Billing Info

/Billing Info
Billing Info2019-01-03T04:13:02+00:00

Castro County Healthcare Pricing Information

The services you receive from your provider are based on your individual need and medical condition. Actual charges will vary based on services delivered and medical condition. Additional tests or services not listed in the estimate may be ordered by your doctor or provider, in order to treat, diagnose or care for individual needs.

LAB

CDM Description CCHD_CPT CHARGE
86696 Antibody; herpes simplex, type 2 86696 $30.25
ACETAMINOPHEN 80329 $31.00
ADD GTT Specimen 82952 $25.00
AFB Smear CVT 87206 $73.00
ALBUMIN, SERUM 82040 $32.00
ALCOHOLS 80320 $69.00
Aldolase CVT 82085 $62.00
Aldosterone CVT 82088 $260.00
ALKALINE PHOSPHATASE 84075 $36.00
Alpha Fetopro,L3 CVT 82107 $332.00
ALT 84460 $35.00
AMMONIA, PLAS (PMH) 82140 $95.00
AMYLASE, SERUM 82150 $42.00
Antibody Screen Gel 86885 $35.00
AST 84450 $34.00
Bacterial ID 87077 $54.00
BASIC METABOLIC PANEL 80048 $55.00
BHCG; QN SERUM 84702 $57.00
BILIRUBIN;TOTAL 82247 $34.00
Bill Surgpath Lev I 88300 88300 $30.00
Bill Surgpath Lev II 88302 88302 $60.00
Bill Surgpath Lev III 88304 88304 $75.00
Bill Surgpath Lev IV 88305 88305 $117.00
Bill Surgpath Level V 88307 88307 $240.00
BLOOD CULTURE (A&A) ADULT 87040 $66.00
BLOOD GAS, ARTERIAL 82803 $134.00
BLOOD GAS, VENOUS 82803 $134.00
BLOOD TYPING, SEROLOGIC; ABO 86900 $19.00
BLOOD TYPING; RH 86901 $19.00
BUN 84520 $26.00
Calcium; Total 82310 $36.00
CARBAM / TEGRETOL TOTAL 80156 $95.00
CARBON DIOXIDE 82374 $32.00
CBC W/AUTO DIFF 85025 $51.00
Chlamydophila pneumoniae PCR Respiratory Panel 87486 $210.00
CHLORIDE; BLOOD 82435 $30.00
CHOLESTEROL; SERUM, TOTAL 82465 $28.00
CK; TOTAL 82550 $42.00
CK-MB FRACTION 82553 $40.00
Cobalt, Blood CVT 83018 $234.00
COMPREHENSIVE METABOLIC 80053 $71.00
COMPUTER CROSSMATCH 86923 $170.00
Creatinine, UR 82570 $33.00
CREATININE; SERUM 82565 $33.00
CRP (Infection) 86140 $34.00
Culture Other 87070 $60.00
CULTURE, ADDL PLATE EA 87046 $28.00
D-DIMER; SQN 85379 $31.00
DIGOXIN, TOTAL 80162 $85.00
ELECTROLYTES PANEL 80051 $49.00
Enterococcus sp. PCR Testing BCID Panel 87150 $70.00
ESR; SED RATE(NON-AUTO) 85651 $24.00
Estriol 82677 $157.00
FRESH FROZEN PLASMA, EACH UNIT $381.00
GI Panel (FilmArray) 87507 $785.00
