Descripon Price CPT-4

LABS ACETONE $40.00 82010 AMINO ACID $62.00 82128 D XYLOSE TOLERANCE $60.00 84620 SALICYLATES $240.00 80307 CAROTENE $25.00 82380 HEPATITIS B ANTIGEN $40.00 87340 GLYCOHEMOGLOBIN $47.00 83036 FERRITIN $40.00 82728 ENOLASE $40.00 84220 ZARONTIN/ETHOSUXIMIDE $60.00 80168 GLUCOSE TOLERANCE 3 SPEC $63.00 82951 GLUCOSE TEST FASTING $20.00 82947 BUN $20.00 84520 CREATININE $24.80 82565 CALCIUM $25.00 82310 PHOSPHORUS $15.00 84100 URIC ACID $22.00 84550 SODIUM (NA) $24.00 84295 POTASSIUM (K) $23.00 84132 CHLORIDE (CL) $23.00 82435 CARBON DIOXIDE (CO2) $24.00 82374 CHOLESTEROL $21.00 82465 TOTAL PROTEIN $18.00 84155 ALBUMIN $24.00 82040 ACID PHOSPHATASE $30.00 84060 ALKALINE PHOSPHATASE $25.50 84075 AMYLASE $31.30 82150 CPK, TOTAL $31.40 82550 LACTATE DEHYDROGENASE $17.00 83615 LIPASE $26.00 83690 SGOT $25.00 84450 SGPT $25.60 84460 BILIRUBIN TOTAL $30.00 82247 SERUM IRON $20.00 83540 TIBC $32.00 83550 AMMONIA $45.00 82140 CREATININE CLEARANCE $30.00 82575 MAGNESIUM $20.00 83735 LIPOPROTEIN FRACTIONS $80.00 83700 COMPREHENSIVE METABOLIC PANEL $50.90 80053 TRIGLYCERIDES $27.70 84478 ELECTROLYTES $33.80 80051 BILIRUBIN DIRECT $20.00 82248 LITHIUM, SERUM $31.90 80178 GLUCOSE TOLERANCE 2 HR $62.00 82951 HEPATITIS B ANTIBODY $54.00 86706 QUANT IMMUNOGLOBULINS EA $35.00 82784 LDH ISOENZYMES $36.00 83625 CK MB FRACTION $27.90 82553 PROSTATIC ACID PHOSPHATAS $40.00 84066 ELECTROPHORESIS PROTEIN TC $40.00 84165 IMMUNO FIXATION SERUM $80.00 86334 CYSTINE $60.00 82131 VITAMIN A $32.50 84590 AMYLASE 2HR URINE $31.30 82150 AMYLASE 24 HR URINE $31.30 82150 CREATININE; NOT BLOOD $25.00 82570 CALCIUM URINE $20.00 82340 PHOSPHORUS URINE $25.00 84105 SODIUM NA URINE $20.00 84300 POTASSIUM URINE $20.00 84133 CHLORIDE CL URINE $25.00 82436 UREA NITROGEN URINE $20.00 84540 URIC ACID; OTHER SOURCE $11.50 84560 GLUCOSE 2HRPP $22.90 82950 GESTATIONAL DIAB SER BS $22.90 82950 OSMOLALITY;URINE $20.00 83935 BODY FLUID GLUCOSE $30.00 82945 BODY FLUID PROTEIN $17.70 84157 CHLORIDE BODY FLUIDS $30.00 82438 LDH BODY FLUIDS $17.00 83615 AMYLASE BODY FLUIDS $31.30 82150 PH BODY FLUIDS $17.30 83986 BLOOD DRAW $10.00 36415 PROTEIN ELECTROPHOREIS URINE $70.00 84166 SODIUM URINE SPOT $20.00 84300 POTASSIUM URINE SPOT $20.00 84133 CHLORIDE URINE SPOT $25.00 82436 BASIC METABOLIC PANEL $40.80 80048 CITRATE URINE $100.00 82507 MAGNESIUM 24HR URINE $20.00 83735 T3 T UPTAKE $25.00 84479 T4 TOTAL THYROXINE $20.00 84436 CSF PROTEIN ELECTRO $70.00 84166 BILIRUBIN TOTAL NEONATAL $30.00 82247 BILIRUBIN DIR NEONATAL $20.00 82248 IMMUNOGLOBULINS CSF EA $35.00 82784 MYOGLOBIN $36.00 83874 TOBRAMYCIN TROUGH $73.00 80200 GENTAMICIN TROUGH $62.00 80170 VAMCOMYCIN TROUGH $40.00 80202 GENTAMICIN RANDOM $62.00 80170 TOBRAMYCIN RANDOM $73.00 80200 VANCOMYCIN RANDOM $40.00 80202 CORTISOL PM $60.00 82533 AB; RUBELLA $40.00 86762 CSF CL CHLORIDE $30.00 82438 CSF GLUCOSE $30.00 82945 CSF PROTEIN $20.00 84157 JOINT FL PROTEIN $20.00 84157 BODY FLUID TOTAL BILIRUBIN $30.00 82247 BODY FLUID CREATININE $15.00 82570 BODY FLUID POTASSIUM $20.00 84133 BODY FLUID SODIUM $20.00 84295 INSULIN ANTIBODIES $50.00 86337 BUN - ARTERIAL $20.00 84520 BUN PERIPHEAL $20.00 84520 BUN VEINOUS $20.00 84520 HOMOCYSTEINE $67.00 83090 T3 TOTAL $45.00 84480 PROTEIN URINE SPOT $15.00 84156 BETA HCG SUBUNIT $50.00 84702 PREGNANCY TEST SERUM $20.00 84703 GLCS TLRNC GSTTN 3 SPEC $50.00 82951 VOLUME & PERIOD $20.00 81050 ACTH STIM PANEL $175.00 80400 BASELINE ACTH CORTISOL $52.00 8253359 IMMUNO TUMR ANTI QUA CA, 27-29 $87.00 86300 HEPATITIS C RIBA $65.00 86804 TROPONIN I $33.00 84484 TSH $58.00 84443 FOLATE LEVEL $52.00 82746 CEA $66.00 82378 VITAMIN B-12 $44.00 82607 HEPATITIS C-RNA,PCR QUANT $191.00 87522 FREE PSA $86.00 84154 TACROLIMUS, FK506 $60.00 80197 TOLERANCE EA ADD'L SPEC $15.00 82952 ANTI THY PEROXIDASE ABY $40.00 86376 GLUTATHIONE $30.00 82978 GLUTATHION REDUCTASE $40.00 82979 PROGESTERONE RECEPTOR EA AB ST $650.00 88361 HEPATITIS A IGM AB $55.00 86709 CHOLINESTERASE;SERUM $35.00 82480 HEMA-STIX URINE $15.00 81003 AB;HIV-1 AND HIV-2,AGL ASSAY $62.00 8670391 UREA NITROGEN CLEAR 24HR URINE $25.00 84545 MICRO ALBUMIN SPOT URINE $23.00 82043 RENAL FUNCTION PANEL $43.00 80069 RUSSEL VIPER VENOM TIME $40.00 85613 CARDIO-C-REACTIVE PROTEIN $40.00 86141 DRUG SCREEN NON TLC DEVICES $250.00 80307 OPIATES QUALITATIVE $152.30 80361 OXYCODONE (QD) $225.00 80365 METHADONE QUANTITATIVE (QD) $225.00 80358 COCAINE SCREEN $236.00 80301 COCAINE QUANTITATIVE (QD) $225.00 80353 METHADONE SCREEN $236.00 80301 BENZODIAZAPINES SCREEN $236.00 80301 BENZODIAZAPINES QUANT (QD) $225.00 80346 NICKEL $90.00 83885 T CELL ANTIGEN RECEPTOR, BETA $890.00 81340 T CELL ANTIGEN RECEPTOR, GAMMA $870.00 81342 EPSTEIN BARR-VIRAL CAPSID $55.00 86665 LACTOFERRIN FECAL (QUANT) $115.00 83631 BUPRENORPHINE CONF $236.00 G0480 H PYLORI (C-13) BREATH TEST $215.00 83013 H PYLORI DRUG ADMIN/SPEC COLL $32.50 83014 UNLISTED MOLECULAR PATHOLOGY $545.00 81479 CHROM ANALY; 20-25 CELLS $540.00 88264 CALR GENE COM VARIANTS $650.00 81219 DEOXYCORTISOL 11 $75.00 82634 ONCOPROTEIN DCP $300.00 83951 THC QUANTITATIVE CONFIRMATION $225.00 80349 HSV ANTIGEN DETECTION, DFA $45.00 87299 DIRUETICS SCREEN, URINE $250.00 80307 LEFLUNOMIDE METABOLITE $385.00 80299 MOPATH PROCEDURE LEVEL 1 $450.00 81400 HLA I TYPING 1 ALLELE HR $430.00 81381 HEP C SCREEN HIGH RISK $180.80 G0472 SEPT 9 METHYLATION ANALYSIS $669.10 81327 HLA II TYPING 1 LOCUS LR $420.00 81376 PROCALCITONIN (PCT) $300.00 84145 ASSAY LIPOPROTEIN PLA2 $175.00 83698 UGT1A1 GENE POLYMORPHISM $456.40 81350 OXYCODONE SCREEN W CONFIRMATIO $240.00 80307 DRUG TOX MONITORING 6 $240.00 80307 BLASTOMYCES ANTIBODY $65.00 86612 OSTEOCALCIN $150.00 83937 CELIAC GENETICS $690.20 81382 AB; HIV-1 $42.80 86701 ANTIBODY; HIV-2 ELISA W/REFLEX $45.00 86702 LEVETIRACETAM $225.00 80177 LAMOTRIGINE $225.00 80175 ZONISAMIDE $225.00 80203 OXCARBAZEPINE $225.00 80183 GABAPENTIN $225.00 80171 BARBITURATES NES (QD) $225.00 80345 MOPATH PROCEDURE LEVEL 4 $941.00 81403 BCR/ABL1 GENE MAJOR BP $700.00 81206 BCR/ABL1 GENE MINOR BP $610.00 81207 JAK 2 GENE $380.00 81270 F5 GENE $773.70 81241 MOPATH PROC LEVEL 2 (2-10 SNP) $669.10 81401 MOPATH PROC LEVEL 3 (>10SNPS) $888.70 81402 HFE GENE $583.70 81256 CFTR GENE COM VARIANTS $1,254.60 81220 F2 GENE $180.90 81240 MTHFR GENE $232.20 81291 GENERAL HEALTH PANEL $80.00 80050 FLUORIDE $100.00 82735 ASO; TITER $30.00 86060 DRUG SCREEN MULTIPLE CLASS-URI $250.00 80307 HOMOVANILLIC ACID $46.70 83150 CYANIDE, BLOOD $95.00 82600 FREE INSULIN $58.00 83527 AB; HELMINTH NES $65.00 86682 MONONUCLEAR CELL ANTIGEN $115.00 86356 PROSTAGLANDIN EACH $85.00 84150 VERY LONG FATTY ACID CHAINS $80.00 82726 ANTIPROTHROMBIN AB EA IG CL $20.00 86849 PAPPA SERUM $40.00 84163 GCMS SING NONDRUG QNT NES SS M $95.00 82542 ASSAY RIBOFLAVIN VITAMIN B-2 $96.00 84252 AB; HEPATITIS D $55.00 86692 GCMS SING NONDRUG QUL NES SS M $95.00 82542 LUTEINIZING RELEASING FACTOR $83.00 83727 CHLORIDE; OTHER $30.00 82438 MICROSOMAL AB EACH $40.00 86376 ENZYME ACTIVITY BC; NOT RA $95.00 82657 FRUCTOSE SEMEN $95.00 82757 LIPOPROTEIN BLD BY NMR $130.00 83704 AB; CAMPYLOBACTER $70.00 86625 QUANT SERUM ACETONES/KETONES $39.40 82010 AB ID; PLATELET IG ASSAY $35.00 86023 SUGARS; SINGLE QUAL EA SPECIME $30.00 84376 LEUCINE AMINOPEPTIDASE $50.00 83670 GCMS MULT NONDRUG QNT NES SS M $95.00 82542 SUGARS; SINGLE QUAN EA SPECIME $50.00 84378 VITAMIN K $73.00 84597 ANDROSTANEDIOL GLUCURONIDE $140.00 82154 FAT/LIPIDS FECES; QUAL $15.00 82705 CHEMILUMINESCENT ASSAY $60.00 82397 DRUG SCREEN COLLECT,NOT BLOOD $21.00 COMPLETE URINE DRUG SCR-CLIENT $51.00 CYSTATIN C $80.00 82610 AMPHETAMINE/METHAM QUANT (QD) $30.00 80324 VITAMIN, NOS $75.00 84591 ASSAY, NONENDOCRINE RECEPTOR $155.00 84238 LHR TEST $55.00 86343 DESOXYCORTICOSTERONE 11 $140.00 82633 PROINSULIN $80.00 84206 AMINO ACIDS, 6/> QUAN EA $72.00 82139 QUAL ORGANIC ACIDS EA SPECIM $86.00 83919 CPK, ISOENZYMES $43.00 82552 CARNITINE, QUAN EA $85.00 82379 HALOPERIDOL ASSAY $40.00 80173 AB; CANDIDA $65.00 86628 PA; SCREEN, EA AB $40.00 86403 QUANTIT ORGANIC ACIDS, EA SPEC $88.00 83918 NICOTINE (QD) $248.70 80323 ALPHA-1-ANTITRYPSIN; PHENOTYPE $45.00 82104 PROTEIN WESTERN BLOT $91.00 84181 AB; PROTOZOA, NES $55.00 86753 AB; ERLICHIA $60.00 86666 PROTOPORPHYRIN, RBC; QUANTITAT $62.00 84202 TB TEST, CELL IMMUN MEASURE $260.00 86480 AB; HSV, NON-SPECIFIC $55.00 86694 IMMUNODIFFUSION; NES $63.00 86329 PROTEIN WB; IM ID FOR BANDS $96.00 84182 ASSAY CALPROTECTIN FECAL $80.00 83993 ACUTE HEPATITIS PANEL $207.00 80074 ASSAY OF LIPOPROTEIN(A) $60.00 83695 DELTA ALA $50.00 82135 C CHROMATOGR, QUAN ,ANALYT NES $95.00 82542 DNA, AB $60.00 86215 FLUORESCENT AB; TITER, EA AB $30.00 86256 EPIDERMAL GROWTH FACTOR RECEPT $155.00 84238 ONCOPROTEIN, HER-2/NEU $471.60 83950 AB ID; LEUKOCYTE AB $36.30 86021 AB; HBEAB $58.00 86707 ALLERG SP IGG,QUAN OR SEMIQUAN $45.90 86001 LACTOFERRIN, FECAL (QUAL) $85.90 83630 AB; BARTONELLA $55.00 86611 AB; VIRUS,NES $65.00 86790 COMPLEMENT; AG, EA $33.50 86160 OCCULT BLD FHG, QUAL,1-3 $76.70 82274 DIHYDROMORPHINONE,QUAN (QD) $152.30 80361 MANGANESE $59.30 83785 STONE; IR SPECTROSCOPY $50.00 82365 URINE SULFATE $20.00 84392 IA NOT INFECT AGENT AB;MULTIST $55.60 83516 ASSAY OF BLOOD LIPOPROTEIN $46.00 83721 ETHYLENE GLYCOL $60.00 82693 AB;ASPERGILLUS $66.00 86606 T3;REVERSE $95.00 84482 ISLET CELL AB $95.00 86341 C CHROMOTOGR,QUAN;MULTI ANALY $95.00 82542 IA;OTHER TUMOR AG QUAN,EA $85.00 86316 SODIUM, OTHER SOURCE $25.00 84302 SPECTROPHOTOMETRY,ANALYTE NES $30.00 84311 ESTRONE $120.20 82679 COOMBS TEST, INDIRECT, TITER $320.00 86886 AB; HISTOPLASMA $40.00 86698 AB; COXIELLA BRUNETII $65.00 86638 AB BRUCELLA $30.00 86622 IA INFECTIOUS AGENT AB QUAN $55.00 86317 PARAINFLUENZA AG BY DFA $73.00 87279 HEP-B DNA QUAN $200.00 87517 FLUORESCENT AB; SCRN, EA AB $34.00 86255 DESIPRAMINE (QD) $71.10 80335 TOPIRAMATE(TOPAMAX) $60.00 80201 VASOPRESSIN $165.00 84588 IMMUNFIX E-PHORSIS/URINE/CSF $125.00 86335 PREGNENOLONE $105.00 84140 QUANTITATIVE ANALYSIS RIA/RPIA $70.00 83519 GLUCAGON $73.00 82943 HEPATITIS B CORE TOTAL $50.00 86704 DIHYDROTESTOSTERONE (QD) $182.90 80327 IA NOT INFECT AGENT; NOS $67.40 83520 VIRAL NEUTRALIZATION $90.00 86382 HYPOGLYCEMIC PANEL $250.00 80377 BUPRENORPHINE BY GCMS QUAL QD $240.00 80307 ANTI-PHOSPHATIDYLSERINE AB $145.00 86148 BETA 2 GLYCOPROTEIN 1 AB EA $150.00 86146 AB ID; PLATELET AB $44.30 86022 STREP PNEUMO URINE Ag $40.00 86403 QUAN MASS SPECTROMETRY $73.00 83789 LYMPHOCYTE SUBSET PANEL 5 CD4 $200.00 86361 IgA $58.00 86671 ASCA IgG $58.00 86671 HYDROXYPREGNENOLONE-17 $110.00 84143 INHIBIN B $67.40 83520 COLLAGEN CROSS LINKS $91.00 82523 SINGLE STRANDED DNA $48.00 86226 NEPHELOMETRY, EA ANALYTE, NES $40.00 83883 ESTROGENS; TOTAL $105.00 82672 SELENIUM $120.00 84255 PANCREATIC ELASTASE, FEC $145.00 82656 THERAPEUTIC DRUG QUANT, NES $50.00 80299 ASCORBIC ACID, BLOOD (VIT C) $45.00 82180 ANGIOTENSIN II $87.00 82163 CMV ANTIGENEMIA $200.00 87497 FETAL LUNG MATURITY $167.00 83663 CHROMATOGRAPHY A2,S,C $95.00 83021 ALBUMIN; OTHER SOURCE $30.40 82042 CYCLIC CITRULLINE PEP IGG $67.40 83520 CELL FLOW CYTOMETRY, EA ADD $45.00 88185 FLOW CYTOMETRY, INTERP 16 & > $290.00 88189 B CELL TOTAL COUNT $160.00 86355 NATURAL KILLER CELLS $160.00 86357 ANTI-XA, HEPARIN $31.60 85520 COUNT 15-20 CELLS 2KARYOTYPE $525.00 88262 ADDITIONAL KAROTYPE $140.00 88280 ADD HIGH RESOLUTION STUDY $150.00 88289 PLASMINOGEN $25.00 85420 VAP CHOLESTEROL $105.00 83701 BNP-B TYPE NATRIURETIC PEPTIDE $163.50 83880 GLIADIN AB 59 $67.40 8352059 GLIADIN AB $67.40 83520 ANTI GLUTAMATE DECARBOXYLASE $70.00 83519 TRANSGLUTAMINASE TISSUE $55.60 83516 CLOZAPINE/CLOZARIL $171.60 80159 HCV RNA GENOTYPING $1,090.00 87902 INHIBIN A $221.60 86336 PSA DIAGNOSTIC $54.00 84153 APOLIPOPROTEIN A-1 $60.00 82172 APOLIPROTEIN B $60.00 82172 LIPOPROTEIN (A) $60.00 82172 CARBAMAZEPINE FREE $37.00 80157 HCV RNA PCR QUAL $175.00 87521 FRUCTOSAMINE $72.60 82985 C1 ESTERASE INHIBITOR TOTAL $33.50 86160 ANTIRIBOSOMAL-P-PROTEIN ANTI $60.00 82172 ANTI SKELETAL-STRIATIONAL ABY $34.00 86255 ACETYLCHOLINE RECP MODUL ABY $160.00 84238 IMMUNOGLOB IGA SUB CLASS $35.00 82784 VARICELLA ZOSTER 1GM $50.00 86787 PREALBUMIN $45.00 84134 FREE DILANTIN $55.00 80186 PTH RELATED PROTEIN $70.00 83519 AMIODARONE $95.00 82542 H BACTER PYLORI SCRN $25.00 87081 THYROID STIMULATING IMMUNO $215.00 84445 CHLORPHENIRAMINE $95.00 82542 LEGIONELLA ANTIGEN URINE $50.00 87450 PARVO VIRUS B19 $55.00 86747 ANTI ACETYLCHOLINE RECEPTOR AB $160.00 84238 HYDROXYPROGESTERONE-17 $115.00 83498 MATERNAL MSHCG $50.00 84702 METHYL ALCOHOL, BLOOD $93.00 80320 ANTI HISTONE ABY $67.40 83520 IMMUNE COMPLEX C1 Q QUANT $100.00 86332 TETANIS ABY $45.00 86774 LORAZEPAM-ATIVAN (QD) $225.00 80346 FACTOR IX $65.00 85250 AB;HAEMOPHILUS INFLUENZA $70.00 86684 DT TITER $70.00 86648 SUPPLEMENTAL NEWBORN SCREENING $62.00 82128 HEPATITIS C AB SCRN $60.00 86803 AB ID; LEUKOCYTE AB $36.30 86021 AB; BORDETELLA $40.00 86615 CELL FLOW CYTOMETRY $650.00 88184 RUBEOLA MEASLES IGG $35.00 86765 ANTICENTROMERE ANTIBODY $34.00 86255 ANTI-SCL-70 (SCLERODERMA ABY) $55.00 86235 OLIGOCLONAL BANDS-SPINAL FLUID $110.00 83916 ANTISPERM ANTIBODIES $30.00 89325 INTRINSIC FACTOR $73.00 86340 HPV HIGH RISK TYPES $348.20 87624 CLOMIPRAMINIE N $95.00 82542 CHROMIUM $48.90 82495 ANDROSTENEDIONE $130.00 82157 ALBUMIN-MICRO 24' HR URINE $27.90 82043 PROTEIN C ACTIVITY $60.00 85303 PERTUSSIS CULTURE $25.00 87070 PROTEIN S TOTAL $32.50 85305 IGG 1 2 3 or 4 EACH $125.00 82787 PNEUMOCOCCAL ABY $65.00 86609 SEX HORMONE BINDING GLOBULIN $80.00 84270 C2 COMPLEMENT $33.50 86160 LYMPHOCYTE CHORIOMENINGITIS AB $40.00 86727 ANTICARDIOLIPIN ANTIBODY PANEL $95.00 86147 VASOACTIVE INTEST POLYPEPTIDE $180.00 84586 CYTOMEGALOVIRUS CULTURE $110.00 87252 RSV DIRECT ANTIGEN $60.00 87420 VITAMIN B12 UNSAT BIND $55.00 82608 RISTOCETIN FACTOR $125.00 85245 VON WILLEBRANDS ANTIGEN $95.00 85246 SOMATOMEDIN C $66.00 84305 HISTAMINE LEVEL $150.00 83088 VITAMIN E $50.00 84446 BETA 2 MICROGLOBULIN $57.00 82232 DESYREL/TRAZODONE $95.00 82542 PORPHOBILINOGEN $25.00 84110 LIBRIUM (QD) $225.00 80346 HYDROXYPROLINE URINE TOTAL $125.00 83505 HYDROXYPROLINE $90.00 83500 CORTISOL FREE 24HR URINE $50.00 82530 FLECAINIDE - TAMBOCAR $67.40 83520 CLONOPIN $95.00 82542 ANTI-PARIETAL CELL ABY $34.00 86255 MYELIN BASIC PROTEIN,CSF $85.00 83873 IMMUN COMPLEX ASSAY EACH $100.00 86332 ALUMINUM (BLOOD) $100.00 82108 DHEA-S $90.00 82627 METHYLMALONIC ACID $60.00 83921 C-PEPTIDE $80.00 84681 AMYLASE ISOENZYME $165.00 82664 PTH INTACT $170.00 83970 CREATININE URINE SPOT $25.00 82570 HEPATIC FUNCTION PANEL $32.00 80076 CYCLOSPORIN LC/MS/MS $65.00 80158 TRIPLE SCREEN MATERNAL AFPM $50.00 82105 PSA SCREEN $100.80 G0103 HDL CHOLESTEROL $39.50 83718 CADMUIM $70.00 82300 DIBUCAINE NUMBER $55.00 82638 CA-15-3 $87.00 86300 ERYTHROPOIETIN $60.00 82668 CA-125 $90.00 86304 CA-19-9 $90.00 86301 THYROGLOBULIN $50.00 84432 ANTI GBM ANTIBODY $67.40 83520 VITAMIN B6 $125.00 84207 IMMUNOGLOBULIN - IGE $62.00 82785 ALDOLASE $40.00 82085 RENIN $84.00 84244 CATECHOLAMINES FRACTION URINE $100.00 82384 ESTRIOL (UE3) $90.00 82677 G-6-PD $35.00 82955 ALDOSTERONE $170.00 82088 VMA - 24 HR URINE $58.00 84585 CERULOPLASMIN $42.00 82390 SEROTONIN (5HIAA) - URINE $45.00 83497 THYROGLOBULIN AB $44.00 86800 ANTI NUCLEAR ANTIBODIES $34.00 86038 FECAL FAT-72HR $55.00 82710 ACTH-ADRENOCORTICOTROPIN $165.00 82024 BLOOD ALCOHOL $93.00 80320 DIGOXIN $40.00 80162 FSH $89.50 83001 LH $89.20 83002 HAPTOGLOBIN $35.00 83010 LEAD $58.40 83655 HEAVY METAL QUANT EACH $125.00 83018 CORTISOL AM $60.00 82533 PHENOBARBITAL $32.00 80184 LACTIC ACID $52.00 83605 ACETAMINOPHEN $240.00 80307 DEPAKENE/VALPROIC ACID $50.00 80164 AMNIOTIC FLUID-LS RATIO $108.00 83661 MYSOLINE-PRIMIDONE $60.00 80188 GAMMA GLUTAMYL TRNSTPTDSE $34.70 82977 METANEPHRINES $55.00 83835 DILANTIN LEVEL $40.00 80185 HYDROXYCORTICOSTEROIDS-17 $55.00 83491 INSULIN LEVEL $32.00 83525 GASTRIN AFTER SECRETIN STIM $84.00 82938 OSMOLALITY BLOOD $25.00 83930 ALPHA 1 ANTITRYPSIN TOTAL $50.00 82103 QUINIDINE $41.00 80194 PROLACTIN $70.00 84146 TUMOR MARKER-ALPHA FETOPROTEIN $50.00 82105 ANTI MITOCHONDRIAL ABY/EA $34.00 86255 C3 COMPLEMENT $33.50 86160 TRANSFERRIN $50.00 84466 TEGRETOL-CARBAMAZEPINE $55.00 80156 THEOPHYLLINE $54.00 80198 HEPATITIS A TOTAL $60.00 86708 PROGESTERONE $90.00 84144 LIPID PROF-LDL,HDL,CHOL,TRG $64.50 80061 COMPLEMENT TOTAL CH50 $90.00 86162 PROCAINAMIDE/PRONESTYL-NAPA $50.00 80192 TESTOSTERONE $110.00 84403 COPPER $45.00 82525 CRYOGLOBULIN $20.00 82595 TOBRAMYCIN PEAK $73.00 80200 CATECHOLAMINE-FRAC PLASMA $100.00 82384 HEMOGLOBIN,PLASMA $17.70 83051 CALCIUM IONIZED $65.90 82330 GENTAMICIN PEAK $62.00 80170 ENA, ANY METHOD $55.00 86235 C4 COMPLEMENT $33.50 86160 GROWTH HORMONE HUMAN $60.00 83003 ESTRADIOL $115.00 82670 ELAVIL (QD) $71.10 80335 CRYOFIBRINOGIN $45.00 82585 HLA-B27 $100.00 86812 MYOGLOBIN URINE $36.00 83874 SSA/SSB-SJOGRENS ANTIBODY $55.00 86235 SPECIFIC GRAVITY $10.00 84315 CALCITONIN $110.00 82308 ARSENIC $70.00 82175 MERCURY $60.00 83825 ACE-ANGIOTEN CONVERT ENZYME $56.00 82164 OXALATES $40.00 83945 TOFRANIL (QD) $71.10 80335 TESTOSTERONE FREE $105.00 84402 25 HYDROXY VIT D $125.00 82306 DIHYDROXY VIT D-1,25 $160.00 82652 THYROID BINDING GLOBULIN $45.00 84442 FREE T3 $60.00 84481 FREE T4 $34.00 84439 AMIKACIN LEVEL $75.00 80150 AVENTYL/NORTRIPTYLINE (QD) $71.10 80335 HISTAMINE URINE $150.00 83088 HISTAMINE,BLOOD $150.00 83088 ALK PHOS ISO ENZ $45.00 84080 RAJI CELL ASSAY $100.00 86332 HEPATITIS B CORE IgM $60.00 86705 DHEA $105.00 82626 ALLERGY TESTING (EACH) $28.00 86003 SEROTONIN BLOOD $130.00 84260 VANCOMYCIN PEAK $40.00 80202 ZINC $45.00 84630 FOLATE,RBC $60.00 82747 C1 ESTERASE INHIBITOR FCTNL $50.00 86161 COMPLEMENT C1Q $33.50 86160 CHOLINESTERASE RBC $30.00 82482 VITAMIN B1 $115.00 84425 PEANUT COMPONENT PANEL IMMUNO $30.00 86008 VORICONAZOLE $385.00 80299 SYNTHETIC STIMULANTS PANEL $128.00 80371 PROTIME $19.00 85610 PART.THROMBOPLASTIN TIME $20.00 85730 FIBRINOGEN $35.00 85384 FIBRIN DEGRADATION PRODUCTS $20.00 85362 THROMBIN TIME $25.00 85670 FDP D-DIMER $30.00 85378 FACTOR VIII, C $66.00 85240 VON W F8 RISTOCETIN COFACTOR $125.00 85245 VON W F8 MULTIMETRIC $115.00 85247 SUBSTITUTION,PLASMA FRAC EA $35.00 85732 PLATELET, AGGREGATION EA $105.00 85576 CLOTTING FUNCT ACTIVITY $171.60 85397 CLOTTING FUNCT ACTIVITY $171.60 85397 CLOTTING; FACTOR V $73.00 85220 FACTOR INHIBITOR TEST $31.00 85335 PT SUBSTITUTION PLASMA FRACTIO $25.00 85611 CLOTTING; FACTOR XIII FS $39.40 85290 PLATELET NEUTRALIZATION $100.00 85597 THROMBOPLASTIN INHIBITION, TIS $40.00 85705 REPTILASE TEST $25.00 85635 ANTI THROMIN III $28.60 85300 ANTI FACTOR VIII $66.00 85240 BODY FLUID CELL COUNT $20.00 89051 CBC AUTOMATED $37.50 85025 HEMOGLOBIN $15.00 85018 HEMATOCRIT $15.00 85014 WBC $10.00 85048 RBC $10.00 85041 RETICULOCYTE COUNT $15.00 85045 PLATELET $40.00 85032 SED RATE $17.00 85651 SICKLE CELL SCREENING $20.00 85660 BONE MARROW STAINING & PREP $145.00 88313 L A P STAIN $45.00 85540 DIFFERENTIAL MANUAL $10.00 85007 EOSINOPHIL COUNT $10.00 85048 HAMS TEST $50.00 85475 HEMOSIDERIN, QUAL URINE $20.00 83070 SUCROSE HEMOLYSIS $53.00 86941 TRAP STAIN TC $145.00 88313 CSF CELL COUNT $20.00 89051 JOINT FL CELL COUNT $20.00 89051 CBC $20.00 85027 T CELLS TOTAL COUNT $175.00 86359 T CELLS T4 T8 INCLUDES RATIO $215.00 86360 H-PTT $20.00 85730 TISSUE CULTURE;BM, BLD CELLS $575.00 88237 SPUN HEMATOCRIT $15.00 85013 OSMOTIC FRAGILITY RBC; INCUBAT $69.00 85557 MURAMIDASE $70.00 85549 PLASMINOGEN ACTIVATOR $70.00 85415 CLOTTING FACTOR XII ACTIVITY $62.00 85280 CLOTTING FACTOR XI ACTIVITY $60.00 85270 CLOTTING FACTOR VII ACTIVITY $73.00 85230 CLOTTING FACTOR II PROTHROMBIN $31.30 85210 PLATELET NEUTRALIZATION $165.90 85598 PLATELET COUNT FROM BLUE TOP $40.00 85032 BRONCHOALVEOLAR LAVAGE CELL CT $20.00 89051 CLOSURE TIME COLLAGEN ADP $84.50 8557691 CLOSURE TIME COLLAGEN EPI $105.00 85576 GROUP II STAIN $145.00 88313 KETOSTIX KETONE $15.00 81002 PROTEIN S ACTIVITY $70.00 85306 FACTOR X $62.00 85260 APC RESISTANCE $60.00 85307 VISCOSITY $63.00 85810 CLOTTING INHIBITOR; PROTEIN C $124.60 85302 TISSUE CULTURE NON NEOPLASTIC $480.00 88230 PROTEIN 24 HR URNRY QUNTV $15.00 84156 URINE HCG $32.00 81025 URINALYSIS $15.00 81003 URINE MICRO $20.00 81015 EOSINOPHIL-URINE $20.00 81015 URINE AUTO W/O MICRO $15.00 81003 ED URINE HCG $35.00 81025 AUTOM URINE DIP W MICRO $10.00 81001 PORPHYRINS,URINE $35.50 84120 AQP4 NMO-IgG AUTOANTIBODY TEST $1,120.00 83516 GROUP STAIN I $20.00 87207 GROUP STAIN II $145.00 88313 WASHINGS $170.00 88112 BRUSH $170.00 88112 FINE NEEDLE $170.00 88112 NON GYNE BODY FLUID $170.00 88112 PAP SMEAR SCREEN $70.00 88164 $170.00 88112 PNEUMOCYSTIS CARINII $145.00 88312 CSF CYTOLOGY $170.00 88112 SPUTUM CYTOLOGY $170.00 88112 THOROCENTESIS $170.00 88112 URINE CYTOLOGY $170.00 88112 BRONCHOALAR LAVAGE $170.00 88112 CYTO LIQUID SCREEN $90.00 88142 CYTO LIQUID BASE DIAGNOSTIC $90.00 88142 HPV REFLEX $348.20 87625 TZANK SMEAR $20.00 87207 PAP SMEAR DIAGNOSTIC $52.00 88164 CP SMR OTHR SCRN & INT $37.00 88160 QUAN RHEUM FACTOR $25.00 86431 VDRL, RPR, STS; QUAN $25.00 86593 ANTINUCLEAR AB (ANA); TITER $50.00 86039 MCG; IP SITU, 100-300 CELLS $210.00 88275 TISSUE CULTURE;LYMPHOCYTE $480.00 88230 CHROM ANALY;15-20 CELLS $525.00 88262 CHROM ANALY;ADDTL HI RESOLN $150.00 88289 FLOW CYTOMETRY INTERP,2-8 