long_description - SouthEast Alaska Regional Health ...
438
LONG_DESCRIPTION CPT/HCPCS FQHC Price SRHC Technical Price SRHC Professional Price Anesthesia, salivary gland 100 $159.60 Anesthesia, repair of cleft lip 102 $159.60 Anesthesia, Reconstructive Procedures of Eyelid 103 $159.60 Anesthesia, electroconvulsive therapy 104 $159.60 Anesthesia, ear surgery 120 $159.60 Anesthesia, otoscopy 124 $159.60 Anesthesia, tympanotomy 126 $159.60 Anesthesia, procedures on eye, NOS 140 $159.60 Anesthesia, procedures on eye, lens surgery 142 $159.60 Anesthesia, procedures on eye, vitreoretinal surgery 144 $159.60 Anesthesia, procedures on eye, iridectomy 145 $159.60 Anesthesia, procedures on eye, ophthalmoscopy 147 $159.60 Anesthesia, procedures on eye, corneal transplant 148 $159.60 Anesthesia, nose/sinus; NOS 160 $159.60 Anesthesia, nose/sinus; radical surgery 162 $159.60 Anesthesia, nose/sinus; biopsy 164 $159.60 Anesthesia, intraoral; NOS 170 $159.60 Anesthesia, intraoral; cleft palate repair 172 $159.60 Anesthesia, intraoral; excision retropharyngeal tumor 174 $159.60 Anesthesia, intraoral, radical surgery 176 $159.60 Anesthesia, face/skull bone surgery, NOS 190 $159.60 Anesthesia, face/skull bone surgery, radical surgery 192 $159.60 Anesthesia, intracranial surg; NOS 210 $159.60 Anesthesia, intracranial surg, craniotomy or craniectomy for hemotoma 211 $159.60 Anesthesia, intracranial surg, subdural taps 212 $159.60 Anesthesia, intracranial surg, burr holes 214 $159.60 Anesthesia, intracranial surg, cranioplasty or elevation of depressed skull fracture 215 $159.60 Anesthesia, intracranial surg, vascular 216 $159.60 Anesthesia, intracranial surg, procedure in a sitting position 218 $159.60 Anesthesia, intracranial surg, cerebral spinal fluid shunting 220 $159.60 Anesthesia, intracranial surg, Electocoagulation of Intracranial Nerve 222 $159.60 Anesthesia, Integumentary, muscles, nerves of head/neck/posterior trunk 300 $159.60 Anesthesia, neck organs, NOS, age 1 + over 320 $159.60 Anesthesia, Needle biopsy of thyroid 322 $159.60 Anesthesia, larynx/trachea, < 1 YR 326 $159.60 Anesthesia, neck vessel surgery, NOS 350 $159.60 Anesthesia, neck vessel surgery, simple ligation 352 $159.60 Anesthesia, skin, extremities/perineum/anterior trunk, NOS 400 $159.60 Anesthesia, Reconstructive procedures of breast 402 $159.60 Anesthesia, surgery of breast, radical or modified radical 404 $159.60 Anesthesia, surgery of breast, radical or modified radical w internal mammary node dissection 406 $159.60 Anesthesia, correct heart rhythm 410 $159.60 Anesthesia, surgery of clavicle, scapula, NOS 450 $159.60 Anesthesia, Clavicle biopsy 454 $159.60 Anesthesia, Partial Rib resection, NOS 470 $159.60 Anesthesia, Partial Rib resection, thoracoplasty, any type 472 $159.60 Anesthesia, Partial Rib resection, radical 474 $159.60 Anesthesia, esophogeal surgery 500 $159.60 Anesthesia, closed chest procedures, NOS 520 $159.60 Anesthesia, closed chest procedures, needle biopsy pleura 522 $159.60 Anesthesia, closed chest procedure, pneumocentisis 524 $159.60
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Transcript of long_description - SouthEast Alaska Regional Health ...
LONG_DESCRIPTION CPT/HCPCS FQHCPrice SRHCTechnicalPrice SRHCProfessionalPriceAnesthesia,salivarygland 100 $159.60Anesthesia,repairofcleftlip 102 $159.60Anesthesia,ReconstructiveProceduresofEyelid 103 $159.60Anesthesia,electroconvulsivetherapy 104 $159.60Anesthesia,earsurgery 120 $159.60Anesthesia,otoscopy 124 $159.60Anesthesia,tympanotomy 126 $159.60Anesthesia,proceduresoneye,NOS 140 $159.60Anesthesia,proceduresoneye,lenssurgery 142 $159.60Anesthesia,proceduresoneye,vitreoretinalsurgery 144 $159.60Anesthesia,proceduresoneye,iridectomy 145 $159.60Anesthesia,proceduresoneye,ophthalmoscopy 147 $159.60Anesthesia,proceduresoneye,cornealtransplant 148 $159.60Anesthesia,nose/sinus;NOS 160 $159.60Anesthesia,nose/sinus;radicalsurgery 162 $159.60Anesthesia,nose/sinus;biopsy 164 $159.60Anesthesia,intraoral;NOS 170 $159.60Anesthesia,intraoral;cleftpalaterepair 172 $159.60Anesthesia,intraoral;excisionretropharyngealtumor 174 $159.60Anesthesia,intraoral,radicalsurgery 176 $159.60Anesthesia,face/skullbonesurgery,NOS 190 $159.60Anesthesia,face/skullbonesurgery,radicalsurgery 192 $159.60Anesthesia,intracranialsurg;NOS 210 $159.60Anesthesia,intracranialsurg,craniotomyorcraniectomyforhemotoma 211 $159.60Anesthesia,intracranialsurg,subduraltaps 212 $159.60Anesthesia,intracranialsurg,burrholes 214 $159.60Anesthesia,intracranialsurg,cranioplastyorelevationofdepressedskullfracture 215 $159.60Anesthesia,intracranialsurg,vascular 216 $159.60Anesthesia,intracranialsurg,procedureinasittingposition 218 $159.60Anesthesia,intracranialsurg,cerebralspinalfluidshunting 220 $159.60Anesthesia,intracranialsurg,ElectocoagulationofIntracranialNerve 222 $159.60Anesthesia,Integumentary,muscles,nervesofhead/neck/posteriortrunk 300 $159.60Anesthesia,neckorgans,NOS,age1+over 320 $159.60Anesthesia,Needlebiopsyofthyroid 322 $159.60Anesthesia,larynx/trachea,<1YR 326 $159.60Anesthesia,neckvesselsurgery,NOS 350 $159.60Anesthesia,neckvesselsurgery,simpleligation 352 $159.60Anesthesia,skin,extremities/perineum/anteriortrunk,NOS 400 $159.60Anesthesia,Reconstructiveproceduresofbreast 402 $159.60Anesthesia,surgeryofbreast,radicalormodifiedradical 404 $159.60Anesthesia,surgeryofbreast,radicalormodifiedradicalwinternalmammarynodedissection 406 $159.60Anesthesia,correctheartrhythm 410 $159.60Anesthesia,surgeryofclavicle,scapula,NOS 450 $159.60Anesthesia,Claviclebiopsy 454 $159.60Anesthesia,PartialRibresection,NOS 470 $159.60Anesthesia,PartialRibresection,thoracoplasty,anytype 472 $159.60Anesthesia,PartialRibresection,radical 474 $159.60Anesthesia,esophogealsurgery 500 $159.60Anesthesia,closedchestprocedures,NOS 520 $159.60Anesthesia,closedchestprocedures,needlebiopsypleura 522 $159.60Anesthesia,closedchestprocedure,pneumocentisis 524 $159.60
Anesthesia,closedchestprocedure,mediastinoscopy+diagnosticthorascopynotusinglungvent 528 $159.60Anesthesia,closedchestprocedure,mediastinoscopy+diagnosticthorascopyusing1lungvent 529 $159.60Anesthesia,permanenttransvenouspacemakerinsertion 530 $159.60Anesthesia,vascularaccess 532 $159.60Anesthesia,Transvenousinsertionorreplacepacingcardioverter/debrillator 534 $159.60Anesthesia,cardiacelectrophysiologicproceduresincludingradiofreqablation 537 $159.60Anesthesia,transbronchialreconstruction 539 $159.60Anesthesia,thoracotomyprocinvolvinglungs,pleura,diaphragm,andmediastinum,NOS 540 $159.60Anesthesia,thoracotomyprocinvolvinglungs,pleura,diaphragm,+mediastinum,usingonelungvent 541 $159.60Anesthesia,thoracotomyprocinvolvinglungs,pleura,diaphragm,andmediastinum,decortication 542 $159.60Anesthesia,thoracotomyinvolvlungs,pleura,diaphragm,mediastinum;pulmresectwthoracoplasty 546 $159.60Anesthesia,thoracotomyinvolvlungs,pleura,diaphragm,mediastinum;intrathoracictrachea+bronchi 548 $159.60Anesthesia,sternaldebridement 550 $159.60Anesthesia,proceduresofheart,pericardialsac,greatvesselsofchest,W/OPUMPoxygenator 560 $159.60Anesthesia,heart,Pericardialsac,greatvesselsofchest,W/PUMPoxygenator,>1yrage 561 $159.60Anesthesia,heart,pericardialsac,gvchest,wpump;age1yror>fornon-CBP/forCBP>1mopostop 562 $159.60Anesthesia,heart,pericardialsac,>vesselsofchest,wpumpoxygenator,whypothermiccircarrest 563 $159.60Anesthesia,CABGW/OPUMPoxygenator 566 $159.60Anesthesia,CABGWPUMPoxygenator 567 $159.60Anesthesia,heartorheart/lungtransplant 580 $159.60Anesthesia,Cervicalspine,cordsurgery,NOS 600 $159.60Anesthesia,Cervicalspine,cordsurgery,Patientinsittingposition 604 $159.60Anesthesia,thoracicspine,cordsurgery,viaanteriortransthoracicappnotusing1lungvent 625 $159.60Anesthesia,thoracicspine,cordsurgery,viaanteriortransthoracicappusing1lungvent 626 $159.60Anesthesia,lumbarspine,surgery,NOS 630 $159.60Anesthesia,lumbarspine,surgery,sympathectomy 632 $159.60Anesthesia,lumbarspine,surgery,diagnosticortherapeuticlumbarpuncture 635 $159.60Anesthesia,spinemanipulationforproconcervical,thoracic,orlumbarspine 640 $159.60Anesthesia,extensivespineandspinalcordsurgery 670 $159.60Anesthesia,upperanteriorabdominalwallsurg,NOS 700 $159.60Anesthesia,upperanteriorabdominalwallsurg,percutaneousliverbx 702 $159.60Anesthesia,upperposteriorabdominalwallsurg 730 $159.60Anesthesiaforuppergastrointestinalendoscopicprocedureproximaltoduodenum,NOS 731 $159.60Anesthesiaforendoscopicretrogradecholangiopancreatography(ERCP) 732 $159.60Anesthesia,upperGIendoscopicprocedures,endoscopeintroducedproximaltoduodenum 740 $159.60Anesthesia,repairofhernia,upperabdomen,NOS 750 $159.60Anesthesia,repairofhernialumbarandventralandwounddehiscence 752 $159.60Anesthesia,repairofherniaomphalocele 754 $159.60Anesthesia,repairofhernia,transabdominal 756 $159.60Anesthesia,majorabdominalBLOODVESSELREPAIR 770 $159.60Anesthesia,intraperitonealsurgupperabdomen,NOS 790 $159.60Anesthesia,intraperitonealsurgupperabdomen,partialhepatectomyformgmtliverhemorrhage 792 $159.60Anesthesia,intraperitonealsurgupperabdomen,partial/totalpancreatectomy 794 $159.60Anesthesia,intraperitonealsurgupperabdomen,livertransplant 796 $159.60Anesthesia,intraperitonealsurgupperabdomen,gastricrestrictiveprocedureformorbidobesity 797 $159.60Anesthesia,loweranteriorabdominalwall;NOS 800 $159.60Anesthesia,loweranteriorabdominalwall;panniculectomy 802 $159.60Anesthesia,lowerintestinalendoscopicprocedures,endoscopeintroduceddistaltoduodenum 810 $159.60Anesthesiaforlowergastrointestinalendoscopicproceduredistaltoduodenum,NOS 811 $159.60Anesthesiaforscreeningcolonoscopy 812 $159.60Anesthesiaforcombinedupperandlowergastrointestinalendoscopicprocedures 813 $159.60Anesthesia,proceduresonlowerposteriorabdominalwall 820 $159.60
Anesthesia,herniarepairsinlowerabdomen,NOS 830 $159.60Anesthesia,herniarepairsinlowerabdomen,ventralandincisionalhernias 832 $159.60Anesthesia,herniarepairsinthelowerabdomenNOS,youngerthan1yrofage 834 $159.60Anesthesia,herniarepairslowerabdomenNOS,infantsyoungerthan37wksgest.Ageatbirthand 836 $159.60Anesthesia,intraperitonealproceduresinlowerabdomenincludinglaparoscopy;NOS 840 $159.60Anesthesia,intraperitonealproceduresinlowerabdomenincludinglaparoscopy;amniocentesis 842 $159.60Anesthesia,intraperitonealproc.inlowerabdomenincludinglaparoscopy;abdominoperinealresection 844 $159.60Anesthesia,intraperitonealproc.inlowerabdomenincludinglaparoscopy;radicalhysterectomy 846 $159.60Anesthesia,intraperitonealproc.inlowerabdomenincludinglaparoscopy;pelvicexenteration 848 $159.60Anesthesia,intraperitonealproc.inlowerabdomenincludinglaparoscopy;tuballigation/transection 851 $159.60Anesthesia,extraperitonealproc.inlowerabdomenincludingurinarytract;NOS 860 $159.60Anesthesia,extraperitoneallowerabdomenincludurinarytract;renalprocincludingupper1/3 862 $159.60Anesthesia,extraperitonealproc.inlowerabdomenincludingurinarytract;totalcystectomy 864 $159.60Anesthesia,extraperitonealproc.inlowerabdomenincludingurinarytract;radicalprostatectomy 865 $159.60Anesthesia,extraperitonealproc.inlowerabdomenincludingurinarytract;adrenalectomy 866 $159.60Anesthesia,extraperitoneallowerabdomenincludingurinarytract;renaltransplant(recipient) 868 $159.60Anesthesia,extraperitonealproc.inlowerabdomenincludingurinarytract;cystolithotomy 870 $159.60Anesthesia,lithotripsy,exracorporealshockwave;withoutwaterbath 873 $159.60Anesthesia,proceduresonmajorlowerabdominalvessels;NOS 880 $159.60Anesthesia,proceduresonmajorlowerabdominalvessels;inferiorvenacavaligation 882 $159.60Anesthesia,anorectalprocedure 902 $159.60Anesthesia,radicalperinealprocedure 904 $159.60Anesthesia,vulvectomy 906 $159.60Anesthesia,perinealprostatectomy 908 $159.60Anesthesia,transurethralprocedures(includingurethrocystoscopy);NOS 910 $81.93Anesthesia,transurethralprocedures;transurethralresectionofbladdertumor(s) 912 $159.60Anesthesia,transurethralprocedures;transurethralresectionofprostate 914 $159.60Anesthesia,transurethralprocedures;post-transurethralresectionbleeding 916 $159.60Anesthesia,transurethralprocedures;w/fragmentation,manipulation+/orremovalofureteralcalculus 918 $159.60Anesthesia,proceduresonmalegenitalia,NOS 920 $159.60Anesthesia,proceduresonmalegenitalia,vasectomy,unilateralorbilateral 921 $159.60Anesthesia,proceduresonmalegenitalia,seminalvesicles 922 $159.60Anesthesia,proceduresonmalegenitalia,undescendedtestis,unilateralorbilateral 924 $159.60Anesthesia,proceduresonmalegenitalia,radicalorchiectomy,inguinal 926 $159.60Anesthesia,proceduresonmalegenitalia,radicalorchiectomy,abdominal 928 $159.60Anesthesia,proceduresonmalegenitalia,orchiopexy,unilateralorbilateral 930 $159.60Anesthesia,proceduresonmalegenitalia,completeamputationofpenis 932 $159.60Anesthesia,proc.onmalegenitalia,radicalamputationofpenisw/bilatinguinallymphadenctomy 934 $159.60Anesthesia,malegenitalia,radicalamputationofpenisw/bilatinguinalandiliaclymphadenctmy 936 $159.60Anesthesia,proc.onmalegenitalia,insertionofpenileprosthesis(perinealapproach) 938 $159.60Anesthesia,vaginalprocedures(includingbiopsyoflabia,vagina,cervixorendometrium);NOS 940 $159.60Anesthesia,vaginalprocedures,colpotomy,vaginectomy,colporrhaphyandopenurethralprocedures 942 $159.60Anesthesia,vaginalprocedures,vaginalhysterectomy 944 $159.60Anesthesia,vaginalprocedures,cervicalcerciage 948 $159.60Anesthesia,vaginalprocedures,culdoscopy 950 $159.60Anesthesia,vaginalprocedures,hysteroscopyand/orhysterosalpingography 952 $159.60Anesthesia,bonemarrowaspirationand/orbiopsy,anteriororposterioriliaccrest 1112 $159.60Anesthesia,proceduresonbonypelvis 1120 $159.60Anesthesia,bodycastapplicationorrevision 1130 $159.60Anesthesia,interpelviabdominal(hindquarter)amputation 1140 $159.60Anesthesia,radicalproceduresfortumorofpelvis,excepthindquarteramputation 1150 $159.60Anesthesia,closedproceduresinvolvingsymphysispubisorsacroiliacjoint 1160 $159.60
Anesthesia,openproceduresinvolvingsymphysispubisorsacroiliacjoint 1170 $159.60Anesthesia,openrepairoffracturedisruptionofpelvisorcolumnfractureinvolvingacetabulum 1173 $159.60Anesthesia,closedproceduresinvolvinghipjoint 1200 $159.60Anesthesia,arthroscopicproceduresofhipjoint 1202 $159.60Anesthesia,openproceduresinvolvinghipjoint;NOS 1210 $159.60Anesthesia,openproceduresinvolvinghipjoint;hipdisarticulation 1212 $159.60Anesthesia,openproceduresinvolvinghipjoint;totalhiparthroplasty 1214 $159.60Anesthesia,openproceduresinvolvinghipjoint;revisionoftotalhiparthroplasty 1215 $159.60Anesthesia,allcloedproceduresinvolvingupper2/3offemur 1220 $159.60Anesthesia,openproceduresinvolvingupper2/3offemur;NOS 1230 $159.60Anesthesia,openproceduresinvolvingupper2/3offemur;amputation 1232 $159.60Anesthesia,openproceduresinvolvingupper2/3offemur;radicalresection 1234 $159.60Anesthesia,allproceduresonnerves,muscles,tendons,fascia,andbursacofupperleg 1250 $159.60Anesthesia,allproceduresinvolvingveinsofupperleg,includingexploration 1260 $159.60Anesthesia,proceduresinvolvingarteriesofupperleg,includingbypassgraft;NOS 1270 $159.60Anesthesia,proceduresinvolvingarteriesofupperleg,femoralarteryligation 1272 $159.60Anesthesia,proceduresinvolvingarteriesofupperleg,femoralarteryembolectomy 1274 $159.60Anesthesia,allproceduresonnerves,muscles,tendons,fascia,bursaeofknee+/orpoplitealarea 1320 $159.60Anesthesia,allclosedproceduresonlower1/3offemur 1340 $159.60Anesthesia,allopenproceduresonlower1/3offemur 1360 $159.60Anesthesia,allclosedproceduresonkneejoint 1380 $159.60Anesthesia,diagnosticarthroscopicproceduresofkneejoint 1382 $159.60Anesthesia,allclosedproceduresonupperendsoftibia,fibula,and/orpatella 1390 $159.60Anesthesia,allopenproceduresonupperendsoftibia,fibula,and/orpatella 1392 $159.60Anesthesia,openorsurgicalarthroscopicproceduresonkneejoint;NOS 1400 $159.60Anesthesia,openorsurgicalarthroscopicproceduresonkneejoint;totalkneearthroplasty 1402 $159.60Anesthesia,openorsurgicalarthroscopicproceduresonkneejoint;disarticulationatknee 1404 $159.60Anesthesia,allcastapplications,removal,orrepairinvolvingkneejoint 1420 $159.60Anesthesia,proceduresonveinsofkneeandpoplitealarea;NOS 1430 $159.60Anesthesia,proceduresonveinsofkneeandpoplitealarea;arteriovenousfistula 1432 $159.60Anesthesia,proceduresonarteriesofkneeandpoplitealarea;NOS 1440 $159.60Anesthesia,arteriesofknee&poplitealarea;poplitealthromboendartrctmy,w/orw/optchgrft 1442 $159.60Anesthesia,arteriesofknee&poplitealarea;poplitealexcision&grftorrprforocclusion 1444 $159.60Anesthesia,allclosedproceduresonlowerleg,ankle,andfoot 1462 $159.60Anesthesia,arthroscopicproceduresofankleand/orfoot 1464 $159.60Anesthesia,proceduresonnerves,muscles,tendons,andfasciaoflowerleg,ankleandfoot;NOS 1470 $159.60Anesthesia,nerves,muscles,tendons,&fasciaoflwrleg,ankle&ft;rprofrupturedAchilles 1472 $159.60Anesthesia,nerves,muscles,tendons,&fasciaoflwrleg,ankle&ft;gastrocnemiusrecession 1474 $159.60Anesthesia,openproceduresonbonesoflowerleg,ankleandfoot;NOS 1480 $159.60Anesthesia,openproc,bonesoflowerleg,ankleandfoot;radicalresection(includbelowkneeamputa 1482 $159.60Anesthesia,openproc,bonesoflwrleg,ankle&ft;osteotomyorosteoplastyoftibiaand/orfibula 1484 $159.60Anesthesia,openproceduresonbonesoflowerleg,ankle&foot;totalanklereplacement 1486 $159.60Anesthesia,lowerlegcastapplication,removal,orrepair 1490 $159.60Anesthesia,proceduresonarteriesoflowerleg,includingbypassgraft;NOS 1500 $159.60Anesthesia,proceduresonarteriesoflowerleg,embolectomy,directorwithcatheter 1502 $159.60Anesthesia,proceduresonveinsoflowerleg;NOS 1520 $159.60Anesthesia,proceduresonveinsoflowerleg;venousthrombectomy,directorwithcatheter 1522 $159.60Anesthesia,allproceduresonnerves,muscles,tendons,fascia,andbursaeofshoulderandaxilla 1610 $159.60Anesthesiaallclosedproconhumeralheadandnecksternoclavicularjntacromioclavicularjnt, 1620 $159.60Anesthesia,diagnosticarthroscopicproceduresofshoulderjoint 1622 $159.60Anesthesia,open/surgarthroscopicproconhumeralhead&neck,sternoclavicularjnt,acromioclav 1630 $159.60Anesthesia,openorsurgicalarthroscopicproc.onhumeralhead&neck,shoulderdisarticulation 1634 $159.60
Anesthesia,openorsurgarthroscopicproc.onhumeralhead&neck,interthoracoscapular(forequarter 1636 $159.60Anesthesia,openorsurgicalarthroscopicproc.onhumeralhead&neck,totalshoulderreplacement 1638 $159.60Anesthesia,proceduresonarteriesofshoulderandaxilla;NOS 1650 $159.60Anesthesia,proceduresonarteriesofshoulderandaxilla;axillary-brachialaneurysm 1652 $159.60Anesthesia,proceduresonarteriesofshoulderandaxilla;bypassgraft 1654 $159.60Anesthesia,proceduresonarteriesofshoulderandaxilla;axillary-femoralbypassgraft 1656 $159.60Anesthesia,allproceduresonveinsofshoulderandaxilla 1670 $159.60Anesthesia,shouldercastapplication,removalorrepair;NOS 1680 $86.03Anesthesia,proceduresonnerves,muscles,tendons,fascia,andbursaeofupperarm&elbow;NOS 1710 $159.60Anesthesia,proceduresonnerves,muscles,tendons,fascia,+bursaeofupperarm&elbow;tenotomy 1712 $159.60Anesthesia,proceduresonnerves,muscles,tendons,fascia,bursaeofupperarm&elbow;tenoplasty 1714 $159.60Anesthesia,proceduresonnerves,muscles,tendons,fascia,bursaeofupperarm&elbow;tenodesis 1716 $159.60Anesthesia,allclosedproceduresonhumerusandelbow 1730 $159.60Anesthesia,diagnosticarthroscopicproceduresofelbowjoint 1732 $159.60Anesthesia,openorsurgicalarthroscopicproceduresofelbow;NOS 1740 $159.60Anesthesia,openorsurgicalarthroscopicproceduresofelbow;osteotomyofhumerus 1742 $159.60Anesthesia,openorsurgicalarthroscopicprocofelbow;repairofnonunionormalunionofhumerus 1744 $159.60Anesthesia,openorsurgicalarthroscopicproceduresofelbow;radicalprocedures 1756 $159.60Anesthesia,openorsurgicalarthroscopicproceduresofelbow;excisionofcystortumorofhumerus 1758 $159.60Anesthesia,openorsurgicalarthroscopicproceduresofelbow;totalelbowreplacement 1760 $159.60Anesthesia,proceduresonarteriesofupperarmandelbow;NOS 1770 $159.60Anesthesia,proceduresonarteriesofupperarmandelbow;embolectomy 1772 $159.60Anesthesia,proceduresonveinsofupperarmandelbow;NOS 1780 $159.60Anesthesia,proceduresonveinsofupperarmandelbow;phleborrhaphy 1782 $159.60Anesthesia,allproceduresonnerves,muscles,tendons,fascia,andbursaeofforearm/wrist/hand 1810 $159.60Anesthesia,allclosedprocedfuresonradius,ulna,wrist,orhandbones 1820 $159.60Anesthesia,diagnosticarthroscopicproceduresonthewrist 1829 $159.60Anesthesia,opnorsurgiclarthroscopic/endoscopicondistalradius,distalulna,wrst,orhndjnts 1830 $159.60Anesthesia,opnorsurgiclarthroscopic/endoscopicproc.ondistalradius,totalwristreplacement 1832 $159.60Anesthesia,proceduresonarteriesofforearm,wrist,andhand;NOS 1840 $159.60Anesthesia,proceduresonarteriesofforearm,wrist,andhand;embolectomy 1842 $159.60Anesthesia,vascularshunt,orshuntrevision,anytype(eg,dialysis) 1844 $159.60Anesthesia,proceduresonveinsofforearm,wrist,andhand;NOS 1850 $159.60Anesthesia,proceduresonveinsofforearm,wrist,andhand;phleborrhaphy 1852 $159.60Anesthesia,forearm,wrist,orhandcastapplication,removal,orrepair 1860 $159.60Anesthesia,diagnosticarteriography/venography 1916 $159.60Anesthesia,cardiaccatheterizationincludingcoronaryangiographyandventriculography 1920 $159.60Anesthesia,non-invasiveimagingorradiationtherapy 1922 $159.60Anesthesia,therapeuticinterventionalradiologicalproceduresinvolvingthearterialsystem;NOS 1924 $159.60Anesthesia,therapeuticinterventionalradiologicalproc.involvngarterialsystem;carotidorcoron 1925 $159.60Anesthesiatherapeuticinterventionalradiologicalprocinvolvngarterialsystemintracranial 1926 $159.60Anesthesia,therapeuticinterventionalradiologicalproc.involvngvenous/lymphaticsystem;NOS 1930 $159.60Anesthesia,therapeuticinterventionalradiologicalproc.involvvenous/lymphaticsyst;intrahepatic 1931 $159.60Anesthesia,therapeuticinterventionalradiologicalproc.involvvenous/lymphaticsyst;intrathoracic 1932 $159.60Anesthesia,therapeuticinterventionalradiologicalproc.involvvenous/lymphaticsyst;intracranial 1933 $159.60Anesthesia,percutaneousimageguidedproceduresonthespineandspinalcord;diagnostic 1935 $159.60Anesthesia,percutaneousimageguidedproceduresonthespineandspinalcord;therapeutic 1936 $159.60Anesthesia,2ndand3rddegburnexcision/debridemntworw/oskingrftng,TBSA;<4%totlbdysurfce 1951 $159.60Anesthesia,2ndand3rddegburnexcision/debridemntworw/oskingrftng,TBSA;betw4%&9%totl 1952 $159.60Anesthesia,2ndand3rddegburnexcision/debridemntworw/oskingrftng,TBSA;eaadd9%totl 1953 $159.60Anesthesia,externalcephalicversionprocedure 1958 $159.60Anesthesia,vaginaldeliveryonly 1960 $159.60
Anesthesia,cesareandeliveryonly 1961 $159.60Anesthesia,urgenthysterectomyfollowingdelivery 1962 $159.60Anesthesia,cesareanhysterectomywithoutanylaboranalgesia/Anesthesiaesiacare 1963 $159.60Anesthesia,incompleteormissedabortionprocedures 1965 $159.60Anesthesia,inducedabortionprocedures 1966 $159.60Anesthesia/ANALG,neuraxiallaboranalgesia/Anesthesiaesiaforplannedvaginaldelivery 1967 $159.60Anesthesia/ANALG,cesareandeliveryfollowingneuraxiallaboranalgesia/Anesthesiaesia 1968 $159.60Anesthesia/ANALG,cesareanhysterectomyfollowingneuraxiallaboranalgesia/Anesthesiaesia 1969 $159.60Anesthesia,physiologicalsupportforharvestingoforgan(s)frombrain-deadpatient 1990 $159.60Anesthesia,diagnosticortherapeuticnerveblocksandinjections 1991 $159.60Anesthesia,diagnosticortherapeuticnerveblocksandinjections;proneposition 1992 $159.60Anesthesia,dailyhospitalmanagementofepiduralorsubarachnoidcontinuousdrugadministration 1996 $159.60Anesthesia,unlistedanesthesiaprocedure(s) 1999 $159.60FineneedleaspirationBX,includingUSguidance;firstlesion 10005 $869.01 $256.20USFNA;1stLesion 10005 $869.01 $256.20Fineneedleaspirationoforbitalcontents 10021 $1,055.08 $265.48Fineneedleaspiration;withimagingguidance 10022 $590.30 $253.71FNAwithImagingGuidance 10022 $590.30 $253.71CTGuide-PercDrainSoftTissuewCath 10030 $2,670.66CTGuide-PercDrainSoftTissuewCath-Report 10030 $579.41USGuide-PercDrainSoftTissuewCath 10030 $2,670.66USGuide-PercDrainSoftTissuewCath-Report 10030 $579.41Acnesurgery(eg,marsupialization,openingorremovalofmultiplemilia,comedones,cysts,pustules 10040 $230.14 $322.20Incisionanddrainageofabscess;simpleorsingle 10060 $234.61 $352.09Incisionanddrainageofabscess;complicatedormultiple 10061 $519.81 $655.01Incisionanddrainageofpilonidalcyst;simple. 10080 $792.75 $367.90Incisionandremovalofforeignbody,subcutaneous;simple 10120 $341.60 $370.63Incisionandremovalofforeignbody,subcutaneous;complicated 10121 $5,453.66 $682.33Incisionanddrainageofhematoma,seromaorfluidcollection 10140 $3,208.60 $430.15Punctureaspirationofabscess,hematoma,bullaorcyst 10160 $888.42 $347.59Incisionanddrainage,complex,postoperativewoundinfection 10180 $879.80 $639.99Debridementofextensiveeczematousorinfectedskin;upto10%ofbodysurface. 11000 $3,892.20 $112.73Debridementofskin,sqtissue,muscleandfasciafornecrotizingsofttissueinfection;abdwall,w 11005 $5,942.83 $2,951.75Removeprostheticmaterial/mesh,abdominalwallforinfection 11008 $1,036.91Debride(incrmvlofforeignmaterialassociatedw/openfracture(s)and/ordislocation(s);skinand 11010 $3,406.35 $1,043.11Debride(incrmvlofforeignmaterialassociatedw/openfracture(s)and/ordislocation(s);skin,su 11011 $2,401.24 $1,057.91Debride(incrmvlofforeignmaterialassociatedwithopenfracture(s)and/ordislocation(s);skin, 11012 $3,578.60 $1,582.60Debridement;skin,andsubcutaneoustissue 11042 $1,506.87 $231.75Debridement;skin,subcutaneoustissue,andmuscle 11043 $1,124.47 $588.65Debridement;skin,subcutaneoustissue,muscle,andbone 11044 $1,922.64 $874.09Debridement,subcutaneoustissue;eaaddl20sqcmorpartthereof 11045 $948.51 $101.32Paringorcuttingofbenignhyperkeratoticlesion(eg,cornorcallus);singlelesion 11055 $223.51 $64.07Yes-RemovalCorn/callus;SGLLesions 11055 $223.51Paringorcuttingofbenignhyperkeratoticlesion(eg,cornorcallus);2to4lesions. 11056 $255.31 $90.70Yes-RemovalCorn/callus;2-4Lesions 11056 $255.31Paringorcuttingofbenignhyperkeratoticlesion;morethan4lesions. 11057 $348.30 $118.42Yes-RemovalCorn/callus;4+Lesions 11057 $348.30Biopsyofskin,subcutaneoustissueand/ormucousmembrane;eachaddllesion 11101 $164.88 $93.79Tangentialbiopsyofskin;singlelesion 11102 $203.71 $140.89Tangentialbiopsyofskin;eachseparate/additionallesion 11103 $134.50 $81.59Punchbiopsyofskin;1stlesion 11104 $203.71 $176.92Punchbiopsyofskin;eachadditionallesion 11105 $134.50 $96.42
