Learning Center Articles

Richmond 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$1,243.38
10061INS/DRAIN ABSCESS COMPL$1,566.72
10080INCISION & DRAINAGE PILONIDAL CYST SIMPLE$1,216.00
10081I&D PILONIDAL CST COMP$590.00
10120I & RMVL SUB-CUT SIMPLE$3,376.43
10121I & RMVL FB, SUB-CUT,COMP$583.00
10160PUNCTURE ASP OF ABSCESS$328.00
10180Incision and drainage, complex, postoperative wound infecti…$1,950.00
11011DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC$263.00
11040DBRDMT, SKIN, PARTIAL THICK$205.00
11042DBRD SKN SUBQ TISSUE$1,455.00
11200RMVL SKIN TAGS$443.74
11404EXC BGN LSN TRUNK 3.1-4.0$833.00
11719TRIMMING NONDYSTROPHIC NAILS ANY NUMBER$360.00
11730AVULSION/1-NAIL PLATE$1,540.00
11740EVAC SUBUNGUAL HEMATOMA$1,180.00
11750EXC NAIL PART/COMP$1,404.00
11760REPAIR NAIL BED$531.00
11765WEDGE EXC SKIN/NAIL BED$341.00
11771EXCISION PILONIDAL CYST SINUS EXTENSIVE$297.00
11982REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT$895.00
12001LACERATION REPAIR$290.54
12002REPAIR LAC SCALP 2.6-7.5$326.36
12004REPAIR LAC SCALP 7.6-12.5$356.21
12005REPAIR LAC,SCALP 12.6-20C$902.50
12011REPAIR LAC FACE LESS THAN 2.5 CM$812.92
12013REPAIR LAC FACE 2.6-5.0CM$854.70
12014REPAIR LAC FACE 5.1-7.5CM$1,258.00
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$344.27
12034INTERM RPR SCLP/TRNK/EXTR$707.00
12035REPAIR INTERM S/A/T/E 12.$1,226.55
12036REPAIR INTERM S/A/T/E 20.1-30.0 CM$762.00
12041LAYER CLSR NECK/HAND 2.6$292.53
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$1,540.00
12052LYR CLSR WOUND 2.6-5.0FAC$1,180.00
12053LYR CLSR F/E/E/N/L/M&/MUC$957.00
12054REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM$1,404.00
13120REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM$2,023.03
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$2,618.93
13153REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM<$669.00
15850SUTURE RMVL W/ANESTHESIA$895.00
16000BURN, INITIAL TREATMENT$1,350.00
16020BURN, DRESSING/DBRDMNT-SM$284.57
17250UMBILICAL CAUTERIZATION$368.15
19000PUNCTURE ASPIRATION CYST BREAST$2,521.33
19100BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX$779.08
20552TRIGGER POINT INJ 1-2 MUS$805.95
20600ARTHROCENTESIS, SML JOINT$1,523.75
20605ARTHROCENTESIS, MED JOINT$1,412.50
20610ARTHROCENTESIS, LG JOINT$1,523.00
20611Arthrocentesis, aspiration and/or injection, major joint or…$1,922.00
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
23550OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC$890.00
23570CLSD TX SCAPULAR FX WO MA$839.00
23600CLTX PROX HUMRL FX WO MAN$381.00
23650SHOULDER DISLOCATION TRMT$1,100.00
23665CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ$1,320.00
24075EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM$1,000.00
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$1,000.00
24640RADIAL HEAD SUBLUX. CHILD$1,100.00
24650CLTX RDL HEAD FX WO MANP$959.00
24670CLTX ULNR FX PROX END WO$942.00
25066BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP$1,000.00
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$999.00
26600CLSD TX METACARPAL FX$909.00
26605CLSD TX MEDICARPAL FX$1,200.00
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$1,080.00
26755CLTX DSTL PHLNGL FX FNGR/$1,259.00
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…$8,700.00
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$1,320.00
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$850.00
28515FX CARE PHALANX NOT GREAT$622.00
28660CLSD TX PIP JNT DISLOCATI$1,000.00
29075APPLICATION CAST ELBOW FINGER SHORT ARM$950.00
29085CAST HAND/LOWER FOREARM GAUNTLET$176.00
29086APPLICATION CAST FINGER$920.00
29105LONG ARM SPLINT$829.18
29125SHORT ARM SPLINT$725.36
29126SHORT ARM SPLINT DYNAMIC$176.00
29130APPLICATION FINGER SPLINT$542.74
29131APPLICATION FINGER SPLINT DYNAMIC$733.20
29240STRPG SHO$723.36
29280STRAPPING HAND/FINGER$605.96
29450APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG$1,150.00
29505LONG LEG SPLINT$935.75
29515SHORT LEG SPLINT$890.00
29530STRAPPING KNEE$492.52
29540STRAPPING ANKLE/FOOT$465.66
29550STRAPPING TOES$505.46
29580STRAPPING UNNA BOOT$220.00
29700RMVL/BIVALV GAUNTLET BOOT$1,100.00
30300RMVL FOREIGN BODY NASAL$1,300.00
30901NASAL PACKING$1,440.39
30903CTRL NSL HEMRRG ANT CPLX$443.00
30905CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST$1,325.00
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$1,197.00
33415RESCJ/INC SUBVALVULAR TISSUE$980.00
33512CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS$2,700.00
36000INTRODUCTION OF NEEDLE/IN$76.32
36005NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH$604.79
36010INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA$590.00
36410VENIPUNCTURE, 3 YRS OR OLDER$68.00
36415VENIPUNCTURE$75.22
36416COLL CAPILLARY BLG SPEC$595.00
36556Insertion of non-tunneled centrally inserted central venous…$3,150.00
36558INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR$2,156.00
36589RMVL TUN CVC W/O SUBQ PORT/PMP$1,912.75
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
43752NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE$2,050.00
43753GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING …$128.00
45900Manipulation Procedures on the Colon and Rectum$800.00
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$989.03
51703INSERT BLADDER CATH COMPL$1,110.00
56405INC/DRAIN VULVA/PERINEAL$259.00
56420I & D BARTHOLIN ABSCESS$100.00
57415REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL$1,115.00
59025FTL NON-STRS TST$950.00
59409VAG DLVR ONLY$3,960.00
62270SPINAL PUNCTURE,LUMBAR$554.00
