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CPT Code CPT Code Description Charge Amount
0001A
 Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose
$178.51
0202U Infectious disease (bacterial or viral respiratory tract in… $420.78
10021 FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION $2,492.00
10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE $1,323.00
10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE $2,323.00
10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE $2,085.72
10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED $3,013.19
10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE $1,947.99
10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL $9,189.00
10140 I&D HEMATOMA SEROMA/FLUID COLLECTION $7,345.00
10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST $1,427.82
10180 INCISION & DRAINAGE COMPLEX PO WOUND INFECTION $7,715.00
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS $3,896.00
11011 DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC $8,652.75
11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< $6,638.12
11043 DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< $5,488.25
11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM $3,801.85
11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 $1,721.85
11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 $5,567.00
11402 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM $5,485.00
11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< $10,133.00
11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER $1,069.00
11720 DEBRIDEMENT NAIL ANY METHOD 1-5 $228.35
11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 $1,196.86
11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL $376.95
11740 EVACUATION SUBUNGUAL HEMATOMA $673.39
11750 EXCISION NAIL MATRIX PERMANENT REMOVAL $4,277.00
11760 REPAIR NAIL BED $2,212.00
11765 WEDGE EXCISION SKIN NAIL FOLD $3,953.99
11771 EXCISION PILONIDAL CYST/SINUS EXTENSIVE $8,996.00
11900 INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS $1,623.75
11982 REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT $1,375.09
12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< $1,088.26
12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM $1,154.70
12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM $1,176.31
12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM $1,758.37
12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM $1,688.00
12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM $2,203.00
12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< $1,082.99
12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM $1,173.49
12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM $1,350.52
12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM $1,228.80
12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM $1,803.00
12017 SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM $2,300.00
12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE $3,283.00
12021 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING $2,226.00
12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< $1,678.85
12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM $1,789.92
12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM $2,017.16
12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM $2,494.00
12036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM $6,519.16
12037 REPAIR INTERMEDIATE S/A/T/E >30.0 CM $6,835.00
12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< $1,370.35
12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM $1,589.00
12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM $1,827.00
12045 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM $2,565.00
12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< $1,547.77
12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM $1,612.40
12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM $2,309.00
12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM $1,673.19
12055 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM $1,744.43
12056 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM $2,582.45
13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM $3,522.30
13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM $3,768.97
13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< $5,076.35
13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM $2,350.17
13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM $3,074.00
13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< $3,074.00
13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM $2,209.83
13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM $3,760.25
13133 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< $2,500.93
13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM $2,740.00
13152 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM $3,398.42
13153 REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/< $2,957.08
16000 INITIAL TX 1ST DEGREE BURN LOCAL TX $1,127.89
16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL $1,170.16
16025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM $1,627.36
16030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE $1,112.36
17000 DESTRUCTION PREMALIGNANT LESION 1ST $887.00
17110 DESTRUCTION BENIGN LESIONS UP TO 14 $1,064.00
17111 DESTRUCTION BENIGN LESIONS 15/> $1,225.13
17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE $819.30
19000 PUNCTURE ASPIRATION CYST BREAST $1,908.29
19020 MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP $11,088.00
20102 EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK $9,643.00
20103 EXPLORATION PENETRATING WOUND SPX EXTREMITY $6,881.00
20520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE $9,411.00
20525 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP $10,040.00
20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS $1,347.00
20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES $1,628.97
20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES $1,885.86
20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US $1,778.14
20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US $1,448.71
20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US $1,893.67
20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US $2,514.34
20650 INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX $16,771.00
21315 CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION $7,064.33
21320 CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION $7,097.00
21337 CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION $7,284.00
21451 CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION $12,884.57
21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ $1,718.31
21485 CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ $9,258.21
21501 I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX $14,086.00
22310 CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING $1,772.55
