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. Below, you will find information on our 300 most common procedures as of January 2023. We will update this information 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
- Nashville General Chargemaster (download as a XLS)
- Nashville General Price Estimator Tool (download as XLS)
- Nashville General Payor Comparison (download as PDF or CSV)
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 | $18,386.00 |
| CMS-70 | 46. Removal of 1 or more breast growth, open procedure (19120) | 19120 | $7,434.00 |
| CMS-70 | 47. Shaving of shoulder bone using an endoscope (29826) | 29826 | Not provided by hospital |
| CMS-70 | 48. Removal of one knee cartilage using an endoscope (29881) | 29881 | $7,790.00 |
| 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 | $1,948.00 |
| CMS-70 | 51. Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope (43239) | 43239 | $2,757.00 |
| CMS-70 | 52. Diagnostic examination of large bowel using an endoscope (45378) | 45378 | $3,911.00 |
| CMS-70 | 53. Biopsy of large bowel using an endoscope (45380) | 45380 | $2,964.00 |
| CMS-70 | 54. Removal of polyps or growths of large bowel using an endoscope (45385) | 45385 | $2,882.00 |
| CMS-70 | 55. Ultrasound examination of lower large bowel using an endoscope (45391) | 45391 | $3,186.00 |
| CMS-70 | 56. Removal of gallbladder using an endoscope (47562) | 47562 | $13,383.00 |
| 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 | $4,215.00 |
| 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 | $6,177.00 |
| CMS-70 | 61. Routine obstetric care for cesarean delivery, excluding pre-and post-delivery care (59510) | 59510 | $11,025.00 |
| CMS-70 | 62. Routine obstetric care for vaginal delivery after prior cesarean delivery excluding pre-and post-delivery care (59610) | 59610 | $8,690.00 |
| CMS-70 | 63. Injection of substance into spinal canal of lower back or sacrum using imaging guidance (62322 or 62323) | 62323 | $1,595.00 |
| CMS-70 | 64. Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance (64483) | 64483 | $1,938.00 |
| CMS-70 | 65. Removal of recurring cataract in lens capsule using laser (66821) | 66821 | $1,713.00 |
| CMS-70 | 66. Removal of cataract with insertion of lens (66984) | 66984 | $4,889.00 |
| CMS-70 | 67. Electrocardiogram, routine, with interpretation and report (93000)/ (93005) | 93000/93005 | $303.00 |
| CMS-70 | 68. Insertion of catheter into left heart for diagnosis (93452) | 93452 | $12,504.00 |
| CMS-70 | 69. Sleep study (95810) | 95810 | Not provided by hospital |
| CMS-70 | 70. Physical therapy, therapeutic exercise (97110) | 97110 | $147.00 |
Pharmacy
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| PHARMACY | PENI G BENZ 1.2 MU//2 ML SYRG | J0561 | $402.25 |
| PHARMACY | CEFTRIAXONE SOD 1 GRAM SOLR J | J0696 | $20.00 |