Incisionalbiopsyofskin;singlelesion 11106 $203.71 $215.04Incisionalbiopsyofskin;eachadditionallesion 11107 $134.50 $115.13Removalofskintags,multiplefibrocutaneoustags,anyareauptoandincluding15lesions 11200 $526.89 $262.66Removalofskintags,multiplefibrocutaneoustags,anyarea;eachadd10lesions 11201 $364.20 $63.18Shavingofsinglelesion,trunk,armsorlegs;lesiondiameter0.5cmorless. 11300 $301.64 $133.82Shavingofsinglelesion,trunk,armsorlegs;lesiondiameter0.6to1.0cm. 11301 $319.97 $202.94Shavingofsinglelesion,trunk,armsorlegs;lesiondiameter1.1to2.0cm. 11302 $359.18 $237.66Shavingofsinglelesion,trunk,arms,legs;lesiondiameterover2.0cm 11303 $489.15 $281.01Shavingofsinglelesion,scalp,neck,hands,feet,genitalia;(0.5cmorless) 11305 $322.88 $154.27Shavingofsinglelesion,scalp,neck,hands,feet,genitalia;(0.6to1.0cm) 11306 $303.88 $200.09Shavingofsinglelesion,scalp,neck,hands,feet,genitalia;(1.1to2.0cm) 11307 $455.55 $255.76Shavingofsinglelesion,face,ears,eyelids,nose,lips,mucousmembrane;(0.5cmorless) 11310 $615.23 $179.40Shavingofsinglelesion,face,ears,eyelids,nose,lips,mucousmembrane;(0.6to1.0cm) 11311 $216.05 $247.40Excisebenignlesion,trunk,arm,leg;0.5cmorless 11400 $1,082.99 $287.23Excision,benignlesioninclmargins,exceptskintag,trunk,armsorlegs;excised.5cmorless 11400 $1,082.99 $287.23Excisebenignlesion,trunk,arm,leg;0.6to1.0cm 11401 $1,082.99 $374.29Excision,benignlesioninclmargins,exceptskintag,trunk,armsorlegs;excised.6to1.0cm 11401 $1,082.99 $374.29Excisionbenignlesion,trunk,arm,leg;1.1to2.0cm 11402 $1,010.86 $411.61Excisebenignlesion,trunk,arm,leg;2.1to3.0cm 11403 $3,742.62 $530.17Excisebenignlesion,trunk,arm,leg;3.1to4.0cm 11404 $4,634.14 $585.78Excisebenignlesion,trunk,arm,leg;over4.0cm 11406 $3,697.25 $898.99Excisebenignlesion,scalp,neck,hand,feet,genitalia;0.5cmorless 11420 $2,043.09 $296.06Excise,b9lesion+margins,exceptskintag,scalp,neck,hands,feet,genitalia;0.5cmor 11420 $2,043.09 $296.06Excisebenignlesion,scalp,neck,hand,feet,genitalia;0.6to1.0cm 11421 $2,043.09 $401.33Excisebenignlesion,scalp,neck,hand,feet,genitalia;1.1to2.0cm 11422 $3,960.47 $488.87Excisebenignlesion,scalp,neck,hand,feet,genitalia;2.1to3.0cm 11423 $4,187.73 $568.41Excisebenignlesion,scalp,neck,hand,feet,genitalia;3.1to4.0cm 11424 $4,187.73 $655.80Excisebenignlesion,scalp,neck,hand,feet,genitalia;over4.0cm 11426 $6,165.94 $1,009.82Excisebenignlesion,face,ear,eyelid,nose,lip,mucousmembrane;0.5cmorless 11440 $2,843.77 $363.31Excise,otherb9lesion+margins,exceptskintag,face,ears,eyelids,nose,lips,mucous 11440 $2,843.77 $363.31Excisebenignlesion,face,ear,eyelid,nose,lip,mucousmembrane;0.6to1.0cm 11441 $2,817.58 $468.65Excise,otherb9lesion+margins,exceptskintag,face,ears,eyelids,nose,lips,mucous 11441 $2,817.58 $468.65Excisebenignlesion,face,ear,eyelid,nose,lip,mucousmembrane;1.1to2.0cm 11442 $3,763.01 $521.65Excise,otherb9lesion+margins,exceptskintag,face,ears,eyelids,nose,lips,mucous 11442 $3,763.01 $521.65Excisebenignlesion,face,ear,eyelid,nose,lip,mucousmembrane;2.1to3.0cm 11443 $4,178.04 $645.69Excise,otherb9lesion+margins,exceptskintag,face,ears,eyelids,nose,lips,mucous 11443 $4,178.04 $645.69Excisebenignlesion,face,ear,eyelid,nose,lip,mucousmembrane;over4.0cm 11446 $5,770.40 $1,198.95Excise,otherb9lesion+margins,exceptskintag,face,ears,eyelids,nose,lips,mucous 11446 $5,770.40 $1,198.95Exciseskin+subcutaneoustissueforhidradenitis,axillary;w/simple/intmdrepair 11450 $822.63Excisemalignantlesion,trunk,arm,leg;0.5cmorless 11600 $4,179.56 $436.43Excisemalignantlesion,trunk,arm,leg;0.6to1.0cm 11601 $2,905.83 $546.20Excisemalignantlesion,trunk,arm,leg;1.1to2.0cm 11602 $2,846.08 $599.58Excisemalignantlesion,trunk,arm,leg;2.1to3.0cm 11603 $3,645.63 $721.71Destructmalignantlesion,trunk,arm,leg;3.1to4.0cm 11604 $2,534.41 $795.65Excisemalignantlesion,trunk,arm,leg;3.1to4.0cm 11604 $2,534.41 $795.65Excision,malignantlesionincludingmargins,trunk,arms,orlegs;exciseddiameterover4.0cm 11606 $5,302.23 $1,188.90Excisemalignantlesion,scalp,neck,hand,feet,genitalia;0.5orless 11620 $2,590.79 $440.49Excise,mlglesion+margins,scalp,neck,hands,feet,genitalia;0.5cm/< 11620 $2,590.79 $440.49Excisemalignantlesion,scalp,neck,hand,feet,genitalia;0.6to1.0cm 11621 $3,362.99 $549.53Excisemalignantlesion,scalp,neck,hand,feet,genitalia;1.1to2.0cm 11622 $3,772.23 $630.58Excisemalignantlesion,scalp,neck,hand,feet,genitalia;2.1to3.0cm 11623 $4,165.61 $783.38Excisemalignantlesion,scalp,neck,hand,feet,genitalia;over4.0cm 11626 $5,724.54 $1,094.11
Excisemalignantlesion,face,ear,eyelid,nose,lip;0.5cmorless 11640 $4,010.75 $455.04Excisemalignantlesion,face,ear,eyelid,nose,lip;0.6to1.0cm 11641 $3,513.88 $572.68Excisemalignantlesion,face,ear,eyelid,nose,lip;1.1to2.0cm 11642 $3,878.58 $677.25Excisemalignantlesion,face,ear,eyelid,nose,lip;2.1to3.0cm 11643 $4,020.43 $852.48Excisemalignantlesion,face,ear,eyelid,nose,lip;3.1to4.0 11644 $4,808.43 $1,057.20Excise,mlglesion+margins,face,ears,eyelids,nose,lips;over4.0cm 11646 $1,474.48Trimmingofnondystrophicnails,anynumber. 11719 $93.03 $30.72Debridementofnail(s)byanymethod(s)1to5 11720 $190.28 $58.46Debridementofnail(s)byanymethod(s);6ormore 11721 $199.28 $98.53Avulsionofnailplate,partialorcomplete,simple;single 11730 $283.72 $214.84Avulsionofnailplate,partialorcomplete,simple;eachadditionalnailplate. 11732 $954.37 $70.41Evacuationofsubungualhematoma. 11740 $369.79 $116.83Excisionofnailandnailmatrix,partialorcomplete,forpermanentremoval 11750 $914.47 $417.75Biopsyofnailunit(separateprocedure) 11755 $2,793.00 $294.38Repairofnailbed. 11760 $293.75 $421.35Wedgeexcisionofskinofnailfold(eg,foringrowntoenail) 11765 $656.91 $343.65Excisionofpilonidalcystorsinus;simple 11770 $675.77Excisionofpilonidalcystorsinus;extensive 11771 $1,586.14Excisionofpilonidalcystorsinus;complicated 11772 $2,075.18Injection,intralesional;uptoandincluding7lesions 11900 $336.20 $117.73Injection,intralesional;morethan7lesions 11901 $274.83 $182.72Removal,implantablecontraceptivecapsules. 11976 $1,114.96 $361.72Removal,implantablecontraceptivecapsules 11976 $1,114.96 $361.72Subcutaneoushormonepelletimplantation(implantestradiol+/ortestosteronepelletsbeneathskin) 11980 $176.00 $195.5811981TCinsetion,non-biodegradabledrugdeliveryimplant 11981 $524.36 $313.49Insertion,implantablecontraceptivecapsules 11981 $524.36 $313.49Insertion,non-biodegradabledrugdeliveryimplant 11981 $524.36 $313.49Insertion,non-biodegradabledrugdeliveryimplant 11981 $524.36 $313.49Removal,non-biodegradabledrugdeliveryimplant 11982 $593.06 $380.00Removalw/reinsertion,implantablecontraceptivecapsule 11983 $314.50 $674.23Removalwithreinsertion,non-biodegradabledrugdeliveryimplant. 11983 $314.50 $674.23Simplerepairofsuperficialwoundsofscalp,neck,axillae,externalgenitalia,trunk/extremities; 12001 $410.69 $169.80Simplerepairofsuperficialwoundsscalp,neck,axillae,externalgenitalia,trunk/extremities;2.6 12002 $455.26 $225.56Simplerepairofsuperficialwoundsscalp,neck,axillae,external 12002 $455.26 $225.56Simplerepairwndsscalp/neck/axillae/extgenitalia/trunk/extremity/hand/ft);2.6cmto7.5cm 12002 $455.26 $225.56Simplerepairsuperficialwoundsscalp/neck/axillae/externalgenitalia/trunk/extremities;7.6-12.5 12004 $417.21 $282.02Simplerepairwndsscalp/neck/axillae/extgenitalia/trunk/extremity/hand/ft;7.6cm-12.5cm 12004 $417.21 $282.02Simplerepairofsuperficialwoundsofscalp,neck,axillae,externalgenitalia,trunkand/orextrem 12005 $783.15 $369.62Simplerepairofsuperficialwoundsofface,ears,eyelids,nose,lipsand/ormucousmembranes;2.5 12011 $378.80 $211.69Simplerepairofsuperficialwoundsofface,ears,eyelids,nose,lipsand/ormucousmembranes;2.6 12013 $351.11 $225.6112014-SimpleWoundRepairf/e/n/l/mm;5.1-7.5cm 12014 $710.31 $290.72Woundrepair,superficial,face,ears,eyelids,nose,lipsandmucousmem(5.1-7.5c) 12014 $710.31 $290.72Simplerepairofsuperficialwoundsofface,ears,eyelids,nose,lipsand/ormucousmembranes7.6cm 12015 $742.72 $366.66Simplerepairwndsface,ears,eyelids,nose,lips+/ormucousmembranes;12.6cmto20.0cm 12016 $470.22Simplerepairofsuperficialwoundsofface,ears,eyelids,nose,lipsand/ormucousmembranes;20.1 12017 $567.15 $594.94Treatmentofsuperficialwounddehiscencesimpleclosure 12020 $4,004.05 $690.35Repair,intmd,wndsscalp,axillae,trunk+/orextremities(exclhands+feet);2.5cm/< 12031 $877.00 $556.85Repairintermedwoundscalp/axillae/trunkand/orextremitiesexcludehands/feet2.6cmto7.5cm 12032 $2,329.07 $709.12Repair,intmd,wndsscalp,axillae,trunk+/orextremities(exclhands+feet);7.6cmto12.5cm 12034 $1,696.46 $762.71Repair,intmd,wndsscalp,axillae,trunk+/orextremities(exclhands+feet);12.6cmto20.0cm 12035 $1,117.70 $887.70Repair,intermediate,woundsofneck,hands,feetand/orexternalgenitalia;2.5cmorless 12041 $1,439.27 $552.94Repair,intermediate,woundsofneck,hands,feetand/orexternalgenitalia;2.5cmorless 12041 $1,439.27 $552.94
Repair,intermediate,woundsofneck,hands,feetand/orexternalgenitalia;2.6cmto7.5cm 12042 $1,428.39 $736.96Repair,intermediate,woundsofface,ears,eyelids,nose,lipsand/ormucousmembranes;2.5cmorl 12051 $1,253.50 $627.14
12052 12052 $760.17 $750.81Repair,intmd,wndsface,ears,eyelids,nose,lips+/ormucousmembranes;2.6cmto5.0cm 12052 $760.17 $750.81Repair,intmd,wndsface,ears,eyelids,nose,lips+/ormucousmembranes;5.1cmto7.5cm 12053 $822.62 $803.93Repair,complex,scalp,arms,and/orlegs;2.6cmto7.5cm 13121 $2,234.40 $993.01Repair,complex,scalp,arms,+/orlegs;eachadd5cm/< 13122 $324.27Repair,complex,forehead,cheeks,chin,mouth,neck,axillae,genitalia,hands,feet;1.1to2.5cm 13131 $1,939.66 $928.39Repair,complex,forehead,cheeks,chin,mouth,neck,axillae,genitalia,hands,feet;2.6to7.5cm 13132 $1,174.66Repair,complex,forehead,cheek,chin,mouth,neck,axillae,genitalia,hand,orfeet;eachadd5cmor< 13133 $1,067.76 $496.43Repair,complex,eyelids,nose,ears&orlips;1.1cmto2.5cm 13151 $2,389.70 $1,068.47Repair,complex,eyelids,nose,earsand/orlips;1.1cmto2.5cm 13151 $2,389.70 $1,068.47Repair,complex,eyelids,nose,earsand/orlips;2.6cmto7.5cm 13152 $1,300.34Secondaryclosureofsurgicalwoundordehiscence,extensiveorcomplicated 13160 $2,953.80Adjacenttissuetransferorrearrangement,scalp,armsand/orlegs;defect10sqcmorless 14020 $1,843.15Adjacenttissuetransferorrearrangement,fh/chk/chn/m/nk/ax/gen/h/ft;defect10sqcmorless 14040 $2,288.32Surgprep/createrecipsitetrunk,arms,legs;1st100sqcmor1%bodyareainf/child 15002 $796.64Split-thickautograft,trunk,arms,legs;first100sqcmor<,or1%bodyareainfants+children 15100 $2,610.51Fullthickgraft,free,incldirectclosuredonorsite,nose,ears,eyelids,+/orlips;20sqcm/< 15260 $2,961.16Dressingchange(forotherthanburns)underanesthesia(otherthanlocal)) 15852 $4,393.39 $178.28Initialtreatment,firstdegreeburn,whennomorethanlocaltreatmentisrequired. 16000 $216.05 $177.30Dressingsand/ordebridementofpartial-thicknessburns,initialorsubsequent;small(lessthan5% 16020 $368.78 $196.77Dressingsand/ordebridementofpartial-thicknessburns,initialorsubsequent;medium(eg,wholefa 16025 $368.78 $414.29Dressingsand/ordebridementofpartial-thicknessburns,initialorsubsequent;large(eg,morethan 16030 $1,094.00 $621.18Destructofpre-malig.lesion,first 17000 $147.30 $189.92Destructofpre-malig.lesion,2-14 17003 $51.69 $8.97Destruction,premalignantlesions(eg,acitinickeratoses);15ormorelesions 17004 $616.98 $364.41Destructionofcutaneousvascularproliferativelesions;10.0to50.0sqcm 17107 $1,929.41 $1,266.85Destructionofbenignlesionsotherthanskintagsorcutaneousvascularproliflesions;upto14 17110 $223.67 $447.82Destruction,ofbenignlesionsotherthanskintagsorcutaneousvascularproliferativelesions;15 17111 $306.00 $306.71Chemicalcauterizationofgranulationtissue(proudflesh,sinusorfistula) 17250 $228.78 $134.79Destructmalignantlesion,trunk,arm,leg;0.5cmorless 17260 $381.03 $256.84Destructmalignantlesion,trunk,arm,leg;1.1to2.0cm 17262 $585.83 $531.82Destructmalignantlesion,face,ear,eyelid,nose,lip;0.6to1.0cm 17281 $719.99 $570.85Cryotherapy(CO2slush,liquidN2)foracne. 17340 $223.67 $182.38Punctureaspirationofcystofbreast 19000 $1,113.85 $168.67BreastCystAspiration 19000 $1,113.85 $168.67Mastotomywithexplorationordrainageofabscess,deep 19020 $4,448.63 $1,041.18USBiopsyBreastworwoSpecimenLeft 19083 $2,761.16USBiopsyBreastworwoSpecimenLeft-Report 19083 $619.59USBiopsyBreastworwoSpecimenRight 19083 $2,761.16USBiopsyBreastworwoSpecimenRight-Report 19083 $619.59USBiopsyBreastwwoSpecEaAddLeft 19084 $2,111.51USBiopsyBreastwwoSpecEaAddLeft-Report 19084 $309.08USBiopsyBreastwwoSpecEaAddRight 19084 $2,111.51USBiopsyBreastwwoSpecEaAddRight-Report 19084 $309.08Biopsyofbreast;percutaneous,needlecore,notusingimagingguidance 19100 $3,773.90 $262.88Biopsyofbreast;open,incisional 19101 $727.6519120Removalofbreastlesion1+ 19120 $6,532.16 $1,498.42MABreastPercLocalizationLeft-Report 19281 $397.11MABreastPercLocalizationRight 19281 $904.43MABreastPercLocalizationRight-Report 19281 $397.11
MABreastPercLocalizationEaAddLeft 19282 $1,916.49MABreastPercLocalizationEaAddLeft-Report 19282 $199.12MABreastPercLocalizationEaAddRight 19282 $1,916.49MABreastPercLocalizationEaAddRight-Report 19282 $199.12USLocalizationBreastPercLeft 19285 $316.95USLocalizationBreastPercLeft-Report 19285 $339.04USLocalizationBreastPercRight 19285 $316.95USLocalizationBreastPercRight-Report 19285 $339.04USLocalizationBreastPercEaAddLeft 19286 $1,836.07USLocalizationBreastPercEaAddLeft-Report 19286 $169.87USLocalizationBreastPercEaAddRight 19286 $1,836.07USLocalizationBreastPercEaAddRight-Report 19286 $169.87Mastectomy,partial(eg,lumpectomy,tylectomy,quadrantectomy,segmentectomy); 19301 $2,390.25Mastectomy,simple,complete 19303 $7,749.16 $3,708.21Nipple/areolareconstruction 19350 $2,100.24Incision+drainagesofttissueabscess,subfascial(ie,involvesthesofttissuebelowdeepfascia) 20005 $2,354.97ExplorationofExtremityWound 20103 $3,798.48 $1,288.19Biopsy,muscle;deep 20205 $570.70Injection,therapeutic(eg,localanesthetic,corticosteroid),carpaltunnel. 20526 $793.50 $215.16Injection(s);singletendonsheath,orligamentaponeurosis(eg,plantarfascia")." 20550 $481.94 $151.49Injection(s);singletendonorigin/insertion. 20551 $263.34 $161.94Injection(s);singleormultipletriggerpoint(s),1or2muscle(s) 20552 $317.07 $144.34Injection(s);1ormultipletriggerpoint(s),1or2muscle(s) 20552 $317.07 $144.34Injections;singleormultipletriggerpoint(s),3ormoremuscle(s). 20553 $950.92 $164.17Arthrocentesis,aspirationand/orinjection;smalljointorbursa(eg,fingers,toes) 20600 $452.54 $136.55Arthrocentesis,aspirationand/orinjection,smalljointorbursa;USguidance,wrecord/report 20604 $1,170.38 $179.96Drain/InjSmallJoint/Bursaw/US 20604 $1,170.38Arthrocentesis,aspirationand/orinjection,LEFTintermediatejointorbursa;withoutultrasoundgu 20605 $378.84 $142.50Arthrocentesis,aspirationand/orinjection,RIGHTintermediatejointorbursa;withoutultrasoundg 20605 $378.84 $142.50Arthrocentesis,aspirationand/orinjection;intermediatejointorbursa(eg,temporomandinular,acr 20605 $378.84 $142.50InjorAspInterJntorBursa 20605 $378.84 $142.50Arthrocentesis,aspirationand/orinjection,intermediatejoint/bursa;USguidance,wrecord/report 20606 $193.28Drain/InjIntmedJoint/Bursaw/US 20606 $1,170.38Arthrocentesis,aspirationand/orinjection,LEFTmajorjointorbursa;w/oU 20610 $381.82 $174.15Arthrocentesis,aspirationand/orinjection,RIGHTmajorjointorbursa;w/oUS 20610 $381.82 $174.15Arthrocentesis,aspirationand/orinjection;majorjointorbursa(eg,shoulder,hip,kneejoint) 20610 $381.82 $174.15InjorAspMajorJntorBursa 20610 $381.82 $174.15Arthrocentesis,aspirationand/orinjection,majorjointorbursa;USguidance,wrecording/report 20611 $749.95 $233.64Drain/InjMajorJoint/Bursaw/US 20611 $749.95Aspirationand/orinjectionofganglioncyst(s)anylocation 20612 $313.37 $157.35Aspirationandinjectionfortreatmentofbonecyst. 20615 $2,084.69 $596.45PinRemoval 20670 $3,330.63 $528.72Removalofimplant;superficial(eg,buriedwire,pinorrod)(separateprocedure) 20670 $3,330.63 $528.72Removalofimplant;deep(eg,buriedwire,pin,screw,metalband,nail,rodorplate) 20680 $5,736.32 $1,546.91Removal,underanesthesia,ofexternalfixationsystem 20694 $1,226.65Tendongraft,fromadistance(eg,palmaris,toeextensor,plantaris) 20924 $1,834.28Tissuegrafts,other(eg,paratenon,fat,dermis) 20926 $1,545.42Excision,tumor,softtissueoffaceorscalp,subcutaneous;lessthan2cm 21011 $827.38Excision,tumor,softtissueoffaceorscalp,subcutaneous;2cmorgreater 21012 $11,012.00Closedtreatmentofnasalbonefracture;withoutstabilization 21315 $4,262.12 $544.06Closedtreatmentofnasalbonefracture;withstabilization 21320 $4,632.12 $493.18Closedtreatmentofnasalseptalfracture,withorwithoutstabilization 21337 $4,844.18 $1,054.58
Closedtreatmentoftemporomandibulardislocation;initialorsubsequent 21480 $619.37 $123.11Excision,tumor,softtissueofneckoranteriorthorax,subcutaneous;3cmorgreater 21552 $6,009.42 $1,635.75Excisionofrib,partial 21600 $2,001.57Excision,tumor,softtissueofbackorflank,subcutaneous;lessthan3cm 21930 $1,328.69Excision,tumor,softtissueofbackorflank,subcutaneous;3cmorgreater 21931 $9,442.44 $1,714.66Excision,tumor,softtissueofabdominalwall,subcutaneous;3cmorgreater 22903 $4,403.14 $1,598.92Claviculectomy;partial 23120 $5,629.18 $2,097.13Acromioplastyoracromionectomy,partial,withorwithoutcoracoacromialligamentrelease 23130 $5,070.67 $2,188.03Excisionorcurettageofbonecystorbenigntumorofproximalhumerus; 23150 $2,412.70InjectionprocedureforshoulderarthrographyorenhancedCT/MRIshoulderarthrography 23350 $817.79 $199.12InjShoulderArthrogram 23350 $817.79 $199.12Tenotomy,shoulderarea;singletendon 23405 $5,518.21 $2,259.42Repairofrupturedmusculotendinouscuff(eg,rotatorcuff)open;acute 23410 $2,821.77Repairofrupturedmusculotendinouscuff(eg,rotatorcuff)open;chronic 23412 $3,099.15Reconstructionofcompleteshoulder(rotator)cuffavulsion,chronic(includesacromioplasty) 23420 $3,183.63Tenodesisoflongtendonofbiceps 23430 $6,388.71 $2,702.98Capsulorrhaphy,anterior,anytype;withcoracoidprocesstransfer 23462 $3,685.82Arthroplasty,glenohumeraljnt;totalshoulder(glenoid+proxhumeralreplace-eg,totalshoulder) 23472 $5,396.85Closedtreatmentofclavicularfracture:withoutmanipulation 23500 $553.69 $773.98Opentreatmentofclavicularfracture,includesinternalfixation,whenperformed 23515 $17,490.96 $2,606.49Opentxacromioclaviculardisloc,acute/chronic;w/fascialgraft 23552 $2,382.71Closedtreatmentofproximalhumeral(surgicaloranatomicalneck)fracturewithoutmanipulation 23600 $500.50 $971.25Clsdtxproxhumeral(surg/anatomicalneck)fx;w/manipulation,w/orw/oskeletaltraction 23605 $2,404.38 $1,517.42Closedtreatmentofshoulderdislocation,withmanipulation;withoutanesthesia. 23650 $988.94 $1,029.54Closedtreatmentofshoulderdislocation,withmanipulation;requiringanesthesia 23655 $2,457.84 $1,439.72Clsdtxshoulderdisloc,w/fxgreaterhumeraltuberosity,w/manipulation 23665 $1,272.00Unlistedprocedure,shoulder 23929 $661.13Incisionanddrainage,upperarmorelbowarea;bursa 23931 $4,692.08 $568.76Arthrotomy,elbow,includingexploration,drainage,orremovalofforeignbody 24000 $1,621.34Biopsy,softtissueofupperarmorelbowarea;superficial 24065 $609.07Excision,tumor,softtissueofupperarmorelbowarea,subcutaneous;3cmorgreater 24071 $4,330.21 $1,472.80Excision,tumor,softtissueofupperarmorelbowarea,subcutaneous;lessthan3cm 24075 $1,195.18InjElbowArthrography 24220 $587.66 $248.88Repair,tendon/muscle,upperarm/elbow,eachtendon/muscle,primary/secondary(exclrotatorcuff) 24341 $6,883.63 $2,681.40Reinsertionofrupturedbicepsortricepstendon,distal,withorwithouttendongraft 24342 $13,599.67 $2,821.65Tenotomy,elbow,lateral/medial;debridement,softtissue+/orbone,open 24358 $7,542.84 $1,877.67Closedtreatmenthumeralshaftfracturewithoutmanipulation 24500 $997.50 $1,450.65Closedtreatmentofhumeralshaftfracture;withoutmanipulation 24500 $696.01 $1,142.73Opentreatmentofhumeralshaftfracturewithplate/screws,withorwithoutcerclage 24515 $2,874.05Opentxhumeralsupracondylar/transcondylarfx,inclintfix,ifperform;w/ointercondylarextension 24545 $3,054.18Closedtreatmentofhumeralcondylarfracture,medialorlateral;w/omanipulation 24576 $604.40 $1,065.48Treatmentofclosedelbowdislocation;withoutanesthesia 24600 $650.46 $1,200.35Closedtreatmentofradialheadsubluxationinchild,nursemaidelbow,withmanipulation. 24640 $783.15 $315.25Closedtreatmentofradialheadorneckfracture;withoutmanipulation 24650 $601.05 $834.60Opentxulnarfx,proxend(eg,olecranon/coronoidprocess[es]),inclintfix,ifperformed 24685 $2,368.28Incision,extensortendonsheath,wrist(eg,deQuervainsdisease) 25000 $1,074.38Excision,tumor,softtissueofforearmand/orwristarea,subcutaneous;lessthan3cm 25075 $1,073.08Excision,lesionoftendonsheath,forearmand/orwrist 25110 $1,148.78Excisionofganglion,wrist(dorsalorvolar);primary 25111 $6,625.00 $1,130.88Excisionofganglion,wrist(dorsalorvolar);recurrent 25112 $1,310.90Injectionprocedureforwristarthrography 25246 $553.01 $292.62InjWristArthorgraphy 25246 $553.01 $292.62
Repair,tendonormuscle,extensor,forearmand/orwrist;primary,single,eachtendonormuscle 25270 $4,463.43 $1,773.70Tendontransplantationortransfer,flexororextensor,forearmand/orwrist,single;eachtendon 25310 $2,252.92Osteoplasty,radiusORulna;shortening 25390 $2,651.62Repairofnonunionormalunion,radiusORulna;withoutgraft(eg,compressiontechnique) 25400 $2,946.21Repairnonunion,scaphoidcarpal(navicular)bone,w/orw/oradialstyloidectomy 25440 $2,819.31Arthroplasty,interposition,intercarpalorcarpometacarpaljoints 25447 $9,547.03 $3,001.36Closedtreatmentofradialshaftfracture;withoutmanipulation 25500 $492.68 $879.24Closedtreatmentofradialshaftfracturew/manipulation 25505 $1,039.84 $1,628.30ClosedTreatmentofulnarshaftfracture;withoutmanipulation 25530 $505.53 $822.99Opentreatmentofulnarshaftfracture,includesinternalfixation,whenperformed 25545 $2,020.80Closedtreatmentofradialandulnarshaftfractures;withoutmanipuation 25560 $811.51 $879.96Closedtreatmentofradialandulnarshaftfractures;withmanipulation 25565 $1,507.11 $1,671.42Opentxradial+ulnarshaftfxs,w/intfix,ifperformed;ofradius+ulna 25575 $3,087.37Closedtreatmentofdistalradialfractureorepiphysealseparation,includesclosedtreatmentoffr 25600 $718.36 $1,071.09Closedtreatmentofdistalradialfractureorepiphysealseparation,includesclosedtreatmentoffr 25600 $718.36 $1,071.09Clsdtxdistradialfx(eg,Colles/Smithtype)/epiphysealseparation,inclClsdtxfxulnarstyloid 25605 $1,278.08 $1,832.93Percutaneousskeletalfixationofdistalradialfractureorepiphysealseparation 25606 $2,373.71Opentxdistradialextra-articularfx/epiphysealseparation,w/intfix 25607 $14,209.02 $2,647.31Opentxdistradialintra-articularfx/epiphysealseparation;w/intfix2fragments 25608 $2,691.40Opentxdistradialintra-articularfx/epiphysealseparation;w/intfix3/>fragments 25609 $3,828.63Closedtreatmentofcarpalscaphoidfracture;withoutmanipulation 25622 $731.77 $969.73Opentreatmentofcarpalscaphoid(navicular)fracture,includesinternalfixation,whenperformed 25628 $6,802.40 $2,353.80Closedtreatmentcarpalbonefracture;withoutmanipulation,eachbone 25630 $626.74 $987.08Percutaneousskeletalfixationofulnarstyloidfracture 25651 $1,639.78Opentreatmentofulnarstyloidfracture 25652 $2,258.53Unlistedprocedure,forearmorwrist 25999 $0.01Drainageoffingerabscess;simple. 26010 $748.41 $489.50Drainageoftendonsheath,digitand/orpalm,each 26020 $4,184.93 $1,554.03Tendonsheathincision(eg,fortriggerfinger). 26055 $3,698.50 $1,084.74Arthrotomy,w/explore,drain,/removeloose/foreignbody;interphalangealjnt,each 26080 $1,319.43Excise,tumor/vascularmalformation,softtissuehand/finger,subcutaneous;1.5cm/greater 26111 $1,423.64Excise,tumor,softtissue,/vascularmalformation,hand/finger,subfascial;1.5cm/greater 26113 $6,839.22 $1,979.34Excise,tumor,softtissue,/vascularmalformation,hand/finger,subfascial;<than1.5cm 26116 $1,797.68Fasciectomy,palmonly,w/orw/oZ-plasty,otherlocaltissuerearrangement,/skingrafting 26121 $2,038.61Fasciectomy,partialpalmarw/relsgldigtinclprxintrphlngljnt, 26123 $9,091.77 $3,009.88Exciselesiontendonsheath/jntcapsule(eg,cyst,mucouscyst,/ganglion),hand/finger 26160 $1,187.39Partialexcise(craterize,saucerize,/diaphysectomy)bone(eg,osteomyelitis);distphalanxfinger 26236 $3,856.46 $1,592.55Removalofimplantfromfingerorhand 26320 $5,387.14 $1,234.65Repair/advance,flextendon,inzone2digitalflextendonsheath;pri,w/ofreegraft,eatendon 26356 $2,690.20Repair,extensortendon,finger,primaryorsecondary;withoutfreegraft,eachtendon 26418 $1,759.77Closedtreatmentoffracture,phalanxorphalanges,otherthangreattoe;withoutmanipulation 26510 $377.68 $400.45Repairofcollateralligament,metacarpophalangealorinterphalangealjoint 26540 $2,159.09Reconstruct,collaterallig,metacarpophalangealjnt,single;w/localtiss(eg,adductoradvancement) 26542 $2,121.38Closedtreatmentofmetacarpalfracture,single;withoutmanipulation,eachbone 26600 $596.59 $959.09Closedtreatmentofmetacarpalfracture,single;withmanipulationmeachbone 26605 $1,199.31 $1,024.17Percutaneousskeletalfixationofmetacarpalfracture,eachbone 26608 $1,704.12Opentreatmentofmetacarpalfracture,single,includesinternalfixation,whenperformed,eachbone 26615 $1,951.82Closedtreatmentofcarpometacarpaldislocation,thumb,withmanipulation 26641 $1,056.76 $1,218.57Closedtreatmentofcarpometacarpalfracturedislocation,thumb,withmanipulation 26645 $1,154.07 $1,386.92ClosedTxofMetacarpophalangealdislocation,single,w/manipulation; 26700 $748.17 $1,087.52Closedtreatmentofphalangealshaftfracture,proximalormiddlephalanx,fingerorthumb;without 26720 $649.36 $640.13Closedtreatmentofphalangealshaftfracture,proximalormiddlephalanx,fingerorthumb;withman 26725 $979.79 $1,073.10
Percskeletalfixunstablephalangealshaftfx,prox/middlephalanx,finger/thumb,w/manip,each 26727 $7,731.20 $1,664.83Opentxphalangealshaftfx,prox/middlephalanx,finger/thumb,inclintfix,ifperformed,each 26735 $9,724.34 $2,136.79Closedtreatmentofarticularfracture,involvingmetacarpophalangealorinterphalangealjoint;with 26740 $698.65 $751.10Closedtreatmentofarticularfracture,involvingmetacarpophalangealorinterphalangealjoint;with 26742 $370.07 $1,189.24Closedtreatmentofdistalphalangealfracture,fingerorthumb;withoutmanipulation,each 26750 $585.42 $642.09Closedtreatmentofdistalphalangealfracture,fingerorthumb;withmanipulation,each 26755 $837.90 $969.22Percutaneousskeletalfixationofdistalphalangealfracture,fingerorthumb,each 26756 $1,393.75Opentxdistphalangealfx,finger/thumb,inclintfix,ifperformed,each 26765 $1,795.99Closedtreatmentofinterphalangealjointdislocation,single,withmanipulation;withoutanesthesia 26770 $729.53 $910.66Clsdtxinterphalangealjntdisloc,single,w/manipulation;requiringanes 26775 $1,231.54Arthrodesis,metacarpophalangealjoint,withorwithoutinternalfixation; 26850 $2,424.13Arthrodesis,interphalangealjoint,withorwithoutinternalfixation; 26860 $1,948.71Amputation,finger/thumb,prim/sec,anyjnt/phalanx,single,inclneurectomies;w/directclosure 26951 $4,372.13 $2,239.51Amputation,fingerorthumb,priorsec,anyjoint/phalanx,1,inclneurectomies;localadvanceflaps 26952 $4,813.71 $2,009.75Injectionprocedureforhiparthrography;withoutanesthesia 27093 $818.80 $270.08InjHipArthrowoAnesthesia 27093 $818.80 $270.08InjHipArthrowAnesthesia 27095 $1,371.48 $286.58Injectionprocedureforsacroiliacjoint,anesthetic/steroid,wimaging&arthrographywhenperformed 27096 $1,239.21 $320.25Injectionprocedureforsacroiliacjoint,arthrographyand/oranesthetic/steroid 27096 $1,239.21CTInjSIJntwoorwArthrogramLeft 27096 $1,239.21CTInjSIJntwoorwArthrogramLeft-Report 27096 $320.25CTInjSIJntwoorwArthrogramRight 27096 $1,239.21CTInjSIJntwoorwArthrogramRight-Report 27096 $320.25XRInjSIJntwoorwArthrogramLeft-Report 27096 $320.25XRInjSIJntwoorwArthrogramRight 27096 $1,239.21XRInjSIJntwoorwArthrogramRight-Report 27096 $320.25XRInjSIJntwoorwoArthrogramLeft 27096 $1,239.21Arthroplasty,acetabular+proxfemoralprostheticreplace,w/orw/oautograft/allograft 27130 $16,949.49 $5,002.80Treatmentofslippedfemoralepiphysis;bysingleormultiplepinning,insitu 27176 $3,362.66Opentreatmentoffemoralfracture,proximalend,neck,internalfixationorprostheticreplacement 27236 $4,387.95Txintertrochanteric,peritrochanteric,/subtrochantericfemoralfx;w/plate/screw,w/orw/ocerclage 27244 $4,542.17Txintertrochanteric,peritrochanteric,/subtrochantericfemoralfx;w/intramedullaryimplantscrew 27245 $13,357.24 $4,517.44Closedtreatmentofhipdislocation,traumatic;withoutanesthesia 27250 $1,061.34 $703.28Closedtreatmentofhipdislocation,traumatic;requiringanesthesia 27252 $1,983.67 $2,770.02Txspontaneoushipdislocation,byabduction,splint/traction;w/manipulation,requiringanes 27257 $1,264.34Closedtreatmentofposthiparthroplastydislocation;withoutanesthesia 27265 $665.46 $1,438.82Incisionanddrainage,deepabscess,bursa,orhematoma,thighorkneeregion 27301 $2,506.01Excision,tumor,softtissueofthighorkneearea,subcutaneous;lessthan3cm 27327 $1,062.02Excisionofsynovialcystofpoplitealspace(eg,Bakerscyst) 27345 $1,735.49Excisionoflesionofmeniscusorcapsule(eg,cyst,ganglion),knee 27347 $2,588.49Excisionorcurettageofbonecystorbenigntumoroffemur; 27355 $8,553.28 $2,176.20Excise/curettagebonecyst/b9tumorfemur;w/intfix(Listinadditiontocodeforprimaryprocedure) 27358 $3,765.22 $1,045.90InjKneeArthrography 27369 $528.21 $141.00Sutureofinfrapatellartendon;primary 27380 $2,140.65Sutureofquadricepsorhamstringmusclerupture;primary 27385 $2,064.48Lateralretinacularrelease,open 27425 $9,144.96Ligamentousreconstruction(augmentation),knee;extra-articular 27427 $2,330.65Arthroplasty,knee,condyleandplateau;medialORlateralcompartment 27446 $4,267.96Arthroplasty,knee,condyle+plateau;med+latcompartsw/orw/opatellaresurfacing 27447 $19,413.59 $5,000.98Osteotomy,femur,shaftorsupracondylar;withfixation 27450 $3,697.46Revisionoftotalkneearthroplasty,withorwithoutallograft;1component 27486 $5,176.75Revisionoftotalkneearthroplasty,withorwithoutallograft;femoralandentiretibialcomponent 27487 $6,531.65
