Hospital Name Hospital Code Place of Service Service Code Service Line Service Description Charges Average Rates Monmouth Medical Center MMC Inpatient 216 Cardiac Surgery Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc "$138,814.55 " Monmouth Medical Center MMC Inpatient 460 Spine Spinal Fusion Except Cervical Without Mcc "$54,881.36 " Monmouth Medical Center MMC Inpatient 470 Orthopedics Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc "$30,459.63 " Monmouth Medical Center MMC Inpatient 473 Spine Cervical Spinal Fusion Without Cc/Mcc "$36,756.73 " Monmouth Medical Center MMC Inpatient 743 Gynecology Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc "$16,214.72 " Monmouth Medical Center MMC Outpatient 19120 Procedure - Integumentary System Removal of breast lesion "$6,961.00 " "$4,169.28 " Monmouth Medical Center MMC Outpatient 29826 Procedure - Musculoskeletal Sys Shoulder arthroscopy/surgery "$5,831.55 " Monmouth Medical Center MMC Outpatient 29881 Procedure - Musculoskeletal Sys Knee arthroscopy/surgery "$7,350.95 " Monmouth Medical Center MMC Outpatient 42820 Procedure - Digestive System Remove tonsils and adenoids "$4,349.94 " Monmouth Medical Center MMC Outpatient 43235 Procedure - Digestive System Egd diagnostic brush wash "$2,993.50 " Monmouth Medical Center MMC Outpatient 43239 Procedure - Digestive System Egd biopsy single/multiple "$3,222.64 " Monmouth Medical Center MMC Outpatient 45378 Procedure - Digestive System Diagnostic colonoscopy "$3,222.64 " Monmouth Medical Center MMC Outpatient 45380 Procedure - Digestive System Colonoscopy and biopsy "$3,222.64 " Monmouth Medical Center MMC Outpatient 45385 Procedure - Digestive System Colonoscopy w/lesion removal "$3,222.64 " Monmouth Medical Center MMC Outpatient 45391 Procedure - Digestive System Colonoscopy w/endoscope us "$3,482.68 " Monmouth Medical Center MMC Outpatient 47562 Laparoscopy Laparoscopic cholecystectomy "$7,233.68 " Monmouth Medical Center MMC Outpatient 49505 Procedure - Digestive System Prp i/hern init reduc >5 yr "$5,251.19 " Monmouth Medical Center MMC Outpatient 55700 Procedure - Male Genital System Biopsy of prostate "$3,737.48 " Monmouth Medical Center MMC Outpatient 55866 Procedure - Male Genital System Laparo radical prostatectomy "$6,674.63 " Monmouth Medical Center MMC Outpatient 59400 Maternity Care and Delivery Obstetrical care "$5,544.00 " Monmouth Medical Center MMC Outpatient 59510 Maternity Care and Delivery Cesarean delivery "$5,544.00 " Monmouth Medical Center MMC Outpatient 59610 Maternity Care and Delivery Vbac delivery "$5,544.00 " Monmouth Medical Center MMC Outpatient 62322 Procedure - Nervous System Njx interlaminar lmbr/sac "$3,398.67 " Monmouth Medical Center MMC Outpatient 62323 Procedure - Nervous System Njx interlaminar lmbr/sac "$3,029.00 " "$3,398.67 " Monmouth Medical Center MMC Outpatient 64483 Procedure - Nervous System Inj foramen epidural l/s "$2,407.00 " "$3,053.63 " Monmouth Medical Center MMC Outpatient 66821 Procedure - Eye / Ocular Adnexa After cataract laser surgery "$2,935.60 " Monmouth Medical Center MMC Outpatient 66984 Procedure - Eye / Ocular Adnexa Xcapsl ctrc rmvl w/o ecp "$5,604.42 " Monmouth Medical Center MMC Outpatient 70450 Computerized Axial Tomography (CAT) Ct head/brain w/o dye "$1,698.00 " $336.58 Monmouth Medical Center MMC Outpatient 70553 Magnetic Resonance Img (MRI) Mri brain stem w/o & w/dye "$5,288.00 " $770.74 Monmouth Medical Center MMC Outpatient 72110 Radiology X-ray exam l-2 spine 4/>vws "$1,105.00 " $181.51 Monmouth Medical Center MMC Outpatient 72148 Magnetic Resonance Img (MRI) Mri lumbar spine w/o dye "$2,383.00 " $563.93 Monmouth Medical Center MMC Outpatient 72193 Computerized Axial Tomography (CAT) Ct pelvis w/dye "$2,332.00 " $529.49 Monmouth Medical Center MMC Outpatient 73721 Magnetic Resonance Img (MRI) Mri jnt of lwr extre w/o dye $598.61 Monmouth Medical Center MMC Outpatient 74177 Computerized Axial Tomography (CAT) Ct abd & pelv w/contrast "$2,913.00 " $627.26 Monmouth Medical Center MMC Outpatient 76700 Diagnostic Ultrasound Us exam abdom complete $711.00 $267.91 Monmouth Medical Center MMC Outpatient 76805 Diagnostic Ultrasound Ob us >= 14 wks sngl fetus "$1,206.00 " $285.33 Monmouth Medical Center MMC Outpatient 76830 Diagnostic