Prices Posted and Effective on 12-22-2020

Arkansas Valley Regional Medical Center - Price List for Shoppable Services

Prices Posted and Effective as of 12-22-2020

Disclaimer: The Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary. Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise.

Service DescriptionService CodeCash PriceRates
Service DescriptionService CodeCash PriceRates
CT Scan
CT scanCPT 70450$1,028
CT scan of abdomen and pelvis with contrastCPT 74177$2,586
CT scan of pelvis with contrast (Not Offered)CPT 72193--
Ct abd & pelv 1/> regnsCPT 74178$3,858
Ct abd & pelvis w/o contrastCPT 74176$2,742
Ct angiography chestCPT 71275$2,477
Ct angiography headCPT 70496$1,531
Ct bone density axialCPT 77078$350
Ct lower extremity w/o dyeCPT 73700$1,121
Ct lumbar spine w/o dyeCPT 72131$1,162
Ct maxillofacial w/o dyeCPT 70486$1,007
Ct neck spine w/o dyeCPT 72125$1,299
Ct soft tissue neck w/dyeCPT 70491$1,498
Ct thorax dx c+CPT 71260$1,617
Ct thorax dx c-CPT 71250$1,125
Cardiovascular stress testCPT 93017$869
Tte w/doppler completeCPT 93306$2,156
Initial new patient preventative medicine evaluation (18-3... (Not Offered)CPT 99385--
Initial new patient preventative medicine evaluation (40-6... (Not Offered)CPT 99386--
New patient office or other outpatient visit, 30 min (Not Offered)CPT 99203--
New patient office or other outpatient visit, 45 min (Not Offered)CPT 99204--
New patient office or other outpatient visit, 60 min (Not Offered)CPT 99205--
Patient office consultation, 40 min (Not Offered)CPT 99243--
Patient office consultation, 60 min (Not Offered)CPT 99244--
Eeg awake and asleepCPT 95819$1,710
Sleep studyCPT 95810$2,224
Ecg monit/reprt up to 48 hrsCPT 93226$206
Ecg monit/reprt up to 48 hrsCPT 93225$1,128
Electrocardiogram reportCPT 93010$161
Electrocardiogram tracingCPT 93005$161
Electrocardiogram, routine, with interpretation and report (Not Offered)CPT 93000--
Emergency Room
Emergency dept visitCPT 99284$3,011
Emergency dept visitCPT 99282$514
Emergency dept visitCPT 99283$922
Emergency dept visitCPT 99285$1,006
Emergency dept visitCPT 99281$303
Heart/lung resuscitation cprCPT 92950$1,050
Place needle in veinCPT 36000$142
Tx/pro/dx inj same drug adonCPT 96376$17
IV Therapy
Hydrate iv infusion add-onCPT 96361$157
Hydration iv infusion initCPT 96360$206
Ther/proph/diag iv inf addonCPT 96366$142
Ther/proph/diag iv inf initCPT 96365$355
Tx/proph/dg addl seq iv infCPT 96367$174
Abdomial ultrasound of pregnant uterus (Not Offered)CPT 76805--
Echo exam of abdomenCPT 76705$472
Mammography of both breastsCPT 77066$352
Mammography of one breastCPT 77065$338
Mammography, screening, bilateralCPT 77067$252
Ob us < 14 wks single fetusCPT 76801$663
Ob us limited fetus(s)CPT 76815$352
Transvaginal us obstetricCPT 76817$402
Ultrasound breast limitedCPT 76642$196
Ultrasound of abdomenCPT 76700$604
Ultrasound pelvis through vaginaCPT 76830$455
Us compl joint r-t w/imgCPT 76881$443
Us exam abdo back wall compCPT 76770$516
Us exam abdo back wall limCPT 76775$429
Us exam of head and neckCPT 76536$442
Us exam pelvic completeCPT 76856$689
Us exam scrotumCPT 76870$414
Inpatient Procedures
