Pricing, Cost Estimates & Pricing Transparency
We want to help you be informed about out-of-pocket costs for care or services you will receive at Johnson Memorial Health Services (JMHS). To help you learn what your costs may be, we now offer estimates for the cost of care.
Price Estimate Request Form
You also may use the Price Estimate Request Form to learn how much a medical service or procedure will cost. Staff from JMHS’ Business Office will review your information and respond to you within two business days.
For questions, please call 888-769-2164
Good Faith Estimate Disclosure
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. For questions or more information about your right to a Good Faith Estimate, visit CMS.gov or call 1-888-769-2164.
Learn more about Good Faith Estimates
Hospital Standard Charges
In compliance with federal regulations, Johnson Memorial Health Services provides a machine-readable file containing a comprehensive list of standard charges for all hospital items and services.
These charges include:
- Gross charges
- Discounted cash prices
- Payer-specific negotiated charges
- De-identified minimum and maximum negotiated charges
Download Machine-Readable Standard Charges File (JSON)
Download Compressed Standard Charges File (.gz)
Common Healthcare Services & Estimated Prices
A consumer-friendly list of common shoppable services and estimated prices is available below.
Download Shoppable Services List
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Common Healthcare Services & Estimated Prices
Amounts are estimates. Actual patient responsibility depends on insurance benefits, deductibles, coinsurance, clinical circumstances, and services actually provided.
| Service Category | Service Name | Code | Setting | Cash Price | Insurance Range |
|---|---|---|---|---|---|
| Clinic / Office Visit | Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20 Min Met Or E… | 99213 | Professional | 155.9523 | $43.57 – $168.84 |
| Clinic / Office Visit | Sup Cl Urinary Drainage Bag, Leg Or Abdomen, Vinyl, W/W/O Tube, W/Straps, Each | A4358 | Professional | 11.879 | $5.67 – $27.75 |
| Clinic / Office Visit | Sup Cl Pessary, Reusable, Non Rubber, Any Type | A4562 | Professional | 74.263 | $7.54 – $112.63 |
| Clinic / Office Visit | Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10 Min Me… | 99212 | Professional | 118.8208 | $7.27 – $143.10 |
| Clinic / Office Visit | Canalith Repositioning Procedure(S) Per Day (Pbb) | 95992 | Professional | 109.592 | $31.13 – $134.00 |
| Clinic / Office Visit | Laryngoscopy, Flexible; Diagnostic (Pbb) | 31575 | Professional | 161.2156 | $97.51 – $605.66 |
| Clinic / Office Visit | Sup Catheter Tray Complete | A4314 | Professional | 23.023 | $13.16 – $40.25 |
| Clinic / Office Visit | Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30 Min Met… | 99214 | Professional | 193.0838 | $97.70 – $392.74 |
| Clinic / Office Visit | Cystourethroscopy (Pbb) | 52000 | Professional | 1062.5233 | $165.95 – $872.31 |
| Clinic / Office Visit | ECG-Interpretation Only (Pro Cah) | 93010 | Professional | 55.517 | $6.17 – $17.23 |
| Clinic / Office Visit | New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15 Min Me… | 99202 | Professional | 129.9603 | $58.51 – $294.27 |
| Clinic / Office Visit | Appl Splint Short Arm (Pbb) | 29125 | Professional | 138.131 | $43.75 – $132.07 |
| Clinic / Office Visit | New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30 Min Met Or E… | 99203 | Professional | 167.0917 | $90.52 – $343.75 |
| Clinic / Office Visit | Destruction Premalignant Lesions; 1St Lesion (Pbb) | 17000 | Professional | 171.5475 | $50.94 – $161.95 |
| Clinic / Office Visit | Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pbb) | 69420 | Professional | 176.4 | $133.98 – $389.03 |
| Clinic / Office Visit | Incision & Drainage Abscess; Simple (Pbb) | 10060 | Professional | 181.692 | $98.54 – $239.02 |
| Clinic / Office Visit | New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45 Min Met… | 99204 | Professional | 204.2232 | $136.71 – $544.54 |
| Clinic / Office Visit | Destruction 0F Benign Lesions (Other Than Skin Tags); Up To 14 Lesions (Pbb) | 17110 | Professional | 207.7057 | $104.10 – $404.13 |
| Clinic / Office Visit | Destruction Of Benign Lesions (Other Than Skin Tages); 15 Or More Lesions (Pbb) | 17111 | Professional | 232.4432 | $91.07 – $267.73 |
| Clinic / Office Visit | Nursing Facility Care, Initial, Moderate Mdm 35 Min (Pro Cah) | 99305 | Professional | 334.544 | $108.37 – $438.25 |
| Clinic / Office Visit | Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah) | 99223 | Professional | 410.97 | $118.08 – $399.38 |
| Clinic / Office Visit | Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah) | 10061 | Professional | 416.6154 | $166.21 – $420.62 |
| Clinic / Office Visit | Lysis Intranasal Synechia (Pro Cah) | 30560 | Professional | 612.129 | $237.33 – $628.97 |
| Clinic / Office Visit | Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graf… | 30520 | Professional | 1039.1701 | $461.85 – $1,266.87 |
| Clinic / Office Visit | Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30… | 43249 | Professional | 1999.9026 | $169.19 – $2,068.62 |
| Clinic / Office Visit | Destruction Premalignant Lesions; 2Nd-14Th Lesions (List Primary Code) (Pbb) | 17003 | Professional | 8.2482 | $4.27 – $12.37 |
| Clinic / Office Visit | Sup Extension Drainage Tubing Urinary | A4331 | Professional | 23.023 | $4.44 – $13.16 |
| Clinic / Office Visit | Fluoroscopy (Sep Procedure), Up To 1 Hr Physician Or Other Qualified Health Care Prof T… | 76000 | Professional | 25.3071 | $15.25 – $88.38 |
| Clinic / Office Visit | Remote Monitoring Of Physiologic Parameter(S), Initial; Set-Up And Patient Education On… | 99453 | Professional | 53.802 | $17.05 – $36.34 |