| PHARMACY | MEDROXYPROG AC 150 MG/ 1ML INJ BIL | J1050 | $376.75 |
| PHARMACY | DEXAMETH NA PHOS 10 MG/1ML IJ | J1100 | $16.00 |
| PHARMACY | FOSAPREPITANT (EMEND) 150 MG VIAL | J1453 | $1,511.25 |
| PHARMACY | HEPARIN 100U/ML 5ML CLF INJ PF | J1642 | $19.75 |
| PHARMACY | HEPARIN NA (PORK) 5,000 UNIT/1ML J | J1644 | $112.50 |
| PHARMACY | ENOXAPARIN SODIUM 40 MG/0.4 ml J | J1650 | $288.00 |
| PHARMACY | IRON SUCROSE (VENOFER) 20 MG/ML 5 ML INJ | J1756 | $364.50 |
| PHARMACY | INSULIN REG HUMAN 100 UNITS/ML | J1815 | $80.00 |
| PHARMACY | KETOROLAC TROM 60 MG/2 ML INJ | J1885 | $38.25 |
| PHARMACY | LEVETIRACETAM INJ 500 MG/5 ML INJ | J1953 | $54.50 |
| PHARMACY | MEROPENEM 1000 MG SOLR INJ | J2185 | $2,050.00 |
| PHARMACY | MICAFUNGIN(MYCAMINE) 100MG VIAL | J2248 | $3,406.00 |
| PHARMACY | MORPHINE SULFATE 4 MG/ML 1ml inj | J2270 | $19.75 |
| PHARMACY | ONDANSETRON 4mg/ 2ml inj | J2405 | $27.75 |
| PHARMACY | PROPOFOL 10 MG/ML 20ml BOLUS | J2704 | $35.75 |
| PHARMACY | NAROPIN(ROPIVACAINE)0.5%30ML VIAL | J2795 | $104.50 |
| PHARMACY | FENTANYL CITRATE 10 MCG/ML IN NS 250(PF) | J3010 | $326.00 |
| PHARMACY | VANCOMYCIN HCL 1,000 MG SOLR J | J3370 | $228.00 |
| PHARMACY | POTASSIUM CL 10 MEQ/100 ML PGBK | J3480 | $99.00 |
| PHARMACY | PREDNISONE 20 MG TAB | J7512 | $18.00 |
| PHARMACY | OXALIPLATIN 100 MG SOLR INJ | J9263 | $1,720.00 |
| PHARMACY | PERTUZUMAB(PERJETA)420MG/14ML | J9306 | $13,189.75 |
| PHARMACY | EPOETIN DIALYSIS 10,000 UNITS/ML ESRD | Q4081 | $1,934.50 |
| PHARMACY | IOHEXOL 9 MG IODINE/ML 500 ML ORAL SOLN | Q9958 | $38.25 |
| PHARMACY | Iohexol 350mg/ml 100ml INJ | Q9967 | $509.50 |
HCPCS / OUTPATIENT - IMAGING
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| IMAGING | CT MAXILLOFACIAL W/O CONTRAST | 70486 | $1,941.00 |
| IMAGING | MRI BRAIN W/O CONTRAST | 70551 | $3,082.00 |
| IMAGING | X-RAY EXAM CHEST 1 VIEW | 71045 | $331.00 |
| IMAGING | X-RAY EXAM CHEST 2 VIEWS | 71046 | $386.00 |
| IMAGING | CT THORAX W/O CONT | 71250 | $2,029.00 |
| IMAGING | CT THORAX- W/CONT | 71260 | $2,564.00 |
| IMAGING | CTA CHEST (NONCORONARY) W/WO CONT | 71275 | $3,056.00 |
| IMAGING | SPINE, LUMBOSACRAL- 2 OR 3 VW | 72100 | $490.00 |
| IMAGING | CT CERVICAL SPINE W/O CONTRAST | 72125 | $2,274.00 |
| IMAGING | CT LUMBAR SPINE- W/O CONT | 72131 | $2,255.00 |
| IMAGING | SHOULDER-COMP ,2+VIEWS | 73030 | $444.00 |
| IMAGING | HAND,-3+ VIEWS | 73130 | $442.00 |
| IMAGING | KNEE, - COMP 4+ VIEWS | 73564 | $546.00 |
| IMAGING | ANKLE RT- COMP,3+ VIEWS | 73610 | $440.00 |
| IMAGING | FOOT,COMPLETE - 3+ VIEWS | 73630 | $438.00 |
| IMAGING | X-RAY EXAM ABDOMEN 1 VIEW | 74018 | $355.00 |
| IMAGING | ABD,ACUTE COMP W/1 VIEW CHEST | 74022 | $610.00 |
| IMAGING | CT TOTAL ABD W/CONT | 74160 | $2,560.00 |
| IMAGING | CT ABD/PEL WO/CONTRAST | 74176 | $3,476.00 |
