Hospital Charges / Price Transparency

OVERVIEW 

In compliance with the Centers for Medicare and Medicaid Services (CMS), Sabine County Hospital is making available to the public a copy of its standard charges known as a “Charge Master,” “Charge Description Master” or “CDM”.

Since payment rates for hospital care provided to insured patients are either negotiated with health plans, set by the federal government for Medicare, or set by state governments for Medicaid enrollees, the payments hospitals receive for patient care do not necessarily reflect the prices reflected in the Charge Master.  A patient’s responsibility may vary depending on the payment plans negotiated with insurance companies as well as the patient’s individual and/or family deductibles and co-payments with their insurance plan.  Additionally, uninsured patients are not generally expected to pay the hospital’s standard charges as reflected in the CDM and may be eligible for financial assistance.

The information provided is based on information we have gathered from contracts with managed care commercial insurance plans.  This is not a guarantee of what you will be charged. Your actual charges may differ from the estimated charges for many reasons, including the seriousness of your medical condition, actual time the procedure takes and the services and supplies that you receive.

The charges listed here are for services from the Hospital.  They do not reflect the charges for physicians (such as surgeon, anesthesiologist, radiologist, pathologist, etc.) who may be involved in providing particular services to a patient. These charges are billed separately from the individual physician/physicians group.

Sabine County Hospital shall not be liable for any difference between charges listed in the price lists and the final bill for services.

AVAILABLE FILES 
There are two files regarding the hospital’s CDM for price transparency. 

The CSV file is a comprehensive, machine-readable file that makes public all standard charge information for all hospital items and services.  This can easily be imported into Microsoft Excel or similar software. This file contains the following information: 

  • Charge Code – specific charge code for each item or service
  • Description – description of each item or service
  • Department – department where item or service performed
  • Rev Code – corresponding department’s revenue code for item or service
  • CPT Code – corresponding CPT billing code for item or service (if applicable)
  • Gross Charge – corresponding gross charge for each individual item or service
  • Cash Price – corresponding discounted cash price that applies to each item or service
  • Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header
  • De-identified minimum negotiated charge that applies to each item or service
  • De-identified maximum negotiated charge that applies to each item or service

The PDF file is a searchable consumer-friendly format of payer-specific negotiated charge information of 300 “shoppable outpatient services” at the hospital.  The file contains the following information: 

  • Charge Code – specific charge code for each item or service
  • Description – description of each item or service
  • Department – department where item or service performed
  • Rev Code – corresponding department’s revenue code for item or service
  • CPT Code – corresponding CPT billing code for item or service (if applicable)
  • Gross Charge – corresponding gross charge for each individual item or service
  • Cash Price – corresponding discounted cash price that applies to each item or service
  • Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header
  • De-identified minimum negotiated charge that applies to each item or service
  • De-identified maximum negotiated charge that applies to each item or service

QUESTIONS?

If you have further questions about the Sabine County Hospital CDM, please contact our hospital business office at (409) 737-3300 or come by and speak to one of our business office representatives.  Thank you for choosing Sabine County Hospital for your health care needs! 

