 |
58.21 |
|
CORTISOL; TOTAL |
82533 |
152.00 |
121.60 |
114.00 |
47.12 |
145.92 |
|
CPK (CREATINE
PHOSPHOKINASE); TOTAL |
82550 |
105.00 |
84.00 |
78.75 |
20.46 |
100.80 |
|
CPK MB FRACTION ON
LY |
82553 |
150.00 |
120.00 |
112.50 |
45.88 |
144.00 |
|
CREATININE; BLOOD |
82565 |
59.00 |
47.20 |
44.25 |
20.46 |
56.64 |
|
CREATININE; OTHER
SOURCE (URINE) |
82570 |
71.00 |
56.80 |
53.25 |
20.46 |
68.16 |
|
CROSSMATCH |
86922 |
234.00 |
187.20 |
175.50 |
97.34 |
224.64 |
|
CRYPTOSPORIDUM |
87328 |
113.00 |
90.40 |
84.75 |
31.00 |
108.48 |
|
CRYSTALS POLARIZAT
ION,
ALL BUT URINE |
89060 |
44.10 |
35.28 |
33.08 |
32.63 |
67.52 |
|
CT: ABD & PELV
IS
W/O CONTRAST |
74176 |
1,567.80 |
1,254.24 |
1,175.85 |
1,042.22 |
1,505.09 |
|
CT: ABD & PELV
IS
WITH CONTRAST |
74177 |
1,757.80 |
1,406.24 |
1,318.35 |
1,042.22 |
1,687.49 |
|
CT: HEAD OR BRAIN
WITHOUT CONTRAST |
70450 |
1,463.00 |
1,170.40 |
1,097.25 |
1,042.22 |
1,404.48 |
|
CT:CHEST WITH AND
WITHOUT CONTRAST |
71270 |
2,455.00 |
1,964.00 |
1,841.25 |
1,042.22 |
2,356.80 |
|
CULTURE
BACTERIA,EXCEPT BLOOD |
87075 |
153.00 |
122.40 |
114.75 |
31.00 |
146.88 |
|
CULTURE, BACTERIAL
BLOOD |
87040 |
172.00 |
137.60 |
129.00 |
31.00 |
165.12 |
|
CULTURE, BACTERIAL
FECES (STOOL) |
87045 |
139.00 |
111.20 |
104.25 |
31.00 |
133.44 |
|
CULTURE, BACTERIAL
ID, URINE |
87088 |
73.00 |
58.40 |
54.75 |
31.00 |
70.08 |
|
CULTURE, BACTERIAL
URINE-COLONY CNT |
87086 |
113.00 |
90.40 |
84.75 |
31.00 |
108.48 |
|
CULTURE, IMMUNOLOG
IC
METHOD |
87147 |
164.00 |
131.20 |
123.00 |
31.00 |
157.44 |
|
CULTURE,FUNGI;OTHE
SOURCE BUT BLOOD |
87102 |
233.00 |
186.40 |
174.75 |
31.00 |
223.68 |
|
CULTURE,OTHER SOUR
CE
EXCEPT URINE/BLD/S |
87070 |
132.00 |
105.60 |
99.00 |
31.00 |
126.72 |
|
CULTURE; ID, AEROB
IC,
ORGANISM ID |
87077 |
75.00 |
60.00 |
56.25 |
31.00 |
72.00 |
|
CYCLIC CITRULLINAT
ED
PEPTIDE, ANTIBODY |
86200 |
225.00 |
180.00 |
168.75 |
47.12 |
216.00 |
|
CYTOMEGALOVIRUS |
86644 |
143.00 |
114.40 |
107.25 |
47.12 |
137.28 |
|
DIGOXIN |
80162 |
111.00 |
88.80 |
83.25 |
49.60 |
106.56 |
|
DIHYDROXVITAMIN D
1.25 |
82652 |
131.40 |
105.12 |
98.55 |
97.24 |
126.14 |
|
