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Charge Master – Frontline ER Dallas

Updated 01/07/24

CPT CodeCPT Code DescriptionCharge Amount
0001AImmunization 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
0202UInfectious disease (bacterial or viral respiratory tract in…$420.78
10021FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION$2,492.00
10060INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE$1,323.00
10061INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE$2,323.00
10080INCISION & DRAINAGE PILONIDAL CYST SIMPLE$2,085.72
10081INCISION & DRAINAGE PILONIDAL CYST COMPLICATED$3,013.19
10120INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE$1,947.99
10121INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL$9,189.00
10140I&D HEMATOMA SEROMA/FLUID COLLECTION$7,345.00
10160PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST$1,427.82
10180INCISION & DRAINAGE COMPLEX PO WOUND INFECTION$7,715.00
11010DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS$3,896.00
11011DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC$8,652.75
11042DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<$6,638.12
11043DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<$5,488.25
11045DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM$3,801.85
11055PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1$1,721.85
11200REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15$5,567.00
11402EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM$5,485.00
11420EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<$10,133.00
11719TRIMMING NONDYSTROPHIC NAILS ANY NUMBER$1,069.00
11720DEBRIDEMENT NAIL ANY METHOD 1-5$228.35
11730AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1$1,196.86
11732AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL$376.95
11740EVACUATION SUBUNGUAL HEMATOMA$673.39
11750EXCISION NAIL MATRIX PERMANENT REMOVAL$4,277.00
11760REPAIR NAIL BED$2,212.00
11765WEDGE EXCISION SKIN NAIL FOLD$3,953.99
11771EXCISION PILONIDAL CYST/SINUS EXTENSIVE$8,996.00
11900INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS$1,623.75
11982REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT$1,375.09
12001SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<$1,088.26
12002SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM$1,154.70
12004SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM$1,176.31
12005SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM$1,758.37
12006SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM$1,688.00
12007SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM$2,203.00
12011SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<$1,082.99
12013SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM$1,173.49
12014SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM$1,350.52
12015SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM$1,228.80
12016SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM$1,803.00
12017SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM$2,300.00
12020TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE$3,283.00
12021TX SUPERFICIAL WOUND DEHISCENCE W/PACKING$2,226.00
12031REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<$1,678.85
12032REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM$1,789.92
12034REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM$2,017.16
12035REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM$2,494.00
12036REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM$6,519.16
12037REPAIR INTERMEDIATE S/A/T/E >30.0 CM$6,835.00
12041REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<$1,370.35
12042REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM$1,589.00
12044REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM$1,827.00
12045REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM$2,565.00
12051REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<$1,547.77
12052REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM$1,612.40
12053REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM$2,309.00
12054REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM$1,673.19
12055REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM$1,744.43
12056REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM$2,582.45
13100REPAIR COMPLEX TRUNK 1.1-2.5 CM$3,522.30
13101REPAIR COMPLEX TRUNK 2.6-7.5 CM$3,768.97
13102REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<$5,076.35
13120REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM$2,350.17
13121REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM$3,074.00
13122REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<$3,074.00
13131REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM$2,209.83
13132REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM$3,760.25
13133REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<$2,500.93
13151REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM$2,740.00
13152REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM$3,398.42
13153REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<$2,957.08
16000INITIAL TX 1ST DEGREE BURN LOCAL TX$1,127.89
16020DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL$1,170.16
16025DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM$1,627.36
16030DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE$1,112.36
17000DESTRUCTION PREMALIGNANT LESION 1ST$887.00
17110DESTRUCTION BENIGN LESIONS UP TO 14$1,064.00
17111DESTRUCTION BENIGN LESIONS 15/>$1,225.13
17250CHEMICAL CAUTERIZATION OF GRANULATION TISSUE$819.30
19000PUNCTURE ASPIRATION CYST BREAST$1,908.29
19020MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP$11,088.00
20102EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK$9,643.00
20103EXPLORATION PENETRATING WOUND SPX EXTREMITY$6,881.00
20520REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE$9,411.00
20525RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP$10,040.00
20550INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS$1,347.00
20552INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES$1,628.97
20553INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES$1,885.86
20600ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US$1,778.14
20605ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US$1,448.71
20610ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US$1,893.67
20611ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US$2,514.34
20650INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX$16,771.00
21315CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION$7,064.33
21320CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION$7,097.00
21337CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION$7,284.00
21451CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION$12,884.57
