Charge Master – Frontline ER Dallas

Updated 8/21/21

10060Drainage of skin abscess$1,970.53
10061Drainage of skin abscess$2,215.83
10081Drainage of pilonidal cyst$2,816.73
10120Remove foreign body$3,510.46
10121Remove foreign body$4,299.89
10160Puncture drainage of lesion$1,281.01
11011Debride skin musc at fx site$1,640.89
11042Deb subq tissue 20 sq cm/<$3,088.37
11200Removal of skin tags <w/15$4,554.95
11404Exc tr-ext b9+marg 3.1-4 cm$6,302.06
11730Removal of nail plate$982.41
11740Drain blood from under nail$588.97
11750Removal of nail bed$1,738.04
11760Repair of nail bed$1,615.96
11765Excision of nail fold toe$1,095.63
11771Remove pilonidal cyst exten$7,234.13
12001Rpr s/n/ax/gen/trnk 2.5cm/<$896.21
12002Rpr s/n/ax/gen/trnk2.6-7.5cm$1,013.45
12004Rpr s/n/ax/gen/trk7.6-12.5cm$1,442.44
12005Rpr s/n/a/gen/trk12.6-20.0cm$1,261.16
12011Rpr f/e/e/n/l/m 2.5 cm/<$941.45
12013Rpr f/e/e/n/l/m 2.6-5.0 cm$1,114.56
12014Rpr f/e/e/n/l/m 5.1-7.5 cm$1,435.78
12020Closure of split wound$4,340.93
12031Intmd rpr s/a/t/ext 2.5 cm/<$1,329.73
12032Intmd rpr s/a/t/ext 2.6-7.5$1,598.10
12034Intmd rpr s/tr/ext 7.6-12.5$1,741.77
12035Intmd rpr s/a/t/ext 12.6-20$1,560.38
12036Intmd rpr s/a/t/ext 20.1-30$2,054.03
12041Intmd rpr n-hf/genit 2.5cm/<$1,602.70
12042Intmd rpr n-hf/genit2.6-7.5$1,724.30
12044Intmd rpr n-hf/genit7.6-12.5$1,299.80
12045Intmd rpr n-hf/genit12.6-20$2,110.64
12051Intmd rpr face/mm 2.5 cm/<$1,136.14
12052Intmd rpr face/mm 2.6-5.0 cm$1,575.97
12053Intmd rpr face/mm 5.1-7.5 cm$2,666.56
12054Intmd rpr face/mm 7.6-12.5cm$1,465.67
13121Cmplx rpr s/a/l 2.6-7.5 cm$2,510.06
13122Cmplx rpr s/a/l addl 5 cm/>$1,557.49
13132Cmplx rpr f/c/c/m/n/ax/g/h/f$3,241.75
13151Cmplx rpr e/n/e/l 1.1-2.5 cm$2,617.61
13152Cmplx rpr e/n/e/l 2.6-7.5 cm$2,752.93
13153Cmplx rpr e/n/e/l addl 5cm/<$1,721.22
15850Remove sutures same surgeon$4,805.95
16000Initial treatment of burn(s)$919.87
16020Dress/debrid p-thick burn s$1,054.15
20552Inj trigger point 1/2 muscl$2,634.28
20600Drain/inj joint/bursa w/o us$1,279.81
20605Drain/inj joint/bursa w/o us$1,820.47
20610Drain/inj joint/bursa w/o us$2,459.82
20611Drain/inj joint/bursa w/us$3,345.86
21480Reset dislocated jaw$1,008.34
23600Treat humerus fracture$1,314.84
23650Treat shoulder dislocation$1,576.39
24500Treat humerus fracture$1,030.50
24530Treat humerus fracture$2,993.75
24600Treat elbow dislocation$1,036.44
24640Treat elbow dislocation$1,393.15
25505Treat fracture of radius$3,373.00
25530Treat fracture of ulna$657.34
25535Treat fracture of ulna$2,827.19
25600Treat fracture radius/ulna$1,497.81
25605Treat fracture radius/ulna$3,120.90
25635Treat wrist bone fracture$1,898.28
25650Treat wrist bone fracture$904.12
26010Drainage of finger abscess$1,057.79
26600Treat metacarpal fracture$1,314.17
26605Treat metacarpal fracture$1,541.68
26700Treat knuckle dislocation$1,565.76
26725Treat finger fracture each$1,675.91
26750Treat finger fracture each$2,805.78
26755Treat finger fracture each$1,757.40
26770Treat finger dislocation$1,237.40
27372Removal of foreign body$3,398.36
27550Treat knee dislocation$1,759.63
27560Treat kneecap dislocation$1,081.07
27752Treatment of tibia fracture$6,933.56
27780Treatment of fibula fracture$2,589.00
27786Treatment of ankle fracture$638.79
27792Treatment of ankle fracture$12,607.88
27810Treatment of ankle fracture$2,491.37
27840Treat ankle dislocation$846.39
28190Removal of foot foreign body$2,681.82
28192Removal of foot foreign body$4,902.95
28470Treat metatarsal fracture$945.38
28510Treatment of toe fracture$1,026.57
28515Treatment of toe fracture$1,773.00
28660Treat toe dislocation$1,364.00
29075Application of forearm cast$1,036.39
29085Apply hand/wrist cast$597.31
29105Apply long arm splint$880.60
29125Apply forearm splint$789.85