Downloadable CDM and Shoppable Services

Charge Description Master

Shoppable Services

Searchable Shoppable Services

Sabine County Hospital Shoppable Services as of 7/15/2022

Charge NumberDescriptionDeptDept DescriptionRev CodeCPT Code PriceShoppableDiscounted Cash PriceAetna CommercialAetna Medicare AdvantageBCBS - Blue AdvantageBCBS - HMOBCBS - PPOBCBS - TraditionalCIGNAHumana CommercialHumana Medicare AdvantageUnited CommercialUnited Medicare AdvantageMinimum Negotiated PriceMaximum Negotiated Price
7300001#EKG 12 LEAD TRACING730 EKG73093005$170.00O$85.00$85.00$58.96$88.02$108.92$128.17$128.17$110.50$106.59$58.38$121.21$57.80$57.80$128.17
3000120(CK) MB FRACTION ONLY300 Lab30182553$200.00O$100.00$100.00$69.36$28.30$33.03$38.92$38.92$130.00$125.40$68.68$142.60$68.00$28.30$142.60
300090824 HR URN CREA300 Lab30182570$57.00O$28.50$28.50$19.77$12.69$14.81$17.46$17.46$37.05$35.74$19.57$40.64$19.38$12.69$40.64
300085024hr Microalbu(R)300 Lab30182043$93.00O$46.50$46.50$32.25$14.16$16.53$19.48$19.48$60.45$58.31$31.94$66.31$31.62$14.16$66.31
3000693AEROBIC ID #2 (RL)300 Lab30687077$94.00O$47.00$47.00$32.60$19.80$23.11$27.23$27.23$61.10$58.94$32.28$67.02$31.96$19.80$67.02
3000499AEROBIC ID (RL)300 Lab30687077$94.00O$47.00$47.00$32.60$19.80$23.11$27.23$27.23$61.10$58.94$32.28$67.02$31.96$19.80$67.02
3000181AEROBIC SUSCEPTIBILITY300 Lab30687186$125.00O$62.50$62.50$43.35$21.19$24.74$29.15$29.15$81.25$78.38$42.93$89.13$42.50$21.19$89.13
3000498AEROBIC SUSCEPTIBILITY300 Lab30687186$125.00O$62.50$62.50$43.35$21.19$24.74$29.15$29.15$81.25$78.38$42.93$89.13$42.50$21.19$89.13
3000017ALBUMIN;SERUM, PLASMA300 Lab30182040$43.00O$21.50$21.50$14.91$12.13$14.16$16.68$16.68$27.95$26.96$14.77$30.66$14.62$12.13$30.66
3000415ALPHA-FETOPROTEIN SER300 Lab30182105$89.00O$44.50$44.50$30.87$41.09$47.96$56.51$56.51$57.85$55.80$30.56$63.46$30.26$30.26$63.46
3000166AMMONIA (R)300 Lab30182140$74.00O$37.00$37.00$25.66$35.70$41.67$49.10$49.10$48.10$46.40$25.41$52.76$25.16$25.16$52.76
3000022AMYLASE300 Lab30182150$91.00O$45.50$45.50$31.56$15.88$18.53$21.84$21.84$59.15$57.06$31.25$64.88$30.94$15.88$64.88
3000224ANA W/RFX (R)300 Lab30286038$191.00O$95.50$95.50$66.24$29.62$34.58$40.74$40.74$124.15$119.76$65.59$136.18$64.94$29.62$136.18
3000581ANCA W/REFLEX TITER300 Lab30086021$151.00O$75.50$75.50$52.37$36.87$43.04$50.72$50.72$98.15$94.68$51.85$107.66$51.34$36.87$107.66
3000094ANCA-C TITER (RL)300 Lab30086021$151.00O$75.50$75.50$52.37$36.87$43.04$50.72$50.72$98.15$94.68$51.85$107.66$51.34$36.87$107.66
3000486ANGIOTENSION CONVERTIN300 Lab30182164$84.00O$42.00$42.00$29.13$35.77$41.76$49.20$49.20$54.60$52.67$28.85$59.89$28.56$28.56$59.89
3000152Antibody Screen300 Lab30286885$500.00O$250.00$250.00$173.40$351.58$410.41$483.60$483.60$325.00$313.50$171.70$356.50$170.00$170.00$483.60
3000549ANTI-DSNA AB, EIA (R)300 Lab30286225$83.00O$41.50$41.50$28.78$33.66$39.30$46.30$46.30$53.95$52.04$28.50$59.18$28.22$28.22$59.18
3000372ANTI-HEPATITIS B SURFA300 Lab30286706$58.00O$29.00$29.00$20.11$26.31$30.72$36.19$36.19$37.70$36.37$19.92$41.35$19.72$19.72$41.35
3000242APTT-LA300 Lab30585730$60.00R$30.00$30.00$20.81$14.72$17.19$20.25$20.25$39.00$37.62$20.60$42.78$20.40$14.72$42.78
3000391BASIC METABOLIC PANEL,300 Lab30180048$228.00R$114.00$114.00$79.07$20.73$24.20$28.51$28.51$148.20$142.96$78.30$162.56$77.52$20.73$162.56
3000299BETA HCG SERUM (RL)300 Lab30184702$74.00O$37.00$37.00$25.66$36.87$43.04$50.72$50.72$48.10$46.40$25.41$52.76$25.16$25.16$52.76
3000029BILIRUBIN BLOOD DIRECT300 Lab30182248$57.00O$28.50$28.50$19.77$12.30$14.36$16.92$16.92$37.05$35.74$19.57$40.64$19.38$12.30$40.64
3000028BILIRUBIN;BLOOD,TOTAL300 Lab30182247$57.00O$28.50$28.50$19.77$12.30$14.36$16.92$16.92$37.05$35.74$19.57$40.64$19.38$12.30$40.64
3000434BNP - Natriuretic Peptide300 Lab30183880$201.00O$100.50$100.50$69.71$96.19$112.28$132.31$132.31$130.65$126.03$69.02$143.31$68.34$68.34$143.31
3000766BNP (RL)300 Lab30183880$201.00O$100.50$100.50$69.71$96.19$112.28$132.31$132.31$130.65$126.03$69.02$143.31$68.34$68.34$143.31
3000131BUN-UREA NITROGEN BLOOD300 Lab30184520$74.00O$37.00$37.00$25.66$9.68$11.30$13.31$13.31$48.10$46.40$25.41$52.76$25.16$9.68$52.76
3000797CA 19-9300 Lab30286301$158.00O$79.00$79.00$54.79$50.98$59.52$70.13$70.13$102.70$99.07$54.26$112.65$53.72$50.98$112.65
3000767CALC, Totall (R)300 Lab30182310$45.00O$22.50$22.50$15.61$12.64$14.76$17.39$17.39$29.25$28.22$15.45$32.09$15.30$12.64$32.09
3000032CALCIUM300 Lab30182310$45.00O$22.50$22.50$15.61$12.64$14.76$17.39$17.39$29.25$28.22$15.45$32.09$15.30$12.64$32.09
3000212CARBAMAZEPINE(TEGRETOL300 Lab30180156$127.00O$63.50$63.50$44.04$35.70$41.67$49.10$49.10$82.55$79.63$43.61$90.55$43.18$35.70$90.55
3000981Cardio PROBNP(R)300 Lab30183880$201.00O$100.50$100.50$69.71$96.19$112.28$132.31$132.31$130.65$126.03$69.02$143.31$68.34$68.34$143.31
3000891CARDIQ VITD25(R)300 Lab30182306$223.00O$111.50$111.50$77.34$72.52$84.66$99.75$99.75$144.95$139.82$76.58$159.00$75.82$72.52$159.00
3000504CBC AUTO W/O DIFF300 Lab30585027$100.00R$50.00$50.00$34.68$15.85$18.50$21.80$21.80$65.00$62.70$34.34$71.30$34.00$15.85$71.30
3000139CBC W/ Auto Diff300 Lab30585025$145.00R$72.50$72.50$50.29$19.04$22.22$26.18$26.18$94.25$90.92$49.79$103.39$49.30$19.04$103.39
3000567CENTROMERE AB300 Lab30286038$191.00O$95.50$95.50$66.24$29.62$34.58$40.74$40.74$124.15$119.76$65.59$136.18$64.94$29.62$136.18
3000041CHOLESTEROL SERUM TOT300 Lab30182465$54.00O$27.00$27.00$18.73$10.66$12.44$14.66$14.66$35.10$33.86$18.54$38.50$18.36$10.66$38.50
3000774Chromatin (Nucleosomal) Antibody300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000143CLOSTRIDIUM DIFFICILE (R)300 Lab30687230$256.00O$128.00$128.00$88.78$48.36$56.46$66.52$66.52$166.40$160.51$87.91$182.53$87.04$48.36$182.53
3000731CMP (RL)300 Lab30180053$267.00R$133.50$133.50$92.60$25.87$30.20$35.59$35.59$173.55$167.41$91.69$190.37$90.78$25.87$190.37
3000617CMV DNA BY PCR QN300 Lab30687497$825.00O$412.50$412.50$286.11$104.96$122.52$144.37$144.37$536.25$517.28$283.31$588.23$280.50$104.96$588.23
3000116COMPLEMENT C3300 Lab30286160$129.00O$64.50$64.50$44.74$29.40$34.32$40.44$40.44$83.85$80.88$44.30$91.98$43.86$29.40$91.98
3000118COMPLEMENT C4300 Lab30286160$129.00O$64.50$64.50$44.74$29.40$34.32$40.44$40.44$83.85$80.88$44.30$91.98$43.86$29.40$91.98
3000184COMPREHENSIVE METABOLI300 Lab30180053$267.00R$133.50$133.50$92.60$25.87$30.20$35.59$35.59$173.55$167.41$91.69$190.37$90.78$25.87$190.37
3000990COVID-19 (RL)300 Lab30687635$250.00O$125.00$125.00$86.70$125.71$146.75$172.91$172.91$162.50$156.75$85.85$178.25$85.00$85.00$178.25
3000991COVID-19 (STATE_CDC)300 Lab306U0001$150.00O$75.00$75.00$52.02$88.00$102.73$121.05$121.05$97.50$94.05$51.51$106.95$51.00$51.00$121.05
3000021C-PEPTIDE (RL)300 Lab30184681$108.00O$54.00$54.00$37.45$50.98$59.52$70.13$70.13$70.20$67.72$37.09$77.00$36.72$36.72$77.00
3000903CREA RAND URN300 Lab30182570$57.00O$28.50$28.50$19.77$12.69$14.81$17.46$17.46$37.05$35.74$19.57$40.64$19.38$12.69$40.64
3000411C-REACTIVE PROTEIN (R)300 Lab30286140$61.00O$30.50$30.50$21.15$12.69$14.81$17.46$17.46$39.65$38.25$20.95$43.49$20.74$12.69$43.49
