Learning Center Articles

Dallas Charge Master 04.09.21

CPT CodeCPT Short DescriptionCPT Default Price
0202UCOVID-19 BioFire Respiratory Panel 2.1 (RP2.1) Testing$1,500.00
10060INCISION/DRAINAGE ABSCESS$748.24
10061INS/DRAIN ABSCESS COMPL$444.00
10081I&D PILONIDAL CST COMP$590.00
10120I & RMVL SUB-CUT SIMPLE$200.00
10121I & RMVL FB, SUB-CUT,COMP$583.00
10160PUNCTURE ASP OF ABSCESS$328.00
11011DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC$263.00
11040DBRDMT, SKIN, PARTIAL THICK$205.00
11042DBRD SKN SUBQ TISSUE$1,098.00
11200RMVL SKIN TAGS$294.00
11404EXC BGN LSN TRUNK 3.1-4.0$833.00
11730AVULSION/1-NAIL PLATE$290.00
11740EVAC SUBUNGUAL HEMATOMA$303.00
11750EXC NAIL PART/COMP$619.00
11760REPAIR NAIL BED$531.00
11765WEDGE EXC SKIN/NAIL BED$341.00
11771EXCISION PILONIDAL CYST SINUS EXTENSIVE$297.00
12001LACERATION REPAIR$352.23
12002REPAIR LAC SCALP 2.6-7.5$430.00
12004REPAIR LAC SCALP 7.6-12.5$496.00
12005REPAIR LAC,SCALP 12.6-20C$658.00
12011REPAIR LAC FACE LESS THAN 2.5 CM$759.00
12013REPAIR LAC FACE 2.6-5.0CM$526.00
12014REPAIR LAC FACE 5.1-7.5CM$729.00
12020TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE$320.00
12031LYR CLSR S/A/T/E 2.5CM$504.00
12032REPAIR-INT SCALP 2.6-7.5$761.00
12034INTERM RPR SCLP/TRNK/EXTR$707.00
12035REPAIR INTERM S/A/T/E 12.$318.00
12036REPAIR INTERM S/A/T/E 20.1-30.0 CM$762.00
12041LAYER CLSR NECK/HAND 2.6$524.00
12042REPAIR LAC HAND/FOOT 2.6-$883.00
12044LYR CLSR N/H/F/ETRNL GENT$762.00
12045REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM$760.00
12051LAYER CLSR OF WND NCK/HND$594.00
12052LYR CLSR WOUND 2.6-5.0FAC$708.00
12053LYR CLSR F/E/E/N/L/M&/MUC$957.00
12054REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM$865.00
13121RPR CMPX SCALP ARM2.6-7.5$1,236.00
13122CMPLX RPR ADD 5 CM OR LES$531.00
13132RPR CMPX FOREHEAD/CHECK/C$1,462.00
13151CMPX RPR EYE NOSE 1.1-2.5$1,055.00
13152RPR CPLX E/N/E/L 2.6-7.5$1,830.00
13153REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM<$669.00
15850SUTURE RMVL W/ANESTHESIA$653.00
16000BURN, INITIAL TREATMENT$274.00
16020BURN, DRESSING/DBRDMNT-SM$270.00
20552TRIGGER POINT INJ 1-2 MUS$176.00
20600ARTHROCENTESIS, SML JOINT$640.00
20605ARTHROCENTESIS, MED JOINT$154.00
20610ARTHROCENTESIS, LG JOINT$361.00
20611Arthrocentesis, aspiration and/or injection, major joint or…$1,009.00
21310CLTX NSL B1 FX W/O MNPJ$498.00
21480CLDS TX TEMP DISLOCATION$452.00
21800CLTX RIB FX UNCOMP EA$425.00
23500CLTX CLAVICULAR FX WO MNP$814.00
23570CLSD TX SCAPULAR FX WO MA$839.00
23600CLTX PROX HUMRL FX WO MAN$381.00
23650SHOULDER DISLOCATION TRMT$934.00
24500CLTX HUMRL SHFT FX W/O MN$378.00
24530CLTX SPRCNDYLR/TRANSCNDYL$1,392.00
24576CLTX HUMRL CNDLYR FX MEDI$381.00
24600CLSD TX ELBOW DISLOCAT$650.00
24640RADIAL HEAD SUBLUX. CHILD$519.00
24650CLTX RDL HEAD FX WO MANP$959.00
24670CLTX ULNR FX PROX END WO$942.00
25500CLTX RDL SHFT FX WO MANP$650.00
25505CLSD TX RAD SHAFT W/MANIP$2,213.00
25530CLSD TX ULNAR SHFT FX NO$378.00
25535CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION$715.00
25560CLTX RDL&UR SHFT FXS W/O$378.00
25600CLSD TX DISTAL RAD FX WO$1,045.00
25605CLSD TX DISTAL RAD FX$1,992.00
25622CLSD TX NAVICULAR FX WO M$650.00
25635CLTTX CARPL B1 FX W/MNPJ EA B1$1,085.00
25650CLTX UR SYLOID FX$1,097.00
26010I & D FINGER ABSCESS,SIMP$298.00
26600CLSD TX METACARPAL FX$909.00
26605CLSD TX MEDICARPAL FX$1,053.00
26607CLTX MTCRPL FX W/MNP W/XT$1,670.00
26700CLS TX MCP DISLOCATION$381.00
26720CLSD TX PHALANGEAL SHFTFX$628.00
26725CLTX PHLNGL FX PROX/MIDDL$1,027.00
26750CLS TX FX FINGER/THUMB$618.00
26755CLTX DSTL PHLNGL FX FNGR/$792.00
26770TREAT FINGER DISLOC FINGE$560.00
27220CLTX ACETABULUM HIP/SOCKT FX W/O MNP$635.00
27372REMOVAL FOREIGN BODY DEEP THIGH/KNEE$350.00
27508CLTX FEM FX DSTAL END MED$381.00
27520CLTX PATELLAR FX W/O MNPJ$1,205.00
27530CLTX TIBL FX PROX W/O MNPJ$507.00
27550CLOSED TX KNEE DISLOCATION W/O ANESTHESIA$1,366.00
27560CLTX PATELLAR DISLC W/O A$381.00
27752CLTX TIBL SFT FX W/MANP$1,968.00
27760CLTX MEDIAL MALLS FX W/O$1,153.00
27780CLTX PROX FIVULA/SHFT FX$1,055.00
27786CLSD TX DISTAL FIBULAR FX$993.00
27792Open treatment of distal fibular fracture (lateral malleolu…$5,342.00
27808CLOSED TX BIMALLEOLAR ANK$507.00
27810CLTX BIMAL ANKLE FX W/POT$1,704.00
27840CLOSED TX ANKLE DISLOCATI$100.00
28190RMVL FB BODY FOOT SUBQ$745.00
28192RMVL FB FOOT DEEP$1,373.00
28400CLSD TX CLAVICLE FX WO MA$650.00
28430CLTX TALUS FX W/O MNPJ$106.00
28450TX TARSAL B1 FX XCP TALUS$635.00
28470CLTX METAR FX WO MNP$840.00
28490CLTX FX GRT TOE W/O MNLJ$594.00
28510CLSD TX FX PLALANX/PHALAN$523.00
28515FX CARE PHALANX NOT GREAT$622.00
28660CLSD TX PIP JNT DISLOCATI$622.00
29075APPLICATION CAST ELBOW FINGER SHORT ARM$610.93
29085CAST HAND/LOWER FOREARM GAUNTLET$176.00
29105LONG ARM SPLINT$176.00
29125SHORT ARM SPLINT$532.80
29126SHORT ARM SPLINT DYNAMIC$176.00
29130APPLICATION FINGER SPLINT$176.00
29131APPLICATION FINGER SPLINT DYNAMIC$364.17
29240STRPG SHO$260.00
29280STRAPPING HAND/FINGER$239.00
29505LONG LEG SPLINT$176.00
29515SHORT LEG SPLINT$176.00
29540STRAPPING ANKLE/FOOT$220.00
29550STRAPPING TOES$176.00
29580STRAPPING UNNA BOOT$220.00
29700RMVL/BIVALV GAUNTLET BOOT$127.00
30300RMVL FOREIGN BODY NASAL$496.00
30901NASAL PACKING$131.00
30903CTRL NSL HEMRRG ANT CPLX$443.00
