Union County General Hospital's Price List for Shoppable Services

Prices Posted and Effective as of 12-30-2020

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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 Description	Service Code	Cash Price	Rates
CT Scan
CT scan	CPT 70450	$927
CT scan of abdomen and pelvis with contrast	CPT 74177	$2,372
CT scan of pelvis with contrast (Not Offered)	CPT 72193	-	-
Ct abd & pelv 1/> regns	CPT 74178	$3,035
Ct abdomen w/dye	CPT 74160	$1,575
Ct angiography chest	CPT 71275	$1,973
Ct angiography head	CPT 70496	$1,042
Ct bone density axial	CPT 77078	$499
Ct chest spine w/o dye	CPT 72128	$1,330
Ct head/brain w/o & w/dye	CPT 70470	$1,697
Ct lower extremity w/o dye	CPT 73700	$826
Ct lumbar spine w/o dye	CPT 72131	$1,250
Ct maxillofacial w/dye	CPT 70487	$1,130
Ct maxillofacial w/o dye	CPT 70486	$897
Ct neck spine w/o dye	CPT 72125	$1,253
Ct pelvis w/o dye	CPT 72192	$924
Ct soft tissue neck w/dye	CPT 70491	$966
Ct soft tissue neck w/o dye	CPT 70490	$755
Ct thorax w/o dye	CPT 71250	$980
Ct upper extremity w/o dye	CPT 73200	$941
Cardiology
Tte w/doppler complete	CPT 93306	$1,272
Clinic
Initial new patient preventative medicine evaluation (18-3...	CPT 99385	$674
Initial new patient preventative medicine evaluation (40-6... (Not Offered)	CPT 99386	-	-
New patient office or other outpatient visit, 30 min	CPT 99203	$674
New patient office or other outpatient visit, 45 min	CPT 99204	$674
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
Sleep study	CPT 95810	$2,050
EKG
Electrocardiogram tracing	CPT 93005	$145
Electrocardiogram, routine, with interpretation and report	CPT 93000	$78
Emergency Room
Catheterize for urine spec	HCPCS P9612	$39
Emergency dept visit	CPT 99284	$532
Emergency dept visit	CPT 99283	$351
Emergency dept visit	CPT 99282	$208
Emergency dept visit	CPT 99285	$1,467
Emergency dept visit	CPT 99281	$132
Inj trigger point 1/2 muscl	CPT 20552	$258
Insert temp bladder cath	CPT 51702	$161
Place needle in vein	CPT 36000	$122
Rmvl devital tis addl 20cm/<	CPT 97598	$139
Ther/proph/diag inj sc/im	CPT 96372	$55
Tx/pro/dx inj new drug addon	CPT 96375	$128
Tx/pro/dx inj same drug adon	CPT 96376	$83
IV Therapy
Hydration iv infusion init	CPT 96360	$77
Ther/diag concurrent inf	CPT 96368	$186
Ther/proph/diag inj iv push	CPT 96374	$200
Ther/proph/diag iv inf addon	CPT 96366	$36
Ther/proph/diag iv inf init	CPT 96365	$121
Tx/proph/dg addl seq iv inf	CPT 96367	$194
Imaging
Abdomial ultrasound of pregnant uterus (Not Offered)	CPT 76805	-	-
Echo exam of abdomen	CPT 76705	$259
Mammography of both breasts (Not Offered)	CPT 77066	-	-
Mammography of one breast (Not Offered)	CPT 77065	-	-
Mammography, screening, bilateral (Not Offered)	CPT 77067	-	-
Ob us < 14 wks single fetus	CPT 76801	$376
Ultrasound of abdomen	CPT 76700	$394
Ultrasound pelvis through vagina (Not Offered)	CPT 76830	-	-