Removeprosthesis,incltotalkneeprosthesis,methylmethacrylatew/orw/oInsertspacer,knee 27488 $4,159.29Clsdtxfemoralshaftfx,w/manipulation,w/orw/oskin/skeletaltraction 27502 $2,513.23Opentxfemoralshaftfx,w/orw/oextfix,w/insertintramedullaryimplant,w/orw/ocerclage+/or 27506 $4,960.70Opentreatmentoffemoralshaftfracturewithplate/screws,withorwithoutcerclage 27507 $3,590.43Opentxfemoralfx,distend,medial/lateralcondyle,inclintfix,ifperformed 27514 $3,576.27Closedtreatmentofpatellarfracture,withoutmanipulation 27520 $649.09 $1,031.96Opentxpatellarfx,w/intfix+/orpartial/completepatellectomy+softtissuerepair 27524 $15,494.07 $2,729.85Closedtreatmentofkneedislocation;withoutanesthesia 27550 $679.14 $1,610.91Closedtreatmentofpatellardislocation;w/oanesthesia 27560 $893.76 $1,183.04Closedtreatmentofpatellardislocation;requiringanesthesia 27562 $1,594.49 $1,703.76Manipulationkneejntundergeneralanes(inclapplicationtraction/otherfixdevices) 27570 $540.45Repair,primary,openorpercutaneous,rupturedAchillestendon; 27650 $11,492.54 $2,408.05Repair,primary,open/Perc,rupturedAchillestendon;w/graft 27652 $2,548.14Lengtheningorshorteningoftendon,legorankle;singletendon(separateprocedure) 27685 $1,709.82Transfer/transplantsingletendon(w/muscleredirect/rerouting);deep 27691 $2,744.54Repair,primary,disruptedligament,ankle;collateral 27695 $1,748.53Closedtreatmentoftibialshaftfracture(withorwithoutfibularfracture);withmanipulation,wit 27752 $3,735.39 $1,773.42Opentxtibialshaftfx(w/orw/ofibularfx),w/plate/screws,w/orw/ocerclage 27758 $3,264.78Txtibialshaftfx(w/orw/ofibularfx)byintramedullaimplant,w/orw/ointerlockscrews/cerclage 27759 $3,651.32Closedtreatmentofmedialmalleolusfracture;withoutmanipulation 27760 $661.32 $1,067.65Opentreatmentofmedialmalleolusfracture,includesinternalfixation,whenperformed 27766 $2,071.65Closedtreatmentofposteriormalleolusfracture;withoutmanipulation 27767 $663.62 $978.78Closedtreatmentofproximalfibulaorshaftfracture;withoutmanipulation 27780 $443.52 $983.52Closedtreatmentofproximalfibulaorshaftfracture;withoutmanipulation 27780 $443.52 $983.52Closedtreatmentofdistalfibularfracture(lateralmalleolus);withoutmanipulation 27786 $690.43 $1,004.92Closedtreatmentofdistalfibularfracture(lateralmalleolus)w/manipulation 27788 $1,335.05 $1,369.46Opentxdistfibularfx(lateralmalleolus),inclintfix,ifperformed 27792 $2,361.85Clsdtxbimalleolaranklefx;withmanipulation 27810 $1,172.03 $1,524.17Opentxbimalleolaranklefx,i 27814 $2,802.00Closedtreatmentoftrimalleolaranklefracture;withmanipulation 27818 $1,429.82 $1,561.43Opentxtrimalleolaranklefx,inclintfix,ifperform,medial+/orlateralmalleolus;w/ofixpost 27822 $15,162.57 $3,099.56Opentxdisttibiofibularjnt(syndesmosis)disruption,inclintfix,ifperformed 27829 $2,502.64Arthrodesis,ankle,open 27870 $3,583.21Amputation,leg,throughtibiaandfibula; 27880 $3,423.52Tenotomy,percutaneous,toe;singletendon 28010 $730.48Excision,interdigital(Morton)neuroma,single,each 28080 $1,272.79Exciselesion,tendon,tendonsheath,/capsule(inclsynovectomy)(eg,cyst/ganglion);foot 28090 $1,082.50Exciselesion,tendon,tendonsheath,/capsule(inclsynovectomy)(eg,cyst/ganglion);toe(s),each 28092 $3,679.49 $997.47Excisionorcurettageofbonecystorbenigntumor,phalangesoffoot 28108 $1,077.40Ostectomy,partialexcision,fifthmetatarsalhead(bunionette)(separateprocedure) 28110 $972.85Partialexcise(crater/saucer/sequestr-/diaphys-ectomy)bone;tarsal/metatarsal,excltaluscalcaneus 28122 $1,655.74PartialExcise(craterization,saucerization,sequestrectomy,/diaphysectomy)bone;phalanxtoe 28124 $1,243.44Removalofforeignbody,foot;subcutaneous. 28190 $3,186.26 $500.06Repair,tendon,flexor,foot;primaryorsecondary,withoutfreegraft,eachtendon 28200 $1,207.58Tenotomy,open,extensor,footortoe,eachtendon 28234 $2,417.90 $874.23Reconstruct(advancement),posttibialtendonw/Exciseaccessorytarsalnavicularbone 28238 $1,846.39Capsulotomy;metatarsophalangealjoint,withorwithouttenorrhaphy,eachjoint(separateprocedure) 28270 $1,177.45Correction,hammertoe(eg,interphalangealfusion,partialortotalphalangectomy) 28285 $1,416.98Halluxrigiduscorrectionw/cheilectomy,debridement+capsularrelease1stmetatarsophalangealjnt 28289 $1,731.59Correction,halluxvalgus(bunion),w/orw/osesamoidectomy;Keller,McBride,/Mayotypeprocedure 28292 $1,831.20Correction,halluxvalgus(bunion),withorwithoutsesamoidectomy;Lapidus-typeprocedure 28297 $2,129.38Osteotomy;calcaneus(eg,DwyerorChamberstypeprocedure),withorwithoutinternalfixation 28300 $2,273.83
Closedtreatmentofmetatarsalfracture;withoutmanipulation,each 28470 $642.39 $718.22Opentreatmentofmetatarsalfracture,includesinternalfixation,whenperformed,each 28485 $2,001.13Closedtreatmentoffracturegreattoe,phalanxorphalanges;withoutmanipulation 28490 $573.12 $438.50Opentxfx,greattoe,phalanx/phalanges,inclintfix,ifperformed 28505 $1,666.10Closedtreatmentoffracture,phalanxorphalanges,otherthangreattoe;withmanipulation 28515 $791.82 $510.11Opentxfx,phalanx/phalanges,otherthangreattoe,inclintfix,ifperformed,each 28525 $2,597.77Percutaneousskeletalfixationoftarsometatarsaljointdislocation,withmanipulation 28606 $1,340.72Opentreatmentoftarsometatarsaljointdislocation,includesinternalfixation,whenperformed 28615 $2,781.06Arthrodesis;triple 28715 $3,462.68Arthrodesis;subtalar 28725 $7,396.32 $2,859.51Amputation,foot;transmetatarsal 28805 $2,368.28Amputation,metatarsal,withtoe,single 28810 $1,601.65Amputation,toe;metatarsophalangealjoint 28820 $1,381.82Amputation,toe;interphalangealjoint 28825 $1,372.98Unlistedprocedure,footortoes 28899 $1,140.94Application,cast;shouldertohand(longarm) 29065 $504.98 $246.27Application,cast;elbowtofinger(shortarm) 29075 $510.56 $224.22Application,cast;handandlowerforearm(gauntlet). 29085 $429.01 $245.14Application,cast;finger 29086 $363.09 $180.30Applicationoflongarmsplint(shouldertohand) 29105 $465.08 $219.20LongArmSplint 29105 $465.08Applicationofshortarmsplint(forearmtohand);static. 29125 $435.42 $142.59ShortArmSplint 29125 $435.42Applicationofshortarmsplint(forearmtohand);dynamic 29126 $573.68 $176.63Applicationoffingersplint;static. 29130 $216.55 $108.03Yes-ApplicationSplintStaticFinger 29130 $216.55FingerSplints 29130 $216.55Applicationoffingersplint;dynamic 29131 $468.73 $124.46Strapping;elboworwrist. 29260 $362.53 $75.97Strapping;handorfinger 29280 $270.36 $78.93Applicationoflonglegcast(thightotoes) 29345 $709.48 $368.34Applicationoflonglegcastbrace 29358 $381.19Applicationofshortlegcast(belowkneetotoes) 29405 $558.60 $219.11Applicationofshortlegcast(belowkneetotoes);walkingorambulatorytype 29425 $577.57 $208.78Yes-TotalContactCastLeg 29445 $400.72Applicationoflonglegsplint(thightoankleortoes). 29505 $527.85 $182.61LongLegSplint 29505 $527.85Applicationofshortlegsplint(calftofoot) 29515 $485.53 $184.17ShortLegSplint 29515 $485.53Yes-StrappingKnee 29530 $441.29Strapping;ankleand/orfoot 29540 $345.22 $71.92Strappingtoes 29550 $341.62 $45.70Strappingunnaboot 29580 $449.40 $132.28Strappingunnaboot 29580 $449.40 $132.28Yes-ApplicationStrappingUnnaBoot 29580 $449.40Applicationofmulti-layervenouswoundcompressionsystem,belowknee 29581 $378.23Fullarmorlegcast 29705 $384.32 $175.91Arthroscopy,shoulder,diagnostic,withorwithoutsynovialbiopsy(separateprocedure) 29805 $1,708.76Arthroscopy,shoulder,surgical;capsulorrhaphy 29806 $3,894.43Arthroscopy,shoulder,surgical;repairofSLAPlesion 29807 $3,799.88Arthroscopy,shoulder,surgical;synovectomy,complete 29821 $2,121.69Arthroscopy,shoulder,surgical;debridement,limited 29822 $5,541.81 $2,059.76
Arthroscopy,shoulder,surgical;debridement,extensive 29823 $6,127.84 $2,249.86Arthroscopy,shoulder,surg;distclaviculectomyincldistarticularsurface(Mumfordprocedure) 29824 $5,511.22 $2,423.75Arthroscopy,shoulder,surgical;withlysisandresectionofadhesions,withorwithoutmanipulation 29825 $5,073.99 $2,098.25Arthroscopy,shoulder,surg;decompresssubacromialspacew/partacromioplasty,w/orw/ocoracoacrom 29826 $5,915.91 $661.36Arthroscopy,shoulder,surgical;withrotatorcuffrepair 29827 $6,696.12 $3,887.61ArthroscopyShoulderRotatorCuffRepair 29827 $6,696.12 $3,887.61Arthroscopy,shoulder,surgical;bicepstenodesis 29828 $6,739.58 $3,342.31Arthroscopy,elbow,surgical;synovectomy,partial 29835 $13,647.52 $1,814.27Arthroscopy,hip,surgical;wdebridement/chondroplasty,abrasionarthroplasty,+/orresectlabrum 29862 $2,274.62Arthroscopy,knee,diagnostic,withorwithoutsynovialbiopsy(separateprocedure) 29870 $1,479.82Arthroscopy,knee,surgery;forremovalloosebody/foreignbody 29874 $1,954.93Arthroscopy,knee,surgery;abrasionarthroplasty(inclchondroplasty)/multidrilling/microfx 29879 $2,402.10Arthroscopy,knee,surgical;withmeniscectomy(medialANDlateral,includinganymeniscalshaving) 29880 $1,922.86Arthroscopy,knee,surgical;withmeniscectomy(medialORlateral,includinganymeniscalshaving) 29881 $6,252.41 $1,952.59Arthroscopy,knee,surgical;withmeniscusrepair(medialORlateral) 29882 $9,030.54 $2,544.84Arthroscopy,knee,surgical;withmeniscusrepair(medialANDlateral) 29883 $3,073.48Arthroscopicallyaidedanteriorcruciateligamentrepair/augmentationorreconstruction 29888 $3,607.47Arthroscopy,ankle,surg,Exciseosteochondraldefecttalus+/ortibia,incldrillingthedefect 29891 $10,443.58 $2,469.13Arthroscopy,ankle(tibiotalar+fibulotalarjnts),surgical;w/Removeloosebody/foreignbody 29894 $1,837.82Arthroscopy,ankle(tibiotalarandfibulotalarjoints),surgical;debridement,extensive 29898 $2,097.09Arthroscopy,hip,surgical;withfemoroplasty(ie,treatmentofcamlesion) 29914 $3,643.52Arthroscopy,hip,surgical;withacetabuloplasty(ie,treatmentofpincerlesion) 29915 $3,532.07Arthroscopy,hip,surgical;withlabralrepair 29916 $3,754.90Unlistedprocedure,arthroscopy 29999 $6,669.56Biopsy,intranasal 30100 $1,838.49 $249.78Excisioninferiorturbinate,partialorcomplete,anymethod 30130 $5,077.29 $1,317.91Submucousresectioninferiorturbinate,partialorcomplete,anymethod 30140 $1,506.75Removalforeignbody,intranasal;officetypeprocedure 30300 $438.72 $372.25Removalforeignbody,intranasal;requiringgeneralanesthesia 30310 $703.43Septoplasty/submucousResect,w/orw/ocartilagescoring,contouring/replacew/graft 30520 $5,103.23 $2,199.69Ablation,softtissueofinferiorturbinates,unilateralorbilateral,anymethod;superficial 30801 $1,838.49 $469.68Ablation,softtissueofinferiorturbinates,unilateralorbilateral,anymethod;intramural 30802 $3,708.90 $669.60Ablation,softtissueinferiorturbinates,unilat/bilat,anymethod/intramural 30802 $3,708.90 $669.60Controlnasalhemorrhage,anterior,simple(limitedcauteryand/orpacking)anymethod 30901 $218.02Controlnasalhemorrhage,anterior,complex(limitedcauteryand/orpacking)anymethod 30903 $263.88 $308.51Controlnasalhemorrhage,posterior,withposteriornasalpacksand/orcautery,anymethod;initial 30905 $678.14 $405.30Controlnasalhemorrhage,posterior,withposteriornasalpacksand/orcautery,anymethod;subseque 30906 $734.00 $519.26Fracturenasalinferiorturbinate(s),therapeutic 30930 $4,189.50 $432.69Unlistedprocedure,nose 30999 $1,107.49Lavagebycannulation;maxillarysinus(antrumpunctureornaturalostium) 31000 $3,343.78 $375.32Sinusotomy,maxillary(antrotomy);intranasal 31020 $1,197.42Nasalendoscopy,diagnostic,unilateralorbilateral(separateprocedure) 31231 $1,150.72 $244.05Nasalendoscopy,diagnostic,unilateralorbilateral 31231 $1,150.72 $244.05Nasal/sinusendoscopy,surgicalw/biopsypolypectomyordebrideseparateprocedure 31237 $5,776.85 $600.04Nasal/sinusendoscopy,surgical;withbiopsy,polypectomyordebridement(separateprocedure) 31237 $5,776.85 $600.04Nasal/sinusendoscopy,surgical;withethmoidectomy,partial(anterior) 31254 $868.80Nasal/sinusendoscopy,surgical;withethmoidectomy,total(anteriorandposterior) 31255 $1,506.66Nasal/sinusendoscopy,surgical,withmaxillaryantrostomy; 31256 $739.90Nasal/sinusendoscopy,surgicalwithethmoidectomy;total,inclsphenoidotomy 31257 $1,596.61Nasal/sinusendoscopy,surgical,w/maxillaryantrostomy;w/Removetissuefrommaxillarysinus 31267 $952.04Nasal/sinusendoscopy,surgw/frontalsinusexploration,w/orw/oRemovetissuefromfrontalsinus 31276 $1,352.48Intubation,endotracheal,emergencyprocedure 31500 $826.65 $555.84
IntubatedbyRespiratoyTherapist-EndotrachealTubeActivity 31500 $826.65Tracheotomytubechangepriortoestablishmentoffistulatract 31502 $604.18 $121.13Laryngoscopydiagnosticindirect 31505 $504.98 $177.67Laryngoscopydirect,withorwithouttracheoscopy;diagnostic,exceptnewborn 31525 $3,216.10 $536.40Laryngoscopy,direct,operative,withbiopsy; 31535 $5,287.79 $637.93Laryngoscopy,flexiblefiberoptic;diagnostic 31575 $942.46 $247.57Tracheostomy,emergencyprocedure;cricothyroidmembrane 31605 $1,473.59 $706.05Bronchoscopy,rigidorflexible,;diagnostic,wcellwashing,whenperform 31622 $4,056.55 $511.79Bronchoscopy,rigidorflexible,includingfluoro,whenperformed;wbrushingorprotectedbrushings 31623 $2,399.73 $524.78Bronchoscopy,rigidorflexible,includingfluoro,whenperformed;wbronchialalveolarlavage 31624 $2,231.19 $529.95Bronchoscopy,rigidorflexible,inclfluoro;wbronchialorendobronchialbx(s),1/>sites 31625 $2,767.19 $614.61Bronchoscopyrigidorflexiblewplacefiducialmarkers1ormore 31626 $5,483.22 $776.38Bronchoscopy,rigidorflexible,;wcomputer-assisted,image-guidednavigation 31627 $3,211.95 $383.65Bronchoscopy,rigidorflexible,wtransbronchiallungbx(s)1lobe 31628 $3,233.93 $694.16Bronchoscopy,rigid/flex;wtransbronchialneedleaspirationbx,trachea/mainstem/lobarbronchus(i) 31629 $4,501.69 $736.29Bronchoscopy,rigidorflexible,inclfluoro;wtracheal/bronchialdilationorclosedreductfracture 31630 $6,650.38 $773.49Bronchoscopy,rigidorflexible,;wplacementoftrachealstent(s) 31631 $6,647.59 $883.98Bronchoscopy,rigidorflexible,;wtransbronchiallungbx(s),eaaddlobe 31632 $2,487.54 $195.12Bronchoscopy,rigidorflexible,inclfluoro;wtransbronchialneedleaspirationbx(s),eaaddlobe 31633 $2,435.46 $250.90Bronchoscopy,rigidorflexible;wballoonocclusion 31634 $3,425.87 $753.44Bronchoscopy,rigidorflexible,withremovalofforeignbody 31635 $4,406.24 $684.04Bronchoscopy,rigidorflexible;wplacementofbronchialstent(s),initialbronchus 31636 $6,382.56 $857.12Bronchoscopy,rigidorflexible,eaadditionalmajorbronchusstented 31637 $295.14Bronchoscopy,rigidorflexible,wrevisetrachealorbronchialstentinsertedatprevioussession 31638 $6,971.33 $974.85Bronchoscopy,rigidorflexible,;withbronchialthermoplasty,1lobe 31640 $6,437.50 $982.05Bronchoscopy,rigidorflex;wdestructtumororrelievestenosisbyanymethodotherthanexcision 31641 $6,652.54 $1,003.08Bronchoscopy,rigidorflexible,inclfluoro;wplacecatheter(s)forintracavitaryradioelement 31643 $3,861.18 $694.34Bronchoscopy 31645 $3,421.60Bronchoscopy,rigidorflexible,inclfluoro;wtxaspirationoftracheobronchialtree,subsequent 31646 $3,428.96 $497.37Bronchoscopy,rigidorflexible,winsertionofbronchialvalve(s),initiallobe 31647 $5,966.96 $822.40Bronchoscopy,rigidorflexible,wremovebronchialvalve(s),initiallobe 31648 $5,586.00 $761.19Bronchoscopy,rigidorflexible,wremovebronchialvalve(s),eaaddlobe 31649 $1,159.10 $274.42Bronchoscopy,rigidorflexible;winsertionofbronchialvalve(s),eachadditionallobe 31651 $295.87Bronchoscopy,rigidorflexiblewbronchialthermoplasty2or>lobes 31661 $8,697.40 $817.44Catheterizationwithbronchialbrushbiopsy 31717 $419.10 $423.79Catheteraspiration;nasotracheal 31720 $262.54 $204.00Nasotrachealcatheteraspiration-RTMiscTreatments 31720 $262.54Yes-NasalSuctionBilling 31720 $262.5432550-Insertionofindwellingtunneledpleuralcatheterwithcuff 32550 $717.20Tubethoracostomy,includeswatersealwhenperformedseparateprocedure 32551 $1,948.96 $605.97Thoracentesis,pleuralspace;w/oguidance 32554 $1,890.98 $351.80Thoracentesis,needleorcatheter,aspirationofthepleuralspace;withoutimagingguidance 32554 $1,890.98 $351.80Thoracentesispunctureofpleuralcavityforaspiration,intitialorsubsequent 32555 $3,217.20 $553.56Thoracentesis,pleuralspace;w/guidance 32555 $2,240.67 $442.89Thoracentesis,needleorcatheter,aspirationofthepleuralspace;withimagingguidance 32555 $2,240.67 $442.89CTThoracentesiswithImagingGuidance 32555 $2,240.67CTThoracentesiswithImagingGuidance-Report 32555 $442.89USThoracentesiswithImagingGuidance 32555 $2,240.67USThoracentesiswithImagingGuidance-Report 32555 $442.89Pleuraldrainage,percutaneous,withinsertionofindwellingcatheter;withoutimagingguidance 32556 $2,005.08 $482.78CTGuide-PercPleuralDrainagewCath 32557 $3,025.38CTGuide-PercPleuralDrainagewCathPl-Report 32557 $604.23
Thoracoscopy,diagnostic;lungs,pericardialsac,mediastinalorpleuralspace,withoutbiopsy 32601 $5,718.95 $1,161.22Removalpermanentpacemakerpulsegeneratorw/replacementpacemakerpulsegenerator;duallead 33228 $1,176.25Injectionofneedleorintracatheter,vein 36000 $272.82 $43.41Collectionofvenousbloodbyvenipuncture 36415 $45.75Collectionofvenousbloodbyvenipuncture 36415 $45.75Collectionofvenousbloodbyvenipuncture 36415 $45.75Venipuncuture(1x/pt/day-OPonly) 36415 $45.75Collectionofcapillarybloodspecimen(eg,finger,heel,earstick) 36416 $30.26CapillaryBloodcollection 36416 $30.26Capillaryblood(ie.fingerstick) 36416 $30.26Capillarystick(CPT36416)-ACCCharges 36416 $30.26Transfusion,blood/bloodcomponents 36430 $1,586.62 $109.55Transfusion,bloodorbloodcomponents 36430 $1,586.62 $109.55Catheterizationofumbilicalveinfordiagnosisortherapy,newborn 36510 $217.33Therapeuticapheresis;forplasmapheresis 36514 $4,609.78 $360.66Centralline(nontunneled)Insertionage5andolder 36556 $1,806.71 $473.44Inserttunneledcentrallyinsertedcentralvenouscatheter,w/osubcutaneousport/pump;5yearsor> 36558 $1,004.01Insertionof(PICC),withoutsubcutaneousportorpump;5yearsorolder 36569 $2,600.05 $359.72Removaloftunneledcentralvenouscatheter,w/oSQportorpump 36589 $1,953.93Removetunneledcentralvenousaccessdevice,w/subcutaneousport/pump,central/peripheral 36590 $4,563.49 $714.39Collectionofbloodspecimenfromacompletelyimplantablevenousaccessdevice 36591 $318.91 $74.27BlooddrawimplantedVAD 36591 $318.91Collectionofbloodspecimenusingestablishedcentralorperipheralcatheter,venous,nototherwise 36592 $194.23 $83.21BlooddrawPICC-non-implntVAD 36592 $194.23Declottingbythrombolyticagentofimplantedvascularaccessdeviceorcatheter 36593 $519.43 $98.41DeclotVAD/VACthrombagent 36593 $519.43Arterialpuncture,withdrawalofbloodfordiagnosis 36600 $178.41 $60.70Arterialpuncture(ABG) 36600 $178.41Ligationorbiopsy,temporalartery 37609 $762.86Ligation,majorartery(eg,post-traumatic,rupture);extremity 37618 $4,834.36 $1,338.12Ligation,division,and/orexcisionofvaricoseveincluster(s),1leg 37785 $5,581.22 $961.97DiagnosticBonemarrow;aspiration 38220 $1,660.10 $234.37Bonemarrow;biopsy,needleortrocar 38221 $1,564.08 $289.30Biopsyorexcisionoflymphnode(s);open,superficial 38500 $6,064.28 $930.49Biopsyorexcisionoflymphnode(s);byneedle,superficial(eg,cervical,inguinal,axillary) 38505 $1,626.87 $269.52biopsyandorexcisionoflymphnode(s);byNeedle,Superfical,(eg,cervical,inguinal,.axil) 38505 $1,626.87 $269.52Biopsyorexcisionoflymphnode(s);byneedle,superficial(eg,cervical,inguinal,axillary) 38505 $1,626.87 $269.52Biopsyorexcisionoflymphnode(s);open,deepcervicalnode(s) 38510 $1,465.64Biopsyorexcisionoflymphnode(s);open,deepaxillarynode(s) 38525 $1,594.69Biopsyoflip 40490 $767.54 $278.02Drainageofabscess,cyst,hematoma,vestibuleofmouth;simple 40800 $873.65 $468.92Biopsy,vestibuleofmouth 40808 $2,363.99 $385.08Biopsy,vestibuleofmouth 40808 $2,363.99 $385.08Excisionoflesionofmucosaandsubmucosa,vestibuleofmouth;withoutrepair 40810 $3,518.71 $429.56Excisionoflesionofmucosaandsubmucosa,vestibuleofmouth;withsimplerepair 40812 $5,600.52 $720.71Excisionoffrenum,labialorbuccal(frenumectomy,frenulectomy,frenectomy) 40819 $4,306.84 $861.47Incisionoflingualfrenum(frenotomy) 41010 $2,518.73 $383.37Extraoralincisionanddrainageofabscess,cyst,orhematomaoffloorofmouth;submandibular 41017 $1,142.65Biopsyoftongue;posteriorone-third 41105 $2,180.78 $411.27Biopsyoftongue;posteriorone-third 41105 $2,180.78 $411.27Biopsyoffloorofmouth 41108 $330.19Excisionoflesionoftonguewithoutclosure 41110 $5,445.79 $477.19
Exicisionoflesionoftonguewithclosure;anteriortwo-thirds 41112 $4,156.71 $916.78Excisionoflingualfrenum(frenectomy) 41115 $1,838.49 $528.41Excisionoflingualfrenum(frenectomy) 41115 $1,838.49 $528.41Excision,lesionoffloorofmouth 41116 $707.63Repairoflaceration2.5cmorless;floorofmouthand/oranteriortwo-thirdsoftongue 41250 $527.62Drainageofabscess,cyst,hematomafromdentoalveolarstructures 41800 $497.52Unlistedprocedure,dentoalveolarstructures 41899 $778.02Drainageofabscessofpalate,uvula 42000 $1,117.50 $471.91Biopsyofpalate,uvula 42100 $2,862.27 $398.90Excision,lesionofpalate,uvula;withoutclosure 42104 $5,207.54 $506.69Uvulectomy,excisionofuvula 42140 $554.29Palatopharyngoplasty(eg,uvulopalatopharyngoplasty,uvulopharyngoplasty) 42145 $2,588.49Unlistedprocedure,palate,uvula 42299 $4,016.33Drainageofabscess,parotid,simple 42300 $5,502.21 $556.87Sialolithotomy;submandibular(submaxillary),sublingualorparotid,uncomplicated,intraoral 42330 $5,970.16 $606.28Biopsyofsalivarygland;incisional 42405 $751.73Excisionofsublingualsalivarycyst(ranula 42408 $1,207.58Excisionofsublingualsalivarycyst(ranula) 42408 $1,207.58Marsupializationofsublingualsalivarycyst(ranula) 42409 $756.58Incisionanddrainageabscess;peritonsillar 42700 $1,186.47 $491.10Biopsy;oropharynx 42800 $4,006.11 $407.59Excisionordestructionoflesionofpharynx,anymethod 42808 $6,806.31 $599.35Tonsillectomyandadenoidectomy;youngerthanage12 42820 $1,067.31Tonsillectomyandadenoidectomy;age12orover 42821 $1,111.71Tonsillectomy,primaryorsecondary;youngerthanage12 42825 $951.33Tonsillectomy,primaryorsecondary;age12orover 42826 $922.14Adenoidectomy,primary;youngerthanage12 42830 $753.20Adenoidectomy,primary;age12orover 42831 $5,453.05 $812.12Adenoidectomy,secondary;age12orover 42836 $875.55Controloropharyngealhemorrhage,primaryorsecondary(eg,post-tonsillectomy);simple 42960 $621.25Esophagoscopy,rigid,transoral;diagnostic,inclcollectspecimen(s)brushing/washingwhenperform 43191 $3,127.23 $580.17Esophagoscopy,rigid,transoral;withbiopsy,singleormultiple 43192 $5,014.83 $641.19Esophagoscopy,rigid,transoral;withremovalofforeignbody 43194 $6,076.46 $738.44Esophagoscopy,rigid,transoral;withballoondilation(lessthan30mmdiameter) 43195 $5,336.87 $698.73Esophagoscopy,rigid,transoral;withinsertionofguidewirefollowedbydilationoverguidewire 43196 $5,258.66 $746.15Esophagoscopy,flexible,transnasal;diagnostic,inclcollectspecimen(s)brush/washwhenperformed 43197 $3,072.30 $318.07Esophagoscopy,flexible,transnasal;withbiopsy,singleormultiple 43198 $2,843.12 $380.52Esophagoscopy,flexible,transoral;diagnostic,inclcollectspecimen(s)brush/wash,whenperformed 43200 $3,263.73 $331.70Esophagoscopy,flexible,transoral;withdirectedsubmucosalinjection(s),anysubstance 43201 $3,664.42 $393.46Esophagoscopy,flexible,transoral;withbiopsy,singleormultiple 43202 $3,294.06 $394.15Esophagoscopy,flexible,transoral;withinjectionsclerosisofesophagealvarices 43204 $2,498.15 $523.28Esophagoscopy,flexible,transoral;withbandligationofesophagealvarices 43205 $3,042.13 $544.97Esophagoscopy,flexible,transoral;withopticalendomicroscopy 43206 $2,942.71 $513.91Esophagoscopy,flexible,transoral;withendoscopicmucosalresection 43211 $4,505.64 $913.63Esophagoscopy,flexible,transoral;wplacementofendoscopicstent 43212 $7,150.08 $730.03Esophagoscopy,flexible,transoral;wdilationofesophagus,byballoonordilator,retrograde 43213 $5,310.05 $999.89Esophagoscopy,flexible,transoral;wdilationofesophaguswballoon(30mmdiameterorlarger) 43214 $4,527.36 $742.65Esophagoscopy,flexible,transoral;withremovalofforeignbody 43215 $4,210.73 $542.88Esophagoscopy,flexible,transoral;wremovetumor/polyp/lesion(s)byhotbxforceps/bipolarcautery 43216 $5,129.06 $517.65Esophagoscopy,flexible,transoral;wremovetumor/polyp/lesion(s)bysnaretechnique 43217 $4,007.40 $618.09Esophagoscopy,flexible,transoral;withtransendoscopicballoondilation(lessthan30mmdiameter) 43220 $4,434.64 $451.77Esophagoscopy,flexible,transoral;winsertguidewirefollowedbypassdilator(s)overguidewire 43226 $4,909.09 $500.31
Esophagoscopy,flexible,transoral;withcontrolofbleeding,anymethod 43227 $4,407.35 $637.29Esophagoscopy,flexible,transoral;wablationoftumor/polyp/lesion(s) 43229 $6,430.60 $762.88Esophagoscopy,flexible,transoral;withendoscopicultrasoundexamination 43231 $4,457.63 $618.68Esophagoscopy,flexible,transoral;wtransendoscopicUS-guidedintramural/transmuralFNA/biopsy(s) 43232 $5,317.76 $770.31Esophagogastroduodenoscopy,flexible,transoral;wdilationofesophaguswballoon(30mmdiaor>) 43233 $3,586.72 $880.61Esophagogastroduodenoscopy,flexible,transoral;diagnostic,inclcollectspecimen(s)bybrush/wash 43235 $2,660.01 $472.00Esophagogastroduodenoscopy,flexible,transoral;withdirectedsubmucosalinjectionanysubstance 43236 $1,677.14 $534.11Esophagogastroduodenoscopy,flexible,transoral;wdirectedsubmucosalinjection(s),anysubstance 43236 $1,677.14 $534.11Esophagogastroduodenoscopy,flexible,transoral;wendoscopicUSexaminationlimited 43237 $4,442.56 $758.13Esophagogastroduodenoscopy,flex,transoral;wUS-guidedintramural/transmuralFNA/biopsy,esophagus 43238 $5,753.49 $903.57Esophagogastroduodenoscopy,flexible,transoral;withbx,singleormultiple 43239 $2,393.48 $534.84Esophagogastroduodenoscopy,flexible,transoral;wtransmuraldrainageofpseudocyst 43240 $4,797.48 $1,528.02Esophagogastroduodenoscopy,flexible,transoral;withinsertionofintraluminaltubeorcatheter 43241 $3,759.75 $549.77Esophagogastroduodenoscopy,flexible,transoral;wUS-guidedintramural/transmuralFNA/biopsy(s) 43242 $5,176.21 $1,021.79Esophagogastroduodenoscopy,flexible,transoral;winjectionsclerosisofesophageal/gastricvarices 43243 $3,022.03 $920.41Esophagogastroduodenoscopy,flexible,transoral;withbandligationofesophageal/gastricvarices 43244 $3,906.98 $953.34Esophagogastroduodenoscopy,flexible,transoral;wdilationofgastric/duodenalstricture(s) 43245 $3,548.98 $676.41Esophagogastroduodenoscopy,flexible,transoral;wdirectedplacementpercutaneousgastrostomytube 43246 $4,008.51 $771.71Esophagogastroduodenoscopy,flexible,transoral;withremovalofforeignbody 43247 $3,080.28 $683.26Esophagogastroduodenoscopy,flex,transoral;winsertgw,passdilator(s)thruesophagusovergw 43248 $1,750.12 $641.81Esophagogastroduodenoscopy,flexible,transoral;wtransendoballoondilateesophagus(<30mmdia) 43249 $2,118.47 $593.16Esophagogastroduodenoscopy,flexible,transoral;wremvt/p/lbyhotbxforceps/bipolarcautery 43250 $3,231.50 $654.29Esophagogastroduodenoscopy,flexible,transoral;wremovaloftumor/polyp/lesion(s)bysnare 43251 $1,494.11 $758.45Esophagogastroduodenoscopy,flexible,transoral;withopticalendomicroscopy 43252 $3,510.70 $650.36Esophagogastroduodenoscopy,flex,transoral;wUS-guidedtransmuralinjorfiducialmarker 43253 $4,519.63 $1,021.79Esophagogastroduodenoscopy,flexible,transoral;withendoscopicmucosalresection 43254 $3,750.02 $1,051.26Esophagogastroduodenoscopy,flexible,transoral;withcontrolofbleeding,anymethod 43255 $3,365.47 $778.67Esophagogastroduodenoscopy,flexible,transoral;wthermaltx,fortreatmentofGERD 43257 $5,416.08 $898.94Esophagogastroduodenoscopy,flexible,transoral;wUSexameitherduodenumorjejunum 43259 $4,460.98 $877.82Endoscopicretrogradecholangiopancreatography;diagnostic,inclcollectspecimenbybrush/wash 43260 $6,286.49 $1,254.78Endoscopicretrogradecholangiopancreatography(ERCP);withbiopsy,singleormultiple 43261 $5,165.34 $1,318.33Endoscopicretrogradecholangiopancreatography(ERCP);withsphincterotomy/papillotomy 43262 $3,628.20 $1,391.25Endoscopicretrogradecholangiopancreatography(ERCP);wpressuremeasurementofsphincterofOddi 43263 $5,564.40 $1,392.68Endoscopicretrogradecholangiopancreatography;wremvcalculi/debrisfrombiliary/pancreaticduct(s) 43264 $2,306.64 $1,418.17Endoscopicretrogradecholangiopancreatography(ERCP);wdestructionofcalculi,anymethod 43265 $5,915.75 $1,689.29Esophagogastroduodenoscopy,flexible,transoral;wplacementofendoscopicstent 43266 $6,288.72 $845.50Esophagogastroduodenoscopy,flexible,transoral;wablationoftumor/polyp/lesion(s) 43270 $4,054.56 $871.78Endoscopiccannulationofpapillawithdirectvisualizationofpancreatic/commonbileduct(s) 43273 $4,410.66 $467.78Endoscopicretrogradecholangiopancreatography;wplacestentintobiliary/pancreaticduct,eastent 43274 $4,652.50 $1,804.83Endoscopicretrogradecholangiopancreatography;wremvforeignbody/stentfrombiliary/pancreaticduct 43275 $2,456.79 $1,466.78Endoscopicretrogradecholangiopancreatography;wremv/exchgstent,biliary/pancreaticduct,eastent 43276 $6,414.74 $1,879.64Endoscopicretrogradecholangiopancreatography;wdilatebiliary/pancreaticduct(s)/ampulla,eaduct 43277 $5,443.78 $1,475.02Endoscopicretrogradecholangiopancreatography(ERCP);wablationt/p/l(s),inclpre/post-dilation 43278 $4,781.25 $1,687.79Laparoscopy,surgical,esophagogastricfundoplasty(eg,Nissen,Toupetprocedures) 43280 $3,796.94Laparoscopy,surg,repairparaesophagealhernia,inclfundoplasty,ifperformed;w/oimplantationmesh 43281 $5,454.31DilateEsophagus,overguidewire 43453 $2,943.02 $328.49Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,inclileum;diagnostic 43453 $2,943.02 $328.49Gastrectomy,partial,distal;withgastrojejunostomy 43632 $7,628.46Naso-/oro-gastrictubeplacement,requirephysicianskill+fluoroguid(inclfluoro,imagdoc,rpt) 43752 $609.55 $159.82GastricTubeInsertion 43754 $985.37Changeofgastrostomytube,percutaneous,withoutimagingorendoscopicguidance 43760 $732.87 $181.36Laparoscopy,surg,gastricrestrictprocedure;removeadjustablegastricrestrictdevicecomponent 43772 $3,524.21
