Dept. Description Std.Price DefauCPTCode ANESTHESIA Anesthesia for Reconstructive Procedures of Eyelid $102.00 00103-P ANESTHESIA Anesthesia on eye-Pterygium $102.00 00140-P ANESTHESIA Anesthesia for Lens Surgery $51.00 00142-P ANESTHESIA Anesthesia for skin,ms,head neck back $51.00 300 ANESTHESIA Anesthesia for breast I&D $102.00 00400-P ANESTHESIA Lumbar Punc diag or thera $51.00 635 ANESTHESIA Anesthesia for Upper GI Endoscopic Procedures $51.00 00731-P ANESTHESIA Anesthesia for Colonoscopy $51.00 00811-P ANESTHESIA Anesthesia for Colonoscopy-screening $51.00 00812-P ANESTHESIA Anesthesia for combined EGD,colonscopy $51.00 00813-P ANESTHESIA Anesthesia for Extraperitoneal Procedures $102.00 00860-P ANESTHESIA Anesthesia for Lithotripsy without water $102.00 00873-P ANESTHESIA Anesthesia for Transurethral Procedures $102.00 00910-P ANESTHESIA Anesthesia Transurethral Resection Prostate $12.48 00914-P ANESTHESIA Anesthesia for Male External Genitalia $102.00 00920-P ANESTHESIA Anesthesia for Undescended Testis $102.00 00924-P ANESTHESIA Anesthesia for penis amputataion $12.48 00932-P ANESTHESIA Anesthesia for Vaginal Procedures $102.00 00940-P ANESTHESIA Anesthesia diagnostic artho knee $102.00 01382-P ANESTHESIA Anesthesia arthro knee, unspecified $102.00 1400 ANESTHESIA Anesthesia Total Knee $102.00 1402 ANESTHESIA Anesthesia for procedure lower leg, foot $102.00 01470-P ANESTHESIA Anesthesia for Open Procedure-Bone $102.00 01480-P ANESTHESIA Anesthesia for Nerves, Muscles, Tendons, etc. Shoulder $102.00 01610-P ANESTHESIA Anesthesia Upper arm or elbow $102.00 1710 ANESTHESIA Anesthesia for tenotomy elbow to shoulder $102.00 01712-P ANESTHESIA Anesthesia for Nerves, Muscles, Tendons, etc. Wrist, Hand $51.00 01810-P ANESTHESIA Anesthesia closed procedures on wrist,hand $51.00 1820 ANESTHESIA Anethesia open hand surgery $12.48 01830-P ANESTHESIA * venipuncture - requiring MD or CRNA>3 $50.00 36410 ANESTHESIA Anesthesia Technical Level for Eye surgery $107.17 40000-M ANESTHESIA Anesthesia Technical Level I 1-29 min $269.49 411111-M ANESTHESIA Anesthesia Technical Level III >60 min $816.00 411113-M ANESTHESIA Anesthesia Technical Level II 30 to 60 min $535.86 422222-M ANESTHESIA ANES epidural, C or T w/o imaging $700.00 62320-P ANESTHESIA ANES Epidural Steroid Inj. LS w/o images-Fac $500.00 62322-T ANESTHESIA Mod sedation -other 5+yrs 15 min-PRO $350.00 99156-P ANESTHESIA Mod sedation-other addt 15 min-PRO $250.00 99157-P BLOOD BANK Blood/Blood Products Administration $486.96 36430-T BLOOD BANK PRBC, Leuko Reduced -tranfuse $794.95 P9016 BLOOD BANK Fresh Frozen Plasma - Administer $144.63 P9017 BLOOD BANK Platelets apher irradiated -administer $893.18 P9036 BLOOD BANK PRBC, LR Irradiated -transfused $878.18 P9040 CAT SCAN CT Head w/o contrast $1,184.09 70450 CAT SCAN CT Head w/ contrast $1,321.44 70460 CAT SCAN CT Head w, w/o $1,586.76 70470 CAT SCAN CT IAC/MID/INNER EAR WO $1,136.23 70480 CAT SCAN CT ORBIT/SELLA/OUTER-M $1,437.98 70481 CAT SCAN CT IAC/mid-inner ear, w/wo $1,346.41 70482 CAT SCAN CT Max/Fac w/o contrast $1,238.20 70486 CAT SCAN CT Sinus w/o contrast $1,238.20 70486-1 CAT SCAN CT Max/Fac w/ contrast $1,397.39 70487 CAT SCAN CT Max/Fac w, w/o contrast $1,676.25 70488 CAT SCAN CT Soft Tissue Neck w/o contrast $1,251.72 70490 CAT SCAN CT Soft Tissue Neck w/ contrast $1,437.98 70491 CAT SCAN CT Soft Tissue Neck w/wo contrast $1,722.04 70492 CAT SCAN CT Angio of the Brain (COW) $1,640.87 70496 CAT SCAN CT Angio of Carotids $1,754.29 70498 CAT SCAN CT Thorax w/o contrast $1,700.18 71250 CAT SCAN CT Thorax w/ contrast $1,951.98 71260 CAT SCAN CT Thorax w, w/o contrast $2,347.38 71270 CAT SCAN CT Angio Chest - Chest Disection of Aorta Protocol $2,188.18 71275 CAT SCAN CTA-PE study $2,606.41 71275-1 CAT SCAN CT C-Spine w/o contrast $1,229.88 72125 CAT SCAN CT T-Spine w/o contrast $1,229.88 72128 CAT SCAN CT L-Spine w/o contrast $1,229.88 72131 CAT SCAN CT Angio PEL - AAA Protocol $1,359.94 72191 CAT SCAN CT Pelvis, w/o contrast $1,032.18 72192 CAT SCAN CT Pelvis, w/ contrast $1,184.09 72193 CAT SCAN CT Upper Ext, w/o contrast $881.30 73200 CAT SCAN CT Upper Ext, w/ contrast $1,013.45 73201 CAT SCAN CT Angio Upper Extremitiy w/ cont $1,381.78 73206 CAT SCAN CT Lower Ext, w/o contrast $627.42 73700 CAT SCAN CT Lower Ext, w/ contrast $1,010.33 73701 CAT SCAN CT Angio Lower Extrem w/ cont $1,098.77 73706 CAT SCAN CT Abd, w/o contrast $1,311.04 74150 CAT SCAN CT Abd, w/ contrast $1,509.77 74160 CAT SCAN CT ABD w, w/o contrast $2,738.60 74170 CAT SCAN CT Angio ABD - AAA Protocol $1,827.13 74175 CAT SCAN CT Abd/Pelvis, w/o contrast $2,273.50 74176 CAT SCAN CT Abd/Pelvis, w/contrast $2,489.92 74177 CAT SCAN CT Abd/Pelvis, w/wo contrast $3,248.45 74178 CAT SCAN CT Urogram $3,500.00 74178-1 CAT SCAN Low dose CT screening for lung cancer $1,000.00 G0297 CENTRAL SUPPLY Oxygen titrate 94-99% per hr $20.81 22271-M CENTRAL SUPPLY Oxygen titrate 88-94% per hr $20.60 22272-M CENTRAL SUPPLY Oxygen Heat, High Flow HFNC protocol per hr $25.76 22273-M EKG *EKG Facility Charge $122.78 93005 EKG STRESS TEST/TREADMILL - facility $420.36 93017 EKG Holter Monitor Hookup $190.41 93225-T EKG EKG-Welcome to Medicare -global $163.36 G0403 EKG EKG- Welcome to Medicare - Tech $122.78 G0405-T EMERGENCY ROOM Acne surgery-FAC $81.16 10040-T EMERGENCY ROOM I&D Abcess Simple or Single (SQ)-Fac $234.11 10060-T EMERGENCY ROOM I&D multi/complex-Fac $389.15 10061-T EMERGENCY ROOM Drain pilonidal cyst-simple fac $329.66 10080-T EMERGENCY ROOM FB Removal/Incision-Fac $103.01 10120-T EMERGENCY ROOM FBR-complicated-Fac $162.32 10121-T EMERGENCY ROOM I&D hematoma/fluid-Fac $1,827.13 10140-T EMERGENCY ROOM Punct. asp. abscess,hematoma,bulla or cyst-FAC $84.28 10160-T EMERGENCY ROOM