Services HALE COUNTY HOSPITAL HALE COUNTY HOSPITAL CLINIC PHYSICAL THERAPY HOME HEALTH MOUNDVILLE MEDICAL ASSOCIATES PRICING SHOPPABLE SERVICES Hale County Hospital Prices Posted are Effective December 1, 2020 View notes and disclamers Select Plan(s) De-identified Minimum Negotiated Charge De-identified Maximum Negotiated Charge BCBSAL: Commercial BCBSAL: Medicare Advantage Humana Choice Care Humana Tricare: Commercial United Healthcare: Commercial United Healthcare: Medicare Advantage Department of Alabama: Workers' Compensation SHOPPABLE SERVICE PRIMARY SERVICE AND ANCILLARY SERVICES REVENUE CODE PROCEDURE CODE GROSS UB CHARGED CASH PRICE SERVICE LOCATION SITE TYPE Psychotherapy, 30 min - - 90832 80.00 64.00 Hale County Hospital Clinic OP Psychotherapy, 45 min - - 90834 105.00 84.00 Hale County Hospital Clinic OP Psychotherapy, 60 min - - 90837 150.00 120.00 Hale County Hospital Clinic OP Family psychotherapy, not including patient, 50 min - - 90846 Service not offered Service not offered Hale County Hospital OP Family psychotherapy, including patient, 50 min - - 90847 Service not offered Service not offered Hale County Hospital OP Group psychotherapy - - 90853 Service not offered Service not offered Hale County Hospital OP New patient office or other outpatient visit, typically 30 min - - 99203 105.00 84.00 Hale County Hospital Clinic OP New patient office of other outpatient visit, typically 45 min - - 99204 155.00 124.00 Hale County Hospital Clinic OP New patient office of other outpatient visit, typically 60 min - - 99205 195.00 156.00 Hale County Hospital Clinic OP Patient office consultation, typically 40 min - - 99243 110.00 88.00 Hale County Hospital Clinic OP Patient office consultation, typically 60 min - - 99244 160.00 128.00 Hale County Hospital Clinic OP Initial new patient preventive medicine evaluation (18-39 years) - - 99385 90.00 72.00 Hale County Hospital Clinic OP Initial new patient preventive medicine evaluation (40-64 years) - - 99386 90.00 72.00 Hale County Hospital Clinic OP Basic metabolic panel - - 80048 115.59 92.47 Hale County Hospital OP Blood test, comprehensive group of blood chemicals - - 80053 14.85 11.88 Hale County Hospital OP Obstetric blood test panel - - 80055 Service not offered Service not offered Hale County Hospital OP Blood test, lipids (cholesterol and triglycerides) - - 80061 16.22 12.98 Hale County Hospital OP Kidney function panel test - - 80069 117.75 94.20 Hale County Hospital OP Liver function blood test panel - - 80076 11.48 9.18 Hale County Hospital OP Manual urinalysis test with examination using microscope - - 81000 or 81001 4.45 3.56 Hale County Hospital OP Automated urinalysis test - - 81002 or 81003 24.25 19.40 Hale County Hospital OP Automated urinalysis test - - 81002 or 81003 15.00 12.00 Hale County Hospital Clinic OP PSA (prostate specific antigen) - - 84153-84154 39.41 31.53 Hale County Hospital OP Blood test, thyroid stimulating hormone (TSH) - - 84443 44.00 35.20 Hale County Hospital OP Complete blood cell count, with differential white blood cells, automated - - 85025 70.18 56.14 Hale County Hospital OP Complete blood count, automated - - 85027 31.68 25.34 Hale County Hospital OP Blood test, clotting time - - 85610 47.50 38.00 Hale County Hospital OP Coagulation assessment blood test - - 85730 19.16 15.33 Hale County Hospital OP CT scan, head or brain, without contrast - - 70450 1210.15 968.12 Hale County Hospital OP MRI scan of brain before and after contrast - - 70553 Service not offered Service not offered Hale County Hospital OP X-Ray, lower back, minimum four views - - 72110 242.00 193.60 Hale County Hospital OP X-Ray, lower back, minimum four views 72110 15.00 12.00 Hale County Hospital