Shoppable Services
EASTERN STATE HOSPITAL CONSUMER SHOPPABLE SERVICES DISCLAIMER
Eastern State Hospital in adoption of 45 CFR Part 180, CMS-1717-F2, the Centers for Medicare and Medicaid Services hospital price transparency rule (the “Rule”) requiring certain healthcare providers to disclose their pricing to patients for a number of standard provider service offerings.
Please note, the estimate for any service provided is limited to disclosure of Eastern State Hospital standard charges and/or per diem rates.
As such, Eastern State Hospital makes no guarantee of any kind. Actual service and care expenses vary pursuant to a number of factors that may not be properly considered in any displayed rate.
Eastern State Hospital, its officers, directors, employees, and agents, disclaim all warranties not listed above, whether statutory, express or implied, including but not limited to, any implied warranties, including, but not limited to the implied warranties of merchantability, specific outcome, validity, accuracy, or fitness for a particular purpose.
To the maximum extent permitted by applicable law, in no event will Eastern State Hospital or its vendors, suppliers or other third parties it is working with be liable for any direct, consequential, incidental, special, punitive or other damages whatsoever arising out of or in any way related to any claim regarding any claim related to a service price estimate whether based on contract, tort, negligence, strict liability or otherwise.
If there are questions, you agree to discuss it with Eastern State Hospital prior to receiving any service.
The services listed below are considered typical shoppable services that are provided while an inpatient at Eastern State Hospital. Eastern State Hospital is an inpatient only facility. Outpatient services are not provided. The services listed below cannot be scheduled by the patient in advance, these services are utilized during your inpatient hospital stay.
Services considered Shoppable Provided at Eastern State Hospital
| Specified Shoppable Service | CPT / HCPCS Code | Standard Charge |
|---|---|---|
| CORONAVIRUS 2019-NCOV | U0002QW | Included in inpatient hospital charge |
| SARS 2 COV 19 HIGH | U0003 | Included in inpatient hospital charge |
| BASIC METABOLIC PANEL | 80048 | Included in inpatient hospital charge |
| GENERAL HEALTH PANEL | 80050 | Included in inpatient hospital charge |
| ELECTROLYTE PANEL | 80051 | Included in inpatient hospital charge |
| COMPREHENSIVE METABOLIC PANEL | 80053 | Included in inpatient hospital charge |
| HEPATIC FUNCTION PANEL | 80076 | Included in inpatient hospital charge |
| LIPID PROFILE | 80061 | Included in inpatient hospital charge |
| RENAL FUNCTION PANEL | 80069 | Included in inpatient hospital charge |
| ACUTE HEPATITIS PANEL | 80074 | Included in inpatient hospital charge |
| TORCH PANEL | 80090 | Included in inpatient hospital charge |
| DRUG SCRN;MULTI DRUG CLASSES | 80307 | Included in inpatient hospital charge |
| DRUG SCRN; ANY FRM DRUG LIST A | 80301 | Included in inpatient hospital charge |
| ROUTINE PAP IMAGING | G0145 | Included in inpatient hospital charge |
| SCREENING CYTOPATH | G0148 | Included in inpatient hospital charge |
| AMIKACIN | 80150 | Included in inpatient hospital charge |
| CARBAMAZEPINE TOTAL | 80156 | Included in inpatient hospital charge |
| CARBAMAZEPINE FREE | 80157 | Included in inpatient hospital charge |
| CYCLOSPORINE | 80158 | Included in inpatient hospital charge |
| LIDOCAINE | 80176 | Included in inpatient hospital charge |
| LEVETIRACETAM | 80177 | Included in inpatient hospital charge |
| LITHIUM THERAPEUTIC DRUG | 80178 | Included in inpatient hospital charge |
| SALICYLATE | 80179 | Included in inpatient hospital charge |
| NORTRIPTYLINE THERAPEUTIC | 80335 | Included in inpatient hospital charge |
| TRILEPTAL-OXCARBAZEPINE | 80183 | Included in inpatient hospital charge |
| PHENOBARB THERAPEUTIC DRUG | 80184 | Included in inpatient hospital charge |
| PHENYTOIN:TOTAL | 80185 | Included in inpatient hospital charge |
| PHENYTOINFREE-SERUM | 80186 | Included in inpatient hospital charge |
| PRIMIDONE | 80188 | Included in inpatient hospital charge |
| PROCAINAMIDE THER DRUG ASSAY | 80190 | Included in inpatient hospital charge |
| PROCAINAMIDE W/METABOLITES | 80192 | Included in inpatient hospital charge |
| QUINIDINE-SERUM | 80194 | Included in inpatient hospital charge |
| THERAP DRUG ASSAY SIROLIMUS | 80195 | Included in inpatient hospital charge |
| SALICYLATES(ASPIRIN) | 80329 | Included in inpatient hospital charge |
| ELEC ANALYSIS,IMP PUMP,NO PRGM | 62367 | Included in inpatient hospital charge |
| ELEC ANALYSIS,PUMP READ W/PRGM | 62368 | Included in inpatient hospital charge |
| ELEC ANALYSIS PUMP PRGRM&REFIL | 62369 | Included in inpatient hospital charge |
| ELEC ANALYSIS PRG/REFILL BY DR | 62370 | Included in inpatient hospital charge |
| VENIPUNCTURE/ VENOUS BLOOD | G0001 | Included in inpatient hospital charge |
| MULTICHANNEL;1OR2 CHEM T | 80002L1 | Included in inpatient hospital charge |
| 3 CLINICAL CHEMISTRY TESTS | 80003 | Included in inpatient hospital charge |
| 4 CLINICAL CHEM. TESTS | 80004 | Included in inpatient hospital charge |
| 5 CLINICAL CHEMISTRY TESTS | 80005 | Included in inpatient hospital charge |
| 6 CLINICAL CHEM. TESTS | 80006 | Included in inpatient hospital charge |
| 7 CLINICAL CHEMISTRY TESTS | 80007 | Included in inpatient hospital charge |
| 8 CLINICAL CHEMISTRY TESTS | 80008 | Included in inpatient hospital charge |
| 10 CLINICAL CHEMISTRY TESTS | 80010 | Included in inpatient hospital charge |
| 12 CLINICAL CHEMISTRY TESTS | 80012 | Included in inpatient hospital charge |
| ROUTINE PAP IMAGING | G0001 | Included in inpatient hospital charge |
| 13-16 CLINICAL CHEMISTRY TESTS | 80016 | Included in inpatient hospital charge |
| OXCARBAZEPINE METABOLITE | 80183 | Included in inpatient hospital charge |
| 17-18 CLINICAL CHEM. TEST | 80018 | Included in inpatient hospital charge |
| 19 CLINICAL CHEMISTRY TESTS | 80019 | Included in inpatient hospital charge |
| LAB ANALYSES CDM | 0029U | Included in inpatient hospital charge |
| DOXEPIN | 80335 | Included in inpatient hospital charge |
| ETHOSUXIMIDE | 80168 | Included in inpatient hospital charge |
| GENTAMICIN | 80170 | Included in inpatient hospital charge |
| ASSAY GABAPENTIN | 80171 | Included in inpatient hospital charge |
| HALDOL (HALOPERIDOL) | 80173 | Included in inpatient hospital charge |
| IMIPRAMINE | 80335 | Included in inpatient hospital charge |
| TACROLIMUS | 80197 | Included in inpatient hospital charge |
| THEOPHYLLINE | 80198 | Included in inpatient hospital charge |
| TOBRAMYCIN | 80200 | Included in inpatient hospital charge |
| TOPIRAMATE (TOPAMAX) | 80201 | Included in inpatient hospital charge |
| VANCOMYCIN-SERUM | 80202 | Included in inpatient hospital charge |
| ZONISAMIDE (ZONEGRAN) | 80203 | Included in inpatient hospital charge |
| SEROQUEL | 80342 | Included in inpatient hospital charge |
| QUANT OF DRUG NOT SPEC | 80299 | Included in inpatient hospital charge |
| QUANT OF DRUG NOT SPECIFIED | 80299 | Included in inpatient hospital charge |
| UNSPECIFIED DRUG-LAMICTAL | 80299 | Included in inpatient hospital charge |
| DRUG SCRN SINGLE DRUG CLASS | 80301 | Included in inpatient hospital charge |
| PRESUMPTIVE DRUG TEST | 80307 | Included in inpatient hospital charge |
| DEFINITIVE DRUG TEST; ALCOHOLS | 80320 | Included in inpatient hospital charge |
| ANTIDEPRESSANTS, TRICYCLIC 1-2 | 80335 | Included in inpatient hospital charge |
| RISPERDAL LEVELS | 80341 | Included in inpatient hospital charge |
| ANTIPSYCHOTICS, NOS | 80342 | Included in inpatient hospital charge |
| GONADOTR RLS HORM STIM PNL | 80426 | Included in inpatient hospital charge |
| AMPHETAMINES SCREEN | G0434 | Included in inpatient hospital charge |
| TRH STIMULATION PANEL | 80438 | Included in inpatient hospital charge |
| DRUGS OF ABUSE SERUM LCMSMS | G0481 | Included in inpatient hospital charge |
| CLINICAL PATH CONSULT LIM | 80500 | Included in inpatient hospital charge |
| SALICYLATE SCREEN | G6038 | Included in inpatient hospital charge |
| URINAL. NONAUTO W/MICRO | 81000 | Included in inpatient hospital charge |
| URINAL. AUTO W/MICRO | 81001 | Included in inpatient hospital charge |
| URINAL. NONAUTO W/O MICRO | 81002 | Included in inpatient hospital charge |
| URINAL. AUTO W/O MICRO | 81003 | Included in inpatient hospital charge |
| URINALYSIS CHEMICAL | 81005 | Included in inpatient hospital charge |
| URINALYSIS MICRO ONLY | 81015 | Included in inpatient hospital charge |
| URINE PREG TEST VISUAL COLOR | 81025 | Included in inpatient hospital charge |
