Dept. - Rio Grande Hospital

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);Over 4.0 cm-FAC $339.20 11646-T

EMERGENCY ROOM Debrid. of Nail(s) Any Method(s); 1-5-FAC $20.81 11720-T

EMERGENCY ROOM Debrid. of Nail;Trim. Nondys.;6 or <-FAC $22.89 11721-T

EMERGENCY ROOM Debridement of Nail; Nail Plate-FAC $50.98 11730-T

EMERGENCY ROOM Debrid. of Nail;Evac.;Sub.Hematoma-FAC $27.05 11740-T

EMERGENCY ROOM Debrid. of Nail;Evac.;Sub.Hematoma-FAC $27.05 11740-T

EMERGENCY ROOM Repair of Nail Bed-FAC $976.00 11760-T

EMERGENCY ROOM Debrid. Nail;Wedge Exc.of Skin;Fold-FAC $59.31 11765-T

EMERGENCY ROOM Treatment of Lesions; Inj.up to 7 Lesions-FAC $33.29 11900-T

EMERGENCY ROOM Removal Contraceptive-FAC $86.36 11976-T

EMERGENCY ROOM Lac Repair FAC Supf Nonface less than 2.5 cm $249.72 12001-T

EMERGENCY ROOM Lac Repair-FAC Supf.Nonface;2.6-7.5 cm $127.98 12002-T

EMERGENCY ROOM Lac Repair-FAC Supf.Nonface;12.6-20cm $249.72 12005-T

EMERGENCY ROOM Suture-Sup.wounds(sc,n,ax,EG,tr,fe,ha); Over 30.0cm-FAC $249.72 12007-T

EMERGENCY ROOM Lac Repair Supf. Face/Head FAC; <2.5 cm $249.72 12011-T

EMERGENCY ROOM Lac Repair Supf. Face/Head FAC ; 2.6-5.0cm $143.59 12013-T

EMERGENCY ROOM Lac Repair Supf. Face/Head FAC;5.1-7.5cm $249.72 12014-T

EMERGENCY ROOM Lac Repair Supf. Face/Head FAC;7.6-12.5cm $249.72 12015-T

EMERGENCY ROOM Suture-Sup.wound(simple,fa,ea,ey,no,li,mm);12.6-20cm-FAC$621.00 12016-T

EMERGENCY ROOM Lac Repair Supf Head/Face FAC;20.1-30.0cm $228.91 12017-T

EMERGENCY ROOM Lac Repair-FAC Supf Head/Face;< 30.0cm $275.74 12018-T

EMERGENCY ROOM Sup. Wound Dehis Simp.-FAC $164.40 12020-T

EMERGENCY ROOM Sup. wound Dehis.; w/ Pack-FAC $117.58 12021-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Nonface;2.5cm or < $249.72 12031-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Nonface;7.6-12.5cm $249.72 12034-T



EMERGENCY ROOM Lac Repair-FAC Intermed. Nonface;< 30.0cm $665.92 12037-T

EMERGENCY ROOM Lac Repair FAC Intermed. Head/Face;2.6-7.5cm $249.72 12042-T

EMERGENCY ROOM Lac Repair FAC Intermed. Head/Face;2.6-7.5cm $249.72 12042-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Head/Face;7.6-12.5cm $249.72 12044-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Head/Face;12.6-20cm $249.72 12045-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Head/Face;20.1-30.0cm $249.72 12046-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Head/Face;< 30.0cm $665.92 12047-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Face;2.5cm or < $249.72 12051-T

EMERGENCY ROOM Lac Repair-FAC Intermed. Face;2.6-5.0cm $249.72 12052-T




EMERGENCY ROOM Lac Repair Intermed. Face;20.1-30cm-Fac $249.72 12056-T

EMERGENCY ROOM Lac Repair Int. Face; over 30.0 cm - FAC $621.60 12057-T

EMERGENCY ROOM Lac Repair Cmplx. Trunk; 1.1 cm-2.5 cm-FAC $977.00 13100-T

EMERGENCY ROOM Lac Repair Cmplx. Trunk; 2.6 cm-7.5 cm-FAC $976.00 13101-T

EMERGENCY ROOM Lac Repair Cmplx. Trunk; addtl. 5cm< - FAC $500.00 13102-T

EMERGENCY ROOM Lac Repair Cmplx.(sc,ar,lg); 1.1cm-2.5cm-FAC $976.00 13120-T

EMERGENCY ROOM Suture,Complex(sa,a,l);2.6-7.5cm-FAC $372.50 13121-T

EMERGENCY ROOM Suture,Cmplx(sa,a,l);Each Add. 5cm or <-FAC $249.72 13122-T

EMERGENCY ROOM Repair complx face, nect,gen,extrem 1.1-2.5cm FAC $596.70 13131-T

EMERGENCY ROOM repair complx lac-f/n/g/ext 2.6-7.5cm FAC $655.51 13132-T

EMERGENCY ROOM Lac Repair Cmplx Face; 1.1cm-2.5cm-FAC $727.00 13151-T

EMERGENCY ROOM Lac Repair Cmplx Face; 2.6cm-7.5cm-FAC $976.00 13152-T

EMERGENCY ROOM Lac Repair Cmplx Face; addtional 5cm< - FAC $500.00 13153-T

EMERGENCY ROOM Burn Init. Trmt-FAC $39.54 16000-T

EMERGENCY ROOM Burn, Debride <5%-FAC $47.86 16020-T

EMERGENCY ROOM Burn Debride 5%-10% (med.) - FAC $338.00 16025-T

EMERGENCY ROOM Burn; Large> 10%-FAC $113.41 16030-T

EMERGENCY ROOM Cryo-1st Lesion-FAC $58.27 17000-T

EMERGENCY ROOM Cryo:2-14 Lesions-FAC $10.40 17003-T

EMERGENCY ROOM Cryo Lesions 15+-FAC $199.78 17004-T

EMERGENCY ROOM Wart Removal;up to 14 Lesions-FAC $67.64 17110-T

EMERGENCY ROOM Chem. Cauterize of Gran Tissue-FAC $31.21 17250-T

EMERGENCY ROOM Malignant Lesion Destruc. .5 or <;Trunk Ext.-FAC $86.36 17260-T

EMERGENCY ROOM Malignant Lesion Destruc. 0.6-1.0cm;Trunk Ext.-FAC $106.13 17261-T

EMERGENCY ROOM Malignant Lesion Destruc. 1.1-2.0cm;Trunk Ext-FAC $126.94 17262-T

EMERGENCY ROOM Acne/Hair Removal Cryo.-FAC $55.15 17340-T

EMERGENCY ROOM Explore penetrating wound to extremety-Fac $859.45 20103-T

EMERGENCY ROOM FB Rmv. Muscle/Tendon sheath- FAC $140.46 20520-T

EMERGENCY ROOM FBR-From finger/deep complicated-Fac $2,711.55 20525-T

EMERGENCY ROOM Inj. Tendon/Ligament-FAC $48.90 20550-T

EMERGENCY ROOM Therapeutic Inj Trigger Point(s);1or 2 Muscles-FAC $309.03 20552-T

EMERGENCY ROOM INJ; Trig pts-3 or < muscles-FAC $138.38 20553-T

EMERGENCY ROOM INJ; Trig pts-3 or < muscles-FAC $138.38 20553-T

EMERGENCY ROOM Asp/Inj.; Joint-FAC small joint $58.27 20600-T

EMERGENCY ROOM Asp/Inj.; Joint-FAC small joint $58.27 20600-T

EMERGENCY ROOM Asp./Inj. Sm. Jnt. (w/US) - FAC $489.00 20604-T

EMERGENCY ROOM Asp./Inj. join; Inter.(w,el,an)-FAC $85.32 20605-T

EMERGENCY ROOM Asp./Inj. join; Inter.(w,el,an)-FAC $85.32 20605-T

EMERGENCY ROOM Asp./Inj. Int. Jnt. (w/US) - FAC $1,086.00 20606-T

EMERGENCY ROOM Asp./Inj Joint; Major(s,h,k)-FAC $92.61 20610-T



EMERGENCY ROOM Asp./Inj. Mjr. Jnt. (w/US) - FAC $489.00 20611-T

EMERGENCY ROOM Asp/Inj. of Ganglion-FAC $57.23 20612-T

EMERGENCY ROOM FRX/DIS-Clsd.Nasal W/O Manip.-FAC $137.34 21310-T

EMERGENCY ROOM Closed Eye Socket Fracture-Fac $954.14 21400-T

EMERGENCY ROOM FRX/DIS-Mandible W/O Manip.-FAC $411.00 21450-T

EMERGENCY ROOM Dislocation TX jaw facility $288.46 21480-T

EMERGENCY ROOM FRX-Ribs Closed, ea-FAC $98.85 21800-T

EMERGENCY ROOM FXR- Sternum Closed-FAC $203.94 21820-T

EMERGENCY ROOM Closed Vetebral Fracture-Fac $275.74 22305-T

EMERGENCY ROOM I&D Shoulder area deep abscess or hematoma-PRO $857.37 23030-P

EMERGENCY ROOM I&D Shoulder area; deep abscess or hematoma-Fac $2,844.73 23030-T

EMERGENCY ROOM FBR-Shoulder; subcutaneous-Fac $1,068.59 23330-T

EMERGENCY ROOM Soft tissue FB removal - Shoulder - Deep-FAC $2,022.00 23333-T

EMERGENCY ROOM Closed Clavicle Fracture-Fac $258.04 23500-T

EMERGENCY ROOM Closed Fracture Reduction- Clavicular-FAC $2,025.00 23505-T

EMERGENCY ROOM Dislocation of Clavicle-Fac $258.04 23520-T

EMERGENCY ROOM Closed Frx Red-Prox Hum (w/man.) - FAC $2,025.00 23605-T

EMERGENCY ROOM Disloc.-Shoulder W/ Manip,W/O anes-FAC $223.71 23650-T

EMERGENCY ROOM Dislocation Shoulder w/ manip w/ propofol-Fac $1,989.44 23655-T

EMERGENCY ROOM I&D upper arm or elbow area; deep abscess or hematoma-Fac$2,844.73 23930-T

EMERGENCY ROOM Soft tissue FB removal - Upper Arm-FAC $2,022.00 24200-T

EMERGENCY ROOM Soft tissue FB removal - Upper Arm - Deep-FAC $3,487.00 24201-T

EMERGENCY ROOM Closed Humerus FXR-FAC $259.08 24500-T

EMERGENCY ROOM Closed Humerus Fx w/ manipulation-Fac $874.02 24505-T

EMERGENCY ROOM Closed Fracture Reduction - Supracondylar-FAC $2,025.00 24535-T

EMERGENCY ROOM FX-HUM epicon W/O manip-FAC $227.87 24560-T

EMERGENCY ROOM Disl-Elbow,Closed W/O Manip-FAC $279.90 24600-T

EMERGENCY ROOM FRX-Radial Head W/O Manip-FAC $215.38 24650-T

EMERGENCY ROOM Closed Fracture Reduction - Ulnar-FAC $2,025.00 24675-T

EMERGENCY ROOM Closed Radius Fracture-Fac $258.04 25500-T

EMERGENCY ROOM Closed Radial Fx w/ manipulation-Fac $1,117.50 25505-T

EMERGENCY ROOM Closed Ulnar Shaft Fracture-Fac $258.04 25530-T

EMERGENCY ROOM Closed Ulnar Shaft Fx w/ manipulation-Fac $1,040.50 25535-T

EMERGENCY ROOM FRX-RDL/Ulnar Shaft W/O Manip-FAC $260.13 25560-T

EMERGENCY ROOM Closed Radial & Ulnar Fx w/ manipulation-Fac $1,375.54 25565-T

EMERGENCY ROOM FX Scaphoid (Navicular) closed-Fac $400.00 25622-T

EMERGENCY ROOM FRX-Carpal Bone W/O Manip-FAC $222.67 25630-T

EMERGENCY ROOM FRX-Ulnar Styloid-FAC $266.37 25650-T

EMERGENCY ROOM Dislocation of Intercarpel-Fac $275.74 25660-T

EMERGENCY ROOM Closed Wrist Fx w/ dislocation w/ manipulation-Fac $277.82 25680-T

EMERGENCY ROOM Drainage of finger abcess simple-Fac $247.64 26010-T

EMERGENCY ROOM FRX-HAND W/O Manip, Each Bone-FAC $258.04 26600-T

EMERGENCY ROOM FRX/DIS-Carpo:Thumb W/ Manip-FAC $315.27 26645-T

EMERGENCY ROOM DISL.-METACARP. W/ Manip, W/O Anes-FAC $237.23 26700-T

EMERGENCY ROOM Closed Phalanx Fracture-Fac $275.74 26720-T

EMERGENCY ROOM FRX/DIS-W/ Manip; W/ or W/O Skin/Skele. Tract.-FAC $252.84 26725-T

EMERGENCY ROOM FRX-Finger/Thumb; W/O Manip-FAC $149.83 26750-T

EMERGENCY ROOM Open Tuft Fracture (phalange) splinting & sutures-Fac $3,070.53 26765-T

EMERGENCY ROOM DIS Treatment Inter joint w/manip w/o anes-FAC $239.31 26770-T

EMERGENCY ROOM FBR-pelvis or hip; subcutaneous tissue-Fac $1,068.59 27086-T

EMERGENCY ROOM FBR Pelvis/Hip; Deep - FAC $3,968.00 27087-T

EMERGENCY ROOM Coccygeal Fracture-Fac $258.04 27200-T

EMERGENCY ROOM Closed Hip Socket Fracture-Fac $275.74 27220-T

EMERGENCY ROOM Dislocation of Hip-Fac $254.92 27250-T

EMERGENCY ROOM Spon. Hip Disloc. (w/o anes./manip.) - FAC $430.00 27256-T

EMERGENCY ROOM Post Hip Arthro. Disloc.(w/o anes.) - FAC $430.00 27265-T

EMERGENCY ROOM Closed Frx. Red. Femoral Shft. (w/manip.)-FAC $2,025.00 27502-T

EMERGENCY ROOM Closed Frx. Red. Supracond. (w/manip) - FAC $2,025.00 27503-T

EMERGENCY ROOM Closed Frx. Red. Femoral Distal (w/manip)-FAC $2,025.00 27510-T

EMERGENCY ROOM Closed Patellar Fracture-fac $258.04 27520-T

EMERGENCY ROOM FRX-Tibial, Proximal; W/O Mantip-FAC $335.04 27530-T

EMERGENCY ROOM Dislocation of Patella-Fac $258.04 27550-T

EMERGENCY ROOM DIS-Patellar; W/O Anes-Fac $428.00 27560-T

EMERGENCY ROOM FRX(Lower Leg&Ankle)-Tibial Shaft W/O Manip-fac $258.04 27750-T

EMERGENCY ROOM Closed Frx Red.Tibial Shaft (w/manip)-FAC $2,025.00 27752-T

EMERGENCY ROOM Closed Frx Red Medial Mall. (w/manip)-FAC $2,025.00 27762-T

EMERGENCY ROOM Closed Frx Red Posterior Mall. (w/manip)-FAC $2,025.00 27768-T

EMERGENCY ROOM Closed Frx Red. Prox. Fibula (w/manip)-FAC $2,025.00 27781-T

EMERGENCY ROOM Closed Fibular Fracture-Fac $258.04 27786-T

EMERGENCY ROOM Closed Frx Red. Distal Fibular (w/manip)-FAC $430.00 27788-T

EMERGENCY ROOM Closed Ankle Fracture-PRO $809.51 27808-P

EMERGENCY ROOM Closed Ankle Fracture-Fac $275.74 27808-T

EMERGENCY ROOM Closed Frx Red. Bimalleolar (w/manip)-FAC $2,025.00 27810-T

EMERGENCY ROOM Closed Frx Red. Trimalleolar (w/manip)-FAC $2,025.00 27818-T

EMERGENCY ROOM Closed Frx Red. Wt. Bear. Art. DT-FAC $2,025.00 27825-T

EMERGENCY ROOM DIS-Ankle (w/o anesth.)-FAC $430.00 27840-T

EMERGENCY ROOM FBR-From foot-Fac $581.64 28190-T

EMERGENCY ROOM FB Removal From foot/deep-Fac $2,083.08 28192-T

EMERGENCY ROOM FB Removal From foot/deep-Fac $2,083.08 28192-T

EMERGENCY ROOM FBR Foot Complicated - FAC $2,022.00 28193-T

EMERGENCY ROOM Closed Calcaneal Fracture w/o manipulation-Fac $398.51 28400-T

EMERGENCY ROOM Closed Frx Red-Metatarsal - FAC $430.00 28475-T

EMERGENCY ROOM Closed Great Toe Fracture-Fac $258.04 28490-T

EMERGENCY ROOM Closed Frx Red-Great Toe - FAC $430.00 28495-T

EMERGENCY ROOM Closed Fracture Other Than Great Toe-Fac $258.04 28510-T

EMERGENCY ROOM Closed Frx Red - Phalanx - FAC $430.00 28515-T

EMERGENCY ROOM DIS Toe - Metatarsophalangeal - FAC $430.00 28630-T

EMERGENCY ROOM DIS-Toe Interphal. Jnt. (w/out anesth.)-FAC $430.00 28660-T

EMERGENCY ROOM APPLY CAST LONG ARM-FAC $475.00 29065-T

EMERGENCY ROOM Casting:Arm/Shldr/Torso'Elbow to Finger-FAC $475.00 29075-T

EMERGENCY ROOM Splint/Strap:Torso/Upper;Shldr. to Hand(long)FAC $82.20 29105-T

EMERGENCY ROOM Apply forearm splint-Fac $153.99 29125-T

EMERGENCY ROOM Application of finger splint-Fac $57.23 29130-T

EMERGENCY ROOM Strapping - Thorax - FAC $271.00 29200-T

EMERGENCY ROOM Strapping - Shoulder - FAC $210.00 29240-T

EMERGENCY ROOM Strapping - Elbow or wrist - FAC $64.00 29260-T

EMERGENCY ROOM Strapping - Hand or finger - FAC $64.00 29280-T

EMERGENCY ROOM Cast - Long Leg (Thigh to Toes)-FAC $475.00 29345-T

EMERGENCY ROOM Casting:Legs;Below Knee to Toes(short)-FAC $475.00 29405-T

EMERGENCY ROOM Application, long leg splint-Fac $165.44 29505-T

EMERGENCY ROOM Splint/Strap:Ankle/FT-Calf(Short)-Fac $165.44 29515-T

EMERGENCY ROOM Strapping - Knee - FAC $210.00 29530-T

EMERGENCY ROOM Strapping - Ankle and or/foot - FAC $271.00 29540-T

EMERGENCY ROOM Strapping Toes - FAC $112.00 29550-T

EMERGENCY ROOM Strapping - Unna Boot - FAC $271.00 29580-T

EMERGENCY ROOM Turb.inj.FB, intranasal-FAC $107.17 30300-T

EMERGENCY ROOM Control of nosebleed-simple anterior-Fac $194.58 30901-T

EMERGENCY ROOM Control of nosebleed-complex anterior-Fac $194.58 30903-T

EMERGENCY ROOM Nasal Cauterization/pac-Fac $196.66 30905

EMERGENCY ROOM Control of nosebleed simple/comp-posterior-PRO $508.81 30905-P

EMERGENCY ROOM Control of nosebleed-simple/comp-posterior-Fac $194.58 30905-T

EMERGENCY ROOM Intubation-Fac $387.07 31500-T

EMERGENCY ROOM Chest tube thoracostomy with draining-facility $501.52 32551-T

EMERGENCY ROOM Thorocentesis w/o imaging, w/o tube -Fac $948.94 32554-T

EMERGENCY ROOM Thorocentesis w imaging w/o tube -FAC $926.05 32555-T

EMERGENCY ROOM Place needle in vein IV/Int-Fac $178.97 36000-T

EMERGENCY ROOM * Venipuncture - < 3 years-FAC $50.00 36400-T

EMERGENCY ROOM * Venipuncture - > 3 years-FAC $50.00 36410-T

EMERGENCY ROOM Central Line insertion-FAC $1,966.00 36556-T

EMERGENCY ROOM IO Placement-Fac $214.34 36680-T

EMERGENCY ROOM Thrombolytic -cerebral FAC $1,500.00 37195-T

EMERGENCY ROOM FBR-Mouth-Fac $93.65 40804-T

EMERGENCY ROOM Soft tissue FBR - Vestibule - Complicated-FAC $920.00 40805-T

EMERGENCY ROOM Wound Repair - Mouth, Tongue <2.5 cm-FAC $210.00 41250-T

EMERGENCY ROOM Wound Repair - Posterior Tongue - FAC $357.00 41251-T

EMERGENCY ROOM Wound Repair - Mouth, Tongue >2.6 cm-FAC $920.00 41252-T

EMERGENCY ROOM Drainage of gum lesions facility $153.00 41800-T

EMERGENCY ROOM FBO dental-alveolar-Fac $1,591.20 41805-T

EMERGENCY ROOM I&D Peritonsillar-FAC $508.81 42700-T

EMERGENCY ROOM FBR-pharynx-Fac $93.65 42809-T

EMERGENCY ROOM Gastric intubations treatment-NG tube-Fac $206.02 43752-T

EMERGENCY ROOM Gastric Lavage-Fac $247.64 43753-T

EMERGENCY ROOM Change gastrostomy tube-Fac $368.34 43760-T

EMERGENCY ROOM I&D - Perirectal - FAC $1,873.00 46040-T

EMERGENCY ROOM I&D perianal abscess; superficial-Fac $1,227.79 46050-T

EMERGENCY ROOM I & D Thrombosed Hemorrhoid - pro $387.60 46320-P

EMERGENCY ROOM I & D Thrombosed Hemorrhoid -Fac $1,687.08 46320-T

EMERGENCY ROOM Anoscopy - FAC $210.00 46600-T

EMERGENCY ROOM Anoscopy - w/FBR - FAC $1,420.00 46608-T

EMERGENCY ROOM Abd Paracentesis Facility w/o image guidance $735.63 49082-T

EMERGENCY ROOM Abd Paracentesisfacility w imaging PRO $272.62 49083-P

EMERGENCY ROOM Abd Paracentesisfacility w imaging-FAC $893.80 49083-T

EMERGENCY ROOM Peritoneal lavage - FAC $1,487.00 49084-T

EMERGENCY ROOM Aspiration of bladder by needle $306.00 51100-T

EMERGENCY ROOM Irrigation of bladder-Fac $186.25 51700-T

EMERGENCY ROOM Insert urinary catheter straight $183.13 51701-T

EMERGENCY ROOM Insert Foley catheter , complicated $350.00 51703-T

EMERGENCY ROOM Bladder Scan - FAC $112.00 51798-T

EMERGENCY ROOM I&D Epididymis, testis and/or scrotal space (abscess/hematoma)-Fac$2,598.13 54700-T

EMERGENCY ROOM I&D - Scrotal Wall Abcess - FAC $2,022.00 55100-T

EMERGENCY ROOM I&D Vulva/Perineal Abscess-Fac $561.87 56405-T

EMERGENCY ROOM I&D Bartholin gland abcess-Fac $314.23 56420-T

EMERGENCY ROOM Procuder of Endo; Samp.W/or W/O Endo. Samp. W/O Dilation-FAC$170.65 58100-T

EMERGENCY ROOM Vaginal delivery only-Fac $2,810.40 59409-T

EMERGENCY ROOM Delivery Placenta-Fac $2,810.40 59414-T

EMERGENCY ROOM Incomplete Abortion-Fac $2,643.91 59812-T

EMERGENCY ROOM Lumbar Puncture-Fac $368.34 62270-T

EMERGENCY ROOM dentoalveolar block-FAC $489.00 64400-T

EMERGENCY ROOM Occipital (greater) Block $475.00 64405-T

EMERGENCY ROOM N block-Intercostal single-PRO $126.00 64420-P

EMERGENCY ROOM N block-Intercostal single $1,000.00 64420-t

EMERGENCY ROOM N block-Intercostal mult regional-pro $180.00 64421-P

EMERGENCY ROOM N block-Intercostal mult regional-fac $1,200.00 64421-T

EMERGENCY ROOM Nerve Block - Fascia Iliaca-Pro $470.00 64450-P1

EMERGENCY ROOM Digital Nerve Block - Other Periph.-FAC $1,087.00 64450-T

EMERGENCY ROOM FB Removal:Eye;Conjunctival Superficial-FAC $43.70 65205-T

EMERGENCY ROOM FB Rmv:Eye;Conj Embedded,Sub./Scleral Nonper.-FAC $41.62 65210-T

EMERGENCY ROOM FBR-Corneal w/o slit lamp-Fac $216.42 65220-T

EMERGENCY ROOM FBR Eye - Corneal with slit lamp - FAC $210.00 65222-T

EMERGENCY ROOM FBR - eye Epithelium - FAC $1,617.00 65435-T

EMERGENCY ROOM FBR-Eyelid - FAC $535.00 67938-T

EMERGENCY ROOM Drainage external auditory canal abscess-Fac $247.64 69020-T

EMERGENCY ROOM Excis. Proc:Exter. Ear/Canal;Rmv from Canal,W/O Anes.-FAC$111.33 69200-T

