Vidant North Hospital - Shoppable Services
Select Plan(s)
  • Aetna: Commercial
  • Aetna: Medicare Advantage
  • BCBSAL: Commercial
  • BCBSAL: Medicare Advantage
  • Cigna: Commercial
  • Coventry First Health: Direct
  • Coventry First Health: PPO
  • Coventry: WellPath
  • Employers Choice Network: Workers Compensation
  • Liberty Advantage: Medicare Advantage
  • Medcost: Ultra
  • Medcost: Commercial
  • Medcost: Employee Benefits Plan
  • United Healthcare: Commercial
  • United Healthcare: Medicare Advantage
  • De-Identified Minimum Negotiated Charge
  • De-Identified Maximum Negotiated Charge
Shoppable Service Primary Service and Ancillary Services Revenue Code Procedure Code Cash Price Service Location Site Type Aetna: Commercial Aetna: Medicare Advantage BCBSAL: Commercial BCBSAL: Medicare Advantage Cigna: Commercial Coventry First Health: Direct Coventry First Health: PPO Coventry: WellPath Employers Choice Network: Workers Compensation Liberty Advantage: Medicare Advantage Medcost: Ultra Medcost: Commercial Medcost: Employee Benefits Plan United Healthcare: Commercial United Healthcare: Medicare Advantage De-Identified Minimum Negotiated Charge De-Identified Maximum Negotiated Charge
Biopsy of prostate gland Primary Procedure 360 55700 4941.30 Vidant North Hospital OP 5788.38 1571.93 4666.00 1571.93 5513.08 6494.28 6494.28 5788.38 2986.67 1697.69 5082.48 5294.25 4235.40 6211.92 1571.93 1571.93 6494.28
Pharmacy 250 J3490, J1956, J2001, J2250 252.71 Vidant North Hospital OP 296.03 Included in Primary Procedure 238.63 Included in Primary Procedure 281.95 332.13 332.13 296.03 Included in Primary Procedure Included in Primary Procedure 259.93 270.76 216.61 317.69 Included in Primary Procedure 216.61 332.13
Supplies 270 115.50 Vidant North Hospital OP 135.30 Included in Primary Procedure 109.07 Included in Primary Procedure 128.87 151.80 151.80 135.30 Included in Primary Procedure Included in Primary Procedure 118.80 123.75 99.00 145.20 Included in Primary Procedure 99.00 151.80
Laboratory 300 80048 118.30 Vidant North Hospital OP 138.58 8.46 111.71 8.46 131.99 155.48 155.48 138.58 16.07 9.14 121.68 126.75 101.40 148.72 8.46 8.46 155.48
Laboratory 300 85025 87.50 Vidant North Hospital OP 102.50 7.77 82.63 7.77 97.63 115.00 115.00 102.50 14.76 8.39 90.00 93.75 75.00 110.00 7.77 7.77 115.00
Laboratory 300 85730 64.40 Vidant North Hospital OP 75.44 6.01 60.81 6.01 71.85 84.64 84.64 75.44 11.42 6.49 66.24 69.00 55.20 80.96 6.01 6.01 84.64
Laboratory 300 85610 35.00 Vidant North Hospital OP 41.00 4.29 33.05 4.29 39.05 46.00 46.00 41.00 8.15 4.63 36.00 37.50 30.00 44.00 4.29 4.29 46.00
Laboratory 300 82962 7.00 Vidant North Hospital OP 8.20 3.28 6.61 3.28 7.81 9.20 9.20 8.20 6.23 3.54 7.20 7.50 6.00 8.80 3.28 3.28 9.20
Laboratory 300 36415 3.50 Vidant North Hospital OP 4.10 3.00 3.31 3.00 3.91 4.60 4.60 4.10 5.70 3.24 3.60 3.75 3.00 4.40 3.00 3.00 5.70
Pathology 310 88305 2377.20 Vidant North Hospital OP 2784.72 43.90 2244.76 43.90 2652.28 3124.32 3124.32 2784.72 83.40 47.41 2445.12 2547.00 2037.60 2988.48 43.90 43.90 3124.32
Anesthesia 370 947.80 Vidant North Hospital OP 1110.28 Included in Primary Procedure 894.99 Included in Primary Procedure 1057.47 1245.68 1245.68 1110.28 Included in Primary Procedure Included in Primary Procedure 974.88 1015.50 812.40 1191.52 Included in Primary Procedure 812.40 1245.68
Respiratory Services 412 94640 22.40 Vidant North Hospital OP 26.24 163.23 21.15 163.23 24.99 29.44 29.44 26.24 310.14 176.29 23.04 24.00 19.20 28.16 163.23 19.20 310.14
Pulmonary Function 460 94760 24.50 Vidant North Hospital OP 28.70 0.00 23.14 0.00 27.34 32.20 32.20 28.70 0.00 0.00 25.20 26.25 21.00 30.80 0.00 0.00 32.20
Pharmacy 636 J2704 84.60 Vidant North Hospital OP 99.11 0.00 79.89 0.00 94.39 111.19 111.19 99.11 0.00 0.00 87.02 90.65 72.52 106.36 0.00 0.00 111.19
Recovery Room 710 549.50 Vidant North Hospital OP 643.70 Included in Primary Procedure 518.89 Included in Primary Procedure 613.09 722.20 722.20 643.70 Included in Primary Procedure Included in Primary Procedure 565.20 588.75 471.00 690.80 Included in Primary Procedure 471.00 722.20
EKG/ECG General 730 93005 123.90 Vidant North Hospital OP 145.14 48.81 117.00 48.81 138.24 162.84 162.84 145.14 92.74 52.72 127.44 132.75 106.20 155.76 48.81 48.81 162.84
Removal of Breast Growth Primary Procedure 360 19120 4978.40 Vidant North Hospital OP 5831.84 2688.18 4701.03 2688.18 5554.47 6543.04 6543.04 5831.84 5107.54 2903.23 5120.64 5334.00 4267.20 6258.56 2688.18 2688.18 6543.04
Pharmacy 250 249.64 Vidant North Hospital OP 292.44 Included in Primary Procedure 235.73 Included in Primary Procedure 278.53 328.10 328.10 292.44 Included in Primary Procedure Included in Primary Procedure 256.77 267.47 213.98 313.83 Included in Primary Procedure 213.98 328.10
Supplies 270 168.70 Vidant North Hospital OP 197.62 Included in Primary Procedure 159.30 Included in Primary Procedure 188.22 221.72 221.72 197.62 Included in Primary Procedure Included in Primary Procedure 173.52 180.75 144.60 212.08 Included in Primary Procedure 144.60 221.72
Laboratory 300 80048 115.50 Vidant North Hospital OP 135.30 Included in Primary Procedure 109.07 Included in Primary Procedure 128.87 151.80 151.80 135.30 Included in Primary Procedure Included in Primary Procedure 118.80 123.75 99.00 145.20 Included in Primary Procedure 99.00 151.80
Laboratory 300 84703 98.70 Vidant North Hospital OP 115.62 Included in Primary Procedure 93.20 Included in Primary Procedure 110.12 129.72 129.72 115.62 Included in Primary Procedure Included in Primary Procedure 101.52 105.75 84.60 124.08 Included in Primary Procedure 84.60 129.72
Laboratory 300 85025 85.40 Vidant North Hospital OP 100.04 Included in Primary Procedure 80.64 Included in Primary Procedure 95.28 112.24 112.24 100.04 Included in Primary Procedure Included in Primary Procedure 87.84 91.50 73.20 107.36 Included in Primary Procedure 73.20 112.24
Laboratory 300 36415 2.80 Vidant North Hospital OP 3.28 Included in Primary Procedure 2.64 Included in Primary Procedure 3.12 3.68 3.68 3.28 Included in Primary Procedure Included in Primary Procedure 2.88 3.00 2.40 3.52 Included in Primary Procedure 2.40 3.68
Pathology 310 88305 387.80 Vidant North Hospital OP 454.28 Included in Primary Procedure 366.19 Included in Primary Procedure 432.67 509.68 509.68 454.28 Included in Primary Procedure Included in Primary Procedure 398.88 415.50 332.40 487.52 Included in Primary Procedure 332.40 509.68
Anesthesia 370 1341.90 Vidant North Hospital OP 1571.94 Included in Primary Procedure 1267.14 Included in Primary Procedure 1497.18 1763.64 1763.64 1571.94 Included in Primary Procedure Included in Primary Procedure 1380.24 1437.75 1150.20 1686.96 Included in Primary Procedure 1150.20 1763.64
Pharmacy 636 J2704 120.99 Vidant North Hospital OP 141.73 Included in Primary Procedure 114.25 Included in Primary Procedure 134.99 159.01 159.01 141.73 Included in Primary Procedure Included in Primary Procedure 124.44 129.63 103.70 152.10 Included in Primary Procedure 103.70 159.01
Recovery Room 710 549.50 Vidant North Hospital OP 643.70 Included in Primary Procedure 518.89 Included in Primary Procedure 613.09 722.20 722.20 643.70 Included in Primary Procedure Included in Primary Procedure 565.20 588.75 471.00 690.80 Included in Primary Procedure 471.00 722.20
Endoscopic Removal of Single Knee Cartilage Primary Procedure 360 29881 5624.50 Vidant North Hospital OP 6588.70 2428.99 5311.14 2428.99 6275.34 7392.20 7392.20 6588.70 4615.09 2623.31 5785.20 6026.25 4821.00 7070.80 2428.99 2428.99 7392.20
Pharmacy 250 326.67 Vidant North Hospital OP 382.67 Included in Primary Procedure 308.47 Included in Primary Procedure 364.47 429.34 429.34 382.67 Included in Primary Procedure Included in Primary Procedure 336.00 350.00 280.00 410.67 Included in Primary Procedure 280.00 429.34
Supplies 270 204.40 Vidant North Hospital OP 239.44 Included in Primary Procedure 193.01 Included in Primary Procedure 228.05 268.64 268.64 239.44 Included in Primary Procedure Included in Primary Procedure 210.24 219.00 175.20 256.96 Included in Primary Procedure 175.20 268.64
Laboratory 300 85025 87.50 Vidant North Hospital OP 102.50 Included in Primary Procedure 82.63 Included in Primary Procedure 97.63 115.00 115.00 102.50 Included in Primary Procedure Included in Primary Procedure 90.00 93.75 75.00 110.00 Included in Primary Procedure 75.00 115.00
Laboratory 300 36415 3.50 Vidant North Hospital OP 4.10 Included in Primary Procedure 3.31 Included in Primary Procedure 3.91 4.60 4.60 4.10 Included in Primary Procedure Included in Primary Procedure 3.60 3.75 3.00 4.40 Included in Primary Procedure 3.00 4.60
Anesthesia 370 1088.50 Vidant North Hospital OP 1275.10 Included in Primary Procedure 1027.86 Included in Primary Procedure 1214.46 1430.60 1430.60 1275.10 Included in Primary Procedure Included in Primary Procedure 1119.60 1166.25 933.00 1368.40 Included in Primary Procedure 933.00 1430.60
Pharmacy 636 J2704 84.60 Vidant North Hospital OP 99.11 Included in Primary Procedure 79.89 Included in Primary Procedure 94.39 111.19 111.19 99.11 Included in Primary Procedure Included in Primary Procedure 87.02 90.65 72.52 106.36 Included in Primary Procedure 72.52 111.19
Recovery Room 710 549.50 Vidant North Hospital OP 643.70 Included in Primary Procedure 518.89 Included in Primary Procedure 613.09 722.20 722.20 643.70 Included in Primary Procedure Included in Primary Procedure 565.20 588.75 471.00 690.80 Included in Primary Procedure 471.00 722.20
EKG/ECG General 730 93005 123.90 Vidant North Hospital OP 145.14 48.81 117.00 48.81 138.24 162.84 162.84 145.14 92.74 52.72 127.44 132.75 106.20 155.76 48.81 48.81 162.84
Endoscopic diagnostic examination of esophagus, stomach, and/or upper small bowel Primary Procedure 360 43235 865.20 Vidant North Hospital OP 1013.52 697.36 817.00 697.36 965.32 1137.12 1137.12 1013.52 1324.99 753.15 889.92 927.00 741.60 1087.68 697.36 697.36 1324.99
Pharmacy 250 26.07 Vidant North Hospital OP 30.54 Included in Primary Procedure 24.62 Included in Primary Procedure 29.08 34.26 34.26 30.54 Included in Primary Procedure Included in Primary Procedure 26.81 27.93 22.34 32.77 Included in Primary Procedure 22.34 34.26
Supplies 270 59.50 Vidant North Hospital OP 69.70 Included in Primary Procedure 56.19 Included in Primary Procedure 66.39 78.20 78.20 69.70 Included in Primary Procedure Included in Primary Procedure 61.20 63.75 51.00 74.80 Included in Primary Procedure 51.00 78.20
Pharmacy 636 J2704 84.10 Vidant North Hospital OP 98.51 Included in Primary Procedure 79.41 Included in Primary Procedure 93.83 110.53 110.53 98.51 Included in Primary Procedure Included in Primary Procedure 86.50 90.11 72.08 105.72 Included in Primary Procedure 72.08 110.53
Endoscopic biopsy of the esophagus, stomach, and/or upper small bowel Primary Procedure 360 43239 882.70 Vidant North Hospital OP 1034.02 697.36 833.52 697.36 984.84 1160.12 1160.12 1034.02 1324.99 753.15 907.92 945.75 756.60 1109.68 697.36 697.36 1324.99
Pharmacy 250 862.95 Vidant North Hospital OP 1010.88 Included in Primary Procedure 814.87 Included in Primary Procedure 962.80 1134.16 1134.16 1010.88 Included in Primary Procedure Included in Primary Procedure 887.60 924.59 739.67 1084.85 Included in Primary Procedure 739.67 1134.16
IV Therapy 260 66365 232.40 Vidant North Hospital OP 272.24 Included in Primary Procedure 219.45 Included in Primary Procedure 259.29 305.44 305.44 272.24 Included in Primary Procedure Included in Primary Procedure 239.04 249.00 199.20 292.16 Included in Primary Procedure 199.20 305.44
IV Therapy 260 96376 285.60 Vidant North Hospital OP 334.56 Included in Primary Procedure 269.69 Included in Primary Procedure 318.65 375.36 375.36 334.56 Included in Primary Procedure Included in Primary Procedure 293.76 306.00 244.80 359.04 Included in Primary Procedure 244.80 375.36
Supplies 270 965.30 Vidant North Hospital OP 1130.78 Included in Primary Procedure 911.52 Included in Primary Procedure 1077.00 1268.68 1268.68 1130.78 Included in Primary Procedure Included in Primary Procedure 992.88 1034.25 827.40 1213.52 Included in Primary Procedure 827.40 1268.68
Laboratory 300 84484 380.80 Vidant North Hospital OP 446.08 Included in Primary Procedure 359.58 Included in Primary Procedure 424.86 500.48 500.48 446.08 Included in Primary Procedure Included in Primary Procedure 391.68 408.00 326.40 478.72 Included in Primary Procedure 326.40 500.48
Laboratory 300 80053 184.10 Vidant North Hospital OP 215.66 Included in Primary Procedure 173.84 Included in Primary Procedure 205.40 241.96 241.96 215.66 Included in Primary Procedure Included in Primary Procedure 189.36 197.25 157.80 231.44 Included in Primary Procedure 157.80 241.96
Laboratory 300 86922 140.00 Vidant North Hospital OP 164.00 Included in Primary Procedure 132.20 Included in Primary Procedure 156.20 184.00 184.00 164.00 Included in Primary Procedure Included in Primary Procedure 144.00 150.00 120.00 176.00 Included in Primary Procedure 120.00 184.00
Laboratory 300 80061 137.20 Vidant North Hospital OP 160.72 13.39 129.56 13.39 153.08 180.32 180.32 160.72 25.44 14.46 141.12 147.00 117.60 172.48 13.39 13.39 180.32
Laboratory 300 80048 473.20 Vidant North Hospital OP 554.32 Included in Primary Procedure 446.84 Included in Primary Procedure 527.96 621.92 621.92 554.32 Included in Primary Procedure Included in Primary Procedure 486.72 507.00 405.60 594.88 Included in Primary Procedure 405.60 621.92
Laboratory 300 82150 97.30 Vidant North Hospital OP 113.98 Included in Primary Procedure 91.88 Included in Primary Procedure 108.56 127.88 127.88 113.98 Included in Primary Procedure Included in Primary Procedure 100.08 104.25 83.40 122.32 Included in Primary Procedure 83.40 127.88
Laboratory 300 85025 437.50 Vidant North Hospital OP 512.50 Included in Primary Procedure 413.13 Included in Primary Procedure 488.13 575.00 575.00 512.50 Included in Primary Procedure Included in Primary Procedure 450.00 468.75 375.00 550.00 Included in Primary Procedure 375.00 575.00
Laboratory 300 73690 71.40 Vidant North Hospital OP 83.64 Included in Primary Procedure 67.42 Included in Primary Procedure 79.66 93.84 93.84 83.64 Included in Primary Procedure Included in Primary Procedure 73.44 76.50 61.20 89.76 Included in Primary Procedure 61.20 93.84
Laboratory 300 83605 69.30 Vidant North Hospital OP 81.18 Included in Primary Procedure 65.44 Included in Primary Procedure 77.32 91.08 91.08 81.18 Included in Primary Procedure Included in Primary Procedure 71.28 74.25 59.40 87.12 Included in Primary Procedure 59.40 91.08
Laboratory 300 82552 64.40 Vidant North Hospital OP 75.44 Included in Primary Procedure 60.81 Included in Primary Procedure 71.85 84.64 84.64 75.44 Included in Primary Procedure Included in Primary Procedure 66.24 69.00 55.20 80.96 Included in Primary Procedure 55.20 84.64
Laboratory 300 85730 64.40 Vidant North Hospital OP 75.44 Included in Primary Procedure 60.81 Included in Primary Procedure 71.85 84.64 84.64 75.44 Included in Primary Procedure Included in Primary Procedure 66.24 69.00 55.20 80.96 Included in Primary Procedure 55.20 84.64