23330 REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS $4,642.80
23500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION $1,077.00
23505 CLSD TX CLAVICULAR FRACTURE W/MANIPULATION $8,392.49
23540 CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION $2,048.58
23545 CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION $2,339.00
23550 OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC $18,172.00
23600 CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION $3,216.53
23620 CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ $1,144.77
23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES $1,897.00
23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES $5,016.41
23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ $3,094.75
23930 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA $9,241.00
23931 INCISION&DRAINAGE UPPER ARM/ELBOW BURSA $12,157.37
24200 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS $7,428.00
24500 CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION $2,398.75
24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ $4,224.71
24530 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ $1,878.50
24535 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ $8,305.30
24565 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ $6,565.53
24586 OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO $24,064.00
24600 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES $1,512.71
24605 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES $5,346.87
24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ $7,073.35
24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ $1,600.45
24650 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION $1,066.00
24655 CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION $8,078.76
24675 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ $5,017.00
25028 I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA $9,808.88
25111 EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY $9,084.85
25500 CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION $2,072.08
25505 CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION $5,291.93
25520 CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT $7,566.07
25530 CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION $1,318.62
25535 CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION $4,437.41
25560 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN $2,031.17
25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ $3,494.76
25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ $1,587.22
25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF $3,724.34
25607 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP $16,929.46
25635 CLTX CARPAL BONE FX W/MANJ EACH BONE $7,293.00
25650 CLOSED TREATMENT ULNAR STYLOID FRACTURE $2,002.00
25652 OPEN TREATMENT ULNAR STYLOID FRACTURE $17,544.00
25660 CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ $1,245.00
25675 CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ $2,513.64
25690 CLOSED TX LUNATE DISLOCATION W/MANIPULATION $8,117.33
26010 DRAINAGE FINGER ABSCESS SIMPLE $1,421.08
26011 DRAINAGE FINGER ABSCESS COMPLICATED $4,597.00
26600 CLTX METACARPAL FX W/O MANIPULATION EACH BONE $1,473.45
26605 CLTX METACARPAL FX W/MANIPULATION EACH BONE $1,935.67
26607 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE $4,599.00
26615 OPEN TX METACARPAL FRACTURE SINGLE EA BONE $14,905.00
26641 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ $1,798.38
26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES $2,400.01
26675 CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES $5,111.00
26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES $1,575.89
26705 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES $3,695.00
26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA $1,867.00
26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA $1,896.13
26735 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA $11,705.00
26742 CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ $4,724.00
26746 OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA $11,669.00
26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA $1,726.45
26755 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA $2,009.00
26765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH $9,370.56
26770 CLTX IPHAL JT DISLC W/MANJ W/O ANES $1,485.59
26775 CLTX IPHAL JT DISLC W/MANJ REQ ANES $3,824.32
26952 AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP $14,338.14
27301 I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION $14,322.00
27372 REMOVAL FOREIGN BODY DEEP THIGH/KNEE $16,859.00
27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ $10,922.74
27508 CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ $1,724.00
27520 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION $3,322.16
27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA $2,254.00
27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA $1,440.94
27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ $5,028.61
27760 CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION $1,284.55
27762 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ $4,707.20
27780 CLTX PROX FIBULA/SHFT FX W/O MANJ $1,592.00
27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ $1,189.00
27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ $1,786.83
27792 OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS $23,734.72
27808 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ $2,105.56
27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ $4,329.57
27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION $3,704.75
27840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA $1,805.48
27842 CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ $4,227.85
28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS $3,711.38
28192 REMOVAL FOREIGN BODY FOOT DEEP $6,787.27
28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION $1,076.00
28475 CLTX METAR FX W/MANJ $2,617.81
28490 CLTX FX GRT TOE PHLX/PHLG W/O MANJ $912.00
28495 CLTX FX GRT TOE PHLX/PHLG W/MANJ $2,523.16
28505 OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES $16,243.00
28510 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ $4,017.85
28515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ $2,001.51
28630 CLTX METATARSOPHLNGL JT DISLC W/O ANES $1,263.00
28660 CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES $1,508.08
29065 APPLICATION CAST SHOULDER HAND LONG ARM $1,716.90
29075 APPLICATION CAST ELBOW FINGER SHORT ARM $1,449.27
29085 APPLICATION CAST HAND & LOWER FOREARM GAUNTLET $771.13
29105 APPLICATION LONG ARM SPLINT SHOULDER HAND $937.92
29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC $818.00
29126 APPLICATION SHORT ARM SPLINT DYNAMIC $884.89
29130 APPLICATION FINGER SPLINT STATIC $568.93
29131 APPLICATION FINGER SPLINT DYNAMIC $1,000.64
29240 STRAPPING SHOULDER $782.04
29260 STRAPPING ELBOW/WRIST $636.64