Gastrorrhaphy,sutureofperforatedduodenalorgastriculcer,wound,orinjury 43840 $5,061.45Enterolysis(freeingofintestinaladhesion)(separateprocedure) 44005 $4,099.74Reductionofvolvulus,intussusception,internalhernia,bylaparotomy 44050 $3,288.84Enterectomy,resectionofsmallintestine;singleresectionandanastomosis 44120 $4,570.02Enterectomy,resectionofsmallintestine;withenterostomy 44125 $4,370.92Colectomy,partial;withanastomosis 44140 $5,026.15Colectomy,partial;withendcolostomyandclosureofdistalsegment(Hartmanntypeprocedure) 44143 $6,150.15Colectomy,partial,withremovalofterminalileumwithileocolostomy 44160 $4,635.86Laparoscopy,surgical,enterolysis(freeingofintestinaladhesion)(separateprocedure) 44180 $3,422.75Laparoscopy,surgical;colectomy,partial,withanastomosis 44204 $5,448.03Laparoscopy,surgical;colectomy,partial,w/anastomosis,w/coloproctostomy(lowpelvicanastomosis) 44207 $6,895.24Laparoscopy,surg,mobilization(take-down)splenicflexureperformedinconjw/partialcolectomy 44213 $719.92Placement,enterostomy/cecostomy,tubeopen(eg,forfeeding/decompress) 44300 $3,137.88Ileostomyorjejunostomy,non-tube 44310 $3,924.97Colostomyorskinlevelcecostomy; 44320 $4,226.09Smallintestinalendoscopy,enteroscopybeyond2ndportionofduodenum,notincludingileum;dx 44360 $3,632.95 $555.45Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;wbiopsy,1or> 44361 $3,815.64 $614.16Smallintestinalendoscopy,enteroscopybeyond2ndportionofduodenum,notinclileum;wremvforeign 44363 $3,360.54 $741.96Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;wsnareremoval 44364 $3,730.34 $792.54Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;whotbx/bpcaut 44365 $3,314.19 $701.10Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;wcontrolbleed 44366 $4,516.11 $932.41Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;wablation 44369 $4,091.84 $955.93Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;wtransendostent 44370 $6,728.89 $1,030.48Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;wplacepercJT 44372 $4,618.51 $930.72Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,notinclileum;convertGTtoJT 44373 $4,224.13 $741.88Smallintestinalendoscopy,enteroscopybeyond2ndportionofduodenum,inclileum;wbiopsy,1/> 44377 $3,911.75 $1,164.18Smallintestinalendoscopy,enteroscopybeyond2ndportionofduodenum,inclileum;wcontrolbleed 44378 $5,010.64 $1,499.34Smallintestinalendoscopy,enteroscopybeyond2ndportionduodenum,inclileum;wtransendostent 44379 $12,111.25 $1,592.21Ileoscopy,throughstoma;diagnostic,worw/ocollectionofspecimen(s)bybrushingorwashing 44380 $2,801.94 $213.33Ileoscopy,throughstoma;withbiopsy,singleormultiple 44382 $3,063.36 $279.11Endoscopicevaluationofsmallintestinalpouch;diagnostic,w/w-ocollectspecimenbybrush/washing 44385 $2,853.02 $275.00Endoscopicevaluationofsmallintestinal(abdominalorpelvic)pouch;wbiopsy,singleormultiple 44386 $3,078.44 $340.80Colonoscopythroughstoma;diagnostic,worw/ocollectionofspecimen(s)bybrushingorwashing 44388 $3,234.29 $600.09Colonoscopythroughstoma;withbiopsy,singleormultiple 44389 $3,471.28 $662.61Colonoscopythroughstoma;withremovalofforeignbody 44390 $3,807.64 $817.17Colonoscopythroughstoma;wcontrolofbleeding 44391 $3,010.74 $892.68Colonoscopythroughstoma;wremovaloftumor/polyp/lesion(s)byhotbxforcepsorbipolarcautery 44392 $3,161.68 $764.64Colonoscopythroughstoma;withremovaloftumor(s),polyp(s),orotherlesion(s)bysnaretechnique 44394 $3,425.33 $872.36Suturelargeintestineforperforatedulcer/diverticulum/wnd/injury/rupture(1/<perfs);w/ocolostomy 44604 $3,567.30Closureenterostomy,large/smallintestine;w/Resect+anastomosisotherthancolorectal 44625 $3,602.13Closureenterostomy,large/smallintestine;w/Resect+colorectalanastomosis 44626 $6,020.34Appendectomy; 44950 $10,500.28 $2,384.83Appendectomy;forrupturedappendixwithabscessorgeneralizedperitonitis 44960 $3,261.16Laparoscopy,surgical,appendectomy 44970 $9,797.78 $2,215.72Exciserectaltumor,transanalapproach;notinclmuscularispropria(ie,partialthick) 45171 $1,976.43Excisionofrectaltumor,transanalapproach;includingmuscularispropria(ie,fullthickness) 45172 $3,021.64Proctosigmoidoscopy,rigid;diagnostic,worw/ocollectionofspecimen(s)bybrushingorwashing 45300 $340.19 $200.88Proctosigmoidoscopy,rigid;withdilation(eg,balloon,guidewire,bougie) 45303 $5,070.98 $324.86Proctosigmoidoscopy,rigid;withbiopsy,singleormultiple 45305 $5,356.59 $273.69Proctosigmoidoscopy,rigid;withremovalofforeignbody 45307 $5,777.14 $366.00Proctosigmoidoscopy,rigid;wremovalofsingletumor/polyp/lesionbyhotbxforceps/bipolarcautery 45308 $10,299.47 $310.05Proctosigmoidoscopy,rigid;withremovalofsingletumor,polyp,orotherlesionbysnaretechnique 45309 $5,359.36 $330.56
Proctosigmoidoscopy,rigid;wremovalofmultipletumors,polyps,orotherlesionsbyHBX/BPC/Snare 45315 $5,351.39 $391.89Proctosigmoidoscopy,rigid;wcontrolofbleeding 45317 $3,923.23 $424.79Proctosigmoidoscopy,rigid;wablationoftumor/polyp/lesion(s) 45320 $8,148.86 $387.37Proctosigmoidoscopy,rigid;withdecompressionofvolvulus 45321 $5,568.69 $379.68ENDO-PROCTOSIGMOIDOSCOPYWSTENT 45327 $12,111.25 $431.24Sigmoidoscopy,flexible;diagnostic,withorwithoutcollectionofspecimen(s)bybrushingorwashin 45330 $2,183.77 $210.65Sigmoidoscopy,flexible;diagnostic,withorw/ocollectionofspecimen(s)bybrushingorwashing 45330 $2,183.77 $210.65Sigmoidoscopy,flexible;withbiopsy,singleormultiple. 45331 $2,030.85 $273.49Sigmoidoscopy,flexible;withbiopsy,1ormore 45331 $2,030.85 $273.49Sigmoidoscopy,flexible;withremovalofforeignbody 45332 $3,558.28 $402.39Sigmoidoscopy,flexible;wremovaloftumor/polyp/lesion(s)byhotbiopsyforcepsorbipolarcautery 45333 $2,838.80 $358.26Sigmoidoscopy,flexible;wcontrolofbleeding 45334 $3,458.97 $452.97Sigmoidoscopy,flexible;withdirectedsubmucosalinjection(s),anysubstance 45335 $2,371.68 $251.76Sigmoidoscopy,flexible;withdecompressionofvolvulus,anymethod 45337 $2,790.40 $447.05Sigmoidoscopy,flexible;withremovaloftumor(s),polyp(s),orotherlesion(s)bysnaretechnique 45338 $3,164.58 $462.63Sigmoidoscopy,flexible;withdilationbyballoon,1ormorestrictures 45340 $3,284.57 $295.50Sigmoidoscopy,flexible;withendoscopicultrasoundexamination 45341 $3,940.37 $477.30Sigmoidoscopy,flexible;wtransendoscopicUSguidedintramuralortransmuralFNA/biopsy(s) 45342 $4,712.35 $656.81Sigmoidoscopy,flexible;withbandligation(s)(eg,hemorrhoids) 45350 $385.99Colonoscopy,flexible,proximaltosplenicflexure;diagnostic,w/w-ocollectspecimenbybrush/wash 45378 $2,413.32 $714.20Colonoscopy,flexible,proximaltosplenicflexure;withremovalofforeignbody 45379 $3,585.10 $925.88Colonoscopywbiopsy,singleormultiple 45380 $2,477.86 $776.77Colonoscopy,flexible,proximaltosplenicflexure;withbiopsy,singleormultiple 45380 $2,477.86 $776.77Colonoscopy,flexible,proximaltosplenicflexure;wdirectedsubmucosalinjection(s),anysubstance 45381 $1,794.61 $777.16Colonoscopy,flexible,proximaltosplenicflexure;wcontrolofbleeding 45382 $3,546.00 $1,006.40Colonoscopy,flex,proximaltosplenicflexure;wremvtumor/p/l(s)byhotbxforceps/bipolarcautery 45384 $3,036.69 $881.22Colonoscopy,flexible,proximaltosplenicflexure;wremovaloftumor/polyp/lesion(s)bysnare 45385 $2,429.29 $986.92Colonoscopy,flexible,proximaltosplenicflexure;withdilationbyballoon,1ormorestrictures 45386 $3,237.64 $819.69Colonoscopy,flexible;wablationoftumor(s),polyp(s),orotherlesion(s) 45388 $1,049.25Colonoscopy,flexible,proximaltosplenicflexure;withendoscopicultrasoundexamination 45391 $3,762.99 $1,001.57Colonoscopy,flex,proximaltosplenicflexure;wtransendoUSguidedintramural/transmuralFNA/bx(s) 45392 $3,603.34 $1,181.78Colonoscopy,flexible;w/bandligation(s)(eg,hemorrhoids) 45398 $2,789.65 $909.12Repairofrectocele(separateprocedure) 45560 $2,449.31Anorectalexam,surgical,requiringanesthesia(general,spinal,orepidural),diagnostic 45990 $509.23 $404.07Unlistedprocedure,rectum 45999 $0.01Placementofseton 46020 $6,426.14 $846.09Incisionanddrainageofischiorectaland/orperirectalabscess(separateprocedure) 46040 $5,324.69 $1,494.59Incisionanddrainageofischiorectaland/orperirectalabscess 46040 $5,324.69 $1,494.59Incision+drainageintramural,intramuscular,/submucosalabscess,transanal,underanes 46045 $4,037.00 $1,577.30Incisionanddrainageperianalabscess,superficial 46050 $3,257.11 $352.17Sphincterotomy,anal,divisionofsphincter(separateprocedure) 46080 $593.40Incisionofthrombosedhemorrhoid,external 46083 $843.49 $388.93Excisionofsingleexternalpapillaortag,anus 46220 $5,376.34 $431.74Hemorrhoidectomy,internal,byrubberbandligation(s) 46221 $2,661.79 $687.70Hemorrhoidectomy,internal,byrubberbandligation(s) 46221 $2,661.79 $687.70Excisionofmultipleexternalpapillaeortags,anus 46230 $4,796.69 $637.64Excisionofmultipleexternalpapillaeortags,anus 46230 $4,796.69 $637.64Hemorrhoidectomy,external,2ormorecolumns/groups 46250 $6,135.11 $1,143.11Hemorrhoidectomy,internalandexternal,singlecolumn/group; 46255 $1,624.02 $1,289.96Hemorrhoidectomy,internalandexternal,singlecolumn/group;withfissurectomy 46257 $6,436.89 $1,530.15Hemorrhoidectomy,internal&external,1column/group;wfistulectomy,inclfissurectomy,whenperform 46258 $8,517.09 $1,677.92Hemorrhoidectomy,internalandexternal,2ormorecolumns/groups; 46260 $7,866.20 $1,735.51
Hemorrhoidectomy,internalandexternal,2ormorecolumns/groups;withfissurectomy 46261 $7,734.37 $1,923.23Hemorrhoidectomy,internal&external,2or>columns/groups;wfistulectomy,inclfissurectomy 46262 $7,107.33 $2,028.17Surgicaltreatmentofanalfistula(fistulectomy/fistulotomy);subcutaneous 46270 $5,865.30 $1,407.96Excisionofthrombosedhemorrhoid,external 46320 $5,849.26 $408.37Anoscopy;diagnostic,withorwithoutcollectionofspecimen(s)bybrushingorwashing 46600 $265.74 $149.29Anoscopy;diagnostic,withorw/ocollectionofspecimen(s)bybrushingorwashing 46600 $265.74 $149.29Anoscopy;withdilation(eg,balloon,guidewire,bougie) 46604 $4,355.97 $248.34Anoscopy;withbiopsy,singleormultiple 46606 $5,116.78 $283.83Anoscopy;withremovalofforeignbody 46608 $4,207.37 $308.22Anoscopy;wremovalofsingletumor,polyp,orotherlesionbyhotbiopsyforcepsorbipolarcautery 46610 $7,345.59 $302.37Anoscopy;withremovalofsingletumor,polyp,orotherlesionbysnaretechnique 46611 $3,102.10 $304.75Anoscopy;wremovalofmultipletumors/polyps/lesionsbyhotbxforceps,bipolarcauteryorsnare 46612 $5,921.16 $342.73Anoscopy;wcontrolofbleeding 46614 $3,731.50 $240.87Anoscopy;wablationoftumor/polyp/lesion(s) 46615 $6,403.24 $345.78Destructionoflesion(s),anus,simple;chemical 46900 $1,426.11 $503.28Destructionoflesion(s),anus,simple;electrodesiccation 46910 $5,162.58 $490.54Destructionoflesion(s),anus,simple;cryosurgery 46916 $577.30 $524.17Destructionoflesion(s),anus,simple;lasersurgery 46917 $5,159.23 $489.59Destructionoflesion(s),anus,simple;surgicalexcision 46922 $6,130.58 $494.08Destructionoflesion(s),anus,extensive 46924 $6,439.54 $680.41Destructinternalhemorrhoid(s)bythermalenergy 46930 $3,776.04 $524.14Curettageorcauteryofanalfissure,includingdilationofanalsphincter;initial 46940 $5,480.98 $546.87Curettageorcauteryofanalfissure,includingdilationofanalsphincter;subsequent 46942 $1,650.50 $490.06Hemorrhoidectomy,internal,byligationotherthanrubberband;singlehemorrhoidcolumn/group 46945 $5,239.67 $793.94Hemorrhoidectomy,internal,byligationotherthanrubberband;2ormorehemorrhoidcolumns/groups 46946 $6,236.21 $805.64Hemorrhoidopexy(eg,forprolapsinginternalhemorrhoids)bystapling 46947 $7,932.12 $1,397.42Unlistedprocedure,anus 46999 $4,570.46Biopsyofliver,needle;percutaneous 47000 $2,612.45 $349.05Biopsyofliver,wedge 47100 $3,103.17XRCholangiogramwithExistingAccess 47531 $1,469.32XRCholangiogramwithExistingAccess-Report 47531 $275.33Laparoscopy,surgical;cholecystectomy 47562 $4,497.33 $2,429.24Laparoscopy,surgical;cholecystectomywithcholangiography 47563 $10,288.38 $2,640.83Cholecystectomy; 47600 $3,959.67Cholecystectomy;withcholangiography 47605 $3,935.22Reopeningofrecentlaparotomy 49002 $3,900.02Abdominalparacentesis(diagnosticortherapeutic);withoutimagingguidance 49082 $1,218.68 $281.42Abdominalparacentesis(diagnosticortherapeutic);withimagingguidance 49083 $1,471.42 $421.63Abdominalparacentesis;withimagingguidance 49083 $1,471.42 $421.63CTParacentesiswithImagingGuidance 49083 $1,471.42CTParacentesiswithImagingGuidance-Report 49083 $421.63USParacentesiswithImagingGuidance 49083 $1,471.42USParacentesiswithImagingGuidance-Report 49083 $421.63Laparoscopy,abdomen,peritoneum,+omentum,diag,w/orw/ocollectspecimen(s)bybrushing/washing 49320 $1,206.89Unlistedlaparoscopyprocedure,abdomen,peritoneumandomentum 49329 $1,206.58CTGuide-PercDrainVisceralwithCath 49405 $2,180.78CTGuide-PercDrainVisceralwithCath-Report 49405 $784.61USGuide-PercDrainVisceralwithCath 49405 $2,180.78USGuide-PercDrainVisceralwithCath-Report 49405 $784.61Image-guidedfluidcollectiondrainagebycatheter;peritonealorretroperitoneal,percutaneous 49406 $784.61CTGuide-PercDrain(Retro)Peritoneal 49406 $4,619.62CTGuide-PercDrain(Retro)Peritoneal-Report 49406 $784.61
USGuide-PercDrain(Retro)Peritoneal 49406 $4,619.62USGuide-PercDrain(Retro)Peritoneal-Report 49406 $784.61XRPercInsertofGastroTubewFluoro 49440 $3,197.43XRPercutaneousInsertionofGastrostomyTubewithFluoroscopyGuidanceIncludingContrast-Report 49440 $810.06XRPercReplaceColonicTubewFluoro 49450 $1,925.52XRReplacementofGastrostomyorCecostomyorOtherColonicTubeunderFluorowContrastInjection-Report 49450 $263.89XRPercReplaceJorDTubewFluoro 49451 $2,308.58XRPercutaneousReplacementofDuodenostomyorJejunostomyTubewithFluoroGuidanceIncludingContr-Report 49451 $357.45XRPercReplaceGastro-JTubewFluoro 49452 $2,092.99XRPercutaneousReplacementofGastro-JejunostomyTubewFluoroGuidanceIncludingContrast-Report 49452 $552.60XRPercInjEvalExistingcolonicTube 49465 $869.46XRPercutaneousContrastInjectionsforRadiologicEvaluationofExistingColonicTube-Report 49465 $122.42Repairinitialinguinalhernia,age5yearsorolder;reducible 49505 $1,910.63Repairinitialinguinalhernia,age5yearsorolder;incarceratedorstrangulated 49507 $2,165.00Repairrecurrentinguinalhernia,anyage;reducible 49520 $2,330.29Repairinitialincisionalorventralhernia;reducible 49560 $2,741.95Repairinitialincisionalorventralhernia;incarceratedorstrangulated 49561 $3,452.99Repairrecurrentincisionalorventralhernia;reducible 49565 $6,091.53 $2,842.97Implantmesh/othprosthesis4opnincis/ventralherniarpr/meshforclosdbrd4necrotizingsfttiss 49568 $1,009.22Repairumbilicalhernia,age5yearsorolder;reducible 49585 $6,049.31 $1,626.57Repairumbilicalhernia,age5yearsorolder;incarceratedorstrangulated 49587 $1,747.53Laparoscopy,surgical;repairinitialinguinalhernia 49650 $1,575.18Laparoscopy,surgical;repairrecurrentinguinalhernia 49651 $2,038.87Laparoscopy,surg,repair,ventral,umbilical,spigelian/epigastrichernia;reducible 49652 $13,995.59 $2,749.15Laparoscopy,surg,rpr,ventral/umbilical/spigelian/epigastrichernia;incarcerated/strangulated 49653 $14,718.00 $3,431.70Laparoscopy,surgical,repair,incisionalhernia(inclmeshInsert,ifperformed);reducible 49654 $2,961.87Laparoscopy,surgical,repair,incisionalhernia;incarceratedorstrangulated 49655 $3,617.95Laparoscopy,surgical,repair,recurrentincisionalhernia(includesmeshinsertionwhenused);reduc 49656 $3,212.74Unlistedlaparoscopyprocedure,hernioplasty,herniorrhaphy,herniotomy 49659 $900.00Suture,secondary,ofabdominalwallforeviscerationordehiscence 49900 $2,995.61Ureterorrhaphy,sutureofureter(separateprocedure) 50900 $3,250.08Aspirationofbladder;withinsertionofsuprapubiccatheter 51102 $6,028.96 $559.25InjforVCUG/Cystography 51600 $758.00Injectionprocedureforretrogradeurethrocystography 51610 $829.52 $244.10Bladderirrigation,simple,lavageand/orinstillation 51700 $713.99 $136.84Irrigated-UrinaryCatheterActivityType 51700 $713.99Insertionofnon-indwellingbladdercatheter(eg,straightcatheterizationforresidualurine). 51701 $164.57 $99.52StraightCatheter 51701 $164.57Catheter;urinary(straight/ua) 51701 $164.57Insertionoftemporaryindwellingbladdercatheter;simple(eg,Foley). 51702 $285.99 $99.52Catheter;urinary(ieFoley) 51702 $285.99Inserted-GastricTubeActivity 51702 $285.99Inserted-UrinaryCatheterActivityType 51702 $285.99Insertionoftemporaryindwellingbladdercather;complicated 51703 $592.40 $298.18Changeofcystostomytube;simple. 51705 $731.40 $198.17Endoscopicinjectionofimplantmaterialintosubmucosaltissuesoftheurethraand/orbladderneck 51715 $6,831.68 $771.29Measurementofpost-voidingresidualurineand/orbladdercapacitybyultrasound,non-imaging 51798 $232.45 $47.12Postvoidmeasureand/orbladderscan 51798 $232.45Cystourethroscopy 52000 $1,199.89 $380.35Cystourethroscopy 52000 $1,199.89 $380.35Drainageofdeepperiurethralabscess 53040 $5,359.01 $1,488.62Destructionoflesion(s),penis(eg,condyloma,papilloma,molluscumcontagiosum,herpeticvesicle), 54050 $291.58 $383.29
Destructionoflesion(s),penis(eg,condyloma,papilloma,molluscumcontagiosum,herpeticvesicle), 54055 $3,840.31 $339.77Destructionoflesion(s),penis,simple;cryosurgery. 54056 $351.46 $398.49Circumcision,usingclamporotherdevicewithregionaldorsalpenileorringblock. 54150 $4,592.80 $380.07Done-NewbornCircumcision 54150 $4,592.80 $380.07Circumcision,neonate,surgicalexcisionw/deviceotherthanclamp,ordorsalslit 54160 $5,048.91 $550.81Circumcision,surgExciseotherthanclamp,device,/dorsalslit;neonate(28daysage/<) 54160 $5,048.91 $550.81Circumcision,olderthan28d,surgicalexcisionw/deviceotherthanclamp,ordorsalslit 54161 $7,181.36 $746.94Circumcision,surgicalexcisionotherthanclamp,device,ordorsalslit;olderthan28daysofage 54161 $7,181.36 $746.94Explorationforundescendedtestis(inguinalorscrotalarea) 54450 $1,423.32 $267.19Drainageofscrotalwallabscess 55100 $2,028.13 $615.57Vasectomy,unilateralorbilateral,includingpostoperativesemenexamination(s) 55250 $5,058.68 $848.79Excisionoflesionofspermaticcord(separateprocedure) 55520 $1,656.53Incisionanddrainageofvulvaorperinealabscess. 56405 $1,075.86 $394.71LanceandDebridementVulvaorPerinealAbscess 56405 $1,075.86 $394.71LanceandDebridementBartholin'sglandabscess 56420 $804.38 $338.57MarsupializationofBartholin'sglandcyst. 56440 $5,087.96 $676.39CondylomaTreatment 56501 $5,372.69 $418.98Destructionoflesion(s),vulva;simple 56501 $5,372.69 $418.98Destructionoflesion(s),vulva;extensive 56515 $6,205.49 $742.97Biopsyvulva/perin(sepproc)1lesion 56605 $1,695.26 $229.97Biopsyvulva/perin,eachadd'llesion 56606 $1,470.23 $114.04Vulvectomysimple;partial 56620 $1,797.92Partialhymenectomyorrevisionofhymenalring 56700 $5,570.36 $691.15ExcisionofBartholinsglandorcyst 56740 $1,132.9856820-COLPOSCOPYOFVULVA 56820 $545.64 $326.22Colposcopyofthevulva;withbiopsy(s) 56821 $1,833.99 $437.69Incisionanddrainageofvaginalhematoma;non-obstetrical(eg,post-trauma,spontaneousbleeding) 57023 $5,669.79 $1,157.7557061Destroyvaginallesions,simple 57061 $6,499.87 $355.80Biopsyvaginalmucosa,simple 57100 $3,635.79 $254.14Fittingandinsertionofpessaryorotherintravaginalsupportdevice. 57160 $274.26 $179.96Pessary/OtherDeviceInsert/Fit 57160 $274.26 $179.96Diaphram/CervicalCapFit 57170 $212.32 $185.90Colpopexy,abdominalapproach 57280 $3,408.54Pelvicexaminationunderanesthesia(otherthanlocal) 57410 $5,663.09 $401.69Colposcopyoftheentirevagina,withcervixifpresent;withbiopsy(s)ofvagina/cervix 57421 $469.09Colposcopyoftheentirevagina,withcervixifpresent;withbiopsy(s)ofvagina/cervix 57421 $3,599.20 $469.09Colpo(sepproc) 57452 $930.58 $344.55Colposcopyofthecervixincludingupper/adjacentvagina. 57452 $930.58 $344.55ColpoCervBiopsy&EndocervicalCurettage 57454 $1,100.89 $511.82Colposcopyofthecervixincludingupper/adjacentvagina;w/Bxofcervix&endocervicalcurettage 57454 $1,100.89 $511.82ColpowithBiopsy 57455 $1,049.06 $420.66ColpowithEndocervicalcurettage 57456 $925.04 $391.50Colposcopyofthecervixincludingupper/adjacentvagina;withendocervicalcurettage. 57456 $925.04 $391.50colpoLEEP 57460 $5,046.42 $613.57LEEP/Conization 57461 $5,087.96 $713.54BiopsyCervixOne/Multiorlocalexcisionw/wofulguration 57500 $3,309.89 $282.51Biopsyofcervix,singleormultiple,orlocalexcisionoflesion,withorwithoutfulguration 57500 $3,309.89 $282.51Endocervicalcurettage 57505 $3,214.75 $332.99Conizationcervix,w/orw/ofulguration,dilation+curettage,orrepair;loopelectrodeexcise 57522 $852.76Dilationofcervicalcanal,instrumental 57800 $5,979.26 $180.85EndometrialBiopsy 58100 $843.49 $330.50Endometrialand/orEndocervBiopsy 58100 $843.49 $330.50
Endometrialsampling(biopsy)withorwithoutendocervicalsampling(biopsy),w/ocervicaldilation 58100 $843.49 $330.50EndoBiopsyinconjunctionw/colpo 58110 $1,413.26 $156.74Totalabdhysterectomy(corpus+cervix),w/orw/oRemovetube(s),w/orw/oRemoveovary(s); 58150 $18,903.02 $3,799.59Vaginalhysterectomy,foruterus250gorless;withrepairofenterocele 58270 $3,308.9658300Insertionofintrauterinedevice(IUD) 58300 $480.95 $245.57IUDInsert 58300 $480.95 $245.57Insertionofintrauterinedevice(IUD) 58300 $480.95 $245.57Removalofintrauterinedevice(IUD) 58301 $1,862.37 $258.47CatheterizationandintroductionsalineorcontrastmaterialforSISorhysterosalpingography 58340 $216.21HSGorSISInj&Cath 58340 $566.85 $216.21Hysteroscopy,surgical;w/sampling(bx)endometrium+/orpolypectomy,w/orw/oD&C 58558 $6,274.77 $890.27TubalSterilizationImplantPermanent 58565 $7,469.59 $1,616.31Ligationortransectionoffallopiantube(s),abdominalorvaginalapproach,unilateralorbilateral 58600 $1,352.54Ligation/transectionfallopiantube(s),abd/vaginalapp,postpartum,unilat/bilat,duringsamestay 58605 $1,220.32Ligation/transectionfallopiantube(s)whendoneatthetimecesareandelivery/intra-abdsurg 58611 $3,951.54 $293.65Laparoscopy,surgical;withlysisofadhesions(salpingolysis,ovariolysis)(separateprocedure) 58660 $2,386.42Laparoscopy,surg;w/Removeadnexalstructures(partial/totaloophorectomy+/orsalpingectomy) 58661 $2,442.59Laparoscopy,surg;w/fulguration/exciselesionsovary,pelvicviscera,/peritonealsurface,anymethod 58662 $2,501.76Laparoscopy,surgical;withfulgurationofoviducts(withorwithouttransection) 58670 $1,355.31Salpingectomy,completeorpartial,unilateralorbilateral(separateprocedure) 58700 $2,901.07Salpingo-oophorectomy,completeorpartial,unilateralorbilateral(separateprocedure) 58720 $2,744.85Oophorectomy,partialortotal,unilateralorbilateral; 58940 $1,938.10FetalContractionStressTest 59020 $704.95 $245.50Fetalnon-stresstest 59025 $169.20FetalNonstressTest 59025 $244.87Transabdominalamnioinfusion,includingultrasoundguidance 59070 $1,312.32 $1,147.03Laparoscopictreatmentofectopicpregnancy;withoutsalpingectomyand/oroophorectomy 59150 $7,719.85 $2,829.76Laparoscopictreatmentofectopicpregnancy;withsalpingectomyand/oroophorectomy 59151 $13,157.27 $2,757.11Curettage,postpartum 59160 $4,424.11 $637.98Insertionofcervicaldilator(eg,laminaria,prostaglandin)(separateprocedure) 59200 $1,117.20 $167.97Episiotomyorvaginalrepair,byoththanattending 59300 $6,237.93 $547.43Episiotomyorvaginalrepair,byotherthanattendingphysician 59300 $6,237.93 $547.43Routineobstetriccareincludingantepartumcare,vaginaldelivery&postpartumcare 59400 $8,988.00Vaginaldeliveryonly(withorwithoutepisiotomyand/orforceps) 59409 $3,963.82 $3,050.18Vaginaldeliveryonly(withorwithoutepisiotomyand/orforceps);includingpostpartumcare 59410 $3,477.28ExternalCephalicVersion-ECV 59412 $1,790.46 $382.86Externalcephalicversion,withorwithouttocolysis 59412 $1,790.46 $382.86Deliveryofplacenta(separateprocedure) 59414 $6,237.93 $343.30Antepartumcareonly;4-6visits 59425 $1,334.98AntepartumCare4-6Visits 59425 $1,334.98Postpartumcareonly(separateprocedure) 59430 $560.88 $522.29PostpartumCareonly 59430 $522.2959510OBAntepartumCareCesareanDLVR&Postpartum 59510 $9,969.00Cesareandeliveryonly; 59514 $12,348.20 $3,430.06Subtotal/totalhysterectomyaftercesareandelivery 59525 $1,815.54Routineobstetriccareinclantecare,vagdeliv,+postpartum,afterprevcesarian 59610 $8,039.48Vaginaldeliveryonly,afterpreviouscesareandelivery(withorwithoutepisiotomyand/orforceps); 59612 $3,053.50Treatmentofincompleteabortion,anytrimester,completedsurgically 59812 $6,004.95 $1,079.04Treatmentofmissedabortion,completedsurgically;firsttrimester 59820 $6,015.01 $1,284.54Treatmentofmissedabortion,completedsurgically;firsttrimester 59820 $6,015.01 $1,284.54Treatmentofmissedabortion,completedsurgically;secondtrimester 59821 $4,597.28 $1,294.87Treatmentofsepticabortion,completedsurgically 59830 $4,223.02 $1,594.86
