Visits & medical services prices at Community Hospital, LLC

Oklahoma City, OK · every code in this section with a posted price and a Medicare benchmark.

574 codes. Prices are the hospital's own posted facility charges.

Compare against other hospitals interactively →

ProcedurePosted cashPosted gross× Medicare
1St psychiatric collab care mgmt 1st 70 mins (99492) $293.13 — 3.0×
1St set-up & prgrmg phys/qhp of wearable cvdfb (93745) $886.20 — 3.0×
Ablate Heart Dysrhythm Focus (93650) $22,504.44 — 3.0×
Acoustic Immit Test Tympanometry/Acoust Reflex/Decay (92570) $371.25 — 3.0×
Acoustic Reflex Testing (92568) $107.76 — 3.0×
Actigraphy Testing Recording Analysis I&R (95803) $170.22 — 3.0×
Actinotherapy Ultraviolet Light (96900) $107.76 — 3.0×
Acupunct W/Stimul 15 Min (97813) $83.46 — 3.0×
Acupuncture 1/> ndles w/o elec stimj init 15 min (97810) $83.46 — 3.0×
Adapt bhv tx prtcl modificaj phys/qhp ea 15 min (97155) $512.13 — 3.0×
Adaptive behavior tx by protocol tech ea 15 min (97153) $293.13 — 3.0×
Admn Sarscov2 Vacc 1 Dose (90480) $117.27 — 3.0×
Advncd Care Plan 30 Min (99497) $293.13 — 3.0×
Aep Hearing Status Deter Broadband Stimuli I&R (92651) $623.01 — 3.0×
Aep neurodiagnostic i&r (92653) $623.01 — 3.0×
Aep threshold estimation mlt frequencies i&r (92652) $623.01 $1,165 3.0×
Airway Inhalation Treatment (94640) $631.83 $584 3.0×
Airway resistance by oscillometry (94728) $371.25 — 3.0×
Allg test perq & ic drug/biol immed react w/ i&r (95018) $107.76 — 3.0×
Allg tstg perq & ic venoms immed react w/i&r (95017) $83.46 — 3.0×
Ambulatory bp mntr w/sw 24 hr+ recording only (93786) $383.88 — 3.0×
Ambulatory bp mntr w/sw 24 hr+ scanning a/r (93788) $383.88 — 3.0×
Analysis Cochlear Implt Pt <7 Yr Prgrmg (92601) $371.25 — 3.0×
Analysis w/prgrmg aud brainstem implant pr hr (92640) $371.25 — 3.0×
Analyze neurostim complex (95972) $274.32 $444 3.0×
Analyze neurostim no prog (95970) $383.88 — 3.0×
Analyze Neurostim Simple (95971) $274.32 — 3.0×
Analyze Pacemaker System (93724) $886.20 — 3.0×
Anogenital Xm Magnify Child/Suspect Trauma W Img (99170) $583.32 — 3.0×
Ans parasymp & symp w/tilt (95924) $623.01 — 3.0×
Ant Sgm Imaging W/Fluoroscein Angio & I&R (92287) $383.88 — 3.0×
Ant sgm imaging w/microscopy endothelial analy (92286) $383.88 — 3.0×
Appl modality 1+ areas lllt po pain reduction (97037) $107.76 — 3.0×
Application on-body injector (96377) $135.12 — 3.0×
Arrhythmia Induction (93618) $3,512.97 — 3.0×
Art pressure waveform analys (93050) $83.46 — 3.0×
Assessment of tinnitus (92625) $371.25 — 3.0×
Assmt & care planning pt w/cognitive impairment (99483) $293.13 — 3.0×
Audiometry Air & Bone (92553) $371.25 — 3.0×
Auditory Function, 60 Min (92620) $371.25 — 3.0×
Basic vestibular evaluation (92540) $623.01 — 3.0×
Behavior id assessment by phys/qhp ea 15 min (97151) $293.13 — 3.0×
Behavior id support assmt by 1 tech ea 15 min (97152) $293.13 — 3.0×
Bioimpedance Cv Analysis (93701) $383.88 — 3.0×
Bis Xtracell Fluid Analysis (93702) $371.25 — 3.0×
Blink reflex test (95933) $170.22 — 3.0×
Breath hydrogen/methane test (91065) $623.01 — 3.0×
Breathing response to hypoxia (94450) $371.25 — 3.0×
Brief Emotional/Behav Assmt (96127) $107.76 — 3.0×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $1,076.67 $979 3.0×
Bundle of his recording (93600) $22,504.44 — 3.0×
C motor evoked uppr limbs (95928) $2,477.73 — 3.0×
C motor evoked upr&lwr limbs (95939) $2,477.73 — 3.0×
Caloric vestibular test w/rec bi monothermal (92538) $623.01 — 3.0×
Caloric Vstblr Test W/Rec (92537) $371.25 — 3.0×
Car seat/bed test 60 min (94780) $107.76 — 3.0×
Cardiac Stress Tst,Tracing Only (93017) $623.01 — 3.0×
Cardiopulmonary exercise testing (94621) $1,076.67 — 3.0×
Cardiopulmonary resuscitation (92950) $623.01 $963 3.0×
Cardioversion (92960) $1,907.04 $4,399 3.0×
Cardioversion elective internal (92961) $1,907.04 — 3.0×
Care mgmt services behavioral hlth cond 20 mins (99484) $108.12 — 3.0×
Caregiver hlth risk assmt score doc stnd instrm (96161) $108.12 — 3.0×
Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) $9,353.97 — 3.0×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $9,353.97 — 3.0×
Cbt 1st hour (94644) $383.88 $270 3.0×
Cdp-Sot 6 Conditions W/I&R W/Mct & Adt (92549) $383.88 — 3.0×
Cervical & Ocular Vemp Testing W/I&R (92519) $623.01 — 3.0×
Cervical Vemp Testing W/I&R (92517) $371.25 — 3.0×
Chemo Admin Peritoneal Cavity (96446) $953.04 — 3.0×
