CHARGE CODEĀ DESCRIPTIONCURRENT FEE
10060INCISION/DRAINAGE ABSCESS $ 1,479.00
10061INS/DRAIN ABSCESS COMPL $ 2,175.00
10080INCISION AND DRAINAGE OF PILONDIAL CYST $ 641.00
10081I&D PILONIDAL CST COMP $ 3,828.00
10120I & RMVL SUB-CUT SIMPLE $ 2,175.00
10121I & RMVL FB, SUB-CUT,COMP $ 786.00
10140I&D OF HEMATOMA, SEROMA OR FLUID COLLECTION $ 5,876.00
10160PUNCTURE ASP OF ABSCESS $ 2,375.00
11011DBRDMT W RMVL FM FX & DISLC SKN SUBQ T/M/F/ MUSC $ 355.00
11040DBRDMT, SKIN, PARTIAL THICK $ 276.00
11042DBRD SKN SUBQ TISSUE $ 2,719.00
11200RMVL SKIN TAGS $ 395.00
11404EXC BGN LSN TRUNK 3.1-4.0 $ 1,124.00
11730AVULSION/1-NAIL PLATE $ 1,479.00
11732REMOVAL OF ADDL NAIL PLAT $ 195.00
11740EVAC SUBUNGUAL HEMATOMA $ 919.00
11750EXC NAIL PART/COMP $ 2,175.00
11760REPAIR NAIL BED $ 590.00
11765WEDGE EXC SKIN/NAIL BED $ 2,175.00
11771EXCISION PILONIDAL CYST SINUS EXTENSIVE $ 399.00
12001REPAIR LAC OF SCALP, NECK, AXILLAE, TRUNK, OR EXTREMITIES INCL HANDS OR FEET $ 1,183.00
12002REPAIR LAC SCALP 2.6-7.5 $ 1,055.00
12004REPAIR LAC SCALP 7.6-12.5 $ 1,196.00
12005REPAIR LAC,SCALP 12.6-20C $ 2,175.00
12006LACERATION REPAIR, SIMPLE, 20.1 CM TO 30 CM $ 2,175.00
12011REPAIR LAC FACE LESS THAN 2.5 CM $ 1,183.00
12013REPAIR LAC FACE 2.6-5.0CM $ 1,183.00
12014REPAIR LAC FACE 5.1-7.5CM $ 1,183.00
12015LACERATION REPAIR, FACE, 7.6 TO 12.5 CM $ 1,262.00
12020TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE $ 433.00
12031LYR CLSR S/A/T/E 2.5CM $ 679.00
12032REPAIR-INT SCALP 2.6-7.5 $ 2,175.00
12034INTERM RPR SCLP/TRNK/EXTR $ 2,175.00
12035REPAIR INTERM S/A/T/E 12. $ 2,175.00
12036REPAIR INTERM S/A/T/E 20.1-30.0 CM $ 1,029.00
12041LAYER CLSR NECK/HAND 2.6 $ 2,175.00
12042WOUND REPAIR, INTERMEDIATE N-HF $ 2,175.00
12044LYR CLSR N/H/F/ETRNL GENT $ 1,028.00
12045REPAIR INTERMEDIATE N/H/F/XTRNAL GEN 12.6 -20 CM $ 1,024.00
12051LAYER CLSR OF WND NCK/HND $ 2,175.00
12052LYR CLSR WOUND 2.6-5.0FAC $ 955.00
12053LYR CLSR F/E/E/N/L/M&/MUC $ 1,290.00
12054REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM $ 2,175.00
13121RPR CMPX SCALP ARM2.6-7.5 $ 1,666.00
13122CMPLX RPR ADD 5 CM OR LES $ 718.00
13132RPR CMPX FOREHEAD/CHECK/C $ 1,970.00
13151CMPX RPR EYE NOSE 1.1-2.5 $ 1,421.00
13152RPR CPLX E/N/E/L 2.6-7.5 $ 2,470.00
13153REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM< $ 901.00
15850SUTURE RMVL W/ANESTHESIA $ 883.00
16000BURN, INITIAL TREATMENT $ 1,479.00
16020BURN, DRESSING/DBRDMNT-SM $ 1,479.00
20552TRIGGER POINT INJ 1-2 MUS $ 2,141.00
20600ARTHROCENTESIS, SML JOINT $ 865.00
20605DRAIN, INJECT JOINT BURSA ARTHROCENTISIS $ 624.00
20610ARTHROCENTESIS, LG JOINT $ 2,141.00
21310CLTX NSL B1 FX W/O MNPJ $ 1,880.00
21480CLDS TX TEMP DISLOCATION $ 1,880.00
21800CLTX RIB FX UNCOMP EA $ 574.00
23500CLTX CLAVICULAR FX WO MNP $ 1,880.00
23570CLSD TX SCAPULAR FX WO MA $ 1,131.00
23600CLTX PROX HUMRL FX WO MAN $ 1,880.00
23650SHOULDER DISLOCATION TRMT $ 1,880.00
24500CLTX HUMRL SHFT FX W/O MN $ 510.00
24530CLTX SPRCNDYLR/TRANSCNDYL $ 1,880.00
24565CLOSED TREATMENT OF HUMERAL EPICONDYLAR FX, MIDIALOR LATERAL W MAN $ 1,130.00
24576CLTX HUMRL CNDLYR FX MEDI $ 513.00
24600CLSD TX ELBOW DISLOCAT $ 878.00
24640RADIAL HEAD SUBLUX. CHILD $ 1,880.00
24650CLTX RDL HEAD FX WO MANP $ 1,880.00
24670CLTX ULNR FX PROX END WO $ 1,880.00
25500CLTX RDL SHFT FX WO MANP $ 878.00
25505CLSD TX RAD SHAFT W/MANIP $ 1,212.00
25530CLSD TX ULNAR SHFT FX NO $ 510.00
25560CLTX RDL&UR SHFT FXS W/O $ 1,880.00
25565CLOSED TX RADIAL & ULNAR SH $ 2,283.00
25600CLSD TX DISTAL RAD FX WO $ 1,880.00
25605CLSD TX DISTAL RAD FX $ 2,210.00
25622CLSD TX NAVICULAR FX WO M $ 1,880.00
25630CLOSED TREATMENT OF CARPAL BONE FRACTURE $ 1,880.00
25635CLTTX CARPL B1 FX W/MNPJ EA B1 $ 1,461.00
25650CLTX UR SYLOID FX $ 1,880.00
26010I & D FINGER ABSCESS,SIMP $ 400.00
26600CLSD TX METACARPAL FX $ 1,880.00
26605CLSD TX MEDICARPAL FX $ 1,880.00
26607CLTX MTCRPL FX W/MNP W/XT $ 2,251.00
26700CLS TX MCP DISLOCATION $ 1,880.00
26720CLSD TX PHALANGEAL SHFTFX $ 1,880.00
26725CLTX PHLNGL FX PROX/MIDDL $ 1,880.00
26750CLS TX FX FINGER/THUMB $ 1,880.00
26755CLTX DSTL PHLNGL FX FNGR/ $ 1,880.00
26770TREAT FINGER DISLOC FINGE $ 1,880.00
27220CLTX ACETABULUM HIP/SOCKT FX W/O MNP $ 855.00
27372REMOVAL FOREIGN BODY DEEP THIGH/KNEE $ 473.00
27508CLTX FEM FX DSTAL END MED $ 1,880.00
27520CLTX PATELLAR FX W/O MNPJ $ 1,880.00
27530CLTX TIBL FX PROX W/O MNPJ $ 1,880.00
27550CLOSED TX KNEE DISLOCATION W/O ANESTHESIA $ 1,843.00
27560CLTX PATELLAR DISLC W/O A $ 1,880.00
27752CLTX TIBL SFT FX W/MANP $ 2,654.00
