Patient Price Information List

About Our Prices

Nashville General Hospital is committed to providing compassionate, comprehensive health care to all — regardless of whether or not they have health insurance. At the same time, it’s important to remember that all patients still have some degree of financial responsibility for the care they receive.

We want you to clearly understand the charges attached to your visit or hospital stay. So we’re pleased to provide access to our “Charge Master,” an ongoing, living document that outlines the charges for various hospital services and procedures. This document outlines the most common procedures, and is updated periodically to reflect changes in the costs we incur in performing those services. The prices listed include a 40% discount for patients without insurance.

Please search by the CPT4 code when searching for a price. If you cannot find a specific charge or price, or have a question about a charge, please email your question to: PricingQuestions@NashvilleHA.org

If you have questions about your bill, contact us at 615-341-4200 or billingquestions@nashvilleha.org.

Downloads and Tools

 

Evaluation and Management Services

Service Description CPT/DRG PRICE
CMS-70 1. Psychotherapy, 30 minutes (90832) 90832
Not provided by hospital
CMS-70 2. Psychotherapy, 45 minutes (90834) 90834
Not provided by hospital
CMS-70 3. Psychotherapy, 60 minutes (90837) 90837
Not provided by hospital
CMS-70 4. Family psychotherapy, not including patient, 50 minutes (90846) 90846
Not provided by hospital
CMS-70 5. Family psychotherapy, including patient, 50 min (90847) 90847
Not provided by hospital
CMS-70 6. Group psychotherapy (90853) 90853
Not provided by hospital
CMS-70 7. New patient office or other outpatient visit, typically 30 min (99203) 99203 $155.00
CMS-70 8. New patient office of other outpatient visit, typically 45 min (99204) 99204 $174.00
CMS-70 9. New patient office of other outpatient visit, typically 60 min (99205) 99205 $215.00
CMS-70 10. Patient office consultation, typically 40 min (99243) 99243 $222.00
CMS-70 11. Patient office consultation, typically 60 min (99244) 99244 $301.00
CMS-70 12. Initial new patient preventive medicine evaluation, for those ages 18 to 39 (99385) 99385 $249.00
CMS-70 13. Initial new patient preventive medicine evaluation, for those ages 40 to 64 (99386) 99386 $243.00

Laboratory and Pathology Services

Service Description CPT/DRG PRICE
CMS-70 14. Basic metabolic panel (80048) 80048 $228.00
CMS-70 15. Blood test, comprehensive group of blood chemicals (80053) 80053 $297.00
CMS-70 16. Obstetric blood test panel (80055) 80055 $336.00
CMS-70 17. Blood test, lipids (80061) 80061 $143.00
CMS-70 18. Kidney function panel test (80069) 80069 $210.00
CMS-70 19. Liver function blood test panel (80076) 80076 $179.00
CMS-70 20. Manual urinalysis test with examination using microscope (81000 or 81001) 81001 $93.00
CMS-70 21. Automated urinalysis test (81002 or 81003) 81003 $53.00
CMS-70 22. Prostate specific antigen (84153 or 84154) 84154 $91.00
CMS-70 23. Blood test, thyroid stimulating hormone (84443) 84443 $185.00
CMS-70 24. Complete blood cell count, with differential white blood cells, automated (85025) 85025 $129.00
CMS-70 25. Complete blood count, automated (85027) 85027 $109.00
CMS-70 26. Blood test, clotting time (85610) 85610 $147.00
CMS-70 27. Coagulation assessment blood test (85730) 85730 $99.00

Radiology Services

Service Description CPT/DRG PRICE
CMS-70 28. CT scan, head or brain, without contrast (70450) 70450 $1,839.00
CMS-70 29. MRI scan of brain before and after contrast (70553) 70553 $4,831.00
CMS-70 30. X-Ray, lower back, minimum four views (72110) 72110 $546.00
CMS-70 31. MRI scan of lower spinal canal (72148) 72148 $3,217.00
CMS-70 32. CT scan, pelvis, with contrast (72193) 72193 $2,341.00
CMS-70 33. MRI scan of leg joint (73721) 73721 $2,795.00
CMS-70 34. CT scan of abdomen and pelvis with contrast (74177) 74177 $3,543.00
CMS-70 35. Ultrasound of abdomen (76700) 76700 $1,057.00
CMS-70 36. Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus (76805) 76805 $894.00
CMS-70 37. Ultrasound pelvis through vagina (76830) 76830 $656.00
CMS-70 38. Mammography of one breast (77056) 77056 $229.00
CMS-70 39. Mammography of both breasts (77066) 77066 $318.00
CMS-70 40. Mammography, screening, bilateral (77067) 77067 $304.00

