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Shoppable Service | Primary Service and Ancillary Services | Revenue Code | CPT/HCPCS Code | Cash Price | Service Location | Site Type | Aetna: Commercial | Aetna: Medicare Advantage | BCBSAL: Commercial | BCBSAL: Medicare Advantage | United Healthcare: Commercial | United Healthcare: Medicare Advantage | Viva Health: Commercial | Viva Health: Medicare Advantage | ChoiceCare: Medicare Advantage | Department of Labor: Workers Compensation | De-identified Minimum Negotiated Charge | De-identified Maximum Negotiated Charge | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Removal of Breast Growth | Primary Procedure | 360 | 19120 | 1129.92 | Russell Medical Center | OP | 1455.20 | 2673.64 | 821.03 | 2620.17 | 4853.33 | 2673.64 | 684.80 | 2673.64 | 2673.64 | 1609.28 | 399.59 | 4853.33 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 281.56 | Russell Medical Center | OP | 362.61 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 170.64 | Included in Primary Procedure | Included in Primary Procedure | 401.00 | 170.64 | 401.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 1160.18 | Russell Medical Center | OP | 1494.17 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 703.14 | Included in Primary Procedure | Included in Primary Procedure | 1652.38 | 703.14 | 1652.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 140.88 | Russell Medical Center | OP | 181.43 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 85.38 | Included in Primary Procedure | Included in Primary Procedure | 200.64 | 85.38 | 200.64 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 36415 | 5.28 | Russell Medical Center | OP | 6.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3.20 | Included in Primary Procedure | Included in Primary Procedure | 7.52 | 1.05 | 7.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 80048 | 33.00 | Russell Medical Center | OP | 42.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 20.00 | Included in Primary Procedure | Included in Primary Procedure | 47.00 | 20.00 | 47.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 85025 | 52.97 | Russell Medical Center | OP | 68.21 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 32.10 | Included in Primary Procedure | Included in Primary Procedure | 75.44 | 2.72 | 75.44 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | C9803 | 38.28 | Russell Medical Center | OP | 49.30 | Included in Primary Procedure | 40.33 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 23.20 | Included in Primary Procedure | Included in Primary Procedure | 54.52 | 23.20 | 54.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | U0003 | 85.80 | Russell Medical Center | OP | 110.50 | Included in Primary Procedure | 169.26 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 52.00 | Included in Primary Procedure | Included in Primary Procedure | 122.20 | 52.00 | 169.26 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88304 | 72.27 | Russell Medical Center | OP | 93.08 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 43.80 | Included in Primary Procedure | Included in Primary Procedure | 102.93 | 43.80 | 102.93 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 27059 | 331.98 | Russell Medical Center | OP | 427.55 | Included in Primary Procedure | 3650.09 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 201.20 | Included in Primary Procedure | Included in Primary Procedure | 472.82 | 201.20 | 3650.09 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0690 | 16.50 | Russell Medical Center | OP | 21.25 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 10.00 | Included in Primary Procedure | Included in Primary Procedure | 23.50 | 10.00 | 23.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 39.93 | Russell Medical Center | OP | 51.43 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.20 | Included in Primary Procedure | Included in Primary Procedure | 56.87 | 0.09 | 56.87 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1100 | 12.87 | Russell Medical Center | OP | 16.58 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7.80 | Included in Primary Procedure | Included in Primary Procedure | 18.33 | 0.12 | 18.33 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 377.52 | Russell Medical Center | OP | 486.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 228.80 | Included in Primary Procedure | Included in Primary Procedure | 537.68 | 228.80 | 537.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EKG | 730 | 93005 | 80.52 | Russell Medical Center | OP | 103.70 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 48.80 | Included in Primary Procedure | Included in Primary Procedure | 114.68 | 48.80 | 114.68 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic Removal of Single Knee Cartilage | Primary Procedure | 29881 | 1461.90 | Russell Medical Center | OP | 1882.75 | 2415.85 | 2932.10 | 2367.54 | 4385.39 | 2415.85 | 886.00 | 2415.85 | 2415.85 | 2082.10 | 886.00 | 4385.39 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 360.59 | Russell Medical Center | OP | 464.40 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 218.54 | Included in Primary Procedure | Included in Primary Procedure | 513.57 | 218.54 | 513.57 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 2448.73 | Russell Medical Center | OP | 3153.67 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1484.08 | Included in Primary Procedure | Included in Primary Procedure | 3487.59 | 1484.08 | 3487.59 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 143.88 | Russell Medical Center | OP | 185.30 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 87.20 | Included in Primary Procedure | Included in Primary Procedure | 204.92 | 87.20 | 204.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88304 | 36.14 | Russell Medical Center | OP | 46.54 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 21.90 | Included in Primary Procedure | Included in Primary Procedure | 51.47 | 21.90 | 51.47 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therp | 420 | 97116 | 47.52 | Russell Medical Center | OP | 61.20 | Included in Primary Procedure | 286.49 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 28.80 | Included in Primary Procedure | Included in Primary Procedure | 67.68 | 28.80 | 286.49 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2250 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2175 | 22.44 | Russell Medical Center | OP | 28.90 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 13.60 | Included in Primary Procedure | Included in Primary Procedure | 31.96 | 4.72 | 31.96 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 79.86 | Russell Medical Center | OP | 102.85 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 48.40 | Included in Primary Procedure | Included in Primary Procedure | 113.74 | 0.09 | 113.74 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1100 | 12.87 | Russell Medical Center | OP | 16.58 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7.80 | Included in Primary Procedure | Included in Primary Procedure | 18.33 | 0.12 | 18.33 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0690 | 16.50 | Russell Medical Center | OP | 21.25 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 10.00 | Included in Primary Procedure | Included in Primary Procedure | 23.50 | 10.00 | 23.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0702 | 63.36 | Russell Medical Center | OP | 81.60 | Included in Primary Procedure | 0.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 38.40 | Included in Primary Procedure | Included in Primary Procedure | 90.24 | 0.00 | 90.24 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 425.04 | Russell Medical Center | OP | 547.40 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 257.60 | Included in Primary Procedure | Included in Primary Procedure | 605.36 | 257.60 | 605.36 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic diagnostic examination of esophagus, stomach, and/or upper small bowel | Primary Procedure | 360 | 43235 | 925.32 | Russell Medical Center | OP | 1191.70 | 693.59 | 1195.90 | 679.72 | 1259.04 | 693.59 | 560.80 | 693.59 | 693.59 | 1317.88 | 120.24 | 1317.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 28.71 | Russell Medical Center | OP | 36.98 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 17.40 | Included in Primary Procedure | Included in Primary Procedure | 40.89 | 17.40 | 40.89 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 255.02 | Russell Medical Center | OP | 328.44 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 154.56 | Included in Primary Procedure | Included in Primary Procedure | 363.22 | 154.56 | 363.22 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 55.01 | Russell Medical Center | OP | 70.85 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 33.34 | Included in Primary Procedure | Included in Primary Procedure | 78.35 | 33.34 | 78.35 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | C9803 | 38.28 | Russell Medical Center | OP | 49.30 | Included in Primary Procedure | 40.33 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 23.20 | Included in Primary Procedure | Included in Primary Procedure | 54.52 | 23.20 | 54.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | U0003 | 85.80 | Russell Medical Center | OP | 110.50 | 100.00 | 169.26 | 98.00 | 90.00 | 100.00 | 52.00 | 100.00 | 100.00 | 122.20 | 52.00 | 169.26 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 23.76 | Russell Medical Center | OP | 30.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.40 | Included in Primary Procedure | Included in Primary Procedure | 33.84 | 14.40 | 33.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic biopsy of the esophagus, stomach, and/or upper small bowel | Primary Procedure | 360 | 43239 | 279.84 | Russell Medical Center | OP | 360.40 | 693.59 | 597.95 | 679.72 | 1259.04 | 693.59 | 169.60 | 693.59 | 693.59 | 398.56 | 135.75 | 1259.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 57.42 | Russell Medical Center | OP | 73.95 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 34.80 | Included in Primary Procedure | Included in Primary Procedure | 81.78 | 34.80 | 81.78 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 247.73 | Russell Medical Center | OP | 319.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 150.14 | Included in Primary Procedure | Included in Primary Procedure | 352.83 | 150.14 | 352.83 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | C1773 | 131.90 | Russell Medical Center | OP | 169.87 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 79.94 | Included in Primary Procedure | Included in Primary Procedure | 187.86 | 79.94 | 187.86 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88305 | 84.48 | Russell Medical Center | OP | 108.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 51.20 | Included in Primary Procedure | Included in Primary Procedure | 120.32 | 51.20 | 120.32 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0290 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 637 | A9270 | 5.28 | Russell Medical Center | OP | 6.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3.20 | Included in Primary Procedure | Included in Primary Procedure | 7.52 | 3.20 | 7.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 23.76 | Russell Medical Center | OP | 30.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.40 | Included in Primary Procedure | Included in Primary Procedure | 33.84 | 14.40 | 33.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastrointestinal Services | 750 | 45385 | 1015.74 | Russell Medical Center | OP | 1308.15 | 443.12 | 615.26 | 434.26 | 804.38 | 443.12 | 615.60 | 443.12 | 443.12 | 1446.66 | 250.71 | 1446.66 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic diagnostic examination of large bowel | Primary Procedure | 750 | 45378 | 677.38 | Russell Medical Center | OP | 872.38 | 674.14 | 499.51 | 660.66 | 1223.73 | 674.14 | 410.53 | 674.14 | 674.14 | 964.75 | 182.01 | 1223.73 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 77.55 | Russell Medical Center | OP | 99.88 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 47.00 | Included in Primary Procedure | Included in Primary Procedure | 110.45 | 47.00 | 110.45 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 296.21 | Russell Medical Center | OP | 381.48 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 179.52 | Included in Primary Procedure | Included in Primary Procedure | 421.87 | 179.52 | 421.87 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 140.38 | Russell Medical Center | OP | 180.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 85.08 | Included in Primary Procedure | Included in Primary Procedure | 199.94 | 85.08 | 199.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 82607 | 40.10 | Russell Medical Center | OP | 51.64 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.30 | Included in Primary Procedure | Included in Primary Procedure | 57.11 | 24.30 | 57.11 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 82728 | 47.85 | Russell Medical Center | OP | 61.63 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 29.00 | Included in Primary Procedure | Included in Primary Procedure | 68.15 | 29.00 | 68.15 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 82746 | 31.52 | Russell Medical Center | OP | 40.59 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 19.10 | Included in Primary Procedure | Included in Primary Procedure | 44.89 | 19.10 | 44.89 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 83540 | 16.83 | Russell Medical Center | OP | 21.68 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 10.20 | Included in Primary Procedure | Included in Primary Procedure | 23.97 | 10.20 | 23.97 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 84466 | 35.15 | Russell Medical Center | OP | 45.26 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 21.30 | Included in Primary Procedure | Included in Primary Procedure | 50.06 | 21.30 | 50.06 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 85025 | 52.97 | Russell Medical Center | OP | 68.21 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 32.10 | Included in Primary Procedure | Included in Primary Procedure | 75.44 | 2.72 | 75.44 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 23.76 | Russell Medical Center | OP | 30.