| Clinic / Office Visit | Fluoroscopic Guidance For Needle Placement (Pro Cah) | 77002 | Professional | 83.636 | $48.81 – $387.86 |
| Clinic / Office Visit | Application Of Finger Splint; Static (Pbb) | 29130 | Professional | 85.4 | $34.47 – $83.98 |
| Clinic / Office Visit | Office Or Outpt Consult, New Or Est Pt, Straightforward Mdm Or 20-29 Mins (Pbb) | 99242 | Professional | 94.311 | $58.51 – $180.88 |
| Clinic / Office Visit | Application Of Long Leg Splint (Pbb) | 29505 | Professional | 100.94 | $83.87 – $175.01 |
| Clinic / Office Visit | Interrogation Dev Eval W/Dr Analys, Review, Rpt;Per Encounter Sing/Dual/Mult/Leadless P… | 93288 | Professional | 103.103 | $37.22 – $98.90 |
| Clinic / Office Visit | Remove Ventilating Tube (Pro Cah) | 69424 | Professional | 106.3114 | $100.86 – $259.12 |
| Clinic / Office Visit | Debridement Of Extensive Eczematous Or Infected Skin; Up To 10% Of Body Surface (Pro Cah) | 11000 | Professional | 113.9757 | $45.28 – $110.54 |
| Clinic / Office Visit | Inpt Or Obs Consult, New Or Est Pt, Straightforward Mdm Or 35-44 Mins (Pro Cah) | 99252 | Professional | 118.8208 | $53.79 – $151.45 |
| Clinic / Office Visit | Paring Or Cut Of Benign Hyper (Pbb) | 11056 | Professional | 123.725 | $39.66 – $150.89 |
| Clinic / Office Visit | Closed Treatment Of Nasal Bone Fracture; With Manipulation; Without Stabilization (Pro… | 21315 | Professional | 127.4728 | $122.98 – $564.17 |
| Clinic / Office Visit | Inpt Or Obs Consult, New Or Est Pt, Low Mdm Or 45-59 Mins (Pro Cah) | 99253 | Professional | 133.6734 | $75.83 – $232.56 |
| Clinic / Office Visit | Office Or Outpt Consult, New Or Est Pt, Low Mdm Or 30-39 Mins (Pbb) | 99243 | Professional | 135.898 | $87.37 – $247.63 |
| Clinic / Office Visit | Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah) | 76705 | Professional | 142.758 | $51.25 – $178.13 |
| Clinic / Office Visit | Ultrasonic Guidance, Intraoperative (Pro Cah) | 76998 | Professional | 144.921 | $34.73 – $129.92 |
| Clinic / Office Visit | Inpt Or Obs Consult, New Or Est Pt, Moderate Mdm Or 60-79 Mins (Pro Cah) | 99254 | Professional | 148.526 | $105.74 – $338.07 |
| Clinic / Office Visit | Inpt Or Obs Consult, New Or Est Pt, High Mdm Or 80+ Mins (Pro Cah) | 99255 | Professional | 155.9523 | $141.69 – $407.70 |
| Clinic / Office Visit | Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year O… | 36569 | Professional | 156.1181 | $60.46 – $509.62 |
| Clinic / Office Visit | Shaving Of Epid Or Dermal Lesion (Pbb) | 11301 | Professional | 163.3786 | $89.79 – $245.48 |
| Clinic / Office Visit | Control Nasal Hemorrhage Simple (Pbb) | 30901 | Professional | 164.9648 | $99.45 – $288.79 |
| Clinic / Office Visit | Icd Device Interrogate Eval F2F 1/Dual/Mlt Leads Cvdfb (Pbb) | 93289 | Professional | 165.83 | $55.06 – $126.31 |
| Clinic / Office Visit | Application Of Short Arm Splint (Forearm To Hand); Dynamic (Pbb) | 29126 | Professional | 166.348 | $65.35 – $155.04 |
| Clinic / Office Visit | Debridement, Mastoidectomy Cavity, Simple (Pbb) | 69220 | Professional | 173.213 | $59.17 – $183.75 |
| Clinic / Office Visit | Inj Proc For Si Joint, Anesthetic/Steroid W Image Guidance (Pro Cah) | 27096 | Professional | 179.2118 | $135.33 – $324.43 |
| Clinic / Office Visit | Appl Splint Long Arm (Pbb) | 29105 | Professional | 184.912 | $73.07 – $180.16 |
| Clinic / Office Visit | Shaving Of Epidermal Or Dermal (Pbb) | 11300 | Professional | 193.081 | $62.23 – $199.54 |
| Clinic / Office Visit | Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb) | 99244 | Professional | 193.0838 | $124.64 – $370.37 |
| Clinic / Office Visit | Change Of Cystostomy Tube; Simple (Pbb) | 51705 | Professional | 205.4562 | $77.19 – $185.90 |
| Clinic / Office Visit | Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah) | 99221 | Professional | 205.485 | $55.10 – $206.00 |
| Clinic / Office Visit | Icd Device Progr Eval Dual(Pbb) | 93283 | Professional | 213.416 | $74.61 – $172.19 |
| Clinic / Office Visit | Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah) | 11046 | Professional | 216.1053 | $56.09 – $150.01 |
| Clinic / Office Visit | Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40 Min Met Or… | 99215 | Professional | 230.2153 | $149.30 – $346.13 |
| Clinic / Office Visit | Office Or Outpt Consult, New Or Est Pt, High Mdm Or 55+ Mins (Pbb) | 99245 | Professional | 230.2153 | $162.16 – $451.48 |
| Clinic / Office Visit | New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60 Min Met Or… | 99205 | Professional | 241.3547 | $181.84 – $407.46 |
| Clinic / Office Visit | Endocervical Curettage (Pbb) | 57505 | Professional | 242.2 | $113.21 – $283.85 |
| Clinic / Office Visit | Destruction, Malignant Lesion, F/E/E/N/L Diam 0.6-1.0Cm (Pbb) | 17281 | Professional | 252.35 | $134.31 – $362.48 |
| Clinic / Office Visit | Colposcopy Of The Entire Vagina, With Cervix If Present (Pbb) | 57420 | Professional | 256.949 | $102.14 – $247.98 |
| Clinic / Office Visit | Nursing Facility Care, Initial, Straightforward/Low Mdm 25 Min (Pro Cah) | 99304 | Professional | 261.002 | $62.71 – $185.19 |
| Clinic / Office Visit | Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah) | 99222 | Professional | 279.027 | $87.90 – $269.06 |
| Clinic / Office Visit | Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah) | 10021 | Professional | 295.568 | $76.41 – $249.07 |
| Clinic / Office Visit | Colposcopy Of Cervix W/Upper/Adjacent Vagina (Pbb) | 57452 | Professional | 298.536 | $93.39 – $234.99 |
| Clinic / Office Visit | Layer Closure Wound Scalp,Trunk,Extremities; 2.5 Cm Or Less (Pbb) | 12031 | Professional | 312.914 | $200.17 – $483.78 |