21480CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ$1,718.31
21485CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ$9,258.21
21501I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX$14,086.00
22310CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING$1,772.55
23330REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS$4,642.80
23500CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION$1,077.00
23505CLSD TX CLAVICULAR FRACTURE W/MANIPULATION$8,392.49
23540CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION$2,048.58
23545CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION$2,339.00
23550OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC$18,172.00
23600CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION$3,216.53
23620CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ$1,144.77
23650CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES$1,897.00
23655CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES$5,016.41
23665CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ$3,094.75
23930I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA$9,241.00
23931INCISION&DRAINAGE UPPER ARM/ELBOW BURSA$12,157.37
24200RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS$7,428.00
24500CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION$2,398.75
24505CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ$4,224.71
24530CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ$1,878.50
24535CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ$8,305.30
24565CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ$6,565.53
24586OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO$24,064.00
24600TREATMENT CLOSED ELBOW DISLOCATION W/O ANES$1,512.71
24605TREATMENT CLOSED ELBOW DISLOCATION REQ ANES$5,346.87
24620CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ$7,073.35
24640CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ$1,600.45
24650CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION$1,066.00
24655CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION$8,078.76
24675CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ$5,017.00
25028I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA$9,808.88
25111EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY$9,084.85
25500CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION$2,072.08
25505CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION$5,291.93
25520CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT$7,566.07
25530CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION$1,318.62
25535CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION$4,437.41
25560CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN$2,031.17
25565CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ$3,494.76
25600CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ$1,587.22
25605CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF$3,724.34
25607OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP$16,929.46
25635CLTX CARPAL BONE FX W/MANJ EACH BONE$7,293.00
25650CLOSED TREATMENT ULNAR STYLOID FRACTURE$2,002.00
25652OPEN TREATMENT ULNAR STYLOID FRACTURE$17,544.00
25660CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ$1,245.00
25675CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ$2,513.64
25690CLOSED TX LUNATE DISLOCATION W/MANIPULATION$8,117.33
26010DRAINAGE FINGER ABSCESS SIMPLE$1,421.08
26011DRAINAGE FINGER ABSCESS COMPLICATED$4,597.00
26600CLTX METACARPAL FX W/O MANIPULATION EACH BONE$1,473.45
26605CLTX METACARPAL FX W/MANIPULATION EACH BONE$1,935.67
26607CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE$4,599.00
26615OPEN TX METACARPAL FRACTURE SINGLE EA BONE$14,905.00
26641CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ$1,798.38
26670CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES$2,400.01
26675CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES$5,111.00
26700CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES$1,575.89
26705CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES$3,695.00
26720CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA$1,867.00
26725CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA$1,896.13
26735OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA$11,705.00
26742CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ$4,724.00
26746OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA$11,669.00
26750CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA$1,726.45
26755CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA$2,009.00
26765OPEN TX DISTAL PHALANGEAL FRACTURE EACH$9,370.56
26770CLTX IPHAL JT DISLC W/MANJ W/O ANES$1,485.59
26775CLTX IPHAL JT DISLC W/MANJ REQ ANES$3,824.32
26952AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP$14,338.14
27301I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION$14,322.00
27372REMOVAL FOREIGN BODY DEEP THIGH/KNEE$16,859.00
27502CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ$10,922.74
27508CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ$1,724.00
27520CLOSED TX PATELLAR FRACTURE W/O MANIPULATION$3,322.16
27550CLOSED TX KNEE DISLOCATION W/O ANESTHESIA$2,254.00
27560CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA$1,440.94
27752CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ$5,028.61
27760CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION$1,284.55
27762CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ$4,707.20
27780CLTX PROX FIBULA/SHFT FX W/O MANJ$1,592.00
27786CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ$1,189.00
27788CLTX DSTL FIBULAR FX LAT MALLS W/MANJ$1,786.83
27792OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS$23,734.72
27808CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ$2,105.56
27810CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ$4,329.57
27818CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION$3,704.75
27840CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA$1,805.48
27842CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ$4,227.85
28190REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS$3,711.38
28192REMOVAL FOREIGN BODY FOOT DEEP$6,787.27
28470CLOSED TX METATARSAL FRACTURE W/O MANIPULATION$1,076.00
28475CLTX METAR FX W/MANJ$2,617.81
28490CLTX FX GRT TOE PHLX/PHLG W/O MANJ$912.00
28495CLTX FX GRT TOE PHLX/PHLG W/MANJ$2,523.16
28505OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES$16,243.00
28510CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ$4,017.85
28515CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ$2,001.51
28630CLTX METATARSOPHLNGL JT DISLC W/O ANES$1,263.00
28660CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES$1,508.08
29065APPLICATION CAST SHOULDER HAND LONG ARM$1,716.90
29075APPLICATION CAST ELBOW FINGER SHORT ARM$1,449.27
29085APPLICATION CAST HAND & LOWER FOREARM GAUNTLET$771.13
