BILL_ITEM_ID LONG_DESCRIPTION ACTIVITY_TYPE CPT CODE HCPCS CODE Base Price Profee Base Price ITEMS ADDED AS CHARGES TO OTHER ITEM SUCH AS LABS AND XRAYS 15847+ excision,excessive skin & sub-q tissue addomen, includes umbilical transposition & facial plication (lists in addition to 3345588 primary procedure-15830) AFC GENERIC ADD-ON 15847 $1,243.95 3321533 38500 Biopsy or excision of lymph noes(s); open, superficial AFC GENERIC ADD-ON 38500 $882.20 3321513 57240 Anterior colporrhaphy, repair cystocele w/ or w/out repair of urethrocele AFC GENERIC ADD-ON 57240 $2,040.00 3321495 57260 Combined anteroposterior colporrhaphy-pro-fee AFC GENERIC ADD-ON 57260 $2,611.20 3321565 57288 Sling operation for stress incontinence AFC GENERIC ADD-ON 57288 $2,475.60 3321470 58400 Uterosacral ligament suspension-pro-fee AFC GENERIC ADD-ON 58400 $1,524.00 3370911 76000,Fluoroscopy, up to 1 hour physician or other qualified heath care professional time. profee AFC GENERIC ADD-ON 76000 $52.80 3370912 76000,Fluoroscopy, up to 1 hour physician or other qualified heath care professional. facility fee AFC GENERIC ADD-ON 76000 $338.41 3287086 76830, ultrasound transvaginal AFC GENERIC ADD-ON 76830 $311.00 $118.80 3469345 76942 U/S guidance for needle placement-TC AFC GENERIC ADD-ON 76942 $152.00 3336736 76942,Ultrasound guidance for needle placement(eg,biopsy,aspiration,injection,localizaion device) Profee AFC GENERIC ADD-ON 76942 $109.20 3345334 77002, fluoroscoopic guidance for needle placement AFC GENERIC ADD-ON 77002 $94.80 3336727 77012, CT guidance for needle placement(eg,biopsy,aspiration,injection,localization device.) Profee AFC GENERIC ADD-ON 77012 $252.00 3469346 77012, CT guidance for needle placement-TC AFC GENERIC ADD-ON 77012 $374.00 3317935 77081, bone density study, DEXA, appendicular skeleton AFC GENERIC ADD-ON 77081 $148.43 3317936 77081, bone density, DEXA, appendicular skeleton (pro-fee) AFC GENERIC ADD-ON 77081 $34.80 3529520 80156,Carbamazine Level, (R) AFC GENERIC ADD-ON 80156 $46.11 3531119 80184,Phenobarbital,(R) AFC GENERIC ADD-ON 80184 $43.61 3310254 80186,Phenytoin;free AFC GENERIC ADD-ON 80186 $43.58 3526458 80299,Quantitation of therapeutic,drug,nes AFC GENERIC ADD-ON 80299 $53.12 3438749 80337,Antidepressants,tricyclic and other;6 or more, (R) AFC GENERIC ADD-ON 80337 $29.50 3438750 80338,Antidepressants,not otherwise specified,(R) AFC GENERIC ADD-ON 80338 $36.34 3340928 80369,skeletal muscle relaxants,(R) AFC GENERIC ADD-ON 80369 $38.05 3539503 81162,full sequence analysis and full duplication/deletion analysis (R) AFC GENERIC ADD-ON 81162 $5,778.77 3379185 81203, APC (eg familial adenomatosis polyposis) (R) AFC GENERIC ADD-ON 81203 $570.00 3529500 81207,BCR/ABL1(t(9;22) (eg,chronic myelogenous lukemia),(R) AFC GENERIC ADD-ON 81207 $458.65 3379186 81211, BRCA1,BRCA2 (eg hereditary breast and ovarian) (R) AFC GENERIC ADD-ON $6,828.14 3321997 81213, BRCA1,BRCA2 (breast cancer 1 and 2) (R) AFC GENERIC ADD-ON $1,576.05 3552479 81226,CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6), (R) AFC GENERIC ADD-ON 81226 $1,285.09 3552508 81231,CYP3A5 (cytocrome P450 family 3 subfamily A member 5) (R) AFC GENERIC ADD-ON 81231 $498.21 3530689 81244,FMR1(fragile X Mental retardation....),(R) AFC GENERIC ADD-ON 81244 $127.94 3321965 81276,KRAS GENE ANAYLSIS ADD VARIANT(S) (R) AFC GENERIC ADD-ON 81276 $550.76 3310769 81291,MTHFR, (R) AFC GENERIC ADD-ON 81291 $186.22 3379202 81292,MLH1(mutL homolog 1,colon cancer, nonpolyposis type 2) (R) AFC GENERIC ADD-ON 81292 $1,924.89 3379187 81294,MLH1(mutL homolog 1,colon cancer,nonpolyposis type 2) (R) AFC GENERIC ADD-ON 81294 $576.84 3539550 81294,MLH1 with 59 mod AFC GENERIC ADD-ON 81294 $576.84 3379188 81295,MSH2 (mutS homolog 2, colon cancer,nonpolyposis type 1) (R) AFC GENERIC ADD-ON 81295 $1,087.85 3379189 81297,MSH2 (mutS homolog 2, colon cancer,nonpolyposi type 1) (R) AFC GENERIC ADD-ON 81297 $607.91 3539504 81297,MSH2 with 59 mod AFC GENERIC ADD-ON 81297 $607.91 3379190 81298,MSH6 (E.coli) (hereditary non-polyposis colorectal ca) (R) AFC GENERIC ADD-ON 81298 $1,829.27 3539505 81300, MSH6 with 59 mod AFC GENERIC ADD-ON 81300 $678.30 3379191 81300,MSH6 (mutS homolog 6 (hereditary nonplyposis colorectal ca (R) AFC GENERIC ADD-ON 81300 $678.30 3568630 81301,Microsatellite instability analysis (R) AFC GENERIC ADD-ON 81301 $993.40 3321977 81311,NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 (R) AFC GENERIC ADD-ON 81311 $843.00 3379192 81317,PSM2 (postmeiotic segrecation increased 2{s.cerevisiae}) (R) AFC GENERIC ADD-ON 81317 $1,928.03 3539506 81319, PSM2 with 59 mod AFC GENERIC ADD-ON 81319 $579.98 3379193 81319,PMS2(postmeiotic segregation increased 2) (R) AFC GENERIC ADD-ON 81319 $579.98 3379194 81321,PTEN(phosphatase and tensin homolog) (R) AFC GENERIC ADD-ON 81321 $1,710.00 3379195 81323,PTEN(phosphatase and tensin homolog) (R) AFC GENERIC ADD-ON 81323 $855.00 3539507 81323,PTEN with 59 mod AFC GENERIC ADD-ON 81323 $855.00 3528639 81355,VLPRC1(vit k epxoside reductase comples, subunit 1) eg warfarin (R) AFC GENERIC ADD-ON 81355 $251.37 3292817 81383,HLA Class II typing (R) AFC GENERIC ADD-ON 81383 $345.59 3379196 81403,Molecular path procedure, level 4 (R) AFC GENERIC ADD-ON 81403 $527.82 3379197 81404,Molecular path procedure, level 5 (R) AFC GENERIC ADD-ON 81404 $783.27 3539508 81404,Molecular path procedure, level 5 with 59 mod AFC GENERIC ADD-ON 81404 $783.27 3379198 81405,Molecular path procedure level 6 (R) AFC GENERIC ADD-ON 81405 $858.85 3539509 81405,molecular path procedure level 6(R) with 59 mod AFC GENERIC ADD-ON 81405 $858.85 3379199 81406,Molecular path procedure level 7 (R) AFC GENERIC ADD-ON 81406 $806.21 3539510 81406,Molecular path procedure level 7 (R) with 59 mod AFC GENERIC ADD-ON 81406 $806.21 3379200 81408,Molecular path procedure level 9 (R) AFC GENERIC ADD-ON 81408 $5,700.00 3321978 81479, UNLISTED MOLECULAR PATHOLOGY PROCEDURE (R) AFC GENERIC ADD-ON 81479 $1,065.43 3379201 81479,unlisted molecular path(VistaSeq) (R) AFC GENERIC ADD-ON 81479 $500.00 3540363 82042.Albumin; urine or other source, quantitative, ea spec. (R) AFC GENERIC ADD-ON 82042 $22.17 3481872 82088, Aldosterone,(R) AFC GENERIC ADD-ON 82088 $129.05 3291042 82104 Alpha-1-antitrypsin; phenotype (R) AFC GENERIC ADD-ON 82104 $45.80 3292937 82108,Aluminum (R) AFC GENERIC ADD-ON 82108 $80.68 3293371 82131,Amino acids,single (R) AFC GENERIC ADD-ON 82131 $65.49 3293372 82140,Ammonia (R) AFC GENERIC ADD-ON 82140 $46.14 3310221 82150,amylase level AFC GENERIC ADD-ON 82150 $20.52 3291137 82172,apolipoprotein A-1 or B (R) AFC GENERIC ADD-ON 82172 $60.11 3292927 82175,Arsenic,(R) AFC GENERIC ADD-ON 82175 $60.08 3292964 82247,Biliruben total (R) AFC GENERIC ADD-ON 82247 $15.87 3348653 82310,Calcium (R) AFC GENERIC ADD-ON 82310 $16.33 3293373 82340,Calcium,urine,quant,(R) AFC GENERIC ADD-ON 82340 $19.10 3293374 82436,Chloride,urine (R) AFC GENERIC ADD-ON 82436 $16.39 3544398 82465, Cholesterol, serum or whole blood, total, (R) AFC GENERIC ADD-ON 82465 $13.79 3293375 82507,Citrate (R) AFC GENERIC ADD-ON 82507 $88.04 3291494 82533 Cortisol, total (R) AFC GENERIC ADD-ON 82533 $51.61 3481913 82533 Cortisol, total (R) with 59 modifier AFC GENERIC ADD-ON 82533 $51.61 3291228 82550,creatine kinase (CK),total (R) AFC GENERIC ADD-ON 82550 $20.61 3293376 82570,Creatinine,other source (R) AFC GENERIC ADD-ON 82570 $16.39 3288327 82570,creatinine, other source AFC GENERIC ADD-ON 82570 $16.39 3292407 82607,Vitamin b12 (R) AFC GENERIC ADD-ON 82607 $47.74 3529378 82677,Estriol,(R) AFC GENERIC ADD-ON 82677 $76.58 3306665 82728,Ferritin (R) AFC GENERIC ADD-ON 82728 $43.18 3293351 82784,gammagobulin,AB (R) AFC GENERIC ADD-ON 82784 $29.47 3540364 82784,gammaglobulin,AB (R) w/59 mod AFC GENERIC ADD-ON 82784 $29.47 3292863 82787,Gammaglobulin,immuno,subclasses(R) AFC GENERIC ADD-ON 82787 $25.39 3544399 82947, Glucose:quantitative, blood (except reagent strip) (R) AFC GENERIC ADD-ON 82947 $12.45 3293710 82952,Glucose Tolerance test each additional draw. AFC GENERIC ADD-ON 82952 $12.43 3310224 82977,Glutanyl Transferase AFC GENERIC ADD-ON 82977 $22.80 3292965 82977,y-Glutanyl Transferase (R) AFC GENERIC ADD-ON 82977 $22.80 3292966 83010,Haptoglobin (R) AFC GENERIC ADD-ON 83010 $39.81 3290910 83497,hydroxyindolacetic acid, 5-(HIAA) (R) AFC GENERIC ADD-ON 83497 $40.84 3290900 83498,hydroxyprogesterone, 17-D (R) AFC GENERIC ADD-ON 83498 $86.04 83516,Immunoassay for analyte othre than infectious agent antibody or infectious agent antigen;qualitative or semiquantitative, 3496245 multiple step method AFC GENERIC ADD-ON 83516 $36.51 3440659 83519,immunoassay for analyte other than infectious agent antibody (R) AFC GENERIC ADD-ON 83519 $52.44 3290952 83520,immunoassay for analyte orther than infectionus agen ab or antigen;quantitative, NOS (R) 83520 AFC GENERIC ADD-ON 83520 $49.22 3540335 83520,immuoassay for analyte other than infectious agent (R) w/59 mod AFC GENERIC ADD-ON 83520 $49.22 3293099 83525,insulin,total (R) AFC GENERIC ADD-ON 83525 $36.20 3404772 83525,insulin,total (R) w/59 modifier AFC GENERIC ADD-ON 83525 $36.20 3482508 83527,insulin free, (R) AFC GENERIC ADD-ON 83527 $41.01 3291077 83540,Iron (R) AFC GENERIC ADD-ON 83540 $20.49 3291078 83550,Iron Binding Capacity (R) AFC GENERIC ADD-ON 83550 $27.67 3292543 83615 lactate dehydrogenase (LD) (LDH) AFC GENERIC ADD-ON 83615 $19.12 3292872 83655,Lead (R) AFC GENERIC ADD-ON 83655 $38.33 3496247 83704,quantitation of lipoprotein particle number(s), includes lipoprotein particle subclass(es), when performed AFC GENERIC ADD-ON 83704 $99.92 3293377 83735,Magnesium (R) AFC GENERIC ADD-ON 83735 $21.20 3292873 83825.Mercury (R) AFC GENERIC ADD-ON 83825 $51.47 3531016 83835,Metanephrines,(R) AFC GENERIC ADD-ON 83835 $53.64 3292967 83883.Nephelometry (R) AFC GENERIC ADD-ON 83883 $43.06 3540362 83916,Oligoclonal immune (oligoclonal bands) (R) AFC GENERIC ADD-ON 83916 $78.06 3293378 83935,Osmolity,urine (R) AFC GENERIC ADD-ON 83935 $21.57 3293379 83945,Oxalate,(R) AFC GENERIC ADD-ON 83945 $41.18 3281993 83970,PTH AFC GENERIC ADD-ON 83970 $130.70 3533410 84075,Phosphatase, alkaline,(R) AFC GENERIC ADD-ON 84075 $16.39 3293380 84105,Phosphate,urine (R) AFC GENERIC ADD-ON 84105 $16.47 3293381 84133,Potassium,urine,(R) AFC GENERIC ADD-ON 84133 $13.65 3293342 84154,PSA free (R) AFC GENERIC ADD-ON 84154 $58.25 3310275 84155,Protein,total,except by refractometry;serum,plasma or whole blood (R) AFC GENERIC ADD-ON 84155 $11.60 3306608 84156,Protein,total,urine, (R) AFC GENERIC ADD-ON 84156 $11.60 3467894 84156,Protein, total, urine AFC GENERIC ADD-ON 84156 $11.60 3310270 84166,Protein;electrophoretic fractionation & quantitation,other fluids(eg.urine,CSF) (R) AFC GENERIC ADD-ON 84166 $56.46 3293222 84206,proinsulin (R) AFC GENERIC ADD-ON 84206 $76.07 3293382 84300,Sodium,urine (R) AFC GENERIC ADD-ON 84300 $15.39 3293383 84392,Sulfate,urine (R) AFC GENERIC ADD-ON 84392 $15.65 3292287 84403 testosterone, total (R) AFC GENERIC ADD-ON 84403 $81.74 3288313 84432,thyroglobulin AFC GENERIC ADD-ON 84432 $50.84 3288272 84436,thyroxine; total AFC GENERIC ADD-ON 84436 $21.75 3288745 84443, TSH, (R) AFC GENERIC ADD-ON 84443 $53.21 3288273 84443,TSH AFC GENERIC ADD-ON 84443 $53.21 3292968 84460,Alanine Aminotransferase,(R) AFC GENERIC ADD-ON 84460 $16.79 3544397 84478,Triglycerides, (R) AFC GENERIC ADD-ON 84478 $18.18 3288274 84479,thyroid hormone upate or THBR AFC GENERIC ADD-ON 84479 $20.46 3288275 84480,triiodothyronine T3; total (TT-3) AFC GENERIC ADD-ON 84480 $44.89 3293014 84484,Troponin I (R) AFC GENERIC ADD-ON 84484 $35.54 3293022 84520,urea nitrogen,quant (R) AFC GENERIC ADD-ON 84520 $12.51 3306609 84550,Uric acid; blood (R) AFC GENERIC ADD-ON 84550 $14.31 3293384 84560,Uric acid,other source (R) AFC GENERIC ADD-ON 84560 $15.02 3292854 84585, VMA urine(R) AFC GENERIC ADD-ON 84585 $49.08 3529384 84702,gonadotropin, chorionic (hCG),(R) AFC GENERIC ADD-ON 84702 $47.68 3306485 85014, Hematocrit AFC GENERIC ADD-ON 85014 $7.50 3293362 85014,Hematocrit, (R) AFC GENERIC ADD-ON 85014 $7.50 3434680 85018,hemoglobin (Hgb) (R) AFC GENERIC ADD-ON 85018 $7.50 3291079 85025,Blood Count, complete(CBC), automated (R) AFC GENERIC ADD-ON 85025 $24.60 3434681 85041,red blood cell (RBC), automated (R) AFC GENERIC ADD-ON 85041 $9.55 3306664 85045,reticulocyte, automated (R) AFC GENERIC ADD-ON 85045 $12.65 3292570 85048,wbc (R) AFC GENERIC ADD-ON 85048 $8.04 3306590 85245,clotting factor III,VW factor, (R) AFC GENERIC ADD-ON 85245 $72.65 3306591 85246,clotting factor VIII, VW factor antigen, (R) AFC GENERIC ADD-ON 85246 $72.65 3310770 85300,Antithrombin III activity, (R) AFC GENERIC ADD-ON 85300 $37.53 3340335 85301,antithrombin III,antigen assay (R) AFC GENERIC ADD-ON 85301 $34.23 3293049 85303,clotting inhibitors or anticoagulants,protein C,activity (R) AFC GENERIC ADD-ON 85303 $43.80 3293036 85306,clotting inhibitors or anticoagulants,protein S free,(R) AFC GENERIC ADD-ON 85306 $48.54 3310771 85307,Activated Protein C assay (R) AFC GENERIC ADD-ON 85307 $48.54 3310772 85420, Plasminogen assay (R) AFC GENERIC ADD-ON 85420 $20.69 3528193 85597,phospholipid neutralization platelet, (R) AFC GENERIC ADD-ON 85597 $56.91 3528194 85598,phospholipid neutralization;hexagonal phospholipid, (R) AFC GENERIC ADD-ON 85598 $56.91 3320336 85610,Prothrombin Time (R) AFC GENERIC ADD-ON 85610 $12.45 3310773 85613,Russell Viper Venom time, (R) AFC GENERIC ADD-ON 85613 $30.32 3530850 85660,Sickling of RBC reduction,(R) AFC GENERIC ADD-ON 85660 $17.44 3304164 85670, thrombin time, plasma (R) AFC GENERIC ADD-ON 85670 $18.27 3293477 85705,Thrombolastin Inhibition,tissue (R) AFC GENERIC ADD-ON 85705 $30.50 3292946 85730,Partial Thrombolastin Time (R) AFC GENERIC ADD-ON 85730 $19.01 3345610 85730,Partial Thrombolastin Time AFC GENERIC ADD-ON 85730 $19.01 3293059 85732,thromboplastin time,partial,substitution,(R)with 59 mod AFC GENERIC ADD-ON 85732 $20.46 3539485 85732,thromboplastin time, partial, substitution, (R) AFC GENERIC ADD-ON 85732 $20.46 3290980 86003,allergen specific IgE;quant.or semiquant.ea.allergen (R) w/59 mod AFC GENERIC ADD-ON 86003 $16.53 3323289 86022 Antibody indentification; platelet antibodies (R) AFC GENERIC ADD-ON 86022 $58.17 3291161 86038, Antinuclear antibodies, (ANA) (R) AFC GENERIC ADD-ON 86038 $38.28 3293695 86060, Antistreptolysin 0: titer AFC GENERIC ADD-ON 86060 $23.11 3306626 86060,Antistreptolysin 0; titer (R) AFC GENERIC ADD-ON 86060 $23.11 3293697 86140,C-reative protein AFC GENERIC ADD-ON 86140 $16.39 3306627 86140,C-reactive protein (R) AFC GENERIC ADD-ON 86140 $16.39 3293122 86146,Beta 2 Glycoprotein I antibody,ea (R) with 59.mod AFC GENERIC ADD-ON 86146 $80.60 3539486 86146,Beta 2 Glycoprotein I antibody,ea (R) AFC GENERIC ADD-ON 86146 $80.60 3293108 86147,cardiolipin AB,ea Ig class (R) with 59 mod AFC GENERIC ADD-ON 86147 $80.60 3539487 86147,cardiolipin AB,ea Ig class (R) AFC GENERIC ADD-ON 86147 $80.60 3291127 86148,Antiphosphatidylserine,antibody (R) AFC GENERIC ADD-ON 86148 $50.87 3291196 86160,complement antigen,ea.component (R) AFC GENERIC ADD-ON 86160 $37.99 3496293 86160,complement antigen,ea.component (R) w/59 mod AFC GENERIC ADD-ON 86160 $37.99 3291109 86235,Antiextractable Nuclear Ag (R) AFC GENERIC ADD-ON 86235 $56.80 3540326 86235,Antiextractable Nuclear Ag (R),w/59 mod AFC GENERIC ADD-ON 86235 $56.80 3292447 86235,EXTRACTABLE NUCLEAR ANTIGEN (R) AFC GENERIC ADD-ON 86235 $56.80 3290947 86256,flourescent non-infections agent ab,titer, ea.ab (R) AFC GENERIC ADD-ON 86256 $38.16 3540334 86256,flourescent non-infections agent ab,titer,ea.ab(R) w/59 mod AFC GENERIC ADD-ON 86256 $38.16 3293333 86317,immunoassay for infectious agent (R) AFC GENERIC ADD-ON 86317 $47.85 3561693 86331.Immonodiffusion; gel diffusion, qualitative (Ouchterlony), ea antigen.... AFC GENERIC ADD-ON 86331 $37.93 3529386 86336,Inhibin A, (R) AFC GENERIC ADD-ON 86336 $49.36 3552400 86356,Mononuclear cell antigen, quantatative, not otherwise spec.,(R) AFC GENERIC ADD-ON 86356 $84.79 3552401 86357,Natural killer (NK) cells, total count, (R) AFC GENERIC ADD-ON 86357 $119.47 3293445 86359,Tcells total count (R) AFC GENERIC ADD-ON 86359 $119.47 3293446 86360,Tcells absolute,CD4 and CD8 count includes ratio, (R) AFC GENERIC ADD-ON 86360 $148.77 3292442 86431,RHEUMATOID FACTOR,QUANTATIVE(R) AFC GENERIC ADD-ON 86431 $17.96 3310743 86592,Syphilis,(R) AFC GENERIC ADD-ON 86592 $13.54 3561692 86602, antibody; actinomyces with 59 mod AFC GENERIC ADD-ON 86602 $32.23 3420662 86606 Antibody; Aspergillus (R) AFC GENERIC ADD-ON 86606 $47.68 3540354 86606,Antibody;Aspergillus (R) w/59 mod AFC GENERIC ADD-ON 86606 $47.68 3561694 86609, Antibody; bacterium, not elsewhere specified AFC GENERIC ADD-ON 86609 $40.78 3292522 86611,antibody bartinella (R)with 59 mod AFC GENERIC ADD-ON 86611 $32.23 3420661 86612 Antibody; Blastomyces (R) AFC GENERIC ADD-ON 86612 $40.87 3480806 86615,B pertussis IgG/IgM AB (R) AFC GENERIC ADD-ON 86615 $41.75 3526475 86615,B pertussis IgG/IgM AB with 59 mod AFC GENERIC ADD-ON 86615 $41.75 3293790 86617,lyme dz (R) AFC GENERIC ADD-ON 86617 $49.05 3291186 86622,brucella ab (R) AFC GENERIC ADD-ON 86622 $28.27 3420663 86635 Antibody; Coccidioides (R) AFC GENERIC ADD-ON 86635 $36.34 3529541 86645,Antibody;cytomegalovirus (CMV), IgM, (R) AFC GENERIC ADD-ON 86645 $53.35 3529547 86658,Antibody;enterovirus (eg,coxsakie), (R) with 59 mod AFC GENERIC ADD-ON 86658 $41.24 3291624 86663 Epstein-Barr (EB)virus, early antigen (EA) (R) AFC GENERIC ADD-ON 86663 $41.55 3292533 86664,epstein-barr nuclear antigen (R) AFC GENERIC ADD-ON 86664 $48.42 3292534 86665,Epstein-Barr antibodies VCA.IgG (R) AFC GENERIC ADD-ON 86665 $57.46 3522343 86665,Epstein-Barr antibodies VCA.IgG (R) -59 AFC GENERIC ADD-ON 86665 $57.46 3292424 86666,Antibody Ehrlichia (R) AFC GENERIC ADD-ON 86666 $32.23 3339886 86668, Tularemia Antibody Titer AFC GENERIC ADD-ON 86668 $40.36 3293181 86671,Fungus AB (R) AFC GENERIC ADD-ON 86671 $38.82 3482607 86671,Fungus AB (R) with 59 modifier AFC GENERIC ADD-ON 86671 $38.82 3293131 86677, H.pylori AB (R) AFC GENERIC ADD-ON 86677 $48.02 3404698 86677, H. pylori AB w/ 59 modifier (R) AFC GENERIC ADD-ON 86677 $48.02 3293167 86696,herpes simplex AB type 2 (R) AFC GENERIC ADD-ON 86696 $61.30 3467630 86698 Histoplasma capsulatum Abs (R) wi/59 modifier AFC GENERIC ADD-ON 86698 $39.56 3293767 86702,HIV 2 AB (R) AFC GENERIC ADD-ON 86702 $42.81 3468115 86704,Hepatitis B core atibody (HBcAb);total (R) AFC GENERIC ADD-ON 86704 $38.16 3468114 86706, Hepatitis b surface atibody (HBsAb) (R) AFC GENERIC ADD-ON 86706 $34.00 3293145 86738, mycoplasma,AB (R) AFC GENERIC ADD-ON 86738 $41.92 3562865 86741, Antibody; Neisseria meningitidis (R), with 59 mod AFC GENERIC ADD-ON 86741 $41.75 3528219 86747, antibody parvovirus (R) AFC GENERIC ADD-ON 86747 $47.60 3292853 86757,rickettsia,ab (R) AFC GENERIC ADD-ON 86757 $61.30 3311779 86757,ricketsia,ab,(R) AFC GENERIC ADD-ON 86757 $61.30 3310692 86762,rubella antibody,(R) AFC GENERIC ADD-ON 86762 $45.57 3310693 86765,Rubeolla antibody (R) AFC GENERIC ADD-ON 86765 $40.78 3293522 86778,Toxoplasma AB,IgM (R) AFC GENERIC ADD-ON 86778 $45.63 3292580 86780,Treponema Pallidum AB (R) AFC GENERIC ADD-ON 86780 $41.92 3531194 86787,Antibody:varicella-zoster,(R) AFC GENERIC ADD-ON 86787 $40.78 3531271 86789,Antibody,West Nile virus,(R) AFC GENERIC ADD-ON 86789 $45.57 3288317 86800,thyroglobulin antibody AFC GENERIC ADD-ON 86800 $50.36 3410821 86849, unlisted immunology procedure,for thrombotic risk panel (R) AFC GENERIC ADD-ON 86849 $78.86 3310744 86850,Antibody Screen,RBC. (R) AFC GENERIC ADD-ON 86850 $27.84 3310745 86900, Blood typing, (R) AFC GENERIC ADD-ON 86900 $9.46 3290927 86901,Blood typing, serologic:Rh (D) (R) AFC GENERIC ADD-ON 86901 $9.46 3282871 86901,Rh (D) AFC GENERIC ADD-ON 86901 $9.46 3340246 87015,concentration any type for infections agents,(R) AFC GENERIC ADD-ON 87015 $21.15 3292996 87046,culture,bacterial,stool,aerobic,additional pathogens (R) AFC GENERIC ADD-ON 87046 $29.90 3291068 87070,culture,bacterial;any other source except bld,urine,stool,aerobic (R) AFC GENERIC ADD-ON 87070 $27.27 3292501 87101,Fungus Culture(R) AFC GENERIC ADD-ON 87101 $24.40 3291421 87140 culture,typing; immunoflourescent method, ea. antiserum (R) AFC GENERIC ADD-ON 87140 $17.64 3306649 87150,Culture,typing by neucleic acid, (R) AFC GENERIC ADD-ON 87150 $111.12 3304005 87188,Suceptibility studies,antimicrobial agent,macrobroth dilution method (R) AFC GENERIC ADD-ON 87188 $21.03 3340249 87190,mycobacteria, proportion method, each agent, (R) AFC GENERIC ADD-ON 87190 $20.83 3293703 87206, Fungus stain (R) AFC GENERIC ADD-ON 87206 $17.07 3292955 87209,Smear,primary source with interpretation,complex stain (R) AFC GENERIC ADD-ON 87209 $56.91 3293489 87329,Infections agent antigen detected by enzyme immunoassay (R) AFC GENERIC ADD-ON 87329 $37.96 3310746 87340, infectious agent antigen detection, (R) AFC GENERIC ADD-ON 87340 $32.72 3292997 87427,infectious agent antigen detection by enzyme (R) AFC GENERIC ADD-ON 87427 $37.96 3293190 87481,infec agent/candida spec (R) AFC GENERIC ADD-ON 87481 $111.12 3293191 87491,inf agent/Chlamycia spec (R) AFC GENERIC ADD-ON 87491 $111.12 3310705 87510,Gardnerella (R) AFC GENERIC ADD-ON 87510 $63.50 3292613 87529,Herpes 1 / 2 PCR (R) AFC GENERIC ADD-ON 87529 $111.12 3454701 87536,infectious agent dection by DNA or RNA HIV-1,(R) AFC GENERIC ADD-ON 87536 $269.47 3340243 87556, Mycobacteria tuberculosis (MTB), amplified probe tech,(R) AFC GENERIC ADD-ON 87556 $118.79 3283038 87591,neisseria gonorrhoeae, quant. (R) AFC GENERIC ADD-ON 87591 $111.12 3304089 87624,Human Papillomavirus (HPV), high risk types (R) AFC GENERIC ADD-ON 87624 $111.12 3310706 87660,Trichomonas (R) AFC GENERIC ADD-ON 87660 $63.50 3293193 87661,inf agent/Trichomanas (R) AFC GENERIC ADD-ON 87661 $111.12 3500918 87662 Zika virus, amplified probe technique (R) AFC GENERIC ADD-ON 87662 $162.51 3291162 87798,infectious agent detectio by DNA or RNA, NOS, amplifiedtechnique,ea.organism (R) 87798 with 59 mod AFC GENERIC ADD-ON 87798 $111.12 3293081 87798.infectious agent detection by DNA (R) AFC GENERIC ADD-ON 87798 $111.12 3288359 87804,influenza A or B screen, POC AFC GENERIC ADD-ON 87804 $47.17 3319767 87804,influenza A or B screen AFC GENERIC ADD-ON 87804 $47.17 3288479 87899,infectious agent antigen detection by immunoassay with direct opt.obs.;NOS (R) AFC GENERIC ADD-ON 87899 $45.80 3528179 87899,infectious agent antigen detection w/59 mod.(R) AFC GENERIC ADD-ON 87899 $45.80 3454700 87900,infectious agent durg susceptability phenotype prediction,(R) AFC GENERIC ADD-ON 87900 $412.77 3384688 87901,HIV-1 reverse transcriptase and proteas regions (R) AFC GENERIC ADD-ON 87901 $815.24 3293246 87902,Hepatitis genotype,DNA/RNA (R) AFC GENERIC ADD-ON 87902 $815.24 3384689 87903, Infections agent phenotype analysis by nucleic acid (DNA or RNA),HIV1; first through 10 drugs tested (R) AFC GENERIC ADD-ON 87903 $1,547.41 3384690 87904,ea additional drug tested (R) AFC GENERIC ADD-ON 87904 $82.56 3384691 87906,HIV-1, other region (R) AFC GENERIC ADD-ON 87906 $407.64

3341061 88142,Cytopatholgy,cervical or vagina colleced in preservative fluid,Manual screening under physician supervision (R) AFC GENERIC ADD-ON 88142 $64.15 3304102 88155, cytopathology slides, cervical or vaginal, definitive hormonal eval. (eg,maturation index) li AFC GENERIC ADD-ON 88155 $41.75 3530661 88173,cytology fine needle aspiration,(R) AFC GENERIC ADD-ON 88173 $44.70 3478694 88184,Flow cytometry,cell surface,cytoplasmic,or nuclear marker,first marker (R) AFC GENERIC ADD-ON 88184 $150.00 3478695 88185,flow cytometry, ea addit,marker (R) AFC GENERIC ADD-ON 88185 $150.00 3478696 88187,flow cytometry,interpretation;2to8 markers (R) AFC GENERIC ADD-ON 88187 $56.96 3478697 88188,flow cytometry,interpretation, 9 to 15 markers,(R) AFC GENERIC ADD-ON 88188 $91.71 3478698 88189,flow cytometry,interpretaion,16 or more markers(R) AFC GENERIC ADD-ON 88189 $113.20 3532334 88233,Chromosome, Biopsies, POC/Skin,(R) AFC GENERIC ADD-ON 88233 $445.63 3532332 88248,Score 50-100 cells, count 20 cells, 2 Karyo,(R) AFC GENERIC ADD-ON 88248 $548.40 3532333 88249,Score 100 cells,(R) AFC GENERIC ADD-ON 88249 $548.40 3532324 88261,Chrom Analysis 5 Cell 1 Karyo,(R) AFC GENERIC ADD-ON 88261 $753.37 3532326 88262,Cell 15-20 Cells, 2 Karyotype,(R) AFC GENERIC ADD-ON 88262 $394.70 3532327 88264,Analyze 20-25 Cells,(R) AFC GENERIC ADD-ON 88264 $412.14 3532330 88267,15 cells, 1 Karyotyping,(R) AFC GENERIC ADD-ON 88267 $569.29 3532328 88269,Chron Analysis 6-12 colonies, 1 Karyo,(R) AFC GENERIC ADD-ON 88269 $526.71 3293232 88271,molecular cytogenics DNA probe (R) AFC GENERIC ADD-ON 88271 $67.83 3481724 88271,molecular cytogenics DNA probe (R) with 59 modifier AFC GENERIC ADD-ON 88271 $67.83 3523446 88274 Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells AFC GENERIC ADD-ON 88274 $120.78 3293233 88275, molecular cytogenics (R) w/59 mod AFC GENERIC ADD-ON 88275 $145.89 3532325 88280,Chrom Analysis Add Karyoty(R) AFC GENERIC ADD-ON 88280 $95.39 3532329 88285,Additional Cells Counted,(R) AFC GENERIC ADD-ON 88285 $76.69 3532331 88289,additional High Resolution study,(R) AFC GENERIC ADD-ON 88289 $109.04 3321985 88381,MICRODISECTION PREP IDENTIFIED TARGET MANUAL (R) AFC GENERIC ADD-ON 88381 $291.60 3291402 89051 cell count,misc.body fluids,except blood;with diff. (R) AFC GENERIC ADD-ON 89051 $17.44 3291403 89060 crystal ID by light micro w/without polarizing lens anallysis, any except urine (R) AFC GENERIC ADD-ON 89060 $22.66 3283065 93042,Rhythm ECG,1-3 leads; interp.& report only AFC GENERIC ADD-ON 93042 $24.00 3480896 A7037 Tubing used with positive airway pressure device AFC GENERIC ADD-ON A7037 $21.00 3480897 A7038 Filter, disposable,used with positive airway pressure device AFC GENERIC ADD-ON A7038 $22.00 3220580 Anesthesia Base Units AFC GENERIC ADD-ON $35.00 3522359 Anesthesia Base Units-Vag Delivery AFC GENERIC ADD-ON $35.00 ITEM DONE BY NURSING IN THE CLINIC TO GET IMMEDIATE RESULTS 3144738 CMP Plus Piccolo POC Ambulatory POC 80053 $37.16 3357025 ED I-Stat Chem 8 POC (Nursing) Ambulatory POC 80047 $39.13 3144749 HGB Hemocue POC (Nursing) Ambulatory POC 85018 $8.35 1019765 Hemoglobin A1c POC (Nursing) Ambulatory POC 83036 $34.17 1019767 Influenza POC (Nursing) Ambulatory POC 87804 $47.17 1083775 Influenza A B POC Ambulatory POC 3144747 Nitrazine and/or Fern Test POC (Nursing) Ambulatory POC 83986 $12.60 3144748 Nitrazine and/or Fern Test POC Ambulatory POC 83986 $12.60 1019775 PPD Administration (TB Screen) POC (Nursing) Ambulatory POC 86580 $28.80 3144751 Peak Flow POC (Nursing) Ambulatory POC 94150 $136.31 3144752 Peak Flow POC Ambulatory POC $135.95 1019777 Pulse Oximetry POC Ambulatory POC 94760 $12.00 3288735 Rapid Hepatitis C Ab POC (Nursing) Ambulatory POC 86803 $50.19 3319727 Rapid Influenza POC (Nursing) Ambulatory POC 87804 $47.17 1019780 Rapid Strep POC (Nursing) Ambulatory POC 87880 $47.11 3467910 Rapid Strep POC Ambulatory POC 87880 $47.11 1019781 Spirometry POC (Nursing) Ambulatory POC 94010 $135.95 1083785 Spirometry POC Ambulatory POC 94010 $135.95 1025790 Stool Occult Blood POC (Nursing) Ambulatory POC 82270 $33.00 1083786 Stool Occult Blood POC Ambulatory POC 82270 $12.48 1025836 Urinalysis Dipstick POC (Nursing) Ambulatory POC 81002 $9.92 1083787 Urinalysis Dipstick POC Ambulatory POC 81002 $9.92 1025837 Urine Pregnancy POC (Nursing) Ambulatory POC 81025 $24.71 1083788 Urine Pregnancy POC Ambulatory POC 81025 $24.71 1019786 Vaginal Wet Mount POC (Nursing) Ambulatory POC 87210 $16.59 1083790 Vaginal Wet Mount POC Ambulatory POC 87210 $16.59 1019784 Vision Testing POC Ambulatory POC 99173 $20.00 1083789 Vision Testing POC Ambulatory POC 99173 $20.00 607621 Urine Pregnancy Test POC (Nursing) POC Asmt/Tx/Monitoring 81025 $24.71 607609 Blood Glucose Monitoring POC Task 82948 $21.00 3145389 Blood Glucose Monitoring POC Amb Task 82948 $21.00 3144728 Glucose POC Task 82948 $21.00 3144729 Ketones POC Task 81003 $20.00 3288727 Rapid Hepatitis C Ab POC Task 86803 $92.00 3145438 Rapid Strep POC ED Task 87880 $48.42 1882308 Tuberculosis Testing and Screening Task 86580 $73.10 PROCEDURES DONE IN THE CLINIC SETTING 3311149 2 inch - Ace Wrap Applied Ambulatory Procedures A6441 $5.00 3311148 4 Inch - Ace Wrap Applied Ambulatory Procedures A6441 $5.00 3311147 6 Inch - Ace Wrap Applied Ambulatory Procedures A6441 $5.00 3143961 ACE Wrap Ambulatory Procedures S8431 $5.00 3276519 ALD FM/DM Monaural Ambulatory Procedures V5281 $880.50 3276520 ALD FM/DM Binaural Ambulatory Procedures V5282 $861.00 3276528 ALD Transmit Microphone Ambulatory Procedures V5290 $693.46 3282110 After cataract laser surgery Ambulatory Procedures 66821 $1,255.08 $1,062.00 3144121 Allergy Injection, Not Including Extract Ambulatory Procedures 95115 $107.96 3144122 Allergy Injection, Not Including Extract, 2 or More Ambulatory Procedures 95117 $107.96 3144108 Ambulatory Continuous Glucose Monitoring, 72 hrs-14 days Ambulatory Procedures 95250 $330.17 3252312 Ambulatory Continuous Glucose Monitoring, 72 hrs-14 days Report Ambulatory Procedures 95251 $121.20 3144023 Ankle Brace Ambulatory Procedures L4350 $381.62 3176317 Ankle Block Ambulatory Procedures 64450 $133.83 $153.60 3144206 Anoscopy; Diagnostic with or w/out Specimen Ambulatory Procedures 46600 $303.47 $141.60 3144207 Anoscopy with Biopsy, Single or Multiple Ambulatory Procedures 46606 $260.40 3144208 Anoscopy with Snaring of Lesion Single Ambulatory Procedures 46611 $2,122.94 $279.60 3144226 Apligraf Used as Graft, per sq cm #______Ambulatory Procedures Q4101 $175.00 3144227 Apligraf Used as Dressing, per sq cm #____ Ambulatory Procedures Q4101 $175.00 3143995 Application of Patellar Tendon Bearing Cast Ambulatory Procedures 29435 $671.40 $285.60 3144071 Application of Finger Splint, Static Ambulatory Procedures 29130 $159.32 $99.60 3144072 Application Long Leg Splint (Thigh to Ankle/Toes) Ambulatory Procedures 29505 $383.67 $174.00 3144073 Application Short Leg Splint (Calf to Foot) Ambulatory Procedures 29515 $383.67 $170.40 3144074 Application Long Arm Splint (Shoulder to Hand) Ambulatory Procedures 29105 $383.67 $165.60 3144075 Application Short Arm Splint, Static (Forearm to Hand) Ambulatory Procedures 29125 $303.47 $135.60 3144164 Application Multi-Layer Venous Wound Compression Sys, Below Knee Ambulatory Procedures 29581 $383.67 $95.00 3144166 Application Multi-layer Compression System; Leg (below knee) Incl Ankle and Foot Ambulatory Procedures 29515 $383.67 $170.40 3144230 Application Knee Immobilizer Ambulatory Procedures 29530 $303.47 $64.80 3312641 Application cast; hand and lower forearm (gauntlet) Ambulatory Procedures 29085 $383.67 $230.40 3414690 Application of surface (transcutaneous) neurostimulator (TENS) Ambulatory Procedures 97014 $52.80 3143967 Arm Sling Ambulatory Procedures A4565 $59.90 3144209 Arthrocentesis-Small Joint (eg. Finger, Toes) Ambulatory Procedures 20600 $705.32 $123.60 3144210 Arthrocentesis-Intermediate (eg. Wrist, Ankle) Ambulatory Procedures 20605 $705.32 $128.40 3144211 Arthrocentesis-Major (eg. Shoulder, Hip, Knee) Ambulatory Procedures 20610 $705.32 $158.40 3312631 Arthrotomy with biopsy; carpometacarpal joint, each Ambulatory Procedures 26100 $7,476.52 $1,156.80 3312890 Arthrotomy of wrist, with or without biopsy, with or without removal of loose or foreign body Ambulatory Procedures 25101 $7,476.52 $1,393.20 3143946 Aspiration/Injection Ganglion Cyst Ambulatory Procedures 20612 $705.32 $144.00 1021840 Avulsion Of Nail Plate, Single Ambulatory Procedures 11730 $502.88 $189.60 1021841 Avulsion Of Nail Plate, Each Additional Ambulatory Procedures 11732 $- $61.20 3472687 B-scan w/wo superimposed non-quantitative A-scan Ambulatory Procedures 76512 $118.80 3276540 BICROS, In Ear Ambulatory Procedures V5210 $1,587.43 3276533 Bilateral, Body Worn Ambulatory Procedures V5100 $1,816.08 3144177 Bimalleolar Ankle Fx (incl. Potts), Closed Treatment w/out Manip Ambulatory Procedures 27808 $641.51 $1,034.40 3276535 Binaural, Body Ambulatory Procedures V5120 $1,587.43 3276536 Binaural, In Ear Ambulatory Procedures V5130 $1,688.75 3276537 Binaural, Behind Ear Ambulatory Procedures V5140 $1,756.30 1021775 Biopsy Of Skin, Single Lesion Ambulatory Procedures 11100 $642.82 $169.20 1021776 Biopsy Of Skin, Each Add'L Lesion Ambulatory Procedures 11101 $86.40 3144200 Biopsy of Breast, Percutaneous, Needle Core, Not Using Image Guidance (Separate Procedure) Ambulatory Procedures 19100 $3,920.18 $243.60 3144201 Biopsy of Breast, Open/Incisional Ambulatory Procedures 19101 $8,025.63 $766.80 3144202 Biopsy of Breast, Fine Needle Aspiration w/out Imaging Guidance; 1st lesion Ambulatory Procedures 10021 $895.13 $193.20 3312638 Biopsy of salivary gland; needle Ambulatory Procedures 42400 $1,651.12 $186.00 3312645 Biopsy of vulva or perineum (separate procedure); 1 lesion Ambulatory Procedures 56605 $1,590.41 $205.20 3312647 Biopsy of prostate; needle or punch, single or multiple, any approach Ambulatory Procedures 55700 $4,958.29 $452.40 3312648 Biopsy of external ear Ambulatory Procedures 69100 $587.50 $168.00 3312660 Biopsy soft tissue of leg or ankle area; superficial Ambulatory Procedures 27613 $3,920.80 $554.40 3312663 Biopsy of vaginal mucosa; simple Ambulatory Procedures 57100 $1,590.41 $229.20 3312671 Biopsy soft tissue of neck or thorax Ambulatory Procedures 21550 $3,920.18 $541.20 3312679 Biopsy of muscle, percutaneous needle Ambulatory Procedures 20206 $3,920.18 $201.60 3312680 Biopsy of anorectal wall, anal approach (eg, congenital megacolon) Ambulatory Procedures 45100 $6,653.55 $1,036.80 3312874 Biopsy of Breast; 1st lesion, stereotactic guidance Ambulatory Procedures 19081 $3,920.18 $582.00 3312884 Biopsy vulva or perineum each additional lesion Ambulatory Procedures 56606 $- $102.00 3468007 Biopsy of Intranasal Ambulatory Procedures 30100 $3,645.44 $231.60 3522646 Biopsy of bone, trocare or needle; superficial Ambulatory Procedures 20220 $3,920.18 $247.20 3562826 Biopsy of Breast; 1st lesion, US guidance Ambulatory Procedures 19083 $3,920.18 $548.40 3566671 Biopsy of Breast, Fine Needle Aspiration w/out Imaging Guidance; ea. add'l lesion Ambulatory Procedures 10004 $- $150.00 3566680 Biopsy of Skin, tangential (eg. shave, scoop, saucerize, curette); single lesion Ambulatory Procedures 11102 $502.88 $136.80 3566681 Biopsy of Skin, tangential (eg. shave, scoop, saucerize, curette); ea, add'l lesion Ambulatory Procedures 11103 $- $79.20 3566682 Biopsy of Skin, punch (includes simple closure, when performed); single lesion Ambulatory Procedures 11104 $502.88 $171.60 3566683 Biopsy of Skin, punch (includes simple closure, when performed); ea. add'l lesion Ambulatory Procedures 11105 $- $93.60 3566688 Biopsy of skin, incisional (ie. Wedge)(includes simple closure when preformed); single lesion Ambulatory Procedures 11106 $895.13 $208.80 3566689 Biopsy of skin, incisional (ie. Wedge)(includes simple closure when preformed); ea. add'l lesion Ambulatory Procedures 11107 $- $111.60 3144232 Bladder Scan amb Ambulatory Procedures 51798 $159.32 $43.20 3312661 Bladder instillation of anticarcinogenic agent Ambulatory Procedures 51720 $659.55 $152.40 3478686 Bladder irrigation,simple,lavage and/or instillation Ambulatory Procedures 51700 $659.55 $104.40 3144249 Blood Draws Through Central IV Line Ambulatory Procedures 36592 $303.47 3144109 Bronchospasm Evaluation With Bronchodilator Administration Ambulatory Procedures 94060 $719.08 3252309 Bronchospasm Evaluation With Bronchodilator Report Ambulatory Procedures 94060 $44.40 3144019 CAM Walker Ambulatory Procedures L4387 $356.18 3276539 CROS, In Ear Ambulatory Procedures V5170 $1,304.39 3144179 Calcaneal Fx, Closed Treatment; w/out Manip Ambulatory Procedures 28400 $641.51 $782.40 3467984 Canalith repositioning procedure(s) (eg,Epley maneuver, Semont maneuver) per day Ambulatory Procedures 95992 $128.40 3144089 Cantharone Treatment of Warts Ambulatory Procedures 17110 $502.88 $235.20 3386661 Capillary blood specimen (ie finger,heel,ear stick) Ambulatory Procedures 36416 $15.00 3144151 Cardio-Pulmonary Resusitation Ambulatory Procedures 92950 $719.08 $642.00 3144010 Cardioversion Ambulatory Procedures 92960 $1,500.50 $375.60 3143947 Carpal Tunnel Injection Ambulatory Procedures 20526 $705.32 $199.20 3144076 Cast Removal or Bivalving; Gauntlet, Boot or Body Cast Ambulatory Procedures 29700 $671.40 $115.20 3144077 Cast Removal or Bivalving; Full Arm/Full Leg Cast Ambulatory Procedures 29705 $671.40 $159.60 3144040 Cautery of Umbilical Granuloma Ambulatory Procedures 17250 $502.88 $126.00 3144107 Cervical Polyp Removal Ambulatory Procedures 57500 $1,590.41 $255.60 3312639 Change of cystostomy tube; complicated Ambulatory Procedures 51710 $1,602.41 $276.00 3312652 Change of cystostomy tube; simple Ambulatory Procedures 51705 $659.55 $180.00 3144158 Chemical Cauterization of Granulation Tissue Ambulatory Procedures 17250 $502.88 $126.00 3144191 Chemotherapy Administration SQ or IM -Use for Methrotrexate Ambulatory Procedures 96401 $170.29 3332074 Chiropractic Manipulative Treatment (CMT);spinal,1-2 regions Ambulatory Procedures 98940 $65.41 $76.80 3332075 Chiropractic Manipulative Treatment (CMT);spinal,3-4 regions Ambulatory Procedures 98941 $65.41 $117.60 3332076 Chiropractic Manipulative Treatment (CMT);spinal,5 regions Ambulatory Procedures 98942 $65.41 $159.60 3332077 Chiropractic Manipulative Treatment (CMT);extraspinal,1 or more regions Ambulatory Procedures 98943 $65.41 $80.40 3144159 Circumcision, surgical excision other than clamp,device or dorsal slit, neonate (28 days old or less Ambulatory Procedures 54160 $1,602.41 $500.40 3469286 Circumcision, using clamp or other device with regional dorsal penile or ring block Ambulatory Procedures 54150 $4,958.29 $339.60 3144268 Clavicle Strap Application amb Ambulatory Procedures 29240 $303.47 $64.80 3282101 Close tear duct opening Ambulatory Procedures 68761 $403.20 3143972 Closed Tx of Metacarpal Fx; w/out Manip, each Ambulatory Procedures 26600 $641.51 $952.80 3143973 Closed Tx of Distal Radius/Ulna Fx Ambulatory Procedures 25600 $641.51 $1,071.60 3143974 Closed Tx of Finger or Thumb Fx; Mid-Phal w/out Manip, each Ambulatory Procedures 26720 $641.51 $631.20 3143975 Closed Tx of Clavicle Fx; w/out Manip Ambulatory Procedures 23500 $641.51 $764.40 3143977 Closed Tx of Humerus Fx; Prox, w/out Manip Ambulatory Procedures 23600 $641.51 $1,058.40 3143978 Closed Tx of Finger or Thumb Fx; Dist-Phal w/out Manip, each Ambulatory Procedures 26750 $641.51 $633.60 3143980 Closed Tx of Radial Head or Neck Fx; w/out Manip Ambulatory Procedures 24650 $641.51 $826.80 3143981 Closed Tx of Humerus Fx; Med or Lat, w/out Manip Ambulatory Procedures 24560 $641.51 $993.60 3143982 Closed Tx of Ulna Shaft Fx; w/out Manip Ambulatory Procedures 25530 $641.51 $816.00 3144185 Closed Treatment of Fx, Phalanx or Phalanges, Other Than Great Toe; w/out Manip, each Ambulatory Procedures 28510 $641.51 $411.60 3144186 Closed Treatment of Fx, Phalanx or Phalanges, other than Great Toe; with Manip, each Ambulatory Procedures 28515 $641.51 $489.60 3144187 Closed Treatment of Sesamoid Fx Ambulatory Procedures 28530 $641.51 $354.00 3312640 Closed treatment of humeral shaft fracture; without manipulation Ambulatory Procedures 24500 $641.51 $1,122.00 3312662 Closed treatment of ulnar styloid fracture Ambulatory Procedures 25650 $641.51 $1,028.40 3312726 Closed treatment of carpal scaphoid (navicular) fracture; without manipulation Ambulatory Procedures 25622 $641.51 $957.60 3312868 Closed treatment of greater humeral tuberosity fracture; without manipulation Ambulatory Procedures 23620 $641.51 $878.40 3312870 Closed treatment fracture distal tibia Ambulatory Procedures 27824 $641.51 $1,045.00 3312873 Closed treatment of MCP/IP articular joint fracture w/out manipulation, each Ambulatory Procedures 26740 $641.51 $742.80 3312875 Closed treatment of carpal bone fracture (not scaphoid); w/out manipulation, each bone Ambulatory Procedures 25630 $641.51 $964.80 3312876 Closed treatment of humerus fracture (condylar) Ambulatory Procedures 24576 $641.51 $1,050.00 3312883 Closed treatment of metacarpal fracture, single; with manipulation, each bone Ambulatory Procedures 26605 $641.51 $1,005.60 3312888 Closed treatment of humerus fracture w/out Manipulation (supracondylar/transcondylar) Ambulatory Procedures 24530 $641.51 $1,186.80 3144188 Club Foot Cast w/Molding Long or Short Ambulatory Procedures 29450 $383.67 $391.20 3282090 Cmptrophth img optic nreve Ambulatory Procedures 92133 $159.32 $75.60 3282088 Color vision exam Ambulatory Procedures 92283 $31.20 3312676 Colporrhaphy suture of injury of vagina (nonobstetrical) Ambulatory Procedures 57200 $6,729.62 $1,064.40 3144094 Colposcopy of Cervix Including Upper/Adjacent Vagina Ambulatory Procedures 57452 $472.90 $314.40 3144095 Colposcopy of Cervix Including Upper/Adjacent Vagina with Biopsy of Cervix and Endocervical Curettag Ambulatory Procedures 57454 $778.05 $457.20 3144096 Colposcopy of Cervix Including Upper/Adjacent Vagina with Biopsy(s) of the Cervix Ambulatory Procedures 57455 $778.05 $374.40 3144097 Colposcopy of Cervix Including Upper/Adjacent Vagina with Endocervical Curettage Ambulatory Procedures 57456 $778.05 $348.00 3144098 Colposcopy of the cervix including upper/adjacent vagina; w/loop electrode biopsy of cervix Ambulatory Procedures 57460 $6,729.62 $549.60 3312889 Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix Ambulatory Procedures 57421 $1,590.41 $422.40 3252301 Complex Cystometrogram Ambulatory Procedures 51726 $659.55 $295.20 3144021 Compression Knee High Stockings Ambulatory Procedures A4500 $15.00 3144269 Compression Stocking Thigh High Ambulatory Procedures A4495 $15.00 3446652 Computerized corneal topography, unilat/bilat , wi/ interp. & report Ambulatory Procedures 92025 $159.32 $68.40 3282080 Contact lens fitting for tx Ambulatory Procedures 92071 $114.00 3144149 Control Nasal Hemorrhage, Anterior, Simple Ambulatory Procedures 30901 $303.47 $194.40 3144150 Control Nasal Hemorrhage, Posterior, Initial Ambulatory Procedures 30905 $303.47 $361.20 3144221 Control Nasal Hemorrhage, Posterior, Subsequent Ambulatory Procedures 30906 $587.50 $468.00 3282091 Cptr ophth dx img post segmt, retina Ambulatory Procedures 92134 $159.32 $87.60 3434695 Cptr ophth dx img anterior segmt Ambulatory Procedures 92132 $159.32 $56.40 3434696 Cptr ophth dx img post segmt, optic nerve Ambulatory Procedures 92133 $159.32 $75.60 3144270 Crutches amb Ambulatory Procedures E0116 $195.93 3312682 Curettage, postpartum Ambulatory Procedures 59160 $6,729.62 $613.20 3282094 Curette/treat cornea Ambulatory Procedures 65435 $237.60 3144034 Debridement, Muscle and/or Fascia, up to 20 sq cm Ambulatory Procedures 11043 $1,376.24 $534.00 3144035 Debridement of Benign Hyperkeratotic Tissue 1 Ambulatory Procedures 11055 $502.88 $55.20 3144036 Debridement of Benign Hyperkeratotic Tissue 2-4 Ambulatory Procedures 11056 $502.88 $78.00 3144037 Debridement of Benign Hyperkeratotic Tissue >4 Ambulatory Procedures 11057 $502.88 $102.00 3144136 Debride Nails, Any Method: 1-5 Nails Ambulatory Procedures 11720 $159.32 $50.40 3144137 Debride Nails, Any Method: 6 or More Nails Ambulatory Procedures 11721 $159.32 $85.20 3176302 Debridement Skin; up to 20 sq cm Ambulatory Procedures 97597 $502.88 $81.60 3176303 Debridement Skin; each add'l 20 sq cm or part Ambulatory Procedures 97598 $- $38.40 3176304 Debridement Subcutaneous Tissue; up to 20 sq cm Ambulatory Procedures 11042 $895.13 $211.20 3176305 Debridement Subcutaneous Tissue; each add'l 20 sq cm or part Ambulatory Procedures 11045 $- $91.20 3312633 Debridement, mastoidectomy cavity, simple (eg, routine cleaning) Ambulatory Procedures 69220 $502.88 $176.40 3385802 Debriedment, Mastoidectomy cavity, simple Ambulatory Procedures 69222 $1,388.32 $460.80 1021906 Destruction benign lesion (not skin tag) up to 14 lesions Ambulatory Procedures 17110 $502.88 $235.20 3143965 Destruction premalignant lesion, first lesion Ambulatory Procedures 17000 $502.88 $183.60 3144013 Destruction Vag Lesion(s); simple Ambulatory Procedures 57061 $6,729.62 $350.40 3144014 Destruction Vag Lesion(s); extensive Ambulatory Procedures 57065 $6,729.62 $609.60 3144015 Destruction Vulva Lesion(s); simple Ambulatory Procedures 56501 $4,414.54 $409.20 3144016 Destruction Vulva Lesion(s); extensive Ambulatory Procedures 56515 $4,414.54 $696.00 3144093 Destruction benign lesion (not skin tag) 15 or more lesions Ambulatory Procedures 17111 $502.88 $289.20 3176306 Destruction premalignant lesions, 15 or more lesions Ambulatory Procedures 17004 $895.13 $342.00 3176349 Destruction premalignant lesion, 2nd - 14th lesions Ambulatory Procedures 17003 $- $8.40 3176351 Destruction cutaneous vascular proliferative lesions; less than 10 sq cm Ambulatory Procedures 17106 $895.13 $951.60 3286795 Destruction, Malignant Lesion (truck,arms or legs) dia 0.5cm or less Ambulatory Procedures 17260 $502.88 $243.60 3286796 Destruction, Malignant Lesion (truck,arms or legs) dia 0.6 to 1.0cm Ambulatory Procedures 17261 $502.88 $309.60 3286798 Destruction, Malignant Lesion (truck,arms or legs) dia 1.1 to 2.0 cm Ambulatory Procedures 17262 $502.88 $396.00 3286803 Destruction, Malignant Lesion (trunk,arms or legs) dia 2.1 to 3.0 cm Ambulatory Procedures 17263 $502.88 $439.20 3286804 Destruction, Malignant Lesion (trunk,arms or legs) dia 3.1 to 4.0 cm Ambulatory Procedures 17264 $895.13 $468.00 3286805 Destruction, Malignant Lesion (trunk,arms or legs) dia over 4.0cm Ambulatory Procedures 17266 $895.13 $552.00 3286806 Destruction, malignant lesion (scalp,neck,hands,feet,genitalia) dia 0.5cm or less Ambulatory Procedures 17270 $502.88 $340.80 3286807 Destruction, Malignant Lesion (scalp, neck,hands feet genitalia) dia 0.6 to 1.0 cm Ambulatory Procedures 17271 $502.88 $376.80 3286808 Destruction, Malignant Lesion (scalp,neck,hands,feet,genitalia) dia 1.1 to 2.0 cm Ambulatory Procedures 17272 $502.88 $435.60 3286809 Destruction, Malignant Lesion (scalp,neck,hands,feet,genitalia) dia 2.1 to 3.0cm Ambulatory Procedures 17273 $895.13 $493.20 3286810 Destruction, Malignant Lesion (scalp,neck,hands,feet,genitalia) dia 3.1 to 4.0cm Ambulatory Procedures 17274 $895.13 $604.80 3286811 Destruction, Malignant Lesion (scalp,neck,hands, feet, genitalia) dia over 4.0 cm Ambulatory Procedures 17276 $895.13 $722.40 3286812 Destruction, Malignant Lesion (face,ears,eyelids,nose,lips,mucous membrane), dia 0.5 cm or less Ambulatory Procedures 17280 $502.88 $309.60 3286813 Destruction, Malignant Lesion (face,ears,eyelids,nose,lips,mucous membrane) dia 0.6 to 1.0cm Ambulatory Procedures 17281 $895.13 $424.80 3286814 Destruction, Malignant Lesion (face,ears,eyelids,nose,lips,mucous membrane) dia 1.1 to 2.0cm Ambulatory Procedures 17282 $895.13 $492.00 3286815 Destruction, Malignant Lesion (face,ears,eyelids,nose,lips,mucous membrane) 2.1 to 3.0 cm Ambulatory Procedures 17283 $895.13 $615.60 3286816 Destruction, Malignant Lesion (face, ears eyelids, nose,lips,mucous membrane) 3.1 to 4.0 cm Ambulatory Procedures 17284 $1,376.24 $716.40 3286817 Destruction, Malignant Lesion (face,ears,eyelids,nose,lips,mucous membrane) dia over 4.0 cm Ambulatory Procedures 17286 $1,376.24 $963.60 3312628 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), Ambulatory Procedures 46900 $895.13 $470.40 3312891 Destruction of lesion(s), penis, simple; cryosurgery Ambulatory Procedures 54056 $502.88 $381.60 3319863 Destruction cutaneous vascular proliferative lesions; 10.0 to 50.0 sq cm Ambulatory Procedures 17107 $1,376.24 $1,220.40 3282078 Determine refractive state Ambulatory Procedures 92015 $66.00 3144140 Diaphragm Fitting Ambulatory Procedures 57170 $472.90 $164.40 3276546 Dig Mono CIC Ambulatory Procedures V5254 $560.00 3276544 Dig Prog Binaur ITE Ambulatory Procedures V5252 $840.00 3276545 Dig Prog Binaur BTE Ambulatory Procedures V5253 $1,008.00 3282104 Dilate tear duct opening Ambulatory Procedures 68801 $266.40 3312727 Dilation of female urethra including suppository and/or instillation; initial Ambulatory Procedures 53660 $387.46 $144.00 3144176 Distal Fibula Fx (Lateral Malleolus) Closed Treatment; w/out Manip Ambulatory Procedures 27786 $641.51 $980.40 3282098 Drainage of eyelid abscess Ambulatory Procedures 67700 $397.20 3312644 Drainage external ear, abscess or hematoma; simple Ambulatory Procedures 69000 $1,651.12 $410.40 3312653 Drainage of finger abscess; simple Ambulatory Procedures 26010 $502.88 $468.00 3467994 Drainage external ear ,abscess or hematoma, complicated Ambulatory Procedures 69005 $3,920.18 $540.00 3144197 Dress/Debride Partial Thickness Burn Initial/Subsq w/out Anes, Small <5% TBS Ambulatory Procedures 16020 $502.88 $186.00 3144198 Dress/Debride Partial Thickness Burn Initial/Subsq w/out Anes, Medium, Whole Face/Extremity 5-10% TB Ambulatory Procedures 16025 $502.88 $379.20 3144033 EPAT-Extracorporeal Pulse Activation Technology Ambulatory Procedures 20999 $641.51 $775.20 3282092 Echo exam of eye thickness Ambulatory Procedures 76514 $48.93 $27.60 3562876 Elbow Sleeve, off-the-shelf Ambulatory Procedures L3999 $273.32 3144152 Endo-Tracheal Intubation, Emergent Ambulatory Procedures 31500 $587.50 $488.40 3143944 Endocervical Curettage Ambulatory Procedures 57505 $1,590.41 $330.00 3144106 Endometrial Biopsy (AMB) Ambulatory Procedures 58100 $472.90 $241.20 3312872 Epistaxis/nasal hemorrhage control by anterior packing/cautery Ambulatory Procedures 30903 $303.47 $270.00 3312630 Escharotomy initial incision Ambulatory Procedures 16035 $895.13 $678.00 1021842 Evacuation Subungual Hematoma Ambulatory Procedures 11740 $303.47 $110.40 1021804 Exc Ben Les Trunk Arm Leg 0.5cm or less Ambulatory Procedures 11400 $1,651.12 $279.60 1021805 Exc Ben Les Trunk Arm Leg 0.6-1.0cm Ambulatory Procedures 11401 $895.13 $358.80 1021806 Exc Ben Les Trunk Arm Leg 1.1-2.0cm Ambulatory Procedures 11402 $1,651.12 $394.80 1021807 Exc Ben Les Trunk Arm Leg 2.1-3.0cm Ambulatory Procedures 11403 $1,651.12 $510.00 1021808 Exc Ben Les Trunk Arm Leg 3.1-4.0cm Ambulatory Procedures 11404 $3,920.18 $560.40 1021809 Exc Ben Les Trunk Arm Leg 4.1cm or Greater Ambulatory Procedures 11406 $3,920.18 $853.20 1021810 Exc Ben Les Scalp Neck Hand Feet 0.5cm or less Ambulatory Procedures 11420 $3,920.18 $279.60 1021811 Exc Ben Les Scalp Neck Hand Feet .6-1.0cm Ambulatory Procedures 11421 $1,651.12 $378.00 1021812 Exc Ben Les Scalp Neck Hand Feet 1.1-2.0cm Ambulatory Procedures 11422 $3,920.18 $468.00 1021813 Exc Ben Les Scalp Neck Hand Feet 2.1-3.0cm Ambulatory Procedures 11423 $3,920.18 $537.60 1021814 Exc Ben Les Scalp Neck Hand Feet 3.1-4.0cm Ambulatory Procedures 11424 $3,920.18 $619.20 1021815 Exc Ben Les Scalp Neck Hand Feet greater than 4.0cm Ambulatory Procedures 11426 $6,778.13 $951.60 1021816 Exc Ben Les Face Ear Nose 0.5cm or less Ambulatory Procedures 11440 $1,651.12 $355.20 1021817 Exc Ben Les Face Ear Nose 0.6-1.0cm Ambulatory Procedures 11441 $1,651.12 $451.20 1021818 Exc Ben Les Face Ear Nose 1.1-2.0cm Ambulatory Procedures 11442 $1,651.12 $499.20 1021819 Exc Ben Les Face Ear Nose 2.1-3.0cm Ambulatory Procedures 11443 $3,920.18 $613.20 1021820 Exc Ben Les Face Ear Nose 3.1-4.0cm Ambulatory Procedures 11444 $3,920.18 $781.20 1021821 Exc Ben Les Face Ear Nose greater than 4.0cm Ambulatory Procedures 11446 $6,778.13 $1,119.60 1021822 Exc Mal Les Trunk Arm Leg 0.5cm or less Ambulatory Procedures 11600 $1,651.12 $414.00 1021823 Exc Mal Les Trunk Arm Leg 0.6-1.0cm Ambulatory Procedures 11601 $1,651.12 $514.80 1021824 Exc Mal Les Trunk Arm Leg 1.1-2.0cm Ambulatory Procedures 11602 $895.13 $564.00 1021825 Exc Mal Les Trunk Arm Leg 2.1-3.0cm Ambulatory Procedures 11603 $1,651.12 $675.60 1021826 Exc Mal Les Trunk Arm Leg 3.1-4.0cm Ambulatory Procedures 11604 $1,651.12 $742.80 1021827 Exc Mal Les Trunk Arm Leg greater than 4.0cm Ambulatory Procedures 11606 $3,920.18 $1,108.80 1021828 Exc Mal Les Scalp Neck Hand Feet 0.5cm or less Ambulatory Procedures 11620 $3,920.18 $418.80 1021829 Exc Mal Les Scalp Neck Hand Feet 0.6-1.0cm Ambulatory Procedures 11621 $1,651.12 $518.40 1021830 Exc Mal Les Scalp Neck Hand Feet 1.1-2.0cm Ambulatory Procedures 11622 $1,651.12 $591.60 1021831 Exc Mal Les Scalp Neck Hand Feet 2.1-3.0cm Ambulatory Procedures 11623 $3,920.18 $732.00 1021832 Exc Mal Les Scalp Neck Hand Feet 3.1-4.0cm Ambulatory Procedures 11624 $3,920.18 $830.40 1021833 Exc Mal Les Scalp Neck Hand Feet greater than 4.0cm Ambulatory Procedures 11626 $6,778.13 $1,017.60 1021834 Exc Mal Les Face Ears Nose Lips 0.5cm or less Ambulatory Procedures 11640 $1,651.12 $433.20 1021835 Exc Mal Les Face Ears Nose Lips 0.6-1.0cm Ambulatory Procedures 11641 $1,651.12 $540.00 1021836 Exc Mal Les Face Ears Nose Lips 1.1-2.0cm Ambulatory Procedures 11642 $1,651.12 $636.00 1021837 Exc Mal Les Face Ears Nose Lips 2.1-3.0cm Ambulatory Procedures 11643 $3,920.18 $794.40 1021838 Exc Mal Les Face Ears Nose Lips 3.1-4.0cm Ambulatory Procedures 11644 $1,920.18 $985.20 1021839 Exc Mal Les Face Ears Nose Lips greater than 4.0cm Ambulatory Procedures 11646 $6,778.13 $1,366.80 3523557 Exchange of intraocular lens Ambulatory Procedures 66986 $3,099.60 1021843 Excision Of Nail Matrix, Permanent Removal Ambulatory Procedures 11750 $895.13 $350.40 3312629 Excision or transposition of pterygium without graft Ambulatory Procedures 65420 $5,166.14 $1,290.00 3312673 Excision nasal polyp(s), simple Ambulatory Procedures 30110 $3,645.44 $442.80 3312885 