29126Apply forearm splint$703.95
29130Application of finger splint$538.88
29131Application of finger splint$504.73
29240Strapping of shoulder$560.21
29280Strapping of hand or finger$572.08
29505Application long leg splint$845.33
29515Application lower leg splint$838.98
29540Strapping of ankle and/or ft$488.47
29580Application of paste boot$691.49
30300Remove nasal foreign body$706.42
30901Control of nosebleed$1,045.95
30903Control of nosebleed$1,692.51
31500Insert emergency airway$1,274.88
31502Change of windpipe airway$2,395.75
31515Laryngoscopy for aspiration$1,101.50
31525Dx laryngoscopy excl nb$4,184.03
32551Insertion of chest tube$3,693.36
36000Place needle in vein$1,019.62
36410Non-routine bl draw 3/> yrs$1,727.00
36415Routine venipuncture$79.35
36416Capillary blood draw$84.51
36556Insert non-tunnel cv cath$4,819.77
36558Insert tunneled cv cath$7,040.12
36589Removal tunneled cv cath$6,652.10
36591Draw blood off venous device$431.58
40650Repair lip$2,975.92
41800Drainage of gum lesion$1,003.03
42700Drainage of tonsil abscess$2,148.80
43753Tx gastro intub w/asp$1,897.64
46040Incision of rectal abscess$5,286.10
46050Incision of anal abscess$3,180.76
46083Incise external hemorrhoid$1,275.12
46320Removal of hemorrhoid clot$6,631.35
51700Irrigation of bladder$1,816.73
51701Insert bladder catheter$438.62
51702Insert temp bladder cath$752.97
51703Insert bladder cath complex$2,228.70
56405I & d of vulva/perineum$1,375.13
56420Drainage of gland abscess$1,002.34
59025Fetal non-stress test$1,141.42
59409Obstetrical care$5,641.48
62270Spinal fluid tap diagnostic$2,201.61
64400N block inj trigeminal$1,745.26
64402N block inj facial$919.03
64450N block other peripheral$2,398.50
64640Injection treatment of nerve$2,861.75
65205Remove foreign body from eye$600.16
65220Remove foreign body from eye$1,113.23
65222Remove foreign body from eye$964.40
67700Drainage of eyelid abscess$917.89
69200Clear outer ear canal$692.53
69205Clear outer ear canal$3,169.73
69209Remove impacted ear wax uni$441.90
69210Remove impacted ear wax uni$769.28
70030X-ray eye for foreign body$575.64
70100X-ray exam of jaw <4views$790.30
70110X-ray exam of jaw 4/> views$1,096.68
70120X-ray exam of mastoids$517.93
70130X-ray exam of mastoids$706.13
70140X-ray exam of facial bones$973.66
70150X-ray exam of facial bones$1,170.86
70160X-ray exam of nasal bones$983.20
70200X-ray exam of eye sockets$1,121.74
70210X-ray exam of sinuses$647.33
70220X-ray exam of sinuses$1,268.49
70250X-ray exam of skull$1,061.46
70260X-ray exam of skull$1,719.91
70330X-ray exam of jaw joints$928.88
70350X-ray head for orthodontia$458.85
70360X-ray exam of neck$855.44
70450Ct head/brain w/o dye$6,250.43
70460Ct head/brain w/dye$6,413.03
70470Ct head/brain w/o & w/dye$7,306.83
70480Ct orbit/ear/fossa w/o dye$4,944.58
70481Ct orbit/ear/fossa w/dye$6,883.52
70482Ct orbit/ear/fossa w/o&w/dye$7,421.20
70486Ct maxillofacial w/o dye$5,760.58
70487Ct maxillofacial w/dye$6,456.83
70488Ct maxillofacial w/o & w/dye$7,850.44
70490Ct soft tissue neck w/o dye$5,613.27
70491Ct soft tissue neck w/dye$7,446.03
70496Ct angiography head$8,748.82
70498Ct angiography neck$8,724.82
70544Mr angiography head w/o dye$7,387.90
70547Mr angiography neck w/o dye$7,254.81
70551Mri brain stem w/o dye$7,892.81
70553Mri brain stem w/o & w/dye$10,284.54
71045X-ray exam chest 1 view$1,069.10
71046X-ray exam chest 2 views$1,166.18
71047X-ray exam chest 3 views$1,208.97
71048X-ray exam chest 4+ views$1,505.13
71100X-ray exam ribs uni 2 views$1,046.72
71101X-ray exam unilat ribs/chest$1,292.21
71110X-ray exam ribs bil 3 views$1,247.46
71111X-ray exam ribs/chest4/> vws$1,480.42
71120X-ray exam breastbone 2/>vws$886.55
71250Ct thorax w/o dye$5,663.17
71260Ct thorax w/dye$7,072.46
