Legent Orthopedic Hospital
Prices Posted and Effective: 05/10/2022
Notes:
Shoppable Service Category CPT/HCPCS/DRG  Out Patient Aver Gross Charge  In-Patient Aver Gross Charge  Average Insurance Allowable
Psychotherapy, 30 min Evaluation & Management Services 90832  Service Not Available  Service Not Available  Service Not Available
Psychotherapy, 45 min Evaluation & Management Services 90834  Service Not Available  Service Not Available  Service Not Available
Psychotherapy, 60 min Evaluation & Management Services 90837  Service Not Available  Service Not Available  Service Not Available
Family psychotherapy, not including patient, 50 min Evaluation & Management Services 90846  Service Not Available  Service Not Available  Service Not Available
Family psychotherapy, including patient, 50 min Evaluation & Management Services 90847  Service Not Available  Service Not Available  Service Not Available
Group psychotherapy Evaluation & Management Services 90853  Service Not Available  Service Not Available  Service Not Available
New patient office or other outpatient visit, typically 30 min Evaluation & Management Services 99203  Service Not Available  Service Not Available  Service Not Available
New patient office of other outpatient visit, typically 45 min Evaluation & Management Services 99204  Service Not Available  Service Not Available  Service Not Available
New patient office of other outpatient visit, typically 60 min Evaluation & Management Services 99205  Service Not Available  Service Not Available  Service Not Available
Patient office consultation, typically 40 min Evaluation & Management Services 99243  Service Not Available  Service Not Available  Service Not Available
Patient office consultation, typically 60 min Evaluation & Management Services 99244  Service Not Available  Service Not Available  Service Not Available
Initial new patient preventive medicine evaluation (18-39 years) Evaluation & Management Services 99385  Service Not Available  Service Not Available  Service Not Available
Initial new patient preventive medicine evaluation (40-64 years) Evaluation & Management Services 99386  Service Not Available  Service Not Available  Service Not Available
Basic metabolic panel Laboratory & Pathology Services 80048 $805.20 $805.20 $8.32
Blood test, comprehensive group of blood chemicals Laboratory & Pathology Services 80053 $1,237.20 $1,237.20 $10.38
Obstetric blood test panel Laboratory & Pathology Services 80055  Service Not Available  Service Not Available  Service Not Available
Blood test, lipids (cholesterol and triglycerides) Laboratory & Pathology Services 80061 $1,237.20 $1,237.20 $13.17
Kidney function panel test Laboratory & Pathology Services 80069 $1,112.40 $1,112.40 $8.54
Liver function blood test panel Laboratory & Pathology Services 80076 $1,168.80 $1,168.80 $8.03
Manual urinalysis test with examination using microscope Laboratory & Pathology Services 81000  Service Not Available  Service Not Available  Service Not Available
Manual urinalysis test with examination using microscope Laboratory & Pathology Services 81001 $326.40 $326.40 $3.12
Automated urinalysis test Laboratory & Pathology Services 81002 $132.00 $132.00 $3.34
Automated urinalysis test Laboratory & Pathology Services 81003 $89.40 $89.40 $2.21
PSA (prostate specific antigen) Laboratory & Pathology Services 84153 $469.20 $469.20 $18.09
PSA (prostate specific antigen) Laboratory & Pathology Services 84154 $300.60 $300.60 $18.09
Blood test, thyroid stimulating hormone (TSH) Laboratory & Pathology Services 84443 $1,023.00 $1,023.00 $16.52
Complete blood cell count, with differential white blood cells, automated Laboratory & Pathology Services 85025 $407.40 $407.40 $7.64
Complete blood count, automated Laboratory & Pathology Services 85027 $363.60 $363.60 $6.36
Blood test, clotting time Laboratory & Pathology Services 85610 $375.00 $375.00 $4.14
Coagulation assessment blood test Laboratory & Pathology Services 85730 $411.60 $411.60 $5.91
CT scan, head or brain, without contrast Radiology Services 70450 $6,128.40 $6,128.40 $320.88
MRI scan of brain before and after contrast Radiology Services 70553 $8,186.40 $8,186.40 $823.50
X-Ray, lower back, minimum four views Radiology Services 72110 $1,944.00 $1,944.00 $161.91
MRI scan of lower spinal canal Radiology Services 72148 $4,989.60 $4,989.60 $623.30
CT scan, pelvis, with contrast Radiology Services 72193 $7,780.80 $7,780.80 $418.54
MRI scan of leg joint Radiology Services 73721 $4,989.60 $4,989.60 $623.30
CT scan of abdomen and pelvis with contrast Radiology Services 74177 $11,670.00 $11,670.00 $690.17
Ultrasound of abdomen Radiology Services 76700 $2,338.80 $2,338.80 $171.97
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus Radiology Services 76805 $1,891.20 $1,891.20 $159.93
Ultrasound pelvis through vagina Radiology Services 76830 $1,755.60 $1,755.60 $157.01
Mammography of one breast Radiology Services 77065  Service Not Available  Service Not Available  Service Not Available
Mammography of both breasts Radiology Services 77066  Service Not Available  Service Not Available  Service Not Available