EMERGENCY ROOM Remove impacted cerumen-Fac $40.58 69210-T

EMERGENCY ROOM Admin. one vaccine - FAC $116.00 90471-T

EMERGENCY ROOM Admin additional vaccines - FAC $115.00 90472-T

EMERGENCY ROOM CPR- facility $521.29 92950-T

EMERGENCY ROOM Temporary External Pacing-Fac $151.91 92953-T

EMERGENCY ROOM Defibrillation (Cardioversion)-Fac $374.58 92960-T

EMERGENCY ROOM Thrombolytic Therapy-CORONARY fac $1,100.00 92977-T

EMERGENCY ROOM IV infusion therapy, for hydration > 30 minutes $245.55 96360-T

EMERGENCY ROOM IV infusion hydration, ea add hr up to 8-Fac $75.96 96361-T

EMERGENCY ROOM IV infusion therapy, 1 hour $245.55 96365

EMERGENCY ROOM IV infusion therapy, ea add hr up to 8 $75.96 96366-T

EMERGENCY ROOM IV Therapy new drug $32.25 96367-T

EMERGENCY ROOM Concurrent infusion (once per encounter)-Fac $139.42 96368-T

EMERGENCY ROOM IM injection/SQ injection-Fac $39.54 96372-T

EMERGENCY ROOM IV push, single or initial drug $141.50 96374-T

EMERGENCY ROOM IV push, Each additional new drug $92.61 96375-T

EMERGENCY ROOM IV push each add, same drug $93.65 96376-T

EMERGENCY ROOM Mod sedation 1st 15min <5y Fac $100.00 99151-T

EMERGENCY ROOM Mod sedation 1st 15 min ea $306.00 99152-P

EMERGENCY ROOM Mod sedation 1st 15 min Fac $100.00 99152-T

EMERGENCY ROOM Mod sedation each add 15 min $102.00 99153-P

EMERGENCY ROOM Mod sedation-other addt 15 min $100.00 99153-T

EMERGENCY ROOM Mod sedation-other <5yr 15min $100.00 99155-T

EMERGENCY ROOM Mod sedation -other 5+yrs 15 min $100.00 99156-T

EMERGENCY ROOM ED Visit Minor-Fac $120.70 99281-T

EMERGENCY ROOM ED Visit, Low Mod.-Fac $228.91 99282-T

EMERGENCY ROOM ED Visit Moderate-Fac $316.31 99283-T

EMERGENCY ROOM ED Visit Moderate Complex-Fac $555.62 99284-T

EMERGENCY ROOM ED Visit High Complex-Fac $1,225.71 99285-T

EMERGENCY ROOM CRITICAL CARE; First Hour-Fac $1,331.84 99291-T

EMERGENCY ROOM CRITICAL CARE-Fac $296.54 99292-T

EMERGENCY ROOM Attemdamce at Delivery-newborn $515.10 99464-P

INPATIENT Inpatient Bed Charges $1,428.61 1346

INPATIENT Hospice Bed Charge $669.63 hosp

INPATIENT Respite/Hospice Day Charges $345.12 res[ote

LABORATORY Urine Calcium - Random $62.43 22002324

LABORATORY Risperidone $133.18 23397

LABORATORY Hemoglobinopathy Evaluation $15.10 35489

LABORATORY Venipuncture, Routine $21.85 36415

LABORATORY Venipuncture, Routine $21.85 36415

LABORATORY BMP (ISTAT) $88.44 80047

LABORATORY BMP (Basic Metab Panel) $86.36 80048

LABORATORY General Health Panel[Panel] $336.60 80050

LABORATORY ELECTROLYTES $39.54 80051

LABORATORY CMP - Comp Metab Panel $173.77 80053

LABORATORY OBSTETRIC PANEL $178.97 80055

LABORATORY LIPID PROFILE $95.73 80061

LABORATORY LIPID W/ VLDL - REF $95.73 80061-2

LABORATORY Cardio IQ Lipid panel Cholesterol $38.76 80061-3

LABORATORY RENAL PANEL $63.47 80069

LABORATORY Hepatitis A,B,C Panel $504.80 80074

LABORATORY LIVER PROFILE $114.45 80076

LABORATORY Benzodiazepines Screen(serum) $124.86 80101

LABORATORY Clozapine $188.33 80154

LABORATORY Carbamazepine, Total(Tegretol) $58.27 80156-2

LABORATORY Carbamazepine, Free Serum $106.05 80157

LABORATORY cyclosporine A trough-blood $255.00 80158

LABORATORY Cyclosporine A Peak $265.00 80158-1

LABORATORY Digoxin $79.08 80162

LABORATORY Valproic Acid (DEPAKOTE) $47.86 80164-2

LABORATORY Doxepin/Nordoxepin $132.14 80166

LABORATORY Everolimus $192.49 80169

LABORATORY Gentamicin-peak $160.00 80170

LABORATORY Gentamicin-trough $165.00 80170-1

LABORATORY Lithium $30.17 80178

LABORATORY Mycophenolic $174.81 80180

LABORATORY Phenobarbital $42.66 80184

LABORATORY Phenytoin (dilantin) $67.64 80185

LABORATORY Phenytoin, Free $121.74 80186

LABORATORY Primidone $131.69 80188

LABORATORY Sirolimus LC/MS/MS $180.54 80195

LABORATORY Tacrolimus, Highly Sensitive $240.35 80197

LABORATORY (Result) Tacrolimus, Highly Sensitive $0.00 80197-2

LABORATORY Theophylline Level $77.65 80198

LABORATORY Tobramycin Peak OR Trough $162.32 80200

LABORATORY Topiramate $88.90 80201

LABORATORY Vancomycin (Peak) $107.17 80202-1

LABORATORY Vancomycin (Trough) $107.17 80202-2

LABORATORY Keppra (Levetiracetam) $93.65 80299

LABORATORY Seroquel(Quetiapine) $165.44 80299-10

LABORATORY Dexamethasone $138.48 80299-11

LABORATORY Amiodarone level $180.29 80299-12

LABORATORY Methotrexate $138.00 80299-15

LABORATORY Lamictal (Lamotrigine), Serum $95.73 80299-2

LABORATORY Eslicarbazepine $223.00 80299-20

LABORATORY Zonisamide $130.06 80299-4

LABORATORY FLECAINIDE $139.42 80299-6

LABORATORY LACOSAMIDE $189.37 80299-7

LABORATORY Coumadin $99.03 80299-9

LABORATORY Drugs of abuse 7 serum panel w/o confirm $649.03 80301

LABORATORY Drugs of abuse 7 serum panel w/o confirm $649.03 80301

LABORATORY Clinic drug testing $105.09 80303-15

LABORATORY Clinic drug testing $105.09 80303-15

LABORATORY Urine Drug Screen[Panel] $230.99 80303-30

LABORATORY Urine Drug Screen[Panel] $230.99 80303-30

LABORATORY Pain Management Pro 1 w/o urine $339.66 80307

LABORATORY Drug Monitoring Panel 7 with confirm $100.00 80307-1

LABORATORY Buprenorphine with confirmation $93.00 80307-10

LABORATORY Blood Alcohol $108.21 80320

LABORATORY Volatiles $143.00 80320-1

LABORATORY Drug Tox - alcohol metabolites quant UR $111.00 80321

LABORATORY Drug Tox - alcohol metabolites quant UR $111.00 80321

LABORATORY Nicotine and Cotinine, LC/MS/MS, Urine $114.65 80323-1

LABORATORY Nicotine and Cotinine serum $122.42 80323-2

LABORATORY Salicylate $119.66 80329

LABORATORY Salicylate $119.66 80329

LABORATORY Acetaminophen Level $68.68 80330

LABORATORY AMITRIPTYLINE $148.00 80335

LABORATORY Clobazam $171.69 80346

LABORATORY Cocaine confirmation (urine) $153.00 80353

LABORATORY Oxycodone and Metabolites $133.18 80364

LABORATORY Oxy Drug Classess Confirmation $115.00 80365-1

LABORATORY Oxy Drug Classess Confirmation $115.00 80365-1

LABORATORY Thiopurine metabolites $117.44 80375

LABORATORY UA Chemstrip $16.65 81000

LABORATORY Clinic US- with Micro $58.27 81000-1

LABORATORY Urinalysis Panel $58.27 81001

LABORATORY Clinic- UA Chemstrip $16.65 81002-1

LABORATORY HCG - Urine $71.40 81025

LABORATORY Clinic Pregnancy Test $71.40 81025-1

LABORATORY P210 BCR ABL1 $155.99 81206-1

LABORATORY P190 BCR-ABL1 $155.99 81207

LABORATORY Cystic Fib D1152H mutation $241.00 81221

LABORATORY Prothrombin, Gene Mutation $319.89 81240

LABORATORY Factor V Leiden $388.54 81241

LABORATORY Hereditary Hemochromatosis $504.65 81256

LABORATORY Alpha Globulin mutation $634.71 81257

LABORATORY Chronic Lumphocytic Leukemia IgVH Mutation Status Cell Based$575.93 81263

