UH Procedures and Services
Our Commitment to Quality
Helping ensure our patients receive the highest level of care, delivered with dignity and compassion, is our goal with every patient and family member, every time. Our Board challenges us to remain in the Top 10 percent of hospitals in the country in quality scores, and they meet monthly with physicians and clinical staff to analyze the data and develop a plan to better serve our patients. It is this goal-driven mindset that has earned us recognition in key areas for our quality strides. Learn more about our quality awards and recognition.
NOTE: Charges are displayed for the procedure only. These do not include any medications, supplies or pre-procedure laboratory tests that may be needed prior to the study (for example - CT Scan of the Abdomen with Contrast does not include the contrast medication given. If the contrast is IV, you may have additional charges for the IV supplies). Please contact Scheduling and Benefits for a more accurate estimate of what the procedure will cost.
University Hospital/University Summerville: 706-774-8209 or 706-774-8210
University Hospital McDuffie: 706-597-5219
| Service | Charge Code | Charge Description | Charge |
|---|---|---|---|
| Procedurals | 36000827 | HC INJ SPINE L/S W/IMAGE GUIDANCE | $835 |
| Procedurals | 36000828 | HC INJ W/CATH C/T WO IMAGE GUIDANCE | $1,370 |
| Procedurals | 36000829 | HC INJ W/CATH C/T W/IMAGE GUIDE | $1,370 |
| Procedurals | 36000830 | HC INJ L/S W/CATH CAUDAL W/IMAGE GUIDE | $1,370 |
| Procedurals | 36000831 | HC TRNSCATH STENT PLCMNT, CTRL DIALYSIS SEGMNT | $6,197 |
| Procedurals | 36000832 | HC VASC EMBOLIZ OR OCCLUSION, PERM DIALYSIS CIRCUIT | $6,197 |
| Procedurals | 36000833 | HC MOCA, ABLATION THRPY 1ST VEIN | $4,708 |
| Procedurals | 36000834 | HC MOCA, ABLATION THRPY ADDL VEINS | $2,608 |
| Procedurals | 36000835 | HC UNLISTED SURGICAL PROCEDURE | |
| Procedurals | 36000836 | HC TRANSCATH AORTIC VALVE REPLCMNT (TAVR) | $8,680 |
| Procedurals | 36000837 | HC INJ PARAVERTEBRAL C/T 2 LEVELS | $924 |
| Procedurals | 36000838 | HC INJ PARAVERTEBRAL C/T 3 LEVELS | $924 |
| Procedurals | 36000839 | HC INJ PARAVERTEBRAL L/S 2 LEVELS | $813 |
| Procedurals | 36000840 | HC INJ PARAVERTEBRAL L/S 3 LEVELS | $813 |
| Procedurals | 36000841 | HC INJ SGL TENDON SHTH OR LIGAMENT | $379 |
| Procedurals | 36000842 | HC INSERT ANT SEGMNT DRAIN INT, W/O EXTRAOCULAR RESERVOIR | $4,392 |
| Procedurals | 36000843 | HC CRYOABLATION OF PULM TUMORS | $5,395 |
| Procedurals | 36000844 | HC PVB THORACIC SINGLE INJ SITE | $652 |
| Procedurals | 36000845 | HC ENDOVAS RPR A-AO NDGFT OTH THAN RUPTURE | $3,706 |
| Procedurals | 36000846 | HC ENDOVAS RPR A-AO NDGFT FOR RUPTURE | $3,706 |
| Procedurals | 36000847 | HC ENDOVAS RPR AO OR ILIAC NDGFT OTH THAN RUPTURE | $3,706 |
| Procedurals | 36000848 | HC ENDOVAS RPR AO OR ILIAC NDGFT FOR RUPTURE | $3,706 |
| Procedurals | 36000849 | HC ENDOVAS RPR AO/ILIAC BY A-BIILIAC NDGFT OTH THAN RUPTURE | $3,706 |
| Procedurals | 36000850 | HC ENDOVAS RPR AO/ILIAC BY A-BIILIAC NDGFT FOR RUPTURE | $3,706 |
| Procedurals | 36000851 | HC ENDOVAS RPR ILIAC BY ILIO-ILIAC NDGFT OTH THAN RUPTURE | $3,706 |
| Procedurals | 36000852 | HC ENDOVAS RPR ILIAC BY ILIO-ILIAC NDGFT FOR RUPTURE | $3,706 |
| Procedurals | 36000853 | HC PLACEMENT XTN PROSTH ENDOVAS PER VESS TREATED | $2,350 |
| Procedurals | 36000854 | HC DELAYED PLMT XTN PROSTH 1ST VESSEL | $2,350 |
| Procedurals | 36000855 | HC DELAYED PLMT XTEN PROSTH EACH ADDL VESSEL | $2,350 |
| Procedurals | 36000856 | HC ENDOVAS RPR ILIAC ARTERY BIFUR | $2,350 |
| Procedurals | 36000857 | HC ABDOM PLEURX CATH PLACE W/CUFF | $3,803 |
| Procedurals | 36000858 | HC ABDOM PLEURX CATH REMOVAL W/CUFF | $3,256 |
| Procedurals | 36000859 | HC PLACE FEM-FEM GRATH AT AA REP | $3,000 |
| Procedurals | 36000860 | HC OPEN ILIAC ART EXPOS | $3,706 |
| Procedurals | 36000861 | HC VISC & INFRAREN ABD 4+ PROST | $2,350 |