Mammography, screening, bilateral Radiology Services 77067  Service Not Available  Service Not Available  Service Not Available
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities Medicine and Surgery Services 216  Service Not Available  Service Not Available  Service Not Available
Spinal fusion except cervical without major comorbid conditions or complications (MCC) Medicine and Surgery Services 460  Outpatient Charge at CPT $277,505.63 $49,331.28
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). Medicine and Surgery Services 470  Outpatient Charge at CPT $192,236.94 $25,018.64
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). Medicine and Surgery Services 473  Outpatient Charge at CPT $130,182.92 $32,016.63
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) Medicine and Surgery Services 743  Service Not Available  Service Not Available  Service Not Available
Removal of 1 or more breast growth, open procedure Medicine and Surgery Services 19120  Service Not Available  Service Not Available  Service Not Available
Shaving of shoulder bone using an endoscope Medicine and Surgery Services 29826  Service Not Available  Service Not Available  Service Not Available
Removal of one knee cartilage using an endoscope Medicine and Surgery Services 29881 $24,141.02  Included in Inpatient Charge $12,169.79
Removal of tonsils and adenoid glands patient younger than age 12 Medicine and Surgery Services 42820  Service Not Available  Service Not Available  Service Not Available
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope Medicine and Surgery Services 43235  Service Not Available  Service Not Available  Service Not Available
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope Medicine and Surgery Services 43239  Service Not Available  Service Not Available  Service Not Available
Diagnostic examination of large bowel using an endoscope Medicine and Surgery Services 45378  Service Not Available  Service Not Available  Service Not Available
Biopsy of large bowel using an endoscope Medicine and Surgery Services 45380  Service Not Available  Service Not Available  Service Not Available
Removal of polyps or growths of large bowel using an endoscope Medicine and Surgery Services 45385  Service Not Available  Service Not Available  Service Not Available
Ultrasound examination of lower large bowel using an endoscope Medicine and Surgery Services 45391  Service Not Available  Service Not Available  Service Not Available
Removal of gallbladder using an endoscope Medicine and Surgery Services 47562  Service Not Available  Service Not Available  Service Not Available
Repair of groin hernia patient age 5 years or older Medicine and Surgery Services 49505  Service Not Available  Service Not Available  Service Not Available
Biopsy of prostate gland Medicine and Surgery Services 55700  Service Not Available  Service Not Available  Service Not Available
Surgical removal of prostate and surrounding lymph nodes using an endoscope Medicine and Surgery Services 55866  Service Not Available  Service Not Available  Service Not Available
Routine obstetric care for vaginal delivery, including pre-and post-delivery care Medicine and Surgery Services 59400  Service Not Available  Service Not Available  Service Not Available
Routine obstetric care for cesarean delivery, including pre-and post-delivery care Medicine and Surgery Services 59510  Service Not Available  Service Not Available  Service Not Available
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care Medicine and Surgery Services 59610  Service Not Available  Service Not Available  Service Not Available
Injection of substance into spinal canal of lower back or sacrum using imaging guidance Medicine and Surgery Services 62322  Service Not Available  Service Not Available  Service Not Available
Injection of substance into spinal canal of lower back or sacrum using imaging guidance Medicine and Surgery Services 62323  Service Not Available  Service Not Available  Service Not Available
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance Medicine and Surgery Services 64483  Service Not Available  Service Not Available  Service Not Available
Removal of recurring cataract in lens capsule using laser Medicine and Surgery Services 66821  Service Not Available  Service Not Available  Service Not Available
Removal of cataract with insertion of lens Medicine and Surgery Services 66984  Service Not Available  Service Not Available  Service Not Available
Electrocardiogram, routine, with interpretation and report Medicine and Surgery Services 93000  Service Not Available  Service Not Available  Service Not Available
Insertion of catheter into left heart for diagnosis Medicine and Surgery Services 93452  Service Not Available  Service Not Available  Service Not Available
Sleep study Medicine and Surgery Services 95810  Service Not Available  Service Not Available  Service Not Available
Physical therapy, therapeutic exercise Medicine and Surgery Services 97110 $208.00 $208.00 $105.61
Combined Anterior And Posterior Spinal Fusion Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 455  Outpatient Charge at CPT $291,364.73 $66,195.07