Medicine and Surgery Services

Service Description CPT/DRG PRICE
CMS-70 41. Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities (216) DRG-216 Not provided by hospital
CMS-70 42. Spinal fusion except cervical without major comorbid conditions or complications (460) DRG-460 Not provided by hospital
CMS-70 43. Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (470) DRG-470 Not provided by hospital
CMS-70 44. Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications (473) DRG-472 Not provided by hospital
CMS-70 45. Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications (743) DRG-743 $66,494.00
CMS-70 46. Removal of 1 or more breast growth, open procedure (19120) 19120 $5,395.00
CMS-70 47. Shaving of shoulder bone using an endoscope (29826) 29826 $3,654.00
CMS-70 48. Removal of one knee cartilage using an endoscope (29881) 29881 $9,017.00
CMS-70 49. Removal of tonsils and adenoid glands patient younger than age 12 (42820) 42820 Not provided by hospital
CMS-70 50. Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope (43235) 43235 $1,789.00
CMS-70 51. Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope (43239) 43239 $2,071.00
CMS-70 52. Diagnostic examination of large bowel using an endoscope (45378) 45378 $2,034.00
CMS-70 53. Biopsy of large bowel using an endoscope (45380) 45380 $2,628.00
CMS-70 54. Removal of polyps or growths of large bowel using an endoscope (45385) 45385 $2,260.00
CMS-70 55. Ultrasound examination of lower large bowel using an endoscope (45391) 45391 $3,477.00
CMS-70 56. Removal of gallbladder using an endoscope (47562) 47562 $11,216.00
CMS-70 57. Repair of groin hernia patient age 5 or older (49505) 49505 $9,979.00
CMS-70 58. Biopsy of prostate gland (55700) 55700 $2,874.00
CMS-70 59. Surgical removal of prostate and surrounding lymph nodes using an endoscope (55866) 55866 $24,576.00
CMS-70 60. Routine obstetric care for vaginal delivery, excluding pre-and post-delivery care (59400) 59400 or 59410 $7,900.00
CMS-70 61. Routine obstetric care for cesarean delivery, excluding pre-and post-delivery care (59510) 59510 $12,500.00
CMS-70 62. Routine obstetric care for vaginal delivery after prior cesarean delivery excluding pre-and post-delivery care (59610) 59610 $7,900.00
CMS-70 63. Injection of substance into spinal canal of lower back or sacrum using imaging guidance (62322 or 62323) 62323 $1,054.00
CMS-70 64. Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance (64483) 64483 $1,835.00
CMS-70 65. Removal of recurring cataract in lens capsule using laser (66821) 66821 $1,524.00
CMS-70 66. Removal of cataract with insertion of lens (66984) 66984 $6,549.00
CMS-70 67. Electrocardiogram, routine, with interpretation and report (93000)/ (93005) 93000/93005 $235.00
CMS-70 68. Insertion of catheter into left heart for diagnosis (93452) 93452 $8,278.00
CMS-70 69. Sleep study (95810) 95810 Not provided by hospital
CMS-70 70. Physical therapy, therapeutic exercise (97110) 97110 $169.00

 

