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CPT Code Description Charge Amount 83498 17-Alpha CPT Code Description Charge Amount 83498 17-alpha-Hydroxyprogester 308.41 83497 5-HIAA, SO 125.99 83516 A MYELOPEROX (MPO) AB QL 74.1 86021 AB ID LEUKOCYTE AB/SO 610.25 86022 AB ID, PLATELET ABS;SRA U 1318 86720 AB LEPTOSPIRA/SO 166.12 86850 AB SCREEN (IDC) 207.83 86850 AB SCREEN RBC EA SRM TECH 195.25 86793 AB, YERSINIA/SO 149 74018 ABDOMEN 1 VIEW 348.75 74018 ABDOMEN 1 VIEW PORTABLE 321.36 74022 ABDOMEN ACUTE COMP WSGL V 398.36 74019 ABDOMEN COMPLETE 398.36 74018 ABDOMEN SGL ANTEROPOSTERI 475.8 49083 ABDOMINAL PARACENTESIS W/ 1216.89 86870 ABID,WNJ 294.85 ABLATOR APOLLORF XL90 ASP 877.8 86900 ABO BLOOD TYPE 370 86900 ABO,BBSO 176.5 73050 AC JOINTS W/WO WEIGHTS BI 297.94 ACCUGRID RADIOGRAPH BREAS 121.36 82164 ACE, CSF SO 144.38 83519 ACHR BIND AB QT,RIA/SO MA 258 83519 ACHR BIND QNT MGP/SO 181.37 83519 ACHR BLOC QNT MGP/SO 181.37 83519 ACHR GANGL NEUR AB,RIA/SO 258 83519 ACHR MOD QNT MGP/SO 201.16 87116 ACID FAST CULTURE SO 227.33 83519 ACR BLOCKING QNT SO 181.37 83519 ACR RECEPTOR QNT SO 108.61 82024 ACTH,SO 459.3 86602 ACTINOMYCES AB/SO 64 85347 ACTIVATED CLOTTING TIME 126.93 85307 Activated Protein C Resis 216.04 97535GO ACTIVITY DAILY LIVING 15 265.91 78278 ACUTE GI BLOOD LOSS IMAGI 1326.15 82017 ACYLCARNITINES; QUANT, EA 574 85397 ADAMSTS 13 ACTIVITY/SO 796.62 ADAPTER CATH LUER 8.69 ADAPTER CONFIDENCE CEMENT 743.66 ADAPTER DLP PERFUS Y W/6 47.54 ADAPTER FIBEROPTIC SWIVEL 73.16 ADAPTER LUER LOC SHORT 3/ 2.2 ADAPTER LUER TO COLDER 15.29 ADAPTER MALE-MALE 4.57 C1776 ADAPTER PFC SIGMA FEMORAL 8474.76 ADAPTER PLUG MALE CLAVE 5.02 ADAPTER PRODIGY EXTENSION 2340 ADAPTER UROSTOMY DRAIN TU 9.09 ADAPTER VERSO AIRWAY ADUL 33.51 82952 ADDL GLUCOSE > 3 SPEC 136.24 87260 ADENOV/ RSPFAC / SO 141.75 ADHESIVE DEMABOND .07 PEN 193.48 ADHESIVE DEMABOND .07 PEN 193.48 ADHESIVE DERMABOND PEN 0. 181.76 ADHESIVE DERMABOND PRINEO 64.26 ADHESIVE LIQUIBAND 100.38 ADHESIVE SKIN BLUE TOPIC 115.04 ADJ ADMIN ADJUSTMENT IP ADJ ADMIN ADJUSTMENT OP ADJ EMPLOYEE HEALTH ADJU ADJ EMPLOYEE HEALTH ADJU ADJ PATIENT ACCT TRANSER G0008 ADM INFLUENZA VIRUS VACCI 38.58 G0009 ADM PNEUMOCOCCAL VACCINE 119.96 87077 AEROBIC ID EA ISOLATE 187.95 87077 AEROBIC ID SO 187.95 87015 AFB CONCENTRATION SO 171.94 82107 AFP-L3 FRACT ISO AND TOTA 705 86902 AG TEST OF DONOR BLD EA A 272.21 86902 AG TEST OF DONOR BLD EA A 259.25 86256 AGNA1 AB