CMS Shoppable Services
#
Code
Description
Available
1
90832
Psychotherapy, 30 minutes with patient
N/A
2
90834
Psychotherapy, 45 minutes with patient
N/A
3
90837
Psychotherapy, 60 minutes with patient
N/A
4
90846
Family psychotherapy
N/A
5
90847
Family psychotherapy including patient
N/A
6
90853
Group psychotherapy
N/A
7
99203
New patient ofice visit, complex
YES
8
99204
New patient office or other outpatient visit, typically 45 min
YES
9
99205
New patient ofice visit, comprehensive visit
YES
10
99243
Office visit consultation, complex
N/A
11
99244
Office consultation - new or established patient - 60 min
N/A
12
99385
Initial new patient preventative medicine evaluation (18-39 years)
N/A
13
99386
Initial new patient preventative medicine evaluation (40-64 years)
N/A
14
80048
Blood test, basic group of blood chemicals
YES
15
80053
Blood test, comprehensive group of blood chemicals
YES
16
80055
Obstetric panel (includes HIV testing)
N/A
17
80061
Blood test, lipids (cholesterol and triglycerides)
YES
18
80069
Kidney Function Blood Test Panel
YES
19
80076
Liver function blood test panel
YES
20
81000
Manual urinalysis test with examination using microscope
N/A
21
81001
Urinalysis with Examination, using Microscope
YES
22
81002
Urinalysis, Manual Test
YES
23
81003
Urinalysis, Automated Test
YES
24
84153
PSA (prostate specific antigen) measurement
YES
25
84154
PSA Measurement; Free
YES
26
84443
Blood test, thyroid stimulating hormone (TSH)
YES
27
85025
Complete blood cell count - automated differential WBC count
YES
28
85027
Complete blood cell count - automated test with out Differential
YES
29
85610
Blood test, clotting time
YES
30
85730
Coagulation assessment blood test
YES
31
70450
CT Head Brain without Contrast
YES
32
70553
MRI Brain with and without Conrast
YES
33
72110
X-Ray Lower Sacral Spine, 4 or More Views
YES
34
72148
MRI Spine Lumbar without Contrast
YES
35
72193
CT Pelvis with Contrast
YES
36
73721
MRI Leg Joint without Contrast
YES
37
74177
CT Abdomen & Pelvis with Contrast
YES
38
76700
Ultrasound Abdomen - Complete
YES
39
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
YES
40
76830
Ultrasound Pelvis through Vagina
YES
41
77065
Diagnostic mammography, unilateral
YES
42
77066
Diagnostic mammography, bilateral
YES
43
77067
Screening Mammography, Bilateral, with CAD
YES
44
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
N/A
45
460
Spinal fusion other than the neck without major complications
N/A
46
470
Total Knee or Hip Replacement
N/A
47
473
Cervical spinal fusion without complications
N/A
48
743
Uterus or Ovary Surgery Not Related to Cancer without complications
N/A
49
19120
Removal of 1 or more breast growth, open procedure
YES
50
29826
Shaving of shoulder bone using an endoscope
YES
51
29881
Removal of one knee cartilage using an endoscope
YES
52
42820
Removal of tonsils and adenoid glands patient younger than age 12
N/A
53
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
YES
54
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
YES
55
45378
Colonscopy
YES
56
45380
Biopsy of Large Bowel, Using an Endoscope
YES
57
45385
Removal of Polyps in Large Bowel, Using an Endoscope
YES
58
45391
Ultrasound examination of lower large bowel using an endoscope
N/A
59
47562
Gallbladder Removal Using an Endoscope
YES
60
49505
Repair of groin hernia patient age 5 years or older
YES
61
55700
Biopsy of prostate gland
N/A
62
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
N/A
63
59400
Routine obstetric care for vaginal delivery, including pre and post
N/A
64
59510
Routine obstetric care for cesarean delivery, including pre and post
N/A
65
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
N/A
66
62322
Injection of substance into spinal canal or lower back using imaging
N/A
67
62323
Epidural Injection Thoracic
N/A
68
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
N/A
69
66821
Removal of recurring cataract in lens capsule using laser
N/A
70
66984
Removal of cataract with insertion of lens
N/A
71
93000
Routine electrocardiogram
N/A
72
93452
Insertion of catheter into left heart for diagnosis
N/A
73
95810
Sleep monitoring of patient (6 years or older) in sleep lab
YES
74
97110
Physical Therapy Exercise, 15 Minutes
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:

*

Enter Deductible Already Paid:

*

Enter Co-Pay:

*

Enter Co-Insurance %:

*

Out-of-Pocket Max Amount:

*

*-Required Field
All Required fields must be completed to receive an estimate.