Pharmacy

Service Description HCPCS NDC Units Charge
PHARMACY PENI G BENZ 1.2 MU//2 ML SYRG J0561 60793070102 12 ml $402.25
PHARMACY CEFTRIAXONE SOD 1 GRAM SOLR J J0696 00409733211 1 grm $20.00
PHARMACY MEDROXYPROG AC 150 MG/ 1ML INJ BIL J1050 59762453701 150 MG $376.75
PHARMACY DEXAMETH NA PHOS 10 MG/1ML IJ J1100 67457042300 8 ml $16.00
PHARMACY FOSAPREPITANT (EMEND) 150 MG VIAL J1453 143938401 150 MG $1,511.25
PHARMACY HEPARIN 100U/ML 5ML CLF INJ PF J1642 64253033335 50 U $19.75
PHARMACY HEPARIN NA (PORK) 5,000 UNIT/1ML J J1644 00641040037 30 $112.50
PHARMACY ENOXAPARIN SODIUM 40 MG/0.4 ml J J1650 16714001601 8 $288.00
PHARMACY IRON SUCROSE (VENOFER) 20 MG/ML 5 ML INJ J1756 517234010 200 MG $364.50
PHARMACY INSULIN REG HUMAN 100 UNITS/ML J1815 00169183311 20 UNITS $80.00
PHARMACY KETOROLAC TROM 60 MG/2 ML INJ J1885 00338007225 2 ml $38.25
PHARMACY LEVETIRACETAM INJ 500 MG/5 ML INJ J1953 409188602 100 MG $54.50
PHARMACY MEROPENEM 1000 MG SOLR INJ J2185 55150020830 100 MG $2,050.00
PHARMACY MICAFUNGIN(MYCAMINE) 100MG VIAL J2248 00469321110 400 MG $3,406.00
PHARMACY MORPHINE SULFATE 4 MG/ML 1ml inj J2270 00409189003 1 ml $19.75
PHARMACY ONDANSETRON 4mg/ 2ml inj J2405 00409475518 4 MG $27.75
PHARMACY PROPOFOL 10 MG/ML 20ml BOLUS J2704 00409469954 20 MG $35.75
PHARMACY NAROPIN(ROPIVACAINE)0.5%30ML VIAL J2795 55150019720 100 ML $104.50
PHARMACY FENTANYL CITRATE 10 MCG/ML IN NS 250(PF) J3010 06155311302 100 $326.00
PHARMACY VANCOMYCIN HCL 1,000 MG SOLR J J3370 63323028441 12 $228.00
PHARMACY POTASSIUM CL 10 MEQ/100 ML PGBK J3480 00338070948 20 $99.00
PHARMACY PREDNISONE 20 MG TAB J7512 00054001820 120 MG $18.00
PHARMACY OXALIPLATIN 100 MG SOLR INJ J9263 63323075020 400 MG $1,720.00
PHARMACY PERTUZUMAB(PERJETA)420MG/14ML J9306 50242014501 420 MG $13,189.75
PHARMACY EPOETIN DIALYSIS 10,000 UNITS/ML ESRD Q4081 59676031000 200 $1,934.50
PHARMACY IOHEXOL 9 MG IODINE/ML 500 ML ORAL SOLN Q9958 00407141509 500 ML $38.25
PHARMACY Iohexol 350mg/ml 100ml INJ Q9967 00407141387 100 ML $509.50

HCPCS

Service Description HCPCS NDC PRICE
IMAGING CT MAXILLOFACIAL W/O CONTRAST 70486   $1,890.00
IMAGING MRI BRAIN W/O CONTRAST 70551   $3,056.00
IMAGING X-RAY EXAM CHEST 1 VIEW 71045   $273.00
IMAGING X-RAY EXAM CHEST 2 VIEWS 71046   $348.00
IMAGING CT THORAX W/O CONT 71250   $2,144.00
IMAGING CT THORAX- W/CONT 71260   $2,519.00
IMAGING CTA CHEST (NONCORONARY) W/WO CONT 71275   $2,956.00
IMAGING SPINE, LUMBOSACRAL- 2 OR 3 VW 72100   $423.00
IMAGING CT CERVICAL SPINE W/O CONTRAST 72125   $2,384.00
IMAGING CT LUMBAR SPINE- W/O CONT 72131   $2,420.00
IMAGING SHOULDER-COMP ,2+VIEWS 73030   $325.00
IMAGING HAND,-3+ VIEWS 73130   $325.00
IMAGING KNEE, - COMP 4+ VIEWS 73564   $464.00
IMAGING ANKLE RT- COMP,3+ VIEWS 73610   $348.00
IMAGING FOOT,COMPLETE - 3+ VIEWS 73630   $347.00
IMAGING X-RAY EXAM ABDOMEN 1 VIEW 74018   $318.00
IMAGING ABD,ACUTE COMP W/1 VIEW CHEST 74022   $564.00
IMAGING CT TOTAL ABD W/CONT 74160   $2,624.00
IMAGING CT ABD/PEL WO/CONTRAST 74176   $2,515.00
IMAGING US ABDOMEN LIMITED STUDY 76705   $715.00
IMAGING US RENAL 76770   $720.00
IMAGING US OB LIMITED 1 OR > FETUSES 76815   $456.00
IMAGING US OB TRANSVAGINAL 76817   $720.00
IMAGING US PELVIC NONOBSTETRIC 76856   $786.00
IMAGING US EXTREM VENOUS DOPPLER BILAT 93970   $1,100.00
IMAGING US VENOUS DOPPLER UNILAT/LIMITED 93971   $937.00
IMAGING 0.9% Saline 500ml IV J7040 338004903 $64.00