| Clinic / Office Visit | Closed Tx Of Shoulder Dislocation, W/ Manip (Pbb) | 23650 | Professional | 315.6178 | $325.74 – $652.41 |
| Clinic / Office Visit | Incision Of Eardrum (Pro Cah) | 69421 | Professional | 317.961 | $103.17 – $305.05 |
| Clinic / Office Visit | Catheterization And Introduction Saline/Contrast Material For Sis Or Hysterosalpingogra… | 58340 | Professional | 318.682 | $101.28 – $431.64 |
| Clinic / Office Visit | Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb) | 11442 | Professional | 327.509 | $148.20 – $382.57 |
| Clinic / Office Visit | Cautery Of The Cervic; Cryocautery, Initial Or Repeat (Pro Cah) | 57511 | Professional | 338.9277 | $142.80 – $367.33 |
| Clinic / Office Visit | Change Of Cystostomy Tube; Complicated (Procah) | 51710 | Professional | 340.4995 | $107.03 – $263.42 |
| Clinic / Office Visit | Drainage External Ear, Abscess Or Hematoma; Complicated (Pbb) | 69005 | Professional | 347.928 | $168.53 – $437.84 |
| Clinic / Office Visit | Closed Treatment Phalangeal Shaft Fx, Proximal/Middle Phalanx, Finger/Thumb; Wo Manip,… | 26720 | Professional | 349.2884 | $178.56 – $403.39 |
| Clinic / Office Visit | Closed Treatment Of Distal Phalangeal Fracture, Finger Or Thumb; Without Manipulation,… | 26750 | Professional | 351.0765 | $166.21 – $375.40 |
| Clinic / Office Visit | Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramu… | 30802 | Professional | 359.779 | $213.81 – $589.29 |
| Clinic / Office Visit | Destruction Benign/Premalignant Lesion; 15 Or More Lesions (Pbb) | 17004 | Professional | 366.114 | $125.04 – $309.20 |
| Clinic / Office Visit | Closed Tx Of Fx;Phalanx Or Phalanges Other Than Great Toe W/ Manipulation Each (Pbb) | 28515 | Professional | 380.226 | $133.53 – $332.33 |
| Clinic / Office Visit | Closed Treatment Metacarpal Fx Wo Manipulation (Pbb) | 26600 | Professional | 389.34 | $259.61 – $599.34 |
| Clinic / Office Visit | Control Oropharyngeal Hemorrhage, Primary Or Secondary (Eg, Post-Tonsillectomy); Simple… | 42960 | Professional | 389.8807 | $106.52 – $352.43 |
| Clinic / Office Visit | Closed Treatment Patellar Disloc W/O Anest (Pbb) | 27560 | Professional | 405.0073 | $349.67 – $735.00 |
| Clinic / Office Visit | Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip… | 26740 | Professional | 406.7521 | $198.89 – $469.42 |
| Clinic / Office Visit | Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah) | 11042 | Professional | 427.7549 | $101.89 – $239.32 |
| Clinic / Office Visit | Colposcopy Of Cervix Incl Upper/Adj Vag W/Bx Of Cervix And Endocerv Curettage (Pro Cah) | 57454 | Professional | 432.208 | $122.21 – $313.53 |
| Clinic / Office Visit | Nursing Facility Care, Initial, High Mdm 50 Min Met Or Exceeded (Pro Cah) | 99306 | Professional | 437.647 | $148.78 – $338.07 |
| Clinic / Office Visit | Closed Tx Of Ulnar Shaft Fracture; W/O Manipulation (Pbb) | 25530 | Professional | 478.744 | $229.25 – $534.02 |
| Clinic / Office Visit | Closed Treatment Distal Radial Fx W/O Mani (Pbb) | 25600 | Professional | 480.186 | $293.06 – $668.97 |
| Clinic / Office Visit | Submucous Resection Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah) | 30140 | Professional | 517.3896 | $222.56 – $894.35 |
| Clinic / Office Visit | Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm… | 52235 | Professional | 523.4244 | $184.74 – $600.06 |
| Clinic / Office Visit | Amputation, Toe; Metatarsophalangeal Joint (Pro Cah) | 28820 | Professional | 523.6479 | $225.13 – $1,168.54 |
| Clinic / Office Visit | Open Treatment Distal Phalangeal Fracture, Finger/Thumb, Inc Internal Fixation, Ea (Pro… | 26765 | Professional | 526.7265 | $360.22 – $1,027.85 |
| Clinic / Office Visit | Closed Treatment Interphal Disloc W/ Mani (Pbb) | 26770 | Professional | 526.7265 | $271.19 – $568.31 |
| Clinic / Office Visit | Transcath Implantation Of Wireless Pulm Artery Pressure Sensor For Long-Term Hemodynami… | 33289 | Professional | 534.3691 | $198.37 – $607.89 |
| Clinic / Office Visit | Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah) | 42830 | Professional | 549.5462 | $145.63 – $428.51 |
| Clinic / Office Visit | Incision And Drainage Of Pilonidal Cyst; Complicated (Pro Cah) | 10081 | Professional | 551.0315 | $290.23 – $628.29 |
| Clinic / Office Visit | Cardioversion (Pro Cah) | 92960 | Professional | 552.286 | $118.10 – $322.28 |
| Clinic / Office Visit | Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah) | 42826 | Professional | 558.4578 | $171.87 – $520.39 |
| Clinic / Office Visit | Relocation Of Skin Pocket For Pacemaker (Pro Cah) | 33222 | Professional | 570.0803 | $221.27 – $699.11 |
| Clinic / Office Visit | Frenulotomy Of Penis (Pro Cah) | 54164 | Professional | 581.8398 | $137.91 – $401.24 |
| Clinic / Office Visit | Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah) | 11043 | Professional | 602.2729 | $179.85 – $465.12 |
| Clinic / Office Visit | Closed Treatment Of Clavicular Fracture; With Manipulation (Pbb) | 23505 | Professional | 610.442 | $305.92 – $716.34 |
| Clinic / Office Visit | Incision And Drainage, Upper Arm Or Elbow Area; Deep Abscess Or Hematoma (Pro Cah) | 23930 | Professional | 634.79 | $288.17 – $726.39 |
| Clinic / Office Visit | Hysteroscopy, Diagnostic (Pro Cah) | 58555 | Professional | 639.4909 | $249.58 – $628.91 |
| Clinic / Office Visit | Closed Treatment Of Carpal Scaphoid (Pbb) | 25622 | Professional | 646.016 | $265.53 – $620.87 |
| Clinic / Office Visit | Closed Treatment Of Ulnar Styloid Fracture (Pro Cah) | 25650 | Professional | 668.367 | $285.60 – $651.02 |
| Clinic / Office Visit | Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah) | 55250 | Professional | 673.568 | $264.24 – $790.99 |
| Clinic / Office Visit | Hemorrhoidectomy Ext-Complete (Pro Cah) | 46250 | Professional | 686.8534 | $406.53 – $950.33 |