Chemo Anti-Neopl Sq/Im (96401) $207.75 — 3.0×
Chemo Hormon Antineopl Sq/Im (96402) $207.75 — 3.0×
Chemo Ia Push (96420) $953.04 — 3.0×
Chemo Intralesional Over 7 (96406) $613.71 — 3.0×
Chemo intralesional up to 7 (96405) $207.75 — 3.0×
Chemo IV infusion addl hr (96415) $207.75 — 3.0×
Chemo IV push addl drug (96411) $207.75 — 3.0×
Chemother Prolong Infuse W/Pump (96416) $953.04 — 3.0×
Chemotherapy Admin Intra-Arterial Infus </1 Hr (96422) $953.04 — 3.0×
Chemotherapy Admn Intraarterial Infusion Ea Hr (96423) $135.12 — 3.0×
Chemotherapy Into Cns (96450) $953.04 — 3.0×
Chemotherapy Intracavitary (96440) $953.04 — 3.0×
Chemotherapy Unspecified (96549) $135.12 — 3.0×
Chemotx Admn Ia Nfs >8 Hr Prtble Impltbl Pmp (96425) $953.04 — 3.0×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $207.75 — 3.0×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $953.04 — 3.0×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $953.04 — 3.0×
Chemotx Njx Subarachnd/Intraventr Rsvr 1/Mult (96542) $953.04 — 3.0×
Chest Wall Manipulation (94668) $383.88 $330 3.0×
Chiropract manj 3-4 regions (98941) $62.31 — 3.0×
Chiropractic manipulative treatment (CMT); spinal, 1-2 regions Facility (98940) $62.31 — 3.0×
Chiropractic manipulative treatment (CMT); spinal, 5 regions Facility (98942) $62.31 — 3.0×
Chron Care Mgmt Srvc 20 Min (99490) $293.13 — 3.0×
Circadian Respiratry Pattern Rec 12-24 Hr Infant (94772) $1,076.67 — 3.0×
Cmptr ophth dx img ant segmt (92132) $170.22 — 3.0×
Colon Motility 6 Hr Study (91117) $623.01 — 3.0×
Color Vision Xm Extended Anomaloscope/Equiv (92283) $170.22 — 3.0×
Color/duplex Doppler, complete (93975) $688.44 $3,452 3.0×
Color/duplex Doppler, limited (93976) $301.65 $855 3.0×
Complex chronic care mgmt svc 1st 60 min cal mo (99487) $512.13 — 3.0×
Compre cptr mtn alys w/dyn plntr pres meas walkg (96001) $2,477.73 — 3.0×
Comprehensive computer-based motion analysis by video-taping and 3D kinematics; Facility (96000) $1,076.67 — 3.0×
Comprehensive Hearing Test (92557) $371.25 — 3.0×
Computerized dynamic posturography (92548) $383.88 — 3.0×
Computerized Ophthalmic Imaging Optic Nerve (92133) $170.22 — 3.0×
Computerized Ophthalmic Imaging Retina (92134) $170.22 — 3.0×
Conditioning Play Audiometry (92582) $371.25 — 3.0×
Cont gluc mntr physician/qhp provided equiptment (95250) $384.15 — 3.0×
Cont Gluc Mntr Pt Prov Eqp (95249) $170.22 — 3.0×
Contact Lens Fit,Corneoscleral Lens (92313) $383.88 — 3.0×
Continuous Pulse Ox (94762) $371.25 — 3.0×
Cornea hysteresis determin impulse stimj uni/bi (92145) $170.22 — 3.0×
Corneal Topography (92025) $170.22 — 3.0×
Coronary Art/Grft Angio S&I (93455) $9,353.97 — 3.0×
Coronary Artery Angio S&I (93454) $9,353.97 — 3.0×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $631.83 $1,312 3.0×
Cpt initial (94667) $383.88 $404 3.0×
Cptrizd oph dx img pst sgm uni/bi rta oct angrph (92137) $623.01 — 3.0×
Critical care first hour (99291) $2,383.35 $6,336 3.0×
Ctr Motor Ep Std Transcrnl Motor Stimj Lwr Limbs (95929) $1,076.67 — 3.0×
Dark Adaptation Eye Exam (92284) $1,288.95 — 3.0×
Debridement Open Wound 20 Sq Cm< (97597) $578.88 $1,576 3.0×
Debridement Prmlg Hyperkeratotic Les W/Pdt (96574) $578.88 — 3.0×
Developmental tst admin phys/qhp 1st hour (96112) $371.25 — 3.0×
Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming Facility (92602) $371.25 — 3.0×
Dialysis One Evaluation (90945) $1,203.93 — 3.0×
Distrt prod evokd otoacoustic emsns comp/dx eval (92588) $1,076.67 — 3.0×
Duodenal motility study (91022) $1,076.67 — 3.0×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $688.44 — 3.0×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $301.65 — 3.0×
Dup-Scan Artl Infl&Ven O/F Pen Vsl Compl (93980) $301.65 — 3.0×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $688.44 $3,186 3.0×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $301.65 $2,196 3.0×
Dup-Scan Xtr Veins Complete Bilateral Study (93970)
range across 2 matching MRF lines
$688.44 $2,777–$4,860 3.0×
Dup-scan xtr veins unilateral/limited study (93971) $301.65 $2,074 3.0×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) $688.44 — 3.0×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) $301.65 — 3.0×
Duplex Scan Hemodialysis Access (93990) $301.65 — 3.0×
Duplex up extrem art bilat (93930) $688.44 $3,049 3.0×
Duplex up extrem art unilat/ltd (93931) $301.65 $1,846 3.0×
