Northwest Hills Surgical Hospital
6818 Austin Center Blvd. Suite 100
Austin, TX 78731
Phone: 512-346-1994
NorthwestHillsSurgical.com
Prices Posted are Effective January 1, 2021
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Shoppable Service | Primary Service and Ancillary Services | Revenue Code | CPT/HCPCS Code | Cash Price | Service Location | Site Type | Aetna Commercial | Arcadian Medicare Advantage | BCBS Commercial HMO Blue | BCBS Commercial PPO | BCBS Commercial Blue Premier | BCBS Commercial Traditional | Cigna Commercial | Connected Senior Care Medicare Advantage | Elder Health TX Medicare Advantage | Fair Price Commercial | Healthcare Highways Commercial | Humana Commercial HMO | Humana Commercial PPO | Humana Military | Occunet UT Athletes | Oscar Exchange | Prime Health Commercial | Prime Health Workers Compensation | Prime Health Medicare Advantage | Sendero Exchange | Sendero CHAP | Seton CHIP & STAR | Seton Commercial | Superior Exchange | Superior Medicare Advantage & Dual | United Healthcare Commercial | Wellmed Medicare Advantage | De-identified Minimum Negotiated Charge | De-identified Maximum Negotiated Charge | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Removal of Breast Growth | Primary Procedure | 360 | 19120 | 4284.48 | Northwest Hills Surgical Hospital | OP | 2069.00 | 510.00 | 1776.83 | 1991.03 | 1776.83 | 1974.26 | 1273.00 | 2856.32 | 507.08 | 4284.48 | 1500.00 | 2324.00 | 8796.00 | 892.80 | 3427.58 | 1301.00 | 4532.50 | 3527.56 | 2856.32 | 4998.56 | 2799.19 | 408.42 | 4548.76 | 3093.15 | 2856.32 | 1919.00 | 2856.32 | 408.42 | 8796.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 199.15 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 199.15 | 199.15 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1029.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1029.00 | 1029.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic Removal of Single Knee Cartilage | Primary Procedure | 360 | 29881 | 3871.38 | Northwest Hills Surgical Hospital | OP | 2549.00 | 630.00 | 1940.10 | 2179.99 | 1940.10 | 2155.67 | 4725.00 | 2580.92 | 1400.00 | 3871.38 | 4500.00 | 2869.00 | 10862.00 | 1203.42 | 3097.10 | 1606.00 | 5292.00 | 3187.44 | 2580.92 | 4516.61 | 2529.30 | 503.08 | 4077.22 | 2772.51 | 2580.92 | 2277.00 | 2580.92 | 503.08 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 433.48 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 433.48 | 433.48 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supply / Implants | 278 | C1713 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | 1892.00 | Included in Primary Procedure | 1754.40 | 1754.40 | 1754.40 | 1754.40 | 1806.00 | Included in Primary Procedure | 3612.00 | 1806.00 | 1548.00 | 2580.00 | 2580.00 | Included in Primary Procedure | 1754.40 | Included in Primary Procedure | 3612.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1720.00 | 1548.00 | 3612.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 29876 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | 1274.50 | Included in Primary Procedure | 970.05 | 1089.99 | 970.05 | 1077.84 | 2362.50 | Included in Primary Procedure | 700.00 | Included in Primary Procedure | 2250.00 | 1434.50 | 5431.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 5848.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 4077.22 | 2772.51 | Included in Primary Procedure | 1138.50 | Included in Primary Procedure | 700.00 | 5848.50 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 29879 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | 517.25 | Included in Primary Procedure | 485.03 | 545.00 | 485.03 | 538.92 | 1181.25 | Included in Primary Procedure | 700.00 | Included in Primary Procedure | 2250.00 | 581.00 | 2199.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 5439.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 4077.22 | 2772.51 | Included in Primary Procedure | 569.25 | Included in Primary Procedure | 485.03 | 5439.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 445.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 445.20 | 445.20 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic diagnostic examination of esophagus, stomach, and/or upper small bowel | Primary Procedure | 360 | 43235 | 1111.47 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 603.42 | 678.28 | 603.42 | 670.47 | 950.00 | 740.98 | 331.10 | 1111.47 | 1100.00 | 1517.00 | 5741.00 | 357.12 | 889.18 | 854.00 | 1501.50 | 915.11 | 740.98 | 1296.72 | 726.16 | 265.97 | 1166.24 | 793.04 | 740.98 | 1200.00 | 740.98 | 265.97 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 75.78 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 75.78 | 75.78 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 210.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 210.00 | 210.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic biopsy of the esophagus, stomach, and/or upper small bowel | Primary Procedure | 360 | 43239 | 1111.47 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 603.42 | 678.28 | 603.42 | 670.47 | 1125.00 | 740.98 | 443.45 | 1111.47 | 1100.00 | 2032.00 | 7693.00 | 491.04 | 889.18 | 1139.00 | 1589.00 | 915.11 | 740.98 | 1296.72 | 726.16 | 356.12 | 1166.24 | 793.04 | 740.98 | 1200.00 | 740.98 | 356.12 | 7693.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 78.58 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 78.58 | 78.58 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | 315.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic diagnostic examination of large bowel | Primary Procedure | 750 | 45378 | 1080.30 | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | 446.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 720.20 | Included in Primary Procedure | 1080.30 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 491.04 | 864.24 | 1139.00 | 1666.00 | 889.45 | 720.20 | 1260.35 | 705.80 | 356.12 | 1143.26 | Included in Primary Procedure | 720.20 | Included in Primary Procedure | Included in Primary Procedure | 356.12 | 1666.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 99.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 99.05 | 99.05 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 210.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 210.00 | 210.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic biopsy of Large Bowel | Primary Procedure | 360 | 45380 | 1420.20 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 663.16 | 685.01 | 663.16 | 736.84 | 1125.00 | 946.80 | 443.45 | 1420.20 | 1100.00 | 2032.00 | 7693.00 | 541.26 | 1136.16 | 1139.00 | 1753.50 | 1169.30 | 946.80 | 1656.90 | 927.86 | 356.12 | 1493.75 | 1015.75 | 946.80 | 1200.00 | 946.80 | 356.12 | 7693.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 99.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 99.05 | 99.05 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 420.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 420.00 | 420.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic removal of polyps or growths of large bowel | Primary Procedure | 750 | 45385 | 1420.20 | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | 446.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 946.80 | Included in Primary Procedure | 1420.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 541.26 | 1136.16 | 1139.00 | 1879.50 | 1169.30 | 946.80 | 1656.90 | 927.86 | 356.12 | 1493.75 | Included in Primary Procedure | 946.80 | Included in Primary Procedure | Included in Primary Procedure | 356.12 | 1879.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 135.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 135.45 | 135.45 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | 315.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal of cataract with insertion of lens | Primary Procedure | 360 | 66984 | 2859.38 | Northwest Hills Surgical Hospital | OP | 3889.00 | 973.00 | 794.70 | 794.29 | 794.70 | 883.01 | 2975.00 | 1906.25 | 968.29 | 2859.38 | 750.00 | 4488.00 | 16995.00 | 1203.42 | 2287.50 | 2532.00 | 4245.50 | 2354.22 | 1906.25 | 3335.94 | 1868.13 | 844.15 | 2995.05 | 2036.63 | 1906.25 | 959.50 | 1906.25 | 750.00 | 16995.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 496.13 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 496.13 | 496.13 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sterile Supply | 272 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 735.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 735.00 | 735.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supply / Implants | 278 | V2632 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | 107.10 | 107.10 | 107.10 | 107.10 | Included in Primary Procedure | Included in Primary Procedure | 220.50 | 110.25 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 107.10 | Included in Primary Procedure | 220.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 105.00 | 105.00 | 220.50 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 67036 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | 1274.50 | Included in Primary Procedure | 2754.30 | 1588.59 | 2754.30 | 3060.33 | 780.00 | Included in Primary Procedure | 313.20 | Included in Primary Procedure | 2000.00 | 1434.50 | 5431.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7287.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 5643.54 | 3837.61 | Included in Primary Procedure | 2738.00 | Included in Primary Procedure | 313.20 | 7287.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 445.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 445.20 | 445.20 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shaving of shoulder bone using an endoscope | Primary Procedure | 360 | 29826 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | 517.25 | Included in Primary Procedure | 0.00 | 0.00 | 0.00 | 0.00 | 4725.00 | Included in Primary Procedure | 1400.00 | Included in Primary Procedure | 4500.00 | 1162.00 | 4398.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7444.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 0.00 | 0.00 | Included in Primary Procedure | 79.50 | Included in Primary Procedure | 0.00 | 7444.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1092.88 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1092.88 | 1092.88 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supply/ Implants | 278 | C1713 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | 331.84 | 331.84 | 331.84 | 331.84 | Included in Primary Procedure | Included in Primary Procedure | 683.20 | 341.60 | 292.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 331.84 | Included in Primary Procedure | 683.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 325.33 | 292.80 | 683.20 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 23430 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | 1274.50 | Included in Primary Procedure | 3403.48 | 4522.03 | 3403.48 | 3781.64 | 390.00 | Included in Primary Procedure | 313.20 | Included in Primary Procedure | 1000.00 | 2869.00 | 10862.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 8438.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 9024.72 | 6136.81 | Included in Primary Procedure | 4450.00 | Included in Primary Procedure | 313.20 | 10862.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 29822 | 3871.38 | Northwest Hills Surgical Hospital | OP | 3667.00 | 510.00 | 970.05 | 1089.99 | 970.05 | 1077.84 | 2362.50 | 2580.92 | 700.00 | 3871.38 | 2250.00 | 581.00 | 2199.00 | 674.25 | 3097.10 | 1301.00 | 6195.00 | 3187.44 | 2580.92 | 4516.61 | 2529.30 | 408.42 | 4077.22 | 2772.51 | 2580.92 | 1485.00 | 2580.92 | 408.42 | 6195.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 2017.40 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 2017.40 | 2017.40 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance | Primary Procedure | 360 | 64483 | 1148.43 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 602.92 | 532.50 | 602.92 | 669.91 | 950.00 | 765.62 | 331.10 | 1148.43 | 750.00 | 1517.00 | 5741.00 | 357.12 | 918.74 | 854.00 | 3724.00 | 945.54 | 765.62 | 1339.84 | 750.31 | 265.97 | 1184.76 | 805.64 | 765.62 | 788.00 | 765.62 | 265.97 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 113.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 113.05 | 113.05 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DX X-ray | 320 | 77003 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 311.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 311.50 | 311.50 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | OP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | OP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | 315.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). | MS-DRG | 470 | 17587.71 | Northwest Hills Surgical Hospital | IP | 17734.00 | 11725.14 | 14596.69 | 9281.28 | 12794.63 | 16218.54 | 17000.00 | Not Applicable | Not Applicable | 17587.71 | 16268.00 | 8517.00 | 0.00 | Not Applicable | 11725.14 | 15293.88 | 0.00 | 16740.90 | 11725.14 | 20519.00 | 11725.14 | 8234.21 | 18049.05 | 11941.06 | 11725.14 | 15373.99 | 11725.14 | 0.00 | 20519.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Room and Board | 110 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6300.00 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 5880.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 5880.00 | 6300.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1139.81 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 1063.83 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1063.83 | 1139.81 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Medical/surgical Supplies | 270 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 731.03 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 682.29 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 682.29 | 731.03 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supply/ Implants | 278 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | 9356.26 | 9356.26 | 9356.26 | 9356.26 | 9631.44 | Not Applicable | Not Applicable | 9631.44 | 8255.52 | 13759.20 | 20638.80 | Not Applicable | 9356.26 | Included in Primary Procedure | 19262.88 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 8255.52 | 20638.80 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 80.43 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 75.07 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 75.07 | 80.43 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory / Chemistry | 301 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.56 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 22.93 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 22.93 | 24.56 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DX X-ray | 320 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 108.75 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 101.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 101.50 | 108.75 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 29180.63 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 27235.25 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 27235.25 | 29180.63 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | IP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound | 402 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 613.11 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 572.24 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 572.24 | 613.11 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy | 420 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1192.50 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 1113.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1113.00 | 1192.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 364.50 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 340.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 340.20 | 364.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). | MS-DRG | 473 | 22523.04 | Northwest Hills Surgical Hospital | IP | 19196.00 | 15015.36 | 13439.28 | 10323.41 | 11780.11 | 14932.53 | 16000.00 | Not Applicable | Not Applicable | 22523.04 | 20833.00 | 8517.00 | 0.00 | Not Applicable | 15015.36 | 19585.53 | 0.00 | 22382.87 | 15015.36 | 26276.88 | 15015.36 | 8164.54 | 24131.90 | 15965.41 | 15015.36 | 20555.30 | 15015.36 | 0.00 | 26276.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Room and Board | 110 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3150.00 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 2940.