Laboratory 300 86850 60.90 Vidant North Hospital OP 71.34 Included in Primary Procedure 57.51 Included in Primary Procedure 67.95 80.04 80.04 71.34 Included in Primary Procedure Included in Primary Procedure 62.64 65.25 52.20 76.56 Included in Primary Procedure 52.20 80.04
Laboratory 300 81001 57.40 Vidant North Hospital OP 67.24 Included in Primary Procedure 54.20 Included in Primary Procedure 64.04 75.44 75.44 67.24 Included in Primary Procedure Included in Primary Procedure 59.04 61.50 49.20 72.16 Included in Primary Procedure 49.20 75.44
Laboratory 300 83036 49.70 Vidant North Hospital OP 58.22 Included in Primary Procedure 46.93 Included in Primary Procedure 55.45 65.32 65.32 58.22 Included in Primary Procedure Included in Primary Procedure 51.12 53.25 42.60 62.48 Included in Primary Procedure 42.60 65.32
Laboratory 300 85014 142.80 Vidant North Hospital OP 167.28 Included in Primary Procedure 134.84 Included in Primary Procedure 159.32 187.68 187.68 167.28 Included in Primary Procedure Included in Primary Procedure 146.88 153.00 122.40 179.52 Included in Primary Procedure 122.40 187.68
Laboratory 300 85018 142.80 Vidant North Hospital OP 167.28 Included in Primary Procedure 134.84 Included in Primary Procedure 159.32 187.68 187.68 167.28 Included in Primary Procedure Included in Primary Procedure 146.88 153.00 122.40 179.52 Included in Primary Procedure 122.40 187.68
Laboratory 300 85610 35.00 Vidant North Hospital OP 41.00 Included in Primary Procedure 33.05 Included in Primary Procedure 39.05 46.00 46.00 41.00 Included in Primary Procedure Included in Primary Procedure 36.00 37.50 30.00 44.00 Included in Primary Procedure 30.00 46.00
Laboratory 300 82270 29.40 Vidant North Hospital OP 34.44 4.38 27.76 4.38 32.80 38.64 38.64 34.44 8.32 4.73 30.24 31.50 25.20 36.96 4.38 4.38 38.64
Laboratory 300 82962 133.00 Vidant North Hospital OP 155.80 Included in Primary Procedure 125.59 Included in Primary Procedure 148.39 174.80 174.80 155.80 Included in Primary Procedure Included in Primary Procedure 136.80 142.50 114.00 167.20 Included in Primary Procedure 114.00 174.80
Laboratory 300 83735 25.20 Vidant North Hospital OP 29.52 Included in Primary Procedure 23.80 Included in Primary Procedure 28.12 33.12 33.12 29.52 Included in Primary Procedure Included in Primary Procedure 25.92 27.00 21.60 31.68 Included in Primary Procedure 21.60 33.12
Laboratory 300 36415 21.00 Vidant North Hospital OP 24.60 Included in Primary Procedure 19.83 Included in Primary Procedure 23.43 27.60 27.60 24.60 Included in Primary Procedure Included in Primary Procedure 21.60 22.50 18.00 26.40 Included in Primary Procedure 18.00 27.60
Pathology 310 88305 396.20 Vidant North Hospital OP 464.12 Included in Primary Procedure 374.13 Included in Primary Procedure 442.05 520.72 520.72 464.12 Included in Primary Procedure Included in Primary Procedure 407.52 424.50 339.60 498.08 Included in Primary Procedure 339.60 520.72
Radiology 320 Q0092 25.90 Vidant North Hospital OP 30.34 Included in Primary Procedure 24.46 Included in Primary Procedure 28.90 34.04 34.04 30.34 Included in Primary Procedure Included in Primary Procedure 26.64 27.75 22.20 32.56 Included in Primary Procedure 22.20 34.04
Radiology 324 71045 130.20 Vidant North Hospital OP 152.52 Included in Primary Procedure 122.95 Included in Primary Procedure 145.27 171.12 171.12 152.52 Included in Primary Procedure Included in Primary Procedure 133.92 139.50 111.60 163.68 Included in Primary Procedure 111.60 171.12
Nuclear Medicine 341 78452 1648.50 Vidant North Hospital OP 1931.10 1128.84 1556.66 1128.84 1839.26 2166.60 2166.60 1931.10 2144.80 1219.15 1695.60 1766.25 1413.00 2072.40 1128.84 1128.84 2166.60
Nuclear Medicine 343 A9500 163.80 Vidant North Hospital OP 191.88 Included in Primary Procedure 154.67 Included in Primary Procedure 182.75 215.28 215.28 191.88 Included in Primary Procedure Included in Primary Procedure 168.48 175.50 140.40 205.92 Included in Primary Procedure 140.40 215.28
Blood Processing 390 P9016 446.60 Vidant North Hospital OP 523.16 167.13 421.72 167.13 498.28 586.96 586.96 523.16 317.54 180.50 459.36 478.50 382.80 561.44 167.13 167.13 586.96
Blood Transfusion Service 391 36430 306.60 Vidant North Hospital OP 359.16 344.32 289.52 344.32 342.08 402.96 402.96 359.16 654.20 371.86 315.36 328.50 262.80 385.44 344.32 262.80 654.20
Emergency Room 450 99285 949.90 Vidant North Hospital OP 1112.74 Included in Primary Procedure 896.98 Included in Primary Procedure 1059.82 1248.44 1248.44 1112.74 Included in Primary Procedure Included in Primary Procedure 977.04 1017.75 814.20 1194.16 Included in Primary Procedure 814.20 1248.44
Pulmonary Function 460 94760 24.50 Vidant North Hospital OP 28.70 Included in Primary Procedure 23.14 Included in Primary Procedure 27.34 32.20 32.20 28.70 Included in Primary Procedure Included in Primary Procedure 25.20 26.25 21.00 30.80 Included in Primary Procedure 21.00 32.20
Cardiology 482 93017 531.30 Vidant North Hospital OP 622.38 Included in Primary Procedure 501.70 Included in Primary Procedure 592.78 698.28 698.28 622.38 Included in Primary Procedure Included in Primary Procedure 546.48 569.25 455.40 667.92 Included in Primary Procedure 455.40 698.28
Cardiology 483 93306 879.90 Vidant North Hospital OP 1030.74 427.32 830.88 427.32 981.72 1156.44 1156.44 1030.74 811.90 461.50 905.04 942.75 754.20 1106.16 427.32 427.32 1156.44
Pharmacy 636 J2785 1016.35 Vidant North Hospital OP 1190.58 Included in Primary Procedure 959.73 Included in Primary Procedure 1133.96 1335.78 1335.78 1190.58 Included in Primary Procedure Included in Primary Procedure 1045.39 1088.95 871.16 1277.70 Included in Primary Procedure 871.16 1335.78
Pharmacy 636 J1815 225.32 Vidant North Hospital OP 263.94 Included in Primary Procedure 212.76 Included in Primary Procedure 251.39 296.13 296.13 263.94 Included in Primary Procedure Included in Primary Procedure 231.75 241.41 193.13 283.25 Included in Primary Procedure 193.13 296.13
Pharmacy 636 J1815 225.32 Vidant North Hospital OP 263.94 Included in Primary Procedure 212.76 Included in Primary Procedure 251.39 296.13 296.13 263.94 Included in Primary Procedure Included in Primary Procedure 231.75 241.41 193.13 283.25 Included in Primary Procedure 193.13 296.13
Pharmacy 636 J2704 84.60 Vidant North Hospital OP 99.11 Included in Primary Procedure 79.89 Included in Primary Procedure 94.39 111.19 111.19 99.11 Included in Primary Procedure Included in Primary Procedure 87.02 90.65 72.52 106.36 Included in Primary Procedure 72.52 111.19
EKG/ECG General 730 93041 784.00 Vidant North Hospital OP 918.40 Included in Primary Procedure 740.32 Included in Primary Procedure 874.72 1030.40 1030.40 918.40 Included in Primary Procedure Included in Primary Procedure 806.40 840.00 672.00 985.60 Included in Primary Procedure 672.00 1030.40
EKG/ECG General 730 93005 123.90 Vidant North Hospital OP 145.14 Included in Primary Procedure 117.00 Included in Primary Procedure 138.24 162.84 162.84 145.14 Included in Primary Procedure Included in Primary Procedure 127.44 132.75 106.20 155.76 Included in Primary Procedure 106.20 162.84
Other Therapeutic Services 940 96372 431.20 Vidant North Hospital OP 505.12 Included in Primary Procedure 407.18 Included in Primary Procedure 481.10 566.72 566.72 505.12 Included in Primary Procedure Included in Primary Procedure 443.52 462.00 369.60 542.08 Included in Primary Procedure 369.60 566.72
Other Therapeutic Services 940 96375 67.90 Vidant North Hospital OP 79.54 33.82 64.12 33.82 75.76 89.24 89.24 79.54 64.25 36.52 69.84 72.75 58.20 85.36 33.82 33.82 89.24
Endoscopic diagnostic examination of large bowel Primary Procedure 360 45378 1764.70 Vidant North Hospital OP 2067.22 677.81 1666.38 677.81 1968.90 2319.32 2319.32 2067.22 1287.83 732.03 1815.12 1890.75 1512.60 2218.48 677.81 677.81 2319.32
Pharmacy 250 2052.69 Vidant North Hospital OP 2404.58 Included in Primary Procedure 1938.33 Included in Primary Procedure 2290.22 2697.83 2697.83 2404.58 Included in Primary Procedure Included in Primary Procedure 2111.34 2199.32 1759.45 2580.53 Included in Primary Procedure 1759.45 2697.83
Pharmacy 255 Q9967 408.95 Vidant North Hospital OP 479.05 Included in Primary Procedure 386.16 Included in Primary Procedure 456.27 537.47 537.47 479.05 Included in Primary Procedure Included in Primary Procedure 420.63 438.16 350.53 514.10 Included in Primary Procedure 350.53 537.47
Pharmacy 258 J3490 119.00 Vidant North Hospital OP 139.40 Included in Primary Procedure 112.37 Included in Primary Procedure 132.77 156.40 156.40 139.40 Included in Primary Procedure Included in Primary Procedure 122.40 127.50 102.00 149.60 Included in Primary Procedure 102.00 156.40
IV Therapy 260 96361 1543.50 Vidant North Hospital OP 1808.10 33.82 1457.51 33.82 1722.11 2028.60 2028.60 1808.10 64.25 36.52 1587.60 1653.75 1323.00 1940.40 33.82 33.82 2028.60
IV Therapy 260 96365 232.40 Vidant North Hospital OP 272.24 163.04 219.45 163.04 259.29 305.44 305.44 272.24 309.77 176.08 239.04 249.00 199.20 292.16 163.04 163.04 309.77
IV Therapy 260 96367 152.60 Vidant North Hospital OP 178.76 53.66 144.10 53.66 170.26 200.56 200.56 178.76 101.95 57.95 156.96 163.50 130.80 191.84 53.66 53.66 200.56
IV Therapy 260 96366 138.60 Vidant North Hospital OP 162.36 33.82 130.88 33.82 154.64 182.16 182.16 162.36 64.25 36.52 142.56 148.50 118.80 174.24 33.82 33.82 182.16
Supplies 270 1015.70 Vidant North Hospital OP 1189.82 Included in Primary Procedure 959.11 Included in Primary Procedure 1133.23 1334.92 1334.92 1189.82 Included in Primary Procedure Included in Primary Procedure 1044.72 1088.25 870.60 1276.88 Included in Primary Procedure 870.60 1334.92
Laboratory 300 80053 368.20 Vidant North Hospital OP 431.32 Included in Primary Procedure 347.69 Included in Primary Procedure 410.81 483.92 483.92 431.32 Included in Primary Procedure Included in Primary Procedure 378.72 394.50 315.60 462.88 Included in Primary Procedure 315.60 483.92
Laboratory 300 87040 170.80 Vidant North Hospital OP 200.08 Included in Primary Procedure 161.28 Included in Primary Procedure 190.56 224.48 224.48 200.08 Included in Primary Procedure Included in Primary Procedure 175.68 183.00 146.40 214.72 Included in Primary Procedure 146.40 224.48
Laboratory 300 U0002 139.30 Vidant North Hospital OP 163.18 51.31 131.54 51.31 155.42 183.08 183.08 163.18 97.49 55.41 143.28 149.25 119.40 175.12 51.31 51.31 183.08
Laboratory 300 80048 709.80 Vidant North Hospital OP 831.48 Included in Primary Procedure 670.25 Included in Primary Procedure 791.93 932.88 932.88 831.48 Included in Primary Procedure Included in Primary Procedure 730.08 760.50 608.40 892.32 Included in Primary Procedure 608.40 932.88
Laboratory 300 85025 612.50 Vidant North Hospital OP 717.50 Included in Primary Procedure 578.38 Included in Primary Procedure 683.38 805.00 805.00 717.50 Included in Primary Procedure Included in Primary Procedure 630.00 656.25 525.00 770.00 Included in Primary Procedure 525.00 805.00
Laboratory 300 84443 81.20 Vidant North Hospital OP 95.12 Included in Primary Procedure 76.68 Included in Primary Procedure 90.60 106.72 106.72 95.12 Included in Primary Procedure Included in Primary Procedure 83.52 87.00 69.60 102.08 Included in Primary Procedure 69.60 106.72
Laboratory 300 83690 71.40 Vidant North Hospital OP 83.64 Included in Primary Procedure 67.42 Included in Primary Procedure 79.66 93.84 93.84 83.64 Included in Primary Procedure Included in Primary Procedure 73.44 76.50 61.20 89.76 Included in Primary Procedure 61.20 93.84
Laboratory 300 83605 69.30 Vidant North Hospital OP 81.18 Included in Primary Procedure 65.44 Included in Primary Procedure 77.32 91.08 91.08 81.18 Included in Primary Procedure Included in Primary Procedure 71.28 74.25 59.40 87.12 Included in Primary Procedure 59.40 91.08
Laboratory 300 81001 57.40 Vidant North Hospital OP 67.24 Included in Primary Procedure 54.20 Included in Primary Procedure 64.04 75.44 75.44 67.24 Included in Primary Procedure Included in Primary Procedure 59.04 61.50 49.20 72.16 Included in Primary Procedure 49.20 75.44
Laboratory 300 85610 35.00 Vidant North Hospital OP 41.00 Included in Primary Procedure 33.05 Included in Primary Procedure 39.05 46.00 46.00 41.00 Included in Primary Procedure Included in Primary Procedure 36.00 37.50 30.00 44.00 Included in Primary Procedure 30.00 46.00
Laboratory 300 83735 25.20 Vidant North Hospital OP 29.52 Included in Primary Procedure 23.80 Included in Primary Procedure 28.12 33.12 33.12 29.52 Included in Primary Procedure Included in Primary Procedure 25.92 27.00 21.60 31.68 Included in Primary Procedure 21.60 33.12
Laboratory 300 82962 7.00 Vidant North Hospital OP 8.20 Included in Primary Procedure 6.61 Included in Primary Procedure 7.81 9.20 9.20 8.20 Included in Primary Procedure Included in Primary Procedure 7.20 7.50 6.00 8.80 Included in Primary Procedure 6.00 9.20
Laboratory 300 36415 21.00 Vidant North Hospital OP 24.60 Included in Primary Procedure 19.83 Included in Primary Procedure 23.43 27.60 27.60 24.60 Included in Primary Procedure Included in Primary Procedure 21.60 22.50 18.00 26.40 Included in Primary Procedure 18.00 27.60
Pathology 310 88305 396.20 Vidant North Hospital OP 464.12 Included in Primary Procedure 374.13 Included in Primary Procedure 442.05 520.72 520.72 464.12 Included in Primary Procedure Included in Primary Procedure 407.52 424.50 339.60 498.08 Included in Primary Procedure 339.60 520.72
Radiology 320 74246 177.80 Vidant North Hospital OP 208.28 Included in Primary Procedure 167.89 Included in Primary Procedure 198.37 233.68 233.68 208.28 Included in Primary Procedure Included in Primary Procedure 182.88 190.50 152.40 223.52 Included in Primary Procedure 152.40 233.68
Radiology 320 Q0092 25.90 Vidant North Hospital OP 30.34 Included in Primary Procedure 24.46 Included in Primary Procedure 28.90 34.04 34.04 30.34 Included in Primary Procedure Included in Primary Procedure 26.64 27.75 22.20 32.56 Included in Primary Procedure 22.20 34.04
Radiology 324 71045 130.20 Vidant North Hospital OP 152.52 Included in Primary Procedure 122.95 Included in Primary Procedure 145.27 171.12 171.12 152.52 Included in Primary Procedure Included in Primary Procedure 133.92 139.50 111.60 163.68 Included in Primary Procedure 111.60 171.12
CT Scan 350 74177 3656.80 Vidant North Hospital OP 4283.68 Included in Primary Procedure 3453.06 Included in Primary Procedure 4079.94 4806.08 4806.08 4283.68 Included in Primary Procedure Included in Primary Procedure 3761.28 3918.00 3134.40 4597.12 Included in Primary Procedure 3134.40 4806.08
Respiratory Services 410 94664 67.20 Vidant North Hospital OP 78.72 Included in Primary Procedure 63.46 Included in Primary Procedure 74.98 88.32 88.32 78.72 Included in Primary Procedure Included in Primary Procedure 69.12 72.00 57.60 84.48 Included in Primary Procedure 57.60 88.32