Dx aly prgrmg&verif aud oi sound processr 1st 60 (92622) $371.25 — 3.0×
Dx Anal Cochlear Imp,Pt >7 Yrs,Reprog (92604) $371.25 — 3.0×
Dx Anal Cochlear Imp,Pt >7 Yrs,W/Prog (92603) $371.25 — 3.0×
Dyn surf EMG walkg/funcjal actv 1-12 musc (96002) $623.01 — 3.0×
Ear and throat examination (92502) $1,556.13 — 3.0×
Ear Protector Evaluation (92596) $107.76 — 3.0×
ECG/monitoring and analysis (93271) $274.32 — 3.0×
Echo Congenital Complete (93303) $1,576.59 — 3.0×
Echo Heart Xthoracic,Limited (93308) $688.44 $887 3.0×
Echo r-t 2d w/probe placement only (93313) $1,576.59 — 3.0×
Echo transesophag congen probe plcmt only (93316) $1,576.59 — 3.0×
Echo transesophag montr cardiac pump functj (93318) $1,576.59 — 3.0×
Echo transesophageal (93312) $1,576.59 — 3.0×
Echo Transesophageal - Congenital Tee Complete (93315) $1,576.59 — 3.0×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,576.59 — 3.0×
Ecog Implanted Brain Npgt W/Rec I&R <30 Days (95836) $107.67 — 3.0×
Eeg 41-60 Minutes (95812) $623.01 — 3.0×
EEG awake and asleep (95819) $623.01 — 3.0×
EEG awake drowsy (95816) $623.01 — 3.0×
EEG cerebral death evaluation (95824) $1,076.67 — 3.0×
EEG cont rec w/video by tech min 8 channels (95700) $623.01 — 3.0×
EEG extended monitoring 61-119 minutes (95813) $623.01 — 3.0×
Eeg Sleep Only (95822) $623.01 — 3.0×
Eeg W/O Vid 2-12 Hr Unmntr (95705) $623.01 — 3.0×
EEG w/o vid 2-12hr cont mntr (95707) $623.01 — 3.0×
EEG w/o vid ea 12-26hr intmt (95709) $1,076.67 — 3.0×
Eeg W/O Vid Tech Ea Incr 12-26 Hr Cont R-T Mntr (95710) $1,076.67 — 3.0×
EEG w/o video by tech 2-12 hr intermittent mntr (95706) $623.01 — 3.0×
EEG wo vid ea 12-26hr unmntr (95708) $1,076.67 — 3.0×
EKG signal averaged (93278) $170.22 — 3.0×
Elec alys implt brn npgt prgrmg 1st 15 min (95983) $274.32 — 3.0×
Elec Alys Implt Cplx Cn Npgt Prgrmg (95977) $274.32 — 3.0×
Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) $107.67 — 3.0×
Electro-Oculography (92270) $383.88 — 3.0×
Electrocardiogram Tracing (93005) $170.22 $581 3.0×
Electrocochleography (92584) $371.25 — 3.0×
Electroconvulsive Therapy (90870) $2,477.73 — 3.0×
Electrogastrography, diagnostic, transcutaneous; Non-Facility (91132) $623.01 — 3.0×
Electrogastrography, diagnostic, transcutaneous; with provocative testing Non-Facility (91133) $383.88 — 3.0×
Electrophysiologic Follow-Up W/Pac/Rec W/Arrhyt (93624) $22,504.44 — 3.0×
Electrophysiology Evaluation (93642) $3,512.97 — 3.0×
Emergency Dept Visit Level 2 (99282) $443.01 $1,100 3.0×
Emergency Dept Visit Level 3 (99283) $787.62 $1,805 3.0×
Emergency Dept Visit Level 4 (99284) $1,203.93 $2,883 3.0×
Emg 3 Extremities (95863) $371.25 — 3.0×
Emg 4 Extremities (95864) $371.25 — 3.0×
Endomyocardial Biopsy (93505) $9,110.31 — 3.0×
Ep & ablate supravent arrhyt (93653) $75,415.80 — 3.0×
Ep & ablate ventric tachy (93654) $75,415.80 — 3.0×
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $22,504.44 — 3.0×
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $22,504.44 — 3.0×
Ep Esophageal Recording Atria+Pacing (93616) $3,512.97 — 3.0×
Er level 1 (99281) $243.30 $651 3.0×
Er level v (99285) $1,718.28 $3,328 3.0×
Ergonovine provocation test (93024) $1,288.95 — 3.0×
Esoph Atrial Electrogram (93615) $3,512.97 — 3.0×
Esophageal Capsule Endoscopy (91111) $2,616.93 — 3.0×
Esophagus acid perfusion test esophagitis (91030) $1,076.67 — 3.0×
Esophgl Balo Distension Dx Std W/Provocation (91040) $1,076.67 — 3.0×
Esophgl funcj g-esop rflx impd eltrd prolng (91038) $1,076.67 — 3.0×
Eval aud funcj cand/po surg implt dev 1st hr (92626) $371.25 — 3.0×
Evaluate pt use of inhaler (94664) $631.83 $584 3.0×
Evoked Auditory Test,Limited (92587) $623.01 — 3.0×
Excimer laser tx psoriasis 250-500 sq cm (96921) $578.88 — 3.0×
Excimer laser tx psoriasis >500 sq cm (96922) $1,172.91 — 3.0×
Excimer laser tx psoriasis tot area <250 sq cm (96920) $578.88 — 3.0×
Exercise test for bronchospasm (94617) $383.88 — 3.0×
Exhaled Air Analysis O2 (94680) $371.25 — 3.0×
External ECG rec>48hr<7d recording (93242) $107.76 — 3.0×
External ECG rec>48hr<7d scanning alys w/report (93243) $383.88 — 3.0×
External ECG rec>7d<15d recording (93246) $107.76 — 3.0×
External ECG rec>7d<15d scanning alys w/report (93247) $383.88 — 3.0×
External Ecg Scanning Analysis Report (93226) $170.22 — 3.0×
Extracranial Bilat Study (93880) $688.44 $2,925 3.0×
Extracranial Uni/Ltd Study (93882) $301.65 $1,880 3.0×
Eye Allergy Tests (95060) $383.88 — 3.0×