64400NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH$1,000.00
64402INJ ANESTHETIC FACIAL NRV$640.00
64450INJ ANESTHETIC AGENT$1,432.80
64640DSTRJ NULYT OTH PRPH NVR/BRANCH$1,220.00
65205REMOVAL FB EYE-SUPERFCL$1,300.00
65220RMVL FB EYE W/O SLIT LAMP$1,190.00
65222RMVL FB EYE$1,320.00
65435RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION$1,190.00
67700I&D ABSCESS EYELID$773.00
69005DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED$363.00
69200RMVL FOREIGN BODY EAR$1,190.00
69205RMVL FB XTRNL AUD CANAL A$409.00
69209REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL$1,190.00
69210RMVL IMPACTED CERUMEN$202.98
69399Under Other Procedures of the External Ear$1,200.00
70030RADEX EYE DETCJ FB$636.80
70100XRAY MANDIBLE LESS THAN 4 VIEWS$913.41
70110XRAY MANDIBLE MIN 4 VIEWS$1,480.56
70120RADEX MASTOIDS LESS THAN 3 VIEWS PR SIDE$157.00
70130RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE$1,355.19
70140XRAY FACIAL BONES LESS THAN 3 VIEW$1,148.53
70150XRAY FACIAL BONES GREATER THAN 3 VIEW$1,816.13
70160Radiologic examination, nasal bones, complete, minimum of 3…$1,165.14
70200RAD EXAM ORBIT COMP.$1,801.94
70210RADEX SINUSES PARANASAL <3 VIEWS$1,694.48
70220RAD EXAM SINUS COMPLETE$1,276.68
70250SKULL LESS THAN 4 VIEWS$1,675.08
70260RAD EXAM SKULL COMPLETE$2,371.39
70328RADEX TMPRMAND JT OPN&CLSD MOUTH UNI$351.00
70330RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT$1,215.89
70350CEPHALOGRAM ORTHODONTIC$257.00
70360RAD EXAM NECK,SOFT TISSUE$645.66
70450COMPUTED TOMOGRAPHY HD/BR$5,538.75
70460TOMOGRAPHY HEAD/BRAIN WIT$6,331.50
70470COMPUTED TOMOGRAPHY HEAD/$7,147.88
70480CT ORBIT SELLA/POST FOSSA$5,801.25
70481CT ORBIT SELLA/POST FOSSA$6,365.90
70482CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR$7,103.52
70486CT MAXLFCL AREA C-MATRL$5,858.95
70487CT MAXLFCL AREA C+ MATRL$6,703.15
70488CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL$7,092.00
70490CT NECK WO CONTRAST$5,911.50
70491CT SOFT TISS NCK C+MATRL$6,395.38
70492CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL$6,801.53
70496CTA HEAD C-/C+$5,991.19
70498CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST$6,306.75
70544MRA HEAD C-MATRL$3,150.00
70547MRA NECK C-MATRL$2,772.00
70551MRI BRN BRN STEM C-MATRL$2,772.00
70553MRI BRN BRN STEM C-/C+$3,268.00
71035RADEX CHEST SPECIAL VIEWS$2,393.97
71045Radiologic examination, chest ; single view$1,385.24
71046CHEST XRAY 2 VIEWS$1,526.53
71047Radiologic examination, chest ; 3 views$2,039.75
71048(Radiologic examination, chest ; 4 or more$1,895.92
71060BRONCHOGRAPHY BI RS&I$537.00
71100RIBS UNILATERAL 2 VIEWS$1,552.20
71101RIB UNILATERAL W CHEST$1,313.40
71110RIBS BILATERAL 3 VIEWS$2,085.02
71111RIBS BILATERAL W/CHEST$1,596.38
71120Radiologic examination; sternum, minimum of 2 views$1,345.84
71250CT CHEST W/O CONTRAST$6,450.65
71260CT THORAX W/CONTRAST$6,947.90
71270CT THORAX WO CONTRAST$7,342.40
71275CT ANGIOGRAPHY$7,164.50
71550MRI CH C-MATRL$2,771.00
72020Radiologic examination, spine, single view, specify level$1,155.20
72040SPINE, CERVICAL 2/3 VIEWS$1,458.67
72050SPINE, CERVICAL MIN 4VIEW$2,220.39
72052SPINE CERV. COMP FLEX/EXT$2,503.42
72069RADEX SPI THORACOLMBR STANDING SCOLIOSIS$374.00
72070SPINE THORACIC 2 VIEWS$1,603.94
72072SPINE THORACIC 3 VIEWS$1,895.48
72074RAD EXAN SPINE THROAC 4 V$2,044.92
72080RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS$1,580.06
72082RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW$1,373.10
72100SPINE LUMBO. MIN 4 VIEWS$1,566.13
72110LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS$2,435.76
72114RAD EXAM SPINE LUMBO COMP$1,746.82
72120SPINE LUMBAR AP & LAT W F$1,855.68
72125COMPUTED TOMOGRAPHY CERVI$6,227.92
72126CT CRV SPI C+MATRL$6,944.93
72127CT CRV SPI C-/C+$7,326.08
72128CT THRC SPI C-MATRL$6,248.82
72129CT THRC SPI C+ MATRL$6,723.90
72130CT THORACIC SPINE W/O & W/CONTRAST MATERIAL$7,033.50
72131CT L SPINE WO CONTRST$6,378.00
72132CT LMBR SPI C+ MATRL$6,946.84
72133CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL$6,928.82
72141MRI SPI CANAL&CNTS CRV C-MATRL$1,867.00
72146MRI SPI CANAL&CNTS THRC C-MATRL$2,772.00
72148MRI SPI CANAL&CNTS LMBR C-MATRL$2,772.00
72156MRI SPI CANAL&CNTS C-/C+ CRV$3,268.00
72157MRI SPI CANAL&CNTS C-/C+$2,772.00
72158MRI SPI CANAL&CNTS C-/C+ LMBR$2,801.00
72170RAD EXAM PELVIS 1/2 VEIW$1,284.54
72190RADEX PELVIS COMPL MIN 3$1,573.10
72191CTA PELVIS C-/C+ POST-PXE$7,154.61
72192CT PELVIS WO CONTRAST$5,718.08
72193TOMOGRAPHY PELVIS WCONTRS$6,255.48
72194CT PELVIS W OR WO CONTRST$9,776.87
72195MRI PELVIS C-MATRL$2,772.00
72196MRI PELVIS C+ MATRL$3,735.00
72220XRAY COCCYX/SACRUM$1,628.82
72270MYELOGRAPY 2/MORE REGIONS RS&I$2,450.00
73000XRAY CLAVICLE 2 VIEWS$1,301.46
73010SCAPULA COMPLETE$1,641.75
73020RADEX SHO 1 VIEW$1,032.81
73030SHOULDR COMPLETE 2 VIEWS$1,720.36
73050XRAY AC JOINTS-BILAT$841.77
73060XRAY HUMERUS MIN 2 VIEWS$1,337.28
73070XRAY ELBOW 2 VIEWS$1,206.94
73080XRAY ELBOW GREATER THAN 3 VIEWS-COMP$1,590.01
73090XRAY FOREARM AP & LAT$1,278.58
73100XRAY WRIST AP & LAT VIEW$1,019.88
73110XRAY WRIST/COMP MIN 3 VIE$1,445.24
73120XRAY HAND AP & LAT$1,026.84
73130XRAY HAND MIN 3 VIEWS$1,415.88
73140XRAY FINGER MIN 2 VIEWS$1,029.82
73200CT UPPR EXTR WO CNTRS$5,749.44
73201CT UPPER EXTREMITY W/CONTRAST MATERIAL$6,270.61
73202CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL$6,710.40
73220MRI UXTR OTH/THN JT C-/C+$3,268.00
73221MRI ANY JT UXTR C-MATRL$2,772.00
73500RADIOLOGIC EXAM HIP UNILAT 1 VIEW$380.00
73501RADEX HIP UNILATERAL WITH PELVIS 1 VIEW$966.14
73502RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN P…$881.57
