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 |
|---|---|---|---|
| Audiology | 47100010 | HC AIR AND BONE COND AUDIOGRAM | $134 |
| Audiology | 47100011 | HC SPEECH RECEPTION THRESHOLD | $81 |
| Audiology | 47100012 | HC SPEECH DISCRIMINATION | $119 |
| Audiology | 47100013 | HC COMPLETE AUDIOGRAM | $244 |
| Audiology | 47100014 | HC TYMPANOMETRY | $112 |
| Audiology | 47100015 | HC ACOUSTIC REFLEX | $81 |
| Audiology | 47100016 | HC VISUAL AUDIOMETRY(VRA) | $146 |
| Audiology | 47100018 | HC ABR BRAINSTEM EVOKED RESPONSE | $598 |
| Audiology | 47100020 | HC AUDITORY EVOKED POTENT COMP | $1,076 |
| Audiology | 47100021 | HC NEONATE HEARING TEST | $304 |
| Audiology | 47100022 | HC AUDITORY EVOKED POTENT LIMITED | $395 |
| Audiology | 47100023 | HC OTOACOUSTIC EMISS'N-DIAGNOSTIC | $266 |
| Audiology | 47100024 | HC ANALYSIS COCHLEAR IMPLANT <7YR | $280 |
| Audiology | 47100025 | HC REPRGRAM COCHLEAR IMPLANT <7YR | $170 |
| Audiology | 47100026 | HC ANALYSIS COCHLEAR IMPLANT >7YR | $280 |
| Audiology | 47100027 | HC CENTRAL AUDITORY FUNCTION SCAN | $256 |
| Audiology | 47100028 | HC STENGER PURE TONE | $52 |
| Audiology | 47100029 | HC ACOUSTIC IMMITTANCE TESTING | $52 |
| Audiology | 47100030 | HC STENGER SPEECH TEST | $194 |
| Audiology | 47100031 | HC CONDITIONING PLAY AUDIOMETRY | $137 |
| Audiology | 47100032 | HC SELECT PICTURE AUDIOMETRY | $52 |
| Audiology | 47100033 | HC HEARING AID EXAM BOTH EARS | $130 |
| Audiology | 47100034 | HC AUDIOLOGY CONSULT PER 15 MIN | $64 |
| Audiology | 47100035 | HC TINNITUS ASSESSMENT | $137 |
| Audiology | 47100036 | HC AUDITORY FUNCTION ADDTL 15 MIN | $64 |
| Audiology | 47100037 | HC EVAL AUD REHAB STATUS | $194 |
| Audiology | 47100038 | HC EVAL AUD STATUS EA ADDL 15 MIN | $64 |
| Procedurals | 36000719 | HC IMPLT SUBQ DEFIB INTEROGAT | $197 |
| Procedurals | 36000720 | HC IMPLT SUBQ DEFIB SYS DEV EVL | $197 |
| Cath Lab | 48000002 | HC TEMPORARY PACING TRANSCUTANEOUS | $1,232 |
| Cath Lab | 48000005 | HC MICROVOLT T-WAVE ALTERNANS | $361 |
| Cath Lab | 48000006 | HC ELEC ANALY PACE W/REPRO/SINGLE | $215 |
| Cath Lab | 48000007 | HC ELEC ANALY PACER W/REPROG/DUAL | $238 |
| Cath Lab | 48000008 | HC ELEC ANALY AICD/SING/W/REPROG | $175 |
| Cath Lab | 48000009 | HC ELEC ANALY AICD/DUAL/W/REPROG | $197 |
| Cath Lab | 48000010 | HC ELEC ANALY AICD/MULT/W/REPROG | $197 |
| Cath Lab | 48000011 | HC ELECTRONIC ANALYSIS LOOP (ILR) | $534 |
| Cath Lab | 48000012 | HC PM DEVICE INTERROGATION | $175 |
| Cath Lab | 48000013 | HC ICD DEVICE INTERROGATION | $133 |
| Cardiac Diagnostics | 48000014 | HC ECHO CONGENITAL ANOMALIES COMPLETE | $1,880 |
| Cardiac Diagnostics | 48000015 | HC ECHO CONGENITAL ANOMALIES LIMITED | $658 |
| Cardiac Diagnostics | 48000016 | HC ECHOCARDIOGRAM COMPLETE | $1,709 |
| Cardiac Diagnostics | 48000017 | HC ECHOCARDIOGRAM 2D ONLY | $684 |
| Cardiac Diagnostics | 48000018 | HC ECHOCARDOGRAM LIMITED STUDY | $658 |
| Cardiac Diagnostics | 48000019 | HC TRANSESOPHAGEAL ECHOCARDIOGRAM | $1,260 |
| Cardiac Diagnostics | 48000020 | HC CARDIAC PULSED WAVE DOPPLER | $599 |
| Cardiac Diagnostics | 48000021 | HC COLOR FLOW MAPPING | $599 |
| Cardiac Diagnostics | 48000022 | HC STRESS ECHOCARDIOGRAM | $1,878 |
| Cath Lab | 48000023 | HC DILUTION STUDY W/CARDIAC OTPUT | $104 |