Excision tumor, shoulder area, soft tissue >5 cm Ambulatory Procedures 23076 $6,778.13 $1,872.00 3321316 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm Ambulatory Procedures 25075 $3,920.18 $1,090.80 3468883 Excision of lesion, cornea (keratectomy, lamellar, partial ) except pterygium Ambulatory Procedures 65400 $2,056.80 3540196 Excision or Transposition of pterygium;with graft/post care Ambulatory Procedures 65426 $1,632.00 3312882 Extracapsular cataract removal Ambulatory Procedures 66982 $5,463.91 $2,707.20 3282074 Eye Exam New Patient Ambulatory Procedures 92002 $163.20 3282075 Eye Exam Established Patient Ambulatory Procedures 92012 $178.80 3282076 Eye Exam New Patient 1 or More Visits Ambulatory Procedures 92004 $337.20 3282077 Eye Exam & tx establ pt 1/>visits Ambulatory Procedures 92014 $270.00 3282089 Eye photography Ambulatory Procedures 92285 $159.32 3144234 Fetal Non-Stress Test (NST) Ambulatory Procedures 59025 $472.90 3536324 Fetal Non-Stress Test PROFEE (NST) Ambulatory Procedures 59025 $102.00 3562841 Foot, arch support, plastic, silicone or equal, heel stabilizer, prefab, off-the-shelf, ea Ambulatory Procedures L3070 $91.11 3527041 Foot, insert, removable, molded to patient model, Spenco, each Ambulatory Procedures L3001 $275.56 3143951 Foreign Body Removal, Ear Ambulatory Procedures 69200 $303.47 $162.00 3143952 Foreign Body Removal, Nose Ambulatory Procedures 30300 $303.47 $376.80 3282093 Foreign body removal, corneal with slit lamp Ambulatory Procedures 65222 $177.60 3282087 Fundus photography with interpretation and report Ambulatory Procedures 92250 $303.47 3282108 Glaucoma surgery Ambulatory Procedures 66170 $3,734.40 3514416 Grafix Core, 5cm x 5cm (25 cm sq.) Ambulatory Procedures Q4132 $214.34 3514417 Grafix Prime, 5cm x 5cm (25 cm sq.) Ambulatory Procedures Q4133 $214.34 3514678 Grafix Core, 3cm x 2cm (6cm sq.) Ambulatory Procedures Q4132 $345.36 3514679 Grafix Core, 4cm x 3cm (12cm sq.) Ambulatory Procedures Q4132 $211.92 3514672 Grafix, Prime, Disc, 16mm (1.6 cm) Ambulatory Procedures Q4133 $466.13 3514673 Grafix, Prime, 2cm x 1.5cm (3cm sq.) Ambulatory Procedures Q4133 $442.03 3514674 Grafix, Prime, 3cm x 2cm (6cm sq.) Ambulatory Procedures Q4133 $345.36 3514675 Grafix, Prime, 4cm x 3cm (12cm sq.) Ambulatory Procedures Q4133 $211.92 3514676 Grafix, Core, Disc, 16mm (1.6 cm) Ambulatory Procedures Q4132 $466.13 3514677 Grafix, Core, 2cm x 1.5 cm (3cm sq.) Ambulatory Procedures Q4132 $442.03 3144183 Great Toe/Phalanx/Phalanges, Closed Treatment; w/out Manip Ambulatory Procedures 28490 $641.51 $428.40 3144184 Great Toe/Phalanx/Phalanges, Closed Treatment; with Manip Ambulatory Procedures 28495 $641.51 $513.60 3494157 Hand/Finger Orthosis w/out Joint, Custom Ambulatory Procedures L3923 $190.00 3144193 Hickman/Port, Draw Blood Ambulatory Procedures 36591 $303.47 3144120 Hormonal Chemotherapy Drug Administration (Use of Lupron) Ambulatory Procedures 96402 $170.29 3175683 I & D Abscess Complex or Multiple Ambulatory Procedures 10061 $895.13 $619.20 3175684 I & D Abscess Simple or Single Ambulatory Procedures 10060 $502.88 $337.20 3176340 I & D Hematoma; Seroma; or Fluid Collect Ambulatory Procedures 10140 $3,920.18 $408.00 3144018 I & D of Bartholins Gland Abscess Ambulatory Procedures 56420 $472.90 $330.00 3144123 IV Drug Infusion-1st hr Ambulatory Procedures 96365 $533.46 3144124 IV Drug Infusion-each add'l hr Ambulatory Procedures 96366 $107.96 3144125 IV Drug Push-Initial or Single (up to 15 min) Ambulatory Procedures 96374 $533.46 3144126 IV Drug Push, each add'l NEW Drug/Substance Ambulatory Procedures 96375 $107.96 3144127 IV Drug Push, each add'l SAME Drug/Substance Ambulatory Procedures 96376 $95.00 3144130 IV Drug Infusion-Sequential, up to 1 hr Ambulatory Procedures 96367 $170.29 3144131 IV Drug Infusion; Concurrent (ONE Per Visit) Ambulatory Procedures 96368 $108.00 3144128 IV Infusion-Hydration, 1st 31-60 min Ambulatory Procedures 96360 $533.46 3144129 IV Infusion-Hydration, each add'l hr Ambulatory Procedures 96361 $107.96 1021763 Incision and Drainage Abscess Simple or Single Ambulatory Procedures 10060 $502.88 $337.20 3144048 Incision& Removal FB Complicated Ambulatory Procedures 10121 $3,920.18 $638.40 3144049 Incision & Removal FB Simple Ambulatory Procedures 10120 $895.13 $355.20 3144190 Incision Thrombosed Hemorrhoid, External Ambulatory Procedures 46083 $659.55 $369.60 3312654 Incision and drainage bursa, foot Ambulatory Procedures 28001 $3,920.18 $588.00 3312656 Incision and drainage of pilonidal cyst; simple Ambulatory Procedures 10080 $1,651.12 $351.60 3312678 Incision of lingual frenum (frenotomy) Ambulatory Procedures 41010 $3,645.44 $373.20 3312892 Incision and drainage below fascia of bursa Ambulatory Procedures 28002 $3,743.02 $1,104.00 3481969 Incision of Conjuctiva, drainage of cyst Ambulatory Procedures 68020 $378.00 3144235 Influenza Screening amb Ambulatory Procedures 87804 $47.17 3144167 Infrared treatment, 1 or More Areas Ambulatory Procedures 97026 $21.60 1021845 Injection, Intralesional; Up To And Including 7 Lesions Ambulatory Procedures 11900 $502.88 $108.00 1021846 Injection, Intralesional; More Than 7 Lesions Ambulatory Procedures 11901 $502.88 $166.80 1021899 Injection(s); Single Tendon Sheath, Or Ligament Aponeurosis Ambulatory Procedures 20550 $705.32 $135.60 3144189 Injection Anesthetic Agent, other Peripheral Nerve Ambulatory Procedures 64450 $1,706.61 $153.60 3144216 Injection(s) of sclerosant for spider veins, limb or trunk Ambulatory Procedures 36468 $502.88 3282102 Injection treatment of eye Ambulatory Procedures 66030 $379.20 3312632 Injection, turbinate(s), therapeutic Ambulatory Procedures 30200 $1,388.32 $199.20 3312637 Injection of sinus tract; therapeutic (separate procedure) Ambulatory Procedures 20500 $3,645.44 $294.00 3312646 Injection(s); single tendon origin/insertion Ambulatory Procedures 20551 $705.32 $138.00 3312650 Injection(s); single or multiple trigger point(s), 3 or more muscles Ambulatory Procedures 20553 $705.32 $148.80 3144111 Insert Indwelling Bladder Catheter; Simple Ambulatory Procedures 51702 $303.27 $87.60 3144112 Insert Non-Indwelling Bladder Catheter Ambulatory Procedures 51701 $303.47 $87.60 3144222 Insert PICC Line Ambulatory Procedures 36556 $3,116.85 $294.00 3144082 Insertion, Non-Biodegradable Drug Delivery Implant Ambulatory Procedures 3385801 Intrapulmonary Surfectant administered by a physician or other qualified professional through trache Ambulatory Procedures 94610 $546.06 $190.80 3144104 Intrauterine Device Removal Ambulatory Procedures 58301 $472.90 $229.20 3144110 Irrigation of Implanted Venous Access Device (Use Only if no Other Service Performed on SDOS) Ambulatory Procedures 96523 $159.32 3481936 Irrigation of vagina and/or application of medicament for treatment of bacterial,parasistic,or fungo Ambulatory Procedures 57150 $303.47 $90.00 3143963 Knee Orthosis, Elastic with Condylar Pads and Joints Ambulatory Procedures L1820 $255.90 3567155 Knee Orthosis, Elastic with open patella, prefab, off-the-shelf Ambulatory Procedures L2999 $31.00 3556616 Knee orthosis (KO), elastic with joints, prefabricated, off-the-shelf Ambulatory Procedures L1812 $131.69 3562875 Knee orthosis, adjustable knee joints, positional orthosis, rigid support, prefab, off-the-shelf Ambulatory Procedures L1833 $1,469.38 3481912 LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC (AMB) Ambulatory Procedures 31575 $467.31 $229.20 3282107 Laser surgery of eye Ambulatory Procedures 65855 $711.60 3252304 Limited bil noninvasive physiologic studies of upper or lower extremity arteries 1-2 levels Report Ambulatory Procedures 93922 $222.35 3143976 Long Arm Cast (Shoulder to Hand) Ambulatory Procedures 29065 $592.46 $235.20 3143983 Long Leg Cast (Thigh to Toes) Ambulatory Procedures 29345 $592.46 $348.00 3144160 Lumbar Puncture, Diagnostic Ambulatory Procedures 62270 $1,706.61 3312634 Lysis or excision of penile post-circumcision adhesions Ambulatory Procedures 54162 $4,958.29 $692.40 3407138 MLS treatment for plantar fasciitis Ambulatory Procedures S8948 $100.00 3276550 MNT; Initial assessment, individual each 15 minuted Ambulatory Procedures 97802 $110.40 3276551 MNT; Re-assessment, individual each 15 minuted Ambulatory Procedures 97803 $94.80 3276553 MNT; Re-assessment Individual; each 15 minutes (Medicare) Ambulatory Procedures $94.80 3276554 MNT; Re-assessment group; each 30 minutes (Medicare) Ambulatory Procedures $51.60 3276552 MNT; group, each 30 minutes Ambulatory Procedures 97804 $51.60 3312869 Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejun Ambulatory Procedures 49460 $2,170.42 $166.80 3144174 Medial Malleolous Fx, Closed Treatment; w/out Manip Ambulatory Procedures 27760 $641.51 $1,046.40 3276547 Medication Therapy Mgmt Srvs provided by Pharmacist initial 15min-New Patient Ambulatory Procedures 99605 $50.00 3276548 Medication Therapy Mgmt Srvs provided by Pharmacist initial 15 mins-established patient Ambulatory Procedures 99606 $65.00 3276549 Medication Therapy Management Srvs provided by Pharmacist each additional 15 minutes Ambulatory Procedures 99607 $95.00 3144025 Metatarsal Off Loading Pad Ambulatory Procedures L3050 $137.13 3144182 Metatarsal Fx, Closed Treatment; w/out Manip, each Ambulatory Procedures 28470 $491.14 $702.00 3470696 Moderate Sedation Same Provider, Initial 15 min, < 5 yrs Ambulatory Procedures 99151 $86.40 3470697 Moderate Sedation Same Provider, Initial 15 min, 5 + yrs Ambulatory Procedures 99152 $42.00 3470698 Moderate Sedation Same Provider, Each add'l 15 min Ambulatory Procedures 99153 $36.00 3470699 Moderate Sedation Other Provider, Initial 15 min, < 5 yrs Ambulatory Procedures 99155 $304.80 3470700 Moderate Sedation Other Provider, Initial 15 min, 5 + yrs Ambulatory Procedures 99156 $268.80 3470701 Moderate Sedation Other Provider, Each add'l 15 min Ambulatory Procedures 99157 $218.40 3276529 Monaural, Air Conduction Ambulatory Procedures V5030 $1,103.77 3276530 Monaural, Bone Conduction Ambulatory Procedures V5040 $838.97 3276531 Monaural, In Ear Ambulatory Procedures V5050 $970.02 3276532 Monaural, Behind Ear Ambulatory Procedures V5060 $810.60 3504096 Motion fluoroscopic evaluation of swallowing function by cine or video recording Ambulatory Procedures 92611 $306.00 3312636 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) Ambulatory Procedures 31231 $467.31 $223.20 3341903 Nasopharyngoscopy w/ Endoscope Ambulatory Procedures 92511 $467.31 $129.60 3144132 Nebulizer; Initial Demo to Patient Ambulatory Procedures 94664 $546.06 3144133 Nebulizer/Inhlr/IPPB/Aerosol Trmt/Diagnostic Sputum Ambulatory Procedures 94640 $546.06 3144134 Nebulizer/Inhlr/IPPB/Aerosol Trmt/add'l Treatments Ambulatory Procedures 94640 $546.06 3144052 Neck/Hands/Feet/External Genitalia 7.6 cm to 12.5 cm Ambulatory Procedures 12044 $1,376.24 $740.40 3144146 Nerve Block; Digital Ambulatory Procedures 64450 $1,706.61 $153.60 3144103 Nexplanon Removal Ambulatory Procedures 11982 $992.26 $344.40 3143956 Osteopathic Manipulation, 5-6 Body Regions Ambulatory Procedures 98927 $70.62 $162.00 3144147 Osteopathic Manipulation, 3-4 Body Regions Ambulatory Procedures 98926 $70.62 $122.40 3144278 Osteopathic Manipulation, 1-2 Body Regions Ambulatory Procedures 98925 $70.62 $81.60 3316749 Osteopathic Manipulation, 7-8 Body Regions Ambulatory Procedures 98928 $70.62 $202.80 3316750 Osteopathic Manipulation, 9-10 Body Regions Ambulatory Procedures 98929 $70.62 $246.00 3504057 Otolaryngologic examination Binocular microscopy(separate diagnostic procedure) Ambulatory Procedures 92504 $162.04 $32.40 3144194 PICC Catheter, Flush Ambulatory Procedures 96523 $159.32 3144195 PICC Catheter, Draw Blood Ambulatory Procedures 36592 $303.47 3144064 Paring/Cutting Hypkeratotic Lesion; Single Ambulatory Procedures 11055 $502.88 $55.20 3144065 Paring/Cutting Hypkeratotic Lesion; 2-4 lesions Ambulatory Procedures 11056 $502.88 $78.00 3144066 Paring/Cutting Hypkeratotic Lesion; More than 4 Lesions Ambulatory Procedures 11057 $502.88 $102.00 3144011 Pessary Insertion & Fitting Ambulatory Procedures 57160 $472.90 $159.60 3538717 Pessary, Rubber Ambulatory Procedures A4561 $23.26 3538807 Pessary, Non Rubber Ambulatory Procedures A4562 $57.92 3143960 Pneumatic Walking Boot Ambulatory Procedures L4360 $624.50 3144028 Profore Ambulatory Procedures S8431 $62.13 3144175 Proximal Fibula/Shaft Fx, Closed Treatment; w/out Manip Ambulatory Procedures 27780 $641.51 $957.60 3144135 Pulse Oximeter, Multiple Determinations Ambulatory Procedures 94761 $14.40 3144218 Pulse Oximetry Continuous amb Ambulatory Procedures 94762 $387.46 3144219 Pulse Oximetry, Single Determination Ambulatory Procedures 94760 $8.40 1021904 Puncture Aspiration Of Cyst Of Breast Ambulatory Procedures 19000 $1,651.12 $151.20 3143969 Puncture Aspiration of Abscess, Hematoma or Cyst Ambulatory Procedures 10160 $895.13 $326.40 3144067 Puncture Aspiration of Breast Cyst each add'l Ambulatory Procedures 19001 $- $74.40 3144204 Puncture Aspiration Breast Cyst Ambulatory Procedures 19000 $1,651.12 $151.20 3144205 Puncture Aspiration Breast Cyst; each add'l Cyst #______Ambulatory Procedures 19001 $- $74.40 3176339 Puncture Aspiration of Breast Cyst Ambulatory Procedures 19000 $1,651.12 $151.20 3450655 Puraply,and Puraply AM, any type, per square cm Ambulatory Procedures Q4172 $148.00 3144145 Reduce Shoulder Dislocation WITHOUT Anesthesia Ambulatory Procedures 23650 $641.51 $994.80 3144041 Reduction of Nurse Maid's Elbow Ambulatory Procedures 24640 $641.51 $267.60 1021778 Removal Of Skin Tags, Up To and Including 15 Ambulatory Procedures 11200 $502.88 $252.00 1021786 Removal Of Skin Tags, Each Additional Ten Ambulatory Procedures 11201 $- $57.60 3143970 Removal of Implant; Superficial (eg. Wire, Pin or Rod) Ambulatory Procedures 20670 $3,920.18 $502.80 3144069 Removal of Ingrown Nail Ambulatory Procedures 11730 $502.88 $189.60 3144083 Removal, Non-Biodegradable Drug Delivery Implant Ambulatory Procedures 11982 $992.26 $344.40 3144084 Removal w/Reinsertion, Non-Biodegradable Drug Delivery Implant Ambulatory Procedures 11983 $992.26 $614.40 3312627 Removal of foreign body, external eye; conjunctival superficial Ambulatory Procedures 65205 $303.47 $122.40 3312635 Removal of tissue expander(s) without insertion of prosthesis Ambulatory Procedures 11971 $6,778.13 $1,099.20 3312881 Removal of foreign body from eye Ambulatory Procedures 65210 $992.26 $146.40 3322012 Removal impacted cerumen by instrumentation, bilateral Ambulatory Procedures 69210 $159.32 $169.20 3322013 Removal impacted cerumen by instrumentation, left Ambulatory Procedures 69210 $159.32 $112.80 3322014 Removal impacted cerumen by instrumentation, right Ambulatory Procedures 69210 $159.32 $112.80 3322015 Removal impacted cerumen by irrigation/lavage, bilateral Ambulatory Procedures 69209 $159.32 3322016 Removal impacted cerumen by irrigation/lavage, left Ambulatory Procedures 69209 $159.32 3322017 Removal impacted cerumen by irrigation/lavage, right Ambulatory Procedures 69209 $159.32 3398653 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia Ambulatory Procedures 97602 $502.88 $164.40 3282095 Remove eyelid lesion Ambulatory Procedures 67800 $351.60 3282096 Remove eyelid lesions Ambulatory Procedures 67801 $454.80 3282097 Remove eyelid lesions different lids Ambulatory Procedures 67805 $560.40 3282100 Remove eyelis lesion without closure Ambulatory Procedures 67840 $538.80 3282103 Remove eyelid foreign body Ambulatory Procedures 67938 $397.20 1021848 Repair Wound Simple Scalp Neck Trunk Ext 2.5cm or less Ambulatory Procedures 12001 $502.88 $152.40 1021849 Repair Wound Simple Scalp Neck Trunk Ext 2.6-7.5 cm Ambulatory Procedures 12002 $502.88 $200.40 1021850 Repair Wound Simple Scalp Neck Trunk Ext 7.6-12.5cm Ambulatory Procedures 12004 $502.88 $250.80 1021851 Repair Wound Simple Scalp Neck Trunk Ext 12.6-20cm Ambulatory Procedures 12005 $895.13 $325.20 1021852 Repair Wound Simple Scalp Neck Trunk Ext 20.1-30cm Ambulatory Procedures 12007 $502.88 $498.00 1021853 Repair Wound Simple Face Ears Nose 2.5cm or less Ambulatory Procedures 12011 $502.88 $188.40 1021854 Repair Wound Simple Face Ears Nose 2.6-5.0cm Ambulatory Procedures 12013 $502.88 $199.20 1021855 Repair Wound Simple Face Ears Nose 5.1-7.5cm Ambulatory Procedures 12014 $502.88 $256.80 1021856 Repair Wound Simple Face Ears Nose 7.6-12.5cm Ambulatory Procedures 12015 $502.88 $322.80 1021857 Repair Wound Simple Face Ears Nose 12.6-20cm Ambulatory Procedures 12016 $895.13 $440.40 1021858 Repair Wound Simple Face Ears Nose 20.1-30cm Ambulatory Procedures 12017 $895.13 $520.80 1021862 Repair Wound Intermediate; Scalp/Axillae/Trunk/Arms/Legs 12.6 cm to 20.0 cm Ambulatory Procedures 12035 $895.13 $829.20 3144005 Repair of Spica, Body Cast/Jacket Ambulatory Procedures 29720 $383.67 $153.60 3144050 Repair Wound Intermediate; Neck/Hands/Feet/External Genitalia 2.5 cm or Less Ambulatory Procedures 12041 $895.13 $514.80 3144051 Repair Wound Intermediate; Neck/Hands/Feet/External Genitalia 2.6 cm to 7.5 cm Ambulatory Procedures 12042 $895.13 $690.00 3144053 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips 2.5 cm or less Ambulatory Procedures 12055 $895.13 $1,040.40 3144054 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips 2.6-5.0 cm Ambulatory Procedures 12052 $895.13 $702.00 3144055 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips 20.1-30 cm Ambulatory Procedures 12056 $895.13 $1,320.00 3144056 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips 5.1-7.5 cm Ambulatory Procedures 12053 $895.13 $751.20 3144057 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips 7.6-12.5 cm Ambulatory Procedures 12054 $895.13 $764.40 3144058 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips 2.5 cm or less Ambulatory Procedures 12051 $895.13 $590.40 3144060 Repair Wound Intermediate; Scalp/Axillae/Trunk/Arms/Legs 2.5 cm or less Ambulatory Procedures 12031 $895.13 $528.00 3144061 Repair Wound Intermediate; Scalp/Axillae/Trunk/Arms/Legs 2.6 cm to 7.5 cm Ambulatory Procedures 12032 $895.13 $669.60 3144062 Repair Wound Intermediate; Scalp/Axillae/Trunk/Arms/Legs 20.1 cm to 30.0 cm Ambulatory Procedures 12036 $1,376.24 $966.00 3144063 Repair Wound Intermediate; Scalp/Axillae/Trunk/Arms/Legs 7.6 cm to 12.5 cm Ambulatory Procedures 12034 $895.13 $715.20 3312655 Repair of nail bed Ambulatory Procedures 11760 $1,376.24 $392.40 3323005 Repair Wound Simple Face Ears Nose over 30.0 cm Ambulatory Procedures 12018 $502.88 $590.40 3323006 Repair Wound Simple Scalp Neck Trunk Ext 20.1-30.0 cm Ambulatory Procedures 12006 $895.13 $399.60 3323470 Repair Wound Intermediate; Face/Ears/Eyelids/Nose/Lips over 30.0 cm Ambulatory Procedures 12057 $895.13 $1,465.20 3323471 Repair Wound Intermediate; Neck/Hands/Feet/External Genitalia 12.6 cm to 20.0 cm Ambulatory Procedures 12045 $1,376.24 $925.20 3323473 Repair Wound Intermediate; Neck/Hands/Feet/External Genitalia 20.1 cm to 30.0 cm Ambulatory Procedures 12046 $895.13 $1,076.40 3323475 Repair Wound Intermediate; Neck/Hands/Feet/External Genitalia over 30.0 cm Ambulatory Procedures 12047 $4,414.54 $1,198.80 3323477 Repair Wound Intermediate; Scalp/Axillae/Trunk/Arms/Legs over 30.0 cm Ambulatory Procedures 12037 $4,414.54 $1,129.20 3321323 Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure Ambulatory Procedures 66825 $5,463.91 $2,622.00 3282099 Revise eyelashes Ambulatory Procedures 67820 $118.80 3282106 Revision of cornea Ambulatory Procedures 65600 $1,168.80 3282109 Revision of iris Ambulatory Procedures 66761 $805.20 3144165 Rigid Total Contact Leg Cast Ambulatory Procedures 29445 $671.40 $352.80 1019814 Routine Venipuncture Ambulatory Procedures 36415 $15.00 3144156 Routine Foot Care of a Patient with Diabetes and Loss of Protective Sensation Ambulatory Procedures G0247 $502.88 $78.00 3271572 S2083 Adjustment of Gastric Band Ambulatory Procedures S2083 $400.00 $400.00 3312672 Scraping of cornea, diagnostic, for smear and/or culture Ambulatory Procedures 65430 $992.26 $352.80 3472674 Sensorimotor exam w/ multiple measurements of ocular deviation w/interp. & report Ambulatory Procedures 92060 $159.32 $129.60 3282085 Serial tonometry Ambulatory Procedures 92100 $115.20 1021788 Shave 1 Lesion; Trunk, Arms Or Legs (0.5 cm Or Less) Ambulatory Procedures 11300 $502.88 $121.20 1021791 Shave 1 Lesion; Trunk, Arms Or Legs (0.6 To 1.0 cm) Ambulatory Procedures 11301 $502.88 $183.60 1021793 Shave 1 Lesion; Trunk, Arms Or Legs (1.1 To 2.0 cm) Ambulatory Procedures 11302 $502.88 $216.00 1021796 Shave 1 Lesion; Scalp, Neck, Hands, Feet, Genitalia (0.5 cm Or Less) Ambulatory Procedures 11305 $502.88 $134.40 1021798 Shave 1 Lesion; Scalp, Neck, Hands, Feet, Genitalia (0.6 -1.0 cm) Ambulatory Procedures 11306 $502.88 $178.80 1021800 Shave 1 Lesion; Scalp, Neck, Hands, Feet, Genitalia (1.1 -2.0 cm) Ambulatory Procedures 11307 $502.88 $230.40 3312877 Shave skin lesion of scalp/neck/hands/feet/genitals >2cm Ambulatory Procedures 11308 $895.13 $256.80 3312880 Shaving skin lesion over 2.0 cm Ambulatory Procedures 11303 $895.13 $255.60 3312886 Shaving skin lesion of face/ mucous membrane >2 cm (single lesion) Ambulatory Procedures 11313 $895.13 $346.80 3312887 Shaving skin lesion of face/ mucous membrane 1.1-2cm (single lesion) Ambulatory Procedures 11312 $895.13 $267.60 3336754 Shaving skin lesion of face/ mucous membrane 0.5cm or less (single lesion) Ambulatory Procedures 11310 $502.88 $163.20 3522419 Shaving skin lesion of face/mucous membrane 0.6-1.0 cm (single lesion) Ambulatory Procedures 11311 $502.88 $225.60 3525152 Shirmer Test Ambulatory Procedures 92499 $48.93 $344.40 3144079 Short Arm Cast (Elbow to Finger) Ambulatory Procedures 29075 $671.00 $212.40 3144080 Short Leg Cast (Below Knee to Toes) Ambulatory Procedures 29405 $671.40 $204.00 3144264 Shoulder Immobilizer amb Ambulatory Procedures A4565 $59.90 3252300 Simple Cystometrogram (CMG) Ambulatory Procedures 51725 $659.55 $262.80 3282079 Special eye evaluation Ambulatory Procedures 92020 $72.00 3282086 Special eye exam initial Ambulatory Procedures 92225 $73.20 3504058 Spinal puncture,therapeutic,for drainage of cerebrospinal fluid(by needle or catheter) Ambulatory Procedures 62272 $1,706.61 $289.20 3144114 Spirometry, Including Vital Capacity, Expiratory Flow Rate Ambulatory Procedures 94010 $387.46 3144238 Spirometry Simple Ambulatory Procedures 94010 $387.46 3144162 Strapping, Ankle and/or Foot Ambulatory Procedures 29540 $383.67 $62.40 3144163 Strapping, Toes Ambulatory Procedures 29550 $159.32 $39.60 3144020 Surgical Shoe Ambulatory Procedures L3260 $19.50 3144180 Talus Fx, Closed Tratment; w/out Manip Ambulatory Procedures 28430 $641.51 $721.20 3144181 Tarsal Bone Fx (Except Talus & Calcaneus); w/out Manip, each Ambulatory Procedures 28450 $641.51 $656.40 3144087 Therapeutic Phlebotomy Ambulatory Procedures 99195 $303.47 3144172 Tibial Fx, Proximal (Plateau); Closed Treatment; w/out Manip Ambulatory Procedures 27530 $641.51 $966.00 3144173 Tibial Shaft Fx (with or w/out Fibular Fx), Closed Treatment; w/out Manip Ambulatory Procedures 27750 $641.51 $1,093.20 3312893 Transcervical fallopian tube catheter placement, diagnostic or therapeutic Ambulatory Procedures 58345 $6,729.62 $952.80 3143945 Trigger Point Injections, 3 or more Muscles Ambulatory Procedures 20553 $705.32 $148.80 3144148 Trigger Point Injection(s); Single/Multiple, 1-2 Muscles Ambulatory Procedures 20552 $705.32 $130.80 3144139 Trim Nondystrophic Nails, Any Number Ambulatory Procedures 11719 $159.32 $26.40 3144178 Trimalleolar Ankle Fx, Closed Treatment; w/out Manip Ambulatory Procedures 27816 $641.51 $993.60 3143966 Tympanometry Ambulatory Procedures 92567 $91.54 3385803 Tympanostomy, local or topical anesthetic Ambulatory Procedures 69433 $1,388.32 $450.00 3144115 UNNA Boot Application-LT Ambulatory Procedures 29580 $383.67 $94.80 3144116 UNNA Boot Application-RT Ambulatory Procedures 29580 $383.67 $94.80 3144017 Urodynamic Testing, Cystometrogram (CMG) Simple Ambulatory Procedures 51725 $659.55 $262.80 3144101 Urodynamic Test, Cystometrogram (CMG) Complex Ambulatory Procedures 51726 $659.55 $295.20 3143949 Vasectomy with follow/up Post-Vasectomy Semen Analysis Ambulatory Procedures 55250 $4,958.29 $789.60 3144273 Vision Testing amb Ambulatory Procedures 99173 $62.00 3144161 Visual Acuity Test, Quantitative, Bilateral Ambulatory Procedures 99173 $62.00 3282082 Visual field exam(s) Ambulatory Procedures 92081 $159.32 $55.20 3282084 Visual field exam(s) 3 isopters Ambulatory Procedures 92083 $303.47 $94.80 3472686 Visual fctn scr,auto/semi-auto bilat quant determination of visual acuity,ocular alignment,color vis Ambulatory Procedures 99172 $75.00 2410297 Vital Capacity Ambulatory Procedures 94150 $135.95 3468884 Vitrectomy, mech,pars plana approach; w/ removal of internal of subretinal membrane,incl, if perform Ambulatory Procedures 67043 $4,146.00 3561376 Walking boot, pneumatic and/or vacuum, w/wo joints, w/wo interface material prefab, off the shelf Ambulatory Procedures L4361 $837.60 3176345 Wart Removal, Up to 14 Lesions Ambulatory Procedures 17110 $502.88 $235.20 3323434 Wart Removal, 15 or more Lesions Ambulatory Procedures 17111 $502.88 $289.20 1021844 Wedge Exc Skin Of Nail Fold/Ingrown Toenail Ambulatory Procedures 11765 $895.13 $320.40 3144003 Wedging of Clubfoot Cast Ambulatory Procedures 29750 $671.40 $271.20 3144078 Wedging of Cast (Except Clubfoot Casts) Ambulatory Procedures 29740 $671.40 $242.40 3144004 Windowing of Cast Ambulatory Procedures 29730 $383.67 $152.40 3144220 Wound Packing Ambulatory Procedures 12021 $895.13 $477.60 3143962 Wrist Cock-Up Nonmolded Ambulatory Procedures L3908 $231.57 3544320 Wrist hand orthosis, wrist extension control, non-molded, prefab, off the shelf Ambulatory Procedures L3908 $196.62 3143964 Wrist/Hand/Finger Orthosis w/out Joints, Custom Ambulatory Procedures L3808 $929.54 3276513 ALD Television Caption Decoer Audiology Tx/Procedures V5271 3343437 Acoustic Reflex Testing, Threshold Audiology Tx/Procedures 92568 $86.95 $52.80 BLOOD BANK ITEMS 3254621 1 - # of Panels Blood Bank 86870 $98.00 3254620 2 - # of Panels Blood Bank 86870 $196.00 3254619 3 - # of Panels Blood Bank 86870 $294.00 3254618 4 - # of Panels Blood Bank 86870 $392.00 3254617 5 - # of Panels Blood Bank 86870 $490.00 3254679 AB4 - Test Code Blood Bank 86905 $31.00 634326 ABO/Rh Blood Bank 86900 $32.00 2438298 ABO/Rh Blood Bank 86900 $10.52 634329 Antibody Screen Tube Blood Bank 86850 $58.00 1173830 Antibody Identification Interp Blood Bank 86870 $98.00 3106298 Antibody Screen Gel Blood Bank 86850 $58.00 3192703 Antibody Screen Gel Blood Bank 86850 $27.84 1173874 Antigen Type Interp Blood Bank $55.00 3106436 Bill Only Auto Handling Fee Blood Bank 86890 $232.00 3133129 Bill Only Unit Ag Type Blood Bank 86902 $42.61 3254598 Compatible - Crossmatch AHG Interpretation Blood Bank 86922 $98.00 3254599 Compatible - Crossmatch Tube Interpretation Blood Bank 86922 $98.00 3254600 Compatible - Serological Immediate Spin Blood Bank 86920 $98.00 3254593 Computer XM OK - Computer Crossmatch Interp Blood Bank 86923 $42.61 3106300 Cord ABO/Rh Tube Blood Bank 86900 $32.00 3106302 Cord DAT Blood Bank 86880 $41.00 669591 Crossmatch Blood Bank 86920 $312.80 3133263 Crossmatch AHG Interpretation Blood Bank 86922 $98.00 634331 DAT IgG Blood Bank 86880 $41.00 1173770 DAT Poly Blood Bank 86880 $41.00 3254678 FY1 - Test Code Blood Bank 86905 $73.00 3254677 FY2 - Test Code Blood Bank 86905 $73.00 3134663 Fetal Hemoglobin Stain (R) Blood Bank 85460 $59.00 3254676 JK1 - Test Code Blood Bank 86905 $73.00 3254675 JK2 - Test Code Blood Bank 86905 $73.00 3254674 K1 - Test Code Blood Bank 86905 $43.00 3254673 K2 - Test Code Blood Bank 86905 $31.00 3254672 LE1 - Test Code Blood Bank 86905 $85.00 3254671 LE2 - Test Code Blood Bank 86905 $85.00 3254670 MS1 - Test Code Blood Bank 86905 $84.00 3254669 MS2 - Test Code Blood Bank 86905 $43.00 3254668 MS3 - Test Code Blood Bank 86905 $85.00 3254667 MS4 - Test Code Blood Bank 86905 $43.00 3254666 OTH - Test Code Blood Bank 86905 $60.00 3254665 P1 - Test Code Blood Bank 86905 $85.00 3254856 PLT Bill Irradiated Blood Bank P9040 $813.00 3254643 Patient - Bill Ag Blood Bank 86905 $42.61 3254664 RH2 - Test Code Blood Bank 86905 $31.00 3254663 RH3 - Test Code Blood Bank 86905 $31.00 3254662 RH4 - Test Code Blood Bank 86905 $43.00 3254661 RH5 - Test Code Blood Bank 86905 $43.00 3254660 RH8 - Test Code Blood Bank 86905 $60.00 2438297 Type and Screen Blood Bank $32.00 3254644 Unit - Bill Ag Blood Bank 86902 $42.61 3133154 ARBC CPD 500 LR Blood Bank Product P9016 $555.35 3133220 ARBC CPD AS1 500 LR Blood Bank Product P9016 $555.35 3133216 ARBC LR Washed Op Blood Bank Product P9022 $814.50 3133158 Aph ARBC ACDA AS1 LR Blood Bank Product P9016 $555.35 3133159 Aph ARBC ACDA AS3 LR Blood Bank Product P9016 $555.35 3133187 Aph ARBC CP2D AS3 LR 2 Blood Bank Product P9016 $555.35 3133193 Aph ARBC CP2D AS3 LR 1 Blood Bank Product P9016 $555.35 3133208 Aph ARBC CP2D AS3 LR Blood Bank Product P9016 $555.35 3133211 Aph ARBC ACDA AS3 LR 2 Blood Bank Product P9016 $555.35 3133223 Aph ARBC ACDA AS3 LR 1 Blood Bank Product P9016 $555.35 3133163 Aph DRBC CP2D AS3 LR 1 Blood Bank Product P9016 $555.35 3133164 Aph DRBC ACDA AS3 LR 2 Blood Bank Product P9016 $555.35 3133170 Aph DRBC CP2D AS3 LR Blood Bank Product P9016 $555.35 3133181 Aph DRBC ACDA AS3 LR 1 Blood Bank Product P9016 $555.35 3133184 Aph DRBC ACDA AS3 LR Blood Bank Product P9016 $555.35 3133191 Aph DRBC CP2D AS3 LR 2 Blood Bank Product P9016 $555.35 3133204 Aph DRBC ACDA AS1 LR Blood Bank Product P9016 $555.35 3133179 Aph FFP Thawed ACDA Blood Bank Product P9017 $237.50 3133182 Aph FFP Thawed NaCitrate Op Blood Bank Product P9017 $237.50 3143875 Aph FFP Thawed NaCitrate Op Dv Blood Bank Product P9017 $237.50 3143876 Aph FFP Thawed CP2D Dv Blood Bank Product P9017 $237.50 3140717 Aph FP 24 Thawed ACDA Dv Blood Bank Product P9017 $237.50 3133156 Aph Plt ACDA LR <3 X log 11 3 Blood Bank Product P9035 $1,534.75 3133161 Aph Plt LR Irr Washed Op Blood Bank Product P9037 $1,867.69 3133165 Aph Plt ACDA LR Irr 1 Blood Bank Product P9037 $1,867.69 3133166 Aph Plt ACDA LR Blood Bank Product P9035 $1,534.75 3133173 Aph Plt ACDA LR <3 X log 11 2 Blood Bank Product P9035 $1,534.75 3133176 Aph Plt LR Irr Washed 3 Op Blood Bank Product P9037 $1,867.69 3133177 Aph Plt ACDA LR Irr <3 X log 11 Blood Bank Product P9037 $1,867.69 3133183 Aph Plt ACDA LR Irr Blood Bank Product P9037 $1,867.69 3133185 Aph Plt LR Washed 3 Op Blood Bank Product P9035 $1,534.75 3133188 Aph Plt ACDA LR <3 X log 11 Blood Bank Product P9035 $1,534.75 3133189 Aph Plt ACDA LR 1 Blood Bank Product P9035 $1,534.75 3133194 Aph Plt LR Washed 1 Op Blood Bank Product P9035 $1,534.75 3133197 Aph Plt ACDA LR Irr 3 Blood Bank Product P9037 $1,867.69 3133201 Aph Plt LR Washed Op Blood Bank Product P9035 $1,534.75 3133203 Aph Plt LR Irr Washed 2 Op Blood Bank Product P9037 $1,867.69 3133209 Aph Plt ACDA LR 3 Blood Bank Product P9035 $1,534.75 3133212 Aph Plt LR Washed 2 Op Blood Bank Product P9035 $1,534.75 3133213 Aph Plt ACDA LR Irr 2 Blood Bank Product P9037 $1,867.69 3133221 Aph Plt ACDA LR Irr <3 X log 11 3 Blood Bank Product P9037 $1,867.69 3133222 Aph Plt LR Irr Washed 1 Op Blood Bank Product P9037 $1,867.69 3133225 Aph Plt ACDA LR 2 Blood Bank Product P9035 $1,534.75 3133227 Aph Plt ACDA LR Irr <3 X log 11 2 Blood Bank Product P9037 $1,867.69 3133153 Aph RBC CP2D AS3 LR Irr 2 Blood Bank Product P9040 $706.34 3133155 Aph RBC CP2D AS3 LR Irr Blood Bank Product P9040 $706.34 3133167 Aph RBC ACDA AS3 LR Blood Bank Product P9016 $555.35 3133168 Aph RBC ACDA AS1 LR Blood Bank Product P9016 $555.35 3133174 Aph RBC ACDA AS3 LR Irr Blood Bank Product P9040 $706.34 3133180 Aph RBC CP2D AS3 LR 2 Blood Bank Product P9016 $555.35 3133186 Aph RBC ACDA AS3 LR 2 Blood Bank Product P9016 $555.35 3133192 Aph RBC ACDA AS1 LR Irr Blood Bank Product P9040 $706.34 3133196 Aph RBC CP2D AS3 LR 1 Blood Bank Product P9016 $555.35 3133199 Aph RBC CP2D AS3 LR Irr 1 Blood Bank Product P9040 $706.34 3133205 Aph RBC ACDA AS3 LR Irr 2 Blood Bank Product P9040 $706.34 3133210 Aph RBC CP2D AS3 LR Blood Bank Product P9016 $555.35 3133219 Aph RBC ACDA AS3 LR 1 Blood Bank Product P9016 $555.35 3133226 Aph RBC ACDA AS3 LR Irr 1 Blood Bank Product P9040 $706.34 1378500 Cryo Thawed AHF Blood Bank Product P9012 $143.90 3133202 DRBC CPD 500 LR Blood Bank Product P9016 $555.35 3133228 DRBC CPD AS1 500 LR Blood Bank Product P9016 $555.35 3133218 DRBC LR Washed Op Blood Bank Product P9022 $814.50 3133190 FFP Thawed CPD Blood Bank Product P9017 $237.50 3140279 OP Blood Transfusion 0-1 hr Blood Bank Product 36430 $350.00 3140280 OP Blood Transfusion 0-2 hrs Blood Bank Product 36430 $420.00 3140281 OP Blood Transfusion 0-4 hrs Blood Bank Product 36430 $490.58 3140282 OP Blood Transfusion 0-6 hrs Blood Bank Product 36430 $584.03 3140283 OP Blood Transfusion 0-8 hrs Blood Bank Product 36430 $680.00 3133157 Plasma Thawed CPD <=24H Blood Bank Product P9059 $237.50 3133178 Pooled 5 Thawed Cryo Blood Bank Product P9012 $143.90 3133198 Pooled 10 Thawed Cryo Blood Bank Product P9012 $143.90 3133162 RBC CPD 500 LR Irr Blood Bank Product P9040 $706.34 3133195 RBC CPD 500 LR Blood Bank Product P9016 $555.35 3133206 RBC CPD AS1 500 LR Blood Bank Product P9016 $555.35 3133215 RBC CPD AS1 500 LR Irr Blood Bank Product P9040 $706.34 3133200 RBC LR Washed Op Blood Bank Product P9022 $814.50 CARDIOLOGY PROCEDURES 3318414 ED EKG Cardiology 93005 $77.69 2322784 ED Electrocardiogram Cardiology 93010 $36.00 3251006 EEG Ambulatory 24 Cardiology 95953 $1,130.08 $559.20 3251007 EEG Ambulatory 72 Cardiology 95953 $1,130.08 $559.20 3251008 EEG Ambulatory-48 Cardiology 95953 $1,130.80 $559.20 3150585 EKG 12-Lead Cardiology 93005 $77.69 3275643 EKG 15-Lead Cardiology 93005 $77.69 3127321 EKG Rhythm Strip Cardiology 93042 $35.00 3187141 EKG Rhythm Strip Cardiology 93041 $52.50 2322786 Electrocardiogram - WWH Cardiology 93010 $36.00 3304264 Electrocardiogram Cardiology 93005 $77.69 3325277 Electrocardiogram - Clinic Cardiology 93010 $36.00 3500862 Electrocardiogram Clinic Cardiology 93005 $77.69 2322789 Holter Monitor 24 hr - WWH Cardiology 93227 $84.70 3127309 Holter Monitor 48 hr - WWH Cardiology 93227 $84.70 3127310 Holter Monitor 72 hr - WWH Cardiology 93227 $84.70 3127311 Holter Monitor 96 hr - WWH Cardiology 93227 $84.70 3128614 Holter Monitor 96 hr Cardiology 93226 $188.81 3130530 Holter Monitor 48 hr Cardiology 93226 $188.81 3130531 Holter Monitor 72 hr Cardiology 93226 $188.81 3277920 Holter Monitor 24 hr Cardiology 93226 $188.81 3382714 Holter Monitor 24 hr - Clinic Cardiology 93227 $84.70 3382715 Holter Monitor 48 hr - Clinic Cardiology 93227 $84.70 ITEMS DONE IN THE EMERGENCY ROOM 3213901 ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE Critical Care 49082 $1,376.07 3213902 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE Critical Care 49083 $1,376.07 3213921 ACCUCHECK, GLUCOSE Critical Care 82962 $9.38 3213946 ADMIN HEPATITIS B VACCINE Critical Care G0010 $27.80 3213770 ADMIN INJ; IM SUBQ Critical Care 96372 $120.58 3213771 ADMIN INJ; IM SUBQ-59 Critical Care 96372 $120.58 3213772 ADMIN INJ; IM SUBQ-KX Critical Care 96372 $120.58 3213773 ADMIN INJ; IA Critical Care 96373 $263.34 3213944 ADMIN INFLUENZA VIRUS VAC Critical Care G0008 $75.10 3213945 ADMIN PNEUMOCOCCAL VACCINE Critical Care G0009 $75.10 3213917 ALCOHOL(ETHAN);NON-BREATH SPEC Critical Care $51.00 3213838 APPL SHORT ARM SPLINT;STATIC Critical Care 29125 $259.86 3213835 APPLICATION CAST SHOULDER HAND LONG ARM Critical Care 29065 $592.46 3213836 APPLICATION CAST ELBOW FINGER SHORT ARM Critical Care 29075 $592.46 3213837 APPLICATION LONG ARM SPLINT SHOULDER HAND Critical Care 29105 $339.83 3213840 APPLICATION LONG LEG CAST THIGH-TOE Critical Care 29345 $592.46 3213841 APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE Critical Care 29355 $592.46 3213842 APPLICATION CYLINDER CAST THIGH ANKLE Critical Care 29365 $592.46 3213843 APPLICATION SHORT LEG CAST BELOW KNEE-TOE Critical Care 29405 $592.46 3213844 APPLICATION SHORT LEG CAST WALKING/AMBULATORY Critical Care 29425 $592.46 3213845 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES Critical Care 29505 $339.83 3522755 APPLICATION UNNA BOOT - LT Critical Care 29580 $135.41 3522762 APPLICATION UNNA BOOT - RT Critical Care 29580 $135.41 3213839 APPLY FINGER SPLINT; STATIC Critical Care 29130 $159.43 3213897 ARTERIAL PUNCTURE Critical Care 36600 $259.86 3213823 ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA Critical Care 20600 $637.72 3213824 ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS Critical Care 20605 $637.72 3213825 ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA Critical Care 20610 $637.72 3213903 ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER Critical Care 51102 $4,293.30 3213789 AUDIT/DAST, 15-30 MIN Critical Care 99408 $198.50 3213790 AUDIT/DAST, OVER 30 MIN Critical Care 99409 $356.36 3213948 AUDIT/DAST BRIEF INTERV;15-30M Critical Care G0396 $198.50 3213949 AUDIT/DAST INTERVENTION; 30+M Critical Care G0397 $356.36 3213805 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 Critical Care 11730 $335.82 3213891 BLOOD DRAW IMPLANTED VAD Critical Care 36591 $259.86 3213892 BLOOD DRAW PICC-NON-IMPLNT VAD Critical Care 36592 $259.86 3213820 BURN DRSG,SMALL Critical Care 16020 $335.82 3213821 BURN DRSG,MED(EXTRE,FACE) Critical Care 16025 $642.82 3213822 BURN DRSG,LG(>1 EXTREM) Critical Care 16030 $642.82 3213930 CARDIOPULMONARY RESUSCITATION Critical Care 92950 $628.00 3213932 CARDIOVERSION, ELECTIVE Critical Care 92960 $1,331.21 3213939 CBT; 1ST HOUR Critical Care 94644 $259.86 3213940 CBT; EACH ADDL HOUR Critical Care 94645 $259.86 3213782 CHEMO ADM SQ IM;ANTI-NEOPL Critical Care 96401 $263.34 3213783 CHEMO ADM SQ IM;ANTI-NEOPL-59 Critical Care 96401 $263.34 3213784 CHEMO ADM SQ IM;ANTI-NEOPL-KX Critical Care 96401 $263.34 3213785 CHEMO ADM SQ IM;HORM ANTI-NEO Critical Care 96402 $120.58 3213786 CHEMO ADM SQ IM;HORM ANTI-NEO-59 Critical Care 96402 $120.58 3213833 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA Critical Care 27560 $491.14 3213834 CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA Critical Care 27562 $676.88 3366670 CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC;WITHOUT ANESTHESIA Critical Care 27250 $491.14 3468881 CLOSED TX METACARPOPHALANGEAL DISLOCATION, SINGLE, W/MANIPULATION W/O ANES Critical Care 26700 $676.88 3522721 CLOSED TX CLAVICLE FX W/O MANIP Critical Care 23500 $214.89 3522723 CLOSED TX ULNA SHAFT FX W/O MANIP Critical Care 25530 $214.89 3522725 CLOSED TX DISTAL RADIUS/ULNA FX W/O MANIP Critical Care 25600 $214.89 3522727 CLOSED TX CARPAL SCAPHOID FX W/O MANIP Critical Care 25622 $214.89 3522729 CLOSED TX CARPAL BONE FX W/O MANIP, EA. BONE Critical Care 25630 $214.89 3522731 CLOSED TX ULNAR STYLOID FX Critical Care 25650 $214.89 3522733 CLOSED TX METACARPAL FX, SNGL W/O MANIP, EA. BONE Critical Care 26600 $214.89 3522735 CLOSED TX METACARPAL FX, SNGL WI/ MANIP, EA. BONE Critical Care 26605 $214.89 3522737 CLOSED TX PHALANGEAL SHAFT FX, PROX/MID, FNGR/THMB, W/O MANIP, EA. Critical Care 26720 $214.89 3522739 CLOSED TX ARTICULAR FX, MCP/IP JOINT, W/O MANIP, EA. Critical Care 26740 $214.89 3522741 CLOSED TX DISTAL PHALANGEAL FX, FNGR/THMB, W/O MANIP, EA. Critical Care 26750 $214.89 3522743 CLOSED TX METATARSAL FX, W/O MANIP, EA. Critical Care 28470 $214.89 3522745 CLOSED TX FX GREAT TOE PHALANX/PHALANGES, W/O MANIP Critical Care 28490 $214.89 3522747 CLOSED TX FX GREAT TOE PHALANX/PHALANGES, WI/ MANIP Critical Care 28495 $214.89 3522749 CLOSED TX FX PHALANX/PHALANGES, OTHER THAN GREAT TOE, W/O MANIP, EA. Critical Care 28510 $214.89 3522751 CLOSED TX FX PHALANX/PHALANGES, OTHER THAN GREAT TOE, WI/ MANIP, EA. Critical Care 28515 $214.89 3522753 CLOSED TX SESAMOID FX Critical Care 28530 $214.89 3562582 CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA Critical Care 27252 $3,847.04 3562814 CLOSED TX ACUTE OR CHRONIC ELBOW DISLOCATION Critical Care 24615 $5,606.03 3213826 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES Critical Care 23650 $491.14 3213827 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES Critical Care 23655 $3,124.88 3213831 CLTX IPHAL JT DISLC W/MANJ W/O ANES Critical Care 26770 $491.14 3213832 CLTX IPHAL JT DISLC W/MANJ REQ ANES Critical Care 26775 $592.46 3213830 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ Critical Care 24640 $676.88 3213856 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE Critical Care 30901 $259.86 3213857 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX Critical Care 30903 $368.48 3213744 CRITICAL CARE; FIRST HOUR Critical Care 99291 $1,898.87 3213745 CRITICAL CARE;EA ADDL 30 MIN Critical Care 99292 $949.44 3213858 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST Critical Care 30905 $368.48 3213859 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ Critical Care 30906 $368.48 3336008 Closed Treatment of Radial and Ulnar Shaft Fractures; without Manipulation Critical Care $491.14 3213893 DECLOT VAD/VAC THROMB AGENT Critical Care 36593 $569.43 3213941 DEMO/EVAL AEROSOL/NEB/MDI/IPPB Critical Care 94664 $425.96 3213934 EKG;12 LEAD TRACING ONLY Critical Care 93005 $159.43 3213935 EKG;12 LEAD TRACING ONLY-76 Critical Care 93005 $159.43 3213734 EMERGENT VISIT LEVEL 1 Critical Care 99281 $169.01 3213736 EMERGENT VISIT LEVEL 2 Critical Care 99282 $312.08 3213738 EMERGENT VISIT LEVEL 3 Critical Care 99283 $558.54 3213740 EMERGENT VISIT LEVEL 4 Critical Care 99284 $931.92 3213742 EMERGENT VISIT LEVEL 5 Critical Care 99285 $1,385.21 3213735 ER VISIT/PROC; LEVEL I Critical Care 99281 $169.01 3213737 ER VISIT/PROC; LEVEL II Critical Care 99282 $312.08 3213739 ER VISIT/PROC; LEVEL III Critical Care 99283 $558.54 3213741 ER VISIT/PROC; LEVEL IV Critical Care 99284 $931.92 3213743 ER VISIT/PROC; LEVEL V Critical Care 99285 $1,385.21 3213806 EVACUATION SUBUNGUAL HEMATOMA Critical Care 11740 $159.43 3213898 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE Critical Care 43753 $628.00 3213916 HCG, QUAL Critical Care 81025 $24.71 3522764 I & D BARTHOLINS GLAND ABSCESS Critical Care 56420 $160.69 3213803 I&D HEMATOMA SEROMA/FLUID COLLECTION Critical Care 10140 $2,684.64 3213899 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX Critical Care 46040 $4,735.28 3213928 IMMUN ADMIN NASAL/ORAL;1 Critical Care 90473 $75.10 3213929 IMMUN ADMIN NASAL/ORAL;EA ADDL Critical Care 90474 $42.00 3213927 IMMUNIZATION ADMIN;EA ADDL VAC Critical Care 90472 $75.10 3213798 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE Critical Care 10060 $335.82 3213799 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE Critical Care 10061 $650.57 3213800 INCISION & DRAINAGE PILONIDAL CYST SIMPLE Critical Care 10080 $650.57 3213801 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE Critical Care 10120 $642.82 3213802 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL Critical Care 10121 $4,030.70 3213900 INCISION THROMBOSED HEMORRHOID EXTERNAL Critical Care 46083 $588.84 3213819 INITIAL TX 1ST DEGREE BURN LOCAL TX Critical Care 16000 $335.82 3213874 INS TUN CV DEV W-2-ACC WO PORT Critical Care 36565 $6,404.89 3213875 INS TUN CV DEV W-2-ACC W PORT Critical Care 36566 $10,816.55 3213867 INSERT NON TUNNEL CV CATH < 5 Critical Care 36555 $2,458.15 3213868 INSERT NON TUNNEL CV CATH 5 > Critical Care 36556 $2,458.15 3213869 INSERT TUNN CV CATH WO PORT <5 Critical Care 36557 $6,404.89 3213870 INSERT TUNN CV CATH WO PORT 5> Critical Care 36558 $6,404.89 3213871 INSERT TUNN CV DEV W PORT < 5 Critical Care 36560 $6,404.89 3213872 INSERT TUNN CV DEV W PORT > 5 Critical Care 36561 $6,404.89 3213873 INSERT TUNN CV DEV W PUMP Critical Care 36563 $10,816.55 3213876 INSERT CV CATH PICC WO PORT, WO IMAGE GUIDANCE, <5 YRS Critical Care 36568 $1,767.03 3213877 INSERT CV CATH PICC WO PORT, WO IMAGE GUIDANCE, 5> YRS Critical Care 36569 $3,116.85 3213878 INSERT CV DEV W PORT < 5 Critical Care 36570 $6,404.89 3213879 INSERT CD DEV W PORT 5 > Critical Care 36571 $6,404.89 3213904 INSERT NON-INDWELLING BLADDER Critical Care 51701 $259.86 3213905 INSERT TEMP INDWELL CATH;SIMPL Critical Care 51702 $259.86 3566672 INSERT CV CATH PICC WO PORT, WITH IMAGE GUIDANCE, <5 YRS Critical Care 36572 $1,767.03 3566673 INSERT CV CATH PICC WO PORT, WITH IMAGE GUIDANCE, 5> YRS Critical Care 36573 $3,116.85 3213860 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE Critical Care 31500 $368.48 3213797 IPECAC ADMINISTRATION Critical Care 99175 $148.00 3213764 IV CONCURRENT DRUG INFUSION Critical Care 96368 $91.00 3213765 IV CONCURRENT DRUG INFUSION-59 Critical Care 96368 $91.00 3213753 IV DRUG INFUSION;1ST HR Critical Care 96365 $493.56 3213756 IV DRUG INFUSION;1ST HR-59 Critical Care 96365 $493.56 3213758 IV DRUG INFUSION;1ST HR-KX Critical Care 96365 $493.56 3213759 IV DRUG INFUSION;EA ADDL HR Critical Care 96366 $87.98 3213760 IV DRUG INFUSION;EA ADDL HR-59 Critical Care 96366 $87.98 3213747 IV HYDRATION INITIAL 31M-1H Critical Care 96360 $263.34 3213748 IV HYDRATION INITIAL 31M-1H-59 Critical Care 96360 $263.34 3213750 IV HYDRATION EA ADDL HR Critical Care 96361 $87.98 3213752 IV HYDRATION EA ADDL HR-59 Critical Care 96361 $87.98 3213774 IV PUSH INIT Critical Care 96374 $263.34 3213775 IV PUSH INIT-59 Critical Care 96374 $263.34 3213777 IV PUSH INIT-KX Critical Care 96374 $263.34 3213778 IV PUSH DIFF DRUG Critical Care 96375 $120.58 3213779 IV PUSH DIFF DRUG-59 Critical Care 96375 $120.58 3213780 IV PUSH SAME DRUG Critical Care 96376 $120.00 3213781 IV PUSH SAME DRUG-59 Critical Care 96376 $120.00 3213761 IV SEQ NEW DRUG INFSN;1ST HR Critical Care 96367 $120.58 3213762 IV SEQ NEW DRUG INFSN;1ST H-59 Critical Care 96367 $120.58 3213861 LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC Critical Care 31575 $402.73 3213862 LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY Critical Care 31577 $1,069.12 3213894 MECH REMOVE FB CV DEV SEP ACC Critical Care 36595 $6,404.89 3213895 MECH REMOVE FB CV DEV IN LUMEN Critical Care 36596 $2,458.15 3213918 OCCULT BLOOD;MULT SPEC/SGL DET Critical Care 82270 $12.71 3213919 OCCULT BLD;OTHER SOURCES Critical Care 82271 $12.71 3213920 OCCULT BLD;FECES 1-3 NON-NEO Critical Care 82272 $12.71 3213942 OXIMETRY;SGL DETERMINATION Critical Care 94760 $12.00 3213943 OXIMETRY;MULT DETERMINATION Critical Care 94761 $20.40 3522730 P - CLOSED TX ULNAR STYLOID FX Critical Care 25650 $1,027.20 3213959 P - EMERGENCY DEPT VISIT LOW/MOD SEVERITY Critical Care 99282 $140.40 3214071 P - ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE Critical Care 49082 $258.00 3214072 P - ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE Critical Care 49083 $378.00 3214040 P - APPLICATION CAST SHOULDER HAND LONG ARM Critical Care 29065 $237.60 3214041 P - APPLICATION CAST ELBOW FINGER SHORT ARM Critical Care 29075 $217.20 3214042 P - APPLICATION LONG ARM SPLINT SHOULDER HAND Critical Care 29105 $205.20 3214043 P - APPLICATION LONG LEG CAST THIGH-TOE Critical Care 29345 $350.40 3214044 P - APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE Critical Care 29355 $368.40 3214045 P - APPLICATION CYLINDER CAST THIGH ANKLE Critical Care 29365 $303.60 3214046 P - APPLICATION SHORT LEG CAST BELOW KNEE-TOE Critical Care 29405 $207.60 3214047 P - APPLICATION SHORT LEG CAST WALKING/AMBULATORY Critical Care 29425 $195.60 3214048 P - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES Critical Care 29505 $171.60 3522754 P - APPLICATION UNNA BOOT - LT Critical Care 29580 $99.60 3522761 P - APPLICATION UNNA BOOT - RT Critical Care 29580 $99.60 3522778 P - APPL SHORT ARM SPLINT;STATIC Critical Care 29125 $136.80 3522779 P - APPLY FINGER SPLINT; STATIC Critical Care 29130 $99.60 3214021 P - ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA Critical Care 20600 $122.40 3214023 P - ARTHORCENTESIS ASPIR&/INJECTION INTERM JT/BURS Critical Care 20605 $128.40 3214025 P - ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA Critical Care 20610 $159.60 3522782 P - ARTERIAL PUNCTURE Critical Care 36600 $54.00 3214073 P - ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER Critical Care 51102 $499.20 3213979 P - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 Critical Care 11730 $175.20 3214083 P - CARDIOPULMONARY RESUSCITATION Critical Care 92950 $639.60 3214038 P - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA Critical Care 27560 $1,156.80 3214039 P - CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA Critical Care 27562 $1,622.40 3366671 P - CLOSED TREATMENT OF HIP DISLOCATION,TRAUMATIC; WITHOUT ANESTHESIA Critical Care 27250 $625.20 3516162 P - CLOSED TX METACARPOPHALANGEAL DISLOCATION, SINGLE, W/MANIPULATION W/O ANES Critical Care 26700 $1,039.20 3522720 P - CLOSED TX CLAVICLE FX W/O MANIP Critical Care 23500 $760.80 3522722 P - CLOSED TX ULNA SHAFT FX W/O MANIP Critical Care 25530 $814.80 3522724 P - CLOSED TX DISTAL RADIUS/ULNA FX W/O MANIP Critical Care 25600 $1,065.60 3522726 P - CLOSED TX CARPAL SCAPHOID FX W/O MANIP Critical Care 25622 $955.20 3522728 P - CLOSED TX CARPAL BONE FX W/O MANIP, EA. BONE Critical Care 25630 $963.60 3522732 P - CLOSED TX METACARPAL FX, SNGL W/O MANIP, EA. BONE Critical Care 26600 $949.20 3522734 P - CLOSED TX METACARPAL FX, SNGL WI/ MANIP, EA. BONE Critical Care 26605 $1,004.50 3522736 P - CLOSED TX PHALANGEAL SHAFT FX, PROX/MID, FNGR/THMB, W/O MANIP, EA. Critical Care 26720 $631.20 3522738 P - CLOSED TX ARTICULAR FX, MCP/IP JOINT, W/O MANIP, EA. Critical Care 26740 $740.40 3522740 P - CLOSED TX DISTAL PHALANGEAL FX, FNGR/THMB, W/O MANIP, EA. Critical Care 26750 $631.20 3522742 P - CLOSED TX METATARSAL FX, W/O MANIP, EA. Critical Care 28470 $702.00 3522744 P - CLOSED TX FX GREAT TOE PHALANX/PHALANGES, W/O MANIP Critical Care 28490 $430.80 3522746 P - CLOSED TX FX GREAT TOE PHALANX/PHALANGES, WI/ MANIP Critical Care 28495 $513.60 3522748 P - CLOSED TX FX PHALANX/PHALANGES, OTHER THAN GREAT TOE, W/O MANIP, EA. Critical Care 28510 $412.80 3522750 P - CLOSED TX FX PHALANX/PHALANGES, OTHER THAN GREAT TOE, WI/ MANIP, EA. Critical Care 28515 $489.60 3522752 P - CLOSED TX SESAMOID FX Critical Care 28530 $356.40 3562581 P - CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA Critical Care 27252 $2,614.80 3562813 P - CLOSED TX ACUTE OR CHRONIC ELBOW DISLOCATION Critical Care 24615 $2,461.20 3214026 P - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES Critical Care 23650 $981.60 3214028 P - CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES Critical Care 23655 $1,388.40 3214033 P - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ Critical Care 24640 $318.00 3214036 P - CLTX IPHAL JT DISLC W/MANJ W/O ANES Critical Care 26770 $867.60 3214037 P - CLTX IPHAL JT DISLC W/MANJ REQ ANES Critical Care 26775 $1,191.60 3214057 P - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE Critical Care 30901 $195.60 3214058 P - CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX Critical Care 30903 $278.40 3213965 P - CRITICAL CARE; INIT 30-74M Critical Care 99291 $757.20 3213967 P - CRITICAL CARE; ADDL 30M Critical Care 99292 $379.20 3214059 P - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST Critical Care 30905 $369.60 3214060 P - CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ Critical Care 30906 $475.20 3213958 P - EMERGENCY DEPT VISIT LIMITED/MINOR PROB Critical Care 99281 $72.00 3213960 P - EMERGENCY DEPT VISIT MOD SEVERITY Critical Care 99283 $210.00 3213962 P - EMERGENCY DEPT VISIT HIGH/URGENT SEVERITY Critical Care 99284 $398.40 3213963 P - EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT Critical Care 99285 $588.00 3213981 P - EVACUATION SUBUNGUAL HEMATOMA Critical Care 11740 $112.80 3214068 P - GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE Critical Care 43753 $75.60 3522763 P - I & D BARTHOLINS GLAND ABSCESS Critical Care 56420 $309.60 3213977 P - I&D HEMATOMA SEROMA/FLUID COLLECTION Critical Care 10140 $405.60 3214069 P - I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX Critical Care 46040 $1,436.40 3213970 P - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE Critical Care 10060 $332.40 3213971 P - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE Critical Care 10061 $614.40 3213972 P - INCISION & DRAINAGE PILONIDAL CYST SIMPLE Critical Care 10080 $352.80 3213973 P - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE Critical Care 10120 $354.00 3213975 P - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL Critical Care 10121 $640.80 3214070 P - INCISION THROMBOSED HEMORRHOID EXTERNAL Critical Care 46083 $367.20 3214012 P - INITIAL TX 1ST DEGREE BURN LOCAL TX Critical Care 16000 $158.40 3214061 P - INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE Critical Care 31500 $380.40 3214062 P - LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC Critical Care 31575 $265.20 3214063 P - LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY Critical Care 31577 $520.80 3213978 P - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST Critical Care 10160 $330.00 3214049 P - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST Critical Care 29700 $115.20 3214050 P - REMOVAL/BIVALVING FULL ARM/FULL LEG CAST Critical Care 29705 $163.20 3214056 P - REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE Critical Care 30300 $363.60 3214078 P - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL Critical Care 65205 $150.00 3522771 P - REMOVAL IMPACTED CERUMEN INSTRUMENTATION, BILAT. Critical