TITR/EA, SO MAYO 258 86256 AGNA1, FNIF, TITR, EA/SO 236.5 86886 AHG INDIRECT EA AB TITER/ 292 AIRWAY NASAL 26FR 20.66 AIRWAY NASAL 28FR 20.66 AIRWAY NASAL 30FR 20.66 AIRWAY NASAL 32FR 20.66 AIRWAY NASAL 34FR 20.66 AIRWAY NASAL DOYLE 158.34 82042 ALBUMIN CSF QNT MSP/SO 38.5 82042 ALBUMIN QNT URINE EA 40.99 82040 ALBUMIN SERUM 107.24 82085 ALDOLASE SO 640.5 86008 ALERGEN EA,QNT RECOM/PURI 136.5 84075 ALKALINE PHOSPHATASE 217.35 84080 ALKALINE PHOSPHATSE ISOEN 80.34 86003 ALLERGEN EA QL SQNT SO 25.95 86003 ALLERGEN EA QNT ALTER/SO 25.95 86003 ALLERGEN EA QNT ASPER/SO 25.95 86003 ALLERGEN EA QNT BERMUDA/S 25.95 86003 ALLERGEN EA QNT CAT EPI/S 25.95 86003 ALLERGEN EA QNT CRAG/SO 25.95 86003 ALLERGEN EA QNT DFARI/SO 25.95 86003 ALLERGEN EA QNT DOG EPI/S 25.95 86003 ALLERGEN EA QNT GRAG/SO 25.95 86003 ALLERGEN EA QNT JOHNSON/S 25.95 86003 ALLERGEN EA QNT MARSHELD/ 25.95 86003 ALLERGEN EA QNT MT CEDAR/ 25.95 86003 ALLERGEN EA QNT OAK/SO 25.95 86003 ALLERGEN EA QNT/BOX ELDER 25.95 86003 ALLERGEN EA QNT/C ALBICAN 25.95 86003 ALLERGEN EA QNT/CLADOSPOR 25.95 86003 ALLERGEN EA QNT/CLAM/SO 25 86003 ALLERGEN EA QNT/COTTONWOO 25.95 86003 ALLERGEN EA QNT/CRAB/SO 25 86003 ALLERGEN EA QNT/DOCK SORR 25.95 86003 ALLERGEN EA QNT/ENGLISH P 25.95 86003 ALLERGEN EA QNT/HEIMINTHO 25.95 86003 ALLERGEN EA QNT/LAMBS QTR 25.95 86003 ALLERGEN EA QNT/LOBSTER/S 25 86003 ALLERGEN EA QNT/MESQUITE 25.95 86003 ALLERGEN EA QNT/MUCOR RAC 25.95 86003 ALLERGEN EA QNT/MUGWORT/S 25.95 86003 ALLERGEN EA QNT/OYSTER/SO 25 86003 ALLERGEN EA QNT/PECAN TRE 25.95 86003 ALLERGEN EA QNT/PENICILLI 25.95 86003 ALLERGEN EA QNT/PIGWEED/S 25.95 86003 ALLERGEN EA QNT/SCALLOP/S 25 86003 ALLERGEN EA QNT/SHRIMP/SO 25 86003 ALLERGEN EA QNT/TIMOTHY G 25.95 86003 ALLERGEN EA QNT/WHITE ASH 25.95 82103 ALPHA-1-ANTITRYPSIN/TOTAL 209.72 82104 ALPHA-1-ANTITYRPSIN PHENO 53.5 82105 ALPHA-FETOPROTEIN (M) SER 204.25 82105 ALPHA-FETOPROTEIN (S) SER 204.25 84460 ALT,FIBROSURE/SO 160 86753 AMEBIASIS AB PROTOZOA NOS 101.92 82139 Amino Acid Quant >6 UM SO 452.34 82135 AMINOLEVULINIC ACID, UR, 375.57 80299 AMIO METABO DRG QNT NOS S 161.75 80299 AMIODARONE DRUG QNT NOS S 161.75 82140 AMMONIA 124.28 AMNIOHOOK 6.95 86256 AMPHIP AB TITR/EA,SO MAYO 258 86256 AMPHIPHY, FNIF, TITR, EA/ 236.5 82150 AMYLASE 315.79 82150 AMYLASE URINARY 315.79 86038 ANA SCREEN SO 289.75 87075 ANAEROBIC CULTURE 357.91 87076 ANAEROBIC ISOLATE ID EA 212.36 86039 ANA-TITER & PATTERN SO 304.24 86255 ANCA SCREEN