Cardiac valve or cardiothoracic procedure with cardiac cat... (Not Offered)DRG 216--
Cervical spinal fusion without CC or MCC (Not Offered)DRG 473--
Major joint replacement or reattachment of lower extremity... (Not Offered)DRG 470--
Spinal fusion except cervical without MCC (Not Offered)DRG 460--
Uterine and adnexa procedures for non-malignancy without C... (Not Offered)DRG 743--
Labor and Delivery
Fetal non-stress testCPT 59025$329
Alanine amino (alt) (sgpt)CPT 84460$74
Alpha-fetoprotein serumCPT 82105$122
Amino acids single quantCPT 82131$282
Analgesics non-opioid 1 or 2CPT 80329$134
Antinuclear antibodiesCPT 86038$124
Assay carbamazepine totalCPT 80156$136
Assay glucose blood quantCPT 82947$80
Assay iga/igd/igg/igm eachCPT 82784$77
Assay of ammoniaCPT 82140$142
Assay of amylaseCPT 82150$66
Assay of blood lipoproteinCPT 83721$84
Assay of blood pkuCPT 84030$185
Assay of blood/uric acidCPT 84550$75
Assay of calciumCPT 82310$62
Assay of ck (cpk)CPT 82550$53
Assay of creatinineCPT 82565$62
Assay of digoxin totalCPT 80162$135
Assay of estrogensCPT 82671$112
Assay of ferritinCPT 82728$111
Assay of folic acid serumCPT 82746$114
Assay of free testosteroneCPT 84402$190
Assay of free thyroxineCPT 84439$90
Assay of gonadotropin (fsh)CPT 83001$105
Assay of ironCPT 83540$44
Assay of lactic acidCPT 83605$152
Assay of ldh enzymesCPT 83625$82
Assay of lipaseCPT 83690$77
Assay of lithiumCPT 80178$77
Assay of magnesiumCPT 83735$62
Assay of natriuretic peptideCPT 83880$106
Assay of parathormoneCPT 83970$455
Assay of phenytoin totalCPT 80185$158
Assay of phosphorusCPT 84100$70
Assay of prealbuminCPT 84134$76
Assay of protein urineCPT 84156$111
Assay of serum albuminCPT 82040$62
Assay of serum potassiumCPT 84132$66
Assay of tacrolimusCPT 80197$250
Assay of total testosteroneCPT 84403$198
Assay of total thyroxineCPT 84436$106
Assay of troponin quantCPT 84484$25
Assay of urea nitrogenCPT 84520$66
Assay of urine creatinineCPT 82570$120
Assay of vancomycinCPT 80202$162
Assay triiodothyronine (t3)CPT 84480$120
Basic metabolic panelCPT 80048$95
Bilirubin directCPT 82248$35
Bilirubin totalCPT 82247$62
Bl smear w/diff wbc countCPT 85007$14
Blood culture for bacteriaCPT 87040$153
Blood gases any combinationCPT 82803$190
Blood gases w/o2 saturationCPT 82805$207
Blood test, clotting timeCPT 85610$48
Blood test, comprehensive group of blood chemicalsCPT 80053$124
Blood test, lipidsCPT 80061$147
Blood test, thyroid stimulating hormone (TSH)CPT 84443$146
Blood typing serologic aboCPT 86900$59
Blood typing serologic rh(d)CPT 86901$59
C-reactive proteinCPT 86140$61
Carcinoembryonic antigenCPT 82378$14
Chorionic gonadotropin assayCPT 84703$59
Chorionic gonadotropin testCPT 84702$172
Chylmd trach dna dir probeCPT 87490$66
Clostridium ag iaCPT 87324$113
Coagulation assessment blood testCPT 85730$75
Compatibility test antiglobCPT 86922$231
Compatibility test incubateCPT 86921$231
Compatibility test spinCPT 86920$231
Complete blood cell count (CBC), automatedCPT 85027$112
Complete blood cell count (CBC), with differential white b...CPT 85025$71
Coombs test directCPT 86880$80
Cultr bacteria except bloodCPT 87075$218
Culture aerobic identifyCPT 87077$53
Culture othr specimn aerobicCPT 87070$82