Ultrasound Transvaginal us non-ob $941.00 $279.30 Monmouth Medical Center MMC Outpatient 77065 Mammography Dx mammo incl cad uni $285.59 Monmouth Medical Center MMC Outpatient 77066 Mammography Dx mammo incl cad bi "$1,030.00 " $365.52 Monmouth Medical Center MMC Outpatient 77067 Mammography Scr mammo bi incl cad $541.00 $302.01 Monmouth Medical Center MMC Outpatient 80048 Pathology and Laboratory Metabolic panel total ca $195.00 $9.18 Monmouth Medical Center MMC Outpatient 80053 Pathology and Laboratory Comprehen metabolic panel $330.00 $11.67 Monmouth Medical Center MMC Outpatient 80055 Pathology and Laboratory Obstetric panel $292.00 $38.37 Monmouth Medical Center MMC Outpatient 80061 Pathology and Laboratory Lipid panel $330.00 $14.92 Monmouth Medical Center MMC Outpatient 80069 Pathology and Laboratory Renal function panel $105.00 $9.36 Monmouth Medical Center MMC Outpatient 80076 Pathology and Laboratory Hepatic function panel $151.00 $8.95 Monmouth Medical Center MMC Outpatient 81000 Pathology and Laboratory Urinalysis nonauto w/scope $41.00 $3.70 Monmouth Medical Center MMC Outpatient 81001 Pathology and Laboratory Urinalysis auto w/scope $68.00 $3.35 Monmouth Medical Center MMC Outpatient 81002 Pathology and Laboratory Urinalysis nonauto w/o scope $31.00 $3.56 Monmouth Medical Center MMC Outpatient 81003 Pathology and Laboratory Urinalysis auto w/o scope $96.00 $2.31 Monmouth Medical Center MMC Outpatient 84153 Pathology and Laboratory Assay of psa total $368.00 $20.60 Monmouth Medical Center MMC Outpatient 84154 Pathology and Laboratory Assay of psa free $110.00 $20.34 Monmouth Medical Center MMC Outpatient 84443 Pathology and Laboratory Assay thyroid stim hormone $216.00 $19.79 Monmouth Medical Center MMC Outpatient 85025 Pathology and Laboratory Complete cbc w/auto diff wbc $140.00 $8.73 Monmouth Medical Center MMC Outpatient 85027 Pathology and Laboratory Complete cbc automated $120.00 $7.58 Monmouth Medical Center MMC Outpatient 85610 Pathology and Laboratory Prothrombin time $111.00 $4.42 Monmouth Medical Center MMC Outpatient 85730 Pathology and Laboratory Thromboplastin time partial $135.00 $6.82 Monmouth Medical Center MMC Outpatient 90832 Behavioral Medicine Psytx w pt 30 minutes $380.29 $40.39 Monmouth Medical Center MMC Outpatient 90834 Behavioral Medicine Psytx w pt 45 minutes $434.14 $48.96 Monmouth Medical Center MMC Outpatient 90837 Behavioral Medicine Psytx w pt 60 minutes $534.75 $48.96 Monmouth Medical Center MMC Outpatient 90846 Behavioral Medicine Family psytx w/o pt 50 min $531.00 $73.44 Monmouth Medical Center MMC Outpatient 90847 Behavioral Medicine Family psytx w/pt 50 min $552.00 $73.44 Monmouth Medical Center MMC Outpatient 90853 Behavioral Medicine Group psychotherapy (other than of a multiple-family group) $325.00 $48.96 Monmouth Medical Center MMC Outpatient 93000 Electrocardiogram Electrocardiogram complete $35.23 Monmouth Medical Center MMC Outpatient 93452 Cardiac Catheterization Left hrt cath w/ventrclgrphy "$14,455.00 " "$10,197.60 " Monmouth Medical Center MMC Outpatient 95810 Sleep Testing Polysom 6/> yrs 4/> param "$8,558.00 " "$3,323.00 " Monmouth Medical Center MMC Outpatient 97110 Physical Medicine and Rehab Therapeutic exercises $60.00 Monmouth Medical Center MMC Outpatient 99203 Office Visit or Consult Claim Office/outpatient visit new $493.00 $186.77 Monmouth Medical Center MMC Outpatient 99204 Office Visit or Consult Claim Office/outpatient visit new $605.00 $302.13 Monmouth Medical Center MMC Outpatient 99205 Office Visit or Consult Claim Office/outpatient visit new $766.00 $385.88 Monmouth Medical Center MMC Outpatient 99243 Office Visit or Consult Claim Office consultation $226.13 Monmouth Medical Center MMC Outpatient 99244 Office Visit or Consult Claim Office consultation $349.64 Monmouth Medical Center MMC Outpatient 99385 Office Visit or Consult Claim Prev visit new age 18-39 $235.36 Monmouth Medical Center MMC Outpatient 99386 Office Visit or Consult Claim Prev visit new age 40-64 $278.89 Monmouth Medical Center MMC Outpatient 80156 Pathology and Laboratory Assay carbamazepine total $192.00 $17.04 Monmouth Medical Center MMC Outpatient 80158 Pathology and Laboratory Drug assay cyclosporine $403.00 $21.26 Monmouth Medical Center MMC