NOTE: The following are Shirley Ryan AbilityLab's standard charges as of Jan. 1, 2019. These standard charges often do not reflect what a patient or their insurance company/payer may be required to pay. Contact Patient Financial Services at 312-238-6039 for more information.

• Description
• Price

11-Deoxycortisol, Urine Random 12 Lead Ekg, Tracing Only
$531 $245
17 Hydroxycorticosteroids, Urine Timed 17 Hydroxyprogesterone, Serum
$363 $172

• 17 Ketosteroids, Urine Timed
• $273

17-Ketosteroids with Creatinine, Urine Random 2D Gait Analysis Charge(95999) 5' Nucleotidase, Serum
$273
$2,174
$269

• 5.5 PDC PEDS CUFFED TRACH
• $226

• 5-HIAA-24 Hr Urine
• $99

A4566 Shoulder sling or vest design, abduction res A4595 FES Electrode, each
$226
$38
A6545 Gradient Compression Wrap, Non-Elastic, Belo ABO Rh Type
$171 $106

• Above Knee Nylon Hose PR
• $83

• Above Knee Suction Sheath
• $131

Above knee, for proximal femoral focal deficiency, Above knee, molded socket, open end, SACH foot, en Above knee, molded socket, single axis constant fr Above knee, short prosthesis, no knee joint (""stu_L5210 Above knee, short prosthesis, no knee joint (""stu_L5220 ACAPELLA DH GREEN VIBRATORY PEP W/MOUTHPIECE DEVIC Acetabuloplasty (27120)
$14,344 $10,751 $10,935
$8,682 $7,429
$181
$4,493

• $27
• Acetone, Serum

Acetylcholine Receptor Binding Antibody Acid Phosphatase
$405
$66

• Acid Phosphatase, Prostatic fraction
• $66

ACNE SURGERY MILIA CYSTS (10040) Acorn Nebulizer
$530 $174
Activated PTT/Partial Thromboplastin Time Active Wound Care > 20 cm Units
$109 $171
Active Wound Care/20 cm or < Units Acupuncture with E-Stim. Each additional 15 minute Acupuncture with E-Stim. Initial 15 minutes Charge Acupuncture without E-Stim each additional 15 minu Acupuncture without E-Stim. Initial 15 minutes Cha Acute Hepatitis Panel
$171
$65
$110
$65 $89
$348

• Add Padding to Belt
• $113

Addit to LE, BK/AK, custom fab or prefab, socket i Addit to LE, BK/AK, custom fab socket insert for c Addit to LE, BK/AK, custom fab socket insert for o Addition to Halo Procedure, MRI Compatible System Addition to LE pros, endo knee-shin sys, microproc Addition to LE pros, endo knee-shin sys, microproc_L5857 Addition to LE pros, endo knee-shin sys, microproc_L5858 Addition to LE pros, endo knee-shin sys, powered & Addition to LE, AK or knee disartic, acrylic socke Addition to LE, AK or knee disartic, pelvic joint Addition to LE, AK or knee disartic, Silesian band Addition to LE, AK or knee disarticulation, pelvic Addition to LE, AK, air cushion socket Addition to LE, AK, flexible inner socket, externa Addition to LE, AK, leather socket Addition to LE, AK, pelvic control belt, light Addition to LE, AK, pelvic control belt, padded an Addition to LE, AK, pelvic control, sleeve suspens Addition to LE, AK, wood socket Addition to LE, BK flexible inner socket, external Addition to LE, BK, acrylic socket Addition to LE, BK, air cushion socket Addition to LE, BK, back check (extension control) Addition to LE, BK, cuff suspension
$2,072 $4,164 $4,164 $2,529
$72,220 $20,724 $43,410 $36,322
$1,353
$589 $481 $279
$1,764 $4,497 $1,641
$395 $730 $655
$1,419 $3,083 $1,268 $1,494
$176 $308

• Addition to LE, BK, fork strap
• $143

• Addition to LE, BK, joint covers, pair
• $118

Addition to LE, BK, knee joints, polycentric, pair Addition to LE, BK, knee joints, single axis, pair Addition to LE, BK, leather socket Addition to LE, BK, molded distal cushion Addition to LE, BK, molded supracondylar suspensio Addition to LE, BK, removable medial brim Addition to LE, BK, suction socket
$1,660 $1,114 $1,559
$356 $835 $868
$2,502
$385
$1,871
Addition to LE, BK, suspension/sealing sleeve, w/ Addition to LE, BK, thigh lacer, gluteal/ischial, Addition to LE, BK, thigh lacer, non-molded Addition to LE, BK, total contact Addition to LE, BK, waist belt, padded and lined Addition to LE, BK, waist belt, webbing
$936
$1,535
$376 $184

• Addition to LE, BK, wood socket
• $2,694

$2,063 $2,487 $7,704 $5,070 $6,078 $3,740 $4,107 $6,026 $7,752 $2,035 $1,771 $1,353
$491
Addition to LE, BK/AK suspension locking mechanism Addition to LE, BK/AK, custom fab or prefab, socke Addition to LE, endo sys, AK or knee disartic, 4-b Addition to LE, endo sys, AK or knee disartic, 4-b_L5611 Addition to LE, endo sys, AK, hydracadence system Addition to LE, endo sys, AK, universal multiplex Addition to LE, endosys, AK or knee disartic, 4-ba Addition to LE, hip disartic, flexible inner socke Addition to LE, ischial containment/narrow M-L soc Addition to LE, knee disartic, expandable wall soc Addition to LE, knee disartic, leather socket Addition to LE, quick change self aligning unit, A Addition to LE, shoulder harness Addition to LE, socket insert, AK (Kemblo, Pelite, Addition to LE, socket insert, AK, silicone gel or Addition to LE, socket insert, AK, silicone gel or_L5665 Addition to LE, socket insert, BK (Kemblo, Pelite, Addition to LE, socket insert, BK, silicone gel or Addition to LE, socket insert, knee disartic, sili Addition to LE, socket insert, multidurometer, Sym Addition to LE, socket insert, Symes, silicone gel Addition to LE, socket insert, Synes Addition to LE, suction suspension, AK or knee dis Addition to LE, Symes type, ""PTB"" brim socket de Addition to LE, Symes type, expandable wall socket Addition to LE, Symes type, medial opening socket Addition to LE, Symes type, posterior opening (Can Addition to LE, test socket, AK
$1,892 $2,487 $1,793
$877
$1,573 $1,573 $1,573 $2,487 $1,211 $1,341 $1,085 $1,365
$772
$1,012 $1,237 $1,193 $1,926 $1,902 $1,238 $1,344 $1,500 $1,332
$635
$1,238
$11,732
$3,234 $2,874
$11,750
$2,618 $8,866 $4,980 $1,825 $7,599 $2,429 $1,760 $5,272 $4,833 $5,393 $2,123 $1,004 $3,546 $3,111 $1,450 $2,353
$10,128
$3,513 $3,482
$513
Addition to LE, test socket, BK Addition to LE, test socket, Hemipel Addition to LE, test socket, Hip disartic Addition to LE, test socket, Knee disartic Addition to LE, test socket, Symes Addition to LE, total contact, AK or knee disartic Addition to LE,socket insert, knee disartic (Kembl Addition to lower extremity, Long tongue stirrup Addition to UE, External power, additional switch Addition, endo knee-shin sys, 4-bar linkage or mul Addition, endo knee-shin sys, hydraulic stance ext Addition, endo knee-shin sys, polycentric, frictio Addition, endo knee-shin sys, polycentric, hydraul Addition, endo knee-shin sys, polycentric, mechani Addition, endo knee-shin sys, single axis, fluid s Addition, endo knee-shin sys, single axis, fluid s_L5824 Addition, endo knee-shin sys, single axis, frictio Addition, endo knee-shin sys, single axis, hydraul Addition, endo knee-shin sys, single axis, manual Addition, endo knee-shin sys, single axis, manual _L5810 Addition, endo knee-shin sys, single axis, pneumat Addition, endo knee-shin sys, single axis, pneumat_L5830 Addition, endo knee-shin sys, stance flexion featu Addition, endo sys, AK or hip disartic, alignable Addition, endo sys, AK or knee disartic or hip dis Addition, endo sys, AK, flexible protective outer Addition, endo sys, AK, ultra-light material (tita Addition, endo sys, BK, alignable system Addition, endo sys, BK, flexible protective outer Addition, endo sys, high activity knee control fra Addition, endo sys, hip disartic, flexible protect Addition, endo sys, hip disartic, ultra-light mate Addition, endo system, AK or hip disartic, knee ex Addition, endo system, BK, ultra-light material (t Addition, endo system, hip disartic, mechanical hi Addition, exo knee-shin sys, polycentric mechanica Addition, exo knee-shin sys, polycentric, friction Addition, exo knee-shin sys, single axis, external Addition, exo knee-shin sys, single axis, fluid sw Addition, exo knee-shin sys, single axis, fluid sw_L5724 Addition, exo knee-shin sys, single axis, friction Addition, exo knee-shin sys, single axis, manual l Addition, exo knee-shin sys, single axis, manual l_L5710 Addition, exo knee-shin sys, single axis, pneumati Addition, exo knee-shin sys, single axis, pneumati_L5722 Addition, exo knee-shin sys, single axis, variable
$2,006
$926
$2,083 $2,227 $4,973 $5,865 $4,205 $1,035 $1,450
$863
$3,209 $2,708 $1,053
Addition, exo sys, BK, ultra-light material (tita Addition, exo sys, AK, ultra-light material (titan Addition, exo sys, hip disartic, ultra-light mater Addition, Knee Joint, Cam Lock Addition, Knee Joint, Disc/Dial Lock Addition, Knee Joint, Drop Lock, Stance or Swing Addition, Knee Joint, Lift Loop for Drop Lock Ring Addition, Knee Joint, Ratchet Addition, vacuum pump, residual limb volume manage Addition, vacuum pump, residual limb volume manage_L5781 Addtion to LE prosthesis, user adj heel height Adductor Release Thumb
$1,658 $2,394 $3,213
$547 $647 $392 $528 $647
$12,689 $12,655
$5,458 $2,097

• $86
• Adenovirus Antibody

• ADHESIVE GEL PATCH
• $32

• Adjustable Hip Block Hardware
• $277

$393
$42
Adrenocorticotropic Hormone (ACTH) ADULT 24 HOUR ORAL SUCTION CLEANING KIT 6308 ADULT RESUSCITATION BAG/MASK ADV POST TIBIAL TENDON W EXC NAVICLR BONE (28238) ADV POST TIBIAL TENDON W EXC NAVICLR BONE,Bilatera Advanced Care Planning 30 min (99497) AE, ext power, molded inner socket, remov shell, i AE, ext power, molded inner socket, remov shell, i_L6955 AE, molded double wall socket, internal locking el AE, molded socket, endo sys, incl soft prosthetic AEL Abductor Hardware Lever Release AEL Abductor Hardware Push-Button Release AEL Abductor Pad
$37
$19,435 $29,148
$335
$31,289 $29,341
$9,772
$10,506
$459 $459 $158 $182 $286 $180 $120 $210 $165 $444 $296 $702
$59
AEL Bracket Adapter AEL Contoured Arm Support, All Sizes, Each AEL Dynaform Chest Harness, All Sizes AEL Fixed Mounting Hardware AEL H and X Straps AEL Lateral Trunk Support Pad AEL POSAlinc Arm Support Hardware, Each AEL Quick/Swing Away Trunk Support Hardware AEL Tri-pad Headrest AEL Wrist Strap Padded, Each AEROCHAMBER MV (USE W/MANU VENT) AEROCHAMBER PLUS (USE W/MOUTHPC) AEROCHAMBER W/LARGE MASK
$53 $40 $82
AEROCHAMBER W/MEDIUM MASK AEROCHAMBER W/SMALL MASK Aerosol Therapy AEROTRACH PLUS (USE W/TRACH) AERPGEN NEB AERO KIT AF531 ORO-NASAL/LARGE AF531 ORO-NASAL/MEDIUM AF531 ORO-NASAL/SMALL Affiliates 00003-0293-20 Kenalog 40mg Affiliates 00023-1145-01 Botox/unit Affiliates 00409-1162-18- Bupivacaine 5mg/1ml- Sil Affiliates 00409-1587-50 Marcaine .25% Affiliates 45945-0157-02 Baclofen 10mg Affiliates 58468-0090-03 Synvisc One 1mg Affiliates On Site Technical Charge AFO WALK BOOT TYPE CUS FAB
$80
$102 $107
$65
$193 $107 $107 $107
$43 $14
$3 $8
$2,102
$158 $231
$5,526
$40,415
$2,141
$69
AK/FT POWER ASST INCL MOTORS (L5969) Akin Albumin Level

• Albumin-Fluid
• $36

Aldolase Aldosterone Aldosterone, random Urine Aldosterone, Urine timed
$102
$1,105
$333 $579

• $85
• Alkaline Phosphatase

Alkaline Phosphatase-Bone Specific Alkaline Phosphatase-Iso Alkaline Phosphatase-Isoenzymes All 4 compartments All endoskeletal LE prostheses, axial rotation uni All endoskeletal LE prostheses, dynamic prosthetic All exoskeletal lower extremity prostheses, axial All LE prostheses, combination single axis and fle All LE prostheses, energy storing foot (Seattle, C All LE prostheses, Flex-Foot system All LE prostheses, flexible keel foot, (SAFE, STEN All LE prostheses, Flex-Walk system or equal All LE prostheses, foot, multi-axial ankle/foot
$106 $236 $236
$2,105 $2,585
$683
$1,553 $1,393 $1,819
$12,014
$1,223
$10,793
$963
All LE prostheses, multi-axial ankle/foot, dynamic All LE prostheses, multi-axial rotation unit (""MC All LE prosthesis, ankle, multiaxial shock absorbi All LE prosthesis, combination vertical shock and All LE prosthesis, shank foot system with vertical All lLE prostheses, foot, single axis ankle foot Allergen-Latex Enhanced IgE
$7,887 $3,128 $8,842 $6,318
$22,751
$719
$55
AllLE prostheses, foot, external keel, SACH foot Alpha 1 Antitrypsin Phenotype
$672
$91

• Alpha 1 Antitrypsin Total
• $300

• Alpha Fetoprotein
• $266

• Alpha Fetoprotein Quad 4
• $504

• Alpha Fetoprotein, Tumor Marker
• $219

• ALT/SGPT
• $90

• Aluminum Level, Serum
• $162

• Aluminum Level, Urine Random
• $227

• Aluminum Level, Urine timed
• $227

• Ambu Bag and Treatment
• $574

• Amikacin-Peak
• $390

• Amikacin-Random
• $390

• Amikacin-Trough
• $390

• Amino Acid Profile, Quantitative
• $442

• Aminolevulinic Acid, Urine
• $337

Amiodarone & Metabolites (Desethylamiodarone) Ammonia
$37 $53
AMPUT ANKLE TO TIB-FIB M W PL REP (27888) AMPUTATE THIGH-FEMUR ANY LEVEL (27590) AMPUTATELEG THRU TIBIA AND FIBULA (27880) Amputation Metatarsal (Single) Amputation Secondary Closure or Scar Revision Amputation Secondary Closure or Scar Revision Bila Amputation Toe, Interphalangeal Joint Amputation, finger or thumb , primary or secondary Amputation, leg, through tibia and fibula; re-ampu Amputation, Toe; Metatarsal Phalangeal Joint Amylase Level, Random Urine
$2,264 $2,958 $3,240 $1,807 $2,029 $3,042 $1,578 $2,492 $2,296 $1,787
$107

• Amylase Level, Serum
• $137

• Amylase, Fluid
• $89

• Amylase, Timed Urine
• $103

Anal SP inf pmp wt reprog/refill (62369) Anal SP inf pmp wt reprog/refill RN(62369) ANALYZE NEUROSTIM SIMPLE (95971) Analyze Neurostim, Complex, 1st hour Androstenedione
$726 $644 $600 $875 $358

