CPT Code |
CPT Code Description |
Charge Amount |
0001A |
Immunization administration by intramuscular injection of (… |
$100.00 |
0202U |
COVID-19 BioFire Respiratory Panel 2.1 (RP2.1) Testing |
$1,500.00 |
10060 |
INCISION/DRAINAGE ABSCESS |
$1,970.53 |
10061 |
INS/DRAIN ABSCESS COMPL |
$2,215.83 |
10081 |
I&D PILONIDAL CST COMP |
$2,816.73 |
10120 |
I & RMVL SUB-CUT SIMPLE |
$3,510.46 |
10121 |
I & RMVL FB, SUB-CUT,COMP |
$4,299.89 |
10160 |
PUNCTURE ASP OF ABSCESS |
$1,281.01 |
11011 |
DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC |
$1,640.89 |
11040 |
DBRDMT, SKIN, PARTIAL THICK |
$205.00 |
11042 |
DBRD SKN SUBQ TISSUE |
$3,088.37 |
11200 |
RMVL SKIN TAGS |
$4,554.95 |
11404 |
EXC BGN LSN TRUNK 3.1-4.0 |
$6,302.06 |
11720 |
DEBRIDE NAIL 1-5 |
$353.00 |
11730 |
AVULSION/1-NAIL PLATE |
$982.41 |
11732 |
Avulsion of nail plate, partial or complete, simple; each a… |
$265.00 |
11740 |
EVAC SUBUNGUAL HEMATOMA |
$588.97 |
11750 |
EXC NAIL PART/COMP |
$1,738.04 |
11760 |
REPAIR NAIL BED |
$1,615.96 |
11765 |
WEDGE EXC SKIN/NAIL BED |
$1,095.63 |
11771 |
EXCISION PILONIDAL CYST SINUS EXTENSIVE |
$7,234.13 |
12001 |
LACERATION REPAIR |
$896.21 |
12002 |
REPAIR LAC SCALP 2.6-7.5 |
$1,013.45 |
12004 |
REPAIR LAC SCALP 7.6-12.5 |
$1,442.44 |
12005 |
REPAIR LAC,SCALP 12.6-20C |
$1,261.16 |
12011 |
REPAIR LAC FACE LESS THAN 2.5 CM |
$941.45 |
12013 |
REPAIR LAC FACE 2.6-5.0CM |
$1,114.56 |
12014 |
REPAIR LAC FACE 5.1-7.5CM |
$1,435.78 |
12020 |
TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE |
$4,340.93 |
12031 |
LYR CLSR S/A/T/E 2.5CM |
$1,329.73 |
12032 |
REPAIR-INT SCALP 2.6-7.5 |
$1,598.10 |
12034 |
INTERM RPR SCLP/TRNK/EXTR |
$1,741.77 |
12035 |
REPAIR INTERM S/A/T/E 12. |
$1,560.38 |
12036 |
REPAIR INTERM S/A/T/E 20.1-30.0 CM |
$2,054.03 |
12041 |
LAYER CLSR NECK/HAND 2.6 |
$1,602.70 |
12042 |
REPAIR LAC HAND/FOOT 2.6- |
$1,724.30 |
12044 |
LYR CLSR N/H/F/ETRNL GENT |
$1,299.80 |
12045 |
REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM |
$2,110.64 |
12051 |
LAYER CLSR OF WND NCK/HND |
$1,136.14 |
12052 |
LYR CLSR WOUND 2.6-5.0FAC |
$1,575.97 |
12053 |
LYR CLSR F/E/E/N/L/M&/MUC |
$2,666.56 |
12054 |
REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM |
$1,465.67 |
13121 |
RPR CMPX SCALP ARM2.6-7.5 |
$2,510.06 |
13122 |
CMPLX RPR ADD 5 CM OR LES |
$1,557.49 |
13132 |
RPR CMPX FOREHEAD/CHECK/C |
$3,241.75 |
13151 |
CMPX RPR EYE NOSE 1.1-2.5 |
$2,617.61 |
13152 |
RPR CPLX E/N/E/L 2.6-7.5 |
$2,752.93 |
13153 |
REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM< |
$1,721.22 |
15850 |
SUTURE RMVL W/ANESTHESIA |
$4,805.95 |
16000 |
BURN, INITIAL TREATMENT |
$919.87 |
16020 |
BURN, DRESSING/DBRDMNT-SM |
$1,054.15 |
20552 |
TRIGGER POINT INJ 1-2 MUS |
$2,634.28 |
20600 |
ARTHROCENTESIS, SML JOINT |
$1,279.81 |
20605 |
ARTHROCENTESIS, MED JOINT |
$1,820.47 |
20610 |
ARTHROCENTESIS, LG JOINT |
$2,459.82 |
20611 |
Arthrocentesis, aspiration and/or injection, major joint or… |
$3,345.86 |
21310 |
CLTX NSL B1 FX W/O MNPJ |
$498.00 |
21480 |
CLDS TX TEMP DISLOCATION |
$1,008.34 |
21800 |
CLTX RIB FX UNCOMP EA |
$425.00 |
23500 |
CLTX CLAVICULAR FX WO MNP |
$814.00 |
23570 |
CLSD TX SCAPULAR FX WO MA |
$839.00 |
23600 |
CLTX PROX HUMRL FX WO MAN |
$1,314.84 |
23650 |
SHOULDER DISLOCATION TRMT |
$1,576.39 |
23655 |
Closed treatment of shoulder dislocation, with manipulatio… |
$4,245.00 |
24500 |
CLTX HUMRL SHFT FX W/O MN |
$1,030.50 |
24530 |
CLTX SPRCNDYLR/TRANSCNDYL |
$2,993.75 |
24576 |
CLTX HUMRL CNDLYR FX MEDI |
$381.00 |
24600 |
CLSD TX ELBOW DISLOCAT |
$1,036.44 |
24605 |
Treatment of closed elbow dislocation; requiring anesthesia |
$4,200.00 |
24640 |
RADIAL HEAD SUBLUX. CHILD |
$1,393.15 |
24650 |
CLTX RDL HEAD FX WO MANP |
$959.00 |
24670 |
CLTX ULNR FX PROX END WO |
$942.00 |
25500 |
CLTX RDL SHFT FX WO MANP |
$650.00 |
25505 |
CLSD TX RAD SHAFT W/MANIP |
$3,373.00 |
25530 |
CLSD TX ULNAR SHFT FX NO |
$657.34 |
25535 |
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION |
$2,827.19 |
25560 |
CLTX RDL&UR SHFT FXS W/O |
$378.00 |
25600 |
CLSD TX DISTAL RAD FX WO |
$1,497.81 |
25605 |
CLSD TX DISTAL RAD FX |
$3,120.90 |
25622 |
CLSD TX NAVICULAR FX WO M |
$650.00 |
25635 |
CLTTX CARPL B1 FX W/MNPJ EA B1 |
$1,898.28 |
25650 |
CLTX UR SYLOID FX |
$904.12 |
26010 |
I & D FINGER ABSCESS,SIMP |
$1,057.79 |
26600 |
CLSD TX METACARPAL FX |
$1,314.17 |
26605 |
CLSD TX MEDICARPAL FX |
$1,541.68 |
26607 |
CLTX MTCRPL FX W/MNP W/XT |
$1,670.00 |
26700 |
CLS TX MCP DISLOCATION |
$1,565.76 |
26720 |
CLSD TX PHALANGEAL SHFTFX |
$628.00 |
26725 |
CLTX PHLNGL FX PROX/MIDDL |
$1,675.91 |
26750 |
CLS TX FX FINGER/THUMB |
$2,805.78 |
26755 |
CLTX DSTL PHLNGL FX FNGR/ |
$1,757.40 |
26770 |
TREAT FINGER DISLOC FINGE |
$1,237.40 |
26775 |
Treat finger dislocation |
$1,852.04 |
27220 |
CLTX ACETABULUM HIP/SOCKT FX W/O MNP |
$635.00 |
27301 |
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION |
$11,571.00 |
27372 |
REMOVAL FOREIGN BODY DEEP THIGH/KNEE |
$3,398.36 |
27508 |
CLTX FEM FX DSTAL END MED |
$381.00 |
27520 |
CLTX PATELLAR FX W/O MNPJ |
$1,205.00 |
27530 |
CLTX TIBL FX PROX W/O MNPJ |
$507.00 |
27550 |
CLOSED TX KNEE DISLOCATION W/O ANESTHESIA |
$1,759.63 |
27560 |
CLTX PATELLAR DISLC W/O A |
$1,081.07 |
27752 |
CLTX TIBL SFT FX W/MANP |
$6,933.56 |
27760 |
CLTX MEDIAL MALLS FX W/O |
$1,153.00 |
27780 |
CLTX PROX FIVULA/SHFT FX |
$2,589.00 |
27786 |
CLSD TX DISTAL FIBULAR FX |
$638.79 |
27792 |
Open treatment of distal fibular fracture (lateral malleolu… |
$12,607.88 |
27808 |
CLOSED TX BIMALLEOLAR ANK |
$507.00 |
27810 |
CLTX BIMAL ANKLE FX W/POT |
$2,491.37 |
27840 |
CLOSED TX ANKLE DISLOCATI |
$846.39 |
28190 |
RMVL FB BODY FOOT SUBQ |
$2,681.82 |
28192 |
RMVL FB FOOT DEEP |
$4,902.95 |
28400 |
CLSD TX CLAVICLE FX WO MA |
$650.00 |
28430 |
CLTX TALUS FX W/O MNPJ |
$106.00 |
28450 |
TX TARSAL B1 FX XCP TALUS |
$635.00 |
28470 |
CLTX METAR FX WO MNP |
$945.38 |
28490 |
CLTX FX GRT TOE W/O MNLJ |
$594.00 |
28510 |
CLSD TX FX PLALANX/PHALAN |
$1,026.57 |
28515 |
FX CARE PHALANX NOT GREAT |
$1,773.00 |
28660 |
CLSD TX PIP JNT DISLOCATI |
$1,364.00 |
29075 |
APPLICATION CAST ELBOW FINGER SHORT ARM |
$1,036.39 |
29085 |
CAST HAND/LOWER FOREARM GAUNTLET |
$597.31 |
29105 |
LONG ARM SPLINT |
$880.60 |
29125 |
SHORT ARM SPLINT |
$789.85 |
29126 |
SHORT ARM SPLINT DYNAMIC |
$703.95 |
29130 |
APPLICATION FINGER SPLINT |
$538.88 |
29131 |
APPLICATION FINGER SPLINT DYNAMIC |
$504.73 |
29240 |
STRPG SHO |
$560.21 |
29280 |
STRAPPING HAND/FINGER |
$572.08 |
29505 |
LONG LEG SPLINT |
$845.33 |
29515 |
SHORT LEG SPLINT |
$838.98 |
29540 |
STRAPPING ANKLE/FOOT |
$488.47 |
29550 |
STRAPPING TOES |
$176.00 |
29580 |
STRAPPING UNNA BOOT |
