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| 10060 | Drainage of skin abscess | $1,970.53 |
| 10061 | Drainage of skin abscess | $2,215.83 |
| 10081 | Drainage of pilonidal cyst | $2,816.73 |
| 10120 | Remove foreign body | $3,510.46 |
| 10121 | Remove foreign body | $4,299.89 |
| 10160 | Puncture drainage of lesion | $1,281.01 |
| 11011 | Debride skin musc at fx site | $1,640.89 |
| 11042 | Deb subq tissue 20 sq cm/< | $3,088.37 |
| 11200 | Removal of skin tags <w/15 | $4,554.95 |
| 11404 | Exc tr-ext b9+marg 3.1-4 cm | $6,302.06 |
| 11730 | Removal of nail plate | $982.41 |
| 11740 | Drain blood from under nail | $588.97 |
| 11750 | Removal of nail bed | $1,738.04 |
| 11760 | Repair of nail bed | $1,615.96 |
| 11765 | Excision of nail fold toe | $1,095.63 |
| 11771 | Remove pilonidal cyst exten | $7,234.13 |
| 12001 | Rpr s/n/ax/gen/trnk 2.5cm/< | $896.21 |
| 12002 | Rpr s/n/ax/gen/trnk2.6-7.5cm | $1,013.45 |
| 12004 | Rpr s/n/ax/gen/trk7.6-12.5cm | $1,442.44 |
| 12005 | Rpr s/n/a/gen/trk12.6-20.0cm | $1,261.16 |
| 12011 | Rpr f/e/e/n/l/m 2.5 cm/< | $941.45 |
| 12013 | Rpr f/e/e/n/l/m 2.6-5.0 cm | $1,114.56 |
| 12014 | Rpr f/e/e/n/l/m 5.1-7.5 cm | $1,435.78 |
| 12020 | Closure of split wound | $4,340.93 |
| 12031 | Intmd rpr s/a/t/ext 2.5 cm/< | $1,329.73 |
| 12032 | Intmd rpr s/a/t/ext 2.6-7.5 | $1,598.10 |
| 12034 | Intmd rpr s/tr/ext 7.6-12.5 | $1,741.77 |
| 12035 | Intmd rpr s/a/t/ext 12.6-20 | $1,560.38 |
| 12036 | Intmd rpr s/a/t/ext 20.1-30 | $2,054.03 |
| 12041 | Intmd rpr n-hf/genit 2.5cm/< | $1,602.70 |
| 12042 | Intmd rpr n-hf/genit2.6-7.5 | $1,724.30 |
| 12044 | Intmd rpr n-hf/genit7.6-12.5 | $1,299.80 |
| 12045 | Intmd rpr n-hf/genit12.6-20 | $2,110.64 |
| 12051 | Intmd rpr face/mm 2.5 cm/< | $1,136.14 |
| 12052 | Intmd rpr face/mm 2.6-5.0 cm | $1,575.97 |
| 12053 | Intmd rpr face/mm 5.1-7.5 cm | $2,666.56 |
| 12054 | Intmd rpr face/mm 7.6-12.5cm | $1,465.67 |
| 13121 | Cmplx rpr s/a/l 2.6-7.5 cm | $2,510.06 |
| 13122 | Cmplx rpr s/a/l addl 5 cm/> | $1,557.49 |
| 13132 | Cmplx rpr f/c/c/m/n/ax/g/h/f | $3,241.75 |
| 13151 | Cmplx rpr e/n/e/l 1.1-2.5 cm | $2,617.61 |
| 13152 | Cmplx rpr e/n/e/l 2.6-7.5 cm | $2,752.93 |
| 13153 | Cmplx rpr e/n/e/l addl 5cm/< | $1,721.22 |
| 15850 | Remove sutures same surgeon | $4,805.95 |
| 16000 | Initial treatment of burn(s) | $919.87 |
| 16020 | Dress/debrid p-thick burn s | $1,054.15 |
| 20552 | Inj trigger point 1/2 muscl | $2,634.28 |
| 20600 | Drain/inj joint/bursa w/o us | $1,279.81 |
| 20605 | Drain/inj joint/bursa w/o us | $1,820.47 |
| 20610 | Drain/inj joint/bursa w/o us | $2,459.82 |
| 20611 | Drain/inj joint/bursa w/us | $3,345.86 |
| 21480 | Reset dislocated jaw | $1,008.34 |
| 23600 | Treat humerus fracture | $1,314.84 |
| 23650 | Treat shoulder dislocation | $1,576.39 |
| 24500 | Treat humerus fracture | $1,030.50 |
| 24530 | Treat humerus fracture | $2,993.75 |
| 24600 | Treat elbow dislocation | $1,036.44 |
| 24640 | Treat elbow dislocation | $1,393.15 |
| 25505 | Treat fracture of radius | $3,373.00 |
| 25530 | Treat fracture of ulna | $657.34 |
| 25535 | Treat fracture of ulna | $2,827.19 |
| 25600 | Treat fracture radius/ulna | $1,497.81 |
| 25605 | Treat fracture radius/ulna | $3,120.90 |
| 25635 | Treat wrist bone fracture | $1,898.28 |
| 25650 | Treat wrist bone fracture | $904.12 |
| 26010 | Drainage of finger abscess | $1,057.79 |
| 26600 | Treat metacarpal fracture | $1,314.17 |
| 26605 | Treat metacarpal fracture | $1,541.68 |
| 26700 | Treat knuckle dislocation | $1,565.76 |
| 26725 | Treat finger fracture each | $1,675.91 |
| 26750 | Treat finger fracture each | $2,805.78 |
| 26755 | Treat finger fracture each | $1,757.40 |
| 26770 | Treat finger dislocation | $1,237.40 |
| 27372 | Removal of foreign body | $3,398.36 |
| 27550 | Treat knee dislocation | $1,759.63 |
| 27560 | Treat kneecap dislocation | $1,081.07 |
| 27752 | Treatment of tibia fracture | $6,933.56 |
| 27780 | Treatment of fibula fracture | $2,589.00 |
| 27786 | Treatment of ankle fracture | $638.79 |
| 27792 | Treatment of ankle fracture | $12,607.88 |
| 27810 | Treatment of ankle fracture | $2,491.37 |
| 27840 | Treat ankle dislocation | $846.39 |
| 28190 | Removal of foot foreign body | $2,681.82 |
| 28192 | Removal of foot foreign body | $4,902.95 |
| 28470 | Treat metatarsal fracture | $945.38 |
| 28510 | Treatment of toe fracture | $1,026.57 |
| 28515 | Treatment of toe fracture | $1,773.00 |
| 28660 | Treat toe dislocation | $1,364.00 |
| 29075 | Application of forearm cast | $1,036.39 |
| 29085 | Apply hand/wrist cast | $597.31 |
| 29105 | Apply long arm splint | $880.60 |
| 29125 | Apply forearm splint | $789.85 |
| 29126 | Apply forearm splint | $703.95 |
| 29130 | Application of finger splint | $538.88 |