3000043CREATINE KINASE (CK) (300 Lab30182550$116.00O$58.00$58.00$40.23$15.95$18.62$21.94$21.94$75.40$72.73$39.83$82.71$39.44$15.95$82.71
3000219CREATININE300 Lab30182565$74.00O$37.00$37.00$25.66$12.54$14.64$17.25$17.25$48.10$46.40$25.41$52.76$25.16$12.54$52.76
3000367CREATININE RAND URINE (R)300 Lab30182570$57.00O$28.50$28.50$19.77$12.69$14.81$17.46$17.46$37.05$35.74$19.57$40.64$19.38$12.69$40.64
3000301CULTURE AEROBIC BAC (R)300 Lab30687070$114.00O$57.00$57.00$39.54$21.12$24.65$29.05$29.05$74.10$71.48$39.15$81.28$38.76$21.12$81.28
3000354CULTURE ANAEROBIC300 Lab30687075$151.00O$75.50$75.50$52.37$23.20$27.08$31.91$31.91$98.15$94.68$51.85$107.66$51.34$23.20$107.66
3000172CULTURE ANY OTHER SOUR300 Lab30687070$114.00O$57.00$57.00$39.54$21.12$24.65$29.05$29.05$74.10$71.48$39.15$81.28$38.76$21.12$81.28
3000171CULTURE EXCEP UR/BLOOD300 Lab30687070$114.00O$57.00$57.00$39.54$21.12$24.65$29.05$29.05$74.10$71.48$39.15$81.28$38.76$21.12$81.28
3000240CULTURE SPUTUM300 Lab30687070$114.00O$57.00$57.00$39.54$21.12$24.65$29.05$29.05$74.10$71.48$39.15$81.28$38.76$21.12$81.28
3000378CULTURE STOOL A S/S (R300 Lab30687045$66.00O$33.00$33.00$22.89$23.13$27.00$31.81$31.81$42.90$41.38$22.66$47.06$22.44$22.44$47.06
3000379CULTURE STOOL B CMPY (300 Lab30687046$54.00O$27.00$27.00$18.73$23.13$27.00$31.81$31.81$35.10$33.86$18.54$38.50$18.36$18.36$38.50
30087070Culture, throat300 Lab30087070$114.00O$57.00$57.00$39.54$21.12$24.65$29.05$29.05$74.10$71.48$39.15$81.28$38.76$21.12$81.28
3000173CULTURE; BACTERIAL URI300 Lab30687086$83.00O$41.50$41.50$28.78$19.77$23.08$27.20$27.20$53.95$52.04$28.50$59.18$28.22$19.77$59.18
3000183CULTURE; BLOOD, BACTERIAL (R)300 Lab30687040$250.00O$125.00$125.00$86.70$25.28$29.52$34.78$34.78$162.50$156.75$85.85$178.25$85.00$25.28$178.25
3000524CYCLIC CITRULLINATED P300 Lab30286200$254.00O$127.00$127.00$88.09$31.73$37.04$43.64$43.64$165.10$159.26$87.22$181.10$86.36$31.73$181.10
3000702CYTO THIN PREP (Pap Smear) (R)300 Lab31088175$110.00O$55.00$55.00$38.15$65.19$76.10$89.68$89.68$71.50$68.97$37.77$78.43$37.40$37.40$89.68
3000762D-Dimer300 Lab30585379$158.00O$79.00$79.00$54.79$24.94$29.11$34.31$34.31$102.70$99.07$54.26$112.65$53.72$24.94$112.65
3000753DIGOXIN (RL)300 Lab30180162$170.00O$85.00$85.00$58.96$32.54$37.98$44.75$44.75$110.50$106.59$58.38$121.21$57.80$32.54$121.21
3000207DIGOXIN LEVEL300 Lab30180162$170.00O$85.00$85.00$58.96$32.54$37.98$44.75$44.75$110.50$106.59$58.38$121.21$57.80$32.54$121.21
3000285DRUG SCREEN MULTI300 Lab30180305$165.00O$82.50$82.50$57.22$30.87$36.04$42.46$42.46$107.25$103.46$56.66$117.65$56.10$30.87$117.65
3000261Drug Test by Chem Analyzer_UDOA (R)300 Lab30180307$225.00O$112.50$112.50$78.03$152.24$177.72$209.41$209.41$146.25$141.08$77.27$160.43$76.50$76.50$209.41
3000365ELECTROLYTES300 Lab30180051$78.00O$39.00$39.00$27.05$17.17$20.05$23.62$23.62$50.70$48.91$26.79$55.61$26.52$17.17$55.61
3000630ESBL CONFIRMATION300 Lab30687184$52.00O$26.00$26.00$18.03$18.33$21.39$25.21$25.21$33.80$32.60$17.86$37.08$17.68$17.68$37.08
3000685ESTRADIOL (RL)300 Lab30182670$193.00O$96.50$96.50$66.93$68.45$79.91$94.16$94.16$125.45$121.01$66.28$137.61$65.62$65.62$137.61
3000384FERRITIN (R)300 Lab30182728$83.00O$41.50$41.50$28.78$33.39$38.98$45.93$45.93$53.95$52.04$28.50$59.18$28.22$28.22$59.18
3000271FOLATE, SERUM (R)300 Lab30182746$84.00O$42.00$42.00$29.13$36.02$42.04$49.54$49.54$54.60$52.67$28.85$59.89$28.56$28.56$59.89
3000287FOLIC ACID RBC (RL)300 Lab30182747$87.00O$43.50$43.50$30.17$43.24$50.48$59.48$59.48$56.55$54.55$29.88$62.03$29.58$29.58$62.03
3000141FREE PSA-A (RL)300 Lab30184154$108.00R$54.00$54.00$37.45$45.06$52.60$61.97$61.97$70.20$67.72$37.09$77.00$36.72$36.72$77.00
3000150FREE PSA-B (RL)300 Lab30184153$176.00R$88.00$88.00$61.04$45.06$52.60$61.97$61.97$114.40$110.35$60.44$125.49$59.84$45.06$125.49
3000466FREE TESTOSTERONE (RL)300 Lab30184402$220.00O$110.00$110.00$76.30$62.40$72.84$85.83$85.83$143.00$137.94$75.55$156.86$74.80$62.40$156.86
3000189FSH (R)300 Lab30183001$80.00O$40.00$40.00$27.74$45.52$53.14$62.61$62.61$52.00$50.16$27.47$57.04$27.20$27.20$62.61
3000070GGT300 Lab30182977$82.00O$41.00$41.00$28.44$17.64$20.59$24.26$24.26$53.30$51.41$28.16$58.47$27.88$17.64$58.47
3000216GLUCOSE BLOOD BY GMD300 Lab30182962$48.00O$24.00$24.00$16.65$8.04$9.38$11.05$11.05$31.20$30.10$16.48$34.22$16.32$8.04$34.22
3000060GLUCOSE QUANT300 Lab30182947$50.00O$25.00$25.00$17.34$9.63$11.24$13.24$13.24$32.50$31.35$17.17$35.65$17.00$9.63$35.65
3000591GLUCOSE-6-PHOSPHATE DE300 Lab30182955$96.00O$48.00$48.00$33.29$23.77$27.74$32.69$32.69$62.40$60.19$32.97$68.45$32.64$23.77$68.45
3000114HELICOBACTER PYLORI300 Lab30286677$148.00O$74.00$74.00$51.33$41.28$48.19$56.78$56.78$96.20$92.80$50.82$105.52$50.32$41.28$105.52
3000135HEMATOCRIT300 Lab30585014$32.00O$16.00$16.00$11.10$5.81$6.78$7.99$7.99$20.80$20.06$10.99$22.82$10.88$5.81$22.82
3000136HEMOGLOBIN300 Lab30585018$32.00O$16.00$16.00$11.10$5.81$6.78$7.99$7.99$20.80$20.06$10.99$22.82$10.88$5.81$22.82
3000243HEMOGLOBIN; GLYOSYLATE300 Lab30183036$100.00O$50.00$50.00$34.68$23.79$27.77$32.72$32.72$65.00$62.70$34.34$71.30$34.00$23.79$71.30
3000226HEP B SURF AG W/CONF (R)300 Lab30687340$72.00O$36.00$36.00$24.97$25.31$29.54$34.81$34.81$46.80$45.14$24.72$51.34$24.48$24.48$51.34
3000190HEP B SURFACE AB QN (R)300 Lab30286317$78.00O$39.00$39.00$27.05$36.73$42.87$50.52$50.52$50.70$48.91$26.79$55.61$26.52$26.52$55.61
3000339HEP C AB (R)300 Lab30286803$78.00O$39.00$39.00$27.05$34.96$40.81$48.09$48.09$50.70$48.91$26.79$55.61$26.52$26.52$55.61
3000292HEPATIC FUNCTION PAN300 Lab30180076$176.00R$88.00$88.00$61.04$20.02$23.37$27.53$27.53$114.40$110.35$60.44$125.49$59.84$20.02$125.49
3000456HEPATITIS A AB IGM300 Lab30286709$110.00O$55.00$55.00$38.15$27.59$32.20$37.95$37.95$71.50$68.97$37.77$78.43$37.40$27.59$78.43
3000420HEPATITIS A AB Tot(R)300 Lab30286708$110.00O$55.00$55.00$38.15$30.36$35.44$41.75$41.75$71.50$68.97$37.77$78.43$37.40$30.36$78.43
3000191HEPATITIS B CORE AB, TOT300 Lab30286704$95.00O$47.50$47.50$32.95$29.52$34.46$40.61$40.61$61.75$59.57$32.62$67.74$32.30$29.52$67.74
3000717HGB A1C W/Reflex to Glycomark (R)300 Lab30183036$100.00O$50.00$50.00$34.68$23.79$27.77$32.72$32.72$65.00$62.70$34.34$71.30$34.00$23.79$71.30
3000227HIV 1/2 (RL)300 Lab30286703$493.00O$246.50$246.50$170.97$33.59$39.21$46.20$46.20$320.45$309.11$169.30$351.51$167.62$33.59$351.51
3000199IMMUNOFIXATION (RL)300 Lab30286334$225.00O$112.50$112.50$78.03$54.73$63.89$75.29$75.29$146.25$141.08$77.27$160.43$76.50$54.73$160.43
3000948Influenza A300 Lab30687804$83.00O$41.50$41.50$28.78$40.55$47.33$55.77$55.77$53.95$52.04$28.50$59.18$28.22$28.22$59.18
3000949Influenza B300 Lab30687804$83.00O$41.50$41.50$28.78$40.55$47.33$55.77$55.77$53.95$52.04$28.50$59.18$28.22$28.22$59.18
3000154IRON (RL)300 Lab30183540$48.00O$24.00$24.00$16.65$15.85$18.50$21.80$21.80$31.20$30.10$16.48$34.22$16.32$15.85$34.22
3000547JO-1 AB300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000086LACTATE DEHYDROGENASE300 Lab30183615$74.00O$37.00$37.00$25.66$14.80$17.27$20.35$20.35$48.10$46.40$25.41$52.76$25.16$14.80$52.76
3000558LACTATE PLASMA300 Lab30183605$50.00O$25.00$25.00$17.34$28.35$33.09$38.99$38.99$32.50$31.35$17.17$35.65$17.00$17.00$38.99
