Dallas Charge Master 04.09.21

CPT Code CPT Short Description CPT Default Price
0202U COVID-19 BioFire Respiratory Panel 2.1 (RP2.1) Testing $1,500.00
10060 INCISION/DRAINAGE ABSCESS $748.24
10061 INS/DRAIN ABSCESS COMPL $444.00
10081 I&D PILONIDAL CST COMP $590.00
10120 I & RMVL SUB-CUT SIMPLE $200.00
10121 I & RMVL FB, SUB-CUT,COMP $583.00
10160 PUNCTURE ASP OF ABSCESS $328.00
11011 DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC $263.00
11040 DBRDMT, SKIN, PARTIAL THICK $205.00
11042 DBRD SKN SUBQ TISSUE $1,098.00
11200 RMVL SKIN TAGS $294.00
11404 EXC BGN LSN TRUNK 3.1-4.0 $833.00
11730 AVULSION/1-NAIL PLATE $290.00
11740 EVAC SUBUNGUAL HEMATOMA $303.00
11750 EXC NAIL PART/COMP $619.00
11760 REPAIR NAIL BED $531.00
11765 WEDGE EXC SKIN/NAIL BED $341.00
11771 EXCISION PILONIDAL CYST SINUS EXTENSIVE $297.00
12001 LACERATION REPAIR $352.23
12002 REPAIR LAC SCALP 2.6-7.5 $430.00
12004 REPAIR LAC SCALP 7.6-12.5 $496.00
12005 REPAIR LAC,SCALP 12.6-20C $658.00
12011 REPAIR LAC FACE LESS THAN 2.5 CM $759.00
12013 REPAIR LAC FACE 2.6-5.0CM $526.00
12014 REPAIR LAC FACE 5.1-7.5CM $729.00
12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE $320.00
12031 LYR CLSR S/A/T/E 2.5CM $504.00
12032 REPAIR-INT SCALP 2.6-7.5 $761.00
12034 INTERM RPR SCLP/TRNK/EXTR $707.00
12035 REPAIR INTERM S/A/T/E 12. $318.00
12036 REPAIR INTERM S/A/T/E 20.1-30.0 CM $762.00
12041 LAYER CLSR NECK/HAND 2.6 $524.00
12042 REPAIR LAC HAND/FOOT 2.6- $883.00
12044 LYR CLSR N/H/F/ETRNL GENT $762.00
12045 REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM $760.00
12051 LAYER CLSR OF WND NCK/HND $594.00
12052 LYR CLSR WOUND 2.6-5.0FAC $708.00
12053 LYR CLSR F/E/E/N/L/M&/MUC $957.00
12054 REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM $865.00
13121 RPR CMPX SCALP ARM2.6-7.5 $1,236.00
13122 CMPLX RPR ADD 5 CM OR LES $531.00
13132 RPR CMPX FOREHEAD/CHECK/C $1,462.00
13151 CMPX RPR EYE NOSE 1.1-2.5 $1,055.00
13152 RPR CPLX E/N/E/L 2.6-7.5 $1,830.00
13153 REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM< $669.00
15850 SUTURE RMVL W/ANESTHESIA $653.00
16000 BURN, INITIAL TREATMENT $274.00
16020 BURN, DRESSING/DBRDMNT-SM $270.00
20552 TRIGGER POINT INJ 1-2 MUS $176.00
20600 ARTHROCENTESIS, SML JOINT $640.00
20605 ARTHROCENTESIS, MED JOINT $154.00
20610 ARTHROCENTESIS, LG JOINT $361.00
20611 Arthrocentesis, aspiration and/or injection, major joint or… $1,009.00
21310 CLTX NSL B1 FX W/O MNPJ $498.00
21480 CLDS TX TEMP DISLOCATION $452.00
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 $381.00
23650 SHOULDER DISLOCATION TRMT $934.00
24500 CLTX HUMRL SHFT FX W/O MN $378.00
24530 CLTX SPRCNDYLR/TRANSCNDYL $1,392.00
24576 CLTX HUMRL CNDLYR FX MEDI $381.00
24600 CLSD TX ELBOW DISLOCAT $650.00
24640 RADIAL HEAD SUBLUX. CHILD $519.00
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 $2,213.00
25530 CLSD TX ULNAR SHFT FX NO $378.00
25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION $715.00
25560 CLTX RDL&UR SHFT FXS W/O $378.00
25600 CLSD TX DISTAL RAD FX WO $1,045.00
25605 CLSD TX DISTAL RAD FX $1,992.00
25622 CLSD TX NAVICULAR FX WO M $650.00
25635 CLTTX CARPL B1 FX W/MNPJ EA B1 $1,085.00
25650 CLTX UR SYLOID FX $1,097.00
26010 I & D FINGER ABSCESS,SIMP $298.00
26600 CLSD TX METACARPAL FX $909.00
26605 CLSD TX MEDICARPAL FX $1,053.00
26607 CLTX MTCRPL FX W/MNP W/XT $1,670.00
26700 CLS TX MCP DISLOCATION $381.00
26720 CLSD TX PHALANGEAL SHFTFX $628.00
26725 CLTX PHLNGL FX PROX/MIDDL $1,027.00
26750 CLS TX FX FINGER/THUMB $618.00
26755 CLTX DSTL PHLNGL FX FNGR/ $792.00
26770 TREAT FINGER DISLOC FINGE $560.00
27220 CLTX ACETABULUM HIP/SOCKT FX W/O MNP $635.00
27372 REMOVAL FOREIGN BODY DEEP THIGH/KNEE $350.00
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 $1,366.00
27560 CLTX PATELLAR DISLC W/O A $381.00
27752 CLTX TIBL SFT FX W/MANP $1,968.00
27760 CLTX MEDIAL MALLS FX W/O $1,153.00
27780 CLTX PROX FIVULA/SHFT FX $1,055.00
27786 CLSD TX DISTAL FIBULAR FX $993.00
27792 Open treatment of distal fibular fracture (lateral malleolu… $5,342.00
27808 CLOSED TX BIMALLEOLAR ANK $507.00
27810 CLTX BIMAL ANKLE FX W/POT $1,704.00
27840 CLOSED TX ANKLE DISLOCATI $100.00
28190 RMVL FB BODY FOOT SUBQ $745.00
28192 RMVL FB FOOT DEEP $1,373.00
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 $840.00
28490 CLTX FX GRT TOE W/O MNLJ $594.00
28510 CLSD TX FX PLALANX/PHALAN $523.00
28515 FX CARE PHALANX NOT GREAT $622.00
28660 CLSD TX PIP JNT DISLOCATI $622.00
29075 APPLICATION CAST ELBOW FINGER SHORT ARM $610.93
29085 CAST HAND/LOWER FOREARM GAUNTLET $176.00
29105 LONG ARM SPLINT $176.00
29125 SHORT ARM SPLINT $532.80
29126 SHORT ARM SPLINT DYNAMIC $176.00
29130 APPLICATION FINGER SPLINT $176.00
29131 APPLICATION FINGER SPLINT DYNAMIC $364.17
29240 STRPG SHO $260.00
29280 STRAPPING HAND/FINGER $239.00
29505 LONG LEG SPLINT $176.00
29515 SHORT LEG SPLINT $176.00
29540 STRAPPING ANKLE/FOOT $220.00
29550 STRAPPING TOES $176.00
29580 STRAPPING UNNA BOOT $220.00
29700 RMVL/BIVALV GAUNTLET BOOT $127.00
30300 RMVL FOREIGN BODY NASAL $496.00
30901 NASAL PACKING $131.00
30903 CTRL NSL HEMRRG ANT CPLX $443.00
3120F 12-LEAD ECG PERFORMED $250.00