 

Lab Services

Service Description HCPCS PRICE
LAB VENIPUNCTURE 36415 $25.00
LAB COMPREHENSIVE METABOLIC PANEL 80053 $297.00
LAB ACUTE HEPATITIS PANEL 80074 $378.00
LAB VANCOMYCIN 80202 $310.00
LAB DRUG SCREEN 13 DIFFERENT DRUGS 80306 $900.00
LAB ALCOHOL BLOOD (ETHYL) 80320 $235.00
LAB ACETOMENOPHEN 80329 $243.00
LAB URINE PREGNANCY TEST VISUAL/1 81025 $129.00
LAB ALBUMIN URINE MICROALBUMIN 82043 $77.00
LAB AMYLASE, SERUM 82150 $129.00
LAB BILIRUBIN TOTAL 82247 $59.00
LAB BILIRUBIN DIRECT 82248 $79.00
LAB CPK, TOTAL- SERUM 82550 $127.00
LAB CKMB FRACTION 82553 $179.00
LAB CREATININE, OTHER SOURCE 82570 $52.00
LAB VITAMIN B12 82607 $75.00
LAB VITAMIN D 25 OH 82652 $137.00
LAB FERRITIN 82728 $129.00
LAB FOLATE, SERUM 82746 $96.00
LAB GASES BLOOD PH PCO2 PO2 CO2 82803 $286.00
LAB HEMOGLOBIN A1C GLYCOHEMOGLOBIN 83036 $85.00
LAB IRON 83540 $87.00
LAB IRON BINDING CAPACITY 83550 $81.00
LAB LACTATE (LACTIC ACID) 83605 $159.00
LAB LACTATE DEHYDROGENASE (LD) 83615 $70.00
LAB LIPASE 83690 $146.00
LAB MAGNESIUM 83735 $99.00
LAB NATRIURETIC PEPTIDE 83880 $189.00
LAB PHOSPHORUS INORGANIC (PHOSPHATE) 84100 $47.00
LAB PROSTATIC SPECIFIC ANTIGEN 84153 $171.00
LAB THYROXINE FREE 84439 $169.00
LAB TROPONIN QUANTITATIVE 84484 $168.00
LAB PCV/HEMATOCRIT 85014 $55.00
LAB HEMOGLOBIN 85018 $60.00
LAB D-DIMER 85378 $161.00
LAB SEDIMENTATION RATE ERYTHROCYTE 85651 $53.00
LAB ALLG SPEC IGE CRUDE XTRC EA 86003 $1,680.00
LAB C-REACTIVE PROTEIN 86140 $79.00
LAB RPR (SYPHILLIS TEST QUALITATIVE) 86592 $70.00
LAB HIV 1 AND HIV 2 SINGLE ASSAY 86703 $134.00
LAB ANTIBODY SCREEN RBC EACH SERUM 86850 $226.00
LAB BLOOD TYPING ABO 86900 $226.00
LAB BLOOD TYPING RH (D) 86901 $222.00
LAB CROSSMATCH IMMEDIATE SPIN 86920 $603.00
LAB CULTURE, BLOOD 87040 $504.00
LAB CULTURE, BACTERIAL ANY OTHER 87070 $152.00
LAB AEROBIC ISOLATE IDENTIFICATION 87077 $196.00
LAB CULTURE, URINE 87086 $119.00
LAB SUSCEPTIB STUDIES ANTIMICRO AGT 87186 $218.00
LAB GRAM STAIN 87205 $49.00
LAB WET PREP 87210 $71.00
LAB HEP B SURFACE ANTIGEN (HBSAG) 87340 $167.00
LAB INFLUENZA ANTIGEN 87400 $126.00
LAB CHLAMYDIA TRACHOMATIS AMP TECH 87491 $169.00
LAB NEISSERIA GONORRHOEAE AMP TECH 87591 $129.00
LAB RAPID STREP A ANTIGEN 87880 $133.00
LAB 2019-nCoV Coronavirus, SARS-CoV-2/2019 CC-710752340 $95.00
LAB SARS-COV-2 COVID-19 ANTIBODY CC-710752347 $40.00
LAB RBCS LEUKOCYTE REDUCED EACH UNIT P9016 $1,581.00

