Richmond Facility Fee Schedule

PRACTICE

CHARGE CODE

DESCRIPTION

CPT CODE

CURRENT FEE

FLF

77079

CT BONE MINERAL DENSITY STUDY 1+SITS APPND

77079

613

FLF

76376

3D RNDR I&R CT MRI US/OTH

76376

964

FLF

74176

COMP TOMOG AB/PEL W/O CON

74176

1696

FLF

70480

CT ORBIT SELLA/POST FOSSA

70480

1750

FLF

73200

CT UPPR EXTR WO CNTRS

73200

2193

FLF

72191

CTA PELVIS C-/C+ POST-PXE

72191

2265

FLF

70487

CT MAXLFCL AREA C+ MATRL

70487

2451

FLF

74177

COMP TOMO AB/PELV W/OCONT

74177

2624

FLF

72193

TOMOGRAPHY PELVIS WCONTRS

72193

2750

FLF

70486

CT MAXLFCL AREA C-MATRL

70486

2881

FLF

70496

CTA HEAD C-/C+

70496

2973

FLF

70490

CT NECK WO CONTRAST

70490

3020

FLF

70450

COMPUTED TOMOGRAPHY HD/BR

70450

3064

FLF

74174

COMPUTED TOMOGRAPHY ABD AND PELVIS

74174

3100

FLF

71250

CT CHEST W/O CONTRAST

71250

3174

FLF

75574

CT CORONARY

75574

3245

FLF

74150

COMPUTED TOMOGRAPHY ABD

74150

3265

FLF

72128

CT THRC SPI C-MATRL

72128

3346

FLF

70491

CT SOFT TISS NCK C+MATRL

70491

3502

FLF

70481

CT ORBIT SELLA/POST FOSSA

70481

3564

FLF

72126

CT CRV SPI C+MATRL

72126

3564

FLF

72129

CT THRC SPI C+ MATRL

72129

3564

FLF

72125

COMPUTED TOMOGRAPHY CERVI

72125

3681

FLF

74160

TOMOGRAPHY ABD W/CONTRAST

74160

3840

FLF

71260

CT THORAX W/CONTRAST

71260

4158

FLF

72192

CT PELVIS WO CONTRAST

72192

4168

FLF

71270

CT THORAX WO CONTRAST

71270

4334

FLF

72131

CT L SPINE WO CONTRST

72131

4382

FLF

73702

CT LXTR C-/C+

73702

4403

FLF

72127

CT CRV SPI C-/C+

72127

4502

FLF

74170

TOMOGRAPHY ABD W/OCONTRAS

74170

4524

FLF

70460

TOMOGRAPHY HEAD/BRAIN WIT

70460

4753

FLF

73700

CT LWR EXTR WO CONTRAST

73700

4753

FLF

74175

CT ANGIO ABDOMEN W/CONTRA

74175

4848

FLF

71275

CT ANGIOGRAPHY

71275

4887

FLF

74178

CT ABD & PELVIS 1 PLUS SECTION/REGNS

74178

5440

FLF

70470

COMPUTED TOMOGRAPHY HEAD/

70470

7574

FLF

72194

CT PELVIS W OR WO CONTRST

72194

7574

FLF

73701

CT LWR EXT W CONT

73701

7574

FLF

72132

CT LMBR SPI C+ MATRL

72132

8404

FLF

93041

RHYTHEM ECG 1-3 LDS

93041

146

FLF

93224

WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I

93224

149

FLF

93010

RTN ECG 12 LEADS INTRP/RP

93010

151

FLF

93000

EKG W/INTREP AND REPORT

93000

248

FLF

93005

EKG

93005

262

FLF

93875

N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD

93875

840

FLF

93306

ECHO TEST

93306

1367

FLF

93351

ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG

93351

1560

FLF

93313

TEE R-T IMG 2D W/PROBE PLMT ONLY

93313

2626

FLF

99406

SMOKING CESSATION 3-10

99406

81

FLF

99407

SMOKING CESSATION 10 MIN

99407

94

FLF

99281

E/M VISIT LEVEL 1 TECH COMP

99281

255

FLF

99282

E/M VISIT LEVEL 2 TECH COMP

99282

510

FLF

99283

E/M VISIT LEVEL 3 TECH COMP

99283

1019

FLF

99284

E/M VISIT LEVEL 4 TECH COMP

99284

2218

FLF

99292

CRITICAL CARE ADD 30 MIN

99292

2305

FLF

99285

E/M VISIT LEVEL 5 TECH COMP

99285

2917

FLF

99291

CRITICAL CARE 30-74 MIN

99291

3443

FLF

84165

PROTEIN ELECTROPHORESIS

84165

1

FLF

86256

SMOOTH MUSCLE AB TITER

86256

1

FLF

86320

IMMUNOELECTROPHORESIS

86320

1

FLF

87207

SMR PRIM SRC SPEC STAIN

87207

1

FLF

88305

PATH SURG LEVEL IV

88305

1

FLF

89060

CRYSTAL INDENTIFICATION

89060

1

FLF

90471

IMMUN ADM 1 VAC

90471

6

FLF

77777

SHORTNESS OF BREATH PANEL

77777

12

FLF

85044

RETICULOCYTE COUNT

85044

21

FLF

85347

COAGJ TM ACTIVATED

85347

35

FLF

82009

KETONES-SERUM

82009

36

FLF

87088

CULTURE BCT ISOL&PRSMPTV

87088

40

FLF

87807

INF AGT DET IMNAS OPT RSV

87807

42

FLF

86038

ANTINUCLEAR AB

86038

46

FLF

83735

MAGNESIUM

83735

53

FLF

87275

IAADI INF B VIRUS

87275

55

FLF

86039

ANTINUCLEAR AB TITER

86039

58

FLF

80178

LITHIUM

80178

59

FLF

82540

CREATINE

82540

68

FLF

82962

GLUCOSE FINGER STICK

82962

69

FLF

82607

VITAMIN B-12

82607

72

FLF

86430

RHEUMATOID FACTOR

86430

74

FLF

84295

SODIUM; SERUM

84295

76

FLF

82948

GLUCOSE BLOOD REAGET STR

82948

77

FLF

82977

GLUTAMYLTRANSFERASE-GTT

82977

77

FLF

86592

RPR

86592

77

FLF

83690

LIPASE

83690

78

FLF

96593

SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE

96593

82

FLF

82075

ALCOHOL BREATH TEST

82075

84

FLF

81001

U/A DIP STICK

81001

85

FLF

87106

CUL FNGI DEFINITIVE ID EA ORGANISM YEAST

87106

85

FLF

86140

C REACTIVE PROTEIN

86140

86

FLF

86901

RH FACTOR-BLOOD

86901

86

FLF

86906

BLD TYPING RH PHEXYPING COMPL

86906

86

FLF

86713

LEGIONELLA PNEUMONPILA AB

