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  • De-identified Minimum Negotiated Charge
  • De-identified Maximum Negotiated Charge
  • BCBSAL: Commercial
  • Cigna: Commercial
  • Humana Tricare: Commercial
  • United Healthcare: Medicare Advantage
  • Alabama Department of Labor: Workers' Compensation

Prices Posted are Effective December 1, 2020

Shoppable Service Primary Service and Ancillary Services Revenue Code Procedure Code Gross UB Charges Service Location Site Type De-identified Minimum Negotiated Charge De-identified Maximum Negotiated Charge BCBSAL: Commercial Cigna: Commercial Humana Tricare: Commercial United Healthcare: Medicare Advantage Alabama Department of Labor: Workers' Compensation
Psychotherapy, 30 min - - 90832 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Psychotherapy, 45 min - - 90834 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Psychotherapy, 60 min - - 90837 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Family psychotherapy, not including patient, 50 min - - 90846 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Family psychotherapy, including patient, 50 min - - 90847 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Group psychotherapy - - 90853 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
New patient office or other outpatient visit, typically 30 min - - 99203 135.00 J Paul Jones Hospital Clinic OP 63.56 73.00 73.00 63.56 Contact Health Plan Contact Health Plan Contact Health Plan
New patient office of other outpatient visit, typically 45 min - - 99204 205.00 J Paul Jones Hospital Clinic OP 104.00 107.88 104.00 107.88 Contact Health Plan Contact Health Plan Contact Health Plan
New patient office of other outpatient visit, typically 60 min - - 99205 206.00 J Paul Jones Hospital Clinic OP 140.22 155.00 155.00 140.22 Contact Health Plan Contact Health Plan Contact Health Plan
Patient office consultation, typically 40 min - - 99243 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Patient office consultation, typically 60 min - - 99244 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Initial new patient preventive medicine evaluation (18-39 years) - - 99385 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Initial new patient preventive medicine evaluation (40-64 years) - - 99386 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Basic metabolic panel - - 80048 61.00 J Paul Jones Hospital OP 8.46 54.90 16.59 39.65 8.46 8.46 54.90
Blood test, comprehensive group of blood chemicals - - 80053 75.00 J Paul Jones Hospital OP 10.56 67.50 16.59 48.75 10.56 10.56 67.50
Obstetric blood test panel - - 80055 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Blood test, lipids (cholesterol and triglycerides) - - 80061 82.00 J Paul Jones Hospital OP 13.39 73.80 16.59 53.30 13.39 13.39 73.80
Kidney function panel test - - 80069 38.30 J Paul Jones Hospital OP 8.68 34.47 16.59 24.90 8.68 8.68 34.47
Liver function blood test panel - - 80076 58.50 J Paul Jones Hospital OP 8.17 52.65 16.59 38.03 8.17 8.17 52.65
Manual urinalysis test with examination using microscope - - 81000 or 81001 38.10 J Paul Jones Hospital OP 4.02 34.29 5.40 24.77 4.02 4.02 34.29
Automated urinalysis test - - 81002 or 81003 15.30 J Paul Jones Hospital OP 3.48 13.77 5.40 9.95 3.48 3.48 13.77
PSA (prostate specific antigen) - - 84153-84154 58.35 J Paul Jones Hospital OP 17.92 52.52 17.92 37.93 18.39 18.39 52.52
Blood test, thyroid stimulating hormone (TSH) - - 84443 49.55 J Paul Jones Hospital OP 16.80 44.60 24.74 32.21 16.80 16.80 44.60
Complete blood cell count, with differential white blood cells, automated - - 85025 58.50 J Paul Jones Hospital OP 7.77 52.65 10.71 38.03 7.77 7.77 52.65
Complete blood count, automated - - 85027 33.50 J Paul Jones Hospital OP 6.47 30.15 10.71 21.78 6.47 6.47 30.15
Blood test, clotting time - - 85610 34.00 J Paul Jones Hospital OP 4.29 30.60 6.83 22.10 4.29 4.29 30.60
Coagulation assessment blood test - - 85730 38.10 J Paul Jones Hospital OP 6.01 34.29 6.83 24.77 6.01 6.01 34.29
CT scan, head or brain, without contrast - - 70450 585.00 J Paul Jones Hospital OP 112.08 526.50 514.76 380.25 112.08 112.08 526.50
MRI scan of brain before and after contrast - - 70553 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
X-Ray, lower back, minimum four views - - 72110 165.15 J Paul Jones Hospital OP 94.42 148.64 94.42 107.35 112.08 112.08 148.64
MRI scan of lower spinal canal - - 72148 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
CT scan, pelvis, with contrast - - 72193 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
MRI scan of leg joint - - 73721 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
CT scan of abdomen and pelvis with contrast - - 74177 1843.80 J Paul Jones Hospital OP 381.85 1659.42 514.76 1198.47 381.85 381.85 1659.42
Ultrasound of abdomen - - 76700 312.48 J Paul Jones Hospital OP 112.08 345.36 345.36 203.11 112.08 112.08 281.23