| VOLUME MEAS TIMED COL | 81050 | Included in inpatient hospital charge |
| URINE SG ONLY | 81099 | Included in inpatient hospital charge |
| CYP2D6 CYTOCHROME GENE ANALYSI | 81226 | Included in inpatient hospital charge |
| CYP2CP CYTOCHROME GENE ANALYSI | 81227 | Included in inpatient hospital charge |
| FRAGILE X | 81243 | Included in inpatient hospital charge |
| GENOTYPE-SQL CYP2C19 | 81225 | Included in inpatient hospital charge |
| 257 HUNTINGTONS RPT EXP-SO+ | 81401 | Included in inpatient hospital charge |
| ACETAMINOPHEN | 80329 | Included in inpatient hospital charge |
| ACETONE-SERUM; QUAL | 82009 | Included in inpatient hospital charge |
| ACETONEQUANTITATIVE | 82010 | Included in inpatient hospital charge |
| ADRENOCORTICOTROPIC HORM. | 82024 | Included in inpatient hospital charge |
| ALBUMIN;SERUM | 82040 | Included in inpatient hospital charge |
| ALBUMIN URINE | 82042 | Included in inpatient hospital charge |
| URINE,MICROALBUMIN,SEMIQUANTIT | 82043 | Included in inpatient hospital charge |
| ALCOHOL SPECIMAN NOT BREATH | 80320 | Included in inpatient hospital charge |
| ALDOLASE | 82085 | Included in inpatient hospital charge |
| ALDOSTERONE | 82088 | Included in inpatient hospital charge |
| ALKALOIDS NES | 80323 | Included in inpatient hospital charge |
| ALPHA1-ANTITRYPSIN;TOTAL | 82103 | Included in inpatient hospital charge |
| ALPHA1-ANTITRYPSIN PHENOTYPE | 82104 | Included in inpatient hospital charge |
| ALPHA-FETOPROTEIN;SERUM | 82105 | Included in inpatient hospital charge |
| ALUMINUM | 82108 | Included in inpatient hospital charge |
| AMINO ACID;MULTQUAL-SPEC | 82128 | Included in inpatient hospital charge |
| AMINO ACID;SINGQUAN-SPEC | 82131 | Included in inpatient hospital charge |
| AMINOLEVULINIC ACIDDELTA | 82135 | Included in inpatient hospital charge |
| AMINO ACIDS; 6 OR MORE QUAN | 82139 | Included in inpatient hospital charge |
| AMMONIA | 82140 | Included in inpatient hospital charge |
| AMYLASE | 82150 | Included in inpatient hospital charge |
| ANDROSTENEDIONE | 82157 | Included in inpatient hospital charge |
| ANDROSTERONE | 82160 | Included in inpatient hospital charge |
| ANGIOTENSIN 1-CONVERT. ENZY | 82164 | Included in inpatient hospital charge |
| APOLIPOPROTEIN | 82172 | Included in inpatient hospital charge |
| ARSENIC | 82175 | Included in inpatient hospital charge |
| VITAMIN CASCORBIC ACIDBLOOD | 82180 | Included in inpatient hospital charge |
| BARBITURATESNES | 80345 | Included in inpatient hospital charge |
| BETA-2 MICROGLOBULIN | 82232 | Included in inpatient hospital charge |
| CHOLYGLYCINE | 82240 | Included in inpatient hospital charge |
| BILIRUBIN-TOTAL | 82247 | Included in inpatient hospital charge |
| BILIRUBIN DIRECT | 82248 | Included in inpatient hospital charge |
| BLOODOCC-GUAIAC COLOREC SCREEN | 82274 | Included in inpatient hospital charge |
| BLOOD OCCULT-GUAIAC-OTHR SOURC | 82271 | Included in inpatient hospital charge |
| BLOODOCC-OTHR THAN COLOREC SCR | 82272 | Included in inpatient hospital charge |
| BLOODOCCULTBY FECAL HGB | 82274 | Included in inpatient hospital charge |
| CADMIUM | 82300 | Included in inpatient hospital charge |
| VIT D 25 HYDROXY WITH FRACTION | 82306 | Included in inpatient hospital charge |
| CALCITONIN | 82308 | Included in inpatient hospital charge |
| CALCIUM;TOTAL | 82310 | Included in inpatient hospital charge |
| CALCIUM IONIZED | 82330 | Included in inpatient hospital charge |
| CALCIUM;URINE-QUANTTIMED | 82340 | Included in inpatient hospital charge |
| CALCULUS QUALITATIVE ANALYSIS | 82355 | Included in inpatient hospital charge |
| KIDNEY ST./X-RAY DIFFRACT | 82370 | Included in inpatient hospital charge |
| CARBON DIOXIDE (BICARBONATE) | 82374 | Included in inpatient hospital charge |
| CARBON MONOXIDEQUANT. | 82375 | Included in inpatient hospital charge |
| CEA CARCINOEMBRYONIC AG | 82378 | Included in inpatient hospital charge |
| CARNITINE (TOT/ FREE) QUAN. | 82379 | Included in inpatient hospital charge |
| CAROTENE-SERUM | 82380 | Included in inpatient hospital charge |
| CATECHOLAMINES;TOTAL URINE | 82382 | Included in inpatient hospital charge |
| CATECHOLAMINES;BLOOD | 82383 | Included in inpatient hospital charge |
| CATECHOLAMINES;FRAC. | 82384 | Included in inpatient hospital charge |
| CERULOPLASMIN | 82390 | Included in inpatient hospital charge |
| CHLORIDE; SERUM | 82435 | Included in inpatient hospital charge |
| CHLORIDE;URINE | 82436 | Included in inpatient hospital charge |
| CHOLESTEROLSERUMTOTAL | 82465 | Included in inpatient hospital charge |
| CHOLINESTERASE;SERUM | 82480 | Included in inpatient hospital charge |
| CHOLINESTERASE; RBC | 82482 | Included in inpatient hospital charge |
| CHROMATQUALCOLUMNNES | 82486 | Included in inpatient hospital charge |
| CHROMATOGRAPHY THIN LAYER | 82489 | Included in inpatient hospital charge |
| CHROMAT QUAN SGLE ANALYTE | 82491 | Included in inpatient hospital charge |
| CHROMAT MULT ANALYTES | 82492 | Included in inpatient hospital charge |
| CHROMIUM | 82495 | Included in inpatient hospital charge |
| COCAINE OR METABOLITE | 80353 | Included in inpatient hospital charge |
| COLLAGEN CROSS LINKS ANY | 82523 | Included in inpatient hospital charge |
| COPPER (SERUM/URINE) | 82525 | Included in inpatient hospital charge |
| CORTISOL;FREE | 82530 | Included in inpatient hospital charge |
| CORTISOL;TOTAL | 82533 | Included in inpatient hospital charge |
| CREATINE | 82540 | Included in inpatient hospital charge |
| COL CHROM/MASSQUANTITATIVE | 82542 | Included in inpatient hospital charge |
| CPK TOTAL | 82550 | Included in inpatient hospital charge |
| CPK; ISOENZYMES | 82552 | Included in inpatient hospital charge |
| MB FRACTION ONLY | 82553 | Included in inpatient hospital charge |
| CREATININE;BLOOD | 82565 | Included in inpatient hospital charge |
| CREATININE;OTHER SOURCE | 82570 | Included in inpatient hospital charge |
| CREATININE;CLEARANCE | 82575 | Included in inpatient hospital charge |
| CRYOCRIT | 82595 | Included in inpatient hospital charge |
| VITAMIN B-12 | 82607 | Included in inpatient hospital charge |
| VIT B-12;UNSAT BIND CAPAC. | 82608 | Included in inpatient hospital charge |
| CYSTINE/HOMOCYSTINEUR.QUAL.I | 82615 | Included in inpatient hospital charge |
| DHEA | 82626 | Included in inpatient hospital charge |
| DHEA-S | 82627 | Included in inpatient hospital charge |
| DESOXYCORTICOSTERONE 11- | 82633 | Included in inpatient hospital charge |
| DEOXYCORTISOL 11- | 82634 | Included in inpatient hospital charge |
| DIBUCAINE NUMBER-SERU | 82638 | Included in inpatient hospital charge |
| DIHYDROTESTOSTERONE (DHT) | 80327 | Included in inpatient hospital charge |
| DIHYDROXYVITAMIN D 125 | 82652 | Included in inpatient hospital charge |
| ELECTROPHORETIC TECH.NES | 82664 | Included in inpatient hospital charge |
| ERYTHROPOIETIN | 82668 | Included in inpatient hospital charge |
| ESTRADIOL | 82670 | Included in inpatient hospital charge |
| ESTROGENS;FRACTIONATED | 82671 | Included in inpatient hospital charge |
| ESTROGENS;TOTAL | 82672 | Included in inpatient hospital charge |
| ESTRIOL-SERUM TOTAL/ U | 82677 | Included in inpatient hospital charge |
| FAT OR LIPIDS FECES; QUAL. | 82705 | Included in inpatient hospital charge |
| FAT OR LIPIDSFECES;QUAN. | 82710 | Included in inpatient hospital charge |
| FERRITIN | 82728 | Included in inpatient hospital charge |
| FLURAZEPAM (DALMANE) | 80346 | Included in inpatient hospital charge |
| FOLIC ACID;SERUM | 82746 | Included in inpatient hospital charge |
| FOLIC ACID;RBC | 82747 | Included in inpatient hospital charge |
| G.GLOBULIN;IGA;IGDIGGIGM | 82784 | Included in inpatient hospital charge |
| IMMONOGLOBULINE (IGE) | 82785 | Included in inpatient hospital charge |
| GASESBLOOD (VENOUS PH) | 82800 | Included in inpatient hospital charge |
| ARTERIAL BLOOD GASES | 82803 | Included in inpatient hospital charge |
| GASTRIN | 82941 | Included in inpatient hospital charge |
| GLUCAGON | 82943 | Included in inpatient hospital charge |
| GLUCOSE BLOOD | 82947 | Included in inpatient hospital charge |
| GLUCOSE;BLOODREAGENT STRIP | 82948 | Included in inpatient hospital charge |
| POST GLUCOSE DOSE (INC. GLUC.) | 82950 | Included in inpatient hospital charge |
| TOLERANCE TEST (GTT) 3 SPEC. | 82951 | Included in inpatient hospital charge |
| TOLERANCE TESTEA. ADD. BEY 3 | 82952 | Included in inpatient hospital charge |
| GLUCOSE 6-PD | 82955 | Included in inpatient hospital charge |
| GLUCOSE,BLOOD GLUCOSE MONITOR | 82962 | Included in inpatient hospital charge |
| GGT GAMMA-GLUTAMYL TRANS. | 82977 | Included in inpatient hospital charge |
