Compare real prices at Polk Medical Center in Cedartown, GA. Taven tracks 259 procedures at this hospital using data from their publicly filed transparency report. Last updated March 2026.
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259
Procedures Tracked
with pricing data
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6.0x
Markup Ratio
Avg = 3.0x
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Grade F
Data Quality
Minimal data coverage
✓
CMS v3.0 Compliant
This hospital's pricing data meets the latest CMS v3.0 requirements, including actual allowed amounts from insurer remittance data.
Attested by: TIM PRESTRIDGEOrg NPI: 1609820661
🔒 De-identification Notice: All pricing data shown on this page is derived from publicly available hospital machine-readable files and insurer transparency data as mandated by federal law. No individual patient data, protected health information (PHI), or personally identifiable information is collected, stored, or displayed. Aggregate statistics (such as allowed amount medians and percentiles) are calculated from de-identified claim payment data reported by hospitals per CMS requirements.
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Procedure Prices at Polk Medical Center
259 procedures with pricing data. Prices reflect negotiated rates across insurance payers compared to the Cedartown, GA metro average. Includes actual allowed amounts from insurer remittance data (CMS v3.0).
Last updated: March 26, 2026
| Procedure | Cash Price | Avg Negotiated | Median Allowed | Range (10th–90th) | Cedartown Avg | vs. Avg | Payers |
|---|---|---|---|---|---|---|---|
| Total Hip Replacement CPT 27130 Total hip replacement surgery where the damaged hip joint is replaced with an artificial implant to relieve pain and improve mobility. |
— | $54,080 | $54,080 | $54,080–$54,080 | $54,080 | avg | 1 |
| Total Knee Replacement - Unicompartmental CPT 27446 Partial knee replacement surgery that replaces only the damaged compartment of the knee joint with an artificial implant, preserving healthy bone and tissue. |
— | $54,080 | $54,080 | $54,080–$54,080 | $54,080 | avg | 1 |
| Total Knee Replacement CPT 27447 Full knee replacement surgery where the damaged knee joint is replaced with artificial metal and plastic components to relieve pain and restore function. |
— | $54,080 | $54,080 | $54,080–$54,080 | $54,080 | avg | 1 |
| Shoulder Arthroscopy - Debridement CPT 29823 Minimally invasive shoulder surgery using a small camera (arthroscope) to clean out damaged tissue, bone spurs, or loose fragments from the shoulder joint. |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Arthroscopic Rotator Cuff Repair CPT 29827 Arthroscopic repair of a torn rotator cuff — the group of tendons that stabilize the shoulder. The surgeon reattaches the torn tendon to the bone using small anchors. |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Knee Arthroscopy Medial & Lateral CPT 29880 Arthroscopic knee surgery to treat torn meniscus cartilage on both the inner and outer sides of the knee. Uses a small camera and tools to trim or repair the damaged cartilage. |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Knee Arthroscopy (Meniscus Surgery) CPT 29881 Arthroscopic knee surgery to treat a torn meniscus on one side of the knee. The surgeon trims or repairs the damaged cartilage through small incisions. |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Venipuncture (blood draw) CPT 36415 A routine blood draw where a needle is inserted into a vein (usually in the arm) to collect blood for laboratory testing. |
$30 | $11 | $11 | $11–$11 | $11 | +1% | 1 |
| Laparoscopic Hiatal Hernia Repair CPT 43282 Laparoscopic Hiatal Hernia Repair — CPT code 43282 covers laparoscopic hiatal hernia repair performed in a clinical or hospital setting. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Gastric Bypass (Laparoscopic Roux-en-Y) CPT 43644 Gastric Bypass (Laparoscopic Roux-en-Y) — CPT code 43644 covers gastric bypass (laparoscopic roux-en-y) performed in a clinical or hospital setting. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Gastric Sleeve (Laparoscopic Sleeve Gastrectomy) CPT 43775 Gastric Sleeve (Laparoscopic Sleeve Gastrectomy) — CPT code 43775 covers gastric sleeve (laparoscopic sleeve gastrectomy) performed in a clinical or hospital setting. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Small Bowel Enterostomy CPT 44180 Laparoscopic Small Bowel Enterostomy — CPT code 44180 covers laparoscopic small bowel enterostomy performed in a clinical or hospital setting. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Appendectomy CPT 44970 Laparoscopic appendectomy — minimally invasive surgical removal of the appendix, typically performed for appendicitis. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Colonoscopy (diagnostic) CPT 45378 Diagnostic colonoscopy — a flexible tube with a camera is inserted through the rectum to examine the entire large intestine for polyps, cancer, or other abnormalities. |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Colonoscopy with Biopsy CPT 45380 Colonoscopy with biopsy — examination of the large intestine with a camera, during which tissue samples are taken from suspicious areas for laboratory analysis. |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Colonoscopy with Polyp Removal CPT 45385 Colonoscopy with polyp removal — examination of the large intestine during which precancerous growths (polyps) are found and removed to prevent colon cancer. |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Gallbladder Removal (Laparoscopic) CPT 47562 Minimally invasive removal of the gallbladder (laparoscopic cholecystectomy). Small incisions and a camera are used to remove the gallbladder, typically for gallstones or inflammation. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Gallbladder Removal with Cholangiography CPT 47563 Laparoscopic gallbladder removal with X-ray imaging of the bile ducts (cholangiography) to check for gallstones in the ducts during surgery. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Inguinal Hernia Repair CPT 49650 Laparoscopic inguinal hernia repair — minimally invasive repair of a groin hernia using small incisions and a camera. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Robotic Prostatectomy CPT 55866 Robotic Prostatectomy — CPT code 55866 covers robotic prostatectomy performed in a clinical or hospital setting. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Hysterectomy (250g or Less) CPT 58571 Total laparoscopic hysterectomy including removal of the cervix — minimally invasive complete removal of the uterus and cervix. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Ovarian Cyst/Adnexal Removal CPT 58661 Laparoscopic removal of the uterus (hysterectomy) — minimally invasive surgery using small incisions and a camera to remove the uterus. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Lumbar Laminotomy CPT 63030 Lumbar laminotomy — surgical removal of a small portion of the vertebral bone (lamina) in the lower back to relieve pressure on spinal nerves, typically for a herniated disc. |
— | $59,488 | $59,488 | $59,488–$59,488 | $59,488 | avg | 1 |
| Lumbar Laminectomy (Single Level) CPT 63047 Lumbar laminectomy — surgical removal of the bony arch (lamina) of a vertebra in the lower back to create more space for the spinal cord and nerves. |
— | $59,488 | $59,488 | $59,488–$59,488 | $59,488 | avg | 1 |
| Chest X-Ray (single view) CPT 71045 X-ray imaging — chest x-ray (single view). A quick imaging test using small amounts of radiation to create pictures of bones and internal structures. |
— | $44 | $44 | $44–$44 | $44 | avg | 1 |
| Chest X-Ray (2 views) CPT 71046 Chest X-ray, two views — standard imaging of the lungs and chest from front and side to evaluate for pneumonia, heart problems, or other chest conditions. |
— | $59 | $59 | $59–$59 | $59 | avg | 1 |
| Lumbar Spine X-Ray CPT 72100 X-ray imaging — lumbar spine x-ray. A quick imaging test using small amounts of radiation to create pictures of bones and internal structures. |
— | $74 | $74 | $74–$74 | $74 | +1% | 1 |
| Shoulder X-Ray CPT 73030 X-ray imaging — shoulder x-ray. A quick imaging test using small amounts of radiation to create pictures of bones and internal structures. |
— | $65 | $65 | $65–$65 | $65 | avg | 1 |
| Hand X-Ray CPT 73130 X-ray imaging — hand x-ray. A quick imaging test using small amounts of radiation to create pictures of bones and internal structures. |
— | $73 | $73 | $73–$73 | $73 | avg | 1 |
| Knee X-Ray CPT 73560 X-ray imaging — knee x-ray. A quick imaging test using small amounts of radiation to create pictures of bones and internal structures. |
— | $67 | $67 | $67–$67 | $67 | avg | 1 |
| Ankle X-Ray CPT 73610 X-ray imaging — ankle x-ray. A quick imaging test using small amounts of radiation to create pictures of bones and internal structures. |
— | $73 | $73 | $73–$73 | $73 | avg | 1 |
| Breast Ultrasound CPT 76642 Ultrasound — breast ultrasound. This imaging test uses sound waves to create pictures of organs and structures inside the body. |
— | $134 | $134 | $134–$134 | $134 | avg | 1 |
| Abdominal Ultrasound CPT 76700 Abdominal ultrasound — uses sound waves to create images of organs in the abdomen including the liver, gallbladder, kidneys, and pancreas. |
— | $200 | $200 | $200–$200 | $200 | avg | 1 |
| OB Ultrasound (first trimester) CPT 76801 Ultrasound — ob ultrasound (first trimester). This imaging test uses sound waves to create pictures of organs and structures inside the body. |
— | $181 | $181 | $181–$181 | $181 | avg | 1 |
| OB Ultrasound (complete) CPT 76805 Ultrasound — ob ultrasound (complete). This imaging test uses sound waves to create pictures of organs and structures inside the body. |
— | $226 | $226 | $226–$226 | $226 | avg | 1 |
| Transvaginal Ultrasound CPT 76830 Transvaginal ultrasound — an ultrasound probe is placed internally to obtain detailed images of the uterus, ovaries, and pelvic structures. |
— | $222 | $222 | $222–$222 | $222 | avg | 1 |
| Pelvic Ultrasound CPT 76856 Pelvic ultrasound — uses sound waves to examine the uterus, ovaries, bladder, and other pelvic organs. |
— | $186 | $186 | $186–$186 | $186 | avg | 1 |
| 3D Mammography (Tomosynthesis) CPT 77063 3D Mammography (Tomosynthesis) — CPT code 77063 covers 3d mammography (tomosynthesis) performed in a clinical or hospital setting. |
— | $61 | $61 | $61–$61 | $61 | avg | 1 |