86713

88

FLF

P7001

CULTURE BACTERIAL URINE

P7001

89

FLF

87210

WET SMEAR

87210

91

FLF

85652

SED RATE ERYTHROCYTE NON

85652

92

FLF

81025

PREG.TST URINE VISUAL

81025

96

FLF

83615

LDH

83615

96

FLF

89220

SPTM OBTG SPEC AERSL INDUCED SPX

89220

98

FLF

87086

URINE CULTURE

87086

99

FLF

83540

IRON-TOTAL

83540

102

FLF

85014

HEMATOCRIT

85014

102

FLF

85018

HEMOGLOBIN

85018

102

FLF

84480

T3 TOTAL

84480

106

FLF

86308

MONO,HETEROPHILE ANTIBODI

86308

107

FLF

82693

ASSAY OF ETHYLENE GLYCOL

82693

110

FLF

82947

GLUCOSE

82947

110

FLF

80196

SALICYLATE

80196

112

FLF

87661

INF AGENT DET NUCLEIC ACID; TRICHMONAS VAGINALIS; AMP PROBE

87661

112

FLF

80320

DRUG SCREEN

80320

117

FLF

82272

BLD OCLT PEROXIDASE ACTV

82272

117

FLF

82541

COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE

82541

121

FLF

84520

BUN

84520

127

FLF

81000

U/A DIPSTICK

81000

128

FLF

81002

URNLS DIP STICK/TABLET RG

81002

128

FLF

81003

U/A W/O MICRO DIPSTICK

81003

128

FLF

82800

GASES BLD PH ONLY

82800

130

FLF

86631

ANTB CHLAMYDIA

86631

130

FLF

86787

VARICELLA

86787

130

FLF

87850

NEISSERIA GONORRHOEAE DET

87850

130

FLF

86664

EPSTEIN-BARR VIRUS EBNA

86664

133

FLF

86403

MONO SPOT

86403

134

FLF

84450

AST

84450

136

FLF

84560

URIC ACID OTH SRC

84560

138

FLF

82040

ALBUMIN; SERUM

82040

141

FLF

84075

ALK PHOS/PROFILE OR PANEL

84075

141

FLF

80305

DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PRO

80305

143

FLF

86756

ANTB RSV

86756

143

FLF

87880

RAPID STREP-BETA STREP

87880

143

FLF

83520

IMMUNOASSAY ANALYTE QUANTITIATIVE NOS

83520

144

FLF

86701

HIV SERUM

86701

145

FLF

82565

CREATININE

82565

146

FLF

85651

SEDIMENTATION RATE NONAUT

85651

146

FLF

85027

CBC W/O DIFF

85027

149

FLF

84550

URIC ACID

84550

151

FLF

85378

FIBRIN DEGRADATION PROD

85378

151

FLF

82270

OCCULT BLOOD

82270

152

FLF

85032

BLD# MNL C-CNT RBC/PLTLT EA

85032

152

FLF

82253

MB FRACTION

82253

154

FLF

84512

TROPONIN QUAL

84512

154

FLF

84460

ALT-TRANSFERASE;ALANINE

84460

156

FLF

82310

CALCIUM

82310

158

FLF

84155

PROTEIN,TOTAL,EXCEPT REFR

84155

158

FLF

85730

THROMBOPLASTIN TIME PART

85730

162

FLF

82247

BILIRUBIN TOTAL

82247

164

FLF

86702

ANTB HIV-2

86702

164

FLF

82784

IGC IMMUNOGLOBULIN

82784

165

FLF

87425

ROTAVURUS AG EIA

87425

165

FLF

87804

INFLUENZA IMMUNOASSAY OPT

87804

168

FLF

80104

DRUG SCREEN

80104

172

FLF

83874

MYOGLOBIN

83874

172

FLF

85610

PROTHROMBIN TIME

85610

172

FLF

87389

HIV-1 AG W/HIV-1 & HIV-S AB

87389

172

FLF

87400

INFLUENZA A&B

87400

174

FLF

82550

CREATINE CK-TOTAL

82550

176

FLF

82785

GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE

82785

182

FLF

84439

THYROXINE-FREE

84439

187

FLF

86705

HEPATITIS B CORE IGM

86705

187

FLF

86850

ANTB SCR RBC EA SERUM TQ

86850

189

FLF

87070

CULTURE BODY FLUID

87070

190

FLF

84436

THYRIXINE TOTAL

84436

193

FLF

87493

INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE

87493

197

FLF

80329

DRUG SCREEN

80329

198

FLF

82055

ALCOHOL-BLOOD

82055

201

FLF

87081

CULTURE, BACTERIAL-SCREEN

87081

201

FLF

85025

CBC

85025

204

FLF

84702

HCG QUANTATIVE

84702

209

FLF

82150

AMYLASE

82150

210

FLF

80304

DRUG SCREEN

80304

211

FLF

84703

PREGNANCY TEST BLOOD

84703

212

FLF

86689

ANTB HTLV/HIV ANTB CONFIRMATION TST

86689

216

FLF

84479

THYROID HORMONE

84479

218

FLF

80300

DRUG SCREEN

80300

221

FLF

80202

VANCOMYCIN PEAK

80202

229

FLF

82003

ACETAMINOPHEN

82003

229

FLF

80100

DRUG ABUSE PANEL II

80100

230

FLF

G0434

DRUG ABUSE PANEL II

G0434

230

FLF

87430

INF AGT IMMUNO STREP A

87430

234

FLF

80047

BASIC METABOLIC PANEL CALCIUM IONIZED

80047

255

FLF

87110

CHLAMYDIA CULTURE

87110

260

FLF

82553

CREATINE CKMB

82553

263

FLF

84443

TSH

84443

263

FLF

84484

TROPONIN I

84484

263

FLF

87040

BLOOD CULTURE

87040

263

FLF

80048

METABOLIC PANEL BASIC

80048

270

FLF

80051

ELECTROLYTE PANEL

80051

277

FLF

80061

LIPID PROFILE III

80061

277

FLF

80076

HEPATIC FUNCTION PANEL

80076

285

FLF

87075

CULTURE ANAEROBIC

87075

286

FLF

87798

O&P SMEAR W/AMPLIFIC

87798

295

FLF

85379

D-DIMER

85379

315

FLF

83880

B-TYPE NATRIURETIC

83880

320

FLF

80074

HEPATITIS PANEL

80074

342

FLF

80197

TACROLIMUS

80197

350

FLF

87847

NO DESCRIPTION

87847

409

FLF

87529

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA &RNA)