Combined Anterior And Posterior Spinal Fusion With Comorbid Conditions Medicine and Surgery Services 454  Outpatient Charge at CPT $383,121.43 $90,816.20
Hip And Femur Procedures Except Major Joint With Comorbid Conditions Medicine and Surgery Services 481  Outpatient Charge at CPT $183,917.16 $11,574.24
Hip And Femur Procedures Except Major Joint Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 482  Outpatient Charge at CPT $228,267.77 $15,721.44
Cervical Spinal Fusion With Comorbid Conditions Medicine and Surgery Services 472  Outpatient Charge at CPT $179,059.42 $35,831.23
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 494  Outpatient Charge at CPT $219,505.07 $13,833.31
Revision Of Hip Or Knee Replacement Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 468  Outpatient Charge at CPT $366,780.47 $34,777.57
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 517  Outpatient Charge at CPT $195,298.30 $12,140.38
Aftercare, Musculoskeletal System And Connective Tissue With Comorbid Conditions Medicine and Surgery Services 560  Outpatient Charge at CPT $121,779.94 $7,198.93
Knee Procedures Without Principal Diagnosis Of Infection Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 489  Outpatient Charge at CPT $76,598.71 $11,582.80
Combined Anterior And Posterior Spinal Fusion With Major Comorbid Conditions Or Complications Medicine and Surgery Services 453  Outpatient Charge at CPT $538,170.34 $145,763.81
Knee Procedures With Principal Diagnosis Of Infection Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 487  Outpatient Charge at CPT $50,046.00 $13,285.88
Major Joint Or Limb Reattachment Procedures Of Upper Extremities Medicine and Surgery Services 483  Outpatient Charge at CPT $299,511.95 $22,007.32
Spinal Procedures Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 30  Outpatient Charge at CPT $73,918.77 $12,256.92
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Major Comorbid Conditions Or Complications Medicine and Surgery Services 522  Outpatient Charge at CPT $133,573.50 $11,383.32
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Comorbid Conditions Medicine and Surgery Services 493  Outpatient Charge at CPT $192,717.20 $21,178.40
Postoperative And Post-Traumatic Infections Without Major Comorbid Conditions Or Complications Medicine and Surgery Services 863  Outpatient Charge at CPT $7,929.53 $5,082.48
Revision Of Hip Or Knee Replacement With Comorbid Conditions Medicine and Surgery Services 467  Outpatient Charge at CPT $242,471.38 $46,008.51
Back And Neck Procedures Except Spinal Fusion Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 520  Outpatient Charge at CPT $99,008.76 $4,643.40
Soft Tissue Procedures Without Cc/Major Comorbid Conditions Or Complications Medicine and Surgery Services 502  Outpatient Charge at CPT $129,583.79 $19,441.96
Fractures Of Hip And Pelvis Without Major Comorbid Conditions Or Complications Medicine and Surgery Services 536  Outpatient Charge at CPT $12,299.04 $4,012.32
Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 513  Outpatient Charge at CPT $29,618.34 $4,395.68
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Comorbid Conditions Medicine and Surgery Services 857  Outpatient Charge at CPT $86,011.34 $23,126.40
Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Comorbid Conditions/Major Comorbid Conditions Or Complications Medicine and Surgery Services 514  Outpatient Charge at CPT $95,314.15 $13,240.95
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Major Comorbid Conditions Or Complications Medicine and Surgery Services 462  Outpatient Charge at CPT $229,909.51 $42,603.91
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Comorbid Conditions Medicine and Surgery Services 516  Outpatient Charge at CPT $104,511.88 $6,424.56
Sho arthrs srg rt8tr cuf rpr Medicine and Surgery Services 29827 $83,780.48  Included in Inpatient Charge $16,527.86
Knee arthroscopy/surgery Medicine and Surgery Services 29876 $40,242.25  Included in Inpatient Charge $8,802.84
Total hip arthroplasty Medicine and Surgery Services 27130 $123,097.60  Included in Inpatient Charge $24,222.72
Total knee arthroplasty Medicine and Surgery Services 27447 $133,250.48  Included in Inpatient Charge $26,413.51
Hip arthro w/labral repair Medicine and Surgery Services 29916 $130,585.23  Included in Inpatient Charge $19,762.22
Knee arthroscopy/surgery Medicine and Surgery Services 29888 $91,149.30  Included in Inpatient Charge $12,911.32
Sho arthrs srg bicp tenodsis Medicine and Surgery Services 29828 $60,925.55  Included in Inpatient Charge $12,549.45
Arthrd ant ntrbdy cervical Medicine and Surgery Services 22551 $112,319.97  Included in Inpatient Charge $26,652.58
Repair of ruptured tendon Medicine and Surgery Services 24342 $54,769.82  Included in Inpatient Charge $13,020.49
Revision of knee joint Medicine and Surgery Services 27446 $100,641.50  Included in Inpatient Charge $21,377.65
Sho arthrs srg rpr slap les Medicine and Surgery Services 29807 $59,475.47  Included in Inpatient Charge $12,631.22
Sho arthrs srg capsulorraphy Medicine and Surgery Services 29806 $131,528.65  Included in Inpatient Charge $11,742.80