Outpatient 80162 Pathology and Laboratory Assay of digoxin total $144.00 $15.53 Monmouth Medical Center MMC Outpatient 80164 Pathology and Laboratory Assay dipropylacetic acd tot $173.00 $14.96 Monmouth Medical Center MMC Outpatient 80168 Pathology and Laboratory Assay of ethosuximide $104.00 $18.99 Monmouth Medical Center MMC Outpatient 80169 Pathology and Laboratory Drug assay everolimus $199.00 $11.71 Monmouth Medical Center MMC Outpatient 80170 Pathology and Laboratory Assay of gentamicin $128.00 $19.42 Monmouth Medical Center MMC Outpatient 80175 Pathology and Laboratory Drug screen quan lamotrigine $128.00 $11.45 Monmouth Medical Center MMC Outpatient 80177 Pathology and Laboratory Drug scrn quan levetiracetam $134.00 $11.45 Monmouth Medical Center MMC Outpatient 80178 Pathology and Laboratory Assay of lithium $125.00 $7.66 Monmouth Medical Center MMC Outpatient 80180 Pathology and Laboratory Drug scrn quan mycophenolate $402.00 $15.75 Monmouth Medical Center MMC Outpatient 80183 Pathology and Laboratory Drug scrn quant oxcarbazepin $218.00 $11.45 Monmouth Medical Center MMC Outpatient 80184 Pathology and Laboratory Assay of phenobarbital $141.00 $14.06 Monmouth Medical Center MMC Outpatient 80185 Pathology and Laboratory Assay of phenytoin total $148.00 $15.37 Monmouth Medical Center MMC Outpatient 80195 Pathology and Laboratory Assay of sirolimus $290.00 $15.02 Monmouth Medical Center MMC Outpatient 80197 Pathology and Laboratory Assay of tacrolimus $389.00 $15.02 Monmouth Medical Center MMC Outpatient 80200 Pathology and Laboratory Assay of tobramycin $158.00 $18.67 Monmouth Medical Center MMC Outpatient 80201 Pathology and Laboratory Assay of topiramate $158.00 $13.17 Monmouth Medical Center MMC Outpatient 80202 Pathology and Laboratory Assay of vancomycin $275.00 $14.96 Monmouth Medical Center MMC Outpatient 80203 Pathology and Laboratory Drug screen quant zonisamide $148.00 $11.45 Monmouth Medical Center MMC Outpatient 82043 Pathology and Laboratory Ur albumin quantitative $162.00 $6.61 Monmouth Medical Center MMC Outpatient 82104 Pathology and Laboratory Alpha-1-antitrypsin pheno $124.00 $16.64 Monmouth Medical Center MMC Outpatient 82105 Pathology and Laboratory Alpha-fetoprotein serum $532.00 $19.48 Monmouth Medical Center MMC Outpatient 82128 Pathology and Laboratory Amino acids mult qual $366.00 $15.77 Monmouth Medical Center MMC Outpatient 82139 Pathology and Laboratory Amino acids quan 6 or more $519.00 $18.72 Monmouth Medical Center MMC Outpatient 82140 Pathology and Laboratory Assay of ammonia $145.00 $17.04 Monmouth Medical Center MMC Outpatient 82164 Pathology and Laboratory Angiotensin i enzyme test $125.00 $17.09 Monmouth Medical Center MMC Outpatient 82172 Pathology and Laboratory Assay of apolipoprotein $256.00 $14.91 Monmouth Medical Center MMC Outpatient 82175 Pathology and Laboratory Assay of arsenic $209.00 $22.30 Monmouth Medical Center MMC Outpatient 82232 Pathology and Laboratory Assay of beta-2 protein $153.00 $18.83 Monmouth Medical Center MMC Outpatient 82239 Pathology and Laboratory Bile acids total $102.00 $19.43 Monmouth Medical Center MMC Outpatient 82247 Pathology and Laboratory Bilirubin total $86.00 $5.20 Monmouth Medical Center MMC Outpatient 82330 Pathology and Laboratory Assay of calcium $261.00 $15.86 Monmouth Medical Center MMC Outpatient 82340 Pathology and Laboratory Assay of calcium in urine $106.00 $6.83 Monmouth Medical Center MMC Outpatient 82360 Pathology and Laboratory Calculus assay quant $77.00 $14.78 Monmouth Medical Center MMC Outpatient 82365 Pathology and Laboratory Calculus spectroscopy $133.00 $15.20 Monmouth Medical Center MMC Outpatient 82378 Pathology and Laboratory Carcinoembryonic antigen $370.00 $22.00 Monmouth Medical Center MMC Outpatient 82390 Pathology and Laboratory Assay of ceruloplasmin $209.00 $12.51 Monmouth Medical Center MMC Outpatient 82397 Pathology and Laboratory Chemiluminescent assay $134.33 $15.87 Monmouth Medical Center MMC Outpatient 82438 Pathology and Laboratory Assay other fluid chlorides $48.00 $5.47 Monmouth Medical Center MMC Outpatient 82465 Pathology and Laboratory Assay bld/serum cholesterol $113.00 $3.07 Monmouth Medical Center MMC Outpatient 82523 Pathology and Laboratory Collagen crosslinks $247.00 $16.52 