LABORATORY JAK2 V617F Leumeta $666.54 81270

LABORATORY MTHFR DNA Mutation Analysis $517.13 81291

LABORATORY MTHFR Reductase $348.88 81291-1

LABORATORY Alpha-1 Antitrypsin Mutation Analysis Genotype $482.80 81332

LABORATORY HLA-B27 DNA typing $264.00 81374

LABORATORY HLA-B-1502 $520.25 81381

LABORATORY TPMT Thiopurine S-Methyltransferase $575.40 81401

LABORATORY Huntington Disease Mutation analysis $467.71 81401-1

LABORATORY JAK2 EXON 12 and 13 $666.54 81403

LABORATORY Beta-Globulin Complete $947.90 81404

LABORATORY Serum Ketone $38.49 82009

LABORATORY Beta-hydroxybutyrate $96.84 82010

LABORATORY ACTH Plasma $289.26 82024

LABORATORY Albumin $35.37 82040

LABORATORY Albumin, Peritoneal Fluid $41.23 82042

LABORATORY Microalbumin $119.66 82043

LABORATORY Microablumin 24 hr w/o creat $72.42 82043-5

LABORATORY Aldolase $138.38 82085

LABORATORY (result) Aldosterone, Serum $146.71 82088

LABORATORY Alsosterone $146.71 82088-1

LABORATORY Aldosterone LC/MS/MS $143.00 82088-10

LABORATORY Alpha-1 Antitrypsin, Quantitative $120.70 82103

LABORATORY Alpha-1-Antitrypsin (AAT) pheno $68.00 82104

LABORATORY Alpha Fetoprotein (AFP) $131.10 82105

LABORATORY Aluminum $150.87 82108

LABORATORY Aminolevulinic Acid $127.98 82135

LABORATORY Amino Acid Analysis, LC/MS Plasma $719.13 82139

LABORATORY Ammonia $142.55 82140

LABORATORY Stone risk profile-ammonium $40.18 82140-1

LABORATORY Amylase $42.66 82150

LABORATORY Amylase, Peritoneal Fluid $51.27 82150-1

LABORATORY Androstenedione $298.63 82157

LABORATORY Angiotensin Converting Enzyme (ACE) $125.91 82164

LABORATORY Apolipoprotein B Evaluation $25.50 82172

LABORATORY Cardio IQ iLipid panel-apolipo B $38.76 82172-3

LABORATORY Arsenic $98.81 82175-1

LABORATORY Heavy Metals-arsenic $170.34 82175-2

LABORATORY Beta 2 Microglobulin $140.46 82232

LABORATORY B2 Microglobulin $138.62 82232-1

LABORATORY Bile Acids, Total $83.64 82239

LABORATORY Bilirubin, Total $33.29 82247

LABORATORY T. Bili newborn with cap $54.11 82247-1

LABORATORY Bilirubin, Direct $33.29 82248

LABORATORY Occult Blood-Guiac only $30.60 82270

LABORATORY Clinic- Hemoccult, feces card $31.21 82270-1

LABORATORY Gastroccult $26.01 82271

LABORATORY Fecal Occult blood test IFOB Diagnostic $53.07 82274

LABORATORY *VITAMIN D 25 HYDROXY PANEL $328.80 82306

LABORATORY Vitamin D (D2,D3) $239.01 82306-5

LABORATORY VITAMIN D,25-OH,TOTAL,IA $200.00 82306-7

LABORATORY Calcitonin $213.54 82308

LABORATORY Calcium $35.37 82310

LABORATORY (Result) Calcium, PTH $30.17 82310-01

LABORATORY Ionized Calcium $146.71 82330

LABORATORY 24hr Calcium Urine $43.70 82340-1

LABORATORY Stone risk profile-calcium urine $41.21 82340-5

LABORATORY 24 HOUR Calcium URINE WCREATININE $39.54 82340-7

LABORATORY Stone Analysis $222.67 82365

LABORATORY Carbon Dioxide $38.49 82374

LABORATORY Carboxyhemoglobin $164.40 82375

LABORATORY CEA $137.34 82378

LABORATORY Carnitine LC/MS/MS $242.02 82379

LABORATORY 24HR CATECHOLAMINES, FRACT URINE $257.00 82384

LABORATORY 24 hr Catecholamins Urine w/Creat $254.92 82384-1

LABORATORY Catecholamines, Plasma $221.63 82384-2

LABORATORY Ceruloplasmin level $95.73 82390

LABORATORY Chloride $35.37 82435

LABORATORY **Chloride, Urine - Random $46.82 82436

LABORATORY Chloride Urine, Random $46.82 82436-1

LABORATORY Cholesterol serum or fluid $76.50 82465

LABORATORY Heroin Screen(serum) $124.86 82486

LABORATORY Coenzyme Q10 $382.91 82491

LABORATORY Chromium, Plasma $144.63 82495-3

LABORATORY Chromium, Serum $144.63 82495-4

LABORATORY Citrate 24hr Urine $210.18 82507

LABORATORY Stone risk profile-Citrate urine $41.21 82507-5

LABORATORY C-Telopeptide $198.01 82523

LABORATORY Collagen xlink N telopeptide urine $250.92 82523-1

LABORATORY COPPER, SERUM $130.06 82525

LABORATORY Copper (HM PROFILE) $72.84 82525-1

LABORATORY Copper 24 hr Urine $72.50 82525-2

LABORATORY Cortisol, Free $189.37 82530

LABORATORY CORTISOL FREE AND TOTAL $251.80 82530-1

LABORATORY Cortisol, Saliva $105.09 82530-2

LABORATORY Cortisol Saliva $103.55 82530-3

LABORATORY Cortisol Free 24hr Urine $164.37 82530-4

LABORATORY Cortisol, P.M. $63.47 82533

LABORATORY Cortisol, A.M. $63.47 82533-1

LABORATORY Cortisol, Total (Random) $63.47 82533-3

LABORATORY cortisol baseline (ACTH) $118.32 82533-5

LABORATORY cortisol 30 min p ACTH $118.32 82533-6

LABORATORY Cortisol 60 min p ACTH $118.32 82533-7

LABORATORY CPK $33.29 82550

LABORATORY Creatine Kinase Isoenzyme Panel(Quest) $155.03 82552

LABORATORY CK-MB (CK-2) $140.76 82553-1

LABORATORY Creatinine $27.05 82565

LABORATORY Creatinine - Reference Lab $25.50 82565-1

LABORATORY Urine Creatinine, Random $49.94 82570

LABORATORY Magnesium 24hr Urine w/creatine $103.01 82570-3

LABORATORY Metanephrine, Fractionated Random Urine $218.40 82570-4

LABORATORY (FENA) Urine Crea $49.94 82570-5

LABORATORY Stone Risk profile-magnesium urine $41.21 82570-6

LABORATORY Creatinine 24-hour urine $57.69 82570-7

LABORATORY Heavy Metals panel-creat $28.56 82570-9

LABORATORY Creatinine Clearance $68.68 82575

LABORATORY Cryoglobulin AB QL Analysis $61.39 82595

LABORATORY **DO NOT Vitamin B12 Serum $58.27 82607

LABORATORY Vitamin B12 (COBALAMIN) Serum $58.27 82607-2

LABORATORY cystatin C $150.96 82610

LABORATORY DHEA SULFATE $199.78 82627

LABORATORY Dihydrotestosterone $212.26 82651

LABORATORY VITAMIN D, 1,25 DIHYDROXY $387.07 82652

LABORATORY Pancreatic elastase $324.51 82656

LABORATORY Erythropoietin level $185.44 82668

LABORATORY Estradiol $116.54 82670

LABORATORY Estradiol Free $251.80 82670-1

LABORATORY Estradiol Ultrasensitive $223.00 82670-4

LABORATORY ESTROGEN, TOTAL, SERUM $160.24 82672

LABORATORY Estriol QUAD SCREEN $206.04 82677

LABORATORY Estrone $218.28 82679

LABORATORY FECAL FAT, QUALITATIVE $63.47 82705

LABORATORY Fecal Fat, Total, Quantitative $200.22 82710

LABORATORY Ferritin $105.09 82728

LABORATORY Hemogram-Ferritin $80.00 82728-2

LABORATORY Folate, Serum $130.06 82746-3

LABORATORY Folate RBC $182.35 82747

LABORATORY IgA $65.56 82784-1

LABORATORY IgD $117.00 82784-10

LABORATORY (Result) IgA $69.02 82784-11

LABORATORY IgM $65.56 82784-2

LABORATORY (Result) IgM $69.02 82784-21

LABORATORY IgG $65.56 82784-3

LABORATORY (Result) IgG $69.02 82784-31

LABORATORY (Result) IGA, Serum (Celiac) $58.27 82784-4

LABORATORY Celiac panel - IGA $112.20 82784-5

LABORATORY IgE, Serum $91.57 82785

LABORATORY IgE $35.70 82785-6

LABORATORY IgG subclass 1 $88.00 82787-1




LABORATORY VBG $98.85 82803

LABORATORY ABG $297.59 82805

LABORATORY Gastrin $122.78 82941

LABORATORY Glucose, Body Fluid $35.37 82945

LABORATORY Glucose, random urine $35.37 82945-01

LABORATORY Synovial Fluid Analysis(Quest) $535.86 82945-1

LABORATORY CSF Glucose $40.80 82945-2

LABORATORY Fluid Glucose, Alamosa $59.75 82945-3

LABORATORY Glucose $28.09 82947

LABORATORY Glucose 1 hr pp $33.29 82950

LABORATORY 3 Hr GTT- 3 specimen $75.96 82951

LABORATORY 3 Hr GTT each add $23.93 82952

LABORATORY G-6-PD $100.95 82955

LABORATORY Glucose, Whole Blood $21.85 82962

LABORATORY Clinic FBS0 Fingerstick Blood Sugar $9.36 82962-1

LABORATORY GGTP (Gamma-glutamy transferase) $42.66 82977

LABORATORY Fructosamine $106.00 82985

LABORATORY FSH $68.68 83001

LABORATORY FSH-PEDIATRICS $129.54 83001-1

LABORATORY LH $68.68 83002

LABORATORY LH Pediatric $129.54 83002-1

LABORATORY Growth Hormone $122.78 83003

LABORATORY Haptoglobin $100.95 83010

LABORATORY Urea breath test - H.pylori $226.83 83013

LABORATORY Cobalt $124.86 83018

LABORATORY Tin $146.71 83018-2

LABORATORY Platinum $180.01 83018-3

LABORATORY Thorium $230.99 83018-4

LABORATORY Uranium $176.89 83018-5

LABORATORY Chromatography HBG eacg $150.00 83021

LABORATORY Thal-hemoglobinopathy types $150.00 83021-3

LABORATORY Hemoglobin A1C $68.68 83036

LABORATORY Clinic Hemoglobin A1C whole blood $75.00 83037



LABORATORY Histamine plasma $191.76 83088

LABORATORY Homocysteine $226.83 83090

LABORATORY Barium $190.41 83118

LABORATORY **Cardio IQ iLipid panel-HDL $38.76 83465-3l

LABORATORY 17 OH Cortocosteroid urine 24 results $123.62 83491

LABORATORY 5 Hydroxyindoleacelic Acid 24 HR Urine $110.02 83497

LABORATORY Gliadin(Deaminated) AB IGA $134.22 83516

LABORATORY Gliadin(Deaminated) AB IGG $280.94 83516-1

LABORATORY Celiac panel - Tissue Transglutaminase $112.20 83516-10

LABORATORY Parietal Cell Ab $110.29 83516-2

LABORATORY Myositis MI-2 Autoab $168.30 83516-20

LABORATORY Myositis KU Autoab $168.30 83516-21

LABORATORY Myositis EJ Autoab $168.30 83516-22

LABORATORY Myositis OJ Autoab $168.30 83516-23

LABORATORY Myositis SRP Autoab $168.30 83516-24

LABORATORY ANA Ribosomal P AB $126.94 83516-3

LABORATORY Tissue Transglutaminase IgA $168.25 83516-5

LABORATORY Histone Antibodies $121.38 83516-9

LABORATORY Myastheria Gravis Panel 2 $830.32 83519

LABORATORY Alpha Subunit $203.94 83519-1

LABORATORY PTH-related Protein $296.00 83519-11

LABORATORY Thyrotropin Binding inhibitory Immuno(TBII) $299.67 83519-2

LABORATORY Auto Neu - RIA nonab $262.00 83519-20

LABORATORY TSH receptor binding Ab (TRab) $223.38 83519-21

LABORATORY Acetylcholine Recept BLOCKING ab $251.00 83519-25

LABORATORY Acetylcholine Recept MODULATING Ab $310.00 83519-26

LABORATORY Acetylcholine Receptor Binding AB $250.34 83519-5

LABORATORY procollagen Type 1 intact $285.60 83519-9

LABORATORY aspergillus niger IgA $85.00 83520--20

LABORATORY (Result) Tissue Transglutam AB IGA $168.25 83520-1

LABORATORY IBSDetex-Vinculin $91.80 83520-10

LABORATORY Phopholipase A2 recept AB Elisa $244.80 83520-12

LABORATORY Mitochondria M2 Ab IgG $122.00 83520-13

LABORATORY (Result) Tissue Transglutam AB IGG $168.25 83520-2

LABORATORY Phosphatidy AB panel IgG $144.84 83520-20

LABORATORY Phosphatidy AB panel IgA $135.66 83520-21

LABORATORY Phosphtidy AB Panel IgM $145.86 83520-22

LABORATORY 14.3.3 eta Protein $129.54 83520-23

LABORATORY Desmoglein Ab 3 $61.20 83520-25

LABORATORY Tryptase serum $214.00 83520-3

LABORATORY Desmoglein Ab 1 $91.80 83520-4

LABORATORY Anti-Mullerian Hormone(AMH) $152.95 83520-5

LABORATORY Bullous Pemphigoid 180 ab $252.33 83520-6

LABORATORY Anti GBM (Glomerular basement membrane) $225.79 83520-7

LABORATORY Bullous Pemphigoid 230 IgG ab $106.08 83520-8

LABORATORY IBSDeTex-Cytolethal Distend Toxin B Ab $99.96 83520-9

LABORATORY INSULIN $59.31 83525

LABORATORY Iron, Serum $162.32 83540

LABORATORY Iron and TIBC[Package] $162.32 83540-1

LABORATORY (Result) TIBC $41.62 83550

LABORATORY 17 Ketosteroids, 24 Urine RESULTS $123.62 83586

LABORATORY Lactic Acid $44.74 83605

LABORATORY Lactic Acid I-STAT $61.20 83605-2

LABORATORY LDH (QUEST ONLY) $29.13 83615

LABORATORY LD, Pleural Fluid $57.94 83615-1

LABORATORY LDH(SLV) $61.81 83615-2

LABORATORY LD, Peritoneal Fluid $57.94 83615-3

LABORATORY LDH(In house) $61.81 83615-4

LABORATORY Fecal Leukocytes (Lactoferrin) $83.24 83630

LABORATORY Lactoferrin, quanitative stool $254.00 83631

LABORATORY Lead, Blood $111.33 83655

LABORATORY Heavy Metals - Lead $170.34 83655-1

LABORATORY Lipase $88.44 83690

LABORATORY Lipoprotein (a) $25.76 83695

LABORATORY Cardio IQ iLipid panel-lipo $38.76 83695-3

LABORATORY Cardio IQ iLipid panel-Lp-PtA2 $38.76 83698

LABORATORY VAP CHOLESTEROL TEST $252.84 83701

LABORATORY Cardio IQ iLipid panel-Lipo fraction $38.76 83704-3

LABORATORY HDL $59.31 83718

LABORATORY Cardio IQ iLipid panel-HDL $38.76 83718-2

LABORATORY LDL-Direct $51.51 83721-1

LABORATORY Magnesium $33.29 83735

LABORATORY Magnesium, RBC $100.00 83735-1

LABORATORY Stone RIsk Profile-Creatinine urine $41.21 83735-5

LABORATORY Oxycarbazepine-Trileptal $155.03 83789

LABORATORY Iodine, Serum/Plasma(Blue Top) $159.20 83789-2

LABORATORY Pro-predict Metabolites $223.08 83789-3

LABORATORY Heavy Metals -Mercury $170.34 83825

LABORATORY Metanephrines Free Plasma[Panel] $376.67 83835

LABORATORY Metanephrines 24hr Urine Fractionated $349.61 83835-4

LABORATORY Myoglobin $191.45 83874

LABORATORY Myoglobin Serum $148.79 83874-1

LABORATORY BNP $182.09 83880

LABORATORY (Result) Kappa Ligth Chain, Free $169.98 83883-1

LABORATORY (Result) Lambda Ligth Chain, Free $169.98 83883-2

LABORATORY Alpha-2-Macroglobulin $77.27 83883-5

LABORATORY Nickel $96.77 83885

LABORATORY Oligoclonal Bands, CSF $148.92 83916

LABORATORY 63 organic acids $340.00 83919

LABORATORY Methymalonic acid $258.04 83921

LABORATORY Osmolality, Urine $103.02 83935

LABORATORY Osteocalcin N-MID $183.60 83937

LABORATORY Oxalate Urine 24hrs $68.68 83945

LABORATORY Stone risk profile-oxalate urine $41.21 83945-5

LABORATORY PTH, Intact and Calcium $247.64 83970

LABORATORY (Result) PTH, Intact $217.46 83970-01

LABORATORY PTH intact wo calcium $216.24 83970-1

LABORATORY pH, Feces $84.25 83986

LABORATORY pH - body fluid SLVH $77.27 83986-6

LABORATORY Calprotectin (Stool) $246.60 83993

LABORATORY Alk Phos $103.01 84075

LABORATORY Alk Phos-Bone specific $128.52 84075-1

LABORATORY ALK PHOS ISOENZYME $79.08 84080

LABORATORY Phosphorus $33.29 84100

LABORATORY Phosporus 24hr Urine $43.70 84105

LABORATORY Stone risk profile-phosphorus urine $41.21 84105-5

LABORATORY Porphobilinogen quant, urine $83.64 84110

LABORATORY Porphyrins Fractionated QT random Urine $128.30 84120

LABORATORY Potassium $43.70 84132

LABORATORY potassium-RBC $121.00 84132-3

LABORATORY Potassium, Urine - 24 hr w/o Creat $61.81 84133

LABORATORY Potassium Urine, Random $38.49 84133-1

LABORATORY Stone RIsk profile- potassium urine $41.21 84133-5

LABORATORY Prealbumin $92.61 84134

LABORATORY PROGESTERONE $58.27 84144

LABORATORY 17 OH Progesterone $125.90 84144-1

LABORATORY Procalcitonin $339.97 84145

LABORATORY Prolactin $68.68 84146

LABORATORY Prolactin 2 Dilution study $156.08 84146-1

LABORATORY Prolactin 1 dilution study $161.28 84146-2

LABORATORY Prolactin 1 dilution study $161.28 84146-2

LABORATORY Prolactin, Dilution Study $322.99 84146-5

LABORATORY Prolactin, Total and Monometric $288.32 84146-6

LABORATORY PSA Total $96.77 84153

LABORATORY (Result) Total PSA $96.77 84153-1

LABORATORY PSA Free $206.02 84154

LABORATORY (Result) PSA, Free $206.02 84154-1

LABORATORY Total Protein $43.70 84155

LABORATORY Urine Protein 24 HR $46.82 84156-01

LABORATORY (Result) Urine Protein Random $40.80 84156-03

LABORATORY Protein, Body Fluid $61.39 84157

LABORATORY Protein, Total Peritoneal Fluid $64.63 84157-1

LABORATORY Fluid Protein Alamosa $62.84 84157-2

LABORATORY CSF Protein $61.20 84157-3

LABORATORY Protein, Body Fluid ref lab $61.20 84157-5

LABORATORY **PROTEIN ELECTROPHORESIS, SERUM $76.50 84165

LABORATORY (Result) Protein, Total Serum $43.70 84165-1

LABORATORY (Result) Albumin (PE) $5.20 84165-2

LABORATORY (Result) Globulin (PE) $8.32 84165-3

LABORATORY (Result) A/G Ratio (PE) $5.20 84165-4

LABORATORY (Result) Alpha-1 $5.20 84165-5

LABORATORY (Result) Alpha-2 $5.20 84165-6

LABORATORY (Result) Beta $5.20 84165-7

LABORATORY (Result) Gamma $5.20 84165-8

LABORATORY (result)Protein Electrophoresis $70.00 84166

LABORATORY Auto Neu Western Blot $262.00 84182

LABORATORY Vit B6, Plasma $247.86 84207

LABORATORY Anti-IgE Receptor AB $216.42 84238

LABORATORY Plasma Renin Activity $129.81 84244

LABORATORY Selenium $158.00 84255

LABORATORY Serotonin, Serum $272.62 84260

LABORATORY SEX HORMONE BINDING GLOBULIN $95.73 84270

LABORATORY Sodium $27.05 84295

LABORATORY Sodium, Urine - Random $48.90 84300

LABORATORY (RESULT) URINE SODIUM-RANDOM-1 $48.90 84300-11

LABORATORY Sodium 24hr Urine $43.70 84300-2

LABORATORY (FENA) Urine Sodium $48.90 84300-3

LABORATORY Stone Risk profile-Sodium urate urine $41.21 84300-5

LABORATORY Stone risk profile-sodium urine $41.21 84300-6

LABORATORY IGF-1 $215.38 84305

LABORATORY Adenosine Deaminase -pleural fluid $211.19 84311

LABORATORY Arylsulfatase A $382.00 84311-1

LABORATORY Stone Risk profile-sulfate urine $41.21 84392-5

LABORATORY Testosterone, Free & Total $215.38 84402

LABORATORY (Result) Testosterone, Free $121.74 84402-1

LABORATORY Testosterone, Total $93.65 84403

LABORATORY Vitamin B1(thiamine) -blood $162.77 84425

LABORATORY Thyroglobulin $100.00 84432

LABORATORY **T-4 Total $64.52 84436

LABORATORY T-4, Total $64.52 84436-3

LABORATORY Free T4 $90.53 84439

LABORATORY T4 Free Direct Dialysis $210.18 84439-2

LABORATORY THYROXINE BINDING GLOBULIN $116.54 84442

LABORATORY TSH $89.48 84443

LABORATORY Thyroid Antibody $213.30 84443-3

LABORATORY TSI (Thyroid Stimulating Immunogloblins) $399.55 84445

LABORATORY Vitamin E $116.54 84446

LABORATORY AST (SGOT) $35.37 84450

LABORATORY ALT (SGPT) $33.29 84460

LABORATORY Transferin $97.81 84466

LABORATORY Triglyceride $33.29 84478

LABORATORY Triglyceride-pleural fluid SLVH $77.27 84478-1

LABORATORY Cardio IQ iLipid panel-nonHDL $38.76 84478-3

LABORATORY Cardio IQ Lipid panel-Trigs $38.76 84478-4

LABORATORY **DO NOT T-3 Uptake $39.54 84479

LABORATORY T3 UPTAKE $50.14 84479-2

LABORATORY T-3 TOTAL $101.97 84480

LABORATORY (Result) T3, Free $0.00 84481-1

LABORATORY Free T3 $64.52 84481-2

LABORATORY T-3,REVERSE $267.41 84482

LABORATORY Troponin $68.68 84484

LABORATORY Troponin 6hr after initial $68.34 84484-1

LABORATORY Troponin 12 hr after initial $68.34 84484-2

LABORATORY BUN $33.29 84520

LABORATORY Urea Nitrogen - Urine $61.81 84540

LABORATORY Hanta virus IgM ab $113.32 84540-3

LABORATORY Uric Acid $33.29 84550

LABORATORY Uric Acid 24hr Urine $43.70 84560

LABORATORY Uric Acid- Urine w/o creatinine $61.20 84560-2l

LABORATORY Stone Risk profile-uric acid $41.21 84560-5

LABORATORY Stone risk profile-uric acid urine $41.21 84560-6

LABORATORY VMA(Vanllylmandelc Acid) 24hr Urine $291.34 84585

LABORATORY Vasoactive Intestinal Polypeptide $289.90 84586

LABORATORY Vitamin A $28.09 84590

LABORATORY ZINC $121.74 84630

LABORATORY C-Peptide $173.77 84681

LABORATORY HCG - Quantitative(send out) $144.63 84702

LABORATORY HCG Quantitative Serum $146.71 84702-2

LABORATORY HCG - Blood $64.52 84703

LABORATORY HCT $16.65 85014

LABORATORY Clinic- Hematoctit (HCT) $16.65 85014-1

LABORATORY HGB $16.65 85018

LABORATORY CBC w/ Auto Diff and Platelet $72.84 85025

LABORATORY CBC w/ Auto Diff and Platelet $72.84 85025

LABORATORY Reticulocytes $35.37 85044

LABORATORY WBC Count $17.69 85048

LABORATORY Platelet Count $42.66 85049

LABORATORY Factor II Activity $207.07 85210

LABORATORY Factor V Human Inhibitor $219.30 85220

LABORATORY Factor VII Activity $207.07 85230

LABORATORY Factor VIII Clotting factor AHG $100.00 85240-1

LABORATORY Factor VIII ristocetin(result) $100.00 85245

LABORATORY Factor VIII VW factor(result) $100.00 85246

LABORATORY Factor VIII Multimetric(result) $100.00 85247

LABORATORY Factor IX Avtivity $212.25 85250

LABORATORY Factor X Activity $212.25 85260

LABORATORY Antithrombin III Antigen $223.71 85300

LABORATORY Antithrombin III Activity $108.21 85300-1

LABORATORY Protein C Antigen $255.00 85302

LABORATORY Protein C Functional $116.54 85303

LABORATORY Protein C Activity $228.46 85303-1

LABORATORY Protein S Antigen-total $170.00 85305

LABORATORY Protein S Functional $116.54 85306

LABORATORY Protein S AG, Free $280.94 85306-1

LABORATORY Protein S Activity $240.83 85306-2

LABORATORY Activated Protein C Resistance $156.08 85307

LABORATORY Factor V Activity $219.30 85335

LABORATORY D Dimer $114.45 85379

LABORATORY Fibrinogen Activity Clauss $79.56 85384

LABORATORY Fibrinogen level $152.00 85384-1

LABORATORY Lysozyme, Serum $136.30 85549

LABORATORY DRVVT confirm $128.00 85597

LABORATORY Hexagonal phase confirm $151.00 85598

LABORATORY (Result) Protime (PT) $0.00 85610

LABORATORY INR-Whole Blood (Fingerstick) $59.31 85610-1

LABORATORY Protime Panel w/ INR $43.70 85610-4

LABORATORY (Result) INR $0.00 85610-5

LABORATORY Lupus Eval DRVVT $112.37 85613

LABORATORY dRVVT screen with reflex $70.38 85613-2

LABORATORY Sed Rate(ESR) $41.62 85651-1

LABORATORY Sickle Cell Screen $46.36 85660

LABORATORY PTT $47.86 85730

LABORATORY Lupus Eval PTT $37.45 85730-1

LABORATORY VW PTT(result) $47.86 85730-3

