CMS Shoppable Services
#
Code
Description
Available
1
74177
Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]
YES
2
76700
Abdominal ultrasound (complete) [HCPCS 76700]
NO
3
76805
Abdominal ultrasound of pregnant uterus after first trimester, greater than or equal to 14 weeks 0 days (single or first fetus) [HCPCS 76805]
NO
4
64483
Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]
NO
5
19120
Breast cyst removal, male or female (1 or more cysts) [HCPCS 19120]
NO
6
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
NO
7
66984
Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]
NO
8
93452
Catheter insertion into left heart with injection, imaging interpretation, and supervision [HCPCS 93452]
NO
9
473
Cervical spinal fusion without complications
YES
10
45380
Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
NO
11
45385
Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
NO
12
45391
Colon (large bowel) examination and ultrasound of large bowel with flexible endoscope [HCPCS 45391]
NO
13
45378
Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
NO
14
59510
Delivery of infant through incision in abdomen and uterus (cesarean delivery) with obstetric care before and after delivery [HCPCS 59510]
NO
15
59610
Delivery of infant through uterus and vagina after previous delivery of infant through incision in abdomen and uterus (cesarean delivery) with obstetric care before and after delivery [HCPCS 59610]
NO
16
59400
Delivery of infant through uterus and vagina with obstetric care before and after delivery [HCPCS 59400]
NO
17
43239
Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
NO
18
43235
Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
YES
19
90847
Family psychotherapy treatment with patient (50 minutes) [HCPCS 90847]
NO
20
90846
Family psychotherapy treatment without patient (50 minutes) [HCPCS 90846]
NO
21
47562
Gallbladder removal with an endoscope [HCPCS 47562]
YES
22
49505
Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]
NO
23
70450
Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]
YES
24
70553
Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]
NO
25
73721
Imaging of leg joint by MRI without contrast [HCPCS 73721]
YES
26
72148
Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]
YES
27
76830
Imaging of pelvis by ultrasound through vagina [HCPCS 76830]
NO
28
99385
Initial new patient well visit (preventive medicine evaluation) to assess overall health and identify potential health problems before they occur (18-39 years of age) [HCPCS 99385]
NO
29
99386
Initial new patient well visit (preventive medicine evaluation) to assess overall health and identify potential health problems before they occur (40-64 years of age) [HCPCS 99386]
NO
30
29881
Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
YES
31
80055
Lab analysis for pregnant woment identify the hepatitis B antigen, rubella anitbody, test for syphilis, and perform ABO and Rh(D) blood typing from blood specimen [HCPCS 80055]
NO
32
81001
Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]
NO
33
81000
Lab analysis of urine specimen by dipstick with microscope (non-automated) [HCPCS 81000]
NO
34
81003
Lab analysis of urine specimen by dipstick without microscope (automated) [HCPCS 81003]
NO
35
81002
Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]
YES
36
80069
Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]
NO
37
85610
Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
YES
38
84443
Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]
YES
39
85730
Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]
YES
40
85027
Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]
NO
41
85025
Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]
YES
42
80076
Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 80076]
YES
43
84154
Lab analysis to measure the amount of free PSA (prostate specific antigen) in serum specimen [HCPCS 84154]
NO
44
80061
Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]
YES
45
84153
Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]
NO
46
80048
Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]
YES
47
80053
Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
YES
48
77067
Mammography of both breasts (screening exam) [HCPCS 77067]
NO
49
77066
Mammography of both breasts for diagnosis [HCPCS 77066]
NO
50
77065
Mammography of one breast for diagnosis [HCPCS 77065]
NO
51
99203
New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 30-44 minutes) [HCPCS 99203]
NO
52
99204
New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 45-59 minutes) [HCPCS 99204]
NO
53
99205
New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 60-74 minutes) [HCPCS 99205]
NO
54
99243
Patient office consultation visit with consulting physician or other qualified health care professional (typically 40 minutes) [HCPCS 99243]
NO
55
99244
Patient office consultation visit with consulting physician or other qualified health care professional (typically 60 minutes) [HCPCS 99244]
NO
56
72193
Pelvis CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 72193]
NO
57
97110
Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]
YES
58
55700
Prostate gland biopsy [HCPCS 55700]
NO
59
90832
Psychotherapy treatment by physician face-to-face with patient (30 minutes) [HCPCS 90832]
NO
60
90834
Psychotherapy treatment by physician face-to-face with patient (45 minutes) [HCPCS 90834]
NO
61
90837
Psychotherapy treatment by physician face-to-face with patient (60 minutes) [HCPCS 90837]
NO
62
90853
Psychotherapy treatment for multiple patients in one group session [HCPCS 90853]
NO
63
66821
Recurring cataract removal in lens capsule by laser [HCPCS 66821]
NO
64
93000
Routine EKG (electrocardiogram) tracing using at least 12 wires with interpretation and report (complete) [HCPCS 93000]
NO
65
29826
Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
NO
66
95810
Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]
NO
67
62322
Spinal canal injection of substance into lower back or sacrum [HCPCS 62322]
NO
68
62323
Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]
YES
69
460
Spinal fusion other than the neck without major complications
YES
70
72110
Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]
NO
71
55866
Surgical prostate removal and surrounding lymph nodes with endoscope [HCPCS 55866]
NO
72
42820
Tonsils and adenoid glands removal (younger than 12 years of age) [HCPCS 42820]
NO
73
470
Total Knee or Hip Replacement
YES
74
743
Uterus or Ovary Surgery Not Related to Cancer without complications
NO