Emergency Room 450 99285 949.90 Vidant North Hospital OP 1112.74 Included in Primary Procedure 896.98 Included in Primary Procedure 1059.82 1248.44 1248.44 1112.74 Included in Primary Procedure Included in Primary Procedure 977.04 1017.75 814.20 1194.16 Included in Primary Procedure 814.20 1248.44
Emergency Room 450 96375 77.00 Vidant North Hospital OP 90.20 33.82 72.71 33.82 85.91 101.20 101.20 90.20 64.25 36.52 79.20 82.50 66.00 96.80 33.82 33.82 101.20
Pulmonary Function 460 94760 196.00 Vidant North Hospital OP 229.60 Included in Primary Procedure 185.08 Included in Primary Procedure 218.68 257.60 257.60 229.60 Included in Primary Procedure Included in Primary Procedure 201.60 210.00 168.00 246.40 Included in Primary Procedure 168.00 257.60
Pharmacy 636 J1650 99.65 Vidant North Hospital OP 116.73 Included in Primary Procedure 94.09 Included in Primary Procedure 111.18 130.96 130.96 116.73 Included in Primary Procedure Included in Primary Procedure 102.49 106.76 85.41 125.27 Included in Primary Procedure 85.41 130.96
Pharmacy 636 J2704 84.60 Vidant North Hospital OP 99.11 Included in Primary Procedure 79.89 Included in Primary Procedure 94.39 111.19 111.19 99.11 Included in Primary Procedure Included in Primary Procedure 87.02 90.65 72.52 106.36 Included in Primary Procedure 72.52 111.19
Pharmacy 636 Q0167 524.25 Vidant North Hospital OP 614.12 Included in Primary Procedure 495.04 Included in Primary Procedure 584.91 689.02 689.02 614.12 Included in Primary Procedure Included in Primary Procedure 539.23 561.70 449.36 659.06 Included in Primary Procedure 449.36 689.02
Pharmacy 636 J1650 132.86 Vidant North Hospital OP 155.64 Included in Primary Procedure 125.46 Included in Primary Procedure 148.23 174.62 174.62 155.64 Included in Primary Procedure Included in Primary Procedure 136.66 142.35 113.88 167.02 Included in Primary Procedure 113.88 174.62
EKG/ECG General 730 93041 1097.60 Vidant North Hospital OP 1285.76 Included in Primary Procedure 1036.45 Included in Primary Procedure 1224.61 1442.56 1442.56 1285.76 Included in Primary Procedure Included in Primary Procedure 1128.96 1176.00 940.80 1379.84 Included in Primary Procedure 940.80 1442.56
Observation 762 G0378 240.70 Vidant North Hospital OP 281.96 Included in Primary Procedure 227.28 Included in Primary Procedure 268.55 316.34 316.34 281.96 Included in Primary Procedure Included in Primary Procedure 247.57 257.89 206.31 302.59 Included in Primary Procedure 206.31 316.34
Other Therapeutic Services 940 96375 67.90 Vidant North Hospital OP 79.54 33.82 64.12 33.82 75.76 89.24 89.24 79.54 64.25 36.52 69.84 72.75 58.20 85.36 33.82 33.82 89.24
Other Therapeutic Services 940 96372 431.20 Vidant North Hospital OP 505.12 Included in Primary Procedure 407.18 Included in Primary Procedure 481.10 566.72 566.72 505.12 Included in Primary Procedure Included in Primary Procedure 443.52 462.00 369.60 542.08 Included in Primary Procedure 369.60 566.72
Endoscopic biopsy of Large Bowel Primary Procedure 360 45380 496.65 Vidant North Hospital OP 581.79 891.06 468.98 891.06 554.12 652.74 652.74 581.79 1693.02 962.35 510.84 532.13 425.70 624.36 891.06 425.70 1693.02
Pharmacy 250 19.52 Vidant North Hospital OP 22.86 Included in Primary Procedure 18.43 Included in Primary Procedure 21.77 25.65 25.65 22.86 Included in Primary Procedure Included in Primary Procedure 20.07 20.91 16.73 24.53 Included in Primary Procedure 16.73 25.65
Supplies 270 142.10 Vidant North Hospital OP 166.46 Included in Primary Procedure 134.18 Included in Primary Procedure 158.54 186.76 186.76 166.46 Included in Primary Procedure Included in Primary Procedure 146.16 152.25 121.80 178.64 Included in Primary Procedure 121.80 186.76
Laboratory 300 U0002 139.30 Vidant North Hospital OP 163.18 51.31 131.54 51.31 155.42 183.08 183.08 163.18 97.49 55.41 143.28 149.25 119.40 175.12 51.31 51.31 183.08
Pathology 310 88305 792.40 Vidant North Hospital OP 928.24 Included in Primary Procedure 748.25 Included in Primary Procedure 884.09 1041.44 1041.44 928.24 Included in Primary Procedure Included in Primary Procedure 815.04 849.00 679.20 996.16 Included in Primary Procedure 679.20 1041.44
Pharmacy 636 J2704 122.25 Vidant North Hospital OP 143.20 Included in Primary Procedure 115.44 Included in Primary Procedure 136.39 160.67 160.67 143.20 Included in Primary Procedure Included in Primary Procedure 125.74 130.98 104.78 153.68 Included in Primary Procedure 104.78 160.67
Gastrointestinal Services 750 45385 496.65 Vidant North Hospital OP 581.79 445.53 468.98 445.53 554.12 652.74 652.74 581.79 846.51 481.17 510.84 532.13 425.70 624.36 445.53 425.70 846.51
Endoscopic removal of polyps or growths of large bowel Primary Procedure 360 45385 496.65 Vidant North Hospital OP 581.79 891.06 468.98 891.06 554.12 652.74 652.74 581.79 1693.02 962.35 510.84 532.13 425.70 624.36 891.06 425.70 1693.02
Pharmacy 250 19.52 Vidant North Hospital OP 22.86 Included in Primary Procedure 18.43 Included in Primary Procedure 21.77 25.65 25.65 22.86 Included in Primary Procedure Included in Primary Procedure 20.07 20.91 16.73 24.53 Included in Primary Procedure 16.73 25.65
Supplies 270 142.10 Vidant North Hospital OP 166.46 Included in Primary Procedure 134.18 Included in Primary Procedure 158.54 186.76 186.76 166.46 Included in Primary Procedure Included in Primary Procedure 146.16 152.25 121.80 178.64 Included in Primary Procedure 121.80 186.76
Laboratory 300 U0002 139.30 Vidant North Hospital OP 163.18 51.31 131.54 51.31 155.42 183.08 183.08 163.18 97.49 55.41 143.28 149.25 119.40 175.12 51.31 51.31 183.08
Pathology 310 88305 792.40 Vidant North Hospital OP 928.24 Included in Primary Procedure 748.25 Included in Primary Procedure 884.09 1041.44 1041.44 928.24 Included in Primary Procedure Included in Primary Procedure 815.04 849.00 679.20 996.16 Included in Primary Procedure 679.20 1041.44
Pharmacy 636 J2704 122.25 Vidant North Hospital OP 143.20 Included in Primary Procedure 115.44 Included in Primary Procedure 136.39 160.67 160.67 143.20 Included in Primary Procedure Included in Primary Procedure 125.74 130.98 104.78 153.68 Included in Primary Procedure 104.78 160.67
Gastrointestinal Services 750 45380 496.65 Vidant North Hospital OP 581.79 445.53 468.98 445.53 554.12 652.74 652.74 581.79 846.51 481.17 510.84 532.13 425.70 624.36 445.53 425.70 846.51
Endoscopic Removal of Gallbladder Primary Procedure 360 47562 6990.90 Vidant North Hospital OP 8189.34 4289.05 6601.41 4289.05 7799.85 9188.04 9188.04 8189.34 8149.19 4632.17 7190.64 7490.25 5992.20 8788.56 4289.05 4289.05 9188.04
Pharmacy 250 603.90 Vidant North Hospital OP 707.42 Included in Primary Procedure 570.25 Included in Primary Procedure 673.78 793.69 793.69 707.42 Included in Primary Procedure Included in Primary Procedure 621.15 647.03 517.63 759.18 Included in Primary Procedure 517.63 793.69
Supplies 270 567.70 Vidant North Hospital OP 665.02 Included in Primary Procedure 536.07 Included in Primary Procedure 633.39 746.12 746.12 665.02 Included in Primary Procedure Included in Primary Procedure 583.92 608.25 486.60 713.68 Included in Primary Procedure 486.60 746.12
Laboratory 300 U0002 139.30 Vidant North Hospital OP 163.18 51.31 131.54 51.31 155.42 183.08 183.08 163.18 97.49 55.41 143.28 149.25 119.40 175.12 51.31 51.31 183.08
Laboratory 300 84702 121.80 Vidant North Hospital OP 142.68 Included in Primary Procedure 115.01 Included in Primary Procedure 135.89 160.08 160.08 142.68 Included in Primary Procedure Included in Primary Procedure 125.28 130.50 104.40 153.12 Included in Primary Procedure 104.40 160.08
Laboratory 300 80048 118.30 Vidant North Hospital OP 138.58 Included in Primary Procedure 111.71 Included in Primary Procedure 131.99 155.48 155.48 138.58 Included in Primary Procedure Included in Primary Procedure 121.68 126.75 101.40 148.72 Included in Primary Procedure 101.40 155.48
Laboratory 300 85025 87.50 Vidant North Hospital OP 102.50 Included in Primary Procedure 82.63 Included in Primary Procedure 97.63 115.00 115.00 102.50 Included in Primary Procedure Included in Primary Procedure 90.00 93.75 75.00 110.00 Included in Primary Procedure 75.00 115.00
Laboratory 300 86850 60.90 Vidant North Hospital OP 71.34 43.90 57.51 43.90 67.95 80.04 80.04 71.34 83.40 47.41 62.64 65.25 52.20 76.56 43.90 43.90 83.40
Pathology 310 88304 234.50 Vidant North Hospital OP 274.70 43.90 221.44 43.90 261.64 308.20 308.20 274.70 83.40 47.41 241.20 251.25 201.00 294.80 43.90 43.90 308.20
Radiology 320 Q0092 25.90 Vidant North Hospital OP 30.34 Included in Primary Procedure 24.46 Included in Primary Procedure 28.90 34.04 34.04 30.34 Included in Primary Procedure Included in Primary Procedure 26.64 27.75 22.20 32.56 Included in Primary Procedure 22.20 34.04
Radiology 324 71045 130.20 Vidant North Hospital OP 152.52 Included in Primary Procedure 122.95 Included in Primary Procedure 145.27 171.12 171.12 152.52 Included in Primary Procedure Included in Primary Procedure 133.92 139.50 111.60 163.68 Included in Primary Procedure 111.60 171.12
Anesthesia 370 1369.90 Vidant North Hospital OP 1604.74 Included in Primary Procedure 1293.58 Included in Primary Procedure 1528.42 1800.44 1800.44 1604.74 Included in Primary Procedure Included in Primary Procedure 1409.04 1467.75 1174.20 1722.16 Included in Primary Procedure 1174.20 1800.44
Pharmacy 636 J3490 438.07 Vidant North Hospital OP 513.16 Included in Primary Procedure 413.66 Included in Primary Procedure 488.76 575.75 575.75 513.16 Included in Primary Procedure Included in Primary Procedure 450.58 469.36 375.49 550.71 Included in Primary Procedure 375.49 575.75
Pharmacy 636 J2704 84.60 Vidant North Hospital OP 99.11 Included in Primary Procedure 79.89 Included in Primary Procedure 94.39 111.19 111.19 99.11 Included in Primary Procedure Included in Primary Procedure 87.02 90.65 72.52 106.36 Included in Primary Procedure 72.52 111.19
Pharmacy 636 J2001 39.03 Vidant North Hospital OP 45.72 Included in Primary Procedure 36.86 Included in Primary Procedure 43.55 51.30 51.30 45.72 Included in Primary Procedure Included in Primary Procedure 40.15 41.82 33.46 49.07 Included in Primary Procedure 33.46 51.30
Recovery Room 710 549.50 Vidant North Hospital OP 643.70 Included in Primary Procedure 518.89 Included in Primary Procedure 613.09 722.20 722.20 643.70 Included in Primary Procedure Included in Primary Procedure 565.20 588.75 471.00 690.80 Included in Primary Procedure 471.00 722.20
EKG/ECG General 730 93005 123.90 Vidant North Hospital OP 145.14 48.81 117.00 48.81 138.24 162.84 162.84 145.14 92.74 52.72 127.44 132.75 106.20 155.76 48.81 48.81 162.84
Professional Fees - Anesthesia 964 790 849.80 Vidant North Hospital OP 995.48 Included in Primary Procedure 802.45 Included in Primary Procedure 948.13 1116.88 1116.88 995.48 Included in Primary Procedure Included in Primary Procedure 874.08 910.50 728.40 1068.32 Included in Primary Procedure 728.40 1116.88
Repair of groin hernia patient age 5 years or older Primary Procedure 360 49505 5406.80 Vidant North Hospital OP 6333.68 2758.98 5105.56 2758.98 6032.44 7106.08 7106.08 6333.68 5242.06 2979.70 5561.28 5793.00 4634.40 6797.12 2758.98 2758.98 7106.08
Pharmacy 250 189.57 Vidant North Hospital OP 222.07 Included in Primary Procedure 179.01 Included in Primary Procedure 211.51 249.15 249.15 222.07 Included in Primary Procedure Included in Primary Procedure 194.99 203.12 162.49 238.32 Included in Primary Procedure 162.49 249.15
Supplies 270 489.30 Vidant North Hospital OP 573.18 Included in Primary Procedure 462.04 Included in Primary Procedure 545.92 643.08 643.08 573.18 Included in Primary Procedure Included in Primary Procedure 503.28 524.25 419.40 615.12 Included in Primary Procedure 419.40 643.08
Laboratory 300 80048 115.50 Vidant North Hospital OP 135.30 Included in Primary Procedure 109.07 Included in Primary Procedure 128.87 151.80 151.80 135.30 Included in Primary Procedure Included in Primary Procedure 118.80 123.75 99.00 145.20 Included in Primary Procedure 99.00 151.80
Laboratory 300 85025 85.40 Vidant North Hospital OP 100.04 Included in Primary Procedure 80.64 Included in Primary Procedure 95.28 112.24 112.24 100.04 Included in Primary Procedure Included in Primary Procedure 87.84 91.50 73.20 107.36 Included in Primary Procedure 73.20 112.24
Laboratory 300 36415 2.80 Vidant North Hospital OP 3.28 Included in Primary Procedure 2.64 Included in Primary Procedure 3.12 3.68 3.68 3.28 Included in Primary Procedure Included in Primary Procedure 2.88 3.00 2.40 3.52 Included in Primary Procedure 2.40 3.68
Anesthesia 370 1066.10 Vidant North Hospital OP 1248.86 Included in Primary Procedure 1006.70 Included in Primary Procedure 1189.46 1401.16 1401.16 1248.86 Included in Primary Procedure Included in Primary Procedure 1096.56 1142.25 913.80 1340.24 Included in Primary Procedure 913.80 1401.16
Respiratory Services 412 94640 22.40 Vidant North Hospital OP 26.24 163.23 21.15 163.23 24.99 29.44 29.44 26.24 310.14 176.29 23.04 24.00 19.20 28.16 163.23 19.20 310.14
Pulmonary Function 460 94760 24.50 Vidant North Hospital OP 28.70 Included in Primary Procedure 23.14 Included in Primary Procedure 27.34 32.20 32.20 28.70 Included in Primary Procedure Included in Primary Procedure 25.20 26.25 21.00 30.80 Included in Primary Procedure 21.00 32.20
Pharmacy 635 J3490 110.19 Vidant North Hospital OP 129.08 Included in Primary Procedure 104.05 Included in Primary Procedure 122.95 144.83 144.83 129.08 Included in Primary Procedure Included in Primary Procedure 113.34 118.07 94.45 138.53 Included in Primary Procedure 94.45 144.83
Pharmacy 636 J2704 84.10 Vidant North Hospital OP 98.51 Included in Primary Procedure 79.41 Included in Primary Procedure 93.83 110.53 110.53 98.51 Included in Primary Procedure Included in Primary Procedure 86.50 90.11 72.08 105.72 Included in Primary Procedure 72.08 110.53
Recovery Room 710 549.50 Vidant North Hospital OP 643.70 Included in Primary Procedure 518.89 Included in Primary Procedure 613.09 722.20 722.20 643.70 Included in Primary Procedure Included in Primary Procedure 565.20 588.75 471.00 690.80 Included in Primary Procedure 471.00 722.20
Injection of substance into spinal canal of lower back or sacrum using imaging guidance Primary Procedure 360 62323 4750.20 Vidant North Hospital OP 5564.52 554.62 4485.55 554.62 5299.87 6243.12 6243.12 5564.52 1053.78 598.99 4885.92 5089.50 4071.60 5971.68 554.62 554.62 6243.12
Pharmacy 250 161.35 Vidant North Hospital OP 189.01 Included in Primary Procedure 152.36 Included in Primary Procedure 180.02 212.06 212.06 189.01 Included in Primary Procedure Included in Primary Procedure 165.96 172.88 138.30 202.84 Included in Primary Procedure 138.30 212.06
Pharmacy 258 J7050 59.50 Vidant North Hospital OP 69.70 Included in Primary Procedure 56.19 Included in Primary Procedure 66.39 78.20 78.20 69.70 Included in Primary Procedure Included in Primary Procedure 61.20 63.75 51.00 74.80 Included in Primary Procedure 51.00 78.20