Culture screen onlyCPT 87081$102
Detect agent nos dna ampCPT 87798$107
Dipropylacetic acid freeCPT 80165$99
Dna/rna amplified probeCPT 87150$1,888
Drug assay cyclosporineCPT 80158$154
Drug screen amphetamines 1/2CPT 80324$48
Drug screen quantalcoholsCPT 80320$107
Drug test prsmv chem anlyzrCPT 80307$351
Eval amniotic fluid proteinCPT 84112$109
Fibrin degradation quantCPT 85379$119
Free assay (ft-3)CPT 84481$170
Glycosylated hemoglobin testCPT 83036$77
Helicobacter pylori antibodyCPT 86677$34
HematocritCPT 85014$34
HemoglobinCPT 85018$34
Hep b core antibody totalCPT 86704$78
Hep b surface antibodyCPT 86706$161
Hepatitis a antibodyCPT 86708$90
Hepatitis a igm antibodyCPT 86709$306
Hepatitis b surface ag iaCPT 87340$138
Hepatitis c ab testCPT 86803$315
Hepatitis c revrs trnscrpjCPT 87522$637
Heterophile antibody screenCPT 86308$117
Hiv-1antibodyCPT 86701$98
Hpylori stool ag iaCPT 87338$62
Iadna-dna/rna probe tq 12-25CPT 87507$747
Immunoassay tumor ca 125CPT 86304$35
Immunoassay tumor ca 15-3CPT 86300$16
Influenza assay w/opticCPT 87804$126
Iron binding testCPT 83550$50
Kidney function panel testCPT 80069$204
Lactate (ld) (ldh) enzymeCPT 83615$74
Liver function blood testCPT 80076$150
Manual reticulocyte countCPT 85044$76
Microbe susceptible micCPT 87186$159
Microscopic exam of urineCPT 81015$38
Mumps antibodyCPT 86735$14
N.gonorrhoeae dna dir probCPT 87590$66
Obstetric blood test panel (Not Offered)CPT 80055--
Procalcitonin (pct)CPT 84145$117
Protein e-phoresis serumCPT 84165$90
Prothrombin testCPT 85611$46
Rbc antibody screenCPT 86850$96
Rbc sed rate nonautomatedCPT 85651$46
Resp syncytial virus ag iaCPT 87420$102
Resp virus 12-25 targetsCPT 87633$1,050
Rheumatoid factor quantCPT 86431$71
Rubella antibodyCPT 86762$11
Rubeola antibodyCPT 86765$13
Serum immunoelectrophoresisCPT 86320$265
Smear gram stainCPT 87205$57
Smear wet mount saline/inkCPT 87210$66
Special stains group 1CPT 88312$98
Special stains group 2CPT 88313$75
Strep a assay w/opticCPT 87880$63
Strep a dna amp probeCPT 87651$111
Strep b assay w/opticCPT 87802$283
Test for acetone/ketonesCPT 82009$71
Tissue exam by pathologistCPT 88305$146
Tissue exam by pathologistCPT 88304$109
Tissue exam by pathologistCPT 88302$85
Total prostate-specific antigen (PSA) testCPT 84153$126
Total prostate-specific antigen (PSA) testCPT 84154$104
Ur albumin quantitativeCPT 82043$70
Urinalysis testCPT 81003$27
Urinalysis test (Not Offered)CPT 81002--
Urinalysis test using microscope (Not Offered)CPT 81000--
Urinalysis test using microscope (Not Offered)CPT 81001--
Urinalysis volume measureCPT 81050$30
Urine culture/colony countCPT 87086$78
Varicella-zoster antibodyCPT 86787$18
Vit d 1 25-dihydroxyCPT 82652$200
Vitamin b-12CPT 82607$102
Vitamin d 25 hydroxyCPT 82306$172
Language Pathology
Evaluate swallowing functionCPT 92610$428
Motion fluoroscopy/swallowCPT 92611$238
Oral function therapyCPT 92526$159
Speech sound lang comprehenCPT 92523$261
Speech/hearing therapyCPT 92507$140
MRI ScanCPT 70553$3,118
MRI scan of leg jointCPT 73721$182
MRI scan of lower spinal canalCPT 72148$1,950
Mri brain stem w/o dyeCPT 70551$2,322
Mri joint upr extrem w/o dyeCPT 73221$2,024