• Angiotensin Converting Enzyme
• $147

Angiotensin Converting Enzyme-CSF ANK-FOOT SYS DORS-PLANT FLEX Ankle Contracture Splint
$147
$44,219
$758
Ankle foot orthosis, multiligamentous ankle suppor Ankle Strap, Each
$508 $113
Ankle, Symes, metal frame, molded leather socket, Ankle, Symes, molded socket, SACH foot Ankle-Foot Orthosis, Ankle Gauntlet Ankle-Foot Orthosis, Double Upright, Plantar Dorsi Ankle-Foot Orthosis, Inhibitory
$7,835 $8,323
$337
$2,104 $2,766 $2,033 $2,113 $2,193 $2,792 $5,055 $3,120
$606
$1,136 $4,019 $1,686 $1,851
$864
$2,271 $3,783 $1,650
$657
$2,535 $2,466 $1,357 $1,692
$848
Ankle-Foot Orthosis, Molded Ankle Gauntlet Ankle-Foot Orthosis, Plastic or Other Material, w/ Ankle-Foot Orthosis, Plastic, Molded to Patient Ankle-Foot Orthosis, Plastic, Posterior Solid Ankl Ankle-Foot Orthosis, Plastic, Rigid Anterior Tibia Ankle-Foot Orthosis, Plastic, w/ Ankle Joint, Mold Ankle-Foot Orthosis, Posterior, Single Bar, Clasp Ankle-Foot Orthosis, Prefabricated includes Fit an Ankle-Foot Orthosis, Rigid Anterior Tibial Section Ankle-Foot Orthosis, Rigid, Tibial Fracture Orthos Ankle-Foot Orthosis, Single Upright w/ Static or A Ankle-Foot Orthosis, Single Upright, Plantar/Dorsi Ankle-Foot Orthosis, Soft, Tibial Fracture Orthosi Ankle-Foot Orthosis, Spiral, Plastic or Other Mate Ankle-Foot Orthosis, Spiral, Plastic, Custom Fabri Ankle-Foot Orthosis, Spring Wire, Dorsiflexion Cal Ankle-Foot Orthosis, Supramalleolar w/ Straps Ankle-Foot Orthosis, Tibial Fracture Orthosis, Mol Ankle-Foot Orthosis, Tibial Fracture Orthosis, Sem Ankle-Foot Orthosis, Tibial Fracture Orthosis, The ANL SP infusion pmp wt/MD reprogram and refill (62

• Anodal Trypsin Assay- HAT
• $72

Anorectal manometry (90911) Anterior Tongue
$1,330
$217
Anti Neutrophil Cytoplasmic AB by IF Anti OKT3 Ab Titers Anti Streptolysin O AB
$247 $368
$27

• Anti Xa Assay - Atrixtra
• $81

• Anti Xa Assay - Fragmin
• $81

• Anti Xa Assay - Lovenox
• $81

Anti Xa Assay - Rivaroxaban Anti Xa Assay - Unfractionated Heparin Antibodies Antibodies * Antibody Elution
$81 $81
$103 $103 $254 $168 $225 $124 $152 $165
$97
Antibody Elution, referred Antibody Identification (blood bank) Antibody Identification Interpretation Antibody Screen Antibody Screen (Blood Bank) Antibody Titration, indirect, each

• Anticardiolipin Antibody
• $565

$260
$30
Anticardiolipin Antibody_86147 Anticentromere Antibodies Antidiuretic Hormone Anti-DNA Antibody Anti-DNA Antibody_86225 Anti-Dnase B Antibodies, Streptococcal Antigen Screen on Blood, Reagent Method Anti-Mitochondrial AB
$180 $274 $274
$86 $77
$130

• $70
• ANTINUCLEAR AB (ANA)

Antinuclear Antibody Anti-Parietal Cell AB Anti-Smooth Muscle AB Antithrombin III Anti-Thrust Wedge Option Anti-Thyroglobulin AB Anti-Thyroglobulin AB_86800 APATER FEEDING DUAL PORT APC Resistance
$223 $141 $137 $193 $113 $190 $190
$64
$131

• $99
• Apolipoprotein (a)

• Apolipoprotein B
• $99

• Apolipoprotein E
• $99

Appl. of Rigid Total Contact Leg Cast/TCC (2944) Application ex-fix
$248
$1,926
$512
$1,025
$154 $180
$48
Apply Multlay Comprs LWR Leg (29581) Apply Multlay Comprs LWR Leg, Bilateral (29581) Apply Short Arm Splint; Dynamic (29126) APTT-Activated PTT/Partial Thromboplastin Time AQUAGUARD "7 X 7"

• AQUAGUARD 12" X 14"
• $86

• AQUAGUARD 9" X 9"
• $61

• AQUAGUARD BOOT
• $48

AQUAPHOR COMPOUNDING OINTMENT 14oz Arginaid
$62
$1
Arhtroscopically aided treatment on intercondylar Arhtrotomy wrist, I&D Arrest, epiphyseal, any method (eg, epiphysiodesis Arrest, epiphysiodesis, open; distal fibula (27732 Arsenic
$3,871 $2,349
$17,085 $11,241
$457 $135 $135 $124 $165
$1,345
$896
$1,393
$926
$1,339
$891
$2,247 $2,455
$29,788
$1,400 $2,906 $3,502 $3,064 $3,515
$321
$4,070 $2,163 $2,806 $2,483
Arsenic Level, Urine timed Arsenic, random Urine Arterial Blood Gas Collection Arterial Blood Gas Lab Charge Arthrocentesis Intermediate Joint - Bilateral Char Arthrocentesis Intermediate Joint Charge (20605) Arthrocentesis Major Joint Bilateral Charge (20610 Arthrocentesis Major Joint Charge (20610) Arthrocentesis Small Joint - Bilateral Charge (206 Arthrocentesis Small Joint Charge (20600) ARTHROD GT IP JNT W EHL TRANSFER,Bilateral (28760- Arthrodesis Great Toe, MP Joint Arthrodesis Great Toe, MP Joint,Bilateral (28750-5 Arthrodesis Interphalangeal Joint Great Toe Arthrodesis w/Tendon Lengthen and Advancement, Mid Arthrodesis with Bone Graft Arthrodesis Wrist Complete Arthrodesis Wrist w/Sliding Graft Arthrogram, hip Arthroscopically aided ACL Arthroscopy ankle, debridement Arthroscopy ankle, OCD drilling Arthroscopy knee, chondroplasty Arthroscopy knee, chondroplasty microfracture Arthroscopy knee, diagnostic
$2,658 $1,657 $2,092 $2,097 $2,776 $2,585 $2,797 $2,527 $2,983 $2,029 $2,167 $2,359 $2,663 $4,012 $1,378 $2,872 $2,183 $1,898 $2,924 $3,882 $4,589 $2,295
$344
Arthroscopy knee, infection and drainage Arthroscopy knee, lateral release Arthroscopy knee, medial AND lateral meniscectomy Arthroscopy knee, medial OR lateral meniscectomy Arthroscopy knee, meniscus repair Arthroscopy knee, OCD drilling Arthroscopy knee, OCD internal fixation Arthroscopy knee, plica Arthroscopy knee, removal loose body Arthroscopy shoulder with debridement Arthrotomy ankle Arthrotomy Hip Arthrotomy Intertarsal or Tarsometatarsal Joint Arthrotomy Knee Arthrotomy W/ OP Meniscus Repair (27403) Arthrotomy, elbow Arthrotomy, glenohumeral joint Arthrotomy, hip Arthrotomy, posterior capsular release, ankle, wit Arthrotomy, posterior capsular release, ankle, wit_27612 Artificial Airway ARTIFICIAL TEARS EYE DROPS 15ML Aspiration (biopsy) deep (femur, vertebral body) Aspiration/injection bone cyst
$25
$488 $628
Aspiration/Injection Ganglion Cyst Charge (20612) Assay IgA/IgD/IgG/IgM Each
$913
$53

• Assay of PSA, free
• $118

• ASSAY PH BODY FLUID NOS
• $25

• Assessment of aphasia
• $306

• AST/SGOT
• $86

ATT E/N/E/L; D 10 SQ CM (14060) ATT E/N/E/L; D 10.1-30 (14061)
$6,412 $6,824 $6,304 $6,683 $6,141 $6,536 $5,968 $6,372
$12,930
$138
ATT F/C/M/N/A/G/H/F; 10 SQ CM (14040) ATT F/C/M/N/A/G/H/F; 10.1-30SQCM (14041) ATT S/A/L; D 10 SQ CM/< (14020) ATT S/A/L; D 10.1-30 SQ CM (14021) ATT TRUNK; D 10 SQ CM/< (14000) ATT TRUNK; D 10.1-30 SQ (14001) Automatic grasp feature, addition to upper-limb pr AVOGEL 8" X 8"

• AVOGEL 8IN X 8IN SINGLE
• $176

Avulsion of nail plate, partial or complete, simpl Back Cover Only
$698 $455
Back Cushion Cover - Complex Upgrade Option Back Hardware - Adjustable/Growth Option BAG BREATHING TEST LUNG 1 LITER BAG BREATHING ANESTHESIA TEST LUNG 3 LITER BAG FEED GASTRIC GRAVITY 1000ML BAG LEG 800ML
$223 $679
$4 $6
$12 $21

• BAG NIGHT DRAINAGE
• $34

• Band Applicator
• $124

BANDAGE COMPRILAN 10CM LYMPHEDEMA BANDAGE COMPRILAN 12CM LYMPHEDEMA BANDAGE COMPRILAN 6 CM LYMPHEDEMA BANDAGE COMPRILAN 8 CM LYMPHEDEMA BANDAGE ELASTINET SURGILAST SZ-1 BANDAGE ELASTINET SURGILAST SZ-10 BANDAGE ELASTINET SURGILAST SZ-2 BANDAGE ELASTINET SURGILAST SZ-3 BANDAGE ELASTINET SURGILAST SZ-4 BANDAGE ELASTINET SURGILAST SZ-5 BANDAGE ELASTINET SURGILAST SZ-6 BANDAGE ELASTINET SURGILAST SZ-8 BANDAGE ELASTINET SURGILAST SZ-9 BANDAGE GAUZE KERLIX 4.5IN X 4YDS Basement Membrane IgG Abs
$64 $77 $38 $63 $37
$154
$39 $48 $58 $63 $69
$119 $138
$6
$155

• Basic Chemistry Panel
• $379

Basic Chemistry Panel, Calcium, total BATERIAL FILTER
$379
$4
Battery Charger, six volt, Otto Bock or equal Battery Charger, twelve volt, Utah or equal BE, ext power, self-susp inner socket, remov shell be, ext power, self-susp inner socket, remov shell_L6930 BE, molded socket (Muenster or Northwestern suspen BE, molded socket (Muenster or Northwestern suspen_L6120 BE, molded socket, endo sys, incl soft prosthetic BE, molded socket, flexible elbow hinges, triceps
$868
$1,713
$26,799 $19,630
$8,082 $7,032 $8,265 $7,638
Behavioral and Qualitative Analysis of Voice and R Below Knee Nylon Hose PR Below knee, molded socket shin, SACH foot (EXO) Below knee, molded socket, shin, SACH foot, endosk Below knee, plastic socket, joints and thigh lacer BELT OSTOMY
$164
$50
$8,283 $8,060
$11,583
$25

• BENGAY CREAM 4oz
• $30

Beta 2 Mircroglobulin, Serum Beta-2 GPI Antoantibodies Beta-2-Transferrin Biangular Back Option Bilirubin, Direct
$99
$215 $523 $135
$85

• Bilirubin, Fluid
• $85

• Bilirubin, Total
• $85

BINDER ABDOMINAL LF LG 10IN BINDER ABDOMINAL LF LG 8IN BINDER ABDOMINAL LF MED 10IN BINDER ABDOMINAL LF MED 8IN BINDER ABDOMINAL LF SM 8IN BINDER ABDOMINAL LF XL 8IN Biofeedback Training
$93 $80 $93 $80 $80 $87 $66
Biopsy, muscle deep BiPAP- Initial BiPAP Initial Charge BiPAP Subsequent Charge BK Virus Quant, Bld
$592 $486 $780 $632 $597 $597 $188 $221
$56
BK Virus Quant, Urine Bladder Irrigation/Lavage/Instill Charge (51700) Blastomyces Antigen, Urine Bld Glucose, Capillary

• BLISTEX LIP BALM .15oz
• $4

Blood Gas, Adult ABG w Measured Sat Blood Gas, Adult VBG w Measured Sat Blood Glucose POC
$174 $174
$54
Blood Smear Path Consult without Review of Chart Blood typing; ABO
$72 $24
Blood, Split Unit, 175 cc Blood, split unit, 175 mL B-Natiuretic Peptide Body Fluid Cell Count and Differential Body Fluid pH
$362 $333 $306 $145
$86

• Bone age studies
• $120

$2,609
$154 $358
$1,475
$625 $211 $211 $158
$30
BONE BX TR/NDL; SUPERF (20220) Bone Density DEXA App Skeleton Charge Bone Density DEXA Axial Skeleton Charge Bone Graft Ileum BONE GRFT; MINOR/SM (20900) Bone length studies (orthoroentgenogram, scanogram) Bonth Length Studies BOOT, Z-FLEX FLUIDIZED HEEL BOOTS BORDERED FOAM 6X8 BORDERED FOAM DRESSING 4X4 BORDERED FOAM DRESSING 6X6 BREATHABLE UNDERPAD PROT PLUS 23 X 36" Brief emotional/behavioral assessment Bronchial Hygiene Evaluation Charge Bronchospasm- Pre & Post BD (94060) Brucella Abortus IgG Ab
$7 $7
$20 $50
$109 $572
$57
Brucella Abortus IgG,IgM,IgA Ab BUN, Fluid
$168
$61

• BUN, Serum
• $61

BUTTON TRACH SZ-10CM X 27CM BUTTON TRACH SZ-10CM X 40CM BUTTON TRACH SZ-11CM X 27CM BUTTON TRACH SZ-11CM X 40CM BUTTON TRACH SZ-12CM X 27CM BUTTON TRACH SZ-12CM X 40CM BUTTON TRACH SZ-9CM X 27CM BUTTON TRACH SZ-9CM X 40CM BVI C Difficile by PCR C Difficile Culture & Toxin C Difficile Toxin C Reactive Protein C1 Esterase Inhibitor
$1,034
$965 $486
$1,147 $1,147 $1,147
$697
$1,147
$122 $193 $245 $140 $109 $106

• $12
• C3

• C3 *
• $88

• C3_86160
• $88

• C4
• $12

C4 * C4_86160 CA19-9 CA27.29
$88 $88
$132
$65
$112 $202 $170
$9
$25 $35
$223
$74 $91
$116 $101 $228 $111 $159 $225
$8
CADIOLIPIN AB EA IG CLASS Cadmium,random Urine with Creatinine Ratio Calcitonin Level CALCIUM ALGINATE DRESSING 4X4 CALCIUM ALGINATE DRESSING 4X8 CALCIUM ALGINATE DRESSING ROPE 12" Calcium Ionized Calcium, Urine Random Calcium, Urine Timed Calcium/CA++ Level Calculus Analysis Calf Sling, Vinyl Calf Strap, 2 inch Webbing Canalith Repositioning Units Cancer Antigen 125 CANISTER SUCTION 1200ML

• CANISTER SUCTION 2000ML
• $8

CANISTER VAC WOUND DRAIN W/GEL 10-PK CAP DDCP 15MM W/DISP FEN CANULA CAP SHILEY TRACHEOSTOMY WHITE FOR DECANNULATION 15 Capsulotomy Hip w/Release Hip Flexor Capsulotomy MP Joint 5th Toe Extensor Tendon (ea) Capsulotomy, Posterior Capsular Release, Knee Capsulotomy, posterior capsular release, knee; Bil Carbon Dioxide, Urine Carbon Insert Carbon Monoxide, quant. Carcinoembryonic Antigen Cardiolipin antibody
$206
$29 $29
$4,073 $1,401 $4,580 $4,641
$102 $231
$72
$363 $260
$20
$227 $387 $229 $258 $245
$27 $26 $24
$5
CARE-E-VAC II W BATTERY, TABLE TOP PORTABLE Carotene Level Casting/Strapping Procedure Catecholamines, Fractionated, Urine, Random Catecholamines, Plasma, Fractionated Catecholamines-Fractionated, Urine timed CATH KIT TOUCLS URET UNISX 10 FR INTERMIT CATH KIT TOUCLS URET UNISX 12FR INTERMIT CATH KIT TOUCLS URET UNISX 8 FR INTERMIT CATH STRAIGHT COUDE 12FR 16"