29105APPLICATION LONG ARM SPLINT SHOULDER HAND$937.92
29125APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC$818.00
29126APPLICATION SHORT ARM SPLINT DYNAMIC$884.89
29130APPLICATION FINGER SPLINT STATIC$568.93
29131APPLICATION FINGER SPLINT DYNAMIC$1,000.64
29240STRAPPING SHOULDER$782.04
29260STRAPPING ELBOW/WRIST$636.64
29280STRAPPING HAND/FINGER$695.11
29355APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE$1,600.00
29405APPLICATION SHORT LEG CAST BELOW KNEE-TOE$1,014.13
29505APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES$948.37
29515APPLICATION SHORT LEG SPLINT CALF FOOT$859.46
29530STRAPPING KNEE$618.52
29540STRAPPING ANKLE &/FOOT$646.65
29550STRAPPING TOES$588.00
29580STRAPPING UNNA BOOT$565.49
30300REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE$767.78
30901CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE$922.14
30903CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX$933.50
30905CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST$1,340.00
30906CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ$1,062.75
31500INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE$1,297.91
31502TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT$4,044.00
31525LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN$11,950.00
31541LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP$10,022.00
31575LARYNGOSCOPY FLEXIBLE DIAGNOSTIC$1,090.18
31605TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE$2,831.69
32550INSERTION INDWELLING TUNNELED PLEURAL CATHETER$11,312.30
32551TUBE THORACOSTOMY INCLUDES WATER SEAL$3,501.00
32556PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING$9,427.26
36000INTRODUCTION NEEDLE/INTRACATHETER VEIN$1,069.00
36005NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH$3,058.77
36010INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA$3,804.22
36011SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH$6,860.00
36410VNPNXR 3 YEARS/> PHYS/QHP SKILL$2,309.05
36415COLLECTION VENOUS BLOOD VENIPUNCTURE$76.46
36416COLLECTION CAPILLARY BLOOD SPECIMEN$123.30
36556INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>$6,066.00
36558INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>$11,312.42
36569INSERTION PICC W/O IMG GDN 5 YR/>$5,582.76
36573INSERTION PICC W/RS&I 5 YR/>$7,172.57
36575RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP$2,830.14
36589RMVL TUN CVC W/O SUBQ PORT/PMP$7,338.00
36591COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE$339.09
36592COLLECT BLOOD FROM CATHETER VENOUS NOS$408.56
36680PLACEMENT NEEDLE INTRAOSSEOUS INFUSION$999.97
37785LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG$13,216.00
40650RPR LIP FULL THICKNESS VERMILION ONLY$3,650.91
40800DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL$2,087.09
40801DRG ABSC CST HMTMA VESTIBULE MOUTH COMP$6,465.00
40804RMVL EMBEDDED FB VESTIBULE MOUTH SMPL$2,758.00
40830CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<$2,893.80
40831CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL$3,038.57
41008INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE$9,867.00
41250RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG$1,200.05
41252RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX$2,671.00
41800DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS$1,088.59
42700I&D ABSCESS PERITONSILLAR$2,011.17
42809REMOVAL FOREIGN BODY PHARYNX$2,341.47
43215ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY$9,194.89
43752NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE$7,610.56
43753GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE$1,600.36
45900RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE$5,736.72
45915RMVL FECAL IMPACTION/FB SPX UNDER ANES$12,632.58
46040I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX$8,599.00
46050I&D PERIANAL ABSCESS SUPERFICIAL$4,456.40
46083INCISION THROMBOSED HEMORRHOID EXTERNAL$1,538.00
46221HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS$2,372.08
46320EXC THROMBOSED HEMORRHOID XTRNL$11,547.93
46608ANOSCOPY W/RMVL FOREIGN BODY$4,075.52
49083ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE$3,910.36
49505RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE$15,387.60
51700BLDR IRRIGATION SMPL LAVAGE &/INSTLJ$3,194.71
51701INSJ NON-NDWELLG BLADDER CATHETER$887.11
51702INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE$945.34
51703INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED$2,296.93
54001SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN$14,646.83
54015I&D PENIS DEEP$5,352.11
54163REPAIR INCOMPLETE CIRCUMCISION$8,002.00
54220IRRIGATION CORPORA CAVERNOSA PRIAPISM$939.00
54235NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT$2,989.65
54437REPAIR OF TRAUMATIC CORPOREAL TEAR(S)$12,227.07
54450FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING$1,619.65
55100DRAINAGE SCROTAL WALL ABSCESS$6,714.97
56405I&D VULVA/PERINEAL ABSCESS$1,700.77
56420I&D OF BARTHOLINS GLAND ABSCESS$1,383.01
56440MARSUPIALIZATION BARTHOLINS GLAND CYST$14,649.00
57410PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL$10,921.00
57415REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL$14,721.00
58301REMOVAL INTRAUTERINE DEVICE IUD$2,124.00
59025FETAL NONSTRESS TEST$2,206.31
59409VAGINAL DELIVERY ONLY$9,990.00
62270DIAGNOSTIC LUMBAR SPINAL PUNCTURE$2,273.03
62272THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF$2,849.65
64400INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH$2,119.00
64405INJECTION AA&/STRD GREATER OCCIPITAL NERVE$2,049.25
64415INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN$6,351.34
64447INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN$5,104.00
64450INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH$2,977.20
64455NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES$1,456.82
64640DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE$3,869.56
65205REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL$823.16
65210RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR$1,261.83
65220RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP$1,224.67
65222RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP$1,121.00
65235RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS$6,059.10
67700BLEPHAROTOMY DRAINAGE ABSCESS EYELID$2,162.59
67938REMOVAL EMBEDDED FOREIGN BODY EYELID$1,244.35
69000DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE$1,888.67
69005DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX$6,055.62
69020DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS$1,612.14
69200RMVL FB XTRNL AUDITORY CANAL W/O ANES$792.20
69205RMVL FB XTRNL AUDITORY CANAL ANES$4,650.00
69209REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT$689.53
69210REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT$671.24