73503RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS$1,749.21
73510XRAY HIP MIN 2 VIEWS$1,371.11
73520HIPS BILAT MIN 2 VIEW INC$507.00
73522RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS$2,594.49
73550XRAY FEMUR AP & LAT VIEW$311.00
73551RADIOLOGIC EXAMINATION FEMUR 1 VIEW$1,422.34
73552FEMUR; MIN 2 VIEWS$1,287.63
73560XRAY KNEE, SUNRISE VIEW$1,287.63
73562XRAY KNEE MIN 3 VIEWS$1,508.42
73564RAD EXAM KNEE 4 OR MORE$1,815.88
73565RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOSTC$770.13
73580X-RAY KNEE.BILATERAL STANDING$3,065.12
73590XRAY TIBIA/FIBULA AP/LAT$796.00
73592RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS$829.73
73600XRAY ANKLE 2 VIEWS$1,009.38
73610XRAY ANKLE 3 VIEWS/COMPLE$1,514.39
73620XRAY FOOT MIN 2 VIEWS$1,257.68
73630XRAY FOOT MIN 3 VIEWS$1,516.88
73650RAD EXAN HEEL MIN 2 VIEWS$756.20
73660XRAY TOES, MIN 2 VIEWS$993.01
73700CT LWR EXTR WO CONTRAST$5,335.19
73701CT LWR EXT W CONT$7,574.00
73702CT LXTR C-/C+$4,403.00
73718MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL$6,901.12
73721MRI ANY JT LXTR C-MATRL$2,772.00
73722MRI ANY JT LXTR C+ MATRL$3,076.00
73723MRI ANY JT LXTR C-/C+$5,049.00
73725MRA LXTR C+-MATRL$3,735.00
74010RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS$426.00
74018Radiologic examination, abdomen; 1 view$1,098.48
74019Radiologic examination, abdomen; 2 views$1,128.33
74020RAD EXAM ABDOMEN COMPL$2,500.00
74021Radiologic examination, abdomen; 3 or more views$1,317.38
74022RAD EXAM COMPLETE ABD$1,871.60
74150COMPUTED TOMOGRAPHY ABD$6,892.88
74160TOMOGRAPHY ABD W/CONTRAST$7,306.24
74170TOMOGRAPHY ABD W/OCONTRAS$8,060.85
74174CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG$7,619.70
74175CT ANGIO ABDOMEN W/CONTRA$7,362.99
74176COMP TOMOG AB/PEL W/O CON$7,973.35
74177COMP TOMO AB/PELV W/OCONT$8,656.42
74178CT ABD & PELVIS 1 PLUS SECTION/REGNS$10,859.59
74181MRI ABD C-MATRL$2,772.00
74183MRI ABD C-/C+$3,268.00
74190PERITONEOGRAM RS&I$3,174.50
74240RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB$3,543.03
74241RADEX GI TRC UPR +-DLYD FLMS W/KUB$2,665.65
74245RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES$3,014.76
74246Radiologic examination, gastrointestinal tract, upper, air …$2,131.50
74247RADEX GI UPR C+ +-GLUC +-DYLD FLMS W/KUB$1,010.00
74250RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES$2,349.75
74251RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE$2,300.00
74328ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I$3,200.00
74329ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I$2,450.00
74330CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I$3,732.00
74340INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I$1,409.85
74440VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I$2,300.00
75574CT CORONARY$3,245.00
763763D RNDR I&R CT MRI US/OTH$964.00
76380CT LIMITED/LOCALIZED FOLLOW UP STUDY$2,924.30
76536ULTRASOUND, SOFT TISSUES OF HEAD AND NECK$2,120.25
76604US CHEST REAL TIME W/IMAGE DOCUMENTATION$2,017.61
76641US BREAST UNI REAL TIME WITH IMAGE COMPLETE$2,279.50
76642US BREAST UNI REAL TIME WITH IMAGE LIMITED$2,007.21
76645US BREAST R-T W/IMAGE DOCUMENTATION$719.00
76700US ABDOMINAL R-T W/IMAGE$3,158.36
76705US ABDOMINAL$3,251.16
76770US RETROPERITONEAL R-T W/$3,237.75
76775US RPR B-SCAN&/R-T IMG LMTD$1,399.96
76801ULTRASOUND 14 WK TABDL 1/1ST GESTATION$2,767.39
76802US PREG UTERUS 14 WK TRANSABDL EACH GESTATION$2,145.00
76805US PG UTER F&MAT AFTER 1S$2,751.88
76810US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO$2,911.21
76815ULTRASND PG UTER$356.00
76816US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS$1,862.95
76817UT PG UTER R-T IMG TRVG$2,224.82
76830TRANSVAGINAL ULTRASOUND$2,135.27
76856US PELVIC NONOB REAL-TIME$2,992.95
76857PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97$1,777.07
76870US SCROTUM&CNTS$2,807.64
76881US EXTREMITY NON-VASC REAL-TIME IMG COMPL$2,930.24
76882ULTRASOUND, EXTREMITY, NON VASCULAR$1,829.62
76942ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND I…$495.00
77777SHORTNESS OF BREATH PANEL$12.00
78075ADRNL IMG CORTEX&/MEDULLA$3,618.00
78223HIDA SCAN-HEPATBL DUX SYS IMG GLBLDR$2,509.00
78306B1&/JT IMG WHBDY$1,440.00
78315B1&/JT IMG 3 PHASE STD$1,440.00
78320B1&/JT IMG TOMOG SPECT$923.00
78472CARD BPI GTD=BRM PLNR 1 STD REST/STRS$2,039.00
80047BASIC METABOLIC PANEL CALCIUM IONIZED$766.00
80048METABOLIC PANEL BASIC$918.86
80051ELECTROLYTE PANEL$614.65
80053METABOLIC COMPRE PANEL$1,085.42
80061LIPID PROFILE III$648.74
80074HEPATITIS PANEL$1,087.50
80076HEPATIC FUNCTION PANEL$843.50
80100DRUG ABUSE PANEL II$230.00
80102Drug confirmation, each procedure$435.94
80104DRUG SCREEN$172.00
80143Acetaminophen$533.28
80178LITHIUM$59.00
80179Salicylate$324.00
80196SALICYLATE$270.00
80197TACROLIMUS$350.00
80202VANCOMYCIN PEAK$229.00
80300DRUG SCREEN$221.00
80304DRUG SCREEN$211.00
80305DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUM…$532.50
80307DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS$351.50
80320DRUG SCREEN$155.22
80324DRUG SCREEN QUANT AMPHETAMINES 1 OR 2$665.00
80329DRUG SCREEN$464.07
80335ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2$143.28
80345DRUG SCREENING BARBITURATES$228.85
80346DRUG SCREENING BENZODIAZEPINES 1-12$173.13
80347DRUG SCREENING BENZODIAZEPINES 13 OR MORE$450.00
80349DRUG SCREENING CANNABINOIDS NATURAL$272.63
80351DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6$338.30
80352DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE$280.00
80353DRUG SCREENING COCAINE$240.79
80356DRUG SCREENING HEROIN METABOLITE$148.20