Monmouth Medical Center MMC Outpatient 82525 Pathology and Laboratory Assay of copper $161.00 $14.32 Monmouth Medical Center MMC Outpatient 82530 Pathology and Laboratory Cortisol free $112.00 $20.25 Monmouth Medical Center MMC Outpatient 82533 Pathology and Laboratory Total cortisol $202.00 $18.83 Monmouth Medical Center MMC Outpatient 82552 Pathology and Laboratory Assay of cpk in blood $106.00 $15.48 Monmouth Medical Center MMC Outpatient 82570 Pathology and Laboratory Assay of urine creatinine $89.00 $6.11 Monmouth Medical Center MMC Outpatient 82575 Pathology and Laboratory Creatinine clearance test $219.00 $10.99 Monmouth Medical Center MMC Outpatient 82595 Pathology and Laboratory Assay of cryoglobulin $79.00 $7.62 Monmouth Medical Center MMC Outpatient 82607 Pathology and Laboratory Vitamin b-12 $96.00 $17.48 Monmouth Medical Center MMC Outpatient 82656 Pathology and Laboratory Pancreatic elastase fecal $413.00 $12.09 Monmouth Medical Center MMC Outpatient 82710 Pathology and Laboratory Fats/lipids feces quant $445.00 $19.79 Monmouth Medical Center MMC Outpatient 82746 Pathology and Laboratory Assay of folic acid serum $209.00 $17.04 Monmouth Medical Center MMC Outpatient 82784 Pathology and Laboratory Assay iga/igd/igg/igm each $231.00 $10.88 Monmouth Medical Center MMC Outpatient 82785 Pathology and Laboratory Assay of ige $349.00 $18.99 Monmouth Medical Center MMC Outpatient 82941 Pathology and Laboratory Assay of gastrin $265.00 $20.21 Monmouth Medical Center MMC Outpatient 82947 Pathology and Laboratory Assay glucose blood quant $45.00 $2.95 Monmouth Medical Center MMC Outpatient 82948 Pathology and Laboratory Reagent strip/blood glucose $53.67 $3.61 Monmouth Medical Center MMC Outpatient 82950 Pathology and Laboratory Glucose test $80.00 $5.17 Monmouth Medical Center MMC Outpatient 82951 Pathology and Laboratory Glucose tolerance test (gtt) $252.00 $15.15 Monmouth Medical Center MMC Outpatient 82955 Pathology and Laboratory Assay of g6pd enzyme $199.00 $11.10 Monmouth Medical Center MMC Outpatient 82985 Pathology and Laboratory Assay of glycated protein $372.00 $15.80 Monmouth Medical Center MMC Outpatient 83001 Pathology and Laboratory Assay of gonadotropin (fsh) $585.00 $21.74 Monmouth Medical Center MMC Outpatient 83002 Pathology and Laboratory Assay of gonadotropin (lh) $566.00 $21.91 Monmouth Medical Center MMC Outpatient 83003 Pathology and Laboratory Assay growth hormone (hgh) $386.00 $19.20 Monmouth Medical Center MMC Outpatient 83020 Pathology and Laboratory Hemoglobin electrophoresis $115.00 $13.91 Monmouth Medical Center MMC Outpatient 83021 Pathology and Laboratory Hemoglobin chromotography $187.00 $20.10 Monmouth Medical Center MMC Outpatient 83090 Pathology and Laboratory Assay of homocystine $156.00 $21.23 Monmouth Medical Center MMC Outpatient 83150 Pathology and Laboratory Assay of homovanillic acid $208.00 $17.45 Monmouth Medical Center MMC Outpatient 83516 Pathology and Laboratory Immunoassay nonantibody $248.00 $12.09 Monmouth Medical Center MMC Outpatient 83519 Pathology and Laboratory Ria nonantibody $196.00 $16.40 Monmouth Medical Center MMC Outpatient 83520 Pathology and Laboratory Immunoassay quant nos nonab $658.00 $15.59 Monmouth Medical Center MMC Outpatient 83525 Pathology and Laboratory Assay of insulin $167.00 $12.96 Monmouth Medical Center MMC Outpatient 83540 Pathology and Laboratory Assay of iron $113.00 $7.62 Monmouth Medical Center MMC Outpatient 83550 Pathology and Laboratory Iron binding test $163.00 $9.97 Monmouth Medical Center MMC Outpatient 83655 Pathology and Laboratory Assay of lead $224.00 $14.12 Monmouth Medical Center MMC Outpatient 83721 Pathology and Laboratory Assay of blood lipoprotein $131.00 $10.30 Monmouth Medical Center MMC Outpatient 83825 Pathology and Laboratory Assay of mercury $231.00 $18.86 Monmouth Medical Center MMC Outpatient 83835 Pathology and Laboratory Assay of metanephrines $362.00 $19.79 Monmouth Medical Center MMC Outpatient 83883 Pathology and Laboratory Assay nephelometry not spec $112.00 $15.43 Monmouth Medical Center MMC Outpatient 83918 Pathology and Laboratory Organic acids total quant $650.00 $21.24 Monmouth Medical Center MMC Outpatient 83921 Pathology and Laboratory Organic acid single quant $254.00 $20.24 Monmouth