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["Shoppable Services"]
["Nexus Children's Hospital-Dallas"]
["Only Inpatient Services Offered at this Facility"]
[]
["EVALUATION & MANAGEMENT SERVICES"]
["Shoppable Service","Primary Service and Ancillary Services","CPT/HCPCS Code","Inpatient Default Gross Charge","Outpatient Default Gross Charge","De-Identified Minimum Negotiated Charges","De-Identified Maximum Negotiated Charges","Discounted Cash Price"]
["Psychotherapy, 30 min","Service Not Provided",90832,"NA","NA","NA","NA","NA"]
["Psychotherapy, 45 min","Service Not Provided",90834,"NA","NA","NA","NA","NA"]
["Psychotherapy, 60 min","Service Not Provided",90837,"NA","NA","NA","NA","NA"]
["Family psychotherapy, not including patient, 50 min","Service Not Provided",90846,"NA","NA","NA","NA","NA"]
["Family psychotherapy, including patient, 50 min","Service Not Provided",90847,"NA","NA","NA","NA","NA"]
["Group psychotherapy","Service Not Provided",90853,"NA","NA","NA","NA","NA"]
["New patient office or other outpatient visit, typically 30 min","Service Not Provided",99203,"NA","NA","NA","NA","NA"]
["New patient office of other outpatient visit, typically 45 min","Service Not Provided",99204,"NA","NA","NA","NA","NA"]
["New patient office of other outpatient visit, typically 60 min","Service Not Provided",99205,"NA","NA","NA","NA","NA"]
["Patient office consultation, typically 40 min","Service Not Provided",99243,"NA","NA","NA","NA","NA"]
["Patient office consultation, typically 60 min","Service Not Provided",99244,"NA","NA","NA","NA","NA"]
["Initial new patient preventive medicine evaluation (18-39 years)","Service Not Provided",99385,"NA","NA","NA","NA","NA"]
["Initial new patient preventive medicine evaluation (40-64 years)","Service Not Provided",99386,"NA","NA","NA","NA","NA"]
["LABORATORY & PATHOLOGY SERVICES"]
["Shoppable Service","Primary Service and Ancillary Services","CPT/HCPCS Code","Inpatient Default Gross Charge","Outpatient Default Gross Charge","De-Identified Minimum Negotiated Charges","De-Identified Maximum Negotiated Charges","Discounted Cash Price"]
["Basic metabolic panel","Service Not Provided",80048,"NA","NA","NA","NA","NA"]
["Blood test, comprehensive group of blood chemicals","Service Not Provided",80053,"NA","NA","NA","NA","NA"]
["Obstetric blood test panel","Service Not Provided",80055,"NA","NA","NA","NA","NA"]
["Blood test, lipids (cholesterol and triglycerides)","Service Not Provided",80061,"NA","NA","NA","NA","NA"]
["Kidney function panel test","Service Not Provided",80069,"NA","NA","NA","NA","NA"]
["Liver function blood test panel","Service Not Provided",80076,"NA","NA","NA","NA","NA"]
["Manual urinalysis test with examination using microscope","Service Not Provided","81000 or 81001","NA","NA","NA","NA","NA"]
["Automated urinalysis test","Service Not Provided","81002 or 81003","NA","NA","NA","NA","NA"]
["PSA (prostate specific antigen)","Service Not Provided","84153-84154","NA","NA","NA","NA","NA"]
["Blood test, thyroid stimulating hormone (TSH)","Service Not Provided",84443,"NA","NA","NA","NA","NA"]
["Complete blood cell count, with differential white blood cells, automated","Service Not Provided",85025,"NA","NA","NA","NA","NA"]
["Complete blood count, automated","Service Not Provided",85027,"NA","NA","NA","NA","NA"]
["Blood test, clotting time","Service Not Provided",85610,"NA","NA","NA","NA","NA"]
["Coagulation assessment blood test","Service Not Provided",85730,"NA","NA","NA","NA","NA"]
["RADIOLOGY SERVICES"]
["Shoppable Service","Primary Service and Ancillary Services","CPT/HCPCS Code","Inpatient Default Gross Charge","Outpatient Default Gross Charge","De-Identified Minimum Negotiated Charges","De-Identified Maximum Negotiated Charges","Discounted Cash Price"]
["CT scan, head or brain, without contrast","Service Not Provided",70450,"NA","NA","NA","NA","NA"]
["MRI scan of brain before and after contrast","Service Not Provided",70553,"NA","NA","NA","NA","NA"]
["X-Ray, lower back, minimum four views","Service Not Provided",72110,"NA","NA","NA","NA","NA"]
["MRI scan of lower spinal canal","Service Not Provided",72148,"NA","NA","NA","NA","NA"]
["CT scan, pelvis, with contrast","Service Not Provided",72193,"NA","NA","NA","NA","NA"]
["MRI scan of leg joint","Service Not Provided",73721,"NA","NA","NA","NA","NA"]