| IMAGING | US ABDOMEN LIMITED STUDY | 76705 | $843.00 |
| IMAGING | US RENAL | 76770 | $915.00 |
| IMAGING | US OB LIMITED 1 OR > FETUSES | 76815 | $574.00 |
| IMAGING | US OB TRANSVAGINAL | 76817 | $654.00 |
| IMAGING | US PELVIC NONOBSTETRIC | 76856 | $932.00 |
| IMAGING | US EXTREM VENOUS DOPPLER BILAT | 93970 | $1,466.00 |
| IMAGING | US VENOUS DOPPLER UNILAT/LIMITED | 93971 | $1,004.00 |
Lab Services
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| LAB | VENIPUNCTURE | 36415 | $28.00 |
| LAB | COMPREHENSIVE METABOLIC PANEL | 80053 | $205.00 |
| LAB | ACUTE HEPATITIS PANEL | 80074 | $393.00 |
| LAB | VANCOMYCIN | 80202 | $173.00 |
| LAB | DRUG SCREEN 13 DIFFERENT DRUGS | 80306 | $189.00 |
| LAB | ALCOHOL BLOOD (ETHYL) | 80320 | $142.00 |
| LAB | ACETOMENOPHEN | 80329 | $122.00 |
| LAB | URINE PREGNANCY TEST VISUAL/1 | 81025 | $98.00 |
| LAB | ALBUMIN URINE MICROALBUMIN | 82043 | $77.00 |
| LAB | AMYLASE, SERUM | 82150 | $106.00 |
| LAB | BILIRUBIN TOTAL | 82247 | $58.00 |
| LAB | BILIRUBIN DIRECT | 82248 | $65.00 |
| LAB | CPK, TOTAL- SERUM | 82550 | $91.00 |
| LAB | CKMB FRACTION | 82553 | $154.00 |
| LAB | CREATININE, OTHER SOURCE | 82570 | $68.00 |
| LAB | VITAMIN B12 | 82607 | $86.00 |
| LAB | VITAMIN D 25 OH | 82652 | $217.00 |
| LAB | FERRITIN | 82728 | $139.00 |
| LAB | FOLATE, SERUM | 82746 | $135.00 |
| LAB | GASES BLOOD PH PCO2 PO2 CO2 | 82803 | $263.00 |
| LAB | HEMOGLOBIN A1C GLYCOHEMOGLOBIN | 83036 | $100.00 |
| LAB | IRON | 83540 | $76.00 |
| LAB | IRON BINDING CAPACITY | 83550 | $89.00 |
| LAB | LACTATE (LACTIC ACID) | 83605 | $136.00 |
| LAB | LACTATE DEHYDROGENASE (LD) | 83615 | $76.00 |
| LAB | MAGNESIUM | 83735 | $90.00 |
| LAB | HEPATITIS C | 86804 | $295.00 |
| LAB | RESP VIRUS 12-25 TARGETS | 87633 | $1,129.00 |
| LAB | CHLAMYDOPHILA PNEUMONIAE | 87486 | $150.00 |
| LAB | MYCAPLASMA PNEUMONIAE | 87581 | $167.00 |
| LAB | PHOSPHORUS INORGANIC (PHOSPHATE) | 84100 | $63.00 |
| LAB | PROSTATIC SPECIFIC ANTIGEN | 84153 | $151.00 |
| LAB | THYROXINE FREE | 84439 | $119.00 |
| LAB | TROPONIN QUANTITATIVE | 84484 | $185.00 |
| LAB | PCV/HEMATOCRIT | 85014 | $42.00 |
| LAB | HEMOGLOBIN | 85018 | $42.00 |
| LAB | D-DIMER | 85378 | $139.00 |
| LAB | ALLG SPEC IGE CRUDE XTRC EA | 86003 | $35.00 |
| LAB | C-REACTIVE PROTEIN | 86140 | $87.00 |
| LAB | RPR (SYPHILLIS TEST QUALITATIVE) | 86592 | $63.00 |
| LAB | ANTIBODY SCREEN RBC EACH SERUM | 86850 | $140.00 |
| LAB | BLOOD TYPING ABO | 86900 | $265.00 |
| LAB | BLOOD TYPING RH (D) | 86901 | $80.00 |
| LAB | CROSSMATCH IMMEDIATE SPIN | 86920 | $351.00 |
| LAB | CULTURE, BLOOD | 87040 | $193.00 |
| LAB | CULTURE, BACTERIAL ANY OTHER | 87070 | $142.00 |
| LAB | CULTURE, URINE | 87086 | $103.00 |
| LAB | KPC (CARBAPENEM-RESISTANCE GENE) | 87150 | $145.00 |