27760CLTX MEDIAL MALLS FX W/O $ 1,880.00
27780CLTX PROX FIVULA/SHFT FX $ 1,880.00
27786CLSD TX DISTAL FIBULAR FX $ 1,880.00
27808CLOSED TX BIMALLEOLAR ANK $ 1,880.00
27810CLTX BIMAL ANKLE FX W/POT $ 2,298.00
27824UNDER FRACTURE AND/OR DISLOCATION PROCEDURES ON THE LEG (TIBIA AND FIBULA) $ 1,880.00
27840CLOSED TX ANKLE DISLOCATI $ 1,966.00
28190RMVL FB BODY FOOT SUBQ $ 1,005.00
28192RMVL FB FOOT DEEP $ 1,851.00
28400CLSD TX CLAVICLE FX WO MA $ 1,880.00
28430CLTX TALUS FX W/O MNPJ $ 856.00
28450TX TARSAL B1 FX XCP TALUS $ 1,880.00
28470CLTX METAR FX WO MNP $ 1,880.00
28490CLTX FX GRT TOE W/O MNLJ $ 1,880.00
28510CLSD TX FX PLALANX/PHALAN $ 1,880.00
28515FX CARE PHALANX NOT GREAT $ 1,880.00
28660CLSD TX PIP JNT DISLOCATI $ 839.00
29085CAST HAND/LOWER FOREARM GAUNTLET $ 236.00
29105LONG ARM SPLINT $ 1,185.00
29125SHORT ARM SPLINT $ 919.00
29126SHORT ARM SPLINT DYNAMIC $ 236.00
29130APPLICATION FINGER SPLINT $ 490.00
29240STRPG SHO $ 351.00
29280STRAPPING HAND/FINGER $ 323.00
29505LONG LEG SPLINT $ 1,185.00
29515SHORT LEG SPLINT $ 1,185.00
29540STRAPPING ANKLE/FOOT $ 298.00
29550STRAPPING TOES $ 236.00
29580STRAPPING UNNA BOOT $ 298.00
29700RMVL/BIVALV GAUNTLET BOOT $ 171.00
29720REPAIR OF BODY CAST $ 399.00
30300RMVL FOREIGN BODY NASAL $ 919.00
30901NASAL PACKING $ 919.00
30903CTRL NSL HEMRRG ANT CPLX $ 919.00
31500INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE $ 1,561.00
31502TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT $ 1,200.00
31515LARYNGOSCOPY +- TRACHEOSCOPY ASPIRATION $ 904.00
32551TUBE THORACOSTOMY INCLUDES WATER SEAL $ 3,880.00
33415RESCJ/INC SUBVALVULAR TISSUE $ 1,323.00
36000INTRODUCTION OF NEEDLE/IN $ 330.00
36415VENIPUNCTURE $ 52.00
36416COLL CAPILLARY BLG SPEC $ 55.00
36556INS NON TUN CTR CVC GREATER THAN 5 YRS $ 6,880.00
36558INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR $ 2,909.00
36569INSJ PRPH CVS W/O SUBQ PO $ 1,375.00
36591COLLECT BLOOD FROM IMPLAN $ 198.00
38300DRAINAGE LYMPH NODE ABSC/LYMPHADENITIS SMPL $ 409.00
40650RPR LIP FULL THICKNESS $ 4,024.00
41250LACERATION REPAIR 2.5 CM OR LESS, FLOOR OF MOUTH AND/OR ANTERIOR 2/3 OF TONGE $ 1,106.00
41252LACERATION REPAIR OF TONGUE $ 1,559.00
41800DRNG ABSC DENTOALVEOLAR S $ 919.00
42700I&D ABSC PRITONSILLAR $ 1,561.00
43752NASAL/ORAGASTRIC W/STENT $ 554.00
45915REMOVE RECTAL OBSTRUCTION $ 2,936.00
46040I&D ISCHIOR/PRIRC ABSC SP $ 3,595.00
46083INCISION THROM HEMORRHOID $ 2,009.00
46320ENULEATION EXCC OF EXT HE $ 824.00
51700BLDR IRR SMPL LVG&/INSTLJ $ 405.00
51701INSR NONDWELLING BLDR CAT $ 919.00
51702INSERTION BLADDER CATH $ 919.00
51703INSERT BLADDER CATH COMPL $ 766.00
56405INC/DRAIN VULVA/PERINEAL $ 348.00
56420I & D BARTHOLIN ABSCESS $ 1,406.00
59025FTL NON-STRS TST $ 809.00
59409VAG DLVR ONLY $ 5,341.00
62270SPINAL PUNCTURE,LUMBAR $ 4,754.00
64400NERVE BLOCK, TRIGEMENAL $ 2,141.00
64402INJ ANESTHETIC FACIAL NRV $ 919.00
64450INJ ANESTHETIC AGENT $ 4,754.00
64640DSTRJ NULYT OTH PRPH NVR/BRANCH $ 1,645.00
65205REMOVAL FB EYE-SUPERFCL $ 919.00
65220RMVL FB EYE W/O SLIT LAMP $ 2,888.00
65222RMVL FB EYE $ 919.00
67700I&D ABSCESS EYELID $ 2,343.00
69200RMVL FOREIGN BODY EAR $ 919.00
69205RMVL FB XTRNL AUD CANAL A $ 551.00
69209REMOVAL IMPACTED CERUMEN USING IRRAGATION/LAVAGE, UNILATERAL $ 490.00
69210RMVL IMPACTED CERUMEN $ 490.00
70030RADEX EYE DETCJ FB $ 355.00
70100XRAY MANDIBLE LESS THAN 4 VIEWS $ 544.00
70110XRAY MANDIBLE MIN 4 VIEWS $ 1,039.00
70120RADEX MASTOIDS LESS THAN 3 VIEWS PR SIDE $ 1,039.00
70140XRAY FACIAL BONES LESS THAN 3 VIEW $ 544.00
70150XRAY FACIAL BONES GREATER THAN 3 VIEW $ 1,039.00
70160NASAL BONE X-RAY $ 544.00
70200RAD EXAM ORBIT COMP. $ 631.00
70220RAD EXAM SINUS COMPLETE $ 664.00
70250SKULL LESS THAN 4 VIEWS $ 1,039.00
70260RAD EXAM SKULL COMPLETE $ 520.00
70328RADEX TMPRMAND JT OPN&CLSD MOUTH UNI $ 474.00
70350CEPHALOGRAM ORTHODONTIC $ 345.00
70360RAD EXAM NECK,SOFT TISSUE $ 544.00
70450CT HEAD/BRAIN WO CONTRAST $ 3,342.00
70460CT HEAD W/CONTRAST $ 4,070.00
70470CT HEAD/BRAIN W & WO CONTRAST $ 5,480.00
70480CT ORBIT SELLA/POST FOSSA $ 2,841.00
70481CT ORBIT SELLA/POST FOSSA $ 3,700.00
70486CT MAXLFCL AREA C-MATRL $ 3,878.00
70487CT MAXLFCL AREA C+ MATRL $ 4,475.00
70490CT NECK WO CONTRAST $ 1,039.00
70491CT SOFT TISS NCK C+MATRL $ 2,211.00
70496CTA HEAD C-/C+ $ 2,211.00
70498CT ANGIOGRAPHY NECK WITH CON $ 2,211.00
70544MRA HEAD C-MATRL $ 4,249.00
70547MRA NECK C-MATRL $ 3,739.00
70551MRI BRN BRN STEM C-MATRL $ 3,739.00
70553MRI BRN BRN STEM C-/C+ $ 4,408.00
71010XRAY CHEST AP $ 309.00
71020XRAY CHEST PA & LATERAL $ 455.00