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.40 | Included in Primary Procedure | Included in Primary Procedure | 33.84 | 14.40 | 33.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastrointestinal Services | 750 | 43249 | 677.38 | Russell Medical Center | OP | 872.38 | Included in Primary Procedure | 597.95 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 410.53 | Included in Primary Procedure | Included in Primary Procedure | 964.75 | 150.47 | 964.75 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastrointestinal Services | 750 | 43239 | 677.38 | Russell Medical Center | OP | 872.39 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 410.54 | Included in Primary Procedure | Included in Primary Procedure | 964.76 | 135.75 | 964.76 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic biopsy of Large Bowel | Primary Procedure | 360 | 45380 | 1295.58 | Russell Medical Center | OP | 1668.55 | 886.24 | 999.02 | 868.52 | 1608.75 | 886.24 | 785.20 | 886.24 | 886.24 | 1845.22 | 197.33 | 1845.22 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 33.99 | Russell Medical Center | OP | 43.78 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 20.60 | Included in Primary Procedure | Included in Primary Procedure | 48.41 | 20.60 | 48.41 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 1181.83 | Russell Medical Center | OP | 1522.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 716.26 | Included in Primary Procedure | Included in Primary Procedure | 1683.21 | 716.26 | 1683.21 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 131.90 | Russell Medical Center | OP | 169.87 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 79.94 | Included in Primary Procedure | Included in Primary Procedure | 187.86 | 79.94 | 187.86 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88305 | 84.48 | Russell Medical Center | OP | 108.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 51.20 | Included in Primary Procedure | Included in Primary Procedure | 120.32 | 51.20 | 120.32 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 23.76 | Russell Medical Center | OP | 30.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.40 | Included in Primary Procedure | Included in Primary Procedure | 33.84 | 14.40 | 33.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic removal of polyps or growths of large bowel | Primary Procedure | 750 | 45385 | 1015.74 | Russell Medical Center | OP | 1308.15 | 886.24 | 615.26 | 868.52 | 1608.75 | 886.24 | 615.60 | 886.24 | 886.24 | 1446.66 | 250.71 | 1608.75 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 57.42 | Russell Medical Center | OP | 73.95 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 34.80 | Included in Primary Procedure | Included in Primary Procedure | 81.78 | 34.80 | 81.78 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 247.73 | Russell Medical Center | OP | 319.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 150.14 | Included in Primary Procedure | Included in Primary Procedure | 352.83 | 150.14 | 352.83 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | C1773 | 131.90 | Russell Medical Center | OP | 169.87 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 79.94 | Included in Primary Procedure | Included in Primary Procedure | 187.86 | 79.94 | 187.86 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88305 | 84.48 | Russell Medical Center | OP | 108.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 51.20 | Included in Primary Procedure | Included in Primary Procedure | 120.32 | 51.20 | 120.32 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0290 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 637 | A9270 | 5.28 | Russell Medical Center | OP | 6.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3.20 | Included in Primary Procedure | Included in Primary Procedure | 7.52 | 3.20 | 7.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 23.76 | Russell Medical Center | OP | 30.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.40 | Included in Primary Procedure | Included in Primary Procedure | 33.84 | 14.40 | 33.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastrointestinal Services | 750 | 43239 | 279.84 | Russell Medical Center | OP | 360.40 | 346.80 | 597.95 | 339.86 | 629.52 | 346.80 | 169.60 | 346.80 | 346.80 | 398.56 | 135.75 | 629.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Endoscopic Removal of Gallbladder | Primary Procedure | 360 | 47562 | 2453.88 | Russell Medical Center | OP | 3160.30 | 4265.85 | 5376.54 | 4180.53 | 7743.58 | 4265.85 | 1487.20 | 4265.85 | 4265.85 | 3494.92 | 540.21 | 7743.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 479.82 | Russell Medical Center | OP | 617.95 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 290.80 | Included in Primary Procedure | Included in Primary Procedure | 683.38 | 290.80 | 683.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 546.84 | Russell Medical Center | OP | 704.27 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 331.42 | Included in Primary Procedure | Included in Primary Procedure | 778.84 | 331.42 | 778.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 2666.00 | Russell Medical Center | OP | 3433.49 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1615.76 | Included in Primary Procedure | Included in Primary Procedure | 3797.04 | 1615.76 | 3797.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88304 | 36.14 | Russell Medical Center | OP | 46.54 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 21.90 | Included in Primary Procedure | Included in Primary Procedure | 51.47 | 21.90 | 51.47 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | 109.07 | Russell Medical Center | OP | 140.46 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 66.10 | Included in Primary Procedure | Included in Primary Procedure | 155.34 | 66.10 | 155.34 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1885 | 39.93 | Russell Medical Center | OP | 51.43 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.20 | Included in Primary Procedure | Included in Primary Procedure | 56.87 | 24.20 | 56.87 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0330 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 39.93 | Russell Medical Center | OP | 51.43 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.20 | Included in Primary Procedure | Included in Primary Procedure | 56.87 | 0.09 | 56.87 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1100 | 12.87 | Russell Medical Center | OP | 16.58 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7.80 | Included in Primary Procedure | Included in Primary Procedure | 18.33 | 0.12 | 18.33 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 637 | A9270 | 2.15 | Russell Medical Center | OP | 2.76 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1.30 | Included in Primary Procedure | Included in Primary Procedure | 3.06 | 1.30 | 3.06 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 637 | A9270 | 106.92 | Russell Medical Center | OP | 137.70 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 64.80 | Included in Primary Procedure | Included in Primary Procedure | 152.28 | 64.80 | 152.28 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 646.80 | Russell Medical Center | OP | 833.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 392.00 | Included in Primary Procedure | Included in Primary Procedure | 921.20 | 392.00 | 921.20 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injection of substance into spinal canal of lower back or sacrum using imaging guidance | Primary Procedure | 62323 | 778.80 | Russell Medical Center | OP | 1003.00 | Included in Primary Procedure | 1146.83 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 472.00 | Included in Primary Procedure | Included in Primary Procedure | 1109.20 | 472.00 | 1146.83 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy of prostate gland | Primary Procedure | 55700 | 1129.92 | Russell Medical Center | OP | 1455.20 | 1563.43 | 1792.83 | 1532.16 | 2838.01 | 1563.43 | 684.80 | 1563.43 | 1563.43 | 1609.28 | 129.13 | 2838.01 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 225.06 | Russell Medical Center | OP | 289.85 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 136.40 | Included in Primary Procedure | Included in Primary Procedure | 320.54 | 136.40 | 320.54 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 311.52 | Russell Medical Center | OP | 401.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 188.80 | Included in Primary Procedure | Included in Primary Procedure | 443.68 | 188.80 | 443.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 97.65 | Russell Medical Center | OP | 125.76 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 59.18 | Included in Primary Procedure | Included in Primary Procedure | 139.07 | 59.18 | 139.07 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | U0003 | 85.80 | Russell Medical Center | OP | 110.50 | Included in Primary Procedure | 169.26 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 52.00 | Included in Primary Procedure | Included in Primary Procedure | 122.20 | 52.00 | 169.26 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
C9803 | 38.28 | OP | 49.30 | Included in Primary Procedure | 40.33 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 23.20 | Included in Primary Procedure | Included in Primary Procedure | 54.52 | 23.20 | 54.52 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
80048 | 33.00 | OP | 42.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 20.00 | Included in Primary Procedure | Included in Primary Procedure | 47.00 | 20.00 | 47.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
36415 | 5.28 | OP | 6.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3.20 | Included in Primary Procedure | Included in Primary Procedure | 7.52 | 1.05 | 7.52 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88305 | 1182.72 | Russell Medical Center | OP | 1523.20 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 716.80 | Included in Primary Procedure | Included in Primary Procedure | 1684.48 | 716.80 | 1684.48 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound | 402 | 76942 XU | 251.46 | Russell Medical Center | OP | 323.85 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 152.40 | Included in Primary Procedure | Included in Primary Procedure | 358.14 | 152.40 | 358.14 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
76872 | 197.51 | OP | 254.36 | Included in Primary Procedure | 218.71 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 119.70 | Included in Primary Procedure | Included in Primary Procedure | 281.30 | 97.17 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1580 | 23.76 | Russell Medical Center | OP | 30.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.40 | Included in Primary Procedure | Included in Primary Procedure | 33.84 | 1.51 | 33.84 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 39.93 | Russell Medical Center | OP | 51.43 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.20 | Included in Primary Procedure | Included in Primary Procedure | 56.87 | 0.09 | 56.87 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1100 | 12.87 | Russell Medical Center | OP | 16.58 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7.80 | Included in Primary Procedure | Included in Primary Procedure | 18.33 | 0.12 | 18.33 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | A9270 GY | 2.15 | Russell Medical Center | OP | 2.76 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1.30 | Included in Primary Procedure | Included in Primary Procedure | 3.06 | 1.30 | 3.06 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 353.76 | Russell Medical Center | OP | 455.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 214.40 | Included in Primary Procedure | Included in Primary Procedure | 503.84 | 214.40 | 503.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EKG | 730 | 93005 | 80.52 | Russell Medical Center | OP | 103.70 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 48.80 | Included in Primary Procedure | Included in Primary Procedure | 114.68 | 48.80 | 114.68 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Spinal fusion except cervical without major comorbid conditions or complications (MCC) | MS-DRG | 460 | 0.00 | Russell Medical Center | IP | 0.00 | 21747.31 | $3,519 per diem | 21312.36 | 34322.49 | 21747.31 | $2,300 per diem | 21747.31 | 21747.31 | $3,650 per diem | 0.00 | 34322.49 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Room & Board | 120 | 462.00 | Russell Medical Center | IP | 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 | 595.00 | 595.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 1020.76 | Russell Medical Center | IP | 1314.61 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1314.61 | 1314.61 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 5750.45 | Russell Medical Center | IP | 7405.88 | 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 | 7405.88 | 7405.