$691.49 |
29700 |
RMVL/BIVALV GAUNTLET BOOT |
$127.00 |
30300 |
RMVL FOREIGN BODY NASAL |
$706.42 |
30901 |
NASAL PACKING |
$1,045.95 |
30903 |
CTRL NSL HEMRRG ANT CPLX |
$1,692.51 |
30905 |
Control nasal hemorrhage, posterior, with posterior nasal p… |
$1,755.81 |
3120F |
12-LEAD ECG PERFORMED |
$250.00 |
31500 |
INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE |
$1,274.88 |
31502 |
TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT |
$2,395.75 |
31515 |
LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION |
$1,101.50 |
31525 |
LARGSC +-TRACHEOSCOPY DX |
$4,184.03 |
32551 |
TUBE THORACOSTOMY INCLUDES WATER SEAL |
$3,693.36 |
33415 |
RESCJ/INC SUBVALVULAR TISSUE |
$980.00 |
36000 |
INTRODUCTION OF NEEDLE/IN |
$1,019.62 |
36011 |
Place catheter in vein |
$4,767.33 |
36410 |
VENIPUNCTURE, 3 YRS OR OLDER |
$1,727.00 |
36415 |
VENIPUNCTURE |
$79.35 |
36416 |
COLL CAPILLARY BLG SPEC |
$84.51 |
36556 |
Insertion of non-tunneled centrally inserted central venous… |
$4,819.77 |
36558 |
INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR |
$7,040.12 |
36573 |
Insertion through the skin of a thin tube (catheter) into a… |
$6,202.81 |
36589 |
Removal of tunneled central venous catheter, without subcut… |
$6,652.10 |
36591 |
COLLECT BLOOD FROM IMPLAN |
$431.58 |
38300 |
DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL |
$303.00 |
40650 |
RPR LIP FULL THICKNESS |
$2,975.92 |
41800 |
DRNG ABSC DENTOALVEOLAR S |
$1,003.03 |
42700 |
I&D ABSC PRITONSILLAR |
$2,148.80 |
42809 |
REMOVAL FOREIGN BODY PHARYNX |
$945.00 |
43753 |
GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING … |
$1,897.64 |
46040 |
I&D ISCHIOR/PRIRC ABSC SP |
$5,286.10 |
46050 |
INC/DRAIN PERIANAL ABS SU |
$3,180.76 |
46083 |
INCISION THROM HEMORRHOID |
$1,275.12 |
46221 |
Hemorrhoidectomy, internal, by rubber band ligation(s) |
$701.00 |
46320 |
ENULEATION EXCC OF EXT HE |
$6,631.35 |
51700 |
BLDR IRR SMPL LVG&/INSTLJ |
$1,816.73 |
51701 |
INSR NONDWELLING BLDR CAT |
$438.62 |
51702 |
INSERTION BLADDER CATH |
$752.97 |
51703 |
INSERT BLADDER CATH COMPL |
$2,228.70 |
56405 |
INC/DRAIN VULVA/PERINEAL |
$1,375.13 |
56420 |
I & D BARTHOLIN ABSCESS |
$1,002.34 |
56440 |
Surgery for vulva lesion |
$5,784.61 |
59025 |
FTL NON-STRS TST |
$1,141.42 |
59409 |
VAG DLVR ONLY |
$5,641.48 |
62200 |
Establish brain cavity shunt |
$15,151.65 |
62270 |
SPINAL PUNCTURE,LUMBAR |
$2,201.61 |
64400 |
NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH |
$1,745.26 |
64402 |
INJ ANESTHETIC FACIAL NRV |
$919.03 |
64450 |
INJ ANESTHETIC AGENT |
$2,398.50 |
64640 |
DSTRJ NULYT OTH PRPH NVR/BRANCH |
$2,861.75 |
65205 |
REMOVAL FB EYE-SUPERFCL |
$600.16 |
65220 |
RMVL FB EYE W/O SLIT LAMP |
$1,113.23 |
65222 |
RMVL FB EYE |
$964.40 |
67700 |
I&D ABSCESS EYELID |
$917.89 |
69005 |
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED |
$363.00 |
69200 |
RMVL FOREIGN BODY EAR |
$692.53 |
69205 |
RMVL FB XTRNL AUD CANAL A |
$3,169.73 |
69209 |
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL |
$441.90 |
69210 |
RMVL IMPACTED CERUMEN |
$769.28 |
70030 |
RADEX EYE DETCJ FB |
$575.64 |
70100 |
XRAY MANDIBLE LESS THAN 4 VIEWS |
$790.30 |
70110 |
XRAY MANDIBLE MIN 4 VIEWS |
$1,096.68 |
70120 |
RADEX MASTOIDS LESS THAN 3 VIEWS PR SIDE |
$517.93 |
70130 |
RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE |
$706.12 |
70140 |
XRAY FACIAL BONES LESS THAN 3 VIEW |
$973.66 |
70150 |
XRAY FACIAL BONES GREATER THAN 3 VIEW |
$1,170.86 |
70160 |
NASAL BONE X-RAY |
$983.20 |
70200 |
RAD EXAM ORBIT COMP. |
$1,121.74 |
70210 |
RADEX SINUSES PARANASAL <3 VIEWS |
$647.33 |
70220 |
RAD EXAM SINUS COMPLETE |
$1,268.49 |
70250 |
SKULL LESS THAN 4 VIEWS |
$1,061.46 |
70260 |
RAD EXAM SKULL COMPLETE |
$1,719.91 |
70328 |
RADEX TMPRMAND JT OPN&CLSD MOUTH UNI |
$396.01 |
70330 |
RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT |
$928.88 |
70350 |
CEPHALOGRAM ORTHODONTIC |
$458.85 |
70360 |
RAD EXAM NECK,SOFT TISSUE |
$855.44 |
70450 |
CT HEAD/BRAIN W/O CONTRAST MATERIAL |
$6,250.43 |
70460 |
CT HEAD/BRAIN W/CONTRAST MATERIAL |
$6,413.03 |
70470 |
CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL |
$7,306.83 |
70480 |
CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL |
$4,944.58 |
70481 |
CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL |
$6,883.52 |
70482 |
CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR |
$7,421.20 |
70486 |
CT MAXILLOFACIAL W/O CONTRAST MATERIAL |
$5,760.58 |
70487 |
CT MAXILLOFACIAL W/CONTRAST MATERIAL |
$6,456.83 |
70488 |
CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL |
$7,850.44 |
70490 |
CT NECK WO CONTRAST |
$5,613.27 |
70491 |
CT SOFT TISS NCK C+MATRL |
$7,446.03 |
70496 |
CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST |
$8,748.82 |
70498 |
CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST |
$8,724.82 |
70544 |
MRA HEAD C-MATRL |
$7,387.90 |
70547 |
MRA NECK C-MATRL |
$7,254.81 |
70551 |
MRI BRN BRN STEM C-MATRL |
$7,892.81 |
70553 |
MRI BRN BRN STEM C-/C+ |
$10,284.54 |
71045 |
RADIOLOGIC EXAM CHEST SINGLE VIEW |
$1,069.10 |
71046 |
CHEST XRAY 2 VIEWS |
$1,166.18 |
71047 |
RADIOLOGIC EXAM CHEST 3 VIEWS |
$1,208.97 |
71048 |
RADIOLOGIC EXAM CHEST 4+ VIEWS |
$1,505.13 |
71060 |
BRONCHOGRAPHY BI RS&I |
$537.00 |
71100 |
RIBS UNILATERAL 2 VIEWS |
$1,046.72 |
71101 |
RIB UNILATERAL W CHEST |
$1,292.21 |
71110 |
RIBS BILATERAL 3 VIEWS |
$1,247.46 |
71111 |
RIBS BILATERAL W/CHEST |
$1,480.42 |
71120 |
Radiologic examination; sternum, minimum of 2 views |
$886.55 |
71250 |
CT CHEST W/O CONTRAST |
$5,663.17 |
71260 |
CT THORAX W/CONTRAST |
$7,072.46 |
71270 |
CT THORAX WO CONTRAST |
$7,637.36 |
71275 |
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST |
$8,820.46 |
71550 |
MRI CH C-MATRL |
$6,937.29 |
72020 |
SPINE SINGLE VIEW |
$893.78 |
72040 |
SPINE, CERVICAL 2/3 VIEWS |
$1,169.60 |
72050 |
SPINE, CERVICAL MIN 4VIEW |
$1,748.58 |
72052 |
SPINE CERV. COMP FLEX/EXT |
$1,753.81 |
72069 |
RADEX SPI THORACOLMBR STANDING SCOLIOSIS |
$374.00 |
72070 |
SPINE THORACIC 2 VIEWS |
$1,379.90 |
72072 |
SPINE THORACIC 3 VIEWS |
$1,616.62 |
72074 |
RAD EXAN SPINE THROAC 4 V |
$984.58 |
72080 |
RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS |
$847.78 |
72082 |
RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW |
$1,390.34 |
72100 |
SPINE LUMBO. MIN 4 VIEWS |
$1,466.45 |
72110 |
LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS |
$1,769.62 |
72114 |
RAD EXAM SPINE LUMBO COMP |
$1,674.05 |
72120 |
SPINE LUMBAR AP & LAT W F |
$1,150.72 |
72125 |
CT CERVICAL SPINE W/O CONTRAST MATERIAL |
$6,899.72 |
72126 |
CT CERVICAL SPINE W/CONTRAST MATERIAL |
$7,261.86 |
72127 |
CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL |
$8,241.83 |
72128 |
CT THRC SPI C-MATRL |
$5,993.51 |
72129 |
CT THRC SPI C+ MATRL |
$6,608.08 |
72130 |
CT THORACIC SPINE W/O & W/CONTRAST MATERIAL |
$7,543.10 |
72131 |
CT LUMBAR SPINE W/O CONTRAST MATERIAL |
$6,857.74 |
72132 |
CT LUMBAR SPINE W/CONTRAST MATERIAL |
$7,650.90 |
72133 |
CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL |
$8,524.60 |
72141 |
MRI SPI CANAL&CNTS CRV C-MATRL |
$7,109.20 |
72146 |
MRI SPI CANAL&CNTS THRC C-MATRL |
$6,861.20 |
72148 |
MRI SPI CANAL&CNTS LMBR C-MATRL |
$6,896.90 |
72150 |
Diagnostic Radiology (Diagnostic Imaging) Procedures of the… |
$10,217.87 |
72156 |
MRI SPI CANAL&CNTS C-/C+ CRV |
$10,073.46 |
72157 |
MRI SPI CANAL&CNTS C-/C+ |
$9,931.72 |
72158 |
MRI SPI CANAL&CNTS C-/C+ LMBR |
$9,630.29 |
72170 |
RAD EXAM PELVIS 1/2 VEIW |
$1,052.68 |
72190 |
RADEX PELVIS COMPL MIN 3 |
$1,357.91 |
72191 |
CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST |
$7,419.44 |
72192 |
CT PELVIS WO CONTRAST |
$6,035.36 |
72193 |
TOMOGRAPHY PELVIS WCONTRS |
$6,635.61 |
72194 |
CT PELVIS W OR WO CONTRST |
$7,635.46 |
72195 |
MRI PELVIS C-MATRL |
$7,039.42 |
72196 |
MRI PELVIS C+ MATRL |
$8,207.89 |
72220 |
XRAY COCCYX/SACRUM |
$951.99 |
72270 |
MYELOGRAPY 2/MORE REGIONS RS&I |
$4,893.71 |
73000 |
XRAY CLAVICLE 2 VIEWS |
$986.84 |
73010 |
SCAPULA COMPLETE |
$1,014.48 |
73020 |
RADEX SHO 1 VIEW |
$847.88 |
73030 |
SHOULDR COMPLETE 2 VIEWS |
$1,275.51 |
73050 |
XRAY AC JOINTS-BILAT |
$995.85 |
73060 |
XRAY HUMERUS MIN 2 VIEWS |
$1,103.34 |
73070 |
XRAY ELBOW 2 VIEWS |
$827.70 |
73080 |
XRAY ELBOW GREATER THAN 3 VIEWS-COMP |
$981.15 |
73090 |
XRAY FOREARM AP & LAT |
$1,078.84 |
73100 |
XRAY WRIST AP & LAT VIEW |
$866.46 |
73110 |
XRAY WRIST/COMP MIN 3 VIE |
$1,220.02 |
73120 |
XRAY HAND AP & LAT |
$887.55 |
73130 |
XRAY HAND MIN 3 VIEWS |
$1,120.38 |
73140 |
XRAY FINGER MIN 2 VIEWS |
$838.86 |
73200 |
CT UPPR EXTR WO CNTRS |
$4,804.57 |
73201 |
CT UPPER EXTREMITY W/CONTRAST MATERIAL |
$6,243.23 |
73202 |
CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL |
$7,150.91 |
73220 |
MRI UXTR OTH/THN JT C-/C+ |
$8,670.35 |
73221 |
MRI ANY JT UXTR C-MATRL |
$7,281.36 |
73501 |
RADEX HIP UNILATERAL WITH PELVIS 1 VIEW |
$868.27 |
73502 |
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN P… |
$1,198.14 |
73503 |
RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS |
$2,248.12 |
73520 |
HIPS BILAT MIN 2 VIEW INC |
$507.00 |
73522 |
RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS |
$1,573.84 |
73523 |
RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS |
$2,405.00 |
73551 |
RADIOLOGIC EXAMINATION FEMUR 1 VIEW |
$655.45 |
73552 |
FEMUR; MIN 2 VIEWS |
$939.64 |
73560 |
XRAY KNEE, SUNRISE VIEW |
$813.35 |
73562 |
XRAY KNEE MIN 3 VIEWS |
$906.80 |
73564 |
RAD EXAM KNEE 4 OR MORE |
$1,288.74 |
73565 |
RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST |
$803.84 |
73580 |
X-RAY KNEE.BILATERAL STANDING |
$2,724.00 |
73590 |
XRAY TIBIA/FIBULA AP/LAT |
$1,079.10 |
73592 |
RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS |
$1,394.22 |
73600 |
XRAY ANKLE 2 VIEWS |
$847.40 |
73610 |
XRAY ANKLE 3 VIEWS/COMPLE |
$1,058.35 |
73620 |
XRAY FOOT MIN 2 VIEWS |
$937.41 |
73630 |
XRAY FOOT MIN 3 VIEWS |
$1,035.55 |
73650 |
RAD EXAN HEEL MIN 2 VIEWS |
$838.01 |
73660 |
XRAY TOES, MIN 2 VIEWS |
$923.80 |
73700 |
CT LOWER EXTREMITY W/O CONTRAST MATERIAL |
$5,595.48 |
73701 |
CT LWR EXT W CONT |
$6,122.83 |
73702 |
CT LXTR C-/C+ |
$7,134.98 |
73718 |
MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL |
$5,271.95 |
73721 |
MRI ANY JT LXTR C-MATRL |
$6,044.10 |
73722 |
MRI ANY JT LXTR C+ MATRL |
$5,399.08 |
73723 |
MRI ANY JT LXTR C-/C+ |
$7,865.38 |
73725 |
MRA LXTR C+-MATRL |
$3,945.60 |
74000 |
RAD EXAM ABD SINGL ANTER |
$759.00 |
74010 |
RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS |
$426.00 |
74018 |
RADIOLOGIC EXAM ABDOMEN 1 VIEW |
$906.51 |
74019 |
RADIOLOGIC EXAM ABDOMEN 2 VIEWS |
$1,045.13 |
74020 |
RAD EXAM ABDOMEN COMPL |
$454.00 |
74021 |
RADIOLOGIC EXAM ABDOMEN 3+ VIEWS |
$1,141.96 |
74022 |
RAD EXAM COMPLETE ABD |
$1,631.74 |
74150 |
CT ABDOMEN W/O CONTRAST MATERIAL |
$5,755.36 |
74160 |
CT ABDOMEN W/CONTRAST MATERIAL |
$6,827.85 |
74170 |
CT ABDOMEN W/O & W/CONTRAST MATERIAL |
$7,789.34 |
74174 |
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG |
$9,920.02 |
74175 |
CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST |
$7,492.15 |
74176 |
CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL |
$9,556.67 |
74177 |
CT ABDOMEN & PELVIS W/CONTRAST MATERIAL |
$10,615.21 |
74178 |
CT ABD & PELVIS 1 PLUS SECTION/REGNS |
$12,514.63 |
74181 |
MRI ABD C-MATRL |
$6,118.29 |
74183 |
MRI ABD C-/C+ |
$7,163.23 |
74190 |
PERITONEOGRAM RS&I |
$2,295.23 |
74240 |
RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB |
$1,447.65 |
74241 |
RADEX GI TRC UPR +-DLYD FLMS W/KUB |
$998.00 |
74245 |
RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES |
$3,871.50 |
74246 |
Radiologic examination, gastrointestinal tract, upper, air … |
$1,910.17 |
74247 |
RADEX GI UPR C+ +-GLUC +-DYLD FLMS W/KUB |
$1,010.00 |
74250 |
RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES |
$1,615.90 |
74251 |
RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE |
$2,605.80 |
74283 |
Therapeutic enema, contrast or air, for reduction of intuss… |
$2,038.49 |
74328 |
ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I |
$3,597.46 |
74329 |
ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I |
$2,720.52 |
74330 |
CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I |
$1,749.01 |
74340 |
INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I |
$999.91 |
74440 |
VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I |
$2,857.80 |
75574 |
CT CORONARY |
$3,340.10 |
76010 |
X-ray nose to rectum |
$928.99 |
76376 |
3D RNDR I&R CT MRI US/OTH |
$1,642.09 |
76380 |
CT LIMITED/LOCALIZED FOLLOW UP STUDY |
$1,974.35 |
76536 |
ULTRASOUND, SOFT TISSUES OF HEAD AND NECK |
$1,994.75 |
76604 |
US CHEST REAL TIME W/IMAGE DOCUMENTATION |
$1,253.43 |
76641 |
US BREAST UNI REAL TIME WITH IMAGE COMPLETE |
$1,517.90 |
76642 |
US BREAST UNI REAL TIME WITH IMAGE LIMITED |
$1,031.54 |
76645 |
US BREAST R-T W/IMAGE DOCUMENTATION |
$784.06 |
76700 |
US ABDOMINAL R-T W/IMAGE |
$2,693.25 |
76705 |
US ABDOMINAL |
$2,173.92 |
76706 |
Ultrasound, abdominal aorta, real time with image documenta… |
$1,445.50 |
76770 |
US RETROPERITONEAL R-T W/ |
$2,043.71 |
76775 |
US RPR B-SCAN&/R-T IMG LMTD |
$1,696.82 |
76801 |
ULTRASOUND 14 WK TABDL 1/1ST GESTATION |
$1,942.32 |
76802 |
US PREG UTERUS 14 WK TRANSABDL EACH GESTATION |
$1,335.27 |
76805 |
US PG UTER F&MAT AFTER 1S |
$2,307.09 |
76810 |