71030RADEX CH COMPL MIN 4 VIEW $ 706.00
71045RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW $ 544.00
71046RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS $ 943.00
71047RADIOLOGIC EXAMINATION, CHEST; 3 VIEWS $ 706.00
71048RADIOLOGIC EXAMINATION, CHEST; 4 OR MORE VIEWS $ 900.00
71060BRONCHOGRAPHY BI RS&I $ 723.00
71100RIBS UNILATERAL 2 VIEWS $ 544.00
71101RIB UNILATERAL W CHEST $ 1,039.00
71110RIBS BILATERAL 3 VIEWS $ 1,039.00
71111RIBS BILATERAL W/CHEST $ 418.00
71120CHEST 2 VIEWS $ 943.00
71250CT CHEST W/O CONTRAST $ 1,039.00
71260CT THORAX W/CONTRAST $ 2,211.00
71270CT THORAX WO CONTRAST $ 3,898.00
71275CT ANGIOGRAPHY $ 2,211.00
71550MRI CH C-MATRL $ 3,739.00
72020SPINE SINGLE VIEW $ 544.00
72040SPINE, CERVICAL 2/3 VIEWS $ 544.00
72050SPINE, CERVICAL MIN 4VIEW $ 1,039.00
72052SPINE CERV. COMP FLEX/EXT $ 1,039.00
72069RADEX SPI THORACOLMBR STANDING SCOLIOSIS $ 505.00
72070SPINE THORACIC 2 VIEWS $ 1,039.00
72072SPINE THORACIC 3 VIEWS $ 1,039.00
72074RAD EXAN SPINE THROAC 4 V $ 1,039.00
72100SPINE LUMBO. MIN 4 VIEWS $ 1,039.00
72110LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS $ 1,039.00
72114RAD EXAM SPINE LUMBO COMP $ 630.00
72120SPINE LUMBAR AP & LAT W F $ 1,039.00
72125COMPUTED TOMOGRAPHY CERVI $ 1,039.00
72126CT CRV SPI C+MATRL $ 3,993.00
72127CT CRV SPI C-/C+ $ 4,049.00
72128CT THRC SPI C-MATRL $ 1,039.00
72129CT THRC SPI C+ MATRL $ 2,211.00
72131CT L SPINE WO CONTRST $ 1,039.00
72132CT LMBR SPI C+ MATRL $ 3,993.00
72141MRI SPI CANAL&CNTS CRV C-MATRL $ 2,516.00
72146MRI SPI CANAL&CNTS THRC C-MATRL $ 3,739.00
72148MRI SPI CANAL&CNTS LMBR C-MATRL $ 3,739.00
72156MRI SPI CANAL&CNTS C-/C+ CRV $ 4,408.00
72157MRI SPI CANAL&CNTS C-/C+ $ 3,739.00
72158MRI SPI CANAL&CNTS C-/C+ LMBR $ 3,778.00
72170RAD EXAM PELVIS 1/2 VEIW $ 1,039.00
72190RADEX PELVIS COMPL MIN 3 $ 585.00
72191CTA PELVIS C-/C+ POST-PXE $ 2,036.00
72192CT PELVIS WO CONTRAST $ 1,039.00
72193TOMOGRAPHY PELVIS WCONTRS $ 2,211.00
72194CT PELVIS W OR WO CONTRST $ 5,447.00
72195MRI PELVIS C-MATRL $ 3,739.00
72196MRI PELVIS C+ MATRL $ 5,035.00
72220XRAY COCCYX/SACRUM $ 544.00
73000XRAY CLAVICLE 2 VIEWS $ 544.00
73010SCAPULA COMPLETE $ 1,039.00
73020RADEX SHO 1 VIEW $ 544.00
73030SHOULDR COMPLETE 2 VIEWS $ 544.00
73050XRAY AC JOINTS-BILAT $ 501.00
73060XRAY HUMERUS MIN 2 VIEWS $ 544.00
73070XRAY ELBOW 2 VIEWS $ 544.00
73080XRAY ELBOW LESS THAN 3 VIEWS-COMP $ 544.00
73090XRAY FOREARM AP & LAT $ 544.00
73100XRAY WRIST AP & LAT VIEW $ 544.00
73110XRAY WRIST/COMP MIN 3 VIE $ 544.00
73120XRAY HAND AP & LAT $ 1,039.00
73130XRAY HAND MIN 3 VIEWS $ 544.00
73140XRAY FINGER MIN 2 VIEWS $ 544.00
73200CT UPPR EXTR WO CNTRS $ 1,039.00
73206CT ANGIOGRAPHY, UPPER EXT, W/CONTRAST $ 3,575.00
73220MRI UXTR OTH/THN JT C-/C+ $ 4,408.00
73221MRI ANY JT UXTR C-MATRL $ 3,739.00
73500RADIOLOGIC EXAM HIP UNILAT 1 VIEW $ 356.00
73502RADIOLOGIC EXAM, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED, 2-3VIEWS $ 544.00
73510XRAY HIP MIN 2 VIEWS $ 486.00
73520HIPS BILAT MIN 2 VIEW INC $ 530.00
73550XRAY FEMUR AP & LAT VIEW $ 421.00
73552FEMUR, MINIMUM 2 VIEWS $ 544.00
73560XRAY KNEE, SUNRISE VIEW $ 544.00
73562XRAY KNEE MIN 3 VIEWS $ 544.00
73564RAD EXAM KNEE 4 OR MORE $ 1,039.00
73590XRAY TIBIA/FIBULA AP/LAT $ 544.00
73600XRAY ANKLE 2 VIEWS $ 544.00
73610XRAY ANKLE 3 VIEWS/COMPLE $ 544.00
73620XRAY FOOT MIN 2 VIEWS $ 544.00
73630XRAY FOOT MIN 3 VIEWS $ 544.00
73650RAD EXAN HEEL MIN 2 VIEWS $ 544.00
73660XRAY TOES, MIN 2 VIEWS $ 544.00
73700CT LWR EXTR WO CONTRAST $ 1,039.00
73701CT LWR EXT W CONT $ 3,015.00
73702CT LXTR C-/C+ $ 2,965.00
73721MRI ANY JT LXTR C-MATRL $ 3,739.00
73722MRI ANY JT LXTR C+ MATRL $ 4,148.00
73723MRI ANY JT LXTR C-/C+ $ 5,447.00
73725MRA LXTR C+-MATRL $ 5,035.00
74000RAD EXAM ABD SINGL ANTER $ 399.00
74010RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS $ 575.00
74018RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW $ 544.00
74019RADIOLOGIC EXAMINATION, ABDOMEN; 2 VIEWS $ 1,039.00
74020RAD EXAM ABDOMEN COMPL $ 473.00
74021RADIOLOGIC EXAMINATION, ABDOMEN; 3 OR MORE VIEWS $ 575.00
74022RAD EXAM COMPLETE ABD $ 1,039.00
74150COMPUTED TOMOGRAPHY ABD $ 2,936.00
74160TOMOGRAPHY ABD W/CONTRAST $ 3,451.00
74170TOMOGRAPHY ABD W/OCONTRAS $ 2,211.00
74174CT ANGIOGRAPHY, ABDOMEN AND PELVIS, WITH CONTRAST, INC NONCONTRAST IMAGES $ 2,211.00
74175CT ANGIO ABDOMEN W/CONTRA $ 4,358.00
74176COMP TOMOG AB/PEL W/O CON $ 2,146.00
74177COMP TOMO AB/PELV W/OCONT $ 2,211.00
74178CT ABD & PELVIS 1 PLUS SECTION/REGNS $ 2,211.00