Care 69210 $169.20 3522773 P - REMOVAL IMPACTED CERUMEN INSTRUMENTATION - LT Critical Care 69210 $112.80 3522775 P - REMOVAL IMPACTED CERUMEN INSTRUMENTATION - RT Critical Care 69210 $112.80 3213983 P - REPAIR NAIL BED Critical Care 11760 $404.40 3214001 P - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< Critical Care 12031 $529.20 3214002 P - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM Critical Care 12032 $673.20 3214003 P - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< Critical Care 12041 $519.60 3214004 P - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM Critical Care 12042 $692.40 3214006 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< Critical Care 12051 $594.00 3214010 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM Critical Care 12052 $704.40 3214053 P - REPAIR SPICA BODY CAST/JACKET Critical Care 29720 $153.60 3327999 P - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20.0 CM Critical Care 12045 $930.00 3522697 P - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM Critical Care 12034 $718.80 3522699 P - REPAIR INTERMEDIATE S/A/T/E 12.6-20 CM Critical Care 12035 $830.40 3522701 P - REPAIR INTERMEDIATE S/A/T/E 20.1-30 CM Critical Care 12036 $969.60 3522703 P - REPAIR INTERMEDIATE S/A/T/E OVER 30 CM Critical Care 12037 $1,135.20 3522705 P - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5 CM Critical Care 12044 $744.00 3522707 P - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30 CM Critical Care 12046 $1,076.40 3522709 P - REPAIR INTERMEDIATE N/H/F/XTRNL GENT OVER 30 CM Critical Care 12047 $1,202.40 3522711 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM Critical Care 12053 $754.80 3522713 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM Critical Care 12054 $769.20 3522715 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20 CM Critical Care 12055 $1,051.20 3522718 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC OVER 30 CM Critical Care 12057 $1,490.40 3522781 P - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30 CM Critical Care 12056 $1,328.40 3214051 P - RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET Critical Care 29710 $288.00 3214079 P - RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR Critical Care 65210 $180.00 3214080 P - RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP Critical Care 65220 $144.00 3214081 P - RMVL FB XTRNL AUDITORY CANAL W/O ANES Critical Care 69200 $163.20 3522780 P - SHORT LEG SPLINT (PLASTER, FG) Critical Care 29515 $171.60 3213986 P - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< Critical Care 12001 $152.40 3213999 P - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< Critical Care 12011 $189.60 3214000 P - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM Critical Care 12013 $199.20 3522660 P - SIMPLE REPAIR F/E/E/N/L/M 5.1-7.5 CM Critical Care 12014 $256.80 3522689 P - SIMPLE REPAIR F/E/E/N/L/M 7.6-12.5 CM Critical Care 12015 $322.80 3522691 P - SIMPLE REPAIR F/E/E/N/L/M 12.6-20 CM Critical Care 12016 $439.20 3522693 P - SIMPLE REPAIR F/E/E/N/L/M 20.1-30 CM Critical Care 12017 $526.80 3522695 P - SIMPLE REPAIR F/E/E/N/L/M OVER 30 CM Critical Care 12018 $596.40 3213988 P - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM Critical Care 12002 $200.40 3522652 P - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM Critical Care 12004 $250.80 3522654 P - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 12.6-20CM Critical Care 12005 $326.40 3522656 P - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 20.1-30CM Critical Care 12006 $400.80 3522658 P - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK OVER 30CM Critical Care 12007 $504.00 3214077 P - SPINAL PUNCTURE LUMBAR DIAGNOSTIC Critical Care 62270 $270.00 3213968 P - SUPRVSN INTERFACILITY TRANSPORT INIT 30M Critical Care 99485 $259.20 3213969 P - SUPRVSN INTERFACILITY TRANSPORT ADDL 30M Critical Care 99486 $225.60 3214084 P - TEMPORARY TRANSCUTANEOUS PACING Critical Care 92953 $38.40 3214066 P - THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING Critical Care 32554 $310.80 3214067 P - THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING Critical Care 32555 $390.00 3214064 P - TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL Critical Care 31603 $780.00 3214030 P - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES Critical Care 24600 $1,147.20 3214031 P - TREATMENT CLOSED ELBOW DISLOCATION REQ ANES Critical Care 24605 $1,626.00 3214065 P - TUBE THORACOSTOMY INCLUDES WATER SEAL Critical Care 32551 $589.20 3214075 P - TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL Critical Care 59812 $1,024.80 3214076 P - TX MISSED ABORTION FIRST TRIMESTER SURGICAL Critical Care 59820 $1,233.60 3214082 P - US PREG UTER,2-3 TRI,SGL/1ST Critical Care 76805 $482.40 3214074 P - VAGINAL DELIVERY ONLY Critical Care 59409 $2,834.40 3213984 P - WEDGE EXCISION SKIN NAIL FOLD Critical Care 11765 $322.80 3214054 P - WEDGING CAST EXCEPT CLUBFOOT CASTS Critical Care 29740 $244.80 3214055 P - WEDGING CLUBFOOT CAST Critical Care 29750 $231.60 3213804 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST Critical Care 10160 $650.57 3213847 REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST Critical Care 29700 $592.46 3213848 REMOVAL/BIVALVING FULL ARM/FULL LEG CAST Critical Care 29705 $592.46 3213855 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE Critical Care 30300 $259.86 3213910 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL Critical Care 65205 $259.86 3522766 REMOVAL IMPACTED CERUMEN BY IRRIG/LAVAGE, BILAT. Critical Care 69209 $55.96 3522768 REMOVAL IMPACTED CERUMEN BY IRRIG/LAVAGE - LT Critical Care 69209 $55.96 3522770 REMOVAL IMPACTED CERUMEN BY IRRIG/LAVAGE - RT Critical Care 69209 $55.96 3522772 REMOVAL IMPACTED CERUMEN INSTRUMENTATION, BILAT. Critical Care 69210 $55.96 3522774 REMOVAL IMPACTED CERUMEN INSTRUMENTATION - LT Critical Care 69210 $55.96 3522776 REMOVAL IMPACTED CERUMEN INSTRUMENTATION - RT Critical Care 69210 $55.96 3213889 REMOVE TUN CV CATH WO PORT Critical Care 36589 $1,376.07 3213890 REMOVE TUN CV CATH W PORT Critical Care 36590 $2,458.15 3213807 REPAIR NAIL BED Critical Care 11760 $1,221.71 3213813 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< Critical Care 12031 $642.82 3213814 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM Critical Care 12032 $642.82 3213815 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< Critical Care 12041 $335.82 3213816 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM Critical Care 12042 $642.82 3213817 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< Critical Care 12051 $642.82 3213818 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM Critical Care 12052 $642.82 3213851 REPAIR SPICA BODY CAST/JACKET Critical Care 29720 $339.83 3213880 REPAIR CV CATH WO PORT Critical Care 36575 $1,376.07 3213881 REPAIR CV DEV W PORT Critical Care 36576 $2,458.15 3328207 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5 CM Critical Care 12044 $488.17 3522698 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM Critical Care 12034 $310.78 3522700 REPAIR INTERMEDIATE S/A/T/E 12.6-20 CM Critical Care 12035 $310.78 3522702 REPAIR INTERMEDIATE S/A/T/E 20.1-30 CM Critical Care 12036 $488.17 3522704 REPAIR INTERMEDIATE S/A/T/E OVER 30 CM Critical Care 12037 $1,568.32 3522706 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM Critical Care 12045 $488.17 3522708 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30 CM Critical Care 12046 $310.78 3522710 REPAIR INTERMEDIATE N/H/F/XTRNL GENT OVER 30 CM Critical Care 12047 $1,568.32 3522712 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM Critical Care 12053 $310.78 3522714 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM Critical Care 12054 $310.78 3522716 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20 CM Critical Care 12055 $310.78 3522717 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30 CM Critical Care 12056 $310.78 3522719 REPAIR INTERMEDIATE F/E/E/N/L&/MUC OVER 30 CM Critical Care 12057 $310.78 3213882 REPLACE CATH OF DEV W PORT Critical Care 36578 $6,404.89 3213883 REPLACE CV CAT W PORT SAME ACCREPLACE CV CAT W PORT SAME ACC Critical Care 36580 $2,458.15 3213896 REPOS CV CATH UNDER FLUORO Critical Care 36597 $2,458.15 3213936 RHYTHM ECG, 1-3 LEADS; TRACING Critical Care 93041 $86.95 3213911 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR Critical Care 65210 $259.86 3213912 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP Critical Care 65220 $259.86 3213913 RMVL FB XTRNL AUDITORY CANAL W/O ANES Critical Care 69200 $259.86 3213849 RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET Critical Care 29710 $592.46 3213887 RPL CV CAT PIC WO PORT SAME AC WI/ IMAGE GUIDANCE WHEN PERFORMED Critical Care 36584 $3,116.85 3213888 RPL CV DEV W PORT SAME ACCESS Critical Care 36585 $6,404.89 3213884 RPL TUN CV CAT WOPORT SAME ACC Critical Care 36581 $6,404.89 3213885 RPL TUN CV DEV W PORT SAME ACC Critical Care 36582 $6,404.89 3213886 RPL TUN DEV W PUMP SAME ACCESS Critical Care 36583 $10,816.55 3213846 SHORT LEG SPLINT (PLASTER, FG) Critical Care 29515 $339.83 3213809 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< Critical Care 12001 $335.82 3213811 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< Critical Care 12011 $335.82 3213812 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CMq Critical Care 12013 $335.82 3522661 SIMPLE REPAIR F/E/E/N/L/M 5.1-7.5 CM Critical Care 12014 $168.93 3522690 SIMPLE REPAIR F/E/E/N/L/M 7.6-12.5 CM Critical Care 12015 $168.93 3522692 SIMPLE REPAIR F/E/E/N/L/M 12.6-20 CM Critical Care 12016 $310.78 3522694 SIMPLE REPAIR F/E/E/N/L/M 20.1-30 CM Critical Care 12017 $310.78 3522696 SIMPLE REPAIR F/E/E/N/L/M OVER 30 CM Critical Care 12018 $168.93 3213922 SKIN TEST, TB; INTRADERMAL Critical Care 86580 $36.20 3213787 SMOKING/TOBACCO CESS;3-10M Critical Care 99406 $77.29 3213788 SMOKING/TOBACCO CESS; +10M Critical Care 99407 $77.29 3213810 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM Critical Care 12002 $335.82 3522653 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM Critical Care 12004 $168.93 3522655 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 12.6-20CM Critical Care 12005 $310.78 3522657 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 20.1-30CM Critical Care 12006 $310.78 3522659 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK OVER 30CM Critical Care 12007 $168.93 3213909 SPINAL PUNCTURE LUMBAR DIAGNOSTIC Critical Care 62270 $1,667.73 3213767 SUBQ DRUG INFUS;1ST HR/PUMP Critical Care 96369 $493.56 3213768 SUBQ DRUG INFUS;EA ADDL HR Critical Care 96370 $87.98 3213769 SUBQ DRUG INFUS;ADDL PUMP Critical Care 96371 $145.98 3213931 TEMPORARY TRANSCUTANEOUS PACING Critical Care 92953 $1,331.21 3213865 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING Critical Care 32554 $1,376.07 3213866 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING Critical Care 32555 $1,376.07 3213933 THROMBOLYSIS CORONARY INTRAVENOUS INFUSION Critical Care 92977 $569.43 3213863 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL Critical Care 31603 $1,965.45 3213828 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES Critical Care 24600 $491.14 3213829 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES Critical Care 24605 $3,124.88 3213864 TUBE THORACOSTOMY INCLUDES WATER SEAL Critical Care 32551 $1,376.07 3213907 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL Critical Care 59812 $5,304.36 3213908 TX MISSED ABORTION FIRST TRIMESTER SURGICAL Critical Care 59820 $5,304.36 3213914 U/A W/O MICRO; MANUAL Critical Care 81002 $9.98 3213947 UNSCHED/EMER DIALYSIS;ESRD PT Critical Care G0257 $1,558.01 3213915 URINALYSIS;W/O MICRO,AUTOMATED Critical Care 81003 $9.98 3213906 VAGINAL DELIVERY ONLY Critical Care 59409 $5,304.36 3213808 WEDGE EXCISION SKIN NAIL FOLD Critical Care 11765 $335.82 3213853 WEDGING CAST EXCEPT CLUBFOOT CASTS Critical Care 29740 $592.46 3213854 WEDGING CLUBFOOT CAST Critical Care 29750 $592.46 3213923 WET PREP AND KOH Critical Care 87210 $16.70 3213852 WINDOWING CAST Critical Care 29730 $339.83 ENT PROCEDURES 3488160 27826 Open Treatment of Fracture of weight bearing articular surface/portion of distal tibia (eg, po ENT Profees 27826 $2,931.60 3269833 30130 Excision inferior turbinate, partial or complete, any method ENT Profees 30130 $1,268.30 3269703 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replaceme ENT Profees 30520 $2,081.20 3488205 30560 Lysis intranasal synechia ENT Profees 30560 $466.80 3271221 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT Profees 31240 $686.00 3269820 31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) ENT Profees 31254 $1,218.00 3270690 31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) ENT Profees 31255 $1,664.00 3269575 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy ENT Profees 31256 $960.00 3271521 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxill ENT Profees 31267 $1,441.00 3271466 31276 Nasal/sinus endoscopy, surgical, w/frontal sinus exploration, incl removal of tissue from fron ENT Profees 31276 $1,720.40 3316473 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy ENT Profees 31287 $1,201.00 3488204 31536 Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope ENT Profees 31536 $729.60 3270815 42145 Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty) ENT Profees 42145 $2,394.70 3269555 42820 Tonsillectomy and adenoidectomy; younger than age 12 ENT Profees 42820 $987.80 3269688 42821 Tonsillectomy and adenoidectomy; age 12 or over ENT Profees 42821 $1,027.40 3270600 42825 Tonsillectomy, primary or secondary; younger than age 12 ENT Profees 42825 $888.80 3269544 42826 Tonsillectomy, primary or secondary; age 12 or over ENT Profees 42826 $854.70 3269760 42830 Adenoidectomy, primary; younger than age 12 ENT Profees 42830 $704.00 3316472 42831 Adenoidectomy, primary; age 12 or over ENT Profees 42830 $704.00 3336007 69145 Excision Soft Tissue Lesion, External Auditory Canal ENT Profees 69145 $865.20 3488203 69421 Myringotomy including aspiration and/or Eustachian tube inflation requiring general anesthesia ENT Profees 69421 $510.00 3269541 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia ENT Profees 69436 $764.00 3488206 69990+ Microsurgical techniques, requiring use of operating microscope ENT Profees 69990 $771.60 3336009 95004 Percutaneous Test (Scratch, Puncture, Prick) with Allergenic Extracts, Immediate Type Reaction ENT Profees 95004 $22.80 3329670 95024 Intracutaneous tests with allergenic extracts, immediate type reaction, including test interpr ENT Profees 95024 $3.60 3327510 95165 Pro-fee supervision of prep/provision of antigens for allergen immunotherapy; sngl.or mult. An ENT Profees 95165 $10.80 EVALUATION AND MANAGEMENT PROCEDURES 3171409 1st care pr day nml nb xcpt hosp/birthing center 99461 Evaluation and Management 99461 $213.60 3171408 1st hosp/birthing center care per day nml nb 99460 Evaluation and Management 99460 $325.20 3171411 1st hosp/birthing center nb admit+dschg sm date 99463 Evaluation and Management 99463 $376.80 3171416 1st inpatient critical care pr day age 28 days/less than 99468 Evaluation and Management 99468 $3,124.80 3244882 ASSESS TINNITUS Evaluation and Management 92625 $249.29 $213.60 3244890 AUDIOMETRIC TESTING GROUPS 92559 Evaluation and Management 92559 $20.00 3492154 Administer patient-focused health risk assessment (eg. health hazard appraisal) + scoring & document Evaluation and Management 96160 $13.20 3492155 Administer caregiver-focused health risk assessment (eg. depression inventory) + scoring & documenta Evaluation and Management 96161 $13.20 1027778 Alcohol/substance abuse structured screening 15 to 30 minutes 99408 Evaluation and Management 99408 $112.80 1027779 Alcohol/substance abuse structured screening greater than 30 minutes 99409 Evaluation and Management 99409 $226.80 3171431 Annual wellness visit; incl personalized prevention plan of service Initial Visit G0438 Evaluation and Management G0438 $584.40 3171441 Annual Alcohol Misuse Screening, 15 min G0442 Evaluation and Management G0442 $32.40 3171443 Annual Depression Screening, 15 min G0444 Evaluation and Management G0444 $32.40 3171412 Attn at delivery+ 1st stabilization of newborn 99464 Evaluation and Management 99464 $254.40 3244926 BATTERY FOR HEARING DEVICE V5266 Evaluation and Management V5266 3244879 BEHAVRAL QUALIT ANALYS VOICE 92524 Evaluation and Management 92524 $298.80 3244899 BEKESY AUDIOMETRY, DIAG 92561 Evaluation and Management 92561 $259.86 3338940 BH Progress Note Billing Evaluation and Management 3171405 Basic life and/or disability examination 99450 Evaluation and Management 99450 $75.00 3171446 Behavioral Counseling for Obesity F2F, 15 Min. G0447 Evaluation and Management G0447 $80.40 3536970 Behavioral Health Screening Evaluation and Management H0002 $80.20 3171442 Brief Behav Counseling for Alcohol Misuse, 15 min G0443 Evaluation and Management G0443 $80.40 3244889 COMP AUDIO(92553+92556) 92557 Evaluation and Management 92557 $249.29 $111.60 3244892 CONDITIONING PLAY AUDIO 92582 Evaluation and Management 92582 $249.29 $231.60 3171331 Critical care ill/injured patient init 30-74 min 99291 Evaluation and Management 99291 $756.00 3171332 Critical care ill/injured patient addl 30 min 99292 Evaluation and Management 99292 $379.20 3171414 Critical care interfacility transport 30-74 min 99466 Evaluation and Management 99466 $811.20 3171415 Critical care interfacility transport ea 30 min 99467 Evaluation and Management 99467 $405.60 3244896 DISTRTN OTOACOUS EMSSN;LTD 92587 Evaluation and Management 92587 $180.23 3171465 DSMT; Group per 30 minutes G0109 Evaluation and Management G0109 $50.04 3171464 DSMT; Individual per 30 minutes G0108 Evaluation and Management G0108 $180.00 3171413 Delivery/birthing room resuscitation 99465 Evaluation and Management 99465 $495.60 3310619 Developmental Testing, Limited w/interp & Report Pro Fee 96110 Evaluation and Management 96110 $47.00 3310620 Developmental Testing Extended w/interp & Report Pro Fee 96111 Evaluation and Management 96111 $430.80 3311132 Developmental Testing, Limited, wi/interp & report 96110 Evaluation and Management 96110 $261.89 3565001 Developmental Testing, Extended, by phys/other QHP; 1st hour 96112 Evaluation and Management 96112 $387.46 3565274 Developmental Testing, Extended, by phys/other QHP; 1st hour 96112 Pro Fee Evaluation and Management 96112 $433.20 3565275 Developmental Testing, Extended, by phys/other QHP; ea. add'l 30 min +96113 Pro Fee Evaluation and Management 96113 $198.00 3171347 Dom/r-home e/m new pt significant new problem 99328 Evaluation and Management 99328 $695.20 3171348 Dom/r-home e/m est pt self-lmtd/minor 99334 Evaluation and Management 99334 $193.60 3171349 Dom/r-home e/m est pt lw mod severity 99335 Evaluation and Management 99335 $303.60 3171350 Dom/r-home e/m est pt mod hi severity 99336 Evaluation and Management 99336 $430.10 3171351 Dom/r-home e/m est pt significant new problem 99337 Evaluation and Management 99337 $620.40 3171343 Domicil/rest home new pt visit low sever 20 min 99324 Evaluation and Management 99324 $178.20 3171344 Domicil/rest home new pt visit mod sever 30 min 99325 Evaluation and Management 99325 $257.40 3171345 Domicil/rest home new pt hi-mod sever 45 min 99326 Evaluation and Management 99326 $451.00 3171346 Domicil/rest home new pt visit hi sever 60 min 99327 Evaluation and Management 99327 $596.20 3171342 E/M annual nursing facility assess stable 30 min 99318 Evaluation and Management 99318 $326.40 3244928 EAR IMPRESSION, EACH V5275 Evaluation and Management V5275 $50.00 3244924 EAR MOLD/INSERT NOT DISPOSABLE V5264 Evaluation and Management V5264 $75.00 3244925 EAR MOLD/INSERT DISPOSABLE V5265 Evaluation and Management V5265 $50.00 3171450 ER Visit/Proc; Level I 99281-25 Evaluation and Management 99281 $119.00 3171451 ER Visit/Proc; Level II 99282-25 Evaluation and Management 99282 $161.00 3171452 ER Visit/Proc; Level III 99283-25 Evaluation and Management 99283 $242.00 3171453 ER Visit/Proc; Level IV 99284-25 Evaluation and Management 99284 $379.50 3171454 ER Visit/Proc; Level V 99285-25 Evaluation and Management 99285 $551.10 3171438 ETOH &/or substance abuse structured assessment & intervention Brief 15-30 min Medicare Code G0396 Evaluation and Management G0396 $114.00 3171439 ETOH &/or substance abuse structured assessment & intervention >30 min Medicare Code G0397 Evaluation and Management G0397 $225.60 3244876 EVAL SPEECH FLUENCY 92521 Evaluation and Management 92521 $319.00 3244877 EVALUATE SPEECH PRODUCTION 92522 Evaluation and Management 92522 $259.00 3244883 EVOKED OTOACOUSTIC SCRN AUTO 92558 Evaluation and Management 92558 $276.00 3171434 Education Svc- Patients with Stage 4 & 5Chronic Kidney Disease (CKD)-Individual, 1 hr session G0420 Evaluation and Management G0420 3171435 Education Svc- Patients with Stage 4 & 5Chronic Kidney Disease (CKD)-Group, 1 hr session G0421 Evaluation and Management G0421 3171325 Emergency department visit limited/minor prob 99281 Evaluation and Management 99281 $119.00 3171326 Emergency department visit low/moder severity 99282 Evaluation and Management 99282 $161.00 3171327 Emergency department visit moderate severity 99283 Evaluation and Management 99283 $242.00 3171328 Emergency department visit high/urgent severity 99284 Evaluation and Management 99284 $379.50 3171329 Emergency dept visit high severity+threat funcj 99285 Evaluation and Management 99285 $551.10 3171388 Established Patient Preventive/Well Exam Under 1 year 99391 Evaluation and Management 99391 $237.60 3171389 Established Patient Preventive/Well Exam 1 to 4 years New 99392 Evaluation and Management 99392 $260.40 3171390 Established Patient Preventive/Well Exam 5 to 11 years New 99393 Evaluation and Management 99393 $295.20 3171391 Established Patient Preventive/Well Exam 12 to 17 years New 99394 Evaluation and Management 99394 $295.20 3171392 Established Patient Preventive/Well Exam 18 to 39 years New 99395 Evaluation and Management 99395 $303.60 3171393 Established Patient Preventive/Well Exam 40 to 64 years New 99396 Evaluation and Management 99396 $328.80 3171394 Established Patient Preventive/Well Exam 65+ years New 99397 Evaluation and Management 99397 $346.80 3244908 FIT/ORIENT/CHECK HEARING AID V5011 Evaluation and Management V5011 $50.00 3188668 Family Psychotherapy with patient Present 90847 Evaluation and Management 90847 $428.70 3188669 Family Psychotherapy without patient Present 90846 Evaluation and Management 90846 $428.70 3311035 Family psychotherapy (with patient present) Pro Fee 90847 Evaluation and Management 90847 $357.60 3311041 Family psychotherapy (without the patient present) Pro Fee 90846 Evaluation and Management 90846 $343.20 3372787 Family Psychotherapy with patient Present 90847 - BH Progress Note Billing Evaluation and Management 90847 $428.70 3372788 Family Psychotherapy without patient Present 90846 - BH Progress Note Billing Evaluation and Management 90846 $428.70 3188671 Group Psychotherapy 90853 Evaluation and Management 90853 $179.95 3311046 Group psychotherapy (other than of a multiple-family group) Pro Fee 90853 Evaluation and Management 90853 $84.00 3504068 H0001 Alcohol and/or drug assessment Evaluation and Management H0001 $103.33 3504069 H0004 BH counseling and therapy, per 15 minutes Evaluation and Management H0004 $21.36 3504070 H0031 Mental health assessment, by non-physician Evaluation and Management H0031 $103.33 3504071 H0032 Mental health svc plan dev. by non-physician Evaluation and Management H0032 $135.08 3504072 H2011 Crisis intervention svc, per 15 minutes Evaluation and Management H2011 $27.86 3244904 HA EXAM&SELECT; MONOAURAL 92590 Evaluation and Management 92590 $50.00 3244905 HA EXAM&SELECT; BINAURAL 92591 Evaluation and Management 92591 $100.00 3244906 HEARING AID CHECK; MONOAURAL 92592 Evaluation and Management 92592 $35.00 3244907 HEARING AID CHECK; BINAURAL 92593 Evaluation and Management 92593 $70.00 3244910 HEARING AID, BICROS, BEHIND EA V5220 Evaluation and Management V5220 $1,361.81 3244911 HEARING AID, CROS, BEHIND EAR V5180 Evaluation and Management V5180 $1,103.77 3244912 HEARING AID DPA MONOAUR ITC V5245 Evaluation and Management V5245 3244913 HEARING AID DPA MONOAUR ITE V5246 Evaluation and Management V5246 $2,875.00 3244914 HEARING AID DPA MONOAUR BTE V5247 Evaluation and Management V5247 $2,400.00 3244915 HEARING AID DIG MONOAUR ITC V5255 Evaluation and Management V5255 $2,500.00 3244916 HEARING AID DIG MONOAUR ITE V5256 Evaluation and Management V5256 $2,300.00 3244917 HEARING AID DIG MONOAUR BTE V5257 Evaluation and Management V5257 $2,750.00 3244918 HEARING AID DIG BINAUR CIC V5258 Evaluation and Management V5258 $5,225.00 3244919 HEARING AID DIG BINAUR ITC V5259 Evaluation and Management V5259 $3,150.00 3244920 HEARING AID DIG BINAUR ITE V5260 Evaluation and Management V5260 $2,900.00 3244921 HEARING AID DIG BINAUR BTE V5261 Evaluation and Management V5261 $4,000.00 3244927 HEARING AID/ALD SUPPLIES NOS V5267 Evaluation and Management V5267 $15.00 3171444 High Intense BH Counsel to prevent STI, F2F Indiv w/Ed Skills Trng, Guidance Semi-Ann 30min G0445 Evaluation and Management G0445 $80.40 3171463 Hospice Eval/Counseling G0337 Evaluation and Management G0337 $246.00 3171313 Hospital discharge day management 30 min/less than 99238 Evaluation and Management 99238 $248.40 3171314 Hospital discharge day management > 30 min 99239 Evaluation and Management 99239 $366.00 3171427 Hospital Outpt Clinic Visit G0463 Evaluation and Management G0463 $231.33 3171428 Hospital Outpt Clinic Visit with Procedure G0463-25 Evaluation and Management G0463 $231.33 3171352 Indiv phys supvj home/dom/r-home mo 15-29 min 99339 Evaluation and Management 99339 $262.80 3171353 Indiv phys supvj home/dom/r-home mo 30 min/> 99340 Evaluation and Management 99340 $368.40 3171298 Initial observation care/day low severity 99218 Evaluation and Management 99218 $339.60 3171299 Initial observation care/day moderate severity 99219 Evaluation and Management 99219 $462.00 3171300 Initial observation care/day high severity 99220 Evaluation and Management 99220 $632.40 3171301 Initial hospital care/day 30 minutes 99221 Evaluation and Management 99221 $344.40 3171302 Initial hospital care/day 50 minutes 99222 Evaluation and Management 99222 $464.40 3171303 Initial Hospital Care/Day 70 Minutes 99223 Evaluation and Management 99223 $688.80 3171324 Initial inpatient consult new/estab pt 110 min 99255 Evaluation and Management 99255 $681.60 3171333 Initial nursing facility care/day low severity 99304 Evaluation and Management 99304 $309.60 3171334 Initial nursing facility care/day moder severity 99305 Evaluation and Management 99305 $442.80 3171335 Initial nursing facility care/day high severity 99306 Evaluation and Management 99306 $566.40 3171418 Initial ped critical care 29 days thru 24 months 99471 Evaluation and Management 99471 $2,704.80 3171420 Initial ped critical care 2 thru 5 years 99475 Evaluation and Management 99475 $1,904.40 3171422 Initial hosp neonate 28 d/less than not critically ill 99477 Evaluation and Management 99477 $1,185.60 3171320 Initl inpatient consult new/estab pt 20 min 99251 Evaluation and Management 99251 $165.60 3171321 Initl inpatient consult new/estab pt 40 min 99252 Evaluation and Management 99252 $253.20 3171322 Initl inpatient consult new/estab pt 55 min 99253 Evaluation and Management 99253 $390.00 3171323 Initl inpatient consult new/estab pt 80 min 99254 Evaluation and Management 99254 $566.40 3171445 Intensive Behavioral Therapy to Reduce CV Dis Risk F2F, Annual , 15 min. G0446 Evaluation and Management G0446 $80.40 3171484 Interactive Complexity 90785 Evaluation and Management 90785 $50.00 3311077 Interactive Complexity Pro Fee 90785 Evaluation and Management 90785 $46.80 3372789 Interactive Complexity 90785 - BH Progress Note Billing Evaluation and Management 90785 $50.00 3490184 Labor Epidural Evaluation and Management $237.00 3171468 MNT; Group each 30 minutes 97804 Evaluation and Management 97804 $51.60 3171470 MNT; Group change diagnosis each 30 minutes G0271 Evaluation and Management G0271 $51.60 3171466 MNT; Individual each 15 minutes 97802 Evaluation and Management 97802 $110.40 3171467 MNT; Individual re-assess each 15 minutes 97803 Evaluation and Management 97803 $94.80 3171469 MNT; Individual change diagnosis each 15 minutes G0270 Evaluation and Management G0270 $94.80 3171296 Medicare Screening Breast & Pelvic Exam G0101 Evaluation and Management G0101 $94.80 3171429 Medicare Digital Rectal Exam (Prostate) G0102 Evaluation and Management G0102 $30.00 3171430 Medicare Initial Preventive Exam G0402 Evaluation and Management G0402 $432.00 3188670 Multiple-Family Group Psychotherapy 90849 Evaluation and Management 90849 $179.95 3311049 Multiple family group psychotherapy Pro Fee 90849 Evaluation and Management 90849 $106.80 3188664 Neurobehavioral Status Exam, w/inter & report per hour Per Hour 96116 Evaluation and Management 96116 $719.08 3310621 Neurobehavioral Status Exam w/interp & Report, per hour, Pro Fee 96116 Evaluation and Management 96116 $289.20 3565276 Neurobehavioral Status Exam, w/inter & report, ea. add'l hour +96121 Pro Fee Evaluation and Management 96121 $265.20 3310622 Neuropsych Testing by Psych/Phys Admin, w/interp & Report Prep per hour, Pro Fee 96118 Evaluation and Management 96118 $266.40 3311078 Neuropsych Testing Admin by Computer Pro Fee 96120 Evaluation and Management 96120 $87.60 3311088 Neuropsych Test by Tech, per hour Pro Fee 96119 Evaluation and Management 96119 $80.40 3565246 Neuropsych test Phys/QHP, w/eval, interp, data, CDM, Tx plan/rpt, + feedbk if perf 1st hr 96132 Evaluation and Management 96132 $387.46 3565277 Neuropsych test Phys/QHP,w/eval, interp, data, CDM, Txplan/rpt,+feedbk if perf 1st hr 96132 Pro Fee Evaluation and Management 96132 $364.80 3565278 Neuropsych testing eval. svcs by phys/other QHP; ea. add'l hour +96133 Pro Fee Evaluation and Management 96133 $279.60 3171381 New Patient Preventive/Well Exam Under 1 year 99381 Evaluation and Management 99381 $260.40 3171382 New Patient Preventive/Well Exam 1 to 4 years New 99382 Evaluation and Management 99382 $278.40 3171383 New Patient Preventive/Well Exam 5 to 11 years New 99383 Evaluation and Management 99383 $295.20 3171384 New Patient Preventive/Well Exam 12 to 17 years New 99384 Evaluation and Management 99384 $346.80 3171385 New Patient Preventive/Well Exam 18 to 39 years New 99385 Evaluation and Management 99385 $332.40 3171386 New Patient Preventive/Well Exam 40 to 64 years New 99386 Evaluation and Management 99386 $404.40 3171387 New Patient Preventive/Well Exam 65+ years New 99387 Evaluation and Management 99387 $433.20 3171340 Nursing facility discharge management 30 min/less than 99315 Evaluation and Management 99315 $247.20 3171341 Nursing facility discharge management > 30 min 99316 Evaluation and Management 99316 $360.00 3171297 Observation care discharge management 99217 Evaluation and Management 99217 $248.40 3171310 Observation/inpatient hospital care low severity 99234 Evaluation and Management 99234 $452.40 3171311 Observation/inpatient hospital care mod severity 99235 Evaluation and Management 99235 $574.80 3171312 Observation/inpatient hospital care hi severity 99236 Evaluation and Management 99236 $741.60 1025788 Office Visit Est 99211 Evaluation and Management 99211 $31.20 1025789 Office Visit New 99201 Evaluation and Management 99201 $91.20 1027764 Office Visit Est 99212 Evaluation and Management 99212 $86.40 1027765 Office Visit New 99202 Evaluation and Management 99202 $171.60 1027766 Office Visit Est 99213 Evaluation and Management 99213 $174.00 1027767 Office Visit New 99203 Evaluation and Management 99203 $260.40 1027768 Office Visit Est 99214 Evaluation and Management 99214 $266.40 1027769 Office Visit New 99204 Evaluation and Management 99204 $439.20 1027770 Office Visit Est 99215 Evaluation and Management 99215 $376.80 1027771 Office Visit New 99205 Evaluation and Management 99205 $573.60 3171315 Office Consult Level 1 MDM-Straight Forward 15 min 99241 Evaluation and Management 99241 $110.40 3171316 Office Consult Level 2 MDM-Straight Forward 30 minutes 99242 Evaluation and Management 99242 $231.60 3171317 Office Consult Level 3 MDM-Low 40 minutes 99243 Evaluation and Management 99243 $324.00 3171318 Office Consult Level 4 MDM-Moderate 60 minutes 99244 Evaluation and Management 99244 $520.80 3171319 Office Consult Level 5 MDM-High 80 minute 99245 Evaluation and Management 99245 $644.40 3468060 Office Visit Level Est 99212 BH Evaluation and Management G0463 $231.33 3468064 Office Visit Level Est 99213 BH Evaluation and Management G0463 $231.33 3468065 Office Visit Level Est 99214 BH Evaluation and Management G0463 $231.33 3468066 Office Visit Level Est 99215 BH Evaluation and Management G0463 $231.33 1027775 Online Est electronic communication 99444 Evaluation and Management 99444 3171471 Outpatient Group; Dietitian (with order) S9470 Evaluation and Management S9470 $60.00 3171472 Outpatient Visit; Dietitian (with order) S9470 Evaluation and Management S9470 $75.00 3244885 PURE TONE AIR ONLY 92552 Evaluation and Management 92552 $117.95 3244886 PURE TONE AIR AND BONE 92553 Evaluation and Management 92553 $249.29 3171378 Phys Supvj Hospice Pt Mo 30 Min/> 99378 Evaluation and Management 99378 $300.00 3171369 Phys standby svc prolng phys attn ea 30 min 99360 Evaluation and Management 99360 $208.80 3171375 Phys supvj pt home hlth agency mo 15-29 minutes 99374 Evaluation and Management 99374 $192.00 3171376 Phys supvj pt home hlth agency mo 30 min/> 99375 Evaluation and Management 99375 $300.00 3171377 Phys supvj hospice pt mo 15-29 min 99377 Evaluation and Management 99377 $192.00 3171379 Phys supvj nf pt mo 15-29 min 99379 Evaluation and Management 99379 $192.00 3171380 Phys supvj nf pt mo 30 min/> 99380 Evaluation and Management 99380 $300.00 3171330 Physician direction emergency medical systems 99288 Evaluation and Management 99288 3171447 Post Op (n/c) 99024 Evaluation and Management 99024 $- 3171401 Prev med counsel+risk factor redj grp spx 30 min 99411 Evaluation and Management 99411 $26.40 3171402 Prev med counsel+risk factor redj grp spx 60 min 99412 Evaluation and Management 99412 $43.20 3171395 Prevent med counsel+/risk factor redj spx 15 min 99401 Evaluation and Management 99401 $84.00 3171396 Prevent med counsel+/risk factor redj spx 30 min 99402 Evaluation and Management 99402 $170.40 3171397 Prevent med counsel+/risk factor redj spx 45 min 99403 Evaluation and Management 99403 $254.40 3171398 Prevent med counsel+/risk factor redj spx 60 min 99404 Evaluation and Management 99404 $338.40 3171363 Prolng svc office o/p dir contact 1st hr 99354 Evaluation and Management 99354 $414.00 3171367 Prolng e/m svc before+/after dir pt care 1st hr 99358 Evaluation and Management 99358 $379.20 3171368 Prolng e/m before+/after dir care ea 30 min 99359 Evaluation and Management 99359 $182.40 3171364 Prolonged svc office o/p dir contact ea 30 min 99355 Evaluation and Management 99355 $310.80 3171365 Prolonged service i/p req unit/floor time 1st hr 99356 Evaluation and Management 99356 $313.20 3171366 Prolonged svc i/p req unit/floor time ea 30 min 99357 Evaluation and Management 99357 $314.40 3310616 Psych Testing by Psych/Phys, Admin, winterp & Report Prep per hour Pro Fee 96101 Evaluation and Management 96101 $243.10 3310617 Psych Testing by Tech, per hour Pro Fee 96102 Evaluation and Management 96102 $90.00 3310618 Psych Testing Admin by Computer Pro Fee 96103 Evaluation and Management 96103 $87.00 3564982 Psych or neuropsych testing admin by computer w/ automated results only 96146 Evaluation and Management 96146 $48.93 3565247 Psych test Phys/QHP, w/eval, interp, data, CDM, Tx plan/rpt, + feedbk if perf 1st hr 96130 Evaluation and Management 96130 $387.46 3565267 Psych test Phys/QHP, w/eval, interp, data, CDM, Tx plan/rpt, + feedbk if perf 1st hr 96130 Pro Fee Evaluation and Management 96130 $372.00 3565268 Psych testing eval. svcs by phys/other QHP:, ea. add'l hour +96131 Pro Fee Evaluation and Management 96131 $283.20 3564995 Psych/Neuropsych test admin & scoring by tech, 2 or more tests, any method; 1st 30 min 96138 Evaluation and Management 96138 $48.93 3565269 Psych/Neuropsych test admin & score by phys/QHP, 2 or more tests, any method; 1st 30 min 96136 Pro F Evaluation and Management 96136 $84.00 3565270 Psych/Neuropsych tst admin&score by phys/QHP,2 or more tests, any method;ea add'l 30 min+96137 Pro F Evaluation and Management 96137 $66.00 3564997 Psych/neuropsych test admin & score by phys/QHP, 2 or more tests, any method; 1st 30 min 96136 Evaluation and Management 96136 $48.93 3171477 Psychiatric Diagnostic Evaluation 90791 Evaluation and Management 90791 $313.96 3171478 Psychiatric Diagnostic Evaluation, with medical services 90792 Evaluation and Management 90792 $313.96 3222888 Psychiatric eval of hosp records, reports and other for medical Dx purpses 90885 Evaluation and Management 90885 $161.70 3310603 Psychiatric diagnostic evaluation Pro Fee 90791 Evaluation and Management 90791 $412.80 3310607 Psychiatric diagnostic evaluation, with medical services Pro Fee 90792 Evaluation and Management 90792 $426.00 3171479 Psychotherapy 30 min 90832 Evaluation and Management 90832 $236.15 3171480 Psychotherapy 45 min 90834 Evaluation and Management 90834 $313.96 3171481 Psychotherapy 60 min 90837 Evaluation and Management 90837 $313.96 3171482 Psychotherapy for Crisis, First 60 min 90839 Evaluation and Management 90839 $313.96 3171483 Psychotherapy for Crisis, Each Additional 30 min 90840 Evaluation and Management 90840 $150.00 3310608 Psychotherapy 30 min Pro Fee 90832 Evaluation and Management 90832 $177.00 3310609 Psychotherapy 45 min Pro Fee 90834 Evaluation and Management 90834 $259.20 3310611 Psychotherapy 60 min Pro Fee 90837 Evaluation and Management 90837 $391.20 3310614 Psychotherapy for crisis, first 60 min Pro Fee 90839 Evaluation and Management 90839 $450.00 3310615 Psychotherapy for crisis, each additional 30 min Pro Fee 90840 Evaluation and Management 90840 $200.00 3372784 Psychotherapy with patient and/or family member 30 min 90832 - BH Progress Note Billing Evaluation and Management 90832 $236.15 3372785 Psychotherapy with patient and/or family member 60 min 90837 - BH Progress Note Billing Evaluation and Management 90837 $313.96 3372786 Psychotherapy with patient and/or family member 45 min 90834 - BH Progress Note Billing Evaluation and Management 90834 $313.96 3244909 REPAIR/MODIFY HEARING AID V5014 Evaluation and Management V5014 $247.97 3222889 Report prep of patient's psychiatric status, hx for other phys, agencies 90889 Evaluation and Management 90889 $161.70 3244884 SCREENING PURE TONE AIR ONLY 92551 Evaluation and Management 92551 $38.40 3244895 SELECT PICTURE AUDIO 92583 Evaluation and Management 92583 $93.20 3244878 SPEECH SOUND LANG COMPREHEN 92523 Evaluation and Management 92523 $538.00 3244887 SPEECH AUDIO THRESHHOLD 92555 Evaluation and Management 92555 $93.20 3244888 SPEECH AUDIO/RECOGNITION 92556 Evaluation and Management 92556 $93.20 3244891 STENGER TEST, PURE TONE 92565 Evaluation and Management 92565 $93.20 3171307 Sbsq hospital care/day 15 minutes 99231 Evaluation and Management 99231 $126.50 3171308 Sbsq hospital care/day 25 minutes 99232 Evaluation and Management 99232 $231.00 3171309 Sbsq hospital care/day 35 minutes 99233 Evaluation and Management 99233 $332.20 3171336 Sbsq nursing facility care/day e/m stable 10 min 99307 Evaluation and Management 99307 $141.90 3171337 Sbsq nursing facil care/day minor complj 15 min 99308 Evaluation and Management 99308 $218.90 3171338 Sbsq nursing facil care/day new problem 25 min 99309 Evaluation and Management 99309 $288.20 3171339 Sbsq nurs facil care/day unstabl/new prob 35 min 99310 Evaluation and Management 99310 $429.00 3171304 Sbsq observation care/day low severity 99224 Evaluation and Management 99224 $125.40 3171305 Sbsq observation care/day moderate severity 99225 Evaluation and Management 99225 $226.60 3171306 Sbsq observation care/day high severity 99226 Evaluation and Management 99226 $325.60 3171433 Screening Pap smear Acquisition Q0091 Evaluation and Management Q0091 $66.00 1027776 Smoking and tobacco use cessation counseling visit 3 to 10 minutes 99406 Evaluation and Management 99406 $38.50 1027777 Smoking and tobacco use cessation counseling visit more than 10 minutes 99407 Evaluation and Management 99407 $82.50 3171410 Subq hospital care per day e/m normal newborn 99462 Evaluation and Management 99462 $138.60 3171417 Subq i/p critical care pr day age 28 days/less than 99469 Evaluation and Management 99469 $1,335.40 3171421 Subsequent ped critical care 2 thru 5 years 99476 Evaluation and Management 99476 $1,117.60 3171423 Subsequent intensive care infant less than 1500 grams 99478 Evaluation and Management 99478 $538.00 3171424 Subsequent intensive care infant 1500-2500 grams 99479 Evaluation and Management 99479 $506.00 3171425 Subsequent intensive care infant 2501-5000 grams 99480 Evaluation and Management 99480 $476.00 3171432 Subsequent Visit G0439 Evaluation and Management G0439 $391.20 3171419 Subsq ped critical care 29 days thru 24 mo 99472 Evaluation and Management 99472 $1,292.50 3244903 TYMPANOMETRY REFLEX THRESHHOLD 92550 Evaluation and Management 92550 $125.00 3171372 Team conference face-to-face nonphysician 99366 Evaluation and Management 99366 $135.30 3171373 Team conference non-face-to-face physician 99367 Evaluation and Management 99367 $181.50 3171374 Team conference non-face-to-face nonphysician 99368 Evaluation and Management 99368 $118.80 3171448 Telemedicine Orig Site Fee Q3014 Evaluation and Management Q3014 $50.00 1027772 Telephone Est 5 to 10 minutes 99441 Evaluation and Management 99441 $74.00 1027773 Telephone Est 11 to 20 minutes 99442 Evaluation and Management 99442 $124.00 1027774 Telephone Est 21 to 30 minutes 99443 Evaluation and Management 99443 $161.00 3171399 Tobacco use cessation intermediate 3-10 minutes 99406 Evaluation and Management 99406 $38.50 3171400 Tobacco use cessation intensive >10 minutes 99407 Evaluation and Management 99407 $82.50 3522643 Transitional Care Mgmt. (MDM mod & F2F 14 d. or <) 99495 Evaluation and Management 99495 $374.40 3522645 Transitional Care Mgmt. (MDM high & F2F 7 d. or <) 99496 Evaluation and Management 99496 $543.60 3372790 Unlisted Service or Procedure 90899 - BH Progress Note Billing Evaluation and Management 90899 $235.78 3244900 VISUAL REINFORCE AUDIO (VRA) 92579 Evaluation and Management 92579 $249.29 3171456 each additional 30 minutes 99486 Evaluation and Management 99486 $226.80 3171455 first 30 minutes 99485 Evaluation and Management 99485 $260.40 LAB TESTS 3241749 %fPSA Reflex General Lab 84154 $58.25 633599 .Glucose 2 Hour General Lab 82951 $40.76 633600 .Glucose 3 Hour General Lab 82951 $40.76 3109067 .Glucose 4 Hour General Lab 82951 $40.76 3109068 .Glucose 5 Hour General Lab 82951 $40.76 3152408 .Glucose 2 Hour General Lab 82947 $12.45 633788 .Occult Blood Stool I General Lab 82270 $12.48 3218649 080032 Result 1 General Lab 87205 $13.54 3218664 080187 Result 1 General Lab 87807 $37.96 3218694 080565 Result 1 General Lab 87206 $17.07 3128975 11-Deoxycortisol (R) General Lab 82634 $92.71 1147685 17 Hydroxyprogesterone (R) General Lab 83498 $86.04 3128976 17 Hydroxyprogesterone Urine (R) General Lab 82570 $16.39 3128982 5 HIAA Urine (R) General Lab 82570 $16.39 3108653 5' Nucleotidase (R) General Lab 83915 $35.31 3108652 5-Hydroxyindoleacetic Acid 24 Hour Urine (R) General Lab 83497 $40.84 3409185 6-Acetylmorphine WB 700779 General Lab 80361 $48.45 3409134 7-Aminoclonazepam WB 700767 General Lab 80347 $65.66 3224967 ABO Grouping and Rho(D) Typing (R) General Lab 86900 $9.46 3227480 ABO Grouping General Lab 86900 $190.18 3213118 AChR Binding Abs, Serum (R) General Lab 83519 $52.44 3175254 AChR Blocking Ab (R) General Lab 83519 $52.44 3175255 AChR Modulating Ab (R) General Lab 83519 $52.44 3335580 AChR Mod Ab 085935 General Lab 83519 $52.44 3566767 AFB Identification (R) General Lab 87149 $63.50 3339725 AFB Org ID DNA Probe General Lab 87149 $63.50 3191503 AFB Smear and Culture (R) General Lab 87116 $34.20 3224982 AFP, Serum, Open Spina Bifida (R) General Lab 82105 $53.12 3304277 ALK FISH, Lung, Non-Small Cell (R) General Lab 88271 $67.83 3304278 ALK FISH Reflex RET + ROS1 (R) General Lab 88271 $67.83 3210933 ANA Analyzer (R) General Lab 86038 $38.28 3175242 ANA Screen Rfx Titer/Pattern (R) General Lab 86038 $38.28 3213165 ANCA Panel (R) General Lab 83520 $49.22 633633 AST General Lab 84450 $16.39 3134426 AST Aspartate Aminotransferase General Lab 84450 $18.21 1503764 Acetaminophen Level General Lab 80329 $32.66 3133229 Acetaminophen Level (R) General Lab 80299 $53.12 3335573 Acetylchol Recep Bind Ab W/Rfx (R) General Lab 83519 $52.44 3133230 Acid Phosphatase (R) General Lab 84066 $30.58 3213112 Activated Protein C Resistance (R) General Lab 85307 $48.54 3561550 Acylcarnitine Profile, Plasma (R) General Lab 82017 $53.41 3526446 Adalimumab+Ab (R) General Lab 82397 $44.72 3526480 Adalimumab+Ab (Serial Monitor) (R) General Lab 82397 $44.72 3213235 Adderall (R) General Lab 80324 $43.21 3242947 Adenovirus+Control General Lab 86603 $40.76 3500376 Adenovirus PCR Qual (NP Swab) (R) General Lab 87798 $111.12 3108910 Adrenal Antibody Screen (R) General Lab 86255 $38.16 3108657 Adrenocorticotropic Hormone (R) General Lab 82024 $122.29 3224980 Aerobe ID + Suscept (R) General Lab 87077 $25.56 3175238 Aerobic Culture (R) General Lab 87070 $27.27 633632 Alanine Aminotransferase Level General Lab 84460 $16.79 3133231 Alanine Aminotransferase Level (R) General Lab 84460 $16.79 1620877 Albumin Level General Lab 82040 $15.68 3133232 Albumin (R) General Lab 82040 $15.68 3133234 Albumin Level Body Fluid (R) General Lab 82042 $22.17 3212899 Aldolase (R) General Lab 82085 $30.75 3108661 Aldosterone 24 Hour Urine (R) General Lab 82088 $129.05 3212901 Aldosterone (R) General Lab 82088 $129.05 3481860 Aldosterone/Renin Ratio (R) General Lab 84244 $69.65 1620878 Alkaline Phosphatase Level General Lab 84075 $16.39 3108663 Alkaline Phosphatase Isoenzymes (R) General Lab 84080 $46.83 3133239 Alkaline Phosphatase Level (R) General Lab 84075 $16.39 3108664 Allergen, Almond (R) General Lab 86003 $16.53 3108666 Allergen, Apple (R) General Lab 86003 $16.53 3108667 Allergen, Avocado (R) General Lab 86003 $16.53 3108668 Allergen, Beef (R) General Lab 86003 $16.53 3108669 Allergen, Black Pepper (R) General Lab 86003 $16.53 3108670 Allergen, Blueberry (R) General Lab 86003 $16.53 3108671 Allergen, Yeast (R) General Lab 86003 $16.53 3108911 Allergen, Aureobasidium pullulans (R) General Lab 86003 $16.53 3108912 Allergen, Casein (R) General Lab 86003 $16.53 3108913 Allergen, Cashew (R) General Lab 86003 $16.53 3108914 Allergen, Cat Dander (R) General Lab 86003 $16.53 3108915 Allergen, Cheese, Cheddar Type (R) General Lab 86003 $16.53 3108916 Allergen, Cheese, Mold Type (R) General Lab 86003 $16.53 3108917 Allergen, Cherry (R) General Lab 86003 $16.53 3108918 Allergen, Chicken Feathers (R) General Lab 86003 $16.53 3108919 Allergen, Chicken Meat (R) General Lab 86003 $16.53 3108920 Allergen, Cladosporium herbarum (Hormodendrum) (R) General Lab 86003 $16.53 3108921 Allergen, Cockroach (R) General Lab 86003 $16.53 3108922 Allergen, Coconut (R) General Lab 86003 $16.53 3108923 Allergen, Coffee (R) General Lab 86003 $16.53 3108924 Allergen, Common Silver Birch Tree (R) General Lab 86003 $16.53 3108925 Allergen, Corn/Maize (R) General Lab 86003 $16.53 3108926 Allergen, Cottonwood Tree (R) General Lab 86003 $16.53 3108927 Allergen, Cow Dander (R) General Lab 86003 $16.53 3108928 Allergen, Cumin (R) General Lab 86003 $16.53 3108929 Allergen, Dog Dander (R) General Lab 86003 $16.53 3108930 Allergen, Egg White (R) General Lab 86003 $16.53 3108931 Allergen, Egg Yolk (R) General Lab 86003 $16.53 3108932 Allergen, Firebush (Kochia) (R) General Lab 86003 $16.53 3108933 Allergen, Fusarium proliferatum (R) General Lab 86003 $16.53 3108934 Allergen, Garlic (R) General Lab 86003 $16.53 3108935 Allergen, Ginger (R) General Lab 86003 $16.53 3108936 Allergen, Gluten (R) General Lab 86003 $16.53 3108937 Allergen, Grapefruit (R) General Lab 86003 $16.53 3108939 Allergen, Horse Dander (R) General Lab 86003 $16.53 3108940 Allergen, Latex (R) General Lab 86003 $16.53 3108941 Allergen, Lettuce (R) General Lab 86003 $16.53 3108942 Allergen, Macadamia Nut (R) General Lab 86003 $16.53 3108943 Allergen, Milk (R) General Lab 86003 $16.53 3108944 Allergen, Mouse Urine Proteins (R) General Lab 86003 $16.53 3108946 Allergen, Oak Tree (R) General Lab 86003 $16.53 3108947 Allergen, Oat (R) General Lab 86003 $16.53 3108950 Allergen, Peanut (R) General Lab 86003 $16.53 3108951 Allergen, Pecan (R) General Lab 86003 $16.53 3108953 Allergen, Pineapple (R) General Lab 86003 $16.53 3108954 Allergen, Pork Meat (R) General Lab 86003 $16.53 3108955 Allergen, Potato (R) General Lab 86003 $16.53 3108956 Allergen, Rice (R) General Lab 86003 $16.53 3108957 Allergen, Scallop (R) General Lab 86003 $16.53 3108958 Allergen, Sesame Seed (R) General Lab 86003 $16.53 3108959 Allergen, Sheep Sorrel (R) General Lab 86003 $16.53 3108960 Allergen, Shrimp (R) General Lab 86003 $16.53 3108961 Allergen, Soybean (R) General Lab 86003 $16.53 3108962 Allergen, Strawberry (R) General Lab 86003 $16.53 3108963 Allergen, Sweet Gum Tree (R) General Lab 86003 $16.53 3108964 Allergen, Sweet Potato (R) General Lab 86003 $16.53 3108965 Allergen, Timothy Grass (T) General Lab 86003 $16.53 3108966 Allergen, Tomato (R) General Lab 86003 $16.53 3108967 Allergen, Tuna (R) General Lab 86003 $16.53 3108968 Allergen, Turkey Meat (R) General Lab 86003 $16.53 3108969 Allergen, Walnut (R) General Lab 86003 $16.53 3108970 Allergen, Walnut Tree (R) General Lab 86003 $16.53 3108971 Allergen, Wheat (R) General Lab 86003 $16.53 3108972 Allergen, White Ash Tree (R) General Lab 86003 $16.53 3128998 Allergen, Allspice (R) General Lab 86003 $16.53 3129001 Allergen, Alternaria alternata (R) General Lab 86003 $16.53 3129002 Allergen, American Beech Tree (R) General Lab 86003 $16.53 3129004 Allergen, Anchovy (R) General Lab 86003 $16.53 3129006 Allergen, Anise (R) General Lab 86003 $16.53 3129007 Allergen, Apricot (R) General Lab 86003 $16.53 3129009 Allergen, Ascaris (R) General Lab 86003 $16.53 3129010 Allergen, Asparagus (R) General Lab 86003 $16.53 3129011 Allergen, Aspergillus fumigatus (R) General Lab 86003 $16.53 3129012 Allergen, Aspergillus niger (R) General Lab 86003 $16.53 3129013 Allergen, Australian Pine Tree (R) General Lab 86003 $16.53 3129014 Allergen, Bahia Grass (R) General Lab 86003 $16.53 3129015 Allergen, Bald Cypress (R) General Lab 86003 $16.53 3129017 Allergen, Banana (R) General Lab 86003 $16.53 3129018 Allergen, Barley (R) General Lab 86003 $16.53 3129019 Allergen, Barley (Grass) (R) General Lab 86003 $16.53 3129020 Allergen, Basil (R) General Lab 86003 $16.53 3129021 Allergen, Bay Leaf (R) General Lab 86003 $16.53 3129022 Allergen, Beets (Beetroot) (R) General Lab 86003 $16.53 3129024 Allergen, Bermuda Grass (R) General Lab 86003 $16.53 3129026 Allergen, Blackberry (R) General Lab 86003 $16.53 3129029 Allergen, Botrytis cinerea (R) General Lab 86003 $16.53 3129030 Allergen, Box-elder Tree (R) General Lab 86003 $16.53 3129031 Allergen, Brazilnut (R) General Lab 86003 $16.53 3129032 Allergen, Broccoli (R) General Lab 86003 $16.53 3129033 Allergen, Brome Grass (R) General Lab 86003 $16.53 3129034 Allergen, Brussel Sprouts (R) General Lab 86003 $16.53 3129035 Allergen, Buckwheat (R) General Lab 86003 $16.53 3129036 Allergen, Budgerigar Droppings (R) General Lab 86003 $16.53 3129037 Allergen, Budgerigar Feathers (R) General Lab 86003 $16.53 3129039 Allergen, Cabbage (R) General Lab 86003 $16.53 3129040 Allergen, Cacao/Cocoa (R) General Lab 86003 $16.53 3129041 Allergen, Canary Bird Feathers (R) General Lab 86003 $16.53 3129042 Allergen, Canary Grass (R) General Lab 86003 $16.53 3129043 Allergen, Candida albicans (Yeast) (R) General Lab 86003 $16.53 3129045 Allergen, Cardamom (R) General Lab 86003 $16.53 3129046 Allergen, Carob (R) General Lab 86003 $16.53 3129047 Allergen, Carrot (R) General Lab 86003 $16.53 3129048 Allergen, Castor Bean (R) General Lab 86003 $16.53 3129050 Allergen, Cauliflower (R) General Lab 86003 $16.53 3129052 Allergen, Celery (R) General Lab 86003 $16.53 3129054 Allergen, Chestnut (R) General Lab 86003 $16.53 3129056 Allergen, Chickpea (R) General Lab 86003 $16.53 3129061 Allergen, Chub Mackerel (R) General Lab 86003 $16.53 3129062 Allergen, Cinnamon (R) General Lab 86003 $16.53 3129063 Allergen, Clam (R) General Lab 86003 $16.53 3129064 Allergen, Clove (R) General Lab 86003 $16.53 3129065 Allergen, Cocklebur (R) General Lab 86003 $16.53 3129067 Allergen, Cod (R) General Lab 86003 $16.53 3129068 Allergen, Common Millet (R) General Lab 86003 $16.53 3129069 Allergen, Common Pigweed (R) General Lab 86003 $16.53 3129071 Allergen, Common Reed Grass (R) General Lab 86003 $16.53 3129072 Allergen, Common Wasp (Yellow Jacket) (R) General Lab 86003 $16.53 3129073 Allergen, Coriander (R) General Lab 86003 $16.53 3129074 Allergen, Cotton Seed (R) General Lab 86003 $16.53 3129076 Allergen, Crab (R) General Lab 86003 $16.53 3129077 Allergen, Cranberry (R) General Lab 86003 $16.53 3129078 