71270Ct thorax w/o & w/dye$7,637.36
71275Ct angiography chest$8,820.46
71550Mri chest w/o dye$6,937.29
72020X-ray exam of spine 1 view$893.78
72040X-ray exam neck spine 2-3 vw$1,169.60
72050X-ray exam neck spine 4/5vws$1,748.58
72052X-ray exam neck spine 6/>vws$1,753.81
72070X-ray exam thorac spine 2vws$1,379.90
72072X-ray exam thorac spine 3vws$1,616.62
72074X-ray exam thorac spine4/>vw$984.58
72080X-ray exam thoracolmb 2/> vw$847.78
72082X-ray exam entire spi 2/3 vw$1,390.34
72100X-ray exam l-s spine 2/3 vws$1,466.45
72110X-ray exam l-2 spine 4/>vws$1,769.62
72114X-ray exam l-s spine bending$1,674.05
72120X-ray bend only l-s spine$1,150.72
72125Ct neck spine w/o dye$6,899.72
72126Ct neck spine w/dye$7,261.86
72127Ct neck spine w/o & w/dye$8,241.83
72128Ct chest spine w/o dye$5,993.51
72129Ct chest spine w/dye$6,608.08
72130Ct chest spine w/o & w/dye$7,543.10
72131Ct lumbar spine w/o dye$6,857.74
72132Ct lumbar spine w/dye$7,650.90
72133Ct lumbar spine w/o & w/dye$8,524.60
72141Mri neck spine w/o dye$7,109.20
72146Mri chest spine w/o dye$6,861.20
72148Mri lumbar spine w/o dye$6,896.90
72156Mri neck spine w/o & w/dye$10,073.46
72157Mri chest spine w/o & w/dye$9,931.72
72158Mri lumbar spine w/o & w/dye$9,630.29
72170X-ray exam of pelvis$1,052.68
72190X-ray exam of pelvis$1,357.91
72191Ct angiograph pelv w/o&w/dye$7,419.44
72192Ct pelvis w/o dye$6,035.36
72193Ct pelvis w/dye$6,635.61
72194Ct pelvis w/o & w/dye$7,635.46
72195Mri pelvis w/o dye$7,039.42
72196Mri pelvis w/dye$8,207.89
72220X-ray exam sacrum tailbone$951.99
72270Myelogphy 2/> spine regions$4,893.71
73000X-ray exam of collar bone$986.84
73010X-ray exam of shoulder blade$1,014.48
73020X-ray exam of shoulder$847.88
73030X-ray exam of shoulder$1,275.51
73050X-ray exam of shoulders$995.85
73060X-ray exam of humerus$1,103.34
73070X-ray exam of elbow$827.70
73080X-ray exam of elbow$981.15
73090X-ray exam of forearm$1,078.84
73100X-ray exam of wrist$866.46
73110X-ray exam of wrist$1,220.02
73120X-ray exam of hand$887.55
73130X-ray exam of hand$1,120.38
73140X-ray exam of finger(s)$838.86
73200Ct upper extremity w/o dye$4,804.57
73201Ct upper extremity w/dye$6,243.23
73202Ct uppr extremity w/o&w/dye$7,150.91
73220Mri uppr extremity w/o&w/dye$8,670.35
73221Mri joint upr extrem w/o dye$7,281.36
73501X-ray exam hip uni 1 view$868.27
73502X-ray exam hip uni 2-3 views$1,198.14
73503X-ray exam hip uni 4/> views$2,248.13
73522X-ray exam hips bi 3-4 views$1,573.84
73551X-ray exam of femur 1$655.45
73552X-ray exam of femur 2/>$939.64
73560X-ray exam of knee 1 or 2$813.35
73562X-ray exam of knee 3$906.80
73564X-ray exam knee 4 or more$1,288.74
73565X-ray exam of knees$803.84
73580Contrast x-ray of knee joint$2,724.00
73590X-ray exam of lower leg$1,079.10
73592X-ray exam of leg infant$1,394.22
73600X-ray exam of ankle$847.40
73610X-ray exam of ankle$1,058.35
73620X-ray exam of foot$937.41
73630X-ray exam of foot$1,035.55
73650X-ray exam of heel$838.01
73660X-ray exam of toe(s)$923.80
73700Ct lower extremity w/o dye$5,595.48
73701Ct lower extremity w/dye$6,122.83
73702Ct lwr extremity w/o&w/dye$7,134.98
73718Mri lower extremity w/o dye$5,271.95
73721Mri jnt of lwr extre w/o dye$6,044.10
73722Mri joint of lwr extr w/dye$5,399.08
73723Mri joint lwr extr w/o&w/dye$7,865.38
73725Mr ang lwr ext w or w/o dye$3,945.60
74018X-ray exam abdomen 1 view$906.51
74019X-ray exam abdomen 2 views$1,045.13
74021X-ray exam abdomen 3+ views$1,141.96
74022X-ray exam series abdomen$1,631.74
74150Ct abdomen w/o dye$5,755.36
74160Ct abdomen w/dye$6,827.85
74170Ct abdomen w/o & w/dye$7,789.34
74174Ct angio abd&pelv w/o&w/dye$9,920.02
74175Ct angio abdom w/o & w/dye$7,492.15
74176Ct abd & pelvis w/o contrast$9,556.67
74177Ct abd & pelv w/contrast$10,615.21