74181MRI ABD C-MATRL $ 3,739.00
74183MRI ABD C-/C+ $ 4,408.00
74241RADEX GI TRC UPR +-DLYD FLMS W/KUB $ 1,348.00
74247RADEX GI UPR C+ +-GLUC +-DYLD FLMS W/KUB $ 1,361.00
74420UROGRAPHY, RETROGRADE, W OR W/O KUB $ 3,993.00
76000FLUOROSCOPY $ 1,094.00
763763D RNDR I&R CT MRI US/OTH $ 938.00
76536ULTRASOUND, SOFT TISSUES OF HEAD AND NECK $ 1,094.00
76642ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION $ 1,039.00
76645US BREAST R-T W/IMAGE DOCUMENTATION $ 1,039.00
76700US ABDOMINAL R-T W/IMAGE $ 1,094.00
76705US ABDOMINAL $ 1,094.00
76770US RETROPERITONEAL R-T W/ $ 1,156.00
76775US RPR B-SCAN&/R-T IMG LMTD $ 1,094.00
76801ULTRASOUND 14 WK TABDL 1/1ST GESTATION $ 1,094.00
76815ULTRASND PG UTER $ 1,094.00
76817UT PG UTER R-T IMG TRVG $ 1,094.00
76830TRANSVAGINAL ULTRASOUND $ 1,094.00
76856US PELVIC NONOB REAL-TIME $ 1,094.00
76857PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 $ 1,094.00
76870US SCROTUM&CNTS $ 1,094.00
76880US EXTREMITY $ 1,113.00
76882ULTRASOUND, EXTREMITY, NONVASCULAR $ 1,094.00
76942ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT $ 469.00
77079CT BONE MINERAL DENSITY STUDY 1+SITS APPND $ 551.00
77777SHORTNESS OF BREATH PANEL $ 1,626.00
78075ADRNL IMG CORTEX&/MEDULLA $ 4,879.00
78223HIDA SCAN-HEPATBL DUX SYS IMG GLBLDR $ 3,384.00
78306B1&/JT IMG WHBDY $ 1,941.00
78315B1&/JT IMG 3 PHASE STD $ 1,941.00
78320B1&/JT IMG TOMOG SPECT $ 1,245.00
78472CARD BPI GTD=BRM PLNR 1 STD REST/STRS $ 2,750.00
78630CEREBROSPINAL FLUID SCAN $ 1,500.00
80047BASIC METABOLIC PANEL CALCIUM IONIZED $ 144.00
80048METABOLIC PANEL BASIC $ 113.00
80051ELECTROLYTE PANEL $ 100.00
80053METABOLIC COMPRE PANEL $ 125.00
80061LIPID PROFILE III $ 156.00
80074HEPATITIS PANEL $ 563.00
80076HEPATIC FUNCTION PANEL $ 438.00
80100DRUG ABUSE PANEL II $ 406.00
80102DRUG CONFIRMATION, EACH PROCEDURE $ 188.00
80104DRUG SCREEN $ 188.00
80178LITHIUM $ 143.00
80185PHENYTOIN LEVEL $ 144.00
80196SALICYLATE $ 151.00
80197TACROLIMUS $ 473.00
80202VANCOMYCIN PEAK $ 309.00
80304DRUG SCREEN $ 188.00
80305DRUG SCREENING $ 188.00
80306DRUG TEST, PRESUMPTIVE, ANY NUMBER DRUG CLASSES, DEVICES, PROCEDURES $ 125.00
80320DRUG SCREEN $ 313.00
80329ANALGESICS, NON OPIOID 1&2 $ 244.00
81000U/A DIPSTICK $ 126.00
81001U/A DIP STICK $ 125.00
81002URNLS DIP STICK/TABLET RG $ 43.00
81003U/A W/O MICRO DIPSTICK $ 24.00
81025PREG.TST URINE VISUAL $ 75.00
82003ACETAMINOPHEN $ 309.00
82009KETONES-SERUM $ 79.00
82010KETONE BODY $ 89.00
82040ASSAY OF SERUM ALBUMIN $ 54.00
82055ALCOHOL-BLOOD $ 409.00
82150AMYLASE $ 70.00
82247BILIRUBIN TOTAL $ 54.00
82253MB FRACTION $ 209.00
82270OCCULT BLOOD $ 39.00
82272BLD OCLT PEROXIDASE ACTV $ 38.00
82274BLD OCLT FECAL HGB DETER $ 171.00
82306VITAMIN D HYDROXY $ 275.00
82310CALCIUM, SERUM $ 69.00
82375CARBOXYHEMOGLOBIN, QUANTITATIVE $ 148.00
82540CREATINE $ 75.00
82541COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE $ 164.00
82550CREATINE CK-TOTAL $ 83.00
82553CREATINE CKMB $ 156.00
82565CREATININE $ 63.00
82657ENZYME CELL ACTIVITY $ 79.00
82800GASES BLD PH ONLY $ 96.00
82803GASES, BLOOD $ 228.00
82945GLUCOSE, BODY FLUID, OTHER THAN BLOOD $ 63.00
82947GLUCOSE $ 63.00
82948GLUCOSE BLOOD REAGET STR $ 44.00
82962GLUCOSE FINGER STICK $ 70.00
82977GLUTAMYLTRANSFERASE-GTT $ 78.00
83036HEMOGLOBIN, GLYCOSYLATED(A1C) $ 105.00
83520IMMUNOASSAY ANALYTE QUANTITIATIVE NOS $ 193.00
83605LACTATE(LACTIC ACID) $ 128.00
83615LDH $ 88.00
83630LACTOFERRIN FECAL QUAL $ 213.00
83690LIPASE $ 100.00
83735SERUM MAGNESIUM $ 102.00
83874MYOGLOBIN $ 140.00
83880B-TYPE NATRIURETIC $ 366.00
84075ASSAY OF ALKALINE PHOSPHATE $ 56.00
84146ASSAY OF PROLACTIN $ 118.00
84153PSA SCREEN TOTAL $ 199.00
84155ASSAY OF PROTEIN SERUM $ 40.00
84165PROTEIN ELECTROPHORESIS $ 266.00
84166PROTEIN, ELECTROPHORETIC FRACTIONATION AND QUANTITATION $ 193.00
84436THYRIXINE TOTAL $ 181.00
84439LAB FOR ASSAY OF FREE THYROXINE $ 98.00
84443TSH $ 181.00
84450TRANSFERASE (AST) $ 56.00
84460ALANINE AMINO (ALT) $ 58.00
84479THYROID HORMONE $ 70.00
84480ASSAY TRIIODOTHYRONINE $ 92.00
84484TROPONIN I $ 109.00
84512TROPONIN QUAL $ 209.00
84520BUN $ 55.00
84550URIC ACID $ 49.00
84560URIC ACID OTH SRC $ 185.00
84702HCG QUANTATIVE $ 163.00
84703GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE $ 81.00
85014HEMATOCRIT $ 70.00
85018HEMOGLOBIN $ 85.00
85025CBC $ 155.00
85027CBC W/O DIFF $ 85.00
85032BLD# MNL C-CNT RBC/PLTLT EA $ 46.00
85045AUTOMATED RETICULOCYTE COUNT $ 118.00
85048AUTOMATED LEUKOCYTE COUNT $ 141.00
85347COAGJ TM ACTIVATED $ 125.00
85378FIBRIN DEGRADATION PROD $ 203.00