Clinic OP MRI scan of lower spinal canal - - 72148 Service not offered Service not offered Hale County Hospital OP CT scan, pelvis, with contrast - - 72193 1328.68 1062.94 Hale County Hospital OP MRI scan of leg joint - - 73721 Service not offered Service not offered Hale County Hospital OP CT scan of abdomen and pelvis with contrast - - 74177 2150.00 1720.00 Hale County Hospital OP Ultrasound of abdomen - - 76700 554.25 443.40 Hale County Hospital OP Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus - - 76805 Service not offered Service not offered Hale County Hospital OP Ultrasound pelvis through vagina - - 76830 484.00 387.20 Hale County Hospital OP Mammography of one breast - - 77065 Service not offered Service not offered Hale County Hospital OP Mammography of both breasts - - 77066 Service not offered Service not offered Hale County Hospital OP Mammography, screening, bilateral - - 77067 Service not offered Service not offered Hale County Hospital OP Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities - - 216* Service not offered Service not offered Hale County Hospital IP Spinal fusion except cervical without major comorbid conditions or complications (MCC) - - 460* Service not offered Service not offered Hale County Hospital IP Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). - - 470* Service not offered Service not offered Hale County Hospital IP Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). - - 473* Service not offered Service not offered Hale County Hospital IP Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) - - 743* Service not offered Service not offered Hale County Hospital IP Removal of 1 or more breast growth, open procedure - - 19120 Service not offered Service not offered Hale County Hospital OP Shaving of shoulder bone using an endoscope - - 29826 Service not offered Service not offered Hale County Hospital OP Removal of one knee cartilage using an endoscope - - 29881 Service not offered Service not offered Hale County Hospital OP Removal of tonsils and adenoid glands patient younger than age 12 - - 42820 Service not offered Service not offered Hale County Hospital OP Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope - - 43235 Service not offered Service not offered Hale County Hospital OP Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope - - 43239 Service not offered Service not offered Hale County Hospital OP Diagnostic examination of large bowel using an endoscope - - 45378 Service not offered Service not offered Hale County Hospital OP Biopsy of large bowel using an endoscope - - 45380 Service not offered Service not offered Hale County Hospital OP Removal of polyps or growths of large bowel using an endoscope - - 45385 Service not offered Service not offered Hale County Hospital OP Ultrasound examination of lower large bowel using an endoscope - - 45391 Service not offered Service not offered Hale County Hospital OP Removal of gallbladder using an endoscope - - 47562 Service not offered Service not offered Hale County Hospital OP Repair of groin hernia patient age 5 years or older - - 49505 Service not offered Service not offered Hale County Hospital OP Biopsy of prostate gland - - 55700 Service not offered Service not offered Hale County Hospital OP Surgical removal of prostate and surrounding lymph nodes using an endoscope - - 55866 Service not offered Service not offered Hale County Hospital OP Routine obstetric care for vaginal delivery, including pre-and post- delivery care - - 59400 Service not offered Service not offered Hale County Hospital OP Routine obstetric care for cesarean delivery, including pre-and post-delivery care - - 59510 Service not offered Service not offered Hale