Eye exam w anesth; complete (92018) $6,859.77 — 3.0×
Eye exam w anesth; limited (92019) $6,859.77 — 3.0×
Eye Exam With Photos (92230) $1,076.67 — 3.0×
F-up/limited tthrc echo congenital car anomaly (93304) $1,576.59 $1,952 3.0×
Facial nerve function studies (92516) $623.01 — 3.0×
Family adapt bhv tx gdn phys/qhp ea 15 min (97156) $108.12 — 3.0×
Filtered Speech Test (92571) $107.76 — 3.0×
Fitting of spectacle mounted low vision aid; single element system Facility (92354) $107.76 — 3.0×
Fitting of spectacle mounted low vision aid; telescopic or other compound lens system Non-Facility OP Neurology,… (92355) $107.76 — 3.0×
Fitting of spectacle prosthesis for aphakia; monofocal Facility (92352) $170.22 — 3.0×
Fitting of spectacle prosthesis for aphakia; multifocal Facility (92353) $170.22 — 3.0×
Fluorescein angiography (92235) $623.01 — 3.0×
Fluorescein Icg Angrph W/Multiframe I&R Uni/Bi (92242) $623.01 — 3.0×
Full Field Electroretinography W/I&R (92273) $623.01 — 3.0×
Funcjal Cort&Subcort Mapg Phys/Qhp Attnd Init Hr (95961) $2,477.73 — 3.0×
Fundus photography (92250) $383.88 — 3.0×
Gastric motility studies (91020) $1,076.67 — 3.0×
Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) $1,076.67 — 3.0×
Gastroesophag Reflx Test W/Intrluml Imped Eltrd (91037) $623.01 — 3.0×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $2,477.73 $2,375 3.0×
Gi tract capsule endoscopy (91110) $2,616.93 $4,918 3.0×
Gi tract imaging intraluminal colon i&r (91113) $2,683.23 — 3.0×
Gi wireless capsule measure (91112) $2,616.93 — 3.0×
Gonioscopy (92020) $383.88 — 3.0×
Group adaptive bhv tx by protocol tech ea 15 min (97154) $108.12 — 3.0×
Grp adapt bhv prtcl modifcaj phys/qhp ea 15 min (97158) $108.12 — 3.0×
Health Behavior Assessment/Re-Assessment (96156) $293.13 — 3.0×
Health behavior ivntj fam w/pt f2f 1st 30 min (96167) $108.12 — 3.0×
Health behavior ivntj group f2f 1st 30 min (96164) $108.12 — 3.0×
Health behavior ivntj indiv f2f 1st 30 min (96158) $512.13 — 3.0×
Heart catheterization, both sides, with coronary and bypass graft angiography (93461) $9,353.97 — 3.0×
Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935) $1,980.24 — 3.0×
High altitude simulation test (94452) $383.88 — 3.0×
High Altitude Simulatj W/Phys I&R W/O2 Titration (94453) $383.88 — 3.0×
Holter monitor recording (93225) $383.88 — 3.0×
Hypnotherapy (90880) $293.13 — 3.0×
Ic Tsts W/Allgic Xtrcs Dlyd Typ Rxn W/Reading (95028) $107.76 — 3.0×
Icd Device Interrogate (93289) $107.67 — 3.0×
Icd device progr eval dual (93283) $107.67 — 3.0×
Icd Device Progr Eval Mult (93284) $107.67 — 3.0×
Icm Device Eval (93290) $107.67 — 3.0×
Ilr Device Eval Progr (93285) $107.67 — 3.0×
Ilr Device Interrogate (93291) $83.46 — 3.0×
Im Adm Intransl/Oral 1 Vaccine (90473) $207.75 — 3.0×
Img retina detcj/mntr ds poc auton a/r uni/bi (92229) $170.22 — 3.0×
Img retina detcj/mntr ds rem clin staff uni/bi (92227) $170.22 — 3.0×
Img Retina Detcj/Mntr Ds Rem Phys/Qhp I&R Uni/Bi (92228) $107.76 — 3.0×
Immunization administration (90471) $207.75 $229 3.0×
Indocyanine-green angrph w/multiframe i&r uni/bi (92240) $623.01 — 3.0×
Ingestion challenge test initial 120 minutes (95076) $1,076.67 — 3.0×
Inhlj Brncl Challenge Tstg W/Histam/Methachol (95070) $1,076.67 — 3.0×
Inital newborn e/m (99460) $384.15 — 3.0×
Insert/Place Heart Catheter (93503) $4,541.91 — 3.0×
Interrog&prgrmg impl phrenic nrv stimulator sys (93151) $274.32 — 3.0×
Interrog&prgrmg ipnss during polysomnography (93152) $886.20 — 3.0×
Interrogate Subq Defib (93261) $107.67 — 3.0×
Interrogation eval in person wr defibrillator (93292) $107.67 — 3.0×
Interrogation vad in person (93750) $274.32 — 3.0×
Interrogation without programming ipnss (93153) $274.32 — 3.0×
Intra-atrial pacing (93610) $22,504.44 — 3.0×
Intra-atrial recording (93602) $22,504.44 — 3.0×
Intracranial Complete Study (93886) $688.44 — 3.0×
Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens,… (95027) $83.46 — 3.0×
Intracutaneous tests w/allergenic extracts (95024) $170.22 — 3.0×
Intraventricular pacing (93612) $22,504.44 — 3.0×
Io anal gast n-stim subsq (95981) $170.22 — 3.0×
Io ga n-stim subsq w/reprog (95982) $107.67 — 3.0×
Irrig Drug Delivery Device (96523) $170.22 $112 3.0×
Ischemic limb exercise test (95875) $371.25 — 3.0×
IV infusion hydration each additional hour (96361) $135.12 $584 3.0×
IV infusion hydration initial 31 min-1 hour (96360) $613.71 $913 3.0×
