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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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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 |
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.