70030RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY$755.54
70100RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS$1,014.05
70110RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS$1,144.38
70140RADEX FACIAL BONES < 3 VIEWS$900.30
70150RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS$1,148.66
70160RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS$1,019.78
70200RADEX ORBITS COMPLETE MINIMUM 4 VIEWS$1,274.20
70210RADEX SINUSES PARANASAL <3 VIEWS$945.49
70220RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS$1,458.42
70250RADIOLOGIC EXAMINATION SKULL 4< VIEWS$1,023.12
70260RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS$2,216.70
70330RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT$1,125.35
70360RADIOLOGIC EXAMINATION NECK SOFT TISSUE$744.85
70450CT HEAD/BRAIN W/O CONTRAST MATERIAL$5,406.62
70460CT HEAD/BRAIN W/CONTRAST MATERIAL$6,851.48
70470CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL$7,018.11
70480CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL$5,029.12
70481CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL$6,863.16
70482CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR$7,800.71
70486CT MAXILLOFACIAL W/O CONTRAST MATERIAL$5,071.38
70487CT MAXILLOFACIAL W/CONTRAST MATERIAL$6,152.12
70488CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL$8,746.32
70490CT SOFT TISSUE NECK W/O CONTRAST MATERIAL$6,134.14
70491CT SOFT TISSUE NECK W/CONTRAST MATERIAL$7,053.79
70492CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL$8,205.14
70496CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST$8,610.72
70498CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST$8,224.80
71045RADIOLOGIC EXAM CHEST SINGLE VIEW$964.25
71046RADIOLOGIC EXAM CHEST 2 VIEWS$1,154.31
71047RADIOLOGIC EXAM CHEST 3 VIEWS$1,529.42
71048RADIOLOGIC EXAM CHEST 4+ VIEWS$1,374.85
71100RADEX RIBS UNILATERAL 2 VIEWS$936.38
71101RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS$1,151.18
71110RADEX RIBS BILATERAL 3 VIEWS$1,306.19
71111RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS$1,844.26
71120RADEX STERNUM MINIMUM 2 VIEWS$747.43
71250DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST$5,853.65
71260DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST$7,331.27
71270DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+$8,779.46
71275CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST$9,162.07
72020RADEX SPINE 1 VIEW SPECIFY LEVEL$882.28
72040RADEX SPINE CERVICAL 2 OR 3 VIEWS$1,079.17
72050RADEX SPINE CERVICAL 4 OR 5 VIEWS$1,694.93
72052RADEX SPINE CERVICAL 6 OR MORE VIEWS$1,358.40
72070RADEX SPINE THORACIC 2 VIEWS$1,190.08
72072RADEX SPINE THORACIC 3 VIEWS$1,452.84
72074RADEX SPINE THORACIC MINIMUM 4 VIEWS$1,415.89
72080RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS$1,223.77
72082RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW$1,123.36
72100RADEX SPINE LUMBOSACRAL 2/3 VIEWS$1,256.92
72110RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS$1,859.14
72114RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6$1,457.16
72120RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS$1,405.63
72125CT CERVICAL SPINE W/O CONTRAST MATERIAL$6,657.18
72126CT CERVICAL SPINE W/CONTRAST MATERIAL$8,031.19
72127CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL$10,077.00
72128CT THORACIC SPINE W/O CONTRAST MATERIAL$6,488.48
72129CT THORACIC SPINE W/CONTRAST MATERIAL$6,801.41
72130CT THORACIC SPINE W/O & W/CONTRAST MATERIAL$10,864.58
72131CT LUMBAR SPINE W/O CONTRAST MATERIAL$6,635.12
72132CT LUMBAR SPINE W/CONTRAST MATERIAL$8,112.87
72133CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL$8,615.06
72170RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS$915.25
72190RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS$1,098.38
72191CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST$7,519.99
72192CT PELVIS W/O CONTRAST MATERIAL$5,676.97
72193CT PELVIS W/CONTRAST MATERIAL$6,984.65
72194CT PELVIS W/O & W/CONTRAST MATERIAL$7,910.23
72220RADEX SACRUM & COCCYX MINIMUM 2 VIEWS$948.93
72270MYELOGRAPY 2/MORE REGIONS RS&I$5,862.05
73000RADEX CLAVICLE COMPLETE$1,000.30
73010RADEX SCAPULA COMPLETE$996.64
73020RADEX SHOULDER 1 VIEW$924.14
73030RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS$1,170.82
73050RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ$1,197.91
73060RADEX HUMERUS MINIMUM 2 VIEWS$982.16
73070RADEX ELBOW 2 VIEWS$928.80
73080RADEX ELBOW COMPLETE MINIMUM 3 VIEWS$1,111.54
73090RADEX FOREARM 2 VIEWS$1,133.85
73092RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS$1,031.69
73100RADEX WRIST 2 VIEWS$975.14
73110RADEX WRIST COMPLETE MINIMUM 3 VIEWS$1,272.53
73120RADEX HAND 2 VIEWS$1,107.91
73130RADEX HAND MINIMUM 3 VIEWS$1,155.55
73140RADEX FINGR MINIMUM 2 VIEWS$882.14
73200CT UPPER EXTREMITY W/O CONTRAST MATERIAL$4,621.26
73201CT UPPER EXTREMITY W/CONTRAST MATERIAL$5,712.04
73202CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL$9,059.37
73501RADEX HIP UNILATERAL WITH PELVIS 1 VIEW$905.44
73502RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS$1,101.03
73503RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS$1,094.94
73521RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS$1,639.23
73522RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS$1,588.93
73523RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS$1,328.53
73551RADIOLOGIC EXAMINATION FEMUR 1 VIEW$750.82
73552RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS$1,052.05
73560RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS$938.22
73562RADIOLOGIC EXAMINATION KNEE 3 VIEWS$973.14
73564RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS$1,524.60
73565RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST$866.90
73590RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS$1,122.07
73592RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS$1,259.44
73600RADIOLOGIC EXAMINATION ANKLE 2 VIEWS$892.84
73610RADEX ANKLE COMPLETE MINIMUM 3 VIEWS$1,110.18
73620RADIOLOGIC EXAMINATION FOOT 2 VIEWS$955.23
73630RADEX FOOT COMPLETE MINIMUM 3 VIEWS$1,104.36
73650RADEX CALCANEUS MINIMUM 2 VIEWS$907.78
73660RADEX TOE MINIMUM 2 VIEWS$872.90
73700CT LOWER EXTREMITY W/O CONTRAST MATERIAL$5,663.70
73701CT LOWER EXTREMITY W/CONTRAST MATERIAL$6,029.99
73702CT LOWER EXTREMITY W/O & W/CONTRAST MATRL$9,008.23
73706CT ANGIOGRAPHY LOWER EXTREMITY$8,059.05
74018RADIOLOGIC EXAM ABDOMEN 1 VIEW$930.95
74019RADIOLOGIC EXAM ABDOMEN 2 VIEWS$1,231.86
74021RADIOLOGIC EXAM ABDOMEN 3+ VIEWS$1,540.13
74022RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES$1,442.96
74150CT ABDOMEN W/O CONTRAST MATERIAL$6,045.98
74160CT ABDOMEN W/CONTRAST MATERIAL$7,665.56
74170CT ABDOMEN W/O & W/CONTRAST MATERIAL$9,055.00
74174CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG$13,001.14
74175CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST$8,484.67