Reconstruct shoulder joint Medicine and Surgery Services 23472 $139,876.61  Included in Inpatient Charge $28,708.88
Hip arthro acetabuloplasty Medicine and Surgery Services 29915 $105,753.44  Included in Inpatient Charge $13,584.99
Treat clavicle fracture Medicine and Surgery Services 23515 $80,033.36  Included in Inpatient Charge $12,780.21
Low back disk surgery Medicine and Surgery Services 63030 $76,234.12  Included in Inpatient Charge $10,551.33
Repair of thigh muscle Medicine and Surgery Services 27385 $100,194.07  Included in Inpatient Charge $14,266.03
Lam facetec & foramot lumbar Medicine and Surgery Services 63047 $81,291.88  Included in Inpatient Charge $12,033.76
Treat humerus fracture Medicine and Surgery Services 23615 $105,742.59  Included in Inpatient Charge $25,326.40
Treat ulnar fracture Medicine and Surgery Services 24685 $97,546.31  Included in Inpatient Charge $10,372.41
Treat fx radial 3+ frag Medicine and Surgery Services 25609 $92,610.35  Included in Inpatient Charge $15,282.20
Knee arthroscopy/surgery Medicine and Surgery Services 29880 $33,502.36  Included in Inpatient Charge $11,050.92
Repair of knee ligament Medicine and Surgery Services 27405 $47,881.90  Included in Inpatient Charge $14,808.61
Sho arthrs srg dstl claviclc Medicine and Surgery Services 29824 $43,525.47  Included in Inpatient Charge $10,860.64
Incision of hip tendons Medicine and Surgery Services 27006 $72,726.10  Included in Inpatient Charge $7,535.80
Sho arthrs srg lss&rescj ads Medicine and Surgery Services 29825 $38,700.68  Included in Inpatient Charge $10,632.01
Removal of support implant Medicine and Surgery Services 20680 $48,047.17  Included in Inpatient Charge $7,022.31
Treat radius fracture Medicine and Surgery Services 24665 $45,346.38  Included in Inpatient Charge $10,727.57
Repair achilles tendon Medicine and Surgery Services 27650 $28,911.50  Included in Inpatient Charge $9,710.52
Repair/graft wrist bone Medicine and Surgery Services 25440 $66,186.96  Included in Inpatient Charge $10,727.57
Treat clavicle dislocation Medicine and Surgery Services 23550 $67,749.94  Included in Inpatient Charge $17,026.63
Treat lower leg joint Medicine and Surgery Services 27829 $76,492.48  Included in Inpatient Charge $16,353.80
Arthrodesis sacroiliac joint Medicine and Surgery Services 27279 $116,281.91  Included in Inpatient Charge $28,232.20
Repair biceps tendon Medicine and Surgery Services 23430 $41,125.18  Included in Inpatient Charge $12,001.91
Muscle transfer shoulder/arm Medicine and Surgery Services 23395 $79,503.05  Included in Inpatient Charge $20,099.37
Njx px discography lumbar Medicine and Surgery Services 62290 $18,463.56  Included in Inpatient Charge $16,212.55
Revision of unstable kneecap Medicine and Surgery Services 27422 $112,032.41  Included in Inpatient Charge $9,206.42
Treat fx rad intra-articul Medicine and Surgery Services 25608 $83,723.96  Included in Inpatient Charge $10,591.32
Wrist arthroscopy Medicine and Surgery Services 29840 $39,650.81  Included in Inpatient Charge $12,169.79
Implant spinal canal cath Medicine and Surgery Services 62350 $232,404.15  Included in Inpatient Charge $7,382.07
Repair of shoulder Medicine and Surgery Services 23420 $79,260.59  Included in Inpatient Charge $17,228.02
Treat humerus fracture Medicine and Surgery Services 24515 $46,081.44  Included in Inpatient Charge $22,849.36
Treat metacarpal fracture Medicine and Surgery Services 26615 $19,932.15  Included in Inpatient Charge $9,880.00
Incision of tendon sheath Medicine and Surgery Services 25000 $18,074.91  Included in Inpatient Charge $7,216.54
Repr elbw med ligmnt w/tissu Medicine and Surgery Services 24345 $39,012.68  Included in Inpatient Charge $11,485.34
Hip arthro w/femoroplasty Medicine and Surgery Services 29914 $85,813.35  Included in Inpatient Charge $9,969.80
Reconstruct elbow med ligmnt Medicine and Surgery Services 24346 $52,904.74  Included in Inpatient Charge $22,849.36
Implant neuroelectrodes Medicine and Surgery Services 63655 $267,500.80  Included in Inpatient Charge $48,720.06
Partial removal of fibula Medicine and Surgery Services 27641 $74,157.44  Included in Inpatient Charge $10,980.00
Fuse hand bones with graft Medicine and Surgery Services 25825 $77,267.80  Included in Inpatient Charge $11,485.34
Arthrd pst tq 1ntrspc lumbar Medicine and Surgery Services 22612 $87,106.61  Included in Inpatient Charge $21,421.28
Tibial arthroscopy/surgery Medicine and Surgery Services 29855 $75,625.11  Included in Inpatient Charge $15,427.27
Destroy lumb/sac facet jnt Medicine and Surgery Services 64635 $15,714.57  Included in Inpatient Charge $8,100.00
Knee arthroscopy/surgery Medicine and Surgery Services 29879 $69,692.80  Included in Inpatient Charge $7,935.69
Revise lower leg tendon Medicine and Surgery Services 27691 $35,856.88  Included in Inpatient Charge $10,013.13
Ankle arthroscopy/surgery Medicine and Surgery Services 29891 $66,664.88  Included in Inpatient Charge $9,969.80
Repair of ankle ligament Medicine and Surgery Services 27695 $52,089.56  Included in Inpatient Charge $18,141.88
Removal of kneecap Medicine and Surgery Services 27350 $36,272.44  Included in Inpatient Charge $15,427.27