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus - - 76805 317.48 J Paul Jones Hospital OP 112.08 285.73 168.27 206.36 112.08 112.08 285.73
Ultrasound pelvis through vagina - - 76830 285.93 J Paul Jones Hospital OP 112.08 265.82 265.82 185.85 112.08 112.08 257.34
Mammography of one breast - - 77065 83.15 J Paul Jones Hospital OP 54.05 112.15 112.15 54.05 83.99 83.99 74.84
Mammography of both breasts - - 77066 114.35 J Paul Jones Hospital OP 74.33 112.15 112.15 74.33 107.09 107.09 102.92
Mammography, screening, bilateral - - 77067 114.35 J Paul Jones Hospital OP 74.33 112.15 112.15 74.33 88.81 88.81 102.92
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities - - 216* Service Not Provided J Paul Jones Hospital IP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Spinal fusion except cervical without major comorbid conditions or complications (MCC) - - 460* Service Not Provided J Paul Jones Hospital IP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). - - 470* Service Not Provided J Paul Jones Hospital IP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). - - 473* Service Not Provided J Paul Jones Hospital IP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) - - 743* Service Not Provided J Paul Jones Hospital IP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of 1 or more breast growth, open procedure - - 19120 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Shaving of shoulder bone using an endoscope - - 29826 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of one knee cartilage using an endoscope - - 29881 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of tonsils and adenoid glands patient younger than age 12 - - 42820 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope - - 43235 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope - - 43239 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Diagnostic examination of large bowel using an endoscope - - 45378 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Biopsy of large bowel using an endoscope - - 45380 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of polyps or growths of large bowel using an endoscope - - 45385 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Ultrasound examination of lower large bowel using an endoscope - - 45391 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of gallbladder using an endoscope - - 47562 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Repair of groin hernia patient age 5 years or older - - 49505 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Biopsy of prostate gland - - 55700 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Surgical removal of prostate and surrounding lymph nodes using an endoscope - - 55866 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Routine obstetric care for vaginal delivery, including pre-and post- delivery care - - 59400 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Routine obstetric care for cesarean delivery, including pre-and post-delivery care - - 59510 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care - - 59610 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Injection of substance into spinal canal of lower back or sacrum using imaging guidance - - 62322-62323 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance - - 64483 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of recurring cataract in lens capsule using laser - - 66821 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Removal of cataract with insertion of lens - - 66984 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Electrocardiogram, routine, with interpretation and report - - 93000 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Insertion of catheter into left heart for diagnosis - - 93452 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Sleep study - - 95810 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Physical therapy, therapeutic exercise - - 97110 Service Not Provided J Paul Jones Hospital OP 0.00 0.00 Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided
Cath Bladder Simple - - 51702 90.10 J Paul Jones Hospital OP 58.57 128.93 128.93 58.57 109.03 109.03 81.09
X-Ray Mandible 4 Views - - 70110 127.05 J Paul Jones Hospital OP 82.58 114.35 94.42 82.58 112.08 112.08 114.35
X-Ray Facial Bones <3 Views - - 70140 83.15 J Paul Jones Hospital OP 54.05 94.42 94.42 54.05 79.81 79.81 74.84
X-Ray Facial Bones <3Views - - 70150 159.40 J Paul Jones Hospital OP 94.42 143.46 94.42 103.61 112.08 112.08 143.46
X-Ray Nasal Bones 3 Views - - 70160 70.45 J Paul Jones Hospital OP 45.79 94.42 94.42 45.79 79.81 79.81 63.41
X-Ray Orbits 4 Views Lt - - 70200 127.05 J Paul Jones Hospital OP 82.58 114.35 94.42 82.58 112.08 112.08 114.35
X-Ray Sinuses <3 Views - - 70210 90.08 J Paul Jones Hospital OP 58.55 94.42 94.42 58.55 79.81 79.81 81.07