87529

485

FLF

80053

METABOLIC COMPRE PANEL

80053

543

FLF

86360

T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO

86360

627

FLF

72141

MRI SPI CANAL&CNTS CRV C-MATRL

72141

1867

FLF

71550

MRI CH C-MATRL

71550

2771

FLF

70547

MRA NECK C-MATRL

70547

2772

FLF

70551

MRI BRN BRN STEM C-MATRL

70551

2772

FLF

72146

MRI SPI CANAL&CNTS THRC C-MATRL

72146

2772

FLF

72148

MRI SPI CANAL&CNTS LMBR C-MATRL

72148

2772

FLF

72157

MRI SPI CANAL&CNTS C-/C+

72157

2772

FLF

72195

MRI PELVIS C-MATRL

72195

2772

FLF

73221

MRI ANY JT UXTR C-MATRL

73221

2772

FLF

73721

MRI ANY JT LXTR C-MATRL

73721

2772

FLF

74181

MRI ABD C-MATRL

74181

2772

FLF

72158

MRI SPI CANAL&CNTS C-/C+ LMBR

72158

2801

FLF

73722

MRI ANY JT LXTR C+ MATRL

73722

3076

FLF

70544

MRA HEAD C-MATRL

70544

3150

FLF

70553

MRI BRN BRN STEM C-/C+

70553

3268

FLF

72156

MRI SPI CANAL&CNTS C-/C+ CRV

72156

3268

FLF

73220

MRI UXTR OTH/THN JT C-/C+

73220

3268

FLF

74183

MRI ABD C-/C+

74183

3268

FLF

72196

MRI PELVIS C+ MATRL

72196

3735

FLF

73725

MRA LXTR C+-MATRL

73725

3735

FLF

73723

MRI ANY JT LXTR C-/C+

73723

5049

FLF

G0378

HOSPITAL OBSERVATION SERVICES PER HOUR

G0378

1750

FLF

A4616

TUBING (OXYGEN) PER FOOT

A4616

1

FLF

A4927

GLOVES NON STERILE

A4927

1

FLF

J0461

INJ ATROPINE SULFATE 0.01

J0461

1

FLF

J2765

METOCLOPRAMIDE HCL 10MG

J2765

1

FLF

J3010

INJ FENTANYL CITRATE .1MG

J3010

1

FLF

J3480

POTASSIUM CHLORIDE 2 MG

J3480

1

FLF

S5000

PRESCRIPTION DRUG GENERIC

S5000

1

FLF

S5011

5% DEXTROSE 1000 ML

S5011

1

FLF

A6453

BANDAGE SELF ADHER BAND W LESS THAN 3

A6453

2

FLF

J0641

LEVOLEUCOVORIN INJECTION

J0641

2

FLF

J1020

INJ METHYLPREDNISOLONE AC

J1020

2

FLF

Q9967

LOW OSMOLAR CNTRS MAT

Q9967

2

FLF

A4216

STERILE WATER/SALINE, FLUSH 10ML

A4216

3

FLF

A4327

URIN CUP FEMALE COLLECT DEV CUP

A4327

3

FLF

A4335

INCONTINENCE SUPPLY MISC

A4335

3

FLF

A4930

GLOVES STERILE PER PAIR

A4930

3

FLF

A4224

ALOCHOL OR PEROXIDE PER PINT

A4224

4

FLF

Q0179

ONDANESTRONG HCL 8MG ORL

Q0179

4

FLF

A4252

GLUCOSE TEST STRIP-BLOOD KETONE TEST OR STRIP

A4252

6

FLF

A4615

CANNULA NASAL

A4615

6

FLF

A5120

SWAB OR WIPE SKIN BARRIER

A5120

6

FLF

A6410

STERILE EYE PAD OR STRIP

A6410

6

FLF

A6413

ADHESIVE BANDAGE FIRST AI

A6413

6

FLF

J1030

DEPO MEDROL 40 MG/ML

J1030

6

FLF

J2650

PRELONE – INJECTION PREDNISOLONE ACTATE UP TO 1 ML

J2650

6

FLF

A4213

20+ CC SYRINGE ONLY

A4213

7

FLF

A4332

LUBE STERILE PACKET

A4332

7

FLF

A4657

SYRINGE W OR WO NEEDLE

A4657

7

FLF

A6212

FOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ IN OR LESS, EACH DRESSING