74176CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL$9,840.13
74177CT ABDOMEN & PELVIS W/CONTRAST MATERIAL$12,367.58
74178CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE$16,009.22
74190PERITONEOGRAM RS&I$2,163.13
74220RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY$1,583.10
74240RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY$2,004.07
74246RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY$2,055.44
74250RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY$2,403.64
74251RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY$5,533.24
74283THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ$3,964.07
74328ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I$2,303.35
74330CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I$2,833.29
74340INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I$1,523.00
75574CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST$3,597.31
75635CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP$8,115.27
76010RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD$812.04
763763D RENDERING W/INTERP & POSTPROCESS SUPERVISION$1,867.37
76380CT LIMITED/LOCALIZED FOLLOW UP STUDY$3,178.00
76512OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN$713.88
76536US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM$2,035.13
76604US CHEST REAL TIME W/IMAGE DOCUMENTATION$1,315.25
76641US BREAST UNI REAL TIME WITH IMAGE COMPLETE$1,192.45
76642US BREAST UNI REAL TIME WITH IMAGE LIMITED$1,393.08
76700US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION$2,570.19
76705US ABDOMINAL REAL TIME W/IMAGE LIMITED$1,945.21
76706US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA$1,295.58
76770US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE$2,123.43
76775US RETROPERITONEAL REAL TIME W/IMAGE LIMITED$1,824.36
76801US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT$1,861.43
76802US PREG UTERUS 14 WK TRANSABDL EACH GESTATION$1,484.37
76805US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION$2,168.57
76810US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO$2,255.98
76815US PREGNANT UTERUS LIMITED 1/> FETUSES$1,543.33
76816US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS$1,289.61
76817US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG$1,504.93
76830US TRANSVAGINAL$1,876.10
76856US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE$2,550.92
76857US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U$1,485.78
76870US SCROTUM & CONTENTS$2,040.92
76881US COMPL JOINT R-T W/IMAGE DOCUMENTATION$1,785.23
76882US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG$1,150.92
76937US VASC ACCESS SITS VSL PATENCY NDL ENTRY$1,856.00
76942US GUIDANCE NEEDLE PLACEMENT IMG S&I$2,599.69
77076RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT$1,846.72
78306BONE &/JOINT IMAGING WHOLE BODY$5,016.38
78315BONE &/JOINT IMAGING 3 PHASE STUDY$4,810.29
80047BASIC METABOLIC PANEL CALCIUM IONIZED$694.23
80048BASIC METABOLIC PANEL CALCIUM TOTAL$845.83
80050GENERAL HEALTH PANEL$1,754.89
80051ELECTROLYTE PANEL$699.71
80053COMPREHENSIVE METABOLIC PANEL$1,093.49
80061LIPID PANEL$825.19
80074ACUTE HEPATITIS PANEL$1,984.00
80076HEPATIC FUNCTION PANEL$1,308.00
80143DRUG ASSAY ACETAMINOPHEN$617.90
80175DRUG SCREEN QUANTITATIVE LAMOTRIGINE$308.97
80177DRUG SCREEN QUANTITATIVE LEVETIRACETAM$464.27
80178DRUG SCREEN QUANTITATIVE LITHIUM$616.36
80179DRUG ASSAY SALICYLATE$390.84
80197DRUG SCREEN QUANTITATIVE TACROLIMUS$1,435.00
80202DRUG SCREEN QUANTITATIVE VANCOMYCIN$799.00
80305DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE$552.00
80307DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE$1,317.95
80320DRUG SCREEN QUANTITATIVE ALCOHOLS$604.00
80324DRUG SCREEN QUANT AMPHETAMINES 1 OR 2$606.07
80329DRUG SCREEN ANALGESICS 1 OR 2$777.52
80335ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2$427.00
80345DRUG SCREENING BARBITURATES$412.83
80346DRUG SCREENING BENZODIAZEPINES 1-12$346.82
80348DRUG SCREENING$331.00
80349DRUG SCREENING CANNABINOIDS NATURAL$209.70
80352DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE$619.00
80353DRUG SCREENING $243.00
80358DRUG SCREENING METHADONE$462.00
80359DRUG SCREENING METHYLENEDIOXYAMPHETAMINES$42.29
80361 $804.37
80365 $45.02
80373DRUG SCREENING TRAMADOL$246.26
81001URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY$365.85
81002URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP$124.77
81003URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY$291.00
81007URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK$354.00
81015URINALYSIS MICROSCOPIC ONLY$236.74
81025URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS$402.80
81240F2 GENE ANALYSIS 20210G >A VARIANT$645.18
82009KETONE BODIES SERUM QUALITATIVE$175.00
82010KETONE BODIES SERUM QUANTITATIVE$420.69
82040ALBUMIN SERUM PLASMA/WHOLE BLOOD$335.90
82140ASSAY OF AMMONIA$542.53
82150ASSAY OF AMYLASE$585.03
82247BILIRUBIN TOTAL$496.39
82248BILIRUBIN DIRECT$344.31
82270BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER$261.92
82271BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES$179.35
82272BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC$156.00
82274BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3$218.66
82310CALCIUM TOTAL$352.77
82330CALCIUM IONIZED$721.37
82374CARBON DIOXIDE BICARBONATE$255.00
82375CARBOXYHEMOGLOBIN QUANTITATIVE$343.82
82435CHLORIDE BLD$218.95
82465CHOLESTEROL SERUM/WHOLE BLOOD TOTAL$339.15
82533CORTISOL TOTAL$808.99
82550CREATINE KINASE TOTAL$471.36
82553CREATINE KINASE MB FRACTION ONLY$643.69
82565CREATININE BLOOD$369.58
82607CYANOCOBALAMIN VITAMIN B-12$526.51
82693ASSAY OF ETHYLENE GLYCOL$410.00
82728ASSAY OF FERRITIN$672.80
82746ASSAY OF FOLIC ACID SERUM$570.82
82747ASSAY OF FOLIC ACID RBC$155.00
82784ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH$432.62
82785ASSAY OF GAMMAGLOBULIN IGE$472.76
82800GASES BLOOD PH ONLY$350.64
82803BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3$1,357.15
82805GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY$1,979.10
82945GLUCOSE BODY FLUID OTHER THAN BLOOD$337.86
82947GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP$317.03
82948GLUCOSE BLOOD REAGENT STRIP$162.24
82962GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE$91.85
82977ASSAY OF GLUTAMYLTRASE GAMMA$436.25
83013HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE$604.46
83036HEMOGLOBIN GLYCOSYLATED A1C$446.81
83050HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE$272.54
83520IMMUNOASSAY ANALYTE QUANTITATIVE NOS$750.86
83525ASSAY OF INSULIN TOTAL$374.16
83540ASSAY OF IRON$505.96
83550IRON BINDING CAPACITY$537.90
83605ASSAY OF LACTATE$579.34
83615LACTATE DEHYDROGENASE LDH$469.21
83690ASSAY OF LIPASE$509.18
83718LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL$330.00