X-Ray Sinuses > 3 Views - - 70220 127.05 J Paul Jones Hospital OP 79.81 114.35 94.42 82.58 79.81 79.81 114.35
X-Ray Skull < 4 Views - - 70250 101.65 J Paul Jones Hospital OP 66.07 112.08 94.42 66.07 112.08 112.08 91.49
X-Ray Skull 4 Views - - 70260 152.45 J Paul Jones Hospital OP 94.42 137.21 94.42 99.09 112.08 112.08 137.21
X-Ray Neck Soft Tissues - - 70360 90.08 J Paul Jones Hospital OP 58.55 94.42 94.42 58.55 79.81 79.81 81.07
CT Head/Brain With Contrast - - 70460 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
CT Head/Brain Without & With Contrast - - 70470 988.00 J Paul Jones Hospital OP 182.22 889.20 514.76 642.20 182.22 182.22 889.20
CT Orbit/Ear/Fossa Without contrast - - 70480 813.00 J Paul Jones Hospital OP 112.08 731.70 198.80 528.45 112.08 112.08 731.70
CT Orbit/Ear/Fossa With Contrast - - 70481 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
CT Orbit/Ear/Fossa Without & With Contrast - - 70482 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
CT Maxillofacial without contrast - - 70486 813.00 J Paul Jones Hospital OP 112.08 731.70 198.80 528.45 112.08 112.08 731.70
CT Maxillofacial With Contrast - - 70487 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
CT Soft Tissue Neck without contrast - - 70490 585.00 J Paul Jones Hospital OP 112.08 526.50 198.80 380.25 112.08 112.08 526.50
CT Soft Tissue Neck With Contrast - - 70491 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
CT Soft Tissue Neck Without & With Contrast - - 70492 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
CTA Neck - - 70498 1219.00 J Paul Jones Hospital OP 182.22 1097.10 542.92 792.35 182.22 182.22 1097.10
X-Ray Chest 1 View - - 71045 92.50 J Paul Jones Hospital OP 60.13 94.42 94.42 60.13 79.81 79.81 83.25
X-Ray Chest 2 Views - - 71046 121.25 J Paul Jones Hospital OP 78.81 109.13 94.42 78.81 79.81 79.81 109.13
X-Ray Ribs and Chest 4/> Views - - 71111 254.10 J Paul Jones Hospital OP 94.42 228.69 94.42 165.17 112.08 112.08 228.69
X-Ray Breastbone 2/>Views - - 71120 88.95 J Paul Jones Hospital OP 57.82 94.42 94.42 57.82 79.81 79.81 80.06
X-Ray Strenoclavical Jointt 3/>Views - - 71130 127.05 J Paul Jones Hospital OP 79.81 114.35 94.42 82.58 79.81 79.81 114.35
CT Thorax without contrast - - 71250 585.00 J Paul Jones Hospital OP 112.08 526.50 198.80 380.25 112.08 112.08 526.50
CT Thorax with constrast - - 71260 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
CT Thorax with and without contrast - - 71270 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
CTA Aorta/Runoff - - 71275 1219.00 J Paul Jones Hospital OP 182.22 1097.10 542.92 792.35 182.22 182.22 1097.10
X-Ray Spine 1 View - - 72020 0.00 J Paul Jones Hospital OP 0.00 94.42 94.42 0.00 79.81 79.81 0.00
X-Ray Neck Spine 2-3 Views - - 72040 95.86 J Paul Jones Hospital OP 62.31 94.42 94.42 62.31 79.81 79.81 86.27
X-Ray Neck Spine 4 -5 Views - - 72050 165.00 J Paul Jones Hospital OP 94.42 148.50 94.42 107.25 112.08 112.08 148.50
X-Ray Neck Spine 6/> Views - - 72052 177.90 J Paul Jones Hospital OP 94.42 160.11 94.42 115.64 112.08 112.08 160.11
X-Ray Thorac Spine 2 Views - - 72070 108.55 J Paul Jones Hospital OP 70.56 112.08 94.42 70.56 112.08 112.08 97.70
X-Ray Entire Spine 2-3 Views - - 72082 254.10 J Paul Jones Hospital OP 94.42 228.69 94.42 165.17 112.08 112.08 228.69
X-Ray L-S Spine 2/3 Views - - 72100 108.55 J Paul Jones Hospital OP 70.56 112.08 94.42 70.56 112.08 112.08 97.70
X-Ray L-S Spine Bending - - 72114 285.15 J Paul Jones Hospital OP 94.42 256.64 94.42 185.35 112.08 112.08 256.64
CT Neck Spine without contrast - - 72125 585.00 J Paul Jones Hospital OP 112.08 526.50 198.80 380.25 112.08 112.08 526.50
CT Chest Spine without contrast - - 72128 813.00 J Paul Jones Hospital OP 112.08 731.70 198.80 528.45 112.08 112.08 731.70
CT Lumbar Spine without contrast - - 72131 585.00 J Paul Jones Hospital OP 112.08 526.50 198.80 380.25 112.08 112.08 526.50
X-Ray Pelvis 1 View - - 72170 90.08 J Paul Jones Hospital OP 58.55 112.08 94.42 58.55 112.08 112.08 81.07
X-Ray Pelvis 3 Views - - 72190 127.05 J Paul Jones Hospital OP 82.58 114.35 94.42 82.58 112.08 112.08 114.35
CT Pelvis without contrast - - 72192 585.00 J Paul Jones Hospital OP 112.08 526.50 198.80 380.25 112.08 112.08 526.50
CT Pelvis with and without contrast - - 72194 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
X-Ray Exam Si Joints 3/> Views - - 72202 101.65 J Paul Jones Hospital OP 66.07 112.08 94.42 66.07 112.08 112.08 91.49
X-Ray Exam Sacrum Tailbone - - 72220 101.65 J Paul Jones Hospital OP 66.07 94.42 94.42 66.07 79.81 79.81 91.49
X-Ray AC Joints Bilateral - - 73050 76.90 J Paul Jones Hospital OP 49.99 94.42 94.42 49.99 79.81 79.81 69.21
X-Ray Finger(S) - - 73140 90.08 J Paul Jones Hospital OP 58.55 94.42 94.42 58.55 79.81 79.81 81.07
CT Upper Extremity without contrast - - 73200 813.00 J Paul Jones Hospital OP 112.08 731.70 198.80 528.45 112.08 112.08 731.70