| 29131 | Application of finger splint | $504.73 |
| 29240 | Strapping of shoulder | $560.21 |
| 29280 | Strapping of hand or finger | $572.08 |
| 29505 | Application long leg splint | $845.33 |
| 29515 | Application lower leg splint | $838.98 |
| 29540 | Strapping of ankle and/or ft | $488.47 |
| 29580 | Application of paste boot | $691.49 |
| 30300 | Remove nasal foreign body | $706.42 |
| 30901 | Control of nosebleed | $1,045.95 |
| 30903 | Control of nosebleed | $1,692.51 |
| 31500 | Insert emergency airway | $1,274.88 |
| 31502 | Change of windpipe airway | $2,395.75 |
| 31515 | Laryngoscopy for aspiration | $1,101.50 |
| 31525 | Dx laryngoscopy excl nb | $4,184.03 |
| 32551 | Insertion of chest tube | $3,693.36 |
| 36000 | Place needle in vein | $1,019.62 |
| 36410 | Non-routine bl draw 3/> yrs | $1,727.00 |
| 36415 | Routine venipuncture | $79.35 |
| 36416 | Capillary blood draw | $84.51 |
| 36556 | Insert non-tunnel cv cath | $4,819.77 |
| 36558 | Insert tunneled cv cath | $7,040.12 |
| 36589 | Removal tunneled cv cath | $6,652.10 |
| 36591 | Draw blood off venous device | $431.58 |
| 40650 | Repair lip | $2,975.92 |
| 41800 | Drainage of gum lesion | $1,003.03 |
| 42700 | Drainage of tonsil abscess | $2,148.80 |
| 43753 | Tx gastro intub w/asp | $1,897.64 |
| 46040 | Incision of rectal abscess | $5,286.10 |
| 46050 | Incision of anal abscess | $3,180.76 |
| 46083 | Incise external hemorrhoid | $1,275.12 |
| 46320 | Removal of hemorrhoid clot | $6,631.35 |
| 51700 | Irrigation of bladder | $1,816.73 |
| 51701 | Insert bladder catheter | $438.62 |
| 51702 | Insert temp bladder cath | $752.97 |
| 51703 | Insert bladder cath complex | $2,228.70 |
| 56405 | I & d of vulva/perineum | $1,375.13 |
| 56420 | Drainage of gland abscess | $1,002.34 |
| 59025 | Fetal non-stress test | $1,141.42 |
| 59409 | Obstetrical care | $5,641.48 |
| 62270 | Spinal fluid tap diagnostic | $2,201.61 |
| 64400 | N block inj trigeminal | $1,745.26 |
| 64402 | N block inj facial | $919.03 |
| 64450 | N block other peripheral | $2,398.50 |
| 64640 | Injection treatment of nerve | $2,861.75 |
| 65205 | Remove foreign body from eye | $600.16 |
| 65220 | Remove foreign body from eye | $1,113.23 |
| 65222 | Remove foreign body from eye | $964.40 |
| 67700 | Drainage of eyelid abscess | $917.89 |
| 69200 | Clear outer ear canal | $692.53 |
| 69205 | Clear outer ear canal | $3,169.73 |
| 69209 | Remove impacted ear wax uni | $441.90 |
| 69210 | Remove impacted ear wax uni | $769.28 |
| 70030 | X-ray eye for foreign body | $575.64 |
| 70100 | X-ray exam of jaw <4views | $790.30 |
| 70110 | X-ray exam of jaw 4/> views | $1,096.68 |
| 70120 | X-ray exam of mastoids | $517.93 |
| 70130 | X-ray exam of mastoids | $706.13 |
| 70140 | X-ray exam of facial bones | $973.66 |
| 70150 | X-ray exam of facial bones | $1,170.86 |
| 70160 | X-ray exam of nasal bones | $983.20 |
| 70200 | X-ray exam of eye sockets | $1,121.74 |
| 70210 | X-ray exam of sinuses | $647.33 |
| 70220 | X-ray exam of sinuses | $1,268.49 |
| 70250 | X-ray exam of skull | $1,061.46 |
| 70260 | X-ray exam of skull | $1,719.91 |
| 70330 | X-ray exam of jaw joints | $928.88 |
| 70350 | X-ray head for orthodontia | $458.85 |
| 70360 | X-ray exam of neck | $855.44 |
| 70450 | Ct head/brain w/o dye | $6,250.43 |
| 70460 | Ct head/brain w/dye | $6,413.03 |
| 70470 | Ct head/brain w/o & w/dye | $7,306.83 |
| 70480 | Ct orbit/ear/fossa w/o dye | $4,944.58 |
| 70481 | Ct orbit/ear/fossa w/dye | $6,883.52 |
| 70482 | Ct orbit/ear/fossa w/o&w/dye | $7,421.20 |
| 70486 | Ct maxillofacial w/o dye | $5,760.58 |
| 70487 | Ct maxillofacial w/dye | $6,456.83 |
| 70488 | Ct maxillofacial w/o & w/dye | $7,850.44 |
| 70490 | Ct soft tissue neck w/o dye | $5,613.27 |
| 70491 | Ct soft tissue neck w/dye | $7,446.03 |
| 70496 | Ct angiography head | $8,748.82 |
| 70498 | Ct angiography neck | $8,724.82 |
| 70544 | Mr angiography head w/o dye | $7,387.90 |
| 70547 | Mr angiography neck w/o dye | $7,254.81 |
| 70551 | Mri brain stem w/o dye | $7,892.81 |
| 70553 | Mri brain stem w/o & w/dye | $10,284.54 |
| 71045 | X-ray exam chest 1 view | $1,069.10 |
| 71046 | X-ray exam chest 2 views | $1,166.18 |
| 71047 | X-ray exam chest 3 views | $1,208.97 |
| 71048 | X-ray exam chest 4+ views | $1,505.13 |
| 71100 | X-ray exam ribs uni 2 views | $1,046.72 |
| 71101 | X-ray exam unilat ribs/chest | $1,292.21 |
| 71110 | X-ray exam ribs bil 3 views | $1,247.46 |
| 71111 | X-ray exam ribs/chest4/> vws | $1,480.42 |
| 71120 | X-ray exam breastbone 2/>vws | $886.55 |
| 71250 | Ct thorax w/o dye | $5,663.17 |
| 71260 | Ct thorax w/dye | $7,072.46 |
| 71270 | Ct thorax w/o & w/dye | $7,637.36 |
| 71275 | Ct angiography chest | $8,820.46 |
| 71550 | Mri chest w/o dye | $6,937.29 |