GLUCOSE GLUCOMETER 82962 $15.00
Glucose, Fasting 82947 $26.00
Glucose; tolerance test (GTT), 3 specimens (includes glucose 82951 $84.00
GLUTAMYLTRANSFERASE, GAMMA (GGT) 82977 $46.00
GRP A STREP SCR R/O CULT 87081 $46.00
H PYLORI IGG AB QL 86677 $52.00
HDL CHOLESTEROL, DIREC T 83718 $53.00
HEMATOCRIT (HCT) 85014 $15.00
HEMOGLOBIN (HGB) 85018 $15.00
Hemogram 85027 $42.00
HEPATIC FUNCTION PANEL 80076 $53.00
HETERPHILE AB; MONOTEST 86308 $34.00
HGB; GLYCATED (HBA1C) 83036 $65.00
H-PYLORI,DRUG ADMIN 83014 $53.00
hsCRP (cardiac) 86141 $84.00
INFLUENZA A, ANTIGEN 87804 $81.00
INFLUENZA B, ANTIGEN 87804 $81.00
Iron, Serum 83540 $44.00
Lactic Acid 83605 $68.00
LIPASE 83690 $45.00
LIPID PANEL 80061 $90.00
LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL 83721 $62.00
MAGNESIUM, SER (PMH) 83735 $43.00
MANUAL DIFF; BLD SMEAR 85007 $22.00
Microalbumin/Creat Ratio 82044 $30.00
MMA (METHYLMALONIC) 83921 $105.00
Mycoplasma pneumoniae PCR Respiratory Panel 87581 $210.00
NATRIURETIC PEPTIDE (BNP) 83880 $221.00
NBS (PRIVATE) PKU 84030 $165.72
OCCULT BLOOD ; IFOB, 1-3 DET 82274 $103.00
O’Sullivan Test 82950 $31.00
PHENYTOIN/DILANTIN, TOT 80185 $86.00
PHOSPHORUS, SERUM 84100 $31.00
PLATELET COUNT; AUTOMATED 85049 $29.00
POTASSIUM; SERUM 84132 $30.00
PREGNANCY TEST; QL URINE 81025 $41.00
PROTEIN, TOTAL SERUM 84155 $23.00
PROTHROMBIN TIME (PT/INR) 85610 $26.00
PSA, TOTAL (SPECIFIC) 84153 $117.00
RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT $661.00
RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT $870.00
RENAL FUNCTION PANEL 80069 $56.00
Respiratory Panel 87633 $1,177.50
Respiratory Syncytial Virus 87807 $81.00
RHEUMATOID FACTOR;QL (RF) 86430 $39.00
SALICYLATES 80329 $45.00
SODIUM, SERUM 84295 $31.00
Stool Culture 87045 $63.00
STOOL WBC, QUAL 89055 $27.00
Strep A 87880 $68.00
Strep B latex 87449 $81.00
SUSCEPTIBILITY, MIC (PMH) 87186 $56.00
TB TEST, T-SPOT (OXFORD) 86481 $319.00
Thromboplastin Time 85730 $39.00
THY. STIM. HORMONE (TSH) 84443 $107.00
THYROXINE,FREE (FT4) 84439 $59.00
THYROXINE,TOTAL (TT4) 84436 $44.00
TRANSFERRIN 84466 $60.00
TRIGLYCERIDES 84478 $38.00
TROPONIN; QUANT 84484 $64.00
UA AUTO W/MICRO 81001 $21.00
UA AUTO W/O MICRO 81003 $17.00
URIC ACID; SERUM 84550 $30.00
URINE CULTURE, QN 87086 $52.00
WBC COUNT, AUTO 85048 $17.00