| Diagnostic Mammogram (unilateral) CPT 77065 Screening mammogram of one breast — X-ray imaging of one breast to check for early signs of breast cancer. |
— | $222 | $222 | $222–$222 | $222 | avg | 1 |
| Diagnostic Mammogram (bilateral) CPT 77066 Screening mammogram of both breasts — routine X-ray imaging of both breasts to detect early breast cancer in women without symptoms. |
— | $282 | $282 | $282–$282 | $282 | avg | 1 |
| Screening Mammogram (bilateral) CPT 77067 Screening mammogram of both breasts including computer-aided detection — enhanced breast X-ray with software assistance for improved cancer detection. |
$376 | $234 | $234 | $234–$234 | $234 | avg | 1 |
| BMP (Basic Metabolic Panel) CPT 80048 Basic metabolic panel — a blood test measuring 8 substances (glucose, calcium, sodium, potassium, CO2, chloride, BUN, creatinine) to assess kidney function, blood sugar, and electrolyte balance. |
— | $17 | $17 | $17–$17 | $17 | -1% | 1 |
| CMP (Comprehensive Metabolic Panel) CPT 80053 Comprehensive metabolic panel — a blood test measuring 14 substances to evaluate kidney and liver function, blood sugar, electrolytes, and protein levels. |
$665 | $21 | $21 | $21–$21 | $21 | avg | 1 |
| Lipid Panel CPT 80061 Lipid panel — a blood test measuring cholesterol levels including total cholesterol, HDL ("good"), LDL ("bad"), and triglycerides to assess heart disease risk. |
— | $27 | $27 | $27–$27 | $27 | avg | 1 |
| Hepatic Function Panel CPT 80076 Hepatic Function Panel — CPT code 80076 covers hepatic function panel performed in a clinical or hospital setting. |
— | $16 | $16 | $16–$16 | $16 | +1% | 1 |
| Urinalysis with Microscopy CPT 81001 Urinalysis with microscopy — a urine test that examines the physical, chemical, and microscopic properties of urine to detect infections, kidney disease, or other conditions. |
— | $6 | $6 | $6–$6 | $6 | +1% | 1 |
| Urinalysis (automated) CPT 81003 Urinalysis (automated) — CPT code 81003 covers urinalysis (automated) performed in a clinical or hospital setting. |
— | $5 | $5 | $5–$5 | $5 | -5% | 1 |
| Vitamin D Level CPT 82306 Vitamin D blood test — measures the level of vitamin D in your blood to check for deficiency. |
— | $59 | $59 | $59–$59 | $59 | avg | 1 |
| Urine Creatinine CPT 82570 Urine Creatinine — CPT code 82570 covers urine creatinine performed in a clinical or hospital setting. |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Ferritin Level CPT 82728 Ferritin Level — CPT code 82728 covers ferritin level performed in a clinical or hospital setting. |
— | $27 | $27 | $27–$27 | $27 | avg | 1 |
| Glucose (blood sugar) CPT 82947 Blood glucose test — measures the level of sugar in your blood, used to screen for and monitor diabetes. |
— | $8 | $8 | $8–$8 | $8 | +1% | 1 |
| Hemoglobin A1C CPT 83036 Hemoglobin A1c test — a blood test that shows your average blood sugar level over the past 2-3 months, used to diagnose and monitor diabetes. |
— | $20 | $20 | $20–$20 | $20 | -2% | 1 |
| Potassium Level CPT 84132 Potassium Level — CPT code 84132 covers potassium level performed in a clinical or hospital setting. |
— | $9 | $9 | $9–$9 | $9 | +5% | 1 |
| PSA (Prostate) CPT 84153 PSA (Prostate) — CPT code 84153 covers psa (prostate) performed in a clinical or hospital setting. |
— | $37 | $37 | $37–$37 | $37 | -1% | 1 |
| Sodium Level CPT 84295 Sodium Level — CPT code 84295 covers sodium level performed in a clinical or hospital setting. |
— | $9 | $9 | $9–$9 | $9 | +5% | 1 |
| TSH (Thyroid) CPT 84443 Thyroid-stimulating hormone (TSH) test — a blood test to check how well your thyroid gland is working. |
— | $34 | $34 | $34–$34 | $34 | -1% | 1 |
| CBC (Complete Blood Count) CPT 85025 Complete blood count (CBC) with differential — a common blood test that measures red blood cells, white blood cells, platelets, and hemoglobin to evaluate overall health. |
$444 | $16 | $16 | $16–$16 | $16 | -3% | 1 |
| PT/INR (Prothrombin Time) CPT 85610 PT/INR (Prothrombin Time) — CPT code 85610 covers pt/inr (prothrombin time) performed in a clinical or hospital setting. |
— | $9 | $9 | $9–$9 | $9 | -2% | 1 |
| TB Skin Test CPT 86580 TB Skin Test — CPT code 86580 covers tb skin test performed in a clinical or hospital setting. |
— | $20 | $20 | $20–$20 | $20 | +2% | 1 |
| Blood Type (ABO) CPT 86900 Blood Type (ABO) — CPT code 86900 covers blood type (abo) performed in a clinical or hospital setting. |
— | $6 | $6 | $6–$6 | $6 | +1% | 1 |
| Chlamydia Test CPT 87491 Chlamydia test — a laboratory test to detect the sexually transmitted infection chlamydia using genetic material from a sample. |
— | $70 | $70 | $70–$70 | $70 | avg | 1 |
| Gonorrhea Test CPT 87591 Gonorrhea test — a laboratory test to detect the sexually transmitted infection gonorrhea using genetic material from a sample. |
— | $70 | $70 | $70–$70 | $70 | avg | 1 |
| Flu Test (rapid) CPT 87804 Flu Test (rapid) — CPT code 87804 covers flu test (rapid) performed in a clinical or hospital setting. |
— | $33 | $33 | $33–$33 | $33 | avg | 1 |
| Pap Smear (ThinPrep) CPT 88175 Pap Smear (ThinPrep) — CPT code 88175 covers pap smear (thinprep) performed in a clinical or hospital setting. |
— | $53 | $53 | $53–$53 | $53 | +1% | 1 |
| Flu Vaccine (high dose) CPT 90662 Flu Vaccine (high dose) — CPT code 90662 covers flu vaccine (high dose) performed in a clinical or hospital setting. |