| Procedurals | 36000862 | HC PROSTATE NEEDLE PUNCH BX | $2,216 |
| Procedurals | 36000863 | HC INJ ANESTH; PUDENDAL NERVE | $941 |
| Procedurals | 36000864 | HC VISC & INFRAREN ABD 3 PROSTH | $2,350 |
| Procedurals | 36000865 | HC PVB THORACIC 2ND+ INJ SITE | $150 |
| Endoscopy | 36000866 | HC BEDSIDE BRONCH | $2,621 |
| Endoscopy | 36000867 | HC BEDSIDE BRONCH W/OTHER PROCEDURES | $2,621 |
| Procedurals | 36000868 | HC STENT PLACEMT ANTE CAROTID | $8,017 |
| Procedurals | 36000869 | HC INSERT VAD ART&VEIN ACCESS | |
| Procedurals | 36000870 | HC REMOVE VAD DIFFERENT SESSION | |
| Procedurals | 36000871 | HC REPOSITION VAD DIFF SESSION | |
| Procedurals | 36000872 | HC NB INJ HYPOGAS PLXS | $1,680 |
| Endoscopy | 36000873 | HC NAVIGATIONAL BRONCHOSCOPY | $2,561 |
| Procedurals | 36000803 | HC HOLDING/TREATMENT ROOM PROCEDURE | $625 |
| Anesthesia | 37000001 | HC ANESTHESIA FIRST 30 MINUTES | $151 |
| Anesthesia | 37000002 | HC OH ANESTHESIA FIRST 30 MINUTES | $160 |
| Anesthesia | 37000003 | HC ANESTHESIA PER MINUTE | $7 |
| Anesthesia | 37000004 | HC OH ANESTHESIA PER MINUTE | $8 |
| Anesthesia | 37000005 | HC MOD SED SAME PHYS/QHP 5/>YRS INITIAL 15 MIN | $151 |
| Anesthesia | 37000006 | HC MOD SED SAME PHYS/QHP 5/>YRS EA ADDL 15 MIN | $7 |
| Anesthesia | 37000007 | HC MOD SED OTH PHYS/QHP 5/>YRS INITIAL 15 MIN | $151 |
| Anesthesia | 37000008 | HC MOD SED OTH PHYS/QHP 5/>YRS EA ADDL 15 MIN | $7 |
| Blood Transfusion | 39100014 | HC TRANSFUS BLD OR COMP | $588 |
| Mammogram | 40100002 | HC MAMMOGRAM DIAG UNILAT/CALLBACK | $258 |
| Mammogram | 40100003 | HC MAMMOGRAM DIAG UNILAT GG | $250 |
| Mammogram | 40100004 | HC MAMMOGRAM DIAGNOSTIC BILAT DIG (INCLUDES CAD) | $273 |
| Mammogram | 40100005 | HC MAMMOGRAM DIAGNOSTI UNILAT DIG (INCLUDES CAD) | $229 |
| Mammogram | 40100006 | HC DIAG DIGITAL TOMOSYNTHESIS, UNILAT OR BILAT | $42 |
| Mammogram | 40100007 | HC MAMMOGRAM DIAG BILAT/CALLBACK | $258 |
| Mammogram | 40100008 | HC MAMMOGRAM DIAG BILAT GG | $250 |
| Ultrasound | 40200001 | HC US ABCESS DRAINAGE | $496 |
| Ultrasound | 40200002 | HC US ECHOENCEPHALOGRAPHY/NEURO | $142 |
| Ultrasound | 40200003 | HC US SOFT ISSUE NECK, THYROID | $574 |
| Ultrasound | 40200004 | HC US CHEST | $667 |
| Ultrasound | 40200005 | HC US BREAST COMPLETE (LEFT) | $348 |
| Ultrasound | 40200006 | HC US BREAST COMPLETE (RIGHT) | $348 |
| Ultrasound | 40200007 | HC US INSERTION MAMMOSITE | $649 |
| Ultrasound | 40200008 | HC US ABDOMEN COMPLETE | $667 |
| Ultrasound | 40200009 | HC US ABDOMEN LIMITED | $667 |
| Ultrasound | 40200010 | HC US RETROPERITONEAL LIMITED | $667 |
| Ultrasound | 40200011 | HC US TRANSPLANTED KIDNEY W/DUPLX | $205 |
| Ultrasound | 40200012 | HC US SPINE INFANT | $669 |
| Ultrasound | 40200013 | HC US OB 1ST TRIMESTER TA | $593 |
| Ultrasound | 40200014 | HC US OB 1ST TRIMESTER TA EA ADD | $393 |
| Ultrasound | 40200015 | HC US OBSTETRIC COMPLETE | $593 |
| Ultrasound | 40200016 | HC US OBSTETRIC MULTI GESTATIONS | $393 |
| Ultrasound | 40200017 | HC US OB 1ST TRIMESTER TV OR TA | $593 |
| Ultrasound | 40200020 | HC OB US LIMITED 1+FETUS(S) | $299 |
| Ultrasound | 40200020 | HC US OBSTETRIC LIMITED | $299 |
| Ultrasound | 40200021 | HC US OB 1ST TRIMESTER TV | $593 |
| Ultrasound | 40200022 | HC US TRANSVAGINAL | $667 |
| Ultrasound | 40200023 | HC US PELVIC COMPLETE | $608 |
| Ultrasound | 40200024 | HC ULTRASOUND PELVIS, LTD OR F/U | $130 |
| Ultrasound | 40200025 | HC US SCROTUM | $519 |
| Ultrasound | 40200026 | HC US TRANSRECTAL | $667 |
| Ultrasound | 40200027 | HC PROSTATE VOLUME STUDY/SEED TX | $385 |
| Ultrasound | 40200028 | HC US XTR NON-VASC COMPLETE | $574 |
| Ultrasound | 40200029 | HC US XTR NON-VASC LMTD | $368 |
| Ultrasound | 40200030 | HC US HIPS INFANT | $669 |
| Ultrasound | 40200031 | HC ULTRASONIC PERICARDIOCENTESIS | $184 |
| Ultrasound | 40200032 | HC PSEUDOANEURYSM ULTRASOUND/COMP | $1,074 |
| Ultrasound | 40200033 | HC ULTRASOUND GUIDE VASC ACCESS | $519 |