RADIOLOGY

CDM Description CCHD_CPT CHARGE
ANKLE/BRACHIAL INDEX 93922 $469.00
BD Bone Density DEXA Axial Skeleton 77080 $295.00
BD DEXA VFA Only 77086 $216.00
CT Abdomen w/ + w/o Contrast 74170 $1,624.00
CT Abdomen w/ Contrast 74160 $1,299.00
CT Abdomen w/o Contrast 74150 $1,044.00
CT Abdomen/Pelvis w + w/o Contrast 74178 $2,804.00
CT Abdomen/Pelvis w/ Contrast 74177 $2,226.00
CT Abdomen/Pelvis w/o Contrast 74176 $1,731.00
CT Angiography Abdomen 74175 $1,450.00
CT Angiography Abdomen/Pelvis 74174 $2,233.00
CT Angiography Head 70496 $1,450.00
CT Angiography Neck 70498 $1,450.00
CT Chest W/Contrast 71260 $1,317.00
CT Chest W/O Contrast 71250 $1,125.00
CT Chest W/WO Contrast 71270 $1,641.00
CT Head or Brain w/ + w/o Contrast 70470 $1,404.00
CT Head or Brain w/ Contrast 70460 $1,096.00
CT Head or Brain w/o Contrast 70450 $945.00
CT Lower Extremity w/ Contrast 73701 $1,131.00
CT Lower Extremity w/o Contrast 73700 $986.00
CT Maxillofacial w/ + w/o Contrast 70488 $1,404.00
CT Maxillofacial w/ Contrast 70487 $1,096.00
CT Maxillofacial w/o Contrast 70486 $945.00
CT Orbit Sella etc. w/ + w/o Contrast 70482 $1,404.00
CT Orbit Sella etc. w/o Contrast 70480 $945.00
CT Pelvis w/ + w/o Contrast 72194 $1,595.00
CT Pelvis w/ Contrast 72193 $1,276.00
CT Pelvis w/o Contrast 72192 $1,131.00
CT Sinus w/o Contrast 70486 $945.00
CT Soft Tissue Neck w/ + w/o Contrast $1,404.00
CT Soft Tissue Neck w/ Contrast 70491 $1,096.00
CT Soft Tissue Neck w/o Contrast 70490 $945.00
CT Spine Cervical w/ Contrast 72126 $1,334.00
CT Spine Cervical w/o Contrast 72125 $1,108.00
CT Spine Lumbar w/ Contrast 72132 $1,334.00
CT Spine Lumbar w/o Contrast 72131 $1,114.00
CT Spine Thoracic w/o Contrast 72128 $1,114.00
CT Upper Extremity w/ Contrast 73201 $1,131.00
CT Upper Extremity w/o Contrast 73200 $986.00
CV EKG Exam Only 93005 $122.00
CV Electrocardiogram (EKG) 93005 $122.00
CV Holter Monitor 48 Hour 93225 $224.00
DUPLEX,AORTIC,COMPLETE 93978 $469.00
DUPLEX,I/O ABD/PEL;CMPLTE 93975 $469.00
EKG POC 93000 $100.00
MRA Abdomen w/ + w/o Contrast 74185 $1,852.00
MRA Head w/o Contrast 70544 $1,755.00
MRA Neck w/ + w/o Contrast 70549 $2,145.00
MRA Neck w/o Contrast 70547 $1,755.00
MRI Abdomen w/ + w/o Contrast 74183 $2,145.00
MRI Abdomen w/ Contrast 74182 $1,950.00
MRI Abdomen w/o Contrast 74181 $1,755.00
MRI Brain w/ + w/o Contrast 70553 $2,145.00
MRI Brain w/ Contrast 70552 $1,950.00
MRI Brain w/o Contrast 70551 $1,755.00
MRI Face Neck Orbit w/ + w/o Contrast 70543 $2,145.00
MRI Face Neck Orbit w/o Contrast 70540 $1,755.00
MRI LE Joint w/ + w/o Contrast 73723 $2,145.00
MRI LE Joint w/ Contrast 73222 $1,755.00
MRI LE Joint w/o Contrast 73721 $1,755.00
MRI LE Non Joint w/ + w/o Contrast 73720 $2,145.00
MRI LE Non Joint w/o Contrast 73718 $1,755.00
MRI Pelvis w/ + w/o Contrast 72197 $2,145.00
MRI Pelvis w/o Contrast 72195 $1,755.00
MRI Spine Cervical w/ + w/o Contrast 72156 $2,145.00
MRI Spine Cervical w/o Contrast 72141 $1,755.00
MRI Spine Lumbar w/ + w/o Contrast 72158 $2,145.00
MRI Spine Lumbar w/ Contrast 72149 $1,950.00
MRI Spine Lumbar w/o Contrast 72148 $1,755.00
MRI Spine Thoracic w/ + w/o Contrast 72157 $2,145.00
MRI Spine Thoracic w/o Contrast 72146 $1,755.00
MRI UE Joint w/ Contrast 73222 $1,755.00
MRI UE Joint w/o Contrast 73221 $1,755.00