A6212

7

FLF

A6402

GAUZE NON-IMPREG STERL 16

A6402

7

FLF

E0325

URINAL MALE JUG-TYPE

E0325

7

FLF

J3030

IMITREX 6MG VIAL

J3030

7

FLF

A6222

GAUZE IMPREGNATED WITH ME

A6222

8

FLF

J0153

ADENOSINE INJ 1MG

J0153

8

FLF

J0170

EPINEPHRINE 3 1/2 NDL 10M

J0170

8

FLF

J0735

CLONIDINE 1MG

J0735

8

FLF

J7506

PREDNISONE ORAL 5 MG

J7506

8

FLF

J7510

PREDNISOLONE ORAL 5 MG

J7510

8

FLF

J7512

PREDNISONE 5 MG

8

FLF

J7699

NOC DRUGS INHAL SOL ADMIN

J7699

8

FLF

S0119

ZOFRAN, 4MG, ORAL

S0119

8

FLF

S5001

PRESCRIPTION DRUG BAND NM

S5001

8

FLF

A4320

IRR TRAY W/BULB/PISTON SY

A4320

9

FLF

A4450

TAPE NO WATERPROOF

A4450

10

FLF

A4452

TAPE WATERPROOF 18 SQ IN

A4452

10

FLF

J1040

METHYLPREDNISOLONE 80MG

J1040

10

FLF

J2920

SOLU-MEDROL 40MG

J2920

10

FLF

J3360

VALIUM INJ 5 MG

J3360

10

FLF

A6213

FOAM DRG 16-48 SQ IN W/BRDR

A6213

11

FLF

A6220

GAUZE, NON IMP, STERILE, PAD SIZE >16 SQ < OR = 48SQ IN

A6220

11

FLF

A6448

LT COMP BANDAGE LESS THAN 3IN

A6448

11

FLF

A6449

LIGHT COMP BANDAGE

A6449

11

FLF

E0275

BED PAN STANDARD

E0275

11

FLF

J2250

MIDAZOLAM HCI PER 1 MG

J2250

11

FLF

J3411

INJ THIAMINE 100 MG

J3411

11

FLF

A4215

NEEDLE STERILE, ANY SIZE, EACH

A4215

12

FLF

A4314

INSRT TRAY W/DRAINAGE BAG

A4314

12

FLF

A4344

INDWELLING CATH FOLEY TYP

A4344

12

FLF

A7011

NONDISPOS CORRUGATED TUBING

A7011

12

FLF

E0230

ICE CAP OR COLLAR

E0230

12

FLF

J0780

COMPAZINE 10 MG

J0780

12

FLF

A4653

PD CATHERTER ANCHOR BELT

A4653

13

FLF

A4673

SALINE BLADE #11

A4673

13

FLF

A6216

GAUZE NONIMPREG 16 SQ IN

A6216

13

FLF

A6217

GAUZE NON STERILE

A6217

13

FLF

A6218

GAUZE, NON STERILE

A6218

13

FLF

A6219

GAUZE- STERILE

A6219

13

FLF

A6454

SELF ADHER BANDAGE

A6454

13

FLF

A6455

SELF ADHER BANDAGE

A6455

13

FLF

J0282

INJ AMIODARONE HYDROCHLOR

J0282

13

FLF

J0595

STADOL

J0595

13

FLF

J1642

HEPARIN SODIUM PER 10 UNI

J1642

13

FLF

J7607

LEVALBUTEROL COMP CON

J7607

13

FLF

J7610

ALBUTEROL, THRU DME 1MG

J7610

13

FLF

J7611

ALBUTEROL 1MG CONC INHALA

J7611

13

FLF

J7613

ALBUT INHAL NON-CP 1MG

J7613

13

FLF

J7620

ALBUTEROL 2.5 MG ATROVENT

J7620

13

FLF

A4358

URINARY DRAINAGE BAG

A4358

14

FLF

A4322

IRRIGATION SYRINGE, BULB

A4322

15

FLF

A9579

GAD-BASE MR CONTRAST NOS,1ML

A9579

15

FLF

J2930

SOLU-MEDROL 125 MG

J2930

15

FLF

Q4007

CAST SUPPLIES LONG ARM CA

Q4007

15

FLF

A6021

COLLAGEN DRESSING STERIL

A6021

17

FLF

A6450

LT COMPRS BANDAGE ELAST

A6450

17

FLF

CASH

XRAY DISC

CASH

17

FLF

J8499

NONCHEMOTHERAPEUTIC ORAL

J8499

17

FLF

A6446

CONFORMING BANDAGE NON-EL

A6446

19

FLF

J0295

INJ AMPCLLN SODIUM/SULBA

J0295

20

FLF

J7614

ALBUTEROL ALL FOMULATIONS

J7614

20

FLF

J7615

LEVALBTERAL INHALATION SO

J7615

20

FLF

J8540

DEXAMETHASONE, ORAL .25MG

J8540

20

FLF

J1335

ERTAPENEM INJECTION

J1335

21

FLF

A6205

COMPOSITE DRSG LESS THAN 48 SQ IN

A6205

22

FLF

J0290

AMPICILLIN 500 MG INJ

J0290

22

FLF

J0500

DICYCLOMINE HCL 20MG

J0500

22

FLF

J0690

KEFZOL 1 GR VIAL

J0690

22

FLF

J0708

J0708

J0708

22

FLF

J1094

DECADRON DEXAMETHASONE ACETATE 1MG

J1094

22

FLF

J1100

DECADRON 4 MG VIAL

J1100

22

FLF

J1200

BENADRYL 50MG

J1200

22

FLF

J1817

INSULIN FOR INSULIN PUMP USE

J1817

22

FLF

J1885

TORADOL INJ 15 MG

J1885

22

FLF

J1940

LASIX 40 MG IV VIAL

J1940

22

FLF

J2270

INJ MORPHINE SULFATE 10 M

J2270

22

FLF

J2405

ONDANSETRON HCI, PER MG

J2405

22

FLF

J2550

PHENERGAN 50 MG

J2550

22

FLF

J2690

PRONESTYL 10 ML

J2690

22

FLF

J2730

PRALIDOXINE CHLORIDE

J2730

22

FLF

J3410

VISTERIL INJ 50 MG

J3410

22

FLF

Q9966

LOCM 200-299MG ML IODINE, 1ML

Q9966

22

FLF

A4649

SURGICAL SUPPLY MISC

A4649

23

FLF

A9150

NON PERSCRIPTION DRUG

A9150

23

FLF

J0171

ADRENALIN EPINEPHRINE INJECT

J0171

23

FLF

J0760

COLCHICINE INJECTION

J0760

23

FLF

Q9963

HI OSM CONTRST MATL 350-3

Q9963

23

FLF

A4270

DISPOSABLE ENDO CODE SHEATH

A4270

24

FLF

A4353

INTERMIT URINARY CATHETER

A4353

24

FLF

J3130

TESTOSTERONE ENANTHATE INJ

J3130

24

FLF

L1830

KNEE IMMOBOLIZER

L1830

24

FLF

Q4038

CAST SUP SHRT LEG FIBERGLASS

Q4038

24

FLF

A4246

BETADINE/PHISOHEX SOLUTION

A4246

25

FLF

A4247

BETADINE/IODINE SWABS/WIPES

A4247

25

FLF

J3475

MAGNESIUM SULFATE 2CC AMP

J3475

25

FLF

Q9965

LOW OSMOLAR CON MAT PER M

Q9965

25

FLF

A4217

STERILE SALINE WATER PER 500 ML

A4217

26

FLF

A4218

STERILE SALINE OR WATER

A4218

26

FLF

J2150

MANNITOL INJECTION

J2150

26

FLF

J7040

INFUS NORM SALINE 500ML

J7040

26

FLF

J7042

5% DEXTROSE

J7042

26

FLF

J7050

INFS NORM SALINE 250CC

J7050

26

FLF

S5550

INSULIN RAPID 5 U

S5550

26

FLF

J2175

DEMEROL 50 MG SYRINGE

J2175

28

FLF

J7060

INFUSION D5W 250ML

J7060

28

FLF

A6407

PACK STRIPS NON-IMPREGNTD

A6407

29

FLF

A4554

DISPOSABLE UNDERPADS

A4554

30

FLF

A6412

OCCLUSIVE EYE PATCH

A6412

30

FLF

J2310

INJ NALOXONE HCL 1MG

J2310

30

FLF

A6211

FOAM DRG LESS THAN 16 LESS THAN 48 SQ IN WO BORDER

A6211

31

FLF

J1815

INJ INSULIN PER 5 UNITS

J1815

31

FLF

J2001

LIDOCAINE HCI 10MG

J2001

31

FLF

J2704

INJECTION PROPOFOL 10 MG

J2704

31

FLF

J7644

IPRATROPIUM BROMIDE INHAL