Supplies 270 322.00 Vidant North Hospital OP 377.20 Included in Primary Procedure 304.06 Included in Primary Procedure 359.26 423.20 423.20 377.20 Included in Primary Procedure Included in Primary Procedure 331.20 345.00 276.00 404.80 Included in Primary Procedure 276.00 423.20
Laboratory 300 80053 179.90 Vidant North Hospital OP 210.74 Included in Primary Procedure 169.88 Included in Primary Procedure 200.72 236.44 236.44 210.74 Included in Primary Procedure Included in Primary Procedure 185.04 192.75 154.20 226.16 Included in Primary Procedure 154.20 236.44
Laboratory 300 84481 172.20 Vidant North Hospital OP 201.72 Included in Primary Procedure 162.61 Included in Primary Procedure 192.13 226.32 226.32 201.72 Included in Primary Procedure Included in Primary Procedure 177.12 184.50 147.60 216.48 Included in Primary Procedure 147.60 226.32
Laboratory 300 85025 170.80 Vidant North Hospital OP 200.08 Included in Primary Procedure 161.28 Included in Primary Procedure 190.56 224.48 224.48 200.08 Included in Primary Procedure Included in Primary Procedure 175.68 183.00 146.40 214.72 Included in Primary Procedure 146.40 224.48
Laboratory 300 80061 134.40 Vidant North Hospital OP 157.44 13.39 126.91 13.39 149.95 176.64 176.64 157.44 25.44 14.46 138.24 144.00 115.20 168.96 13.39 13.39 176.64
Laboratory 300 83036 48.30 Vidant North Hospital OP 56.58 Included in Primary Procedure 45.61 Included in Primary Procedure 53.89 63.48 63.48 56.58 Included in Primary Procedure Included in Primary Procedure 49.68 51.75 41.40 60.72 Included in Primary Procedure 41.40 63.48
Laboratory 300 82962 63.00 Vidant North Hospital OP 73.80 Included in Primary Procedure 59.49 Included in Primary Procedure 70.29 82.80 82.80 73.80 Included in Primary Procedure Included in Primary Procedure 64.80 67.50 54.00 79.20 Included in Primary Procedure 54.00 82.80
Laboratory 300 36415 2.80 Vidant North Hospital OP 3.28 Included in Primary Procedure 2.64 Included in Primary Procedure 3.12 3.68 3.68 3.28 Included in Primary Procedure Included in Primary Procedure 2.88 3.00 2.40 3.52 Included in Primary Procedure 2.40 3.68
Radiology 320 76000 399.70 Vidant North Hospital OP 468.22 206.78 377.43 206.78 445.95 525.32 525.32 468.22 392.88 223.32 411.12 428.25 342.60 502.48 206.78 206.78 525.32
CT Scan 350 72131 448.00 Vidant North Hospital OP 524.80 Included in Primary Procedure 423.04 Included in Primary Procedure 499.84 588.80 588.80 524.80 Included in Primary Procedure Included in Primary Procedure 460.80 480.00 384.00 563.20 Included in Primary Procedure 384.00 588.80
CT Scan 352 72192 1376.90 Vidant North Hospital OP 1612.94 Included in Primary Procedure 1300.19 Included in Primary Procedure 1536.23 1809.64 1809.64 1612.94 Included in Primary Procedure Included in Primary Procedure 1416.24 1475.25 1180.20 1730.96 Included in Primary Procedure 1180.20 1809.64
Physical Therapy 420 97530 74.20 Vidant North Hospital OP 86.92 38.58 70.07 38.58 82.79 90.00 97.52 90.00 73.30 41.67 76.32 79.50 63.60 93.28 38.58 38.58 97.52
Physical Therapy 424 97161 151.20 Vidant North Hospital OP 177.12 84.28 142.78 84.28 168.70 90.00 198.72 90.00 160.13 91.02 155.52 162.00 129.60 190.08 84.28 84.28 198.72
Emergency Room 450 99285 931.00 Vidant North Hospital OP 1090.60 Included in Primary Procedure 879.13 Included in Primary Procedure 1038.73 1223.60 1223.60 1090.60 Included in Primary Procedure Included in Primary Procedure 957.60 997.50 798.00 1170.40 Included in Primary Procedure 798.00 1223.60
Emergency Room 450 96374 315.00 Vidant North Hospital OP 369.00 163.04 297.45 163.04 351.45 414.00 414.00 369.00 309.77 176.08 324.00 337.50 270.00 396.00 163.04 163.04 414.00
Emergency Room 450 96375 Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable 0.00 0.00
Emergency Room 450 96376 74.90 Vidant North Hospital OP 87.74 Included in Primary Procedure 70.73 Included in Primary Procedure 83.57 98.44 98.44 87.74 Included in Primary Procedure Included in Primary Procedure 77.04 80.25 64.20 94.16 Included in Primary Procedure 64.20 98.44
Pulmonary Function 460 94760 24.50 Vidant North Hospital OP 28.70 Included in Primary Procedure 23.14 Included in Primary Procedure 27.34 32.20 32.20 28.70 Included in Primary Procedure Included in Primary Procedure 25.20 26.25 21.00 30.80 Included in Primary Procedure 21.00 32.20
EKG/ECG General 730 93041 627.20 Vidant North Hospital OP 734.72 Included in Primary Procedure 592.26 Included in Primary Procedure 699.78 824.32 824.32 734.72 Included in Primary Procedure Included in Primary Procedure 645.12 672.00 537.60 788.48 Included in Primary Procedure 537.60 824.32
Observation 762 G0378 470.40 Vidant North Hospital OP 551.04 Included in Primary Procedure 444.19 Included in Primary Procedure 524.83 618.24 618.24 551.04 Included in Primary Procedure Included in Primary Procedure 483.84 504.00 403.20 591.36 Included in Primary Procedure 403.20 618.24
Other Therapeutic Services 940 96372 184.80 Vidant North Hospital OP 216.48 Included in Primary Procedure 174.50 Included in Primary Procedure 206.18 242.88 242.88 216.48 Included in Primary Procedure Included in Primary Procedure 190.08 198.00 158.40 232.32 Included in Primary Procedure 158.40 242.88
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). MS-DRG 470 0.00 Vidant North Hospital IP 0.00 10870.74 0.00 11780.72 0.00 0.00 0.00 0.00 16523.52 11740.40 0.00 0.00 0.00 14172.48 10870.74 0.00 16523.52
Private Room & Board 110 502.60 Vidant North Hospital IP 588.76 Included in Primary Procedure 474.60 Included in Primary Procedure 533.47 660.56 660.56 588.76 Included in Primary Procedure Included in Primary Procedure 516.96 538.50 430.80 Included in Primary Procedure Included in Primary Procedure 430.80 660.56
Pharmacy 250 1178.84 Vidant North Hospital IP 1380.93 Included in Primary Procedure 1113.16 Included in Primary Procedure 1251.26 1549.34 1549.34 1380.93 Included in Primary Procedure Included in Primary Procedure 1212.52 1263.05 1010.44 Included in Primary Procedure Included in Primary Procedure 1010.44 1549.34
Supplies 270 378.70 Vidant North Hospital IP 443.62 Included in Primary Procedure 357.60 Included in Primary Procedure 401.96 497.72 497.72 443.62 Included in Primary Procedure Included in Primary Procedure 389.52 405.75 324.60 Included in Primary Procedure Included in Primary Procedure 324.60 497.72
Implants 278 6714.40 Vidant North Hospital IP 7865.44 Included in Primary Procedure 6340.31 Included in Primary Procedure 7126.86 8824.64 8824.64 7865.44 Included in Primary Procedure Included in Primary Procedure 6906.24 7194.00 5755.20 Included in Primary Procedure Included in Primary Procedure 5755.20 8824.64
Laboratory 300 395.50 Vidant North Hospital IP 463.30 Included in Primary Procedure 373.47 Included in Primary Procedure 419.80 519.80 519.80 463.30 Included in Primary Procedure Included in Primary Procedure 406.80 423.75 339.00 Included in Primary Procedure Included in Primary Procedure 339.00 519.80
OR Services 360 6435.10 Vidant North Hospital IP 7538.26 Included in Primary Procedure 6076.57 Included in Primary Procedure 6830.40 8457.56 8457.56 7538.26 Included in Primary Procedure Included in Primary Procedure 6618.96 6894.75 5515.80 Included in Primary Procedure Included in Primary Procedure 5515.80 8457.56
OR Services 361 592.20 Vidant North Hospital IP 693.72 Included in Primary Procedure 559.21 Included in Primary Procedure 628.58 778.32 778.32 693.72 Included in Primary Procedure Included in Primary Procedure 609.12 634.50 507.60 Included in Primary Procedure Included in Primary Procedure 507.60 778.32
Anesthesia 370 1255.80 Vidant North Hospital IP 1471.08 Included in Primary Procedure 1185.83 Included in Primary Procedure 1332.94 1650.48 1650.48 1471.08 Included in Primary Procedure Included in Primary Procedure 1291.68 1345.50 1076.40 Included in Primary Procedure Included in Primary Procedure 1076.40 1650.48
Physical Therapy 420 357.70 Vidant North Hospital IP 419.02 Included in Primary Procedure 337.77 Included in Primary Procedure 379.67 470.12 470.12 419.02 Included in Primary Procedure Included in Primary Procedure 367.92 383.25 306.60 Included in Primary Procedure Included in Primary Procedure 306.60 470.12
Physical Therapy 424 151.20 Vidant North Hospital IP 177.12 Included in Primary Procedure 142.78 Included in Primary Procedure 160.49 198.72 198.72 177.12 Included in Primary Procedure Included in Primary Procedure 155.52 162.00 129.60 Included in Primary Procedure Included in Primary Procedure 129.60 198.72
Pharmacy 636 709.36 Vidant North Hospital IP 830.96 Included in Primary Procedure 669.84 Included in Primary Procedure 752.93 932.30 932.30 830.96 Included in Primary Procedure Included in Primary Procedure 729.63 760.03 608.02 Included in Primary Procedure Included in Primary Procedure 608.02 932.30
Recovery Room 710 938.00 Vidant North Hospital IP 1098.80 Included in Primary Procedure 885.74 Included in Primary Procedure 995.62 1232.80 1232.80 1098.80 Included in Primary Procedure Included in Primary Procedure 964.80 1005.00 804.00 Included in Primary Procedure Included in Primary Procedure 804.00 1232.80
EKG/ECG General 730 123.90 Vidant North Hospital IP 145.14 Included in Primary Procedure 117.00 Included in Primary Procedure 131.51 162.84 162.84 145.14 Included in Primary Procedure Included in Primary Procedure 127.44 132.75 106.20 Included in Primary Procedure Included in Primary Procedure 106.20 162.84
Professional Fees - EKG 985 114.80 Vidant North Hospital IP 134.48 Included in Primary Procedure 108.40 Included in Primary Procedure 121.85 150.88 150.88 134.48 Included in Primary Procedure Included in Primary Procedure 118.08 123.00 98.40 Included in Primary Procedure Included in Primary Procedure 98.40 150.88
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) MS-DRG 743 0.00 Vidant North Hospital IP 0.00 6342.74 0.00 6873.68 0.00 0.00 0.00 0.00 9640.96 6850.16 0.00 0.00 0.00 8269.20 6342.74 0.00 9640.96
Private OB 112 342.30 Vidant North Hospital IP 400.98 Included in Primary Procedure 323.23 Included in Primary Procedure 363.33 449.88 449.88 400.98 Included in Primary Procedure Included in Primary Procedure 352.08 366.75 293.40 Included in Primary Procedure Included in Primary Procedure 293.40 449.88
Pharmacy 250 501.99 Vidant North Hospital IP 588.05 Included in Primary Procedure 474.02 Included in Primary Procedure 532.83 659.76 659.76 588.05 Included in Primary Procedure Included in Primary Procedure 516.33 537.85 430.28 Included in Primary Procedure Included in Primary Procedure 430.28 659.76
Supplies 270 742.70 Vidant North Hospital IP 870.02 Included in Primary Procedure 701.32 Included in Primary Procedure 788.32 976.12 976.12 870.02 Included in Primary Procedure Included in Primary Procedure 763.92 795.75 636.60 Included in Primary Procedure Included in Primary Procedure 636.60 976.12
Laboratory 300 623.70 Vidant North Hospital IP 730.62 Included in Primary Procedure 588.95 Included in Primary Procedure 662.01 819.72 819.72 730.62 Included in Primary Procedure Included in Primary Procedure 641.52 668.25 534.60 Included in Primary Procedure Included in Primary Procedure 534.60 819.72
Pathology 310 316.40 Vidant North Hospital IP 370.64 Included in Primary Procedure 298.77 Included in Primary Procedure 335.84 415.84 415.84 370.64 Included in Primary Procedure Included in Primary Procedure 325.44 339.00 271.20 Included in Primary Procedure Included in Primary Procedure 271.20 415.84
OR Services 360 11090.10 Vidant North Hospital IP 12991.26 Included in Primary Procedure 10472.22 Included in Primary Procedure 11771.35 14575.56 14575.56 12991.26 Included in Primary Procedure Included in Primary Procedure 11406.96 11882.25 9505.80 Included in Primary Procedure Included in Primary Procedure 9505.80 14575.56
Anesthesia 370 2214.10 Vidant North Hospital IP 2593.66 Included in Primary Procedure 2090.74 Included in Primary Procedure 2350.11 2909.96 2909.96 2593.66 Included in Primary Procedure Included in Primary Procedure 2277.36 2372.25 1897.80 Included in Primary Procedure Included in Primary Procedure 1897.80 2909.96
Pharmacy 636 543.59 Vidant North Hospital IP 636.77 Included in Primary Procedure 513.30 Included in Primary Procedure 576.98 714.43 714.43 636.77 Included in Primary Procedure Included in Primary Procedure 559.12 582.41 465.93 Included in Primary Procedure Included in Primary Procedure 465.93 714.43
Recovery Room 710 1467.90 Vidant North Hospital IP 1719.54 Included in Primary Procedure 1386.12 Included in Primary Procedure 1558.07 1929.24 1929.24 1719.54 Included in Primary Procedure Included in Primary Procedure 1509.84 1572.75 1258.20 Included in Primary Procedure Included in Primary Procedure 1258.20 1929.24
EKG/ECG General 730 123.90 Vidant North Hospital IP 145.14 Included in Primary Procedure 117.00 Included in Primary Procedure 131.51 162.84 162.84 145.14 Included in Primary Procedure Included in Primary Procedure 127.44 132.75 106.20 Included in Primary Procedure Included in Primary Procedure 106.20 162.84
Professional Fees - Anesthesia 964 1429.40 Vidant North Hospital IP 1674.44 Included in Primary Procedure 1349.76 Included in Primary Procedure 1517.21 1878.64 1878.64 1674.44 Included in Primary Procedure Included in Primary Procedure 1470.24 1531.50 1225.20 Included in Primary Procedure Included in Primary Procedure 1225.20 1878.64
Professional Fees - EKG 985 114.80 Vidant North Hospital IP 134.48 Included in Primary Procedure 108.40 Included in Primary Procedure 121.85 150.88 150.88 134.48 Included in Primary Procedure Included in Primary Procedure 118.08 123.00 98.40 Included in Primary Procedure Included in Primary Procedure 98.40 150.88
Removal of cataract with insertion of lens Primary Procedure 360 66984 4941.30 Vidant North Hospital OP 5788.38 1794.04 4666.00 1794.04 5513.08 6494.28 6494.28 5788.38 3408.67 1937.56 5082.48 5294.25 4235.40 6211.92 1794.04 1794.04 6494.28
Pharmacy 250 65.81 Vidant North Hospital OP 77.10 Included in Primary Procedure 62.15 Included in Primary Procedure 73.43 86.50 86.50 77.10 Included in Primary Procedure Included in Primary Procedure 67.69 70.52 56.41 82.74 Included in Primary Procedure 56.41 86.50
Supplies 270 1617.80 Vidant North Hospital OP 1895.13 Included in Primary Procedure 1527.66 Included in Primary Procedure 1805.00 2126.25 2126.25 1895.13 Included in Primary Procedure Included in Primary Procedure 1664.02 1733.36 1386.68 2033.80 Included in Primary Procedure 1386.68 2126.25
Intraocular Lens 276 266.70 Vidant North Hospital OP 312.42 Included in Primary Procedure 251.84 Included in Primary Procedure 297.56 350.52 350.52 312.42 Included in Primary Procedure Included in Primary Procedure 274.32 285.75 228.60 335.28 Included in Primary Procedure 228.60 350.52
Laboratory 300 87635 139.30 Vidant North Hospital OP 163.18 51.31 131.54 51.31 155.42 183.08 183.08 163.18 97.49 55.41 143.28 149.25 119.40 175.12 51.31 51.31 183.08
Anesthesia 370 947.80 Vidant North Hospital OP 1110.28 Included in Primary Procedure 894.99 Included in Primary Procedure 1057.47 1245.68 1245.68 1110.28 Included in Primary Procedure Included in Primary Procedure 974.88 1015.50 812.40 1191.52 Included in Primary Procedure 812.40 1245.68