| 72020 | X-ray exam of spine 1 view | $893.78 |
| 72040 | X-ray exam neck spine 2-3 vw | $1,169.60 |
| 72050 | X-ray exam neck spine 4/5vws | $1,748.58 |
| 72052 | X-ray exam neck spine 6/>vws | $1,753.81 |
| 72070 | X-ray exam thorac spine 2vws | $1,379.90 |
| 72072 | X-ray exam thorac spine 3vws | $1,616.62 |
| 72074 | X-ray exam thorac spine4/>vw | $984.58 |
| 72080 | X-ray exam thoracolmb 2/> vw | $847.78 |
| 72082 | X-ray exam entire spi 2/3 vw | $1,390.34 |
| 72100 | X-ray exam l-s spine 2/3 vws | $1,466.45 |
| 72110 | X-ray exam l-2 spine 4/>vws | $1,769.62 |
| 72114 | X-ray exam l-s spine bending | $1,674.05 |
| 72120 | X-ray bend only l-s spine | $1,150.72 |
| 72125 | Ct neck spine w/o dye | $6,899.72 |
| 72126 | Ct neck spine w/dye | $7,261.86 |
| 72127 | Ct neck spine w/o & w/dye | $8,241.83 |
| 72128 | Ct chest spine w/o dye | $5,993.51 |
| 72129 | Ct chest spine w/dye | $6,608.08 |
| 72130 | Ct chest spine w/o & w/dye | $7,543.10 |
| 72131 | Ct lumbar spine w/o dye | $6,857.74 |
| 72132 | Ct lumbar spine w/dye | $7,650.90 |
| 72133 | Ct lumbar spine w/o & w/dye | $8,524.60 |
| 72141 | Mri neck spine w/o dye | $7,109.20 |
| 72146 | Mri chest spine w/o dye | $6,861.20 |
| 72148 | Mri lumbar spine w/o dye | $6,896.90 |
| 72156 | Mri neck spine w/o & w/dye | $10,073.46 |
| 72157 | Mri chest spine w/o & w/dye | $9,931.72 |
| 72158 | Mri lumbar spine w/o & w/dye | $9,630.29 |
| 72170 | X-ray exam of pelvis | $1,052.68 |
| 72190 | X-ray exam of pelvis | $1,357.91 |
| 72191 | Ct angiograph pelv w/o&w/dye | $7,419.44 |
| 72192 | Ct pelvis w/o dye | $6,035.36 |
| 72193 | Ct pelvis w/dye | $6,635.61 |
| 72194 | Ct pelvis w/o & w/dye | $7,635.46 |
| 72195 | Mri pelvis w/o dye | $7,039.42 |
| 72196 | Mri pelvis w/dye | $8,207.89 |
| 72220 | X-ray exam sacrum tailbone | $951.99 |
| 72270 | Myelogphy 2/> spine regions | $4,893.71 |
| 73000 | X-ray exam of collar bone | $986.84 |
| 73010 | X-ray exam of shoulder blade | $1,014.48 |
| 73020 | X-ray exam of shoulder | $847.88 |
| 73030 | X-ray exam of shoulder | $1,275.51 |
| 73050 | X-ray exam of shoulders | $995.85 |
| 73060 | X-ray exam of humerus | $1,103.34 |
| 73070 | X-ray exam of elbow | $827.70 |
| 73080 | X-ray exam of elbow | $981.15 |
| 73090 | X-ray exam of forearm | $1,078.84 |
| 73100 | X-ray exam of wrist | $866.46 |
| 73110 | X-ray exam of wrist | $1,220.02 |
| 73120 | X-ray exam of hand | $887.55 |
| 73130 | X-ray exam of hand | $1,120.38 |
| 73140 | X-ray exam of finger(s) | $838.86 |
| 73200 | Ct upper extremity w/o dye | $4,804.57 |
| 73201 | Ct upper extremity w/dye | $6,243.23 |
| 73202 | Ct uppr extremity w/o&w/dye | $7,150.91 |
| 73220 | Mri uppr extremity w/o&w/dye | $8,670.35 |
| 73221 | Mri joint upr extrem w/o dye | $7,281.36 |
| 73501 | X-ray exam hip uni 1 view | $868.27 |
| 73502 | X-ray exam hip uni 2-3 views | $1,198.14 |
| 73503 | X-ray exam hip uni 4/> views | $2,248.13 |
| 73522 | X-ray exam hips bi 3-4 views | $1,573.84 |
| 73551 | X-ray exam of femur 1 | $655.45 |
| 73552 | X-ray exam of femur 2/> | $939.64 |
| 73560 | X-ray exam of knee 1 or 2 | $813.35 |
| 73562 | X-ray exam of knee 3 | $906.80 |
| 73564 | X-ray exam knee 4 or more | $1,288.74 |
| 73565 | X-ray exam of knees | $803.84 |
| 73580 | Contrast x-ray of knee joint | $2,724.00 |
| 73590 | X-ray exam of lower leg | $1,079.10 |
| 73592 | X-ray exam of leg infant | $1,394.22 |
| 73600 | X-ray exam of ankle | $847.40 |
| 73610 | X-ray exam of ankle | $1,058.35 |
| 73620 | X-ray exam of foot | $937.41 |
| 73630 | X-ray exam of foot | $1,035.55 |
| 73650 | X-ray exam of heel | $838.01 |
| 73660 | X-ray exam of toe(s) | $923.80 |
| 73700 | Ct lower extremity w/o dye | $5,595.48 |
| 73701 | Ct lower extremity w/dye | $6,122.83 |
| 73702 | Ct lwr extremity w/o&w/dye | $7,134.98 |
| 73718 | Mri lower extremity w/o dye | $5,271.95 |
| 73721 | Mri jnt of lwr extre w/o dye | $6,044.10 |
| 73722 | Mri joint of lwr extr w/dye | $5,399.08 |
| 73723 | Mri joint lwr extr w/o&w/dye | $7,865.38 |
| 73725 | Mr ang lwr ext w or w/o dye | $3,945.60 |
| 74018 | X-ray exam abdomen 1 view | $906.51 |
| 74019 | X-ray exam abdomen 2 views | $1,045.13 |
| 74021 | X-ray exam abdomen 3+ views | $1,141.96 |
| 74022 | X-ray exam series abdomen | $1,631.74 |
| 74150 | Ct abdomen w/o dye | $5,755.36 |
| 74160 | Ct abdomen w/dye | $6,827.85 |
| 74170 | Ct abdomen w/o & w/dye | $7,789.34 |
| 74174 | Ct angio abd&pelv w/o&w/dye | $9,920.02 |
| 74175 | Ct angio abdom w/o & w/dye | $7,492.15 |
| 74176 | Ct abd & pelvis w/o contrast | $9,556.67 |
| 74177 | Ct abd & pelv w/contrast | $10,615.21 |
| 74178 | Ct abd & pelv 1/> regns | $12,514.63 |
| 74181 | Mri abdomen w/o dye | $6,118.29 |
| 74183 | Mri abdomen w/o & w/dye | $7,163.23 |
| 74190 | X-ray exam of peritoneum | $2,295.23 |