3000429LEVETIRACETAM (R)300 Lab30180177$158.00O$79.00$79.00$54.79$32.46$37.90$44.65$44.65$102.70$99.07$54.26$112.65$53.72$32.46$112.65
3000355LH (R)300 Lab30183002$75.00O$37.50$37.50$26.01$45.37$52.97$62.41$62.41$48.75$47.03$25.76$53.48$25.50$25.50$62.41
3000093LIPASE BLOOD300 Lab30183690$69.00O$34.50$34.50$23.93$16.88$19.71$23.22$23.22$44.85$43.26$23.69$49.20$23.46$16.88$49.20
3000389LIPID PANEL300 Lab30180061$150.00R$75.00$75.00$52.02$32.81$38.30$45.12$45.12$97.50$94.05$51.51$106.95$51.00$32.81$106.95
3000732LIPID PANEL (RL)300 Lab30180061$150.00R$75.00$75.00$52.02$32.81$38.30$45.12$45.12$97.50$94.05$51.51$106.95$51.00$32.81$106.95
3000312LITHIUM300 Lab30180178$91.00O$45.50$45.50$31.56$16.19$18.90$22.28$22.28$59.15$57.06$31.25$64.88$30.94$16.19$64.88
3000218LYME DISEASE300 Lab30286618$158.00O$79.00$79.00$54.79$41.72$48.71$57.39$57.39$102.70$99.07$54.26$112.65$53.72$41.72$112.65
3000098MAGNESIUM300 Lab30183735$66.00O$33.00$33.00$22.89$16.42$19.16$22.58$22.58$42.90$41.38$22.66$47.06$22.44$16.42$47.06
3000127MANUAL DIFFERENTIAL300 Lab30585007$43.00O$21.50$21.50$14.91$9.31$10.87$12.81$12.81$27.95$26.96$14.77$30.66$14.62$9.31$30.66
3000743MEASLES AB IGG, EIA (R)300 Lab30286765$134.00O$67.00$67.00$46.47$31.56$36.84$43.41$43.41$87.10$84.02$46.02$95.54$45.56$31.56$95.54
3000874Measles IGM(R)300 Lab30286765$134.00O$67.00$67.00$46.47$31.56$36.84$43.41$43.41$87.10$84.02$46.02$95.54$45.56$31.56$95.54
3000011METHYLMALONIC ACID(RL)300 Lab30183921$235.00O$117.50$117.50$81.50$51.96$60.66$71.48$71.48$152.75$147.35$80.70$167.56$79.90$51.96$167.56
3000097MICRO ALBUMIN RAND UR w/o CR (R)300 Lab30182044$93.00O$46.50$46.50$32.25$15.26$17.82$21.00$21.00$60.45$58.31$31.94$66.31$31.62$15.26$66.31
3000711Microalbumin (Urine) Semi-QNT300 Lab30182044$25.00O$12.50$12.50$8.67$15.26$17.82$21.00$21.00$16.25$15.68$8.59$17.83$8.50$8.50$21.00
3000155MONO TEST300 Lab30286308$61.00O$30.50$30.50$21.15$12.69$14.81$17.46$17.46$39.65$38.25$20.95$43.49$20.74$12.69$43.49
3000451MUMPS IGM300 Lab30286735$64.00O$32.00$32.00$22.20$31.97$37.32$43.98$43.98$41.60$40.13$21.98$45.63$21.76$21.76$45.63
3000450MUMPS VIRUS IGG, EIA(R)300 Lab30286735$64.00O$32.00$32.00$22.20$31.97$37.32$43.98$43.98$41.60$40.13$21.98$45.63$21.76$21.76$45.63
3000328NEONATAL BILIRUBIN300 Lab30182248$57.00O$28.50$28.50$19.77$12.30$14.36$16.92$16.92$37.05$35.74$19.57$40.64$19.38$12.30$40.64
3000695OCCULT BLOOD FE300 Lab30182274$59.00O$29.50$29.50$20.46$39.00$45.53$53.65$53.65$38.35$36.99$20.26$42.07$20.06$20.06$53.65
3000031OCCULT BLOOD GASTRIC300 Lab30182271$30.00O$15.00$15.00$10.40$13.03$15.22$17.93$17.93$19.50$18.81$10.30$21.39$10.20$10.20$21.39
3000176OVA & PARASITES STOOL300 Lab30687177$87.00O$43.50$43.50$30.17$21.81$25.45$29.99$29.99$56.55$54.55$29.88$62.03$29.58$21.81$62.03
3000124PARTIAL THROMBOPLASTIN300 Lab30585730$60.00R$30.00$30.00$20.81$14.72$17.19$20.25$20.25$39.00$37.62$20.60$42.78$20.40$14.72$42.78
3000770PATTERN300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000027PHENOBARBITAL QUANITAT300 Lab30180184$116.00O$58.00$58.00$40.23$37.49$43.76$51.56$51.56$75.40$72.73$39.83$82.71$39.44$37.49$82.71
3000194PHLEBOTOMY THEREPEUTIC300 Lab94099195$300.00O$150.00$150.00$104.04$174.45$215.88$254.04$254.04$195.00$188.10$103.02$213.90$102.00$102.00$254.04
3000109PHOSPHORUS INORGANIC P300 Lab30184100$50.00O$25.00$25.00$17.34$11.61$13.56$15.97$15.97$32.50$31.35$17.17$35.65$17.00$11.61$35.65
3000111POTASSIUM; SERUM PLASM300 Lab30184132$48.00O$24.00$24.00$16.65$11.66$13.61$16.04$16.04$31.20$30.10$16.48$34.22$16.32$11.66$34.22
3000168PREGNANCY TEST SERUM300 Lab30184703$74.00O$37.00$37.00$25.66$18.42$21.51$25.34$25.34$48.10$46.40$25.41$52.76$25.16$18.42$52.76
3000074PREGNANCY TEST URINE300 Lab30184703$74.00O$37.00$37.00$25.66$18.42$21.51$25.34$25.34$48.10$46.40$25.41$52.76$25.16$18.42$52.76
3000387PRIMIDONE (RL)300 Lab30180188$70.00O$35.00$35.00$24.28$40.65$47.45$55.91$55.91$45.50$43.89$24.04$49.91$23.80$23.80$55.91
3000117PROGESTERONE (RL)300 Lab30184144$93.00O$46.50$46.50$32.25$51.11$59.66$70.30$70.30$60.45$58.31$31.94$66.31$31.62$31.62$70.30
3000356PROLACTIN (RL)300 Lab30184146$93.00O$46.50$46.50$32.25$47.48$55.43$65.31$65.31$60.45$58.31$31.94$66.31$31.62$31.62$66.31
3000907PROTEIN 24HR UR300 Lab30184156$52.00O$26.00$26.00$18.03$8.99$10.50$12.37$12.37$33.80$32.60$17.86$37.08$17.68$8.99$37.08
3000310PROTEIN TOTAL UA w/o Creat (R)300 Lab30184156$52.00O$26.00$26.00$18.03$8.99$10.50$12.37$12.37$33.80$32.60$17.86$37.08$17.68$8.99$37.08
3000904PROTEIN URINE300 Lab30184156$52.00O$26.00$26.00$18.03$8.99$10.50$12.37$12.37$33.80$32.60$17.86$37.08$17.68$8.99$37.08
3000146PROTHROMBIN, TIME300 Lab30585610$90.00R$45.00$45.00$31.21$10.51$12.27$14.46$14.46$58.50$56.43$30.91$64.17$30.60$10.51$64.17
3000269PSA SCREENING300 Lab309G0103$176.00O$88.00$88.00$61.04$47.31$55.23$65.07$65.07$114.40$110.35$60.44$125.49$59.84$47.31$125.49
3000295PSA; TOTAL300 Lab30184153$176.00R$88.00$88.00$61.04$45.06$52.60$61.97$61.97$114.40$110.35$60.44$125.49$59.84$45.06$125.49
3000024PTH INTACT (R)300 Lab30183970$174.00O$87.00$87.00$60.34$101.14$118.06$139.11$139.11$113.10$109.10$59.75$124.06$59.16$59.16$139.11
3000588RAPAMYCIN (SIROLIMUS)300 Lab30080195$191.00O$95.50$95.50$66.24$33.64$39.27$46.27$46.27$124.15$119.76$65.59$136.18$64.94$33.64$136.18
3000158RENAL FUNCTION PANEL300 Lab30180069$165.00R$82.50$82.50$57.22$21.27$24.82$29.25$29.25$107.25$103.46$56.66$117.65$56.10$21.27$117.65
3000223RHEUMATOID FACTOR (R)300 Lab30286431$54.00O$27.00$27.00$18.73$13.89$16.22$19.11$19.11$35.10$33.86$18.54$38.50$18.36$13.89$38.50
3000349RNP ANTIBODIES (RL)300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000215RPR300 Lab30286592$54.00O$27.00$27.00$18.73$10.46$12.21$14.39$14.39$35.10$33.86$18.54$38.50$18.36$10.46$38.50
3000748RSV Screen, IA300 Lab30687807$96.00O$48.00$48.00$33.29$32.10$37.47$44.15$44.15$62.40$60.19$32.97$68.45$32.64$32.10$68.45
3000837Rubella IGM (R)300 Lab30286762$93.00O$46.50$46.50$32.25$35.26$41.16$48.49$48.49$60.45$58.31$31.94$66.31$31.62$31.62$66.31
3000257RUBELLA IMMUNE (R)300 Lab30286762$93.00O$46.50$46.50$32.25$35.26$41.16$48.49$48.49$60.45$58.31$31.94$66.31$31.62$31.62$66.31
3000345SCL-70 (R)300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000147SEDIMENTATION RATE; NO300 Lab30585651$56.00O$28.00$28.00$19.42$10.46$12.21$14.39$14.39$36.40$35.11$19.23$39.93$19.04$10.46$39.93
3000128SGOT300 Lab30184450$61.00O$30.50$30.50$21.15$12.69$14.81$17.46$17.46$39.65$38.25$20.95$43.49$20.74$12.69$43.49
3000129SGPT300 Lab30184460$61.00O$30.50$30.50$21.15$12.99$15.16$17.86$17.86$39.65$38.25$20.95$43.49$20.74$12.99$43.49
3000298SJOGREN'S AB SS-A(R)300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000357SJOGREN'S AB SS-B(R)300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000294SM ANTIBODIES (RL)300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000811SM/RNP Antibody (R)300 Lab30286235$157.00O$78.50$78.50$54.45$43.93$51.28$60.42$60.42$102.05$98.44$53.91$111.94$53.38$43.93$111.94
3000119SODIUM;SERUM PLASMA/WH300 Lab30184295$48.00O$24.00$24.00$16.65$11.78$13.76$16.21$16.21$31.20$30.10$16.48$34.22$16.32$11.78$34.22