| FRUCTOSAMINE | 82985 | Included in inpatient hospital charge |
| PREGNANCY TEST | 81025 | Included in inpatient hospital charge |
| FSH | 83001 | Included in inpatient hospital charge |
| LH (LUTEINIZING HORMONE) | 83002 | Included in inpatient hospital charge |
| GROWTH HORMONE HUMAN | 83003 | Included in inpatient hospital charge |
| HAPTOGLOBIN CHEMICAL | 83010 | Included in inpatient hospital charge |
| HEAVY METAL QUAN BARIUM | 83018 | Included in inpatient hospital charge |
| HEAVY METAL SCREEN | 83015 | Included in inpatient hospital charge |
| HEAVY METAL QUAN BERYLIUM | 83018 | Included in inpatient hospital charge |
| HEAVY METAL QUAN BISMUTH | 83018 | Included in inpatient hospital charge |
| HEAVY METAL;QUAN;ANTIMONY | 83018 | Included in inpatient hospital charge |
| HEAVY METAL QUAN MERCURY | 83018 | Included in inpatient hospital charge |
| ELECTROPHORESIS;HEMOGLOB. | 83020 | Included in inpatient hospital charge |
| HGB.FRACT&QUANT. CHROMAT. | 83021 | Included in inpatient hospital charge |
| HEMOGLOBIN GLYCATED | 83036 | Included in inpatient hospital charge |
| A1C TEST W/HOME DEVICE | 83037 | Included in inpatient hospital charge |
| SULFHEMOGLOBIN QUANT. | 83060 | Included in inpatient hospital charge |
| HISTAMINE | 83088 | Included in inpatient hospital charge |
| HOMOCYSTINE | 83090 | Included in inpatient hospital charge |
| 17-OH HYDROXYCORTICOI | 83491 | Included in inpatient hospital charge |
| 17-HYDROXYCORTICOSTEROIDS | 83491 | Included in inpatient hospital charge |
| HYDROXYINDOLACETIC ACID | 83497 | Included in inpatient hospital charge |
| HYDROXPROGESTERONE | 83498 | Included in inpatient hospital charge |
| IA;QUAL;SEMIQUAN;MULT STEP | 83516 | Included in inpatient hospital charge |
| OLD AGGLUTININS BY RIA | 83519 | Included in inpatient hospital charge |
| IMMUNO ASSAY NOS | 83520 | Included in inpatient hospital charge |
| INSULIN TOTAL | 83525 | Included in inpatient hospital charge |
| IRON | 83540 | Included in inpatient hospital charge |
| IRON BINDING CAPACIT | 83550 | Included in inpatient hospital charge |
| KETOGENIC STEROIDS;FRACT. | 83582 | Included in inpatient hospital charge |
| KETOSTEROIDS17(17KS)TOTL | 83586 | Included in inpatient hospital charge |
| KETOSTEROIDS17(17KS)FRAC | 83593 | Included in inpatient hospital charge |
| LACTATE WHOLE BLOOD | 83605 | Included in inpatient hospital charge |
| LDH | 83615 | Included in inpatient hospital charge |
| LD-ISOENZYMES SEP. & QUANT. | 83625 | Included in inpatient hospital charge |
| LEAD QUANTITATIVE | 83655 | Included in inpatient hospital charge |
| LIPASE BLOOD | 83690 | Included in inpatient hospital charge |
| LIPIDS BLOOD; TOTAL | 83700 | Included in inpatient hospital charge |
| NMR LIPO PROFILE | 83704 | Included in inpatient hospital charge |
| LIPOPROTEINBLOODELECTRO | 83700 | Included in inpatient hospital charge |
| HDL CHOLESTEROL | 83718 | Included in inpatient hospital charge |
| VLDL CHOLESTEROL | 83719 | Included in inpatient hospital charge |
| LDLCHOLESTROL | 83721 | Included in inpatient hospital charge |
| LITHIUM LEVEL | 80178 | Included in inpatient hospital charge |
| MAGNESIUMBLOOD; CHEMICAL | 83735 | Included in inpatient hospital charge |
| MANGANESE | 83785 | Included in inpatient hospital charge |
| NEURONTIN LEVELS | 83788 | Included in inpatient hospital charge |
| SYNTHETIC CANNABINOIDS | 83788 | Included in inpatient hospital charge |
| BATH SALTS PANEL URINE | 83789 | Included in inpatient hospital charge |
| INR TEST;ANTICOAGULENT MGMT | 93793 | Included in inpatient hospital charge |
| MERCURY QUANTITATIVE | 83825 | Included in inpatient hospital charge |
| METANEPHRINES URINE | 83835 | Included in inpatient hospital charge |
| METHSUXIMIDE | 83858 | Included in inpatient hospital charge |
| MYOGLOBIN | 83874 | Included in inpatient hospital charge |
| NATRIURETIC PEPTIDE | 83880 | Included in inpatient hospital charge |
| NICKEL | 83885 | Included in inpatient hospital charge |
| NICOTINE | 80323 | Included in inpatient hospital charge |
| MOLE DIAG;ISOL. OR EXTRAC | 81161 | Included in inpatient hospital charge |
| ISO OR EXT. OF HIGHLY PURIFIE | 81161 | Included in inpatient hospital charge |
| MOLE DIAG;ENZYM DIGESTION | 81161 | Included in inpatient hospital charge |
| MOLE.DIAG-SEP. GEL ELECTROPH. | 81161 | Included in inpatient hospital charge |
| NUC MOLE DIAG;NUC ACID PROBE | 81161 | Included in inpatient hospital charge |
| MOLE DIAG;AMPL NUC ACDPR | 81161 | Included in inpatient hospital charge |
| MOLE DIAG;REVERSE TRANSCR | 81161 | Included in inpatient hospital charge |
| NUC MOLE DIAG;INTER & REP | 81161 | Included in inpatient hospital charge |
| NUCLEOTIDASE 5'- | 81161 | Included in inpatient hospital charge |
| ORG. ACIDS TOT. QUANT. EACH | 83918 | Included in inpatient hospital charge |
| ORGANIC ACID QUALITATIVE | 83919 | Included in inpatient hospital charge |
| ORGANIC ACID SINGLE QUANT. | 83921 | Included in inpatient hospital charge |
| OSMOLALITY; BLOOD | 83930 | Included in inpatient hospital charge |
| OSMOLALITY; URINE | 83935 | Included in inpatient hospital charge |
| OSTEOCALCIN | 83937 | Included in inpatient hospital charge |
| ASSAY OF OXALATE | 83945 | Included in inpatient hospital charge |
| PARATHYROID HORMONE(PTH) | 83970 | Included in inpatient hospital charge |
| PH BODY FLUID EXCEPT BLOOD | 83986 | Included in inpatient hospital charge |
| PHENULALANINE (PKU) BLOOD | 84030 | Included in inpatient hospital charge |
| PROLACTIN (DILANTIN) | 80185 | Included in inpatient hospital charge |
| ACID PHOSHATASE;TOTAL | 84060 | Included in inpatient hospital charge |
| ACID PHOSPHATASE;PROSTATIC | 84066 | Included in inpatient hospital charge |
| ALKALINE PHOSPHATASE | 84075 | Included in inpatient hospital charge |
| ALKALINE PHOSP ISOENZMES | 84080 | Included in inpatient hospital charge |
| PHOSPHORUS | 84100 | Included in inpatient hospital charge |
| PHOSPHORUS;URINE | 84105 | Included in inpatient hospital charge |
| PORPHOBILINOG;URINEQUAL | 84106 | Included in inpatient hospital charge |
| PORPHOBILINOG;URINEQUANT | 84110 | Included in inpatient hospital charge |
| PORPHYRINS URINE QUALITATIVE | 84119 | Included in inpatient hospital charge |
| PORPHYRINURINE;QUAN&FRAC | 84120 | Included in inpatient hospital charge |
| POTASSIUM;SERUM | 84132 | Included in inpatient hospital charge |
| POTASSIUM;URINE | 84133 | Included in inpatient hospital charge |
| PREALBUMIN | 84134 | Included in inpatient hospital charge |
| MYSOLINE LEVEL | 80188 | Included in inpatient hospital charge |
| PROCAINAMIDE | 80190 | Included in inpatient hospital charge |
| PROGESTERONE | 84144 | Included in inpatient hospital charge |
| PROLACTIN LEVEL | 84146 | Included in inpatient hospital charge |
| PROSTATE SPEC AG(PSA);TOT | 84153 | Included in inpatient hospital charge |
| PSA FREE (TOTAL) | 84154 | Included in inpatient hospital charge |
| PROTEIN TOTAL | 84155 | Included in inpatient hospital charge |
| PROTEIN TOTAL; URINE | 84156 | Included in inpatient hospital charge |
| PROTEINELECT. FRACT. & QUANT. | 84165 | Included in inpatient hospital charge |
| ELECTRO.FRACT.&QUANT OTHER | 84166 | Included in inpatient hospital charge |
| PROTEIN URINE QUANTITATIVE | 84160 | Included in inpatient hospital charge |
| WEST. BLOT INT & RPT BLD/FLUID | 84181 | Included in inpatient hospital charge |
| WESTERN BLOT | 84182 | Included in inpatient hospital charge |
| TRH (T4) | 80439 | Included in inpatient hospital charge |
| PROTOPORPHYRIN RBC;QUANT | 84202 | Included in inpatient hospital charge |
| PROINSULIN | 84206 | Included in inpatient hospital charge |
| PYRIDOXAL PHOSPH.(VIT B6) | 84207 | Included in inpatient hospital charge |
| QUINIDINE TEST (BLOOD) | 80194 | Included in inpatient hospital charge |
| RADIOIMMUNOASSAY | 83519 | Included in inpatient hospital charge |
| PROGESTERONE RECEPTOR ASSAY | 84234 | Included in inpatient hospital charge |
| NON-ENDOCRINE | 84238 | Included in inpatient hospital charge |
| RENIN | 84244 | Included in inpatient hospital charge |
| VITAMIN B2 | 84252 | Included in inpatient hospital charge |
| SELENIUM | 84255 | Included in inpatient hospital charge |
| SERENTONIN | 84260 | Included in inpatient hospital charge |
| SODIUM; SERUM | 84295 | Included in inpatient hospital charge |
| SODIUM;URIINE | 84300 | Included in inpatient hospital charge |
| SPECTROPHOT.ANALYTE NES | 84311 | Included in inpatient hospital charge |
| SPEC GRAVITY-EXCEPT URINE | 84315 | Included in inpatient hospital charge |
| FECAL REDUCING SUBSTANCES | 84377 | Included in inpatient hospital charge |