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 1588.36 | Russell Medical Center | IP | 2045.61 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 2045.61 | 2045.61 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Implants | 278 | 338.58 | Russell Medical Center | IP | 436.05 | 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 | 436.05 | 436.05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 351.29 | Russell Medical Center | IP | 452.41 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 452.41 | 452.41 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Radiology | 320 | 127.84 | Russell Medical Center | IP | 164.65 | 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 | 164.65 | 164.65 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 2457.84 | Russell Medical Center | IP | 3165.40 | 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 | 3165.40 | 3165.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy | 420 | 120.12 | Russell Medical Center | IP | 154.70 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 154.70 | 154.70 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy | 424 | 130.68 | Russell Medical Center | IP | 168.30 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 168.30 | 168.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 425.04 | Russell Medical Center | IP | 547.40 | 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 | 547.40 | 547.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EKG | 730 | 80.52 | Russell Medical Center | IP | 103.70 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 103.70 | 103.70 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). | MS-DRG | 470 | 0.00 | Russell Medical Center | IP | 0.00 | 10808.86 | $3,519 per diem | 10592.68 | 17058.98 | 10808.86 | $2,300 per diem | 10808.86 | 10808.86 | $3,650 per diem | 0.00 | 17058.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Room & Board | 120 | 1386.00 | Russell Medical Center | IP | 1785.00 | 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 | 1785.00 | 1785.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 1173.38 | Russell Medical Center | IP | 1511.17 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1511.17 | 1511.17 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 2567.04 | Russell Medical Center | IP | 3306.03 | 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 | 3306.03 | 3306.03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 335.18 | Russell Medical Center | IP | 431.67 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 431.67 | 431.67 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Implants | 278 | 5240.40 | Russell Medical Center | IP | 6749.00 | 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 | 6749.00 | 6749.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 458.21 | Russell Medical Center | IP | 590.11 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 590.11 | 590.11 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 42.08 | Russell Medical Center | IP | 54.19 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 54.19 | 54.19 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Radiology | 320 | 263.67 | Russell Medical Center | IP | 339.58 | 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 | 339.58 | 339.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 2125.86 | Russell Medical Center | IP | 2737.85 | 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 | 2737.85 | 2737.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Anesthesia | 370 | 109.07 | Russell Medical Center | IP | 140.46 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 140.46 | 140.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood Admin | 390 | 29.04 | Russell Medical Center | IP | 37.40 | 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 | 37.40 | 37.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy | 420 | 425.70 | Russell Medical Center | IP | 548.25 | 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 | 548.25 | 548.25 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical Therapy | 424 | 188.76 | Russell Medical Center | IP | 243.10 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 243.10 | 243.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 330.00 | Russell Medical Center | IP | 425.00 | 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 | 425.00 | 425.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) | MS-DRG | 743 | 0.00 | Russell Medical Center | IP | 0.00 | 6306.63 | $3,519 per diem | 6180.50 | 9953.38 | 6306.63 | $2,300 per diem | 6306.63 | 6306.63 | $3,650 per diem | 0.00 | 9953.38 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Room & Board | 120 | 462.00 | Russell Medical Center | IP | 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 | 595.00 | 595.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 1082.20 | Russell Medical Center | IP | 1393.75 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1393.75 | 1393.75 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 2952.02 | Russell Medical Center | IP | 3801.84 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3801.84 | 3801.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 2761.80 | Russell Medical Center | IP | 3556.87 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3556.87 | 3556.87 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 301.29 | Russell Medical Center | IP | 388.03 | 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 | 388.03 | 388.03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 168.63 | Russell Medical Center | IP | 217.18 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 217.18 | 217.18 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 2789.82 | Russell Medical Center | IP | 3592.95 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3592.95 | 3592.95 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood Admin | 390 | 29.04 | Russell Medical Center | IP | 37.40 | 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 | 37.40 | 37.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 330.00 | Russell Medical Center | IP | 425.00 | 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 | 425.00 | 425.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal of cataract with insertion of lens | Primary Procedure | 66984 | 836.88 | Russell Medical Center | OP | 1077.80 | 1784.33 | 2273.86 | 1748.65 | 3239.01 | 1784.33 | 507.20 | 1784.33 | 1784.33 | 1191.92 | 507.20 | 3239.01 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 282.48 | Russell Medical Center | OP | 363.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 171.20 | Included in Primary Procedure | Included in Primary Procedure | 402.32 | 171.20 | 402.32 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 903.47 | Russell Medical Center | OP | 1163.57 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 547.56 | Included in Primary Procedure | Included in Primary Procedure | 1286.77 | 547.56 | 1286.77 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 14.39 | Russell Medical Center | OP | 18.53 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 8.72 | Included in Primary Procedure | Included in Primary Procedure | 20.49 | 8.72 | 20.49 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intraocular Lens | 276 | C1780 | 683.76 | Russell Medical Center | OP | 880.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 414.40 | Included in Primary Procedure | Included in Primary Procedure | 973.84 | 414.40 | 973.84 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 0.09 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 39.60 | Russell Medical Center | OP | 51.00 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.00 | Included in Primary Procedure | Included in Primary Procedure | 56.40 | 24.00 | 56.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shaving of shoulder bone using an endoscope | Primary Procedure | 360 | 29826 | 365.48 | Russell Medical Center | OP | 470.69 | Included in Primary Procedure | 1466.05 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 221.50 | Included in Primary Procedure | Included in Primary Procedure | 520.53 | 221.50 | 1466.05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 463.39 | Russell Medical Center | OP | 596.79 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 280.84 | Included in Primary Procedure | Included in Primary Procedure | 659.97 | 280.84 | 659.97 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 2878.49 | Russell Medical Center | OP | 3707.15 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 1744.54 | Included in Primary Procedure | Included in Primary Procedure | 4099.67 | 1744.54 | 4099.67 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 1009.73 | Russell Medical Center | OP | 1300.42 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 611.96 | Included in Primary Procedure | Included in Primary Procedure | 1438.11 | 611.96 | 1438.11 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Implants | 278 | C1713 | 970.20 | Russell Medical Center | OP | 1249.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 588.00 | Included in Primary Procedure | Included in Primary Procedure | 1381.80 | 588.00 | 1381.80 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 36415 | 5.28 | Russell Medical Center | OP | 6.80 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 3.20 | Included in Primary Procedure | Included in Primary Procedure | 7.52 | 1.05 | 7.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 80048 | 33.00 | Russell Medical Center | OP | 42.50 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 20.00 | Included in Primary Procedure | Included in Primary Procedure | 47.00 | 20.00 | 47.00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | C9803 | 38.28 | Russell Medical Center | OP | 49.30 | Included in Primary Procedure | 40.33 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 23.20 | Included in Primary Procedure | Included in Primary Procedure | 54.52 | 23.20 | 54.52 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | U0003 | 85.80 | Russell Medical Center | OP | 110.50 | Included in Primary Procedure | 169.26 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 52.00 | Included in Primary Procedure | Included in Primary Procedure | 122.20 | 52.00 | 169.26 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 82948 | 11.88 | Russell Medical Center | OP | 15.30 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7.20 | Included in Primary Procedure | Included in Primary Procedure | 16.92 | 2.27 | 16.92 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory | 300 | 85027 | 23.10 | Russell Medical Center | OP | 29.75 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 14.00 | Included in Primary Procedure | Included in Primary Procedure | 32.90 | 2.26 | 32.90 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathology | 310 | 88304 | 36.14 | Russell Medical Center | OP | 46.54 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 21.90 | Included in Primary Procedure | Included in Primary Procedure | 51.47 | 21.90 | 51.47 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 29827 | 352.28 | Russell Medical Center | OP | 453.69 | 5279.19 | 3471.47 | 5173.61 | 9583.05 | 5279.19 | 213.50 | 5279.19 | 5279.19 | 501.73 | 213.50 | 9583.05 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 29828 | 352.28 | Russell Medical Center | OP | 453.69 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 213.50 | Included in Primary Procedure | Included in Primary Procedure | 501.73 | 213.50 | 501.73 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OR Services | 360 | 29823 | 352.28 | Russell Medical Center | OP | 453.69 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 213.50 | Included in Primary Procedure | Included in Primary Procedure | 501.73 | 213.50 | 501.73 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 39.93 | Russell Medical Center | OP | 51.43 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 24.20 | Included in Primary Procedure | Included in Primary Procedure | 56.87 | 0.09 | 56.87 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1100 | 12.87 | Russell Medical Center | OP | 16.58 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 7.80 | Included in Primary Procedure | Included in Primary Procedure | 18.33 | 0.12 | 18.33 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0690 | 16.50 | Russell Medical Center | OP | 21.25 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 10.00 | Included in Primary Procedure | Included in Primary Procedure | 23.50 | 10.00 | 23.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0702 | 63.36 | Russell Medical Center | OP | 81.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 38.40 | Included in Primary Procedure | Included in Primary Procedure | 90.24 | 38.40 | 90.24 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0330 | 11.22 | Russell Medical Center | OP | 14.45 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 6.80 | Included in Primary Procedure | Included in Primary Procedure | 15.98 | 6.80 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 353.76 | Russell Medical Center | OP | 455.60 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 214.40 | Included in Primary Procedure | Included in Primary Procedure | 503.84 | 214.40 | 503.