US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO |
$2,243.69 |
76815 |
ULTRASND PG UTER |
$1,575.00 |
76816 |
US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS |
$1,124.10 |
76817 |
UT PG UTER R-T IMG TRVG |
$1,611.41 |
76830 |
TRANSVAGINAL ULTRASOUND |
$1,492.21 |
76856 |
US PELVIC NONOB REAL-TIME |
$2,482.38 |
76857 |
PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 |
$1,352.35 |
76870 |
US SCROTUM&CNTS |
$1,996.83 |
76880 |
US EXTREMITY |
$913.00 |
76881 |
US COMPL JOINT R-T W/IMAGE DOCUMENTATION |
$2,010.16 |
76882 |
ULTRASOUND, EXTREMITY, NON VASCULAR |
$1,071.43 |
76937 |
Us guide vascular access |
$1,619.15 |
76942 |
ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND I… |
$2,812.96 |
77076 |
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT |
$1,235.20 |
77079 |
CT BONE MINERAL DENSITY STUDY 1+SITS APPND |
$613.00 |
78075 |
ADRNL IMG CORTEX&/MEDULLA |
$3,618.00 |
78223 |
HIDA SCAN-HEPATBL DUX SYS IMG GLBLDR |
$2,509.00 |
78306 |
B1&/JT IMG WHBDY |
$3,893.49 |
78315 |
B1&/JT IMG 3 PHASE STD |
$4,373.79 |
78320 |
B1&/JT IMG TOMOG SPECT |
$3,891.25 |
78472 |
CARD BPI GTD=BRM PLNR 1 STD REST/STRS |
$3,518.15 |
80047 |
BASIC METABOLIC PANEL CALCIUM IONIZED |
$999.70 |
80048 |
METABOLIC PANEL BASIC |
$699.69 |
80050 |
General health panel |
$1,114.51 |
80051 |
ELECTROLYTE PANEL |
$556.19 |
80053 |
METABOLIC COMPRE PANEL |
$985.40 |
80061 |
LIPID PROFILE III |
$755.70 |
80074 |
HEPATITIS PANEL |
$1,368.96 |
80076 |
HEPATIC FUNCTION PANEL |
$862.28 |
80100 |
DRUG ABUSE PANEL II |
$191.04 |
80102 |
Drug confirmation, each procedure |
$523.13 |
80104 |
DRUG SCREEN |
$172.00 |
80175 |
DRUG SCREEN QUANTITATIVE LAMOTRIGINE |
$168.00 |
80178 |
LITHIUM |
$543.44 |
80196 |
SALICYLATE |
$332.33 |
80197 |
TACROLIMUS |
$1,091.40 |
80202 |
VANCOMYCIN PEAK |
$674.67 |
80300 |
DRUG SCREEN |
$221.00 |
80304 |
DRUG SCREEN |
$211.00 |
80305 |
DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUM… |
$312.79 |
80307 |
DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS |
$1,162.55 |
80320 |
DRUG SCREEN |
$501.12 |
80324 |
DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 |
$534.65 |
80329 |
DRUG SCREEN |
$621.61 |
80335 |
ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 |
$305.00 |
80345 |
DRUG SCREENING BARBITURATES |
$237.80 |
80346 |
DRUG SCREENING BENZODIAZEPINES 1-12 |
$326.38 |
80347 |
DRUG SCREENING BENZODIAZEPINES 13 OR MORE |
$525.00 |
80349 |
DRUG SCREENING CANNABINOIDS NATURAL |
$275.05 |
80351 |
DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6 |
$829.80 |
80352 |
DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE |
$451.07 |
80353 |
DRUG SCREENING COCAINE |
$222.95 |
80356 |
DRUG SCREENING HEROIN METABOLITE |
$212.68 |
80358 |
DRUG SCREENING METHADONE |
$349.24 |
80359 |
DRUG SCREENING METHYLENEDIOXYAMPHETAMINES |
$54.06 |
80361 |
DRUG SCREENING OPIATES 1 OR MORE |
$255.54 |
80362 |
DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 |
$378.24 |
80365 |
DRUG SCREENING OXYCODONE |
$57.76 |
80366 |
DRUG SCREENING PREGABALIN |
$227.86 |
80367 |
DRUG SCREENING PROPOXYPHENE |
$233.83 |
80373 |
DRUG SCREENING TRAMADOL |
$246.26 |
80374 |
DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS |
$420.00 |
81000 |
U/A DIPSTICK |
$115.42 |
81001 |
U/A DIP STICK |
$311.11 |
81002 |
URNLS DIP STICK/TABLET RG |
$104.29 |
81003 |
U/A W/O MICRO DIPSTICK |
$182.92 |
81007 |
URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK |
$292.30 |
81015 |
Urinalysis Microscopic Olny |
$196.44 |
81025 |
PREG.TST URINE VISUAL |
$360.94 |
82003 |
ACETAMINOPHEN |
$624.60 |
82009 |
KETONES-SERUM |
$162.42 |
82040 |
ALBUMIN; SERUM |
$243.19 |
82055 |
ALCOHOL-BLOOD |
$330.34 |
82075 |
ALCOHOL BREATH TEST |
$175.12 |
82140 |
Ammonia |
$495.41 |
82150 |
AMYLASE |
$505.61 |
82247 |
BILIRUBIN TOTAL |
$415.51 |
82248 |
BILIRUBIN DIRECT |
$285.34 |
82250 |
direct bilirubin |
$260.69 |
82253 |
MB FRACTION |
$154.00 |
82270 |
OCCULT BLOOD |
$226.28 |
82271 |
Occult blood other sources |
$190.95 |
82272 |
BLD OCLT PEROXIDASE ACTV |
$131.58 |
82274 |
BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 |
$250.45 |
82310 |
CALCIUM |
$306.94 |
82330 |
CALCIUM IONIZED |
$625.21 |
82355 |
CALCULUS QUALITATIVE ANALYSIS |
$428.40 |
82374 |
CARBON DIOXIDE BICARBONATE |
$225.75 |
82375 |
Under Chemistry Procedures |
$355.34 |
82435 |
CHLORIDE BLD |
$201.16 |
82465 |
CHOLESTEROL SERUM/WHOLE BLOOD TOTAL |
$413.05 |
82533 |
CORTISOL TOTAL |
$613.18 |
82540 |
CREATINE |
$298.50 |
82541 |
COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE |
$121.00 |
82550 |
CREATINE CK-TOTAL |
$384.08 |
82553 |
CREATINE CKMB |
$583.33 |
82565 |
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 |
IGC IMMUNOGLOBULIN |
$329.82 |
82785 |
GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE |
$279.38 |
82800 |
GASES BLD PH ONLY |
$152.39 |
82803 |
BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 |
$998.98 |
82805 |
GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY |
$1,137.03 |
82945 |
GLUCOSE BODY FLUID OTHER THAN BLOOD |
$306.91 |
82947 |
GLUCOSE |
$272.05 |
82948 |
GLUCOSE BLOOD REAGET STR |
$128.11 |
82962 |
GLUCOSE FINGER STICK |
$90.49 |
82977 |
GLUTAMYLTRANSFERASE-GTT |
$465.98 |
83009 |
HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE |
$754.60 |
83013 |
HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE |
$635.04 |
83036 |
HEMOGLOBIN GLYCOSYLATED A1C |
$404.62 |
83050 |
HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE |
$222.64 |
83520 |
IMMUNOASSAY ANALYTE QUANTITIATIVE NOS |
$526.79 |
83525 |
ASSAY OF INSULIN TOTAL |
$462.59 |
83540 |
IRON-TOTAL |
$439.93 |
83605 |
ASSAY OF LACTATE |
$516.66 |
83615 |
Lactate dehydrogenase (LD), (LDH); |
$397.33 |
83690 |
LIPASE |
$431.40 |
83718 |
LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL |
$200.17 |
83735 |
MAGNESIUM |
$334.53 |
83874 |
MYOGLOBIN |
$524.65 |
83880 |
B-TYPE NATRIURETIC |
$801.46 |
83992 |
ASSAY OF PHENCYCLIDINE |
$119.40 |
84075 |
ALK PHOS/PROFILE OR PANEL |
$352.13 |
84100 |
ASSAY OF PHOSPHORUS INORGANIC |
$281.09 |
84132 |
POTASSIUM SERUM PLASMA/WHOLE BLOOD |
$295.29 |
84155 |
PROTEIN,TOTAL,EXCEPT REFR |
$265.08 |
84157 |
PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC |
$358.64 |
84165 |
PROTEIN ELECTROPHORESIS |
$503.22 |
84295 |
SODIUM; SERUM |
$263.84 |
84403 |
ASSAY OF TESTOSTERONE TOTAL |
$684.51 |
84436 |
THYRIXINE TOTAL |
$360.99 |
84439 |
THYROXINE-FREE |
$483.87 |
84443 |
Thyroid stimulating hormone (TSH) |
$709.66 |
84450 |
Aspartate Aminotransferase |
$398.09 |
84460 |
ALT-TRANSFERASE;ALANINE |
$350.99 |
84478 |
ASSAY OF TRIGLYCERIDES |
$417.21 |
84479 |
THYROID HORMONE |
$192.77 |
84480 |
T3 TOTAL |
$499.84 |