MRI UE Non Joint w/ + w/o Contrast 73220 $2,145.00
MRI UE Non Joint w/o Contrast 73218 $1,755.00
MRI, UP EXT W/0 DYE 73218 $1,755.00
SEG PRESSURES UPPER MULTI 93923 $469.00
SEG PRESSURES,UPPER SINGL 93922 $469.00
US Abdomen Complete 76700 $495.00
US Abdomen Limited 76705 $378.00
US Art/Vein Abd/Pelvis/Scrotal Limited 93976 $469.00
US Biophysical Profile 76819 $423.00
US Breast Left Complete 76641 $630.00
US Breast Right Complete 76641 $630.00
US Cardiac Holter Monitor up to 48 Hours 93225 $225.00
US Carotid Doppler 93880 $469.00
US Chest 76604 $360.00
US Echocardiogram Complete 93306 $820.00
US Extremity Non Vascular 76881 $747.00
US Extremity Nonvascular Ltd 76882 $308.00
US Head/Neck Soft Tissue 76536 $360.00
US LE Arterial Duplex 93926 $469.00
US LE Venous Duplex 93970 $469.00
US Pelvic Complete 76856 $450.00
US Pelvic/Transvag 76856 $450.00
US Pregnancy < 14 weeks 76801 $495.00
US Pregnancy Fetus > 14 Weeks 76805 $540.00
US Pregnancy Follow Up 76816 $288.00
US Pregnancy Limited 76815 $387.00
US Pregnancy Multi Gest < 14 weeks 76802 $360.00
US Pregnancy Multi Gest > 14 weeks 76810 $513.00
US Pregnancy Transvaginal 76817 $540.00
US Retroperitoneal Complete 76770 $504.00
US Scrotum (Contents) 76870 $405.00
US Transvaginal 76830 $513.00
US UE Arterial Duplex 93931 $469.00
US UE Venous Duplex 93970 $469.00
XR Abdomen 1 View 74018 $144.00
XR Abdomen 2 Views 74019 $225.00
XR Abdomen Acute 3 Views/Chest 1 View 74022 $234.00
XR Ankle Complete 73610 $162.00
XR Calcaneous Left 73650 $135.00
XR Chest 1 View 71045 $126.00
XR Chest 2 Views 71046 $171.00
XR Child Nose-Rectum For FB 76010 $135.00
XR Clavicle Left 73000 $135.00
XR Elbow 2 Views Bilateral 73070 $292.00
XR Elbow Complete 73080 $153.00
XR Facial Bones Minimum 3 Views 70150 $234.00
XR Femur 1 View 73551 $243.00
XR Femur 2 Views 73552 $292.00
XR Finger Left 73140 $117.00
XR Foot 2 Views 73620 $126.00
XR Foot Complete Bilateral 73630 $259.00
XR Forearm 2 Views 73090 $243.00
XR Hand 2 Views 73120 $126.00
XR Hand Complete 73130 $162.00
XR Hip 1 View Lt w/ Pelvis 73501 $135.00
XR Hip 2-3 Views Lt w/ Pelvis 73502 $180.00
XR Hips Bil w/ Pelvis 2 Views 73521 $189.00
XR Humerus 73060 $162.00
XR IVP 74400 $450.00
XR Knee 3 Views 73562 $162.00
XR Knee Complete 73564 $162.00
XR Knee One or Two Views 73560 $144.00
XR Knee Standing AP B 73565 $144.00
XR Mandible Complete Minimum 4 Views 70110 $216.00
XR Mandible Partial Less Than 4 Views 70100 $180.00
XR Nasal Bones Minimum 3 Views 70160 $180.00
XR Neck Soft Tissue 70360 $126.00
XR Orbits Complete Bilateral 70200 $234.00
XR Pelvis Complete Minimum 3 Views 72190 $207.00
XR Ribs 2 Views 71100 $180.00
XR Ribs Min 3 Views w/ PA Chest 71101 $207.00
XR Sacroiliac Joints 1 or 2 Views 72200 $153.00
XR Sacrum and Coccyx 72220 $153.00
XR Scapula 73010 $153.00
XR Scoliosis Study 72081 $207.00
XR Shoulder 1 View 73020 $126.00
XR Shoulder 2 Views 73030 $144.00
XR Sinuses Paranasal Complete 70220 $207.00
XR Skull Complete 70260 $270.00
XR Spine 1 View Cervical 72020 $108.00
XR Spine 1 View Lumbar 72020 $108.00
XR Spine 1 View Thoracic 72020 $108.00
XR Tib/Fib 2 Views Bilateral 73590 $275.00
XR Tibia/Fibula 2 Views 73590 $153.00
XR Toes 73660 $117.00
XR Wrist 2 Views 73100 $135.00
XR Wrist Complete 73110 $144.00