74178Ct abd & pelv 1/> regns$12,514.63
74181Mri abdomen w/o dye$6,118.29
74183Mri abdomen w/o & w/dye$7,163.23
74190X-ray exam of peritoneum$2,295.23
74240X-ray upper gi delay w/o kub$1,447.65
74246Contrst x-ray uppr gi tract$1,910.17
74250X-ray exam of small bowel$1,615.90
74251X-ray exam of small bowel$2,605.80
74283Contrast x-ray exam of colon$2,038.49
74328X-ray bile duct endoscopy$3,597.46
74329X-ray for pancreas endoscopy$2,720.52
74330X-ray bile/panc endoscopy$1,749.01
74340X-ray guide for gi tube$999.91
75574Ct angio hrt w/3d image$3,340.10
763763d render w/intrp postproces$1,642.09
76380Cat scan follow-up study$1,974.35
76536Us exam of head and neck$1,994.75
76604Us exam chest$1,253.43
76641Ultrasound breast complete$1,517.90
76642Ultrasound breast limited$1,031.54
76700Us exam abdom complete$2,693.25
76705Echo exam of abdomen$2,173.92
76706Us abdl aorta screen aaa$1,445.50
76770Us exam abdo back wall comp$2,043.71
76775Us exam abdo back wall lim$1,696.82
76801Ob us < 14 wks single fetus$1,942.32
76802Ob us < 14 wks addl fetus$1,335.27
76805Ob us >/= 14 wks sngl fetus$2,307.09
76810Ob us >/= 14 wks addl fetus$2,243.69
76815Ob us limited fetus(s)$1,575.00
76816Ob us follow-up per fetus$1,124.10
76817Transvaginal us obstetric$1,611.41
76830Transvaginal us non-ob$1,492.21
76856Us exam pelvic complete$2,482.38
76857Us exam pelvic limited$1,352.35
76870Us exam scrotum$1,996.83
76881Us compl joint r-t w/img$2,010.16
76882Us lmtd jt/nonvasc xtr strux$1,071.43
76942Echo guide for biopsy$2,812.96
77076X-rays bone survey infant$1,235.20
78306Bone imaging whole body$3,893.49
78315Bone imaging 3 phase$4,373.79
78320Bone imaging (3d)$3,891.25
78472Gated heart planar single$3,518.15
80047Metabolic panel ionized ca$999.70
80048Metabolic panel total ca$699.69
80051Electrolyte panel$556.19
80053Comprehen metabolic panel$985.40
80061Lipid panel$755.70
80074Acute hepatitis panel$1,368.96
80076Hepatic function panel$862.28
80178Assay of lithium$543.44
80197Assay of tacrolimus$1,091.40
80202Assay of vancomycin$674.67
80305Drug test prsmv dir opt obs$312.79
80307Drug test prsmv chem anlyzr$1,162.55
80320Drug screen quantalcohols$501.12
80324Drug screen amphetamines 1/2$534.65
80329Analgesics non-opioid 1 or 2$621.61
80335Antidepressant tricyclic 1/2$305.00
80345Drug screening barbiturates$237.81
80349Cannabinoids natural$275.05
80352Cannabinoid synthetic 7/more$451.07
80353Drug screening cocaine$222.95
80358Drug screening methadone$349.25
80361Opiates 1 or more$255.54
80362Opioids & opiate analogs 1/2$378.24
80365Drug screening oxycodone$57.76
80373Drug screening tramadol$246.26
81001Urinalysis auto w/scope$311.11
81002Urinalysis nonauto w/o scope$104.29
81003Urinalysis auto w/o scope$182.92
81007Urine screen for bacteria$292.31
81015Microscopic exam of urine$196.44
81025Urine pregnancy test$360.94
82009Test for acetone/ketones$162.42
82040Assay of serum albumin$243.19
82140Assay of ammonia$495.41
82150Assay of amylase$505.61
82247Bilirubin total$415.51
82248Bilirubin direct$285.34
82270Occult blood feces$226.28
82272Occult bld feces 1-3 tests$131.58
82274Assay test for blood fecal$250.45
82310Assay of calcium$306.94
82330Assay of calcium$625.21
82374Assay blood carbon dioxide$225.75
82375Assay carboxyhb quant$355.34
82435Assay of blood chloride$201.16
82465Assay bld/serum cholesterol$413.05
82533Total cortisol$613.18
82540Assay of creatine$298.50
82550Assay of ck (cpk)$384.08
82553Creatine mb fraction$583.33
82565Assay of creatinine$349.61
82607Vitamin b-12$508.19
82693Assay of ethylene glycol$388.96
82747Assay of folic acid rbc$276.55
82784Assay iga/igd/igg/igm each$329.82
82785Assay of ige$279.38
82800Blood ph$152.39
82803Blood gases any combination$998.98