Allergen, Crayfish (R) General Lab 86003 $16.53 3129079 Allergen, Cucumber (R) General Lab 86003 $16.53 3129080 Allergen, Cultivated Oat (Grass) (R) General Lab 86003 $16.53 3129082 Allergen, Cultivated Wheat (Grass) (R) General Lab 86003 $16.53 3129083 Allergen, Curry (R) General Lab 86003 $16.53 3129084 Allergen, Curvularia lunata (R) General Lab 86003 $16.53 3129085 Allergen, Dandelion (R) General Lab 86003 $16.53 3129086 Allergen, Date (R) General Lab 86003 $16.53 3129088 Allergen, Deer Epithelium (R) General Lab 86003 $16.53 3129089 Allergen, Dill (R) General Lab 86003 $16.53 3129091 Allergen, Douglas Fir Tree (R) General Lab 86003 $16.53 3129092 Allergen, Duck Feathers (R) General Lab 86003 $16.53 3129095 Allergen, Egg (R) General Lab 86003 $16.53 3129096 Allergen, Eggplant (R) General Lab 86003 $16.53 3129099 Allergen, Elm Tree (R) General Lab 86003 $16.53 3129100 Allergen, Epicoccum purpurascens (R) General Lab 86003 $16.53 3129101 Allergen, Ethylene oxide (R) General Lab 86003 $16.53 3129102 Allergen, Eucalyptus, Gum-tree (R) General Lab 86003 $16.53 3129104 Allergen, False Ragweed (R) General Lab 86003 $16.53 3129105 Allergen, Fennel Fresh (R) General Lab 86003 $16.53 3129109 Allergen, Ficus spp. (R) General Lab 86003 $16.53 3129111 Allergen, Finch Feathers (R) General Lab 86003 $16.53 3129112 Allergen, Fire Ant (R) General Lab 86003 $16.53 3129114 Allergen, Formaldehyde/Formalin (R) General Lab 86003 $16.53 3129117 Allergen, Gelatin (R) General Lab 86003 $16.53 3129118 Allergen, Gerbil Epithelium (R) General Lab 86003 $16.53 3129119 Allergen, Giant Ragweed (R) General Lab 86003 $16.53 3129120 Allergen, Goat Epithelium (R) General Lab 86003 $16.53 3129121 Allergen, Goat Milk (R) General Lab 86003 $16.53 3129125 Allergen, Grape (R) General Lab 86003 $16.53 3129126 Allergen, Green Bean (R) General Lab 86003 $16.53 3129135 Allergen, Hazelnut (R) General Lab 86003 $16.53 3129138 Allergen, Hickory Tree (R) General Lab 86003 $16.53 3129139 Allergen, Honey (R) General Lab 86003 $16.53 3129140 Allergen, Honey Bee (R) General Lab 86003 $16.53 3129146 Allergen, House Dust (R) General Lab 86003 $16.53 3129147 Allergen, House Dust Mite (R) General Lab 86003 $16.53 3129148 Allergen, Insulin Bovine (R) General Lab 86003 $16.53 3129149 Allergen, Insulin Human (R) General Lab 86003 $16.53 3129150 Allergen, Insulin Porcine (R) General Lab 86003 $16.53 3129161 Allergen, Johnson Grass (R) General Lab 86003 $16.53 3129162 Allergen, Kiwi (R) General Lab 86003 $16.53 3129163 Allergen, Lamb/Mutton Meat (R) General Lab 86003 $16.53 3129164 Allergen, Lemon (R) General Lab 86003 $16.53 3129165 Allergen, Lentil (R) General Lab 86003 $16.53 3129166 Allergen, Lima Bean (R) General Lab 86003 $16.53 3129167 Allergen, Lime (R) General Lab 86003 $16.53 3129168 Allergen, Linden Tree (R) General Lab 86003 $16.53 3129169 Allergen, Lobster (R) General Lab 86003 $16.53 3129174 Allergen, Malt (R) General Lab 86003 $16.53 3129177 Allergen, Maple Leaf Sycamore, London Plane Tree (R) General Lab 86003 $16.53 3129180 Allergen, Meadow Fescue (Grass) (R) General Lab 86003 $16.53 3129181 Allergen, Meadow Foxtail (Grass) (R) General Lab 86003 $16.53 3129182 Allergen, Meadow Grass, Kentucky Blue (R) General Lab 86003 $16.53 3129184 Allergen, Melon (R) General Lab 86003 $16.53 3129190 Allergen, Mountain Juniper Tree (R) General Lab 86003 $16.53 3129192 Allergen, Mouse Epithelium (R) General Lab 86003 $16.53 3129193 Allergen, Mouse Serum Proteins (R) General Lab 86003 $16.53 3129194 Allergen, Mucor racemosus (R) General Lab 86003 $16.53 3129197 Allergen, Mustard Seed (R) General Lab 86003 $16.53 3129198 Allergen, Nettle (R) General Lab 86003 $16.53 3129212 Allergen, Paper Wasp (R) General Lab 86003 $16.53 3129217 Allergen, Pea (R) General Lab 86003 $16.53 3129218 Allergen, Peach (R) General Lab 86003 $16.53 3129219 Allergen, Pear (R) General Lab 86003 $16.53 3129225 Allergen, Peppertree (R) General Lab 86003 $16.53 3129226 Allergen, Phoma betae (R) General Lab 86003 $16.53 3129230 Allergen, Pine Nut (R) General Lab 86003 $16.53 3129232 Allergen, Pistachio (R) General Lab 86003 $16.53 3129233 Allergen, Pityrosporum orbiculare (R) General Lab 86003 $16.53 3129235 Allergen, Plantain (English), Ribwort (R) General Lab 86003 $16.53 3129239 Allergen, Pumpkin (R) General Lab 86003 $16.53 3129244 Allergen, Raspberry (R) General Lab 86003 $16.53 3129246 Allergen, Rat Epithelium (R) General Lab 86003 $16.53 3129247 Allergen, Rat Serum Proteins (R) General Lab 86003 $16.53 3129248 Allergen, Rat Urine Proteins (R) General Lab 86003 $16.53 3129252 Allergen, Rhizopus nigricans (R) General Lab 86003 $16.53 3129253 Allergen, Rough Marshelder (R) General Lab 86003 $16.53 3129254 Allergen, Rye (R) General Lab 86003 $16.53 3129255 Allergen, Rye Grass (R) General Lab 86003 $16.53 3129258 Allergen, Salmon (R) General Lab 86003 $16.53 3129259 Allergen, Saltwort, Russian Thistle (R) General Lab 86003 $16.53 3129261 Allergen, Scale, Lenscale (R) General Lab 86003 $16.53 3129263 Allergen, Sheep Epithelium (R) General Lab 86003 $16.53 3129268 Allergen, Spinach (R) General Lab 86003 $16.53 3129272 Allergen, Staphylococcal enterotoxin B (R) General Lab 86353 $155.24 3129276 Allergen, Sweet Vernal Grass (R) General Lab 86003 $16.53 3129280 Allergen, Tea (T) General Lab 86003 $16.53 3129283 Allergen, Trichoderma viride (R) General Lab 86003 $16.53 3129284 Allergen, Trichophyton rubrum (R) General Lab 86003 $16.53 3129288 Allergen, Turkey Feathers (R) General Lab 86003 $16.53 3129291 Allergen, Virginia Live Oak (R) General Lab 86003 $16.53 3129293 Allergen, Watermelon (R) General Lab 86003 $16.53 3129294 Allergen, Western Ragweed (R) General Lab 86003 $16.53 3129296 Allergen, White Pine Tree (R) General Lab 86003 $16.53 3129297 Allergen, White-faced Hornet (R) General Lab 86003 $16.53 3129301 Allergen, Yellow Hornet (R) General Lab 86003 $16.53 3131818 Allergen, Onion (R) General Lab 86003 $16.53 3131824 Allergen, Orange (R) General Lab 86003 $16.53 3212976 Allergen, Pecan, Hickory (R) General Lab 86003 $16.53 3212977 Allergen, White Mulberry (R) General Lab 86003 $16.53 3212978 Allergen, Ragweed, Short (R) General Lab 86003 $16.53 3243301 Allergen Panel, Food-Berry (R) General Lab 86003 $16.53 3243302 Allergen Profile, Vegetable II (R) General Lab 86003 $16.53 3243303 Allergen Profile, Vegetable I (R) General Lab 86003 $16.53 3243304 Allergen Profile, Food-Fruit (R) General Lab 86003 $16.53 3243312 Allergens, Zone 7 (R) General Lab 86003 $16.53 3243315 Allergen, Lamb's Quarters (R) General Lab 86003 $16.53 3288650 Allergen, Goose Feather (R) General Lab 86003 $16.53 3288651 Allergen, Hackberry (R) General Lab 86003 $16.53 3335782 Allergen, Pen chrysogen (R) General Lab 86003 $16.53 3534322 Allergen, Chili Pepper (R) General Lab 86003 $16.53 3534323 Allergen Profile, Basic Food (R) General Lab 86005 $25.22 3211251 Allergy Profile Area 10 LabCorp (R) General Lab 82785 $52.13 3243307 Allergy Panel Child 2 and Under (R) General Lab 86003 $16.53 3243309 Allergy Panel Child 2-6 yrs (R) General Lab 86003 $16.53 633643 Alpha Fetoprotein Tumor Marker (R) General Lab 82105 $53.12 3114217 Alpha Fetoprotein Maternal (R) General Lab 82105 $53.12 3481324 Alpha Gal IgE (R) General Lab 86008 $56.80 3213146 Alpha Subunit (Free) (R) General Lab 83520 $49.22 3108974 Alpha-1-Antitrypsin (R) General Lab 82103 $42.55 3213128 Alpha-1-Antitrypsin Phenotype (R) General Lab 82103 $42.55 3486348 Alpha-Gal Panel (R) General Lab 86008 $56.80 3129305 Aluminum Level Urine (R) General Lab 82570 $16.39 3213077 Amebiasis Antibodies (R) General Lab 86753 $39.22 3225058 Amikacin Peak, Serum (R) General Lab 80150 $47.74 3225059 Amikacin Trough, Serum (R) General Lab 80150 $47.74 3108975 Amino Acid Quantitative (R) General Lab 82139 $53.41 3129307 Amino Acid Quantitative Urine (R) General Lab 82139 $53.41 3108977 Amiodarone Level (R) General Lab 80299 $53.12 3108978 Amitriptyline Level (R) General Lab 80335 $14.25 1628880 Ammonia Level General Lab 82140 $46.14 3133240 Ammonia (R) General Lab 82140 $46.14 3409063 Amphet Conf WB 700913 General Lab 80324 $43.21 3409065 Amphet WB 700736 General Lab 80359 $28.84 3482658 Amphet WB 700736 General Lab 80324 $43.21 3325399 Amphetamine (GC/MS), Urine (R) General Lab 80324 $43.21 631567 Amylase Level General Lab 82150 $20.52 2356792 Amylase Level (R) General Lab 82150 $22.80 3129317 Amylase Isoenzymes (R) General Lab 82150 $20.52 3213127 Amylase, Body Fluid (R) General Lab 82150 $20.52 3176371 Anaerobic Culture (R) General Lab 87075 $29.98 3224973 Anaerobic and Aerobic Culture (R) General Lab 87075 $29.98 3108981 Androstenedione (R) General Lab 82157 $92.71 3224959 Anemia Profile A (R) General Lab 85045 $12.65 3224960 Anemia Analyzer (R) General Lab 82746 $46.57 3108982 Angiotensin Converting Enzyme (R) General Lab 82164 $46.23 3243314 Animal Mix Allergy (R) General Lab 86005 $25.22 3540090 Anti 68kD (hsp 70) Abs (R) General Lab 84181 $53.92 3175256 Anti DS DNA (R) General Lab 86225 $43.52 3211191 Anti-Centromere B Antibodies General Lab 86235 $56.80 3285469 Anti-Complement (R) General Lab 86880 $17.07 3211221 Anti-DNA (DS) Ab Qn 165189 General Lab 86225 $43.52 3470771 Anti-HCV Screen General Lab 86803 $45.17 3211194 Anti-Jo-1 General Lab 86235 $56.80 3329193 Anti-Mullerian Hormone (AMH) (R) General Lab 82397 $44.72 3540169 Anti-Myelin Assoc. Gly. IgM (R) General Lab 86256 $38.16 3224966 Antibody Screen (R) General Lab 86850 $27.84 3213155 Anticardiolipin Ab, IgG/M, Qn (R) General Lab 86147 $80.60 3213156 Anticardiolip Ab, IgA/G/M, Qn (R) General Lab 86147 $80.60 3282864 Antichromatin Antibodies 165192 General Lab 86235 $56.80 3129320 Antideoxyribonuclease B Titer (R) General Lab 86215 $41.95 3108983 Antidepressant Tricyclic Screen (R) General Lab 80307 $227.46 3438651 Antidepressant Panel, Ql, Exp (R) General Lab 80334 $27.19 3108660 Antidiuretic Hormone Level (R) General Lab 84588 $107.47 3212907 Antiextractable Nuclear Ag (R) General Lab 86235 $56.80 3552416 Antifungal Suscep 3 Drugs (R) General Lab 87186 $27.39 3470682 Antigliadin IgG (native) General Lab 83516 $36.51 633654 Antiglomerular Basement Membrane Antibody (R) General Lab 83516 $36.51 3213164 Antimyeloperoxidase (MPO) Abs (R) General Lab 83520 $49.22 3222901 Antimyeloperoxidase (MPO) Abs General Lab 83520 $100.00 633656 Antineutrophil Cytoplasmic Antibody (R) General Lab 86256 $38.16 3224957 Antinuclear Antibodies Direct (R) General Lab 86038 $38.28 3311777 Antinuclear Antibodies, IFA General Lab 86038 $46.94 3225054 Antiparietal Cell Antibody (R) General Lab 83516 $36.51 3213130 Antiphosphatidylserine IgG/M/A (R) General Lab 86148 $50.87 3319417 Antiphospholipid Syndrome (R) General Lab 85598 $56.91 3222902 Antiproteinase 3 (PR-3) Abs General Lab 83520 $100.00 3466990 Antiproteinase 3 (PR-3) Abs (R) General Lab 83520 $49.22 3211200 Antiribosomal P Antibodies General Lab 83516 $36.51 3567293 Antiribosomal P Antibodies (R) General Lab 83516 $36.51 633658 Antistreptolysin O Titer (R) General Lab 86060 $23.11 3276375 Antistreptolysin O Titer General Lab 86060 $28.36 3213089 Antithrombin Activity (R) General Lab 85300 $37.53 3340324 Antithrombin III, Func/Immunol (R) General Lab 85300 $37.53 3224946 Antithyroglobulin Ab (R) General Lab 86800 $50.36 3556586 Apixaban Anti-Xa (R) General Lab 85130 $37.65 3129330 Apolipoprotein A-1 (R) General Lab 82172 $60.11 3129331 Apolipoprotein A1 and B (R) General Lab 82172 $60.11 3129332 Apolipoprotein B (R) General Lab 82172 $60.11 3131328 Apolipoprotein A General Lab 82172 $110.00 3131331 Apolipoprotein B General Lab 82172 $110.00 633660 Arsenic Level (R) General Lab 82175 $60.08 3213195 Arthritis Panel ( R) General Lab 86225 $43.52 3133242 Aspartate Aminotransferase Level (R) General Lab 84450 $16.39 3108985 Aspergillus Antibody (R) General Lab 86606 $47.68 3518306 Aspergillus flavus IgE (R) General Lab 86003 $16.53 3518307 Aspergillus versicolor IgE (R) General Lab 86003 $16.53 3222913 Atypical pANCA General Lab 86256 $95.00 3224979 B pertussis, Nasophar Culture (R) General Lab 87070 $27.27 3480779 B pertussis IgG/IgM Ab (R) General Lab 86615 $41.75 3480780 B pertussis IgA Ab (R) General Lab 86615 $41.75 3480781 B pertussis IgG Ab (R) General Lab 86615 $41.75 3480788 B pertussis IgM Ab (R) General Lab 86615 $41.75 3526467 B pertussis IgG/M/A Ab (R) General Lab 86615 $41.75 1383771 B-Type Natriuretic Peptide General Lab 83880 $111.89 3133243 B-type Natriuretic Peptide (R) General Lab 83880 $111.89 3213144 B.pertussisB.parapertussis PCR (R) General Lab 87798 $111.12 3213198 BCR-ABL1, CML/ALL, PCR, Quant (R) General Lab 81206 $519.21 633699 BF Cell Count General Lab 89051 $17.44 3380652 BK Quant PCR (Plasma/Serum) (R) General Lab 87799 $135.66 3527042 BK Quant PCR (Urine)(R) General Lab 87799 $135.66 3130440 BOH Ketone General Lab 82010 $25.88 3304271 BRAF Analysis, Melanoma (R) General Lab 81210 $499.89 3304268 BRAF Gene Mutation Analysis (R) General Lab 81210 $499.89 3539586 BRCA1 Seq LLS Tracking General Lab 81215 $1,069.46 3539567 BRCA1 Targeted Analysis (R) General Lab 81215 $1,069.46 3526683 BRCA2 Targeted Analysis (R) General Lab 81217 $1,069.46 3321702 BRCAssure Comprehensive Test (R) General Lab 81162 $5,778.77 3134687 BUN+Creat+GFR General Lab 84520 $12.51 3213092 BUN+Creat (R) General Lab 82565 $16.22 3129341 Bacterial Antigen (R) General Lab 87802 $37.96 3129342 Bacterial Antigen Cerebrospinal Fluid (R) General Lab 87802 $37.96 3213186 Bacterial Vaginosis, NAA (R) General Lab 87798 $111.12 633661 Barbiturate Screen Urine General Lab 80306 $48.85 3325400 Barbiturate (GC/MS), Urine (R) General Lab 80345 $31.07 3409083 Barbiturates Con WB 700746 General Lab 80345 $31.07 3482662 Barbiturates Con WB 700746 General Lab 80345 $31.07 3129345 Barium Level (R) General Lab 83018 $69.57 3129346 Bartonella Detection by PCR (R) General Lab 87471 $111.12 3133245 Basic Metabolic Panel General Lab 80048 $26.79 3134606 Basic Metabolic Panel (R) General Lab 80048 $26.79 3287433 Baso (Diff) General Lab 85007 $10.89 633662 Benzodiazepine Screen Urine General Lab 80306 $48.85 3325407 Benzodiazepines Confirm, Urine (R) General Lab 80346 $45.91 3567168 Benzodiazepine Confirm,QT Serum/Plasma (R) General Lab 80347 $65.66 3108986 Beta 2 Microglobulin (R) General Lab 82232 $51.21 633665 Beta Human Chorionic Gonadotropin Quantitative General Lab 84702 $47.68 3213157 Beta-2 Glycoprotein I Ab,G/M (R) General Lab 86146 $80.60 3213166 Beta-2 Glycoprotein I Ab,G,A,M (R) General Lab 86146 $80.60 3108987 Beta-Hydroxybutyrate Quantitative (R) General Lab 82010 $25.88 3213085 Beta2-Microglob. CSF (R) General Lab 82232 $51.21 633667 Bicarbonate Level General Lab 82374 $15.48 3540291 Bicarbonate (HCO3), Urine (R) General Lab 82374 $15.48 3108988 Bile Acids Total (R) General Lab 82239 $54.24 3213207 Bile Acids, Fractionated LCMS (R) General Lab 82542 $68.66 633670 Bilirubin Direct General Lab 82248 $15.87 633672 Bilirubin Total General Lab 82247 $15.87 1635542 Bilirubin Total General Lab 82247 $15.87 1635543 Bilirubin Direct General Lab 82248 $15.87 3134424 Bilirubin Total General Lab 82247 $17.65 3528275 Bilirubin, Total/Direct, Serum (R) General Lab 82248 $15.87 3213221 Bismuth, Blood (R) General Lab 83018 $69.57 3108990 Blastomyces Antibody (R) General Lab 86612 $40.87 3193238 Blood Culture, Routine (R) General Lab 87040 $32.69 3193270 Blood Culture (R) General Lab 87040 $42.00 633675 Blood Gas Arterial General Lab 82803 $74.30 633676 Blood Gas Capillary General Lab 82803 $74.30 633677 Blood Gas Venous General Lab 82803 $74.30 633605 Blood Urea Nitrogen General Lab 84520 $12.51 3134688 Blood Urea Nitrogen General Lab 84520 $28.00 3130546 Body Fluid Crystals General Lab 89060 $22.66 3561551 Body Fluid Culture, Sterile (R) General Lab 87070 $27.27 3213169 Brucella Antibody IgG, EIA (R) General Lab 86622 $28.27 3213170 Brucella Antibody IgM, EIA (R) General Lab 86622 $28.27 3213171 Brucella Antibody IgG/IgM (R) General Lab 86622 $28.27 3171110 Bun (R) General Lab 84520 $12.51 3468970 Buprenorphine Con General Lab 80348 $46.63 3213191 C difficile Toxin Gene NAA (R) General Lab 87493 $111.12 3108993 C-Peptide (R) General Lab 84681 $65.92 3213132 C-Reactive Protein, Cardiac (R) General Lab 86141 $41.01 3497409 C. trachomatis NAA, Confirm General Lab 87491 $111.12 3245194 C.Difficile, PCR General Lab 87493 $111.12 3108994 C1 Esterase Inhibitor (R) General Lab 86160 $37.99 3496280 C1 Esterase Inhibitr, Func HAE General Lab 86161 $37.99 3108995 C1q Immune Complex Detection (R) General Lab 86160 $37.99 3108996 C2 Complement (R) General Lab 86160 $37.99 633684 C3 Complement (R) General Lab 86160 $37.99 3108997 C3a Complement Protein (R) General Lab 86160 $37.99 633685 C4 Complement (R) General Lab 86160 $37.99 3213101 C4+C3 (R) General Lab 86160 $37.99 2248297 CA 125 (R) General Lab 86304 $65.92 2248298 CA 15-3 (R) General Lab 86300 $65.92 3130627 CBC (WIC) General Lab 85027 $20.46 1147770 CBC w/ Diff General Lab 85025 $24.60 3434655 CBC+Hematology Review (R) General Lab 85007 $10.89 3213251 CBC, Platelet, No Differential (R) General Lab 85027 $20.46 3341833 CBE 80050 General Health Panel General Lab 80050 $215.37 3552417 CFTR Deletion/Duplication (R) General Lab 81222 $1,239.95 3176369 CK (R) General Lab 82550 $20.61 3212900 CK+Trop I (R) General Lab 82550 $20.61 3225037 CK, Total+Isoenzymes, Serum (R) General Lab 82552 $42.41 633713 CK-MB General Lab 82553 $70.00 3481705 CLL FISH Panel (R) General Lab 88271 $67.83 1519769 CMV Antibody IgG General Lab 86644 $50.63 1519772 CMV Antibody IgM General Lab 86645 $59.28 1779400 COLLECTION: Venous Draw General Lab 36415 $15.00 2356805 COMP General Lab 80053 $33.46 3175244 CRP (R) General Lab 86140 $16.39 3223048 CRP (R) General Lab 86140 $20.09 1628890 CRP WWH (Cardio) General Lab 86140 $18.21 3470751 CRP WWH (Inflammation) General Lab 86140 $18.21 3117656 CYTOLOGY FINE NEEDLE ASPIRATION (R) General Lab 88173 $44.70 $249.60 3252551 CYTOLOGY BREAST DISCHARGE CYTOLOGY (R) General Lab 88161 $73.10 3259289 CYTOLOGY BRONCHIAL WASHINGS CYTOLOGY (R) General Lab 88112 $135.70 3259290 CYTOLOGY PLEURAL FLUID CYTOLOGY (R) General Lab 88112 $135.70 3259291 CYTOLOGY ABDOMINAL FLUID CYTOLOGY (R) General Lab 88112 $135.70 3259292 CYTOLOGY URINE CYTOLOGY (R) General Lab 88112 $135.70 3259293 CYTOLOGY SPUTUM CYTOLOGY (R) General Lab 88108 $58.10 3259294 CYTOLOGY MISCELLANEOUS SMEAR CYTOLOGY (R) General Lab 88161 $73.10 3259295 CYTOLOGY MISCELLANEOUS FLUID CYTOLOGY (R) General Lab 88112 $135.70 3259296 CYTOLOGY ANAL (RECTAL) CYTOLOGY, LBP (R) General Lab 88112 $135.70 3259297 CYTOLOGY BRONCHIAL BRUSHINGS CYTOLOGY (R) General Lab 88104 $58.10 3259298 CYTOLOGY NEEDLE ASPIRATION/STEREOTACTIC CYTO (R) General Lab 88172 $58.10 3259299 CYTOLOGY DUCTAL LAVAGE CYTOLOGY (R) General Lab 88112 $135.70 3122457 Cadmium Level (R) General Lab 82300 $73.30 3129371 Cadmium Level Urine (R) General Lab 82300 $73.30 3108998 Caffeine Level (R) General Lab 80155 $109.92 633686 Calcitonin Level (R) General Lab 82308 $84.84 1628887 Calcium Level Total General Lab 82310 $16.33 3176377 Calcium Level (R) General Lab 82310 $16.33 3212903 Calcium, Ionized, Serum (R) General Lab 82330 $43.32 3213140 Calcium/Creatinine Ratio (R) General Lab 82340 $19.10 3224953 Calcium, 24Hr Urine (R) General Lab 82340 $19.10 3244894 Calcium, Random Urine (R) General Lab 82340 $19.10 3213133 Calculi, Urinary, with Photo (R) General Lab 82360 $40.76 3213134 Calculi, Urinary (R) General Lab 82360 $40.76 3213139 Calprotectin, Fecal (R) General Lab 83993 $62.16 1666976 Cancer Antigen 27 29 (R) General Lab 86300 $65.92 3108999 Candida Antibody (R) General Lab 86628 $38.02 3129372 Candida Antigen (R) General Lab 87899 $45.80 633693 Cannabinoid Screen Urine General Lab 80306 $48.85 3325401 Cannabinoid (GC/MS), Urine (R) General Lab 80349 $38.25 3409167 Cannabidiol WB 700923 General Lab 80349 $38.25 3482697 Cannabidiol WB 700923 General Lab 80349 $38.25 633694 Carbamazepine Level General Lab 80156 $46.11 633695 Carbamazepine Level Free (R) General Lab 80157 $41.98 1147693 Carbamazepine, Free and Total (R) General Lab 80157 $41.98 1660879 Carbamazepine Free Level General Lab 80157 $46.63 1666975 Carbohydrate Antigen 19-9 (R) General Lab 86301 $65.92 1628888 Carbon Dioxide Level General Lab 82374 $15.48 3212896 Carbon Dioxide, Total (R) General Lab 82374 $15.48 633627 Carboxyhemoglobin Level (R) General Lab 82375 $39.02 3281997 Carboxyhemoglobin General Lab 82375 $39.02 633697 Carcinoembryonic Antigen (R) General Lab 82378 $60.05 1503763 Cardiac Enzymes General Lab 82550 $20.61 3109001 Cardiolipin Antibody IgA (R) General Lab 86147 $80.60 3109002 Cardiolipin Antibody IgG (R) General Lab 86147 $80.60 3109003 Cardiolipin Antibody IgM (R) General Lab 86147 $80.60 3481459 Carmine Red Dye (R) General Lab 86003 $16.53 3109004 Carnitine Free and Total (R) General Lab 82379 $53.41 3109005 Carotene Level (R) General Lab 82380 $29.21 3175259 Cat Scratch Disease Abs (R) General Lab 86611 $32.23 3109006 Catecholamines Fractionated (R) General Lab 82384 $79.97 3109007 Catecholamines Fractionated 24 Hour Urine (R) General Lab 82384 $79.97 3213196 Celiac Disease Antibody Screen (R) General Lab 83516 $36.51 3496167 Celiac Disease Comprehensive (R) General Lab 86255 $38.16 633700 Cell Count w/ Diff Cerebrospinal Fluid General Lab 89050 $14.96 3213100 Cell Ct+Cryst+Mucin(Synovial) (R) General Lab 83872 $20.62 3522777 Cell Ct, Synovial w/Crystals (R) General Lab 89060 $22.66 3129377 Centromere Antibody Titer (R) General Lab 86235 $56.80 3109010 Ceruloplasmin (R) General Lab 82390 $34.00 3109011 Chlamydia Antibody IgG (R) General Lab 86631 $37.41 3129378 Chlamydia Antibody (R) General Lab 86632 $40.16 3148956 Chlamydia (R) General Lab 87491 $111.12 3176501 Chlamydia Trachomatis Culture (R) General Lab 87110 $62.04 3497405 Chlamydia, Conjunctiva, NAA (R) General Lab 87491 $111.12 3129380 Chloramphenicol Level (R) General Lab 82415 $40.13 633621 Chloride Level General Lab 82435 $14.56 3212890 Chloride (R) General Lab 82435 $14.56 3224952 Chloride, 24 hr Urine (R) General Lab 82436 $16.39 3244893 Chloride, Urine (R) General Lab 82436 $16.39 633705 Cholesterol Total General Lab 82465 $13.79 1628889 Cholesterol High Density Lipid General Lab 83718 $25.94 3210841 Cholesterol Total (R) General Lab 82465 $13.79 3518476 Cholesterol, Fluid (R) General Lab 84311 $23.09 3213078 Cholinesterase, RBC (R) General Lab 82482 $27.96 3213153 Cholinesterase, Plasma (R) General Lab 82480 $24.94 3109013 Chromium Level (R) General Lab 82495 $64.21 3129387 Chromium Level Urine (R) General Lab 82495 $64.21 3109014 Chromogranin A (R) General Lab 86316 $65.92 3129388 Chromosome Analysis (R) General Lab 88230 $368.90 3213210 Chromosome Microarray (R) General Lab 81229 $3,306.00 3556587 Chronic Urticaria (R) General Lab 86352 $430.24 3109016 Citrate Level 24 Hour Urine (R) General Lab 82507 $88.04 3129392 Citrate Level Urine (R) General Lab 82507 $88.04 3211250 Ck-Mb (R) General Lab 82553 $36.57 3213227 Clobazam (ONFI) (R) General Lab 80339 $14.25 3109017 Clonazepam Level (R) General Lab 80346 $45.91 3528695 Clonazepam, Ur as Metabolite (R) General Lab 80346 $45.91 3340345 Clopidogrel P450 2C19 (R) General Lab 81225 $830.38 3129394 Clorazepate Level (R) General Lab 80346 $45.91 3109018 Clozapine Level (R) General Lab 80159 $58.57 3213107 Cobalt, Plasma (R) General Lab 83018 $69.57 633706 Cocaine Screen Urine General Lab 80306 $56.86 3325403 Cocaine (GC/MS), Urine (R) General Lab 80353 $34.77 3409141 Cocaine Conf WB 700768 General Lab 80353 $20.62 3409142 Cocaine WB 700769 General Lab 80353 $34.77 3109021 Coccidioides CF Antibody (R) General Lab 86635 $36.34 3409183 Codeine WB 700777 General Lab 80356 $45.32 3500927 Coenzyme Q10, Total (R) General Lab 82542 $68.66 633708 Cold Agglutinins Titer (R) General Lab 86157 $25.54 3122462 Complement Total (R) General Lab 86162 $64.35 3134608 Complete Blood Count w/Diff(R) General Lab 85025 $24.60 633709 Comprehensive Metabolic Panel (R) General Lab 80053 $33.46 3339704 Concentration MTB General Lab 87015 $21.15 3109023 Copper Level (R) General Lab 82525 $39.30 3109024 Copper Level 24 Hour Urine (R) General Lab 82525 $39.30 3129406 Copper Level Whole Blood (R) General Lab 82525 $39.30 3130491 Cord Blood Gas Arterial General Lab 82803 $74.30 3130492 Cord Blood Gas Venous General Lab 82803 $74.30 633710 Cortisol (R) General Lab 82533 $51.61 3109025 Cortisol Morning (R) General Lab 82533 $51.61 3109027 Cortisol Evening (R) General Lab 82533 $51.61 3129407 Cortisol Free Urine (R) General Lab 82530 $52.92 3213149 Cortisol, ACTH Stimulation (R) General Lab 82533 $51.61 3109028 Coxsackie A Virus Antibody (R) General Lab 86658 $41.24 3109029 Coxsackie B Virus Antibody (R) General Lab 86658 $41.24 633609 Creat Clear General Lab 82575 $29.95 633606 Creatinine General Lab 82565 $16.22 633712 Creatine Kinase General Lab 82550 $20.61 1507772 Creatine Kinase General Lab 82550 $39.00 1930782 Creatinine Urine Random General Lab 82570 $16.39 3129416 Creatine Level (R) General Lab 82540 $14.68 3134598 Creatinine Lvl General Lab 82565 $18.03 3134689 Creatinine Lvl General Lab 82565 $30.00 3171117 Creatinine (R) General Lab 82565 $16.22 3175257 Creatinine Clearance (R) General Lab 82575 $29.95 3213088 Creatinine, Urine (R) General Lab 82570 $16.39 3224951 Creatinine, 24-Hour Urine (R) General Lab 82570 $16.39 3129418 Cryofibrinogen General Lab 82585 $40.30 633717 Cryoglobulin (R) General Lab 82595 $20.46 3227082 Cryoglobulin % General Lab 86334 $70.77 3109030 Cryptococcal Antigen (R) General Lab 87899 $45.80 3109031 Cryptococcal Antigen CSF (R) General Lab 87899 $45.80 3129419 Cryptococcal Antibody (R) General Lab 86641 $45.63 3466711 Cryptococcus Ag Titer, CSF General Lab 87899 $45.80 3318729 Ct Ng Trich Vag HSV by NAA(R) General Lab 87491 $111.12 3213187 Ct, Ng, Trich vag by NAA (R) General Lab 87491 $111.12 3432654 Ct/GC NAA, Pharyngeal (R) General Lab 87591 $111.12 3481480 Ct/GC NAA, Rectal (R) General Lab 87491 $111.12 3122464 Cyclic Citrulline Peptide (R) General Lab 86200 $41.01 3109032 Cyclosporine Level (R) General Lab 80158 $57.17 3319418 Cystatin C (R) General Lab 82610 $52.78 3552585 Cystic Fibrosis Mutation 97 (R) General Lab 81220 $1,586.31 3109034 Cystine Urine, 24 Hr (R) General Lab 82131 $65.49 3552418 Cytochrome P450 3A4/3A5 (R) General Lab 81230 $498.21 3552461 Cytochrome P450 2D6/2C19 (R) General Lab 81225 $830.38 3562619 Cytochrome P450 2C9 Genotyping (R) General Lab 81227 $498.21 1519764 Cytomegalovirus Antibody IgG and IgM (R) General Lab 86644 $45.57 3109019 Cytomegalovirus Antibody IgM (R) General Lab 86645 $53.35 3109020 Cytomegalovirus DNA by PCR (R) General Lab 87497 $135.66 3129397 Cytomegalovirus Antibody IgG (R) General Lab 86644 $45.57 3222911 Cytoplasmic (C-ANCA) General Lab 86256 $95.00 633718 D-Dimer General Lab 85380 $35.81 3176370 D-Dimer (R) General Lab 85379 $32.23 3122440 DNA Antibody (Single-stranded) (R) General Lab 86226 $38.33 3276376 DNA Antibody (Double-stranded) General Lab 86225 $53.32 3109036 Dehydroepiandrosterone Sulfate (R) General Lab 82627 $70.42 3129433 Dehydroepiandrosterone (R) General Lab 82626 $80.03 3212971 Dermatophagoides farinae (R) General Lab 86003 $16.53 3213082 Desipramine, Serum (R) General Lab 80335 $14.25 3213192 Dexamethasone Suppression 8AM (R) General Lab 82533 $51.61 3312622 Dexamethasone, Serum (R) General Lab 80375 $61.36 3388901 Diazepam (Valium), Serum (R) General Lab 80346 $45.91 3187086 Differential (R) General Lab 85004 $20.46 3126473 Digoxin Lvl (R) General Lab 80162 $42.04 3122465 Dihydroxyvitamin D 1,25 Level (R) General Lab 82652 $121.92 3213204 Dihydrotestosterone (R) General Lab 80327 $63.21 3206797 Dilantin (R) General Lab 80185 $41.98 3109038 Diphtheria Antibody (R) General Lab 86317 $47.45 3321732 Dir Rev BRCA General Lab 81162 $5,778.77 3212891 Direct Bilirubin (R) General Lab 82248 $15.87 3285441 Direct Coombs (R) General Lab 86880 $17.07 3340680 Diuretic Screen, Urine (R) General Lab 80377 $22.14 3109039 Doxepin Level (R) General Lab 80335 $14.25 1148019 Drug Screen Urine General Lab 80306 $56.86 3176380 Drug Screen Blood (R) General Lab 80307 $199.53 3276473 Drug Screen Alere-Jay General Lab 80305 $35.91 3562620 Duchenne/Becker MD Del/Dup (R) General Lab 81161 $795.15 3213173 E. chaffeensis-HME (Monocytic) (R) General Lab 86666 $32.23 3175719 EBV Ab Capsid IgM General Lab 86665 $98.00 3175720 EBV Ab Capsid IgG General Lab 86665 $98.00 3213095 EBV Ab VCA, IgG (R) General Lab 86665 $57.46 3213097 EBV Ab VCA, IgM (R) General Lab 86665 $57.46 3175261 EBV Acute Infection Antibodies (R) General Lab 86663 $41.55 3213096 EBV Early Antigen Ab, IgG (R) General Lab 86663 $41.55 3213093 EBV Nuclear Antigen Ab, IgG (R) General Lab 86664 $48.42 3466658 EBV PCR Quant (Whole Blood) (R) General Lab 87799 $135.66 3213094 EBVCA(IgG/M) (R) General Lab 86665 $57.46 3304272 EGFR Mutation Analysis, NSCLC (R) General Lab 81235 $925.05 3304276 EGFR Oncology FISH (R) General Lab 88271 $116.00 3175245 ESR (R) General Lab 85652 $8.55 3213141 Ehrlichia chaffeensis PCR (R) General Lab 87798 $111.12 3528727 Ehrlichia Detection PCR (R) General Lab 87798 $111.12 3134433 Electrolyte Panel General Lab 80051 $22.20 3171112 Electrolyte Panel (R) General Lab 80051 $22.20 3129443 Endomysial Antibody IgA Screen (R) General Lab 86255 $38.16 3109043 Enterovirus by PCR (R) General Lab 87498 $111.12 633722 Eosinophil Urine (R) General Lab 87205 $13.54 1634901 Eosinophil Smear Nasal (R) General Lab 89190 $16.50 3175724 Epstein Barr Virus Nuclear Antigen General Lab 86664 $86.00 3175727 Epstein Barr Virus Antibody to Early Antigen General Lab 86663 $86.00 3213142 Epstein-Barr DNA Quant, PCR (R) General Lab 87799 $135.66 3338970 Epstein-Barr Virus PCR (Whole Blood) (R) General Lab 87798 $111.12 3109045 Erythropoietin Level (R) General Lab 82668 $59.51 633723 Estradiol (R) General Lab 82670 $88.46 633724 Estriol Level (R) General Lab 82677 $76.58 3109046 Estrogens Total (R) General Lab 82672 $68.71 3109047 Estrone Level (R) General Lab 82679 $79.03 3228603 Ethambutol 5 ug/mL General Lab 87188 $21.03 3228623 Ethambutol 5.0 ug/mL General Lab 87190 $20.83 3339807 Ethambutol 5 ug/mL General Lab 87188 $21.03 3339848 Ethambutol 5.0 ug/mL General Lab 87190 $20.83 1503765 Ethanol Level General Lab 80320 $31.95 3213091 Ethanol, Blood (R) General Lab 80320 $31.95 3526463 Ethanol, Urine (R) General Lab 80307 $184.25 3109049 Ethosuximide Level (R) General Lab 80168 $51.73 3306455 Everolimus (R) General Lab 80169 $43.49 3470688 F004-IgE Wheat General Lab 86003 $16.53 3556679 F352-IgE Ara h 8 General Lab 86008 $56.80 3556664 F354-IgE Ber e 1 General Lab 86008 $56.80 3556676 F422-IgE Ara h 1 General Lab 86008 $56.80 3556677 F423-IgE Ara h 2 General Lab 86008 $56.80 3556678 F424-IgE Ara h 3 General Lab 86008 $56.80 3556647 F425-IgE Cor a 8 General Lab 86008 $56.80 3556680 F427-IgE Ara h 9 General Lab 86008 $56.80 3556646 F428-IgE Cor a 1 General Lab 86008 $56.80 3556649 F439-IgE Cor a 14 General Lab 86008 $56.80 3556648 F440-IgE Cor a 9 General Lab 86008 $56.80 3556655 F441-IgE Jug r 1 General Lab 86008 $56.80 3556656 F442-IgE Jug r 3 General Lab 86008 $56.80 3556660 F443-IgE Ana o 3 General Lab 86008 $56.80 3500929 FISH Oncology (R) General Lab 88271 $75.36 3109052 Factor V Leiden (R) General Lab 81241 $215.00 3129465 Factor XIII Assay (R) General Lab 85291 $31.29 3213119 Factor II Activity (R) General Lab 85210 $45.68 3213120 Factor V Activity (R) General Lab 85220 $62.10 3213121 Factor VIII Activity (R) General Lab 85240 $63.00 3213123 Factor IX Activity (R) General Lab 85250 $67.00 3213124 Factor X Activity (R) General Lab 85260 $63.00 3213125 Factor XI Activity (R) General Lab 85270 $63.00 3213126 Factor XII Activity (R) General Lab 85280 $68.08 3213212 Factor II, DNA Analysis (R) General Lab 81240 $187.22 3213229 Factor VII Activity (R) General Lab 85230 $63.00 3462666 Factor VIII Inhibitor, Comp (R) General Lab 85240 $63.00 3462681 Factor VIII Bethesda Titer General Lab 85335 $40.76 3109058 Fecal Fat Qualitative (R) General Lab 82705 $17.93 3109059 Fecal Fat Quantitative (R) General Lab 82710 $59.12 3109060 Felbamate Level (R) General Lab 80339 $14.25 3213108 Fentanyl and Metabolite (R) General Lab 80354 $43.46 3409210 Fentanyl Conf WB 700790 General Lab 80354 $43.46 3444740 Fentanyl Con PM UDS General Lab 80354 $43.46 1628893 Ferritin Level General Lab 82728 $47.97 3131455 Ferritin Level General Lab 82728 $72.00 3134444 Ferritin Level General Lab 82728 $47.97 3185596 Ferritin (R) General Lab 82728 $47.97 1147772 Fetal Fibronectin General Lab 82731 $226.64 1147773 Fetal Lung Maturity (R) General Lab 83664 $66.54 3335312 Fetal Membranes Rupture Test General Lab 84112 $279.61 633728 Fibrinogen Level General Lab 85384 $29.88 3175253 Fibrinogen Activity (R) General Lab 85384 $29.88 3245198 FilmArray RP, PCR General Lab 87633 $1,466.46 3245199 FilmArray GI, PCR General Lab 87507 $1,466.46 3213117 Flecainide (Tambocor(TM)), S (R) General Lab 80299 $53.12 3122448 Fluorescent Treponemal Antibody-Absorption (R) General Lab 86780 $46.58 3340344 Fluorescent treponema Ab, CSF (R) General Lab 86780 $46.58 3185598 Folate (Folic Acid) (R) General Lab 82746 $51.74 633730 Follicle Stimulating Hormone Level (R) General Lab 83001 $65.38 3243305 Food Allergy Profile (R) General Lab 86003 $18.37 3243308 Food Allergy Panel (R) General Lab 86003 $18.37 3131356 Fragile X DNA Detection General Lab 81243 $370.50 3460654 Fragile X, PCR and Southern (R) General Lab 81243 $162.56 3460655 Fragile X, PCR reflex Southern (R) General Lab 81243 $162.56 3462665 Fragile X Southern Blot General Lab 81244 $127.94 3213135 Free K+L Lt Chains,Qn,S (R) General Lab 83883 $47.84 3213137 Free K+L Lt Chains,Qn,Ur (R) General Lab 83883 $47.84 3226688 Free Kappa Lt Chains,S 121138 General Lab 82784 $29.47 3241779 Free Kappa Lt Chains,S 121138 General Lab 86334 $70.77 3226689 Free Lambda Lt Chains,S 121139 General Lab 82784 $29.47 3241780 Free Lambda Lt Chains,S 121139 General Lab 83883 $43.06 3226759 Free T3 010392 General Lab 84481 $53.64 3175262 Free T4 (R) General Lab 84439 $31.73 3226753 Free T4 019746 General Lab 84439 $28.56 3226756 Free T4 019747 General Lab 84439 $28.56 3482498 Free and Total Insulin (R) General Lab 83525 $40.22 633732 Fructosamine (R) General Lab 82985 $53.04 3243306 Full Inhalant Panel with Molds (R) General Lab 86003 $18.37 3562610 Fungal Antibodies, DID (R) General Lab 86698 $43.96 3175239 Fungus Culture with Stain (R) General Lab 87206 $18.96 3224975 Fungus (Mycology) Culture (R) General Lab 87101 $27.11 3211245 GAD Antibodies (R) General Lab 86341 $69.61 1635507 GC/Chlamydia (R) General Lab 87491 $123.48 3476842 GI Profile, Stool, PCR (R) General Lab 87507 $1,466.46 3213224 Gabapentin (Neurontin), Serum (R) General Lab 80171 $61.76 1628895 Gamma Glutamyl Transferase General Lab 82977 $25.34 3210920 Gamma Glutamyl Transferase (R) General Lab 82977 $25.34 633734 Gastrin Level (R) General Lab 82941 $62.05 3481495 General Health Panel Care Set General Lab 80050 $215.37 3481499 General Health Panel w/TSH (R) Care Set General Lab 80050 $215.37 3224974 Genital Culture, Routine (R) General Lab 87070 $30.32 633735 Gent Level General Lab 80170 $57.64 633736 Gentamicin Level Peak (R) General Lab 80170 $57.64 633737 Gentamicin Level Trough (R) General Lab 80170 $57.64 3241694 Gentamicin Trough General Lab 80170 $57.64 3241695 Gentamicin Peak General Lab 80170 $57.64 3224971 Giardia/Cryptosporidium EIA (R) General Lab 87328 $42.17 3213161 Gliadin IgG/IgA Ab Prof, EIA (R) General Lab 83516 $40.58 633593 Glucose Fasting General Lab 82947 $12.45 633594 Glucose Random General Lab 82947 $13.83 633597 Glucose 1 Hour General Lab 82947 $12.45 633601 Glucose Urine General Lab 82945 $13.83 1147849 Glucose Baseline General Lab 82947 $13.83 1628897 Glucose Cerebrospinal Fluid General Lab 82945 $12.45 1635509 Glucose (POC) General Lab 82948 $14.36 3109071 Glucose-6-PD Quantitative (R) General Lab 82955 $34.11 3152407 Glucose Fasting General Lab 82947 $12.45 3171120 Glucose (R) General Lab 82947 $13.83 3213098 Glucose, Body Fluid (R) General Lab 82945 $13.83 3470668 Gluten Sensitivity Screen (R) General Lab 83516 $40.58 3213206 Gonadotropin Releasing Hormone (R) General Lab 83727 $60.48 3175240 Gram Stain (R) General Lab 87205 $15.03 3218508 Gram Stain/Body Fluid Culture (R) General Lab 87205 $15.03 3224981 Gram Stain w/Sputum Cult Rflx (R) General Lab 87205 $15.03 3122466 Growth Hormone (R) General Lab 83003 $58.66 3524670 H Pylori Breath Test, Adult (R) General Lab 83013 $237.01 3213159 H.Pylori,IGG/IGM ABS (R) General Lab 86677 $51.79 3213158 H.pylori,IgM, IgG, IgA Ab (R) General Lab 86677 $51.79 3211248 HCG Beta Subunit, Qnt (R) General Lab 84702 $52.97 3132759 HCG Qual (R) General Lab 84703 $26.47 633664 HCG Urine (Qualitative) General Lab 84703 $26.47 3341114 HCV Ab w/Rflx to Verification (R) General Lab 86803 $50.20 3341131 HCV Ab Verification General Lab 86804 $49.05 3321439 HCV Antibody RFX Quant PCR (R) General Lab 86803 $50.20 3318730 HCV GT1 NS5A Drug Resistance Assay(R) General Lab 87900 $458.62 3466672 HCV GT3 NS5A Drug Resist Assay (R) General Lab 87902 $905.83 3213218 HCV GenoSure(R) NS3/4A (R) General Lab 87900 $458.62 3331456 HCV Geno Rfx 551222 General Lab 87522 $135.66 3331467 HCV Genotype 550513 General Lab 87902 $815.24 3318731 HCV NS5B Drug Resistance Assay(R) General Lab 87900 $458.62 3321460 HCV Qnt RT-PCR General Lab 87522 $135.66 3213243 HCV RNA by PCR, Qn Rfx Geno (R) General Lab 87522 $150.72 3534321 HCV RealTime Abbott (R) General Lab 87522 $150.72 3218949 HDL (R) General Lab 83718 $28.83 3210756 HIV 1 Ab General Lab 86701 $28.13 3328087 HIV 1 Ab Con General Lab 86701 $28.13 3129531 HIV 1 RNA, Qual (R) General Lab 87535 $123.48 3129532 HIV 1 RNA PCR Quantitative (R) General Lab 87536 $299.41 3317119 HIV 1 RNA Qualitative General Lab 87535 $111.12 3482158 HIV 1 RNA Qualitative General Lab 87535 $111.12 3482162 HIV 1 RNA Qualitative General Lab 87535 $111.12 3210757 HIV 2 Ab General Lab 86702 $41.31 3328088 HIV 2 Ab Con General Lab 86702 $41.31 3562596 HIV 2 Panel 138901 (R) General Lab 86702 $47.56 3317097 HIV Confirmation (R) General Lab 86701 $31.27 3452684 HIV GSArchive General Lab 87901 $815.24 3452687 HIV GSArchive Interp General Lab 87900 $412.77 3452667 HIV GenoSure Archive(SM) (R) General Lab 87901 $905.83 3318732 HIV PhenoSense(R) General Lab 87903 $1,719.35 3328060 HIV Screen 4th Generation wRfx (R) General Lab 87389 $76.24 3384678 HIV-1 RNA by PCR Integrase General Lab 87536 $269.47 3562600 HIV-2 Immunoblot General Lab 86689 $61.30 3175246 HLA B27 Disease Association (R) General Lab 81374 $255.96 3388778 HLA B5701 Test (R) General Lab 81381 $484.22 3377160 HLA-B (IR) (R) General Lab 81373 $391.83 3227259 HME IgG Titer General Lab 86757 $68.10 3227260 HME IgM Titer General Lab 86757 $68.10 3468856 HPV Genotypes 16/18,45 (R) General Lab 87625 $123.48 3211242 HPV High Risk Only (No PAP) (R) General Lab 87624 $123.48 3227489 HPV, low volume rfx 507405 General Lab 87624 $111.12 3213180 HSV 1 and 2-Specific Ab, IgG w/Rfx(R) General Lab 86695 $46.40 3213181 HSV 1 and 2 IgM Abs, Indirect (R) General Lab 86695 $46.40 3224972 HSV Culture Without Typing (R) General Lab 87255 $119.14 3213179 HSV, IgM I/II Combination (R) General Lab 86694 $50.63 3539502 HSV-2 IgG Supplemental Test General Lab 86696 $61.30 3561781 Haemophilus influenzae B IgG (R) General Lab 86317 $52.74 1628901 Haptoglobin (R) General Lab 83010 $44.25 3122468 Heavy Metal Blood Profile I (R) General Lab 82175 $66.74 3122469 Heavy Metal Screen Urine (R) General Lab 82570 $18.21 1628900 Helicobacter Pylori Antibody General Lab 86677 $51.04 3109074 Helicobacter pylori Antibody IgM (R) General Lab 86677 $51.04 3109075 Helicobacter pylori Antigen Stool (R) General Lab 87338 $50.61 3186884 Helper T-Lymph-CD4 (R) General Lab 86361 $94.21 633742 Hematocrit General Lab 85014 $8.34 1635636 Hematocrit General Lab 85014 $24.00 3213253 Hematocrit (R) General Lab 85014 $8.34 3213074 Hematopath Consultation, Smear (R) General Lab 85060 $84.00 3270436 Hemocue Hgb General Lab 85018 $8.34 633741 Hemoglobin General Lab 85018 $8.34 1147850 Hemoglobin Electrophoresis (R) General Lab 83021 $63.54 1383763 Hemoglobin A1c General Lab 83036 $34.17 1628899 Hemoglobin and Hematocrit General Lab 85018 $8.34 1635635 Hemoglobin General Lab 85018 $24.00 3175252 Hemoglogin A1c (R) General Lab 83036 $34.17 3213252 Hemoglobin (R) General Lab 85018 $8.34 3132752 Heparin Antibody (R) General Lab 86022 $64.64 3388779 Heparin Anti-Xa (R) General Lab 85520 $46.07 633744 Hepatic Function Panel General Lab 80076 $28.75 3134409 Hepatic Function Panel 2 General Lab 80076 $28.75 3134607 Hepatic Function Panel (R) General Lab 80076 $28.75 633752 Hepatitis B Surface Antigen (R) General Lab 87340 $36.35 1628902 Hepatitis A Antibody (R) General Lab 86708 $43.58 1628904 Hepatitis A Antibody IgM (R) General Lab 86709 $39.60 1628905 Hepatitis B Core Antibody (R) General Lab 86704 $42.40 1628907 Hepatitis B Core Antibody IgM (R) General Lab 86705 $41.42 1628908 Hepatitis B Surface Antibody (R) General Lab 86706 $37.78 1628909 Hepatitis Be Antibody (R) General Lab 86707 $40.71 1628910 Hepatitis Be Antigen (R) General Lab 87350 $40.55 1628911 Hepatitis C Antibody (R) General Lab 86803 $50.20 3109078 Hepatitis B by PCR Quantitative (R) General Lab 87517 $150.72 3120462 Hepatitis C Genotyping (R) General Lab 87902 $905.83 3120464 Hepatitis C RNA PCR Quantitative (R) General Lab 87522 $150.72 3211244 Hepatitis C Fibrosure (R) General Lab 82172 $60.11 3226617 Hepatitis C Genotype 550513 General Lab 87902 $815.24 3468107 Hepatitis Panel Comprehensive (R) General Lab 80074 $150.85 3213214 Hered.Hemochromatosis, DNA (R) General Lab 81256 $229.98 3496265 Hereditary Angioedema HAE (R) General Lab 86160 $42.22 3148957 Herpes Culture with Typing (R) General Lab 87255 $119.14 3211280 Herpes 1/2 PCR (R) General Lab 87529 $123.48 3227468 Hexagonal Phase Phospholipid 117842 General Lab 85598 $56.91 3212905 Hgb Solubility (R) General Lab 85660 $19.39 3213254 Hgb+Hct (R) General Lab 85018 $8.34 3109079 Histamine (R) General Lab 83088 $103.91 3109080 Histamine 24 Hour Urine (R) General Lab 83088 $103.91 3129522 Histone Antibody IgG (R) General Lab 86235 $63.10 3467610 Histoplasma Abs, Qn, DID (R) General Lab 86698 $43.96 3467616 Histoplasma capsulatum Abs (R) General Lab 86698 $43.96 3467617 Histoplasma Gal'mannan Ag Ser (R) General Lab 87385 $42.17 3467902 Histoplasma Gal'mannan Ag Urine (R) General Lab 87385 $42.17 633758 Homocysteine Total (R) General Lab 83090 $59.35 3213230 Human Anti-Giardia Lamblia IgG (R) General Lab 86674 $51.79 3213172 Human Granulocytic Ehrlich-HGE (R) General Lab 86666 $35.81 3382657 Hypercoagulation Profile (R) General Lab 81241 $215.00 3561527 Hypersensitivity Pneumonitis (R) General Lab 86671 $43.12 3504419 IGF-1, Pediatric with Z-Score (R) General Lab 84305 $74.82 3213200 IL28B Polymorphism Genotype (R) General Lab 81283 $250.00 3226685 IgA General Lab 82784 $29.47 3241776 IgA General Lab 82784 $29.47 3109087 IgA (R) General Lab 82784 $32.73 3109088 IgD (R) General Lab 82784 $32.73 3120472 IgE (R) General Lab 82785 $57.92 3226684 IgG General Lab 83883 $43.06 3241775 IgG General Lab 82784 $29.47 3120473 IgG (R) General Lab 82784 $32.73 3241794 IgG P18 Ab. General Lab 86617 $59.92 3241793 IgG P23 Ab. General Lab 86617 $54.51 3120474 IgG Subclasses (R) General Lab 82784 $32.73 3226686 IgM General Lab 83883 $43.06 3241777 IgM General Lab 82784 $29.47 3120475 IgM (R) General Lab 82784 $32.73 3213080 Imipramine (Tofranil), Serum (R) General Lab 80335 $14.25 3552648 ImmuKnow (R) General Lab 86352 $478.04 3130437 Immunochemical Fecal Occult Blood General Lab 82274 $55.97 3213248 Immunofixation, Serum (R) General Lab 86334 $78.62 3213255 Immunofixation, Urine (R) General Lab 86335 $103.27 3109091 Immunoglobulin G Subclass 4 (R) General Lab 82787 $28.22 3129551 Immunoglobulin G Subclass 1 (R) General Lab 82787 $28.22 3129552 Immunoglobulin G Subclass 2 (R) General Lab 82787 $28.22 3129553 Immunoglobulin G Subclass 3 (R) General Lab 82787 $28.22 3129557 Immunoglobulins Quantitative (R) General Lab 82784 $32.73 3213182 Inflammatory Bowel Disease-IBD (R) General Lab 86256 $42.40 3242950 Influenza A&B Screen General Lab 87804 $47.17 3562618 Influenza A and B, RT PCR (R) General Lab 87502 $299.41 3217811 InformaSeq(SM) Prenatal Test (R) General Lab 81420 $2,163.29 3318631 InformaSeq(SM)with XY Analysis (R) General Lab 81420 $2,163.29 3122475 Inhibin A (R) General Lab 86336 $54.84 3213151 Inhibin B (R) General Lab 83520 $49.22 3109089 Insulin-Like Growth Factor Binding Protein-3 (R) General Lab 83520 $49.22 3122476 Insulin Antibody (R) General Lab 86337 $75.33 3122477 Insulin-Like Growth Factor II (R) General Lab 83519 $52.44 3129573 Insulin Level Total (R) General Lab 83525 $40.22 3129574 Insulin-Like Growth Factor I (R) General Lab 84305 $74.82 3213152 Insulin (2 Specimens) (R) General Lab 83525 $36.20 3109096 Intrinsic Factor Antibody (R) General Lab 86340 $53.04 3468683 Iodine, Serum or Plasma (R) General Lab 83789 $68.71 3469215 Iodine, Random Urine (R) General Lab 83789 $68.71 3212894 Iron (R) General Lab 83540 $22.78 3212920 Iron (R) General Lab 83540 $32.00 3227263 Iron (R) General Lab 83540 $32.00 3131454 Iron Binding Capacity Total General Lab 85460 $50.00 3134445 Iron Binding Capacity Total General Lab 83550 $30.75 3151672 Iron Binding Capacity Total General Lab 83550 $30.75 633765 Iron Level General Lab 83540 $22.78 3109097 Iron Level and TIBC (R) General Lab 83540 $22.78 3131451 Iron Level General Lab 85460 $32.00 3134443 Iron Level General Lab 83540 $22.78 3151671 Iron Level General Lab 83540 $22.78 3109099 Islet Cell Antibody (R) General Lab 86341 $69.61 3213205 Islet Cell Dysfunction Group 1 (R) General Lab 83525 $40.22 3228601 Isoniazid 0.1 ug/mL General Lab 87188 $21.03 3228620 Isoniazid 0.2 ug/mL General Lab 87190 $20.83 3228621 Isoniazid 1 ug/mL General Lab 87190 $20.83 3339805 Isoniazid 0.1 ug/mL General Lab 87188 $21.03 3339845 Isoniazid 0.2 ug/mL General Lab 87190 $20.83 3339846 Isoniazid 1 ug/mL General Lab 87190 $20.83 3471242 Itraconazole, Serum/Plasma (R) General Lab 80299 $53.12 3487346 JAK2 Exons 12-15 (R) General Lab 81403 $527.82 3213201 JAK2 Mutation Analysis, Qual (R) General Lab 81270 $322.52 3556584 JC Virus DNA,PCR (Whole Blood) (R) General Lab 87798 $123.48 3122478 JO-1 Antibody (R) General Lab 86235 $63.10 3242951 KOH Fungal Prep General Lab 87220 $15.03 3304269 KRAS Extended Analysis (R) General Lab 81275 $550.76 3304267 KRAS Mutation Analysis, CRC (R) General Lab 81275 $550.76 3304270 KRAS, NRAS Mutation Analysis (R) General Lab 81275 $550.75 3226690 Kappa/Lambda Ratio, S General Lab 86334 $70.77 3241781 Kappa/Lambda Ratio, S General Lab 83883 $43.06 2930308 Ketone Bodies Qualitative General Lab 82009 $38.00 633769 Ketones Urine General Lab 81002 $9.92 3224956 Kidney Stone, Urine/Saturation (R) General Lab 81003 $7.90 3109100 Kleihauer-Betke (R) General Lab 85460 $27.21 3213190 L. pneumophila Serogp 1 Ur Ag (R) General Lab 87449 $42.17 3213232 LC-1 (Liver Cytosol Protein-1) (R) General Lab 86376 $51.20 3242034 LDH General Lab 83615 $21.24 633704 LDL General Lab 83721 $33.58 3218798 LDL Direct (R) General Lab 83721 $33.58 3384761 Lacosamide (R) General Lab 80339 $14.25 633770 Lactate Dehydrogenase (R) General Lab 83615 $19.12 633771 Lactate Dehydrogenase Body Fluid (R) General Lab 83615 $21.24 1507774 Lactate Dehydrogenase General Lab 83615 $32.00 3122481 Lactate Dehydrogenase Isoenzymes (R) General Lab 83625 $45.02 3134427 Lactate Dehydrogenase General Lab 83615 $21.24 633772 Lactic Acid General Lab 83605 $37.58 1503766 Lactic Acid (R) General Lab 83605 $37.58 3211264 Lactoferrin, Fecal, Quant (R) General Lab 83631 $69.08 3109101 Lamotrigine Level (R) General Lab 80175 $46.63 633774 Lead Level General Lab 83655 $42.60 3208603 Lead, Blood (Pediatric) Venous (R) General Lab 83655 $42.60 3213081 Lead, Blood (Adult) (R) General Lab 83655 $42.60 3404703 Lead, Blood (Peds) Capillary (R) General Lab 83655 $42.60 3129589 Legionella Pneumophila Antibody IgM (R) General Lab 86713 $53.84 3500928 Leptin, Serum (R) General Lab 83520 $49.22 3213197 Leukemia/Lymphoma Immunophenotyping Profile (R General Lab 88184 $150.00 3212898 Leukocyte Alkaline Phos Score (R) General Lab 85540 $30.27 3109105 Levetiracetam Level (R) General Lab 80177 $46.63 3212788 Levetiracetam Level General Lab 80177 $53.49 3109106 Lidocaine Level (R) General Lab 80176 $51.68 633776 Lipase Level General Lab 83690 $24.24 3172528 Lipase (R) General Lab 83690 $24.24 3368675 Lipase, Fluid (R) General Lab 83690 $24.24 3134422 Lipid Profile General Lab 80061 $47.12 3171127 Lipid Profile (R) General Lab 80061 $47.12 3109107 Lipoprotein (a) (R) General Lab 83695 $45.55 2046348 Lithium Level (R) General Lab 80178 $23.26 3213167 Liver-Kidney Microsomal Ab (R) General Lab 86376 $51.20 3304279 Lung Panel, EGFR PCR/ALK FISH (R) General Lab 81235 $925.04 633780 Lupus Anticoagulant Panel Panel (R) General Lab 85613 $33.70 3331167 Lupus Anticoagulant Reflex (R) General Lab 85613 $33.70 3211243 Lupus Panel (R) General Lab 86225 $48.35 633779 Luteinizing Hormone (R) General Lab 83002 $65.15 3213145 Lyme (B. burgdorferi) PCR (R) General Lab 87476 $123.48 3442671 Lyme Ab IgG by WB: General Lab 86617 $49.05 3442683 Lyme Ab IgM by WB: General Lab 86617 $49.05 3224950 Lyme, IgM, Early Test/Reflex (R) General Lab 86618 $59.92 3224949 Lyme, Total Ab Test/Reflex (R) General Lab 86618 $59.92 3225609 Lyme, Western Blot, Serum 163600 (R) General Lab 86617 $59.92 3552320 Lymphocyte Activity Profile (R) General Lab 86360 $165.31 3228508 M avium complex General Lab 87149 $63.50 3241815 M. Mari Amikacn 998549 General Lab 87186 $27.39 3482660 MDA Wb 700738 General Lab 80359 $28.84 3325402 MDMA (GC/MS), Urine (R) General Lab 80359 $28.84 3304280 MEN2: RET Gene Sequencing (R) General Lab 81405 $858.85 3224970 MRSA Screening Culture (R) General Lab 87081 $23.32 3245195 MRSA Surveillance, PCR General Lab 87641 $123.48 3245196 MRSA/MSSA Pre-Surgical, PCR General Lab 87641 $123.48 3245197 MRSA/MSSA Wound, PCR General Lab 87641 $123.48 3339445 MTB NAA Without AFB Culture (R) General Lab 87556 $123.48 3339446 MTB NAA With AFB Culture (R) General Lab 87116 $38.01 633781 Magnesium Level General Lab 83735 $23.57 633782 Magnesium Level 24 Hour Urine (R) General Lab 83735 $23.57 3212895 Magnesium Lvl (R) General Lab 83735 $23.57 3213116 Magnesium, RBC (R) General Lab 83735 $23.57 3132743 Malb/Creat Ratio General Lab 82043 $20.34 3109109 Manganese Level, Plasma (R) General Lab 83785 $86.54 633876 Manual Differential General Lab 85007 $12.08 3516154 Marfan Syndrome: FBN1 (R) General Lab 81408 $5,700.00 3567221 MaterniT21 PLUS Core+ESS+SCA (R) General Lab 81420 $2,163.29 3193236 Measles/Mumps/Rubella Immunity (R) General Lab 86735 $45.91 3199459 Meconium Panel 10 (R) General Lab 80307 $199.53 3500926 Melanocyte Stimulating Hormone (R) General Lab 83519 $52.44 3409228 Meperidine Conf WB 700799 General Lab 80362 $39.33 3444724 Meperidine (GC/MS) Holding PM UDS General Lab 80362 $39.33 3109110 Mercury Level (R) General Lab 83825 $57.20 3109111 Metanephrines (R) General Lab 83835 $57.20 3109112 Metanephrines 24 Hour Urine (R) General Lab 83835 $57.20 3109113 Metanephrines Urine (R) General Lab 82570 $18.21 3325397 Methadone (GC/MS), Urine (R) General Lab 80358 $37.39 3409202 Methadone Conf WB 700788 General Lab 80358 $37.39 3109116 Methylmalonic Acid Quantitative (R) General Lab 83921 $60.45 1932307 Microalbumin Level Urine (R) General Lab 82043 $20.34 3120476 Microalbumin Level 24 Hour Urine (R) General Lab 82043 $20.34 3176372 Microalbumin Panel (R) General Lab 82043 $20.34 3258183 Microalbumin urine General Lab 82043 $20.34 3568601 Microsatellite Instability (R) General Lab 88381 $291.60 3129324 Mitochondrial (M2) Antibody (R) General Lab 83516 $36.51 3243299 Mold Allergy Panel (R) General Lab 86003 $18.37 3129618 Mononucleosis Screen (R) General Lab 86308 $18.21 3276316 Monotest+Control General Lab 86308 $18.21 3339810 Mtb Suscep Tracking General Lab 87188 $21.03 3339802 Mtb complex AST General Lab 87188 $21.03 3339842 Mtb complex AST Confirmation General Lab 87190 $20.83 3213213 Mthfr (R) General Lab 81291 $186.22 3213075 Mucin Clot,Synovial Fluid (R) General Lab 83872 $20.62 3540303 Multiple Sclerosis(MS) Profile (R) General Lab 82040 $17.42 3109117 Mumps Antibody IgG (R) General Lab 86735 $45.91 3109118 Mumps Antibody IgM (R) General Lab 86735 $45.91 3440651 Myasthenia Gravis Full Panel (R) General Lab 86255 $42.40 3213223 Mycophenolic Acid and Metabo. (R) General Lab 80180 $63.51 3213160 Mycoplasma pneumoniae, IgM Ab (R) General Lab 86738 $46.58 3213162 Mycoplasma pneumoniae, IgG Ab (R) General Lab 86738 $46.58 3213163 Mycoplasma pneu. IgG/IgM Abs (R) General Lab 86738 $45.58 3466982 Myelin Basic Protein, CSF (R) General Lab 83873 $60.53 1503767 Myoglobin (R) General Lab 83874 $45.45 3109119 Myoglobin Urine (R) General Lab 83874 $45.45 3530874 Myositis Panel IV (R) General Lab 86235 $63.10 3566766 N. meningitidis Ag (R) General Lab 87899 $44.19 3562852 N.Meningitidis A/C/W-135/Y IgG (R) General Lab 86741 $46.40 3544324 NASH FibroSure (R) General Lab 84450 $18.21 3476655 NMO IgG Autoantibodies (R) General Lab 83520 $49.22 3496177 NMR Lipoprofile (R) General Lab 80061 $47.12 3222968 Narcolepsy Evaluation (R) General Lab 81383 $383.98 3566768 Neisseria gonorrhoeae, NAA (R) General Lab 87591 $107.22 3318424 Neonatal Bilirubin General Lab 82247 $17.65 3131772 Niacin and Metabolite (R) General Lab 84591 $48.62 3131791 Nickel, Plasma (R) General Lab 83885 $86.24 3131792 Nickel, Urine (R) General Lab 82570 $18.21 3122485 Nicotine Level (R) General Lab 80323 $58.00 3213104 Nicotine and Metabolite, Ur Qn (R) General Lab 80323 $58.00 3213143 Norovirus, RT-PCR (R) General Lab 87798 $123.48 3409221 Norpropoxyphene WB General Lab 80367 $35.65 3109120 Nortriptyline Level (R) General Lab 80335 $14.25 3213184 NuSwab Vaginitis Plus (VG+) (R) General Lab 87481 $123.48 3213185 NuSwab Vaginitis (VG) (R) General Lab 87481 $123.48 3556620 Nut Prof. w/Component Rflx (R) General Lab 86003 $18.37 3409239 O-Desmethyltramadol WB 700804 General Lab 80373 $35.06 3210642 OB Panel (R) General Lab 80055 $168.21 3131817 Oligoclonal Banding (R) General Lab 83916 $78.06 3213215 Oncology BCR/ABL1 Fish (R) General Lab 88271 $75.36 633790 Opiate Screen Urine General Lab 80306 $56.86 3325405 Opiates Confirmation, Urine (R) General Lab 80361 $48.45 3528603 Opioid CYP2D6 Genotyping (R) General Lab 81226 $1,285.09 3228514 Org ID 182866 General Lab 87153 $365.28 3228517 Org ID 182866 General Lab 87153 $365.28 3228539 Org ID 182831 General Lab 87186 $27.39 3228573 Org ID 182858 General Lab 87186 $27.39 3339738 Org ID 182866 General Lab 87153 $365.28 3339803 Org ID MTB 183655 General Lab 87188 $21.03 3561552 Organic Acid Analysis, Urine (R) General Lab 83919 $57.89 3219220 Organism ID, Yeast (R) General Lab 87106 $36.32 3224977 Organism ID, Bacteria (R) General Lab 87077 $28.42 3321843 Organism Identification, Mold (R) General Lab 87107 $36.32 633791 Osmolality (R) General Lab 83930 $23.26 633792 Osmolality Urine General Lab 83935 $23.98 3131825 Osmolality, Urine (R) General Lab 83935 $23.98 3134467 Osmolality Serum General Lab 83930 $23.26 3213131 Osmolality, Fecal (R) General Lab 84999 $23.26 3193237 Ova + Parasite Exam (R) General Lab 87177 $31.32 3122487 Oxalate 24 Hour Urine (R) General Lab 83945 $45.30 3516300 Oxalate/Creat Ratio, Random U (R) General Lab 82570 $18.21 3213225 Oxcarbazepine (Trileptal),S (R) General Lab 80183 $46.63 3325406 Oxycodone/Oxymorphone Confirm (R) General Lab 80365 $40.41 3409196 Oxycodone WB 700784 General Lab 80365 $40.41 3482706 Oxycodone WB 700784 General Lab 80365 $40.41 3245503 PAP IG, RFLX HPV 196250 (R) General Lab 88175 $93.21 3245504 PAP IG, GC-CHLAM RFLX HPV ABN 196565 (R) General Lab 88175 $93.21 3245505 PAP IG, HPV-HR (COTESTING) 199123 (R) General Lab 88175 $93.21 3117657 PAP LB 192005 (R) General Lab 88142 $71.28 3245496 PAP LB RFLX HPV IF ASCUS 192047 (R) General Lab 88142 $71.28 3245497 PAP LB, w Mat Indx 192096 General Lab 88142 $71.28 3245498 PAP LB,CT-NG,RFX HPV ALL PATH 192104 (R) General Lab 88142 $71.28 3245499 PAP LB, CT-NG, RFX HPV ASCUS 192112 (R) General Lab 88142 $71.28 3245500 PAP LB, CT-NG TV RFX HPV ALL 192504 (R) General Lab 88142 $71.28 3245501 PAP LB, rfx HPV all pth 192630 (R) General Lab 88142 $71.28 3245502 PAP LB, HPV-HR 195050 (R) General Lab 88142 $71.28 3287464 POC/Tissue Microarray (R) General Lab 81229 $3,306.00 1634882 PSA General Lab 84153 $64.71 3213247 PSA Total+% Free (R) General Lab 84153 $64.71 3313033 PSA, Ultrasensitive (R) General Lab 84153 $64.71 3241609 PT+INR Coaguchek General Lab 85610 $13.83 3132649 PT+Inr (R) General Lab 85610 $13.83 3132651 PT+Inr/PTT (R) General Lab 85610 $13.83 633793 PT/INR General Lab 85610 $13.83 3130539 PT/PTT General Lab 85610 $13.83 3132650 PTT (R) General Lab 85730 $21.14 3227417 PTT-LA Mix General Lab 85732 $20.46 3227471 PTT-LA Incub Mix 117036 General Lab 85732 $20.46 3444651 Pain Management Drug Screen (R ) General Lab 80307 $199.53 3132585 Pancreatic Elastase, Fecal (R) General Lab 82656 $598.50 3500539 Pap IG, Ct-Ng, HPV-hr (R) General Lab 88175 $93.21 3312669 Pap Lb,Ct-Ng,HPV-hr 192146 (R) General Lab 88142 $71.28 3340959 Pap Lb, Ct-Ng TV rfx HPV ASCU 192512 (R) General Lab 87491 $123.48 3516306 Pap Lb, Ct-Ng 192120 (R) General Lab 88142 $71.28 3388780 Paraneoplastic Profile 1 (R) General Lab 86256 $42.40 2178782 Parathyroid Hormone Intact (R) General Lab 83970 $145.23 2178783 Parathyroid Hormone with Calcium (R) General Lab 83970 $145.23 3132589 Parathyroid Hormone-related Peptide (R) General Lab 82397 $49.68 633794 Partial Thromboplastin Time General Lab 85730 $21.14 3130541 Partial Thromboplastin Time General Lab 85730 $23.31 3109126 Parvovirus B19 Antibodies IgG and IgM (R) General Lab 86747 $52.89 3129642 Pentobarbital Level (R) General Lab 80345 $31.07 3222912 Perinuclear (P-ANCA) General Lab 86256 $95.00 3213106 Phencyclidine, Confirm, Urine (R) General Lab 83992 $51.74 3325404 Phencyclidine (GC/MS), Urine (R) General Lab 83992 $51.74 3409148 Phencyclidine Con WB 700771 General Lab 83992 $51.74 3384652 PhenoSenseGT(R) plus Integrase (R) General Lab 87900 $458.62 3206796 Phenobarbital (R) General Lab 80184 $43.61 3109127 Phenylalanine (R) General Lab 82131 $65.49 633801 Phenytoin Level Total General Lab 80185 $46.63 633802 Phenytoin Level Free (R) General Lab 80186 $48.43 3129650 Phenytoin Level Free and Total (R) General Lab 80185 $46.63 633803 Phosphorus Level General Lab 84100 $16.67 633804 Phosphorus Level 24 Hour Urine (R) General Lab 84105 $18.21 3210759 Phosphorus (R) General Lab 84100 $16.67 3212897 Phospholipids, Serum (R) General Lab 84311 $24.60 3349693 Pinworm Prep (R) General Lab 87172 $15.03 2182297 Platelet Count General Lab 85049 $15.75 3122492 Platelet Autoantibody (R) General Lab 86022 $64.64 3212906 Platelet Count (R) General Lab 85049 $15.75 3213239 Pneumococcal IM (14 Serotype) (R) General Lab 86317 $52.74 3109129 Porphobilinogen Quantitative Urine (R) General Lab 84110 $29.70 3129659 Porphyrins 24 Hour Urine (R) General Lab 84120 $51.76 3500931 Porphyrins, Qn, Random U (R) General Lab 84120 $51.76 3518162 Posaconazole, Serum/Plasma (R) General Lab 80299 $53.12 633616 Potassium Level General Lab 84132 $16.19 633617 Potassium Level Urine (R) General Lab 84133 $15.16 3212889 Potassium (R) General Lab 84132 $16.19 3109131 Prealbumin (R) General Lab 84134 $51.33 3561785 Pregabalin (R) General Lab 80366 $23.51 3213148 Pregnenolone, MS (R) General Lab 84140 $72.74 2716782 Prenatal Profile General Lab 80055 $186.90 3501056 Prenatal Panel Care Set General Lab 80081 $292.67 3109132 Primidone Level (R) General Lab 80188 $58.38 2930311 Procalcitonin General Lab 84145 $94.26 3189492 Procalcitonin (R) General Lab 84145 $94.26 633808 Progesterone Level (R) General Lab 84144 $73.41 3213147 Proinsulin (R) General Lab 84206 $76.07 633809 Prolactin Level (R) General Lab 84146 $68.18 3325398 Propoxyphene (GC/MS), Urine (R) General Lab 80367 $35.65 2356847 Prostate Specific Antigen (R) General Lab 84153 $64.71 633811 Protein 24 Hour Urine General Lab 84156 $12.90 633815 Protein S Total (R) General Lab 85305 $40.83 633816 Protein Electrophoresis (R) General Lab 84165 $37.78 633817 Protein Electrophoresis Urine (R) General Lab 84156 $12.90 633818 Protein Total General Lab 84155 $12.90 633819 Protein Urine General Lab 84156 $12.90 1634881 Protein Cerebrospinal Fluid General Lab 84157 $11.60 2356873 Protein 24 Hour Urine (R) General Lab 84156 $12.90 3109134 Protein/Creatinine Ratio Urine (R) General Lab 82570 $18.21 3120480 Protein Electrophoresis 24 Hour Urine (R) General Lab 84156 $12.90 3122494 Protein S Free (R) General Lab 85306 $53.92 3129667 Protein Urine Dipstick General Lab 81000 $11.46 3132571 Protein S Total General Lab 85305 $128.00 3210846 Protein, Total, Serum (R) General Lab 84155 $12.90 3213087 Protein,Total,Urine (R) General Lab 84156 $12.90 3213099 Protein, Body Fluid (R) General Lab 84157 $12.90 3213109 Protein S Panel (R) General Lab 85305 $40.83 3213110 Protein S-Antigen (R) General Lab 85305 $40.83 3213111 Protein S-Functional (R) General Lab 85306 $53.92 3213113 Protein C-Functional (R) General Lab 85303 $48.68 3213114 Protein C Antigen (R) General Lab 85302 $42.27 3213115 Protein C Deficiency Profile (R) General Lab 85302 $42.27 3228604 Pyrazinamide 100 ug/mL General Lab 87188 $21.03 3129676 Pyruvic Acid (R) General Lab 84210 $41.27 3109135 Q Fever Antibody (R) General Lab 86638 $42.66 3228427 QFT TB Ag minus Nil Value General Lab 86480 $196.28 3218918 QuantiFERON TB Gold (R) General Lab 86480 $218.08 3522532 QuantiFERON Client Incubated (R) General Lab 86480 $218.08 3109136 Quinidine Level (R) General Lab 80194 $51.34 3304275 RET Oncology FISH (R) General Lab 88271 $75.36 3500930 RNA Polymerase III IgG Abs (R) General Lab 83520 $49.22 3534320 RNA, Real Time PCR (Non-Graph) (R) General Lab 87536 $299.41 3211224 RNP Antibodies 165193 General Lab 86235 $56.80 3339163 RNP Antibodies (R) General Lab 86235 $63.10 3304274 ROS1 Oncology FISH (R) General Lab 88271 $75.36 3213049 RPR Titer (R) General Lab 86593 $13.94 3193225 RPR, Quant (R) General Lab 86593 $13.94 3193228 RPR, Quant (R) General Lab 86593 $13.94 3288406 RPR, Quant (R) General Lab 86593 $13.94 3175243 RPR, reflexes to FTA (R) General Lab 86592 $15.03 3242953 RSV+Control General Lab 87420 $42.17 3223047 Ra Latex Turbid General Lab 86431 $22.03 3241621 Rapid HIV 1/2 Ag-Ab General Lab 87806 $93.39 3282674 Rapid Hepatitis C Ab General Lab 86803 $50.20 3442651 Rapid HIV 1/2 Ab General Lab 86703 $43.41 633820 Rapid Plasma Reagin Test (R) General Lab 86592 $15.03 3566892 Rapid Plasma Reagin, Quant (R) General Lab 86593 $13.45 3109137 Red Cell Folate (R) General Lab 82747 $60.94 3122496 Reducing Substance Stool (R) General Lab 84376 $19.34 3129681 Reducing Substance Urine General Lab 81005 $7.62 1634883 Renal Function Panel General Lab 80069 $30.55 3211239 Renal Function Panel (R) General Lab 80069 $30.55 3109139 Renin Activity (R) General Lab 84244 $77.39 3481869 Renin Activity and Aldosterone (R) General Lab 84244 $77.39 3129682 Reptilase Test (R) General Lab 85635 $34.65 3562616 Resp Virus Panel (RVP) PCR (R) General Lab 87633 $1,466.46 3129695 Respiratory Syncytial Virus Antigen (R) General Lab 87807 $42.17 3228398 Result 1 080180 General Lab 87070 $27.27 1634884 Reticulocyte Count (R) General Lab 85044 $15.16 3122498 Reticulocyte Count Automated General Lab 85045 $14.06 3227481 Rh Factor General Lab 86901 $190.18 2624297 Rheumatoid Factor (R) General Lab 86431 $19.96 3213154 Rheumatoid Arthritis, Qn/Fluid (R) General Lab 86430 $19.96 3228602 Rifampin 1 ug/mL General Lab 87188 $21.03 3228622 Rifampin 1 ug/mL General Lab 87190 $20.83 3339847 Rifampin 1 ug/mL MTB 998646 General Lab 87190 $20.83 3122499 Ritalin Level (R) General Lab 82542 $68.66 3129690 Rocky Mountain Spotted Fever Ab IgG (R) General Lab 86757 $68.10 3129691 Rocky Mountain Spotted Fever Ab IgM (R) General Lab 86757 $68.10 3227257 Rocky Mountain Spotted Fever Ab IgG General Lab 86666 $35.81 3227258 Rocky Mountain Spotted Fever Ab IgM General Lab 86666 $35.81 3109141 Rotavirus Antibody (R) General Lab 87425 $42.17 3213076 Rotavirus Ag, EIA (R) General Lab 87425 $42.17 3241843 Rpd Gwr Org ID 182916 General Lab 87186 $27.39 3109143 Rubella Antibody IgG (R) General Lab 86762 $50.63 3129697 Rubella Antibody IgM (R) General Lab 86762 $50.63 3109144 Rubeola Antibody IgG (R) General Lab 86765 $45.32 3129699 Rubeola Antibody IgM (R) General Lab 86765 $45.32 3213194 Rufinamide (Banzel) (R) General Lab 80339 $14.25 3482591 Saccharomyces cerevisiae Panel (R) General Lab 86671 $43.12 1503768 Salicylate Level General Lab 80329 $32.66 3213083 Salicylate, Serum (R) General Lab 80299 $53.12 3335551 Salivary Cortisol,MS (R) General Lab 82533 $57.35 3481899 Salivary Cortisol X2, Timed (R) General Lab 82533 $57.35 3566881 Salivary Cortisol X4, Timed (R) General Lab 82533 $49.80 3122503 Scl 70 Antibody (R) General Lab 86235 $63.10 3282859 Scl 70 Antibody General Lab 86235 $56.80 3243300 Seasonal Allrgns, Spring--Tree (R) General Lab 86003 $18.37 3370919 Sed Rate-Automated General Lab 85652 $9.49 1634885 Sedimentation Rate Non-automated General Lab 85651 $12.49 3109145 Selenium Level (R) General Lab 84255 $89.83 3129703 Selenium Level Urine (R) General Lab 84255 $89.83 3109147 Serotonin Level (R) General Lab 84260 $109.01 3242954 Serum Hcg General Lab 84703 $26.47 2248299 Serum Protein Electrophoresis Rflx to IFE (R) General Lab 84165 $37.78 3109148 Sex Hormone Binding Globulin (R) General Lab 84270 $76.46 3213222 Sirolimus (Rapamune), Blood (R) General Lab 80195 $48.32 3109149 Sjogren's Antibody (R) General Lab 86235 $63.10 3211227 Sjogren's Anti-SS-A 165194 General Lab 86235 $56.80 3211230 Sjogren's Anti-SS-B 165195 General Lab 86235 $56.80 3241873 Slo Gro Org ID 182924 General Lab 87186 $27.39 3210929 Smith Antibodies (R) General Lab 86235 $63.10 3210932 Smith Ab (R) General Lab 86235 $113.00 3211233 Smith Antibodies 165190 General Lab 86235 $56.80 3211236 Smith/RNP Antibodies 165191 General Lab 86235 $56.80 3109146 Smn Post Vas General Lab 89321 $39.21 3129707 Smooth Muscle Antibody Titer (R) General Lab 83516 $40.58 633611 Sodium Level General Lab 84295 $16.93 633612 Sodium Level Urine General Lab 84300 $17.11 2356861 Sodium Level (R) General Lab 84295 $16.93 3213086 Sodium, Urine (R) General Lab 84300 $17.11 3213079 Soluble Liver Ag (IgG Ab) (R) General Lab 83516 $40.58 3129711 Specific Gravity Urine Automated General Lab 81001 $11.16 3526701 Specimen Type BRCA Targeted General Lab 81217 $1,069.46 3211249 Stool Culture (R) General Lab 87045 $33.22 3242955 Strep A Screen + Control General Lab 87430 $47.91 3213189 Strep Gp B NAA (R) General Lab 87081 $23.32 3189488 Streptococcus pneumoniae Ag (R) General Lab 87899 $45.80 3228600 Streptomycin 1 ug/mL General Lab 87188 $21.03 3228618 Streptomycin 2 ug/mL General Lab 87190 $20.83 3228619 Streptomycin 10 ug/mL General Lab 87190 $20.83 3339844 Streptomycin 10 ug/mL General Lab 87190 $20.83 3109155 Striated Muscle Antibody IgG (R) General Lab 86255 $42.40 3562617 Strongyloides IgG Antibody (R) General Lab 86682 $45.76 3129719 Sulfate Level 24 Hour Urine (R) General Lab 84392 $16.70 3224978 Susceptibility, Aer + Anaerob (R) General Lab 87186 $30.42 3170820 Synthetic Cannabinoid (R) General Lab 80307 $199.53 3213102 Systemic Lupus Profile A (R) General Lab 86225 $48.35 3224962 T + B-Lymphocyte Differential (R) General Lab 86355 $132.74 3122489 T Cells Absolute CD4 and CD8 (R) General Lab 86360 $165.31 3213208 T-Helper (CD4 Lymph) (R) General Lab 86361 $94.21 633834 T3 Free (R) General Lab 84481 $59.61 633835 T3 Resin Uptake (R) General Lab 84479 $22.75 633836 T3 Reverse (R) General Lab 84482 $55.46 633833 T3 Total (R) General Lab 84480 $49.89 3175791 T4 (R) General Lab 84479 $38.00 3518222 T4F General Lab 84439 $28.56 3226744 THYROGL TG-RIA General Lab 84432 $50.84 3271073 THYROID PROFILE General Lab 84443 $59.12 3226767 TPO Ab 006677 General Lab 86376 $46.08 3175263 TSH (R) General Lab 84443 $59.12 3176494 TSH Reflex Panel (R) General Lab 84443 $59.12 3306718 TSH Reflex Panel General Lab 84443 $59.12 3476964 TSH+Free T4 (R) General Lab 84439 $31.73 3122507 Tacrolimus Level (R) General Lab 80197 $48.32 3206795 Tegretol (R) General Lab 80156 $51.25 3176373 Testosterone, Total Serum (R) General Lab 84403 $90.83 3210924 Testosterone Total Female, Child, Hypogonadal Male (R) General Lab 84403 $90.83 3224940 Testosterone,Free and Total (R) General Lab 84402 $89.62 3224941 Testosterone, Free, Direct (R) General Lab 84402 $89.62 3225511 Testosterone,F/WklyBd+T LC/MS (R) General Lab 84410 $206.77 3225512 Testosterone, F Eqlib+T LC/MS (R) General Lab 84402 $89.62 3292394 Testosterone, Free+Total LC/MS (R) General Lab 84402 $89.62 3109156 Tetanus Antibody (R) General Lab 86317 $52.74 3340458 Tetanus/Diphtheria Ab (R) General Lab 86317 $52.74 3129722 Thallium (R) General Lab 83018 $77.28 3129723 Thallium 24 Hour Urine (R) General Lab 82570 $18.21 3129724 Thallium Urine (R) General Lab 82570 $18.21 2356863 Theophylline Level (R) General Lab 80198 $49.76 3276599 Ther Phleb Lab General Lab 99195 $105.03 3276428 Therapeutic Phlebotomy - Lab General Lab 99195 $105.03 3129725 Thiocyanate Level (R) General Lab 84430 $40.94 3213211 Thiopurine Methyltransferase (R) General Lab 82657 $63.54 3129726 Thrombin Time (R) General Lab 85670 $20.29 3224964 Thrombotic Risk, Acquired (R) General Lab 85613 $33.70 3409012 Thrombotic Risk Acquired Com-I (R) General Lab 85732 $22.75 3176378 Thyroglobulin and Antibody (R) General Lab 86800 $55.97 3226743 Thyroglobulin General Lab 84432 $50.84 3292325 Thyroglobulin IMA (R) General Lab 84432 $50.84 633844 Thyroid Stimulating Hormone General Lab 84443 $59.12 3122508 Thyroid Stimulating Immunoglobulins (R) General Lab 84445 $178.93 3132595 Thyroid Uptake General Lab 84479 $22.75 3175265 Thyroid Panel w/TSH (R) General Lab 84436 $24.16 3224944 Thyroid Peroxidase (TPO) Ab (R) General Lab 86376 $51.20 3224945 Thyroid Antibodies (R) General Lab 86376 $51.20 3129729 Thyrotropin Receptor Antibody (R) General Lab 83520 $49.22 633845 Thyroxine General Lab 84436 $24.16 633846 Thyroxine Free General Lab 84439 $31.73 3109157 Thyroxine Binding Globulin (R) General Lab 84442 $52.02 3185597 Thyroxine (T4) (R) General Lab 84436 $24.16 3339188 Tick Panel (No Tularemia) (R) General Lab 86666 $86.00 3122509 Tissue Transglutaminase Antibody IgA (R) General Lab 83516 $40.58 3129732 Tissue Transglutaminase Antibody IgG (R) General Lab 83516 $40.58 3339701 Tissue Grinding MTB General Lab 87176 $18.64 3339707 Tissue Grind/Digestion/Decon General Lab 87176 $18.64 1634888 Tobramycin Level (R) General Lab 80200 $56.74 1634889 Tobramycin Level Peak (R) General Lab 80200 $56.74 1634890 Tobramycin Level Trough (R) General Lab 80200 $56.74 3129733 Tocainide Level (R) General Lab 80299 $53.12 3109158 Topiramate Level (R) General Lab 80201 $41.94 3212888 Total Bilirubin (R) General Lab 82247 $17.65 3226667 Total Prot (R) General Lab 84165 $59.00 3109159 Toxoplasma Antibody (R) General Lab 86777 $50.63 3129735 Toxoplasma Antibody IgG (R) General Lab 86777 $50.63 3129736 Toxoplasma Antibody IgM (R) General Lab 86778 $50.68 3175800 Toxoplasma Antibody IgG General Lab 86777 $68.00 3175801 Toxoplasma Antibody IgM General Lab 86778 $84.00 3213226 Tramadol Screen, Urine (R) General Lab 80307 $199.53 3444758 Tramadol (GC/MS) Holding PM UDS General Lab 80373 $35.06 3129737 Transferrin Saturation (R) General Lab 84466 $44.91 3212904 Transferrin (R) General Lab 84466 $44.91 3109160 Trazodone Level (R) General Lab 80338 $36.34 3193229 Treponema pallidum Antibodies (R) General Lab 86780 $41.92 3288407 Treponema pallidum Antibodies (R) General Lab 86780 $41.92 3213188 Trich vag by NAA (R) General Lab 87661 $123.48 3340859 Tricyclic Antidepressant Conf (R) General Lab 80337 $29.50 633852 Triglycerides General Lab 84478 $20.21 2356867 Triglycerides (R) General Lab 84478 $20.21 3482164 Triglycerides, Fluid (R) General Lab 84478 $20.21 633853 Troponin General Lab 84484 $35.54 3211256 Troponin I (R) General Lab 84484 $35.54 3129742 Trypsinogen (Trypsin) (R) General Lab 83519 $52.44 3109162 Tryptase Total (R) General Lab 83520 $49.22 3129743 Tularemia Antibody Titer (R) General Lab 86668 $40.36 3339187 Tularemia Antibody Titer (R) General Lab 86668 $68.00 3468903 Tumor Necrosis Factor-Alpha (R) General Lab 83520 $49.22 3129745 Typhus Fever Antibody IgG (R) General Lab 86757 $68.10 3213220 Tyrosine, Qn, P (R) General Lab 82131 $65.49 633618 U24 Potassium (R) General Lab 84133 $15.16 633613 U24 Sodium (R) General Lab 84300 $17.11 633864 UA Microscopic General Lab 81000 $11.46 3481368 UA/Micro, Reflex Urine Culture (R) General Lab 81001 $11.16 3132744 UACR Quant General Lab 82043 $20.34 3468941 UDS (Chronic Controlled Substance Scrn) (R) General Lab 80307 $199.53 3325511 UDS Internal QC General Lab 80305 $14.86 3325355 UDS Poct General Lab 80305 $42.64 3271102 UPC General Lab 82570 $18.21 3482616 Umbilical Cord Bld Drug Scr 9 (R) General Lab 80307 $199.53 3176493 Upper Respiratory Culture (R) General Lab 87070 $30.32 3227193 Ur Bacteria General Lab 81015 $9.66 3213644 Ur Calcium General Lab 82340 $21.21 3131045 Ur Copper General Lab 82525 $91.00 3213645 Ur Creat (R) General Lab 82570 $18.21 633856 Urea Nitrogen 24 Hour Urine (R) General Lab 84540 $16.70 633858 Uric Acid General Lab 84550 $15.90 633859 Uric Acid 24 Hour Urine (R) General Lab 84560 $16.70 633860 Uric Acid Body Fluid (R) General Lab 84560 $16.70 3134425 Uric Acid General Lab 84550 $15.90 3176375 Uric Acid (R) General Lab 84550 $15.90 3223045 Uric Acid (R) General Lab 84550 $17.56 1148022 Urinalysis with Microscopic, if Indicated General Lab 81003 $7.90 3134610 Urinalysis, Complete (R) General Lab 81001 $11.16 3129771 Urine 24 Hour 5 HIAA General Lab 83497 $82.00 3130644 Urine 24 Hour 17-Ketosteroids General Lab 83586 $51.70 3277823 Urine 24 Hour Protein Electrophoresis Interp General Lab 84166 $71.99 3131012 Urine Citrate General Lab 82507 $112.23 3176376 Urine Culture (R) General Lab 87086 $28.39 3271472 Urine Creatinine General Lab 82570 $20.09 3150580 Urine Drug Screen (R) General Lab 80307 $199.53 3271111 Urine Potassium General Lab 84133 $23.00 3271471 Urine Protein General Lab 84156 $14.25 3486371 Urine Streptococcus pneumoniae Ag (R) General Lab 87899 $45.80 3122512 VDRL Screen Cerebrospinal Fluid (R) General Lab 86592 $15.03 3132741 VLDL General Lab 80061 $47.12 3556585 VZV Real Time PCR (R) General Lab 87798 $123.48 3211238 Vaginosis Panel (R) General Lab 87480 $80.94 633867 Valproic Acid Level General Lab 80164 $47.66 3176365 Valproic Acid Level (R) General Lab 80164 $47.66 3148726 Vanco Lvl General Lab 80202 $47.66 3148727 Vanco Lvl Pk General Lab 80202 $47.66 3148728 Vanco Lvl Tr General Lab 80202 $47.66 1634896 Vancomycin Level Peak (R) General Lab 80202 $47.66 1634897 Vancomycin Level Troug (R) General Lab 80202 $47.66 3109175 Vanillylmandelic Acid 24 Hour Urine (R) General Lab 84585 $54.53 3109176 Vanillylmandelic Acid Urine (R) General Lab 82570 $18.21 3109166 Varicella Zoster Antibody IgG (R) General Lab 86787 $45.32 3109167 Varicella Zoster Antibody IgG and IgM (R) General Lab 86787 $45.32 3129749 Varicella Zoster Antibody IgM (R) General Lab 86787 $45.32 3122511 Vasoactive Intestinal Polypeptide (R) General Lab 84586 $124.33 3331855 Vectra(R) DA Disease Activity (R) General Lab 81490 $2,395.85 3211246 Viral Culture (R) General Lab 87252 $91.72 3109168 Viscosity (R) General Lab 85810 $41.07 3321703 VistaSeq Hered. Cancer Panel (R) General Lab 81201 $2,223.00 1634898 Vitamin B12 Level (R) General Lab 82607 $53.04 3109169 Vitamin A Level (R) General Lab 84590 $40.83 3109170 Vitamin B1 (R) General Lab 84425 $74.69 3109171 Vitamin B2 (R) General Lab 84252 $71.20 3109172 Vitamin B6 Level (R) General Lab 84207 $98.86 3109173 Vitamin C Level (R) General Lab 82180 $34.78 3109174 Vitamin E Level (R) General Lab 84446 $49.89 3148952 Vitamin D Total (R) General Lab 82306 $104.16 3212893 Vitamin B12 & Folate (R) General Lab 82746 $51.74 3213136 Vitamin K1 (R) General Lab 84597 $48.27 3213203 Vitamin D 25-Hydroxy, D2 + D3 (R) General Lab 82306 $104.16 3240684 Vitamin D - Total General Lab 82306 $104.16 3129752 Volatile Screen (R) General Lab 80320 $31.95 3109177 Von Willebrand Factor Antigen (R) General Lab 85246 $80.72 3109178 Von Willebrand Factor Assay (R) General Lab 85240 $63.00 3129753 Von Willebrand Factor Multimer Assay (R) General Lab 85247 $80.72 3213105 Warfarin (Coumadin), Serum (R) General Lab 80375 $61.36 3528604 Warfarin (p450 2C9 and VKORC1) (R) General Lab 81227 $498.21 3243310 Weed Panel with Molds (R) General Lab 86003 $18.37 1635505 West Nile Virus Antibodies IgG and IgM (R) General Lab 86788 $59.28 3109179 West Nile Virus Antibodies IgG and IgM Cerebrospinal Fluid (R) General Lab 86788 $59.28 3211240 Wet Prep (R) General Lab 87210 $16.59 3242956 Wet Prep CN General Lab 87210 $16.59 3224976 White Blood Cells (WBC), Stool (R) General Lab 89055 $15.03 3394673 Zika Virus NAA Comprehensive (R) General Lab 87662 $4,062.50 3394674 Zika Virus MAC-ELISA (EUA) (R) General Lab 86794 $45.32 3129761 Zinc Level Urine (R) General Lab 82570 $18.21 3185600 Zinc, Plasma or Serum (R) General Lab 84630 $40.07 3213084 Zonisamide(Zonegran), Serum (R) General Lab 80203 $256.50 3210687 _ABO Grouping 006051 General Lab 86900 $9.46 3227482 _ABO Grouping 006051 General Lab 86900 $9.46 3210718 _Ab ID 1 114035 General Lab 86870 $459.23 3210720 _Ab ID #2 114037 General Lab 86870 $459.23 3284133 _Ab ID 1 114035 General Lab 86870 $459.23 3284134 _Ab ID #2 114037 General Lab 86870 $459.23 3210717 _Ab Screen 114034 General Lab 86870 $459.23 3227473 _Antibody Screen 114033 General Lab 86870 $459.23 3227474 _Antibody Id #1 019786 General Lab 86870 $459.23 3227476 _Antibody Id #2 019810 General Lab 86870 $459.23 3210705 _Coombs Tter #2 019836 General Lab 86850 $27.84 3210719 _Coombs Titer #1 114036 General Lab 86850 $27.84 3210721 _Coombs Titer #2 114038 General Lab 86850 $27.84 3227475 _Coombs Titer #1 019802 General Lab 86850 $27.84 3227477 _Coombs Tter #2 019836 General Lab 86850 $27.84 3284135 _Coombs Titer #2 114038 General Lab 86850 $27.84 3524681 _H Pylori Breat General Lab 83013 $213.29 3241770 _HIV 1 Ab General Lab 86701 $28.13 3241771 _HIV 2 Ab General Lab 86702 $41.31 3319462 _Thrombin Neutralization General Lab 85670 $18.27 3241886 _Thyrogl TG-RIA 503881 General Lab 84432 $50.84 3241889 _Thyroglob, Ser 006694 General Lab 84432 $50.84 3339448 _Tissue Grinding MTB General Lab 87176 $20.70 3319453 _dRVVT Conf APLS General Lab 85613 $30.32 3562807 _dRVVT Conf APLS General Lab 85613 $30.32 3319450 aPTT 1:1 APLS General Lab 85732 $20.46 3565238 aPTT Mixing Studies (R) General Lab 85730 $19.01 3212902 hCG, Beta Subunit, Qn (Serial) (R) General Lab 84702 $52.97 633798 pH Stool (R) General Lab 83986 $12.59 633799 pH Urine General Lab 83986 $12.59 1685798 pH Urine Dipstick General Lab 83986 $12.59 3281996 pH, Blood General Lab 82800 $31.35 3132609 pH, Body Fluid (R) General Lab 83986 $12.59 3271110 potassium urine General Lab 84133 $15.16 3213150 proBNP (R) General Lab 83880 $119.43 3213168 vWF Activity (R) General Lab 85245 $80.72 INFUSION/TRANSFUSION INFORMATION 3151587 0-4 hrs - OP Blood Transfusions Infusion Therapy 36430 $490.58 3151586 0-1 hrs - OP Blood Transfusions Infusion Therapy 36430 $350.00 3151585 0-2 hrs - OP Blood Transfusions Infusion Therapy 36430 $420.00 3151584 0-6 hrs - OP Blood Transfusions Infusion Therapy 36430 $584.03 3151583 0-8 hrs - OP Blood Transfusions Infusion Therapy 36430 $680.00 3151539 Completed - IV Drug Infusion 1st Hr Infusion Therapy 96365 $493.56 3151550 Completed - IV Drug Push Initial/Single (up to 15) Infusion Therapy 96374 $118.00 3151557 Completed - IVP, Each Addtl New Drug/Substance Infusion Therapy 96375 $120.58 3151564 Completed - IVP, Each Addtl Same Drug/Substance Infusion Therapy 96376 $80.00 3151571 Completed - IV Drug Infusion Sequential (up to 1 hr) Infusion Therapy 96367 $123.00 3151578 Completed - IM or SubQ Injection (any) each Infusion Therapy 96372 $41.00 MICROBIOTIC LAB INFORMATION 297645 API Yeast Identification Micro 87106 $41.67 634214 Acid Fast Stain Report Micro 87206 $21.69 634221 Amikacin $$$ Micro 87181 $19.18 294941 Amox/Cla Micro 87181 $19.18 634300 Amoxicillin/Clavulanate $$ Micro 87181 $19.18 294939 Amp/Sul Micro 87181 $19.18 634301 Amphotericin B Micro 87181 $19.18 634299 Ampicillin $ Micro 87181 $19.18 633881 Anaerobic Culture Micro 87075 $45.00 634014 Anaerobe Identification (Vitek) Micro 87076 $32.63 634016 Auramine-Rhodamine stain for AFB Micro 87206 $21.69 634297 Azithromycin Micro 87181 $19.18 634296 Azlocillin Micro 87181 $19.18 634295 Aztreonam $$$$ Micro 87181 $19.18 634025 Beta Lactamase Micro 87185 $19.18 634293 Beta Lactamase Micro 87185 $19.18 633882 Blood Culture Micro 87040 $42.00 633883 Body Fluid Culture Micro 87070 $41.00 3108781 Bone Culture, Aerobic Micro 87070 $41.00 3108782 Bone Culture ,Anaerboic Micro 87070 $41.00 634030 CAMP test Micro 87077 $44.57 634292 Carbenicillin Micro 87181 $19.18 1277763 Catheter Tip Culture Micro 87070 $41.00 634291 Cefaclor Micro 87181 $19.18 634290 Cefamandole Micro 87181 $19.18 634289 Cefazolin $ Micro 87181 $19.18 634320 Cefdinir Micro 87181 $19.18 634288 Cefepime $$$$ Micro 87181 $19.18 634287 Cefetamet Micro 87181 $19.18 634286 Cefixime Micro 87181 $19.18 634285 Cefmetazole Micro 87181 $19.18 634284 Cefonicid Micro 87181 $19.18 634283 Cefoperazone Micro 87181 $19.18 634282 Cefotaxime $$ Micro 87181 $19.18 634281 Cefotetan Micro 87181 $19.18 634280 Cefoxitin $$$ Micro 87181 $19.18 634279 Cefpodoxime $$ Micro 87181 $19.18 634278 Cefprozil Micro 87181 $19.18 634277 Cefsulodine Micro 87181 $19.18 634276 Ceftazidime Micro 87181 $19.18 634305 Ceftibuten Micro 87181 $19.18 634275 Ceftizoxime Micro 87181 $19.18 634274 Ceftriaxone Micro 87181 $19.18 633886 Cerebrospinal Fluid Culture Micro 87070 $27.27 634322 Cerpirome Micro 87181 $19.18 3192607 Concentration Micro 87015 $26.96 634035 Crystal ID Micro 87077 $44.57 634034 Cystine tellurite agar Micro 87077 $44.57 634051 Direct florescent antibody Micro 87270 $48.42 634053 E coli 0157 latex Micro 87335 $48.42 633890 Ear Culture Micro 87070 $41.00 2596297 Environmental Culture Micro 87070 $41.00 633892 Eye Culture Micro 87070 $41.00 3114228 Fecal Lactoferrin Micro 86308 $35.00 633894 Genital Culture Micro 87070 $41.00 634080 Germ tube Micro 87210 $17.24 633895 Gonorrhea Culture Micro 87850 $48.42 3152973 Gram Negative Sensitivity Panel Micro 87186 $35.00 3152991 Gram Negative Sensitivity Panel (Extender Card) Micro 87186 $35.00 3153010 Gram Positive Sensitivity Panel Micro 87186 $35.00 633910 Gram Stain Micro 87205 $19.00 634217 Gram Stain Report Micro 87205 $19.00 297662 Gram negative identification (Vitek) Micro 87077 $44.57 297663 Gram positive identification (Vitek) Micro 87077 $44.57 634081 Gram stain Micro 87205 $19.00 3192608 Homogenization for Grinding Tissue Micro 87176 $23.74 634093 India ink Micro 87210 $17.24 294944 Kirby-Bauer Micro 87184 $27.87 634325 Levofloxacin Micro 87181 $19.18 3108780 MRSA Culture Micro 87081 $27.00 3108785 MRSA/MSSA Blood Culture. PCR Micro 87641 $165.67 294946 Minimum Inhibitory Concentration Micro 87186 $35.00 634115 Modified acid fast stain Micro 87206 $21.69 3108786 Mono Test Micro 86308 $35.00 634311 Moxifloxacin Micro 87181 $19.18 3114227 Occult Blood Immnuo Fecal Test Micro 82274 $117.00 634239 Penicillin Micro 87181 $19.18 634143 Pyr reaction Micro 87077 $44.57 633880 Rapid Adeno virus Micro 87809 $48.42 3108788 Rapid HIV- AG-AB Test Micro 87806 $93.39 3157499 Rapid HIV- AG-AB Test Micro 87389 $93.48 3114225 Rapid Influenza A& B Micro 87804 $48.42 3468212 Rapid Legionella Urinary Antigen Micro 87449 $46.54 633913 Rapid Strep A Micro 87880 $48.42 3108787 Rapid Strep pneumonia Ag. Micro 87450 $38.70 633901 Respiratory Culture Micro 87070 $41.00 633902 Respiratory Syncytial Virus Micro 87420 $48.42 3152950 Respiratory Syncial Virus Micro 87420 $48.42 633914 Rotavirus Direct Detection Stool Micro 86360 $79.23 634148 Salmonella group VI Micro 87147 $20.89 634149 Salmonella group POLY Micro 87147 $20.89 634157 Salmonella group D Micro 87147 $20.89 634165 Shigella group A latex Micro 87147 $20.89 634166 Shigella group D latex Micro 87147 $20.89 634167 Shigella group C latex Micro 87147 $20.89 634168 Shigella group B latex Micro 87147 $20.89 634065 Slide culture for fungal identification Micro 87107 $41.67 2622898 Staphylococcus aureus latex test Micro 87147 $20.89 633904 Stool Culture Micro 87045 $42.00 634179 Strep A latex Micro 87147 $20.89 634183 Strep B latex Micro 87147 $20.89 634182 Strep C latex Micro 87147 $20.89 634181 Strep F latex Micro 87147 $20.89 634180 Strep G latex Micro 87147 $20.89 1513763 Strep Group B Culture Micro 87081 $27.00 3152957 Strep Pneumo Sensitivity Panel Micro 87186 $35.00 297693 Streptex Micro 87147 $20.89 634173 Streptococcus pneumoniae antigen Micro 87899 $48.42 634227 Tetracycline Micro 87181 $19.18 633905 Throat Culture Micro 87081 $27.00 634198 Trehalose fermentation Micro 87106 $41.67 633907 Urine Culture Micro 87088 $36.00 634222 Vancomycin $$ Micro 87181 $19.18 633908 Wound Culture Micro 87070 $41.00 297694 Yeast identification (Vitek) Micro 87077 $44.57 OB/GYN PROCEDURES 3238751 59400 Obstetrical Care OB/GYN Tx/Procedures 59400 $6,959.70 3239073 59409 Obstetrical Care OB/GYN Tx/Procedures 59409 $2,725.80 3239086 59410 Obstetrical Care OB/GYN Tx/Procedures 59410 $3,473.80 3239074 59412 Antepartum Manipulation OB/GYN Tx/Procedures 59412 $572.00 3239072 59412 External Cephalic Version OB/GYN Tx/Procedures 59412 $3,560.53 3239075 59414 Deliver Placenta OB/GYN Tx/Procedures 59414 $458.00 3239071 59414 Field Delivery OB/GYN Tx/Procedures 59414 $500.00 3239076 59425 Antepartum Care Only OB/GYN Tx/Procedures 59425 $1,193.50 3239077 59426 Antepartum Care Only OB/GYN Tx/Procedures 59426 $2,104.30 3239078 59430 Care After Delivery OB/GYN Tx/Procedures 59430 $465.30 3238753 59510 Cesarean Delivery OB/GYN Tx/Procedures 59510 $7,695.60 3239079 59514 Cesarean Delivery Only OB/GYN Tx/Procedures 59514 $3,067.90 3239080 59515 Cesarean Delivery OB/GYN Tx/Procedures 59515 $4,209.70 3239081 59525 Remove Uterus After Cesarean OB/GYN Tx/Procedures 59525 $1,642.30 3238752 59610 VBAC Delivery OB/GYN Tx/Procedures 59610 $7,298.50 3239082 59612 VBAC Delivery Only OB/GYN Tx/Procedures 59612 $3,061.30 3239083 59614 VBAC Care After Delivery OB/GYN Tx/Procedures 59614 $3,806.00 3238754 59618 Attempted VBAC Delivery OB/GYN Tx/Procedures 59618 $7,800.10 3239084 59620 Attempted VBAC Delivery Only OB/GYN Tx/Procedures 59620 $3,171.30 3239085 59622 VBAC After Care OB/GYN Tx/Procedures 59622 $4,324.10 OPTHLMOLOGY PROCEDURES 3500298 15822 Blepharoplasty, upper eyelid, Post-op Management Only Ophthalmology 15822 $265.00 3323709 66984 Cataract Surg w/IOL 1 stage, Post-op Management Only Ophthalmology 66984 $2,000.00 3323708 66985 Insert Lens Prothesis, Post-op Management Only Ophthalmology 66985 $2,048.47 3487381 67825 Correction of trichiasis; epilation by other than forceps (eg, electrosurgery, cryotherapy, la Ophthalmology 67825 $412.80 OCCUPATIONAL THERAPY PROCEDURES 3151471 Apply Finger Splint, Static - Taping Charge OT Tx/Procedures 29130 $219.88 3151472 Apply Finger Splint, Dynamic - Taping Charge OT Tx/Procedures 29131 $219.88 3151470 Apply Long Arm Splint - Taping Charge OT Tx/Procedures 29105 $219.88 3151468 Apply Short Arm Splint, Static - Taping Charge OT Tx/Procedures 29125 $219.88 3151469 Apply Short Arm Splint, Dynamic - Taping Charge OT Tx/Procedures 29126 $219.88 3327530 CBE 90901 OT Biofeedback OT Tx/Procedures 90901 $118.40 3327531 CBE 90911 OT Biofeed Peri/Urethral/Rectal OT Tx/Procedures 90911 $218.08 3327532 CBE 95831 OT MMT, Extremity/Trunk Exclude Hands OT Tx/Procedures 95831 $54.00 3327533 CBE 95832 OT MMT, Hand OT Tx/Procedures 95832 $58.80 3327534 CBE 95833 OT MMT, Body Excluding Hands OT Tx/Procedures 95833 $76.80 3327535 CBE 95834 OT MMT, Total Body With Hands OT Tx/Procedures 95834 $106.80 3327536 CBE 95851 OT ROM Extremity/Trunk Exclude Hands OT Tx/Procedures 95851 $27.60 3327537 CBE 95852 OT ROM Measurement Hand OT Tx/Procedures 95852 $20.40 3327540 CBE 97010 OT Hot/Cold Pack OT Tx/Procedures 97010 $23.00 3327541 CBE 97012 OT Mechanical Traction OT Tx/Procedures 97012 $55.20 3327542 CBE 97014 OT Unattended E-Stim OT Tx/Procedures 97014 $46.80 3327543 CBE 97016 OT Vasopneumatic Devices OT Tx/Procedures 97016 $64.80 3327544 CBE 97018 OT Paraffin OT Tx/Procedures 97018 $36.00 3327545 CBE 97022 OT Whirlpool/Fluidotherapy OT Tx/Procedures 97022 $78.00 3327546 CBE 97032 OT Attended E-Stim., each additional 15 minutes OT Tx/Procedures 97032 $64.80 3327547 CBE 97033 OT Iontophoresis, each additional 15 minutes OT Tx/Procedures 97033 $108.00 3327548 CBE 97034 OT Contrast Bath, each additional 15 minutes OT Tx/Procedures 97034 $61.20 3327549 CBE 97035 OT Ultrasound, each additional 15 minutes OT Tx/Procedures 97035 $43.20 3327550 CBE 97110 OT Therapeutic Exercise, each additional 15 minutes OT Tx/Procedures 97110 $109.20 3327551 CBE 97112 OT Neuromuscular Reeducation, each additional 15 minutes OT Tx/Procedures 97112 $114.00 3327552 CBE 97113 OT Aquatic Exercise, each additional 15 minutes OT Tx/Procedures 97113 $145.20 3327554 CBE 97116 OT Gait Training, each additional 15 minutes OT Tx/Procedures 97116 $96.00 3327557 CBE 97124 OT Massage, each additional 15 minutes OT Tx/Procedures 97124 $88.80 3327558 CBE 97140 OT Manual Therapy, each additional 15 minutes OT Tx/Procedures 97140 $102.00 3327559 CBE 97150 OT Group Therapy/Double Therapy, each additional 15 minutes OT Tx/Procedures 97150 $70.80 3327560 CBE 97530 OT Therapeutic Activity, each additional 15 miutes OT Tx/Procedures 97530 $118.80 3327561 CBE 97533 OT Sensory Integrative Techniques, each additional 15 minutes OT Tx/Procedures 97533 $99.60 3327562 CBE 97535 OT Self Care/Home Management, each additional 15 minutes OT Tx/Procedures 97535 $118.80 3327563 CBE 97537 OT Community/Work Reintegration, each additional 15 minutes OT Tx/Procedures 97537 $103.20 3327564 CBE 97542 OT Wheelchair Management, each additional 15 minutes OT Tx/Procedures 97542 $104.40 3327565 CBE 97545 OT Work Harden/Condition, Initial 2 hrs. OT Tx/Procedures 97545 $400.00 3327566 CBE 97546 OT Work Harden/Condition, each additional hour OT Tx/Procedures 97546 $100.00 3327567 CBE 97750 OT Physical Performance Test, each additional 15 minutes OT Tx/Procedures 97750 $114.00 3327568 CBE 97755 OT Assistive Technology Evaluation, each additional 15 minutes OT Tx/Procedures 97755 $124.80 3327571 CBE 97762 OT Orthotic/Prosthetic Use/Check Out, each additional 15 minutes OT Tx/Procedures $157.20 1373670 OT Assistive Technology Eval Units OT Tx/Procedures 97755 $124.80 1373442 OT Attended E-Stim Units OT Tx/Procedures 97032 $64.80 1373555 OT Biofeedback Units OT Tx/Procedures 90901 $118.40 1373672 OT Biofdbk, Peri, Urethral, Rectal Units OT Tx/Procedures 90911 $218.08 3480671 OT Canalith Repositioning Units OT Tx/Procedures 95992 $117.82 3500760 OT Cognitive Skills Development Units 2018 OT Tx/Procedures 97127 $145.80 1373453 OT Community, Work Reintegration Units OT Tx/Procedures 97537 $103.20 1373567 OT Contrast Bath Units OT Tx/Procedures 97034 $61.20 1373574 OT Double Therapy Units OT Tx/Procedures 97150 $70.80 1373921 OT Elbow Orthosis Right Units OT Tx/Procedures L3740 $2,777.22 1373922 OT Elbow Orthosis Left Units OT Tx/Procedures L3740 $2,777.22 1373935 OT Finger Orthosis Right Units OT Tx/Procedures L3927 $92.73 1373451 OT Group Therapy Units OT Tx/Procedures 97150 $70.80 1373551 OT Hot, Cold Pack Units OT Tx/Procedures 97010 1373679 OT Infrared Units OT Tx/Procedures 97026 $20.40 1373443 OT Iontophoresis Units OT Tx/Procedures 97033 $108.00 1373556 OT MMT, Extremity, Trunk Units OT Tx/Procedures 95831 $54.00 1373557 OT MMT, Hand Units OT Tx/Procedures 95832 $58.80 1373558 OT MMT, Total Body Without Hand Units OT Tx/Procedures 95833 $76.80 1373559 OT MMT, Total Body With Hand Units OT Tx/Procedures 95834 $106.80 1373444 OT Manual Therapy Units OT Tx/Procedures 97140 $102.00 1373445 OT Massage Units OT Tx/Procedures 97124 $88.80 1373446 OT Neuromuscular Reeducation Units OT Tx/Procedures 97112 $114.00 1373573 OT Orthotic Management Intial, Train Units OT Tx/Procedures 97760 $159.60 1373668 OT Orthotic, Prosthetic Use, Check Out OT Tx/Procedures $157.20 3500727 OT Orthotic/Prosthetic Mgmt Subs, Train Units OT Tx/Procedures 97763 $164.40 1373447 OT Paraffin Bath Units OT Tx/Procedures 97018 $36.00 1373669 OT Physical Performance Test OT Tx/Procedures 97750 $114.00 1373575 OT Prosthetic Management Initial, Train Units OT Tx/Procedures 97761 $138.00 1373560 OT ROM, Extremity Units OT Tx/Procedures 95851 $27.60 1373561 OT ROM, Hand Units OT Tx/Procedures 95852 $20.40 1373569 OT Self Care, Home Management Units OT Tx/Procedures 97535 $118.80 1373568 OT Sensory Integrative Techniques Units OT Tx/Procedures 97533 $99.60 1373449 OT Therapeutic Exercise Units OT Tx/Procedures 97110 $109.20 1373450 OT Therapeutic Activities Units OT Tx/Procedures 97530 $118.80 1373448 OT Ultrasound Units OT Tx/Procedures 97035 $43.20 1373552 OT Unattended E-Stim Units OT Tx/Procedures 97014 $34.38 1373553 OT Vasopneumatic Devices Units OT Tx/Procedures 97016 $64.80 1373570 OT Wheelchair Management Units OT Tx/Procedures 97542 $104.40 1373554 OT Whirlpool, Fluidotherapy Units OT Tx/Procedures 97022 $78.00 1373571 OT Work Hardening-Initial 2 Hours Units OT Tx/Procedures 97545 $400.00 1373572 OT Work Hardening-Each Addl Hour Units OT Tx/Procedures 97546 $100.00 3408663 OT Wound Care Selective, 1st 20sq cent. Units OT Tx/Procedures $642.82 3408665 OT Wound Care Selective, ea. add. 20sq cent. Units OT Tx/Procedures $335.82 3408667 OT Wound Care Non-Selective Units OT Tx/Procedures $335.82 1373929 OT Wrist Hand Orthosis Right Units OT Tx/Procedures L3806 $803.00 1373930 OT Wrist Hand Orthosis Left Units OT Tx/Procedures L3806 $803.00 3151461 Strapping, Toes - Taping Charge OT Tx/Procedures 29550 $219.88 3151462 Strapping, Shoulder (Velpeau) - Taping Charge OT Tx/Procedures 29240 $219.88 3151463 Strapping, Knee - Taping Charge OT Tx/Procedures 29530 $219.88 3151464 Strapping, Hip - Taping Charge OT Tx/Procedures 29520 $219.88 3151465 Strapping, Hand or Finger - Taping Charge OT Tx/Procedures 29280 $219.88 3151466 Strapping, Elbow or Wrist - Taping Charge OT Tx/Procedures 29260 $219.88 3151467 Strapping, Ankle/Foot - Taping Charge OT Tx/Procedures 29540 $219.88 3151460 Unna Boot Application - Taping Charge OT Tx/Procedures 29580 $219.88 3151449 Yes - OT Unattended Electrical Therapy Charge OT Tx/Procedures G0283 $46.80 3467174 Yes - OT Re-evaluation 2017 OT Tx/Procedures 97168 $182.40 3467180 Yes - OT Low Complexity Evaluation OT Tx/Procedures 97165 $297.60 3467186 Yes - OT Moderate Complexity Evaluation OT Tx/Procedures 97166 $347.60 3467192 Yes - OT High Complexity Evaluation OT Tx/Procedures 97167 $397.60 MISC PATIENT HOSPITAL CARE ITEMS 1648330 AMB Only hep A Adult Vaccine Med Charge Patient Care 90471 $75.10 1648359 AMB Only Influenza Vaccine Med Charge Patient Care 90471 G0008 $75.10 3183548 AMB Only Hep A Pediatric Charge Patient Care 90460 $75.10 3518196 Additional sequential infusion of new drug, up to 1 hr - AMB IV Infusion Patient Care 96367 $165.87 3287574 Addl Admin Charge 90472 - AMB Only Admin Charge Patient Care 90472 $120.58 3183695 Admin Vac ea addl - 90472 - Vaccine Med Admin Charge Patient Care 90472 $120.58 3183696 Admin Vac 1st - 90471 - Vaccine Med Admin Charge Patient Care 90471 $120.58 3183662 Airway Inh Tx (1/enctr) 94640 - AMB Inh Admin Charge Patient Care 94640 $425.96 3522418 Airway Inh Tx (1/enctr) 94640 - AMB Corticosteroid Patient Care 94640 $425.96 3470755 Allergy Injection- One Injection - Allergy Injection Charges Patient Care 95115 $87.98 3470756 Allergy Injection- 2 or more - Allergy Injection Charges Patient Care 95117 $87.98 3183580 Amb Hepatitis B Charge Patient Care $75.10 3151198 Artificial airway - Suction Patient Care 31720 $170.50 3251709 Awake/Asleep - EEG Patient Status Patient Care 95819 $474.92 3251708 Awake/Drowsy - EEG Patient Status Patient Care 95816 $474.92 3151197 Bag and suction - Suction Patient Care 31720 $170.50 3151196 Broncho-Alveolar lavage - Suction Patient Care 31720 $170.50 3246358 Cane - OT Equipment Issued Patient Care E0100 $107.94 3330571 Cerebral Death Evaluation - EEG Patient Status Patient Care 95824 $530.58 3246339 Compression wrap - Lymphedema Dressing Type Patient Care S8431 $62.13 3518197 Concurrent IV infusion in same IV line - AMB IV Infusion Patient Care 96368 $91.00 3380679 Continuous - SpO2 Monitoring Frequency Patient Care 94762 $182.80 3213572 Date of Holter Monitor Disconnect Patient Care 93225 $188.00 3151195 Directional tip catheter - Suction Patient Care 31720 $170.50 2636787 ECG Completed By Patient Care 93005 $77.69 3184686 ED Abdominal Binder Patient Care L3650 $194.45 3184716 ED Ace Bandage Patient Care S8431 $5.00 3184699 ED Art Line Kit Patient Care A4649 $222.11 3184732 ED C-Collar Semi Rigged Patient Care L0140 $262.70 3184747 ED C-Collar Soft Patient Care L0120 $115.73 3184692 ED Cast Plaster Patient Care A4580 $15.00 3184705 ED Cast Fiberglass Patient Care A4590 $22.50 3184706 ED Cast Shoe Charge Patient Care L3260 $19.50 3184678 ED Catheter Patient Care A4351 $6.65 3184700 ED Crutches Patient Care E0114 $195.93 3184679 ED Defibrillator Pads Patient Care A4649 $20.00 3184717 ED Finger Splint Patient Care L3808 $929.54 3184733 ED Foley Tray Patient Care A4314 $92.22 3184680 ED Knee Immobilizer Patient Care L1830 $341.68 3184720 ED Pacer Pads Patient Care A4649 $222.11 3184697 ED Pleurovac Kit Patient Care A4649 $222.11 3184748 ED Rib Belt Patient Care L0220 $18.24 3184712 ED Shoulder Immobilizer Patient Care A4565 $59.90 3184718 ED Sling Patient Care A4565 $59.90 3184687 ED Splint Patient Care A4570 $21.12 3184734 ED Sutures Patient Care A4649 $222.11 3184681 ED Trach Suction Kit Patient Care A4624 $10.81 3184701 ED Urine Drainage Bag Patient Care A4357 $39.69 3184689 ED Velcro Wrist Splint Patient Care L3908 $231.57 3184749 ED Walking Boot Patient Care L4386 $384.98 3516249 EEG Hour Monitor Units Patient Care 95953 $444.36 $561.60 3288241 Each Additional 90472 - Admin Immunization Charge Patient Care 90472 $120.58 3247372 Electrical stimulation, attended - Type of Modality: Patient Care 97032 $64.80 786479 End Tidal CO2 Patient Care 94770 $128.00 3288240 First Vaccine 90471 - Admin Immunization Charge Patient Care 90471 $120.58 3246338 Gauze bandage roll - Lymphedema Dressing Type Patient Care S8430 $28.00 3246331 Gradient Pressure Aid (Sleeve and Glove Combination) - Lymphedema Dressing Type Patient Care S8421 $281.25 3246340 Gradient Compression Stocking, Below the Knee, 18-30 Mmhg - Lymphedema Dressing Type Patient Care A6530 $50.00 3246341 Gradient Compression Stocking, Below the Knee, 30-40 Mmhg - Lymphedema Dressing Type Patient Care A6531 $507.50 3246211 Hydrotherapy - Type Patient Care 97036 $110.40 3247353 III - Incision, Wound Pressure Ulcer Stage: Patient Care G0329 $34.80 3518183 IUD Failure - AMB Hormonal Contraceptive Patient Care 58300 $528.03 $184.80 3183668 IV 96365/1 hr - AMB IV Infusion Patient Care 96365 $493.56 3183684 IV 96365/1 hr - AMB Inj-IV Med Admin Charge Patient Care 96365 $493.56 3180350 IV Drug Push - Initial or single (up to 15 min) - IV Initial Start Patient Care 96374 $118.00 3180367 IV Drug Infusion - ea Addl HR - Each Addl Hour OF INFUSION AND/OR IVP Patient Care 96366 $87.98 3180378 IV Drug Infusion; Concurrent (ONE per visit) - Types of Drug Infusion Patient Care 96368 $71.00 3180379 IV Drug Infusion - Sequential up to 1 hr - Types of Drug Infusion Patient Care 96367 $123.00 3341224 IV Drug Push - Initial or single (up to 15 min) - AMB Non-Chemo Infusion Patient Care 96374 $263.34 3469141 IV Drug Push - Initial or single (up to 15 min) - AMB Corticosteroid Patient Care 96374 $263.34 3180348 IV Infusion - Hydration, 1st 31-60M - IV Initial Start Patient Care 96360 $163.00 3180349 IV Infusion - 1st Hour - IV Initial Start Patient Care 96365 $493.65 3180366 IV Infusion - Hydration, ea Addl HR - Each Addl Hour OF INFUSION AND/OR IVP Patient Care 96361 $68.00 3340793 IV Infusion, each additional hour - AMB Non-Chemo Infusion Patient Care 96366 $87.98 3340794 IV Infusion - 1st Hour - AMB Non-Chemo Infusion Patient Care 96365 $493.56 3341222 IV Infusion - Hydration, ea Addl HR - AMB Non-Chemo Infusion Patient Care 96361 $87.98 3341223 IV Infusion - Hydration, 1st 31-60 minutes - AMB Non-Chemo Infusion Patient Care 96360 $263.34 3469351 IV Infusion - 1st Hour - AMB Biologic DMARD Patient Care 96413 $280.70 3469352 IV Infusion, each additional hour - AMB Biologic DMARD Patient Care 96415 $42.31 3518194 IV Infusion, Initial up to 1 hr - AMB IV Infusion Patient Care 96365 $544.58 3518195 IV Infusion; each additional hour - AMB IV Infusion Patient Care 96366 $105.54 3518198 IV Infusion w/o drug (Hydration), 31 minutes to 1 hr - AMB IV Infusion Patient Care 96360 $544.58 3472656 IV Push - AMB Inj-IV Med Admin Charge Patient Care 96374 $263.34 3518199 IV infusion w/o drug (Hydration); each additional hr - AMB IV Infusion Patient Care 96361 $105.54 3180364 IVP, each addl SAME drug/substance - Each Addl Hour OF INFUSION AND/OR IVP Patient Care 96376 $80.00 3180365 IVP, each addl NEW drug/substance - Each Addl Hour OF INFUSION AND/OR IVP Patient Care 96375 $120.58 3341220 IVP, each addl SAME drug/substance - AMB Non-Chemo Infusion Patient Care 96376 $31.00 3341221 IVP, each addl NEW drug/substance - AMB Non-Chemo Infusion Patient Care 96375 $120.58 3287573 Initial Admin Charge 90471 - AMB Only Admin Charge Patient Care 90471 $120.58 3288242 Inj Admin Charge 96372 - Admin Injection Charge Patient Care 96372 $75.10 $75.10 3183685 Inj SubQ/IM 96372 - AMB Inj-IV Med Admin Charge Patient Care 96372 $120.58 3151194 Inline - Suction Patient Care 31720 $170.50 3335990 Insertion, IUD - AMB Hormonal Contraceptive Patient Care 58300 $528.03 $184.80 3335991 Insertion, Implant - AMB Hormonal Contraceptive Patient Care 11981 $259.86 $193.20 3330292 Intermediate Joint (Left) - AMB Inj-Jt Med Admin Charge Patient Care 20605 $637.72 $128.40 3330293 Intermediate Joint (Right) - AMB Inj-Jt Med Admin Charge Patient Care 20605 $637.72 $128.40 3469137 Intermediate Joint (Right) - AMB Corticosteroid Patient Care 20605 $637.72 $128.40 3469138 Intermediate Joint (Left) - AMB Corticosteroid Patient Care 20605 $637.72 $128.40 3338483 Intradermal - Amb Inj Med Admin Charge Patient Care 96372 $120.58 3382755 Intrafascial Right - AMB Inj-Jt Med Admin Charge Patient Care 20550 $637.72 $144.00 3382756 Intrafascial Left - AMB Inj-Jt Med Admin Charge Patient Care 20550 $637.72 $144.00 3469142 Intrafascial Right - AMB Corticosteroid Patient Care 20550 $637.72 $144.00 3469221 Intrafascial Left - AMB Corticosteroid Patient Care 20550 $637.72 $144.00 3529836 Intralesional Injection - Amb Inj Med Admin Charge Patient Care 11900 $168.93 $108.00 3526801 Intraosseous - Amb Inj Med Admin Charge Patient Care 36680 $329.99 $202.80 3330295 Large Joint (Left) - AMB Inj-Jt Med Admin Charge Patient Care 20610 $637.72 $159.60 3330296 Large Joint (Right) - AMB Inj-Jt Med Admin Charge Patient Care 20610 $637.72 $159.60 3469134 Large Joint (Right) - AMB Corticosteroid Patient Care 20610 $637.72 $159.60 3469135 Large Joint (Left) - AMB Corticosteroid Patient Care 20610 $637.72 $159.60 3217711 Length of Holter Monitor Recording Patient Care 93226 $170.00 3247333 Mechanical traction therapy - Type of Modality: Patient Care 97012 $55.20 3380696 Multiple Spot Check - SpO2 Monitoring Frequency Patient Care 94761 $116.80 3151192 Nasotracheal, right - Suction Patient Care 31720 $170.50 3151193 Nasotracheal, left - Suction Patient Care 31720 $170.50 3469219 Neuroma Right - AMB Corticosteroid Patient Care 64455 $637.72 $120.00 3469220 Neuroma Left - AMB Corticosteroid Patient Care 64455 $637.72 $120.00 3469225 Neuroma Right - AMB Inj-Jt Med Admin Charge Patient Care 64455 $637.72 $120.00 3469226 Neuroma Left - AMB Inj-Jt Med Admin Charge Patient Care 64455 $637.72 $120.00 3408662 OT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3408664 OT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3408666 OT Wound Care Non-Selective Time Patient Care 97602 $335.82 3151190 Oral - Suction Patient Care 31720 $170.50 1374008 PT Assistive Technology Eval Units Patient Care 97755 $124.80 3407198 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407199 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407200 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407204 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407205 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407206 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407210 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407211 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407212 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407216 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407217 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407218 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407222 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407223 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407224 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407228 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407229 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407230 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407234 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407235 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407236 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407240 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407241 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407242 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407246 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407247 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407248 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407252 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407253 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407254 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407258 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407259 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407260 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407264 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407265 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407266 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407276 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407277 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407278 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407288 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407289 