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 &#60;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