82805Blood gases w/o2 saturation$1,137.03
82945Glucose other fluid$306.91
82947Assay glucose blood quant$272.05
82948Reagent strip/blood glucose$128.11
82962Glucose blood test$90.49
82977Assay of ggt$465.98
83013H pylori (c-13) breath$635.04
83036Glycosylated hemoglobin test$404.62
83050Blood methemoglobin assay$222.64
83520Immunoassay quant nos nonab$526.79
83525Assay of insulin$462.59
83540Assay of iron$439.93
83605Assay of lactic acid$516.66
83615Lactate (ld) (ldh) enzyme$397.33
83690Assay of lipase$431.40
83718Assay of lipoprotein$200.17
83735Assay of magnesium$334.53
83874Assay of myoglobin$524.65
83880Assay of natriuretic peptide$801.46
83992Assay for phencyclidine$119.40
84075Assay alkaline phosphatase$352.13
84100Assay of phosphorus$281.09
84132Assay of serum potassium$295.29
84155Assay of protein serum$265.08
84157Assay of protein other$358.64
84165Protein e-phoresis serum$503.22
84295Assay of serum sodium$263.84
84403Assay of total testosterone$684.51
84436Assay of total thyroxine$360.99
84439Assay of free thyroxine$483.87
84443Assay thyroid stim hormone$709.66
84450Transferase (ast) (sgot)$398.09
84460Alanine amino (alt) (sgpt)$350.99
84478Assay of triglycerides$417.21
84479Assay of thyroid (t3 or t4)$192.77
84480Assay triiodothyronine (t3)$499.84
84481Free assay (ft-3)$512.06
84484Assay of troponin quant$643.09
84520Assay of urea nitrogen$239.11
84550Assay of blood/uric acid$324.15
84560Assay of urine/uric acid$274.58
84702Chorionic gonadotropin test$648.05
84703Chorionic gonadotropin assay$409.33
84999Clinical chemistry test$263.60
85025Complete cbc w/auto diff wbc$319.06
85027Complete cbc automated$433.25
85044Manual reticulocyte count$450.15
85347Coagulation time activated$294.08
85378Fibrin degrade semiquant$468.06
85379Fibrin degradation quant$586.24
85610Prothrombin time$301.03
85651Rbc sed rate nonautomated$240.20
85652Rbc sed rate automated$236.85
85730Thromboplastin time partial$344.03
86038Antinuclear antibodies$513.72
86039Antinuclear antibodies (ana)$562.17
86060Antistreptolysin o titer$336.22
86140C-reactive protein$427.25
86235Nuclear antigen antibody$437.03
86256Fluorescent antibody titer$447.63
86308Heterophile antibody screen$322.12
86320Serum immunoelectrophoresis$1,094.54
86328Immunoassay 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
86360T cell absolute count/ratio$590.57
86403Particle agglut antbdy scrn$266.70
86430Rheumatoid factor test qual$255.72
86431Rheumatoid factor quant$372.77
86592Syphilis test non-trep qual$306.95
86593Syphilis test non-trep quant$261.59
86631Chlamydia antibody$168.00
86644Cmv antibody$472.84
86645Cmv antibody igm$520.96
86664Epstein-barr nuclear antigen$406.28
86677Helicobacter pylori antibody$533.88
86689Htlv/hiv confirmj antibody$587.05
86702Hiv-2 antibody$538.40
86704Hep b core antibody total$539.59
86705Hep b core antibody igm$521.56
86706Hep b surface antibody$512.28
86713Legionella antibody$188.66
86756Respiratory virus antibody$224.52
86769Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])$401.71
86780Treponema pallidum$323.90
86787Varicella-zoster antibody$309.55
86803Hepatitis c ab test$563.61
86850Rbc antibody screen$453.84
86900Blood typing serologic abo$284.77
86901Blood typing serologic rh(d)$230.38
86906Bld typing serologic rh phnt$309.04
87040Blood culture for bacteria$664.25
87045Feces culture aerobic bact$533.49
87046Stool cultr aerobic bact ea$278.14
87070Culture othr specimn aerobic$549.73
87075Cultr bacteria except blood$741.98
87076Culture anaerobe ident each$356.89
87077Culture aerobic identify$382.06
87081Culture screen only$284.80
87086Urine culture/colony count$573.69
87088Urine bacteria culture$242.71
87103Blood fungus culture$402.31
87106Fungi identification yeast$271.54