MARK $221.90 88187 CCP ANTIBODY $97.40 86200 CHROM ANALY; ADDTL CELL COUNTS $88.00 88285 CHROM ANALY; 5 CELLS $800.00 88261 TISSUE CULTURE; OTHER TISSUE $650.00 88239 FLOW CYTOMETRY INTERP 9-15 MAR $136.60 88188 CHROM ANALY; 45 CELLS $730.00 88263 TL PAP W AUTO SCRN & MANUAL RS $110.00 88175 CYTOLOGY QUICK STAIN $369.00 88172 CYTOPATH,CONCENTRATION TECHNIQ $57.00 88108 SURG PATH GROSS (LEVEL I) $90.00 88300 SURG PATH MULTI/F/SEC $30.00 88332 SURG PATH FROZEN TC $310.00 88331 SURG PATH GROSS/MICRO LEVEL II $80.00 88302 SUR PATH GROSS/MICRO LEVEL III $145.00 88304 SURG PATH GROSS/MICRO LEVEL V $650.00 88307 SURG PATH GROSS/MICRO LEVEL VI $1,380.00 88309 ELECTRON MICROSCOPY TC $1,390.00 88348 IF; EA AB; DIRECT $650.00 88346 IMMUNOHISTOCHEM FIRST AB STAIN $650.00 88342 CG, MCG; INT & REP $30.00 88291 MCG; IP SITU, 100-300 CELLS $210.00 88275 MCG; SITU HYBRID, 10-30 CELLS $130.00 88273 KI67 SCORE $375.00 88360 GROUP STAIN I TC $145.00 88312 GROUP STAIN II TC $145.00 88313 CALCULUS; QUAL ANAL $60.00 82355 DECALCIFICATION PROCEDURE BONE $50.00 88311 HER-2/NEU IMMUNOHISTO EA AB ST $650.00 88361 TOUCH PREP $1,375.00 88333 INSITU HYBRIDIZATION,MANUEL $650.00 88368 MOLECULAR CYTO DNA PROBE EA $60.00 88271 PREP SLIDE REFERRED MATERIAL $320.00 88323 INTERPHASE IN SITU HYBRIDIZATI $150.00 88274 UNLISTED SURGICAL PATH PROCEDU $238.70 88399 TOUCH PREP,ADDITIONAL SITE $51.00 88334 CONSULTATION RPT-REFERRED SPEC $130.00 88325 FISH MORPHOMET INSIT HYBR AUTO $650.00 88367 COMPUTER MORPHO ANALY EA AB ST $650.00 88361 CP SMR,OTHR,PREP,SCRN,INT $95.00 88161 FISH INSITU HYBRID,EA PROB STN $320.00 88365 REF CONSULT, PREP ELSEWHERE $105.00 88321 CYTP URNE 3-5 PROBES EA SPEC $660.00 88120 PROSTATE BIOPSY ANY METHOD $700.00 G0416 KI-67 PROTEIN EACH AB STAIN $650.00 88361 SURG PATH GROSS/MICRO LEVEL IV $145.00 88305 IMMUNOHISTO ABY EA ADDL SLIDE $105.00 88341 INSITU HYBRIDIZATION (FISH) $585.00 88364 HISTOCHEMICAL STAINS ADD-ON $590.00 88314 ENZYME HISTOCHEMISTRY $1,390.00 88319 IMMUNOHISTO ANTIBODY SLIDE $650.00 88344 FISH PROBE, MNL TECH $385.00 88377 ESTROGEN RECEPTOR EACH AB STAI $650.00 8836191 MUSCLE BIOPSY TC ONLY $145.00 88305 CML PANEL (FISH) $650.00 88374 IMMUNOFLUOR ANTB ADDL STAIN $275.00 88350 CYTP URINE 3-5 PROBES CMPTR $725.00 88121 SMEAR $20.00 87205 SENSITIVITY - DISK PER PLATE $20.00 87184 AFB SMEAR $20.00 87206 AFB (SMR/CLT) $45.00 87116 KOH PREP $20.00 87220 FUNGUS CULTURE $25.00 87102 URINE CULTURE $30.00 87086 G.C. CULTURE $25.00 87081 GENITAL CULTURE $25.00 87070 RESP CULTURE $25.00 87070 STOOL CULTURE $35.00 87045 CULT BACT; ANY SRC NO BLD ANAE $35.00 87075 MALARIA $20.00 87207 NIH SWAB (PINWORMS) $20.00 87172 OVA AND PARASITES $35.00 87177 OCCULT BLOOD-GUIAC $13.80 82270 BLOOD CULTURE $37.00 87040 BACTERIAL TYPING $30.00 87147 SEMEN SCREENING $58.10 89321 CRYSTALS $20.00 89060 CULTURE WOUND $25.00 87070 STOOL FOR WBC $20.00 89055 HIV $73.00 86703 ROTAVIRUS $50.00 87425 TOXO ANTIBODY $45.00 86778 RUBEOLA MEASLES IGG OR IGM $35.00 86765 CSF CULTURE SPINAL FLUID $25.00 87070 LYME DIS ABY SCREEN $82.10 86618 CULTURE-NOSE $25.00 87070 CULTURE-THROAT $25.00 87070 CULTURE-BRON WASHING $25.00 87070 CULTURE-EYE $25.00 87070 CULTURE-EAR $25.00 87070 CULTURE-IV CATH TIP $25.00 87070 CULTURE-TISSUE BX $25.00 87070 CULTURE-PERITONEAL FLD/ABD CAV $25.00 87070 CULTURE-/BILE $25.00 87070 CULTURE-JOINT FLUID $25.00 87070 CULTURE-PLEURAL FLUID $25.00 87070 CULTURE-PERICARDIAL FLUID $25.00 87070 CULTURE NASAL SINUS $25.00 87070 CULTURE-M.R.S.A $25.00 87081 COLD AGGLUTININ-TITER $35.00 86157 NOCARDIA SMEAR $20.00 87206 PERI FLD BLD CULT $25.00 87070 AB; HELICOBACTER PYLORI $45.00 86677 HERPES SIMPLEX II IGG $80.00 86696 CULTURE SURGICAL SITE $25.00 87070 CULTURE DECUBITUS $25.00 87070 CULTURE ABSCESS $25.00 87070 GRAM SMEAR $20.00 87205 CULTURE BLOOD AFB $45.00 87116 CULTURE BLOOD FUNGUS $40.00 87103 FUNGUS ID, MOLD $30.00 87107 CULTURE VRE $25.00 87081 TICK I.D. $20.00 87168 CULTURE FUNGUS ID $55.00 87106 CULTURE ID URINE $39.00 87077 CYCLOSPORA CYAETINESUS $40.00 87015 GASTRO CULT $37.90 82271 CULTURE ID $38.90 87077 SENSITIVITY MIC $25.00 87186 CHLAMYDIA BY DNA/PCR $142.00 87491 G.C. BY DNA/PCR $143.00 87591 TOXOPLASMA $45.00 86777 CHLAMYDIA IGM $55.00 86632 LYMES IGG,IGM WESTERN BLOT CON $81.00 86617 HSV TYPING STAIN $15.00 87140 CMV-IGM $55.00 86645 HIV-1 RNA BY PCR $375.00 87536 HERPES SMPLX VIRUS BY PCR,CSF $170.00 87529 CULTURE ID-59 $38.90 8707791 CULTURE ID ANAEROBIC-59 $50.00 8707691 CULTURE ID URINE 91 $38.90 8707791 STOOL AND PATHOGENS-91 $26.00 8704691 CHLAMYDIA T, DIR NA PROBE $105.00 87490 NEISSERIA, DIR NA PROBE $95.00 87590 MACROSCOPIC EXAM, ARTHROPOD $20.00 87168 GENOTYPE,DNA,HIV REVERSE T $1,262.40 87901 PHENOTYPE, DNA HIV W/CULTURE $2,110.00 87903 PHENOTYPE, DNA HIV W/CLT ADD $197.60 87904 TRICHOMONAS VAGINALIS AMPLIF $238.60 87661 CRYPTOCOCCAL ANTIGEN SERUM $31.00 87327 CRYPTOCOCCAL ANTIGEN FOR CSF $31.00 87327 REFLEX CRYPTOCOCCAL ANTIGEN $55.00 86406 BACT CULT QUAN AEROBIC $80.00 87071 BACT CULT QUAN ANAEROBIC $96.00 87073 HIV-1 PROBE REVERSE TRNSCRPT J $145.00 87535 RESP VIRUS 3-5 TARGETS $617.70 87631 GROUP B STREP BY PCR $274.10 87653 HERPES SIMPLEX/VARICELLA ZOSTE $70.00 87254 PARASITE IDENTIFICATION, WORM $20.00 87169 HIV-1 INTEGRASE GENOTYPE $785.00 87906 PHENOTYPE INFECT AGENT DRUG $550.00 87900 URINE BACTERIA CULTURE $30.00 87088 HIV-1 AG W/HIV-1 & HIV-2 AB $78.50 87389 DNA/RNA/;MULTI ORG-AMP PR $338.10 87801 GARDNERELLA DIR NA PROBE $88.00 87510 CANDIDA NA DIRECT PROBE $90.00 87480 TRICHOMONAS VAGIN DIR PROBE $80.00 87660 HEP-B AMPLIF NA PROBE $150.00 87516 ASPERGILLUS AG EIA $110.00 87305 AGENT NOS ASSAY W/OPTIC $62.70 87899 GENET VIRUS ISOLATE HSV $145.00 87255 BARTONELLA AMPLIF NAP $145.00 87471 C DIFF AMPLIFIED PROBE $258.60 87493 INFLUENZA DNA AMP PROBE $409.80 87502 HIV-1 AG, EA $87.00 87390 CYTOMEGALOV, AMPLIF NA PROBE $175.00 87496 HPYLORI, STOOL, EIA $69.30 87338 MR-STAPH, DNA, AMP PROBE $145.00 87641 HISTOPLASMA CAPSUL AG, EIA $60.00 87385 FUNGUS CULTURE, DEF ID, MOLD $30.00 87107 MYCOBACTERIA, DIR NA PROBE $88.00 87550 SENSITIVITY-MYCOBACT, EA AGNT $30.00 87190 RSV AG BY IF $60.00 87280 HEPATITIS BE AG, EIA $55.00 87350 CONCENTRATION FOR INFECT AGNT $40.00 87015 SHIGA-LIKE TOXIN AG,EIA $85.90 87427 CRYPTOSPOR AG BY IFA $50.00 87272 LYMES,AMPLIFIED NA PROBE $145.00 87476 MYCOBACTERIA T, DIR NA PROBE $85.00 87555 MYCOBACTERIA A, DIR NA PROBE $85.00 87560 BC-AEROBIC-ADDTL ID $38.90 87077QW ENTEROVIRUS,DNA, AMP PROBE $221.90 87498 NA QUAN NOS AGENT $195.00 87799 AMPLIF NA PROBE NOS AGENT $165.00 87798 SENSITIVITY-MACROBROTH,EA AGNT $25.00 8718891 SENSITIVITY-MACROBROTH,EA AGNT $25.00 87188 HEPATITIS B SURFACE, AG, EIA $35.00 87341 MYCOBACTERIA T, AMPLIF NA PROB $145.00 87556 TRICHOMONAS RAPID TEST $59.70 87808 MRSA ALL ADMISSIONS $23.00 87081 AB; HTLV OR HIV WB $71.00 86689 HOMOGENIZ TISSUE FOR CULTURE $35.00 87176 HERPES SIMPLEX II IGM $80.00 86696 HERPES SIMPLEX I IGM $50.00 86695 WEST NILE VIRUS IGM $75.00 86788 WEST NILE VIRUS IGG $350.00 86789 VAG PERI RECTAL CULT GRP B STR $25.00 87081 CHLAMYDIA/GC DNA $170.00 87800 INFECT AGNT DIRECT INFLUENZA $31.00 87400 STREPT SCREEN GPA $64.50 87880 MYCOPLASMA CULTURE RESPIRATORY $55.00 87109 CULTURE ID ANAEROBIC $55.00 87076 BETA LACTAMASE $15.00 87185 GIARDIA ANTIGEN $40.00 87329 WATER ANALYSIS(BACTERIAL)(CASH $28.80 VDRL CSF $15.00 86592 MYCOPLASMA CULTURE UROGENITAL $55.00 87109 BACT MENG EA ANTIBODY $40.00 86403 HERPES VIRUS CULTURE $145.00 87255 STOOL ADD PATHOGENS $26.00 87046 CLOSTRIOIUM DIFF TOXIN $50.00 87324 MONO TEST $25.00 86308 C REACTIVE PROTEIN $22.00 86140 RHEUMATOID FACTOR (RF) $25.00 86430 SEROLOGY (RPR) $15.00 86592 ASO BLOOD $25.00 86063 STAPH A DNA AMP PROBE $170.00 87640 HERPES S AMPLIF NA PROBE $170.00 87529 TREPONEMA PALLIDUM $63.80 86780 IA BY EIA MULTI STEP $57.80 87449 COXSACKIE VIRUS ""A"" $50.00 86658 COXSACKIE VIRUS ""B"" $50.00 86658 ECHOVIRUS $50.00 86658 POLIOVIRUS $50.00 86658 EBNA (NUCLEAR AG) $45.00 86664 EARLY ANTIGEN-EBV $37.00 86663 GC ANTIBODY $65.00 86609 CHLAMYDIA CULTURE $80.00 87110 MYCOPLASMA IGG/IGM $37.00 86738 ANTI DNA ANTIBODY $40.00 86225 COCCIDIOIDES ABY $50.00 86635 CRYPTOCOCCAL ABY $66.00 86641 CYTOMEGALOVIRUS $45.00 86644 HERPES SIMPLEX I IGG $50.00 86695 VARICELLA ZOSTER $50.00 86787 LEPTOSPIRA ANTI $60.00 86720 MUMPS ANTIBODY $47.00 86735 CHLAMYDIA ANTIBODIES $30.00 86631 ROCKY MOUNT SPOT $80.00 86757 CULTURE VIRAL $110.00 87252 SUDAN IV FAT SC $15.00 89125 COXSACKIE B GROUP $50.00 86658 INFLUENZA VIRUS EA $60.00 86710 LEGIONELLA ANTI $55.00 86713 ADENOVIRUS ANTI $40.00 86603 LEGIONELLA CULTURE $25.00 87081 TRICHINELLA ABY $55.00 86784 MYCOBACTERIA ID $58.00 87118 IADNA-DNA/RNA PROBE TQ 6-11 $920.00 87506 OBSTETRICAL PANEL $123.00 80055 COOMBS DIRECT BROAD $170.00 86880 ANTIBODY SCREEN $145.00 86850 THERAPEUTIC PHLEBOTOMY $272.10 99195 PROC FEE RED CELL $1,250.00 P9021 DEGLYCEROLIZED RBC $862.80 P9039 PROC FEE WHOLE BLOOD $1,053.50 P9010 PROC FEE FF PLSMA $304.50 P9017 PROC FEE PLT CONC $239.00 P9019 PROC FEE CRYOPREC $261.40 P9012 ANTIBODY TITRATION EA $320.00 86886 RBC AB ELUATE $320.00 86860 MINI ANTIBODY INDENTIFICA $648.90 8687091 FETAL SCREEN $35.00 85461 FETAL MATERNAL RBC RATIO $35.00 85460 POOLING PLATELETS $320.00 86965 ANTIBODY IDENTIFICATION $648.90 86870 ABO TYPE $206.00 86900 ANTIBODY IDENT (SPECIAL) $383.00 86870 AUTOABSORPTION (PER SERUM) $56.00 86978 TRANS REACTION EVAL $310.00 86078 PROC FEE SD PLT $1,254.60 P9034 PROC FEE AUTO RBC $784.10 P9016 PROC FEE HLA PLT $1,599.50 P9052 BASIC EVALUATION-ARC $648.90 86870 PR FEE DDNR RBC $784.10 P9016 DIRECTED DONOR SURCHARGE $450.00 HLA TYPING-ARC (ABC) $245.00 86813 CMV SCREEN $45.00 86644 HLA ABY SCR-ARC $200.00 86807 CROSSMATCH BY ARC $320.00 86922 ANTI NEUTRALIZA $320.00 86977 NEUTRAL/TITER $320.00 86977 PROC FEE AUTO WBL $312.00 P9010 IRRADIATION FEE $95.00 86945 POOLING CRYO $320.00 86965 SURCHARGE FEE-ARC $150.00 ZZAP RBC TREATMENT $85.00 86970 COOMBS DIRECT IGG $170.00 86880 COOMBS DIRECT C3 $170.00 86880 AG SCREEN-PT SERUM $85.00 86904 SUPP. ID CHARGE-ARC $648.90 86870 PROC FEE LEUK RDUCED RBC $1,062.50 P9016 HLA DR - ARC $275.00 86817 IRRD DIR DONOR LR RBC $801.10 P9016 PROC FEE CRYOSUPR $127.10 P9016 PROC FEE JB PLSMA $227.60 P9016 INCUBATION $320.00 86921 RHO IMMUNE GLOBULIN 300 UG MGR $472.00 90384 COOMBS DIRECT $170.00 86880 CROSSMATCH $320.00 86920 ABO TYPE FORWARD $206.00 86900 THAW FRZN RBC $650.00 86931 PROC FEE AUTO D RBC $1,173.50 P9039 RH TYPE $85.00 86901 ANTIGLOBULIN-PHASE $320.00 86922 RBC ABY SCR EACH SER TECH ARC $145.00 86850 RBC ABY ELUTION EA ELUTION ARC $320.00 86860 RBC ABY ID EA PANEL/SER TECH $648.90 86870 AGT DIRECT ANTISERUM ARC $170.00 86880 AGT INDIRECT TITER EA ANTISER $310.00 86886 ABO BLOOD TYPING ARC $206.00 86900 BLOOD TYPING RH(D) ARC $85.00 86901 RBC AG OTHER THAN ABO/RH (D) $369.00 86902 RBC AG OTHER THAN ABO/RH(D)ARC $369.00 86905 PHENOTYPING COMPLETE ARC $85.00 86906 COMP TEST EA UNIT AGT TECH ARC $320.00 86920 PRETREAT RBC ABY ID INCUB CHEM $85.00 86970 INCUBATION W/ENZYMES ARC $369.00 86971 BY DENSITY GRADIENT SEP ARC $320.00 86972 INCUBATION W/INHIBITORS ARC $320.00 86977 DIFF RBC ABSORB/EACH ARC $35.00 86978 AUTO SURCHARGE $450.00 PROC FEE LP SD PLT $1,582.40 P9035 PROC FEE SD PLT LREDUCED IRR $1,726.40 P9037 PROC FEE LEUKOREDUC IRR RBC $1,273.00 P9040 PROC FEE PLATELET IRRADIATED $335.00 P9032 PROC FEE PLT RDM LKREDUCED IRR $325.00 P9033 PROC FEE PLT RANDOM LEUKOREDUC $252.00 P9031 WHOLE BLD/RBCS LEUKO RDUC CMV $1,186.10 P9051 PLATLTS PHERES LEUKO RDUC CMV $3,079.00 P9053 SD,PLT,LR,CMVN $2,959.10 P9055 RBC, LEUKO RDUC CMVN, IRR $1,397.30 P9058 FRESH FRZN PLAS BETWN 8-24HR C $284.70 P9059 SICKLING OF RBC, REDUCTION $20.00 85660 PROC FEE IRR RBC $1,713.80 P9038 HLA MATCHING SURCHARGE $340.00 AG TEST DONOR BLOOD/EA AG $369.00 86902 LICENSED RBC PANEL $941.00 81403 TRANSFUSION, BLOOD OR BLD COMP $710.00 36430 OBSTETRIC PANEL W HIV $424.00 80081 FETOMATERNAL BLD FLOW CYTOMETR $30.00 86849 IAT COMPLETE SERVICE $961.00 86891 IAT (CANCEL WITHOUT SET-UP) $961.00 86891

CARDIOLOGY HOLTER MONITOR TC $507.50 93226 ELECTROCARDIOGRAM TC $170.00 93005 EEG; SLEEP ONLY $680.00 95822 EEG CEREBRAL DEATH EVAU ONLY $1,230.00 95824 EEG AWAKE AND DROWSY $675.00 95816 EEG AWAKE & DROWSY W PORTABLE $675.00 95816 EEG AWAKE AND ASLEEP $675.00 95819 ECHO REAL-TI M-MD $1,300.00 93306 TEE TRANSESOPHAGEAL ECHO $2,200.00 93312 DOBUTAMINE STRESS TEST $680.00 93017 NUCLEAR EXERCISE STRESS TEST $680.00 93017 STRESS TTE W CONTINUOUS ECT $1,300.00 93351 ADMIN ECG CONTRAST AGENT $60.00 93352 LEXISCAN STRESS TEST $680.00 93017 TREADMILL $680.00 93017 TTE W OR WO FOL WCON DOPPLER $2,130.00 C8929 MOD SEDATION INITIAL 15 MIN $203.00 99152 MOD SEDATION EA ADDL 15 MIN $203.00 99153 TEE W/ CARDIOVERSION $2,200.00 93312 ECHO FOLLOW UP $480.00 93308 XRAY MANDIBLE (ROUTINE) $226.00 70110 FACIAL BONES (ROUTINE) $226.00 70150 NASAL BONES $126.00 70160 SINUSES $126.00 70220 SKULL (ROUTINE) $226.00 70260 TMJ BILAT $126.00 70330 SKULL (2 VIEWS PARTIAL) $226.00 70250 MANDIBLE (PARTIAL EXAM) $126.00 70100 FACIAL BONES (PARTIAL EXAM) $126.00 70140 PANELIPSE $126.00 70355 ORBITS $226.00 70200 SKULL(2 VIEW)EYE FOREIGN BODY $126.00 70030 SINUSES PARANASAL < 3 VIEWS $126.00 70210 TMJ JOINT-UNILATERAL-RT $126.00 70328RT TMJ JOINT-UNILATERAL-LT $126.00 70328LT RIBS (BILATERAL) $226.00 71110 RIBS(UNILATERAL)LT $126.00 71100LT RIBS(UNILATERAL)RT $126.00 71100RT RIBS, BILATERAL W 1V CHEST $226.00 71111 RIBS UNI RT W/PA CHEST $226.00 71101RT RIBS UNI LT W/PA CHEST $226.00 71101LT CHEST, 1 VIEW $126.00 71045 CHEST, 2 VIEWS $126.00 71046 CHEST, 3 VIEWS $135.00 71047 CHEST, 4 OR MORE VIEWS $255.00 71048 ABDOMEN SERIES W 1V CHEST $226.00 74022 ABDOMEN, 1 VIEW $136.00 74018 ABDOMEN, 2 VIEWS $240.00 74018 ABDOMEN, 3 OR MORE VIEWS $265.00 74021 IVP (NO TOMO) $452.00 74410 RETGOGRADE PYELOGRAM $1,080.00 74420 URETHRO-VOIDING $1,080.00 74455 CYSTOGRAM $452.00 74430 IVP INFUSION & TOMOGRAMS $452.00 74415 URETHRO-RETRO $460.00 74450 BARIUM SWALLOW/ $449.00 74220 SMALL BOWEL $226.00 74250 UPPER GI $449.00 74241 BARIUM ENEMA $449.00 74270 BARIUM ENEMA/AIR CONTRAST $449.00 74280 UPPER GI/AIR CONTRAST $449.00 74247 RHB SWALLOWING STUDY $226.00 74230 UPPER GI W/SM BOWEL $452.00 74249 CHOLANGIOGRAM OPERATIVE $100.00 74300 CHOLANGIOGRAM ADD FILM/OR $90.00 74301 GI WITH BARIUM SWALLOW $449.00 74247 BARIUM ENEMA GASTROGRAPHIN $449.00 74270 BONE AGE $226.00 77072 BONE LENGTH $300.00 77073 SKELETAL SURVEY $324.80 77075 SCANOGRAM/VISIONAIRE $300.00 77073 ACROMIOCLAVICULAR JOINTS $150.00 73050 STERNOCLAVICULAR JOINTS $170.00 71130 ELBOW (ROUTINE)LT $126.00 73080LT ELBOW(ROUTINE)RT $126.00 73080RT CLAVICLE LT $126.00 73000LT CLAVICLE RT $126.00 73000RT SCAPULA LT $226.00 73010LT SCAPULA RT $226.00 73010RT SHOULDER 2 VIEW LT $126.00 73030LT SHOULDER 2 VIEW RT $126.00 73030RT HUMERUS LT $126.00 73060LT HUMERUS RT $126.00 73060RT ELBOW(RECHECK)LT $126.00 73070LT ELBOW(RECHECK)RT $126.00 73070RT FOREARM LT $126.00 73090LT FOREARM RT $126.00 73090RT WRIST(ROUTINE)LT $126.00 73110LT WRIST(ROUTINE)RT $126.00 73110RT HAND LT $126.00 73130LT HAND RT $126.00 73130RT WRIST(RECHECK)LT $126.00 73100LT WRIST(RECHECK)RT $126.00 73100RT UPPER EXTREMITY INFANT LT $226.00 73092LT UPPER EXTREMITY INFANT RT $226.00 73092RT CLAVICLE(RECHECK)LT $126.00 73000LT CLAVICLE(RECHECK)RT $126.00 73000RT SHOULDER(RECHECK 2V)LT $126.00 73030LT SHOULDER(RECHECK 2V)RT $126.00 73030RT HUMERUS(RECHECK)LT $126.00 73060LT HUMERUS(RECHECK)RT $126.00 73060RT FOREARM(RECHECK)LT $126.00 73090LT FOREARM(RECHECK)RT $126.00 73090RT HAND(RECHECK)LT $226.00 73120LT HAND(RECHECK)RT $226.00 73120RT ELBOW(2VIEW)LT $126.00 73070LT ELBOW(2VIEW)RT $126.00 73070RT WRIST(2VIEW)LT $126.00 73100LT WRIST(2VIEW)RT $126.00 73100RT THUMB LT $126.00 73140LT FINGER 2ND LT $126.00 73140F1 FINGER 3RD LT $126.00 73140F2 FINGER 4TH LT $126.00 73140F3 FINGER 5TH LT $126.00 73140F4 THUMB RT $126.00 73140F5 FINGER 2ND RT $126.00 73140F6 FINGER 3RD RT $126.00 73140F7 FINGER 4TH RT $126.00 73140F8 FINGER 5TH RT $126.00 73140F9 THUMB RECHECK LT $126.00 73140FA FINGER 2ND RECHECK LT $126.00 73140F1 FINGER 3RD RECHECK LT $126.00 73140F2 FINGER 4TH RECHECK LT $126.00 73140F3 FINGER 5TH RECHECK LT $126.00 73140F4 THUMB RECHECK RT $126.00 73140F5 FINGER 2ND RECHECK RT $126.00 73140F6 FINGER 3RD RECHECK RT $126.00 73140F7 FINGER 4TH RECHECK RT $126.00 73140F8 FINGER 5TH RECHECK RT $126.00 73140F9 HAND RT (2 VIEW) $226.00 73120RT HAND LT (2 VIEW) $226.00 73120LT SHOULDER 1 VIEW LT $126.00 73020LT SHOULDER 1 VIEW RT $126.00 73020RT KNEES, WEIGHT BEARING $126.00 73565 ANKLE(ROUTINE) 4 VIEW LT $126.00 73610LT ANKLE(ROUTINE) 4 VIEW RT $126.00 73610RT OS CALCIS/HEEL LT $126.00 73650LT OS CALCIS/HEEL RT $126.00 73650RT KNEE(2VIEW)LT $126.00 73560LT KNEE(2VIEW)RT $126.00 73560RT ANKLE 2 VIEW LT $126.00 73600LT ANKLE 2 VIEW RT $126.00 73600RT FOOT LT $126.00 73630LT FOOT RT $126.00 73630RT LOWER LEG LT $126.00 73590LT LOWER LEG RT $126.00 73590RT KNEE 4 OR MORE VIEWS LT $226.00 73564LT KNEE 4 OR MORE VIEWS RT $226.00 73564RT KNEE/OBL/PAT/EREC LT $226.00 73564LT KNEE/OBL/PAT/EREC RT $226.00 73564RT LOWER EXTREMITY INFANT LT $126.00 73592LT LOWER EXTREMITY INFANT RT $126.00 73592RT FOOT(RECHECK)LT $126.00 73620LT FOOT(RECHECK)RT $126.00 73620RT LOWER LEG(RECHECK)LT $126.00 73590LT LOWER LEG(RECHECK)RT $126.00 73590RT ANKLE(2 VIEW)RECHECK LT $126.00 73600LT ANKLE(2 VIEW)RECHECK RT $126.00 73600RT KNEE(2 VIEW)RECHECK LT $126.00 73560LT KNEE(2 VIEW)RECHECK RT $126.00 73560RT TOE 1ST LT $126.00 73660TALT TOE 2ND LT $126.00 73660T1 TOE 3RD LT $126.00 73660T2LT TOE 4TH LT $126.00 73660T3LT TOE 5TH LT $126.00 73660T4LT TOE 1ST RT $126.00 73660T5 TOE 2ND RT $126.00 73660T6 TOE 3RD RT $126.00 73660T7 TOE 4TH RT $126.00 73660T8 TOE 5TH RT $126.00 73660T9 TOE 1ST RECHECK LT $126.00 73660TA TOE 2ND RECHECK LT $126.00 73660T1 TOE 3RD RECHECK LT $126.00 73660T2 TOE 4TH RECHECK LT $126.00 73660T3 TOE 5TH RECHECK LT $126.00 73660T4 TOE 1ST RECHECK RT $126.00 73660T5 TOE 2ND RECHECK RT $126.00 73660T6 TOE 3RD RECHECK RT $126.00 73660T7 TOE 4TH RECHECK RT $126.00 73660T8 TOE 5TH RECHECK RT $126.00 73660T9 FOOT RT (2 VIEW) $126.00 73620RT FOOT LT (2 VIEW) $126.00 73620LT KNEE 3 VIEWS LT $126.00 73562LT KNEE 3 VIEWS RT $126.00 73562RT HIP UNI 1 VIEW RT $126.00 73501RT HIP UNI 1 VIEW LT $126.00 73501LT HIP UNI 2-3 VIEWS RT $126.00 73502RT HIP UNI 2-3 VIEWS LT $126.00 73502LT HIPS BI 2 VIEWS $255.00 73521 HIPS BI 3-4 VIEWS $250.00 73522 FEMUR 2+ VIEWS RT $126.00 73552RT FEMUR 2+ VIEWS LT $126.00 73552LT TOMOGRAMS $226.00 76100 FLUOROSCOPY < 1 HOUR $455.00 76000 C-ARM < 1 HOUR $455.00 76000 PORTABLE ABD SERIES W 1V CHEST $226.00 74022 PORTABLE ANKLE(ROUTINE)4V LT $126.00 73610LT PORTABLE ANKLE 2V RECHECK LT $126.00 73600LT PORTABLE ANKLE 2 VIEW LT $126.00 73600LT PORTABLE ANKLE(ROUTINE)4V RT $126.00 73610RT PORTABLE ANKLE(2V)RECHECK RT $126.00 73600RT PORTABLE ANKLE 2 VIEW RT $126.00 73600RT PORTABLE CLAVICLE LT $126.00 73000LT PORTABLE CLAVICLE RT $126.00 73000RT PORTABLE ELBOW(ROUTINE) LT $126.00 73080LT PORTABLE ELBOW(2VIEW)LT $126.00 73070LT PORTABLE ELBOW(RECHECK) LT $126.00 73070LT PORTABLE ELBOW (ROUTINE) RT $126.00 73080RT PORTABLE ELBOW (2 VIEW) RT $126.00 73070RT PORTABLE ELBOW(RECHECK) RT $126.00 73070RT PORTABLE THUMB LT $126.00 73140LT PORTABLE THUMB RT $126.00 73140F5RT PORTABLE FINGER 2ND LT $126.00 73140F1LT PORTABLE FINGER 2ND RECHECK LT $126.00 73140F1LT PORTABLE FINGER 2ND RT $126.00 73140F6RT PORTABLE FINGER 2ND RECHECK RT $126.00 73140F6RT PORTABLE FINGER 3RD LT $126.00 73140F2LT PORTABLE FINGER 3RD RECHECK LT $126.00 73140F2LT PORTABLE FINGER 3RD RT $126.00 73140F7RT PORTABLE FINGER 3RD RECHECK RT $126.00 73140F7RT PORTABLE FINGER 4TH LT $126.00 73140F3LT PORTABLE FINGER 4TH RECHECK LT $126.00 73140F3LT PORTABLE FINGER 4TH RT $126.00 73140F8RT PORTABLE FINGER 4TH RECHECK RT $126.00 73140F8RT PORTABLE FINGER 5TH LT $126.00 73140F4LT PORTABLE FINGER 5TH RT $126.00 73140F9RT PORTABLE FINGER 5TH RECHECK RT $126.00 73140F9RT PORTABLE FACIAL BONES(PARTIAL $126.00 70140 PORTABLE FOOT LT-3 VIEW $126.00 73630LT PORTABLE FOOT LT (2 VIEW) $126.00 73620LT PORTABLE FOOT(RECHECK) LT-2 V $126.00 73620LT PORTABLE FOOT RT-3 VIEW $126.00 73630RT PORTABLE FOOT RT (2 VIEW) $126.00 73620RT PORTABLE FOOT(RECK) RT-2V $126.00 73620RT PORTABLE FOREARM LT $126.00 73090LT PORTABLE FOREARM(RECHECK) LT $120.00 73090LT PORTABLE FOREARM RT $126.00 73090RT PORTABLE FOREARM(RECHECK) RT $126.00 73090RT PORTABLE HAND LT-3 VIEW $126.00 73130LT PORTABLE HAND LT (2 VIEW) $226.00 73120LT PORTABLE HAND(RECK) LT-2 VIEW $226.00 73120LT PORTABLE HAND RT $126.00 73130RT PORTABLE HAND RT (2 VIEW) $226.00 73120RT PORTABLE HAND(RECK) RT-2 VIEW $226.00 73120RT PORTABLE OS CALCIS/HEEL LT $126.00 73650LT PORTABLE OS CALCIS/HEEL RT $126.00 73650RT PORTABLE HUMERUS LT $126.00 73060LT PORTABLE HUMERUS(RECHECK) LT $126.00 73060LT PORTABLE HUMERUS RT $126.00 73060RT PORTABLE HUMERUS(RECHECK) RT $126.00 73060RT PORTABLE KNEE 4 OR MORE VWS LT $226.00 73564LT PORTABLE KNEE(2VIEW) LT $126.00 73560LT PORTABLE KNEE(2 V)RECHECK LT $126.00 73560LT PORT KNEE 4 OR MORE VWS RT $226.00 73564RT PORTABLE KNEE(2 VIEW) RT $126.00 73560RT PORTABLE KNEE(2VIEW)RECHECK RT $126.00 73560RT PORTABLE LOWER EXT INFANT LT $126.00 73592LT PORTABLE LOWER EXT INFANT RT $126.00 73592RT PORTABLE LOWER LEG LT $126.00 73590LT PORTABLE LOWER LEG(RECHECK)LT $126.00 73590LT PORTABLE LOWER LEG RT $126.00 73590RT PORTABLE LOWER LEG(RECHECK)RT $126.00 73590RT PORTABLE LUMBAR (AP/LAT) $226.00 72100 PORTABLE NASAL BONES $126.00 70160 PORTABLE NECK SOFT TISSUE $126.00 70360 PORTABLE PELVIS $226.00 72170 PORT RIBS(UNILATERAL) LT $126.00 71100LT PORTABLE RIBS(UNILATERAL)RT $126.00 71100RT PORTABLE RIBS (BILATERAL) $226.00 71110 PORTABLE SCAPULA LEFT $226.00 73010LT PORTABLE SCAPULA RT $226.00 73010RT PORTABLE SHOULDER 2 VIEW LT $126.00 73030LT PORT SHOULDER(RECHECK 2V)LT $126.00 73030LT PORTABLE SHOULDER 2 VIEW RT $126.00 73030RT PORT SHOULDER(RECHECK 2V)RT $126.00 73030RT PORTABLE SKULL 2 VIEWS PARTIAL $226.00 70250 PORTABLE SPINE 1 VIEW $126.00 72020 PORTABLE TOE 1ST LT $126.00 73660TALT PORTABLE TOE 1ST RECHECK LT $126.00 73660TALT PORTABLE TOE 1ST RT $126.00 73660T5RT PORTABLE TOE 1ST RECHECK RT $126.00 73660T5RT PORTABLE TOE 2ND LT $126.00 73660T1LT PORTABLE CERVICAL (AP/LAT) $190.00 72040 PORTABLE TOE 2ND RECHECK LT $126.00 73660T1 PORTABLE TOE 2ND RT $126.00 73660T6 PORTABLE TOE 2ND RECHECK RT $126.00 73660T6 PORTABLE TOE 3RD LT $126.00 73660T2 PORTABLE TOE 3RD RECHECK LT $126.00 73660T2 PORTABLE TOE 3RD RT $126.00 73660T7 PORTABLE TOE 3RD RECHECK RT $126.00 73660T7 PORTABLE TOE 4TH LT $126.00 73660T3 PORTABLE TOE 4TH RECHECK LT $126.00 73660T3 PORTABLE TOE 4TH RT $126.00 73660T8 PORTABLE TOE 4TH RECHECK RT $126.00 73660T8 PORTABLE TOE 5TH LT $126.00 73660T4 PORTABLE TOE 5TH RECHECK LT $126.00 73660T4 PORTABLE TOE 5TH RT $126.00 73660T9 PORTABLE TOE 5TH RECHECK RT $126.00 73660T9 PORTABLE THORACIC SPINE $226.00 72072 PORTABLE THORACIC SP 2 VIEW $226.00 72070 PORTABLE UPPER EXT INFANT LT $226.00 73092LT PORTABLE UPPER EXT INFANT RT $226.00 73092RT PORTABLE WRIST ROUTINE LT-4V $126.00 73110LT PORTABLE WRIST 2 VIEW LT $126.00 73100LT PORTABLE WRIST RECHECK LT-2V $126.00 73100LT PORTABLE WRIST ROUTINE RT-4V $126.00 73110RT PORTABLE WRIST 2 VIEW RT $126.00 73100RT PORTABLE WRIST RECHECK RT-2V $126.00 73100RT PORTABLE THUMB RECHECK RT $126.00 73140F5 PORTABLE THUMB RECHECK LT $126.00 73140FA PORTABLE FINGER 5TH RECHECK LT $126.00 73140F4 OR PORT ANKLE 2 VIEWS LT $126.00 73600LT OR PORT ANKLE 2 VIEWS RT $120.00 73600RT OR PORT CLAVICLE LT $126.00 73000LT OR PORT CLAVICLE RT $126.00 73000RT OR PORT ELBOW(2VIEW)LT $126.00 73070LT OR PORT ELBOW (2 VIEW) RT $126.00 73070RT OR PORT FINGER LT 1 $126.00 73140LT OR PORT FINGER RT 1 $126.00 73140F5 OR PORT FINGER 2ND LT $126.00 73140F1 OR PORT FINGER RT 2 $126.00 73140F6 OR PORT FINGER 3RD LT $126.00 73140F2 OR PORT FINGER 3RD RT $126.00 73140F7 OR PORT FINGER LT 4 $126.00 73140F3 OR PORT FINGER RT 4 $126.00 73140F8 OR PORT FINGER 5TH LT $126.00 73140F4 OR PORT FINGER 5TH RT $126.00 73140F9 OR PORT FOOT LT (2 VIEW) $126.00 73620LT OR PORT FOOT RT (2 VIEW) $126.00 73620RT OR PORT FORARM LT $126.00 73090LT OR PORT FOREARM RT $126.00 73090RT OR PORT HAND LT (2 VIEW) $226.00 73120LT OR PORT HAND RT (2 VIEW) $226.00 73120RT OR PORT OS CALCIS/HEEL LT $126.00 73650LT OR PORT OS CALCIS/HEEL RT $126.00 73650RT OR PORT HUMERUS LT $126.00 73060LT OR PORT HUMERUS RT $126.00 73060RT OR PORT KNEE(2VIEW) LT $126.00 73560LT OR PORT KNEE(2 VIEW) RT $126.00 73560RT OR PORT LOWER LEG LT $126.00 73590LT OR PORT LOWER LEG RT $126.00 73590RT OR PORT LUMBAR (AP/LAT) $226.00 72100 OR PORT PELVIS $226.00 72170 OR PORT SCAPULA LEFT $226.00 73010LT OR PORT SCAPULA RT $226.00 73010RT OR PORT SHOULDER 2 VIEW LT $126.00 73030LT OR PORT SHOULDER 2 VIEW RT $126.00 73030RT OR PORT TOE 1ST LT $126.00 73660TA OR PORT TOE 2ND LT $126.00 73660T1 OR PORT CERVICAL (AP/LAT) $190.00 72040 OR PORT TOE 2ND LT $126.00 73660T1 OR PORT TOE 2ND RT $126.00 73660T6 OR PORT TOE 3RD LT $126.00 73660T2 OR PORT TOE 3RD RT $126.00 73660T7 OR PORT TOE 4TH LT $126.00 73660T3 OR PORT TOE 4TH RT $126.00 73660T8 OR PORT TOE 5TH LT $126.00 73660T4 OR PORT THORACIC SP 2 VIEW $226.00 72070 OR PORT WRIST 2 VIEW RT $126.00 73100RT OR PORT SPINE 1 VIEW $126.00 72020 PORTABLE XRAY SHOULDER RT, 1V $126.00 73020RT PORTABLE XRAY SHOULDER LT 1 V $126.00 73020LT OR ERCP $340.00 74330 OR SHOULDER 1V,LT $126.00 73020LT OR SHOULDER 1V,RT $126.00 73020RT OR PORT WRIST 2 VIEW LT $126.00 73100LT OR PORT TOE 1ST RT $126.00 73660T5 OR PORT TOE 5TH RT $126.00 73660T9 OR PORT NECK SOFT TISSUE $126.00 70360 PORTABLE HIP UNI 1 VIEW RT $126.00 73501RT PORTABLE HIP UNI 1 VIEW LT $126.00 73501LT OR PORT HIP UNI 1 VIEW LT $126.00 73501LT OR PORT HIP UNI 1 VIEW RT $126.00 73501RT PORTABLE HIP UNI 2-3 VIEWS RT $126.00 73502RT PORTABLE HIP UNI 2-3 VIEWS LT $126.00 73502LT OR PORT HIP UNI 2-3 VIEWS RT $126.00 73502RT OR PORT HIP UNI 2-3 VIEWS LT $126.00 73502LT PORTABLE HIPS BI 2 VIEWS $255.00 73521 OR PORT HIPS BI 2 VIEWS $255.00 73521 PORTABLE HIPS 3-4 VIEWS $250.00 73522 OR PORT HIPS 3-4 VIEWS $250.00 73522 PORTABLE FEMUR 1 VIEW RT $126.00 73551RT PORTABLE FEMUR 1 VIEW LT $126.00 73551LT OR PORT FEMUR 1 VIEW RT $126.00 73551RT OR PORT FEMUR 1 VIEW LT $126.00 73551LT PORTABLE FEMUR 2+ VIEWS RT $126.00 73552RT PORTABLE FEMUR 2+ VIEWS LT $126.00 73552LT OR PORT FEMUR 2+ VIEWS RT $126.00 73552RT OR PORT FEMUR 2+ VIEWS LT $126.00 73552LT PORTABLE CHEST, 1 VIEW $126.00 71045 PORTABLE CHEST, 2 VIEWS $126.00 71046 PORTABLE CHEST, 3 VIEWS $260.00 71048 PORTABLE CHEST, 4 OR MORE VIEW $255.00 71048 OR PORT CHEST, 1 VIEW $126.00 71045 OR PORT CHEST, 2 VIEWS $126.00 71046 OR PORT CHEST, 3 VIEWS $135.00 71047 OR PORT CHEST, 4 OR MORE VIEWS $255.00 71048 PORTABLE ABDOMEN, 1 VIEW $150.00 74018 PORTABLE ABDOMEN, 2 VIEWS $275.00 74019 PORTABLE ABDOMEN,3 OR MORE VWS $265.00 74021 OR PORT ABDOMEN, 1 VIEW $150.00 74018 OR PORT ABDOMEN, 2 VIEWS $275.00 74019 OR PORT ABDOMEN,3 OR MORE VWS $265.00 74021 MYELOGRAM CERVICAL W PUNC $1,900.00 72240 MYELOGRAM 2 OR MORE REGIONS $2,100.00 72270 SIALOGRAM $500.00 70390 FISTULA/SIN TRCT $1,080.00 76080 CERVICAL PUNCTURE-MYELO $1,700.00 61055 FLOURO GUIDIANCE $263.90 77002 SIALOGRAM INJ PRO $185.00 42550 FISTULA INJ PRO $255.00 20501 URETHROCYSTOGRAM INJ PRO $900.00 VOIDING CYSTO INJ PRO $1,000.00 51600 LUMBAR PUNC DX $1,700.00 62270 ARTHROGRAM KNEE LT $1,000.00 73580LT ARTHROGRAM KNEE RT $1,000.00 73580RT ARTHROGRAM SHOULDER LT $1,000.00 73040LT ARTHROGRAM SHOULDER RT $1,000.00 73040RT ARTHROGRAM WRIST LT $900.00 73115LT ARTHROGRAM WRIST RT $900.00 73115RT ARTHROGRAM HIP LT $1,000.00 73525LT ARTHROGRAM HIP RT $1,000.00 73525RT ARTHROGRAM ANKLE LT $1,000.00 73615LT ARTHROGRAM ANKLE RT $1,000.00 73615RT ARTHROGRAM ELBOW LT $1,000.00 73085LT ARTHROGRAM ELBOW RT $1,000.00 73085RT TMJ ARTHROGRAM LT $460.00 70332LT TMJ ARTHROGRAM RT $460.00 70332RT BONE DENSITY $360.40 77080 ARTH INJ PRO ANKLE LT $1,525.00 27648LT ARTH INJ PRO ANKLE RT $1,525.00 27648RT ARTH INJ PRO ELBOW LT $1,525.00 24220LT ARTH INJ PRO ELBOW RT $1,525.00 24220RT ARTH INJ PRO HIP LT $500.00 27093LT ARTH INJ PRO HIP RT $500.00 27093RT ARTH INJ PRO KNEE LT $155.00 27370LT ARTH INJ PRO KNEE RT $155.00 27370RT ARTH INJ PRO SHOULDER LT $225.00 23350LT ARTH INJ PRO SHOULDER RT $225.00 23350RT ARTH INJ PRO TMJ LT $225.00 21116LT ARTH INJ PRO TMJ RT $225.00 21116RT ARTH INJ PRO WRIST LT $220.00 25246LT ARTH INJ PRO WRIST RT $220.00 25246RT INJECTION PROC, THER MAJ JOINT $650.00 20610 WRIST DEXA LEFT $170.00 77081LT WRIST DEXA RIGHT $170.00 77081RT VERTEBRAL ASSESSMENT $200.00 77086 CHEMO, CNS (INTRATHECAL) $350.00 96542 C ARM > 1 HOUR $300.00 76001 EPIDUROGRAM $190.00 7227559 DRAIN/INJECT SM JNT/BURSA $490.00 20600 DRAIN/INJ INTERM JNT/BURSA $490.00 20605 FLUOROGUIDE FOR SPINE INJECT $175.00 77003 MYELOGRAM - CERVICAL $2,354.80 62302 MYELOGRAM - THORACIC $2,354.80 62303 MYELOGRAM - LUMBAR $2,354.80 62304 MYELOGRAM - 2 OR MORE REGIONS $2,679.60 62305 T-TUBE INJ PROC INCL RADIOLOGY $5,730.00 47531 STEROTACTIC NEEDLE SYS W/CLIP $954.10 A4648 SITZMARK CAPSULE $81.20 99070 NOSE TO FOR FB CHILD $350.00 76010 FLUORO EXAM OF G/COLON TUBE $525.00 49465 ERCP $340.00 74330 SPECIMEN RADIOGRAPHY $900.00 76098 HYSTEROSALPINGOGRAPHY INJ PRO $380.00 58340 DUCTOGRAM SINGLE LT $460.00 77053LT DUCTOGRAM SINGLE RT $460.00 77053RT DUCTOGRAM MULTIPLE LT $538.00 77054LT DUCTOGRAM MULTIPLE RT $538.00 77054RT DUCTOGRAM INJ PROC LT $230.00 19030LT DUCTOGRAM INJ PROC RT $230.00 19030RT HYSTERSALPINGOGRAM $630.00 74740 SURGICAL SPECIMEN XR $900.00 76098 CERVICAL SPINE 4-5 VIEWS $226.00 72050 CERVICAL SPINE 2-3 VIEWS $190.00 72040 CERVICAL SPINE 6+ VIEWS $226.00 72052 THORACIC SPINE $226.00 72072 LUMBAR (ROUTINE) $226.00 72110 PELVIS $226.00 72170 SACROILIAC JOINTS $226.00 72202 SACRUM/COCCYX $126.00 72220 LUMBAR (AP/LAT) $226.00 72100 NECK SOFT TISSUE $126.00 70360 LUMBAR FLEX/EXT $226.00 72120 LUMBAR WITH FLEX/EXT $226.00 72114 SPINE (1 VIEW) $126.00 72020 THORACIC SP - 2 VIEW $226.00 72070 INJ PARAVERT F JNT L/S 1 LEV $1,600.00 64493 CERVICAL FLEX EXT $190.00 72040 PELVIS MINIMUM 3 VIEWS $226.00 72190 SACROILIAC JOINTS < THAN 3 V $226.00 72200 ENTIRE SPINE 1 VIEW $135.00 72081 ENTIRE SPINE 2-3 VIEWS $226.00 72082 ENTIRE SPINE 4-5 VIEWS $452.00 72083 ENTIRE SPINE 6+ VIEWS $452.00 72084 LUMBAR WITH LATERAL BENDING $226.00 72114 LUMBAR W/ BEND RT TO LT 2VWS $226.00 72120 MAMMOGRAPHY MAMMO DX BILATERAL $446.20 77066 MAMMO SCREEN BILATERAL $446.20 77067 MAMMO DX UNILATERAL RT $316.20 77065RT MAMMO DX UNILATERAL LT $316.20 77065LT MAMMO SCREEN TO DX-BILATERAL $446.20 77066GG MAMMO SCREEN TO DX-UNILAT LT $316.20 77065LTGG MAMMO SCREEN TO DX-UNILAT RT $316.20 77065RTGG MAMMO GUIDE NEEDLE LOC INIT RT $900.00 19281RT MAMMO GUIDE NEEDLE LOC INIT LT $900.00 19281LT MAMMO GUIDE NEEDLE LOC ADDL RT $310.00 19282RT MAMMO GUIDE NEEDLE LOC ADDL LT $310.00 19282LT BREAST STRTC BX INIT LESION RT $2,250.00 19081RT BREAST STRTC BX INIT LESION LT $2,250.00 19081LT BREAST STRTC BX ADDL LESION RT $650.00 19082RT BREAST STRTC BX ADDL LESION LT $650.00 19082LT BREAST TOMOSYNTHESIS UNI RT $300.00 77061RT BREAST TOMOSYNTHESIS UNI LT $300.00 77061LT BREAST TOMOSYNTHESIS BI DIAGNO $250.00 77062 BREAST TOMOSYNTHESIS BI SCREEN $200.00 77063 MAMMO SCREEN WALKIN $446.20 77067 WALK IN SCREENING TOMO $200.00 77063 MAMMO POSTPROCEDURAL RT $240.00 77065RT MAMMO POSTPROCEDURAL LT $240.00 77065LT MAMMO POSTPROCEDURAL BILATERAL $400.00 77066 MAMMO SCREENING NO RX $370.00 77067 MAMMO SCREEN UNILATERAL RT $316.20 7706752 MAMMO SCREEN UNILATERAL LT $316.20 7706752 MAMMO SCREEN UNI RT WALKIN $316.20 MAMMO SCREEN UNI LT WALKIN $316.20 WALKIN SCREEN TOMO UNILATERAL $200.00 77063 ULTRASOUND ANGIO, EXTREMITY,BILAT $4,850.00 75716 IO,VISCERAL,SEL/SUPSEL,W OR WO $8,400.00 75726 AORTA ABDOMINAL $4,850.00 75625 NOGRAPHY,CAVAL SUPERIOR(SVC) $1,600.00 75827 EMBOL $3,250.00 75894 CHANGE PERC TUBE $235.00 75984 DILATION NEPH TRACT $3,290.00 74485 CT MOD SEDATION EA ADDL 15 MIN $203.00 99153 NEPHROSTOGRAM RT $900.00 74425RT AORTA THORACIC $8,400.00 75605 I V C $4,850.00 75825 FOLLOW-UP ANGIOGRAPHY $1,469.00 75898 ABD AOR-W RUNOFF $4,850.00 75630 FIRST ORDER ABD $1,525.00 36245 SECOND ORDER ABD $2,010.00 36246 THIRD ORDER ABD $2,240.00 36247 ADDITIONAL 2-3 ABD $400.00 36248 VEIN 1ST ORDER $3,000.00 36011 2ND ORDER VEIN $2,950.00 36012 RETROGRADE BRACHIAL $1,525.00 36140 EXTREMITY ARTERY $1,525.00 36140 CATH INTRO AORTA $1,525.00 36200 CATH SUPER/INFER VENA CAVA $2,960.00 36010 NEPH TRACT INJ PRO $4,150.00 50395 ADRENAL UNI ARTERY $4,850.00 75731 ADRENAL BI ARTERY $4,850.00 75733 PELVIC ARTERY $4,950.00 75736 PULMONARY BILAT $4,850.00 75743 NON DEF VESSEL $1,100.00 75774 EXTREM BI VEIN $2,000.00 75822 RENAL BI VEIN $4,850.00 75833 ADRENAL VEIN BI $4,950.00 75842 BIL DIL W STENT $7,400.00 47556 BIL DIL W/O STENT $4,000.00 47555 BILIARY DILATION $575.00 74363 REPOSITION CENTRAL LINE $1,900.00 36597 CHANGE TUBE $1,000.00 43760 REPOSIT GI FEEDING TUBE DUOD $1,400.00 43761 PERICARDIOCENTESIS INITIAL $2,000.00 33010 PERICARDIOCENTSIS SUBSEQUENT $2,000.00 33011 HEPATIC W/O HEMODYNAMIC EVAL $4,850.00 75891 EXTREMITY UNI ARTY LT $4,850.00 75710LT EXTREMITY UNI ARTY RT $4,850.00 75710RT PULMONARY UNI LT $4,850.00 75741LT PULMONARY UNI RT $4,850.00 75741RT EXTREM UNI VEIN LT $1,250.00 75820LT EXTREM UNI VEIN RT $1,250.00 75820RT RENAL UNI VEIN LT $4,850.00 75831LT RENAL UNI VEIN RT $4,850.00 75831RT LOOPOGRAM $1,000.00 50690 LOOPOGRAM S&I $630.00 74425 NEPHOSTOGRAM LT $630.00 74425LT EMBOLIZATION,CEREBRAL ANEURYSM $5,582.50 61710 DIALYSIS ACCESS DECLOTT W/BALL $6,850.00 36861 TUBE ABSCESSOGRAM $385.00 49424 S&I TUBE ABSCESSOGRAM $630.00 76080 DECLOT BY THROMBOLYTIC AGENT $915.40 36593 VENOGRAM INJ UNI LT $160.00 36005LT VENOGRAM INJ UNI RT $160.00 36005RT PULMONARY SECOND ORDER LT $900.00 36014LT PULMONARY SECOND ORDER RT $900.00 36014RT PULMONARY 3RD ORDER LT $900.00 36015LT PULMONARY 3RD ORDER RT $900.00 36015RT BRACEPH 1ST ORD LT $2,150.00 36215LT BRACEPH 1ST ORD RT $2,150.00 36215RT BRACEPH 2ND ORD LT $2,600.00 36216LT BRACEPH 2ND ORD RT $2,600.00 36216RT BRACEPH 3RD ORD LT $2,600.00 36217LT BRACEPH 3RD ORD RT $2,600.00 36217RT BRACHIO 2-3 ADD LT $350.00 36218LT BRACHIO 2-3 ADD RT $350.00 36218RT FIRST ORDER ABD LT $1,400.00 36245LT FIRST ORDER ABD RT $1,400.00 36245RT SECOND ORDER ABD LT $1,850.00 36246LT SECOND ORDER ABD RT $1,850.00 36246RT THIRD ORDER ABD LT $1,950.00 36247LT THIRD ORDER ABD RT $1,950.00 36247RT ADDITIONAL 2-3 ABD LT $350.00 36248LT ADDITIONAL 2-3 ABD RT $350.00 36248RT ABSCESS DRAIN CHANGE $2,800.00 49423 DISKOGRAPHY, CERV THOR S&I $4,850.00 72285 DISKOGRAPHY, CER THOR $526.00 62291 DISKOGRAPHY, LUMBAR S&I $4,850.00 72295 DISKOGRAPHY LUMBAR $1,875.00 62290 REPEAT DISKOGRAPHY CRV THRS S& $4,850.00 7228576 INSERT NG TUBE $700.00 43752 INSERTION TUNNELED CATHETER $4,900.00 36558 INSERT TUNNELED CATH 2 SEPARAT $5,887.00 36565 INSERT PIC $1,625.00 36569 REPLACE CENTRAL CATHETER $3,552.50 36580 REPLACE TUNNELED CATH $4,900.00 36581 REPLACE PICC $1,650.00 36584 REMOVE TUNNEL CATH $960.00 36589 FLOURO GUIDANCE-VENOUS ACCESS $329.90 77001 CAROTID STENTING W/DISTAL PROT $13,195.00 37218 DRAIN GALLBLADDER $4,000.00 47490 ILIAC REVASC LT $10,000.00 37220LT ILIAC REVASC W/STENT LT $19,270.00 37221LT ILIAC REVASC ADD-ON LT $8,932.00 37222LT ILIAC REVASC W/STENT ADD-ON LT $8,932.00 37223LT FEM/POPL REVAS W/TLA LT $12,180.00 37224LT FEM/POPL REVASC W/STENT LT $26,390.00 37226LT TIB/PER REVASC W/TLA LT $18,000.00 37228LT TIB/PER REVASC W/STENT LT $27,500.00 37230LT TIB/PER REVASC ADD-ON LT $9,135.00 37232LT REVSC OPN/PRQ TIB/PERO STENT L $12,180.00 37234LT INJ CENTRAL VENOUS ACC DEVICE $710.50 36598 INS NON-TUNNEL CV CATH 5 YRS/> $1,650.00 36556 INS ENDOVAS VENA CAVA FILTR $7,205.00 37191 REDO ENDOVAS VENA CAVA FLTR $7,105.00 37192 REM ENDOVAS VENA CAVA FILTER $7,105.00 37193 INS CATH REN ARET 1ST UNILAT $5,227.30 36251 INS CATH REN ART 2ND + ULILAT $5,300.00 36253 INS CATH REN ART 1ST BILAT $5,227.30 36252 INS CATH REN ART 2ND + BILAT $5,227.30 36254 PLACE CATH THORACIC AORTA $5,481.00 36221 PLACE CATH XTRNL CAROTID RT $2,918.20 36227RT PLACE CATH XTRNL CAROTID LT $2,918.20 36227LT PLACE CATH INTRACRANIAL ART RT $2,918.20 36228RT PLACE CATH INTRACRANIAL ART LT $2,918.20 36228LT THROMBOLYTIC ART THERAPY $6,850.00 37211 THROMBOLYTIC VENOUS THERAPY $1,700.00 37212 THROMBLYTIC ART/VEN THERAPY $4,050.00 37213 CESSJ THERAPY CATH REMOVAL $4,050.00 37214 REMOVE INTRVAS FOREIGN BODY $5,650.00 37197 ART OCCLUSIVE DEVICE PLCMT $1,132.00 G0269 ILIAC REVASC RT $10,000.00 37220RT ILIAC REVASC W/STENT RT $18,750.00 37221RT ILIAC REVASC ADD-ON RT $8,932.00 37222RT ILIAC REVASC W/STENT ADD-ON RT $8,932.00 37223RT FEM/POPL REVAS W/TLA RT $12,180.00 37224RT FEM/POPL REVASC W/STENT RT $26,390.00 37226RT TIB/PER REVASC W/TLA RT $18,000.00 37228RT TIB/PER REVASC W/STENT RT $27,500.00 37230RT TIB/PER REVASC ADD-ON RT $9,135.00 37232RT REVSC OPN/PRQ TIB/PERO STENT R $12,180.00 37234RT FEM/POPL REVAS W/ATHER $30,450.00 37225 VASC EMBOLIZ/OCCLUSION VEIN RT $17,000.00 37241RT VASC EMBOLIZ/OCCLUSION VEIN LT $17,000.00 37241LT VASC EMBOLIZ/OCCLUDE ARTERY RT $17,000.00 37242RT VASC EMBOLIZ/OCCLUDE ARTERY LT $17,000.00 37242LT VASC EMBOL/OCC TUMOR/INFARC RT $17,000.00 37243RT VASC EMBOL/OCC TUMOR/INFARC LT $17,000.00 37243LT VASC EMBOL/OCCLU HEMORRHAGE RT $17,000.00 37244RT VASC EMBOL/OCCLU HEMORRHAGE LT $17,000.00 37244LT VASC STENT INITIAL ARTERY RT $17,000.00 37236RT VASC STENT INITIAL ARTERY LT $17,000.00 37236LT VASCULAR STENT ADD ARTERY RT $8,932.00 37237RT VASCULAR STENT ADD ARTERY LT $8,932.00 37237LT VASCULAR STENT INITIAL VEIN RT $17,000.00 37238RT VASCULAR STENT INITIAL VEIN LT $17,000.00 37238LT VASCULAR STENT ADD VEIN RT $8,932.00 37239RT VASCULAR STENT ADD VEIN LT $8,932.00 37239LT US GUIDE VASCULAR ACCESS $93.00 76937 FEM/POPL REVASC STNT & ATHER $28,500.00 37227 TRANSCATH STENT CCA W/O EPS RT $11,672.50 37216RT TRANSCATH STENT CCA W/O EPS LT $11,672.50 37216LT PRIM ART MECH THROMBECTOMY $15,935.50 37184 PRIM ART M-THROMBECT ADD-ON $5,176.50 37185 SEC ART M-THROMBECT ADD-ON $10,759.00 37186 INJ CHOLANGIOGRAM EXIST ACCESS $5,100.00 47531 INJ CHOLANGIOGRAM NEW ACCESS $4,000.00 47532 PLMT BILIARY DRN CATH INT&EXT $4,000.00 47533 PLMT BILIARY DRN CATH EXTERNAL $6,000.00 47534 CONV BIL DR CATH EXT TO INT&EX $6,000.00 47535 EXCHANGE BILIARY DRAIN CATH $4,000.00 47536 REMOVAL BILIARY DRAIN CATH $1,700.00 47537 PRQ PLMT STENT EXIST $7,400.00 47538 PRQ PLMT BILE DUCT STENT NEW A $7,400.00 47539 PRQ PLMT BILE DUCT STNT&CATH N $7,400.00 47540 INJ NEPHGRM&URETRGRM EXIST RT $1,600.00 50430RT INJ NEPHGRM&URETRGRM EXIST LT $1,600.00 50430LT INJ NEPHGRMS&URETRGRM NEW RT $1,600.00 50431RT INJ NEPHGRM&URETRGRM NEW LT $1,600.00 50431LT PLMT NEPHROSTOMY CATHETER RT $2,800.00 50432RT PLMT NEPHROSTOMY CATHETER LT $2,800.00 50432LT PLMT NEPHROURETERAL CATH NEW R $2,800.00 50433RT PLMT NEPHROURETERAL CATH NEW L $2,800.00 50433LT CONVERT NEPHROS CATH RT $1,700.00 50434RT CONVERT NEPHROS CATH LT $1,700.00 50434LT EXCHANGE NEPHROS CATH RT $1,700.00 50435RT EXCHANGE NEPHROS CATH LT $1,700.00 50435LT PLMT URETERAL STENT RT $4,500.00 50693RT PLMT URETERAL STENT LT $4,500.00 50693LT PLMT URET STNT W/O CATH NEW RT $4,500.00 50694RT PLMT URET STNT W/O CATH NEW LT $4,500.00 50694LT PLMT URET STNT W/CATH NEW RT $4,500.00 50695RT PLMT URET STNT W/CATH NEW LT $4,500.00 50695LT IVUS NONCORONARY EA ADD VESSEL $2,500.00 37252 IVUS NONCORONARY INITIAL VESSE $2,000.00 37253 TIB/PER REVAS W/ATHER $48,000.00 37229 ANGIO DIALYSIS CIRCUIT $1,365.00 36901 PTA DIALYSIS CIRCUIT $9,250.00 36902 STENT DIALYSIS CIRCUIT $18,000.00 36903 THROMBECTOMY DIALYSIS CIRCUIT $9,500.00 36904 THROMBECTOMY & PTA DIALYS CIRC $17,500.00 36905 THROMBCTMY & STNT DIALYSIS CIR $27,000.00 36906 PTA CENTRAL DIALYSIS SEGMENT $1,100.00 36907 STENT CENTRAL DIALYSIS SEGMENT $2,300.00 36908 EMBOL/OCCLUS DIALYSIS CIRCUIT $1,700.00 36909 PTA INITAL ARTERY $9,500.00 37246 PTA EACH ADDL ARTERY $600.00 37247 PTA INITIAL VEIN $9,500.00 37248 PTA EACH ADDL VEIN $600.00 37249 SP MOD SEDATION INITIAL 15 MIN $203.00 99152 SP MOD SEDATION EA ADDL 15 MIN $203.00 99153 PLACE CATH CAROTID/INOM ART RT $5,481.00 36222RT PLACE CATH CAROTID/INOM ART LT $5,481.00 36222LT PLACE CATH CAROTID/INOM ART RT $6,850.00 36223RT PLACE CATH CAROTID/INOM ART LT $6,850.00 36223LT PLACE CATH CAROTD ART RT $6,850.00 36224RT PLACE CATH CAROTD ART LT $6,850.00 36224LT PLACE CATH SUBCLAVIAN ART RT $4,850.00 36225RT PLACE CATH SUBCLAVIAN ART LT $4,850.00 36225LT PLACE CATH VERTEBRAL ART RT $8,678.30 36226RT PLACE CATH VERTEBRAL ART LT $8,678.30 36226LT VESSEL DILATOR $253.80 C1894 IVC FILTER $5,075.00 C1880 BALLOON INTRA AORTIC $1,624.00 C1725 MISC SUPPLY DSA $0.00 A4649 HYSTEROSALPINGOGRAPHY CATH $116.80 C1769 ULTRA-THIN BALLOON $999.80 C1725 SYMMETRY BALLOON $1,152.10 C1725 BALLOON, XXL $1,243.40 C1725 BLUE MAX BALLOON $1,202.80 C1725 BALLOON, OCCLUSION $588.70 C2628 ENCORE INFLATION DEVICE $329.90 C1760 AMPLATZ SNARE $659.80 URETERAL STENT $614.10 C2617 NEPHRO-URETERAL STENT $304.50 C1729 DRAINAGE CATH, APDL FLEXIMA $355.30 C1729 MEWISSEN CATHETER $71.10 C1751 TRACKER CATHETER $172.60 GUIDE CATHETER-VISTABRITE $532.90 C1887 PLATINUM PLUS GUIDEWIRE $279.20 C1769 KATZEN GUIDEWIRE $172.60 C1769 WHOLEY GUIDEWIRE $203.00 C1769 TAD GUIDEWIRE $269.00 C1769 TRACKER GUIDEWIRE $121.80 C1769 COPE ACCESS SET $203.00 GLIDEWIRE $96.50 C1769 BALLOON DILIATION $984.60 C1725 STENT, SELF EXPANDING SMART $5,481.00 C1876 STENT,BILIARY,TRANSHEPATIC BIL $2,131.50 C1876 STENT, BILIARY PALMAZ CORDIS $6,597.50 C1877 PERCLOSE/ANGIOSEAL CLOSURE DEV $1,218.00 C1760 FLEXMA BILIARY DRAIN $380.70 C1729 WALLSTENT, RP TRACH $5,481.00 C1876 COOK PIC $355.30 C1751 CORONARY WIRE $1,979.30 C1769 CORONARY GUIDECATH $1,319.50 C1769 CORONARY/CAROTID BALLOON $1,705.20 C1725 STENT NON-COA/NON-COV W/DEL $6,090.00 C1876 FILTER WIRE $7,612.50 C1884 CUTTING BALLOON $3,552.50 C1714 ACCULINK/PRECISE STENT $9,947.00 C1876 SYVEK/STASYS (PATCH) $243.60 C1760 THROMBECT/EMBOLECTOMY CATH $2,476.60 C1757 GUIDEWIRE (VIPER) $771.40 C1769 ATHRECTOMY CATHETER $13,195.00 C1724 VIPER SLIDE LUBRICANT $324.80 A4649 DRUG ELUTING STENT VIABAHN $13,174.70 C1874 STENT COATED/COV W/DEL SYS ICA $11,266.50 C1874 CATHETER SUPPORT 0.018 $3,146.50 C1887 CATH, TRANSLUMIN, DRUG-COAT $13,500.00 C2623 PERC INSERT IN-AORTIC BALLOON $660.00 INTRAVENT PACER $8,300.00 INTRAAORTIC BALLOON $2,207.70 C1725 SEL RT VENT OR RT ATRIAL ANGIO $913.50 ACT (ACTIVATED CLOTTING TIME) $25.00 85347 DRUG ELUDING STENT $5,176.50 C1874 LFT HRT ARTERY/VENTRICLE ANGIO $6,500.00 