County Hospital OP Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care - - 59610 Service not offered Service not offered Hale County Hospital OP Injection of substance into spinal canal of lower back or sacrum using imaging guidance - - 62322-62323 Service not offered Service not offered Hale County Hospital OP Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance - - 64483 Service not offered Service not offered Hale County Hospital OP Removal of recurring cataract in lens capsule using laser - - 66821 Service not offered Service not offered Hale County Hospital OP Removal of cataract with insertion of lens - - 66984 Service not offered Service not offered Hale County Hospital OP Electrocardiogram, routine, with interpretation and report - - 93000 Service not offered Service not offered Hale County Hospital OP Insertion of catheter into left heart for diagnosis - - 93452 Service not offered Service not offered Hale County Hospital OP Sleep study - - 95810 Service not offered Service not offered Hale County Hospital OP Physical therapy, therapeutic exercise - - 97110 5.25 4.20 Hale County Hospital OP Cath Bladder Simple - - 51702 137.50 110.00 Hale County Hospital OP X-Ray Mandible <4 Views - - 70100 71.50 57.20 Hale County Hospital OP X-Ray Mandible 4 Views - - 70110 176.00 140.80 Hale County Hospital OP X-Ray Mastoid <3 Views - - 70120 99.00 79.20 Hale County Hospital OP X-Ray Facial Bones <3 Views - - 70140 99.00 79.20 Hale County Hospital OP X-Ray Facial Bones <3Views - - 70150 242.00 193.60 Hale County Hospital OP X-Ray Nasal Bones 3 Views - - 70160 165.00 132.00 Hale County Hospital OP X-Ray Orbits 4 Views Lt - - 70200 165.00 132.00 Hale County Hospital OP X-Ray Sinuses <3 Views - - 70210 82.50 66.00 Hale County Hospital OP X-Ray Sinuses > 3 Views - - 70220 187.00 149.60 Hale County Hospital OP X-Ray Skull < 4 Views - - 70250 99.00 79.20 Hale County Hospital OP X-Ray Skull 4 Views - - 70260 242.00 193.60 Hale County Hospital OP X-Ray T M Joints Uniflat - - 70328 99.00 79.20 Hale County Hospital OP X-Ray Neck Soft Tissues - - 70360 99.00 79.20 Hale County Hospital OP CT Head/Brain With Contrast - - 70460 1168.27 934.62 Hale County Hospital OP CT Head/Brain Without & With Contrast - - 70470 1418.71 1134.97 Hale County Hospital OP CT Orbit/Ear/Fossa Without contrast - - 70480 936.46 749.17 Hale County Hospital OP CT Orbit/Ear/Fossa With Contrast - - 70481 500.50 400.40 Hale County Hospital OP CT Orbit/Ear/Fossa Without &With Contrast - - 70482 654.50 523.60 Hale County Hospital OP CT Maxillofacial without contrast - - 70486 990.00 792.00 Hale County Hospital OP CT Maxillofacial With Contrast - - 70487 500.50 400.40 Hale County Hospital OP CT Soft Tissue Neck without contrast - - 70490 990.00 792.00 Hale County Hospital OP CT Soft Tissue Neck With Contrast - - 70491 1001.00 800.80 Hale County Hospital OP CT Soft Tissue Neck Without & With Contrast - - 70492 1176.00 940.80 Hale County Hospital OP CTA Neck - - 70498 1400.00 1120.00 Hale County Hospital OP X-Ray Chest 1 View - - 71045 173.00 138.40 Hale County Hospital OP X-Ray Chest 2 Views - - 71046 223.00 178.40 Hale County Hospital OP X-Ray Chest 3 Views - - 71047 273.00 218.40 Hale County Hospital OP X-Ray Chest 4+ Views - - 71048 323.00 258.40 Hale County Hospital OP X-Ray Ribs Unilateral 2 Views - - 71100 195.98 156.78 Hale County Hospital OP X-Ray Unilateral Ribs and Chest - - 71101 190.00 152.00 Hale County Hospital OP X-Ray Ribs and Chest 4/ > Views - - 71111 308.00 246.40 Hale County Hospital OP X-Ray Breastbone 2/ >Views - - 71120 198.00 158.40 Hale County Hospital OP X-Ray Strenoclavical Jointt 3/ >Views - - 71130 93.50 74.80 Hale County Hospital OP CT Thorax without contrast - - 71250 