| Clinic / Office Visit | Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah) | 42820 | Professional | 688.418 | $192.46 – $597.19 |
| Clinic / Office Visit | Tympanostomy Unilateral (Pro Cah) | 69436 | Professional | 717.395 | $107.80 – $328.74 |
| Clinic / Office Visit | Open Treatment Fx, Phalanx/Phalanges, Other Than Great Toe, Incl Internal Fixation, Ea… | 28525 | Professional | 723.5451 | $437.41 – $1,167.82 |
| Clinic / Office Visit | Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah) | 42821 | Professional | 727.0348 | $200.95 – $623.03 |
| Clinic / Office Visit | Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0… | 52234 | Professional | 733.2642 | $157.46 – $3,651.17 |
| Clinic / Office Visit | Placement Of Soft Tissue Localization Device, Percutaneous, Including Imaging Guidance;… | 10035 | Professional | 736.689 | $156.80 – $1,094.61 |
| Clinic / Office Visit | Placement Of Breast Localization Device, Percutaneous; First Lesion, Inc Us Guidance (P… | 19285 | Professional | 784.9599 | $153.14 – $1,052.97 |
| Clinic / Office Visit | Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral… | 58600 | Professional | 832.4233 | $239.80 – $739.31 |
| Clinic / Office Visit | Polysomnography/Split Interp 6 Yrs Or Older (Pro Cah) | 95811 | Professional | 859.432 | $219.64 – $1,173.73 |
| Clinic / Office Visit | Sinusotomy, Maxillary (Antrotomy); Intranasal (Pro Cah) | 31020 | Professional | 867.774 | $332.94 – $986.94 |
| Clinic / Office Visit | Transuretheral Resection; Residual/Regrowth Of Obstructive Prostate Tissue W/Control Of… | 52630 | Professional | 873.3329 | $277.62 – $829.03 |
| Clinic / Office Visit | Synovectomy, Tendon Sheath, Radical, Flexor Tendon, Palm And/Or Finger, Each Tendon (Pr… | 26145 | Professional | 921.6038 | $358.41 – $1,053.69 |
| Clinic / Office Visit | Stab Phlebectomy Of Varicose Veins, 1 Extremity; More Than 20 Incisions (Pro Cah) | 37766 | Professional | 931.568 | $360.22 – $1,592.02 |
| Clinic / Office Visit | Hemorrhoidectomy, Internal & External, Simple (Pro Cah) | 46255 | Professional | 947.394 | $439.46 – $1,040.05 |
| Clinic / Office Visit | Cystourethroscopy, W/Fulguration And/Or Resection Of; Large Bladder Tumor(S) (Pro Cah) | 52240 | Professional | 970.0046 | $249.58 – $814.67 |
| Clinic / Office Visit | Fasciotomy, Palmar (Eg, Dupuytren’S Contracture); Open, Partial (Pro Cah) | 26045 | Professional | 1002.19 | $333.97 – $961.82 |
| Clinic / Office Visit | Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah) | 21501 | Professional | 1013.6899 | $391.61 – $926.65 |
| Clinic / Office Visit | Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (P… | 46040 | Professional | 1030.309 | $472.91 – $1,100.35 |
| Clinic / Office Visit | Polysomnography Interp 6 Yrs Or Older (Pro Cah) | 95810 | Professional | 1031.03 | $211.10 – $1,120.70 |
| Clinic / Office Visit | Repositioning Of Previosly Implanted Transvenous Packemaker Or Implantable Defib Electr… | 33215 | Professional | 1045.45 | $192.97 – $646.71 |
| Clinic / Office Visit | Percutaneous Skeletal Fixation Unstable Phalangeal Shaft Fracture, Prox/Middle Phalanx… | 26727 | Professional | 1045.623 | $338.60 – $962.53 |
| Clinic / Office Visit | Transureatheral Resection Of Bladder Neck (Pro Cah) | 52500 | Professional | 1057.5051 | $260.38 – $1,010.63 |
| Clinic / Office Visit | Suture Of Quadriceps Or Hamstring Muscle Rupture; Primary (Pro Cah) | 27385 | Professional | 1069.1925 | $435.60 – $1,180.74 |
| Clinic / Office Visit | Ethmoidectomy; Intranasal, Anterior (Pro Cah) | 31200 | Professional | 1105.1416 | $451.04 – $1,165.66 |
| Clinic / Office Visit | Closed Tx Of Distal Radial Fracturew/ Manipulation (Pbb) | 25605 | Professional | 1123.318 | $472.66 – $1,111.11 |
| Clinic / Office Visit | Open Treatment Of Ulnar Fracture, Proximal End, Inc Internal Fixation, When Performed (… | 24685 | Professional | 1142.9652 | $455.42 – $1,345.83 |
| Clinic / Office Visit | Open Treatment Of Radial And Ulnar Shaft Fractures,W Internal Fixation; Of Radius Or Ul… | 25574 | Professional | 1178.388 | $468.54 – $1,388.17 |
| Clinic / Office Visit | Metatarsectomy (Pro Cah) | 28140 | Professional | 1182.44 | $423.25 – $1,234.57 |
| Clinic / Office Visit | Endometrial Ablation, Thermal, Without Hysteroscopic Guidance (Pro Cah) | 58353 | Professional | 1199.0446 | $379.49 – $2,039.20 |
| Clinic / Office Visit | Open Treatment Of Distal Radial Extra-Articular Fx Or Epiphyseal Separation,W Internal… | 25607 | Professional | 1253.855 | $510.22 – $1,513.07 |
| Clinic / Office Visit | Open Treatment Of Carpal Scaphoid (Navicular) Fracture, Includes Internal Fixation, Whe… | 25628 | Professional | 1254.2372 | $489.12 – $1,484.36 |
| Clinic / Office Visit | Open Treatment Of Metacarpal Fracture, Single, Includes Internal Fixation, Each Bone (P… | 26615 | Professional | 1255.0447 | $403.96 – $1,183.61 |
| Clinic / Office Visit | Cystourethroscopy, W/Ureteroscopy; And/Or Pyeloscopy; W/Lithotripsy; Includ Insert Sten… | 52356 | Professional | 1262.8459 | $264.24 – $864.20 |
| Clinic / Office Visit | Open Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral, Inc Internal Fixatio… | 24575 | Professional | 1275.4129 | $506.88 – $1,512.35 |
| Clinic / Office Visit | Open Treatment Patellar Fx, W Intern Fix And/Or Part/Comp Patellectomy And Soft Tiss Rp… | 27524 | Professional | 1300.4172 | $511.51 – $1,551.11 |
| Clinic / Office Visit | Amputation, Toe; Interphalangeal Joint (Pro Cah) | 28825 | Professional | 1302.847 | $219.73 – $1,116.86 |
| Clinic / Office Visit | Suture Of Infrapatellar Tendon; Primary (Pro Cah) | 27380 | Professional | 1309.336 | $439.98 – $1,220.22 |
| Clinic / Office Visit | Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah) | 26055 | Professional | 1319.43 | $485.78 – $1,137.67 |