| TESTOSTERONE-FREE SER. | 84402 | Included in inpatient hospital charge |
| TESTOSTERONE; TOTAL | 84403 | Included in inpatient hospital charge |
| SEX HORM. BIND GLOB(SHBG) | 84270 | Included in inpatient hospital charge |
| THIAMINE (VITAMIN B-1) | 84425 | Included in inpatient hospital charge |
| THIOCYANATE | 84430 | Included in inpatient hospital charge |
| THYROGLOBULIN | 84432 | Included in inpatient hospital charge |
| T4 THYROXINE; TOTAL | 84436 | Included in inpatient hospital charge |
| T4 THYROXINE; FREE | 84439 | Included in inpatient hospital charge |
| THYROXINE BINDING GLOBULIN | 84442 | Included in inpatient hospital charge |
| THYROID STIMULATING HORMONE | 84443 | Included in inpatient hospital charge |
| THYROID STIM.IMMUNOGLOBULIN | 84445 | Included in inpatient hospital charge |
| TOCOPHEROL ALPHA (VITAMIN E) | 84446 | Included in inpatient hospital charge |
| AST(SGOT)TRANS;ASPAR AMINO | 84450 | Included in inpatient hospital charge |
| ALT(SPGT)TRANS;ALAN AMINO | 84460 | Included in inpatient hospital charge |
| TRANSFERRIN | 84466 | Included in inpatient hospital charge |
| TRIGLYCERIDES | 84478 | Included in inpatient hospital charge |
| (T3 or T4)UPTAKE | 84479 | Included in inpatient hospital charge |
| T3; TOTAL | 84480 | Included in inpatient hospital charge |
| T3; FREE | 84481 | Included in inpatient hospital charge |
| TROPONINQUANTIATIVE | 84484 | Included in inpatient hospital charge |
| TYROSINE | 84510 | Included in inpatient hospital charge |
| TROPONIN QUALITATIVE | 84512 | Included in inpatient hospital charge |
| UREA NITROGEN;QUANTITATIVE | 84520 | Included in inpatient hospital charge |
| UREA NITROGENURINE | 84540 | Included in inpatient hospital charge |
| URIC ACID-SERUM | 84550 | Included in inpatient hospital charge |
| URIC ACID;OTHER SOURCE | 84560 | Included in inpatient hospital charge |
| UROBILINOGENFECESQUANT. | 84577 | Included in inpatient hospital charge |
| UROBILINOGENURINE;QUAL | 84578 | Included in inpatient hospital charge |
| UROBILINOGENURINE;QUAN | 84580 | Included in inpatient hospital charge |
| VANILLYLMANDELIC ACIDURINE | 84585 | Included in inpatient hospital charge |
| VASOACTIVE INTEST. PEPT. (VIP) | 84586 | Included in inpatient hospital charge |
| ANTIDIURETIC HORMONE | 84588 | Included in inpatient hospital charge |
| VITAMIN A | 84590 | Included in inpatient hospital charge |
| VITAMIN K | 84597 | Included in inpatient hospital charge |
| BLEEDING TIME | 85002 | Included in inpatient hospital charge |
| AUTO DIFFERENTIAL WBC COUNT | 85004 | Included in inpatient hospital charge |
| WBC DIFF W/RBC MORPH&PLT | 85007 | Included in inpatient hospital charge |
| MAN BLD SMR W/O DIFF PARA | 85008 | Included in inpatient hospital charge |
| DIFF WBC CNTBUFFY COAT | 85009 | Included in inpatient hospital charge |
| HEMATOCRIT;OTHR THAN SPUN | 85014 | Included in inpatient hospital charge |
| HEMOGLOBIN | 85018 | Included in inpatient hospital charge |
| CBC COMPLETE AUTO AND DIFF | 85025 | Included in inpatient hospital charge |
| CBC COMPLETE AUTO | 85027 | Included in inpatient hospital charge |
| RED BLOOD CELL(RBC)ONLY | 85041 | Included in inpatient hospital charge |
| RETICULOCYTE MANUAL | 85044 | Included in inpatient hospital charge |
| RETICULOCYTE AUTOMATED | 85045 | Included in inpatient hospital charge |
| WHITE BLOOD COUNT | 85048 | Included in inpatient hospital charge |
| PLATELET AUTOMATED | 85049 | Included in inpatient hospital charge |
| BLOOD SMEAR;MD INTERPRET | 85060 | Included in inpatient hospital charge |
| BONE MARROW; ASP. ONLY | 38220 | Included in inpatient hospital charge |
| CLOT RETRACTION | 85170 | Included in inpatient hospital charge |
| CLOT LYSIS TIMEWHOLE BLOOD | 85175 | Included in inpatient hospital charge |
| CLOTTING;FACTOR 11PTSPEC | 85210 | Included in inpatient hospital charge |
| V ACTIVITY VON WILLEBRAND | 85220 | Included in inpatient hospital charge |
| VII ACTIVITY FACTOR | 85230 | Included in inpatient hospital charge |
| VIII ACTIVITY FACTOR | 85240 | Included in inpatient hospital charge |
| COAG TEST FACTOR VIII RISTOCET | 85245 | Included in inpatient hospital charge |
| VON WILLEBRAND PROFILE | 85246 | Included in inpatient hospital charge |
| FACTOR VIII VON WILLLEBRAND | 85247 | Included in inpatient hospital charge |
| IX ACTIVITY VON WILLEBRAND | 85250 | Included in inpatient hospital charge |
| GLYCOMARK | 84378 | Included in inpatient hospital charge |
| ASSAY OF URINE SULFATE | 84392 | Included in inpatient hospital charge |
| VOLATILES(QUAN.) | 84600 | Included in inpatient hospital charge |
| ZINC QUANTITATIVE;BLOOD | 84630 | Included in inpatient hospital charge |
| C-PEPTIDE | 84681 | Included in inpatient hospital charge |
| PREG . (HCG SERUM QUANT) | 84702 | Included in inpatient hospital charge |
| HCG SERUM QUALITATIVE | 84703 | Included in inpatient hospital charge |
| UNLISTED CHEMISTRY PROCEDURE | 84999 | Included in inpatient hospital charge |
| BONE MARROW; ASP. ONLY | 38220 | Included in inpatient hospital charge |
| CLOT INHIBITORS OR ANTICOAGUL | 85300 | Included in inpatient hospital charge |
| ANTITHROMBIN III ANTIGEN | 85301 | Included in inpatient hospital charge |
| PROTEIN C ACTIVITY | 85303 | Included in inpatient hospital charge |
| PROTEIN S TOTAL | 85305 | Included in inpatient hospital charge |
| PROTEIN S FREE | 85306 | Included in inpatient hospital charge |
| COAGULATION TIME (LEE/WHITE) | 85345 | Included in inpatient hospital charge |
| COAGULATION TIME;OTHER | 85348 | Included in inpatient hospital charge |
| FIBRIN DEGRADATION QUANT. | 85379 | Included in inpatient hospital charge |
| FIBRINOGEN;ACTIVITY | 85384 | Included in inpatient hospital charge |
| PLASMINOGEN | 85420 | Included in inpatient hospital charge |
| HEPARIN ASSAY | 85520 | Included in inpatient hospital charge |
| LEUKOCYTE ALKALINE PHOS. | 85540 | Included in inpatient hospital charge |
| OSMOTIC FRAGILITY RB | 85555 | Included in inpatient hospital charge |
| PLATELET;AUTOMATED COUNT | 85049 | Included in inpatient hospital charge |
| PRO TIME | 85610 | Included in inpatient hospital charge |
| RUSSELL VIPER VENOM TIME;DIL. | 85613 | Included in inpatient hospital charge |
| SEDRATE NONAUTOMATED | 85651 | Included in inpatient hospital charge |
| SEDRATE-AUTOMATED | 85652 | Included in inpatient hospital charge |
| SICKLING OF RBCREDUCTION | 85660 | Included in inpatient hospital charge |
| THROMBIN TIME-PLASMA | 85670 | Included in inpatient hospital charge |
| THROMBOPLASTIN INHIB.TISSUE | 85705 | Included in inpatient hospital charge |
| PTT | 85730 | Included in inpatient hospital charge |
| PTT SUBSTITUTIONPLASMA FRAC. | 85732 | Included in inpatient hospital charge |
| AGGLUTININSFEBRILE | 86000 | Included in inpatient hospital charge |
| FEBRILE AGGLUTFRANCISELL | 86000 | Included in inpatient hospital charge |
| FEBRILE AGGLUTMURINE TYP | 86000 | Included in inpatient hospital charge |
| ALLERGEN SPEC. IGE QUANT/SEM | 86003 | Included in inpatient hospital charge |
| FEBRILE AGGLUTROCKY MTN | 86000 | Included in inpatient hospital charge |
| FEBRILE AGGLUTSCRUB TYPH | 86000 | Included in inpatient hospital charge |
| ANTIBODY ID; LEUKOCYTE | 86021 | Included in inpatient hospital charge |
| PLATELET ANTIBODIES | 86022 | Included in inpatient hospital charge |
| ANTIHUMAN GLOB; INDIRECT | 86885 | Included in inpatient hospital charge |
| ANTINUCLEAR ANTIBODIES (ANA) | 86038 | Included in inpatient hospital charge |
| ANTINUCLEAR ANTIBODIES-TITER | 86039 | Included in inpatient hospital charge |
| ALCOHOLS URINE SCREEN | G6040 | Included in inpatient hospital charge |
| ASSAY OF NICOTINE | G6055 | Included in inpatient hospital charge |
| ANTISTREPTOLYSIN 0;TITER | 86060 | Included in inpatient hospital charge |
| BLOOD TYPING;ABO | 86900 | Included in inpatient hospital charge |
| AUTOL. BLOODINTRA OR POSTOP | 86901 | Included in inpatient hospital charge |
| C-REACTIVE PROTEIN | 86140 | Included in inpatient hospital charge |
| C-REACTIVE PROTEIN; HIGH SENS. | 86141 | Included in inpatient hospital charge |
| COLD AGGLUTININ; SCREEN | 86156 | Included in inpatient hospital charge |
| TITER COLD AGGLUTININ | 86157 | Included in inpatient hospital charge |
| COMPLEMENT:AGEACH COMP. | 86160 | Included in inpatient hospital charge |
| TOTAL HEMOLYTIC (CH50) | 86162 | Included in inpatient hospital charge |
| COMPLEMENT FIX TEST;EA AG | 86171 | Included in inpatient hospital charge |
| ANT-CCP | 86200 | Included in inpatient hospital charge |
| DNA AB;NATIVE OR DBLE STRAND | 86225 | Included in inpatient hospital charge |