| Ultrasound | 40200034 | HC US GUIDANCE / MONITOR VISC ABL | $179 |
| Ultrasound | 40200035 | HC US NEEDLE GUIDANCE | $583 |
| Ultrasound | 40200036 | HC US AMNIOCENTESIS GUIDANCE | $519 |
| Ultrasound | 40200037 | HC US AMNIOCENTESIS, TWINS | $760 |
| Ultrasound | 40200038 | HC INTRAOPERATIVE ULTRASOUND | $817 |
| Ultrasound | 40200039 | HC AAA ULTRASOUND SCREENING | $214 |
| Cardiac Diagnostics | 40200040 | HC 3D RENDERING W/ POST-PROCESS | $588 |
| Ultrasound | 40200042 | HC INTRAOPERATIVE ULTRASOUND | $202 |
| Ultrasound | 40200043 | HC ULTRASOUND GUIDE VASC ACCESS | $533 |
| Ultrasound | 40200046 | HC US ABDOMEN LIMITED | $667 |
| Ultrasound | 40200047 | HC US NEEDLE GUIDANCE | $583 |
| Ultrasound | 40200048 | HC INTRAOPERATIVE ULTRASOUND | $202 |
| Ultrasound | 40200049 | HC ULTRASOUND GUIDE VASC ACCESS | $533 |
| Ultrasound | 40200051 | HC AAA ULTRASOUND SCREENING | $214 |
| Ultrasound | 40200052 | HC ULTRASOUND GUIDE VASC ACCESS | $533 |
| Ultrasound | 40200053 | HC US NEEDLE GUIDANCE | $583 |
| Ultrasound | 40200054 | HC US NEEDLE GUIDANCE | $583 |
| Ultrasound | 40200055 | HC US GUIDE - ENDOMYOCARDIAL BX | $583 |
| Ultrasound | 40200056 | HC US EXAM ABDO BACK WALL COMP | $667 |
| Mammogram | 40200057 | HC US BREAST LIMITED (LEFT) | $267 |
| Mammogram | 40200058 | HC US BREAST LIMITED (RIGHT) | $267 |
| Ultrasound | 40200061 | HC OB US DETAILED SINGLE FETUS | $250 |
| Ultrasound | 40200060 | HC US BONE DENSITY - PERIPHERAL | $69 |
| Procedurals | 40200063 | HC US ABDOMEN W/CONTRAST | $332 |
| Ultrasound | 40200065 | HC ULTRASOUND ELASTOGRAPHY | $200 |
| Mammogram | 40300002 | HC SCRN MAMMO DIR DIGITAL | $213 |
| Mammogram | 40300003 | HC HEALTH DEPT SCRN MAMM | $213 |
| Mammogram | 40300004 | HC SCREENING DIGITAL TOMOSYNTHESIS, BILAT | $49 |
| Mammogram | 40300005 | HC SCREENING DIGITAL TOMOSYNTHESIS, UNILAT (RIGHT) | $49 |
| Mammogram | 40300007 | HC SCREENING DIGITAL TOMOSYNTHESIS, UNILAT (LEFT) | $49 |
| Pet Scan | 40400001 | HC PET MYOCARDIAL METABOLIC EVAL | $5,072 |
| Pet Scan | 40400002 | HC PET BRAIN | $5,072 |
| Pet Scan | 40400003 | HC PET BRAIN PERFUSION EVALUATION | $5,072 |
| Pet Scan | 40400012 | HC PET IMAGE SKULL - THIGH | $4,900 |
| Pet Scan | 40400013 | HC PET FULL BODY | $4,900 |
| Pet Scan | 40400014 | HC ABSL QUAN AMYOCARD BLD FLO PET | $2,536 |
| Respiratory Therapy | 41000001 | HC INTUBATION | $786 |
| Respiratory Therapy | 41000004 | HC VENTILATOR INITIAL DAY | $1,025 |
| Respiratory Therapy | 41000007 | HC VENTILATOR SUBSEQUENT DAY | $947 |
| Respiratory Therapy | 41000009 | HC INHALATION TREATMENT | $261 |
| Respiratory Therapy | 41000024 | HC JET NEB PENTAMIDINE OUTPATIENT | $238 |
| Respiratory Therapy | 41000025 | HC CONTINUOUS JET NEB INITIAL | $299 |
| Respiratory Therapy | 41000026 | HC CONT JET NEB SUBSEQUENT HOUR | $141 |
| Respiratory Therapy | 41000027 | HC NON-INVASIVE VENT SUBSEQUENT DAY | $589 |
| Respiratory Therapy | 41000028 | HC NON-INVASIVE VENT INITIAL DAY | $745 |
| Respiratory Therapy | 41000031 | HC ACAPELLA/PEP, INITIAL THERAPY | $64 |
| Respiratory Therapy | 41000032 | HC PD WITH P INITIAL DAY | $156 |
| Respiratory Therapy | 41000033 | HC CHEST PT | $200 |
| Respiratory Therapy | 41000036 | HC ACAPELLA/PEP, SUBSEQUENT THERAPY | $64 |
| Respiratory Therapy | 41000037 | HC PD WITH P SUBSEQUENT | $156 |
| Respiratory Therapy | 41000039 | HC CHEST PT SUBSEQUENT | $200 |
| Respiratory Therapy | 41000041 | HC N/N TRANSCUTANEOUS MONITORING INITIAL | $205 |
| Respiratory Therapy | 41000043 | HC CARDIOPUL REHAB ED/REFERRAL | $55 |
| Respiratory Therapy | 41000044 | HC APNEA LINK | $369 |
| Respiratory Therapy | 41000045 | HC N/N BUBBLE CPAP SUBSEQUENT DAY | $672 |
| Respiratory Therapy | 41000046 | HC N/N BUBBLE CPAP INITIAL DAY | $850 |
| Respiratory Therapy | 41000047 | HC PUL REHAB THERAPY | $150 |
| Respiratory Therapy | 41000048 | HC PUL REHAB THERAPY GROUP | $100 |
| Respiratory Therapy | 41000049 | HC PUL REHAB COPD W EXER | $525 |