29280 STRAPPING HAND/FINGER $695.11
29355 APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE $1,600.00
29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE $1,014.13
29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES $948.37
29515 APPLICATION SHORT LEG SPLINT CALF FOOT $859.46
29530 STRAPPING KNEE $618.52
29540 STRAPPING ANKLE &/FOOT $646.65
29550 STRAPPING TOES $588.00
29580 STRAPPING UNNA BOOT $565.49
30300 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE $767.78
30901 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE $922.14
30903 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX $933.50
30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST $1,340.00
30906 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ $1,062.75
31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE $1,297.91
31502 TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT $4,044.00
31525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN $11,950.00
31541 LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP $10,022.00
31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC $1,090.18
31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE $2,831.69
32550 INSERTION INDWELLING TUNNELED PLEURAL CATHETER $11,312.30
32551 TUBE THORACOSTOMY INCLUDES WATER SEAL $3,501.00
32556 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING $9,427.26
36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN $1,069.00
36005 NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH $3,058.77
36010 INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA $3,804.22
36011 SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH $6,860.00
36410 VNPNXR 3 YEARS/> PHYS/QHP SKILL $2,309.05
36415 COLLECTION VENOUS BLOOD VENIPUNCTURE $76.46
36416 COLLECTION CAPILLARY BLOOD SPECIMEN $123.30
36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> $6,066.00
36558 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> $11,312.42
36569 INSERTION PICC W/O IMG GDN 5 YR/> $5,582.76
36573 INSERTION PICC W/RS&I 5 YR/> $7,172.57
36575 RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP $2,830.14
36589 RMVL TUN CVC W/O SUBQ PORT/PMP $7,338.00
36591 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE $339.09
36592 COLLECT BLOOD FROM CATHETER VENOUS NOS $408.56
36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION $999.97
37785 LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG $13,216.00
40650 RPR LIP FULL THICKNESS VERMILION ONLY $3,650.91
40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL $2,087.09
40801 DRG ABSC CST HMTMA VESTIBULE MOUTH COMP $6,465.00
40804 RMVL EMBEDDED FB VESTIBULE MOUTH SMPL $2,758.00
40830 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< $2,893.80
40831 CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL $3,038.57
41008 INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE $9,867.00
41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG $1,200.05
41252 RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX $2,671.00
41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS $1,088.59
42700 I&D ABSCESS PERITONSILLAR $2,011.17
42809 REMOVAL FOREIGN BODY PHARYNX $2,341.47
43215 ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY $9,194.89
43752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE $7,610.56
43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE $1,600.36
45900 RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE $5,736.72
45915 RMVL FECAL IMPACTION/FB SPX UNDER ANES $12,632.58
46040 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX $8,599.00
46050 I&D PERIANAL ABSCESS SUPERFICIAL $4,456.40
46083 INCISION THROMBOSED HEMORRHOID EXTERNAL $1,538.00
46221 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS $2,372.08
46320 EXC THROMBOSED HEMORRHOID XTRNL $11,547.93
46608 ANOSCOPY W/RMVL FOREIGN BODY $4,075.52
49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE $3,910.36
49505 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE $15,387.60
51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ $3,194.71
51701 INSJ NON-NDWELLG BLADDER CATHETER $887.11
51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE $945.34
51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED $2,296.93
54001 SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN $14,646.83
54015 I&D PENIS DEEP $5,352.11
54163 REPAIR INCOMPLETE CIRCUMCISION $8,002.00
54220 IRRIGATION CORPORA CAVERNOSA PRIAPISM $939.00
54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT $2,989.65
54437 REPAIR OF TRAUMATIC CORPOREAL TEAR(S) $12,227.07
54450 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING $1,619.65
55100 DRAINAGE SCROTAL WALL ABSCESS $6,714.97
56405 I&D VULVA/PERINEAL ABSCESS $1,700.77
56420 I&D OF BARTHOLINS GLAND ABSCESS $1,383.01
56440 MARSUPIALIZATION BARTHOLINS GLAND CYST $14,649.00
57410 PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL $10,921.00
57415 REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL $14,721.00
58301 REMOVAL INTRAUTERINE DEVICE IUD $2,124.00
59025 FETAL NONSTRESS TEST $2,206.31
59409 VAGINAL DELIVERY ONLY $9,990.00
62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE $2,273.03
62272 THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF $2,849.65
64400 INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH $2,119.00
64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE $2,049.25
64415 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN $6,351.34
64447 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN $5,104.00
64450 INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH $2,977.20
64455 NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES $1,456.82
64640 DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE $3,869.56
65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL $823.16
65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR $1,261.83
65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP $1,224.67
65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP $1,121.00
65235 RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS $6,059.10
67700 BLEPHAROTOMY DRAINAGE ABSCESS EYELID $2,162.59
67938 REMOVAL EMBEDDED FOREIGN BODY EYELID $1,244.35
69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE $1,888.67
69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX $6,055.62
69020 DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS $1,612.14
69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES $792.20
69205 RMVL FB XTRNL AUDITORY CANAL ANES $4,650.00
69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT $689.53
69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT $671.24
70030 RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY $755.54
70100 RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS $1,014.05
70110 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS $1,144.38
70140 RADEX FACIAL BONES < 3 VIEWS $900.30
70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS $1,148.66
70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS $1,019.78