Us exam abdo back wall comp	CPT 76770	$343
Us exam of head and neck	CPT 76536	$292
Us exam pelvic complete	CPT 76856	$317
Us exam scrotum	CPT 76870	$314
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	-	-
Laboratory
Ag detect nos ia mult	CPT 87449	$46
Alanine amino (alt) (sgpt)	CPT 84460	$29
Alpha-fetoprotein serum	CPT 82105	$105
Analgesics non-opioid 1 or 2	CPT 80329	$83
Antinuclear antibodies	CPT 86038	$69
Antistreptolysin o titer	CPT 86060	$41
Assay dipropylacetic acd tot	CPT 80164	$85
Assay glucose blood quant	CPT 82947	$34
Assay of ammonia	CPT 82140	$86
Assay of amylase	CPT 82150	$53
Assay of blood pku	CPT 84030	$116
Assay of blood/uric acid	CPT 84550	$37
Assay of c-peptide	CPT 84681	$156
Assay of ck (cpk)	CPT 82550	$44
Assay of creatinine	CPT 82565	$38
Assay of digoxin total	CPT 80162	$67
Assay of estradiol	CPT 82670	$67
Assay of ferritin	CPT 82728	$74
Assay of folic acid serum	CPT 82746	$72
Assay of free testosterone	CPT 84402	$62
Assay of ggt	CPT 82977	$48
Assay of gonadotropin (fsh)	CPT 83001	$45
Assay of lactic acid	CPT 83605	$62
Assay of lipase	CPT 83690	$71
Assay of magnesium	CPT 83735	$44
Assay of natriuretic peptide	CPT 83880	$170
Assay of parathormone	CPT 83970	$115
Assay of phenytoin total	CPT 80185	$70
Assay of phosphorus	CPT 84100	$34
Assay of progesterone	CPT 84144	$103
Assay of prolactin	CPT 84146	$105
Assay of serum potassium	CPT 84132	$29
Assay of thyroid (t3 or t4)	CPT 84479	$15
Assay of total testosterone	CPT 84403	$62
Assay of total thyroxine	CPT 84436	$53
Assay of triglycerides	CPT 84478	$40
Assay of troponin quant	CPT 84484	$76
Assay of urea nitrogen	CPT 84520	$43
Assay of urine creatinine	CPT 82570	$45
Assay of vancomycin	CPT 80202	$83
Assay triiodothyronine (t3)	CPT 84480	$89
Basic metabolic panel	CPT 80048	$81
Bilirubin direct	CPT 82248	$49
Blood culture for bacteria	CPT 87040	$78
Blood smear interpretation	CPT 85060	$59
Blood test, clotting time	CPT 85610	$41
Blood test, comprehensive group of blood chemicals	CPT 80053	$103
Blood test, lipids	CPT 80061	$90
Blood test, thyroid stimulating hormone (TSH)	CPT 84443	$41
Blood typing serologic abo	CPT 86900	$41
Blood typing serologic rh(d)	CPT 86901	$38
Body fluid cell count	CPT 89051	$40
C-reactive protein	CPT 86140	$59
Capillary blood draw	CPT 36416	$0
Carcinoembryonic antigen	CPT 82378	$97
Ccp antibody	CPT 86200	$81
Chorionic gonadotropin assay	CPT 84703	$46
Chorionic gonadotropin test	CPT 84702	$78
Chylmd trach dna amp probe	CPT 87491	$101
Coagulation assessment blood test	CPT 85730	$41
Complement antigen	CPT 86160	$69
Complete blood cell count (CBC), automated (Not Offered)	CPT 85027	-	-
Complete blood cell count (CBC), with differential white b...	CPT 85025	$51
Creatine mb fraction	CPT 82553	$81
Culture aerobic identify	CPT 87077	$54
Culture othr specimn aerobic	CPT 87070	$57
Culture screen only	CPT 87081	$49