| 74240 | X-ray upper gi delay w/o kub | $1,447.65 |
| 74246 | Contrst x-ray uppr gi tract | $1,910.17 |
| 74250 | X-ray exam of small bowel | $1,615.90 |
| 74251 | X-ray exam of small bowel | $2,605.80 |
| 74283 | Contrast x-ray exam of colon | $2,038.49 |
| 74328 | X-ray bile duct endoscopy | $3,597.46 |
| 74329 | X-ray for pancreas endoscopy | $2,720.52 |
| 74330 | X-ray bile/panc endoscopy | $1,749.01 |
| 74340 | X-ray guide for gi tube | $999.91 |
| 75574 | Ct angio hrt w/3d image | $3,340.10 |
| 76376 | 3d render w/intrp postproces | $1,642.09 |
| 76380 | Cat scan follow-up study | $1,974.35 |
| 76536 | Us exam of head and neck | $1,994.75 |
| 76604 | Us exam chest | $1,253.43 |
| 76641 | Ultrasound breast complete | $1,517.90 |
| 76642 | Ultrasound breast limited | $1,031.54 |
| 76700 | Us exam abdom complete | $2,693.25 |
| 76705 | Echo exam of abdomen | $2,173.92 |
| 76706 | Us abdl aorta screen aaa | $1,445.50 |
| 76770 | Us exam abdo back wall comp | $2,043.71 |
| 76775 | Us exam abdo back wall lim | $1,696.82 |
| 76801 | Ob us < 14 wks single fetus | $1,942.32 |
| 76802 | Ob us < 14 wks addl fetus | $1,335.27 |
| 76805 | Ob us >/= 14 wks sngl fetus | $2,307.09 |
| 76810 | Ob us >/= 14 wks addl fetus | $2,243.69 |
| 76815 | Ob us limited fetus(s) | $1,575.00 |
| 76816 | Ob us follow-up per fetus | $1,124.10 |
| 76817 | Transvaginal us obstetric | $1,611.41 |
| 76830 | Transvaginal us non-ob | $1,492.21 |
| 76856 | Us exam pelvic complete | $2,482.38 |
| 76857 | Us exam pelvic limited | $1,352.35 |
| 76870 | Us exam scrotum | $1,996.83 |
| 76881 | Us compl joint r-t w/img | $2,010.16 |
| 76882 | Us lmtd jt/nonvasc xtr strux | $1,071.43 |
| 76942 | Echo guide for biopsy | $2,812.96 |
| 77076 | X-rays bone survey infant | $1,235.20 |
| 78306 | Bone imaging whole body | $3,893.49 |
| 78315 | Bone imaging 3 phase | $4,373.79 |
| 78320 | Bone imaging (3d) | $3,891.25 |
| 78472 | Gated heart planar single | $3,518.15 |
| 80047 | Metabolic panel ionized ca | $999.70 |
| 80048 | Metabolic panel total ca | $699.69 |
| 80051 | Electrolyte panel | $556.19 |
| 80053 | Comprehen metabolic panel | $985.40 |
| 80061 | Lipid panel | $755.70 |
| 80074 | Acute hepatitis panel | $1,368.96 |
| 80076 | Hepatic function panel | $862.28 |
| 80178 | Assay of lithium | $543.44 |
| 80197 | Assay of tacrolimus | $1,091.40 |
| 80202 | Assay of vancomycin | $674.67 |
| 80305 | Drug test prsmv dir opt obs | $312.79 |
| 80307 | Drug test prsmv chem anlyzr | $1,162.55 |
| 80320 | Drug screen quantalcohols | $501.12 |
| 80324 | Drug screen amphetamines 1/2 | $534.65 |
| 80329 | Analgesics non-opioid 1 or 2 | $621.61 |
| 80335 | Antidepressant tricyclic 1/2 | $305.00 |
| 80345 | Drug screening barbiturates | $237.81 |
| 80346 | Benzodiazepines1-12 | $326.38 |
| 80349 | Cannabinoids natural | $275.05 |
| 80352 | Cannabinoid synthetic 7/more | $451.07 |
| 80353 | Drug screening cocaine | $222.95 |
| 80358 | Drug screening methadone | $349.25 |
| 80359 | Methylenedioxyamphetamines | $54.06 |
| 80361 | Opiates 1 or more | $255.54 |
| 80362 | Opioids & opiate analogs 1/2 | $378.24 |
| 80365 | Drug screening oxycodone | $57.76 |
| 80373 | Drug screening tramadol | $246.26 |
| 81001 | Urinalysis auto w/scope | $311.11 |
| 81002 | Urinalysis nonauto w/o scope | $104.29 |
| 81003 | Urinalysis auto w/o scope | $182.92 |
| 81007 | Urine screen for bacteria | $292.31 |
| 81015 | Microscopic exam of urine | $196.44 |
| 81025 | Urine pregnancy test | $360.94 |
| 82009 | Test for acetone/ketones | $162.42 |
| 82040 | Assay of serum albumin | $243.19 |
| 82140 | Assay of ammonia | $495.41 |
| 82150 | Assay of amylase | $505.61 |
| 82247 | Bilirubin total | $415.51 |
| 82248 | Bilirubin direct | $285.34 |
| 82270 | Occult blood feces | $226.28 |
| 82272 | Occult bld feces 1-3 tests | $131.58 |
| 82274 | Assay test for blood fecal | $250.45 |
| 82310 | Assay of calcium | $306.94 |
| 82330 | Assay of calcium | $625.21 |
| 82374 | Assay blood carbon dioxide | $225.75 |
| 82375 | Assay carboxyhb quant | $355.34 |
| 82435 | Assay of blood chloride | $201.16 |
| 82465 | Assay bld/serum cholesterol | $413.05 |
| 82533 | Total cortisol | $613.18 |
| 82540 | Assay of creatine | $298.50 |
| 82550 | Assay of ck (cpk) | $384.08 |
| 82553 | Creatine mb fraction | $583.33 |
| 82565 | Assay of creatinine | $349.61 |
| 82607 | Vitamin b-12 | $508.19 |
| 82693 | Assay of ethylene glycol | $388.96 |
| 82747 | Assay of folic acid rbc | $276.55 |
| 82784 | Assay iga/igd/igg/igm each | $329.82 |
| 82785 | Assay of ige | $279.38 |
| 82800 | Blood ph | $152.39 |
| 82803 | Blood gases any combination | $998.98 |
| 82805 | Blood gases w/o2 saturation | $1,137.03 |
| 82945 | Glucose other fluid | $306.91 |
| 82947 | Assay glucose blood quant | $272.05 |