| Clinic / Office Visit | Mastectomy, Partial (Pro Cah) | 19301 | Professional | 1336.734 | $446.15 – $1,347.26 |
| Clinic / Office Visit | Percutaneous Skeletal Fixation Of Distal Radial Fracture Or Epiphyseal Separation (Pro… | 25606 | Professional | 1408.834 | $470.60 – $1,363.77 |
| Clinic / Office Visit | Closed Treatment Of Humeral Shaft Fracture; With Manipulation, W/Wo Skeletal Traction (… | 24505 | Professional | 1417.486 | $435.09 – $1,019.96 |
| Clinic / Office Visit | Open Treatment Of Humeral Condylar Fracture, Medial Or Lateral, Incl Internal Fixation… | 24579 | Professional | 1444.3649 | $566.57 – $1,722.66 |
| Clinic / Office Visit | Hemorrhoidectomy (Pro Cah) | 46260 | Professional | 1450.652 | $349.92 – $984.07 |
| Clinic / Office Visit | Synovectomy, Extensor Tendon Sheath, Wrist, Single Compartment (Pro Cah) | 25118 | Professional | 1454.978 | $273.76 – $783.09 |
| Clinic / Office Visit | Exploration Of Penetrating Wound (Separate Procedure); Extremity (Pro Cah) | 20103 | Professional | 1457.7827 | $445.90 – $1,191.50 |
| Clinic / Office Visit | Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah) | 14040 | Professional | 1518.6783 | $581.49 – $1,556.85 |
| Clinic / Office Visit | Open Treatment Of Humeral Shaft Fracture With Plate/Screws, With Or Without Cerclage (P… | 24515 | Professional | 1518.9884 | $596.42 – $1,808.07 |
| Clinic / Office Visit | Percutaneous Skeletal Fixation Of Metacarpal Fracture, Each Bone (Pro Cah) | 26608 | Professional | 1519.868 | $343.75 – $976.17 |
| Clinic / Office Visit | Open Treatment Distal Radial Intra-Articular Fx/Epiphyseal Sep; W Internal Fix 2 Fragme… | 25608 | Professional | 1550.15 | $562.71 – $1,697.54 |
| Clinic / Office Visit | Open Treatment Of Radial And Ulnar Shaft Fractures, W/Internal Fixation; Of Radius And… | 25575 | Professional | 1564.5916 | $614.43 – $1,857.60 |
| Clinic / Office Visit | Closed Treatment Of Carpometacarpal Fracture Dislocation, Thumb, With Manipulation (Pro… | 26645 | Professional | 1582.595 | $361.76 – $872.10 |
| Clinic / Office Visit | Sling Operation For Stress Incontinence (Pro Cah) | 57288 | Professional | 1588.7379 | $481.15 – $1,466.41 |
| Clinic / Office Visit | Open Tx Humeral Supracondylar/Transcondylar Fx, W Internal Fixation; Wo Intercondylar E… | 24545 | Professional | 1595.6307 | $621.89 – $1,917.89 |
| Clinic / Office Visit | Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah) | 64721 | Professional | 1652.532 | $360.22 – $882.86 |
| Clinic / Office Visit | Open Treatment Of Ulnar Styloid Fracture (Pro Cah) | 25652 | Professional | 1687.14 | $432.77 – $1,283.38 |
| Clinic / Office Visit | Sling Operation For Correction Of Male Urinary Incontinence (Pro Cah) | 53440 | Professional | 1741.6981 | $498.64 – $1,560.44 |
| Clinic / Office Visit | Slitting Of Prepuce, Dorsal Or Lateral (Separate Procedure); Except Newborn (Pro Cah) | 54001 | Professional | 1756.3199 | $154.38 – $378.98 |
| Clinic / Office Visit | Open Treatment Articular Fx, Involv Metacarpophalangeal/Interphalangeal Joint, Inc Inte… | 26746 | Professional | 1822.688 | $504.05 – $1,527.42 |
| Clinic / Office Visit | Open Treatment Of Ulnar Shaft Fracture, Includes Internal Fixation, When Performed (Pro… | 25545 | Professional | 1999.333 | $436.12 – $1,282.66 |
| Clinic / Office Visit | Open Treatment Distal Fibular Fracture, Includes Internal Fixation, When Performed (Pro… | 27792 | Professional | 2010.869 | $445.12 – $1,345.11 |
| Clinic / Office Visit | Mastectomy, Partial; With Axillary Lymphadenectomy (Pro Cah) | 19302 | Professional | 2137.5343 | $611.08 – $1,859.03 |
| Clinic / Office Visit | Resection Of Palate Or Extensive Resection Of Lesion (Pro Cah) | 42120 | Professional | 2143.9728 | $682.35 – $2,117.43 |
| Clinic / Office Visit | Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah) | 42145 | Professional | 2151.3703 | $448.98 – $1,458.52 |
| Clinic / Office Visit | Open Tx Distal Radial Intra-Articular Fx; 3 Or More Fragments (Pro Cah) | 25609 | Professional | 2186.072 | $705.00 – $2,159.06 |
| Clinic / Office Visit | Thyroidectomy, Total Or Subtotal For Malignancy; With Limited Neck Dissection (Pro Cah) | 60252 | Professional | 2215.222 | $837.76 – $2,733.28 |
| Clinic / Office Visit | Cholecystectomy (Pro Cah) | 47600 | Professional | 2239.0294 | $706.03 – $2,217.92 |
| Clinic / Office Visit | Radical Resection Of Tumor, Soft Tissue Of Neck Or Anterior Thorax; 5 Cm Or Greater (Pr… | 21558 | Professional | 2241.1925 | $867.61 – $2,784.96 |
| Clinic / Office Visit | Incision And Drainage, Complex, Postoperative Wound Infection (Pro Cah) | 10180 | Professional | 2446.2232 | $217.16 – $502.44 |
| Clinic / Office Visit | Appendectomy; For Ruptured Appendix With Abscess Or Generalized Peritonitis (Pro Cah) | 44960 | Professional | 2543.688 | $573.77 – $1,817.40 |
| Clinic / Office Visit | Vaginal Hysterectomy, For Uterus Greater Than 250 G (Pro Cah) | 58290 | Professional | 2770.8823 | $721.72 – $2,345.69 |
| Clinic / Office Visit | Open Treatment Trimalleolar Ankle Fx,Inc Internal Fix,Medial/Lat Malleolus;Wo Fix Post… | 27822 | Professional | 2832.088 | $606.45 – $1,770.75 |
| Clinic / Office Visit | Reconstruction Of Dislocating Patella; W Ext Realignment And/Or Muscle Advance Or Relea… | 27422 | Professional | 3176.005 | $507.13 – $1,531.01 |
| Clinic / Office Visit | Colostomy Or Skin Level Cecostomy (Pro Cah) | 44320 | Professional | 3367.07 | $789.91 – $2,499.29 |
| Clinic / Office Visit | Laser Vaporization Of Prostate, W/Control Postop Bleeding, Complete (Pro Cah) | 52648 | Professional | 3680.9285 | $387.49 – $3,743.91 |
| Clinic / Office Visit | Tx Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fx; W Intramed Impl… | 27245 | Professional | 3711.708 | $803.03 – $2,547.38 |