Mri lower extremity w/o dyeCPT 73718$1,702
Mri neck spine w/o dyeCPT 72141$2,322
Nuclear Medicine
Hepatobil syst image w/drugCPT 78227$1,343
Ht muscle image spect multCPT 78452$3,436
Other Diagnostic
Extracranial bilat studyCPT 93880$838
Extremity studyCPT 93970$754
Ophthalmic biometryCPT 92136$205
Polysom 6/>yrs cpap 4/> parmCPT 95811$3,837
Sleep study unatt&resp efftCPT 95806$1,104
Upr/lxtr art stdy 3+ lvlsCPT 93923$404
Visual field examination(s)CPT 92083$175
Withdrawal of arterial bloodCPT 36600$74
Other Procedures and Observation
Pure tone hearing test airCPT 92551$90
Other Therapeutic
Blood transfusion serviceCPT 36430$759
Clearance of airwaysCPT 31720$334
Immunization adminCPT 90471$99
Insj picc 5 yr+ w/o imagingCPT 36569$2,714
Medical nutrition indiv inCPT 97802$39
PhlebotomyCPT 99195$152
Ther/proph/diag inj iv pushCPT 96374$175
Ther/proph/diag inj sc/imCPT 96372$129
Tx/pro/dx inj new drug addonCPT 96375$158
Family psychotherapy, including patient, 50 min (Not Offered)CPT 90847--
Family psychotherapy, not including patient, 50 min (Not Offered)CPT 90846--
Group psychotherapy (Not Offered)CPT 90853--
Psychotherapy, 30 min (Not Offered)CPT 90832--
Psychotherapy, 45 min (Not Offered)CPT 90834--
Psychotherapy, 60 min (Not Offered)CPT 90837--
Pulmonary Function
Breathing capacity testCPT 94010$182
Co/membane diffuse capacityCPT 94729$195
Evaluation of wheezingCPT 94060$482
Lung function test (mbc/mvv)CPT 94200$162
Measure blood oxygen levelCPT 94760$61
Measure blood oxygen levelCPT 94761$150
Measure blood oxygen levelCPT 94762$186
Pulm funct tst plethysmograpCPT 94726$162
Pulmonary service/procedureCPT 94799$162
Respiratory flow volume loopCPT 94375$170
Fluoroscopy <1 hr phys/qhpCPT 76000$285
Us guide vascular accessCPT 76937$701
X-Ray of lower back (Not Offered)CPT 72110--
X-ray exam abdomen 1 viewCPT 74018$158
X-ray exam abdomen 2 viewsCPT 74019$188
X-ray exam chest 1 viewCPT 71045$168
X-ray exam chest 2 viewsCPT 71046$223
X-ray exam complete abdomenCPT 74022$405
X-ray exam hip uni 2-3 viewsCPT 73502$359
X-ray exam hips bi 3-4 viewsCPT 73522$294
X-ray exam knee 4 or moreCPT 73564$262
X-ray exam l-s spine 2/3 vwsCPT 72100$239
X-ray exam l-s spine bendingCPT 72114$519
X-ray exam neck spine 2-3 vwCPT 72040$189
X-ray exam neck spine 4/5vwsCPT 72050$362
X-ray exam neck spine 6/>vwsCPT 72052$430
X-ray exam of collar boneCPT 73000$265
X-ray exam of elbowCPT 73080$244
X-ray exam of elbowCPT 73070$197
X-ray exam of femur 2/>CPT 73552$223
X-ray exam of finger(s)CPT 73140$182
X-ray exam of forearmCPT 73090$194
X-ray exam of heelCPT 73650$158
X-ray exam of humerusCPT 73060$182
X-ray exam of knee 1 or 2CPT 73560$170
X-ray exam of kneesCPT 73565$150
X-ray exam of lower legCPT 73590$236
X-ray exam of pelvisCPT 72170$174
X-ray exam of skullCPT 70250$244
X-ray exam of toe(s)CPT 73660$143
X-ray exam of wristCPT 73110$218
X-ray exam of wristCPT 73100$198
X-ray exam sacrum tailboneCPT 72220$252
X-ray exam thorac spine 3vwsCPT 72072$355
X-ray exam unilat ribs/chestCPT 71101$242
X-ray xm swlng funcj c+CPT 74230$350
Airway inhalation treatmentCPT 94640$94
Cbt 1st hourCPT 94644$213
Chest wall manipulationCPT 94668$78