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 2940.00 | 3150.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1293.75 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 1207.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1207.50 | 1293.75 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supply/ Implants | 278 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | 3457.80 | 3457.80 | 3457.80 | 3457.80 | 3559.50 | Not Applicable | Not Applicable | 3559.50 | 3051.00 | 5085.00 | 7627.50 | Not Applicable | 3457.80 | Included in Primary Procedure | 7119.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3051.00 | 7627.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DX X-ray | 320 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 333.75 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 311.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 311.50 | 333.75 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 43446.32 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 40549.90 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 40549.90 | 43446.32 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | May be separately billed | Northwest Hills Surgical Hospital | IP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1407.00 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 1313.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1313.20 | 1407.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Spinal fusion except cervical without major comorbid conditions or complications (MCC) | MS-DRG | 460 | 35534.36 | Northwest Hills Surgical Hospital | IP | 33233.00 | 23689.57 | 24598.97 | 17912.41 | 21562.06 | 27332.19 | 29000.00 | Not Applicable | Not Applicable | 35534.36 | 32868.00 | 8517.00 | 0.00 | Not Applicable | 23689.57 | 30899.88 | 0.00 | 34652.84 | 23689.57 | 41456.75 | 23689.57 | 12469.28 | 37360.65 | 24717.41 | 23689.57 | 31823.41 | 23689.57 | 0.00 | 41456.75 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Room and Board | 110 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6300.00 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 5880.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 5880.00 | 6300.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 926.81 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 865.03 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 865.03 | 926.81 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sterile Supply | 272 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 2587.50 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 2415.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 2415.00 | 2587.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supply/ Implants | 278 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | 19967.71 | 19967.71 | 19967.71 | 19967.71 | 20554.99 | Not Applicable | Not Applicable | 20554.99 | 17618.57 | 29364.28 | 44046.41 | Not Applicable | 19967.71 | Included in Primary Procedure | 41109.99 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 17618.57 | 44046.41 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 13.29 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 12.40 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 12.40 | 13.29 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DX X-ray | 320 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 637.50 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 595.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 595.00 | 637.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 38638.55 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 36062.65 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 36062.65 | 38638.55 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia (Medication Only) | 370 | May be separately billed | Northwest Hills Surgical Hospital | IP | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | May be separately billed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy | 420 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 356.25 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 332.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 332.50 | 356.25 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy Evaluation | 424 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 337.50 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 315.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 315.00 | 337.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1824.00 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 1702.40 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1702.40 | 1824.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other DX Services | 920 | Included in Primary Procedure | Northwest Hills Surgical Hospital | IP | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Not Applicable | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1141.98 | Not Applicable | Included in Primary Procedure | Included in Primary Procedure | 1065.85 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1065.85 | 1141.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-Ray, lower back, minimum four views | 72110 | 158.51 | Northwest Hills Surgical Hospital | OP | 77.72 | 104.65 | 81.80 | 100.69 | 81.80 | 90.89 | 228.67 | 105.67 | 104.65 | 158.51 | 51.00 | 59.94 | 115.60 | 104.65 | 126.80 | Not Applicable | 119.00 | 130.50 | 105.67 | 184.92 | 103.56 | 68.00 | 156.97 | 106.74 | 104.65 | 99.77 | 105.67 | 51.00 | 228.67 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Basic metabolic panel | 80048 | 12.69 | Northwest Hills Surgical Hospital | OP | 0.00 | 8.46 | 10.39 | 11.52 | 10.39 | 11.54 | 18.70 | 8.46 | 8.46 | 12.69 | 9.90 | 15.51 | 22.44 | 8.46 | 8.46 | Not Applicable | 23.10 | 11.49 | 8.46 | 14.81 | 8.29 | 13.20 | 12.69 | 8.63 | 8.46 | 11.51 | 8.46 | 0.00 | 23.10 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, comprehensive group of blood chemicals | 80053 | 15.84 | Northwest Hills Surgical Hospital | OP | 0.00 | 10.56 | 12.97 | 14.39 | 12.97 | 14.41 | 23.35 | 10.56 | 10.56 | 15.84 | 12.30 | 19.37 | 27.88 | 10.56 | 10.56 | Not Applicable | 28.70 | 14.35 | 10.56 | 18.48 | 10.35 | 16.40 | 15.84 | 10.77 | 10.56 | 14.37 | 10.56 | 0.00 | 28.70 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Kidney function panel test | 80069 | 13.02 | Northwest Hills Surgical Hospital | OP | 0.00 | 8.68 | 10.67 | 11.83 | 10.67 | 11.85 | 19.21 | 8.68 | 8.68 | 13.02 | 10.20 | 15.92 | 23.12 | 8.68 | 8.68 | Not Applicable | 23.80 | 11.79 | 8.68 | 15.19 | 8.51 | 13.60 | 13.02 | 8.85 | 8.68 | 11.82 | 8.68 | 0.00 | 23.80 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Liver function blood test panel | 80076 | 12.26 | Northwest Hills Surgical Hospital | OP | 0.00 | 8.17 | 10.03 | 11.13 | 10.03 | 11.14 | 18.05 | 8.17 | 8.17 | 12.26 | 9.60 | 14.98 | 21.76 | 8.17 | 8.17 | Not Applicable | 22.40 | 11.10 | 8.17 | 14.30 | 8.01 | 12.80 | 12.26 | 8.33 | 8.17 | 11.11 | 8.17 | 0.00 | 22.40 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, thyroid stimulating hormone (TSH) | 84443 | 25.20 | Northwest Hills Surgical Hospital | OP | 0.00 | 16.80 | 20.64 | 22.89 | 20.64 | 22.93 | 37.16 | 16.80 | 16.80 | 25.20 | 19.50 | 30.81 | 44.20 | 16.80 | 16.80 | Not Applicable | 45.50 | 22.82 | 16.80 | 29.40 | 16.46 | 26.00 | 25.20 | 17.14 | 16.80 | 22.87 | 16.80 | 0.00 | 45.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete blood cell count, with differential white blood cells, automated | 85025 | 11.66 | Northwest Hills Surgical Hospital | OP | 0.00 | 7.77 | 9.55 | 10.59 | 9.55 | 10.61 | 17.19 | 7.77 | 7.77 | 11.66 | 11.70 | 14.24 | 26.52 | 7.77 | 7.77 | Not Applicable | 27.30 | 10.56 | 7.77 | 13.60 | 7.61 | 15.60 | 11.66 | 7.93 | 7.77 | 10.58 | 7.77 | 0.00 | 27.30 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete blood count, automated | 85027 | 9.71 | Northwest Hills Surgical Hospital | OP | 0.00 | 6.47 | 7.95 | 8.81 | 7.95 | 8.83 | 14.32 | 6.47 | 6.47 | 9.71 | 7.50 | 11.85 | 17.00 | 6.47 | 6.47 | Not Applicable | 17.50 | 8.79 | 6.47 | 11.32 | 6.34 | 10.00 | 9.71 | 6.60 | 6.47 | 8.81 | 6.47 | 0.00 | 17.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, clotting time | 85610 | 6.44 | Northwest Hills Surgical Hospital | OP | 0.00 | 4.29 | 4.83 | 5.36 | 4.83 | 5.37 | 8.69 | 4.29 | 4.29 | 6.44 | 4.50 | 7.21 | 10.20 | 4.29 | 4.29 | Not Applicable | 10.50 | 5.83 | 4.29 | 7.51 | 4.20 | 6.00 | 6.44 | 4.38 | 4.29 | 5.35 | 4.29 | 0.00 | 10.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Coagulation assessment blood test | 85730 | 9.02 | Northwest Hills Surgical Hospital | OP | 0.00 | 6.01 | 7.37 | 8.18 | 7.37 | 8.19 | 13.28 | 6.01 | 6.01 | 9.02 | 5.40 | 11.01 | 12.24 | 6.01 | 6.01 | Not Applicable | 12.60 | 8.16 | 6.01 | 10.52 | 5.89 | 7.20 | 9.02 | 6.13 | 6.01 | 8.17 | 6.01 | 0.00 | 13.28 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical therapy, therapeutic exercise | 97110 | 46.29 | Northwest Hills Surgical Hospital | OP | 44.41 | 30.86 | 27.52 | 32.58 | 27.52 | 30.58 | 120.00 | 30.86 | 30.86 | 46.29 | 90.00 | 71.25 | 64.60 | 30.86 | 30.86 | Not Applicable | 66.50 | 41.92 | 30.86 | 54.01 | 30.24 | 38.00 | 46.29 | 31.48 | 30.86 | 108.00 | 30.86 | 27.52 | 120.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Electrocardiogram, routine, with interpretation and report | 93000 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 374.00 | 0.00 | 14.37 | 17.19 | 14.37 | 15.97 | Not Applicable | 0.00 | 0.00 | 0.00 | 114.60 | 286.50 | 259.76 | 0.00 | 0.00 | Not Applicable | 267.40 | 0.00 | 0.00 | 0.00 | 0.00 | 152.80 | 0.00 | 0.00 | 0.00 | 568.00 | 0.00 | 0.00 | 568.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair Biceps Tendon | 23430 | 8459.85 | Northwest Hills Surgical Hospital | OP | 2549.00 | 630.00 | 3403.48 | 4522.03 | 3403.48 | 3781.64 | 1560.00 | 5639.90 | 626.40 | 8459.85 | 2000.00 | 2869.00 | 10862.00 | 806.31 | 6767.88 | 1606.00 | 8438.50 | 6965.28 | 5639.90 | 9869.83 | 5527.10 | 503.08 | 9024.72 | 6136.81 | 6016.48 | 4450.00 | 5639.90 | 503.08 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shoulder Arthroscopy/Surgery | 29822 | 3871.38 | Northwest Hills Surgical Hospital | OP | 3667.00 | 510.00 | 1940.10 | 2179.99 | 1940.10 | 2155.67 | 4725.00 | 2580.92 | 1400.00 | 3871.38 | 4500.00 | 2324.00 | 8796.00 | 674.25 | 3097.10 | 1301.00 | 6195.00 | 3187.44 | 2580.92 | 4516.61 | 2529.30 | 408.42 | 4077.22 | 2772.51 | 2718.15 | 2970.00 | 2580.92 | 408.42 | 8796.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Knee Arthroscopy/Surgery | 29876 | 3871.38 | Northwest Hills Surgical Hospital | OP | 2549.00 | 630.00 | 1940.10 | 2179.99 | 1940.10 | 2155.67 | 4725.00 | 2580.92 | 1400.00 | 3871.38 | 4500.00 | 2869.00 | 10862.00 | 1203.42 | 3097.10 | 1606.00 | 5848.50 | 3187.44 | 2580.92 | 4516.61 | 2529.30 | 503.08 | 4077.22 | 2772.51 | 2718.15 | 2277.00 | 2580.92 | 503.08 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Knee Arthroscopy/Surgery | 29879 | 3871.38 | Northwest Hills Surgical Hospital | OP | 2069.00 | 510.00 | 1940.10 | 2179.99 | 1940.10 | 2155.67 | 4725.00 | 2580.92 | 1400.00 | 3871.38 | 4500.00 | 2324.00 | 8796.00 | 1203.42 | 3097.10 | 1301.00 | 5439.00 | 3187.44 | 2580.92 | 4516.61 | 2529.30 | 408.42 | 4077.22 | 2772.51 | 2718.15 | 2277.00 | 2580.92 | 408.42 | 8796.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal Of Inner Eye Fluid | 67036 | 5400.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 630.00 | 2754.30 | 1588.59 | 2754.30 | 3060.33 | 1560.00 | 3600.00 | 626.40 | 5400.00 | 2000.00 | 2869.00 | 10862.00 | 806.31 | 4320.00 | 1606.00 | 7287.00 | 4446.00 | 3600.00 | 6300.00 | 3528.00 | 503.08 | 5643.54 | 3837.61 | 3762.36 | 2738.00 | 3600.00 | 503.08 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Routine Venipuncture | 36415 | 4.50 | Northwest Hills Surgical Hospital | OP | 0.00 | 3.00 | 0.00 | 0.00 | 0.00 | 0.00 | 4.88 | 3.00 | 3.00 | 4.50 | 2.48 | 6.19 | 5.61 | 3.00 | 3.00 | Not Applicable | 5.78 | 4.08 | 3.00 | 5.25 | 2.94 | 3.30 | 4.50 | 3.06 | 3.00 | 3.00 | 3.00 | 0.00 | 6.19 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Unlisted Eye Surgery Procedure | 66999 | 2859.38 | Northwest Hills Surgical Hospital | OP | 1296.00 | 1996.70 | 155.14 | 1588.59 | 155.14 | 172.38 | Not Applicable | 1906.25 | 1996.70 | 2859.38 | 1100.00 | 75.00 | 68.00 | 1203.42 | 2287.50 | Not Applicable | 70.00 | 2354.22 | 1906.25 | 3335.94 | 1868.13 | 40.00 | 2995.05 | 2036.63 | 1996.70 | 1200.00 | 1906.25 | 40.00 | 3335.94 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment Of Fibula Fracture | 27780 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 156.82 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 163.10 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Insj Temp Ndwellg Bladder Catheter Simple | 51702 | 154.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 182.09 | 33.48 | 82.97 | 33.48 | 37.20 | 1825.00 | 102.80 | 151.74 | 154.20 | 2050.00 | 171.00 | 646.00 | 203.33 | 123.36 | 91.04 | 212.44 | 126.96 | 102.80 | 179.90 | 100.74 | 121.39 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 33.48 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treat Big Toe Fracture | 28490 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 190.68 | 53.78 | 87.70 | 53.78 | 59.76 | 1825.00 | 203.31 | 158.90 | 304.97 | 2050.00 | 329.00 | 1254.00 | 212.93 | 243.97 | 95.34 | 222.46 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 53.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 2.5 Cm Or Less | 12001 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 225.23 | 36.55 | 107.23 | 36.55 | 40.61 | 1825.00 | 164.74 | 187.69 | 247.11 | 2050.00 | 215.00 | 812.00 | 251.50 | 197.69 | 112.61 | 262.77 | 203.45 | 164.74 | 288.30 | 161.45 | 150.15 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 36.55 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair Of Nail Bed - Minor Surgery - Nail Charges | 11760 | 702.90 | Northwest Hills Surgical Hospital | OP | 1296.00 | 225.23 | 179.13 | 390.09 | 179.13 | 199.03 | 1825.00 | 468.60 | 187.69 | 702.90 | 2050.00 | 393.00 | 1500.00 | 674.25 | 562.32 | 112.61 | 262.77 | 578.72 | 468.60 | 820.05 | 459.23 | 182.00 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 112.61 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Skin Sub Graft T/A/L Add-On | 15272 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 126.75 | 316.88 | 287.30 | 0.00 | 0.00 | Not Applicable | 295.75 | 0.00 | 0.00 | 0.00 | 0.00 | 169.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 12.6 Cm To 20.0 Cm | 12035 | 451.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 368.47 | 205.25 | 368.47 | 409.41 | 1125.00 | 301.24 | 443.45 | 451.86 | 2050.00 | 417.00 | 1577.00 | 541.26 | 361.49 | 1139.00 | 309.90 | 372.03 | 301.24 | 527.17 | 295.22 | 356.12 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 205.25 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incisional Biopsy Of Skin | 11106 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 503.38 | 100.86 | 101.98 | 100.86 | 112.07 | 950.00 | 301.24 | 503.38 | 451.86 | 134.98 | 337.44 | 305.95 | 541.26 | 361.49 | Not Applicable | 314.94 | 372.03 | 301.24 | 527.17 | 295.22 | 83.38 | 755.07 | 513.45 | 503.38 | 318.00 | 301.24 | 83.38 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Cm Or Less | 12011 | 247.11 | Northwest Hills Surgical Hospital | OP | Not Applicable | 298.46 | 41.63 | 107.23 | 41.63 | 46.26 | 1825.00 | 164.74 | 248.72 | 247.11 | 2050.00 | 215.00 | 812.00 | 333.28 | 197.69 | 149.23 | 348.20 | 203.45 | 164.74 | 288.30 | 161.45 | 198.97 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 41.63 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Punch Biopsy Skin Single Lesion | 11104 | 247.11 | Northwest Hills Surgical Hospital | OP | Not Applicable | 332.12 | 81.77 | 82.67 | 81.77 | 90.85 | 1825.00 | 164.74 | 332.12 | 247.11 | 149.23 | 373.07 | 338.25 | 541.26 | 197.69 | Not Applicable | 348.20 | 203.45 | 164.74 | 288.30 | 161.45 | 67.59 | 498.19 | 338.77 | 332.12 | 318.00 | 164.74 | 67.59 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or Ext | 12041 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 315.95 | 98.96 | 59.96 | 98.96 | 109.95 | 1825.00 | 301.24 | 263.30 | 451.86 | 2050.00 | 393.00 | 1500.00 | 357.12 | 361.49 | 157.98 | 368.61 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 59.