J7644

31

FLF

J8498

ENEMA SUPPOSITORY, ANTIEMETIC RECTAL

J8498

31

FLF

A4208

3 CC STERILE SYRINGE & NEEDLE

A4208

32

FLF

A9273

HOT/COLD H2OBOT/CAP/COL/WRAP

A9273

32

FLF

S0077

CLANDAMYCIN PHOSPHATE 300

S0077

32

FLF

A4364

DERMABOND- ADHESIVE, LIQUID OR EQUAL PER OZ

A4364

33

FLF

J1240

ANTIVERT – DIMENHYDRINATE INJECTION 50MG

J1240

33

FLF

A6250

SKIN SEAL PROTECT MOISTURIZER OINTMENT

A6250

34

FLF

A4209

5+ CC STERILE SYRINGE & NEEDLE

A4209

35

FLF

A4311

CATHETER W/O BAG 2 WAY LATEX

A4311

35

FLF

E0220

HOT WATER BOTTLE

E0220

35

FLF

J3486

GEODON – ZIPRASIDONE MESYLATE 10MG

J3486

35

FLF

A4670

AUTOMATIC BP MONITOR #11

A4670

36

FLF

J3260

TOBRAMYCIN SULFATE INJECTION

J3260

36

FLF

J3490

UNCLASSIFIED DRUGS

J3490

36

FLF

A7520

TRACH LARYN TUBE NON CUFFED

A7520

37

FLF

J1650

ENOXAPARIN SODIUM 10MG

J1650

37

FLF

J2780

INJ RANITIDINE 25 MG

J2780

37

FLF

Q4020

LNG ARM SPLNT 0-10 YRS

Q4020

39

FLF

Q4008

CAST SUPPLIES LONG ARM

Q4008

40

FLF

A6457

TUBULAR DRESSING

A6457

41

FLF

E04114

E04114

E04114

41

FLF

J1165

DILANTIN 100 MG VIAL

J1165

41

FLF

J1170

DILAUDID 4 MG

J1170

41

FLF

J1670

TETANUS INJECTION

J1670

41

FLF

J2760

PHENTOLAINE MESYLATE INJ

J2760

41

FLF

L0172

CLAVICAL COLLAR 2 PC

L0172

41

FLF

L1630

ABDUCT CONTROL HIP SEMI FLEX

L1630

41

FLF

A4595

TENS SUPPL 2 LEAD PER MONTH

A4595

46

FLF

J0692

INJ CEFEPIME HCI 500MG

J0692

46

FLF

S0020

INJ, BUPIVICAINE, 30ML

S0020

46

FLF

A4614

HAND HELD PEFR METER

50

FLF

J0560

BICILLIN 600,000

J0560

50

FLF

J1580

GARAMYCIN,GENTAMICIN 80MG

J1580

50

FLF

J2300

NUBAIN 10MG AMP

J2300

50

FLF

J0696

ROCEPHIN 250 MG

J0696

52

FLF

S8100

SPACER WITHOUT MASK

S8100

52

FLF

A4338

INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING

A4338

53

FLF

J7030

INFUS NORM SALINE 1000CC

J7030

53

FLF

A4617

MOUTHPIECE FOR RESPIRATORY OXYGEN EQUIPMENT

A4617

55

FLF

J0561

INJECTION PENICILLIN G BENZATHINE 100,000 UNITS

J0561

55

FLF

Q4010

SHORT ARM CAST ADULT

Q4010

55

FLF

A7003

ADMN SET SM VOL NONFILTER

A7003

57

FLF

A7015

NEBULIZER MASK USED W NEBULIZER

A7015

57

FLF

A7017

NEBULIZER MASK NOT USED W/ OXYGEN

A7017

57

FLF

E0114

CRUTCHES UNDERARM

E0114

59

FLF

E0116

CRTCH UNDARM NOT WOOD ADJ

E0116

59

FLF

J2543

ZOSYN – PIPERACILLIN/TAZOBACTAM

J2543

59

FLF

S8101

MASK NEBULIZER MASK SPACER WITH MASK

S8101

59

FLF

J0698

CLAFORAN 1 GR VIAL

J0698

63

FLF

J0150

ADENOSINE INJ 6MG VIAL

J0150

65

FLF

J0550

BICILLIN – PENICILLIN G BENZATHINE INJ

J0550

65

FLF

J0559

BICILLIN – PENICILLIN G BENZATHINE INJ 2500 UNITS

J0559

65

FLF

J1610

GLUCOGAN 1 MG VIAL

J1610

68

FLF

A6231

GAUZE, 16<SQ IN, EACH

A6231

70

FLF

J1110

INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG

J1110

70

FLF

S0028

INJECT FAMOTIDINE 20 MG

S0028

70

FLF

J7130

HYPERTONIC SALINE SOLUTION

J7130

76

FLF

J0456

INJ AZITHROMYCIN 500MG

J0456

81

FLF

J2370

NEO-SYNEPHRINE UP TO 1 ML

J2370

81

FLF

J1631

HALOPERIDOL DECANOATE INJ PER 50 MG

J1631

83

FLF

A4590

3 ORTHO GLASS 4 SPECIAL CASTING MATERIAL

A4590

84

FLF

S8450

SPLINT

S8450

84

FLF

J7070

INFUSION D5W 1000ML

J7070

86

FLF

J1644

INJ HEPARIN SOD PER 1000

J1644

87

FLF

L3260

SURGICAL BOOT/SHOE

L3260

87

FLF

L3908

WRIST EXTN CONTROL COCKUP

L3908

87

FLF

Q4012

CAST SUPPLIES SHORT ARM

Q4012

87

FLF

S0622

PHYS EXAM FOR COLLEGE

S0622

87

FLF

A4316

CATH W DRAINAGE 3 WAY

A4316

90

FLF

G0009

ADM PNEUMOCOCCAL VACCINE

G0009

90

FLF

J7120

RINGER’S LACTATE INFUS

J7120

90

FLF

Q4006

LONG ARM CAST ADULT

Q4006

92

FLF

A7002

SUCTION TUBING USED W PUMP

A7002

94

FLF

A6210

FOAM DRSG LESS THAN 16=48 SQ IN W/ BORDER

A6210

98

FLF

A6260

WOUND CLEANSER

A6260

100

FLF

A6261

WOUND FILLER

A6261

100

FLF

J2060

ATIVAN 2ML SYRUP

J2060

100

FLF

J0570

BICILLIN 1,200,000

J0570

110

FLF

L3670

SO ACROMIO/CLAVICULAR

L3670

113

FLF

A5200

PERCUTANEOUS CATHETER ANCHOR

A5200

117

FLF

L4360

WALK BOOT PNEUMATIC

L4360

117

FLF

Q4042

LNG ARM SPLNT 11 YRS +

Q4042

117

FLF

J1956

LEVOFLOXACIN 250 MG

J1956

120

FLF

J2360

ORPHENADRINE CITRATE 60MG

J2360

122

FLF

A4570

SPECIAL CASTING MATERIAL

A4570

125

FLF

L4380

PNEUMATIC KNEE SPLINT

L4380

125

FLF

Q4051

SPLINT SUPPLIES MISC

Q4051

125

FLF

A4606

OXYGEN PROBE USED W OXIMETER

A4606

127

FLF

L1906

ANKLE SUPPORT

L1906

133

FLF

Q4009

CAST SUPPLIES SHORT ARM

Q4009

140

FLF

J9027

CLOFARALINE INJECTION

J9027

141

FLF

A4565

SLING

A4565

146

FLF

Q4037

CAST SUPPLIES SHORT LEG

Q4037

146

FLF

Q4039

CAST SUPPLIES SHORT LEG C

Q4039

146

FLF

G0168

WND CLS TISSUE ADHESIVE

G0168

152

FLF

A7016

DOME/MOUTHPEICE NEB

A7016

161

FLF

Q0144

AZITH DIHY ORAL CAP/POWD

Q0144

161

FLF

L4386

WALKING BOOT NON PNEUMATIC

L4386

168

FLF

J0330

SUCCINYLCHOLINE CHLO 20MG

J0330

173

FLF

J0360

HYDRALAZINE HCL INJ UP TO 20MG

J0360

173

FLF

A4222

EXT UNFU PMP PER CASS/BAG

A4222

176

FLF

J0744

CIPRO 200MG

J0744

176

FLF

L3999

UPPER LIMB ORTHOSIS NOS

L3999

176

FLF

Q4034

CAST SUP LNG LEG CYLINDER FB

Q4034

176

FLF

E0352

DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM)