Medical Center MMC Outpatient 83930 Pathology and Laboratory Assay of blood osmolality $80.00 $7.74 Monmouth Medical Center MMC Outpatient 83993 Pathology and Laboratory Assay for calprotectin fecal $252.00 $14.88 Monmouth Medical Center MMC Outpatient 84030 Pathology and Laboratory Assay of blood pku $200.00 $6.31 Monmouth Medical Center MMC Outpatient 84165 Pathology and Laboratory Protein e-phoresis serum $128.00 $12.77 Monmouth Medical Center MMC Outpatient 84166 Pathology and Laboratory Protein e-phoresis/urine/csf $330.00 $20.68 Monmouth Medical Center MMC Outpatient 84425 Pathology and Laboratory Assay of vitamin b-1 $225.00 $24.38 Monmouth Medical Center MMC Outpatient 84432 Pathology and Laboratory Assay of thyroglobulin $490.00 $20.60 Monmouth Medical Center MMC Outpatient 84436 Pathology and Laboratory Assay of total thyroxine $106.00 $8.00 Monmouth Medical Center MMC Outpatient 84479 Pathology and Laboratory Assay of thyroid (t3 or t4) $78.00 $7.62 Monmouth Medical Center MMC Outpatient 84480 Pathology and Laboratory Assay triiodothyronine (t3) $210.00 $16.48 Monmouth Medical Center MMC Outpatient 84481 Pathology and Laboratory Free assay (ft-3) $183.00 $19.90 Monmouth Medical Center MMC Outpatient 84484 Pathology and Laboratory Assay of troponin quant $208.00 $10.47 Monmouth Medical Center MMC Outpatient 84590 Pathology and Laboratory Assay of vitamin a $135.00 $13.72 Monmouth Medical Center MMC Outpatient 84630 Pathology and Laboratory Assay of zinc $198.00 $13.14 Monmouth Medical Center MMC Outpatient 84681 Pathology and Laboratory Assay of c-peptide $217.00 $24.45 Monmouth Medical Center MMC Outpatient 84702 Pathology and Laboratory Chorionic gonadotropin test $139.00 $15.79 Monmouth Medical Center MMC Outpatient 85014 Pathology and Laboratory Hematocrit $38.00 $2.19 Monmouth Medical Center MMC Outpatient 85018 Pathology and Laboratory Hemoglobin $80.00 $2.19 Monmouth Medical Center MMC Outpatient 85032 Pathology and Laboratory Manual cell count each $51.00 $4.97 Monmouth Medical Center MMC Outpatient 85045 Pathology and Laboratory Automated reticulocyte count $54.00 $4.70 Monmouth Medical Center MMC Outpatient 85130 Pathology and Laboratory Chromogenic substrate assay $72.00 $13.53 Monmouth Medical Center MMC Outpatient 85220 Pathology and Laboratory Blooc clot factor v test $548.00 $20.21 Monmouth Medical Center MMC Outpatient 85250 Pathology and Laboratory Clot factor ix ptc/chrstmas $347.00 $21.72 Monmouth Medical Center MMC Outpatient 85260 Pathology and Laboratory Clot factor x stuart-power $317.00 $20.73 Monmouth Medical Center MMC Outpatient 85270 Pathology and Laboratory Clot factor xi pta $437.00 $20.73 Monmouth Medical Center MMC Outpatient 85280 Pathology and Laboratory Clot factor xii hageman $525.00 $21.31 Monmouth Medical Center MMC Outpatient 85306 Pathology and Laboratory Clot inhibit prot s free $223.00 $18.94 Monmouth Medical Center MMC Outpatient 85335 Pathology and Laboratory Factor inhibitor test $366.00 $10.65 Monmouth Medical Center MMC Outpatient 85378 Pathology and Laboratory Fibrin degrade semiquant $131.00 $8.85 Monmouth Medical Center MMC Outpatient 85379 Pathology and Laboratory Fibrin degradation quant $119.00 $9.66 Monmouth Medical Center MMC Outpatient 85415 Pathology and Laboratory Fibrinolytic plasminogen $341.00 $17.24 Monmouth Medical Center MMC Outpatient 85460 Pathology and Laboratory Hemoglobin fetal $181.00 $9.09 Monmouth Medical Center MMC Outpatient 85597 Pathology and Laboratory Phospholipid pltlt neutraliz $309.00 $19.67 Monmouth Medical Center MMC Outpatient 85652 Pathology and Laboratory Rbc sed rate automated $104.00 $2.95 Monmouth Medical Center MMC Outpatient 85660 Pathology and Laboratory Rbc sickle cell test $81.00 $5.79 Monmouth Medical Center MMC Outpatient 86003 Pathology and Laboratory Allg spec ige crude xtrc ea $141.00 $5.86 Monmouth Medical Center MMC Outpatient 86021 Pathology and Laboratory Wbc antibody identification $367.00 $12.98 Monmouth Medical Center MMC Outpatient 86022 Pathology and Laboratory Platelet antibodies $165.00 $15.12 Monmouth Medical Center MMC Outpatient 86023 Pathology and Laboratory Immunoglobulin assay $125.00 $13.43 Monmouth Medical Center MMC Outpatient 86038 Pathology and Laboratory Antinuclear