| ANTI SMITH-ENA AB;EA AB | 86235 | Included in inpatient hospital charge |
| FLORESCENT;SCREENEA AB | 86255 | Included in inpatient hospital charge |
| FLUORESCENT;TITEREA AB | 86256 | Included in inpatient hospital charge |
| HEMAGGLUTINATION INHIBITION | 86280 | Included in inpatient hospital charge |
| HEPATITIS BE ANTIGEN | 87350 | Included in inpatient hospital charge |
| IMMUNO FOR TUMOR AG QUAL | 86300 | Included in inpatient hospital charge |
| IMMUNO FOR TUMOR AG CA-19-9 | 86301 | Included in inpatient hospital charge |
| IMMUNOASSAY TUMOR CA 125 | 86304 | Included in inpatient hospital charge |
| HETEROPHILE ABS;SCRNING | 86308 | Included in inpatient hospital charge |
| HETEROPHILE ABS;TITER-BEEF CEL | 86310 | Included in inpatient hospital charge |
| HIV ANTIGEN | 87390 | Included in inpatient hospital charge |
| PARTICLE AGGLUTINATION; SCREEN | 86403 | Included in inpatient hospital charge |
| VENIPUNCTURE | 36415 | Included in inpatient hospital charge |
| VENIPUNCTURE BY LSC | 36415 | Included in inpatient hospital charge |
| RHEUMATOID FACTOR;QUAL | 86430 | Included in inpatient hospital charge |
| RHEUMATOID FACTOR;QUAN | 86431 | Included in inpatient hospital charge |
| QUANTIFERON TB GOLD | 86480 | Included in inpatient hospital charge |
| COCCIDIOIDOMYCOSIS | 86490 | Included in inpatient hospital charge |
| HIV-1 | 86701 | Included in inpatient hospital charge |
| HIV-1&HIV-2 SINGLE ASSAY | 86703 | Included in inpatient hospital charge |
| HEP. B CORE AB (HBSAB); TOTAL | 86704 | Included in inpatient hospital charge |
| HEP B CORE ANTIBODY-IGM | 86705 | Included in inpatient hospital charge |
| HEP. B SURFACE AB (HBSAB) | 86706 | Included in inpatient hospital charge |
| HEPATITIS BE ANTIBODY (HBEAB) | 86707 | Included in inpatient hospital charge |
| HEP A ANTIBODY TOTAL | 86708 | Included in inpatient hospital charge |
| IGM ANTIBODY; HEPATITIS A | 86709 | Included in inpatient hospital charge |
| INFLUENZA A OR B VIRU | 86710 | Included in inpatient hospital charge |
| MUMPS;ANTIBODY | 86735 | Included in inpatient hospital charge |
| MYCOPLASMA PNEUMONIAE | 86738 | Included in inpatient hospital charge |
| RICKETTSIA ANTIBODY_RKY MTN FV | 86757 | Included in inpatient hospital charge |
| ROTAVIRUS ANTIBODY | 86759 | Included in inpatient hospital charge |
| RUBELLA; ANTIBODY | 86762 | Included in inpatient hospital charge |
| MEASLES (RUBEOLA) | 86765 | Included in inpatient hospital charge |
| SARS-COV2 COVID 19 ANTIBODY | 86769 | Included in inpatient hospital charge |
| TOXOPLASMA | 86777 | Included in inpatient hospital charge |
| TOXOPLASMA IGM | 86778 | Included in inpatient hospital charge |
| TREPONEMA PALLIDUM | 86780 | Included in inpatient hospital charge |
| TREPONEMA PALLIDUMCONF. | 86781 | Included in inpatient hospital charge |
| VARICELLA-ZOSTER ANTIBODY | 86787 | Included in inpatient hospital charge |
| ISLET CELL ANTIBODY | 86341 | Included in inpatient hospital charge |
| B-CELL | 86355 | Included in inpatient hospital charge |
| NATURAL KILLER(NK) CELLS,TOTAL | 86357 | Included in inpatient hospital charge |
| T CELLS; TOTAL COUNT | 86359 | Included in inpatient hospital charge |
| ABS CD4 & CD8 COUNTINC. RATIO | 86360 | Included in inpatient hospital charge |
| ABSOLUTE CD4 COUNT | 86361 | Included in inpatient hospital charge |
| MICROSOMAL ANTIBODIES | 86376 | Included in inpatient hospital charge |
| MICROSOMAL ABS;LIVER/KIDN | 86376 | Included in inpatient hospital charge |
| HISTOPLASMOSIS SKIN TEST | 86510 | Included in inpatient hospital charge |
| PPD | 86580 | Included in inpatient hospital charge |
| STREPTOCOCCUSSCREENDIRECT | 86590 | Included in inpatient hospital charge |
| STREPTOKINASEANTIBODY | 86590 | Included in inpatient hospital charge |
| VDRLRPRART; QUAL | 86592 | Included in inpatient hospital charge |
| VDRLRPRART;QUAN | 86593 | Included in inpatient hospital charge |
| ASPERGILLUS | 86606 | Included in inpatient hospital charge |
| BLASTOMYCES AB DF | 86612 | Included in inpatient hospital charge |
| LYME DISEASE ANTIBODY | 86617 | Included in inpatient hospital charge |
| LYME DISEASE TEST | 86618 | Included in inpatient hospital charge |
| CHLAMYDIA ANTIGEN | 86631 | Included in inpatient hospital charge |
| COCCIDIOIDES AB CF | 86635 | Included in inpatient hospital charge |
| CRYPTOCOCCUS | 86641 | Included in inpatient hospital charge |
| CYTOMEGALOVIRUS | 86644 | Included in inpatient hospital charge |
| CYTOMEGALOVIRUS {CMV}I GM | 86645 | Included in inpatient hospital charge |
| EPSTEIN-BARR{EB}VIRUS | 86663 | Included in inpatient hospital charge |
| EPSTEIN-BARR VIRUSNUCLEAR AG | 86664 | Included in inpatient hospital charge |
| EPSTEIN-BARR VIRUS CSPSID} | 86665 | Included in inpatient hospital charge |
| HELICOBACTER PYLORI | 86677 | Included in inpatient hospital charge |
| HTLV-1 AB | 86687 | Included in inpatient hospital charge |
| HTLV OR HIV ABCONF.TEST | 86689 | Included in inpatient hospital charge |
| HEPATITIS DELTA ANTIB | 86692 | Included in inpatient hospital charge |
| HERPES SIMPLEX NON-SPEC. TYPE | 86694 | Included in inpatient hospital charge |
| HERPES IGM 1 ANTIBODY | 86695 | Included in inpatient hospital charge |
| HERPES IGM 2 ANTIBODY | 86696 | Included in inpatient hospital charge |
| HISTOPLASMA YEAST CF | 86698 | Included in inpatient hospital charge |
| THYROGLOBULIN ANTIBODY | 86800 | Included in inpatient hospital charge |
| HEPATITIS C ANTIBODY | 86803 | Included in inpatient hospital charge |
| SERUM FOR ALCOHOL | 86807 | Included in inpatient hospital charge |
| HLA TYPING;ABOR C SINGLE AG | 86812 | Included in inpatient hospital charge |
| DR/DQ MULTIPLE ANTIGENS | 86817 | Included in inpatient hospital charge |
| TRYPTASE | 86849 | Included in inpatient hospital charge |
| ANTIBODY SCREENRBC | 86850 | Included in inpatient hospital charge |
| AB ELUTION{RBC}EA.ELUTION | 86860 | Included in inpatient hospital charge |
| ANTIHUMAN GLOB;DIRECT | 86880 | Included in inpatient hospital charge |
| ANTIHUM;GLOB;INDIRCT;QUAL | 86885 | Included in inpatient hospital charge |
| ANTIHUMN GLOB;INDIRTITER | 86886 | Included in inpatient hospital charge |
| TYPE ABO | 86900 | Included in inpatient hospital charge |
| RHO (D) | 86901 | Included in inpatient hospital charge |
| HEMOLYSINS & AGGLUTININS | 86940 | Included in inpatient hospital charge |
| CYTOMEGALOVIRUS{CMV} | 86999 | Included in inpatient hospital charge |
| PARASITESOVAOR TUBERCULOS | 87015 | Included in inpatient hospital charge |
| CULTUREBACTERIAL;BLOOD | 87040 | Included in inpatient hospital charge |
| CXBACTSTL AEROB W/ISO&EXAM | 87045 | Included in inpatient hospital charge |
| CX.BACT STL AEROBWITH PATH | 87046 | Included in inpatient hospital charge |
| CULTURE BACTERIAL; OTHER SRCE | 87070 | Included in inpatient hospital charge |
| CULTURE BACTERIA QUAN AERO | 87071 | Included in inpatient hospital charge |
| CULTANAEROBICANY SOURCE | 87075 | Included in inpatient hospital charge |
| CULTREANAEROBIC;ADD METH | 87076 | Included in inpatient hospital charge |
| CX BACT. ID AEROBIC ISOLATE | 87077 | Included in inpatient hospital charge |
| CX PRES. PATHOGENIC ORG. | 87081 | Included in inpatient hospital charge |
| CX W/COLONY EST.FRM CHART | 87084 | Included in inpatient hospital charge |
| URINE CULT. QUANT. COLONY CT | 87086 | Included in inpatient hospital charge |
| URINE CULTURE IDENTIFICATION | 87088 | Included in inpatient hospital charge |
| CULTFUNGI;SKINHAIRNAIL | 87101 | Included in inpatient hospital charge |
| CULTUREFUNGIOTHER (EXC BLD) | 87102 | Included in inpatient hospital charge |
| BLOOD CULTURE | 87103 | Included in inpatient hospital charge |
| CULTURE FUNGI;YEAST | 87106 | Included in inpatient hospital charge |
| CULTUREMYCOPLASMAANY SRCE | 87109 | Included in inpatient hospital charge |
| CULTURECHLAMYDIA | 87110 | Included in inpatient hospital charge |
| CULTURETB OR OTHER ACID-FAST | 87116 | Included in inpatient hospital charge |
| ARTHROPOID ID | 87168 | Included in inpatient hospital charge |
| MACRO. EXAMIN PARASITE | 87169 | Included in inpatient hospital charge |
| PINWORM EXAM (EGTAPE TEST) | 87172 | Included in inpatient hospital charge |
| O&PDIR SMEARSCONC. & ID | 87177 | Included in inpatient hospital charge |
| MICROBIAL IDENTIFICATION | 87797 | Included in inpatient hospital charge |
| INF AGTAMP PROBENOSEA ORG | 87798 | Included in inpatient hospital charge |
| SENSITIVITY (KIRBY BREWER) | 87181 | Included in inpatient hospital charge |
| SENSITIVITY STUDIESDISK METH. | 87184 | Included in inpatient hospital charge |
| SENSITIVITY STUDYMICROTITER | 87186 | Included in inpatient hospital charge |