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

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Enter Deductible Already Paid:

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Enter Co-Pay:

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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
74177
Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]
YES
2
76700
Abdominal ultrasound (complete) [HCPCS 76700]
NO
3
76805
Abdominal ultrasound of pregnant uterus after first trimester, greater than or equal to 14 weeks 0 days (single or first fetus) [HCPCS 76805]
NO
4
64483
Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]
NO
5
19120
Breast cyst removal, male or female (1 or more cysts) [HCPCS 19120]
NO
6
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
NO
7
66984
Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]
NO
8
93452
Catheter insertion into left heart with injection, imaging interpretation, and supervision [HCPCS 93452]
NO
9
473
Cervical spinal fusion without complications
YES
10
45380
Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
NO
11
45385
Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
NO
12
45391
Colon (large bowel) examination and ultrasound of large bowel with flexible endoscope [HCPCS 45391]
NO
13
45378
Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
NO
14
59510
Delivery of infant through incision in abdomen and uterus (cesarean delivery) with obstetric care before and after delivery [HCPCS 59510]
NO
15
59610
Delivery of infant through uterus and vagina after previous delivery of infant through incision in abdomen and uterus (cesarean delivery) with obstetric care before and after delivery [HCPCS 59610]
NO
16
59400
Delivery of infant through uterus and vagina with obstetric care before and after delivery [HCPCS 59400]
NO
17
43239
Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
NO
18
43235
Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
YES
19
90847
Family psychotherapy treatment with patient (50 minutes) [HCPCS 90847]
NO
20
90846
Family psychotherapy treatment without patient (50 minutes) [HCPCS 90846]
NO
21
47562
Gallbladder removal with an endoscope [HCPCS 47562]
YES
22
49505
Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]
NO
23
70450
Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]
YES
24
70553
Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]
NO
25
73721
Imaging of leg joint by MRI without contrast [HCPCS 73721]
YES
26
72148
Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]
YES
27
76830
Imaging of pelvis by ultrasound through vagina [HCPCS 76830]
NO
28
99385
Initial new patient well visit (preventive medicine evaluation) to assess overall health and identify potential health problems before they occur (18-39 years of age) [HCPCS 99385]
NO
29
99386
Initial new patient well visit (preventive medicine evaluation) to assess overall health and identify potential health problems before they occur (40-64 years of age) [HCPCS 99386]
NO
30
29881
Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
YES
31
80055
Lab analysis for pregnant woment identify the hepatitis B antigen, rubella anitbody, test for syphilis, and perform ABO and Rh(D) blood typing from blood specimen [HCPCS 80055]
NO
32
81001
Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]
NO
33
81000
Lab analysis of urine specimen by dipstick with microscope (non-automated) [HCPCS 81000]
NO
34
81003
Lab analysis of urine specimen by dipstick without microscope (automated) [HCPCS 81003]
NO
35
81002
Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]
YES
36
80069
Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]
NO
37
85610
Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
YES
38
84443
Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]
YES
39
85730
Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]
YES
40
85027
Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]
NO
41
85025
Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]
YES
42
80076
Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 80076]
YES
43
84154
Lab analysis to measure the amount of free PSA (prostate specific antigen) in serum specimen [HCPCS 84154]
NO
44
80061
Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]
YES
45
84153
Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]
NO
46
80048
Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]
YES
47
80053
Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
YES
48
77067
Mammography of both breasts (screening exam) [HCPCS 77067]
NO
49
77066
Mammography of both breasts for diagnosis [HCPCS 77066]
NO
50
77065
Mammography of one breast for diagnosis [HCPCS 77065]
NO
51
99203
New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 30-44 minutes) [HCPCS 99203]
NO
52
99204
New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 45-59 minutes) [HCPCS 99204]
NO
53
99205
New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 60-74 minutes) [HCPCS 99205]
NO
54
99243
Patient office consultation visit with consulting physician or other qualified health care professional (typically 40 minutes) [HCPCS 99243]
NO
55
99244
Patient office consultation visit with consulting physician or other qualified health care professional (typically 60 minutes) [HCPCS 99244]
NO
56
72193
Pelvis CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 72193]
NO
57
97110
Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]
YES
58
55700
Prostate gland biopsy [HCPCS 55700]
NO
59
90832
Psychotherapy treatment by physician face-to-face with patient (30 minutes) [HCPCS 90832]
NO
60
90834
Psychotherapy treatment by physician face-to-face with patient (45 minutes) [HCPCS 90834]
NO
61
90837
Psychotherapy treatment by physician face-to-face with patient (60 minutes) [HCPCS 90837]
NO
62
90853
Psychotherapy treatment for multiple patients in one group session [HCPCS 90853]
NO
63
66821
Recurring cataract removal in lens capsule by laser [HCPCS 66821]
NO
64
93000
Routine EKG (electrocardiogram) tracing using at least 12 wires with interpretation and report (complete) [HCPCS 93000]
NO
65
29826
Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
NO
66
95810
Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]
NO
67
62322
Spinal canal injection of substance into lower back or sacrum [HCPCS 62322]
NO
68
62323
Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]
YES
69
460
Spinal fusion other than the neck without major complications
YES
70
72110
Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]
NO
71
55866
Surgical prostate removal and surrounding lymph nodes with endoscope [HCPCS 55866]
NO
72
42820
Tonsils and adenoid glands removal (younger than 12 years of age) [HCPCS 42820]
NO
73
470
Total Knee or Hip Replacement
YES
74
743
Uterus or Ovary Surgery Not Related to Cancer without complications
NO
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.