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EKG | 730 | 93005 | 80.52 | Russell Medical Center | OP | 103.70 | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | Included in Primary Procedure | 48.80 | Included in Primary Procedure | Included in Primary Procedure | 114.68 | 48.80 | 114.68 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Removal of tonsils and adenoid glands patient younger than age 12 | Primary Procedure | 360 | 42820 | 3340.26 | Russell Medical Center | OP | 4301.85 | 4280.69 | 2563.16 | 4195.08 | 7770.52 | 4280.69 | 2024.40 | 4280.69 | 4280.69 | 4757.34 | 2024.40 | 7770.52 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patient office consultation, typically 40 min | 99243 | 108.90 | Russell Medical Center | OP | 140.25 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 99.00 | Not Applicable | Not Applicable | 155.10 | 0.00 | 155.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patient office consultation, typically 60 min | 99244 | 140.58 | Russell Medical Center | OP | 181.05 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 127.80 | Not Applicable | Not Applicable | 200.22 | 0.00 | 200.22 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial new patient preventive medicine evaluation (18-39 years) | 99385 | 71.28 | Russell Medical Center | OP | 91.80 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 64.80 | Not Applicable | Not Applicable | 101.52 | 0.00 | 107.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial new patient preventive medicine evaluation (40-64 years) | 99386 | 75.24 | Russell Medical Center | OP | 96.90 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 68.40 | Not Applicable | Not Applicable | 107.16 | 0.00 | 124.21 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT scan, head or brain, without contrast | 70450 | 413.16 | Russell Medical Center | OP | 532.10 | 98.91 | 423.54 | 96.93 | 179.56 | 98.91 | 375.60 | 98.91 | 98.91 | 588.44 | 96.93 | 588.44 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI scan of brain before and after contrast | 70553 | 4679.40 | Russell Medical Center | OP | 6026.50 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 4254.00 | 336.99 | 336.99 | 6664.60 | 330.25 | 6664.60 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-Ray, lower back, minimum four views | 72110 | 135.96 | Russell Medical Center | OP | 175.10 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 123.60 | 98.91 | 98.91 | 193.64 | 31.08 | 193.64 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI scan of lower spinal canal | 72148 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT scan, pelvis, with contrast | 72193 | 570.90 | Russell Medical Center | OP | 735.25 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 519.00 | 160.81 | 160.81 | 813.10 | 157.60 | 813.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI scan of leg joint | 73721 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT scan of abdomen and pelvis with contrast | 74177 | 864.60 | Russell Medical Center | OP | 1113.50 | 336.99 | 423.54 | 330.25 | 611.73 | 336.99 | 786.00 | 336.99 | 336.99 | 1231.40 | 330.25 | 1231.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound of abdomen | 76700 | 224.40 | Russell Medical Center | OP | 289.00 | 98.91 | 284.15 | 96.93 | 179.56 | 98.91 | 204.00 | 98.91 | 98.91 | 319.60 | 79.62 | 319.60 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus | 76805 | 273.24 | Russell Medical Center | OP | 351.90 | 98.91 | 138.45 | 96.93 | 179.56 | 98.91 | 248.40 | 98.91 | 98.91 | 389.16 | 90.84 | 389.16 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound pelvis through vagina | 76830 | 198.33 | Russell Medical Center | OP | 255.43 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 180.30 | 98.91 | 98.91 | 282.47 | 79.42 | 282.47 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mammography of one breast | 77065 | 121.18 | Russell Medical Center | OP | 156.06 | 83.99 | 92.27 | 82.31 | 83.99 | 83.99 | 110.16 | 83.99 | 83.99 | 172.58 | 82.31 | 172.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mammography of both breasts | 77066 | 285.12 | Russell Medical Center | OP | 367.20 | 107.09 | 92.27 | 104.95 | 107.09 | 107.09 | 259.20 | 107.09 | 107.09 | 406.08 | 92.27 | 406.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mammography, screening, bilateral | 77067 | 157.08 | Russell Medical Center | OP | 202.30 | 88.81 | 92.27 | 87.03 | 88.81 | 88.81 | 142.80 | 88.81 | 88.81 | 223.72 | 87.03 | 223.72 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Basic metabolic panel | 80048 | 30.20 | Russell Medical Center | OP | 38.89 | 8.46 | 13.65 | 8.29 | 0.00 | 8.46 | 27.45 | 8.46 | 8.46 | 43.01 | 0.00 | 43.01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, comprehensive group of blood chemicals | 80053 | 62.37 | Russell Medical Center | OP | 80.33 | 10.56 | 13.65 | 10.35 | 0.00 | 10.56 | 56.70 | 10.56 | 10.56 | 88.83 | 0.00 | 88.83 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, lipids (cholesterol and triglycerides) | 80061 | 15.18 | Russell Medical Center | OP | 19.55 | 13.39 | 13.65 | 13.12 | 12.05 | 13.39 | 13.80 | 13.39 | 13.39 | 21.62 | 4.69 | 21.62 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Kidney function panel test | 80069 | 27.72 | Russell Medical Center | OP | 35.70 | 8.68 | 13.65 | 8.51 | 0.00 | 8.68 | 25.20 | 8.68 | 8.68 | 39.48 | 0.00 | 39.48 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Liver function blood test panel | 80076 | 41.25 | Russell Medical Center | OP | 53.13 | 8.17 | 13.65 | 8.01 | 0.00 | 8.17 | 37.50 | 8.17 | 8.17 | 58.75 | 0.00 | 58.75 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Manual urinalysis test with examination using microscope | 81001 | 35.64 | Russell Medical Center | OP | 45.90 | 3.17 | 4.45 | 3.11 | 0.00 | 3.17 | 32.40 | 3.17 | 3.17 | 50.76 | 0.00 | 50.76 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Automated urinalysis test | 81003 | 28.38 | Russell Medical Center | OP | 36.55 | 2.25 | 4.45 | 2.21 | 0.00 | 2.25 | 25.80 | 2.25 | 2.25 | 40.42 | 0.00 | 40.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
PSA (prostate specific antigen) | 84154 | 48.51 | Russell Medical Center | OP | 62.48 | 18.39 | 14.74 | 18.02 | 0.00 | 18.39 | 44.10 | 18.39 | 18.39 | 69.09 | 0.00 | 69.09 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, thyroid stimulating hormone (TSH) | 84443 | 45.87 | Russell Medical Center | OP | 59.08 | 16.80 | 20.36 | 16.46 | 0.00 | 16.80 | 41.70 | 16.80 | 16.80 | 65.33 | 0.00 | 65.33 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete blood cell count, with differential white blood cells, automated | 85025 | 52.97 | Russell Medical Center | OP | 68.21 | 7.77 | 8.81 | 7.61 | 0.00 | 7.77 | 48.15 | 7.77 | 7.77 | 75.44 | 0.00 | 75.44 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete blood count, automated | 85027 | 23.10 | Russell Medical Center | OP | 29.75 | 6.47 | 8.81 | 6.34 | 0.00 | 6.47 | 21.00 | 6.47 | 6.47 | 32.90 | 0.00 | 32.90 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blood test, clotting time | 85610 | 26.90 | Russell Medical Center | OP | 34.64 | 4.29 | 5.62 | 4.20 | 0.00 | 4.29 | 24.45 | 4.29 | 4.29 | 38.31 | 0.00 | 38.31 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Coagulation assessment blood test | 85730 | 26.24 | Russell Medical Center | OP | 33.79 | 6.01 | 5.62 | 5.89 | 0.00 | 6.01 | 23.85 | 6.01 | 6.01 | 37.37 | 0.00 | 37.37 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Insertion of catheter into left heart for diagnosis | 93452 | 5398.80 | Russell Medical Center | OP | 6953.00 | 2515.14 | 3377.01 | 2464.84 | 4565.60 | 2515.14 | 4908.00 | 2515.14 | 2515.14 | 7689.20 | 2464.84 | 7689.20 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sleep Study | 95810 | 1416.36 | Russell Medical Center | OP | 1824.10 | 802.17 | 1070.39 | 786.12 | 1456.13 | 802.17 | 1287.60 | 802.17 | 802.17 | 2017.24 | 475.58 | 2017.24 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical therapy, therapeutic exercise | 97110 | 43.76 | Russell Medical Center | OP | 56.36 | 29.58 | 286.49 | 28.99 | 29.58 | 29.58 | 39.78 | 29.58 | 29.58 | 62.32 | 28.99 | 286.49 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
New patient office or other outpatient visit, typically 30 min | 99203 | 104.94 | Russell Medical Center | OP | 135.15 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 95.40 | Not Applicable | Not Applicable | 149.46 | 0.00 | 149.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
New patient office of other outpatient visit, typically 45 min | 99204 | 101.64 | Russell Medical Center | OP | 130.90 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 92.40 | Not Applicable | Not Applicable | 144.76 | 0.00 | 144.76 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
New patient office of other outpatient visit, typically 60 min | 99205 | 152.46 | Russell Medical Center | OP | 196.35 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 138.60 | Not Applicable | Not Applicable | 217.14 | 0.00 | 217.14 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Admin hepatitis b vaccine | G0010 | 62.19 | Russell Medical Center | OP | 80.10 | 33.63 | 57.02 | 32.96 | 61.05 | 33.63 | 56.54 | 33.63 | 33.63 | 88.58 | 11.36 | 88.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Admin pneumococcal vaccine | G0009 | 44.88 | Russell Medical Center | OP | 57.80 | 33.63 | 57.02 | 32.96 | 61.05 | 33.63 | 40.80 | 33.63 | 33.63 | 63.92 | 11.36 | 63.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Admin influenza virus vac | G0008 | 85.80 | Russell Medical Center | OP | 110.50 | 33.63 | 57.02 | 32.96 | 61.05 | 33.63 | 78.00 | 33.63 | 33.63 | 122.20 | 11.36 | 122.20 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OUTPATIENT CONSULT LEVEL 5 | 99245 | 174.90 | Russell Medical Center | OP | 225.25 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 159.00 | Not Applicable | Not Applicable | 249.10 | 0.00 | 249.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SUBSEQUENT HOSP VISIT LEVEL 1 | 99231 | 56.10 | Russell Medical Center | OP | 72.25 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 51.00 | Not Applicable | Not Applicable | 79.90 | 0.00 | 79.90 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SUBSEQUENT HOSP VISIT LEVEL 2 | 99232 | 100.98 | Russell Medical Center | OP | 130.05 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 91.80 | Not Applicable | Not Applicable | 143.82 | 0.00 | 143.82 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OFFICE OUTPATIENT VISIT 25 MINUTES | 99214 | 57.42 | Russell Medical Center | OP | 73.95 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 52.20 | Not Applicable | Not Applicable | 81.78 | 0.00 | 96.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OFFICE OUTPATIENT VISIT 15 MINUTES | 99213 | 45.54 | Russell Medical Center | OP | 58.65 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 41.40 | Not Applicable | Not Applicable | 64.86 | 0.00 | 64.86 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OFFICE OUTPATIENT VISIT 10 MINUTES | 99212 | 36.96 | Russell Medical Center | OP | 47.60 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 33.60 | Not Applicable | Not Applicable | 52.64 | 0.00 | 52.64 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OFFICE OUTPATIENT VISIT 5 MINUTES | 99211 | 27.72 | Russell Medical Center | OP | 35.70 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 25.20 | Not Applicable | Not Applicable | 39.48 | 0.00 | 39.48 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OFFICE OUTPATIENT NEW 20 MINUTES | 99202 | 50.82 | Russell Medical Center | OP | 65.45 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 46.20 | Not Applicable | Not Applicable | 72.38 | 0.00 | 72.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
OFFICE OUTPATIENT NEW 10 MINUTES | 99201 | 149.16 | Russell Medical Center | OP | 192.10 | Not Applicable | 0.00 | Not Applicable | Not Applicable | Not Applicable | 135.60 | Not Applicable | Not Applicable | 212.44 | 0.00 | 212.44 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
STRESS ECHO | 93017 | 336.60 | Russell Medical Center | OP | 433.50 | 223.37 | 515.03 | 218.90 | 405.47 | 223.37 | 306.00 | 223.37 | 223.37 | 479.40 | 218.90 | 515.03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EKG WITH MAGNET TRACING ONLY | 93005 | 80.52 | Russell Medical Center | OP | 103.70 | 48.55 | 36.66 | 47.58 | 88.13 | 48.55 | 73.20 | 48.55 | 48.55 | 114.68 | 36.66 | 114.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ECHO DOPPLER | 93320 | 132.00 | Russell Medical Center | OP | 170.00 | 0.00 | 673.61 | 0.00 | 0.00 | 0.00 | 120.00 | 0.00 | 0.00 | 188.00 | 0.00 | 673.61 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ECHO COLOR DOPPLER FLOW | 93325 | 235.47 | Russell Medical Center | OP | 303.25 | 0.00 | 218.71 | 0.00 | 0.00 | 0.00 | 214.06 | 0.00 | 0.00 | 335.36 | 0.00 | 335.36 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
COMPLETE EEG | 95819 | 91.74 | Russell Medical Center | OP | 118.15 | 223.37 | 342.89 | 218.90 | 405.47 | 223.37 | 83.40 | 223.37 | 223.37 | 130.66 | 83.40 | 405.47 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
STREP A AMPLIFIED PROBE | 87651 | 64.02 | Russell Medical Center | OP | 82.45 | 35.09 | 45.47 | 34.39 | 0.00 | 35.09 | 58.20 | 35.09 | 35.09 | 91.18 | 0.00 | 91.18 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
HPV TEST (HUMAN PAP VIRUS) | 87624 | 167.64 | Russell Medical Center | OP | 215.90 | 35.09 | 45.47 | 34.39 | 0.00 | 35.09 | 152.40 | 35.09 | 35.09 | 238.76 | 0.00 | 238.76 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