| Cath Lab | 48000029 | HC EP FOLLOW-UP | $4,447 |
| Cath Lab | 48000030 | HC EVAL/CARDIO-DEFIB LEADS;INTRAO | $1,746 |
| Cardiac Diagnostics | 48000038 | HC BLOOD PRESSURE MONITORING 24HR | $472 |
| Cardiac Diagnostics | 48000039 | HC BLOOD PRESSURE ANALYSIS/REPORT | $164 |
| Cath Lab | 48000040 | HC ASPIRATION THROMBECTOMY | $4,141 |
| Cardiac Diagnostics | 48000041 | HC TEE INCOMPLETE | $918 |
| Cardiac Diagnostics | 48000042 | HC TEE WITH CONTRAST | $1,353 |
| Cardiac Diagnostics | 48000043 | HC TTE COMPLETE WITH CONTRAST | $2,088 |
| Cardiac Diagnostics | 48000044 | HC ECHOCARDIOGRAM COMPLETE | $1,709 |
| Cardiac Diagnostics | 48000045 | HC ECHOCARDIOGRAM 2D ONLY | $684 |
| Cardiac Diagnostics | 48000046 | HC ECHOCARDOGRAM LIMITED STUDY | $658 |
| Cardiac Diagnostics | 48000047 | HC CARDIAC PULSED WAVE DOPPLER | $599 |
| Cardiac Diagnostics | 48000048 | HC COLOR FLOW MAPPING | $599 |
| Cardiac Diagnostics | 48000049 | HC TTE COMPLETE WITH CONTRAST | $2,088 |
| Cardiac Diagnostics | 48000053 | HC ECHOCARDOGRAM LIMITED STUDY | $658 |
| Cardiac Diagnostics | 48000054 | HC PM PHONE DEVICE EVAL=<90 DAYS | $133 |
| Cardiac Diagnostics | 48000055 | HC PM/ICD REMOTE TECH SERV =<90 DAYS | $133 |
| Cardiac Diagnostics | 48000056 | HC ICM/ILR REMOTE TECH SERV =<30 DAYS | $133 |
| Cardiac Diagnostics | 48000057 | HC ICM DEVICE EVAL PER PT ENCOUNTER | $133 |
| Cath Lab | 48000059 | HC ELEC ANALY AICD/MULT/W/REPROG | $197 |
| Cath Lab | 48000060 | HC ECHOCARDOGRAM LIMITED STUDY | $658 |
| Cath Lab | 48000061 | HC EVAL/CARDIO-DEFIB LEADS;INTRAO | $1,746 |
| Cath Lab | 48000062 | HC PM DEVICE INTERROGATION | $175 |
| Cardiac Diagnostics | 48000063 | HC ICD DEVICE INTERROGATION | $133 |
| Cath Lab | 48000064 | HC ELEC ANALY AICD/DUAL/W/REPROG | $197 |
| Cath Lab | 48000065 | HC INTRACARD ECHO DURING INTERVEN | $4,425 |
| Cardiac Diagnostics | 48000067 | HC PRE-OP PM DEVICE EVAL | $133 |
| Cardiac Diagnostics | 48000068 | HC PRE-OP ICD DEVICE EVAL | $133 |
| Cardiac Diagnostics | 48000069 | HC ILR DEVICE INTERROGATE | $133 |
| Cardiac Diagnostics | 48000070 | HC WCD DEVICE INTERROGATE | $133 |
| Cath Lab | 48000071 | HC ELEC ANALY AICD/SING/W/REPROG | $175 |
| Cath Lab | 48000072 | HC EVAL/CARD-DEFIB W/TEST,P/GEN | $2,230 |
| Cath Lab | 48000073 | HC ELEC ANALY PACE W/REPRO/SINGLE | $215 |
| Cath Lab | 48000074 | HC ELEC ANALY PACER W/REPROG/DUAL | $238 |
| Cath Lab | 48000075 | HC ELEC ANALY AICD/DUAL/W/REPROG | $197 |
| Cath Lab | 48000076 | HC ELECTRONIC ANALYSIS LOOP (ILR) | $534 |
| Cardiac Diagnostics | 48000077 | HC PM DEVICE INTERROGATION | $175 |
| Cardiac Diagnostics | 48000078 | HC ICD DEVICE INTERROGATION | $133 |
| Cardiac Diagnostics | 48000079 | HC ELEC ANALY AICD/SING/W/REPROG | $175 |
| Cardiac Diagnostics | 48000080 | HC ELEC ANALY AICD/MULT/W/REPROG | $172 |
| Cardiac Diagnostics | 48000081 | HC PROG EVAL IN PERSON LEADLESS PM | $47 |
| Cardiac Diagnostics | 48000082 | HC INTERROG DEVICE EVAL IN PERSON LEADLESS PM | $47 |
| Procedurals | 48000083 | HC INTERROGATION VAD IN PERSON | $290 |
| Cardiac Diagnostics | 48000084 | HC IMPLT SUBQ DEFIB INTEROGATION | $197 |
| Cardiac Diagnostics | 48000085 | HC IMPLT SUBQ DEFIB SYS DEVICE EVAL | $197 |
| Cardiac Diagnostics | 48000086 | HC AHFC REMOTE ICM <= 30 DAYS | $133 |
| Procedurals | 48000087 | HC HEART FAILURE FLUID MONITORING | $133 |