| LAB | SUSCEPTIB STUDIES ANTIMICRO AGT | 87186 | $107.00 |
| LAB | GRAM STAIN | 87205 | $69.00 |
| LAB | WET PREP | 87210 | $74.00 |
| LAB | HEP B SURFACE ANTIGEN (HBSAG) | 87340 | $110.00 |
| LAB | INFLUENZA ANTIGEN | 87400 | $118.00 |
| LAB | CHLAMYDIA TRACHOMATIS AMP TECH | 87491 | $170.00 |
| LAB | NEISSERIA GONORRHOEAE AMP TECH | 87591 | $170.00 |
| LAB | IADNA SARS-COV-2 COVID-19 AMPLIFIED PROB | 87635 | $141.00 |
| LAB | 2019-nCoV Coronavirus, SARS-CoV-2/2019 | U0002 | $150.00 |
| LAB | RBCS LEUKOCYTE REDUCED EACH UNIT | P9016 | $527.00 |
Therapy Services
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| ST | INDIV TREAT SPEECH LANG DIS SLP | 92507 | $316.00 |
| ST | SPEECH THERAPY EVAL-FLUENCY | 92521 | $350.00 |
| ST | SPEECH THERAPY EVAL-SPEECH | 92522 | $373.00 |
| ST | SPEECH THERAPY EVAL-SPEECH&LANG | 92523 | $527.00 |
| ST | BEHAV-QUAL ANALYSIS VOICE | 92524 | $406.00 |
| ST | TREAT SWALLOWING/FEED DYSF SLP | 92526 | $308.00 |
| ST | EVAL ORAL&PHARY SWALLOW DYSF SLP | 92610 | $423.00 |
| ST | MOTION FLUOR EVAL CINE/VIDEO SLP | 92611 | $534.00 |
| RT | SPIROMETRY | 94010 | $380.00 |
| RT | BRONCHODIL RESPONSE SPIR PRE/POST | 94060 | $697.00 |
| RT | INHALATION TX - OBSTR/SPUT INDUCT INIT | 94640 | $443.00 |
| RT | CPAP/BIPAP SUBSEQ DAY | 94660 | $704.00 |
| RT | AEROSOL/VAPOR INHALA PT DEMO/EVAL | 94664 | $443.00 |
| RT | PULM FUNCT TST PLETHYSMOGRAPHY | 94726 | $623.00 |
| RT | C02/MEMBANE DIFFUSE CAPACITY | 94729 | $404.00 |
| OT | E-STIM, MANUAL, EA 15 MIN, OT | 97032 | $123.00 |
| OT | ULTRASOUND, EA 15 MIN, OT | 97035 | $114.00 |
| OT | NEUROMUSCULAR RE-ED, EA 15 MIN OT | 97112 | $142.00 |
| PT | GAIT TRAINING, EA 15 MIN PT | 97116 | $131.00 |
| OT | MASSAGE, EA 15 MIN, OT | 97124 | $108.00 |
| OT | MANUAL TX (TRAC, DRAIN) EA 15M OT | 97140 | $144.00 |
| PT | PT EVAL LOW COMPLEX 20 MIN | 97161 | $303.00 |
| PT | PT EVAL MOD COMPLEX 30 MIN | 97162 | $349.00 |
| PT | PT EVAL HIGH COMPLEX 45 MIN | 97163 | $394.00 |
| OT | OT EVAL LOW COMPLEX 30 MIN | 97165 | $314.00 |
| OT | OT EVAL MOD COMPLEX 45 MIN | 97166 | $367.00 |
| OT | THER ACTIV ONE-ON-ONE EA 15MN OT | 97530 | $144.00 |
| OT | TRAINING ADL EACH 15 MIN | 97535 | $139.00 |
Procedures
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| PROCEDURES | TTE - TRANSTHORACIC ECHO FLW & SPC W/DPL | 93306 | $2,494.00 |
| PROCEDURES | ARTHROCENTESIS ASPIR&/INJ MAJ JNT | 20610 | $615.00 |
| PROCEDURES | Endo Bronchial Ultrasound | 31652 | $7,293.00 |
| PROCEDURES | Endo Bronchial Ultrasound | 31653 | $7,293.00 |
| PROCEDURES | Port Placement | 36571 | $6,739.00 |
| PROCEDURES | ARTERIAL STICK/PUNCTURE | 36600 | $265.00 |
| PROCEDURES | SDS - EGD WITH BAND LIGATION VARICES | 43244 | $3,824.00 |
| PROCEDURES | SDS - EGD W/ DIL GASTRIC OUTL FOR OBSTR | 43245 | $3,824.00 |
| PROCEDURES | SDS - EGD W/PEG TUBE PLACEMENT | 43246 | $3,824.00 |