LFT HRT ART/GRFT ANGIO $6,500.00 INJECT SUPRVLV AORTOGRAPHY $786.70 RT< HRT ART/VENTRICLE ANGIO $6,500.00 RT< HRT ART/VENTRICLE ANGIO $6,500.00 RIGHT HEART CATH $6,500.00 CORONARY ARTERY ANGIO S&I $6,500.00 CORONARY ART/GRFT ANGIO S&I $6,500.00 INJECT PULM ART HRT CATH $862.80 RENAL ANGIO CARDIAC CATH $532.90 ILIAC ART ANGIO CARDIAC CATH $507.50 PRQ CARD STENT W/ANGIO 1 VSL $17,000.00 PRQ CARD REVASC MI 1 VSL $17,000.00 PRQ CARD REVASC CHRONIC 1VSL $17,000.00 PRQ CARD STENT W/ANGIO ADDL $13,195.00 PRQ CARD REVASC CHRONIC ADDL $13,195.00 PRQ CARDIAC ANGIOPLAST 1 ART $9,566.40 PRQ CARDIAC ANGIO ADDL ART $9,566.40 PRQ REVASC BYP GRAFT 1 VSL $17,000.00 PRQ REVASC BYP GRAFT ADDL $13,195.00 IV US CORONARY V; INITIAL $260.00 IV US CORONARY V; EA ADDTL $243.60 IV DOPPLER (FFR); INIT VESSEL $300.00 IV DOPPLER (FFR); EA ADD VESSL $270.00 IV US CATHETER $3,045.00 C1753 FFR WIRE $2,821.70 C1769 R HRT CORONARY ARTERY ANGIO $6,500.00 C MOD SEDATION INIT 15 MIN $203.00 99152 C MOD SEDATION EA ADDL 15 MIN $203.00 99153 GATED BLOOD POOL FOR RT VEJ(AD $185.00 78496 HELICOBACTER PYLORI TEST $225.00 78268 H PYLORI BREATH TEST $45.00 78267 BLOOD FLOW STUDY TC $600.00 78445 THYROID SCAN TC $1,080.00 78013 ABSCESS WHOLE BODY LOC. $2,100.00 78806 RENAL SPECT 78710 $790.00 78710 BONE SPECT 78320 $700.00 78320 TUMOR SPECT 78803 $790.00 78803 CARD AV INF SPECT 78469 $890.00 78469 SPECT MYOCARD SINGL $2,100.00 78451 CARDIAC REST QUAN $1,318.00 78453 CARDIAC R/S QUAN $2,400.00 78454 ABSCESS SPECT $1,065.80 78807 GALLIUM SCAN W/TUMOR $2,100.00 78804 MECKLES DIVERT SC $600.00 78290 CARD GATED BLD PL SINGLE $600.00 78472 CARD SCAN AVID IN $600.00 78466 PERFUSION LUNG SC $600.00 78597 /SPLEEN SCAN $600.00 78215 BONE SCAN-PARTIAL $600.00 78300 HEPATOBILIARY SCAN $710.50 78226 CISTENOGRAPHY $790.00 78630 GI BLEEDING STUDY $600.00 78278 AEROSOL VENTILATION LUNG IMAGI $600.00 78579 THYROID CA SCAN $810.00 78018 RENAL SCAN W/FLOW GFR $790.00 78707 LIVER SPECT $700.00 78205 SPECT MYOCARD MULTI $2,025.00 78452 LYMPHOSCINTIGRAPHY $900.00 78195 LEVEEN SHUNT $600.00 78291 RENAL BASELINE $790.00 78707 BODY ABSCESS LIMITED $2,400.00 78805 VENT/PERFUSION LUNG SCAN $1,283.00 78598 HEMANGIOMA STUDY $900.00 78206 SALIVARY GLAND-SERIAL IMAGES $600.00 78231 SALIVARY GLAND-FUNCTION $600.00 78232 BONE MARROW-LIMITED AREA $600.00 78102 BONE MARROW-MULTIPLE AREAS $600.00 78103 RENAL W/ PHARM $790.00 78708 SENTINEL NODE INJECTION $850.00 38792 CARD GATED BLD PL MULTIPLE $820.00 78473 BONE SCAN WHOLE BODY $600.00 78306 TRIPHASIC BONE SCAN $600.00 78315 ADMIN. OF I-131, HYPERTHYROID $450.00 79005 I-131 CAP, DIAG PER MCI $270.00 A9528 ADMIN OF I 131, THYROID METS $450.00 79005 SUBSEQ.TX,I-131 THROID CA $450.00 79005 9ADMIN OF STRONTIUM $0.00 79101 HYPER THYROID TREATMENT $450.00 79005 9ADMIN OF QUADRAMET TX $0.00 79101 I-123 THYROID SCAN $1,080.00 78013 ADMIN OF STRONTIUM $450.00 79101 ADMIN OF QUADRAMET TX $450.00 79101 I-123 THYROID IMAGING W/UP MUL $600.00 78014 I-123 THYROID UPTAKE ONLY,MULT $1,055.00 78012 TUMOR LOCAL/ONCOSCINCT $890.00 78802 TUMOR LOCAL SCAN/OCTREOTIDE $2,100.00 78804 TUMOR LOC WHOLE BODY NEO TECT $890.00 78802 MIBG SCAN $2,400.00 78075 NM GASTRIC EMPTYING STUDY $600.00 78264 PARATHYRD PLANAR W/WO SUBTRJ $710.00 78071 PARATHYROID PLANAR NO SPECT $600.00 78070 TC 99M DTPA $258.90 A9539 TECHNETIUM $180.00 A4641 TC 99 MEDRONATE UP TO 30 MCI $157.40 A9503 TC 04-TAG RBC $304.50 A9560 TC 99M PYP $401.00 A9538 GALLIUM 67 PER MCI $796.80 A9556 I-123 CAP $532.90 A9516 TC 99M SULFER COLLOID $153.30 A9541 THALLOUS CHLORIDE 201 P MCI $203.00 A9505 TC 99 ALBUMIN AGGR PER VIAL $395.90 A9540 CYANOCOBALAMIN COBALT CO 57 $289.30 A9559 INDIUM 111 OXINE 0.5 MCI $1,216.90 A9547 STRONTIUM 89 TX $6,090.00 A9600 SATUMOMAB PENTETIDE PER DOSE $3,933.10 A4642 IN 111 OCTREOSCAN $6,318.40 A9572 CARDIOLITE $350.00 A9500 TC 99M CERETEC $3,679.40 A9521 TC 99M HMPAO WBC $3,679.40 A9521 TC 99M MYOVIEW $285.00 A9502 TC 99M NEUROLITE $812.00 A9557 COLD PYP $304.50 A9538 COLLOIDAL P-32 PER MCI $1,650.00 A9564 INDIUM IN 111 CAPROMAB PENDETI $8,120.00 A9507 99M TC GLUCOHEPTONATE $37.60 A9550 TC-MAG3 $723.00 A9562 NEO TECT $1,218.00 A9536 I-131CAP WHOLE BODY CAPSOL $609.00 A9517 I-131 CAP, DIAG PER MCI $82.00 A9517 SINCALIDE (KINEVAC) INJ $275.00 J2805 IODINE I-131 IODIDE CAP DX $270.00 A9528 INPT STAY RADIOLABELED ITEM $1.60 C9898 SM 153 LEXIDRONAM UP TO 150 MC $20,500.00 A9604 I-123 IOBEGUANE UP TO 15MCI $13,195.00 A9582 TC99M SUCCIMER < 10 MCI $2,030.00 A9551 TC99M MEBROFENIN=< 15 MCI $152.30 A9537 LYMPHOSEEK $1,449.50 A9520 AXUMIN F18 10 MCI $16,380.00 A9588 PERC CORON THROMBECTOMY $8,120.00 LUNG-VENT KIT $142.10 FDG-PER DOSE (4-4OMCI/ML) $558.30 A9552 PET SCANS CARDIAC PET METABOL EVAL $4,567.50 78459 PET W/CT SKULL-THIGH(INITIAL) $5,582.50 78815 PET W/CT FULL BODY(INITIAL) $7,105.00 78816 PET W/CT, SKULL-THIGH(RESTAGE) $5,582.50 78815 PET W/CT, FULL BODY (RESTAGE) $7,105.00 78816 PET SCAN, INCOMPLETE $4,060.00 7881252 BRAIN PET; METABOLIC EVAL $3,030.00 78608 SODIUM FLUORIDE F-18 =< 30 MCI $1,300.00 A9580 PET SKELETAL (INITIAL) $7,105.00 78816PI PET SKELETAL (RESTAGE) $7,105.00 78816PS ULTRASOUND US THYROID/NECK $280.00 76536 US LIVER TC $280.00 76705 US GALLBLADDER TC $280.00 76705 US TC $280.00 76705 US KIDNEYS/BLADDER $280.00 76770 US ABD AO $280.00 76775 US PREG > 14 WKS $280.00 76805 US PELVIS TC $280.00 76856 US ABD COMP $286.00 76700 US SCROTUM TC $280.00 76870 US ABD LMTD $280.00 76705 US GUIDANCE $400.00 76942 US SPLEEN $280.00 76705 US TRANSVAGINAL $280.00 76830 US FETAL BPP W/O STRESS TEST $280.00 76819 US CHEST $226.00 76604 US PORT KIDNEY $280.00 76775 US PARACENTESIS $2,588.30 49083 US PREG MULT > 14 WKS $550.00 76810 US PREG LIMITED $280.00 76815 US PROSTATE TRANSRECTAL $280.00 76872 US ABDOMINAL DUPLEX $634.40 93975 US PSEUDOANEURYSM $650.00 76936 US PREG REPEAT $226.00 76816 US PROSTATE BX $3,290.00 55700 US RLQ $280.00 76705 US GB LIMITED PORT $280.00 76705 US ABDOMEN PORTABLE $286.00 76700 US PANCREAS PORT $280.00 76705 US LIVER PORT $280.00 76705 US ABD AORTA PORT $280.00 76775 US RUQ PORT $280.00 76705 US RUQ $280.00 76705 US KIDNEYS & AORTA $280.00 76770 US $1,800.00 47000 US THORACENTESIS LT $975.00 32555LT US THORACENTESIS RT $975.00 32555RT US REANL CYST ASP LT $1,750.00 50390LT US REANL CYST ASP RT $1,750.00 50390RT US EXTREMITIES LT $226.00 76882LT US EXTREMITIES RT $226.00 76882RT US BX RENAL LT $2,550.00 50200LT US BX RENAL RT $2,550.00 50200RT US BX THYROID LT $1,050.00 10022LT US BX THYROID RT $1,050.00 10022RT US BREAST ASP ADD LT $130.00 19001LT US BREAST ASP ADD RT $130.00 19001RT USDRAIN/INJ MAJOR JNT/BURSA LT $410.00 20611LT USDRAIN/INJ MAJOR JNT/BURSA RT $410.00 20610RT US BREAST CYST ASP - LT $960.00 19000LT US BREAT CYST ASP - RT $960.00 19000RT US KIDNEY LT $280.00 76775LT US KIDNEY RT $280.00 76775RT US KIDNEY TRANS LT $456.80 76776LT US KIDNEY TRANS RT $456.80 76776RT US BLADDER PVR $250.00 51798 US BX/REMOVAL LYMPH NODES $1,850.00 38505 US KIDNEYS $280.00 76775 US BLADDER $226.00 76857 US PREG < 14 WKS $285.00 76801 US PREG MULT < 14 WKS $200.00 76802 US PREG TV < 14 WKS $300.00 76817 US PREG REPEAT EA ADD FETUS $226.00 7681659 US RENAL ARTERY DOPPLER $426.30 93976 US RENAL VEIN DOPPLER $426.30 93976 US (ABI) ART BILAT LOW LTD $253.80 93922 US ART BILAT LOW-COMPLETE $329.90 93923 US ART UNI LOW-COMPLETE $253.80 93922 US ART BIL UPP COMPLETE $329.90 93923 US ART DUPLEX LOW UNI $294.40 93926 US ART DUPLEX UPP UNI $304.50 93931 US CAROTID ART DUPLEX $492.30 93880 EXERCISE DOPPLER-LOWER EXT $355.30 93924 VENOUS DUPLEX LOWER EXT BILAT $487.20 93970 VENOUS DUPLEX LOWER EXT-UNI $324.80 93971 VENOUS DUPLEX UPPER EXT-BILAT $487.20 93970 VENOUS DUPLEX UPPER EXT-UNI $324.80 93971 VENOUS MAPPING UNILATERAL $77.00 7693759 US PUNCT ASP - ABSC HEMAT CYST $520.00 10160 US BX OF SALIVARY GLAND RT $1,750.00 42400RT US DRAINAGE CATH UNDER RX $385.00 75989 US BX SALIVARY GLAND LT $1,750.00 42400LT US DUPLEX BILAT UPPER ARTERIAL $456.80 93930 US DUPLEX BILAT LOWER ARTERIAL $460.00 93925 DUPLEX HEMODIALYSIS ACCESS $380.60 93990 US GUIDANCE INTRAOPERATIVE $538.00 76998 US NUCHAL TRANSLUCENCY $335.00 76813 US NUCHAL TRANSLUCENCY MULTIPL $187.80 76814 US BX SOFT TISSUE NECK/THORAX $1,850.00 21550 US LUNG BX RT $1,850.00 32405RT US LUNG BX LT $1,850.00 32405LT US SPINE CANAL AND CONTENTS $250.00 76800 US I-CAROTID DUP LMTD $406.00 93882 US DUPLEX A,IVC,IL/BPG;COMPL $456.80 93978 US AAA SCREEN $265.00 76706 US MUSCLE BX; PERC NDL $1,850.00 20206 US FINE NEEDLE ASPIRATION $1,050.00 10022 US KIDNEYS/BLADDER 2 $280.00 7677059 US ART LTD LOW $253.80 9392252 US ART UNI UPPER COMPLETE $253.80 93922 US ART BILAT LOW w/MOD $329.90 9392359 US ART LTD LOW, w UPPER CMPLT $253.80 ######### US ART LTD BILAT LOW w/MOD $253.80 9392259 US ART CMPLT UNI LOW, W/MOD $253.80 9392259 US BX TESTIS, NEEDLE $2,650.00 54500 US BONE BX TR/NDL;SUPERF $1,850.00 20220 VESSEL MAP HEMODIALYSIS ACCESS $812.00 G0365 US BREAST NEEDLE LOC INIT LT $955.00 19285LT US BREAST NEEDLE LOC INIT RT $955.00 19285RT US BREAST CLIP INITIAL LT $955.00 19285LT US BREAST CLIP INITIAL RT $955.00 19285RT US BREAST NEEDLE LOC ADDL LT $406.00 19286LT US BREAST NEEDLE LOC ADDL RT $406.00 19286RT US BREAST CLIP ADDL LT $406.00 19286LT US BREAST CLIP ADDL RT $406.00 19286RT US BREAST BX INITIAL LESION LT $1,800.00 19083LT US BREAST BX INITIAL LESION RT $1,800.00 19083RT US BREAST BX ADDL LESION LT $735.90 19084LT US BREAST BX ADDL LESION RT $735.90 19084RT US DRAIN PERI/RETRO ABSCESS $2,550.00 49406 US INJ PERC EXTR ANEURYSM $1,200.00 36002 US DRN/INJ MAJOR JNT/BURSA W/L $410.00 20611LT USDRN/INJ MAJOR JNT/BURSA W/R $410.00 20611RT US LONG HEAD OF BICEPS INJ RT $410.00 20550RT US LONG OF HEAD BICEPS INJ LT $410.00 20550LT US INS MARK THOR FOR RDT PERQ $3,950.00 32553 US MAMMOSITE CATHETER PLACE $14,500.00 US SOFT TISSUE LOC, INITIAL $1,200.00 10035 US SOFT TISSUE LOC, EA ADDL $640.00 10036 US MOD SEDATION INITIAL 15 MIN $203.00 99152 US MOD SEDATION EA ADDL 15 MIN $203.00 99153 US BONE DENSITY-BMD $226.00 76977 US OPTHALMIC $280.00 76512 US BX PANCREAS, PERCUTANEOUS $2,700.00 48102 US BREAST CORE BX NEEDLE $30.50 US PROSTATE CORE BX NEEDLE $45.70 PRECUT BIOPSY TRAY $50.80 THORA/PARACENTESIS TRAY $81.20 ENDOCAVITY NEEDLE GUIDE KIT $66.00 H/S CATHETER SET $66.00 BREAST MARKING SYSTEM-SUPPLY $40.60 US BPP-MULT GEST $280.00 7681959 TISSUE MARKER $335.00 INTRODUCER LOCALIZATION SET $761.30 USDRAIN/INJ INTERM JNT/BURSALT $1,100.00 20606LT USDRAIN/INJ INTERM JNT/BURSTRT $1,110.00 20606RT US AXILLA RT $226.00 76882RT US AXILLA LT $226.00 76882LT US BREAST COMPLETE RT $226.00 76641RT US BREAST COMPLETE LT $226.00 76641LT US BREAST LIMITED RT $180.00 76642RT US BREAST LIMITED LT $180.00 76642LT MAMMOSITE CATHETER $9,600.00 US DRAIN SOFT TISS FLUID COLL $1,250.00 10030 US THORACENTESIS W/CATH PLC LT $2,300.00 32557LT US THORACENTESIS W/CATH PLC RT $2,300.00 32557RT CT SCANS CT HEAD W/CONTRAST $964.30 70460 CT HEAD WO/CONTRAST $791.70 70450 CT HEAD W/WO CONTRAST $1,167.30 70470 CT SOFT TISS NECK;W/O CONTRST $791.70 70490 CT SOFT TISSUE NECK;W/CONTRAST $964.30 70491 CT SFT TISS NCK; W/O&W/CONTRST $1,167.30 70492 CT ORBIT,SELLA WO/CONTRAST $862.80 70480 CT ORBIT,SELLA W/CONTRAST $964.30 70481 CT ORBIT,SELLA W/WO CONTRAST $1,167.30 70482 CT PF,MID IN EAR WO/CONTRAST $862.80 70480 CT PF,MID IN EAR W/CONTRAST $964.30 70481 CT PF,MID IN EAR W/WO CONTRAST $1,167.30 70482 CT MAXILLOFACIAL WO/CONTRAST $791.70 70486 CT MAXILLOFACIAL W/CONTRAST $964.30 70487 CT MAXILLOFACIAL W/WO CONTRAST $1,167.30 70488 CT DORSAL SPINE WO/CONTRAST $791.70 72128 CT DORSAL SPINE W/CONTRAST $964.30 72129 CT DORSAL SPINE W/WO CONTRAST $1,167.30 72130 CT COR/SAG/RECON $725.80 76377 CT ABD W/ CONTRAST $1,218.00 74160 CT ABD W/O CONTRAST $964.30 74150 CT ABD W/WO CONTRAST $1,421.00 74170 CT CHEST W/ CONTRAST $964.30 71260 CT CHEST W/WO CONTRAST $1,167.30 71270 CT PELVIS W/ CONTRAST $964.30 72193 CT PELVIS W/O CONTRAST $791.70 72192 CT PELVIS W/WO CONTRAST $1,167.30 72194 CT CERV SPINE W/ CONTRAST $964.30 72126 CT CERV SPINE W/O CONTRAST $791.70 72125 CT CERV SPINE W/WO CONTRAST $1,167.30 72127 CT LUMB SPINE W/ CONTRAST $964.30 72132 CT LUMB SPINE W/O CONTRAST $791.70 72131 CT LUMB SPINE W/WO CONTRAST $1,167.30 72133 CT GUID NEEDLE PLACEMENT $1,289.10 77012 CT BX-ABD/RETRO $1,850.00 49180 CT BX PANCREAS, PERCUTANEOUS $2,700.00 48102 CT BX LUNG $1,850.00 32405 CT BX-BONE DEEP $2,550.00 20225 CT BX-BONE SUPER $1,850.00 20220 CT BX LIVER $1,850.00 47000 CT BX-MUSCLE $1,850.00 20206 CT BIOPSY-RENAL $2,550.00 50200 CT RETROPERITONEAL $2,842.00 49060 CT PERIRENAL/RENAL $3,145.00 50020 CT UPPER EXT W/CONTRAST RT $964.30 73201RT CT UPPER EXT W/WO CONTRAST LT $1,167.30 73202LT CT UPPER EXT W/WO CONTRAST RT $1,167.30 73202RT CT LOWER EXT WO/CONTRAST LT $862.80 73700LT CT LOWER EXT WO/CONTRAST RT $862.80 73700RT CT LOWER EXT W/CONTRAST LT $1,015.00 73701LT CT LOWER EXT W/CONTRAST RT $1,015.00 73701RT CT LOWER EXT W/WO CONTRAST LT $1,202.80 73702LT CT LOWER EXT W/WO CONTRAST RT $1,202.80 73702RT CT GUIDED NERVE BLOCK-LUMBAR $1,350.00 64483 CT GUIDANCE FOR DRAINAGE $639.50 75989 CTA NECK W/WO CONTRAST $1,167.30 70498 CT THORACENTESIS RT $975.00 32555RT CT THORA W/TUBE THERAPUTIC RT $975.00 32555RT CT CHEST TUBE/PNEUMO RT $975.00 32555RT CT ABSCESS DRAIN/PLEURAL RT $975.00 32551RT CT PARACENTESIS $2,588.30 49083 CT ABSCESS DRAIN TUBE CHANGE $2,650.00 49423 CT THORACENTESIS LT $975.00 32555LT CT THORA W/TUBE THERAPUTIC LT $975.00 32555LT CT CHEST TUBE/PNEUMO LT $975.00 32555LT CT ABSCESS DRAIN PLEURAL LT $975.00 32551LT CT INJ SI JNT;ANES&/TX AGT&ART $1,811.80 G0260 CT BX SOFT TISSUE NECK OR THOR $1,850.00 21550 CTA UP EXT W/WO CONTRAST LT $1,167.30 73206LT CTA LW EXT W/WO CONTRAST RT $1,355.10 73706RT CTA UP EXT W/WO CONTRAST RT $1,167.30 73206RT CTA ABD W/WO CONTRAST $1,522.50 74175 CTA LW EXT W/WO CONTRAST LT $1,355.10 73706LT CTA PELVIS W/WO CONTRAST $1,167.30 72191 CTA CHEST W/WO CONTRAST $964.30 71275 CTA HEAD W/WO CONTRAST $1,167.30 70496 CT THORAX W/O CONTRAST $791.70 71250 CT STERNUM(THORAX)WO CONTRAST $791.70 71250 CT HEART WO DYE; QUAL CALC $253.80 75571 CT HEART W/WO DYE FUNCT $964.30 75572 CCTA W/WO DYE $1,431.20 75574 CCTA W/WO DISEASE STRXR $1,334.80 75573 CTA WITH RUNOFFS $1,953.90 75635 CT DRAIN/INJ MAJOR JNT/BURSA $410.00 20610 CT FINE NEEDLE ASPIRATION W/GU $1,050.00 10022 CT CORE NEEDLE BIOPSY KIT $152.30 CT INJECTOR SYRINGES $30.50 CT ACUPLACE STEREOTACTIC GUIDE $76.20 CT 3D RENDER W/O POSTPROCESS $340.10 76376 CT ABD & PELVIS WO CONTRAST $1,532.00 74176 CT ABD & PELVIS W CONTRAST $2,257.00 74177 CT ABD & PELVIS W & WO CONTRAS $2,628.00 74178 CT PELVIS WO & ABD W CONTST $2,650.00 74178 CT PELVIS WO & ABD W&WO CONTST $2,650.00 74178 CT PELVIS W & ABD WO CONTRAST $2,650.00 74178 CT PELVIS W & ABD W&WO CONTRAS $2,628.00 74178 CT PELVIS W&W/O & ABD WO CONTR $2,650.00 74178 CT PELVIS W&W/O & ABD W CONTRA $2,650.00 74178 CT ANGIO ABD&PELV W/O&W/DYE $2,233.00 74174 CT HEAD/STROKE W/O CONTRAST $791.70 70450 CTA STROKE HEAD W/WO CONTRAST $1,167.30 70496 CTA STROKE NECK W/WO CONTRAST $1,167.30 70498 CT THORAX WO CONTRAST $791.70 7125059 CT DRAIN VISCERAL RT $2,000.00 49405RT CT DRAIN VISCERAL LT $2,000.00 49405LT CT DRAIN PERI/RETRO RT $2,450.00 49406RT CT DRAIN PERI/RETRO LT $2,450.00 49406LT CT SIJ INJ ARTHGRM/ANESTH/STE $1,015.00 27096 CT ENTEROGRAPHY $2,270.00 74177 CT UPPER EXT WO/CONTRAST LT $791.70 73200LT CT UPPER EXT WO/CONTRAST RT $791.70 73200RT CT CHEST W/O CONTRAST $791.70 71250 CT UPPER EXT W/CONTRAST LT $964.30 73201LT CT INS MARK THOR FOR RDT PERQ $3,950.00 32553 CT LUNG CA SCREENING LOW DOSE $275.00 CT MOD SEDATION EA ADDL 15 MIN $203.00 99153 PNEUMOTHORAX CATHETER SET $469.32 CT MOD SEDATION INITIAL 15 MIN $203.00 99152 CT INS MARK ABD FOR RDT PERQ $2,350.00 49411 MARKERS, FIDUCIAL FOR RDT $1,500.00 CT STERNUM W/ CONTRAST $964.30 71260 CT LUNG CA LOW DOSE FOLLOWUP $600.00 71250 RADIATAION THERAPY CENTRAL AXIS DEPTH $310.00 77300 SPECIAL DOSIMETRY $310.00 77331 SIMPLE BLOCK $310.00 77332 COMPLEX IRR BLOCK $800.00 77334 SIMPLE RADIOELEMT $1,300.00 77761 RADIOISOTOPE HANDLING $170.00 77790 INFUSION RADIOISO $675.00 77750 INTER INTRACAVITA $1,300.00 77762 COMPLEX INTRACAVI $1,775.00 77763 COMPLEX INTERSTIT $1,775.00 77778 SP TX MANAGEMENT $1,300.00 77470 TELETHER PORT PLN $800.00 77321 PHYSIC CONSULT $310.00 77336 SP PHYSIC CONSULT $310.00 77370 SMPLE RAD SIM AFS $370.00 77280 COMPLEX RADSIM $1,150.00 77290 SIMPLE RAD TREAT DEL >= 1 MEV $430.00 77402 COMP RAD TREAT DEL >= 1 MEV $560.00 77412 THER RAD PORT IMAGES $40.00 77417 ADMIN OF RADIOPHARM. THERAPY $590.00 79101 3D RADIOTHERAPY PLAN INCL D-V $3,000.00 77295 CT SIM $980.00 77014 IMRT PLANNING $4,000.00 77301 ULTRASONIC GUIDANCE FOR XRT $842.50 77387 MLC DESIGN FOR IMRT, PER PLAN $1,436.30 77338 HDR BRACHYTX 1 CHANNEL $1,775.00 77770 HDR BRACHYTX 2-12 CHANNEL $3,714.90 77771 BRACHTX NON-STR HDR IR-192 $800.00 C1717 UNLISTED PROCEDURE $310.00 77799 CENTRL AXIS DEPTH-76 MODIFIER $310.00 7730076 HDR BRACHYTX 2-12 CHNL 76 MOD $3,714.90 7777176 SMPLE RAD SIM AFS 76 MODIFIER $370.00 7728076 SRS LINEAR BASED 1 SESSION-CRA $18,710.00 77372 SBRT DELIVERY PER FRACTION-BOD $13,068.20 77373 INTRAFRACTION TRACK MOTION,EA $842.50 77387 STEREOSCOPIC X-RAY GUIDANCE $842.50 77387 SBRT MANAGEMENT $4,136.20 77435 INSERT VAG BRACHYTX DEVICE $1,320.00 57156 RESPIRATORY MOTION MGMT STIMUL $1,600.00 77293 INSERT UTERI TANDEM/OVOIDS $5,620.00 57155 INTER BRACH ISO INCL CALC $1,218.00 77317 SIMPLE BRACHY ISO INCL CALC $1,200.00 77316 COMPLX BRACHY ISO INCL CALC $1,471.80 77318 COMPLEX ISODOSE INCL CALC $1,065.80 77307 SIMPLE ISODSE PLN INCL CALC $862.80 77306 SIMPLE IMRT DELIVERY $1,903.20 77385 COMPLEX IMRT DELIVERY $2,182.30 77386 BRACHY GUIDING TUBE (RING) $1,120.00 C1728 BRACHY NEEDLE $125.00 C1715 COMP RAD TREAT DEL 76 MOD $560.00 7741276 IGRT 59 MODIFIER $842.50 7738759 DIRECT LARYNGOSCOPY $3,275.00 31525 INDIRECT LARYNGOSCOPY $390.00 31505 LARYNGOSCOPY FLEX; DIAGNOSTIC $390.00 31575 GOLD FIDUCIAL MARKER $320.00 A4648 NEW PT LIMITED OFFICE SVC $285.00 99201 O/P OFF VISIT NEW PT DETAILED $293.00 99203 O/P OFF VISIT NEW PT MOD COMP $308.00 99204 O/P OFF VISIT EST PT EXPANDED $285.00 99212 O/P OFF VISIT PT MOD COMPLX $293.00 99214 O/P OFF VISIT EST PT COMPLX $308.00 99215 EST PT DETAILED OFFICE SVC $268.00 99213 NEW PT EXPANDED OFFICE SVC $268.00 99202 NEW PT HIGHLYCOMPLEX OFFICE S $338.00 99205 EST PT LIMITED OFFICE SVC $285.00 99211 HDR SKIN SURFACE LESION < 2CM $800.00 77767 HDR SKIN SURFACE LESION >2CM $800.00 77768 RECOVERY ROOM $558.90 BLOOD DRAW FROM VAD $201.00 36591 INJECTION, SQ, IM $138.70 96372 IV THERAPY 1ST HOUR $427.50 96365 IV THERAPY EA ADD HOUR $226.30 96366 IV MEDICATION PUSH $360.00 96374 INSERTION FOLEY CATH-STRAIGHT $201.00 51701 INSERT FOLEY CATH-INDWELLING $201.00 51702 CPR $465.00 92950 RECOVERY ROOM PER HOUR $710.50 FETAL MONITOR NON STRESS $305.00 59025 CIRCUMCISION $3,290.00 54150 OBSERVATION CARE - LOW $80.10 G0378 OBSERVATION CARE - MODERATE $89.40 G0378 OBSERVATION CARE - HIGH $98.50 G0378 EXTENDED RECOVERY ROOM $42.60 OBSERVATION COND CODE 44 $98.50 THERAPEUTIC PLASMA EXCHANGE $2,250.00 36514 THER/PROPH/DIAG INJ SC/IM $138.70 96372 THER/PROPH/DIAG INJ IV PUSH $360.00 96374 TX/PRO/DX INJ NEW DRUG ADD ON $151.20 96375 THER/PROPH/DIAG IV INF INIT $427.50 96365 THER/PROPH/DIAG IV INF ADD ON $226.30 96366 HYDRATION IV INFUSION INIT $360.00 96360 HYDRATION IV INFUSION ADD ON $83.40 96361 TX/PROPH/DG ADDL SEQ IV INF $128.40 96367 TX/PROPH/DG ADDL CONCURRENT IV $82.30 96368 TX/PRO/DX INJ SAME DRUG ADON $162.40 96376 TRANSFUSION, BLOOD OR BLD COMP $650.00 36430 PROCEDURE-SIMPLE, OBSERVATION $672.00 PROCEDURE-INTERIM, OBSERVATION $1,142.50 THER/PROPH/DIAG IV INF INIT=<1 $427.50 9636559 LEVEL 1 NEW PATIENT $243.00 99201 LEVEL 1 NEW PT W/PROCEDURE $243.00 9920125 LEVEL II NEW PATIENT $268.00 99202 LEVEL II NEW PT W/PROCEDURE $268.00 9920225 LEVEL III NEW PATIENT $293.00 99203 LEVEL III NEW PT W/PROCEDURE $293.00 9920325 LEVEL IV NEW PATIENT $308.00 99204 LEVEL IV NEW PT W/PROCEDURE $308.00 9920425 LEVEL V NEW PATIENT $338.00 99205 LEVEL V NEW PT W/PROCEDURE $338.00 9920525 LEVEL I ESTABLISHED PATIENT $218.00 99211 LEVEL I EST PT W/PROCEDURE $218.00 9921125 LEVEL II ESTABLISHED PATIENT $243.00 99212 LEVEL II EST PT W/PROCEDURE $243.00 9921225 LEVEL III ESTABLISHED PATIENT $268.00 99213 LEVEL III EST PT W/PROCEDURE $268.00 9921325 LEVEL IV ESTABLISHED PATIENT $293.00 99214 LEVEL IV EST PT W/PROCEDURE $293.00 9921425 LEVEL V ESTABLISHED PATIENT $308.00 99215 LEVEL V EST PT W/PROCEDURE $308.00 9921525 IV THERAPY NON CHEMO 1ST HOUR $427.50 96365 IV THERAPY NON CHEMO EA ADD HR $226.30 96366 BLOOD DRAW FROM VAD $201.00 36591 BLOOD TRANSFUSION $650.00 36430 NON CHEMO INJ; SQ, IM $138.70 96372 NON CHEMO IV PUSH $360.00 96374 PARACENTESIS $1,852.00 49082 THERAPEUTIC PHLEBOTOMY W/ORW/O $272.10 99195 THORACENTESIS $1,200.00 32554 INJECTION IM FLU;NO MD;NO E&M $69.80 G0008 INJ IM PNEUMONIA;NO MD;NO E&M $69.80 G0009 INJ IM HEPATITIS B;NO MD $107.00 90471 INSERT PICC LINE $2,000.00 36569 REPAIR PICC LINE $1,550.00 36575 REPLACE PICC LINE; SAME SITE $2,000.00 36584 THER/PROPH/DIAG INJ ADD-ON $151.20 96375 HYDRATION IV INF,INITIAL $360.00 96360 HYDRATION IV INF, ADD-ON $83.40 96361 IRRIG DRUG DELIVERY DEVICE $138.80 96523 COLLECT BLOOD FROM PICC $201.00 36592 DECLOT VASCULAR DEVICE $915.40 36593 OP SURGICAL ROOM $462.90 SDS-RECOVERY ROOM PER HOUR $69.90 ECT $1,800.60 90870 CONSCIOUS SEDATION IV,IM,INHAL $201.20 99144 OR SET UP CHARGE $1,200.00 OR EACH 15 MIN LEVEL 1 $600.00 OR EACH 15 MIN LEVEL 2 $850.00 OR EACH 15 MIN LEVEL 3 $1,250.00 OR EACH 15 MIN LEVEL 4 $1,600.00 OPER ROOM-OTHER PROCEDURES $0.00 AMB PH GASTRIC MONITORING $832.00 91034 ESOPHAGEAL MOTILITY $832.00 91010 LES IDENTIFICATION $113.30 CASSETTES DRAPE SMALL $17.30 ACUCISE PROCEDURAL PACK $7,060.10 A4649 SCREW - CLASS 2 $274.10 C1713 SCREW, CANCELLOUS $274.10 C1713 PLATE - CLASS 1 $522.40 C1713 NARROW COMP PL 6-7 HOLE $590.90 SM FRAG PL 2.7MM 5 HOLE $274.10 C1713 SM FRAG PL 2.7MM 7 HOLE $274.10 C1713 FIXATION STAPLER $89.40 STEINMAN PINS/K-WIRES $274.10 C1713 BONE CEMENT $342.90 A4649 DISP BOWL AND SPATULA $26.50 RUSH PINS LARGE $274.10 C1713 SCREW, CORTICAL TITANIUM $274.10 C1713 CANNULA, ARTHROSCOPE $109.90 C1887 SAW BLADE, DISPOSABLE-CLS 1 $152.30 A4649 ARTHROSCOPE FILTER $245.90 ARTHROSCOPE BLADE $194.40 A4649 CANCELLOUS BONE/CHIPS 30 CC $2,284.90 L8699 FIXATOR, EXTERNAL SET $6,302.80 A4649 KNEE, TOTAL $11,000.00 C1776 ARTHROFLOW SYSTEM $218.40 A4649 K.I.S.S. KNEE POSTIONER $194.40 PLC75 LINEAR CUTTER $1,269.50 CR 75 CARTRIDGE $636.70 SCREW - CLASS 6 $868.40 C1713 SCREW - CLASS 8 $1,142.50 C1713 PLUG BONE CEMENT $332.70 DRILL & PIN SET $502.80 A4649 JACOB CHUCK 3.2MM DRILL BT $284.70 DRILL BIT, CANULATED-CLS 2 $1,713.80 A4649 STERNAL SAW BLADE $211.60 A4649 PODIATRY DRILL BITS $85.90 SAW BLADES, PODIATRY $245.90 A4649 CABLES, ORTHOPEDIC $1,685.20 C1713 SHOULDER SUSPENSION KIT $443.80 A4649 ANCHOR-ARTHROSCOPIC $1,938.40 C1713 DISP ARTHROSCOPIC DRAPE PACK $131.60 A4649 ARTHRAX ARTHRO-WAND $331.50 HOOK BLADE $834.70 A4649 ELECTRODE, MITEK $1,005.50 A4649 HIP PREP KIT $1,139.30 A4649 STERILE TOURNIQUET $45.90 L3650 OSI SHOULDER KIT $228.60 L3650 SYNTHESIS ORIF HIP $3,574.70 A4649 DON JOY KNEE IMMOBILIZER $376.00 L1830 MITEK CANNULA W OBTURATOR $52.80 HIP, BI-POLAR $9,700.00 ORTHOPEDIC HOOD $129.30 SURGICAL FIBRILLAR $283.50 C9399 GPS SYSTEM/FLOSEAL $1,713.80 C1760 KYPHOPLASTY CEMENT KIT $946.10 A4649 KYPHOPLASTY KIT $17,935.70 A4649 KYPHON BONE BIOPSY DEVICE $685.60 C1830 SCREW - CLASS 4 $579.50 C1713 PLATE, LOCKING $732.70 C1713 NEEDLE, JAM SHIDI $97.40 C1830 KYPHOPAK 2ND FX KIT $11,424.10 A4649 USS SURGICAL ANCHOR SYSTEM $1,160.90 C1713 SCREWS, OSTEOMED/NEURO $595.30 C1713 US SURGICAL ANCHORS $1,160.90 C1713 ACL RECONSTRUCTION KIT $3,400.00 A4649 CROSS PIN KIT $1,233.30 C1776 BUTTON, FIXATION $274.10 C1713 BUTTON, ENDO $1,171.30 C1713 AQUAMANTYS BIPOLAR DEVICE $2,170.70 A4649 EXPRESS SEW $525.70 A4649 BOLT, LOCKING-TROCHANTERIC $612.10 C1713 TROCHANTERIC NAIL $5,735.00 C1713 HELICAL BLADE (TROCH NAIL SYS) $2,570.60 C1713 SCREW - CLASS 5 $742.70 C1713 SCREW - CLASS 7 $936.90 C1713 PLATE - CLASS 3 $777.00 C1713 PLATE - CLASS 7 $2,256.50 C1713 PLATE - CLASS 6 $1,339.20 C1713 PLATE - CLASS 5 $1,182.60 C1713 SCREW, SHAFT $274.10 C1713 WASHER, ORTHOPEDIC $274.10 C1713 HIP, BIRMINGHAM $24,700.00 HIP, UNIPOLAR $8,900.00 HIP, OXINIUM $14,700.00 HIP, CERAMIC $18,400.00 KNEE, HI-FLEX $12,100.00 KNEE, UNI $15,536.80 KNEE, JOURNEY $16,793.30 KNEE, OXINIUM $12,600.00 SHOULDER, TOTAL $23,990.40 SHOULDER, PARTIAL $13,600.00 FIBERWIRE/ORTHO CORD $274.10 C1713 DURASEALENT-CLS 1 $856.90 C1765 DURASEALENT-CLS 2 $4,312.00 C1765 BONE FILLER/PUTTY(ALLOMATRIX)1 $2,284.90 A4649 BONE FILLER/PUTTY(ALLOMATRIX)2 $3,455.90 A4649 BONE FILLER/PUTTY(ALLOMATRIX)3 $4,055.60 A4649 BONE FILLER/PUTTY CLS 4 $4,352.70 A4649 BONE FILLER/PUTTY(ALLOMATRIX)5 $6,254.80 A4649 BONE CEMENT W/ANTIBIOTIC $1,531.10 A4649 TENDON, TIBIAL ANTERIOR $15,556.00 A4649 DRILL BIT, CANULATED-CLS 1 $600.10 PODIATRY BURR $280.10 DRILL BIT/TAP-CLS 1 $2,330.70 DRILL BIT/TAP-CLS 2 $457.20 GUIDEWIRE-TROCH NAIL SYS $400.10 GUIDE/GLIDE WIRE-CLS 2 $314.40 KYPHON INFLATION SYRINGE $548.60 KYPHON DIRECTIONAL BALLOON $5,483.70 ABLATOR, LIGHTWAVE $388.70 SUTURE PASSER $217.30 SUTURE RETRIEVER $466.90 MENISCAL APPLIER $548.60 FAST FIX DELIVERY SYSTEM $1,336.80 FAST FIX KNOW PUSHER $479.90 RESERVOIR (OMMAYA) $782.70 LAPROSCOPIC GEL PORT $2,422.00 BONE FILLER/PUTTY(ALLOMATRIX)6 $1,142.50 PELVIC SLING-CLS1 $4,991.20 PELVIC SLING-CLS 2 $6,876.70 TOE IMPLANT $3,655.80 HIP, METAL ON METAL $29,702.30 SHOULDER, REVERSE $46,152.80 KNEE, HI-FLEX $17,364.50 HIP, CERAMIC ON CERAMIC $24,675.80 PLATE - CLASS 12 $7,425.70 SCREW - CLASS 10 $1,769.20 RADIAL HEAD OR STEM (ELBOW) $9,538.60 CAPSTONE CAGE $16,038.10 SCREW - CLASS 13 $4,569.80 ROD, LUMBAR $600.00 PLATE - CLASS 13 $8,873.10 FEMORAL SHAFT $8,134.20 PLATE, DISTAL RADIUS $7,711.30 A4649 PELVIC SLING-CLS 3 $9,316.70 CATHETER, SINUS BALLOON $3,936.20 GUIDE WIRE, SINUE ILLUMINATED $2,153.70 CATHETER, FRONTAL SINUS GUIDE $1,860.90 CATHETER HANDLE, SINUE GUIDE $277.10 BALLOON INFLATION DEVICE,SINUS $376.40 THD DEVICE $1,986.40 ULTRASONIC GUIDANCE FOR OR $400.00 76942 TENEX DISPOSABLE PACK $2,943.50 TOTAL HIP PACK KIT $1,672.80 TOTAL KNEE PACK KIT $1,463.70 WC SPEC ORD/IMPLANTS CAT 1 $1,000.00 WC SPEC ORD/IMPLANTS CAT 2 $2,000.00 WC SPEC ORD/IMPLANTS CAT 3 $3,000.00 WC SPEC ORD/IMPLANTS CAT 4 $4,000.00 WC SPEC ORD/IMPLANTS CAT 5 $5,000.00 WC SPEC ORD/IMPLANTS CAT 6 $10,000.00 WC SPEC ORD/IMPLANTS CAT 7 $15,000.00 WC SPEC ORD/IMPLANTS CAT 8 $20,000.00 WC SPEC ORD/IMPLANTS CAT 9 $25,000.00 WC SPEC ORD/IMPLANTS CAT 10 $30,000.00 WC SPEC ORD/IMPLANTS CAT 11 $40,000.00 WC SPEC ORD/IMPLANTS CAT 12 $50,000.00 WC SPEC ORD/IMPLANTS CAT 13 $60,000.00 WC SPEC ORD/IMPLANTS CAT 14 $75,000.00 WC SPEC ORD/IMPLANTS CAT 15 $99,000.00 GRAFTJACKET 4X7CM $9,938.90 CAM WALKING BOOT $696.00 CANCELLOUS BONE/CHIPS 15CC $948.00 PLATE - CLASS 2 $650.00 PLATE - CLASS 4 $975.00 PLATE - CLASS 8 $3,500.00 PLATE - CLASS 9 $4,500.00 PLATE - CLASS 10 $5,500.00 PLATE - CLASS 11 $6,500.00 PLATE - CLASS 14 $10,000.00 PLATE - CLASS 15 $11,000.00 SCREW - CLASS 1 $153.50 SCREW - CLASS 3 $425.00 SCREW - CLASS 9 $1,450.00 SCREW - CLASS 11 $2,500.00 SCREW - CLASS 12 $3,500.00 SCREW - CLASS 14 $5,500.00 SCREW - CLASS 15 $6,500.00 BIOVANCE 4X4 CM $8,700.00 INTERFYL 100 MG $5,500.00 INTERFYL FLOWABLE 1.5ML SYRING $9,200.00 KNOTLESS ROPE SYNDESMOSIS $3,520.00 FOOT & ANKLE KIT SCP $13,180.00 REAMER - CLASS 1 $650.00 REAMER - CLASS 2 $850.00 REAMER - CLASS 3 $1,050.00 FLIPCUTTER $1,300.00 INTERNAL BRACING LIGAMENT SYST $4,148.00 SYNDESMOSIS REPAIR IMPLANT $3,520.00 CATHETER $1,900.00 TROCAR STYLETTE $1,900.00 STRAIGHTENING STYLETTE $260.00 TITANIUM ADAPTOR $500.00 EVARREST SEALANT PATCH $3,600.00 REVERSE TOTAL SHOULDER $33,000.00 SERENGETI MI RS DBL DIAMOND $960.00 PERC LAMINECTOMY ONE LEVEL KIT $8,620.00 PERFECT SCALPEL $1,576.00 SYNDESMOSIS IMPLANT SYSTEM $9,400.00 ARTIFICIAL DISC $16,020.00 CRYONEVROLYSIS DEVICE CODE $1,600.00 CRYONEVROLYSIS BLOCK RT $2,000.00 CRYONEVROLYSIS BLOCK LT $2,000.00 IVAS KIT $4,050.00 10 GAUGE DRILL $240.00 10 GAUGE FILLER $220.00 10 GAUGE BIOPSY $280.00 AUTOPLEX w/HV CEMENT $3,048.00 BSS 250CC $442.40 EYE CAUTERY $37.90 EYE SHEILD PLASTIC $15.10 NASAL SPLINT-DENVER $188.70 MYOCURE PHACO KERATOME BLADE $72.20 ALCON VITRECTOMY HANDPIECE $380.60 LENS, INTRAOCCULAR $772.50 EYE PIK PAK - M $985.00 EYE PIK PAK - G $626.30 ARTHROCARE COBLATOR II WAND $868.40 LENS, ANTERIOR CHAMBER $685.60 EYE OCUTOME PROBE $754.20 EYE ABS HANDPIECE $182.90 EYE STABILIZER RING $914.20 EAR BURR $627.30 MYRINGOTOMY TUBE-JAHN $548.60 NASAL SEPTAL BUTTON $508.60 IMPLANT SYNTHETIC VOCAL CORD $1,202.80 NEEDLE BIOFORM RIGIN INJECTION $280.10 RADIESSE VOICE GEL $1,254.60 RADIUS VOICE $1,254.60 RIGID INJ NEEDLE (VOCAL INJ) $280.10 SAUVAGE FABRIC $964.30 CAROTID SHUNT $263.00 EMBOLECTOMY CATHETER $507.50 INTRODUCER $274.40 PERITONEAL ACSS CATH EXTERNAL $731.30 HIP, TOTAL $12,900.00 MIXING CHAMBER $228.60 CEMENT MIXER W/NOZZLE (HIP) $457.20 DIALYSIS CATHETER $565.70 ELECTRODE,LOOP -CLS 1 $360.20 HEMASHIELD GRAFTS-CLASS 1 $2,451.80 MEADOX TEFLON FELT $154.40 VALVULOTOME $2,284.90 MEDOX CARDIOVASC PATCH $1,400.00 SELDINGER ENTRY NEEDLE #44-163 $12.80 PINNACLE INTRODUCER SHEATH $37.90 PACEMAKER LEAD-ATRIAL $3,139.50 PACEMAKER LEAD-VENTRICULAR $3,139.50 TESIO CATH GUIDEWIRE $135.00 STAPLER, HAND PIECE $426.30 US SURG GIA RELOAD $1,543.60 BARD OPTI-FLO CUFFED CATHETER $1,312.80 BOSTON SCIENTIFIC TORQUE DEVIC $40.20 BARD IMPRA GRAFT F7007TW $3,227.50 BARD IMPRA GRAFT F7006TW $3,227.50 BARD IMPRA GRAFT F8006TW $3,913.00 BARD IMPRA GRAFT F4006TW $2,227.90 BARD IMPRA GRAFT F70T7-4 $3,570.20 BARD IMPRA GRAFT CF5006 $2,342.20 BARD IMPRA GRAFT 70S07TW $2,741.90 BARD IMPRA GRAFT 40S06TW $1,713.80 BARD IMPRA GRAFT 40S06 $1,485.30 BARD IMPRA GRAFT DF7006SC $9,596.30 BARD IMPRA GRAFT 70S08 $2,256.50 HEMI GLIDE CATH, BARD $1,607.60 VASCULAR PATCH $1,015.00 BARD GRAFT DFM7006SC $9,515.20 HEMASHIELD GRAFTS-CLASS 2 $1,800.60 BARD GRAFT 70S06TWC $2,570.60 BARD GRAFT 70S08TWC $2,570.60 BARD GRAFT 80S06TW $2,570.60 BARD GRAFT 80S06C $2,627.60 BARD GRAFT F7006TW $3,084.70 BARD GRAFT 80S10TW $3,084.70 BARD GRAFT F70T74TSC $3,570.20 BARD GRAFT F8010C $3,655.80 BARD GRAFT 10002-5050-001 $4,798.20 BARD GRAFT F8008TWSC $7,104.00 BARD GRAFT DFM8006SC $9,596.30 AORTIC PUNCH $137.40 IVC RETRIEVAL SET $1,308.30 INTRODUCER-ENDO AAA $559.90 PACEMAKER, DUAL CHAMBER RR $14,851.20 PACEMAKER, SINGLE CHAMBER RR $13,023.50 BARD GRAFT 70S10TW $2,570.60 CAROTID SHUNT $1,239.80 NEUROSTIMULATOR GENERATOR BLAD $45,604.50 C1820 NEUROSTIMULATOR LEAD $13,891.70 A4290 PT PROGRAMMER (NEUROSTIM)BLADD $5,437.90 C1787 LEAD INTRODUCER KIT $1,279.80 C1894 NEUROSTIMULATOR ANTENNA $365.60 A4649 LEAD, NEUROSTIM TEST KIT $8,225.40 C1897 NEUROSTIMULATOR,GENERATOR(NON $44,276.20 NEUROSTIMULATOR LEAD $13,487.10 NEUROSTIM LEAD INTRODUCE BLADD $1,242.40 NEUROSTIMULATOR PROGRAMING $5,279.50 C1787 NEUOSTIMULATOR ANTENNA $355.00 ARTEGRAFT $4,800.00 DEFIBRILLATOR, SINGLE CHAMBER $39,200.00 DEFIBRILLATOR, DUAL CHAMBER $44,000.00 DEFIBRILLATOR, CRT/BIV $52,000.00 LEAD,DEFIBRILLATOR,SINGLE COIL $12,000.00 LEAD,DEFIBRILLATOR,DUAL COIL $12,000.00 HEMASHIELD GRAFTS-CLASS 3 $3,400.00 PACEMAKER, BIVENTRICULAR $28,000.00 STAPLER, LDS $668.50 STAPLER, E E A $1,510.90 A4649 STAPLER, RELOAD RU 30, 60, 90 $173.80 LINEAR STAPLES RL 30 $1,452.20 LINEAR STAPLES RL 60 $1,486.50 STAPLER, RELOAD LN 30, 60, 90 $457.20 STAPLER, ROTICULATOR 45-60 $1,096.90 PURSE STRING INST. $354.30 SURGINEEDLE 120MM AUTO-SUTURE $71.10 SURGINEEDLE 150MM AUTO SUTURE $71.10 SURGIPORT 5MM to 8MM $108.90 SURGIPORT 11 to 12 MM $328.40 ENDO CLIP AUTO SUTURE $547.10 5.5MM SURG CONVERT $71.10 LAP CHOLI KIT $1,482.50 ETHICON 20MM LIGACLIP/EA $273.30 VESSEL SEALER $3,015.20 ETHICON STAPLER ""G"" EZ45G $3,858.20 STAPLER, RELOAD $565.70 TACKER $2,741.90 CODMAN BIPOLAR CORDS $28.80 EVOKED POTENTIALS; UPPER EXT $1,600.00 95925 DRILL BITS, NEURO-CLASS 1 $363.60 CASPAR DISTRACTION PINS $185.40 BLACK MAX SPEED DRILL BITS $167.00 SPINAL NEUROSTIMULATOR-BACK $70,238.00 EXT KIT, SPINAL STIMULAT-BACK $5,237.40 PT PROGRAMMER SPINAL STIM-BACK $4,039.70 DRILL BITS, NEURO-CLASS 2 $1,025.00 STOCKINETTE 6 $18.50 BILE BAG 19 OZ $18.50 NEEDLE, TRU-CUT BIOPSY $76.80 DERMATONE CUTTING BLADE $49.40 CYTOLOGY BRUSH $491.30 T TUBES $31.10 STAPLER, SKIN $127.40 SURGICLIP $258.40 DISPOSABLE BOVIE PAD $12.80 DISPOSABLE VEIN STRIPPER $8.40 DIS.DERMATONE CUTTING HEA $40.20 ENT-NERVE STIMULATOR $182.90 CATHETER, URETERAL $228.60 URETERAL CATH CONNECTOR $16.30 TRAVENOL GLYCINE $121.80 MOSS TUBE PLAIN $37.90 CHOLANGIOCATH $263.00 DISP DERAMTOME BLADE $137.40 GAUEER PONSKI SET $628.50 MARLEX MESH $1,071.80 PROBE $685.60 PULSAVAC SUCTION LAVAGE $189.90 DERMATOME BLADE $125.80 SCLERO THERAPY NEEDLE $178.50 URETERAL J STENT $307.60 STAPLER, GIA 60/80 $502.80 STAPLER, RELOAD GIA 60/80 $371.50 TRANSMISSION TUBE $171.60 BARD TEF GUIDEWIRE $199.10 BARD BALLOON CATH $781.70 BALLOON INFLAT DEVICE $1,008.90 URETERO FORCEPS-3 WIRE $513.10 GIA REFILL $430.90 DRILL BIT/TWIST DRILL-CLS 2 $284.70 BILIARY STENT KIT $1,833.70 FLAT DRAIN $128.10 MYRINGOTOMY TUBE $114.30 AUTO PROSTATE BX SYSTEM $171.60 VITAL VUE SUCTIONS $369.10 SNARES, DISP POLYPECTOMY $114.30 MALECOT NEPHROS SET $613.70 GUIDE/GLIDE WIRE-CLS 1 $160.10 BX FCPS (MICROVASIVE DISP $258.40 URETERAL BASKET $914.20 URETERAL STONE DISPLACE CATH $152.20 LOOPOSTOMY 4"" GENTLE TOUCH $152.20 LOOPOSTOMY 2 3/4 GENTLE TOUC $124.70 FEMORAL IRR & SUCTION TIP SETS $39.10 SEMIPULSE IRRIGATOR KIT $146.40 STENT, URETERAL CLS 1 $628.50 US SURG 5MM SURGICLIP SLEEVE $369.10 SUCTION IRRIGATOR KIT-LAP CHOL $180.00 URISTIL SUPRAPUBIC TUBE $209.20 MEDITECH-EMPLATZ GUIDEWIRES $213.90 IVC FILTER $4,569.80 ENDOPATH BLUNT TIP TROCAR $486.80 MICRO DUAL LUMEN STONE DIS $191.10 INFUSAPORT $2,524.90 ELECTRODE, LLETZ $91.60 DISTRACTION/SKULL PINS $396.60 LAP AM CATH CHOLANGIO CATH $547.40 TUOHY-BORST/SIDE PORT $67.50 ERCP CATHETER $263.00 KNIFE COLD DISPOSABLE $874.20 APDYNE PHENOL APP KIT $79.00 ETHICON ENDOLOOP #EL10G $66.50 MESH, HERNIA - CLASS 1 $499.60 ELECTROSURG PROBE W NEEDLE TIP $409.20 ENDOSHEARS $342.90 ETHICON CUTTER REFILLS #ERU35 $400.10 ETHICON LINEAR CUTTER #ELC35 $870.70 THORACIC PORT 20MM $558.30 BARD MARLEX MESH PERFIX PLUG $685.60 THORACIC PORT 15MM $558.30 IRRIGATION TUBING $211.60 MUSCLE BX CLAMP $297.20 INTRA NASAL SPLINT $125.80 BERKELEY DC & E SYSTEM $137.40 ETHICON ROTATING HEAD STAPLER $791.90 MONITORING PROBE DISP $185.40 PEG SUPPORT TRAY $93.90 UTERINE MANIPULATOR $251.50 BALLOON KIT,DILATATION-CLASS 1 $1,142.50 ENDOCATCH $371.50 SUTURE DEVICE $2,040.00 ENDOSTITCH, SUTURE $182.90 BABCOCK (GRASPER) $942.70 LIVER RETRACTOR, US SURGICAL $514.30 NASAL TAMPON $57.30 PUMP SYRINGE $211.60 SW100 ETHICON SUTURE ASSIST $370.50 SW110 REFILLS $58.50 MICROVASIVE GAUGE $137.40 DILATOR, ESOPHOGEAL $1,051.20 MICROVASIVE URETERAL DILATORS $293.90 PERI-STRIPS/SEAMGUARD $790.40 LIS QUICK LOAD SUTURE $69.90 FALOPE RINGS, ACMI $228.60 TRANSVAGINAL ANCHOR SYSTEM $4,682.80 OLYMPUS INSUFLATION TUBING $33.30 TUBING, IRRIGATION ENT $122.10 DOLPHIN TUBING SET $217.30 NASAL DEBRIEDER $1,170.90 DERMABOND $335.00 URODYNAMICS CABLES $171.60 MISC OTHER DEVICES $0.00 GASTROSTOMY FEEDING TUBE $161.30 ESOPHAGEAL BAND LIGATOR $1,415.70 RETRIEVAL DEVICE $434.30 SPOT ENDOSCOPIC MARKER CHEKMED $99.60 TRIPOLAR FORCEPS $1,240.80 ABLATION SYSTEM $4,546.80 MICROVASIVE COAXIAL INTRODUCER $187.60 MESH, VENTRALEX #10010301 SM $1,885.10 MESH, VENTRALEX #0010302 MED $2,253.00 CYTOLOGY BRUSH $524.60 JAG WIRE $799.90 TRAPEZOID BASKETS $1,317.30 BILIARY STENT $485.80 BILIARY LOCKING DEVICE $45.90 RX CHOLANGIOGRAM KIT $1,268.20 EXTRACTOR BALLOON $734.70 DILITATION BALLOON $1,219.20 AUTOTOME/JAGTOME/DREAMTOME $1,656.70 BREEZE RX $353.30 ENDOCLOSE $242.40 DAVOL, 20 Q RING,IMPLANT CART $1,876.10 CYSTOGRAM TUBING/CYSTOGRAFFIN $59.70 ARGON TRIPLE OPTION HANDPIECE $217.30 ESSURE MICRO-INSERT SPRINGS(2) $6,443.30 ESSURE DISPOSABLE CATHETER (2) $708.50 MISC FEEDING TUBE $100.80 NON-VASC BALLOON DILATN CATH $1,064.90 APC PROBE $975.80 LIGASURE $1,942.30 MESH, HERNIA - CLASS 2 $685.60 MESH, HERNIA - CLASS 3 $914.20 MESH, HERNIA - CLASS 4 $2,142.20 MESH, HERNIA - CLASS 5 $3,427.30 MESH, HERNIA - CLASS 6 $4,398.40 MESH, HERNIA - CLASS 7 $8,197.00 MESH, VENTRALEX #10010303 LG $2,342.20 HERNIA, KUGEL MODIFIED PATCH $1,005.50 RESOLUTION CLIPS $876.00 ERCP CANNULA (STD OR TAPER) $260.70 WALL STENT $9,596.30 SAW BLADE, DISPOSABLE-CLS 2 $160.10 SAW BLADE, DISPOSABLE-CLS 3 $325.90 DRILL BIT/TWIST DRILL-CLS1 $171.60 STAPLER,RELOAD VASC.-CLASS 1 $1,199.80 CATHETER, BILIARY $497.20 ANAL FISTULA PLUG $3,884.30 MAMMOSITE CED CATHETER $1,120.00 CATHETER, BALLOON TISS DISECTR $1,051.20 J TUBE $491.30 FALOPE RING BAND KITS $856.90 RETRACTOR/STAY $205.80 PH PROBE $457.20 A4649 VESSEL SEALER $845.50 T-ROM KNEE BRACE $1,700.00 PERM CONTRACEPTIVE DEVICE EA $3,806.30 PERM CONTRACEPTIVE INSERT KIT $344.60 BRACHYMESH W/I-125 SEEDS $12,921.80 MAMMOSITE MULTI LUMEN APPLICAT $9,600.00 A-CELL,MM0060,60MG MICROMATRIX $941.00 A-CELL,MM0100,100MG MICROMATRI $1,568.20 A-CELL,MM0200,200MG MICROMATRI $3,136.40 A-CELL,MM0500,500MG MICROMATRI $7,840.90 A-CELL,SMRS0204,2X4CM SURGICAL $705.80 A-CELL,PSMX0505,5X5CM PLASTIC $3,136.40 A-CELL,PSMX0412,4X12CM PLASTIC $6,021.80 A-CELL,PSMX0615,6X15CM,PLASTIC $11,290.90 A-CELL,PSMX0710,7X10CM,PLASTIC $8,781.80 A-CELL,PSMX0816,8X16CM,PLASTIC $16,058.20 A-CELL,PSMX1015,10X15CM,PLASTI $18,818.10 HDR LUNG THERAPY CATH (ELEKTA) $1,979.30 C1728 HDR LUMEN CATH GUIDEWIRE(ELEKT $441.60 C1769 MESHED BIL WND MAT PER SQ, 25 $9,189.90 MESHED BIL WND MAT PER SQ,125 $15,328.60 A-CELL,MM1000,1000MG MICROMAT $9,865.80 ANTERIOR REPAIR MESH $7,917.00 FLOWABLE WOUND MATRIX,FWD301,3 $14,210.00 MESHED BILAYER WOUND MATRIX,MW $9,189.90 SYNTHETIC IMPLNT URINARY 1ML $1,522.50 COAPTITE INJ IMPLANT 1ML $1,492.10 SIDEKICK NEEDLE 14.6" 21GA $182.70 WC SPEC ORD/SURG SUPPLY CAT 1 $500.00 WC SPEC ORD/SURG SUPPLY CAT 2 $1,000.00 WC SPEC ORD/SURG SUPPLY CAT 3 $1,500.00 WC SPEC ORD/SURG SUPPLY CAT 4 $2,000.00 WC SPEC ORD/SURG SUPPLY CAT 5 $2,500.00 WC SPEC ORD/SURG SUPPLY CAT 6 $3,000.00 WC SPEC ORD/SURG SUPPLY CAT 7 $3,500.00 WC SPEC ORD/SURG SUPPLY CAT 8 $4,000.00 WC SPEC ORD/SURG SUPPLY CAT 9 $4,500.00 WC SPEC ORD/SURG SUPPLY CAT 10 $5,000.00 WC SPEC ORD/SURG SUPPLY CAT 11 $5,500.00 WC SPEC ORD/SURG SUPPLY CAT 12 $6,000.00 WC SPEC ORD/SURG SUPPLY CAT 13 $6,500.00 WC SPEC ORD/SURG SUPPLY CAT 14 $7,000.00 WC SPEC ORD/SURG SUPPLY CAT 15 $7,500.00 WC SPEC ORD/SURG SUPPLY CAT 16 $8,000.00 WC SPEC ORD/SURG SUPPLY CAT 17 $9,000.00 WC SPEC ORD/SURG SUPPLY CAT 18 $10,000.00 WC SPEC ORD/SURG SUPPLY CAT 19 $12,500.00 WC SPEC ORD/SURG SUPPLY CAT 20 $15,000.00 THERASKIN 5.1 X 7.6 CM $5,100.00 VPAD CONNECTOR CABLE-NAVBRONCH $935.00 VPAD PATIENT TRACKER-NAVBRONCH $1,360.00 GUIDEWIRE,1.0MM,950MM-NAVBRONC $765.00 BRUSH-NAVBRONCH $2,040.00 FORCEPS,SERRATED CUP-NAVBRONCH $2,040.00 NEEDLE,HISTO,19GA-NAVBRONCH $2,040.00 NEEDLE,CYTO,21GA-NAVBRONCH $2,040.00 NEEDLE,NITINOL,22GA-NAVBRONCH $3,060.00 CATH,PERIPH,3.8MM,2.5MM-NAVBRO $2,890.00 SPINPERC KIT-NAVBRONCH $1,360.00 LAP BAND $15,100.00 LAP BAND ACCESS PORT $3,000.00 TRACH TUBE, HYPERFLEX $760.00 RPEZ APPLIER--LAP BAND $800.00 CALIBRATION TUBE--LAP BAND $500.00 BALLOON KIT,DILATATION-CLASS 2 $1,625.00 C1726 STAPLER,RELOAD VASC.