| Cardiac Diagnostics | 48000088 | HC INTRAOP TEE | $3,046 |
| Cardiac Diagnostics | 48000089 | HC PROGRAM DEVICE EVAL PPM LEADLS IN PERSON | $46 |
| Cath Lab | 48000090 | HC PERIPROCEDURAL EVAL PPM LEADLS | $46 |
| Cardiac Diagnostics | 48000091 | HC INTERROGATION DEVICE EVAL PPM LEADLS | $46 |
| Cardiac Diagnostics | 48000003 | HC CARDIOVERSION/ELECTIVE/EXTERNAL | $914 |
| Cath Lab | 48000004 | HC CORONARY ULTRASOUND, INITIAL | $4,035 |
| Cath Lab | 48000024 | HC DOPPL VELO/ PRES COR FLOW MEAS | $4,035 |
| Cath Lab | 48000025 | HC PRES FLOW MEAS EA ADD'L VESSEL | $4,035 |
| Cath Lab | 48000026 | HC INTRAVENTRICULAR PACING (RV) | $4,902 |
| Cath Lab | 48000027 | HC 3 DIMENSION MAPPING | $6,601 |
| Cath Lab | 48000028 | HC COM EP EVAL W/LT ATRIAL RECORD | $7,286 |
| Cath Lab | 48000031 | HC EVAL/CARD-DEFIB W/TEST,P/GEN | $2,543 |
| Cath Lab | 48000032 | HC EP EVAL/CARDIOVERTER-DEFIB | $2,125 |
| Cath Lab | 48000033 | HC ABLATION OF AV NODE FUNCTION | $9,143 |
| Cardiac Diagnostics | 48000036 | HC TILT TABLE EVALUATION | $1,007 |
| Cath Lab | 48000037 | HC INTRACARD ECHO DURING INTERVEN | $4,425 |
| Procedurals | 48000050 | HC CDU CARDIOVERSION/ELECTIVE/EXTERNAL | $914 |
| Cath Lab | 48000052 | HC CARDIOVERSION/ELECTIVE/EXTERNAL | $914 |
| Cath Lab | 48000058 | HC CARDIOVERSION/ELECTIVE/EXTERNAL | $914 |
| Cardiac Diagnostics | 48000066 | HC PM DEVICE PROGR EVAL MULTI | $175 |
| Cath Lab | 48100001 | HC THROMBECTOMY | $3,632 |
| Cath Lab | 48100002 | HC BRACHYTHERAPY CATHETER PLACEME | $5,200 |
| Cath Lab | 48100003 | HC LEFT HRT W/THROMBOLYTICS USED | $1,188 |
| Cath Lab | 48100004 | HC INTRACOR IV INFUSION W/THROMBOLYSIS | $302 |
| Cath Lab | 48100005 | HC ADD'L VESSEL CORONARY U/S | $4,035 |
| Cath Lab | 48100010 | HC VALVULOPLASTY AORTIC | $6,087 |
| Cath Lab | 48100013 | HC TEE | $1,260 |
| Cath Lab | 48100014 | HC RIGHT HEART CATH | $4,109 |
| Cath Lab | 48100015 | HC LEFT HRT CATH W/VENTRCLGRPHY | $4,297 |
| Cath Lab | 48100016 | HC R&L HRT CATH W/VENTRICLGRPHY | $4,989 |
| Cath Lab | 48100017 | HC CORONARY ARTERY ANGIO S&I | $4,305 |
| Cath Lab | 48100018 | HC CORONARY ART/GRFT ANGIO S&I | $4,555 |
| Cath Lab | 48100019 | HC R HRT CORONARY ARTERY ANGIO | $4,493 |
| Cath Lab | 48100020 | HC R HRT ART/GRFT ANGIO | $4,743 |
| Cath Lab | 48100021 | HC L HRT ARTERY/VENTRICLE ANGIO | $4,493 |
| Cath Lab | 48100022 | HC L HRT ART/GRFT ANGIO | $4,743 |
| Cath Lab | 48100023 | HC R&L HRT ART/VENTRICLE ANGIO | $5,185 |
| Cath Lab | 48100024 | HC R&L HRT ART/VENTRICLE ANGIO | $5,435 |
| Cath Lab | 48100025 | HC L HRT CATH TRNSPTL PUNCTURE | $4,370 |
| Cath Lab | 48100026 | HC DRUG ADMIN DURING CARD CATH | $284 |
| Cath Lab | 48100027 | HC SWANZ-GANZ | $1,889 |
| Cath Lab | 48100028 | HC CORONARIES ONLY | $93 |
| Cath Lab | 48100029 | HC INJECTION INTERNAL GRAFTS | $126 |
| Cath Lab | 48100030 | HC INJ LEFT VENTRI OR ATRIAL | $85 |
| Cath Lab | 48100031 | HC INJ RIGHT VENTRI OR ATRIAL | $85 |
| Cath Lab | 48100032 | HC ROOT SHOT - AORTOGRAM | $82 |
| Cath Lab | 48100033 | HC INJECTION-PULMONARY ANGIOGRAPH | $107 |
| Cath Lab | 48100034 | HC BUNDLE OF HIS RECORDING | $6,601 |
| Cath Lab | 48100035 | HC INTRA-ATRIAL RECORDING | $6,601 |
| Cath Lab | 48100036 | HC RT VENTRICULAR RECORDING | $6,601 |