— | $81 | $81 | $65–$97 | $81 | avg | 1 |
| Tdap Vaccine CPT 90715 Tdap Vaccine — CPT code 90715 covers tdap vaccine performed in a clinical or hospital setting. |
— | $46 | $46 | $37–$55 | $46 | avg | 1 |
| Carotid Ultrasound CPT 93880 Ultrasound — carotid ultrasound. This imaging test uses sound waves to create pictures of organs and structures inside the body. |
— | $389 | $389 | $389–$389 | $389 | avg | 1 |
| Venous Duplex Scan (legs) CPT 93971 Venous Duplex Scan (legs) — CPT code 93971 covers venous duplex scan (legs) performed in a clinical or hospital setting. |
— | $249 | $249 | $249–$249 | $249 | avg | 1 |
| Ceftriaxone Injection 250mg CPT J0696 HCPCS Level II code J0696 — Ceftriaxone Injection 250mg. Healthcare Common Procedure Coding System code for ceftriaxone injection 250mg. |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Triamcinolone Injection CPT J3301 HCPCS Level II code J3301 — Triamcinolone Injection. Healthcare Common Procedure Coding System code for triamcinolone injection. |
— | $1 | $1 | $1–$1 | $1 | -28% | 1 |
| Dexamethasone Injection CPT J1100 HCPCS Level II code J1100 — Dexamethasone Injection. Healthcare Common Procedure Coding System code for dexamethasone injection. |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Endoscopic Carpal Tunnel Release CPT 29848 Endoscopy of wrist, carpal tunnel release |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Shoulder Arthroscopy - Acromioplasty CPT 29826 Arthroscopy, shoulder, surgical, decompression of subacromial space |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Knee Arthroscopy with Meniscus Repair CPT 29882 Arthroscopy, knee, surgical, meniscus repair |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| ACL Reconstruction (Knee Ligament Repair) CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation |
— | $43,264 | $43,264 | $43,264–$43,264 | $43,264 | avg | 1 |
| Colonoscopy with Control of Bleeding CPT 45382 Colonoscopy with control of bleeding |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Colonoscopy with Lesion Removal (hot biopsy) CPT 45384 Colonoscopy with removal of tumor by hot biopsy forceps |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Colonoscopy with Ablation CPT 45388 Colonoscopy with ablation of tumor or polyp |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Colonoscopy with Foreign Body Removal CPT 45390 Colonoscopy with removal of foreign body |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Colonoscopy with Endoscopic Ultrasound CPT 45391 Colonoscopy with endoscopic ultrasound examination |
— | $2,704 | $2,704 | $2,704–$2,704 | $2,704 | avg | 1 |
| Clavicle X-Ray CPT 73000 Radiologic examination of clavicle |
— | $62 | $62 | $62–$62 | $62 | avg | 1 |
| Humerus X-Ray CPT 73060 Radiologic examination of humerus, minimum 2 views |
— | $62 | $62 | $62–$62 | $62 | avg | 1 |
| Elbow X-Ray CPT 73070 Radiologic examination of elbow, 2 views |
— | $54 | $54 | $54–$54 | $54 | avg | 1 |
| Elbow X-Ray (3+ views) CPT 73080 Radiologic examination of elbow, complete, minimum 3 views |
— | $62 | $62 | $62–$62 | $62 | avg | 1 |
| Wrist X-Ray CPT 73100 Radiologic examination of wrist, 2 views |
— | $66 | $66 | $66–$66 | $66 | avg | 1 |
| Wrist X-Ray (3+ views) CPT 73110 Radiologic examination of wrist, complete, minimum 3 views |
— | $83 | $83 | $83–$83 | $83 | avg | 1 |
| Hip X-Ray (2-3 views) CPT 73502 Radiologic examination of hip, 2-3 views |
— | $92 | $92 | $92–$92 | $92 | avg | 1 |
| Femur X-Ray CPT 73552 Radiologic examination of femur, minimum 2 views |
— | $69 | $69 | $69–$69 | $69 | -1% | 1 |
| Knee X-Ray (3 views) CPT 73562 Radiologic examination of knee, 3 views |
— | $80 | $80 | $80–$80 | $80 | avg | 1 |
| Tibia/Fibula X-Ray CPT 73590 Radiologic examination of tibia and fibula, 2 views |
— | $61 | $61 | $61–$61 | $61 | avg | 1 |
| Foot X-Ray (2 views) CPT 73620 Radiologic examination of foot, 2 views |
— | $53 | $53 | $53–$53 | $53 | +1% | 1 |
| Foot X-Ray (3+ views) CPT 73630 Radiologic examination of foot, complete, minimum 3 views |
— | $67 | $67 | $67–$67 | $67 | avg | 1 |
| Abdomen X-Ray (1 view) CPT 74018 Radiologic examination of abdomen, single anteroposterior view |
— | $54 | $54 | $54–$54 | $54 | avg | 1 |
| Abdomen X-Ray (2 views) CPT 74019 Radiologic examination of abdomen, 2 views |
— | $66 | $66 | $66–$66 | $66 | avg | 1 |
| Thyroid Ultrasound CPT 76536 Ultrasound of head and neck, thyroid, real time with image |
— | $215 | $215 | $215–$215 | $215 | avg | 1 |
| Chest Ultrasound CPT 76604 Ultrasound of chest, real time with image documentation |
— | $74 | $74 | $74–$74 | $74 | +1% | 1 |
| Retroperitoneal Ultrasound (complete) CPT 76770 Ultrasound, retroperitoneal, complete |
— | $189 | $189 | $189–$189 | $189 | avg | 1 |
| Retroperitoneal Ultrasound (limited) CPT 76775 Ultrasound, retroperitoneal, limited |
— | $80 | $80 | $80–$80 | $80 | avg | 1 |
| OB Ultrasound (limited) CPT 76815 Ultrasound, pregnant uterus, limited |
— | $129 | $129 | $129–$129 | $129 | avg | 1 |
| Transvaginal OB Ultrasound CPT 76817 Ultrasound, pregnant uterus, transvaginal |
— | $145 | $145 | $145–$145 | $145 | avg | 1 |
| Pelvic Ultrasound (limited) CPT 76857 Ultrasound, pelvic, limited or follow-up |