• CATH STRAIGHT COUDE 14F 16"
• $5

• CATH STRGHT COUDE 16FR 16"
• $5

Cath-Complex Urethral Charge (51703) CATHETER 100% SILICONE 24FR 5CC CATHETER ALL PURPOSE URETHRAL STRAIGHT 14FR CATHETER ALL PURPOSE URETHRAL STRAIGHT 16FR CATHETER ALL PURPOSE URETHRAL STRAIGHT 18FR CATHETER CLEAN ULTRA M/F 16IN 14FR CATHETER COUDE TAPPERED TIP SELF 10FR CATHETER COUDE TIP FUNNEL END SELF 14FR CATHETER EXTERNAL INTERMEDIATE CATHETER EXTERNAL LG
$465
$55
$7 $5 $5 $7 $8 $7 $7 $7

• CATHETER EXTERNAL MED
• $7

• CATHETER EXTERNAL SM
• $7

CATHETER EXTERNAL WIDE BAND L CATHETER FOLEY 100% SILICONE 14FR 5CC-10CC CATHETER FOLEY 100% SILICONE 16FR 5CC-10CC CATHETER FOLEY 100% SILICONE 20FR 30CC CATHETER FOLEY 16FR 5CC
$7
$38 $33 $46 $48 $34 $11 $33
$6 $6 $6 $7
$23
$6
CATHETER FOLEY COUDE TIP 16FR 5CC-10CC CATHETER FOLEY SIL-CTD LTX 20FR 5CC-10CC CATHETER FOLEY SILICONE 20FR 5CC CATHETER FOLEY SILICONE COATED 16FR 5CC-10CC CATHETER FOLEY SILICONE COATED 18FR 5CC-10CC CATHETER FOLEY SILICONE ELASTOMER COATED 5CC-10CC CATHETER SELF COUDE OLIVE TIP FUNNEL END 8FR CATHETER SELF COUDE TAPERED TIP FUNNEL END 8FR CATHETER SUCTION/VENT RED RUBBER 10-12FR CATHETER SUCTION/VENT RED RUBBER 14-16FR CATHETER, CATH ADAPTER STERILE CATHETER, CATH FOLEY 10FR 3CC SIL ELAST CATHETER, CATH FOLEY 6FR 3CC SIL ELAST CATHETER, CATH FOLEY 8FR 3CC SIL ELASTIC CATHETER, CATH FOLEY COUDE 5CC 14FR BARD CATHETER, CATH FOLEY SIL-CTD LATEX 22FR 5CC-10CC CATHETER, CATH SUCTION RED RUBBER 8FR
$6
$20 $30 $24 $48
$103
$8
$20
Cath-Simple Urethral Charge (51702) CBC with Manual Differential CBC with Platelets CBC with Platelets_85027 CBC-Compete Blood Count with Differential and Plat CBC-Complete Blood Count without Platelets CBC-Hemoglobin and Hematocrit Only
$125 $173 $130 $130 $152
$50 $44
CD Treatment Speech Language Voice Communication A CD3 CD3,4 Peripheral Blood
$116 $603 $238 $238
$61
CD34 Cell Count and Differential, CSF

• CEPACOL SORE THROAT LOZENGE
• $22

• Ceruloplasmin
• $158

$326
$2,032
$483 $130 $704
$5,735 $6,902 $4,512
$631
$3,130 $2,518 $1,909 $4,656
$685 $180 $486 $333 $354 $189 $454 $488 $243 $113 $376 $215 $407
$82
$4,694 $4,271 $4,349
$364 $671 $154
$1,808 $2,030 $1,830 $1,794
$295 $256 $908
$1,123 $1,203 $1,806 $1,185 $1,826 $1,888 $1,565 $1,363
$129
$98
Cervical Collar, Flexible, Thermoplastic, Molded t Cervical Collar, Muti-Post, Occip/Mand Supports, A Cervical Collar, Semi-Rigid, Adjustable Molded Chi Cervical Collar, Semi-Rigid, Adjustable Plastic Cervical Collar, Semi-Rigid, Wire-Frame Cervical Halo Procedure, Incorporated Into Jacket Cervical Halo Procedure, Incorporated Into Milwauk Cervical Halo Procedure, Incorporated Into Plaster Cervical-Thoracic Discography (62291) Cervical-Thoracic Transforaminal (64479) Cervical-Thoracic Transforaminal-additional level Cervical-Thoracic Transforaminal-additional level _64480 Cervical-Thoracic Transforaminal-Bilateral (64479) Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1010 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1020 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1025 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1030 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1040 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1050 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1060 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1070 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1080 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1085 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1090 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1100 Cervical-Thoracic-Lumbar-Sacral Orthosis, Addition_L1120 Cervical-Thoracic-Lumbar-Sacral Orthosis, Ant/Post Cervical-Thoracic-Lumbar-Sacral Orthosis, Ant/Post_L0700 Cervical-Thoracic-Lumbar-Sacral Orthosis, Milwauke CH50 Change of Windpipe Airway (31502) Charger, Hosmer CHEMODENER MUSCLE LARYNX EMG (64617) CHEMODENER MUSCLE LARYNX EMG,Bilateral (64617-50) CHEMODENERV 1 EXTREM 5/> MUS (64644) CHEMODENERV 1 EXTREMITY 1-4 (64642) CHEMODENERV EACH ADD'L EXTREM 5/> MUSCLES (64645) CHEMODENERV EACH ADD'L EXTRM 1-4 MUSCLES (64643) CHEMODENERV ECCRINE GLANDS OTHER AREAS (64653) CHEMODENERV MUSC MIGRAINE (64615) CHEMODENERV MUSC NECK DYSTON (64616) CHEMODENERV MUSC NECK DYSTON,Bilateral (64616-50) Chemodenerv Saliv Glands (64611) CHEMODENERV TRUNK MUSC 1-5 (64646) CHEMODENERV TRUNK MUSC 6/> (64647) Chemodenervation-Face (64612) Chemotherapy, into CNS Charge-96450 Chest Percussion- Subsequent Chest Physical Therapy Chest Physical Therapy Initial Charge Chest Physical Therapy Subsequent Charge Chest physical therapy-Initial Chest physical therapy-Subsequent Chest Wall Oscillation Therapy Chest Wall Oscillation Therapy-Initial Charge Chest Wall Oscillation Therapy-Subsequent Charge Chiro E-Stim Attended Charge
$202 $167 $155 $129 $155 $202 $167 $174

• $89
• Chiro E-Stim Unattended Charge

Chiro Manual Therapy Techniques Charge Chiro Manual Treatment Extra Spinal 1 or more Regi Chiro Manual Treatment Spinal 1-2 regions Charge Chiro Manual Treatment Spinal 3-4 regions Charge Chiro Manual Treatment Spinal 5 regions Charge Chiro Massage Charge
$130 $219 $265 $289 $325
$90
Chiro Neuromuscular Re-education Charge Chiro Patient Self/Home Care Charge Chiro Therapeutic Exercise Charge Chiro Therapeutic Fuctional Act Charge Chiro Ultrasound Charge
$119 $122 $113 $130
$89

• Chlamydia by PCR
• $147

• Chloride
• $35

• Chloride, Timed Urine
• $102

• Chloride, Urine Random
• $89

• Cholesterol
• $62

• Chronic Ventilator Support
• $202

• Citrate, Urine Timed
• $130

• CK/CPK
• $290

• CKMB Fraction
• $54

• CKMB Fraction_82553
• $54

CL TX FEMUR FX OR EPIPHYS SEP (27510) CL TX FEMUR FX OR EPIPHYS SEP;Bilateral (27510-50) CL TX OF ACETABULUM X(S); WO MAN CLAMP HICKMAN SOFT JAW EDS CLAMP OSTOMY
$3,570 $5,150 $2,496
$127
$11
CLEANSER HIBICLENS ANTIMICROBIAL 4-OZ Closed Red. Clavicle w/Man
$12
$632

• Closed Red. Clavicle w/o Man
• $1,086

• $900
• Closed Red. Prox Humerus w.o Man

Closed treatment of Galeazzi fracture Closed treatment of Monteggia fracture Closed treatment of proximal humerus fracture with Closed treatment of radial neck fracture, with man Closed treatment proximal tib fracture with manipu Closed TX Calcaneal FX w/o Man Closed TX Carpal Bone w/o Man (ea) Closed TX Dist. Femur Epiphyseal Sep. w/Man Closed TX Dist. Femur Epiphyseal Sep. w/o Man Closed TX Distal Radius w/Man Closed TX Distal Radius w/o Man Closed TX Femoral FX Prox/Neck w/Man Closed TX Femoral FX Prox/Neck w/o Man Closed TX Femoral Shaft FX w/Man Closed TX Femoral Shaft Fx w/o Man Closed TX FX Phalanx (Not Gerat Toe) w/o Man (ea) Closed TX FX Phalanx (Not Great Toe) w/Man (ea) Closed TX Humeral Condyle Med/Lat w/o Man Closed TX Humerus Shaft FX w/o Man Closed TX Intertrochanteric FX w/Man Closed TX Intertrochanteric FX w/o Man Closed TX Metacarpal FX w/o Man (ea) Closed TX Metarpal FX w/Man (ea) Closed TX Metatarsal FX w/ Man (ea) Closed TX Metatarsal FX w/o Man (ea) Closed TX Patellar Disl w/o Anesthesia Closed TX Patellar FX w/o Man Closed TX Phalanx Distal FX w/Man Closed TX Phalanx Distal FX w/o man Closed TX Phalanx Shaft FX w/Man Closed TX Phalanx Shaft FX w/o Man Closed TX Prox Fib or Shaft FX w/Man Closed TX Prox Fib or Shaft FX w/o Man Closed TX Radial & Ulnar Shaft w/ Man Closed TX Radial & Ulnar Shaft w/o Man Closed TX Radial Head/Neck FX w/o Man Closed TX Radial Shaft w/ Man Closed TX Radial Shaft w/o Man Closed TX Supracondylar FX w/Man Closed TX Supracondylar FX w/o Man Closed TX Supracondylar Humeral FX w/ Man Closed TX Supracondylar Humeral FX w/o Man Closed TX Tib Shaft FX w/Man
$2,063 $2,202 $1,685 $1,545 $2,328
$883
$1,026 $2,670 $1,820 $2,223
$978
$3,159 $1,835 $3,221 $1,895
$444 $554
$1,126 $1,190 $3,870 $1,800
$912
$1,111
$987 $739
$1,191 $1,091 $1,022
$644
$1,168
$651
$1,528 $1,011 $1,866
$877 $862
$1,807
$889
$3,267 $1,972 $2,275 $1,290 $1,983 $1,205 $1,420 $1,540
$968
Closed TX Tib Shaft FX w/o Man Closed TX Tibial Fx Prox. w/o Man Closed TX Trochanteric RX w/o Man Closed TX Ulnar FX Prox w/o Man

• Closed TX Ulnar Shaft w/ Man
• $1,771

$1,148
$905
CLTX BIMALLEOLAR ANKLE FRACT W MNP (27810) Clubfoot Cast (29450) Clubfoot Cast Bilateral CMV Culture Non-Blood
$1,261
$235

• CMV DNA Qualitative, Blood
• $127

• CO2/Bicarb
• $62

• Collar, Cervical Multiple
• $2,780

Collar, Cervical, SOMI Collar, Cervical, w/ Thoracic Extensions Collar, Molded to Model Collar, Semi-Rigid 2-Piece COLLECTION: Venous Draw
$2,396 $1,253 $3,623
$636
$24
Collection: Venous Draw_36415 COLLECTOR MID STREAM
$23
$6
Combined Epiphy. Dis Femur Prox Tib Complement C3,C4
$3,184
$88
Complement Functional Activity Complement, Antigen
$85 $88
Complement, Total (CH50, C3 & C4) COMPLEMENT; AG EA
$364
$64
Complex Cystometrogram (51726) Complex Cystometrogram w/ VP & UP (51729) Complex Cystometrogram w/ VP (51728) Complex Uroflowmetry
$1,451 $1,601 $1,523
$633 $737
$2,940 $4,407 $5,141 $5,508 $5,691
$393 $437 $361
$2,743
$11
Complicated (felon) Comprehensive computer based motion analysis-1 Cha Comprehensive computer based motion analysis-2 Cha Comprehensive computer based motion analysis-3 Cha Comprehensive computer based motion analysis-4 Cha Comprehensive computer based motion analysis-5 Cha COMPREHENSIVE EYE EXAM & TREATMENT, ESTAB PT 1+ VI COMPREHENSIVE EYE EXAM. NEW PATIENT 1+ VISITS (920 Comprehensive Metabolic Panel Compression Burn Mask, Custom Fabricated CONNECTOR VAC DRAIN Y-TYPE 10-PK CONNECTOR W/GLOW RING CLAVE CONNECTOR Y ADAPTER MALE LUER LOK 4IN CONTOUR DELUXE W/HEADGEAR M/L CONTOUR DELUXE W/HEADGEAR/SMALL Coombs test, indirect, qual
$23
$6
$55 $55 $35
Coombs, Direct Coombs, Direct (only C3 or IgG) Coombs, Indirect Copper Level Copper Level, Urine random Copper Level, Urine Timed Coronary Risk/Lipid Panel Correction cock-up toe Correction hammertoe
$120
$44
$124 $219 $209 $219 $330
$1,289 $1,338
$539 $449
$6
Cortisol, Free & Creatinine, Urine Timed Cortisol-Total COUDE CATH TAPERED TIP STRL 14FR Coxsackie B Antibodies, Serum Coxsackie B Antibodies, Serum_86658 Coxsackievirus Antibodies, CSF CPAP Initial/Management (0-12 hours) CPAP Initiation and Management Charge CPAP Initiation and Management Pulmonary CPAP/BiPAP Initial Charge CPAP/BiPAP Subsequent Charge C-Peptide CPM-No Show/Cancellation $50 CPR Charge Cranial Cervical Orthosis, Congenital Torticolous C-Reactive Protein-Hi Sensitivity CREAM LANTISEPTIC THERAPEUTIC CREAM TRIPLE CARE EPC 7.75-OZ TUBE Creatine with Creatinine, Urine Timed Creatinine
$85 $85 $85
$732 $632 $486 $644 $644 $132
$50
$439
$6,302
$109
$27 $69
$126
$65

• Creatinine Clearance
• $80

• Creatinine, Fluid
• $80

• Creatinine, Urine Random
• $80

• CREATININE; NOT BLOOD
• $28

CREME SKIN CONDITIONING 4 OZ BTL Crossmatch for Transfusion (electronic, IS or IgG) Crucial
$32 $92
$7
Crutch, Axillary Extension Cryoglobulin Identification Cryoglobulin Screen Cryoprecipitate Charge
$438 $122 $122
$84