1221.55 977.24 Hale County Hospital OP CT Thorax with constrast - - 71260 2450.00 1960.00 Hale County Hospital OP CT Thorax with and without contrast - - 71270 1253.10 1002.48 Hale County Hospital OP CTA Aorta/Runoff - - 71275 1200.00 960.00 Hale County Hospital OP X-Ray Spine 1 View - - 72020 101.00 80.80 Hale County Hospital OP X-Ray Neck Spine 2-3 Views - - 72040 187.00 149.60 Hale County Hospital OP X-Ray Neck Spine 4 -5 Views - - 72050 49.50 39.60 Hale County Hospital OP X-Ray Neck Spine 6/ > Views - - 72052 315.37 252.30 Hale County Hospital OP X-Ray Thorac Spine 2 Views - - 72070 192.41 153.93 Hale County Hospital OP X-Ray Thoracic Spine 4/ > Views - - 72074 126.50 101.20 Hale County Hospital OP X-Ray Entire Spine 2-3 Views - - 72082 77.00 61.60 Hale County Hospital OP X-Ray L-S Spine 2/3 Views - - 72100 198.00 158.40 Hale County Hospital OP X-Ray L-S Spine Bending - - 72114 264.00 211.20 Hale County Hospital OP CT Neck Spine without contrast - - 72125 1315.57 1052.46 Hale County Hospital OP CT Chest Spine without contrast - - 72128 698.50 558.80 Hale County Hospital OP CT Lumbar Spine without contrast - - 72131 720.50 576.40 Hale County Hospital OP X-Ray Pelvis 1 View - - 72170 142.00 113.60 Hale County Hospital OP X-Ray Pelvis 3 Views - - 72190 104.50 83.60 Hale County Hospital OP CT Pelvis without contrast - - 72192 1398.00 1118.40 Hale County Hospital OP CT Pelvis with and without contrast - - 72194 1308.50 1046.80 Hale County Hospital OP X-Ray Exam Si Joints 3/ > Views - - 72202 110.00 88.00 Hale County Hospital OP X-Ray Exam Sacrum Tailbone - - 72220 110.00 88.00 Hale County Hospital OP X-Ray Collar Bone - - 73000 143.00 114.40 Hale County Hospital OP X-Ray Scapula Complete - - 73010 165.00 132.00 Hale County Hospital OP X-Ray Shoulder 2 Views - - 73030 176.00 140.80 Hale County Hospital OP X-Ray AC Joints Bilateral - - 73050 154.00 123.20 Hale County Hospital OP X-Ray Humerus - - 73060 143.00 114.40 Hale County Hospital OP X-Ray Elbow 2 Views - - 73070 88.00 70.40 Hale County Hospital OP X-Ray Elbow 3+ Views - - 73080 165.00 132.00 Hale County Hospital OP X-Ray Forearm 2 Views - - 73090 132.00 105.60 Hale County Hospital OP X-Ray Wrist - - 73100 99.00 79.20 Hale County Hospital OP X-Ray Wrist - - 73110 187.36 149.89 Hale County Hospital OP X-Ray Hand - - 73120 154.00 123.20 Hale County Hospital OP X-Ray Hand - - 73130 176.00 140.80 Hale County Hospital OP X-Ray Finger(S) - - 73140 176.00 140.80 Hale County Hospital OP CT Upper Extremity without contrast - - 73200 1191.71 953.37 Hale County Hospital OP CT Upper Extremity With Contrast - - 73201 660.00 528.00 Hale County Hospital OP CT Uppr Extremity Without &With Contrast - - 73202 720.50 576.40 Hale County Hospital OP X-Ray Exam Hip Uni 1 View - - 73501 88.00 70.40 Hale County Hospital OP X-Ray Exam Hip Uni 2-3 Views - - 73502 166.00 132.80 Hale County Hospital OP X-Ray Exam Hips Bi 2 Views - - 73521 209.00 167.20 Hale County Hospital OP X-Ray Femur 2/ > - - 73552 187.00 149.60 Hale County Hospital OP X-Ray Knee 1 Or 2 - - 73560 147.86 118.29 Hale County Hospital OP X-Ray Knee 3 - - 73562 187.00 149.60 Hale County Hospital OP X-Ray Exam Knee 4 Or More - - 73564 231.00 184.80 Hale County Hospital OP X-Ray Knees - - 73565 115.50 92.40 Hale County Hospital OP X-Ray Lower Leg - - 73590 187.00 149.60 Hale County Hospital OP X-Ray Ankle - - 73600 110.00 88.00 Hale County Hospital OP X-Ray Ankle - - 73610 199.09 159.27 Hale County Hospital OP X-Ray Foot - - 73620 132.00 105.60 Hale County Hospital OP X-Ray Foot - - 73630 165.00 132.00 Hale County Hospital OP X-Ray Heel - - 73650 159.58 127.66 Hale County Hospital OP X-Ray Toe(S) - - 73660 121.00 96.80 Hale County Hospital OP CT Lo/Ext Without Cont