87110Chlamydia culture$496.58
87177Ova and parasites smears$339.31
87205Smear gram stain$234.38
87207Smear special stain$301.54
87209Smear complex stain$268.63
87210Smear wet mount saline/ink$271.40
87252Virus inoculation tissue$611.29
87255Genet virus isolate hsv$387.00
87275Influenza b ag if$218.67
87338Hpylori stool ia$407.93
87340Hepatitis b surface ag ia$378.05
87341Hepatitis b surface ag ia$344.68
87389Hiv-1 ag w/hiv-1 & hiv-2 ab$431.33
87400Influenza a/b ag ia$347.02
87420Resp syncytial ag ia$452.33
87425Rotavirus ag ia$485.07
87426Infectious 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
87427Shiga-like toxin ag ia$349.27
87430Strep a ag ia$260.23
87480Candida dna dir probe$63.68
87486Chylmd pneum dna amp probe$642.05
87491Chylmd trach dna amp probe$551.85
87493C diff amplified probe$634.41
87507Iadna-dna/rna probe tq 12-25$4,327.29
87529Hsv dna amp probe$685.64
87581M.pneumon dna amp probe$617.89
87591N.gonorrhoeae dna amp prob$483.52
87633Resp virus 12-25 targets$2,842.03
87635Infectious 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
87661Trichomonas vaginalis amplif$342.97
87798Detect agent nos dna amp$843.84
87804Influenza assay w/optic$342.53
87807Rsv assay w/optic$403.74
87880Strep a assay w/optic$538.66
88305Tissue exam by pathologist$835.74
89050Body fluid cell count$288.09
89051Body fluid cell count$350.71
89055Leukocyte assessment fecal$240.82
89060Exam synovial fluid crystals$274.10
89220Sputum specimen collection$170.00
90471Immunization admin$267.82
90688Iiv4 vaccine splt 0.5 ml im$171.66
90700Dtap vaccine < 7 yrs im$217.72
90714Td vacc no presv 7 yrs+ im$326.81
90715Tdap vaccine 7 yrs/> im$372.31
90746Hepb vaccine 3 dose adult im$376.20
92950Heart/lung resuscitation cpr$1,833.48
92960Cardioversion electric ext$2,730.97
93005Electrocardiogram tracing$893.06
93010Electrocardiogram report$146.88
93041Rhythm ecg tracing$400.74
93042Rhythm ecg report$118.41
93306Tte w/doppler complete$4,090.66
93307Tte w/o doppler complete$4,864.69
93308Tte f-up or lmtd$3,013.64
93313Echo transesophageal$1,934.28
93320Doppler echo exam heart$2,578.72
93325Doppler color flow add-on$2,596.69
93351Stress tte complete$5,182.32
93880Extracranial bilat study$2,396.12
93882Extracranial uni/ltd study$1,996.50
93922Upr/l xtremity art 2 levels$1,329.03
93923Upr/lxtr art stdy 3+ lvls$1,863.04
93925Lower extremity study$2,688.18
93926Lower extremity study$1,959.69
93930Upper extremity study$2,740.94
93931Upper extremity study$2,032.09
93970Extremity study$2,622.27
93971Extremity study$2,043.21
93975Vascular study$2,484.59
93976Vascular study$1,939.05
94010Breathing capacity test$665.33
94060Evaluation of wheezing$1,279.67
94621Cardiopulm exercise testing$2,408.02
94640Airway inhalation treatment$694.72
94644Cbt 1st hour$597.20
94664Evaluate pt use of inhaler$193.11
94760Measure blood oxygen level$244.35
94761Measure blood oxygen level$376.62
94762Measure blood oxygen level$1,102.92
96360Hydration iv infusion init$1,133.08
96361Hydrate iv infusion add-on$457.51
96365Ther/proph/diag iv inf init$1,163.01
96366Ther/proph/diag iv inf addon$442.96
96367Tx/proph/dg addl seq iv inf$721.25
96368Ther/diag concurrent inf$471.98
96372Ther/proph/diag inj sc/im$509.53
96373Ther/proph/diag inj ia$833.44
96374Ther/proph/diag inj iv push$708.09
96375Tx/pro/dx inj new drug addon$538.26
96376Tx/pro/dx inj same drug adon$578.76
96377Applicaton on-body injector$431.69
96379Ther/prop/diag inj/inf proc$1,641.63
97116Gait training therapy$432.71
97542Wheelchair mngment training$214.92
97597Rmvl devital tis 20 cm/<$2,028.74
99000Specimen handling office-lab$67.90
99001Specimen handling pt-lab$183.33
99024Postop follow-up visit$298.50
99050Medical services after hrs$77.61