3120F12-LEAD ECG PERFORMED$250.00
31500INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE$571.00
31502TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT$891.00
31515LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION$670.00
31525LARGSC +-TRACHEOSCOPY DX$198.00
32551TUBE THORACOSTOMY INCLUDES WATER SEAL$1,342.00
33415RESCJ/INC SUBVALVULAR TISSUE$980.00
36000INTRODUCTION OF NEEDLE/IN$244.00
36410VENIPUNCTURE, 3 YRS OR OLDER$68.00
36415VENIPUNCTURE$28.00
36416COLL CAPILLARY BLG SPEC$41.00
36556Insertion of non-tunneled centrally inserted central venous…$3,816.00
36558INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR$2,156.00
36591COLLECT BLOOD FROM IMPLAN$146.00
38300DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL$303.00
40650RPR LIP FULL THICKNESS$2,990.00
41800DRNG ABSC DENTOALVEOLAR S$480.00
42700I&D ABSC PRITONSILLAR$857.00
43753GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING …$128.00
46040I&D ISCHIOR/PRIRC ABSC SP$1,957.00
46050INC/DRAIN PERIANAL ABS SU$1,111.00
46083INCISION THROM HEMORRHOID$491.00
46320ENULEATION EXCC OF EXT HE$612.00
51700BLDR IRR SMPL LVG&/INSTLJ$97.00
51701INSR NONDWELLING BLDR CAT$231.00
51702INSERTION BLADDER CATH$361.00
51703INSERT BLADDER CATH COMPL$569.00
56405INC/DRAIN VULVA/PERINEAL$259.00
56420I & D BARTHOLIN ABSCESS$100.00
59025FTL NON-STRS TST$600.00
59409VAG DLVR ONLY$3,960.00
62270SPINAL PUNCTURE,LUMBAR$554.00
64400NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH$2,743.00
64402INJ ANESTHETIC FACIAL NRV$640.00
64450INJ ANESTHETIC AGENT$1,312.50
64640DSTRJ NULYT OTH PRPH NVR/BRANCH$1,220.00
65205REMOVAL FB EYE-SUPERFCL$244.00
65220RMVL FB EYE W/O SLIT LAMP$380.00
65222RMVL FB EYE$449.00
67700I&D ABSCESS EYELID$773.00
69005DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED$363.00
69200RMVL FOREIGN BODY EAR$381.00
69205RMVL FB XTRNL AUD CANAL A$409.00
69209REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL$340.00
69210RMVL IMPACTED CERUMEN$196.00
70030RADEX EYE DETCJ FB$396.01
70100XRAY MANDIBLE LESS THAN 4 VIEWS$396.01
70110XRAY MANDIBLE MIN 4 VIEWS$550.80
70120RADEX MASTOIDS LESS THAN 3 VIEWS PR SIDE$459.00
70130RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE$396.01
70140XRAY FACIAL BONES LESS THAN 3 VIEW$396.01
70150XRAY FACIAL BONES GREATER THAN 3 VIEW$769.50
70160NASAL BONE X-RAY$396.01
70200RAD EXAM ORBIT COMP.$641.25
70210RADEX SINUSES PARANASAL <3 VIEWS$523.37
70220RAD EXAM SINUS COMPLETE$622.50
70250SKULL LESS THAN 4 VIEWS$515.41
70260RAD EXAM SKULL COMPLETE$970.20
70328RADEX TMPRMAND JT OPN&CLSD MOUTH UNI$396.01
70330RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT$396.01
70350CEPHALOGRAM ORTHODONTIC$257.00
70360RAD EXAM NECK,SOFT TISSUE$493.52
70450CT HEAD/BRAIN W/O CONTRAST MATERIAL$4,022.10
70460CT HEAD/BRAIN W/CONTRAST MATERIAL$5,317.20
70470CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL$6,624.71
70480CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL$2,718.75
70481CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL$4,801.50
70482CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR$6,740.13
70486CT MAXILLOFACIAL W/O CONTRAST MATERIAL$3,129.30
70487CT MAXILLOFACIAL W/CONTRAST MATERIAL$3,352.50
70488CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL$6,586.13
70490CT NECK WO CONTRAST$3,020.00
70491CT SOFT TISS NCK C+MATRL$3,502.00
70496CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST$4,026.60
70498CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST$6,792.87
70544MRA HEAD C-MATRL$5,975.25
70547MRA NECK C-MATRL$5,178.55
70551MRI BRN BRN STEM C-MATRL$4,780.20
70553MRI BRN BRN STEM C-/C+$6,492.28
71045RADIOLOGIC EXAM CHEST SINGLE VIEW$583.20
71046CHEST XRAY 2 VIEWS$563.25
71047RADIOLOGIC EXAM CHEST 3 VIEWS$818.89
71048RADIOLOGIC EXAM CHEST 4+ VIEWS$899.48
71060BRONCHOGRAPHY BI RS&I$537.00
71100RIBS UNILATERAL 2 VIEWS$505.50
71101RIB UNILATERAL W CHEST$848.25
71110RIBS BILATERAL 3 VIEWS$689.25
71111RIBS BILATERAL W/CHEST$509.25
71120Radiologic examination; sternum, minimum of 2 views$511.50
71250CT CHEST W/O CONTRAST$3,519.00
71260CT THORAX W/CONTRAST$5,201.25
71270CT THORAX WO CONTRAST$5,636.25
71275CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST$3,605.88
71550MRI CH C-MATRL$4,454.40
72020SPINE SINGLE VIEW$428.25
72040SPINE, CERVICAL 2/3 VIEWS$541.50
72050SPINE, CERVICAL MIN 4VIEW$733.50
72052SPINE CERV. COMP FLEX/EXT$608.94
72069RADEX SPI THORACOLMBR STANDING SCOLIOSIS$374.00
72070SPINE THORACIC 2 VIEWS$649.80
72072SPINE THORACIC 3 VIEWS$797.40
72074RAD EXAN SPINE THROAC 4 V$396.01
72080RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS$515.41
72082RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW$1,086.54
72100SPINE LUMBO. MIN 4 VIEWS$649.80
72110LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS$961.17
72114RAD EXAM SPINE LUMBO COMP$608.94
72120SPINE LUMBAR AP & LAT W F$608.94
72125CT CERVICAL SPINE W/O CONTRAST MATERIAL$4,072.90
72126CT CERVICAL SPINE W/CONTRAST MATERIAL$5,183.75
72127CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL$5,523.70
72128CT THRC SPI C-MATRL$4,683.75
72129CT THRC SPI C+ MATRL$3,564.00
72130CT THORACIC SPINE W/O & W/CONTRAST MATERIAL$6,373.50
72131CT LUMBAR SPINE W/O CONTRAST MATERIAL$5,620.50
72132CT LUMBAR SPINE W/CONTRAST MATERIAL$7,483.40
