Service Area|Px Code|Procedure Description|Alternate CPT/HCPCS Code|Alternate Identification|Alternate Code by Location|Alternate Code by Department|Fee Schedule Group Name|Unit Price
PEMBINA COUNTY MEDICAL CENTER|G0008|ADMIN INFLUENZA VIRUS VAC|90471|TRICARE|||PC STANDARD FEE SCHEDULE|9.00
PEMBINA COUNTY MEDICAL CENTER|G0008|ADMIN INFLUENZA VIRUS VAC|90471|TRICARE|||PC NON M/M HB CLINIC|0.00
PEMBINA COUNTY MEDICAL CENTER|4200005|UNATTEND E-STIM|G0283,G0283,G0283,G0283,G0283|VA,HUMANA VETERANS,MEDICARE,TRICARE,SANFORD|,,,,|,,,,|PC STANDARD FEE SCHEDULE|49.00
PEMBINA COUNTY MEDICAL CENTER|4560004|URGENT CARE VISIT-EST PT LEVEL I|G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380,G0380|MEDICARE,BCND,BCMN,TRICARE,AETNA,VA,NDWC,UCARE,PRIME WEST,ITASCA,NDMA,MNMA,SANFORD,MNBLUEPLUS,IHS|,,,,,,,,,,,,,,|,,,,,,,,,,,,,,|PC STANDARD FEE SCHEDULE|35.00
PEMBINA COUNTY MEDICAL CENTER|6100034|MRA ABDOMEN|C8902,C8902|MEDICARE,UCARE|||PC STANDARD FEE SCHEDULE|2,036.00
PEMBINA COUNTY MEDICAL CENTER|7620000|HOURLY OBSERVATION|99218|NDMA|HEART OF AMERICA MEDICAL CENTER (HAMC) [22]||PC STANDARD FEE SCHEDULE|0.00
PEMBINA COUNTY MEDICAL CENTER|7710000|IMMUNIZATION ADMINISTRATION|90782|NDMA|FIRST CARE HEALTH CENTER [50]||PC STANDARD FEE SCHEDULE|56.00
PEMBINA COUNTY MEDICAL CENTER|7710000|IMMUNIZATION ADMINISTRATION|90782|NDMA|FIRST CARE HEALTH CENTER [50]||PC NON M/M HB CLINIC|0.00
PEMBINA COUNTY MEDICAL CENTER|7710001|HC IMMUNIZATION ADMIN EA ADDL|90782|NDMA|FIRST CARE HEALTH CENTER [50]||PC STANDARD FEE SCHEDULE|29.00
PEMBINA COUNTY MEDICAL CENTER|7710001|HC IMMUNIZATION ADMIN EA ADDL|90782|NDMA|FIRST CARE HEALTH CENTER [50]||PC NON M/M HB CLINIC|0.00
PEMBINA COUNTY MEDICAL CENTER|7710002|HC IMMUNIZATION ADMIN,ORAL/NASAL|90782|NDMA|FIRST CARE HEALTH CENTER [50]||PC STANDARD FEE SCHEDULE|53.00
PEMBINA COUNTY MEDICAL CENTER|7710002|HC IMMUNIZATION ADMIN,ORAL/NASAL|90782|NDMA|FIRST CARE HEALTH CENTER [50]||PC NON M/M HB CLINIC|0.00
PEMBINA COUNTY MEDICAL CENTER|4020075|US EXTREMITY|78070||FIRST CARE HEALTH CENTER [500000]||PC STANDARD FEE SCHEDULE|45.00
PEMBINA COUNTY MEDICAL CENTER|80300|DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES|G0434,G0434,G0434,G0479,G0479,G0479|MEDICARE,TRICARE,VA,MEDICARE,TRICARE,VA|,,,,,|,,,,,|PC M/M HB CLINIC|72.00
PEMBINA COUNTY MEDICAL CENTER|PC80346|PC BENZODIAZEPINES;1-12|G6031,G6031,G6031|MEDICARE,TRICARE,VA|,,|,,|PC STANDARD FEE SCHEDULE|209.00
PEMBINA COUNTY MEDICAL CENTER|PC80361|PC OPIATES,1 OR MORE|G6056,G6056,G6056|MEDICARE,TRICARE,VA|,,|,,|PC STANDARD FEE SCHEDULE|220.00
PEMBINA COUNTY MEDICAL CENTER|4340015|HC DRIVING TRAINING|99999|MEDICARE|||PC STANDARD FEE SCHEDULE|0.00
PEMBINA COUNTY MEDICAL CENTER|4340016|HC DRIVING TRAINING|99999|MEDICARE|||PC STANDARD FEE SCHEDULE|0.00
PEMBINA COUNTY MEDICAL CENTER|4340017|HC DRIVING TRAINING|99999|MEDICARE|||PC STANDARD FEE SCHEDULE|0.00
PEMBINA COUNTY MEDICAL CENTER|4300045|HC THERAPEUTIC INTERVENTION-COGNITIVE FUNCTION|G0515|MEDICARE|LIFECARE MEDICAL CENTER [300000]||PC STANDARD FEE SCHEDULE|61.00