Services Offered/ Pricing
Outpatient Services Documentation
The following documentation is required for hospital outpatient services to be rendered:
-
- Documentation that supports medical necessity of the outpatient service (e.g. physician’s office visit note, or progress note, etc.)
- A signed and dated physician’s order for the outpatient service
- All patients without a written order will be seen through the emergency room after a free medical screening (emergency room charges will apply)
Single Laboratory Tests
Name of Lab Test (single), CPT Code, Price
| Laboratory Test (single) | CPT Code | Price |
|---|---|---|
| ABO/RH | 86901/86900 | $60 |
| Ammonia | 82140 | $75 |
| Basic Metabolic Panel (BMP) | 80048 | $55 |
| Blood Type | 86900 | $55 |
| Cholesterol | 82465 | $50 |
| Complete Blood Count (CBC) | 85027 | $60 |
| Comprehensive Metabolic Panel (CMP) | 80053 | $60 |
| CRP | 86140 | $35 |
| D-Dimer | 85379 | $60 |
| ESR | 85652 | $35 |
| Fe & TIBC | 83540/83550 | $55 |
| Free T4 | 84439 | $50 |
| HA1C | 83036 | $55 |
| Hepatic Panel (LFT) | 80076 | $55 |
| Joint Fluid (Crystals & Cells) | 89060/89051 | $125 |
| Lactate Level (CG4) | 82803/83605 | $55 |
| Lipase | 83690 | $55 |
| Lipid Panel | 83960 | $55 |
| Magnesium | 80051 | $55 |
| Phenytoin Total | 80185 | $50 |
| Phlebotomy & Handling | 36415 | $20 |
| Prothrombin Time with INR (PT/INR) | 85730 | $50 |
| PT | 85610 | $30 |
| PTT | 85730 | $30 |
| RH | 86901 | $55 |
| Serum Pregnancy (Qualitative) | 84703 | $35 |
| T3 | 84480 | $50 |
| Thyroid Scree (FT4 & TSH) | 84439/84443 | $90 |
| Triglycerides | 84478 | $25 |
| TSH | 84443 | $55 |
| Uric Acid Level | 84550 | $25 |
| Urinalysis - Routine (UA) | 81001 | $35 |
| Urinalysis -Culture (UAC) | 87088 | $55 |
| Urine Pregnancy Test -Qualitative (HCG) | 81025 | $35 |
| Valproic Acid Level | 80164 | $50 |
Panels
Name of Panel, Includes, Price
| Included | Price | |
|---|---|---|
| Nutrition Lab Panel | CMP. CBC, Iron, Thiamine, Vitamin B12, Folate, Vitamin D, Vitamin C, Zinc | $175 |
| Pre-Operative Lab Panel | CBC, CMP, RH Factor, PT/INR, aPTT | $140 |
| STD Panel 1 (NAAT) | GC, Chlamydia, Trich | $650 |
| STD Panel 2 (NAAT) | GC, Chlamydia, Trich, Herpes | $750 |
| Thyroid Panel | TSH, FT3, FT4, T3 Uptake | $115 |
Studies
Name of Study, Price
| Study | Price |
|---|---|
| X-Ray Any Single Extremity or Joint, 2 views/3 views | $100 |
| Chest X-Ray, 1 view | $115 |
| Chest X-Ray PA & LAT, 2 views | $150 |
| X-Ray C-Spine | $150 |
| X-Ray T-Spine | $150 |
| x-Ray L-Spine | $150 |
| CT Any Body Part Without Contrast | $399 |
| CT Any Body Part with Contrast | $499, labs & IV included |
| CT Angiogram Any Body Part | $549, labs & IV included |
| Ultrasound EXCEPT Transvaginal/Pelvis | $399 |
| Ultrasound Pregnancy with Labs | $699 |
| Ultrasound Transvaginal/Pelvis | $750 |
| MRI Any Body Part Without Contrast | $529 |
| MRI Any Body part With Contrast | $599, labs & IV included |
Point of Care Laboratory Tests
Name of Point of Care Lab Test, CPT Code, Price
| Point Of Care Laboratory Tests (single) | CPT Code | Price |
|---|---|---|
| Fingerstick Glucose | 82962 | $20 |
| Urine Drug Screen (10 Panel) | 80300 | $65 |
| Rapid Strep | 87880 | $30 |
| Rapid Influenza | 87804 | $35 |
| EKG | $75 |