| PROCEDURES | SDS - EGD HOT BX OR CAUTERY | 43250 | $3,824.00 |
| PROCEDURES | SDS - SIGMOIDOSCOPY FLEX DIAGNOSTIC | 45330 | $2,321.00 |
| PROCEDURES | SDS - COLON FLES HOT BX OR CAUTERY | 45384 | $2,883.00 |
| PROCEDURES | US GUIDANCE PARACENTESIS | 49082 | $1,905.00 |
| PROCEDURES | SDS - CYSTO W/URETEROSCOPY W/LITHOTRIPSY | 52353 | $10,387.00 |
| PROCEDURES | Prostate TURP | 52601 | $10,387.00 |
| PROCEDURES | LUMBAR STEROID INJECTION | 62270 | $1,495.00 |
| PROCEDURES | CT GUIDED NEEDLE PLCMNT, S&I | 77012 | $2,205.00 |
| PROCEDURES | Left Heart Catheterization | 93460 | $16,706.00 |
| PROCEDURES | Cystoscopy | 52310 | $4,215.00 |
| PROCEDURES | Cystourethroscope Lithotripsy/ Holmium | 52353 | $10,387.00 |
Clinics
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| CLINICS | ENT - FINE NEEDLE ASPIRAT W/O IMAGING | 10021 | $814.00 |
| CLINICS | POD - DEB SUBQ TISSUE 20 SQ CM/< | 11042 | $1,245.00 |
| CLINICS | POD - PARING/CUT CORN/CALLUS 2-4 LESIO | 11056 | $423.00 |
| CLINICS | POD - DEBRIDEMENT NAIL ANY METHOD 6/> | 11721 | $201.00 |
| CLINICS | BHC - BREAST CORE BX W/US (R or L side) | 19083 | $3,488.00 |
| CLINICS | ENT - LARYNGOSCOPY,FLEX FIBER DIAGNOST | 31575 | $563.00 |
| CLINICS | URO - CYSTOURETHROSCOPY(SEP PROC) | 52000 | $3,619.00 |
| CLINICS | URO - VASECTOMY,UNILAT/BILAT,W/POSTOP | 55250 | $4,524.00 |
| CLINICS | OPC - INTRA-VITREAL INJ OF AGENT LT | 67028 | $979.00 |
| CLINICS | OPC - PHOTOCO TX EXT RETINOPATHY | 67228 | $1,910.00 |
| CLINICS | ORC - PELVIS-1 OR 2 VIEWS | 72170 | $393.00 |
| CLINICS | RHE - JOINTS - SACROILIAC < 3 VIEWS | 72200 | $256.00 |
| CLINICS | RHE - ELBOW - 2 VIEWS (R or L Side) | 73070 | $364.00 |
| CLINICS | RHE - WRIST -COMP,3+ VIEWS (R or L side) | 73110 | $427.00 |
| CLINICS | RHE - KNEE - 1 OR 2 VIEWS (R or L side) | 73560 | $385.00 |
| CLINICS | GIC - GASTROINTESTINAL /X-RAY EXAM ABDOMEN 2 VIEWS | 74019 | $441.00 |
| CLINICS | OPC - CORNEAL PACHYMETRY UNILAT/BILAT | 76514 | $82.00 |
| CLINICS | BHC - US BREAST LIMITED, (R or L Side) | 76642 | $493.00 |
| CLINICS | ENT - PARATHYROID VISIT WITH IMAGING & LABS | 78070 | $1,631.00 |
| CLINICS | GIC - HEPATITIS A ANTIBODY | 86708 | $103.00 |
| CLINICS | GIC - GASTROINTESTINAL LAB TESTS | 87507 | $1,042.00 |
| CLINICS | GIC - HEP B VIRAL LOAD , HBV DNA | 87517 | $295.00 |
| CLINICS | GIC - HEPATITIS C GENOTYPE | 87902 | $644.00 |
| CLINICS | GIC - HEPATITIS B DRUG RESISTANCE PANEL | 87912 | $644.00 |
| CLINICS | OPC - COMPREH NEW OPHTHALM EXAM | 92004 | $225.00 |
| CLINICS | OPC - DETERMINATION, REFRACTIVE STATE | 92015 | $160.00 |
| CLINICS | OPC - GONIOSCOPY (SEP PROC) | 92020 | $265.00 |
| CLINICS | OPC - COMP SCAN (POSTERIOR) OPTICNERVE | 92133 | $153.00 |
| CLINICS | OPC - COMP SCAN (POSTERIOR) RETINA | 92134 | $169.00 |