85379D-DIMER $ 123.00
85610PROTHROMBIN TIME $ 43.00
85651SEDIMENTATION RATE NONAUT $ 39.00
85652SED RATE ERYTHROCYTE NON $ 29.00
85730THROMBOPLASTIN TIME PART $ 65.00
86140C REACTIVE PROTEIN $ 56.00
86256SMOOTH MUSCLE AB TITER $ 258.00
86308MONO,HETEROPHILE ANTIBODI $ 56.00
86320IMMUNOELECTROPHORESIS $ 258.00
86403MONO SPOT $ 188.00
86430RHEUMATOID FACTOR $ 100.00
86490SKN TST COCCIDIOIDOMYCOSI $ 89.00
86510SKN TST HISTOPLASMOSIS $ 85.00
86580TB INTRADERMAL $ 109.00
86592RPR RAPID REGAIN TEST $ 46.00
86631ANTB CHLAMYDIA $ 128.00
86689ANTB HTLV/HIV ANTB CONFIRMATION TST $ 290.00
86701HIV SERUM $ 96.00
86702ANTB HIV-2 $ 221.00
86703SINGLE LAB TEST RESULT $ 148.00
86735MUMPS ANTIBODY $ 141.00
86756ANTB RSV $ 191.00
86788WEST NILE, IGM $ 183.00
86789ANTIBODY, WEST NILE VIRUS $ 155.00
86850ANTB SCR RBC EA SERUM TQ $ 255.00
86901RH FACTOR-BLOOD $ 279.00
86906BLD TYPING RH PHEXYPING COMPL $ 279.00
87040BLOOD CULTURE $ 111.00
87045FECES CULTURE, BACTERIA $ 103.00
87046STOOL CULTURE, BACTERIA $ 103.00
87070CULTURE BODY FLUID $ 93.00
87075CULTURE ANAEROBIC $ 103.00
87081CULTURE, BACTERIAL-SCREEN $ 179.00
87086URINE CULTURE $ 88.00
87088CULTURE BCT ISOL&PRSMPTV $ 118.00
87106CUL FNGI DEFINITIVE ID EA ORGANISM YEAST $ 115.00
87110CHLAMYDIA CULTURE $ 211.00
87177OVA AND PARASITES SMEAR $ 96.00
87205SMEAR, PRIMARY SOURCE WITH INTERP, WET MOUNT FOR INFECTIOUS AGENTS $ 46.00
87207SMR PRIM SRC SPEC STAIN $ 178.00
87210WET SMEAR $ 51.00
87230TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE $ 214.00
87252HSV 1 AND 2 CULTURES $ 225.00
87274INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLORESCENT TECHNIQUE $ 390.00
87275IAADI INF B VIRUS $ 138.00
87400INFLUENZA A&B $ 156.00
87425INFECTIOUS AGENT DETECTION BY ENZYME IMMUNOSSAY TECHNIQUE STEP METHOD; ROTAVIRU $ 130.00
87430INF AGT IMMUNO STREP A $ 238.00
87480INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA);CANDIDA SPECIES,DIRECT $ 203.00
87491INFECTIOUS AGENT DETECTION BY NUCLEIC ACID;CHLAMYDIA TRACHOMATIS,AMP PROBE $ 379.00
87493INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE $ 313.00
87502INFLUENZA DNA AMP PROBE $ 141.00
87510INFECTIOUS AGENT BY NUCLEIC ACID $ 78.00
87529INFECTIOUS AGENT DETECTION BY NUCLEIC ACID(DNA OR RNA) $ 379.00
87591INF AGENT DETECION BY NUCLEIC ACID(DNA OR RNA) NEISSERIA GONORRHOEAE, AMPLIFIED $ 379.00
87660INFECTIOUS AGENT DETECTION BY NUCLEIC ACID ( DNA OR RNA);TRICHOMONAS VAG, DIRECT $ 178.00
87804INFLUENZA IMMUNOASSAY OPT $ 145.00
87807INF AGT DET IMNAS OPT RSV $ 130.00
87808INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OBSERVATION $ 134.00
87847NO DESCRIPTION $ 551.00
87850NEISSERIA GONORRHOEAE DET $ 215.00
87880RAPID STREP-BETA STREP $ 145.00
88300PATH LEVEL 1 $ 133.00
88304PATH LEVEL III $ 343.00
88305PATH SURG LEVEL IV $ 569.00
88313STAIN TRICHOME $ 413.00
89050CELL COUNT, MISC BODY FLUIDS $ 51.00
89055LEUKOCYTE ASSESSMENT, FECAL $ 46.00
89060CRYSTAL INDENTIFICATION $ 78.00
89220SPTM OBTG SPEC AERSL INDUCED SPX $ 131.00
89947GLUCOSE TEST IN MET 8 PANEL $ 141.00
90471IMMUN ADM 1 VAC $ 509.00
90472IMADM PRQ ID SUBQ/IM NJXS $ 65.00
90658INFLUENZA VIRUS VACCINE, SPLIT VIRUS, H1N1 $ 118.00
90660INFLUENZA VIRUS INTRANASA $ 93.00
90703TETANUS TOXID $ 204.00
90714TETANUS DIPTHERIA TOXOID $ 211.00
90715TDAP VACCINE $ 283.00
90718TETANUS & DIPTHERIA $ 204.00
90746HEPATITIS B VACCINE/ADULT $ 109.00
90765IV NFS THER PROPH/DX 1ST $ 253.00
90997HEMOPERFUSION $ 551.00
91105GASTRIC INTUBATION/ASPER $ 806.00
92002OPH MEDICAL XM&EVAL INTRM $ 398.00
92081VIS FLD XM UNI/BI I&R LMT $ 185.00
92551AUDIO SCREENING $ 59.00
92552PURE TONE AUDIOMTRY AIR O $ 120.00
92960CARDIOVERSION ELECTIVE ARRHYT XTRNL $ 4,485.00
93000EKG W/INTREP AND REPORT $ 313.00
93005EKG $ 156.00
93010RTN ECG 12 LEADS INTRP/RP $ 203.00
93040RHYTHM ECG 1-3 LDS W/I&R $ 126.00
93041RHYTHEM ECG 1-3 LDS $ 490.00
93042RHYTHM ECG 1-3 LDS I&R ON $ 98.00
93224WEARABLE ECG 24 HR W/VIS SUPIMPOS SCAN PHYS R&I $ 309.00
93306TRANSTHORACIC ECHOCARDIOGRAPHY $ 1,800.00
93313TEE R-T IMG 2D W/PROBE PLMT ONLY $ 2,605.00
93351ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG $ 2,105.00
93875N-INVAS PHYSIOLOGIC STD XTRC ART COMPL BI STD $ 1,133.00
93880DUP-SCAN XTRC ART COMPL B $ 1,218.00
93882DUP-SCAN XTRC ART UNI/LMTD STD $ 1,218.00
93922N-INVAS PHYSIOLOGIC STD $ 754.00
93926DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD $ 1,184.00
93931DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD $ 785.00
93965QUANT VENOUS FLOW ST $ 1,565.00
93970DUP-SCAN XTR VEINS COMPL $ 2,146.00