72133CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL$8,455.51
72141MRI SPI CANAL&CNTS CRV C-MATRL$4,780.20
72146MRI SPI CANAL&CNTS THRC C-MATRL$4,780.20
72148MRI SPI CANAL&CNTS LMBR C-MATRL$4,780.20
72156MRI SPI CANAL&CNTS C-/C+ CRV$6,047.38
72157MRI SPI CANAL&CNTS C-/C+$4,402.50
72158MRI SPI CANAL&CNTS C-/C+ LMBR$6,047.38
72170RAD EXAM PELVIS 1/2 VEIW$793.80
72190RADEX PELVIS COMPL MIN 3$396.01
72191CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST$4,743.70
72192CT PELVIS WO CONTRAST$4,168.00
72193TOMOGRAPHY PELVIS WCONTRS$2,750.00
72194CT PELVIS W OR WO CONTRST$7,574.00
72195MRI PELVIS C-MATRL$4,454.40
72196MRI PELVIS C+ MATRL$5,194.80
72220XRAY COCCYX/SACRUM$396.01
72270MYELOGRAPY 2/MORE REGIONS RS&I$4,354.12
73000XRAY CLAVICLE 2 VIEWS$396.01
73010SCAPULA COMPLETE$396.01
73020RADEX SHO 1 VIEW$598.00
73030SHOULDR COMPLETE 2 VIEWS$612.90
73050XRAY AC JOINTS-BILAT$396.01
73060XRAY HUMERUS MIN 2 VIEWS$550.80
73070XRAY ELBOW 2 VIEWS$598.00
73080XRAY ELBOW GREATER THAN 3 VIEWS-COMP$388.05
73090XRAY FOREARM AP & LAT$594.90
73100XRAY WRIST AP & LAT VIEW$534.60
73110XRAY WRIST/COMP MIN 3 VIE$396.01
73120XRAY HAND AP & LAT$488.70
73130XRAY HAND MIN 3 VIEWS$550.80
73140XRAY FINGER MIN 2 VIEWS$461.68
73200CT UPPR EXTR WO CNTRS$3,309.75
73201CT UPPER EXTREMITY W/CONTRAST MATERIAL$5,778.90
73202CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL$6,740.13
73220MRI UXTR OTH/THN JT C-/C+$4,402.50
73221MRI ANY JT UXTR C-MATRL$4,365.00
73501RADEX HIP UNILATERAL WITH PELVIS 1 VIEW$545.30
73502RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN P…$894.90
73503RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS$1,142.26
73520HIPS BILAT MIN 2 VIEW INC$507.00
73522RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS$1,286.54
73551RADIOLOGIC EXAMINATION FEMUR 1 VIEW$523.37
73552FEMUR; MIN 2 VIEWS$610.50
73560XRAY KNEE, SUNRISE VIEW$424.87
73562XRAY KNEE MIN 3 VIEWS$543.27
73564RAD EXAM KNEE 4 OR MORE$585.90
73565RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST$396.01
73580X-RAY KNEE.BILATERAL STANDING$2,563.12
73590XRAY TIBIA/FIBULA AP/LAT$396.01
73592RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS$396.01
73600XRAY ANKLE 2 VIEWS$547.25
73610XRAY ANKLE 3 VIEWS/COMPLE$685.80
73620XRAY FOOT MIN 2 VIEWS$498.50
73630XRAY FOOT MIN 3 VIEWS$691.53
73650RAD EXAN HEEL MIN 2 VIEWS$396.01
73660XRAY TOES, MIN 2 VIEWS$467.10
73700CT LOWER EXTREMITY W/O CONTRAST MATERIAL$4,390.94
73701CT LWR EXT W CONT$6,388.90
73702CT LXTR C-/C+$5,080.50
73718MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL$4,678.49
73721MRI ANY JT LXTR C-MATRL$4,365.00
73722MRI ANY JT LXTR C+ MATRL$5,106.00
73723MRI ANY JT LXTR C-/C+$6,503.75
73725MRA LXTR C+-MATRL$6,163.30
74000RAD EXAM ABD SINGL ANTER$759.00
74010RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS$426.00
74018RADIOLOGIC EXAM ABDOMEN 1 VIEW$588.60
74019RADIOLOGIC EXAM ABDOMEN 2 VIEWS$725.25
74020RAD EXAM ABDOMEN COMPL$454.00
74021RADIOLOGIC EXAM ABDOMEN 3+ VIEWS$688.80
74022RAD EXAM COMPLETE ABD$1,360.80
74150CT ABDOMEN W/O CONTRAST MATERIAL$3,407.20
74160CT ABDOMEN W/CONTRAST MATERIAL$4,816.50
74170CT ABDOMEN W/O & W/CONTRAST MATERIAL$5,528.25
74174CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG$7,019.00
74175CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST$5,196.80
74176CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL$4,588.65
74177CT ABDOMEN & PELVIS W/CONTRAST MATERIAL$5,702.97
74178CT ABD & PELVIS 1 PLUS SECTION/REGNS$6,905.88
74181MRI ABD C-MATRL$4,780.20
74183MRI ABD C-/C+$6,047.38
74190PERITONEOGRAM RS&I$2,192.98
74240RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB$718.39
74241RADEX GI TRC UPR +-DLYD FLMS W/KUB$998.00
74245RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES$3,871.50
74246Radiologic examination, gastrointestinal tract, upper, air …$1,108.43
74247RADEX GI UPR C+ +-GLUC +-DYLD FLMS W/KUB$1,010.00
74250RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES$768.14
74251RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE$1,430.81
74283Therapeutic enema, contrast or air, for reduction of intuss…$1,408.00
74328ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I$3,320.40
74329ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I$2,701.60
74330CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I$386.06
74340INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I$228.85
74440VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I$2,857.80
75574CT CORONARY$3,360.60
763763D RNDR I&R CT MRI US/OTH$543.27
76380CT LIMITED/LOCALIZED FOLLOW UP STUDY$1,293.50
76536ULTRASOUND, SOFT TISSUES OF HEAD AND NECK$1,133.10
76604US CHEST REAL TIME W/IMAGE DOCUMENTATION$769.14
76641US BREAST UNI REAL TIME WITH IMAGE COMPLETE$893.51
76642US BREAST UNI REAL TIME WITH IMAGE LIMITED$648.74
76645US BREAST R-T W/IMAGE DOCUMENTATION$784.06
76700US ABDOMINAL R-T W/IMAGE$1,504.80
76705US ABDOMINAL$1,151.10
76706Ultrasound, abdominal aorta, real time with image documenta…$901.00
76770US RETROPERITONEAL R-T W/$1,174.50
76775US RPR B-SCAN&/R-T IMG LMTD$1,089.90
76801ULTRASOUND 14 WK TABDL 1/1ST GESTATION$700.48
76802US PREG UTERUS 14 WK TRANSABDL EACH GESTATION$700.48
76805US PG UTER F&MAT AFTER 1S$881.57
76810US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO$894.51
76815ULTRASND PG UTER$525.36