| Respiratory Therapy | 41000050 | HC APNEA TEST | $67 |
| Respiratory Therapy | 41000051 | HC INHALATION TREATMENT SUBSEQUENT | $170 |
| Respiratory Therapy | 41000053 | HC OSCILLATOR INITIAL DAY | $1,025 |
| Respiratory Therapy | 41000054 | HC OSCILLATOR SUBSEQUENT DAY | $947 |
| Respiratory Therapy | 41000055 | HC MDI INHALATION INITIAL | $110 |
| Respiratory Therapy | 41000056 | HC MDI INHALATION SUBSEQUENT | $99 |
| Respiratory Therapy | 41000057 | HC IPPB INITIAL | $156 |
| Respiratory Therapy | 41000058 | HC IPPB SUBSEQUENT | $148 |
| Respiratory Therapy | 41000067 | HC CPAP AUTOSET SLEEP STUDY | $745 |
| Respiratory Therapy | 41000068 | HC VEST THERAPY INITIAL | $205 |
| Respiratory Therapy | 41000069 | HC VEST THERAPY SUBSEQUENT | $205 |
| Respiratory Therapy | 41000070 | HC N/N TRANSCUTANEOUS MONITORING SUBSEQUENT | $205 |
| Respiratory Therapy | 41000072 | HC INHALATION TREATMENT | $210 |
| Respiratory Therapy | 41000073 | HC CARDIOPULMONARY RESUSCITATION - ER | $666 |
| Respiratory Therapy | 41000074 | HC PULM REHAB COPD PHASE II EDUC | $525 |
| Respiratory Therapy | 41000075 | HC PR PHASE II COPD DISCHARGE PLANNING | $525 |
| Respiratory Therapy | 41000076 | HC PR PHASE II COPD EVALUATION | $525 |
| Hyperbaric | 41300001 | HC HYPERBARIC OXYGEN 0-30MN | $409 |
| Hyperbaric | 41300002 | HC HYPERBARIC OXYGEN 31-60MN | $817 |
| Hyperbaric | 41300003 | HC HYPERBARIC OXYGEN 61-90MN | $1,225 |
| Hyperbaric | 41300004 | HC HYPERBARIC OXYGEN 91-120MN | $1,633 |
| Hyperbaric | 41300005 | HC HYPERBARIC OXYGEN PER 30 MIN | $409 |
| Pulmonary Rehab | 41900001 | HC PULMONARY REHAB TRAINING 15 MI | $125 |
| Pulmonary Rehab | 41900002 | HC CAR SEAT/BED TEST 60 MIN | $41 |
| Pulmonary Rehab | 41900003 | HC CAR SEAT/BED TEST EA ADDL 30 MIN | $20 |
| Physical Therapy | 42000001 | HC MUSCLE TESTING MANUAL PT | $108 |
| Physical Therapy | 42000002 | HC ROM MEASUREMENTS EXT/TRUNK | $108 |
| Physical Therapy | 42000003 | HC DEVELOPMENTAL TEST LIM PT | $73 |
| Physical Therapy | 42000004 | HC HOT PACK THERAPY PT | $35 |
| Physical Therapy | 42000005 | HC TRACTION MECHANICAL,PT | $87 |
| Physical Therapy | 42000006 | HC VASOPNEUMATIC DEVICE | $109 |
| Physical Therapy | 42000007 | HC FLUIDOTHERAPY | $99 |
| Physical Therapy | 42000008 | HC WHIRLPOOL | $110 |
| Physical Therapy | 42000009 | HC IONTOPHORESIS PT(15 MIN UNITS) | $62 |
| Physical Therapy | 42000010 | HC ULTRASOUND PT (15MIN UNITS) | $68 |
| Physical Therapy | 42000011 | HC US W/MEDS PT (15 MIN UNITS) | $77 |
| Physical Therapy | 42000012 | HC HUBBARD TANK, EACH 15MIN. | $92 |
| Physical Therapy | 42000013 | HC THERAPEUTIC EXERCISE PT | $98 |
| Physical Therapy | 42000014 | HC NEUROMUSCULAR RE-ED(15MIN UTS) | $98 |
| Physical Therapy | 42000015 | HC GAIT TRAINING PT(15 MIN UNITS) | $98 |
| Physical Therapy | 42000016 | HC MASSAGE PT (15 MIN UNITS) | $85 |
| Physical Therapy | 42000017 | HC MANUAL TX TECH-PT(15MIN UNITS) | $98 |
| Physical Therapy | 42000018 | HC THERAPEUTIC PROCEDURE, GROUP | $98 |
| Physical Therapy | 42000019 | HC THERAPEUTIC ACT DIR(15MIN UTS | $98 |
| Physical Therapy | 42000020 | HC SELECTIVE DEBRIDEMENT SMALL | $242 |
| Physical Therapy | 42000021 | HC PULSAVAC DEBRIDEMENT 1ST 15 MN | $313 |
| Physical Therapy | 42000022 | HC NON-SELECTIVE DEBRIDEMENT | $71 |
| Physical Therapy | 42000023 | HC PHYSICAL PERF TEST/MEASURE | $108 |
| Physical Therapy | 42000024 | HC PROSTHETIC TRAINING EA 15 MIN | $103 |
| Physical Therapy | 42000026 | HC PREPLACEMENT SCREENING(EA 15M) | $84 |
| Wound Therapy | 42000027 | HC WOUND ULTRASOUND | $352 |
| Physical Therapy | 42000028 | HC ELECTRICAL STIMULATION UNATTENDED | $78 |
| Physical Therapy | 42000029 | HC DEVELOPMENTAL TEST EXT PT | $288 |
| Physical Therapy | 42000030 | HC COLD PACK THERAPY PT | $35 |
| Physical Therapy | 42000049 | HC PT ELECTRICAL STIMULATION MANUAL | $78 |
| Physical Therapy | 42000050 | HC PT SELF CARE/HOME MANAGEMENT | $110 |