• Cryptococcal Screen-Blood
• $60

• Cryptococcal Screen-CSF
• $60

• Cryptococcal Screen-Stool
• $60

Cryptospordium Exam - Stool Cryptosporidium Exam - Other Crystal Identification, Fluid
$121
$99 $87
Crystals Analysis, Fluid C-sp Disc. Add'l level x___ CT Abdomen W/ Contrast CT Abdomen W/&W/O Contrast CT Abdomen W/O Contrast CT Abdomen/Pelvis W/ Contrast CT Abdomen/Pelvis W/&W/O Contrast CT Abdomen/Pelvis W/O Contrast CT Angiogram Abdomen W/&W/O Contrast CT Angiography Abd/Pel W/&W/O Contrast CT Angiography Chest CT Angiography Chest PE-71275 CT Angiography Head CT Angiography Neck CT C-Spine W/ Contrast CT C-Spine W/&W/O Contrast CT C-Spine W/O Contrast CT Head/Brain W/ Contrast CT Head/Brain W/&W/O Contrast CT Head/Brain W/O Contrast CT Lower Extremity W/ Contrast Bil CT Lower Extremity W/ Contrast Lt CT Lower Extremity W/ Contrast Rt CT Lower Extremity W/&W/O Contrast Bil CT Lower Extremity W/&W/O Contrast Lt CT Lower Extremity W/&W/O Contrast Rt CT Lower Extremity W/O Contrast Bil CT Lower Extremity W/O Contrast Lt CT Lower Extremity W/O Contrast Rt CT L-Spine W/ Contrast CT L-Spine W/&W/O Contrast CT L-Spine W/O Contrast CT Maxillofacial W/ Contrast CT Maxillofacial W/&W/O Contrast CT Maxillofacial W/O Contrast CT Orbit/Ear/Fossa W/ Contrast CT Orbit/Ear/Fossa W/&W/O Contrast CT Orbit/Ear/Fossa W/O Contrast CT Pelvis W/ Contrast CT Pelvis W/&W/O Contrast CT Pelvis W/O Contrast CT Soft Tissue Neck W/ Contrast CT Soft Tissue Neck W/&W/O Contrast CT Soft Tissue Neck W/O Contrast CT Thorax W/ Contrast
$109
$1,629 $3,408 $3,931 $3,011 $7,063 $8,131 $5,733 $4,718 $5,236 $4,074 $1,011 $3,536 $3,915 $3,674 $3,184 $3,178 $2,919 $4,190 $2,724 $3,306 $3,306 $3,306 $3,907 $3,907 $3,907 $3,005 $3,005 $3,005 $4,074 $3,184 $3,614 $3,184 $3,184 $2,948 $3,184 $3,184 $2,973 $3,650 $3,893 $2,564 $3,536 $3,184 $2,819 $3,650 $3,837 $3,079 $3,079 $3,079 $4,001 $3,184 $4,001 $3,184 $3,184 $3,184 $3,184 $3,184 $3,184 $2,900 $2,900 $2,900 $3,029
$29,312
$11
CT Thorax W/&W/O Contrast CT Thorax W/O Con Lung CA Screen CT Thorax W/O Con Lung CA Screen:Ep CT Thorax W/O Contrast-71250 CT T-Spine W/ Contrast CT T-Spine W/&W/O Contrast CT T-Spine W/O Contrast CT Upper Extremity W/ Contrast Bil CT Upper Extremity W/ Contrast Lt CT Upper Extremity W/ Contrast Rt CT Upper Extremity W/&W/O Contrast Bil CT Upper Extremity W/&W/O Contrast Lt CT Upper Extremity W/&W/O Contrast Rt CT Upper Extremity W/O Contrast Bil CT Upper Extremity W/O Contrast Lt CT Upper Extremity W/O Contrast Rt Cuboid Osteotomy with Autograft Cuboid Osteotomy with Autograft, Bilateral CUFF, ADULT DISPOSABLE CUFF, ADULT LONG, DISPOSABLE CUFF, CHILD, DISPOSABLE, 2-TUBE LOCKING CUFF, LARGE, ADULT, LONG, DISPOSABLE CUFF, SMALL ADULT, DISPOSABLE, SOFT 2-TUBE CUFF, SMALL CHILD DISPOSABLE SOFT 2-TUBE, LOCKING CUFF,THIGH,DISPOSABLE
$12
$9
$13 $11
$9
$19
Culture-AFB Culture (non-blood) Culture-C. Difficile
$165 $258
Culture-C. Difficile Surveillance Culture-Chlamydia
$279 $134
Culture-CSF Aerobic/Anaerobic Culture w/Gm Stain Culture-CSF with Gram Stain
$630 $204

• Culture-Eye
• $204

• Culture-Eye with Gram Stain
• $228

• Culture-Fluid & Anaerobic Culture with Gram Stain
• $301

Culture-Fluid & Anaerobic w/Gram Stain Culture-Fluid with Gram Stain Culture-Fungus Blood Culture-Fungus CSF Culture-Fungus with Smear
$204 $132 $165 $165 $113

• $48
• Culture-GC

Culture-Genital with Gram Stain Culture-Group B Streptococcus Culture-IV Cath Tip
$132
$86
$188

• $65
• Culture-Legionella

Culture-Mycobacteria Blood Culture-Mycobacteria no Smear Culture-Mycobacteria with AFB Smear Culture-Nose
$122 $165
$99 $59
Culture-Other Aerobic/Anaerobic w/Gm Stain Culture-Other Fungal w/Smear Culture-Sputum Respiratory w/ Gm Stain Culture-Stool Culture-Surveillance Culture-Throat Culture-Tissue with Gram Stain Culture-Urine Culture-Urine_87086
$171 $165 $204 $204 $204 $116 $204 $171 $171 $235 $171 $315
$4
Culture-Virus Culture-Wound Aerobic with Gram Stain Culture-Wound Aerobic/Anaerobic w/Gm Stain CUROS IV PORT PROTECTOR FEMALE CUROS IV PORT PROTECTORS MALE Custom Contour (Foam In Place), Large Custom Contour (Foam In Place), Medium Custom Contour (Foam In Place), Small Custom shaped protective cover, BK Custom shaped protective cover, hip disartic Custom shaped protective cover, knee disartic Cyanide
$12
$337 $291 $274
$2,515 $4,521 $3,365
$181

• $80
• Cyclic Citrulinated Peptide

• Cyclospora
• $99

Cyclosporine Level Cylinder Cast (29365) Cystatin C Cystometrogram w/ UP Cytology Fluid Specimen Cytology-CSF Cytology-CSF_88104 Cytomegalovirus Antibody(IgG & IgM), Serum Cytomegalovirus by PCR, CSF Qualitative Cytomegalovirus by PCR, Urine, Qualitative Cytomegalovirus Viral Load PCR, blood Cytopath, concentrate technique DANDRUFF SHAMPOO 7oz
$258
$1,186
$142
$1,533
$269 $269 $269 $174 $223 $477 $365 $337
$21
D-Dimer D-Dimer_85378
$164
$70
DEB BONE 20 SQ CM/< (11044) Deb Bone ADD-on =<20 Sq cm DEB MUSC/FASCIA ADD-ON =<20 SQ CM Deb skin bone at FX site Deb Subq Tissue ADD-on=<20 Sq cm DEBR EXZ/INF SKIN; 10% BS (11000) DEBR NECROTIZ ST - GENITALS & PERINEUM (11004) DEBR NECROTIZ STISS - ABD WALL (11005) DEBR W OPEN FX; SKIN & SQ Charge (11010) DEBRIDE INFECTED SKIN ADD-ON =<10% BS (11001) Debride Nail 1-5 (11720) Debride Skin to Muscle, Open FX Debridement-skin , sub q, muscle/fascia 20 Sq cm/< Debridement-skin, 20 Sq cm/< (11042) Declot Vascular Device Decompression fasciotomy forearm DEEP DISSECT FOOT INF; MULTI AREAS (28003) DEEP DISSECT FOOT INF; SGL BURSA SP (28002) Deep I&D - UA/ELBOW (23930) Deep Inc Foot w Op Bone Cortex Dehydroepiandrosterone
$3,840 $2,891
$995
$3,264
$914 $941
$1,559 $2,147 $2,684
$332 $284
$2,585 $1,958 $1,167
$620
$2,403 $5,701 $7,846 $6,756 $9,243
$311

• $7
• DENTURE ADHESIVE 2.4oz

DENTURE CLEANSER TABLET DEORDORANT BANISH OSTOMY BTL 1-1/4-OZ Deoxypyridin DESTR W NEUROLYTIC; INTERCOSTAL NRV (64620) DESTROY C/TH FACET JNT ADDL (64634)
$20 $62
$217
$6,762 $1,046
DESTROY C/TH FACET JNT ADDL, Bilateral (64634-50) Destroy Cer/Thor Facet Joint (64633) DESTROY CERV/THOR FACET JNT, Bilateral (64633-50) Destroy L/S Facet Joint B, ea add'l (64636-50) Destroy L/S Facet joint each add'l (64636) Destroy L/S facet joint, bilateral (64635-50) Destroy lumb/sac Facet Joint (64635) DESTROY NERVE FACE MUSCLE, BILATERAL (64612-50) DESTRUCT B9 LESION 1-14 (17110) Dexa Exam Dexa Exam_77081 DHEA Sulfate Diabetic Only, Custom Molded Shoe Diabetic Only, Not Otherwise Specified Shoe Modifi Diabetics only, the off-the-shelf depth inlay to a Diabetisource AC
$1,566 $2,876 $4,663 $3,629 $2,420 $6,752 $4,501 $2,347
$565 $492 $153 $311 $995 $147 $334
$7
Diagnostic Anoscopy Charge-46600 DIAPER BRIEF ADULT XXL DIC Panel Digoxin/Ditgitalis Level Dilantin/Phenytoin, Free Direct and Indirect Antiglobulin Test DISPOSABLE GROUND AND DISK ELECTRODES NCV KIT DIVIDE PLANTAR FASCIA & MSCL,BILATERAL (28250-50) Division of Plantar Release Division of SCM for torticollis DNA
$371 $130 $227 $224 $284
$99 $33
$12,223
$1,707 $1,556
$93
Doctor service required to establish and document Domicil/R-Home Visit est Pat
$24
$681 $499 $354 $229 $326 $533 $822 $698 $226
$1,708 $8,052
$948
$1,423
$981
$1,473
$925
$1,391
$513
$6,752 $1,693
$4
Domicil/R-Home visit est patient - detailed modera Domicil/R-Home visit est patient - expanded proble Domicil/R-Home visit est patient - problem focus/ Domicil/R-Home visit New Pat / low complexity Domicil/R-Home visit New Pat /moderate complexity Domicil/R-Home visit New Pat comprehensive/high co Domicil/R-Home visit New Pat comprehensive/moderat Domicil/R-Home visit New Pat/problem focus Drain Cerebrospinal Fluid Drain Palmar Bursa; Complicated DRAIN/INJ INTER JOINT/BURSA W/US (20606) DRAIN/INJ INTER JOINT/BURSA W/US,Bilateral (20606- DRAIN/INJ MAJOR JOINT/BURSA W/US (20611) DRAIN/INJ MAJOR JOINT/BURSA W/US, Bilateral (20611 DRAIN/INJ SMALL JOINT/BURSA W/US (20604) DRAIN_INJ SMALL JOINT_BURSA W_US, Bilateral (20604 Drainage of finger abscess Drainage of palmar bursa; single, bursa (26025) Drainage of Tendon Sheath DRAINAGE SYSTEM AEROSOL BAG DRESSING 15CM X 20 CM TEGADERM DRESSING 20CM X 30CM TEGADERM DRESSING 8IN X 9IN DUODERM
$12 $23 $88
DRESSING BURN # 20301 ACTICOAT DRESSING BURN 9IN X 15IN EXU-DRY DRESSING EXU-DRY 3" X 4"
$296
$30
$7

• DRESSING FOAM MEPILEX AG 4X4
• $50

DRESSING FOAM MEPILEX AG 8X8 DRESSING PROMOGRAN MATRIX 4.34SQ IN DRESSING STERI STRIP 1/2IN X 4IN
$180
$39
$6
DRESSING TRACHEOSTOMY 3.5INX 3.5IN ALLEVYN DRESSING TRAY, PEDIATRIC W SORBAVIEW SHIELD IV DRESSING XEROFORM 4IN X 3YDS
$27 $37 $27

• DXA BONE DENSITY STUDY (77085)
• $59

• D-Xylose, 1Hr Blood
• $80

• D-Xylose, 2Hr Blood
• $80

• D-Xylose, 5 Hr Urine
• $275

$958
$3,552 $5,022 $5,756 $6,122 $6,306
$958
$79
Dynamic fine wire electromyography Charge (96003) Dynamic plantar pressure meas during walk-1 Charge Dynamic plantar pressure meas during walk-2 Charge Dynamic plantar pressure meas during walk-3 Charge Dynamic plantar pressure meas during walk-4 Charge Dynamic plantar pressure meas during walk-5 Charge Dynamic surface electromyography, during walking o E. Histolytica Antibodies E0770 FES, Complete System, NOS each additional leg tendon (leg) Each Add'l 15 min. MOD SED SAME PHYS/QHP (99153) EBV Qualitative by PCR, Blood Education Supplies
$6,634
$473
$33
$217
$65

• Education/Training
• $79

$65 $65
ELASTIC WRIST BRACE LARGE LEFT ELASTIC WRIST BRACE LARGE RIGHT

• Elbow Arthrogram inj
• $286

• Elbow Arthrogram inj, Bilateral
• $571

• Elbow Block, Each
• $179

Elbow disartic, ext power, molded inner socket, re Elbow disartic, ext power, molded inner socket, re_L6940 Elbow disartic, molded socket with expandable inte Elbow disartic, molded socket, endo sys, incl soft Elbow disartic, molded socket, outside locking hin Elbow Orthosis, Double Upright w/ Forearm/Arm Cuff Elbow Orthosis, Double Upright w/ Forearm/Arm Cuff_L3720 Elbow Orthosis, Double Upright w/ Forearm/Arm Cuff_L3730 Elbow Orthosis, Elastic w/ Metal Jts Elbow Orthosis, Elastic, Custom Fabricated Elbow Orthosis, Rigid w/o Joints, Prefabricated Elbow-Wrist-Hand Orthosis, Nontorsion Joints, Cust Elbow-Wrist-Hand Orthosis, Rigid, Custom Fabricate Elbow-Wrist-Hand-Finger Orthosis, Nontorsion Joint Elbow-Wrist-Hand-Finger Orthosis, Rigid Custom Fab Electrical Stimulation Guidance for Chemodenervati ELECTRODE SILVER MACTROD
$28,280 $25,349 $10,472
$8,309 $7,641 $4,405 $2,801 $3,716
$586
$1,184
$441
$3,212 $3,067 $2,544 $2,401
$390
$24
Electroejaculation Charge Electrolyte Panel
$1,713
$229
Electronic elbow, adolescent, Variety Village or e Electronic elbow, adolescent, Variety Village or e_L7185 Electronic elbow, child, Variety Village or equal, Electronic elbow, child, Variety Village or equal,_L7191 Electronic elbow, Hosmer or equal, switch controll Electronic elbow, microproc sequential control of Electronic elbow, microproc simultaneous control o Electronic Greifer, Otto Bock or equal, myoelectro Electronic hand, Otto Bock, Steeper or equal switc Electronic hand, System Teknik, Variety Village or Electronic hook, child, Michigan or equal, switch Electronic Wrist Rotator Any EMG 1 Limb Charge (95860) EMG 2 Limbs Charge (95861) EMG 3 Limbs Charge (95863) EMG 4 Limbs Charge (95864) EMG Anal/Urethr Sphinct, Not Needle (51784) EMG Facial, Bilateral Charge (95868) EMG Facial, Unilateral Charge (95867) EMG Guidance with Chemodenervation Charge (95874) EMG, Limited Charge (95870)
$20,416 $15,388 $31,987 $27,208 $14,635 $94,684
$104,563
$11,242 $11,489 $17,039
$3,907
$11,141
$1,060 $1,406 $1,617 $1,771
$713 $670 $579 $299 $374

• EMST150
• $166

• ENCLOSURE BED
• $295

ENDO POLY HIP PNEU/HYD/ROT Endomysial Autoantibodies, IgG
$20,558
$122

• ENEMA MINERAL OIL 4.5-OZ
• $6

• Enfamil 20 kcal
• $13

• Enfamil 24 kcal
• $13

• Entamoeba Histolytica Antigen
• $110

• ENVELLA BED (HILL ROM)
• $541

EO with Joint, Prefabricated Custom Fit Eosinophil Count, Urine & Body Fluid Epiphyseal Arrest Distal Radius or Ulna Epiphyseal Arrest Radius and Ulna Epiphysiodesis Distal Femur
$2,049
$50
$2,328 $2,485 $2,544 $3,804
$59
Epiphysiodesis Prox Tib/Fib Epstein Barr Viral Antibody-IgM

• Epstein-Barr Quantitative, CSF
• $609

• Epstein-Barr Quantitative, Serum
• $609

• Epstein-Barr Viral Antibody-IgG
• $59

• Epstein-Barr Virus by PCR
• $134

• Epstein-Barr Virus IgG
• $65

• Epstein-Barr Virus IGM
• $65

• Equipment BIPAP AVAPS
• $107

Equipment Care-E-Vac II W Battery, Table Top,Porta Equipment-Bariatric Bed
$20
$607
Equipment-Bariatric Overylay Low Air Loss Mattress Equipment-Clinitron Specialty Bed Equipment-Cough Assist
$332 $541
$46

• Equipment-CPAP
• $7

• Equipment-CPM Left Hand
• $144

• Equipment-CPM Right Hand
• $144

• Equipment-Crib
• $158

• Equipment-Enclosure Canopy Posey 8050
• $295

Equipment-Flexicare Specialty Bed (Hill Rom) Equipment-Flowtron Excel Leg Pneumatic Compression Equipment-Heat Therapy Pump
$624 $122 $134
Equipment-Infusion Pump - LVP Module Equipment-Infusion Pump-PCU
$48
$186
Equipment-Instavac II Aspirator Suction Machine (E Equipment-IPV 1C PERCUSSIONATOR Equipment-Kangaroo 324 Enteral Feeding Pump LP Equipment-KCI Wound Vac
$20
$1,583
$148 $550
Equipment-Leg CPM (OrthoRehab) Equipment-META NEB
$202
$23