antibodies $239.00 $14.08 Monmouth Medical Center MMC Outpatient 86039 Pathology and Laboratory Antinuclear antibodies (ana) $260.00 $12.32 Monmouth Medical Center MMC Outpatient 86060 Pathology and Laboratory Antistreptolysin o titer $121.00 $8.34 Monmouth Medical Center MMC Outpatient 86063 Pathology and Laboratory Antistreptolysin o screen $146.00 $6.61 Monmouth Medical Center MMC Outpatient 86140 Pathology and Laboratory C-reactive protein $98.00 $6.11 Monmouth Medical Center MMC Outpatient 86157 Pathology and Laboratory Cold agglutinin titer $102.00 $8.96 Monmouth Medical Center MMC Outpatient 86160 Pathology and Laboratory Complement antigen $241.00 $13.38 Monmouth Medical Center MMC Outpatient 86162 Pathology and Laboratory Complement total (ch50) $575.00 $23.42 Monmouth Medical Center MMC Outpatient 86200 Pathology and Laboratory Ccp antibody $281.00 $14.87 Monmouth Medical Center MMC Outpatient 86215 Pathology and Laboratory Deoxyribonuclease antibody $112.00 $15.44 Monmouth Medical Center MMC Outpatient 86225 Pathology and Laboratory Dna antibody native $364.00 $14.83 Monmouth Medical Center MMC Outpatient 86226 Pathology and Laboratory Dna antibody single strand $98.00 $13.78 Monmouth Medical Center MMC Outpatient 86235 Pathology and Laboratory Nuclear antigen antibody $424.00 $20.11 Monmouth Medical Center MMC Outpatient 86255 Pathology and Laboratory Fluorescent antibody screen $296.00 $13.62 Monmouth Medical Center MMC Outpatient 86256 Pathology and Laboratory Fluorescent antibody titer $272.00 $11.33 Monmouth Medical Center MMC Outpatient 86300 Pathology and Laboratory Immunoassay tumor ca 15-3 $379.00 $24.53 Monmouth Medical Center MMC Outpatient 86301 Pathology and Laboratory Immunoassay tumor ca 19-9 $438.00 $24.53 Monmouth Medical Center MMC Outpatient 86304 Pathology and Laboratory Immunoassay tumor ca 125 $383.00 $24.53 Monmouth Medical Center MMC Outpatient 86308 Pathology and Laboratory Heterophile antibody screen $85.00 $6.11 Monmouth Medical Center MMC Outpatient 86316 Pathology and Laboratory Immunoassay tumor other $281.00 $24.53 Monmouth Medical Center MMC Outpatient 86336 Pathology and Laboratory Inhibin a $293.00 $12.26 Monmouth Medical Center MMC Outpatient 86376 Pathology and Laboratory Microsomal antibody each $269.75 $17.08 Monmouth Medical Center MMC Outpatient 86382 Pathology and Laboratory Neutralization test viral $337.00 $18.96 Monmouth Medical Center MMC Outpatient 86403 Pathology and Laboratory Particle agglut antbdy scrn $96.00 $11.18 Monmouth Medical Center MMC Outpatient 86430 Pathology and Laboratory Rheumatoid factor test qual $126.00 $6.21 Monmouth Medical Center MMC Outpatient 86609 Pathology and Laboratory Bacterium antibody $93.00 $16.20 Monmouth Medical Center MMC Outpatient 86617 Pathology and Laboratory Lyme disease antibody $374.00 $17.22 Monmouth Medical Center MMC Outpatient 86618 Pathology and Laboratory Lyme disease antibody $220.00 $19.10 Monmouth Medical Center MMC Outpatient 86644 Pathology and Laboratory Cmv antibody $169.00 $16.66 Monmouth Medical Center MMC Outpatient 86658 Pathology and Laboratory Enterovirus antibody $93.00 $16.24 Monmouth Medical Center MMC Outpatient 86663 Pathology and Laboratory Epstein-barr antibody $167.00 $14.70 Monmouth Medical Center MMC Outpatient 86664 Pathology and Laboratory Epstein-barr nuclear antigen $203.00 $16.87 Monmouth Medical Center MMC Outpatient 86665 Pathology and Laboratory Epstein-barr capsid vca $217.00 $20.42 Monmouth Medical Center MMC Outpatient 86677 Pathology and Laboratory Helicobacter pylori antibody $110.00 $11.59 Monmouth Medical Center MMC Outpatient 86682 Pathology and Laboratory Helminth antibody $93.00 $16.24 Monmouth Medical Center MMC Outpatient 86689 Pathology and Laboratory Htlv/hiv confirmj antibody $149.00 $22.40 Monmouth Medical Center MMC Outpatient 86694 Pathology and Laboratory Herpes simplex nes antbdy $228.00 $16.66 Monmouth Medical Center MMC Outpatient 86695 Pathology and Laboratory Herpes simplex type 1 test $212.25 $16.29 Monmouth Medical Center MMC Outpatient 86696 Pathology and Laboratory Herpes simplex type 2 test $146.00 $22.40 Monmouth Medical Center MMC Outpatient 86701 Pathology and Laboratory Hiv-1antibody $114.00 $10.13 Monmouth Medical Center MMC Outpatient 