80358DRUG SCREENING METHADONE$177.11
80359DRUG SCREENING METHYLENEDIOXYAMPHETAMINES$560.00
80361DRUG SCREENING OPIATES 1 OR MORE$447.75
80362DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2$500.00
80365DRUG SCREENING OXYCODONE$550.00
80366DRUG SCREENING PREGABALIN$179.10
80367DRUG SCREENING PROPOXYPHENE$343.00
80373DRUG SCREENING TRAMADOL$400.00
80374DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS$420.00
81000U/A DIPSTICK$240.34
81001U/A DIP STICK$384.52
81002URNLS DIP STICK/TABLET RG$231.00
81003U/A W/O MICRO DIPSTICK$205.17
81005Urinalysis; qualitative or semiquantitative, except immunoa…$92.00
81007URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK$500.00
81025PREG.TST URINE VISUAL$339.30
82003ACETAMINOPHEN$229.00
82009KETONES-SERUM$36.00
82040ALBUMIN; SERUM$182.52
82055ALCOHOL-BLOOD$201.00
82075ALCOHOL BREATH TEST$84.00
82140Ammonia$330.19
82150AMYLASE$429.84
82247BILIRUBIN TOTAL$200.59
82248BILIRUBIN DIRECT$286.56
82253MB FRACTION$154.00
82270OCCULT BLOOD$750.00
82272BLD OCLT PEROXIDASE ACTV$141.29
82274blood, occult by fecal hemoglobin determination by immunoas…$153.30
82310CALCIUM$233.48
82330CALCIUM IONIZED$293.52
82374CARBON DIOXIDE BICARBONATE$99.50
82375Under Chemistry Procedures$400.00
82435CHLORIDE BLD$152.68
82465CHOLESTEROL SERUM/WHOLE BLOOD TOTAL$159.20
82533CORTISOL TOTAL$365.25
82540CREATINE$68.00
82541COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE$121.00
82550CREATINE CK-TOTAL$195.02
82553CREATINE CKMB$257.01
82565CREATININE$257.70
82607VITAMIN B-12$72.00
82747ASSAY OF FOLIC ACID RBC$310.20
82784IGC IMMUNOGLOBULIN$403.97
82785GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE$182.00
82800GASES BLD PH ONLY$130.00
82803BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3$529.80
82805Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (…$569.62
82945GLUCOSE BODY FLUID OTHER THAN BLOOD$299.25
82947GLUCOSE$163.43
82948GLUCOSE BLOOD REAGET STR$409.94
82962GLUCOSE FINGER STICK$155.63
82977GLUTAMYLTRANSFERASE-GTT$296.97
83009HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE$490.00
83013HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE$439.79
83036HEMOGLOBIN GLYCOSYLATED A1C$278.64
83050Under Chemistry Procedures$350.00
83520IMMUNOASSAY ANALYTE QUANTITIATIVE NOS$144.00
83525ASSAY OF INSULIN TOTAL$172.14
83540IRON-TOTAL$102.00
83605ASSAY OF LACTATE$210.00
83615Lactate dehydrogenase (LD), (LDH);$265.66
83690LIPASE$409.50
83718LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL$356.12
83735MAGNESIUM$391.18
83874MYOGLOBIN$180.10
83880B-TYPE NATRIURETIC$555.21
83992ASSAY OF PHENCYCLIDINE$455.00
84075ALK PHOS/PROFILE OR PANEL$225.22
84100ASSAY OF PHOSPHORUS INORGANIC$234.49
84132POTASSIUM SERUM PLASMA/WHOLE BLOOD$219.90
84155PROTEIN,TOTAL,EXCEPT REFR$77.31
84157PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC$211.04
84165PROTEIN ELECTROPHORESIS$1.00
84295SODIUM; SERUM$180.59
84403Testosterone; total$335.32
84436THYRIXINE TOTAL$243.23
84439THYROXINE-FREE$200.99
84443Thyroid stimulating hormone (TSH)$263.00
84450Transferase; aspartate amino (AST) (SGOT)$95.52
84460ALT-TRANSFERASE;ALANINE$385.55
84478ASSAY OF TRIGLYCERIDES$244.52
84479THYROID HORMONE$224.87
84480T3 TOTAL$601.80
84481ASSAY OF TRIIODOTHYRONINE T3 FREE$123.38
84484TROPONIN I$436.80
84512TROPONIN QUAL$379.35
84520Urea nitrogen; quantitative$194.27
84550URIC ACID$93.53
84560URIC ACID OTH SRC$138.00
84702HCG QUANTATIVE$324.37
84703PREGNANCY TEST BLOOD$419.34
84999UNLISTED CHEMISTRY PROCEDURE$435.56
85014HEMATOCRIT$102.00
85018HEMOGLOBIN$326.81
85025Blood count; complete (CBC)$256.76
85027CBC W/O DIFF$236.11
85032BLD# MNL C-CNT RBC/PLTLT EA$152.00
85044RETICULOCYTE COUNT$21.00
85347COAGJ TM ACTIVATED$35.00
85378FIBRIN DEGRADATION PROD$151.24
85379D-DIMER$267.46
85610PROTHROMBIN TIME$297.90
85651SEDIMENTATION RATE NONAUT$189.05
85652SED RATE ERYTHROCYTE NON$179.40
85730THROMBOPLASTIN TIME PART$393.00
86038ANTINUCLEAR AB$117.01
86039ANTINUCLEAR AB TITER$409.50
86060ANTISTREPTOLYSIN O TITER$108.65
86140C REACTIVE PROTEIN$274.62
86235EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD$317.90
86256SMOOTH MUSCLE AB TITER$1.00
86308MONO,HETEROPHILE ANTIBODI$328.69
86318Immunoassay for infectious agent antibodies, qualitative or…$125.00
86320IMMUNOELECTROPHORESIS$1.00
86328COVID-19 RAPID ANTIBODY TEST SINGLE METHOD$100.00
86360T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO$627.00
86403MONO SPOT$134.00
86430RHEUMATOID FACTOR$74.00
86431RHEUMATOID FACTOR QUANTITATIVE$321.00
86592Syphilis test, non-treponemal antibody; qualitative (eg, VD…$77.00
86593Syphilis test, non-treponemal antibody; quantitative$349.00
86631ANTB CHLAMYDIA$130.00
86644ANTIBODY CYTOMEGALOVIRUS CMV$650.00
86645ANTIBODY CYTOMEGALOVIRUS CMV IGM$150.00
86664EPSTEIN-BARR VIRUS EBNA$133.00
86677ANTIBODY HELICOBACTER PYLORI$700.00
86689ANTB HTLV/HIV ANTB CONFIRMATION TST$481.59
86701HIV SERUM$523.55
86702ANTB HIV-2$164.00
86705HEPATITIS B CORE IGM$187.00
86713LEGIONELLA PNEUMONPILA AB$88.00
86756ANTB RSV$143.00
86769COVID-19 RAPID ANTIBODY TEST MULTIPLE STEP METHOD$100.00
86780TP-Under Qualitative or Semi quantitative Immunologists-$87.56
86803HEPATITIS C ANTIBODY$402.75
86850ANTB SCR RBC EA SERUM TQ$189.00
86900Blood typing, serologic; ABO$131.78
86901RH FACTOR-BLOOD$164.50
86906BLD TYPING RH PHEXYPING COMPL$86.00
87040BLOOD CULTURE$480.31
87045CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL$571.13
87070CULTURE BODY FLUID$508.50
87075CULTURE ANAEROBIC$346.26
87076CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL$510.00