-CLASS 2 $1,800.00 WC SPEC ORD/SURG SUPPLY CAT 21 $17,500.00 WC SPEC ORD/SURG SUPPLY CAT 22 $20,000.00 9 BIOZORB MARKER AND PLACEMENT $0.00 BIOZORB PLACEMENT PROCEDURE $2,500.00 BIOZORB MARKER FOR RDT $4,000.00 9AAA DISPOSABLE PROCEDURE KIT $0.00 AAA INTRODUCER SHEATH $103.00 AAA (2)SELDINGER ENTRY NEEDLES $50.50 AAA(1)NAMIC PROCTECTION STATIO $53.90 AAA2ROYAL FLUSH ANGIO CATH CS $1,224.90 AAA2 TSCMG-35-260-LES3 STIFF G $689.00 AAA2DAIG RT GUIDEWIRES/1TORCON $96.50 AAA ANGIOGRAPHIC CATH VAN 4 $121.80 BALLOON CATHETER, CODA $1,704.60 MAIN BODY GRAPH $35,169.30 A4649 ILIAC ENDOGRAPHS,EA $12,832.70 A-CELL PFM0912 MESH $7,892.70 MEDTRONIC MAGNIFUSE $9,450.00 AVITUS 5 MM HARVESTER $6,300.00 AVITUS PILOT HOLE CREATOR $1,237.00 *ORGAN CHARGES $0.00 C O R E - ORGAN DONATION $3,882.00 MICRON FIBER WO/HAND PIECE $1,354.10 MICRON FIBER W/HAND PIECE $1,549.20 GAS FLUID CARTRIDGE $508.60 *HOLIUM LASER STAND BY FEE $0.00 UNILATERAL LITHOTRIPSY $12,597.70 50590 BILATERAL LITHOTRIPSY $16,727.20 5059050 ELECTRODE,LOOP -CLS 2 $628.50 ELECTRODE, LOOP -CLS 3 $971.20 BIOPSY FORCEP (CYSTO) $1,508.10 STENT, URETERAL CLS 2 $1,462.50 STENT, URETERAL CLS 3 $422.90 MRI/MRA MRI ORBIT FACE NECK $1,522.50 70540 MRI BRAIN $1,522.50 70551 MRI CHEST $1,522.50 71550 MRI CERVICAL SPINE W/O CONT $1,522.50 72141 MRI THORACIC SPINE W/O $1,522.50 72146 MRI LUMBAR SPINE W/O CONT $1,522.50 72148 MRI ABDOMEN $1,814.00 74181 MRI LUMBAR SPINE W/ CONT $2,131.50 72149 MRI BRAIN W/CONTRAST $2,131.50 70552 MRI CERV SPINE W/CONTRAST $2,131.50 72142 MRI THORACIC SPINE W/C $2,131.50 72147 MRI LUMBAR W/WO $2,740.50 72158 MRI THOR W/WO $2,740.50 72157 MRI CERV W/WO $2,740.50 72156 MRI BRAIN W/WO $2,740.50 70553 MRI ABD W/WO CONTRAST $3,095.80 74183 MRA PELVIS WITH CONSTRAST $1,928.50 72198 MRI TMJ $1,644.30 70336 MRI ORBIT FACE NECK W/CONTRAST $2,131.50 70542 MRI ORBIT FACE NECK W/&W/O $2,740.50 70543 MRI CHEST W/CONTRAST $3,781.50 71551 MRI CHEST W/&W/O CONTRAST $2,740.50 71552 MRI PELVIS W/O CONTRAST $1,522.50 72195 MRI PELVIS W/CONTRAST $2,131.50 72196 MRI PELVIS W AND W/O CONTRAST $2,740.50 72197 MRI ABDOMEN W/CONTRAST $1,674.80 74182 MRA HEAD W/O $1,522.50 70544 MRA NECK W/O $1,522.50 70547 MRA NECK W/ $2,131.50 70548 MRA NECK W/ AND W/O $2,740.50 70549 MRI UPPER EXTREMITY LT W/O $1,522.50 73218LT MRI UPPER EXTREMITY LT W/ $2,131.50 73219LT MRI UPPER EXTREMITY RT W/O $1,522.50 73218RT MRI UPPER EXTREMITY RT W/ $2,131.50 73219RT MRI LOWER EXTREMITY LT W/O $1,395.70 73718LT MRI LOWER EXTREMITY LT W/ $1,674.80 73719LT MRI LOWER EXTREMITY RT W/O $1,395.70 73718RT MRI LOWER EXTREMITY RT W/ $1,674.80 73719RT MRI JOINT UPPER EXT LT WITH $2,233.00 73222LT MRI JOINT UPPER EXT LT W/&W/O $2,842.00 73223LT MRI JOINT UPPER EXT RT W/ $2,233.00 73222RT MRI JOINT UPPER EXT RT W/&W/O $2,842.00 73223RT MRI JOINT LOWER EXT LT W/&W/O $2,390.40 73723LT MRI JOINT LOWER EXT RT WITH $1,903.20 73722RT MRI JOINT LOWER EXT RT W/&W/O $2,390.40 73723RT MRI LOWER EXTREMITY LT W/& W/O $2,500.00 73720LT MRI LOWER EXTREMITY RT W/& W/O $2,500.00 73720RT MRA ABD W/CONTRAST $1,801.70 74185 MRA ABD W/O CONTRAST $1,801.70 74185 MRA ABD W & W/O CONTRAST $1,801.70 74185 MRI BREAST W/O (UNI) LT $2,867.50 77058LT MRI BREAST W & W/O (UNI) LT $2,867.50 77058LT MRI BREAST W/O (BI) $1,700.00 C8907 MRI BREAST W & W/O (BI) $2,867.50 77059 MRA CHEST W CONTRAST $1,522.50 71555 MRA CHEST W/O $1,522.50 71555 MRA CHEST W & W/O $1,522.50 71555 MRA LOWER EXT W & W/O LT $2,390.40 73725LT MRI BREAST W/O (UNI) RT $2,867.50 77058RT MRI BREAST W & W/O (UNI) RT $2,867.50 77058RT MRA LOWER EXT W & W/O RT $2,390.40 73725RT MRA, SPINE W/WO CONTR $2,740.50 72159 MRA PELVIS W/O CONTRAST $1,015.00 MRA PELVIS W/WO CONTRAST $1,015.00 MRI MRCP $1,814.00 74181 MRA W/O&W/DYE UPPER EXTR RT $2,892.80 73225RT MRA W/O&W/DYE UPPER EXTR LT $2,892.80 73225LT MR TISSUE MARKER $335.00 A4648 MR ATEC HANDPIECE $1,960.00 C1819 MR ATEC CANISTER $21.70 MRI BREAST W/O (UNI) RT, LTD $1,015.00 C8904RT52 MRI BREAST W/O (UNI) LT, LTD $1,060.00 77058LT52 MRI, IAC ONLY, W & W/O $2,740.50 7055352 MRI BRAIN & PITUITARY W & W/O $2,740.50 70553 MRI PITUITARY ONLY, W & W/O $2,740.50 7055352 MR GRID IMMOBILIZER PLATE $81.20 MRI BRAIN/IAC W/O CONT $1,522.50 70551 MRI BRAIN & PITUITARY W/O $1,522.50 70551 MRI 18G LOC NDL $345.10 MRA LOWER EXTREMITIES, NO CONT $1,015.00 MRI BREAST BX INITIAL RT $2,650.00 19085RT MRI BREAST BX INITIAL LT $2,650.00 19085LT MRI BREAST BX ADDL RT $1,725.50 19086RT MRI BREAST BX ADDL LT $1,725.50 19086LT MRI NEEDLE LOC INITIAL RT $1,150.00 19287RT MRI NEEDLE LOC INITIAL LT $1,150.00 19287LT MRI NEEDLE LOC ADDL RT $761.30 19288RT MRI NEEDLE LOC ADDL LT $761.30 19288LT GADOBUTROL INJ 7.5ML-IRG $162.40 A9585 GADOBUTROL INJ 10ML-IRG $213.20 A9585 MR LOCALIZING OBTURATOR $304.50 C1782 MR NEEDLE BLOCK/GUIDE $50.80 MR INTRODUCER STYLET $192.90 C1894 MR INTRODUCER SHEATH $192.90 C1894 MRI JOINT LOWER EXT LT W/O $1,649.40 73721LT MRI JOINT UPPER EXT RT W/O $1,649.40 73221RT MRI JOINT LOWER EXT RT W/O $1,649.40 73721RT MRI JOINT UPPER 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FACIAL BONES 5BU $30.00 00190QX ANES FACE BNS RAD SURGERY 7BU $30.00 00192QX ANES INTRACRAN PROC 11BU $30.00 00210QX ANES SUBDURAL TAPS 5BU $30.00 00212QX ANES BURR HOLES 9BU $30.00 00214QX ANES VASCULAR PROC 15BU $30.00 00216QX ANES PROL SIT POSITION 13BU $30.00 00218QX ANES SPNL FLD SHUNT 10BU $30.00 00220QX ANES ELECCOAG INTRA NERVE 6BU $30.00 00222QX ANES INTGMNTRY SYS NECK 5BU $30.00 00300QX ANES ESOPH,THY,LAR,TRACHEA 6BU $30.00 00320QX ANES NDL BX THYROID 3BU $30.00 00322QX ANES MAJOR VES NK 10BU $30.00 00350QX ANES SIMP LIGATION 5BU $30.00 00352QX ANES INTGUMNTRY SYS CHEST 3BU $30.00 00400QX ANES RECONST BRST 5BU $30.00 00402QX ANES RAD/MOD BRST 5BU $30.00 00404QX ANES RAD/MOD BRST MAM NODE13BU $30.00 00406QX ANES ELEC CONV ARRHYTHMIAS 4BU $30.00 00410QX ANES POST INTGMNTRY SYS CH 5BU $30.00 00300QX ANES CLAV-SCAPULA 5BU $30.00 00450QX ANES BX CLAVICLE 3BU $30.00 00454QX ANES PART RIB RESECTION 6BU $30.00 00470QX ANE RIB THORACOPLASTY 10BU $30.00 00472QX ANES RIB RADICAL SURGERY 13BU $30.00 00474QX ANES ESOPHAGUS ALL 15BU $30.00 00500QX ANES CLSD CHEST PROC 6BU $30.00 00520QX ANES NDLE BX PLEURA 4BU $30.00 00522QX ANES PNEUMONCENTESIS 4BU $30.00 00524QX ANES MEDIASTINOSCOPY 8BU $30.00 00528QX ANES TRANVNS PACMKR INSRT 4BU $30.00 00530QX ANES THORCTMY PROC 12BU $30.00 00540QX ANES THORCTMY DECORTICATN 15BU $30.00 00542QX ANES PLEURECTOMY 12BU $30.00 00540QX ANES PULM RESEC W/THRPLSY 15BU $30.00 00546QX ANES INTRTHRC REPR TRACH 17BU $30.00 00548QX ANES HEART,PERCRDM,VESSLS 15BU $30.00 00560QX ANES CERV SPINE & CORD 10BU $30.00 00600QX ANES POST CERV LAMINECTOMY13BU $30.00 00604QX ANES THOR SPINE & CORD 10BU $30.00 00620QX ANES LUMBAR REGION 8BU $30.00 00630QX ANES LUMBAR SYMPHCTMY 7BU $30.00 00632QX ANES EXTEN SPINE&CORD PROC13BU $30.00 00670QX ANES UP ANT ABD INTEG 3BU $30.00 00400QX ANES PERC LIVER BX 4BU $30.00 00702QX ANES UP ABD WALL 5BU $30.00 00730QX ANES UP GASTRO ENDOSCOPIC 5BU $30.00 00740QX ANES HERNIA UP ABD 4BU $30.00 00750QX ANES LUM/VEN 6BU $30.00 00752QX ANES TRANSAB REPR DIA HERNA7BU $30.00 00756QX ANES MAJ ABD BL VESSELS 15BU $30.00 00770QX ANES INTRPRTNL PRC UP ABD 7BU $30.00 00790QX ANES PART 13BU $30.00 00792QX ANES 8BU $30.00 00794QX ANES LOW ABD INTEG 3BU $30.00 00400QX ANES PANNICULECTOMY 5BU $30.00 00802QX ANES INTES ENDO PROC 5BU $30.00 00810QX ANES LOW POS ABD WALL 5BU $30.00 00820QX ANES HERNIA REPR LOW ABD 4BU $30.00 00830QX ANES VENT INCIS HERNIAS 6BU $30.00 00832QX ANES ABDPRNL RESECTION 7BU $30.00 00844QX ANES RAD HYSTERECTOMY 8BU $30.00 00846QX ANES PELVIC EXENTRN 8BU $30.00 00848QX ANES CESAREAN SECTION 7BU $30.00 01961QX ANES EXTRPRTNL PROC LOW ABD6BU $30.00 00860QX ANES RENAL PROC 7BU $30.00 00862QX ANES TOTAL CYSTECTOMY 8BU $30.00 00864QX ANES ADRENALECTOMY 10BU $30.00 00866QX ANES CYSTOLITHOTOMY 5BU $30.00 00870QX ANES MAJ LOW ABD VESSELS 15BU $30.00 00880QX ANES INF VENA CAVA LIGTN 10BU $30.00 00882QX ANES TRNSVNS UMBRELLA INSR 5BU $30.00 01930QX ANES INTEG-EXT,ANT TRUNK,PERI3 $30.00 00400QX ANES ANORECTAL PROC 5BU $30.00 00902QX ANES VULVECTOMY 4BU $30.00 00906QX ANES PERINEAL PROSTATECTOMY6BU $30.00 00908QX ANES TUR PROCEDURES 3BU $30.00 00910QX ANES TUR BLADDER TUMOR 5BU $30.00 00912QX ANES TUR PROSTATE 5BU $30.00 00914QX ANES POST TUR BLEEDING 5BU $30.00 00916QX ANES MALE EXT GENITALIA 3BU $30.00 00920QX ANES SEMINAL VESICLES 6BU $30.00 00922QX ANES UNDES TESTIS UNI/BILAT4BU $30.00 00924QX ANES RAD ORCHIECTOMY INGNL 4BU $30.00 00926QX ANES RAD ORCHIECTOMY ABD 6BU $30.00 00928QX ANES ORCHIOPEXY UNI/BILAT 4BU $30.00 00930QX ANES AMPUT PENIS COMPLETE 4BU $30.00 00932QX ANES RAD AMPUT PENIS BIL 6BU $30.00 00934QX ANES RAD AMP PENIS BIL&IL 8BU $30.00 00936QX ANES INSERT PENILE PROS 4BU $30.00 00938QX ANES COLPOT,COLPORR,OPEN URE 4 $30.00 00942QX ANES VAG HYSTERECTOMY 6BU $30.00 00944QX ANES VAG DELIVERY 5BU $30.00 01960QX ANES CERV CERCLAGE 4BU $30.00 00948QX ANES CULDOSCOPY 5BU $30.00 00950QX ANES HYSTEROSCOPY 4BU $30.00 00952QX ANES ANT INTGMNTRY SYS PELV3BU $30.00 00400QX ANES POST INTGNTRY SYS PELV5BU $30.00 00300QX ANES ON BONY PELVIS 6BU $30.00 01120QX ANES INPELABD AMPUTATION 15BU $30.00 01140QX ANES RAD PROC TUMOR PELVIS10BU $30.00 01150QX ANES CLD PROC SYMPHYS PUBIS4BU $30.00 01160QX ANES OPN PROC SYMPHYS PUBIS8BU $30.00 01170QX ANES OBTRTR NEURCTY EXPEVIC3BU $30.00 01180QX ANES OBTRTR NEURCTY INPEVIC4BU $30.00 01190QX ANES CLD PROC HIP JOINT 4BU $30.00 01200QX ANES ARTROSCPC PROC HIP JT 4BU $30.00 01202QX ANES OPN PROC HIP JOINT 6BU $30.00 01210QX ANES OPN PROC HIP DISARTIC10BU $30.00 01212QX ANES TOTAL HIP REPLACEMENT 8BU $30.00 01214QX ANES CLD PROC UP, 2/3 FEMUR4BU $30.00 01220QX ANES OPN PROC UP 2/3FEMUR 6BU $30.00 01230QX ANES OPN PROC AMPUTATION 5BU $30.00 01232QX ANES OPN PROC RAD RESECTION8BU $30.00 01234QX ANES INTEGMNTRY SYS UP LEG 3BU $30.00 00400QX ANES NERV,MUS,TENDON UP LEG4BU $30.00 01250QX ANES VEINS UP LEG INC EXPL 3BU $30.00 01260QX ANES ARTERY UP LEG INC BYPS8BU $30.00 01270QX ANES FEM ARTERY LIGATION 4BU $30.00 01272QX ANES FEM ART EMBOLECTOMY 6BU $30.00 01274QX ANES INTGMNTRY SYS KNEE 3BU $30.00 00400QX ANES NER,MUS,TEN POPLTL ARA4B $30.00 01320QX ANES CLD PROC LOW 1/3 FEMUR4BU $30.00 01340QX ANES OPN PROC LOW 1/3 FEMUR5BU $30.00 01360QX ANES CLD PROC KNEE JOINT 3BU $30.00 01380QX ANES ARTHRO PROC KNEE JOINT3BU $30.00 01382QX ANES CLD PROC UP TIB&FIBULA3BU $30.00 01390QX ANES OPN PROC UP TIB&FIBULA4BU $30.00 01392QX ANES OPN PROC KNEE JOINT 4BU $30.00 01400QX ANES TOT KNEE REPLACEMENT 7BU $30.00 01402QX ANES DISART AT KNEE 5BU $30.00 01404QX ANES CAST APP,REM,REPR KNEE3BU $30.00 01420QX ANES VEIN KNEE & POPLTC ARA3BU $30.00 01430QX ANES ARTRVNS FISTULA 6BU $30.00 01432QX ANES ART KNEE&POPLTL AREA 8BU $30.00 01440QX ANES THROMBENDRTRCTMY 8BU $30.00 01442QX ANES POP EXC&GRT OCC=ANEURY8BU $30.00 01444QX ANES INTGUM SYS LOW LEG 3BU $30.00 00400QX ANES CLOS PROC LL ANK & FT 3BU $30.00 01462QX ANES ARTHRO PROC ANKLE JT 3BU $30.00 01464QX ANES NER,MUS,TEN,FAS LOW LG3BU $30.00 01470QX ANES REPR RUP ACHLLS TENDON5BU $30.00 01472QX ANES GASTRONEM RECESSION 5BU $30.00 01474QX ANES OPN PROC BONE LL LEG 3BU $30.00 01480QX ANES OPN PRO LOW LEG RAD RE4BU $30.00 01482QX ANES OSTTMY-OSTPLSTY TIB-FI4BU $30.00 01484QX ANES TOTAL ANKLE REPLACE 7BU $30.00 01486QX ANES LOW LEG CAST APPLIC 3BU $30.00 01490QX ANES ART LOW LEG INC BYPASS8BU $30.00 01500QX ANES EMBOLCTMY DIR CATHETER6BU $30.00 01502QX ANES VEIN LOW LEG 3BU $30.00 01520QX ANES VEN THROMBECTOMY DIR 5BU $30.00 01522QX ANES INTGUM SYS SHOLDER-AXI3BU $30.00 00400QX ANES NERV MUS TEN SHOULD-AX5BU $30.00 01610QX ANES CLD PRO HUM HD-NK STER4BU $30.00 01620QX ANES ARTHRO PROC SHOULD JT 4BU $30.00 01622QX ANES OPN PRO HUM HD-NK STER5BU $30.00 01630QX ANES SHOULDER DISARTICULAT 9BU $30.00 01634QX ANES INTRTHRCSCPLR AMPUTAT15BU $30.00 01636QX ANES TOT SHOULDER REPLACE 10BU $30.00 01638QX ANES ART SHOULDER-AXILLA 6BU $30.00 01650QX ANES AXIL-BRACH ANEURYSM 10BU $30.00 01652QX ANES BYPASS GRAFT SHOULD-AX8BU $30.00 01654QX ANES AX-FEM BYPASS GRAFT 10BU $30.00 01656QX ANES VEINS SHOULDER-AX 4BU $30.00 01670QX ANES SHOULD CAST APP REMOVE3BU $30.00 01680QX ANES SHOULDER SPICA 4BU $30.00 01682QX ANES INTGUM SYS UP ARM-ELBW3BU $30.00 00400QX ANES NERV,MUS,TEND UP ARM 3BU $30.00 01710QX ANES TENOTOMY ELBW-SHDR OPN5BU $30.00 01712QX ANES TENOPLSY ELBW-SHLDR 5BU $30.00 01714QX ANES TENODESIS RUP TEND BIC5BU $30.00 01716QX ANES CLD PRO HUMERUS-ELBW 3BU $30.00 01730QX ANES ARTHRO PRO ELBOW JOINT3BU $30.00 01732QX ANES OPN PRO HUMERUS-ELBW 4BU $30.00 01740QX ANES OSTEOTOMY OF HUMERUS 5BU $30.00 01742QX ANES REPR NONUN-MALUN HUMER5BU $30.00 01744QX ANES HUMERUS-ELBW RAD PROC 6BU $30.00 01756QX ANES EXC CYST-TUMOR HUMERUS5BU $30.00 01758QX ANES TOT ELBW REPLACEMENT 7BU $30.00 01760QX ANES ART UP ARM 6BU $30.00 01770QX ANES EMBOLECTOMY UP ARM 6BU $30.00 01772QX ANES VEIN UP ARM&ELBOW 3BU $30.00 01780QX ANES PHLEBORRHAPHY UP ARM 4BU $30.00 01782QX ANES INTGUM SYS FORARM WRST3BU $30.00 00400QX ANES NERV,MUS,TEN,FA,WR,HAND3B $30.00 01810QX ANES CLD PRO RAD-ULNA-WRST,3BU $30.00 01820QX ANES OPN PRO RAD-ULNA-WRST 3BU $30.00 01830QX ANES TOT WRIST REPLACEMENT 6BU $30.00 01832QX ANES PRO ART FA-WRST-HAND 6BU $30.00 01840QX ANES EMBOLECTOMY ART FORARM6BU $30.00 01842QX ANES VAS SHNT-SHNT REV DIAL6BU $30.00 01844QX ANES VEINS FORARM-WRST&HAND3BU $30.00 01850QX ANES PHEBORRHAPHY FORARM 4BU $30.00 01852QX ANES CAST APP FA-WRT-HAND 3BU $30.00 01860QX ANES INJ FOR HYSTRSLPNGOGRP4BU $30.00 00952QX ANES BURR HOLE VENTRCLGRPHY9BU $30.00 00214QX ANES DX ARTERIOGRM/VENOGRAM5BU $30.00 01916QX ANES CARD CATH INC COR ART 7BU $30.00 01920QX ANES NONINVAS IMAG/RAD TX 7BU $30.00 01922QX ANES PHYS SUP HARV ORGN 7BU $30.00 01990QX ANES EPIDURAL-SUBAR DR ADM3BU $30.00 01996QX UNLISTED ANESTHESIA $30.00 01999QX TOTAL MINUTES $15.00 PHYSICAL STATUS $30.00 INTUBATION SOLO 6BU $30.00 31500QZ VENIPUNCT UNDER AGE3 OTH VEIN2 $30.00 36406 VENIPUNCTRE CTDOWN UNDER 1 5BU $30.00 36420QX VENIPUNCTRE CUTDOWN 1 & OVR3BU $30.00 36425QX ART PUNCTURE WITHDRL BLD 1BU $30.00 36600QX ART CATH/CANNULTN SAMP,MONT3BU $30.00 36620QX ART CATH/CANN PERC CUTDOWN 5BU $30.00 36625QX SPINAL PUNCT LUMBAR DIAGNOS5BU $30.00 62270QX INJ LUMBAR EPIDURAL BLD/CLT6BU $30.00 62273QX INJ NEUROLYTIC SUBSTNE 20BU $30.00 62280QX INJ NEUROLYTIC SUB EPI/CAU20BU $30.00 62282QX INJ ANES AGENT TRIGEM NERVE $30.00 64400QX INJ ANES AGENT FACIAL NERVE $30.00 64402QX INJ ANES AGENT GR OCCIPITAL $30.00 64405QX INJ ANES AGENT VAGUS NERVE 7BU $30.00 64408QX INJ ANES AGENT PHERNIC NERV8BU $30.00 64410QX INJ ANES AGENT SPIN ACCESS $30.00 64999QX INJ ANES AGENT CERV PLEXUS 8BU $30.00 64413QX INJ ANES AGENT BRACH PLEXUS8BU $30.00 64415QX INJ ANES AGENT AXILLRY NERVE $30.00 64417QX INJ ANES AGENT SUPRASCAPULA5BU $30.00 64418QX ANES VAG PRDC 3BU $30.00 00940QX INJ ANES AGENT INTERCOST MULTI $30.00 64421QX INJ ANES AGENT ILIOINGUINAL $30.00 64425QX INJ ANES AGENT PUDENDAL NER5BU $30.00 64430QX INJ ANES AGENT PARACERV NER5BU $30.00 64435QX INJ ANES AGT SCIATIC NERVE 7BU $30.00 64445QX INJ ANES AGT PERIPHERAL NER5BU $30.00 64450QS INJ ANES AGT SPHENOPAL GAN10BU $30.00 64505QX INJ ANES AGT CAROTID SINUS $30.00 64508QX INJ ANES AGT STELLATE GANG $30.00 64510QX INJ ANES AGT LUMBAR/THORAC $30.00 64520QX INJ ANES AGT CELIAC PLEXUS $30.00 64530QX DESTRUCTION NEUROLYTIC AGT10BU $30.00 64600QX DEST NEUROLY 2-3 FOR OVAL20BU $30.00 64605QX DEST NEURLY 2-3 FOR OV RAD20BU $30.00 64610QX DEST NEURLYTIC INTERCOSTAL10BU $30.00 64620QX DEST NEURLYTIC PUDENDAL NE10BU $30.00 64630QX DESTR NEURLYTC PERIPHRL NERVE $30.00 64640QX AGE UNITS $30.00 99100QX OTHER UNITS $53.90 OXISENSOR $53.90 IV MANIFOLD $53.90 PRESSURE BAG $53.90 ANODE TUBE $53.90 CARD OUTPUT TUBE $53.90 LASER EYE PADS $53.90 TUBE EXCHANGER $53.90 ANES VENIPUNCTURE OVER 3 YRS $30.00 36410QX ANES BLEPHARAPLASTY 5BU $30.00 00103QX ANES IRIDECTOMY 6BU $30.00 00147QX ANES ELEV SKULL FRACT 9BU $30.00 00215QX ANES ACCESS CENT CIRCULAT 4BU $30.00 00532QX ANES INSERT CARDIOVERT/DEFIB7B $30.00 00534QX ANES LITHOTRIPS-NO H2O 5BU $30.00 00873QX ANES INF VENA CAVA LIGAT 10BU $30.00 00882QX ANES FRAG/REM URETERAL CAL 5BU $30.00 00918QX INJ ANES AGENT INTRCSTL 5BU $30.00 64420QX INJ ANES AGENT PARAVENT S CERV $30.00 64479QX INJ ANES AGENT PARAVENT S LUMB $30.00 64483QX INJ ANES AGENT PAR ADD'L CERVI $30.00 64480QX INJ ANES AGENT PAR ADD'L LUMBA $30.00 64484QX ANES INTRVN RAD ART SYS NOS6BU $30.00 01924QX ANES RAD ART SYS CARTD/COR 8BU $30.00 01925QX ANES RAD AORTIC/INTRCRN CA10BU $30.00 01926QX ANES UPPER ABD GST/MRBD OB11BU $30.00 00797QX ANES TUB LIGATION,INC SCOPE6BU $30.00 00851QX ANES VASECTOMY 3BU $30.00 00921QX ANES TRN PORTOCVL SHUNT TIP7BU $30.00 01931QX INSERT TRANS INTRA PORT 7BU $30.00 01931QX ANES REVISION OF TOTAL HIP10BU $30.00 01215QX ANES PROSTATECTOMY;RADICAL 7BU $30.00 00865QX ANES CLOS CHST;MEDIASTNSCO11BU $30.00 00529QX ANES OPN REP FX PELV/COL 12BU $30.00 01173QX ANES EXT CEPHALIC VERSION5BU $30.00 01958QX INSRT NONTUNL CNTRL CVC<5 5BU $30.00 36555QX INSRT NONTUNL CNTRL CVC 5/>4BU $30.00 36556QX INSRT TUNNL CVC NO PORT/PUMP<5 $1,650.00 36557QX INSRT TUNNL CVC NO PORT/PUMP5> $2,200.00 36558QX INSRT TUNNL CNTRL CVAD PORT 5> $3,700.00 36561QX INSRT CNTRL CVAD W/SUBQ PUMP $3,700.00 36563QX INSRT CVAD 2 CATH SITE NO PORT $4,900.00 36565QX INSRT CVAD 2 CATH 2 SITE PORT $3,700.00 36566QX INSERT PICC W/O PORT/PUMP <5YR $1,350.00 36568QX INSERT PICC W/O PORT/PUMP 5YR> $2,000.00 36569QX REP CV ACSS CATH W/O PORT/PUMP $1,200.00 36575QX REP CVAD W/PORT/PUMP CNTRL/PER $1,129.60 36576QX REPL CATH ONLY CVAD SUBQ PORT/ $3,700.00 36578QX REPL NON-TUNLD CVC W/O PORT/PU $2,000.00 36580QX REPL TUNLD CNTRL CVC W/O PORT/ $3,700.00 36581QX REPL TUNLD CNTRL CVAD W/SUBQ P $3,700.00 36582QX REPL TUNLD CNTRL CVAD WSUBQ PO $3,200.00 36583QX REPL PICC W/O PORT/PUMP SAME A $2,000.00 36584QX REMV TUNLD CVC W/O SUBQ PORT/P $1,200.00 36589QX REMV TUNLD CVAD W/SUBQ PORT/PU $1,350.00 36590QX REPSTN PREV PLCD CVC FLUORO GU $2,000.00 36597QX ANES PT EXTREME AGE;<1&>70 1BU $30.00 99100QX ANES COMP BY HYPOTHERMIA 5BU $30.00 99116QX ANES COMP BY HYPOTENSION 5BU $30.00 99135QX ANES COMP BY EMER CONDITIONS2B $30.00 99140QX ANES TRANS-ESOPH ECHO 6BU $30.00 93312QX PAIN MGT RM, 1 - 14 MIN $744.00 PAIN MGT RM, 15 - 29 MIN $788.50 PAIN MGT RM, 30 - 44 MIN $834.20 PAIN MGT RM, 45 - 59 MIN $879.80 PAIN MGT RM, 60 - 74 MIN $923.30 ANES THORCTOMY 1 LUNG VNT 15BU $30.00 00541QX ANES PEC IMG TX SP PROC 5BU $30.00 01936QX ANES INC/MISSED AB PROC 4BU $30.00 01965QX ANESTH N BLOCK/INJ PRONE 5BU $30.00 01992QX ANES INTRAPERI/LAP/LAP HERN6BU $30.00 00840QX ANES ABD WALL UPPER ANT 4BU $30.00 00700QX ANES LOW ANT ABD WALL 4BU $30.00 00800QX ANES NERVE BLOCK/INJ NOT PRONE $30.00 01991QX INJ ANES SUBST CRV/THRC WO GUI $30.00 62320QX INJ ANES SUBST CRV/THRC W/ GUI $30.00 62321QX INJ ANES SUBST LMBR/SAC WO GUI $30.00 62322QX INJ ANES SUBST LMBR/SAC W/ GUI $30.00 62323QX INJ ANES INFUS CRV/THRC WO GUI $30.00 62324QX INJ ANES INFUS CRV/THRC W/ GUI $30.00 62325QX INJ ANES INFUS LUMB/SAC WO GUI $30.00 62326QX INJ ANES INFUS LUMB/SAC W/ GUI $30.00 62327QX ANES GENERAL $170.00 ANES MAC $170.00 ANES RANDOM GLUCOSE $20.00 82947 ANES URINE HCG $35.00 81025 SWIVEL ADAPT BRONCHOSCOPE $34.50 ANES SPINAL TRAY 25 GAUGE $49.40 ANES SPINAL TRAY 22 GAUGE $39.10 DISP ENDO TRACHAEL TUBE $23.10 COUDE TIP SUCTION CATH $6.90 L.T.A. KIT $18.50 NERVE STIMUTE ELECTRODS $39.10 DISP CIRCUIT $33.30 FLUID WARMING DEVICE $37.90 ENDOBRONCH TUBE W/CPAP $387.50 EKG ELECTRODES (3) $19.70 LUMBAR PUNCTURE TRAY $60.70 NG TUBE W/O STYLET $17.30 ULTIPOR BLOOD FILTER $12.80 ENDO TUBE HOLDER $15.10 SUCTION CATHETERS PLASTIC $4.90 AIRWAY TUBING COUPLES $9.40 DEXTROSE 5% WATER 250 CC $17.90 ARROW CENTRAL VIEW KIT $69.90 OXYGEN CATHETER #12 $5.90 NASOPHARYNGEAL AIRWAY $12.80 SONATEMP $18.50 CONT EPIDURAL TRAY $95.00 ESOPH PROBE $20.80 SKIN PROBE $13.80 JACKSON REESE $33.30 THERMO HEAD COVER-A $4.90 THERMO HEAD COVER-B $6.90 THERMO LEGGINGS $10.40 THERMO DRAPE $25.30 DISP LARYNGOSCOPE $20.80 SALTER CANNULA $25.30 HEAD REST $29.90 SOMASENSOR $219.60 BIS SENSOR $45.90 FEMORAL ART-LINE KIT $131.60 LMA $129.30 LASER TUBE $656.00 ENDOBRONCHIAL BLOCKER SET $721.40 GLIDESCOPE $72.00 DISPOSABLE BRONCHOSCOPE $1,308.00 PHASE III C.R. MONTH $70.00 CARD RHB W/ECG MONITOR/PHASEII $228.00 93798 PHASE III C.R. 2 WEEKS $35.00 THERAPEUTIC PROCEDURE GROUP $110.00 CARD REHAB MTN EVAL $85.90 NON COPD REHAB $107.60 G0239 PULMONARY REHAB MAINTENANCE $70.00 MULTIPLE SLEEP LATENCY $1,765.00 95805 SLEEP STAGING 4 OR > $1,765.00 95810 SLEEP STAGING 4OR> W/CPAP/BPAP $1,873.60 95811 NO SHOW SLEEP LAB $66.50 SLEEP STUDY; UNATTENDED $628.50 G0399 DBE IND PER 30 MIN $109.90 DBE GROUP PER 30 MIN $93.90 OP MNT INITIAL CONSULT EA 15MI $110.00 97802 OP MNT F/U CONSULT EA 15 MIN $110.00 97803 OP MNT GROUP PER 30 MIN $110.00 97804 FIRST DIABETES PREVENTION CLAS $63.00 FOURTH DPP CLASS $125.00 TWO CORE MAIN 7-9 MONTHS $37.50 TWO CORE MAIN 10-12 MONTHS $37.50 TWO CORE MAIN 7-9 MONTHS $150.00 TWO CORE MAIN 10-12 MONTHS $150.00 MDPP 5% WT LOSS DURING 1-12 MO $400.00 MDPP 9% WT LOSS 1-24 MONTHS $62.50 TWO ONGOING MAIN 13-15 MONTHS $125.00 TWO ONGOING MAIN 16-18 MONTHS $125.00 TWO ONGOING MAIN 19-21 MONTHS $125.00 TWO ONGOING MAIN 22-24 MONTHS $125.00 NINE TOTAL CORE SESSIONS MDPP $225.00 ORTHOTIC MGMT/TRAIN,INIT EA 15 $148.70 97760GO OT REEVALUATION INITIAL VISIT $110.00 97168GO THER ACTIVITIES-EA15 MIN $69.40 97530GO SELF CARE/HOME TRAIN EA 15 MIN $67.90 97535GO COMMUNITY/WORK TRAIN EA 15 MIN $67.60 97537GO DEVELOP COGNITIVE SKL/EA 15MIN $67.60 97127GO MASSAGE 1 OR > AREAS EA 15 MIN $62.60 97124GO WC MGT EA 15 MIN $67.60 97542GO ORTHOTIC RECHECK EST PT EA 15 $87.00 97762GO OT EVAL,LOW COMPLEXITY,~30MIN $175.00 97165GO OT EVAL,MOD COMPLEXITY,~45MIN $200.00 97166GO OT EVAL,HIGH COMPLEXITY,~60MIN $225.00 97167GO ORTH/PROS TRAIN,SUBS,EA 15MIN $87.00 97763GO REACHER $53.90 DRESSING STICK $6.90 BUTTON HOOK $31.10 STOCKING (SOCK AID) $24.20 SHOEHORN-18" $12.80 SHOEHORN-24" $12.80 ELASTIC SHOELACE $8.40 LONG HANDLED BATH BRUSH $6.90 DENTURE BRUSH $24.20 DYCEM MATTING $8.40 FOAM 3"" $5.90 CUTTING BOARD $56.30 WEIGHTED UTENSIL $10.40 PLATE GUARD $13.80 ISOTONER GLOVE EACH $9.40 ELASTIC WRIST SPLINT $73.30 SHOE BUTTONS $12.80 HAND GRIPPER $15.10 COBAN WRAP 1 INCH $4.90 STAND MAGNIFIER MIRROR $22.00 TOILET AID $104.20 LEG LIFTER $11.70 FOOT DROP SPLINT $190.00 L4398 FUNC POSITION HAND SPLINT $31.10 A4570 WALKER SPLINT $52.80 A4570 STATIC ANKLE FOOT ORTHOSIS $425.00 L4396 WALKER BAG (SMALL) $59.70 WALKER BASKET $85.90 ROCKER T KNIFE $66.50 BUILT UP KNIFE $43.70 BUILT UP SPOON $43.70 BUILT UP FORK $43.70 THERABAND 3 FT PIECE $3.50 THERAPUTTY 2OZ $4.90 HAND HELPER $6.90 ELECTRICAL STIM - UNATTENDED $71.70 97014GO HOT PACKS $60.00 97010GO RESPIRATORY VENTILATOR; INITIAL $820.00 94002 CAR/PUL RESUSC $436.70 92950 CHEST PHYSIOTHERAPY; INITIAL $170.00 94667 DAILY OXYGEN INPATIENT UNIT $263.00 DAILY AEROSOL INPATIENT UNIT $590.90 PENTAMIDINE TREATMENT $280.00 94642 CPAP CONTINOUS DAILY $315.00 94660 BIPAP CONTINOUS $302.00 94660 EBT - BREATH ALCOHOL $55.00 82075 VENTILATOR; SUBSEQUENT $820.00 94003 CHEST PHYSIOTHERAPY;SUBSEQUENT $110.00 94668 INHALATION TX 1ST HR $170.00 94644 ARTERIAL PUNCTURE (BLOOD GAS) $170.00 36600 SVN & OR MDI INITIAL TX $280.00 94640 SVN & OR MDI SUBSEQ TX $280.00 9464076 SVN & OR MDI INSTRUCTION, DAY $280.00 94664 MECH CHESTWALL OSCILLATION EA $280.00 94669 DISP FACE MASK $24.20 VENTI-MASK $13.80 AEROSOL SET UP $24.20 NASAL CANNULA $25.30 CORRUGATED TUBING $23.80 DISP NEBULIZER/HUMIDIFIER $27.70 SPIROMETER INCENTATIVE $58.50 C P A P SET UP $50.50 HAND HELD NEBULIZER $28.80 VENTILATOR SET UP $32.20 SUCTION CATH-24 HR $65.40 AMBU BAGS DISPOSABLE $82.50 CARE CUBE 12X12 $49.40 CARE CUBE 24X24 $52.80 PASSY MUIR VALVE $60.70 PULM FUNC FILTER $29.90 AEROSOL FACE TENT/EA $33.30 PENTAMIDINE NEBULIZER $63.10 HME/FILTER UNIT $36.80 BIPAP SET-UP $93.90 RESP CARE KIT $80.10 PEAK FLOW METER $65.00 RESP CARE KIT $80.10 FRC-STEADY STATE=HEL $240.00 94727 SINGLE-BREATH CO DIFFUS $179.60 94729 CARBON MONOXIDE LEVEL $155.50 82375 SPIROMETRY $304.50 94010 PULSE OXIMETRY - SINGLE $31.10 94760 BRONCHOSPASM PRE/POST DILATOR $400.00 94060 9ARTERIAL BLOOD GAS ANALYSIS $0.00 82803 CONTINOUS PULSE OXIMETRY $240.00 94762 PULSE OXIMETRY;MULTIPLE $48.20 94761 METHEMOGLOBIN $15.00 83050 BLOOD GAS ANALYSIS $84.00 82803 ARTERIAL BLOOD GAS POTASSIUM $15.00 84132 ARTERIAL BLOOD GAS SODIUM $20.00 84295 ARTERIAL BLOOD GAS CHLORIDE $15.00 82435 ARTERIAL BLOOD