CT Upper Extremity With Contrast - - 73201 923.00 J Paul Jones Hospital OP 381.85 830.70 514.76 599.95 381.85 381.85 830.70
CT Uppr Extremity Without & With Contrast - - 73202 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
X-Ray Exam Hips Bi 2 Views - - 73521 152.45 J Paul Jones Hospital OP 94.42 137.21 94.42 99.09 112.08 112.08 137.21
X-Ray Knees - - 73565 108.55 J Paul Jones Hospital OP 70.56 97.70 94.42 70.56 79.81 79.81 97.70
CT Lo/Ext Without Cont Rt - - 73700 813.00 J Paul Jones Hospital OP 112.08 731.70 198.80 528.45 112.08 112.08 731.70
CT Lo/Ext W/Cont Lt - - 73701 922.00 J Paul Jones Hospital OP 182.22 829.80 514.76 599.30 182.22 182.22 829.80
CT Lo/Ext W And Without Rt - - 73702 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
X-Ray Exam Abdomen 1 View - - 74018 90.08 J Paul Jones Hospital OP 58.55 94.42 94.42 58.55 79.81 79.81 81.07
X-Ray Exam Abdomen 2 Views - - 74019 114.35 J Paul Jones Hospital OP 74.33 112.08 94.42 74.33 112.08 112.08 102.92
X-Ray Exam Complete Abdomen - - 74022 151.72 J Paul Jones Hospital OP 94.42 136.55 94.42 98.62 112.08 112.08 136.55
CT Abdomen without contrast - - 74150 811.80 J Paul Jones Hospital OP 112.08 730.62 198.80 527.67 112.08 112.08 730.62
CT Abdomen With Contrast - - 74160 921.80 J Paul Jones Hospital OP 182.22 829.62 514.76 599.17 182.22 182.22 829.62
CT Abdomen Without & With Contrast - - 74170 998.00 J Paul Jones Hospital OP 182.22 898.20 514.76 648.70 182.22 182.22 898.20
CT Angio Abdom Without & With Contrast - - 74175 1219.00 J Paul Jones Hospital OP 182.22 1097.10 542.92 792.35 182.22 182.22 1097.10
CT Abd & Pelvis Without Contrast - - 74176 1624.80 J Paul Jones Hospital OP 233.04 1462.32 514.76 1056.12 233.04 233.04 1462.32
CT Abdomen & Pelvis 1/> Regns - - 74178 1996.00 J Paul Jones Hospital OP 381.85 1796.40 514.76 1297.40 381.85 381.85 1796.40
US Soft Tissue Head & Neck Real Time Image - - 76536 218.55 J Paul Jones Hospital OP 112.08 265.82 265.82 142.06 112.08 112.08 196.70
US Abdominal Real Time W/Image Limited - - 76705 244.05 J Paul Jones Hospital OP 112.08 265.82 265.82 158.63 112.08 112.08 219.65
US Pelvic Nonobstetric Real-Time Image Complete - - 76856 282.84 J Paul Jones Hospital OP 112.08 345.36 345.36 183.85 112.08 112.08 254.56
US Limited Joint/Ott Nonvasc Xtr Strux R-T W/Img - - 76882 220.00 J Paul Jones Hospital OP 112.08 265.82 265.82 143.00 112.08 112.08 198.00
L Bone Survey - - 77074 165.00 J Paul Jones Hospital OP 94.42 148.50 94.42 107.25 112.08 112.08 148.50
Acute Hepatitis Panel - - 80074 100.50 J Paul Jones Hospital OP 16.59 90.45 16.59 65.33 47.63 47.63 90.45
Digoxin Nh - - 80162 95.25 J Paul Jones Hospital OP 13.28 85.73 19.91 61.91 13.28 13.28 85.73
Gentamicin Trough - - 80170 76.20 J Paul Jones Hospital OP 16.38 68.58 19.91 49.53 16.38 16.38 68.58
Phenobarbital Lc Nh - - 80184 67.30 J Paul Jones Hospital OP 15.30 60.57 19.91 43.75 15.30 15.30 60.57
Vancomycin Peak - - 80202 58.50 J Paul Jones Hospital OP 13.54 52.65 19.91 38.03 13.54 13.54 52.65
Urine Pregnancy Test Visual Color Cmprsn Meths - - 81025 20.00 J Paul Jones Hospital OP 5.40 18.00 5.40 13.00 8.61 8.61 18.00
Albumin Serum Plasma/Whole Blood - - 82040 40.70 J Paul Jones Hospital OP 4.95 36.63 7.96 26.46 4.95 4.95 36.63
Assay Of Amylase - - 82150 38.10 J Paul Jones Hospital OP 6.48 34.29 7.96 24.77 6.48 6.48 34.29
Bilirubin Total - - 82247 36.00 J Paul Jones Hospital OP 5.02 32.40 7.96 23.40 5.02 5.02 32.40
Bilirubin DireCT - - 82248 36.00 J Paul Jones Hospital OP 5.02 32.40 7.96 23.40 5.02 5.02 32.40
Calcium Total - - 82310 37.00 J Paul Jones Hospital OP 5.16 33.30 7.96 24.05 5.16 5.16 33.30
Chloride - - 82435 40.70 J Paul Jones Hospital OP 4.60 36.63 7.96 26.46 4.60 4.60 36.63
Cortisol Total - - 82533 76.90 J Paul Jones Hospital OP 16.30 69.21 24.74 49.99 16.30 16.30 69.21
Serum Creatine - - 82540 37.50 J Paul Jones Hospital OP 4.64 33.75 7.96 24.38 4.64 4.64 33.75
Creatine Kinase Total - - 82550 31.80 J Paul Jones Hospital OP 6.51 28.62 7.96 20.67 6.51 6.51 28.62
Creatine Kinase Mb FraCTion Only - - 82553 67.30 J Paul Jones Hospital OP 11.55 60.57 17.92 43.75 11.55 11.55 60.57
Creatinine Blood - - 82565 25.41 J Paul Jones Hospital OP 5.12 22.87 7.96 16.52 5.12 5.12 22.87
Creatinine Other Source - - 82570 35.00 J Paul Jones Hospital OP 5.18 31.50 7.96 22.75 5.18 5.18 31.50
Cryoglobulin - - 82595 30.45 J Paul Jones Hospital OP 6.47 27.41 7.96 19.79 6.47 6.47 27.41
Cyanocobalamin Vitamin B-12 - - 82607 24.00 J Paul Jones Hospital OP 15.08 24.74 24.74 15.60 15.08 15.08 21.60
Assay Of Ferritin - - 82728 41.25 J Paul Jones Hospital OP 13.63 37.13 17.92 26.81 13.63 13.63 37.13
Assay Of Folic Acid Serum - - 82746 51.50 J Paul Jones Hospital OP 14.70 46.35 17.92 33.48 14.70 14.70 46.35
Assay Of Gammaglobulin Iga Igd Igg Igm Each - - 82784 24.75 J Paul Jones Hospital OP 9.30 22.28 17.92 16.09 9.30 9.30 22.28
