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Charge Code Description CPT Charge 0.9% NACL 250ML GLASS 52.00 10% DEXTROSE 500CC 55.00 16-37 MIN

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Charge Code Description CPT Charge 0.9% NACL 250ML GLASS 52.00 10% DEXTROSE 500CC 55.00 16-37 MIN Charge Code Description CPT Charge 0.9% NACL 250ML GLASS 52.00 10% DEXTROSE 500CC 55.00 16-37 MIN. INDIVIDUAL PSYCHOTHERAPY 90832 325.00 1ST NF CARE PR 99304 177.00 1ST NF CARE PR 99305 234.00 1ST NF CARE PR 99306 306.00 38-52 MINS. INDIVIDUAL PSYCHOTHERAPY 90834 350.00 4 IN STERILE ACE 8.60 5% D/W 500CC 55.00 5% DEX/.2% NACL INJ USP 1 40.00 5% DEXTROSE & .33% NA CL( 65.00 5% DEXTROSE INJ USP 250 M 40.00 5% DEXTROSE INJECT 500ML 45.00 5,10-MTHFR 2 MUTATIONS 81291 198.28 53-67 MINS. INDIVIDUAL PSYCHOTHERAPY 90837 375.00 ABATACEPT INJ 250MG VL J0129 2,270.44 ABDOMEN 1 VIEW 74018 193.00 ABDOMEN 2 74019 246.00 ABDOMEN 3+VIEWS 74021 300.00 ABDOMEN ACUTE ABDOMEN SERIES 74022 432.00 ABDOMINAL CAT SCAN W/O CO 74150 1,712.00 ABDOMINAL CAT SCAN W/WO C 74170 2,047.00 ABDOMINAL CAT SCAN WITH C 74160 1,879.00 ABILIFY 10MG TAB 80.30 ABILIFY TAB 5 MG 107.04 ABREVA CREAM NF 55.65 ABSORPTION DRESSING 115.65 ACAPELLA MOUTHPIECE 130.35 ACARBOSE TAB 25 MG 4.00 ACETAMIN/ COD LIQ 120/12 MG/5ML 60ML BTL 61.80 ACETAMIN/ COD TAB 300/ 30 MG 6.36 ACETAMINOPHEN 80307 85.00 ACETAMINOPHEN ADULT SUP 650 mg 4.67 ACETAMINOPHEN CHILD SUP 120 MG 4.58 ACETAMINOPHEN LIQ 160 MG/5ML 4.00 ACETAMINOPHEN ORAL LIQUID 480mg/15ml 4.00 ACETAMINOPHEN TAB 325 MG 2.00 ACETAMINOPHEN TAB 500 MG 2.00 ACETAZOLAMIKE 250 MG TAB 4.00 ACETIC ACID 0.25% IRRG SOL 500ML 8.00 ACETYLCYSTEINE 20% INH/PO 200 mg/ml 4 ml 44.89 ACETYLCYSTEINE SOL 20% 6000 mg (4ML/VL) 75.02 ACHR BINDING AB 83519 99.49 ACID FAST CULTURE 87116 43.00 ACIDOPHILUS TAB 100 MG 4.00 ACITRETIN 25mg CAP 115.38 ACNE SURGERY COMEDONE REMOVAL 10040 168.95 ACT PROT C RESIST 85307 199.25 ACTEMRA INJ 400 MG VL J3262 8.62 ACTH 82024 195.47 ACTH RADIOIMMUN 82024 195.47 ACTINOMYCES (NOCARDIA) AB 86744 31.00 ACTINOMYCES (NOCARDIA)AB 86744 31.00 ACTIVASE INJ 100 MG VL J2997 137.74 Actonel Oral 35 mg Tablet (Pack of 4) 292.54 ACUTE HEPATITIS PANEL 80074 235.00 ACUTE HEPATITIS PANEL 80074 235.00 ACYCLOVIR CAP 200MG J8499 6.12 ACYCLOVIR INJ 500 MG VL J0133 76.40 ADENOSINE INJ 12 MG/4ML SR 36.42 ADENOSINE INJ 6 MG/2ML VL J0153 68.00 ADENOVIRUS PCR 87798 122.21 ADH 84588 96.00 ADH 84588 96.00 ADHESIVE SKIN 57.40 ADJUSTABLE HEMI WALKER 116.25 ADM HEP B VACC G0010 