86703 Pathology and Laboratory Hiv-1/hiv-2 1 result antbdy $230.00 $15.20 Monmouth Medical Center MMC Outpatient 86704 Pathology and Laboratory Hep b core antibody total $226.00 $13.28 Monmouth Medical Center MMC Outpatient 86705 Pathology and Laboratory Hep b core antibody igm $95.00 $13.05 Monmouth Medical Center MMC Outpatient 86706 Pathology and Laboratory Hep b surface antibody $173.00 $11.79 Monmouth Medical Center MMC Outpatient 86707 Pathology and Laboratory Hepatitis be antibody $105.00 $12.88 Monmouth Medical Center MMC Outpatient 86708 Pathology and Laboratory Hepatitis a antibody $247.00 $13.52 Monmouth Medical Center MMC Outpatient 86709 Pathology and Laboratory Hepatitis a igm antibody $118.00 $12.24 Monmouth Medical Center MMC Outpatient 86711 Pathology and Laboratory John cunningham antibody $391.00 $11.85 Monmouth Medical Center MMC Outpatient 86713 Pathology and Laboratory Legionella antibody $96.00 $16.31 Monmouth Medical Center MMC Outpatient 86735 Pathology and Laboratory Mumps antibody $105.00 $16.25 Monmouth Medical Center MMC Outpatient 86738 Pathology and Laboratory Mycoplasma antibody $135.00 $16.30 Monmouth Medical Center MMC Outpatient 86747 Pathology and Laboratory Parvovirus antibody $173.00 $17.21 Monmouth Medical Center MMC Outpatient 86753 Pathology and Laboratory Protozoa antibody nos $119.00 $15.66 Monmouth Medical Center MMC Outpatient 86757 Pathology and Laboratory Rickettsia antibody $148.00 $22.40 Monmouth Medical Center MMC Outpatient 86762 Pathology and Laboratory Rubella antibody $131.00 $16.66 Monmouth Medical Center MMC Outpatient 86765 Pathology and Laboratory Rubeola antibody $133.00 $12.49 Monmouth Medical Center MMC Outpatient 86777 Pathology and Laboratory Toxoplasma antibody $303.00 $16.66 Monmouth Medical Center MMC Outpatient 86778 Pathology and Laboratory Toxoplasma antibody igm $238.00 $17.04 Monmouth Medical Center MMC Outpatient 86780 Pathology and Laboratory Treponema pallidum $87.00 $12.08 Monmouth Medical Center MMC Outpatient 86787 Pathology and Laboratory Varicella-zoster antibody $124.00 $14.52 Monmouth Medical Center MMC Outpatient 86790 Pathology and Laboratory Virus antibody nos $297.00 $16.20 Monmouth Medical Center MMC Outpatient 86800 Pathology and Laboratory Thyroglobulin antibody $200.00 $17.33 Monmouth Medical Center MMC Outpatient 87015 Pathology and Laboratory Specimen infect agnt concntj $70.00 $7.79 Monmouth Medical Center MMC Outpatient 87040 Pathology and Laboratory Blood culture for bacteria $255.00 $12.17 Monmouth Medical Center MMC Outpatient 87045 Pathology and Laboratory Feces culture aerobic bact $113.00 $10.99 Monmouth Medical Center MMC Outpatient 87070 Pathology and Laboratory Culture othr specimn aerobic $175.00 $9.86 Monmouth Medical Center MMC Outpatient 87075 Pathology and Laboratory Cultr bacteria except blood $280.00 $11.03 Monmouth Medical Center MMC Outpatient 87081 Pathology and Laboratory Culture screen only $102.00 $7.22 Monmouth Medical Center MMC Outpatient 87086 Pathology and Laboratory Urine culture/colony count $101.00 $9.56 Monmouth Medical Center MMC Outpatient 87088 Pathology and Laboratory Urine bacteria culture $91.00 $9.38 Monmouth Medical Center MMC Outpatient 87101 Pathology and Laboratory Skin fungi culture $113.00 $8.68 Monmouth Medical Center MMC Outpatient 87102 Pathology and Laboratory Fungus isolation culture $191.00 $9.69 Monmouth Medical Center MMC Outpatient 87106 Pathology and Laboratory Fungi identification yeast $94.00 $11.87 Monmouth Medical Center MMC Outpatient 87116 Pathology and Laboratory Mycobacteria culture $109.00 $12.56 Monmouth Medical Center MMC Outpatient 87147 Pathology and Laboratory Culture type immunologic $39.00 $6.11 Monmouth Medical Center MMC Outpatient 87168 Pathology and Laboratory Macroscopic exam arthropod $39.00 $5.04 Monmouth Medical Center MMC Outpatient 87169 Pathology and Laboratory Macroscopic exam parasite $51.00 $5.04 Monmouth Medical Center MMC Outpatient 87177 Pathology and Laboratory Ova and parasites smears $196.00 $10.02 Monmouth Medical Center MMC Outpatient 87184 Pathology and Laboratory Microbe susceptible disk $115.00 $8.00 Monmouth Medical Center MMC Outpatient 87186 Pathology and Laboratory Microbe susceptible mic $114.00 $9.91 Monmouth Medical