31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE $571.00
31502 TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT $891.00
31515 LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION $670.00
31525 LARGSC +-TRACHEOSCOPY DX $198.00
32551 TUBE THORACOSTOMY INCLUDES WATER SEAL $1,342.00
33415 RESCJ/INC SUBVALVULAR TISSUE $980.00
36000 INTRODUCTION OF NEEDLE/IN $244.00
36410 VENIPUNCTURE, 3 YRS OR OLDER $68.00
36415 VENIPUNCTURE $28.00
36416 COLL CAPILLARY BLG SPEC $41.00
36556 Insertion of non-tunneled centrally inserted central venous… $3,816.00
36558 INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR $2,156.00
36591 COLLECT BLOOD FROM IMPLAN $146.00
38300 DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL $303.00
40650 RPR LIP FULL THICKNESS $2,990.00
41800 DRNG ABSC DENTOALVEOLAR S $480.00
42700 I&D ABSC PRITONSILLAR $857.00
43753 GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING … $128.00
46040 I&D ISCHIOR/PRIRC ABSC SP $1,957.00
46050 INC/DRAIN PERIANAL ABS SU $1,111.00
46083 INCISION THROM HEMORRHOID $491.00
46320 ENULEATION EXCC OF EXT HE $612.00
51700 BLDR IRR SMPL LVG&/INSTLJ $97.00
51701 INSR NONDWELLING BLDR CAT $231.00
51702 INSERTION BLADDER CATH $361.00
51703 INSERT BLADDER CATH COMPL $569.00
56405 INC/DRAIN VULVA/PERINEAL $259.00
56420 I & D BARTHOLIN ABSCESS $100.00
59025 FTL NON-STRS TST $600.00
59409 VAG DLVR ONLY $3,960.00
62270 SPINAL PUNCTURE,LUMBAR $554.00
64400 NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH $2,743.00
64402 INJ ANESTHETIC FACIAL NRV $640.00
64450 INJ ANESTHETIC AGENT $1,312.50
64640 DSTRJ NULYT OTH PRPH NVR/BRANCH $1,220.00
65205 REMOVAL FB EYE-SUPERFCL $244.00
65220 RMVL FB EYE W/O SLIT LAMP $380.00
65222 RMVL FB EYE $449.00
67700 I&D ABSCESS EYELID $773.00
69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED $363.00
69200 RMVL FOREIGN BODY EAR $381.00
69205 RMVL FB XTRNL AUD CANAL A $409.00
69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL $340.00
69210 RMVL IMPACTED CERUMEN $196.00
70030 RADEX EYE DETCJ FB $396.01
70100 XRAY MANDIBLE LESS THAN 4 VIEWS $396.01
70110 XRAY MANDIBLE MIN 4 VIEWS $550.80
70120 RADEX MASTOIDS LESS THAN 3 VIEWS PR SIDE $459.00
70130 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE $396.01
70140 XRAY FACIAL BONES LESS THAN 3 VIEW $396.01
70150 XRAY FACIAL BONES GREATER THAN 3 VIEW $769.50
70160 NASAL BONE X-RAY $396.01
70200 RAD EXAM ORBIT COMP. $641.25
70210 RADEX SINUSES PARANASAL <3 VIEWS $523.37
70220 RAD EXAM SINUS COMPLETE $622.50
70250 SKULL LESS THAN 4 VIEWS $515.41
70260 RAD EXAM SKULL COMPLETE $970.20
70328 RADEX TMPRMAND JT OPN&CLSD MOUTH UNI $396.01
70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT $396.01
70350 CEPHALOGRAM ORTHODONTIC $257.00
70360 RAD EXAM NECK,SOFT TISSUE $493.52
70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL $4,022.10
70460 CT HEAD/BRAIN W/CONTRAST MATERIAL $5,317.20
70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL $6,624.71
70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL $2,718.75
70481 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL $4,801.50
70482 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR $6,740.13
70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL $3,129.30
70487 CT MAXILLOFACIAL W/CONTRAST MATERIAL $3,352.50
70488 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL $6,586.13
70490 CT NECK WO CONTRAST $3,020.00
70491 CT SOFT TISS NCK C+MATRL $3,502.00
70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST $4,026.60
70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST $6,792.87
70544 MRA HEAD C-MATRL $5,975.25
70547 MRA NECK C-MATRL $5,178.55
70551 MRI BRN BRN STEM C-MATRL $4,780.20
70553 MRI BRN BRN STEM C-/C+ $6,492.28
71045 RADIOLOGIC EXAM CHEST SINGLE VIEW $583.20
71046 CHEST XRAY 2 VIEWS $563.25
71047 RADIOLOGIC EXAM CHEST 3 VIEWS $818.89
71048 RADIOLOGIC EXAM CHEST 4+ VIEWS $899.48
71060 BRONCHOGRAPHY BI RS&I $537.00
71100 RIBS UNILATERAL 2 VIEWS $505.50
71101 RIB UNILATERAL W CHEST $848.25
71110 RIBS BILATERAL 3 VIEWS $689.25
71111 RIBS BILATERAL W/CHEST $509.25
71120 Radiologic examination; sternum, minimum of 2 views $511.50
71250 CT CHEST W/O CONTRAST $3,519.00
71260 CT THORAX W/CONTRAST $5,201.25
71270 CT THORAX WO CONTRAST $5,636.25
71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST $3,605.88
71550 MRI CH C-MATRL $4,454.40
72020 SPINE SINGLE VIEW $428.25
72040 SPINE, CERVICAL 2/3 VIEWS $541.50
72050 SPINE, CERVICAL MIN 4VIEW $733.50
72052 SPINE CERV. COMP FLEX/EXT $608.94
72069 RADEX SPI THORACOLMBR STANDING SCOLIOSIS $374.00
72070 SPINE THORACIC 2 VIEWS $649.80
72072 SPINE THORACIC 3 VIEWS $797.40
72074 RAD EXAN SPINE THROAC 4 V $396.01
72080 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS $515.41
72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW $1,086.54
72100 SPINE LUMBO. MIN 4 VIEWS $649.80
72110 LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS $961.17
72114 RAD EXAM SPINE LUMBO COMP $608.94
72120 SPINE LUMBAR AP & LAT W F $608.94
72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL $4,072.90
72126 CT CERVICAL SPINE W/CONTRAST MATERIAL $5,183.75