83735ASSAY OF MAGNESIUM$427.01
83874MYOGLOBIN$539.00
83880NATRIURETIC PEPTIDE$868.55
83992ASSAY OF PHENCYCLIDINE$232.00
84075ASSAY OF PHOSPHATASE ALKALINE$516.01
84100ASSAY OF PHOSPHORUS INORGANIC$336.00
84132POTASSIUM SERUM PLASMA/WHOLE BLOOD$327.69
84155PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD$293.03
84157PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC$363.46
84165PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM$666.15
84295SODIUM SERUM PLASMA OR WHOLE BLOOD$283.98
84403ASSAY OF TESTOSTERONE TOTAL$752.78
84436ASSAY OF THYROXINE TOTAL$566.39
84439ASSAY OF FREE THYROXINE$577.67
84443ASSAY OF THYROID STIMULATING HORMONE TSH$869.43
84450TRANSFERASE ASPARTATE AMINO AST SGOT$465.45
84460TRANSFERASE ALANINE AMINO ALT SGPT$419.20
84478ASSAY OF TRIGLYCERIDES$574.50
84479THYROID HORM UPTK/THYROID HORMONE BINDING RATIO$196.31
84480ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3$657.18
84481ASSAY OF TRIIODOTHYRONINE T3 FREE$601.65
84484ASSAY OF TROPONIN QUANTITATIVE$741.50
84520ASSAY OF UREA NITROGEN QUANTITATIVE$330.87
84550ASSAY OF BLOOD/URIC ACID$387.66
84560ASSAY OF URIC ACID OTHER SOURCE$426.25
84702GONADOTROPIN CHORIONIC QUANTITATIVE$776.01
84703GONADOTROPIN CHORIONIC QUALITATIVE$461.38
84999UNLISTED CHEMISTRY PROCEDURE$383.33
85014BLOOD COUNT HEMATOCRIT$183.58
85018BLOOD COUNT HEMOGLOBIN$183.91
85025BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC$347.30
85027BLOOD COUNT COMPLETE AUTOMATED$917.00
85044BLOOD COUNT RETICULOCYTE MANUAL$506.56
85045BLOOD COUNT RETICULOCYTE AUTOMATED$259.12
85270CLOTTING FACTOR XI PTA$1,230.90
85347COAGULATION TIME ACTIVATED$353.70
85378FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN$568.56
85379FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE$710.85
85384FIBRINOGEN ACTIVITY$429.15
85610PROTHROMBIN TIME$362.40
85651SEDIMENTATION RATE RBC NON-AUTOMATED$276.87
85652SEDIMENTATION RATE RBC AUTOMATED$277.53
85730THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD$430.03
86038ANTINUCLEAR ANTIBODIES ANA$652.31
86039ANTINUCLEAR ANTIBODIES ANA TITER$733.28
86060ANTISTREPTOLYSIN O TITER$427.44
86140C-REACTIVE PROTEIN$488.06
86235EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD$318.80
86256FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY$376.08
86308HETEROPHILE ANTIBODIES SCREEN$403.01
86328IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19$393.40
86360T CELLS ABSOLUTE CD4&CD8 COUNT RATIO$337.48
86403PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY$244.31
86430RHEUMATOID FACTOR QUALITATIVE$271.72
86431RHEUMATOID FACTOR QUANTITATIVE$508.29
86580SKIN TEST TUBERCULOSIS INTRADERMAL$45.77
86592SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL$272.11
86593SYPHILIS TEST QUANTITATIVE$434.50
86617ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST$279.00
86622ANTIBODY BRUCELLA$120.54
86631ANTIBODY CHLAMYDIA$202.00
86644ANTIBODY CYTOMEGALOVIRUS CMV$674.21
86645ANTIBODY CYTOMEGALOVIRUS CMV IGM$668.76
86664ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA$347.17
86677ANTIBODY HELICOBACTER PYLORI$610.34
86689ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST$513.06
86695ANTIBODY HERPES SMPLX TYPE 1$312.04
86696ANTIBODY HERPES SMPLX TYPE 2$410.34
86701ANTIBODY HIV-1$513.63
86702ANTIBODY HIV-2$528.78
86703ANTIBODY HIV-1&HIV-2 SINGLE RESULT$474.56
86704HEPATITIS B CORE ANTIBODY HBCAB TOTAL$471.70
86705HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY$540.54
86706HEPATITIS B SURF ANTIBODY HBSAB$557.90
86708HEPATITIS A ANTIBODY HAAB$438.70
86709HEPATITIS ANTIBODY HAAB IGM ANTIBODY$525.83
86756ANTIBODY RESPIRATORY SYNCTIAL VIRUS$235.24
86757ANTIBODY RICKETTSIA$254.13
86768ANTIBODY SALMONELLA$184.00
86769ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID-19$444.41
86780ANTIBODY TREPONEMA PALLIDUM$394.78
86787ANTIBODY VARICELLA-ZOSTER$228.11
86803HEPATITIS C ANTIBODY$679.05
86850ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE$563.28
86900BLOOD TYPING SEROLOGIC ABO$355.37
86901BLOOD TYPING SEROLOGIC RH (D)$342.26
86906BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE$356.81
87015CONCENTRATION INFECTIOUS AGENTS$164.06
87040CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES$765.46
87045CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL$683.14
87046CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA$292.53
87070CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL$867.00
87075CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID$867.43
87076CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL$374.07
87077CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL$481.69
87081CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ$455.06
87086CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE$744.71
87088CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE$256.12
87103CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD$407.75
87106CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST$396.63
87110CULTURE CHLAMYDIA ANY SOURCE$753.91
87177OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID$375.58
87186SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ$688.77
87205SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL$397.00
87207SMR PRIM SRC SPEC STAIN BODIES/PARASITS$438.87
87209SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS$262.81
87210SMR PRIM SRC WET MOUNT NFCT AGT$378.06
87252VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT$728.61
87255VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC$665.03
87275IAADI INFLUENZA B VIRUS$220.89
87324IAAD IA CLOSTRIDIUM DIFFICILE TOXIN$740.53
87328IAAD IA CRYPTOSPORIDIUM$165.75
87338IAAD IA HPYLORI STOOL$492.87
87340IAAD IA HEPATITIS B SURFACE ANTIGEN$427.64
87341IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION$346.18
87389IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE$492.06
87400IAAD IA INFLUENZA A/B EACH$477.36
87420IAAD IA RESPIRATORY SYNCTIAL VIRUS$540.92
87425IAAD IA ROTAVIRUS$606.84
87426IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS$355.08
87427IAAD IA SHIGA-LIKE TOXIN$395.11
87428IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B$507.45
87430IAAD IA STREPTOCOCCUS GROUP A$331.17
87471IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE$1,093.08
87481IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ$347.00
87486IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ$765.74
87491IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ$627.98
87493INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE$744.85
87506IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11$1,550.70
87507IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25$3,707.75
87529IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ$823.26
87581IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ$567.63