• Equipment-NPWT Wound Vac
• $215

Equipment-Overlay Low Air Loss Mattress Equipment-Pulse Oximeter
$93 $11

• Equipment-Ventilator LTV 1150
• $134

• Equipment-Ventilator LTV 950
• $129

• Equipment-Ventilator Trilogy
• $111

• Erythropoietin Level
• $348

ESC I P ULCER W OSTECT & FLAP (15946) Estradiol
$10,722
$799

• Estriol
• $69

• Estrogen-Total Serum
• $223

• Estrone Level
• $69

Ethafoam Seat Wedge w/ Vinyl Cover EUCERIN CREAM 4oz
$228
$35
Eval Use/Fitting Voice Prosthetic Units Eval Use/Fitting Voice Prosthetic Units_92597 Evaluation of Language Comprehension and Expressio Evaluation of Speech Fluency Units Evaluation of Speech Sound Production Units Evaluation of Speech Sound Production w/ Evaluatio Everolimus Level
$99 $99
$210 $210 $210 $210
$78
EXC ABD LES SC 3 CM/> (22903) EXC BC/B Tumor Clav/Scapula
$8,459 $9,115
$13,673
$898 $371 $526
EXC BC/B Tumor Clav/Scapula, Bilateral EXC BEN LES T/A/L; > 4.0CM (11406) EXC BEN LES T/A/L; 0.6-1.0CM (11401) EXC BEN LES T/A/L; 2.1-3.0CM (11403) EXC BEN LES T/A/L; 3.1-4.0CM (11404) EXC BLES S/N/EX G; 0.5CM/< (11420) EXC BLES S/N/EX G; 0.6-1.0CM (11421) EXC BLES S/N/EX G; 1.1-2.0CM (11422) EXC BLES S/N/EX G; 2.1-3.0CM (11423) EXC BLES S/N/EX G; 3.1-4.0CM (11424) Exc Bone BX;DEEP
$233
$2,536 $2,717 $2,782 $5,078 $4,991 $2,521 $1,655 $2,120 $1,141
$350
EXC C P ULCER; W 1' SUTURE (15920) EXC C P ULCER; W FLAP (15922) EXC FACE-MM B9+MARG > 4 CM (11446) EXC FACE-MM B9+MARG 0.5CM/< (11440) EXC FACE-MM B9+MARG 0.6-1 CM (11441) EXC FACE-MM B9+MARG 1.1-2 CM (11442) EXC FACE-MM B9+MARG 2.1-3 CM (11443) EXC FACE-MM B9+MARG 3.1-4 CM (11444) EXC FOOT CYST/GANGLION (28090) EXC H-F-NK-SP MAL+MARG 0.5 < (11620) EXC HIDRAD AXIL; CPLX REP (11451) EXC HIDRAD AXIL; CPLX REP; Bilateral (11451-50) EXC LEG/ANKLE TUM < 3 CM (27618) EXC S P ULCER PREP FOR FLAP (15936) EXC S P ULCER W SKIN FLAP (15934) EXC S/N/H/F/G MAL+MRG 1.1-2 (11622) EXC SHOULDER LES SC 3 CM/> (23071) EXC T P ULCER; W FLAP (15956) EXC THIGH/KNEE LES SC < 3 CM (27327) EXC THIGH/KNEE TUM DEEP <5CM (27328) EXC THIGH/KNEE TUM DEEP <5CM, Bilateral (27328-50) EXC TIB/FIB CYST/TUMOR W ALLOGRFT (27638) EXC TNDN SHTH LES HND/FING (26160) EXC TR-EXT B9+MARG 0.5CM/< (11400) EXC TROCHANTERIC BURSA/CALCIFICAT (27062) Exc. Benign Les T/A/L; 1-1-2.0 CM EXCISE VAGINAL CYST OR TUMOR (57135) Excision epiphyeal bar
$449 $501 $615
$3,350 $7,798 $2,979 $1,140 $1,710 $6,056 $2,434 $2,514 $3,150 $8,412 $3,023 $4,850 $7,448
$11,171
$2,095
$883 $279
$1,222 $2,002
$588
$3,716 $1,285
$679
Excision ganglion Excision nail matrix-ingrown nail

• Excision of Foot Lesion
• $1,017

$2,986 $2,617 $1,701
Excision or curettage of bone cyst femur with allo Excision or curettage of bone cyst of proximal hum Excision or curettage of calcaneus cyst Excision Osteochondroma Humerus Excision Osteochondroma Metacarpal Excision Osteochondroma Phalanx Excision Osteochondroma Tib Excision Tarsal Coalition Excision/Curettage Bone Cyst Femur Excision/Curettage Bone Cyst Metatarsal Excision/Curettage Bone Cyst Phalanges Foot Excision/Curretage Bone Cyst Radius/Ulna EXCISION; ISCHIAL BURSA (27060) Exercise Oximetry Exhaled air analysis Charge-94690 Exhaled air analysisO2 Charge-94680 Exhaled air analysisO2/CO2 Charge-94681 Expiratory Resistance Valve EXPL P WND; EXTREM (20103) EXPL/REM FB IPH Joint EA (26080) Exploration of Foot Joint EXTENSIVE MIDFOOT CAPSULOTOMY;Bilateral (28262-50) Extractable nuclear antigen F5 Gene Analysis
$2,358 $1,798 $1,747 $2,430 $2,199 $2,450 $1,486 $1,219 $2,328 $1,247
$308 $219 $338 $385 $275
$4,611 $6,088 $1,251
$14,764
$12
$284 $134 $141 $180 $180 $180 $260 $180 $180 $180
$90
Factor II Assay Factor IX Assay Factor V Assay Factor VII Assay Factor VIII Assay Factor VIII Inhibitor Factor X Assay Factor XI Assay Factor XII Assay Factor XIII Assay Family Psychotherapy with Patient Family Psychotherapy Without Patient Fasciotomy leg
$392 $364
$1,713 $1,464 $5,214 $1,190
$422
$60
Fast Charger FB removal in sub q-complex FB removal in sub q-simple Fecal Fat Timed Collection Fecal Leukocytes Fecal Lytes/pH/Osmo Timed Collection FEED TUBE 10FR 36" STYLETE ULTR FEED_FLUSH SET 1000ML, E-PUMP Femoral Shortening Ferritin Fetal Hemoglobin
$229 $113
$25
$4,852
$188 $431 $431
$7
Fetal Hemoglobin_88184 Fibersource HN Fibrin Degradation Product Fibrinogen Fibrinogen Antigen
$65
$130
$88

• Fibrinogen_85384
• $88

• FILTER BACTERIAL
• $34

Fine Needle Aspiration without Imaging Finger Orthosis, Safety Pin, Spring Wire Firbrin degradation products, quant. Fit or Insert Pessary Fixation of ankle joint (Ankle/Foot Manipulation G FLEX SUPERSET W/MASK ELBOW FLEXI SEAL SIGNAL FMS FLEXI SEAL SIGNAL FMS COLLECT W/FILTER FLEXION MITT ROYLAN BEIGE MED Flexor Carpo Ulnaris Transfer Flexor Origin Slide Forearm/Wrist Flexor/Extensor Tendons
$264 $134
$56
$748 $727
$12
$952 $211
$57
$3,651 $3,228 $2,485 $2,251
$129 $529 $603 $146
$91
Flexor-Plasty Elbow Flow cytometry each cell surface, cytoplasmic or n Flow cytometry Interpretation 16 or more markers Flow Cytometry, CSF Fluid CEA Fluid Cell Count and Diff FLUIDIZED ANCILLARY PAD Fluorescent AB; Titer Ea AB Fluoro Guide Non-spine Fluoro Guide Spinal Injection Fluoroscopic Guidance- Needle Localization (77002) Fluoroscopic Guidance- Spine (77003) Fluoroscopy (separate procedure), up to 1 hour phy Fluoxetine & Norfluoxetine FO PIP/DIP W/O JOINT/SPRING
$154
$64
$1,660 $1,848 $3,022 $3,022
$29
$385 $119
Foam Collar Folate-Folic Acid Level Folate-Folic Acid Level_82746 Folate-RBC Follicle Stimulating Hormone Foot Drop Splint
$118 $137 $137 $114 $449 $348 $343 $789 $894 $730 $212 $301 $212 $471 $595
$1,416
$193 $250
$90
Foot Insert, Removable, Formed to Patient Foot Foot Insert, Removable, Longitudinal Arch Support, Foot Insert, Removable, Longitudinal Support Foot Insert, Removable, Plastizote Insert, Molded Foot Insert, Removable, Pre-Molded, Longitudinal A Foot Insert, Removable, Pre-Molded, Longitudinal/M Foot Insert, Removable, Pre-Molded, Metatarsal Arc Foot Insert, Removable, Silicone Gel, Molded to Pa Foot Insert, Removable, Spenco, Molded to Patient Foot Insert, Removable, UCB Type, Molded to Patien Foot Orthosis, Abduction Rotation Bar, Incl Shoes Foot Orthosis, Abduction Rotation Bar, w/out Shoes Foot Orthosis, Arch Support, Longitudinal/Metatars Foot Orthosis, Non-Removable, Longitudinal Arch Su Foot Orthosis, Non-Removable, Metatarsal Support, Foot Plate Padding, Each
$142 $142 $116
$4,580
$27
Forearm Flexor Lenghtening each tendon Fork Holder

• Free Light Chains
• $87

Fresh Frozen Plasma Fresh Frozen Plasma Charge FUNCTIONAL ELECTRIC STIM NOS (Bioness L300) Fungus Stain/PAS
$202 $186
$10,623
$40
Fusion of Foot Bones G TUBE HOLDER 30" - 45"
$2,561
$54

• G TUBE HOLDER 45" - 60"
• $54

Gastric Fluid pH Gastrin Level Gastrocnemius Recession Gastrocnemius Recession, Bilateral Gastrografin 30ml
$127 $294
$1,863 $2,647
$79
GC Culture Gentamcin-Trough Gentamicin-Peak Gentamicin-Random
$223 $171 $224 $171 $105 $124
$5,154
$124
$50
GGTP/GGT Giardia Antigen, Stool (Infectious Agent antigen D Gillette Seat Gliadin AB's IgG, IgA Glucagon Level

• Glucerna- Chocolate
• $7

• Glucerna- Vanilla
• $7

Glucose 6 PD Glucose Level
$202
$62

• Glucose, Fluid
• $66

Glucose, post glucose dose, Including baseline Glucose, Timed Urine
$95 $26

• Glucose, Urine, Random
• $26

• Glucose-CSF
• $26

Glutamic Decarboxylast Abs GM 1 Autoantibodies GM 1 Autoantibodies_83520 Goal Post Style Joystick
$166 $124 $124
$58

• Gonadotropin, chorionic
• $91

Gonorrhoeae by PCR Greater Occipital Nerve Injection Charge Group Psychotherapy Group Therapy Exercise 15 min Growth Hormone Level H. Pylori Antigen, Stool Hallus-Valgus Night Dynamic Splint Halo Replacement Liner/Interface Hamstring Lengthening-Bilateral Hamstring Lengthening-Unilateral hand Orthosis, Custom Fabricated Hand Orthosis, Metacarpal Fx, Prefabricated Hand restoration (incl cast/sahde/measure), replac Hand restoration (incl cast/shade/measure), partia Hand restoration (incl cast/shade/measure), partia_L6905 Hand restoration (incl cast/shade/measure), partia_L6910 Hand-Finger Orthosis, Composite Elastic Hand-Finger Orthosis, Finger Extension w/ Clock Sp Hand-Finger Orthosis, Flexion Glove w/ Elastic Fin
$223
$1,751
$139
$63
$312 $190 $196 $971
$4,115 $2,639 $1,111
$207
$2,438 $4,718 $4,668 $4,593
$182 $135 $206
Hand-Finger Orthosis, Knuckle Bender Hand-Finger Orthosis, Knuckle Bender w/ Outrigger Hand-Finger Orthosis, Knuckle Bender, 2 Segment to Hand-Finger Orthosis, Nontorsion Joints, Custom Fa Hand-Finger Orthosis, Reverse Knuckle Bender Hand-Finger Orthosis, Reverse Knuckle Bender, w/ O Haptoglobin Hard Protet Helmet Prefabricated HCG/Serum Pregnancy Test HCV PCR Qualtitative HCV PCR Quantitation Regular Headrest Padding w/ Cover, All Sizes Health and Behavior Assessment, Initial Health and Behavior Intervention Group Health and Behavior Intervention, Family with Pati Health and Behavior Intervention, Family without P Health and Behavior Intervention, Individual Health and Behavior Re-Assessment HEAT THERAPY PUMP (K-PAD) Heavy and Light Chain, IgA
$197 $243 $233
$1,317
$193 $243 $422 $800 $186 $141 $438 $229 $194
$67
$127 $128 $127 $129 $134
$81
Heavy and Light Chain, IgA_83883 Heavy and Light Chain, IgG
$81 $81
Heavy and Light Chain, IgG_83883 Heavy and Light Chain, IgM
$81 $81
Heavy Metal Screen, Urine, Random Heavy Metals Screen, Urine timed Heavy Metals Screen, Whole Blood Heel, Counter, Plastic Reinforced Heel, New Leather, Standard Heel, New Rubber, Standard Heel, Pad, Removable for Spur Heel, Sach Cushion Type
$909 $909 $909
$59
$134 $154
$61
$106
$67 $67
Heel, Thomas Extended to Ball Heel, Thomas w/ Wedge

• Heinz Body Prep, Direct
• $44

Helicobacter Pylori- IgG Elisa Helmet, Molded to Model Helmet, Non-Molded Hematocrit, Fluid
$176
$2,449
$650
$28

• Hematopathology Review
• $69

Hemiepiphysiodesis Distal Femur or Prox Tibia Hemiepiphysiodesis Distal Femur or Prox Tibia Bila Hemiepiphysiodesis Distal Tibia Hemipel, Canadian type; molded socket, endo system Hemipelvectomy, Canadian type; molded socket, hip Hemochromatosis Panel
$2,793 $3,898 $2,561
$12,992 $14,052
$480
$1,552
$28
Hemodialysis Procedure Charge Hemoglobin Hemoglobin A2 Quantitation Hemoglobin Electrophoresis Hemoglobin Glycosated Hemoglobin, Urine
$281 $467 $127
$8
Heparin Induced Antibody Hepatitis A Antibody, Total Hepatitis A IgM Hepatitis B Core Antibody IgG + IgM Hepatitis B Core Antibody IgM Acute Titer Hepatitis B Core IgM Hepatitis B Surface Antibody Hepatitis B Surface Antibody, Quant, End Hepatitis B Surface Antigen Hepatitis B Surface Antigen_87340 Hepatitis B Viral DNA, Qualitative Hepatitis B Virus Viral Load PCR Hepatitis BE Antigen
$253 $164 $164 $252 $248 $179 $129 $171 $132 $132 $288 $437
$33
Hepatitis BE Antigen/Antibody Hepatitis C Antibody IgM + IgG Hepatitis C Genotype Hepatitis C Virus Antibodies (RIBA) & Bands Hepatitis C Virus Qualitative RT-PCR Hepatitis C Virus-Quantitative Hepatitis D Virus Antibody Panel (IgG) Hepatitis D Virus IgM Herpes Culture Herpes Simplex AB IgG Herpes Simplex AB IgM Herpes Simplex DFA
$119 $224
$1,632
$182 $309 $438 $124 $124 $238 $147 $147 $122 $444 $444
Herpes Simplex Virus 1&2 PCR Herpes Simplex Virus PCR