45.00 ADM INJ SUBCU O 96372 44.00 ADM PNEUMO VACC G0009 44.00 ADMIN FLU SHOT G0008 44.00 ADMIN FLU VIRUS VACCINE G0008 79.05 ADMIN PNEUMONIA VACCINE G0009 79.05 ADMN INJ IV PUSH 96374 191.09 ADRENALIN EPINEPHRINE INJ J0171 4.00 ADULT REBREATHING MASK 5.60 ADVANCED CARE PLANNING 30MIN 99497 94.00 ADVANCED CARE PLANNING ADDL 30MIN 99498 82.00 AFB CONCENTRATION 87015 38.46 AFB SMEAR 87206 34.00 AFO PLASTIC/OTH MATERIAL PREFAB L1930 704.77 AFP TUMOR MARKER 82105 105.00 AFP, MATERNAL SERUM 82105 130.00 AH50 86161 176.75 AIR CAST, UNIVERSAL SM 120.25 AIRCAST LEG BRACE 03AL 135.00 AIRCAST LEG BRACE 03AR 120.75 AIRCAST LEG BRACE 03CL 135.00 AIRCAST LEG BRACE 03CR 135.00 AIRCAST SPORT STIRRUP L. 75.40 AIRCAST UNIVERSAL LG 120.25 AIRCAST UNIVERSAL MED 120.25 ALAWAY OPTH DROPS .025% 82.88 ALBA HEEL & ELBOW PROTECT 25.35 ALBUMIN HUMAN INJ 2500MG 156.09 ALBUMIN SERUM 82040 37.00 ALBUTEROL MDI (8 GM) 81.40 ALBUTEROL SULFATE 90MCG INH 18GM 138.36 ALBUTEROL SYRUP PER 10CC 4.00 ALBUTEROL/ IPRATROPIUM 14.7 GM MDI 549.14 ALCOHOL (ETHANO G0480 79.00 ALCOHOL BLOOD TEST SUPPLI 17.35 ALCOHOL, BLOOD 80307 85.00 ALDOLASE 82085 74.00 ALDOSTERONE 82088 279.75 ALDOSTERONE 82088 280.00 ALENDRONATE TAB 70 MG 61.45 ALK PHOS ISOENZYMES 84080 94.00 ALKALINE PHOSPHATASE 84075 42.00 ALLERGEN SPECIF 86003 31.00 ALLERGY INJ, 2+ 95117 41.00 ALLERGY INJ.SNG 95115 37.03 Allergy Peanut 86003 40.00 ALLERGY SCREEN 86005 42.00 ALLERGY TEST PER ALLERGEN 86003 31.00 ALLOPURINOL TAB 100 MG 4.00 ALLOPURINOL TAB 300 MG 4.00 ALPHA 1 ANTITRYP PHENOTYP 82104 90.90 ALPHA 1 ANTITRYPSIN 82103 80.08 ALPHA-1-ANTITRYPSIN PHENOTYPE 82104 189.75 ALPHA-1-ANTITRYPSIN TOTAL 82103 73.00 ALPHA-FETOPROTE 82105 130.00 ALPRAZOLAM TAB 0.25 MG 6.64 ALTEPLASE INJ 2 MG VL J2997 442.44 AMANTADINE CAP 100 MG 9.13 AMBISOME 50 MG IV 350.00 AMBISOME INJ 50 MG VL J0289 536.95 AMBUL OR-MINOR A 1-45 MIN 1,224.00 AMBUL OR-MINOR A 46-60MIN 1,384.00 AMBUL OR-MINOR A 61-75MIN 1,524.00 AMBUL OR-MINOR A 76-90MIN 1,644.00 AMBUL OR-MINOR A 91-105MI 1,744.00 AMBUL OR-MINOR B 1-45 MIN 1,899.00 AMBUL OR-MINOR B 46-60MIN 2,059.00 AMBUL OR-MINOR B 61-75MIN 2,199.00 AMBUL OR-MINOR B 76-90MIN 2,339.00 AMBUL OR-MINOR B 91-105MI 2,479.00 AMBUL OR-MINOR C 1-45 MIN 2,574.00 AMBUL OR-MINOR C 46-60MIN 2,734.00 AMBUL OR-MINOR C 61-75MIN 2,894.00 AMBUL OR-MINOR C 76-90MIN 3,054.00 AMBUL OR-MINOR C 91-105MI 3,214.00 AMBULATORY OR MINOR B 120 2,619.00 AMBULATORY SURI L3260 24.00 AMIKACIN INJ 500mg / 2ml 38.38 AMIKACIN, PEAK or TROUGH 80150 88.46 