Reconstruct ankle joint Medicine and Surgery Services 27702 $157,074.14  Included in Inpatient Charge $22,269.65
Treat fx rad extra-articul Medicine and Surgery Services 25607 $185,369.07  Included in Inpatient Charge $9,969.80
Optx medial ankle fx Medicine and Surgery Services 27766 $43,107.74  Included in Inpatient Charge $14,113.30
Repair humerus with graft Medicine and Surgery Services 24435 $124,953.31  Included in Inpatient Charge $19,597.24
Treatment of ankle fracture Medicine and Surgery Services 27792 $56,064.16  Included in Inpatient Charge $24,712.48
Total hip arthroplasty Medicine and Surgery Services 27132 $112,128.29  Included in Inpatient Charge $34,257.80
Treatment of ankle fracture Medicine and Surgery Services 27814 $213,097.12  Included in Inpatient Charge $16,819.26
Elbow arthroscopy/surgery Medicine and Surgery Services 29838 $36,229.47  Included in Inpatient Charge $25,032.48
Treat lower leg fracture Medicine and Surgery Services 27828 $81,325.90  Included in Inpatient Charge $18,845.06
Wrist arthroscopy/surgery Medicine and Surgery Services 29846 $110,186.00  Included in Inpatient Charge $11,087.15
Perq vertebral augmentation Medicine and Surgery Services 22513 $86,122.08  Included in Inpatient Charge $11,485.33
Knee arthroscopy/surgery Medicine and Surgery Services 29875 $25,579.38  Included in Inpatient Charge $12,215.02
Revision of foot tendon Medicine and Surgery Services 28238 $102,122.19  Included in Inpatient Charge $20,099.35
Knee arthroscopy/surgery Medicine and Surgery Services 29877 $58,545.97  Included in Inpatient Charge $12,215.02
Correction hallux valgus Medicine and Surgery Services 28299 $108,621.84  Included in Inpatient Charge $11,485.35
Transplant forearm tendon Medicine and Surgery Services 25312 $92,818.78  Included in Inpatient Charge $7,731.77
Incision of metatarsal Medicine and Surgery Services 28308 $30,254.15  Included in Inpatient Charge $9,969.80
Repair/revise wrist joint Medicine and Surgery Services 25320 $48,452.90  Included in Inpatient Charge $11,692.36
Treat metatarsal fracture Medicine and Surgery Services 28485 $52,757.67  Included in Inpatient Charge $9,969.80
Ankle arthroscopy/surgery Medicine and Surgery Services 29898 $88,499.08  Included in Inpatient Charge $7,935.69
Remove spine eltrd plate Medicine and Surgery Services 63662 $52,286.44  Included in Inpatient Charge $8,638.14
Shorten radius or ulna Medicine and Surgery Services 25390 $34,161.99  Included in Inpatient Charge $13,858.07
Fusion of big toe joint Medicine and Surgery Services 28750 $72,818.03  Included in Inpatient Charge $6,378.00
Repair of kneecap tendon Medicine and Surgery Services 27380 $70,061.48  Included in Inpatient Charge $11,485.34
Repair elbow perc Medicine and Surgery Services 24357 $13,332.30  Included in Inpatient Charge $12,169.79
Repair wrist joints Medicine and Surgery Services 25447 $36,402.57  Included in Inpatient Charge $7,326.89
Repair elbow w/deb open Medicine and Surgery Services 24358 $23,809.98  Included in Inpatient Charge $6,573.60
Implant neuroelectrodes Medicine and Surgery Services 63650 $49,912.62  Included in Inpatient Charge $37,550.15
Sho arthrs srg lmtd dbrdmt Medicine and Surgery Services 29822 $40,410.85  Included in Inpatient Charge $12,215.02
Revise finger joint Medicine and Surgery Services 26535 $39,848.36  Included in Inpatient Charge $6,557.08
Sho arthrs srg xtnsv dbrdmt Medicine and Surgery Services 29823 $41,367.60  Included in Inpatient Charge $8,822.20
Repair foot dislocation Medicine and Surgery Services 28615 $106,724.04  Included in Inpatient Charge $9,969.80
Nrv rpr w/nrv algrft 1st Medicine and Surgery Services 64912 $74,470.15  Included in Inpatient Charge $10,605.12
Repair of achilles tendon Medicine and Surgery Services 27654 $161,110.78  Included in Inpatient Charge $10,046.29
CT Abdomen & Pelvis Without Contrast Material Radiology Services 74176 $9,993.60 $9,993.60 $489.97
CT Abdomen Without & With Contrast Material Radiology Services 74170 $9,721.20 $9,721.20 $418.54
CT Abdomen With Contrast Material Radiology Services 74160 $7,780.80 $7,780.80 $418.54
CT Abdomen Without Contrast Material Radiology Services 74150 $7,129.80 $7,129.80 $320.88
CT Abdomen & Pelvis Without Contrst 1/> Body Re Radiology Services 74178 $13,123.20 $13,123.20 $690.17
CT Thorax With Contrast Material Radiology Services 71260 $7,908.00 $7,908.00 $418.54
CT Thorax Without & With Contrast Material Radiology Services 71270 $9,721.20 $9,721.20 $418.54
CT Thorax Without Contrast Material Radiology Services 71250 $7,097.40 $7,097.40 $320.88
CT Cervical Spine With Contrast Material Radiology Services 72126 $7,780.80 $7,780.80 $690.17
CT Cervical Spine Without &With Contrast Material Radiology Services 72127 $9,721.20 $9,721.20 $418.54
CT Cervical Spine Without Contrast Material Radiology Services 72125 $7,129.80 $7,129.80 $320.88
CT Head/Brain With Contrast Material Radiology Services 70460 $6,775.20 $6,775.20 $418.54
CT Head/Brain Without & With Contrast Material Radiology Services 70470 $8,101.20 $8,101.20 $418.54
CT Lumbar Spine With Contrast Material Radiology Services 72132 $7,780.80 $7,780.80 $690.17