THERAPY

CDM Description CCHD_CPT CHARGE
APPL SURFACE NEUROSTIMULA 64550 $123.00
AQUATI THERP EXERC/15 MIN 97113 $102.50
ASSES OF APHASIA PER HOUR 96105 $276.00
BEHAVRL QUAL ANLYS VOICE 92524 $232.00
CK OUT PROS USE EA 15 MIN 97762 $111.75
COGNITIVE DEV 1:1 15MIN 97532 $64.75
COGNITIVE DEV;1/1EA 15MIN 97127 $65.00
CONTRAST BATH EACH 15 MIN 97034 $58.00
DEVEL TEST,EXTENDED/1HOUR 96111 $355.00
DEVELOPMENTAL TEST, LIM 96110 $276.00
ELEC/STIM ATTENDED 15 MIN 97032 $65.00
E-STIM UNATTENDED 97014 $51.00
EVAL ORAL/PHAR SWALLOWING 92610 $254.00
EVAL SPEECH FLUENCY 92521 $213.00
EVAL SPEECH SOUND PRODUC 92522 $223.50
EVAL SPEECH SOUND W/ C&E 92523 $463.00
GAIT TRAINING EA 15 MIN 97116 $77.00
IONTO WO STIM EA 15 MINS 97033 $76.50
MANUAL MANIPULATION/15MIN 97140 $87.00
MASSAGE THERAPY 97124 $63.25
NEURO RE-ED MOVE EA15MIN 97112 $80.50
NON SELECT WOUND DEBRIDE 97602 $209.50
O.T. RE-EVALUATION 97168 $157.00
ORAL SPEECH DEVICE EVAL 92597 $249.00
ORTHOTIC MAN/TRAIN 15 MIN 97760 $91.75
OT EVAL MODERATE COMPLEXITY 97166 $348.00
OT High Complex Units 97167 $464.00
OT Low Complex Unit 97165 $232.00
PARAFFIN BATH THERAPY 97018 $58.00
PROS TRAIN UP/LOW EX 15M 97761 $80.25
PT EVAL HIGH COMPLEXITY 97163 $464.00
PT EVAL LOW COMPLEXITY 97161 $232.00
PT EVAL MODERATE COMPLEXITY 97162 $348.00
PT REEVALUATION 97164 $157.00
SEL WOUND DEBRID > 20SQCM 97598 $204.00
Selective Debridement Charge 97597 $179.75
SELF-CARE MNGMT TRN 15MIN 97535 $83.75
SENSORY TECHNIQ EA 15 MIN 97533 $84.00
SPEECH/LANG/HEARING TX 92507 $246.00
Standardized Cognitive Eval Minutes 96125 $284.00
TECH ASSES W/ RPRT EA 15 97755 $88.00
THER PROCEDURES GROUP 97150 $73.00
THERA/ACTI 1 ON 1 15 MIN 97530 $83.75
Therapeutic Exercise Charges 97110 $96.00
TRACTION/MECHANICAL 97012 $65.00
TREATMENT SWALLOW DYSFUNC 92526 $250.00
US ATTENDED EACH 15 MIN 97035 $58.00
US LOW INTEN HEALING 20979 $81.00
VASOPNEUMATIC DEVICE 97016 $65.00
WHIRLPOOL EXTREMITY 97022 $65.00

RESPIRATORY

CDM Description CCHD_CPT CHARGE
Pressurized or nonpressurized inhalation diagnostic treatmen 94640 $189.00
Demonstration and evaluation of patient utilization of a met 94664 $150.00
HHN CONTINUOUS 1ST HOUR 94644 $189.00
PERCUS/POSTURAL DRAIN,INT 94667 $90.00
PERCUS/POSTURAL DRAIN,SUB 94668 $140.00
Spirometry, including graphic record, total and timed vital 94010 $180.00
Bronchodilation responsiveness, spirometry, pre- and post-br 94060 $327.00
Pulmonary stress testing 94620 $135.00