93971DPLX SCN EXTRM VEINS $ 1,039.00
93975DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, PELVIC, SCROTAL $ 1,495.00
93976DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW ABDOMEN, PELVIS, OR SCROTUM $ 1,039.00
93990DOPPLER FLOW TESTING $ 724.00
94010SPIROMETRY W/RECORD $ 213.00
94060BRNCDILAT RSPSE SPMTRY PR $ 653.00
94150VC TOT SPX $ 150.00
94375RESPIR FLO VOL LOOP $ 556.00
94621PULM STRS TSTG CPLX $ 1,388.00
94640NEBULIZER TREATMENT $ 189.00
94644INHALATION TREATMENT – CONTINUOUS 1ST HR $ 735.00
94664DEMO&/EVAL OF PT UTILIZ $ 93.00
94750PULM COMPLIANCE STD $ 458.00
94760EAR OR PULSE OXIMETRY $ 103.00
94761N-INVAS EAR/PLS OXIMTRY F $ 259.00
95115ALLERGY INJ SRVC; SINGLE $ 64.00
95117ALLERGY INJ SRVC; 2 OR MO $ 79.00
96360IV INFUS INIT 31 MIN 1 HR $ 1,140.00
96361IV INFUS HYDR EA ADD’T HR $ 1,002.00
96365IV INFUSION THERAPY/PROPH $ 719.00
96366IV INFUS THER PROPH/DX EA $ 324.00
96367IV NFS THER PROPH/DX ADDL $ 509.00
96368IV NFS TX PROPHYLAXIS/DX $ 355.00
96370SUB INFUS EA ADD HR $ 188.00
96372THERAPEUTIC PROPHYLACTIC/ $ 509.00
96373INJECTION, INTRA-ARTERIAL $ 308.00
96374THER PROPH/DX NJX IV PUSH $ 423.00
96375THER PROPH/DX NJX EA SEQL $ 324.00
96376SUB INFU EA ADD IV PUSH $ 299.00
96379INJECTION- UNLISTED THERAPEUTIC PROPH/DX/IVA NJX/NFS $ 289.00
97810ACUPUNCTURE, 1 OR MORE NEEDLES, W/OUT ELECTRICAL STIM, INITIAL 15 MINS $ 76.00
99000SPECIMEN HANDLING $ 84.00
99001COC COLLECITON ONLY $ 55.00
99050BLUE CROSS RQRD LVL3 $ 119.00
99053SERVICES PROVIDED BETWEEN 10P AND 8A AT A 24 HOUR FACILITY $ 198.00
99080MEDICAL RECORDS $ 33.00
99143MOD SEDATION &#60;5YRS 30 $ 724.00
99144MOD SEDATION SERV UNDER 5 $ 716.00
99145M-SEDAJ BY SM PHY 15 MIN $ 283.00
99149MOD SEDATION $ 600.00
99173SCREENING TEST OF VISION $ 393.00
99281FACILITY CHG LEVEL 1 $ 495.00
99282FACILITY CHG LEVEL 2 $ 841.00
99283FACILITY CHG LEVEL 3 $ 1,577.00
99284FACILITY CHG LEVEL 4 $ 2,685.00
99285FACILITY CHG LEVEL 5 $ 3,633.00
99291CRITICAL CARE 30-74 MIN $ 5,310.00
99292CRITICAL CARE ADD 30 MIN $ 895.00
99406SMOKING CESSATION 3-10 $ 266.00
99407SMOKING CESSATION 10 MIN $ 126.00
A0394ALS IV DRUG THERAPY SUPPLIES $ 53.00
A0396ALS ESPOHAGEAL INTUB SUPPLIES $ 55.00
A1234SURGICAL TRAY- PNEUMOTHORAX/CHEST KIT $ 586.00
A42083 CC STERILE SYRINGE & NEEDLE $ 26.00
A42095+ CC STERILE SYRINGE & NEEDLE $ 33.00
A421320+ CC SYRINGE ONLY $ 9.00
A4215NEEDLE STERILE, ANY SIZE, EACH $ 9.00
A4216STERILE WATER/SALINE, FLUSH 10ML $ 6.00
A4217STERILE SALINE WATER PER 500 ML $ 36.00
A4218STERILE SALINE OR WATER $ 35.00
A4222EXT UNFU PMP PER CASS/BAG $ 236.00
A4224ALOCHOL OR PEROXIDE PER PINT $ 6.00
A4246BETADINE/PHISOHEX SOLUTION $ 34.00
A4247BETADINE/IODINE SWABS/WIPES $ 19.00
A4252GLUCOSE TEST STRIP-BLOOD KETONE TEST OR STRIP $ 8.00
A4311CATHETER W/O BAG 2 WAY LATEX $ 33.00
A4314INSRT TRAY W/DRAINAGE BAG $ 34.00
A4320IRR TRAY W/BULB/PISTON SY $ 11.00
A4322IRRIGATION SYRINGE, BULB $ 13.00
A4327URIN CUP FEMALE COLLECT DEV CUP $ 4.00
A4332LUBE STERILE PACKET $ 4.00
A4335INCONTINENCE SUPPLY MISC $ 4.00
A4338INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING $ 46.00
A4344INDWELLING CATH FOLEY TYP $ 34.00
A4351STRAIGHT TIP URINE CATHETER $ 8.00
A4353INTERMIT URINARY CATHETER $ 33.00
A4358URINARY DRAINAGE BAG $ 11.00
A4364DERMABOND- ADHESIVE, LIQUID OR EQUAL PER OZ $ 76.00
A4450TAPE NO WATERPROOF $ 8.00
A4452TAPE WATERPROOF 18 SQ IN $ 8.00
A4550LACERATION- SURGICAL KIT $ 254.00
A4554DISPOSABLE UNDERPADS $ 8.00
A4565SLING $ 41.00
A4570SPECIAL CASTING MATERIAL $ 44.00
A4580CAST SUPPLIES $ 69.00
A45903 ORTHO GLASS 4 SPECIAL CASTING MATERIAL $ 53.00
A4595TENS SUPPL 2 LEAD PER MONTH $ 63.00
A4606OXYGEN PROBE USED W OXIMETER $ 48.00
A4614PEAK FLOW SUPPLY $ 63.00
A4615CANNULA NASAL $ 15.00
A4616TUBING (OXYGEN) PER FOOT $ 1.00
A4617MOUTHPIECE FOR RESPIRATORY OXYGEN EQUIPMENT $ 43.00
A4627SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR METERED DOSE INHALER $ 55.00
A4649SURGICAL SUPPLY MISC $ 30.00
A4653PD CATHERTER ANCHOR BELT $ 19.00
A4657SYRINGE W OR WO NEEDLE $ 4.00
A4670AUTOMATIC BP MONITOR #11 $ 49.00
A4673SALINE BLADE #11 $ 9.00
A4930GLOVES STERILE PER PAIR $ 4.00
A5120SWAB OR WIPE SKIN BARRIER $ 4.00
A5200PERCUTANEOUS CATHETER ANCHOR $ 96.00
A6021COLLAGEN DRESSING STERIL $ 24.00
A6205COMPOSITE DRSG LESS THAN 48 SQ IN $ 29.00
A6210FOAM DRSG LESS THAN 16=48 SQ IN W/ BORDER $ 38.00
A6211FOAM DRG LESS THAN 16 LESS THAN 48 SQ IN WO BORDER $ 43.00
A6213FOAM DRG 16-48 SQ IN W/BRDR $ 48.00
A6216GAUZE NONIMPREG 16 SQ IN $ 20.00
A6217GAUZE NON STERILE $ 20.00