| ID & SENSI-DIL.METH. EA ANTIB | 87188 | Included in inpatient hospital charge |
| SENSITIVITY STUDIESTBEA DRUG | 87190 | Included in inpatient hospital charge |
| GRAM OR GIEMSA STAIN | 87205 | Included in inpatient hospital charge |
| AFB STAIN | 87206 | Included in inpatient hospital charge |
| HERPES CULTURE | 86695 | Included in inpatient hospital charge |
| WET MNT(SAL/INDIA INK OR KOH) | 87210 | Included in inpatient hospital charge |
| TISSUE EXAMINATION FOR FUNGI | 87220 | Included in inpatient hospital charge |
| C.DIFF TOXIN OR ANTITOXIN ASSA | 87230 | Included in inpatient hospital charge |
| VIRUS ISOL;TISS CXINOCOBS & ID | 87252 | Included in inpatient hospital charge |
| TISS CULTADDITIONAL STUDIES O | 87253 | Included in inpatient hospital charge |
| SHELL VIALID W/IMMUNOFLUORS | 87254 | Included in inpatient hospital charge |
| INCL.ID.BY NON-IMMUNO- OTHER | 87255 | Included in inpatient hospital charge |
| HERPES SIMPLEX VIRUS TYPE 1 | 87274 | Included in inpatient hospital charge |
| INFLUENZA B VIRUS | 87275 | Included in inpatient hospital charge |
| INFLUENZA A VIRUS | 87276 | Included in inpatient hospital charge |
| TREPONEMA PALLIDUM | 87285 | Included in inpatient hospital charge |
| CLOSTRIDIUM DIFFICILE TOXIN(S) | 87324 | Included in inpatient hospital charge |
| CRYPTOSPORIDIUM | 87328 | Included in inpatient hospital charge |
| GIARDIA LAMBLIA EIA | 87329 | Included in inpatient hospital charge |
| HELICOBACTER PYLORI AG STOOL | 87338 | Included in inpatient hospital charge |
| HEPATITIS B SURFACE AG (HBSAG) | 87340 | Included in inpatient hospital charge |
| HEP B SURF ANTIGEN NEUTRALIZ | 87341 | Included in inpatient hospital charge |
| HEP BE ANTIGEN (HBEAG) | 87350 | Included in inpatient hospital charge |
| HIV AG/AB WITH REFLEXT | 87389 | Included in inpatient hospital charge |
| HIV-2 ANTIGEN | 87391 | Included in inpatient hospital charge |
| HIV-1 ANTIGEN | 87390 | Included in inpatient hospital charge |
| INF AG BY ENZ IMM; STREP GRP A | 87430 | Included in inpatient hospital charge |
| INF AG DET ENZ IMM; MULT STEP | 87449 | Included in inpatient hospital charge |
| CHLAMYDIA-DNA PROBE | 87490 | Included in inpatient hospital charge |
| CHLAYMDIA TRACH. AMP PROBE | 87491 | Included in inpatient hospital charge |
| CLOSTRIDIUM DIFFICILE PCR | 87493 | Included in inpatient hospital charge |
| INFLUENZA A&B RT PCR | 87502 | Included in inpatient hospital charge |
| GASTROINTESTINAL PANEL | 87507 | Included in inpatient hospital charge |
| HEPATITIS B VIRUS DNA | 87517 | Included in inpatient hospital charge |
| HEPATITIS C AMP. PROBE TECH | 87521 | Included in inpatient hospital charge |
| HEP C VIRUS W REFLEX GENOTYPE | 87522 | Included in inpatient hospital charge |
| HIV-1 AMP. PROBE TECHNIQUE | 87535 | Included in inpatient hospital charge |
| HIV VIRAL LOAD | 87536 | Included in inpatient hospital charge |
| MYCOPLASMA PNM DRT PBE TECH | 87580 | Included in inpatient hospital charge |
| MYCOPLASM PNM AMP PBE TECH | 87581 | Included in inpatient hospital charge |
| MYCOPLASMA PNEUMO QUANT | 87582 | Included in inpatient hospital charge |
| GONORRHOEAE N; DIRECT PROBE | 87590 | Included in inpatient hospital charge |
| GC URINE BY PCR (DNA PROBE) | 87591 | Included in inpatient hospital charge |
| HPV HUMAN AMP PROBE | 87623 | Included in inpatient hospital charge |
| INFLUENZA A&B BY PCR | 87631 | Included in inpatient hospital charge |
| SARS-COV2 COVID 19 AMP PROBE | 87635QW | Included in inpatient hospital charge |
| FLU A/B,RSV,COVID19 AMP PROBE | 87637 | Included in inpatient hospital charge |
| STAPH.AUREUSMETHN RESISTANT | 87641 | Included in inpatient hospital charge |
| INF AGT DET BY DNA OR RNA | 87797 | Included in inpatient hospital charge |
| AMP PROBE TECHN EACH ORG | 87798 | Included in inpatient hospital charge |
| DNA/RNA DIR PROBE MULT ORG | 87800 | Included in inpatient hospital charge |
| RAPID FLU TEST | 87804 | Included in inpatient hospital charge |
| GONORRHOEAE NEISSERIA | 87850 | Included in inpatient hospital charge |
| (RAPID) STREP GROUP A | 87880 | Included in inpatient hospital charge |
| SHIGA TOXIN 1 | 87899 | Included in inpatient hospital charge |
| SHIGA TOXIN 2 | 87999 | Included in inpatient hospital charge |
| HIV GENOTYPE QUANT 2 | 87901 | Included in inpatient hospital charge |
| HEP C VIRUS | 87902 | Included in inpatient hospital charge |
| CLOZAPINE LEVELS | 80159 | Included in inpatient hospital charge |
| CYTOLOGY (SPUTUM) | 88104 | Included in inpatient hospital charge |
| CYTOPATHCONC.TECHSM & IN | 88108 | Included in inpatient hospital charge |
| URINE CYTOLOGY | 88112 | Included in inpatient hospital charge |
| CYTOPATHOLOGY (SPERM) | 88125 | Included in inpatient hospital charge |
| CYTOPATH CERVICAL/VAGINAL | 88141 | Included in inpatient hospital charge |
| PAP SMEAR | 88142 | Included in inpatient hospital charge |
| CYTOPATHSMEARSCERV OR VA | 88150 | Included in inpatient hospital charge |
| WITH DEF HORMONE VALUATION | 88155 | Included in inpatient hospital charge |
| CYTOPATHSMRSOTH SRC S&I | 88160 | Included in inpatient hospital charge |
| CYTOPATHSLIDESCERVICAL / VA | 88164 | Included in inpatient hospital charge |
| FLOW CYTOMETRY;EA CELL SURF | 88184 | Included in inpatient hospital charge |
| TISS. CX/NON-NEOPLASTIC DISOR | 88230 | Included in inpatient hospital charge |
| CHROMOSOME AN;SCE STUDY | 88245 | Included in inpatient hospital charge |
| CHROM FRAGILE X | 88248 | Included in inpatient hospital charge |
| CHROM AN;CT51KARY W/BAND | 88261 | Included in inpatient hospital charge |
| CHROM AN;CT15-202KARYBD | 88262 | Included in inpatient hospital charge |
| MOLE CYTOGENETICS DNA PROBE | 88271 | Included in inpatient hospital charge |
| MOLE CHROMOSOMAL | 88273 | Included in inpatient hospital charge |
| CHROMOSOME AN/HIGH RESOL | 88289 | Included in inpatient hospital charge |
| CYTOGENTIC & MOLE CYTOGENTIC | 88291 | Included in inpatient hospital charge |
| UNLISTED CYTOGENETIC STUDY | 88299 | Included in inpatient hospital charge |
| PROTEIN C ANTIGEN | 85302 | Included in inpatient hospital charge |
| SURG PATH GR & MIC UNC. | 88304 | Included in inpatient hospital charge |
| SURG PATH BX W/O CO D | 88305 | Included in inpatient hospital charge |
| DECALCIFICATION PROCEDURE | 88311 | Included in inpatient hospital charge |
| SPECIAL STAINS | 88312 | Included in inpatient hospital charge |
| TRICHROME STAIN | 88313 | Included in inpatient hospital charge |
| QUANT OF ANTIPSYCHOTIC DRUGS | 80342 | Included in inpatient hospital charge |
| PAP | 88342 | Included in inpatient hospital charge |
| HEPATITIS BE ANTIGEN | 87350 | Included in inpatient hospital charge |
| TISSUE IN SITU HYBRIDINTERP | 88365 | Included in inpatient hospital charge |
| SOMATOMEDIN URINE | 84305 | Included in inpatient hospital charge |
| TUBERCULOSIS TEST | 86480 | Included in inpatient hospital charge |
| CYCLIC CITRULLINATED PEPIDE | 86140 | Included in inpatient hospital charge |
| CULTURE ISOLATE ID ADD METHOD | 87077 | Included in inpatient hospital charge |
| SEROLOGICAL IDENT OF ORG | 87147 | Included in inpatient hospital charge |
| SHELL VIAL W/IMMUNOFLR STN | 87254 | Included in inpatient hospital charge |
| MAILOUTS | 99001 | Included in inpatient hospital charge |
| CELL CTMISC.BODY FLDSEXC.BLD | 89050 | Included in inpatient hospital charge |
| CELL COUNT/DIFF SYNOV. | 89051 | Included in inpatient hospital charge |
| LEUKOCYTE COUNT FECAL | 89055 | Included in inpatient hospital charge |
| NASAL SMEAR FOR EOSINOPHILS | 89190 | Included in inpatient hospital charge |
| UNLISTED MISC.PATHOLOGY TEST | 89240 | Included in inpatient hospital charge |
| ROUTINE-CREATINE KINASE;TOTAL | 82550 | Included in inpatient hospital charge |
| ROUTINE-SYPHILIS | 86592 | Included in inpatient hospital charge |
| ROUTINE-HIV | 86703 | Included in inpatient hospital charge |
| ELECT STIM UNATT 1+ AREA | G0283 | Included in inpatient hospital charge |
| ROM MEASUREMNTS EXCL HANDS | 95851GP | Included in inpatient hospital charge |
| ROM MEASUREMENTS HAND | 95852GP | Included in inpatient hospital charge |
| LIMB EXERCISE TEST (ISCHEMIC) | 95875GP | Included in inpatient hospital charge |
| APPL OF MODALITY;HOT/COLD | 97010GP | Included in inpatient hospital charge |
| TRACTION | 97012GP | Included in inpatient hospital charge |
| ELECTRICAL STIMULATION,UNATTEN | 97014GP | Included in inpatient hospital charge |
| VASOPNEUMATIC DEVICE | 97016GP | Included in inpatient hospital charge |
| PARAFFIN BATH | 97018GP | Included in inpatient hospital charge |
| STERILE WHIRLPOOL | 97022GP | Included in inpatient hospital charge |