87591IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ$507.38
87624IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES$410.93
87633IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET$3,927.97
87635IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ$365.47
87636IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ$679.25
87660IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ$386.75
87661IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH$341.91
87798IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM$959.00
87801IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ$1,906.34
87804IAADIADOO INFLUENZA$358.53
87806IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES$526.52
87807IAADIADOO RESPIRATORY SYNCTIAL VIRUS$755.79
87808IAADIADOO TRICHOMONAS VAGINALIS$189.43
87880IAADIADOO STREPTOCOCCUS GROUP A$670.51
88141CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN$222.40
88233TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX$1,160.45
88262CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING$1,464.42
88291CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP$749.08
88305LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM$972.35
89050CELL COUNT MISCELLANEOUS BODY FLUIDS$335.51
89051CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT$402.27
89055LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE$296.43
89060CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID$331.10
89220SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX$571.46
89240UNLISTED MISCELLANEOUS PATHOLOGY TEST$218.90
90471IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE$285.62
90472IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE$206.82
90658IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE$99.50
90688IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE$448.18
90700DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM$229.74
90707MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ$815.67
90714TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE$319.80
90715TDAP VACCINE 7 YRS/> IM$441.00
90746HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE$481.16
91300SARSCOV2 VACCINE DIL RECON 30 MCG/0.3 ML IM USE$0.02
92002OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT$544.05
92552PURE TONE AUDIOMETRY AIR ONLY$458.25
92950CARDIOPULMONARY RESUSCITATION$2,722.70
92960CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL$3,811.56
93005ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R$942.78
93016CV STRS TST XERS&/OR RX CONT ECG W/O I&R$378.10
93017CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY$4,356.39
93041RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R$472.06
93042RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON$142.78
93225XTRNL ECG & 48 HR RECORDING$2,578.24
93226EXTERNAL ECG SCANNING ANALYSIS REPORT$2,740.23
93303COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY$5,799.42
93306ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D$7,339.06
93307ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP$5,257.71
93308ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD$3,458.90
93320DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY$4,003.28
93325DOP ECHOCARD COLOR FLOW VELOCITY MAPPING$3,454.75
93350ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST$6,557.57
93351ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG$8,541.79
93623PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS$6,364.25
93880DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY$4,315.98
93882DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY$2,732.15
93886TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL$2,142.08
93922NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL$1,840.58
93923NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS$2,555.72
93925DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY$3,728.25
93926DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY$2,341.06
93930DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY$3,723.78
93931DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY$2,705.41
93970DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY$3,677.92
93971DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY$2,434.34
93975DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM$3,404.42
93976DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT$2,168.36
93980DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL$2,183.69
94010SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ$1,033.48
94060BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN$1,205.87
94621CARDIOPULMONARY EXERCISE TESTING$2,200.00
94640PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT$746.55
94644CONTINUOUS INHALATION TREATMENT 1ST HR$932.24
94660CPAP VENTILATION CPAP INITIATION&MGMT$4,561.29
94664DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP$609.62
94760NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER$257.45
94761NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER$381.91
94762NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR$1,335.38
95811POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND$6,415.76
96360IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR$1,367.57
96361IV INFUSION HYDRATION EACH ADDITIONAL HOUR$474.26
96365IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR$1,466.94
96366IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR$474.23
96367IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR$789.44
96368IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS$527.76
96372THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM$558.96
96373THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL$1,336.45
96374THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG$789.93
96375THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG$637.64
96376THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC$613.26
96377APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION$530.34
96379UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS$515.41
97110THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES$345.30
97116THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR$357.12
97140MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES$341.65
97166OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS$940.17
97542WHEELCHAIR MGMT EA 15 MIN$296.36
97597DEBRIDEMENT OPEN WOUND 20 SQ CM/<$1,295.55
99001HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB$175.12
99050SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS$161.00
99070SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP$369.80
99151MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS$562.93
99152MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS$668.12
99153MOD SED SAME PHYS/QHP EACH ADDL 15 MINS$383.11