— | $64 | $64 | $64–$64 | $64 | avg | 1 |
| Scrotal Ultrasound CPT 76870 Ultrasound, scrotum and contents |
— | $180 | $180 | $180–$180 | $180 | avg | 1 |
| Extremity Ultrasound (complete) CPT 76881 Ultrasound, complete joint, real time |
— | $28 | $28 | $28–$28 | $28 | avg | 1 |
| Extremity Ultrasound (limited) CPT 76882 Ultrasound, limited, joint or focal evaluation |
— | $24 | $24 | $24–$24 | $24 | -1% | 1 |
| Bone Age Study CPT 77072 Bone age studies |
— | $43 | $43 | $43–$43 | $43 | avg | 1 |
| Bone Length Studies CPT 77073 Bone length studies |
— | $81 | $81 | $81–$81 | $81 | avg | 1 |
| Bone Survey (complete) CPT 77075 Radiologic examination, osseous survey, complete |
— | $187 | $187 | $187–$187 | $187 | avg | 1 |
| DEXA Scan (Bone Density) CPT 77080 DXA bone density study, axial skeleton |
— | $73 | $73 | $73–$73 | $73 | avg | 1 |
| DEXA Scan (Peripheral) CPT 77081 DXA bone density study, appendicular skeleton |
— | $55 | $55 | $55–$55 | $55 | avg | 1 |
| DEXA Body Composition CPT 77085 DXA bone density study, body composition |
— | $95 | $95 | $95–$95 | $95 | avg | 1 |
| Renal Function Panel CPT 80069 Renal function panel blood test |
— | $18 | $18 | $18–$18 | $18 | -2% | 1 |
| Acute Hepatitis Panel CPT 80074 Acute hepatitis panel blood test |
— | $95 | $95 | $95–$95 | $95 | avg | 1 |
| Urinalysis (non-automated, with microscopy) CPT 81000 Urinalysis by dip stick or tablet reagent, non-automated, with microscopy |
— | $8 | $8 | $8–$8 | $8 | +1% | 1 |
| Urinalysis (non-automated, without microscopy) CPT 81002 Urinalysis without microscopy, non-automated |
— | $7 | $7 | $7–$7 | $7 | -3% | 1 |
| Albumin Level CPT 82040 Albumin, serum, plasma or whole blood |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Amylase Level CPT 82150 Amylase test |
— | $13 | $13 | $13–$13 | $13 | -1% | 1 |
| Bilirubin Total CPT 82247 Bilirubin, total |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Bilirubin Direct CPT 82248 Bilirubin, direct |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Calcium Level CPT 82310 Calcium, total |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| CO2/Bicarbonate Level CPT 82374 Carbon dioxide (bicarbonate) |
— | $9 | $9 | $9–$9 | $9 | +5% | 1 |
| Cholesterol Total CPT 82465 Cholesterol, serum or whole blood, total |
— | $9 | $9 | $9–$9 | $9 | -2% | 1 |
| CK/CPK (Creatine Kinase) CPT 82550 Creatine kinase (CK, CPK), total |
— | $13 | $13 | $13–$13 | $13 | -1% | 1 |
| CK-MB (Heart) CPT 82553 Creatine kinase (CK), MB fraction |
— | $23 | $23 | $23–$23 | $23 | avg | 1 |
| Creatinine Level CPT 82565 Creatinine; blood |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Vitamin B12 Level CPT 82607 Cyanocobalamin (Vitamin B-12) |
— | $30 | $30 | $30–$30 | $30 | +1% | 1 |
| Estradiol Level CPT 82670 Estradiol |
— | $55 | $55 | $55–$55 | $55 | +1% | 1 |
| Folic Acid Level CPT 82746 Folic acid, serum |
— | $29 | $29 | $29–$29 | $29 | avg | 1 |
| IgA Level CPT 82784 Gammaglobulin IgA |
— | $18 | $18 | $18–$18 | $18 | +1% | 1 |
| Blood Gas Panel (ABG) CPT 82803 Gases, blood, any combination of pH, pCO2, pO2 |
— | $52 | $52 | $52–$52 | $52 | avg | 1 |
| Glucose (point of care) CPT 82962 Glucose, blood by glucose monitoring device |
— | $7 | $7 | $7–$7 | $7 | -3% | 1 |
| FSH (Follicle Stimulating Hormone) CPT 83001 Gonadotropin, follicle stimulating hormone (FSH) |
— | $37 | $37 | $37–$37 | $37 | +1% | 1 |
| LH (Luteinizing Hormone) CPT 83002 Gonadotropin, luteinizing hormone (LH) |
— | $37 | $37 | $37–$37 | $37 | +1% | 1 |
| Iron Level CPT 83540 Iron |
— | $13 | $13 | $13–$13 | $13 | -1% | 1 |
| Iron Binding Capacity (TIBC) CPT 83550 Iron binding capacity, total |
— | $18 | $18 | $18–$18 | $18 | -2% | 1 |
| LDH (Lactate Dehydrogenase) CPT 83615 Lactate dehydrogenase (LD, LDH) |
— | $12 | $12 | $12–$12 | $12 | +1% | 1 |
| Lipase Level CPT 83690 Lipase |
— | $14 | $14 | $14–$14 | $14 | -3% | 1 |
| Magnesium Level CPT 83735 Magnesium |
— | $14 | $14 | $14–$14 | $14 | -3% | 1 |
| BNP (Brain Natriuretic Peptide) CPT 83880 Natriuretic peptide (BNP) |
— | $78 | $78 | $78–$78 | $78 | +1% | 1 |
| Parathyroid Hormone (PTH) CPT 83970 Parathormone (parathyroid hormone, PTH) |
— | $83 | $83 | $83–$83 | $83 | -1% | 1 |
| Alkaline Phosphatase CPT 84075 Phosphatase, alkaline |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Phosphorus Level CPT 84100 Phosphorus inorganic (phosphate) |
— | $9 | $9 | $9–$9 | $9 | +5% | 1 |
| Prealbumin Level CPT 84134 Prealbumin |
— | $29 | $29 | $29–$29 | $29 | avg | 1 |
| Progesterone Level CPT 84144 Progesterone |
— | $42 | $42 | $42–$42 | $42 | avg | 1 |
| Prolactin Level CPT 84146 Prolactin |
— | $39 | $39 | $39–$39 | $39 | -1% | 1 |
| Testosterone Total CPT 84403 Testosterone, total |
— | $51 | $51 | $51–$51 | $51 | +1% | 1 |
| Thyroxine Total (T4) CPT 84436 Thyroxine, total |
— | $14 | $14 | $14–$14 | $14 | -3% | 1 |
| Free Thyroxine (Free T4) CPT 84439 Thyroxine, free |
— | $18 | $18 | $18–$18 | $18 | +1% | 1 |
| Transferrin Level CPT 84466 Transferrin |
— | $26 | $26 | $26–$26 | $26 | -1% | 1 |
| Triglycerides CPT 84478 Triglycerides |
— | $12 | $12 | $12–$12 | $12 | -4% | 1 |
| T3 (Triiodothyronine) Total CPT 84480 Triiodothyronine T3, total |
— | $28 | $28 | $28–$28 | $28 | +1% | 1 |
| Free T3 CPT 84481 Triiodothyronine T3, free |