76816US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS$851.72
76817UT PG UTER R-T IMG TRVG$581.08
76830TRANSVAGINAL ULTRASOUND$487.50
76856US PELVIC NONOB REAL-TIME$1,089.75
76857PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97$624.00
76870US SCROTUM&CNTS$1,004.40
76880US EXTREMITY$913.00
76881US COMPL JOINT R-T W/IMAGE DOCUMENTATION$801.97
76882ULTRASOUND, EXTREMITY, NON VASCULAR$155.22
76942ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND I…$1,485.00
77076RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT$275.00
77079CT BONE MINERAL DENSITY STUDY 1+SITS APPND$613.00
78075ADRNL IMG CORTEX&/MEDULLA$3,618.00
78223HIDA SCAN-HEPATBL DUX SYS IMG GLBLDR$2,509.00
78306B1&/JT IMG WHBDY$1,701.00
78315B1&/JT IMG 3 PHASE STD$2,022.00
78320B1&/JT IMG TOMOG SPECT$923.00
78472CARD BPI GTD=BRM PLNR 1 STD REST/STRS$2,047.71
80047BASIC METABOLIC PANEL CALCIUM IONIZED$571.13
80048METABOLIC PANEL BASIC$163.18
80051ELECTROLYTE PANEL$414.92
80053METABOLIC COMPRE PANEL$689.54
80061LIPID PROFILE III$452.73
80074HEPATITIS PANEL$508.94
80076HEPATIC FUNCTION PANEL$484.57
80100DRUG ABUSE PANEL II$191.04
80102Drug confirmation, each procedure$523.13
80104DRUG SCREEN$172.00
80178LITHIUM$456.71
80196SALICYLATE$332.33
80197TACROLIMUS$452.70
80202VANCOMYCIN PEAK$390.04
80300DRUG SCREEN$221.00
80304DRUG SCREEN$211.00
80305DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUM…$143.00
80307DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS$763.20
80320DRUG SCREEN$143.28
80324DRUG SCREEN QUANT AMPHETAMINES 1 OR 2$407.70
80329DRUG SCREEN$151.24
80335ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2$165.17
80345DRUG SCREENING BARBITURATES$286.20
80346DRUG SCREENING BENZODIAZEPINES 1-12$246.26
80347DRUG SCREENING BENZODIAZEPINES 13 OR MORE$525.00
80349DRUG SCREENING CANNABINOIDS NATURAL$298.06
80351DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6$829.80
80352DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE$655.20
80353DRUG SCREENING COCAINE$302.10
80356DRUG SCREENING HEROIN METABOLITE$212.68
80358DRUG SCREENING METHADONE$362.18
80359DRUG SCREENING METHYLENEDIOXYAMPHETAMINES$88.06
80361DRUG SCREENING OPIATES 1 OR MORE$298.50
80362DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2$296.51
80365DRUG SCREENING OXYCODONE$37.56
80366DRUG SCREENING PREGABALIN$227.86
80367DRUG SCREENING PROPOXYPHENE$233.83
80373DRUG SCREENING TRAMADOL$256.71
80374DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS$420.00
81000U/A DIPSTICK$115.42
81001U/A DIP STICK$176.12
81002URNLS DIP STICK/TABLET RG$37.81
81003U/A W/O MICRO DIPSTICK$37.81
81007URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK$288.55
81025PREG.TST URINE VISUAL$95.52
82003ACETAMINOPHEN$624.60
82009KETONES-SERUM$36.00
82040ALBUMIN; SERUM$133.33
82055ALCOHOL-BLOOD$330.34
82075ALCOHOL BREATH TEST$175.12
82140Ammonia$278.60
82150AMYLASE$220.89
82247BILIRUBIN TOTAL$311.44
82248BILIRUBIN DIRECT$179.10
82250direct bilirubin$260.69
82253MB FRACTION$154.00
82270OCCULT BLOOD$102.49
82272BLD OCLT PEROXIDASE ACTV$47.76
82274BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3$177.11
82310CALCIUM$174.13
82330CALCIUM IONIZED$476.61
82355CALCULUS QUALITATIVE ANALYSIS$428.40
82374CARBON DIOXIDE BICARBONATE$185.07
82375Under Chemistry Procedures$188.80
82435CHLORIDE BLD$178.11
82465CHOLESTEROL SERUM/WHOLE BLOOD TOTAL$197.01
82533CORTISOL TOTAL$243.03
82540CREATINE$433.82
82541COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE$121.00
82550CREATINE CK-TOTAL$71.64
82553CREATINE CKMB$149.25
82565CREATININE$194.03
82607VITAMIN B-12$297.51
82693ASSAY OF ETHYLENE GLYCOL$158.45
82747ASSAY OF FOLIC ACID RBC$372.13
82784IGC IMMUNOGLOBULIN$84.33
82785GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE$152.73
82800GASES BLD PH ONLY$130.00
82803BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3$284.57
82805GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY$889.10
82945GLUCOSE BODY FLUID OTHER THAN BLOOD$169.15
82947GLUCOSE$169.15
82948GLUCOSE BLOOD REAGET STR$166.66
82962GLUCOSE FINGER STICK$47.76
82977GLUTAMYLTRANSFERASE-GTT$391.04
83009HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE$754.60
83013HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE$742.50
83036HEMOGLOBIN GLYCOSYLATED A1C$195.02
83050HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE$107.46
83520IMMUNOASSAY ANALYTE QUANTITIATIVE NOS$570.00
83525ASSAY OF INSULIN TOTAL$167.16
83540IRON-TOTAL$133.33
83605ASSAY OF LACTATE$548.74
83615Lactate dehydrogenase (LD), (LDH);$275.62
83690LIPASE$241.79
83718LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL$71.89
83735MAGNESIUM$258.70
83874MYOGLOBIN$113.93
83880B-TYPE NATRIURETIC$549.75
83992ASSAY OF PHENCYCLIDINE$225.00
84075ALK PHOS/PROFILE OR PANEL$99.50
84100ASSAY OF PHOSPHORUS INORGANIC$180.10
84132POTASSIUM SERUM PLASMA/WHOLE BLOOD$209.95
84155PROTEIN,TOTAL,EXCEPT REFR$166.17
84157PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC$425.86
84165PROTEIN ELECTROPHORESIS$120.40
84295SODIUM; SERUM$208.95
84403ASSAY OF TESTOSTERONE TOTAL$213.18
84436THYRIXINE TOTAL$133.33
84439THYROXINE-FREE$319.40
84443Thyroid stimulating hormone (TSH)$587.05
84450Aspartate Aminotransferase$99.50
84460ALT-TRANSFERASE;ALANINE$91.54
84478ASSAY OF TRIGLYCERIDES$351.24