Blood Gases Any Combination Ph Pco2 Po2 Co2 Hco3 - - 82803 95.30 J Paul Jones Hospital OP 17.92 85.77 17.92 61.95 26.07 26.07 85.77
Glucose Quantitative Blood Xcpt Reagent Strip - - 82947 28.00 J Paul Jones Hospital OP 3.93 25.20 7.96 18.20 3.93 3.93 25.20
Gonadotropin Follicle Stimulating Hormone - - 83001 67.30 J Paul Jones Hospital OP 18.58 60.57 24.74 43.75 18.58 18.58 60.57
Assay Of Insulin Total - - 83525 19.50 J Paul Jones Hospital OP 11.43 24.74 24.74 12.68 11.43 11.43 17.55
Assay Of Iron - - 83540 20.00 J Paul Jones Hospital OP 6.47 18.00 7.96 13.00 6.47 6.47 18.00
Iron Binding Capacity - - 83550 25.00 J Paul Jones Hospital OP 8.74 22.50 17.92 16.25 8.74 8.74 22.50
Assay Of LaCTate - - 83605 36.50 J Paul Jones Hospital OP 11.57 32.85 17.92 23.73 11.57 11.57 32.85
Lactate Dehydrogenase Ldh - - 83615 41.30 J Paul Jones Hospital OP 6.04 37.17 7.96 26.85 6.04 6.04 37.17
Assay Of Lipase - - 83690 28.50 J Paul Jones Hospital OP 6.89 25.65 7.96 18.53 6.89 6.89 25.65
Assay Of Magnesium - - 83735 43.85 J Paul Jones Hospital OP 6.70 39.47 7.96 28.50 6.70 6.70 39.47
Myoglobin - - 83874 142.03 J Paul Jones Hospital OP 12.92 127.83 17.92 92.32 12.92 12.92 127.83
Natriuretic Peptide - - 83880 243.00 J Paul Jones Hospital OP 39.26 218.70 51.48 157.95 39.26 39.26 218.70
Assay Of Parathormone - - 83970 211.85 J Paul Jones Hospital OP 41.28 190.67 61.24 137.70 41.28 41.28 190.67
Assay Of Phosphatase Alkaline - - 84075 40.70 J Paul Jones Hospital OP 5.18 36.63 7.96 26.46 5.18 5.18 36.63
Assay Of Phosphorus Inorganic - - 84100 29.00 J Paul Jones Hospital OP 4.74 26.10 7.96 18.85 4.74 4.74 26.10
Urine Phosphorous - - 84105 41.30 J Paul Jones Hospital OP 5.78 37.17 7.96 26.85 5.78 5.78 37.17
Potassium Serum Plasma/Whole Blood - - 84132 33.00 J Paul Jones Hospital OP 4.76 29.70 7.96 21.45 4.76 4.76 29.70
Assay Of Progesterone - - 84144 80.40 J Paul Jones Hospital OP 20.86 72.36 24.74 52.26 20.86 20.86 72.36
Assay Of Prolactin - - 84146 87.70 J Paul Jones Hospital OP 19.38 78.93 24.74 57.01 19.38 19.38 78.93
Assay Of Prostate Specific Antigen Total - - 84153 58.35 J Paul Jones Hospital OP 17.92 52.52 17.92 37.93 18.39 18.39 52.52
Protein Total Xcpt RefraCTometry Urine - - 84156 15.00 J Paul Jones Hospital OP 3.67 13.50 7.96 9.75 3.67 3.67 13.50
Protein EleCTro Serum Lc - - 84165 83.85 J Paul Jones Hospital OP 10.74 75.47 17.92 54.50 10.74 10.74 75.47
Sodium (Na) - - 84295 35.00 J Paul Jones Hospital OP 4.81 31.50 7.96 22.75 4.81 4.81 31.50
Assay Of Thyroxine Total - - 84436 50.00 J Paul Jones Hospital OP 6.87 45.00 24.74 32.50 6.87 6.87 45.00
Assay Of Free Thyroxine - - 84439 41.30 J Paul Jones Hospital OP 9.02 37.17 24.74 26.85 9.02 9.02 37.17
Transferase Aspartate Amino Ast Sgot - - 84450 37.00 J Paul Jones Hospital OP 5.18 33.30 7.96 24.05 5.18 5.18 33.30
Transferase Alanine Amino Alt Sgpt - - 84460 38.00 J Paul Jones Hospital OP 5.30 34.20 7.96 24.70 5.30 5.30 34.20
Assay Of Triiodothyronine T3 Free - - 84481 15.00 J Paul Jones Hospital OP 9.75 24.74 24.74 9.75 16.94 16.94 13.50
Assay Of Troponin Quantitative - - 84484 67.30 J Paul Jones Hospital OP 12.47 60.57 17.92 43.75 12.47 12.47 60.57
Assay Of Urea Nitrogen Quantitative - - 84520 25.40 J Paul Jones Hospital OP 3.95 22.86 7.96 16.51 3.95 3.95 22.86
Assay Of Blood/Uric Acid - - 84550 33.00 J Paul Jones Hospital OP 4.52 29.70 7.96 21.45 4.52 4.52 29.70
C-Peptide Lc - - 84681 48.00 J Paul Jones Hospital OP 17.92 43.20 17.92 31.20 20.81 20.81 43.20
Gonadotropin Chorionic Quantitative - - 84702 50.20 J Paul Jones Hospital OP 15.05 45.18 24.74 32.63 15.05 15.05 45.18
Blood Count Hematocrit - - 85014 25.00 J Paul Jones Hospital OP 2.37 22.50 10.71 16.25 2.37 2.37 22.50
Blood Count Hemoglobin - - 85018 25.00 J Paul Jones Hospital OP 2.37 22.50 10.71 16.25 2.37 2.37 22.50
Blood Count Reticulocyte Automated - - 85045 28.60 J Paul Jones Hospital OP 3.99 25.74 10.71 18.59 3.99 3.99 25.74
Blood Count Platelet Automated - - 85049 25.00 J Paul Jones Hospital OP 4.48 22.50 10.71 16.25 4.48 4.48 22.50
Fibrin Dgradj ProduCTs D-Dimer Quantitative - - 85379 143.00 J Paul Jones Hospital OP 6.83 128.70 6.83 92.95 10.18 10.18 128.70
Sedimentation Rate Rbc Non-Automated - - 85651 25.40 J Paul Jones Hospital OP 4.27 22.86 10.71 16.51 4.27 4.27 22.86
Antinuclear Antibodies Ana - - 86038 50.20 J Paul Jones Hospital OP 12.09 45.18 17.73 32.63 12.09 12.09 45.18
C-ReaCTive Protein - - 86140 30.50 J Paul Jones Hospital OP 5.18 27.45 17.73 19.83 5.18 5.18 27.45
Heterophile Antibodies Screen - - 86308 64.00 J Paul Jones Hospital OP 5.18 57.60 17.73 41.60 5.18 5.18 57.60
Rheumatoid FaCTor Qualitative - - 86430 33.65 J Paul Jones Hospital OP 6.14 30.29 17.73 21.87 6.14 6.14 30.29
Syphilis Test Non-Treponemal Antibody Qual - - 86592 25.40 J Paul Jones Hospital OP 4.27 22.86 17.73 16.51 4.27 4.27 22.86
Lyme Igm Antibody Lc - - 86618 293.80 J Paul Jones Hospital OP 17.03 264.42 17.73 190.97 17.03 17.03 264.42