V,ZOSTER 1GG | 86787 | 33.50 | Russell Medical Center | OP | 43.14 | 12.88 | 14.59 | 12.62 | 0.00 | 12.88 | 30.45 | 12.88 | 12.88 | 47.71 | 0.00 | 47.71 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CRYTO ANTIGEN SERUM | 86641 | 44.39 | Russell Medical Center | OP | 57.16 | 14.41 | 14.59 | 14.12 | 0.00 | 14.41 | 40.35 | 14.41 | 14.41 | 63.22 | 0.00 | 63.22 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CHLAMYDIA CULTURE | 86631 | 23.76 | Russell Medical Center | OP | 30.60 | 11.82 | 14.59 | 11.58 | 10.64 | 11.82 | 21.60 | 11.82 | 11.82 | 33.84 | 10.64 | 33.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ENDOMYSIAL AB, 1GA | 86255 | 48.51 | Russell Medical Center | OP | 62.48 | 12.05 | 14.59 | 11.81 | 0.00 | 12.05 | 44.10 | 12.05 | 12.05 | 69.09 | 0.00 | 69.09 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CLOTTING FACTOR VIII | 85240 | 63.53 | Russell Medical Center | OP | 81.81 | 17.90 | 25.66 | 17.54 | 0.00 | 17.90 | 57.75 | 17.90 | 17.90 | 90.48 | 0.00 | 90.48 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
TROPONIN I | 84484 | 63.36 | Russell Medical Center | OP | 81.60 | 12.47 | 14.74 | 12.22 | 0.00 | 12.47 | 57.60 | 12.47 | 12.47 | 90.24 | 0.00 | 90.24 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ASSAY OF FREE THYROXINE | 84439 | 18.32 | Russell Medical Center | OP | 23.59 | 9.02 | 20.36 | 8.84 | 0.00 | 9.02 | 16.65 | 9.02 | 9.02 | 26.09 | 0.00 | 26.09 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
T4 | 84436 | 40.10 | Russell Medical Center | OP | 51.64 | 6.87 | 20.36 | 6.73 | 0.00 | 6.87 | 36.45 | 6.87 | 6.87 | 57.11 | 0.00 | 57.11 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
VITAMIN B | 84425 | 85.64 | Russell Medical Center | OP | 110.29 | 21.23 | 14.74 | 20.81 | 0.00 | 21.23 | 77.85 | 21.23 | 21.23 | 121.97 | 0.00 | 121.97 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ASSAY OF TESTOSTERONE TOTAL | 84403 | 83.66 | Russell Medical Center | OP | 107.74 | 25.81 | 20.36 | 25.29 | 0.00 | 25.81 | 76.05 | 25.81 | 25.81 | 119.15 | 0.00 | 119.15 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ASSAY OF TESTOSTERONE FREE | 84402 | 153.45 | Russell Medical Center | OP | 197.63 | 25.47 | 20.36 | 24.96 | 0.00 | 25.47 | 139.50 | 25.47 | 25.47 | 218.55 | 0.00 | 218.55 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
PROTEIN TOTAL QUANTITATIVE | 84156 | 34.32 | Russell Medical Center | OP | 44.20 | 3.67 | 6.55 | 3.60 | 0.00 | 3.67 | 31.20 | 3.67 | 3.67 | 48.88 | 0.00 | 48.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | 84153 | 48.51 | Russell Medical Center | OP | 62.48 | 18.39 | 14.74 | 18.02 | 0.00 | 18.39 | 44.10 | 18.39 | 18.39 | 69.09 | 0.00 | 69.09 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
IRON BINDING CAPACITY | 83550 | 10.73 | Russell Medical Center | OP | 13.81 | 8.74 | 14.74 | 8.57 | 0.00 | 8.74 | 9.75 | 8.74 | 8.74 | 15.28 | 0.00 | 15.28 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ASSAY OF IRON | 83540 | 16.83 | Russell Medical Center | OP | 21.68 | 6.47 | 6.55 | 6.34 | 0.00 | 6.47 | 15.30 | 6.47 | 6.47 | 23.97 | 0.00 | 23.97 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ASSAY OF INSULIN TOTAL | 83525 | 26.57 | Russell Medical Center | OP | 34.21 | 11.43 | 20.36 | 11.20 | 0.00 | 11.43 | 24.15 | 11.43 | 11.43 | 37.84 | 0.00 | 37.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP | 83516 | 87.12 | Russell Medical Center | OP | 112.20 | 11.53 | 14.59 | 11.30 | 0.00 | 11.53 | 79.20 | 11.53 | 11.53 | 124.08 | 0.00 | 124.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
HYDROXY-INDOL AC A-5 | 83497 | 205.76 | Russell Medical Center | OP | 264.99 | 12.90 | 20.36 | 12.64 | 0.00 | 12.90 | 187.05 | 12.90 | 12.90 | 293.05 | 0.00 | 293.05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
HYDROXYCORTICOST | 83491 | 57.75 | Russell Medical Center | OP | 74.38 | 17.90 | 20.36 | 17.54 | 0.00 | 17.90 | 52.50 | 17.90 | 17.90 | 82.25 | 0.00 | 82.25 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
HEMOGLOBIN GLYCOSYLATED A1C | 83036 | 29.70 | Russell Medical Center | OP | 38.25 | 9.71 | 14.74 | 9.52 | 0.00 | 9.71 | 27.00 | 9.71 | 9.71 | 42.30 | 0.00 | 42.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
GONADOTROPIN LUTEINIZING HORMONE | 83002 | 67.16 | Russell Medical Center | OP | 86.49 | 18.52 | 20.36 | 18.15 | 0.00 | 18.52 | 61.05 | 18.52 | 18.52 | 95.65 | 0.00 | 95.65 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
FSH SERUM | 83001 | 67.16 | Russell Medical Center | OP | 86.49 | 18.58 | 20.36 | 18.21 | 0.00 | 18.58 | 61.05 | 18.58 | 18.58 | 95.65 | 0.00 | 95.65 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
GLUCOSE 3HR TOLERANC | 82951 | 101.48 | Russell Medical Center | OP | 130.69 | 12.87 | 14.74 | 12.61 | 11.58 | 12.87 | 92.25 | 12.87 | 12.87 | 144.53 | 11.58 | 144.53 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | 82947 | 45.05 | Russell Medical Center | OP | 58.01 | 3.93 | 6.55 | 3.85 | 3.54 | 3.93 | 40.95 | 3.93 | 3.93 | 64.16 | 1.77 | 64.16 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
VITAMIN B-12 | 82607 | 40.10 | Russell Medical Center | OP | 51.64 | 15.08 | 20.36 | 14.78 | 0.00 | 15.08 | 36.45 | 15.08 | 15.08 | 57.11 | 0.00 | 57.11 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CREATININE BLOOD | 82565 | 4.46 | Russell Medical Center | OP | 5.74 | 5.12 | 6.55 | 5.02 | 0.00 | 5.12 | 4.05 | 5.12 | 5.12 | 6.35 | 0.00 | 6.55 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
KEPPRA LEVEL | 82542 | 102.30 | Russell Medical Center | OP | 131.75 | 24.09 | 14.74 | 23.61 | 0.00 | 24.09 | 93.00 | 24.09 | 24.09 | 145.70 | 0.00 | 145.70 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CORTISOL TOTAL | 82533 | 43.23 | Russell Medical Center | OP | 55.68 | 16.30 | 20.36 | 15.97 | 0.00 | 16.30 | 39.30 | 16.30 | 16.30 | 61.57 | 0.00 | 61.57 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CALCIUM TOTAL | 82310 | 4.46 | Russell Medical Center | OP | 5.74 | 5.16 | 6.55 | 5.06 | 0.00 | 5.16 | 4.05 | 5.16 | 5.16 | 6.35 | 0.00 | 6.55 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
BILIRUBIN TOTAL | 82247 | 4.46 | Russell Medical Center | OP | 5.74 | 5.02 | 6.55 | 4.92 | 0.00 | 5.02 | 4.05 | 5.02 | 5.02 | 6.35 | 0.00 | 6.55 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
HEP B SCREEN | 82108 | 83.82 | Russell Medical Center | OP | 107.95 | 25.48 | 17.47 | 24.97 | 0.00 | 25.48 | 76.20 | 25.48 | 25.48 | 119.38 | 0.00 | 119.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ALBUMIN | 82040 | 5.94 | Russell Medical Center | OP | 7.65 | 4.95 | 6.55 | 4.85 | 0.00 | 4.95 | 5.40 | 4.95 | 4.95 | 8.46 | 0.00 | 8.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
PREGNANCY URINE | 81025 | 28.38 | Russell Medical Center | OP | 36.55 | 8.61 | 4.45 | 8.44 | 0.00 | 8.61 | 25.80 | 8.61 | 8.61 | 40.42 | 0.00 | 40.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
URINE BACTERIA SCREEN | 81007 | 17.82 | Russell Medical Center | OP | 22.95 | 29.98 | 4.45 | 29.38 | 0.00 | 29.98 | 16.20 | 29.98 | 29.98 | 25.38 | 0.00 | 29.98 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ACUTE HEPATITIS PANEL | 80074 | 111.71 | Russell Medical Center | OP | 143.86 | 47.63 | 13.65 | 46.68 | 0.00 | 47.63 | 101.55 | 47.63 | 47.63 | 159.10 | 0.00 | 159.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acute gi blood loss imaging | 78278 | 478.88 | Russell Medical Center | OP | 616.74 | 324.88 | 1203.38 | 318.38 | 589.73 | 324.88 | 435.35 | 324.88 | 324.88 | 682.05 | 318.38 | 1203.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastric emptying imag study | 78265 | 485.10 | Russell Medical Center | OP | 624.75 | 324.88 | 506.22 | 318.38 | 589.73 | 324.88 | 441.00 | 324.88 | 324.88 | 690.90 | 318.38 | 690.90 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastric emptying imag study | 78264 | 478.88 | Russell Medical Center | OP | 616.74 | 324.88 | 506.22 | 318.38 | 589.73 | 324.88 | 435.35 | 324.88 | 324.88 | 682.05 | 318.38 | 682.05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ct bone density axial | 77078 | 266.64 | Russell Medical Center | OP | 343.40 | 70.43 | 125.66 | 69.03 | 127.85 | 70.43 | 242.40 | 70.43 | 70.43 | 379.76 | 69.03 | 379.76 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-rays bone survey infant | 77076 | 132.00 | Russell Medical Center | OP | 170.00 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 120.00 | 98.91 | 98.91 | 188.00 | 77.69 | 188.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-rays bone survey complete | 77075 | 194.04 | Russell Medical Center | OP | 249.90 | 98.91 | 162.71 | 96.93 | 179.56 | 98.91 | 176.40 | 98.91 | 98.91 | 276.36 | 96.93 | 276.36 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-rays bone survey limited | 77074 | 66.73 | Russell Medical Center | OP | 85.94 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 60.66 | 98.91 | 98.91 | 95.03 | 60.66 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
BONE AGE | 77072 | 66.73 | Russell Medical Center | OP | 85.94 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 60.66 | 98.91 | 98.91 | 95.03 | 60.66 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Breast tomosynthesis bi | 77063 | 36.96 | Russell Medical Center | OP | 47.60 | 22.46 | 92.27 | 22.01 | 22.46 | 22.46 | 33.60 | 22.46 | 22.46 | 52.64 | 22.01 | 92.27 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray of mammary duct | 77053 | 352.14 | Russell Medical Center | OP | 453.52 | 205.66 | 162.71 | 201.55 | 373.33 | 205.66 | 320.13 | 205.66 | 205.66 | 501.54 | 162.71 | 501.54 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mri breast c-+ w/cad bi | 77049 | 1646.04 | Russell Medical Center | OP | 2119.90 | Not Applicable | 601.85 | Not Applicable | Not Applicable | Not Applicable | 1496.40 | Not Applicable | Not Applicable | 2344.36 | 601.85 | 2344.36 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mri breast c-+ w/cad uni | 77048 | 823.02 | Russell Medical Center | OP | 1059.95 | Not Applicable | 601.85 | Not Applicable | Not Applicable | Not Applicable | 748.20 | Not Applicable | Not Applicable | 1172.18 | 601.85 | 1172.18 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mri breast c- bilateral | 77047 | 1257.96 | Russell Medical Center | OP | 1620.10 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1143.60 | 205.66 | 205.66 | 1791.64 | 201.55 | 1791.64 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mri breast c- unilateral | 77046 | 628.98 | Russell Medical Center | OP | 810.05 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 571.80 | 205.66 | 205.66 | 895.82 | 201.55 | 895.82 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
FOLLOW UP STUDY | 76970 | 134.30 | Russell Medical Center | OP | 172.96 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 122.09 | 98.91 | 98.91 | 191.27 | 96.93 | 218.71 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US GUIDANCE NEEDLE PLACEMENT IMG S &I | 76942 | 251.46 | Russell Medical Center | OP | 323.85 | 0.00 | 157.40 | 0.00 | 0.00 | 0.00 | 228.60 | 0.00 | 0.00 | 358.14 | 0.00 | 358.14 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG | 76882 | 139.26 | Russell Medical Center | OP | 179.35 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 126.60 | 98.91 | 98.91 | 198.34 | 29.24 | 218.71 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US SCROTUM & CONTENTS | 76870 | 197.51 | Russell Medical Center | OP | 254.36 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 179.55 | 98.91 | 98.91 | 281.30 | 96.93 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE | 76856 | 198.33 | Russell Medical Center | OP | 255.43 | 98.91 | 284.15 | 96.93 | 179.56 | 98.91 | 180.30 | 98.91 | 98.91 | 282.47 | 70.89 | 284.15 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US TRANSVAGINAL PREGNANT | 76817 | 197.51 | Russell Medical Center | OP | 254.36 | 98.91 | 138.45 | 96.93 | 179.56 | 98.91 | 179.55 | 98.91 | 98.91 | 281.30 | 62.27 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
FETAL BPD | 76815 | 197.51 | Russell Medical Center | OP | 254.36 | 98.91 | 138.45 | 96.93 | 179.56 | 98.91 | 179.55 | 98.91 | 98.91 | 281.30 | 54.62 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
U/S COMP PREGNANCY < 14 WEEKS | 76801 | 165.00 | Russell Medical Center | OP | 212.50 | 98.91 | 138.45 | 96.93 | 179.56 | 98.91 | 150.00 | 98.91 | 98.91 | 235.00 | 77.00 | 235.00 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
RETROPERITONEUM COMPLETE SCAN | 76770 | 227.70 | Russell Medical Center | OP | 293.25 | 98.91 | 284.15 | 96.93 | 179.56 | 98.91 | 207.00 | 98.91 | 98.91 | 324.30 | 73.26 | 324.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ABDOMINAL AORTIC ANEURYSM SCRE | 76706 | 163.02 | Russell Medical Center | OP | 209.95 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 148.20 | 98.91 | 98.91 | 232.18 | 96.93 | 232.18 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
GALLBLADDER ULTRASOUND | 76705 | 197.51 | Russell Medical Center | OP | 254.36 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 179.55 | 98.91 | 98.91 | 281.30 | 58.97 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US BREAST UNI REAL TIME WITH IMAGE LIMITED | 76642 | 316.80 | Russell Medical Center | OP | 408.00 | 70.43 | 218.71 | 69.03 | 127.85 | 70.43 | 288.00 | 70.43 | 70.43 | 451.20 | 56.94 | 451.20 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CHEST COMPLETE | 76604 | 197.34 | Russell Medical Center | OP | 254.15 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 179.40 | 98.91 | 98.91 | 281.06 | 96.93 | 281.06 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM | 76536 | 197.51 | Russell Medical Center | OP | 254.36 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 179.55 | 98.91 | 98.91 | 281.30 | 96.93 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
LEFT EYE US | 76512 | 197.51 | Russell Medical Center | OP | 254.36 | 98.91 | 218.71 | 96.93 | 179.56 | 98.91 | 179.55 | 98.91 | 98.91 | 281.30 | 96.93 | 281.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CYSTOGRAM | 74430 | 284.46 | Russell Medical Center | OP | 366.35 | 336.99 | 162.71 | 330.25 | 611.73 | 336.99 | 258.60 | 336.99 | 336.99 | 405.14 | 162.71 | 611.73 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