DILANTIN (PHENYTOI
N);
TOTAL |
80185 |
131.00 |
104.80 |
98.25 |
49.60 |
125.76 |
|
DNA ANTIBODY NATIV
E /2
STRANDED |
86225 |
26.25 |
21.00 |
19.69 |
19.43 |
51.84 |
|
DRUG SCR QUAL MLT
DRUG
CLASSES |
80305 |
169.00 |
135.20 |
126.75 |
45.88 |
162.24 |
|
DRUG SCR QUAN
LEVETIRACETAM |
80177 |
85.00 |
68.00 |
63.75 |
49.60 |
81.60 |
|
DRUG SCREENING, SI
NGLE |
80307 |
290.00 |
232.00 |
217.50 |
102.92 |
278.40 |
|
DRUG TEST, DEFINIT
IVE,
1-7 DRUG CLASSES |
G0480 |
550.00 |
440.00 |
412.50 |
102.92 |
528.00 |
|
DRUG TEST, DEFINIT
IVE,
1-7 DRUG CLASSES |
G0480 |
146.25 |
117.00 |
109.69 |
102.92 |
467.50 |
|
DRUG/SUBST DEF
QUAL/QUANT NOS 1-3 |
80375 |
131.00 |
104.80 |
98.25 |
45.88 |
125.76 |
|
DUPLEX CAROTID,
COMPLETE BILATERAL |
93880 |
888.60 |
710.88 |
666.45 |
191.58 |
853.06 |
|
EBV VCA IgG/IgM |
86663 |
89.25 |
71.40 |
66.94 |
47.12 |
85.68 |
|
ECHO TTHRC R-T 2D
-+M-MODE |
93306 |
1,518.49 |
1,214.79 |
1,138.87 |
415.40 |
1,457.75 |
|
EKG/ECG, 12 LEADS
OR
>; TRACING ONLY |
93005 |
141.00 |
112.80 |
105.75 |
83.08 |
135.36 |
|
ELBOW 3 VIEWS |
73080 |
152.15 |
121.72 |
114.11 |
59.52 |
146.06 |
|
ELBOW; 2 VIEWS |
73070 |
170.00 |
136.00 |
127.50 |
59.52 |
163.20 |
|
ELECTRICAL STIMULA
TION
(MANUAL) |
97032 |
165.00 |
132.00 |
123.75 |
110.98 |
158.40 |
|
ELECTRICAL STIMULA
TION
(UNATTENDED) |
97014 |
135.00 |
108.00 |
101.25 |
62.00 |
129.60 |
|
ELECTROLYTE PANEL
(NA,K,CL,CO2) |
80051 |
113.00 |
90.40 |
84.75 |
52.08 |
108.48 |
|
EPSTEIN-BARR ANTIB
ODY
VIRUS |
86665 |
117.00 |
93.60 |
87.75 |
47.12 |
112.32 |
|
ERYTHROPOIETIN |
82668 |
47.13 |
37.70 |
35.35 |
34.88 |
50.47 |
|
ESR (ERYTHROCYTE);
NON-AUTOMATED |
85651 |
85.00 |
68.00 |
63.75 |
32.86 |
81.60 |
|
ESTRONE |
82679 |
115.75 |
92.60 |
86.81 |
47.12 |
111.12 |
|
FACTOR V, LABILE
FACTOR |
85220 |
262.00 |
209.60 |
196.50 |
56.42 |
251.52 |
|
FACTOR V, LEIDEN |
81241 |
284.30 |
227.44 |
213.23 |
143.22 |
272.93 |
|
FEMUR, MIN 2 VIEWS
|
73552 |
229.00 |
183.20 |
171.75 |
59.52 |
219.84 |
|
FERRITIN, RIA |
82728 |
145.00 |
116.00 |
108.75 |
45.88 |
139.20 |
|
FIBRINOLYSINS/COAG
ULOPATHY
SCR I&R |
85390 |
45.00 |
36.00 |
33.75 |
24.18 |