CT Lumbar Spine Without & With Contrast Material Radiology Services 72133 $9,721.20 $9,721.20 $418.54
CT Lumbar Spine Without Contrast Material Radiology Services 72131 $7,129.80 $7,129.80 $320.88
CT Lower Extremity With Contrast Material Radiology Services 73701 $7,780.80 $7,780.80 $418.54
CT Lower Extremity Without Contrast Material Radiology Services 73700 $7,129.80 $7,129.80 $320.88
CT Lower Extremity Without & With Contrast Matrl Radiology Services 73702 $9,721.20 $9,721.20 $418.54
CT Maxillofacial Without & With Contrast Material Radiology Services 70488 $6,884.40 $6,884.40 $418.54
CT Maxillofacial Without Contrast Material Radiology Services 70486 $6,655.20 $6,655.20 $320.88
CT Soft Tissue Neck Without & With Contrast Material Radiology Services 70492 $6,157.80 $6,157.80 $418.54
CT Soft Tissue Neck Without Contrast Material Radiology Services 70490 $6,157.80 $6,157.80 $320.88
CT Pelvis Without & With Contrast Material Radiology Services 72194 $7,780.80 $7,780.80 $418.54
CT Pelvis Without Contrast Material Radiology Services 72192 $6,196.20 $6,196.20 $320.88
CT Thoracic Spine With Contrast Material Radiology Services 72129 $7,780.80 $7,780.80 $418.54
CT Thoracic Spine Without & With Contrast Material Radiology Services 72130 $9,721.20 $9,721.20 $418.54
CT Thoracic Spine Without Contrast Material Radiology Services 72128 $7,129.80 $7,129.80 $320.88
CT Upper Extremity With Contrast Material Radiology Services 73201 $5,931.60 $5,931.60 $690.17
CT Upper Extremity Without Contrast Material Radiology Services 73200 $5,931.60 $5,931.60 $320.88
CT Upper Extremity Without & With Contrast Material Radiology Services 73202 $4,382.40 $4,382.40 $418.54
MRI Abdomen Without Contrast Material Radiology Services 74181 $4,989.60 $4,989.60 $623.30
MRI Abdomen With Contrast Material Radiology Services 74182 $8,186.40 $8,186.40 $823.50
MRI Abdomen Without & With Contrast Material Radiology Services 74183 $8,186.40 $8,186.40 $823.50
MRI Brain Brain Stem Without Contrast Material Radiology Services 70551 $4,989.60 $4,989.60 $623.30
MRI Chest With Contrast Material Radiology Services 71551 $14,580.00 $14,580.00 $1,275.25
MRI Chest Without & With Contrast Material Radiology Services 71552 $8,186.40 $8,186.40 $823.50
MRI Chest Without Contrast Material Radiology Services 71550 $4,989.60 $4,989.60 $623.30
MRI Spinal Canal Cervical With Contrast Matrl Radiology Services 72142 $8,186.40 $8,186.40 $823.50
MRI Spinal Canal Cervical Without Contrast Matrl Radiology Services 72141 $4,989.60 $4,989.60 $623.30
MRI Spinal Canal Cervical Without & With Contr Matrl Radiology Services 72156 $8,186.40 $8,186.40 $823.50
MRI Spinal Canal Lumbar With Contrast Material Radiology Services 72149 $8,186.40 $8,186.40 $823.50
MRI Spinal Canal Lumbar Without & With Contr Matrl Radiology Services 72158 $8,186.40 $8,186.40 $823.50
MRI Any Jt Lower Extrem With Contrast Material Radiology Services 73722 $14,580.00 $14,580.00 $1,275.25
MRI Any Jt Lower Extrem Without & With Contrast Matrl Radiology Services 73723 $8,186.40 $8,186.40 $823.50
MRI Lower Extrem Oth/Thn Jt Without Contr Matrl Radiology Services 73718 $4,989.60 $4,989.60 $623.30
MRI Lower Extrem Oth/Thn Jt With Contrast Matrl Radiology Services 73719 $8,186.40 $8,186.40 $823.50
MRI Lower Extrem Oth/Thn Jt Without & With Contr Matr Radiology Services 73720 $8,186.40 $8,186.40 $823.50
MRI Orbit Face & Neck With Contrast Material Radiology Services 70542 $8,186.40 $8,186.40 $823.50
MRI Orbit Face &/Neck Without Contrast Radiology Services 70540 $4,989.60 $4,989.60 $623.30
MRI Orbit Face & Neck Without & With Contrast Matrl Radiology Services 70543 $8,186.40 $8,186.40 $823.50
MRI Pelvis With Contrast Material Radiology Services 72196 $8,186.40 $8,186.40 $823.50
MRI Pelvis Without & With Contrast Material Radiology Services 72197 $8,186.40 $8,186.40 $823.50
MRI Pelvis Without Contrast Material Radiology Services 72195 $4,989.60 $4,989.60 $623.30
MRI Spinal Canal Thoracic With Contrast Matrl Radiology Services 72147 $8,186.40 $8,186.40 $823.50
MRI Spinal Canal Thoracic Without Contrast Matrl Radiology Services 72146 $4,989.60 $4,989.60 $623.30
MRI Spinal Canal Thoracic Without & With Contr Matrl Radiology Services 72157 $8,186.40 $8,186.40 $823.50
MRI Any Jt Upper Extremity With Contrast Matrl Radiology Services 73222 $14,580.00 $14,580.00 $1,275.25
MRI Any Jt Upper Extremity Without Contrast Matrl Radiology Services 73221 $4,989.60 $4,989.60 $623.30
MRI Any Jt Upper Extremity Without & With Contr Matrl Radiology Services 73223 $8,186.40 $8,186.40 $823.50
MRI Upper Extrem Other Than Jt Without & With Contras Radiology Services 73220 $8,186.40 $8,186.40 $823.50
MRI Upper Extremity Oth Than Jt With Contr Matrl Radiology Services 73219 $8,186.40 $8,186.40 $823.50
MRI Upper Extremity Oth Than Jt Without Contr Matrl Radiology Services 73218 $4,989.60 $4,989.60 $623.30
X-Ray Abdomen Kub 1 View Radiology Services 74018 $1,564.80 $1,564.80 $116.40
X-Ray Ankle 2 Views Radiology Services 73600 $946.20 $946.20 $117.10
X-Ray Ankle 3 Views Radiology Services 73610 $3,657.60 $3,657.60 $117.57
X-Ray Heel / Calcaneus 2 Views Radiology Services 73650 $1,416.00 $1,416.00 $116.32