| Clinic / Office Visit | Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fracture;… | 27244 | Professional | 4221.455 | $804.83 – $2,547.38 |
| Clinic / Office Visit | Vaginal Hysterectomy, For Uterus 250 G Or Less (Pro Cah) | 58260 | Professional | 4388.9433 | $532.35 – $1,683.90 |
| Clinic / Office Visit | Ovarian Cystectomy (Pro Cah) | 58925 | Professional | 4388.9433 | $498.64 – $1,528.86 |
| Clinic / Office Visit | Cervical Lymphadenectomy (Modified Radical Neck Dissection) (Pro Cah) | 38724 | Professional | 4605.0486 | $913.67 – $3,002.45 |
| Clinic / Office Visit | Laparoscopy,Abd,Peritoneum,Omentum,Diag,Surg W/ Or W/O Brushing Or Washing (Pro Cah) | 49320 | Professional | 4935.519 | $223.59 – $675.43 |
| Clinic / Office Visit | Laparoscopy; W/Fulguration Of Oviducts (Pro Cah) | 58670 | Professional | 4935.519 | $240.31 – $742.90 |
| Clinic / Office Visit | Laparoscopy; W/Occlusion Of Oviducts By Device (Pro Cah) | 58671 | Professional | 4935.519 | $240.31 – $740.74 |
| Clinic / Office Visit | Office Visit-Nurse Level 1 – Nurse | 99211 | Clinic | 38.2418 | $15.86 – $65.27 |
| Clinic / Office Visit | Zinc Paste Impreg Bandage, Nonelastic, Knitted/Woven, W Greater Than 3 In And Less Than… | A6456 | Clinic | 23.0215 | $1.75 – $16.58 |
| Clinic / Office Visit | Nursing Facility Care, Subsequent, Moderate, 30 Min | 99309 | Clinic | 191.5985 | $88.42 – $379.88 |
| Clinic / Office Visit | Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30 Min Met… | 99214 | Clinic | 224.2022 | $97.70 – $392.74 |
| Clinic / Office Visit | Initial Preventive Physical Exam; Face-To-Face, Limit To New Beneficiary First 12 Month… | G0402 | Clinic | 337.8966 | $133.28 – $397.64 |
| Clinic / Office Visit | Specialty Absorptive Dressing, Wound Cover, Sterile, Pad Size 16Sq In Or Less, W/O Adhe… | A6251 | Clinic | 35.6462 | $2.84 – $42.91 |
| Clinic / Office Visit | Electrocardiogram, Routine ECG W/At Least12 Leads; Interpretation And Report Only | 93010 | Clinic | 55.517 | $6.17 – $17.23 |
| Clinic / Office Visit | Gen Care Mgmt,20 Min Clin Staff Time For Chronic Care Mgmt Svs Directed By Rhc Prov,Per… | G0511 | Clinic | 89.1156 | $50.92 – $394.31 |
| Clinic / Office Visit | Nursing Facility Care, Subsequent, Straightforward Mdm, 10 Min | 99307 | Clinic | 93.5714 | $32.27 – $417.38 |
| Clinic / Office Visit | Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10 Min Me… | 99212 | Clinic | 95.2297 | $43.93 – $379.48 |
| Clinic / Office Visit | Bronchodilation Responsiveness, Pre And Post Bronchodilator Administration | 94060 | Clinic | 130.501 | $22.57 – $393.81 |
| Clinic / Office Visit | Application Of Short Arm Splint (Forearm To Hand); Static | 29125 | Clinic | 138.1292 | $43.75 – $132.07 |
| Clinic / Office Visit | Nursing Facility Care,Subsequent, Low Mdm, 20 Min Met Or Exceeded | 99308 | Clinic | 144.8128 | $61.13 – $381.98 |
| Clinic / Office Visit | Nursing Facility Discharge Day Management;30 Minutes Or Less Total Time On The Date Of… | 99315 | Clinic | 152.2391 | $66.38 – $393.63 |
| Clinic / Office Visit | New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15 Min Me… | 99202 | Clinic | 161.8933 | $58.51 – $294.27 |
| Clinic / Office Visit | Destruction Premalignant Lesions; 1St Lesion | 17000 | Clinic | 175.2607 | $50.94 – $161.95 |
| Clinic / Office Visit | Annual Wellness Visit; Includes A Personalized Prevention Plan Of Service, Subsquent Visit | G0439 | Clinic | 198.2822 | $104.97 – $362.37 |
| Clinic / Office Visit | Annual Wellness Visit; Includes A Personalized Prevention Plan Of Service, Initial Visit | G0438 | Clinic | 211.6496 | $133.02 – $497.09 |
| Clinic / Office Visit | Avulsion Of Nail Plate, Partial Or Complete, Simple; Single | 11730 | Clinic | 214.858 | $39.66 – $213.18 |
| Clinic / Office Visit | Est Pt – 40-64 Yrs Periodic Preventive Medicine Reevaluation And Management | 99396 | Clinic | 223.5316 | $100.23 – $294.27 |
| Clinic / Office Visit | New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30 Min Met Or E… | 99203 | Clinic | 231.7006 | $90.52 – $343.75 |
| Clinic / Office Visit | Destruction Of Benign Lesions (Other Than Skin Tags); Up To 14 Lesions | 17110 | Clinic | 242.0974 | $74.41 – $225.38 |
| Clinic / Office Visit | Incision And Drainage Of Abscess; Simple Or Single | 10060 | Clinic | 243.698 | $98.54 – $239.02 |
| Clinic / Office Visit | Est Pt – 65+ Yrs Periodic Preventive Medicine Reevaluation And Management | 99397 | Clinic | 252.4942 | $108.37 – $346.13 |
| Clinic / Office Visit | Destruction Of Benign Lesions (Other Than Skin Tages); 15 Or More Lesions | 17111 | Clinic | 264.3763 | $91.07 – $267.73 |
| Clinic / Office Visit | Nursing Facility Care, Subsequent, High, 45 Min | 99310 | Clinic | 273.2878 | $125.68 – $294.27 |
| Clinic / Office Visit | Psychiatric Diagnostic Evaluation | 90791 | Clinic | 274.4414 | $144.44 – $405.95 |
| Clinic / Office Visit | Nursing Facility Care, Initial, Moderate Mdm 35 Min | 99305 | Clinic | 274.7731 | $108.37 – $438.25 |
| Clinic / Office Visit | New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45 Min Met… | 99204 | Clinic | 349.7787 | $136.71 – $544.54 |
| Clinic / Office Visit | Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins | 99223 | Clinic | 410.97 | $118.08 – $399.38 |
| Clinic / Office Visit | Incision And Drainage Of Abscess; Complicated Or Multiple | 10061 | Clinic | 416.6154 | $166.21 – $420.62 |
| Clinic / Office Visit | Brief Emotional/Behavioral Assessment, W/Scoring And Documentation, Per Standard Instru… | 96127 | Clinic | 10.094 | $3.88 – $438.25 |
| Clinic / Office Visit | Spacer, Bag Or Reservoir, W Or W/Out Mask, For Use With Metered Dose Inhaler | A4627 | Clinic | 11.1394 | $6.37 – $32.00 |