Pharmacy 636 J0171 61.01 Vidant North Hospital OP 71.46 Included in Primary Procedure 57.61 Included in Primary Procedure 68.06 80.18 80.18 71.46 Included in Primary Procedure Included in Primary Procedure 62.75 65.36 52.29 76.69 Included in Primary Procedure 52.29 80.18
Pharmacy 636 J2001 19.52 Vidant North Hospital OP 22.86 Included in Primary Procedure 18.43 Included in Primary Procedure 21.77 25.65 25.65 22.86 Included in Primary Procedure Included in Primary Procedure 20.07 20.91 16.73 24.53 Included in Primary Procedure 16.73 25.65
Shaving of shoulder bone using an endoscope Primary Procedure 360 29826 0.70 Vidant North Hospital OP 0.82 Included in Primary Procedure 0.66 Included in Primary Procedure 0.78 0.92 0.92 0.82 Included in Primary Procedure Included in Primary Procedure 0.72 0.75 0.60 0.88 Included in Primary Procedure 0.60 0.92
Pharmacy 250 462.83 Vidant North Hospital OP 542.17 Included in Primary Procedure 437.04 Included in Primary Procedure 516.38 608.29 608.29 542.17 Included in Primary Procedure Included in Primary Procedure 476.05 495.89 396.71 581.84 Included in Primary Procedure 396.71 608.29
Supplies 270 800.80 Vidant North Hospital OP 938.08 Included in Primary Procedure 756.18 Included in Primary Procedure 893.46 1052.48 1052.48 938.08 Included in Primary Procedure Included in Primary Procedure 823.68 858.00 686.40 1006.72 Included in Primary Procedure 686.40 1052.48
OR Services 360 29822 6719.30 Vidant North Hospital OP 7871.18 2428.99 6344.94 2428.99 7496.82 8831.08 8831.08 7871.18 4615.09 2623.31 6911.28 7199.25 5759.40 8447.12 2428.99 2428.99 8831.08
OR Services 361 64415 690.20 Vidant North Hospital OP 808.52 360.27 651.75 360.27 770.07 907.12 907.12 808.52 684.52 389.10 709.92 739.50 591.60 867.68 360.27 360.27 907.12
Anesthesia 370 1341.90 Vidant North Hospital OP 1571.94 Included in Primary Procedure 1267.14 Included in Primary Procedure 1497.18 1763.64 1763.64 1571.94 Included in Primary Procedure Included in Primary Procedure 1380.24 1437.75 1150.20 1686.96 Included in Primary Procedure 1150.20 1763.64
Respiratory Services 412 94640 22.40 Vidant North Hospital OP 26.24 Included in Primary Procedure 21.15 Included in Primary Procedure 24.99 29.44 29.44 26.24 Included in Primary Procedure Included in Primary Procedure 23.04 24.00 19.20 28.16 Included in Primary Procedure 19.20 29.44
Pulmonary Function 460 94760 24.50 Vidant North Hospital OP 28.70 Included in Primary Procedure 23.14 Included in Primary Procedure 27.34 32.20 32.20 28.70 Included in Primary Procedure Included in Primary Procedure 25.20 26.25 21.00 30.80 Included in Primary Procedure 21.00 32.20
Pharmacy 636 J3490 389.42 Vidant North Hospital OP 456.18 Included in Primary Procedure 367.73 Included in Primary Procedure 434.49 511.81 511.81 456.18 Included in Primary Procedure Included in Primary Procedure 400.55 417.24 333.79 489.56 Included in Primary Procedure 333.79 511.81
Pharmacy 636 J0171 119.56 Vidant North Hospital OP 140.06 Included in Primary Procedure 112.90 Included in Primary Procedure 133.39 157.14 157.14 140.06 Included in Primary Procedure Included in Primary Procedure 122.98 128.10 102.48 150.30 Included in Primary Procedure 102.48 157.14
Pharmacy 636 J2704 84.10 Vidant North Hospital OP 98.51 Included in Primary Procedure 79.41 Included in Primary Procedure 93.83 110.53 110.53 98.51 Included in Primary Procedure Included in Primary Procedure 86.50 90.11 72.08 105.72 Included in Primary Procedure 72.08 110.53
Pharmacy 636 J0171 59.78 Vidant North Hospital OP 70.03 Included in Primary Procedure 56.45 Included in Primary Procedure 66.70 78.57 78.57 70.03 Included in Primary Procedure Included in Primary Procedure 61.49 64.05 51.24 75.15 Included in Primary Procedure 51.24 78.57
Recovery Room 710 549.50 Vidant North Hospital OP 643.70 Included in Primary Procedure 518.89 Included in Primary Procedure 613.09 722.20 722.20 643.70 Included in Primary Procedure Included in Primary Procedure 565.20 588.75 471.00 690.80 Included in Primary Procedure 471.00 722.20
Obstetric blood test panel 80055 242.20 Vidant North Hospital OP 283.72 47.81 228.71 47.81 270.23 318.32 318.32 283.72 90.84 51.63 249.12 259.50 207.60 304.48 47.81 47.81 318.32
Patient office consultation, typically 40 min 99243 35.00 Vidant North Hospital OP 41.00 Not Applicable 33.05 Not Applicable 39.05 46.00 46.00 41.00 Not Applicable Not Applicable 36.00 37.50 30.00 44.00 Not Applicable 30.00 46.00
Patient office consultation, typically 60 min 99244 49.00 Vidant North Hospital OP 57.40 Not Applicable 46.27 Not Applicable 54.67 64.40 64.40 57.40 Not Applicable Not Applicable 50.40 52.50 42.00 61.60 Not Applicable 42.00 64.40
CT scan, head or brain, without contrast 70450 1048.60 Vidant North Hospital OP 1228.36 99.45 990.18 99.45 1169.94 1378.16 1378.16 1228.36 188.96 107.41 1078.56 1123.50 898.80 1318.24 99.45 99.45 1378.16
MRI scan of brain before and after contrast 70553 2710.40 Vidant North Hospital OP 3175.04 338.82 2559.39 338.82 3024.03 3562.24 3562.24 3175.04 643.76 365.93 2787.84 2904.00 2323.20 3407.36 338.82 338.82 3562.24
X-Ray, lower back, minimum four views 72110 394.80 Vidant North Hospital OP 462.48 99.45 372.80 99.45 440.48 518.88 518.88 462.48 188.96 107.41 406.08 423.00 338.40 496.32 99.45 99.45 518.88
MRI scan of lower spinal canal 72148 1390.20 Vidant North Hospital OP 1628.52 206.78 1312.75 206.78 1551.07 1827.12 1827.12 1628.52 392.88 223.32 1429.92 1489.50 1191.60 1747.68 206.78 206.78 1827.12
CT scan, pelvis, with contrast 72193 170.80 Vidant North Hospital OP 200.08 161.69 161.28 161.69 190.56 224.48 224.48 200.08 307.21 174.62 175.68 183.00 146.40 214.72 161.69 146.40 307.21
MRI scan of leg joint 73721 1446.20 Vidant North Hospital OP 1694.12 206.78 1365.63 206.78 1613.55 1900.72 1900.72 1694.12 392.88 223.32 1487.52 1549.50 1239.60 1818.08 206.78 206.78 1900.72
CT scan of abdomen and pelvis with contrast 74177 3656.80 Vidant North Hospital OP 4283.68 338.82 3453.06 338.82 4079.94 4806.08 4806.08 4283.68 643.76 365.93 3761.28 3918.00 3134.40 4597.12 338.82 338.82 4806.08
Ultrasound of abdomen 76700 625.80 Vidant North Hospital OP 733.08 99.45 590.93 99.45 698.21 822.48 822.48 733.08 188.96 107.41 643.68 670.50 536.40 786.72 99.45 99.45 822.48
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus 76805 453.60 Vidant North Hospital OP 531.36 99.45 428.33 99.45 506.09 596.16 596.16 531.36 188.96 107.41 466.56 486.00 388.80 570.24 99.45 99.45 596.16
Ultrasound pelvis through vagina 76830 597.80 Vidant North Hospital OP 700.28 99.45 564.49 99.45 666.97 785.68 785.68 700.28 188.96 107.41 614.88 640.50 512.40 751.52 99.45 99.45 785.68
Mammography of one breast 77065 175.00 Vidant North Hospital OP 205.00 87.87 165.25 87.87 195.25 230.00 230.00 205.00 166.95 94.90 180.00 187.50 150.00 220.00 87.87 87.87 230.00
Mammography of both breasts 77066 350.00 Vidant North Hospital OP 410.00 112.04 330.50 112.04 390.50 460.00 460.00 410.00 212.88 121.00 360.00 375.00 300.00 440.00 112.04 112.04 460.00
Mammography, screening, bilateral 77067 174.30 Vidant North Hospital OP 204.18 92.91 164.59 92.91 194.47 229.08 229.08 204.18 176.53 100.34 179.28 186.75 149.40 219.12 92.91 92.91 229.08
Basic metabolic panel 80048 118.30 Vidant North Hospital OP 138.58 8.46 111.71 8.46 131.99 155.48 155.48 138.58 16.07 9.14 121.68 126.75 101.40 148.72 8.46 8.46 155.48
Blood test, comprehensive group of blood chemicals 80053 184.10 Vidant North Hospital OP 215.66 10.56 173.84 10.56 205.40 241.96 241.96 215.66 20.06 11.40 189.36 197.25 157.80 231.44 10.56 10.56 241.96
Blood test, lipids (cholesterol and triglycerides) 80061 137.20 Vidant North Hospital OP 160.72 13.39 129.56 13.39 153.08 180.32 180.32 160.72 25.44 14.46 141.12 147.00 117.60 172.48 13.39 13.39 180.32
Kidney function panel test 80069 151.90 Vidant North Hospital OP 177.94 8.68 143.44 8.68 169.48 199.64 199.64 177.94 16.49 9.37 156.24 162.75 130.20 190.96 8.68 8.68 199.64
Liver function blood test panel 80076 154.70 Vidant North Hospital OP 181.22 8.17 146.08 8.17 172.60 203.32 203.32 181.22 15.52 8.82 159.12 165.75 132.60 194.48 8.17 8.17 203.32
Manual urinalysis test with examination using microscope 81001 72.80 Vidant North Hospital OP 85.28 3.17 68.74 3.17 81.22 95.68 95.68 85.28 6.02 3.42 74.88 78.00 62.40 91.52 3.17 3.17 95.68
Automated urinalysis test 81002 22.40 Vidant North Hospital OP 26.24 3.48 21.15 3.48 24.99 29.44 29.44 26.24 6.61 3.76 23.04 24.00 19.20 28.16 3.48 3.48 29.44
PSA (prostate specific antigen) 84154 64.40 Vidant North Hospital OP 75.44 18.39 60.81 18.39 71.85 84.64 84.64 75.44 34.94 19.86 66.24 69.00 55.20 80.96 18.39 18.39 84.64
Blood test, thyroid stimulating hormone (TSH) 84443 81.20 Vidant North Hospital OP 95.12 16.80 76.68 16.80 90.60 106.72 106.72 95.12 31.92 18.14 83.52 87.00 69.60 102.08 16.80 16.80 106.72
Complete blood cell count, with differential white blood cells, automated 85025 87.50 Vidant North Hospital OP 102.50 7.77 82.63 7.77 97.63 115.00 115.00 102.50 14.76 8.39 90.00 93.75 75.00 110.00 7.77 7.77 115.00
Complete blood count, automated 85027 39.90 Vidant North Hospital OP 46.74 6.47 37.68 6.47 44.52 52.44 52.44 46.74 12.29 6.99 41.04 42.75 34.20 50.16 6.47 6.47 52.44
Blood test, clotting time 85610 35.70 Vidant North Hospital OP 41.82 4.29 33.71 4.29 39.83 46.92 46.92 41.82 8.15 4.63 36.72 38.25 30.60 44.88 4.29 4.29 46.92
Coagulation assessment blood test 85730 40.60 Vidant North Hospital OP 47.56 6.01 38.34 6.01 45.30 53.36 53.36 47.56 11.42 6.49 41.76 43.50 34.80 51.04 6.01 6.01 53.36
Sleep Study 95810 2739.10 Vidant North Hospital OP 3208.66 806.53 2586.49 806.53 3056.05 3599.96 3599.96 3208.66 1532.41 871.05 2817.36 2934.75 2347.80 3443.44 806.53 806.53 3599.96
Physical therapy, therapeutic exercise 97110 55.30 Vidant North Hospital OP 64.78 30.21 52.22 30.21 61.70 90.00 72.68 90.00 57.40 32.63 56.88 59.25 47.40 69.52 30.21 30.21 90.00
New patient office or other outpatient visit, typically 30 min 99203 180.60 Vidant North Hospital OP 211.56 Not Applicable 170.54 Not Applicable 201.50 237.36 237.36 211.56 Not Applicable Not Applicable 185.76 193.50 154.80 227.04 Not Applicable 154.80 237.36
New patient office of other outpatient visit, typically 45 min 99204 230.30 Vidant North Hospital OP 269.78 Not Applicable 217.47 Not Applicable 256.95 302.68 302.68 269.78 Not Applicable Not Applicable 236.88 246.75 197.40 289.52 Not Applicable 197.40 302.68
New patient office of other outpatient visit, typically 60 min 99205 338.80 Vidant North Hospital OP 396.88 Not Applicable 319.92 Not Applicable 378.00 445.28 445.28 396.88 Not Applicable Not Applicable 348.48 363.00 290.40 425.92 Not Applicable 290.40 445.28
X-ray Mastoids 70130 251.30 Vidant North Hospital OP 294.38 99.45 237.30 99.45 280.38 330.28 330.28 294.38 188.96 107.41 258.48 269.25 215.40 315.92 99.45 99.45 330.28
X-ray Nose 70160 240.80 Vidant North Hospital OP 282.08 70.82 227.38 70.82 268.66 316.48 316.48 282.08 134.55 76.48 247.68 258.00 206.40 302.72 70.82 70.82 316.48
X-ray Chest 1 view 71045 130.20 Vidant North Hospital OP 152.52 70.82 122.95 70.82 145.27 171.12 171.12 152.52 134.55 76.48 133.92 139.50 111.60 163.68 70.82 70.82 171.12
X-ray exam chest 2 views 71046 241.50 Vidant North Hospital OP 282.90 70.82 228.05 70.82 269.45 317.40 317.40 282.90 134.55 76.48 248.40 258.75 207.00 303.60 70.82 70.82 317.40
X-ray exam chest 4+ views 71048 234.50 Vidant North Hospital OP 274.70 99.45 221.44 99.45 261.64 308.20 308.20 274.70 188.96 107.41 241.20 251.25 201.00 294.80 99.45 99.45 308.20
X-ray exam unilateral ribs/chest 71101 401.10 Vidant North Hospital OP 469.86 99.45 378.75 99.45 447.51 527.16 527.16 469.86 188.96 107.41 412.56 429.75 343.80 504.24 99.45 99.45 527.16
X-ray exam ribs/chest 4/> views 71111 420.70 Vidant North Hospital OP 492.82 99.45 397.26 99.45 469.38 552.92 552.92 492.82 188.96 107.41 432.72 450.75 360.60 528.88 99.45 99.45 552.92
X-ray exam breastbone 2/>views 71120 161.70 Vidant North Hospital OP 189.42 70.82 152.69 70.82 180.41 212.52 212.52 189.42 134.55 76.48 166.32 173.25 138.60 203.28 70.82 70.82 212.52
X-ray strenoclavic joint 3/> views 71130 164.50 Vidant North Hospital OP 192.70 70.82 155.34 70.82 183.54 216.20 216.20 192.70 134.55 76.48 169.20 176.25 141.00 206.80 70.82 70.82 216.20
X-ray exam of spine 1 view 72020 296.80 Vidant North Hospital OP 347.68 70.82 280.26 70.82 331.14 390.08 390.08 347.68 134.55 76.48 305.28 318.00 254.40 373.12 70.82 70.82 390.08
X-ray exam neck spine 2-3 view 72040 241.50 Vidant North Hospital OP 282.90 70.82 228.05 70.82 269.45 317.40 317.40 282.90 134.55 76.48 248.40 258.75 207.00 303.60 70.82 70.82 317.40
X-ray exam neck spine 4/5views 72050 350.70 Vidant North Hospital OP 410.82 99.45 331.16 99.45 391.28 460.92 460.92 410.82 188.96 107.41 360.72 375.75 300.60 440.88 99.45 99.45 460.92
X-ray exam entire spi 1 view 72081 534.80 Vidant North Hospital OP 626.48 70.82 505.00 70.82 596.68 702.88 702.88 626.48 134.55 76.48 550.08 573.00 458.40 672.32 70.82 70.82 702.88
X-ray exam l-s spine 2/3 views 72100 284.20 Vidant North Hospital OP 332.92 99.45 268.37 99.45 317.09 373.52 373.52 332.92 188.96 107.41 292.32 304.50 243.60 357.28 99.45 99.45 373.52
X-ray exam l-s spine bending 72114 100.10 Vidant North Hospital OP 117.26 99.45 94.52 99.45 111.68 131.56 131.56 117.26 188.96 107.41 102.96 107.25 85.80 125.84 99.45 85.80 188.96
X-ray bend only l-s spine 72120 490.00 Vidant North Hospital OP 574.00 99.45 462.70 99.45 546.70 644.00 644.00 574.00 188.96 107.41 504.00 525.00 420.00 616.00 99.45 99.45 644.00
X-ray exam of pelvis 72170 231.00 Vidant North Hospital OP 270.60 99.45 218.13 99.45 257.73 303.60 303.60 270.60 188.96 107.41 237.60 247.50 198.00 290.40 99.45 99.45 303.60
X-ray exam of pelvis 72190 100.10 Vidant North Hospital OP 117.26 99.45 94.52 99.45 111.68 131.56 131.56 117.26 188.96 107.41 102.96 107.25 85.80 125.84 99.45 85.80 188.96
X-ray exam si joints 3/> views 72202 287.00 Vidant North Hospital OP 336.20 99.45 271.01 99.45 320.21 377.20 377.20 336.20 188.96 107.41 295.20 307.50 246.00 360.80 99.45 99.45 377.20
X-ray exam sacrum tailbone 72220 194.60 Vidant North Hospital OP 227.96 70.82 183.76 70.82 217.12 255.76 255.76 227.96 134.55 76.48 200.16 208.50 166.80 244.64 70.82 70.82 255.76
X-ray of lower spine disk 72295 1304.80 Vidant North Hospital OP 1528.48 1525.61 1232.10 1525.61 1455.78 1714.88 1714.88 1528.48 2898.67 1647.66 1342.08 1398.00 1118.40 1640.32 1525.61 1118.40 2898.67
X-ray exam of collar bone 73000 237.30 Vidant North Hospital OP 277.98 70.82 224.08 70.82 264.76 311.88 311.88 277.98 134.55 76.48 244.08 254.25 203.40 298.32 70.82 70.82 311.88
X-ray exam of shoulder blade 73010 258.30 Vidant North Hospital OP 302.58 99.45 243.91 99.45 288.19 339.48 339.48 302.58 188.96 107.41 265.68 276.75 221.40 324.72 99.45 99.45 339.48
X-ray exam of shoulder 73020 248.50 Vidant North Hospital OP 291.10 70.82 234.66 70.82 277.26 326.60 326.60 291.10 134.55 76.48 255.60 266.25 213.00 312.40 70.82 70.82 326.60