LABORATORY Eos count, urine $68.68 85999

LABORATORY Francisella tularemia antigen $162.32 86000

LABORATORY Francisella tularensis AB DA $162.00 86000-1

LABORATORY Helminthosporium Halodes IGG $58.00 86001

LABORATORY hypersen pneumonitis Eval-phoma IgG $44.30 86001-1

LABORATORY hypersen pneumonitis Eval-tricoderm $44.30 86001-2

LABORATORY aspergillus niger IgG $59.00 86001-22

LABORATORY hypersen pneumonitis Eval-mix feather $44.30 86001-3

LABORATORY hypersen pneumonitis Eval-Pidgoen $44.30 86001-4

LABORATORY hypersen pneumonitis Eval-Aureo $44.30 86001-5

LABORATORY hypersen pneumonitis Eval-alteraria IgG $44.30 86001-6

LABORATORY hypersen pneumonitis Eval-cladaspor $44.30 86001-7

LABORATORY hypersen pneumonitis Eval-penicil $44.30 86001-8

LABORATORY Allergy Egg Mix $32.25 86003

LABORATORY Allergy Milk $32.25 86003-1

LABORATORY Baker Brewers Yeast $32.35 86003-10

LABORATORY Cheese Mold $32.35 86003-11

LABORATORY Allergy Pro Egg White IgE $32.35 86003-12

LABORATORY Egg Whole $32.35 86003-14

LABORATORY Egg Yolk $32.35 86003-15

LABORATORY Cow Milk $32.35 86003-16

LABORATORY Allergy Pro Soybean IgE $32.35 86003-17

LABORATORY Allergy Pro Wheat IgE $32.35 86003-18

LABORATORY **Food Allergy Profile, Adult $388.26 86003-2

LABORATORY Allergy Pro Peanut IgE $32.35 86003-20

LABORATORY Resp allergy Alder $35.70 86003-21

LABORATORY Resp allergy Alternaria $35.70 86003-22

LABORATORY Resp allergy Aspergillus $35.70 86003-23

LABORATORY Resp allergy Bermuda grass $35.70 86003-24

LABORATORY resp allergy Cat dander $35.70 86003-25

LABORATORY Resp allergy cladosporium $35.70 86003-26

LABORATORY Resp allergy ragweed $35.70 86003-27

LABORATORY resp allergy Cockroach $35.70 86003-27l

LABORATORY Allergy Yeast $32.25 86003-3

LABORATORY Allergy Pro Almond IgE $32.64 86003-30

LABORATORY Allergy Hazelnut IgE $54.00 86003-31

LABORATORY Resp allergy cottonwood $35.70 86003-32

LABORATORY Pinto Bean IgE $54.00 86003-33

LABORATORY Brazil Nut IgE $54.00 86003-34

LABORATORY Pecan IgE $54.00 86003-35

LABORATORY Allergy Pro tuna IgE $54.00 86003-36

LABORATORY Allergy Pro Walnut IgE $54.00 86003-37

LABORATORY Macadamia IgE $54.00 86003-38

LABORATORY Allergy Peanuts $32.25 86003-4

LABORATORY Pistachio IgE $54.00 86003-40

LABORATORY Resp allergy dermatopha fannae $35.70 86003-41

LABORATORY resp allergy Dermatopha ptero $35.70 86003-42

LABORATORY Resp allergy dog dander $35.70 86003-43

LABORATORY Resp allergy Elm $35.70 86003-44

LABORATORY Resp allergy box elder $35.70 86003-45

LABORATORY Resp allergy cedar $35.70 86003-46

LABORATORY Resp allergy Mouse Urine $35.70 86003-47

LABORATORY Resp allergy mugwort $35.70 86003-48

LABORATORY Resp allergy oak $35.70 86003-49

LABORATORY Allergy Corn $32.25 86003-5

LABORATORY Allergy Pro Cashew Nut IGE $32.64 86003-50

LABORATORY allergy Pro Cod fish IgE $32.64 86003-51

LABORATORY Allergy Pro Cows Milk IgE $32.64 86003-53

LABORATORY Allergy Pro Salmon IGE $32.64 86003-55

LABORATORY Allergy Pro Scallop $32.64 86003-56

LABORATORY Allergy Pro Sesame Seed IgE $32.64 86003-57

LABORATORY Allergy Pro Shrimp IgE $32.64 86003-58

LABORATORY Allergy Soybean $32.25 86003-6

LABORATORY Resp allergy olive $35.70 86003-60

LABORATORY Resp allergy penicillium $35.70 86003-61

LABORATORY Resp Allergy pigweed $35.70 86003-62

LABORATORY Resp allergy thistle $35.70 86003-63

LABORATORY Resp allergy sheep sorrel $35.70 86003-64

LABORATORY Resp allergy timothy grass $35.70 86003-65

LABORATORY Resp allergy white mulberry $35.70 86003-66

LABORATORY Allergy Shellfish - Clam $32.64 86003-67

LABORATORY Allergy Shellfish - Crab $32.64 86003-68

LABORATORY Allergy - Lobster $32.64 86003-69

LABORATORY Allergy Wheat $32.25 86003-7

LABORATORY allergy shellfish - Shrimp $32.64 86003-70

LABORATORY a-GAL galactose a1,3 IGE $20.40 86003-81

LABORATORY a-GAL beef IGE $35.70 86003-82

LABORATORY a-GAL galactose PORK IGE $35.70 86003-83

LABORATORY a-GAL galactose lamb IGE $35.70 86003-84

LABORATORY Helminthosporium Halodes IGE $32.00 86003-90

LABORATORY ANCA Screen $120.70 86021

LABORATORY ANCA Screen P ANCA $140.00 86021-1

LABORATORY IBD Panel myeloperox ab $136.68 86021-10

LABORATORY IBD Panel Sach cer IGG $139.74 86021-12

LABORATORY IBD Panel Sach cer IgA $139.74 86021-13

LABORATORY ANCA SCREEN C-ANCA $140.00 86021-2

LABORATORY ANCA ATYPICAL P-ANCA $140.00 86021-3

LABORATORY IBD Panel $1,150.79 86021-5

LABORATORY Myelopreoxidase AB $143.59 86021-6

LABORATORY Proteinase-3AB $143.59 86021-88

LABORATORY PLATELET AB (IGG) $243.47 86022

LABORATORY Platelet AB Direct flow cytom $254.00 86023

LABORATORY Beef IgE $54.00 86033-39

LABORATORY Centromere B Antibody $84.48 86038

LABORATORY (Result) ANA Choice (TM) $212.26 86038-1

LABORATORY ANA screen IFA w reflex titer/pattern $87.40 86038-2

LABORATORY (Result) ANA Titer IFA $84.28 86038-3

LABORATORY ANA centromere $126.94 86038-6

LABORATORY (Result) ANA Pattern $34.33 86039

LABORATORY Anti Streptolysin-O $73.88 86060

LABORATORY RCRP $68.68 86140

LABORATORY High Sensitivity CRP $68.68 86141

LABORATORY Cardio IQ iLipid panel-CRP hs $38.76 86141-13

LABORATORY Cardio CRP(quest) $92.72 86141-3

LABORATORY (result) Beta 2 IGA $75.00 86146-1

LABORATORY Beta 2 Glyco I AB IgA $148.00 86146-10

LABORATORY (result) Beta 2 IGG $67.00 86146-2

LABORATORY (result) Beta 2 IGM $70.00 86146-3

LABORATORY (result) Cardiolipin AB IgA $54.00 86147-10

LABORATORY (Result) Cardiolipin AB IGM $70.00 86147-11

LABORATORY (Result) Cardiolipin AB IGG $70.00 86147-12

LABORATORY (Result) PHOSPHATIDYLSERINE AB (IGA) $50.00 86148

LABORATORY (Result) PHOSPHATIDYLSERINE AB (IGG) $50.00 86148-1

LABORATORY (Results) PHOSPHATIDYLSERINE AB (IGM) $50.00 86148-2

LABORATORY Hemagglutinins $53.00 86157

LABORATORY Complement C4 $80.12 86160

LABORATORY Complement C3 $69.72 86160-1

LABORATORY C3c $105.00 86160-10

LABORATORY C3C4CH50 $158.16 86160-2

LABORATORY C1 Esterase Inhibitor, Protein $129.23 86160-3

LABORATORY Complement C4c $100.00 86160-6

LABORATORY C1 esterase Inhibitor, Functional $103.02 86161

LABORATORY Complement CH50 $103.02 86162

LABORATORY CYCLIC CITRULLINE PEP IGG $138.38 86200

LABORATORY ANA DNA (ds) Antibody $64.52 86225

LABORATORY DNA (DS) AB $85.32 86225-2

LABORATORY SM Antibody $92.72 86235

LABORATORY ANA SM/RNP AB $103.02 86235-1

LABORATORY ANA CHROMATIN ANTIBODIES $92.72 86235-2

LABORATORY Myositis plt7 autoanti $168.30 86235-20

LABORATORY Myositis Plt-12 autoab $168.30 86235-21

LABORATORY ANA RNP $110.00 86235-3

LABORATORY Sjogren's Antibody(SS-A) $86.36 86235-4

LABORATORY Sjogrens Antibody(SS-B) $86.36 86235-5

LABORATORY ANA Pro SCL-70 $111.00 86235-6

LABORATORY ANA Pro JO-1 ab $94.69 86235-7

LABORATORY Endomysial AB (IGA) $122.78 86255

LABORATORY Smooth muscle AB iGG $92.61 86255-1

LABORATORY Actin(mooth mus) AB IgG $96.90 86255-11

LABORATORY Striated Muscle AB $160.00 86255-16

LABORATORY mitochondrial AB $110.29 86255-2

LABORATORY Auto Neu - IA Fluor qual $262.00 86255-20

LABORATORY Aquaporin-4 IgG, CBA $668.60 86255-5

LABORATORY Phopholipse A2 recpt ab IFA $229.50 86255-7

LABORATORY Endomysial AB Titer $122.78 86256

LABORATORY Neuronal Nueclear AB(Hu) $452.61 86258

LABORATORY CA 27.29 $75.96 86300

LABORATORY (Result) CA 27.29 $0.00 86300-1

LABORATORY CA 15-3 $75.96 86300-2

LABORATORY CA 19-9 $180.01 86301

LABORATORY CA 125 $75.96 86304

LABORATORY MONO test $38.49 86308

LABORATORY Chromogranin A $164.40 86316

LABORATORY HEP B SURFACE AB QUANTITATIVE $126.94 86317

LABORATORY Hepatitis B Surface AB $81.16 86317-1

LABORATORY Strep pneumo Serotype (6) $271.58 86317-2

LABORATORY Strep Pneumo serotype IGG $37.40 86317-4

LABORATORY C4 Binding Protein, Serum $128.13 86329

LABORATORY Immunofixation (IFE), Serum $204.98 86334

LABORATORY Immunofixation Urine $192.49 86335

LABORATORY Beta-2 Transferrin $501.84 86335-1

LABORATORY Inhibin A - QUAD SCREEN $206.04 86336

LABORATORY Insulin Autoantibody $207.00 86337

LABORATORY Intrinsic factor $134.82 86340

LABORATORY Islet Cell Antibody $126.94 86341

LABORATORY IA-2 Antibody $208.10 86341-1

LABORATORY Auto Neu-Islet cell ab $262.00 86341-20

LABORATORY Glutamic Acid Decarb-65 AB $232.56 86341-3

LABORATORY Chronic Urticaria Index $189.37 86343

LABORATORY Lymphocyte Subset Panel 4 $349.05 86360

LABORATORY Lymphocyte Subset Panel 5 $161.57 86361

LABORATORY Lactoferritin, Qualitative Stool $195.62 863630

LABORATORY THYROID PERXIDASE (TPO) $116.54 86376

LABORATORY Liver/Kidney Microsomal AB $94.69 86376-1

LABORATORY Polio $401.64 86382

LABORATORY Polio 1 $151.91 86382-1





LABORATORY Streptozyme Screen with Reflex $153.77 86403

LABORATORY Rheumatoid Factor $64.52 86430

LABORATORY Rheumatoid Factor quant $61.20 86431

LABORATORY Quantiferon TB Gold $336.50 86480

LABORATORY RPR $38.49 86592

LABORATORY RPR Titer $49.00 86593

LABORATORY aspergillus niger IgE $33.00 86603-21

LABORATORY hypersen pneumonitis Eval-aspergillus $44.30 86606

LABORATORY hypersen pneumonitis Eval-polyspora $44.30 86609-1

LABORATORY hypersen pneumonitis Eval-Sacchro $44.30 86609-2

LABORATORY hypersen pneumonitis Eval-thermoact $44.30 86609-3

LABORATORY hypersen pneumonitis Eval atino sacc $44.30 86609-4

LABORATORY hypersen pneumonitis Eval-actino vulg $44.30 86609-5

LABORATORY Blastomyces AB -CF $117.30 86612

LABORATORY Blastomyces AB ID $117.30 86612-1

LABORATORY Bordetella Pertussis AB $244.51 86615

LABORATORY LYME DISEASE ANTIBODIES (IGG, IGM), WBLT $235.15 86617

LABORATORY Borrelia IGG $137.70 86619

LABORATORY Borrelia IGM $137.70 86619-1

LABORATORY Coccidiodes AB panel-F AG ab $57.69 86635

LABORATORY Coccidioides Panel TP ag IGM $56.66 86635-1

LABORATORY Coccidio Antibody Complement Fixation $90.78 86635-3

LABORATORY Coccidio Antibody Immunodiffusion $79.56 86635-4

LABORATORY Coxiella Burnetii ab - Q fever $18.00 86638

LABORATORY Q fever Phase II reflex titer $70.00 86638-20

LABORATORY CMV antibody IGG $122.40 86644

LABORATORY CMV Antibody IGM $124.44 86645

LABORATORY Diphteria $133.18 86648

LABORATORY Diptheria, Tetanus Antitoxoid $227.25 86648-1

LABORATORY Meningoencephalitis Comprehensive Panel CSF $3,785.03 86658

LABORATORY EBV Early AG IGG $131.10 86663

LABORATORY Epstein-Barr AB Panel $315.27 86664

LABORATORY Ehrlichia AB (IgG, IgM) $1.04 86666

LABORATORY (Result) Ehrlichia AB (IgG) $0.00 86666-1

LABORATORY (Result) Ehrlichia AB (IgM) $0.00 86666-2

LABORATORY (Result) Ehrlichia AB Interpretation $0.00 86666-3

LABORATORY IBD Panel-prot 3 ab $136.68 86671

LABORATORY IBD Panel ANCA screen $139.74 86671-2

LABORATORY H. Pylori in-house $146.71 86677

LABORATORY Clinic- H.pylori $146.71 86677-1

LABORATORY Helicobacter Pylori Antibodies $376.67 86677-2

LABORATORY Strongyloides AB IGG $207.00 86682

LABORATORY Filaria AB IgG4 $249.00 86682-3

LABORATORY (Result) HSV 1 IGG $121.74 86695-1

LABORATORY (Result) HSV 2 IGG $121.74 86695-2

LABORATORY (Result) HSV 1 IGM $66.60 86695-8

LABORATORY (Result) HSV 2 IGM $111.33 86696-2

LABORATORY HSV 2 IgG inhibition $348.00 86696-3

LABORATORY Histo AB Panel yeast $83.64 86698-1

LABORATORY Histo AB Panel-mycelial $83.64 86698-2

LABORATORY Histo Panel Ab ID $83.64 86698-3

LABORATORY HIV 1/2 AB EIA W/ REFLEXES $119.66 86703

LABORATORY Hepatitis B Core AB $107.17 86704

LABORATORY Hepatitis B Core AB (IGM) $143.59 86705

LABORATORY HEP B SURFACE AB QUALITATIVE $42.66 86706

LABORATORY Hepatitis BeAB $99.00 86707

LABORATORY Hepatitis A AB, Total $111.33 86708

LABORATORY Hepatitis A AB Total $80.12 86708-1

LABORATORY Hepatitis A IGM $93.19 86709

LABORATORY Haemophilus Influenza B $113.25 86710

LABORATORY Mumps Virus AB(IGG) $110.29 86735

LABORATORY Mumps Virus AB (IGM) $110.29 86735-1

LABORATORY Mycoplasma $106.13 86738

LABORATORY Rickettsia Antibody IgG $75.00 86757

LABORATORY Rickettsia Antibody IGM $75.00 86757-1

LABORATORY Rubella $98.85 86762

LABORATORY Measles IGG $224.75 86765-1

LABORATORY Measles IGM $138.38 86765-2

LABORATORY Salmonella Brucella Panel $292.38 86768

LABORATORY Tetanus $134.22 86774

LABORATORY FTA-ABS, Serum $103.01 86780

LABORATORY Treponema pallidum Antibody, Particle Agglutination $156.43 86780-1

LABORATORY Treponema pallidum IgG IFA $83.64 86780-3

LABORATORY Treponema pallidum IgM IFA $83.64 86780-4

LABORATORY Varicella IGG, IGM $91.57 86787

LABORATORY West Nile Virus Anitbodies-IgG $83.45 86788

LABORATORY West Nile IgM, CSF $78.54 86788-3

LABORATORY WEST Nile Virus Antibodies- IGM $82.42 86789-1

LABORATORY HTLV 1/2 w/ Western Blot $168.57 86790

LABORATORY Dengue Fever Antibody (IgM) $117.05 86790-1

LABORATORY Hanta virus IgG ab $113.32 86790-2

LABORATORY Colorado Tick Fever IgG $115.00 86790-4

LABORATORY Colorado Tick Fever IGM $115.00 86790-5

LABORATORY Hepatitis E AB IgG $102.00 86790-6

LABORATORY Hepatitis E AB IgM $102.00 86790-7

LABORATORY THYROGLOBULIN ANTIBODY-ATA $100.00 86800

LABORATORY Thyroid Cancer (thyroglobulin) monitor $114.35 86800-5

LABORATORY Hepatitis C ab $147.75 86803

LABORATORY HLA-B27 Antigen $189.37 86812

LABORATORY Antibody Screen $81.16 86850

LABORATORY Panel(Bonfils) $156.08 86870

LABORATORY DIRECT COOMBS TEST $23.93 86880

LABORATORY (Result) Blood Type ABO $67.64 86900

LABORATORY (Result) Blood Type Rh $32.25 86901

LABORATORY ASGL(Bonfils) $178.97 86905

LABORATORY Rhphenotype(Bonfils) $156.08 86906

LABORATORY (Result) Crossmatch - IS $32.25 86920

LABORATORY (result) Crossmatch IS #2 $32.25 86920-1

LABORATORY (Result) Crossmatch - AHG $50.98 86922

LABORATORY Blood Culture $91.57 87040

LABORATORY Stool Culture-Sal/Shig(result) $53.00 87045

LABORATORY Stool Culture-Campylobacter(result) $44.00 87046

LABORATORY Culture, other: specify source $67.64 87070

LABORATORY Culture Sputum $75.96 87070-1

LABORATORY Culture CSF $120.00 87070-10

LABORATORY Culture,Ear $105.00 87070-11

LABORATORY Culture,EYE $110.00 87070-12

LABORATORY Culture Wound $92.72 87070-5

LABORATORY Culture Vaginal/GU - alamosa $127.50 87070-6

LABORATORY CULTURE, BODY FLUID $51.00 87070-8

LABORATORY Culture Bone $75.00 87070-9

LABORATORY Culture -Anaerobic $65.56 87073

LABORATORY Clo Test $25.50 87077

LABORATORY Non-Urine ID $32.25 87077-1

LABORATORY Urine ID $32.25 87077-2

LABORATORY Non-Urine ID - ALAMOSA $63.87 87077-3

LABORATORY Culture Throat $66.30 87081

LABORATORY Culture Throat for RST FU $22.89 87081-1

LABORATORY Tularemia (Francisella tularensis) screen $47.39 87081-3

LABORATORY Culture -screen for MRSA $51.00 87081-4

LABORATORY Culture Urine $67.64 87088

LABORATORY Culture Fungus $171.69 87102

LABORATORY *Chlamydia Culture $102.00 87110-1

LABORATORY Culture Mycobacteria $89.76 87116

LABORATORY *Culture typing (HSV) $76.50 87140

LABORATORY STREPTEX - Alamosa $29.88 87147

LABORATORY (Result) Ova & Parasites (1) $25.00 87177

LABORATORY MIC(anerobic) each antibiotic $35.00 87181

LABORATORY Betalactamase ALAMOSA $56.66 87185

LABORATORY Sensitivity (MIC) $93.65 87186

LABORATORY SENSITIVITY - ALamosa $81.39 87186-1

LABORATORY Quest send out ID/MIC $210.18 87186-9

LABORATORY Gram Stain $42.66 87205

LABORATORY Gram Stain - Alamosa $82.42 87205-1

LABORATORY Acid-Fast Bacilli stain $86.70 87206

LABORATORY CYCLOSPORA $162.32 87207

LABORATORY Malaria Bebesia and other blood parasites $168.00 87207-1

LABORATORY (Result) Ova & Parasites (2) $52.03 87209

LABORATORY Wet Prep / KOH $38.49 87210

LABORATORY Clinic Wet prep/KOH $38.49 87210-1

LABORATORY C. Diff cytotoxin AB neutral $255.49 87230

LABORATORY Stool Culture Shiga Ecoli 0157 $77.27 87247-2

LABORATORY Culture, Virus $266.37 87252

LABORATORY Varicella zoster Rapid culture $165.00 87254

LABORATORY Culture Herpes Simplex Virus (HSV) $103.02 87255

LABORATORY C. Difficile Toxin $198.74 87324

LABORATORY Cryptosporidium $125.90 87328

LABORATORY Giardia ag $53.00 87329

LABORATORY H. Pylori Quest, Stool $376.38 87338-1

LABORATORY HEPATITIS B SURFACE ANTIGEN $79.08 87340

LABORATORY Hepatitis BeAg $99.00 87350

LABORATORY Histooplasma galac AG-urine $151.98 87385

LABORATORY Rotavirus Antigen detection $181.00 87425

LABORATORY Stool Culture-Shiga Toxin RFL(result) $100.00 87427

LABORATORY Stool Culture Shiga Toxin 2(result) $36.41 87427-1

LABORATORY Clinic Rapid Strep $35.37 87430-1

LABORATORY Legionella AG EIA Urine $190.59 87449

LABORATORY Campylobacter antigen EIA $139.08 87449-1

LABORATORY *Respiratory Panel -Chlamy $77.27 87486

LABORATORY Resp panel Chlamydophila pneumo $77.27 87486-1

LABORATORY C. TRACHOMATIS RNA, TMA(OLD not working) $91.57 87491

LABORATORY Chlamydia RNA $91.57 87491-1

LABORATORY Reflex C. Diff Charge $144.63 87493

LABORATORY C.diff- PCR in-house $128.78 87493-1

LABORATORY CMV DNA Qualitative $345.44 87496

LABORATORY CMV DNA QUALITATIVE RT PCR $352.73 87496-1

LABORATORY *CSF Panel-CMV $61.81 87496-10

LABORATORY Meningitis PCR-CMV $51.00 87496-21

LABORATORY CMV DNA QNT RT-PCR $451.57 87497

LABORATORY Enterovirus/Parachovirus RNA QL $415.16 87498

LABORATORY *CSF Panel-Entero virus $61.81 87498-10

LABORATORY Meningitis PCR-enterovirus $51.00 87498-21

LABORATORY Influenza A and B Confirmation, RT-PCR $344.40 87502

LABORATORY Stool Gastrointestinal PCR Panel $772.65 87507-3

LABORATORY Hep B DNA Quant PCR $446.58 87517

LABORATORY Hepatitis C Viral RNA Qual TMA $306.00 87521

LABORATORY Hepatitis C RNA Quant PCR $565.58 87522

LABORATORY Hepatitis C RNA, DNA Probe QNT $571.41 87522-3

LABORATORY Herpes Simplex type 2-PCR $71.40 87529

LABORATORY Herpes Simplex type 1 PCR $71.40 87529-1

LABORATORY *CSF Panel-HSV 1 $61.81 87529-10

LABORATORY *CSF Panel-HSV 2 $61.81 87529-11

LABORATORY Meningitis PCR-Herpes $51.00 87529-21

LABORATORY HSV type1 DNA RT qual $195.00 87529-90

LABORATORY HSV Type 2 DNA RT PCR $195.00 87529-91

LABORATORY *CSF Panel-Herpe 6 $71.40 87532

LABORATORY HIV Viral Load $343.36 87536

LABORATORY M Avium DNA $250.92 87561

LABORATORY M.intracellulare DNA $250.92 87561-1

LABORATORY Resp panel Myco pneumoniae $76.50 87581-1

LABORATORY N. GONORRHOEAE RNA, TMA(not Working) $91.57 87591

LABORATORY Gonorrheae RNA $91.57 87591-1

LABORATORY Resp panel 12 - 25 targets[Panel] $510.00 87633-1

LABORATORY **Respiratory Bordetella pertussis $77.27 87633-15

LABORATORY **Respiratory Chlamydophila pneumoniae $77.27 87633-16

LABORATORY Group B Strep - Molecular DNA $92.72 87653

LABORATORY Group B Strep $92.72 87653-01

LABORATORY *CSF Panel-Group B Strep $51.51 87653-2

LABORATORY Meningitis PCR Strep b $51.00 87653-21

LABORATORY Zika virus RNA qual RT-PCR $520.00 87662

LABORATORY Bordetella pertusis and parapertusis $315.27 87798

LABORATORY Norovirus RNA PCR $357.93 87798-1

LABORATORY *CSF Panel-Cryto $51.51 87798-10

LABORATORY *CSF Panel-E. coli K1 $51.51 87798-11

LABORATORY *CSF Panel-H inf $61.81 87798-12

LABORATORY *CSF Panel-Listeria $61.81 87798-13

LABORATORY *CSF Panel-n.men $51.51 87798-14

LABORATORY *CSF Panel-S pneumo $51.51 87798-15

LABORATORY *CSF Panel-Varicella $61.81 87798-16

LABORATORY *CSF Panel-Parechovirus $61.81 87798-17

LABORATORY Meningitis PCR - direct probe each organism $51.00 87798-21

LABORATORY Chikungunya Virus RNA, Qualitative, Real-Time PCR $387.59 87798-4

LABORATORY **Respiratory Panel-Pertussis $77.27 87798-5

LABORATORY Resp panel B. pertussis $77.27 87798-6

LABORATORY Quantitative BK Virus PCR Plasma $437.78 87799

LABORATORY Parvo B-19 Quant $559.36 87799-1

LABORATORY Herpes Virus 7DNA Quant $476.90 87799-2

LABORATORY Epstein BV DNA, PCR $342.00 87799-3

LABORATORY Rapid Strep $58.27 87800

LABORATORY C. diff screen $129.02 87803

LABORATORY Influenza A and B $96.77 87804

LABORATORY Clinic Influenza A & B Test $56.10 87804-4

LABORATORY RSV $134.22 87807

LABORATORY Strep pneumonomiae ag $163.80 87899

LABORATORY HEP C VIRAL RNA, GENOTYPE, LIPA(R) $515.10 87902

LABORATORY Hepatitis C Viral Genotype $711.96 87902-1

LABORATORY HEP C RNA geno, 1N5b resistance $760.92 87902-3

LABORATORY Cytology, Non-Gynecological, Fluid, Washings, Brushings or FNA$294.17 88112