72127 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL $5,523.70
72128 CT THRC SPI C-MATRL $4,683.75
72129 CT THRC SPI C+ MATRL $3,564.00
72130 CT THORACIC SPINE W/O & W/CONTRAST MATERIAL $6,373.50
72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL $5,620.50
72132 CT LUMBAR SPINE W/CONTRAST MATERIAL $7,483.40
72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL $8,455.51
72141 MRI SPI CANAL&CNTS CRV C-MATRL $4,780.20
72146 MRI SPI CANAL&CNTS THRC C-MATRL $4,780.20
72148 MRI SPI CANAL&CNTS LMBR C-MATRL $4,780.20
72156 MRI SPI CANAL&CNTS C-/C+ CRV $6,047.38
72157 MRI SPI CANAL&CNTS C-/C+ $4,402.50
72158 MRI SPI CANAL&CNTS C-/C+ LMBR $6,047.38
72170 RAD EXAM PELVIS 1/2 VEIW $793.80
72190 RADEX PELVIS COMPL MIN 3 $396.01
72191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST $4,743.70
72192 CT PELVIS WO CONTRAST $4,168.00
72193 TOMOGRAPHY PELVIS WCONTRS $2,750.00
72194 CT PELVIS W OR WO CONTRST $7,574.00
72195 MRI PELVIS C-MATRL $4,454.40
72196 MRI PELVIS C+ MATRL $5,194.80
72220 XRAY COCCYX/SACRUM $396.01
72270 MYELOGRAPY 2/MORE REGIONS RS&I $4,354.12
73000 XRAY CLAVICLE 2 VIEWS $396.01
73010 SCAPULA COMPLETE $396.01
73020 RADEX SHO 1 VIEW $598.00
73030 SHOULDR COMPLETE 2 VIEWS $612.90
73050 XRAY AC JOINTS-BILAT $396.01
73060 XRAY HUMERUS MIN 2 VIEWS $550.80
73070 XRAY ELBOW 2 VIEWS $598.00
73080 XRAY ELBOW GREATER THAN 3 VIEWS-COMP $388.05
73090 XRAY FOREARM AP & LAT $594.90
73100 XRAY WRIST AP & LAT VIEW $534.60
73110 XRAY WRIST/COMP MIN 3 VIE $396.01
73120 XRAY HAND AP & LAT $488.70
73130 XRAY HAND MIN 3 VIEWS $550.80
73140 XRAY FINGER MIN 2 VIEWS $461.68
73200 CT UPPR EXTR WO CNTRS $3,309.75
73201 CT UPPER EXTREMITY W/CONTRAST MATERIAL $5,778.90
73202 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL $6,740.13
73220 MRI UXTR OTH/THN JT C-/C+ $4,402.50
73221 MRI ANY JT UXTR C-MATRL $4,365.00
73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW $545.30
73502 RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN P… $894.90
73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS $1,142.26
73520 HIPS BILAT MIN 2 VIEW INC $507.00
73522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS $1,286.54
73551 RADIOLOGIC EXAMINATION FEMUR 1 VIEW $523.37
73552 FEMUR; MIN 2 VIEWS $610.50
73560 XRAY KNEE, SUNRISE VIEW $424.87
73562 XRAY KNEE MIN 3 VIEWS $543.27
73564 RAD EXAM KNEE 4 OR MORE $585.90
73565 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST $396.01
73580 X-RAY KNEE.BILATERAL STANDING $2,563.12
73590 XRAY TIBIA/FIBULA AP/LAT $396.01
73592 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS $396.01
73600 XRAY ANKLE 2 VIEWS $547.25
73610 XRAY ANKLE 3 VIEWS/COMPLE $685.80
73620 XRAY FOOT MIN 2 VIEWS $498.50
73630 XRAY FOOT MIN 3 VIEWS $691.53
73650 RAD EXAN HEEL MIN 2 VIEWS $396.01
73660 XRAY TOES, MIN 2 VIEWS $467.10
73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL $4,390.94
73701 CT LWR EXT W CONT $6,388.90
73702 CT LXTR C-/C+ $5,080.50
73718 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL $4,678.49
73721 MRI ANY JT LXTR C-MATRL $4,365.00
73722 MRI ANY JT LXTR C+ MATRL $5,106.00
73723 MRI ANY JT LXTR C-/C+ $6,503.75
73725 MRA LXTR C+-MATRL $6,163.30
74000 RAD EXAM ABD SINGL ANTER $759.00
74010 RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS $426.00
74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW $588.60
74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS $725.25
74020 RAD EXAM ABDOMEN COMPL $454.00
74021 RADIOLOGIC EXAM ABDOMEN 3+ VIEWS $688.80
74022 RAD EXAM COMPLETE ABD $1,360.80
74150 CT ABDOMEN W/O CONTRAST MATERIAL $3,407.20
74160 CT ABDOMEN W/CONTRAST MATERIAL $4,816.50
74170 CT ABDOMEN W/O & W/CONTRAST MATERIAL $5,528.25
74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG $7,019.00
74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST $5,196.80
74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL $4,588.65
74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL $5,702.97
74178 CT ABD & PELVIS 1 PLUS SECTION/REGNS $6,905.88
74181 MRI ABD C-MATRL $4,780.20
74183 MRI ABD C-/C+ $6,047.38
74190 PERITONEOGRAM RS&I $2,192.98
74240 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB $718.39
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 … $1,108.43
74247 RADEX GI UPR C+ +-GLUC +-DYLD FLMS W/KUB $1,010.00
74250 RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES $768.14
74251 RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE $1,430.81
74283 Therapeutic enema, contrast or air, for reduction of intuss… $1,408.00
74328 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I $3,320.40
74329 ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I $2,701.60
74330 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I $386.06
74340 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I $228.85
74440 VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I $2,857.80
75574 CT CORONARY $3,360.60
76376 3D RNDR I&R CT MRI US/OTH $543.27
76380 CT LIMITED/LOCALIZED FOLLOW UP STUDY $1,293.50
76536 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK $1,133.10
76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION $769.14
76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE $893.51