84479THYROID HORMONE$209.95
84480T3 TOTAL$155.72
84481ASSAY OF TRIIODOTHYRONINE T3 FREE$356.21
84484TROPONIN I$369.15
84512TROPONIN QUAL$549.24
84520Urea nitrogen$178.11
84550URIC ACID$166.17
84560URIC ACID OTH SRC$167.16
84702HCG QUANTATIVE$492.30
84703PREGNANCY TEST BLOOD$149.25
84999UNLISTED CHEMISTRY PROCEDURE$179.10
85014HEMATOCRIT$81.59
85018HEMOGLOBIN$81.59
85025BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC$268.65
85027CBC W/O DIFF$125.37
85032BLD# MNL C-CNT RBC/PLTLT EA$152.00
85044RETICULOCYTE COUNT$248.75
85347COAGJ TM ACTIVATED$83.58
85378FIBRIN DEGRADATION PROD$93.53
85379D-DIMER$140.54
85610PROTHROMBIN TIME$182.09
85651SEDIMENTATION RATE NONAUT$177.11
85652SED RATE ERYTHROCYTE NON$51.74
85730THROMBOPLASTIN TIME PART$117.41
86038ANTINUCLEAR AB$486.56
86039ANTINUCLEAR AB TITER$477.60
86060ANTISTREPTOLYSIN O TITER$291.54
86140C REACTIVE PROTEIN$399.99
86235EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD$463.67
86256SMOOTH MUSCLE AB TITER$251.24
86308MONO,HETEROPHILE ANTIBODI$99.50
86320IMMUNOELECTROPHORESIS$48.76
86328COVID-19 RAPID ANTIBODY TEST SINGLE METHOD$297.00
86360T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO$300.49
86403MONO SPOT$221.89
86430RHEUMATOID FACTOR$300.49
86431RHEUMATOID FACTOR QUANTITATIVE$219.90
86592Syphilis test, non-treponemal antibody; qualitative (eg, VD…$281.59
86593SYPHILIS TEST, NON- TREPONEMAL ANTIBODY; QUANTITATIVE$65.67
86631ANTB CHLAMYDIA$111.94
86644ANTIBODY CYTOMEGALOVIRUS CMV$408.60
86645ANTIBODY CYTOMEGALOVIRUS CMV IGM$450.74
86664EPSTEIN-BARR VIRUS EBNA$133.00
86677ANTIBODY HELICOBACTER PYLORI$454.72
86689ANTB HTLV/HIV ANTB CONFIRMATION TST$820.88
86701HIV SERUM$131.34
86702ANTB HIV-2$536.25
86704HEPATITIS B CORE ANTIBODY HBCAB TOTAL$505.46
86705HEPATITIS B CORE IGM$455.40
86706HEPATITIS B SURF ANTIBODY HBSAB$359.20
86713LEGIONELLA PNEUMONPILA AB$133.33
86756ANTB RSV$143.00
86769COVID-19 RAPID ANTIBODY TEST MULTIPLE STEP METHOD$325.00
86780ANTIBODY TREPONEMA PALLIDUM$113.18
86787Antibody; varicella-zoster$450.74
86803HEPATITIS C ANTIBODY$517.40
86850ANTB SCR RBC EA SERUM TQ$248.75
86900Blood typing, serologic; ABO$141.29
86901RH FACTOR-BLOOD$135.32
86906BLD TYPING RH PHEXYPING COMPL$86.00
87040BLOOD CULTURE$400.99
87045CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL$198.01
87046CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA$198.01
87070CULTURE BODY FLUID$167.16
87075CULTURE ANAEROBIC$485.10
87076CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL$523.37
87077CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL$155.22
87081CULTURE, BACTERIAL-SCREEN$81.59
87086URINE CULTURE$99.00
87088CULTURE BCT ISOL&PRSMPTV$61.69
87106CUL FNGI DEFINITIVE ID EA ORGANISM YEAST$151.24
87110CHLAMYDIA CULTURE$259.70
87177OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID$206.46
87205SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL$100.74
87207SMR PRIM SRC SPEC STAIN$189.05
87209SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS$262.68
87210WET SMEAR$83.58
87252VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT$394.02
87255Herpes Simplex Virus Culture with Reflex Typing$432.83
87275IAADI INF B VIRUS$220.89
87338IAAD IA HPYLORI STOOL$220.89
87340IAAD IA HEPATITIS B SURFACE ANTIGEN$332.33
87341IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION$501.60
87389HIV-1 AG W/HIV-1 & HIV-S AB$467.65
87400INFLUENZA A&B$95.52
87420IAAD IA RESPIRATORY SYNCTIAL VIRUS$987.78
87425ROTAVIRUS AG EIA$389.05
87426COVID-19 RAPID ANTIGEN TESTING$353.00
87427IAAD IA SHIGA-LIKE TOXIN$447.60
87428Multiplex viral pathogen panel using Antigen technique for …$700.00
87430INF AGT IMMUNO STREP A$220.89
87480IADNA CANDIDA SPECIES DIRECT PROBE TQ$231.84
87486IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ$579.60
87491IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ$403.28
87493INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE$497.50
87507IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25$3,998.40
87529INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA &RNA)$601.50
87581IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ$429.17
87591IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ$289.05
87633IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET$2,061.60
87635IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ$301.00
87636“severe acute respiratory syndrome coronavirus 2 (SARSCoV-2…$800.00
87661INF AGENT DETECTED NUCLEIC ACID; TRICHMONAS VAGINALIS AMP P…$460.80
87798O&P SMEAR W/AMPLIFIC$702.00
87800IAADIADOO NEISSERIA GONORRHOEAE$197.23
87804INFLUENZA IMMUNOASSAY OPT$168.00
87807INF AGT DET IMNAS OPT RSV$42.00
87847NO DESCRIPTION$409.00
87850NEISSERIA GONORRHOEAE DET$169.65
87880RAPID STREP-BETA STREP$200.99
87905INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS$394.50
88305PATH SURG LEVEL IV$405.96
89050CELL COUNT MISCELLANEOUS BODY FLUIDS$134.33
89051CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT$127.36
89055LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE$98.51
89060CRYSTAL INDENTIFICATION$105.47
89220SPTM OBTG SPEC AERSL INDUCED SPX$98.00
90471IMMUN ADM 1 VAC$154.23
90660INFLUENZA VIRUS INTRANASA$70.00
90688Influenza virus vaccine, quadrivalent (IIV4), split virus, …$525.30
90700DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM$231.60