SO 258.41 86256 ANCA TITER SO 248.33 C1713 ANCHOR BIO-SWIVLELOCK 4.7 2455.52 C1713 ANCHOR CLIK X 1580 C1713 ANCHOR CLIK X MRI COMPATI 1316.25 C1713 ANCHOR PEG GLENOID 44MM 8223.98 C1713 ANCHOR PEG GLENOID SZ48MM 7832.37 C1713 ANCHOR PUSHLOCK 2.9MM SHT 2522.52 C1713 ANCHOR QUICK GII 1270.09 C1713 ANCHOR SUTURE 3.0 W/ TIGE 2143.26 ANCHOR UMBILICAL CATH 17.16 82157 ANDROSTENEDIONE SO 209.72 ANES GEN 1ST 15 MIN 1278.9 ANES GEN EA ADDL 15 MIN 164 ANES LABOR EPIDURAL 370.44 ANES LOCAL 1ST 15 MIN 304.02 ANES LOCAL EA ADDL 15 MIN 87.37 ANES MAC 1ST 15 MIN 330.75 ANES MAC EA ADDL 15 MIN 108.05 ANES REGIONAL 1ST 15 MIN 517.07 ANES REGIONAL EA ADDL 15 143.88 36245 ANGIO 1ST ORDER ABD-LOWER 2337.04 36215 ANGIO 1ST ORDER THOR-BRAC 2724.42 36246 ANGIO 2ND ORDER ABD-LOWER 2337.04 75791 ANGIO AV SHUNT EVAL S&I 1101.98 75716 ANGIO EXTREMITY BILATERAL 3747.19 75710 ANGIO EXTREMITY UNILATERA 3747.19 75726 ANGIOG VISCERAL SEL S&I 4611.6 82164 ANGIOTENSIN CONV ENZ SO 144.38 86022 ANITBODY ID, PLATELET AB 152 86022 ANITBODY ID, PLATELET AB 152 7360050 ANKLE 2V BIL 373.09 73600LT ANKLE AP & LAT VIEWS LT 373.09 73600RT ANKLE AP & LAT VIEWS RT 373.09 7361050 ANKLE COMP MIN 3V BIL 475.8 73610LT ANKLE COMPLETE MIN 3 VIEW 475.8 73610RT ANKLE COMPLETE MIN 3 VIEW 475.8 86255 ANNA IGG SCREEN SO 301.47 86256 ANNA1 AB TITR/EA,SO MAYO 258 86256 ANNA1, FNIF, TITR, EA/SO 236.5 86256 ANNA2 AB TITR/EA,SO MAYO 258 86256 ANNA2, FNIF, TITR, EA/SO 236.5 86256 ANNA3 AB TITR/EA,SO MAYO 258 86256 ANNA3, FNIF, TITR, EA/SO 236.5 ANTENNA INTERSTIM RF 36 407.49 86609 ANTIBODY BACTERIUM NOS/SO 340.8 86666 ANTIBODY EHRLICHIA/SO 116.63 86682 ANTIBODY HELMINTH NOS, ST 79.95 86870 ANTIBODY ID EA PNL, BBSO 366.25 84588 ANTIDIURETIC HORMONE SO 544.95 86215 ANTI-DNASE B (STREP) ANTI 228.91 80307 ANTIEPILEPTICS,NOS, LACOS 722 87186 ANTIFUNGAL SUSCPT AMPHOTE 125 86905 ANTIGEN TYPING EA, BBS0 58.01 83516 ANTIMITOCHONDRIAL AB QL S 185.91 86022 ANTI-PLATELET AB SO 416.59 83516 ANTIPROTEINASE 3 (PR3) AB 74.1 85300 ANTI-THROMBIN III ACT/SO 236.5 J7197 ANTITHROMBIN III HUMAN 8625 86800 ANTITHYROGLOBULIN AB SO 257.57 86376 ANTITHYROID MICROSOM SO 207.56 75625 AORTOG ABDOM BY SERIALOG 3747.19 75630 AORTOGR, ABD&BLE CATH BY 3798.71 82172 APOLIPOPROTEIN, EACH/SO 121.18 APPLICATOR CHLOR 10.5ML 17.67 APPLICATOR CHLOR 3ML 4.8 APPLICATOR ENDOSCOPIC 237.97 APPLIER ENDO CLIP PISTOL 400.26 APPLIER LIGATION CLIP SM 320.84 APPLIER LIGATION CLIP LRG 325.88 APPLIER LIGATION CLIP MED 322.27 APPLIER LIGATION CLIP MED 322.27 29581 APPLY MULTLAY COMPRS LWR 1017 29581 APPLY MULTLAY COMPRS LWR 1017 97113GP AQUATIC THERAPY W/EXER 15 134.14 J0401 ARIPIPRAZOLE ER 400MG INJ 8867.85 ARMBOARD ART ADULT 70.84 ARMBOARD BABY IV 1.625X3. 