EMERGENCY

CDM Description CCHD_CPT CHARGE
I&D ABCESS SMPL SINGLE 10060 $223.00
I&D ABSC COMP & MULTIPLE 10061 $355.00
I&D REMOVE FB SQ SIMPLE 10120 $408.50
11719 TRIM NONDYSTROPHIC NAILS 11719 $73.75
AVUL NAIL PLTE SMPL SINGL 11730 $222.00
DRAIN SUBLUNGUAL HEMATOMA 11740 $138.00
11760 REPAIR OF NAIL BED 11760 $541.00
SIM RPR S,AX,G,T,EX<2.5CM 12001 $220.00
RPR SIM FACE,EARS <2.5CM 12011 $237.00
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE 12020 $641.75
12031 RPR LAYER S,AX,T,EX<2.5CM 12031 $408.50
RPR LAY;N,H,FT,G;<2.5CM 12041 $372.00
12051 RPR LAYR;FACE,ERS;<2.5CM 12051 $389.00
13100 REPR,COMPX,TRNK 1.1-2.5CM 13100 $642.00
13120 RPR COMPX;SC,EX;1.1-2.5CM 13120 $642.00
13131 RPR COMPX;FH,CH;1.1-2.5CM 13131 $490.00
13151 RPR CPX;LID,N,E;1.1-2.5CM 13151 $625.00
INITIAL TRMNT 1DEGRE BURN 16000 $222.25
BURN PAR THICK < 5% TBSA 16020 $222.25
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MU 20552 $249.00
INJ TRIGR PTS =/>3 20553 $304.00
ARTHRO,ASP,INJ;SM JT,BURS 20600 $248.00
ARTHRO,ASP,INJ;INT JT/BUR 20605 $268.00
ARTHO,ASP,MAJOR JNT,BURSA 20610 $288.00
21310 FX NASAL BONE CLSD WO MAN 21310 $282.50
21400 FX CLSD ORBIT WO MANIPULA 21400 $739.00
21450 FX CLSD MANDIBLE WO MANIP 21450 $604.50
22310 FX CLSD VERT BODY WO MANI 22310 $592.00
FX CLAVICULAR CLSD WO MAN 23500 $490.00
24640 SUBLXTN RAD HE CHILD CLSD 24640 $439.00
24650 FX RAD HE/NK CLSD WO MANI 24650 $372.00
24655 FX RAD HE/NK CLSD W MANIP 24655 $1,775.25
FX RAD SHFT CLSD WO MANIP 25500 $406.00
25505 FX RAD SHFT CLSD W MANIPU 25505 $1,775.25
25530 CLSD TX UL SHAF FX W/OMAN 25530 $608.00
25535 FX ULN SHFT CLSD W MANIPU 25535 $676.00
FX RAD ULN SHFT CLSD WOMA 25560 $541.00
25565 FX CLSD TX RAD ULN SH WMA 25565 $1,775.00
25600 Closed treatment of distal radial fracture 25600 $558.00
25605 FX DIS RAD CLSD W MANIPUL 25605 $1,775.00
25622 FX NAVIC CLSD WO MANIPULA 25622 $659.00
25630 FX NAVIC CLSD WO MAN EACH 25630 $659.00
25650 FX CLSD TX ULNAR STYLOID 25650 $980.00
25675 DISLOC CLSD RAD/ULN W MAN 25675 $1,014.00
FX MTCRPL CLSD SNGL WO MA 26600 $287.00
26605 FX MTCRPL CLSD SGL WMA EA 26605 $473.00
26641 DSCL THUMB CLSD W MANIPUL 26641 $372.00
26645 FX DSLC THUMB CLSD W MANI 26645 $1,775.00
26670 DSLC HAND CLSD W MANIPULA 26670 $304.00
26700 DSLC KNUCKLE CLSD WO ANE 26700 $389.00
FX PHAL SHFT PROX CLSD WO 26720 $287.00
26725 FX PHAL SHFT PROX CLSD WM 26725 $406.00
26740 FX CLSD TX JOIN W/O MANIP 26740 $473.50
FX DIS PHAL CLSD WO MANIP 26750 $282.50
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR TH 26755 $283.00