3000186STREPTOCOCCUS GROUP A300 Lab30687880$75.00O$37.50$37.50$26.01$40.50$47.28$55.71$55.71$48.75$47.03$25.76$53.48$25.50$25.50$55.71
3000543T3 FREE300 Lab30184481$159.00O$79.50$79.50$55.14$41.50$48.45$57.09$57.09$103.35$99.69$54.60$113.37$54.06$41.50$113.37
3000063T3 TOTAL (RL)300 Lab30184480$61.00O$30.50$30.50$21.15$34.74$40.55$47.79$47.79$39.65$38.25$20.95$43.49$20.74$20.74$47.79
3000163T-3 UPTAKE (R)300 Lab30184479$61.00O$30.50$30.50$21.15$15.85$18.50$21.80$21.80$39.65$38.25$20.95$43.49$20.74$15.85$43.49
3000350T-4 (THYROXINE) (R)300 Lab30184436$61.00O$30.50$30.50$21.15$16.83$19.65$23.15$23.15$39.65$38.25$20.95$43.49$20.74$16.83$43.49
3000042T-4 FREE (R)300 Lab30184439$95.00O$47.50$47.50$32.95$22.10$25.80$30.40$30.40$61.75$59.57$32.62$67.74$32.30$22.10$67.74
3000471TACROLIMUS (R)300 Lab30180197$214.00O$107.00$107.00$74.22$33.64$39.27$46.27$46.27$139.10$134.18$73.49$152.58$72.76$33.64$152.58
3000836TB Gold Quant(R)300 Lab30286480$255.00O$127.50$127.50$88.43$151.85$177.26$208.87$208.87$165.75$159.89$87.57$181.82$86.70$86.70$208.87
3000214TB SKIN TEST300 Lab30286580$100.00O$50.00$50.00$34.68$56.33$65.75$77.48$77.48$65.00$62.70$34.34$71.30$34.00$34.00$77.48
3000933TESTOST, TOT (R)300 Lab30184403$141.00O$70.50$70.50$48.90$63.23$73.82$86.98$86.98$91.65$88.41$48.42$100.53$47.94$47.94$100.53
3000138TESTOSTERONE TOTAL (R)300 Lab30184403$141.00O$70.50$70.50$48.90$63.23$73.82$86.98$86.98$91.65$88.41$48.42$100.53$47.94$47.94$100.53
3000203THYROID PEROXIDASE AN300 Lab30286376$78.00O$39.00$39.00$27.05$35.65$41.61$49.03$49.03$50.70$48.91$26.79$55.61$26.52$26.52$55.61
3000390TIBC (RL)300 Lab30183550$93.00O$46.50$46.50$32.25$21.41$25.00$29.45$29.45$60.45$58.31$31.94$66.31$31.62$21.41$66.31
3000703TISSUE PATHOLOGY REPORT300 Lab31088302$100.00O$50.00$50.00$34.68$56.33$65.75$77.48$77.48$65.00$62.70$34.34$71.30$34.00$34.00$77.48
3000769TITER300 Lab30286309$52.00O$26.00$26.00$18.03$15.85$18.50$21.80$21.80$33.80$32.60$17.86$37.08$17.68$15.85$37.08
3000359TRANSFERRIN(RL)300 Lab30184466$74.00O$37.00$37.00$25.66$31.26$36.49$43.00$43.00$48.10$46.40$25.41$52.76$25.16$25.16$52.76
3000130TRIGLYCERIDES BLOOD300 Lab30184478$48.00O$24.00$24.00$16.65$14.06$16.42$19.34$19.34$31.20$30.10$16.48$34.22$16.32$14.06$34.22
3000162TROPONIN, QUANTITATIVE300 Lab30184484$345.00O$172.50$172.50$119.65$30.55$35.66$42.02$42.02$224.25$216.32$118.47$245.99$117.30$30.55$245.99
3000399TSH (R)300 Lab30184443$170.00R$85.00$85.00$58.96$41.16$48.05$56.62$56.62$110.50$106.59$58.38$121.21$57.80$41.16$121.21
3000744TSH W/RFLX FT4 (R)300 Lab30184443$170.00R$85.00$85.00$58.96$41.16$48.05$56.62$56.62$110.50$106.59$58.38$121.21$57.80$41.16$121.21
3000132URIC ACID300 Lab30184550$54.00O$27.00$27.00$18.73$11.07$12.93$15.23$15.23$35.10$33.86$18.54$38.50$18.36$11.07$38.50
3000009URINALYSIS300 Lab30781001$59.00R$29.50$29.50$20.46$7.77$9.07$10.68$10.68$38.35$36.99$20.26$42.07$20.06$7.77$42.07
3000003Urine Dipstick300 Lab30781003$40.00R$20.00$20.00$13.87$5.51$6.44$7.58$7.58$26.00$25.08$13.74$28.52$13.60$5.51$28.52
3000977Urine Ictotest300 Lab30781002$121.00R$60.50$60.50$41.96$8.53$9.95$11.73$11.73$78.65$75.87$41.55$86.27$41.14$8.53$86.27
3000248VALPROIC ACID (R)300 Lab30180164$116.00O$58.00$58.00$40.23$33.17$38.72$45.63$45.63$75.40$72.73$39.83$82.71$39.44$33.17$82.71
3000105VANCOMYCIN300 Lab30180202$116.00O$58.00$58.00$40.23$33.17$38.72$45.63$45.63$75.40$72.73$39.83$82.71$39.44$33.17$82.71
3000340VARICELLA IGM AB (RL)300 Lab30286787$125.00O$62.50$62.50$43.35$31.56$36.84$43.41$43.41$81.25$78.38$42.93$89.13$42.50$31.56$89.13
3000258VARICELLA-ZOSTER IGG AB (R)300 Lab30286787$125.00O$62.50$62.50$43.35$31.56$36.84$43.41$43.41$81.25$78.38$42.93$89.13$42.50$31.56$89.13
3000534VDRL (SERUM)300 Lab30286592$61.00O$30.50$30.50$21.15$10.46$12.21$14.39$14.39$39.65$38.25$20.95$43.49$20.74$10.46$43.49
3000768VIT B1, PLASMA300 Lab30184425$176.00O$88.00$88.00$61.04$52.01$60.72$71.55$71.55$114.40$110.35$60.44$125.49$59.84$52.01$125.49
3000470VIT D 25 HYDROXYL-URIN300 Lab30182306$223.00O$111.50$111.50$77.34$72.52$84.66$99.75$99.75$144.95$139.82$76.58$159.00$75.82$72.52$159.00
3000523VIT D 25 OH LS/MS/MS (SERUM)(R)300 Lab30182306$223.00O$111.50$111.50$77.34$72.52$84.66$99.75$99.75$144.95$139.82$76.58$159.00$75.82$72.52$159.00
3000642VIT D I 25-DIHYDORXY300 Lab30182652$315.00O$157.50$157.50$109.24$94.33$110.11$129.75$129.75$204.75$197.51$108.17$224.60$107.10$94.33$224.60
3000270VITAMIN B12 (R)300 Lab30182607$127.00O$63.50$63.50$44.04$36.95$43.13$50.82$50.82$82.55$79.63$43.61$90.55$43.18$36.95$90.55
3000308VITAMIN B1-THIAMINE (R300 Lab30184425$176.00O$88.00$88.00$61.04$52.01$60.72$71.55$71.55$114.40$110.35$60.44$125.49$59.84$52.01$125.49
3000605VITAMIN B6300 Lab30184207$179.00O$89.50$89.50$62.08$68.85$80.37$94.70$94.70$116.35$112.23$61.47$127.63$60.86$60.86$127.63
3000405WBC STOOL (RL)300 Lab30089055$43.00O$21.50$21.50$14.91$10.46$12.21$14.39$14.39$27.95$26.96$14.77$30.66$14.62$10.46$30.66
4200015Electric Stem/Manual420 Physical Therapy42097032$140.00O$70.00$70.00$48.55$24.22$29.98$35.28$35.28$91.00$87.78$48.08$99.82$47.60$24.22$99.82
4200014ELECTRIC STEM/MOD 1420 Physical Therapy420G0283$46.00O$23.00$23.00$15.95$23.07$28.55$33.60$33.60$29.90$28.84$15.80$32.80$15.64$15.64$33.60
4200003EXERCISE/PRO EACH 15 M420 Physical Therapy42097110$100.00R$50.00$50.00$34.68$50.16$62.07$73.05$73.05$65.00$62.70$34.34$71.30$34.00$34.00$73.05
4200006GAIT TRAINING EA 15 M420 Physical Therapy42097116$90.00O$45.00$45.00$31.21$49.58$61.36$72.21$72.21$58.50$56.43$30.91$64.17$30.60$30.60$72.21
4200025IONTOPHORESIS EA 15 MI420 Physical Therapy42097033$75.00O$37.50$37.50$26.01$34.02$42.09$49.54$49.54$48.75$47.03$25.76$53.48$25.50$25.50$53.48
4200049NEUROMUSCULAR RE-ED420 Physical Therapy42097112$100.00O$50.00$50.00$34.68$57.09$70.65$83.13$83.13$65.00$62.70$34.34$71.30$34.00$34.00$83.13
4200033PT Eval High Complexity 45 Mins420 Physical Therapy42497163$225.00O$112.50$112.50$78.03$138.38$171.25$201.52$201.52$146.25$141.08$77.27$160.43$76.50$76.50$201.52
4200031PT Eval Low Complexity 20 Mins420 Physical Therapy42497161$255.00O$127.50$127.50$88.43$138.38$171.25$201.52$201.52$165.75$159.89$87.57$181.82$86.70$86.70$201.52
4200032PT Eval Moderate Complexity 30 Min420 Physical Therapy42497162$225.00O$112.50$112.50$78.03$138.38$171.25$201.52$201.52$146.25$141.08$77.27$160.43$76.50$76.50$201.52
42097597REMOVE DEVITAL TISS 20 CM/<420 Physical Therapy42097597$220.00O$110.00$110.00$76.30$39.22$48.53$57.11$57.11$143.00$137.94$75.55$156.86$74.80$39.22$156.86
42097598REMOVE DEVITAL TISS WN Add'l 20CM420 Physical Therapy42097598$80.00O$40.00$40.00$27.74$18.45$22.83$26.86$26.86$52.00$50.16$27.47$57.04$27.20$18.45$57.04
4200050THERAPEUTIC ACTIVITY420 Physical Therapy42097530$100.00O$50.00$50.00$34.68$65.15$80.63$94.88$94.88$65.00$62.70$34.34$71.30$34.00$34.00$94.88
4200037TRACTION MANUAL EA 15420 Physical Therapy42097140$80.00O$40.00$40.00$27.74$45.55$56.37$66.34$66.34$52.00$50.16$27.47$57.04$27.20$27.20$66.34
3200001ABDOMEN 1 VIEW320 Radiology32074018$166.00O$83.00$83.00$57.57$100.56$106.15$124.50$124.50$107.90$104.08$57.00$118.36$56.44$56.44$124.50
