CMS Shoppable Services
#
Code
Description
Available
1
45380
Biopsy of Large Bowel, Using an Endoscope
Yes
2
55700
Biopsy of prostate gland
No
3
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
Yes
4
80048
Blood test, basic group of blood chemicals
No
5
85610
Blood test, clotting time
No
6
80053
Blood test, comprehensive group of blood chemicals
No
7
80061
Blood test, lipids (cholesterol and triglycerides)
No
8
84443
Blood test, thyroid stimulating hormone (TSH)
No
9
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
No
10
473
Cervical spinal fusion without complications
No
11
85730
Coagulation assessment blood test
No
12
45378
Colonscopy
Yes
13
85025
Complete blood cell count - automated differential WBC count
No
14
85027
Complete blood cell count - automated test with out Differential
No
15
74177
CT Abdomen & Pelvis with Contrast
Yes
16
70450
CT Head Brain without Contrast
Yes
17
72193
CT Pelvis with Contrast
Yes
18
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
Yes
19
77066
Diagnostic mammography, bilateral
Yes
20
77065
Diagnostic mammography, unilateral
Yes
21
62323
Epidural Injection Thoracic
No
22
90846
Family psychotherapy
Yes
23
90847
Family psychotherapy including patient
Yes
24
47562
Gallbladder Removal Using an Endoscope
Yes
25
90853
Group psychotherapy
Yes
26
99385
Initial new patient preventative medicine evaluation (18-39 years)
Yes
27
99386
Initial new patient preventative medicine evaluation (40-64 years)
Yes
28
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
No
29
62322
Injection of substance into spinal canal or lower back using imaging
No
30
93452
Insertion of catheter into left heart for diagnosis
No
31
80069
Kidney Function Blood Test Panel
No
32
80076
Liver function blood test panel
No
33
81000
Manual urinalysis test with examination using microscope
No
34
70553
MRI Brain with and without Conrast
Yes
35
73721
MRI Leg Joint without Contrast
Yes
36
72148
MRI Spine Lumbar without Contrast
Yes
37
99204
New patient office or other outpatient visit, typically 45 min
Yes
38
99203
New patient ofice visit, complex
Yes
39
99205
New patient ofice visit, comprehensive visit
Yes
40
80055
Obstetric panel (includes HIV testing)
No
41
99244
Office consultation - new or established patient - 60 min
Yes
42
99243
Office visit consultation, complex
Yes
43
97110
Physical Therapy Exercise, 15 Minutes
No
44
84153
PSA (prostate specific antigen) measurement
No
45
84154
PSA Measurement; Free
No
46
90832
Psychotherapy, 30 minutes with patient
Yes
47
90834
Psychotherapy, 45 minutes with patient
Yes
48
90837
Psychotherapy, 60 minutes with patient
Yes
49
19120
Removal of 1 or more breast growth, open procedure
Yes
50
66984
Removal of cataract with insertion of lens
No
51
29881
Removal of one knee cartilage using an endoscope
No
52
45385
Removal of Polyps in Large Bowel, Using an Endoscope
Yes
53
66821
Removal of recurring cataract in lens capsule using laser
No
54
42820
Removal of tonsils and adenoid glands patient younger than age 12
No
55
49505
Repair of groin hernia patient age 5 years or older
Yes
56
93000
Routine electrocardiogram
No
57
59510
Routine obstetric care for cesarean delivery, including pre and post
No
58
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
No
59
59400
Routine obstetric care for vaginal delivery, including pre and post
No
60
77067
Screening Mammography, Bilateral, with CAD
Yes
61
29826
Shaving of shoulder bone using an endoscope
No
62
95810
Sleep monitoring of patient (6 years or older) in sleep lab
No
63
460
Spinal fusion other than the neck without major complications
Yes
64
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
No
65
470
Total Knee or Hip Replacement
No
66
76700
Ultrasound Abdomen - Complete
Yes
67
45391
Ultrasound examination of lower large bowel using an endoscope
No
68
76830
Ultrasound Pelvis through Vagina
Yes
69
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
Yes
70
81001
Urinalysis with Examination, using Microscope
No
71
81003
Urinalysis, Automated Test
No
72
81002
Urinalysis, Manual Test
No
73
743
Uterus or Ovary Surgery Not Related to Cancer without complications
No
74
72110
X-Ray Lower Sacral Spine, 4 or More Views
Yes

This link leads to the downloadable machine-readable file of all items and services provided by this facility as required by CMS. Please be advised the file size may exceed 1.5 gigabytes and therefore may take an extended amount of time to download depending on each individual user’s internet speed, bandwidth, connectivity, available hard drive space, etc.

STEP 1 - ENTER INSURANCE COVERAGE
STEP 2 - CHOOSE YOUR SERVICE
STEP 1 - CHOOSE YOUR COVERAGE

Enter Yearly Deductible:

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Enter Deductible Already Paid:

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Enter Co-Pay:

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Enter Co-Insurance %:

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Out-of-Pocket Max Amount:

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Professional Fees

Professional Fees includes charges for employed physicians and non-physician practitioners. Patient may receive a separate bill for physicians and non-physician practitioners who are not employed by the hospital.