Dehydroepiandrosterone	CPT 82626	$142
Dna antibody native	CPT 86225	$109
Drug assay cyclosporine	CPT 80158	$85
Drug test def 1-7 classes	HCPCS G0480	$59
Exam synovial fluid crystals	CPT 89060	$53
Feces culture aerobic bact	CPT 87045	$55
Fibrin degradation products	CPT 85362	$76
Free assay (ft-3)	CPT 84481	$41
Glucose tolerance test (gtt)	CPT 82951	$82
Glycosylated hemoglobin test	CPT 83036	$72
Helicobacter pylori antibody	CPT 86677	$85
Hematocrit	CPT 85014	$27
Hemoglobin	CPT 85018	$27
Hepatitis b surface ag ia	CPT 87340	$71
Hepatitis c ab test	CPT 86803	$83
Hepatitis c probe&rvrs trnsc	CPT 87521	$212
Hepatitis c revrs trnscrpj	CPT 87522	$212
Heterophile antibody screen	CPT 86308	$62
Hiv-1antibody	CPT 86701	$81
Hpylori stool ia	CPT 87338	$92
Iadna-dna/rna probe tq 12-25	CPT 87507	$420
Immunoassay infectious agent	CPT 86317	$61
Immunoassay tumor ca 125	CPT 86304	$130
Influenza virus antibody	CPT 86710	$47
Iron binding test	CPT 83550	$59
Kidney function panel test	CPT 80069	$71
Lactoferrin fecal (qual)	CPT 83630	$57
Liver function blood test	CPT 80076	$80
Manual cell count each	CPT 85032	$130
Manual reticulocyte count	CPT 85044	$49
Microbe susceptible mic	CPT 87186	$59
Microsomal antibody each	CPT 86376	$59
Mycoplasma antibody	CPT 86738	$112
Obstetric blood test panel (Not Offered)	CPT 80055	-	-
Ova and parasites smears	CPT 87177	$75
Protein e-phoresis serum	CPT 84165	$81
Rbc antibody screen	CPT 86850	$91
Rbc sed rate automated	CPT 85652	$65
Reagent strip/blood glucose	CPT 82948	$16
Respiratory virus antibody	CPT 86756	$70
Rheumatoid factor quant	CPT 86431	$53
Rotavirus antibody	CPT 86759	$76
Rubella antibody	CPT 86762	$49
Smear gram stain	CPT 87205	$57
Stool cultr aerobic bact ea	CPT 87046	$42
Strep a ag ia	CPT 87430	$43
Syphilis test non-trep qual	CPT 86592	$52
Tissue exam by pathologist	CPT 88305	$159
Tissue exam by pathologist	CPT 88304	$83
Total cortisol	CPT 82533	$91
Total prostate-specific antigen (PSA) test	CPT 84153	$44
Total prostate-specific antigen (PSA) test (Not Offered)	CPT 84154	-	-
Transferase (ast) (sgot)	CPT 84450	$29
Trichomonas vaginalis amplif	CPT 87661	$57
Ur albumin quantitative	CPT 82043	$63
Urinalysis test	CPT 81002	$12
Urinalysis test	CPT 81003	$215
Urinalysis test using microscope	CPT 81000	$15
Urinalysis test using microscope (Not Offered)	CPT 81001	-	-
Urine culture/colony count	CPT 87086	$50
Vitamin d 25 hydroxy	CPT 82306	$112
Withdrawal of arterial blood	CPT 36600	$46
MRI
MRI Scan	CPT 70553	$3,065
MRI scan of leg joint	CPT 73721	$2,535
MRI scan of lower spinal canal	CPT 72148	$2,525
Mri abdomen w/o & w/dye	CPT 74183	$3,007
Mri chest spine w/o dye	CPT 72146	$2,535
Mri neck spine w/o dye	CPT 72141	$2,535
Medical and Surgical Supplies
Bedside drainage bag	HCPCS A4357	$6
Cath insertion tray w/bag	HCPCS A4354	$13
Disposable canister for pump	HCPCS A7000	$37
Dme supply or accessory, nos	HCPCS A9999	$10