| Clinic / Office Visit | Urinary Drainage Bag, Leg Or Abdomen, Vinyl, W/W/O Tube, W/Straps, Each | A4358 | Clinic | 11.8821 | $6.79 – $9.32 |
| Clinic / Office Visit | Foam Dressing, Wound Cover, Sterile, > 16 Sq In; </= 48 Sq In , W/ Adhesive Border, Eac… | A6213 | Clinic | 11.8821 | $6.79 – $16.46 |
| Clinic / Office Visit | Gauze, Impregnated, Other Than Water, Normal Saline, Or Zinc Paste, Sterile, Any Width,… | A6266 | Clinic | 11.8821 | $2.67 – $6.79 |
| Clinic / Office Visit | Packing Strips, Non-Impregnated, Sterile, Up To 2 Inches In Width, Per Linear Yard | A6407 | Clinic | 11.8821 | $2.61 – $6.79 |
| Clinic / Office Visit | Light Compress Bandage, Elastic, Knitted/Woven, Width Less Than 3 In, Per Yard | A6448 | Clinic | 11.8821 | $1.61 – $6.79 |
| Clinic / Office Visit | Cervical, Flexible, Nonadjustable (Foam Collar) | L0120 | Clinic | 11.8821 | $6.79 – $32.51 |
| Clinic / Office Visit | Developmental Screening, W/Scoring And Documentation Per Standardized Instrument | 96110 | Clinic | 14.9968 | $9.52 – $20.85 |
| Clinic / Office Visit | Prenatal Care, At-Risk Enhanced Service; Care Coordination | H1002 | Clinic | 15.5952 | $8.91 – $241.00 |
| Clinic / Office Visit | Smoking And Tobacco Use Cessation Counseling Visit; Intermediate, Greater Than 3 Min An… | 99406 | Clinic | 18.746 | $11.80 – $29.43 |
| Clinic / Office Visit | Destruction Premalignant Lesions; 2 Through 14 Lesions | 17003 | Clinic | 20.051 | $4.27 – $12.37 |
| Clinic / Office Visit | Screening Test Of Visual Acuity, Quantitative, Bilateral | 99173 | Clinic | 20.051 | $2.31 – $6.46 |
| Clinic / Office Visit | Extension Drainage Tubing, Any Type, Any Length, W/Connector/Adaptor, Use W/Urinary Leg… | A4331 | Clinic | 23.0215 | $4.44 – $13.16 |
| Clinic / Office Visit | Alginate Or Other Fiber Gelling Dressing, Wound Cover, Sterile, Pad Size 16Sq In To 48S… | A6197 | Clinic | 23.0215 | $13.16 – $23.44 |
| Clinic / Office Visit | Cervical, Semi-Rigid, Adjustable (Plastic Collar) | L0140 | Clinic | 23.0215 | $13.16 – $73.56 |
| Clinic / Office Visit | Skin Test; Tuberculosis, Intradermal | 86580 | Clinic | 26.6 | $11.10 – $34.66 |
| Clinic / Office Visit | Application Of Topical Fluoride Varnish By A Physician Or Other Qualified Health Care P… | 99188 | Clinic | 28.9626 | $14.00 – $20.85 |
| Clinic / Office Visit | Bilirubin, Total, Transcutaneous | 88720 | Clinic | 37.8 | $5.02 – $21.60 |
| Clinic / Office Visit | Admin Rsv, Monoclonal Antibody, Seasonal Dose By Im Inj, With Counseling By Physician O… | 96380 | Clinic | 39.655 | $22.66 – $41.11 |
| Clinic / Office Visit | Smoking And Tobacco Use Cessation Counseling Visit; Intensive, > 10 Mins | 99407 | Clinic | 39.7415 | $22.30 – $56.70 |
| Clinic / Office Visit | Prostate Cancer Screening; Digital Rectal Exam | G0102 | Clinic | 43.0725 | $15.25 – $417.38 |
| Clinic / Office Visit | Oxygen Probe For Use With Oximeter Device, Replacement | A4606 | Clinic | 44.555 | $25.46 – $56.25 |
| Clinic / Office Visit | Flu Clinic-Flu Administration (Medicare Patient) | G0008 | Clinic | 46.2 | $17.31 – $33.10 |
| Clinic / Office Visit | Pure Tone Audiometry; Air Only | 92552 | Clinic | 47.9898 | $31.64 – $71.50 |
| Clinic / Office Visit | Moderate Sedation, By Same Dr Performing Service; Pt Under 5Yrs, Initial 15 Min Intra-S… | 99151 | Clinic | 49.7562 | $40.88 – $156.47 |
| Clinic / Office Visit | Flu Clinic – Intranasal Flu Administration | 90473 | Clinic | 56.7 | $13.64 – $51.68 |
| Clinic / Office Visit | ECG W/12 Leads; Interp And Report Only, As Screen For Initial Preventive Physical Exam | G0405 | Clinic | 57.1825 | $6.17 – $438.25 |
| Clinic / Office Visit | Psychotherapy, 30 Minutes W/ Patient When Performed With An E&M Service | 90833 | Clinic | 61.4869 | $66.53 – $133.51 |
| Clinic / Office Visit | Debridement Of Nail(S) By Any Method(S); 1 To 5 | 11720 | Clinic | 63.448 | $24.95 – $65.32 |
| Clinic / Office Visit | Spirometry, W/Graphic Rec, Total/Timed Vital Capacity, Expiratory Flow Rate, W/W/O Max… | 94010 | Clinic | 73.542 | $14.64 – $48.86 |
| Clinic / Office Visit | Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins | 99231 | Clinic | 83.9821 | $33.32 – $86.99 |
| Clinic / Office Visit | Application Of Finger Splint; Static | 29130 | Clinic | 85.4025 | $34.47 – $83.98 |
| Clinic / Office Visit | Prolonged Op E&M, Time W And Wo Pt, Beyond Min Req Time Of Primary Proc Ea 15 Min, In A… | 99417 | Clinic | 96.5419 | $24.66 – $55.17 |
| Clinic / Office Visit | Home Or Residence Visit, Est Pt, Straightforward Mdm Or 20-29 Mins | 99347 | Clinic | 97.2845 | $35.68 – $111.97 |
| Clinic / Office Visit | Application Of Long Leg Splint (Thigh To Ankle Or Toes) | 29505 | Clinic | 100.94 | $83.87 – $175.01 |
| Clinic / Office Visit | Evacuation Subungual Hematoma | 11740 | Clinic | 105.266 | $44.51 – $106.98 |
| Clinic / Office Visit | Paring Or Cutting Of Benign Hyperkeratotic Lesion; Single Lesion | 11055 | Clinic | 110.2265 | $28.06 – $129.86 |
| Clinic / Office Visit | Debridement Extensive Eczematous Or Infected Skin; Up To 10% Of Body | 11000 | Clinic | 113.9757 | $45.28 – $110.54 |
| Clinic / Office Visit | Administration Of Patient-Focused Health Risk Assesment Instrument W/Scoring And Doc, P… | 96160 | Clinic | 121.128 | $2.31 – $9.33 |
| Clinic / Office Visit | Paring Or Cutting Of Benign Hyperkeratotic Lesion; 2-4 Lesions | 11056 | Clinic | 123.7236 | $39.66 – $150.89 |
| Clinic / Office Visit | Unna Boot | 29580 | Clinic | 124.7618 | $48.11 – $116.88 |
| Clinic / Office Visit | Aspiration Of Bladder; By Needle | 51100 | Clinic | 125.2233 | $56.60 – $136.05 |
| Clinic / Office Visit | Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20 Min Met Or E… | 99213 | Clinic | 137.2207 | $73.99 – $163.85 |