99070Special supplies phys/qhp$258.10
99151Mod sed same phys/qhp <5 yrs$694.07
99217Observation care discharge$942.81
99218Initial observation care$5,520.93
99219Initial observation care$1,400.49
99220Initial observation care$499.22
99225Subsequent observation care$865.80
99234Observ/hosp same date$676.60
99281Emergency dept visit$825.67
99282Emergency dept visit$1,371.99
99283Emergency dept visit$2,694.72
99284Emergency dept visit$3,957.82
99285Emergency dept visit$5,492.84
99291Critical care first hour$6,405.16
99292Critical care addl 30 min$2,779.23
99406Behav chng smoking 3-10 min$109.98
99407Behav chng smoking > 10 min$176.94
A4215Sterile needle$371.44
A4216Sterile water/saline, 10 ml$139.30
A4217Sterile water/saline, 500 ml$133.39
A4247Betadine/iodine swabs/wipes$378.30
A4314Cath w/drainage 2-way latex$319.21
A4315Cath w/drainage 2-way silcne$445.36
A4335Incontinence supply$11.94
A4338Indwelling catheter latex$142.51
A4344Cath indw foley 2 way silicn$860.51
A4353Intermittent urinary cath$164.51
A4358Urinary leg or abdomen bag$50.34
A4364Adhesive, liquid or equal$255.12
A4606Oxygen probe used w oximeter$208.95
A4615Cannula nasal$124.77
A4649Surgical supplies$6,352.32
A5200Percutaneous catheter anchor$37.81
A6021Collagen dressing <=16 sq in$133.67
A6210Foam drg >16<=48 sq in w/o b$101.92
A6211Foam drg > 48 sq in w/o brdr$580.27
A6212Foam drg <=16 sq in w/border$99.18
A6213Foam drg >16<=48 sq in w/bdr$187.24
A6217Non-sterile gauze>16<=48 sq$88.12
A6218Non-sterile gauze > 48 sq in$149.37
A6219Gauze <= 16 sq in w/border$42.36
A6220Gauze >16 <=48 sq in w/bordr$34.39
A6222Gauze <=16 in no w/sal w/o b$15.35
A6250Skin seal protect moisturizr$98.03
A6260Wound cleanser any type/size$96.95
A6261Wound filler gel/paste /oz$423.60
A6402Sterile gauze <= 16 sq in$40.83
A6407Packing strips, non-impreg$89.35
A6453Self-adher band w <3″/yd$13.73
A6454Self-adher band w>=3″ <5″/yd$150.26
A6455Self-adher band >=5″/yd$30.50
A6457Tubular dressing$176.44
A7002Tubing used w suction pump$75.62
A7520Trach/laryn tube non-cuffed$563.31
A9150Misc/exper non-prescript dru$21.55
A9579Gad-base mr contrast nos,1ml$137.01
C9399Unclassified drugs or biolog$6,744.41
E0114Crutch underarm pair no wood$97.93
G0009Admin pneumococcal vaccine$185.38
G0168Wound closure by adhesive$270.55
G0378Hospital observation per hr$242.42
J0129Abatacept injection$179.48
J0131Acetaminophen injection$91.69
J0150Injection adenosine 6 mg$75.00
J0153Adenosine inj 1mg$35.95
J0171Adrenalin epinephrine inject$26.65
J0282Amiodarone hcl$18.51
J0290Ampicillin 500 mg inj$45.70
J0295Ampicillin sodium per 1.5 gm$62.90
J0330Succinycholine chloride inj$72.12
J0360Hydralazine hcl injection$187.10
J0461Atropine sulfate injection$9.46
J0500Dicyclomine injection$264.25
J0558Peng benzathine/procaine inj$91.97
J0561Penicillin g benzathine inj$108.27
J0595Butorphanol tartrate 1 mg$39.18
J0610Calcium gluconate injection$84.19
J0690Cefazolin sodium injection$23.22
J0692Cefepime hcl for injection$47.21
J0696Ceftriaxone sodium injection$52.71
J0697Sterile cefuroxime injection$28.36
J0735Clonidine hydrochloride$147.94
J0744Ciprofloxacin iv$159.10
J0780Prochlorperazine injection$112.70
J1030Methylprednisolone 40 mg inj$78.34
J1040Methylprednisolone 80 mg inj$115.22
J1100Dexamethasone sodium phos$21.07
J1110Inj dihydroergotamine mesylt$616.55
J1165Phenytoin sodium injection$43.88
J1170Hydromorphone injection$43.56
J1200Diphenhydramine hcl injectio$28.06
J1335Ertapenem injection$288.40
J1580Garamycin gentamicin inj$50.73
J1610Glucagon hydrochloride/1 mg$891.43
J1630Haloperidol injection$56.40
J1631Haloperidol decanoate inj$140.95
J1642Inj heparin sodium per 10 u$18.32
J1644Inj heparin sodium per 1000u$66.80
J1650Inj enoxaparin sodium$76.51
J1670Tetanus immune globulin inj$2,302.39
