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.
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 CSV)
- 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 | $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 |