| Physical Therapy | 42000051 | HC PT ORTHOTICS FITTING/TRAINING | $119 |
| Physical Therapy | 42000052 | HC PT WHEELCHAIR MGMT TRAINING | $34 |
| Physical Therapy | 42000053 | HC PT TRANSCUTANEOUS NEUROSTIM | $67 |
| Physical Therapy | 42000054 | HC PT HEEL WEDGE SMALL | $16 |
| Physical Therapy | 42000055 | HC PT HEEL WEDGE MEDIUM OR LARGE | $14 |
| Physical Therapy | 42000056 | HC PT HEAT PACKS CERVICAL | $27 |
| Physical Therapy | 42000057 | HC PT HEAT PACKS STD | $31 |
| Physical Therapy | 42000058 | HC PT WRIST BRACE MEDIUM | $25 |
| Physical Therapy | 42000060 | HC PT SENSORY INTEGRATION THERAPY | $60 |
| Physical Therapy | 42400001 | HC EVAL PT LOW COMPLEXITY | $163 |
| Physical Therapy | 42400002 | HC EVAL PT MOD COMPLEXITY | $212 |
| Physical Therapy | 42400003 | HC EVAL PT HIGH COMPLEXITY | $245 |
| Physical Therapy | 42400004 | HC PT RE-EVALUATION | $212 |
| Occupational Therapy | 43000001 | HC OT TENS/ESTIM HOME INSTRUCT 15 ONE UNIT CHARGE | $100 |
| Occupational Therapy | 43000002 | HC OT TENS/ESTIM HOME INSTRUCT 30 ONE UNIT CHARGE | $199 |
| Occupational Therapy | 43000003 | HC OT TENS/ESTIM HOME INSTRUCT 45 ONE UNIT CHARGE | $298 |
| Occupational Therapy | 43000004 | HC OT TENS/ESTIM HOME INSTRUCT 60 ONE UNIT CHARGE | $397 |
| Occupational Therapy | 43000005 | HC OT IP DEVELOPMENTAL EXT EVAL (45) | $262 |
| Occupational Therapy | 43000007 | HC OT HOT/COLD PACK THERAPY 15 MIN | $61 |
| Occupational Therapy | 43000008 | HC OT FLUIDOTHERAPY/WHIRLPOOL-15 MIN(1 UNIT CHARGE) | $46 |
| Occupational Therapy | 43000009 | HC OT FLUIDOTHERAPY/WHIRLPOOL -30 MIN(1 UNIT CHARGE) | $90 |
| Occupational Therapy | 43000010 | HC OT E-STIM OT-15MIN UNITS ATTENDED NMES | $63 |
| Occupational Therapy | 43000011 | HC OT E-STIM OT W/NEW SET ELECTRODES ATTENDED NMES | $82 |
| Occupational Therapy | 43000012 | HC OT IONTOPHORESIS OT 1 SITE (15 MIN) | $56 |
| Occupational Therapy | 43000013 | HC OT IONTOPHORESIS OT 2 SITES(15MIN) | $62 |
| Occupational Therapy | 43000014 | HC OT IONTOPHORESIS OT 3 SITES(15MIN) | $70 |
| Occupational Therapy | 43000015 | HC OT IONTOPHORESIS OT 4 SITES(15MIN) | $78 |
| Occupational Therapy | 43000016 | HC OT CONTRAST BATH (PER 15 MIN) | $31 |
| Occupational Therapy | 43000017 | HC OT ULTRASOUND OT 15MIN UNITS | $61 |
| Occupational Therapy | 43000018 | HC OT ULTRASOUND W/MEDS 15MIN UNITS | $70 |
| Occupational Therapy | 43000021 | HC OT THERAPEUTIC EXER OT15MIN UNITS NOT W OFF | $89 |
| Occupational Therapy | 43000022 | HC OT MANUAL THERAPY 15MIN UNITS NOT W TH AC OFF | $97 |
| Occupational Therapy | 43000023 | HC OT THERAPEUTIC GROUP ONE UNIT CHARGE ONLY RX | $89 |
| Occupational Therapy | 43000024 | HC OT THERAPEUTIC ACTIVITY OT-15MIN UNITS NOT W SC, MAN THER | $89 |
| Occupational Therapy | 43000025 | HC OT SELFCARE/HOME MGT TRAIN-15M UNITS NOT WITH THER ACT | $102 |
| Occupational Therapy | 43000026 | HC WORK CONDITIONING(UP TO 2 HRS) | $651 |
| Occupational Therapy | 43000027 | HC WORK CONDITIONING(EA ADD'L HR) | $326 |
| Occupational Therapy | 43000028 | HC OT FUNCT CAPACITY EVAL 1-25 | $134 |
| Occupational Therapy | 43000029 | HC OT ORTHO FAB FIT 15MIN UNITS NOT WITH ORTHO CHECK OR THER EX | $85 |
| Occupational Therapy | 43000030 | HC OT ORTHO CHECK 15MIN UNITS NOT WITH ORTHO FAB FIT | $85 |
| Occupational Therapy | 43000032 | HC OT IMPAIRMENT RATING 45 | $210 |
| Occupational Therapy | 43000033 | HC OT IMPAIRMENT RATING 60 | $280 |
| Occupational Therapy | 43000034 | HC OT IMPAIRMENT RATING 75 | $350 |
| Occupational Therapy | 43000035 | HC IMPAIRMENT RATING UPPER EXTREMITY | $420 |
| Occupational Therapy | 43000036 | HC OT ESTIM UNATTENDED - 1 UNIT CHARGE ONLY TENS | $60 |
| Occupational Therapy | 43000037 | HC OT IP DEVELOPMENTAL EXT EVAL-(60) | $262 |
| Occupational Therapy | 43000038 | HC OT FUNCT CAPAC EVAL 26+ | $134 |
| Occupational Therapy | 43000039 | HC OT IMPAIRMENT RATING SPINE | $140 |
| Occupational Therapy | 43000040 | HC OT IMPAIRMENT RATING 30 | $140 |