76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED $648.74
76645 US BREAST R-T W/IMAGE DOCUMENTATION $784.06
76700 US ABDOMINAL R-T W/IMAGE $1,504.80
76705 US ABDOMINAL $1,151.10
76706 Ultrasound, abdominal aorta, real time with image documenta… $901.00
76770 US RETROPERITONEAL R-T W/ $1,174.50
76775 US RPR B-SCAN&/R-T IMG LMTD $1,089.90
76801 ULTRASOUND 14 WK TABDL 1/1ST GESTATION $700.48
76802 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION $700.48
76805 US PG UTER F&MAT AFTER 1S $881.57
76810 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO $894.51
76815 ULTRASND PG UTER $525.36
76816 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS $851.72
76817 UT PG UTER R-T IMG TRVG $581.08
76830 TRANSVAGINAL ULTRASOUND $487.50
76856 US PELVIC NONOB REAL-TIME $1,089.75
76857 PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 $624.00
76870 US SCROTUM&CNTS $1,004.40
76880 US EXTREMITY $913.00
76881 US COMPL JOINT R-T W/IMAGE DOCUMENTATION $801.97
76882 ULTRASOUND, EXTREMITY, NON VASCULAR $155.22
76942 ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND I… $1,485.00
77076 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT $275.00
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 $1,701.00
78315 B1&/JT IMG 3 PHASE STD $2,022.00
78320 B1&/JT IMG TOMOG SPECT $923.00
78472 CARD BPI GTD=BRM PLNR 1 STD REST/STRS $2,047.71
80047 BASIC METABOLIC PANEL CALCIUM IONIZED $571.13
80048 METABOLIC PANEL BASIC $163.18
80051 ELECTROLYTE PANEL $414.92
80053 METABOLIC COMPRE PANEL $689.54
80061 LIPID PROFILE III $452.73
80074 HEPATITIS PANEL $508.94
80076 HEPATIC FUNCTION PANEL $484.57
80100 DRUG ABUSE PANEL II $191.04
80102 Drug confirmation, each procedure $523.13
80104 DRUG SCREEN $172.00
80178 LITHIUM $456.71
80196 SALICYLATE $332.33
80197 TACROLIMUS $452.70
80202 VANCOMYCIN PEAK $390.04
80300 DRUG SCREEN $221.00
80304 DRUG SCREEN $211.00
80305 DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUM… $143.00
80307 DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS $763.20
80320 DRUG SCREEN $143.28
80324 DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 $407.70
80329 DRUG SCREEN $151.24
80335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 $165.17
80345 DRUG SCREENING BARBITURATES $286.20
80346 DRUG SCREENING BENZODIAZEPINES 1-12 $246.26
80347 DRUG SCREENING BENZODIAZEPINES 13 OR MORE $525.00
80349 DRUG SCREENING CANNABINOIDS NATURAL $298.06
80351 DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6 $829.80
80352 DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE $655.20
80353 DRUG SCREENING COCAINE $302.10
80356 DRUG SCREENING HEROIN METABOLITE $212.68
80358 DRUG SCREENING METHADONE $362.18
80359 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES $88.06
80361 DRUG SCREENING OPIATES 1 OR MORE $298.50
80362 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 $296.51
80365 DRUG SCREENING OXYCODONE $37.56
80366 DRUG SCREENING PREGABALIN $227.86
80367 DRUG SCREENING PROPOXYPHENE $233.83
80373 DRUG SCREENING TRAMADOL $256.71
80374 DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS $420.00
81000 U/A DIPSTICK $115.42
81001 U/A DIP STICK $176.12
81002 URNLS DIP STICK/TABLET RG $37.81
81003 U/A W/O MICRO DIPSTICK $37.81
81007 URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK $288.55
81025 PREG.TST URINE VISUAL $95.52
82003 ACETAMINOPHEN $624.60
82009 KETONES-SERUM $36.00
82040 ALBUMIN; SERUM $133.33
82055 ALCOHOL-BLOOD $330.34
82075 ALCOHOL BREATH TEST $175.12
82140 Ammonia $278.60
82150 AMYLASE $220.89
82247 BILIRUBIN TOTAL $311.44
82248 BILIRUBIN DIRECT $179.10
82250 direct bilirubin $260.69
82253 MB FRACTION $154.00
82270 OCCULT BLOOD $102.49
82272 BLD OCLT PEROXIDASE ACTV $47.76
82274 BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 $177.11
82310 CALCIUM $174.13
82330 CALCIUM IONIZED $476.61
82355 CALCULUS QUALITATIVE ANALYSIS $428.40
82374 CARBON DIOXIDE BICARBONATE $185.07
82375 Under Chemistry Procedures $188.80
82435 CHLORIDE BLD $178.11
82465 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL $197.01
82533 CORTISOL TOTAL $243.03
82540 CREATINE $433.82
82541 COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE $121.00
82550 CREATINE CK-TOTAL $71.64
82553 CREATINE CKMB $149.25
82565 CREATININE $194.03
82607 VITAMIN B-12 $297.51
82693 ASSAY OF ETHYLENE GLYCOL $158.45
82747 ASSAY OF FOLIC ACID RBC $372.13
82784 IGC IMMUNOGLOBULIN $84.33
82785 GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE $152.73
82800 GASES BLD PH ONLY $130.00
82803 BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 $284.57
82805 GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY $889.10
82945 GLUCOSE BODY FLUID OTHER THAN BLOOD $169.15
82947 GLUCOSE $169.15
82948 GLUCOSE BLOOD REAGET STR $166.66
82962 GLUCOSE FINGER STICK $47.76
82977 GLUTAMYLTRANSFERASE-GTT $391.04
83009 HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE $754.60
83013 HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE $742.50
83036 HEMOGLOBIN GLYCOSYLATED A1C $195.02
83050 HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE $107.46
83520 IMMUNOASSAY ANALYTE QUANTITIATIVE NOS $570.00