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407290 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3407294 PT Wound Care Selective, 1st 20sq cent. Time Patient Care 97597 $642.82 3407295 PT Wound Care Selective, ea. add. 20sq cent. Time Patient Care 97598 $335.82 3407296 PT Wound Care Non-Selective Time Patient Care 97602 $335.82 3336603 Removal & Reinsertion, Implant - AMB Hormonal Contraceptive Patient Care 11983 $259.86 $598.80 1374747 Sacral Torsion Patient Care L3915 $939.68 3380695 Single Spot Check - SpO2 Monitoring Frequency Patient Care 94760 $110.80 3251707 Sleep Only - EEG Patient Status Patient Care 95822 $474.92 3330298 Small Joint (Left) - AMB Inj-Jt Med Admin Charge Patient Care 20600 $637.72 $122.40 3330299 Small Joint (Right) - AMB Inj-Jt Med Admin Charge Patient Care 20600 $637.72 $122.40 3469130 Small Joint (Right) - AMB Corticosteroid Patient Care 20600 $637.72 $122.40 3469131 Small Joint (Left) - AMB Corticosteroid Patient Care 20600 $637.72 $122.40 3151189 Stoma - Suction Patient Care 31720 $170.50 3330300 SubQ/IM Injection - AMB Inj-Jt Med Admin Charge Patient Care 96372 $150.58 3358684 SubQ/IM Injection - Amb Inj Med Admin Charge Patient Care 96372 $120.58 3467784 SubQ/IM Injection - AMB Nonhormonal Antineoplastic Patient Care 96401 $263.34 3469129 SubQ/IM Injection - AMB Corticosteroid Patient Care 96372 $150.58 3469353 SubQ/IM Injection - AMB Biologic DMARD Patient Care 96401 $263.34 3244880 TRMT S,L,VOICE &/OR AUD DISORD 92507 Patient Care 92507 $250.80 3151188 Tracheostomy - Suction Patient Care 31720 $170.50 3247405 Transcutaneous electrical nerve stimulator - Activities Patient Care 97140 $67.87 3338967 Trigger Point, 3+ muscles - AMB Trigger Point Patient Care 20553 $637.72 $148.80 3338968 Trigger Point, 1 or 2 muscles - AMB Trigger Point Patient Care 20552 $637.72 $130.80 3480856 Trigger Point, 1 or 2 muscles - AMB Corticosteroid Patient Care 20552 $637.72 $130.80 3480857 Trigger Point, 3+ muscles - AMB Corticosteroid Patient Care 20553 $637.72 $148.80 3290812 Vaccine Admin 1st Inj - AMB Vaccine Admin Charge Patient Care 90471 $120.58 3290813 Vaccine Admin each add inj - AMB Vaccine Admin Charge Patient Care 90472 $120.58 3290814 Vaccine Oral/Nasal 1st Dose - AMB Vaccine Admin Charge Patient Care 90473 $120.58 3290815 Vaccine Oral/Nasal Ea Add Dose - AMB Vaccine Admin Charge Patient Care 90474 $60.00 3334669 Vaccine Oral/Nasal Ea Add Dose - AMB Influenza Vaccine Charge Patient Care 90474 $60.00 3334670 Vaccine Oral/Nasal 1st Dose - AMB Influenza Vaccine Charge Patient Care 90473 $120.58 3334671 Vaccine Admin each add inj - AMB Influenza Vaccine Charge Patient Care 90472 $120.58 3334672 Vaccine Admin 1st Inj - AMB Influenza Vaccine Charge Patient Care 90471 $120.58 3334689 Vaccine Admin each add inj - Amb Hepatitis B Charge Patient Care 90472 $120.58 3334690 Vaccine Admin 1st Inj - Amb Hepatitis B Charge Patient Care 90471 $120.58 3338949 Vaccine Admin each add inj - AMB Pneumonia Vaccine Charge Patient Care 90472 $120.58 3338950 Vaccine Admin 1st Inj - AMB Pneumonia Vaccine Charge Patient Care 90471 $120.58 3471235 Yes - L3650SO, P/F, OTS Patient Care L3650 $165.10 3471254 Yes - L3660SO, P/F, OTS Patient Care L3660 $240.74 3471261 Yes - L3670SO, P/F, OTS Patient Care L3670 $336.70 3471268 Yes - L3671SO, C/F Patient Care L3671 $1,183.29 3471275 Yes - L3674SO, C/F Patient Care L3674 $1,275.10 3471282 Yes - L3675SO, P/F, OTS Patient Care L3675 $359.18 3471289 Yes - L3702EO, C/F Patient Care L3702 $433.36 3471296 Yes - L3710EO, P/F, OTS Patient Care L3710 $274.52 3471303 Yes - L3720EO, C/F Patient Care L3720 $1,370.52 3471310 Yes - L3730EO, C/F Patient Care L3730 $1,478.13 3471317 Yes - L3740EO, C/F Patient Care L3740 $2,222.18 3471324 Yes - L3760, P/F, OTS Patient Care L3760 $716.41 3471331 Yes - L3762EO, P/F, OTS Patient Care L3762 $201.74 3471338 Yes - L3763EWHO, C/F Patient Care L3763 $1,058.68 3471345 Yes - L3764EWHO, C/F Patient Care L3764 $1,214.72 3471352 Yes - L3765EWHFO, C/F Patient Care L3765 $1,383.17 3471359 Yes - L3766EWHFO, C/F Patient Care L3766 $1,464.72 3471366 Yes - L3806WHFO, C/F Patient Care L3806 $681.78 3471373 Yes - L3807WHFO, P/F Patient Care L3807 $409.44 3471380 Yes - L3808WHFO, C/F Patient Care L3808 $789.22 3471387 Yes - L3809WHFO, P/F, OTS Patient Care L3809 $409.44 3471394 Yes - L3900WHFO, C/F Patient Care L3900 $1,743.86 3471401 Yes - L3901WHFO, C/F Patient Care L3901 $2,151.27 3471408 Yes - L3904WHFO, C/F Patient Care L3904 $5,734.31 3471415 Yes - L3905WHO, C/F Patient Care L3905 $1,302.32 3471422 Yes - L3906WHO, C/F Patient Care L3906 $711.28 3471429 Yes - L3908WHO, P/F, OTS Patient Care L3908 $196.62 3471436 Yes - L3912HFO, P/F, OTS Patient Care L3912 $269.40 3471443 Yes - L3913HFO, C/F Patient Care L3913 $406.46 3471450 Yes - L3915WHO, P/F Patient Care L3915 $797.84 3471457 Yes - L3916WHO, P/F, OTS Patient Care L3916 $797.84 3471464 Yes - L3917HO, P/F Patient Care L3917 $198.10 3471471 Yes - L3918HO, P/F, OTS Patient Care L3918 $198.10 3471478 Yes - L3919HO, C/F Patient Care L3919 $406.46 3471485 Yes - L3921HFO, C/F Patient Care L3921 $482.06 3471492 Yes - L3923HFO, P/F Patient Care L3923 $203.76 3471499 Yes - L3924HFO, P/F, OTS Patient Care L3924 $203.76 3471506 Yes - L3925FO, P/F, OTS Patient Care L3925 $118.50 3471513 Yes - L3927FO, P/F, OTS Patient Care L3927 $65.60 3471520 Yes - L3929HFO, P/F Patient Care L3929 $203.14 3471527 Yes - L3930HFO, P/F, OTS Patient Care L3930 $203.14 3471534 Yes - L3931WHFO, P/F Patient Care L3931 $349.02 3471541 Yes - L3933FO, C/F Patient Care L3933 $320.29 3471548 Yes - L3935FO, C/F Patient Care L3935 $331.54 3471562 Yes - L3960SEWHO, P/F Patient Care L3960 $1,150.23 3471569 Yes - L3961SEWHO, C/F Patient Care L3961 $1,812.38 3471576 Yes - L3962SEWHO, P/F Patient Care L3962 $1,274.67 3471583 Yes - L3967SEWHO, C/F Patient Care L3967 $2,139.83 3471590 Yes - L3971SEWHO, C/F Patient Care L3971 $2,031.16 3471597 Yes - L3973SEWHO, C/F Patient Care L3973 $2,139.83 3471604 Yes - L3975SEWHFO, C/F Patient Care L3975 $1,812.38 3471611 Yes - L3976SEWHFO, C/F Patient Care L3976 $1,812.38 3471618 Yes - L3977SEWHFO, C/F Patient Care L3977 $2,031.16 3471625 Yes - L3978SEWHFO, C/F Patient Care L3978 $2,139.83 3471632 Yes - L3980 Upper extermity orthosis, humeral, P/F Patient Care L3980 $1,154.26 3471639 Yes - L3981 Upper extremity orthosis, humeral, P/F Patient Care L3981 $1,321.84 3471649 Yes - L3984 Upper extremity orthosis, wrist, P/F Patient Care L3984 $732.38 3471656 Yes - L3995 Addition: Sock or Sleeve Patient Care L3995 $89.20 3471688 Yes - L3982 Upper extremity orthosis, radial/ulnar, P/F Patient Care L3982 $1,154.26 PUBLIC HEALTH NURSE CHARGES 3469381 Home visit est pt low-mod severity 25 min 99348 PHN / Home Visit 99348 $285.60 3469382 Home visit est pt mod-hi severity 40 min 99349 PHN / Home Visit 99349 $433.20 3469383 Home visit est pt self limited/minor 15 min 99347 PHN / Home Visit 99347 $188.40 3469384 Home visit new patient hi severity 60 min 99344 PHN / Home Visit 99344 $614.40 3469385 Home visit new patient low severity 20 min 99341 PHN / Home Visit 99341 $187.20 3469386 Home visit new patient mod severity 30 min 99342 PHN / Home Visit 99342 $268.80 3469387 Home visit new pt unstabl/signif new prob 75 min 99345 PHN / Home Visit 99345 $745.20 3469388 Home vst est pt unstable/significant new problem 99350 PHN / Home Visit 99350 $600.00 3469389 Home vst new patient mod-hi severity 45 min 99343 PHN / Home Visit 99343 $439.20 3276555 PHN Visit for Intramuscular Injections PHN / Home Visit 99506 $75.00 3276556 PHN Visit for assistance with activities of daily living and personal care PHN / Home Visit 99509 $75.00 3276557 PHN Visit for Postnatal assessment and follow-up care PHN / Home Visit 99501 $75.00 3276558 PHN Visit for Newborn care assessment PHN / Home Visit 99502 $75.00 3388732 PHN Visit for care and maintenance of catheter(s) PHN / Home Visit 99507 $75.00 3398655 PHN Visit for stoma care and maintenance including colostomy and cystostomy PHN / Home Visit 99505 $75.00 PHYSICAL THERAPY OUTPATIENT PROCEDURES 1373936 OT Finger Orthosis Left Units PT Tx/Procedures L3927 $92.73 1373918 PT Aquatic Units PT Tx/Procedures 97113 $145.20 1374009 PT Attended E-Stim Units PT Tx/Procedures 97032 $64.80 1374029 PT Biofdbk, Peri, Urethral, Rectal Units PT Tx/Procedures 90911 $218.08 1374113 PT Biofeedback Units PT Tx/Procedures 90901 $118.40 3480714 PT Canalith Repositioning Units PT Tx/Procedures 95992 $117.82 1374010 PT Club Foot Molding App Units PT Tx/Procedures L3908 $231.57 1374118 PT Community,Work Reintegration Units PT Tx/Procedures 97537 $103.20 1374011 PT Contrast Bath Units PT Tx/Procedures 97034 $61.20 1374012 PT Double Therapy Units PT Tx/Procedures 97150 $70.80 1374013 PT Gait Training Units PT Tx/Procedures 97116 $96.00 1374125 PT Group Therapy Units PT Tx/Procedures 97150 $70.80 3240522 PT Hot, Cold Pack Units PT Tx/Procedures 97010 $23.00 1373909 PT Iontophoresis Units PT Tx/Procedures 97033 $108.00 1374014 PT MMT Hand Units PT Tx/Procedures 95832 $58.80 1374114 PT MMT, Extremity, Trunk Units PT Tx/Procedures 95831 $54.00 1374115 PT MMT, Total Body Exclude Hand Units PT Tx/Procedures 95833 $76.80 1374116 PT MMT, Total Body With Hand Units PT Tx/Procedures 95834 $106.80 1373910 PT Manual Therapy Units PT Tx/Procedures 97140 $102.00 1373911 PT Massage Units PT Tx/Procedures 97124 $88.80 1373912 PT Mechanical Traction Units PT Tx/Procedures 97012 $55.20 1373913 PT Neuromuscular Reeducation Units PT Tx/Procedures 97112 $114.00 3240494 PT Neuromuscular Reeducation Units PT Tx/Procedures 97112 $114.00 1374015 PT Orthotic Prosthetic Check Out Units PT Tx/Procedures $157.20 1374120 PT Orthotic Management Initial, Train Units PT Tx/Procedures 97760 $159.60 3500794 PT Orthotic/Prosthetic Mgmt Subs, Train Units PT Tx/Procedures 97763 $164.40 1373914 PT Paraffin Units PT Tx/Procedures 97018 $36.00 1374017 PT Physical Performance Test PT Tx/Procedures 97750 $114.00 1374121 PT Prosthetic Management Initial, Train Units PT Tx/Procedures 97761 $138.00 1374019 PT ROM Measurement Hand Units PT Tx/Procedures 95852 $20.40 1374030 PT ROM Measure Extremity Trunk No Hands PT Tx/Procedures 95851 $27.60 1374018 PT Rigid Total Contact Leg Cast App Unit PT Tx/Procedures L0627 $798.42 1374347 PT Rigid Total Contact Leg Cast App Time PT Tx/Procedures L3808 $929.54 1374117 PT Self Care, Home Management Units PT Tx/Procedures 97535 $118.80 1373916 PT Sensory Integration Units PT Tx/Procedures 97533 $99.60 1374020 PT Therapeutic Exercise Units PT Tx/Procedures 97110 $109.20 1374031 PT Therapeutic Activity Units PT Tx/Procedures 97530 $118.80 1374021 PT Ultrasound Units PT Tx/Procedures 97035 $43.20 1374022 PT Unattended E-Stim Units PT Tx/Procedures 97014 G0283 $46.80 1374023 PT Vasopneumatic Devices Units PT Tx/Procedures 97016 $64.80 1373917 PT Wheelchair Management Units PT Tx/Procedures 97542 $104.40 1374112 PT Whirlpool, Fluidotherapy Units PT Tx/Procedures 97022 $78.00 1374024 PT Work Hardening Initial 2 Hours Units PT Tx/Procedures 97545 $400.00 1374119 PT Work Hardening-Each Addl Hour Units PT Tx/Procedures 97546 $100.00 3151337 Yes - E-Stim for Stage III-IV Wound Charge PT Tx/Procedures G0281 $46.80 3467570 Yes - PT Re-Evaluation 2017 PT Tx/Procedures 97164 $145.20 3467577 Yes - PT Low Complexity Evaluation PT Tx/Procedures 97161 $260.40 3467582 Yes - PT Moderate Complexity Evaluation PT Tx/Procedures 97162 $310.40 3467588 Yes - PT High Complexity Evaluation PT Tx/Procedures 97163 $360.40 3151344 Yes - Wound Care Selective Debridement Charge PT Tx/Procedures 97597 $293.95 3151351 Yes - Wound Care Non-Selective Debride Charge PT Tx/Procedures 97602 $264.94 PULMONARY FUCTION TESTS 3250148 PFT Airway Resistance Pulmonary Function 94728 $148.06 3150958 Yes - PFT Spirometry Only Pulmonary Function 94010 $169.95 3150966 Yes - PFT Pre & Post Spirometry Pulmonary Function 94060 $285.00 3150971 Yes - PFT Lung Nitrogen Washout Curve Pulmonary Function 94727 $148.06 3150976 Yes - PFT Diffusion Capacity; Co, Any Method Pulmonary Function 94729 $177.73 3311101 Yes - PFT Airway Resistance Pulmonary Function 94728 $148.06 3311096 Yes - Thoracic Gas Volume Pulmonary Function 94726 $148.06 RADIOLOGY PROCEDURES

3332071 XR Spine Scoliosis Series 4 or 5 View Radiology 72083 $62.40 611588 BD Appendicular Skeleton Radiology 77081 $37.20 1167837 BD Appendicular Skeleton Radiology 77081 $173.28 611590 BD Axial Skeleton 1 or More Sites Radiology 77080 $34.80 1167839 BD Axial Skeleton 1 or More Sites Radiology 77080 $286.97 675633 BD Vertebral Fracture Assessment Radiology 77086 $30.00 1167841 BD Vertebral Fracture Assessment Radiology 77086 $173.28 1167842 BD Vertebral Fracture Assessment Radiology 77086 $30.00 675631 BD Whole Body Composition Radiology 77080 $34.80 615590 CT Abdomen wo/w IV Contrast Radiology 74170 $240.00 615591 CT Abdomen wo/w IV Contrast - Report Radiology 74170 $241.20 625598 CT Abdomen w/IV Contrast Radiology 74160 $217.20 625599 CT Abdomen w/IV Contrast - Report Radiology 74160 $218.40 625600 CT Abdomen wo/IV Contrast Radiology 74150 $204.00 625601 CT Abdomen wo/IV Contrast - Report Radiology 74150 $204.00 1167845 CT Abdomen wo/w IV Contrast Radiology 74170 $675.05 1167847 CT Abdomen w/IV Contrast Radiology 74160 $675.05 1167849 CT Abdomen wo/IV Contrast Radiology 74150 $320.60 3114337 CT Abdomen & Pelvis w/IV Contrast Radiology 74177 $312.00 3114338 CT Abdomen & Pelvis wo/IV Contrast Radiology 74176 $297.60 3114341 CT Abdomen & Pelvis w/wo IV Contrast Radiology 74178 $342.00 3114407 CT Abdomen & Pelvis w/wo IV Contrast Radiology 74178 $991.00 3114409 CT Abdomen & Pelvis w/wo IV Contrast - Report Radiology 74178 $346.80 3114410 CT Abdomen & Pelvis w/IV Contrast Radiology 74177 $991.00 3114412 CT Abdomen & Pelvis w/IV Contrast - Report Radiology 74177 $313.20 3114413 CT Abdomen & Pelvis wo/IV Contrast Radiology 74176 $547.11 3114415 CT Abdomen & Pelvis wo/IV Contrast - Report Radiology 74176 $298.80 625588 CT Angio Aorta w/LE Runoff Radiology 75635 $404.40 625596 CT Angio Abdomen w/IV Contrast Radiology 74175 $308.40 629700 CT Angio Chest (Non-Coronary) w/wo Cont Radiology 71275 $310.80 629762 CT Angio Head w/wo IV Contrast Radiology 70496 $298.80 629764 CT Angio Lower Extremity Bilat Radiology 73706 $484.20 629766 CT Angio Lower Extremity Left Radiology 73706 $322.80 629768 CT Angio Lower Extremity Right Radiology 73706 $322.80 629770 CT Angio Neck w/wo IV Contrast Radiology 70498 $298.80 629772 CT Angio Pelvis w/wo IV Contrast Radiology 72191 $307.20 629774 CT Angio Upper Extremity Bilat Radiology 73206 $459.00 629776 CT Angio Upper Extremity Left Radiology 73206 $306.00 629778 CT Angio Upper Extremity Right Radiology 73206 $306.00 1167863 CT Angio Chest (Non-Coronary) w/wo Cont Radiology 71275 $675.05 2384299 CT Angio Abdomen + Pelvis Radiology 74174 $372.00 2410304 CT Angio Abdomen + Pelvis - Report Radiology 74174 $372.00 2410305 CT Angio Abdomen + Pelvis Radiology 74174 $991.00 3144818 CT Angio Aorta w/IV Contrast Radiology 74175 $308.40 3144819 CT Angio Head w/IV Contrast Radiology 70496 $298.80 3144820 CT Angio Neck w/IV Contrast Radiology 70498 $298.80 3144821 CT Angio Pelvis w/IV Contrast Radiology 72191 $307.20 3145380 CT Angio Chest (Non-Coronary) w/IV Contrast Radiology 71275 $310.80 3145383 CT Angio Lower Ext; w/IV Contrast Bilat Radiology 73706 $484.20 3145384 CT Angio Lower Ext; w/IV Contrast Left Radiology 73706 $322.80 3145385 CT Angio Lower Ext; w/IV Contrast Right Radiology 73706 $322.80 3145414 CT Angio Upper Ext; w/IV Contrast Bilat Radiology 73206 $459.00 3145415 CT Angio Upper Ext; w/IV Contrast Left Radiology 73206 $306.00 3145416 CT Angio Upper Ext; w/IV Contrast Right Radiology 73206 $306.00 3148752 CT Angio Chest (Non-Coronary) w/ Cont Radiology 71275 $310.80 3148753 CT Angio Coronary Artery w/ Eval Radiology 75574 $403.20 3148775 CT Angio Abdomen and Pelvis w/IV Contrast Radiology 74174 $372.00 3150588 CT Angio Chest (Non-Coronary) w/ Cont Radiology 71275 $675.05 3150591 CT Angio Coronary Artery w/ Eval Radiology 75574 $746.64 3150596 CT Angio Abdomen and Pelvis w/IV Contrast - Report Radiology 74174 $372.00 625680 CT Ankle w/wo IV Contrast Bilateral Radiology 73702 $311.40 625682 CT Ankle w/wo IV Contrast Left Radiology 73702 $207.60 625683 CT Ankle w/wo IV Contrast Left - Report Radiology 73702 $210.00 625684 CT Ankle w/wo IV Contrast Right Radiology 73702 $207.60 625685 CT Ankle w/wo IV Contrast Right - Report Radiology 73702 $210.00 625686 CT Ankle w/IV Contrast Bilateral Radiology 73701 $298.80 625688 CT Ankle w/IV Contrast Left Radiology 73701 $199.20 625689 CT Ankle w/IV Contrast Left - Report Radiology 73701 $199.20 625690 CT Ankle w/IV Contrast Right Radiology 73701 $199.20 625691 CT Ankle w/IV Contrast Right - Report Radiology 73701 $199.20 625692 CT Ankle wo/IV Contrast Bilateral Radiology 73700 $257.40 625694 CT Ankle wo/IV Contrast Left Radiology 73700 $171.60 625695 CT Ankle wo/IV Contrast Left - Report Radiology 73700 $172.80 625696 CT Ankle wo/IV Contrast Right Radiology 73700 $171.60 625697 CT Ankle wo/IV Contrast Right - Report Radiology 73700 $172.80 1167891 CT Ankle w/wo IV Contrast Left Radiology 73702 $1,003.00 1167893 CT Ankle w/wo IV Contrast Right Radiology 73702 $1,003.00 1167897 CT Ankle w/IV Contrast Left Radiology 73701 $856.62 1167899 CT Ankle w/IV Contrast Right Radiology 73701 $856.62 1167903 CT Ankle wo/IV Contrast Left Radiology 73700 $718.00 1167905 CT Ankle wo/IV Contrast Right Radiology 73700 $718.00 3194582 CT Ankle w/IV Contrast Bilat Radiology 73701 $298.80 3194583 CT Ankle w/wo IV Contrast Bilat Radiology 73702 $311.40 3194584 CT Ankle wo/ IV Contrast Bilat Radiology 73700 $257.40 3194588 CT Ankle w/IV Contrast Bilateral Radiology 73701 $854.46 3194590 CT Ankle w/wo IV Contrast Bilateral Radiology 73702 $1,003.00 3194592 CT Ankle wo/IV Contrast Bilat Radiology 73700 $718.00 629782 CT Biopsy Liver, Guide Needle Placement Radiology 77012 $195.60 629784 CT Biopsy Lung Left Radiology 77012 $195.60 629786 CT Biopsy Lung Right Radiology 77012 $195.60 629608 CT C-Spine w/IV Contrast Radiology 72126 $208.80 629609 CT C-Spine w/IV Contrast - Report Radiology 72126 $208.80 629610 CT C-Spine wo/IV Contrast Radiology 72125 $182.40 629611 CT C-Spine wo/IV Contrast - Report Radiology 72125 $170.40 1168238 CT C-Spine w/IV Contrast Radiology 72126 $991.00 1168240 CT C-Spine wo/IV Contrast Radiology 72125 $320.60 3199449 CT C-Spine w/wo IV Contrast Radiology 72127 $216.00 3199451 CT C-Spine w/wo IV Contrast Radiology 72127 $675.05 1167851 CT CTA Aorta w/LE Runoff Radiology 75635 $675.05 1167853 CT CTA Abdomen w/IV Contrast Radiology 74175 $675.05 1167871 CT CTA Head w/wo IV Contrast Radiology 70496 $675.05 1167879 CT CTA Neck w/wo IV Contrast Radiology 70498 $675.05 1167881 CT CTA Pelvis w/wo IV Contrast Radiology 72191 $675.05 3144832 CT CTA Aorta w/IV Contrast Radiology 74175 $675.02 3144835 CT CTA Head w/IV Contrast Radiology 70496 $675.05 3144838 CT CTA Neck w/IV Contrast Radiology 70498 $675.05 3144841 CT CTA Pelvis w/IV Contrast Radiology 72191 $675.05 3150594 CT CTA Abdomen and Pelvis w/IV Contrast Radiology 74174 $991.00 3150597 CT CTA Chest (Non-Coronary) w/IV Contras Radiology 71275 $675.05 3150600 CT CTA Lower Ext; w/IV Contrast Bilat Radiology 73706 $1,270.00 3150603 CT CTA Lower Ext; w/IV Contrast Left Radiology 73706 $1,270.00 3150606 CT CTA Lower Ext; w/IV Contrast Right Radiology 73706 $1,270.00 3150609 CT CTA Upper Ext; w/IV Contrast Bilat Radiology 73206 $1,782.00 3150612 CT CTA Upper Ext; w/IV Contrast Left Radiology 73206 $1,782.00 3150615 CT CTA Upper Ext; w/IV Contrast Right Radiology 73206 $1,782.00 3144773 CT Colonography Screening Radiology 74263 $387.60 3144774 CT Colonography w/wo IV Contrast Radiology 74262 $427.20 3144775 CT Colonography wo/IV Contrast Radiology 74261 $410.40 3144844 CT Colonography w/wo IV Contrast Radiology 74262 $675.05 3144846 CT Colonography w/wo IV Contrast - Report Radiology 74262 $429.60 3144847 CT Colonography wo/IV Contrast Radiology 74261 $320.60 3144849 CT Colonography wo/IV Contrast - Report Radiology 74261 $410.40 3150618 CT Colonography Screening Radiology 74263 $2,160.00 3150619 CT Colonography Screening - Report Radiology 74263 $408.00 3148754 CT Coronary Cardiac Structure and Ven Radiology 75572 $296.40 3148755 CT Coronary Calcium Scoring Radiology 75571 $98.40 3148939 CT Coronary Congenital Heart Disease Radiology 75573 $429.60 3150620 CT Coronary Calcium Scoring Radiology 75571 $36.20 3150623 CT Coronary Cardiac Structure and Ven Radiology 75572 $675.05 3150626 CT Coronary Congenital Heart Disease Radiology 75573 $675.05 629820 CT Elbow w/wo IV Contrast Bilat Radiology 73202 $313.20 629821 CT Elbow w/wo IV Contrast Bilat - Report Radiology 73202 $210.00 629822 CT Elbow w/wo IV Contrast Left Radiology 73202 $208.80 629823 CT Elbow w/wo IV Contrast Left - Report Radiology 73202 $210.00 629824 CT Elbow w/wo IV Contrast Right Radiology 73202 $208.80 629825 CT Elbow w/wo IV Contrast Right - Report Radiology 73202 $210.00 629826 CT Elbow w/IV Contrast Bilat Radiology 73201 $298.80 629827 CT Elbow w/IV Contrast Bilat - Report Radiology 73201 $200.40 629828 CT Elbow w/IV Contrast Left Radiology 73201 $199.20 629829 CT Elbow w/IV Contrast Left - Report Radiology 73201 $200.40 629830 CT Elbow wo/IV Contrast Bilat Radiology 73200 $257.40 629831 CT Elbow wo/IV Contrast Bilat - Report Radiology 73200 $172.80 629832 CT Elbow w/IV Contrast Right Radiology 73201 $199.20 629833 CT Elbow w/IV Contrast Right - Report Radiology 73201 $200.40 629834 CT Elbow wo/IV Contrast Left Radiology 73200 $171.60 629835 CT Elbow wo/IV Contrast Left - Report Radiology 73200 $172.80 629836 CT Elbow wo/IV Contrast Right Radiology 73200 $171.60 629837 CT Elbow wo/IV Contrast Right - Report Radiology 73200 $172.80 1167988 CT Elbow w/wo IV Contrast Bilat Radiology 73202 $1,318.00 1167990 CT Elbow w/wo IV Contrast Left Radiology 73202 $1,318.00 1167992 CT Elbow w/wo IV Contrast Right Radiology 73202 $1,318.00 1167994 CT Elbow w/IV Contrast Bilat Radiology 73201 $1,130.00 1167996 CT Elbow w/IV Contrast Left Radiology 73201 $1,130.00 1167998 CT Elbow w/IV Contrast Right Radiology 73201 $1,130.00 1168000 CT Elbow wo/IV Contrast Bilat Radiology 73200 $1,004.00 1168002 CT Elbow wo/IV Contrast Left Radiology 73200 $1,004.00 1168004 CT Elbow wo/IV Contrast Right Radiology 73200 $1,004.00 629838 CT Femur w/wo IV Contrast Bilat Radiology 73702 $311.40 629839 CT Femur w/wo IV Contrast Bilat - Report Radiology 73702 $210.00 629840 CT Femur w/wo IV Contrast Left Radiology 73702 $207.60 629841 CT Femur w/wo IV Contrast Left - Report Radiology 73702 $210.00 629842 CT Femur w/wo IV Contrast Right Radiology 73702 $207.60 629843 CT Femur w/wo IV Contrast Right - Report Radiology 73702 $210.00 629844 CT Femur w/IV Contrast Bilat Radiology 73701 $298.80 629845 CT Femur w/IV Contrast Bilat - Report Radiology 73701 $199.20 629846 CT Femur w/IV Contrast Left Radiology 73701 $199.20 629847 CT Femur w/IV Contrast Left - Report Radiology 73701 $199.20 629848 CT Femur w/IV Contrast Right Radiology 73701 $199.20 629849 CT Femur w/IV Contrast Right - Report Radiology 73701 $199.20 629850 CT Femur wo/IV Contrast Bilat Radiology 73700 $257.40 629851 CT Femur wo/IV Contrast Bilat - Report Radiology 73700 $172.80 629852 CT Femur wo/IV Contrast Left Radiology 73700 $171.60 629853 CT Femur wo/IV Contrast Left - Report Radiology 73700 $172.80 629854 CT Femur wo/IV Contrast Right Radiology 73700 $171.60 629855 CT Femur wo/IV Contrast Right - Report Radiology 73700 $172.80 1168006 CT Femur w/wo IV Contrast Bilat Radiology 73702 $1,003.00 1168008 CT Femur w/wo IV Contrast Left Radiology 73702 $1,003.00 1168010 CT Femur w/wo IV Contrast Right Radiology 73702 $1,003.00 1168012 CT Femur w/IV Contrast Bilat Radiology 73701 $856.62 1168014 CT Femur w/IV Contrast Left Radiology 73701 $856.62 1168016 CT Femur w/IV Contrast Right Radiology 73701 $856.62 1168018 CT Femur wo/IV Contrast Bilat Radiology 73700 $718.00 1168020 CT Femur wo/IV Contrast Left Radiology 73700 $718.00 1168022 CT Femur wo/IV Contrast Right Radiology 73700 $718.00 629856 CT Fistula or Sinus Tract Abscess Study Radiology 77012 $195.60 1168024 CT Fistula or Sinus Tract Abscess Study Radiology 77012 $374.00 629860 CT Foot w/wo IV Contrast Bilat Radiology 73702 $311.40 629861 CT Foot w/wo IV Contrast Bilat - Report Radiology 73702 $210.00 629862 CT Foot w/wo IV Contrast Left Radiology 73702 $207.60 629863 CT Foot w/wo IV Contrast Left - Report Radiology 73702 $210.00 629864 CT Foot w/wo IV Contrast Right Radiology 73702 $207.60 629865 CT Foot w/wo IV Contrast Right - Report Radiology 73702 $210.00 629868 CT Foot w/IV Contrast Bilat Radiology 73701 $298.80 629869 CT Foot w/IV Contrast Bilat - Report Radiology 73701 $199.20 629870 CT Foot w/IV Contrast Left Radiology 73701 $199.20 629871 CT Foot w/IV Contrast Left - Report Radiology 73701 $199.20 629872 CT Foot w/IV Contrast Right Radiology 73701 $199.20 629873 CT Foot w/IV Contrast Right - Report Radiology 73701 $199.20 629874 CT Foot wo/IV Contrast Bilat Radiology 73700 $257.40 629875 CT Foot wo/IV Contrast Bilat - Report Radiology 73700 $172.80 629878 CT Foot wo/IV Contrast Left Radiology 73700 $171.60 629879 CT Foot wo/IV Contrast Left - Report Radiology 73700 $172.80 629880 CT Foot wo/IV Contrast Right Radiology 73700 $171.60 629881 CT Foot wo/IV Contrast Right - Report Radiology 73700 $172.80 1168026 CT Foot w/wo IV Contrast Bilat Radiology 73702 $1,003.00 1168028 CT Foot w/wo IV Contrast Left Radiology 73702 $1,003.00 1168030 CT Foot w/wo IV Contrast Right Radiology 73702 $1,003.00 1168032 CT Foot w/IV Contrast Bilat Radiology 73701 $856.62 1168034 CT Foot w/IV Contrast Left Radiology 73701 $856.62 1168036 CT Foot w/IV Contrast Right Radiology 73701 $856.62 1168038 CT Foot wo/IV Contrast Bilat Radiology 73700 $718.00 1168040 CT Foot wo/IV Contrast Left Radiology 73700 $718.00 1168042 CT Foot wo/IV Contrast Right Radiology 73700 $718.00 629884 CT Forearm w/wo IV Contrast Bilat Radiology 73202 $313.20 629885 CT Forearm w/wo IV Contrast Bilat - Report Radiology 73202 $210.00 629886 CT Forearm w/wo IV Contrast Left Radiology 73202 $208.80 629887 CT Forearm w/wo IV Contrast Left - Report Radiology 73202 $210.00 629888 CT Forearm w/wo IV Contrast Right Radiology 73202 $208.80 629889 CT Forearm w/wo IV Contrast Right - Report Radiology 73202 $210.00 629892 CT Forearm w/IV Contrast Bilat Radiology 73201 $298.80 629893 CT Forearm w/IV Contrast Bilat - Report Radiology 73201 $200.40 629894 CT Forearm w/IV Contrast Left Radiology 73201 $199.20 629895 CT Forearm w/IV Contrast Left - Report Radiology 73201 $200.40 629898 CT Forearm w/IV Contrast Right Radiology 73201 $199.20 629900 CT Forearm w/IV Contrast Right - Report Radiology 73201 $200.40 629902 CT Forearm wo/IV Contrast Bilat Radiology 73200 $257.40 629903 CT Forearm wo/IV Contrast Bilat - Report Radiology 73200 $172.80 629904 CT Forearm wo/IV Contrast Left Radiology 73200 $171.60 629905 CT Forearm wo/IV Contrast Left - Report Radiology 73200 $172.80 629906 CT Forearm wo/IV Contrast Right Radiology 73200 $171.60 629907 CT Forearm wo/IV Contrast Right - Report Radiology 73200 $172.80 1168044 CT Forearm w/wo IV Contrast Bilat Radiology 73202 $1,318.00 1168046 CT Forearm w/wo IV Contrast Left Radiology 73202 $1,318.00 1168048 CT Forearm w/wo IV Contrast Right Radiology 73202 $1,318.00 1168050 CT Forearm w/IV Contrast Bilat Radiology 73201 $1,130.00 1168052 CT Forearm w/IV Contrast Left Radiology 73201 $1,130.00 1168054 CT Forearm w/IV Contrast Right Radiology 73201 $1,130.00 1168056 CT Forearm wo/IV Contrast Bilat Radiology 73200 $1,004.00 1168058 CT Forearm wo/IV Contrast Left Radiology 73200 $1,004.00 1168060 CT Forearm wo/IV Contrast Right Radiology 73200 $1,004.00 3144822 CT Guidance for Needle Placement Radiology 77012 $195.60 3144850 CT Guidance for Needle Placement Radiology 77012 $374.00 3144852 CT Guidance for Needle Placement - Report Radiology 77012 $195.60 629926 CT Hand w/wo IV Contrast Bilat Radiology 73202 $313.20 629927 CT Hand w/wo IV Contrast Bilat - Report Radiology 73202 $210.00 629930 CT Hand w/wo IV Contrast Left Radiology 73202 $208.80 629931 CT Hand w/wo IV Contrast Left - Report Radiology 73202 $210.00 629934 CT Hand w/IV Contrast Bilat Radiology 73201 $298.80 629935 CT Hand w/IV Contrast Bilat - Report Radiology 73201 $200.40 629938 CT Hand w/wo IV Contrast Right Radiology 73202 $208.80 629939 CT Hand w/wo IV Contrast Right - Report Radiology 73202 $210.00 629940 CT Hand w/IV Contrast Left Radiology 73201 $199.20 629941 CT Hand w/IV Contrast Left - Report Radiology 73201 $200.40 629944 CT Hand w/IV Contrast Right Radiology 73201 $199.20 629945 CT Hand w/IV Contrast Right - Report Radiology 73201 $200.40 629948 CT Hand wo/IV Contrast Bilat Radiology 73200 $257.40 629949 CT Hand wo/IV Contrast Bilat - Report Radiology 73200 $172.80 629950 CT Hand wo/IV Contrast Left Radiology 73200 $171.60 629951 CT Hand wo/IV Contrast Left - Report Radiology 73200 $172.80 629954 CT Hand wo/IV Contrast Right Radiology 73200 $171.60 629955 CT Hand wo/IV Contrast Right - Report Radiology 73200 $172.80 1168072 CT Hand w/wo IV Contrast Bilat Radiology 73202 $1,318.00 1168074 CT Hand w/wo IV Contrast Left Radiology 73202 $1,318.00 1168076 CT Hand w/wo IV Contrast Right Radiology 73202 $1,318.00 1168078 CT Hand w/IV Contrast Bilat Radiology 73201 $1,130.00 1168080 CT Hand w/IV Contrast Left Radiology 73201 $1,130.00 1168082 CT Hand w/IV Contrast Right Radiology 73201 $1,130.00 1168084 CT Hand wo/IV Contrast Bilat Radiology 73200 $1,004.00 1168086 CT Hand wo/IV Contrast Left Radiology 73200 $1,004.00 1168088 CT Hand wo/IV Contrast Right Radiology 73200 $1,004.00 629958 CT Head/Brain w/wo IV Contrast Radiology 70470 $217.20 629959 CT Head/Brain w/wo IV Contrast - Report Radiology 70450 $145.20 629962 CT Head/Brain w/IV Contrast Radiology 70460 $194.40 629963 CT Head/Brain w/IV Contrast - Report Radiology 70460 $193.20 629966 CT Head/Brain wo/IV Contrast Radiology 70450 $145.20 629967 CT Head/Brain wo/IV Contrast - Report Radiology 70470 $218.40 1168090 CT Head/Brain w/wo IV Contrast Radiology 70470 $675.05 1168092 CT Head/Brain w/IV Contrast Radiology 70460 $675.05 1168094 CT Head/Brain wo/IV Contrast Radiology 70450 $320.60 629968 CT Hip w/wo IV Contrast Bilat Radiology 73702 $311.40 629969 CT Hip w/wo IV Contrast Bilat - Report Radiology 73702 $210.00 629972 CT Hip w/wo IV Contrast Left Radiology 73702 $207.60 629973 CT Hip w/wo IV Contrast Left - Report Radiology 73702 $210.00 629978 CT Hip w/IV Contrast Bilat Radiology 73701 $298.80 629979 CT Hip w/IV Contrast Bilat - Report Radiology 73701 $199.20 629980 CT Hip w/wo IV Contrast Right Radiology 73702 $207.60 629981 CT Hip w/wo IV Contrast Right - Report Radiology 73702 $210.00 629984 CT Hip w/IV Contrast Left Radiology 73701 $199.20 629985 CT Hip w/IV Contrast Left - Report Radiology 73701 $199.20 629988 CT Hip w/IV Contrast Right Radiology 73701 $199.20 629989 CT Hip w/IV Contrast Right - Report Radiology 73701 $199.20 629990 CT Hip wo/IV Contrast Bilat Radiology 73700 $257.40 629991 CT Hip wo/IV Contrast Bilat - Report Radiology 73700 $172.80 629992 CT Hip wo/IV Contrast Left Radiology 73700 $171.60 629993 CT Hip wo/IV Contrast Left - Report Radiology 73700 $172.80 629996 CT Hip wo/IV Contrast Right Radiology 73700 $171.60 629998 CT Hip wo/IV Contrast Right - Report Radiology 73700 $172.80 1168102 CT Hip w/wo IV Contrast Bilat Radiology 73702 $1,003.00 1168104 CT Hip w/wo IV Contrast Left Radiology 73702 $1,003.00 1168106 CT Hip w/wo IV Contrast Right Radiology 73702 $1,003.00 1168108 CT Hip w/IV Contrast Bilat Radiology 73701 $856.62 1168110 CT Hip w/IV Contrast Left Radiology 73701 $856.62 1168112 CT Hip w/IV Contrast Right Radiology 73701 $856.62 1168114 CT Hip wo/IV Contrast Bilat Radiology 73700 $718.00 1168116 CT Hip wo/IV Contrast Left Radiology 73700 $718.00 1168118 CT Hip wo/IV Contrast Right Radiology 73700 $718.00 630000 CT Humerus w/wo IV Contrast Bilat Radiology 73202 $313.20 630001 CT Humerus w/wo IV Contrast Bilat - Report Radiology 73202 $210.00 630004 CT Humerus w/wo IV Contrast Left Radiology 73202 $208.80 630005 CT Humerus w/wo IV Contrast Left - Report Radiology 73202 $210.00 630008 CT Humerus w/wo IV Contrast Right Radiology 73202 $208.80 630009 CT Humerus w/wo IV Contrast Right - Report Radiology 73202 $210.00 630010 CT Humerus w/IV Contrast Bilat Radiology 73201 $298.80 630011 CT Humerus w/IV Contrast Bilat - Report Radiology 73201 $200.40 630014 CT Humerus w/IV Contrast Left Radiology 73201 $199.20 630015 CT Humerus w/IV Contrast Left - Report Radiology 73201 $200.40 630016 CT Humerus w/IV Contrast Right Radiology 73201 $199.20 630018 CT Humerus w/IV Contrast Right - Report Radiology 73201 $200.40 630020 CT Humerus wo/IV Contrast Bilat Radiology 73200 $257.40 630021 CT Humerus wo/IV Contrast Bilat - Report Radiology 73200 $172.80 630024 CT Humerus wo/IV Contrast Right Radiology 73200 $171.60 630025 CT Humerus wo/IV Contrast Right - Report Radiology 73200 $172.80 635588 CT Humerus wo/IV Contrast Left Radiology 73200 $171.60 635589 CT Humerus wo/IV Contrast Left - Report Radiology 73200 $172.80 1168120 CT Humerus w/wo IV Contrast Bilat Radiology 73202 $1,318.00 1168122 CT Humerus w/wo IV Contrast Left Radiology 73202 $1,318.00 1168124 CT Humerus w/wo IV Contrast Right Radiology 73202 $1,318.00 1168126 CT Humerus w/IV Contrast Bilat Radiology 73201 $1,130.00 1168128 CT Humerus w/IV Contrast Left Radiology 73201 $1,130.00 1168130 CT Humerus w/IV Contrast Right Radiology 73201 $1,130.00 1168132 CT Humerus wo/IV Contrast Bilat Radiology 73200 $1,004.00 1168134 CT Humerus wo/IV Contrast Left Radiology 73200 $1,004.00 1168136 CT Humerus wo/IV Contrast Right Radiology 73200 $1,004.00 661605 CT IAC w/o IV Contrast Radiology 70480 $218.40 661607 CT IAC w/ IV Contrast Radiology 70481 $236.40 661609 CT IAC w/ + w/o IV Contrast Radiology 70482 $247.20 3148756 CT Injection Epidura of Bl or Clot Patch Radiology 62273 $391.20 3150631 CT Injection Epidura of Bl or Clot Patch - Report Radiology 62273 $596.00 630026 CT Knee w/wo IV Contrast Bilat Radiology 73702 $311.40 630027 CT Knee w/wo IV Contrast Bilat - Report Radiology 73702 $210.00 630030 CT Knee w/wo IV Contrast Left Radiology 73702 $207.60 630031 CT Knee w/wo IV Contrast Left - Report Radiology 73702 $210.00 630034 CT Knee w/wo IV Contrast Right Radiology 73702 $207.60 630035 CT Knee w/wo IV Contrast Right - Report Radiology 73702 $210.00 630036 CT Knee w/IV Contrast Bilat Radiology 73701 $298.80 630037 CT Knee w/IV Contrast Bilat - Report Radiology 73701 $199.20 630038 CT Knee w/IV Contrast Left Radiology 73701 $199.20 630039 CT Knee w/IV Contrast Left - Report Radiology 73701 $199.20 630040 CT Knee w/IV Contrast Right Radiology 73701 $199.20 630041 CT Knee w/IV Contrast Right - Report Radiology 73701 $199.20 630042 CT Knee wo/IV Contrast Bilat Radiology 73700 $257.40 630043 CT Knee wo/IV Contrast Bilat - Report Radiology 73700 $172.80 630044 CT Knee wo/IV Contrast Left Radiology 73700 $171.60 630045 CT Knee wo/IV Contrast Left - Report Radiology 73700 $172.80 630046 CT Knee wo/IV Contrast Right Radiology 73700 $171.60 630047 CT Knee wo/IV Contrast Right - Report Radiology 73700 $172.80 1168144 CT Knee w/wo IV Contrast Bilat Radiology 73702 $1,003.00 1168146 CT Knee w/wo IV Contrast Left Radiology 73702 $1,003.00 1168148 CT Knee w/wo IV Contrast Right Radiology 73702 $1,003.00 1168150 CT Knee w/IV Contrast Bilat Radiology 73701 $856.62 1168152 CT Knee w/IV Contrast Left Radiology 73701 $856.62 1168154 CT Knee w/IV Contrast Right Radiology 73701 $856.62 1168156 CT Knee wo/IV Contrast Bilat Radiology 73700 $718.00 1168158 CT Knee wo/IV Contrast Left Radiology 73700 $718.00 1168160 CT Knee wo/IV Contrast Right Radiology 73700 $718.00 630049 CT L-Spine w/wo IV Contrast Radiology 72133 $217.20 630051 CT L-Spine w/wo IV Contrast - Report Radiology 72131 $171.60 630052 CT L-Spine w/IV Contrast Radiology 72132 $208.80 630053 CT L-Spine w/IV Contrast - Report Radiology 72132 $208.80 630056 CT L-Spine wo/IV Contrast Radiology 72131 $171.60 630057 CT L-Spine wo/IV Contrast - Report Radiology 72133 $217.20 1168242 CT L-Spine w/wo IV Contrast Radiology 72133 $675.05 1168244 CT L-Spine w/IV Contrast Radiology 72132 $991.00 1168246 CT L-Spine wo/IV Contrast Radiology 72131 $320.60 3144823 CT Limited or Localized Follow-Up Study Radiology 76380 $166.80 3144853 CT Limited or Localized Follow-Up Study Radiology 76380 $173.28 3144855 CT Limited or Localized Follow-Up Study - Report Radiology 76380 $168.00 630060 CT Lower Ext w/wo IV Contrast Bilat Radiology 73702 $311.40 630061 CT Lower Ext w/wo IV Contrast Bilat - Report Radiology 73701 $199.20 630062 CT Lower Ext w/wo IV Contrast Left Radiology 73702 $207.60 630063 CT Lower Ext w/wo IV Contrast Left - Report Radiology 73701 $199.20 630064 CT Lower Ext w/wo IV Contrast Right Radiology 73702 $207.60 630065 CT Lower Ext w/wo IV Contrast Right - Report Radiology 73701 $199.20 630066 CT Lower Ext w/IV Contrast Bilat Radiology 73701 $298.80 630067 CT Lower Ext w/IV Contrast Bilat - Report Radiology 73702 $210.00 630068 CT Lower Ext w/IV Contrast Left Radiology 73701 $199.20 630069 CT Lower Ext w/IV Contrast Left - Report Radiology 73702 $210.00 630070 CT Lower Ext w/IV Contrast Right Radiology 73701 $199.20 630071 CT Lower Ext w/IV Contrast Right - Report Radiology 73702 $210.00 630072 CT Lower Ext wo/IV Contrast Bilat Radiology 73700 $257.40 630073 CT Lower Ext wo/IV Contrast Bilat - Report Radiology 73700 $172.80 630074 CT Lower Ext wo/IV Contrast Left Radiology 73700 $171.60 630075 CT Lower Ext wo/IV Contrast Left - Report Radiology 73700 $172.80 630077 CT Lower Ext wo/IV Contrast Right Radiology 73700 $171.60 630079 CT Lower Ext wo/IV Contrast Right - Report Radiology 73700 $172.80 1168164 CT Lower Ext w/IV Contrast Bilat Radiology 73701 $856.62 1168166 CT Lower Ext w/IV Contrast Left Radiology 73701 $856.62 1168168 CT Lower Ext w/IV Contrast Right Radiology 73701 $856.62 1168170 CT Lower Ext w/wo IV Contrast Bilat Radiology 73702 $1,003.00 1168172 CT Lower Ext w/wo IV Contrast Left Radiology 73702 $1,003.00 1168174 CT Lower Ext w/wo IV Contrast Right Radiology 73701 $856.62 1168176 CT Lower Ext wo/IV Contrast Bilat Radiology 73700 $718.00 1168178 CT Lower Ext wo/IV Contrast Left Radiology 73700 $718.00 1168180 CT Lower Ext wo/IV Contrast Right Radiology 73700 $718.00 630086 CT Maxillofacial w/wo IV Contrast Radiology 70488 $217.20 630087 CT Maxillofacial w/wo IV Contrast - Report Radiology 70486 $196.80 630090 CT Maxillofacial w/IV Contrast Radiology 70487 $192.00 630091 CT Maxillofacial w/IV Contrast - Report Radiology 70487 $223.20 630094 CT Maxillofacial wo/IV Contrast Radiology 70486 $146.40 630095 CT Maxillofacial wo/IV Contrast - Report Radiology 70488 $243.60 1168182 CT Maxillofacial w/wo IV Contrast Radiology 70488 $675.05 1168184 CT Maxillofacial w/IV Contrast Radiology 70487 $675.05 1168186 CT Maxillofacial wo/IV Contrast Radiology 70486 $320.60 630098 CT Orb/Post Fossa, Ear w/wo IV Contrast Radiology 70482 $247.20 630099 CT Orb/Post Fossa, Ear w/wo IV Contrast - Report Radiology 70482 $207.00 630104 CT Orb/Post Fossa, Ear wo/IV Contrast Radiology 70480 $218.40 630106 CT Orb/Post Fossa, Ear wo/IV Contrast - Report Radiology 70480 $179.00 1168188 CT Orb/Post Fossa, Ear w/wo IV Contrast Radiology 70482 $1,257.00 1168192 CT Orb/Post Fossa, Ear wo/IV Contrast Radiology 70480 $952.00 630102 CT Ort/Post Fossa, Ear w/IV Contrast Radiology 70481 $236.40 630103 CT Ort/Post Fossa, Ear w/IV Contrast - Report Radiology 70481 $237.60 1168190 CT Ort/Post Fossa, Ear w/IV Contrast Radiology 70481 $1,049.00 630108 CT Pelvis w/wo IV Contrast Radiology 72194 $208.80 630109 CT Pelvis w/wo IV Contrast - Report Radiology 72194 $174.00 630112 CT Pelvis w/IV Contrast Radiology 72193 $199.20 630113 CT Pelvis w/IV Contrast - Report Radiology 72193 $199.20 630114 CT Pelvis wo/IV Contrast Radiology 72192 $186.00 630115 CT Pelvis wo/IV Contrast - Report Radiology 72192 $156.00 1168194 CT Pelvis w/wo IV Contrast Radiology 72194 $675.05 1168196 CT Pelvis w/IV Contrast Radiology 72193 $675.05 1168198 CT Pelvis wo/IV Contrast Radiology 72192 $320.60 630128 CT Shoulder w/wo IV Contrast Bilat Radiology 73202 $131.20 630129 CT Shoulder w/wo IV Contrast Bilat - Report Radiology 73202 $210.00 630132 CT Shoulder w/wo IV Contrast Left Radiology 73202 $208.80 630133 CT Shoulder w/wo IV Contrast Left - Report Radiology 73202 $210.00 630134 CT Shoulder w/wo IV Contrast Right Radiology 73202 $208.80 630135 CT Shoulder w/wo IV Contrast Right - Report Radiology 73202 $210.00 630136 CT Shoulder w/IV Contrast Bilat Radiology 73201 $298.80 630137 CT Shoulder w/IV Contrast Bilat - Report Radiology 73201 $200.40 630138 CT Shoulder w/IV Contrast Left Radiology 73201 $199.20 630139 CT Shoulder w/IV Contrast Left - Report Radiology 73201 $200.40 630140 CT Shoulder w/IV Contrast Right Radiology 73201 $199.20 630141 CT Shoulder w/IV Contrast Right - Report Radiology 73201 $200.40 630144 CT Shoulder wo/IV Contrast Bilat Radiology 73200 $257.40 630145 CT Shoulder wo/IV Contrast Bilat - Report Radiology 73200 $172.80 630148 CT Shoulder wo/IV Contrast Left Radiology 73200 $171.60 630149 CT Shoulder wo/IV Contrast Left - Report Radiology 73200 $172.80 630152 CT Shoulder wo/IV Contrast Right Radiology 73200 $171.60 630153 CT Shoulder wo/IV Contrast Right - Report Radiology 73200 $172.80 1168206 CT Shoulder w/wo IV Contrast Bilat Radiology 73202 $1,013.78 1168208 CT Shoulder w/wo IV Contrast Left Radiology 73202 $675.50 1168210 CT Shoulder w/wo IV Contrast Right Radiology 73202 $675.05 1168212 CT Shoulder w/IV Contrast Bilat Radiology 73201 $1,486.50 1168214 CT Shoulder w/IV Contrast Left Radiology 73201 $991.00 1168216 CT Shoulder w/IV Contrast Right Radiology 73201 $991.00 1168218 CT Shoulder wo/IV Contrast Bilat Radiology 73200 $480.90 1168220 CT Shoulder wo/IV Contrast Left Radiology 73200 $320.60 1168222 CT Shoulder wo/IV Contrast Right Radiology 73200 $320.60 661599 CT Sinuses w/wo IV Contrast Radiology 70488 $217.20 661600 CT Sinuses w/wo IV Contrast - Report Radiology 70488 $243.60 661601 CT Sinuses w/IV Contrast Radiology 70487 $192.00 661602 CT Sinuses w/IV Contrast - Report Radiology 70487 $223.20 661603 CT Sinuses wo/IV Contrast Radiology 70486 $146.40 661604 CT Sinuses wo/IV Contrast - Report Radiology 70486 $196.80 1168224 CT Sinuses w/wo IV Contrast Radiology 70488 $675.05 1168226 CT Sinuses w/IV Contrast Radiology 70487 $675.05 1168228 CT Sinuses wo/IV Contrast Radiology 70486 $320.60 630154 CT Soft Tissue Neck w/wo IV Contrast Radiology 70492 $277.20 630155 CT Soft Tissue Neck w/wo IV Contrast - Report Radiology 70490 $219.60 630158 CT Soft Tissue Neck w/IV Contrast Radiology 70491 $236.40 630159 CT Soft Tissue Neck w/IV Contrast - Report Radiology 70491 $237.60 630160 CT Soft Tissue Neck wo/IV Contrast Radiology 70490 $219.60 630161 CT Soft Tissue Neck wo/IV Contrast - Report Radiology 70492 $248.40 1168230 CT Soft Tissue Neck w/wo IV Contrast Radiology 70490 $320.60 1168232 CT Soft Tissue Neck w/IV Contrast Radiology 70491 $675.05 1168234 CT Soft Tissue Neck wo/IV Contrast Radiology 70492 $675.05 630164 CT T-Spine w/wo IV Contrast Radiology 72130 $217.20 630166 CT T-Spine w/wo IV Contrast - Report Radiology 72128 $170.40 630168 CT T-Spine w/IV Contrast Radiology 72129 $208.80 630169 CT T-Spine w/IV Contrast - Report Radiology 72129 $210.00 630172 CT T-Spine wo/IV Contrast Radiology 72128 $171.60 630173 CT T-Spine wo/IV Contrast - Report Radiology 72130 $217.20 1168248 CT T-Spine w/wo IV Contrast Radiology 72130 $675.05 1168250 CT T-Spine w/IV Contrast Radiology 72129 $675.05 1168252 CT T-Spine wo/IV Contrast Radiology 72128 $320.60 711752 CT TMJ w/wo IV Contrast Right Radiology 70482 $247.20 711753 CT TMJ w/IV Contrast Bilat Radiology 70481 $354.60 711754 CT TMJ w/IV Contrast Left Radiology 70481 $236.40 711755 CT TMJ w/wo IV Contrast Bilat Radiology 70482 $370.80 711756 CT TMJ w/wo IV Contrast Left Radiology 70482 $247.20 711757 CT TMJ w/IV Contrast Right Radiology 70481 $236.40 711758 CT TMJ wo/IV Contrast Bilat Radiology 70480 $327.60 711759 CT TMJ wo/IV Contrast Left Radiology 70480 $218.40 711760 CT TMJ wo/IV Contrast Right Radiology 70480 $218.40 1168256 CT TMJ w/wo IV Contrast Bilat Radiology 70482 $1,012.58 1168258 CT TMJ w/wo IV Contrast Bilat - Report Radiology 70482 $248.40 1168259 CT TMJ w/wo IV Contrast Left Radiology 70482 $675.05 1168261 CT TMJ w/wo IV Contrast Left - Report Radiology 70482 $248.40 1168262 CT TMJ w/wo IV Contrast Right Radiology 70482 $675.05 1168264 CT TMJ w/wo IV Contrast Right - Report Radiology 70482 $248.40 1168265 CT TMJ w/IV Contrast Bilat Radiology 70481 $1,049.00 1168267 CT TMJ w/IV Contrast Bilat - Report Radiology 70481 $237.60 1168268 CT TMJ w/IV Contrast Left Radiology 70481 $675.50 1168270 CT TMJ w/IV Contrast Left - Report Radiology 70481 $237.60 1168271 CT TMJ w/IV Contrast Right Radiology 70481 $675.05 1168273 CT TMJ w/IV Contrast Right - Report Radiology 70481 $237.60 1168274 CT TMJ wo/IV Contrast Bilat Radiology 70480 $480.90 1168276 CT TMJ wo/IV Contrast Bilat - Report Radiology 70480 $220.80 1168277 CT TMJ wo/IV Contrast Left Radiology 70480 $320.60 1168279 CT TMJ wo/IV Contrast Left - Report Radiology 70480 $220.80 1168280 CT TMJ wo/IV Contrast Right Radiology 70480 $320.60 1168282 CT TMJ wo/IV Contrast Right - Report Radiology 70480 $220.80 629698 CT Thorax w/wo IV Contrast Radiology 71270 $236.40 629699 CT Thorax w/wo IV Contrast - Report Radiology 71250 $170.40 629702 CT Thorax w/IV Contrast Radiology 71260 $212.40 629703 CT Thorax w/IV Contrast - Report Radiology 71260 $213.60 629704 CT Thorax wo/IV Contrast Radiology 71250 $199.20 629705 CT Thorax wo/IV Contrast - Report Radiology 71270 $235.20 1168283 CT Thorax w/wo IV Contrast Radiology 71270 $991.00 1168285 CT Thorax w/IV Contrast Radiology 71260 $675.05 1168287 CT Thorax wo/IV Contrast Radiology 71250 $320.60 630182 CT Tibia/Fibula w/wo IV Contrast Bilat Radiology 73702 $311.40 630183 CT Tibia/Fibula w/wo IV Contrast Bilat - Report Radiology 73702 $210.00 630184 CT Tibia/Fibula w/wo IV Contrast Left Radiology 73702 $207.60 630185 CT Tibia/Fibula w/wo IV Contrast Left - Report Radiology 73702 $210.00 630188 CT Tibia/Fibula w/wo IV Contrast Right Radiology 73702 $207.60 630189 CT Tibia/Fibula w/wo IV Contrast Right - Report Radiology 73702 $210.00 630190 CT Tibia/Fibula w/IV Contrast Bilat Radiology 73701 $298.80 630191 CT Tibia/Fibula w/IV Contrast Bilat - Report Radiology 73701 $199.20 630194 CT Tibia/Fibula w/IV Contrast Left Radiology 73701 $199.20 630195 CT Tibia/Fibula w/IV Contrast Left - Report Radiology 73701 $199.20 630198 CT Tibia/Fibula w/IV Contrast Right Radiology 73701 $199.20 630199 CT Tibia/Fibula w/IV Contrast Right - Report Radiology 73701 $199.20 630201 CT Tibia/Fibula wo/IV Contrast Bilat Radiology 73700 $257.40 630202 CT Tibia/Fibula wo/IV Contrast Bilat - Report Radiology 73700 $172.80 630203 CT Tibia/Fibula wo/IV Contrast Left Radiology 73700 $171.60 630204 CT Tibia/Fibula wo/IV Contrast Left - Report Radiology 73700 $172.80 630205 CT Tibia/Fibula wo/IV Contrast Right Radiology 73700 $171.60 630206 CT Tibia/Fibula wo/IV Contrast Right - Report Radiology 73700 $172.80 1168289 CT Tibia/Fibula w/wo IV Contrast Bilat Radiology 73702 $1,003.00 1168291 CT Tibia/Fibula w/wo IV Contrast Left Radiology 73702 $1,003.00 1168293 CT Tibia/Fibula w/wo IV Contrast Right Radiology 73702 $1,003.00 1168295 CT Tibia/Fibula w/IV Contrast Bilat Radiology 73701 $856.62 1168297 CT Tibia/Fibula w/IV Contrast Left Radiology 73701 $856.62 1168299 CT Tibia/Fibula w/IV Contrast Right Radiology 73701 $856.62 1168301 CT Tibia/Fibula wo/IV Contrast Bilat Radiology 73700 $718.00 1168303 CT Tibia/Fibula wo/IV Contrast Left Radiology 73700 $718.00 1168305 CT Tibia/Fibula wo/IV Contrast Right Radiology 73700 $718.00 630209 CT Upper Ext w/wo IV Contrast Bilat Radiology 73202 $313.20 630210 CT Upper Ext w/wo IV Contrast Bilat - Report Radiology 73201 $200.40 630211 CT Upper Ext w/wo IV Contrast Left Radiology 73202 $208.80 630212 CT Upper Ext w/wo IV Contrast Left - Report Radiology 73201 $200.40 630213 CT Upper Ext w/wo IV Contrast Right Radiology 73202 $208.80 630214 CT Upper Ext w/wo IV Contrast Right - Report Radiology 73201 $200.40 630219 CT Upper Ext w/IV Contrast Bilat Radiology 73201 $298.80 630220 CT Upper Ext w/IV Contrast Bilat - Report Radiology 73202 $210.00 630221 CT Upper Ext w/IV Contrast Left Radiology 73201 $199.20 630223 CT Upper Ext w/IV Contrast Left - Report Radiology 73202 $210.00 630235 CT Upper Ext w/IV Contrast Right Radiology 73201 $199.20 630236 CT Upper Ext w/IV Contrast Right - Report Radiology 73202 $210.00 630239 CT Upper Ext wo/IV Contrast Bilat Radiology 73200 $257.40 630240 CT Upper Ext wo/IV Contrast Bilat - Report Radiology 73200 $172.80 630241 CT Upper Ext wo/IV Contrast Left Radiology 73200 $171.60 630242 CT Upper Ext wo/IV Contrast Left - Report Radiology 73200 $172.80 630243 CT Upper Ext wo/IV Contrast Right Radiology 73200 $171.60 630244 CT Upper Ext wo/IV Contrast Right - Report Radiology 73200 $172.80 1168309 CT Upper Ext w/IV Contrast Bilat Radiology 73202 $1,318.00 1168311 CT Upper Ext w/IV Contrast Left Radiology 73202 $1,318.00 1168313 CT Upper Ext w/IV Contrast Right Radiology 73202 $1,318.00 1168315 CT Upper Ext w/wo IV Contrast Bilat Radiology 73201 $1,130.00 1168317 CT Upper Ext w/wo IV Contrast Left Radiology 73201 $1,130.00 1168319 CT Upper Ext w/wo IV Contrast Right Radiology 73201 $1,130.00 1168321 CT Upper Ext wo/IV Contrast Bilat Radiology 73200 $1,004.00 1168323 CT Upper Ext wo/IV Contrast Left Radiology 73200 $1,004.00 1168325 CT Upper Ext wo/IV Contrast Right Radiology 73200 $1,004.00 630247 CT Wrist w/wo IV Contrast Bilat Radiology 73202 $313.20 630248 CT Wrist w/wo IV Contrast Bilat - Report Radiology 73202 $210.00 630249 CT Wrist w/wo IV Contrast Left Radiology 73202 $208.80 630250 CT Wrist w/wo IV Contrast Left - Report Radiology 73202 $210.00 630251 CT Wrist w/wo IV Contrast Right Radiology 73202 $208.80 630252 CT Wrist w/wo IV Contrast Right - Report Radiology 73202 $210.00 630253 CT Wrist w/IV Contrast Bilat Radiology 73201 $298.80 630254 CT Wrist w/IV Contrast Bilat - Report Radiology 73201 $200.40 630255 CT Wrist w/IV Contrast Left Radiology 73201 $199.20 630256 CT Wrist w/IV Contrast Left - Report Radiology 73201 $200.40 630257 CT Wrist w/IV Contrast Right Radiology 73201 $199.20 630258 CT Wrist w/IV Contrast Right - Report Radiology 73201 $200.40 630259 CT Wrist wo/IV Contrast Bilat Radiology 73200 $257.40 630260 CT Wrist wo/IV Contrast Bilat - Report Radiology 73200 $172.80 630261 CT Wrist wo/IV Contrast Left Radiology 73200 $171.60 630262 CT Wrist wo/IV Contrast Left - Report Radiology 73200 $172.80 630263 CT Wrist wo/IV Contrast Right Radiology 73200 $171.60 630264 CT Wrist wo/IV Contrast Right - Report Radiology 73200 $172.80 1168327 CT Wrist w/wo IV Contrast Bilat Radiology 73202 $1,318.00 1168329 CT Wrist w/wo IV Contrast Left Radiology 73202 $1,318.00 1168331 CT Wrist w/wo IV Contrast Right Radiology 73202 $1,318.00 1168333 CT Wrist w/IV Contrast Bilat Radiology 73201 $1,130.00 1168335 CT Wrist w/IV Contrast Left Radiology 73201 $1,130.00 1168337 CT Wrist w/IV Contrast Right Radiology 73201 $1,130.00 1168339 CT Wrist wo/IV Contrast Bilat Radiology 73200 $1,004.00 1168341 CT Wrist wo/IV Contrast Left Radiology 73200 $1,004.00 1168343 CT Wrist wo/IV Contrast Right Radiology 73200 $1,004.00 3254904 Cysto-Conray II Sol 250Ml CS12 Radiology Q9958 3134590 Gastrografin 30ml Radiology Q9963 3254906 Gastrografin Sol 30Ml 24 Radiology Q9963 3254908 MD-Gastroview Sol 30Ml 25 Radiology Q9963 675654 MG Mammogram Digital Diagnostic Bilat Radiology 77066 $158.40 675656 MG Mammogram Digital Diagnostic Left Radiology 77065 $134.40 675658 MG Mammogram Digital Diagnostic Right Radiology 77065 $134.40 677598 MG Mammogram Digital Screening Radiology 77067 $127.20 969799 MG Mammogram Digital Diagnostic Bilat Radiology 77066 $265.00 969801 MG Mammogram Digital Diagnostic Left Radiology 77065 $265.00 969803 MG Mammogram Digital Diagnostic Right Radiology 77065 $265.00 969805 MG Mammogram Digital Screening Radiology 77067 $280.00 3254912 Omnipaque 300 Polyb 50Ml 10 Radiology Q9967 $50.00 3254916 Omnipaque 350 Polyb 150Ml 10 Radiology Q9967 $150.00 985772 Speech Language Pathology Video Swallow Radiology 74230 $275.00 1169850 US 2/3 Trimester OB Radiology 76805 $437.70 675777 US 3D Reconstruction Radiology 76376 $33.60 675778 US 3D Reconstruction - Report Radiology 76376 $34.80 1169565 US 3D Reconstruction Radiology 76376 $72.00 3270798 US ABI Radiology 93922 $43.20 3270802 US ABI Radiology 93922 $222.35 625608 US Abdomen Complete Radiology 76700 $138.00 625609 US Abdomen Complete - Report Radiology 76700 $139.20 1169567 US Abdomen Complete Radiology 76700 $437.70 3148940 US Abdomen Limited Radiology 76705 $100.80 3150634 US Abdomen Limited Radiology 76705 $437.70 3150636 US Abdomen Limited - Report Radiology 76705 $100.80 625728 US Aorta Duplex Complete Radiology 93978 $135.60 625729 US Aorta Duplex Complete - Report Radiology 93978 $115.20 625732 US Aorta IVC Iliac Duplex Complete Radiology 76770 $126.00 625733 US Aorta IVC Iliac Duplex Complete - Report Radiology 76770 $127.20 1169573 US Aorta Duplex Complete Radiology 93978 $437.70 1169577 US Aorta IVC Iliac Duplex Complete Radiology 76770 $437.70 3194621 US Aorta Complete Radiology 