90703TETANUS TOXID$152.00
90714TETANUS DIPHTHERIA TOXOID$374.32
90715TDAP VACCINE$116.00
90718TETANUS & DIPTHERIA$152.00
90746HEPATITIS B VACCINE/ADULT$79.00
90765IV NFS THER PROPH/DX 1ST$210.00
90997HEMOPERFUSION$409.00
91105GASTRIC INTUBATION/ASPER$596.00
92002OPH MEDICAL XM&EVAL INTRM$1.00
92081VIS FLD XM UNI/BI I&R LMT$1.00
92552PURE TONE AUDIOMTRY AIR O$1.00
92950cardiopulmonary resuscitation$1,301.00
92960CARDIOVERSION ELECTIVE ARRHYT XTRNL$1,089.00
93000EKG W/INTREP AND REPORT$248.00
93005Electrocardiogram, routine ECG$534.00
93010RTN ECG 12 LEADS INTRP/RP$624.00
93018CV STRS TST XERS&/OR RX CONT ECG I&R ONLY$475.61
93040RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT$459.69
93041RHYTHEM ECG 1-3 LDS$146.00
93042RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON$340.29
93224WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I$149.00
93306ECHO TEST$1,367.00
93307ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP$3,524.29
93308ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD$2,795.40
93313TEE R-T IMG 2D W/PROBE PLMT ONLY$2,626.00
93320DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY$1,457.30
93325DOP ECHOCARD COLOR FLOW VELOCITY MAPPING$1,480.10
93351ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG$1,560.00
93631INTRAOP EPICAR& ENDOCAR PACG& MAPG$10,386.84
93784Orthostatic$387.84
93875N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD$840.00
93880DUP-SCAN XTRC ART COMPL B$903.00
93882DUP-SCAN XTRC ART UNI/LMTD STD$903.00
93922NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL$557.20
93923NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS$845.75
93925DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY$923.36
93926DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD$878.00
93930DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY$923.36
93931DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD$466.00
93965QUANT VENOUS FLOW ST$1,806.00
93970DUP-SCAN XTR VEINS COMPL$1,201.96
93971DPLX SCN EXTRM VEINS$645.00
93975DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, P…$514.00
93976DUPLEX SCAN- LIMITED$466.00
94010SPIROMETRY W/RECORD$150.00
94060BRNCDILAT RSPSE SPMTRY PR$385.00
94621PULM STRS TSTG CPLX$1,029.00
94640NEBULIZER TREATMENT$873.65
94644INHALATION TREATMENT – CONTINUOUS 1ST HR$157.00
94664DEMO&/EVAL OF PT UTILIZ$1.00
94760EAR OR PULSE OXIMETRY$25.87
94761N-INVAS EAR/PLS OXIMTRY F$238.00
94762NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR$644.76
96360IV INFUS INIT 31 MIN 1 HR$634.50
96361IV INFUS HYDR EA ADD’T HR$356.21
96365IV INFUSION THERAPY/PROPH$497.50
96366IV INFUS THER PROPH/DX EA$356.21
96367IV NFS THER PROPH/DX ADDL$470.64
96368IV NFS TX PROPHYLAXIS/DX$263.00
96372THERAPEUTIC PROPHYLACTIC/$87.56
96373INJECTION, INTRA-ARTERIAL$228.00
96374THER PROPH/DX NJX IV PUSH$441.78
96375THER PROPH/DX NJX EA SEQL$402.98
96376SUB INFU EA ADD IV PUSH$388.05
96377APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION$232.83
96379INJECTION- UNLISTED THERAPEUTIC PROPH/DX/IVA NJX/NFS$213.00
97010APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS$101.49
97116THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR$302.48
97542WHEELCHAIR MGMT EA 15 MIN$278.60
97597DEBRIDEMENT OPEN WOUND 20 SQ CM/<$638.79
99000SPECIMEN HANDLING$54.00
99001COC COLLECITON ONLY$41.00
99024POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX$789.00
99050BLUE CROSS RQRD LVL3$87.00
99053SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HOUR FACILITY$146.00
99070SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP$183.08
99080MEDICAL RECORDS$46.00
99143MOD SEDATION &#60;5YRS 30$439.00
99144MOD SEDATION SERV UNDER 5$433.00
99145M-SEDAJ BY SM PHY 15 MIN$168.00
99149MOD SEDATION$363.00
99151MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS$857.69
99173SCREENING TEST OF VISION$293.00
99217OBSERVATION CARE DISCHARGE MANAGEMENT$975.10
99218INITIAL OBSERVATION CARE/DAY 30 MINUTES$187.06
99219INITIAL OBSERVATION CARE/DAY 50 MINUTES$957.19
99220INITIAL OBSERVATION CARE/DAY 70 MINUTES$957.19
99234OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES$1,066.64
99235OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES$1,852.69
99236OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES$2,454.80
99281E/M VISIT LEVEL 1 TECH COMP$479.59
99282E/M VISIT LEVEL 2 TECH COMP$1,035.80
99283E/M VISIT LEVEL 3 TECH COMP$2,055.67
99284E/M VISIT LEVEL 4 TECH COMP$2,692.47
99285E/M VISIT LEVEL 5 TECH COMP$3,770.06
99291CRITICAL CARE 30-74 MIN$4,779.00
99292CRITICAL CARE ADD 30 MIN$1,365.14
99406SMOKING CESSATION 3-10$81.00
99407SMOKING CESSATION 10 MIN$94.00
A0394ALS IV DRUG THERAPY SUPPLIES$1.00
A0396ALS ESPOHAGEAL INTUB SUPPLIES$30.00
A42083 CC STERILE SYRINGE & NEEDLE$32.00
A42095+ CC STERILE SYRINGE & NEEDLE$35.00
A421320+ CC SYRINGE ONLY$7.00
A4215NEEDLE STERILE, ANY SIZE, EACH$12.00
A4216STERILE WATER/SALINE, FLUSH 10ML$3.00
A4217STERILE SALINE WATER PER 500 ML$26.00
A4218STERILE SALINE OR WATER$26.00
A4222EXT UNFU PMP PER CASS/BAG$176.00
A4224ALOCHOL OR PEROXIDE PER PINT$4.00
A4246BETADINE/PHISOHEX SOLUTION$25.00
A4247BETADINE/IODINE SWABS/WIPES$25.00
A4252GLUCOSE TEST STRIP-BLOOD KETONE TEST OR STRIP$6.00
A4270DISPOSABLE ENDO CODE SHEATH$24.00
A4311CATHETER W/O BAG 2 WAY LATEX$35.00