70200 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS $1,274.20
70210 RADEX SINUSES PARANASAL <3 VIEWS $945.49
70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS $1,458.42
70250 RADIOLOGIC EXAMINATION SKULL 4< VIEWS $1,023.12
70260 RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS $2,216.70
70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT $1,125.35
70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE $744.85
70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL $5,406.62
70460 CT HEAD/BRAIN W/CONTRAST MATERIAL $6,851.48
70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL $7,018.11
70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL $5,029.12
70481 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL $6,863.16
70482 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR $7,800.71
70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL $5,071.38
70487 CT MAXILLOFACIAL W/CONTRAST MATERIAL $6,152.12
70488 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL $8,746.32
70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL $6,134.14
70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL $7,053.79
70492 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL $8,205.14
70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST $8,610.72
70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST $8,224.80
71045 RADIOLOGIC EXAM CHEST SINGLE VIEW $964.25
71046 RADIOLOGIC EXAM CHEST 2 VIEWS $1,154.31
71047 RADIOLOGIC EXAM CHEST 3 VIEWS $1,529.42
71048 RADIOLOGIC EXAM CHEST 4+ VIEWS $1,374.85
71100 RADEX RIBS UNILATERAL 2 VIEWS $936.38
71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS $1,151.18
71110 RADEX RIBS BILATERAL 3 VIEWS $1,306.19
71111 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS $1,844.26
71120 RADEX STERNUM MINIMUM 2 VIEWS $747.43
71250 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST $5,853.65
71260 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST $7,331.27
71270 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+ $8,779.46
71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST $9,162.07
72020 RADEX SPINE 1 VIEW SPECIFY LEVEL $882.28
72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS $1,079.17
72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS $1,694.93
72052 RADEX SPINE CERVICAL 6 OR MORE VIEWS $1,358.40
72070 RADEX SPINE THORACIC 2 VIEWS $1,190.08
72072 RADEX SPINE THORACIC 3 VIEWS $1,452.84
72074 RADEX SPINE THORACIC MINIMUM 4 VIEWS $1,415.89
72080 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS $1,223.77
72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW $1,123.36
72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS $1,256.92
72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS $1,859.14
72114 RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 $1,457.16
72120 RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS $1,405.63
72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL $6,657.18
72126 CT CERVICAL SPINE W/CONTRAST MATERIAL $8,031.19
72127 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL $10,077.00
72128 CT THORACIC SPINE W/O CONTRAST MATERIAL $6,488.48
72129 CT THORACIC SPINE W/CONTRAST MATERIAL $6,801.41
72130 CT THORACIC SPINE W/O & W/CONTRAST MATERIAL $10,864.58
72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL $6,635.12
72132 CT LUMBAR SPINE W/CONTRAST MATERIAL $8,112.87
72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL $8,615.06
72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS $915.25
72190 RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS $1,098.38
72191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST $7,519.99
72192 CT PELVIS W/O CONTRAST MATERIAL $5,676.97
72193 CT PELVIS W/CONTRAST MATERIAL $6,984.65
72194 CT PELVIS W/O & W/CONTRAST MATERIAL $7,910.23
72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS $948.93
72270 MYELOGRAPY 2/MORE REGIONS RS&I $5,862.05
73000 RADEX CLAVICLE COMPLETE $1,000.30
73010 RADEX SCAPULA COMPLETE $996.64
73020 RADEX SHOULDER 1 VIEW $924.14
73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS $1,170.82
73050 RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ $1,197.91
73060 RADEX HUMERUS MINIMUM 2 VIEWS $982.16
73070 RADEX ELBOW 2 VIEWS $928.80
73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS $1,111.54
73090 RADEX FOREARM 2 VIEWS $1,133.85
73092 RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS $1,031.69
73100 RADEX WRIST 2 VIEWS $975.14
73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS $1,272.53
73120 RADEX HAND 2 VIEWS $1,107.91
73130 RADEX HAND MINIMUM 3 VIEWS $1,155.55
73140 RADEX FINGR MINIMUM 2 VIEWS $882.14
73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL $4,621.26
73201 CT UPPER EXTREMITY W/CONTRAST MATERIAL $5,712.04
73202 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL $9,059.37
73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW $905.44
73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS $1,101.03
73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS $1,094.94
73521 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS $1,639.23
73522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS $1,588.93
73523 RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS $1,328.53
73551 RADIOLOGIC EXAMINATION FEMUR 1 VIEW $750.82
73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS $1,052.05
73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS $938.22
73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS $973.14
73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS $1,524.60
73565 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST $866.90
73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS $1,122.07
73592 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS $1,259.44
73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS $892.84
73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS $1,110.18
73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS $955.23
73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS $1,104.36
73650 RADEX CALCANEUS MINIMUM 2 VIEWS $907.78
73660 RADEX TOE MINIMUM 2 VIEWS $872.90
73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL $5,663.70
73701 CT LOWER EXTREMITY W/CONTRAST MATERIAL $6,029.99
73702 CT LOWER EXTREMITY W/O & W/CONTRAST MATRL $9,008.23
73706 CT ANGIOGRAPHY LOWER EXTREMITY $8,059.05
74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW $930.95
74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS $1,231.86
74021 RADIOLOGIC EXAM ABDOMEN 3+ VIEWS $1,540.13
74022 RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES $1,442.96
74150 CT ABDOMEN W/O CONTRAST MATERIAL $6,045.98
74160 CT ABDOMEN W/CONTRAST MATERIAL $7,665.56
74170 CT ABDOMEN W/O & W/CONTRAST MATERIAL $9,055.00
74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG $13,001.14
74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST $8,484.67
74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL $9,840.13