["CT scan of abdomen and pelvis with contrast","Service Not Provided",74177,"NA","NA","NA","NA","NA"]
["Ultrasound of abdomen","Service Not Provided",76700,"NA","NA","NA","NA","NA"]
["Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus","Service Not Provided",76805,"NA","NA","NA","NA","NA"]
["Ultrasound pelvis through vagina","Service Not Provided",76830,"NA","NA","NA","NA","NA"]
["Mammography of one breast","Service Not Provided",77065,"NA","NA","NA","NA","NA"]
["Mammography of both breasts","Service Not Provided",77066,"NA","NA","NA","NA","NA"]
["Mammography, screening, bilateral","Service Not Provided",77067,"NA","NA","NA","NA","NA"]
["MEDICINE AND SURGERY SERVICES"]
["Shoppable Service","Primary Service and Ancillary Services","CPT/HCPCS Code","Inpatient Default Gross Charge","Outpatient Default Gross Charge","De-Identified Minimum Negotiated Charges","De-Identified Maximum Negotiated Charges","Discounted Cash Price"]
["Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities","Service Not Provided",216,"NA","NA","NA","NA","NA"]
["Spinal fusion except cervical without major comorbid conditions or complications (MCC)","Service Not Provided",460,"NA","NA","NA","NA","NA"]
["Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).","Service Not Provided",470,"NA","NA","NA","NA","NA"]
["Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).","Service Not Provided",473,"NA","NA","NA","NA","NA"]
["Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications\n(MCC)","Service Not Provided",743,"NA","NA","NA","NA","NA"]
["Removal of 1 or more breast growth, open procedure","Service Not Provided",19120,"NA","NA","NA","NA","NA"]
["Shaving of shoulder bone using an endoscope","Service Not Provided",29826,"NA","NA","NA","NA","NA"]
["Removal of one knee cartilage using an endoscope","Service Not Provided",29881,"NA","NA","NA","NA","NA"]
["Removal of tonsils and adenoid glands patient younger than age 12","Service Not Provided",42820,"NA","NA","NA","NA","NA"]
["Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope","Service Not Provided",43235,"NA","NA","NA","NA","NA"]
["Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope","Service Not Provided",43239,"NA","NA","NA","NA","NA"]
["Diagnostic examination of large bowel using an endoscope","Service Not Provided",45378,"NA","NA","NA","NA","NA"]
["Biopsy of large bowel using an endoscope","Service Not Provided",45380,"NA","NA","NA","NA","NA"]
["Removal of polyps or growths of large bowel using an endoscope","Service Not Provided",45385,"NA","NA","NA","NA","NA"]
["Ultrasound examination of lower large bowel using an endoscope","Service Not Provided",45391,"NA","NA","NA","NA","NA"]
["Removal of gallbladder using an endoscope","Service Not Provided",47562,"NA","NA","NA","NA","NA"]
["Repair of groin hernia patient age 5 years or older","Service Not Provided",49505,"NA","NA","NA","NA","NA"]
["Biopsy of prostate gland","Service Not Provided",55700,"NA","NA","NA","NA","NA"]
["Surgical removal of prostate and surrounding lymph nodes using an endoscope","Service Not Provided",55866,"NA","NA","NA","NA","NA"]
["Routine obstetric care for vaginal delivery, including pre-and post- delivery care","Service Not Provided",59400,"NA","NA","NA","NA","NA"]
["Routine obstetric care for cesarean delivery, including pre-and post- delivery care","Service Not Provided",59510,"NA","NA","NA","NA","NA"]
["Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care","Service Not Provided",59610,"NA","NA","NA","NA","NA"]
["Injection of substance into spinal canal of lower back or sacrum using imaging guidance","Service Not Provided","62322-62323","NA","NA","NA","NA","NA"]
["Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance","Service Not Provided",64483,"NA","NA","NA","NA","NA"]
["Removal of recurring cataract in lens capsule using laser","Service Not Provided",66821,"NA","NA","NA","NA","NA"]
["Removal of cataract with insertion of lens","Service Not Provided",66984,"NA","NA","NA","NA","NA"]
["Electrocardiogram, routine, with interpretation and report","Service Not Provided",93000,"NA","NA","NA","NA","NA"]
["Insertion of catheter into left heart for diagnosis","Service Not Provided",93452,"NA","NA","NA","NA","NA"]
["Sleep study","Service Not Provided",95810,"NA","NA","NA","NA","NA"]
["Physical therapy, therapeutic exercise","Service Not Provided",97110,"NA","NA","NA","NA","NA"]