| Cath Lab | 48100037 | HC MAPPING OF TACHYCARDIA SITES | $6,601 |
| Cath Lab | 48100038 | HC INTRA-ATRIAL PACING | $6,601 |
| Cath Lab | 48100039 | HC ESOPHAGEAL RECORDING | $6,601 |
| Cath Lab | 48100040 | HC ESOPHAGEAL RECORDING W/PACING | $6,601 |
| Cath Lab | 48100041 | HC INDUCTION OF ARRHYTHMIA | $6,601 |
| Cath Lab | 48100042 | HC COMPREHENSIVE EP EVALUATION | $7,286 |
| Cath Lab | 48100043 | HC COMP EP EVAL W/INDUCT ARRHYTHM | $7,286 |
| Cath Lab | 48100044 | HC COMP EP EVAL W/VENTRIC RECORD | $7,286 |
| Cath Lab | 48100045 | HC STIM/PACING AFTER IV DRUG INFU | $6,601 |
| Cardiac Diagnostics | 48100046 | HC EVAL CARD DEFIB TEST PULSE GEN | $2,543 |
| Cath Lab | 48100047 | HC OCCLUSIVE DEV PLACEMENT OF | $915 |
| Cath Lab | 48100049 | HC NONSEL ILIAC ANGIOGRM W/LT HRT | $914 |
| Cath Lab | 48100052 | HC RT HRT TRANSSEPTAL LT HRT CATH | $4,370 |
| Cath Lab | 48100053 | HC INJECTION PULMONARY ANGIOGRAPH | $107 |
| Cath Lab | 48100054 | HC INJECTION PULMONARY ANGIOGRAPH | $107 |
| Cath Lab | 48100055 | HC PRQ CARDIAC ANGIOPLAST 1 ART | $7,039 |
| Cath Lab | 48100056 | HC PRQ CARDIAC ANGIO ADDL ART | $7,039 |
| Cath Lab | 48100057 | HC PRQ CARD ANGIO/ATHRECT 1 ART | $12,529 |
| Cath Lab | 48100058 | HC PRQ CARD ANGIO/ATHRECT ADDL | $12,529 |
| Cath Lab | 48100059 | HC PRQ CARD STENT W/ANGIO 1 VSL | $12,529 |
| Cath Lab | 48100060 | HC PRQ CARD STENT W/ANGIO ADDL | $12,529 |
| Cath Lab | 48100061 | HC PRQ CARD STENT/ATH/ANGIO | $18,990 |
| Cath Lab | 48100062 | HC PRQ CARD STENT/ATH/ANGIO | $18,990 |
| Cath Lab | 48100063 | HC PRQ REVASC BYP GRAFT 1 VSL | $12,529 |
| Cath Lab | 48100064 | HC PRQ REVASC BYP GRAFT ADDL | $12,529 |
| Cath Lab | 48100065 | HC PRQ CARD REVASC MI 1 VSL | $12,529 |
| Cath Lab | 48100066 | HC PRQ CARD REVASC CHRONIC 1VSL | $12,529 |
| Cath Lab | 48100067 | HC PRQ CARD REVASC CHRONIC ADDL | $12,529 |
| Cath Lab | 48100068 | HC EP & ABLATE SUPRAVENT ARRHYT | $9,143 |
| Cath Lab | 48100069 | HC EP & ABLATE VENTRIC TACHY | $9,143 |
| Cath Lab | 48100070 | HC ABLATE ARRHYTHMIA ADD ON | $9,143 |
| Cath Lab | 48100071 | HC TX ATRIAL FIB PULM VEIN ISOL | $9,143 |
| Cath Lab | 48100072 | HC TX L/R ATRIAL FIB ADDL | $9,143 |
| Cath Lab | 48100073 | HC PERC DRUG-EL COR STENT SING | $12,529 |
| Cath Lab | 48100074 | HC PERC DRUG-EL COR STENT BRAN | $12,529 |
| Cath Lab | 48100075 | HC PERC D-E COR STENT ATHER S | $12,529 |
| Cath Lab | 48100076 | HC PERC D-E COR STENT ATHER BR | $12,529 |
| Cath Lab | 48100077 | HC PERC D-E COR REVASC T CABG S | $12,529 |
| Cath Lab | 48100078 | HC PERC D-E COR REVASC T CABG B | $12,529 |
| Cath Lab | 48100079 | HC PERC D-E COR REVASC W AMI S | $12,529 |
| Cath Lab | 48100080 | HC PERC D-E COR REVASC CHRO SIN | $12,529 |
| Cath Lab | 48100081 | HC PERC D-E CORREVASC CHRO ADD | $12,529 |
| Cath Lab | 48100082 | HC CARDIOVERSION ELECTIVE, INTERNAL | $914 |
| Procedurals | 48100083 | HC IMPLANT PRESSURE SENSOR W/ANGIO (CARDIOMEMS) | $37,921 |
| Procedurals | 48100084 | HC ENDOMYOCARDIAL BIOPSY | $3,035 |
| Cath Lab | 48100085 | HC INSERT/REPLACE PPM LEADLESS (MICRA) | $18,991 |
| Cath Lab | 48100086 | HC REMOVAL PPM LEADLESS (MICRA) | $3,033 |
| Stress Test | 48200001 | HC CARDIOVASCULAR STRESS TEST | $830 |
| Stress Test | 48200003 | HC CVP CARDIOVASCULAR STRESS TEST | $830 |
| Stress Test | 48300001 | HC ECHO LTD/FOLLOW-UP W/ CONTRAST | $909 |