83525 ASSAY OF INSULIN TOTAL $167.16
83540 IRON-TOTAL $133.33
83605 ASSAY OF LACTATE $548.74
83615 Lactate dehydrogenase (LD), (LDH); $275.62
83690 LIPASE $241.79
83718 LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL $71.89
83735 MAGNESIUM $258.70
83874 MYOGLOBIN $113.93
83880 B-TYPE NATRIURETIC $549.75
83992 ASSAY OF PHENCYCLIDINE $225.00
84075 ALK PHOS/PROFILE OR PANEL $99.50
84100 ASSAY OF PHOSPHORUS INORGANIC $180.10
84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD $209.95
84155 PROTEIN,TOTAL,EXCEPT REFR $166.17
84157 PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC $425.86
84165 PROTEIN ELECTROPHORESIS $120.40
84295 SODIUM; SERUM $208.95
84403 ASSAY OF TESTOSTERONE TOTAL $213.18
84436 THYRIXINE TOTAL $133.33
84439 THYROXINE-FREE $319.40
84443 Thyroid stimulating hormone (TSH) $587.05
84450 Aspartate Aminotransferase $99.50
84460 ALT-TRANSFERASE;ALANINE $91.54
84478 ASSAY OF TRIGLYCERIDES $351.24
84479 THYROID HORMONE $209.95
84480 T3 TOTAL $155.72
84481 ASSAY OF TRIIODOTHYRONINE T3 FREE $356.21
84484 TROPONIN I $369.15
84512 TROPONIN QUAL $549.24
84520 Urea nitrogen $178.11
84550 URIC ACID $166.17
84560 URIC ACID OTH SRC $167.16
84702 HCG QUANTATIVE $492.30
84703 PREGNANCY TEST BLOOD $149.25
84999 UNLISTED CHEMISTRY PROCEDURE $179.10
85014 HEMATOCRIT $81.59
85018 HEMOGLOBIN $81.59
85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC $268.65
85027 CBC W/O DIFF $125.37
85032 BLD# MNL C-CNT RBC/PLTLT EA $152.00
85044 RETICULOCYTE COUNT $248.75
85347 COAGJ TM ACTIVATED $83.58
85378 FIBRIN DEGRADATION PROD $93.53
85379 D-DIMER $140.54
85610 PROTHROMBIN TIME $182.09
85651 SEDIMENTATION RATE NONAUT $177.11
85652 SED RATE ERYTHROCYTE NON $51.74
85730 THROMBOPLASTIN TIME PART $117.41
86038 ANTINUCLEAR AB $486.56
86039 ANTINUCLEAR AB TITER $477.60
86060 ANTISTREPTOLYSIN O TITER $291.54
86140 C REACTIVE PROTEIN $399.99
86235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD $463.67
86256 SMOOTH MUSCLE AB TITER $251.24
86308 MONO,HETEROPHILE ANTIBODI $99.50
86320 IMMUNOELECTROPHORESIS $48.76
86328 COVID-19 RAPID ANTIBODY TEST SINGLE METHOD $297.00
86360 T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO $300.49
86403 MONO SPOT $221.89
86430 RHEUMATOID FACTOR $300.49
86431 RHEUMATOID FACTOR QUANTITATIVE $219.90
86592 Syphilis test, non-treponemal antibody; qualitative (eg, VD… $281.59
86593 SYPHILIS TEST, NON- TREPONEMAL ANTIBODY; QUANTITATIVE $65.67
86631 ANTB CHLAMYDIA $111.94
86644 ANTIBODY CYTOMEGALOVIRUS CMV $408.60
86645 ANTIBODY CYTOMEGALOVIRUS CMV IGM $450.74
86664 EPSTEIN-BARR VIRUS EBNA $133.00
86677 ANTIBODY HELICOBACTER PYLORI $454.72
86689 ANTB HTLV/HIV ANTB CONFIRMATION TST $820.88
86701 HIV SERUM $131.34
86702 ANTB HIV-2 $536.25
86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL $505.46
86705 HEPATITIS B CORE IGM $455.40
86706 HEPATITIS B SURF ANTIBODY HBSAB $359.20
86713 LEGIONELLA PNEUMONPILA AB $133.33
86756 ANTB RSV $143.00
86769 COVID-19 RAPID ANTIBODY TEST MULTIPLE STEP METHOD $325.00
86780 ANTIBODY TREPONEMA PALLIDUM $113.18
86787 Antibody; varicella-zoster $450.74
86803 HEPATITIS C ANTIBODY $517.40
86850 ANTB SCR RBC EA SERUM TQ $248.75
86900 Blood typing, serologic; ABO $141.29
86901 RH FACTOR-BLOOD $135.32
86906 BLD TYPING RH PHEXYPING COMPL $86.00
87040 BLOOD CULTURE $400.99
87045 CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL $198.01
87046 CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA $198.01
87070 CULTURE BODY FLUID $167.16
87075 CULTURE ANAEROBIC $485.10
87076 CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL $523.37
87077 CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL $155.22
87081 CULTURE, BACTERIAL-SCREEN $81.59
87086 URINE CULTURE $99.00
87088 CULTURE BCT ISOL&PRSMPTV $61.69
87106 CUL FNGI DEFINITIVE ID EA ORGANISM YEAST $151.24
87110 CHLAMYDIA CULTURE $259.70
87177 OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID $206.46
87205 SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL $100.74
87207 SMR PRIM SRC SPEC STAIN $189.05
87209 SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS $262.68
87210 WET SMEAR $83.58
87252 VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT $394.02
87255 Herpes Simplex Virus Culture with Reflex Typing $432.83
87275 IAADI INF B VIRUS $220.89
87338 IAAD IA HPYLORI STOOL $220.89
87340 IAAD IA HEPATITIS B SURFACE ANTIGEN $332.33
87341 IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION $501.60
87389 HIV-1 AG W/HIV-1 & HIV-S AB $467.65
87400 INFLUENZA A&B $95.52
87420 IAAD IA RESPIRATORY SYNCTIAL VIRUS $987.78
87425 ROTAVIRUS AG EIA $389.05
87426 COVID-19 RAPID ANTIGEN TESTING $353.00
87427 IAAD IA SHIGA-LIKE TOXIN $447.60
87428 Multiplex viral pathogen panel using Antigen technique for … $700.00
87430 INF AGT IMMUNO STREP A $220.89
87480 IADNA CANDIDA SPECIES DIRECT PROBE TQ $231.84
87486 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ $579.60
87491 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ $403.28
87493 INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE $497.50
87507 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 $3,998.40