Drug screen quantalcohols	CPT 80320	$31
Foam drg <=16 sq in w/border	HCPCS A6212	$39
Foam drsg <=16 sq in w/o bdr	HCPCS A6209	$22
Nasal/orogastric w/tube plmt	CPT 43752	$6
Neg pres wound ther drsg set	HCPCS A6550	$40
Non-covered item or service	HCPCS A9270	$6
Non-waterproof tape	HCPCS A4450	$16
Sterile water/saline, 500 ml	HCPCS A4217	$10
Zinc paste band w >=3"<5"/yd	HCPCS A6456	$27
Nuclear Medicine
Bone imaging whole body	CPT 78306	$1,106
Hepatobil syst image w/drug	CPT 78227	$812
Ht muscle image spect mult	CPT 78452	$3,041
Iodine i-123 sod iodide mic	HCPCS A9516	$152
Tc99m mebrofenin	HCPCS A9537	$155
Tc99m medronate	HCPCS A9503	$106
Tc99m sestamibi	HCPCS A9500	$97
Other Diagnostic
Extracranial bilat study	CPT 93880	$800
Extremity study	CPT 93971	$407
Extremity study	CPT 93970	$363
Fetal non-stress test	CPT 59025	$386
Polysom 6/>yrs cpap 4/> parm	CPT 95811	$2,036
Other Procedures and Observation
Removal of nail bed	CPT 11750	$204
Other Therapeutic
Blood transfusion service	CPT 36430	$431
Phlebotomy	CPT 99195	$267
Plasma 1 donor frz w/in 8 hr	HCPCS P9017	$124
Pharmacy
5% dextrose/normal saline	HCPCS J7042	$13
Adrenalin epinephrine inject	HCPCS J0171	$42
Albuterol ipratrop non-comp	HCPCS J7620	$8
Amiodarone hcl	HCPCS J0282	$11
Azithromycin	HCPCS J0456	$28
Bumetanide 0.5 mg	HCPCS S0171	$25
Cefazolin sodium injection	HCPCS J0690	$15
Cefepime hcl for injection	HCPCS J0692	$28
Ceftriaxone sodium injection	HCPCS J0696	$11
Ciprofloxacin iv	HCPCS J0744	$21
D5w infusion	HCPCS J7070	$14
Dexamethasone sodium phos	HCPCS J1100	$14
Diazepam injection	HCPCS J3360	$92
Dicyclomine injection	HCPCS J0500	$172
Diphenhydramine hcl injectio	HCPCS J1200	$13
Drugs unclassified injection	HCPCS J3490	$20
Ertapenem injection	HCPCS J1335	$398
Fentanyl citrate injection	HCPCS J3010	$11
Fluphenazine decanoate 25 mg	HCPCS J2680	$95
Furosemide injection	HCPCS J1940	$16
Haloperidol decanoate inj	HCPCS J1631	$28
Hydromorphone injection	HCPCS J1170	$14
Hydroxyzine hcl injection	HCPCS J3410	$71
Iiv4 vaccine splt 0.5 ml im	CPT 90688	$14
Inj enoxaparin sodium	HCPCS J1650	$147
Inj heparin sodium per 10 u	HCPCS J1642	$8
Inj iron dextran	HCPCS J1750	$95
Inj midazolam hydrochloride	HCPCS J2250	$13
Inj naloxone hydrochloride	HCPCS J2310	$53
Inj, afstyla, 1 i.u.	HCPCS J7210	$20
Inj, propofol, 10 mg	HCPCS J2704	$15
Injection, clindamycin phosp	HCPCS S0077	$17
Injection, metronidazole	HCPCS S0030	$12
Ketorolac tromethamine inj	HCPCS J1885	$11
Levalbuterol non-comp unit	HCPCS J7614	$26
Levofloxacin injection	HCPCS J1956	$50
Lidocaine injection	HCPCS J2001	$16
Lorazepam injection	HCPCS J2060	$13
Meropenem	HCPCS J2185	$173
Methylprednisolone injection	HCPCS J2930	$38
Metoclopramide hcl injection	HCPCS J2765	$12
Morphine sulfate injection	HCPCS J2270	$12
Normal saline solution infus	HCPCS J7030	$35
Normal saline solution infus	HCPCS J7050	$13