74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL $12,367.58
74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE $16,009.22
74190 PERITONEOGRAM RS&I $2,163.13
74220 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY $1,583.10
74240 RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY $2,004.07
74246 RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY $2,055.44
74250 RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY $2,403.64
74251 RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY $5,533.24
74283 THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ $3,964.07
74328 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I $2,303.35
74330 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I $2,833.29
74340 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I $1,523.00
75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST $3,597.31
75635 CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP $8,115.27
76010 RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD $812.04
76376 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION $1,867.37
76380 CT LIMITED/LOCALIZED FOLLOW UP STUDY $3,178.00
76512 OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN $713.88
76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM $2,035.13
76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION $1,315.25
76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE $1,192.45
76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED $1,393.08
76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION $2,570.19
76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED $1,945.21
76706 US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA $1,295.58
76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE $2,123.43
76775 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED $1,824.36
76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT $1,861.43
76802 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION $1,484.37
76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION $2,168.57
76810 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO $2,255.98
76815 US PREGNANT UTERUS LIMITED 1/> FETUSES $1,543.33
76816 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS $1,289.61
76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG $1,504.93
76830 US TRANSVAGINAL $1,876.10
76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE $2,550.92
76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U $1,485.78
76870 US SCROTUM & CONTENTS $2,040.92
76881 US COMPL JOINT R-T W/IMAGE DOCUMENTATION $1,785.23
76882 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG $1,150.92
76937 US VASC ACCESS SITS VSL PATENCY NDL ENTRY $1,856.00
76942 US GUIDANCE NEEDLE PLACEMENT IMG S&I $2,599.69
77076 RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT $1,846.72
78306 BONE &/JOINT IMAGING WHOLE BODY $5,016.38
78315 BONE &/JOINT IMAGING 3 PHASE STUDY $4,810.29
80047 BASIC METABOLIC PANEL CALCIUM IONIZED $694.23
80048 BASIC METABOLIC PANEL CALCIUM TOTAL $845.83
80050 GENERAL HEALTH PANEL $1,754.89
80051 ELECTROLYTE PANEL $699.71
80053 COMPREHENSIVE METABOLIC PANEL $1,093.49
80061 LIPID PANEL $825.19
80074 ACUTE HEPATITIS PANEL $1,984.00
80076 HEPATIC FUNCTION PANEL $1,308.00
80143 DRUG ASSAY ACETAMINOPHEN $617.90
80175 DRUG SCREEN QUANTITATIVE LAMOTRIGINE $308.97
80177 DRUG SCREEN QUANTITATIVE LEVETIRACETAM $464.27
80178 DRUG SCREEN QUANTITATIVE LITHIUM $616.36
80179 DRUG ASSAY SALICYLATE $390.84
80197 DRUG SCREEN QUANTITATIVE TACROLIMUS $1,435.00
80202 DRUG SCREEN QUANTITATIVE VANCOMYCIN $799.00
80305 DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE $552.00
80307 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE $1,317.95
80320 DRUG SCREEN QUANTITATIVE ALCOHOLS $604.00
80324 DRUG SCREEN QUANT $606.07
80329 DRUG SCREEN ANALGESICS $777.52
80335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 $427.00
80345 DRUG SCREENING BARBITURATES $412.83
80346 DRUG SCREENING BENZODIAZEPINES 1-12 $346.82
80348 DRUG SCREENING $331.00
80349 DRUG SCREENING $209.70
80352 DRUG SCREENING $619.00
80353 DRUG SCREENING $243.00
80358 DRUG SCREENING $462.00
80359 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES $42.29
80361 DRUG SCREENING $804.37
80365 DRUG SCREENING $45.02
80373 DRUG SCREENING TRAMADOL $246.26
81001 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY $365.85
81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP $124.77
81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY $291.00
81007 URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK $354.00
81015 URINALYSIS MICROSCOPIC ONLY $236.74
81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS $402.80
81240 F2 GENE ANALYSIS 20210G >A VARIANT $645.18
82009 KETONE BODIES SERUM QUALITATIVE $175.00
82010 KETONE BODIES SERUM QUANTITATIVE $420.69
82040 ALBUMIN SERUM PLASMA/WHOLE BLOOD $335.90
82140 ASSAY OF AMMONIA $542.53
82150 ASSAY OF AMYLASE $585.03
82247 BILIRUBIN TOTAL $496.39
82248 BILIRUBIN DIRECT $344.31
82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER $261.92
82271 BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES $179.35
82272 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC $156.00
82274 BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 $218.66
82310 CALCIUM TOTAL $352.77
82330 CALCIUM IONIZED $721.37
82374 CARBON DIOXIDE BICARBONATE $255.00
82375 CARBOXYHEMOGLOBIN QUANTITATIVE $343.82
82435 CHLORIDE BLD $218.95
82465 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL $339.15
82533 CORTISOL TOTAL $808.99
82550 CREATINE KINASE TOTAL $471.36
82553 CREATINE KINASE MB FRACTION ONLY $643.69
82565 CREATININE BLOOD $369.58
82607 CYANOCOBALAMIN VITAMIN B-12 $526.51
82693 ASSAY OF ETHYLENE GLYCOL $410.00
82728 ASSAY OF FERRITIN $672.80
82746 ASSAY OF FOLIC ACID SERUM $570.82
82747 ASSAY OF FOLIC ACID RBC $155.00
82784 ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH $432.62
82785 ASSAY OF GAMMAGLOBULIN IGE $472.76
82800 GASES BLOOD PH ONLY $350.64
82803 BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 $1,357.15
82805 GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY $1,979.10
82945 GLUCOSE BODY FLUID OTHER THAN BLOOD $337.86
82947 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP $317.03
82948 GLUCOSE BLOOD REAGENT STRIP $162.24
82962 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE $91.85
82977 ASSAY OF GLUTAMYLTRASE GAMMA $436.25
83013 HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE $604.46
83036 HEMOGLOBIN GLYCOSYLATED A1C $446.81
83050 HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE $272.54
83520 IMMUNOASSAY ANALYTE QUANTITATIVE NOS $750.86
83525 ASSAY OF INSULIN TOTAL $374.16
83540 ASSAY OF IRON $505.96
83550 IRON BINDING CAPACITY $537.90
83605 ASSAY OF LACTATE $579.34
83615 LACTATE DEHYDROGENASE LDH $469.21
83690 ASSAY OF LIPASE $509.18
83718 LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL $330.00
83735 ASSAY OF MAGNESIUM $427.01
83874 MYOGLOBIN $539.00
83880 NATRIURETIC PEPTIDE $868.55