GAS GLUCOSE $20.00 82947 ARTERIAL BLOOD GAS LACTATE $56.00 83605 VENOUS BLOOD GAS POTASSIUM $15.00 84132 VENOUS BLOOD GAS SODIUM $20.00 84295 VENOUS BLOOD GAS CHLORIDE $15.00 82435 VENOUS BLOOD GAS GLUCOSE $20.00 82947 VENOUS BLOOD GAS LACTATE $56.00 83605 VENOUS BLOOD GAS ANALYSIS $95.00 82803 NOCTURNAL PULSE OXIMETRY $240.00 94762 MUCOMYST 10% ML $24.40 VAPONEFRIN $5.70 ATROVENT .5MG $6.86 PENTAMIDINE 300MG $513.52 J2545 XOPENEX 0.63MG $9.14 XOPENEX 1.25MG $17.13 DUONEB INHAL SOL $39.98 SPIRIVA HANDIHALER(TIOTROPIUM) $63.00 PROVENTIL SOLN .083% 3ML $7.76 PHYSICAL THERAPY HOT PACKS $60.00 97010GP WHIRLPOOL $72.20 97022GP PARAFFIN BATH $42.60 97018GP ELECTRICAL STIM - UNATTENDED $71.70 97014GP GAIT TRAINING PER EA 15MIN $60.70 97116GP ULTRA SOUND - EACH 15 MIN $75.60 97035GP THERAPEUTIC PROCEDURE EA 15MIN $62.00 97110GP NEUROMUSCULAR RE-EDUC EA 15MIN $79.00 97112GP MASSAGE PER 15 MIN $62.60 97124GP THERABAND EXERCISOR 3 FT $3.50 CPM PER DAY RENTAL $88.80 97016GP DEBRIDEMENT PART THICK <20 CM $410.00 97597GP CPM-SHOULDER PER DAY $141.90 IONTOPHORESIS EACH 15 MIN $72.20 97033GP PT REEVAL $110.00 97164GP ELECTRICAL STIMULATION EA 15 $75.60 97032GP JOINT MOBILIZATION EA 15 MIN $74.50 97140GP ORTHOTIC MGMT/TRN,INIT EA 15MI $148.70 PROSTH MGMT/TRAIN,INIT EA 15MI $75.20 97761GP WHEELCHAIR MANAGEMENT EA 15 $67.60 97542GP MANUEL TECHNIQUES EA 15 MIN $74.50 97140GP THERAPEUTIC ACTIV PER 15 MI $69.40 97530GP ORTHOTIC MGMT/TRN,INIT EA 15MI $148.70 97760GP SKIN THERAPY $68.80 97039 PT ADL SELF CARE TR EA 15 MIN $67.90 97535GP THERAPEUTIC REHAB GROUP $130.80 97150GP SLCTV WND DEBRIDEM ADDL 20CM $332.50 97598GP LOW FREQ NONTHERMAL US PT $270.00 97610GP PT EVAL,LOW COMPLEXITY,~20MIN $200.00 97161GP PT EVAL,MOD COMPLEXITY,~30MIN $225.00 97162GP PT EVAL,HIGH COMPLEXITY,~45MIN $250.00 97163GP ORTH/PROS TRAIN,SUBS,EA 15MIN $87.00 97763GP PHILADELPHIA COLLAR $242.00 L0140 HAND EXERCISER $58.50 THERAPLAST $9.40 AFO PLASTIC $409.20 L1930 EMPI ELECTRODES $6.90 PHYSIOTH NEO SLEEVE $26.50 ABDOMINAL BINDER $59.70 HEEL WEDGE HEALING SHOE $43.70 L3350 CAM WALKING BOOT $268.70 AIR CAST ANKLE BRACE $700.00 WARM-N-FORM BACK SUPPORT W/INS $603.60 SEMIRIG 2PC THERMOPL CERV COLL $650.00 TLSO TRIPANEL CNTRL W HYPEREXT $969.30 CUSTOM TLSO 2PC PL SHELL W LIN $4,450.00 LSO POST RIGID PANEL $365.40 LSO S/C SHELL/PANEL PREFAB $3,230.50 PREFAB POSTOP HO $2,799.80 KO ADJ JNT POS RIGID SUPP $1,700.00 CUSTOM PLASTIC AFO SOLID ANKLE $1,615.30 CUSTOM PLASTIC AFO W ANKLE JNT $1,675.00 UE FX ORTHOSIS HUMER $775.40 HEEL CUP $45.70 KNEE PLUS COOL BRACE $2,270.00 LEG LENGTH DISCREPANCY PAD $190.00 SPEECH TREATMENT 15 MIN $150.00 92507GN SPEECH TREATMENT 30 MIN $200.00 92507GN SPEECH TREATMENT 45 MIN $250.00 92507GN SPEECH TREATMENT 60 MIN $300.00 92507GN HEARING SCREENING $51.60 92551 EVALUATION SWALLOWING $345.10 92610GN TREATMENT SWALLOWING 1-15 MIN $332.90 92526GN TREATMENT SWALLOWING 16-30 MIN $332.90 92526GN TREATMENT SWALLOWING 31-45 MIN $360.70 92526GN TREATMENT SWALLOWING 46-60 MIN $438.30 92526GN MODIFIED BARIUM SWALLOW EVAL $438.30 92611GN EVAL SPEECH FLUENCY $243.60 92521GN EVAL SPEECH SOUND PRODUCTION $233.50 92522GN EVAL SPEECH SND PROD W/COMPRES $366.00 92523GN BEHAV/QUANT ANALYSIS VOICE/RES $233.50 92524GN COMPLETE PHYSICAL EXAM $62.00 NEW PATIENT LEVEL 1 $71.00 99201 NEW PATIENT LEVEL 2 $97.00 99202 NEW PATIENT LEVEL 3 $125.00 99203 NEW PATIENT LEVEL 4 $186.00 99204 NEW PATIENT LEVEL 5 $232.00 99205 ESTABLISHED PATIENT LEVEL 1 $37.00 99211 ESTABLISHED PATIENT LEVEL 2 $63.00 99212 ESTABLISHED PATIENT LEVEL 3 $85.00 99213 ESTABLISHED PATIENT LEVEL 4 $120.00 99214 ESTABLISHED PATIENT LEVEL 5 $180.00 99215 CONSULTATION LEVEL 1 $120.00 99241 CONSULTATION LEVEL 2 $159.00 99242 CONSULTATION LEVEL 3 $192.00 99243 CONSULTATION LEVEL 4 $285.00 99244 CONSULTATION LEVEL 5 $338.00 99245 INDEPENDENT MEDICAL EXAM $1,998.00 99456 INDEPEND MED EXAM ADD 15 MIN $500.00 99456 DEPOSITION $1,887.00 DEPOSITION ADD 15 MIN SUB 1HR $473.00 RETURN TO WORK EVALUATION $106.00 99455 EXTENDED (RETURN TO WORK EVAL) $125.00 99455 CHART REVIEW & SUMMARY $338.00 CHART REVIEW & SUMMARY EXTEND $464.00 RESP QUESTIONNAIRE REVIEW $27.00 DOT PHYSICAL EXAM + EXTRAS $89.00 SCHOOL BUS PHYSICAL EXAM + EXT $89.00 99450 DRIVERS LICENSE PHYSICAL EXAM $40.00 RESPIRATORY PHYSICAL EXAM $52.00 NEW PATIENT;LEVEL 1 W/PROC $71.00 9920125 NEW PT;LEVEL 2 W/PROC $97.00 9920225 NEW PT;LEVEL 3 W/PROC $125.00 9920325 NEW PT;LEVEL 4 W/PROC $186.00 9920425 NEW PT;LEVEL 5 W/PROC $232.00 9920525 EST PT;LEVEL 1 W/PROC $37.00 9921125 EST PT LEVEL 2 W/PROC $63.00 9921225 EST PT; LEVEL 3 W/PROC $85.00 9921325 EST PT;LEVEL 4 W/PROC $120.00 9921425 EST PT;LEVEL 5 W/PROC $180.00 9921525 ONLINE CONSULT-BRIEF <5 MINUTE $17.00 99444 ONLINE CONSULT-INTERMEDIATE $32.00 99444 ONLINE CONSULT-EXTENDED >10MIN $65.00 99444 MEDICAL CONFERENCE < 30 MINUTE $65.00 99367 REVIEW TB QUESTIONNAIRE $14.00 CASE MANAGER CONSULT $76.00 99367 B&W PHYSICAL EXAM $95.00 COLLATE & MAIL DATA $12.00 RESP CLEARANCE FORM $8.00 INGRAM BARGE PE $95.00 CFH 15 MIN ASSESS $20.00 DOT PE FOLLOW-UP $45.00 MSHA SMPLE PE $52.00 MSHA MED SURV $61.00 MSHA EXTENSIVE $106.00 MSHA EXTENSIVE 2 VISITS $125.00 MSHA CDL $89.00 RECTAL EXAM $10.00 HERR'S DOT W/ORTHO $140.00 A-M REVIEW $50.00 CHS PHYSICAL EXAMINATION $45.00 CHS DOT COMM.DRIVER EXAM $89.00 CHS HISTORY REVIEW W/O EXAM $10.00 CHS VITALS ONLY $5.00 CHS BREAST EXAMINATION $10.00 99203 CHS TRAVEL CONSULTATION $25.00 CHS FOCUSED EXAM W/REP 10 MIN $50.00 CHS FOCUSED EXAM W/REP 20 MIN $80.00 CHS FOCUSED EXAM W/REP 30 MIN $110.00 CHS FOCUSED EXAM W/REP 40 MIN $160.00 CHS FOCUSED EXAM W/REP 50 MIN $200.00 DR. FINGER ABSCESS SIMPLE $152.00 26010 PUNC. ASP. HEMATOMA/ABSCESS $138.00 10160 SPIROMETRY $41.00 94016 AUDIOGRAM $27.00 92551 STOOL GUAIAC TEST/HEMOCULT $20.00 82272 I & R FB SIMPLE $146.00 10120 REMVL FB EXT EYE CONJUNCTIVAL $104.00 65205 REM FB EXTERNAL AUD CANAL $104.00 69200 SHORT ARM SPLINT STATIC $97.00 29125 FABRICATE THUMB SPICA SPLINT $163.00 29125 FINGER SPLINT STATIC $85.00 29130 SIMPLE REPAIR WOUND 2.5CC/LESS $236.00 12001 RESPIRATORY FIT TEST $21.00 TRNK,SCLP,NECK,EXT 2.6-7.5CM $219.00 12002 INITIAL HISTORY & PHYSICAL IP $167.00 99233 I & D ABSCESS SIMPLE $138.00 10060 EVAC. SUBUNGUAL HEMATOMA $92.00 11740 SECOND MEDICAL OPINION $551.00 99456 BLOOD PRESSURE CHECK $18.00 SCLP,ARMS,LEGS 2.6-7.5 CM $533.00 13121 SPECIAL FORMS/REPORTS $25.00 99080 PFT INTERPRETATION $36.00 94016 AUDIO INTERPRETATION $18.00 TRNK,SCLP,NECK,EXT 2.6-7.5 CM $272.00 12032 CARD REPLACEMENT $9.00 DIRECTOR FOR AED EST CLIENT $298.00 FINGER STRAPPING $71.00 29280 WRIST STRAPPING $157.00 29260 ANKLE STRAPPING $157.00 29240 FOOT STRAPPING $157.00 29590 HAND STRAPPING $157.00 29280 STRAPPING TOE $157.00 29550 I & D; COMPLICATED $246.00 10061 I & R FB;COMPLICATED $326.00 10121 I & D HEMATOMA $159.00 10140 DEBRID;SKIN/SUBCUTANEOUS $186.00 11042 AVULSION NAIL PLATE;ONE $120.00 11730 EX. NAIL/NAIL MATRIX $405.00 11750 RPR. NAILBED $180.00 11760 TRNK,SCLP,NK,EXT.;2.5CM OR < $164.00 12001 TRNK,SCLP,NK,EXT;7.6-12.5CM $305.00 12004 TRNK,SCLP,NK,EXT;12.6-20.0CM $393.00 12005 FACE,EAR,EYELID,NOSE; 2.5CM < $180.00 12011 FACE,EAR,EYELID,NOSE;2.6-5.0CM $252.00 12013 FACE,EAR,EYELID,NOSE;5.1-7.5CM $285.00 12014 FACE,EAR,EYELID,NOSE;7.6-12.5C $393.00 12015 TX. WOUND DEHISCENCE;SIMPLE $359.00 12020 TX;COMPLICATED $427.00 12021 TRNK,SCLP,NK,EXT.;2.5CM OR < $204.00 12031 TRNK,SCLP,NECK,EXT 7.6-12.5CM $387.00 12034 TRNK,SCLP,NECK,EXT 12.6-20.0CM $473.00 12035 NK,HANDS,FT; 2.5CM OR LESS $211.00 12041 NK,HANDS,FT; 2.6 - 7.5CM $299.00 12042 NK,HANDS,FT; 7.6 - 12.5CM $393.00 12044 NK,HANDS,FT; 12.5 - 20.0 CM $473.00 12045 FACE,EAR,EYELID,NOSE; 2.5CM < $252.00 12051 FACE,EAR,EYELID,NOSE;2.6-5.0CM $332.00 12052 FACE,EAR,EYELID,NOSE;5.1-7.5CM $379.00 12053 FACE,EAR,EYELID,NOSE;7.6-12.5C $533.00 12054 TRUNK; 1.1 - 2.5CM $326.00 13100 SCLP, ARMS/LEGS; 1.1 - 2.5 CM $346.00 13120 FACE,HANDS/FEET; 1.1 - 2.5CM $447.00 13131 FACE,HANDS/FEET; 2.6 - 7.5CM $707.00 13132 EYELID,NOSE,EAR; 1.0CM OR < $439.00 13150 EYELID,NOSE,EAR; 1.1 - 2.5 CM $614.00 13151 EYELID,NOSE,EAR;2.6 - 7.5CM $1,022.00 13152 TX WOUND DEHISCENCE; EXT $1,129.00 13160 INITIAL TREATMENT 1ST DEGREE $104.00 16000 DRSG/DBRD;INITIAL/SUB;SMALL $97.00 16020 DRSG/DBRD;MEDIUM $204.00 16025 DRSG/DBRD;LARGE $232.00 16030 EXCHAROTOMY; INITIAL $572.00 16035 ESCHAROTOMY;EA ADDITIONAL $104.00 16036 CL TX SCAPULAR FX; W/O MANI $346.00 23570 DR FINGER ABSCESS;FELON $278.00 26011 REMOVE FB FOOT,SUBC $186.00 28190 REM FB EXT EYE;EMBEDDED NON-PE $120.00 65210 REM FB;EXT EYE;CORNEAL,W/O SLI $104.00 65220 DEBRIDEMENT;SELECTIVE;EACH $138.00 97597 DEBRID;NON-SELECTIVE;EACH $138.00 97602 KNEE STRAPPING $157.00 29530 TYMPANIC MEMBRANE CHECK BILAT $15.00 PE W/EXPANDED ORTHO $64.00 DEBRIDEMENT; 20 CM OR < $92.00 97597 DEBRIDEMENT > 20 CM $138.00 97598 PE MD REVIEW $31.00 INCENTIVE SPIROMETER TX $24.00 G0237 CHS SPIROMETRY (PFT) 3 TRACING $41.00 94010 EVIDENTIAL BREATH ALCOHOL TEST $27.00 82075 CONFIRMATORY BREATH ALCOHOL $45.00 82075 URINE DRUG SCREEN COLLECT ONLY $21.00 COMPLETE URINE DRUG SCREEN $51.00 HAIR DRUG SCREEN COLLECT ONLY $34.00 MRO FUNCTION (DOT DS) $47.00 TOXOLOGICAL REVIEW(NON-DOT DS) $51.00 ADD/DELETE RANDOM DRUG SCREEN $8.00 CONSORTIUM/DRUG SCREEN START U $13.00 REVIEW URINE DRUG SCREEN POLIC $167.00 CREATE URINE DRUG SCREEN POLIC $332.00 6-MONOACETYLMORPHINE LEVEL $127.00 AMPHETAMINE ISOMERIZATION TEST $62.00 SPECIMEN REANALYSIS,EA METABOL $159.00 AFTER HRS SERVICE/TRAVEL $93.00 OFFICE STAFF TESTIMONY/PER HR $82.00 DRUG TEST REVIEW/SIGN OFF $17.00 CHF DRUG SCREEN $23.00 5 PANEL HAIR DRUG SCREEN $62.00 EXPANDED OPIATES UDS $68.00 UDS QUANTITATIVE OPIATE LEVEL $96.00 SIGN OFF ON NEGATIVE DRUG TEST $9.00 URINE ALCOHOL SCREEN $24.00 RAPID URINE DRUG SCREEN $31.00 HAIR DRUG SCREEN W/EXP OPIATES $64.00 *INJECTIONS $0.00 INJ. TENDON SHEATH/TRIGGER $97.00 20550 ARTHROCENTESIS-INTERMED JO $104.00 20605 DEPO MEDDROL INTRA MUSCULAR $52.00 LIDOCAINE INJ 2% PER CC $8.00 INJ;TENDON ORIGIN/INSERTION $104.00 20551 INJ;SINGLE/MULTIPLE 1-2 MUSCLE $104.00 20552 IV INF UNDER DIR SUP PHY 1 HR $80.00 IM/SQ INJECTION $18.00 96372 CELESTONE 6MG $39.00 VACCINE ADMINISTRATION $17.00 DIPTHERIA/TETANUS VACCINE $27.00 90718 HEPATITIS A VACCINE $71.00 90632 HEPATITIS B VACCINE $60.00 90746 INFLUENZA VACCINE $28.00 Q2038 VARICELLA-ZOSTER VACCINE $180.00 90716 HEPATITIS B IMMUNE GLOBULIN $85.00 90371 ADMIN HEPATITIS VACCINE $13.00 90471 PNEUMOCOCCAL VACCINE $40.00 90732 TDAP (ADACEL) VACCINE $76.00 90715 CHS HEPATITIS B VACCINE & ADMI $60.00 90746 CHS HEPATITIS A VACCINE & ADMI $71.00 90632 CHS TETANUS-DIPHTHERIA VAC. & $27.00 90718 CHS TDAP VACCINE & ADMIN $76.00 90715 CHS INFLUENZA VACCINE & ADMIN $23.00 90658 PHYSCN VENIPUNCTURE NONROUTINE $31.00 36410 VENIPUNCTURE $13.00 36415 LEAD/ZPP $54.00 83655 URINE HEAVY METAL SCREEN $101.00 83015 ZINC BLOOD $41.00 84630 OH CBC WITH DIFF $15.00 85025 HEPATITIS C ANTIBODY $30.00 86803 HEPATITIS B SURFACE ANTI TITER $30.00 86706 ANABOLIC STEROIDS $188.00 HIV $122.00 86689 LYMES TITER $170.00 86618 NASAL PHARYNX CULTURE $115.00 87070 VARICELLA ANTIBODY TITRE $94.00 LDL CHOLESTEROL LEVEL $41.00 BLOOD ARSENIC LEVEL $81.00 82175 BLOOD KIT W/BLOOD DRAW $20.00 BLOOD ALCOHOL $99.00 HEALTH FAIR SCREENING $40.00 OH COMP METAB PANEL $26.00 80053 OH LIPID PANEL $27.00 80061 OH PSA $36.00 84153 OH CRP $24.00 86141 CREATININE; NOT BLOOD $15.50 82570 CADMIUM $31.00 82300 BETA-2 MICROGLOBULIN $15.50 82232 B&W LEAD/ZPP 22996 $28.40 83655 B&W SERIUM CADMIUM 56093P $26.40 82300 B&W SERUM MERCURY 56853P $30.40 83825 B&W SERUM ARSENIC 55830P $36.20 82175 URINE CYTO $100.00 88112 URINALYSIS R & M $16.00 81003 HEMOGLOBIN A1C $26.00 83036 URINE NICOTINE $20.00 83887 HEMOCCULT $10.00 82270 CLOSETMAID DRUG SCRN COLLECT $12.00 CHS BLOOD DRAW $10.00 36415 CHS FINGER STICK FOR BLOOD SUG $5.00 CHS ROUTINE U/A COLLECT $16.00 CHS REGULATED DRUG SCRN COLLEC $21.00 CHS NON-REG DRUG SCRN COLLECT $21.00 CHS DIRECT OBSERVATION DRG SCR $12.00 CHS HAIR DRUG SCRN COLLECT $34.00 CHS RAPID DRG SCRN QUAL $31.00 80300 CHS BREATH ALCOHOL TEST $27.00 82075 CHS URINE DIPSTICK (NOT DOT) $16.00 81000 CHS HCG ONE STEP PREG TEST $5.00 CHS RECTAL EXAM W/ OCCULT BLOO $18.00 CHS PPD/TB ADMIN & READ $21.00 86580 CHS DNA BUCCAL SWAB COLLECT $15.00 URINE DIP $16.00 81002 PPD PLANT & READ $21.00 86580 AUDIOSCOPE SCREENING TEST $13.00 VISION TEST (TITMUS) $31.00 VISION TEST (SNELLEN CHART) $10.00 99173 COLOR VISION (ISHIHARA BOOK) $11.00 WORK PERFORM EVAL < 30 MIN $123.00 99450 FUNCTIONAL CAPACITY SCREEN $125.00 FCE EXPANDED $150.00 TELEPHONE CONSULTATION,SIMPLE $33.00 99441 TELEPHONE CONSULTATION,INTERME $48.00 99442 WORK PERFORM EVAL > THAN 30MIN $143.00 99450 CHEST XRAY 1 VIEW $59.00 71045 CHEST XRAY 2 VIEWS $62.00 71120 L-S SPINE 3 VIEWS $62.00 72110 B-READ CXR $70.00 RIGGING FCE $175.00 DYNEGY PWS $40.00 CHS AUDIOGRAM PURE TONE $27.00 92553 CHS BODY MEASUREMENTS $5.00 CHS VISUAL ACUITY W/O PHYSICAL $10.00 CHS VISION-COLOR,TITMUS/SIMILA $5.00 CHS COLOR VISION ISHIHARA 14+ $11.00 CHS DEPTH PERCEPTION $10.00 CHS PERIPHERAL VISUAL FIELDS $5.00 CHS CHEST XRAY SINGL VIEW FRON $59.00 71045 CHS CHEST XRAY 2 VIEW FRONT/LA $62.00 71046 CHS CHEST XRAY COPY/MAIL FEE $10.00 CHS BRIEF FIT TEST/EVAL <20MIN $50.00 CHS PERFORM FIT TEST (PA003C) $50.00 CHS PERFORM FIT TEST (PA003AM) $50.00 CHS PERFORM FIT TEST (PA003I) $50.00 CHS FITNESS TEST UP TO 45 MIN $50.00 CHS FLEXIBILITY ASSESSMENT $50.00 CHS FITNESS TEST-SEAFARERS $50.00 97750 ORBIT XRAY FOREIGN BODY $74.00 70030 FINGER SPLINT $66.00 WRIST SPLINT $97.00 ANKLE SPLINT $62.00 ACE WRAP-2" $13.00 ACE WRAP-3" $14.00 ACE WRAP-6" $19.00 CRUTCHES (PAIR) $115.00 E0110 ARM SLING $18.00 SHORT;DYNAMIC $113.00 29126 FINGER;DYNAMIC $159.00 29131 LONG LEG SPLINT $125.00 29505 SHORT LEG SPLINT $113.00 29515 LONG ARM SPLINT $125.00 29105 MEDTOX $13.00 MULTIPURPOSE TRAY $39.00 A4550 TRAY, SUTURE REMOVAL $14.00 A4649 PETROLEUM GAUZE 3X9 $9.00 A6223 XEROFORM GAUZE 5X9 $9.00 A6229 STAPLE REMOVER PSX $29.00 A4649 ETHICON PROXIMATE PLUS STAPLER $88.00 A4649 SMALL DRESSING $6.00 A6216 AIR CAST ANKLE BRACE $269.00 EKG W/O INTERPRETATION $47.00 93005 EKG PROFESSIONAL $20.00 PLAIN TREADMILL STRESS TEST $180.00 93017 PROF PLAIN TREADMILL STRESS TE $19.00 93018 CHS RESTING EKG 12 LEAD W/INTE $47.00 93000 IBUPROFEN 800MG 30TAB $22.00 METHYLPREDNISOLONE 4MG 21 DOSE $22.00 SILVER SULFADIAZINE CREAM 50G $52.00 KENALOG 40IM $31.00 NON-CLIENT COMP URINE DRUG $88.00 NON-CLIENT PPD TEST $35.00 86580 CHEMO IV PUSH SNGL DRUG $360.00 96409 CHEMO INFUSION TECH 1 HR $559.00 96413 NON-CHEMO ADMIN 1ST HOUR $427.50 96365 NON-CHEMO/ADMIN EA ADD HOUR $226.30 96366 CHEMO OTHER THAN INF >1HR $238.00 96401 INFLUENZA VACCINE W/O MD VISIT $69.80 MEDICATION INJECTION SQ OR IM $138.70 96372 INTRAVESICAL OR BLADDER INSTA $620.00 51720 RN EST PT PROBLEM-5 MIN $218.00 99211 RN EST PT PROB W PROC-5 MIN $218.00 9921125 MEDICATION INJECTION (IV PUSH) $360.00 96374 PARACENTESIS $1,852.00 49082 TRANSFUSIONS(ALL BLOOD/BLOOD $666.00 36430 SUBARACHNOID OR INTRAVEN CHEMO $360.00 96542 RN EST PT COMPREHENSIVE-25 MIN $300.70 99214 LEVEL V NEW PT W/PROC-60 MIN $338.00 9920525 RN EST PT EXPANDED PROB-10 MIN $246.90 99212 RN VISIT-EST PT COMPLEX-40 MIN $328.20 99215 RN EST PT DETAIL W PROC-15 MIN $266.40 9921325 CHEMO INFUSION EA ADD 1 HR $249.70 96415 BONE MARROW ASPIRATION $2,700.00 38220 BONE MARROW BIOPSY $2,550.00 38221 LEVEL 1 NEW PATIENT-10 MIN $243.00 99201 LEVEL 1 NEW PT W/PROC-10 MIN $243.00 9920125 LEVEL II NEW PATIENT-20 MIN $268.00 99202 LEVEL II NEW PT W/PROC-20 MIN $268.00 9920225 LEVEL III NEW PATIENT-30 MIN $293.00 99203 LEVEL III NEW PT W/PROC-30 MIN $293.00 9920325 LEVEL IV NEW PATIENT-45 MIN $304.10 99204 LEVEL V NEW PATIENT-60 MIN $335.00 99205 LEVEL II EST PT W/PROC-10 MIN $246.90 9921225 LEVEL IV EST PT W/PROC-25 MIN $300.70 9921425 LEVEL V EST PT W/PROC-40 MIN $328.20 9921525 BLOOD DRAW FROM VAD $201.00 36591 THORACENTESIS $1,200.00 32554 INJ IM PNEUMONIA;NO MD;NO E&M $69.80 INSERT PICC LINE $2,000.00 36569 REPAIR PICC LINE $1,550.00 36575 REPLACE PICC LINE; SAME SITE $2,000.00 36584 BONE ASPIRATE & BIOPSY $2,635.00 CHEMO-HORMONAL INJ SQ/IM $215.00 96402 HYDRATION IV INF, INITIAL $360.00 96360 HYDRATE IV INF, ADD-ON $83.40 96361 THER/PROPH/DIAG INJ ADD-ON $151.20 96375 CHEMO IV;EA ADDL SEQ INF UP1HR $221.90 96417 CHEMO IV PUSH, ADDL DRUG $249.70 96411 THERAPEUTIC PHLEBOTOMY W/ORW/O $272.10 99195 IRRIG DRUG DELIVERY DEVICE $138.80 96523 RN VISIT-EST PT MODERATE-15 MN $268.00 99213 RN NEW PT LEVEL IV W/PRO-45 MN $308.00 9920425 CHEMO CNS (INTRATHECAL) W LP $627.30 96450 APPLICATION ON BODY INJECTOR $80.00 96377 *MEDICAL ONCOLOGY SUPPLIES $0.00 DECLOT VASCULAR DEVICE $915.40 36593 TX/PROPH/DG ADDL CONCURRENT IV $82.30 96368 IV TX ADD SEQ NON CHEMO INF $128.40 96367 TX/PROPH/DG ADDL SEQ IV INF =< $128.40 96367 TX/PRO/DX INJ SAME DRUG ADDON $162.40 96376 CHEMO PROLONG 8+ HRS INFUSE W/ $581.50 96416 PROLONGED IV INF REQ PUMP >8 H $592.30 C8957 COLLECT BLOOD FROM PICC $201.00 36592 SKIN TEST; TB ID (PPD SKIN) $35.00 86580 SKIN TEST; CANDIDA $65.00 86485 IRRIGATION $119.20 A4400 SQUIBB IRRIGATOR $119.20 A4400 OSTOMY POUCHES 1 3/4"" $41.40 A5054 OSTOMY POUCHES 2 3/4"" $32.20 A5054 OSTOMY POUCHES 4"" $36.80 A5054 UROSTOMY POUCH 1 3/4"" $29.90 A5073 OSTOMY IRRIGATION SLEEVE $24.20 A4397 SOD CHL.IRRIG.SOLN 1000ML $37.90 A4217 SOD CHL.IRRIG.SOLN 3000ML $42.60 A4217 WATER FOR IRRIG 1000ML $23.10 A4217 LR IRRIG SOLN 3000 ML $39.10 A4217 4.25 DIALYSATE W/2.5 CALCIUM $19.70 A4722 2.5 DIALYSATE W/2.5 CALCIUM $19.70 A4722 DEXTROSE 1.5%/LO CALCIUM 2000 $17.30 A4722 DELFLEX 1.5 5000ML LO-CAL $28.80 A4725 DELFLEX 2.5 5000ML LO-CAL $12.80 A4725 DELFLEX 4.25 5000ML LO-CAL $12.80 A4725 DELFLEX 1.5 2000ML LO-CAL W/D $28.80 A4722 DELFLEX 2.5 2000ML LO-CAL W/D $28.80 A4722 DELFLEX 4.25 2000ML LO-CAL W/ $28.80 A4722 STERILE TAPE PATCH 4 X 7 $3.50 A4452 WOUND DRAIN BAG 10 1/2 CM $68.80 A6154 DUODERM-4 X 4 $25.30 A6234 HYDROSORB DRESSING $27.70 A6209 V.A.C. LG DRESSING $70.00 A6550 DRESSING VAC SILVER MEDIUM $70.00 A6550 ARM SLING $39.10 A4565 CERVICAL COLLAR SM $138.50 L0120 SHOULDER IMMOBILIZER $328.20 L3670 ANKLE SPLINT $70.00 A4570 COCK UP SPLINT $303.00 L3908 KNEE IMMOBILIZER $228.60 L1830 CANE $74.50 E0100 CRUTCHES, PAIR $284.00 E0114 SLING & SWATHE $249.30 L3650 WRIST & FOREARM SPLINT $244.90 A4570 LONG LEG CUTTER CAST $275.60 A4590 LONG ARM CUTTER CAST $193.30 A4590 SHORT LEG CUTTER CAST $209.20 A4590 SHORT ARM CUTTER CAST $177.30 A4590 ADJUSTABLE CANE $141.00 E0100 HAND SPLINT $134.00 A4570 PADDED HAND SPLINT $108.90 A4570 FINGER SPLINT $115.00 L3925 WRIST AND HAND CAST $115.80 A4590 CLAVICLE STRAP OR SUPPORT $240.00 L3650 POSTERIOR LEG (PLASTER) $159.00 A4580 FOOT CRADLE BOOT $373.30 L3260 WOODEN SURGICAL SHOE $373.30 L3260 MED ABD PILLOW DISP $92.80 SM ABD PILLOW DISP $91.60 SHOULDER IMMOBIL MED $430.50 L3675 SHOULDER IMMOBIL LG $430.50 L3675 LUMBAR SAC BELT MED-LG $461.80 L0628 CAST BOOT OT MED $148.70 L3260 CAST BOOT OT LG $148.70 L3260 CAST BOOT OT XLG $129.30 L3260 CAST BOOT CT SM $132.60 L3260 CAST BOOT CT MED $152.20 L3260 CAST BOOT CT LG $152.20 L3260 CAST BOOT CT XLG $152.20 L3260 CAST BOOT SM O.T $129.30 L3260 CAST BOOT XSM C.T $119.20 L3260 PELVIC TX LARGE $332.70 E0944 CRUTCH CHILD EACH $59.70 E0116 CRUTCHES MED ADULT EACH $59.70 E0116 CRUTCH YOUTH EACH $175.00 E0116 TUBEGAUZE 01 $16.30 TUBEGAUZE 1 $16.30 BELT SACRAL PELVIC SM-MED $384.00 L0621 SURGICAL SHOE $373.30 L3260 KNEE IMMOBULIZER PO/6"" XXL $340.70 L1830 COLLAR CERVICAL XLGE $68.80 L0120 BRACE ANKLE GEL-AIRLINER $220.00 L4350 ARM BOARDS $40.60 AVETINE $339.90 C1760 BREAST PUMP $55.90 E0602 HYPOTHER UNIT $187.80 ZIMMERO POSEY WRISTLETS $20.80 E0710 ENEMA KIT $12.80 DEFIB PADS $26.50 ELECTRODES $10.40 PLEUROVAC $155.50 C1729 ATHLETIC SUPPORTER $87.00 SEXUAL ASSULT EVIDENCE KIT $201.20 BILE BAG 9 OZ $31.10 SURGICAL HEMOSTASIS 1/2X2 $121.80 A6262 SURGICAL HEMOSTASIS 2 X 3 $60.70 A6262 SURGICEL $339.90 C1760 DISP HYPOTHERMIA BLANKET $137.40 VAGINAL SPECULUM DISP $13.80 UMBILICAL VESSEL CATHETER $20.80 HEEL FREE $355.30 E0191 SUPPORTER MED (REG BAND) $36.80 SUPPORTER LG (REG BAND) $28.80 DRESSING AQUACEL 6X6 $35.70 A6229 LYMPHEDEMA PUMP $24.20 ISO-FLEX MATTRESS $36.80 MATTRESS CFT STAGE I & II $19.70 MATTRESS APM OVERLAY $19.70 MATTRESS TURN Q $39.10 MATTRESS PLEXUS 2500 $29.90 MULTIPURPOSE TRAY $36.80 A4550 NEEDLE HUBER 20G X 3/4"" $42.60 A4212 DRESSING AQUACEL AG 4X4.7 $75.60 A6196 LOW BED PACKAGE #1 $91.60 MATTRESS ALTERNATING PRESSURE $32.20 NEEDLE HUBER PORT ACCESS TRAY $42.60 A4212 TEK FLUID MATTRESS $77.90 LOW BED PACKAGE #2 $103.00 LOW BED PACKAGE #3 $149.90 SELECT AIR LOSS MATTRESS $85.90 LOW BED PACKAGE #4 $93.90 IMMERSE AIR MATTRESS $120.00 HERCULES BED $520.00 GUAZE IODOFORM $47.10 A6266 KERLIX $11.70 TAPE $13.80 MICROFOAM TAPE $27.70 BANDAGE KLING 3 INCH $8.40 BANDAGE KLING 4 INCH $10.40 ACE BANDAGE 6""&UP WIDE $15.10 TRANSPARENT DRESSING 4X5 $22.00 ADD'L 4"" ACE BANDAGE $13.80 PLAIN GUAZE PACKING 1"" $119.20 TUBE GUAZE $15.10 EXT PACEMAKER W/PADS $1,243.40 STERI STRIP 1/2"" $26.50 AIRSTRIP DRESSING 4.75 X 3.25 $11.70 COBAN 6"" $24.20 DRESSING SETOPRESS 4" $53.90 AQUACEL SILVER 3.5 X 12 INCHES $155.64 AQUACEL SILVER 3.5 X 4 INCHES $91.80 AQUACEL SILVER 3.5 X 6 INCHES $139.68 AQUACEL SILVER 3.5 X 10 INCHES $139.68 MEPILEX BORDER AG 4X8 INCH $80.90 MEPILEX BORDER