TOMOGRAM 11 TO 20 IMAGES | 74415 | 273.90 | Russell Medical Center | OP | 352.75 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 249.00 | 160.81 | 160.81 | 390.10 | 157.60 | 390.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Radiologic Examination Colon with air contrast | 74280 | 257.90 | Russell Medical Center | OP | 332.14 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 234.45 | 160.81 | 160.81 | 367.31 | 157.60 | 367.31 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Radiologic Examination Colon with Barium Enema | 74270 | 196.19 | Russell Medical Center | OP | 252.66 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 178.35 | 160.81 | 160.81 | 279.42 | 157.60 | 291.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray of small intestine by small bowel tube | 74251 | 280.12 | Russell Medical Center | OP | 360.76 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 254.65 | 160.81 | 160.81 | 398.95 | 157.60 | 398.95 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam small intestine contrast | 74250 | 127.84 | Russell Medical Center | OP | 164.65 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 116.22 | 160.81 | 160.81 | 182.08 | 116.22 | 291.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray upper gastrointestinal tract | 74248 | 265.32 | Russell Medical Center | OP | 341.70 | 0.00 | 162.71 | 0.00 | 0.00 | 0.00 | 241.20 | 0.00 | 0.00 | 377.88 | 0.00 | 377.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray gastrointestinal tract upper air contrast with high density barium | 74246 | 193.38 | Russell Medical Center | OP | 249.05 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 175.80 | 160.81 | 160.81 | 275.42 | 157.60 | 291.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam gastrointestinal tract upper without KUB | 74240 | 265.32 | Russell Medical Center | OP | 341.70 | 160.81 | 162.71 | 157.60 | 291.92 | 160.81 | 241.20 | 160.81 | 160.81 | 377.88 | 157.60 | 377.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Esophogram single contrast study | 74220 | 146.19 | Russell Medical Center | OP | 188.28 | 160.81 | 77.69 | 157.60 | 291.92 | 160.81 | 132.90 | 160.81 | 160.81 | 208.21 | 77.69 | 291.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT abdomen & pelvis | 74178 | 864.60 | Russell Medical Center | OP | 1113.50 | 336.99 | 423.54 | 330.25 | 611.73 | 336.99 | 786.00 | 336.99 | 336.99 | 1231.40 | 330.25 | 1231.40 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT abdomen & pelvis without contrast | 74176 | 603.24 | Russell Medical Center | OP | 776.90 | 205.66 | 423.54 | 201.55 | 373.33 | 205.66 | 548.40 | 205.66 | 205.66 | 859.16 | 201.55 | 859.16 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT angio abdomen with and without contrast | 74175 | 504.15 | Russell Medical Center | OP | 649.29 | 160.81 | 446.71 | 157.60 | 291.92 | 160.81 | 458.32 | 160.81 | 160.81 | 718.04 | 157.60 | 718.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT angio abdomen & pelvis with and without contrast | 74174 | 1037.52 | Russell Medical Center | OP | 1336.20 | 336.99 | 446.71 | 330.25 | 611.73 | 336.99 | 943.20 | 336.99 | 336.99 | 1477.68 | 330.25 | 1477.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT abdomen with and without contrast | 74170 | 784.08 | Russell Medical Center | OP | 1009.80 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 712.80 | 160.81 | 160.81 | 1116.72 | 157.60 | 1116.72 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT abdomen with contrast | 74160 | 766.92 | Russell Medical Center | OP | 987.70 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 697.20 | 160.81 | 160.81 | 1092.28 | 157.60 | 1092.28 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT abdomen without contrast | 74150 | 460.68 | Russell Medical Center | OP | 593.30 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 418.80 | 98.91 | 98.91 | 656.12 | 96.93 | 656.12 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam complete abdomen | 74022 | 147.18 | Russell Medical Center | OP | 189.55 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 133.80 | 98.91 | 98.91 | 209.62 | 31.23 | 209.62 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam abdomen 3+ views | 74021 | 170.94 | Russell Medical Center | OP | 220.15 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 155.40 | 98.91 | 98.91 | 243.46 | 77.69 | 243.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam abdomen 2 views | 74019 | 170.94 | Russell Medical Center | OP | 220.15 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 155.40 | 98.91 | 98.91 | 243.46 | 23.15 | 243.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam abdomen 1 view | 74018 | 89.10 | Russell Medical Center | OP | 114.75 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 81.00 | 70.43 | 70.43 | 126.90 | 18.76 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI joint lower extremity with and without contrast | 73723 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI joint of lower extremity with contrast | 73722 | 1438.14 | Russell Medical Center | OP | 1852.15 | 600.84 | 601.85 | 588.82 | 1090.67 | 600.84 | 1307.40 | 600.84 | 600.84 | 2048.26 | 588.82 | 2048.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI lower extremity with and without contrast | 73720 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI lower extremity with contrast | 73719 | 1438.14 | Russell Medical Center | OP | 1852.15 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1307.40 | 336.99 | 336.99 | 2048.26 | 330.25 | 2048.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI lower extremity without contrast | 73718 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of toe(s) | 73660 | 37.45 | Russell Medical Center | OP | 48.23 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 34.04 | 70.43 | 70.43 | 53.34 | 17.45 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of heel 2 views | 73650 | 66.73 | Russell Medical Center | OP | 85.94 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 60.66 | 70.43 | 70.43 | 95.03 | 18.04 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of foot complete | 73630 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 20.98 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of foot 2 views | 73620 | 79.20 | Russell Medical Center | OP | 102.00 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 72.00 | 70.43 | 70.43 | 112.80 | 17.82 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of ankle complete | 73610 | 90.42 | Russell Medical Center | OP | 116.45 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 82.20 | 70.43 | 70.43 | 128.78 | 22.28 | 128.78 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of ankle 2 views | 73600 | 66.73 | Russell Medical Center | OP | 85.94 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 60.66 | 70.43 | 70.43 | 95.03 | 20.29 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of lower leg | 73590 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 19.61 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Contrast x-ray of knee joint | 73580 | 417.91 | Russell Medical Center | OP | 538.22 | 336.99 | 162.71 | 330.25 | 611.73 | 336.99 | 379.92 | 336.99 | 336.99 | 595.21 | 162.71 | 611.73 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of knees | 73565 | 66.73 | Russell Medical Center | OP | 85.94 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 60.66 | 70.43 | 70.43 | 95.03 | 60.66 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam knee 4 or more | 73564 | 99.33 | Russell Medical Center | OP | 127.93 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 90.30 | 98.91 | 98.91 | 141.47 | 27.10 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of knee 1 or 2 | 73560 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 21.41 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of femur 2 | 73552 | 88.72 | Russell Medical Center | OP | 114.26 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 80.65 | 70.43 | 70.43 | 126.35 | 22.13 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of femur 1 | 73551 | 88.72 | Russell Medical Center | OP | 114.26 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 80.65 | 70.43 | 70.43 | 126.35 | 18.71 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Contrast x-ray of hip | 73525 | 495.66 | Russell Medical Center | OP | 638.35 | 336.99 | 162.71 | 330.25 | 611.73 | 336.99 | 450.60 | 336.99 | 336.99 | 705.94 | 162.71 | 705.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam hips bilateral 5 views | 73523 | 279.84 | Russell Medical Center | OP | 360.40 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 254.40 | 98.91 | 98.91 | 398.56 | 37.94 | 398.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam hips bilateral 3-4 views | 73522 | 147.18 | Russell Medical Center | OP | 189.55 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 133.80 | 98.91 | 98.91 | 209.62 | 33.40 | 209.62 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam hips bilateral 2 views | 73521 | 147.18 | Russell Medical Center | OP | 189.55 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 133.80 | 98.91 | 98.91 | 209.62 | 25.59 | 209.62 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam hip unilateral 4 views | 73503 | 146.93 | Russell Medical Center | OP | 189.23 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 133.57 | 98.91 | 98.91 | 209.26 | 35.83 | 209.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam hip unilateral 2-3 views | 73502 | 88.44 | Russell Medical Center | OP | 113.90 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 80.40 | 70.43 | 70.43 | 125.96 | 28.97 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam hip unilateral 1 view | 73501 | 88.44 | Russell Medical Center | OP | 113.90 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 80.40 | 70.43 | 70.43 | 125.96 | 20.34 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mr angio upper extremity with and without contrast | 73225 | 953.70 | Russell Medical Center | OP | 1228.25 | Not Applicable | 585.08 | Not Applicable | Not Applicable | Not Applicable | 867.00 | Not Applicable | Not Applicable | 1358.30 | 585.08 | 1358.30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI joint upper extremity with and without contrast | 73223 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI joint upper extremity with contrast | 73222 | 1438.14 | Russell Medical Center | OP | 1852.15 | 600.84 | 601.85 | 588.82 | 1090.67 | 600.84 | 1307.40 | 600.84 | 600.84 | 2048.26 | 588.82 | 2048.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI joint upper extremity without contrast | 73221 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI upper extremity withou and without contrast | 73220 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI upper extremity with contrast | 73219 | 1423.62 | Russell Medical Center | OP | 1833.45 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1294.20 | 336.99 | 336.99 | 2027.58 | 330.25 | 2027.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI upper extremity without contrast | 73218 | 1339.14 | Russell Medical Center | OP | 1724.65 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1217.40 | 205.66 | 205.66 | 1907.26 | 201.55 | 1907.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT upper extremity with and without contrast | 73202 | 623.04 | Russell Medical Center | OP | 802.40 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 566.40 | 160.81 | 160.81 | 887.36 | 157.60 | 887.36 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT upper extremity with contrast | 73201 | 595.32 | Russell Medical Center | OP | 766.70 | 336.99 | 423.54 | 330.25 | 611.73 | 336.99 | 541.20 | 336.99 | 336.99 | 847.88 | 330.25 | 847.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT upper extremity without contrast | 73200 | 439.56 | Russell Medical Center | OP | 566.10 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 399.60 | 98.91 | 98.91 | 626.04 | 96.93 | 626.