83992 ASSAY OF PHENCYCLIDINE $232.00
84075 ASSAY OF PHOSPHATASE ALKALINE $516.01
84100 ASSAY OF PHOSPHORUS INORGANIC $336.00
84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD $327.69
84155 PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD $293.03
84157 PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC $363.46
84165 PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM $666.15
84295 SODIUM SERUM PLASMA OR WHOLE BLOOD $283.98
84403 ASSAY OF TESTOSTERONE TOTAL $752.78
84436 ASSAY OF THYROXINE TOTAL $566.39
84439 ASSAY OF FREE THYROXINE $577.67
84443 ASSAY OF THYROID STIMULATING HORMONE TSH $869.43
84450 TRANSFERASE ASPARTATE AMINO AST SGOT $465.45
84460 TRANSFERASE ALANINE AMINO ALT SGPT $419.20
84478 ASSAY OF TRIGLYCERIDES $574.50
84479 THYROID HORM UPTK/THYROID HORMONE BINDING RATIO $196.31
84480 ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 $657.18
84481 ASSAY OF TRIIODOTHYRONINE T3 FREE $601.65
84484 ASSAY OF TROPONIN QUANTITATIVE $741.50
84520 ASSAY OF UREA NITROGEN QUANTITATIVE $330.87
84550 ASSAY OF BLOOD/URIC ACID $387.66
84560 ASSAY OF URIC ACID OTHER SOURCE $426.25
84702 GONADOTROPIN CHORIONIC QUANTITATIVE $776.01
84703 GONADOTROPIN CHORIONIC QUALITATIVE $461.38
84999 UNLISTED CHEMISTRY PROCEDURE $383.33
85014 BLOOD COUNT HEMATOCRIT $183.58
85018 BLOOD COUNT HEMOGLOBIN $183.91
85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC $347.30
85027 BLOOD COUNT COMPLETE AUTOMATED $917.00
85044 BLOOD COUNT RETICULOCYTE MANUAL $506.56
85045 BLOOD COUNT RETICULOCYTE AUTOMATED $259.12
85270 CLOTTING FACTOR XI PTA $1,230.90
85347 COAGULATION TIME ACTIVATED $353.70
85378 FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN $568.56
85379 FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE $710.85
85384 FIBRINOGEN ACTIVITY $429.15
85610 PROTHROMBIN TIME $362.40
85651 SEDIMENTATION RATE RBC NON-AUTOMATED $276.87
85652 SEDIMENTATION RATE RBC AUTOMATED $277.53
85730 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD $430.03
86038 ANTINUCLEAR ANTIBODIES ANA $652.31
86039 ANTINUCLEAR ANTIBODIES ANA TITER $733.28
86060 ANTISTREPTOLYSIN O TITER $427.44
86140 C-REACTIVE PROTEIN $488.06
86235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD $318.80
86256 FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY $376.08
86308 HETEROPHILE ANTIBODIES SCREEN $403.01
86328 IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19 $393.40
86360 T CELLS ABSOLUTE CD4&CD8 COUNT RATIO $337.48
86403 PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY $244.31
86430 RHEUMATOID FACTOR QUALITATIVE $271.72
86431 RHEUMATOID FACTOR QUANTITATIVE $508.29
86580 SKIN TEST TUBERCULOSIS INTRADERMAL $45.77
86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL $272.11
86593 SYPHILIS TEST QUANTITATIVE $434.50
86617 ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST $279.00
86622 ANTIBODY BRUCELLA $120.54
86631 ANTIBODY CHLAMYDIA $202.00
86644 ANTIBODY CYTOMEGALOVIRUS CMV $674.21
86645 ANTIBODY CYTOMEGALOVIRUS CMV IGM $668.76
86664 ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA $347.17
86677 ANTIBODY HELICOBACTER PYLORI $610.34
86689 ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST $513.06
86695 ANTIBODY HERPES SMPLX TYPE 1 $312.04
86696 ANTIBODY HERPES SMPLX TYPE 2 $410.34
86701 ANTIBODY HIV-1 $513.63
86702 ANTIBODY HIV-2 $528.78
86703 ANTIBODY HIV-1&HIV-2 SINGLE RESULT $474.56
86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL $471.70
86705 HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY $540.54
86706 HEPATITIS B SURF ANTIBODY HBSAB $557.90
86708 HEPATITIS A ANTIBODY HAAB $438.70
86709 HEPATITIS ANTIBODY HAAB IGM ANTIBODY $525.83
86756 ANTIBODY RESPIRATORY SYNCTIAL VIRUS $235.24
86757 ANTIBODY RICKETTSIA $254.13
86768 ANTIBODY SALMONELLA $184.00
86769 ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID-19 $444.41
86780 ANTIBODY TREPONEMA PALLIDUM $394.78
86787 ANTIBODY VARICELLA-ZOSTER $228.11
86803 HEPATITIS C ANTIBODY $679.05
86850 ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE $563.28
86900 BLOOD TYPING SEROLOGIC ABO $355.37
86901 BLOOD TYPING SEROLOGIC RH (D) $342.26
86906 BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE $356.81
87015 CONCENTRATION INFECTIOUS AGENTS $164.06
87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES $765.46
87045 CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL $683.14
87046 CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA $292.53
87070 CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL $867.00
87075 CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID $867.43
87076 CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL $374.07
87077 CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL $481.69
87081 CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ $455.06
87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE $744.71
87088 CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE $256.12
87103 CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD $407.75
87106 CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST $396.63
87110 CULTURE CHLAMYDIA ANY SOURCE $753.91
87177 OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID $375.58
87186 SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ $688.77
87205 SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL $397.00
87207 SMR PRIM SRC SPEC STAIN BODIES/PARASITS $438.87
87209 SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS $262.81
87210 SMR PRIM SRC WET MOUNT NFCT AGT $378.06
87252 VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT $728.61
87255 VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC $665.03
87275 IAADI INFLUENZA B VIRUS $220.89
87324 IAAD IA CLOSTRIDIUM DIFFICILE TOXIN $740.53
87328 IAAD IA CRYPTOSPORIDIUM $165.75
87338 IAAD IA HPYLORI STOOL $492.87
87340 IAAD IA HEPATITIS B SURFACE ANTIGEN $427.64
87341 IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION $346.18
87389 IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE $492.06
87400 IAAD IA INFLUENZA A/B EACH $477.36
87420 IAAD IA RESPIRATORY SYNCTIAL VIRUS $540.92
87425 IAAD IA ROTAVIRUS $606.84
87426 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS $355.08
87427 IAAD IA SHIGA-LIKE TOXIN $395.11
87428 IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B $507.45
87430 IAAD IA STREPTOCOCCUS GROUP A $331.17
87471 IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE $1,093.08
87481 IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ $347.00
87486 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ $765.74
87491 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ $627.98
87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE $744.85
87506 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 $1,550.70
87507 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 $3,707.75
87529 IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ $823.26
87581 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ $567.63
87591 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ $507.38