| Stress Test | 48200004 | HC CARDIOVASCULAR STRESS TEST | $730 |
| General Outpatient Clinic | 51000001 | 99201 OFFICE/OUTPATIENT VISIT NEW PATIENT | $127 |
| General Outpatient Clinic | 51000003 | 99202 OFFICE/OUTPATIENT VISIT NEW PATIENT | $142 |
| General Outpatient Clinic | 51000005 | 99203 OFFICE/OUTPATIENT VISIT NEW PATIENT | $160 |
| General Outpatient Clinic | 51000007 | 99204 OFFICE/OUTPATIENT VISIT NEW PATIENT | $177 |
| General Outpatient Clinic | 51000009 | 99205 OFFICE/OUTPATIENT VISIT NEW PATIENT | $193 |
| General Outpatient Clinic | 51000010 | 99211 OFFICE/OUTPATIENT VISIT ESTABLISHED PATIENT | $127 |
| General Outpatient Clinic | 51000012 | 99212 OFFICE/OUTPATIENT VISIT ESTABLISHED PATIENT | $142 |
| General Outpatient Clinic | 51000015 | 99213 OFFICE/OUTPATIENT VISIT ESTABLISHED PATIENT | $160 |
| General Outpatient Clinic | 51000017 | 99214 OFFICE/OUTPATIENT VISIT ESTABLISHED PATIENT | $177 |
| General Outpatient Clinic | 51000019 | 99215 OFFICE/OUTPATIENT VISIT ESTABLISHED PATIENT | $193 |
| General Outpatient Clinic | 51000021 | HC ASTHMA/COPD/TB EDUCATION INITIAL | $157 |
| General Outpatient Clinic | 51000022 | HC ASTHMA/COPD/TB EDUCATION FOLLOWUP | $79 |
| MRI | 61000001 | HC MRI TEMPOROMANDIBULAR JOINT | $2,611 |
| MRI | 61000002 | HC MRI MRA BRAIN (COMPONENT) | $1,362 |
| MRI | 61000003 | HC MRI BRAIN W/WO CONTRAST | $3,335 |
| MRI | 61000004 | HC MRI CHEST | $2,832 |
| MRI | 61000005 | HC MRI CHEST WITH CONTRAST(S) | $2,876 |
| MRI | 61000006 | HC MRI CHEST W,W/O CONTRAST(S) | $3,335 |
| MRI | 61000007 | HC MRI CERVICAL W/WO CONTRAST | $3,335 |
| MRI | 61000008 | HC MRI THORACIC W/WO CONTRAST | $3,335 |
| MRI | 61000009 | HC MRI LUMBAR W/WO CONTRAST | $3,335 |
| MRI | 61000010 | HC MRI PELVIS | $2,613 |
| MRI | 61000011 | HC MRI PELVIS/LIMITED BONE | $1,362 |
| MRI | 61000012 | HC MRI PELVIS WITH CONTRAST(S) | $2,969 |
| MRI | 61000013 | HC MRI PELVIS W/WO CONTRAST(S) | $3,335 |
| MRI | 61000014 | HC MRI MRA PELVIS | $2,613 |
| MRI | 61000015 | HC MRI UPPER EXTR.(NO JOINT) | $2,611 |
| MRI | 61000016 | HC MRI UPPER EXTR (NO JOINT) WITH | $2,975 |
| MRI | 61000017 | HC MRI UPPER EXTREMITY | $2,611 |
| MRI | 61000018 | HC MRI UPPER EXTREMITY W/WO CONTR | $3,335 |
| MRI | 61000019 | HC MRI SHOULDER | $2,611 |
| MRI | 61000020 | HC MRI JOINT UPPER EXTREMITY | $2,722 |
| MRI | 61000021 | HC MRI JOINT UPPER EXTREM WITH | $2,976 |
| MRI | 61000022 | HC MRI JOINT UPPER EXT W/WO CONTR | $3,335 |
| MRI | 61000023 | HC MRI MRA UPPER EXTREMITY W CONTRAST | $2,613 |
| MRI | 61000024 | HC MRI LOWER EXTREMITY | $2,611 |
| MRI | 61000025 | HC MRI LOWER EXT (NOT JOINT) WITH | $2,975 |
| MRI | 61000026 | HC MRI LOWER EXTREMITY W/WO CONTR | $3,335 |
| MRI | 61000027 | HC MRI JOINT(S) FOR PROSTH WRKUP | $439 |
| MRI | 61000028 | HC MRI JOINT LOWER EXTREMITY | $2,722 |
| MRI | 61000029 | HC MRI JOINT LOWER EXTREMITY WITH | $2,975 |
| MRI | 61000030 | HC MRI JOINT LOWER EXT W/WO CONTR | $3,335 |
| MRI | 61000031 | HC MRI ABDOMEN KIDNEY SIZE | $2,015 |
| MRI | 61000032 | HC MRI ABDOMEN WITHOUT CONTRAST | $2,832 |
| MRI | 61000033 | HC MRI ABDOMEN WITH CONTRAST | $2,975 |
| MRI | 61000034 | HC MRI ABDOMEN W/WO CONTRAST | $3,335 |
| MRI | 61000035 | HC MRI CARDIAC FOR MORPHOLOGY | $2,613 |