Center MMC Outpatient 87188 Pathology and Laboratory Microbe suscept macrobroth $147.00 $7.33 Monmouth Medical Center MMC Outpatient 87205 Pathology and Laboratory Smear gram stain $86.00 $5.04 Monmouth Medical Center MMC Outpatient 87206 Pathology and Laboratory Smear fluorescent/acid stai $87.00 $5.42 Monmouth Medical Center MMC Outpatient 87324 Pathology and Laboratory Clostridium ag ia $302.00 $12.70 Monmouth Medical Center MMC Outpatient 87329 Pathology and Laboratory Giardia ag ia $119.00 $12.70 Monmouth Medical Center MMC Outpatient 87338 Pathology and Laboratory Hpylori stool ia $180.00 $14.48 Monmouth Medical Center MMC Outpatient 87340 Pathology and Laboratory Hepatitis b surface ag ia $124.00 $11.49 Monmouth Medical Center MMC Outpatient 87350 Pathology and Laboratory Hepatitis be ag ia $116.00 $12.43 Monmouth Medical Center MMC Outpatient 87430 Pathology and Laboratory Strep a ag ia $142.00 $13.98 Monmouth Medical Center MMC Outpatient 87449 Pathology and Laboratory Ag detect nos ia mult $108.00 $12.70 Monmouth Medical Center MMC Outpatient 87804 Pathology and Laboratory Influenza assay w/optic $94.00 $13.92 Monmouth Medical Center MMC Outpatient 87880 Pathology and Laboratory Strep a assay w/optic $74.00 $13.91 Monmouth Medical Center MMC Outpatient 88142 Pathology and Laboratory Cytopath c/v thin layer $171.00 $23.93 Monmouth Medical Center MMC Outpatient 89050 Pathology and Laboratory Body fluid cell count $131.00 $5.46 Monmouth Medical Center MMC Outpatient 89051 Pathology and Laboratory Body fluid cell count $99.00 $6.39 Monmouth Medical Center MMC Outpatient 89300 Pathology and Laboratory Semen analysis w/huhner $10.18 Monmouth Medical Center MMC Outpatient 89320 Pathology and Laboratory Semen anal vol/count/mot $139.00 $13.92 Monmouth Medical Center MMC Outpatient 89322 Pathology and Laboratory Semen anal strict criteria $206.00 $17.93 Monmouth Medical Center MMC Outpatient 76999 Diagnostic Ultrasound Echo examination procedure 127.74 Monmouth Medical Center MMC Outpatient 22510 Procedure - Musculoskeletal Sys Perq cervicothoracic inject "$10,125.00 " 5726.333333 Monmouth Medical Center MMC Outpatient 43233 Procedure - Digestive System Egd balloon dil esoph30 mm/> 3481 Monmouth Medical Center MMC Outpatient 43253 Procedure - Digestive System Egd us transmural injxn/mark 3481 Monmouth Medical Center MMC Outpatient 43254 Procedure - Digestive System Egd endo mucosal resection 3481 Monmouth Medical Center MMC Outpatient 43259 Procedure - Digestive System Egd us exam duodenum/jejunum 3230.1775 Monmouth Medical Center MMC Outpatient 43270 Procedure - Digestive System Egd lesion ablation 3481 Monmouth Medical Center MMC Outpatient 45300 Procedure - Digestive System Proctosigmoidoscopy dx 2310.836666 Monmouth Medical Center MMC Outpatient 45330 Procedure - Digestive System Diagnostic sigmoidoscopy 2310.836666 Monmouth Medical Center MMC Outpatient 45333 Procedure - Digestive System Sigmoidoscopy & polypectomy 2310.836666 Monmouth Medical Center MMC Outpatient 45346 Procedure - Digestive System Sigmoidoscopy w/ablation 3536.12 Monmouth Medical Center MMC Outpatient 77336 Radiation Oncology Radiation physics consult "$1,379.00 " 277.43425 Monmouth Medical Center MMC Outpatient 91035 Procedure - Digestive System G-esoph reflx tst w/electrod 2150 Monmouth Medical Center MMC Outpatient 91040 Procedure - Digestive System Esoph balloon distension tst "$1,602.00 " 2150 Monmouth Medical Center MMC Outpatient 91110 Procedure - Digestive System Gi tract capsule endoscopy 3481 Monmouth Medical Center MMC Outpatient 91122 Procedure - Digestive System Anal pressure record 2150 Monmouth Medical Center MMC Outpatient 92960 Echocardiogram Cardioversion electric ext "$2,439.00 " 2457 Monmouth Medical Center MMC Outpatient 93620 Electrophysiology Studies Electrophysiology evaluation 6149.333333 Monmouth Medical Center MMC Outpatient 95782 Sleep Testing Polysom <6 yrs 4/> paramtrs "$8,558.00 " 3323 Monmouth Medical Center MMC Outpatient 95783 Sleep Testing Polysom <6 yrs cpap/bilvl "$8,759.00 " 3323 Monmouth Medical Center MMC Outpatient 95811 Sleep Testing Polysom 6/>yrs cpap 4/> parm "$9,503.00 " 3323 Monmouth Medical Center MMC Outpatient 95991 Procedure - Nervous System Spin/brain pump refil & main 2150