J1741Ibuprofen injection$27.35
J1815Insulin injection$40.65
J1817Insulin for insulin pump use$12.76
J1885Ketorolac tromethamine inj$23.67
J1930Lanreotide injection$244.18
J1940Furosemide injection$34.68
J1956Levofloxacin injection$123.32
J2001Lidocaine injection$27.51
J2060Lorazepam injection$82.49
J2150Mannitol injection$58.37
J2175Meperidine hydrochl /100 mg$33.82
J2250Inj midazolam hydrochloride$13.76
J2270Morphine sulfate injection$30.76
J2274Inj morphine pf epid ithc$88.41
J2300Inj nalbuphine hydrochloride$65.52
J2310Inj naloxone hydrochloride$99.62
J2360Orphenadrine injection$128.30
J2370Phenylephrine hcl injection$88.06
J2405Ondansetron hcl injection$25.09
J2550Promethazine hcl injection$30.00
J2690Procainamide hcl injection$420.79
J2704Inj, propofol, 10 mg$34.84
J2765Metoclopramide hcl injection$28.82
J2780Ranitidine hydrochloride inj$45.66
J2790Rho d immune globulin inj$385.42
J2800Methocarbamol injection$201.28
J2920Methylprednisolone injection$39.72
J2930Methylprednisolone injection$76.90
J3010Fentanyl citrate injection$29.80
J3030Sumatriptan succinate / 6 mg$372.73
J3105Terbutaline sulfate inj$90.73
J3230Chlorpromazine hcl injection$339.50
J3260Tobramycin sulfate injection$121.64
J3360Diazepam injection$84.74
J3370Vancomycin hcl injection$122.52
J3410Hydroxyzine hcl injection$41.26
J3411Thiamine hcl 100 mg$47.42
J3430Vitamin k phytonadione inj$68.79
J3475Inj magnesium sulfate$30.27
J3480Inj potassium chloride$20.01
J3486Ziprasidone mesylate$170.41
J3490Drugs unclassified injection$1,033.56
J7030Normal saline solution infus$59.03
J7040Normal saline solution infus$55.94
J70425% dextrose/normal saline$96.89
J7050Normal saline solution infus$54.37
J70605% dextrose/water$64.71
J7070D5w infusion$138.67
J7120Ringers lactate infusion$93.74
J71215% dextrose in lac ringers$116.31
J7131Hypertonic saline sol$1.50
J7192Factor viii recombinant nos$16.81
J7506Prednisone oral$10.10
J7510Prednisolone oral per 5 mg$20.75
J7512Prednisone ir or dr oral 1mg$3.65
J7610Albuterol comp con$52.43
J7611Albuterol non-comp con$9.76
J7613Albuterol non-comp unit$14.08
J7614Levalbuterol non-comp unit$27.47
J7615Levalbuterol comp unit$30.30
J7620Albuterol ipratrop non-comp$26.46
J7644Ipratropium bromide non-comp$126.80
J7682Tobramycin non-comp unit$507.51
J8499Oral prescrip drug non chemo$130.44
J8540Oral dexamethasone$4.59
J9027Clofarabine injection$701.71
J9206Irinotecan injection$79.63
L0120Cerv flex n/adj foam pre ots$142.78
L0172Cerv col sr foam 2pc pre ots$139.39
L1830Ko immob canvas long pre ots$180.48
L1906Afo multilig ank sup pre ots$163.75
L3260Ambulatory surgical boot eac$413.25
L3650So 8 abd restraint pre ots$158.72
L3670So acro/clav can web pre ots$351.28
L3809Whfo w/o joints pre ots$824.25
L3908Who cock-up nonmolde pre ots$197.41
L4350Ankle control ortho pre ots$203.01
L4360Pneumat walking boot pre cst$388.31
L4386Non-pneum walk boot pre cst$420.80
L4387Non-pneum walk boot pre ots$305.30
P9612Catheterize for urine spec$186.02
Q0144Azithromycin dihydrate, oral$172.69
Q4038Cast sup shrt leg fiberglass$1,513.23
Q4051Splint supplies misc$198.00
Q9954Oral mr contrast, 100 ml$193.03
Q9963Hocm 350-399mg/ml iodine,1ml$51.73
Q9965Locm 100-199mg/ml iodine,1ml$34.49
Q9966Locm 200-299mg/ml iodine,1ml$64.36
Q9967Locm 300-399mg/ml iodine,1ml$113.61
S0020Injection, bupivicaine hydro$216.80
S0028Injection, famotidine, 20 mg$85.34
S0030Injection, metronidazole$193.46
S0077Injection, clindamycin phosp$57.93
S0119Ondansetron 4 mg$96.22
S0164Injection pantroprazole$137.54
S0630Removal of sutures$179.78
S5000Prescription drug, generic$1,296.63
S50105% dextrose and 0.45% saline$243.48
S5550Insulin rapid 5 u$16.98
U00022019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC$327.39