X-ray exam of shoulder 73030 304.50 Vidant North Hospital OP 356.70 70.82 287.54 70.82 339.74 400.20 400.20 356.70 134.55 76.48 313.20 326.25 261.00 382.80 70.82 70.82 400.20
Contrast x-ray of shoulder 73040 479.50 Vidant North Hospital OP 561.70 338.82 452.79 338.82 534.99 630.20 630.20 561.70 643.76 365.93 493.20 513.75 411.00 602.80 338.82 338.82 643.76
X-ray exam of shoulders 73050 261.10 Vidant North Hospital OP 305.86 70.82 246.55 70.82 291.31 343.16 343.16 305.86 134.55 76.48 268.56 279.75 223.80 328.24 70.82 70.82 343.16
X-ray exam of humerus 73060 231.00 Vidant North Hospital OP 270.60 70.82 218.13 70.82 257.73 303.60 303.60 270.60 134.55 76.48 237.60 247.50 198.00 290.40 70.82 70.82 303.60
X-ray exam of elbow 73070 246.40 Vidant North Hospital OP 288.64 70.82 232.67 70.82 274.91 323.84 323.84 288.64 134.55 76.48 253.44 264.00 211.20 309.76 70.82 70.82 323.84
X-ray exam of elbow 73080 301.70 Vidant North Hospital OP 353.42 70.82 284.89 70.82 336.61 396.52 396.52 353.42 134.55 76.48 310.32 323.25 258.60 379.28 70.82 70.82 396.52
X-ray exam of forearm 73090 254.10 Vidant North Hospital OP 297.66 70.82 239.94 70.82 283.50 333.96 333.96 297.66 134.55 76.48 261.36 272.25 217.80 319.44 70.82 70.82 333.96
X-ray exam of arm infant 73092 100.10 Vidant North Hospital OP 117.26 99.45 94.52 99.45 111.68 131.56 131.56 117.26 188.96 107.41 102.96 107.25 85.80 125.84 99.45 85.80 188.96
X-ray exam of wrist 73100 219.10 Vidant North Hospital OP 256.66 70.82 206.89 70.82 244.45 287.96 287.96 256.66 134.55 76.48 225.36 234.75 187.80 275.44 70.82 70.82 287.96
X-ray exam of wrist complete 73110 219.10 Vidant North Hospital OP 256.66 70.82 206.89 70.82 244.45 287.96 287.96 256.66 134.55 76.48 225.36 234.75 187.80 275.44 70.82 70.82 287.96
X-ray exam of wrist 2 views 73115 385.00 Vidant North Hospital OP 451.00 338.82 363.55 338.82 429.55 506.00 506.00 451.00 643.76 365.93 396.00 412.50 330.00 484.00 338.82 330.00 643.76
X-ray exam of hand 2 views 73120 260.40 Vidant North Hospital OP 305.04 99.45 245.89 99.45 290.53 342.24 342.24 305.04 188.96 107.41 267.84 279.00 223.20 327.36 99.45 99.45 342.24
X-ray exam of hand 3 views 73130 297.50 Vidant North Hospital OP 348.50 70.82 280.93 70.82 331.93 391.00 391.00 348.50 134.55 76.48 306.00 318.75 255.00 374.00 70.82 70.82 391.00
X-ray exam of finger(s) 73140 232.40 Vidant North Hospital OP 272.24 70.82 219.45 70.82 259.29 305.44 305.44 272.24 134.55 76.48 239.04 249.00 199.20 292.16 70.82 70.82 305.44
X-ray exam hip unilateral 1 view 73501 64.40 Vidant North Hospital OP 75.44 70.82 60.81 70.82 71.85 84.64 84.64 75.44 134.55 76.48 66.24 69.00 55.20 80.96 70.82 55.20 134.55
X-ray exam hip unilateral 2-3 views 73502 84.70 Vidant North Hospital OP 99.22 70.82 79.98 70.82 94.50 111.32 111.32 99.22 134.55 76.48 87.12 90.75 72.60 106.48 70.82 70.82 134.55
X-ray exam hips bilateral 2 views 73521 366.10 Vidant North Hospital OP 428.86 99.45 345.70 99.45 408.46 481.16 481.16 428.86 188.96 107.41 376.56 392.25 313.80 460.24 99.45 99.45 481.16
X-ray exam hip with contrast 73525 479.50 Vidant North Hospital OP 561.70 338.82 452.79 338.82 534.99 630.20 630.20 561.70 643.76 365.93 493.20 513.75 411.00 602.80 338.82 338.82 643.76
X-ray exam of femur 2 views 73552 257.60 Vidant North Hospital OP 301.76 70.82 243.25 70.82 287.41 338.56 338.56 301.76 134.55 76.48 264.96 276.00 220.80 323.84 70.82 70.82 338.56
X-ray exam of knee 1 or 2 73560 93.10 Vidant North Hospital OP 109.06 70.82 87.91 70.82 103.87 122.36 122.36 109.06 134.55 76.48 95.76 99.75 79.80 117.04 70.82 70.82 134.55
X-ray exam of knee 3 73562 259.00 Vidant North Hospital OP 303.40 70.82 244.57 70.82 288.97 340.40 340.40 303.40 134.55 76.48 266.40 277.50 222.00 325.60 70.82 70.82 340.40
X-ray exam knee 4 or more 73564 200.20 Vidant North Hospital OP 234.52 99.45 189.05 99.45 223.37 263.12 263.12 234.52 188.96 107.41 205.92 214.50 171.60 251.68 99.45 99.45 263.12
X-ray exam of knees 73565 84.70 Vidant North Hospital OP 99.22 70.82 79.98 70.82 94.50 111.32 111.32 99.22 134.55 76.48 87.12 90.75 72.60 106.48 70.82 70.82 134.55
Contrast x-ray of knee joint 73580 479.50 Vidant North Hospital OP 561.70 338.82 452.79 338.82 534.99 630.20 630.20 561.70 643.76 365.93 493.20 513.75 411.00 602.80 338.82 338.82 643.76
X-ray exam of lower leg 73590 240.80 Vidant North Hospital OP 282.08 70.82 227.38 70.82 268.66 316.48 316.48 282.08 134.55 76.48 247.68 258.00 206.40 302.72 70.82 70.82 316.48
X-ray exam of ankle 2 views 73600 254.10 Vidant North Hospital OP 297.66 70.82 239.94 70.82 283.50 333.96 333.96 297.66 134.55 76.48 261.36 272.25 217.80 319.44 70.82 70.82 333.96
X-ray exam of ankle complete 73610 293.30 Vidant North Hospital OP 343.58 70.82 276.96 70.82 327.24 385.48 385.48 343.58 134.55 76.48 301.68 314.25 251.40 368.72 70.82 70.82 385.48
X-ray exam of foot 2 views 73620 231.00 Vidant North Hospital OP 270.60 70.82 218.13 70.82 257.73 303.60 303.60 270.60 134.55 76.48 237.60 247.50 198.00 290.40 70.82 70.82 303.60
X-ray exam of foot complete 73630 263.20 Vidant North Hospital OP 308.32 70.82 248.54 70.82 293.66 345.92 345.92 308.32 134.55 76.48 270.72 282.00 225.60 330.88 70.82 70.82 345.92
X-ray exam of heel 73650 184.80 Vidant North Hospital OP 216.48 70.82 174.50 70.82 206.18 242.88 242.88 216.48 134.55 76.48 190.08 198.00 158.40 232.32 70.82 70.82 242.88
X-ray exam of toe(s) 73660 252.70 Vidant North Hospital OP 296.02 70.82 238.62 70.82 281.94 332.12 332.12 296.02 134.55 76.48 259.92 270.75 216.60 317.68 70.82 70.82 332.12
X-ray exam abdomen 1 view 74018 249.20 Vidant North Hospital OP 291.92 70.82 235.32 70.82 278.04 327.52 327.52 291.92 134.55 76.48 256.32 267.00 213.60 313.28 70.82 70.82 327.52
X-ray exam abdomen 2 views 74019 282.80 Vidant North Hospital OP 331.28 99.45 267.04 99.45 315.52 371.68 371.68 331.28 188.96 107.41 290.88 303.00 242.40 355.52 99.45 99.45 371.68
X-ray exam complete abdomen 74022 394.80 Vidant North Hospital OP 462.48 99.45 372.80 99.45 440.48 518.88 518.88 462.48 188.96 107.41 406.08 423.00 338.40 496.32 99.45 99.45 518.88
Us Soft Tissue Head & Neck Real Time Image 76536 442.40 Vidant North Hospital OP 518.24 99.45 417.75 99.45 493.59 581.44 581.44 518.24 188.96 107.41 455.04 474.00 379.20 556.16 99.45 99.45 581.44
Us Breast Unilateral Real Time With Image Limited 76642 378.00 Vidant North Hospital OP 442.80 70.82 356.94 70.82 421.74 496.80 496.80 442.80 134.55 76.48 388.80 405.00 324.00 475.20 70.82 70.82 496.80
Us Abdominal Real Time W/Image Limited 76705 543.20 Vidant North Hospital OP 636.32 99.45 512.94 99.45 606.06 713.92 713.92 636.32 188.96 107.41 558.72 582.00 465.60 682.88 99.45 99.45 713.92
Aorta Echo 76775 281.40 Vidant North Hospital OP 329.64 99.45 265.72 99.45 313.96 369.84 369.84 329.64 188.96 107.41 289.44 301.50 241.20 353.76 99.45 99.45 369.84
Obstetric US < 14 Weeks Single Fetus 76801 453.60 Vidant North Hospital OP 531.36 99.45 428.33 99.45 506.09 596.16 596.16 531.36 188.96 107.41 466.56 486.00 388.80 570.24 99.45 99.45 596.16
Transvaginal US 76817 557.20 Vidant North Hospital OP 652.72 99.45 526.16 99.45 621.68 732.32 732.32 652.72 188.96 107.41 573.12 597.00 477.60 700.48 99.45 99.45 732.32
US Pelvic Nonobstetric Real-Time Image Complete 76856 507.50 Vidant North Hospital OP 594.50 99.45 479.23 99.45 566.23 667.00 667.00 594.50 188.96 107.41 522.00 543.75 435.00 638.00 99.45 99.45 667.00
US Pelvic Limited Bladder 76857 53.20 Vidant North Hospital OP 62.32 99.45 50.24 99.45 59.36 69.92 69.92 62.32 188.96 107.41 54.72 57.00 45.60 66.88 99.45 45.60 188.96
Testicular Echo 76870 495.60 Vidant North Hospital OP 580.56 99.45 467.99 99.45 552.95 651.36 651.36 580.56 188.96 107.41 509.76 531.00 424.80 623.04 99.45 99.45 651.36
Ultrasound of Limited evaluation of Joint or structure in extremity other than Joint 76882 385.70 Vidant North Hospital OP 451.82 99.45 364.21 99.45 430.33 506.92 506.92 451.82 188.96 107.41 396.72 413.25 330.60 484.88 99.45 99.45 506.92
US Guidance Needle Placement Imaging S&I 76942 175.00 Vidant North Hospital OP 205.00 0.00 165.25 0.00 195.25 230.00 230.00 205.00 0.00 0.00 180.00 187.50 150.00 220.00 0.00 0.00 230.00
Whole Body Scan 78806 665.70 Vidant North Hospital OP 779.82 Not Applicable 628.61 Not Applicable 742.73 874.92 874.92 779.82 Not Applicable Not Applicable 684.72 713.25 570.60 836.88 Not Applicable 570.60 874.92
Acute Hepatitis Panel 80074 375.20 Vidant North Hospital OP 439.52 47.63 354.30 47.63 418.62 493.12 493.12 439.52 90.50 51.44 385.92 402.00 321.60 471.68 47.63 47.63 493.12
Urine Pregnancy Test Visual Color 81025 72.80 Vidant North Hospital OP 85.28 8.61 68.74 8.61 81.22 95.68 95.68 85.28 16.36 9.30 74.88 78.00 62.40 91.52 8.61 8.61 95.68
Albumin Serum Plasma 82040 21.70 Vidant North Hospital OP 25.42 4.95 20.49 4.95 24.21 28.52 28.52 25.42 9.41 5.35 22.32 23.25 18.60 27.28 4.95 4.95 28.52
Other Source Albumin Quantitative Each Specimen 82042 8.40 Vidant North Hospital OP 9.84 7.78 7.93 7.78 9.37 11.04 11.04 9.84 14.78 8.40 8.64 9.00 7.20 10.56 7.78 7.20 14.78
Urine Albumin Quantitative 82043 50.40 Vidant North Hospital OP 59.04 5.78 47.59 5.78 56.23 66.24 66.24 59.04 10.98 6.24 51.84 54.00 43.20 63.36 5.78 5.78 66.24
Assay Of Amylase 82150 97.30 Vidant North Hospital OP 113.98 6.48 91.88 6.48 108.56 127.88 127.88 113.98 12.31 7.00 100.08 104.25 83.40 122.32 6.48 6.48 127.88
Bilirubin Total 82247 50.40 Vidant North Hospital OP 59.04 5.02 47.59 5.02 56.23 66.24 66.24 59.04 9.54 5.42 51.84 54.00 43.20 63.36 5.02 5.02 66.24
Bilirubin Direct 82248 55.30 Vidant North Hospital OP 64.78 5.02 52.22 5.02 61.70 72.68 72.68 64.78 9.54 5.42 56.88 59.25 47.40 69.52 5.02 5.02 72.68
Calcium Total 82310 48.30 Vidant North Hospital OP 56.58 5.16 45.61 5.16 53.89 63.48 63.48 56.58 9.80 5.57 49.68 51.75 41.40 60.72 5.16 5.16 63.48
Cortisol Total 82533 67.90 Vidant North Hospital OP 79.54 16.30 64.12 16.30 75.76 89.24 89.24 79.54 30.97 17.60 69.84 72.75 58.20 85.36 16.30 16.30 89.24
Creatine Kinase Total 82550 73.50 Vidant North Hospital OP 86.10 6.51 69.41 6.51 82.01 96.60 96.60 86.10 12.37 7.03 75.60 78.75 63.00 92.40 6.51 6.51 96.60
Creatine Kinase Mb Fracton Only 82553 133.00 Vidant North Hospital OP 155.80 11.55 125.59 11.55 148.39 174.80 174.80 155.80 21.95 12.47 136.80 142.50 114.00 167.20 11.55 11.55 174.80
Creatinine Blood 82565 56.00 Vidant North Hospital OP 65.60 5.12 52.88 5.12 62.48 73.60 73.60 65.60 9.73 5.53 57.60 60.00 48.00 70.40 5.12 5.12 73.60
Creatinine Other Source 82570 31.50 Vidant North Hospital OP 36.90 5.18 29.75 5.18 35.15 41.40 41.40 36.90 9.84 5.59 32.40 33.75 27.00 39.60 5.18 5.18 41.40
Vitamin B-12 82607 69.30 Vidant North Hospital OP 81.18 15.08 65.44 15.08 77.32 91.08 91.08 81.18 28.65 16.29 71.28 74.25 59.40 87.12 15.08 15.08 91.08
DHEA Sulfate Test 82627 80.50 Vidant North Hospital OP 94.30 22.23 76.02 22.23 89.82 105.80 105.80 94.30 42.24 24.01 82.80 86.25 69.00 101.20 22.23 22.23 105.80
Assay Of Estradiol 82670 134.40 Vidant North Hospital OP 157.44 27.94 126.91 27.94 149.95 176.64 176.64 157.44 53.09 30.18 138.24 144.00 115.20 168.96 27.94 27.94 176.64
Assay Of Ferritin 82728 71.40 Vidant North Hospital OP 83.64 13.63 67.42 13.63 79.66 93.84 93.84 83.64 25.90 14.72 73.44 76.50 61.20 89.76 13.63 13.63 93.84
Assay Of Folic Acid Serum 82746 50.40 Vidant North Hospital OP 59.04 14.70 47.59 14.70 56.23 66.24 66.24 59.04 27.93 15.88 51.84 54.00 43.20 63.36 14.70 14.70 66.24
Assay Of Gammaglobulin IgA, IgE IgG, IgM 82784 77.70 Vidant North Hospital OP 91.02 9.30 73.37 9.30 86.69 102.12 102.12 91.02 17.67 10.04 79.92 83.25 66.60 97.68 9.30 9.30 102.12
Glucose Tolerance Test Non Gestational 2 Hour 82947 57.40 Vidant North Hospital OP 67.24 3.93 54.20 3.93 64.04 75.44 75.44 67.24 7.47 4.24 59.04 61.50 49.20 72.16 3.93 3.93 75.44
Glucose Blood Monitor Home Use 82962 7.00 Vidant North Hospital OP 8.20 3.28 6.61 3.28 7.81 9.20 9.20 8.20 6.23 3.54 7.20 7.50 6.00 8.80 3.28 3.28 9.20
Gonadotropin Follicle Stimulating Hormone 83001 160.30 Vidant North Hospital OP 187.78 18.58 151.37 18.58 178.85 210.68 210.68 187.78 35.30 20.07 164.88 171.75 137.40 201.52 18.58 18.58 210.68
Gonadotropin Luteinizing Hormone 83002 158.90 Vidant North Hospital OP 186.14 18.52 150.05 18.52 177.29 208.84 208.84 186.14 35.19 20.00 163.44 170.25 136.20 199.76 18.52 18.52 208.84
Hemoglobin Glycosylated A1C 83036 48.30 Vidant North Hospital OP 56.58 9.71 45.61 9.71 53.89 63.48 63.48 56.58 18.45 10.49 49.68 51.75 41.40 60.72 9.71 9.71 63.48
Immunoassay Analyte Qual/Semiqual Multiple Step 83516 124.60 Vidant North Hospital OP 145.96 11.53 117.66 11.53 139.02 163.76 163.76 145.96 21.91 12.45 128.16 133.50 106.80 156.64 11.53 11.53 163.76
Assay Of Insulin Total 83525 65.10 Vidant North Hospital OP 76.26 11.43 61.47 11.43 72.63 85.56 85.56 76.26 21.72 12.34 66.96 69.75 55.80 81.84 11.43 11.43 85.56
Assay Of Iron 83540 28.00 Vidant North Hospital OP 32.80 6.47 26.44 6.47 31.24 36.80 36.80 32.80 12.29 6.99 28.80 30.00 24.00 35.20 6.47 6.47 36.80
Iron Binding Capacity 83550 33.60 Vidant North Hospital OP 39.36 8.74 31.73 8.74 37.49 44.16 44.16 39.36 16.61 9.44 34.56 36.00 28.80 42.24 8.74 8.74 44.16
Assay Of Lactate 83605 69.30 Vidant North Hospital OP 81.18 11.57 65.44 11.57 77.32 91.08 91.08 81.18 21.98 12.50 71.28 74.25 59.40 87.12 11.57 11.57 91.08
Lactate Dehydrogenase Ldh 83615 38.50 Vidant North Hospital OP 45.10 6.04 36.36 6.04 42.96 50.60 50.60 45.10 11.48 6.52 39.60 41.25 33.00 48.40 6.04 6.04 50.60
Assay Of Lipase 83690 71.40 Vidant North Hospital OP 83.64 6.89 67.42 6.89 79.66 93.84 93.84 83.64 13.09 7.44 73.44 76.50 61.20 89.76 6.89 6.89 93.84
Assay Of Magnesium 83735 25.20 Vidant North Hospital OP 29.52 6.70 23.80 6.70 28.12 33.12 33.12 29.52 12.73 7.24 25.92 27.00 21.60 31.68 6.70 6.70 33.12
Myoglobin 83874 126.70 Vidant North Hospital OP 148.42 12.92 119.64 12.92 141.36 166.52 166.52 148.42 24.55 13.95 130.32 135.75 108.60 159.28 12.92 12.92 166.52
Natriuretic Peptide 83880 121.10 Vidant North Hospital OP 141.86 39.26 114.35 39.26 135.11 159.16 159.16 141.86 74.59 42.40 124.56 129.75 103.80 152.24 39.26 39.26 159.16
Assay Of Parathormone 83970 51.80 Vidant North Hospital OP 60.68 41.28 48.91 41.28 57.79 68.08 68.08 60.68 78.43 44.58 53.28 55.50 44.40 65.12 41.28 41.28 78.43
Assay Of Phosphatase Alkaline 84075 49.00 Vidant North Hospital OP 57.40 5.18 46.27 5.18 54.67 64.40 64.40 57.40 9.84 5.59 50.40 52.50 42.00 61.60 5.18 5.18 64.40
Assay Of Phosphorus Inorganic 84100 11.90 Vidant North Hospital OP 13.94 4.74 11.24 4.74 13.28 15.64 15.64 13.94 9.01 5.12 12.24 12.75 10.20 14.96 4.74 4.74 15.64
Potassium Serum Plasma/Whole Blood 84132 24.50 Vidant North Hospital OP 28.70 4.76 23.14 4.76 27.34 32.20 32.20 28.70 9.04 5.14 25.20 26.25 21.00 30.80 4.76 4.76 32.20
Progesterone 84144 88.20 Vidant North Hospital OP 103.32 20.86 83.29 20.86 98.41 115.92 115.92 103.32 39.63 22.53 90.72 94.50 75.60 110.88 20.86 20.86 115.92
Prolactin 84146 137.20 Vidant North Hospital OP 160.72 19.38 129.56 19.38 153.08 180.32 180.32 160.72 36.82 20.93 141.12 147.00 117.60 172.48 19.38 19.38 180.32