| Occupational Therapy | 43000041 | HC OT IMPAIRMENT RATING 90 | $140 |
| Occupational Therapy | 43000042 | HC OT PREPLACEMENT SCREENING(EA 15M) | $76 |
| Occupational Therapy | 43000043 | HC OT MASTECTOMY THERAPEUTIC EXER OT(15MIN UNITS) | $89 |
| Occupational Therapy | 43000044 | HC OT HOT/COLD PACK THERAPY 30 MIN | $61 |
| Occupational Therapy | 43000063 | HC OT NEUROMUSCULAR RE-EDUC | $105 |
| Occupational Therapy | 43000064 | HC OT COGNITIVE SKILLS | $86 |
| Occupational Therapy | 43000031 | HC OT IMPAIR RATE SPINE | $140 |
| Occupational Therapy | 43000065 | HC OT SENSORY INTEGRATION THERAPY | $60 |
| Occupational Therapy | 43400001 | HC OT EVAL MOD COMPLEXITY | $212 |
| Occupational Therapy | 43400006 | HC OT REEVALUATION | $212 |
| Occupational Therapy | 43400010 | HC OT EVAL LOW COMPLEXITY | $163 |
| Occupational Therapy | 43400018 | HC OT EVAL HIGH COMPLEXITY | $245 |
| Audiology | 44000001 | HC AUD REHAB POSTLING HEAR LOSS | $130 |
| Audiology | 44000002 | HC AUD REHAB PRE-LING HEAR LOSS | $130 |
| Audiology | 44000003 | HC AUDITORY FUNCTION ADDTL 15 MIN | $64 |
| Audiology | 44000004 | HC EVAL AUD REHAB STATUS | $194 |
| Audiology | 44000005 | HC EVAL AUD STATUS EA ADDL 15 MIN | $64 |
| Speech Therapy | 44000006 | HC FEEDING THERAPY - 1 | $158 |
| Speech Therapy | 44000007 | HC FEEDING THERAPY - 2 | $158 |
| Speech Therapy | 44000008 | HC FEEDING THERAPY - 3 | $158 |
| Speech Therapy | 44000009 | HC FEEDING THERAPY - 4 | $313 |
| Speech Therapy | 44000010 | HC FEEDING THERAPY - 5 | $313 |
| Speech Therapy | 44000011 | HC FEEDING THERAPY - 6 | $466 |
| Speech Therapy | 44000012 | HC FEEDING THERAPY - 7 | $466 |
| Speech Therapy | 44000013 | HC MOD-VOICE PROTHESIS | $224 |
| Speech Therapy | 44000021 | HC SENSORY INTEGRATIVE TECHNIQUES | $62 |
| Speech Therapy | 44000022 | HC SENSORY INTEGRATION EA 15M | $69 |
| Speech Therapy | 44000023 | HC SPEECH THERAPY - 1 | $160 |
| Speech Therapy | 44000024 | HC SPEECH THERAPY - 2 | $160 |
| Speech Therapy | 44000025 | HC SPEECH THERAPY - 3 | $160 |
| Speech Therapy | 44000026 | HC SPEECH THERAPY - 4 | $316 |
| Speech Therapy | 44000027 | HC SPEECH THERAPY - 5 | $316 |
| Speech Therapy | 44000028 | HC SPEECH THERAPY - 6 | $472 |
| Speech Therapy | 44000029 | HC SPEECH THERAPY - 7 | $472 |
| Speech Therapy | 44000030 | HC SPEECH THERAPY - 8 | $629 |
| Speech Therapy | 44000032 | HC SWALLOW THER VITALSTIM BRIEF | $184 |
| Speech Therapy | 44000033 | HC SWALLOW THER VITALSTIM STANDARD | $368 |
| Speech Therapy | 44000034 | HC SWALLOWING THERAPY - 1 | $158 |
| Speech Therapy | 44000035 | HC SWALLOWING THERAPY - 2 | $158 |
| Speech Therapy | 44000036 | HC SWALLOWING THERAPY - 3 | $158 |
| Speech Therapy | 44000037 | HC SWALLOWING THERAPY - 4 | $313 |
| Speech Therapy | 44000038 | HC SWALLOWING THERAPY - 5 | $313 |
| Speech Therapy | 44000039 | HC SWALLOWING THERAPY - 6 | $466 |
| Speech Therapy | 44000040 | HC SWALLOWING THERAPY - 7 | $466 |
| Speech Therapy | 44000042 | HC VIDEO FLUORO SWAL EVAL | $563 |
| Speech Therapy | 44000067 | HC SP EVAL VOICE 1 | $160 |
| Speech Therapy | 44000068 | HC SP EVAL VOICE 2 | $160 |
| Speech Therapy | 44000069 | HC SP EVAL VOICE 3 | $160 |
| Speech Therapy | 44000070 | HC SP EVAL VOICE 4 | $316 |
| Speech Therapy | 44000071 | HC SP EVAL VOICE 5 | $316 |
| Speech Therapy | 44000072 | HC SP EVAL VOICE 6 | $472 |
| Speech Therapy | 44000073 | HC SP EVAL VOICE 7 | $472 |
| Speech Therapy | 44000074 | HC SP EVAL VOICE 8 | $629 |
| Speech Therapy | 44000075 | HC SP EVAL VOICE 9 | $629 |
| Speech Therapy | 44000076 | HC SPEECH DISORDER IND | $280 |
| Speech Therapy | 44000077 | HC SWALLOW/ORAL FEEDING THERAPY | $320 |
| Speech Therapy | 44000078 | HC EVAL ORAL/PHAR SWALLOW | $254 |
| Speech Therapy | 44000079 | HC MOTION FLOUROSCOPY SWALLOW | $383 |
| Speech Therapy | 44100001 | HC INFANT STIMULATION | $123 |
| Speech Therapy | 44300001 | HC SPEECH DEVELOPMENT GROUP 1 | $160 |