Inducedabortion,bydilationandevacuation 59841 $6,810.45 $1,325.00Inducedabortion,by1/>vaginalsuppositoriesw/orw/ocervicaldilation,inclhospitaladmit 59855 $1,428.61Partialthyroidlobectomy,unilateral;withourwithoutisthmusectomy 60210 $14,822.45 $2,619.03Totalthyroidlobectomy,unilateral;withorwithoutisthmusectomy 60220 $2,617.54Excisionofthyroglossalductcystorsinus; 60280 $1,615.78Spinalpuncture,lumbar,diagnostic 62270 $1,244.25 $296.43LumbarPuncture-Diagnostic 62270 $1,244.25Spinalpuncture,therapeutic,fordrainageofcerebrospinalfluidbyneedleorcatheter 62272 $1,638.86 $311.28LumbarPuncture-Therapeutic 62272 $1,638.86Injection,epidural,ofbloodorclotpatch 62273 $1,836.59 $439.34INJSpineMylogram/CTNonC1-2 62284 $1,374.91XRMyelographyCervical-LumbarInj 62302 $2,238.63XRMyelographyCervical-LumbarInj-Report 62302 $476.30XRMyelographyThoracic-LumbarInj 62303 $2,238.63XRMyelographyThoracic-LumbarInj-Report 62303 $479.65XRMyelographyLumbosacral-LumbarInj 62304 $1,100.01XRMyelographyLumbosacral-LumbarInj-Report 62304 $467.36XRMyelographyMin2Areas-LumbarInj-Report 62305 $488.66Injection,single,excludingneurolyticsubstances,worw/ocont,diagnosticortherapeuticsubstan 62320 $2,744.57 $498.28Injectdxortherapeuticsubstance,notinclneurolytic,epiduralorsubarachnoid;cervical/thoracic 62320 $2,744.57 $498.28Injcdxthersubsnotinclneurlyticsubsincnedlcatplcmintrlmnlepisubarlmbrsacrlw/imgegd 62321 $419.51Injectdxortxsubstance,notinclneurolyticsubstance,epiduralorsubarachnoid;lumbarorsacral 62322 $1,206.07 $335.02Injcdxthersubsnotinclneurlyticsubsinclnedlcatplcmintrlmepisublmbrsacrlw/oimgegde 62322 $1,206.07 $335.02Injcdxthersubsnotinclneurlyticsubsinclnedlcatplcmintrlmnrepisublmbrsacrlw/imgegde 62323 $1,382.64 $384.07XRMyelographyMin2Areas-LumbarInj 62350 $2,238.63Injection,anestheticagent;trigeminalnerve,anydivisionorbranch 64400 $645.18 $262.41Injection,anestheticagent;facialnerve. 64402 $852.42 $295.53Injection,anestheticagent;facialnerve 64402 $852.42 $295.5364405-InjAnesth;greateroccipitalnerveblock 64405 $1,414.94 $230.64Injection,anestheticagent;greateroccipitalnerve 64405 $1,414.94 $230.64Injection,anestheticagent;greateroccipitalnerve 64405 $1,414.94 $230.64Injection,anestheticagent;vagusnerve 64408 $645.18 $324.71Injection,anestheticagent;phrenicnerve 64410 $1,784.54 $291.03Injection,anestheticagent;cervicalplexus 64413 $1,416.59 $306.12Injection,anestheticagent;brachialplexus,single 64415 $1,784.51 $260.06Injection,anestheticagent;brachialplexus,continuousinfusionbycathete 64416 $1,784.54 $316.67Injection,anestheticagent;axillarynerve 64417 $1,784.53 $275.23Injection,anestheticagent;suprascapularnerve 64418 $1,416.59 $289.80Injection,anestheticagent;intercostalnerve,single 64420 $1,416.59 $257.71Injection,anestheticagent;intercostalnerves,multiple,regionalblock 64421 $1,784.54 $352.84Injection,anestheticagent;ilioinguinal,iliohypogastricnerves 64425 $1,724.96 $359.94Injection,anestheticagent;ilioinguinal,iliohypogastricnerves 64425 $1,724.96 $359.94Injection,anestheticagent;pudendalnerve 64430 $1,784.54 $310.86Injection,anestheticagent;paracervical(uterine)nerve 64435 $1,416.59 $314.83Injection,anestheticagent;sciaticnerve,single 64445 $1,416.58 $282.24Injection,anestheticagent;femoralnerve,single 64447 $1,416.58 $265.03Injection,anestheticagent;femoralnerve,continuous 64448 $86.03Injection,anestheticagent;otherperipheralnerveorbranch. 64450 $1,416.59 $171.24Injection,anestheticagent;otherperipheralnerveorbranch 64450 $1,416.59 $171.24Injection(s),anestheticagentand/orsteroid,plantarcommondigitalnerve(s) 64455 $642.00 $138.23Paravertebralblock(PVB)(paraspinousblock),thoracic;singleinjectionsite 64461 $1,416.59 $339.88Paravertebralblock(PVB)(paraspinousblock),thoracic;continuousinfusionbycatheter 64463 $1,416.59 $352.70
Inj(s),anestheticagent+/orsteroid,transforaminalepidural,w/imagguid;cervical/thoracic,single 64479 $1,784.53 $503.44Injectanestheticagentand/orsteroid,transforaminalepidural,wfluoro/CT;lumbar/sacral,1level 64483 $1,784.54 $425.65Inj(s),anesagent+/orsteroid,transforaminalepidural,w/imagguid;lumbar/sacral,singlelevel 64483 $1,784.54 $425.65Injectanestheticagent/steroid,transforaminalepidural,wfluoro/CT;lumbarorsacral,eaaddlevel 64484 $1,694.79 $201.75Transversusabdominisplane(TAP)block(abdominalplane/rectussheathblock)unilat;byinjection 64486 $222.89Transversusabdominisplane(TAP)block(abdominalplane/rectussheathblock)bilat;byinjection 64488 $292.49Injection(s),diagnosticortherapeuticagent,paravertebralfacetjoint,cervica/thoracic;1stlevel 64490 $1,784.54 $404.29Injection,dx/therapeutic,paravertebralfacetjoint,cervical/thoracic;singlelevel 64490 $1,784.54 $404.29Injection(s),diagnosticortherapeuticagent,paravertebralfacetjoint,cervical/thoracic;2ndlvl 64491 $1,571.23 $233.92Injection(s),diagnostic/therapeuticagent,paravertebralfacetjnt,cervical/thoracic;3rd/addlvl 64492 $1,501.99 $236.16Inject,dxortxagent,paravertebralfacetjoint(ornervesinnervating),lumbarorsacral;1level 64493 $2,818.66 $343.69Injection,dx/therapeutic,paravertebralfacetjoint,lumbar/sacral;singlelevel 64493 $2,818.66 $343.69XRFacetJointInjectionLorS1LevelwithImagingGuidance-FluoroorCT-Report 64493 $343.69XRFacetJtInjLorS1LevelFlorCT 64493 $2,818.66Injection(s),diagnosticortherapeuticagent,paravertebralfacetjoint,lumbar/sacral;2ndlevel 64494 $1,441.60 $201.35XRFacetJointInjectionLorS2ndLevelwithImagingGuidance-FluoroorCT-AddOnCode-Report 64494 $201.35XRFacetJtInjLorS2ndLvlFlorCT 64494 $1,441.60Injection(s),diagnosticortherapeuticagent,paravertebralfacetjnt,lumbar/sacral;3rd&addlvl 64495 $1,383.00 $203.58XRFacetJointInjectionLorS3ormoreLevelswithImagingGuidance-FluoroorCT-AddOnCode-Report 64495 $203.58XRFacetJtInjLorSmin3LvlFl-CT 64495 $1,383.00Injection,anestheticagent;sphenopalatineganglion 64505 $645.18 $326.93Injection,anestheticagent;carotidsinus(separateprocedure) 64508 $645.18 $267.12Injection,anestheticagent;stellateganglion(cervicalsympathetic) 64510 $1,784.54 $277.49Injection,anestheticagent;stellateganglion(cervicalsympathetic) 64510 $1,784.54 $277.49Injection,anestheticagent;lumbarorthoracic(paravertebralsympathetic) 64520 $1,784.54 $306.25Injection,anestheticagent;celiacplexus,withorwithoutradiologicmonitoring 64530 $1,784.54 $348.26Applicationofsurface(transcutaneous)neurostimulator 64550 $176.36Yes-ApplicationofTens 64550 $176.36Destructbyneurolyticagent,trigeminalnerve;supraorbital/infraorbital/mental/inferioralveolarbr 64600 $1,784.54 $816.23Chemodenervationofmuscle(s)innervatedbyfacialnerve 64612 $645.18 $416.55Chemodenervationmuscle(s);muscle(s)innervatedbyfacialnerve(eg,forblepharo-,hemifacialspasm) 64612 $645.18 $416.55Chemodenervationofmuscle(s)facial,trigem,cerv,nerves,bilateral(eg,forchronicmigraine) 64615 $645.18 $449.67Chemodenervationofmuscle(s);neckmuscle(s),excludingmusclesofthelarynx,unilateral 64616 $645.18 $393.00Chemodenervmuscneckmuscexclmuscoflarynx,unilat,forcervicaldystonia,spasmodictorticollis 64616 $645.18 $393.00Chemodenervationofmuscle(s);larynx,unilateral,percutaneous 64617 $1,416.59 $435.47Destructionbyneurolyticagent,intercostalnerve 64620 $1,784.54 $650.02Destructionbyneurolyticagent;pudendalnerve 64630 $1,784.54 $713.54Destructbyneurolyticagt,paravertebralfacetjntnrvsw/imgguid(fluoro/CT)cerv/thor,sglfacetjnt 64633 $4,040.78 $858.04Destructbyneurolyticagt,paravertebralfacetjtnrvs,w/imgguid(fluoro/CT)c/thoraddlfacetjt 64634 $2,148.25 $265.37Destructbyneurolyticagent,paravertebralfacetjntnerve(s),wfluoro/CT;lumbar/sacral,1joint 64635 $4,503.11 $846.06Destructionbyneurolyticagent;otherperipheralnerveorbranch 64640 $1,784.53 $340.29Chemodenervationofoneextremity;1-4muscle(s) 64642 $1,416.59 $399.58Chemodenervationofoneextremity;5ormoremuscle(s) 64644 $1,416.59 $437.30Chemodenervationoftrunkmuscle(s);1-5muscle(s) 64646 $1,416.59 $427.92Chemodenervationoftrunkmuscle(s);6ormoremuscle(s) 64647 $1,416.59 $503.44Destructionbyneurolyticagent,withorwithoutradiologicmonitoring;celiacplexus 64680 $1,784.53 $620.58Neuroplastyand/ortransposition;ulnarnerveatelbow 64718 $2,005.40Neuroplastyand/ortransposition;mediannerveatcarpaltunnel 64721 $5,131.44 $1,516.21Excisionofneuroma;handorfoot,exceptdigitalnerve 64782 $1,686.97Excisionofneurofibromaorneurolemmoma;cutaneousnerve 64788 $400.45Sutureofdigitalnerve,handorfoot;1nerve 64831 $2,354.97Removalofforeignbody,externaleye;conjunctivalsuperficial. 65205 $165.32
EyeIrrigation 65205 $260.91Removalofforeignbody,externaleye 65210 $553.01 $198.98Corneal,withoutslitlamp 65220 $260.91 $159.25Removalofforeignbody,externaleye;corneal,withslitlamp. 65222 $530.67 $195.63Removalofcorenalepithelium;worw/ochemocauterization(abrasion,curettage) 65435 $2,369.58 $254.05CataractSurgeryPostOpCare(Eccew/IOL) 66984 $4,755.98 $2,328.72LASIKPOSTOP 66999 $4,573.25RefractiveSurgeryPostOpCare 66999 $4,573.25RefractiveSurgeryPreOpCare 66999 $4,573.25Blepharotomy,drainageofabscess,eyelid 67700 $1,077.54 $417.84Canthotomy(separateprocedure) 67715 $4,691.68 $386.36Excisionofchalazion;single 67800 $764.73 $378.50Correctionoftrichiasis 67820 $316.44 $194.31Correctionoftrichiasis,epilation,byforcepsonly 67820 $316.44 $194.31Correctionoftrichiasis;epilation,byforcepsonly 67820 $316.44 $194.31Excisionoflesionofeyelid,exceptchalazion,w/oclosureorw/simpledirectclosure 67840 $1,886.56 $575.31Repairofbrowptosis(supraciliary,mid-foreheadorcoronalapproach) 67900 $1,668.85Removalofembeddedforeignbody,eyelid 67938 $1,407.67 $417.87Exc+repreyelid,involvlidmrgn,tarsus,conj,canth,/fullthick;over1/4oflidmargin 67966 $2,165.33Incisionofconjunctiva,drainageofcyst 68020 $764.73 $400.07ClosureofLowerLeftLacrimalPunctumPlug,Each 68761 $736.87 $426.86ClosureofLowerRightLacrimalPunctumbyPlug,Each 68761 $736.87 $426.86ClosureofUpperLeftLacrimalPunctumbyPlug,Each 68761 $736.87 $426.86ClosureofUpperRightLacrimalPunctumbyPlug,Each 68761 $736.87 $426.86Closureoflacrimalpunctumbyplug,each 68761 $736.87 $426.86E2CLOSURELACPUNCTUM;BYPLUG 68761 $736.87 $426.86E4CLOSURELACPUNCTUM;BYPLUG 68761 $736.87 $426.86Dilationoflacrimalpunctum,withorwithoutirrigation 68801 $1,281.67 $279.55Probingofnasolacrimalduct,withorwithoutirrigation 68810 $1,585.40 $458.98Drainageexternalear,abscessorhematoma;simple 69000 $350.12 $429.65Drainageexternalear,abscessorhematoma;complicated 69005 $4,799.49 $570.86Biopsyexternalear 69100 $1,821.31 $184.22Biopsyexternalauditorycanal 69105 $4,372.13 $231.09Excisionsofttissuelesion,externalauditorycanal 69145 $4,187.73 $882.92Removalforeignbodyfromexternalauditorycanal;withoutgeneralanesthesia 69200 $309.39 $177.5069205-REMVLFBEXTAUDITORYCANAL;WANESTH 69205 $4,784.13 $363.46Removalimpactedcerumenusingirrigation/lavageunilateral 69209 $111.72 $39.72Removalimpactedcerumenusingirrigation/lavageunilateral-AUD 69209 $111.72 $39.72Removalimpactedcerumenrequiringinstrumentation,unilateral 69210 $266.40 $125.6869210--Cerumenmanagementw/instrumentation(modifywith50forbilateral) 69210 $266.40Debridement,mastoidectomycavity,simple(eg,routinecleaning) 69220 $291.58 $192.41Myringotomyincludingaspirationand/oreustachiantubeinflation 69420 $695.57 $426.77Myringotomyincludingaspirationand/oreustachiantubeinflationrequiringgeneralanesthesia 69421 $532.49Ventilatingtuberemovalrequiringgeneralanesthesia 69424 $5,199.45 $226.62Tympanostomy(requiringinsertionofventilatingtube);localortopicalanesthesia 69433 $2,534.48 $473.13Tympanostomy(requiringinsertionofventilatingtube),generalanesthesia 69436 $5,379.49 $576.98Excisionauralpolyp 69540 $417.69Tympanicmembranerepair,withorwithoutsitepreparationofperforationforclosure,withorwitho 69610 $6,139.01 $1,077.26Myringoplasty(surgeryconfinedtodrumheadanddonorarea) 69620 $1,640.24Tympanoplastyw/omastoidectomy,initial/revision;w/oossicularchainreconstruct 69631 $3,148.03Microsurgtechs,requiringuseoperatingmicroscope 69990 $796.49XRForeignBodyLocEyeBilateral-Report 70030 $92.76
XRMandiblePartialLessThan4Views 70100 $477.05XRMandiblePartialLessThan4Views-Report 70100 $109.85XRMandibleCompleteMinimum4Views 70110 $249.86XRMandibleCompleteMinimum4Views-Report 70110 $128.17XRMastoidsLessThan3ViewsLeft 70120 $431.24XRMastoidsLessThan3ViewsLeft-Report 70120 $112.09XRMastoidsLessThan3ViewsRight 70120 $431.24XRMastoidsLessThan3ViewsRight-Report 70120 $112.09XRMastoidsCompleteLeft 70130 $557.49XRMastoidsCompleteLeft-Report 70130 $183.67XRMastoidsCompleteRight 70130 $557.49XRMastoidsCompleteRight-Report 70130 $183.67XRFacialBonesLessThan3Views-InClinic 70140 $231.09 $100.2170140Facialbones,lessthan3views 70140 $231.09 $100.21XRFacialBonesLessThan3Views 70140 $231.09XRFacialBonesLessThan3Views-Report 70140 $100.21XRFacialBonesMinimum3Views-InClinic 70150 $285.05 $139.7070150FacialBones,Min3Views 70150 $285.05 $139.70XRFacialBonesMinimum3Views 70150 $285.05XRFacialBonesMinimum3Views-Report 70150 $139.70XRNasalBonesMinimum3Views 70160 $483.82XRNasalBonesMinimum3Views-Report 70160 $108.35XROpticForaminaLeft 70190 $388.23XROpticForaminaLeft-Report 70190 $118.82XROpticForaminaRight 70190 $388.23XROpticForaminaRight-Report 70190 $118.82XROrbitsMinimum4Views 70200 $288.57XROrbitsMinimum4Views-Report 70200 $142.73XRSinusesParanasalLessThan3Views 70210 $192.38XRSinusesParanasalLessThan3Views-Report 70210 $99.44XRSinusesParanasalComplete 70220 $716.84XRSinusesParanasalComplete-Report 70220 $127.08XRSellaTurcica 70240 $335.16XRSellaTurcica-Report 70240 $101.32XRSkullLessThan4Views-InClinic 70250 $475.98 $122.22XRSkullLessThan4Views 70250 $475.98XRSkullLessThan4Views-Report 70250 $122.22XRSkullCompleteMinimum4Views 70260 $327.28XRSkullCompleteMinimum4Views-Report 70260 $155.79XRTMJOpenandClosedLeft 70328 $413.84XRTMJOpenandClosedLeft-Report 70328 $102.06XRTMJOpenandClosedRight 70328 $413.84XRTMJOpenandClosedRight-Report 70328 $102.06XRTMJOpenandClosedBilateral 70330 $346.05XRTMJOpenandClosedBilateral-Report 70330 $160.12MRITemporomandibularJoint(s) 70336 $3,604.08MRITemporomandibularJoint(s)-Report 70336 $1,065.62XRNeckSoftTissue 70360 $444.50XRNeckSoftTissue-Report 70360 $93.88XRPharynxorLarynxwithFluoroscopy 70370 $737.91XRPharynxorLarynxwithFluoroscopy-Report 70370 $253.10XRPharyngealandSpeechEvalwVideo 70371 $1,020.00
XRPharyngealandSpeechEvalwVideo-Report 70371 $313.76XRSalivaryGlandCalculusLeft-Report 70380 $118.40CTHeadorBrainwithoutContrast 70450 $2,034.73CTHeadorBrainwithoutContrast-Report 70450 $396.25Computedtomography,headorbrain;withoutcontrastmaterial 70450 $2,034.73 $396.25CTHeadorBrainwithContrast 70460 $2,269.27CTHeadorBrainwithContrast-Report 70460 $551.62CTHeadorBrainwo+withContrast 70470 $2,985.16CTHeadorBrainwo+withContrast-Report 70470 $650.30CTMastoidorTemporalBonewoContrast 70480 $1,802.58CTMastoidorTemporalBonewoContrast-Report 70480 $780.00CTOrbitswithoutContrast 70480 $1,802.58CTOrbitswithoutContrast-Report 70480 $780.00CTMastoidorTemporalBonewContrast 70481 $1,972.11CTMastoidorTemporalBonewContrast-Report 70481 $917.22CTOrbitswithContrast 70481 $1,972.11CTOrbitswithContrast-Report 70481 $917.22CTMastoidorTemporalBonewo+wCont 70482 $3,354.68CTMastoidorTemporalBonewo+wCont-Report 70482 $998.70CTOrbitswo+withContrast 70482 $3,354.68CTOrbitswo+withContrast-Report 70482 $998.70CTMaxillofacialwithoutContrast 70486 $1,978.97CTMaxillofacialwithoutContrast-Report 70486 $468.70CTSinuswithoutContrast 70486 $1,978.97CTSinuswithoutContrast-Report 70486 $468.70CTMaxillofacialwithContrast 70487 $2,202.45CTMaxillofacialwithContrast-Report 70487 $568.35CTSinuswithContrast 70487 $2,202.45CTSinuswithContrast-Report 70487 $568.35CTMaxillofacialwo+withContrast 70488 $3,351.43CTMaxillofacialwo+withContrast-Report 70488 $689.31CTSinuswo+withContrast 70488 $3,351.43CTSinuswo+withContrast-Report 70488 $689.31CTSoftTissueNeckwithoutContrast 70490 $1,931.82CTSoftTissueNeckwithoutContrast-Report 70490 $654.04CTSoftTissueNeckwithContrast 70491 $2,217.39CTSoftTissueNeckwithContrast-Report 70491 $791.29CTSoftTissueNeckwo+withContrast 70492 $3,852.79CTSoftTissueNeckwo+withContrast-Report 70492 $926.64CTAHeadwithContrast 70496 $3,701.18CTAHeadwithContrast-Report 70496 $986.15CTANeckwithContrast 70498 $3,466.32CTANeckwithContrast-Report 70498 $983.91MRIFaceNeckOrbitwithoutContrast 70540 $3,243.17MRIOrbitFaceNeckwithoutContrast-Report 70540 $999.67MRIFaceNeckOrbitwithContrast 70542 $4,776.03MRIOrbitFaceNeckwithContrast-Report 70542 $1,126.40MRIFaceNeckOrbitwo+withContrast 70543 $4,090.06MRIOrbitFaceNeckwo+withContrast-Report 70543 $1,388.7970544-ChargeServicesReport 70544 $2,592.15 $1,276.96MRAHeadwithoutContrast 70544 $2,592.15MRAHeadwithoutContrast-Report 70544 $1,276.96
MRAHeadwithContrast 70545 $4,019.13MRAHeadwithContrast-Report 70545 $1,264.70MRAHeadwo+withContrast 70546 $3,294.14MRAHeadwo+withContrast-Report 70546 $1,947.78MRANeckwithoutContrast 70547 $3,580.63MRANeckwithoutContrast-Report 70547 $1,282.52MRANeckwithContrast 70548 $2,979.81MRANeckwithContrast-Report 70548 $1,342.71MRANeckwo+withContrast 70549 $4,002.39MRANeckwo+withContrast-Report 70549 $1,958.9370551-ChargeServices-Report 70551 $3,262.04 $780.68MRIBrainwithoutContrast 70551 $3,262.04MRIBrainwithoutContrast-Report 70551 $780.68MRIBrainwithContrast 70552 $4,598.00MRIBrainwithContrast-Report 70552 $1,072.04MRIBrainwo+withContrast 70553 $3,599.42MRIBrainwo+withContrast-Report 70553 $1,271.24MRIIACwo+withContrast 70553 $3,599.42MRIIACwo+withContrast-Report 70553 $1,271.24MRIPituitarywo+withContrast 70553 $3,599.42MRIPituitarywo+withContrast-Report 70553 $1,271.24XRChestFrontal-SingleView-InClinic 71045 $257.63 $77.5371010CSRadReportOnly 71045 $257.63 $77.53XRChestDecubitusLeft 71045 $257.63XRChestDecubitusLeft-Report 71045 $77.53XRChestDecubitusRight 71045 $257.63XRChestDecubitusRight-Report 71045 $77.53XRChestFrontal-SingleView-Report 71045 $77.53XRChestFrontal-SingleView 71045 $257.63XRChestSpecial-1View 71045 $257.63XRChestSpecial-1View-Report 71045 $77.53XRChest2Views-InClinic 71046 $275.95 $95.8071020CSRADReportOnly 71046 $275.95 $95.80XRChest2Views 71046 $275.95XRChestDecubitusBilateral 71046 $275.95XRChestDecubitusBilateral-Report 71046 $95.80XRChestFrontalandLateral-2Views-Report 71046 $95.80XRChestSpecial-2Views 71046 $275.95XRChestSpecial-2Views-Report 71046 $95.80XRChest2ViewswithApicalLordotic-InClinic 71047 $294.44 $116.69XRChest2ViewswithApicalLordotic 71047 $294.44XRChest2ViewswithApicalLordotic-Report 71047 $116.69XRChestSpecial-3Views 71047 $294.44XRChestSpecial-3Views-Report 71047 $116.69XRChest2ViewswithObliques 71048 $659.15XRChest2ViewswithObliques-Report 71048 $142.39XRChestMinimum4Views 71048 $659.15XRChestMinimum4Views-Report 71048 $142.39XRRibs2ViewsLeft-InClinic 71100 $392.00 $111.42XRRibs2ViewsRight-InClinic 71100 $392.00 $111.42XRRibs2ViewsLeft 71100 $392.00XRRibs2ViewsLeft-Report 71100 $111.42
XRRibs2ViewsRight 71100 $392.00XRRibs2ViewsRight-Report 71100 $111.42XRRibswithPAChestLeft-InClinic 71101 $544.58 $124.10XRRibswithPAChestRight-InClinic 71101 $544.58 $124.10XRRibswithPAChestLeft 71101 $544.58XRRibswithPAChestLeft-Report 71101 $124.10XRRibswithPAChestRight 71101 $544.58XRRibswithPAChestRight-Report 71101 $124.10XRRibs3ViewsBilateral-InClinic 71110 $700.49 $127.84XRRibs3ViewsBilateral 71110 $700.49XRRibs3ViewsBilateral-Report 71110 $127.84XRRibswithPAChestBilateral-InClinic 71111 $485.76 $162.83XRRibswithPAChestBilateral 71111 $485.76XRRibswithPAChestBilateral-Report 71111 $162.83XRSternumMinimum2Views 71120 $242.82XRSternumMinimum2Views-Report 71120 $99.49XRSternoclavicularJntsMinimum3Views 71130 $269.81XRSternoclavicularJntsMinimum3Views-Report 71130 $120.32CTSternoclavicularJointswoContrast 71250 $1,824.94CTSternoclavicularJointswoContrast-Report 71250 $605.34CTThoraxwithoutContrast 71250 $1,824.94CTThoraxwithoutContrast-Report 71250 $605.34CTThoraxwithContrast 71260 $2,275.99CTThoraxwithContrast-Report 71260 $767.30CTThoraxwo+withContrast 71270 $3,664.64CTThoraxwo+withContrast-Report 71270 $915.02CTAChestwContrastwoifperformed 71275 $3,341.26CTAChestwContrastwoifperformed-Report 71275 $1,011.16MRIChestwithoutContrast 71550 $3,898.08MRIChestwithoutContrast-Report 71550 $1,359.11MRIChestwithContrast 71551 $3,897.92MRIChestwithContrast-Report 71551 $1,514.81MRIChestwo+withContrast 71552 $5,264.92MRIChestwo+withContrast-Report 71552 $1,904.99MRAChestwithorwithoutContrast 71555 $2,383.05MRAChestwithorwithoutContrast-Report 71555 $1,318.83XRSpineCervical1View-InClinic 72020 $550.22 $74.13XRSpineLumbosacral1View-InClinic 72020 $550.22 $74.13XRSpineThoracic1View-InClinic 72020 $550.22 $74.13X-rayofspine,anteroposteriorviewatcervicallevel 72020 $550.22 $74.13XRSpineCervical1View 72020 $550.22XRSpineCervical1View-Report 72020 $74.13XRSpineCervicalCross-TableLateral 72020 $550.22XRSpineCervicalCross-TableLateral-Report 72020 $74.13XRSpineLumbosacral1View 72020 $550.22XRSpineLumbosacral1View-Report 72020 $74.13XRSpineThoracic1View 72020 $550.22XRSpineThoracic1View-Report 72020 $74.13XRSpineThoracolumbar1View-Report 72020 $74.13XRSpineCervical3ViewsorLess-InClinic 72040 $525.80 $111.42X-rayofcervicalspine,anteroposterior,lateral,andcross-tablelateralviews 72040 $525.80 $111.42XRSpineCervical2or3Views 72040 $525.80
XRSpineCervical2or3Views-Report 72040 $111.42XRSpineCervical4or5Views 72050 $508.74XRSpineCervical4or5Views-Report 72050 $153.54XRSpineCervical6orMoreViews 72052 $732.45XRSpineCervical6orMoreViews-Report 72052 $188.92XRSpineThoracic2Views-InClinic 72070 $456.15 $114.76XRSpineThoracic2Views 72070 $456.15XRSpineThoracic2Views-Report 72070 $114.76XRSpineThoracic3Views 72072 $533.19XRSpineThoracic3Views-Report 72072 $115.89XRSpineThoracicMinimum4Views 72074 $685.96XRSpineThoracicMinimum4Views-Report 72074 $130.36XRSpineThoracolumbarMinimum2Views 72080 $596.59XRSpineThoracolumbarMinimum2Views-Report 72080 $103.62XRSpineScoliosis1View 72081 $473.48XRSpineScoliosis1View-Report 72081 $131.52XRSpineScoliosis2or3Views 72082 $745.26XRSpineScoliosis2or3Views-Report 72082 $207.02XRSpineLumbosacral2or3Views-InClinic 72100 $482.95 $118.08XRSpineLumbosacral2or3Views 72100 $482.95XRSpineLumbosacral2or3Views-Report 72100 $118.08XRSpineLumbosacralMinimum4Views 72110 $532.07XRSpineLumbosacralMinimum4Views-Report 72110 $164.67XRSpineLumbosacralwBendingMin6V 72114 $856.25XRSpineLumbosacralwBendingMin6Vws-Report 72114 $206.29XRSpineLumbosacralBending2or3Vw 72120 $637.42XRSpineLumbosacralBending2or3Vws-Report 72120 $134.82CTSpineCervicalwithoutContrast 72125 $2,229.96CTSpineCervicalwithoutContrast-Report 72125 $620.63CTSpineCervicalwithContrast 72126 $3,548.22CTSpineCervicalwithContrast-Report 72126 $763.16CTSpineCervicalwo+withContrast 72127 $4,074.09CTSpineCervicalwo+withContrast-Report 72127 $895.52CTSpineThoracicwithoutContrast 72128 $1,880.97CTSpineThoracicwithoutContrast-Report 72128 $604.55CTSpineThoracicwithContrast 72129 $3,503.54CTSpineThoracicwithContrast-Report 72129 $766.51CTSpineThoracicwo+withContrast 72130 $3,909.09CTSpineThoracicwo+withContrast-Report 72130 $898.87CTSpineLumbarwithContrast 72131 $1,569.30CTSpineLumbarwithoutContrast 72131 $1,569.30CTSpineLumbarwithoutContrast-Report 72131 $602.31CTSpineLumbarwithContrast-Report 72132 $762.04CTSpineLumbarwo+withContrast 72133 $4,027.51CTSpineLumbarwo+withContrast-Report 72133 $894.41MRISpineCervicalwithoutContrast 72141 $2,779.78MRISpineCervicalwithoutContrast-Report 72141 $760.20MRIofcervicalspinalcanalandcontentswithoutcontrast 72141 $2,779.78 $760.20MRISpineCervicalwithContrast 72142 $4,445.29MRISpineCervicalwithContrast-Report 72142 $1,087.63MRISpineThoracicwithoutContrast 72146 $2,728.13MRISpineThoracicwithoutContrast-Report 72146 $761.31
MRISpineThoracicwithContrast 72147 $4,386.12MRISpineThoracicwithContrast-Report 72147 $1,080.94MRISpineLumbarwithoutContrast 72148 $2,725.79MRISpineLumbarwithoutContrast-Report 72148 $758.00MRISpineLumbarwithContrast 72149 $3,993.10MRISpineLumbarwithContrast-Report 72149 $1,076.08MRISpineCervicalwo+withContrast 72156 $3,765.37MRISpineCervicalwo+withContrast-Report 72156 $1,279.03MRISpineThoracicwo+withContrast 72157 $3,533.04MRISpineThoracicwo+withContrast-Report 72157 $1,281.26MRISpineLumbarwo+withContrast 72158 $3,472.81MRISpineLumbarwo+withContrast-Report 72158 $1,274.55MRASpinalCanal+ContentsworwoCont 72159 $766.74MRASpinalCanal+ContentsworwoCont-Report 72159 $1,374.88XRPelvis1View-InClinic 72170 $401.54 $106.13XRPelvis1View-Report 72170 $106.13XRPelvis1or2Views 72170 $401.54XRPelvis2Views 72170 $401.54XRPelvis2Views-Report 72170 $106.13XRPelvisCompleteMinimum3Views 72190 $624.97XRPelvisCompleteMinimum3Views-Report 72190 $126.63CTAPelviswithContrastwoifperformed 72191 $3,761.61CTAPelviswithContrastwoifperformed-Report 72191 $1,028.21CTPelviswithoutContrast 72192 $1,700.93CTPelviswithoutContrast-Report 72192 $499.93CTPelviswithContrast 72193 $2,143.40CTPelviswithContrast-Report 72193 $753.03CTPelviswo+withContrast 72194 $3,820.82CTPelviswo+withContrast-Report 72194 $862.36MRIPelviswithoutContrast 72195 $2,680.40MRIPelviswithoutContrast-Report 72195 $1,233.16MRIPelviswithContrast 72196 $4,373.84MRIPelviswithContrast-Report 72196 $1,354.32MRIPelviswo+withContrast 72197 $3,131.36MRIPelviswo+withContrast-Report 72197 $1,672.45MRAPelviswithorwithoutContrast 72198 $731.48MRAPelviswithorwithoutContrast-Report 72198 $1,328.05XRSacroiliacJoints1or2Views 72200 $345.21XRSacroiliacJoints1or2Views-Report 72200 $94.99XRSacroiliacJointsMinimum3Views 72202 $365.95XRSacroiliacJointsMinimum3Views-Report 72202 $110.25XRSacrumCoccyxMinimum2Views-InClinic 72220 $459.87 $93.88XRSacrumCoccyxMinimum2Views 72220 $459.87XRSacrumCoccyxMinimum2Views-Report 72220 $93.88XRClavicleLeft-InClinic 73000 $356.22 $92.37XRClavicleRight-InClinic 73000 $356.22 $92.37XRClavicleLeft 73000 $356.22XRClavicleLeft-Report 73000 $92.37XRClavicleRight 73000 $356.22XRClavicleRight-Report 73000 $92.37XRScapulaLeft-InClnic 73010 $392.64 $100.55XRScapulaRight-InClinic 73010 $392.64 $100.55
XRScapulaLeft 73010 $392.64XRScapulaLeft-Report 73010 $100.55XRScapulaRight 73010 $392.64XRScapulaRight-Report 73010 $100.55XRShoulder1ViewLeft-InClinic 73020 $341.29 $77.48XRShoulder1ViewRight-InClinic 73020 $341.29 $77.48XRShoulder1ViewLeft 73020 $341.29XRShoulder1ViewLeft-Report 73020 $77.48XRShoulder1ViewRight 73020 $341.29XRShoulder1ViewRight-Report 73020 $77.48XRShoulderMinimum2ViewsLeft-InClinic 73030 $428.70 $97.59XRShoulderMinimum2ViewsRight-InClinic 73030 $428.70 $97.59XRShoulderMinimum2ViewsLeft 73030 $428.70XRShoulderMinimum2ViewsLeft-Report 73030 $97.59XRShoulderMinimum2ViewsRight 73030 $428.70XRShoulderMinimum2ViewsRight-Report 73030 $97.59XRArthrogramShoulderLeft 73040 $922.12XRArthrogramShoulderLeft-Report 73040 $333.71XRArthrogramShoulderRight 73040 $922.12XRArthrogramShoulderRight-Report 73040 $333.71XRACJointsBilateralworwoweights-InClinic 73050 $288.57 $118.42XRACJointsBilateralw+woweights 73050 $288.57XRACJointsBilateralworwoweights-Report 73050 $118.42XRHumerusMinimum2ViewsLeft-InClnic 73060 $391.06 $96.81XRHumerusMinimum2ViewsRight-InClinic 73060 $391.06 $96.81XRHumerusMinimum2ViewsLeft 73060 $391.06XRHumerusMinimum2ViewsLeft-Report 73060 $96.81XRHumerusMinimum2ViewsRight 73060 $391.06XRHumerusMinimum2ViewsRight-Report 73060 $96.81XRElbow2ViewsLeft-InClinic 73070 $431.51 $90.87XRElbow2ViewsRight-InClinic 73070 $431.51 $90.87XRElbow2ViewsLeft 73070 $431.51XRElbow2ViewsLeft-Report 73070 $90.87XRElbow2ViewsRight 73070 $431.51XRElbow2ViewsRight-Report 73070 $90.87XRElbowCompleteLeft-InClinic 73080 $456.99 $103.90XRElbowCompleteRight-InClinic 73080 $456.99 $103.90XRElbowCompleteLeft 73080 $456.99XRElbowCompleteLeft-Report 73080 $103.90XRElbowCompleteRight 73080 $456.99XRElbowCompleteRight-Report 73080 $103.90XRArthrogramElbowLeft 73085 $1,131.72XRArthrogramElbowLeft-Report 73085 $319.95XRArthrogramElbowRight 73085 $1,131.72XRArthrogramElbowRight-Report 73085 $319.95XRForearm2ViewsLeft-InClinic 73090 $459.24 $86.78XRForearm2ViewsRight-InClinic 73090 $459.24 $86.78XRForearm2ViewsLeft 73090 $459.24XRForearm2ViewsLeft-Report 73090 $86.78XRForearm2ViewsRight 73090 $459.24XRForearm2ViewsRight-Report 73090 $86.78XRUpperExtInfantMin2ViewsLeft 73092 $337.47