IV infusion ther proph addl sequential to 1 hr (96367) $207.75 $313 3.0×
IV infusion therapy prophylaxis/dx ea hour (96366) $135.12 $217 3.0×
IV push initial (96374) $613.71 $558 3.0×
L Hrt Art/Grft Angio (93459) $9,353.97 — 3.0×
L Hrt Cath Chd Img Cath Trgt Zon Nml/Abnl Nt Cnj (93595) $9,353.97 — 3.0×
Laryngeal Function Studies (92520) $383.88 — 3.0×
Liver Elastography W/O Imag W/I&R (91200) $371.25 — 3.0×
Loudness balance test (92562) $623.01 — 3.0×
Low frequency non-thermal us (97610) $578.88 — 3.0×
Lung Function Test (Mbc/Mvv) (94200) $170.22 — 3.0×
Lwr Xtr Vasc Stdy Bilat (93924) $623.01 — 3.0×
Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (eg, sensory, motor,… (95966) $2,477.73 — 3.0×
Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (eg, epileptic cerebral… (95965) $2,477.73 — 3.0×
Meas Spiro Frcd Exp Flo Pre&Post Bronch Inf/2yrs (94012) $623.01 — 3.0×
Measurement Lung Volumes Infant/Child/2 Yrs (94013) $1,076.67 — 3.0×
Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age Facility (94011) $371.25 — 3.0×
Mechanical chest wall oscillation per session (94669) $631.83 $584 3.0×
Methacholine challenge (94070) $1,076.67 — 3.0×
Microvolt T-Wave Assess (93025) $371.25 — 3.0×
Modification of contact lens (separate procedure), with medical supervision of adaptation Facility (92325) $383.88 — 3.0×
Motility study esophagus (91010) $1,076.67 $1,481 3.0×
Motor &/sens nrv cndj preconf eltrd array limb (95905) $1,288.95 — 3.0×
Multifocal Electroretinography W/I&R (92274) $371.25 — 3.0×
Multiple fam group bhv tx gdn phys/qhp ea 15 min (97157) $108.12 — 3.0×
Multiple Family Group Psychotherapy (90849) $512.13 — 3.0×
Multiple Sleep Latency Test (95805) $2,477.73 — 3.0×
Muscle Test 2 Limbs (95861) $383.88 — 3.0×
Muscle Test Hemidiaphragm (95866) $371.25 — 3.0×
Muscle Test Nonparaspinal (95870) $383.88 — 3.0×
Muscle Test One Limb (95860) $383.88 — 3.0×
Narcosynthesis (90865) $512.13 — 3.0×
Nasal function studies (92512) $623.01 — 3.0×
Nasopharyngoscopy (92511) $575.94 — 3.0×
Needle Electromyography Cranial Nrv Muscle Bi (95868) $623.01 — 3.0×
Needle Electromyography Cranial Nrv Muscle Uni (95867) $623.01 — 3.0×
Needle electromyography larynx (95865) $383.88 — 3.0×
Needle Emg Thrc Paraspi Musc Excluding T1/T12 (95869) $623.01 — 3.0×
Needle EMG w/1 fiber electrode quan meas jitter (95872) $623.01 — 3.0×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $1,172.91 — 3.0×
Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) $1,172.91 — 3.0×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $578.88 — 3.0×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $1,172.91 — 3.0×
Nerve Conduction Studies 1-2 Studies (95907) $623.01 — 3.0×
Nerve Conduction Studies 11-12 Studies (95912) $1,076.67 — 3.0×
Nerve conduction studies 13 or more studies (95913) $1,076.67 — 3.0×
Nerve Conduction Studies 3-4 Studies (95908) $623.01 — 3.0×
Nerve conduction studies 5-6 studies (95909) $623.01 — 3.0×
Nerve conduction studies 7-8 studies (95910) $1,076.67 — 3.0×
Nerve Conduction Studies 9-10 Studies (95911) $1,076.67 — 3.0×
Neurobehavioral Status Exam (96116) $623.01 — 3.0×
Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) $371.25 — 3.0×
Neuromuscular Reeducation (97112) — $279 —
Newborn resuscitation (99465) $1,907.04 — 3.0×
Nitric oxide expired gas determination (95012) $107.76 — 3.0×
Nose Allergy Test (95065) $107.76 — 3.0×
Nrpsyc tst eval phys/qhp 1st (96132) $1,076.67 — 3.0×
O2 Uptk Exp Gas Alys W/Co2 Output % O2 Xtrc (94681) $1,076.67 — 3.0×
Ocular Vemp Testing W/I&R (92518) $371.25 — 3.0×
Oculoelectromyography (92265) $170.22 — 3.0×
Oph bmtry prtl coher intrfrmtry io lens pwr cal (92136) $383.88 — 3.0×
Ophth Medical Xm&Eval Compre New Pt 1/> Vst (92004) $384.15 — 3.0×
Ophth medical xm&eval comprhnsv estab pt 1/> (92014) $384.15 — 3.0×
Ophth medical xm&eval intermediate estab pt (92012) $384.15 — 3.0×
Ophth Medical Xm&Eval Intermediate New Pt (92002) $384.15 — 3.0×
Ophthalmodynamometry (92260) $107.76 — 3.0×
Opscpy extnd optic nrv/macula drawing i&r uni/bi (92202) $170.22 — 3.0×
Opscpy extnd rta drawing & scl deprsn i&r uni/bi (92201) $170.22 — 3.0×
Optokinetic Nystagmus Test (92544) $371.25 — 3.0×
Orthc/Prostc Mgmt Sbsq Enc (97763) — $208 —
Orthoptic training under supervision of phys/qhp (92066) $170.22 — 3.0×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) — $268 —
Oscillating Tracking Test (92545) $623.01 — 3.0×