87077CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL$197.01
87081CULTURE, BACTERIAL-SCREEN$493.02
87086URINE CULTURE$277.90
87088CULTURE BCT ISOL&PRSMPTV$286.90
87106CUL FNGI DEFINITIVE ID EA ORGANISM YEAST$85.00
87110CHLAMYDIA CULTURE$260.00
87177Ova and parasites, direct smears, concentration and identif…$217.31
87205SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL$173.43
87207SMR PRIM SRC SPEC STAIN$1.00
87210WET SMEAR$91.00
87252VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT$240.79
87255Herpes Simplex Virus Culture with Reflex Typing$309.00
87275IAADI INF B VIRUS$55.00
87338IAAD IA HPYLORI STOOL$66.86
87341IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION$474.12
87389infection agent etc$203.50
87400INFLUENZA A&B$174.00
87420IAAD IA RESPIRATORY SYNCTIAL VIRUS$578.02
87426COVID-19 RAPID ANTIGEN TESTING$349.00
87428Multiplex viral pathogen panel using Antigen technique for …$843.00
87430INF AGT IMMUNO STREP A$234.00
87480IADNA CANDIDA SPECIES DIRECT PROBE TQ$500.00
87486IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ$640.78
87491IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ$501.48
87493INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE$197.00
87507IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25$500.00
87581IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ$700.00
87591IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ$370.70
87633IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET$1,500.00
87635Infectious agent detection by nucleic acid (DNA or RNA); se…$150.00
87636severe acute respiratory syndrome coronavirus 2 (SARSCoV-2)…$700.00
87661IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH$546.00
87798IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM$700.00
87801Infectious agent detection by nucleic acid$500.00
87804INFLUENZA IMMUNOASSAY OPT$346.50
87807INF AGT DET IMNAS OPT RSV$201.39
87808Infectious agent antigen detection by immunoassay with dire…$253.75
87847NO DESCRIPTION$409.00
87850NEISSERIA GONORRHOEAE DET$130.00
87880RAPID STREP-BETA STREP$820.00
87905Infectious agent enzymatic activity other than virus eg, si…$172.00
88305PATH SURG LEVEL IV$1.00
89051CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT$325.00
89055LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE$185.07
89060CRYSTAL INDENTIFICATION$277.60
89220SPTM OBTG SPEC AERSL INDUCED SPX$98.00
90471IMMUN ADM 1 VAC$203.05
90660INFLUENZA VIRUS INTRANASA$70.00
90688Influenza virus vaccine, quadrivalent (IIV4), split virus, …$480.00
90700DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM$72.52
90703TETANUS TOXID$152.00
90714TETANUS DIPHTHERIA TOXOID$302.98
90715TDAP VACCINE$292.53
90718TETANUS & DIPTHERIA$229.76
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 (eg, in cardiac arrest)$1,906.00
92960CARDIOVERSION ELECTIVE ARRHYT XTRNL$1,089.00
93000EKG W/INTREP AND REPORT$335.81
93005Electrocardiogram, routine ECG with at least 12 leads; trac…$752.95
93010RTN ECG 12 LEADS INTRP/RP$213.75
93018CV STRS TST XERS&/OR RX CONT ECG I&R ONLY$1,000.00
93040RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT$335.81
93041RHYTHEM ECG 1-3 LDS$146.00
93042RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON$550.00
93224WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I$924.00
93306ECHO TEST$3,658.22
93307ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP$2,967.50
93308ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD$3,794.06
93313TEE R-T IMG 2D W/PROBE PLMT ONLY$2,626.00
93320DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY$1,417.50
93325DOP ECHOCARD COLOR FLOW VELOCITY MAPPING$1,485.00
93351ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG$1,000.00
93631INTRAOP EPICAR& ENDOCAR PACG& MAPG$650.00
93784Ambulatory blood pressure monitoring,$500.00
93875N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD$840.00
93880DUP-SCAN XTRC ART COMPL B$2,508.98
93882DUP-SCAN XTRC ART UNI/LMTD STD$903.00
93922NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL$1,643.74
93923NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS$3,155.00
93925DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY$2,342.23
93926DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD$2,351.97
93930DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY$2,379.04
93931DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD$2,599.96
93965QUANT VENOUS FLOW ST$1,806.00
93970DUP-SCAN XTR VEINS COMPL$3,938.65
93971DPLX SCN EXTRM VEINS$2,716.05
93975DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, P…$4,000.50
93976DUPLEX SCAN- LIMITED$466.00
94010SPIROMETRY W/RECORD$922.50
94060BRNCDILAT RSPSE SPMTRY PR$385.00
94621PULM STRS TSTG CPLX$1,029.00
94640NEBULIZER TREATMENT$277.77
94644INHALATION TREATMENT – CONTINUOUS 1ST HR$157.00
94664DEMO&/EVAL OF PT UTILIZ$1.00
94760EAR OR PULSE OXIMETRY$333.38
94761N-INVAS EAR/PLS OXIMTRY F$458.96
94762NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR$734.25
96360IV INFUS INIT 31 MIN 1 HR$784.50
96361IV INFUS HYDR EA ADD’T HR$242.78
96365IV INFUSION THERAPY/PROPH$904.22
96366IV INFUS THER PROPH/DX EA$811.12
96367IV NFS THER PROPH/DX ADDL$1,029.94
96368IV NFS TX PROPHYLAXIS/DX$749.14
96372THERAPEUTIC PROPHYLACTIC/$503.55
96373INJECTION, INTRA-ARTERIAL$228.00
96374THER PROPH/DX NJX IV PUSH$790.12
96375THER PROPH/DX NJX EA SEQL$532.88
96376SUB INFU EA ADD IV PUSH$578.93
96377APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION$720.00
96379INJECTION- UNLISTED THERAPEUTIC PROPH/DX/IVA NJX/NFS$213.00
97010APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS$183.21