43.20 |
|
FINGER(S), MIN. 2
VIEWS |
73140 |
164.00 |
131.20 |
123.00 |
59.52 |
157.44 |
|
FOLATE (FOLIC) ACI
D;
SERUM |
82746 |
144.00 |
115.20 |
108.00 |
45.88 |
138.24 |
|
FOOT; COMPLETE, MI
N. 3
VIEWS |
73630 |
187.00 |
149.60 |
140.25 |
59.52 |
179.52 |
|
FOREARM; INCL. 1
JOINT, 2 VIEWS |
73090 |
206.00 |
164.80 |
154.50 |
59.52 |
197.76 |
|
FSH (FOLLICLE
STIMULATING HORMONE) |
83001 |
148.00 |
118.40 |
111.00 |
47.12 |
142.08 |
|
GAIT TRAINING (15
MIN) |
97116 |
90.00 |
72.00 |
67.50 |
66.60 |
122.08 |
|
GAMMA
INTERFERON-PRODUCING T-CELLS |
86481 |
127.50 |
102.00 |
95.63 |
94.35 |
122.40 |
|
GAMMAGLOBULIN,IgA,
IgD,IgG,IgM |
82784 |
178.00 |
142.40 |
133.50 |
45.88 |
170.88 |
|
GGT GAMMA GT |
82977 |
71.00 |
56.80 |
53.25 |
20.46 |
68.16 |
|
GIARDIA ANTIGEN |
87329 |
124.00 |
99.20 |
93.00 |
31.00 |
119.04 |
|
GLUCOSE; QUANT. BL
OOD,
FBS 2H |
82947 |
46.00 |
36.80 |
34.50 |
20.46 |
44.16 |
|
GONADOTROPIN;
LUTEINIZING HORMONE |
83002 |
84.90 |
67.92 |
63.68 |
47.12 |
81.50 |
|
GONORRHOEAE AMPLIF
IED
PROBE |
87591 |
119.00 |
95.20 |
89.25 |
68.82 |
114.24 |
|
GRAM, PRIM WRIGHTS
& STOOL SMEARS |
87205 |
64.00 |
51.20 |
48.00 |
31.00 |
61.44 |
|
HAND; MIN. 3 VIEWS
|
73130 |
212.00 |
169.60 |
159.00 |
59.52 |
203.52 |
|
HCT |
85014 |
32.00 |
25.60 |
24.00 |
23.68 |
36.15 |
|
HELICOBACTOR PYLOR
I,
STOOL |
87338 |
75.00 |
60.00 |
56.25 |
31.00 |
72.00 |
|
HEMOGLOBIN; GLYCAT
ED |
83036 |
92.00 |
73.60 |
69.00 |
45.88 |
88.32 |
|
HEPATITIS B CORE
ANTIBODY; TOTAL |
86704 |
103.00 |
82.40 |
77.25 |
47.12 |
98.88 |
|
HEPATITIS B SURFACE
ANTIBODY (HBsAb) |
86706 |
108.00 |
86.40 |
81.00 |
47.12 |
103.68 |
|
HEPATITIS B SURFAC
ANTIGEN (HBsAg) |
87340 |
106.00 |
84.80 |
79.50 |
31.00 |
101.76 |
|
HEPATITIS C ANTIBO
DY |
86803 |
128.00 |
102.40 |
96.00 |
47.12 |
122.88 |
|
HEPATITIS C QUANT |
87522 |
773.00 |
618.40 |
579.75 |
68.82 |
742.08 |
|
HERPES SIMPLEX, TY
PE 1 |
86695 |
58.80 |
47.04 |
44.10 |
43.51 |
56.45 |
|
HERPES SIMPLEX, TY
PE 2 |
86696 |
30.30 |
24.24 |
22.73 |
22.42 |
51.84 |
|
HIP, COMPLETE 2-3
VIEWS |
73502 |
215.00 |
172.00 |
161.25 |
59.52 |
206.40 |
|
HIV-1/2 AG AND AB |
87389 |
157.50 |