A6218GAUZE, NON STERILE $ 20.00
A6219GAUZE- STERILE $ 20.00
A6222GAUZE IMPREGNATED WITH ME $ 11.00
A6228GAUZE GREATER THAN 16 SQ IN $ 10.00
A6231GAUZE, 16 LESS THAN SQ IN, EACH $ 18.00
A6250SKIN SEAL PROTECT MOISTURIZER OINTMENT $ 30.00
A6260WOUND CLEANSER $ 41.00
A6261WOUND FILLER $ 41.00
A6266GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE $ 11.00
A6402STERILE GUAZE LESS THAN 16 INCHES $ 8.00
A6407PACK STRIPS NON-IMPREGNTD $ 40.00
A6410STERILE EYE PAD OR STRIP $ 8.00
A6412EYE PATCH $ 8.00
A6413ADHESIVE BANDAGE FIRST AI $ 8.00
A6446CONFORMING BANDAGE, > THAN 3 INCHES $ 16.00
A6448LT COMP BANDAGE LESS THAN 3IN $ 15.00
A6449LIGHT COMP BANDAGE $ 15.00
A6450LT COMPRS BANDAGE ELAST $ 24.00
A6453BANDAGE SELF ADHER BAND W LESS THAN 3 $ 3.00
A6454SELF ADHER BANDAGE $ 19.00
A6455SELF ADHER BANDAGE $ 19.00
A6457TUBULAR DRESSING $ 40.00
A7002SUCTION TUBING USED W PUMP $ 34.00
A7003ADMN SET SM VOL NONFILTER $ 76.00
A7011NONDISPOS CORRUGATED TUBING $ 18.00
A7015NEBULIZER MASK USED W NEBULIZER $ 33.00
A7016DOME/MOUTHPIECE NEB $ 155.00
A7017NEBULIZER MASK NOT USED W/ OXYGEN $ 33.00
A7520TRACH LARYN TUBE NON CUFFED $ 35.00
A9150NON PRESCRIPTION DRUG $ 30.00
A9273HOT/COLD H2OBOT/CAP/COL/WRAP $ 33.00
A9284NON-ELECTRONIC SPIROMETER $ 341.00
A9579GAD-BASE MR CONTRAST NOS,1ML $ 21.00
CASHXRAY DISC $ 15.00
E0114CRUTCHES UNDERARM $ 79.00
E0116CRTCH UNDARM NOT WOOD ADJ $ 79.00
E0220HOT WATER BOTTLE $ 18.00
E0230ICE CAP OR COLLAR $ 18.00
E0275BED PAN STANDARD $ 10.00
E0325URINAL MALE JUG-TYPE $ 10.00
E0352DISPOSABLE PACK W/BOWEL SYST (VAG SPECULUM) $ 238.00
E0445OXIMETER NON-INVASIVE $ 779.00
E0570NEBULIZER WITH COMPRESSION $ 195.00
E0580NEBULIZER FOR USE W/ REGULAT $ 393.00
G0009ADM PNEUMOCOCCAL VACCINE $ 123.00
G0168WND CLS TISSUE ADHESIVE $ 204.00
G0378HOSPITAL OBSERVATION SERVICES PER HOUR $ 1,000.00
G0434DRUG ABUSE PANEL II $ 310.00
J0131INJECTION, ACETAMINOPHEN, 10MG $ 5.00
J0150ADENOSINE INJ 6MG VIAL $ 46.00
J0153INJECTION, ADENOSINE, 1 MG $ 8.00
J0170EPINEPHRINE 3 1/2 NDL 10M $ 51.00
J0171ADRENALIN EPINEPHRINE INJECT $ 8.00
J0282INJ AMIODARONE HYDROCHLOR $ 19.00
J0290AMPICILLIN 500 MG INJ $ 44.00
J0295INJ AMPCLLN SODIUM/SULBA $ 21.00
J0330SUCCINYLCHOLINE CHLO 20MG $ 171.00
J0360HYDRALAZINE HCL INJ UP TO 20MG $ 30.00
J0456INJ AZITHROMYCIN 500MG $ 25.00
J0461INJ ATROPINE SULFATE 0.01 $ 35.00
J0500DICYCLOMINE HCL 20MG $ 660.00
J0550BICILLIN – PENICILLIN G BENZATHINE INJ $ 244.00
J0559BICILLIN – PENICILLIN G BENZATHINE INJ 2500 UNITS $ 244.00
J0560BICILLIN 600,000 $ 221.00
J0561INJECTION PENICILLIN G BENZATHINE 100,000 UNITS $ 104.00
J0570BICILLIN 1,200,000 $ 304.00
J0595STADOL $ 19.00
J0610INJECTION CALCIUM GLUCONATE $ 33.00
J0641LEVOLEUCOVORIN INJECTION $ 5.00
J0690KEFZOL 1 GR VIAL $ 10.00
J0692INJ CEFEPIME HCI 500MG $ 93.00
J0694MEFOXIN 1 GM INJECTION $ 55.00
J0696ROCEPHIN 250 MG $ 9.00
J0698INJECTION, CEFOTAXIME SODIUM, PER G $ 23.00
J0708J0708 $ 29.00
J0735CLONIDINE 1MG $ 115.00
J0744INJECTION, CIPROFLAXIN FOR IV INFUSION $ 11.00
J0760COLCHICINE INJECTION $ 30.00
J0780COMPAZINE 10 MG $ 88.00
J1020INJ METHYLPREDNISOLONE AC $ 43.00
J1030DEPO MEDROL 40 MG/ML $ 58.00
J1040METHYLPREDNISOLONE 80MG $ 36.00
J1094DECADRON DEXAMETHASONE ACETATE 1MG $ 29.00
J1100DECADRON 4 MG VIAL $ 3.00
J1165DILANTIN 100 MG VIAL $ 40.00
J1170DILAUDID 4 MG $ 14.00
J1200BENADRYL 50MG $ 8.00
J1240ANTIVERT – DIMENHYDRINATE INJECTION 50MG $ 44.00
J1265DOPAMINE HCL, 40MG $ 8.00
J1335ERTAPENEM INJECTION $ 495.00
J1580GARAMYCIN,GENTAMICIN 80MG $ 13.00
J1610GLUCOGAN 1 MG VIAL $ 1,439.00
J1630HALOPERIDOL INJECTION, 5MG $ 10.00
J1631INJECTION, HALOPERIDOL DECANOATE, 50 MG $ 154.00
J1642HEPARIN SODIUM PER 10 UNI $ 3.00
J1650ENOXAPARIN SODIUM 10MG $ 8.00
J1670TETANUS INJECTION $ 119.00
J1710INJECTIONS, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG $ 19.00
J1815INJ INSULIN PER 5 UNITS $ 10.00
J1817INSULIN FOR INSULIN PUMP USE $ 29.00
J1885TORADOL INJ 15 MG $ 8.00
J1940LASIX 40 MG IV VIAL $ 13.00
J1956LEVOFLOXACIN 250 MG $ 14.00
J2001LIDOCAINE HCI 10MG $ 43.00
J2060ATIVAN 2ML SYRUP $ 10.00
J2150MANNITOL INJECTION $ 35.00
J2175DEMEROL 50 MG SYRINGE $ 36.00
J2250MIDAZOLAM HCI PER 1 MG $ 3.00
J2270INJ MORPHINE SULFATE 10 M $ 11.00
J2300NUBAIN 10MG AMP $ 23.00
J2310INJ NALOXONE HCL 1MG $ 225.00
J2360ORPHENADRINE CITRATE 60MG $ 165.00
J2370NEO-SYNEPHRINE UP TO 1 ML $ 111.00
J2405ONDANSETRON HCI, PER MG $ 3.00
J2410INJECTION, OXYMORPHONE HCI, UP TO 1 MG $ 33.00
J2543ZOSYN – PIPERACILLIN/TAZOBACTAM $ 26.00
J2550PHENERGAN 50 MG $ 16.00