Ondansetron hcl injection	HCPCS J2405	$14
Oral prescrip drug non chemo	HCPCS J8499	$3
Oxytocin injection	HCPCS J2590	$11
PROTONIX (PANTOPRAZOLE	HCPCS C9113	$25
Penicillin g benzathine inj	HCPCS J0561	$306
Phenytoin sodium injection	HCPCS J1165	$11
Piperacillin/tazobactam	HCPCS J2543	$44
Ppsv23 vacc 2 yrs+ subq/im	CPT 90732	$179
Prednisone ir or dr oral 1mg	HCPCS J7512	$9
Prochlorperazine injection	HCPCS J0780	$69
Promethazine hcl 12.5mg oral	HCPCS Q0169	$4
Promethazine hcl injection	HCPCS J2550	$14
Ranitidine hydrochloride inj	HCPCS J2780	$49
Regadenoson injection	HCPCS J2785	$380
Sincalide injection	HCPCS J2805	$451
Thiamine hcl 100 mg	HCPCS J3411	$38
Triamcinolone acet inj nos	HCPCS J3301	$33
Vancomycin hcl injection	HCPCS J3370	$41
Psychiatric
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
Evaluation of wheezing	CPT 94060	$329
Measure blood oxygen level	CPT 94760	$65
Respiratory flow volume loop	CPT 94375	$309
Radiology
X-Ray of lower back (Not Offered)	CPT 72110	-	-
X-ray exam abdomen 1 view	CPT 74018	$120
X-ray exam abdomen 2 views	CPT 74019	$159
X-ray exam chest 1 view	CPT 71045	$132
X-ray exam chest 2 views	CPT 71046	$152
X-ray exam complete abdomen	CPT 74022	$247
X-ray exam l-s spine 2/3 vws	CPT 72100	$169
X-ray exam neck spine 2-3 vw	CPT 72040	$161
X-ray exam of pelvis	CPT 72170	$136
X-ray exam thorac spine 2vws	CPT 72070	$166
X-ray exam thorac spine 3vws	CPT 72072	$206
Respiratory
Airway inhalation treatment	CPT 94640	$209
Chest wall manipulation	CPT 94667	$83
Insert emergency airway	CPT 31500	$447
Surgical Procedures
Biopsy exam of esophagus, stomach or small bowel using an ...	CPT 43239	$305
Biopsy exam of large bowel using an endoscope (Not Offered)	CPT 45380	-	-
Biopsy of prostate gland (Not Offered)	CPT 55700	-	-
Diagnostic exam of esophagus, stomach or small bowel using...	CPT 43235	$550
Diagnostic exam of large bowel using an endoscope	CPT 45378	$659
Injection(s) of anesthetic into lower spine using imaging ... (Not Offered)	CPT 64483	-	-
Injection(s) of therapeutic substance	CPT 62322	$263
Injection(s) of therapeutic substance (Not Offered)	CPT 62323	-	-
Insert non-tunnel cv cath	CPT 36556	$927
Insertion of catheter into left heart for diagnosis (Not Offered)	CPT 93542	-	-
Lap inc hernia repair	CPT 49654	$1,862
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 endoscope	CPT 47562	$1,449
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 laser (Not Offered)	CPT 66821	-	-
Removal of tonsils and adenoid glands, patient younger tha... (Not Offered)	CPT 42820	-	-
Repair of groin hernia patient age 5 years or older (Not Offered)	CPT 49505	-	-
Rmvl devital tis 20 cm/<	CPT 97597	$133
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	-	-
Therapy
Physical therapy, therapeutic exercise	CPT 97110	$76
Uncategorized
Immunization admin	CPT 90471	$40
Slings	HCPCS A4565	$11