| 82948 | Reagent strip/blood glucose | $128.11 |
| 82962 | Glucose blood test | $90.49 |
| 82977 | Assay of ggt | $465.98 |
| 83013 | H pylori (c-13) breath | $635.04 |
| 83036 | Glycosylated hemoglobin test | $404.62 |
| 83050 | Blood methemoglobin assay | $222.64 |
| 83520 | Immunoassay quant nos nonab | $526.79 |
| 83525 | Assay of insulin | $462.59 |
| 83540 | Assay of iron | $439.93 |
| 83605 | Assay of lactic acid | $516.66 |
| 83615 | Lactate (ld) (ldh) enzyme | $397.33 |
| 83690 | Assay of lipase | $431.40 |
| 83718 | Assay of lipoprotein | $200.17 |
| 83735 | Assay of magnesium | $334.53 |
| 83874 | Assay of myoglobin | $524.65 |
| 83880 | Assay of natriuretic peptide | $801.46 |
| 83992 | Assay for phencyclidine | $119.40 |
| 84075 | Assay alkaline phosphatase | $352.13 |
| 84100 | Assay of phosphorus | $281.09 |
| 84132 | Assay of serum potassium | $295.29 |
| 84155 | Assay of protein serum | $265.08 |
| 84157 | Assay of protein other | $358.64 |
| 84165 | Protein e-phoresis serum | $503.22 |
| 84295 | Assay of serum sodium | $263.84 |
| 84403 | Assay of total testosterone | $684.51 |
| 84436 | Assay of total thyroxine | $360.99 |
| 84439 | Assay of free thyroxine | $483.87 |
| 84443 | Assay thyroid stim hormone | $709.66 |
| 84450 | Transferase (ast) (sgot) | $398.09 |
| 84460 | Alanine amino (alt) (sgpt) | $350.99 |
| 84478 | Assay of triglycerides | $417.21 |
| 84479 | Assay of thyroid (t3 or t4) | $192.77 |
| 84480 | Assay triiodothyronine (t3) | $499.84 |
| 84481 | Free assay (ft-3) | $512.06 |
| 84484 | Assay of troponin quant | $643.09 |
| 84520 | Assay of urea nitrogen | $239.11 |
| 84550 | Assay of blood/uric acid | $324.15 |
| 84560 | Assay of urine/uric acid | $274.58 |
| 84702 | Chorionic gonadotropin test | $648.05 |
| 84703 | Chorionic gonadotropin assay | $409.33 |
| 84999 | Clinical chemistry test | $263.60 |
| 85014 | Hematocrit | $138.64 |
| 85018 | Hemoglobin | $153.28 |
| 85025 | Complete cbc w/auto diff wbc | $319.06 |
| 85027 | Complete cbc automated | $433.25 |
| 85044 | Manual reticulocyte count | $450.15 |
| 85347 | Coagulation time activated | $294.08 |
| 85378 | Fibrin degrade semiquant | $468.06 |
| 85379 | Fibrin degradation quant | $586.24 |
| 85610 | Prothrombin time | $301.03 |
| 85651 | Rbc sed rate nonautomated | $240.20 |
| 85652 | Rbc sed rate automated | $236.85 |
| 85730 | Thromboplastin time partial | $344.03 |
| 86038 | Antinuclear antibodies | $513.72 |
| 86039 | Antinuclear antibodies (ana) | $562.17 |
| 86060 | Antistreptolysin o titer | $336.22 |
| 86140 | C-reactive protein | $427.25 |
| 86235 | Nuclear antigen antibody | $437.03 |
| 86256 | Fluorescent antibody titer | $447.63 |
| 86308 | Heterophile antibody screen | $322.12 |
| 86320 | Serum immunoelectrophoresis | $1,094.54 |
| 86328 | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) | $346.72 |
| 86360 | T cell absolute count/ratio | $590.57 |
| 86403 | Particle agglut antbdy scrn | $266.70 |
| 86430 | Rheumatoid factor test qual | $255.72 |
| 86431 | Rheumatoid factor quant | $372.77 |
| 86592 | Syphilis test non-trep qual | $306.95 |
| 86593 | Syphilis test non-trep quant | $261.59 |
| 86631 | Chlamydia antibody | $168.00 |
| 86644 | Cmv antibody | $472.84 |
| 86645 | Cmv antibody igm | $520.96 |
| 86664 | Epstein-barr nuclear antigen | $406.28 |
| 86677 | Helicobacter pylori antibody | $533.88 |
| 86689 | Htlv/hiv confirmj antibody | $587.05 |
| 86701 | Hiv-1antibody | $435.76 |
| 86702 | Hiv-2 antibody | $538.40 |
| 86704 | Hep b core antibody total | $539.59 |
| 86705 | Hep b core antibody igm | $521.56 |
| 86706 | Hep b surface antibody | $512.28 |
| 86713 | Legionella antibody | $188.66 |
| 86756 | Respiratory virus antibody | $224.52 |
| 86769 | Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) | $401.71 |
| 86780 | Treponema pallidum | $323.90 |
| 86787 | Varicella-zoster antibody | $309.55 |
| 86803 | Hepatitis c ab test | $563.61 |
| 86850 | Rbc antibody screen | $453.84 |
| 86900 | Blood typing serologic abo | $284.77 |
| 86901 | Blood typing serologic rh(d) | $230.38 |
| 86906 | Bld typing serologic rh phnt | $309.04 |
| 87040 | Blood culture for bacteria | $664.25 |
| 87045 | Feces culture aerobic bact | $533.49 |
| 87046 | Stool cultr aerobic bact ea | $278.14 |
| 87070 | Culture othr specimn aerobic | $549.73 |
| 87075 | Cultr bacteria except blood | $741.98 |
| 87076 | Culture anaerobe ident each | $356.89 |
| 87077 | Culture aerobic identify | $382.06 |
| 87081 | Culture screen only | $284.80 |
| 87086 | Urine culture/colony count | $573.69 |
| 87088 | Urine bacteria culture | $242.71 |
| 87103 | Blood fungus culture | $402.31 |
| 87106 | Fungi identification yeast | $271.54 |
| 87110 | Chlamydia culture | $496.58 |