A4314INSRT TRAY W/DRAINAGE BAG$12.00
A4315Insertion tray with drainage bag with indwelling catheter, …$15.00
A4316CATH W DRAINAGE 3 WAY$90.00
A4320IRR TRAY W/BULB/PISTON SY$9.00
A4322IRRIGATION SYRINGE, BULB$15.00
A4327URIN CUP FEMALE COLLECT DEV CUP$3.00
A4332LUBE STERILE PACKET$7.00
A4335INCONTINENCE SUPPLY MISC$3.00
A4338INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING$53.00
A4344INDWELLING CATH FOLEY TYP$12.00
A4353INTERMIT URINARY CATHETER$24.00
A4358URINARY DRAINAGE BAG$14.00
A4364DERMABOND- ADHESIVE, LIQUID OR EQUAL PER OZ$33.00
A4450TAPE NO WATERPROOF$10.00
A4452TAPE WATERPROOF 18 SQ IN$10.00
A4550LACERATION- SURGICAL KIT$409.00
A4554DISPOSABLE UNDERPADS$30.00
A4565SLING$146.00
A4570SPECIAL CASTING MATERIAL$125.00
A45903 ORTHO GLASS 4 SPECIAL CASTING MATERIAL$84.00
A4595TENS SUPPL 2 LEAD PER MONTH$46.00
A4606OXYGEN PROBE USED W OXIMETER$127.00
A4614HAND HELD PEFR METER$50.00
A4615CANNULA NASAL$6.00
A4616TUBING (OXYGEN) PER FOOT$1.00
A4617MOUTHPIECE FOR RESPIRATORY OXYGEN EQUIPMENT$55.00
A4649SURGICAL SUPPLY MISC$23.00
A4653PD CATHERTER ANCHOR BELT$13.00
A4657SYRINGE W OR WO NEEDLE$7.00
A4670AUTOMATIC BP MONITOR #11$36.00
A4673SALINE BLADE #11$13.00
A4927GLOVES NON STERILE$1.00
A4930GLOVES STERILE PER PAIR$3.00
A5120SWAB OR WIPE SKIN BARRIER$6.00
A5200PERCUTANEOUS CATHETER ANCHOR$117.00
A6021COLLAGEN DRESSING STERIL$17.00
A6205COMPOSITE DRSG LESS THAN 48 SQ IN$22.00
A6210FOAM DRSG LESS THAN 16=48 SQ IN W/ BORDER$98.00
A6211FOAM DRG LESS THAN 16 LESS THAN 48 SQ IN WO BORDER$31.00
A6212FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ IN OR LESS, EACH…$7.00
A6213FOAM DRG 16-48 SQ IN W/BRDR$11.00
A6216GAUZE NONIMPREG 16 SQ IN$13.00
A6217GAUZE NON STERILE$13.00
A6218GAUZE, NON STERILE$13.00
A6219GAUZE- STERILE$13.00
A6220GAUZE, NON IMP, STERILE, PAD SIZE >16 SQ < OR = 48SQ IN$11.00
A6222GAUZE IMPREGNATED WITH ME$8.00
A6231GAUZE, 16<SQ IN, EACH$70.00
A6250SKIN SEAL PROTECT MOISTURIZER OINTMENT$34.00
A6260WOUND CLEANSER$100.00
A6261WOUND FILLER$100.00
A6402GAUZE NON-IMPREG STERL 16$7.00
A6407PACK STRIPS NON-IMPREGNTD$29.00
A6410STERILE EYE PAD OR STRIP$6.00
A6412OCCLUSIVE EYE PATCH$30.00
A6413ADHESIVE BANDAGE FIRST AI$6.00
A6446CONFORMING BANDAGE NON-EL$19.00
A6448LT COMP BANDAGE LESS THAN 3IN$11.00
A6449LIGHT COMP BANDAGE$11.00
A6450LT COMPRS BANDAGE ELAST$17.00
A6453BANDAGE SELF ADHER BAND W LESS THAN 3$2.00
A6454SELF ADHER BANDAGE$13.00
A6455SELF ADHER BANDAGE$13.00
A6457TUBULAR DRESSING$41.00
A7002SUCTION TUBING USED W PUMP$94.00
A7003ADMN SET SM VOL NONFILTER$57.00
A7011NONDISPOS CORRUGATED TUBING$12.00
A7015NEBULIZER MASK USED W NEBULIZER$57.00
A7016DOME/MOUTHPEICE NEB$161.00
A7017NEBULIZER MASK NOT USED W/ OXYGEN$57.00
A7520TRACH LARYN TUBE NON CUFFED$37.00
A9150NON PERSCRIPTION DRUG$23.00
A9273HOT/COLD H2OBOT/CAP/COL/WRAP$32.00
A9284NON-ELECTRONIC SPIROMETER$254.00
A9579GAD-BASE MR CONTRAST NOS,1ML$15.00
C9399ORBACTIV 1200 MG IV$10,153.00
CASHXRAY DISC$17.00
E0110CRUTCH FOREARM PAIR$225.00
E0114CRUTCHES UNDERARM$59.00
E0116CRTCH UNDARM NOT WOOD ADJ$59.00
E0220HOT WATER BOTTLE$35.00
E0230ICE CAP OR COLLAR$12.00
E0275BED PAN STANDARD$11.00
E0325URINAL MALE JUG-TYPE$7.00
E0352DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM)$177.00
E04114E04114$41.00
E0445OXIMETER NON-INVASIVE$578.00
E0570NEBULIZER WITH COMPRESSION$677.00
E0580NEBULIZER FOR USE W/ REGULAT$293.00
G0009ADM PNEUMOCOCCAL VACCINE$90.00
G0168WND CLS TISSUE ADHESIVE$152.00
G0378HOSPITAL OBSERVATION SERVICES PER HOUR$2,000.00
G0434DRUG ABUSE PANEL II$230.00
G2023COVID-19 Testing specimen collection for severe acute respi…$30.00
J0120TETRACYCLIN INJECTION$30.00
J0129ABATACEPT INJECTION$25.00
J0131INJECTION, ACETAMINOPHEN, 10 MG$3.00
J0150ADENOSINE INJ 6MG VIAL$65.00
J0153ADENOSINE INJ 1MG$8.00
J0170EPINEPHRINE 3 1/2 NDL 10M$8.00
J0171ADRENALIN EPINEPHRINE INJECT$23.00
J0210METHYLDOPATE HCL INJECTION$40.00
J0282INJ AMIODARONE HYDROCHLOR$13.00
J0290AMPICILLIN 500 MG INJ$22.00
J0295INJ AMPCLLN SODIUM/SULBA$20.00
J0330SUCCINYLCHOLINE CHLO 20MG$173.00
J0360HYDRALAZINE HCL INJ UP TO 20MG$173.00
J0456INJ AZITHROMYCIN 500MG$81.00
J0461INJ ATROPINE SULFATE 0.01$1.00
J0500DICYCLOMINE HCL 20MG$22.00
J0550BICILLIN – PENICILLIN G BENZATHINE INJ$65.00
J0558PENG BENZATHINE/PROCAINE INJ$90.00
J0559BICILLIN – PENICILLIN G BENZATHINE INJ 2500 UNITS$65.00
J0560BICILLIN 600,000$50.00
J0561INJECTION PENICILLIN G BENZATHINE 100,000 UNITS$55.00
J0570BICILLIN 1,200,000$110.00
J0595STADOL$13.00
J0610CALCIUM GLUCONATE INJECTION$79.80
J0641LEVOLEUCOVORIN INJECTION$2.00
J0690KEFZOL 1 GR VIAL$22.00
J0692INJ CEFEPIME HCI 500MG$46.00
J0696ROCEPHIN 250 MG$52.00
J0697STERILE CEFUROXIME INJECTION$25.00
J0698CLAFORAN 1 GR VIAL$63.00
J0735CLONIDINE 1MG$8.00
J0744CIPRO 200MG$176.00
J0760COLCHICINE INJECTION$23.00
J0780COMPAZINE 10 MG$12.00
J1020INJ METHYLPREDNISOLONE AC$2.00
J1030DEPO MEDROL 40 MG/ML$75.64
J1040METHYLPREDNISOLONE 80MG$10.00
J1094DECADRON DEXAMETHASONE ACETATE 1MG$22.00
J1100DECADRON 4 MG VIAL$22.00
J1110INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG$70.00
J1165DILANTIN 100 MG VIAL$41.00
J1170DILAUDID 4 MG$41.00
J1200BENADRYL 50MG$22.00
J1240ANTIVERT – DIMENHYDRINATE INJECTION 50MG$33.00
J1335ERTAPENEM INJECTION$21.00
J1580GARAMYCIN,GENTAMICIN 80MG$50.00
J1610GLUCOGAN 1 MG VIAL$68.00