DSLC IP JT CLSD W MAN WOA 26770 $282.50
FX POSTERIOR PELVIC RING CLSD W/O MANIPULATION 27197 $1,234.00
27200 FX COCCYGEAL CLSD TX 27200 $304.00
27220 FX CLSD ACETABULUM 27220 $507.00
27246 FX CLSD GR TROCHAN WO MAN 27246 $440.00
27250 DSCL HIP TRAUM CLSD WO AN 27250 $659.00
27372 REMOVAL FB THIGHKNEE DEEP 27372 $3,056.00
27508 FX CLSD MED COND WO MANIP 27508 $1,014.00
CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION 27520 $490.00
FX TIB PROX CLSD WO MANIP 27530 $507.00
27560 DSLC PATELLA CLSD WO ANES 27560 $439.00
27750 FX TIB SHFT CLSD WO MANIP 27750 $946.00
27752 FX CLSD TX TIV SHFT W MAN 27752 $1,774.25
27760 FX MED MALLE CLSD WO MANI 27760 $456.00
27780 FX FIB PROX SHFT CLSD WOM 27780 $338.00
FX DIST FIB CLSD WO MANIP 27786 $507.00
27808 FX BI ANKLE CLSD WO MANIP 27808 $507.00
27816 FX TRI ANKLE CLSD WO MANI 27816 $507.00
PARTIAL EXCISION DISTAL PHALANX OF TOE 28124 $2,266.00
REMOVAL FB FOOT SUBQ 28190 $753.00
FX BIG TOE CLSD WO MANIP 28490 $282.50
28495 FX BIG TOE CLSD W MANIPUL 28495 $220.00
FX TOE CLSD WO MANIP EACH 28510 $282.50
28515 FX TOE CLSD W MANIP EACH 28515 $220.00
28630 DISLOC CLSD TX MTP JT WO 28630 $389.00
CAST APPLICA SHORT ARM 29075 $312.00
29086 CASTING THUMB SPICA 29086 $178.00
APPLY LONG ARM SPLINT. 29105 $178.00
APPLY FOREARM SPLINT 29125 $120.00
APPLY FINGER SPLINT 29130 $115.00
29200 STRAPPING THORAX CHEST. 29200 $178.00
29240 STRAPPING SHOULDER. 29240 $138.25
29260 STRAPPING ELBOW WRIST 29260 $51.00
29280 STRAPPING HAND FINGER 29280 $51.00
CASTING SHRT LEG FIBRGLAS 29405 $312.00
29505 APPLY LONG LEG SPLINT 29505 $178.00
APPLY SHORT LEG SPLINT 29515 $178.00
29520 STRAPPING HIP. 29520 $85.00
29530 STRAPPING KNEE. 29530 $138.25
29540 STRAPPING ANKL & OR FOOT 29540 $178.00
29550 STRAPPING TOES. 29550 $73.75
29799 STRAPPING LOW BACK. 29799 $178.00
30300 REMOVAL FB INTRANASAL 30300 $220.00
FACILITY SIMPLE EPISTAXIS CONTROL 30901 $169.00
PACK CAUT NASL SMP ANTERI 30901 $169.00
30903 CONTROL ANT NOSEBLEED CMX 30903 $254.00
30905 INIT CONTR POST NOSEBLEED 30905 $490.00
30906 SUBSQ CONTR POST NOSEBLEE 30906 $389.00
INTUBATION EMERG AIRWAY 31500 $235.50
31603 TRACH,EMERG;TRANSTRACHEAL 31603 $1,496.00
31605 TRACH EMERG CRICOTHYROID 31605 $777.00
32554 THORACENTESIS. 32554 $805.25
SALINE LOCK VEIN 36000 $100.00
BLOOD ADMIN >8 HOURS 36430 $713.00
BLOOD ADMIN 4-8 HOURS 36430 $684.00
36680 INSERT IO NEEDLE 36680 $433.75
37195 THROMBOLYSIS CRBRL IV 37195 $1,183.00
40650 REPAIR LIP VERMILLION ONL 40650 $608.00
41800 DRAIN ABSC CYST HEMATMA DENTAL STRUCTURES 41800 $203.00