| 87177 | Ova and parasites smears | $339.31 |
| 87205 | Smear gram stain | $234.38 |
| 87207 | Smear special stain | $301.54 |
| 87209 | Smear complex stain | $268.63 |
| 87210 | Smear wet mount saline/ink | $271.40 |
| 87252 | Virus inoculation tissue | $611.29 |
| 87255 | Genet virus isolate hsv | $387.00 |
| 87275 | Influenza b ag if | $218.67 |
| 87338 | Hpylori stool ia | $407.93 |
| 87340 | Hepatitis b surface ag ia | $378.05 |
| 87341 | Hepatitis b surface ag ia | $344.68 |
| 87389 | Hiv-1 ag w/hiv-1 & hiv-2 ab | $431.33 |
| 87400 | Influenza a/b ag ia | $347.02 |
| 87420 | Resp syncytial ag ia | $452.33 |
| 87425 | Rotavirus ag ia | $485.07 |
| 87426 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) | $488.56 |
| 87427 | Shiga-like toxin ag ia | $349.27 |
| 87430 | Strep a ag ia | $260.23 |
| 87480 | Candida dna dir probe | $63.68 |
| 87486 | Chylmd pneum dna amp probe | $642.05 |
| 87491 | Chylmd trach dna amp probe | $551.85 |
| 87493 | C diff amplified probe | $634.41 |
| 87507 | Iadna-dna/rna probe tq 12-25 | $4,327.29 |
| 87529 | Hsv dna amp probe | $685.64 |
| 87581 | M.pneumon dna amp probe | $617.89 |
| 87591 | N.gonorrhoeae dna amp prob | $483.52 |
| 87633 | Resp virus 12-25 targets | $2,842.03 |
| 87635 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique | $351.58 |
| 87661 | Trichomonas vaginalis amplif | $342.97 |
| 87798 | Detect agent nos dna amp | $843.84 |
| 87804 | Influenza assay w/optic | $342.53 |
| 87807 | Rsv assay w/optic | $403.74 |
| 87880 | Strep a assay w/optic | $538.66 |
| 88305 | Tissue exam by pathologist | $835.74 |
| 89050 | Body fluid cell count | $288.09 |
| 89051 | Body fluid cell count | $350.71 |
| 89055 | Leukocyte assessment fecal | $240.82 |
| 89060 | Exam synovial fluid crystals | $274.10 |
| 89220 | Sputum specimen collection | $170.00 |
| 90471 | Immunization admin | $267.82 |
| 90688 | Iiv4 vaccine splt 0.5 ml im | $171.66 |
| 90700 | Dtap vaccine < 7 yrs im | $217.72 |
| 90714 | Td vacc no presv 7 yrs+ im | $326.81 |
| 90715 | Tdap vaccine 7 yrs/> im | $372.31 |
| 90746 | Hepb vaccine 3 dose adult im | $376.20 |
| 92950 | Heart/lung resuscitation cpr | $1,833.48 |
| 92960 | Cardioversion electric ext | $2,730.97 |
| 93005 | Electrocardiogram tracing | $893.06 |
| 93010 | Electrocardiogram report | $146.88 |
| 93041 | Rhythm ecg tracing | $400.74 |
| 93042 | Rhythm ecg report | $118.41 |
| 93306 | Tte w/doppler complete | $4,090.66 |
| 93307 | Tte w/o doppler complete | $4,864.69 |
| 93308 | Tte f-up or lmtd | $3,013.64 |
| 93313 | Echo transesophageal | $1,934.28 |
| 93320 | Doppler echo exam heart | $2,578.72 |
| 93325 | Doppler color flow add-on | $2,596.69 |
| 93351 | Stress tte complete | $5,182.32 |
| 93880 | Extracranial bilat study | $2,396.12 |
| 93882 | Extracranial uni/ltd study | $1,996.50 |
| 93922 | Upr/l xtremity art 2 levels | $1,329.03 |
| 93923 | Upr/lxtr art stdy 3+ lvls | $1,863.04 |
| 93925 | Lower extremity study | $2,688.18 |
| 93926 | Lower extremity study | $1,959.69 |
| 93930 | Upper extremity study | $2,740.94 |
| 93931 | Upper extremity study | $2,032.09 |
| 93970 | Extremity study | $2,622.27 |
| 93971 | Extremity study | $2,043.21 |
| 93975 | Vascular study | $2,484.59 |
| 93976 | Vascular study | $1,939.05 |
| 94010 | Breathing capacity test | $665.33 |
| 94060 | Evaluation of wheezing | $1,279.67 |
| 94621 | Cardiopulm exercise testing | $2,408.02 |
| 94640 | Airway inhalation treatment | $694.72 |
| 94644 | Cbt 1st hour | $597.20 |
| 94664 | Evaluate pt use of inhaler | $193.11 |
| 94760 | Measure blood oxygen level | $244.35 |
| 94761 | Measure blood oxygen level | $376.62 |
| 94762 | Measure blood oxygen level | $1,102.92 |
| 96360 | Hydration iv infusion init | $1,133.08 |
| 96361 | Hydrate iv infusion add-on | $457.51 |
| 96365 | Ther/proph/diag iv inf init | $1,163.01 |
| 96366 | Ther/proph/diag iv inf addon | $442.96 |
| 96367 | Tx/proph/dg addl seq iv inf | $721.25 |
| 96368 | Ther/diag concurrent inf | $471.98 |
| 96372 | Ther/proph/diag inj sc/im | $509.53 |
| 96373 | Ther/proph/diag inj ia | $833.44 |
| 96374 | Ther/proph/diag inj iv push | $708.09 |
| 96375 | Tx/pro/dx inj new drug addon | $538.26 |
| 96376 | Tx/pro/dx inj same drug adon | $578.76 |
| 96377 | Applicaton on-body injector | $431.69 |
| 96379 | Ther/prop/diag inj/inf proc | $1,641.63 |
| 97116 | Gait training therapy | $432.71 |
| 97542 | Wheelchair mngment training | $214.92 |
| 97597 | Rmvl devital tis 20 cm/< | $2,028.74 |
| 99000 | Specimen handling office-lab | $67.90 |
| 99001 | Specimen handling pt-lab | $183.33 |
| 99024 | Postop follow-up visit | $298.50 |
| 99050 | Medical services after hrs | $77.61 |
| 99070 | Special supplies phys/qhp | $258.10 |
| 99151 | Mod sed same phys/qhp <5 yrs | $694.07 |