AMINOPHYLLINE INJ 250 MG VL 54.11 AMIODARONE 82492 101.50 AMIODARONE 150MG VL J0282 20.00 AMIODARONE INJ 50 MG/1ML (9 ml VL) J0282 33.14 AMITIZA 24MCG CAP 22.27 AMITRIPTYLINE TAB 10 MG 4.00 AMITRIPTYLLINE TAB 25 MG 4.00 AMLODIPINE TAB 5 MG 6.92 AMMONIA 82140 74.00 AMNIO HOOK 5.60 AMOX/CLAV POT TAB 875/125 MG 15.15 AMOXICIL/ POT CLAV SUS 400/57 MG/50 ML 113.25 AMOXICILLIN 400MG/5ML SUS 50ML BTL 19.60 AMOXICILLIN CAP 250 MG 4.00 AMOXICILLIN SUS 125 MG/5ML (100 ML BTL) 14.36 AMOXICILLIN SUS 250 MG/5ML (80 ML BTL) 18.39 AMOXICILLIN TAB 500 MG 4.00 AMOXICILLIN TAB 875 MG 4.00 AMOXIL/CLAV 500/125MG TAB 15.14 AMPHETAMINE SALTS TAB (10 MG) 12.86 AMPHETAMINE, SERUM 82145 176.50 AMPHETAMINE, SERUM 82145 176.50 AMPHOTERICIN B INJ 50 MG VL J0285 124.88 AMPICILLIN 250 MG TAB (50 9.00 AMPICILLIN 500MG TAB 4.00 AMPICILLIN/SULB INJ 1.5GM VL J0295 63.04 AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM 87798 122.00 AMPUTATION TOE INTERPHALANGEAL JOINT 28825 2,438.34 AMYLASE 82150 36.00 AMYLASE,SERUM 82150 36.00 ANA ANTINUCLEAR 86038 94.00 ANA SCREEN 86038 94.00 ANA TITER 86039 33.00 ANA TITER 86039 33.00 ANAEROBIC CULTURE 87075 72.00 ANAGRELIDE HCL CAP 0.5 MG 33.49 ANASTROZOLE TAB 1 MG J8999 62.96 ANCA 86021 258.00 ANCA MPO OR ANCA PR3 86021 97.00 ANESTHESIA CIRCUIT PEDS 25.10 ANESTHESIA GEN/LOCAL 151 791.00 ANESTHESIA GEN/LOCAL 181 868.00 ANESTHESIA GEN/LOCAL 31 462.00 ANESTHESIA GEN/LOCAL 61 562.00 ANESTHESIA GEN/LOCAL 91 638.00 ANESTHESIA GEN/LOCAL 1 - 332.00 ANESTHESIA GEN/LOCAL 121 715.00 ANESTHESIA MAC/IV SED 1 192.00 ANESTHESIA MAC/IV SED 12 415.00 ANESTHESIA MAC/IV SED 15 459.00 ANESTHESIA MAC/IV SED 18 503.00 ANESTHESIA MAC/IV SED 31 268.00 ANESTHESIA MAC/IV SED 61 326.00 ANESTHESIA MAC/IV SED 91 370.00 ANESTHESIOLOGY SUPPLIES 132.00 ANGIOTENSIN CONVERTING EN 82164 117.25 ANGIOTENSIN CONVERTING EN 82164 117.25 ANKLE FOOT ORTHOS ANK GAUNTLY PRFAB L1902 237.83 ANKLE LEFT (3 VIEWS) 73610 208.00 ANKLE LEFT(2 VIEWS) 73600 172.05 ANKLE RIGHT (2 VIEWS) 73600 172.05 ANKLE RIGHT (3 VIEWS) 73610 208.00 ANKLE STRAPPING 29540 319.24 ANKLE SUPPORT SM 55.00 ANKLE WRAP, FIGURE EIGHT 26.00 ANNUAL WELLNEST VST G0438 242.00 ANOSCOPY, DIAGN 46600 193.00 ANTEPARTUM CARE 59425 998.00 ANTEPARTUM CARE 59426 1,593.00 ANTI TISSUE TRANSGLUTAMIN 82397 151.00 ANTIBIOTIC SENS 87186 45.00 ANTIBODY IDENTI 86021 194.00 ANTIBODY, ASPIR 86606 33.00 ANTIBODY, BLAST 86612 31.00 ANTIBODY, CMV, 86645 109.00 ANTIBODY, COCCI 86635 74.97 ANTIBODY, HEPAT 86706 67.00 ANTIBODY, HEPAT 86704 77.00 