| CLINICS | OPC - FUNDUS PHOTOGRAPHY W/INTERPRET | 92250 | $237.00 |
| CLINICS | CAC - EKG Tracing visit/test | 93005 | $303.00 |
| CLINICS | POD - US ARTER STUDY EXT SGL LEV BILAT | 93922 | $592.00 |
| CLINICS | POD - US DUPLX SCAN LW EXT ART COMP BIL | 93925 | $1,361.00 |
| CLINICS | URO - CHEMO SC/IM HORMONAL | 96402 | $258.00 |
| CLINICS | OFC/OUTPT E&M NEW LOW-MOD 20 MIN | 99202 | $153.00 |
| CLINICS | OFC/OUTPT E&M ESTAB MINOR 10 | 99212 | $142.00 |
| CLINICS | OFC/OUTPT E&M ESTAB LOW-MOD 15 | 99213 | $152.00 |
| CLINICS | OFC/OUTPT E&M ESTAB MOD-HI 25 | 99214 | $162.00 |
| CLINICS | OFC/OUTPT E&M ESTAB MOD-HI 40 | 99215 | $172.00 |
Labor and Delivery
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| L&D | NEWBORN SCREENING TEST | 84030 | $108.00 |
| L&D | C-SECTION | CC-607010001 | $11,025.00 |
| L&D | L & D PRIVATE/LABOR ROOM OBSTET | CC-607010003 | $1,950.00 |
| L&D | VAGINAL DELIVERY | CC-607013301 | $6,177.00 |
| L&D | RECOVERY | CC-607013396 | $1,000.00 |
| L&D | NEWBORN NURSERY LEV 1 NORMAL | CC-607110006 | $2,250.00 |
| L&D | PP PRIVATE OBSTETRICS | CC-607311101 | $3,100.00 |
| L&D | BREAST PUMP | CC-729012370 | $210.00 |
Emergency Department
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| ER | ER L-1 Visit - (CPT 99281 = $261) | 99281 | $352.00 |
| ER | ER L-2 Visit - (CPT 99282 $273) | 99282 | $418.00 |
| ER | ER L-3 Visit - (CPT 99283 = $421) | 99283 | $684.00 |
| ER | ER L-4 Visit - (CPT 99284 = $577) | 99284 | $1,099.00 |
| ER | ER L-5 Visit - (CPT 99285 = $750) | 99285 | $1,625.00 |
| ER | INF HYDRATION 31-90 MINUTES | 96360 | $482.00 |
| ER | INF HYDRATION EA ADDL 60 MIN | 96361 | $190.00 |
| ER | INF THERAPY 16-90 MIN | 96365 | $482.00 |
| ER | INF THERAPY EA ADDL 60 MIN | 96366 | $209.00 |
| ER | INJ IM SQ AB | 96372 | $175.00 |
| ER | INJECTION IV PUSH | 96374 | $482.00 |
| ER | IMMUN/VACCIN ADMIN 1ST DRUG | 90471 | $146.00 |
Inpatient and Observation
| Service | Description | CPT/DRG | PRICE |
|---|---|---|---|
| IO & OBV | BLOOD GLUCOSE BY REAGENT STRIP | 82962 | $35.00 |
| IO & OBV | VENTILATOR EACH ADDTL DAY | 94003 | $1,147.00 |
| IO & OBV | PULSE OXIMETERY SGL DETERMINATION | 94760 | $94.00 |
| IO & OBV | PULSE OXIMETERY CONTINUO PER DAY | 94762 | $329.00 |
| IO & OBV | INF CONCURRENT | 96368 | $220.00 |
| IO & OBV | CRITICAL CARE FIRST 30-74 MIN | 99291 | $2,284.00 |
| IO & OBV | MED/SURG PRIVATE PER DAY | CC-602050001 | $1,100.00 |
| IO & OBV | SICU INTENSIVE CARE | CC-606190766 | $3,157.00 |
| IO & OBV | SICU STEP DOWN PER DAY | CC-606196415 | $2,129.00 |
| IO & OBV | HEMODIALYSIS INPATIENT | CC-630099999 | $1,493.00 |
| IO & OBV | ISOLATION CART | CC-734003979 | $171.00 |
| IO & OBV | HEMODIALYSIS EMERGENT | G0257 | $1,928.00 |
| IO & OBV | MED/SURG OBSERVATION PER HOUR | G0378 | $102.00 |
| IO & OBV | DIRECT ADMIT | G0379 | $1,229.00 |