3200002ABDOMEN 2 VIEWS320 Radiology32074019$300.00O$150.00$150.00$104.04$141.22$149.07$174.84$174.84$195.00$188.10$103.02$213.90$102.00$102.00$213.90
3200003ABDOMEN 3 VIEWS320 Radiology32074022$339.00O$169.50$169.50$117.57$141.22$149.07$174.84$174.84$220.35$212.55$116.41$241.71$115.26$115.26$241.71
4000184ABDOMEN COMPLETE US320 Radiology40276700$539.00R$269.50$269.50$186.93$141.22$149.07$174.84$174.84$150.00$337.95$185.09$384.31$183.26$141.22$384.31
4000185ABDOMINAL AORTA US320 Radiology40276770$472.00O$236.00$236.00$163.69$141.22$149.07$174.84$174.84$150.00$295.94$162.08$336.54$160.48$141.22$336.54
3200206ANKLE 2 VIEWS320 Radiology32073600$350.00O$175.00$175.00$121.38$100.56$106.15$124.50$124.50$227.50$219.45$120.19$249.55$119.00$100.56$249.55
3200206RANKLE 2 VIEWS320 Radiology32073600$350.00O$175.00$175.00$121.38$100.56$106.15$124.50$124.50$227.50$219.45$120.19$249.55$119.00$100.56$249.55
3200044ANKLE 4 VIEWS320 Radiology32073610$428.00O$214.00$214.00$148.43$100.56$106.15$124.50$124.50$278.20$268.36$146.98$305.16$145.52$100.56$305.16
3200044RANKLE 4 VIEWS320 Radiology32073610$428.00O$214.00$214.00$148.43$100.56$106.15$124.50$124.50$278.20$268.36$146.98$305.16$145.52$100.56$305.16
3200228Ankle Bilateral Complete Xray min 3views320 Radiology32073610$428.00O$214.00$214.00$148.43$100.56$106.15$124.50$124.50$278.20$268.36$146.98$305.16$145.52$100.56$305.16
3200227Ankle Bilateral Xray 2views320 Radiology32073600$350.00O$175.00$175.00$121.38$100.56$106.15$124.50$124.50$227.50$219.45$120.19$249.55$119.00$100.56$249.55
3200009ANKLE MIN 3 VIEWS320 Radiology32073610$428.00O$214.00$214.00$148.43$100.56$106.15$124.50$124.50$278.20$268.36$146.98$305.16$145.52$100.56$305.16
3200009RANKLE MIN 3 VIEWS320 Radiology32073610$428.00O$214.00$214.00$148.43$100.56$106.15$124.50$124.50$278.20$268.36$146.98$305.16$145.52$100.56$305.16
3200015CHEST 1 VIEW320 Radiology32471045$185.00O$92.50$92.50$64.16$100.56$106.15$124.50$124.50$120.25$116.00$63.53$131.91$62.90$62.90$131.91
3200016CHEST 2 VIEWS320 Radiology32471046$236.00O$118.00$118.00$81.84$100.56$106.15$124.50$124.50$153.40$147.97$81.04$168.27$80.24$80.24$168.27
3200021CLAVICLE 2 VIEWS320 Radiology32073000$199.00O$99.50$99.50$69.01$100.56$106.15$124.50$124.50$129.35$124.77$68.34$141.89$67.66$67.66$141.89
3500179CT ABDOMEN W/CONTRAST320 Radiology35274160$1,805.00O$902.50$902.50$625.97$575.82$619.55$728.88$728.88$575.00$1,131.74$619.84$1,286.97$613.70$575.00$1,286.97
3500167CT ABDOMEN WITHOUT CON320 Radiology35274150$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500246CT ABDOMEN/PELVIS W/CO320 Radiology35274177$2,300.00R$1,150.00$1,150.00$797.64$1,206.65$1,298.29$1,527.40$1,527.40$575.00$1,442.10$789.82$1,639.90$782.00$575.00$1,639.90
3500245CT ABDOMEN/PELVIS W/O320 Radiology35274176$2,100.00O$1,050.00$1,050.00$728.28$736.41$792.34$932.16$932.16$575.00$1,316.70$721.14$1,497.30$714.00$575.00$1,497.30
3500247CT ABDOMEN/PELVIS W/WO320 Radiology35274178$3,400.00O$1,700.00$1,700.00$1,179.12$1,206.65$1,298.29$1,527.40$1,527.40$575.00$2,131.80$1,167.56$2,424.20$1,156.00$575.00$2,424.20
3500241CT ANGIO CHEST W/WO320 Radiology35271275$1,700.00O$850.00$850.00$589.56$575.82$619.55$728.88$728.88$575.00$1,065.90$583.78$1,212.10$578.00$575.00$1,212.10
3500140CT CHEST W/O CONTRAST320 Radiology35271250$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500143CT CHEST W/WO CONTRAS320 Radiology35271270$1,608.00O$804.00$804.00$557.65$575.82$619.55$728.88$728.88$575.00$1,008.22$552.19$1,146.50$546.72$546.72$1,146.50
3500163CT CHEST WITH CONTRAS320 Radiology35271260$1,805.00O$902.50$902.50$625.97$575.82$619.55$728.88$728.88$575.00$1,131.74$619.84$1,286.97$613.70$575.00$1,286.97
3500197CT C-SPINE WO CONTRAST320 Radiology35272125$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500186CT FACIAL W/CONTRAST320 Radiology35170487$1,152.00O$576.00$576.00$399.51$575.82$619.55$728.88$728.88$575.00$722.30$395.60$821.38$391.68$391.68$821.38
3500187CT FACIAL WO/CONTRAST320 Radiology35170486$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500141CT HEAD WITHOUT CONT.320 Radiology35170450$1,500.00R$750.00$750.00$520.20$354.17$381.07$448.32$448.32$575.00$940.50$515.10$1,069.50$510.00$354.17$1,069.50
3500169RCT Lower Joint w/o contrast; Right320 Radiology35273700$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500169CT LOWER JOINT WO CONT320 Radiology35273700$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500198CT L-SPINE W0/ CONTRAS320 Radiology35272131$1,500.00O$750.00$750.00$520.20$354.17$381.07$448.32$448.32$575.00$940.50$515.10$1,069.50$510.00$354.17$1,069.50
3500190CT NECK W/WO CONTRAST320 Radiology35170492$2,708.00O$1,354.00$1,354.00$939.13$575.82$619.55$728.88$728.88$575.00$1,697.92$929.93$1,930.80$920.72$575.00$1,930.80
3500191CT NECK WO/CONTRAST320 Radiology35170490$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500180CT PELVIS W/CONTRAST320 Radiology35272193$1,805.00R$902.50$902.50$625.97$575.82$619.55$728.88$728.88$575.00$1,131.74$619.84$1,286.97$613.70$575.00$1,286.97
3500151CT PELVIS WITHOUT CO320 Radiology35272192$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500233CT SINUSES320 Radiology35170486$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500200CT T-SPINE WO/CONTRAST320 Radiology35272128$1,305.00O$652.50$652.50$452.57$354.17$381.07$448.32$448.32$575.00$818.24$448.14$930.47$443.70$354.17$930.47
3500168RCT Upper Joint w/o contrast; Right320 Radiology35273200$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
3500168CT UPPER JOINT WO/CONT320 Radiology35273200$1,467.00O$733.50$733.50$508.76$354.17$381.07$448.32$448.32$575.00$919.81$503.77$1,045.97$498.78$354.17$1,045.97
4000213ECHO TTHRC R-T 2D W/WOM320 Radiology48393306$800.00O$400.00$400.00$277.44$216.82$268.31$315.74$315.74$520.00$501.60$274.72$570.40$272.00$216.82$570.40
3200028ELBOW 2V320 Radiology32073070$331.00O$165.50$165.50$114.79$100.56$106.15$124.50$124.50$215.15$207.54$113.67$236.00$112.54$100.56$236.00
3200028RELBOW 2V320 Radiology32073070$331.00O$165.50$165.50$114.79$100.56$106.15$124.50$124.50$215.15$207.54$113.67$236.00$112.54$100.56$236.00
3200215Elbow Bilateral Xray 2views320 Radiology32073070$331.00O$165.50$165.50$114.79$100.56$106.15$124.50$124.50$215.15$207.54$113.67$236.00$112.54$100.56$236.00
3200232Elbow Complete X Min 3V320 Radiology32073080$165.00O$82.50$82.50$57.22$100.56$106.15$124.50$124.50$107.25$103.46$56.66$117.65$56.10$56.10$124.50
3200232RElbow Complete X Min 3V320 Radiology32073080$165.00O$82.50$82.50$57.22$100.56$106.15$124.50$124.50$107.25$103.46$56.66$117.65$56.10$56.10$124.50
3200035FEMUR 2 V320 Radiology32073552$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200035RFEMUR 2 V320 Radiology32073552$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200222Femur Bilateral Xray 2views320 Radiology32073552$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200038FINGER(S) 3 VIEW320 Radiology32073140$337.00O$168.50$168.50$116.87$100.56$106.15$124.50$124.50$219.05$211.30$115.73$240.28$114.58$100.56$240.28
3200038RFINGER(S) 3 VIEW320 Radiology32073140$337.00O$168.50$168.50$116.87$100.56$106.15$124.50$124.50$219.05$211.30$115.73$240.28$114.58$100.56$240.28