87529 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA &RNA) $601.50
87581 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ $429.17
87591 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ $289.05
87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET $2,061.60
87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ $301.00
87636 “severe acute respiratory syndrome coronavirus 2 (SARSCoV-2… $800.00
87661 INF AGENT DETECTED NUCLEIC ACID; TRICHMONAS VAGINALIS AMP P… $460.80
87798 O&P SMEAR W/AMPLIFIC $702.00
87800 IAADIADOO NEISSERIA GONORRHOEAE $197.23
87804 INFLUENZA IMMUNOASSAY OPT $168.00
87807 INF AGT DET IMNAS OPT RSV $42.00
87847 NO DESCRIPTION $409.00
87850 NEISSERIA GONORRHOEAE DET $169.65
87880 RAPID STREP-BETA STREP $200.99
87905 INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS $394.50
88305 PATH SURG LEVEL IV $405.96
89050 CELL COUNT MISCELLANEOUS BODY FLUIDS $134.33
89051 CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT $127.36
89055 LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE $98.51
89060 CRYSTAL INDENTIFICATION $105.47
89220 SPTM OBTG SPEC AERSL INDUCED SPX $98.00
90471 IMMUN ADM 1 VAC $154.23
90660 INFLUENZA VIRUS INTRANASA $70.00
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, … $525.30
90700 DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM $231.60
90703 TETANUS TOXID $152.00
90714 TETANUS DIPHTHERIA TOXOID $374.32
90715 TDAP VACCINE $116.00
90718 TETANUS & DIPTHERIA $152.00
90746 HEPATITIS B VACCINE/ADULT $79.00
90765 IV NFS THER PROPH/DX 1ST $210.00
90997 HEMOPERFUSION $409.00
91105 GASTRIC INTUBATION/ASPER $596.00
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 $1,301.00
92960 CARDIOVERSION ELECTIVE ARRHYT XTRNL $1,089.00
93000 EKG W/INTREP AND REPORT $248.00
93005 Electrocardiogram, routine ECG $534.00
93010 RTN ECG 12 LEADS INTRP/RP $624.00
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 $146.00
93042 RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON $340.29
93224 WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I $149.00
93306 ECHO TEST $1,367.00
93307 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP $3,524.29
93308 ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD $2,795.40
93313 TEE R-T IMG 2D W/PROBE PLMT ONLY $2,626.00
93320 DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY $1,457.30
93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING $1,480.10
93351 ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG $1,560.00
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 $903.00
93882 DUP-SCAN XTRC ART UNI/LMTD STD $903.00
93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL $557.20
93923 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS $845.75
93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY $923.36
93926 DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD $878.00
93930 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY $923.36
93931 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD $466.00
93965 QUANT VENOUS FLOW ST $1,806.00
93970 DUP-SCAN XTR VEINS COMPL $1,201.96
93971 DPLX SCN EXTRM VEINS $645.00
93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, P… $514.00
93976 DUPLEX SCAN- LIMITED $466.00
94010 SPIROMETRY W/RECORD $150.00
94060 BRNCDILAT RSPSE SPMTRY PR $385.00
94621 PULM STRS TSTG CPLX $1,029.00
94640 NEBULIZER TREATMENT $873.65
94644 INHALATION TREATMENT – CONTINUOUS 1ST HR $157.00
94664 DEMO&/EVAL OF PT UTILIZ $1.00
94760 EAR OR PULSE OXIMETRY $25.87
94761 N-INVAS EAR/PLS OXIMTRY F $238.00
94762 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR $644.76
96360 IV INFUS INIT 31 MIN 1 HR $634.50
96361 IV INFUS HYDR EA ADD’T HR $356.21
96365 IV INFUSION THERAPY/PROPH $497.50
96366 IV INFUS THER PROPH/DX EA $356.21
96367 IV NFS THER PROPH/DX ADDL $470.64
96368 IV NFS TX PROPHYLAXIS/DX $263.00
96372 THERAPEUTIC PROPHYLACTIC/ $87.56
96373 INJECTION, INTRA-ARTERIAL $228.00
96374 THER PROPH/DX NJX IV PUSH $441.78
96375 THER PROPH/DX NJX EA SEQL $402.98
96376 SUB INFU EA ADD IV PUSH $388.05
96377 APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION $232.83
96379 INJECTION- UNLISTED THERAPEUTIC PROPH/DX/IVA NJX/NFS $213.00
97010 APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS $101.49
97116 THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR $302.48
97542 WHEELCHAIR MGMT EA 15 MIN $278.60
97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/< $638.79
99000 SPECIMEN HANDLING $54.00
99001 COC COLLECITON ONLY $41.00
99024 POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX $789.00
99050 BLUE CROSS RQRD LVL3 $87.00
99053 SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HOUR FACILITY $146.00
99070 SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP $183.08
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 $857.69
99173 SCREENING TEST OF VISION $293.00
99217 OBSERVATION CARE DISCHARGE MANAGEMENT $975.10
99218 INITIAL OBSERVATION CARE/DAY 30 MINUTES $187.06
99219 INITIAL OBSERVATION CARE/DAY 50 MINUTES $957.19
99220 INITIAL OBSERVATION CARE/DAY 70 MINUTES $957.19
99234 OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES $1,066.64