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $62.31 — 3.0×
Osteopathic manipulative tx 3-4 body regions (98926) $62.31 — 3.0×
Osteopathic manipulative tx 5-6 body regions (98927) $62.31 — 3.0×
Osteopathic manipulative tx 7-8 body regions (98928) $62.31 — 3.0×
Osteopathic manipulative tx 9-10 body regions (98929) $62.31 — 3.0×
Ot manual therapy 15 min (97140) — $268 —
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $371.94 — 3.0×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $371.94 — 3.0×
Oxygen Uptake Rest Indirect (94690) $170.22 — 3.0×
Patch/Application Test Specify Number Tests (95044) $2,477.73 — 3.0×
Patient-initiated spirometric phys/qhp r&i only (94016) — $24 —
Patient-initiated spirometric recording (94015) $623.01 — 3.0×
Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of… (94014) $1,288.95 — 3.0×
Pdt dstr prmlg les phys/qhp (96573) $578.88 — 3.0×
Pdt dstr prmlg les skn illum/activj per day (96567) $578.88 — 3.0×
Pediatric apnea monitor analyses computer (94776) $371.25 — 3.0×
Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of… (94775) $371.25 — 3.0×
Penile Vascular Study,Ltd or F/U (93981) $301.65 — 3.0×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $631.83 — 3.0×
Percutaneous tests w/allergenic extracts (95004) $2,477.73 — 3.0×
Peripheral arterial disease rehab per session (93668) $170.22 — 3.0×
Perq transcath closure pda (93582) $52,892.43 — 3.0×
Perq Transcath Cls Aortic (93591) $52,892.43 — 3.0×
Perq Transcath Cls Mitral (93590) $52,892.43 — 3.0×
Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) $16,421.91 — 3.0×
Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) $33,308.55 — 3.0×
Phlebotomy therapeutic (99195) $383.88 — 3.0×
Photo patch test(s) (95052) $170.22 — 3.0×
Photo Tests (95056) $383.88 — 3.0×
Photochemotherapy Dermatoses 4-8 Hrs Supervision (96913) $1,172.91 — 3.0×
Photochemotx Psoralens&Ultraviolet Puva (96912) $170.22 — 3.0×
Photochemotx Tar&Uvb/Petrolatum/Uvb (96910) $170.22 — 3.0×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $170.22 — 3.0×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $170.22 — 3.0×
Plethysmography (94726) $1,076.67 — 3.0×
Pm device eval in person (93288) $107.67 $110 3.0×
Pm device progr eval dual (93280) $107.67 — 3.0×
Pm device progr eval multi (93281) $107.67 — 3.0×
Pm Device Progr Eval Sngl (93279) $107.67 — 3.0×
Pm/Icd Remote Tech Serv (93296) $107.67 — 3.0×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,477.73 — 3.0×
Polysom <6 yrs 4/> paramtrs (95782) $2,477.73 — 3.0×
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $2,477.73 — 3.0×
Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) $2,477.73 — 3.0×
Positional nystagmus test (92542) $383.88 — 3.0×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $135.12 — 3.0×
Prepj& Antigen Allergen Immunotherapy 1 Insect (95145) $135.12 — 3.0×
Prepj& antigen allergen immunotherapy 2 insect (95146) $135.12 — 3.0×
Prepj& Antigen Allergen Immunotherapy 3 Insect (95147) $207.75 — 3.0×
Prepj& antigen allergen immunotherapy 5 insect (95149) $207.75 — 3.0×
Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of… (92311) $1,288.95 — 3.0×
Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and… (92316) $383.88 — 3.0×
Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and… (92315) $383.88 — 3.0×
Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and… (92317) $107.76 — 3.0×
Prgrmg Dev Eval Implantable Subq Lead Dfb System (93260) $107.67 — 3.0×
Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) $107.67 — 3.0×
Principal care management services, for a single high-risk disease, with the following required elements: one complex… (99426) $293.13 — 3.0×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $135.12 — 3.0×
Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) $135.12 — 3.0×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95148) $207.75 — 3.0×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single… (95144) $135.12 — 3.0×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole… (95170) $135.12 — 3.0×
Prosthesis service for aphakia, temporary (disposable or loan, including materials) Facility (92358) $170.22 — 3.0×
Prq Card Angio/Athrect 1 Art (92924) $33,308.55 — 3.0×
Prq Card Stent W/Angio 1 Vsl (92928) $33,308.55 — 3.0×
Prq Card Stent/Ath/Angio (92933) $52,892.43 — 3.0×
Prq Revasc Byp Graft 1 Vsl (92937) $33,308.55 — 3.0×