87624 IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES $410.93
87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET $3,927.97
87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ $365.47
87636 IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ $679.25
87660 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ $386.75
87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH $341.91
87798 IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM $959.00
87801 IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ $1,906.34
87804 IAADIADOO INFLUENZA $358.53
87806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES $526.52
87807 IAADIADOO RESPIRATORY SYNCTIAL VIRUS $755.79
87808 IAADIADOO TRICHOMONAS VAGINALIS $189.43
87880 IAADIADOO STREPTOCOCCUS GROUP A $670.51
88141 CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN $222.40
88233 TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX $1,160.45
88262 CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING $1,464.42
88291 CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP $749.07
88305 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $972.35
89050 CELL COUNT MISCELLANEOUS BODY FLUIDS $335.51
89051 CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT $402.27
89055 LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE $296.43
89060 CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID $331.10
89220 SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX $571.46
89240 UNLISTED MISCELLANEOUS PATHOLOGY TEST $218.90
90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE $285.62
90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE $206.82
90658 IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE $99.50
90688 IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE $448.18
90700 DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM $229.74
90707 MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ $815.67
90714 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE $319.80
90715 TDAP VACCINE 7 YRS/> IM $441.00
90746 HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE $481.16
91300 SARSCOV2 VACCINE DIL RECON 30 MCG/0.3 ML IM USE $0.02
92002 OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT $544.05
92552 PURE TONE AUDIOMETRY AIR ONLY $458.25
92950 CARDIOPULMONARY RESUSCITATION $2,722.70
92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL $3,811.56
93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R $942.78
93016 CV STRS TST XERS&/OR RX CONT ECG W/O I&R $378.10
93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY $4,356.39
93041 RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R $472.06
93042 RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON $142.78
93225 XTRNL ECG & 48 HR RECORDING $2,578.24
93226 EXTERNAL ECG SCANNING ANALYSIS REPORT $2,740.23
93303 COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY $5,799.42
93306 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D $7,339.06
93307 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP $5,257.71
93308 ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD $3,458.90
93320 DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY $4,003.28
93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING $3,454.75
93350 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST $6,557.57
93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG $8,541.79
93623 PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS $6,364.25
93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY $4,315.98
93882 DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY $2,732.15
93886 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL $2,142.08
93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL $1,840.58
93923 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS $2,555.72
93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY $3,728.25
93926 DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY $2,341.06
93930 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY $3,723.78
93931 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY $2,705.41
93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY $3,677.92
93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY $2,434.34
93975 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM $3,404.42
93976 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT $2,168.36
93980 DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL $2,183.69
94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ $1,033.48
94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN $1,205.87
94621 CARDIOPULMONARY EXERCISE TESTING $2,200.00
94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT $746.55
94644 CONTINUOUS INHALATION TREATMENT 1ST HR $932.24
94660 CPAP VENTILATION CPAP INITIATION&MGMT $4,561.29
94664 DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP $609.62
94760 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER $257.45
94761 NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER $381.91
94762 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR $1,335.38
95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND $6,415.76
96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR $1,367.57
96361 IV INFUSION HYDRATION EACH ADDITIONAL HOUR $474.26
96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR $1,466.94
96366 IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR $474.23
96367 IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR $789.44
96368 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS $527.76
96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM $558.96
96373 THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL $1,336.45
96374 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG $789.93
96375 THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG $637.64
96376 THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC $613.26
96377 APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION $530.34
96379 UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS $515.41
97110 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES $345.30
97116 THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR $357.12
97140 MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES $341.65
97166 OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS $940.17
97542 WHEELCHAIR MGMT EA 15 MIN $296.36
97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/< $1,295.55
99001 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB $175.12
99050 SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS $161.00
99070 SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP $369.80
99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS $562.93
99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS $668.12
99153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS $383.11
99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS $1,190.00
99156 MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS $588.86
