ADENA FAYETTE MEDICAL CENTER Hospital ★★★☆☆

WASHINGTON COURT HOUSE, OH 431601703 (740) 335-1210 275N00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION	00002	N/A	N/A
LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX	00003	N/A	N/A
LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX	00004	N/A	N/A
NAIL PROCEDURES	00005	N/A	N/A
LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS	00009	N/A	N/A
LEVEL II SKIN EXCISIONS, BIOPSIES, AND REPAIRS	00010	N/A	N/A
LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS	00011	N/A	N/A
SIMPLE WOUND REPAIR AND TREATMENT	00016	N/A	N/A
INTERMEDIATE WOUND REPAIR AND TREATMENT	00017	N/A	N/A
COMPLEX WOUND REPAIR AND TREATMENT	00018	N/A	N/A
MOHS MICROGRAPHIC SURGERY	00019	N/A	N/A
RBC DNA HEA 35 AG 11 BLD GRP	0001U	N/A	N/A
BREAST BIOPSIES, EXCISIONS, AND OTHER RELATED PROCEDURES	00020	N/A	N/A
LEVEL I POST MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES	00021	N/A	N/A
LEVEL II POST MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES	00022	N/A	N/A
LEVEL I FOREARM AND WRIST PROCEDURES	00023	N/A	N/A
LEVEL II FOREARM AND WRIST PROCEDURES	00024	N/A	N/A
LEVEL I SHOULDER AND UPPER ARM PROCEDURES	00025	N/A	N/A
LEVEL I KNEE AND LOWER LEG PROCEDURES	00026	N/A	N/A
LEVEL I HIP AND FEMUR PROCEDURES	00027	N/A	N/A
LEVEL I SPINE PROCEDURES	00028	N/A	N/A
LEVEL II SPINE PROCEDURES	00029	N/A	N/A
ONC CLRCT 3 UR METAB ALG PLP	0002U	N/A	N/A
LEVEL I HAND PROCEDURES	00033	N/A	N/A
LEVEL II HAND PROCEDURES	00034	N/A	N/A
LEVEL I FOOT PROCEDURES	00035	N/A	N/A
LEVEL II FOOT PROCEDURES	00036	N/A	N/A
LEVEL I ARTHROSCOPY	00037	N/A	N/A
LEVEL II ARTHROSCOPY	00038	N/A	N/A
CAST APPLICATION OR REPLACEMENT	00039	N/A	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.