E0352

177

FLF

P9612

CATHETERIZE FOR URINE

P9612

177

FLF

S0030

METRONIDAZOLE 500 MG INJ

S0030

188

FLF

S0164

PROTONIX PANTROPRAZOLE 40MG

S0164

194

FLF

J2790

RHOGAM INJECTION

J2790

199

FLF

Q4049

FINGER SPLNT STATIC

Q4049

206

FLF

J3370

VANCOMYCIN HCI INJ 500MG

J3370

229

FLF

S5010

STERILE SALINE 5% DEXTROSE AND 0.45% SALINE

S5010

232

FLF

Q4046

SHRT LG SPLNT 11 YRS +

Q4046

249

FLF

L3650

SO FIGURE EIGHT ABDUCTION

L3650

251

FLF

A9284

NON-ELECTRONIC SPIROMETER

A9284

254

FLF

E0580

NEBULIZER FOR USE W/ REGULAT

E0580

293

FLF

L0120

CERVICAL FLEX NONADJ COLL

L0120

320

FLF

J3230

THOROZINE 50 MG

J3230

330

FLF

A4550

LACERATION- SURGICAL KIT

A4550

409

FLF

Q9954

ORAL MR CONTRAST, 100ML

Q9954

416

FLF

L4350

AIR SPLINT

L4350

453

FLF

E0445

OXIMETER NON-INVASIVE

E0445

578

FLF

E0570

NEBULIZER WITH COMPRESSION

E0570

677

FLF

Q4022

SHRT ARM SPLNT 11 YRS +

Q4022

805

FLF

C9399

ORBACTIV 1200 MG IV

C9399

10153

FLF

A0394

ALS IV DRUG THERAPY SUPPLIES

A0394

1

FLF

A0396

ALS ESPOHAGEAL INTUB SUPPLIES

A0396

30

FLF

92002

OPH MEDICAL XM&EVAL INTRM

92002

1

FLF

92081

VIS FLD XM UNI/BI I&R LMT

92081

1

FLF

92552

PURE TONE AUDIOMTRY AIR O

92552

1

FLF

94664

DEMO&/EVAL OF PT UTILIZ

94664

1

FLF

J0131

INJECTION, ACETAMINOPHEN, 10 MG

J0131

3

FLF

S3000

BILAT DIL RETINAL EXAM

S3000

11

FLF

99000

SPECIMEN HANDLING

99000

18

FLF

36415

VENIPUNCTURE

36415

28

FLF

36416

COLL CAPILLARY BLG SPEC

36416

41

FLF

99001

COC COLLECITON ONLY

99001

41

FLF

99080

MEDICAL RECORDS

99080

46

FLF

S0630

RMV SUTURES; PHYS NOT PHY

S0630

65

FLF

36410

VENIPUNCTURE, 3 YRS OR OLDER

36410

68

FLF

94640

NEBULIZER TREATMENT

94640

69

FLF

99050

BLUE CROSS RQRD LVL3

99050

87

FLF

51700

BLDR IRR SMPL LVG&/INSTLJ

51700

97

FLF

27840

CLOSED TX ANKLE DISLOCATI

27840

100

FLF

56420

I & D BARTHOLIN ABSCESS

56420

100

FLF

28430

CLTX TALUS FX W/O MNPJ

28430

106

FLF

94760

EAR OR PULSE OXIMETRY

94760

111

FLF

29700

RMVL/BIVALV GAUNTLET BOOT

29700

127

FLF

43753

GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING PHYSICIANS SKILL

43753

128

FLF

30901

NASAL PACKING

30901

131

FLF

36591

COLLECT BLOOD FROM IMPLAN

36591

146

FLF

99053

SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HOUR FACILITY

99053

146

FLF

94010

SPIROMETRY W/RECORD

94010

150

FLF

20605

ARTHROCENTESIS, MED JOINT

20605

154

FLF

94644

INHALATION TREATMENT – CONTINUOUS 1ST HR

94644

157

FLF

96372

THERAPEUTIC PROPHYLACTIC/

96372

165

FLF

99145

M-SEDAJ BY SM PHY 15 MIN

99145

168

FLF

20552

TRIGGER POINT INJ 1-2 MUS

20552

176

FLF

29085

CAST HAND/LOWER FOREARM GAUNTLET

29085

176

FLF

29105

LONG ARM SPLINT

29105

176

FLF

29125

SHORT ARM SPLINT

29125

176

FLF

29126

SHORT ARM SPLINT DYNAMIC

29126

176

FLF

29130

APPLICATION FINGER SPLINT

29130

176

FLF

29505

LONG LEG SPLINT

29505

176

FLF

29515

SHORT LEG SPLINT

29515

176

FLF

29550

STRAPPING TOES

29550

176

FLF

69210

RMVL IMPACTED CERUMEN

69210

196

FLF

31525

LARGSC +-TRACHEOSCOPY DX

31525

198

FLF

10120

I & RMVL SUB-CUT SIMPLE

10120

200

FLF

96375

THER PROPH/DX NJX EA SEQL

96375

202

FLF

11040

DBRDMT, SKIN, PARTIAL THICK

11040

205

FLF

90765

IV NFS THER PROPH/DX 1ST

90765

210

FLF

96379

INJECTION- UNLISTED THERAPEUTIC PROPH/DX/IVA NJX/NFS

96379

213

FLF

29540

STRAPPING ANKLE/FOOT

29540

220

FLF

29580

STRAPPING UNNA BOOT

29580

220

FLF

96376

SUB INFU EA ADD IV PUSH

96376

221

FLF

96373

INJECTION, INTRA-ARTERIAL

96373

228

FLF

51701

INSR NONDWELLING BLDR CAT

51701

231

FLF

96366

IV INFUS THER PROPH/DX EA

96366

232

FLF

96361

IV INFUS HYDR EA ADD’T HR

96361

233

FLF

94761

N-INVAS EAR/PLS OXIMTRY F

94761

238

FLF

29280

STRAPPING HAND/FINGER

29280

239

FLF

36000

INTRODUCTION OF NEEDLE/IN

36000

244

FLF

65205

REMOVAL FB EYE-SUPERFCL

65205

244

FLF

96360

IV INFUS INIT 31 MIN 1 HR

96360

251

FLF

56405

INC/DRAIN VULVA/PERINEAL

56405

259

FLF

29240

STRPG SHO

29240

260

FLF

11011

DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC

11011

263

FLF

96367

IV NFS THER PROPH/DX ADDL

96367

263

FLF

96368

IV NFS TX PROPHYLAXIS/DX

96368

263

FLF

16020

BURN, DRESSING/DBRDMNT-SM

16020

270

FLF

16000

BURN, INITIAL TREATMENT

16000

274

FLF

11730

AVULSION/1-NAIL PLATE

11730

290

FLF

99173

SCREENING TEST OF VISION

99173

293

FLF

11200

RMVL SKIN TAGS

11200

294

FLF

11771

EXCISION PILONIDAL CYST SINUS EXTENSIVE

11771

297

FLF

26010

I & D FINGER ABSCESS,SIMP

26010

298

FLF

96374

THER PROPH/DX NJX IV PUSH

96374

300

FLF

11740

EVAC SUBUNGUAL HEMATOMA

11740

303

FLF

38300

DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL

38300

303

FLF

12035

REPAIR INTERM S/A/T/E 12.