| Speech Therapy | 44300002 | HC SPEECH DEVELOPMENT GROUP 2 | $160 |
| Speech Therapy | 44300003 | HC SPEECH DEVELOPMENT GROUP 3 | $160 |
| Speech Therapy | 44300004 | HC SPEECH DEVELOPMENT GROUP 4 | $316 |
| Speech Therapy | 44300005 | HC SPCH DEVEL DELAY STIMUL GROUP | $108 |
| Speech Therapy | 44400001 | HC AUG/ALT COMM - 1 | $154 |
| Speech Therapy | 44400002 | HC AUG/ALT COMM - 2 | $154 |
| Speech Therapy | 44400003 | HC AUG/ALT COMM - 3 | $154 |
| Speech Therapy | 44400004 | HC AUG/ALT COMM - 4 | $306 |
| Speech Therapy | 44400005 | HC AUG/ALT COMM - 5 | $306 |
| Speech Therapy | 44400006 | HC AUG/ALT COMM - 6 | $457 |
| Speech Therapy | 44400007 | HC AUG/ALT COMM - 7 | $457 |
| Speech Therapy | 44400008 | HC AUG/ALT COMM EVAL - 1 | $220 |
| Speech Therapy | 44400009 | HC AUG/ALT COMM EVAL - 2 | $220 |
| Speech Therapy | 44400010 | HC AUG/ALT COMM EVAL - 3 | $220 |
| Speech Therapy | 44400011 | HC AUG/ALT COMM EVAL - 4 | $306 |
| Speech Therapy | 44400015 | HC EVAL/FIT OP VOICE PROTHESIS | $299 |
| Speech Therapy | 44400016 | HC FEEDING EVAL - 1 | $209 |
| Speech Therapy | 44400017 | HC FEEDING EVAL - 2 | $209 |
| Speech Therapy | 44400018 | HC FEEDING EVAL - 3 | $209 |
| Speech Therapy | 44400019 | HC FEEDING EVAL - 4 | $413 |
| Speech Therapy | 44400020 | HC FEEDING EVAL - 5 | $413 |
| Speech Therapy | 44400021 | HC FEEDING EVAL - 6 | $615 |
| Speech Therapy | 44400022 | HC FEEDING EVAL - 7 | $615 |
| Speech Therapy | 44400023 | HC FEEDING EVAL - 8 | $820 |
| Speech Therapy | 44400024 | HC FEEDING EVAL - 9 | $820 |
| Speech Therapy | 44400025 | HC NEONATAL ASSESSMENT - 1 | $209 |
| Speech Therapy | 44400026 | HC NEONATAL ASSESSMENT - 2 | $209 |
| Speech Therapy | 44400027 | HC NEONATAL ASSESSMENT - 3 | $209 |
| Speech Therapy | 44400028 | HC NEONATAL ASSESSMENT - 4 | $413 |
| Speech Therapy | 44400029 | HC NEONATAL ASSESSMENT - 5 | $413 |
| Speech Therapy | 44400030 | HC NEONATAL ASSESSMENT - 6 | $615 |
| Speech Therapy | 44400031 | HC NEONATAL ASSESSMENT - 7 | $615 |
| Speech Therapy | 44400032 | HC NEONATAL ASSESSMENT - 8 | $820 |
| Speech Therapy | 44400033 | HC NEONATAL ASSESSMENT - 9 | $820 |
| Speech Therapy | 44400034 | HC PRE FLUORO SWAL EVAL - 1 | $209 |
| Speech Therapy | 44400034 | HC PRE-FLUORO SWAL EVAL - 1 | $209 |
| Speech Therapy | 44400035 | HC PRE FLUORO SWAL EVAL - 2 | $209 |
| Speech Therapy | 44400036 | HC PRE-FLUORO SWAL EVAL - 3 | $209 |
| Speech Therapy | 44400037 | HC PRE FLUORO SWAL EVAL - 4 | $413 |
| Speech Therapy | 44400038 | HC PRE-FLUORO SWAL EVAL - 5 | $413 |
| Speech Therapy | 44400041 | HC SPEECH EVAL - 1 | $160 |
| Speech Therapy | 44400042 | HC SPEECH EVAL - 2 | $160 |
| Speech Therapy | 44400043 | HC SPEECH EVAL - 3 | $160 |
| Speech Therapy | 44400044 | HC SPEECH EVAL - 4 | $316 |
| Speech Therapy | 44400045 | HC SPEECH EVAL - 5 | $316 |
| Speech Therapy | 44400046 | HC SPEECH EVAL - 6 | $472 |
| Speech Therapy | 44400047 | HC SPEECH EVAL - 7 | $472 |
| Speech Therapy | 44400048 | HC SPEECH EVAL - 8 | $629 |
| Speech Therapy | 44400049 | HC SPEECH EVAL - 9 | $629 |
| Speech Therapy | 44400052 | HC AUG/ALT COMM EVAL EA ADD 30MIN | $52 |
| Speech Therapy | 44400053 | HC SP EVAL FLUENCY 1 | $160 |
| Speech Therapy | 44400054 | HC SP EVAL FLUENCY 2 | $160 |
| Speech Therapy | 44400055 | HC SP EVAL FLUENCY 3 | $160 |
| Speech Therapy | 44400056 | HC SP EVAL FLUENCY 4 | $316 |
| Speech Therapy | 44400057 | HC SP EVAL FLUENCY 5 | $316 |
| Speech Therapy | 44400058 | HC SP EVAL FLUENCY 6 | $472 |
| Speech Therapy | 44400059 | HC SP EVAL FLUENCY 7 | $472 |
| Speech Therapy | 44400060 | HC SP EVAL FLUENCY 8 | $629 |
| Speech Therapy | 44400061 | HC SP EVAL FLUENCY 9 | $629 |
| Speech Therapy | 44400062 | HC SP EVAL SOUND PROD 1 | $160 |
| Speech Therapy | 44400063 | HC SP EVAL SOUND PROD 2 | $160 |
| Speech Therapy | 44400064 | HC SP EVAL SOUND PROD 3 | $160 |
| Speech Therapy | 44400065 | HC SP EVAL SOUND PROD 4 | $316 |