Therapy Services

Service CHARGE DESCRIPTION - THERAPY CPT/HCPCS PRICE
Speech Therapy INDIV TREAT SPEECH LANG DIS SLP 92507 $225.00
Speech Therapy SPEECH THERAPY EVAL-FLUENCY 92521 $420.00
Speech Therapy SPEECH THERAPY EVAL-SPEECH 92522 $434.00
Speech Therapy SPEECH THERAPY EVAL-SPEECH&LANG 92523 $434.00
Speech Therapy BEHAV-QUAL ANALYSIS VOICE 92524 $434.00
Speech Therapy TREAT SWALLOWING/FEED DYSF SLP 92526 $273.00
Speech Therapy EVAL ORAL&PHARY SWALLOW DYSF SLP 92610 $428.00
Speech Therapy MOTION FLUOR EVAL CINE/VIDEO SLP 92611 $543.00
Respiratory Therapy SPIROMETRY 94010 $376.00
Respiratory Therapy BRONCHODIL RESPONSE SPIR PRE/POST 94060 $697.00
Respiratory Therapy INHALATION TX - OBSTR/SPUT INDUCT INIT 94640 $230.00
Respiratory Therapy AEROSOL/VAPOR INHALA PT DEMO/EVAL 94664 $229.00
Respiratory Therapy PULM FUNCT TST PLETHYSMOGRAPHY 94726 $353.00
Respiratory Therapy C02/MEMBANE DIFFUSE CAPACITY 94729 $347.00
Occupational Therapy E-STIM, MANUAL, EA 15 MIN, OT 97032 $120.00
Occupational Therapy IONTOPHORESIS EA 15 MIN OT 97033 $168.00
Occupational Therapy ULTRASOUND, EA 15 MIN, OT 97035 $113.00
Occupational Therapy NEUROMUSCULAR RE-ED, EA 15 MIN OT 97112 $153.00
Physical Therapy GAIT TRAINING, EA 15 MIN PT 97116 $126.00
Occupational Therapy MASSAGE, EA 15 MIN, OT 97124 $118.00
Occupational Therapy MANUAL TX (TRAC, DRAIN) EA 15M OT 97140 $131.00
Physical Therapy PT EVAL LOW COMPLEX 20 MIN 97161 $306.00
Physical Therapy PT EVAL MOD COMPLEX 30 MIN 97162 $358.00
Physical Therapy PT EVAL HIGH COMPLEX 45 MIN 97163 $400.00
Occupational Therapy OT EVAL LOW COMPLEX 30 MIN 97165 $317.00
Occupational Therapy OT EVAL MOD COMPLEX 45 MIN 97166 $369.00
Occupational Therapy OT EVAL HIGH COMPLEX 60 MIN 97167 $395.00
Occupational Therapy THER ACTIV ONE-ON-ONE EA 15MN OT 97530 $142.00
Occupational Therapy TRAINING ADL EACH 15 MIN 97535 $119.00
Occupational Therapy ORTHOTIC TRAINING, EA 15 MIN OT 97760 $182.00