Rt - - 73700 996.57 797.26 Hale County Hospital OP CT Lo/Ext W/Cont Lt - - 73701 500.50 400.40 Hale County Hospital OP CT Lo/Ext W And Without Rt - - 73702 588.50 470.80 Hale County Hospital OP X-Ray Exam Abdomen 1 View - - 74018 154.00 123.20 Hale County Hospital OP X-Ray Exam Abdomen 2 Views - - 74019 154.00 123.20 Hale County Hospital OP X-Ray Exam Abdomen 3+ Views - - 74021 323.00 258.40 Hale County Hospital OP X-Ray Exam Complete Abdomen - - 74022 323.18 258.54 Hale County Hospital OP CT Abdomen without contrast - - 74150 1309.63 1047.70 Hale County Hospital OP CT Abdomen With Contrast - - 74160 1451.19 1160.95 Hale County Hospital OP CT Abdomen Without & With Contrast - - 74170 1441.00 1152.80 Hale County Hospital OP CT Angio Abdom Without & With Contrast - - 74175 1200.00 960.00 Hale County Hospital OP CT Abd & Pelvis Without Contrast - - 74176 2050.00 1640.00 Hale County Hospital OP CT Abdomen & Pelvis 1/ > Regns - - 74178 2050.00 1640.00 Hale County Hospital OP US Soft Tissue Head & Neck Real Time Image - - 76536 397.00 317.60 Hale County Hospital OP US Abdominal Real Time W/Image Limited - - 76705 459.14 367.31 Hale County Hospital OP US Pelvic Nonobstetric Real-Time Image Complete - - 76856 456.07 364.86 Hale County Hospital OP US Limited Joint/Ott Nonvasc Xtr Strux R-T W/Img - - 76882 220.00 176.00 Hale County Hospital OP Us Guidance Needle Placement Img S &I - - 76942 324.01 259.21 Hale County Hospital OP L Bone Survey - - 77074 75.14 60.11 Hale County Hospital OP General Health Panel - - 80050 242.00 193.60 Hale County Hospital OP Acute Hepatitis Panel - - 80074 62.79 50.23 Hale County Hospital OP Digoxin Nh - - 80162 35.33 28.26 Hale County Hospital OP Gentamicin Trough - - 80170 81.68 65.34 Hale County Hospital OP Phenobarbital Lc Nh - - 80184 16.23 12.98 Hale County Hospital OP Procainamide - - 80190 68.75 55.00 Hale County Hospital OP Vancomycin Peak - - 80202 81.00 64.80 Hale County Hospital OP Alcohol - - 80307 100.00 80.00 Hale County Hospital OP Lacosamide Nh - - 80339 178.00 142.40 Hale County Hospital OP Dexamethasone - - 80375 76.00 60.80 Hale County Hospital OP Urnls Dip Stick/Tablet Reagent Auto Microscopy - - 81001 4.45 3.56 Hale County Hospital OP Urnls Dip Stick/Tablet Rgnt Auto Without Microscopy - - 81003 24.25 19.40 Hale County Hospital OP Urine Pregnancy Test Visual Color Cmprsn Meths - - 81025 35.75 28.60 Hale County Hospital OP Hereditary Hemochromatosis Dna - - 81256 255.00 204.00 Hale County Hospital OP Albumin Serum Plasma/Whole Blood - - 82040 7.02 5.62 Hale County Hospital OP Urine Albumin Quantitative - - 82043 8.27 6.62 Hale County Hospital OP Assay Of Amylase - - 82150 16.29 13.03 Hale County Hospital OP Bilirubin Total - - 82247 44.87 35.90 Hale County Hospital OP Bilirubin DireCT - - 82248 49.70 39.76 Hale County Hospital OP Calcium Total - - 82310 35.19 28.15 Hale County Hospital OP Chloride - - 82435 43.67 34.94 Hale County Hospital OP Cortisol Total - - 82533 18.27 14.62 Hale County Hospital OP Serum Creatine - - 82540 34.75 27.80 Hale County Hospital OP Creatine Kinase Total - - 82550 59.40 47.52 Hale County Hospital OP Creatine Kinase Mb FraCTion Only - - 82553 103.13 82.50 Hale County Hospital OP Creatinine Blood - - 82565 6.61 5.29 Hale County Hospital OP Creatinine Other Source - - 82570 40.75 32.60 Hale County Hospital OP Cryoglobulin - - 82595 42.45 33.96 Hale County Hospital OP Cyanocobalamin Vitamin B-12 - - 82607 21.52 17.22 Hale County Hospital OP Dehydroepiandrosterone-Sulfate - - 82627 132.00 105.60 Hale County Hospital OP Assay Of Estradiol - - 82670 48.13 38.50 Hale County Hospital OP Assay Of Ferritin - - 82728 19.46 15.57 Hale County Hospital OP Assay Of Folic Acid Serum - - 82746 17.86 14.29 