Hepatitis B Surf Antibody Hbsab - - 86706 10.40 J Paul Jones Hospital OP 6.76 17.73 17.73 6.76 10.74 10.74 9.36
Antibody Rubella - - 86762 33.65 J Paul Jones Hospital OP 14.39 30.29 17.73 21.87 14.39 14.39 30.29
Antibody Treponema Pallidum - - 86780 34.90 J Paul Jones Hospital OP 13.24 31.41 17.73 22.69 13.24 13.24 31.41
Hepatitis C Antibody - - 86803 66.05 J Paul Jones Hospital OP 14.27 59.45 17.73 42.93 14.27 14.27 59.45
Antibody Screen Rbc Each Serum Technique - - 86850 30.00 J Paul Jones Hospital OP 19.50 49.47 22.56 19.50 49.47 49.47 27.00
Culure Bacteria - Stool Salmonella & Shigell - - 87045 36.85 J Paul Jones Hospital OP 9.44 33.17 14.13 23.95 9.44 9.44 33.17
Culture Bacteria Xcpt Urine Blood/Stool Aerobic Isol - - 87070 36.85 J Paul Jones Hospital OP 8.62 33.17 14.13 23.95 8.62 8.62 33.17
Cul BaCT Aerobic Addl Meths Definitive Ea Isol - - 87077 17.43 J Paul Jones Hospital OP 8.08 15.69 14.13 11.33 8.08 8.08 15.69
Cul Prsmptv Pthgnc Organism Scrn W/Colony Estimj - - 87081 50.80 J Paul Jones Hospital OP 6.63 45.72 14.13 33.02 6.63 6.63 45.72
Culture BCT Isol & Prsmptv Id Isolate Ea Urine - - 87088 36.85 J Paul Jones Hospital OP 8.09 33.17 14.13 23.95 8.09 8.09 33.17
Susceptiblty Study Antimicrobial Micro - - 87186 225.23 J Paul Jones Hospital OP 8.65 202.71 14.13 146.40 8.65 8.65 202.71
Smr Prim Src Gram/Giemsa Stain BCT Fungi/Cell - - 87205 11.15 J Paul Jones Hospital OP 4.27 14.13 14.13 7.25 4.27 4.27 10.04
Iaad Ia Hepatitis B Surface Antigen - - 87340 17.60 J Paul Jones Hospital OP 10.33 15.84 14.13 11.44 10.33 10.33 15.84
Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single - - 87389 24.00 J Paul Jones Hospital OP 14.13 24.08 14.13 15.60 24.08 24.08 21.60
Iadna Chlamydia Trachomatis Amplified Probe Tq - - 87491 140.73 J Paul Jones Hospital OP 35.09 126.66 55.27 91.47 35.09 35.09 126.66
Iadna Neisseria Gonorrhoeae Amplified Probe Tq - - 87591 155.03 J Paul Jones Hospital OP 35.09 139.53 55.27 100.77 35.09 35.09 139.53
Evaluation Speech Sound Production W Evaluation Of Lang Co - - 92523 375.00 J Paul Jones Hospital OP 187.76 337.50 258.42 243.75 187.76 187.76 337.50
Swallowing Function Treatment - - 92526 175.00 J Paul Jones Hospital OP 84.61 258.42 258.42 113.75 84.61 84.61 157.50
Speech Cognitive Testing - - 96125 333.75 J Paul Jones Hospital OP 105.74 1320.94 1320.94 216.94 105.74 105.74 300.38
Op Iv Therapy Initial Up To 1 Hr - - 96365 257.00 J Paul Jones Hospital OP 167.05 570.79 570.79 167.05 183.74 183.74 231.30
Outpatient Concurrent Infusion - - 96368 123.20 J Paul Jones Hospital OP 0.00 570.79 570.79 80.08 0.00 0.00 110.88
Therapeutic Or Diagnostic Injection - - 96372 53.00 J Paul Jones Hospital OP 0.00 60.47 0.00 34.45 60.47 60.47 47.70
Occupational Therapy Treatment Sit/Standing Activity - - 97112 140.00 J Paul Jones Hospital OP 33.96 348.20 348.20 91.00 33.96 33.96 126.00
Physical Therapy Gait Training- O/P - - 97116 160.00 J Paul Jones Hospital OP 29.26 348.20 348.20 104.00 29.26 29.26 144.00
Physical Therapy Evaluation Low Complex 20 Mins - - 97161 76.28 J Paul Jones Hospital OP 49.58 348.20 348.20 49.58 82.44 82.44 68.65
Physical Therapy Evaluation Mod Complex 30 Mins - - 97162 76.28 J Paul Jones Hospital OP 49.58 348.20 348.20 49.58 82.44 82.44 68.65
Physical Therapy Evaluation High Complex 45 Mins - - 97163 76.28 J Paul Jones Hospital OP 49.58 348.20 348.20 49.58 82.44 82.44 68.65
Physical Therapy Re-Evaluation Estimated Plan Care 20 Mins - - 97164 166.89 J Paul Jones Hospital OP 56.39 348.20 348.20 108.48 56.39 56.39 150.20
Occupational Therapy Evaluation Low - - 97165 74.05 J Paul Jones Hospital OP 48.13 401.86 401.86 48.13 87.25 87.25 66.65
Pt Therapeutic Activities- O/P - - 97530 35.00 J Paul Jones Hospital OP 22.75 348.20 348.20 22.75 37.56 37.56 31.50
Office Outpatient New 20 Minutes - - 99202 95.00 J Paul Jones Hospital OP 41.56 49.00 49.00 41.56 Contact Health Plan Contact Health Plan Contact Health Plan
Office Outpatient Visit 5 Minutes - - 99211 35.00 J Paul Jones Hospital OP 7.72 17.82 17.82 7.72 Contact Health Plan Contact Health Plan Contact Health Plan
Office Outpatient Visit 10 Minutes - - 99212 55.00 J Paul Jones Hospital OP 21.20 39.00 39.00 21.20 Contact Health Plan Contact Health Plan Contact Health Plan
Office Outpatient Visit 15 Minutes - - 99213 90.00 J Paul Jones Hospital OP 42.34 62.75 62.75 42.34 Contact Health Plan Contact Health Plan Contact Health Plan
Office Outpatient Visit 25 Minutes - - 99214 135.00 J Paul Jones Hospital OP 65.37 95.00 95.00 65.37 Contact Health Plan Contact Health Plan Contact Health Plan
Blood Collection Fee - - 36415 7.65 J Paul Jones Hospital OP 3.00 6.89 4.08 4.97 3.00 3.00 6.89
EKG - - 93005 127.05 J Paul Jones Hospital OP 44.56 114.35 44.56 82.58 55.01 55.01 114.35
Ultrasound Cartoid Bilateral - - 93880 667.83 J Paul Jones Hospital OP 233.04 601.05 265.82 434.09 233.04 233.04 601.05
