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

 

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