99235 OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES $1,852.69
99236 OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES $2,454.80
99281 E/M VISIT LEVEL 1 TECH COMP $479.59
99282 E/M VISIT LEVEL 2 TECH COMP $1,035.80
99283 E/M VISIT LEVEL 3 TECH COMP $2,055.67
99284 E/M VISIT LEVEL 4 TECH COMP $2,692.47
99285 E/M VISIT LEVEL 5 TECH COMP $3,770.06
99291 CRITICAL CARE 30-74 MIN $4,779.00
99292 CRITICAL CARE ADD 30 MIN $1,365.14
99406 SMOKING CESSATION 3-10 $81.00
99407 SMOKING CESSATION 10 MIN $94.00
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 $12.00
A4216 STERILE WATER/SALINE, FLUSH 10ML $3.00
A4217 STERILE SALINE WATER PER 500 ML $26.00
A4218 STERILE SALINE OR WATER $26.00
A4222 EXT UNFU PMP PER CASS/BAG $176.00
A4224 ALOCHOL OR PEROXIDE PER PINT $4.00
A4246 BETADINE/PHISOHEX SOLUTION $25.00
A4247 BETADINE/IODINE SWABS/WIPES $25.00
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 $12.00
A4315 Insertion tray with drainage bag with indwelling catheter, … $15.00
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 $3.00
A4338 INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING $53.00
A4344 INDWELLING CATH FOLEY TYP $12.00
A4353 INTERMIT URINARY CATHETER $24.00
A4358 URINARY DRAINAGE BAG $14.00
A4364 DERMABOND- ADHESIVE, LIQUID OR EQUAL PER OZ $33.00
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
A4565 SLING $146.00
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 $127.00
A4614 HAND HELD PEFR METER $50.00
A4615 CANNULA NASAL $6.00
A4616 TUBING (OXYGEN) PER FOOT $1.00
A4617 MOUTHPIECE FOR RESPIRATORY OXYGEN EQUIPMENT $55.00
A4649 SURGICAL SUPPLY MISC $23.00
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 $117.00
A6021 COLLAGEN DRESSING STERIL $17.00
A6205 COMPOSITE DRSG LESS THAN 48 SQ IN $22.00
A6210 FOAM DRSG LESS THAN 16=48 SQ IN W/ BORDER $98.00
A6211 FOAM DRG LESS THAN 16 LESS THAN 48 SQ IN WO BORDER $31.00
A6212 FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ IN OR LESS, EACH… $7.00
A6213 FOAM DRG 16-48 SQ IN W/BRDR $11.00
A6216 GAUZE NONIMPREG 16 SQ IN $13.00
A6217 GAUZE NON STERILE $13.00
A6218 GAUZE, NON STERILE $13.00
A6219 GAUZE- STERILE $13.00
A6220 GAUZE, NON IMP, STERILE, PAD SIZE >16 SQ < OR = 48SQ IN $11.00
A6222 GAUZE IMPREGNATED WITH ME $8.00
A6231 GAUZE, 16<SQ IN, EACH $70.00
A6250 SKIN SEAL PROTECT MOISTURIZER OINTMENT $34.00
A6260 WOUND CLEANSER $100.00
A6261 WOUND FILLER $100.00
A6402 GAUZE NON-IMPREG STERL 16 $7.00
A6407 PACK STRIPS NON-IMPREGNTD $29.00
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
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 $2.00
A6454 SELF ADHER BANDAGE $13.00
A6455 SELF ADHER BANDAGE $13.00
A6457 TUBULAR DRESSING $41.00
A7002 SUCTION TUBING USED W PUMP $94.00
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 $37.00
A9150 NON PERSCRIPTION DRUG $23.00
A9273 HOT/COLD H2OBOT/CAP/COL/WRAP $32.00
A9284 NON-ELECTRONIC SPIROMETER $254.00
A9579 GAD-BASE MR CONTRAST NOS,1ML $15.00
C9399 ORBACTIV 1200 MG IV $10,153.00
CASH XRAY DISC $17.00
E0110 CRUTCH FOREARM PAIR $225.00
E0114 CRUTCHES UNDERARM $59.00
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 $90.00
G0168 WND CLS TISSUE ADHESIVE $152.00
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 $3.00
J0150 ADENOSINE INJ 6MG VIAL $65.00
J0153 ADENOSINE INJ 1MG $8.00
J0170 EPINEPHRINE 3 1/2 NDL 10M $8.00
J0171 ADRENALIN EPINEPHRINE INJECT $23.00
J0210 METHYLDOPATE HCL INJECTION $40.00
J0282 INJ AMIODARONE HYDROCHLOR $13.00
J0290 AMPICILLIN 500 MG INJ $22.00
J0295 INJ AMPCLLN SODIUM/SULBA $20.00
J0330 SUCCINYLCHOLINE CHLO 20MG $173.00
J0360 HYDRALAZINE HCL INJ UP TO 20MG $173.00
J0456 INJ AZITHROMYCIN 500MG $81.00
J0461 INJ ATROPINE SULFATE 0.01 $1.00
J0500 DICYCLOMINE HCL 20MG $22.00
J0550 BICILLIN – PENICILLIN G BENZATHINE INJ $65.00
J0558 PENG BENZATHINE/PROCAINE INJ $90.00
J0559 BICILLIN – PENICILLIN G BENZATHINE INJ 2500 UNITS $65.00
J0560 BICILLIN 600,000 $50.00
J0561 INJECTION PENICILLIN G BENZATHINE 100,000 UNITS $55.00
J0570 BICILLIN 1,200,000 $110.00
J0595 STADOL $13.00
J0610 CALCIUM GLUCONATE INJECTION $79.80
J0641 LEVOLEUCOVORIN INJECTION $2.00
J0690 KEFZOL 1 GR VIAL $22.00
J0692 INJ CEFEPIME HCI 500MG $46.00
J0696 ROCEPHIN 250 MG $52.00
J0697 STERILE CEFUROXIME INJECTION $25.00
J0698 CLAFORAN 1 GR VIAL $63.00
J0735 CLONIDINE 1MG $8.00
J0744 CIPRO 200MG $176.00
J0760 COLCHICINE INJECTION $23.00
J0780 COMPAZINE 10 MG $12.00
J1020 INJ METHYLPREDNISOLONE AC $2.00
J1030 DEPO MEDROL 40 MG/ML $75.64
J1040 METHYLPREDNISOLONE 80MG $10.00
J1094 DECADRON DEXAMETHASONE ACETATE 1MG $22.00
J1100 DECADRON 4 MG VIAL $22.00
J1110 INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG $70.00
J1165 DILANTIN 100 MG VIAL $41.00
J1170 DILAUDID 4 MG $41.00
J1200 BENADRYL 50MG $22.00
J1240 ANTIVERT – DIMENHYDRINATE INJECTION 50MG $33.00
J1335 ERTAPENEM INJECTION $21.00
J1580 GARAMYCIN,GENTAMICIN 80MG $50.00
J1610 GLUCOGAN 1 MG VIAL $68.00
J1630 HALOPERIDOL INJECTION $39.70
J1631 HALOPERIDOL DECANOATE INJ PER 50 MG $83.00
J1642 HEPARIN SODIUM PER 10 UNI $13.00
J1644 INJ HEPARIN SOD PER 1000 $87.00
J1650 ENOXAPARIN SODIUM 10MG $37.00
J1670 TETANUS INJECTION $41.00
J1741 IBUPROFEN INJECTION $22.00