LABORATORY Leukemia/Lymphoma CD2 $75.61 88184

LABORATORY Flow Cytom, first marker $154.02 88184-1

LABORATORY Flow Cytom, each additionl $94.17 88185

LABORATORY leukemia/lymphoma CD3 $75.61 88185-1









LABORATORY leukemia/lymphoma HLA-DR $75.61 88185-18

LABORATORY leukemia/lymphoma sKAPPA $75.61 88185-19


LABORATORY leukemia/lymphoma sLAMBDA $75.61 88185-20






LABORATORY leukemia/lymphoma CD11C $75.61 88185-6



LABORATORY flow Cytom Interpretation 2-8 $140.37 88187

LABORATORY leukemia/lymphoma interpretation $77.27 88189

LABORATORY Fragile X Chromosome Analysis $1,250.68 88230

LABORATORY Chromosome Analysis $783.76 88230-1

LABORATORY Bladder Cancer, Fish $1,039.46 88271

LABORATORY Fish Chromosomal Analysis Preg. $608.23 88271-1

LABORATORY FISH, DNA probe $300.00 88271-2

LABORATORY FISH DUP,interface analysis $200.00 88275

LABORATORY Cell Count, Body Fluid w/ Differential $77.27 89051

LABORATORY Fluid Cell Count with Diff Alamosa $87.57 89051-1

LABORATORY Crystals Synovial $143.59 89060

LABORATORY Crystal evauation - synovial (alamosa lab) $127.50 89060-1

LABORATORY Semen analysis post VAS Check $102.00 89321

LABORATORY Galloping Gorilla Courier Charge(Childrens Hospital) $48.90 99000-1

LABORATORY Therapeutic Phlebotamy $122.78 99195

LABORATORY Welcome to Medicare PSA $95.81 G0103

LABORATORY Hepatitis C ab (medicare screening only) $147.32 G0472

LABORATORY Cortrosyn (ACTH) $112.20 J0834

LABORATORY Rh0(D)immune glob Rhophylac $178.97 J2791

LABORATORY Myositis AssessR[Package] $168.30 MYOsitis

LABORATORY Opiate metabolites Screen w/confirmation $80.12 OPIATES

LABORATORY Platelets pheresed, leuko reduced $800.00 P9035

LABORATORY ** DO NOT USE OLD URINE DRUG SCREEN $230.99 X8030

LABORATORY ** DO NOT USE OLD URINE DRUG SCREEN $230.99 X8030

LABORATORY XXTotal Protein, Random Urine $34.33 XX84156

LABORATORY ZZ - CEA $137.34 zz82378

MRI MRI Temporomandibular Jts $1,862.50 70336-T

MRI MRI Face, Neck or Orbits w/o contrast $2,360.90 70540

MRI MRI Face, Neck or Orbits w/ contrast $2,626.22 70542

MRI MRI Face, Neck or Orbits w, w/o contrast $4,076.69 70543

MRI MRI MRA Head w/o contrast $2,680.34 70544

MRI MRI MRA Head w/wo contrast $3,123.59 70545

MRI MRI MRA Neck w/o contrast $2,387.95 70547

MRI MRI MRA Neck w/contrast $2,913.41 70548

MRI MRI MRA Neck w/wo contrast $3,652.16 70549

MRI MRI Brain w/o contrast $2,795.83 70551

MRI MRI Brain w/ contrast $3,136.07 70552

MRI MRI Brain w, w/o contrast $4,138.08 70553

MRI MRI Chest w/o contrast $2,263.09 71550

MRI MRI Chest w/ contrast $2,525.30 71551

MRI MRI Chest w, w/o contrast $4,059.00 71552

MRI MRI C-Spine w/o contrast $2,391.07 72141

MRI MRI C-Spine w/ contrast $2,778.14 72142

MRI MRI T-Spine w/o contrast $2,381.71 72146

MRI MRI T-Spine w/ contrast $2,862.43 72147

MRI MRI L-Spine w/o contrast $2,381.71 72148

MRI MRI L-Spine w/ contrast $2,842.65 72149

MRI MRI C-Spine w, w/o contrast $4,138.08 72156

MRI MRI T-Spine w, w/o contrast $4,138.08 72157

MRI MRI L-Spine w, w/o contrast $4,138.08 72158

MRI MRI L spine w/wo, with AMB to Ala $6,261.74 72158-1

MRI MRI Pelvis w/o contrast $2,370.27 72195

MRI MRI Pelvis w/ contrast $2,735.48 72196

MRI MRI Pelvis w, w/o contrast $4,087.09 72197

MRI MRI Upper Extrem Other Than JT $1,716.83 73218

MRI MRI Bi-lateral Upper Extem Other Than JT $3,433.66 73218-2



MRI MRI Upper Ext; w/wo contrast $2,982.08 73220

MRI MRI Upper Ext jt. wo (Shoulder, Elbow, Wrist) $1,716.83 73221

MRI MRI Bi-lateral Upper Ext w/o contrast $3,433.66 73221-2

MRI MRI Upper Extrem jt. (Shoulder, Elbow, Wrist w/cont) $1,716.66 73222

MRI MRI Upper Extrem jt (Shoulder, Elbow, Wrist w/wo cont)$1,836.00 73223

MRI MRI Lower Ext., w/o contrast $2,347.38 73718

MRI MRI Bi-lateral Lower Ext, wo contrast $4,694.74 73718-2

MRI MRI Lower Ext; Other/Than Jt. w/wo contrast $3,810.32 73720

MRI MRI Lower Extremity jt. (Knee, Hip, Ankle wo) $2,733.40 73721

MRI MRI Bi-lateral KNEE w contrast $5,466.80 73721-2

MRI MRI Lower Extrem jt., (Hip, Knee, Ankle w/cont) $2,754.00 73722

MRI MRI Lower Extrem jt. (Hip, Knee, Ankle w/wo cont) $2,856.00 73723

MRI MRI Abd w/o contrast $2,863.47 74181

MRI MRCP w Amb to SLVH $4,804.20 74181-1

MRI MRI Abd w/ contrast $3,073.65 74182

MRI MRI Abd w, w/o contrast $3,817.61 74183

OBSERVATION NG Tube insertion $185.21 43752

OBSERVATION 1st-2nd hour / Per Hr $176.89 99218

OBSERVATION 3rd-12th hour/ per hour $71.80 99218-1

OBSERVATION 13th-24th hour/per hour $29.13 99218-2

OBSERVATION Observation facility low per hr $67.64 99218-T

OBSERVATION Observation facility mod per hr $69.72 99219-T

OBSERVATION Observation facility high per hr. $71.80 99220-T

OCCUPATIONAL THERAPYOT eval-low $140.00 95165

OCCUPATIONAL THERAPYOT Eval-mod $160.00 97166

OCCUPATIONAL THERAPYOT eval -high $165.00 97167

OCCUPATIONAL THERAPYOT TherapeuticActivities $85.32 97530-1

OP WOUND CARE WND I&D Abcess Simple FAC $234.11 10060-5-T

OP WOUND CARE WND I&D multi/complex-Fac $389.15 10061-5-T

OP WOUND CARE WND Drain pilonidal cyst-simple FAC $620.00 10080-5-T

OP WOUND CARE WND I&D hematoma/fluid-Fac $1,827.13 10140-5-T

OP WOUND CARE WND Punct. drainage-FAC $244.00 10160-5-T

OP WOUND CARE WND Deb infected skin-FAC $300.00 11000-5-T

OP WOUND CARE WND Deb sq tissue 20 cm2/< FAC $360.00 11042-5-T

OP WOUND CARE Debridement - Skin 20 Sq cm or< PRO $360.57 11042-P

OP WOUND CARE WND Deb Mus/fascia <20cm2,-FAC $450.00 11043-5-T

OP WOUND CARE WND Deb Bone <20cm/<-FAC $900.00 11044-5-T

OP WOUND CARE WND Deb subq add on 20 sq cm FAC $51.00 11045-5-T

OP WOUND CARE WND Deb mus/fascia add-on FAC $490.00 11046-5-T

OP WOUND CARE WND Deb bone add-on FAC $1,350.00 11047-5-T

OP WOUND CARE WND Trim skin lesion FAC $31.21 11055-5-T

OP WOUND CARE WND Trim skin.Lesion; 2-4-FAC $42.66 11056-5-T

OP WOUND CARE WND Biopsy;Skin,lesion single-FAC $250.00 11100-5-T

OP WOUND CARE WND Biopsy skin add-on lesion FAC $27.05 11101-5-T

OP WOUND CARE WND Excis B9(Face);2.1-3cm-FAC $400.00 11143-5-T

OP WOUND CARE WND Shave-Benign, Skin Tags1-15-FAC $120.00 11200-5-T

OP WOUND CARE WND Shave, B9;Each Additional 10 FAC $25.00 11201-5-T

OP WOUND CARE WND Excise B9 (tr,a,l) Lesion .5cm-<,-FAC $440.00 114000-5-T

OP WOUND CARE WND Excise B9(tr,a,l) Lesion .6 to 1cm-FAC $240.00 11401-5-T

OP WOUND CARE WND Excise B9(tr,a,l) 1 to 2cm-FAC $300.00 11402-5-T

OP WOUND CARE WND Excise B9(tr,a,l)2.1-3cm-FAC $400.00 11403-5-T

OP WOUND CARE WND Excise B9(tr,a,l)3.1-4cm-FAC $800.00 11404-5-T

OP WOUND CARE WND Excise B9(tr,a,l)>4.0cm-FAC $1,000.00 11406-5-T

OP WOUND CARE WND Excise B9(sc,n,ha,fe,g);.5cm or<-FAC $140.00 11420-5-T

OP WOUND CARE WND Excise B9(sc,n,ha,fe,g) .6 to 1.cm-FAC $200.00 11421-5-T

OP WOUND CARE WND Exc B9(head,neck,ext, gen) 1.1-2cm Fac $500.00 11422-5-T

OP WOUND CARE WND Exc B9(sc,n,ha,fe,g) 2.1 to 3cm-FAC $1,000.00 11423-5-T

OP WOUND CARE WND Exc B9(sc,n,ha,fe,g)3.1-4cm FAC $1,200.00 11424-5-T

OP WOUND CARE WND Excis B9 Face .5cm/<-FAC $150.00 11440-5-T

OP WOUND CARE WND Excis B9(Face);0.6-1.cm-FAC $200.00 11441-5-T

OP WOUND CARE WND Excis B9(Face);1.1-2cm-FAC $220.00 11442-5-T

OP WOUND CARE WND Debrid Nail 1-5-FAC $20.00 11720-5-T

OP WOUND CARE WND Debride Nail 6 or <-FAC $25.00 11721-5-T

OP WOUND CARE WND Removal of Nail plate-FAC $60.00 11730-5-T

OP WOUND CARE WND Removal of Nail plate add-on FAC $20.00 11732-5-T

OP WOUND CARE WND Drain blood from under nail-FAC $39.54 11740-5-T

OP WOUND CARE WND Removal of nail bed-FAC $120.00 11750-5-T

OP WOUND CARE WND Repair of Nail Bed-FAC $150.00 11760-5-T

OP WOUND CARE WND Excision of nail fold toe-FAC $75.00 11765-5-T

OP WOUND CARE WND Debrid. Nail;Wedge Exc.of Skin;Fold-FAC $100.00 12001-5-T

OP WOUND CARE WND Lac Repair-Supf.Nonface;2.6-7.5 cm-FAC $127.98 12002-5-T

OP WOUND CARE WND Closure wound dehis simp-FAC $164.40 12020-5-T

OP WOUND CARE WND Closure of wound dehis w/pack-FAC $117.58 12021-5-T

OP WOUND CARE WND Lac Repair-Intermed. Nonface;2.5cm or < FAC $175.00 12031-5-T

OP WOUND CARE WND Lac Repair Intermed. Nonface;2.6-7.5cm FAC $200.00 12032-5-T



OP WOUND CARE WND Lac Repair Intermed Nonface;20.1-30cm FAC $275.00 12036-5-T

OP WOUND CARE WND Lac Repair- Intermed Nonface< 30.0cm FAC $350.00 12037-5-T

OP WOUND CARE WND Lac Repair Intermed Head/Face;2.5cm/<FAC $125.00 12040-5-T

OP WOUND CARE WND Lac Repair-Intermed. Head/Face;2.6-7.5 FAC $175.00 12042-5-T

OP WOUND CARE WND Lac Repair Intermed Head/Face7.6-12.5cm FAC $200.00 12044-5-T

OP WOUND CARE WND Lac Repair Intermed Head/Face12.6-20cm FAC $250.00 12045-5-T

OP WOUND CARE WND Lac Repair-Intermed Head/Face;20.1-30 FAC $275.00 12046-5-T

OP WOUND CARE WND Lac Repair-Intermed. Head/Face;< 30.0cm FAC $500.00 12047-5-T

OP WOUND CARE WND Lac Repair Intermed Face;2.5cm/<FAC $125.00 12051-5-T

OP WOUND CARE WND Lac Repair-Intermed Face;2.6-5cm FAC $200.00 12052-5-T

OP WOUND CARE WND Lac Repair Intermed Face;5.1-7.5cm FAC $225.00 12053-5-T

OP WOUND CARE WND Lac Repair Intermed Face 7.6-12.5cm FAC $250.00 12054-5-T

OP WOUND CARE WND Lac Repair Intermed Face 12.6-20cm FAC $275.00 12055-5-T

OP WOUND CARE WND Lac Repair Intermed. Face;20.1-30cm-FAC $275.00 12056-5-T

OP WOUND CARE WND Burn init Trmt-FAC $70.00 16000-5-T

OP WOUND CARE WND Burn, Debride <5%-FAC $120.00 16020-5-T

OP WOUND CARE WND Burn Debride 5%-10% (med.) - FAC $250.00 16025-5-T

OP WOUND CARE WND Burn; Large> 10%-FAC $300.00 16030-5-T

OP WOUND CARE WND Cryo-1st Lesion-FAC $65.00 17000-5-T

OP WOUND CARE WND Cryo:2-14 Lesions-FAC $5.00 17003-5-T

OP WOUND CARE WND Cryo Lesions 15+-FAC $200.00 17004-5-T

OP WOUND CARE WND Wart Removal;up to 14 Lesions-FAC $70.00 17110-5-T

OP WOUND CARE WND Chem. Cauterize of Gran Tissue-FAC $35.00 17250-5-T

OP WOUND CARE WND Apply rigid leg cast (TCC)PRO $220.00 29445-P

OP WOUND CARE WND Apply rigid leg cast(TCC) FAC $400.00 29445-T

OP WOUND CARE WND Strapping - Unna Boot - FAC $75.00 29580-5-T

OP WOUND CARE WND Strapping low extremity -FAC $152.63 29581-5-T

OP WOUND CARE WND Apply multi-layer cast PRO $120.00 29581-P

OP WOUND CARE WND Apply Multi-layer cast-FAC $200.00 29581-T

OP WOUND CARE WND FBR-Eyelid - FAC $535.00 67938-5-T

OP WOUND CARE WND Remove impacted Cerumen, 1 or both-FAC $40.58 69210-5-T

OP WOUND CARE WND ABI (Ankle-Brachial Index)-Fac $150.00 93922-5-T

OP WOUND CARE ABI (Ankle-Brachial Index)-Pro $300.00 93922-P

OP WOUND CARE ABI (Ankle-Brachial Index)-Fac $150.00 93922-T

OP WOUND CARE Wound Care Active Management first 20 sq cm $288.46 97597

OP WOUND CARE Wound Care Active Management first 20 sq cm $288.46 97597

OP WOUND CARE HBOT supervision $200.00 99183

OP WOUND CARE WND Wound NEW Min - FAC $37.45 99201-5-T

OP WOUND CARE WND Wound New Brief-FAC $43.70 99202-5-T

OP WOUND CARE WND Wound New Int-FAC $84.28 99203-5-T

OP WOUND CARE WND Wound New Ext-FAC $117.58 99204-5-T

OP WOUND CARE WND Wound New Ext+-FAC $136.30 99205-5-T

OP WOUND CARE WND Wound/Nurse visit FAC $25.00 99211-5-T

OP WOUND CARE WND Wound Visit Est. Brief-FAC $34.33 99212-5-T

OP WOUND CARE WND Wound Visit Est.Int FAC $43.70 99213-5-T

OP WOUND CARE WND Wound Visit Est.ext-FAC $69.72 99214-5-T

OP WOUND CARE WND Wound Visit Est.ext+FAC $105.09 99215-5-T

OP WOUND CARE HBOT,full body 30min $100.00 G0277

ORTHOPEDICS Closed Phalanx Fracture $420.36 26720

OUTPATIENT Anes for cardioversion $51.00 410

OUTPATIENT Rmv. Inf./Devit.Tissue;Partial Thick-FAC $42.66 11040-T

OUTPATIENT EXC - paring or cutting benign lesion -single-FAC $31.21 11055-T

OUTPATIENT Exc Benigh(head,neck,ext, gen) 1.1-2cm Fac $135.26 11422-T

OUTPATIENT Lesion rem; malig head/face 3.1-4.0-T $315.27 11644-T

OUTPATIENT Asp./Inj joint; BILATERAL Inter.(w,el,an) FACILITY $170.65 20605-T-1

OUTPATIENT Asp./Inj Joint; Major(s,h,k) BILATERAL -Facility $185.21 20610-F-1

OUTPATIENT FRX/Dislocation-Finger/Thumb; W manip-FAC $525.45 26755-T

OUTPATIENT Insertion of PICC line >5yrs $1,024.90 36569

OUTPATIENT Remove impacted Cerumen w/o instru[Package] $82.42 69209

OUTPATIENT Remove impacted Cerumen w/o instru-fac $51.51 69209-T

OUTPATIENT Clinic IV therapy for Vit C, MAG $94.69 96367-1

OUTPATIENT Port Flush $114.45 96523

OUTPATIENT Office Visit New Min - FAC $37.45 99201-T

OUTPATIENT Office Visit New Brief- FAC $43.70 99202-T

OUTPATIENT Office Visit New Int.-FAC $84.28 99203-T

OUTPATIENT Office Visit New Ext.-FAC $117.58 99204-T

OUTPATIENT Office Visit New Ext. +-FAC $136.30 99205-T

OUTPATIENT Office Visit Est. Brief-FAC $34.33 99212-T

OUTPATIENT Office Visit Est. Int.-FAC $43.70 99213-T

OUTPATIENT Office Visit Est. Ext.-FAC $69.72 99214-T

OUTPATIENT Office Visit Est. Ext. +-FAC $105.09 99215-T

OUTPATIENT OFFICE CONSULT-MINOR- 15 MIN-FAC $85.32 99241-T

OUTPATIENT OFFICE COUSULT-LOW-FAC 30 MIN $113.41 99242-T

OUTPATIENT OFFICE CONSULT-MODERATE-40 MIN-FAC $111.33 99243-T

OUTPATIENT OFFICE CONSULT-MOD/HIGH-60 MIN-FAC $145.67 99244-T

OUTPATIENT OFFICE CONSULT-HIGH-HIGH-80 MIN-FAC $152.95 99245-T

OUTPATIENT PICC device $263.25 C1751

OUTPATIENT Clinic Admin- flu vaccine $35.37 G0008

PHARMACY Clinic Racemic Epi Inh $22.89 468146

PHARMACY Clinic Doxycycline 100mg/100ml $21.85 515-M

PHARMACY Medicaid Vaccine 1st $22.56 90471-3

PHARMACY Clinic Hep A adult vaccine $94.69 90632

PHARMACY Clinic Hep A Ped/Adolescent vaccine 2 dose $42.66 90633

PHARMACY Clinic PedvaxHib $65.56 90647

PHARMACY Clinic Haemophilus Influenza B (HIB) $46.82 90648

PHARMACY Clinic HPV (Human Palilloma Virus) $263.25 90649

PHARMACY HPV 9 vaccine, Gardasil $234.11 90651

PHARMACY Clinic Flu vaccine, high dose 65 or greater $57.23 90662

PHARMACY Clinic Pneumococcal Conjugate (Prevnar PCV13) $436.18 90670

PHARMACY Clinic Rotavirus vaccine 3 Dose $110.29 90680

PHARMACY Clinic Flu (6 months to 35 months) $28.85 90685

PHARMACY Clinic Kinrix DTAP/IVP $72.11 90696

PHARMACY Clinic DTaP, HIB, IP $97.81 90698

PHARMACY Clinic DTap <7 years $85.32 90700

PHARMACY Clinic MMR vaccine $105.09 90707

PHARMACY Clinic Vaccine MMRV $227.87 90710

PHARMACY Clinic IPV $48.90 90713

PHARMACY Clinic Td vaccine- Adult $59.31 90714

PHARMACY Clinic - TDAP; 7 yrs, or less $85.32 90715

PHARMACY Clinic Varicella vaccine- pediatric $150.87 90716

PHARMACY Clinic DTap, Hep B, IPV vaccine $98.85 90723

PHARMACY Clinic Pneumovax $208.41 90732

PHARMACY Clinic Meningococcal MCV4 $134.22 90734

PHARMACY Clinic Zoster (Shingles) vaccine $263.25 90736

PHARMACY Hep B Ped/adolescent 3 dose $33.29 90744

PHARMACY Clinic Hep B vaccine adult dose $100.93 90746

PHARMACY INJ OPTISON - ECHO CONTRAST $299.67 A9700

PHARMACY Clinic Bicillin LA 100,000U $16.65 J0561

PHARMACY Clinic Rocephin 250mg $5.20 J0696

PHARMACY Clinic Rocephin 500mg $5.20 J0696-1

PHARMACY Clinic Rocephin 1gram $5.20 J0696-2

PHARMACY Clinic Depo-Esteradiol 5mg/mL $14.57 J1000

PHARMACY Clinic Depo-Medrol 40mg/mL $45.78 J1030

PHARMACY Clinic Depo-Medrol 80mg/mL $192.49 J1040

PHARMACY Clinic Depo-Provera, 1mg $0.31 J1050

PHARMACY Clinic Adenosine 1mg $21.42 J1053-1

PHARMACY Clinic Depo-Testosterone-1 mg $0.11 J1071

PHARMACY Clinic Decadron(dexamethasone) $2.08 J1100

PHARMACY Clinic Dilaudid $29.13 J1170

PHARMACY Clinic Benadryl 50mg/ml $2.08 J1200

PHARMACY Clinic Toradol 15mg $15.61 J1885

PHARMACY Clinic Lasix 10mg/mL $14.57 J1940

PHARMACY Clinic Lorazepam Inj. $64.52 J2060

PHARMACY Clinic Demerol 50mg $29.13 J2175

PHARMACY Clinic Demerol 75mg $29.13 J2175-1

PHARMACY Clinic Demerol 100mg $29.13 J2175-2

PHARMACY Clinic Morphine Sulfate 10mg Inj. $10.40 J2270

PHARMACY Clinic Zofran 2 mg $15.61 J2405

PHARMACY Clinic Zofran 4mg $15.61 J2405-1

PHARMACY Clinic Phenergan 25mg/mL $19.77 J2550

PHARMACY Clinic Phenergan 50mg/mL $19.77 J2550-1

PHARMACY Clinic Reglan Inj. $29.13 J2765

PHARMACY Clinic Solumedrol 125mg $40.58 J2930

PHARMACY Clinic Imitrex 6mg $80.12 J3030

PHARMACY Clinic Kenalog 10 mg $16.65 J3301

PHARMACY Clinic Valium(Diazepam) Inj. $34.33 J3360

PHARMACY Clinic Vitamin B12 1000mcg $3.12 J3420

PHARMACY Magnesium Sulfate 1gram/2 mL $22.89 J3475

PHARMACY Clinic Metoprolo 5mg Inj. $6.24 J3490

PHARMACY IUD (MIRENA) $486.96 J7298

PHARMACY IUD (Paragard) $940.61 J7300

PHARMACY Nexplanon $936.45 J7307

PHARMACY Clinic Hyalgan Inj.per dose $330.88 J7321

PHARMACY Clinic Hymovis 1mg $25.00 J7322

PHARMACY Clinic Synvisc or Synvisc-one per mg $22.89 J7325

PHARMACY Clinic Albuterol Inhalent $22.89 J7609

PHARMACY Clinic DuoNeb 0.5/3ml $22.89 J7620

PHARMACY Clinic Dexamethasone (inhaled) $24.97 J7638

PHYSICAL THERAPY PT TENS evaluation/Training $48.90 64550

PHYSICAL THERAPY PT Canalith repositioning $84.28 95992

PHYSICAL THERAPY PT cold/hot packs $10.40 97010

PHYSICAL THERAPY Mechanical traction $38.00 97012

PHYSICAL THERAPY PT electrical stimulation $44.74 97014

PHYSICAL THERAPY PT iontophoresis $30.17 97033

PHYSICAL THERAPY PT contrast bath $33.29 97034

PHYSICAL THERAPY PT ultrasound $49.94 97035

PHYSICAL THERAPY Laser therapy/attended15 min $80.00 97039

PHYSICAL THERAPY PT exercises $69.72 97110

PHYSICAL THERAPY PT Neuromuscular Re-ed $85.32 97112

PHYSICAL THERAPY PT Gait Training $49.94 97116

PHYSICAL THERAPY PT manual therapy $57.23 97140

PHYSICAL THERAPY PT group therapy $41.62 97150

PHYSICAL THERAPY PT Eval - low complex $177.48 97161

PHYSICAL THERAPY PT eval- medium complex $177.48 97162

PHYSICAL THERAPY PT Eval - high complex $177.48 97163

PHYSICAL THERAPY PT re-evaluation $82.20 97164

PHYSICAL THERAPY PT Therapeutic Activities $85.32 97530

PHYSICAL THERAPY Work Comp Dry Needle trigger 3- $36.41 Z0501

PHYSICAL THERAPY Work Comp Dry Needle trigger 3- $36.41 Z0501

PHYSICAL THERAPY Work Comp Dry Needle Trigger +3 mus $38.49 Z0502

PHYSICAL THERAPY Work Comp Dry Needle Trigger +3 mus $38.49 Z0502

PHYSICIAN SERVICES Acne surgery $206.02 10040

PHYSICIAN SERVICES Acne surgery-PRO $124.86 10040-P

PHYSICIAN SERVICES I&D Abcess Simple or Single[Package] $199.78 10060

PHYSICIAN SERVICES WND I&D Abcess Simple PRO $226.83 10060-6-P

PHYSICIAN SERVICES I&D Abcess Simple or Single (SQ)-PRO $226.83 10060-P

PHYSICIAN SERVICES I&D Complicated or Multiple[Package] $352.73 10061

PHYSICIAN SERVICES WND I&D multi/complex-PRO $234.11 10061-6-P

PHYSICIAN SERVICES I&D multi/complex-PRO $234.11 10061-P

PHYSICIAN SERVICES I&D multi/complex-PRO $234.11 10061-P

PHYSICIAN SERVICES WND drain pilonidal cyst-simple PRO $268.00 10080-6-P

PHYSICIAN SERVICES drain pilonidal cyst-simple pro $370.87 10080-P

PHYSICIAN SERVICES FB Removal/Incision[Package] $198.74 10120

PHYSICIAN SERVICES FB Removal/Incision -PRO $95.73 10120-P

PHYSICIAN SERVICES FBR-Complicated [Package] $402.68 10121

PHYSICIAN SERVICES FBR-Complicated -PRO $240.35 10121-P

PHYSICIAN SERVICES WND I&D hematoma/fluid-PRO $307.99 10140-6-P

PHYSICIAN SERVICES Punct. asp. abscess,hematoma,bulla or cyst $208.10 10160

PHYSICIAN SERVICES WND Punct. drainage-PRO $248.00 10160-6-P

PHYSICIAN SERVICES Punct. asp. abscess,hematoma,bulla or cyst-PRO $123.82 10160-P

PHYSICIAN SERVICES Repair INT Layer 20[Package] $727.31 10256

PHYSICIAN SERVICES WND Debridement infected skin PRO $180.00 11000-6-P

PHYSICIAN SERVICES Debride, Rem Fo-skin to Muscle $68.68 11011

PHYSICIAN SERVICES Rmv. Inf./Devit.Tissue;Partial Thick $110.29 11040

PHYSICIAN SERVICES Rmv. Inf./Devit.Tissue;Partial Thick-PRO $67.64 11040-P

PHYSICIAN SERVICES WND Deb sq tissue 20 cm2/< PRO $300.00 11042-6-P

PHYSICIAN SERVICES WND Deb Mus/fascia <20cm2,-PRO $405.00 11043-6-P

PHYSICIAN SERVICES Debridement - Muscle or fascia <20cm or less-PRO $450.00 11043-P

PHYSICIAN SERVICES WND Deb Bone <20cm/<-PRO $600.00 11044-6-P

PHYSICIAN SERVICES WND Deb subq add on 20 sq cm PRO $88.74 11045-6-P

PHYSICIAN SERVICES Debridement skin addtn 20 sq cm-PRO $88.74 11045-P

PHYSICIAN SERVICES WND Deb mus/fascia add-on PRO $152.00 11046-6-P

PHYSICIAN SERVICES Debridement - additional 20 cm - muscle-PRO $152.00 11046-P

PHYSICIAN SERVICES WND Deb bone add-on PRO $257.18 11047-6-P

PHYSICIAN SERVICES Debridement - additional 20cm - bone-PRO $257.18 11047-P

PHYSICIAN SERVICES ORTHO EXC-trimming single lession $84.28 11055-1

PHYSICIAN SERVICES WND Trim skin lesion PRO $53.07 11055-6-P

PHYSICIAN SERVICES EXC - paring or cutting benign lesion -singlePRO $53.07 11055-P

PHYSICIAN SERVICES Exc. Benign Hyper. Lesion; 2-4 $109.25 11056

PHYSICIAN SERVICES WND Trim skin.Lesion; 2-4-PRO $66.60 11056-6-P

PHYSICIAN SERVICES Exc. Benign Hyper. Lesion; 2-4-PRO $66.60 11056-P

PHYSICIAN SERVICES Biopsy;Skin,Sub. tissue&/or mucous membrane single(package)$186.25 11100

PHYSICIAN SERVICES WND Biopsy;Skin,lesion single-PRO $130.00 11100-6-P

PHYSICIAN SERVICES Biopsy;Skin,Sub. tissue&/or mucous membrane single-PRO$111.33 11100-P

PHYSICIAN SERVICES Surg. Biopsy:Muc./Memb. Sep./Add Lesoin[Package] $68.68 11101

PHYSICIAN SERVICES WND Biopsy skin add-on lesion PRO $39.54 11101-6-P

PHYSICIAN SERVICES Surg. Biopsy:Muc./Memb. Sep./Add Lesoin-PRO $39.54 11101-P

PHYSICIAN SERVICES Shave-Benign, Skin Tags1-15 $173.77 11200

PHYSICIAN SERVICES WND Shave-B9, Skin Tags1-15-PRO $200.00 11200-6-P

PHYSICIAN SERVICES Shave-Benign, Skin Tags1-15-PRO $104.05 11200-P

PHYSICIAN SERVICES Shave, Benign;Each Additional 10 $96.77 11201

PHYSICIAN SERVICES WND Shave, B9;Each Additional 10 PRO $44.00 11201-6-P

PHYSICIAN SERVICES Shaving,Benign(tr, a, l)=<0.5cm $113.41 11300

PHYSICIAN SERVICES Shave Benign(tr,a,l); Diameter 0.6-1.0cm $155.03 11301

PHYSICIAN SERVICES Shave Benign(tr,a,l); Diameter 0.6-1.0cm-PRO $93.65 11301-P

PHYSICIAN SERVICES Skin Rmv.: Shave;1.1-2.0cm[Package] $184.17 11302

PHYSICIAN SERVICES Skin Rmv.: Shave;1.1-2.0cm-PRO $88.44 11302-P

PHYSICIAN SERVICES Skin Rmv.: Shave;over 2.0cm[Package] $232.03 11303

PHYSICIAN SERVICES Skin Rmv.: Shave; over 2.0cm-PRO $109.25 11303-P

PHYSICIAN SERVICES Shave Benign(sc,n,ha,fe,g);Lesion .5cm or less $137.34 11305

PHYSICIAN SERVICES Shave Benign(sc,n,ha,fe,g);Lesion .5cm or less-PRO $83.24 11305-P

PHYSICIAN SERVICES Shave Benign(sc,n,ha,fe,g);Lesion 0.6-1.0cm $202.90 11306

PHYSICIAN SERVICES Shave Benign(sc,n,ha,fe,g);Lesion 0.6-1.0cm-PRO $95.73 11306-P

PHYSICIAN SERVICES Shave: Epid/Derm., Nonface; Lesion over 2.0cm $275.74 11308

PHYSICIAN SERVICES Shave: Epid/Derm., Nonface; Lesion over 2.0cm-PRO $166.48 11308-P

PHYSICIAN SERVICES Shave: Epid/Derm.,Face; 0.6 to 1.0cm $172.73 11311

PHYSICIAN SERVICES Shave: Epid/Derm.,Face; 0.6 to 1.0cm-PRO $103.01 11311-P

PHYSICIAN SERVICES Excision Benign(tr,a,l); Lesion 0.5cm/less $295.50 11400

PHYSICIAN SERVICES WND Excise B9 (tr,a,l) Lesion .5cm-> PRO $210.00 11400-6-P

PHYSICIAN SERVICES Excision Benign(tr,a,l); Lesion 0.5cm/less-PRO $177.93 11400-P

PHYSICIAN SERVICES Excision Benign(tr,a,l); Lesion .6 to 1.0cm $267.41 11401

PHYSICIAN SERVICES WND Excise B9(tr,a,l) Lesion .6 to 1cm-PRO $270.00 11401-6-P

PHYSICIAN SERVICES Excision Benign(tr,a,l); Lesion .6 to 1.0cm-PRO $160.24 11401-P

PHYSICIAN SERVICES Excision Benign(tr,a,l); Lesion .6 to 1.0cm-PRO $160.24 11401-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);1.1 to 2.0cm $295.50 11402

PHYSICIAN SERVICES WND Excise B9(tr,a,l) 1 to 2cm-PRO $300.00 11402-6-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);1.1 to 2.0cm-PRO $177.93 11402-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);2.1-3.0cm $389.15 11403

PHYSICIAN SERVICES WND Excise B9(tr,a,l)2.1-3cm-PRO $350.00 11403-6-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);2.1-3.0cm-PRO $233.07 11403-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);3.1-4.0cm $441.17 11404

PHYSICIAN SERVICES WND Excision B9(tr,a,l);3.1-4.0cm-PRO $450.00 11404-6-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);3.1-4.0cm-PRO $264.29 11404-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);Over 4.0cm $610.78 11406

PHYSICIAN SERVICES WND Excision B9(tr,a,l);Over 4.0cm-PRO $600.00 11406-6-P

PHYSICIAN SERVICES Excision Benign(tr,a,l);Over 4.0cm-PRO $365.22 11406-P

PHYSICIAN SERVICES Excis Benign(sc,n,ha,fe,g);0.5 cm or < $174.81 11420

PHYSICIAN SERVICES WND Excise B9(sc,n,ha,fe,g);.5cm or<-PRO $210.00 11420-6-P

PHYSICIAN SERVICES Excis Benign(sc,n,ha,fe,g);0.5cm or <-PRO $104.05 11420-P

PHYSICIAN SERVICES Excis Benign(sc,n,ha,fe,g); 0.6 to 1.0cm $270.53 11421

PHYSICIAN SERVICES WND Excise B9(sc,n,ha,fe,g) .6 to 1.cm-PRO $275.00 11421-6-P

PHYSICIAN SERVICES Excis Benign(sc,n,ha,fe,g); 0.6 to 1.0cm-PRO $138.38 11421-P

PHYSICIAN SERVICES Exc Benigh(head,neck,ext, gen) 1.1-2cm PRO $166.48 11422-P

PHYSICIAN SERVICES Excis Benign(sc,n,ha,fe,g);2.1 to 3.0cm $424.52 11423

PHYSICIAN SERVICES WND Exc B9(sc,n,ha,fe,g) 2.1 to 3cm-PRO $400.00 11423-6-P

PHYSICIAN SERVICES Excis Benign(sc,n,ha,fe,g);2.1 to 3.0cm-PRO $253.88 11423-P

PHYSICIAN SERVICES WND Exc B9(sc,n,ha,fe,g)3.1-4cm PRO $460.00 11424-6-P

PHYSICIAN SERVICES Excis Benign Face;0.5cm or < $210.18 11440

PHYSICIAN SERVICES WND Excis B9 Face;0.5cm or <-PRO $250.00 11440-6-P

PHYSICIAN SERVICES Excis Benign Face;0.5cm or <-PRO $124.86 11440-P

PHYSICIAN SERVICES Excis Benign(Face);0.6-1.0cm $273.66 11441

PHYSICIAN SERVICES WND Excis B9 (Face);0.6-1.0cm-PRO $325.00 11441-6-P

PHYSICIAN SERVICES Excis Benign(Face);0.6-1.0cm-PRO $164.40 11441-P

PHYSICIAN SERVICES Excis Benign(Face);1.1-2.0cm $300.71 11442

PHYSICIAN SERVICES WND Excis B9(Face);1.1-2cm-PRO $350.00 11442-6-P

PHYSICIAN SERVICES Excis Benign(Face);1.1-2.0cm-PRO $181.05 11442-P

PHYSICIAN SERVICES WND Excis B9(Face);2.1-3cm-PRO $400.00 11443-6-P

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);0.5 or < $232.03 11600

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);0.5 or <-PRO $138.38 11600-P

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);0.5 or <-FAC $93.65 11600-T

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);0.6-1.0cm $298.63 11601

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);0.6-1.0cm-PRO $180.01 11601-P

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);1.1-2.0cm $349.61 11602

PHYSICIAN SERVICES Exc,Skin,Mal-(tr,a,l);1.1-2.0cm-PRO $210.18 11602-P

PHYSICIAN SERVICES Excision,Mal(tr,a,l);2.1-3.0cm $1,071.71 11603

PHYSICIAN SERVICES Excision,Mal(tr,a,l);2.1-3.0cm-PRO $300.71 11603-P

PHYSICIAN SERVICES Lesion Rmv.:Malig.(ma,tr,ar,le); exc. 3.1-4.0cm $672.16 11604

PHYSICIAN SERVICES Lesion Rmv.:Malig.(ma,tr,ar,le); exc. 3.1-4.0cm-PRO $403.72 11604-P

PHYSICIAN SERVICES Lesion Rmv.:Malig.(ma,tr,ar,le); exc. 3.1-4.0cm-FAC $270.53 11604-T

PHYSICIAN SERVICES Lesion Rmv.;Malig.(sc,ne,fe,ha,gen)0.5cm/less-PRO $241.39 11620-P

PHYSICIAN SERVICES Exc., Mal(sc,n,ha,fe,g);0.6-1.0cm $300.71 11621

PHYSICIAN SERVICES Exc., Mal(sc,n,ha,fe,g);0.6-1.0cm-PRO $181.05 11621-P

PHYSICIAN SERVICES Exc., Mal(sc,n,ha,fe,g);0.6-1.0cm-FAC $119.66 11621-T

PHYSICIAN SERVICES Lesion Rmv.;Malig.(sc,ne,fe,ha,gen);0.6-1.0cm $469.27 11622

PHYSICIAN SERVICES Lesion Rmv.;Malig.(sc,ne,fe,ha,gen);0.6-1.0cm-PRO $283.02 11622-P

PHYSICIAN SERVICES Excision, Mal(sc,n,ha,fe,g);< 4.0cm $620.14 11626

PHYSICIAN SERVICES Excision, Mal(sc,n,ha,fe,g);< 4.0cm-PRO $372.50 11626-P

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);0.5cm or < $250.76 11640

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);0.5cm or <-PRO $149.83 11640-P

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);0.5cm or <-FAC $100.93 11640-T

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);0.6-1.0cm $329.84 11641

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);0.6-1.0cm-PRO $198.74 11641-P





PHYSICIAN SERVICES Lesion rem; malig head/face 3.1-4.0-Pro $735.63 11644-P

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);Over 4.0 cm $850.09 11646

PHYSICIAN SERVICES Excis, Mal Lesion(sc,n,ha,fe,g);Over 4.0 cm-PRO $510.89 11646-P

PHYSICIAN SERVICES Debrid. of Nail(s) Any Method(s); 1-5 $54.11 11720

PHYSICIAN SERVICES Debrid. of Nail(s) Any Method(s); 1-5-PRO $31.21 11720-P

PHYSICIAN SERVICES Debrid. of Nail(s) Any Method(s); 1-5-PRO $31.21 11720-P

PHYSICIAN SERVICES Debrid. of Nail;Trim. Nondys.;6 or < $60.35 11721

PHYSICIAN SERVICES Debrid. of Nail;Trim. Nondys.;6 or <-PRO $35.37 11721-P

PHYSICIAN SERVICES Debridement of Nail; Nail Plate $130.06 11730

PHYSICIAN SERVICES WND Removal of Nail plate-PRO $140.00 11730-6-P

PHYSICIAN SERVICES Debridement of Nail; Nail Plate-PRO $79.08 11730-P

PHYSICIAN SERVICES WND Removal of Nail plate add-on PRO $40.00 11732-6-P

PHYSICIAN SERVICES Debridement Nail plate ea add PRO $73.00 11732-P

PHYSICIAN SERVICES Debrid. of Nail;Evac.;Sub.Hematoma $68.68 11740

PHYSICIAN SERVICES WND Drain blood from under nail-PRO $50.00 11740-6-P

PHYSICIAN SERVICES Debrid. of Nail;Evac.;Sub.Hematoma-PRO $39.54 11740-P

PHYSICIAN SERVICES Excision:Nail/Matrix, Part/Comp.Rmv. $377.71 11750

PHYSICIAN SERVICES Excision:Nail/Matrix, Part/Comp.Rmv.-PRO $225.79 11750-P

PHYSICIAN SERVICES WND Repair of Nail Bed-PRO $200.00 11760-6-P

PHYSICIAN SERVICES Repair of Nail Bed-PRO $390.00 11760-P

PHYSICIAN SERVICES Debrid. Nail;Wedge Exc.of Skin;Fold $145.67 11765

PHYSICIAN SERVICES Debrid. Nail;Wedge Exc.of Skin;Fold-PRO $88.44 11765- P

PHYSICIAN SERVICES WND Excision of nail fold toe-PRO $200.00 11765-6-P

PHYSICIAN SERVICES Treatment of Lesions; Inj.up to 7 Lesions $84.28 11900

PHYSICIAN SERVICES Treatment of Lesions; Inj.up to 7 Lesions-PRO $48.90 11900-P

PHYSICIAN SERVICES Removal Contraceptive $213.30 11976

PHYSICIAN SERVICES Removal Contraceptive-PRO $126.94 11976-P

PHYSICIAN SERVICES Insertion, Delivery Implant $214.34 11981

PHYSICIAN SERVICES Lac Repair Supf Nonface less than 2.5 cm $245.55 12001

PHYSICIAN SERVICES WND Debrid. Nail;Wedge Exc.of Skin;Fold-PRO $120.00 12001-6-P

PHYSICIAN SERVICES Lac Repair, PRO Supf Nonface less than 2.5cm $146.71 12001-P

PHYSICIAN SERVICES COA Lac Repair Supf.Nonface:2.6-7.5 $322.55 12002-1

PHYSICIAN SERVICES WND Lac Repair-Supf.Nonface;2.6-7.5 cm-PRO $150.00 12002-6-P

PHYSICIAN SERVICES Lac Repair-PRO Supf. Nonface;2.6-7.5 cm $194.58 12002-P

PHYSICIAN SERVICES Lac Repair Supf Nonface.;7.6-12.5cm [Package] $322.55 12004

PHYSICIAN SERVICES Lac Repair-PRO Supf.Nonface;7.6-12.5cm $402.68 12004-P

PHYSICIAN SERVICES Lac Repair Supf.Nonface;12.6-20.0cm [Package] $356.89 12005

PHYSICIAN SERVICES Lac Repair-PRO Supf.Nonface;12.6-20cm $501.52 12005-P

PHYSICIAN SERVICES Lac Repair Supf.Nonface; 20.1-30.0cm [Package] $452.61 12006

PHYSICIAN SERVICES Lac Repair-PRO Supf.Nonface; 20.1-30.0cm $622.22 12006-P

PHYSICIAN SERVICES Suture-Sup.wounds(sc,n,ax,EG,tr,fe,ha); Over 30.0cm $517.13 12007

PHYSICIAN SERVICES Suture-Sup.wounds(sc,n,ax,EG,tr,fe,ha);Over 30cm-PRO $702.34 12007-P

PHYSICIAN SERVICES Lac Repair Supf. Face/Head; <2.5 cm[Package] $225.79 12011

PHYSICIAN SERVICES Lac Repair Supf. Face/Head PRO; <2.5 cm $343.36 12011-P

PHYSICIAN SERVICES Lac Repair Supf. Face/Head;2.6-5.0cm[Package] $259.08 12013

PHYSICIAN SERVICES Lac Repair Supf. Face/Head PRO; 2.6-5.0cm $378.75 12013-P


PHYSICIAN SERVICES Lac Repair Supf. Face/Head PRO;5.1-7.5cm $442.21 12014-P


PHYSICIAN SERVICES Lac Repair Supf. Face/Head PRO;7.6-12.5cm $555.62 12015-P

PHYSICIAN SERVICES Suture-Sup. wound(simple,fa,ea,ey,no,li,mm);12.6-20.0cm $474.47 12016

PHYSICIAN SERVICES Suture-Sup.wound(simple,fa,ea,ey,no,li,mm);12.6-20cm-PRO$645.11 12016-P

PHYSICIAN SERVICES Lac Repair Supf Head/Face;20.1-30.0cm $572.28 12017

PHYSICIAN SERVICES Lac Repair Supf Head/Face PRO;20.1-30.0cm $343.36 12017-P

PHYSICIAN SERVICES Lac Repair Supf Head/Face;< 30.0cm $687.78 12018

PHYSICIAN SERVICES Lac Repair-PRO Supf Head/Face;< 30.0cm $413.08 12018-P

PHYSICIAN SERVICES Sup. Wound Dehis Simp. $406.84 12020

PHYSICIAN SERVICES WND Closure wound dehis simp-PRO $350.00 12020-6-P

PHYSICIAN SERVICES Sup. Wound Dehis Simp.-PRO $242.43 12020-P

PHYSICIAN SERVICES Sup. wound Dehis.; w/ Pack $295.50 12021

PHYSICIAN SERVICES WND Closure of wound dehis w/pack PRO $200.00 12021-6-P

PHYSICIAN SERVICES Sup. wound Dehis.; w/ Pack-PRO $177.93 12021-P

PHYSICIAN SERVICES Lac Repair Intermed. Nonface;2.5cm or <[Package] $314.23 12031

PHYSICIAN SERVICES WND Lac Repair-Intermed. Nonface;2.5cm or < PRO $400.00 12031-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Nonface;2.5cm or < $475.51 12031-P

PHYSICIAN SERVICES Lac Repair Intermed. Nonface;2.6-7.5cm[Package] $402.68 12032

PHYSICIAN SERVICES WND Lac Repair Intermed. Nonface;2.6-7.5cm PRO $485.00 12032-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Nonface;2.6-7.5cm $635.75 12032-P








PHYSICIAN SERVICES WND Lac Repair Intermed Nonface;20.1-30cm PRO $725.00 12036-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Nonface; 20.1-30cm $877.14 12036-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Nonface; 20.1-30cm $877.14 12036-P

PHYSICIAN SERVICES Lac Repair Intermed. Nonface;< 30.0cm[Package] $684.65 12037

PHYSICIAN SERVICES WND Lac Repair- Intermed Nonface< 30.0cm PRO $800.00 12037-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Nonface;< 30.0cm $980.15 12037-P

PHYSICIAN SERVICES Lac Repair Intermed. Head/Face;2.5 cm or <[Package] $339.20 12041

PHYSICIAN SERVICES WND Lac Repair Intermed Head/Face;2.5cm/< PRO $350.00 12041-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Head/Face;2.5cm or < $505.69 12041-P

PHYSICIAN SERVICES Lac Repair Intermed. Head/Face;2.6-7.5cm[Package] $402.68 12042

PHYSICIAN SERVICES WND Lac Repair-Intermed. Head/Face;2.6-7.5 PRO $400.00 12042-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Head/Face;2.6-7.5cm $599.33 12042-P


PHYSICIAN SERVICES WND Lac Repair Intermed Head/Face7.6-12.5cm PRO $450.00 12044-6-P


PHYSICIAN SERVICES Lac Repair Intermed. Head/Face;12.6-20cm[Package] $525.45 12045

PHYSICIAN SERVICES WND Lac Repair Intermed Head/Face12.6-20cm PRO $600.00 12045-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Head/Face;12.6-20cm $805.35 12045-P


PHYSICIAN SERVICES WND Lac Repair-Intermed Head/Face;20.1-30 PRO $700.00 12046-6-P


PHYSICIAN SERVICES Lac Repair Intermed. Head/Face;< 30.0cm[Package] $684.65 12047

PHYSICIAN SERVICES WND Lac Repair-Intermed. Head/Face;< 30.0cm PRO $800.00 12047-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Head/Face;< 30.0cm $1,016.57 12047-P

PHYSICIAN SERVICES Lac Repair Intermed. Face;2.5cm or <[Package] $372.50 12051

PHYSICIAN SERVICES WND Lac Repair Intermed Face;2.5cm/< PRO $400.00 12051-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Face;2.5cm or < $558.75 12051-P