| Clinic / Office Visit | Duplex Scan Of Extremity Veins Including Responses To Compression/Other Maneuvers; Unil… | 93971 | Clinic | 140.595 | $38.44 – $210.91 |
| Clinic / Office Visit | Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins | 99232 | Clinic | 152.2391 | $53.26 – $142.82 |
| Clinic / Office Visit | Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less | 99238 | Clinic | 152.9818 | $56.94 – $147.14 |
| Clinic / Office Visit | Initial Treatment, 1St Degree Burn, No More Than Local Treatment Required | 16000 | Clinic | 156.457 | $67.92 – $149.65 |
| Clinic / Office Visit | Home Or Residence Visit, Est Pt, Low Mdm Or 30-39 Mins | 99348 | Clinic | 164.1212 | $61.13 – $170.83 |
| Clinic / Office Visit | Debridement, Open Wound, W/Topical App, Wound Assess, Whirlpool, Per Session, Tot Wound… | 97597 | Clinic | 165.7146 | $40.27 – $152.89 |
| Clinic / Office Visit | Nursing Facility Discharge Day Management; More Than 30 Min Total Time On The Date Of T… | 99316 | Clinic | 165.7146 | $106.53 – $231.77 |
| Clinic / Office Visit | Application Of Short Arm Splint (Forearm To Hand); Dynamic | 29126 | Clinic | 166.3491 | $65.35 – $155.04 |
| Clinic / Office Visit | Chemical Cauterization Of Granulation Tissue | 17250 | Clinic | 169.3196 | $64.67 – $160.78 |
| Clinic / Office Visit | Est Pt – Infant Periodic Preventive Medicine Reevaluation And Management | 99391 | Clinic | 170.0623 | $80.29 – $200.26 |
| Clinic / Office Visit | Dressings And/Or Debridement Of Partial Thickness Burns, Initial Or Subsequent; Small | 16020 | Clinic | 173.0328 | $70.75 – $166.52 |
| Clinic / Office Visit | Control Nasal Hemorrhage, Posterior, W/Posterior Nasal Packs And/Or Cautery, Any Method… | 30905 | Clinic | 176.1619 | $186.08 – $640.66 |
| Clinic / Office Visit | Nursing Facility Care, Initial, Straightforward/Low Mdm 25 Min | 99304 | Clinic | 178.2312 | $62.71 – $185.19 |
| Clinic / Office Visit | Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance | 32555 | Clinic | 183.819 | $198.29 – $591.45 |
| Clinic / Office Visit | Application Of Long Arm Splint (Shoulder To Hand) | 29105 | Clinic | 184.9149 | $73.07 – $180.16 |
| Clinic / Office Visit | Application Of Short Leg Splint (Calf To Foot) | 29515 | Clinic | 187.46 | $62.52 – $147.86 |
| Clinic / Office Visit | Closed Treatment Radial Head Subluxation In Child, With Manipulation | 24640 | Clinic | 188.5631 | $80.27 – $239.02 |
| Clinic / Office Visit | Est Pt – 5-11 Yrs Periodic Preventive Medicine Reevaluation And Management | 99393 | Clinic | 188.628 | $85.01 – $213.18 |
| Clinic / Office Visit | Closed Treatment Of A Temporomandibular Dislocation; Initial Or Subsequent | 21480 | Clinic | 188.9597 | $56.13 – $258.49 |
| Clinic / Office Visit | Est Pt – 1-4 Yrs Periodic Preventive Medicine Reevaluation And Management | 99392 | Clinic | 189.3706 | $85.28 – $213.90 |
| Clinic / Office Visit | Application, Cast; Elbow To Finger (Short Arm) | 29075 | Clinic | 190.8559 | $74.10 – $178.01 |
| Clinic / Office Visit | Shaving Of Epidermal Or Dermal Lesion, Trunk, Arms Or Legs; 0.5 Cm Or Less | 11300 | Clinic | 193.0838 | $62.23 – $199.54 |
| Clinic / Office Visit | New Pt – Infant Initial Preventive Medicine Evaluation And Management | 99381 | Clinic | 201.2527 | $88.95 – $223.23 |
| Clinic / Office Visit | Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins | 99221 | Clinic | 205.485 | $55.10 – $206.00 |
| Clinic / Office Visit | Est Pt – 12-17 Yrs Periodic Preventive Medicine Reevaluation And Management | 99394 | Clinic | 205.7085 | $92.88 – $233.99 |
| Clinic / Office Visit | Est Pt – 18-39 Yrs Periodic Preventive Medicine Reevaluation And Management | 99395 | Clinic | 206.4511 | $94.72 – $235.98 |
| Clinic / Office Visit | Control Nasal Hemorrhage, Anterior, Simple Any Method | 30901 | Clinic | 209.2054 | $99.45 – $288.79 |
| Clinic / Office Visit | Drainage External Ear, Abscess Or Hematoma; Simple | 69000 | Clinic | 216.3 | $146.40 – $381.86 |
| Clinic / Office Visit | Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins | 99233 | Clinic | 218.3332 | $81.08 – $209.72 |
| Clinic / Office Visit | New Pt – 1-4 Yrs Initial Preventive Medicine Evaluation And Management | 99382 | Clinic | 218.3332 | $92.88 – $233.28 |
| Clinic / Office Visit | Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes | 99239 | Clinic | 225.7595 | $81.34 – $213.70 |
| Clinic / Office Visit | New Pt – 5-11 Yrs Initial Preventive Medicine Evaluation And Management | 99383 | Clinic | 228.73 | $96.56 – $243.33 |
Minnesota Pricing Transparency
In accordance with Minnesota pricing transparency requirements, JMHS provides information about common clinic services and resources to request cost estimates or billing assistance.
Minnesota Pricing Transparency & Patient Resources
In accordance with Minnesota state requirements, Johnson Memorial Health Services provides resources to help patients understand the cost of care and access financial assistance.
- Cost Estimates: Patients may request a personalized estimate prior to receiving services.
- Financial Assistance: Financial assistance programs may be available for those who qualify.
- Billing Support: Our team is available to answer questions regarding your bill or insurance coverage.
For assistance, please contact:
- Phone: (320) 312-2104
- Email: [email protected]
If you have questions about this file or need assistance interpreting the data, please contact:
Johnson Memorial Health Services
Phone: (320) 769-4323
Website: https://jmhsmn.org/
Primary Care Price Transparency
In compliance with the Minnesota Statute 62J.812 requiring clinic price transparency, we provide this document listing the 25 most frequent clinic services provided that cost more than $25.
Last Updated: May 2026