• Heterophile Screen
• $91

$347 $375 $365
$98
HFO NONTORSION JNTS PRE OTS (L3930) HFO Nontorsion Joint, Prefabricated HFO WITHOUT JOINTS PRE OTS (L3924) HHTC Charge-Subsequent HI STRNGTH LTWT FOOT INSERT EACH High Density Lipoprotein High Humidity Trach Collar Charge-Equipment Hip Arthrogram (73525)
$231 $193 $126
$89
Hip Block Cover - Complex Upcharge Hip disart, Canadian type; molded socket, endo sys Hip disartic, Canadian type; molded socket, hip jt Hip disartic, tilt table type; molded socket, lock Hip Orthosis Bilateral Thighcuffs w/ Spreader Bar Hip Orthosis, Abduction Control Hip Orthosis, Abduction Control, Custom Fabricated Hip Orthosis, Abduction Control, Flexible, Frejka Hip Orthosis, Abduction Control, Flexible, Pavlik Hip Orthosis, Abduction Control, Post-op type Hip Orthosis, Abduction Control, Semi-Flexible (Vo Hip Orthosis, Abduction Control, Static, Adjustabl Hip Orthosis, Abduction Control, Static, Pelvic Ba Hip Orthosis, Adbuction Control, Flexible, Frejka Hip Orthosis, Adduction Control Hip Orthosis, Dynamic, Abduction/Pelvic/Adj Hip Co Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Bil Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Bil_L2040 Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Bil_L2050 Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Uni Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Uni_L2070 Hip-Knee-Ankle-Foot Orthosis, Torsion Control, Uni_L2080 Histone Semi-Quantitative Histoplasma Antigen, Urine HIV Antigen/Antibody Combo HIV P24 Antigen Test HIV-1 Viral Load (Regular) HIV-1 Viral Load (Ultra) HIV-2 IgG with Confirmation HLA B27 Home Health Cert. Medicare Only Charge (G0180) Home Health Re-certification Greater than 60 days Homocysteine-Serum Homocysteine-Urine HOOK/HAND HVY DTY VOL CLOS HOSE ANTIEMBOLISM THIGH SMALL SHORT HOSE COMPRESSION LRG 15-20mmHg HOSE COMPRESSION LRG 20-30mmHg HOSE COMPRESSION LRG 30-40mmHg HOSE COMPRESSION MED 15-20mmHg HOSE COMPRESSION MED 20-30mmHg HOSE COMPRESSION MED 30-40mmHg HOSE COMPRESSION SML 15-20mmHg HOSE COMPRESSION SML 20-30mmHg HOSE COMPRESSION STOCKING JOBST 30-40MMhG SMALL HOSE COMPRESSION XLG 15-20mmHg HOSE COMPRESSION XLG 20-30mmHg HOSE COMPRESSION XLG 30-40mmHg HOSE, ANTIEMB THIGH XL SHORT Hospital Discharge > 30 min Charge - 99239 Hospital Discharge 30 min or less Charge - 99238 HTLV, IgG
$56
$15,743 $12,973 $14,452
$1,603
$453
$5,009
$580 $338
$4,220
$455 $529
$2,132
$247
$8,711 $5,131 $2,449
$437
$2,196 $2,239
$333 $800 $118 $120 $114 $244 $541 $541 $257 $180 $247 $188 $107 $171
$6,105
$44
$102 $119 $119 $102 $119 $119 $102 $119 $119 $102 $119 $119 $384 $352 $279
$55
Human Anti-Mouse IgG Antibodies HUMID - VENT MINI
$124
$8

• HUMID - VENT 1
• $5

• HUMID - VENT 2 STRAIGHT
• $8

• HUMID TRACH VENT
• $5

• HUMIDIFIER CHAMBER
• $47

HYDROFERA BLUE FOAM DRESSING 4" X 4" HYDROGEL IMPREGNATEED GAUZE PAD 4X4 HYDROGEL TUBE 3 OZ
$5
$24 $25
Hypnotherapy Hypobaric Sheath Hypobaric Wool I&D PELV/HIP JNT; INF BURSA (26991) I&D PILONID CYS; SMPL (10080)
$330 $141 $186
$1,411
$776
$3,361
$82
I&D PILONID CYST; CPLX (10081) I.M.S.T.

• IgE Level
• $30

• IgG/Albumin Index, CSF
• $135

Iliac Osteotomy with Femoral Shortening Iliac Osteotomy with Femoral Shortening and Open R Iliac Osteotomy with Open Reduction
$6,077 $6,738 $5,768 $1,268 $4,674 $3,698 $1,022 $3,285 $3,910 $4,948 $1,464 $1,439 $1,203 $1,085
$74
Immediate postsurg/early fitting, ""AK"" or knee d Immediate postsurg/early fitting, app of initial r Immediate postsurg/early fitting, app of initial r_L5400 Immediate postsurg/early fitting, app of initial r_L5410 Immediate postsurg/early fitting, app of initial r_L6380 Immediate postsurg/early fitting, app of initial r_L6382 Immediate postsurg/early fitting, app of initial r_L6384 Immediate postsurg/early fitting, app of nonweight Immediate postsurg/early fitting, app of nonweight_L5460 Immediate postsurg/early fitting, app of rigid drs Immediate postsurg/early fitting, each, addit cast Immunoassay Nonantibody (Histone)

• Immunoassay Quant NOS NONAB
• $69

Immunoassay, RIA, not elsewhere specified Immunoassay,other analytes
$196 $211 immunofixation electrophoresis, other fluid requir Immunofixation Electrophoresis, Timed Urine Immunofixation Electrophoresis, Urine
$331 $331 $263

• Immunofixation Profile
• $179

• Immunoglobulins
• $791

Immunoglobulins, Quantitative IgA, IgG, IgM IMPL OR REVISE EPID CATH FOR PAIN (62350) IMPL/REPL PR PUMP FOR INFUSION (62362) Implant Neuroelectrodes INC DEEP W OP BONE CORTEX PELV (26992) INC/REPL SPINE NSTIM PG/RCVR (63685) INCENTIVE SPIROMETER
$791
$1,421 $1,380
$24,585
$3,102 $1,283
$27

• INCISE FOOT/TOE FASCIA (28008)
• $998

• Incise Thigh Tendon and Fascia
• $9,802

$14,700
$3,562 $2,481 $5,975 $1,153
$866
$4,634
$13,450
$8,070 $1,947 $1,363 $8,150 $2,817 $2,920 $2,594 $2,092
$10,737
$77
Incise Thigh Tendon and Fascia, Bilateral Incision (eg, osteomyelitis or bone abscess), leg Incision (eg, osteomyelitis or bone abscess), leg _27607 Incision and drainage complex, post-op infection Incision and Drainage of Abscess, complicated or m Incision and Drainage of Abscess, single or simple Incision and Drainage of Hematoma, Seroma or Fluid Incision and Drainage, deep abscess, bursa or hema Incision and Drainage, deep abscess, bursa, or hem Incision and Drainage, leg or ankle; Infected burs Incision and Drainage, leg or ankle; Infected burs_27604 Incision and Drainage; Leg, Ankle, Deep Abscess, o Incision bone cortex (osteomyelitis) shoulder area Incision bone cortex, forearm/wrist Incision deep femur (osteomyelitis) Incision, bone cortex, hand or finger (eg. osteomy Incision/fixation of femur bilateral Individual Education 15 min

• Individual Therapy Exercise 15 min
• $89

Infant Above Elbow INFANT RESPIRATORY CARE SYSTEM
$6,361
$195

• INFANT RESUSCITATION BAG
• $34

• Infectious agent antigen detection
• $77

Infectious Agent Detection by Nucleic Acid,Amplifi Influenza A + B IgG, IgA, & IgM Antibodies Influenza A+B IgG, IgA & IgM Antibodies INFUSION PUMP MODULE -LVP
$86 $87 $87 $48

• INFUSION PUMP- PCU
• $186

Initial Hospital Care Level 1 Charge - 99221 Initial Hospital Care Level 2 Charge - 99222 Initial Hospital Care Level 3 Charge - 99223 Initial Inpatient Consultation Level 1Charge - 992 Initial Inpatient Consultation Level 2 Charge- 992 Initial Inpatient Consultation Level 3 Charge - 99 Initial Inpatient Consultation Level 4 Charge - 99 Initial Inpatient Consultation Level 5 Charge - 99 Initial, AK or knee disartic, ischial level socket Initial, BK ""PTB"" type socket, non-alignable sys Inj Anesth; Intercost Nrv, Multi/Region Inj Anesth; Intercost Nrv, Multi/Region, Bilateral INJ ANESTH; PUDENDAL NERVE (64430) INJ ANESTH; SPHENOPALATINE GANGLION (64505) INJ ANESTH; SUPRASCAPULAR NERVE (64418) Inj Epidural Blood or Clot Patch
$407 $467 $569 $407 $407 $467 $569 $569
$4,811 $3,422 $2,690 $4,857 $2,955 $1,096 $1,669 $1,538 $7,336 $2,956 $5,909
INJ NEUROLYTIC; EPIDURAL LUMB/CAUDAL (62282) Inj Paravert F Jnt C/T One Level (64490) Inj Paravert F Jnt C/T One Level-Bilateral (64490- Inj Paravert F Jnt C/T Three Levels (64492) Inj Paravert F Jnt C/T Three Levels-Bilateral (644 Inj Paravert F Jnt C/T Two Levels (64491) Inj Paravert F Jnt C/T Two Levels-Bilateral (64491 Inj Paravert F Jnt L/S One Level (64493) Inj Paravert F Jnt L/S One Level-Bilateral (64493- Inj Paravert F Jnt L/S Three Levels (64495) Inj Paravert F Jnt L/S Three Levels-Bilateral (644 Inj Paravert F Jnt L/S Two Levels (64494) Inj Paravert F Jnt L/S Two Levels-Bilateral (64494 Injection intralesional; up to and incl. 7 lesions Injection Tendon Origin/Insertion Charge (20551) Injection Tendon Sheath, Ligament Charge (20550) Injection Therapeutic Carpal Tunnel Charge (20526) Injection Therapeutic Carpal Tunnel-Bilateral Char Injection Trigger Point(s): 1 or 2 Muscle(s) Charg Injection Trigger Point(s): 3 or more Muscle(s) Ch Injection(s) Plantar digital nerve(s) (Morton's Ne Injection(s), platelet rich plasma, any site, incl Injection, anesthetic agent; intercostal nerve, si Injection, Anesthetic Agent; Lumbar or Thoracic (p Injection, Anesthetic Agent; Stellate Ganglion Injection, anesthetic agent; trigeminal nerve, any Injection, intralesional; more than 7 lesions (119 Inpatient Vocational Rehab Evaluation INS PIC Age 5 yrs/>
$1,181 $2,254 $1,123 $2,246 $2,905 $5,804 $1,098 $2,194 $1,094 $2,189
$109
$1,008 $1,008 $1,073 $1,624 $1,002 $1,002
$917
$1,107 $1,612 $2,653 $2,879
$909 $170 $162
$3,006 $3,046 $4,549
$55
Insall Insert Non-Tunnel CV Cath age 5 Yr/> Insole, Leather

• Insole, Rubber
• $48

• Inspiratory Muscle Trainer
• $85

• Insulin Level
• $203

• Intact Parathyroid Hormone
• $317

• Intensive Aphasia Program
• $996

Intensive Aphasia Program Half Day INTERCARPAL FUSION, WO BONE GRAFT (25820) Interleukin-6
$498
$15,468
$217
INTERMEDIATE EYE EXAM EST PT (92012) INTERMEDIATE NEW PATIENT, EYE EXAM PT (92002) International Case Managment, per hour Interscapular thoracic, molded socket, shoulder bu Interscapular thoracic, passive restoration (compl Interscapular-thoracic, ext power, molded inner so INTERVAL TIMER
$333 $321
$76
$11,450
$9,798
$43,142
$80
INTMD WND REPAIR S/A/T/EXT (12035) INTMD WND REPAIR S/A/T/EXT (12036) INTMD WND REPAIR S/A/T/EXT, 2.6-7.5 cm (12032) INTMD WND REPAIR S/TR/EXT 30.0+ CM (12037) INTMD WND REPAIR S/TR/EXT 7.6-12.5 CM (12034) Intra-abdominal Pressure Test (51797) Intrascapular thoracic, passive restoration (shoul Intrerscapular-thoracic, ext power, molded inner s IONM REMOTE/>1 PT OR PER HR (95941) IPPB
$1,697 $1,735
$668
$1,168 $1,456
$905
$5,681
$39,137
$118 $152

• IPPB Charge
• $197

IPV PULMONARY TUBING CIRCUIT, INDIVIDUAL Iron
$263 $122

• Iron and Iron Binding Capacity
• $146

Iron and Iron Binding Capacity with Transferrin Iron Binding Capacity
$184 $155

• Iron Level
• $146

• IRRIGATION SYSTEM VISI-FLOW
• $266

• Isocal HN
• $3

• Isosource
• $7

• Isosource 1.5
• $7

• Isospora Exam
• $99

• Itraconazole Level
• $385

IV SAFETY START KIT W/GLOVE, MEDC IVAC PROBE RECTAL TEMP PLUS 2880A Jo-1 Quantitative
$8
$25
$118

• Job Coaching Units
• $110

• Job Placement - Individual
• $72

Job Placement Case Management Units Job Placement Group Units
$129
$69

• Job Placement Individual Units
• $72

Joint survey, single view, 2 or more joints (specify)_77077 Jones Procedure KANGAROO E-PUMP ENTERNAL FEEDING PUMP Kappa/Lambda Ratio
$194
$1,499
$148 $119
KCI WOUND VAC Kidney Chemistry Panel
$550 $338

• Kindercal with Fiber
• $4

KIT BLOOD GAS W/SAFETY CATH 3CC KIT CATHETER SUCTION W/NACL 10FR KIT CATHETER SUCTION W/NACL 12FR KIT CATHETER SUCTION W/NACL 14FR KIT CATHETER SUCTION W/NACL 8FR KIT CATHETER TOUCHLESS FOR INTERMITTENT UNISEX 14F KIT COMFORT PERSONAL (TOOTHPASTE/TOOTHBRUSH/COMB) KIT DRESSING VAC MED 10-PK
$7 $6 $6 $6 $7
$20
$5
$266

• KIT IRRIGATION 60CC
• $8

• KIT STAPLE REMOVER
• $6

• KIT SUTURE REMOVER
• $5

• KIT TRACHEOSTOMY CARE
• $7

• KIT,LG VAC DRESSING 10-PK
• $321

• KIT,SMALL VAC DRESSING 10-PK
• $223

• Klonopin Level
• $385

KNEE DISART, SACH FT, ENDO (L5312) Knee disartic (or through knee), molded socket, ex Knee disarticulation, molded socket, bent knee con Knee Orthosis, Derotation, Medial/Lateral, Custom Knee Orthosis, Double Upright, Medial/Lateral Rota Knee Orthosis, Double Upright, Medial/Lateral/Rota Knee Orthosis, Elastic w/ Condylar Pads and Joints Knee Orthosis, Elastic w/ Conylar Pads Knee Orthosis, Elastic w/ Joints
$11,758 $11,729 $10,902
$1,890 $3,773 $5,272
$641 $204 $462

• Knee Orthosis, Elastic w/ Stays
• $284

• Knee Orthosis, Immobilizer, Canvas
• $375

• Knee Orthosis, Neoprene
• $176

Knee Orthosis, Positional Adjustable Knee Joints, Knee Orthosis, Positional, Locking Knee Joint, Pre Knee Orthosis, Rigid, Molded to Patient, w/o Knee Knee Orthosis, Rigid, Prefabricated, w/o Knee Join Knee Orthosis, Single Upright w/ Adjustable Joint, Knee Orthosis, Single Upright, Thigh/Calf Adjustab Knee Orthosis, Supracondylar Model, Molded to Pati Knee Orthosis, Swedish Style Knee-Ankle-Foot Orthosis, Double Upright, Free Ank Knee-Ankle-Foot Orthosis, Double Upright, Free Kne Knee-Ankle-Foot Orthosis, Double Upright, Free Kne_L2020 Knee-Ankle-Foot Orthosis, Femoral Fx, Thermoplasti Knee-Ankle-Foot Orthosis, Full Plastic, Static, Pr Knee-Ankle-Foot Orthosis, Full Plastic, w/out Knee Knee-Ankle-Foot Orthosis, Molded to Patient, Femor Knee-Ankle-Foot Orthosis, Plastic Ankle-Foot Secti Knee-Ankle-Foot Orthosis, Rigid, Femoral Fx Knee-Ankle-Foot Orthosis, Semi-Rigid, Femoral Fx Knee-Ankle-Foot Orthosis, Single or Double Upright Knee-Ankle-Foot Orthosis, Single Upright, Free Ank Knee-Ankle-Foot Orthosis, Single Upright, Free Kne Knee-Ankle-Foot Orthosis, Single Upright, Full Pla Knee-Ankle-Foot Orthosis, Soft, Femoral Fx KO ADJ JNT POS R SUP PRE OTS (L1833) KO DBL UPRIGHT W/AIR PRE OTS (L1848) KO ELASTIC W/JOINTS PRE OTS (L1812) KOH Prep
$3,102 $1,325 $3,269
$288
$2,180 $6,860 $5,616 $1,283 $2,324 $8,350 $4,964 $2,737
$373
$2,743 $3,218 $4,203 $2,705 $2,472
$18,456
$1,872 $5,041 $7,470 $2,087 $2,872 $2,397
$429 $176