Chest wall manipulationCPT 94667$119
Vent mgmt inpat init dayCPT 94002$1,328
Vent mgmt inpat subq dayCPT 94003$662
Surgical Procedures
Biopsy exam of esophagus, stomach or small bowel using an ...CPT 43239$1,514
Biopsy exam of large bowel using an endoscopeCPT 45380$1,678
Biopsy of prostate gland (Not Offered)CPT 55700--
Diagnostic exam of esophagus, stomach or small bowel using...CPT 43235$1,514
Diagnostic exam of large bowel using an endoscopeCPT 45378$1,678
Injection(s) of anesthetic into lower spine using imaging ... (Not Offered)CPT 64483--
Injection(s) of therapeutic substance (Not Offered)CPT 62322--
Injection(s) of therapeutic substance (Not Offered)CPT 62323--
Insertion of catheter into left heart for diagnosis (Not Offered)CPT 93452--
Obstetric care, planned cesarean delivery (Not Offered)CPT 59510--
Obstetric care, planned vaginal delivery (Not Offered)CPT 59400--
Obstetric care, planned vaginal delivery (post delivery by... (Not Offered)CPT 59610--
Removal of cataract with insertion of lens (Not Offered)CPT 66984--
Removal of gallbladder using an endoscopeCPT 47562$8,578
Removal of one knee cartilage using an endoscope (Not Offered)CPT 29881--
Removal of one or more breast growth, open procedure (Not Offered)CPT 19120--
Removal of polyps or growths of large bowel using an endos... (Not Offered)CPT 45385--
Removal of recurring cataract in lens capsule using laserCPT 66821$2,189
Removal of tonsils and adenoid glands, patient younger tha... (Not Offered)CPT 42820--
Repair of groin hernia patient age 5 years or olderCPT 49505$5,893
Shaving of shoulder bone using endoscope (Not Offered)CPT 29826--
Surgical removal of prostate and surrounding lymph nodes u... (Not Offered)CPT 55866--
Ultrasound examination of lower large bowel using an endos... (Not Offered)CPT 45391--
Electric current therapyCPT 97033$71
Electric stimulation therapyCPT 97014$61
Gait training therapyCPT 97116$65
Manual therapy 1/> regionsCPT 97140$92
Mechanical traction therapyCPT 97012$79
Ot eval low complex 30 minCPT 97165$137
Ot eval mod complex 45 minCPT 97166$206
Physical therapy, therapeutic exerciseCPT 97110$89
Pt eval high complex 45 minCPT 97163$308
Pt eval low complex 20 minCPT 97161$137
Pt eval mod complex 30 minCPT 97162$206
Pt re-eval est plan careCPT 97164$93
Self care mngment trainingCPT 97535$78
Therapeutic activitiesCPT 97530$102
Ultrasound therapyCPT 97035$50
Whirlpool therapyCPT 97022$45
Application long leg splintCPT 29505$210
Application lower leg splintCPT 29515$210
Apply forearm splintCPT 29125$210
Apply long arm splintCPT 29105$210
Critical care addl 30 minCPT 99292$393
Critical care first hourCPT 99291$1,227
Drainage of skin abscessCPT 10060$265
Ecg monit/reprt up to 48 hrsCPT 93227$77
Extremity studyCPT 93971$62
Remove foreign bodyCPT 10120$511
Rpr f/e/e/n/l/m 2.5 cm/<CPT 12011$393
Rpr f/e/e/n/l/m 2.6-5.0 cmCPT 12013$446
Rpr s/n/ax/gen/trnk 2.5cm/<CPT 12001$378
Rpr s/n/ax/gen/trnk2.6-7.5cmCPT 12002$416
Treat shoulder dislocationCPT 23655$2,850
X-ray exam of ankleCPT 73610$25
X-ray exam of footCPT 73630$23
X-ray exam of handCPT 73130$24
X-ray exam of knee 3CPT 73562$26
X-ray exam of shoulderCPT 73030$26