PHYSICIAN SERVICES Lac Repair Intermed. Face;2.6-5.0cm[Package] $372.50 12052

PHYSICIAN SERVICES WND Lac Repair-Intermed Face;2.6-5cm PRO $450.00 12052-6-P

PHYSICIAN SERVICES Lac Repair-PRO Intermed. Face;2.6-5.0cm $617.02 12052-P


PHYSICIAN SERVICES WND Lac Repair Intermed. Face;5.1-7.5cm PRO $500.00 12053-6-P



PHYSICIAN SERVICES WND Lac Repair Intermed Face 7.6-12.5cm PRO $550.00 12054-6-P



PHYSICIAN SERVICES WND Lac Repair Intermed Face 12.6-20cm PRO $750.00 12055-6-P


PHYSICIAN SERVICES WND Lac Repair Intermed. Face;20.1-30cm-PRO $900.00 12056-6-P

PHYSICIAN SERVICES Lac Repair Intermed. Face;20.1-30cm-PRO $1,084.20 12056-P

PHYSICIAN SERVICES Lac Repair Int. Face; over 30.0 cm - PRO $1,226.00 12057-P1

PHYSICIAN SERVICES Lac Repair Cmplx. Trunk; 1.1 cm-2.5 cm-PRO $660.00 13100-P

PHYSICIAN SERVICES Lac Repair Cmplx. Trunk; 2.6 cm-7.5 cm-PRO $780.00 13101-P

PHYSICIAN SERVICES Lac Repair Cmplx. Trunk; addtl. 5cm< - PRO $253.00 13102-P

PHYSICIAN SERVICES Lac Repair Cmplx.(sc,ar,lg); 1.1cm-2.5cm-PRO $727.00 13120-P

PHYSICIAN SERVICES Suture,Complex(sc,a,l);2.6-7.5cm[Package] $669.04 13121

PHYSICIAN SERVICES Suture,Complex(sa,a,l);2.6-7.5cm-PRO $910.44 13121-P

PHYSICIAN SERVICES Suture,Cmplx(sa,a,l);Each Add. 5cm or <[Package] $185.21 13122

PHYSICIAN SERVICES Suture,Cmplx(sa,a,l);Each Add. 5cm or <-PRO $260.13 13122-P

PHYSICIAN SERVICES Repair complx face, nect,gen,extrem 1.1-2.5cm PRO $535.50 13131-P

PHYSICIAN SERVICES Repair compx lac face/neck ext, gen 2.6 c- 7.5 c PRO $1,170.56 13132-P

PHYSICIAN SERVICES PRO LACERATION COMPLEX HAND/DDD EA ADD 5 CM OR LESS$279.90 13133-P

PHYSICIAN SERVICES Lac Repair Cmplx Face; 1.1cm-2.5cm-PRO $875.00 13151-P

PHYSICIAN SERVICES Lac Repair Cmplx Face; 2.6cm-7.5cm-PRO $1,050.00 13152-P

PHYSICIAN SERVICES Lac Repair Cmplx Face; addtional 5cm< - PRO $401.00 13153-P

PHYSICIAN SERVICES FULL GRAFT/INCL DIR CLS 20CM< $1,542.03 15220-P

PHYSICIAN SERVICES OR PRO FULL THICKNESS GRAFT $1,739.72 15240-P

PHYSICIAN SERVICES Burn Init. Trmt $100.93 16000

PHYSICIAN SERVICES WND Burn init Trmt- PRO $120.00 16000-6-P

PHYSICIAN SERVICES Burn Init. Trmt-PRO $61.39 16000-P

PHYSICIAN SERVICES Burn Init. Trmt-PRO $61.39 16000-P

PHYSICIAN SERVICES Burn, Debride <5% $121.74 16020

PHYSICIAN SERVICES WND Burn, Debride <5%-PRO $140.00 16020-6-P

PHYSICIAN SERVICES Burn, Debride <5%-PRO $73.88 16020-P

PHYSICIAN SERVICES Burn, Debride <5%-PRO $73.88 16020-P

PHYSICIAN SERVICES WND Burn Debride 5%-10% (med.) - PRO $275.00 16025-6-P

PHYSICIAN SERVICES Burn Debride 5%-10% (med.) - PRO $307.00 16025-P

PHYSICIAN SERVICES Burn; Large> 10% $285.10 16030

PHYSICIAN SERVICES WND Burn; Large> 10%- PRO $250.00 16030-6-P

PHYSICIAN SERVICES Burn; Large> 10%-PRO $171.69 16030-P

PHYSICIAN SERVICES Cryo-1st Lesion $143.59 17000

PHYSICIAN SERVICES WND Cryo-1st Lesion-PRO $85.00 17000-6-P

PHYSICIAN SERVICES Cryo:2-14 Lesions $20.80 17003

PHYSICIAN SERVICES WND Cryo:2-14 Lesions-PRO $5.00 17003-6-P

PHYSICIAN SERVICES Cryo:2-14 Lesions-PRO $10.40 17003-P

PHYSICIAN SERVICES Cryo Lesions 15+ $498.41 17004

PHYSICIAN SERVICES WND Cryo Lesions 15+-PRO $250.00 17004-6-P

PHYSICIAN SERVICES Cryo Lesions 15+-PRO $298.63 17004-P

PHYSICIAN SERVICES Wart Removal;up to 14 Lesions $167.52 17110

PHYSICIAN SERVICES WND Wart Removal;up to 14 Lesions-PRO $140.00 17110-6-P

PHYSICIAN SERVICES Wart Removal;up to 14 Lesions-PRO $99.89 17110-P

PHYSICIAN SERVICES Chem. Cauterize of Gran Tissue $79.08 17250

PHYSICIAN SERVICES WND Chem. Cauterize of Gran Tissue-PRO $75.00 17250-6-P

PHYSICIAN SERVICES Chem. Cauterize of Gran Tissue-PRO $45.78 17250-P

PHYSICIAN SERVICES Malignant Lesion Destruc. .5 or <;Trunk Ext. $213.30 17260

PHYSICIAN SERVICES Malignant Lesion Destruc. .5 or <;Trunk Ext.-PRO $126.94 17260-P

PHYSICIAN SERVICES Malignant Lesion Destruc. 0.6-1.0cm;Trunk Ext.[Package] $264.29 17261

PHYSICIAN SERVICES Malignant Lesion Destruc. 0.6-1.0cm;Trunk Ext.-PRO $158.16 17261-P

PHYSICIAN SERVICES Malignant Lesion Destruc. 1.1-2.0cm;Trunk Ext[Package] $319.43 17262

PHYSICIAN SERVICES Malignant Lesion Destruc. 1.1-2.0cm;Trunk Ext-PRO $192.49 17262-P

PHYSICIAN SERVICES Acne/Hair Removal Cryo. $135.27 17340

PHYSICIAN SERVICES Acne/Hair Removal Cryo.-PRO $80.12 17340-P

PHYSICIAN SERVICES INCISION OF SOFT TISSUE ABSCESS (SUPERFICIAL) $425.56 20000-P

PHYSICIAN SERVICES Explore penetrating wound to extremety-PRO $1,118.54 20103-P

PHYSICIAN SERVICES FB Rmv. Muscle/Tenon Sheath $351.69 20520

PHYSICIAN SERVICES FB Rmv. Muscle/Tenon Sheath-PRO $211.22 20520-P

PHYSICIAN SERVICES FBR-From Finger / deep complicated-PRO $967.66 20525-P

PHYSICIAN SERVICES Inj. Tendon/Ligament[Package] $124.86 20550

PHYSICIAN SERVICES Inj. Tendon/Ligament-PRO $75.96 20550-P

PHYSICIAN SERVICES Therapeutic Inj Trigger Point(s);1or 2 Muscles[Package] $155.03 20552

PHYSICIAN SERVICES Therapeutic Inj Trigger Point(s);1or 2 Muscles-PRO $117.58 20552-P

PHYSICIAN SERVICES INJ; Trig pts-3 or < muscles $316.31 20553

PHYSICIAN SERVICES INJ; Trig pts-3 or < muscles-PRO $209.14 20553-P

PHYSICIAN SERVICES Asp/Inj.; Joint small joint $132.14 20600

PHYSICIAN SERVICES Asp/Inj.; Joint-PRO - small joint $74.92 20600-P

PHYSICIAN SERVICES Asp./Inj. Sm. Jnt. (w/US) - PRO $149.00 20604-P

PHYSICIAN SERVICES Asp./Inj joint; Inter.(w,el,an) $211.22 20605

PHYSICIAN SERVICES Asp./Inj. join; Inter.(w,el,an)-PRO $125.90 20605-P

PHYSICIAN SERVICES Asp./Inj joint; BILATERAL Inter.(w,el,an) PRO $251.80 20605-P-1

PHYSICIAN SERVICES Asp./Inj. Int. Jnt. (w/US) - PRO $166.00 20606-P

PHYSICIAN SERVICES Asp./Inj Joint; Major(s,h,k) $238.27 20610

PHYSICIAN SERVICES Asp./Inj Joint; Major(s,h,k)-PRO $145.67 20610-P

PHYSICIAN SERVICES Asp./Inj Joint; Major(s,h,k) BILATERAL PRO $291.34 20610-P-1

PHYSICIAN SERVICES Asp./Inj. Mjr. Jnt. (w/US) - PRO $188.00 20611-P

PHYSICIAN SERVICES Asp/Inj. of Ganglion $140.46 20612

PHYSICIAN SERVICES Asp/Inj. of Ganglion-PRO $85.32 20612-P

PHYSICIAN SERVICES Pin removal - distal plalanx-pro $754.80 20670

PHYSICIAN SERVICES REMOVAL OF IMPLANT(SUPERFICIAL) $977.03 20670-P

PHYSICIAN SERVICES FRX/DIS-Clsd.Nasal W/O Manip. $360.01 21310

PHYSICIAN SERVICES FRX/DIS-Clsd.Nasal W/O Manip.-PRO $216.42 21310-P

PHYSICIAN SERVICES FRX/DIS-Closed Nasal W/O Stabilize $571.23 21315

PHYSICIAN SERVICES Closed Eye Socket Fracture-PRO $287.18 21400-P

PHYSICIAN SERVICES FRX/DIS-Mandible W/O Manip. $1,026.98 21450

PHYSICIAN SERVICES Dislocation TX jaw PRO $267.85 21480-P

PHYSICIAN SERVICES FRX-Ribs Closed, ea $245.55 21800

PHYSICIAN SERVICES FXR- Sternum Closed $510.89 21820

PHYSICIAN SERVICES FXR-Sternum Closed-PRO $306.95 21820-P

PHYSICIAN SERVICES Closed Vertebral Fracture-PRO $485.92 22305-P

PHYSICIAN SERVICES FRX-Closed Vert W/O manip $557.71 22310

PHYSICIAN SERVICES FBR-Shoulder; subcutaneous-PRO $445.33 23330-P

PHYSICIAN SERVICES Soft tissue FB removal - Shoulder - Deep-PRO $975.00 23333-P

PHYSICIAN SERVICES FRX CLSD Clavicular[Package] $437.01 23500

PHYSICIAN SERVICES Closed Clavicle Fracture-PRO $591.01 23500-P

PHYSICIAN SERVICES Closed Fracture Reduction- Clavicular-PRO $735.00 23505-P

PHYSICIAN SERVICES Dislocate Shoulder-Sternocl.W/O manip $460.94 23520

PHYSICIAN SERVICES Dislocate Shoulder-Sternocl.W/O Manip.-PRO $454.70 23520-P

PHYSICIAN SERVICES FX Scapular Closed $483.84 23570

PHYSICIAN SERVICES FX prox_hum W/O Manip $611.82 23600

PHYSICIAN SERVICES Closed Frx Red-Prox Hum (w/man.) - PRO $966.00 23605-P

PHYSICIAN SERVICES Disloc.-Shoulder W/ Manip,W/O anes $558.75 23650

PHYSICIAN SERVICES Disloc.-Shoulder W/ Manip,W/O anes-PRO $335.04 23650-P

PHYSICIAN SERVICES Dislocation shoulder w/ manip w/ propofol-PRO $195.62 23655-P

PHYSICIAN SERVICES I&D upper arm or elbow area deep abscess or hematoma-PRO$715.87 23930-P

PHYSICIAN SERVICES Excise Oleocranon bursa-PRO $700.00 24105-P

PHYSICIAN SERVICES Soft tissue FB removal - Upper Arm-PRO $433.00 24200-P

PHYSICIAN SERVICES Soft tissue FB removal - Upper Arm - Deep-PRO $1,152.00 24201-P

PHYSICIAN SERVICES 0R PRO ARTHROTOMY ELBOW W DEBR $1,752.21 24358-P

PHYSICIAN SERVICES OR PRO FASCIOTOMY LOWER ARM $1,286.06 24495-P

PHYSICIAN SERVICES Closed Humerus FXR-PRO $391.23 24500-P

PHYSICIAN SERVICES Closed Humerus Fx w/ manipulation-PRO $458.86 24505-P

PHYSICIAN SERVICES FRX/DIS Elbow/Upper Arm W/ manip $1,224.67 24535

PHYSICIAN SERVICES FX-HUM epicon W/O manip $569.15 24560

PHYSICIAN SERVICES FX-HUM epicon W/O Manip-PRO $341.28 24560-P

PHYSICIAN SERVICES Disl-Elbow,Closed W/O Manip $698.18 24600

PHYSICIAN SERVICES Disl-Elbow,Closed W/O Manip-PRO $418.28 24600-P

PHYSICIAN SERVICES FRX/DIS-Radial Head Nursemaid W/ Manip $316.31 24640

PHYSICIAN SERVICES FRX/DIS-Radial Head Nursemaid W/ Manip.-PRO $190.41 24640-P

PHYSICIAN SERVICES FRX/DIS-Radial Head Nursemaid W/ Manip.-FAC $125.90 24640-T

PHYSICIAN SERVICES FRX-Radial Head W/O Manip $537.94 24650

PHYSICIAN SERVICES FRX-Radial Head W/O Manip-PRO $322.55 24650-P

PHYSICIAN SERVICES Closed Fracture Reduction - Radial head-PRO $914.00 24655-P

PHYSICIAN SERVICES FX- Ulna, W/O Manip $528.57 24670

PHYSICIAN SERVICES Closed Fracture Reduction - Ulnar-PRO $950.00 24675-P

PHYSICIAN SERVICES OR PRO Inc. Extensor Tendon Sheath $496.32 25000-P

PHYSICIAN SERVICES OR PRO EXCISION GANGLION HAND DOR $1,084.20 25111-P

PHYSICIAN SERVICES FRX-Radial Shaft; W/O Manip $547.30 25500

PHYSICIAN SERVICES FRX-Radial Shaft;W/O Manip-PRO $679.45 25500-P

PHYSICIAN SERVICES Closed Radial Fx w/ manipulation-PRO $43.70 25505-P

PHYSICIAN SERVICES FRX-Ulnar Shaft W/O Manip $534.82 25530

PHYSICIAN SERVICES FRX-Ulnar Shaft W/O Manip-PRO $679.45 25530-P

PHYSICIAN SERVICES FRX-RDL/Ulnar Shaft W/O Manip[Package] $555.62 25560

PHYSICIAN SERVICES FRX-RDL/Ulnar Shaft W/O Manip-PRO $757.48 25560-P

PHYSICIAN SERVICES Closed Radial & Ulnar Fx w/ manipulation-PRO $910.44 25565-P

PHYSICIAN SERVICES FRX-Distal Radial W/O Manip $609.74 25600

PHYSICIAN SERVICES FRX-Distal Radial W/O Manip-PRO $633.66 25600-P

PHYSICIAN SERVICES OR PRO Decompression fasciotomy, leg posterior compartment(s) only$636.79 25601-P

PHYSICIAN SERVICES FRX CARE COLLES CLOSED W MANIP-PRO $1,231.96 25605-P

PHYSICIAN SERVICES OR PRO Open reduct with int fix radius $1,126.87 25607-P

PHYSICIAN SERVICES OR PRO FX RADIUS 3 FRAG FIX $2,292.23 25609-P

PHYSICIAN SERVICES FRX-Carpal Bone W/O Manip $557.71 25630

PHYSICIAN SERVICES FRX-Carpal Bone W/O Manip-PRO $335.04 25630-P

PHYSICIAN SERVICES FRX-Ulnar Styloid $662.80 25650

PHYSICIAN SERVICES FRX-Ulnar Styloid-PRO $398.51 25650-P

PHYSICIAN SERVICES Dislocation of Intercarpel-PRO $764.77 25660-P

PHYSICIAN SERVICES OR PRO FX PROX HUMERUS OPEN $1,261.09 25676-P

PHYSICIAN SERVICES Closed Wrist Fx w/ dislocation w/ manipulation-PRO $958.30 25680-P

PHYSICIAN SERVICES Drainage of finger abscess simple-PRO $525.45 26010-P

PHYSICIAN SERVICES OR PRO-TENOVAGINOTOMY FINGER $1,111.80 26055-P

PHYSICIAN SERVICES OR PRO Exc. tumor, mal, soft hand <1.5cm $702.34 26115-P

PHYSICIAN SERVICES OR Pro Repair Extensor Tendon-Hand $1,137.27 26401-P

PHYSICIAN SERVICES Repair Extensor Tendon-Hand - PRO $1,167.00 26410-P

PHYSICIAN SERVICES PRO TENDON REPAIR EXT FINGER $1,406.76 26418-P

PHYSICIAN SERVICES FRX-HAND Single; W/O Manip, Each Bone{package} $506.73 26600

PHYSICIAN SERVICES FRX-HAND Sinlge; W/O Manip, Each Bone-PRO $630.54 26600-P

PHYSICIAN SERVICES FRX-Single; W/ Manip ,Each Bone $815.76 26605

PHYSICIAN SERVICES FRX-Single; W/ Manip ,Each Bone-PRO $556.67 26605-P

PHYSICIAN SERVICES OR PRO FX METACAR FIX $2,166.33 26615-P

PHYSICIAN SERVICES FRX/DIS-Carpo:Thumb W/ Manip $785.58 26645

PHYSICIAN SERVICES FRX/DIS-Carpo:Thumb W/ Manip-PRO $470.31 26645-P

PHYSICIAN SERVICES DISL.-METACARP. W/ Manip, W/O Anes $595.17 26700

PHYSICIAN SERVICES DISL.-METACARP. W/ Manip, W/O Anes-PRO $356.89 26700-P

PHYSICIAN SERVICES Closed Phalanx Fracture-PRO $473.43 26720-P

PHYSICIAN SERVICES FRX/DIS-W/ Manip; W/ or W/O Skin/Skele. Tract. $634.71 26725

PHYSICIAN SERVICES FRX/DIS-W/ Manip; W/ or W/O Skin/Skele. Tract.-PRO $381.87 26725-P

PHYSICIAN SERVICES FRX CARE-OPEN PROXIMAL PHALANGEAL SHAFT INT FIX EA$2,606.46 26735-P

PHYSICIAN SERVICES OR PRO FX PHALANGEAL CLOSED $401.64 26740-P

PHYSICIAN SERVICES FRX-Finger/Thumb; W/O Manip-PRO $225.79 26750-P

PHYSICIAN SERVICES FRX/Dislocation-Finger/Thumb; W manip-package $1,209.07 26755

PHYSICIAN SERVICES FRX/Dislocation-Finger/Thumb; W Manip-PRO $683.61 26755-P

PHYSICIAN SERVICES Open Tuft Fracture (phalange) Splinting & sutures-PRO $945.82 26765-P

PHYSICIAN SERVICES DIS-treatment Inter. Joint W/ Manip;W/O Anes. $802.23 26770

PHYSICIAN SERVICES DIS-treatment Inter. Joint W/ Manip.; W/O Anes.-PRO $534.82 26770-P

PHYSICIAN SERVICES Dislocation-interphalangeal closed w anes[Package] $1,366.18 26775

PHYSICIAN SERVICES OR PRO AMPUTATION FINGER $1,051.95 26951-P

PHYSICIAN SERVICES FBR-pelvis or hip; subcutaneous tissue-PRO $497.36 27086-P

PHYSICIAN SERVICES FBR Pelvis/Hip; Deep - PRO $1,277.00 27087-P

PHYSICIAN SERVICES FRX-Treatment Coccygeal CLSD $468.23 27200

PHYSICIAN SERVICES FRX-Treatment Coccygeal CLSD-PRO $458.86 27200-P

PHYSICIAN SERVICES Closed Hip Socket Fracture-PRO $1,568.04 27220-P

PHYSICIAN SERVICES Closed Femoral Fracture-PRO $1,048.83 27230-P

PHYSICIAN SERVICES OR PRO FX FEMUR PROX FIX $1,761.57 27235-P

PHYSICIAN SERVICES DIS-Hip, Traumatic; W/O anes. $1,043.62 27250

PHYSICIAN SERVICES DIS-Hip, Traumatic; W/O Anes.-PRO $1,073.79 27250-P

PHYSICIAN SERVICES Spon. Hip Disloc. (w/o anes./manip.) - PRO $489.00 27256-P

PHYSICIAN SERVICES Post Hip Arthro. Disloc.(w/o anes.) - PRO $832.00 27265-P

PHYSICIAN SERVICES OR PRO Arthrotomy with exc of menis knee $1,071.71 27332-P

PHYSICIAN SERVICES OR PRO EXC-SYN-BAKER'S CYST $959.34 27345-P

PHYSICIAN SERVICES Total Knee Arthroplasty Pro $4,456.38 27447-P

PHYSICIAN SERVICES Closed Frx. Red. Femoral Shft. (w/manip.)-PRO $1,586.00 27502-P

PHYSICIAN SERVICES Closed Frx. Red. Supracond. (w/manip) - PRO $1,678.00 27503-P

PHYSICIAN SERVICES Closed Frx. Red. Femoral Distal (w/manip)-PRO $1,427.00 27510-P

PHYSICIAN SERVICES FRX-Patellar W/O Manip $670.08 27520

PHYSICIAN SERVICES FRX-Patellar W/O Manip-PRO $755.40 27520-P

PHYSICIAN SERVICES FRX-Tibial, Proximal; W/O Mantip $839.68 27530

PHYSICIAN SERVICES FRX-Tibial, Proximal; W/O Mantip-PRO $504.65 27530-P

PHYSICIAN SERVICES DIS-Treatment of Knee W/O Anes $964.54 27550

PHYSICIAN SERVICES DIS-Treatment of Knee W/O Anes.-PRO $1,029.06 27550-P

PHYSICIAN SERVICES DIS-Patellar; W/O Anes-PRO $720.00 27560-P

PHYSICIAN SERVICES FRX(Lower Leg&Ankle)-Tibial Shaft W/O Manip $725.23 27750

PHYSICIAN SERVICES FRX(Lower Leg&Ankle)-Tibial Shaft W/O Manip-PRO $466.14 27750-P

PHYSICIAN SERVICES Closed Frx Red.Tibial Shaft (w/manip)-PRO $1,118.00 27752-P

PHYSICIAN SERVICES OR PRO FX TIBIA OPEN INT FIX $3,260.93 27758-P

PHYSICIAN SERVICES FRX-Medial Malleolus W/O Manip $621.18 27760

PHYSICIAN SERVICES Closed Frx Red Medial Mall. (w/manip)-PRO $980.00 27762-P

PHYSICIAN SERVICES OR PROF FX MED ANKLE OPEN FIX $1,984.24 27766-P

PHYSICIAN SERVICES Closed Frx Red Posterior Mall. (w/manip)-PRO $922.00 27768-P

PHYSICIAN SERVICES FRX-Proximal Fibula/Shaft; W/O Manip $508.81 27780

PHYSICIAN SERVICES Closed Frx Red. Prox. Fibula (w/manip)-PRO $894.00 27781-P

PHYSICIAN SERVICES FRX-Distal Fibular; W/O Manip $580.60 27786

PHYSICIAN SERVICES FRX-Distal Fibular; W/O Manip-PRO $718.99 27786-P

PHYSICIAN SERVICES Closed Frx Red. Distal Fibular (w/manip)-PRO $878.00 27788-P

PHYSICIAN SERVICES Closed Frx Red. Bimalleolar (w/manip)-PRO $972.00 27810-P

PHYSICIAN SERVICES OR PRO FX ANKLE BIMAL INT FIX $1,505.60 27814-P

PHYSICIAN SERVICES FRX-Trimalleolar ankle; W/O Manip $659.67 27816

PHYSICIAN SERVICES Closed Frx Red. Trimalleolar (w/manip)-PRO $1,009.00 27818-P

PHYSICIAN SERVICES Closed Frx Red. Wt. Bear. Art. DT-PRO $1,142.00 27825-P

PHYSICIAN SERVICES OR PRO FX TIB/FIB OPEN DISTAL $1,356.81 27829-P

PHYSICIAN SERVICES DIS-Ankle (w/o anesth.)-PRO $772.00 27840-P

PHYSICIAN SERVICES OR PRO DIS ANKLE OPEN FIX $1,492.08 27846-P

PHYSICIAN SERVICES OR PRO Plantar Fascia Faxciectomy $1,231.96 28060-P

PHYSICIAN SERVICES OR PRO EXCISE MORTON NEUROMA $851.13 28080-P

PHYSICIAN SERVICES OR PRO OSTEOTOMY CALCANEOUS $789.75 28118-P

PHYSICIAN SERVICES OR PRO HEMIPHALANECTOMY $579.56 28160-P

PHYSICIAN SERVICES FB Removal:Foot;Subcutaneous-PRO $277.82 28190-P

PHYSICIAN SERVICES FB Removal: Foot; Deep $739.80 28192

PHYSICIAN SERVICES FB Removal: Foot; Deep -PRO $775.17 28192-P

PHYSICIAN SERVICES FB Removal: Foot; Complicated $1,122.70 28193

PHYSICIAN SERVICES FBR Foot Complicated - PRO $1,117.00 28193-P

PHYSICIAN SERVICES OR PRO CAPSULOTOMY TOE $1,132.07 28270-P

PHYSICIAN SERVICES OR PRO SYNDACTYLIZATION TOE $1,612.78 28280-P

PHYSICIAN SERVICES FRX/DIS: Foot/Toe; FRX W/O Manip $530.66 28400

PHYSICIAN SERVICES FRX/DIS: Foot/Toe;FRX Talus; W/O $498.40 28430

PHYSICIAN SERVICES FRX/DIS, FT/Toe; Tarsal FRX W/O Manip $457.82 28450

PHYSICIAN SERVICES FRX/DIS, FT/Toe;Metatarsal FRX; W/O Manip $455.74 28470

PHYSICIAN SERVICES FRX/DIS, FT/Toe;Metatarsal FRX; W/ Manip $569.15 28475

PHYSICIAN SERVICES Closed Frx Red-Metatarsal - PRO $532.50 28475-P

PHYSICIAN SERVICES FRX/DIS, FT/Toe;Great Toe/Phalanx/Phalanges FRX W/O Manip$292.38 28490

PHYSICIAN SERVICES FRX/DIS, FT/Toe;Great Toe/Phalanx/Phalanges FRX W/O Manip-PRO$306.95 28490-P

PHYSICIAN SERVICES Closed Frx Red-Great Toe - PRO $373.00 28495-P

PHYSICIAN SERVICES FRX/DIS, FT/Toe; FRX Of Phalanx or Phalanges W/O Manip $250.76 28510

PHYSICIAN SERVICES FRX/DIS, FT/Toe;FRX Of Phalanx or Phalanges W/O Manip-PRO$294.46 28510-P

PHYSICIAN SERVICES FRX/DIS, FT/Toe; FRX Of Phalanx or Phalanges W/ Manip $307.99 28515