• KOH Prep_87220
• $57

• K-Typing, Patient
• $55

• K-Typing, Unit
• $55

L0450 Thoracic-Lumbar-Sacral Orthosis, Flexible, P L0452 Thoracic-Lumbar-Sacral Orthosis, Flexible, C L0490 Thoracic-Lumbar-Sacral Orthosis, 1-Piece Rig L0633 Lumbar-Sacral Orthosis, Rigid Posterior Pane L0635 LSO Sag Rigid Panel, Pre
$732
$1,528
$612
$1,290 $2,158 $2,927 $2,797 $4,712 $3,822 $2,589 $9,149
$438
L0636 LSO Sag Rigid Panel, Cust L0639 Lumbar-Sacral Orthosis, Sac - T9, Prefabrica L0640 Lumbar-Sacral Orthosis, sac - T9, Custom Fab L1005 Tension Scoliosis Orthosis with Pads L1847 KO Adjustable with air Chambers L2034 Knee-Ankle-Foot Orthosis, Full Plastic, Sing L2232 Rocker bottom, Cus Fab Only

• L2387 Polycentric Knee JT
• $861

L2999 Supra Malleolar AFO L2999c Instep Strap
$1,257
$106
L2999-THKAO Standing Frame L3252 Custom Plastazote Ea
$5,356
$174

• L3254 Non Standard Size/Width Pr
• $214

• L3255 Non Standard Size/Length Pr
• $186

L3257 Split Size Additional charge L3410 Metatarsal bar wedge, between sole L3480 Pad & Depression for Spur
$248 $411 $279
L3649 Orthopedic Shoe Addition/Modification, Velcr L3649a Rockport
$132 $266
L3675 Shoulder orthosis (SO), vest type abduction L3761 Elbow orthosis with adjustable position lock L3913 HFO, w/o JTs, Custom Fab
$708
$1,670 $1,111

• $873
• L3933 FO, w/o JTs, Custom Fab

L3935 FO, Nontorsion JT, Custom Fab L3967 SEWHO, Airplane Design, w/o JTs, Custom Fab L3971 SEWHO, Shoulder cap design, Incl Nontorsion L3973 SEWHO, Airplane design, Incl Nontorsion JTs/ L3975 SEWHO, Shoulder cap design, w/o JTs L3976 SEWHFO, Airplane design, w/o JTs L3977 SEWHFO, Shoulder cap design, Incl nontorsion L3978 SEWHFO, Airplane design, Incl Nontorsion JTs L4002 Replacement Strap, Any
$904
$3,715 $3,805 $4,007 $3,396 $3,396 $3,805 $4,007
$59
L4045 Replace non-molded thigh lacer, for custom f L4205 Repair Labor 15 minutes
$1,360
$126
L5580 Prep, AK or knee disartic, ischial level soc L5703 Ankle, symes, molded to patient model w/o so L5705 Custom shaped protective cover, AK L5971 All lower extremity prosthesis,solid ankle c L6130 BE, molded socket (Muenster or Northwestern L6570 Shoulder disartic, molded socket, endo sys, L6621 Upper extremity additions,flexion/extension L6677 Upper extremity addition,harness,triple cont L6714 Terminal device, hand, VC, pediatric L6880 ELEC HAND IND ART DIGITS L6883 Replacement socket,below elbow/wrist disarti L6884 Replacement socket,above elbow/elbow disarti L6885 Replacement socket,shoulder disarticulation/ L6895 UE Pros Addition, glove for terminal device, L7400 Addition to upper extremity prosthesis,below L7401 Addition to upper extremity prosthesis,above L7402 Addition to upper extremity prosthesis,shoul L7403 Addition to upper extremity prosthesis,below L7404 Addition to upper extremity prosthesis,above L7405 Addition to upper extremity prosthesis,shoul L7600 Prosthetic donning sleeve, any material, ea L7700 Gasket or seal, for use with prosthetic sock Labac Arm Support, All Sizes, Each
$8,538 $5,612 $3,625
$653
$7,414
$11,793
$6,881
$688
$3,982
$70,703
$8,964 $6,046 $9,394 $2,009
$924
$1,033 $1,114 $1,109 $1,672 $2,186
$161 $366 $365
LACRI-LUB S.O.P. OINTMENT 3.5gm Lactate Dehydrogenase Isoenzymes (contains LDH) Lactate Dehydrogenase, Fluid
$46 $76 $76

• Lactate Dehydrogenase/LDH
• $92

• Lactic Acid, Venous Specimen
• $65

• Lamictal Level
• $207

• Lamotrigine Level
• $385

• Laptray Edging
• $438

• Laptray Padding
• $266

• Laptray Velcro Straps, Pair
• $111

• Laptray, Custom
• $561

• Laryngoscopy Flex Fibroptic
• $165

Laryngoscopy Flex Fibroptic- Physician fee Laryngoscopy Indirect Diagnostic (31505) Lateral Contour Option
$387 $479 $110

• Lateral Hip Block w/ Cover
• $347

• LDH Isoenzymes
• $72

• Lead Level
• $319

• LEG CPM MACHINE
• $202

Legg Perthes Orthosis, Newington Type Legg Perthes Orthosis, Patten Bottom Type Legg Perthes Orthosis, Toronto Type Legg Perthes Orthosis, Trilateral, Tachdijan Type Legionella Antigen, Urine
$4,250 $3,841 $3,340 $3,164
$48

• Legionella DFA Stain
• $168

Legionella Pneumophila IgG & IgM Antibodies, Sero Leishmania Antibodies
$158
$77

• Lengthen Flexor Tendon (ea)
• $2,251

$2,414 $2,703 $1,863
$385
Lengthen, Extensor, Hand/Finger (ea) Tendon Lengthening or Shortening of Tendon, leg or ankle; Lengthening or Shortening of Tendon, leg or ankle;_27685 Levetiracetam Level

• Lewis Phenotyping, blood
• $55

• Lift, Heel and Sole, Cork, Per Inch
• $174

Lift, Heel and Sole, Neoprene, Per Inch Lift, Heel, Per Inch
$368 $172
Lift, Heel, Tapered to Metatarsal, Per Inch Lift, Inside Shoe, Tapered, Per Inch
$235 $333
Lift, Metal Extension (Skate) Lipase
$1,214
$181

• Lipase, Fluid
• $181

• Lipoprotein (a)
• $124

• Lipoprotein Electrophoresis
• $236

• Lipoprotein Fractionation
• $58

• Lipoprotein, blood
• $77

Lithium ion battery, charger Lithium ion battery, replacement Lithium Level
$1,518 $1,172
$122

• LITTLE SWIMMERS LARGE
• $4

• LITTLE SWIMMERS MEDIUM
• $4

• Liver Chemistry Panel
• $266

Liver-Kidney Microsome Autoantibodies LNGTHN.SHORTN MULTI LEG/ANKLE TENDONS EA BILATERAL LO RIG POS PNL L1-L5 PRE OTS (L0641)
$204
$17,804
$324
Long Arm Cast (29065) Long Leg Cast Long Leg Cast Bilateral Long Leg Splint
$1,103 $1,243 $1,863
$187

• Low Level IgM
• $79

Lower Extremity Addition Thigh/Weight Bearing Lace Lower Extremity Addition, Abduction Bar, Jointed, Lower Extremity Addition, Abduction Bar, Straight Lower Extremity Addition, Anterior Swing Band Lower Extremity Addition, Dorsiflexion/Plantarflex Lower Extremity Addition, Dorsiflexion/Plantarflex_L2210 Lower Extremity Addition, Extended Steel Shank Lower Extremity Addition, Foot Plate, Stirrup Atta Lower Extremity Addition, Lacer, Molded to Patient Lower Extremity Addition, Limited Ankle Motion Joi Lower Extremity Addition, Molded Inner Boot Lower Extremity Addition, Non-Corrosive Finish Bar Lower Extremity Addition, Non-Molded Lacer, Custom Lower Extremity Addition, Offset Knee Joint Lower Extremity Addition, Offset Knee Joint, Heavy Lower Extremity Addition, Patten Bottom Lower Extremity Addition, Pelvic Control Band/Belt Lower Extremity Addition, Pelvic Control Hip Joint Lower Extremity Addition, Pelvic Control Sling Lower Extremity Addition, Pelvic Control, Band/Bel Lower Extremity Addition, Pelvic Control, Hip Jt, Lower Extremity Addition, Pelvic Control, Hip Jt, _L2570 Lower Extremity Addition, Pelvic Control, Hip Jt, _L2600 Lower Extremity Addition, Pelvic Control, Hip Jt, _L2610 Lower Extremity Addition, Pelvic Control, Hip Jt, _L2624 Lower Extremity Addition, Pelvic Control, Reciproc Lower Extremity Addition, Pelvic Control, Reciproc_L2628 Lower Extremity Addition, Pelvic/Thoracic Control Lower Extremity Addition, Pre-Tibial Shell, Molded Lower Extremity Addition, PTB Socket, Molded to Pa Lower Extremity Addition, Reinforced Solid Stirrup Lower Extremity Addition, Round caliper, Plate Att Lower Extremity Addition, Split Flat Caliper Stirr Lower Extremity Addition, Straight Knee Joint, Hea Lower Extremity Addition, Suspension Sleeve Lower Extremity Addition, Thigh Weight Bearing Isc Lower Extremity Addition, Thigh Weight Bearing Lac Lower Extremity Addition, Thigh Weight Bearing, Hi Lower Extremity Addition, Thigh Weight Bearing, Qu Lower Extremity Addition, Thigh/Gluteal/Ischial We Lower Extremity Addition, Thigh/Weight Bearing Isc Lower Extremity Addition, Thigh/Weight Bearing Qua Lower Extremity Addition, Thoracic Control Band Lower Extremity Addition, Thoracic Control Lateral Lower Extremity Addition, Thoracic Control, Parasp Lower Extremity Addition, Torsion Control, Ankle J Lower Extremity Addition, Torsion Control, Straigh Lower Extremity Addition, Valgus/Varus Correction Lower Extremity Addition, Valgus/Varus Correction _L2270 Lower Extremity Foot Orthosis Addition, Adj Motion Lower Extremity Foot Orthosis Addition, Drop Lock Lower Extremity Foot Orthosis Addition, Hip Jt, Pe Lower Extremity Foot Orthosis Addition, Limited Mo Lower Extremity Foot Orthosis Addition, Plastic, S Lower Extremity Foot Orthosis Addition, Quadrilate Lower Extremity Foot Orthosis Addition, Waist belt
$2,045
$512 $520 $600 $363 $284 $233
$1,850 $1,656
$227
$2,544
$285 $868 $461 $657 $726
$1,416 $1,127 $1,956
$537
$1,432 $1,033
$494
$1,063
$903
$9,625 $7,056
$624
$1,882 $1,612
$843 $427 $429 $662 $231
$1,482
$555 $790
$1,245
$727
$2,296 $2,492
$804 $660 $372 $285 $300 $588 $276 $357 $516 $770 $268 $307 $650 $197
Lower Extremity Orthosis Addition, Carbon Laminati Lower Extremity Orthosis Addition, Condylar Pad Lower Extremity Orthosis Addition, Drop Lock Retai Lower Extremity Orthosis Addition, Extension Per B Lower Extremity Orthosis Addition, Femoral Length Lower Extremity Orthosis Addition, Full Knee Cap Lower Extremity Orthosis Addition, Knee Cap, Media Lower Extremity Orthosis Addition, Plating Chrome/ Lower Extremity Orthosis Addition, Sidebar Disconn Lower Extremity Orthosis Addition, Soft Interface Lower Extremity Orthosis Addition, Soft Interface _L2820 Lower Extremity Orthosis, Tibial Length Sock, Fx o LSO SAG CTR RIGI POS PRE OTS (L0643) LSO SAG R AN/POS PNL PRE OTS (L0648) LSO SAG-CO SHELL PNL PRE OTS (L0651) LSO SC R ANT/POS PNL PRE OTS (L0650) LSO SC R POS/LAT PNL PRE OTS (L0649) LTV CIRCUIT W/O PEEP, ADULT
$589 $368 $134 $490 $273 $372 $455 $182 $588 $394 $365 $196 $676
$4,281 $5,402 $5,402 $1,195
$40
LTV CIRCUIT WITH PEEP, ADULT W/MOUTHPICE DEVICE LUBRICATING JELLY SURGILUBE FLIP-TOP 4.25-OZ TUBE LUBRIDERM 3.3oz
$57
$7
$11
Lumbar Discography (62290) Lumbar Epidural (64483)
$774
$3,083
$248 $886 $351
$1,074 $2,423 $1,909
$111 $338 $210 $378 $673 $306
$2,216 $2,797 $2,788 $2,848
$731 $523
$4,890
$452 $281 $330 $173 $510 $109 $224 $109 $118
$44
Lumbar Orthosis, Flexible, Prefabricated, w/ Strap Lumbar Orthosis, Sagittal, Prefabricated, Rigid Pa Lumbar Orthosis, Sagittal, Prefabricated, w/ Pads/ Lumbar TFESI add'l level x___ Lumbar Transforaminal Epidural Inj-Add'l Level BiL Lumbar Transforaminal Epidural Injection-Additiona Lumbar/Sacral Contour Option Lumbar-Sacral Orthosis, Corset Front Lumbar-Sacral Orthosis, Flexible, Custom Fabricate Lumbar-Sacral Orthosis, Flexible, Prefabricated, S Lumbar-Sacral Orthosis, Full Corset Lumbar-Sacral Orthosis, Protective Body Sock for S Lumbar-Sacral Orthosis, Rigid Anterior, Sac - T9, Lumbar-Sacral Orthosis, Rigid Anterior-Posterior F Lumbar-Sacral Orthosis, Rigid Anterior-Posterior P Lumbar-Sacral Orthosis, Rigid Posterior Frame/Pane Lumbar-Sacral Orthosis, Rigid Posterior, Prefabric Lumbar-Sacral Orthosis, Thoracic Extension Lumbosacral Transforaminal-Bilateral (64483) Lupus Activity Reporter Luteinizing Hormone Lyme Disease by PCR Lyme Disease by PCR_86618 Lyme Disease DNA, Real-Time PCR, Blood Lyme Disease, Serum (Confirmatory IgG & IgM) Lyme's Disease Antibodies (Total IgG/IgM) Serum Lymes Disease, Serum Confirmatory IgM Magnesium Level Magnesium, Random Urine

• Magnesium, Timed Urine
• $40

• Malarial Prep
• $60

Mammaplasty, augmentation; with prosthetic implant Manganese, RBC Manipulation Elbow G/A Manipulation Knee Under G/A Manipulation of Hip Joint
$2,291
$158
$1,241
$595 $675
Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated MASK TRACHEOSTOMOY PEDIATRIC Massage Therapy 30 minutes
$77
$5
$76
Massage Therapy 60 minutes Massage Therapy 90 minutes Maximum Breathing Capacity and Maximum Voluntary V MC Abductor Hardware Removable MC Abductor Hardware Swingaway MC Abductor Pad
$120 $181 $151 $127 $127 $158 $165
$11
MC Lateral Trunk Support Pad Measure Blood Oxygen Level

• Mechanical In-ExSufflator Charge
• $197

$780 $632
$74 $74 $53
Mechanical Ventilation Initiation Charge Mechanical Ventilation Subsequent Days Charge Med Nutrition Assess and Intervention, Individual Med Nutrition Re-Assessment and Intervention each MEDIHONEY ADHESIVE DRESSING 4 1/2"X 4 1/2" MEDIHONEY CALCIUM ALGINATE DRESSING 2"X 2" MEDIHONEY CALCIUM ALGINATE DRESSING 4"X5"
$21 $58
MEDIHONEY GEL 0.5 TUBE MEDIHONEY GEL 1.5 TUBE
$22 $53
MEDIHONEY NON-ADHESIVE DRESSING (HCS) 4.33"X 4.33" MEPILEX TRANSFER 6X8
$46 $47

• Mercury Level, Serum
• $299

MESH UNDERWEAR SZ 2X/3X 2/PK MESH UNDERWEAR SZ 4X 2/PK MESH UNDERWEAR SZ LG/ XL 2/PK MESH UNDERWEAR SZ SM/MD 2/PK METACARP FX ORTHOSIS PRE OTS (L3918) METANEB CIRCUITS
$6 $8 $6 $5
$401 $290

• Metanephrines
• $61

Metanephrines, Fractionated -24 Hr Urine Metanephrines, Plasma Free
$66
$233

• Metatarsal Bar, Rocker
• $147

• Meter Dose Inhaler
• $75

Meter dose inhaler teaching = inhaler Meter Dose Inhaler Teaching Charge Methotrexate Level
$174 $109 $385