Prq Tcat Clsr Cgen Ventr Septal Dfct W/Implt (93581) $52,892.43 — 3.0×
Prq trluml pulmonary art balloon angiop 1 vsl (92997) $33,308.55 — 3.0×
Psych diag eval w/med srvcs (90792) $512.13 — 3.0×
Psychiatric diagnostic evaluation (90791) $512.13 — 3.0×
Psychoanalysis (90845) $512.13 — 3.0×
Psychological tst eval svc phys/qhp first hour (96130) $623.01 — 3.0×
Psycl/Nrpsyc Tst Auto Result (96146) $83.46 — 3.0×
Psycl/nrpsycl tst tech 2+ tst 1st 30 min (96138) $1,288.95 — 3.0×
Psyl/nrpsycl tst phys/qhp 2+ tst 1st 30 min (96136) $383.88 — 3.0×
Psytx Crisis Initial 60 Min (90839) $512.13 — 3.0×
Pt Eval High Complex (97163) — $605 —
Pt eval low complex 20 min (97161) — $466 —
Pt Eval Mod Complex (97162) — $536 —
Pt gait training 15 min (97116) — $242 —
Pt Re-Eval Est Plan Care (97164) — $284 —
Pt-focused hlth risk assmt score doc stnd instrm (96160) $108.12 — 3.0×
Pulm function test by gas (94727) $623.01 $849 3.0×
Pulmonary service/procedure (94799) $371.25 $1,077 3.0×
Pulmonary Stress Testing (94618) $383.88 $482 3.0×
Pure Tone Audiometry Air (92552) $383.88 — 3.0×
Quan puplmtry phy/qhp uni/bi (95919) $383.88 — 3.0×
R Hrt Art/Grft Angio (93457) $9,353.97 — 3.0×
R Hrt Cath Chd W/Img Cath Trgt Zon Abnl Nt Connj (93594) $9,353.97 — 3.0×
R Hrt Cath Chd W/Img Cath Trgt Zone Nml Nt Connj (93593) $9,353.97 — 3.0×
R hrt coronary artery angio (93456) $9,353.97 — 3.0×
R&L Hrt Cath Chd Img Cath Trgt Zon Abnl Nt Connj (93597) $9,353.97 — 3.0×
R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj (93596) $9,353.97 — 3.0×
R&L Hrt Cath W/Ventriclgrphy (93453) $9,353.97 — 3.0×
Rapid Desensitization Procedure Each Hour (95180) $1,288.95 — 3.0×
Refill&Maintenance Pump Drug Dlvr Spinal/Brain (95990) $953.04 — 3.0×
Refill/Maint Portable Pump (96521) $613.71 $407 3.0×
Refill/Maint Pump/Resvr Syst (96522) $613.71 $409 3.0×
Rem interrog icpms <30 d phys/qhp (93297) $107.67 — 3.0×
Rem Interrog Scrms <30 D Phys/Qhp (93298) $107.67 — 3.0×
Rem mntr physiol param 1st dev supply ea 30 d (99454) $107.67 — 3.0×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $384.15 — 3.0×
Rem Mntr Wrls P-Art Prs Snr (93264) $107.67 — 3.0×
Rem Ther Mntr Dev Sply Cbt (98978) $107.67 — 3.0×
Rem ther mntr dev sply data muscskel sys ea 30 d (98977) $107.67 — 3.0×
Rem ther mntr dev sply resp (98976) $107.67 — 3.0×
Remote 30 Day Ecg Rev/Report (93270) $107.67 — 3.0×
Remote 30 Day Ecg Tech Supp (93229) $1,076.67 — 3.0×
Remote therapeutic mntr 1st set-up&pt educaj eqp (98975) $384.15 — 3.0×
Repair and refitting spectacles; spectacle prosthesis for aphakia Facility (92371) $170.22 — 3.0×
Repet tms tx initial w/map/motr threshld/del&m (90867) $623.01 — 3.0×
Repet Tms Tx Subseq Motr Threshld W/Deliv & Mngt (90869) $623.01 — 3.0×
Replacement of contact lens (92326) $170.22 — 3.0×
Respiratory flow volume loop (94375) $623.01 — 3.0×
Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) $170.22 $270 3.0×
Right Heart Cath (93451) $9,353.97 — 3.0×
Right ventricular recording (93603) $3,512.97 — 3.0×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $578.88 — 3.0×
Rx&Fitg Contact Corneal Lens Aphakia Both Eyes (92312) $383.88 — 3.0×
Rx/Physical Eeg Activaj Phys/Qhp Attendance (95954) $1,076.67 — 3.0×
Same day nb discharge (99463) $384.15 — 3.0×
Sbsq Psyc Collab Care Mgmt (99493) $293.13 — 3.0×
Select picture audiometry (92583) $170.22 — 3.0×
Self Care Mngment Training (97535) — $214 —
Self-meas bp pt educaj/traing & dev calibration (99473) $83.46 — 3.0×
Sensormotor xm w/mlt meas ocular devij w/i&r spx (92060) $170.22 — 3.0×
Short-Latency Somatosens Ep Std Trnk/Head (95927) $623.01 — 3.0×
Short-latency somatosens ep std upr limbs (95925) $623.01 — 3.0×
Sinusoidal Vertical Axis Rotational Testing (92546) $371.25 — 3.0×
Sleep study attended (95807) $1,076.67 — 3.0×
Sleep study unattended (95806) $623.01 — 3.0×
Slp Stdy Unatnd W/Anal (95801) $170.22 — 3.0×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $623.01 — 3.0×
Somatosensory Testing (95938) $2,477.73 — 3.0×
Speech Audiometry Complete (92556) $170.22 — 3.0×
Speech audiometry threshold (92555) $170.22 — 3.0×
Spin/Brain Pump Refil & Main (95991) $885.66 — 3.0×
Spirometry (94010) $623.01 $351 3.0×
Spontaneous Nystagmus Test (92541) $383.88 — 3.0×
Ssep lower limbs (95926) $623.01 — 3.0×
Staggered Spondaic Word Test (92572) $371.25 — 3.0×
Stenger Test Speech (92577) $1,076.67 — 3.0×