X-Ray Chest 1 View Radiology Services 71045 $1,392.00 $1,392.00 $115.62
X-Ray Chest 2 Views Radiology Services 71046 $1,359.60 $1,359.60 $116.71
X-Ray Clavicle 2 Views Radiology Services 73000 $1,334.40 $1,334.40 $116.71
X-Ray Cervical Spine < 4 Views Radiology Services 72040 $1,088.40 $1,088.40 $117.72
X-Ray Elbow Radiology Services 73070 $1,862.40 $1,862.40 $116.32
X-Ray Elbow 3 Views Radiology Services 73080 $1,140.00 $1,140.00 $116.79
X-Ray Facial Bones 3 Views Radiology Services 70150 $1,366.20 $1,366.20 $160.82
X-Ray Femur 2 Views Radiology Services 73552 $2,491.20 $2,491.20 $117.49
X-Ray Fingers Min 2 Views Radiology Services 73140 $719.40 $719.40 $118.03
X-Ray Foot 2 Views Radiology Services 73620 $1,065.60 $1,065.60 $116.40
X-Ray Foot 3 Views Complete Radiology Services 73630 $1,348.80 $1,348.80 $117.18
X-Ray Forearm 2 Views Radiology Services 73090 $1,555.20 $1,555.20 $116.48
X-Ray Hand 2 Views Radiology Services 73120 $1,780.80 $1,780.80 $158.72
X-Ray Hand Min 3 Views Radiology Services 73130 $2,112.00 $2,112.00 $117.57
X-Ray Hip Unilateral With Pelvis 1 View Radiology Services 73501 $753.60 $753.60 $116.87
X-Ray Hip L / R With Or Without Pelvis Min 2-3 Views Radiology Services 73502 $753.60 $753.60 $119.13
X-Ray Humerus 2 Views Radiology Services 73060 $1,045.20 $1,045.20 $116.94
X-Ray Knee 1-2 Views Radiology Services 73560 $1,173.60 $1,173.60 $117.41
X-Ray Knee 3 Views Radiology Services 73562 $2,452.80 $2,452.80 $118.27
X-Ray Exam Of Knee 4 Views Radiology Services 73564 $1,267.20 $1,267.20 $160.82
X-Ray Lateral Spine 2-3 Views Radiology Services 72100 $1,561.20 $1,561.20 $159.73
X-Ray Mastoids 3 Views Radiology Services 70120 $714.60 $714.60 $159.73
X-Ray Nasal Bones 3 Views Radiology Services 70160 $816.60 $816.60 $117.80
X-Ray Neck Soft Tissue Radiology Services 70360 $524.40 $524.40 $116.94
X-Ray OR Skull 4 Views AP-Lateral Radiology Services 70250 $1,682.40 $1,682.40 $159.73
X-Ray Paranasal Sinuses 3 Views Radiology Services 70220 $1,206.00 $1,206.00 $117.96
X-Ray Pelvis 1-2 Views Radiology Services 72170 $1,105.80 $1,105.80 $159.50
X-Ray Pelvis 3+ Views Radiology Services 72190 $1,206.00 $1,206.00 $160.51
X-Ray Ribs 4 Views Radiology Services 71111 $609.50 $609.50 $161.29
X-Ray Ribs 3 Views Radiology Services 71101 $836.40 $836.40 $159.81
X-Ray Coccyx / Sacrum 2 Views Radiology Services 72220 $914.40 $914.40 $116.94
X-Ray Scapula Radiology Services 73010 $804.00 $804.00 $159.18
X-Ray Shoulder 1 View Radiology Services 73020 $914.40 $914.40 $115.62
X-Ray Shoulder 2 Views Radiology Services 73030 $2,448.00 $2,448.00 $116.71
X-Ray Sinuses < 3 Views Radiology Services 70210 $621.60 $621.60 $117.18
X-Ray Skull 4 Views Radiology Services 70260 $1,562.40 $1,562.40 $160.74
X-Ray Spine 1 View Radiology Services 72020 $979.20 $979.20 $115.54
X-Ray Tib/Fib 2 Views Radiology Services 73590 $2,366.40 $2,366.40 $116.87
X-Ray Toe(s) 2 Views Radiology Services 73660 $1,053.60 $1,053.60 $117.02
X-Ray Thoracic Spine 2 Views Radiology Services 72070 $1,206.00 $1,206.00 $159.18
X-Ray Thoracic Spine 3 Views Radiology Services 72072 $1,105.80 $1,105.80 $159.73
X-Ray Wrist 2 Views Radiology Services 73100 $2,040.00 $2,040.00 $117.33
X-Ray Wrist 3 Views Radiology Services 73110 $2,452.80 $2,452.80 $118.27
Electrolyte panel Laboratory & Pathology Services 80051 $714.60 $714.60 $6.89
Acute hepatitis panel Laboratory & Pathology Services 80074 $1,483.20 $1,483.20 $46.84
Assay dipropylacetic acd tot Laboratory & Pathology Services 80164 $714.60 $714.60 $13.32
Assay of vancomycin Laboratory & Pathology Services 80202 $1,145.40 $1,145.40 $13.32
Drug test prsmv dir opt obs Laboratory & Pathology Services 80305 $177.60 $177.60 $12.10
Urine pregnancy test Laboratory & Pathology Services 81025 $408.00 $408.00 $8.27
Assay of serum albumin Laboratory & Pathology Services 82040 $292.20 $292.20 $4.87
Assay of ammonia Laboratory & Pathology Services 82140 $523.20 $523.20 $14.33
Assay of amylase Laboratory & Pathology Services 82150 $868.80 $868.80 $6.37
Bilirubin total Laboratory & Pathology Services 82247 $634.20 $634.20 $4.94
Occult blood feces Laboratory & Pathology Services 82270 $130.50 $130.50 $4.20
Vitamin d 25 hydroxy Laboratory & Pathology Services 82306 $843.00 $843.00 $29.11
Assay of calcium Laboratory & Pathology Services 82310 $498.60 $498.60 $5.07
Assay of ck (cpk) Laboratory & Pathology Services 82550 $445.20 $445.20 $6.40
Creatine mb fraction Laboratory & Pathology Services 82553 $1,003.20 $1,003.20 $11.36
Assay of creatinine Laboratory & Pathology Services 82565 $524.40 $524.40 $5.04
Vitamin b-12 Laboratory & Pathology Services 82607 $582.60 $582.60 $14.83
Assay of ferritin Laboratory & Pathology Services 82728 $283.20 $283.20 $13.40
Assay of folic acid serum Laboratory & Pathology Services 82746 $473.40 $473.40 $14.46
Blood gases w/o2 saturation Laboratory & Pathology Services 82805 $1,260.00 $1,260.00 $75.62
Assay glucose blood quant Laboratory & Pathology Services 82947 $253.80 $253.80 $3.87
Glucose blood test Laboratory & Pathology Services 82962 $88.20 $88.20 $3.15
Glycosylated hemoglobin test Laboratory & Pathology Services 83036 $419.40 $419.40 $9.55