J1810 DROPERIDOL/FENTANYL INJ $25.00
J1815 INJ INSULIN PER 5 UNITS $31.00
J1817 INSULIN FOR INSULIN PUMP USE $22.00
J1885 TORADOL INJ 15 MG $22.00
J1930 LANREOTIDE INJECTION $45.00
J1940 LASIX 40 MG IV VIAL $22.00
J1956 LEVOFLOXACIN 250 MG $120.00
J2001 LIDOCAINE HCI 10MG $31.00
J2060 ATIVAN 2ML SYRUP $100.00
J2150 MANNITOL INJECTION $26.00
J2175 DEMEROL 50 MG SYRINGE $28.00
J2180 MEPERIDINE/PROMETHAZINE INJ $30.00
J2250 MIDAZOLAM HCI PER 1 MG $11.00
J2270 INJ MORPHINE SULFATE 10 M $22.00
J2274 INJ MORPHINE PF EPID ITHC $30.00
J2300 NUBAIN 10MG AMP $50.00
J2310 INJ NALOXONE HCL 1MG $30.00
J2360 ORPHENADRINE CITRATE 60MG $122.00
J2370 NEO-SYNEPHRINE UP TO 1 ML $81.00
J2405 ONDANSETRON HCI, PER MG $22.00
J2410 OXYMORPHONE HCL INJECTION $25.00
J2425 PALIFERMIN INJECTION $25.00
J2504 PEGADEMASE BOVINE, 25 IU $25.00
J2543 ZOSYN – PIPERACILLIN/TAZOBACTAM $59.00
J2550 PHENERGAN 50 MG $22.00
J2650 PRELONE – INJECTION PREDNISOLONE ACTATE UP TO 1 ML $6.00
J2690 PRONESTYL 10 ML $22.00
J2704 INJECTION PROPOFOL 10 MG $32.00
J2730 PRALIDOXINE CHLORIDE $22.00
J2760 PHENTOLAINE MESYLATE INJ $41.00
J2765 METOCLOPRAMIDE HCL 10MG $1.99
J2780 INJ RANITIDINE 25 MG $37.00
J2790 RHOGAM INJECTION $199.00
J2800 METHOCARBAMOL INJECTION $50.00
J2920 SOLU-MEDROL 40MG $10.00
J2930 SOLU-MEDROL 125 MG $15.00
J3010 INJ FENTANYL CITRATE .1MG $1.00
J3030 IMITREX 6MG VIAL $216.41
J3105 INJECTION, TREBUTALINE SULFATE, UP TO 1 MG $35.00
J3130 TESTOSTERONE ENANTHATE INJ $24.00
J3230 THOROZINE 50 MG $330.00
J3260 TOBRAMYCIN SULFATE INJECTION $36.00
J3360 VALIUM INJ 5 MG $10.00
J3370 VANCOMYCIN HCI INJ 500MG $229.00
J3410 VISTERIL INJ 50 MG $22.00
J3411 INJ THIAMINE 100 MG $11.00
J3430 INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG $12.00
J3475 MAGNESIUM SULFATE 2CC AMP $25.00
J3480 POTASSIUM CHLORIDE 2 MG $1.99
J3486 GEODON – ZIPRASIDONE MESYLATE 10MG $35.00
J3490 UNCLASSIFIED DRUGS $36.00
J7030 INFUS NORM SALINE 1000CC $53.00
J7040 INFUS NORM SALINE 500ML $26.00
J7042 5% DEXTROSE $26.00
J7050 INFS NORM SALINE 250CC $26.00
J7060 INFUSION D5W 250ML $28.00
J7070 INFUSION D5W 1000ML $86.00
J7120 RINGER’S LACTATE INFUS $90.00
J7121 5% DEXTROSE IN LAC RINGERS $65.27
J7130 HYPERTONIC SALINE SOLUTION $76.00
J7131 HYPERTONIC SALINE SOL $61.74
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 $8.00
J7512 PREDNISONE 5 MG $8.00
J7607 LEVALBUTEROL COMP CON $13.00
J7610 ALBUTEROL, THRU DME 1MG $13.00
J7611 ALBUTEROL 1MG CONC INHALA $13.00
J7613 ALBUT INHAL NON-CP 1MG $13.00
J7614 ALBUTEROL ALL FOMULATIONS $20.00
J7615 LEVALBTERAL INHALATION SO $20.00
J7620 ALBUTEROL 2.5 MG ATROVENT $13.00
J7631 CROMOLYN SODIUM NONCOMP UNIT $20.00
J7637 DEXAMETHASONE COMP CON $20.00
J7644 IPRATROPIUM BROMIDE INHAL $31.00
J7682 TOBRAMYCIN NON-COMP UNIT $25.00
J7699 NOC DRUGS INHAL SOL ADMIN $8.00
J8498 ENEMA SUPPOSITORY, ANTIEMETIC RECTAL $31.00
J8499 NONCHEMOTHERAPEUTIC ORAL $17.00
J8540 DEXAMETHASONE, ORAL .25MG $20.00
J9027 CLOFARALINE INJECTION $141.00
J9206 IRINOTECAN INJECTION $25.00
L0120 CERVICAL FLEX NONADJ COLL $320.00
L0172 CLAVICAL COLLAR 2 PC $41.00
L1630 ABDUCT CONTROL HIP SEMI FLEX $41.00
L1830 KNEE IMMOBOLIZER $24.00
L1906 ANKLE SUPPORT $133.00
L3260 SURGICAL BOOT/SHOE $87.00
L3650 SO FIGURE EIGHT ABDUCTION $251.00
L3670 SO ACROMIO/CLAVICULAR $113.00
L3908 WRIST EXTN CONTROL COCKUP $87.00
L3999 UPPER LIMB ORTHOSIS NOS $176.00
L4350 AIR SPLINT $453.00
L4360 WALK BOOT PNEUMATIC $117.00
L4380 PNEUMATIC KNEE SPLINT $125.00
L4386 WALKING BOOT NON PNEUMATIC $168.00
L4387 NON-PNEUM WALK BOOT PRE OTS $250.00
P7001 CULTURE BACTERIAL URINE $89.00
P9612 CATHETERIZE FOR URINE $177.00
Q0144 AZITH DIHY ORAL CAP/POWD $161.00
Q0179 ONDANESTRONG HCL 8MG ORL $4.00
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 $24.00
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 $125.00
Q9954 ORAL MR CONTRAST, 100ML $416.00
Q9963 HI OSM CONTRST MATL 350-3 $23.00
Q9965 LOW OSMOLAR CON MAT PER M $25.00
Q9966 LOCM 200-299MG ML IODINE, 1ML $22.00
Q9967 LOW OSMOLAR CNTRS MAT $20.00
S0020 INJ, BUPIVICAINE, 30ML $46.00
S0028 INJECT FAMOTIDINE 20 MG $70.00
S0030 METRONIDAZOLE 500 MG INJ $188.00
S0077 CLANDAMYCIN PHOSPHATE 300 $32.00
S0119 ZOFRAN, 4MG, ORAL $8.00
S0164 PROTONIX PANTROPRAZOLE 40MG $194.00
S0622 PHYS EXAM FOR COLLEGE $87.00
S0630 RMV SUTURES; PHYS NOT PHY $65.00
S3000 BILAT DIL RETINAL EXAM $11.00
S5000 PRESCRIPTION DRUG GENERIC $1.00
S5001 PRESCRIPTION DRUG BAND NM $8.00
S5010 STERILE SALINE 5% DEXTROSE AND 0.45% SALINE $232.00
S5011 5% DEXTROSE 1000 ML $1.00
S5550 INSULIN RAPID 5 U $26.00
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
U0002 COVID-19 PCR Testing $301.00

Share:

More Posts

Heart Attack Symptoms

Español Not all heart attacks begin with the sudden and crushing chest pain that comes when the blood flow to heart gets blocked. Heart attack

Sun Safety

Skin cancer is the most common cancer in the U.S. Too much sun can cause skin cancer. Spending time outside is a great way to

Leave Fireworks to the Experts

Summer is synonymous with barbecues, parades and fireworks. The National Safety Council advises everyone to enjoy fireworks at public displays conducted by professionals, and not