| MRI | 61000036 | HC MRI 3-D RENDERING,AT MODALITY | $555 |
| MRI | 61000037 | HC MRI 3-D RENDERING,REMOTE WKSTN | $555 |
| MRI | 61000038 | HC MRI NOVA QUANT. BLD FLOW | $502 |
| MRI | 61000038 | HC MRI NOVA QUANT. BLD FLOW | $502 |
| MRI | 61000039 | HC MRI GUIDED NEEDLE PLACEMENT | $2,613 |
| MRI | 61000040 | HC MRI BREAST CAD | $110 |
| MRI | 61000041 | HC MRI MRA ABDOMEN WITH CONTRAST | $2,613 |
| MRI | 61000042 | HC MRI MRA ABDOMEN | $2,613 |
| MRI | 61000043 | HC MRI MRA ABDOMEN W/WO CONTRAST | $2,613 |
| MRI | 61000044 | HC MRI BREAST UNILAT W/WO CONTRAS | $2,613 |
| MRI | 61000045 | HC MRI BREAST BILAT W/WO CONTRAST | $3,042 |
| MRI | 61000046 | HC MRI MRA CHEST WITH CONTRAST | $2,613 |
| MRI | 61000047 | HC MRI MRA CHEST | $2,613 |
| MRI | 61000048 | HC MRI MRA CHEST W/WO CONTRAST | $2,613 |
| MRI | 61000049 | HC MRI MRA LOWER EXTREM WITH CONT | $2,613 |
| MRI | 61000050 | HC MRI MRA LOWER EXTREMITY | $2,613 |
| MRI | 61000051 | HC MRI MRA LOWER EXTREM W/WO CONT | $2,613 |
| MRI | 61000052 | HC MRI MRA PELVIS WITH CONTRAST | $2,613 |
| MRI | 61000053 | HC MRI MRA PELVIS WO CONTR | $2,613 |
| MRI | 61000054 | HC MRI MRA PELVIS WITH,W/O CONTR. | $2,613 |
| MRI | 61000055 | HC CARDIAC MRI W/STRESS IMG | $2,613 |
| MRI | 61000056 | HC CARDIAC MRI FOR MORPH W/DYE | $2,824 |
| MRI | 61000057 | HC CARD MRI W/STRESS IMG & DYE | $2,824 |
| MRI | 61000058 | HC MRI FOR TISSUE ABLATION | $2,613 |
| MRI MRA | 61000059 | HC MRI MRA UPPER EXTREMITY WO CONTRAST | $2,613 |
| MRI MRA | 61000060 | HC MRI MRA UPPER EXTREMITY W & WO CONTRAST | $2,613 |
| MRI | 61000061 | HC MRI FETAL SINGLE-1ST GESTATION | $364 |
| MRI | 61000062 | HC MRI FETA EA ADD'L GESTATION | $364 |
| MRI | 61000063 | HC CARD MRI VELOCITY FLW MAP ADD-ON | $2,824 |
| MRI | 61100001 | HC MRI ORBITS, FACE AND NECK | $2,832 |
| MRI | 61100002 | HC MRI INT AUDITORY CANALS | $3,335 |
| MRI | 61100003 | HC MRI ORBIT,FACE,NECK WITH CONT | $2,832 |
| MRI | 61100004 | HC MRI ORBIT,FACE,NECK W,W/O CONT | $3,053 |
| MRI | 61100005 | HC MRI STEALTH BRAIN PROTOCOL | $1,639 |
| MRI | 61100006 | HC MRI BRAIN WITHOUT CONTRAST | $2,722 |
| MRI | 61100007 | HC MRI BRAIN WITH CONTRAST | $2,876 |
| MRI | 61200002 | HC MRI CERVICAL WITHOUT CONTRAST | $2,722 |
| MRI | 61200003 | HC MRI CERVICAL WITH CONTRAST | $2,876 |
| MRI | 61200005 | HC MRI THORACIC WITHOUT CONTRAST | $2,722 |
| MRI | 61200006 | HC MRI THORACIC WITH CONTRAST | $2,876 |
| MRI | 61200008 | HC MRI LUMBAR WITHOUT CONTRAST | $2,722 |
| MRI | 61200009 | HC MRI LUMBAR WITH CONTRAST | $2,876 |
| MRI MRA | 61200010 | HC MRI CERVICAL MET W/WO CONTRAST | $3,012 |
| MRI MRA | 61200011 | HC MRI THORACIC MET W/WO CONTRAST | $3,012 |
| MRI MRA | 61200012 | HC MRI LUMBAR MET W/WO CONTRAST | $2,895 |
| MRI | 61400001 | HC MRI BREAST UNILAT WITH CONTRAS | $2,613 |
| MRI | 61400002 | HC MRI BREAST UNILATERAL | $2,613 |
| MRI | 61400003 | HC MRI BREAST BILAT WITH CONTRAST | $3,042 |
| MRI | 61400004 | HC MRI BREAST BILATERAL | $3,042 |
| MRI MRA | 61500001 | HC MRI MRA HEAD LIMITED/COMPONENT | $1,362 |
| MRI MRA | 61500002 | HC MRI MRA HEAD WITHOUT CONTRAST | $2,613 |
| MRI MRA | 61500003 | HC MRI MRA HEAD WITH CONTRAST | $2,832 |
| MRI MRA | 61500004 | HC MRI MRA HEAD WITH,W/O CONTRAST | $3,053 |
| MRI MRA | 61500005 | HC MRI MRA NECK | $2,613 |
| MRI MRA | 61500006 | HC MRI MRA NECK WITH CONTRAST | $2,832 |