— | $34 | $34 | $34–$34 | $34 | -1% | 1 |
| Troponin (Cardiac) CPT 84484 Troponin, quantitative |
— | $25 | $25 | $25–$25 | $25 | avg | 1 |
| BUN (Blood Urea Nitrogen) CPT 84520 Urea nitrogen, blood (BUN) |
— | $8 | $8 | $8–$8 | $8 | +1% | 1 |
| Uric Acid Level CPT 84550 Uric acid, blood |
— | $9 | $9 | $9–$9 | $9 | -2% | 1 |
| CBC (Automated) CPT 85027 Complete blood count, automated |
— | $13 | $13 | $13–$13 | $13 | -1% | 1 |
| D-Dimer CPT 85379 Fibrin degradation products, D-dimer |
— | $20 | $20 | $20–$20 | $20 | +1% | 1 |
| Sed Rate (ESR) CPT 85652 Sedimentation rate, erythrocyte; automated |
— | $5 | $5 | $5–$5 | $5 | +8% | 1 |
| PTT (Partial Thromboplastin Time) CPT 85730 Thromboplastin time, partial (PTT) |
— | $12 | $12 | $12–$12 | $12 | +1% | 1 |
| Allergen Specific IgE CPT 86003 Allergen specific IgE; quantitative or semiquantitative, each allergen |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| C-Reactive Protein (CRP) CPT 86140 C-reactive protein |
— | $10 | $10 | $10–$10 | $10 | +2% | 1 |
| Cyclic Citrullinated Peptide (CCP) CPT 86200 Cyclic citrullinated peptide (CCP), antibody |
— | $26 | $26 | $26–$26 | $26 | -1% | 1 |
| Nuclear Antigen Antibody (ENA) CPT 86235 Extractable nuclear antigen (ENA) antibody |
— | $36 | $36 | $36–$36 | $36 | avg | 1 |
| CA 125 Tumor Marker CPT 86300 Immunoassay for tumor antigen, CA 125 |
— | $41 | $41 | $41–$41 | $41 | +1% | 1 |
| CA 19-9 Tumor Marker CPT 86304 Immunoassay for tumor antigen, CA 19-9 |
— | $41 | $41 | $41–$41 | $41 | +1% | 1 |
| Rheumatoid Factor CPT 86431 Rheumatoid factor, quantitative |
— | $12 | $12 | $12–$12 | $12 | -4% | 1 |
| TB Blood Test (QuantiFERON) CPT 86480 Tuberculosis test, cell mediated immunity antigen response |
— | $124 | $124 | $124–$124 | $124 | avg | 1 |
| Syphilis Test (RPR/VDRL) CPT 86592 Syphilis test, non-treponemal antibody; qualitative |
— | $9 | $9 | $9–$9 | $9 | -2% | 1 |
| Helicobacter Pylori Antibody CPT 86677 Antibody, Helicobacter pylori |
— | $34 | $34 | $34–$34 | $34 | -1% | 1 |
| Herpes Simplex Antibody CPT 86695 Antibody, herpes simplex, type specific |
— | $26 | $26 | $26–$26 | $26 | +1% | 1 |
| Hepatitis A Antibody CPT 86696 Antibody, hepatitis A |
— | $39 | $39 | $39–$39 | $39 | -1% | 1 |
| Hepatitis B Core Antibody CPT 86704 Hepatitis B core antibody (HBcAb); total |
— | $24 | $24 | $24–$24 | $24 | +1% | 1 |
| Hepatitis B Surface Antibody CPT 86706 Hepatitis B surface antibody (HBsAb) |
— | $22 | $22 | $22–$22 | $22 | -2% | 1 |
| Rubella Antibody CPT 86762 Antibody, rubella |
— | $28 | $28 | $28–$28 | $28 | +1% | 1 |
| Rubeola (Measles) Antibody CPT 86765 Antibody, rubeola |
— | $26 | $26 | $26–$26 | $26 | -1% | 1 |
| Varicella Antibody (Chickenpox) CPT 86787 Antibody, varicella-zoster |
— | $26 | $26 | $26–$26 | $26 | -1% | 1 |
| Hepatitis C Antibody CPT 86803 Hepatitis C antibody |
— | $28 | $28 | $28–$28 | $28 | +1% | 1 |
| Antibody Screen (RBC) CPT 86850 Antibody screen, RBC, each serum technique |
— | $20 | $20 | $20–$20 | $20 | -2% | 1 |
| Rh Blood Type CPT 86901 Blood typing, Rh (D) |
— | $6 | $6 | $6–$6 | $6 | +1% | 1 |
| Bacterial Culture CPT 87070 Culture, bacterial; any other source except urine, blood or stool |
— | $17 | $17 | $17–$17 | $17 | -1% | 1 |
| Bacterial Culture (aerobic isolate) CPT 87077 Culture, bacterial; aerobic isolate, additional methods |
— | $16 | $16 | $16–$16 | $16 | +1% | 1 |
| Culture, presumptive (screen) CPT 87081 Culture, presumptive, pathogenic organisms, screening only |
— | $14 | $14 | $14–$14 | $14 | -3% | 1 |
| Urine Culture CPT 87086 Culture, bacterial; quantitative colony count, urine |
— | $16 | $16 | $16–$16 | $16 | +1% | 1 |
| Chlamydia Culture CPT 87110 Culture, chlamydia |
— | $39 | $39 | $39–$39 | $39 | +1% | 1 |
| Antibiotic Sensitivity (MIC) CPT 87186 Susceptibility studies, antimicrobial agent; microdilution or agar dilution |
— | $18 | $18 | $18–$18 | $18 | -2% | 1 |
| Gram Stain CPT 87205 Smear, primary source with interpretation; Gram or Giemsa stain |
— | $9 | $9 | $9–$9 | $9 | -2% | 1 |
| Hepatitis B Surface Antigen CPT 87340 Infectious agent antigen detection; hepatitis B surface antigen (HBsAg) |
— | $20 | $20 | $20–$20 | $20 | +1% | 1 |
| HIV-1/HIV-2 Antibody Test CPT 87389 HIV-1 and HIV-2, single result, immunoassay |
— | $48 | $48 | $48–$48 | $48 | avg | 1 |
| Flu Test (PCR/molecular) CPT 87502 Infectious agent detection, influenza, multiplex reverse transcription |
— | $191 | $191 | $191–$191 | $191 | avg | 1 |
| Mycobacterium TB Detection CPT 87580 Infectious agent detection, Mycobacterium tuberculosis, amplified probe |
— | $40 | $40 | $40–$40 | $40 | avg | 1 |
| HPV High-Risk Test CPT 87624 Infectious agent detection, human papillomavirus (HPV), high-risk types |
— | $70 | $70 | $70–$70 | $70 | avg | 1 |
| Strep Test (rapid) CPT 87880 Infectious agent antigen detection, Streptococcus, group A |
— | $33 | $33 | $33–$33 | $33 | avg | 1 |
| Venipuncture (age 3+) CPT 36410 Venipuncture, age 3 years or older, necessitating physician skill |
— | $12 | $12 | $12–$12 | $12 | -1% | 1 |
| Hepatitis A Vaccine (adult) CPT 90632 Hepatitis A vaccine, adult dosage |
— | $82 | $82 | $69–$94 | $82 | -1% | 1 |
| Hepatitis A & B Vaccine (combo) CPT 90636 Hepatitis A and hepatitis B vaccine, adult dosage |