97116THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR$197.01
97542WHEELCHAIR MGMT EA 15 MIN$320.39
97597DEBRIDEMENT OPEN WOUND 20 SQ CM/<$736.30
99000SPECIMEN HANDLING$52.00
99001COC COLLECITON ONLY$41.00
99024POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX$650.00
99050BLUE CROSS RQRD LVL3$87.00
99053SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HOUR FACILITY$303.00
99070SUPPLIES&MATERIALS ABOVE or BEYOND PROV BY PHYS or QHP$93.53
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$997.12
99152MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS$1,480.00
99173SCREENING TEST OF VISION$1,300.00
99217OBSERVATION CARE DISCHARGE MANAGEMENT$1,200.00
99218INITIAL OBSERVATION CARE/DAY 30 MINUTES$242.78
99219INITIAL OBSERVATION CARE/DAY 50 MINUTES$1,800.00
99220INITIAL OBSERVATION CARE/DAY 70 MINUTES$3,250.00
99234OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES$1,800.00
99235OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES$2,000.00
99236OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES$2,200.00
99281E/M VISIT LEVEL 1 TECH COMP$619.45
99282E/M VISIT LEVEL 2 TECH COMP$1,125.75
99283E/M VISIT LEVEL 3 TECH COMP$2,012.25
99284E/M VISIT LEVEL 4 TECH COMP$3,009.75
99285E/M VISIT LEVEL 5 TECH COMP$4,029.75
99291CRITICAL CARE 30-74 MIN$5,434.38
99292CRITICAL CARE ADD 30 MIN$1,430.52
99406SMOKING CESSATION 3-10$69.54
99407SMOKING CESSATION 10 MIN$94.00
A0382BASIC SUPPORT ROUTINE SUPPLS$18.00
A0394ALS IV DRUG THERAPY SUPPLIES$1.02
A0396ALS ESPOHAGEAL INTUB SUPPLIES$25.00
A42061 CC STERILE SYRINGE&NEEDLE$15.00
A42072 CC STERILE SYRINGE&NEEDLE$18.00
A42083 CC STERILE SYRINGE & NEEDLE$26.90
A42095+ CC STERILE SYRINGE & NEEDLE$30.00
A4210NONNEEDLE INJECTION DEVICE$30.00
A4211SUPP FOR SELF-ADM INJECTIONS$15.00
A4212NON CORING NEEDLE OR STYLET$15.00
A421320+ CC SYRINGE ONLY$5.98
A4215NEEDLE STERILE, ANY SIZE, EACH$10.75
A4216STERILE WATER/SALINE, FLUSH 10ML$3.00
A4217STERILE SALINE WATER PER 500 ML$22.80
A4218STERILE SALINE OR WATER$26.00
A4221SUPP NON-INSULIN INF CATH/WK$20.00
A4222EXT UNFU PMP PER CASS/BAG$176.00
A4223INFUSION SUPPLIES W/O PUMP$40.00
A4224ALOCHOL OR PEROXIDE PER PINT$22.00
A4232SYRINGE W/NEEDLE INSULIN 3CC$15.00
A4244ALCOHOL OR PEROXIDE PER PINT$4.00
A4245ALCOHOL WIPES PER BOX$5.00
A4246BETADINE/PHISOHEX SOLUTION$21.58
A4247BETADINE/IODINE SWABS/WIPES$21.58
A4248CHLORHEXIDINE ANTISEPT$42.00
A4252GLUCOSE TEST STRIP-BLOOD KETONE TEST OR STRIP$6.00
A4253BLOOD GLUCOSE/REAGENT STRIPS$10.00
A4270DISPOSABLE ENDO CODE SHEATH$24.00
A4281REPLACEMENT BREASTPUMP TUBE$15.00
A4283REPLACEMENT BREASTPUMP CAP$15.00
A4300CATH IMPL VASC ACCESS PORTAL$10.00
A4310INSERT TRAY W/O BAG/CATH$15.00
A4311CATHETER W/O BAG 2 WAY LATEX$139.00
A4314INSRT TRAY W/DRAINAGE BAG$44.00
A4315CATH W/DRAINAGE 2-WAY SILCNE$18.00
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$10.00
A4332LUBE STERILE PACKET$12.00
A4335INCONTINENCE SUPPLY MISC$3.00
A4338INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING$15.00
A4344INDWELLING CATH FOLEY TYP$19.00
A4352COUDE TIP URINARY CATHETER$20.00
A4353INTERMIT URINARY CATHETER$120.00
A4358URINARY DRAINAGE BAG$12.50
A4364DERMABOND- ADHESIVE, LIQUID OR EQUAL PER OZ$33.00
A4369SKIN BARRIER LIQUID PER OZ$10.00
A4402LUBRICANT PER OUNCE$10.00
A4406PECTIN BASED OSTOMY PASTE$12.00
A4450TAPE NO WATERPROOF$10.00
A4452TAPE WATERPROOF 18 SQ IN$12.00
A4458REUSABLE ENEMA BAG$25.00
A4465NON-ELASTIC EXTREMITY BINDER$20.00
A4470GRAVLEE JET WASHER$15.00
A4550LACERATION- SURGICAL KIT$50.00
A4554DISPOSABLE UNDERPADS$18.00
A4556ELECTRODES, PAIR$60.00
A4558CONDUCTIVE GEL OR PASTE$15.00
A4562PESSARY, NON RUBBER,ANY TYPE$12.00
A4565SLING$183.82
A4566SHOULD SLING/VEST/ABRESTRAIN$25.00
A4570SPECIAL CASTING MATERIAL$50.00
A4580CAST SUPPLIES (PLASTER)$35.00
A45903 ORTHO GLASS 4 SPECIAL CASTING MATERIAL$84.00
A4595TENS SUPPL 2 LEAD PER MONTH$46.00
A4606OXYGEN PROBE USED W OXIMETER$20.00
A4613BATTERY CHARGER$60.00
A4614HAND HELD PEFR METER$50.00
A4615CANNULA NASAL$20.00
A4616TUBING (OXYGEN) PER FOOT$25.00
A4617MOUTHPIECE FOR RESPIRATORY OXYGEN EQUIPMENT$55.00
A4620VARIABLE CONCENTRATION MASK$15.00
A4628OROPHARYNGEAL SUCTION CATH$20.00
A4629TRACHEOSTOMY CARE KIT$35.00
A4649SURGICAL SUPPLY MISC$40.00
A4653PD CATHERTER ANCHOR BELT$20.00
A4657SYRINGE W OR WO NEEDLE$10.00
A4670AUTOMATIC BP MONITOR #11$30.00
A4673SALINE BLADE #11$15.00
A4750ART OR VENOUS BLOOD TUBING$20.00
A4770BLOOD COLLECTION TUBE or VACUUM$25.00
A4927GLOVES NON STERILE$10.00
A4930GLOVES STERILE PER PAIR$12.00
A5112URINARY LEG BAG$20.00
A5120SWAB OR WIPE SKIN BARRIER$12.00
A5126DISK/FOAM PAD +OR- ADHESIVE$15.00
A5200PERCUTANEOUS CATHETER ANCHOR$117.00
A6021COLLAGEN DRESSING STERIL$15.00
A6196ALGINATE DRESSING <=16 SQ IN$20.00
A6203COMPOSITE DRSG <= 16 SQ IN$15.00
A6205COMPOSITE DRSG LESS THAN 48 SQ IN$22.00
A6208CONTACT LAYER > 48 SQ IN$20.00
A6209FOAM DRSG <=16 SQ IN W/O BDR$15.00
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…$15.00
A6213FOAM DRG 16-48 SQ IN W/BRDR$11.00
A6216GAUZE NONIMPREG 16 SQ IN$10.00
A6217GAUZE NON STERILE$12.00
A6218GAUZE, NON STERILE$15.00
A6219GAUZE- STERILE$10.00
A6220GAUZE, NON IMP, STERILE, PAD SIZE >16 SQ < OR = 48SQ IN$12.00
A6221GAUZE > 48 SQ IN W/BORDER$15.00
A6222GAUZE IMPREGNATED WITH ME$12.00
A6223GAUZE >16<=48 NO W/SAL W/O B$15.00
A6224GAUZE > 48 IN NO W/SAL W/O B$20.00
A6231GAUZE, 16<SQ IN, EACH$12.00
A6233HYDROGEL DRESSING >48 SQ IN$15.00
A6235HYDROCOLLD DRG >16<=48 W/O B$18.00
A6238HYDROCOLLD DRG >16<=48 W/BDR$20.00
A6239HYDROCOLLD DRG > 48 IN W/BDR$22.00
A6246HYDROGEL DRG >16<=48 IN W/B$25.00
A6248HYDROGEL DRSG GEL FILLER$15.00