| MRI MRA | 61500007 | HC MRI MRA NECK WITH,W/O CONTRAST | $3,053 |
| MRI MRA | 61800001 | HC MRI MRA SPINAL CANAL | $2,613 |
| Wound Therapy | 63600002 | HC APLIGRAF SKIN SUB PER 1 SQ CM | $228 |
| Wound Therapy | 63600003 | HC OASIS SKIN SUB 3X3.5 CM | $285 |
| Wound Therapy | 63600004 | HC OASIS SKIN SUB 3X7 CM | $285 |
| Wound Therapy | 63600005 | HC DERMAGRAFT SKIN SUB PER 1 SQ C | $165 |
| Wound Therapy | 63600006 | HC DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIG | $333 |
| Radiopharm | 63600007 | HC REGADENOSON 0.1 MG (LEXISCAN) | $74 |
| Wound Therapy | 63600008 | HC EPIFIX / EPICORD PER 1 SQ CM | $795 |
| Wound Therapy | 63600009 | HC PURAPLY AM PER SQ CM | $563 |
| Contrast | 63600010 | HC IOHEXOL (OMNIPAQUE) 300MG IODINE/ML SOLUTION | $132 |
| Wound Therapy | 63600011 | HC AMNIO WOUND PER SQ CM | $550 |
| Ortho Clinic | 70000001 | HC ARM TRACTION | $75 |
| Ortho Clinic | 70000002 | HC BALANCE TRACTION | $70 |
| Ortho Clinic | 70000003 | HC BUCK'S TRACTION | $71 |
| Ortho Clinic | 70000004 | HC CERVICAL TRACTION | $54 |
| Ortho Clinic | 70000005 | HC 90-90 TRACTION | $75 |
| Ortho Clinic | 70000006 | HC SKELETAL TRACTION | $93 |
| Ortho Clinic | 70000007 | HC DEBRIDEMENT | $18 |
| Ortho Clinic | 70000008 | HC LEVEL I PROCEDURE | $132 |
| Ortho Clinic | 70000009 | HC LEVEL II PROCEDURE | $198 |
| Ortho Clinic | 70000010 | HC LEVEL III PROCEDURE | $262 |
| Post-Op | 71000001 | HC RECOVERY ROOM UP TO 30 MINUTES | $399 |
| Post-Op | 71000002 | HC RECOVERY ROOM 30 MINUTES - 1 HOUR | $531 |
| Post-Op | 71000003 | HC RECOVERY ROOM 1 HOUR - 1 HOUR 30 MINUTES | $670 |
| Post-Op | 71000004 | HC RECOVERY ROOM 1 HOUR 30 MINUTES - 2 HOURS | $813 |
| Post-Op | 71000005 | HC RECOVERY ROOM 2 HOURS - 2 HOUR 30 MINUTES | $957 |
| Post-Op | 71000006 | HC RECOVERY ROOM 2 HOURS 30 MINUTES - 3 HOURS | $1,093 |
| Post-Op | 71000007 | HC RECOVERY ROOM 3 HOURS - 3 HOURS 30 MINUTES | $1,233 |
| Post-Op | 71000008 | HC RECOVERY ROOM 3 HOURS 30 MINUTES - 4 HOURS | $1,375 |
| Post-Op | 71000009 | HC RECOVERY ROOM 4 HOURS - 4 HOURS 30 MINUTES | $1,514 |
| Post-Op | 71000010 | HC RECOVERY ROOM 4 HOURS 30 MINUTES - 5 HOURS | $1,659 |
| Post-Op | 71000011 | HC RECOVERY ROOM 5 HOURS - 5 HOURS 30 MINUTES | $1,798 |
| Post-Op | 71000012 | HC RECOVERY ROOM 5 HOURS 30 MINUTES - 6 HOURS | $1,936 |
| Post-Op | 71000013 | HC RECOVERY ROOM 6 HOURS - 6 HOURS 30 MINUTES | $2,075 |
| Post-Op | 71000014 | HC RECOVERY ROOM 6 HOURS 30 MINUTES - 7 HOURS | $2,214 |
| Post-Op | 71000015 | HC RECOVERY ROOM 7 HOURS - 7 HOURS 30 MINUTES | $2,355 |
| Post-Op | 71000016 | HC RECOVERY ROOM 7 HOURS 30 MINUTES - 8 HOURS | $2,493 |
| Post-Op | 71000017 | HC RECOVERY ROOM 8 HOURS - 8 HOURS 30 MINUTES | $2,632 |
| Post-Op | 71000018 | HC RECOVERY ROOM 8 HOURS 30 MINUTES - 9 HOURS | $2,651 |
| Post-Op | 71000019 | HC RECOVERY ROOM 9 HOURS - 9 HOURS 30 MINUTES | $2,782 |
| Post-Op | 71000031 | HC PHASE II RECOVERY UP TO 30 MINUTES | $200 |
| Post-Op | 71000032 | HC PHASE II RECOVERY 30 MINUTES - 1 HOUR | $266 |
| Post-Op | 71000033 | HC PHASE II RECOVERY 1 HOUR - 1 HOUR 30 MINUTES | $335 |
| Post-Op | 71000034 | HC PHASE II RECOVERY 1 HOUR 30 MINUTES - 2 HOURS | $407 |
| Post-Op | 71000035 | HC PHASE II RECOVERY 2 HOURS - 2 HOUR 30 MINUTES | $479 |