Procedures

Service DESCRIPTION CPT/HCPCS PRICE
PROCEDURES FINE ASPIRATION BX W/CT GDN 1ST 10009 $2,400.00
PROCEDURES FINE NEEDLE ASPIRATION BX W/CT GDN EA A 10010 $1,034.00
PROCEDURES IRRIGATION AND DEBRIDEMENT EXTRIMITY 11010 $1,589.00
PROCEDURES EXCISIONAL BIOPSY OF BREAST MASS 19101 $3,254.00
PROCEDURES MANDIBLE FRACTURE CLOSED REDUCTION 21452 $13,494.00
PROCEDURES INJECTION SHOULDER ARTHROGRAPHY CT/MRI 23350 $702.00
PROCEDURES SHOULDER ARTHROSCOPY 23470 $15,657.00
PROCEDURES FINGER TRIGGER RELEASE 26055 $4,425.00
PROCEDURES REMOVAL OF HARDWARE 27704 $7,615.00
PROCEDURES OPEN TX BIMALLEOLAR ANKLE FX 27814 $12,640.00
PROCEDURES SHOULDER ROTATOR CUFF REPAIR 29827 $7,176.00
PROCEDURES NDSC WRST SURG W/RLS TRANSVRS CARL LIGM 29848 $6,084.00
PROCEDURES KNEE ARTHROSCOPY 29875 $5,215.00
PROCEDURES ENDO BRONCHIAL ULTRASOUND 31652 $5,524.00
PROCEDURES ENDO BRONCHIAL ULTRASOUND 31653 $6,524.00
PROCEDURES PORT PLACEMENT 36571 $4,420.00
PROCEDURES SDS - EGD WITH BAND LIGATION VARICES 43244 $5,040.00
PROCEDURES SDS - EGD W/ DIL GASTRIC OUTL FOR OBSTR 43245 $11,500.00
PROCEDURES SDS - EGD W/PEG TUBE PLACEMENT 43246 $5,300.00
PROCEDURES SDS - EGD HOT BX OR CAUTERY 43250 $4,400.00
PROCEDURES SDS - SIGMOIDOSCOPY FLEX DIAGNOSTIC 45330 $7,000.00
PROCEDURES SDS - COLON FLES HOT BX OR CAUTERY 45384 $3,297.00
PROCEDURES HEMORRHOIDECTOMY 46221 $1,141.00
PROCEDURES US GUIDANCE PARACENTESIS 49082 $1,115.00
PROCEDURES LAPAROSCOPIC INGUINAL HERNIA 49650 $17,596.00
PROCEDURES URETEROSCOPY WITH STONE MANIPULATION 52332 $7,105.00
PROCEDURES SDS - CYSTO W/URETEROSCOPY W/LITHOTRIPSY 52353 $11,800.00
PROCEDURES PROSTATE TURP 52601 $4,119.00
PROCEDURES COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERV 57460 $5,238.00
PROCEDURES COLPOSCOPY CERVIX VAG ELTRD CONIZATION 57461 $1,188.00
PROCEDURES CONIZATION CERVIX W/WO D&C RPR ELTRD EX 57522 $5,684.00
PROCEDURES SALPINGECTOMY LAPAROSCOPIC 58661 $12,768.00
PROCEDURES THYROID LOBECTOMY 60220 $16,663.00
PROCEDURES LUMBAR STEROID INJECTION 62270 $969.00
PROCEDURES NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE 64721 $6,207.00
PROCEDURES XCAPSL CTRC RMVL INSJ IO LENS PROSTH CP 66982 $7,460.00
PROCEDURES ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG 66983 $7,064.00
PROCEDURES CT GUIDED NEEDLE PLCMNT, S&I 77012 $2,190.00
PROCEDURES EXCISION OF SOFT TISSUE 88304 $155.00
PROCEDURES EXCISION OF SOFT TISSUE 88307 $350.00
PROCEDURES LEFT HEART CATHETERIZATION 93460 $13,642.00
PROCEDURES LAPAROTOMY EXPLORATORY, (BILLED AS IP) 49000 $35,000.00
PROCEDURES CYSTOSCOPY 52310 $2,449.00
PROCEDURES CYSTOURETHROSCOPE LITHOTRIPSY/ HOLMIUM 52353 $5,574.00
PROCEDURES LAPAROSCOPIC INCIS VENT UMBILICAL HERNIA 49587 $8,601.00