Xray Thoracic Spine 3 Vws - - 72072 127.05 J Paul Jones Hospital OP 82.58 114.35 94.42 82.58 112.08 112.08 114.35
Xray Mastoids Complete Min 3 Vws - - 70130 127.10 J Paul Jones Hospital OP 82.62 114.39 94.42 82.62 112.08 112.08 114.39
Xray Tmj Open/Closed Bilateral - - 70330 95.85 J Paul Jones Hospital OP 62.30 94.42 94.42 62.30 79.81 79.81 86.27
Xray Knee 3 Vws, Right - - 73562 102.22 J Paul Jones Hospital OP 66.44 94.42 94.42 66.44 79.81 79.81 92.00
Xray Chest Pa/Lat Lordotic - - 71021 126.85 J Paul Jones Hospital OP 82.45 114.17 Contact Health Plan 82.45 Contact Health Plan Contact Health Plan 114.17
Xray Chest Pa And Lateralwith Decubitus - - 71035 190.60 J Paul Jones Hospital OP 123.89 171.54 Contact Health Plan 123.89 Contact Health Plan Contact Health Plan 171.54
Xray Ribs W/Pa Chest Min 3 Vws, Left - - 71101 127.05 J Paul Jones Hospital OP 82.58 114.35 94.42 82.58 112.08 112.08 114.35
Xray Spine Entire Survey Ap/Lat - - 72010 254.10 J Paul Jones Hospital OP 165.17 228.69 Contact Health Plan 165.17 Contact Health Plan Contact Health Plan 228.69
Xray Thoracolumbar Spine Min 2 Vws - - 72080 108.55 J Paul Jones Hospital OP 70.56 97.70 94.42 70.56 79.81 79.81 97.70
Xray Upper Extremity, Infant Min 2 Vws - - 73092 70.45 J Paul Jones Hospital OP 45.79 112.08 94.42 45.79 112.08 112.08 63.41
Xray Hip 2-3 Vws, Left - - 73502 90.08 J Paul Jones Hospital OP 58.55 94.42 94.42 58.55 79.81 79.81 81.07
Xray Femur 2 Vws, Left - - 73552 95.85 J Paul Jones Hospital OP 62.30 94.42 94.42 62.30 79.81 79.81 86.27
Xray Femur 2 Vws, Bilateral - - 73550 190.60 J Paul Jones Hospital OP 123.89 171.54 Contact Health Plan 123.89 Contact Health Plan Contact Health Plan 171.54
Xray Internal Auditory Comp - - 70134 127.05 J Paul Jones Hospital OP 82.58 481.58 94.42 82.58 481.58 481.58 114.35
Xray Hip 1Vw, Left - - 73501 90.08 J Paul Jones Hospital OP 58.55 94.42 94.42 58.55 79.81 79.81 81.07
Xray Ribs 3 Vws, Bilateral - - 71110 190.55 J Paul Jones Hospital OP 94.42 171.50 94.42 123.86 112.08 112.08 171.50
Urinalysis - - 81000 38.10 J Paul Jones Hospital OP 4.02 34.29 5.40 24.77 4.02 4.02 34.29
Vanillylmandelic Acid 24Hr Urin - - 84585 67.30 J Paul Jones Hospital OP 15.50 60.57 24.74 43.75 15.50 15.50 60.57
Smear Wet Prep Saline India Koh - - 87210 20.35 J Paul Jones Hospital OP 5.82 18.32 14.13 13.23 5.82 5.82 18.32
Glucose Tolar 3 Spec - - 82951 123.90 J Paul Jones Hospital OP 12.87 111.51 17.92 80.54 12.87 12.87 111.51
Hdl Cholesterol - - 83718 16.50 J Paul Jones Hospital OP 8.19 17.92 17.92 10.73 8.19 8.19 14.85
Hepatitis Be Antigen Eia - - 87350 57.80 J Paul Jones Hospital OP 11.53 52.02 14.13 37.57 11.53 11.53 52.02
Immunass Inf Antbdy Qual Semiql - - 86318 44.50 J Paul Jones Hospital OP 17.73 40.05 17.73 28.93 18.09 18.09 40.05
Occult Blood - - 82272 27.95 J Paul Jones Hospital OP 4.23 25.16 7.96 18.17 4.23 4.23 25.16
Homovalnillic Acid Ava - - 83150 92.10 J Paul Jones Hospital OP 22.41 82.89 24.74 59.87 22.41 22.41 82.89
Hydroxycorticosteroids, 17 - - 83491 85.15 J Paul Jones Hospital OP 17.90 76.64 24.74 55.35 17.90 17.90 76.64
Immunogobulin E - - 82785 67.30 J Paul Jones Hospital OP 16.46 60.57 17.92 43.75 16.46 16.46 60.57
Insulin Antibodies - - 86337 114.05 J Paul Jones Hospital OP 21.41 102.65 24.74 74.13 21.41 21.41 102.65
Assey Of Ketosteroids 17;Total Urine - - 83586 47.00 J Paul Jones Hospital OP 12.80 42.30 24.74 30.55 12.80 12.80 42.30
Ldh Isoenzymes - - 83625 67.30 J Paul Jones Hospital OP 12.79 60.57 17.92 43.75 12.79 12.79 60.57
Lead - - 83655 58.46 J Paul Jones Hospital OP 12.11 52.61 21.24 38.00 12.11 12.11 52.61
Assay Lithium - - 80178 52.75 J Paul Jones Hospital OP 6.61 47.48 19.91 34.29 6.61 6.61 47.48
Infectious Agent Antigen Detection By Immunoassay, Rsv - - 87807 16.00 J Paul Jones Hospital OP 10.40 14.40 14.13 10.40 13.10 13.10 14.40
Wbc - - 85048 25.00 J Paul Jones Hospital OP 2.54 22.50 10.71 16.25 2.54 2.54 22.50
Ova And Para Smear Conc Id - - 87177 33.65 J Paul Jones Hospital OP 8.90 30.29 14.13 21.87 8.90 8.90 30.29
Ethosuximide - - 80168 49.55 J Paul Jones Hospital OP 16.34 44.60 19.91 32.21 16.34 16.34 44.60
Procainamide - - 80192 67.30 J Paul Jones Hospital OP 16.75 60.57 19.91 43.75 16.75 16.75 60.57
Quinidine-Labcorp - - 80194 50.15 J Paul Jones Hospital OP 14.60 45.14 19.91 32.60 14.60 14.60 45.14
Rubeola Ab Igg And Igm - - 86765 40.65 J Paul Jones Hospital OP 12.88 36.59 17.73 26.42 12.88 12.88 36.59
Semen Analysis Complete - - 89320 43.85 J Paul Jones Hospital OP 12.31 39.47 27.30 28.50 12.31 12.31 39.47
Hydroxyindolacetic Acid - - 83497 68.00 J Paul Jones Hospital OP 12.90 61.20 24.74 44.20 12.90 12.90 61.20
Miscellaneous Fluid Cytology - - 88112 172.90 J Paul Jones Hospital OP 49.47 155.61 58.68 112.39 49.47 49.47 155.61
Theophylline - - 80198 83.85 J Paul Jones Hospital OP 14.14 75.47 19.91 54.50 14.14 14.14 75.47
Triglycerides - - 84478 41.90 J Paul Jones Hospital OP 5.74 37.71 7.96 27.24 5.74 5.74 37.71