| Post-Op | 71000036 | HC PHASE II RECOVERY 2 HOURS 30 MINUTES - 3 HOURS | $547 |
| Post-Op | 71000037 | HC PHASE II RECOVERY 3 HOURS - 3 HOURS 30 MINUTES | $617 |
| Post-Op | 71000038 | HC PHASE II RECOVERY 3 HOURS 30 MINUTES - 4 HOURS | $688 |
| Post-Op | 71000039 | HC PHASE II RECOVERY 4 HOURS - 4 HOURS 30 MINUTES | $757 |
| Post-Op | 71000040 | HC PHASE II RECOVERY 4 HOURS 30 MINUTES - 5 HOURS | $830 |
| Post-Op | 71000041 | HC PHASE II RECOVERY 5 HOURS - 5 HOURS 30 MINUTES | $899 |
| L&D | 72000001 | HC AMNIOCENTESIS, DIAGNOSTIC | $308 |
| L&D | 72000002 | HC AMNIO-REDUCTION | $687 |
| L&D | 72000003 | HC CORDOCENTESIS | $308 |
| L&D | 72000004 | HC EXT. CEPHALIC VERSION | $1,783 |
| L&D | 72000005 | HC INDUCTION/AUGMENTATION | $105 |
| L&D | 72000006 | HC EPIDURAL INJECTION | $346 |
| L&D | 72000007 | HC DELIVERY LEVEL I | $972 |
| L&D | 72000008 | HC DELIVERY LEVEL II | $1,444 |
| L&D | 72000009 | HC DELIVERY LEVEL III | $1,687 |
| L&D | 72000010 | HC DELIVERY LEVEL IV | $1,715 |
| Emergency Department | 72000011 | HC EMERGENCY VAGINAL DELIVERY | $972 |
| L&D Observation | 72100001 | HC MONITOR FETAL SCALP ELECTRODE | $129 |
| L&D Observation | 72100002 | HC LABOR INTENSIVE MONITOR(PER HR | $48 |
| L&D Observation | 72100003 | HC LBR INTENS MONITOR LVL II | $55 |
| L&D Observation | 72100004 | HC LDR TRIAGE ROOM/TX.ROOM-PER HR | $117 |
| L&D Observation | 72100005 | HC FETAL MONITORING | $154 |
| L&D Observation | 72100006 | HC LB/INTEN MONITOR UP TO 6 HOURS | $415 |
| L&D Observation | 72100007 | HC L/D RECOVERY ROOM/ 1ST HOUR | $420 |
| EKG | 73000001 | HC EKG | $262 |
| EKG | 73000002 | HC EKG WITH TRACING/RHYTHM STRIP | $463 |
| EKG | 73000003 | HC ERGONOVINE TEST | $323 |
| EKG | 73000004 | HC EVENT MONITOR-HOOK UP | $168 |
| EKG | 73000005 | HC SIGNALED AVERAGED EKG | $463 |
| EKG | 73100001 | HC HOLTER MONITOR-24 HOUR | $621 |
| EKG | 73100002 | HC HOLTER MONITOR-48 HOUR | $810 |
| EKG | 73100003 | HC SCANNING HOLTER MONITOR | $533 |
| EEG | 74000001 | HC EEG EXTENDED MONITOR 41-60 MIN | $712 |
| EEG | 74000002 | HC EEG GREATER THAN 1 HOUR | $855 |
| EEG | 74000003 | HC EEG AWAKE AND DROWSY | $572 |
| EEG | 74000004 | HC EEG AWAKE AND ASLEEP | $572 |
| EEG | 74000005 | HC SLEEP EEG | $728 |
| EEG | 74000006 | HC DEATH EEG | $728 |
| EEG | 74000007 | HC EEG 24 HOUR MONITORING | $1,187 |
| Neuro Diagnostic | 74000008 | HC DIGITAL ANALYSIS OF EEG | $104 |
| Neuro Diagnostic | 74000009 | HC EEG ALL NIGHT RECORDING | $578 |
| Endoscopy | 75000001 | HC CONVERT PERC G-TUBE > J-TUBE | $1,113 |
| Endoscopy | 75000002 | HC PERC GI TUBE PLACEMENT | $1,810 |
| Endoscopy | 75000003 | HC INSERTION OF NASOGASTRIC TUBE | $240 |
| Endoscopy | 75000004 | HC HEMORRHOID BANDING | $360 |
| Endoscopy | 75000005 | HC LARYNGSCOPY | $360 |
| Endoscopy | 75000006 | HC GASTRIC LAVAGE | $360 |
| Endoscopy | 75000007 | HC INSERTION OF CHEST TUBE | $379 |
| Endoscopy | 75000008 | HC PEG TUBE CHANGE/POSITIONING | $450 |
| Endoscopy | 75000009 | HC PROCTOSCOPY | $503 |
| Endoscopy | 75000010 | HC SIGMOIDOSCOPY FLEX NO STENT | $773 |
| Endoscopy | 75000011 | HC ESOPHAGEAL DILATION | $890 |
| Endoscopy | 75000012 | HC SIGMOIDOSCOPY WITH OTHER PROC | $941 |
| Endoscopy | 75000013 | HC SMALL INTESTINAL ENDOSCOPY | $958 |
| Endoscopy | 75000014 | HC 24 HOUR PH MONITORING | $975 |