AG 4X12 INCH $116.60 URETHRAL CATHETER $24.20 TUBES FEEDING $10.40 MID STREAM URINE COLLECTR $16.30 CATHETER TRAY $56.30 MONTGOMERY STRAP $10.40 FOLEY 5CC BAG $35.70 FOLEY 30CC BAG $31.10 MALE EXTERIOR CATHETER-TEXAS $9.40 VASELINE GUAZE 1/2X72 $24.20 XEROFORM 1X8 $11.70 XEROFORM 5X9 $11.70 SUCTION CATH PLASTIC $12.00 URINE STRAINER $10.40 BARDEX 3WAY FOLEY $58.50 URINE DRAINAGE BAG $47.10 CATHETER THORACIC 34 36 $116.80 LUKIPORE BLOOD FILTER $57.30 TRACHESTOMY TUBE W CUFF $203.60 TRACH TUBE $366.30 UROGATE CYSTOSCOPY SET $33.30 TRACH PLUG $40.20 IV TUBING SET-REGULAR $27.90 VESSEL TIP 3.5 CM $42.60 ROBINSON CATHETER $19.70 IV PUMP EXTENSION SET $26.50 AIRWAY TUBE $5.90 URETHRAL TRAY W/OCTH $20.80 FENESTRATED TRACH TUBE $219.60 G.P. BIOPSY KIT $168.20 FEMORAL ARTERY KIT 18GA $221.80 CATHETER TRIPLE LUMEN EDWARDS $259.70 JELCO CATH KIT $13.80 CATHETER DOUBLE LUMEN EDWARDS $260.70 CATHETER SET TROCAR $173.80 TUBE TRACH SIZE 6 $239.00 ENG TUBE-4 LUMEN $2,125.30 SWAN-GANZ V.I.P. CATHETER-7.5 $285.80 HEMAQUET INTRODUCER KIT,9FR $141.90 PRESSURE EXTENSION SET $23.10 YELLOW CAPS (MALELEUR LOCK),#3 $12.80 SINGLE STOPCOCK (3 WAY) $72.20 DOUBLE STOPCOCK (3 WAY) $104.20 COOK NEEDLE 1 1/2 OR 3 INCH $11.70 RAD ART CATH SET-20 GA $195.60 COOK GUIDEWIRE .038CM $96.50 RAE ENDO TUBE $66.50 AXILLARY BLOCK KIT $17.30 SADDLE BLOCK TRAY $104.20 TWIN SITE EXTENSION $8.40 SINGLE TRANSDUCER $135.00 DOUBLE TRANSDUCER $226.50 TRIPLE TRANSDUCER $346.40 SUCTION CATH 14FR $9.40 SUCTION CATH COUDE 14FR $9.40 INNER CANNULAS 10 $24.20 TUBE TRACH SIZE 8 $227.60 SHILEY DCT 10 $197.90 DERMICLEAR TAPE 2"" $9.40 DERMILITE TAPE 1"" $9.40 DERMILITE TAPE 2"" $9.40 TRACH TUBE O (SS) $204.70 TRACH TUBE 1 (SS) $204.70 TRACH TUBE 2 (SS) $204.70 TRACH TUBE 4 (SS) $184.20 TRACH TUBE 5 (SS) $184.20 TRACH TUBE 6 (SS) $234.50 TRACH TUBE 7 (SS) $204.70 TRACH TUBE 8 (SS) $204.70 TRACH TUBE 9 (SS) $204.70 TRACH TUBE 10 (SS) $184.20 TRACH PLUG 4 1/4"" $44.80 TRACH PLUG 4 1/2"" $44.80 TRACH PLUG 4 3/4"" $44.80 TRACH PLUG 4 FC $44.80 TRACH PLUG 5 FC $40.20 TRACH PLUG 6 1/4"" $44.80 TRACH PLUG 6 1/2"" $44.80 TRACH PLUG 6 3/4"" $44.80 TRACH PLUG 6 FC $51.60 TRACH PLUG 8 FC $44.80 TRACH PLUG 10 FC $44.80 SHILEY FENESTRATED 8 $243.00 SHILEY PEDIATRIC 1 $794.30 SHILEY PEDIATRIC 2 $794.30 SHILEY PEDIATRIC 3 $794.30 FOLEY CATH 3 WAY 20FR 5CC $75.60 FOLEY CATH 3WAY 22FR 5CC $85.90 FOLEY CATH 3WAY 24FR 5CC $75.60 FOLEY CATH 3WAY 30CC 18FR $75.60 FOLEY CATH 3WAY 30CC 20FR $67.60 FOLEY CATH 3WAY 30CC 22FR $67.60 FOLEY CATH 3WAY 30CC 24FR $67.60 AIRWAY 60MM $5.90 AIRWAY 70MM $4.90 SHILEY CANNULA 4 $191.10 SHILEY TRACH 4DCT $197.90 SUCTION CATH 14FR $9.40 FOLEY CATH 2WAY 10FR 3CC $33.30 FOLEY CATH 2 WAY 12FR 5CC $33.30 FOLEY CATH 2 WAY 14FR 5CC $33.30 FOLEY CATH 2WAY 18FR 5CC $33.30 FOLEY CATH 2 WAY 5CC 24FR $33.30 FOLEY CATH 2WAY 5CC 26FR $33.30 FOLEY CATH 2WAY 5CC 28FR $33.30 FOLEY CATH 2WAY 3CC 8FR $33.30 FOLEY CATH 2WAY 30CC 20FR $33.30 FOLEY CATH 2WAY 30CC 22FR $33.30 FOLEY CATH 2 WAY 30CC 24FR $33.30 FOLEY CATH 2 WAY 30CC 28FR $33.30 FOLEY CATH 2 WAY 30CC 30FR $56.30 URETHRAL CATH 16FR $19.70 URETHRAL CATH 18FR $19.70 URETHRAL CATH 20FR $19.70 URETHRAL CATH 14FR COUDE $19.70 CATH FOLEY 26FR 30CC 2 WAY $37.90 SUCTION CATH 8FR $9.40 CATHETER 5FR SPIRAL FILIFORM $267.60 CATH 6FR SPIRAL FILIFORM $233.30 CATHETER 3FR OLIVE TIP FILIFO $233.30 CATHETER 4FR OLIVE TIP FILIFO $209.20 CATH 5FR OLIVE TIP FILIFORM $209.20 CATH 6FR OLIVE TIP FILIFORM $209.20 CATH 8FR PHILLIPS FOLLOWER $209.20 CATH 10FR PHILLIPS FOLLOWER $267.60 CATH 12FR PHILLIPS FOLLOWER $267.60 CATH 14FR PHILLIPS FOLLOWER $209.20 CATH 16FR PHILLIPS FOLLOWER $209.20 CATH 18FR PHILLIPS FOLLOWER $209.20 CATH 20FR PHILLIPS FOLLOWER $209.20 CATH 24FR PHILLIPS FOLLOWER $209.20 CATH URETHRAL 10FR COUDE $16.30 CATH URETHRAL 12FR COUDE $19.70 CATH URETHRAL 16FR COUDE $19.70 CATH URETHRAL 18FR COUDE $17.30 CATH URETHRAL 20FR COUDE $17.30 CATH URETHRAL 22FR COUDE $16.30 CATH URETHRAL 24FR COUDE $17.30 THORACIC CATHETER 32FR $121.80 FOLEY CATHETER 16FR 5CC 3 WA $83.60 FOLEY CATHETER 24FR 5CC 3 WAY $74.50 FOLEY CATHETER 26FR 5CC 3 WAY $83.60 FOLEY CATHETER 16FR 30CC 2 WA $37.90 FOLEY CATHETER 20FR 30CC 2 WA $37.90 FOLEY CATHETER 28FR 30CC 2 WA $37.90 FOLEY CATHETER 30FR 30CC 2 WA $37.90 FOLEY CATHETER 12FR COUDE $74.50 FOLEY CATHETER 22FR COUDE $71.10 FOLEY CATH 3WAY 30CC 16FR $83.60 FOLEY CATH 5CC 2WAY 26FR $37.90 CATHETER FOLEY IOFR COUDE I2W $65.40 CATH FOLEY COUDE 20FR 2 WAY 5 $74.50 CATH FOLEY COUDE 24FR 2 WAY 5 $74.50 CATH FOLEY COUDE 26FR 2 WAY 5 $65.40 CATH FOLEY COUDE 28FR 5CC 2WA $65.40 CATH FOLEY 28FR 5CC 2 WAY $37.90 CATH FOLEY 10FR 30CC 2 WAY $37.90 CATH FOLEY 12FR 30CC 2 WAY $37.90 CATH FOLEY 14FR 30CC 2 WAY $37.90 CATH FOLEY 10FR 5CC 3 WAY $83.60 CATH FOLEY 12FR 5CC 3 WAY $83.60 CATH FOLEY 14FR 5CC 3 WAY $83.60 CATH FOLEY 18FR 5CC 3 WAY $83.60 CATH FOLEY 28FR 5CC 3 WAY $83.60 CATH FOLEY 10FR 30CC 3 WAY $83.60 CATH FOLEY 12FR 30CC 3 WAY $83.60 CATH FOLEY 14FR 30CC 3 WAY $83.60 CATH FOLEY 26FR 30CC 3 WAY $83.60 CATH FOLEY 14FR COUDE 2-W $74.50 TRACH SHILEY #6 CUFFLESS $233.00 TRACH TUBE-8 FR CUFFLESS $265.30 LARYNGECTOMY TUBE, # 8 $265.30 LARYNGECTOMY TUBE. # 10 $265.30 LARYNGECTOMY TUBE-6FR $265.30 LARYNGECTOMY TUBE-8FR $265.30 LARYNGECTOMY TUBE-10FR $265.30 HEYMAN FOLLOWER-10F $157.90 HEYMAN FOLLOWER-12FR $157.90 HEYMAN FOLLOWER-14FR $157.90 HEYMAN FOLLOWER-16FR $157.90 HEYMAN FOLLOWER-18FR $157.90 HEYMAN FOLLOWER-20 FR $157.90 HEYMAN FOLLOWER-22 FR $157.90 HEYMAN FOLLOWER-24FR $157.90 CUFFLESS TRACH TUBE-4FR SHILEY $258.60 URETHRAL CATH 22FR $17.30 DRAINAGE SET FOR CYCLER $77.90 SET DISCONNECT FOR UV FLASH $40.20 VAGINAL DILATORS X-SMALL $39.10 VAGINAL DILATOR SMALL $39.10 VAGINAL DILATOR MEDIUM $47.10 VAGINAL DILATOR LARGE $56.30 CATH FOLEY 16FR COUDE 30CC 2W $71.10 CATH FOLEY 18FR COUDE 30CC 2W $71.10 CATH FOLEY 20FR COUDE 30CC 2W $71.10 CATH FOLEY 30FR COUDE 30CC 2W $71.10 GROSHONG CATH CONNECTOR $52.80 MINICAP W/PVP SOLUTION $20.80 TROCAR CATH 24 FR $45.90 TROCAR CATH 28 FR $45.90 COOK GUIDEWIRE .35CM $96.50 CATH FOLEY COUDE 16FR 2WAY $99.50 CATHETER TRAY TEMP DUAL LUMEN $446.90 THYMAPAD EPAD $11.70 HOT/ICE HIP PAD $124.70 CATHETER COUNCIL 16FR $91.60 CATHETER COUNCIL 18FR $91.60 CATHETER COUNCIL 20FR $91.60 CATHETER COUNCIL 22FR $91.60 TRACH TUBE 8 SCT $192.20 TRACH TUBE 9 SCT $192.20 URETHRAL GUIDEWIRE $169.30 FOLEY CATH 18FR 2WAY 30CC $37.90 AIRWAY NASOPHARYNGEAL 34FR $20.80 AIRWAY NASOPHARYNGEAL 36FR $20.80 CATHETER TRIPLE LUMEN HEMODIAL $448.10 CATH FOLEY 14FR 30CC 2WAY COU $66.50 CATHETER CLEARVUE PICC 4 FR $249.70 CATHETER RADIAL ARTERY $57.30 CATHETER HEMODIALYSIS CURVED $301.90 CATHETER GROSHONG DBL.LUMEN 5F $337.20 TUBE PEDIATRIC 8 FR FEEDING $40.20 TUBE TRACH SHILEY 10 SCT $191.10 CATHETER SINGLE LUMEN 3 FR $128.10 CATHETER GROSH MIDLINE 4FR 18G $157.90 CATHETER DUAL LUMEN 4.5FR $274.40 TUBE SHILEY 0 PT $191.10 DELCLAMP $3.50 MARKER RECTAL $28.80 MARKER VAGINAL $28.80 CATHETER PICC SINGLE LUMEN 3F $332.70 HYPAFIX TAPE $9.40 URETHRAL CATHETER 12FR $6.00 CATHETER FOLEY 24FR COUDE 30C $71.10 FOLEY CATH 12FR 5CC LATEX FRE $71.10 CATHETER DOUBLE LUMEN LF $81.30 TUBE SHILEY #8 DCFN $191.10 OSTOMY BELT SMALL $33.30 OSTOMY BELT MEDIUM $33.30 OSTOMY BELT LARGE $33.30 V.A.C. UNIT $152.20 GASTROSTOMY TUBE 20 FR $191.10 HYPAFIX 6X10 TAPE $47.10 TUBE TRACH SHILEY 8 X LONG $380.60 INNER CANNULA 8 X LONG $137.10 CATHETER QUAD LUMEN EDWARDS $298.50 SAFELOCK 4""ADAPTER DIALYSIS $49.40 DRAIN SET 4-LEAD $27.00 ECOSET 4-LEAD $26.50 FLEXI-SEAL FECAL COLLECTOR KIT $1,236.80 NEWTON CYCLER SET W/2 PIN CONN $27.00 IV TUBING SET-NON PVC $83.40 CATHETER POWER PICC SOLO $860.80 POWERGLIDE KIT 22 GAUGE $384.00 POWERGLIDE NEEDLE 22 GAUGE $220.00 POWERGLIDE KIT 20 GAUGE $340.00 POWERGLIDE NEEDLE 20 GAUGE $192.00 POWERGLIDE NEEDLE 18 GAUGE $220.00 POWERGLIDE KIT 18 GAUGE $384.00 POWERGLIDE BASIC KIT 10CM $220.00 ET TUBE-CUFFED $0.00 ET TUBE-UNCUFFED $0.00 PARACERVICAL PUDENTAL TRAY $74.50 TRAY LUMBAR PUNCTURE $91.60 DISP DOUCHE TRAY $19.70 SYRINGE MAGNIFIER $43.70 DISP URETHER CATH TRAY $36.80 SUTURE TRAY $102.00 NASAL TRAY $72.20 VAGINAL TRAY $72.20 PED. LUMBAR PUCTURE TRAY $82.50 OBESE BED PER DAY $398.90 CVP LINE DRESSING TRAY $72.20 UROLOGY TRAY $144.20 ENT TRAY $140.70 BASIC BIOPSY TRAY $82.50 PERICARDIALCENTESIS SET $342.90 THORACENTESIS SUPPLY KIT $182.90 EYE PAD $6.90 STER SODIUM CHL IRRIG SOL (P) $53.90 ACE BANDAGE 4"" $13.80 XEROFORM DRESSING 5X9 $13.80 XEROFORM DRESSING 1X8 $11.70 DEXTROSE 5% IN WATER 100ML $17.90 DEXTROSE 5% IN WATER 250 ML $17.90 DEXTROSE 5% IN WATER 500ML $17.90 DEXTROSE 5% IN WATER 1000ML $17.90 DEXTROSE 5% IN 1/4SALINE 500ML $12.80 DEXTROSE 5% IN 1/4SALINE1000ML $12.80 DEXTROSE 5% IN 1/3SALINE 500ML $12.80 DEXTROSE 5% IN 1/2SALINE 500ML $12.80 DEXTROSE 5% IN 1/2SALINE1000ML $12.80 DEXTROSE 5% IN SALINE 500ML $12.80 DEXTROSE 5% IN SALINE 1000ML $12.80 DEXTROSE 5% IN RINGERS 500ML $16.20 DEXTROSE 5% IN RINGERS 1000ML $16.20 DEXTROSE 5% IN LACT RING 500ML $16.20 DEXTROSE 5% IN LACT RING1000ML $16.20 DEXTROSE 10% IN WATER 500ML $17.90 DEXTROSE 10% IN WATER 1000ML $17.90 DEXTROSE 10% IN SALINE 1000ML $12.80 DEXTROSE 50% IN WATER 500ML $17.90 LACTATED RINGERS 250ML $16.20 LACTATED RINGERS 500ML $16.20 LACTATED RINGERS 1000ML $12.80 RINGERS INJECTION 500ML $16.20 RINGERS INJECTION 1000ML $16.20 NORMAL SALINE 250ML $12.80 NORMAL SALINE 500ML $12.80 NORMAL SALINE 1000ML $12.80 SODIUM CHLORIDE SOLN 5% 500ML $12.80 MANNITOL SOLN 5% 1000ML $127.10 MANNITOL SOLN 10% 1000ML $146.40 INVERT SUGAR 10% 1000ML $36.80 NORMOSOL M IN D5W 500ML $74.50 NORMOSOL M IN D5W 1000ML $82.50 NORMOSOL R 500ML $52.80 NORMOSOL R 1000ML $72.20 NORMOSOL R IN D5W 1000ML $82.50 LMD 10% IN DEXTROSE 5% 500ML $252.80 LMD 10% IN SALINE 500ML $252.80 DEXTRAN 6% IN DEXTROSE 5%500ML $308.50 DEXTRAN 6% IN SALINE 500ML $308.50 SALINE SOLN 0.45% 1000ML $48.20 SODIUM LACTATE SOLN 1/6M 500ML $36.80 SODIUM LACTATE SOLN 1/6M1000ML $48.20 MANNITOL SOLN 20% 500ML $146.40 AMINOSYN M 3.5% 1000ML $202.50 ALCOHOL 5% IN D5W 1000ML $31.10 NORMAL SALINE 100ML $10.00 SALINE SOLUTION 0.45% 500ML $42.60 THEOPHYLLINE 400MG D5W 500 $49.40 NITROGLYCERIN ADM SET $71.10 FAT EMULSION ADM SET $62.00 NONVENT VOL TUB W FILTER $63.10 NONVENTED TUBING W FILTER $62.00 NONVENTED ANESTHESIA SET $16.30 VENTED VOL TUBE WO FILTER $97.40 VENTED PRI SET W/O FILTER $10.40 SOLUSETS $32.20 BLOOD Y SET $6.90 JELCO NEEDLE $12.80 VENOSET $18.50 N-V SEC MICRO DRIP SET $36.80 MIRO PUMP W/FILTER SET $60.70 Y-BLOOD BUMP SET $47.10 HEMA MICROAGGREGATE $29.90 INFUSAID NEEDLE $15.10 MIRCO NITROGLYCERIN SET $62.00 ANGLED INFUSAID NEEDLE $24.20 LEUKOCYTE FILTR $143.00 TPN ADMIN SET $9.40 VENTED ADAPTER $8.40 VENTED SECONDARY SET 1059 $6.90 NON-VENTED SECONDARY SET 1058 $6.90 VENTED NITROGLYCERINE SET $29.90 SET SECONDARY PUMP $10.40 BLOOD WARMING SET $33.30 PRIMARY SET W/FILTER $45.90 PLATELET REMOVAL FILTER $338.40 IV CAD PLUS PUMP (1-31 DAYS) $562.30 RECERTIFICATION,IV ANTIBIOTIC $225.30 EMERGENCY ROOM LEVEL 1 $224.90 99281 EMERGENCY ROOM LEVEL 2 $376.40 99282 EMERGENCY ROOM LEVEL 3 $627.30 99283 EMERGENCY ROOM LEVEL 4 $1,261.30 99284 EMERGENCY ROOM LEVEL 5 $1,318.60 99285 ED CRITICAL CARE UP TO 74MIN $1,663.80 99291 ED CRITICAL CARE EA ADD 30MIN $575.00 99292 IMMUNIZATION ADM;ONE $107.00 90471 TELEHEALTH FACILITY FEE $143.00 THER/PROPH/DIAG INJ SC/M $138.70 96372 IMMUNE ADMIN PEDIATRIC $40.00 90460 DERMABOND $137.10 NG TUBE $45.90 RAPID RHINO $119.20 ADMIN FLU VIRUS VACCINE $69.80 G0008 ADMIN HEPATITIS B VACCINE $80.00 ADMIN PNEUMONIA VACCINE $69.80 ER ULTRASOUND LINE PLACEMENT $400.00 76942 PLACE NEEDLE INTRAOSSEOUS INFU $820.00 36680 INTRAOSSEOUS INF SYSTEM $418.20 ADMIN OF PREVNAR $69.80 THER/PROPH/DIAG IV INF INIT=<1 $427.50 9636559 PROCEDURE-SIMPLE $700.00 PROCEDURE-COMPLEX $2,000.00 PROCEDURE-INTERIM $1,400.00 ADM INJ $107.00 SPICA SPLINT $540.00 ZMI EXT CARD PACE W/PADS $773.70 ZMI PACER PADS $213.90 CAUTERY KNIVES-DISPOSABLE $29.90 SHORT ARM SPLINT $201.00 29125 ANKLE STRAPPING $251.00 29540 SHORT LEG SPLINT $251.00 29515 STRAPPING SHOULDER $187.00 29240 AIRCAST FOAM WALKER $696.00 ARTHROCENTESIS-INTERMEDIATE JO $1,325.60 CARDIOVERSION/DEFIBRILLATION $963.00 92960 CHEST TUBE INSERTION $1,590.80 THORACENTESIS $1,369.00 32554 SPLINT OCL ARM $381.90 ARTERIAL/VENOUS LINE INSERTION $828.40 CENTRAL LINE INSTERTION $1,193.60 THER/PROPH/DIAG INJ SC/IM $138.70 96372 THER/PROPH/DIAG INJ IV PUSH $360.00 96374 TX/PRO/DX INJ NEW DRUG ADDON $151.20 96375 THER/PROPH/DIAG IV INF INIT $427.50 96365 THER/PROPH/DIAG IV INF, ADD ON $124.70 96366 HYDRATION IV INFUSION INIT $360.00 96360 HYDRATION IV INFUSION ADD ON $83.40 96361 TX/PROPH/DG ADDL SEQ IV INF $128.40 96367 TX/PROPH/DG ADDL CONCURRENT IV $82.30 96368 TX/PRO/DX INJ SAME DRUG ADON $162.40 96376 HYDRATION IV INFUSION, INIT $360.00 96360 PORT FLUSH $138.80 MOD SEDATION INITIAL 15 MIN $203.00 99152 MOD SEDATION EA ADDL 15 MIN $203.00 99153 OP MNT INITIAL CONSULT EA 15MI $110.00 97802 OP MNT F/U CONSULT EA 15 MIN $110.00 97803 OP MNT GROUP PER 30 MIN $110.00 97804 MNT EA 15 M AFTER 2ND REFRL $53.90 MNT GRP/30M AFTER 2ND RFERL $53.90 V-U-H NUTRITIONAL COUNSELING $45.90 CHOOSE TO LOSE $143.00 BARIATRIC FOLLOWUP 30 MIN $51.00 97803 MINOR/SELF-LIMITED VST <10 MIN $243.00 99201 STRAIGHT FORWARD <20 MINUTES $268.00 99202 LOW <30 MINUTES $293.00 99203 MODERATE <45 MINUTES $308.00 99204 HIGH >45 MINUTES $338.00 99205 EST PT NURSE VISIT 10 MINUTES $218.00 99211 EST PT STRAIGHT FORWARD <10MIN $243.00 99212 EST PT MODERATE < 25 MINUTES $293.00 99214 EST PT HIGH > 40 MINUTES $308.00 99215 PRC/INTR MINOR/SELF LIMIT<10 $243.00 9920125 PRC/INTR STRAIGHT FORWARD <20 $268.00 9920225 PROC/INTER MODERATE < 45 MIN $308.00 9920425 PROC/INTER HIGH > 45 MIN $338.00 9920525 EST PT PRO/INTR NURSE VST 10 $218.00 9921125 EST PT PRO/INTR LOW <15 MIN $268.00 9921325 EST PT PRO/INTR MODERATE <25 $293.00 9921425 EST PT PRO/INTR HIGH > 40 MIN $308.00 9921525 DESTRUCTION BENIG LESION/WART $350.00 17000 DESTRUCT BENIGN LESION/WARTS $130.00 17003 PARING/CUTTING CORN/CALLOUS 1 $350.00 11055 PARING/CUTTING CORN/CALLOUS2-4 $350.00 11056 PARING/CUTTING CORN/CALLOUS >5 $410.00 11057 ARTRL VASCULAR EX ANKLE $253.80 93922 REPAIR WOUND SIMPLE <2.5CM $370.00 12001 DEBRIDEMENT;SKIN AND SUBQ $1,325.00 11042 DEBRIDEMENT;SKIN AND MUSCLE $1,325.00 11043 DEBRIDEMENT;NAIL 1-5 $175.00 11720 DEBRIDEMENT; NAIL >6 $225.00 11721 AVULSION NAIL PLATE,PART/COMP $350.00 11730 REMOVAL FOREIGN BODY FOOT;SUBQ $1,750.00 28190 BX SKIN &/SUBQ TISSUE;1 LESION $615.00 11100 TRIMMING NON-DYSTROPHIC NAILS $110.00 11719 I & D OF ABSCESS $370.00 10060 EXC BENIGN LESION .5CM $2,700.00 11420 EXC BENIGN LESION .6CM $1,750.00 11421 EXC BENIGN LESION 1.1-2CM $2,700.00 11422 EXC BENIGN LESION 2.1 - 3 CM $2,700.00 11423 EXC BENIGN LESION 3.1CM - 4CM $2,550.00 11424 EXC BENIGN LESION OVER 4CM $4,600.00 11426 WOUND CLOSURE W/ TISSUE ADHES $223.10 INIT PHYS E&M DIABETIC PT W/LO $223.10 F/U EVAL DIABETIC PT W/LOPS $223.10 ROUTINE FT CARE PHYS DIAB PT W $350.00 I & D OF BONE INFECTION $5,160.00 28005 DEBRIDEMENT; SKIN TO BONE $2,635.00 11044 I&D; COMPLEX $615.00 10061 PUNC ABCESS/CYST $615.00 10160 I&D; POST OP WOUND $4,600.00 10180 INJ TRIGGER POINT, 1/2 MUSCL $490.00 20552 BIOPSY OF SKIN;EA ADD LESION $375.00 11101 FLEXOR TENOTOMY, SINGLE TOE $2,650.00 28232 AQUACEL AG 4X4 DRESSING $22.00 CURASOL HYDROGEL 4X4 DRESSING $23.10 FIBRACOL PLUS 4X4 WOUND DRESS $34.50 I&D HEMATOMA,SUBUNGUAL RT HALL $2,700.00 10140 REMOVAL FB,SUBQ TISSUE, SIMPLE $615.00 10120 INJECTION TENDON OR LIGAMENT $490.00 20550 TX TARSAL BONE FX,W/O MANIP RT $660.00 28450RT TX TARSAL BONE FX,WO MANIP LT $660.00 28450LT CL TX METARSAL FX;WO MANIP RT $660.00 28470RT CL METARSAL FX; WO MANIP LT $660.00 28470LT TRIM DYSTROPHIC NAIL, ANY # $110.00 PRISMA WOUND DRESSING $61.00 DEEP DISSECT FOOT INF;SGL BURS $4,877.00 28002 MISC WOUND CARE $0.00 APLIGRAF 44 SQ CM $5,257.70 ALGINATE(MAXORB)DRESS 19 SQ CM $49.00 WOUND PREP,CH/INF,TRK/ARM/LG $3,100.00 15002 WOUND PREP, CH/INF ADDL 100CM $1,575.00 15003 WOUND PREP CH/INF, F/N/HF/G $1,480.00 15004 WOUND PREP, F/N/HF/G, ADDL CM $1,130.00 15005 NWS DEBRIDEM WO A/SESSION PT $350.00 97602GP WND CARE UNATT ELECTR STIM PT $71.70 97014GP NON WND ELECT STIM PT $71.70 97014GP NWS DEBRIDEM WO/SESSION RN $350.00 97602 LESSOR TOE,CLOSED TX W/O MANIP $425.00 28510 PT-MANUAL THERAPY EA 15 MIN $74.50 97140GP PT ADL SELF CARE TR EA 15 MIN $67.90 97535GP PT MODALITY VASOPNEUMATIC DEVI $88.80 97016GP PT THERAP EXERCISE ROM EA 15 M $62.00 97110GP PT MASSAGE THERAPY EA 15 MIN $62.60 97124GP LEVEL IV SKIN REPAIR $5,300.00 11960 ORTHOTIC MGMT/TRN,INIT EA 15MI $148.70 97760GP SKIN THERAPY $68.80 97039 3M COBAN COMFORT LAYER $20.30 WET-TO-MOIST DRESSINGS, RN $350.00 97602 SLCTV WND DEBRIDEM 20 CM OR < $410.00 97597 SLCTV WND DEBRIDEM ADD 20 CM/< $332.50 97598 DERMAGRAFT SKIN SUB, PER SQ CM $5,075.00 VOLUMETRIC MEASUREMENT, EA 15M $111.00 97750GP TENOTOMY, SQ, TOE; SINGLE $2,650.00 28010 SLCTV WND DEBRIDEM 20 CM OR < $410.00 97597 SLCTV WND DEBRIDEM ADDL 20CM/< $332.50 97598 CHEM CAUT GRANULATION TISS $330.00 17250 DEB SUBQ TISSUE ADD-ON=<20SQ $549.00 11045 DEB MUSC/FASCIA ADD-ON=<20SQ $653.50 11046 DEB BONE ADD-ON=<20 SQ CM $1,646.70 11047 UNNA BOOT APPLICATION, LT $268.00 29580LT UNNA BOOT APPLICATION, RT $268.00 29580RT SKIN SUB GRAFT TRNK/ARM/LEG $3,856.00 15271 SKIN SUB GRAFT T/A/L ADD-ON $794.60 15272 SKIN SUB GRFT T/ARM/LG> 100CM $5,300.00 15273 SKN SUB GRFT T/A/L > 100CM ADD $1,076.90 15274 SKIN SUB GRAFT FACE/NK/HF/G $3,100.00 15275 SKIN SUB GRAFT F/N/HF/G ADDL $794.60 15276 SKN SUB GRFT F/N/HF/G > 100CM $3,100.00 15277 SKN SUB GRFT F/N/HF/G> 100CM A $1,076.90 15278 THERASKIN 5.1 x 7.6 CM $5,100.00 APPLY RIGID TOTAL CONTACT LEG $522.80 29445 CAST SUP SHRT LEG ADULT FIBERG $161.60 NEG PRE WOUND <=50 SQ CM $610.00 97607 NEG PRES WOUND >50 SQ CM $610.00 97608 EPIFIX 2 x 3 (6CM) $4,576.00 EPIFIX 4 X 4 (16CM) $12,204.00 EPIFIX 7 X 7 (49 SQ CM) $37,376.00 GRAFIX PRIM 5 X 5 CM $10,759.00 GRAFIX CORE 5 X 5 CM $10,759.00 GRAFIX CORE 2 X 3 $4,466.00 OASIS TRI-LAYER MATRIX 35 SQ C $1,451.50 LC SKIN SUB GRAFT TRNK/ARM/LEG $1,076.90 C5271 LC SKIN SUB GRAFT T/A/L ADD-ON $794.60 C5272 LC SKIN SUB GRFT T/ARM/LG>100C $3,850.00 C5273 LC SKN SUB GRFT T/A/L>100CM AD $1,076.90 C5274 LC SKIN SUB GRAFT FACE/NK/HF/G $1,076.90 C5275 LC SKIN SUB GRAFT F/N/HF/G ADD $794.60 C5276 LC SKIN SUB GRFT F/N/HF/G>100C $2,550.00 C5277 LC SKN SUB GRFT F/N/HF/G>100CM $1,076.90 C5278 TX WOUND DEHISCENCE; SIMPLE $1,674.80 12020 THERASKIN 2.5 X 5.1 $3,900.00 Q4121 3M COBAN COMPRESSION LAYER $147.20 EST PT PRO/INTR STRGHT FOR <10 $243.00 9921225 PROC/INTER LOW <30MIN $293.00 9920325 EST PT LOW <15 MINUTES $268.00 99213 GRAFIX PRIME 2 X 3 $4,466.00 GRAFIX PRIME 3X4 CM $5,481.00 APPLY MULTLAY COMPRS LWR LEG R $583.70 29581RT APPLY MULTLAY COMP LWR LEG LT $583.70 29581LT DRESS/DEBRID P-THICK BURN S $350.00 16020 DRESS/DEBRID P-THICK BURN M $410.00 16025 DRESS/DEBRID P-THICK BURN L $1,000.00 16030 LOW FREQ NONTHERMAL US $350.00 97610 EPIFIX 14MM DISK $1,252.00 EPIFIX 18MM DISK $2,976.00 EPIFIX 2CM X 2 CM $4,256.00 EPIFIX 2CM X 4CM $5,400.00 EPIFIX 3CM X 4CM $9,516.00 EPIFIX 5CM X 6CM $22,884.00 EPIFIX MESH 3.5CM X 3.5CM $4,976.00 EPIFIX MESH 4CM X 4.5CM $5,576.00 PRIMATRIX, MESHED 2:1, 3X3 CM $3,220.00 PRIMATRIX, SOLID 4X4 CM $5,000.00 PRIMATRIX, FENESTRATED, 4X4 $5,000.00 PRIMATRIX, MESHED 2:1, 4X4CM $5,500.00 PRIMATRIX, MESHED 2:1, 5X5 CM $7,980.00 PRIMATRIX, SOLID, 6X6 CM $9,996.00 PRIMATRIX, FENESTRATED, 6X6 CM $9,996.00 PRIMATRIX, MESHED 2:1, 6X6 CM $10,995.60 PRIMATRIX AG, SOLID, 4X4 CM $5,750.00 PRIMATRIX AG,FENESTRATED,4X4CM $5,750.00 PRIMATRIX AG,MESHED 2:1,4X4CM $5,750.00 PRIMATRIX AG, SOLID, 6X6 CM $11,495.40 PRIMATRIX AG,FENESTRATED,6X6CM $11,495.40 HYALOMATRIX 2.5 X 2.5 CM $700.00 HYALOMATRIX 5 X 5 CM $1,100.00 HYALOMATRIX 10 X 10 CM $3,900.00 HYALOMATRIX 10 X 20 CM $7,100.00 PURAPLY 2 X 4 CM $3,296.00 PURAPLY 5 X 5 CM $10,300.00 PURAPLY 6 X 9 CM $22,248.00 PURAPLY AM 2 X 2 CM $2,368.00 PURAPLY AM 2 X 4 CM $3,584.00 PURAPLY AM 5 X 5 CM $11,200.00 PURAPLY AM 6 X 9 CM $24,192.00 FAST CAST KIT $469.00 CAM BOOT $266.00 TWO PRESS 2 COMPRESSION LAYER $264.96 TWO PRESS 2 COMFORT LAYER $47.32 HYDROFERA BLUE FOAM 2X2 $30.00 HYDROFERA BLUE FOAM 4X4 $30.00 HYDROFERA BLUE READY TRANS 4X5 $60.00 EXTREMITY STUDY $329.90 93923 HYPERBARIC O2 PER 30 MIN $600.10 GLUCOSE; BLD BYMONITOR DEVICE $15.50 82962 REPEAT GLUCOSE; BLD BY MONITOR $15.00 8296291 EST PT NURSE VISIT 10 MIN $218.00 99211 EST PT STRAIGHTFORWARD <10MIN $243.00 99212 EST PT LOW <15 MIN $268.00 99213 EST PT MODERATE <25 MIN $293.00 99214 EST PT HIGH >40 MIN $308.00 99215 NEW PT LOW <30 MINUTES $293.00 99203 HEMO-DIALYSIS $940.00 UNSCHG/EMRG DIALYS OUTPATIENT $940.00

ROOM CHARGES ROOM CHARGE 5E $1,000.00 ROOM CHARGE 5E $1,000.00 VIP BED 5E $1,100.00 ROOM CHARGE 5 $1,000.00 REHAB $925.00 ROOM CHARGE 6E $1,000.00 ROOM CHARGE 6E $1,000.00 VIP BED 6E $1,100.00 ROOM CHARGE 6W $1,000.00 ROOM CHARGE 6W $1,000.00 VIP BED 6W $1,100.00 ROOM CHARGE 7E $1,000.00 ROOM CHARGE 7E $1,000.00 VIP BED 7E $1,100.00 ROOM CHARGE 7W $1,000.00 ROOM CHARGE 7W $1,000.00 CRIB BED 7W $600.00 VIP BED 7W $1,100.00 ROOM CHARGE 4W $1,000.00 ROOM CHARGE 4 PCU $1,800.00 PSYCH BED 2W $975.00 ICU BED $1,900.00 M/S ICU $1,000.00 CCU BED $1,900.00 M/S CCU $1,000.00 PRIVATE PCU $1,800.00 PRIVATE BED PCU $1,800.00 M/S PCU $1,000.00