| Speech Therapy | 44400066 | HC SP EVAL SOUND PROD 5 | $316 |
| Speech Therapy | 44400067 | HC SP EVAL SOUND PROD 6 | $472 |
| Speech Therapy | 44400068 | HC SP EVAL SOUND PROD 7 | $472 |
| Speech Therapy | 44400069 | HC SP EVAL SOUND PROD 8 | $629 |
| Speech Therapy | 44400070 | HC SP EVAL SOUND PROD 9 | $629 |
| Speech Therapy | 44400071 | HC SP EVAL LANG 1 | $160 |
| Speech Therapy | 44400072 | HC SP EVAL LANG 2 | $160 |
| Speech Therapy | 44400073 | HC SP EVAL LANG 3 | $160 |
| Speech Therapy | 44400074 | HC SP EVAL LANG 4 | $316 |
| Speech Therapy | 44400075 | HC SP EVAL LANG 5 | $316 |
| Speech Therapy | 44400076 | HC SP EVAL LANG 6 | $472 |
| Speech Therapy | 44400077 | HC SP EVAL LANG 7 | $472 |
| Speech Therapy | 44400078 | HC SP EVAL LANG 8 | $629 |
| Speech Therapy | 44400080 | HC SP EVAL LANG 9 | $629 |
| Speech Therapy | 44400081 | HC EVALUATION OF SPEECH FLUENCY | $160 |
| Speech Therapy | 44400082 | HC EVALUATE SPEECH PRODUCTION | $160 |
| Speech Therapy | 44400083 | HC SPEECH SOUND LANG COMPREHEN | $316 |
| Speech Therapy | 44400084 | HC BEHAVRAL QUALIT ANALYS VOICE | $160 |
| Speech Therapy | 44400085 | HC EVAL SPEECH,VOICE,COMM | $558 |
| Speech Therapy | 44400086 | HC ASSESSMENT OF APHASIA 1HR | $145 |
| Speech Therapy | 44400087 | HC DEVELOPMENTAL TESTING, EXTENDED | $173 |
| Speech Therapy | 44000080 | HC STANDARD COGNITIVE PERFORM TESTING 1HR | $158 |
| Emergency Department | 45000001 | HC ER LEVEL 1 | $225 |
| Emergency Department | 45000002 | HC ER LEVEL 2 | $270 |
| Emergency Department | 45000003 | HC ER LEVEL 3 | $394 |
| Emergency Department | 45000004 | HC ER LEVEL 4 | $825 |
| Emergency Department | 45000005 | HC ER LEVEL 5 | $1,080 |
| Emergency Department | 45000006 | HC ER COMPLEX | $1,418 |
| Pulmonary Function | 46000001 | HC SPIROMETRY | $159 |
| Pulmonary Function | 46000002 | HC ADULT SPIROMETRY FULL MEASURE | $169 |
| Pulmonary Function | 46000003 | HC SINGLE-SPIROMETRY-PFT | $309 |
| Pulmonary Function | 46000004 | HC BRONCHOSPASM EVALUATION | $169 |
| Pulmonary Function | 46000005 | HC SPIROMETRY- B AND A BRONCHODIL | $648 |
| Pulmonary Function | 46000006 | HC BRONCHIAL CHALLENGE | $759 |
| Pulmonary Function | 46000007 | HC MAXIMUM BREATHING CAPACITY | $185 |
| Pulmonary Function | 46000010 | HC NITROGEN LUNG VOLUMES | $197 |
| Pulmonary Function | 46000011 | HC HIGH ALTITUDE SIM | $132 |
| Pulmonary Function | 46000012 | HC HIGH ALTITUDE SIM WITH OXYGEN | $132 |
| Pulmonary Function | 46000013 | HC N/N SURFACTANT ADMINISTRATION | $154 |
| Pulmonary Function | 46000014 | HC 6 MINUTE WALK | $150 |
| Pulmonary Function | 46000015 | HC PULMONARY STRESS TEST - SIMPLE | $150 |
| Pulmonary Function | 46000016 | HC PULMONARY STRESS TEST-COMPLEX | $730 |
| Pulmonary Function | 46000017 | HC CLOSED SYSTEM O2-INCL CO2 AND | $268 |
| Pulmonary Function | 46000018 | HC CALORIMETRY-O2 UPTAKE INDIRECT | $662 |
| Pulmonary Function | 46000019 | HC DLCO-DIFFUSION- PL | $441 |
| Pulmonary Function | 46000020 | HC OXYGEN SATURATION | $34 |
| Pulmonary Function | 46000022 | HC OXIMETER N200 MULTIPLE ER | $103 |
| Pulmonary Function | 46000023 | HC SLEEP OXIMETRY STUDY | $498 |
| Pulmonary Function | 46000024 | HC ETCO2 MONITORING | $108 |
| Pulmonary Function | 46000025 | HC PULMONARY REHAB PHASE II MOD | $30 |
| Pulmonary Function | 46000026 | HC PULM FUNCT TEST PLETHYSMOGRAPY | $536 |
| Pulmonary Function | 46000027 | HC FLOW VOLUME LOOP | $309 |
| Pulmonary Function | 46000030 | HC PULSE OX O2 DESAT STUDY ADULT | $98 |
| Pulmonary Function | 46000031 | HC PULM REHAB EDUCATION ASSISTANCE | $30 |
| Audiology | 47000001 | HC OTOACOUSTIC EMISSIONS-SCREEN | $130 |
| Audiology | 47000002 | HC REPRGRAM COCHLEAR IMPLANT >7YR | $170 |
| Audiology | 47000004 | HC AUD REHAB PRE-LING HEAR LOSS | $130 |
| Audiology | 47000005 | HC AUD REHAB POSTLING HEAR LOSS | $130 |
| Audiology | 47100008 | HC SCREENING-PURE TONE AIR ONLY | $57 |
| Audiology | 47100009 | HC AIR CONDUCTION AUDIOGRAM | $91 |