76770 $126.00 3194622 US Aorta Duplex Limited Radiology 93979 $85.20 3194623 US Aorta IVC Iliac Duplex Limited Radiology 76775 $98.40 3194635 US Aorta Complete Radiology 76770 $437.70 3194637 US Aorta Duplex Limited Radiology 93979 $437.70 3194639 US Aorta IVC Iliac Duplex Limited Radiology 76775 $467.70 625738 US Art/Vein Abd/Pelvis/Scrotal Limited Radiology 93976 $135.60 625739 US Art/Vein Abd/Pelvis/Scrotal Limited - Report Radiology 76870 $110.40 1169583 US Art/Vein Abd/Pelvis/Scrotal Limited Radiology 93976 $118.74 3148757 US Art/Ven Inflow/Outflow Abd/Pel Ltd Radiology 93976 $135.60 3150637 US Art/Ven Inflow/Outflow Abd/Pel Ltd Radiology 93976 $437.70 3150639 US Art/Ven Inflow/Outflow Abd/Pel Ltd - Report Radiology 93976 $208.80 630809 US Arterial Duplex Upper Ext Right Radiology 93931 $84.00 630810 US Arterial Duplex Upper Ext Right - Report Radiology 93931 $54.00 630813 US Arterial Duplex Upper Ext Left Radiology 93931 $84.00 630814 US Arterial Duplex Upper Ext Left - Report Radiology 93931 $54.00 630816 US Arterial Duplex Upper Ext Bilat Radiology 93930 $136.80 630818 US Arterial Duplex Upper Ext Bilat - Report Radiology 93930 $80.40 631045 US Arterial Duplex Lower Ext Right Radiology 93926 $82.80 631047 US Arterial Duplex Lower Ext Right - Report Radiology 93926 $69.60 631049 US Arterial Duplex Lower Ext Left Radiology 93926 $82.80 631050 US Arterial Duplex Lower Ext Left - Report Radiology 93926 $69.60 631051 US Arterial Duplex Lower Ext Bilat Radiology 93925 $135.60 631052 US Arterial Duplex Lower Ext Bilat - Report Radiology 93925 $100.80 627594 US Aspiration/Injection/Biopsy Bilat Radiology 76942 $165.60 627595 US Aspiration/Injection/Biopsy Bilat - Report Radiology 76942 $116.40 627596 US Aspiration/Injection/Biopsy Left Radiology 76942 $110.40 627597 US Aspiration/Injection/Biopsy Left - Report Radiology 76942 $116.40 627598 US Aspiration/Injection/Biopsy Right Radiology 76942 $110.40 627599 US Aspiration/Injection/Biopsy Right - Report Radiology 76942 $116.40 1169585 US Aspiration/Injection/Biopsy Bilat Radiology 76942 $152.00 1169587 US Aspiration/Injection/Biopsy Left Radiology 76942 $152.00 1169589 US Aspiration/Injection/Biopsy Right Radiology 76942 $152.00 625594 US Biopsy Abdomen Radiology 76942 $110.40 625595 US Biopsy Abdomen - Report Radiology 76942 $116.40 627686 US Biopsy Breast Bilat Radiology 76942 $165.60 627687 US Biopsy Breast Bilat - Report Radiology 76942 $116.40 627688 US Biopsy Breast Left Radiology 76942 $110.40 627689 US Biopsy Breast Left - Report Radiology 76942 $116.40 627690 US Biopsy Breast Right Radiology 76942 $110.40 627691 US Biopsy Breast Right - Report Radiology 76942 $116.40 631291 US Biopsy Renal Right Radiology 76942 $110.40 631292 US Biopsy Renal Right - Report Radiology 76942 $116.40 631303 US Biopsy Liver, Guide Needle Placement Radiology 76942 $110.40 631304 US Biopsy Liver, Guide Needle Placement - Report Radiology 76942 $116.40 631306 US Biopsy Renal Left Radiology 76942 $110.40 631308 US Biopsy Renal Left - Report Radiology 76942 $116.40 631311 US Biopsy Renal Bilat Radiology 76942 $165.60 631312 US Biopsy Renal Bilat - Report Radiology 76942 $116.40 631323 US Biopsy Pleura Right Radiology 76942 $110.40 631324 US Biopsy Pleura Right - Report Radiology 76942 $116.40 631327 US Biopsy Pleura Left Radiology 76942 $110.40 631328 US Biopsy Pleura Left - Report Radiology 76942 $116.40 631333 US Biopsy Pleura Bilat Radiology 76942 $165.60 631334 US Biopsy Pleura Bilat - Report Radiology 76942 $116.40 631336 US Biopsy Lung/Meduastium Right Radiology 76942 $110.40 631338 US Biopsy Lung/Meduastium Right - Report Radiology 76942 $116.40 631340 US Biopsy Lung/Mediastium Left Radiology 76942 $110.40 631343 US Biopsy Lung/Mediastium Left - Report Radiology 76942 $116.40 631345 US Biopsy Lung/Mediastinum Bilat Radiology 76942 $165.60 631346 US Biopsy Lung/Mediastinum Bilat - Report Radiology 76942 $116.40 1169591 US Biopsy Abdomen Radiology 76942 $152.00 1169593 US Biopsy Breast Bilat Radiology 76942 $328.00 1169595 US Biopsy Breast Left Radiology 76942 $152.00 1169597 US Biopsy Breast Right Radiology 76942 $152.00 1169599 US Biopsy Liver Radiology 47000 $2,684.64 1169601 US Biopsy Lung/Mediastinum Bilat Radiology 76942 $328.00 1169603 US Biopsy Lung/Mediastium Left Radiology 76942 $152.00 1169605 US Biopsy Lung/Meduastium Right Radiology 76942 $152.00 1169607 US Biopsy Pleura Bilat Radiology 76942 $328.00 1169609 US Biopsy Pleura Left Radiology 76942 $152.00 1169611 US Biopsy Pleura Right Radiology 76942 $152.00 1169613 US Biopsy Renal Bilat Radiology 76942 $328.00 1169615 US Biopsy Renal Left Radiology 76942 $152.00 1169617 US Biopsy Renal Right Radiology 76942 $152.00 627716 US Breast Bilat Radiology 76642 $174.60 627718 US Breast Left Radiology 76642 $116.40 627720 US Breast Right Radiology 76642 $116.40 1169621 US Breast Bilat Radiology 76642 $391.98 1169623 US Breast Left Radiology 76642 $261.32 1169625 US Breast Right Radiology 76642 $261.32 629658 US Carotid Doppler Bilat Radiology 93880 $136.80 629660 US Carotid Duplex Complete, Bilat Radiology 93880 $136.80 629661 US Carotid Duplex Complete, Bilat - Report Radiology 93880 $104.40 1169627 US Carotid Doppler Bilat Radiology 93880 $437.70 3194602 US Carotid Duplex Limited, Left Radiology 93882 $86.40 3194603 US Carotid Duplex Limited, Right Radiology 93882 $86.40 631024 US Drainage Abscess or Cyst Radiology 76942 $110.40 631026 US Drainage Abscess or Cyst - Report Radiology 76942 $116.40 631222 US Drainage Subdiaphragm/Subphrenic Radiology 76942 $110.40 631224 US Drainage Subdiaphragm/Subphrenic - Report Radiology 76942 $116.40 631229 US Drainage Retroperitoneal Abscess Radiology 76942 $110.40 631230 US Drainage Retroperitoneal Abscess - Report Radiology 76942 $116.40 631231 US Drainage Renal Right Radiology 76942 $110.40 631232 US Drainage Renal Right - Report Radiology 76942 $116.40 631235 US Drainage Renal Left Radiology 76942 $110.40 631237 US Drainage Renal Left - Report Radiology 76942 $116.40 631241 US Drainage Renal Bilat Radiology 76942 $165.60 631243 US Drainage Renal Bilat - Report Radiology 76942 $116.40 631249 US Drainage Peritoneal Radiology 76942 $110.40 631250 US Drainage Peritoneal - Report Radiology 76942 $116.40 631255 US Drainage Pancreas Radiology 76942 $110.40 631256 US Drainage Pancreas - Report Radiology 76942 $116.40 631261 US Drainage Lung Right Radiology 76942 $110.40 631263 US Drainage Lung Right - Report Radiology 76942 $116.40 631266 US Drainage Lung Left Radiology 76942 $110.40 631268 US Drainage Lung Left - Report Radiology 76942 $116.40 631271 US Drainage Lung Bilat Radiology 76942 $165.60 631272 US Drainage Lung Bilat - Report Radiology 76942 $116.40 631275 US Drainage Liver Radiology 76942 $110.40 631276 US Drainage Liver - Report Radiology 76942 $116.40 1169645 US Drainage Abscess or Cyst Radiology 76942 $152.00 1169647 US Drainage Liver Radiology 76942 $152.00 1169649 US Drainage Lung Bilat Radiology 76942 $328.00 1169651 US Drainage Lung Left Radiology 76942 $152.00 1169653 US Drainage Lung Right Radiology 76942 $152.00 1169655 US Drainage Pancreas Radiology 76942 $152.00 1169657 US Drainage Peritoneal Radiology 76942 $152.00 1169659 US Drainage Renal Bilat Radiology 76942 $328.00 1169661 US Drainage Renal Left Radiology 76942 $152.00 1169663 US Drainage Renal Right Radiology 76942 $152.00 1169665 US Drainage Retroperitoneal Abscess Radiology 76942 $152.00 1169667 US Drainage Subdiaphragm/Subphrenic Radiology 76942 $152.00 631039 US Duplex Scan Of Hemodialysis Access Radiology 93990 $94.00 631040 US Duplex Scan Of Hemodialysis Access - Report Radiology 93990 $45.60 1169629 US Duplex Scan Carotid Complete, Bilat Radiology 93880 $437.70 1169669 US Duplex Scan Of Hemodialysis Access Radiology 93990 $262.40 3194640 US Duplex Scan Carotid Limited, Left Radiology 93882 $468.00 3194644 US Duplex Scan Carotid Limited, Right Radiology 93882 $468.00 631055 US Echoencephalography Radiology 76506 $109.20 631057 US Echoencephalography - Report Radiology 76506 $109.20 1169679 US Echoencephalography Radiology 76506 $262.40 1844782 US Echocardiogram Complete Radiology 93306 $249.60 1844783 US Echocardiogram Complete - Report Radiology 93306 $223.20 1844784 US Echocardiogram Complete Radiology 93306 $1,187.88 3330323 US FIBROSCAN shear wave, Liver elastograph Radiology 91200 $437.70 631102 US Fetal Biop. Prof. w/Non-Stress Test Radiology 76818 $186.00 631104 US Fetal Biop. Prof. w/Non-Stress Test - Report Radiology 76818 $187.20 631107 US Fetal Biop. Prof. wo/Non-Stress Test Radiology 76819 $134.40 631109 US Fetal Biop. Prof. wo/Non-Stress Test - Report Radiology 76819 $136.80 675773 US Fetal Umbilical Artery Doppler Radiology 76820 $87.60 675774 US Fetal Umbilical Artery Doppler - Report Radiology 76820 $88.80 1169677 US Fetal Umbilical Artery Doppler Radiology 76820 $262.40 1169687 US Fetal Biop. Prof. w/Non-Stress Test Radiology 76818 $437.70 1169689 US Fetal Biop. Prof. wo/Non-Stress Test Radiology 76819 $437.70 1169699 US Follow Up OB Radiology 76816 $262.40 661682 US Gallbladder Radiology 76705 $100.80 661683 US Gallbladder - Report Radiology 76705 $100.80 1169701 US Gallbladder Radiology 76705 $437.70 625670 US Guidance of Amniocentesis Radiology 76946 $67.20 625671 US Guidance of Amniocentesis - Report Radiology 76946 $67.20 629742 US Guided Chorionic Villus Sample Radiology 76945 $116.40 631065 US Guided Endomyocardial Biopsy Radiology 76932 $111.60 631190 US Guidance Tissue Ablation Radiology 76940 $352.80 631193 US Guided Pericardiocentesis Radiology 76930 $112.80 631197 US Guided Ova Aspiration Radiology 76948 $118.80 631201 US Guided Needle Placement Radiology 76942 $110.40 631202 US Guided Needle Placement - Report Radiology 76942 $116.40 1169707 US Guidance of Amniocentesis Radiology 76946 $74.00 1169719 US Guided Needle Placement S&I Radiology 76942 $152.00 3329926 US Hep C FIBROSCAN shear wave, Liver elastography Radiology 91200 $48.00 631135 US Hips Infant Radiology 76886 $106.80 631136 US Hips Infant - Report Radiology 76886 $111.60 631145 US Hips Infant Dynamic(Prov Manip Req) Radiology 76885 $127.20 631146 US Hips Infant Dynamic(Prov Manip Req) - Report Radiology 76885 $128.40 1169731 US Hips Infant Dynamic Radiology 76885 $262.40 1169733 US Hips Infant Static Radiology 76886 $437.70 631207 US Intraoperative Guidance Radiology 76998 $217.20 631209 US Intraoperative Guidance - Report Radiology 76998 $231.60 711775 US Left Lower Quadrant Radiology 76705 $100.80 711776 US Left Upper Quadrant Radiology 76705 $100.80 1169775 US Left Lower Quadrant Radiology 76705 $437.70 1169777 US Left Lower Quadrant - Report Radiology 76705 $100.80 1169778 US Left Upper Quadrant Radiology 76705 $437.70 1169780 US Left Upper Quadrant - Report Radiology 76705 $100.80 711777 US Lower Ext Non-Vascular, Comp. Bilat Radiology 76881 $162.00 711778 US Lower Ext Non-Vascular Left Radiology 76882 $84.00 711779 US Lower Ext Non-Vascular Right Radiology 76882 $84.00 1169759 US Lower Ext Arterial Bilat Radiology 93925 $437.70 1169761 US Lower Ext Arterial Left Radiology 93926 $437.70 1169763 US Lower Ext Arterial Right Radiology 93926 $437.70 1169781 US Lower Ext. Non-Vascular, Comp. Bilat Radiology 76881 $275.00 1169783 US Lower Ext Non-Vascular, Comp. Bilat - Report Radiology 76881 $102.00 1169784 US Lower Ext Non-Vascular Left Radiology 76882 $229.23 1169786 US Lower Ext Non-Vascular Left - Report Radiology 76882 $70.80 1169787 US Lower Ext Non-Vascular Right Radiology 76882 $229.23 1169789 US Lower Ext Non-Vascular Right - Report Radiology 76882 $70.80 631005 US Needle Placement Renal Right Radiology 76942 $110.40 631006 US Needle Placement Renal Right - Report Radiology 76942 $116.40 631013 US Needle Placement Renal Left Radiology 76942 $110.40 631014 US Needle Placement Renal Left - Report Radiology 76942 $116.40 631017 US Needle Placement Renal Bilat Radiology 76942 $165.60 631018 US Needle Placement Renal Bilat - Report Radiology 76942 $116.40 1169790 US Needle Placement Renal Bilat Radiology 76942 $328.00 1169792 US Needle Placement Renal Left Radiology 76942 $152.00 1169794 US Needle Placement Renal Right Radiology 76942 $152.00 630921 US OB 1st Tri, Complete Radiology 76801 $170.40 630923 US OB 1st Tri, Complete - Report Radiology 76801 $171.60 711780 US OB 1st Trimest Nuchal Measure Radiology 76813 $207.60 1169858 US OB 1st Trimest Nuchal Measure Radiology 76813 $262.40 1169860 US OB 1st Trimest Nuchal Measure - Report Radiology 76813 $211.20 3148759 US OB 1st Tri, Each Additional Gestation Radiology 76802 $145.20 3148760 US OB 1st Tri Nuchal Meas addition gest Radiology 76814 $176.40 3150646 US OB 1st Tri Nuchal Meas addition gest Radiology 76814 $230.00 3150648 US OB 1st Tri Nuchal Meas addition gest - Report Radiology 76814 $177.60 3150649 US OB 1st Tri, Each Additional Gestation Radiology 76802 $209.00 3150651 US OB 1st Tri, Each Additional Gestation - Report Radiology 76802 $145.20 630919 US OB 2/3 Trimester, Complete Radiology 76805 $172.80 630920 US OB 2/3 Trimester, Complete - Report Radiology 76805 $172.80 3148758 US OB 2/3 Tri, Each Additional Gestation Radiology 76810 $171.60 3150652 US OB 2/3 Tri, Each Additional Gestation Radiology 76810 $275.00 3150654 US OB 2/3 Tri, Each Additional Gestation - Report Radiology 76810 $171.60 1169848 US OB Complete, First Trimester Radiology 76801 $437.70 631141 US OB Follow Up Radiology 76816 $150.00 631142 US OB Follow Up - Report Radiology 76816 $151.20 630906 US OB Limited Radiology 76815 $111.60 630908 US OB Limited - Report Radiology 76815 $111.60 1169856 US OB Limited Radiology 76815 $437.70 630903 US OB Transvaginal Radiology 76817 $129.60 630904 US OB Transvaginal - Report Radiology 76817 $130.80 631481 US Parathyroid Radiology 76536 $96.00 661684 US Paracentesis Radiology 49083 $378.00 661685 US Paracentesis - Report Radiology 76942 $116.40 677591 US Parathyroid - Report Radiology 76536 $97.20 1169838 US Paracentesis Radiology 49083 $1,376.07 1169840 US Parathyroid Radiology 76536 $437.70 631477 US Parotid Radiology 76536 $96.00 631478 US Parotid - Report Radiology 76536 $97.20 1169842 US Parotid Radiology 76536 $437.70 630925 US Pelvic Limited or Follow Up (Non-OB) Radiology 76857 $85.20 630926 US Pelvic Limited or Follow Up (Non-OB) - Report Radiology 76857 $67.20 630929 US Pelvic (Non-Obstetric) Radiology 76856 $117.60 630930 US Pelvic (Non-Obstetric) - Report Radiology 76856 $118.80 1169844 US Pelvic (Non-Obstetric) Radiology 76856 $437.70 1169846 US Pelvic Limited or Follow Up (Non-OB) Radiology 76857 $262.40 3271091 US Pelvic w/ Transvaginal Radiology 76856 $117.60 3271093 US Pelvic w/ Transvaginal Radiology 76856 $437.70 630895 US Prostate Volume Radiology 76873 $266.40 1169865 US Prostate Volume Radiology 76873 $437.70 625610 US Pylorus Radiology 76705 $100.80 1169569 US Pylorus Radiology 76705 $437.70 3317121 US Renal Pediatric Radiology 76775 $98.40 3317123 US Renal Pediatric Radiology 76775 $437.70 630854 US Retroperitoneal Limited Radiology 76775 $98.40 630892 US Retroperitoneal Complete Radiology 76770 $126.00 630894 US Retroperitoneal Complete - Report Radiology 76770 $127.20 1169867 US Retroperitoneal Complete Radiology 76770 $437.70 1169869 US Retroperitoneal Limited Radiology 76775 $437.70 711781 US Right Lower Quadrant Radiology 76705 $100.80 711782 US Right Upper Quadrant Radiology 76705 $100.80 1169871 US Right Lower Quadrant Radiology 76705 $437.70 1169873 US Right Lower Quadrant - Report Radiology 76705 $100.80 1169874 US Right Upper Quadrant Radiology 76705 $437.70 1169876 US Right Upper Quadrant - Report Radiology 76705 $100.80 630851 US Scrotum (Contents) Radiology 76870 $109.20 630852 US Scrotum (Contents) - Report Radiology 76870 $110.40 1169877 US Scrotum (Contents) Radiology 76870 $437.70 631151 US Soft Tissue Head And Neck Radiology 76536 $96.00 631152 US Soft Tissue Head And Neck - Report Radiology 76536 $97.20 1169729 US Soft Tissue Head And Neck Radiology 76536 $437.30 3199264 US Spinal Canal Radiology 76800 $204.00 3199265 US Spinal Canal Radiology 76800 $262.40 661686 US Thoracentesis Radiology 32555 $390.00 661687 US Thoracentesis - Report Radiology 76942 $116.40 1169881 US Thoracentesis Radiology 32555 $1,376.07 661688 US Thyroid Radiology 76536 $96.00 661689 US Thyroid - Report Radiology 76536 $97.20 1169883 US Thyroid Radiology 76536 $437.70 630827 US Transvaginal (Non-Obstetrical) Radiology 76830 $118.80 630829 US Transvaginal (Non-Obstetrical) - Report Radiology 76830 $120.00 631060 US Transplanted Kidney; Right Radiology 76776 $129.60 631063 US Transplanted Kidney; Right - Report Radiology 76776 $129.60 631067 US Transplanted Kidney; Left Radiology 76776 $129.60 631068 US Transplanted Kidney; Left - Report Radiology 76776 $129.60 631071 US Transplanted Kidney; Bilat Radiology 76776 $194.40 631072 US Transplanted Kidney; Bilat - Report Radiology 76776 $129.60 1169749 US Transplanted Kidney; Bilat Radiology 76776 $514.50 1169751 US Transplanted Kidney; Left Radiology 76776 $343.00 1169753 US Transplanted Kidney; Right Radiology 76776 $343.00 1169861 US Transvaginal Obstetrical Radiology 76817 $437.70 1169889 US Transvaginal (Non-Obstetrical) Radiology 76830 $437.70 711783 US Upper Ext Non-Vascular, Comp., Bilat Radiology 76881 $162.00 711784 US Upper Ext Non-Vascular Left Radiology 76882 $84.00 711785 US Upper Ext Non-Vascular Right Radiology 76882 $94.00 1169895 US Upper Ext Arterial Bilat Radiology 93930 $437.70 1169897 US Upper Ext Arterial Left Radiology 93931 $274.40 1169899 US Upper Ext Arterial Right Radiology 93931 $274.40 1169909 US Upper Ext Non-Vascular, Comp., Bilat Radiology 76881 $275.00 1169911 US Upper Ext Non-Vascular, Comp., Bilat - Report Radiology 76881 $102.00 1169912 US Upper Ext Non-Vascular Left Radiology 76882 $229.23 1169914 US Upper Ext Non-Vascular Left - Report Radiology 76882 $70.80 1169915 US Upper Ext Non-Vascular Right Radiology 76882 $229.23 1169917 US Upper Ext Non-Vascular Right - Report Radiology 76882 $70.80 3271092 US Vein Mapping for Hemodialysis Graft Radiology 93990 $84.00 3271096 US Vein Mapping for Hemodialysis Graft Radiology 93990 $262.40 630801 US Venous Duplex Upper Ext Right Radiology 93971 $76.80 630802 US Venous Duplex Upper Ext Right - Report Radiology 93971 $79.20 630805 US Venous Duplex Upper Ext Left Radiology 93971 $76.80 630806 US Venous Duplex Upper Ext Left - Report Radiology 93971 $79.20 630807 US Venous Duplex Upper Ext Bilat Radiology 93970 $117.60 630808 US Venous Duplex Upper Ext Bilat - Report Radiology 93970 $120.00 631019 US Venous Duplex Lower Ext Right Radiology 93971 $76.80 631020 US Venous Duplex Lower Ext Right - Report Radiology 93971 $79.20 631023 US Venous Duplex Lower Ext Left Radiology 93971 $76.80 631025 US Venous Duplex Lower Ext Left - Report Radiology 93971 $79.20 1169771 US Venous Doppler Lower Ext. Left Radiology 93971 $318.35 1169773 US Venous Doppler Lower Ext. Right Radiology 93971 $318.35 1169901 US Venous Doppler Upper Ext. Bilat Radiology 93970 $436.02 1169903 US Venous Doppler Upper Ext. Left Radiology 93971 $318.35 1169905 US Venous Doppler Upper Ext. Right Radiology 93971 $318.35 3194661 US Venous Duplex Lower Ext Bilat Radiology 93970 $117.60 3194662 US Venous Doppler Lower Ext. Bilat Radiology 93970 $436.02 3254920 Visipaque 270Mg Polyb 100Ml 10 Radiology Q9966 $100.00 630503 XR 1 V Nose to Rect., Foreign Body Radiology 76010 $31.20 630504 XR 1 V Nose to Rect., Foreign Body - Report Radiology 76010 $31.20 1170207 XR 1 V Nose to Rect., Foreign Body Radiology 76010 $547.11 625648 XR AC Joints w/wo Weights Radiology 73050 $36.00 625649 XR AC Joints w/wo Weights - Report Radiology 73050 $39.60 1169922 XR AC Joints w/wo Weights Radiology 73050 $173.28 3148941 XR AP Pelvis w/Lateral Hips Radiology 72190 $37.20 3150658 XR AP Pelvis w/Lateral Hips Radiology 72190 $286.97 3150660 XR AP Pelvis w/Lateral Hips - Report Radiology 72190 $40.80 625614 XR Abdomen 1 View Radiology 74018 $31.20 1169926 XR Abdomen 1 View Radiology 74018 $173.28 2384297 XR Abdomen Flat and Upright Radiology 74019 $39.60 2408784 XR Abdomen Flat and Upright Radiology 74019 $173.28 625630 XR Acute Abdomen Series Radiology 74022 $55.20 625631 XR Acute Abdomen Series - Report Radiology 74022 $54.00 1169932 XR Acute Abdomen Series Radiology 74022 $286.97 625716 XR Ankle 2 Views Bilat Radiology 73600 $28.80 625717 XR Ankle 2 Views Bilat - Report Radiology 73600 $28.80 625718 XR Ankle 2 Views Left Radiology 73600 $28.80 625719 XR Ankle 2 Views Left - Report Radiology 73600 $28.80 625720 XR Ankle 2 Views Right Radiology 73600 $28.80 625721 XR Ankle 2 Views Right - Report Radiology 73600 $28.80 625722 XR Ankle 3 Views Bilat Radiology 73610 $45.00 625723 XR Ankle 3 Views Bilat - Report Radiology 73610 $31.20 625724 XR Ankle 3 Views Left Radiology 73610 $30.00 625725 XR Ankle 3 Views Left - Report Radiology 73610 $31.20 625726 XR Ankle 3 Views Right Radiology 73610 $30.00 625727 XR Ankle 3 Views Right - Report Radiology 73610 $31.20 1169934 XR Ankle 2 Views Bilat Radiology 73600 $356.33 1169936 XR Ankle 2 Views Left Radiology 73600 $237.55 1169938 XR Ankle 2 Views Right Radiology 73600 $237.55 1169940 XR Ankle 3 Views Bilat Radiology 73610 $356.33 1169942 XR Ankle 3 Views Left Radiology 73610 $237.55 1169944 XR Ankle 3 Views Right Radiology 73610 $237.55 625674 XR Arthrogram Ankle Bilat Radiology 73615 $147.60 625675 XR Arthrogram Ankle Bilat - Report Radiology 73615 $102.00 625676 XR Arthrogram Ankle Left Radiology 73615 $98.40 625677 XR Arthrogram Ankle Left - Report Radiology 73615 $102.00 625678 XR Arthrogram Ankle Right Radiology 73615 $98.40 625679 XR Arthrogram Ankle Right - Report Radiology 73615 $102.00 630725 XR Arthrogram Wrist Right Radiology 73115 $97.20 630726 XR Arthrogram Wrist Right - Report Radiology 73115 $99.60 630730 XR Arthrogram Wrist Left Radiology 73115 $97.20 630732 XR Arthrogram Wrist Left - Report Radiology 73115 $99.60 630735 XR Arthrogram Wrist Bilat Radiology 73115 $145.80 630736 XR Arthrogram Wrist Bilat - Report Radiology 73115 $99.60 630741 XR Arthrogram Shoulder Right Radiology 73040 $93.60 630742 XR Arthrogram Shoulder Right - Report Radiology 73040 $96.00 630745 XR Arthrogram Shoulder Left Radiology 73040 $93.60 630746 XR Arthrogram Shoulder Left - Report Radiology 73040 $96.00 630749 XR Arthrogram Shoulder Bilat Radiology 73040 $140.40 630750 XR Arthrogram Shoulder Bilat - Report Radiology 73040 $96.00 630759 XR Arthrogram Knee Right Radiology 73580 $98.40 630760 XR Arthrogram Knee Right - Report Radiology 73580 $105.60 630763 XR Arthrogram Knee Left Radiology 73580 $98.40 630764 XR Arthrogram Knee Left - Report Radiology 73580 $105.60 630767 XR Arthrogram Knee Bilat Radiology 73580 $147.60 630768 XR Arthrogram Knee Bilat - Report Radiology 73580 $105.60 630771 XR Arthrogram Hip Right Radiology 73525 $99.60 630772 XR Arthrogram Hip Right - Report Radiology 73525 $100.80 630773 XR Arthrogram Hip Left Radiology 73525 $99.60 630774 XR Arthrogram Hip Left - Report Radiology 73525 $100.80 630777 XR Arthrogram Hip Bilat Radiology 73525 $149.40 630778 XR Arthrogram Hip Bilat - Report Radiology 73525 $100.80 630783 XR Arthrogram Elbow Right Radiology 73085 $98.40 630784 XR Arthrogram Elbow Right - Report Radiology 73085 $98.40 630785 XR Arthrogram Elbow Left Radiology 73085 $98.40 630786 XR Arthrogram Elbow Left - Report Radiology 73085 $98.40 630787 XR Arthrogram Elbow Bilat Radiology 73085 $147.60 630788 XR Arthrogram Elbow Bilat - Report Radiology 73085 $98.40 1169948 XR Arthrogram Ankle Bilat Radiology 73615 $1,200.38 1169950 XR Arthrogram Ankle Left Radiology 73615 $800.25 1169952 XR Arthrogram Ankle Right Radiology 73615 $800.25 1169954 XR Arthrogram Elbow Bilat Radiology 73085 $1,200.38 1169956 XR Arthrogram Elbow Left Radiology 73085 $800.25 1169958 XR Arthrogram Elbow Right Radiology 73085 $800.25 1169960 XR Arthrogram Hip Bilat Radiology 73525 $1,200.38 1169962 XR Arthrogram Hip Left Radiology 73525 $800.25 1169964 XR Arthrogram Hip Right Radiology 73525 $800.25 1169968 XR Arthrogram Knee Bilat Radiology 73580 $1,200.38 1169970 XR Arthrogram Knee Left Radiology 73580 $800.25 1169972 XR Arthrogram Knee Right Radiology 73580 $800.25 1169982 XR Arthrogram Shoulder Bilat Radiology 73040 $1,200.38 1169984 XR Arthrogram Shoulder Left Radiology 73040 $800.25 1169986 XR Arthrogram Shoulder Right Radiology 73040 $800.25 1169994 XR Arthrogram Wrist Bilat Radiology 73115 $149.40 1169996 XR Arthrogram Wrist Left Radiology 73115 $800.25 1169998 XR Arthrogram Wrist Right Radiology 73115 $800.25 627609 XR Barium Enema - Report Radiology 74270 $118.80 627613 XR Barium Enema Air Contrast (ACBE) - Report Radiology 74280 $169.20 1170291 XR Bilat Knees Standing Radiology 73565 $173.28 627628 XR Bone Age Study Radiology 77072 $32.40 627629 XR Bone Age Study - Report Radiology 77072 $33.60 627646 XR Bone Length Study Radiology 77073 $49.20 627647 XR Bone Length Study - Report Radiology 77073 $54.00 627658 XR Bone Survey Complete Radiology 77075 $92.40 627659 XR Bone Survey Complete - Report Radiology 77075 $92.40 627660 XR Bone Survey, Infant Radiology 77076 $120.00 627661 XR Bone Survey, Infant - Report Radiology 77076 $121.20 627662 XR Bone Survey Limited Radiology 77074 $78.00 627663 XR Bone Survey Limited - Report Radiology 77074 $78.00 1170014 XR Bone Age Study Radiology 77072 $286.97 1170016 XR Bone Length Study Radiology 77073 $173.28 1170018 XR Bone Survey Complete Radiology 77075 $286.97 1170020 XR Bone Survey, Infant Radiology 77076 $286.97 1170022 XR Bone Survey Limited Radiology 77074 $286.97 630439 XR C-Arm Hip Right Radiology 73502 $38.40 630443 XR C-Arm Hip Left Radiology 73502 $38.40 630445 XR C-Arm Hip Bilat Radiology 73502 $57.60 1170237 XR C-Arm Hip Bilat Radiology 73502 $259.92 1170239 XR C-Arm Hip Left Radiology 73502 $173.28 1170241 XR C-Arm Hip Right Radiology 73502 $173.28 3241437 XR C-Arm Abdomen Radiology 74018 $31.20 3241438 XR C-Arm Ankle Bilat Radiology 73600 $43.20 3241439 XR C-Arm Ankle Left Radiology 73600 $28.80 3241440 XR C-Arm Ankle Right Radiology 73600 $28.80 3241441 XR C-Arm Chest Radiology 76000 $30.00 3241442 XR C-Arm Cholangiogram Radiology 74300 $62.40 3241443 XR C-Arm Clavicle Bilat Radiology 73000 $43.20 3241444 XR C-Arm Clavicle Left Radiology 73000 $28.80 3241445 XR C-Arm Clavicle Right Radiology 73000 $28.80 3241446 XR C-Arm Elbow Bilat Radiology 73070 $41.40 3241447 XR C-Arm Elbow Left Radiology 73070 $27.60 3241448 XR C-Arm Elbow Right Radiology 73070 $27.60 3241449 XR C-Arm Finger Bilat Radiology 73140 $36.00 3241450 XR C-Arm Finger Left Radiology 73140 $24.00 3241451 XR C-Arm Finger Right Radiology 73140 $24.00 3241452 XR C-Arm Foot Bilat Radiology 73620 $39.60 3241453 XR C-Arm Foot Left Radiology 73620 $26.40 3241454 XR C-Arm Foot Right Radiology 73620 $26.40 3241455 XR C-Arm Forearm Bilat Radiology 73090 $43.20 3241456 XR C-Arm Forearm Left Radiology 73090 $28.80 3241457 XR C-Arm Forearm Right Radiology 73090 $28.80 3241458 XR C-Arm Hand Bilat Radiology 73120 $43.20 3241459 XR C-Arm Hand Left Radiology 73120 $28.80 3241460 XR C-Arm Hand Right Radiology 73120 $28.80 3241461 XR C-Arm Humerus Bilat Radiology 73060 $43.20 3241462 XR C-Arm Humerus Left Radiology 73060 $28.80 3241463 XR C-Arm Humerus Right Radiology 73060 $28.80 3241464 XR C-Arm Knee Bilat Radiology 73560 $43.20 3241465 XR C-Arm Knee Left Radiology 73560 $28.80 3241466 XR C-Arm Knee Right Radiology 73560 $28.80 3241467 XR C-Arm Shoulder Bilat Radiology 73030 $48.60 3241468 XR C-Arm Shoulder Left Radiology 73030 $32.40 3241469 XR C-Arm Shoulder Right Radiology 73030 $32.40 3241470 XR C-Arm Tib/Fib Bilat Radiology 73590 $43.20 3241471 XR C-Arm Tib/Fib Left Radiology 73590 $28.80 3241472 XR C-Arm Tib/Fib Right Radiology 73590 $28.80 3241473 XR C-Arm Toe Bilat Radiology 73660 $34.20 3241474 XR C-Arm Toe Left Radiology 73660 $22.80 3241475 XR C-Arm Toe Right Radiology 73660 $22.80 3241476 XR C-Arm Wrist Bilat Radiology 73100 $45.00 3241477 XR C-Arm Wrist Left Radiology 73100 $30.00 3241478 XR C-Arm Wrist Right Radiology 73100 $30.00 3241479 XR C-Arm Abdomen Radiology 74018 $173.28 3241482 XR C-Arm Ankle Bilat Radiology 73600 $173.28 3241485 XR C-Arm Ankle Left Radiology 73600 $173.28 3241488 XR C-Arm Ankle Right Radiology 73600 $173.28 3241491 XR C-Arm Chest Radiology 76000 $547.11 3241494 XR C-Arm Cholangiogram Radiology 74300 $120.00 3241497 XR C-Arm Clavicle Bilat Radiology 73000 $259.92 3241500 XR C-Arm Clavicle Left Radiology 73000 $173.28 3241503 XR C-Arm Clavicle Right Radiology 73000 $173.28 3241506 XR C-Arm Elbow Bilat Radiology 73070 $259.92 3241509 XR C-Arm Elbow Left Radiology 73070 $173.28 3241512 XR C-Arm Elbow Right Radiology 73070 $173.28 3241515 XR C-Arm Finger Bilat Radiology 73140 $259.92 3241518 XR C-Arm Finger Left Radiology 73140 $173.28 3241521 XR C-Arm Finger Right Radiology 73140 $173.28 3241524 XR C-Arm Foot Bilat Radiology 73620 $259.92 3241527 XR C-Arm Foot Left Radiology 73620 $173.28 3241530 XR C-Arm Foot Right Radiology 73620 $173.28 3241533 XR C-Arm Forearm Bilat Radiology 73090 $259.92 3241536 XR C-Arm Forearm Left Radiology 73090 $173.28 3241539 XR C-Arm Forearm Right Radiology 73090 $173.28 3241542 XR C-Arm Hand Bilat Radiology 73120 $430.55 3241545 XR C-Arm Hand Left Radiology 73120 $286.97 3241548 XR C-Arm Hand Right Radiology 73120 $286.97 3241551 XR C-Arm Humerus Bilat Radiology 73060 $259.92 3241554 XR C-Arm Humerus Left Radiology 73060 $173.28 3241557 XR C-Arm Humerus Right Radiology 73060 $173.28 3241560 XR C-Arm Knee Bilat Radiology 73560 $259.92 3241563 XR C-Arm Knee Left Radiology 73560 $173.28 3241566 XR C-Arm Knee Right Radiology 73560 $173.28 3241569 XR C-Arm Shoulder Bilat Radiology 73030 $259.92 3241572 XR C-Arm Shoulder Left Radiology 73030 $173.28 3241575 XR C-Arm Shoulder Right Radiology 73030 $173.28 3241578 XR C-Arm Tib/Fib Bilat Radiology 73590 $259.92 3241581 XR C-Arm Tib/Fib Left Radiology 73590 $173.28 3241584 XR C-Arm Tib/Fib Right Radiology 73590 $173.28 3241587 XR C-Arm Toe Bilat Radiology 73660 $259.92 3241590 XR C-Arm Toe Left Radiology 73660 $173.28 3241593 XR C-Arm Toe Right Radiology 73660 $173.28 3241596 XR C-Arm Wrist Bilat Radiology 73100 $259.92 3241599 XR C-Arm Wrist Left Radiology 73100 $173.28 3241602 XR C-Arm Wrist Right Radiology 73100 $173.28 1170452 XR C-Spine 3 Views Radiology 72040 $286.97 1170454 XR C-Spine w/Obliques Complete Radiology 72050 $286.97 1170463 XR C-Spine w/Flexion and/or Extension Radiology 72052 $286.97 3150661 XR C-Spine w/Obl. + Flex And Ext Radiology 72052 $286.97 629616 XR Calcaneous 2 Views Bilat Radiology 73650 $41.40 629617 XR Calcaneous 2 Views Bilat - Report Radiology 73650 $28.80 629618 XR Calcaneous 2 Views Left Radiology 73650 $27.60 629619 XR Calcaneous 2 Views Left - Report Radiology 73650 $28.80 629620 XR Calcaneous 2 Views Right Radiology 73650 $27.60 629621 XR Calcaneous 2 Views Right - Report Radiology 73650 $28.80 1170030 XR Calcaneous 2 Views Bilat Radiology 73650 $259.92 1170032 XR Calcaneous 2 Views Left Radiology 73650 $173.28 1170034 XR Calcaneous 2 Views Right Radiology 73650 $173.28 629718 XR Chest 2 View Radiology 71046 $37.20 629720 XR Chest 2 View; w/Lordotic Radiology 71047 $48.00 629724 XR Chest 2 View; w/Oblique Radiology 71047 $48.00 629726 XR Chest 4 View Radiology 71048 $55.20 657589 XR Chest Decubitus Bilat Radiology 71046 $37.20 657590 XR Chest Decubitus Right Radiology 71045 $31.20 689607 XR Chest 2 View Radiology 71046 $173.28 1170040 XR Chest 2 View; w/Lordotic Radiology 71047 $173.28 1170044 XR Chest 2 Views; w/Oblique Radiology 71047 $173.28 1170046 XR Chest Decubitus Bilat Radiology 71046 $259.92 1170049 XR Chest Decubitus Left Radiology 71045 $173.28 1170051 XR Chest Decubitus Right Radiology 71045 $173.28 1170053 XR Chest 4 Views Radiology 71048 $173.28 1228133 XR Chest Decubitus Left Radiology 71045 $31.20 1276484 XR Chest One View Radiology 71045 $31.20 1345763 XR Chest One View Radiology 71045 $173.28 3148942 XR Chest 2 View w/Fluoroscopy Radiology 71047 $48.00 3150664 XR Chest 2 Views w/Fluoroscopy Radiology 71047 $286.97 3193056 XR Chest 1 View Frontal Radiology 71045 $31.20 3193108 XR Chest 1 View Frontal Radiology 71045 $173.28 629734 XR Cholangiogram T-Tube Radiology 47531 $248.40 629736 XR Chol/Panc Intraoperative Radiology 74300 $62.40 629737 XR Chol/Panc Intraoperative - Report Radiology 74300 $63.60 629738 XR Cholangiography Addtl. Set in Surgery Radiology 74301 $36.00 629739 XR Cholangiography Addtl. Set in Surgery - Report Radiology 74301 $38.40 1170061 XR Cholangiography Addtl. Set in Surgery Radiology 74301 $120.00 1170063 XR Cholangiogram T-Tube Radiology 47531 $1,002.37 1170065 XR Chol/Panc Intraoperative Radiology 74300 $120.00 629750 XR Clavicle Bilat Radiology 73000 $43.20 629751 XR Clavicle Bilat - Report Radiology 73000 $30.00 629752 XR Clavicle Left Radiology 73000 $28.80 629753 XR Clavicle Left - Report Radiology 73000 $30.00 629754 XR Clavicle Right Radiology 73000 $28.80 629755 XR Clavicle Right - Report Radiology 73000 $30.00 1170073 XR Clavicle Bilat Radiology 73000 $259.92 1170075 XR Clavicle Left Radiology 73000 $173.28 1170077 XR Clavicle Right Radiology 73000 $173.28 630267 XR Cystography Radiology 74430 $55.20 630268 XR Cystography - Report Radiology 74430 $54.00 1170083 XR Cystography Radiology 74430 $547.11 630679 XR Elbow 3 View Right Radiology 73080 $30.00 630680 XR Elbow 3 View Right - Report Radiology 73080 $30.00 630683 XR Elbow 3 View Left Radiology 73080 $30.00 630684 XR Elbow 3 View Left - Report Radiology 73080 $30.00 630685 XR Elbow 3 View Bilat Radiology 73080 $45.00 630686 XR Elbow 3 View Bilat - Report Radiology 73080 $30.00 630687 XR Elbow 2 View Right Radiology 73070 $27.60 630688 XR Elbow 2 View Right - Report Radiology 73070 $27.60 630689 XR Elbow 2 View Left Radiology 73070 $27.60 630690 XR Elbow 2 View Left - Report Radiology 73070 $27.60 630691 XR Elbow 2 View Bilat Radiology 73070 $41.40 630692 XR Elbow 2 View Bilat - Report Radiology 73070 $27.60 1170119 XR Elbow 2 Views Bilat Radiology 73070 $259.92 1170121 XR Elbow 2 Views Left Radiology 73070 $173.28 1170123 XR Elbow 2 Views Right Radiology 73070 $173.28 1170125 XR Elbow 3 Views Bilat Radiology 73080 $259.92 1170127 XR Elbow 3 Views Left Radiology 73080 $173.28 1170129 XR Elbow 3 Views Right Radiology 73080 $173.28 630082 XR Esoph/Pharyngal w/Speech Eval. Radiology 70371 $142.80 630083 XR Esoph/Pharyngal w/Speech Eval. - Report Radiology 70371 $146.40 630672 XR Esophagram; Barium Swallow (BaSw) - Report Radiology 74220 $79.20 1170444 XR Esoph/Pharyngal w/Speech Eval. Radiology 70371 $286.97 630663 XR Facial Bones >3 View Radiology 70150 $45.60 630664 XR Facial Bones >3 View - Report Radiology 70150 $45.60 630666 XR Facial Bones <3 View Radiology 70140 $36.00 630668 XR Facial Bones <3 View - Report Radiology 70140 $36.00 1170139 XR Facial Bones <3 Views Radiology 70140 $173.28 1170141 XR Facial Bones >3 Views Radiology 70150 $286.97 3333570 XR Femur Bilat Min 2 View Radiology 73552 $48.60 3333571 XR Femur 1 View Left Radiology 73551 $28.80 3333572 XR Femur Left Min 2 View Radiology 73552 $32.40 3333573 XR Femur 1 View Right Radiology 73551 $28.80 3333574 XR Femur Right Min 2 View Radiology 73552 $32.40 3333578 XR Femur Bilat Min 2 View Radiology 73552 $259.89 3333581 XR Femur Left 1 View Radiology 73551 $173.28 3333584 XR Femur Left Min 2 View Radiology 73552 $173.28 3333587 XR Femur Right 1 View Radiology 73551 $173.28 3333590 XR Femur Right Min 2 View Radiology 73552 $173.28 3145448 XR Finger(s) Bilat Radiology 73140 $36.00 3145449 XR Finger(s) Left Radiology 73140 $24.00 3145450 XR Finger(s) Right Radiology 73140 $24.00 3150684 XR Finger(s) Bilat Radiology 73140 $259.92 3150687 XR Finger(s) Left Radiology 73140 $173.28 3150690 XR Finger(s) Right Radiology 73140 $173.28 630595 XR Fistulagram Radiology 76080 $88.80 630596 XR Fistulagram - Report Radiology 76080 $92.40 1170171 XR Fistulagram Radiology 76080 $1,002.37 3193070 XR Fluoroscopy Up To 1 Hour Radiology 76000 $30.00 3193123 XR Fluoroscopy Up To 1 Hour Radiology 76000 $547.11 1170183 XR Foot 2 Views Bilat Radiology 73620 $259.92 1170185 XR Foot 2 Views Left Radiology 73620 $173.28 1170187 XR Foot 2 Views Right Radiology 73620 $173.28 1170189 XR Foot 3 Views Bilat Radiology 73630 $259.92 1170191 XR Foot 3 Views Left Radiology 73630 $173.28 1170193 XR Foot 3 Views Right Radiology 73630 $173.28 630519 XR Forearm 2 View Right Radiology 73090 $28.80 630520 XR Forearm 2 View Right - Report Radiology 73090 $28.80 630523 XR Forearm 2 View Left Radiology 73090 $28.80 630524 XR Forearm 2 View Left - Report Radiology 73090 $28.80 630527 XR Forearm 2 View Bilat Radiology 73090 $43.20 630528 XR Forearm 2 View Bilat - Report Radiology 73090 $28.80 1170195 XR Forearm 2 Views Bilat Radiology 73090 $259.92 1170197 XR Forearm 2 Views Left Radiology 73090 $173.28 1170199 XR Forearm 2 Views Right Radiology 73090 $173.28 1170213 XR Hand 2 Views Bilat Radiology 73120 $286.97 1170215 XR Hand 2 Views Left Radiology 73120 $286.97 1170217 XR Hand 2 Views Right Radiology 73120 $286.97 1170219 XR Hand 3 Views Bilat Radiology 73130 $259.92 1170221 XR Hand 3 Views Left Radiology 73130 $173.28 1170223 XR Hand 3 Views Right Radiology 73130 $173.28 3332187 XR Hip 1 View Left w/Pelvis Radiology 73501 $32.40 3332188 XR Hip 1 View Left wo/Pelvis Radiology 73501 $32.40 3332189 XR Hip 1 View Right w/Pelvis Radiology 73501 $32.40 3332190 XR Hip 1 View Right wo/Pelvis Radiology 73501 $32.40 3332196 XR Hip 1 View Left w/Pelvis Radiology 73501 $173.28 3332199 XR Hip 1 View Left wo/Pelvis Radiology 73501 $173.28 3332202 XR Hip 1 View Right w/Pelvis Radiology 73501 $173.28 3332205 XR Hip 1 View Right wo/Pelvis Radiology 73501 $173.28 3332289 XR Hip Left 2-3 View w/Pelvis Radiology 73502 $38.40 3332290 XR Hip Left 2-3 View wo/Pelvis Radiology 73502 $38.40 3332291 XR Hip Right 2-3 View w/Pelvis Radiology 73502 $38.40 3332292 XR Hip Right 2-3 View wo/Pelvis Radiology 73502 $38.40 3332293 XR Hip Left Min of 4 View w/Pelvis Radiology 73503 $49.20 3332294 XR Hip Left Min of 4 View wo/Pelvis Radiology 73503 $49.20 3332295 XR Hip Right Min of 4 View w/Pelvis Radiology 73503 $49.20 3332296 XR Hip Right Min of 4 View wo/Pelvis Radiology 73503 $49.20 3332297 XR Hip Left 2-3 View w/Pelvis Radiology 73502 $173.28 3332300 XR Hip Left 2-3 View wo/Pelvis Radiology 73502 $173.28 3332303 XR Hip Left Min of 4 View w/Pelvis Radiology 73503 $286.97 3332306 XR Hip Left Min of 4 View wo/Pelvis Radiology 73503 $286.97 3332309 XR Hip Right 2-3 View w/Pelvis Radiology 73502 $173.28 3332312 XR Hip Right 2-3 View wo/Pelvis Radiology 73502 $173.28 3332315 XR Hip Right Min of 4 View w/Pelvis Radiology 73503 $286.97 3332318 XR Hip Right Min of 4 View wo/Pelvis Radiology 73503 $286.97 3332531 XR Hip Bilat 2 View w/Pelvis Radiology 73521 $38.40 3332532 XR Hip Bilat 2 View wo/Pelvis Radiology 73521 $38.40 3332533 XR Hip Bilat 3-4 View w/Pelvis Radiology 73522 $51.60 3332534 XR Hip Bilat 3-4 View wo/Pelvis Radiology 73522 $51.60 3332535 XR Hip Bilat Min of 5 View w/Pelvis Radiology 73523 $55.20 3332536 XR Hip Bilat Min of 5 View wo/Pelvis Radiology 73523 $55.20 3332537 XR Hip Bilat 2 View w/Pelvis Radiology 73521 $286.97 3332540 XR Hip Bilat 2 View wo/Pelvis Radiology 73521 $286.97 3332543 XR Hip Bilat 3-4 View w/Pelvis Radiology 73522 $286.97 3332546 XR Hip Bilat 3-4 View wo/Pelvis Radiology 73522 $286.97 3332549 XR Hip Bilat Min of 5 View w/Pelvis Radiology 73523 $547.11 3332552 XR Hip Bilat Min of 5 View wo/Pelvis Radiology 73523 $547.11 3333557 XR Hip Infant Bilat 2 View w/Pelvis Radiology 73521 $38.40 3333558 XR Hip Infant Bilat 2 View wo/Pelvis Radiology 73521 $38.40 3333559 XR Hip Infant Bilat Min 5 View w/Pelvis Radiology 73523 $55.20 3333560 XR Hip Infant Bilat Min 5 View wo/Pelvis Radiology 73523 $55.20 3333593 XR Hip Infant Bilat 2 View w/Pelvis Radiology 73521 $286.97 3333596 XR Hip Infant Bilat 2 View wo/Pelvis Radiology 73521 $286.97 3333599 XR Hip Infant Bilat Min 5 View w/Pelvis Radiology 73523 $547.11 3333602 XR Hip Infant Bilat Min 5 View wo/Pelvis Radiology 73523 $547.11 3343217 XR Hip Infant Bilat 3 to 4 View w/Pelvis Radiology 73522 $51.60 3343218 XR Hip Infant Bilat 3 to 4 View wo/Pelvis Radiology 73522 $51.60 3343286 XR Hip Infant Bilat 3 to 4 View w/Pelvis Radiology 73522 $286.97 3343289 XR Hip Infant Bilat 3 to 4 View wo/Pelvi Radiology 73522 $286.97 630427 XR Humerus Right Radiology 73060 $28.80 630428 XR Humerus Right - Report Radiology 73060 $31.20 630429 XR Humerus Left Radiology 73060 $28.80 630430 XR Humerus Left - Report Radiology 73060 $31.20 630433 XR Humerus Bilat Radiology 73060 $43.20 630434 XR Humerus Bilat - Report Radiology 73060 $31.20 1170243 XR Humerus Bilat Radiology 73060 $259.92 1170245 XR Humerus Left Radiology 73060 $148.43 1170247 XR Humerus Right Radiology 73060 $173.28 630425 XR Hysterosalpingography, HSG Radiology 74740 $64.80 630426 XR Hysterosalpingography, HSG - Report Radiology 74740 $64.80 1170249 XR Hysterosalpingography, HSG Radiology 74740 $1,002.37 630417 XR IVP w/Nephrotomography Radiology 74415 $84.00 630418 XR IVP w/Nephrotomography - Report Radiology 74415 $84.00 1170251 XR IVP w/Nephrotomography Radiology 74415 $547.11 630419 XR Internal Aud. Meatus., Comp. Right Radiology 70134 $58.80 630420 XR Internal Aud. Meatus., Comp. Right - Report Radiology 70134 $57.60 630421 XR Internal Aud. Meatus., Comp. Left Radiology 70134 $58.80 630422 XR Internal Aud. Meatus., Comp. Left - Report Radiology 70134 $57.60 630423 XR Internal Aud. Meatus., Comp. Bilat Radiology 70134 $88.20 630424 XR Internal Aud. Meatus., Comp. Bilat - Report Radiology 70134 $57.60 1170253 XR Internal Aud. Meatus., Comp. Bilat Radiology 70134 $430.55 1170255 XR Internal Aud. Meatus., Comp. Left Radiology 70134 $286.97 1170257 XR Internal Aud. Meatus., Comp. Right Radiology 70134 $286.97 630410 XR Joint Survey Radiology 77077 $55.20 630412 XR Joint Survey - Report Radiology 77077 $60.00 1170259 XR Joint Survey Radiology 77077 $286.97 630351 XR Knees Bilat Standing Radiology 73565 $45.00 630352 XR Knees Bilat Standing - Report Radiology 73565 $34.80 630365 XR Knee <3 View Bilat Radiology 73560 $43.20 630366 XR Knee <3 View Bilat - Report Radiology 73560 $33.60 630369 XR Knee 4 View Right Radiology 73564 $38.40 630370 XR Knee 4 View Right - Report Radiology 73564 $42.00 630373 XR Knee 4 View Left Radiology 73564 $38.40 630374 XR Knee 4 View Left - Report Radiology 73564 $42.00 630395 XR Knee 3 View Right Radiology 73562 $32.40 630396 XR Knee 3 View Right - Report Radiology 73562 $36.00 630403 XR Knee 3 View Left Radiology 73562 $32.40 630404 XR Knee 3 View Left - Report Radiology 73562 $36.00 630415 XR Knee 3 View Bilat Radiology 73562 $48.60 630416 XR Knee 3 View Bilat - Report Radiology 73562 $36.00 711788 XR Knee 4 View w/Patella Left Radiology 73564 $38.40 711789 XR Knee 4 View w/Patella Right Radiology 73564 $38.40 711790 XR Knee 4 View w/Tunnel+Sunrise Left Radiology 73564 $38.40 711791 XR Knee 4 View w/Tunnel+Sunrise Right Radiology 73564 $38.40 1170261 XR Knee <3 Views Bilat Radiology 73560 $259.92 1170267 XR Knee 3 Views Bilat Radiology 73562 $259.92 1170269 XR Knee 3 Views Left Radiology 73562 $173.28 1170271 XR Knee 3 Views Right Radiology 73562 $173.28 1170273 XR Knee 4 Views w/Patella Left Radiology 73564 $286.97 1170275 XR Knee 4 View w/Patella Left - Report Radiology 73564 $42.00 1170276 XR Knee 4 Views w/Patella Right Radiology 73564 $286.97 1170278 XR Knee 4 View w/Patella Right - Report Radiology 73564 $42.00 1170279 XR Knee 4 Views w/Tunnel+Sunrise Left Radiology 73564 $286.97 1170281 XR Knee 4 View w/Tunnel+Sunrise Left - Report Radiology 73564 $42.00 1170282 XR Knee 4 Views w/Tunnel+Sunrise Right Radiology 73564 $286.97 1170284 XR Knee 4 View w/Tunnel+Sunrise Right - Report Radiology 73564 $42.00 1170287 XR Knee 4 Views Left Radiology 73564 $286.97 1170289 XR Knee 4 Views Right Radiology 73564 $286.97 3144828 XR Knee 4 View Bilat Radiology 73564 $57.60 3144899 XR Knee 4 Views Bilat Radiology 73564 $430.55 3144901 XR Knee 4 View Bilat - Report Radiology 73564 $42.00 3148778 XR Knee <3 View Left Radiology 73560 $28.80 3148779 XR Knee <3 View Right Radiology 73560 $28.80 3150705 XR Knee <3 Views Left Radiology 73560 $173.28 3150707 XR Knee <3 View Left - Report Radiology 73560 $33.60 3150708 XR Knee <3 Views Right Radiology 73560 $173.28 3150710 XR Knee <3 View Right - Report Radiology 73560 $33.60 3193077 XR Knee Complete Bilateral Radiology 73564 $57.60 1170474 XR L-Spine W/Obl. + Flex and Ext Radiology 72114 $286.97 630237 XR Larynx & Pharynx Radiology 76499 $43.20 1170361 XR Larynx & Pharynx Radiology 76499 $671.32 630238 XR Larynx & Pharynx - Report Radiology $75.60 630341 XR Lower Ext Infant Right Radiology 73592 $27.60 630342 XR Lower Ext Infant Right - Report Radiology 73592 $30.00 630343 XR Lower Ext Infant Left Radiology 73592 $27.60 630344 XR Lower Ext Infant Left - Report Radiology 73592 $30.00 630345 XR Lower Ext Infant Bilat Radiology 73592 $41.40 630346 XR Lower Ext Infant Bilat - Report Radiology 73592 $30.00 1170295 XR Lower Ext Infant Bilat Radiology 73592 $259.92 1170297 XR Lower Ext Infant Left Radiology 73592 $173.28 1170299 XR Lower Ext Infant Right Radiology 73592 $173.28 1170467 XR Lumbar Spine, Flex and Ext Views Only Radiology 72120 $173.28 1170470 XR Lumbar Spine 3 Views Radiology 72100 $286.97 1170476 XR Lumbar Spine w/Obliques Radiology 72110 $286.97 630337 XR Mandible <4 View Radiology 70100 $31.20 630338 XR Mandible <4 View - Report Radiology 70100 $32.40 630339 XR Mandible 4 View Radiology 70110 $43.20 630340 XR Mandible 4 View - Report Radiology 70110 $43.20 1170301 XR Mandible 4 Views Radiology 70110 $286.97 1170303 XR Mandible <4 Views Radiology 70100 $173.28 1170305 XR Manual Stress Application to Joint Radiology $128.36 630327 XR Mastoids <3 View/Side; Right Radiology 70120 $31.20 630328 XR Mastoids <3 View/Side; Right - Report Radiology 70120 $32.40 630333 XR Mastoids <3 View/Side; Left Radiology 70120 $31.20 630334 XR Mastoids <3 View/Side; Left - Report Radiology 70120 $32.40 630335 XR Mastoids <3 View/Side; Bilat Radiology 70120 $46.80 630336 XR Mastoids <3 View/Side; Bilat - Report Radiology 70120 $32.40 1170307 XR Mastoids <3 View/Side; Bilat Radiology 70120 $259.92 1170309 XR Mastoids <3 View/Side; Left Radiology 70120 $173.28 1170311 XR Mastoids <3 View/Side; Right Radiology 70120 $173.28 630322 XR Mastoids <3 View/Side; Right - Report Radiology $150.00 630324 XR Mastoids <3 View/Side; Right - Report Radiology $150.00 630326 XR Mastoids <3 View/Side; Right - Report Radiology $150.00 629690 XR Myelogram Cervical Radiology 72240 $154.80 629691 XR Myelogram Cervical - Report Radiology 72240 $157.20 630311 XR Myelogram Thoracic Radiology 72255 $158.40 630312 XR Myelogram Thoracic - Report Radiology 72255 $158.40 630317 XR Myelogram 2 or More Regions Radiology 72270 $230.20 630318 XR Myelogram 2 or More Regions - Report Radiology 72270 $229.20 1170319 XR Myelogram Cervical Radiology 72240 $1,903.60 1170325 XR Myelogram 2 or More Regions Radiology 72270 $1,903.60 1170327 XR Myelogram Thoracic Radiology 72255 $1,903.60 630309 XR Nasal Bones 3 View Radiology 70160 $30.00 630310 XR Nasal Bones 3 View - Report Radiology 70160 $30.00 1170329 XR Nasal Bones 3 Views Radiology 70160 $173.28 630303 XR Optic Foramina Right Radiology 70190 $38.40 630304 XR Optic Foramina Right - Report Radiology 70190 $37.20 630305 XR Optic Foramina Left Radiology 70190 $38.40 630306 XR Optic Foramina Left - Report Radiology 70190 $37.20 1170333 XR Optic Foramina Left Radiology 70190 $173.28 1170335 XR Optic Foramina Right Radiology 70190 $173.28 630297 XR Orbits Right; Min 4 View Radiology 70200 $49.20 630298 XR Orbits Right; Min 4 View - Report Radiology 70200 $48.00 630299 XR Orbits Left; Min 4 View Radiology 70200 $49.20 630300 XR Orbits Left; Min 4 View - Report Radiology 70200 $48.00 630301 XR Orbits Bilat; Min 4 View Radiology 70200 $73.80 630302 XR Orbits Bilat; Min 4 View - Report Radiology 70200 $48.00 630507 XR Orbit Foreign Body Right Radiology 70030 $28.80 630508 XR Orbit Foreign Body Right - Report Radiology 70030 $28.80 630511 XR Orbit Foreign Body Left Radiology 70030 $28.80 630512 XR Orbit Foreign Body Left - Report Radiology 70030 $28.80 630515 XR Orbit Foreign Body Bilat Radiology 70030 $43.20 630516 XR Orbit Foreign Body Bilat - Report Radiology 70030 $28.80 1170201 XR Orbit Foreign Body Bilat Radiology 70030 $259.92 1170203 XR Orbit Foreign Body Left Radiology 70030 $173.28 1170205 XR Orbit Foreign Body Right Radiology 70030 $173.28 1170337 XR Orbits Bilateral; Min 4 Views Radiology 70200 $430.55 1170339 XR Orbits Left; Min 4 Views Radiology 70200 $286.97 1170341 XR Orbits Right; Min 4 Views Radiology 70200 $286.97 630285 XR Pelvis Radiology 72170 $30.00 630286 XR Pelvis - Report Radiology 72170 $33.60 1170351 XR Pelvis Radiology 72170 $286.97 630245 XR Pharynx and or Cervical Esophagus Radiology 74210 $61.20 630246 XR Pharynx and or Cervical Esophagus - Report Radiology 74210 $60.00 1170359 XR Pharynx and or Cervical Esophagus Radiology 74210 $286.97 3148772 XR Pharynx or Larynx w/ Fluoroscopy Radiology 70370 $54.00 3150723 XR Pharynx or Larynx w/ Fluoroscopy Radiology 70370 $173.28 3150725 XR Pharynx or Larynx w/ Fluoroscopy - Report Radiology 70370 $56.40 630225 XR Ribs Bilat and Chest Radiology 71111 $56.40 630226 XR Ribs Bilat and Chest - Report Radiology 71111 $55.20 630227 XR Ribs Right Radiology 71100 $38.40 630228 XR Ribs Right - Report Radiology 71100 $38.40 630229 XR Ribs Left Radiology 71100 $38.40 630230 XR Ribs Left - Report Radiology 71100 $38.40 630231 XR Ribs Bilat Radiology 71110 $50.40 630232 XR Ribs Bilat - Report Radiology 71110 $48.00 1170371 XR Ribs Left Radiology 71100 $173.28 1170373 XR Ribs Right Radiology 71100 $173.28 1170375 XR Ribs Bilat Radiology 71110 $286.97 1170377 XR Ribs Bilat and Chest Radiology 71111 $286.97 629964 XR SW Funct. w/Video; Speech Path. Radiology 74230 $91.20 629965 XR SW Funct. w/Video; Speech Path. - Report Radiology 74230 $91.20 1170500 XR SW Funct. w/Video; Speech Path. Radiology 74230 $286.97 630186 XR Sacrum and Coccyx Radiology 72220 $30.00 630187 XR Sacrum and Coccyx - Report Radiology 72220 $30.00 630196 XR Sacroiliac Joints 3 or More View Radiology 72202 $32.40 630197 XR Sacroiliac Joints 3 or More View - Report Radiology 72202 $32.40 630215 XR Sacroiliac Joints <3 View Radiology 72200 $30.00 630216 XR Sacroiliac Joints <3 View - Report Radiology 72200 $30.00 1170385 XR Sacroiliac Joints <3 Views Radiology 72200 $286.97 1170387 XR Sacroiliac Joints 3 or More Views Radiology 72202 $286.97 1170391 XR Sacrum and Coccyx Radiology 72220 $173.28 630162 XR Scapula Right Radiology 73010 $31.20 630163 XR Scapula Right - Report Radiology 73010 $33.60 630165 XR Scapula Left Radiology 73010 $31.20 630167 XR Scapula Left - Report Radiology 73010 $33.60 630170 XR Scapula Bilat Radiology 73010 $46.80 630171 XR Scapula Bilat - Report Radiology 73010 $33.60 1170399 XR Scapula Bilat Radiology 73010 $259.92 1170401 XR Scapula Left Radiology 73010 $173.28 1170403 XR Scapula Right Radiology 73010 $173.28 1170478 XR Scoliosis Standing Radiology 72081 $216.20 630156 XR Sella Turcica Radiology 70240 $33.60 630157 XR Sella Turcica - Report Radiology 70240 $33.60 1170405 XR Sella Turcica Radiology 70240 $173.28 630142 XR Shoulder 1 View Right Radiology 73020 $27.60 630143 XR Shoulder 1 View Right - Report Radiology 73020 $27.60 630146 XR Shoulder 1 View Left Radiology 73020 $27.60 630147 XR Shoulder 1 View Left - Report Radiology 73020 $27.60 630150 XR Shoulder 1 View Bilat Radiology 73020 $41.40 630151 XR Shoulder 1 View Bilat - Report Radiology 73020 $27.60 711792 XR Shoulder 2 View Bilat Radiology 73030 $48.60 711793 XR Shoulder 2 View Left Radiology 73030 $32.40 711794 XR Shoulder 2 View Right Radiology 73030 $32.40 1170407 XR Shoulder 1 View Bilat Radiology 73020 $259.92 1170409 XR Shoulder 1 View Left Radiology 73020 $173.28 1170411 XR Shoulder 1 View Right Radiology 73020 $173.28 1170419 XR Shoulder 2 View Bilat Radiology 73030 $259.92 1170421 XR Shoulder 2 View Bilat - Report Radiology 73030 $36.00 1170422 XR Shoulder 2 View Left Radiology 73030 $173.92 1170424 XR Shoulder 2 View Left - Report Radiology 73030 $36.00 1170425 XR Shoulder 2 View Right Radiology 73030 $173.92 1170427 XR Shoulder 2 View Right - Report Radiology 73030 $36.00 630100 XR Sinus >3 View Radiology 70220 $43.20 630101 XR Sinus >3 View - Report Radiology 70220 $44.40 630105 XR Sinus <3 View Radiology 70210 $30.00 630107 XR Sinus <3 View - Report Radiology 70210 $31.20 1170432 XR Sinus <3 Views Radiology 70210 $173.28 1170434 XR Sinus >3 Views Radiology 70220 $173.28 630092 XR Skull >4 View Radiology 70260 $60.00 630093 XR Skull >4 View - Report Radiology 70260 $60.00 630096 XR Skull <4 View Radiology 70250 $43.20 630097 XR Skull <4 View - Report Radiology 70250 $43.20 1170436 XR Skull <4 Views Radiology 70250 $286.97 1170438 XR Skull >4 Views Radiology 70260 $286.97 630084 XR Small Bowel Follow Through, SBFT Radiology 74250 $80.40 630085 XR Small Bowel Follow Through, SBFT - Report Radiology 74250 $81.60 1170442 XR Small Bowel Follow Through, SBFT Radiology 74250 $286.97 630307 XR Soft Tissue Neck Radiology 70360 $28.80 630308 XR Soft Tissue Neck - Report Radiology 70360 $30.00 1170331 XR Soft Tissue Neck Radiology 70360 $173.28 629600 XR Spine Cervical 3 View Radiology 72040 $38.40 629601 XR Spine Cervical 3 View - Report Radiology 72040 $42.00 629602 XR Spine Cervical w/Obl Radiology 72050 $54.00 629603 XR Spine Cervical w/Obl - Report Radiology 72050 $55.20 629614 XR Spine Cervical w/Flex and Ext Radiology 72052 $62.40 629692 XR Spine Cervical 1 view Radiology 72020 $26.40 629693 XR Spine Cervical 1 view - Report Radiology 72020 $26.40 629987 XR Spine Thoracic w/Obliques - Report Radiology 72080 $42.00 629994 XR Spine Thoracic w/Obliques Radiology 72074 $37.20 629995 XR Spine Thoracic w/Obliques - Report Radiology 72074 $38.40 629997 XR Spine Thoracic 2 View w/Swim Radiology 72072 $37.20 629999 XR Spine Thoracic 2 View w/Swim - Report Radiology 72072 $37.20 630002 XR Spine Thoracic 2 View Radiology 72070 $38.40 630003 XR Spine Thoracic 2 View - Report Radiology 72070 $39.60 630007 XR Spine Scoliosis Series - Report Radiology 72020 $26.40 630017 XR Spine Scoliosis Series Radiology 72081 $45.60 630022 XR Spine Lumbar w/Obl Radiology 72110 $54.00 630023 XR Spine Lumbar w/Obl - Report Radiology 72110 $56.40 630028 XR Spine Lumbar w/Obl.