126.00 |
118.13 |
31.00 |
151.20 |
|
HLA TYPING, A,B, O
R C,
SINGLE ANTIGEN |
86812 |
246.00 |
196.80 |
184.50 |
31.00 |
236.16 |
|
HOLTER MONITOR, EX
TRNL
ECG SCANNING |
93226 |
605.00 |
484.00 |
453.75 |
281.48 |
580.80 |
|
HOMOCYSTEINE LEVEL
|
83090 |
188.00 |
150.40 |
141.00 |
47.12 |
180.48 |
|
HUMERUS; INCL. 1
JOINT, MIN. 2 VIEWS |
73060 |
222.00 |
177.60 |
166.50 |
59.52 |
213.12 |
|
INFECTIOUS AGENT
DNA/RNA INFLUENZA 1ST 2 |
87502 |
121.50 |
97.20 |
91.13 |
68.82 |
116.64 |
|
INJ IMM FIRST
VACC/TOXIOD THRU 18YRS, |
90460 |
36.00 |
28.80 |
27.00 |
26.64 |
34.56 |
|
IONTOPHORESIS, EAC
H 15
MIN. |
97033 |
81.00 |
64.80 |
60.75 |
59.94 |
122.08 |
|
IRON BINDING CAPAC
ITY
(IBC) |
83550 |
103.00 |
82.40 |
77.25 |
45.88 |
98.88 |
|
IRON SERUM |
83540 |
73.00 |
58.40 |
54.75 |
20.46 |
70.08 |
|
IV INFURSION -
ADDITIONAL INFUSION, UP TO 1 HOUR |
96367 |
137.00 |
109.60 |
102.75 |
101.38 |
610.39 |
|
IV INFUSION - EA
ADDITIONAL HOUR |
96366 |
99.00 |
79.20 |
74.25 |
73.26 |
609.03 |
|
IV INFUSION (SPECI
FY
DRUG) UP TO 1 HR |
96365 |
231.00 |
184.80 |
173.25 |
170.94 |
610.39 |
|
KNEE; 1 OR 2 VIEWS
|
73560 |
159.00 |
127.20 |
119.25 |
59.52 |
152.64 |
|
KNEE; 3 VIEWS |
73562 |
257.00 |
205.60 |
192.75 |
59.52 |
246.72 |
|
KOH TISSUE EXAM FO
FUNGI |
87220 |
27.85 |
22.28 |
20.89 |
20.61 |
34.10 |
|
KUB, I VIEW
|
74018 |
182.00 |
145.60 |
136.50 |
59.52 |
174.72 |
|
LACOSAMIDE, ASSAY |
80235 |
200.00 |
160.00 |
150.00 |
49.60 |
192.00 |
|
LACTATE DEHYDROGEN
ASE
(LD), (LDH) |
83615 |
73.00 |
58.40 |
54.75 |
20.46 |
70.08 |
|
LACTATE, (LACTIC A
CID) |
83605 |
126.00 |
100.80 |
94.50 |
45.88 |
120.96 |
|
LAMOTRIGINE
|
80175 |
90.00 |
72.00 |
67.50 |
49.60 |
86.40 |
|
LIPASE |
83690 |
110.00 |
88.00 |
82.50 |
20.46 |
105.60 |
|
LIPID PANEL
82465,83718,84478 |
80061 |
144.00 |
115.20 |
108.00 |
52.08 |
138.24 |
|
LITHIUM |
80178 |
115.00 |
92.00 |
86.25 |
32.86 |
110.40 |
|
LIVER (HEPATIC)
FUNCTION PANEL |
80076 |
149.00 |
119.20 |
111.75 |
52.08 |
143.04 |
|
LONG TERM CARE
ROOM-SEMI PRIVATE |
n-a |
147.84 |
118.27 |
110.88 |
125.66 |
141.93 |
|
LONG TERM CARE-SHO
RT
STAY |
n-a |
225.00 |
180.00 |
168.75 |