Immunoassay nonantibody Laboratory & Pathology Services 83516 $363.60 $363.60 $11.34
Assay of iron Laboratory & Pathology Services 83540 $796.80 $796.80 $6.36
Iron binding test Laboratory & Pathology Services 83550 $30.00 $30.00 $8.60
Assay of lactic acid Laboratory & Pathology Services 83605 $610.80 $610.80 $11.17
Assay of lipase Laboratory & Pathology Services 83690 $505.80 $505.80 $6.77
Assay of magnesium Laboratory & Pathology Services 83735 $505.80 $505.80 $6.59
Assay of natriuretic peptide Laboratory & Pathology Services 83880 $678.00 $678.00 $37.69
Assay of blood osmolality Laboratory & Pathology Services 83930 $697.20 $697.20 $6.50
Assay alkaline phosphatase Laboratory & Pathology Services 84075 $598.20 $598.20 $5.09
Assay of serum potassium Laboratory & Pathology Services 84132 $448.80 $448.80 $4.64
Assay of prealbumin Laboratory & Pathology Services 84134 $714.60 $714.60 $14.35
Assay of serum sodium Laboratory & Pathology Services 84295 $253.80 $253.80 $4.73
Assay of vitamin b-1 Laboratory & Pathology Services 84425 $212.54 $212.54 $20.88
Assay of total thyroxine Laboratory & Pathology Services 84436 $407.40 $407.40 $6.75
Assay of free thyroxine Laboratory & Pathology Services 84439 $898.80 $898.80 $8.87
Transferase (ast) (sgot) Laboratory & Pathology Services 84450 $498.60 $498.60 $5.09
Alanine amino (alt) (sgpt) Laboratory & Pathology Services 84460 $468.00 $468.00 $5.21
Assay of troponin quant Laboratory & Pathology Services 84484 $1,072.20 $1,072.20 $11.97
Assay of urea nitrogen Laboratory & Pathology Services 84520 $419.40 $419.40 $3.89
Assay of blood/uric acid Laboratory & Pathology Services 84550 $411.60 $411.60 $4.44
Hematocrit Laboratory & Pathology Services 85014 $190.20 $190.20 $2.33
Hemoglobin Laboratory & Pathology Services 85018 $190.20 $190.20 $2.33
Automated reticulocyte count Laboratory & Pathology Services 85045 $363.60 $363.60 $3.93
Automated platelet count Laboratory & Pathology Services 85049 $245.40 $245.40 $4.40
Fibrin degradation quant Laboratory & Pathology Services 85379 $1,237.20 $1,237.20 $10.01
Blood platelet aggregation Laboratory & Pathology Services 85576 $2.40 $2.40 $23.91
Rbc sed rate automated Laboratory & Pathology Services 85652 $253.80 $253.80 $2.66
C-reactive protein Laboratory & Pathology Services 86140 $375.00 $375.00 $5.09
Hiv-1/hiv-2 1 result antbdy Laboratory & Pathology Services 86703 $683.40 $683.40 $13.48
Hep b surface antibody Laboratory & Pathology Services 86706 $683.40 $683.40 $10.56
COVID-19, Antibody Laboratory & Pathology Services 86769 $864.00 $864.00 $42.13
Hepatitis c ab test Laboratory & Pathology Services 86803 $683.40 $683.40 $14.03
Rbc antibody screen Laboratory & Pathology Services 86850 $564.00 $564.00 $54.41
Blood typing serologic abo Laboratory & Pathology Services 86900 $326.40 $326.40 $119.23
Blood typing serologic rh(d) Laboratory & Pathology Services 86901 $326.40 $326.40 $36.47
Compatibility test each unit; immediate spin technique Laboratory & Pathology Services 86920 $561.00 $561.00 $161.89
Blood culture for bacteria Laboratory & Pathology Services 87040 $849.60 $849.60 $10.15
Culture othr specimn aerobic Laboratory & Pathology Services 87070 $705.60 $705.60 $8.48
Culture bacteria anaerobic Laboratory & Pathology Services 87073 $525.60 $525.60 $9.45
Culture screen only Laboratory & Pathology Services 87081 $426.60 $426.60 $6.52
Urine culture/colony count Laboratory & Pathology Services 87086 $746.40 $746.40 $7.94
Skin fungi culture Laboratory & Pathology Services 87101 $660.00 $660.00 $7.58
Fungus isolation culture Laboratory & Pathology Services 87102 $660.00 $660.00 $8.27
Mycobacteria culture Laboratory & Pathology Services 87116 $625.20 $625.20 $10.62
Smear gram stain Laboratory & Pathology Services 87205 $637.80 $637.80 $4.20
Smear fluorescent/acid stai Laboratory & Pathology Services 87206 $625.20 $625.20 $5.30
Hepatitis b surface ag ia Laboratory & Pathology Services 87340 $601.80 $601.80 $10.16
COVID-19, Antigen Laboratory & Pathology Services 87426 $864.00 $864.00 $51.31
COVID-19, PCR Laboratory & Pathology Services 87635 $864.00 $864.00 $51.31
Mr-staph dna amp probe Laboratory & Pathology Services 87641 $825.60 $825.60 $34.50
Strep a assay w/optic Laboratory & Pathology Services 87880 $648.60 $648.60 $15.87
Level I-Surgical pathology, gross examination only Laboratory & Pathology Services 88300 $828.00 $828.00 $27.19
Level III- Surgical pathology, gross and microscopic examination Laboratory & Pathology Services 88304 $345.00 $345.00 $57.18
Level IV- Surgical pathology, gross and microscopic examination Laboratory & Pathology Services 88305 $2,115.60 $2,115.60 $57.38
Level V- Surgical pathology, gross and microscopic examination Laboratory & Pathology Services 88307 $778.20 $778.20 $334.12
Decalcification procedure (List separately in addition to code for surgic Laboratory & Pathology Services 88311 $874.80 $874.80 $8.66
Immunohistochemistry or immunocytochemistry, per specimen; each ad Laboratory & Pathology Services 88341 $571.20 $571.20 $62.12
Immunohistochemistry (including tissue immunoperoxidase), each anti b Laboratory & Pathology Services 88342 $288.00 $288.00 $166.84