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of finger(s) | 73140 | 68.15 | Russell Medical Center | OP | 87.76 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 61.95 | 70.43 | 70.43 | 97.06 | 17.45 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of hand 3 views | 73130 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 22.28 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of hand 2 views | 73120 | 79.20 | Russell Medical Center | OP | 102.00 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 72.00 | 98.91 | 98.91 | 112.80 | 72.00 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Contrast x-ray of wrist | 73115 | 496.00 | Russell Medical Center | OP | 638.79 | 336.99 | 162.71 | 330.25 | 611.73 | 336.99 | 450.91 | 336.99 | 336.99 | 706.43 | 162.71 | 706.43 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of wrist complete | 73110 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 22.28 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of wrist 2 views | 73100 | 66.73 | Russell Medical Center | OP | 85.94 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 60.66 | 70.43 | 70.43 | 95.03 | 20.60 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of arm infant | 73092 | 82.17 | Russell Medical Center | OP | 105.83 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 74.70 | 98.91 | 98.91 | 117.03 | 74.70 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of forearm | 73090 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 18.49 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Contrast x-ray of elbow | 73085 | 559.02 | Russell Medical Center | OP | 719.95 | 336.99 | 162.71 | 330.25 | 611.73 | 336.99 | 508.20 | 336.99 | 336.99 | 796.18 | 162.71 | 796.18 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of elbow complete | 73080 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 19.86 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of elbow 2 views | 73070 | 66.73 | Russell Medical Center | OP | 85.94 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 60.66 | 70.43 | 70.43 | 95.03 | 18.26 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of humerus | 73060 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 20.06 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of AC Joints Bilateral | 73050 | 90.92 | Russell Medical Center | OP | 117.09 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 82.65 | 70.43 | 70.43 | 129.49 | 20.11 | 129.49 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Contrast x-ray of shoulder and arthrography | 73040 | 417.91 | Russell Medical Center | OP | 538.22 | 336.99 | 162.71 | 330.25 | 611.73 | 336.99 | 379.92 | 336.99 | 336.99 | 595.21 | 162.71 | 611.73 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of shoulder comlpete 2+ views | 73030 | 89.76 | Russell Medical Center | OP | 115.60 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 81.60 | 70.43 | 70.43 | 127.84 | 21.23 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of shoulder 1 view | 73020 | 66.73 | Russell Medical Center | OP | 85.94 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 60.66 | 70.43 | 70.43 | 95.03 | 13.75 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of shoulder blade | 73010 | 82.17 | Russell Medical Center | OP | 105.83 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 74.70 | 98.91 | 98.91 | 117.03 | 17.84 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of collar bone | 73000 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 20.06 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam tailbone | 72220 | 104.28 | Russell Medical Center | OP | 134.30 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 94.80 | 70.43 | 70.43 | 148.52 | 20.08 | 148.52 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam si joints 3 views | 72202 | 103.95 | Russell Medical Center | OP | 133.88 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 94.50 | 98.91 | 98.91 | 148.05 | 24.50 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI pelvis with contrast | 72196 | 1909.38 | Russell Medical Center | OP | 2459.05 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1735.80 | 336.99 | 336.99 | 2719.42 | 330.25 | 2719.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI pelvis without contrast | 72195 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT pelvis with and without contrast | 72194 | 829.62 | Russell Medical Center | OP | 1068.45 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 754.20 | 160.81 | 160.81 | 1181.58 | 157.60 | 1181.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT pelvis without contrast | 72192 | 413.16 | Russell Medical Center | OP | 532.10 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 375.60 | 98.91 | 98.91 | 588.44 | 96.93 | 588.44 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of pelvis | 72170 | 112.43 | Russell Medical Center | OP | 144.80 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 102.21 | 98.91 | 98.91 | 160.13 | 18.28 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI lumbar spine with and without contrast | 72158 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI chest spine with and without contrast | 72157 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI neck spine without and with contrast | 72156 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI lumbar spine with contrast | 72149 | 1909.38 | Russell Medical Center | OP | 2459.05 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1735.80 | 336.99 | 336.99 | 2719.42 | 330.25 | 2719.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI chest spine with contrast | 72147 | 1889.58 | Russell Medical Center | OP | 2433.55 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1717.80 | 336.99 | 336.99 | 2691.22 | 330.25 | 2691.22 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI chest spine without contrast | 72146 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI neck spine with contrast | 72142 | 1909.38 | Russell Medical Center | OP | 2459.05 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1735.80 | 336.99 | 336.99 | 2719.42 | 330.25 | 2719.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI neck spine without contrast | 72141 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT lumbar spine with and without contrast | 72133 | 925.32 | Russell Medical Center | OP | 1191.70 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 841.20 | 160.81 | 160.81 | 1317.88 | 157.60 | 1317.88 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT lumbar spine with contrast | 72132 | 650.76 | Russell Medical Center | OP | 838.10 | 336.99 | 423.54 | 330.25 | 611.73 | 336.99 | 591.60 | 336.99 | 336.99 | 926.84 | 330.25 | 926.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT lumbar spine without contrast | 72131 | 619.74 | Russell Medical Center | OP | 798.15 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 563.40 | 98.91 | 98.91 | 882.66 | 96.93 | 882.66 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT chest spine with and without contrast | 72130 | 1011.78 | Russell Medical Center | OP | 1303.05 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 919.80 | 160.81 | 160.81 | 1441.02 | 157.60 | 1441.02 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT chest spine with contrast | 72129 | 875.82 | Russell Medical Center | OP | 1127.95 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 796.20 | 160.81 | 160.81 | 1247.38 | 157.60 | 1247.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT chest spine without contrast | 72128 | 619.74 | Russell Medical Center | OP | 798.15 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 563.40 | 98.91 | 98.91 | 882.66 | 96.93 | 882.66 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT neck spine with and without contrast | 72127 | 497.61 | Russell Medical Center | OP | 640.86 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 452.37 | 160.81 | 160.81 | 708.71 | 157.60 | 708.71 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT neck spine with contrast | 72126 | 447.58 | Russell Medical Center | OP | 576.43 | 336.99 | 423.54 | 330.25 | 611.73 | 336.99 | 406.89 | 336.99 | 336.99 | 637.46 | 330.25 | 637.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT neck spine without contrast | 72125 | 619.74 | Russell Medical Center | OP | 798.15 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 563.40 | 98.91 | 98.91 | 882.66 | 96.93 | 882.66 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray bend only lumbosacral spine | 72120 | 68.31 | Russell Medical Center | OP | 87.98 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 62.10 | 98.91 | 98.91 | 97.29 | 62.10 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam lumbosacral spine complete | 72114 | 112.43 | Russell Medical Center | OP | 144.80 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 102.21 | 98.91 | 98.91 | 160.13 | 77.69 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam lumbosacral spine 2-3 views | 72100 | 68.15 | Russell Medical Center | OP | 87.76 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 61.95 | 98.91 | 98.91 | 97.06 | 24.47 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam entire spine 4-5 views | 72083 | 352.14 | Russell Medical Center | OP | 453.52 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 320.13 | 98.91 | 98.91 | 501.54 | 50.34 | 501.54 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam entire spine 2-3 views | 72082 | 352.14 | Russell Medical Center | OP | 453.52 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 320.13 | 98.91 | 98.91 | 501.54 | 43.29 | 501.54 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam thorac spine 3 views | 72072 | 99.33 | Russell Medical Center | OP | 127.93 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 90.30 | 98.91 | 98.91 | 141.47 | 24.72 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam neck spine 6 views | 72052 | 112.43 | Russell Medical Center | OP | 144.80 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 102.21 | 98.91 | 98.91 | 160.13 | 77.69 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam neck spine 4-5 views | 72050 | 146.19 | Russell Medical Center | OP | 188.28 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 132.90 | 98.91 | 98.91 | 208.21 | 32.45 | 208.21 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam neck spine 2-3 view | 72040 | 77.22 | Russell Medical Center | OP | 99.45 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 70.20 | 70.43 | 70.43 | 109.98 | 24.47 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam of spine 1 view | 72020 | 127.84 | Russell Medical Center | OP | 164.65 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 116.22 | 70.43 | 70.43 | 182.08 | 69.03 | 182.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI chest with and without contrast | 71552 | 2463.12 | Russell Medical Center | OP | 3172.20 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 2239.20 | 336.99 | 336.99 | 3508.08 | 330.25 | 3508.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI chest with contrast | 71551 | 1909.38 | Russell Medical Center | OP | 2459.05 | 600.84 | 601.85 | 588.82 | 1090.67 | 600.84 | 1735.80 | 600.84 | 600.84 | 2719.42 | 588.82 | 2719.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI chest without contrast | 71550 | 1339.14 | Russell Medical Center | OP | 1724.65 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1217.40 | 205.66 | 205.66 | 1907.26 | 201.55 | 1907.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT thorax with and without contrast | 71270 | 605.88 | Russell Medical Center | OP | 780.30 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 550.80 | 160.81 | 160.81 | 862.92 | 157.60 | 862.92 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT thorax with contrast | 71260 | 560.34 | Russell Medical Center | OP | 721.65 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 509.40 | 160.81 | 160.81 | 798.06 | 157.60 | 798.06 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT thorax without contrast | 71250 | 347.82 | Russell Medical Center | OP | 447.95 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 316.20 | 98.91 | 98.91 | 495.38 | 96.93 | 495.38 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray strenoclavic joint 3 views | 71130 | 82.50 | Russell Medical Center | OP | 106.25 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 75.00 | 70.43 | 70.43 | 117.50 | 25.59 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam breastbone 2 views | 71120 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 21.06 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam ribs and/ or chest 4 views | 71111 | 155.93 | Russell Medical Center | OP | 200.81 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 141.75 | 98.91 | 98.91 | 222.08 | 33.03 | 222.08 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam ribs bilateral 3 views | 71110 | 81.84 | Russell Medical Center | OP | 105.40 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 74.40 | 98.91 | 98.91 | 116.56 | 74.40 | 179.56 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam unilateral ribs and chest | 71101 | 128.54 | Russell Medical Center | OP | 165.54 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 116.85 | 98.91 | 98.91 | 183.07 | 26.39 | 183.07 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam ribs unilateral 2 views | 71100 | 82.17 | Russell Medical Center | OP | 105.83 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 74.70 | 70.43 | 70.43 | 117.03 | 22.90 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam chest 4+ views | 71048 | 170.94 | Russell Medical Center | OP | 220.15 | 98.91 | 77.69 | 96.93 | 179.56 | 98.91 | 155.40 | 98.91 | 98.91 | 243.46 | 77.69 | 243.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam chest 3 views | 71047 | 89.10 | Russell Medical Center | OP | 114.75 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 81.00 | 70.43 | 70.43 | 126.90 | 69.03 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam chest 2 views | 71046 | 89.10 | Russell Medical Center | OP | 114.75 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 81.00 | 70.43 | 70.43 | 126.90 | 21.11 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