Clinics

Service Description CPT/HCPCS NDC PRICE
CLINICS OFC/OUTPT E&M NEW MINOR 10 MIN 99201   $117.00
CLINICS OFC/OUTPT E&M NEW LOW-MOD 20 MIN 99202   $145.00
CLINICS OFC/OUTPT E&M ESTAB 5 MIN 99211   $112.00
CLINICS OFC/OUTPT E&M ESTAB MINOR 10 99212   $135.00
CLINICS OFC/OUTPT E&M ESTAB LOW-MOD 15 99213   $145.00
CLINICS OFC/OUTPT E&M ESTAB MOD-HI 25 99214   $155.00
CLINICS OFC/OUTPT E&M ESTAB MOD-HI 40 99215   $165.00
CLINICS ENT - FINE NEEDLE ASPIRAT W/O IMAGING 10021   $425.00
CLINICS Podiatry - DEB SUBQ TISSUE 20 SQ CM/< 11042   $1,095.00
CLINICS Podiatry - PARING/CUT CORN/CALLUS 2-4 LESIO 11056   $279.00
CLINICS Podiatry - DEBRIDEMENT NAIL ANY METHOD 6/> 11721   $237.00
CLINICS Breast Health Center- BREAST CORE BX W/US (R or L side) 19083   $2,150.00
CLINICS ENT - LARYNGOSCOPY,FLEX FIBER DIAGNOST 31575   $915.00
CLINICS Urology - CYSTOURETHROSCOPY(SEP PROC) 52000   $2,187.00
CLINICS Urology - VASECTOMY,UNILAT/BILAT,W/POSTOP 55250   $2,251.00
CLINICS Ophthalmology - INTRA-VITREAL INJ OF AGENT LT 67028   $943.00
CLINICS Ophthalmology - PHOTOCO TX EXT RETINOPATHY 67228   $1,287.00
CLINICS ORC - PELVIS-1 OR 2 VIEWS 72170   $310.00
CLINICS Rheumatology - JOINTS - SACROILIAC < 3 VIEWS 72200   $229.00
CLINICS Rheumatology - ELBOW - 2 VIEWS (R or L Side) 73070   $307.00
CLINICS Rheumatology - WRIST -COMP,3+ VIEWS (R or L side) 73110   $348.00
CLINICS Rheumatology - KNEE - 1 OR 2 VIEWS (R or L side) 73560   $294.00
CLINICS Gastro Intestinal - GASTROINTESTINAL /X-RAY EXAM ABDOMEN 2 VIEWS 74019   $402.00
CLINICS Ophthalmology - CORNEAL PACHYMETRY UNILAT/BILAT 76514   $131.00
CLINICS Breast Health Center- US BREAST LIMITED, (R or L Side) 76642   $433.00
CLINICS ENT - PARATHYROID VISIT WITH IMAGING & LABS 78070   $2,150.00
CLINICS Gastro Intestinal - HEPATITIS A ANTIBODY 86708   $72.00
CLINICS Gastro Intestinal - GASTROINTESTINAL LAB TESTS 87507   $795.00
CLINICS Gastro Intestinal - HEP B VIRAL LOAD , HBV DNA 87517   $296.00
CLINICS Gastro Intestinal - HEPATITIS C GENOTYPE 87902   $501.00
CLINICS Gastro Intestinal - HEPATITIS B DRUG RESISTANCE PANEL 87912   $742.00
CLINICS Ophthalmology - COMPREH NEW OPHTHALM EXAM 92004   $295.00
CLINICS Ophthalmology - DETERMINATION, REFRACTIVE STATE 92015   $64.00
CLINICS Ophthalmology - GONIOSCOPY (SEP PROC) 92020   $159.00
CLINICS Ophthalmology - COMP SCAN (POSTERIOR) OPTICNERVE 92133   $145.00
CLINICS Ophthalmology - COMP SCAN (POSTERIOR) RETINA 92134   $145.00
CLINICS Ophthalmology - FUNDUS PHOTOGRAPHY W/INTERPRET 92250   $439.00
CLINICS Cardiology - EKG Tracing visit/test 93005   $1,300.00
CLINICS Podiatry - US ARTER STUDY EXT SGL LEV BILAT 93922   $606.00
CLINICS Podiatry - US DUPLX SCAN LW EXT ART COMP BIL 93925   $984.00
CLINICS Urology - CHEMO SC/IM HORMONAL 96402   $228.00
CLINICS Cardiology - CONT CARDIO RECORDING 2-21 DAYS 0296T   $590.00
CLINICS Cardiology - TECH SUPPORT 2-21DAY CONT MONITOR 0297T   $690.00
CLINICS Breast Health Center- MARKER ULTRASOUND BREAST BIOPSY SITE A4648   $316.00
CLINICS HYLAN G-F 20 48 MG/6 ML SYRINGE J7325   $4,247.00
CLINICS LEUPROLIDE 22.5MG(ELIGARD) SYR KIT J9217 62935022305 $4,521.75