| DIATHERMY | 97024GP | Included in inpatient hospital charge |
| INFRARED | 97026GP | Included in inpatient hospital charge |
| ULTRAVIOLET | 97028GP | Included in inpatient hospital charge |
| ELECTRIC STIMULATION | 97032GP | Included in inpatient hospital charge |
| IONTOPHORESIS (1 on 1) | 97033GP | Included in inpatient hospital charge |
| CONTRAST BATHS EA 15 DIRECT | 97034GP | Included in inpatient hospital charge |
| ULTRASOUND (1 on 1) | 97035GP | Included in inpatient hospital charge |
| HUBBARD TANK (1 on 1) | 97036GP | Included in inpatient hospital charge |
| TILT TABLE | 97039GP | Included in inpatient hospital charge |
| THERAP PROC EXCERC 1 OR MORE | 97110GP | Included in inpatient hospital charge |
| THERAP PROC EXC 1+ TELEHEALTH | 97110GP95 | Included in inpatient hospital charge |
| PTA TELEH-THERAP PROC EXC 1+ | 97110GPCQ95 | Included in inpatient hospital charge |
| TELEH NEUROMUSC RE-ED MVMNT | 97112GP95 | Included in inpatient hospital charge |
| PTA TELE NEUROMUSC RE-ED MVMT | 97112GPCQ95 | Included in inpatient hospital charge |
| NEUROMUSC RE-ED OF MVEMNT | 97112GP | Included in inpatient hospital charge |
| AQUATIC THERAPY W/EXERC DIR | 97113GP | Included in inpatient hospital charge |
| GAIT TRAINING TELEHEALTH | 97116GP95 | Included in inpatient hospital charge |
| PTA TELEH-GAIT TRAINING | 97116GPCQ95 | Included in inpatient hospital charge |
| GAIT TRAININGINCL. STAIR CLIMB | 97116GP | Included in inpatient hospital charge |
| MASSAGE-15 MINUTES | 97124GP | Included in inpatient hospital charge |
| UNLISTED THERAPEUTIC PRO | 97139GP | Included in inpatient hospital charge |
| MAN THER TECH 1+ EA 15 MIN | 97140GP | Included in inpatient hospital charge |
| THER PROCGROUP2 + INDIVIDUA | 97150GP | Included in inpatient hospital charge |
| PT EVAL LOW COMPLEXITY | 97161GP | Included in inpatient hospital charge |
| PT EVAL MODERATE COMPLEXITY | 97162GP | Included in inpatient hospital charge |
| PT EVAL HIGH COMPLEXITY | 97163GP | Included in inpatient hospital charge |
| PT RE EVALUATION | 97164GP | Included in inpatient hospital charge |
| MYOFACIAL RELEASE | 97140GP | Included in inpatient hospital charge |
| SOFT TISSUE MOBILIZATION | 97140GP | Included in inpatient hospital charge |
| PROSTHETIC TRAINING | 97761GP | Included in inpatient hospital charge |
| THERAPEUTIC ACT;BED MOBILITY | 97530GP | Included in inpatient hospital charge |
| THERAP ACT;BED MOB TELEHLTH | 97530GP95 | Included in inpatient hospital charge |
| PTA TELEH-THERAP ACT;BED MOB | 97530GPCQ95 | Included in inpatient hospital charge |
| SELFCARE MANAGEMENT | 97535GP | Included in inpatient hospital charge |
| TELEH SELF CARE MGMT | 97535GP95 | Included in inpatient hospital charge |
| PTA/TELEH SELFCARE MGMT | 97535GPCQ95 | Included in inpatient hospital charge |
| HOME ENVIRONMENT ASSESSMEN | 97537GP | Included in inpatient hospital charge |
| WHEELCHR MGMT/PROPUL TRNG | 97542GP | Included in inpatient hospital charge |
| WORK COND/HARDEN-INIT 2 HRS | 97545GP | Included in inpatient hospital charge |
| WORK COND./HARDEN-ADD'L. HR | 97546GP | Included in inpatient hospital charge |
| PHYSICAL PERFORMANCE TEST | 97750GP | Included in inpatient hospital charge |
| ASSISTIVE TECH ASSESSMENT | 97755GP | Included in inpatient hospital charge |
| ORTHOTIC MGT & TRNG | 97760GP | Included in inpatient hospital charge |
| ORTHOTIC TRNG; TELEH | 97760GP95 | Included in inpatient hospital charge |
| PTA TELEH-ORTHOTIC TRNG | 97760GPCQ95 | Included in inpatient hospital charge |
| CHECK ORTHO/PROSTHETIC USE | 97762GP | Included in inpatient hospital charge |
| UNLISTED PT PROCEDURE | 97799GP | Included in inpatient hospital charge |
| APPL OF LONG ARM SPLINT | 29105GP | Included in inpatient hospital charge |
| APPLICATION SHORT ARM SPLINT | 29125GP | Included in inpatient hospital charge |
| DYNAMIC | 29126GP | Included in inpatient hospital charge |
| APPL OF FINGER SPLINT | 29130GP | Included in inpatient hospital charge |
| APPL OF LONG LEG SPLINT | 29505GP | Included in inpatient hospital charge |
| APPL OF SHORT LEG SPLINT | 29515GP | Included in inpatient hospital charge |
| SELF CARE(ADLS) | 97535GO | Included in inpatient hospital charge |
| MUSCLE TESTING W/O HAND | 95831GO | Included in inpatient hospital charge |
| MANUAL MUSCLE TEST-HAND | 95832GO | Included in inpatient hospital charge |
| EVALUATION OF BODY W/O HAND | 95833GO | Included in inpatient hospital charge |
| EVALUATION OF BODY W/HAND | 95834GO | Included in inpatient hospital charge |
| RANGE OF MOTION W/O HANDS | 95851GO | Included in inpatient hospital charge |
| RNGE OF MOTION MEASRE-HAND | 95852GO | Included in inpatient hospital charge |
| APPL OF MOD 1+ AREA HOT/COLD | 97010GO | Included in inpatient hospital charge |
| TRACTION MECHANICAL | 97012GO | Included in inpatient hospital charge |
| ELECTRICAL STIMUL (UNATTENDED) | 97014GO | Included in inpatient hospital charge |
| VASOPNEUMATIC DEVICES | 97016GO | Included in inpatient hospital charge |
| PARAFFIN BATH | 97018GO | Included in inpatient hospital charge |
| WHIRLPOOL | 97022GO | Included in inpatient hospital charge |
| DIATHERMY | 97024GO | Included in inpatient hospital charge |
| INFRARED | 97026GO | Included in inpatient hospital charge |
| ULTRAVIOLET | 97028GO | Included in inpatient hospital charge |
| ELECTRICAL STIM (ATTENDED) | 97032GO | Included in inpatient hospital charge |
| IONTOPHORESIS EA 15M (1 ON 1) | 97033GO | Included in inpatient hospital charge |
| CONTRAST BATH EA 15M (1 ON 1) | 97034GO | Included in inpatient hospital charge |
| ULTRASOUND EA 15M (1 ON 1) | 97035GO | Included in inpatient hospital charge |
| THERAP PROC EXERCISE EA15 MIN | 97110GO | Included in inpatient hospital charge |
| NEUROMUSC RE-ED OF MVMT OT | 97112GO | Included in inpatient hospital charge |
| AQUATIC THER W/THERAPEUT EX | 97113GO | Included in inpatient hospital charge |
| GAIT TRAINING 1:1 EA 15 | 97116GO | Included in inpatient hospital charge |
| MASSAGEINC EFFLEURAGEPETRI | 97124GO | Included in inpatient hospital charge |
| OT UNLIST THER PROC. (SPECIFY) | 97139GO | Included in inpatient hospital charge |
| MANUAL THER TECHEA 15 MIN | 97140GO | Included in inpatient hospital charge |
| OT GROUP THERAPY/VISIT | 97150GO | Included in inpatient hospital charge |
| OT EVAL LOW COMPLEXITY | 97165GO | Included in inpatient hospital charge |
| OT EVAL MODERATE COMPLEXITY | 97166GO | Included in inpatient hospital charge |
| OT EVAL HIGH COMPLEXITY | 97167GO | Included in inpatient hospital charge |
| OT RE EVALUATION | 97168GO | Included in inpatient hospital charge |
| ORTHO FITTING/TRNG/EA 15 MIN | 97760GO | Included in inpatient hospital charge |
| PROSTHETIC TRNG EA 15 MIN | 97761GO | Included in inpatient hospital charge |
| THERAP ACT;BED MOB 15M TELEHLT | 97530GO95 | Included in inpatient hospital charge |
| OTA TELEH-THER ACT;BED MOB15M | 97530GOCO95 | Included in inpatient hospital charge |
| THERAP: ACT BED MOB TRAIN 15M | 97530GO | Included in inpatient hospital charge |
| OT SENSORY TECH 1:1EA 15 | 97533GO | Included in inpatient hospital charge |
| OT SELF CARE ADL 1:1 15M TELEH | 97535GO95 | Included in inpatient hospital charge |
| OT SELF-CARE(ADL)1:1EA15 | 97535GO | Included in inpatient hospital charge |
| OTA SELF-CARE(ADL)1:1 EA15M | 97535GOCO | Included in inpatient hospital charge |
| OT REINTEG TRAIN 1:1 EA15 | 97537GO | Included in inpatient hospital charge |
| WHEELCHAIR MGMTPROP EA 15M | 97542GO | Included in inpatient hospital charge |
| WORK HARDN/CONDINIT 2 HRS | 97545GO | Included in inpatient hospital charge |
| WORK HARDN/COND-EA.ADD HR | 97546GO | Included in inpatient hospital charge |
| CHECK ORTHOTIC/PROSTHET USE | 97762GO | Included in inpatient hospital charge |
| OT PHYS PERF W/REPEA 15 | 97750GO | Included in inpatient hospital charge |
| ASSISTIVE TECHN ASSESSMENT | 97755GO | Included in inpatient hospital charge |
| ORTHOTIC MGMT & TRAINING | 97760GO | Included in inpatient hospital charge |
| ORTHOTIC TRNG TELEH | 97760GO95 | Included in inpatient hospital charge |
| PROSTHETIC TRAINING | 97761GO | Included in inpatient hospital charge |
| DEVELOP COGNITIVE SKILLS | 97532GO | Included in inpatient hospital charge |
| UNLISTED PHYSICAL MED/REHAB | 97799GO | Included in inpatient hospital charge |
| APPL OF LONG ARM SPLINT | 29105GO | Included in inpatient hospital charge |
| APPL OF SHORT ARM SPLINT | 29125GO | Included in inpatient hospital charge |
| DYNAMIC | 29126GO | Included in inpatient hospital charge |
| APPL OF FINGER SPLINT | 29130GO | Included in inpatient hospital charge |