Debridement - Skin 20 Sq cm or< fac $100.00 11042-T EMERGENCY ROOM Debridement - Muscle or fascia <20cm or less-FAC $405.00 11043-T EMERGENCY ROOM Debridement - Bone <20cm-FAC $900.00 11044-T EMERGENCY ROOM Debridement skin addtn 20 sq cm-fac $51.00 11045-T EMERGENCY ROOM Debridement - additional 20 cm - muscle-FAC $490.00 11046-T EMERGENCY ROOM Debridement - additional 20cm - bone-FAC $1,350.00 11047-T EMERGENCY ROOM Exc. Benign Hyper. Lesion; 2-4-FAC $42.66 11056-T EMERGENCY ROOM Biopsy;Skin,Sub. tissue&/or mucous membrane single-FAC $74.92 11100-T EMERGENCY ROOM Surg. Biopsy:Muc./Memb. Sep./Add Lesoin-FAC $27.05 11101-T EMERGENCY ROOM Shave-Benign, Skin Tags1-15-FAC $69.72 11200-T EMERGENCY ROOM Shave Benign(tr,a,l); Diameter 0.6-1.0cm-FAC $63.47 11301-T EMERGENCY ROOM Skin Rmv.: Shave;1.1-2.0cm-FAC $95.73 11302-T EMERGENCY ROOM Skin Rmv.: Shave; over 2.0cm-FAC $122.78 11303-T EMERGENCY ROOM Shave Benign(sc,n,ha,fe,g);Lesion .5cm or less-FAC $56.19 11305-T EMERGENCY ROOM Shave Benign(sc,n,ha,fe,g);Lesion 0.6-1.0cm-FAC $107.17 11306-T EMERGENCY ROOM Shave: Epid/Derm., Nonface; Lesion over 2.0cm-FAC $109.25 11308-T EMERGENCY ROOM Shaving,Benign face <0.5cm $257.55 11310 EMERGENCY ROOM Shave: Epid/Derm.,Face; 0.6 to 1.0cm-FAC $69.72 11311-T EMERGENCY ROOM Excision Benign(tr,a,l); Lesion 0.5cm/less-FAC $117.58 11400-T EMERGENCY ROOM Excision Benign(tr,a,l); Lesion .6 to 1.0cm-FAC $107.17 11401-T EMERGENCY ROOM Excision Benign(tr,a,l);1.1 to 2.0cm-FAC $117.58 11402-T EMERGENCY ROOM Excision Benign(tr,a,l);2.1-3.0cm-FAC $153.99 11403-T EMERGENCY ROOM Excision Benign(tr,a,l);3.1-4.0cm-FAC $177.93 11404-T EMERGENCY ROOM Excision Benign(tr,a,l);Over 4.0cm-FAC $243.47 11406-T EMERGENCY ROOM Excis Benign(sc,n,ha,fe,g);0.5cm or <-FAC $70.76 11420-T EMERGENCY ROOM Excis Benign(sc,n,ha,fe,g); 0.6 to 1.0cm-FAC $120.70 11421-T EMERGENCY ROOM Excis Benign(sc,n,ha,fe,g);2.1 to 3.0cm-FAC $170.65 11423-T EMERGENCY ROOM Excis Benign Face;0.5cm or <-FAC $85.32 11440-T EMERGENCY ROOM Excis Benign(Face);0.6-1.0cm-FAC $109.25 11441-T EMERGENCY ROOM Excis Benign(Face);1.1-2.0cm-FAC $119.66 11442-T EMERGENCY ROOM Exc,Skin,Mal-(tr,a,l);0.6-1.0cm-FAC $118.62 11601-T EMERGENCY ROOM Exc,Skin,Mal-(tr,a,l);1.1-2.0cm-FAC $139.42 11602-T EMERGENCY ROOM Excision,Mal(tr,a,l);2.1-3.0cm-FAC $771.01 11603-T EMERGENCY ROOM Lesion Rmv.;Malig.(sc,ne,fe,ha,gen)0.5cm/less-FAC $163.36 11620-T EMERGENCY ROOM Lesion Rmv.;Malig.(sc,ne,fe,ha,gen);0.6-1.0cm-FAC $188.33 11622-T EMERGENCY ROOM Excision, Mal(sc,n,ha,fe,g);< 4.0cm-FAC $247.64 11626-T EMERGENCY ROOM Excis, Mal Lesion(sc,n,ha,fe,g);0.6-1.0cm-FAC $131.10 11641-T EMERGENCY ROOM Excis, Mal Lesion(sc,n,ha,fe,g);1.1-2.0cm-FAC $153.99 11642-T EMERGENCY ROOM Excis, Mal Lesion(sc,n,ha,fe,g);2.1-3.0cm-FAC $302.79 11643-T EMERGENCY ROOM Excis, Mal Lesion(sc,n,ha,fe,g);Over 4.0 cm-FAC $339.20 11646-T EMERGENCY ROOM Debrid.