191.25 |
216.00 |
|
LOWER LEG, TIB/FIB
; 2
VIEWS |
73590 |
215.00 |
172.00 |
161.25 |
59.52 |
206.40 |
|
LUMBAR SPINE; 2-3
VIEWS |
72100 |
266.00 |
212.80 |
199.50 |
59.52 |
255.36 |
|
LYME DISEASE SEROL
OGY
EVALUATION |
86618 |
147.00 |
117.60 |
110.25 |
47.12 |
141.12 |
|
MAGNESIUM |
83735 |
75.00 |
60.00 |
56.25 |
20.46 |
72.00 |
|
MAMMOGRAM, SCREENI
NG |
77067 |
255.00 |
204.00 |
191.25 |
188.70 |
244.80 |
|
MANDIBLE; LESS THA
N 4
VIEWS |
70100 |
290.00 |
232.00 |
217.50 |
59.52 |
278.40 |
|
MANUAL THERAPY
TECHNIQUES,EA.15 MIN. |
97140 |
122.00 |
97.60 |
91.50 |
90.28 |
150.04 |
|
METHYLENETETRAHYDR
OFOLATE
REDUCTASE |
81291 |
300.00 |
240.00 |
225.00 |
143.22 |
288.00 |
|
MICROALBUMIN-URINE
QUANTITATIVE |
82043 |
98.00 |
78.40 |
73.50 |
22.32 |
94.08 |
|
MONOSPOT |
86308 |
75.00 |
60.00 |
56.25 |
47.12 |
72.00 |
|
MRI: LUMBAR W/O
CONTRAST |
72148 |
1,155.00 |
924.00 |
866.25 |
854.70 |
1,108.80 |
|
MRI: UPPER EXT OTH
/THN
JT, W/WO CONTRAST |
73218 |
1,650.00 |
1,320.00 |
1,237.50 |
983.32 |
1,584.00 |
|
MRI:ANY JT LOWR EX
T |
73721 |
1,210.00 |
968.00 |
907.50 |
895.40 |
1,161.60 |
|
MRI:ANY JT UPPER E
XT |
73221 |
1,207.50 |
966.00 |
905.63 |
893.55 |
1,159.20 |
|
MRI:CERVICAL W/O
CONTRAST |
72141 |
1,155.00 |
924.00 |
866.25 |
854.70 |
1,108.80 |
|
MRI:THORACIC |
72146 |
1,155.00 |
924.00 |
866.25 |
854.70 |
1,108.80 |
|
MUMPS ANTIBODY/IgG
& IgM x (2) |
86735 |
120.00 |
96.00 |
90.00 |
47.12 |
115.20 |
|
NECK, SOFT TISSUE |
70360 |
222.00 |
177.60 |
166.50 |
59.52 |
213.12 |
|
NEUROMUSCULAR RE-E
D. |
97112 |
90.00 |
72.00 |
67.50 |
66.60 |
150.04 |
|
NOS ASSAY W/OPTIC
(SHIGA TOXIN 1) |
87899 |
91.00 |
72.80 |
68.25 |
31.00 |
87.36 |
|
OCCULT BLOOD,1-3,N
OT
SCREENING |
82272 |
24.25 |
19.40 |
18.19 |
17.95 |
23.28 |
|
OCCULT BLOOD; FECE
S,
1-3 SPECIMENS |
82270 |
27.00 |
21.60 |
20.25 |
19.98 |
25.92 |
|
ORBITS X-RAY |
70030 |
110.25 |
88.20 |
82.69 |
59.52 |
105.84 |
|
ORGANIC
ACID,SINGLE,QUANTITATIVE |
83921 |
240.00 |
192.00 |
180.00 |
45.88 |
230.40 |
|
OS CALCIS (CALCANE
US);
MIN. 2 VIEWS |
73650 |
176.00 |
140.80 |
132.00 |
59.52 |
168.96 |
|
OT EVAL HIGH COMP,
60
MINUTES |
97167 |