12035

318

FLF

12020

TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

12020

320

FLF

10160

PUNCTURE ASP OF ABSCESS

10160

328

FLF

69209

REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL

69209

340

FLF

11765

WEDGE EXC SKIN/NAIL BED

11765

341

FLF

27372

REMOVAL FOREIGN BODY DEEP THIGH/KNEE

27372

350

FLF

20610

ARTHROCENTESIS, LG JOINT

20610

361

FLF

51702

INSERTION BLADDER CATH

51702

361

FLF

69005

DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED

69005

363

FLF

96365

IV INFUSION THERAPY/PROPH

96365

363

FLF

99149

MOD SEDATION

99149

363

FLF

24500

CLTX HUMRL SHFT FX W/O MN

24500

378

FLF

25530

CLSD TX ULNAR SHFT FX NO

25530

378

FLF

25560

CLTX RDL&UR SHFT FXS W/O

25560

378

FLF

65220

RMVL FB EYE W/O SLIT LAMP

65220

380

FLF

23600

CLTX PROX HUMRL FX WO MAN

23600

381

FLF

24576

CLTX HUMRL CNDLYR FX MEDI

24576

381

FLF

26700

CLS TX MCP DISLOCATION

26700

381

FLF

27508

CLTX FEM FX DSTAL END MED

27508

381

FLF

27560

CLTX PATELLAR DISLC W/O A

27560

381

FLF

69200

RMVL FOREIGN BODY EAR

69200

381

FLF

94060

BRNCDILAT RSPSE SPMTRY PR

94060

385

FLF

69205

RMVL FB XTRNL AUD CANAL A

69205

409

FLF

90997

HEMOPERFUSION

90997

409

FLF

12001

LACERATION REPAIR

12001

425

FLF

21800

CLTX RIB FX UNCOMP EA

21800

425

FLF

12002

REPAIR LAC SCALP 2.6-7.5

12002

430

FLF

99144

MOD SEDATION SERV UNDER 5

99144

433

FLF

99143

MOD SEDATION &#60;5YRS 30

99143

439

FLF

30903

CTRL NSL HEMRRG ANT CPLX

30903

443

FLF

10061

INS/DRAIN ABSCESS COMPL

10061

444

FLF

65222

RMVL FB EYE

65222

449

FLF

21480

CLDS TX TEMP DISLOCATION

21480

452

FLF

93931

DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD

93931

466

FLF

41800

DRNG ABSC DENTOALVEOLAR S

41800

480

FLF

46083

INCISION THROM HEMORRHOID

46083

491

FLF

76942

ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND INTERP

76942

495

FLF

12004

REPAIR LAC SCALP 7.6-12.5

12004

496

FLF

30300

RMVL FOREIGN BODY NASAL

30300

496

FLF

21310

CLTX NSL B1 FX W/O MNPJ

21310

498

FLF

12031

LYR CLSR S/A/T/E 2.5CM

12031

504

FLF

27530

CLTX TIBL FX PROX W/O MNPJ

27530

507

FLF

27808

CLOSED TX BIMALLEOLAR ANK

27808

507

FLF

24640

RADIAL HEAD SUBLUX. CHILD

24640

519

FLF

28510

CLSD TX FX PLALANX/PHALAN

28510

523

FLF

12041

LAYER CLSR NECK/HAND 2.6

12041

524

FLF

12013

REPAIR LAC FACE 2.6-5.0CM

12013

526

FLF

11760

REPAIR NAIL BED

11760

531

FLF

13122

CMPLX RPR ADD 5 CM OR LES

13122

531

FLF

62270

SPINAL PUNCTURE,LUMBAR

62270

554

FLF

64450

INJ ANESTHETIC AGENT

64450

559

FLF

26770

TREAT FINGER DISLOC FINGE

26770

560

FLF

51703

INSERT BLADDER CATH COMPL

51703

569

FLF

31500

INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE

31500

571

FLF

10121

I & RMVL FB, SUB-CUT,COMP

10121

583

FLF

10081

I&D PILONIDAL CST COMP

10081

590

FLF

12051

LAYER CLSR OF WND NCK/HND

12051

594

FLF

28490

CLTX FX GRT TOE W/O MNLJ

28490

594

FLF

91105

GASTRIC INTUBATION/ASPER

91105

596

FLF

59025

FTL NON-STRS TST

59025

600

FLF

46320

ENULEATION EXCC OF EXT HE

46320

612

FLF

26750

CLS TX FX FINGER/THUMB

26750

618

FLF

11750

EXC NAIL PART/COMP

11750

619

FLF

28515

FX CARE PHALANX NOT GREAT

28515

622

FLF

28660

CLSD TX PIP JNT DISLOCATI

28660

622

FLF

26720

CLSD TX PHALANGEAL SHFTFX

26720

628

FLF

27220

CLTX ACETABULUM HIP/SOCKT FX W/O MNP

27220

635

FLF

28450

TX TARSAL B1 FX XCP TALUS

28450

635

FLF

20600

ARTHROCENTESIS, SML JOINT

20600

640

FLF

64402

INJ ANESTHETIC FACIAL NRV

64402

640

FLF

24600

CLSD TX ELBOW DISLOCAT

24600

650

FLF

25500

CLTX RDL SHFT FX WO MANP

25500

650

FLF

25622

CLSD TX NAVICULAR FX WO M

25622

650

FLF

28400

CLSD TX CLAVICLE FX WO MA

28400

650

FLF

15850

SUTURE RMVL W/ANESTHESIA

15850

653

FLF

12005

REPAIR LAC,SCALP 12.6-20C

12005

658

FLF

13153

REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM<

13153

669

FLF

31515

LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION

31515

670

FLF

12034

INTERM RPR SCLP/TRNK/EXTR

12034

707

FLF

12052

LYR CLSR WOUND 2.6-5.0FAC

12052

708

FLF

25535

CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION

25535

715

FLF

12014

REPAIR LAC FACE 5.1-7.5CM

12014

729

FLF

28190

RMVL FB BODY FOOT SUBQ

28190

745

FLF

10060

INCISION/DRAINAGE ABSCESS

10060

759

FLF

12011

REPAIR LAC FACE LESS THAN 2.5 CM

12011

759

FLF

12045

REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM

12045

760

FLF

12032

REPAIR-INT SCALP 2.6-7.5

12032

761

FLF

12036

REPAIR INTERM S/A/T/E 20.1-30.0 CM

12036

762

FLF

12044

LYR CLSR N/H/F/ETRNL GENT

12044

762

FLF

67700

I&D ABSCESS EYELID

67700

773

FLF

26755

CLTX DSTL PHLNGL FX FNGR/

26755

792

FLF

23500

CLTX CLAVICULAR FX WO MNP

23500

814

FLF

11404

EXC BGN LSN TRUNK 3.1-4.0

11404

833

FLF

23570

CLSD TX SCAPULAR FX WO MA

23570

839

FLF

28470

CLTX METAR FX WO MNP

28470

840

FLF

42700

I&D ABSC PRITONSILLAR

42700

857

FLF

12054

REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM

12054

865

FLF

93926

DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD

93926

878

FLF

12042

REPAIR LAC HAND/FOOT 2.6-

12042

883

FLF

31502

TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT

31502

891

FLF

93880

DUP-SCAN XTRC ART COMPL B

93880

903

FLF

93882

DUP-SCAN XTRC ART UNI/LMTD STD

93882

903

FLF

26600

CLSD TX METACARPAL FX

26600

909

FLF

23650

SHOULDER DISLOCATION TRMT

23650

934

FLF

24670

CLTX ULNR FX PROX END WO

24670

942

FLF

12053

LYR CLSR F/E/E/N/L/M&/MUC

12053

957

FLF

24650

CLTX RDL HEAD FX WO MANP

24650

959

FLF

33415

RESCJ/INC SUBVALVULAR TISSUE

33415

980

FLF

27786

CLSD TX DISTAL FIBULAR FX

27786

993

FLF

26725

CLTX PHLNGL FX PROX/MIDDL

26725

1027

FLF

94621

PULM STRS TSTG CPLX

94621

1029

FLF

25600

CLSD TX DISTAL RAD FX WO

25600

1045

FLF

26605

CLSD TX MEDICARPAL FX

26605

1053

FLF

13151

CMPX RPR EYE NOSE 1.1-2.5

13151

1055

FLF

27780

CLTX PROX FIVULA/SHFT FX

27780

1055

FLF

25635

CLTTX CARPL B1 FX W/MNPJ EA B1

25635

1085

FLF

92960

CARDIOVERSION ELECTIVE ARRHYT XTRNL

92960

1089

FLF

25650

CLTX UR SYLOID FX

25650

1097

FLF

11042

DBRD SKN SUBQ TISSUE

11042

1098

FLF

46050

INC/DRAIN PERIANAL ABS SU

46050

1111

FLF

27760

CLTX MEDIAL MALLS FX W/O

27760

1153

FLF

23620

CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; W/O MANIPULATION

23620

1155

FLF

27520

CLTX PATELLAR FX W/O MNPJ

27520

1205

FLF

64640

DSTRJ NULYT OTH PRPH NVR/BRANCH

64640

1220

FLF

13121

RPR CMPX SCALP ARM2.6-7.5

13121

1236

FLF

32551

TUBE THORACOSTOMY INCLUDES WATER SEAL

32551

1342

FLF

27550

CLOSED TX KNEE DISLOCATION W/O ANESTHESIA