Hale County Hospital OP Assay Of Gammaglobulin Iga Igd Igg Igm Each - - 82784 40.00 32.00 Hale County Hospital OP Blood Gases Any Combination Ph Pco2 Po2 Co2 Hco3 - - 82803 27.42 21.94 Hale County Hospital OP Glucose Quantitative Blood Xcpt Reagent Strip - - 82947 37.25 29.80 Hale County Hospital OP Gluc Bld Gluc Mntr Dev Cleared Fda Spec Home Use - - 82962 22.00 17.60 Hale County Hospital OP Gonadotropin Follicle Stimulating Hormone - - 83001 31.56 25.25 Hale County Hospital OP Gonadotropin Luteinizing Hormone - - 83002 24.92 19.94 Hale County Hospital OP Helicobacteria Pylori Breath Test - - 83013 140.00 112.00 Hale County Hospital OP Cobalt Level - - 83018 316.00 252.80 Hale County Hospital OP Hemoglobin Glycosylated A1C - - 83036 69.06 55.25 Hale County Hospital OP Hemoglobin Free Plasma - - 83051 69.06 55.25 Hale County Hospital OP Immunoassay Analyte Qual/Semiqual Multiple Step - - 83516 119.00 95.20 Hale County Hospital OP Assay Of Insulin Total - - 83525 0.00 0.00 Hale County Hospital OP Assay Of Iron - - 83540 9.25 7.40 Hale County Hospital OP Iron Binding Capacity - - 83550 84.75 67.80 Hale County Hospital OP Assay Of LaCTate - - 83605 51.00 40.80 Hale County Hospital OP Lactate Dehydrogenase Ldh - - 83615 27.41 21.93 Hale County Hospital OP Assay Of Lipase - - 83690 0.00 0.00 Hale County Hospital OP Lipo Protein A - - 83695 94.00 75.20 Hale County Hospital OP Lipoprotein DireCT Measurement Ldl Cholesterol - - 83721 27.50 22.00 Hale County Hospital OP Assay Of Magnesium - - 83735 35.75 28.60 Hale County Hospital OP Myoglobin - - 83874 132.00 105.60 Hale County Hospital OP Natriuretic Peptide - - 83880 250.00 200.00 Hale County Hospital OP Assay Of Parathormone - - 83970 58.51 46.81 Hale County Hospital OP Assay Of Phosphatase Alkaline - - 84075 14.00 11.20 Hale County Hospital OP Assay Of Phosphorus Inorganic - - 84100 5.00 4.00 Hale County Hospital OP Urine Phosphorous - - 84105 41.00 32.80 Hale County Hospital OP Potassium Serum Plasma/Whole Blood - - 84132 6.56 5.25 Hale County Hospital OP Assay Of Progesterone - - 84144 31.94 25.55 Hale County Hospital OP Assay Of Prolactin - - 84146 18.71 14.97 Hale County Hospital OP Assay Of Prostate Specific Antigen Total - - 84153 0.00 0.00 Hale County Hospital OP Protein Total Xcpt RefraCTometry Urine - - 84156 52.03 41.62 Hale County Hospital OP Protein EleCTro Serum Lc - - 84165 66.00 52.80 Hale County Hospital OP Serotonin,Serum - - 84260 99.68 79.74 Hale County Hospital OP Sodium (Na) - - 84295 6.87 5.50 Hale County Hospital OP Assay Of Testosterone Free - - 84402 60.97 48.78 Hale County Hospital OP Assay Of Testosterone Total - - 84403 44.90 35.92 Hale County Hospital OP Assay Of Thyroxine Total - - 84436 42.87 34.30 Hale County Hospital OP Assay Of Free Thyroxine - - 84439 90.75 72.60 Hale County Hospital OP Transferase Aspartate Amino Ast Sgot - - 84450 58.39 46.71 Hale County Hospital OP Transferase Alanine Amino Alt Sgpt - - 84460 59.88 47.90 Hale County Hospital OP Assay Of Triiodothyronine T3 Total Tt3 - - 84480 20.25 16.20 Hale County Hospital OP Assay Of Triiodothyronine T3 Free - - 84481 78.13 62.50 Hale County Hospital OP Assay Of Troponin Quantitative - - 84484 150.00 120.00 Hale County Hospital OP Assay Of Urea Nitrogen Quantitative - - 84520 5.63 4.50 Hale County Hospital OP Urea Nitrogen Urine - - 84540 40.75 32.60 Hale County Hospital OP Assay Of Blood/Uric Acid - - 84550 6.46 5.17 Hale County Hospital OP Antidiuretic Hormone (Adh),Plasma - - 84588 171.00 136.80 Hale County Hospital OP C-Peptide Lc - - 84681 117.75 94.20 Hale County Hospital OP Gonadotropin Chorionic Quantitative - - 84702 108.23 86.58 Hale County Hospital OP Gonadotropin Chorionic Qualitative - - 84703 46.37 37.10 