ANTIBODY, HEPAT 86709 77.00 ANTIBODY, HEPAT 86803 105.00 ANTIBODY, HERPE 86695 96.00 ANTIBODY, HERPE 86696 98.00 ANTIBODY, HISTO 86698 124.00 ANTIBODY, RUBEO 86765 106.00 ANTIBODY, THYRO 86800 94.00 ANTIBODY, VARIC 86787 72.97 ANTI-DS DNA 86225 79.00 ANTI-EM HOSE, KNEE 17.35 ANTI-EM HOSE, L REG 96.50 ANTI-GBM AB 83520 107.75 ANTI-IgE 83516 159.50 ANTIMICROBIAL AGENT 87185 27.00 ANTIMICROBIAL AGENT DISK METHOD 87184 25.98 ANTIMICROBIAL AGENT DISK METHOD 87184 25.98 ANTIMICROBIAL AGENT ENZYM 87185 27.00 ANTI-MITOCHONDRIAL AB 83516 90.85 ANTI-MULLERIAN HORMONE 83516 116.00 ANTIPYRINE AND BENZOCAINE 10 ML 23.90 ANTI-SMOOTH MUSCLE AB 83516 126.75 ANTISTREPTOLYSI 86060 59.00 ANTI-THROMBIN 3 AG 85301 337.50 ANTI-THYROGLOBULIN AB 86800 94.00 AP CHEST 71045 186.00 APAP DROP 2.00 APHASIA ASSESMENT,PER HR 96105 290.77 APIXABAN 2.5MG TAB 25.14 APIXABAN 5MG TAB NF 25.14 APOLIPOPROTEIN A AND B 82172 67.02 APOLIPOPROTEIN A AND B 82172 67.00 APP LONG ARM SPLINT 29105 218.00 APP.FINGER SPLINT STATIC 29130 167.55 APPLICATION LONG LEG SPLI 29505 300.63 APPLICATION OF 29515 203.00 APPLICATION OF 29505 256.00 APPLICATION OF FOREARM CA 29075 256.00 APPLICATION RIGID TOTAL CONTACT LEG CAST 29445 566.77 APPLIER CLIP LIGOMAX 319.75 APPLIER CLIP ROT LIGACLIP 219.10 APPLY ELBOW TO 29075 278.00 APPLY FINGER SP 29130 102.00 APPLY FINGER SPLINT 29130 94.00 APPLY FINGER SPLINT 29130 130.75 APPLY FOREARM S 29125 182.00 APPLY FOREARM SPLINT 29125 167.00 APPLY FOREARM SPLINT 29125 328.93 APPLY FOREARM SPLINT 29125 328.93 APPLY LONG ARM SPLINT 29105 319.24 APPLY LONG LEG SPLINT 29505 300.63 APPLY LOWER LEG SPLINT 29515 135.35 APPLY LOWER LEG SPLINT 29515 162.78 APPLY LOWER LEG SPLINT 29515 319.24 APPLY MLTLAYR COMPRESS ARM/HAND 29584 319.24 APPLY MULTLAY COMPRS LWR LEG 29581 319.24 APPLY MULTLAYR COMPRES LEG 29581 319.24 APPLY SHORT LEG CAST 29425 237.28 APPLY SHORT LEG CAST 29425 331.00 APPLY SHOULDER 29065 318.00 APPLY SPLINT FINGER (DYNA 29131 231.45 APPLY SPLINT SHORT ARM (D 29126 231.45 APPLY TENS UNIT 64550 42.00 AQUA-MEPHYTON TAB 5 MG 36.99 AQUAPAK STERILE WATER 7.00 ARANESP 300MCG SYG INJ J0881 15.40 ARANESP INJ (200 MG SYR) J0881 14.66 ARANESP INJ (500 MCG) J0881 14.66 ARANESP INJ (60 MCG SYR) J0881 14.66 ARANESP INJ 100MCG SYG J0881 14.66 ARGINAID PKT 4.72 ARIPIPRAZOLE 15MG TAB NF 96.00 ARSENIC URINE OR BLOOD 82175 183.00 ARTERIAL DOPPLER LIMB COM 93923 591.00 ARTERIAL DOPPLER LIMB LIM 93922 362.00 ARTHRITIS CREAM W/ LIDOCAINE
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