265.45 |
212.36 |
199.09 |
120.90 |
254.83 |
|
OT EVAL LOW COMP,
30
MINUTES |
97165 |
142.93 |
114.34 |
107.20 |
105.77 |
137.21 |
|
OT EVAL MOD COMP,
45
MINUTES |
97166 |
204.19 |
163.35 |
153.14 |
120.90 |
196.02 |
|
OVA PARASITS SMR P
RIM
CPLX SPEC STRAIN |
87209 |
47.78 |
38.22 |
35.84 |
31.00 |
45.87 |
|
PARATHYROID HORMON
(C-TERMINAL) |
83970 |
264.00 |
211.20 |
198.00 |
85.56 |
253.44 |
|
PELVIS; 1-2 VIEWS |
72170 |
196.00 |
156.80 |
147.00 |
59.52 |
188.16 |
|
PHENOBARBITAL |
80184 |
154.00 |
123.20 |
115.50 |
49.60 |
147.84 |
|
PHOSPHORUS INORGAN
IC;
SERUM |
84100 |
59.00 |
47.20 |
44.25 |
20.46 |
56.64 |
|
PLATELET COUNT |
85049 |
30.85 |
24.68 |
23.14 |
22.83 |
36.15 |
|
POLYSOM 6>YRS S
LEEP
4>ADDL PARAM ATTENDED |
95810 |
2,756.00 |
2,204.80 |
2,067.00 |
1,115.38 |
2,645.76 |
|
POLYSOM 6>YRS S
LEEP
W/CPAP 4>ADDL |
95811 |
3,032.00 |
2,425.60 |
2,274.00 |
1,115.38 |
2,910.72 |
|
POTASSIUM (K); SER
UM |
84132 |
58.00 |
46.40 |
43.50 |
20.46 |
55.68 |
|
PRE-ALBUMIN
|
84134 |
108.00 |
86.40 |
81.00 |
45.88 |
103.68 |
|
PROCALCITONIN (PCT
) |
84145 |
125.00 |
100.00 |
93.75 |
47.12 |
120.00 |
|
PROGESTRONE; SERUM
|
84144 |
148.00 |
118.40 |
111.00 |
47.12 |
142.08 |
|
PROLACTIN; SERUM |
84146 |
182.00 |
145.60 |
136.50 |
47.12 |
174.72 |
|
PROTEIN C, ACTIVIT
Y |
85303 |
303.00 |
242.40 |
227.25 |
24.18 |
290.88 |
|
PROTEIN S, FREE |
85306 |
368.00 |
294.40 |
276.00 |
24.18 |
353.28 |
|
PROTEIN-TOTAL |
84155 |
90.00 |
72.00 |
67.50 |
66.60 |
113.22 |
|
PROTEIN; ELECTROPH
ORESIS-(SERUM) |
84165 |
156.00 |
124.80 |
117.00 |
45.88 |
149.76 |
|
PROTHROMBIN TIME (
PT) |
85610 |
50.00 |
40.00 |
37.50 |
24.18 |
48.00 |
|
PROTIME SUBSTITUTI
ON,
PLASMA FRACTIONS |
85611 |
175.00 |
140.00 |
131.25 |
24.18 |
168.00 |
|
PSA SCREEN; TOTAL
(MEDICARE) |
G0103 |
131.00 |
104.80 |
98.25 |
45.88 |
125.76 |
|
PSA, FREE |
84154 |
185.00 |
148.00 |
138.75 |
45.88 |
177.60 |
|
PSA; TOTAL |
84153 |
131.00 |
104.80 |
98.25 |
45.88 |
125.76 |
|
PT EVAL HIGH COMP,
45
MIN |
97163 |
256.10 |
204.88 |
192.08 |
136.40 |
245.86 |
|
PT EVAL LOW COMP,
20
MIN |
97161 |
137.90 |
110.32 |
103.43 |
102.05 |
150.04 |
|