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Unlisted Procedure, Musculoskeletal System, General - Other Procedures - Orthopedic Charges | 20999 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 198.01 | 1475.16 | 1324.29 | 1475.16 | 1639.07 | Not Applicable | 203.31 | 198.01 | 304.97 | 180.05 | 450.14 | 408.12 | 541.26 | 243.97 | Not Applicable | 420.13 | 251.09 | 203.31 | 355.79 | 199.24 | 240.07 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 180.05 | 1639.07 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shoulder Surgery Procedure | 23929 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 360.11 | 97.35 | 156.82 | 97.35 | 108.17 | Not Applicable | 203.31 | 300.09 | 304.97 | 2050.00 | 2114.00 | 10862.00 | 541.26 | 243.97 | 180.05 | 420.13 | 251.09 | 203.31 | 355.79 | 199.24 | 240.07 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Calcaneal Fracture; With Manipulation - Closed Treatement - Foot/Toes Charges | 28405 | 304.97 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 404.03 | 216.13 | 404.03 | 448.92 | 1125.00 | 203.31 | 443.45 | 304.97 | 2050.00 | 471.00 | 1786.00 | 541.26 | 243.97 | 1139.00 | 443.57 | 251.09 | 203.31 | 355.79 | 199.24 | 356.12 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 198.01 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Graft Repair Of Spine Defect | 63710 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | Not Applicable | 0.00 | 967.82 | 1028.61 | 967.82 | 1075.35 | Not Applicable | 0.00 | 0.00 | 0.00 | 190.20 | 475.50 | 431.12 | 0.00 | 0.00 | Not Applicable | 443.80 | 0.00 | 0.00 | 0.00 | 0.00 | 253.60 | 0.00 | 0.00 | 0.00 | 1317.00 | 0.00 | 0.00 | 1317.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Unlisted Procedure, Humerus Or Elbow - Other Procedures - Orthopedic Charges | 24999 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 198.01 | 97.35 | 156.82 | 97.35 | 108.17 | Not Applicable | 203.31 | 198.01 | 304.97 | 190.37 | 475.92 | 431.50 | 541.26 | 243.97 | Not Applicable | 444.19 | 251.09 | 203.31 | 355.79 | 199.24 | 253.82 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Calcaneal Fracture; Without Manipulation - Closed Treatement - Foot/Toes Charges | 28400 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 216.13 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 451.42 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 20.1 Cm To 30.0 Cm | 12036 | 702.90 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 368.47 | 390.09 | 368.47 | 409.41 | 1125.00 | 468.60 | 443.45 | 702.90 | 2050.00 | 417.00 | 1577.00 | 541.26 | 562.32 | 1139.00 | 476.47 | 578.72 | 468.60 | 820.05 | 459.23 | 356.12 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 318.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chemodervate Facial/Trigem/Cerv Musc Migraine | 64615 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 250.81 | 38.91 | 54.09 | 38.91 | 43.23 | 1825.00 | 246.80 | 250.81 | 370.20 | 218.57 | 171.00 | 646.00 | 357.12 | 296.16 | Not Applicable | 509.99 | 304.80 | 246.80 | 431.90 | 241.86 | 33.11 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 33.11 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debrid Extensive Eczemati | 11001 | 377.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 377.50 | 377.50 | 2050.00 | 171.00 | 646.00 | 505.85 | 0.00 | 226.50 | 528.50 | 0.00 | 0.00 | 0.00 | 0.00 | 302.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruct Premalg Lesion | 17000 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 33.25 | 107.23 | 33.25 | 36.94 | 1825.00 | 164.74 | 377.50 | 247.11 | 2050.00 | 171.00 | 646.00 | 505.85 | 197.69 | 226.50 | 528.50 | 203.45 | 164.74 | 288.30 | 161.45 | 302.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 33.25 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection Intraesional Up | 11900 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 22.40 | 107.23 | 22.40 | 24.89 | 1825.00 | 164.74 | 377.50 | 247.11 | 2050.00 | 171.00 | 646.00 | 505.85 | 197.69 | 226.50 | 528.50 | 203.45 | 164.74 | 288.30 | 161.45 | 302.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 22.40 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruct B9 Lesion 1-14 | 17110 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 41.63 | 107.23 | 41.63 | 46.26 | 1825.00 | 164.74 | 377.50 | 247.11 | 2050.00 | 171.00 | 646.00 | 505.85 | 197.69 | 226.50 | 528.50 | 203.45 | 164.74 | 288.30 | 161.45 | 302.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 41.63 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy Skin Subcutaneous | 11100 | 377.50 | Northwest Hills Surgical Hospital | OP | Not Applicable | 453.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 226.50 | 377.50 | 377.50 | 2050.00 | 171.00 | 646.00 | 505.85 | Not Applicable | 226.50 | 528.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 302.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 171.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruction Of Skin Lesions | 17264 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 73.28 | 114.78 | 73.28 | 81.42 | 1825.00 | 301.24 | 377.50 | 451.86 | 2050.00 | 215.00 | 812.00 | 505.85 | 361.49 | 226.50 | 528.50 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 73.28 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal Skin Tags M | 11200 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 36.08 | 107.23 | 36.08 | 40.09 | 1825.00 | 164.74 | 377.50 | 247.11 | 2050.00 | 171.00 | 646.00 | 505.85 | 197.69 | 226.50 | 528.50 | 203.45 | 164.74 | 288.30 | 161.45 | 302.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 36.08 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal Of Fixation Device | 20665 | 514.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 88.43 | 82.97 | 88.43 | 98.25 | 1825.00 | 342.80 | 377.50 | 514.20 | 2050.00 | 171.00 | 646.00 | 505.85 | 411.36 | 226.50 | 528.50 | 423.36 | 342.80 | 599.90 | 335.94 | 265.97 | 389.25 | 264.69 | 259.50 | 318.00 | 342.80 | 82.97 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incision And Drainage Of Abscess; Simple Or Single - Incision And Drainage Charges | 10060 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 45.28 | 59.96 | 45.28 | 50.31 | 1825.00 | 164.74 | 377.50 | 247.11 | 2050.00 | 215.00 | 812.00 | 674.25 | 197.69 | 226.50 | 528.50 | 203.45 | 164.74 | 288.30 | 161.45 | 52.87 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 45.28 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb; Without Manipulation, Each | 26720 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 53.78 | 87.70 | 53.78 | 59.76 | 1825.00 | 203.31 | 377.50 | 304.97 | 2050.00 | 329.00 | 1254.00 | 541.26 | 243.97 | 226.50 | 528.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 53.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Radial And Ulnar Shaft Fractures; Withou - Closed Treatment - Upper Extremity Charges | 25560 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 53.78 | 87.70 | 53.78 | 59.76 | 1825.00 | 203.31 | 377.50 | 304.97 | 2050.00 | 329.00 | 1254.00 | 541.26 | 243.97 | 226.50 | 528.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 53.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection For Hip X-Ray | 27095 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 226.50 | 566.25 | 513.40 | 0.00 | 0.00 | Not Applicable | 528.50 | 0.00 | 0.00 | 0.00 | 0.00 | 302.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Fracture Great Toe, Phalanx Or Phalanges; With Manipulation | 28495 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 349.36 | 74.75 | 87.70 | 74.75 | 83.06 | 1825.00 | 203.31 | 291.14 | 304.97 | 2050.00 | 329.00 | 1254.00 | 390.12 | 243.97 | 174.68 | 528.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 74.75 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery - Nasal Hemorrhage Charges | 30901 | 154.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 34.66 | 82.97 | 34.66 | 38.51 | 1825.00 | 102.80 | 377.50 | 154.20 | 2050.00 | 171.00 | 646.00 | 505.85 | 123.36 | 226.50 | 528.50 | 126.96 | 102.80 | 179.90 | 100.74 | 302.00 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 34.66 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy Of Uterus Lining | 58100 | 234.84 | Northwest Hills Surgical Hospital | OP | 1296.00 | 453.00 | 32.07 | 44.64 | 32.07 | 35.63 | 1825.00 | 156.56 | 377.50 | 234.84 | 2050.00 | 171.00 | 646.00 | 357.12 | 187.87 | 226.50 | 528.50 | 193.35 | 156.56 | 273.98 | 153.43 | 265.97 | 245.35 | 166.84 | 163.57 | 318.00 | 156.56 | 32.07 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
N Block Inj Plantar Digit | 64455 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 465.00 | 12.74 | 17.92 | 12.74 | 14.15 | Not Applicable | 246.80 | 387.50 | 370.20 | 2050.00 | 171.00 | 646.00 | 357.12 | 296.16 | 232.50 | 542.50 | 304.80 | 246.80 | 431.90 | 241.86 | 265.97 | 376.22 | 255.83 | 250.81 | Not Applicable | 246.80 | 12.74 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Place Needle Wire Breast | 19290 | 392.50 | Northwest Hills Surgical Hospital | OP | Not Applicable | 333.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 235.50 | 331.10 | 392.50 | 2050.00 | 2114.00 | 10862.00 | 525.95 | Not Applicable | 854.00 | 549.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 314.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 235.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Wound Prep F/N/Hf/G | 15004 | 702.90 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 368.47 | 390.09 | 368.47 | 409.41 | 1125.00 | 468.60 | 396.55 | 702.90 | 2050.00 | 1473.00 | 5575.00 | 541.26 | 562.32 | 1139.00 | 555.17 | 578.72 | 468.60 | 820.05 | 459.23 | 356.12 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 318.00 | 5575.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands And/Or Feet; 1.1 Cm To 2.5 Cm | 13131 | 451.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 179.13 | 390.09 | 179.13 | 199.03 | 1125.00 | 301.24 | 443.45 | 451.86 | 2050.00 | 417.00 | 1577.00 | 541.26 | 361.49 | 1139.00 | 555.17 | 372.03 | 301.24 | 527.17 | 295.22 | 356.12 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 179.13 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debridement, Muscle And/Or Fascia (Includes Epidermis, Dermi - Debridement Charges | 11043 | 702.90 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 247.33 | 390.09 | 247.33 | 274.81 | 1125.00 | 468.60 | 443.45 | 702.90 | 2050.00 | 749.00 | 2836.00 | 541.26 | 562.32 | 1139.00 | 555.17 | 578.72 | 468.60 | 820.05 | 459.23 | 356.12 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 247.33 | 2836.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debridement, Subcutaneous Tissue (Includes Epidermis And Dermis, If Performed); First 20 Sq Cm Or Less | 11042 | 451.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 247.33 | 205.25 | 247.33 | 274.81 | 1125.00 | 301.24 | 443.45 | 451.86 | 2050.00 | 749.00 | 2836.00 | 204.60 | 361.49 | 1139.00 | 555.17 | 372.03 | 301.24 | 527.17 | 295.22 | 356.12 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 204.60 | 2836.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Distal Radial Fracture (Eg, Colles Or Smith Type) Or Epiphyseal Separation, Includes Closed Treatment Of Fracture Of Ulnar Styloid, When Performed; Without Manipulation | 25600 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 480.00 | 86.24 | 120.85 | 86.24 | 95.82 | 1825.00 | 203.31 | 400.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 541.26 | 243.97 | 240.00 | 560.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 86.24 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.6 Cm To 5.0 Cm | 12052 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 495.00 | 98.96 | 114.78 | 98.96 | 109.95 | 1825.00 | 301.24 | 412.50 | 451.86 | 2050.00 | 393.00 | 1500.00 | 541.26 | 361.49 | 247.50 | 577.50 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 98.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chemodenerv 1 Extremity 1-4 | 64642 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 609.42 | 46.93 | 65.49 | 46.93 | 52.14 | 1825.00 | 589.31 | 609.42 | 883.97 | 750.00 | 215.00 | 812.00 | 674.25 | 707.17 | Not Applicable | 577.60 | 727.80 | 589.31 | 1031.29 | 577.52 | 38.79 | 914.13 | 621.61 | 609.42 | 788.00 | 589.31 | 38.79 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Cm Or Less | 12051 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 513.00 | 98.96 | 114.78 | 98.96 | 109.95 | 1825.00 | 301.24 | 427.50 | 451.86 | 2050.00 | 393.00 | 1500.00 | 357.12 | 361.49 | 256.50 | 598.50 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 98.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 2.6 Cm To 7.5 Cm | 12032 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 519.00 | 98.96 | 114.78 | 98.96 | 109.95 | 1825.00 | 301.24 | 432.50 | 451.86 | 2050.00 | 393.00 | 1500.00 | 357.12 | 361.49 | 259.50 | 605.50 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 98.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debridement Including Removal Of Foreign Material At The Site Of An Open Fracture And/Or An Open Dislocation (Eg, Excisional Debridement); Skin, Subcutaneous Tissue, Muscle Fascia, Muscle, And Bone | 11012 | 3279.45 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 576.82 | 1286.99 | 576.82 | 640.91 | 1125.00 | 2186.30 | 443.45 | 3279.45 | 750.00 | 1146.00 | 4338.00 | 541.26 | 2623.56 | 1139.00 | 606.38 | 2700.08 | 2186.30 | 3826.03 | 2142.57 | 356.12 | 3414.02 | 2321.54 | 2276.02 | 788.00 | 2186.30 | 356.12 | 4338.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Excision Of Nail And Nail Matrix, Partial Or Complete, For P - Minor Surgery - Nail Charges | 11750 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 519.75 | 84.65 | 111.10 | 84.65 | 94.06 | 950.00 | 301.24 | 433.13 | 451.86 | 2050.00 | 417.00 | 1577.00 | 892.80 | 361.49 | 259.88 | 606.38 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 84.65 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Excise Benign Lesion | 11422 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1296.00 | 519.75 | 70.04 | 99.05 | 70.04 | 77.82 | 950.00 | 1294.11 | 433.13 | 1941.17 | 750.00 | 403.00 | 1526.00 | 674.25 | 1552.93 | 259.88 | 606.38 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 265.97 | 2026.80 | 1378.22 | 1351.20 | 788.00 | 1294.11 | 70.04 | 2264.69 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debridement, Bone (Includes Epidermis, Dermis, Subcutaneous - Debridement Charges | 11044 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 576.82 | 857.20 | 576.82 | 640.91 | 1125.00 | 1294.11 | 443.45 | 1941.17 | 750.00 | 1927.00 | 7294.00 | 541.26 | 1552.93 | 1139.00 | 606.38 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 356.12 | 2026.80 | 1378.22 | 1351.20 | 788.00 | 1294.11 | 356.12 | 7294.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm To 7.5 Cm | 12042 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 537.00 | 98.96 | 114.78 | 98.96 | 109.95 | 1825.00 | 301.24 | 447.50 | 451.86 | 2050.00 | 393.00 | 1500.00 | 491.04 | 361.49 | 268.50 | 626.50 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 98.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Bone Marrow Aspiration Bone Grfg | 20939 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 274.50 | 686.25 | 622.20 | 0.00 | 0.00 | Not Applicable | 640.50 | 0.00 | 0.00 | 0.00 | 0.00 | 366.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 2.5 Cm Or Less | 12031 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 511.58 | 98.96 | 114.78 | 98.96 | 109.95 | 1825.00 | 301.24 | 426.32 | 451.86 | 2050.00 | 393.00 | 1500.00 | 357.12 | 361.49 | 255.79 | 644.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 98.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair Complex Trunk | 13102 | 477.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 477.50 | 477.50 | 2050.00 | 417.00 | 1577.00 | 357.12 | 0.00 | 854.00 | 668.50 | 0.00 | 0.00 | 0.00 | 0.00 | 382.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruction Of Skin Lesions | 17263 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 573.00 | 73.28 | 107.23 | 73.28 | 81.42 | 1825.00 | 164.74 | 477.50 | 247.11 | 2050.00 | 215.00 | 812.00 | 639.85 | 197.69 | 286.50 | 668.50 | 203.45 | 164.74 | 288.30 | 161.45 | 382.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 73.28 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair Complex Trunk | 13101 | 702.90 | Northwest Hills Surgical Hospital | OP | 2069.00 | 510.00 | 368.47 | 390.09 | 368.47 | 409.41 | 1273.00 | 468.60 | 507.08 | 702.90 | 2050.00 | 1473.00 | 5575.00 | 674.25 | 562.32 | 1301.00 | 668.50 | 578.72 | 468.60 | 820.05 | 459.23 | 408.42 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 318.00 | 5575.