27550

1366

FLF

28192

RMVL FB FOOT DEEP

28192

1373

FLF

24530

CLTX SPRCNDYLR/TRANSCNDYL

24530

1392

FLF

13132

RPR CMPX FOREHEAD/CHECK/C

13132

1462

FLF

26607

CLTX MTCRPL FX W/MNP W/XT

26607

1670

FLF

27810

CLTX BIMAL ANKLE FX W/POT

27810

1704

FLF

93965

QUANT VENOUS FLOW ST

93965

1806

FLF

13152

RPR CPLX E/N/E/L 2.6-7.5

13152

1830

FLF

46040

I&D ISCHIOR/PRIRC ABSC SP

46040

1957

FLF

27752

CLTX TIBL SFT FX W/MANP

27752

1968

FLF

25605

CLSD TX DISTAL RAD FX

25605

1992

FLF

36558

INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR

36558

2156

FLF

25505

CLSD TX RAD SHAFT W/MANIP

25505

2213

FLF

40650

RPR LIP FULL THICKNESS

40650

2990

FLF

59409

VAG DLVR ONLY

59409

3960

FLF

76815

ULTRASND PG UTER

76815

356

FLF

76857

PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97

76857

438

FLF

76882

ULTRASOUND, EXTREMITY, NON VASCULAR

76882

441

FLF

93976

DUPLEX SCAN- LIMITED

93976

466

FLF

93975

DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, PELVIC, SCROTAL

93975

514

FLF

76817

UT PG UTER R-T IMG TRVG

76817

602

FLF

93971

DPLX SCN EXTRM VEINS

93971

645

FLF

76645

US BREAST R-T W/IMAGE DOCUMENTATION

76645

719

FLF

76830

TRANSVAGINAL ULTRASOUND

76830

723

FLF

76801

ULTRASOUND 14 WK TABDL 1/1ST GESTATION

76801

726

FLF

76775

US RPR B-SCAN&/R-T IMG LMTD

76775

750

FLF

76870

US SCROTUM&CNTS

76870

762

FLF

76805

US PG UTER F&MAT AFTER 1S

76805

793

FLF

76770

US RETROPERITONEAL R-T W/

76770

834

FLF

76856

US PELVIC NONOB REAL-TIME

76856

839

FLF

76880

US EXTREMITY

76880

913

FLF

76536

ULTRASOUND, SOFT TISSUES OF HEAD AND NECK

76536

998

FLF

76705

US ABDOMINAL

76705

1027

FLF

76700

US ABDOMINAL R-T W/IMAGE

76700

1156

FLF

93970

DUP-SCAN XTR VEINS COMPL

93970

1250

FLF

J3430

INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG

J3430

12

FLF

J3105

INJECTION, TREBUTALINE SULFATE, UP TO 1 MG

J3105

35

FLF

90660

INFLUENZA VIRUS INTRANASA

90660

70

FLF

90746

HEPATITIS B VACCINE/ADULT

90746

79

FLF

90715

TDAP VACCINE

90715

116

FLF

90703

TETANUS TOXID

90703

152

FLF

90714

TETANUS DIPHTHERIA TOXOID

90714

152

FLF

90718

TETANUS & DIPTHERIA

90718

152

FLF

90675

RABIES VAC IM

90675

475

FLF

71048

XRAY ABDOMEN 1 VIEW

71048

97

FLF

74018

XRAY ABDOMEN 1 VIEW

74018

97

FLF

73552

FEMUR; MIN 2 VIEWS

73552

102

FLF

74019

XRAY ABDOMEN, 2 VIEWS

74019

118

FLF

74021

XRAY ABDOMEN, 3 OR MORE VIEWS

74021

138

FLF

71110

RIBS BILATERAL 3 VIEWS

71110

144

FLF

70120

RADEX MASTOIDS LESS THAN 3 VIEWS PR SIDE

71020

157

FLF

73090

XRAY FOREARM AP & LAT

73090

176

FLF

71045

CHEST X RAY 1 VIEW

71045

205

FLF

73020

RADEX SHO 1 VIEW

73020

231

FLF

73660

XRAY TOES, MIN 2 VIEWS

73660

233

FLF

70160

NASAL BONE X-RAY

70160

234

FLF

73070

XRAY ELBOW 2 VIEWS

73070

234

FLF

73600

XRAY ANKLE 2 VIEWS

73600

234

FLF

71120

CHEST 2 VIEWS

71120

255

FLF

70350

CEPHALOGRAM ORTHODONTIC

70350

257

FLF

73562

XRAY KNEE MIN 3 VIEWS

73562

261

FLF

70030

RADEX EYE DETCJ FB

70030

263

FLF

71111

RIBS BILATERAL W/CHEST

71111

263

FLF

71100

RIBS UNILATERAL 2 VIEWS

71100

264

FLF

72070

SPINE THORACIC 2 VIEWS

72070

271

FLF

73000

XRAY CLAVICLE 2 VIEWS

73000

278

FLF

72220

XRAY COCCYX/SACRUM

72220

284

FLF

71010

XRAY CHEST AP

71010

299

FLF

73550

XRAY FEMUR AP & LAT VIEW

73550

311

FLF

73560

XRAY KNEE, SUNRISE VIEW

73560

312

FLF

72020

SPINE SINGLE VIEW

72020

314

FLF

73650

RAD EXAN HEEL MIN 2 VIEWS

73650

320

FLF

73120

XRAY HAND AP & LAT

73120

322

FLF

73080

XRAY ELBOW GREATER THAN 3 VIEWS-COMP

73080

338

FLF

70100

XRAY MANDIBLE LESS THAN 4 VIEWS

70100

351

FLF

70110

XRAY MANDIBLE MIN 4 VIEWS

70110

351

FLF

70328

RADEX TMPRMAND JT OPN&CLSD MOUTH UNI

70328

351

FLF

73010

SCAPULA COMPLETE

73010

354

FLF

73140

XRAY FINGER MIN 2 VIEWS

73140

355

FLF

73060

XRAY HUMERUS MIN 2 VIEWS

73060

367

FLF

73110

XRAY WRIST/COMP MIN 3 VIE

73110

367

FLF

73050

XRAY AC JOINTS-BILAT

73050

372

FLF

72069

RADEX SPI THORACOLMBR STANDING SCOLIOSIS

72069

374

FLF

70140

XRAY FACIAL BONES LESS THAN 3 VIEW

70140

377

FLF

70250

SKULL LESS THAN 4 VIEWS

70250

378

FLF

73100

XRAY WRIST AP & LAT VIEW

73100

378

FLF

72170

RAD EXAM PELVIS 1/2 VEIW

72170

380

FLF

73500

RADIOLOGIC EXAM HIP UNILAT 1 VIEW

73500

380

FLF

73590

XRAY TIBIA/FIBULA AP/LAT

73590

381

FLF

73620

XRAY FOOT MIN 2 VIEWS

73620

382

FLF

71046

CHEST XRAY 2 VIEWS

71046

387

FLF

73030

SHOULDR COMPLETE 2 VIEWS

73030

389

FLF

73564

RAD EXAM KNEE 4 OR MORE

73564

393

FLF

72040

SPINE, CERVICAL 2/3 VIEWS

72040

411

FLF

73130

XRAY HAND MIN 3 VIEWS

73130

416

FLF

73501

RADIOLOGIC EXAM, HIP UNIL W/PELVIS 1 VIEW

73501

425

FLF

74010

RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS

74010

426

FLF

72190

RADEX PELVIS COMPL MIN 3

72190

433

FLF

74020

RAD EXAM ABDOMEN COMPL

74020

454

FLF

71020

XRAY CHEST PA & LATERAL

71020

464

FLF

72114

RAD EXAM SPINE LUMBO COMP

72114

466

FLF

70200

RAD EXAM ORBIT COMP.

70200

468

FLF

73510

XRAY HIP MIN 2 VIEWS

73510

476

FLF

71101

RIB UNILATERAL W CHEST

71101

484

FLF

73610

XRAY ANKLE 3 VIEWS/COMPLE

73610

485

FLF

72050

SPINE, CERVICAL MIN 4VIEW

72050

491

FLF

70220

RAD EXAM SINUS COMPLETE

70220

493

FLF

70150

XRAY FACIAL BONES GREATER THAN 3 VIEW

70150

499

FLF

70260

RAD EXAM SKULL COMPLETE

70260

501

FLF

73520

HIPS BILAT MIN 2 VIEW INC

73520

507

FLF

71030

RADEX CH COMPL MIN 4 VIEW

71030

524

FLF

72074

RAD EXAN SPINE THROAC 4 V

72074

535

FLF

71060

BRONCHOGRAPHY BI RS&I

71060

537

FLF

73630

XRAY FOOT MIN 3 VIEWS

73630

537

FLF

72072

SPINE THORACIC 3 VIEWS

72072

554

FLF

72120

SPINE LUMBAR AP & LAT W F

72120

554

FLF

74022

RAD EXAM COMPLETE ABD

74022

570

FLF

72100

SPINE LUMBO. MIN 4 VIEWS

72100

583

FLF

70360

RAD EXAM NECK,SOFT TISSUE

70360

682

FLF

73502

RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED;2-3 VIEWS

701

FLF

74000

RAD EXAM ABD SINGL ANTER

74000

759

FLF

72110

LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS

72110

793

FLF

72052

SPINE CERV. COMP FLEX/EXT

72052

840

FLF

78320

B1&/JT IMG TOMOG SPECT

78320

923

FLF

74241

RADEX GI TRC UPR +-DLYD FLMS W/KUB

74241

998

FLF

74247

RADEX GI UPR C+ +-GLUC +-DYLD FLMS W/KUB

74247

1010

FLF

S8037

MRCP MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY

S8037

1284

FLF

78306

B1&/JT IMG WHBDY

78306

1440

FLF

78315

B1&/JT IMG 3 PHASE STD

78315

1440

FLF

78472

CARD BPI GTD=BRM PLNR 1 STD REST/STRS

78472

2039

FLF

78223

HIDA SCAN-HEPATBL DUX SYS IMG GLBLDR

78223

2509

FLF

78075

ADRNL IMG CORTEX&/MEDULLA

78075

3618