— | $107 | $107 | $65–$148 | $107 | avg | 1 |
| Hib Vaccine CPT 90647 Haemophilus influenzae type b vaccine |
— | $50 | $50 | $35–$65 | $50 | avg | 1 |
| HPV Vaccine (9-valent) CPT 90651 Human papillomavirus vaccine, 9-valent, 3 dose schedule |
— | $217 | $217 | $65–$369 | $217 | avg | 1 |
| Pneumococcal Vaccine (PCV13) CPT 90670 Pneumococcal conjugate vaccine, 13 valent |
— | $254 | $254 | $254–$254 | $254 | avg | 1 |
| Rotavirus Vaccine CPT 90681 Rotavirus vaccine, human, attenuated |
— | $115 | $115 | $65–$165 | $115 | avg | 1 |
| Flu Vaccine (quadrivalent) CPT 90686 Influenza virus vaccine, quadrivalent, preservative free |
— | $44 | $44 | $22–$65 | $44 | -1% | 1 |
| DTaP-IPV Vaccine CPT 90696 Diphtheria, tetanus, acellular pertussis and polio vaccine |
— | $68 | $68 | $65–$70 | $68 | avg | 1 |
| MMR Vaccine CPT 90707 Measles, mumps, rubella vaccine |
— | $86 | $86 | $65–$107 | $86 | avg | 1 |
| MMRV Vaccine CPT 90710 Measles, mumps, rubella, and varicella vaccine |
— | $194 | $194 | $65–$324 | $194 | avg | 1 |
| Polio Vaccine (IPV) CPT 90713 Poliovirus vaccine, inactivated |
— | $59 | $59 | $54–$65 | $59 | avg | 1 |
| Td Vaccine (adult) CPT 90714 Tetanus and diphtheria toxoids, adult, preservative free |
— | $44 | $44 | $37–$51 | $44 | avg | 1 |
| Varicella (Chickenpox) Vaccine CPT 90716 Varicella virus vaccine, live |
— | $140 | $140 | $65–$215 | $140 | avg | 1 |
| Pneumococcal Vaccine (PPSV23) CPT 90732 Pneumococcal polysaccharide vaccine, 23-valent |
— | $131 | $131 | $131–$131 | $131 | avg | 1 |
| Shingles Vaccine (Zoster) CPT 90736 Zoster (shingles) vaccine, live |
— | $65 | $65 | $65–$65 | $65 | avg | 1 |
| Hepatitis B Vaccine (adult) CPT 90746 Hepatitis B vaccine, adult dosage |
— | $81 | $81 | $81–$81 | $81 | avg | 1 |
| Shingles Vaccine (Shingrix) CPT 90750 Zoster vaccine, recombinant, adjuvanted |
— | $153 | $153 | $65–$241 | $153 | avg | 1 |
| Laparoscopy with Lysis of Adhesions CPT 58660 Laparoscopy, lysis of adhesions |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Endometriosis Excision CPT 58662 Laparoscopy with fulguration or excision of lesions of ovary/peritoneum |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Tubal Ligation CPT 58670 Laparoscopy, surgical, with fulguration of oviducts |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Laparoscopic Partial Colectomy CPT 44204 Laparoscopic partial colectomy with anastomosis |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Diagnostic Laparoscopy CPT 49320 Laparoscopy, abdomen, diagnostic |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Ankle-Brachial Index (ABI) CPT 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries |
— | $178 | $178 | $178–$178 | $178 | avg | 1 |
| Complete Bilateral Extremity Study CPT 93923 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries |
— | $271 | $271 | $271–$271 | $271 | avg | 1 |
| Lower Extremity Arterial Duplex CPT 93925 Duplex scan of lower extremity arteries, complete bilateral study |
— | $516 | $516 | $516–$516 | $516 | avg | 1 |
| Venous Duplex Scan (complete) CPT 93970 Duplex scan of extremity veins, complete bilateral study |
— | $395 | $395 | $395–$395 | $395 | avg | 1 |
| Aorta/IVC/Iliac Duplex Scan CPT 93978 Duplex scan of aorta, inferior vena cava, iliac vasculature |
— | $363 | $363 | $363–$363 | $363 | avg | 1 |
| Cytopathology (fluids) CPT 88104 Cytopathology, fluids, washings or brushings, smears with interpretation |
— | $86 | $86 | $86–$86 | $86 | avg | 1 |
| Cytopathology (concentration technique) CPT 88108 Cytopathology, concentration technique, smears and interpretation |
— | $89 | $89 | $89–$89 | $89 | avg | 1 |
| Cytopathology (selective cellular enhancement) CPT 88112 Cytopathology, selective cellular enhancement technique with interpretation |
— | $81 | $81 | $81–$81 | $81 | -1% | 1 |
| Pap Smear - Physician Interpretation CPT 88141 Cytopathology, cervical or vaginal, requiring interpretation by physician |
— | $30 | $30 | $30–$30 | $30 | avg | 1 |
| Pap Smear - ThinPrep (automated) CPT 88142 Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer |
— | $41 | $41 | $41–$41 | $41 | -1% | 1 |
| Cytopathology (smears, any source) CPT 88160 Cytopathology, smears, any other source, screening and interpretation |
— | $101 | $101 | $101–$101 | $101 | avg | 1 |
| Flow Cytometry (first marker) CPT 88184 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, first marker |
— | $150 | $150 | $150–$150 | $150 | avg | 1 |
| Flow Cytometry (each additional marker) CPT 88185 Flow cytometry, each additional marker |
— | $48 | $48 | $48–$48 | $48 | avg | 1 |
| Surgical Pathology (gross only) CPT 88300 Level I surgical pathology, gross examination only |
— | $24 | $24 | $24–$24 | $24 | -1% | 1 |
| Surgical Pathology (gross & micro) CPT 88302 Level II surgical pathology, gross and microscopic examination |
— | $53 | $53 | $53–$53 | $53 | avg | 1 |
| Surgical Pathology (Level III) CPT 88304 Level III surgical pathology |
— | $64 | $64 | $64–$64 | $64 | -1% | 1 |
| Surgical Pathology (Level IV) CPT 88305 Level IV surgical pathology, each specimen |
— | $70 | $70 | $70–$70 | $70 | +1% | 1 |
| Surgical Pathology (Level V) CPT 88307 Level V surgical pathology, each specimen |
— | $423 | $423 | $423–$423 | $423 | avg | 1 |