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separa - Endoscopic Procedures Charges | 31231 | 221.40 | Northwest Hills Surgical Hospital | OP | 1695.00 | 573.00 | 74.78 | 71.91 | 74.78 | 83.09 | 1825.00 | 147.60 | 477.50 | 221.40 | 2050.00 | 215.00 | 812.00 | 892.80 | 177.12 | 286.50 | 668.50 | 182.29 | 147.60 | 258.30 | 144.65 | 265.97 | 236.81 | 161.03 | 157.87 | 318.00 | 147.60 | 71.91 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection Intraesional Mo | 11901 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 582.60 | 24.53 | 107.23 | 24.53 | 27.25 | 1825.00 | 164.74 | 485.50 | 247.11 | 2050.00 | 171.00 | 646.00 | 650.57 | 197.69 | 291.30 | 679.70 | 203.45 | 164.74 | 288.30 | 161.45 | 388.40 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 24.53 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Correction Hallux Bunion | 28291 | 8459.85 | Northwest Hills Surgical Hospital | OP | 2069.00 | 6016.48 | 4697.42 | 4749.62 | 4697.42 | 5219.36 | Not Applicable | 5639.90 | 6016.48 | 8459.85 | 2400.00 | 6097.00 | 23086.00 | 674.25 | 6767.88 | Not Applicable | 688.80 | 6965.28 | 5639.90 | 9869.83 | 5527.10 | 1036.82 | 9024.72 | 6136.81 | 6016.48 | 3290.00 | 5639.90 | 674.25 | 23086.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands And/Or Feet; Each Additional 5 Cm Or Less | 13133 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 417.00 | 1577.00 | 357.12 | 0.00 | 854.00 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, Complex, Scalp, Arms, And/Or Legs; Each Additional 5 - Complex Wound Closures Charges | 13122 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 417.00 | 1577.00 | 357.12 | 0.00 | 854.00 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dressings And/Or Debridement Of Partial-Thickness Burns Initial Or Subsequent; Small | 16020 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 35.14 | 107.23 | 35.14 | 39.04 | 950.00 | 164.74 | 497.50 | 247.11 | 2050.00 | 171.00 | 646.00 | 666.65 | 197.69 | 298.50 | 696.50 | 203.45 | 164.74 | 288.30 | 161.45 | 398.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 35.14 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint Or Bursa; Without Ultrasound Guidance | 20605 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 15.33 | 21.83 | 15.33 | 17.03 | 950.00 | 246.80 | 497.50 | 370.20 | 2050.00 | 171.00 | 646.00 | 491.04 | 296.16 | 298.50 | 696.50 | 304.80 | 246.80 | 431.90 | 241.86 | 17.89 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 15.33 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15819 Plastic Surgery Neck | 15819 | 2294.93 | Northwest Hills Surgical Hospital | OP | 1695.00 | 597.00 | 1234.07 | 1284.20 | 1234.07 | 1371.19 | 950.00 | 1529.95 | 497.50 | 2294.93 | 1100.00 | 393.00 | 1500.00 | 666.65 | 1835.94 | 298.50 | 696.50 | 1889.49 | 1529.95 | 2677.41 | 1499.35 | 408.42 | 2470.99 | 1680.28 | 1647.33 | 1200.00 | 1529.95 | 298.50 | 2677.41 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Arthrocentesis, Aspiration And/Or Injection, Major Joint Or - Arthocentesis/Aspiration/Injection-Joint Or Bursa | 20610 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 18.86 | 26.39 | 18.86 | 20.96 | 950.00 | 246.80 | 497.50 | 370.20 | 2050.00 | 171.00 | 646.00 | 491.04 | 296.16 | 298.50 | 696.50 | 304.80 | 246.80 | 431.90 | 241.86 | 21.63 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 18.86 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15157 Cult Epiderm Grft F/N/Hfg +% | 15157 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 1517.00 | 5741.00 | 357.12 | 0.00 | 854.00 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15152 Cult Skin Graft T/A/L +% | 15152 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 1517.00 | 5741.00 | 357.12 | 0.00 | 854.00 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Scapular Fracture; Without Manipulation - Closed Treatment - Shoulder Charges | 23570 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 97.35 | 156.82 | 97.35 | 108.17 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Shoulder Dislocation, With Manipulation; Without Anesthesia | 23650 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 156.82 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 204.60 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
21820 Treat Sternum Fracture | 21820 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 97.35 | 156.82 | 97.35 | 108.17 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Ulnar Fracture, Proximal End; Without Ma - Closed Treatment - Upper Extremity Charges | 24670 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 97.35 | 156.82 | 97.35 | 108.17 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Clavicular Fracture; Without Manipulatio - Closed Treatment - Shoulder Charges | 23500 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 97.35 | 156.82 | 97.35 | 108.17 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Acromioclavicular Dislocation; Without M - Closed Treatment - Shoulder Charges | 23540 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 156.82 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Temporomandibular Dislocation; Initial O - Closed Treatment - Skull/Face Charges | 21480 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 75.71 | 117.65 | 75.71 | 84.12 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 688.00 | 2597.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 75.71 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Supracondylar Or Transcondylar Humeral F | 24530 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 216.13 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
21800 Treatment Of Rib Fracture | 21800 | 497.50 | Northwest Hills Surgical Hospital | OP | Not Applicable | 333.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 298.50 | 331.10 | 497.50 | 2050.00 | 2114.00 | 10862.00 | 357.12 | Not Applicable | 854.00 | 696.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 398.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 298.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed Treatment Of Humeral Condylar Fracture, Medial Or Lateral; Without Manipulation | 24576 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 216.13 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation | 24560 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 97.35 | 156.82 | 97.35 | 108.17 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each | 26725 | 304.97 | Northwest Hills Surgical Hospital | OP | 1695.00 | 597.00 | 86.24 | 120.85 | 86.24 | 95.82 | 1825.00 | 203.31 | 497.50 | 304.97 | 2050.00 | 329.00 | 1254.00 | 541.26 | 243.97 | 298.50 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 86.24 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treat wrist dislocation | 25660 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 216.13 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 696.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fine Needle Aspiration W | 10022 | 760.00 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 456.00 | 760.00 | 760.00 | 750.00 | 813.00 | 3093.00 | 1018.40 | Not Applicable | 456.00 | 1064.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 608.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 456.00 | 3093.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acne surgery | 10040 | 247.11 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 34.43 | 107.23 | 34.43 | 38.25 | 1825.00 | 164.74 | 760.00 | 247.11 | 2050.00 | 171.00 | 646.00 | 1018.40 | 197.69 | 456.00 | 1064.00 | 203.45 | 164.74 | 288.30 | 161.45 | 608.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 34.43 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Deb musc/fascia add-on | 11046 | 650.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 650.00 | 650.00 | 2050.00 | 471.00 | 1786.00 | 871.00 | 0.00 | 390.00 | 910.00 | 0.00 | 0.00 | 0.00 | 0.00 | 520.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Trim skin lesion | 11055 | 247.11 | Northwest Hills Surgical Hospital | OP | 1296.00 | 912.00 | 22.64 | 107.23 | 22.64 | 25.15 | 1825.00 | 164.74 | 760.00 | 247.11 | 2050.00 | 171.00 | 646.00 | 1018.40 | 197.69 | 456.00 | 1064.00 | 203.45 | 164.74 | 288.30 | 161.45 | 608.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 22.64 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shave skin lesion >2.0 cm | 11303 | 451.86 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 68.38 | 107.23 | 68.38 | 75.98 | 1825.00 | 301.24 | 760.00 | 451.86 | 2050.00 | 215.00 | 812.00 | 1018.40 | 361.49 | 456.00 | 1064.00 | 372.03 | 301.24 | 527.17 | 295.22 | 608.00 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 68.38 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shave skin lesion 0.5 cm/< | 11305 | 247.11 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 41.63 | 107.23 | 41.63 | 46.26 | 1825.00 | 164.74 | 760.00 | 247.11 | 2050.00 | 171.00 | 646.00 | 1018.40 | 197.69 | 456.00 | 1064.00 | 203.45 | 164.74 | 288.30 | 161.45 | 608.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 41.63 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shave skin lesion >2.0 cm | 11308 | 451.86 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 61.31 | 107.23 | 61.31 | 68.12 | 1825.00 | 301.24 | 760.00 | 451.86 | 2050.00 | 171.00 | 646.00 | 1018.40 | 361.49 | 456.00 | 1064.00 | 372.03 | 301.24 | 527.17 | 295.22 | 608.00 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 61.31 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shave skin lesion 1.1-2.0 cm | 11312 | 451.86 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 69.80 | 99.70 | 69.80 | 77.55 | 1825.00 | 301.24 | 760.00 | 451.86 | 2050.00 | 171.00 | 646.00 | 541.26 | 361.49 | 456.00 | 1064.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 69.80 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shave skin lesion >2.0 cm | 11313 | 451.86 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 73.28 | 108.83 | 73.28 | 81.42 | 1825.00 | 301.24 | 760.00 | 451.86 | 2050.00 | 171.00 | 646.00 | 1018.40 | 361.49 | 456.00 | 1064.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 73.28 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exc tr-ext b9+marg 0.6-1 cm | 11401 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 870.00 | 62.96 | 89.27 | 62.96 | 69.96 | 950.00 | 301.24 | 725.00 | 451.86 | 2050.00 | 329.00 | 1254.00 | 491.04 | 361.49 | 435.00 | 1015.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 62.96 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exc tr-ext mal+marg 1.1-2 cm | 11602 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 846.00 | 101.39 | 143.69 | 101.39 | 112.66 | 950.00 | 301.24 | 705.00 | 451.86 | 2050.00 | 579.00 | 2192.00 | 357.12 | 361.49 | 423.00 | 987.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 101.39 | 2192.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy nail unit | 11755 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 753.00 | 55.18 | 77.54 | 55.18 | 61.31 | 950.00 | 575.13 | 627.50 | 862.70 | 750.00 | 306.00 | 1154.00 | 541.26 | 690.16 | 376.50 | 878.50 | 710.29 | 575.13 | 1006.48 | 563.63 | 265.97 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 55.18 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Correct skin color ea 20.0cm | 11922 | 732.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 879.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 732.50 | 732.50 | 2050.00 | 171.00 | 646.00 | 981.55 | 0.00 | 439.50 | 1025.50 | 0.00 | 0.00 | 0.00 | 0.00 | 586.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Remove contraceptive capsule | 11976 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 912.00 | 47.87 | 66.79 | 47.87 | 53.19 | 950.00 | 575.13 | 760.00 | 862.70 | 750.00 | 215.00 | 812.00 | 541.26 | 690.16 | 456.00 | 1064.00 | 710.29 | 575.13 | 1006.48 | 563.63 | 139.50 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 47.87 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Implant hormone pellet(s) | 11980 | 514.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 813.00 | 28.76 | 82.97 | 28.76 | 31.96 | 1825.00 | 342.80 | 677.50 | 514.20 | 2050.00 | 171.00 | 646.00 | 907.85 | 411.36 | 406.50 | 948.50 | 423.36 | 342.80 | 599.90 | 335.94 | 542.00 | 389.25 | 264.69 | 259.50 | 318.00 | 342.80 | 28.76 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Wnd prep f/n/hf/g addl cm | 15005 | 627.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 627.50 | 627.50 | 2050.00 | 1473.00 | 5575.00 | 357.12 | 0.00 | 854.00 | 878.50 | 0.00 | 0.00 | 0.00 | 0.00 | 356.12 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 5575.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Skin pinch graft | 15050 | 702.90 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 368.47 | 390.09 | 368.47 | 409.41 | 1125.00 | 468.60 | 443.45 | 702.90 | 2050.00 | 1473.00 | 5575.00 | 541.26 | 562.32 | 1139.00 | 871.50 | 578.72 | 468.60 | 820.05 | 459.23 | 356.12 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 318.00 | 5575.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Epidrm autogrft t/a/l add-on | 15111 | 627.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 627.50 | 627.50 | 2050.00 | 1517.00 | 5741.00 | 357.12 | 0.00 | 854.00 | 878.50 | 0.00 | 0.00 | 0.00 | 0.00 | 502.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cult skin grft t/arm/leg | 15150 | 2294.93 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 1234.07 | 1945.12 | 1234.07 | 1371.19 | 1125.00 | 1529.95 | 565.00 | 2294.93 | 1800.00 | 2032.00 | 7693.00 | 541.26 | 1835.94 | 1139.00 | 791.00 | 1889.49 | 1529.95 | 2677.41 | 1499.35 | 356.12 | 2470.99 | 1680.28 | 1647.33 | 1919.00 | 1529.95 | 356.12 | 7693.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cult skin graft f/n/hf/g | 15155 | 4210.58 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 2034.41 | 1284.20 | 2034.41 | 2260.46 | 1125.00 | 2807.05 | 565.00 | 4210.58 | 1800.00 | 2032.00 | 7693.00 | 541.26 | 3368.46 | 1139.00 | 791.00 | 3466.71 | 2807.05 | 4912.34 | 2750.91 | 356.12 | 5073.69 | 3450.11 | 3382.46 | 2277.00 | 2807.05 | 356.12 | 7693.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acell Graft T/Arm/Leg Add-On | 15171 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acell Graft F/N/Hf/G Add-On | 15176 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Aply Acell Grft T/A/L Add-On | 15331 | 502.50 | Northwest Hills Surgical Hospital | OP | 2549.00 | 333.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 301.50 | 502.50 | 502.50 | 2050.00 | 2114.00 | 10862.00 | 357.12 | Not Applicable | 854.00 | 703.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 402.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 301.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Cult Skin Substitute | 15340 | 692.50 | Northwest Hills Surgical Hospital | OP | 2549.00 | 831.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 415.50 | 692.50 | 692.50 | 2050.00 | 2114.00 | 10862.00 | 927.95 | Not Applicable | 415.50 | 969.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 554.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 415.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Cult Skin Sub Add-On | 15341 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Cult Derm Sub T/A/L | 15360 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Aply Cult Derm Sub T/A/L Add | 15361 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Cult Derm Sub F/N/Hf/G | 15365 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Cult Derm F/Hf/G Add | 15366 | 665.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Skn Xenogrft T/A/L Add | 15401 | 565.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 446.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 339.00 | 443.45 | 565.00 | 2050.00 | 2114.00 | 10862.00 | 541.26 | Not Applicable | 1139.00 | 791.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 452.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 339.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Apply Acellular Xenograft | 15430 | 667.50 | Northwest Hills Surgical Hospital | OP | 2549.00 | 446.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 400.50 | 667.50 | 667.50 | 2050.00 | 2114.00 | 10862.00 | 894.45 | Not Applicable | 1139.00 | 934.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 534.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 400.