+Flex & Ext Radiology 72114 $56.40 630029 XR Spine Lumbar w/Obl.+Flex & Ext - Report Radiology 72114 $67.20 630032 XR Spine Lumbosacral Bending Only Radiology 72120 $38.40 630048 XR Spine Lumbar 3 View Radiology 72100 $38.40 630050 XR Spine Lumbar 3 View - Report Radiology 72100 $42.00 630076 XR Spine Thoracic 1 view Radiology 72020 $26.40 630078 XR Spine Thoracic 1 view - Report Radiology 72020 $26.40 630080 XR Spine Lumbar 1 view Radiology 72020 $26.40 630081 XR Spine Lumbar 1 view - Report Radiology 72020 $26.40 711796 XR Spine Lumbar, Flex & Ext View Only Radiology 72120 $38.40 1170446 XR Spine 1 View; Cervical Radiology 72020 $173.28 1170448 XR Spine 1 View; Lumbar Radiology 72020 $173.28 1170450 XR Spine 1 View; Thoracic Radiology 72020 $173.28 1170465 XR Spine Entire AP&Lat Radiology $398.83 1170469 XR Spine Lumbar, Flex & Ext View Only - Report Radiology 72120 $43.20 1170482 XR Spine Single View Specify Level Radiology 72020 $148.43 3148943 XR Spine Cervical w/Obl.+Flex and Ext Radiology 72052 $62.40 3150663 XR Spine Cervical w/Obl.+Flex and Ext - Report Radiology 72052 $64.80 3332069 XR Spine Scoliosis AP Only Radiology 72081 $45.60 3332070 XR Spine Scoliosis Series AP & LAT Radiology 72082 $55.20 3332072 XR Spine Scoliosis Series Min of 6 View Radiology 72084 $73.20 3332139 XR Spine Scoliosis AP Only Radiology 72081 $173.28 3332141 XR Spine Scoliosis Series 4 or 5 View Radiology 72083 $547.11 3332144 XR Spine Scoliosis Series AP & LAT Radiology 72082 $286.97 3332147 XR Spine Scoliosis Series Min of 6 View Radiology 72084 $547.11 629974 XR Sternum Radiology 71120 $38.40 629975 XR Sternum - Report Radiology 71120 $34.80 629976 XR Sternoclavicular Joints Radiology 71130 $38.40 629977 XR Sternoclavicular Joints - Report Radiology 71130 $38.40 1170494 XR Sternoclavicular Joints Radiology 71130 $173.28 1170496 XR Sternum Radiology 71120 $173.28 629922 XR TMJ, Open &Closed Mouth; Right Radiology 70328 $31.20 629924 XR TMJ, Open &Closed Mouth; Right - Report Radiology 70328 $32.40 629928 XR TMJ, Open & Closed Mouth; Left Radiology 70328 $31.20 629929 XR TMJ, Open & Closed Mouth; Left - Report Radiology 70328 $32.40 629932 XR TMJ, Open & Closed Mouth; Bilat Radiology 70330 $42.00 629933 XR TMJ, Open & Closed Mouth; Bilat - Report Radiology 70330 $43.20 1170502 XR TMJ, Open & Closed Mouth; Bilat Radiology 70330 $173.28 1170504 XR TMJ, Open & Closed Mouth; Left Radiology 70328 $173.28 1170506 XR TMJ, Open &Closed Mouth; Right Radiology 70328 $173.28 1170484 XR Thoracic Spine 2 Views Radiology 72070 $286.97 1170486 XR Thoracic Spine 2 Views w/Swim View Radiology 72072 $286.97 1170488 XR Thoracic Spine w/Obliques Radiology 72074 $286.97 1170490 XR Thoracolumbar Spine 2 Views Radiology 72080 $148.43 629936 XR Tibia and Fibula Right Radiology 73590 $28.80 629937 XR Tibia and Fibula Right - Report Radiology 73590 $30.00 629942 XR Tibia and Fibula Left Radiology 73590 $28.80 629943 XR Tibia and Fibula Left - Report Radiology 73590 $30.00 629946 XR Tibia and Fibula Bilat Radiology 73590 $43.20 629947 XR Tibia and Fibula Bilat - Report Radiology 73590 $30.00 1170514 XR Tibia and Fibula Bilat Radiology 73590 $259.92 1170516 XR Tibia and Fibula Left Radiology 73590 $173.28 1170518 XR Tibia and Fibula Right Radiology 73590 $173.28 3145456 XR Toe(s) Left Radiology 73660 $22.80 3145457 XR Toe(s) Right Radiology 73660 $22.80 3150738 XR Toe(s) Left Radiology 73660 $173.28 3150741 XR Toe(s) Right Radiology 73660 $173.28 3193095 XR Toe(s) Bilat Radiology 73660 $34.20 3193179 XR Toe(s) Bilat Radiology 73660 $259.92 613636 XR Tomogram, Other Than Urography; Right Radiology 76101 $97.20 613637 XR Tomogram, Other Than Urography; Right - Report Radiology 76101 $128.40 613638 XR Tomogram, Other Than Urography; Left Radiology 76101 $97.20 613639 XR Tomogram, Other Than Urography; Left - Report Radiology 76101 $128.40 613640 XR Tomo Bilat, Other Than Uro. Radiology 76102 $118.80 613641 XR Tomo Bilat, Other Than Uro. - Report Radiology 76102 $132.00 1170548 XR Tomo Bilat, Other Than Uro. Radiology 76102 $547.11 1170550 XR Tomogram, Other Than Urography; Left Radiology 76101 $286.97 1170552 XR Tomogram, Other Than Urography; Right Radiology 76101 $286.97 3145458 XR Tomography Other Than, W/Urography Radiology 76100 $108.00 3150747 XR Tomography Other Than, W/Urography Radiology 76100 $286.97 3150749 XR Tomography Other Than, W/Urography - Report Radiology 76100 $112.80 613595 XR UGI wo/KUB - Report Radiology 74240 $120.00 613597 XR UGI w/KUB - Report Radiology 74241 $117.60 613601 XR UGI w/Air Contrast w/KUB - Report Radiology 74247 $118.80 613605 XR UGI w/SBFT - Report Radiology 74245 $156.00 1170570 XR UGI w/Small Bowel (SBFT) Radiology 74249 $502.00 661733 XR Unlist. Diag. Rad. Proc. Radiology 76499 $25.00 661734 XR Unlist. Diag. Rad. Proc. - Report Radiology 76499 $25.00 1170554 XR Unlist. Diag. Rad. Proc. Radiology 76499 $148.43 613588 XR Upper Ext Infant 2 View Bilat Radiology 73092 $41.40 613589 XR Upper Ext Infant 2 View Bilat - Report Radiology 73092 $28.80 613590 XR Upper Ext Infant 2 View Left Radiology 73092 $27.60 613591 XR Upper Ext Infant 2 View Left - Report Radiology 73092 $28.80 613592 XR Upper Ext Infant 2 View Right Radiology 73092 $27.60 613593 XR Upper Ext Infant 2 View Right - Report Radiology 73092 $28.80 1170556 XR Upper Ext Infant 2 Views Bilat Radiology 73092 $430.55 1170558 XR Upper Ext Infant 2 Views Left Radiology 73092 $286.97 1170560 XR Upper Ext Infant 2 Views Right Radiology 73092 $286.97 613606 XR Urethrocystography, Retrograde Radiology 74450 $56.40 613607 XR Urethrocystography, Retrograde - Report Radiology 74450 $57.60 1170578 XR Urethrocystography, Retrograde Radiology 74450 $547.11 613610 XR Urography, Retrograde Radiology 74420 $60.00 613611 XR Urography, Retrograde - Report Radiology 74420 $63.60 613617 XR Urography, Retrograde - Report Radiology 75822 $182.40 613619 XR Urography, Retrograde - Report Radiology 75820 $120.00 613621 XR Urography, Retrograde - Report Radiology 75820 $120.00 613623 XR Urography, Retrograde - Report Radiology 75822 $182.40 613625 XR Urography, Retrograde - Report Radiology 75820 $120.00 613627 XR Urography, Retrograde - Report Radiology 75820 $120.00 1170582 XR Urography, Retrograde Radiology 74420 $1,002.37 1170590 XR Venogram Lower Ext Bilat Radiology 75822 $1,876.64 1170592 XR Venogram Lower Ext Left Radiology 75820 $1,876.64 1170594 XR Venogram Lower Ext Right Radiology 75820 $1,876.64 1170596 XR Venogram Upper Ext Bilat Radiology 75822 $1,876.64 1170598 XR Venogram Upper Ext Left Radiology 75820 $1,876.64 1170600 XR Venogram Upper Ext Right Radiology 75820 $1,876.64 613609 XR Voiding Cystourethrogram (VCUG) - Report Radiology 74455 $56.40 611594 XR Wrist 3 View Right Radiology 73110 $30.00 611595 XR Wrist 3 View Right - Report Radiology 73110 $31.20 611596 XR Wrist 3 View Left Radiology 73110 $30.00 611597 XR Wrist 3 View Left - Report Radiology 73110 611598 XR Wrist 3 View Bilat Radiology 73110 $45.00 611599 XR Wrist 3 View Bilat - Report Radiology 73110 613630 XR Wrist 2 View Bilat Radiology 73100 $43.20 613631 XR Wrist 2 View Bilat - Report Radiology 73100 $32.40 613632 XR Wrist 2 View Left Radiology 73100 $28.80 613633 XR Wrist 2 View Left - Report Radiology 73100 $32.40 613634 XR Wrist 2 View Right Radiology 73100 $28.80 613635 XR Wrist 2 View Right - Report Radiology 73100 $32.40 1170604 XR Wrist 2 Views Bilat Radiology 73100 $259.92 1170606 XR Wrist 2 Views Left Radiology 73100 $173.28 1170608 XR Wrist 2 Views Right Radiology 73100 $173.28 1170610 XR Wrist >2 Views Bilat Radiology 73110 $259.92 1170612 XR Wrist >2 Views Left Radiology 73110 $173.28 1170614 XR Wrist >2 Views Right Radiology 73110 $173.28 3193102 XR Wrist w/ Navicular Left Radiology 73110 $30.00 3193103 XR Wrist Complete w/ Navicular Right Radiology 73110 $30.00 3193174 XR Wrist Complete w/ Navicular Left Radiology 73110 $173.28 3193176 XR Wrist Complete w/ Navicular Right Radiology 73110 $173.28 RESPIRATORY THERAPY PROCEDURES 3150920 1st hour - Continuous Aerosol 1st Hour Charge RT Tx/Procedures 94644 $259.86 1058047 Aerosol Inhalation Pentamindine Charge RT Tx/Procedures 94642 $425.96 3151269 Completed - Arterial Puncture RT Tx/Procedures 36600 $259.86 3151280 Completed - RT Demo/Eval NEB RT Tx/Procedures 94664 $425.96 3151287 Completed - RT Demo/Eval MDI RT Tx/Procedures 94664 $425.96 3151294 Completed - RT Demo/Eval DPI RT Tx/Procedures 94664 $425.96 3338434 Completed - RT Demo/Eval EzPAP RT Tx/Procedures 94664 $425.96 1058045 Continuous Aerosol Each Addl Hour Charge RT Tx/Procedures 94645 $47.00 3150915 Done - CO2 Charge RT Tx/Procedures 94770 $128.00 3134307 End Tidal CO2 Monitoring RT Tx/Procedures 94770 $628.00 3150894 Initial - Ventilator Charge RT Tx/Procedures 94002 $1,302.76 $228.00 3150937 Initial - Chest Physiotherapy Charge RT Tx/Procedures 94667 $259.86 3150946 Initial - Metered Treatment Charge RT Tx/Procedures 94640 $425.96 3151244 Initial - BiPAP Charge RT Tx/Procedures 94660 $191.00 3151260 Initial - CPAP Charge RT Tx/Procedures 94660 $425.96 3311762 Initial - Airway Treatment Charge RT Tx/Procedures 94640 $425.96 3338393 Initial - Aerosol Treatment Charge RT Tx/Procedures 94640 $425.96 3338417 Initial - EzPAP Charge RT Tx/Procedures 94640 $425.96 3339471 Initial - Dry powder inhaler charge RT Tx/Procedures 94640 $425.96 3338428 Nebulizer set-up - Respiratory Therapy Equipment Changed RT Tx/Procedures A7003 $13.36 3134303 Pulse Oximetry Continuous RT RT Tx/Procedures 94762 $12.00 3134305 Pulse Oximetry Spot Check RT RT Tx/Procedures 94761 $12.00 3133062 RT Demo/Eval NEB RT Tx/Procedures 94664 $425.96 3127332 Respiratory Syncytial Virus Washing RT Tx/Procedures 94799 $425.96 689590 Sputum Induction RT Tx/Procedures 94640 $425.96 3150893 Subsequent - Ventilator Charge RT Tx/Procedures 94003 $760.00 $232.00 3150936 Subsequent - Chest Physiotherapy Charge RT Tx/Procedures 94668 $159.53 3150945 Subsequent - Metered Treatment Charge RT Tx/Procedures 94640 $340.76 3151243 Subsequent - BiPAP Charge RT Tx/Procedures 94660 $191.00 3151259 Subsequent - CPAP Charge RT Tx/Procedures 94660 $425.96 3311761 Subsequent - Airway Treatment Charge RT Tx/Procedures 94640 $340.76 3338392 Subsequent - Aerosol Treatment Charge RT Tx/Procedures 94640 $340.76 3338416 Subsequent - EzPAP Charge RT Tx/Procedures 94640 $340.76 3339470 Subsequent - Dry powder inhaler charge RT Tx/Procedures 94640 $340.76 3134301 Suction Non Vent Patient RT Tx/Procedures 31720 $170.50 SLEEP STUDY CHARGES 3311496 Polysomnography Diagnostic 95810 Sleep Lab 95810 $570.00 3311497 Polysomnography; titration/split-night 95811 Sleep Lab 95811 $610.80 3151176 Yes - Diagnostic Sleep Study Sleep Lab 95810 $2,225.19 3150981 Yes - Home Sleep Study Sleep Lab G0399 $369.79 3151169 Yes - Multi Sleep Latency Test (MSLT) Sleep Lab 95805 $1,245.60 3151183 Yes - Split Sleep/Titration Sleep Study Sleep Lab 95811 $2,225.19 3151272 Yes - Unattended Sleep Study Completed Sleep Lab 95806 $369.79 SURGERY CHARGES NOT INCLUDING OR TIME/SUPPLIES/ANESTHESEIA AS THESE ARE DETERMINED BY THE LENGTH OF THE PROCEDURE AND THE PREFERENCES OF YOUR SURGEON 3142848 Abdominal Paracentesis Surgery 49083 $378.00 3142849 Abdominoplasty Surgery 15830 $4,078.80 3284113 Abdominal Paracentesis; without Imaging Guidance Surgery 49082 $258.00 3142850 Ablation Endometrial Surgery 58353 $745.20 3142851 Adenoidectomy Surgery 42830 $723.60 3142852 Adjustment External Fixator Surgery 20693 $1,536.00 3142853 Adrenalectomy Surgery 60540 $3,681.60 3142854 Adrenalectomy Laparoscopic Surgery 60650 $4,143.60 3142856 Alveoloplasty Surgery 41874 $912.00 3142857 Amputation Arm Lower Surgery 25900 $2,457.60 3142858 Amputation Arm Upper Surgery 24900 $2,536.80 3142859 Amputation Finger Surgery 26952 $2,210.40 3142860 Amputation Foot Surgery 28800 $1,886.40 3142861 Amputation Hand Surgery 25920 $2,402.40 3142862 Amputation Knee Above Surgery 27591 $3,350.40 3142863 Amputation Knee Below Surgery 27880 $3,217.20 3142864 Amputation Penis Surgery 54125 $2,800.80 3142865 Amputation Revision Arm Surgery 25909 $2,373.60 3142866 Amputation Revision Finger Surgery 26952 $2,210.40 3142867 Amputation Revision Foot Surgery 28800 $1,886.40 3142868 Amputation Revision Hand Surgery 25931 $2,283.60 3142870 Amputation Revision Toe Surgery 28810 $1,507.20 3142871 Amputation Thumb Surgery 26952 $2,210.40 3142872 Amputation Toe Surgery 28820 $1,378.80 3142873 Anoscopy Surgery 46600 $141.60 3108674 Appendectomy Laparoscopic Surgery 44970 $2,092.80 3142874 Appendectomy Surgery 44950 $2,238.00 3142875 Application Arch Bars Surgery 21110 $2,359.20 3142877 Application External Fixatior Foot Surgery 20692 $3,876.00 3142878 Application External Fixation Maxilla Surgery 20692 $3,876.00 3142879 Application External Fixator Hand Surgery 20692 $3,876.00 3142880 Application External Fixator Lower Extremity Surgery 20692 $3,876.00 3142881 Application Splint Surgery 29131 $114.00 3142882 Application Wound Vac Surgery 97605 $85.20 3142883 Arthrodesis Ankle Surgery 27870 $3,571.20 3142884 Arthrodesis Foot Surgery 28730 $2,540.40 3142885 Arthrodesis Subtalar Joint Surgery 28725 $2,691.60 3142886 Arthrodesis Triple Surgery 28715 $3,248.40 3182094 Arthrodesis First Metatarsophalangeal Joint Surgery 28750 $2,050.80 3182095 Arthroeresis Subtalar Joint Surgery 28725 $2,599.30 3142887 Arthroplasty Ankle Surgery 27700 $2,056.80 3142888 Arthroplasty Elbow Surgery 24360 $3,072.00 3142889 Arthroplasty Hip Surgery 27125 $3,937.20 3142890 Arthroplasty Toe Surgery 28153 $903.60 3254610 Arthroplasty, temporomandibular joint, with or without graft Surgery 21240 $3,932.40 3283999 Arthroplasty, Metacarpophalangeal Joint, with Prosthetic Implant, each Joint Surgery 26531 $2,163.60 3142891 Arthroscopy Ankle Surgery 29894 $1,726.80 3142892 Arthroscopy Knee Surgery 29870 $1,431.60 3142893 Arthroscopy Knee Chondroplasty Surgery 29877 $2,160.00 3142894 Arthroscopy Knee Lateral Release Surgery 29873 $1,822.80 3142895 Arthroscopy Knee Ligament Repair Surgery 29888 $3,415.20 3142896 Arthroscopy Knee Meniscal Repair Surgery 29882 $2,434.80 3142897 Arthroscopy Knee Meniscectomy Surgery 29881 $1,880.40 3142898 Arthrotomy Ankle Surgery 27610 $2,256.00 3142899 Arthrotomy Finger Surgery 26075 $1,146.00 3142900 Arthrotomy Foot Surgery 28022 $1,132.80 3142901 Arthrotomy Toe Surgery 28024 $1,056.00 3142902 Aspiration Amniotic Fluid Surgery 59000 $280.80 3142903 Aspiration Bone Marrow Surgery 38220 $212.40 3142904 Aspiration Breast Cyst Surgery 19000 $151.20 3142905 Aspiration Joint Surgery 20610 $159.60 3143535 Aspiration Bladder Surgery 51101 $180.00 3142907 Biopsy Anus Surgery 46606 $264.00 3142908 Biopsy Artery Surgery 37200 $766.80 3142909 Biopsy Artery Temporal Surgery 37609 $723.60 3142910 Biopsy Bone Surgery 20245 $1,785.60 3142911 Biopsy Bone Iliac Crest Surgery 20220 $252.00 3142912 Biopsy Bone Marrow Surgery 38221 $258.00 3142913 Biopsy Breast Surgery 19101 $764.40 3142914 Biopsy Breast Percutaneous Surgery 19100 $242.40 3142915 Biopsy Bronchus Surgery 31625 $585.60 3142916 Biopsy Chest Wall Surgery 21550 $547.20 3142917 Biopsy Clavicle Surgery 20245 $1,785.60 3142918 Biopsy Colon Surgery 44100 $379.20 3142919 Biopsy Ear Surgery 69100 $169.20 3142920 Biopsy Endocervical Surgery 57500 $259.20 3142921 Biopsy Endometrial Surgery 58100 $298.80 3142922 Biopsy Esophagus Surgery 43202 $382.80 3142923 Biopsy Esophagus Endoscopic Surgery 43202 $382.80 3142924 Biopsy Eyelid Surgery 67810 $246.00 3142925 Biopsy Gland Parotid Surgery 42405 $790.80 3142926 Biopsy Gland Salivary Surgery 42405 $790.80 3142927 Biopsy Intestine Large Surgery 44025 $3,438.00 3142928 Biopsy Intestine Small Surgery 44010 $3,004.80 3142929 Biopsy Kidney Surgery 50205 $2,605.20 3142930 Biopsy Lip Surgery 40490 $254.40 3142931 Biopsy Liver Surgery 47100 $2,938.80 3142932 Biopsy Liver Laparoscopic Surgery 49321 $1,200.00 3142933 Biopsy Liver Percutaneous Surgery 47000 $357.60 3142934 Biopsy Lung Surgery 32405 $360.00 3142936 Biopsy Lymph Node Surgery 38500 $884.40 3142937 Biopsy Lymph Node Pelvic Surgery 38500 $884.40 3142938 Biopsy Lymph Node Peritoneal Surgery 38570 $1,747.20 3142939 Biopsy Mass Abdominal Surgery 49180 $297.60 3142940 Biopsy Muscle Surgery 20205 $541.20 3142941 Biopsy Nipple Surgery 19100 $242.40 3142942 Biopsy Oral Mucosa Surgery 41108 $319.20 3142943 Biopsy Palate Surgery 42100 $387.60 3142944 Biopsy Pancreas Surgery 48100 $3,078.00 3142945 Biopsy Penis Surgery 54105 $734.40 3142946 Biopsy Perineal Surgery 56605 $206.40 3142947 Biopsy Pleural Surgery 32400 $302.40 3142948 Biopsy Rectum Surgery 45100 $1,039.20 3142949 Biopsy Soft Tissue Surgery 27614 $1,394.40 3142950 Biopsy Spermatic Cord Surgery 54800 $440.40 3142951 Biopsy Stomach Surgery 43605 $2,918.40 3142952 Biopsy Testicle Surgery 54505 $724.80 3142953 Biopsy Tongue Surgery 41100 $380.40 3142954 Biopsy Trachea Surgery 31535 $662.40 3142955 Biopsy Ureter Surgery 52354 $1,442.40 3142956 Biopsy Vagina Surgery 57100 $229.20 3142957 Biopsy Vulva Surgery 56605 $206.40 3143536 Biopsy Ovary Surgery 58900 $1,558.80 3142989 Bronchoscopy Surgery 31622 $498.00 3142990 Bronchoscopy Fiber Optic Surgery 31622 $498.00 3142991 Bronchoscopy with Biopsy Surgery 31625 $585.60 3145093 Bronchoscopy with Washings Surgery 31624 $585.60 3142992 Bunionectomy Surgery 28296 $1,802.40 3142993 Bursectomy Surgery 24105 $1,213.20 3142994 Bursectomy Knee Surgery 27340 $1,286.40 3319482 CRT-D Generator Change Out, Dual Lead Surgery 33263 $1,392.00 3319535 CRT-D Generator Change Out, Multiple Lead Surgery 33264 $1,450.80 3319487 CRT-P Generator Change Out, Multiple Lead Surgery 33229 $1,340.40 3142995 Calcanectomy Surgery 28119 $1,246.80 3142996 Catheterization Ureteral Surgery 52005 $459.60 3142997 Cerclage Cervical Surgery 59320 $530.40 3116507 Cesarean Section Surgery 59515 $4,393.20 3142998 Change Dressing Surgery 15852 $162.00 3494323 Chest Tube Removal Surgery 32552 $549.60 3108672 Cholecystectomy Laparoscopic Surgery 47562 $2,287.20 3108679 Cholecystectomy Laparoscopic with Cholangiogram Surgery 47563 $2,484.00 3142999 Cholecystectomy Surgery 47600 $3,717.60 3143000 Cholecystectomy Cholangiogram Surgery 47605 $3,915.60 3143003 Cholecystojejunostomy Surgery 47720 $4,005.60 3182097 Cholecystectomy Laparoscopic with Cholangiogram and Common Duct Exploration Surgery 47564 $3,876.00 3143004 Choledochoduodenostomy Surgery 47720 $4,005.60 3143005 Circumcision Surgery 54161 $678.00 3143006 Closed Reduction Elbow Surgery 24605 $1,626.00 3143007 Closed Reduction Femur Surgery 27268 $1,840.80 3143008 Closed Reduction Fibula Surgery 27788 $1,330.80 3143009 Closed Reduction Finger Surgery 26755 $943.20 3143010 Closed Reduction Humerus Surgery 24500 $1,124.40 3143011 Closed Reduction Mandible Surgery 21451 $2,238.00 3143012 Closed Reduction Maxilla Surgery 21421 $2,221.20 3143013 Closed Reduction Nasal Fracture Surgery 21310 $93.60 3143014 Closed Reduction Radius Surgery 24655 $1,365.60 3143015 Closed Reduction Temporomandibular Dislocation Surgery 21485 $2,052.00 3143016 Closed Reduction Tibia Surgery 27752 $1,722.00 3143017 Closed Reduction Ulna Surgery 24675 $1,428.00 3182098 Closed Reduction Tibia with IM Nail Surgery 27759 $3,465.60 3368667 Closed Reduction Ankle Surgery 27810 $1,471.20 3143019 Closure Colostomy Surgery 44625 $3,546.00 3143020 Closure Colostomy Laparoscopic Surgery 44227 $5,816.40 3143021 Closure Fistula Enterocutaneous Surgery 44640 $4,893.60 3143022 Closure Fistula Small Intestine Surgery 44650 $5,061.60 3143023 Closure Fistula Stomach Surgery 43880 $5,574.00 3143024 Closure Ileostomy Surgery 44620 $3,024.00 3143025 Closure Vein Minimally Invasive Surgery 36475 $986.40 3143026 Closure Wound Dehiscence Surgery 12020 $672.00 3143027 Closure Wound Secondary Surgery 13160 $2,792.40 3143028 Closure Wound Sternal Surgery 13101 $878.40 3108673 Colonoscopy Surgery 45378 $670.80 3143029 Colonoscopy Biopsy Surgery 45380 $727.20 3143030 Colonoscopy Control Bleeding Surgery 45382 $933.60 3143031 Colonoscopy Decompression Surgery 45393 $910.80 3143032 Colonoscopy Dilatation Surgery 45386 $766.80 3143033 Colonoscopy Foreign Body Removal Surgery 45379 $862.80 3143034 Colonoscopy Polypectomy Surgery 45385 $918.00 3143035 Colonoscopy Stoma Surgery 44388 $570.00 3143036 Colonoscopy Stoma Biopsy Surgery 44389 $625.00 3143037 Colonoscopy Stoma Control Bleeding Surgery 44391 $832.80 3143038 Colonoscopy Stoma Foreign Body Removal Surgery 44390 $762.00 3143039 Colonoscopy Stoma Snare Surgery 44394 $814.80 3143040 Colostomy Surgery 44320 $4,188.00 3143041 Colostomy Laparoscopic Surgery 44188 $4,270.80 3143042 Colpocleisis Surgery 57120 $1,736.40 3143043 Colpopexy Abdominal Surgery 57280 $3,249.60 3143044 Colpopexy Laparoscopic Surgery 57425 $3,302.40 3143045 Colpopexy Vaginal Surgery 57283 $2,347.20 3143046 Colposcopy Surgery 57420 $315.60 3143047 Colpotomy Surgery 57000 $642.00 3143048 Cone Biopsy Cervix Surgery 57520 $939.60 3143049 Control Hemorrhage Post Op Tonsillectomy and Adenoidectomy Surgery 42960 $595.20 3143050 Curettage Bone Cyst Surgery 28104 $1,224.00 3143051 Cystectomy Ovarian Laparoscopic Surgery 58661 $2,220.00 3143052 Cystectomy Partial Surgery 51550 $3,313.20 3143538 Cystectomy Surgery 51570 $5,102.40 3143053 Cystoscopy Surgery 52000 $434.40 3143054 Cystoscopy Foreign Body Removal Surgery 52315 $948.00 3143055 Cystoscopy Ureteral Stent Insertion Surgery 52332 $537.60 3143056 Cystoscopy Ureteral Stent Removal Surgery 52310 $523.20 3143057 Cystoscopy Ureteral Stent Replacement Surgery 50387 $337.20 3143058 Debridement Abdominal Wall Surgery 11005 $2,728.80 3143059 Debridement Ankle Surgery 29898 $1,954.80 3143060 Debridement Arm Surgery 11012 $1,484.40 3143061 Debridement Ear Surgery 11042 $212.40 3143062 Debridement Elbow Surgery 11012 $1,484.40 3143063 Debridement Flank Surgery 11012 $1,484.40 3143064 Debridement Foot Surgery 11044 $801.60 3143065 Debridement Hand Surgery 11043 $537.60 3143066 Debridement Hip Surgery 11043 $537.60 3143067 Debridement Lower Extremity Surgery 11044 $801.60 3143068 Debridement Metatarsophalangeal Joint Surgery 11044 $801.60 3143069 Debridement Muscle Surgery 11043 $537.60 3143070 Debridement Nose Surgery 11044 $801.60 3143071 Debridement Perineum Surgery 11004 $2,014.80 3143072 Debridement Shoulder Surgery 11043 $537.60 3143073 Debridement Sternum Surgery 21627 $1,867.20 3143074 Debridement Tendon Surgery 11043 $537.60 3143075 Debridement Upper Extremity Surgery 11043 $537.60 3143076 Debridement Wound Surgery 11044 $801.60 3143077 Debridement Wrist Surgery 11044 $801.60 3143078 Decompression Hip Core Surgery 27071 $3,172.80 3143079 Decompression Nerve Median Surgery 64721 $1,483.20 3143080 Decompression Nerve Ulnar Surgery 64718 $2,056.80 3143081 Decompression Tarsal Tunnel Release Surgery 28035 $1,225.20 3143082 Decortication Lung Surgery 32220 $5,527.20 3143083 Decortication Lung Partial Surgery 32225 $3,470.40 3143084 Dilatation and Curettage Surgery 59812 $1,018.80 3143085 Dilatation and Curettage Suction Surgery 58120 $747.60 3143086 Dilatation and Evacuation Surgery 59841 $1,252.80 3143087 Dilatation Biliary Surgery 47555 $1,278.00 3143088 Dilatation Esophageal Surgery 43249 $560.40 3143089 Dilatation Esophageal with Stent Insertion Surgery 43212 $688.80 3143090 Dilatation Ileostomy Surgery 44314 $3,492.00 3143091 Dilatation Rectum Surgery 45910 $674.40 3143092 Dilatation Urethral Surgery 53605 $223.20 3143093 Direct Laryngoscopy Surgery 31525 $558.00 3143094 Direct Laryngoscopy Biopsy Surgery 31535 $662.40 3143095 Disarticulation Ankle Surgery 27889 $2,281.20 3143096 Dissection Lymph Node Surgery 38500 $884.40 3143097 Dissection Lymph Node Axillary Surgery 38500 $884.40 3143098 Dissection Lymph Node Pelvic Surgery 38500 $884.40 3143099 Dissection Lymph Node Sentinel Surgery 38500 $884.40 3143100 Dissection Lymph Node Supraclavicular Surgery 38510 $1,464.00 3143101 Drainage Pancreatic Pseudocyst Surgery 48510 $3,793.20 3143102 Drainage Pancreatic Pseudocyst Laparoscopic Surgery 49322 $1,278.00 3254614 Drainage Abscess, Cyst, Hematoma from Dentoalveolar Structure - Dentistry Surgery 41800 $517.20 3254616 Drainage Abscess, Cyst, Hematoma from Dentoalveolar Structure - Oral Maxillofacial Surgery 41800 $517.20 3261932 Drainage Abscess, Cyst, Hematoma from Dentoalveolar Structure Surgery 41800 $517.20 3108677 Esophagogastroduodenoscopy Surgery 43235 $451.20 3143103 Esophagogastroduodenoscopy Balloon Dilatation Surgery 43249 $560.40 3143104 Esophagogastroduodenoscopy Biopsy Surgery 43239 $506.40 3143105 Esophagogastroduodenoscopy Control Bleeding Surgery 43255 $727.20 3143106 Esophagogastroduodenoscopy Foreign Body Removal Surgery 43247 $644.40 3143107 Esophagogastroduodenoscopy Gastric Outlet Dilatation Surgery 43245 $638.40 3143108 Esophagogastroduodenoscopy Guided Dilatation Surgery 43248 $604.80 3143109 Esophagogastroduodenoscopy Polypectomy Surgery 43250 $618.00 3143110 Esophagogastroduodenoscopy Snare Surgery 43251 $711.60 3143111 Esophagogastroduodenoscopy with Peg Placement Surgery 43246 $724.80 3143112 Evacuation Hematoma Surgery 10140 $405.60 3182099 Exam Under Anesthesia Rectal Surgery 45990 $375.60 3143117 Excision Bone Spur Surgery 28119 $1,246.80 3143118 Excision Condyloma Surgery 46922 $469.20 3143119 Excision Cyst Bakers Surgery 27345 $1,656.00 3143120 Excision Cyst Bile Duct Surgery 47715 $4,644.00 3143121 Excision Cyst Bladder Surgery 52224 $704.40 3143124 Excision Cyst Mandible Surgery 21047 $4,628.40 3143125 Excision Cyst Maxilla Surgery 21049 $4,219.20 3143126 Excision Cyst Mediastinal Surgery 39200 $3,090.00 3143127 Excision Cyst Neck Surgery 11426 $950.40 3143128 Excision Cyst Nose Surgery 30125 $2,095.20 3143129 Excision Cyst Ovarian Surgery 58925 $2,548.80 3143130 Excision Cyst Pancreatic Surgery 48120 $3,864.00 3143131 Excision Cyst Pilonidal Surgery 11770 $638.40 3143132 Excision Cyst Vaginal Surgery 57135 $591.60 3143133 Excision Cyst Vulva Surgery 56625 $2,164.80 3143134 Excision Ganglion Surgery 25111 $1,107.60 3143136 Excision Goiter Substernal Surgery 60270 $4,761.60 3143137 Excision Gynecomastia Surgery 19300 $1,428.00 3143138 Excision Ingrown Nail Surgery 11750 $349.20 3143139 Excision Keloid Surgery 11406 $850.80 3143140 Excision Lesion Anus Surgery 46922 $469.20 3143141 Excision Lesion Basal Cell Surgery 11646 $1,376.40 3143143 Excision Lesion Facial Surgery 11440 $354.00 3143144 Excision Lesion Neck Surgery 11426 $950.40 3143145 Excision Lesion Penis Surgery 54065 $597.60 3143146 Excision Lesion Rectum Surgery 45172 $2,812.80 3143147 Excision Lesion Trunk Surgery 11046 $194.40 3143148 Excision Lesion Vaginal Surgery 57135 $591.60 3143149 Excision Lesion Vulvar Surgery 56740 $1,028.40 3143150 Excision Lipoma Surgery 15839 $2,557.20 3143151 Excision Lipoma Abdominal Wall Surgery 22900 $1,958.40 3143152 Excision Lipoma Arm Surgery 25073 $1,844.40 3143153 Excision Lipoma Back Surgery 21933 $2,559.60 3143154 Excision Lipoma Breast Surgery 19120 $1,430.40 3143155 Excision Lipoma Chest Wall Surgery 19260 $4,180.80 3143156 Excision Lipoma Knee Surgery 27328 $2,151.60 3143157 Excision Lipoma Leg Surgery 27619 $1,627.20 3143158 Excision Lipoma Neck Surgery 21556 $1,840.80 3143159 Excision Lipoma Pelvis Surgery 27045 $2,594.40 3143160 Excision Lipoma Scalp Surgery 21012 $1,173.60 3143161 Excision Lipoma Scapula Surgery 23140 $1,842.00 3143162 Excision Lipoma Shoulder Surgery 11406 $850.80 3143163 Excision Lymphangioma Surgery 38308 $1,533.60 3143164 Excision Mammary Duct Surgery 19112 $1,071.60 3143165 Excision Melanoma Surgery 11640 $430.80 3143166 Excision Neuroblastoma Surgery 49203 $4,167.60 3143167 Excision Neuroma Mortons Surgery 28080 $1,269.60 3143168 Excision Papilloma Anus Surgery 46924 $636.00 3143169 Excision Papilloma Penis Surgery 54060 $448.80 3143170 Excision Submandibular Gland Surgery 42440 $1,441.20 3143171 Excision Xiphoid Process Surgery 21620 $1,749.60 3143539 Excision Cyst Toe Surgery 28092 $928.80 3143540 Excision Lesion Oral Surgery 40814 $1,083.60 3143541 Excision Neuroma Surgery 64774 $1,447.20 3145094 Excision Lesion Arm Surgery 11406 $850.80 3145095 Excision Lesion Back Surgery 11406 $850.80 3182100 Excision Lipoma Flank Surgery 21933 $2,559.60 3254686 Excision Benign Tumor/Cyst Mandible Osteotomy (Destructive Lesion) Surgery 21046 $3,924.00 3282940 Excision of Lip, Transverse Wedge Excision with Primary Closure Surgery 40510 $1,249.20 3287314 Excision, Excessive Skin and Subcutaneous Tissue, Arms Surgery 15836 $2,647.20 3287319 Excision, Excessive Skin and Subcutaneous Tissue, Thigh Surgery 15832 $3,195.60 3287460 Excision of Lingual Frenum Surgery 41115 $540.00 3323244 Excision Soft Tissue Mass Forearm/Wrist Surgery 25071 $1,476.00 3323245 Excision Soft Tissue Mass Upper Arm/Elbow Surgery 24071 $1,406.40 3323249 Excision Soft Tissue Mass Shoulder Surgery 23071 $1,454.40 3323250 Excision Soft Tissue Mass Pelvis/Hip Surgery 27043 $1,630.80 3323251 Excision Soft Tissue Mass Thigh/Knee Surgery 27337 $1,450.80 3323252 Excision Soft Tissue Mass Leg/Ankle Surgery 27632 $1,438.80 3323253 Excision Soft Tissue Mass Foot/Toe Surgery 28041 $1,600.80 3323284 Excision Soft Tissue Mass Leg/Ankle Surgery 27632 $1,438.80 3482758 Excision Lesion Leg Surgery 11400 $277.20 3500478 Excision Umbilicus Surgery 49250 $2,042.40 3143172 Exostectomy Foot Surgery 28288 $1,480.80 3143173 Exploration Abdominal Wall Surgery 49000 $2,683.20 3143174 Exploration Finger Surgery 26075 $1,146.00 3143175 Exploration Foot Surgery 28024 $1,056.00 3143176 Exploration Inguinal Surgery 49010 $3,253.20 3143177 Exploration Knee Surgery 29870 $1,431.60 3143178 Exploration Neck Surgery 60500 $3,352.80 3143179 Exploration Scrotum Surgery 55110 $1,336.80 3143180 Exploration Wound Surgery 20102 $886.80 3143182 Fasciectomy Surgery 28060 $1,231.20 3143183 Fasciotomy Plantar Surgery 28008 $1,009.20 3143542 Fasciotomy Surgery 25020 $1,996.80 3182103 Fasciotomy Plantar Endoscopic Surgery 29893 $1,478.40 3143184 Fissurectomy Anal Surgery 46200 $1,122.00 3143185 Fistulectomy Anal Surgery 46275 $1,432.80 3143186 Fulguration Condyloma Surgery 46910 $464.40 3143187 Fulguration Endometrial Surgery 58353 $745.20 3379280 Fulguration Warts, Benign, Up to 14 Surgery 17110 $240.00 3379281 Fulguration Warts, Benign, 15 or more Surgery 17111 $295.20 3143188 Fundoplication Laparoscopic Surgery 43280 $3,766.80 3143190 Gastrectomy Surgery 43632 $7,089.60 3143191 Gastrectomy Laparoscopic Surgery 43775 $4,267.20 3143192 Gastrectomy Partial Laparoscopic Surgery 43775 $4,267.20 3143194 Gastric Banding Laparoscopic Surgery 43770 $3,896.40 3143195 Gastric Stapling Laparoscopic Surgery 43644 $6,025.20 3145096 Gastric Analysis Surgery 43754 $114.00 3143196 Gastroenterostomy Surgery 43810 $3,544.80 3143197 Gastrojejunostomy Surgery 43820 $4,678.80 3143198 Gastrojejunostomy with Partial Gastrectomy Surgery 43632 $7,089.60 3143199 Gastroscopy with Bravo Capsule Placement Surgery 91035 $1,628.40 3143200 Gastrostomy Laparoscopic Surgery 43653 $1,992.00 3182104 Genioplasty Surgery 21120 $1,815.60 3182105 Gingivectomy Surgery 41820 $1,616.90 3143201 Graft Bone Femur Surgery 27170 $4,075.20 3143202 Graft Bone Iliac Crest Surgery 20956 $9,243.60 3143203 Graft Bone Malar Area Surgery 21210 $3,040.80 3143204 Graft Bone Mandible Surgery 21215 $3,163.20 3143205 Graft Bone Maxilla Surgery 21210 $3,040.80 3143206 Graft Bone Navicular Surgery 25431 $2,724.00 3143550 Graft Bone Alveolar Surgery 21146 $5,383.20 3143207 Hemiarthroplasty Shoulder Surgery 23470 $4,168.80 3145097 Hemiarthroplasty Hip Surgery 27125 $3,937.20 3143208 Hemorrhoid Banding Surgery 46221 $656.40 3143209 Hemorrhoidectomy Surgery 46260 $1,650.00 3143211 Hydrocelectomy Surgery 55041 $1,758.00 3143212 Hymenotomy Surgery 56442 $163.20 3143213 Hysterectomy Abdominal Total Surgery 58150 $3,468.00 3143214 Hysterectomy Abdominal Total Anterior Posterior Repair Surgery 58150 $3,468.00 3143215 Hysterectomy Abdominal Total Anterior Posterior Repair with Salpingo-Oophorectomy Surgery 58150 $3,468.00 3143216 Hysterectomy Abdominal Total with Burch Procedure Surgery 58152 $4,262.40 3143217 Hysterectomy Abdominal Total with Salpingo-Oophorectomy Surgery 58150 $3,468.00 3143218 Hysterectomy Supracervical Laparoscopic Surgery 58541 $2,440.80 3143219 Hysterectomy Total Vaginal Surgery 58260 $2,811.60 3143220 Hysterectomy Vaginal Anterior Posterior Repair Surgery 58260 $2,811.60 3143221 Hysterectomy Vaginal Anterior Posterior Repair with Salpingo-Oophorectomy Surgery 58262 $3,139.20 3143222 Hysterectomy Vaginal Laparoscopic Surgery 58550 $3,001.20 3143223 Hysterectomy Vaginal Laparoscopic Anterior Posterior Repair Surgery 58550 $3,001.20 3143224 Hysterectomy Vaginal Total Anterior Repair Surgery 58260 $2,811.60 3143226 Hysterectomy Vaginal with Salpingo-Oophorectomy Surgery 58262 $3,139.20 3148875 Hysterectomy Vaginal Total Surgery 58260 $2,811.60 3148876 Hysterectomy Vaginal Total with Uterosacral Ligament Suspension Surgery 58260 $2,811.60 3148945 Hysterectomy Vaginal Laparoscopic With Uterosacral Ligament Suspension Surgery 58550 $3,001.20 3182106 Hysterectomy Total Laparoscopic Surgery 58571 $3,069.60 3182107 Hysterectomy Total Vaginal with Uterosacral Ligament Suspension Surgery 58260 $2,811.60 3143227 Hysteroscopy Surgery 58555 $645.60 3319470 ICD Generator Change Out, Single Lead Surgery 33262 $1,339.20 3319477 ICD Generator Removal Surgery 33241 $792.00 3319471 ICD Implantation Single Lead Surgery 33249 $3,226.80 3319472 ICD Implantation Dual Lead Surgery 33249 $3,226.80 3143229 Ileojejunostomy Surgery 44120 $4,268.40 3143230 Ileojejunostomy Laparoscopic Surgery 44202 $4,831.20 3143231 Ileostomy Surgery 44310 $3,642.00 3143232 Ileostomy Laparoscopic Surgery 44187 $3,859.20 3143233 Incision and Drainage Breast Surgery 19020 $1,053.60 3143234 Incision and Drainage Buttock Surgery 10140 $405.60 3143235 Incision and Drainage Face Surgery 10140 $405.60 3143236 Incision and Drainage Femur Surgery 27303 $2,200.80 3143237 Incision and Drainage Finger Surgery 26011 $639.60 3143238 Incision and Drainage Hand Surgery 26025 $1,453.20 3143239 Incision and Drainage Head Surgery 10140 $405.60 3143240 Incision and Drainage Hip Surgery 26990 $2,161.20 3143241 Incision and Drainage Humerus Surgery 23935 $1,752.00 3143242 Incision and Drainage Knee Surgery 27301 $1,738.80 3143243 Incision and Drainage Lower Extremity Surgery 27603 $1,346.40 3143244 Incision and Drainage Lymphocele Surgery 49062 $2,552.40 3143245 Incision and Drainage Neck Surgery 21501 $1,113.60 3143246 Incision and Drainage Pelvis Surgery 26990 $2,161.20 3143247 Incision and Drainage Perineal Area Surgery 56405 $369.60 3143248 Incision and Drainage Rectal Abscess Surgery 45005 $559.20 3143250 Incision and Drainage Upper Extremity Surgery 25028 $1,810.80 3145098 Incision and Drainage Surgery 10040 $302.40 3143251 Injection Blood Patch Epidural Surgery 62273 $397.20 3143252 Injection Botox Surgery 46505 $825.60 3143253 Injection Nerve Spinal Accessory Surgery 64615 $432.00 3143254 Injection Steroid Sacroiliac Joint Surgery 27096 $292.80 3143255 Injection Steroid Surgery 27096 $292.80 3143258 Injection Trigger Point Surgery 20552 $130.80 3143259 Insertion Antibiotics Beads Hip Surgery 11981 $285.60 3143260 Insertion Arterial Line Surgery 36620 $178.80 3143261 Insertion Central Venous Line Surgery 36561 $1,236.00 3143262 Insertion Chest Tube Surgery 32551 $589.20 3143263 Insertion Compression Screw Hip Surgery 27244 $4,281.60 3143265 Insertion Feeding Tube Surgery 49440 $770.40 3143266 Insertion Gastrojejunostomy Tube Surgery 49441 $891.60 3143268 Insertion Gastrostomy Tube Laparoscopic Surgery 43653 $1,992.00 3143269 Insertion Gastrostomy Tube Percutaneous Surgery 43246 $724.80 3143270 Insertion Implantable Venous Access Port Surgery 36561 $1,236.00 3143271 Insertion Intrathecal Catheter Surgery 62350 $1,404.00 3143273 Insertion Stent Ureteral Surgery 51045 $1,671.60 3143274 Insertion Stimulator Bone Surgery 20975 $610.80 3143275 Insertion Stimulator Vagus Nerve Surgery 61885 $1,815.60 3143276 Insertion Suprapubic Catheter Surgery 51102 $499.20 3143277 Insertion Tension Free Vaginal Tape Surgery 57288 $2,439.60 3143278 Insertion Tissue Expander Surgery 19357 $5,241.60 3143279 Insertion Tracheostomy Tube Percutaneous Surgery 31603 $780.00 3143280 Insertion Traction Pin Surgery 20650 $543.60 3182109 Insertion Fat Graft Orbital Surgery 15770 $2,334.00 3319488 Insertion Loop Recorder Surgery 33285 $310.80 3353590 Insertion Percutaneous Drain Tube Surgery 10030 $585.60 3276164 Intrauterine Device Removal OR Surgery 58301 $230.40 3143281 Intubation Surgery 31500 $380.40 3143544 Irrigation Bladder Surgery 51700 $154.80 3143282 Jejunostomy Surgery 44310 $3,642.00 3143283 Koch Pouch with Stone Removal Endoscopic Surgery 44385 $268.80 3143284 Laparoscopy Diagnostic Surgery 49320 $1,130.40 3143285 Laparoscopy Exploratory Surgery 49320 $1,130.40 3143286 Laparotomy Exploratory Surgery 49000 $2,683.20 3143287 Laparotomy Mini Surgery 58615 $825.60 3143288 Laparotomy Staging Surgery 58960 $3,357.60 3143289 Laryngoscopy Surgery 31575 $265.20 3143290 Laryngoscopy Biopsy Surgery 31535 $662.40 3143291 Lengthening Achilles Tendon Surgery 27685 $1,598.40 3143292 Ligation and Stripping Vein Surgery 37718 $1,546.80 3143293 Ligation Tubal Surgery 58615 $825.60 3143294 Ligation Tubal Laparoscopic Surgery 58671 $1,240.80 3143295 Ligation Tubal Post Partum Surgery 58611 $262.80 3143296 Lobectomy Lung Surgery 32480 $5,161.20 3143297 Lobectomy Thyroid Surgery 60210 $2,456.40 3143298 Lobectomy Thyroidectomy Surgery 60225 $3,238.80 3143299 Loop Electrode Excision Procedure Surgery 57460 $555.60 3143300 Lumbar Puncture Surgery 62270 $270.00 3143301 Lumpectomy Breast Surgery 19301 $2,263.20 3143302 Lumpectomy Breast with Sentinel Node Biopsy Surgery 19301 $2,263.20 3143545 Lymph Node, Open Biopsy Surgery 38500 $884.40 3143303 Lymphadenectomy Surgery 38747 $928.80 3143304 Lymphadenectomy Laparoscopic Surgery 38571 $2,304.00 3143305 Lysis Adhesions Surgery 44005 $3,813.60 3143306 Lysis Adhesions Laparoscopic Surgery 44180 $3,198.00 3143307 Manipulation Stone Surgery 52330 $912.00 3145099 Manipulation Joint Knee Surgery 27570 $523.20 3528494 Manipulation Joint Shoulder Surgery 23700 $678.00 3143308 Marsupialization Bartholin Cyst Surgery 56440 $621.60 3143310 Mastectomy Modified Radical with Sentinel Node Biopsy Surgery 19307 $4,143.60 3143311 Mastectomy Radical Surgery 19305 $3,907.20 3143312 Mastectomy Simple Surgery 19303 $3,500.47 3143313 Meatoplasty Surgery 53450 $1,407.60 3143314 Meatotomy Surgery 53025 $248.40 3252585 Menisectomy, Partial or Complete, Temporomandibular Joint Surgery 21060 $2,779.20 3143315 Myomectomy Surgery 58140 $3,146.40 3143316 Myomectomy Laparoscopic Surgery 58545 $3,080.40 3143317 Nephrectomy Surgery 50220 $3,613.20 3143318 Nephrectomy Laparoscopic Surgery 50546 $4,153.20 3276248 Omental flap, intra-abdominal Surgery 49905 $1,230.00 3143319 Omentectomy Surgery 49255 $2,751.60 3143320 Oophorectomy Surgery 58940 $1,791.60 3516241 Oophorectomy Laparoscopic Surgery 58661 $2,214.00 3143321 Open Reduction Internal Fixation Ankle Surgery 27814 $2,677.20 3143322 Open Reduction Internal Fixation Calcaneus Surgery 28415 $3,834.00 3143323 Open Reduction Internal Fixation Clavicle Surgery 23515 $2,490.00 3143324 Open Reduction Internal Fixation Elbow Surgery 24635 $2,330.40 3143325 Open Reduction Internal Fixation Femur Surgery 27269 $4,304.40 3143326 Open Reduction Internal Fixation Fibula Surgery 27784 $2,481.60 3143327 Open Reduction Internal Fixation Finger Surgery 26765 $1,736.40 3143328 Open Reduction Internal Fixation Foot Surgery 28485 $1,812.00 3143329 Open Reduction Internal Fixation Hand Surgery 26615 $1,999.20 3143330 Open Reduction Internal Fixation Hip Surgery 27228 $6,560.40 3143331 Open Reduction Internal Fixation Humerus Surgery 23615 $3,063.60 3143332 Open Reduction Internal Fixation Mandible Surgery 21462 $3,668.40 3143333 Open Reduction Internal Fixation Maxilla Surgery 21422 $2,353.20 3143334 Open Reduction Internal Fixation Nasal Fracture Surgery 21330 $1,969.20 3143335 Open Reduction Internal Fixation Patella Surgery 27524 $2,606.40 3143336 Open Reduction Internal Fixation Pelvis Surgery 27217 $2,998.80 3143337 Open Reduction Internal Fixation Radius Surgery 25515 $2,316.00 3143338 Open Reduction Internal Fixation Radius and Ulna Surgery 25574 $2,326.80 3143339 Open Reduction Internal Fixation Shoulder Surgery 23615 $3,063.60 3143340 Open Reduction Internal Fixation Sinus Facial Fracture Surgery 21344 $4,843.20 3143341 Open Reduction Internal Fixation Supracondylar Fracture Surgery 27511 $3,460.80 3143342 Open Reduction Internal Fixation Tibia Surgery 27535 $3,115.20 3143343 Open Reduction Internal Fixation Toe Surgery 28505 $1,731.60 3143344 Open Reduction Internal Fixation Ulna Surgery 24685 $2,263.20 3143345 Open Reduction Internal Fixation Wrist Surgery 25628 $2,499.60 3143346 Open Reduction Internal Fixation Zygoma Surgery 21365 $3,882.00 3143347 Open Reduction Mandible Surgery 21462 $3,668.40 3182110 Open Reduction Internal Fixation Orbital Surgery 21406 $1,801.20 3143349 Orchiectomy Surgery 54520 $1,118.40 3143350 Orchiopexy Surgery 54650 $2,446.80 3143351 Osteotomy Calcaneus Surgery 28300 $2,240.40 3143352 Osteotomy Cuboid with Fusion Surgery 28304 $2,060.40 3143359 Osteotomy Metatarsal Surgery 28308 $1,296.00 3143360 Osteotomy Talus Surgery 28302 $2,482.80 3143361 Osteotomy Tarsal Surgery 28305 $2,280.00 3143362 Osteotomy Toe Surgery 28312 $1,099.20 3182113 Osteotomy Maxilla LeFort I Surgery 21141 $4,696.80 3182114 Osteotomy Maxilla LeFort I Segmental Surgery 21141 $4,696.80 3182115 Osteotomy Maxilla LeFort II Surgery 21150 $5,845.20 3319441 Pacemaker Generator Change Out, Dual Lead Surgery 33228 $1,272.00 3319442 Pacemaker Generator Change Out, Single Lead Surgery 33227 $1,220.40 3319467 Pacemaker Implantation Single Lead Surgery 33207 $1,712.40 3319468 Pacemaker Implantation Dual Lead Surgery 33208 $1,855.20 3319469 Pacemaker Generator Removal Surgery 33233 $842.40 3143363 Pancreatectomy Surgery 48150 $10,869.60 3143364 Panniculectomy Surgery 15830 $4,078.80 3143366 Parathyroidectomy Surgery 60500 $3,352.80 3143367 Parotidectomy Surgery 42410 $2,174.40 3143368 Patellectomy Surgery 27350 $2,247.60 3143369 Pelviscopy Chromotubation Surgery 58350 $266.40 3143370 Perineoplasty Surgery 56810 $886.80 3143372 Pinning Percutaneous Arm Surgery 25606 $2,295.60 3143373 Pinning Percutaneous Finger Surgery 26756 $1,446.00 3143374 Pinning Percutaneous Foot Surgery 28476 $1,216.80 3143375 Pinning Percutaneous Hand Surgery 26608 $1,649.80 3143376 Pinning Percutaneous Hip Surgery 27235 $3,160.80 3143377 Pinning Percutaneous Leg Surgery 27509 $2,221.20 3143378 Pinning Percutaneous Shoulder Surgery 24582 $2,788.80 3143379 Pinning Percutaneous Toe Surgery 28496 $808.80 3143380 Pinning Percutaneous Wrist Surgery 25651 $1,666.80 3254627 Plastic Repair Cleft Lip/Nasal Deformity, Primary, Bilateral, 1-Stage Surgery 40701 $3,535.20 3254639 Plastic Repair Cleft Lip/Nasal Deformity, Primary, Unilateral Surgery 40700 $3,153.60 3254652 Plastic Repair of Cleft Lip/Nasal Deformity with Cross Lip Pedicle Flap (Abbe-Estlander Type), Inclu Surgery 40761 $3,796.80 3254656 Plastic Repair of Cleft Lip/Nasal Deformity, Primary Bilateral, 1 of 2 Stage Surgery 40702 $2,964.00 3254682 Plastic Repair of Cleft Lip/Nasal Deformity, Secondary, By Recreation of Defect and Re-Closure Surgery 40720 $3,588.00 3143381 Pleurodesis Thoracoscopic Surgery 32650 $2,323.20 3143382 Pneumonectomy Surgery 32440 $5,473.20 3143383 Polypectomy Cervical Surgery 57500 $259.20 3143384 Polypectomy Rectal Surgery 45308 $309.60 3143385 Polypectomy Uterine Surgery 58558 $909.60 3143386 Proctoscopy Surgery 46600 $141.60 3143387 Proctosigmoidectomy Surgery 45123 $3,901.20 3145100 Pyloroplasty Surgery 43800 $3,237.60 3143388 Reanastomosis Bowel Surgery 44130 $4,579.20 3143389 Reconstruction Ankle Surgery 27700 $2,056.80 3143390 Reconstruction Mandibular with Allograft Surgery 21194 $5,007.60 3182116 Reconstruction Orbital Floor Surgery 21386 $2,427.60 3143392 Reduction Breast Surgery 19318 $3,836.40 3143393 Release Contracture Surgery 23020 $2,368.80 3143394 Release Contracture Dupuytrens Surgery 26045 $1,623.60 3143395 Release Mallet Finger Surgery 26432 $1,704.00 3143396 Release Tendon Surgery 27685 $1,598.40 3143397 Release Tendon Adductor Surgery 27001 $1,849.20 3143398 Release Tendon Elbow Surgery 24357 $1,478.40 3143399 Release Tenosynovitis Hand Surgery 25000 $1,166.40 3143400 Release Trigger Finger Surgery 26055 $1,072.80 3143401 Removal Arch Bars Surgery 21110 $2,359.20 3143402 Removal Breast Implant Surgery 19328 $1,725.60 3143403 Removal Dialysis Catheter Surgery 49422 $1,326.00 3143404 Removal External Fixator Ankle Surgery 20694 $1,164.00 3143405 Removal External Fixator Elbow Surgery 20694 $1,164.00 3143406 Removal External Fixator Leg Surgery 20694 $1,164.00 3143407 Removal External Fixator Wrist Surgery 20694 $1,164.00 3143408 Removal Foreign Body Surgery 10121 $640.80 3143409 Removal Foreign Body Ear Surgery 69205 $351.60 3143410 Removal Foreign Body Nose Surgery 30310 $709.20 3143411 Removal Gastric Band Laparoscopic Surgery 43772 $3,301.20 3143412 Removal Hardware Elbow Surgery 20680 $1,467.60 3143413 Removal Hardware Extremity Lower Surgery 20680 $1,467.60 3143414 Removal Hardware Extremity Upper Surgery 20680 $1,467.60 3143415 Removal Hardware Finger Surgery 20670 $510.00 3143416 Removal Hardware Pelvis Surgery 20680 $1,467.60 3143417 Removal Hardware Shoulder Surgery 20680 $1,467.60 3143419 Removal Intramedullary Rod Surgery 20680 $1,467.60 3143420 Removal Jejunostomy Tube Surgery 43999 $3,019.20 3143423 Removal Sternal Wire Surgery 20680 $1,467.60 3143424 Removal Suture Surgery 15851 $157.20 3143425 Removal Tissue Expander Surgery 11971 $1,106.40 3143547 Removal of tunneled central venous access device Surgery 36590 $714.00 3145101 Removal Hardware Hip Surgery 20680 $1,467.60 3145102 Removal Skin Tag Surgery 11200 $250.80 3182117 Removal Hardware Facial Fracture Surgery 20680 $1,467.60 3182118 Removal Mandibular Tori Surgery 21031 $1,036.80 3182119 Removal Maxillary Tori Surgery 21032 $1,026.00 3261930 Removal of Oral Implant, Deep Surgery 20680 $1,467.60 3275661 Removal of Cervical Cerclage Suture under Anesthesia Surgery 59871 $463.20 3319491 Removal Loop Recorder Surgery 33286 $304.80 3108676 Repair Hernia Umbilical Surgery 49585 $1,545.60 3143426 Repair Achilles Tendon Surgery 27650 $2,281.20 3143427 Repair Anterior Vagina Surgery 57240 $2,289.60 3143428 Repair Biceps Muscle Surgery 24341 $2,582.40 3143429 Repair Bladder Rupture Surgery 51865 $3,082.80 3143430 Repair Cleft Lip Surgery 40700 $3,153.60 3143431 Repair Cleft Palate Surgery 42210 $3,472.80 3143432 Repair Club Foot Surgery 28262 $4,116.00 3143433 Repair Cystocele Surgery 57240 $2,289.60 3143434 Repair Cystocele and Enterocele Surgery 57265 $3,106.80 3143435 Repair Cystocele with Insertion Tension Free Vaginal Tape Surgery 57240 $2,289.60 3143436 Repair Dehiscence Abdominal Fascial Defect Surgery 49900 $2,833.20 3143437 Repair Diastasis Recti Surgery 22999 $4,624.80 3143438 Repair Enterocele Surgery 57268 $1,650.00 3143439 Repair Esophageal Fistula Surgery 43420 $3,548.40 3143440 Repair Evisceration Surgery 49900 $2,833.20 3143442 Repair Hammer Toe Surgery 28285 $1,294.80 3143443 Repair Hernia Diaphragmatic Surgery 39541 $3,288.00 3143445 Repair Hernia Epigastric Surgery 49570 $1,446.00 3143446 Repair Hernia Hiatal Abdominal Approach Surgery 43337 $5,701.20 3143447 Repair Hernia Hiatal Laparoscopic Surgery 49652 $2,586.00 3143448 Repair Hernia Hiatal Thoracic Approach Surgery 39541 $3,288.00 3143449 Repair Hernia Incisional Surgery 49560 $2,562.00 3143450 Repair Hernia Incisional Laparoscopic Surgery 49654 $2,936.40 3143451 Repair Hernia Inguinal Surgery 49505 $1,807.20 3143452 Repair Hernia Inguinal Laparoscopic Surgery 49650 $1,485.60 3143453 Repair Hernia Spigelian Surgery 49590 $1,988.40 3143454 Repair Hernia Umbilical Laparoscopic Surgery 49652 $2,586.00 3143455 Repair Hernia Ventral Surgery 49560 $2,562.00 3143456 Repair Hernia Ventral Laparoscopic Surgery 49652 $2,586.00 3143457 Repair Laceration Surgery 40831 $792.00 3143458 Repair Laceration Liver Surgery 47360 $6,483.60 3143459 Repair Posterior Sacrospinous Fixation Surgery 57282 $1,707.60 3143460 Repair Posterior Vagina Surgery 57250 $2,304.00 3143461 Repair Rectal Prolapse Surgery 45540 $3,685.20 3143462 Repair Rectocele Surgery 57250 $2,304.00 3143464 Repair Rotator Cuff Shoulder Surgery 29827 $3,668.40 3143465 Repair Tendon Extremity Surgery 24341 $2,582.40 3143467 Repair Vaginal Tear Surgery 57200 $1,026.00 3143468 Repair Vaginal Vault Surgery 57282 $1,707.60 3182120 Repair Hallux Limitus Surgery 28291 $1,663.20 3261931 Repair Fistula Oromaxillary Surgery 30600 $1,546.80 3276176 Repair Perforated Gastric/Duodenal Ulcer Surgery 43840 $4,740.00 3281943 Repair Cleft Palate w/ Pharyngeal Flap Attachment Surgery 42225 $3,076.80 3143470 Replacement Gastrostomy Tube Surgery 43762 $130.80 3143471 Resection Bowel Surgery 44147 $6,778.80 3143472 Resection Bowel Laparoscopic Surgery 44212 $7,138.80 3143473 Resection Colon Surgery 44147 $6,778.80 3143474 Resection Colon Laparoscopic Surgery 44204 $5,358.00 3143475 Resection Colon Low Anterior Surgery 44145 $5,780.40 3143476 Resection Colon Low Anterior Laparoscopic Surgery 44207 $6,345.60 3143479 Resection Liver Surgery 47120 $8,131.20 3143481 Resection Lung Wedge Surgery 32096 $2,817.60 3143482 Resection Lung Wedge Thoracoscopic Surgery 32607 $1,083.60 3143483 Resection Metatarsal Head Surgery 28114 $2,905.20 3143485 Resection Saphenous Vein Surgery 37722 $1,694.40 3143486 Resection Sigmoid Colon Surgery 44140 $4,676.40 3182121 Resection Gastrocnemius Surgery 27687 $1,567.20 3143488 Revision Colostomy Surgery 44345 $3,666.00 3143489 Revision Gastric Band Laparoscopic Surgery 43771 $4,435.20 3143549 Revision Scar Surgery 31830 $1,191.60 3275642 Revision Gastric Port Open Surgery 43886 $1,256.40 3143490 Salpingo Oophorectomy Surgery 58720 $2,520.00 3143491 Salpingo Oophorectomy Laparoscopic Surgery 58661 $2,220.00 3312859 Salpingectomy Surgery 58700 $2,655.60 3143492 Sigmoidoscopy Biopsy Surgery 45331 $253.20 3143493 Sigmoidoscopy Control Bleeding Surgery 45334 $433.20 3143494 Sigmoidoscopy Diagnostic Surgery 45300 $187.20 3143495 Sigmoidoscopy Flexible Surgery 45330 $195.60 3143496 Sigmoidoscopy Flexible Biopsy Surgery 45331 $253.20 3143497 Sigmoidoscopy Flexible Control Bleeding Surgery 45334 $433.20 3143498 Sigmoidoscopy Flexible Dilatation Surgery 45340 $292.80 3143499 Sigmoidoscopy Flexible Polypectomy Surgery 45333 $349.20 3143500 Sigmoidoscopy Polyp Snare Surgery 45338 $442.80 3143501 Sigmoidoscopy Removal Foreign Body Surgery 45332 $390.00 3143502 Sigmoidoscopy Rigid Surgery 45300 $187.20 3143503 Skin Graft Full Thickness Surgery 15240 $2,784.00 3143504 Skin Graft Full Thickness Arm Surgery 15220 $2,134.80 3143505 Skin Graft Full Thickness Leg Surgery 15220 $2,134.80 3143506 Skin Graft Full Thickness Nose Surgery 15260 $2,979.60 3143507 Skin Graft Full Thickness Trunk Surgery 15200 $2,335.20 3143508 Skin Graft Split Thickness Surgery 15120 $2,427.60 3143510 Sphincteroplasty Anal Surgery 46750 $2,616.00 3143511 Sphincterotomy Surgery 46080 $552.00 3143512 Splenectomy Surgery 38100 $4,026.00 3143513 Splenectomy Laparoscopic Surgery 38120 $3,668.40 3143514 Suspension Bladder Surgery 51845 $2,018.41 3143515 Suspension Retropubic Urethrovesical Surgery 51841 $2,684.40 3143516 Suspension Sacrospinous Vault Surgery 57282 $1,707.60 3143517 Suspension Uterine Surgery 58400 $1,504.80 3145104 Thoracentesis Surgery 32554 $310.80 3143519 Thoracoscopy Surgery 32606 $1,620.00 3143520 Thoracotomy Mini with Lung Biopsy Surgery 32098 $2,670.00 3145105 Thoracoscopy with Bullectomy Surgery 32655 $3,344.40 3143521 Thyroidectomy Surgery 60240 $3,194.40 3143522 Tonsillectomy Surgery 42825 $915.60 3143523 Tonsillectomy and Adenoidectomy Surgery 42820 $1,014.00 3143524 Tonsillectomy Lingual Surgery 42870 $2,116.80 3143525 Trachelectomy Surgery 57530 $1,186.80 3143526 Tracheostomy Surgery 31600 $1,383.60 3143527 Tracheostomy Percutaneous Surgery 31605 $858.00 3143509 Transobturator Tape Sling Placement Surgery 57288 $2,439.60 3143528 Transposition Ulnar Nerve Elbow Surgery 64718 $2,056.80 3422651 Vaginal Delivery in OR Surgery 59400 $6,959.70 3143530 Vagotomy Surgery 64760 $1,740.00 3143531 Vagotomy and Antrectomy Surgery 43640 $4,107.60 3143532 Varicocelectomy Surgery 55530 $1,209.60 3108678 Vasectomy Surgery 55250 $781.20 3143533 Vulvectomy Surgery 56620 $1,789.20