XRUpperExtInfantMin2ViewsLeft-Report 73092 $92.37XRUpperExtInfantMin2ViewsRight 73092 $337.47XRUpperExtInfantMin2ViewsRight-Report 73092 $92.37XRWrist2ViewsLeft-InClinic 73100 $329.30 $96.81XRWrist2ViewsRight-InClinic 73100 $329.30 $96.81XRWrist2ViewsLeft 73100 $329.30XRWrist2ViewsLeft-Report 73100 $96.81XRWrist2ViewsRight 73100 $329.30XRWrist2ViewsRight-Report 73100 $96.81XRWristCompleteLeft-InClinic 73110 $407.78 $117.28XRWristCompleteRight-InClinic 73110 $407.78 $117.28XRWristCompleteLeft 73110 $407.78XRWristCompleteLeft-Report 73110 $117.28XRWristCompleteRight 73110 $407.78XRWristCompleteRight-Report 73110 $117.28XRWristCompletewithNavicularLeft 73110 $407.78XRWristCompletewithNavicularLeft-Report 73110 $117.28XRWristCompletewithNavicularRight 73110 $407.78XRWristCompletewithNavicularRight-Report 73110 $117.28XRArthrogramWristLeft 73115 $1,194.29XRArthrogramWristLeft-Report 73115 $353.37XRArthrogramWristRight 73115 $1,194.29XRArthrogramWristRight-Report 73115 $353.37XRHand2ViewsLeft-InClinic 73120 $396.72 $87.91XRHand2ViewsRight-InClinic 73120 $396.72 $87.91XRHand2ViewsLeft 73120 $396.72XRHand2ViewsLeft-Report 73120 $87.91XRHand2ViewsRight 73120 $396.72XRHand2ViewsRight-Report 73120 $87.91XRHandCompleteLeft-InClinic 73130 $405.05 $102.78XRHandCompleteRight-InClinic 73130 $405.05 $102.78XRThumb3ViewsRight-InClinic 73130 $405.05 $102.7873130Hand,Min3Views 73130 $405.05 $102.78XRHandCompleteLeft 73130 $405.05XRHandCompleteLeft-Report 73130 $102.78XRHandCompleteRight 73130 $405.05XRHandCompleteRight-Report 73130 $102.78XRFinger(s)2ViewsLeft-InClinic 73140 $296.68 $103.46XRFinger(s)2ViewsRight-InClinic 73140 $296.68 $103.46XRFinger(s)CompleteLeft-InClinic 73140 $296.68 $103.46XRFinger(s)CompleteRight-InClinic 73140 $296.68 $103.46XRThumb2ViewsLeft-InClinic 73140 $296.68 $103.46XRThumb2ViewsRight-InClinic 73140 $296.68 $103.46XRThumb3ViewsLeft-InClinic 73140 $296.68 $103.46XRFinger(s)2ViewsLeft-Report 73140 $103.46XRFinger(s)2ViewsRight-Report 73140 $103.46XRFinger(s)CompleteLeft 73140 $296.68XRFinger(s)CompleteLeft-Report 73140 $103.46XRFinger(s)CompleteRight 73140 $296.68XRFinger(s)CompleteRight-Report 73140 $103.46XRFinger(s)Minimum2ViewsLeft 73140 $296.68XRFinger(s)Minimum2ViewsRight 73140 $296.68
XRThumb2ViewsLeft 73140 $296.68XRThumb2ViewsLeft-Report 73140 $103.46XRThumb2ViewsRight 73140 $296.68XRThumb2ViewsRight-Report 73140 $103.46XRThumb3ViewsLeft 73140 $296.68XRThumb3ViewsLeft-Report 73140 $102.78XRThumb3ViewsRight 73140 $296.68XRThumb3ViewsRight-Report 73140 $102.78CTElbowwithoutContrastLeft 73200 $2,194.92CTElbowwithoutContrastLeft-Report 73200 $601.20CTElbowwithoutContrastRight 73200 $2,194.92CTElbowwithoutContrastRight-Report 73200 $601.20CTForearmwithoutContrastLeft 73200 $2,194.92CTForearmwithoutContrastLeft-Report 73200 $601.20CTForearmwithoutContrastRight 73200 $2,194.92CTForearmwithoutContrastRight-Report 73200 $601.20CTHandwithoutContrastLeft 73200 $2,194.92CTHandwithoutContrastLeft-Report 73200 $601.20CTHandwithoutContrastRight 73200 $2,194.92CTHandwithoutContrastRight-Report 73200 $601.20CTHumeruswithoutContrastLeft 73200 $2,194.92CTHumeruswithoutContrastLeft-Report 73200 $601.20CTHumeruswithoutContrastRight 73200 $2,194.92CTHumeruswithoutContrastRight-Report 73200 $601.20CTShoulderwithoutContrastLeft 73200 $2,194.92CTShoulderwithoutContrastLeft-Report 73200 $601.20CTShoulderwithoutContrastRight 73200 $2,194.92CTShoulderwithoutContrastRight-Report 73200 $601.20CTWristwithoutContrastLeft 73200 $2,194.92CTWristwithoutContrastLeft-Report 73200 $601.20CTWristwithoutContrastRight 73200 $2,194.92CTWristwithoutContrastRight-Report 73200 $601.20CTElbowwithContrastLeft 73201 $2,794.23CTElbowwithContrastLeft-Report 73201 $741.88CTElbowwithContrastRight 73201 $2,794.23CTElbowwithContrastRight-Report 73201 $741.88CTForearmwithContrastLeft 73201 $2,794.23CTForearmwithContrastLeft-Report 73201 $741.88CTForearmwithContrastRight 73201 $2,794.23CTForearmwithContrastRight-Report 73201 $741.88CTHandwithContrastLeft 73201 $2,794.23CTHandwithContrastLeft-Report 73201 $741.88CTHandwithContrastRight 73201 $2,794.23CTHandwithContrastRight-Report 73201 $741.88CTHumeruswithContrastLeft 73201 $2,794.23CTHumeruswithContrastLeft-Report 73201 $741.88CTHumeruswithContrastRight 73201 $2,794.23CTHumeruswithContrastRight-Report 73201 $741.88CTShoulderwithContrastLeft 73201 $2,794.23CTShoulderwithContrastLeft-Report 73201 $741.88CTShoulderwithContrastRight 73201 $2,794.23CTShoulderwithContrastRight-Report 73201 $741.88
CTWristwithContrastLeft 73201 $2,794.23CTWristwithContrastLeft-Report 73201 $741.88CTWristwithContrastRight 73201 $2,794.23CTWristwithContrastRight-Report 73201 $741.88CTElbowwo+withContrastLeft-Report 73202 $915.88CTElbowwo+withContrastRight-Report 73202 $915.88CTForearmwo+withContrastLeft 73202 $3,364.34CTForearmwo+withContrastLeft-Report 73202 $915.88CTForearmwo+withContrastRight 73202 $3,364.34CTForearmwo+withContrastRight-Report 73202 $915.88CTHandwo+withContrastLeft 73202 $3,364.34CTHandwo+withContrastLeft-Report 73202 $915.88CTHandwo+withContrastRight 73202 $3,364.34CTHandwo+withContrastRight-Report 73202 $915.88CTHumeruswo+withContrastLeft 73202 $3,364.34CTHumeruswo+withContrastLeft-Report 73202 $915.88CTHumeruswo+withContrastRight 73202 $3,364.34CTHumeruswo+withContrastRight-Report 73202 $915.88CTShoulderwo+withContrastLeft 73202 $3,364.34CTShoulderwo+withContrastLeft-Report 73202 $915.88CTShoulderwo+withContrastRight 73202 $3,364.34CTShoulderwo+withContrastRight-Report 73202 $915.88CTWristwo+withContrastLeft 73202 $3,364.34CTWristwo+withContrastLeft-Report 73202 $915.88CTWristwo+withContrastRight 73202 $3,364.34CTWristwo+withContrastRight-Report 73202 $915.88CTAUpperExtremityLeft 73206 $3,642.36CTAUpperExtremityLeft-Report 73206 $1,098.82CTAUpperExtremityRight 73206 $3,642.36CTAUpperExtremityRight-Report 73206 $1,098.82MRIForearmwithoutContrastLeft 73218 $2,135.84MRIForearmwithoutContrastLeft-Report 73218 $1,197.67MRIForearmwithoutContrastRight 73218 $2,135.84MRIForearmwithoutContrastRight-Report 73218 $1,197.67MRIHandwithoutContrastLeft 73218 $2,135.84MRIHandwithoutContrastLeft-Report 73218 $1,197.67MRIHandwithoutContrastRight 73218 $2,135.84MRIHandwithoutContrastRight-Report 73218 $1,197.67MRIHumeruswithoutContrastLeft 73218 $2,135.84MRIHumeruswithoutContrastLeft-Report 73218 $1,197.67MRIHumeruswithoutContrastRight 73218 $2,135.84MRIHumeruswithoutContrastRight-Report 73218 $1,197.67MRIForearmwithContrastLeft 73219 $2,679.26MRIForearmwithContrastLeft-Report 73219 $1,322.58MRIForearmwithContrastRight 73219 $2,679.26MRIForearmwithContrastRight-Report 73219 $1,322.58MRIHandwithContrastLeft 73219 $2,679.26MRIHandwithContrastLeft-Report 73219 $1,322.58MRIHandwithContrastRight 73219 $2,679.26MRIHandwithContrastRight-Report 73219 $1,322.58MRIHumeruswithContrastLeft 73219 $2,679.26MRIHumeruswithContrastLeft-Report 73219 $1,322.58
MRIHumeruswithContrastRight 73219 $2,679.26MRIHumeruswithContrastRight-Report 73219 $1,322.58MRIForearmwo+withContrastLeft 73220 $3,496.33MRIForearmwo+withContrastLeft-Report 73220 $1,650.72MRIForearmwo+withContrastRight 73220 $3,496.33MRIForearmwo+withContrastRight-Report 73220 $1,650.72MRIHandwo+withContrastLeft 73220 $3,496.33MRIHandwo+withContrastLeft-Report 73220 $1,650.72MRIHandwo+withContrastRight 73220 $3,496.33MRIHandwo+withContrastRight-Report 73220 $1,650.72MRIHumeruswo+withContrastLeft 73220 $3,496.33MRIHumeruswo+withContrastLeft-Report 73220 $1,650.72MRIHumeruswo+withContrastRight 73220 $3,496.33MRIHumeruswo+withContrastRight-Report 73220 $1,650.72MRIElbowwithoutContrastLeft 73221 $2,406.89MRIElbowwithoutContrastLeft-Report 73221 $795.28MRIElbowwithoutContrastRight 73221 $2,406.89MRIElbowwithoutContrastRight-Report 73221 $795.28MRIShoulderwithoutContrastLeft 73221 $2,406.89MRIShoulderwithoutContrastLeft-Report 73221 $795.28MRIShoulderwithoutContrastRight 73221 $2,406.89MRIShoulderwithoutContrastRight-Report 73221 $795.28MRIWristwithoutContrastLeft 73221 $2,406.89MRIWristwithoutContrastLeft-Report 73221 $795.28MRIWristwithoutContrastRight 73221 $2,406.89MRIWristwithoutContrastRight-Report 73221 $795.28MRIElbowwithContrastLeft 73222 $2,869.41MRIElbowwithContrastLeft-Report 73222 $1,247.89MRIElbowwithContrastRight 73222 $2,869.41MRIElbowwithContrastRight-Report 73222 $1,247.89MRIShoulderwithContrastLeft 73222 $2,869.41MRIShoulderwithContrastLeft-Report 73222 $1,247.89MRIShoulderwithContrastRight 73222 $2,869.41MRIShoulderwithContrastRight-Report 73222 $1,247.89MRIWristwithContrastLeft 73222 $2,869.41MRIWristwithContrastLeft-Report 73222 $1,247.89MRIWristwithContrastRight 73222 $2,869.41MRIWristwithContrastRight-Report 73222 $1,247.89MRIElbowwo+withContrastLeft 73223 $3,776.31MRIElbowwo+withContrastLeft-Report 73223 $1,557.10MRIElbowwo+withContrastRight 73223 $3,776.31MRIElbowwo+withContrastRight-Report 73223 $1,557.10MRIShoulderwo+withContrastLeft 73223 $3,776.31MRIShoulderwo+withContrastLeft-Report 73223 $1,557.10MRIShoulderwo+withContrastRight 73223 $3,776.31MRIShoulderwo+withContrastRight-Report 73223 $1,557.10MRIWristwith+withoutContrastLeft 73223 $3,776.31MRIWristwith+withoutContrastLeft-Report 73223 $1,557.10MRIWristwith+withoutContrastRight 73223 $3,776.31MRIWristwith+withoutContrastRight-Report 73223 $1,557.10MRAUpperExtremityworwoContLeft 73225 $750.79MRAUpperExtremityworwoContLeft-Report 73225 $1,348.74
MRAUpperExtremityworwoContRight 73225 $750.79MRAUpperExtremityworwoContRight-Report 73225 $1,348.74XRHip1ViewwithPelvisLeft-InClinic 73501 $386.97 $99.82XRHip1ViewwithPelvisRight-InClinic 73501 $386.97 $99.82XRHip1VwLeft-InClinic 73501 $386.97 $99.82XRHip1VwRight-InClinic 73501 $386.97 $99.82XRHip1ViewLeft 73501 $386.97XRHip1ViewRight 73501 $386.97XRHip1ViewwithPelvisLeft 73501 $386.97XRHip1ViewwithPelvisLeft-Report 73501 $99.82XRHip1ViewwithPelvisRight 73501 $386.97XRHip1ViewwithPelvisRight-Report 73501 $99.82XRHip1VwLeft 73501 $386.97XRHip1VwLeft-Report 73501 $99.82XRHip1VwRight 73501 $386.97XRHip1VwRight-Report 73501 $99.82XRHip2-3ViewsLeft-InClinic 73502 $458.48 $138.18XRHip2-3ViewsRight-InClinic 73502 $458.48 $138.18XRHip2-3ViewswithPelvisLeft-InClinic 73502 $458.48 $138.18XRHip2-3ViewswithPelvisRight-InClinic 73502 $458.48 $138.18XRHip2-3ViewsLeft 73502 $458.48XRHip2-3ViewsLeft-Report 73502 $138.18XRHip2-3ViewsRight 73502 $458.48XRHip2-3ViewsRight-Report 73502 $138.18XRHip2-3ViewswithPelvisLeft 73502 $458.48XRHip2-3ViewswithPelvisLeft-Report 73502 $138.18XRHip2-3ViewswithPelvisRight 73502 $458.48XRHip2-3ViewswithPelvisRight-Report 73502 $138.18XRHipMinimum4ViewsLeft 73503 $619.28XRHipMinimum4ViewsLeft-Report 73503 $172.02XRHipMinimum4ViewsRight 73503 $619.28XRHipMinimum4ViewsRight-Report 73503 $172.02XRHipMinimum4ViewswithPelvisLeft 73503 $619.28XRHipMinimum4ViewswithPelvisLeft-Report 73503 $172.02XRHipMinimum4ViewswithPelvisRight 73503 $619.28XRHipMinimum4ViewswithPelvisRight-Report 73503 $172.0273521Hip,Bilateralw/Pelvis1View 73521 $516.98 $132.59XRHipsBilateral2Views 73521 $516.98XRHipsBilateral2Views-Report 73521 $132.59XRHipsBilateral2ViewswithPelvis 73521 $516.98XRHipsBilateral2ViewswithPelvis-Report 73521 $132.59XRHipsBilateral3-4Views 73522 $317.65XRHipsBilateral3-4Views-Report 73522 $163.89XRHipsBilateral3-4ViewswithPelvis 73522 $317.65XRHipsBilateral3-4ViewswithPelvis-Report 73522 $163.8973523Hip,Bilateral,w/PelvisMin5Views 73523 $742.27 $189.20XRHipsBilateralMin5Views-Report 73523 $189.20XRHipsBilateralMin5ViewswithPelvi 73523 $742.27XRHipsBilateralMin5ViewswithPelvis-Report 73523 $189.20XRArthrogramHipLeft 73525 $555.40XRArthrogramHipLeft-Report 73525 $338.88XRArthrogramHipRight 73525 $555.40
XRArthrogramHipRight-Report 73525 $338.88XRFemur1ViewLeft 73551 $565.52XRFemur1ViewLeft-Report 73551 $93.49XRFemur1ViewRight 73551 $565.52XRFemur1ViewRight-Report 73551 $93.49XRFemurMinimum2ViewsLeft-InClinic 73552 $534.11 $108.74XRFemurMinimum2ViewsRight-InClinic 73552 $534.11 $108.74XRFemur2ViewsLeft 73552 $534.11XRFemur2ViewsRight 73552 $534.11XRFemurminimum2ViewsLeft 73552 $534.11XRFemurminimum2ViewsLeft-Report 73552 $108.74XRFemurminimum2ViewsRight 73552 $534.11XRFemurminimum2ViewsRight-Report 73552 $108.74XRKnee1ViewLeft-InClinic 73560 $400.56 $102.40XRKnee1ViewRight-InClinic 73560 $400.56 $102.40XRKnee2ViewsLeft-InClinic 73560 $400.56 $102.40XRKnee2ViewsRight-InClinic 73560 $400.56 $102.40XRKnee1ViewLeft-Report 73560 $102.40XRKnee1ViewRight-Report 73560 $102.40XRKnee1or2ViewsLeft 73560 $400.56XRKnee1or2ViewsRight 73560 $400.56XRKnee2ViewsLeft 73560 $400.56XRKnee2ViewsLeft-Report 73560 $102.40XRKnee2ViewsRight 73560 $400.56XRKnee2ViewsRight-Report 73560 $102.40XRKneeStandingAP+RegLateralLeft 73560 $400.56XRKneeStandingAP+RegLateralLeft-Report 73560 $102.40XRKneeStandingAP+RegLateralRight 73560 $400.56XRKneeStandingAP+RegLateralRight-Report 73560 $102.40XRKnee3ViewsLeft-InClinic 73562 $455.92 $118.80XRKnee3ViewsRight-InClinic 73562 $455.92 $118.80XRKnee3ViewsLeft 73562 $455.92XRKnee3ViewsLeft-Report 73562 $118.80XRKnee3ViewsRight 73562 $455.92XRKnee3ViewsRight-Report 73562 $118.80XRKnee4orMoreViewsLeft-InClinic 73564 $521.12 $132.59XRKnee4orMoreViewsRight-InClinic 73564 $521.12 $132.59XRKnee4OrMoreViewsLeft 73564 $521.12XRKnee4ViewswTunnel+SunriseLeft 73564 $521.12XRKnee4ViewswTunnel+SunriseLeft-Report 73564 $132.59XRKnee4ViewswTunnel+SunriseRight 73564 $521.12XRKnee4ViewswTunnel+SunriseRight-Report 73564 $132.59XRKnee4orMoreViewsLeft-Report 73564 $132.59XRKnee4orMoreViewsRight-Report 73564 $132.59XRKnee4ormoreViewsRight 73564 $521.12XRKneeStandingBilateral 73565 $290.42XRKneeStandingBilateralAP 73565 $290.42XRKneeStandingBilateralAP-Report 73565 $118.01XRKneeStandingBilateralPA-Report 73565 $118.01XRArthrogramKneeLeft 73580 $895.50XRArthrogramKneeLeft-Report 73580 $376.77XRArthrogramKneeRight 73580 $895.50
XRArthrogramKneeRight-Report 73580 $376.77XRTibia-Fibula2ViewsLeft-InClinic 73590 $464.58 $95.72XRTibia-Fibula2ViewsRight-InClinic 73590 $464.58 $95.72XRTibia-Fibula2viewsLeft 73590 $464.58XRTibia-Fibula2viewsLeft-Report 73590 $95.72XRTibia-Fibula2viewsRight 73590 $464.58XRTibia-Fibula2viewsRight-Report 73590 $95.72XRLowerExtInfantMin2ViewsLeft 73592 $203.77XRLowerExtInfantMin2ViewsLeft-Report 73592 $92.37XRLowerExtInfantMin2ViewsRight 73592 $203.77XRLowerExtInfantMin2ViewsRight-Report 73592 $92.37XRAnkle2ViewsLeft-InClinic 73600 $405.36 $99.04XRAnkle2ViewsRight-InClinic 73600 $405.36 $99.04XRAnkle2ViewsLeft 73600 $405.36XRAnkle2ViewsLeft-Report 73600 $99.04XRAnkle2ViewsRight 73600 $405.36XRAnkle2ViewsRight-Report 73600 $99.04XRAnkleCompleteLeft-InClinic 73610 $410.07 $105.02XRAnkleCompleteRight-InClinic 73610 $410.07 $105.02XRAnkleCompleteLeft 73610 $410.07XRAnkleCompleteLeft-Report 73610 $105.02XRAnkleCompleteRight 73610 $410.07XRAnkleCompleteRight-Report 73610 $105.02XRArthrogramAnkleLeft 73615 $1,056.21XRArthrogramAnkleLeft-Report 73615 $350.45XRArthrogramAnkleRight 73615 $1,056.21XRArthrogramAnkleRight-Report 73615 $350.45XRFoot2ViewsLeft-InClinic 73620 $397.68 $86.78XRFoot2ViewsRight-InClinic 73620 $397.68 $86.78XRFoot2ViewsLeft 73620 $397.68XRFoot2ViewsLeft-Report 73620 $86.78XRFoot2ViewsRight 73620 $397.68XRFoot2ViewsRight-Report 73620 $86.78XRFootCompleteLeft-InClinic 73630 $408.15 $97.20XRFootCompleteRight-InClinic 73630 $408.15 $97.2073630Foot,Complete,Min3Views 73630 $408.15 $97.20XRFootCompleteLeft 73630 $408.15XRFootCompleteLeft-Report 73630 $97.20XRFootCompleteRight 73630 $408.15XRFootCompleteRight-Report 73630 $97.20XRCalcaneusMinimum2ViewsLeft-InClinic 73650 $353.91 $90.13XRCalcaneusMinimum2ViewsRight-InClinic 73650 $353.91 $90.13XRCalcaneusMinimum2ViewsLeft 73650 $353.91XRCalcaneusMinimum2ViewsLeft-Report 73650 $90.13XRCalcaneusMinimum2ViewsRight 73650 $353.91XRCalcaneusMinimum2ViewsRight-Report 73650 $90.13XRToeorToes2ViewsLeft-InClinic 73660 $325.25 $92.32XRToeorToes2ViewsRight-InClinic 73660 $325.25 $92.32XRToeorToesCompleteLeft-InClinic 73660 $325.25 $92.32XRToeorToesCompleteRight-InClinic 73660 $325.25 $92.32XRToeorToes2ViewsLeft-Report 73660 $92.32XRToeorToes2ViewsRight-Report 73660 $92.32
XRToeorToesCompleteLeft 73660 $325.25XRToeorToesCompleteLeft-Report 73660 $92.32XRToeorToesCompleteRight 73660 $325.25XRToeorToesCompleteRight-Report 73660 $92.32XRToeorToesMinimumof2ViewsLeft 73660 $325.25XRToeorToesMinimumof2ViewsRight 73660 $325.25CTAnklewithoutContrastLeft 73700 $1,988.08CTAnklewithoutContrastLeft-Report 73700 $602.31CTAnklewithoutContrastRight 73700 $1,988.08CTAnklewithoutContrastRight-Report 73700 $602.31CTFemurwithoutContrastLeft 73700 $1,988.08CTFemurwithoutContrastLeft-Report 73700 $602.31CTFemurwithoutContrastRight 73700 $1,988.08CTFemurwithoutContrastRight-Report 73700 $602.31CTFootwithoutContrastLeft 73700 $1,988.08CTFootwithoutContrastLeft-Report 73700 $602.31CTFootwithoutContrastRight 73700 $1,988.08CTFootwithoutContrastRight-Report 73700 $602.31CTHipwithoutContrastLeft 73700 $1,988.08CTHipwithoutContrastLeft-Report 73700 $602.31CTHipwithoutContrastRight 73700 $1,988.08CTHipwithoutContrastRight-Report 73700 $602.31CTKneewithoutContrastLeft 73700 $1,988.08CTKneewithoutContrastLeft-Report 73700 $602.31CTKneewithoutContrastRight 73700 $1,988.08CTKneewithoutContrastRight-Report 73700 $602.31CTTibia-FibulawithoutContrastLeft 73700 $1,988.08CTTibia-FibulawithoutContrastLeft-Report 73700 $602.31CTTibia-FibulawithoutContrastRight 73700 $1,988.08CTTibia-FibulawithoutContrastRight-Report 73700 $602.31CTAnklewithContrastLeft 73701 $1,872.78CTAnklewithContrastLeft-Report 73701 $753.03CTAnklewithContrastRight 73701 $1,872.78CTAnklewithContrastRight-Report 73701 $753.03CTFemurwithContrastLeft 73701 $1,872.78CTFemurwithContrastLeft-Report 73701 $753.03CTFemurwithContrastRight 73701 $1,872.78CTFemurwithContrastRight-Report 73701 $753.03CTFootwithContrastLeft 73701 $1,872.78CTFootwithContrastLeft-Report 73701 $753.03CTFootwithContrastRight 73701 $1,872.78CTFootwithContrastRight-Report 73701 $753.03CTHipwithContrastLeft 73701 $1,872.78CTHipwithContrastLeft-Report 73701 $753.03CTHipwithContrastRight 73701 $1,872.78CTHipwithContrastRight-Report 73701 $753.03CTKneewithContrastLeft 73701 $1,872.78CTKneewithContrastLeft-Report 73701 $753.03CTKneewithContrastRight 73701 $1,872.78CTKneewithContrastRight-Report 73701 $753.03CTTibia-FibulawithContrastLeft 73701 $1,872.78CTTibia-FibulawithContrastLeft-Report 73701 $753.03
CTTibia-FibulawithContrastRight 73701 $1,872.78CTTibia-FibulawithContrastRight-Report 73701 $753.03CTAnklewo+withContrastLeft 73702 $3,482.82CTAnklewo+withContrastLeft-Report 73702 $905.82CTAnklewo+withContrastRight 73702 $3,482.82CTAnklewo+withContrastRight-Report 73702 $905.82CTElbowwo+withContrastLeft 73702 $3,482.82CTElbowwo+withContrastRight 73702 $3,482.82CTFemurwo+withContrastLeft 73702 $3,482.82CTFemurwo+withContrastLeft-Report 73702 $905.82CTFemurwo+withContrastRight 73702 $3,482.82CTFemurwo+withContrastRight-Report 73702 $905.82CTFootwo+withContrastLeft 73702 $3,482.82CTFootwo+withContrastLeft-Report 73702 $905.82CTFootwo+withContrastRight 73702 $3,482.82CTFootwo+withContrastRight-Report 73702 $905.82CTHipwo+withContrastLeft 73702 $3,482.82CTHipwo+withContrastLeft-Report 73702 $905.82CTHipwo+withContrastRight 73702 $3,482.82CTHipwo+withContrastRight-Report 73702 $905.82CTKneewo+withContrastLeft 73702 $3,482.82CTKneewo+withContrastLeft-Report 73702 $905.82CTKneewo+withContrastRight 73702 $3,482.82CTKneewo+withContrastRight-Report 73702 $905.82CTTibia-Fibulawo+wContrastLeft 73702 $3,482.82CTTibia-Fibulawo+wContrastLeft-Report 73702 $905.82CTTibia-Fibulawo+wContrastRight 73702 $3,482.82CTTibia-Fibulawo+wContrastRight-Report 73702 $905.82CTALowerExtremityLeft 73706 $5,547.29CTALowerExtremityLeft-Report 73706 $1,187.36CTALowerExtremityRight 73706 $5,547.29CTALowerExtremityRight-Report 73706 $1,187.36Magneticresonance(eg,proton)imaginglowerextremityotherthanjointw/ocontrastmaterial/s 73718 $2,778.07 $1,195.44MRIFemurwithoutContrastLeft 73718 $2,778.07MRIFemurwithoutContrastLeft-Report 73718 $1,195.44MRIFemurwithoutContrastRight 73718 $2,778.07MRIFemurwithoutContrastRight-Report 73718 $1,195.44MRIFootwithoutContrastLeft 73718 $2,778.07MRIFootwithoutContrastLeft-Report 73718 $1,195.44MRIFootwithoutContrastRight 73718 $2,778.07MRIFootwithoutContrastRight-Report 73718 $1,195.44MRITibia-FibulawithoutContrastLeft 73718 $2,778.07MRITibia-FibulawithoutContrastLeft-Report 73718 $1,195.44MRITibia-FibulawithoutContrastRight 73718 $2,778.07MRITibia-FibulawithoutContrastRight-Report 73718 $1,195.44MRIFemurwithContrastLeft 73719 $4,249.83MRIFemurwithContrastLeft-Report 73719 $1,332.60MRIFemurwithContrastRight 73719 $4,249.83MRIFemurwithContrastRight-Report 73719 $1,332.60MRIFootwithContrastLeft 73719 $4,249.83MRIFootwithContrastLeft-Report 73719 $1,332.60MRIFootwithContrastRight 73719 $4,249.83
MRIFootwithContrastRight-Report 73719 $1,332.60MRITibia-FibulawithContrastLeft 73719 $4,249.83MRITibia-FibulawithContrastLeft-Report 73719 $1,332.60MRITibia-FibulawithContrastRight 73719 $4,249.83MRITibia-FibulawithContrastRight-Report 73719 $1,332.60MRIFemurwo+withContrastLeft 73720 $3,242.54MRIFemurwo+withContrastLeft-Report 73720 $1,658.54MRIFemurwo+withContrastRight 73720 $3,242.54MRIFemurwo+withContrastRight-Report 73720 $1,658.54MRIFootwo+withContrastLeft 73720 $3,242.54MRIFootwo+withContrastLeft-Report 73720 $1,658.54MRIFootwo+withContrastRight 73720 $3,242.54MRIFootwo+withContrastRight-Report 73720 $1,658.54MRITibia-Fibulawo+withContrastLeft 73720 $3,242.54MRITibia-Fibulawo+withContrastLeft-Report 73720 $1,658.54MRITibia-Fibulawo+withContrastRight 73720 $3,242.54MRITibia-Fibulawo+withContrastRight-Report 73720 $1,658.54MRIAnklewithoutContrastLeft 73721 $2,550.52MRIAnklewithoutContrastLeft-Report 73721 $794.16MRIAnklewithoutContrastRight 73721 $2,550.52MRIAnklewithoutContrastRight-Report 73721 $794.16MRIHipwithoutContrastLeft 73721 $2,550.52MRIHipwithoutContrastLeft-Report 73721 $794.16MRIHipwithoutContrastRight 73721 $2,550.52MRIHipwithoutContrastRight-Report 73721 $794.16MRIKneewithoutContrastLeft 73721 $2,550.52MRIKneewithoutContrastLeft-Report 73721 $794.16MRIKneewithoutContrastRight 73721 $2,550.52MRIKneewithoutContrastRight-Report 73721 $794.16MRIAnklewithContrastLeft 73722 $2,714.95MRIAnklewithContrastLeft-Report 73722 $1,257.91MRIAnklewithContrastRight 73722 $2,714.95MRIAnklewithContrastRight-Report 73722 $1,257.91MRIHipwithContrastLeft 73722 $2,714.95MRIHipwithContrastLeft-Report 73722 $1,257.91MRIHipwithContrastRight 73722 $2,714.95MRIHipwithContrastRight-Report 73722 $1,257.91MRIKneewithContrastLeft 73722 $2,714.95MRIKneewithContrastLeft-Report 73722 $1,257.91MRIKneewithContrastRight 73722 $2,714.95MRIKneewithContrastRight-Report 73722 $1,257.91MRIAnklewo+withContrastLeft 73723 $3,850.19MRIAnklewo+withContrastLeft-Report 73723 $1,558.21MRIAnklewo+withContrastRight 73723 $3,850.19MRIAnklewo+withContrastRight-Report 73723 $1,558.21MRIHipwo+withContrastLeft 73723 $3,850.19MRIHipwo+withContrastLeft-Report 73723 $1,558.21MRIHipwo+withContrastRight 73723 $3,850.19MRIHipwo+withContrastRight-Report 73723 $1,558.21MRIKneewo+withContrastLeft 73723 $3,850.19MRIKneewo+withContrastLeft-Report 73723 $1,558.21MRIKneewo+withContrastRight 73723 $3,850.19
MRIKneewo+withContrastRight-Report 73723 $1,558.21MRALowerExtremityworwoContLeft 73725 $2,361.31MRALowerExtremityworwoContLeft-Report 73725 $1,328.83MRALowerExtremityworwoContRight 73725 $2,361.31MRALowerExtremityworwoContRight-Report 73725 $1,328.83X-rayofabdomen,singleview 74018 $173.50 $77.53XRAbdomen1View 74018 $173.50XRAbdomen1View-Report 74018 $77.53XRAbdomen2Views 74019 $255.75XRAbdomen2Views-Report 74019 $113.6274177XRabdomenmin3views 74021 $319.68 $132.69XRAbdomen3orMoreViews 74021 $319.68XRAbdomen3orMoreViews-Report 74021 $132.69XRAbdomenAcute-InClinic 74022 $675.38 $151.69XRAbdomenAcute-Report 74022 $151.69XRAcuteAbdomen 74022 $675.38CTAbdomenwithoutContrast 74150 $1,770.30CTAbdomenwithoutContrast-Report 74150 $514.56CTAbdomenwithContrast 74160 $2,373.92CTAbdomenwithContrast-Report 74160 $772.92CTAbdomenwo+withContrast 74170 $2,830.17CTAbdomenwo+withContrast-Report 74170 $876.78CTAAbd+PelviswContwoifPerforme 74174 $5,174.05CTAAbd+PelviswContwoifPerformed-Report 74174 $1,303.39CTAAbdomenwContrastwoifperformed 74175 $3,706.85CTAAbdomenwContrastwoifperformed-Report 74175 $1,032.35CTAbdomen+PelviswithoutContrast 74176 $3,233.84CTAbdomen+PelviswithoutContrast-Report 74176 $696.35CTStoneStudy-Abdomen+PelviswithoutContrast-Report 74176 $696.35CTStoneStudy-Abd+PelviswoContrast 74176 $3,233.84CTAbdomen+PelviswithContrast 74177 $3,759.43CTAbdomen+PelviswithContrast-Report 74177 $1,046.13CTofabdomenandpelviswithcontrast 74177 $3,759.43 $1,046.13CTAbdomen+PelviswithoutandwithContrastandfurthersectionsinoneorbothbodyregions-Report 74178 $1,185.34CTAbdomen+Pelviswo+withContrast 74178 $4,678.17CTIVP-Abd+Pelviswo+withContrast 74178 $4,678.17CTIVP-Abdomen+Pelviswithout+withContrast-Report 74178 $1,185.34MRIAbdomenwithoutContrast 74181 $3,018.87MRIAbdomenwithoutContrast-Report 74181 $1,099.41MRIMRCP 74181 $3,018.87MRIMRCP-Report 74181 $1,099.41MRIAbdomenwithContrast 74182 $4,481.08MRIAbdomenwithContrast-Report 74182 $1,492.52MRIAbdomenwo+withContrast 74183 $3,313.73MRIAbdomenwo+withContrast-Report 74183 $1,675.78MRAAbdomenwithorwithoutContrast 74185 $1,798.15MRAAbdomenwithorwithoutContrast-Report 74185 $1,333.64XRBariumSwallow-Esophagus 74220 $646.86XRBariumSwallow-Esophagus-Report 74220 $293.82XRUpperGI 74240 $1,181.34XRUpperGI-Report 74240 $379.27XRUpperGI+KUB 74241 $1,046.31
XRUpperGI+KUB-Report 74241 $394.87XRUpperGIwithSmallBowel 74245 $1,649.16XRUpperGIwithSmallBowel-Report 74245 $571.34XRModifiedBariumSwallowwithVideo 74246 $913.28XRModifiedBariumSwallowwithVideo-Report 74246 $421.39XRUpperGIwithAirContrast 74246 $580.60XRUpperGIwithAirContrast-Report 74246 $423.86XRUpperGIwithAirContrast+KUB 74247 $770.70XRUpperGIwithAirContrast+KUB-Report 74247 $469.56XRUpperGIwithAirwithSmallBowel 74249 $1,088.65XRUpperGIwithAirwithSmallBowel-Report 74249 $610.36XRSmallBowelwithSerialFilms 74250 $709.80XRSmallBowelwithSerialFilms-Report 74250 $343.26XRColonContrastEnema 74270 $1,404.35XRColonContrastEnema-Report 74270 $496.31XRColonAirContrastEnema 74280 $1,330.18XRColonAirContrastEnema-Report 74280 $706.68XRTherapeuticEnemawContrastorAir 74283 $1,089.27XRTherapeuticEnemawContrastorAir-Report 74283 $730.96XRCholangiograminOR 74300 $1,039.07XRCholangiograminOR-Report 74300 $70.75XRCholangiogramInORAdditonalSet 74301 $537.37XRCholangiogramInORAdditonalSet-Report 74301 $40.81XRIntroLongGITubeWFluoro+Films 74340 $997.66XRIntroLongGITubeWFluoro+Films-Report 74340 $105.63XRNaso-oroGastric-TubePlacementRequiringPhysicianskillandFluoroscopicGuidance-Report 74340 $105.63XRIVP 74400 $1,363.82XRIVP-Report 74400 $364.10XRCystography 74430 $824.40XRCystography-Report 74430 $130.49XRUrethrocystographyVoiding 74455 $653.39XRUrethrocystographyVoiding-Report 74455 $269.12XRHysterosalpingography 74740 $570.11XRHysterosalpingography-Report 74740 $248.74CTAAbdAorta+BilatIliofemoralwCont 75635 $3,004.16CTAAbdominalAorta+IliofemoralLERunoffBilateral-Report 75635 $1,288.08XRTubeorCathChange 75984 $1,336.77XRTubeorCathChange 75984 $1,336.77XRTubeorCathChange-Report 75984 $359.27CTDrainage-AbscessorCyst 75989 $2,180.78CTGuide-PercDrainagewithCathPlace 75989 $2,180.78CTGuide-PercDrainagewithCathPlace-Report 75989 $424.25USGuide-PercDrainwithCathPlace 75989 $2,180.78USGuide-PercDrainwithCathPlace-Report 75989 $424.25XRDrainage-AbscessorCyst 75989 $2,180.78XRDrainage-AbscessorCyst-Report 75989 $424.25XRGuide-PercDrainwCathPlacement 75989 $2,180.78XRGuide-PercDrainwCathPlacement-Report 75989 $424.25Fluoroscopy,separateprocedureupto1hrphys.time 76000 $795.15 $154.77XRFluoroscopyUpto1Hour 76000 $795.15XRFluoroscopyUpto1Hour-Report 76000 $154.77XRForeignBodyLocNosetoRectumChild-InClinic 76010 $281.54 $88.68