| Surgical Pathology (Level VI) CPT 88309 Level VI surgical pathology, each specimen |
— | $597 | $597 | $597–$597 | $597 | avg | 1 |
| Special Stain (Group I) CPT 88312 Special stain including interpretation and report, Group I |
— | $175 | $175 | $175–$175 | $175 | avg | 1 |
| Immunohistochemistry (first antibody) CPT 88342 Immunohistochemistry, each antibody, per specimen, first stain |
— | $133 | $133 | $133–$133 | $133 | avg | 1 |
| Botulinum Toxin A (Botox) Injection CPT J0585 Injection, onabotulinumtoxinA, 1 unit |
— | $6 | $6 | $6–$6 | $6 | +3% | 1 |
| Testosterone Injection CPT J1071 Injection, testosterone cypionate, 1 mg |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Diphenhydramine (Benadryl) Injection CPT J1200 Injection, diphenhydramine HCl, up to 50 mg |
— | $1 | $1 | $1–$1 | $1 | -31% | 1 |
| Heparin Injection (per 10 units) CPT J1642 Injection, heparin sodium, per 10 units |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Ketorolac (Toradol) Injection CPT J1885 Injection, ketorolac tromethamine, per 15 mg |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Meperidine (Demerol) Injection CPT J2175 Injection, meperidine hydrochloride, per 100 mg |
— | $8 | $8 | $8–$8 | $8 | -1% | 1 |
| Midazolam Injection CPT J2250 Injection, midazolam hydrochloride, per 1 mg |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Morphine Injection CPT J2270 Injection, morphine sulfate, up to 10 mg |
— | $3 | $3 | $3–$3 | $3 | -2% | 1 |
| Ondansetron (Zofran) Injection CPT J2405 Injection, ondansetron hydrochloride, per 1 mg |
— | $0 | $0 | $0–$1 | — | — | 1 |
| Promethazine (Phenergan) Injection CPT J2550 Injection, promethazine HCl, up to 50 mg |
— | $4 | $4 | $4–$4 | $4 | -4% | 1 |
| Propofol Injection CPT J2704 Injection, propofol, 10 mg |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Ropivacaine Injection CPT J2795 Injection, ropivacaine hydrochloride, 1 mg |
— | $0 | $0 | $0–$0 | — | — | 1 |
| Fentanyl Injection CPT J3010 Injection, fentanyl citrate, 0.1 mg |
— | $1 | $1 | $1–$1 | $1 | +16% | 1 |
| Normal Saline (1000 ml) CPT J7120 Ringers lactate infusion, up to 1000 cc |
— | $2 | $2 | $2–$2 | $2 | +16% | 1 |
| Normal Saline Infusion (1000 cc) CPT J7030 Infusion, normal saline solution, 1000 cc |
— | $2 | $2 | $2–$2 | $2 | -3% | 1 |
| Normal Saline with Dextrose (500 ml) CPT J7040 Infusion, normal saline solution, sterile, 500 ml |
— | $1 | $1 | $1–$1 | $1 | +25% | 1 |
| Normal Saline Infusion (250 cc) CPT J7050 Infusion, normal saline solution, 250 cc |
— | $1 | $1 | $1–$1 | $1 | -35% | 1 |
| Lap-Band Surgery (Laparoscopic Gastric Band) CPT 43770 Lap-Band Surgery (Laparoscopic Gastric Band) — CPT code 43770 covers lap-band surgery (laparoscopic gastric band) performed in a clinical or hospital setting. |
— | $32,448 | $32,448 | $32,448–$32,448 | $32,448 | avg | 1 |
| Embryo Culture (IVF Lab) CPT 89250 Embryo Culture (IVF Lab) — CPT code 89250 covers embryo culture (ivf lab) performed in a clinical or hospital setting. |
— | $2,171 | $2,171 | $2,171–$2,171 | $2,171 | avg | 1 |
| Assisted Embryo Hatching (IVF) CPT 89253 Assisted Embryo Hatching (IVF) — CPT code 89253 covers assisted embryo hatching (ivf) performed in a clinical or hospital setting. |
— | $204 | $204 | $204–$204 | $204 | avg | 1 |
| Egg/Embryo Freezing (Cryopreservation) CPT 89258 Egg/Embryo Freezing (Cryopreservation) — CPT code 89258 covers egg/embryo freezing (cryopreservation) performed in a clinical or hospital setting. |
— | $1,009 | $1,009 | $1,009–$1,009 | $1,009 | avg | 1 |
| IVF Fertilization (Oocyte Insemination) CPT 89268 IVF Fertilization (Oocyte Insemination) — CPT code 89268 covers ivf fertilization (oocyte insemination) performed in a clinical or hospital setting. |
— | $204 | $204 | $204–$204 | $204 | avg | 1 |
| Extended Embryo Culture (IVF) CPT 89272 Extended Embryo Culture (IVF) — CPT code 89272 covers extended embryo culture (ivf) performed in a clinical or hospital setting. |
— | $1,009 | $1,009 | $1,009–$1,009 | $1,009 | avg | 1 |
| Lumbar Laminectomy (Each Additional Level) CPT 63048 Lumbar Laminectomy (Each Additional Level) — CPT code 63048 covers lumbar laminectomy (each additional level) performed in a clinical or hospital setting. |
— | $59,488 | $59,488 | $59,488–$59,488 | $59,488 | avg | 1 |
Prices are typical ranges based on Polk Medical Center's published transparency data, including actual allowed amounts calculated from insurer remittance (ERA) data per CMS v3.0 requirements. Your actual cost depends on your specific plan, deductible status, and clinical details.
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As a nonprofit hospital, Polk Medical Center is required under IRS Section 501(r) to offer a financial assistance program (also called "charity care").
Patients at or below 300% of the Federal Poverty Level generally qualify for reduced or free care. You can apply as soon as care is received — through the hospital's financial counseling office, online portal, or billing department.
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▸ Technical Details
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare Provider #
111330
Emergency Services
Yes
Metro Area
Cedartown, GA
Procedures Tracked
259
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