3200246Fingers xray 2v; left320 Radiology32073140$139.00O$69.50$69.50$48.21$100.56$106.15$124.50$124.50$90.35$87.15$47.73$99.11$47.26$47.26$124.50
3200246RFingers xray 2v; right320 Radiology32073140$139.00O$69.50$69.50$48.21$100.56$106.15$124.50$124.50$90.35$87.15$47.73$99.11$47.26$47.26$124.50
3200207FOOT 2 VIEWS320 Radiology32073620$306.00O$153.00$153.00$106.12$100.56$106.15$124.50$124.50$198.90$191.86$105.08$218.18$104.04$100.56$218.18
3200207RFOOT 2 VIEWS320 Radiology32073620$306.00O$153.00$153.00$106.12$100.56$106.15$124.50$124.50$198.90$191.86$105.08$218.18$104.04$100.56$218.18
3200041FOOT 3+V320 Radiology32073630$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200041RFOOT 3+V320 Radiology32073630$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200230Foot Bilateral Complete Xray min 3views320 Radiology32073630$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200229Foot Bilateral Xray 2views320 Radiology32073620$360.00O$180.00$180.00$124.85$100.56$106.15$124.50$124.50$234.00$225.72$123.62$256.68$122.40$100.56$256.68
3200042FOREARM 2V320 Radiology32073090$368.00O$184.00$184.00$127.62$100.56$106.15$124.50$124.50$239.20$230.74$126.37$262.38$125.12$100.56$262.38
3200042RFOREARM 2V320 Radiology32073090$368.00O$184.00$184.00$127.62$100.56$106.15$124.50$124.50$239.20$230.74$126.37$262.38$125.12$100.56$262.38
3200216Forearm Bilateral Xray 2views320 Radiology32073090$368.00O$184.00$184.00$127.62$100.56$106.15$124.50$124.50$239.20$230.74$126.37$262.38$125.12$100.56$262.38
4000188GALLBLADDER US320 Radiology40276705$472.00O$236.00$236.00$163.69$141.22$149.07$174.84$174.84$150.00$295.94$162.08$336.54$160.48$141.22$336.54
3200257Groin Ultrasound320 Radiology40276882$410.00O$205.00$205.00$142.19$141.22$149.07$174.84$174.84$150.00$257.07$140.79$292.33$139.40$139.40$292.33
3200202HAND 2 VIEWS320 Radiology32073120$325.00O$162.50$162.50$112.71$141.22$149.07$174.84$174.84$211.25$203.78$111.61$231.73$110.50$110.50$231.73
3200202RHAND 2 VIEWS320 Radiology32073120$325.00O$162.50$162.50$112.71$141.22$149.07$174.84$174.84$211.25$203.78$111.61$231.73$110.50$110.50$231.73
3200048HAND 3 V320 Radiology32073130$374.00O$187.00$187.00$129.70$100.56$106.15$124.50$124.50$243.10$234.50$128.43$266.66$127.16$100.56$266.66
3200048RHAND 3 V320 Radiology32073130$374.00O$187.00$187.00$129.70$100.56$106.15$124.50$124.50$243.10$234.50$128.43$266.66$127.16$100.56$266.66
3200219Hand Bilateral Xray 2views320 Radiology32073120$325.00O$162.50$162.50$112.71$141.22$149.07$174.84$174.84$211.25$203.78$111.61$231.73$110.50$110.50$231.73
3200220Hand Bilateral Xray min 3view320 Radiology32073130$374.00O$187.00$187.00$129.70$100.56$106.15$124.50$124.50$243.10$234.50$128.43$266.66$127.16$100.56$266.66
3200051HIP JOINT 2 VIEWS UNIL320 Radiology32073502$211.00O$105.50$105.50$73.17$100.56$106.15$124.50$124.50$137.15$132.30$72.46$150.44$71.74$71.74$150.44
3200051RHIP JOINT 2 VIEWS UNIL320 Radiology32073502$211.00O$105.50$105.50$73.17$100.56$106.15$124.50$124.50$137.15$132.30$72.46$150.44$71.74$71.74$150.44
3200052HIP JOINT BILATERAL CO320 Radiology32073521$253.00O$126.50$126.50$87.74$141.22$149.07$174.84$174.84$164.45$158.63$86.88$180.39$86.02$86.02$180.39
3200055HUMERUS 2V320 Radiology32073060$407.00O$203.50$203.50$141.15$100.56$106.15$124.50$124.50$264.55$255.19$139.76$290.19$138.38$100.56$290.19
3200055RHUMERUS 2V320 Radiology32073060$407.00O$203.50$203.50$141.15$100.56$106.15$124.50$124.50$264.55$255.19$139.76$290.19$138.38$100.56$290.19
3200214Humerus Bilateral Xray min 2views320 Radiology32073060$407.00O$203.50$203.50$141.15$100.56$106.15$124.50$124.50$264.55$255.19$139.76$290.19$138.38$100.56$290.19
3200004KNEE 1-2 V320 Radiology32073560$370.00O$185.00$185.00$128.32$100.56$106.15$124.50$124.50$240.50$231.99$127.06$263.81$125.80$100.56$263.81
3200004RKNEE 1-2 V320 Radiology32073560$370.00O$185.00$185.00$128.32$100.56$106.15$124.50$124.50$240.50$231.99$127.06$263.81$125.80$100.56$263.81
3200211KNEE 3V320 Radiology32073562$471.00O$235.50$235.50$163.34$100.56$106.15$124.50$124.50$306.15$295.32$161.74$335.82$160.14$100.56$335.82
3200211RKNEE 3V320 Radiology32073562$471.00O$235.50$235.50$163.34$100.56$106.15$124.50$124.50$306.15$295.32$161.74$335.82$160.14$100.56$335.82
3200225Knee Bilateral Completel Xray min 4views320 Radiology32073564$282.00O$141.00$141.00$97.80$141.22$149.07$174.84$174.84$183.30$176.81$96.84$201.07$95.88$95.88$201.07
3200224Knee Bilateral Xray 3views320 Radiology32073562$471.00O$235.50$235.50$163.34$100.56$106.15$124.50$124.50$306.15$295.32$161.74$335.82$160.14$100.56$335.82
3200058KNEE COMPLETE 4+V320 Radiology32073564$282.00O$141.00$141.00$97.80$141.22$149.07$174.84$174.84$183.30$176.81$96.84$201.07$95.88$95.88$201.07
3200058RKNEE COMPLETE 4+V320 Radiology32073564$282.00O$141.00$141.00$97.80$141.22$149.07$174.84$174.84$183.30$176.81$96.84$201.07$95.88$95.88$201.07
3200250Knee xray 2v; bilateral320 Radiology32073560$165.00O$82.50$82.50$57.22$100.56$106.15$124.50$124.50$107.25$103.46$56.66$117.65$56.10$56.10$124.50
3200057KUB 1 V320 Radiology32074018$166.00O$83.00$83.00$57.57$100.56$106.15$124.50$124.50$107.90$104.08$57.00$118.36$56.44$56.44$124.50
3200057RKUB 1 V320 Radiology32074018$166.00O$83.00$83.00$57.57$100.56$106.15$124.50$124.50$107.90$104.08$57.00$118.36$56.44$56.44$124.50
3200062LEG 2 V320 Radiology32073590$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200062RLEG 2 V320 Radiology32073590$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200226Leg Bilateral Xray 2views320 Radiology32073590$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
4000199LIVER US320 Radiology40276705$472.00O$236.00$236.00$163.69$141.22$149.07$174.84$174.84$150.00$295.94$162.08$336.54$160.48$141.22$336.54
6100015MRI BRAIN W&WO CONT320 Radiology61170553$2,704.00R$1,352.00$1,352.00$937.75$1,206.65$1,298.29$1,527.40$1,527.40$650.00$1,695.41$928.55$1,927.95$919.36$650.00$1,927.95
3500243MRI BRAIN With & W/O CONTRAST320 Radiology61070553$2,704.00R$1,352.00$1,352.00$937.75$1,206.65$1,298.29$1,527.40$1,527.40$650.00$1,695.41$928.55$1,927.95$919.36$650.00$1,927.95
6100024MRI C-SPINE WO CONT320 Radiology61272141$2,024.00O$1,012.00$1,012.00$701.92$736.41$792.34$932.16$932.16$650.00$1,269.05$695.04$1,443.11$688.16$650.00$1,443.11
6100070MRI LOW EXTREM JT WO C320 Radiology61473721$2,699.00R$1,349.50$1,349.50$936.01$736.41$792.34$932.16$932.16$650.00$1,692.27$926.84$1,924.39$917.66$650.00$1,924.39
6100072MRI LOW EXTREM JT WO C320 Radiology61073721$2,699.00R$1,349.50$1,349.50$936.01$736.41$792.34$932.16$932.16$650.00$1,692.27$926.84$1,924.39$917.66$650.00$1,924.39
6100072RMRI LOW EXTREM JT WO C320 Radiology61073721$2,699.00R$1,349.50$1,349.50$936.01$736.41$792.34$932.16$932.16$650.00$1,692.27$926.84$1,924.39$917.66$650.00$1,924.39
6100028MRI L-SPINE WO CONT320 Radiology61272148$1,969.00R$984.50$984.50$682.85$736.41$792.34$932.16$932.16$650.00$1,234.56$676.15$1,403.90$669.46$650.00$1,403.90
3200192NECK, SOFT TISSUE 2 VI320 Radiology32070360$185.00O$92.50$92.50$64.16$100.56$106.15$124.50$124.50$120.25$116.00$63.53$131.91$62.90$62.90$131.91