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chemical peel face dermal | 15789 | 702.90 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 73.28 | 114.78 | 73.28 | 81.42 | 1825.00 | 468.60 | 760.00 | 702.90 | 2050.00 | 215.00 | 812.00 | 1018.40 | 562.32 | 456.00 | 1064.00 | 578.72 | 468.60 | 820.05 | 459.23 | 608.00 | 755.07 | 513.45 | 503.38 | 318.00 | 468.60 | 73.28 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dress/debrid p-thick burn l | 16030 | 451.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 132.65 | 205.25 | 132.65 | 147.39 | 1125.00 | 301.24 | 565.00 | 451.86 | 2050.00 | 451.00 | 1719.00 | 541.26 | 361.49 | 1139.00 | 791.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 132.65 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incision of burn scab initi | 16035 | 451.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 780.00 | 132.65 | 390.09 | 132.65 | 147.39 | Not Applicable | 301.24 | 650.00 | 451.86 | 2050.00 | 488.00 | 1843.00 | 871.00 | 361.49 | 390.00 | 910.00 | 372.03 | 301.24 | 527.17 | 295.22 | 356.12 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 132.65 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruct premalg les 2-14 | 17003 | 760.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 912.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 760.00 | 760.00 | 2050.00 | 171.00 | 646.00 | 1018.40 | 0.00 | 456.00 | 1064.00 | 0.00 | 0.00 | 0.00 | 0.00 | 608.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruction of skin lesions | 17106 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 729.00 | 124.04 | 179.20 | 124.04 | 137.82 | 950.00 | 301.24 | 607.50 | 451.86 | 2050.00 | 488.00 | 1843.00 | 541.26 | 361.49 | 364.50 | 850.50 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 124.04 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruction of skin lesions | 17273 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 79.94 | 113.71 | 79.94 | 88.82 | 1825.00 | 301.24 | 665.00 | 451.86 | 2050.00 | 451.00 | 1719.00 | 891.10 | 361.49 | 399.00 | 931.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 79.94 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of breast lesion | 19000 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 699.00 | 52.11 | 73.64 | 52.11 | 57.90 | 950.00 | 575.13 | 582.50 | 862.70 | 750.00 | 329.00 | 1254.00 | 541.26 | 690.16 | 349.50 | 815.50 | 710.29 | 575.13 | 1006.48 | 563.63 | 65.23 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 52.11 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Bx breast 1st lesion us imag | 19083 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1695.00 | 1351.20 | 631.87 | 857.20 | 631.87 | 702.08 | 1273.00 | 1294.11 | 1351.20 | 1941.17 | 1100.00 | 1698.00 | 6431.00 | 541.26 | 1552.93 | Not Applicable | 965.09 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 265.97 | 2026.80 | 1378.22 | 1351.20 | 1200.00 | 1294.11 | 265.97 | 6431.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Us bone stimulation | 20979 | 32.52 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 18.86 | 27.76 | 18.86 | 20.96 | 1825.00 | 21.68 | 760.00 | 32.52 | 2050.00 | 171.00 | 646.00 | 1018.40 | 26.02 | 456.00 | 1064.00 | 26.77 | 21.68 | 37.94 | 21.25 | 608.00 | 35.54 | 24.17 | 23.69 | 318.00 | 21.68 | 18.86 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Neck/chest surgery procedure | 21899 | 288.00 | Northwest Hills Surgical Hospital | OP | Not Applicable | 203.21 | 75.71 | 117.65 | 75.71 | 84.12 | Not Applicable | 192.00 | 203.21 | 288.00 | 345.93 | 864.83 | 784.11 | 541.26 | 230.40 | Not Applicable | 807.17 | 237.12 | 192.00 | 336.00 | 188.16 | 461.24 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 75.71 | 864.83 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed tx vert fx w/o manj | 22310 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 216.13 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 899.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection for hip x-ray | 27093 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 301.37 | 753.41 | 683.09 | 0.00 | 0.00 | Not Applicable | 703.19 | 0.00 | 0.00 | 0.00 | 0.00 | 401.82 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fixation of ankle joint | 27860 | 3871.38 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 1039.01 | 997.77 | 1039.01 | 1154.45 | 950.00 | 2580.92 | 331.10 | 3871.38 | 1100.00 | 1517.00 | 5741.00 | 357.12 | 3097.10 | 854.00 | 802.24 | 3187.44 | 2580.92 | 4516.61 | 2529.30 | 265.97 | 4077.22 | 2772.51 | 2718.15 | 1200.00 | 2580.92 | 265.97 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of nose lesion | 30000 | 288.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 41.82 | 65.79 | 41.82 | 46.47 | 1825.00 | 192.00 | 665.00 | 288.00 | 2050.00 | 451.00 | 1719.00 | 891.10 | 230.40 | 399.00 | 931.00 | 237.12 | 192.00 | 336.00 | 188.16 | 71.14 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 41.82 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Largsc w/ther injection | 31573 | 2023.22 | Northwest Hills Surgical Hospital | OP | 1695.00 | 1437.04 | 1142.33 | 1155.02 | 1142.33 | 1269.25 | 2575.00 | 1348.81 | 1437.04 | 2023.22 | 1100.00 | 3263.00 | 12368.00 | 1437.04 | 1618.57 | Not Applicable | 902.41 | 1665.78 | 1348.81 | 2360.42 | 1321.83 | 574.31 | 2155.56 | 1465.78 | 1437.04 | 1200.00 | 1348.81 | 574.31 | 12368.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diagnostic laryngoscopy | 31575 | 221.40 | Northwest Hills Surgical Hospital | OP | 1695.00 | 597.00 | 47.87 | 65.81 | 47.87 | 53.19 | 1825.00 | 147.60 | 497.50 | 221.40 | 2050.00 | 215.00 | 812.00 | 541.26 | 177.12 | 298.50 | 696.50 | 182.29 | 147.60 | 258.30 | 144.65 | 265.97 | 236.81 | 161.03 | 157.87 | 318.00 | 147.60 | 47.87 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laryngoscopy telescopic | 31579 | 534.42 | Northwest Hills Surgical Hospital | OP | 1695.00 | 819.00 | 82.76 | 112.73 | 82.76 | 91.96 | 950.00 | 356.28 | 682.50 | 534.42 | 2050.00 | 488.00 | 1843.00 | 914.55 | 427.54 | 409.50 | 955.50 | 440.01 | 356.28 | 623.49 | 349.15 | 77.43 | 542.37 | 368.81 | 361.58 | 318.00 | 356.28 | 77.43 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Bronchial brush biopsy | 31717 | 534.42 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 332.61 | 341.37 | 332.61 | 369.57 | 950.00 | 356.28 | 331.10 | 534.42 | 2050.00 | 1076.00 | 4073.00 | 357.12 | 427.54 | 854.00 | 784.00 | 440.01 | 356.28 | 623.49 | 349.15 | 265.97 | 542.37 | 368.81 | 361.58 | 318.00 | 356.28 | 265.97 | 4073.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Clearance of airways | 31720 | 260.16 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 70.37 | 136.01 | 70.37 | 78.19 | 950.00 | 173.44 | 331.10 | 260.16 | 2050.00 | 215.00 | 812.00 | 357.12 | 208.13 | 854.00 | 696.50 | 214.20 | 173.44 | 303.52 | 169.97 | 398.00 | 270.64 | 184.04 | 180.43 | 318.00 | 173.44 | 70.37 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Thoracentesis For Aspiration | 32421 | 717.50 | Northwest Hills Surgical Hospital | OP | 2549.00 | 861.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 430.50 | 717.50 | 717.50 | 2050.00 | 2114.00 | 10862.00 | 961.45 | Not Applicable | 430.50 | 1004.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 574.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 430.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Lyse chest fibrin subq day | 32562 | 891.69 | Northwest Hills Surgical Hospital | OP | 1296.00 | 840.00 | 436.67 | 439.38 | 436.67 | 485.19 | 950.00 | 594.46 | 700.00 | 891.69 | 750.00 | 2114.00 | 10862.00 | 938.00 | 713.35 | 420.00 | 980.00 | 734.16 | 594.46 | 1040.31 | 582.57 | 560.00 | 780.21 | 530.54 | 520.14 | 788.00 | 594.46 | 420.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pseudoaneurysm injection trt | 36002 | 891.69 | Northwest Hills Surgical Hospital | OP | 1296.00 | 897.00 | 171.76 | 379.29 | 171.76 | 190.84 | 950.00 | 594.46 | 747.50 | 891.69 | 750.00 | 417.00 | 1577.00 | 1001.65 | 713.35 | 448.50 | 1046.50 | 734.16 | 594.46 | 1040.31 | 582.57 | 265.97 | 780.21 | 530.54 | 520.14 | 788.00 | 594.46 | 171.76 | 1577.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Vein access cutdown > 1 yr | 36425 | 514.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 10.99 | 82.97 | 10.99 | 12.21 | 1825.00 | 342.80 | 665.00 | 514.20 | 2050.00 | 171.00 | 646.00 | 891.10 | 411.36 | 399.00 | 931.00 | 423.36 | 342.80 | 599.90 | 335.94 | 532.00 | 389.25 | 264.69 | 259.50 | 318.00 | 342.80 | 10.99 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inj w/fluor eval cv device | 36598 | 259.85 | Northwest Hills Surgical Hospital | OP | 1695.00 | 798.00 | 54.71 | 75.91 | 54.71 | 60.79 | 950.00 | 173.23 | 665.00 | 259.85 | 2050.00 | 417.00 | 1577.00 | 891.10 | 207.88 | 399.00 | 931.00 | 213.94 | 173.23 | 303.15 | 169.77 | 265.97 | 293.14 | 199.34 | 195.43 | 318.00 | 173.23 | 54.71 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Insert needle bone cavity | 36680 | 514.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 48.10 | 82.97 | 48.10 | 53.44 | 1825.00 | 342.80 | 665.00 | 514.20 | 2050.00 | 171.00 | 646.00 | 891.10 | 411.36 | 399.00 | 931.00 | 423.36 | 342.80 | 599.90 | 335.94 | 532.00 | 389.25 | 264.69 | 259.50 | 318.00 | 342.80 | 48.10 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx bone marrow aspirations | 38220 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 78.53 | 112.73 | 78.53 | 87.25 | 950.00 | 1294.11 | 665.00 | 1941.17 | 750.00 | 488.00 | 1843.00 | 806.31 | 1552.93 | 399.00 | 931.00 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 265.97 | 2026.80 | 1378.22 | 1351.20 | 788.00 | 1294.11 | 78.53 | 2264.69 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx bone marrow biopsies | 38221 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 76.17 | 107.20 | 76.17 | 84.63 | 950.00 | 1294.11 | 665.00 | 1941.17 | 750.00 | 580.00 | 2200.00 | 806.31 | 1552.93 | 399.00 | 931.00 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 265.97 | 2026.80 | 1378.22 | 1351.20 | 788.00 | 1294.11 | 76.17 | 2264.69 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Io map of sent lymph node | 38900 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 390.00 | 975.00 | 884.00 | 0.00 | 0.00 | Not Applicable | 910.00 | 0.00 | 0.00 | 0.00 | 0.00 | 520.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of mouth lesion | 40808 | 624.69 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 100.69 | 140.10 | 100.69 | 111.88 | 1825.00 | 416.46 | 665.00 | 624.69 | 2050.00 | 451.00 | 1719.00 | 674.25 | 499.75 | 399.00 | 931.00 | 514.33 | 416.46 | 728.81 | 408.13 | 112.68 | 651.63 | 443.11 | 434.42 | 318.00 | 416.46 | 100.69 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of mouth lesion | 41005 | 288.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 234.98 | 284.77 | 234.98 | 261.09 | 950.00 | 192.00 | 331.10 | 288.00 | 2050.00 | 688.00 | 2597.00 | 357.12 | 230.40 | 854.00 | 696.50 | 237.12 | 192.00 | 336.00 | 188.16 | 265.97 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 188.16 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of mouth lesion | 41015 | 624.69 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 234.98 | 284.77 | 234.98 | 261.09 | 950.00 | 416.46 | 331.10 | 624.69 | 2050.00 | 688.00 | 2597.00 | 357.12 | 499.75 | 854.00 | 696.50 | 514.33 | 416.46 | 728.81 | 408.13 | 265.97 | 651.63 | 443.11 | 434.42 | 318.00 | 416.46 | 234.98 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair tongue laceration | 41251 | 288.00 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 234.98 | 284.77 | 234.98 | 261.09 | 1125.00 | 192.00 | 443.45 | 288.00 | 2050.00 | 688.00 | 2597.00 | 541.26 | 230.40 | 1139.00 | 791.00 | 237.12 | 192.00 | 336.00 | 188.16 | 356.12 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 188.16 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of gum lesion | 41800 | 154.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 143.69 | 82.97 | 143.69 | 159.66 | 950.00 | 102.80 | 331.10 | 154.20 | 2050.00 | 403.00 | 1526.00 | 357.12 | 123.36 | 854.00 | 696.50 | 126.96 | 102.80 | 179.90 | 100.74 | 398.00 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 82.97 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair palate | 42180 | 624.69 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 234.98 | 284.77 | 234.98 | 261.09 | 950.00 | 416.46 | 331.10 | 624.69 | 2050.00 | 688.00 | 2597.00 | 357.12 | 499.75 | 854.00 | 696.50 | 514.33 | 416.46 | 728.81 | 408.13 | 265.97 | 651.63 | 443.11 | 434.42 | 318.00 | 416.46 | 234.98 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Preparation palate mold | 42280 | 624.69 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 69.80 | 97.42 | 69.80 | 77.55 | 1825.00 | 416.46 | 665.00 | 624.69 | 2050.00 | 329.00 | 1254.00 | 891.10 | 499.75 | 399.00 | 931.00 | 514.33 | 416.46 | 728.81 | 408.13 | 532.00 | 651.63 | 443.11 | 434.42 | 318.00 | 416.46 | 69.80 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Control nose/throat bleeding | 42970 | 288.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 41.82 | 65.79 | 41.82 | 46.47 | 1825.00 | 192.00 | 665.00 | 288.00 | 2050.00 | 171.00 | 646.00 | 541.26 | 230.40 | 399.00 | 931.00 | 237.12 | 192.00 | 336.00 | 188.16 | 71.14 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 41.82 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx gastr intub w/asp spec | 43754 | 357.95 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 88.43 | 200.52 | 88.43 | 98.25 | 950.00 | 238.63 | 650.00 | 357.95 | 2050.00 | 171.00 | 646.00 | 871.00 | 286.36 | 390.00 | 910.00 | 294.71 | 238.63 | 417.60 | 233.86 | 520.00 | 380.94 | 259.04 | 253.96 | 318.00 | 238.63 | 88.43 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx gastr intub w/asp specs | 43755 | 195.66 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 117.95 | 118.07 | 117.95 | 131.06 | 950.00 | 130.44 | 650.00 | 195.66 | 2050.00 | 171.00 | 646.00 | 871.00 | 156.53 | 390.00 | 910.00 | 161.09 | 130.44 | 228.27 | 127.83 | 520.00 | 201.02 | 136.70 | 134.02 | 318.00 | 130.44 | 117.95 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx duod intub w/asp spec | 43756 | 1111.47 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 141.00 | 91.63 | 141.00 | 156.67 | 950.00 | 740.98 | 650.00 | 1111.47 | 1100.00 | 171.00 | 646.00 | 871.00 | 889.18 | 390.00 | 910.00 | 915.11 | 740.98 | 1296.72 | 726.16 | 520.00 | 1166.24 | 793.04 | 777.49 | 1200.00 | 740.98 | 91.63 | 1296.72 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx duod intub w/asp specs | 43757 | 1111.47 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 141.00 | 678.28 | 141.00 | 156.67 | 950.00 | 740.98 | 650.00 | 1111.47 | 1100.00 | 171.00 | 646.00 | 871.00 | 889.18 | 390.00 | 910.00 | 915.11 | 740.98 | 1296.72 | 726.16 | 265.97 | 1166.24 | 793.04 | 777.49 | 1200.00 | 740.98 | 141.00 | 1296.72 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reduction of rectal prolapse | 45900 | 1080.30 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 425.57 | 448.13 | 425.57 | 472.86 | 950.00 | 720.20 | 331.10 | 1080.30 | 750.00 | 1417.00 | 5380.00 | 357.12 | 864.24 | 854.00 | 980.00 | 889.45 | 720.20 | 1260.35 | 705.80 | 265.97 | 1143.26 | 777.42 | 762.17 | 788.00 | 720.20 | 265.97 | 5380.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destruction anal lesion(s) | 46900 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 109.18 | 114.78 | 109.18 | 121.31 | 950.00 | 301.24 | 665.00 | 451.86 | 2050.00 | 488.00 | 1843.00 | 541.26 | 361.49 | 399.00 | 931.00 | 372.03 | 301.24 | 527.17 | 295.22 | 117.53 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 109.18 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cryosurgery anal lesion(s) | 46916 | 247.11 | Northwest Hills Surgical Hospital | OP | 1695.00 | 798.00 | 73.28 | 114.78 | 73.28 | 81.42 | 1825.00 | 164.74 | 665.00 | 247.11 | 2050.00 | 215.00 | 812.00 | 891.10 | 197.69 | 399.00 | 931.00 | 203.45 | 164.74 | 288.30 | 161.45 | 61.51 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 61.51 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drain bladder by needle | 51100 | 332.21 | Northwest Hills Surgical Hospital | OP | 1296.00 | 804.00 | 20.28 | 28.35 | 20.28 | 22.53 | 1825.00 | 221.47 | 670.00 | 332.21 | 750.00 | 171.00 | 646.00 | 897.80 | 265.76 | 402.00 | 938.00 | 273.52 | 221.47 | 387.57 | 217.04 | 265.97 | 383.38 | 260.70 | 255.58 | 788.00 | 221.47 | 20.28 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cystometrogram w/vp&up | 51729 | 787.07 | Northwest Hills Surgical Hospital | OP | 1296.00 | 711.00 | 138.42 | 194.18 | 138.42 | 153.80 | 1825.00 | 524.71 | 592.50 | 787.07 | 750.00 | 488.00 | 1843.00 | 357.12 | 629.65 | 355.50 | 829.50 | 648.02 | 524.71 | 918.24 | 514.22 | 160.20 | 827.96 | 563.01 | 551.97 | 788.00 | 524.71 | 138.42 | 1843.