Assay Of Prostate Specific Antigen Total 84153 126.70 Vidant North Hospital OP 148.42 18.39 119.64 18.39 141.36 166.52 166.52 148.42 34.94 19.86 130.32 135.75 108.60 159.28 18.39 18.39 166.52
Protein Total Urine 84156 58.10 Vidant North Hospital OP 68.06 3.67 54.86 3.67 64.82 76.36 76.36 68.06 6.97 3.96 59.76 62.25 49.80 73.04 3.67 3.67 76.36
Testosterone Free T4 84402 84.70 Vidant North Hospital OP 99.22 25.47 79.98 25.47 94.50 111.32 111.32 99.22 48.39 27.51 87.12 90.75 72.60 106.48 25.47 25.47 111.32
Testosterone Total 84403 126.00 Vidant North Hospital OP 147.60 25.81 118.98 25.81 140.58 165.60 165.60 147.60 49.04 27.87 129.60 135.00 108.00 158.40 25.81 25.81 165.60
Thyroxine Total 84436 49.00 Vidant North Hospital OP 57.40 6.87 46.27 6.87 54.67 64.40 64.40 57.40 13.05 7.42 50.40 52.50 42.00 61.60 6.87 6.87 64.40
Free Thyroxine 84439 69.30 Vidant North Hospital OP 81.18 9.02 65.44 9.02 77.32 91.08 91.08 81.18 17.14 9.74 71.28 74.25 59.40 87.12 9.02 9.02 91.08
Transferase Aspartate Amino Ast Sgot 84450 63.00 Vidant North Hospital OP 73.80 5.18 59.49 5.18 70.29 82.80 82.80 73.80 9.84 5.59 64.80 67.50 54.00 79.20 5.18 5.18 82.80
Transferase Alanine Amino Alt Sgpt 84460 58.80 Vidant North Hospital OP 68.88 5.30 55.52 5.30 65.60 77.28 77.28 68.88 10.07 5.72 60.48 63.00 50.40 73.92 5.30 5.30 77.28
Triiodothyronine T3 Total Tt3 84480 135.80 Vidant North Hospital OP 159.08 14.18 128.23 14.18 151.51 178.48 178.48 159.08 26.94 15.31 139.68 145.50 116.40 170.72 14.18 14.18 178.48
T3 Free 84481 177.10 Vidant North Hospital OP 207.46 16.94 167.23 16.94 197.59 232.76 232.76 207.46 32.19 18.30 182.16 189.75 151.80 222.64 16.94 16.94 232.76
Troponin Quantitative 84484 95.20 Vidant North Hospital OP 111.52 12.47 89.90 12.47 106.22 125.12 125.12 111.52 23.69 13.47 97.92 102.00 81.60 119.68 12.47 12.47 125.12
Urea Nitrogen Quantitative 84520 39.90 Vidant North Hospital OP 46.74 3.95 37.68 3.95 44.52 52.44 52.44 46.74 7.51 4.27 41.04 42.75 34.20 50.16 3.95 3.95 52.44
Blood/Uric Acid 84550 46.20 Vidant North Hospital OP 54.12 4.52 43.63 4.52 51.55 60.72 60.72 54.12 8.59 4.88 47.52 49.50 39.60 58.08 4.52 4.52 60.72
Gonadotropin Chorionic Quantitative 84702 136.50 Vidant North Hospital OP 159.90 15.05 128.90 15.05 152.30 179.40 179.40 159.90 28.60 16.25 140.40 146.25 117.00 171.60 15.05 15.05 179.40
Gonadotropin Chorionic Qualitative 84703 100.80 Vidant North Hospital OP 118.08 7.52 95.18 7.52 112.46 132.48 132.48 118.08 14.29 8.12 103.68 108.00 86.40 126.72 7.52 7.52 132.48
Blood Count Hematocrit 85014 35.70 Vidant North Hospital OP 41.82 2.37 33.71 2.37 39.83 46.92 46.92 41.82 4.50 2.56 36.72 38.25 30.60 44.88 2.37 2.37 46.92
Blood Count Hemoglobin 85018 35.70 Vidant North Hospital OP 41.82 2.37 33.71 2.37 39.83 46.92 46.92 41.82 4.50 2.56 36.72 38.25 30.60 44.88 2.37 2.37 46.92
Blood Count Reticulocyte Automated 85045 47.60 Vidant North Hospital OP 55.76 3.99 44.95 3.99 53.11 62.56 62.56 55.76 7.58 4.31 48.96 51.00 40.80 59.84 3.99 3.99 62.56
Blood Count Platelet Automated 85049 47.60 Vidant North Hospital OP 55.76 4.48 44.95 4.48 53.11 62.56 62.56 55.76 8.51 4.84 48.96 51.00 40.80 59.84 4.48 4.48 62.56
Sedimentation Rate Rbc Non-Automated 85651 62.30 Vidant North Hospital OP 72.98 4.27 58.83 4.27 69.51 81.88 81.88 72.98 8.11 4.61 64.08 66.75 53.40 78.32 4.27 4.27 81.88
Antinuclear Antibodies Ana 86038 137.90 Vidant North Hospital OP 161.54 12.09 130.22 12.09 153.86 181.24 181.24 161.54 22.97 13.06 141.84 147.75 118.20 173.36 12.09 12.09 181.24
C-Reactive Protein 86140 90.30 Vidant North Hospital OP 105.78 5.18 85.27 5.18 100.75 118.68 118.68 105.78 9.84 5.59 92.88 96.75 77.40 113.52 5.18 5.18 118.68
C-Reactive Protein High Sensitivity 86141 40.60 Vidant North Hospital OP 47.56 12.95 38.34 12.95 45.30 53.36 53.36 47.56 24.61 13.99 41.76 43.50 34.80 51.04 12.95 12.95 53.36
Microsomal Antibodies Each 86376 96.60 Vidant North Hospital OP 113.16 14.55 91.22 14.55 107.78 126.96 126.96 113.16 27.65 15.71 99.36 103.50 82.80 121.44 14.55 14.55 126.96
Rheumatoid Factor Quantitative 86431 81.20 Vidant North Hospital OP 95.12 5.67 76.68 5.67 90.60 106.72 106.72 95.12 10.77 6.12 83.52 87.00 69.60 102.08 5.67 5.67 106.72
Syphilis Test Non-Treponemal Antibody Qual 86592 60.90 Vidant North Hospital OP 71.34 4.27 57.51 4.27 67.95 80.04 80.04 71.34 8.11 4.61 62.64 65.25 52.20 76.56 4.27 4.27 80.04
Antibody Hiv-1&Hiv-2 Single Result 86703 63.00 Vidant North Hospital OP 73.80 13.71 59.49 13.71 70.29 82.80 82.80 73.80 26.05 14.81 64.80 67.50 54.00 79.20 13.71 13.71 82.80
Hepatitis B Surf Antibody Hbsab 86706 193.90 Vidant North Hospital OP 227.14 10.74 183.10 10.74 216.34 254.84 254.84 227.14 20.41 11.60 199.44 207.75 166.20 243.76 10.74 10.74 254.84
Antibody Rubella 86762 62.30 Vidant North Hospital OP 72.98 14.39 58.83 14.39 69.51 81.88 81.88 72.98 27.34 15.54 64.08 66.75 53.40 78.32 14.39 14.39 81.88
Rapid Strep Test 87651 92.40 Vidant North Hospital OP 108.24 35.09 87.25 35.09 103.09 121.44 121.44 108.24 66.67 37.90 95.04 99.00 79.20 116.16 35.09 35.09 121.44
Antibody Treponema Pallidum 86780 91.70 Vidant North Hospital OP 107.42 13.24 86.59 13.24 102.31 120.52 120.52 107.42 25.16 14.30 94.32 98.25 78.60 115.28 13.24 13.24 120.52
Thyroglobulin Antibody 86800 21.00 Vidant North Hospital OP 24.60 15.91 19.83 15.91 23.43 27.60 27.60 24.60 30.23 17.18 21.60 22.50 18.00 26.40 15.91 15.91 30.23
Hepatitis C Antibody 86803 277.90 Vidant North Hospital OP 325.54 14.27 262.42 14.27 310.06 365.24 365.24 325.54 27.11 15.41 285.84 297.75 238.20 349.36 14.27 14.27 365.24
Antibody Screen Rbc Each Serum Technique 86850 60.90 Vidant North Hospital OP 71.34 43.90 57.51 43.90 67.95 80.04 80.04 71.34 83.40 47.41 62.64 65.25 52.20 76.56 43.90 43.90 83.40
Stool Culture 87045 88.20 Vidant North Hospital OP 103.32 9.44 83.29 9.44 98.41 115.92 115.92 103.32 17.94 10.20 90.72 94.50 75.60 110.88 9.44 9.44 115.92
Bacterial Culture Urine Blood/Stool 87070 114.80 Vidant North Hospital OP 134.48 8.62 108.40 8.62 128.08 150.88 150.88 134.48 16.38 9.31 118.08 123.00 98.40 144.32 8.62 8.62 150.88
Culture Anaerobic Bacteria Gram Stain 87075 72.80 Vidant North Hospital OP 85.28 9.47 68.74 9.47 81.22 95.68 95.68 85.28 17.99 10.23 74.88 78.00 62.40 91.52 9.47 9.47 95.68
Culture Aerobic Bacteria 87077 44.10 Vidant North Hospital OP 51.66 8.08 41.64 8.08 49.20 57.96 57.96 51.66 15.35 8.73 45.36 47.25 37.80 55.44 8.08 8.08 57.96
Bacterium Anaerobic Identification 87086 88.90 Vidant North Hospital OP 104.14 8.07 83.95 8.07 99.19 116.84 116.84 104.14 15.33 8.72 91.44 95.25 76.20 111.76 8.07 8.07 116.84
Susceptiblty Study Antimicrobacterial 87186 37.10 Vidant North Hospital OP 43.46 8.65 35.03 8.65 41.39 48.76 48.76 43.46 16.44 9.34 38.16 39.75 31.80 46.64 8.65 8.65 48.76
Smear Stain Bacterial Fungi/Cell 87205 57.40 Vidant North Hospital OP 67.24 4.27 54.20 4.27 64.04 75.44 75.44 67.24 8.11 4.61 59.04 61.50 49.20 72.16 4.27 4.27 75.44
Hepatitis B Surface Antigen 87340 158.20 Vidant North Hospital OP 185.32 10.33 149.39 10.33 176.51 207.92 207.92 185.32 19.63 11.16 162.72 169.50 135.60 198.88 10.33 10.33 207.92
Chlamydia Trachomatis Amplified Probe Test 87491 40.60 Vidant North Hospital OP 47.56 35.09 38.34 35.09 45.30 53.36 53.36 47.56 66.67 37.90 41.76 43.50 34.80 51.04 35.09 34.80 66.67
Influenza A & B RNA 87502 142.80 Vidant North Hospital OP 167.28 95.80 134.84 95.80 159.32 187.68 187.68 167.28 182.02 103.46 146.88 153.00 122.40 179.52 95.80 95.80 187.68
Chlamydia, Trachomatis, Gonorroeae Urine Test 87591 40.60 Vidant North Hospital OP 47.56 35.09 38.34 35.09 45.30 53.36 53.36 47.56 66.67 37.90 41.76 43.50 34.80 51.04 35.09 34.80 66.67
Cytopathology Cell Enhancement 88112 37.10 Vidant North Hospital OP 43.46 43.90 35.03 43.90 41.39 48.76 48.76 43.46 83.40 47.41 38.16 39.75 31.80 46.64 43.90 31.80 83.40
Cytopathology, cervical or vaginal (thin layer Papsmear) 88175 37.10 Vidant North Hospital OP 43.46 26.61 35.03 26.61 41.39 48.76 48.76 43.46 50.56 28.74 38.16 39.75 31.80 46.64 26.61 26.61 50.56
Level 3 Surgical Pathology Gross&Microscopic Exam 88304 234.50 Vidant North Hospital OP 274.70 43.90 221.44 43.90 261.64 308.20 308.20 274.70 83.40 47.41 241.20 251.25 201.00 294.80 43.90 43.90 308.20
Level 4 Surgical Pathology Gross&Microscopic Exam 88305 396.20 Vidant North Hospital OP 464.12 43.90 374.13 43.90 442.05 520.72 520.72 464.12 83.40 47.41 407.52 424.50 339.60 498.08 43.90 43.90 520.72
Level 5 Surgical Pathology Gross&Microscopic Exam 88307 316.40 Vidant North Hospital OP 370.64 251.48 298.77 251.48 353.01 415.84 415.84 370.64 477.80 271.59 325.44 339.00 271.20 397.76 251.48 251.48 477.80
Cell Count Body Fluids W/Differential Count 89051 49.70 Vidant North Hospital OP 58.22 5.60 46.93 5.60 55.45 65.32 65.32 58.22 10.64 6.05 51.12 53.25 42.60 62.48 5.60 5.60 65.32
Flu Vaccine 65 years & up 90662 221.15 Vidant North Hospital OP 259.06 0.00 208.83 0.00 246.74 290.66 290.66 259.06 0.00 0.00 227.47 236.95 189.56 278.02 0.00 0.00 290.66
Pneumonia Vaccine- 90670 410.94 Vidant North Hospital OP 481.39 0.00 388.05 0.00 458.49 540.10 540.10 481.39 0.00 0.00 422.68 440.30 352.24 516.61 0.00 0.00 540.10
Flu Pediatric Vaccine 90685 0.00 Vidant North Hospital OP 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Flu Vaccine Administration 90686 41.01 Vidant North Hospital OP 48.04 0.00 38.72 0.00 45.75 53.89 53.89 48.04 0.00 0.00 42.18 43.94 35.15 51.55 0.00 0.00 53.89
Diptheria/Tetanus Treatment Pediatric 90702 17.50 Vidant North Hospital OP 20.50 0.00 16.53 0.00 19.53 23.00 23.00 20.50 0.00 0.00 18.00 18.75 15.00 22.00 0.00 0.00 23.00
Pneumovax 23 Vial 90732 28.00 Vidant North Hospital OP 32.80 0.00 26.44 0.00 31.24 36.80 36.80 32.80 0.00 0.00 28.80 30.00 24.00 35.20 0.00 0.00 36.80
Administration Hepb Ped Vaccin 90744 14.00 Vidant North Hospital OP 16.40 Not Applicable 13.22 Not Applicable 15.62 18.40 18.40 16.40 Not Applicable Not Applicable 14.40 15.00 12.00 17.60 Not Applicable 12.00 18.40
Engerix-B 1Ml Vial 90746 178.50 Vidant North Hospital OP 209.10 Not Applicable 168.56 Not Applicable 199.16 234.60 234.60 209.10 Not Applicable Not Applicable 183.60 191.25 153.00 224.40 Not Applicable 153.00 234.60
Evaluation Speech Fluency 92521 91.70 Vidant North Hospital OP 107.42 111.66 86.59 111.66 102.31 120.52 120.52 107.42 212.15 120.59 94.32 98.25 78.60 115.28 111.66 78.60 212.15
Evaluation Speech Sound Prod 92522 75.60 Vidant North Hospital OP 88.56 91.23 71.39 91.23 84.35 99.36 99.36 88.56 173.34 98.53 77.76 81.00 64.80 95.04 91.23 64.80 173.34
Evaluation Speech Sound/Comp 92523 154.70 Vidant North Hospital OP 181.22 191.49 146.08 191.49 172.60 203.32 203.32 181.22 363.83 206.81 159.12 165.75 132.60 194.48 191.49 132.60 363.83
Analysis Voice Resonance 92524 184.10 Vidant North Hospital OP 215.66 89.21 173.84 89.21 205.40 241.96 241.96 215.66 169.50 96.35 189.36 197.25 157.80 231.44 89.21 89.21 241.96
Tympanometry Screening 92567 55.30 Vidant North Hospital OP 64.78 29.66 52.22 29.66 61.70 72.68 72.68 64.78 56.36 32.04 56.88 59.25 47.40 69.52 29.66 29.66 72.68
Speech Therapy Swallowing Evaluation 92610 119.70 Vidant North Hospital OP 140.22 72.39 113.03 72.39 133.55 157.32 157.32 140.22 137.54 78.18 123.12 128.25 102.60 150.48 72.39 72.39 157.32
EKG 93005 123.90 Vidant North Hospital OP 145.14 48.81 117.00 48.81 138.24 162.84 162.84 145.14 92.74 52.72 127.44 132.75 106.20 155.76 48.81 48.81 162.84
EKG Interpretation 93010 92.40 Vidant North Hospital OP 108.24 Not Applicable 87.25 Not Applicable 103.09 121.44 121.44 108.24 Not Applicable Not Applicable 95.04 99.00 79.20 116.16 Not Applicable 79.20 121.44
EKG Stress Test 93017 123.90 Vidant North Hospital OP 145.14 224.58 117.00 224.58 138.24 162.84 162.84 145.14 426.70 242.55 127.44 132.75 106.20 155.76 224.58 106.20 426.70
Doppler Complete 93320 197.40 Vidant North Hospital OP 231.24 0.00 186.40 0.00 220.24 259.44 259.44 231.24 0.00 0.00 203.04 211.50 169.20 248.16 0.00 0.00 259.44
Doppler Follow Up 93321 109.20 Vidant North Hospital OP 127.92 0.00 103.12 0.00 121.84 143.52 143.52 127.92 0.00 0.00 112.32 117.00 93.60 137.28 0.00 0.00 143.52
Carotid Artery Echo 93380 699.30 Vidant North Hospital OP 819.18 Not Applicable 660.34 Not Applicable 780.22 919.08 919.08 819.18 Not Applicable Not Applicable 719.28 749.25 599.40 879.12 Not Applicable 599.40 919.08
Venous Doppler Bilateral 93970 695.10 Vidant North Hospital OP 814.26 206.78 656.37 206.78 775.53 913.56 913.56 814.26 392.88 223.32 714.96 744.75 595.80 873.84 206.78 206.78 913.56
Venous Doppler Unilateral 93971 464.10 Vidant North Hospital OP 543.66 99.45 438.24 99.45 517.80 609.96 609.96 543.66 188.96 107.41 477.36 497.25 397.80 583.44 99.45 99.45 609.96
Physical Therapy Re-Evaluation 97002 74.90 Vidant North Hospital OP 87.74 Not Applicable 70.73 Not Applicable 83.57 98.44 98.44 87.74 Not Applicable Not Applicable 77.04 80.25 64.20 94.16 Not Applicable 64.20 98.44
Physical Therapy Evalulation Low Complexity 97161 151.20 Vidant North Hospital OP 177.12 84.28 142.78 84.28 168.70 198.72 198.72 177.12 160.13 91.02 155.52 162.00 129.60 190.08 84.28 84.28 198.72
Occupational Therapy Evaluation Low Complexity 97165 164.50 Vidant North Hospital OP 192.70 89.31 155.34 89.31 183.54 216.20 216.20 192.70 169.69 96.45 169.20 176.25 141.00 206.80 89.31 89.31 216.20
Occupational Therapy Evaluation Moderate Complexity 97166 164.50 Vidant North Hospital OP 192.70 88.98 155.34 88.98 183.54 216.20 216.20 192.70 169.06 96.10 169.20 176.25 141.00 206.80 88.98 88.98 216.20
Occupational Therapy Evaluation High Complexity 97167 164.50 Vidant North Hospital OP 192.70 88.98 155.34 88.98 183.54 216.20 216.20 192.70 169.06 96.10 169.20 176.25 141.00 206.80 88.98 88.98 216.20
Occupational Therapy Re-evaluation 97168 114.80 Vidant North Hospital OP 134.48 61.45 108.40 61.45 128.08 150.88 150.88 134.48 116.76 66.37 118.08 123.00 98.40 144.32 61.45 61.45 150.88
Physical Therapy 15 Minutes 97750 68.60 Vidant North Hospital OP 80.36 34.24 64.78 34.24 76.54 90.16 90.16 80.36 65.06 36.98 70.56 73.50 58.80 86.24 34.24 34.24 90.16
Therapeutic Rehab 97150 56.00 Vidant North Hospital OP 65.60 18.12 52.88 18.12 62.48 73.60 73.60 65.60 34.43 19.57 57.60 60.00 48.00 70.40 18.12 18.12 73.60
Physical Therapy Evaluation Moderate Complexity 30 Mins 97162 151.20 Vidant North Hospital OP 177.12 84.28 142.78 84.28 168.70 198.72 198.72 177.12 160.13 91.02 155.52 162.00 129.60 190.08 84.28 84.28 198.72
Physical Therapy Evaluation High Complexity 45 Mins 97163 151.20 Vidant North Hospital OP 177.12 84.28 142.78 84.28 168.70 198.72 198.72 177.12 160.13 91.02 155.52 162.00 129.60 190.08 84.28 84.28 198.72
Physical Therapy Re-Evaluation Plan Care 20 Mins 97164 74.90 Vidant North Hospital OP 87.74 57.76 70.73 57.76 83.57 98.44 98.44 87.74 109.74 62.38 77.04 80.25 64.20 94.16 57.76 57.76 109.74
Prosthetic Training 97761 58.80 Vidant North Hospital OP 68.88 41.08 55.52 41.08 65.60 77.28 77.28 68.88 78.05 44.37 60.48 63.00 50.40 73.92 41.08 41.08 78.05
Medical Nutrition Re-Assessment Preventative 97802 35.00 Vidant North Hospital OP 41.00 33.43 33.05 33.43 39.05 46.00 46.00 41.00 63.52 36.10 36.00 37.50 30.00 44.00 33.43 30.00 63.52