A6250SKIN SEAL PROTECT MOISTURIZER OINTMENT$10.00
A6251ABSORPT DRG <=16 SQ IN W/O B$10.00
A6252ABSORPT DRG >16 <=48 W/O BDR$15.00
A6253ABSORPT DRG > 48 SQ IN W/O B$18.00
A6254ABSORPT DRG <=16 SQ IN W/BDR$10.00
A6255ABSORPT DRG >16<=48 IN W/BDR$15.00
A6257TRANSPARENT FILM <= 16 SQ IN$18.00
A6258TRANSPARENT FILM >16<48 IN$20.00
A6260WOUND CLEANSER$100.00
A6261WOUND FILLER$100.00
A6266IMPREG GAUZE NO H20/SAL/YARD$22.00
A6402GAUZE NON-IMPREG STERL 16$15.00
A6403STERILE GAUZE>16 <= 48 SQ IN$15.00
A6404STERILE GAUZE > 48 SQ IN$18.00
A6407PACK STRIPS NON-IMPREGNTD$15.00
A6410STERILE EYE PAD OR STRIP$6.00
A6412OCCLUSIVE EYE PATCH$15.00
A6413ADHESIVE BANDAGE FIRST AI$18.00
A6441PAD BAND W>=3 <5/YD$15.00
A6442CONFORM BAND N/S W<3/YD$10.00
A6445CONFORM BAND S W <3/YD$12.00
A6446CONFORMING BANDAGE NON-EL$15.00
A6447CONFORM BAND S W >=5/YD$18.00
A6448LT COMP BANDAGE LESS THAN 3IN$12.00
A6449LIGHT COMP BANDAGE$15.00
A6450LT COMPRS BANDAGE ELAST$18.00
A6453BANDAGE SELF ADHER BAND W LESS THAN 3$25.00
A6454SELF ADHER BANDAGE$12.00
A6455SELF ADHER BANDAGE$15.00
A6456ZINC PASTE BAND W >=3<5/YD$15.00
A6457TUBULAR DRESSING$30.00
A6530COMPRESSION STOCKING BK18-30$15.00
A6545GRAD COMP NON-ELASTIC BK$20.00
A7002SUCTION TUBING USED W PUMP$40.00
A7003ADMN SET SM VOL NONFILTER$35.00
A7004DISPOSABLE NEBULIZER SML VOL$35.00
A7005NONDISPOSABLE NEBULIZER SET$30.00
A7006FILTERED NEBULIZER ADMIN SET$25.00
A7011NONDISPOS CORRUGATED TUBING$12.00
A7015NEBULIZER MASK USED W NEBULIZER$25.00
A7016DOME/MOUTHPEICE NEB$161.00
A7017NEBULIZER MASK NOT USED W/ OXYGEN$57.00
A7030CPAP FULL FACE MASK$20.00
A7046REPL WATER CHAMBER, PAP DEV$30.00
A7047RESP SUCTION ORAL INTERFACE$25.00
A7520TRACH LARYN TUBE NON CUFFED$37.00
A9150NON PERSCRIPTION DRUG$35.00
A9270NON-COVERED ITEM OR SERVICE$50.00
A9273HOT/COLD H2OBOT/CAP/COL/WRAP$35.00
A9281REACHING/GRABBING DEVICE$80.00
A9284NON-ELECTRONIC SPIROMETER$254.00
A9579GAD-BASE MR CONTRAST NOS,1ML$15.00
C1722AICD, SINGLE CHAMBER$400.00
C1751CATH, INF, PER/CENT/MIDLINE$505.75
C1781MESH (IMPLANTABLE)$475.00
C2618PROBE/NEEDLE, CRYO$35.00
C9285PATCH, LIDOCAINE/TETRACAINE$20.00
C9399ORBACTIV 1200 MG IV$10,153.00
CASHXRAY DISC$17.00
E0110CRUTCH FOREARM PAIR$225.00
E0114CRUTCHES UNDERARM$250.00
E0116CRTCH UNDARM NOT WOOD ADJ$200.00
E0220HOT WATER BOTTLE$35.00
E0230ICE CAP OR COLLAR$12.00
E0240BATH/SHOWER CHAIR$80.00
E0275BED PAN STANDARD$100.00
E0325URINAL MALE JUG-TYPE$50.00
E0326URINAL FEMALE JUG-TYPE$50.00
E0352DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM)$177.00
E04114E04114$41.00
E0445OXIMETER NON-INVASIVE$578.00
E0570NEBULIZER WITH COMPRESSION$200.00
E0580NEBULIZER FOR USE W/ REGULAT$293.00
E0607BLOOD GLUCOSE MONITOR HOME$80.00
E0625PATIENT LIFT BATHROOM OR TOI$200.00
E2630MONOSUSPENSION ARM/HAND SUPP$3,379.10
G0009ADM PNEUMOCOCCAL VACCINE$90.00
G0168WND CLS TISSUE ADHESIVE$100.00
G0378HOSPITAL OBSERVATION SERVICES PER HOUR$510.44
G0402INITIAL PREVENTIVE EXAM$1,500.00
G0434DRUG ABUSE PANEL II$230.00
G2023specimen collection for severe acute respiratory syndrome c…$30.00
G2024specimen collection for severe acute respiratory syndrome c…$200.00
G6039Acetaminophen or just “Assay of acetaminophen” for shor…$150.00
G6040Saliva Alcohol Test$131.34
G6058Drug confirmation, each procedure$250.00
G8598ASA/ANTIPLAT THER USED$65.00
G8601NO ELIG TPA INIT W/IN 3 HRS$800.00
G8602NO TPA INIT W/IN 3 HRS$750.00
J0120TETRACYCLIN INJECTION$30.00
J0129ABATACEPT INJECTION$25.00
J0131INJECTION, ACETAMINOPHEN, 10 MG$30.00
J0150ADENOSINE INJ 6MG VIAL$65.00
J0153ADENOSINE INJ 1MG$40.00
J0170EPINEPHRINE 3 1/2 NDL 10M$12.44
J0171ADRENALIN EPINEPHRINE INJECT$30.00
J0282INJ AMIODARONE HYDROCHLOR$25.00
J0290AMPICILLIN 500 MG INJ$45.77
J0295INJ AMPCLLN SODIUM/SULBA$20.00
J0330SUCCINYLCHOLINE CHLO 20MG$173.00
J0360HYDRALAZINE HCL INJ UP TO 20MG$30.00
J0456INJ AZITHROMYCIN 500MG$25.00
J0461INJ ATROPINE SULFATE 0.01$20.00
J0500DICYCLOMINE HCL 20MG$45.00
J0550BICILLIN – PENICILLIN G BENZATHINE INJ$65.00
J0559BICILLIN – PENICILLIN G BENZATHINE INJ 2500 UNITS$65.00
J0560BICILLIN 600,000$50.00
J0561INJECTION PENICILLIN G BENZATHINE 100,000 UNITS$30.00
J0570BICILLIN 1,200,000$110.00
J0595STADOL$13.00
J0610CALCIUM GLUCONATE INJECTION$30.00
J0641LEVOLEUCOVORIN INJECTION$2.00
J0690KEFZOL 1 GR VIAL$25.00
J0692INJ CEFEPIME HCI 500MG$46.00
J0696ROCEPHIN 250 MG$30.00
J0697STERILE CEFUROXIME INJECTION$25.00
J0698CLAFORAN 1 GR VIAL$63.00
J0708J0708$22.00
J0735CLONIDINE 1MG$25.00
J0744CIPRO 200MG$30.00
J0760COLCHICINE INJECTION$23.00
J0780COMPAZINE 10 MG$30.00
J1020INJ METHYLPREDNISOLONE AC$20.00
J1030DEPO MEDROL 40 MG/ML$22.00
J1040METHYLPREDNISOLONE 80MG$25.00
J1094DECADRON DEXAMETHASONE ACETATE 1MG$32.53
J1100DECADRON 4 MG VIAL$29.02
J1165DILANTIN 100 MG VIAL$41.00
J1170DILAUDID 4 MG$35.00
J1200BENADRYL 50MG$20.00
J1240ANTIVERT – DIMENHYDRINATE INJECTION 50MG$33.00
J1335ERTAPENEM INJECTION$21.00
J1580GARAMYCIN,GENTAMICIN 80MG$50.00
J1610GLUCOGAN 1 MG VIAL$50.00
J1630HALOPERIDOL INJECTION$39.70
J1631HALOPERIDOL DECANOATE INJ$45.00
J1642HEPARIN SODIUM PER 10 UNI$20.00
J1644INJ HEPARIN SOD PER 1000$30.00
J1650ENOXAPARIN SODIUM 10MG$258.09
J1670TETANUS INJECTION$41.00
J1741IBUPROFEN INJECTION$22.00
J1810DROPERIDOL/FENTANYL INJ$25.00
J1815INJ INSULIN PER 5 UNITS$20.00
J1817INSULIN FOR INSULIN PUMP USE$22.00
J1885TORADOL INJ 15 MG$20.00
J1930LANREOTIDE INJECTION$45.00
J1940LASIX 40 MG IV VIAL$35.00
J1956LEVOFLOXACIN 250 MG$45.00
J2001LIDOCAINE HCI 10MG$30.00
J2060ATIVAN 2ML SYRUP$35.00
J2150MANNITOL INJECTION$26.00
J2175DEMEROL 50 MG SYRINGE$25.00
J2180MEPERIDINE/PROMETHAZINE INJ$30.00