84481 |
ASSAY OF TRIIODOTHYRONINE T3 FREE |
$512.06 |
84484 |
TROPONIN I |
$643.09 |
84512 |
TROPONIN QUAL |
$549.24 |
84520 |
Urea nitrogen |
$239.11 |
84550 |
URIC ACID |
$324.15 |
84560 |
URIC ACID OTH SRC |
$274.58 |
84702 |
HCG QUANTATIVE |
$648.05 |
84703 |
PREGNANCY TEST BLOOD |
$409.33 |
84999 |
UNLISTED CHEMISTRY PROCEDURE |
$263.60 |
85014 |
HEMATOCRIT |
$138.64 |
85018 |
HEMOGLOBIN |
$153.28 |
85025 |
BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC |
$319.06 |
85027 |
CBC W/O DIFF |
$433.25 |
85032 |
BLD# MNL C-CNT RBC/PLTLT EA |
$152.00 |
85044 |
RETICULOCYTE COUNT |
$450.15 |
85347 |
COAGJ TM ACTIVATED |
$294.08 |
85378 |
FIBRIN DEGRADATION PROD |
$468.06 |
85379 |
D-DIMER |
$586.24 |
85610 |
PROTHROMBIN TIME |
$301.03 |
85651 |
SEDIMENTATION RATE NONAUT |
$240.20 |
85652 |
SED RATE ERYTHROCYTE NON |
$236.85 |
85730 |
THROMBOPLASTIN TIME PART |
$344.03 |
86038 |
ANTINUCLEAR AB |
$513.72 |
86039 |
ANTINUCLEAR AB TITER |
$562.17 |
86060 |
ANTISTREPTOLYSIN O TITER |
$336.22 |
86140 |
C REACTIVE PROTEIN |
$427.25 |
86235 |
EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD |
$437.03 |
86256 |
SMOOTH MUSCLE AB TITER |
$447.63 |
86308 |
MONO,HETEROPHILE ANTIBODI |
$322.12 |
86320 |
IMMUNOELECTROPHORESIS |
$1,094.54 |
86328 |
COVID-19 RAPID ANTIBODY TEST SINGLE METHOD |
$346.72 |
86360 |
T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO |
$590.57 |
86403 |
MONO SPOT |
$266.70 |
86430 |
RHEUMATOID FACTOR |
$255.72 |
86431 |
RHEUMATOID FACTOR QUANTITATIVE |
$372.77 |
86592 |
Syphilis test, non-treponemal antibody; qualitative (eg, VD… |
$306.95 |
86593 |
SYPHILIS TEST, NON- TREPONEMAL ANTIBODY; QUANTITATIVE |
$261.59 |
86631 |
ANTB CHLAMYDIA |
$168.00 |
86644 |
ANTIBODY CYTOMEGALOVIRUS CMV |
$472.84 |
86645 |
ANTIBODY CYTOMEGALOVIRUS CMV IGM |
$520.96 |
86664 |
EPSTEIN-BARR VIRUS EBNA |
$406.28 |
86677 |
ANTIBODY HELICOBACTER PYLORI |
$533.88 |
86689 |
ANTB HTLV/HIV ANTB CONFIRMATION TST |
$587.05 |
86695 |
Antibody; herpes simplex, type 1 |
$217.00 |
86696 |
Antibody; herpes simplex, type 2 |
$148.00 |
86701 |
HIV SERUM |
$435.76 |
86702 |
ANTB HIV-2 |
$538.40 |
86703 |
Antibody; HIV-1 and HIV-2, single result |
$520.00 |
86704 |
HEPATITIS B CORE ANTIBODY HBCAB TOTAL |
$539.59 |
86705 |
HEPATITIS B CORE IGM |
$521.56 |
86706 |
HEPATITIS B SURF ANTIBODY HBSAB |
$512.28 |
86708 |
Hepatitis a antibody |
$339.70 |
86713 |
LEGIONELLA PNEUMONPILA AB |
$188.66 |
86756 |
ANTB RSV |
$224.52 |
86769 |
COVID-19 RAPID ANTIBODY TEST MULTIPLE STEP METHOD |
$401.71 |
86780 |
ANTIBODY TREPONEMA PALLIDUM |
$323.90 |
86787 |
Antibody; varicella-zoster |
$309.55 |
86803 |
HEPATITIS C ANTIBODY |
$563.61 |
86850 |
ANTB SCR RBC EA SERUM TQ |
$453.84 |
86900 |
Blood typing, serologic; ABO |
$284.77 |
86901 |
RH FACTOR-BLOOD |
$230.38 |
86906 |
BLD TYPING RH PHEXYPING COMPL |
$309.04 |
87040 |
BLOOD CULTURE |
$664.25 |
87045 |
CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL |
$533.49 |
87046 |
CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA |
$278.14 |
87070 |
CULTURE BODY FLUID |
$549.73 |
87075 |
CULTURE ANAEROBIC |
$741.98 |
87076 |
CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL |
$356.89 |
87077 |
CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL |
$382.06 |
87081 |
CULTURE, BACTERIAL-SCREEN |
$284.80 |
87086 |
URINE CULTURE |
$573.69 |
87088 |
CULTURE BCT ISOL&PRSMPTV |
$242.71 |
87103 |
Under Microbiology Culture and Typing Procedures |
$402.31 |
87106 |
CUL FNGI DEFINITIVE ID EA ORGANISM YEAST |
$271.54 |
87110 |
CHLAMYDIA CULTURE |
$496.58 |
87177 |
OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID |
$339.31 |
87186 |
Susceptibility studies, antimicrobial agent |
$254.00 |
87205 |
SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL |
$234.38 |
87207 |
SMR PRIM SRC SPEC STAIN |
$301.54 |
87209 |
SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS |
$268.63 |
87210 |
WET SMEAR |
$271.40 |
87252 |
VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT |
$611.29 |
87255 |
Herpes Simplex Virus Culture with Reflex Typing |
$387.00 |
87275 |
IAADI INF B VIRUS |
$218.67 |
87338 |
IAAD IA HPYLORI STOOL |
$407.93 |
87340 |
IAAD IA HEPATITIS B SURFACE ANTIGEN |
$378.05 |
87341 |
IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION |
$344.68 |
87389 |
HIV-1 AG W/HIV-1 & HIV-S AB |
$431.33 |
87400 |
INFLUENZA A&B |
$347.02 |
87403 |
Particle agglutination; screen, each antibody |
$350.00 |
87420 |
IAAD IA RESPIRATORY SYNCTIAL VIRUS |
$452.33 |
87425 |
ROTAVIRUS AG EIA |
$485.07 |
87426 |
COVID-19 RAPID ANTIGEN TESTING |
$488.56 |
87427 |
IAAD IA SHIGA-LIKE TOXIN |
$349.27 |
87428 |
Multiplex viral pathogen panel using Antigen technique for … |
$700.00 |
87430 |
INF AGT IMMUNO STREP A |
$260.23 |
87480 |
IADNA CANDIDA SPECIES DIRECT PROBE TQ |
$63.68 |
87486 |
IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ |
$642.05 |
87491 |
IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ |
$551.85 |
87493 |
INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE |
$634.41 |
87507 |
IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 |
$4,327.29 |
87529 |
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA &RNA) |
$685.64 |
87581 |
IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ |
$617.89 |
87591 |
IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ |
$483.52 |
87633 |
IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET |
$2,842.03 |
87635 |
IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ |
$351.58 |
87636 |
“severe acute respiratory syndrome coronavirus 2 (SARSCoV-2… |
$800.00 |
87661 |
INF AGENT DETECTED NUCLEIC ACID; TRICHMONAS VAGINALIS AMP P… |
$342.97 |
87798 |
O&P SMEAR W/AMPLIFIC |
$843.84 |
87800 |
IAADIADOO NEISSERIA GONORRHOEAE |
$197.23 |
87804 |
INFLUENZA IMMUNOASSAY OPT |
$342.53 |
87806 |
Infectious agent antigen detection by immunoassay with dire… |
$271.00 |
87807 |
INF AGT DET IMNAS OPT RSV |
$403.74 |
87847 |
NO DESCRIPTION |
$409.00 |
87850 |
NEISSERIA GONORRHOEAE DET |
$169.65 |
87880 |
RAPID STREP-BETA STREP |
$538.66 |
87905 |
INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS |
$394.50 |
88305 |
PATH SURG LEVEL IV |
$835.74 |
89050 |
CELL COUNT MISCELLANEOUS BODY FLUIDS |
$288.09 |
89051 |
CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT |
$350.71 |
89055 |
LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE |
$240.82 |
89060 |
CRYSTAL INDENTIFICATION |
$274.10 |
89220 |
SPTM OBTG SPEC AERSL INDUCED SPX |
$170.00 |
90471 |
IMMUN ADM 1 VAC |
$267.82 |
90660 |
INFLUENZA VIRUS INTRANASA |
$70.00 |
90688 |
Influenza virus vaccine, quadrivalent (IIV4), split virus, … |
$171.66 |
90700 |
DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM |
$217.72 |
90703 |
TETANUS TOXID |
$152.00 |
90714 |
TETANUS DIPHTHERIA TOXOID |
$326.81 |
90715 |
TDAP VACCINE |
$372.31 |
90718 |
TETANUS & DIPTHERIA |
$152.00 |
90746 |
HEPATITIS B VACCINE/ADULT |
$376.20 |
90765 |
IV NFS THER PROPH/DX 1ST |
$210.00 |
90997 |
HEMOPERFUSION |
$409.00 |
91105 |
GASTRIC INTUBATION/ASPER |
$596.00 |
91300 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2… |
$0.01 |
92002 |
OPH MEDICAL XM&EVAL INTRM |
$1.00 |
92081 |
VIS FLD XM UNI/BI I&R LMT |
$1.00 |
92552 |
PURE TONE AUDIOMTRY AIR O |
$1.00 |
92950 |
cardiopulmonary resuscitation |
$1,833.48 |
92960 |
CARDIOVERSION ELECTIVE ARRHYT XTRNL |
$2,730.97 |
93000 |
EKG W/INTREP AND REPORT |
$248.00 |
93005 |
Electrocardiogram, routine ECG |
$893.06 |
93010 |
RTN ECG 12 LEADS INTRP/RP |
$146.88 |
93018 |
CV STRS TST XERS&/OR RX CONT ECG I&R ONLY |
$475.61 |
93040 |
RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT |
$459.69 |
93041 |
RHYTHEM ECG 1-3 LDS |
$400.74 |
93042 |
RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON |
$118.40 |
93224 |
WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I |
$149.00 |
93306 |
ECHO TEST |
$4,090.66 |
93307 |
ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP |
$4,864.69 |
93308 |
ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD |
$3,013.64 |
93313 |
TEE R-T IMG 2D W/PROBE PLMT ONLY |
$1,934.28 |
93320 |
DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY |
$2,578.72 |
93325 |
DOP ECHOCARD COLOR FLOW VELOCITY MAPPING |
$2,596.69 |
93351 |
ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG |
$5,182.32 |
93631 |
INTRAOP EPICAR& ENDOCAR PACG& MAPG |
$10,386.84 |
93784 |
Orthostatic |
$387.84 |
93875 |
N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD |
$840.00 |
93880 |
DUP-SCAN XTRC ART COMPL B |
$2,396.12 |
93882 |
DUP-SCAN XTRC ART UNI/LMTD STD |
$1,996.50 |
93922 |
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL |
$1,329.03 |
93923 |
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS |
$1,863.04 |
93925 |
DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY |
$2,688.18 |
93926 |
DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD |
$1,959.69 |
93930 |
DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY |
$2,740.94 |
93931 |
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD |
$2,032.09 |
93965 |
QUANT VENOUS FLOW ST |
$1,806.00 |
93970 |
DUP-SCAN XTR VEINS COMPL |
$2,622.27 |
93971 |
DPLX SCN EXTRM VEINS |
$2,043.21 |
93975 |
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, P… |
$2,484.59 |
93976 |
DUPLEX SCAN- LIMITED |
$1,939.05 |
94010 |
SPIROMETRY W/RECORD |
$665.33 |
94060 |
BRNCDILAT RSPSE SPMTRY PR |
$1,279.67 |
94621 |
PULM STRS TSTG CPLX |
$2,408.02 |
94640 |
NEBULIZER TREATMENT |
$694.72 |
94644 |
INHALATION TREATMENT – CONTINUOUS 1ST HR |
$597.20 |
94664 |
DEMO&/EVAL OF PT UTILIZ |
$193.11 |
94760 |
EAR OR PULSE OXIMETRY |
$500.00 |
94761 |
N-INVAS EAR/PLS OXIMTRY F |
$376.62 |
94762 |
NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR |
$1,102.92 |
96360 |
IV INFUS INIT 31 MIN 1 HR |
$1,133.08 |
96361 |
IV INFUS HYDR EA ADD’T HR |
$457.51 |
96365 |
IV INFUSION THERAPY/PROPH |
$1,163.01 |
96366 |
IV INFUS THER PROPH/DX EA |
$442.96 |
96367 |
IV NFS THER PROPH/DX ADDL |
$721.25 |
96368 |
IV NFS TX PROPHYLAXIS/DX |
$471.98 |
96372 |
THERAPEUTIC PROPHYLACTIC/ |
$509.53 |
96373 |
INJECTION, INTRA-ARTERIAL |
$833.44 |
96374 |
THER PROPH/DX NJX IV PUSH |
$708.09 |
96375 |
THER PROPH/DX NJX EA SEQL |
$538.26 |
96376 |
SUB INFU EA ADD IV PUSH |
$578.76 |
96377 |
APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION |
$431.69 |
96379 |
INJECTION- UNLISTED THERAPEUTIC PROPH/DX/IVA NJX/NFS |
$1,641.63 |
97010 |
APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS |
$101.49 |
97110 |
Therapeutic procedure, 1 or more areas, each 15 minutes; th… |
$97.00 |
97116 |
THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR |
$432.70 |
97542 |
WHEELCHAIR MGMT EA 15 MIN |
$214.92 |
97597 |
DEBRIDEMENT OPEN WOUND 20 SQ CM/< |
$2,028.74 |
99000 |
SPECIMEN HANDLING |
$67.90 |
99001 |
COC COLLECITON ONLY |
$183.33 |
99024 |
POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX |
$298.50 |
99050 |
BLUE CROSS RQRD LVL3 |
$77.61 |
99053 |
SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HOUR FACILITY |
$150.00 |
99070 |
SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP |
$258.10 |
99080 |
MEDICAL RECORDS |
$46.00 |
99143 |
MOD SEDATION <5YRS 30 |
$439.00 |
99144 |
MOD SEDATION SERV UNDER 5 |
$433.00 |
99145 |
M-SEDAJ BY SM PHY 15 MIN |
$168.00 |
99149 |
MOD SEDATION |
$363.00 |
99151 |
MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS |
$694.07 |
99152 |
MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS |
$12.13 |
99153 |
MOD SED SAME PHYS/QHP EACH ADDL 15 MINS |
$10.20 |
99173 |
SCREENING TEST OF VISION |
$293.00 |
99217 |
OBSERVATION CARE DISCHARGE MANAGEMENT |
$942.81 |
99218 |
INITIAL OBSERVATION CARE/DAY 30 MINUTES |
$5,520.93 |
99219 |
INITIAL OBSERVATION CARE/DAY 50 MINUTES |
$1,400.49 |
99220 |
INITIAL OBSERVATION CARE/DAY 70 MINUTES |
$499.22 |
99224 |
SBSQ OBSERVATION CARE/DAY 15 MINUTES |
$107.00 |
99225 |
Subsequent observation care, per day, for the evaluation an… |
$865.80 |
99234 |
OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES |
$676.60 |
99235 |
OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES |
$1,800.00 |
99236 |
OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES |
$2,400.00 |
99281 |
E/M VISIT LEVEL 1 TECH COMP |
$0.01 |
99282 |
E/M VISIT LEVEL 2 TECH COMP |
$1,371.99 |
99283 |
E/M VISIT LEVEL 3 TECH COMP |
$2,694.72 |
99284 |
E/M VISIT LEVEL 4 TECH COMP |
$3,957.82 |
99285 |
E/M VISIT LEVEL 5 TECH COMP |
$5,492.84 |
99291 |
CRITICAL CARE 30-74 MIN |
$6,405.16 |
99292 |
CRITICAL CARE ADD 30 MIN |
$2,779.23 |
99406 |
SMOKING CESSATION 3-10 |
$109.98 |
99407 |
SMOKING CESSATION 10 MIN |
$176.94 |
A0394 |
ALS IV DRUG THERAPY SUPPLIES |
$1.00 |
A0396 |
ALS ESPOHAGEAL INTUB SUPPLIES |
$30.00 |
A4208 |
3 CC STERILE SYRINGE & NEEDLE |
$32.00 |
A4209 |
5+ CC STERILE SYRINGE & NEEDLE |
$35.00 |
A4213 |
20+ CC SYRINGE ONLY |
$7.00 |
A4215 |
NEEDLE STERILE, ANY SIZE, EACH |
$371.44 |
A4216 |
STERILE WATER/SALINE, FLUSH 10ML |
$139.30 |
A4217 |
STERILE SALINE WATER PER 500 ML |
$133.39 |
A4218 |
STERILE SALINE OR WATER |
$26.00 |
A4222 |
EXT UNFU PMP PER CASS/BAG |
$176.00 |
A4224 |
ALOCHOL OR PEROXIDE PER PINT |
$4.00 |
A4244 |
Alcohol or peroxide, per pint |
$13.98 |
A4245 |
Alcohol wipes, per box |
$13.98 |
A4246 |
BETADINE/PHISOHEX SOLUTION |
$25.00 |
A4247 |
BETADINE/IODINE SWABS/WIPES |
$378.30 |
A4248 |
Chlorhexidine containing antiseptic, 1 ml |
$5.00 |
A4252 |