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anal/urinary muscle study | 51785 | 332.21 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 189.99 | 188.02 | 189.99 | 211.10 | 950.00 | 221.47 | 331.10 | 332.21 | 2050.00 | 306.00 | 1154.00 | 357.12 | 265.76 | 854.00 | 696.50 | 273.52 | 221.47 | 387.57 | 217.04 | 265.97 | 383.38 | 260.70 | 255.58 | 318.00 | 221.47 | 188.02 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dilate urethra stricture | 53601 | 154.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 28.30 | 82.97 | 28.30 | 31.44 | 950.00 | 102.80 | 665.00 | 154.20 | 2050.00 | 171.00 | 646.00 | 891.10 | 123.36 | 399.00 | 931.00 | 126.96 | 102.80 | 179.90 | 100.74 | 265.97 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 28.30 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dilation of urethra | 53660 | 195.66 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 28.06 | 39.42 | 28.06 | 31.18 | 1825.00 | 130.44 | 665.00 | 195.66 | 2050.00 | 171.00 | 646.00 | 891.10 | 156.53 | 399.00 | 931.00 | 161.09 | 130.44 | 228.27 | 127.83 | 265.97 | 201.02 | 136.70 | 134.02 | 318.00 | 130.44 | 28.06 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment of penis lesion | 54220 | 332.21 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 189.99 | 188.02 | 189.99 | 211.10 | 950.00 | 221.47 | 331.10 | 332.21 | 2050.00 | 598.00 | 2267.00 | 357.12 | 265.76 | 854.00 | 696.50 | 273.52 | 221.47 | 387.57 | 217.04 | 265.97 | 383.38 | 260.70 | 255.58 | 318.00 | 221.47 | 188.02 | 2267.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Penis study | 54240 | 195.66 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 22.64 | 31.60 | 22.64 | 25.15 | 1825.00 | 130.44 | 665.00 | 195.66 | 2050.00 | 171.00 | 646.00 | 891.10 | 156.53 | 399.00 | 931.00 | 161.09 | 130.44 | 228.27 | 127.83 | 532.00 | 380.94 | 259.04 | 253.96 | 318.00 | 130.44 | 22.64 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Penis study | 54250 | 332.21 | Northwest Hills Surgical Hospital | OP | 1296.00 | 840.00 | 6.84 | 9.45 | 6.84 | 7.60 | 1825.00 | 221.47 | 700.00 | 332.21 | 2050.00 | 171.00 | 646.00 | 938.00 | 265.76 | 420.00 | 980.00 | 273.52 | 221.47 | 387.57 | 217.04 | 560.00 | 383.38 | 260.70 | 255.58 | 318.00 | 221.47 | 6.84 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of gland abscess | 56420 | 234.84 | Northwest Hills Surgical Hospital | OP | 1296.00 | 690.00 | 42.44 | 59.30 | 42.44 | 47.16 | 950.00 | 156.56 | 575.00 | 234.84 | 2050.00 | 215.00 | 812.00 | 770.50 | 187.87 | 345.00 | 805.00 | 193.35 | 156.56 | 273.98 | 153.43 | 265.97 | 245.35 | 166.84 | 163.57 | 318.00 | 156.56 | 42.44 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of vulva/perineum | 56605 | 902.93 | Northwest Hills Surgical Hospital | OP | 1296.00 | 909.00 | 25.70 | 35.52 | 25.70 | 28.56 | 950.00 | 601.95 | 757.50 | 902.93 | 2050.00 | 171.00 | 646.00 | 1015.05 | 722.34 | 454.50 | 1060.50 | 743.41 | 601.95 | 1053.41 | 589.91 | 265.97 | 912.43 | 620.45 | 608.29 | 788.00 | 601.95 | 25.70 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of vulva/perineum | 56606 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 171.00 | 646.00 | 666.65 | 0.00 | 298.50 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exam of vulva w/scope | 56820 | 234.84 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 34.19 | 47.25 | 34.19 | 37.99 | 1825.00 | 156.56 | 665.00 | 234.84 | 2050.00 | 215.00 | 812.00 | 357.12 | 187.87 | 399.00 | 931.00 | 193.35 | 156.56 | 273.98 | 153.43 | 265.97 | 245.35 | 166.84 | 163.57 | 318.00 | 156.56 | 34.19 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exam/biopsy of vulva w/scope | 56821 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 828.00 | 43.39 | 60.28 | 43.39 | 48.21 | 950.00 | 255.24 | 690.00 | 382.86 | 2050.00 | 215.00 | 812.00 | 924.60 | 306.29 | 414.00 | 966.00 | 315.22 | 255.24 | 446.67 | 250.14 | 265.97 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 43.39 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ins vag brachytx device | 57156 | 382.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 780.00 | 170.49 | 228.32 | 170.49 | 189.43 | 950.00 | 255.24 | 650.00 | 382.86 | 2050.00 | 634.00 | 2399.00 | 871.00 | 306.29 | 390.00 | 910.00 | 315.22 | 255.24 | 446.67 | 250.14 | 110.76 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 110.76 | 2399.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exam of vagina w/scope | 57420 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 807.00 | 35.14 | 48.55 | 35.14 | 39.04 | 950.00 | 255.24 | 672.50 | 382.86 | 2050.00 | 215.00 | 812.00 | 901.15 | 306.29 | 403.50 | 941.50 | 315.22 | 255.24 | 446.67 | 250.14 | 265.97 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 35.14 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exam of cervix w/scope | 57452 | 234.84 | Northwest Hills Surgical Hospital | OP | 1695.00 | 597.00 | 32.78 | 45.29 | 32.78 | 36.42 | 950.00 | 156.56 | 497.50 | 234.84 | 2050.00 | 171.00 | 646.00 | 357.12 | 187.87 | 298.50 | 696.50 | 193.35 | 156.56 | 273.98 | 153.43 | 265.97 | 245.35 | 166.84 | 163.57 | 318.00 | 156.56 | 32.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Bx/curett of cervix w/scope | 57454 | 382.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 666.00 | 40.56 | 56.04 | 40.56 | 45.07 | 950.00 | 255.24 | 555.00 | 382.86 | 2050.00 | 215.00 | 812.00 | 743.70 | 306.29 | 333.00 | 777.00 | 315.22 | 255.24 | 446.67 | 250.14 | 265.97 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 40.56 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of cervix w/scope | 57455 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 816.00 | 42.21 | 58.98 | 42.21 | 46.90 | 950.00 | 255.24 | 680.00 | 382.86 | 2050.00 | 215.00 | 812.00 | 911.20 | 306.29 | 408.00 | 952.00 | 315.22 | 255.24 | 446.67 | 250.14 | 265.97 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 42.21 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endocerv curettage w/scope | 57456 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 40.80 | 56.37 | 40.80 | 45.33 | 950.00 | 255.24 | 665.00 | 382.86 | 2050.00 | 215.00 | 812.00 | 891.10 | 306.29 | 399.00 | 931.00 | 315.22 | 255.24 | 446.67 | 250.14 | 265.97 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 40.80 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cryocautery of cervix | 57511 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 44.80 | 62.55 | 44.80 | 49.78 | 950.00 | 255.24 | 665.00 | 382.86 | 2050.00 | 215.00 | 812.00 | 891.10 | 306.29 | 399.00 | 931.00 | 315.22 | 255.24 | 446.67 | 250.14 | 265.97 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 44.80 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Insert intrauterine device | 58300 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 44.96 | 50.18 | 44.96 | 49.95 | 1825.00 | 0.00 | 497.50 | 497.50 | 2050.00 | 2114.00 | 10862.00 | 674.25 | 0.00 | 298.50 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Remove intrauterine device | 58301 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 29.71 | 41.05 | 29.71 | 33.01 | 950.00 | 255.24 | 497.50 | 382.86 | 2050.00 | 171.00 | 646.00 | 674.25 | 306.29 | 298.50 | 696.50 | 315.22 | 255.24 | 446.67 | 250.14 | 33.91 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 29.71 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Transfer of embryo | 58974 | 902.93 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 332.24 | 228.32 | 332.24 | 369.16 | 950.00 | 601.95 | 331.10 | 902.93 | 2050.00 | 1122.00 | 4241.00 | 710.20 | 722.34 | 854.00 | 742.00 | 743.41 | 601.95 | 1053.41 | 589.91 | 424.00 | 912.43 | 620.45 | 608.29 | 788.00 | 601.95 | 228.32 | 4241.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Transfer of embryo | 58976 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 170.49 | 228.32 | 170.49 | 189.43 | 950.00 | 255.24 | 331.10 | 382.86 | 2050.00 | 1122.00 | 4241.00 | 666.65 | 306.29 | 854.00 | 696.50 | 315.22 | 255.24 | 446.67 | 250.14 | 398.00 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 170.49 | 4241.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Amniocentesis diagnostic | 59000 | 902.93 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 45.98 | 64.18 | 45.98 | 51.09 | Not Applicable | 601.95 | 665.00 | 902.93 | 750.00 | 329.00 | 1254.00 | 891.10 | 722.34 | 399.00 | 931.00 | 743.41 | 601.95 | 1053.41 | 589.91 | 52.60 | 912.43 | 620.45 | 608.29 | 788.00 | 601.95 | 45.98 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Transabdom amnioinfus w/us | 59070 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 332.24 | 228.32 | 332.24 | 369.16 | 950.00 | 255.24 | 665.00 | 382.86 | 2050.00 | 488.00 | 1843.00 | 891.10 | 306.29 | 399.00 | 931.00 | 315.22 | 255.24 | 446.67 | 250.14 | 532.00 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 228.32 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Umbilical cord occlud w/us | 59072 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 170.49 | 228.32 | 170.49 | 189.43 | 950.00 | 255.24 | 665.00 | 382.86 | 2050.00 | 488.00 | 1843.00 | 891.10 | 306.29 | 399.00 | 931.00 | 315.22 | 255.24 | 446.67 | 250.14 | 532.00 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 170.49 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fetal fluid drainage w/us | 59074 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 170.49 | 228.32 | 170.49 | 189.43 | 950.00 | 255.24 | 665.00 | 382.86 | 2050.00 | 634.00 | 2399.00 | 891.10 | 306.29 | 399.00 | 931.00 | 315.22 | 255.24 | 446.67 | 250.14 | 110.76 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 110.76 | 2399.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fetal shunt placement w/us | 59076 | 382.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 170.49 | 228.32 | 170.49 | 189.43 | 950.00 | 255.24 | 665.00 | 382.86 | 2050.00 | 488.00 | 1843.00 | 891.10 | 306.29 | 399.00 | 931.00 | 315.22 | 255.24 | 446.67 | 250.14 | 532.00 | 405.47 | 275.72 | 270.32 | 318.00 | 255.24 | 170.49 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of thyroid | 60100 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 825.00 | 35.37 | 49.19 | 35.37 | 39.30 | 950.00 | 575.13 | 687.50 | 862.70 | 750.00 | 215.00 | 812.00 | 541.26 | 690.16 | 412.50 | 962.50 | 710.29 | 575.13 | 1006.48 | 563.63 | 40.32 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 35.37 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Aspir/inj thyroid cyst | 60300 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 750.00 | 53.06 | 74.61 | 53.06 | 58.95 | 1825.00 | 575.13 | 625.00 | 862.70 | 750.00 | 215.00 | 812.00 | 837.50 | 690.16 | 375.00 | 875.00 | 710.29 | 575.13 | 1006.48 | 563.63 | 265.97 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 53.06 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dx lmbr spi pnxr | 62270 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 318.59 | 532.50 | 318.59 | 353.99 | 950.00 | 589.31 | 331.10 | 883.97 | 750.00 | 634.00 | 2399.00 | 204.60 | 707.17 | 854.00 | 896.00 | 727.80 | 589.31 | 1031.29 | 577.52 | 265.97 | 914.13 | 621.61 | 609.42 | 788.00 | 589.31 | 204.60 | 2399.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ther spi pnxr drg csf | 62272 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 318.59 | 532.50 | 318.59 | 353.99 | 950.00 | 589.31 | 331.10 | 883.97 | 750.00 | 634.00 | 2399.00 | 357.12 | 707.17 | 854.00 | 959.00 | 727.80 | 589.31 | 1031.29 | 577.52 | 265.97 | 914.13 | 621.61 | 609.42 | 788.00 | 589.31 | 265.97 | 2399.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx px discography lumbar | 62290 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 399.00 | 997.50 | 904.40 | 0.00 | 0.00 | Not Applicable | 931.00 | 0.00 | 0.00 | 0.00 | 0.00 | 532.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx px discography crv/thrc | 62291 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 399.00 | 997.50 | 904.40 | 0.00 | 0.00 | Not Applicable | 931.00 | 0.00 | 0.00 | 0.00 | 0.00 | 532.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Analyze spine infus pump | 62367 | 383.13 | Northwest Hills Surgical Hospital | OP | 1695.00 | 678.00 | 22.32 | 26.14 | 22.32 | 24.80 | 1125.00 | 255.42 | 565.00 | 383.13 | 2050.00 | 171.00 | 646.00 | 757.10 | 306.50 | 339.00 | 791.00 | 315.44 | 255.42 | 446.99 | 250.31 | 452.00 | 392.50 | 266.90 | 261.66 | 318.00 | 255.42 | 22.32 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Analyze sp inf pump w/reprog | 62368 | 383.13 | Northwest Hills Surgical Hospital | OP | 1695.00 | 678.00 | 30.28 | 36.52 | 30.28 | 33.64 | 1125.00 | 255.42 | 565.00 | 383.13 | 2050.00 | 171.00 | 646.00 | 757.10 | 306.50 | 339.00 | 791.00 | 315.44 | 255.42 | 446.99 | 250.31 | 452.00 | 392.50 | 266.90 | 261.66 | 318.00 | 255.42 | 30.28 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd trigeminal nrv | 64400 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 52.82 | 75.27 | 52.82 | 58.69 | Not Applicable | 246.80 | 497.50 | 370.20 | 2050.00 | 215.00 | 812.00 | 357.12 | 296.16 | 298.50 | 696.50 | 304.80 | 246.80 | 431.90 | 241.86 | 61.15 | 376.22 | 255.83 | 250.81 | Not Applicable | 246.80 | 52.82 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
N Block Inj Facial | 64402 | 665.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | Not Applicable | 82.97 | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 215.00 | 812.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 82.97 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd gr ocpl nrv | 64405 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 903.00 | 40.80 | 57.35 | 40.80 | 45.33 | 950.00 | 246.80 | 752.50 | 370.20 | 2050.00 | 215.00 | 812.00 | 491.04 | 296.16 | 451.50 | 1053.50 | 304.80 | 246.80 | 431.90 | 241.86 | 46.19 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 40.80 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
N Block Inj Phrenic | 64410 | 735.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | Not Applicable | 532.50 | Not Applicable | Not Applicable | Not Applicable | 441.00 | 331.10 | 735.00 | 750.00 | 1517.00 | 5741.00 | 984.90 | Not Applicable | 854.00 | 1029.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 588.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 331.10 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd axillary nrv | 64417 | 1148.43 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 318.59 | 532.50 | 318.59 | 353.99 | Not Applicable | 765.62 | 331.10 | 1148.43 | 750.00 | 634.00 | 2399.00 | 357.12 | 918.74 | 854.00 | 696.50 | 945.54 | 765.62 | 1339.84 | 750.31 | 265.97 | 1184.76 | 805.64 | 789.84 | Not Applicable | 765.62 | 265.97 | 2399.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd sprscap nrv | 64418 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 855.00 | 61.31 | 88.30 | 61.31 | 68.12 | Not Applicable | 589.31 | 712.50 | 883.97 | 750.00 | 329.00 | 1254.00 | 491.04 | 707.17 | 427.50 | 997.50 | 727.80 | 589.31 | 1031.29 | 577.52 | 71.02 | 914.13 | 621.61 | 609.42 | Not Applicable | 589.31 | 61.31 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd ntrcost nrv 1 | 64420 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 318.59 | 532.50 | 318.59 | 353.99 | Not Applicable | 589.31 | 331.10 | 883.97 | 750.00 | 634.00 | 2399.00 | 357.12 | 707.17 | 854.00 | 1008.00 | 727.80 | 589.31 | 1031.29 | 577.52 | 265.97 | 914.13 | 621.61 | 609.42 | Not Applicable | 589.31 | 265.97 | 2399.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd ii ih nerves | 64425 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 831.00 | 43.62 | 61.25 | 43.62 | 48.47 | Not Applicable | 589.31 | 692.50 | 883.97 | 750.00 | 215.00 | 812.00 | 674.25 | 707.17 | 415.50 | 969.50 | 727.80 | 589.31 | 1031.29 | 577.52 | 48.60 | 914.13 | 621.61 | 609.42 | Not Applicable | 589.31 | 43.62 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd paracrv nrv | 64435 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 51.17 | 73.64 | 51.17 | 56.86 | Not Applicable | 589.31 | 497.50 | 883.97 | 750.00 | 329.00 | 1254.00 | 674.25 | 707.17 | 298.50 | 696.50 | 727.80 | 589.31 | 1031.29 | 577.52 | 59.28 | 914.13 | 621.61 | 609.42 | Not Applicable | 589.31 | 51.17 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Njx aa&/strd other pn/branch | 64450 | 883.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 741.00 | 34.19 | 47.57 | 34.19 | 37.99 | 950.00 | 589.31 | 617.50 | 883.97 | 750.00 | 215.00 | 812.00 | 892.80 | 707.17 | 370.50 | 864.50 | 727.80 | 589.31 | 1031.29 | 577.52 | 38.72 | 914.13 | 621.61 | 609.42 | 788.00 | 589.31 | 34.19 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inj paravert f jnt c/t 2 lev | 64491 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 451.00 | 1719.00 | 357.12 | 0.00 | 298.50 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inj paravert f jnt c/t 3 lev | 64492 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 451.00 | 1719.00 | 357.12 | 0.00 | 298.50 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inj paravert f jnt l/s 2 lev | 64494 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 451.00 | 1719.00 | 357.12 | 0.00 | 298.50 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inj paravert f jnt l/s 3 lev | 64495 | 497.50 | Northwest Hills Surgical Hospital | OP | 1296.00 | 597.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 497.50 | 497.50 | 2050.00 | 451.00 | 1719.00 | 357.12 | 0.00 | 298.50 | 696.50 | 0.00 | 0.00 | 0.00 | 0.00 | 398.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