| 99217 | Observation care discharge | $942.81 |
| 99218 | Initial observation care | $5,520.93 |
| 99219 | Initial observation care | $1,400.49 |
| 99220 | Initial observation care | $499.22 |
| 99225 | Subsequent observation care | $865.80 |
| 99234 | Observ/hosp same date | $676.60 |
| 99281 | Emergency dept visit | $825.67 |
| 99282 | Emergency dept visit | $1,371.99 |
| 99283 | Emergency dept visit | $2,694.72 |
| 99284 | Emergency dept visit | $3,957.82 |
| 99285 | Emergency dept visit | $5,492.84 |
| 99291 | Critical care first hour | $6,405.16 |
| 99292 | Critical care addl 30 min | $2,779.23 |
| 99406 | Behav chng smoking 3-10 min | $109.98 |
| 99407 | Behav chng smoking > 10 min | $176.94 |
| A4215 | Sterile needle | $371.44 |
| A4216 | Sterile water/saline, 10 ml | $139.30 |
| A4217 | Sterile water/saline, 500 ml | $133.39 |
| A4247 | Betadine/iodine swabs/wipes | $378.30 |
| A4314 | Cath w/drainage 2-way latex | $319.21 |
| A4315 | Cath w/drainage 2-way silcne | $445.36 |
| A4335 | Incontinence supply | $11.94 |
| A4338 | Indwelling catheter latex | $142.51 |
| A4344 | Cath indw foley 2 way silicn | $860.51 |
| A4353 | Intermittent urinary cath | $164.51 |
| A4358 | Urinary leg or abdomen bag | $50.34 |
| A4364 | Adhesive, liquid or equal | $255.12 |
| A4565 | Slings | $45.63 |
| A4606 | Oxygen probe used w oximeter | $208.95 |
| A4615 | Cannula nasal | $124.77 |
| A4649 | Surgical supplies | $6,352.32 |
| A5200 | Percutaneous catheter anchor | $37.81 |
| A6021 | Collagen dressing <=16 sq in | $133.67 |
| A6210 | Foam drg >16<=48 sq in w/o b | $101.92 |
| A6211 | Foam drg > 48 sq in w/o brdr | $580.27 |
| A6212 | Foam drg <=16 sq in w/border | $99.18 |
| A6213 | Foam drg >16<=48 sq in w/bdr | $187.24 |
| A6217 | Non-sterile gauze>16<=48 sq | $88.12 |
| A6218 | Non-sterile gauze > 48 sq in | $149.37 |
| A6219 | Gauze <= 16 sq in w/border | $42.36 |
| A6220 | Gauze >16 <=48 sq in w/bordr | $34.39 |
| A6222 | Gauze <=16 in no w/sal w/o b | $15.35 |
| A6250 | Skin seal protect moisturizr | $98.03 |
| A6260 | Wound cleanser any type/size | $96.95 |
| A6261 | Wound filler gel/paste /oz | $423.60 |
| A6402 | Sterile gauze <= 16 sq in | $40.83 |
| A6407 | Packing strips, non-impreg | $89.35 |
| A6453 | Self-adher band w <3″/yd | $13.73 |
| A6454 | Self-adher band w>=3″ <5″/yd | $150.26 |
| A6455 | Self-adher band >=5″/yd | $30.50 |
| A6457 | Tubular dressing | $176.44 |
| A7002 | Tubing used w suction pump | $75.62 |
| A7520 | Trach/laryn tube non-cuffed | $563.31 |
| A9150 | Misc/exper non-prescript dru | $21.55 |
| A9579 | Gad-base mr contrast nos,1ml | $137.01 |
| C9399 | Unclassified drugs or biolog | $6,744.41 |
| E0114 | Crutch underarm pair no wood | $97.93 |
| G0009 | Admin pneumococcal vaccine | $185.38 |
| G0168 | Wound closure by adhesive | $270.55 |
| G0378 | Hospital observation per hr | $242.42 |
| J0129 | Abatacept injection | $179.48 |
| J0131 | Acetaminophen injection | $91.69 |
| J0150 | Injection adenosine 6 mg | $75.00 |
| J0153 | Adenosine inj 1mg | $35.95 |
| J0171 | Adrenalin epinephrine inject | $26.65 |
| J0282 | Amiodarone hcl | $18.51 |
| J0290 | Ampicillin 500 mg inj | $45.70 |
| J0295 | Ampicillin sodium per 1.5 gm | $62.90 |
| J0330 | Succinycholine chloride inj | $72.12 |
| J0360 | Hydralazine hcl injection | $187.10 |
| J0456 | Azithromycin | $82.41 |
| J0461 | Atropine sulfate injection | $9.46 |
| J0500 | Dicyclomine injection | $264.25 |
| J0558 | Peng benzathine/procaine inj | $91.97 |
| J0561 | Penicillin g benzathine inj | $108.27 |
| J0595 | Butorphanol tartrate 1 mg | $39.18 |
| J0610 | Calcium gluconate injection | $84.19 |
| J0690 | Cefazolin sodium injection | $23.22 |
| J0692 | Cefepime hcl for injection | $47.21 |
| J0696 | Ceftriaxone sodium injection | $52.71 |
| J0697 | Sterile cefuroxime injection | $28.36 |
| J0735 | Clonidine hydrochloride | $147.94 |
| J0744 | Ciprofloxacin iv | $159.10 |
| J0780 | Prochlorperazine injection | $112.70 |
| J1030 | Methylprednisolone 40 mg inj | $78.34 |
| J1040 | Methylprednisolone 80 mg inj | $115.22 |
| J1100 | Dexamethasone sodium phos | $21.07 |
| J1110 | Inj dihydroergotamine mesylt | $616.55 |
| J1165 | Phenytoin sodium injection | $43.88 |
| J1170 | Hydromorphone injection | $43.56 |
| J1200 | Diphenhydramine hcl injectio | $28.06 |
| J1335 | Ertapenem injection | $288.40 |
| J1580 | Garamycin gentamicin inj | $50.73 |
| J1610 | Glucagon hydrochloride/1 mg | $891.43 |
| J1630 | Haloperidol injection | $56.40 |
| J1631 | Haloperidol decanoate inj | $140.95 |
| J1642 | Inj heparin sodium per 10 u | $18.32 |
| J1644 | Inj heparin sodium per 1000u | $66.80 |
| J1650 | Inj enoxaparin sodium | $76.51 |
| J1670 | Tetanus immune globulin inj | $2,302.39 |
| J1741 | Ibuprofen injection | $27.35 |