X-ray exam chest 1 view | 71045 | 89.10 | Russell Medical Center | OP | 114.75 | 70.43 | 77.69 | 69.03 | 127.85 | 70.43 | 81.00 | 70.43 | 70.43 | 126.90 | 16.09 | 127.85 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI orbit/face/neck with contrast | 70542 | 1909.38 | Russell Medical Center | OP | 2459.05 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1735.80 | 336.99 | 336.99 | 2719.42 | 330.25 | 2719.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI orbit/face/neck without contrast | 70540 | 1353.66 | Russell Medical Center | OP | 1743.35 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 1230.60 | 205.66 | 205.66 | 1927.94 | 201.55 | 1927.94 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT soft tissue of neck with and without contrast | 70492 | 830.94 | Russell Medical Center | OP | 1070.15 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 755.40 | 160.81 | 160.81 | 1183.46 | 157.60 | 1183.46 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT soft tissue neck with contrast | 70491 | 571.56 | Russell Medical Center | OP | 736.10 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 519.60 | 160.81 | 160.81 | 814.04 | 157.60 | 814.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT soft tissue neck without contrast | 70490 | 413.16 | Russell Medical Center | OP | 532.10 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 375.60 | 98.91 | 98.91 | 588.44 | 96.93 | 588.44 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT maxillofacial with and without contrast | 70488 | 896.28 | Russell Medical Center | OP | 1154.30 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 814.80 | 160.81 | 160.81 | 1276.52 | 157.60 | 1276.52 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT maxillofacial with contrast | 70487 | 778.14 | Russell Medical Center | OP | 1002.15 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 707.40 | 160.81 | 160.81 | 1108.26 | 157.60 | 1108.26 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT maxillofacial without contrast | 70486 | 476.52 | Russell Medical Center | OP | 613.70 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 433.20 | 98.91 | 98.91 | 678.68 | 96.93 | 678.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT orbit or ear with and without contrast | 70482 | 655.38 | Russell Medical Center | OP | 844.05 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 595.80 | 160.81 | 160.81 | 933.42 | 157.60 | 933.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT orbit or ear with contrast | 70481 | 554.40 | Russell Medical Center | OP | 714.00 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 504.00 | 160.81 | 160.81 | 789.60 | 157.60 | 789.60 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT orbit or ear without contrast | 70480 | 509.52 | Russell Medical Center | OP | 656.20 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 463.20 | 98.91 | 98.91 | 725.68 | 96.93 | 725.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT head or brain without and with contrast | 70470 | 838.86 | Russell Medical Center | OP | 1080.35 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 762.60 | 160.81 | 160.81 | 1194.74 | 157.60 | 1194.74 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT head or brain with contrast | 70460 | 570.90 | Russell Medical Center | OP | 735.25 | 160.81 | 423.54 | 157.60 | 291.92 | 160.81 | 519.00 | 160.81 | 160.81 | 813.10 | 157.60 | 813.10 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EKG Routine with 12+ leads (interpretation & report) | 93010 | 23.76 | Russell Medical Center | OP | 30.60 | Not Applicable | 36.66 | Not Applicable | Not Applicable | Not Applicable | 21.60 | Not Applicable | Not Applicable | 33.84 | 6.99 | 36.66 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Complete EEG-Sleep Deprived | 95816 | 358.38 | Russell Medical Center | OP | 461.55 | 223.37 | 342.89 | 218.90 | 405.47 | 223.37 | 325.80 | 223.37 | 223.37 | 510.42 | 127.00 | 510.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tumor Wholebody Single | 78802 | 1852.62 | Russell Medical Center | OP | 2385.95 | 1122.73 | 1203.38 | 1100.28 | 2038.04 | 1122.73 | 1684.20 | 1122.73 | 1122.73 | 2638.58 | 1100.28 | 2638.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Echo Stress | 93350 | 651.42 | Russell Medical Center | OP | 838.95 | 425.00 | 673.61 | 416.50 | 771.49 | 425.00 | 592.20 | 425.00 | 425.00 | 927.78 | 416.50 | 927.78 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Echo Doppler Limited | 93321 | 215.48 | Russell Medical Center | OP | 277.52 | 0.00 | 673.61 | 0.00 | 0.00 | 0.00 | 195.89 | 0.00 | 0.00 | 306.90 | 0.00 | 673.61 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ECG Non-Monitored | 93797 | 159.72 | Russell Medical Center | OP | 205.70 | 97.10 | 215.44 | 95.16 | 176.27 | 97.10 | 145.20 | 97.10 | 97.10 | 227.48 | 95.16 | 227.48 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6 Minute Walk Test | 94618 | 151.14 | Russell Medical Center | OP | 194.65 | 96.22 | 342.65 | 94.30 | 174.67 | 96.22 | 137.40 | 96.22 | 96.22 | 215.26 | 27.16 | 342.65 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Angiography Neck | 70498 | 504.15 | Russell Medical Center | OP | 649.29 | 160.81 | 446.71 | 157.60 | 291.92 | 160.81 | 458.32 | 160.81 | 160.81 | 718.04 | 157.60 | 718.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
T-Spine without Constrast | 72128 | 619.74 | Russell Medical Center | OP | 798.15 | 98.91 | 163.57 | 96.93 | 179.56 | 98.91 | 563.40 | 98.91 | 98.91 | 882.66 | 96.93 | 882.66 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Coronary Angiography with/ without Calcium | 75574 | 655.38 | Russell Medical Center | OP | 844.05 | 160.81 | 446.71 | 157.60 | 291.92 | 160.81 | 595.80 | 160.81 | 160.81 | 933.42 | 157.60 | 933.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Heart without Contrast Calcium | 75571 | 85.80 | Russell Medical Center | OP | 110.50 | 70.43 | 163.57 | 69.03 | 127.85 | 70.43 | 78.00 | 70.43 | 70.43 | 122.20 | 69.03 | 163.57 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Angiography Chest | 71275 | 560.34 | Russell Medical Center | OP | 721.65 | 160.81 | 446.71 | 157.60 | 291.92 | 160.81 | 509.40 | 160.81 | 160.81 | 798.06 | 157.60 | 798.06 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Angiography Pelvis | 72191 | 504.15 | Russell Medical Center | OP | 649.29 | 160.81 | 446.71 | 157.60 | 291.92 | 160.81 | 458.32 | 160.81 | 160.81 | 718.04 | 157.60 | 718.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Angiography Abdominal Arteries | 75635 | 504.15 | Russell Medical Center | OP | 649.29 | 160.81 | 446.71 | 157.60 | 291.92 | 160.81 | 458.32 | 160.81 | 160.81 | 718.04 | 157.60 | 718.04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT Guide For Needle Placement | 77012 | 730.62 | Russell Medical Center | OP | 940.95 | 0.00 | 143.83 | 0.00 | 0.00 | 0.00 | 664.20 | 0.00 | 0.00 | 1040.58 | 0.00 | 1040.58 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fine Needle Aspiration Biopsy | 10010 | 79.86 | Russell Medical Center | OP | 102.85 | 0.00 | 878.20 | 0.00 | 0.00 | 0.00 | 72.60 | 0.00 | 0.00 | 113.74 | 0.00 | 878.20 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI MRA Brain Without Contrast | 70551 | 2399.76 | Russell Medical Center | OP | 3090.60 | 205.66 | 344.84 | 201.55 | 373.33 | 205.66 | 2181.60 | 205.66 | 205.66 | 3417.84 | 201.55 | 3417.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRA Neck Without Contrast | 70547 | 1046.10 | Russell Medical Center | OP | 1347.25 | 205.66 | 585.08 | 201.55 | 373.33 | 205.66 | 951.00 | 205.66 | 205.66 | 1489.90 | 201.55 | 1489.90 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI IACS WITH CONTRAST | 70552 | 1909.38 | Russell Medical Center | OP | 2459.05 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1735.80 | 336.99 | 336.99 | 2719.42 | 330.25 | 2719.42 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Repair of groin hernia patient age 5 years or older | Primary Procedure | 360 | 49505 | 1793.88 | Russell Medical Center | OP | 2310.30 | 2744.05 | 3390.58 | 2689.17 | 4981.15 | 2744.05 | 1630.80 | 2744.05 | 2744.05 | 2554.92 | 426.59 | 4981.15 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 250 | 476.92 | Russell Medical Center | OP | 614.21 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 433.56 | Not Applicable | Not Applicable | 679.24 | 433.56 | 679.24 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 270 | 1026.00 | Russell Medical Center | OP | 1321.37 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 932.73 | Not Applicable | Not Applicable | 1461.28 | 932.73 | 1461.28 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplies | 272 | 363.86 | Russell Medical Center | OP | 468.61 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 330.78 | Not Applicable | Not Applicable | 518.22 | 330.78 | 518.22 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0330 | 11.22 | Russell Medical Center | OP | 14.45 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 10.20 | 0.00 | 0.00 | 15.98 | 0.00 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J2405 | 79.86 | Russell Medical Center | OP | 102.85 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 72.60 | 0.00 | 0.00 | 113.74 | 0.00 | 113.74 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J1100 | 12.87 | Russell Medical Center | OP | 16.58 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 11.70 | 0.00 | 0.00 | 18.33 | 0.00 | 18.33 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J0690 | 16.50 | Russell Medical Center | OP | 21.25 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 15.00 | 0.00 | 0.00 | 23.50 | 0.00 | 23.50 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 636 | J3010 | 11.22 | Russell Medical Center | OP | 14.45 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 10.20 | 0.00 | 0.00 | 15.98 | 0.00 | 15.98 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pharmacy | 637 | A9270 | 2.15 | Russell Medical Center | OP | 2.76 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 1.95 | 0.00 | 0.00 | 3.06 | 0.00 | 3.06 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recovery Room | 710 | 377.52 | Russell Medical Center | OP | 486.20 | Not Applicable | Not Applicable | Not Applicable | Not Applicable | Not Applicable | 343.20 | Not Applicable | Not Applicable | 537.68 | 343.20 | 537.68 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgical removal of prostate and surrounding lymph nodes using an endoscope | Primary Procedure | 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance | Primary Procedure | 64483 | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). | MS-DRG | 473 | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | Service not provided | 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 | Primary Procedure | 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ultrasound examination of lower large bowel using an endoscope | Primary Procedure | 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Routine obstetric care for vaginal delivery, including pre-and post- delivery care | Primary Procedure | 59400 | 1821.60 | Russell Medical Center | OP | 2210.00 | Not Applicable | 2208.00 | Not Applicable | 1643.12 | 1727.31 | 1656.00 | Not Applicable | 2049.54 | 2594.40 | 1643.12 | 2659.25 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Routine obstetric care for cesarean delivery, including pre-and post-delivery care | Primary Procedure | 59510 | 1821.60 | Russell Medical Center | OP | 2210.00 | Not Applicable | 2268.19 | Not Applicable | 1862.67 | 1911.56 | 1656.00 | Not Applicable | 2268.19 | 2594.40 | 1656.00 | 3403.14 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Electrocardiogram, routine, with interpretation and report | Primary Procedure | 93000 | 34.98 | Russell Medical Center | OP | 42.00 | Not Applicable | 33.12 | Not Applicable | 25.54 | 13.48 | 31.80 | 0.00 | 15.95 | 49.82 | 0.00 | 49.82 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRI Pelvis With & Without Contrast | 72197 | 2016.30 | Russell Medical Center | OP | 2596.75 | 336.99 | 601.85 | 330.25 | 611.73 | 336.99 | 1833.00 | 336.99 | 336.99 | 2871.70 | 330.25 | 2871.70 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
TriGlycerides VAP Lab | 84478 | 37.95 | Russell Medical Center | OP | 48.88 | 5.74 | 6.55 | 5.63 | 5.17 | 5.74 | 34.50 | 5.74 | 5.74 | 54.05 | 5.17 | 54.05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Potassium | 84132 | 4.46 | Russell Medical Center | OP | 5.74 | 4.76 | 6.55 | 4.66 | 0.00 | 4.76 | 4.05 | 4.76 | 4.76 | 6.35 | 0.00 | 6.55 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Lyme Disease Test | 86617 | 49.74 | Russell Medical Center | OP | 64.06 | 15.49 | 14.59 | 15.18 | 0.00 | 15.49 | 45.22 | 15.49 | 15.49 | 70.84 | 0.00 | 70.84 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
MRA Left Lower Extremity with Contrast | 73725 | 1364.88 | Russell Medical Center | OP | 1757.80 | Not Applicable | 585.08 | Not Applicable | Not Applicable | Not Applicable | 1240.80 | Not Applicable | Not Applicable | 1943.92 | 585.08 | 1943.92 |
The following pricing may not reflect the total amount due on a claim, nor does it reflect your financial responsibility as a patient. Pricing and services included reflect a typical encounter; however, your physician may render a different variation of services to provide you the best level of care.
Pricing listed represents negotiated rates effective as of the original posting date of this file. Individual payors have unique effective dates and update parameters within their contracts, which may result in variation of pricing for some services as changes are implemented by each payor. Pricing will be updated annually in accordance with stated requirements.
The inclusion of pricing below does not indicate that a service is covered under your benefit plan. Actual claim reimbursement made by payor can vary based on many factors including but not limited to individual benefit structures, utilization management decisions, diagnosis, and case by case treatment rendered. Members should always consult with their health plans and physician(s) to validate treatment and cost planning decisions.
"Included in primary procedure" indicates that, typically, the specified service is not separately priced; rather, it is considered packaged with the primary procedure pricing by a specific payor.
Professional services provided by a physician or other practitioner not employed by RMC are separately billable. These services are contracted with the applicable professional and thus not reflected in the hospital agreement or consumer table.
CPT codes 54000, 59510, and 93000 represent the global professional component only. Separate codes and pricing are applied by the facility for stated services performed in the IP or OP setting. Pricing represents professional services when performed by a RMC employed physician only. Physician pricing is negotiated seperately.
For questions regarding your bill or insurance coverage, please contact our Business Office at 256-329-7308 during the hours of 8 am – 4:30 pm Monday – Friday.