PT EVAL MOD COMP,
30
MIN |
97162 |
197.00 |
157.60 |
147.75 |
136.40 |
189.12 |
|
PT RE-EVAL EST PLA
CARE |
97164 |
99.00 |
79.20 |
74.25 |
73.26 |
150.04 |
|
PT THER/ACT/TRANSF
ER
(FUNCTIONAL)15 MN |
97530 |
90.00 |
72.00 |
67.50 |
66.60 |
150.04 |
|
QUANT. OF DRUG, NO
OTHER SPECIFICATI |
80299 |
183.00 |
146.40 |
137.25 |
49.60 |
175.68 |
|
QUANTITATIVE D-DIM
ER |
85379 |
141.00 |
112.80 |
105.75 |
24.18 |
135.36 |
|
QUANTITATIVE, NOT
OTHERWISE SPECIFIED |
83520 |
95.00 |
76.00 |
71.25 |
47.12 |
91.20 |
|
RA FACTOR (RHEUMAT
OID
ARTHRITIS)QUAL |
86430 |
62.00 |
49.60 |
46.50 |
45.88 |
59.52 |
|
RA TITER (RHEUMATO
ID
ARTHRITIS)QUANT |
86431 |
46.30 |
37.04 |
34.73 |
34.26 |
51.84 |
|
RED BLOOD CELL |
P9016 |
389.43 |
311.54 |
292.07 |
61.38 |
373.85 |
|
REHAB W/CONTINUOUS
ECG, PER SESSION |
93798 |
105.85 |
84.68 |
79.39 |
78.33 |
255.07 |
|
RENAL FUNCTION PAN
EL |
80069 |
190.00 |
152.00 |
142.50 |
52.08 |
182.40 |
|
RETICULOCYTE,
AUTOMATED |
85045 |
56.00 |
44.80 |
42.00 |
32.86 |
53.76 |
|
REVERSE T3 TEST |
84482 |
79.40 |
63.52 |
59.55 |
47.12 |
76.22 |
|
RHC:ANNUAL WELLNES
VISIT, INIT |
G0438 |
296.25 |
237.00 |
222.19 |
219.23 |
284.40 |
|
RHC:EST PATIENT HI
GH
LEVEL |
99215 |
210.00 |
168.00 |
157.50 |
155.40 |
201.60 |
|
RHC:EST PATIENT
LOW-MOD, 15 MIN |
99213 |
110.00 |
88.00 |
82.50 |
81.40 |
105.60 |
|
RHC:EST PATIENT MI
NOR
LEVEL, 10 MIN |
99212 |
65.00 |
52.00 |
48.75 |
48.10 |
62.40 |
|
RHC:EST PATIENT
MODERATE-HIGH, 25 MIN |
99214 |
160.00 |
128.00 |
120.00 |
118.40 |
153.60 |
|
RHC:NEW OFFICE OUT
PT,
HIGH, 60 MIN |
99205 |
290.00 |
232.00 |
217.50 |
214.60 |
278.40 |
|
RHC:NEW OFFICE OUT
PT,
MINOR-MOD, 20 MIN |
99202 |
88.00 |
70.40 |
66.00 |
65.12 |
84.48 |
|
RHC:NEW OFFICE OUT
PT,
MOD-HIGH 45 MIN |
99204 |
225.00 |
180.00 |
168.75 |
166.50 |
216.00 |
|
RHC:NEW OFFICE OUT
PT,
MOD-SEV 30 MIN |
99203 |
134.00 |
107.20 |
100.50 |
99.16 |
128.64 |
|
RHC:PREV VISIT, ES
T (1
THRU 4 YEARS) |
99392 |
135.00 |
108.00 |
101.25 |
99.90 |
129.60 |
|
RHC:PREV VISIT, ES
(12 THRU 17 YEARS) |
99394 |
145.00 |
116.00 |
108.75 |
107.30 |
139.20 |
|
RHC:PREV VISIT, ES
(18 THRU 39 YEARS) |
99395 |
150.00 |