Medical Nutrition Re-Assessment Individual 15 minutes 97803 28.70 Vidant North Hospital OP 33.62 28.20 27.10 28.20 32.02 37.72 37.72 33.62 53.58 30.46 29.52 30.75 24.60 36.08 28.20 24.60 53.58
Medical Nutriation Group Assessment 97804 17.50 Vidant North Hospital OP 20.50 15.67 16.53 15.67 19.53 23.00 23.00 20.50 29.77 16.92 18.00 18.75 15.00 22.00 15.67 15.00 29.77
Office Outpatient New Patient 10 Minutes 99201 114.80 Vidant North Hospital OP 134.48 Not Applicable 108.40 Not Applicable 128.08 150.88 150.88 134.48 Not Applicable Not Applicable 118.08 123.00 98.40 144.32 Not Applicable 98.40 150.88
Office Outpatient New Patient 20 Minutes 99202 224.70 Vidant North Hospital OP 263.22 Not Applicable 212.18 Not Applicable 250.70 295.32 295.32 263.22 Not Applicable Not Applicable 231.12 240.75 192.60 282.48 Not Applicable 192.60 295.32
Office Outpatient Visit Established 5 Minutes 99211 111.30 Vidant North Hospital OP 130.38 Not Applicable 105.10 Not Applicable 124.18 146.28 146.28 130.38 Not Applicable Not Applicable 114.48 119.25 95.40 139.92 Not Applicable 95.40 146.28
Office Outpatient Visit Established 10 Minutes 99212 256.20 Vidant North Hospital OP 300.12 Not Applicable 241.93 Not Applicable 285.85 336.72 336.72 300.12 Not Applicable Not Applicable 263.52 274.50 219.60 322.08 Not Applicable 219.60 336.72
Office Outpatient Visit  Established 15 Minutes 99213 218.40 Vidant North Hospital OP 255.84 Not Applicable 206.23 Not Applicable 243.67 287.04 287.04 255.84 Not Applicable Not Applicable 224.64 234.00 187.20 274.56 Not Applicable 187.20 287.04
Office Outpatient Visit Established 25 Minutes 99214 200.20 Vidant North Hospital OP 234.52 Not Applicable 189.05 Not Applicable 223.37 263.12 263.12 234.52 Not Applicable Not Applicable 205.92 214.50 171.60 251.68 Not Applicable 171.60 263.12
Initial Hospital Care 50 Minutes 99222 140.00 Vidant North Hospital OP 164.00 Not Applicable 132.20 Not Applicable 156.20 184.00 184.00 164.00 Not Applicable Not Applicable 144.00 150.00 120.00 176.00 Not Applicable 120.00 184.00
Initial Hospital Care 70 Minutes 99223 210.00 Vidant North Hospital OP 246.00 Not Applicable 198.30 Not Applicable 234.30 276.00 276.00 246.00 Not Applicable Not Applicable 216.00 225.00 180.00 264.00 Not Applicable 180.00 276.00
Subsequent Hospital Care 25 Minutes 99232 77.00 Vidant North Hospital OP 90.20 Not Applicable 72.71 Not Applicable 85.91 101.20 101.20 90.20 Not Applicable Not Applicable 79.20 82.50 66.00 96.80 Not Applicable 66.00 101.20
Subsequent Hospital Care 35 Minutes 99233 108.50 Vidant North Hospital OP 127.10 Not Applicable 102.46 Not Applicable 121.06 142.60 142.60 127.10 Not Applicable Not Applicable 111.60 116.25 93.00 136.40 Not Applicable 93.00 142.60
Hospital Discharge Day 30 < Minutes 99238 77.00 Vidant North Hospital OP 90.20 Not Applicable 72.71 Not Applicable 85.91 101.20 101.20 90.20 Not Applicable Not Applicable 79.20 82.50 66.00 96.80 Not Applicable 66.00 101.20
Hospital Discharge Day >30 Minutes 99239 112.00 Vidant North Hospital OP 131.20 Not Applicable 105.76 Not Applicable 124.96 147.20 147.20 131.20 Not Applicable Not Applicable 115.20 120.00 96.00 140.80 Not Applicable 96.00 147.20
Administration of Influenza Virus Vaccine G0008 19.60 Vidant North Hospital OP 22.96 33.82 18.51 33.82 21.87 25.76 25.76 22.96 64.25 36.52 20.16 21.00 16.80 24.64 33.82 16.80 64.25
Administration of Pneumococcal Vaccine G0009 16.02 Vidant North Hospital OP 18.76 33.82 15.12 33.82 17.87 21.05 21.05 18.76 64.25 36.52 16.47 17.16 13.73 20.13 33.82 13.73 64.25
CT Head/Brain With Contrast 70460 1428.70 Vidant North Hospital OP 1673.62 161.69 1349.10 161.69 1594.02 1877.72 1877.72 1673.62 307.21 174.62 1469.52 1530.75 1224.60 1796.08 161.69 161.69 1877.72
CT Head/Brain Without & With Contrast 70470 1735.30 Vidant North Hospital OP 2032.78 161.69 1638.62 161.69 1936.10 2280.68 2280.68 2032.78 307.21 174.62 1784.88 1859.25 1487.40 2181.52 161.69 161.69 2280.68
CT Orbit/Ear/Fossa Without Contrast 70480 1561.70 Vidant North Hospital OP 1829.42 99.45 1474.69 99.45 1742.41 2052.52 2052.52 1829.42 188.96 107.41 1606.32 1673.25 1338.60 1963.28 99.45 99.45 2052.52
CT Orbit/Ear/Fossa With Contrast 70481 2101.40 Vidant North Hospital OP 2461.64 161.69 1984.32 161.69 2344.56 2761.84 2761.84 2461.64 307.21 174.62 2161.44 2251.50 1801.20 2641.76 161.69 161.69 2761.84
CT Orbit/Ear/Fossa Without &With Contrast 70482 1497.30 Vidant North Hospital OP 1753.98 161.69 1413.88 161.69 1670.56 1967.88 1967.88 1753.98 307.21 174.62 1540.08 1604.25 1283.40 1882.32 161.69 161.69 1967.88
CT Maxillofacial Without Contrast 70486 1700.30 Vidant North Hospital OP 1991.78 99.45 1605.57 99.45 1897.05 2234.68 2234.68 1991.78 188.96 107.41 1748.88 1821.75 1457.40 2137.52 99.45 99.45 2234.68
CT Maxillofacial With Contrast 70487 1961.40 Vidant North Hospital OP 2297.64 161.69 1852.12 161.69 2188.36 2577.84 2577.84 2297.64 307.21 174.62 2017.44 2101.50 1681.20 2465.76 161.69 161.69 2577.84
CT Maxillofacial Without & With Contrast 70488 1491.00 Vidant North Hospital OP 1746.60 161.69 1407.93 161.69 1663.53 1959.60 1959.60 1746.60 307.21 174.62 1533.60 1597.50 1278.00 1874.40 161.69 161.69 1959.60
CT Soft Tissue Neck With Contrast 70491 1430.10 Vidant North Hospital OP 1675.26 161.69 1350.42 161.69 1595.58 1879.56 1879.56 1675.26 307.21 174.62 1470.96 1532.25 1225.80 1797.84 161.69 161.69 1879.56
CT Soft Tissue Neck Without & With Contrast 70492 1730.40 Vidant North Hospital OP 2027.04 161.69 1633.99 161.69 1930.63 2274.24 2274.24 2027.04 307.21 174.62 1779.84 1854.00 1483.20 2175.36 161.69 161.69 2274.24
CT Thorax Without Contrast 71250 1193.50 Vidant North Hospital OP 1398.10 99.45 1127.01 99.45 1331.61 1568.60 1568.60 1398.10 188.96 107.41 1227.60 1278.75 1023.00 1500.40 99.45 99.45 1568.60
CT Thorax With Contrast 71260 1645.70 Vidant North Hospital OP 1927.82 161.69 1554.01 161.69 1836.13 2162.92 2162.92 1927.82 307.21 174.62 1692.72 1763.25 1410.60 2068.88 161.69 161.69 2162.92
CT Thorax Without & With Contrast 71270 1926.40 Vidant North Hospital OP 2256.64 161.69 1819.07 161.69 2149.31 2531.84 2531.84 2256.64 307.21 174.62 1981.44 2064.00 1651.20 2421.76 161.69 161.69 2531.84
CT Neck Spine Without Contrast 72125 1443.40 Vidant North Hospital OP 1690.84 99.45 1362.98 99.45 1610.42 1897.04 1897.04 1690.84 188.96 107.41 1484.64 1546.50 1237.20 1814.56 99.45 99.45 1897.04
CT Chest Spine Without Contrast 72128 1443.40 Vidant North Hospital OP 1690.84 99.45 1362.98 99.45 1610.42 1897.04 1897.04 1690.84 188.96 107.41 1484.64 1546.50 1237.20 1814.56 99.45 99.45 1897.04
CT Lumbar Spine Without Contrast 72131 462.00 Vidant North Hospital OP 541.20 99.45 436.26 99.45 515.46 607.20 607.20 541.20 188.96 107.41 475.20 495.00 396.00 580.80 99.45 99.45 607.20
CT Lumbar Spine With Contrast 72132 721.00 Vidant North Hospital OP 844.60 338.82 680.83 338.82 804.43 947.60 947.60 844.60 643.76 365.93 741.60 772.50 618.00 906.40 338.82 338.82 947.60
CT Lumbar Spine Without & With Contrast 72133 1081.50 Vidant North Hospital OP 1266.90 161.69 1021.25 161.69 1206.65 1421.40 1421.40 1266.90 307.21 174.62 1112.40 1158.75 927.00 1359.60 161.69 161.69 1421.40
CT Pelvis Without Contrast 72192 1418.90 Vidant North Hospital OP 1662.14 99.45 1339.85 99.45 1583.09 1864.84 1864.84 1662.14 188.96 107.41 1459.44 1520.25 1216.20 1783.76 99.45 99.45 1864.84
CT Pelvis Without & With Contrast 72194 2202.20 Vidant North Hospital OP 2579.72 161.69 2079.51 161.69 2457.03 2894.32 2894.32 2579.72 307.21 174.62 2265.12 2359.50 1887.60 2768.48 161.69 161.69 2894.32
CT Upper Extremity Without Contrast 73200 1561.00 Vidant North Hospital OP 1828.60 99.45 1474.03 99.45 1741.63 2051.60 2051.60 1828.60 188.96 107.41 1605.60 1672.50 1338.00 1962.40 99.45 99.45 2051.60
CT Upper Extremity With Contrast 73201 614.60 Vidant North Hospital OP 719.96 338.82 580.36 338.82 685.72 807.76 807.76 719.96 643.76 365.93 632.16 658.50 526.80 772.64 338.82 338.82 807.76
CT Uppr Extremity Without&With Contrast 73202 2499.00 Vidant North Hospital OP 2927.40 161.69 2359.77 161.69 2788.17 3284.40 3284.40 2927.40 307.21 174.62 2570.40 2677.50 2142.00 3141.60 161.69 161.69 3284.40
CT Abdomen Without Contrast 74150 1295.70 Vidant North Hospital OP 1517.82 99.45 1223.51 99.45 1445.63 1702.92 1702.92 1517.82 188.96 107.41 1332.72 1388.25 1110.60 1628.88 99.45 99.45 1702.92
CT Abdomen With Contrast 74160 1786.40 Vidant North Hospital OP 2092.64 161.69 1686.87 161.69 1993.11 2347.84 2347.84 2092.64 307.21 174.62 1837.44 1914.00 1531.20 2245.76 161.69 161.69 2347.84
CT Abdomen Without & With Contrast 74170 2089.50 Vidant North Hospital OP 2447.70 161.69 1973.09 161.69 2331.29 2746.20 2746.20 2447.70 307.21 174.62 2149.20 2238.75 1791.00 2626.80 161.69 161.69 2746.20
CT Angio Abdom Without & With Contrast 74175 403.90 Vidant North Hospital OP 473.14 161.69 381.40 161.69 450.64 530.84 530.84 473.14 307.21 174.62 415.44 432.75 346.20 507.76 161.69 161.69 530.84
CT Abd & Pelvis Without Contrast 74176 2713.20 Vidant North Hospital OP 3178.32 206.78 2562.04 206.78 3027.16 3565.92 3565.92 3178.32 392.88 223.32 2790.72 2907.00 2325.60 3410.88 206.78 206.78 3565.92
CT Guide For Needle Placement 77012 1551.20 Vidant North Hospital OP 1817.12 0.00 1464.78 0.00 1730.70 2038.72 2038.72 1817.12 0.00 0.00 1595.52 1662.00 1329.60 1950.08 0.00 0.00 2038.72
CT Lower Extremity Without Contrast 73700 1486.80 Vidant North Hospital OP 1741.68 99.45 1403.96 99.45 1658.84 1954.08 1954.08 1741.68 188.96 107.41 1529.28 1593.00 1274.40 1869.12 99.45 99.45 1954.08
CT Lower Extremity Without and With Contrast 73702 2499.00 Vidant North Hospital OP 2927.40 161.69 2359.77 161.69 2788.17 3284.40 3284.40 2927.40 307.21 174.62 2570.40 2677.50 2142.00 3141.60 161.69 161.69 3284.40
CT Lower Ext W/Contrast  Rt 73701 1800.40 Vidant North Hospital OP 2109.04 161.69 1700.09 161.69 2008.73 2366.24 2366.24 2109.04 307.21 174.62 1851.84 1929.00 1543.20 2263.36 161.69 161.69 2366.24
CT Neck Soft Tissue Without Contrast 70490 1114.40 Vidant North Hospital OP 1305.44 99.45 1052.31 99.45 1243.35 1464.64 1464.64 1305.44 188.96 107.41 1146.24 1194.00 955.20 1400.96 99.45 99.45 1464.64
CT 3D ReconstruCTion 76377 606.90 Vidant North Hospital OP 710.94 0.00 573.09 0.00 677.13 797.64 797.64 710.94 0.00 0.00 624.24 650.25 520.20 762.96 0.00 0.00 797.64
CT Limited Or Localized 76380 655.90 Vidant North Hospital OP 768.34 70.82 619.36 70.82 731.80 862.04 862.04 768.34 134.55 76.48 674.64 702.75 562.20 824.56 70.82 70.82 862.04
Catheter Into Renal Pelvis 74475 899.50 Vidant North Hospital OP 1053.70 Not Applicable 849.39 Not Applicable 1003.59 1182.20 1182.20 1053.70 Not Applicable Not Applicable 925.20 963.75 771.00 1130.80 Not Applicable 771.00 1182.20
CT Angiogram Lower Extremity 73706 401.80 Vidant North Hospital OP 470.68 161.69 379.41 161.69 448.29 528.08 528.08 470.68 307.21 174.62 413.28 430.50 344.40 505.12 161.69 161.69 528.08
Mumps Virus AB 86735 17.50 Vidant North Hospital OP 20.50 13.05 16.53 13.05 19.53 23.00 23.00 20.50 24.80 14.09 18.00 18.75 15.00 22.00 13.05 13.05 24.80
Surgical removal of prostate and surrounding lymph nodes using an endoscope 55866 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities 216 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Spinal fusion except cervical without major comorbid conditions or complications (MCC) 460 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided 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). 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 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of recurring cataract in lens capsule using laser 66821 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of tonsils and adenoid glands patient younger than age 12 42820 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Ultrasound examination of lower large bowel using an endoscope 45391 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Routine obstetric care for cesarean delivery, including pre-and post-delivery care 59510 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care 59610 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Psychotherapy, 30 min 90832 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Psychotherapy, 45 min 90834 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Psychotherapy, 60 min 90837 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Family psychotherapy, not including patient, 50 min 90846 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Family psychotherapy, including patient, 50 min 90847 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Group psychotherapy 90853 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Electrocardiogram, routine, with interpretation and report 93000 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Initial new patient preventive medicine evaluation (18-39 years) 99385 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Initial new patient preventive medicine evaluation (40-64 years) 99386 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Insertion of catheter into left heart for diagnosis 93452 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance 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 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Routine obstetric care for vaginal delivery, including pre-and post- delivery care 59400 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Notes and Disclaimers

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. Payors often price claims with a 'lesser of' methodology; therefore, services may be priced less than the rates below.

The inclusion of pricing below does not indicate that a service is covered under your benefit plan. Likewise, the exclusion of a service below or pricing at $0 does not indicate that a service is not covered by your health plan, not offered by our facility, nor that the service may come at no cost to you.

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.

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. Any variation in services provided – including whether individual services below are provided along with other services, rather than independently – can cause variation in pricing, due to payor policies.

Professional services provided by a physician or other practitioner are separately billable. These services are contracted with the applicable professional and thus not reflected in the hospital agreement or consumer table.

Lab pricing varies dependent upon the specifics of your care plan and can vary based on whether the service is provided in the hospital or through a reference lab. The lab rates below reflect our median pricing.

Workers' Compensation rates reflected below are based on claims filed in North Carolina. Rates may vary depending on the state in which the injury claim is filed.

For health plan coverage questions about your specific out of pocket financial responsibility, please contact your health plan.

If you have questions around billing or pricing, please call 252-535-8011.

Back to top