J1630HALOPERIDOL INJECTION$39.70
J1631HALOPERIDOL DECANOATE INJ PER 50 MG$83.00
J1642HEPARIN SODIUM PER 10 UNI$13.00
J1644INJ HEPARIN SOD PER 1000$87.00
J1650ENOXAPARIN SODIUM 10MG$37.00
J1670TETANUS INJECTION$41.00
J1741IBUPROFEN INJECTION$22.00
J1810DROPERIDOL/FENTANYL INJ$25.00
J1815INJ INSULIN PER 5 UNITS$31.00
J1817INSULIN FOR INSULIN PUMP USE$22.00
J1885TORADOL INJ 15 MG$22.00
J1930LANREOTIDE INJECTION$45.00
J1940LASIX 40 MG IV VIAL$22.00
J1956LEVOFLOXACIN 250 MG$120.00
J2001LIDOCAINE HCI 10MG$31.00
J2060ATIVAN 2ML SYRUP$100.00
J2150MANNITOL INJECTION$26.00
J2175DEMEROL 50 MG SYRINGE$28.00
J2180MEPERIDINE/PROMETHAZINE INJ$30.00
J2250MIDAZOLAM HCI PER 1 MG$11.00
J2270INJ MORPHINE SULFATE 10 M$22.00
J2274INJ MORPHINE PF EPID ITHC$30.00
J2300NUBAIN 10MG AMP$50.00
J2310INJ NALOXONE HCL 1MG$30.00
J2360ORPHENADRINE CITRATE 60MG$122.00
J2370NEO-SYNEPHRINE UP TO 1 ML$81.00
J2405ONDANSETRON HCI, PER MG$22.00
J2410OXYMORPHONE HCL INJECTION$25.00
J2425PALIFERMIN INJECTION$25.00
J2504PEGADEMASE BOVINE, 25 IU$25.00
J2543ZOSYN – PIPERACILLIN/TAZOBACTAM$59.00
J2550PHENERGAN 50 MG$22.00
J2650PRELONE – INJECTION PREDNISOLONE ACTATE UP TO 1 ML$6.00
J2690PRONESTYL 10 ML$22.00
J2704INJECTION PROPOFOL 10 MG$32.00
J2730PRALIDOXINE CHLORIDE$22.00
J2760PHENTOLAINE MESYLATE INJ$41.00
J2765METOCLOPRAMIDE HCL 10MG$1.99
J2780INJ RANITIDINE 25 MG$37.00
J2790RHOGAM INJECTION$199.00
J2800METHOCARBAMOL INJECTION$50.00
J2920SOLU-MEDROL 40MG$10.00
J2930SOLU-MEDROL 125 MG$15.00
J3010INJ FENTANYL CITRATE .1MG$1.00
J3030IMITREX 6MG VIAL$216.41
J3105INJECTION, TREBUTALINE SULFATE, UP TO 1 MG$35.00
J3130TESTOSTERONE ENANTHATE INJ$24.00
J3230THOROZINE 50 MG$330.00
J3260TOBRAMYCIN SULFATE INJECTION$36.00
J3360VALIUM INJ 5 MG$10.00
J3370VANCOMYCIN HCI INJ 500MG$229.00
J3410VISTERIL INJ 50 MG$22.00
J3411INJ THIAMINE 100 MG$11.00
J3430INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG$12.00
J3475MAGNESIUM SULFATE 2CC AMP$25.00
J3480POTASSIUM CHLORIDE 2 MG$1.99
J3486GEODON – ZIPRASIDONE MESYLATE 10MG$35.00
J3490UNCLASSIFIED DRUGS$36.00
J7030INFUS NORM SALINE 1000CC$53.00
J7040INFUS NORM SALINE 500ML$26.00
J70425% DEXTROSE$26.00
J7050INFS NORM SALINE 250CC$26.00
J7060INFUSION D5W 250ML$28.00
J7070INFUSION D5W 1000ML$86.00
J7120RINGER’S LACTATE INFUS$90.00
J71215% DEXTROSE IN LAC RINGERS$65.27
J7130HYPERTONIC SALINE SOLUTION$76.00
J7131HYPERTONIC SALINE SOL$61.74
J7192FACTOR VIII RECOMBINANT NOS$20.00
J7313FLUOCINOL ACET INTRAVIT IMP$20.00
J7506PREDNISONE ORAL 5 MG$8.00
J7510PREDNISOLONE ORAL 5 MG$8.00
J7512PREDNISONE 5 MG$8.00
J7607LEVALBUTEROL COMP CON$13.00
J7610ALBUTEROL, THRU DME 1MG$13.00
J7611ALBUTEROL 1MG CONC INHALA$13.00
J7613ALBUT INHAL NON-CP 1MG$13.00
J7614ALBUTEROL ALL FOMULATIONS$20.00
J7615LEVALBTERAL INHALATION SO$20.00
J7620ALBUTEROL 2.5 MG ATROVENT$13.00
J7631CROMOLYN SODIUM NONCOMP UNIT$20.00
J7637DEXAMETHASONE COMP CON$20.00
J7644IPRATROPIUM BROMIDE INHAL$31.00
J7682TOBRAMYCIN NON-COMP UNIT$25.00
J7699NOC DRUGS INHAL SOL ADMIN$8.00
J8498ENEMA SUPPOSITORY, ANTIEMETIC RECTAL$31.00
J8499NONCHEMOTHERAPEUTIC ORAL$17.00
J8540DEXAMETHASONE, ORAL .25MG$20.00
J9027CLOFARALINE INJECTION$141.00
J9206IRINOTECAN INJECTION$25.00
L0120CERVICAL FLEX NONADJ COLL$320.00
L0172CLAVICAL COLLAR 2 PC$41.00
L1630ABDUCT CONTROL HIP SEMI FLEX$41.00
L1830KNEE IMMOBOLIZER$24.00
L1906ANKLE SUPPORT$133.00
L3260SURGICAL BOOT/SHOE$87.00
L3650SO FIGURE EIGHT ABDUCTION$251.00
L3670SO ACROMIO/CLAVICULAR$113.00
L3908WRIST EXTN CONTROL COCKUP$87.00
L3999UPPER LIMB ORTHOSIS NOS$176.00
L4350AIR SPLINT$453.00
L4360WALK BOOT PNEUMATIC$117.00
L4380PNEUMATIC KNEE SPLINT$125.00
L4386WALKING BOOT NON PNEUMATIC$168.00
L4387NON-PNEUM WALK BOOT PRE OTS$250.00
P7001CULTURE BACTERIAL URINE$89.00
P9612CATHETERIZE FOR URINE$177.00
Q0144AZITH DIHY ORAL CAP/POWD$161.00
Q0179ONDANESTRONG HCL 8MG ORL$4.00
Q4006LONG ARM CAST ADULT$92.00
Q4007CAST SUPPLIES LONG ARM CA$15.00
Q4008CAST SUPPLIES LONG ARM$40.00
Q4009CAST SUPPLIES SHORT ARM$140.00
Q4010SHORT ARM CAST ADULT$55.00
Q4012CAST SUPPLIES SHORT ARM$87.00
Q4020LNG ARM SPLNT 0-10 YRS$39.00
Q4022SHRT ARM SPLNT 11 YRS +$805.00
Q4034CAST SUP LNG LEG CYLINDER FB$176.00
Q4037CAST SUPPLIES SHORT LEG$146.00
Q4038CAST SUP SHRT LEG FIBERGLASS$24.00
Q4039CAST SUPPLIES SHORT LEG C$146.00
Q4042LNG ARM SPLNT 11 YRS +$117.00
Q4046SHRT LG SPLNT 11 YRS +$249.00
Q4049FINGER SPLNT STATIC$206.00
Q4051SPLINT SUPPLIES MISC$125.00
Q9954ORAL MR CONTRAST, 100ML$416.00
Q9963HI OSM CONTRST MATL 350-3$23.00
Q9965LOW OSMOLAR CON MAT PER M$25.00
Q9966LOCM 200-299MG ML IODINE, 1ML$22.00
Q9967LOW OSMOLAR CNTRS MAT$20.00
S0020INJ, BUPIVICAINE, 30ML$46.00
S0028INJECT FAMOTIDINE 20 MG$70.00
S0030METRONIDAZOLE 500 MG INJ$188.00
S0077CLANDAMYCIN PHOSPHATE 300$32.00
S0119ZOFRAN, 4MG, ORAL$8.00
S0164PROTONIX PANTROPRAZOLE 40MG$194.00
S0622PHYS EXAM FOR COLLEGE$87.00
S0630RMV SUTURES; PHYS NOT PHY$65.00
S3000BILAT DIL RETINAL EXAM$11.00
S5000PRESCRIPTION DRUG GENERIC$1.00
S5001PRESCRIPTION DRUG BAND NM$8.00
S5010STERILE SALINE 5% DEXTROSE AND 0.45% SALINE$232.00
S50115% DEXTROSE 1000 ML$1.00
S5550INSULIN RAPID 5 U$26.00
S8037MRCP MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY$1,284.00
S8100SPACER WITHOUT MASK$52.00
S8101MASK NEBULIZER MASK SPACER WITH MASK$59.00
S8450SPLINT$84.00
U0002COVID-19 PCR Testing$301.00