STEP 2 - CHOOSE YOUR SERVICE
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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
90832
Psychotherapy, 30 minutes with patient
N/A
2
90834
Psychotherapy, 45 minutes with patient
N/A
3
90837
Psychotherapy, 60 minutes with patient
N/A
4
90846
Family psychotherapy
N/A
5
90847
Family psychotherapy including patient
N/A
6
90853
Group psychotherapy
N/A
7
99203
New patient ofice visit, complex
YES
8
99204
New patient office or other outpatient visit, typically 45 min
YES
9
99205
New patient ofice visit, comprehensive visit
YES
10
99243
Office visit consultation, complex
N/A
11
99244
Office consultation - new or established patient - 60 min
N/A
12
99385
Initial new patient preventative medicine evaluation (18-39 years)
N/A
13
99386
Initial new patient preventative medicine evaluation (40-64 years)
N/A
14
80048
Blood test, basic group of blood chemicals
YES
15
80053
Blood test, comprehensive group of blood chemicals
YES
16
80055
Obstetric panel (includes HIV testing)
N/A
17
80061
Blood test, lipids (cholesterol and triglycerides)
YES
18
80069
Kidney Function Blood Test Panel
YES
19
80076
Liver function blood test panel
YES
20
81000
Manual urinalysis test with examination using microscope
N/A
21
81001
Urinalysis with Examination, using Microscope
YES
22
81002
Urinalysis, Manual Test
YES
23
81003
Urinalysis, Automated Test
YES
24
84153
PSA (prostate specific antigen) measurement
YES
25
84154
PSA Measurement; Free
YES
26
84443
Blood test, thyroid stimulating hormone (TSH)
YES
27
85025
Complete blood cell count - automated differential WBC count
YES
28
85027
Complete blood cell count - automated test with out Differential
YES
29
85610
Blood test, clotting time
YES
30
85730
Coagulation assessment blood test
YES
31
70450
CT Head Brain without Contrast
YES
32
70553
MRI Brain with and without Conrast
YES
33
72110
X-Ray Lower Sacral Spine, 4 or More Views
YES
34
72148
MRI Spine Lumbar without Contrast
YES
35
72193
CT Pelvis with Contrast
YES
36
73721
MRI Leg Joint without Contrast
YES
37
74177
CT Abdomen & Pelvis with Contrast
YES
38
76700
Ultrasound Abdomen - Complete
YES
39
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
YES
40
76830
Ultrasound Pelvis through Vagina
YES
41
77065
Diagnostic mammography, unilateral
YES
42
77066
Diagnostic mammography, bilateral
YES
43
77067
Screening Mammography, Bilateral, with CAD
YES
44
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
N/A
45
460
Spinal fusion other than the neck without major complications
N/A
46
470
Total Knee or Hip Replacement
N/A
47
473
Cervical spinal fusion without complications
N/A
48
743
Uterus or Ovary Surgery Not Related to Cancer without complications
N/A
49
19120
Removal of 1 or more breast growth, open procedure
YES
50
29826
Shaving of shoulder bone using an endoscope
YES
51
29881
Removal of one knee cartilage using an endoscope
YES
52
42820
Removal of tonsils and adenoid glands patient younger than age 12
N/A
53
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
YES
54
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
YES
55
45378
Colonscopy
YES
56
45380
Biopsy of Large Bowel, Using an Endoscope
YES
57
45385
Removal of Polyps in Large Bowel, Using an Endoscope
YES
58
45391
Ultrasound examination of lower large bowel using an endoscope
N/A
59
47562
Gallbladder Removal Using an Endoscope
YES
60
49505
Repair of groin hernia patient age 5 years or older
YES
61
55700
Biopsy of prostate gland
N/A
62
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
N/A
63
59400
Routine obstetric care for vaginal delivery, including pre and post
N/A
64
59510
Routine obstetric care for cesarean delivery, including pre and post
N/A
65
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
N/A
66
62322
Injection of substance into spinal canal or lower back using imaging
N/A
67
62323
Epidural Injection Thoracic
N/A
68
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
N/A
69
66821
Removal of recurring cataract in lens capsule using laser
N/A
70
66984
Removal of cataract with insertion of lens
N/A
71
93000
Routine electrocardiogram
N/A
72
93452
Insertion of catheter into left heart for diagnosis
N/A
73
95810
Sleep monitoring of patient (6 years or older) in sleep lab
YES
74
97110
Physical Therapy Exercise, 15 Minutes
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.