Hiv Reflexes - - 86689 465.75 J Paul Jones Hospital OP 17.73 419.18 17.73 302.74 19.35 19.35 419.18
Wbc-Stool - - 89055 15.00 J Paul Jones Hospital OP 4.27 13.50 10.71 9.75 4.27 4.27 13.50
Alpha Fetoprotein Serum - - 82105 51.20 J Paul Jones Hospital OP 16.77 46.08 17.92 33.28 16.77 16.77 46.08
Alpha 1 Antitrypsin - - 82103 61.00 J Paul Jones Hospital OP 13.44 54.90 17.92 39.65 13.44 13.44 54.90
Aldolase - - 82085 50.25 J Paul Jones Hospital OP 9.71 45.23 17.92 32.66 9.71 9.71 45.23
Kefzol - - 80299 56.50 J Paul Jones Hospital OP 18.64 50.85 19.91 36.73 18.64 18.64 50.85
Complement Antigen Each - - 86160 66.50 J Paul Jones Hospital OP 12.00 59.85 17.73 43.23 12.00 12.00 59.85
Zinc (Serum Or Plasma) - - 84630 96.20 J Paul Jones Hospital OP 11.39 86.58 21.24 62.53 11.39 11.39 86.58
Ch 50 Heterophile Antibody Screen - - 86162 83.90 J Paul Jones Hospital OP 17.73 75.51 17.73 54.54 20.32 20.32 75.51
Rapid Drug Screen - - 80305 42.00 J Paul Jones Hospital OP 12.60 37.80 17.92 27.30 12.60 12.60 37.80
Catecholamines Total Urine - - 82382 50.20 J Paul Jones Hospital OP 24.74 45.18 24.74 32.63 27.30 27.30 45.18
Hiv 2 - - 86702 30.75 J Paul Jones Hospital OP 13.52 27.68 17.73 19.99 13.52 13.52 27.68
Carcinoembryonic Antigen Cea - - 82378 87.80 J Paul Jones Hospital OP 17.92 79.02 17.92 57.07 18.96 18.96 79.02
Ceruloplasmin - - 82390 67.40 J Paul Jones Hospital OP 10.74 60.66 17.92 43.81 10.74 10.74 60.66
Cell Count + Diff(Cs,Jt Fluid) - - 89051 29.50 J Paul Jones Hospital OP 5.60 27.30 27.30 19.18 5.60 5.60 26.55
Cold Agglutinins Titer - - 86157 33.00 J Paul Jones Hospital OP 8.06 29.70 17.73 21.45 8.06 8.06 29.70
Crystal Id Any Fuild Es Urine - - 89060 20.95 J Paul Jones Hospital OP 7.33 27.30 27.30 13.62 7.33 7.33 18.86
Alcohol - - 82055 61.00 J Paul Jones Hospital OP 39.65 54.90 Contact Health Plan 39.65 Contact Health Plan Contact Health Plan 54.90
Hepatitis B Core Ab Igm - - 86705 49.55 J Paul Jones Hospital OP 11.77 44.60 17.73 32.21 11.77 11.77 44.60
Hepatitis Be Ab - - 86707 57.80 J Paul Jones Hospital OP 11.57 52.02 17.73 37.57 11.57 11.57 52.02
Xylose Absorption - - 84620 78.75 J Paul Jones Hospital OP 12.91 70.88 17.92 51.19 12.91 12.91 70.88
Estriol - - 82677 153.45 J Paul Jones Hospital OP 24.18 138.11 24.74 99.74 24.18 24.18 138.11
Estrogens Total - - 82672 115.00 J Paul Jones Hospital OP 21.70 103.50 24.74 74.75 21.70 21.70 103.50
Estrone - - 82679 153.45 J Paul Jones Hospital OP 24.74 138.11 24.74 99.74 24.95 24.95 138.11
Fibrinogen Activity - - 85384 33.65 J Paul Jones Hospital OP 6.83 30.29 6.83 21.87 9.72 9.72 30.29
Gamma Glutamyl Transf Ggt - - 82977 31.80 J Paul Jones Hospital OP 7.20 28.62 7.96 20.67 7.20 7.20 28.62
Rapid COVID (BD Veritor) - - 87426 92.25 J Paul Jones Hospital OP 0.00 83.03 14.13 59.96 0.00 0.00 83.03
PCR COVID Testing - - 87635 145.00 J Paul Jones Hospital OP 51.31 130.50 55.27 94.25 51.31 51.31 130.50
Rapid Flu and A & B (BD Veritor) - - 87804 49.65 J Paul Jones Hospital OP 14.13 44.69 14.13 32.27 16.55 16.55 44.69
Respiratory Virus Panel (PCR Flu A.B.RSV) - - 87631 150.00 J Paul Jones Hospital OP 97.50 205.72 205.72 97.50 142.63 142.63 135.00
Notes and Disclaimers

The following pricing may not reflect the total amount due on a claim, nor does it reflect your financial responsibility as a patient. Pricing and services included reflect a typical encounter; however, your physician may render a different variation of services to provide you the best level of care.

Pricing listed represents negotiated rates effective as of the original posting date of this file. Individual payors have unique effective dates and update parameters within their contracts, which may result in variation of pricing for some services as changes are implemented by each payor. Pricing will be updated annually in accordance with stated requirements.

The inclusion of pricing below does not indicate that a service is covered under your benefit plan.

Actual claim reimbursement made by payor can vary based on many factors including but not limited to individual benefit structures, utilization management decisions, diagnosis, and case by case treatment rendered. Members should always consult with their health plans and physician(s) to validate treatment and cost planning decisions.

Professional services provided by a physician or other practitioner not employed by JPJ are separately billable. These services are contracted with the applicable professional and thus not reflected in the hospital agreement or consumer table.

Current rates listed as "Contact Health Plan" were unavailable/ unverified at time of posting. If you require information regarding cost or out of pocket costs, please contact your HR department or the health plan member services department. JPJ will make updates per Price Transparency update requirements.

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