PHYSICIAN SERVICES Closed Frx Red - Phalanx - PRO $339.50 28515-P

PHYSICIAN SERVICES FRX/DIS, FT/Toe; Tarsal Bone DIS W/O Anes. $428.69 28540

PHYSICIAN SERVICES OR Pro Open Tx talotarsal joint $1,835.45 28585-P

PHYSICIAN SERVICES FRX/DIS, FT/Toe;MTP Joint DIS W/O Anes. $313.19 28630

PHYSICIAN SERVICES DIS Toe - Metatarsophalangeal - PRO $329.00 28630-P

PHYSICIAN SERVICES DIS-Toe Interphal. Jnt. (w/out anesth.)-PRO $243.00 28660-P

PHYSICIAN SERVICES OR PRO ORIF DIP JOINT GRT TOE $1,148.71 28675-P

PHYSICIAN SERVICES APPLY CAST LONG ARM-PRO $193.53 29065-P

PHYSICIAN SERVICES Casting:Arm/Shldr/ Torso;Elbow to Finger $153.99 29075

PHYSICIAN SERVICES Casting:Arm/Shldr/Torso'Elbow to Finger-PRO $163.36 29075-P

PHYSICIAN SERVICES APPLY CAST GAUNTLET $189.37 29085-P

PHYSICIAN SERVICES Splint/Strap:Torso/Upper;Shldr. to Hand(long) $187.29 29105

PHYSICIAN SERVICES Splint/Strap:Torso/Upper;Shldr. to Hand(long)-PRO $105.09 29105-P

PHYSICIAN SERVICES Splint/Strap:Torso/Upper;Forearm to Splint(short) $143.59 29125

PHYSICIAN SERVICES Splint/Strap:Torso/Upper;Forearm to Splint(short)-PRO $140.46 29125-P

PHYSICIAN SERVICES Application of finger splint-PRO $78.04 29130-P

PHYSICIAN SERVICES Strapping - Thorax - PRO $65.00 29200-P

PHYSICIAN SERVICES Strapping - Shoulder - PRO $62.50 29240-P

PHYSICIAN SERVICES Strapping - Elbow or wrist - PRO $62.00 29260-P

PHYSICIAN SERVICES Strapping - Hand or finger - PRO $62.50 29280-P

PHYSICIAN SERVICES Cast - Long Leg (Thigh to Toes)-PRO $284.00 29345-P

PHYSICIAN SERVICES Casting:Legs;Below Knee to Toes(short) $192.49 29405

PHYSICIAN SERVICES Casting:Legs;Below Knee to Toes(short)-PRO $200.82 29405-P

PHYSICIAN SERVICES Application, long leg splint-PRO $148.79 29505-P

PHYSICIAN SERVICES Splint/Strap:Ankle/FT/Leg/Toes;Calf to FT(Short) $148.79 29515

PHYSICIAN SERVICES Split/Strap:Ankle/Ft to Calf(Short)-PRO $145.67 29515-P

PHYSICIAN SERVICES Strapping - Knee - PRO $62.00 29530-P

PHYSICIAN SERVICES Splint/Strap:Ankle/FT/Leg/Toes; Ankle and or FT $104.05 29540

PHYSICIAN SERVICES Strapping - Ankle and or/foot - PRO $54.50 29540-P

PHYSICIAN SERVICES Strapping Toes - PRO $40.00 29550-P

PHYSICIAN SERVICES WND Strapping - Unna Boot - PRO $75.00 29580-6-P

PHYSICIAN SERVICES Strapping - Unna Boot - PRO $128.00 29580-P

PHYSICIAN SERVICES Strapping, low extremity $257.55 29581

PHYSICIAN SERVICES WND Strapping, low extremity -PRO $70.00 29581-6-P

PHYSICIAN SERVICES Removal/Revision of Cast $104.05 29705

PHYSICIAN SERVICES OR PRO ARTHROS KNEE SYNV LIMIT $959.34 29875-P

PHYSICIAN SERVICES OR PRO ARTHROS KNEE SYNV MAJOR $3,059.07 29876-P

PHYSICIAN SERVICES OR Chondroplasty Pro $1,342.32 29877-P

PHYSICIAN SERVICES Arthroscopy- lat-med meniscctomy PRO $1,224.00 29880-P

PHYSICIAN SERVICES OR Arthro w meniscectomy-PRO $1,173.00 29881-P

PHYSICIAN SERVICES Turb. Inj. FB:Nose;Intranasal $267.41 30300

PHYSICIAN SERVICES Turb.Inj,FB:Nose;Intranasal-PRO $160.24 30300-P

PHYSICIAN SERVICES Control Nose Bleed,ante., simple pkg $155.03 30901

PHYSICIAN SERVICES Control Nose Bleed,ante., simple-PRO $224.75 30901-P

PHYSICIAN SERVICES Control Nose Bleed:Nasal hemo.,ante.,Complex $176.89 30903

PHYSICIAN SERVICES Control Nose Bleed:Nasal hemo.,hemo.,ante.,Complex-PRO$370.42 30903-P

PHYSICIAN SERVICES Intubation-PRO $395.39 31500-P

PHYSICIAN SERVICES Chest tube thoracostomy with draining-PRO $501.52 32551-P

PHYSICIAN SERVICES Thorocentesis w/o imaging w/o tube -PRO $491.12 32554-P

PHYSICIAN SERVICES Thorocentesis w imaging w/o tube -PRO $405.80 32555-P

PHYSICIAN SERVICES * Venipuncture - < 3 years-PRO $40.00 36400-P

PHYSICIAN SERVICES Central Line insertion-PRO $650.31 36556-P

PHYSICIAN SERVICES IO Insertion-PRO $214.34 36680-P

PHYSICIAN SERVICES FBR-Mouth -PRO $399.55 40804-P

PHYSICIAN SERVICES Soft tissue FBR - Vestibule - Complicated-PRO $670.00 40805-P

PHYSICIAN SERVICES Wound Repair - Mouth, Tongue <2.5 cm-PRO $564.00 41250-P

PHYSICIAN SERVICES Wound Repair - Posterior Tongue - PRO $624.00 41251-P

PHYSICIAN SERVICES Drainage of gum lesion Pro $255.00 41800-P

PHYSICIAN SERVICES FBR-embedded dentoalveolar- soft tissues-PRO $510.00 41805-P

PHYSICIAN SERVICES I&D Peritonsillar-PRO $269.49 42700-P

PHYSICIAN SERVICES FBR-pharynx-PRO $334.00 42809-P

PHYSICIAN SERVICES OR EGD- Diagnostic PRO $400.86 43235-P

PHYSICIAN SERVICES OR EGD- w biopsy PRO $306.00 43239-P

PHYSICIAN SERVICES OR PRO EGD w band ligation $510.00 43244-P

PHYSICIAN SERVICES OR EGD PRO w hot forcep/caut $367.20 43250-P

PHYSICIAN SERVICES OR EGD-PRO w snare $424.32 43251-P

PHYSICIAN SERVICES Gastric Intubations-PRO $165.44 43752-P

PHYSICIAN SERVICES Gastric Lavage-PRO $376.67 43753-P

PHYSICIAN SERVICES Change gastrostomy tube-PRO $1,032.00 43760-P

PHYSICIAN SERVICES OR PRO Colonoscopy-Diagnostic $315.27 45378-P

PHYSICIAN SERVICES OR PRO Colonoscopy w biopsy $1,050.91 45380-P

PHYSICIAN SERVICES OR PRO Colonoscopy biopsy hot for/cautery $630.54 45384-P

PHYSICIAN SERVICES OR PRO Colonoscopy biopsy snare $694.02 45385-P

PHYSICIAN SERVICES I&D - Perirectal - PRO $1,126.00 46040-P

PHYSICIAN SERVICES I&D perianal abscess superficial-PRO $336.08 46050-P

PHYSICIAN SERVICES Surg Incision:Anus;Thrombosed Hem. Ext. $334.00 46083

PHYSICIAN SERVICES Anoscopy - PRO $186.00 46600-P

PHYSICIAN SERVICES Anoscopy - w/FBR - PRO $501.00 46608-P

PHYSICIAN SERVICES AND Physical (DSS) $37.45 466511-M

PHYSICIAN SERVICES AND Physical (DSS) $37.45 466511-M

PHYSICIAN SERVICES Abd Paracentesis PRO w/o image guidance $158.16 49082-P

PHYSICIAN SERVICES Peritoneal lavage - PRO $228.00 49084-P

PHYSICIAN SERVICES aspiration of bladder by needle-pro $122.40 51100-P

PHYSICIAN SERVICES Bladder Scan - PRO $33.00 51798-P

PHYSICIAN SERVICES Urethral Dilation:Female;Suppository/Instillaion;initial $172.73 53660

PHYSICIAN SERVICES Lysis fo Preputial Adhesions pro $437.00 54450-p

PHYSICIAN SERVICES I&D epididymis, testis and/or scrotal space (abscess/hematoma)-PRO$446.37 54700-P

PHYSICIAN SERVICES I&D - Scrotal Wall Abcess - PRO $453.00 55100-P

PHYSICIAN SERVICES I&D Vulva/Perineal Abscess-PRO $220.59 56405-P

PHYSICIAN SERVICES I&D Bartholin gland abcess-PRO $286.14 56420-P

PHYSICIAN SERVICES Vulvar/Perineal; Biopsy: 1 lesion $125.90 56605

PHYSICIAN SERVICES Excis Procedure: Vagina; Mucosa;Simple $136.30 57100

PHYSICIAN SERVICES Irrag./Ins./Intro.:Vag Med./Supply:Insert Pessary $155.03 57160

PHYSICIAN SERVICES Irrag./Ins./Intro:Vag Med./Supply:Insert Pessary-PRO $94.69 57160-P

PHYSICIAN SERVICES Diaphragm Fitting $158.16 57170

PHYSICIAN SERVICES Endo. Vag Procedures:Colposcopy,Entire;W/ Cervix $188.33 57420

PHYSICIAN SERVICES Endo. Cervical Procedures:Cervix&Upper/Adj. Vagina $192.49 57452

PHYSICIAN SERVICES Endo. Cervical Procedures:Cervix&Upper/Adj. Vagina W/ Biopsy$286.14 57454

PHYSICIAN SERVICES Endo. Cervical Procedures:Cervix&Upper/Adj. Vagina W/ cervix Biopsy$232.03 57455

PHYSICIAN SERVICES Endo. Cervical Procedures:W/ endocervical Curettage $217.46 57456

PHYSICIAN SERVICES Irrag./Ins./Intro.:Vag Med./Supply:Insert Pessary-PRO $94.69 57610-P

PHYSICIAN SERVICES Irrag./Ins./Intro.:Vag Med./Supply:Insert Pessary-PRO $94.69 57610-P

PHYSICIAN SERVICES Procuder of Endo; Samp.W/or W/O Endo. Samp. W/O Dilation$283.02 58100

PHYSICIAN SERVICES Contraceptions/Reproduction:Insertion of IUD $234.11 58300

PHYSICIAN SERVICES IUD Removal $118.62 58301

PHYSICIAN SERVICES Vaginal delivery only-PRO $1,843.77 59409-P

PHYSICIAN SERVICES Delivery Placenta-PRO $548.34 59414-P

PHYSICIAN SERVICES Prenatal/Postpartum:Antepartum Care; 7> visits $1,632.55 59426

PHYSICIAN SERVICES Incomplete Abortion-PRO $806.39 59812-P

PHYSICIAN SERVICES Spine Punct./Sub.-Space;Spine Punct., Lumbar, Diagnostic $335.04 62270

PHYSICIAN SERVICES Occipital (greater) BLock-Pro $180.00 64405-P

PHYSICIAN SERVICES Digital Nerve Block - Other Periph.-PRO $166.00 64450-P

PHYSICIAN SERVICES OR PRO ulnar nerve transposition-elbow $1,122.00 64718-P

PHYSICIAN SERVICES OR CARPAL TUNNEL med rpr-PRO $947.90 64721-P

PHYSICIAN SERVICES OR PRO DECOMPRESS NERVE $1,066.51 64722-P

PHYSICIAN SERVICES FB Removal:Eye;Conjunctival Superficial $112.37 65205

PHYSICIAN SERVICES FB Rmv:Eye;Conj Embedded,Sub./Scleral Nonper. $107.17 65210

PHYSICIAN SERVICES FBR-Corneal w/o slit lamp -PRO $107.17 65220-P

PHYSICIAN SERVICES FBR Eye - Corneal with slit lamp - PRO $140.00 65222-P

PHYSICIAN SERVICES FBR - eye Epithelium - PRO $169.00 65435-P

PHYSICIAN SERVICES IUD (Copper)-Paragard $940.61 66453

PHYSICIAN SERVICES WND FBR-Eyelid - PRO $509.00 67938-6-P

PHYSICIAN SERVICES Drainage external auditory canal abscess-PRO $453.66 69020-P

PHYSICIAN SERVICES Excis. Proc:Exter. Ear/Canal;Rmv from Canal,W/O Anes. $279.90 69200

PHYSICIAN SERVICES Excis. Proc:Exter. Ear/Canal;Rmv from Canal,W/O Anes.-PRO$168.57 69200-P

PHYSICIAN SERVICES Remove impacted Cerumen w/o instru-Pro $30.91 69202-P

PHYSICIAN SERVICES Exter Ear/Canal;Rmvl Cerumen, 1 or both [Panel] $103.01 69210

PHYSICIAN SERVICES Sports Physical $39.54 704262-M

PHYSICIAN SERVICES Sports Physical $39.54 704262-M

PHYSICIAN SERVICES Insurance Physical $112.37 7099450-M

PHYSICIAN SERVICES Brief Physical $41.62 7199450-M

PHYSICIAN SERVICES Tuberculosis;Intradermal $27.05 86580

PHYSICIAN SERVICES Admin Vaccine- 1st vaccine $35.37 90471

PHYSICIAN SERVICES VFC-Vaccine Admin 1st $21.68 90471-2

PHYSICIAN SERVICES Admin Flu vaccine $35.37 90471-4

PHYSICIAN SERVICES Admin Vaccine Pneumovac $35.37 90471-6

PHYSICIAN SERVICES ADMIN vaccine Addt. $21.85 90472

PHYSICIAN SERVICES Admin Vaccine;Oral/Intranasal $22.89 90473

PHYSICIAN SERVICES Clinic Flu vaccine 3 and older $25.50 90686

PHYSICIAN SERVICES Hearing&Speech tests:Pure Tone Audio;Air Only $50.98 92552

PHYSICIAN SERVICES CPR-PRO $575.40 92950-P

PHYSICIAN SERVICES Temporary External Pacing-PRO $395.39 92953-P

PHYSICIAN SERVICES Defibrillation - Cardioversion-PRO $457.82 92960-P

PHYSICIAN SERVICES *EKG Professional $40.58 93010-P

PHYSICIAN SERVICES Stress test with interp and supv $788.70 93015

PHYSICIAN SERVICES STRESS TEST - SUPERVISION $158.16 93016

PHYSICIAN SERVICES STRESS TEST INTERP & REPT ONLY $210.18 93018

PHYSICIAN SERVICES Holter Professional Read $115.49 93227-P

PHYSICIAN SERVICES MCT Telemetry Interp $35.00 93228-P

PHYSICIAN SERVICES Event Monitor- Hook Up $83.24 93270

PHYSICIAN SERVICES Event Monitor- Reading $41.62 93272

PHYSICIAN SERVICES WND ABI (Ankle-Brachial Index)-Pro $300.00 93922-6-P

PHYSICIAN SERVICES PFT simple pro $78.04 94010-P

PHYSICIAN SERVICES PFT pre & post Profession $112.37 94060-P

PHYSICIAN SERVICES PFT N2 washout professional $96.77 94727-P

PHYSICIAN SERVICES PFT Co2 diffusing professional $96.77 94729-P

PHYSICIAN SERVICES Allergy Immuno.:Allergen,not Includ. Provision;Single Inj. $23.93 95115

PHYSICIAN SERVICES Allergy Immuno.:Allergen,not Includ. Provision;2> Injections$32.25 95117

PHYSICIAN SERVICES Rmvl devital tissue addl 20cm $357.00 97598

PHYSICIAN SERVICES Neg Pressure wound therapy <50cm $132.60 97605

PHYSICIAN SERVICES FITTING FOR BOOT EA 15 MIN $50.98 97760-P

PHYSICIAN SERVICES Osteo.Manip;1-2 Body Regions $72.84 98925

PHYSICIAN SERVICES Osteo.Manip.;3-4 Body Regions $93.65 98926

PHYSICIAN SERVICES OMIT 5-6 BODY REG $110.29 98927

PHYSICIAN SERVICES Osteo.Manip.;7-8 Body Regions $144.63 98928

PHYSICIAN SERVICES Supplement&Supplies:Handling Specimen for Transfer $144.63 99000

PHYSICIAN SERVICES Supplement&Supplies:Office Emergaency;Disprupts other Scheduled Services$111.33 99058

PHYSICIAN SERVICES Mod sedation 1st 15min <5y $325.00 99151-P

PHYSICIAN SERVICES Office Visit New Min $96.77 99201

PHYSICIAN SERVICES WND Wound New Min - PRO $60.00 99201-6-P

PHYSICIAN SERVICES Office Visit New Min - PRO $59.31 99201-P

PHYSICIAN SERVICES Office Visit New Brief $156.08 99202

PHYSICIAN SERVICES Office Visit New Brief -PRO $112.37 99202-P

PHYSICIAN SERVICES Office Visit New Int. $208.10 99203

PHYSICIAN SERVICES WND Wound New Int. -PRO $175.00 99203-6-P

PHYSICIAN SERVICES Office Visit New Int. -PRO $123.82 99203-P

PHYSICIAN SERVICES Office Visit New Ext. $295.50 99204

PHYSICIAN SERVICES WND Wound New Ext.-PRO $250.00 99204-6-P

PHYSICIAN SERVICES Office Visit New Ext.-PRO $177.93 99204-P

PHYSICIAN SERVICES Office Visit New Ext. + $342.32 99205

PHYSICIAN SERVICES WND Wound New Ext. + -PRO $300.00 99205-6-P

PHYSICIAN SERVICES Office Visit New Ext. + -PRO $206.02 99205-P

PHYSICIAN SERVICES Office/Outpatient;Est. 5min.Visit $50.98 99211

PHYSICIAN SERVICES Office Visit Est. Brief[Package] $83.24 99212

PHYSICIAN SERVICES WND Wound Est. Brief-PRO $75.00 99212-6-P

PHYSICIAN SERVICES Office Visit Est. Brief-PRO $47.86 99212-P

PHYSICIAN SERVICES Office Visit Est. Int. $112.37 99213

PHYSICIAN SERVICES COA Office Visit exam Init $107.17 99213-1

PHYSICIAN SERVICES WND Wound Est. Int.-PRO $130.00 99213-6-P

PHYSICIAN SERVICES Office Visit Est. Int.-PRO $68.68 99213-P

PHYSICIAN SERVICES Office Visit Est. Ext. $172.73 99214

PHYSICIAN SERVICES WND Wound Est Ext-PRO $175.00 99214-6-P

PHYSICIAN SERVICES Office Visit Est. Ext.-PRO $103.01 99214-P

PHYSICIAN SERVICES Office Visit Est. Ext. + $261.17 99215

PHYSICIAN SERVICES WND Wound Est ext+PRO $200.00 99215-6-P

PHYSICIAN SERVICES Office Visit Est. Ext. +-PRO $156.08 99215-P

PHYSICIAN SERVICES Discharge Observation Care $152.95 99217-P

PHYSICIAN SERVICES Initial Observation Care (low) $162.32 99218-P

PHYSICIAN SERVICES Initial Observation Care (mod) $255.96 99219-P

PHYSICIAN SERVICES Initial Observation Care (high) $357.93 99220-P

PHYSICIAN SERVICES Initial Hospital Care/Admission (low) $224.75 99221-P

PHYSICIAN SERVICES Initial Hospital Care/Admission (mod) $303.83 99222-P

PHYSICIAN SERVICES initial Hospital Care/Admission (high) $374.58 99223-P

PHYSICIAN SERVICES Subsequent Hospital Care/Day (low) $115.49 99231-P

PHYSICIAN SERVICES Subsequent Hospital Care/Day (mod) $163.36 99232-P

PHYSICIAN SERVICES Subsequent Hospital Care/Day (high) $182.09 99233-P

PHYSICIAN SERVICES Same day admit/discharge - low $316.31 99234-P

PHYSICIAN SERVICES Same day admit/discharge - E&M mod $395.39 99235-P

PHYSICIAN SERVICES Same day admit discharge E&M high $526.49 99236-P

PHYSICIAN SERVICES Discharge Hospital Care (30 min or less) $142.55 99238-P

PHYSICIAN SERVICES Discharge Hospital Care (30 min or more) $153.99 99239-P

PHYSICIAN SERVICES OFFICE CONSULT-MINOR- 15 MIN $176.89 99241

PHYSICIAN SERVICES OFFICE CONSULT-MINOR- 15 MIN-PRO $91.57 99241-P

PHYSICIAN SERVICES OFFICE CONSULT-LOW-30 MIN[Package] $220.59 99242

PHYSICIAN SERVICES OFFICE COUSULT-LOW-PRO 30 MIN $107.17 99242-P

PHYSICIAN SERVICES OFFICE CONSULT-MODERATE-40 MIN $280.94 99243

PHYSICIAN SERVICES OFFICE CONSULT-MODERATE-40 MIN-PRO $169.61 99243-P

PHYSICIAN SERVICES OFFICE CONSULT-MOD/HIGH-60 MIN $365.22 99244

PHYSICIAN SERVICES OFFICE CONSULT-MOD/HIGH-60 MIN-PRO $219.54 99244-P

PHYSICIAN SERVICES OFFICE CONSULT-HIGH-HIGH-80 MIN $365.22 99245

PHYSICIAN SERVICES OFFICE CONSULT-HIGH-HIGH-80 MIN-PRO $212.26 99245-P

PHYSICIAN SERVICES INPATIENT CONSULT LOW $259.08 99252-P

PHYSICIAN SERVICES ORTHO-INPATIENT CONSULT MOD $323.60 99253-P



PHYSICIAN SERVICES ORTHO-INPATIENT CONSULT MOD TO HIGH $405.80 99254-P

PHYSICIAN SERVICES ED Visit, Minor-PRO $44.74 99281-P

PHYSICIAN SERVICES ED Visit, Low Moderate-PRO $85.32 99282-P

PHYSICIAN SERVICES ED Visit, Moderate-PRO $136.30 99283-P

PHYSICIAN SERVICES ED Visit, Moderate Complex-PRO $294.46 99284-P

PHYSICIAN SERVICES ED Visit, High Complex-PRO $374.58 99285-P

PHYSICIAN SERVICES CRITICAL CARE First Hour-PRO $1,086.28 99291-P

PHYSICIAN SERVICES CRITICAL CARE; each additional 30 mins-PRO $254.92 99292-P

PHYSICIAN SERVICES Nursing Facility Patient;Low PRO RHC $168.57 99304

PHYSICIAN SERVICES Nursing FacilitT;Mod RHC $227.87 99305

PHYSICIAN SERVICES Nursing Facility ;Mod SB,NH PRO $208.10 99305-P

PHYSICIAN SERVICES Nursing Facility Patient;High -pro $283.02 99306

PHYSICIAN SERVICES Nursing Facility ;High-SB NH PRO $255.96 99306-P

PHYSICIAN SERVICES Nursing Facility ;High-SB NH PRO $255.96 99306-P

PHYSICIAN SERVICES Nursing Facility Subset:Low stable SB NH-PRO $96.77 99307-P

PHYSICIAN SERVICES Nursing Facility Subse Pt;Low -RHC $148.79 99308

PHYSICIAN SERVICES Nursing Fac Subsequent new prob, RHC pro $201.86 99309

PHYSICIAN SERVICES Nursing fac Subsequent Visit SB, NH (new problem)pro $182.09 99309-P

PHYSICIAN SERVICES Nursing Facility ;Medium NH pro $247.64 99310

PHYSICIAN SERVICES Nursing Facility E-M RGH Discharge <30min $142.55 99315

PHYSICIAN SERVICES Discharge Care Swingbed NH PRO (30 min or less) $209.14 99315-P