Hale County Hospital OP Blood Count Hematocrit - - 85014 25.54 20.43 Hale County Hospital OP Blood Count Hemoglobin - - 85018 25.63 20.50 Hale County Hospital OP Blood Count Reticulocyte Automated - - 85045 22.95 18.36 Hale County Hospital OP Blood Count Platelet Automated - - 85049 56.62 45.30 Hale County Hospital OP Fibrin Dgradj ProduCTs D-Dimer Qual/Semiquan - - 85378 159.00 127.20 Hale County Hospital OP Fibrin Dgradj ProduCTs D-Dimer Quantitative - - 85379 110.00 88.00 Hale County Hospital OP Sedimentation Rate Rbc Non-Automated - - 85651 5.07 4.06 Hale County Hospital OP Platelet Antibody - - 86022 160.00 128.00 Hale County Hospital OP Antinuclear Antibodies Ana - - 86038 67.67 54.14 Hale County Hospital OP C-ReaCTive Protein - - 86140 6.91 5.53 Hale County Hospital OP C-ReaCTive Protein High Sensitivity - - 86141 44.00 35.20 Hale County Hospital OP Beta 2 Glycoprotein Iga - - 86146 66.00 52.80 Hale County Hospital OP Chromatin Antibody - - 86235 88.75 71.00 Hale County Hospital OP Heterophile Antibodies Screen - - 86308 60.58 48.46 Hale County Hospital OP Protein EleCTophoresis - - 86334 165.00 132.00 Hale County Hospital OP Microsomal Antibodies Each - - 86376 25.29 20.23 Hale County Hospital OP Rheumatoid FaCTor Qualitative - - 86430 8.11 6.49 Hale County Hospital OP Syphilis Test Non-Treponemal Antibody Qual - - 86592 36.11 28.89 Hale County Hospital OP Lyme Igm Antibody Lc - - 86618 42.30 33.84 Hale County Hospital OP Hepatitis B Surf Antibody Hbsab - - 86706 28.29 22.63 Hale County Hospital OP Antibody Rubella - - 86762 19.05 15.24 Hale County Hospital OP Antibody Treponema Pallidum - - 86780 22.00 17.60 Hale County Hospital OP Thyroglobulin Antibody - - 86800 96.00 76.80 Hale County Hospital OP Hepatitis C Antibody - - 86803 0.00 0.00 Hale County Hospital OP Antibody Screen Rbc Each Serum Technique - - 86850 60.71 48.57 Hale County Hospital OP Culure Bacteria - Stool Salmonella & Shigell - - 87045 13.47 10.78 Hale County Hospital OP Culture Bacteria Xcpt Urine Blood/Stool Aerobic Isol - - 87070 34.16 27.33 Hale County Hospital OP Culture BaCTerial Any Source Anaerobic Iso &Id - - 87075 12.73 10.18 Hale County Hospital OP Cul BaCT Aerobic Addl Meths Definitive Ea Isol - - 87077 4.60 3.68 Hale County Hospital OP Cul Prsmptv Pthgnc Organism Scrn W/Colony Estimj - - 87081 16.29 13.03 Hale County Hospital OP Culture BCT Isol &Prsmptv Id Isolate Ea Urine - - 87088 49.17 39.34 Hale County Hospital OP Susceptiblty Study Antimicrobial Micro - - 87186 282.16 225.73 Hale County Hospital OP Smr Prim Src Gram/Giemsa Stain BCT Fungi/Cell - - 87205 10.40 8.32 Hale County Hospital OP Iaad Ia Hepatitis B Surface Antigen - - 87340 49.50 39.60 Hale County Hospital OP Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single - - 87389 61.20 48.96 Hale County Hospital OP Iaad Ia Influenza A/B Each - - 87400 45.00 36.00 Hale County Hospital OP RSV - - 87420 116.75 93.40 Hale County Hospital OP Iadna Chlamydia Trachomatis Amplified Probe Tq - - 87491 0.00 0.00 Hale County Hospital OP Hepatitis C RNA - - 87521 753.00 602.40 Hale County Hospital OP Iadna Neisseria Gonorrhoeae Amplified Probe Tq - - 87591 50.00 40.00 Hale County Hospital OP Bk Virus, Quant, Urine - - 87799 603.03 482.42 Hale County Hospital OP Iaadiadoo Influenza - - 87804 176.00 140.80 Hale County Hospital OP Iaadiadoo Streptococcus Group A - - 87880 47.29 37.83 Hale County Hospital OP Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys - - 88175 0.00 0.00 Hale County Hospital OP Level Iii Surg Pathology Gross &Microscopic Exam - - 88304 89.50 71.60 Hale County Hospital OP Level Iv Surg Pathology Gross &Microscopic Exam - - 88305 114.00 91.20 Hale County Hospital OP Ppsv23 Vacc 2 Yrs+ Subq/Im - - 90732 240.80 192.64 Hale County Hospital OP Nasopharyngoscopy With Endoscope - - 92511 4.34 3.47 Hale County Hospital OP Evaluation Speech Sound Production - - 92522 10.00 8.00 Hale County Hospital OP Evaluation Speech Sound Production W Evaluation Of Lang Co - - 92523 20.00 16.00 Hale County Hospital OP Swallowing Function Treatment - - 92526 16.08 12.86 Hale County Hospital OP Speech Cognitive Testing - - 96125 31.00 24.80 Hale County Hospital OP Op Iv Therapy Initial Up To 1 Hr - - 96365 100.00 80.00 Hale County Hospital OP Outpatient Concurrent Infusion - - 96368 100.00 80.00 Hale County Hospital OP Therapeutic Or Diagnostic Injection - - 96372 51.59 41.27 Hale County Hospital OP Physical Therapy Estimated Unattended O/P - - 97014 11.00 8.80 Hale County Hospital OP Physical Therapy Paraffin Bath - - 97018 47.17 37.74 Hale County Hospital OP Physical Therapy Diathermy O/P - - 97024 47.17 37.74 Hale County Hospital OP Physical Therapy E-Stim Manual O/P - - 97032 5.25 4.20 Hale County Hospital OP Occupational Therapy Treatment Sit/Standing Activity - - 97112 6.99 5.59 Hale County Hospital OP Physical Therapy Gait Training- O/P - - 97116 4.72 3.78 Hale County Hospital OP Physical Therapy Massage Treatment - O/P - - 97124 4.72 3.78 Hale County Hospital OP Occupational Manual Therapy - - 97140 6.64 5.31 Hale County Hospital OP Physical Therapy Evaluation Low Complex 20 Mins - - 97161 20.00 16.00 Hale County Hospital OP Physical Therapy Evaluation Mod Complex 30 Mins - - 97162 24.00 19.20 Hale County Hospital OP Physical Therapy Evaluation High Complex 45 Mins - - 97163 27.00 21.60 Hale County Hospital OP Physical Therapy Re-Evaluation Estimated Plan Care 20 Mins - - 97164 13.00 10.40 Hale County Hospital OP Occupational Therapy Evaluation Low - - 97165 20.00 16.00 Hale County Hospital OP Pt Therapeutic Activities- O/P - - 97530 3.92 3.14 Hale County Hospital OP Occupational Treatment Wheelchair Management - - 97542 3.07 2.46 Hale County Hospital OP Office Outpatient New 10 Minutes - - 99201 40.00 32.00 Hale County Hospital OP Office Outpatient New 20 Minutes - - 99202 70.00 56.00 Hale County Hospital OP Office Outpatient Visit 5 Minutes - - 99211 35.00 28.00 Hale County Hospital OP Office Outpatient Visit 10 Minutes - - 99212 50.00 40.00 Hale County Hospital OP Office Outpatient Visit 15 Minutes - - 99213 70.00 56.00 Hale County Hospital OP Office Outpatient Visit 25 Minutes - - 99214 100.00 80.00 Hale County Hospital OP Blood Collection Fee - - 36415 3.00 2.40 Hale County Hospital OP EKG - - 93005 126.68 101.34 Hale County Hospital OP Ultrasound Cartoid Bilateral - - 93880 330.00 264.00 Hale County Hospital OP Heart Monitor - - 93041 110.00 88.00 Hale County Hospital OP Helico Bacteria Pylori - - 86677 113.25 90.60 Hale County Hospital OP 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 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. "Included in primary procedure" indicates that, typically, the specified service is not separately priced; rather, it is considered packaged with the primary procedure pricing by a specific payor. Professional services provided by a physician or other practitioner not employed by HCH 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 from the health plan at time of posting. If you require information regarding lab benefits or out of pocket costs, please contact your HR department or the health plan member services department. Back to top Download CDM 508 Greene Street, Greensboro AL, 36744 Hale County Hospital (334) 624-3024 Hale County Hospital Clinic (334) 624-4442 Moundville Medical Associates (205) 371-4444 Hale County Hospital Home Health (334) 624-3066 Hale County Hospital Physical Therapy (334) 624-1713