Stenger Test, Pure Tone (92565) $170.22 — 3.0×
Stress Tte Only (93350) $1,576.59 — 3.0×
Subcutaneous Infusion Each Additional Hour (96370) $135.12 $124 3.0×
Subcutaneous infusion initial 1 hr w/pump set-up (96369) $613.71 $535 3.0×
Subq Infusion Additional Pump Infusion Site (96371) $207.75 $429 3.0×
Surfactant Admin Thru Tube (94610) $631.83 — 3.0×
Synthetic Sentence Identification Test (92576) $107.76 — 3.0×
Tcd std icr art ven-artl shnt detcj IV mbubb njx (93893) $301.65 — 3.0×
Temp transcutaneous pacing (92953) $1,907.04 $1,631 3.0×
Temperature Gradient Studies (93740) $371.25 — 3.0×
Tensilon Test (95857) $623.01 — 3.0×
Test to assess hearing loss using different tone pitches (92575) $107.76 — 3.0×
Testing Autonomic Nervous System Function (95923) $383.88 — 3.0×
Ther Activation Impl Phrenic Nrv Stimulator Sys (93150) $274.32 — 3.0×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) — $195 —
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) — $219 —
Ther/Prop/Diag Inj/Inf Proc (96379) $135.12 $102 3.0×
Ther/Proph/Diag Inj Ia (96373) $613.71 — 3.0×
Ther/Proph/Diag Inj Sc/Im (96372) $207.75 $247 3.0×
Ther/Proph/Diag Iv Inf Init (96365) $613.71 $721 3.0×
Therap repetitive tms tx subseq delivery & mng (90868) $623.01 — 3.0×
Therapeutic Activities (97530) — $189 —
Tilt table test with heart rhythm and blood pressure monitoring (93660) $1,076.67 — 3.0×
Tobacco Use Cessation Intensive >10 Minutes (99407) $108.12 $223 3.0×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $108.12 $223 3.0×
Tone Decay Test (92563) $107.76 — 3.0×
Trans Care Mgmt 14 Day Disch (99495) $384.15 — 3.0×
Trans Care Mgmt 7 Day Disch (99496) $384.15 — 3.0×
Transcath Closure of Asd (93580) $52,892.43 — 3.0×
Transcranial Doppler Intracran Art Emboli Detect (93892) $301.65 — 3.0×
Transcranial Doppler Stdy Intracranial Art Lmtd (93888) $301.65 — 3.0×
Transtelephonic Rhythm Strip Pacemaker Eval (93293) $107.67 — 3.0×
Tstg Ans Funcj Cardiovagal Innervaj Parasymp (95921) $371.25 — 3.0×
Tstg ans funcj vasomotor adrenergic innervaj (95922) $383.88 — 3.0×
Tte w/doppler, complete (93306) $1,576.59 $6,774 3.0×
Tte W/O Doppler Complete (93307) $688.44 $1,738 3.0×
Tx atrial fib pulm vein isol (93656) $75,415.80 — 3.0×
Tx/Pro/Dx Inj New Drug Addon (96375) $135.12 $217 3.0×
Tympanometry (92567) $107.76 — 3.0×
Tympanometry and reflex threshold measurements (92550) $623.01 — 3.0×
Unlis neurological/neuromuscular dx px (95999) $371.25 — 3.0×
Unlisted allergy/clinical immunologic srvc/px (95199) $83.46 — 3.0×
Unlisted cardiovascular service/procedure (93799) $371.25 — 3.0×
Unlisted Diagnostic Gastroenterology Procedure (91299) $371.25 — 3.0×
Unlisted noninvasive vascular diagnostic study (93998) $83.46 $372 3.0×
Unlisted ophthalmological service/procedure (92499) $83.46 — 3.0×
Unlisted otorhinolaryngological service (92700) $83.46 — 3.0×
Unlisted Psychiatric Service/Procedure (90899) $108.12 — 3.0×
Unlisted Special Dermatological Service/Px (96999) $578.88 — 3.0×
Upr/L Xtremity Art 2 Levels (93922) $383.88 — 3.0×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $623.01 — 3.0×
Valvuloplasty aortic valve (92986) $16,421.91 — 3.0×
Valvuloplasty mitral valve (92987) $33,308.55 — 3.0×
Valvuloplasty pulmonary valve (92990) $33,308.55 — 3.0×
Veeg 2-12 Hr Cont Mntr (95713) $1,076.67 — 3.0×
Veeg 2-12 hr intmt mntr (95712) $1,076.67 — 3.0×
Veeg 2-12 hr unmonitored (95711) $623.01 — 3.0×
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $1,076.67 — 3.0×
Veeg Ea 12-26 Hr Unmntr (95714) $1,076.67 — 3.0×
Veeg ea 12-26hr cont mntr (95716) $2,477.73 — 3.0×
Vent Mgmt Inpat Init Day (94002)
range across 2 matching MRF lines
$1,782.51 $430–$5,431 3.0×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,782.51 $3,981 3.0×
Visual Evoked Potential Test (95930) $623.01 — 3.0×
Visual Field Exam Extended (92083) $383.88 — 3.0×
Visual field xm uni/bi w/interp intermed exam (92082) $170.22 — 3.0×
Visual field xm uni/bi w/interpretj limited exam (92081) $170.22 — 3.0×
Visual reinforcement audiometry (vra) (92579) $623.01 — 3.0×
Vital capacity, total (94150) $371.25 — 3.0×
Wada Activation Test Hemispheric Function W/Eeg (95958) $2,477.73 — 3.0×
Wheelchair Mgmt Ea 15 Min (97542) — $105 —
Xers tst brncspsm pre&post spmtry&pls ox wo /ECG (94619) $170.22 — 3.0×
Xtrnl Ocular Photog W/I&R Docmt Medical Progre (92285) $107.76 — 3.0×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.