PHYSICIAN SERVICES Nursing Facility E-M:Established Patient:High $163.36 99316

PHYSICIAN SERVICES Discharge Care Swingbed (30 min or more) $246.60 99316-P

PHYSICIAN SERVICES Nursing facility Assess-Pro $174.81 99318-P

PHYSICIAN SERVICES Dom Care- New- Mod -Pro $203.94 99325-P

PHYSICIAN SERVICES Dom Care- New-High- Pro $230.99 99326-P

PHYSICIAN SERVICES Dom Care- New-High- 60-Pro $395.39 99327-P

PHYSICIAN SERVICES Dom Care- Est- High- 40- Pro $280.94 99336-P

PHYSICIAN SERVICES Dom Care- Est- High- 60-Pro $446.37 99337-P

PHYSICIAN SERVICES Prev New < 1yr. $137.34 99381

PHYSICIAN SERVICES Prev. New 5-11 yrs. $216.42 99383

PHYSICIAN SERVICES Prev. New 5-11 yrs. $216.42 99383

PHYSICIAN SERVICES Prev New;12-17yrs. $229.95 99384

PHYSICIAN SERVICES Prev New;18-39 yrs. $313.19 99385

PHYSICIAN SERVICES CDL Physical- Age 18-39 $108.21 99385-1

PHYSICIAN SERVICES Prev. New;40-64yrs. $337.12 99386

PHYSICIAN SERVICES CDL Physical 40-64 $108.21 99386-1

PHYSICIAN SERVICES Prev.New;65 and > $386.03 99387

PHYSICIAN SERVICES CDL Physical 65 + $108.21 99387-1

PHYSICIAN SERVICES Prev. Est;< 1yr. $93.65 99391

PHYSICIAN SERVICES Prev. Est.;5-11yrs $177.93 99393

PHYSICIAN SERVICES Prev. Est.;12-17 yrs. $193.53 99394

PHYSICIAN SERVICES Prev. Est.;18-39yrs. $259.08 99395

PHYSICIAN SERVICES Prev. Est.;40-64 yrs. $296.54 99396

PHYSICIAN SERVICES Prev. Est.;65 and up $322.55 99397

PHYSICIAN SERVICES Smoking/tobacco cessation-3-10min clinic $26.01 99406

PHYSICIAN SERVICES Smoking Counseling $53.07 99407

PHYSICIAN SERVICES Advanced Care Planning 30 minutes $90.00 99497

PHYSICIAN SERVICES Advanced Care planning addt 30 min $75.00 99498

PHYSICIAN SERVICES Pessary $95.73 A4561

PHYSICIAN SERVICES Oral eval with counselling age 3-4 yr $49.94 D0190

PHYSICIAN SERVICES Floride Varnish $10.40 D1206

PHYSICIAN SERVICES Flight Physical Basic Med $50.00 FAA

PHYSICIAN SERVICES Admin vaccine Pneumovax $33.29 G0009

PHYSICIAN SERVICES Screening PAP/Breast-Medicare annual $125.90 G0101

PHYSICIAN SERVICES OR PRO Colonoscopy-Screening (high risk) $851.13 G0105-P

PHYSICIAN SERVICES OR PRO Colonoscopy Screening $325.68 G0121-P

PHYSICIAN SERVICES Counselling for Lung cancer scrrening $95.00 G0296

PHYSICIAN SERVICES Welcome to Medicare $341.28 G0402-P

PHYSICIAN SERVICES EKG- Welcome to medicare pro $40.58 G0404-P

PHYSICIAN SERVICES Medicare Annual Wellness $295.50 G0438

PHYSICIAN SERVICES Medicare Annual Wellness- subsequent $172.73 G0439

PHYSICIAN SERVICES Telehealth Facility Charge $33.29 Q3014

PHYSICIAN SERVICES WC Initial Report $71.80 Z0750

PHYSICIAN SERVICES WC Progress Report $67.64 Z0751

PHYSICIAN SERVICES WC Closing Report $71.80 Z0752

PHYSICIAN SERVICES WC Initial and Closing Report $71.80 Z0753

PHYSICIAN SERVICES WC Completion of Form $71.80 Z0754

RADIOLOGY Eye Detection For Foreign Body $61.39 70030

RADIOLOGY Mandible $286.14 70110

RADIOLOGY Mastoids $286.14 70130

RADIOLOGY Facial Bones 2V (PA&LAT) $218.50 70140

RADIOLOGY Zygomatic Arches $218.50 70140-1

RADIOLOGY Facial Bones Complete $293.42 70150

RADIOLOGY Nasal Bones $208.10 70160

RADIOLOGY Orbits $286.14 70200

RADIOLOGY Sinus 1 V $171.69 70210

RADIOLOGY Waters View $174.81 70210-3

RADIOLOGY Sinus 2 V $254.92 70220

RADIOLOGY Sinus Comp $254.92 70220-1

RADIOLOGY Skull 2 V $251.80 70250

RADIOLOGY Skull Comp $326.72 70260

RADIOLOGY TMJS $269.49 70330

RADIOLOGY Neck Soft Tissue $147.75 70360

RADIOLOGY Chest Apical/Lordotic 1V $258.04 71021

RADIOLOGY Chest 1 V PA-AP Decubitis $182.09 71035

RADIOLOGY Chest 1 V PA-AP $162.32 71045

RADIOLOGY Chest -2 view PA/LAT $200.82 71046

RADIOLOGY Ribs Unilat w/o PA CXR $235.15 71100

RADIOLOGY Rib Unilateral w/ PA CXR $286.14 71101

RADIOLOGY Ribs Bilat w/o PA CXR $281.98 71110

RADIOLOGY Ribs Bilat w/ PA CXR $380.83 71111

RADIOLOGY Sternum $204.98 71120

RADIOLOGY Sterno/Clavicular Jts $191.45 71130

RADIOLOGY C-Spine 3 View or Less $220.59 72040

RADIOLOGY C-Spine 4-5 views(Complete) $289.26 72050

RADIOLOGY C-Spine 6 or More Views (Flexion&Extension) $326.72 72052

RADIOLOGY T-Spine 2 V $240.35 72070

RADIOLOGY T-Spine Comp $302.79 72072

RADIOLOGY Thoraco-Lumbar Spine $240.35 72080

RADIOLOGY Scoliosis one view $199.86 72081

RADIOLOGY Scoliosis 2 v $206.04 72082

RADIOLOGY L-Spine 2V-3V $245.55 72100

RADIOLOGY L-Spine Comp $326.72 72110

RADIOLOGY L-Spine 7V (Flex & Ext) $386.03 72114

RADIOLOGY Pelvis $200.82 72170

RADIOLOGY Pelvis w/Cleaves Position (Baby) $239.31 72190

RADIOLOGY SI JTS $240.35 72202

RADIOLOGY Sacrum/Coccyx $230.99 72220

RADIOLOGY Clavicle L/R $200.82 73000

RADIOLOGY Clavicle bi-lateral $401.64 73000-2

RADIOLOGY Scapula $189.37 73010

RADIOLOGY Scapula bi-lateral $378.75 73010-2

RADIOLOGY Shoulder 1 V L/R $147.75 73020

RADIOLOGY Shoulder bi-lateral 1V $295.50 73020-2

RADIOLOGY Shoulder 2 V L/R $182.09 73030

RADIOLOGY Shoulder Comp $198.74 73030-1

RADIOLOGY Shoulder bi-lateral 2V $364.18 73030-2

RADIOLOGY Bi-lat Shoulders completes $273.66 73030-3

RADIOLOGY Acromion/Clavicular Joints W/WO Wts $207.06 73050

RADIOLOGY Humerus L/R $204.98 73060

RADIOLOGY Humerus bi-lateral $409.96 73060-2

RADIOLOGY Elbow 2 V L/R $167.52 73070

RADIOLOGY Elbow bi-lateral 2V $335.04 73070-2

RADIOLOGY Elbow Comp L/R $182.09 73080

RADIOLOGY Elbow bi-lateral Comp $364.18 73080-2

RADIOLOGY Forearm L/R $184.17 73090

RADIOLOGY Forearm bi-lateral $368.34 73090-2

RADIOLOGY Upper Extremity Infant $93.65 73092

RADIOLOGY Upper Extremity bi-lateral infant $187.29 73092-2

RADIOLOGY Wrist 2V L/R $169.61 73100

RADIOLOGY Wrist bi-lateral 2V $339.20 73100-2

RADIOLOGY Wrist Comp L/R $191.45 73110

RADIOLOGY Wrist bi-lateral complete $382.91 73110-2

RADIOLOGY Hand 2 V L/R $147.75 73120

RADIOLOGY Hand-bilateral 2 V $295.50 73120-2

RADIOLOGY Hand Complete L/R $182.09 73130

RADIOLOGY Hand Complete bi-lateral $364.18 73130-2

RADIOLOGY Finger $182.09 73140

RADIOLOGY Finger bi-lateral $364.18 73140-2

RADIOLOGY HIP Unilateral w pelvis 1 view $175.13 73501

RADIOLOGY Hip Unilat 2 V w pelvis $224.75 73502

RADIOLOGY Hip Bilat w pelvis 2 views $302.79 73521

RADIOLOGY Hips Bilat w pelvis 3-4 view $360.57 73522

RADIOLOGY Femur 1 view $144.23 73551

RADIOLOGY Femur bi-lateral 1V $288.46 73551-2

RADIOLOGY Femur 2 view $199.86 73552

RADIOLOGY Femur bi-lateral 2V $399.72 73552-2

RADIOLOGY Knee 1V-2V L/R $182.09 73560

RADIOLOGY Knee bi-lateral 1V-2V $364.18 73560-2

RADIOLOGY Knee Comp $235.15 73564

RADIOLOGY Knee bi-lateral complete $470.31 73564-2

RADIOLOGY Knee, Bilat Standing $176.89 73565

RADIOLOGY Tibia-Fibula L/R $200.82 73590

RADIOLOGY Tibia-Fibula bi-lateral $401.64 73590-2

RADIOLOGY Lower Extremity Infant $95.73 73592

RADIOLOGY Lower Extremity bi-lateral infant $191.45 73592-2

RADIOLOGY Ankle 2V $134.22 73600

RADIOLOGY Ankle bi-lateral 2V $268.45 73600-2

RADIOLOGY Ankle Comp $201.86 73610

RADIOLOGY Ankle bi-lateral complete $403.72 73610-2

RADIOLOGY Foot 2V L/R $171.69 73620

RADIOLOGY Foot bi-lateral 2V $343.36 73620-2

RADIOLOGY Foot Complete L/R $199.78 73630

RADIOLOGY Foot bi-lateral complete $399.55 73630-2

RADIOLOGY Heel $70.76 73650

RADIOLOGY Heel bi-lateral $141.50 73650-2

RADIOLOGY Toes $162.32 73660

RADIOLOGY Abdomen 1 V(KUB or Upright) $176.89 74018

RADIOLOGY Abdomen 2 V $226.83 74019

RADIOLOGY Abdomen 3 V(Complete) $305.91 74022

RADIOLOGY Barium Swallow $407.88 74230

RADIOLOGY Barium Swallow w/Ambulance $1,706.42 74230-1

RADIOLOGY I.V.P $369.38 74400

RADIOLOGY Bone Mineral Density(BMD) (HEEL) $129.02 76977

RADIOLOGY Bone Survey Limited $329.84 77074

RADIOLOGY VQ Scan with ambulance to SLVH $4,409.66 78580

RADIOLOGY VQ Scan $2,277.77 78580-T

RECOVERY OR FAC Recovery Room <60 min $6.24 30000-M

RECOVERY OR FAC Recovery room >60 min $459.90 30001-M

RESPIRATORY RT-CPR Assist-Non $277.82 92950

RESPIRATORY Holter Monitor Analysis $343.36 93226

RESPIRATORY Ventilator Mech Initial $805.35 94002

RESPIRATORY Incentive Spirometry $126.94 94010

RESPIRATORY PFT-Simple $105.09 94010-T

RESPIRATORY PFT pre & post Technical $158.16 94060-T

RESPIRATORY 6 minute walk test study $0.00 946

RESPIRATORY 6-minute walk test-PRO $128.78 94620-P

RESPIRATORY 6-minute walk test-facility $345.12 94620-T

RESPIRATORY Nebulizer Inhalation Initial Treatment $99.89 94640

RESPIRATORY Sputum Induction $42.66 94640-1

RESPIRATORY Nebulizer Subsequent $78.04 94640-2

RESPIRATORY Nebulizer Subsequent - Drug 2 $78.04 94640-3

RESPIRATORY Chest Percussion Initial $89.48 9466-1

RESPIRATORY BIPAP/CPAP $572.28 94660

RESPIRATORY Eval/Demo Nebulizer $42.66 94664

RESPIRATORY Manipulate Chest Subs $92.61 94668

RESPIRATORY PFT FRC by nitrogen washout $123.82 94727-T

RESPIRATORY PFT Co DIffusing capacity $134.22 94729-T

RESPIRATORY Pulse Oximetry Single $23.93 94760

RESPIRATORY PEAK FLOW on admission, before and after each neb $0.00 res

RGH CLINIC Debridement - Skin 20 Sq cm or<[Package] $460.57 11042

RGH CLINIC Debridement - Muscle or fascia <20cm[Package] $810.00 11043

RGH CLINIC Debridement Bone <20cm[Package] $1,500.00 11044

RGH CLINIC Exc/debride subq add 20sq c[Package] $139.74 11045

RGH CLINIC Debride- muscle/fascia add 20cm[Package] $642.00 11046

RGH CLINIC EXC - paring or cutting benign lesion -single[Package] $84.28 11055

RGH CLINIC Exc Benigh(head,neck,ext, gen) 1.1-2cm[Package] $197.70 11422

RGH CLINIC Lesion rem Mal head,face 3.1-4.0cm[Package] $1,050.91 11644

RGH CLINIC Asp./Inj joint; BILATERAL Inter.(w,el,an) $422.44 20605-1

RGH CLINIC Asp./Inj Joint; Major(s,h,k) BILATERAL $468.23 20610-2

RGH CLINIC Dislocation-interphalangeal closed w anes-Pro $840.72 26775-P

RGH CLINIC Dislocation-interphalangeal closed w anes-Facility $525.45 26775-T

RGH CLINIC Application of Finger splint[Package] $134.22 29130

RGH CLINIC Strapping UNA boot $150.00 29580-9

RGH CLINIC dentoalveolar block-PRO $306.00 64400-P

RGH CLINIC VFC Vaccine adm additional $12.59 90472-1

SLEEP STUDY Polysomnography baseline $2,143.44 95810

SLEEP STUDY Polysomnography sleep staging $2,709.47 95811

SPEECH THERAPY ST Treatment Language Voice $176.89 92507

SPEECH THERAPY ST Treatment Dysphagia $228.91 92526

SPEECH THERAPY ST Dysphagia Evaluation $350.65 92610

SURGERY Anesthesia Vitroretinal Surgery $105.00 145

SURGERY FAC Lac Complex Hand 5cm $261.17 13133-T

SURGERY Secondary (add) wound closure-PRO $1,634.00 13160-P

SURGERY Secondary (add) wound closure $2,068.00 13160-T

SURGERY OR FAC Adjacent tissue transfer, eyelids, nose, etc $2,320.32 14060-T

SURGERY OR FAC Pinch graft minimal 0-2cm $797.03 15050-T

SURGERY OR FAC Full Thickness Graft $2,388.99 15240-T

SURGERY OR FAC Full thickness skin graft eyelids, nose, etc $2,320.32 15260-T

SURGERY OR FAC Blepharoplasty, lower eyelid $1,974.87 15820-T

SURGERY OR FAC Blepharoplasty, upper eyelid $2,010.25 15823-T

SURGERY Incision-Breast mastotomy with drainage $1,768.85 19020-T

SURGERY OR FAC Tisseel (fibrin sealant) $277.82 20300

SURGERY Pin removal - distal plalanx-facility $2,652.00 20670-T

SURGERY OR PRO Removal hardware $793.91 20680-P

SURGERY OR FAC Removal Hardware $2,637.67 20680-T

SURGERY Blades 2108 2 set $170.34 2108

SURGERY OR FAC Exc. Malignant Lesion 4cm $1,723.08 21626-T

SURGERY OR FAC Excision tumor soft tissue shoulder-3cm $3,529.38 23071-T

SURGERY Excise Oleocranon bursa-FAC $5,000.00 24105-T

SURGERY OR FAC Arthrotomy elbow with debridement $4,895.56 24358-T

SURGERY OR FAC Fasciotomy Lower Arm $4,548.04 24495-T

SURGERY OR FAC Inc. Extensor Tendon Sheath $3,216.19 25000-T

SURGERY OR FAC Exc. Ganglion Dorsum Hand $3,373.30 25111-T

SURGERY OR FAC Open Red Internal Fixation-Radius $3,216.19 25574-T

SURGERY Fx Rep, Cl w/man-FAC $1,413.01 25605-T

SURGERY OR FAC Decompress Fasciotomy Hand $2,534.66 26037-T

SURGERY OR FAC Tenovaginotomy Finger $1,937.42 26055-T

SURGERY OR FAC Lesion Exc $2,572.12 26113-T

SURGERY OR fac Exc. tumor, mal, soft hand <1.5cm $2,357.78 26115-T

SURGERY OR FAC Exc. Lesion Tendon Sheath $3,773.90 26160-T

SURGERY Repair Extensor Tendon-Hand-FAC $2,175.69 26410-T

SURGERY FAC Tendon Rep Ext Fing $2,170.49 26418-T

SURGERY OR FAC Repair Extensor Tendon-insertion $2,510.73 26433-T

SURGERY OR FAC ORIF Metacarpal dislocation $3,820.73 26715-T

SURGERY OR FAC Amputation Finger / DI CL $1,311.04 26951-T

SURGERY Knee Arthroplasty-uni PRO $4,000.00 27446-P

SURGERY Total Knee arthroplasty $6,500.00 27447-T

SURGERY OR FAC Exc. Lesion Leg $2,285.98 27618-T

SURGERY OR FAC Plantar Fascia Fasciectomy $3,360.82 28060-T

SURGERY OR FAC Exc. Morton's Neuroma $2,506.57 28080-T

SURGERY OR FAC Exc. Bone Cyst or Tumor $3,329.61 28104-T

SURGERY OR FAC Osteotomy Calcaneous $2,548.18 28118-T

SURGERY OR FAC Hemiphalenectomy $3,475.27 28160-T

SURGERY OR FAC Capsulotomy Toe $2,957.10 28270-T

SURGERY OR FAC Syndactilization Toe $3,241.16 28280-T

SURGERY OR FAC Hammer Toe correction $3,013.29 28285-T

SURGERY OR Fac Open tx, talotarsal joint $1,240.28 28585-T

SURGERY OR FAC ORIF DIP Joint Toe $4,548.04 28675-T

SURGERY OR Chondroplasty - Facility $6,120.00 29877-T

SURGERY Arthroscopy- lat-med meniscctomy -Facility $5,100.00 29880-T

SURGERY OR Arthro w meniscectomy-FAC $6,630.00 29881-T

SURGERY OR FAC Bronch flex w/biopsy $1,550.35 31628-T

SURGERY OR FAC EGD-Diagnostic $1,683.00 43235-T

SURGERY OR FAC EGD-Diagnostic w/biopsy $1,786.54 43239-T

SURGERY OR FAC EGD-w/band ligation $2,042.51 43244-T

SURGERY OR FAC EGD-w/snare $2,042.51 43251-T

SURGERY OR FAC Colonoscopy-Diagnostic $1,547.23 45378-T

SURGERY OR FAC Colonoscopy-w/biopsy $2,023.77 45380-T

SURGERY OR FAC Colonoscopy-w/biopsy, hot forceps/cautery $1,863.54 45384-T

SURGERY OR FAC Colonoscopy-w/biopsy, snare $2,023.77 45385-T

SURGERY OR FAC Herniorrhaphy, inguinal (initial) $4,384.67 49505-T

SURGERY OR FAC Lithotripsy $5,850.74 50590-T

SURGERY OR FAC Suprapubic Cath Insertion $1,013.45 51040-T

SURGERY OR FAC Cystourethroscopy $557.71 52000-T

SURGERY OR FAC Cystourethroscopy w/biopsy $2,503.45 52204-T

SURGERY OR FAC Cystourethroscopy Bladder Dilation $2,357.78 52260-T

SURGERY OR FAC Cysto w/Calibration $2,510.73 52281-T

SURGERY Cystoscopy with stent removal $2,518.01 52310

SURGERY OR FAC Cysto Ureteral Stent $2,572.12 52310-T

SURGERY OR FAC Transurethral Resection, Bladder Neck $2,087.25 52500-T

SURGERY OR FAC PVP $6,964.08 52648-T

SURGERY OR FAC Meatotomy $1,842.73 53020-T

SURGERY OR FAC Urethromeatoplasty $2,455.59 53540-T

SURGERY OR FAC Dorsal slit of Prepuce $3,354.33 54001-T

SURGERY OR FAC Exc. lesions penis $970.79 54055-T

SURGERY OR FAC Penis - destr. of lesions $1,717.87 54060-T

SURGERY OR FAC Penis - biopsy $1,474.39 54100-T

SURGERY OR FAC Partial Amp of Penis $5,834.09 54120-T

SURGERY OR FAC Circumcision $1,842.73 54161-T

SURGERY OR FAC Lysis preputal adhesions $2,680.34 54162-T

SURGERY OR FAC Circumcision, repair incomplete $1,842.73 54163-T

SURGERY OR FAC Lysis fo Preputial Adhesions $437.01 54450-T

SURGERY OR FAC Testis, Incisional Biopsy $905.24 54505-T

SURGERY OR FAC Orchiectomy,simple $2,110.14 54520-T

SURGERY OR FAC Orchiectomy, inguinal approach $2,701.14 54530-T

SURGERY OR FAC Testis, Reduction of Torsion $1,730.36 54600-T

SURGERY OR FAC Epidiymus-needle biopsy $368.34 54800-T

SURGERY OR Fac EXC, local lesion epididymus $3,573.08 54830

SURGERY OR FAC Spermatocelectomy $1,863.54 54840-T

SURGERY OR FAC Epididyectomy-unilateral $1,974.87 54860-T

SURGERY OR FAC Hydrocele, excision, unilateral $2,701.14 55040-T

SURGERY OR FAC Bilateral Hydrocele $4,155.77 55041-T

SURGERY OR FAC Scrotal Exploration $3,496.09 55110-T

SURGERY OR FAC Vasectomy $1,305.83 55250-T

SURGERY OR FAC Prostate - needle biopsy $1,044.66 55700-T

SURGERY OR FAC TVT, OB Sling, Mini Arc Abdominal Approach $3,133.99 57280-T

SURGERY OR FAC TVT, OB Sling, Mini Arc $4,824.80 57288-T

SURGERY ANES Epidural Steroid Injection LS w/o images $600.00 62322-P

SURGERY OR FAC ulnar nerve tranposition elbow $3,182.40 64718-T

SURGERY OR FAC Carpal Tunnel, med rep $2,824.96 64721-T

SURGERY OR FAC Decompress Nerve $2,703.22 64722-T

SURGERY OR FAC Ocular Implant-reinsertion $2,891.56 65150-T

SURGERY OR FAC Corneal repair wound $2,026.89 65275-T

SURGERY OR FAC Corneal lac $3,062.19 65280-T

SURGERY OR FAC Exc. corneal lesion $2,425.41 65400-T

SURGERY OR FAC Exc pterygium w/o graft $857.37 65420-T

SURGERY OR FAC Pterygium exc. with graft $3,980.96 65426-T

SURGERY OR FAC Penetrating Keratoplasty $5,896.53 65730-T

SURGERY OR FAC LRI, Limbal relaxing Incision $1,898.91 65772-T

SURGERY OR FAC Ocular surface reconstruct w/ amniotic membrane$5,467.84 65780-t

SURGERY OR FAC Inject Anterior Chamber eye $2,643.91 66020-T

SURGERY OR FAC Suture of Iris $2,867.63 66682-T

SURGERY OR FAC YAG-Iridotomy $887.55 66761-T

SURGERY OR FAC YAG-Iridotomy-Bilateral $1,775.10 66761-T1

SURGERY OR FAC YAG-Capsulotomy $781.42 66821-T

SURGERY OR FAC YAG-Capsulotomy -Bilateral $1,563.87 66821-T1

SURGERY OR FAC YAG-Capsulotomy -Bilateral $1,563.87 66821-T1

SURGERY OR FAC Cataract removal, aspiration $1,702.26 66840-T

SURGERY removal of lens material by frag $2,000.00 66850

SURGERY OR FAC Extra cap cataract-no IOL $2,329.68 66940-T

SURGERY OR FAC Cataract removal, complex $3,316.08 66982-T

SURGERY OR FAC Exchange of IOL $3,266.13 66986-T

SURGERY OR FAC Anterior vitrectomy $4,366.99 67010-T

SURGERY OR FAC Vitrectomy, mechanical $4,471.04 67036-T

SURGERY OR FAC exc. Chalazion mult same lid $525.45 67801

SURGERY OR FAC EXC chalazion w anesthesia $2,522.17 67808

SURGERY OR FAC Exc. eyelid with biopsy $1,127.91 67840-T

SURGERY OR FAC Eyelid closure-suture $1,109.18 67875-T

SURGERY OR FAC Brow Ptosis Repair $3,955.99 67900-T

SURGERY OR FAC Rep of blepharoptosis $2,340.08 67904-T

SURGERY OR FAC Reduction of overcorrection of ptosis $2,788.55 67909-T

SURGERY OR FAC Ectropion Repair $2,522.17 67916-T

SURGERY OR FAC Rep Ectop. ext. $2,843.69 67917-T

SURGERY OR FAC Rep of Entrop $2,624.14 67923-T

SURGERY OR FAC Rep Entrop ext $2,899.88 67924-T

SURGERY OR FAC Conjunctival bx $842.81 68100-T

SURGERY OR FAC Biopsy lacrimal gland $2,622.06 68510-T

SURGERY OR FAC Surgery-IV Therapy-Initial $203.94 96365-T

SURGERY Blood conservation w PVC drain $1,468.80 BS

SURGERY Palacos R+G w gent $406.98 C1776

SURGERY Tibial Plate $2,449.02 C1776-1

SURGERY MIS Headed Screw 33mm $170.00 C1776-10

SURGERY Articular surface inserter $195.00 C1776-11

SURGERY Knee-uni slotted holding pin $244.00 C1776-12

SURGERY Femoral Size E-uni $4,025.00 C1776-13

SURGERY TIB base uni $2,400.00 C1776-14

SURGERY Articular surface-UNI $1,043.00 C1776-16

SURGERY Nexgen stem ext $847.62 C1776-2

SURGERY Nexgen art surf $1,453.50 C1776-3

SURGERY Femoral Implant $4,239.12 C1776-4

SURGERY Nexgen Patella $829.26 C1776-5

SURGERY MIS Head screw 48mm $90.00 C1776-8

SURGERY MIS Headless screw 48mm $195.00 C1776-9

SURGERY OR FAC Mini arc Precise Sling $2,165.29 C1781

SURGERY Cement for knee implants $2,700.00 cem-M

SURGERY OR FAC Colonoscopy-Screening (high risk) $1,342.25 G0105-T

SURGERY 4.5 incisor and blade $255.00 OR1

SURGERY Dyonics 25 inflow tube set $280.50 OR2

SURGERY Recip blade double $91.90 rec

SURGERY Recip blade-Long $81.60 recb

SURGERY Blade - sagittal $154.02 sag

SURGERY OR FAC IOL Anterior Chamber $363.13 V2630

SURGERY OR FAC Corneal tissue $5,521.94 V2785

SURGERY OR FAC IOL Astigmatism Correcting $530.66 V2787

SURGERY OR FAC IOL Presbyopia correcting $883.38 V2788

SURGERY OR FAC Human Amniotic Membrane $640.95 V2790

SWING Swing Bed Charge $1,098.77 1036

ULTRASOUND US Bladder $106.13 51798

ULTRASOUND US THYROID/HEAD/NECK $507.77 76536

ULTRASOUND ER Soft Tissue/Head-US $199.78 76536-4

ULTRASOUND ER Mediastinum (FAST)-US $273.66 76604

ULTRASOUND US Breast Soft Tissue $419.32 76641

ULTRASOUND US Abdominal Complete $878.18 76700

ULTRASOUND US Abdominal-Limited $415.16 76705

ULTRASOUND ER Trauma Abd US (FAST) $215.38 76705-2

ULTRASOUND ER Gallbladder US $215.38 76705-3

ULTRASOUND US Renal Retroperitoneal $507.77 76770

ULTRASOUND ER Aorta US $214.34 76775

ULTRASOUND ER Renal US $214.34 76775-2

ULTRASOUND US OB 1st tri Complete $467.18 76801

ULTRASOUND US OB-Complete $476.55 76811

ULTRASOUND US OB Complete (Twin) Add $364.18 76812

ULTRASOUND US OB Limited $338.16 76815

ULTRASOUND US OB Follow-up $376.67 76816

ULTRASOUND US OB Transvaginal -add $397.47 76817

ULTRASOUND US Transvaginal Add $259.08 76830

ULTRASOUND ER Pelvic Trans Abd US (FAST) $249.72 76830-1

ULTRASOUND US Pelvic Complete $480.72 76856

ULTRASOUND US Pelvic Limited $368.34 76857

ULTRASOUND ER Pelvic Endovaginal-US $241.39 76857-1

ULTRASOUND ER Limited Pelvis-US $241.39 76857-2

ULTRASOUND US Pelvic-Limited $368.34 76857-3

ULTRASOUND US Testicular $512.97 76870

ULTRASOUND ER Scrotum US $195.62 76870-1

ULTRASOUND US Prostate Volume Transrectal $525.45 76873

ULTRASOUND US Extremity Non-Vascular Limited $402.68 76882

ULTRASOUND US GUIDANCE AND NEEDLE PLACEMENT $207.06 76942

ULTRASOUND ECHO Congenital Complete $1,231.96 93303

ULTRASOUND ECHO COMPLETE -Facility $1,279.81 93306

ULTRASOUND ER Cardiac (FAST)-US $118.62 93308

ULTRASOUND ECHO 2D limited $782.46 93308-1

ULTRASOUND ECHO CLINIC-DOPPLER $330.88 93320

ULTRASOUND ECHO CLINIC -DOPPLER,COLOR $422.44 93325

ULTRASOUND ECHO CLINIC-WITH STRESS $527.53 93350

ULTRASOUND US VASC Carotid Duplex Bilateral $915.64 93880

ULTRASOUND ER Bi-Lateral Lower Extremity-US $865.69 93925

ULTRASOUND ER DVT-US $551.46 93926

ULTRASOUND US VASC Venous Duplex Extrem Bilateral $880.26 93970

ULTRASOUND US VASC Venous Duplex Extrem Unilateral $746.04 93971

ULTRASOUND US VASC Renal Doppler $633.66 93976

ULTRASOUND Welcome to Medicare Abd US for AAA $824.16 G0389

ULTRASOUND ECHO CLINIC contrast -perflutren/Definity $401.64 Q9957

Dept. - Rio Grande Hospital

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