99157 MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS $779.00
99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM $2,065.14
99283 EMERGENCY DEPARTMENT VISIT LOW MDM $3,796.82
99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM $5,891.67
99285 EMERGENCY DEPARTMENT VISIT HIGH MDM $8,139.58
99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN $11,436.47
99292 CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN $3,357.76
99406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES $156.24
99407 TOBACCO USE CESSATION INTENSIVE >10 MINUTES $183.00
E0114 CRUTCH UNDERARM PAIR NO WOOD $256.47
E0484    Oscillatory positive expiratory pressure device, nonelectric, any type, each $403.65
G0378 HOSPITAL OBSERVATION PER HR $2,500.00
J0131 ACETAMINOPHEN INJECTION $65.22
J0153 ADENOSINE INJ 1MG $55.25
J0171 ADRENALIN EPINEPHRINE INJECT $40.73
J0282 AMIODARONE HCL $37.90
J0290 AMPICILLIN 500 MG INJ $64.86
J0295 AMPICILLIN SULBACTAM 1.5 GM $72.27
J0360 HYDRALAZINE HCL INJECTION $168.44
J0456 AZITHROMYCIN $89.54
J0461 ATROPINE SULFATE INJECTION $24.86
J0500 DICYCLOMINE INJECTION $339.15
J0515 INJ BENZTROPINE MESYLATE $184.22
J0558 PENG BENZATHINE/PROCAINE INJ $127.93
J0561 PENICILLIN G BENZATHINE INJ $137.97
J0610 CALCIUM GLUCONATE INJECTION $51.10
J0690 CEFAZOLIN SODIUM INJECTION $35.03
J0692 CEFEPIME HCL FOR INJECTION $68.60
J0696 CEFTRIAXONE SODIUM INJECTION $55.73
J0697 STERILE CEFUROXIME INJECTION $51.34
J0735 CLONIDINE HYDROCHLORIDE $238.75
J0744 CIPROFLOXACIN IV $129.14
J0780 PROCHLORPERAZINE INJECTION $167.49
J0840 CROTALIDAE POLY IMMUNE FAB $24,660.55
J1030 METHYLPREDNISOLONE 40 MG INJ $77.17
J1040 METHYLPREDNISOLONE 80 MG INJ $105.36
J1100 DEXAMETHASONE SODIUM PHOS $20.28
J1110 INJ DIHYDROERGOTAMINE MESYLT $691.60
J1170 HYDROMORPHONE INJECTION $69.03
J1200 DIPHENHYDRAMINE HCL INJECTIO $34.03
J1610 GLUCAGON HYDROCHLORIDE/1 MG $1,014.98
J1630 HALOPERIDOL INJECTION $61.76
J1631 HALOPERIDOL DECANOATE INJ $159.07
J1642 INJ HEPARIN SODIUM PER 10 U $23.44
J1644 INJ HEPARIN SODIUM PER 1000U $32.21
J1650 INJ ENOXAPARIN SODIUM $73.68
J1741 IBUPROFEN INJECTION $28.67
J1815 INSULIN INJECTION $27.74
J1817 INSULIN FOR INSULIN PUMP USE $26.00
J1885 KETOROLAC TROMETHAMINE INJ $30.36
J1930 LANREOTIDE INJECTION $441.29
J1940 FUROSEMIDE INJECTION $37.74
J1956 LEVOFLOXACIN INJECTION $60.71
J2001 LIDOCAINE INJECTION $29.36
J2060 LORAZEPAM INJECTION $41.01
J2175 MEPERIDINE HYDROCHL /100 MG $137.48
J2250 INJ MIDAZOLAM HYDROCHLORIDE $21.25
J2270 MORPHINE SULFATE INJECTION $54.39
J2274 INJ MORPHINE PF EPID ITHC $131.59
J2405 ONDANSETRON HCL INJECTION $25.68
J2543 PIPERACILLIN/TAZOBACTAM $50.58
J2550 PROMETHAZINE HCL INJECTION $53.81
J2704 INJ, PROPOFOL, 10 MG $26.69
J2765 METOCLOPRAMIDE HCL INJECTION $36.03
J2780 RANITIDINE HYDROCHLORIDE INJ $29.72
J2800 METHOCARBAMOL INJECTION $309.63
J2920 METHYLPREDNISOLONE INJECTION $73.01
J2930 METHYLPREDNISOLONE INJECTION $88.81
J3010 CITRATE INJECTION $40.23
J3030 SUMATRIPTAN SUCCINATE / 6 MG $416.42
J3260 TOBRAMYCIN SULFATE INJECTION $119.10
J3360 DIAZEPAM INJECTION $120.35
J3370 VANCOMYCIN HCL INJECTION $89.09
J3430 VITAMIN K PHYTONADIONE INJ $63.81
J3475 INJ MAGNESIUM SULFATE $56.79
J3480 INJ POTASSIUM CHLORIDE $46.25
J3490 DRUGS UNCLASSIFIED INJECTION $250.41
J7030 NORMAL SALINE SOLUTION INFUS $104.19
J7040 NORMAL SALINE SOLUTION INFUS $83.99
J7042 5% DEXTROSE/NORMAL SALINE $133.67
J7050 NORMAL SALINE SOLUTION INFUS $54.57
J7070 D5W INFUSION $113.45
J7120 RINGERS LACTATE INFUSION $61.77
J7121 5% DEXTROSE IN LAC RINGERS $97.97
J7131 HYPERTONIC SALINE SOL $1.01
J7192 FACTOR VIII RECOMBINANT NOS $17.55
J7510 PREDNISOLONE ORAL PER 5 MG $19.90
J7611 ALBUTEROL NON-COMP CON $11.23
J7613 ALBUTEROL NON-COMP UNIT $14.74
J7614 LEVALBUTEROL NON-COMP UNIT $43.61
J7615 LEVALBUTEROL COMP UNIT $58.50
J7620 ALBUTEROL IPRATROP NON-COMP $40.11
J7644 IPRATROPIUM BROMIDE NON-COMP $144.68
J7682 TOBRAMYCIN NON-COMP UNIT $953.12
J8499 ORAL PRESCRIP DRUG NON CHEMO $136.48
J9206 IRINOTECAN INJECTION $116.89
L0120 CERV FLEX N/ADJ FOAM PRE OTS $142.29
L0140 CERVICAL SEMI-RIGID ADJUSTAB $550.00
L0150 CERV SEMI-RIG ADJ MOLDED CHN $353.00
L0172 CERV COL SR FOAM 2PC PRE OTS $405.29
L0174 CERV SR 2PC THOR EXT PRE OTS $1,396.06
L0180 CER POST COL OCC/MAN SUP ADJ $1,200.00
L0190 CERV COLLAR SUPP ADJ CERV BA $1,580.00
L0450 TLSO FLEX TRUNK/THOR PRE OTS $563.17
L0458 TLSO 2MOD SYMPHIS-XIPHO PRE $2,328.30
L0460 TLSO 2 SHL SYMPHYS-STERN CST $2,452.69
L0462 TLSO 3MOD SACRO-SCAP PRE $8,086.85
L0464 TLSO 4MOD SACRO-SCAP PRE $6,819.00
L0467 TLSO R FRAM SOFT PRE OTS $1,040.00
L0470 TLSO RIGID FRAME PRE SUBCLAV $3,654.75
L0472 TLSO RIGID FRAME HYPEREX PRE $2,130.00
L0625 LO FLEX L1-BELOW L5 PRE OTS $144.00
L0627 LO SAG RI AN/POS PNL PRE CST $2,871.57
L0628 LSO FLEX NO RI STAYS PRE OTS $219.70
L0630 LSO R POST PNL SJ-T9 PRE CST $435.81
L0631 LSO SAG R AN/POS PNL PRE CST $7,038.87
L0635 LSO SAGIT RIGID PANEL PREFAB $7,678.00
L0650 LSO SC R ANT/POS PNL PRE OTS $4,991.00
L0700 CTLSO A-P-L CONTROL MOLDED $8,453.31
L0810 HALO CERVICAL INTO JCKT VEST $8,346.06
L0859 MRI COMPATIBLE SYSTEM $3,863.34
L0976 LSO FULL CORSET $458.50
L1620 HO FLEX PAVLIK HARNS PRE CST $545.26
L1686 HO POST-OP HIP ABDUCTION $3,076.42
L1810 KO ELASTIC WITH JOINTS $452.00
L1820 KO ELAS W/ CONDYLE PADS & JO $950.12
L1830 KO IMMOB CANVAS LONG PRE OTS $408.99
L1832 KO ADJ JNT POS R SUP PRE CST $1,242.00
L1845 KO DOUBLE UPRIGHT PRE CST $2,592.97
L1902 AFO ANKLE GAUNTLET PRE OTS $260.69
L1930 AFO PLASTIC $715.80
L1940 AFO MOLDED TO PATIENT PLASTI $1,866.62
L1960 AFO POS SOLID ANK PLASTIC MO $1,355.19
L2114 AFO TIB FX SEMI-RIGID $1,897.00
L2624 HIP ADJ FLEX EXT ABDUCT CONT $855.77
L3650 SO 8 ABD RESTRAINT PRE OTS $228.85
L3660 SO 8 AB RSTR CAN/WEB PRE OTS $256.00
L3670 SO ACRO/CLAV CAN WEB PRE OTS $364.00
L3763 EWHO RIGID W/O JNTS CF $1,696.00
L3764 EWHO W/JOINT(S) CF $2,251.00
L3807 WHFO W/O JOINTS PRE CST $559.00
L3808 WHFO, RIGID W/O JOINTS $634.31
L3905 WHO W/NONTORSION JNT(S) CF $2,332.00
L3908 WHO COCK-UP NONMOLDE PRE OTS $201.00
L3980 UP EXT FX ORTHOS HUMERAL NOS $1,098.48
L3984 UPPER EXT FX ORTHOSIS WRIST $1,288.38
L3995 SOCK FRACTURE OR EQUAL EACH $102.68
L4350 ANKLE CONTROL ORTHO PRE OTS $327.00
L4360 PNEUMAT WALKING BOOT PRE CST $395.00
L4361 PNEUMA/VAC WALK BOOT PRE OTS $444.17
L4386 NON-PNEUM WALK BOOT PRE CST $502.76
L4387 NON-PNEUM WALK BOOT PRE OTS $513.65
L4396 STATIC OR DYNAMI AFO PRE CST $604.79
L4397 STATIC OR DYNAMI AFO PRE OTS $1,036.62
L8000 MASTECTOMY BRA $212.93
L8020 MASTECTOMY FORM $1,409.26
L8509 TRACH-ESOPH VOICE PROS MD IN $938.00
L8670 VASCULAR GRAFT, SYNTHETIC $7,707.31
M0243 CASIRIVI AND IMDEVI INJ $1,567.80
Q0144 AZITHROMYCIN DIHYDRATE, ORAL $201.31
Q0243 CASIRIVIMAB AND IMDEVIMAB $0.01
Q9963 HOCM 350-399MG/ML IODINE,1ML $28.66
Q9965 LOCM 100-199MG/ML IODINE,1ML $30.71
Q9966 LOCM 200-299MG/ML IODINE,1ML $31.15
Q9967 LOCM 300-399MG/ML IODINE,1ML $62.08
S0028 INJECTION, FAMOTIDINE, 20 MG $102.67
S0119 ONDANSETRON 4 MG $101.13
S0164 INJECTION PANTROPRAZOLE $139.76
U0002 COVID-19 LAB TEST NON-CDC $416.59