GLUCOSE TEST STRIP-BLOOD KETONE TEST OR STRIP |
$6.00 |
A4270 |
DISPOSABLE ENDO CODE SHEATH |
$24.00 |
A4311 |
CATHETER W/O BAG 2 WAY LATEX |
$35.00 |
A4314 |
INSRT TRAY W/DRAINAGE BAG |
$319.21 |
A4315 |
Insertion tray with drainage bag with indwelling catheter, … |
$445.36 |
A4316 |
CATH W DRAINAGE 3 WAY |
$90.00 |
A4320 |
IRR TRAY W/BULB/PISTON SY |
$9.00 |
A4322 |
IRRIGATION SYRINGE, BULB |
$15.00 |
A4327 |
URIN CUP FEMALE COLLECT DEV CUP |
$3.00 |
A4332 |
LUBE STERILE PACKET |
$7.00 |
A4335 |
INCONTINENCE SUPPLY MISC |
$11.94 |
A4338 |
INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING |
$142.51 |
A4344 |
INDWELLING CATH FOLEY TYP |
$860.51 |
A4353 |
INTERMIT URINARY CATHETER |
$164.51 |
A4358 |
URINARY DRAINAGE BAG |
$50.34 |
A4364 |
DERMABOND- ADHESIVE, LIQUID OR EQUAL PER OZ |
$255.12 |
A4450 |
TAPE NO WATERPROOF |
$10.00 |
A4452 |
TAPE WATERPROOF 18 SQ IN |
$10.00 |
A4550 |
LACERATION- SURGICAL KIT |
$409.00 |
A4554 |
DISPOSABLE UNDERPADS |
$30.00 |
A4556 |
ELECTRODES, (E.G., APNEA MONITOR), PER PAIR |
$60.00 |
A4565 |
SLING |
$45.63 |
A4566 |
Shoulder sling or vest design, abduction restrainer, with o… |
$40.00 |
A4570 |
SPECIAL CASTING MATERIAL |
$125.00 |
A4590 |
3 ORTHO GLASS 4 SPECIAL CASTING MATERIAL |
$84.00 |
A4595 |
TENS SUPPL 2 LEAD PER MONTH |
$46.00 |
A4606 |
OXYGEN PROBE USED W OXIMETER |
$208.95 |
A4614 |
HAND HELD PEFR METER |
$50.00 |
A4615 |
CANNULA NASAL |
$124.77 |
A4616 |
TUBING (OXYGEN) PER FOOT |
$1.00 |
A4617 |
MOUTHPIECE FOR RESPIRATORY OXYGEN EQUIPMENT |
$55.00 |
A4649 |
SURGICAL SUPPLY MISC |
$6,352.32 |
A4653 |
PD CATHERTER ANCHOR BELT |
$13.00 |
A4657 |
SYRINGE W OR WO NEEDLE |
$7.00 |
A4670 |
AUTOMATIC BP MONITOR #11 |
$36.00 |
A4673 |
SALINE BLADE #11 |
$13.00 |
A4927 |
GLOVES NON STERILE |
$1.00 |
A4930 |
GLOVES STERILE PER PAIR |
$3.00 |
A5120 |
SWAB OR WIPE SKIN BARRIER |
$6.00 |
A5200 |
PERCUTANEOUS CATHETER ANCHOR |
$37.81 |
A6021 |
COLLAGEN DRESSING STERIL |
$133.67 |
A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, w… |
$16.17 |
A6205 |
COMPOSITE DRSG LESS THAN 48 SQ IN |
$22.00 |
A6210 |
FOAM DRSG LESS THAN 16=48 SQ IN W/ BORDER |
$101.92 |
A6211 |
FOAM DRG LESS THAN 16 LESS THAN 48 SQ IN WO BORDER |
$580.27 |
A6212 |
FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ IN OR LESS, EACH… |
$99.18 |
A6213 |
FOAM DRG 16-48 SQ IN W/BRDR |
$187.24 |
A6216 |
GAUZE NONIMPREG 16 SQ IN |
$13.00 |
A6217 |
GAUZE NON STERILE |
$88.12 |
A6218 |
GAUZE, NON STERILE |
$149.37 |
A6219 |
GAUZE- STERILE |
$42.36 |
A6220 |
GAUZE, NON IMP, STERILE, PAD SIZE >16 SQ < OR = 48SQ IN |
$34.39 |
A6222 |
GAUZE IMPREGNATED WITH ME |
$15.35 |
A6231 |
GAUZE, 16<SQ IN, EACH |
$70.00 |
A6250 |
SKIN SEAL PROTECT MOISTURIZER OINTMENT |
$98.03 |
A6260 |
WOUND CLEANSER |
$96.95 |
A6261 |
WOUND FILLER |
$423.60 |
A6402 |
GAUZE NON-IMPREG STERL 16 |
$40.83 |
A6407 |
PACK STRIPS NON-IMPREGNTD |
$89.35 |
A6410 |
STERILE EYE PAD OR STRIP |
$6.00 |
A6412 |
OCCLUSIVE EYE PATCH |
$30.00 |
A6413 |
ADHESIVE BANDAGE FIRST AI |
$6.00 |
A6446 |
CONFORMING BANDAGE NON-EL |
$19.00 |
A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, wi… |
$26.57 |
A6448 |
LT COMP BANDAGE LESS THAN 3IN |
$11.00 |
A6449 |
LIGHT COMP BANDAGE |
$11.00 |
A6450 |
LT COMPRS BANDAGE ELAST |
$17.00 |
A6453 |
BANDAGE SELF ADHER BAND W LESS THAN 3 |
$13.73 |
A6454 |
SELF ADHER BANDAGE |
$150.26 |
A6455 |
SELF ADHER BANDAGE |
$30.50 |
A6457 |
TUBULAR DRESSING |
$176.44 |
A7002 |
SUCTION TUBING USED W PUMP |
$75.62 |
A7003 |
ADMN SET SM VOL NONFILTER |
$57.00 |
A7011 |
NONDISPOS CORRUGATED TUBING |
$12.00 |
A7015 |
NEBULIZER MASK USED W NEBULIZER |
$57.00 |
A7016 |
DOME/MOUTHPEICE NEB |
$161.00 |
A7017 |
NEBULIZER MASK NOT USED W/ OXYGEN |
$57.00 |
A7520 |
TRACH LARYN TUBE NON CUFFED |
$563.31 |
A9150 |
NON PERSCRIPTION DRUG |
$21.55 |
A9273 |
HOT/COLD H2OBOT/CAP/COL/WRAP |
$32.00 |
A9284 |
NON-ELECTRONIC SPIROMETER |
$254.00 |
A9579 |
GAD-BASE MR CONTRAST NOS,1ML |
$137.01 |
C1751 |
Catheter, infusion, inserted peripherally, centrally or mid… |
$558.25 |
C9399 |
ORBACTIV 1200 MG IV |
$6,744.41 |
CASH |
XRAY DISC |
$17.00 |
E0110 |
CRUTCH FOREARM PAIR |
$225.00 |
E0114 |
CRUTCHES UNDERARM |
$97.93 |
E0116 |
CRTCH UNDARM NOT WOOD ADJ |
$59.00 |
E0220 |
HOT WATER BOTTLE |
$35.00 |
E0230 |
ICE CAP OR COLLAR |
$12.00 |
E0275 |
BED PAN STANDARD |
$11.00 |
E0325 |
URINAL MALE JUG-TYPE |
$7.00 |
E0352 |
DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM) |
$177.00 |
E04114 |
E04114 |
$41.00 |
E0445 |
OXIMETER NON-INVASIVE |
$578.00 |
E0570 |
NEBULIZER WITH COMPRESSION |
$677.00 |
E0580 |
NEBULIZER FOR USE W/ REGULAT |
$293.00 |
G0009 |
ADM PNEUMOCOCCAL VACCINE |
$185.38 |
G0168 |
WND CLS TISSUE ADHESIVE |
$270.55 |
G0378 |
HOSPITAL OBSERVATION SERVICES PER HOUR |
$2,000.00 |
G0434 |
DRUG ABUSE PANEL II |
$230.00 |
G2023 |
COVID-19 Testing specimen collection for severe acute respi… |
$30.00 |
J0120 |
TETRACYCLIN INJECTION |
$30.00 |
J0129 |
ABATACEPT INJECTION |
$25.00 |
J0131 |
INJECTION, ACETAMINOPHEN, 10 MG |
$30.00 |
J0153 |
ADENOSINE INJ 1MG |
$40.00 |
J0170 |
EPINEPHRINE 3 1/2 NDL 10M |
$12.44 |
J0171 |
ADRENALIN EPINEPHRINE INJECT |
$30.00 |
J0282 |
INJ AMIODARONE HYDROCHLOR |
$25.00 |
J0290 |
AMPICILLIN 500 MG INJ |
$50.00 |
J0295 |
INJ AMPCLLN SODIUM/SULBA |
$53.55 |
J0360 |
HYDRALAZINE HCL INJ UP TO 20MG |
$30.00 |
J0456 |
INJ AZITHROMYCIN 500MG |
$25.00 |
J0461 |
INJ ATROPINE SULFATE 0.01 |
$20.00 |
J0500 |
DICYCLOMINE HCL 20MG |
$45.00 |
J0515 |
INJ BENZTROPINE MESYLATE |
$19.02 |
J0558 |
PENG BENZATHINE/PROCAINE INJ |
$85.00 |
J0561 |
INJECTION PENICILLIN G BENZATHINE 100,000 UNITS |
$30.00 |
J0610 |
CALCIUM GLUCONATE INJECTION |
$30.00 |
J0690 |
KEFZOL 1 GR VIAL |
$25.00 |
J0692 |
INJ CEFEPIME HCI 500MG |
$55.60 |
J0696 |
ROCEPHIN 250 MG |
$30.00 |
J0697 |
STERILE CEFUROXIME INJECTION |
$25.00 |
J0735 |
CLONIDINE 1MG |
$25.00 |
J0744 |
CIPRO 200MG |
$30.00 |
J0760 |
COLCHICINE INJECTION |
$23.00 |
J0780 |
COMPAZINE 10 MG |
$20.00 |
J0840 |
Injection, crotalidae polyvalent immune fab (ovine), up to … |
$25.00 |
J1020 |
INJ METHYLPREDNISOLONE AC |
$20.00 |
J1030 |
DEPO MEDROL 40 MG/ML |
$22.00 |
J1040 |
METHYLPREDNISOLONE 80MG |
$25.00 |
J1094 |
DECADRON DEXAMETHASONE ACETATE 1MG |
$32.53 |
J1100 |
DECADRON 4 MG VIAL |
$21.00 |
J1110 |
INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG |
$240.00 |
J1170 |
DILAUDID 4 MG |
$35.00 |
J1200 |
BENADRYL 50MG |
$20.00 |
J1610 |
GLUCOGAN 1 MG VIAL |
$50.00 |
J1630 |
HALOPERIDOL INJECTION |
$39.70 |
J1631 |
HALOPERIDOL DECANOATE INJ PER 50 MG |
$45.00 |
J1642 |
HEPARIN SODIUM PER 10 UNI |
$20.00 |
J1644 |
INJ HEPARIN SOD PER 1000 |
$30.00 |
J1650 |
ENOXAPARIN SODIUM 10MG |
$25.00 |