• Methylmalonic Acid
• $102

MIC-KEY FEED TUBE 12FR 1.5CM MIC-KEY SECUR-LOK EXT SET
$394
$62
MIC-KEY SKIN LEVEL 12 FR 1.2 KIT Microalbumin with Creatinine, Urine Timed Microalbumin with Creatinine, Urine, Random Microproc control feature, addtion to upper-limb p Microsporidium
$376
$35 $74
$9,330
$99
Midfoot/Post Talotibial Capsulotomy with Tendon Le Mini-Nebulizer
$5,046
$98

• Minor Inhalation Therapy
• $135

MIRROR LONG HANDLE HAND HELD Mirtazapine Level
$111 $385

• MN Phenotyping, blood
• $55

MOD SED SAME PHYS/QHP 5/>YRS, initial 15 minutes ( Modified Education Binder
$37 $33
MOTOR&/SENS 1-2 NRV CNDJ TST (95907) MOTOR&/SENS 3-4 NRV CNDJ TST (95908) MOTOR&/SENS 5-6 NRV CNDJ TST (95909) MOTOR&SEN 11-12 NRV CND TEST (95912) MOTOR&SEN 9-10 NRV CNDJ TEST (95911) MOTOR&SENS 13/> NRV CND TEST (95913) MOTOR&SENS 7-8 NRV CNDJ TEST (95910) Motor/Sensory Nerve Conduct Test MR290 AUTO FILL HUMIDIFICATION CHAMBER MRA Abdomen W/O Contrast MRA Abdomen W&W/O Contrast MRA Abdomen W/ Contrast
$307 $341 $371 $717 $651 $787 $437 $232
$48
$3,952 $3,952 $3,952 $3,888 $3,888 $4,677 $6,321 $3,184 $3,921 $3,921 $3,921 $3,741 $5,291 $4,232 $3,929 $3,929 $4,103 $4,103 $4,103 $4,068 $4,068 $4,068 $4,096 $5,235 $4,096 $5,235 $5,235 $5,235 $5,124 $4,096 $5,124 $4,458 $4,458 $5,390 $5,390
MRA Chest W/O Contrast MRA Chest W/ Contrast MRA Head W/O Contrast MRA Head W&W/O Contrast MRA Head W/ Contrast MRA Lower Ext W/O Contrast MRA Lower Ext W&W/O Contrast MRA Lower Ext W/Contrast MRA Neck W/O Contrast MRA Neck W&W/O Contrast MRA Neck W/ Contrast MRA Pelvis W/O Contrast MRA Pelvis W/ Contrast MRA Spinal Canal W/O Contrast MRA Spinal Canal W&W/O Contrast MRA Spinal Canal W/ Contrast MRA Upper Ext W/O Contrast MRA Upper Ext W&W/O Contrast MRA Upper Ext W/ Contrast MRI Abdomen W/O Contrast MRI Abdomen Enterography W&W/O Contrast MRI Abdomen MRCP W/O Contrast MRI Abdomen MRCP W&W/O Contrast MRI Abdomen Urography W&W/O Contrast MRI Abdomen W&W/O Contrast MRI Abdomen W/ Contrast MRI Abdominal Wall W/O Contrast MRI Abdominal Wall W/ Contrast MRI Ankle/Hindfoot W/O Contrast Left MRI Ankle/Hindfoot W/O Contrast Right MRI Ankle/Hindfoot W&W/O Contrast Left MRI Ankle/Hindfoot W&W/O Contrast Right MRI Brachial Plexus W/O Contrast Lt MRI Brachial Plexus W/O Contrast Rt MRI Brachial Plexus W&W/O Contrast Lt MRI Brachial Plexus W/W&O Contrast Rt MRI Brain W/O Contrast
$3,558 $3,558 $5,224 $5,224 $2,713 $2,713 $3,184 $2,713 $2,713 $3,184 $5,124 $3,184 $3,184 $5,124 $3,558 $5,224 $7,891 $3,558 $5,224 $4,124 $5,124 $5,124 $4,124 $5,745 $5,124 $2,713 $4,990 $4,990 $4,124 $4,124 $5,124 $5,124 $2,713 $2,713 $4,990 $4,990 $4,124 $4,124 $5,124 $5,124 $2,713 $2,713 $2,713 $2,713 $5,124 $5,124 $5,390 $5,390 $4,458 $4,458 $5,124 $5,124 $2,713 $2,713 $5,390 $5,390 $4,458 $4,458 $4,458 $4,458 $5,390 $5,390 $5,745 $5,124 $2,713 $5,235 $5,832 $3,947 $5,235 $5,832 $3,947 $5,832 $3,947 $3,947 $5,832 $5,124 $5,124 $5,124 $4,124
MRI Brain CSF Study W/O Contrast MRI Brain CSF Study W&W/O Contrast MRI Brain FMRI MRI Brain IAC/Cranial Nerve W/O Contrast MRI Brain IAC/Cranial Nerve W&W/O Cont MRI Brain IAC/Cranial Nerve W/Contrast MRI Brain W&W/O Contrast MRI Brain W&W/O Contrast w/ Perfusion MRI Brain W/Contrast MRI Chest W/O Contrast MRI Chest W&W/O Contrast MRI Chest W/Contrast MRI Chest Wall W/O Contrast MRI Chest Wall W&W/O Contrast MRI Elbow W/O Contrast Left MRI Elbow W&W/O Contrast Left MRI Elbow W&W/O Contrast Right MRI Elbow W/O Contrast Right MRI Face/Neck W&W/O Contrast MRI Face/Neck W/Contrast MRI Face/Neck W/O Contrast MRI Femur W&W/O Contrast Left MRI Femur W&W/O Contrast Right MRI Femur W/O Contrast Left MRI Femur W/O Contrast Right MRI Finger W&W/O Contrast Left MRI Finger W&W/O Contrast Right MRI Finger W/O Contrast Left MRI Finger W/O Contrast Right MRI Foot W&W/O Contrast Lt MRI Foot W&W/O Contrast Rt MRI Foot W/O Contrast Lt MRI Foot W/O Contrast Rt MRI Forearm W&W/O Contrast Left MRI Forearm W&W/O Contrast Right MRI Forearm W/O Contrast Left MRI Forearm W/O Contrast Right MRI Hand W/O Contrast Left MRI Hand W/O Contrast Right MRI Hand W&W/O Contrast Left MRI Hand W&W/O Contrast Right MRI Hip W&W/O Contrast Lt MRI Hip W&W/O Contrast Rt MRI Hip W/O Contrast Lt MRI Hip W/O Contrast Rt MRI Humerus W&W/O Contrast Lt MRI Humerus W&W/O Contrast Rt MRI Humerus W/O Contrast Lt MRI Humerus W/O Contrast Rt MRI Knee W&W/O Contrast Lt MRI Knee W&W/O Contrast Rt MRI Knee W/O Contrast Lt MRI Knee W/O Contrast Rt MRI Lower Ext Joint W/Contrast Lt MRI Lower Ext Joint W/Contrast Rt MRI Lower Ext W/Contrast Left MRI Lower Ext W/Contrast Right MRI Orbits W&W/O Contrast MRI Orbits W/ Contrast MRI Orbits W/O Contrast MRI Pelvis Enterography W&W/O Contrast MRI Pelvis MSK W&WO Contrast MRI Pelvis MSK W/O Contrast MRI Pelvis Urography W&W/O Contrast MRI Pelvis Viscera W&W/O Contrast MRI Pelvis Viscera W/O Contrast MRI Prostate W&W/O Contrast MRI Prostate W/O Contrast MRI Sacrum Coccyx W/O Contrast MRI Sacrum Coccyx W&W/O Contrast MRI Sacrum Coccyx W/ Contrast MRI Shoulder W&W/O Contrast Lt MRI Shoulder W&W/O Contrast Rt MRI Shoulder W/O Contrast Lt MRI Shoulder W/O Contrast Rt MRI Spine Cervical W&W/O Contrast MRI Spine Cervical W/Contrast MRI Spine Cervical W/O Contrast MRI Spine Lumbar W&W/O Contrast MRI Spine Lumbar W/Contrast MRI Spine Lumbar W/O Contrast MRI Spine Thoracic W&W/O Contrast MRI Spine Thoracic W/ Contrast MRI Spine Thoracic W/O Contrast MRI Tibia W&W/O Contrast Lt MRI Tibia W&W/O Contrast Rt MRI Tibia W/O Contrast Lt MRI Tibia W/O Contrast Rt MRI TMJ W&W/O Contrast MRI TMJ W/O Contrast MRI Upper Ext Joint W/Contrast Lt MRI Upper Ext Joint W/Contrast Rt MRI Upper Ext W/ Contrast Left MRI Upper Ext W/ Contrast Right MRI Wrist W&W/O Contrast Lt MRI Wrist W&W/O Contrast Rt MRI Wrist W/O Contrast Lt
$4,124 $5,619 $5,124 $4,360 $5,619 $5,124 $4,353 $5,619 $5,124 $4,353 $4,990 $4,990 $4,124 $4,124 $2,713 $2,713 $7,891 $7,891 $5,124 $5,124 $5,124 $5,124 $4,124 $4,124
$258
MRI Wrist W/O Contrast Rt MRSA Screen, PCR MRV Head W&W/O Contrast MRV Head W/O Contrast MRV Pelvis W&W/O Contrast Multi Density Insert
$6,321 $4,677 $3,929
$135
Multiple Density Insert, Custom Fabricated, Molde Multiple Density Insert, Prefabricated, Molded to Multiple Family Group Psychotherapy Mumps Antibody IgG (Immunity) Mumps Antibody IgM
$202 $135 $139 $119
$86

• Mumps Virus Culture
• $147

MUSCLE BX; PERC NDL (20206) MUSCLE BX; SUPERF (20200)
$152
$4,919 $9,656 $3,602 $3,124 $2,485
$839
MUSCLE FLAP; LOWER EXTREMITY (15738) MUSCLE FLAP; TRUNK (15734) MUSCLE FLAP; UPPER EXTREMITY (15736) Muscle/Tendon Transfer Upper Arm/Elbow, Single MUSK Antibody

• Mycobacteria Smear
• $99

Mycobacterium Tuberculosis PCR Mycophenolic acid Level
$376 $105

• Mycoplasma Antibody
• $86

• Myelin Basic Protein, CSF
• $101

• Myeloperoxidase
• $153

• Myoglobin Serum
• $179

• Myoglobin, Urine Random
• $179

• Mysoline Level
• $321

• NAIL CARE KIT
• $6

• NASAL CANNULA 21FT
• $6

• Nasal Saline Irrigation
• $82

• Natural Killer Cells(NK cells)
• $284

NB INJ HYPOGAS PLXS (64517) NEBULIZER CAP 1000MI
$3,084
$12
Needle electromyography, each extremity, with rela Needle electromyography, each extremity, with rela_95886 Needle electromyography, each extremity; limited ( Needle electromyography, each extremity; limited B Needle Electromyography, non-extremity (95887) Needle Electromyography, non-extremity Bilateral ( Needle Electromyography; Thoracic Paraspinal Muscl Needle EMG, Anal/Urethral Sphincter (51785) NEEDLE NEXIVA 18G X 1 1/4
$380 $253 $170 $256 $228 $345 $464
$1,051
$24

• NEEDLE NEXIVA 20G X 1 IN
• $24

• NEEDLE NEXIVA 22G X 1 IN
• $24

• NEEDLE NEXIVA 24G X 3/4 IN
• $24

NEEDLE, INOJECT 38 X 0.45 MM X 26G NEEDLE, INOJECT 50 X 0.50 MM X 25G Neg Pressure Wound Tx < 50 sq cm (97605) Neg Pressure Wound Tx > 50 sq cm (97606) Negative Inspiratory Force
$129 $129 $431 $688 $362
Negative Inspiratory Force Charge Nephelometry
$362
$88
Nerve Block Ilioing/Iliohypogastric Bilateral Nerve Block Ilioning/Iliohypogastric Nerve Destruction Other Peripheral or Branch Charg
$2,342 $1,478 $3,643
Nerve Destruction Other Peripheral or Branch Charg_64640 Neurobehavioral Status Exam Add On Neurobehavioral Status Exam, per hour Neuromyelitis Optica IgG
$3,262
$100 $513 $457
$8,170
$858 $771
$2,115 $2,601 $2,558 $2,138 $2,108 $2,070 $2,549 $2,569 $1,500
$25
Neuroplasty; ulnar nerve Neuropsych testing by physicial or other qualified healthcare profesional. First Hour Neuropsych testing by physician or other qualified healthcare professional, each additional hour NJX INTERLAMINAR CRV/THR, C without imaging guidan NJX INTERLAMINAR CRV/THRC, incl indw cath, cont in NJX INTERLAMINAR CRV/THRC, incl indw cath/cont fus NJX INTERLAMINAR CRV/THRC, with imaging guidance ( NJX INTERLAMINAR LMBR/SAC, with imaging guidance ( NJX INTERLAMINAR LMBR/SAC, without imaging guidanc NJX INTERLAMINAR LMBR/SAC,incl ind cath, cont infu NJX INTERLAMINAR LMBR/SAC,incl indw cath, cont inf NO SHOW / CANCELLATION PAIN PROGRAM CHARGE $1500 No Show/Cancellation

• No Show/Cancellation_00000
• $25

• No Show/Cancellation-P&O
• $25

• No Show/Cancellation-Program
• $25

NON ADHERENT CONTACT LAYER DRESSING 2X2 NON ADHERENT CONTACT LAYER WITH TRIACT 4X5 NON BORDERED FOAM, DRESSING 4X4 NON BORDERED FOAM, HEEL
$8
$24
$9
$35
NON BORDERED LITE FOAM DRESSING 4X5 Nonadjustable Hip Block Hardware NON-BORDERED FOAM DRESSING 2.5 X 2.5 NON-BORDERED FOAM DRESSING 6X8 NON-PNEUM WALK BOOT PRE OTS (L4387) Non-Pneumatic Walking Splint Non-Selective Debridement Including Topical Applic Nontunnelled Catheter Charge Norovirus
$9
$840
$9
$25
$660 $714 $685 $567 $173 $385 $141 $236 $235
$8,060
$387 $263 $197 $101
$2,457
$30
Norpace (Disopyramide) Level N-Telopeptide Serum N-Telopeptides (NTX) with Creatinine, Urine Random N-Telopeptides (NTX), Urine Timed NU Pro Control Nursing fac care, subseq comprehensive exam Nursing fac care, subseq detail exam Nursing fac care, subseq expanded problem focused Nursing fac care, subseq problem focused exam O2 Uptk Exp Gas Alys Rest Indir Spx Charge-95805 OASIS SALINE MOUTH SPRAY 1oz OASIS WOUND MATRIX 3X7CM FENESTRATED Oasis wound matrix skin sub per sq cm (Q4102) OAT BETA GLUCAN OCCLUSIVE OINTMENT OB Combination Headrest OB Elevating/Swivel Arm Trough Hardware OB Flat Headrest, Large OB Flat Headrest, Small OB Forearm Trough OB Hand Pad, Flat
$824
$35
$170 $171 $255 $182 $151 $110
$89

• OB Hand Pad, Molded
• $89

OB Headrest Hardware, Clamp Only OB Single Axis Headrest Hardware Occult Blood Exam
$67
$221
$70

• Occult Blood Screen
• $70

• Occult Blood, Feces-POCT
• $70

• OCEAN SALINE NASAL SPRAY 45cc
• $26

Office Consult Level 1 Charge- 99241 Office Consult Level 2 Charge- 99242 Office Consult Level 3 Charge- 99243 Office Consult Level 4 Charge- 99244 Office Consult Level 5 Charge- 99245 Office Visit Level 1 Est Charge- 99211 Office Visit Level 1 New Charge- 99201 Office Visit Level 2 Est Charge- 99212 Office Visit Level 2 New Charge- 99202 Office Visit Level 3 Est Charge- 99213 Office Visit Level 3 New Charge- 99203 Office Visit Level 4 Est Charge- 99214 Office Visit Level 4 New Charge- 99204 Office Visit Level 5 Est Charge- 99215 Office Visit Level 5 New Charge- 99205 Off-set Heel
$195 $354 $442 $662 $834 $214 $260 $295 $366 $359 $514 $508 $736 $685 $957 $147

• $30
• OINTMENT BARRIER 5.6-OZ

Oligoclonal Bands One Piece Foot Board
$204 $124