99155MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS$1,190.00
99156MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS$588.86
99157MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS$779.00
99282EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM$2,065.14
99283EMERGENCY DEPARTMENT VISIT LOW MDM$3,796.82
99284EMERGENCY DEPARTMENT VISIT MODERATE MDM$5,891.67
99285EMERGENCY DEPARTMENT VISIT HIGH MDM$8,139.58
99291CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN$11,436.47
99292CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN$3,357.76
99406TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES$156.24
99407TOBACCO USE CESSATION INTENSIVE >10 MINUTES$183.00
E0114CRUTCH UNDERARM PAIR NO WOOD$256.47
E0484Oscillatory positive expiratory pressure device, nonelectric, any type, each$403.65
G0378HOSPITAL OBSERVATION PER HR$2,500.00
J0131ACETAMINOPHEN INJECTION$65.22
J0153ADENOSINE INJ 1MG$55.25
J0171ADRENALIN EPINEPHRINE INJECT$40.73
J0282AMIODARONE HCL$37.90
J0290AMPICILLIN 500 MG INJ$64.86
J0295AMPICILLIN SULBACTAM 1.5 GM$72.27
J0360HYDRALAZINE HCL INJECTION$168.44
J0456AZITHROMYCIN$89.54
J0461ATROPINE SULFATE INJECTION$24.86
J0500DICYCLOMINE INJECTION$339.15
J0515INJ BENZTROPINE MESYLATE$184.22
J0558PENG BENZATHINE/PROCAINE INJ$127.93
J0561PENICILLIN G BENZATHINE INJ$137.97
J0610CALCIUM GLUCONATE INJECTION$51.10
J0690CEFAZOLIN SODIUM INJECTION$35.03
J0692CEFEPIME HCL FOR INJECTION$68.60
J0696CEFTRIAXONE SODIUM INJECTION$55.73
J0697STERILE CEFUROXIME INJECTION$51.34
J0735CLONIDINE HYDROCHLORIDE$238.75
J0744CIPROFLOXACIN IV$129.14
J0780PROCHLORPERAZINE INJECTION$167.49
J0840CROTALIDAE POLY IMMUNE FAB$24,660.55
J1030METHYLPREDNISOLONE 40 MG INJ$77.17
J1040METHYLPREDNISOLONE 80 MG INJ$105.36
J1100DEXAMETHASONE SODIUM PHOS$20.28
J1110INJ DIHYDROERGOTAMINE MESYLT$691.60
J1170HYDROMORPHONE INJECTION$69.03
J1200DIPHENHYDRAMINE HCL INJECTIO$34.03
J1610GLUCAGON HYDROCHLORIDE/1 MG$1,014.98
J1630HALOPERIDOL INJECTION$61.76
J1631HALOPERIDOL DECANOATE INJ$159.07
J1642INJ HEPARIN SODIUM PER 10 U$23.44
J1644INJ HEPARIN SODIUM PER 1000U$32.21
J1650INJ ENOXAPARIN SODIUM$73.68
J1741IBUPROFEN INJECTION$28.67
J1815INSULIN INJECTION$27.74
J1817INSULIN FOR INSULIN PUMP USE$26.00
J1885KETOROLAC TROMETHAMINE INJ$30.36
J1930LANREOTIDE INJECTION$441.29
J1940FUROSEMIDE INJECTION$37.74
J1956LEVOFLOXACIN INJECTION$60.71
J2001LIDOCAINE INJECTION$29.36
J2060LORAZEPAM INJECTION$41.01
J2175MEPERIDINE HYDROCHL /100 MG$137.48
J2250INJ MIDAZOLAM HYDROCHLORIDE$21.25
J2270MORPHINE SULFATE INJECTION$54.39
J2274INJ MORPHINE PF EPID ITHC$131.59
J2405ONDANSETRON HCL INJECTION$25.68
J2543PIPERACILLIN/TAZOBACTAM$50.58
J2550PROMETHAZINE HCL INJECTION$53.81
J2704INJ, PROPOFOL, 10 MG$26.69
J2765METOCLOPRAMIDE HCL INJECTION$36.03
J2780RANITIDINE HYDROCHLORIDE INJ$29.72
J2800METHOCARBAMOL INJECTION$309.63
J2920METHYLPREDNISOLONE INJECTION$73.01
J2930METHYLPREDNISOLONE INJECTION$88.81
  $40.23
J3030SUMATRIPTAN SUCCINATE / 6 MG$416.42
J3260TOBRAMYCIN SULFATE INJECTION$119.10
J3360DIAZEPAM INJECTION$120.35
J3370VANCOMYCIN HCL INJECTION$89.09
J3430VITAMIN K PHYTONADIONE INJ$63.81
J3475INJ MAGNESIUM SULFATE$56.79
J3480INJ POTASSIUM CHLORIDE$46.25
J3490DRUGS UNCLASSIFIED INJECTION$250.41
J7030NORMAL SALINE SOLUTION INFUS$104.19
J7040NORMAL SALINE SOLUTION INFUS$83.99
J70425% DEXTROSE/NORMAL SALINE$133.67
J7050NORMAL SALINE SOLUTION INFUS$54.57
J7070D5W INFUSION$113.45
J7120RINGERS LACTATE INFUSION$61.77
J71215% DEXTROSE IN LAC RINGERS$97.97
J7131HYPERTONIC SALINE SOL$1.01
J7192FACTOR VIII RECOMBINANT NOS$17.55
J7510PREDNISOLONE ORAL PER 5 MG$19.90
J7611ALBUTEROL NON-COMP CON$11.23
J7613ALBUTEROL NON-COMP UNIT$14.74
J7614LEVALBUTEROL NON-COMP UNIT$43.61
J7615LEVALBUTEROL COMP UNIT$58.50
J7620ALBUTEROL IPRATROP NON-COMP$40.11
J7644IPRATROPIUM BROMIDE NON-COMP$144.68
J7682TOBRAMYCIN NON-COMP UNIT$953.12
J8499ORAL PRESCRIP DRUG NON CHEMO$136.48
J9206IRINOTECAN INJECTION$116.89
L0120CERV FLEX N/ADJ FOAM PRE OTS$142.29
L0140CERVICAL SEMI-RIGID ADJUSTAB$550.00
L0150CERV SEMI-RIG ADJ MOLDED CHN$353.00
L0172CERV COL SR FOAM 2PC PRE OTS$405.29
L0174CERV SR 2PC THOR EXT PRE OTS$1,396.06
L0180CER POST COL OCC/MAN SUP ADJ$1,200.00
L0190CERV COLLAR SUPP ADJ CERV BA$1,580.00
L0450TLSO FLEX TRUNK/THOR PRE OTS$563.17
L0458TLSO 2MOD SYMPHIS-XIPHO PRE$2,328.30
L0460TLSO 2 SHL SYMPHYS-STERN CST$2,452.69
L0462TLSO 3MOD SACRO-SCAP PRE$8,086.85
L0464TLSO 4MOD SACRO-SCAP PRE$6,819.00
L0467TLSO R FRAM SOFT PRE OTS$1,040.00
L0470TLSO RIGID FRAME PRE SUBCLAV$3,654.75
L0472TLSO RIGID FRAME HYPEREX PRE$2,130.00
L0625LO FLEX L1-BELOW L5 PRE OTS$144.00
L0627LO SAG RI AN/POS PNL PRE CST$2,871.57
L0628LSO FLEX NO RI STAYS PRE OTS$219.70
L0630LSO R POST PNL SJ-T9 PRE CST$435.81
L0631LSO SAG R AN/POS PNL PRE CST$7,038.87
L0635LSO SAGIT RIGID PANEL PREFAB$7,678.00
L0650LSO SC R ANT/POS PNL PRE OTS$4,991.00
L0700CTLSO A-P-L CONTROL MOLDED$8,453.31
L0810HALO CERVICAL INTO JCKT VEST$8,346.06
L0859MRI COMPATIBLE SYSTEM$3,863.34
L0976LSO FULL CORSET$458.50
L1620HO FLEX PAVLIK HARNS PRE CST$545.26
L1686HO POST-OP HIP ABDUCTION$3,076.42
L1810KO ELASTIC WITH JOINTS$452.00
L1820KO ELAS W/ CONDYLE PADS & JO$950.12
L1830KO IMMOB CANVAS LONG PRE OTS$408.99
L1832KO ADJ JNT POS R SUP PRE CST$1,242.00
L1845KO DOUBLE UPRIGHT PRE CST$2,592.97
L1902AFO ANKLE GAUNTLET PRE OTS$260.69
L1930AFO PLASTIC$715.80
L1940AFO MOLDED TO PATIENT PLASTI$1,866.62
L1960AFO POS SOLID ANK PLASTIC MO$1,355.19
L2114AFO TIB FX SEMI-RIGID$1,897.00
L2624HIP ADJ FLEX EXT ABDUCT CONT$855.77
L3650SO 8 ABD RESTRAINT PRE OTS$228.85
L3660SO 8 AB RSTR CAN/WEB PRE OTS$256.00
L3670SO ACRO/CLAV CAN WEB PRE OTS$364.00
L3763EWHO RIGID W/O JNTS CF$1,696.00
L3764EWHO W/JOINT(S) CF$2,251.00
L3807WHFO W/O JOINTS PRE CST$559.00
L3808WHFO, RIGID W/O JOINTS$634.31
L3905WHO W/NONTORSION JNT(S) CF$2,332.00
L3908WHO COCK-UP NONMOLDE PRE OTS$201.00
L3980UP EXT FX ORTHOS HUMERAL NOS$1,098.48
L3984UPPER EXT FX ORTHOSIS WRIST$1,288.38
L3995SOCK FRACTURE OR EQUAL EACH$102.68
L4350ANKLE CONTROL ORTHO PRE OTS$327.00
L4360PNEUMAT WALKING BOOT PRE CST$395.00
L4361PNEUMA/VAC WALK BOOT PRE OTS$444.17
L4386NON-PNEUM WALK BOOT PRE CST$502.76
L4387NON-PNEUM WALK BOOT PRE OTS$513.65
L4396STATIC OR DYNAMI AFO PRE CST$604.79
L4397STATIC OR DYNAMI AFO PRE OTS$1,036.62
L8000MASTECTOMY BRA$212.93
L8020MASTECTOMY FORM$1,409.26
L8509TRACH-ESOPH VOICE PROS MD IN$938.00
L8670VASCULAR GRAFT, SYNTHETIC$7,707.31
M0243CASIRIVI AND IMDEVI INJ$1,567.80
Q0144AZITHROMYCIN DIHYDRATE, ORAL$201.31
Q0243CASIRIVIMAB AND IMDEVIMAB$0.01
Q9963HOCM 350-399MG/ML IODINE,1ML$28.66
Q9965LOCM 100-199MG/ML IODINE,1ML$30.71
Q9966LOCM 200-299MG/ML IODINE,1ML$31.15
Q9967LOCM 300-399MG/ML IODINE,1ML$62.08
S0028INJECTION, FAMOTIDINE, 20 MG$102.67
S0119ONDANSETRON 4 MG$101.13
S0164INJECTION PANTROPRAZOLE$139.76
U0002COVID-19 LAB TEST NON-CDC$416.59