J1741 |
IBUPROFEN INJECTION |
$22.00 |
J1810 |
DROPERIDOL/FENTANYL INJ |
$25.00 |
J1815 |
INJ INSULIN PER 5 UNITS |
$20.00 |
J1817 |
INSULIN FOR INSULIN PUMP USE |
$22.00 |
J1885 |
TORADOL INJ 15 MG |
$20.00 |
J1930 |
LANREOTIDE INJECTION |
$45.00 |
J1940 |
LASIX 40 MG IV VIAL |
$35.00 |
J1956 |
LEVOFLOXACIN 250 MG |
$45.00 |
J2001 |
LIDOCAINE HCI 10MG |
$30.00 |
J2060 |
ATIVAN 2ML SYRUP |
$35.00 |
J2175 |
DEMEROL 50 MG SYRINGE |
$25.00 |
J2180 |
MEPERIDINE/PROMETHAZINE INJ |
$30.00 |
J2250 |
MIDAZOLAM HCI PER 1 MG |
$30.00 |
J2270 |
INJ MORPHINE SULFATE 10 M |
$30.00 |
J2274 |
INJ MORPHINE PF EPID ITHC |
$30.00 |
J2360 |
ORPHENADRINE CITRATE 60MG |
$30.00 |
J2405 |
ONDANSETRON HCI, PER MG |
$21.00 |
J2410 |
OXYMORPHONE HCL INJECTION |
$25.00 |
J2425 |
PALIFERMIN INJECTION |
$25.00 |
J2504 |
PEGADEMASE BOVINE, 25 IU |
$25.00 |
J2543 |
ZOSYN – PIPERACILLIN/TAZOBACTAM |
$30.00 |
J2550 |
PHENERGAN 50 MG |
$35.00 |
J2704 |
INJECTION PROPOFOL 10 MG |
$22.00 |
J2765 |
METOCLOPRAMIDE HCL 10MG |
$30.00 |
J2770 |
QUINUPRISTIN/DALFOPRISTIN |
$405.68 |
J2780 |
INJ RANITIDINE 25 MG |
$20.00 |
J2800 |
METHOCARBAMOL INJECTION |
$50.00 |
J2920 |
SOLU-MEDROL 40MG |
$32.00 |
J2930 |
SOLU-MEDROL 125 MG |
$35.00 |
J3010 |
INJ FENTANYL CITRATE .1MG |
$33.00 |
J3030 |
IMITREX 6MG VIAL |
$50.00 |
J3260 |
TOBRAMYCIN SULFATE INJECTION |
$50.00 |
J3360 |
VALIUM INJ 5 MG |
$25.00 |
J3370 |
VANCOMYCIN HCI INJ 500MG |
$30.00 |
J3430 |
INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG |
$50.00 |
J3475 |
MAGNESIUM SULFATE 2CC AMP |
$20.00 |
J3480 |
POTASSIUM CHLORIDE 2 MG |
$125.00 |
J3490 |
UNCLASSIFIED DRUGS |
$31.00 |
J7030 |
INFUS NORM SALINE 1000CC |
$45.00 |
J7040 |
INFUS NORM SALINE 500ML |
$40.00 |
J7042 |
5% DEXTROSE |
$45.00 |
J7050 |
INFS NORM SALINE 250CC |
$48.00 |
J7070 |
INFUSION D5W 1000ML |
$20.00 |
J7120 |
RINGER’S LACTATE INFUS |
$50.00 |
J7121 |
5% DEXTROSE IN LAC RINGERS |
$50.00 |
J7131 |
HYPERTONIC SALINE SOL |
$20.00 |
J7192 |
FACTOR VIII RECOMBINANT NOS |
$20.00 |
J7313 |
FLUOCINOL ACET INTRAVIT IMP |
$20.00 |
J7506 |
PREDNISONE ORAL 5 MG |
$8.00 |
J7510 |
PREDNISOLONE ORAL 5 MG |
$15.00 |
J7611 |
ALBUTEROL 1MG CONC INHALA |
$35.00 |
J7613 |
ALBUT INHAL NON-CP 1MG |
$35.00 |
J7614 |
ALBUTEROL ALL FOMULATIONS |
$35.00 |
J7615 |
LEVALBTERAL INHALATION SO |
$35.00 |
J7620 |
ALBUTEROL 2.5 MG ATROVENT |
$35.00 |
J7631 |
CROMOLYN SODIUM NONCOMP UNIT |
$20.00 |
J7637 |
DEXAMETHASONE COMP CON |
$20.00 |
J7644 |
IPRATROPIUM BROMIDE INHAL |
$50.00 |
J7682 |
TOBRAMYCIN NON-COMP UNIT |
$25.00 |
J7699 |
NOC DRUGS INHAL SOL ADMIN |
$25.00 |
J8498 |
ENEMA SUPPOSITORY, ANTIEMETIC RECTAL |
$25.00 |
J8499 |
NONCHEMOTHERAPEUTIC ORAL |
$25.00 |
J9206 |
IRINOTECAN INJECTION |
$25.00 |
L0120 |
CERVICAL FLEX NONADJ COLL |
$142.78 |
L0172 |
CLAVICAL COLLAR 2 PC |
$139.39 |
L0174 |
Cervical, collar, semi-rigid, thermoplastic foam, two piece… |
$382.86 |
L1630 |
ABDUCT CONTROL HIP SEMI FLEX |
$41.00 |
L1812 |
Knee orthosis (KO), elastic with joints, prefabricated, off… |
$143.01 |
L1830 |
KNEE IMMOBOLIZER |
$180.48 |
L1906 |
ANKLE SUPPORT |
$163.75 |
L1960 |
Ankle foot orthosis (AFO), posterior solid ankle, plastic, … |
$2,358.00 |
L2116 |
Ankle foot orthosis (AFO), fracture orthosis, tibial fractu… |
$1,978.68 |
L2136 |
Knee-ankle-foot orthosis (KAFO), fracture orthosis, femoral… |
$1,720.92 |
L3260 |
SURGICAL BOOT/SHOE |
$413.25 |
L3650 |
SO FIGURE EIGHT ABDUCTION |
$158.72 |
L3670 |
SO ACROMIO/CLAVICULAR |
$351.28 |
L3762 |
Elbow orthosis (EO), rigid, without joints, includes soft i… |
$954.21 |
L3809 |
Wrist-hand-finger orthosis (WHFO), without joint(s), prefab… |
$824.25 |
L3908 |
WRIST EXTN CONTROL COCKUP |
$197.41 |
L3924 |
Hand finger orthosis (HFO), without joints, |
$158.50 |
L3930 |
HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINT… |
$405.96 |
L3999 |
UPPER LIMB ORTHOSIS NOS |
$176.00 |
L4350 |
AIR SPLINT |
$203.01 |
L4360 |
WALK BOOT PNEUMATIC |
$388.31 |
L4380 |
PNEUMATIC KNEE SPLINT |
$125.00 |
L4386 |
WALKING BOOT NON PNEUMATIC |
$420.80 |
L4387 |
NON-PNEUM WALK BOOT PRE OTS |
$305.30 |
L4631 |
Ankle foot orthosis (AFO) |
$1,399.17 |
M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion … |
$1,200.00 |
M0243 |
Intravenous infusion, casirivimab and imdevimab includes in… |
$1,200.00 |
M0245 |
intravenous infusion, bamlanivimab and etesevimab, includes… |
$1,200.00 |
P7001 |
CULTURE BACTERIAL URINE |
$89.00 |
P9612 |
CATHETERIZE FOR URINE |
$186.02 |
Q0144 |
AZITH DIHY ORAL CAP/POWD |
$172.69 |
Q0179 |
ONDANESTRONG HCL 8MG ORL |
$4.00 |
Q0239 |
Injection, bamlanivimab, 700 mg |
$0.01 |
Q0243 |
Injection, casirivimab and imdevimab, 2400 mg |
$0.01 |
Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
$0.01 |
Q0245 |
Injection, bamlanivimab and etesevimab, 2100 mg |
$0.01 |
Q4006 |
LONG ARM CAST ADULT |
$92.00 |
Q4007 |
CAST SUPPLIES LONG ARM CA |
$15.00 |
Q4008 |
CAST SUPPLIES LONG ARM |
$40.00 |
Q4009 |
CAST SUPPLIES SHORT ARM |
$140.00 |
Q4010 |
SHORT ARM CAST ADULT |
$55.00 |
Q4012 |
CAST SUPPLIES SHORT ARM |
$87.00 |
Q4020 |
LNG ARM SPLNT 0-10 YRS |
$39.00 |
Q4022 |
SHRT ARM SPLNT 11 YRS + |
$805.00 |
Q4034 |
CAST SUP LNG LEG CYLINDER FB |
$176.00 |
Q4037 |
CAST SUPPLIES SHORT LEG |
$146.00 |
Q4038 |
CAST SUP SHRT LEG FIBERGLASS |
$1,513.23 |
Q4039 |
CAST SUPPLIES SHORT LEG C |
$146.00 |
Q4042 |
LNG ARM SPLNT 11 YRS + |
$117.00 |
Q4046 |
SHRT LG SPLNT 11 YRS + |
$249.00 |
Q4049 |
FINGER SPLNT STATIC |
$206.00 |
Q4051 |
SPLINT SUPPLIES MISC |
$198.00 |
Q9954 |
ORAL MR CONTRAST, 100ML |
$193.03 |
Q9963 |
HI OSM CONTRST MATL 350-3 |
$51.73 |
Q9965 |
LOW OSMOLAR CON MAT PER M |
$34.49 |
Q9966 |
LOCM 200-299MG ML IODINE, 1ML |
$64.36 |
Q9967 |
LOW OSMOLAR CNTRS MAT |
$15.00 |
S0020 |
INJ, BUPIVICAINE, 30ML |
$216.80 |
S0028 |
INJECT FAMOTIDINE 20 MG |
$85.34 |
S0030 |
METRONIDAZOLE 500 MG INJ |
$193.46 |
S0077 |
CLANDAMYCIN PHOSPHATE 300 |
$57.93 |
S0119 |
ZOFRAN, 4MG, ORAL |
$96.22 |
S0164 |
PROTONIX PANTROPRAZOLE 40MG |
$137.54 |
S0622 |
PHYS EXAM FOR COLLEGE |
$87.00 |
S0630 |
RMV SUTURES; PHYS NOT PHY |
$179.78 |
S3000 |
BILAT DIL RETINAL EXAM |
$11.00 |
S5000 |
PRESCRIPTION DRUG GENERIC |
$10.00 |
S5001 |
PRESCRIPTION DRUG BAND NM |
$15.00 |
S5010 |
STERILE SALINE 5% DEXTROSE AND 0.45% SALINE |
$243.48 |
S5011 |
5% DEXTROSE 1000 ML |
$1.00 |
S5550 |
INSULIN RAPID 5 U |
$16.98 |
S8037 |
MRCP MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY |
$1,284.00 |
S8100 |
SPACER WITHOUT MASK |
$52.00 |
S8101 |
MASK NEBULIZER MASK SPACER WITH MASK |
$59.00 |
S8450 |
SPLINT |
$84.00 |
S8451 |
Splint, prefabricated, wrist or ankle |
$33.00 |
U0002 |
COVID-19 PCR Testing |
$327.39 |
V2799 |
Vision item or service, miscellaneous |
$25.00 |