XRForeignBodyLocNosetoRectumChild 76010 $281.54XRForeignBodyLocNosetoRectumChild-Report 76010 $88.68XRFistulaorSinusTractAbscessStudy 76080 $461.01XRFistulaorSinusTractAbscessStudy-Report 76080 $193.27MABreastTissueSpecimenLeft 76098 $676.25MABreastTissueSpecimenLeft-Report 76098 $57.81MABreastTissueSpecimenRight 76098 $676.25MABreastTissueSpecimenRight-Report 76098 $57.81XRSurgicalSpecimen 76098 $676.25XRSurgicalSpecimen-Report 76098 $57.81CTLimitedorLocalizedFollowUpStudy 76380 $882.78CTLimitedorLocalizedFollowUpStudy-Report 76380 $494.53USNeonatalHead 76506 $652.47USNeonatalHead-Report 76506 $396.61UltrasoundCharge76510 76510 $985.54UltrasoundCharge76511 76511 $493.80UltrasoundCharge76512 76512 $570.88UltrasoundCharge76513 76513 $609.99Cornealpachymetry,unilateralorbilateral(determinationofcornealthickness) 76514 $112.61 $53.74UltrasoundCharge76514 76514 $112.61UltrasoundCharge76516 76516 $471.46UltrasoundCharge76519 76519 $536.48UltrasoundCharge76529 76529 $481.5676536-USSoftTissueHead-NeckorThyroid 76536 $657.44 $389.12UltrasoundCharge76536 76536 $657.44USSoftTissueHead-NeckorThyroid-Report 76536 $389.12USSoftTissueHead-NeckorThyroid 76536 $657.44USChest(IncludesMediastinum)-InClinic 76604 $602.06 $299.55UltrasoundCharge76604 76604 $602.06USChest(IncludesMediastinum) 76604 $602.06USChest(IncludesMediastinum)-Report 76604 $299.55USBreastwAxillaifperfCompLeft 76641 $371.19USBreastwAxillaifperfCompLeft-Report 76641 $366.33USBreastwAxillaifperfCompRight 76641 $371.19USBreastwAxillaifperfCompRight-Report 76641 $366.3376642PFUltrasound,breast,unilateral;limited-report 76642 $414.30 $304.2276642Ultrasound,breast,unilateral,realtimewithimagedoc,inclaxillawhenperformed;limited 76642 $414.30 $304.22USBreastwAxillaifperfLimitedLeft 76642 $414.30USBreastwAxillaifperfLimitedLeft-Report 76642 $304.22USBreastwAxillaifperfLimitedRight 76642 $414.30USBreastwAxillaifperfLimitedRight-Report 76642 $304.22UltrasoundCharge76700 76700 $943.87USAbdomenComplete 76700 $943.87USAbdomenComplete-Report 76700 $417.39Ultrasound,abdominal,realtimewithimagedocumentationlimited(eg,singleorgan,quadrant,f/u 76705 $592.39 $330.39UltrasoundCharge76705 76705 $592.39USAbdomenLimited 76705 $592.39USAbdomenLimited-Report 76705 $330.39USAbdominalAorticAneurysmScreening 76706 $1,138.61USAbdominalAorticAneurysmScreening-Report 76706 $316.28UltrasoundCharge76770 76770 $759.35USRetroperitonealComplete 76770 $759.35
USRetroperitonealComplete-Report 76770 $385.69zzMFMUSRetroperitonealLimited-InClinic 76775 $593.61 $205.99UltrasoundCharge76775 76775 $593.61USRenal 76775 $593.61USRenal-Report 76775 $205.99USRetroperitonealLimited 76775 $593.61USRetroperitonealLimited-Report 76775 $205.99UltrasoundCharge76800 76800 $692.11USSpinalCanal 76800 $692.11USSpinalCanal-Report 76800 $489.65MFMUSOB1stTrimesterSingleGestation-InClinic 76801 $708.25 $428.03OBUS1stTrimester,1stGest-inClinic 76801 $708.25 $428.03UltrasoundCharge76801 76801 $708.25USOB1stTrimesterSingleGestation 76801 $708.25USOB1stTrimesterSingleGestation-Report 76801 $428.03MFMUSOB1stTrimesterEaAddGestation-InClinic 76802 $567.54 $234.95UltrasoundCharge76802 76802 $567.54USOB1stTrimesterEaaddGestation 76802 $567.54USOB1stTrimesterEaaddGestation-Report 76802 $234.95MFMUSOBAfter1stTrimesterSingleGest-InClinic 76805 $662.78 $487.83UltrasoundCharge76805 76805 $662.78USOBAfter1stTrimesterSingleGest 76805 $662.78USOBAfter1stTrimesterSingleGest-Report 76805 $487.83MFMUSOBAfter1stTrimesterEaAddGest-InClinic 76810 $374.21 $331.79UltrasoundCharge76810 76810 $374.21USOBAfter1stTrimesterEaAddGest 76810 $374.21USOBAfter1stTrimesterEaAddGest-Report 76810 $331.79MFMUSOB1stGestwDetailedFetalExam-InClinic 76811 $1,154.29 $650.72UltrasoundCharge76811 76811 $1,154.29USOB1stGestwDetailedFetalExam 76811 $1,154.29USOB1stGestwDetailedFetalExam-Report 76811 $650.72MFMUSOBEaAddGestwDetailedFetalExam-InClinic 76812 $675.62 $716.66UltrasoundCharge76812 76812 $675.62USOBEaAddGestWDetailedFetalExam 76812 $675.62USOBEaAddGestWDetailedFetalExam-Report 76812 $716.66UltrasoundCharge76813 76813 $664.73UltrasoundCharge76814 76814 $418.95MFMUSOBLimited-OneorMoreFetuses-InClinic 76815 $483.30 $293.02Ultrasound,pregnantuterus,realtimewithimagedocumentatio,limited,1ormorefetus 76815 $483.30 $293.02UltrasoundCharge76815 76815 $483.30USOBLimited-OneorMoreFetuses 76815 $483.30USOBLimited-OneorMoreFetuses-Report 76815 $293.02MFMUSOBFollowUp 76816 $430.51 $398.78UltrasoundCharge76816 76816 $430.51USOBFollowUp 76816 $430.51USOBFollowUp-Report 76816 $398.78AbdomenUSLimited-inClinic 76817 $518.01 $336.61MFMUSOBTransvaginal-InClinic 76817 $518.01 $336.61UltrasoundCharge76817 76817 $518.01USOBTransvaginal 76817 $518.01USOBTransvaginal-Report 76817 $336.61Fetalbiophysicalprofile;withnon-stresstesting 76818 $655.74 $429.88
USFetalBiophysicalProfilewNon-Str 76818 $655.74USFetalBiophysicalProfilewNon-Str-Report 76818 $429.88MFMUSFetalBiophysicalProfilewoNon-Str-InClinic 76819 $320.64 $314.72USFetalBiophysicalProfilewoNon-Str 76819 $320.64USFetalBiophysicalProfilewoNon-Str-Report 76819 $314.72USFetalDopplerUmbilicalArtery 76820 $585.42USFetalDopplerUmbilicalArtery-Report 76820 $171.24MFMUSFetalDopplerEchocardiographyFU-InClinic 76828 $591.00 $191.44TransvaginalultrasoundOB-inClinic 76830 $541.47 $412.72UltrasoundCharge76830 76830 $541.47USTransvaginalNon-OB 76830 $541.47USTransvaginalNon-OB-Report 76830 $412.7276381-SIS 76831 $721.43 $405.69SonohysterogramwDopplerColorFlow 76831 $721.43 $405.69USSalineInfusionSonohysterography 76831 $721.43USSalineInfusionSonohysterography-Report 76831 $405.69UltrasoundCharge76856 76856 $733.91USPelvicNon-OBComplete-Report 76856 $374.82USPelvisNon-OBComplete 76856 $733.91PelvicUSLimited(NonOB)-inClinic 76857 $507.39 $170.54UltrasoundCharge76857 76857 $507.39USPelvicNon-OBLimited-Report 76857 $170.54USPelvisNon-OBLimited 76857 $507.39Ultrasound,scrotumandcontents 76870 $835.96 $239.12UltrasoundCharge76870 76870 $835.96USScrotum(Contents) 76870 $835.96USScrotum(Contents)-Report 76870 $239.12USLowerExtremityCompleteNon-VascularLeft 76881 $517.53USLowerExtremityCompleteNon-VascularLeft-Report 76881 $397.42USLowerExtremityCompleteNon-VascularRight 76881 $517.53USLowerExtremityCompleteNon-VascularRight-Report 76881 $397.42USUpperExtremityCompleteNon-VascularLeft 76881 $517.53USUpperExtremityCompleteNon-VascularLeft-Report 76881 $397.42USUpperExtremityCompleteNon-VascularRight 76881 $517.53USUpperExtremityCompleteNon-VascularRight-Report 76881 $397.42USExtremity,nonvascular,realtimeimagedocumentation;ltd-inclinic 76882 $342.55 $131.13UltrasoundCharge76882 76882 $342.55USAxillaryLeft 76882 $342.55USAxillaryLeft-Report 76882 $131.13USAxillaryRight 76882 $342.55USAxillaryRight-Report 76882 $131.13USLowerExtremityLimitedNon-VascularLeft 76882 $342.55USLowerExtremityLimitedNon-VascularLeft-Report 76882 $131.13USLowerExtremityLimitedNon-VascularRight 76882 $342.55USLowerExtremityLimitedNon-VascularRight-Report 76882 $131.13USUpperExtremityLimitedNon-VascularLeft 76882 $342.55USUpperExtremityLimitedNon-VascularLeft-Report 76882 $131.13USUpperExtremityLimitedNon-VascularRight 76882 $342.55USUpperExtremityLimitedNon-VascularRight-Report 76882 $131.13UltrasoundCharge76930 76930 $959.68UltrasoundCharge76937 76937 $699.42Ultrasonicguidanceforneedleplacementimagingsupervisionandinterpretation 76942 $1,107.72 $215.06
UltrasoundCharge76942 76942 $1,107.72USAspiration 76942 $1,107.72USAspiration-Report 76942 $215.06USBiopsyAxillaLeft 76942 $1,107.72USBiopsyAxillaLeft-Report 76942 $215.06USBiopsyAxillaRight 76942 $1,107.72USBiopsyAxillaRight-Report 76942 $215.06USBiopsyLiver 76942 $1,107.72USBiopsyLiver-Report 76942 $215.06USBiopsyRenalLeft 76942 $1,107.72USBiopsyRenalLeft-Report 76942 $215.06USBiopsyRenalRight 76942 $1,107.72USBiopsyRenalRight-Report 76942 $215.06USBiopsyThyroid 76942 $1,107.72USBiopsyThyroid-Report 76942 $215.06USDrainageAbscessorCyst 76942 $1,107.72USDrainageAbscessorCyst-Report 76942 $215.06USGuidanceforNeedlePlacement 76942 $1,107.72USGuidanceforNeedlePlacement-Report 76942 $215.06USInjection 76942 $1,107.72USInjection-Report 76942 $215.06UltrasoundCharge76970 76970 $612.22USFollowUpStudy 76970 $612.22USFollowUpStudy-Report 76970 $306.39UltrasoundCharge76977 76977 $159.57USGuidedIntraoperative 76998 $1,213.70USGuidedIntraoperative-Report 76998 $501.63UltrasoundCharge76999 76999 $634.57Fluoroscopicguidanceforneedleplacement(eg,biopsy,aspiration,injection,localizationdevice) 77002 $496.73 $312.14XRFluoroGuidanceNeedlePlacement 77002 $496.73XRFluoroGuidanceNeedlePlacement-Report 77002 $312.14Fluoroscopicguidanceandlocalizationofneedle/cathetertipforspineorparaspinousdxortxinj 77003 $370.08 $318.21XRFluoroGuidanceNeedleLocSpine 77003 $370.08XRFluoroGuidanceNeedleLocSpine-Report 77003 $318.21CTAspiration 77012 $2,330.76CTAspiration-Report 77012 $433.14CTAspirationAbdomen 77012 $2,330.76CTAspirationAbdomen-Report 77012 $433.14CTAspirationPelvis 77012 $2,330.76CTAspirationPelvis-Report 77012 $433.14CTBiopsy 77012 $2,330.76CTBiopsy-Report 77012 $433.14CTBiopsyBone 77012 $2,330.76CTBiopsyBone-Report 77012 $433.14CTBiopsyLiver 77012 $2,330.76CTBiopsyLiver-Report 77012 $433.14CTBiopsyLungLeft 77012 $2,330.76CTBiopsyLungLeft-Report 77012 $433.14CTBiopsyLungRight 77012 $2,330.76CTBiopsyLungRight-Report 77012 $433.14CTBiopsyPancreas 77012 $2,330.76CTBiopsyPancreas-Report 77012 $433.14
CTBiopsyRenalLeft 77012 $2,330.76CTBiopsyRenalLeft-Report 77012 $433.14CTBiopsyRenalRight 77012 $2,330.76CTBiopsyRenalRight-Report 77012 $433.14CTGuidanceforNeedlePlacement 77012 $2,330.76CTGuidanceforNeedlePlacement-Report 77012 $433.14CTInjection 77012 $2,330.76CTInjection-Report 77012 $433.14BreastTomoUnilateralDiag 77061 $234.11MATomosynthesisDiagnosticBreastLeft 77061 $234.11MATomosynthesisDiagnosticBreastLeft-Report 77061 $234.11MATomosynthesisDiagnosticBreastRight 77061 $234.11MATomosynthesisDiagnosticBreastRight-Report 77061 $234.11MATomosynthesisDiagnosticBreastBilat 77062 $234.11MATomosynthesisDiagnosticBreastBilat-Report 77062 $234.11MATomosynthesisScreeningBreastBilat 77063 $186.95MATomosynthesisScreeningBreastBilat-Report 77063 $197.13MAMammogramAdditionalView(s)Left-Report 77065 $365.39MAMammogramAdditionalView(s)Right-Report 77065 $365.39MAMammogramDiagnosticLeft-Report 77065 $365.39MAMammogramDiagnosticRight-Report 77065 $365.39MAMammographyAdditionalView(s)Left 77065 $551.61MAMammographyAdditionalView(s)Right 77065 $551.61MAMammographyDiagnosticLeft 77065 $551.61MAMammographyDiagnosticRight 77065 $551.61Diagnosticmammography,includingCADwhenperformed;bilateral 77066 $721.71MAMammogramDiagnosticBilateral-Report 77066 $468.58MAMammographyDiagnosticBilateral 77066 $721.71MAMammogramScreening-Report 77067 $456.68MAMammographyScreeningBilateral 77067 $492.68Screeningmammography,bilateral(2-viewstudyofeachbreast),inclCADwhenperformed 77067 $492.68 $456.68XRStresstoJointworwoContralatJnt 77071 $378.74XRStresstoJointworwoContralatJnt-Report 77071 $165.83XRBoneAgeStudies 77072 $197.07XRBoneAgeStudies-Report 77072 $79.04XRBoneLengthStudiesScanogram-Report 77073 $121.86XRBoneLengthStudiesScanograms 77073 $541.60XRBoneSurveyLtd-Metsor24+Months-Report 77074 $218.75XRBoneSurveyComp-Metsor24+Months-Report 77075 $293.60XRBoneSurveyComplete(Mets) 77075 $891.08XRBoneSurvey-Under24MonthsOld-Report 77076 $329.52XRBoneSurveyInfant 77076 $765.62XRJntSvy1Vw2orMoreJnts-Specify 77077 $457.14XRJntSvy1Vw2orMoreJnts-Specify-Report 77077 $127.90XRPAHandsandWristsforArthritis 77077 $457.14XRPAHandsandWristsforArthritis-Report 77077 $127.90BDBoneDensityDEXAAxialSkeleton 77080 $427.64BDBoneDensityDEXAAxialSkeleton-Report 77080 $136.28BDBoneDensityDEXAAppSkeleton 77081 $418.48BDBoneDensityDEXAAppSkeleton-Report 77081 $95.80G3+(I-Stat) 80047 $220.41BASICMETABOLICPANEL(CALCIUM,TOTAL) 80048 $224.70
BMPWB 80048 $224.70BasicMetabolicPanel 80048 $224.70ELECTROLYTEPANEL 80051 $88.85CMPWB 80053 $303.45COMPREHENSIVEMETABOLICPANEL 80053 $303.45ComprehensiveMetabolicPanel 80053 $303.45LIPIDPANEL 80061 $197.40RENALFUNCTIONPANEL 80069 $131.44ACUTEHEPATITISPANEL 80074 $469.85HEPATICFUNCTIONPANEL 80076 $136.92TricyclicScreen,Urine 80152 $153.67Carbamazepine(Tegretol)Level 80156 $227.12CarbamazepineandMetabolite 80156 $227.12CyclosporineLevel 80158 $163.59ClozapineLevel 80159 $158.64DigoxinLevel 80162 $231.37ValproicAcidFree+Total 80164 $203.23ValproicAcidLevel 80164 $203.23DRUGSCRNQUANTEVEROLIMUSS/O 80169 $291.58GentamicinLevel 80170 $342.03GabapentinLevel 80171 $167.58LamotrigineLevel 80175 $197.28LevetiracetamLevel 80177 $198.68LithiumLevel 80178 $119.26MycophenolicAcidPanel 80180 $230.23OxcarbazepineLevel 80183 $147.99PhenobarbitalLEVL 80184 $141.32PhenobarbitalLevel 80184 $141.32PrimidoneLevel 80184 $141.32PHENYTOIN(DILANTIN)TOTALXXPHE 80185 $204.76PhenytoinLevelTotal 80185 $204.76Sirolimus(Rapamycin) 80195 $337.01Tacrolimus(FK506) 80197 $165.91TheophyllineLevel 80198 $182.61Tobramycin,Trough 80200 $255.84TopiramateLevel 80201 $240.83VancomycinLevel 80202 $265.98Zonisamide(zonegran)Level 80203 $239.08Flecainide(Tambocor)Level 80299 $155.33LacosamideLevel 80299 $155.33MeconiumDrugScreen 80301 $94.4380305-DrugScreenQualitate/MultiPOC 80305 $118.48ALCOHOL(ETHANOL)ANYSPECIMENEXCEPTBREATH 80305 $118.48DrugScreenUrine 80305 $118.48POCUrineToxScreen 80305 $118.48DrugTest,qualitative,directopticalobservation;perday 80306 $66.86Drugtestchemanalyzer,anynumclasses 80307 $133.74Alcohols 80320 $205.05EthanolLevel 80320 $205.05NicotineandMetabolite,Serum 80323 $120.66AmphetamineConfirm 80324 $77.43AcetaminophenLevel 80329 $136.30
SalicylateLevel 80329 $136.30Fluoxetine(Prozac)Level 80332 $83.45Sertraline(zoloft)Level 80332 $83.45AmitriptylineLevel 80335 $83.79QuetiapineLevel 80342 $83.45ClonazepamLevel 80346 $83.45Buprenorphine,Quant,Urine 80348 $83.12MarijuanaConfirmation 80349 $83.12CocaineConfirmation 80353 $83.12FentanylLevel 80354 $83.45MethadoneLevelUrine 80358 $83.12OpiatesConfirmation 80361 $83.12OxycodoneConfirmation 80365 $187.4081001Urinalysis,automated,withmicroscopy 81001 $78.54URINALYSIS,AUTOMATED,WITHMICROSCOPY 81001 $78.54Urinalysis,bydipstickortabreagentnon-autow/omicroscopy 81002 $27.50OBUrinalysis 81003 $76.59POCUrinalysis 81003 $76.59URINALYSIS,AUTOMATED,WITHOUTMICROSCOPY 81003 $76.59URINALYSIS,AUTOMATED,WITHOUTMICROSCOPY,S/O 81003 $76.59UrinalysisMacroscopic 81003 $76.59UrinalysiswithReflexMicroscopic 81003 $76.59URINALYSIS,MICROSCOPICONLY 81015 $57.94UrinalysisMicroscopic 81015 $57.9481025-UAForPregTestbyVisualClrComparison 81025 $91.35BetaHumanChorionicGonadotropinQualitativeUrine 81025 $91.35HCG,UrinePOC 81025 $91.35POCUrineHCG 81025 $91.35URINEPREGNANCYTEST,BYVISUALCOLORCOMPARISON,QUAL.(HCG) 81025 $91.35CalciumLevel24HourUrine 81050 $41.70Creatinine24HourUrine 81050 $41.70Protein24HourUrine 81050 $41.70SodiumLevel24HourUrine 81050 $41.70TOTALPROTEIN24HRURINEW/CREATININE 81050 $41.70UricAcid24HourUrine 81050 $41.70VOLUMEMEASUREMENTFORTIMEDCOLLEC 81050 $41.70VOLUMEMEASUREMENTFORTIMEDCOLLEC,S/O 81050 $41.70VanillylmandelicAcid24HourUrine 81050 $41.70BRCAdvantage(comprehensive) 81162 $60.89BCR/ABL1GENEMAJORBPS/O 81206 $503.85BCR/ABL1GENEMINORBPS/O 81207 $378.61CALRGENECOMVARIANTS 81219 $615.02CysticFibrosisCarrierScreen 81220 $208.80GenomicAlterations,PostnatalOglioSNP 81229 $4,014.94EGFRGENECOMVARIANTSS/O 81235 $1,174.24ProthrombinGeneAnalysis 81240 $375.78FactorVLeidenMutationAnalysisw/rfxHR2Mutation 81241 $315.06FragileX,PCRreflexSouthern 81243 $558.60HemochromatosisAnalysis 81256 $536.26HBA1/HBA2GENES/O 81257 $678.25JAK2MutationV617F 81270 $554.25AccuTypeIL28B 81283 $602.17
MTHFRgeneanalysis,commonvariantsS/O 81291 $305.37TPMTGeneticAssessment 81335 $886.78HLAB*5701Typing 81381 $601.78MOLPATHPROCEDURELEVEL1 81400 $207.36MOLPATHL3S/O 81402 $637.81MOLPATHL4S/O 81403 $610.77MOLPATHL9COL1A1 81408 $2,925.97FetalChrmomlAneuploidy 81420 $2,188.32FETALCHROMMICRODELSEQANALY 81422 $896.36INHERCARDIOMYOPATHSEQANAL5MINGENES 81439 $896.36HarmonyPrenataltest 81507 $2,086.88FirstTrimesterScreenHyperglycosylatedhCG 81508 $225.54MaternalSerumScreen4 81511 $114.38NFCTDSCHRNCHCV6BIOCHEMASSAYSRMALGLVR 81596 $227.40HepCLiverFibrotest/ActitestPanel 81599 $944.03Ketones(serum/plasma) 82009 $113.63KetonesUrine 82009 $113.63Acetone 82010 $88.26ACYLCARNITINES,QUANT.EASPECIMEN,S/O 82017 $239.64AdrenocorticotropicHormone 82024 $246.32ALBUMIN,SERUM,PLASMAORWHOLEBLOOD 82040 $58.94ALBUMIN,SERUM,PLASMAORWHOLEBLOOD,S/O 82040 $58.94AlbuminLevel 82040 $58.94IgGSynthesisRate/index,CSF 82040 $58.94MethotrexateChemistryPanel 82040 $58.94Testosterone,Free,Total,Bioavailable 82040 $58.94AlbuminPeritonealFluid 82042 $68.88MICROALBUMIN,URINE,QUANT 82043 $101.24Microalbumin/CreatinineRatio 82043 $101.24BrACPOC 82075 $78.54Aldolase 82085 $116.37Aldosterone 82088 $231.72Aldosterone/PlasmaReninActivityRatio 82088 $231.72Alpha-1-Antitrypsin 82103 $140.18ALPHA-1-ANTITRYPSIN,PHENOTYPE,S/O 82104 $122.89AlphaFetoproteinTumorMarker 82105 $129.03MaternalAFP 82105 $129.03AminoAcidQuantitative 82139 $489.33AMMONIA 82140 $198.33AmmoniaLevel 82140 $198.33StoneRiskDiagnosticProfile 82140 $198.33AMYLASE 82150 $99.44AmylaseLevel 82150 $99.44AmylasePeritonealFluid 82150 $99.44AmylasePleuralFluid 82150 $99.44Androstenedione 82157 $201.77AngiotensinConvertingEnzyme 82164 $150.55ApolipoproteinA-1 82172 $96.87ApolipoproteinA1andBFasting 82172 $96.87ArsenicLevel 82175 $127.13HeavyMetalScreen 82175 $127.13Beta2Microglobulin 82232 $124.83
BileAcids,Total 82239 $133.51BILIRUBIN,TOTAL 82247 $56.28BilirubinFractionated 82247 $56.28BilirubinTotal 82247 $56.28BilirubinTotalPediatric 82247 $56.28NeonatalBilirubin 82247 $56.28BilirubinDirect 82248 $71.34OCCULTBLOOD,(GUAIAC)QUAL,FECES,1-3CARDS,CONSECCOLLECTIONFORCOLORECTALNEOPLASMSCREENING 82270 $66.22OccultBloodGastricFluid 82271 $39.88HemoccultCard1(Inpatientnon-cancerscreen) 82272 $47.13HemoccultDRE 82272 $47.13HemoccultNon-CancerScreen(1-3cards) 82272 $47.13POCHemoccult/Guaiac1-3(NON-CANCERSCREEN) 82272 $47.13POCHemoccult/GuaiacDRE 82272 $47.13FecalImmunochemicalTest 82274 $72.52VitaminD25OH,Total 82306 $254.10CalcitoninLevel 82308 $214.67CALCIUM,TOTAL 82310 $59.87CalciumLevelTotal 82310 $59.87CalciumLevelUrine 82310 $59.87PTHIntactandIonizedCalcium 82310 $59.87CalciumLevelIonized 82330 $159.79IonizedCalciumWB 82330 $159.79CALCIUM,URINE,QUANT,TIMEDSPECIMEN 82340 $113.92KidneyStoneAnalysis 82365 $116.47StoneAnalysis 82365 $116.47CARBONDIOXIDE(BICARBONATE) 82374 $34.02CarbonDioxideLevel 82374 $34.02CarboxyhemoglobinLevel 82375 $316.41CarcinoembryonicAntigen 82378 $146.93CatecholaminesFractionated 82384 $191.59CatecholaminesFractionated24HourUrine 82384 $191.59Ceruloplasmin 82390 $123.35AntiMullerianHormone 82397 $85.64InhibinB 82397 $85.64ChlorideLevel 82435 $65.45CHLORIDE,URINE 82436 $34.02ChlorideLevelUrine 82436 $34.02ElectrolytePanelUrine 82436 $34.02ElectrolytesFecal 82438 $58.65CHOLESTEROL,SERUMORWHOLEBLOOD,TOTAL 82465 $39.52CholesterolTotal 82465 $39.52CITRATE,S/O 82507 $152.08CopperLevelWholeBlood 82525 $118.37CortisolFree24HourUrine 82530 $205.57Cortisol 82533 $165.14DexamethasoneSuppressionTest(DST)8am 82533 $165.14BileAcids,FractionatedandTotal,Pregnancy 82542 $296.58CREATINEKINASE(CPK)TOTAL 82550 $120.08CardiacPanel 82550 $120.08CreatineKinase 82550 $120.08CKIsoenzymesw/oTotalCK 82552 $161.88
CKCK-MBCKMBIPanel 82553 $282.49CK-MBIsoenzyme 82553 $282.49CREATINEKINASE(CPK),MBFRACTIONONLY 82553 $282.49CREATININEKINASEISOENZYMESXXCKI 82553 $282.49CREATININE,BLOOD 82565 $53.62Creatinine 82565 $53.62CREATININEOTHERSOURCE 82570 $65.34CreatininePeritonealFluid 82570 $65.34CreatinineUrine 82570 $65.34ProteinElectrophoresisUrine 82570 $65.34TP/CreatinineRatio(Urine) 82570 $65.34CREATININECLEARANCE 82575 $128.10Cryoglobulin 82595 $110.40B12/folatePanel 82607 $110.85VitaminB12Level 82607 $110.85DehydroepiandrosteroneSulfate 82627 $155.64DihydroxyvitaminD1,25Level 82652 $329.02PancreaticElastase1 82656 $363.59ErythropoietinLevel 82668 $166.99EstradiolLevel 82670 $178.13EstradiolUltrasensitive 82670 $178.13EstrogensTotal 82672 $234.61ESTRIOL,S/O 82677 $167.75FecalFatQualitative 82705 $82.68FecalLipids,Total 82710 $191.20Ferritin 82728 $127.25FETALFIBRONECTINCERVICOVAGINALSEMIQUANT,S/O 82731 $234.61FetalFibronectin 82731 $234.61FolateLevel 82746 $103.53RedCellFolate 82747 $191.20CeliacDiseasePanel 82784 $85.90CeliacDiseasePanelInfant 82784 $85.90IgA 82784 $85.90IgG 82784 $85.90IgGCSF 82784 $85.90IgM 82784 $85.90ImmunoglobulinsQuantitative 82784 $85.90AllergyPanel-Alaska 82785 $130.56AllergyPanel-Childhood(Food/Environmental) 82785 $130.56AllergyPanel-NorthwesternInhalant 82785 $130.56IgE 82785 $130.56IMMUNOGLOBULINSUBCLASSES,EA,S/O 82787 $77.43BloodGasArterial 82803 $288.62BloodGasVenous 82803 $288.62CordBloodGas-Arterial 82803 $288.62CordBloodGas-Venous 82803 $288.62POCCABG-BLOODGAS-XXABG 82803 $288.62GastrinLevel 82941 $151.40GlucagonLevel 82943 $169.82GlucoseCerebrospinalFluid 82945 $102.04GlucosePeritonealFluid 82945 $102.04GlucosePleuralFluid 82945 $102.04
GlucoseSynovialFluid 82945 $102.04GLUCOSE,QUANT,BLOOD(EXCEPTREAGENTSTRIP) 82947 $53.11Glucose2HourPostPrandial 82947 $53.11GlucoseFasting 82947 $53.11GlucoseRandom 82947 $53.11Glucose;quantitative,bloodreagentstrip 82948 $86.27GLUCOSE,POSTDOSE(INCLUDESGLUCOSE) 82950 $94.67Glucose,1HRScreen 82950 $94.67GlucoseTolerance,Non-Pregnant,Fastingand2Hr 82950 $94.67GLUCOSETOLERANCE(GTT)1ST3SPEC 82951 $175.92GlucoseTolerance2HRPrenatalN 82951 $175.92Prenatal2HRglucoseTolerance 82951 $175.92Glucose-6-PDQuantitative 82955 $128.48CapillaryBloodGlucosePOC 82962 $23.87GLUCOSEBLOODTEST 82962 $23.8782962-Glucose,bloodbyglucosemonitoringdevice 82962 $23.87Glucose(POC) 82962 $23.87POCGlucose 82962 $23.87POCGlucose 82962 $23.87GLUTAMYLTRANSFERASE,GAMMA(GGT) 82977 $70.08GammaGlutamylTransferase 82977 $70.08Glutamyltransferase,gamma(GGT)S/O 82977 $70.08Fructosamine 82985 $79.77FollicleStimulatingHormoneLevel 83001 $170.54FollicleStimulatingHormoneLevelPeds 83001 $170.54LuteinizingHormone 83002 $177.08LuteinizingHormone(Peds) 83002 $177.08GrowthHormone 83003 $186.57Haptoglobin 83010 $122.39Helicobacterpylori;breathtestanalysisforureaseactivity,non-radioactiveisotope 83013 $286.17HELICOBACTERPYLORIBREATHTEST 83013 $286.17PediatricH.pyloriUreaBreathTest(<18Yrs) 83013 $286.17HemoglobinopathyEvaluation 83021 $93.25HEMOGLOBINGLYCOSYLATED(A1C) 83036 $115.37HemoglobinA1c 83036 $115.37HemoglobinA1CglycosylatedFDAAnalyzer 83037 $46.94Hemoglobin,Plasma 83051 $115.03HomocysteineTotal 83090 $235.98MethylmalonicAcidandHomocysteine 83090 $235.985-HydroxyindoleaceticAcid24HourUrine 83497 $137.92HYDROXYPROGESTERONE17-D,S/O 83498 $225.22ANAw/ReflexT/P/CStage3 83516 $216.11GliadinAntibody 83516 $216.11Lupus(SLE)Panel 83516 $216.11LupusAnticoagulant 83516 $216.11SmoothMuscleAntibodyScreen 83516 $216.11TissueTransglutaminaseAntibodyIgA 83516 $216.11TissueTransglutaminaseAntibodyIgG 83516 $216.11AcetylcholineReceptorBindingAntibody 83519 $242.28AcetylcholineReceptorBlockingAntibody 83519 $242.28AcetylcholineReceptorModulatingAntibody 83519 $242.28AntiTSHAutoAntibody 83519 $242.28
Insulin-LikeGrowthFactorBindingProtein-3 83519 $242.28PTH-RelatedProtein 83519 $242.28ParathyroidHormoneRelatatedPeptide 83519 $242.28ThyroidAutoantibodies 83519 $242.28AntiglomerularBasementMembraneAntibody 83520 $139.55IMMUNOASSAYQUANT,NOSXXNOS 83520 $139.55TryptaseTotal 83520 $139.55InsulinLevelTotal 83525 $111.25IRON 83540 $81.13IronLevel 83540 $81.13IronProfile 83540 $81.13IronTIBCandFerritin 83540 $81.13IRONBINDINGCAPACITY 83550 $113.06LacticAcid 83605 $176.90LacticAcid,Arterial 83605 $176.90LACTATEDEHYDROGENASE(LDH) 83615 $74.54LactateDehydrogenase 83615 $74.54LactateDehydrogenasePeritonealFluid 83615 $74.54LactateDehydrogenasePleuralFluid 83615 $74.54LACTOFERRIN,STOOL,QUAL,S/O 83630 $160.88LACTOFERRIN,STOOL,QUAL 83631 $274.08LeadLevel 83655 $72.15LeadRandomUrine 83655 $72.15LIPASE 83690 $122.89LipaseLevel 83690 $122.89CholesterolHighDensityLipid 83718 $74.51HDLCHOLESTEROL,DIRECT 83718 $74.51MAGNESIUM 83735 $101.38MagnesiumLevel 83735 $101.38MagnesiumLevel24HourUrine 83735 $101.3817-dHydroxyprogesterone 83789 $209.98TPMTEnzymeActivity 83789 $209.98ThiopurineMetabolites 83789 $209.98MercuryLevel 83825 $102.18Metanephrines,Fractionated(Plasma) 83835 $226.81Metanephrines,Fractionated(Urine) 83835 $226.81Myoglobin 83874 $287.67MyoglobinUrine 83874 $287.67B-TypeNatiureticPeptideBNP 83880 $340.13NATRIURETICPEPTIDE 83880 $340.13NT-proBNP 83880 $340.13FreeKappaandLambdaLightChainswRatioandReflexImmunofixation 83883 $192.77KappaLambdaLightChains,Total24Ur 83883 $192.77Kappa/LambdaLightChain,Serum 83883 $192.77Kappa/LambdaRatio,RandomUrine 83883 $192.775'Nucleotidase 83915 $110.27OligoclonalBandsCerebrospinalFluid 83916 $190.04MethylmalonicAcidQuantitative 83921 $187.66Osmolality 83930 $173.22OsmolalityUrine 83935 $140.71OXALATE,S/O 83945 $90.23IntactParathyroidHormone 83970 $301.93
PTHIntactandCalcium 83970 $301.93POCNitrazine(AMNIOTIC) 83986 $77.83POCNitrazine(VAGINOSIS) 83986 $77.83pHBodyFluid 83986 $77.83pHStool 83986 $77.83PCPConfirmation 83992 $83.12CALPROTECTIN,S/O 83993 $393.26ALKALINEPHOSPHATASE 84075 $54.19AlkalinePhosphatase 84075 $54.19AlkalinePhosphataseIsoenzymes 84075 $54.19PhosphorusLevel 84100 $61.84PhosphorusLevel24HourUrine 84105 $55.14PhosphorusLevelUrine 84105 $55.14RuptureofFetalMembraneRapid 84112 $330.41PorphyrinsUrineFractionated 84120 $140.76POTASSIUM,SERUM,PLASMAORWHOLEBLOOD 84132 $60.19PotassiumLevel 84132 $60.19POTASSIUMURINE 84133 $58.88PotassiumLevel24HourUrine 84133 $58.88PotassiumLevelUrine 84133 $58.88PREALBUMIN 84134 $144.03Pregnenolone 84140 $129.03ProgesteroneLevel 84144 $139.31ProlactinLevel 84146 $168.16ASSAYOFTYROSINE 84150 $375.38PROSTATESPECIFICANTIGEN(PSA)TOTAL 84153 $184.68PSAFreeandTotal 84153 $184.68PSAPost-Prostatectomy 84153 $184.68PSA,TOTALPSAT 84153 $184.68ProstateSpecificAntigen 84153 $184.68PROTEINELECTROPHORESISW/SCN(serum) 84155 $41.06PROTEIN,TOTAL,SERUM,PLASMAORWHOLEBLOOD 84155 $41.06ProteinTotal 84155 $41.06ProteinTotalandProetinElectrophoresis(SPEP) 84155 $41.06PROTEIN,TOTAL,URINE 84156 $96.95ProteinUrine 84156 $96.95PROTEIN,TOTAL,OTHERSOURCE 84157 $146.71ProteinCerebrospinalFluid 84157 $146.71ProteinPeritonealFluid 84157 $146.71ProteinPleuralFluid 84157 $146.71ProteinSynovialFluid 84157 $146.71PROTEINELECTROPHORESIS,SERUMPE 84165 $107.43ProteinElectrophoresis(PEP)CSF 84166 $124.56ProinsulinLevel 84206 $214.50VitaminB6Level 84207 $234.38PyruvicAcid 84210 $102.06ReninActivity 84244 $172.66VitaminB2(riboflavin) 84252 $154.84SEROTONIN,S/O 84260 $316.17SexHormoneBindingProtein 84270 $117.63POCCSODIUM-XX295 84295 $67.19SODIUM,SERUM,PLASMAORWHOLEBLOOD 84295 $67.19
SodiumLevel 84295 $67.19SODIUM,URINE 84300 $63.49SodiumLevelUrine 84300 $63.49Insulin-LikeGrowthFactor(IGF-I) 84305 $211.56Somatostatin 84307 $420.06ReducingSubstanceStool 84376 $28.39SULFATE,URINE,S/O 84392 $61.70Testosterone,FreeandTotal,Lc/ms/ms 84402 $107.49TestosteroneTotal 84403 $134.23Testosterone,Total 84403 $134.23VitaminB1 84425 $234.62ThyroglobulinLevelandAntibody 84432 $204.55Thyroxine 84436 $98.37FreeT4FT4Q 84439 $142.95ThyroxineFree 84439 $142.95THYROXINEBINDINGGLOBULINS/O 84442 $164.23THYROIDSTIMHORMONE(TSH) 84443 $239.40TSHwithReflexFreeT4 84443 $239.40ThyroidStimulatingHormone 84443 $239.40ThyroidStimulatingImmunoglobulins 84445 $452.47VitaminELevel 84446 $187.87AspartateAminotransferase 84450 $53.91AlanineAminotransferase 84460 $95.26Transferrin 84466 $90.17TRIGLYCERIDES 84478 $60.65T3Uptake 84479 $104.15Triiodothyronine 84480 $153.11T3Free 84481 $193.58T3Reverse 84482 $140.77TroponinIWB 84484 $347.84Troponin-I 84484 $347.84BloodUreaNitrogen 84520 $55.93UreaNitrogenUrine 84540 $72.50UricAcid 84550 $46.65UricAcidUrine 84560 $93.42VASOACTIVEINTESTINALPEPTIDE,S/O 84586 $320.64VASOPRESSIN(ANTIDIURETICHORMONE,ADH),S/O 84588 $189.42VitaminALevel 84590 $186.78VitaminB3 84591 $194.73VitaminK1 84597 $262.76XYLOSEABSORPTIONTEST 84620 $155.30ZincLevel 84630 $143.54C-Peptide 84681 $219.31BetaHumanChorionicGonadotropinQuantitative 84702 $164.42HCGQuant(BRH) 84702 $164.42HCGTotal,Quant(non-pregnancy) 84702 $164.42HCGQualitative,Serum 84703 $133.85FecalOsmolality 84999 $428.98ManualDifferential 85007 $111.36HEMATOCRIT 85014 $52.07HemoglobinandHematocrit 85014 $52.0785018-Hemoglobenbloodcount 85018 $45.39