CMS Shoppable Services
#
Code
Description
Available
1
45380
Biopsy of Large Bowel, Using an Endoscope
Yes
2
55700
Biopsy of prostate gland
No
3
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
Yes
4
80048
Blood test, basic group of blood chemicals
No
5
85610
Blood test, clotting time
No
6
80053
Blood test, comprehensive group of blood chemicals
No
7
80061
Blood test, lipids (cholesterol and triglycerides)
No
8
84443
Blood test, thyroid stimulating hormone (TSH)
No
9
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
No
10
473
Cervical spinal fusion without complications
No
11
85730
Coagulation assessment blood test
No
12
45378
Colonscopy
Yes
13
85025
Complete blood cell count - automated differential WBC count
No
14
85027
Complete blood cell count - automated test with out Differential
No
15
74177
CT Abdomen & Pelvis with Contrast
Yes
16
70450
CT Head Brain without Contrast
Yes
17
72193
CT Pelvis with Contrast
Yes
18
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
Yes
19
77066
Diagnostic mammography, bilateral
Yes
20
77065
Diagnostic mammography, unilateral
Yes
21
62323
Epidural Injection Thoracic
No
22
90846
Family psychotherapy
Yes
23
90847
Family psychotherapy including patient
Yes
24
47562
Gallbladder Removal Using an Endoscope
Yes
25
90853
Group psychotherapy
Yes
26
99385
Initial new patient preventative medicine evaluation (18-39 years)
Yes
27
99386
Initial new patient preventative medicine evaluation (40-64 years)
Yes
28
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
No
29
62322
Injection of substance into spinal canal or lower back using imaging
No
30
93452
Insertion of catheter into left heart for diagnosis
No
31
80069
Kidney Function Blood Test Panel
No
32
80076
Liver function blood test panel
No
33
81000
Manual urinalysis test with examination using microscope
No
34
70553
MRI Brain with and without Conrast
Yes
35
73721
MRI Leg Joint without Contrast
Yes
36
72148
MRI Spine Lumbar without Contrast
Yes
37
99204
New patient office or other outpatient visit, typically 45 min
Yes
38
99203
New patient ofice visit, complex
Yes
39
99205
New patient ofice visit, comprehensive visit
Yes
40
80055
Obstetric panel (includes HIV testing)
No
41
99244
Office consultation - new or established patient - 60 min
Yes
42
99243
Office visit consultation, complex
Yes
43
97110
Physical Therapy Exercise, 15 Minutes
No
44
84153
PSA (prostate specific antigen) measurement
No
45
84154
PSA Measurement; Free
No
46
90832
Psychotherapy, 30 minutes with patient
Yes
47
90834
Psychotherapy, 45 minutes with patient
Yes
48
90837
Psychotherapy, 60 minutes with patient
Yes
49
19120
Removal of 1 or more breast growth, open procedure
Yes
50
66984
Removal of cataract with insertion of lens
No
51
29881
Removal of one knee cartilage using an endoscope
No
52
45385
Removal of Polyps in Large Bowel, Using an Endoscope
Yes
53
66821
Removal of recurring cataract in lens capsule using laser
No
54
42820
Removal of tonsils and adenoid glands patient younger than age 12
No
55
49505
Repair of groin hernia patient age 5 years or older
Yes
56
93000
Routine electrocardiogram
No
57
59510
Routine obstetric care for cesarean delivery, including pre and post
No
58
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
No
59
59400
Routine obstetric care for vaginal delivery, including pre and post
No
60
77067
Screening Mammography, Bilateral, with CAD
Yes
61
29826
Shaving of shoulder bone using an endoscope
No
62
95810
Sleep monitoring of patient (6 years or older) in sleep lab
No
63
460
Spinal fusion other than the neck without major complications
Yes
64
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
No
65
470
Total Knee or Hip Replacement
No
66
76700
Ultrasound Abdomen - Complete
Yes
67
45391
Ultrasound examination of lower large bowel using an endoscope
No
68
76830
Ultrasound Pelvis through Vagina
Yes
69
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
Yes
70
81001
Urinalysis with Examination, using Microscope
No
71
81003
Urinalysis, Automated Test
No
72
81002
Urinalysis, Manual Test
No
73
743
Uterus or Ovary Surgery Not Related to Cancer without complications
No
74
72110
X-Ray Lower Sacral Spine, 4 or More Views
Yes
Yearly Deductible

Your Yearly Deductible is the amount you must pay out-of-pocket for each benefit period (typically 12 months) before the insurance company will start paying. For example, if your deductible is $500, then you must pay the first $500 of your bills during the benefit period.

Deductible Already Paid

This is the Deductible amount you have already paid during the current benefit period. For example, if your deductible is $1,000 per benefit period and you had a medical service performed for $300, then you paid this full $300 medical service out-of-pocket, and you have $700 remaining on your deductible.

Co-Pay

A Co-Pay or Co-Payment is a fixed amount that you pay out-of-pocket each time you go to a hospital for a medical service. For example, if you have a S20.00 Co-Pay that means you owe this amount every time you have a medical service and this amount is separate from the amount you will be billed for your deductible and co-insurance.

Co-Insurance Percentage

This is the percentage amount that your insurance coverage pays after your deductible has been met. For example, if you have a $1,000 deductible and a 20% Co-Insurance, then for a $2,500 surgery bill, you would pay the first $1,000 as your deductible. The balance would be $1,500 ($2,500 less $1,000). Of the remaining $1,500, you would pay 20% per your Co-Insurance and your insurance company would pay the remaining 80% of the balance. In particular, your 20% Co-Insurance payment of the balance would be S300 (20% of $1,500) and the insurance company would pay $1,200 (80% of S1,500).

Out-of-Pocket Max Amount

This is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.

Your Out-of-Pocket Max Amount may be found on the back of your insurance card or in the Summary of Benefits and Coverage provided to you by your health plan.