Labor and Delivery

Service CHARGE DESCRIPTION  CPT/HCPCS CODE PRICE
Labor and Delivery NEWBORN SCREENING TEST 84030 $129.00
Labor and Delivery C-SECTION CC-607010001 $10,500.00
Labor and Delivery L & D PRIVATE/LABOR ROOM OBSTET CC-607010003 $1,730.77
Labor and Delivery VAGINAL DELIVERY CC-607013301 $6,000.00
Labor and Delivery RECOVERY CC-607013396 $896.70
Labor and Delivery NEWBORN NURSERY LEV 1 NORMAL CC-607110006 $1,910.00
Labor and Delivery PP PRIVATE OBSTETRICS CC-607311101 $2,895.52
Labor and Delivery BREAST PUMP CC-729012370 $205.28

Emergency Department

Service Description CPT/HCPCS NDC UNITS PRICE
ER ER L-1 Visit - (CPT 99281 = $261) 99281     $261.00
ER ER L-2 Visit - (CPT 99282 $273) 99282     $412.00
ER ER L-3 Visit - (CPT 99283 = $421) 99283     $1,150.00
ER ER L-4 Visit - (CPT 99284 = $577) 99284     $3,000.00
ER ER L-5 Visit - (CPT 99285 = $750) 99285     $4,800.00
ER INF HYDRATION 31-90 MINUTES 96360     $357.00
ER INF HYDRATION EA ADDL 60 MIN 96361     $129.00
ER INF THERAPY 16-90 MIN 96365     $347.00
ER INF THERAPY EA ADDL 60 MIN 96366     $181.00
ER INJ IM SQ AB 96372     $139.00
ER INJECTION IV PUSH 96374     $228.00
ER IMMUN/VACCIN ADMIN 1ST DRUG 90471     $116.00
ER OXYGEN/HOURLY CC-723023676     $33.00
ER POTASSIUM CHLORIDE 20 MEQ PACK CC-734005335 42806009499 2 Units $85.50
ER ASPIRIN 81 MG CHEW CC-734005703 904404073 4 units $1.00
ER KETOROLAC TROM 10 MG TAB CC-734005990 93031401 1 tab $10.50
ER AZITHROMYCIN 250 MG TAB CC-734006042 65862064169 4 tabs $126.00
ER ALBUTEROL SUL 90 MCG/ HFA 6.7G A CC-734006419 00254100752 1 unit $103.75
ER ACETAMINOPHEN 325 MG TAB CC-734007061 50580060002 1 tab $0.25
ER ONDANSETRON DISINTEGRA TAB 4MG CC-734009927 68084022011 1 tab $86.00
ER SODIUM CHLORIDE 0.9% 1000ML CC-737000212 00338055318   $64.00

Inpatient and Observation

Service Description CPT/HCPCS PRICE
Inpatient and Observation BLOOD GLUCOSE BY REAGENT STRIP 82962 $44.00
Inpatient and Observation VENTILATOR EACH ADDTL DAY 94003 $1,023.00
Inpatient and Observation PULSE OXIMETERY SGL DETERMINATION 94760 $78.00
Inpatient and Observation PULSE OXIMETERY CONTINUO PER DAY 94762 $294.00
Inpatient and Observation INF CONCURRENT 96368 $119.00
Inpatient and Observation CRITICAL CARE FIRST 30-74 MIN 99291 $2,195.00
Inpatient and Observation CRITICAL CARE EA ADD'L 30 MIN 99292 $282.00
Inpatient and Observation MED/SURG PRIVATE PER DAY CC-602050001 $1,000.00
Inpatient and Observation SICU INTENSIVE CARE CC-606240043 $2,870.00
Inpatient and Observation SICU STEP DOWN PER DAY CC-606240044 $1,935.00
Inpatient and Observation SKIN STAPLES UNIT CC-610120232 $70.72
Inpatient and Observation HEMODIALYSIS INPATIENT CC-630099999 $1,357.00
Inpatient and Observation ISOLATION CART CC-729076366 $171.00
Inpatient and Observation HEMODIALYSIS EMERGENT G0257 $1,657.00
Inpatient and Observation MED/SURG OBSERVATION PER HOUR G0378 $70.00
Inpatient and Observation DIRECT ADMIT G0379 $547.00