4000191PANCREAS US320 Radiology40276705$472.00O$236.00$236.00$163.69$141.22$149.07$174.84$174.84$150.00$295.94$162.08$336.54$160.48$141.22$336.54
4000193PELVIC US NON-OB LIMIT320 Radiology40276857$221.00O$110.50$110.50$76.64$141.22$149.07$174.84$174.84$150.00$138.57$75.89$157.57$75.14$75.14$174.84
4000207PELVIC US TRANSVAG NON320 Radiology40276830$523.00R$261.50$261.50$181.38$111.26$117.44$137.75$137.75$150.00$327.92$179.60$372.90$177.82$111.26$372.90
3200072PELVIS 1V320 Radiology32072170$300.00O$150.00$150.00$104.04$141.22$149.07$174.84$174.84$195.00$188.10$103.02$213.90$102.00$102.00$213.90
4000209PREGNANCY US > 14 WKS320 Radiology40276805$450.00R$225.00$225.00$156.06$115.34$121.75$142.80$142.80$150.00$282.15$154.53$320.85$153.00$115.34$320.85
4000196RENAL COMPLETE US320 Radiology40276770$472.00O$236.00$236.00$163.69$141.22$149.07$174.84$174.84$150.00$295.94$162.08$336.54$160.48$141.22$336.54
3200196RRibs 3 views w/AP Chest; Right320 Radiology32071101$247.00O$123.50$123.50$85.66$141.22$149.07$174.84$174.84$160.55$154.87$84.82$176.11$83.98$83.98$176.11
3200078RIBS BILAT 3V320 Radiology32071110$289.00O$144.50$144.50$100.23$141.22$149.07$174.84$174.84$187.85$181.20$99.24$206.06$98.26$98.26$206.06
3200196RIBS MIN 3 VIEW/AP CHEST320 Radiology32071101$247.00O$123.50$123.50$85.66$141.22$149.07$174.84$174.84$160.55$154.87$84.82$176.11$83.98$83.98$176.11
3200079RIBS UNILAT MIN 2 VIEWS320 Radiology32071100$231.00O$115.50$115.50$80.11$100.56$106.15$124.50$124.50$150.15$144.84$79.33$164.70$78.54$78.54$164.70
3200079RRIBS UNILAT MIN 2 VIEWS320 Radiology32071100$231.00O$115.50$115.50$80.11$100.56$106.15$124.50$124.50$150.15$144.84$79.33$164.70$78.54$78.54$164.70
3200080RIBS UNILATERAL 2V320 Radiology32071100$231.00O$115.50$115.50$80.11$100.56$106.15$124.50$124.50$150.15$144.84$79.33$164.70$78.54$78.54$164.70
3200080RRIBS UNILATERAL 2V320 Radiology32071100$231.00O$115.50$115.50$80.11$100.56$106.15$124.50$124.50$150.15$144.84$79.33$164.70$78.54$78.54$164.70
3200188RIBS/CHEST MIN 4 VIEW320 Radiology32071111$365.00O$182.50$182.50$126.58$141.22$149.07$174.84$174.84$237.25$228.86$125.34$260.25$124.10$124.10$260.25
3200082SACRUM & COCCYX MIN 2320 Radiology32072220$391.00O$195.50$195.50$135.60$100.56$106.15$124.50$124.50$254.15$245.16$134.27$278.78$132.94$100.56$278.78
3200085SCAPULA CMPLTE 2V320 Radiology32073010$191.00O$95.50$95.50$66.24$141.22$149.07$174.84$174.84$124.15$119.76$65.59$136.18$64.94$64.94$174.84
3200085RScapula Complete 2 view; Right320 Radiology32073010$191.00O$95.50$95.50$66.24$141.22$149.07$174.84$174.84$124.15$119.76$65.59$136.18$64.94$64.94$174.84
3200198SCOLIOSIS STANDING SER320 Radiology32072082$236.00O$118.00$118.00$81.84$141.22$149.07$174.84$174.84$153.40$147.97$81.04$168.27$80.24$80.24$174.84
4000201SCROTUM320 Radiology40276870$477.00O$238.50$238.50$165.42$141.22$149.07$174.84$174.84$150.00$299.08$163.80$340.10$162.18$141.22$340.10
3200089SHOULDER 2 V320 Radiology32073030$440.00O$220.00$220.00$152.59$100.56$106.15$124.50$124.50$286.00$275.88$151.10$313.72$149.60$100.56$313.72
3200089RSHOULDER 2 V320 Radiology32073030$440.00O$220.00$220.00$152.59$100.56$106.15$124.50$124.50$286.00$275.88$151.10$313.72$149.60$100.56$313.72
3200253Shoulder xray 2v; bilateral320 Radiology32073030$165.00O$82.50$82.50$57.22$100.56$106.15$124.50$124.50$107.25$103.46$56.66$117.65$56.10$56.10$124.50
4000202SINGLE ORGAN320 Radiology40276705$472.00O$236.00$236.00$163.69$141.22$149.07$174.84$174.84$150.00$295.94$162.08$336.54$160.48$141.22$336.54
3200094SKULL COMPLETE 4+V320 Radiology32070260$328.00O$164.00$164.00$113.75$141.22$149.07$174.84$174.84$213.20$205.66$112.64$233.86$111.52$111.52$233.86
3200098SPINE C 4+V320 Radiology32072050$367.00O$183.50$183.50$127.28$141.22$149.07$174.84$174.84$238.55$230.11$126.03$261.67$124.78$124.78$261.67
3200097SPINE CERVICAL 2V or 3V320 Radiology32072040$234.00O$117.00$117.00$81.15$100.56$106.15$124.50$124.50$152.10$146.72$80.36$166.84$79.56$79.56$166.84
3200103SPINE LUMBAR 2V OR 3V320 Radiology32072100$300.00O$150.00$150.00$104.04$141.22$149.07$174.84$174.84$195.00$188.10$103.02$213.90$102.00$102.00$213.90
3200104SPINE LUMBAR COMP SER MIN 4 VIEWS320 Radiology32072110$387.00R$193.50$193.50$134.21$141.22$149.07$174.84$174.84$251.55$242.65$132.90$275.93$131.58$131.58$275.93
3200100SPINE THORACIX 2 VIEW320 Radiology32072070$234.00O$117.00$117.00$81.15$141.22$149.07$174.84$174.84$152.10$146.72$80.36$166.84$79.56$79.56$174.84
3200180SPINE THORACIX W/SWIMM320 Radiology32072072$296.00O$148.00$148.00$102.65$141.22$149.07$174.84$174.84$192.40$185.59$101.65$211.05$100.64$100.64$211.05
4000200THYROID SOFT TISSUE US320 Radiology40276536$444.00O$222.00$222.00$153.98$141.22$149.07$174.84$174.84$150.00$278.39$152.47$316.57$150.96$141.22$316.57
3200111TOE(S) 3V320 Radiology32073660$337.00O$168.50$168.50$116.87$100.56$106.15$124.50$124.50$219.05$211.30$115.73$240.28$114.58$100.56$240.28
3200111RTOE(S) 3V320 Radiology32073660$337.00O$168.50$168.50$116.87$100.56$106.15$124.50$124.50$219.05$211.30$115.73$240.28$114.58$100.56$240.28
3200254Toes xray 2v; left320 Radiology32073660$175.00O$87.50$87.50$60.69$100.56$106.15$124.50$124.50$113.75$109.73$60.10$124.78$59.50$59.50$124.78
3200254RToes xray 2v; Right320 Radiology32073660$175.00O$87.50$87.50$60.69$100.56$106.15$124.50$124.50$113.75$109.73$60.10$124.78$59.50$59.50$124.78
3200256US Extremity non vascular; Rt320 Radiology40276882$410.00O$205.00$205.00$142.19$141.22$149.07$174.84$174.84$150.00$257.07$140.79$292.33$139.40$139.40$292.33
4000125US, Limited, Joint or other nonvascular320 Radiology40276882$410.00O$205.00$205.00$142.19$141.22$149.07$174.84$174.84$150.00$257.07$140.79$292.33$139.40$139.40$292.33
3200130WRIST 3 VIEWS320 Radiology32073110$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200130RWRIST 3 VIEWS320 Radiology32073110$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200218Wrist Bilateral Complete Xray min 3views320 Radiology32073110$416.00O$208.00$208.00$144.27$100.56$106.15$124.50$124.50$270.40$260.83$142.85$296.61$141.44$100.56$296.61
3200217Wrist Bilateral Xray 2views320 Radiology32073100$292.00O$146.00$146.00$101.27$100.56$106.15$124.50$124.50$189.80$183.08$100.27$208.20$99.28$99.28$208.20
3200201WRIST TWO VIEWS320 Radiology32073100$292.00O$146.00$146.00$101.27$100.56$106.15$124.50$124.50$189.80$183.08$100.27$208.20$99.28$99.28$208.20
3200201RWRIST TWO VIEWS320 Radiology32073100$292.00O$146.00$146.00$101.27$100.56$106.15$124.50$124.50$189.80$183.08$100.27$208.20$99.28$99.28$208.20
51093000EKG COMPLETE521Rural Health Clinic52193000$64.00R$32.00$14.59 $-$14.59$14.59$14.59$14.59$14.59$14.59 $-$14.59 $- $-$32.00
51099386PREVENTIVE EXAM NEW 40521Rural Health Clinic52199386$218.00R$109.00 $-$212.66 $- $- $- $- $- $-$212.66 $-$212.66 $-$212.66
51081002URINE DIPSTICK521Rural Health Clinic52181002$15.00R$7.50 $- $- $- $- $- $- $- $- $- $- $- $-$7.50

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.  This included related costs like medical test, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.  You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call {877-696-6775}

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