42000 DRAINAGE OF ABSCESS PALAT 42000 $235.00
42700 I&D ABSCESS TONSILLAR 42700 $287.50
42809 REMOV FB FROM PHARYNX 42809 $433.75
CHANGE GASTROSTOMY TUBE 43760 $301.75
46050 I&D PERI ANAL ABCSESS,SUP 46050 $933.25
INCISE EX THROMB HEMORHOI 46083 $301.75
EX/ENEC THROMB EX HEMORHO 46320 $1,230.75
51700 IRRIGATION BLADDER SIMPLE 51700 $301.75
STRAIGHT CATH FOR RES URI 51701 $138.25
CATH;INDWELL BLADDER.COMP 51703 $179.25
65220 REMOVE FB EYE;CORNEAL 65220 $433.75
67700 DRAINAGE ABSCESS; EYELID 67700 $338.00
REMOVE FB EAR CANAL WO/AN 69200 $135.00
REMOVAL IMPACTED CERUMEN 69210 $100.00
CPR HEART/LUNG RESUSCITATION 92950 $359.00
92977 THROMBOLYSIS CORONARY IV 92977 $373.00
INTRAVENOUS INFUSION, HYDRATION; INITIAL, 31 MINUTES TO 1 HOUR 96360 $242.00
INTRAVENOUS INFUSION, HYDRATION; EACH ADDITIONAL HOUR 96361 $48.75
INTRAVENOUS INFUSION, INITIAL, UP TO 1 HOUR 96365 $242.00
INTRAVENOUS INFUSION, EACH ADDITIONAL HOUR 96366 $48.75
INTRAVENOUS INFUSION, ADDITIONAL SEQUENTIAL INFUSION OF A NEW DRUG/SUBSTANCE, UP 96367 $96.00
INTRAVENOUS INFUSION, CONCURRENT INFUSION 96368 $96.00
96372 – Subq/IM Injection 96372 $76.50
IV Push Primary 96374 $252.00
96375 – IV Injection, add new drug 96375 $96.00
96376 – IV Injection, add same drug 96376 $96.00
98925 OMT 1-2 BODY REGIONS ED Charge 98925 $126.50
98926 OMT 3-4 BODY REGIONS ED Charge 98926 $184.00
CONSCIOUS SEDATION 1ST 15 MIN < 5YRS 99151 $254.00
CONSCIOUS SEDATION 1ST 15 MIN 5 YRS> 99152 $254.00
CONSCIOUS SEDATION EA ADD’L 15 MIN 99153 $63.00
EMERGENCY DEPARTMENT VISIT; LEVEL I 99281 $150.00
EMERGENCY DEPARTMENT VISIT; LEVEL II 99282 $195.00
EMERGENCY DEPARTMENT VISIT; LEVEL III 99283 $322.00
EMERGENCY DEPARTMENT VISIT; LEVEL IV 99284 $488.00
EMERGENCY DEPARTMENT VISIT; LEVEL V 99285 $722.00
CRITICAL CARE; FIRST 30-74 MINUTES 99291 $1,229.00
CRITICAL CARE, 30 MINUTES 99292 $409.50
CATH FOR CLCT SPCM SGL PT $16.00
TRAUMA TEAM ACTIVATION L4 $1,403.00

AMBULANCE

CDM Description CCHD_HCPCS CHARGE
EVENT STANDBY PER 4 HRS A0999 $56.00
TRANSPORT NON EMERG BLS A0428 $431.00
TRANSPORT EMERG BLS A0429 $690.00
TRANSPORT NON EMERG ALS1 A0426 $517.00
TRANSPORT EMERG ALS1 A0427 $819.00
TRANSPORT ALS2 A0433 $1,185.00
TIME WAITING PER 1/2 HR A0420 $55.00
ATTENDANT EXTRA A0424 $102.00
TREATMENT NO TRANSPORT A0998 $0.00
TRANSPORT SPECIALTY CARE A0434 $1,401.00
MILEAGE EMRG/TENTH ML BLS A0425 $1.50
MILEAGE EMRG/TENTH ML ALS A0425 $1.50
MILEAGE NONER/TENTH BLS A0425 $1.50
MILEAGE NONER/TENTH ALS A0425 $1.50
MILEAGE NON COV/TENTH MIL A0888 $1.50