| COMP DYNAMIC PHAR/SPCH EVAL | 70371GN | Included in inpatient hospital charge |
| TX OF SPEECHLANGUAGE;IND | 92507GN | Included in inpatient hospital charge |
| TX SPEECH/LANGUAGE INDIV TELEH | 92507GN95 | Included in inpatient hospital charge |
| COMMUNICAT-SPEECH-GROUP | 92580GN | Included in inpatient hospital charge |
| SPEECH EVAL (FLUENCY) | 92521GN | Included in inpatient hospital charge |
| SPEECH EVAL SOUND PROD;TELEHLT | 92522GN95 | Included in inpatient hospital charge |
| SPEECH EVAL WITH SOUND PROD | 92522GN | Included in inpatient hospital charge |
| SPEECH EVAL SND PROD W/EVA | 92523GN | Included in inpatient hospital charge |
| VOICE/RES BEH&QUAL ANALYS/EVAL | 92524GN | Included in inpatient hospital charge |
| TX OF SWALLOW DYSFUNCTION | 92526GN | Included in inpatient hospital charge |
| TX SWALLOWING DYSFUNC;TELEHLTH | 92526GN95 | Included in inpatient hospital charge |
| SCREENING TEST PURE TONE | 92551GN | Included in inpatient hospital charge |
| PURE TONE AUDIOMETRY THRE | 92552GN | Included in inpatient hospital charge |
| SPEECH-AUDIOMETRY AIR & BONE | 92553GN | Included in inpatient hospital charge |
| SPEECH AUDIOMETREY THRESH | 92555GN | Included in inpatient hospital charge |
| WITH SPEECH REC SRT | 92556GN | Included in inpatient hospital charge |
| COMPREHENSIVE AUDIO THRES | 92557GN | Included in inpatient hospital charge |
| STENGER TEST PURE TONE ST | 92565GN | Included in inpatient hospital charge |
| TYMPANOMETRY IMPEDENCE TE | 92567GN | Included in inpatient hospital charge |
| ACOUSTIC REFLEX TESTING A | 92568GN | Included in inpatient hospital charge |
| STENGER TEST SPEECH STES | 92577GN | Included in inpatient hospital charge |
| VISUAL REINFORCEMENT AUDI | 92579GN | Included in inpatient hospital charge |
| CONDITIONING PLAY AUDIO | 92582GN | Included in inpatient hospital charge |
| SELECT PICTURE AUDIO SPA | 92583GN | Included in inpatient hospital charge |
| AUDITORY EVOKED POTENTIAL | 92585GN | Included in inpatient hospital charge |
| EVOKED OTOACOUSTIC EMISSION | 92587GN | Included in inpatient hospital charge |
| COMPREHENSIVE DIAGNOSTIC | 92588GN | Included in inpatient hospital charge |
| HA EXAM AND SELECTION MON | 92590GN | Included in inpatient hospital charge |
| BINAURAL HAEB | 92591GN | Included in inpatient hospital charge |
| HA CHECK MONAURAL HACM | 92592GN | Included in inpatient hospital charge |
| BINAURAL | 92593GN | Included in inpatient hospital charge |
| ELECTROACOUSTIC EVAL HA M | 92594GN | Included in inpatient hospital charge |
| BINAURAL EAEB | 92595GN | Included in inpatient hospital charge |
| EAR PROTECTOR ATTENUATION | 92596GN | Included in inpatient hospital charge |
| EVAL FOR USE/FITOF VOICE PROST | 92597GN | Included in inpatient hospital charge |
| MOD OF VOICE PROS.OR AUGME | 92607GN | Included in inpatient hospital charge |
| EVAL FOR RX NON SPEECH GENER | 92605GN | Included in inpatient hospital charge |
| THER SVRC NON SPEECH GEN AUG | 92606GN | Included in inpatient hospital charge |
| EVAL RX FOR SPCH GEN AUG DEV | 92607GN | Included in inpatient hospital charge |
| EVAL RX SPCH GEN AUG; ADD 30M | 92608GN | Included in inpatient hospital charge |
| THER SVRC USE SPEECH GEN DEV | 92609GN | Included in inpatient hospital charge |
| THER SVC;SPEECH GEN DEV;TELEHL | 92609GN95 | Included in inpatient hospital charge |
| EVAL -ORAL&PHARYN SWALLOW | 92610GN | Included in inpatient hospital charge |
| EVAL RX SPCH GEN AUG ADD 30M | 92618GN | Included in inpatient hospital charge |
| ASSESSMENT OF APHASIA | 96105GN | Included in inpatient hospital charge |
| DEVELOPMENTAL TEST-LIMITED | 96110GN | Included in inpatient hospital charge |
| DEVELOPMENTAL TEST-EXTENDED | 96111GN | Included in inpatient hospital charge |
| SPEECH ASSESSMENT | 96150GN | Included in inpatient hospital charge |
| APPL OF MODALITY 1+;E STIM 15M | 97032GN | Included in inpatient hospital charge |
| THERAPY EXERCISE STRENGTH | 97110GN | Included in inpatient hospital charge |
| THERAPEUTIC FUNCT DEVOP DISAB | 97129GN | Included in inpatient hospital charge |
| THERAP FUNC DEV DIS ADDL 15MIN | 97130GN | Included in inpatient hospital charge |
| SPEECH THERAPEUTIC PROC.-GRP | 97150GN | Included in inpatient hospital charge |
| THERAPEUTIC ACT 1:1 15MIN SLP | 97530GN | Included in inpatient hospital charge |
| SPEECH-COGNITIVE SKILL DEVELOP | 97532GN | Included in inpatient hospital charge |
| SENSORY INTEGRAT TECHNIQUE | 97533GN | Included in inpatient hospital charge |
| DEVELOP COGNITIVE SKILLS | 97532GN | Included in inpatient hospital charge |
| UNLISTED PX MED/REHAB | 97799GN | Included in inpatient hospital charge |
| HOSPITAL DISCH 30M OR LESS | 99238GN | Included in inpatient hospital charge |
| PURE TONE AUD; AIR ONLY | 92552 | Included in inpatient hospital charge |
| PURE TONE; AIR AND BONE | 92553 | Included in inpatient hospital charge |
| SPEECH AUDIOMETRY THRESHOLD | 92555 | Included in inpatient hospital charge |
| SPEECH AUD W/ SPEECH RECOG | 92556 | Included in inpatient hospital charge |
| COMP AUDI THRESH EVAL & SPCH | 92557 | Included in inpatient hospital charge |
| TYMPANOMET (IMPEDANCE TEST) | 92567 | Included in inpatient hospital charge |
| VISUAL REINFORCEMENT AUDIOM | 92579 | Included in inpatient hospital charge |
| SELECT PICTURE AUDIOMETRY | 92583 | Included in inpatient hospital charge |
| AUDITORY EVOKED POTENTIAL | 92585 | Included in inpatient hospital charge |
| DISTORTION EVOKED OTOACOUST | 92587 | Included in inpatient hospital charge |
| HEARING AID EXAM; MONAURAL | 92590 | Included in inpatient hospital charge |
| HEARING AID EXAM; BINAURAL | 92591 | Included in inpatient hospital charge |
| HEARING AID CHECK; MONAURAL | 92592 | Included in inpatient hospital charge |
| HEARING AID CHECK; BINAURAL | 92593 | Included in inpatient hospital charge |
| EVAL FITTING OF VOICE PROST | 92597 | Included in inpatient hospital charge |
| EAR MOLD/INSERT NOT DISPOSAB | V5264 | Included in inpatient hospital charge |
| HEARING SERVICE MISC | V5299 | Included in inpatient hospital charge |
| VAC ADMIN PFIZER 1ST DOSE .3ML | 0001A | Included in inpatient hospital charge |
| VAC ADMIN PFIZER 2ND DOSE .3ML | 0002A | Included in inpatient hospital charge |
| VAC ADMIN PFIZER 3RD DOSE .3ML | 0003A | Included in inpatient hospital charge |
| VAC ADMIN PFIZER BOOST-4TH.3ML | 0004A | Included in inpatient hospital charge |
| INFLUENZA VAC ADMIN FEE | G0008 | Included in inpatient hospital charge |
| PNEUMOCOCCAL VAC ADM FEE | G0009 | Included in inpatient hospital charge |
| HEPATITIS B VAC ADMIN FEE | G0010 | Included in inpatient hospital charge |
| VAC ADMIN MODERNA 3RD DOSE.5ML | 0013A | Included in inpatient hospital charge |
| VAC ADM PFIZER 1STDSE TRS-SUCR | 0051A | Included in inpatient hospital charge |
| VAC ADM PFIZER 2NDDSE TRS-SUCR | 0052A | Included in inpatient hospital charge |
| VAC ADM PFIZER 3RDDSE TRS-SUCR | 0053A | Included in inpatient hospital charge |
| VAC ADM PFIZER BOOSTR TRS-SUCR | 0054A | Included in inpatient hospital charge |
| ADMIN MODERNA BIVAL 50MCG/.5ML | 0134A | Included in inpatient hospital charge |
| PROCRIT PER 1000 UNITS | Q0136 | Included in inpatient hospital charge |
| VAC IMMUNIZATION ADMIN FEE | 90471 | Included in inpatient hospital charge |
| VAC IMMUN ADMIN EACH ADDL | 90472 | Included in inpatient hospital charge |
| INFLUENZA VAC IM PRESERV FREE | 90656 | Included in inpatient hospital charge |
| FLU VAC TRIV .5ML IM_EP/ZP | 90656 | Included in inpatient hospital charge |
| INFLUENZA VAC IM SPLIT VIRUS | 90658 | Included in inpatient hospital charge |
| INFLUENZA VAC LIVE INTRANASAL | 90660 | Included in inpatient hospital charge |
| FLUZONE HIGH-DOSE QUAD | 90662 | Included in inpatient hospital charge |
| FLU VAC (FLUZONE) HD IM_EP/ZP | 90662 | Included in inpatient hospital charge |
| PREVANER PNEUMONIA | 90670 | Included in inpatient hospital charge |
| PNEUMOCOCCAL VACCINE 20-VAL .5 | 90677 | Included in inpatient hospital charge |
| FLUVIRIN | Included in inpatient hospital charge | |
| FLU VAC QUAD SPLIT PF IM .5ML | 90686 | Included in inpatient hospital charge |
| TENIVAC TD | 90714 | Included in inpatient hospital charge |
| ADACEL TETNAUS | 90715 | Included in inpatient hospital charge |
| HEPATITIS B VAC ADULT DOSE IM | 90746 | Included in inpatient hospital charge |
| ALLERGY INJECTION; SINGLE INJ | 95115 | Included in inpatient hospital charge |
| ALERGY INJECTION 2 OR MORE | 95117 | Included in inpatient hospital charge |
| THERAPEUTIC INJ PROPHYLACTIC | 96372 | Included in inpatient hospital charge |
| EKG W/INTERP AND REPORT | 93000 | Included in inpatient hospital charge |