5.95 ARMBOARD BABY NEONATAL 2X 9.54 ARMBOARD IV WRIST ADULT 9 698.65 82175 ARSENIC WHOLE BLOOD SO 355.31 82175 ARSENIC, URINE SO 664.83 82803 ARTERIAL BLOOD GAS 376.81 36620 ARTERIAL CATH/ MONITOR PE 242.03 36600 ARTERIAL PUNCTURE 128.43 36600 ARTERIAL PUNCTURE 128.43 20605 ARTHRO/INJ INTERMEDIATE J 336.54 73525LT ARTHROGRAPHY HIP S& I LT 542.59 73525RT ARTHROGRAPHY HIP S& I RT 542.59 73040LT ARTHROGRAPHY SHOULDER S&I 688.8 73040RT ARTHROGRAPHY SHOULDER S&I 688.8 73115LT ARTHROGRAPHY WRIST S & I 654.41 86060 ASO TITER SO 362.25 87305 ASPER. GALACT AG SO 473.28 86606 Aspergillus antibodies SO 231.79 ASPIRATION/INJ ANY JOINT/ 619.76 ASSEMBLY TENSILE BAR 311.48 C1762 ASSURITY MRI DUAL CHAMBER 17300 C2621 ASSURITY MRI SINGLE CHAMB 13300 84450 AST,FIBROSURE/SO 160 85301 ATIII FUNCTION TEST SO 274.42 ATTACH TUBE FEEDING 12.76 G9165GNCHATTEN CURRENT STATUS 0% I 0.01 G9165GNCIATTEN CURRENT STATUS 1-19 0.01 G9165GNCJATTEN CURRENT STATUS 20-3 0.01 G9165GNCKATTEN CURRENT STATUS 40-5 0.01 G9167GNCHATTEN D/C STATUS 0% IMPAI 0.01 G9166GNCHATTEN GOAL STATUS 0% IMPA 0.01 G9166GNCIATTEN GOAL STATUS 1-19% I 0.01 G9166GNCJATTEN GOAL STATUS 20-39% 0.01 ATTENDING PROVIDER NOT CO ATTENDING PROVIDER NOT CO 11730 AVUL NAIL PLATE SIMPLE SI 462.24 83883 AZMACRO,FIBROSURE/SO 160 BAG WASTE BRAT AUTOTRANS 76.66 BAG BAND LRG 36X30 10.21 BAG BILE 31.5 BAG BLOOD 272.51 BAG DECANTER (BAG-A-JET) 6.26 BAG DRAIN ACCESSORY PRISM 61.02 BAG DRAINAGE 38.38 BAG DRAINAGE CYSTO 4000ML 23.26 BAG DRAINAGE EDM BECKER 193.62 BAG DRAINAGE URINARY 40.36 BAG DRAINAGE UROLOGICAL 69.48 BAG FLATUS RECTAL TUBE 9.99 BAG LEG LRG 9.43 BAG LEG MED 9.43 BAG PRESSURE INFUSOR 500M 71.29 BAG PRISMAFLEX 5 LITER 33.56 BAG RESUSC PEDI W/MASK 57.24 BAG RESUSCITATOR ADULT 64.13 BAG RESUSCITATOR CPR INFA 104.09 BAG RPLCMT FLEXI SEAL BOW 35.17 BAG SPECIMEN ENDO POUCH 428.47 C1725 BALLOON EMERGE 1.5MM MON 764.03 C1725 BALLOON SLEEK OTW 2.0X8X 1431.04 C1725 BALLOON 50MM 65CM 2419.44 C1725 BALLOON 6X40 40CM .035 1298.87 C1725 BALLOON ADVANCED 1.5MMX2C 2424.53 C1725 BALLOON ADVANCED 2MMX12CM 2424.53 C1725 BALLOON ADVANCED 2MMX2CM 2495.83 C1725 BALLOON ADVANCED 2MMX4CM
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