N block spenopalatine gangl | 64505 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 732.00 | 34.90 | 48.22 | 34.90 | 38.78 | 950.00 | 246.80 | 610.00 | 370.20 | 2050.00 | 171.00 | 646.00 | 817.40 | 296.16 | 366.00 | 854.00 | 304.80 | 246.80 | 431.90 | 241.86 | 39.53 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 34.90 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
N Block Carotid Sinus S/P | 64508 | 497.50 | Northwest Hills Surgical Hospital | OP | Not Applicable | 597.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 298.50 | 497.50 | 497.50 | 2050.00 | 2114.00 | 10862.00 | 666.65 | Not Applicable | 298.50 | 696.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 398.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 298.50 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Neuroeltrd stim post tibial | 64566 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 64.14 | 95.47 | 64.14 | 71.27 | 950.00 | 246.80 | 650.00 | 370.20 | 2050.00 | 451.00 | 1719.00 | 871.00 | 296.16 | 390.00 | 910.00 | 304.80 | 246.80 | 431.90 | 241.86 | 520.00 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 64.14 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destroy nerve face muscle | 64612 | 370.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 48.34 | 66.79 | 48.34 | 53.71 | 950.00 | 246.80 | 665.00 | 370.20 | 2050.00 | 329.00 | 1254.00 | 891.10 | 296.16 | 399.00 | 931.00 | 304.80 | 246.80 | 431.90 | 241.86 | 265.97 | 376.22 | 255.83 | 250.81 | 318.00 | 246.80 | 48.34 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destroy Nerve Neck Muscle | 64613 | 665.00 | Northwest Hills Surgical Hospital | OP | Not Applicable | 798.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 665.00 | 665.00 | 2050.00 | 2114.00 | 10862.00 | 891.10 | Not Applicable | 399.00 | 931.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 532.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 399.00 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destr Paravertebral N Add-On | 64623 | 735.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 333.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 441.00 | 331.10 | 735.00 | 2050.00 | 2114.00 | 10862.00 | 984.90 | Not Applicable | 854.00 | 1029.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 588.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 331.10 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destr Paravertebral N Add-On | 64627 | 625.00 | Northwest Hills Surgical Hospital | OP | 2549.00 | 333.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 375.00 | 331.10 | 625.00 | 2050.00 | 2114.00 | 10862.00 | 837.50 | Not Applicable | 854.00 | 875.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 500.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 331.10 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destroy c/th facet jnt addl | 64634 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 375.00 | 937.50 | 850.00 | 0.00 | 0.00 | Not Applicable | 875.00 | 0.00 | 0.00 | 0.00 | 0.00 | 500.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Remove skin nerve lesion | 64788 | 2431.56 | Northwest Hills Surgical Hospital | OP | 2069.00 | 510.00 | 1245.50 | 1267.23 | 1245.50 | 1383.89 | 1273.00 | 1621.04 | 507.08 | 2431.56 | 1500.00 | 2324.00 | 8796.00 | 674.25 | 1945.25 | 1301.00 | 1030.30 | 2001.98 | 1621.04 | 2836.82 | 1588.62 | 408.42 | 2527.22 | 1718.51 | 1684.81 | 1919.00 | 1621.04 | 408.42 | 8796.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ophthalmic endoscope add-on | 66990 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 356.70 | 891.75 | 808.52 | 0.00 | 0.00 | Not Applicable | 832.30 | 0.00 | 0.00 | 0.00 | 0.00 | 475.60 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection eye drug | 67028 | 437.85 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 31.60 | 43.66 | 31.60 | 35.11 | 950.00 | 291.90 | 665.00 | 437.85 | 2050.00 | 403.00 | 1526.00 | 891.10 | 350.28 | 399.00 | 931.00 | 360.50 | 291.90 | 510.83 | 286.06 | 265.97 | 447.64 | 304.39 | 298.43 | 318.00 | 291.90 | 31.60 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment of retina | 67141 | 382.53 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 386.63 | 237.54 | 386.63 | 429.59 | 1125.00 | 255.02 | 443.45 | 382.53 | 2050.00 | 1099.00 | 4167.00 | 541.26 | 306.02 | 1139.00 | 948.50 | 314.95 | 255.02 | 446.29 | 249.92 | 356.12 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 237.54 | 4167.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ocular photodynamic ther | 67221 | 716.91 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 103.99 | 144.34 | 103.99 | 115.54 | 950.00 | 477.94 | 665.00 | 716.91 | 750.00 | 600.00 | 2274.00 | 891.10 | 573.53 | 399.00 | 931.00 | 590.26 | 477.94 | 836.40 | 468.38 | 408.42 | 725.82 | 493.55 | 483.88 | 788.00 | 477.94 | 103.99 | 2274.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Eye photodynamic ther add-on | 67225 | 665.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 665.00 | 665.00 | 2050.00 | 171.00 | 646.00 | 891.10 | 0.00 | 399.00 | 931.00 | 0.00 | 0.00 | 0.00 | 0.00 | 532.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tr retinal les preterm inf | 67229 | 716.91 | Northwest Hills Surgical Hospital | OP | 1695.00 | 825.00 | 212.91 | 224.10 | 212.91 | 236.57 | 1825.00 | 477.94 | 687.50 | 716.91 | 750.00 | 952.00 | 3610.00 | 921.25 | 573.53 | 412.50 | 962.50 | 590.26 | 477.94 | 836.40 | 468.38 | 265.97 | 725.82 | 493.55 | 483.88 | 788.00 | 477.94 | 212.91 | 3610.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Destroy nerve of eye muscle | 67345 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 81.59 | 113.06 | 81.59 | 90.65 | 950.00 | 255.02 | 665.00 | 382.53 | 2050.00 | 403.00 | 1526.00 | 541.26 | 306.02 | 399.00 | 931.00 | 314.95 | 255.02 | 446.29 | 249.92 | 92.65 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 81.59 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inject/treat eye socket | 67515 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 759.00 | 29.48 | 40.73 | 29.48 | 32.75 | 950.00 | 255.02 | 632.50 | 382.53 | 2050.00 | 171.00 | 646.00 | 541.26 | 306.02 | 379.50 | 885.50 | 314.95 | 255.02 | 446.29 | 249.92 | 33.38 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 29.48 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of eyelid abscess | 67700 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 126.96 | 132.83 | 126.96 | 141.07 | 950.00 | 255.02 | 665.00 | 382.53 | 2050.00 | 488.00 | 1843.00 | 541.26 | 306.02 | 399.00 | 931.00 | 314.95 | 255.02 | 446.29 | 249.92 | 107.85 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 107.85 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Remove eyelid lesion | 67800 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 852.00 | 48.82 | 67.77 | 48.82 | 54.24 | 950.00 | 255.02 | 710.00 | 382.53 | 2050.00 | 215.00 | 812.00 | 541.26 | 306.02 | 426.00 | 994.00 | 314.95 | 255.02 | 446.29 | 249.92 | 265.97 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 48.82 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy eyelid & lid margin | 67810 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 828.00 | 81.12 | 115.34 | 81.12 | 90.13 | 950.00 | 255.02 | 690.00 | 382.53 | 2050.00 | 488.00 | 1843.00 | 541.26 | 306.02 | 414.00 | 966.00 | 314.95 | 255.02 | 446.29 | 249.92 | 265.97 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 81.12 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Close tear duct opening | 68760 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 723.00 | 88.43 | 123.16 | 88.43 | 98.25 | 1825.00 | 255.02 | 602.50 | 382.53 | 2050.00 | 403.00 | 1526.00 | 541.26 | 306.02 | 361.50 | 843.50 | 314.95 | 255.02 | 446.29 | 249.92 | 356.12 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 88.43 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Close tear duct opening | 68761 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 62.49 | 86.67 | 62.49 | 69.43 | 1825.00 | 255.02 | 665.00 | 382.53 | 2050.00 | 329.00 | 1254.00 | 541.26 | 306.02 | 399.00 | 931.00 | 314.95 | 255.02 | 446.29 | 249.92 | 265.97 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 62.49 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Probe nasolacrimal duct | 68810 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 229.82 | 237.54 | 229.82 | 255.36 | 950.00 | 255.02 | 331.10 | 382.53 | 2050.00 | 600.00 | 2274.00 | 357.12 | 306.02 | 854.00 | 980.00 | 314.95 | 255.02 | 446.29 | 249.92 | 265.97 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 229.82 | 2274.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Explore/irrigate tear ducts | 68840 | 382.53 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 52.35 | 72.65 | 52.35 | 58.17 | 1825.00 | 255.02 | 665.00 | 382.53 | 2050.00 | 215.00 | 812.00 | 541.26 | 306.02 | 399.00 | 931.00 | 314.95 | 255.02 | 446.29 | 249.92 | 265.97 | 376.38 | 255.94 | 250.92 | 318.00 | 255.02 | 52.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drain external ear lesion | 69000 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 852.00 | 79.38 | 116.16 | 79.38 | 88.20 | 1825.00 | 575.13 | 710.00 | 862.70 | 750.00 | 215.00 | 812.00 | 541.26 | 690.16 | 426.00 | 994.00 | 710.29 | 575.13 | 1006.48 | 563.63 | 96.92 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 79.38 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Remove impacted ear wax uni | 69210 | 77.79 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 16.97 | 50.91 | 16.97 | 18.86 | 1825.00 | 51.86 | 665.00 | 77.79 | 2050.00 | 171.00 | 646.00 | 891.10 | 62.23 | 399.00 | 931.00 | 64.05 | 51.86 | 90.76 | 50.82 | 532.00 | 80.18 | 54.52 | 53.45 | 318.00 | 51.86 | 16.97 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incision of eardrum | 69420 | 288.00 | Northwest Hills Surgical Hospital | OP | 2069.00 | 834.00 | 92.91 | 127.72 | 92.91 | 103.23 | 950.00 | 192.00 | 695.00 | 288.00 | 2050.00 | 451.00 | 1719.00 | 541.26 | 230.40 | 417.00 | 973.00 | 237.12 | 192.00 | 336.00 | 188.16 | 265.97 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 92.91 | 2069.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Application of finger splint; dynamic - Cast/Splint Application-Upper Body/Ext | 29131 | 77.79 | Northwest Hills Surgical Hospital | OP | Not Applicable | 603.90 | 19.58 | 50.91 | 19.58 | 21.75 | 1825.00 | 51.86 | 503.25 | 77.79 | 2050.00 | 171.00 | 646.00 | 674.36 | 62.23 | 301.95 | 704.55 | 64.05 | 51.86 | 90.76 | 50.82 | 402.60 | 80.18 | 54.52 | 53.45 | 318.00 | 51.86 | 19.58 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Arterial puncture, withdrawal of blood for diagnosis - Diagnostic Procedures Charges | 36600 | 154.20 | Northwest Hills Surgical Hospital | OP | Not Applicable | 798.00 | 88.43 | 82.97 | 88.43 | 98.25 | 1825.00 | 102.80 | 665.00 | 154.20 | 2050.00 | 2114.00 | 10862.00 | 891.10 | 123.36 | 399.00 | 931.00 | 126.96 | 102.80 | 179.90 | 100.74 | 532.00 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 82.97 | 10862.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Change of gastrostomy tube, percutaneous, without imaging or - GI Tube Placement/Change Charges | 43760 | 497.50 | Northwest Hills Surgical Hospital | OP | Not Applicable | 333.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 298.50 | 331.10 | 497.50 | 2050.00 | 660.00 | 2500.00 | 666.65 | Not Applicable | 854.00 | 696.50 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 398.00 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 298.50 | 2500.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each | 26740 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 840.00 | 86.24 | 120.85 | 86.24 | 95.82 | 1825.00 | 203.31 | 700.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 938.00 | 243.97 | 420.00 | 980.00 | 251.09 | 203.31 | 355.79 | 199.24 | 80.27 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 80.27 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone | 25630 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 86.24 | 87.70 | 86.24 | 95.82 | 1825.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 541.26 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 86.24 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of carpometacarpal fracture dislocation, th - Closed Treatment - Hand/Fingers Charges | 26645 | 1916.84 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 997.77 | 156.11 | 173.46 | 950.00 | 1277.89 | 331.10 | 1916.84 | 2050.00 | 471.00 | 1786.00 | 357.12 | 1533.47 | 854.00 | 899.50 | 1578.19 | 1277.89 | 2236.31 | 1252.33 | 265.97 | 2005.69 | 1363.87 | 1337.13 | 318.00 | 1277.89 | 156.11 | 2236.31 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each | 28515 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 66.97 | 94.49 | 66.97 | 74.41 | 1825.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 541.26 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 66.97 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of greater humeral tuberosity fracture; wit - Closed Treatment - Shoulder Charges | 23620 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 53.78 | 120.85 | 53.78 | 59.76 | 950.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 891.10 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 53.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation | 24565 | 1916.84 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 156.11 | 997.77 | 156.11 | 173.46 | 1125.00 | 1277.89 | 443.45 | 1916.84 | 2050.00 | 471.00 | 1786.00 | 541.26 | 1533.47 | 1139.00 | 892.50 | 1578.19 | 1277.89 | 2236.31 | 1252.33 | 356.12 | 2005.69 | 1363.87 | 1337.13 | 318.00 | 1277.89 | 156.11 | 2236.31 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of humeral shaft fracture; without manipula - Closed Treatment - Upper Extremity Charges | 24500 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 216.13 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 745.50 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of metacarpal fracture, single; with manipu - Closed Treatment - Hand/Fingers Charges | 26605 | 304.97 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 156.11 | 216.13 | 156.11 | 173.46 | 1125.00 | 203.31 | 443.45 | 304.97 | 2050.00 | 471.00 | 1786.00 | 541.26 | 243.97 | 1139.00 | 791.00 | 251.09 | 203.31 | 355.79 | 199.24 | 356.12 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of nasal bone fracture without manipulation - Closed Treatment - Skull/Face Charges | 21310 | 304.97 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 75.71 | 117.65 | 75.71 | 84.12 | 1125.00 | 203.31 | 443.45 | 304.97 | 2050.00 | 688.00 | 2597.00 | 541.26 | 243.97 | 1139.00 | 791.00 | 251.09 | 203.31 | 355.79 | 199.24 | 356.12 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 75.71 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation | 23600 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 86.24 | 87.70 | 86.24 | 95.82 | 950.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 891.10 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 86.24 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of radial head or neck fracture; without ma - Closed Treatment - Upper Extremity Charges | 24650 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 86.24 | 87.70 | 86.24 | 95.82 | 1825.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 891.10 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 86.24 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of radial shaft fracture; without manipulat - Closed Treatment - Upper Extremity Charges | 25500 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 53.78 | 87.70 | 53.78 | 59.76 | 1825.