J2250MIDAZOLAM HCI PER 1 MG$30.00
J2270INJ MORPHINE SULFATE 10 M$30.00
J2274INJ MORPHINE PF EPID ITHC$30.00
J2300NUBAIN 10MG AMP$50.00
J2310INJ NALOXONE HCL 1MG$30.00
J2360ORPHENADRINE CITRATE 60MG$30.00
J2370NEO-SYNEPHRINE UP TO 1 ML$81.00
J2405ONDANSETRON HCI, PER MG$21.00
J2410OXYMORPHONE HCL INJECTION$25.00
J2425PALIFERMIN INJECTION$25.00
J2504PEGADEMASE BOVINE, 25 IU$25.00
J2543ZOSYN – PIPERACILLIN/TAZOBACTAM$30.00
J2550PHENERGAN 50 MG$35.00
J2650PRELONE – INJECTION PREDNISOLONE ACTATE UP TO 1 ML$6.00
J2690PRONESTYL 10 ML$22.00
J2704INJ, PROPOFOL, 10 MG$22.00
J2730PRALIDOXINE CHLORIDE$22.00
J2760PHENTOLAINE MESYLATE INJ$41.00
J2765METOCLOPRAMIDE HCL 10MG$30.00
J2780INJ RANITIDINE 25 MG$20.00
J2790RHOGAM INJECTION$199.00
J2800METHOCARBAMOL INJECTION$50.00
J2920SOLU-MEDROL 40MG$32.00
J2930SOLU-MEDROL 125 MG$35.00
J3010INJ FENTANYL CITRATE .1MG$33.00
J3030IMITREX 6MG VIAL$50.00
J3105INJECTION, TREBUTALINE SULFATE, UP TO 1 MG$35.00
J3130TESTOSTERONE ENANTHATE INJ$24.00
J3230THOROZINE 50 MG$330.00
J3260TOBRAMYCIN SULFATE INJECTION$50.00
J3360VALIUM INJ 5 MG$25.00
J3370VANCOMYCIN HCI INJ 500MG$30.00
J3410VISTERIL INJ 50 MG$22.00
J3411INJ THIAMINE 100 MG$11.00
J3430INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG$50.00
J3475MAGNESIUM SULFATE 2CC AMP$20.00
J3480POTASSIUM CHLORIDE 2 MG$125.00
J3486GEODON – ZIPRASIDONE MESYLATE 10MG$35.00
J3490UNCLASSIFIED DRUGS$31.00
J7030INFUS NORM SALINE 1000CC$45.00
J7040INFUS NORM SALINE 500ML$40.00
J70425% DEXTROSE$45.00
J7050INFS NORM SALINE 250CC$48.00
J7060INFUSION D5W 250ML$28.00
J7070INFUSION D5W 1000ML$20.00
J7120RINGER’S LACTATE INFUS$50.00
J71215% DEXTROSE IN LAC RINGERS$50.00
J7130HYPERTONIC SALINE SOLUTION$76.00
J7131HYPERTONIC SALINE SOL$20.00
J7192FACTOR VIII RECOMBINANT NOS$20.00
J7313FLUOCINOL ACET INTRAVIT IMP$20.00
J7506PREDNISONE ORAL 5 MG$8.00
J7510PREDNISOLONE ORAL 5 MG$15.00
J7512PREDNISONE 5 MG$8.00
J7607LEVALBUTEROL COMP CON$13.00
J7610ALBUTEROL, THRU DME 1MG$13.00
J7611ALBUTEROL 1MG CONC INHALA$35.00
J7613ALBUT INHAL NON-CP 1MG$35.00
J7614ALBUTEROL ALL FOMULATIONS$35.00
J7615LEVALBTERAL INHALATION SO$35.00
J7620ALBUTEROL 2.5 MG ATROVENT$35.00
J7631CROMOLYN SODIUM NONCOMP UNIT$20.00
J7637DEXAMETHASONE COMP CON$20.00
J7644IPRATROPIUM BROMIDE INHAL$50.00
J7682TOBRAMYCIN NON-COMP UNIT$25.00
J7699NOC DRUGS INHAL SOL ADMIN$25.00
J8498ENEMA SUPPOSITORY, ANTIEMETIC RECTAL$25.00
J8499NONCHEMOTHERAPEUTIC ORAL$25.00
J8540DEXAMETHASONE, ORAL .25MG$20.00
J9027CLOFARALINE INJECTION$141.00
J9206IRINOTECAN INJECTION$25.00
L0112CRANIAL CERVICAL ORTHOSIS$250.00
L0120CERVICAL FLEX NONADJ COLL$397.94
L0150CERV SEMI-RIG ADJ MOLDED CHN$303.00
L0172CLAVICAL COLLAR 2 PC$303.00
L0174CERV SR 2PC THOR EXT PRE OTS$300.00
L1630ABDUCT CONTROL HIP SEMI FLEX$41.00
L1810KO ELASTIC WITH JOINTS$750.00
L1830KNEE IMMOBOLIZER$569.33
L1902AFO ANKLE GAUNTLET PRE OTS$20.00
L1906ANKLE SUPPORT$133.00
L2360EXTENDED STEEL SHANK$350.00
L3031FOOT LAMIN/PREPREG COMPOSITE$450.00
L3201OXFORD W SUPINAT/PRONAT INF$400.00
L3209SURGICAL BOOT EACH CHILD$400.00
L3250CUSTOM MOLD SHOE REMOV PROST$400.00
L3260SURGICAL BOOT/SHOE$350.00
L3310SHOE LIFT ELEV HEEL/SOLE NEO$300.00
L3500ORTHO SHOE ADD LEATHER INSOL$350.00
L3540ORTHO SHOE ADD FULL SOLE$450.00
L3650SO FIGURE EIGHT ABDUCTION$204.75
L3660SO 8 AB RSTR CAN/WEB PRE OTS$375.00
L3670SO ACROMIO/CLAVICULAR$400.00
L3720FOREARM/ARM CUFFS FREE MOTIO$550.00
L3808WHFO, RIGID W/O JOINTS$655.20
L3809WHFO W/O JOINTS PRE OTS$700.00
L3905WHO W/NONTORSION JNT(S) CF$1,310.98
L3906WHO W/O JOINTS CF$658.69
L3908WRIST EXTN CONTROL COCKUP$85.57
L3999UPPER LIMB ORTHOSIS NOS$176.00
L4350AIR SPLINT$358.54
L4360WALK BOOT PNEUMATIC$250.00
L4361PNEUMA/VAC WALK BOOT PRE OTS$250.00
L4380PNEUMATIC KNEE SPLINT$125.00
L4386WALKING BOOT NON PNEUMATIC$285.65
L4387NON-PNEUM WALK BOOT PRE OTS$250.00
L4398FOOT DROP SPLINT PRE OTS$80.00
L4631AFO, WALK BOOT TYPE, CUS FAB$250.00
M0239Intravenous infusion, bamlanivimab-xxxx, includes infusion …$550.00
P7001CULTURE BACTERIAL URINE$89.00
P9612CATHETERIZE FOR URINE$60.00
Q0144AZITH DIHY ORAL CAP/POWD$15.00
Q0169PROMETHAZINE HCL 12.5MG ORAL$9.95
Q0179ONDANESTRONG HCL 8MG ORL$4.00
Q0239Injection, bamlanivimab-xxxx, 700 mg$0.01
Q4001CAST SUP BODY CAST PLASTER$900.00
Q4006LONG ARM CAST ADULT$950.00
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
Q4018CAST SUP LNG ARM SPLINT FBRG$320.00
Q4019CAST SUP LNG ARM SPLNT PED P$750.00
Q4020LNG ARM SPLNT 0-10 YRS$620.00
Q4021CAST SUP SHT ARM SPLINT PLST$650.00
Q4022SHRT ARM SPLNT 11 YRS +$500.00
Q4023CAST SUP SHT ARM SPLNT PED P$525.00
Q4024CAST SUP SHT ARM SPLNT PED F$550.00
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 +$800.00
Q4046SHRT LG SPLNT 11 YRS +$850.00
Q4049FINGER SPLNT STATIC$100.00
Q4051SPLINT SUPPLIES MISC$125.00
Q9954ORAL MR CONTRAST, 100ML$416.00
Q9962HOCM 300-349MG/ML IODINE,1ML$60.00
Q9963HI OSM CONTRST MATL 350-3$40.00
Q9965LOW OSMOLAR CON MAT PER M$25.00
Q9966LOCM 200-299MG ML IODINE, 1ML$22.00
Q9967LOW OSMOLAR CNTRS MAT$15.92
S0020INJ, BUPIVICAINE, 30ML$55.00
S0028INJECT FAMOTIDINE 20 MG$45.00
S0030METRONIDAZOLE 500 MG INJ$50.00
S0077CLANDAMYCIN PHOSPHATE 300$30.33
S0119ZOFRAN, 4MG, ORAL$21.44
S0164PROTONIX PANTROPRAZOLE 40MG$45.00
S0622PHYS EXAM FOR COLLEGE$87.00
S0630RMV SUTURES; PHYS NOT PHY$300.00
S1015IV TUBING EXTENSION SET$30.00
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$38.00
S8101MASK NEBULIZER MASK SPACER WITH MASK$40.00
S8430PADDING FOR COMPRSSN BDG$35.00
S8431COMPRESSION BANDAGE$45.00
S8450SPLINT$84.00
S8451SPLINT WRIST OR ANKLE$125.00
U0002SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple ty…$150.00