| J1815 | Insulin injection | $40.65 |
| J1817 | Insulin for insulin pump use | $12.76 |
| J1885 | Ketorolac tromethamine inj | $23.67 |
| J1930 | Lanreotide injection | $244.18 |
| J1940 | Furosemide injection | $34.68 |
| J1956 | Levofloxacin injection | $123.32 |
| J2001 | Lidocaine injection | $27.51 |
| J2060 | Lorazepam injection | $82.49 |
| J2150 | Mannitol injection | $58.37 |
| J2175 | Meperidine hydrochl /100 mg | $33.82 |
| J2250 | Inj midazolam hydrochloride | $13.76 |
| J2270 | Morphine sulfate injection | $30.76 |
| J2274 | Inj morphine pf epid ithc | $88.41 |
| J2300 | Inj nalbuphine hydrochloride | $65.52 |
| J2310 | Inj naloxone hydrochloride | $99.62 |
| J2360 | Orphenadrine injection | $128.30 |
| J2370 | Phenylephrine hcl injection | $88.06 |
| J2405 | Ondansetron hcl injection | $25.09 |
| J2543 | Piperacillin/tazobactam | $66.90 |
| J2550 | Promethazine hcl injection | $30.00 |
| J2690 | Procainamide hcl injection | $420.79 |
| J2704 | Inj, propofol, 10 mg | $34.84 |
| J2765 | Metoclopramide hcl injection | $28.82 |
| J2780 | Ranitidine hydrochloride inj | $45.66 |
| J2790 | Rho d immune globulin inj | $385.42 |
| J2800 | Methocarbamol injection | $201.28 |
| J2920 | Methylprednisolone injection | $39.72 |
| J2930 | Methylprednisolone injection | $76.90 |
| J3010 | Fentanyl citrate injection | $29.80 |
| J3030 | Sumatriptan succinate / 6 mg | $372.73 |
| J3105 | Terbutaline sulfate inj | $90.73 |
| J3230 | Chlorpromazine hcl injection | $339.50 |
| J3260 | Tobramycin sulfate injection | $121.64 |
| J3360 | Diazepam injection | $84.74 |
| J3370 | Vancomycin hcl injection | $122.52 |
| J3410 | Hydroxyzine hcl injection | $41.26 |
| J3411 | Thiamine hcl 100 mg | $47.42 |
| J3430 | Vitamin k phytonadione inj | $68.79 |
| J3475 | Inj magnesium sulfate | $30.27 |
| J3480 | Inj potassium chloride | $20.01 |
| J3486 | Ziprasidone mesylate | $170.41 |
| J3490 | Drugs unclassified injection | $1,033.56 |
| J7030 | Normal saline solution infus | $59.03 |
| J7040 | Normal saline solution infus | $55.94 |
| J7042 | 5% dextrose/normal saline | $96.89 |
| J7050 | Normal saline solution infus | $54.37 |
| J7060 | 5% dextrose/water | $64.71 |
| J7070 | D5w infusion | $138.67 |
| J7120 | Ringers lactate infusion | $93.74 |
| J7121 | 5% dextrose in lac ringers | $116.31 |
| J7131 | Hypertonic saline sol | $1.50 |
| J7192 | Factor viii recombinant nos | $16.81 |
| J7506 | Prednisone oral | $10.10 |
| J7510 | Prednisolone oral per 5 mg | $20.75 |
| J7512 | Prednisone ir or dr oral 1mg | $3.65 |
| J7610 | Albuterol comp con | $52.43 |
| J7611 | Albuterol non-comp con | $9.76 |
| J7613 | Albuterol non-comp unit | $14.08 |
| J7614 | Levalbuterol non-comp unit | $27.47 |
| J7615 | Levalbuterol comp unit | $30.30 |
| J7620 | Albuterol ipratrop non-comp | $26.46 |
| J7644 | Ipratropium bromide non-comp | $126.80 |
| J7682 | Tobramycin non-comp unit | $507.51 |
| J8499 | Oral prescrip drug non chemo | $130.44 |
| J8540 | Oral dexamethasone | $4.59 |
| J9027 | Clofarabine injection | $701.71 |
| J9206 | Irinotecan injection | $79.63 |
| L0120 | Cerv flex n/adj foam pre ots | $142.78 |
| L0172 | Cerv col sr foam 2pc pre ots | $139.39 |
| L1830 | Ko immob canvas long pre ots | $180.48 |
| L1906 | Afo multilig ank sup pre ots | $163.75 |
| L3260 | Ambulatory surgical boot eac | $413.25 |
| L3650 | So 8 abd restraint pre ots | $158.72 |
| L3670 | So acro/clav can web pre ots | $351.28 |
| L3809 | Whfo w/o joints pre ots | $824.25 |
| L3908 | Who cock-up nonmolde pre ots | $197.41 |
| L4350 | Ankle control ortho pre ots | $203.01 |
| L4360 | Pneumat walking boot pre cst | $388.31 |
| L4386 | Non-pneum walk boot pre cst | $420.80 |
| L4387 | Non-pneum walk boot pre ots | $305.30 |
| P9612 | Catheterize for urine spec | $186.02 |
| Q0144 | Azithromycin dihydrate, oral | $172.69 |
| Q4038 | Cast sup shrt leg fiberglass | $1,513.23 |
| Q4051 | Splint supplies misc | $198.00 |
| Q9954 | Oral mr contrast, 100 ml | $193.03 |
| Q9963 | Hocm 350-399mg/ml iodine,1ml | $51.73 |
| Q9965 | Locm 100-199mg/ml iodine,1ml | $34.49 |
| Q9966 | Locm 200-299mg/ml iodine,1ml | $64.36 |
| Q9967 | Locm 300-399mg/ml iodine,1ml | $113.61 |
| S0020 | Injection, bupivicaine hydro | $216.80 |
| S0028 | Injection, famotidine, 20 mg | $85.34 |
| S0030 | Injection, metronidazole | $193.46 |
| S0077 | Injection, clindamycin phosp | $57.93 |
| S0119 | Ondansetron 4 mg | $96.22 |
| S0164 | Injection pantroprazole | $137.54 |
| S0630 | Removal of sutures | $179.78 |
| S5000 | Prescription drug, generic | $1,296.63 |
| S5010 | 5% dextrose and 0.45% saline | $243.48 |
| S5550 | Insulin rapid 5 u | $16.98 |
| U0002 | 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC | $327.39 |
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