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 891.10 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 53.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation | 25680 | 304.97 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 97.35 | 216.13 | 97.35 | 108.17 | 1125.00 | 203.31 | 443.45 | 304.97 | 2050.00 | 471.00 | 1786.00 | 541.26 | 243.97 | 1139.00 | 791.00 | 251.09 | 203.31 | 355.79 | 199.24 | 356.12 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 97.35 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Closed treatment of ulnar shaft fracture; without manipulati - Closed Treatment - Upper Extremity Charges | 25530 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 53.78 | 87.70 | 53.78 | 59.76 | 1825.00 | 203.31 | 665.00 | 304.97 | 2050.00 | 329.00 | 1254.00 | 891.10 | 243.97 | 399.00 | 931.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 53.78 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Control nasal hemorrhage, anterior, complex (extensive caute - Other Minor Surgery - ENT Charges | 30903 | 154.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 75.71 | 117.65 | 75.71 | 84.12 | 950.00 | 102.80 | 331.10 | 154.20 | 2050.00 | 329.00 | 1254.00 | 357.12 | 123.36 | 854.00 | 696.50 | 126.96 | 102.80 | 179.90 | 100.74 | 265.97 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 75.71 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Control nasal hemorrhage, posterior, with posterior nasal pa - Nasal Hemorrhage Charges | 30906 | 288.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 75.71 | 117.65 | 75.71 | 84.12 | 950.00 | 192.00 | 331.10 | 288.00 | 2050.00 | 329.00 | 1254.00 | 357.12 | 230.40 | 854.00 | 696.50 | 237.12 | 192.00 | 336.00 | 188.16 | 265.97 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 75.71 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Control nasal hemorrhage, posterior, with posterior nasal pa - Other Minor Surgery - ENT Charges | 30905 | 154.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 75.71 | 117.65 | 75.71 | 84.12 | 950.00 | 102.80 | 331.10 | 154.20 | 2050.00 | 329.00 | 1254.00 | 357.12 | 123.36 | 854.00 | 696.50 | 126.96 | 102.80 | 179.90 | 100.74 | 265.97 | 161.27 | 109.66 | 107.51 | 318.00 | 102.80 | 75.71 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debridement of nail(s) by any method(s); 1 to 5 - Debridement Charges | 11720 | 77.79 | Northwest Hills Surgical Hospital | OP | 1296.00 | 912.00 | 13.20 | 82.97 | 13.20 | 14.67 | 1825.00 | 51.86 | 760.00 | 77.79 | 2050.00 | 171.00 | 646.00 | 1018.40 | 62.23 | 456.00 | 1064.00 | 64.05 | 51.86 | 90.76 | 50.82 | 608.00 | 80.18 | 54.52 | 53.45 | 318.00 | 51.86 | 13.20 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof | 11045 | 650.00 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 650.00 | 650.00 | 2050.00 | 471.00 | 1786.00 | 871.00 | 0.00 | 390.00 | 910.00 | 0.00 | 0.00 | 0.00 | 0.00 | 520.00 | 0.00 | 0.00 | 0.00 | 318.00 | Not Applicable | 0.00 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Declotting by thrombolytic agent of implanted vascular acces - Vascular Access Charges | 36593 | 437.85 | Northwest Hills Surgical Hospital | OP | 1296.00 | 603.00 | 20.04 | 28.02 | 20.04 | 22.27 | 1825.00 | 291.90 | 502.50 | 437.85 | 2050.00 | 171.00 | 646.00 | 673.35 | 350.28 | 301.50 | 703.50 | 360.50 | 291.90 | 510.83 | 286.06 | 23.23 | 447.64 | 304.39 | 298.43 | 318.00 | 291.90 | 20.04 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of abscess of palate, uvula - Drainage of Abscess Charges | 42000 | 288.00 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 234.98 | 284.77 | 234.98 | 261.09 | 1125.00 | 192.00 | 443.45 | 288.00 | 2050.00 | 688.00 | 2597.00 | 541.26 | 230.40 | 1139.00 | 791.00 | 237.12 | 192.00 | 336.00 | 188.16 | 356.12 | 304.81 | 207.27 | 203.21 | 318.00 | 192.00 | 188.16 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Drainage of finger abscess; complicated - Drainage of Abscess Charges | 26011 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 760.10 | 857.20 | 760.10 | 844.55 | 950.00 | 1294.11 | 331.10 | 1941.17 | 1100.00 | 1517.00 | 5741.00 | 357.12 | 1552.93 | 854.00 | 1030.84 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 265.97 | 2026.80 | 1378.22 | 1351.20 | 1200.00 | 1294.11 | 265.97 | 5741.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dressings and/or debridement of partial-thickness burns initial or subsequent; medium | 16025 | 247.11 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 132.65 | 205.25 | 132.65 | 147.39 | 1125.00 | 164.74 | 565.00 | 247.11 | 2050.00 | 306.00 | 1154.00 | 541.26 | 197.69 | 1139.00 | 791.00 | 203.45 | 164.74 | 288.30 | 161.45 | 61.51 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 61.51 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastric intubation and aspiration(s) therapeutic, necessitat - Other Minor Procedures - GI Charges | 43753 | 357.95 | Northwest Hills Surgical Hospital | OP | 1296.00 | 780.00 | 88.43 | 200.52 | 88.43 | 98.25 | 950.00 | 238.63 | 650.00 | 357.95 | 2050.00 | 171.00 | 646.00 | 871.00 | 286.36 | 390.00 | 910.00 | 294.71 | 238.63 | 417.60 | 233.86 | 520.00 | 380.94 | 259.04 | 253.96 | 318.00 | 238.63 | 88.43 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incision and drainage of abscess; complicated or multiple - Incision and Drainage Charges | 10061 | 451.86 | Northwest Hills Surgical Hospital | OP | 1296.00 | 702.00 | 71.69 | 101.00 | 71.69 | 79.65 | 950.00 | 301.24 | 585.00 | 451.86 | 2050.00 | 215.00 | 812.00 | 541.26 | 361.49 | 351.00 | 819.00 | 372.03 | 301.24 | 527.17 | 295.22 | 265.97 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 71.69 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incision and drainage of hematoma, seroma or fluid collectio - Incision and Drainage Charges | 10140 | 1941.17 | Northwest Hills Surgical Hospital | OP | 1296.00 | 883.58 | 66.02 | 92.86 | 66.02 | 73.36 | 1825.00 | 1294.11 | 736.32 | 1941.17 | 1100.00 | 329.00 | 1254.00 | 806.31 | 1552.93 | 441.79 | 1030.84 | 1598.23 | 1294.11 | 2264.69 | 1268.23 | 265.97 | 2026.80 | 1378.22 | 1351.20 | 1200.00 | 1294.11 | 66.02 | 2264.69 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Incision and drainage of pilonidal cyst; simple - Incision and Drainage Charges | 10080 | 862.70 | Northwest Hills Surgical Hospital | OP | 1296.00 | 717.00 | 79.38 | 116.16 | 79.38 | 88.20 | 1825.00 | 575.13 | 597.50 | 862.70 | 750.00 | 215.00 | 812.00 | 541.26 | 690.16 | 358.50 | 836.50 | 710.29 | 575.13 | 1006.48 | 563.63 | 98.26 | 895.95 | 609.25 | 597.30 | 788.00 | 575.13 | 79.38 | 1825.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial treatment, first degree burn, when no more than loca - Burns Charges | 16000 | 247.11 | Northwest Hills Surgical Hospital | OP | Not Applicable | 912.00 | 22.40 | 107.23 | 22.40 | 24.89 | 1825.00 | 164.74 | 760.00 | 247.11 | 2050.00 | 171.00 | 646.00 | 1018.40 | 197.69 | 456.00 | 1064.00 | 203.45 | 164.74 | 288.30 | 161.45 | 608.00 | 258.64 | 175.88 | 172.43 | 318.00 | 164.74 | 22.40 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inject for sacroiliac joint | G0259 | Please Contact for Details | Northwest Hills Surgical Hospital | OP | 1296.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | Not Applicable | 0.00 | 0.00 | 0.00 | 399.00 | 997.50 | 904.40 | 0.00 | 0.00 | Not Applicable | 931.00 | 0.00 | 0.00 | 0.00 | 0.00 | 532.00 | 0.00 | 0.00 | 0.00 | 318.00 | 0.00 | 0.00 | 1296.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Naso- or oro-gastric tube placement, requiring physician's s - GI Tube Placement/Change Charges | 43752 | 514.20 | Northwest Hills Surgical Hospital | OP | 1695.00 | 798.00 | 136.11 | 174.69 | 136.11 | 151.23 | 1825.00 | 342.80 | 665.00 | 514.20 | 2050.00 | 215.00 | 812.00 | 891.10 | 411.36 | 399.00 | 931.00 | 423.36 | 342.80 | 599.90 | 335.94 | 105.89 | 389.25 | 264.69 | 259.50 | 318.00 | 342.80 | 105.89 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal of foreign body from pharynx - Foreign Body Removal - Throat Charges | 42809 | 514.20 | Northwest Hills Surgical Hospital | OP | 1296.00 | 798.00 | 88.43 | 82.97 | 88.43 | 98.25 | 950.00 | 342.80 | 665.00 | 514.20 | 2050.00 | 171.00 | 646.00 | 891.10 | 411.36 | 399.00 | 931.00 | 423.36 | 342.80 | 599.90 | 335.94 | 532.00 | 389.25 | 264.69 | 259.50 | 318.00 | 342.80 | 82.97 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair of laceration 2.5 cm or less; floor of mouth and/or a - Laceration Repair - Mouth/Lip Charges | 41250 | 154.20 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 75.71 | 82.97 | 75.71 | 84.12 | 1125.00 | 102.80 | 443.45 | 154.20 | 2050.00 | 688.00 | 2597.00 | 541.26 | 123.36 | 1139.00 | 791.00 | 126.96 | 102.80 | 179.90 | 100.74 | 452.00 | 389.25 | 264.69 | 259.50 | 318.00 | 102.80 | 75.71 | 2597.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm | 12034 | 451.86 | Northwest Hills Surgical Hospital | OP | 1695.00 | 446.00 | 179.13 | 205.25 | 179.13 | 199.03 | 1125.00 | 301.24 | 443.45 | 451.86 | 2050.00 | 417.00 | 1577.00 | 541.26 | 361.49 | 1139.00 | 822.50 | 372.03 | 301.24 | 527.17 | 295.22 | 356.12 | 498.19 | 338.77 | 332.12 | 318.00 | 301.24 | 179.13 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment of closed elbow dislocation; without anesthesia - Closed Treatment - Upper Extremity Charges | 24600 | 304.97 | Northwest Hills Surgical Hospital | OP | 1296.00 | 333.00 | 156.11 | 156.82 | 156.11 | 173.46 | 950.00 | 203.31 | 331.10 | 304.97 | 2050.00 | 471.00 | 1786.00 | 357.12 | 243.97 | 854.00 | 700.00 | 251.09 | 203.31 | 355.79 | 199.24 | 265.97 | 297.02 | 201.97 | 198.01 | 318.00 | 203.31 | 156.11 | 2050.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic Removal of Gallbladder | 47562 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection of substance into spinal canal of lower back or sacrum using imaging guidance | 62323 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of prostate gland | 55700 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) | 743 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal of tonsils and adenoid glands patient younger than age 12 | 42820 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patient office consultation, typically 40 min | 99243 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patient office consultation, typically 60 min | 99244 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial new patient preventive medicine evaluation (18-39 years) | 99385 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial new patient preventive medicine evaluation (40-64 years) | 99386 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT scan, head or brain, without contrast | 70450 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI scan of brain before and after contrast | 70553 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI scan of lower spinal canal | 72148 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT scan, pelvis, with contrast | 72193 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI scan of leg joint | 73721 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT scan of abdomen and pelvis with contrast | 74177 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound of abdomen | 76700 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus | 76805 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound pelvis through vagina | 76830 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mammography of one breast | 77065 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mammography of both breasts | 77066 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mammography, screening, bilateral | 77067 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, lipids (cholesterol and triglycerides) | 80061 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Manual urinalysis test with examination using microscope | 81001 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Automated urinalysis test | 81003 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
PSA (prostate specific antigen) | 84154 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Insertion of catheter into left heart for diagnosis | 93452 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sleep Study | 95810 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
New patient office or other outpatient visit, typically 30 min | 99203 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
New patient office of other outpatient visit, typically 45 min | 99204 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
New patient office of other outpatient visit, typically 60 min | 99205 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities | 216 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care | 59610 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Obstetric blood test panel | 80055 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Psychotherapy, 30 min | 90832 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Psychotherapy, 45 min | 90834 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Psychotherapy, 60 min | 90837 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Family psychotherapy, not including patient, 50 min | 90846 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Family psychotherapy, including patient, 50 min | 90847 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Group psychotherapy | 90853 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair of groin hernia patient age 5 years or older | 49505 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgical removal of prostate and surrounding lymph nodes using an endoscope | 55866 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal of recurring cataract in lens capsule using laser | 66821 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound examination of lower large bowel using an endoscope | 45391 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Routine obstetric care for vaginal delivery, including pre-and post- delivery care | 59400 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Routine obstetric care for cesarean delivery, including pre-and post-delivery care | 59510 | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided | Service Not Provided |
The following pricing is subject to change at any time. Pricing listed may not reflect the total amount due on a claim, nor does it reflect your financial responsibility as a patient. Pricing and services below reflect a typical encounter; however, your physician may render a different variation of services to provide you the best level of care. The amount you pay may be less than what is reflected here.
The inclusion of pricing below does not indicate that a service is covered under your benefit plan. Likewise, the exclusion of a service below or pricing at $0 does not indicate that a service is not covered by your health plan, not offered by our facility, nor that the service may come at no cost to you.
"Included in primary procedure" indicates that, typically, the specified service is not separately priced; rather, it is considered packaged with the primary procedure. However, any variation in services provided – including whether individual services below are provided along with other services, rather than independently – can cause variation in pricing, due to payor policies.
Texas Medicaid utilizes a unique payment methodology for inpatient services that does not align with the coding reflected here; however, a median pricing estimate is shown in the grid. Your plan's rate may be more or less, depending upon the care you receive.
Workers' Compensation rates reflected below are based on claims filed in Texas. Rates may vary depending on the state in which the injury claim is filed.
Reimbursement by health plans can vary based on many factors including but not limited to benefit structures, diagnosis and case by case circumstances. Patients should always consult with their health plans and physician(s) to validate treatment and cost planning decisions.
Physician and other professional charges are not reflected here, as our facility does not negotiate such fees. These services may be separately billable by the physician/professional provider.
Please contact Richard Peters, Chief Operating Officer (512-346-1994, richard.peters@scasurgery.com) with any questions or for patient price estimates.