J2650PRELONE – INJECTION PREDNISOLONE ACTATE UP TO 1 ML $ 8.00
J2690PRONESTYL 10 ML $ 29.00
J2704INJECTION, PROPOFOL, 10MG $ 3.00
J2730PRALIDOXINE CHLORIDE $ 29.00
J2760PHENTOLAINE MESYLATE INJ $ 55.00
J2765METOCLOPRAMIDE HCL 10MG $ 10.00
J2780INJ RANITIDINE 25 MG $ 35.00
J2790RHOGAM INJECTION $ 660.00
J2920SOLU-MEDROL 40MG $ 40.00
J2930SOLU-MEDROL 125 MG $ 59.00
J3010INJ FENTANYL CITRATE .1MG $ 8.00
J3030IMITREX 6MG VIAL $ 165.00
J3101INJECTION, TENECTEPLASE, 1 MG. $ 978.00
J3105INJECTION, TREBUTALINE SULFATE, UP TO 1 MG $ 48.00
J3130TESTOSTERONE ENANTHATE INJ $ 33.00
J3260TOBRAMYCIN SULFATE INJECTION $ 49.00
J3301INJECTION, TRIAMCINOLONE ACETONIDE 10 MG $ 16.00
J3360VALIUM INJ 5 MG $ 56.00
J3370VANCOMYCIN HCI INJ 500MG $ 79.00
J3410VISTERIL INJ 50 MG $ 56.00
J3411INJ THIAMINE 100 MG $ 33.00
J3430INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG $ 18.00
J3475MAGNESIUM SULFATE 2CC AMP $ 8.00
J3480POTASSIUM CHLORIDE 2 MG $ 3.00
J3486GEODON – ZIPRASIDONE MESYLATE 10MG $ 48.00
J3490UNCLASSIFIED DRUGS $ 49.00
J3535DRUG ADMINISTERED THROUGH A METERED DOSE INHALER $ 79.00
J7030INFUS NORM SALINE 1000CC $ 38.00
J7040INFUS NORM SALINE 500ML $ 20.00
J70425% DEXTROSE $ 23.00
J7044INJECTION, CIPROFLOXACIN FOR IV INFUSION $ 118.00
J7050INFS NORM SALINE 250CC $ 10.00
J7060INFUSION D5W 250ML $ 38.00
J7070INFUSION, D-5W, 1000 CC $ 74.00
J7120RINGER’S LACTATE INFUS $ 45.00
J7130HYPERTONIC SALINE SOLUTION $ 200.00
J7506PREDNISONE ORAL 5 MG $ 10.00
J7510PREDNISOLONE ORAL 5 MG $ 3.00
J7607LEVALBUTEROL COMP CON $ 35.00
J7610ALBUTEROL, THRU DME 1MG $ 20.00
J7611ALBUTEROL 1MG CONC INHALA $ 20.00
J7614ALBUTEROL ALL FOMULATIONS $ 3.00
J7615LEVALBTERAL INHALATION SO $ 25.00
J7620ALBUTEROL 2.5 MG ATROVENT $ 3.00
J7644IPRATROPIUM BROMIDE INHAL $ 5.00
J7645IPRATROPIUM BROMIDE COMP $ 33.00
J7699NOC DRUGS INHAL SOL ADMIN $ 13.00
J8498ENEMA SUPPOSITORY, ANTIEMETIC RECTAL $ 25.00
J8499NONCHEMOTHERAPEUTIC ORAL $ 24.00
J8540DEXAMETHASONE, ORAL .25MG $ 3.00
J9027CLOFARALINE INJECTION $ 189.00
L0120CERVICAL FLEX NONADJ COLL $ 121.00
L0172CLAVICAL COLLAR 2 PC $ 55.00
L1630ABDUCT CONTROL HIP SEMI FLEX $ 55.00
L1830KNEE IMMOBOLIZER $ 111.00
L1906ANKLE SUPPORT $ 118.00
L3260SURGICAL BOOT/SHOE $ 56.00
L3650SO FIGURE EIGHT ABDUCTION $ 104.00
L3660SHOULDER ORTHOSIS $ 219.00
L3807WRIST HAND FINGER ORHTOSIS, WITHOUT JOINT COLLES SPLINT $ 76.00
L3908WRIST EXTN CONTROL COCKUP $ 56.00
L3999UPPER LIMB ORTHOSIS NOS $ 236.00
L4350AIR SPLINT $ 489.00
L4360WALK BOOT PNEUMATIC $ 156.00
L4361WALKING BOOT, PNEUMATIC AND/OR VACUUM W OR W/O JOINTS, INTERFACE MATERIAL $ 173.00
L4380PNEUMATIC KNEE SPLINT $ 170.00
L4386WALKING BOOT NON PNEUMATIC $ 229.00
P7001CULTURE BACTERIAL URINE $ 121.00
P9612CATHETERIZE FOR URINE $ 240.00
Q0111WET MOUNTS WITH PREPARATION $ 174.00
Q0144AZITH DIHY ORAL CAP/POWD $ 218.00
Q0179ONDANESTRONG HCL 8MG ORL $ 41.00
Q2009FOSPHENYTOIN INJECTION $ 93.00
Q4006LONG ARM CAST ADULT $ 156.00
Q4007CAST SUPPLIES LONG ARM CA $ 180.00
Q4008CAST SUPPLIES LONG ARM $ 180.00
Q4009CAST SUPPLIES SHORT ARM $ 188.00
Q4010SHORT ARM CAST ADULT $ 180.00
Q4012CAST SUPPLIES SHORT ARM $ 180.00
Q4020LNG ARM SPLNT 0-10 YRS $ 169.00
Q4022SHRT ARM SPLNT 11 YRS + $ 186.00
Q4034CAST SUP LNG LEG CYLINDER FB $ 236.00
Q4037CAST SUPPLIES SHORT LEG $ 198.00
Q4038CAST SUP SHRT LEG FIBERGLASS $ 80.00
Q4039CAST SUPPLIES SHORT LEG C $ 198.00
Q4042LNG ARM SPLNT 11 YRS + $ 156.00
Q4046SHRT LG SPLNT 11 YRS + $ 179.00
Q4049FINGER SPLNT STATIC $ 123.00
Q4051SPLINT SUPPLIES MISC $ 170.00
Q9954ORAL MR CONTRAST, 100ML $ 561.00
Q9963HI OSM CONTRST MATL 350-3 $ 46.00
Q9965LOW OSMOLAR CON MAT PER M $ 34.00
Q9966LOCM 200-299MG ML IODINE, 1ML $ 44.00
Q9967LOW OSMOLAR CNTRS MAT $ 1.00
S0020INJ, BUPIVICAINE, 30ML $ 64.00
S0028INJECT SAMOTIDINE 20 MG $ 96.00
S0030METRONIDAZOLE 500 MG INJ $ 46.00
S0077CLANDAMYCIN PHOSPHATE 300 $ 43.00
S0119ZOFRAN, 4MG, ORAL $ 30.00
S0164PROTONIX PANTROPRAZOLE 40MG $ 104.00
S0622PHYS EXAM FOR COLLEGE $ 119.00
S0630RMV SUTURES; PHYS NOT PHY $ 86.00
S3000BILAT DIL RETINAL EXAM $ 15.00
S5000PRESCRIPTION DRUG GENERIC $ 6.00
S5001PRESCRIPTION DRUG BAND NM $ 10.00
S5010STERILE SALINE 5% DEXTROSE AND 0.45% SALINE $ 313.00
S50115% DEXTROSE 1000 ML $ 13.00
S5550INSULIN RAPID 5 U $ 36.00
S8037MRCP MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY $ 1,730.00
S8100SPACER WITHOUT MASK $ 41.00
S8101MASK NEBULIZER MASK SPACER WITH MASK $ 79.00
S8430PADDING FOR COMPRESSION BANDAGE, ROLL $ 21.00
S8450SPLINT $ 114.00
S8451SPLINT, WRIST OR ANKLE $ 155.00
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