HEMOGLOBIN 85018 $45.39Hemoglobin 85018 $45.39Hemoglobin(POC) 85018 $45.39POCHemoglobin 85018 $45.39POCCHGB-XXHGB 85018 $45.39BNPWB 85025 $144.33CompleteBloodCountw/AutomatedDifferential 85025 $144.33CompleteBloodCountwithoutDiff 85027 $109.24ReticulocyteCountAutomated 85045 $114.46PlateletCount 85049 $43.67BLOODSMEAR,PERIPHERAL,INTERPBYPHYSICIANWWRITTENREPORT 85060 $124.00BLOODSMEARPERIPHERAL,INTERPRETATIONBYPHYSICIANWITHWRITTENREPORT 85060 $95.83BLOODSMEARPERIPHERAL,INTERPRETATIONBYPHYSICIANWITHWRITTENREPORT 85060 $124.00FactorVIIAssay 85230 $279.18FactorVIIIAssay 85240 $302.65VonWillebrandFactorAntigen 85246 $275.95AntithrombinIIIAssay 85300 $213.74ProteinCActivity 85303 $152.21ProteinCandSActivityw/rfxtoProteinCand/orSAntigen 85303 $152.21FibrinDegradationProduct 85362 $130.21D-Dimer 85379 $322.13FibrinogenActivity(CLAUSS) 85384 $168.80Kleihauer-Betke 85460 $134.90Post-PartumRhlgEvaluation 85460 $134.90Heparin,Anti-Xa 85520 $279.30MURAMIDASE,S/O 85549 $125.13PHOSPHOLIPIDNEUTRALIZATION,PLATELET,S/O 85597 $68.88PHOSPHOLIPIDNEUTRALIZATION,HEXAGONALPHOSPOLIPID,S/O 85598 $133.95Prothrombintime 85610 $137.5585610POCProtime/INR 85610 $137.55Coagulation(PT&PTT,INR) 85610 $137.55INR(POC) 85610 $137.55POCINR 85610 $137.55ProthrombinTime 85610 $137.55AntiphospholipidSyndromeDiagnosticPanel 85613 $129.24SedimentationRate 85651 $54.59SEDIMENTATIONRATE,RBC,AUTO 85652 $63.24SickleCellSolubilityTest 85660 $72.73PartialThromboplastinTime 85730 $151.50RubeolaAntibodyIgG 85765 $139.89ALLERGENSPECIFICIGG,QUANTORSEMIQNT,EA,S/O 86001 $42.23AllergyPanel-AdultFood 86003 $57.81AllergyPanel-Alder 86003 $57.81AllergyPanel-Carmine/RedDye 86003 $57.81AllergyPanel-EggWhite 86003 $57.81AllergyPanel-EggYolk 86003 $57.81AllergyPanel-Food 86003 $57.81AllergyPanel-Gluten 86003 $57.81AllergyPanel-Halibut 86003 $57.81AllergyPanel-Latex 86003 $57.81AllergyPanel-Milk 86003 $57.81AllergyPanel-Mold 86003 $57.81
AllergyPanel-MountainCedar 86003 $57.81AllergyPanel-Nut 86003 $57.81AllergyPanel-PenicillinProfile2 86003 $57.81AllergyPanel-Rice 86003 $57.81AllergyPanel-Salmon 86003 $57.81AllergyPanel-Seafood 86003 $57.81AllergyPanel-SmallAlaska 86003 $57.81AllergyPanel-Strawberry 86003 $57.81RAST-PeanutPanel 86003 $57.81ANCAScreenw/MPO+PR3w/rfxtoANCAtiter 86021 $154.81ANCAVasculitides 86021 $154.81ANACascadingReflex 86038 $110.54ANAScreenw/rfxTiterandPattern 86038 $110.54ANAw/rfxTiter/Pattern/Cascade 86038 $110.54CentromereAntibodyScreen 86038 $110.54ANTINUCLEARANTIBODIES(ANA),TITER,S/O 86039 $121.19AntistreptolysinOScreen 86060 $91.50C-ReactiveProteinHighSensitivity 86140 $106.90CardioCRP 86141 $152.85Beta-2-GlycoproteinIAntibodies(igG,IgA,IgM) 86146 $104.29PhospholipidAntibodyPanel 86146 $104.29CardiolipinAntibodyScreen 86147 $120.40ColdAgglutininsTiter 86157 $102.60C3C4ComplementCH50 86160 $123.31C3Complement 86160 $123.31C3,C4Complement 86160 $123.31C4Complement 86160 $123.31COMPLEMENT,FUNCTIONALACTIVITY,S/O 86161 $109.48ComplementTotal 86162 $197.40CyclicCitrullinePeptide 86200 $178.46AntideoxyribonucleaseBTiter 86215 $131.83ANACascadingReflexStage1 86225 $128.95ANAw/ReflexT/P/CStage1 86225 $128.95DNAAntibody(Double-stranded) 86225 $128.95ANAw/ReflexT/P/CStage2 86235 $114.89EXTRACTABLENUCLEARANTIGEN,ANTIBODYTO,ANYMETHOD,EAAB,S/O 86235 $114.89JO-1Antibody 86235 $114.89SMAntibody 86235 $114.89Scl70Antibody 86235 $114.89Sjogren'sAntibody 86235 $114.89SmandSm/rnpAntibodies 86235 $114.89EndomysialAntibodyIgAScreen 86255 $191.75MitochondrialAB/ReflexTITER 86255 $191.75CancerAntigen2729 86300 $145.23CarbohydrateAntigen15-3 86300 $145.23CarbohydrateAntigen19-9 86301 $187.41CancerAntigen125 86304 $179.66IMMUNOASSAYFORTUMORANTIGEN,CA125,S/O 86304 $179.66MononucleosisScreen 86308 $104.31IMMUNOASSAYTUMORANTIGEN,OTHERANTIGEN,QUANT(CA50,72-4,549)EA,S/O 86316 $174.43NuclearMatrixProteins(NMP) 86316 $174.43HepBVaccineScreen 86317 $22.36
IMMUNODIFFUSION,NES,S/O 86329 $112.61Immunoelectrophoresis-New 86334 $145.62ImmunofixationEletrophoresis 86334 $145.62Immunofixation,UrRandom 86335 $335.86INHIBINA 86336 $185.18InsulinAntibody 86337 $232.38IntrinsicFactorAntibody 86340 $183.00Gad-65Ab 86341 $223.51IsletCellAntibody 86341 $223.51LEUKOCYTEHISTAMINERELEASETEST(LHR),S/O 86343 $170.05MONONUCLEARCELLAGNOSQUANTXXMCA 86356 $128.48TCELLS,TOTALCOUNT,S/O 86359 $164.23LymphocyteSubsetPanel4 86360 $131.93LymphocyteSubsetPanel5(CD4) 86361 $76.84LiverKidneyAb(Igg) 86376 $124.24ThyroidPeroxidaseAb 86376 $124.24PARTICLEAGGLUTINATIONSCREEN,EACHAB,S/O 86403 $124.00RheumatoidFactorQuantitative 86431 $98.08QuantiferonTBGold 86480 $155.79INTRADERMALTUBERCULOSISSKINTEST 86580 $44.49PPD-OtherMedicationCharge 86580 $44.49Skintest;tuberculosis,intradermal 86580 $44.49PPDplaced 86580 $44.49RPR,Quant 86592 $72.07VDRLScreen 86592 $72.07VDRLScreenCerebrospinalFluid 86592 $72.07RPRTITER 86593 $65.13AspergillusAntibodiesPanel 86606 $120.82BartonellaSpeciesAntibody(Igg,igm)WithReflexToTiters 86611 $110.04BordetellaPertussis(IGG,IGA) 86615 $147.47LymeDiseaseAntibody,Total,Eia,ReflexToWesternBlot 86617 $107.39CytomegalovirusAntibodyIgG 86644 $105.23CytomegalovirusAntibodyIgM 86645 $165.41CoxsackieAAbPanel 86658 $127.36EpsteinBarrVirusPanel 86664 $162.14SaccharomycesABIgA 86671 $153.62SaccharomycesABIgG 86671 $153.62Herpes1/2Igg,TypeSpecificAb 86695 $128.48HerpesVirusType2IgG 86696 $128.48AssayforHumanimmunodeficiencyvirus2(HIV-2)antibody 86702 $158.36POCHIVRapidOralSwab 86703 $127.90AB,HIV-1ANDHIV-2,SINGLERESULT 86703 $127.90POCRapidHIV1/2 86703 $127.90RapidHIVTest 86703 $127.90HepatitisBCoreAntibodyIgG+IgM 86704 $115.51HepatitisBCoreAntibodyTotalw/rfxIgM 86704 $115.51HEPATITISBCOREAB(HBcAb)IGM 86705 $114.12HepatitisBCoreAntibodyIgMAcuteTiter 86705 $114.12HepatitisBSurfaceAntibody 86706 $120.32HepatitisBeAntibody 86707 $147.03HepatitisBePanel 86707 $147.03HepatitisAAntibodyTotalw/reflexIgM 86708 $134.45
HepatitisAAntibodyIgMAcuteTiter 86709 $124.95JCVirusAntibodywithReflextoInhibitionAssay 86711 $188.43MumpsAntibodyIgG 86735 $137.25MumpsAntibodyPanel 86735 $137.25MycoplasmaAntibodyIgGandIgMbyELISA 86738 $137.25ParvovirusB19AntibodiesIgGandIgM 86747 $158.90PROTOZOAABNOTSPECIFIEDXXHIS 86753 $89.71AB,RICKETTSIA,S/O 86757 $123.88RubellaAntibodiesIgG/IgM 86762 $78.18RubellaAntibodyIgG 86762 $78.18Rubeola/MeaslesAntibodiesIgG/IgM 86765 $144.29ToxoplasmaAntibodiesIgG/IgMPregnancyw/rfx 86777 $113.79ToxoplasmaAntibodyIgG 86777 $113.79FluorescentTreponemalAntibody-Absorption 86780 $110.62VaricellaZosterAntibodyIgG 86787 $129.00VaricellaZosterAntibodyIgM 86787 $129.00VaricellaZosterImmunityScreen(IgG) 86787 $129.00VaricellaZosterImmunityScreenIgG&IgM 86787 $129.00AB,VIRUS,NES,S/O 86790 $129.03ThyroglobulinAntibody 86800 $113.59HepatitisCAntibodyIgM+IgG 86803 $151.69POCHepatitsCScreen 86803 $151.69Hla-b27Antigen 86812 $189.35AntibodyScreenAutomated 86850 $201.66TypeandScreen 86850 $201.66PrenatalAntibodyIDw/rfxtoTiter(PSBC) 86870 $308.73CordDirectCoombsCDAT 86880 $135.34ABO/Rh 86900 $75.36CordBloodEval. 86900 $75.36Rhig 86901 $70.40AntigenType 86905 $121.83BLOODTYPINGRH(D) 86906 $139.23CrossmatchUnit1 86920 $217.16CrossmatchUnit10 86920 $217.16CrossmatchUnit11 86920 $217.16CrossmatchUnit12 86920 $217.16CrossmatchUnit13 86920 $217.16CrossmatchUnit14 86920 $217.16CrossmatchUnit15 86920 $217.16CrossmatchUnit2 86920 $217.16CrossmatchUnit3 86920 $217.16CrossmatchUnit4 86920 $217.16CrossmatchUnit5 86920 $217.16CrossmatchUnit6 86920 $217.16CrossmatchUnit7 86920 $217.16CrossmatchUnit8 86920 $217.16CrossmatchUnit9 86920 $217.16AcidFastBacilliCulture 87015 $86.37CULTURE,BACTERIAL,BLOOD 87040 $254.12BloodCultureAdult(First) 87040 $254.12BloodCulturePediatric 87040 $254.12StoolCulture 87045 $203.94
CultureYersinia 87046 $71.90ShigaToxin(EnterohemorrhagicEcoli) 87046 $71.90BodyFluidCulture 87070 $187.17CerebrospinalFluidCulture 87070 $187.17CultureMRSAMSSAScreen 87070 $187.17CultureSputum 87070 $187.17EarCulture 87070 $187.17EyeCulture 87070 $187.17GenitalCulture 87070 $187.17NasalCulture 87070 $187.17ThroatCulture 87070 $187.17WoundCulture,Superficial(Aerobiconly) 87070 $187.17CultureAnaerobicw/gramstain 87075 $230.91TissueCulture 87075 $230.91CULTUREANAEROBIC,ADDLMETHODSFORIDS/O 87076 $127.93CultureAnaerobicCXANA 87077 $100.67GonorrheaCulture 87081 $95.38GroupAStrepCulture 87081 $95.38GroupBStrepCulture 87081 $95.38MRSACulture 87081 $95.38UrineCulture 87086 $157.62CULTURE,BACTERIAL,WISOLATIONANDPRESUMPTIVEIDEAISOLATE,URINE 87088 $89.34Culture,Fungus,Skin,Hair,Nail/dirFlKOH 87101 $198.14Culture,Fungus,notHair,skin,nail,OrBlood 87102 $171.21CultureYeastw/DFKOH 87102 $171.21YeastID 87106 $82.93FUNGAL/YEASTID 87107 $64.80Mycoplasma/UreaplasmaCulture 87109 $198.79ChlamydiaTrachomatisCulture 87110 $146.63CULTURE,TYPING,IMMUNOFLUORESCENTMETHODS/O 87140 $100.21VIRALIDRESPIRATORY 87140 $100.21CULTURE,TYPING,IMMUNOLOGICMETHODOTHERTHANFLUORESCENT(EGAGGLUTINATION)PERANTISERUM, 87147 $64.59TickandotherArthropodID 87168 $89.38ParasiteIDIntestinal 87169 $58.29PINWORMEXAM 87172 $62.17POCPinworm 87172 $62.17PinwormPrep 87172 $62.17OvaandParasites 87177 $104.84OvaandParasitesw/GiardiaAntigen 87177 $104.84ESBLConfirmation 87184 $71.79SUSCEPT,ENZYMEDETECTION(EGBETALACTAMASE)S/O 87185 $61.33YeastSusceptibility 87186 $121.60Smeargramstain 87205 $74.52GramStain 87205 $74.52GramStainSputum 87205 $74.52Gramstain 87205 $74.52SMEAR,FLUORAND/ORACIDFASTSTAINFORBACTERIA,FUNGI,PARASITES,VIRUSESORCELLTYPES,S/O 87206 $95.09Malaria/Babesia/ParasiteSmear 87207 $110.61Smear,primarysourcewithinterpretation;wetmountforinfectiousagents 87210 $98.11Ferning 87210 $98.11POCFerning 87210 $98.11POCWetPrep 87210 $98.11
WetPrep(LAB) 87210 $98.11POCKOH(hair/skin/nails) 87220 $127.91Scabies 87220 $127.91TISSUEEXAMBYKOH,SKIN,HAIRORNAILSFORFUNGIORECTOPARASITEOVAORMITES,S/O 87220 $127.91Culture,Viral,BodyFluids,Tissues 87252 $208.80Herpessimplex/VaricellazosterRapidCulture 87254 $194.40CultureEnterovirus 87254 $194.40CultureInfluenza 87254 $194.40RespiratoryCulture 87254 $194.40HERPESSIMPLEXVIRUSCultureWITHTYPING 87255 $208.80CryptosporidiumparvumAgScreen 87272 $90.05AdenovirusAntigenStool 87301 $73.90C.DifficileDNAAmplification 87324 $197.07ClostridiumDifficileToxin 87324 $197.07INFAGTAGDETECTIONBYEIA,CRYPTOSPORIDIUM, 87328 $204.73GiardialambliaAgScreen 87329 $180.24HelicobacterpyloriAntigenStool 87338 $269.71HepatitisBSurfaceAntigen 87340 $102.49HepatitisBeAntigen 87350 $173.67HIV1/2Ag/AbCombo 87389 $130.95INFAGTAGDETECTIONBYEIA,INFLUENZAAORB,EA 87400 $122.89RotavirusAntigenStool 87425 $73.90LegionellaAntigenUrine 87449 $180.51Norovirusstool 87449 $180.51AptimaCT/NG(Rectal) 87491 $203.88AptimaCT/NG(Throat) 87491 $203.88CT/NG(Swab/Urine/PAP) 87491 $203.88CDifficileDNAAmpS/O 87493 $235.37CMVDNA,QT,RealTimePCR 87497 $503.01CytomegalovirusDNAbyPCR 87497 $503.01EnterovirusbyPCR 87498 $254.55HBVPCR,Quant 87517 $488.71HepatitisCRNAQualitativeTMA 87521 $287.68INFAGTDETECTIONBYNUCLEICACID(DNAORRNA),HEPATITISC,AMPPROBE,S/O 87521 $287.68HCVPCR,Quant 87522 $446.82HepCViralRNAQuantPCR/rfxGenotype 87522 $446.82HepCViralRNAQuantPCR/rfxTMA 87522 $446.82INFAGTDETECTIONBYNUCLEICACID(DNAORRNA),HERPESSIMPLEX,AMPPROBE,S/O 87529 $239.08HerpesVirus(1/2)DNAQuantPCR(fluid) 87530 $207.63HERPESSIMPLEXVIRUS-6,AMPPROBE 87533 $457.16HIV-1RNAQualitative,TMA 87535 $197.07HIV1DNAPCRQualitative 87535 $197.07HIV1PCR,Quant 87536 $560.21HIV-2DNA/RNAQualitativePCR 87538 $207.63M.tuberculosisComplex,Pcr,Non-respiratory 87556 $447.99Chlamydia/N.GonorrhoaeDNA,SDA 87591 $196.19HPVmRNAE6/E7 87624 $145.29HPVtypes16&18only 87625 $228.74PCRRespiratoryPanel 87633 $85.67TrichomonasPAP 87661 $215.23TrichomonasURINEorSWAB 87661 $215.23TrichomonasUrineorSWAB(male) 87661 $215.23
VaricellaZosterDNA,QualPCR 87798 $60.85ZikaVirus(StateLab) 87798 $60.85BPertussisDNAAmplification 87798 $60.85BordetellaPertussisPCR 87798 $60.85INFAGENTDETECT,AMPLIFIEDPROBE 87798 $60.85EBVDNAQuantPCR 87799 $382.19BroadRangePCRBACTERIA(UofW) 87801 $351.74STREPTOCOCCUSGROUPB 87802 $95.22Infectiousagentantigendetectionbyimmunoassaywithdirectopticalobservation;Influenza 87804 $101.52POCRapidInfluenza 87804 $101.52InfluenzaA&BAntigen,RapidTesting 87804 $101.52RSV,RapidAg 87807 $92.67POCAdenovirus 87809 $55.1087880-RapidStrep 87880 $83.52POCRapidStrep 87880 $83.52POCRapidStrep. 87880 $83.52StrepGrpAAg,Rapid 87880 $83.52GenoSureArchiveHIV 87900 $732.54Hiv-1Genotype 87901 $1,026.43HepatitisCGenotyping 87902 $207.63INFAGTGENOTYPEBYNUCLEICACID,HEPATITISCVIRUS 87902 $207.63GENOTYPEDNAHEPATITISBS/O 87912 $768.08CYTOPATHOLOGY,FLUIDS,WASHINGSORBRUSHINGSEXCEPTCERVICALORVAGINAL,SMEARSWITHINTERP 88104 $386.83CYTOPATH,CELLENHANCE,NON-GYNWINTERP 88112 $278.19CYTOPATHOLOGY,SELECTIVECELLULARENHANCEMENTTECHNIQUEWITHINTERPRETATION(EGLIQUIDBASEDSLIDEP 88112 $111.67FISHVysisUrovisionBladderCancer 88120 $1,222.22CYTOPATH,CERVICALORVAGINAL,THINLAYERPREP,MANUALSCREEN,S/O 88141 $122.89CYTOPATH,CERVICALORVAGINAL,THINLAYERPREP,MANUALSCREEN 88142 $188.33CYTOPATHOLOGY,SMEARS,ANYOTHERSOURCE(OTHERTHANPAP)SCREENINGANDINTERPRETATION 88160 $229.74CYTOPATH,EVALOFFINENEEDLEASPTODETERMINEADEQUACY,1STEVALEASITE 88172 $272.03CYTOPATHOLOGY,EVALUATIONOFFINENEEDLEASPIRATE,EAANATOMICALSITE,;INTERPRETATIONANDREPORT 88173 $286.97ThinPrepPAP 88175 $146.63ThinPrepPAPandCT/NGandHRHPV 88175 $146.63ThinPrepPAPandCT/NGw/rfxHRHPV 88175 $146.63ThinprepRFXHPV 88175 $146.63ThinprepwithHPV 88175 $146.63ER/PR/DNA/HER2w/rfxHER2FISH,ParaffinBlock 88182 $207.63FLOWCYTOMETRY,CELLCYCLEORDNAANAL 88182 $207.63FLOWCYTOMETRY,CELLCYCLEORDNAANALYSIS 88182 $426.46FLOWCYTOMETRY,CELLSURFACE,CYTOPLASMICORNUCLEARMARKER,TCONLY1STMARKER,S/O 88184 $210.07Leukemia/LymphomaEvaluation 88184 $210.07FLOWCYTOMETRY,INTERPRETATION16>MARKERS 88189 $317.39ChromosomeAnalysis,Blood 88230 $558.60ChromosomeAnalysis,Tissue 88233 $866.89ChromosomeAnalysis(AmnioticFluid) 88235 $812.21ChromosomeAnalysisAmnioticFluid 88235 $812.21SURGICALPATH,GROSSONLYLEVELI 88300 $114.85LEVELI,SURGICALPATHOLOGY,GROSSEXAMINATIONONLY 88300 $114.85SURGICALPATH,GROSS&MICROLEVELII 88302 $132.20LEVELII,SURGICALPATHOLOGY,GROSSANDMICROSCOPICEXAMINATION 88302 $101.22SURGICALPATH,GROSS&MICROLEVELIII 88304 $188.03LEVELIII,SURGICALPATHOLOGY,GROSSANDMICROSCOPICEXAMINATION 88304 $137.06
PathologyBillingSurgicalPathologyLevelIVComplexity 88305 $292.50SURGICALPATH,GROSS&MICROLEVELIV 88305 $292.50LEVELIV,SURGICALPATHOLOGY,GROSSANDMICROSCOPIC 88305 $292.50LEVELIV,SURGICALPATHOLOGY,GROSSANDMICROSCOPIC 88305 $292.50SURGICALPATH,GROSS&MICROLEVELV 88307 $386.47LEVELV,SURGICALPATHOLOGY,GROSSANDMICROSCOPICEXAMINATION 88307 $685.51SURGICALPATH,GROSS&MICROLEVELVI 88309 $588.70LEVELVI,SURGICALPATHOLOGY,GROSSANDMICROSCOPIC 88309 $588.70DECALCIFICATIONPROCEDURE 88311 $78.76SpecialStaingroup1,NSHC 88312 $199.93SPECIALSTAINS,GROUPIFORMICROORGANISMS(EGGRIDLEY,ACIDFAST,METHENAMINESILVER)INCLUDINGINT 88312 $199.93SPECIALSTAINGROUP2SPS2 88313 $194.04CONSULTATIONANDREPORTONREFERREDSLIDESPREPAREDELSEWHERE 88321 $334.62PATHOLOGYCONSULTATIONDURINGSURGERY,FIRSTTISSUEBLOCK,WITHFROZENSECTION(S)SINGLESPECIMEN 88331 $332.17Immunohisto/cytochem,perspec,eaadditionalsingleabstain 88341 $293.40Immunohistocytostain1ststain,NSHC 88342 $362.70LynchSyndromeTumorPanel 88342 $362.70IMMUNOHISTOCHEMISTRY(INCLUDINGTISSUREIMMUNOPEROXIDASE)EAANTIBODY 88342 $362.64MORPHOMETRICANALYSIS,TUMORIMMUNOHISTOCHEMISTRY,(EGHER-2/NEU,ESTROGENRECEPTOR/PROGESTERONEREC 88360 $482.97HER2FISHPARAFFINBLOCK 88377 $748.41MORPHOMETRICANAL,INSITUHYBRIDIZATION,QUANTORSEMIQUANT,EAPROBE,MANUAL,S/O 88377 $748.41CellCountw/DiffBodyFluid 89051 $249.85CellCountw/DiffCerebrospinalFluid 89051 $249.85CellCountw/DiffSynovialFluid 89051 $249.85FecalLactoferrin(Leukocytes) 89055 $89.61CrystalExaminationBodyFluid 89060 $156.30Eosinophils,Smear 89190 $35.20Post-VasSpermSearch 89321 $89.16HBIG90371-ImmuneGlobulinCharge 90371 $347.1890378RSVMABIM50mg 90378 $6,527.21Synagis90681-ImmuneGlobulinCharge 90378 $3,615.63Injection,RhoDimmuneglobulin,human,fulldose,300micrograms(1500i.u.) 90384 $505.13Injection,RhoDimmuneglobulin,human,minidose,50micrograms(250i.u.) 90384 $505.15Rho(D)ImmuneGlobulin(Rhogam)Mini-DoseInj-InjMedicationCharge 90384 $505.1390460IMMADMIN1ST/ONLYCOMPONENT 90460 $41.0690461IMADMTHRU18YRANYRTEADDLVAC 90461 $23.4690471IMMADMPRQIDSUBQ/IMNJXS1VAC 90471 $28.8190471ImmunizationAdministration 90471 $28.81AdministrationImmunizationOne 90471 $28.81InitialAdministration90471-ImmunizationAdministrationCharge 90471 $28.81InitialAdministration90471-VaccineInjection 90471 $28.81InitialAdministration90471-VaccineInjectionCharge 90471 $28.8190472IMMADMPRQIDSUBQ/IMNJXSEAADD 90472 $13.35ImmunizationAdministration-EaAdd 90472 $13.35Immunizationadministration;eachadditionalvaccine 90472 $13.35AdditionalAdmin90472-VaccineInjection 90472 $13.35AdditionalAdministration90472-ImmunizationAdministrationCharge 90472 $13.35AdditionalAdministration90472-VaccineInjectionCharge 90472 $13.35AdministrationImmunizationEachAddtl 90472 $13.35Immunizationadmnbyintranasalororalroute;1vaccine(singleorcombinationvaccine/toxoid) 90473 $41.06InitialAdministration90473-OtherImmunizationAdministrationCharge 90473 $41.06IMMUNIZATIONADMINTRANSL/ORALEAVACCINE 90474 $23.46
AdditionalAdministration90474-OtherImmunizationAdministrationCharge 90474 $23.46MenB(Bexsero)charge90620-ImmunizationCharge 90620 $387.61MenB(Bexsero)nocharge-ImmunizationCharge 90620 $0.01MenB(Bexsero)nocharge-StateNoChargeImmunizations 90620 $0.01Meningococcalrecombinantproteinandoutermembranevesiclevaccine,SerogroupB,2doseschedule, 90620 $414.70MenB(Trumenba)90621-ImmunizationCharge 90621 $273.67MenB(Trumenba)charge90621-ImmunizationCharge 90621 $295.6790632HepatitisAvaccine,adultdosage,forintramuscularuse 90632 $237.96HepatitisA-adult90632-ImmunizationCharge 90632 $237.9690633HepatitisAvaccine,pediatric/adolescentdosage-2doseschedule,forintramuscularuse 90633 $140.21HepatitisA-pediatric90633-ImmunizationCharge 90633 $140.21HepatitisA-pediatricNoCharge-ImmunizationCharge 90633 $0.01HepatitisA-pediatricNoCharge-StateNoChargeImmunizations 90633 $0.01HepatitisAandhepatitisBvaccine(HepA-HepB),adultdosage,forintramuscularuse 90636 $236.1290647Hemophilusinfluenzabvaccine(Hib),PRP-OMPconjugate(3doseschedule),IM 90647 $116.19PedvaxHIBNoCharge-ImmunizationCharge 90647 $0.01PedvaxHIBNoCharge-StateNoChargeImmunizations 90647 $0.01PedvaxHib(19+yrs)90647-ImmunizationCharge 90647 $116.1990648Hemophilusinfluenzabvaccine(Hib),PRP-Tconjugate(4doseschedule),IM 90648 $169.40Hiberix90648-ImmunizationCharge 90648 $169.4090649HumanPapillomavirus(HPV)vaccine,types6,11,16,18(quadrivalent),3dosesched,IM 90649 $380.96HPV-4(22-26yrsmale)90649-ImmunizationCharge 90649 $380.96HPV-4NoCharge-ImmunizationCharge 90649 $0.0190651Humanpapilomavirusvacctypesnonavalent3doseschedforintra 90651 $515.02HPV-990651-ImmunizationCharge 90651 $515.02HPV-9(22-26yrsmale)90651-ImmunizationCharge 90651 $515.02HPV-9NoCharge-ImmunizationCharge 90651 $0.01HPV-9NoCharge-StateNoChargeImmunizations 90651 $0.01FluPFAdjuvanted(65+yrinj)-FLUVaccineCharges 90653 $75.08Influenzavaccine,inactivated,subunit,adjuvanted,forintramuscularuse 90653 $75.08FluIntradermalNoCharge-ImmunizationCharge 90654 $0.0190655Influenzavirusvaccine,trivalent,splitvirus,preservativefree,6-35monthsofage,IM 90655 $82.32FluPF(6-35moinj)90655-ImmunizationCharge 90655 $82.32FluPF(6-35moinj)NoCharge-ImmunizationCharge 90655 $0.0190656Influenzavirusvaccine,trivalent,splitvirus,preservativefree,3yrsand>,IM 90656 $56.80FluPF(>36moinj)90656-ImmunizationCharge 90656 $56.80FluPF(>36moinj)NoCharge-ImmunizationCharge 90656 $0.0190657Influenzavirusvaccine,trivalent,splitvirus,adminto6-35monthsofage,IM 90657 $77.12Flu(6-35moinj)90657-ImmunizationCharge 90657 $77.12Flu(6-35moinj)NoCharge-ImmunizationCharge 90657 $0.01FluTrivalentMDV(6-35moinj)90657-FLUVaccineCharges 90657 $77.1290658Influenzavirusvaccine,trivalent,splitvirus,adminto3yearsofageandolder,IM 90658 $55.52Flu(>36moinj)90658-ImmunizationCharge 90658 $55.52Flu(>36moinj)NoCharge-ImmunizationCharge 90658 $0.01FluTrivalentMDV(>36moinj)90658-FLUVaccineCharges 90658 $55.5290660Influenzavirusvaccine,trivalent,live,forintranasaluse 90660 $67.03FluMistNoCharge-OtherImmunizationCharge 90660 $0.0190662Influenzavirusvaccine,splitvirus,preservativefree,enhancedimmunogenicity;forIMuse 90662 $136.18FluHighDoseNoCharge-ImmunizationCharge 90662 $0.01FluPFHighDose(65+yrinj)90662-FLUVaccineCharges 90662 $136.18FluPFHighDose(65+yrinj)NoCharge-StateNoChargeFluVaccines 90662 $0.01FluPFHighDose90662-ImmunizationCharge 90662 $136.18
Splitviruspreservativefreeinfluenzavirusvaccineenhancdimmunogenicityincreasdantigencontnt 90662 $136.1890670Pneumococcalconjugatevaccine,13valent,forintramuscularuse 90670 $598.8190670Pneumococcalconjugatevaccine,13valent,forintramuscularuse 90670 $598.8190670NCPneumococcalconjugatevaccine,13valent,forintramuscularuse 90670 $0.01Prevnar-13(19+yrs)90670-ImmunizationCharge 90670 $598.81Prevnar-13NoCharge-ImmunizationCharge 90670 $0.01Prevnar-13NoCharge-StateNoChargeImmunizations 90670 $0.0100005-1971-01-pneumococcal13-valentvaccine1-Susp-Inj 90670 CallforPrice00005-1971-02-pneumococcal13-valentvaccineInjSusp0.5mL-00005-1971-02 90670 CallforPrice00005-1971-02-pneumococcal13-valentvaccineSusp 90670 CallforPrice90672Influenzavirusvaccine,quadrivalent,live,forintranasaluse 90672 $50.73FluQuad(nasal)90672-OtherImmunizationCharge 90672 $50.73FluQuad(nasal)NoCharge-OtherImmunizationCharge 90672 $0.01FluQuadNasalNoCharge-FluQuadNasal 90672 $0.01FluRIV3(18+yrinj)90673-FLUVaccineCharges 90673 $113.43FluRIV3(18+yrinj)90673-ImmunizationCharge 90673 $113.43FluRIV3(18+yrinj)NoCharge-StateNoChargeFluVaccines 90673 $0.01FluRIV3(18-49yrinj)NoCharge-ImmunizationCharge 90673 $0.01Livevirus,trivalentpreservative-freeinfluenzavirusvaccine 90673 $113.43FluccIIV4PF(Flucelvax)-FLUVaccineCharges 90674 $36.0863851-0501-01-rabiesvaccine,purifiedchickembyrocell2.5intlunitsIMInj1mL-63851-0501-0 90675 CallforPrice63851-0501-01rabiesvaccine,purifiedchickembryocell2.5intlunitsPow 90675 CallforPrice63851-0501-02-rabiesvaccine,purifiedchickembryocell2.5intlunitsPow 90675 CallforPrice90680NCRotavirusvaccine,pentavalent,3doseschedule,live,fororaluse 90680 $0.01RotaTeq(rotavirus)90680-OtherImmunizationCharge 90680 $182.32RotavirusNoCharge-OtherImmunizationCharge 90680 $0.01RotavirusNoCharge-ImmunizationCharge 90681 $0.01FluRIV4(18+yrinj)90682-FLUVaccineCharges 90682 $129.35FluRIV4(18+yrinj)NoCharge-StateNoChargeFluVaccines 90682 $0.0190685Influenzavirusvaccine,quadrivalent,splitvirus,preservativefree,6-35mo,IM 90685 $55.52FluQuadPF(6-35moinj)90685-FLUVaccineCharges 90685 $55.52FluQuadPF(6-35moinj)90685-ImmunizationCharge 90685 $55.52FluQuadPF(6-35moinj)NoCharge-ImmunizationCharge 90685 $0.01FluQuadPF(6-35moinj)NoCharge-StateNoChargeFluVaccines 90685 $0.0190686Influenzavirusvaccine,quadrivalent,splitvirus,preservativefree,3yrsor>,IM 90686 $41.44FluQuadPF(6+moinj)90686-FLUVaccineCharges 90686 $41.44FluQuadPF(6+moinj)NoCharge-StateNoChargeFluVaccines 90686 $0.01FluQuadPF(>36moinj)90686-FLUVaccineCharges 90686 $41.44FluQuadPF(>36moinj)90686-ImmunizationCharge 90686 $41.44FluQuadPF(>36moinj)NoCharge-ImmunizationCharge 90686 $0.01FluQuadPF(>36moinj)NoCharge-StateNoChargeFluVaccines 90686 $0.0149281-0418-50-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus 90686 CallforPrice49281-0625-15-influenzavirusvaccine,inactivatedquadrivalentSus 90686 CallforPrice58160-0898-52-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus 90686 CallforPrice58160-0907-52-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus 90686 CallforPriceFluQuad(6-35moinj)90687-ImmunizationCharge 90687 $26.25FluQuad(6-35moinj)NoCharge-ImmunizationCharge 90687 $0.01FluQuadMDV(6-35moinj)90687-FLUVaccineCharges 90687 $26.25FluQuadMDV(6-35moinj)NoCharge-StateNoChargeFluVaccines 90687 $0.01Influenzavirusvaccine,quadrivalent(IIV4),splitvirus,0.25mLdosage,forintramuscularuse 90687 $40.21FluQuad(>36moinj)90688-FLUVaccineCharges 90688 $49.79FluQuad(>36moinj)90688-ImmunizationCharge 90688 $49.79
FluQuad(>36moinj)NoCharge-ImmunizationCharge 90688 $0.01FluQuadMDV(>36moinj)90688-FLUVaccineCharges 90688 $49.79FluQuadMDV(>36moinj)NoCharge-StateNoChargeFluVaccines 90688 $0.01Splitvirusinfluenzavirusvaccine,quadrivalent,0.5mLdosage,forintramuscularuse 90688 $49.7949281-0629-15-influenzavirusvaccine,inactivatedquadrivalentSus 90688 CallforPrice90696Diphtheria,tetanustoxoids,acellularpertussis,poliovirusvacc,inact(DTap-IPV),4-6yr,IM 90696 $117.88Kinrix90696-ImmunizationCharge 90696 $117.88KinrixNoCharge-ImmunizationCharge 90696 $0.01KinrixNoCharge-StateNoChargeImmunizations 90696 $0.01DiphtheriatetanustoxoidsacellularpertussisvacHIB&inactivatedpoliovirusvaccineIMuse 90698 $215.6890700Diphtheria,tetanustoxoids,andacellularpertussisvaccine(DTaP),youngerthan7yrs,IM 90700 $151.71DTaP90700-ImmunizationCharge 90700 $151.71DTaPNoCharge-ImmunizationCharge 90700 $0.01DTaPNoCharge-StateNoChargeImmunizations 90700 $0.0158160-0840-11-diphtheria/tetanus/pertussis,acel(DTaP)Susp 90700 CallforPrice58160-0842-52-tetanus/diphth/pertuss(Tdap)adult/adol5units-2.5units-18.5mcg/0.5mLSus 90700 CallforPrice90702Diphtheriaandtetanustoxoids(DT)adsorbedadmintoyoungerthan7years,IM 90702 $228.69DT-Pediatric90702-ImmunizationCharge 90702 $228.69DT-Pediatric-NoCharge-ImmunizationCharge 90702 $0.01DT-Pediatric-NoCharge-StateNoChargeImmunizations 90702 $0.0190707Measles,mumpsandrubellavirusvaccine(MMR),live,forsubcutaneoususe 90707 $235.96MMR(19+yrs)90707-ImmunizationCharge 90707 $235.96MMRNoCharge-ImmunizationCharge 90707 $0.01MMRNoCharge-StateNoChargeImmunizations 90707 $0.0190713Poliovirusvaccine,inactivated(IPV),forsubcutaneousorintramuscularuse 90713 $153.95IPV(19+yrs)90713-ImmunizationCharge 90713 $153.95IPVNoCharge-ImmunizationCharge 90713 $0.01IPVNoCharge-StateNoChargeImmunizations 90713 $0.0190714Tetanusanddiphtheriatoxoids(Td)adsorbed,preservativefree,7yrsor>,IM 90714 $156.45TdPF90714-ImmunizationCharge 90714 $156.45TdPFNoCharge-ImmunizationCharge 90714 $0.01TdPFNoCharge-StateNoChargeImmunizations 90714 $0.0190715Tetanus,diphtheriatoxoidsandacellularpertussisvaccine(Tdap),7yrsor>,IM 90715 $113.96Tdap90715-ImmunizationCharge 90715 $113.96TdapNoCharge-StateNoChargeImmunizations 90715 $0.0190715Tetanus,diphtheriatoxoidsandacellularpertussisvaccine(Tdap),7yrsor>,IM 90715 $113.9613533-0131-01-tetanus-diphthtoxoids(Td)adult/adol2units-2units/0.5mLSus 90715 CallforPrice58160-0842-01-tetanus/diphtheria/pertussis,acel(Tdap)0.5mLSusp-Inj 90715 CallforPrice58160-0842-11-tetanus/diphtheria/pertussis,acel(Tdap)Susp 90715 CallforPrice90716Varicellavirusvaccine,live,forsubcutaneoususe 90716 $356.60Varicella(19+yrs)90716-ImmunizationCharge 90716 $356.60VaricellaNoCharge-ImmunizationCharge 90716 $0.01VaricellaNoCharge-StateNoChargeImmunizations 90716 $0.01YellowFeverVaccine-ImmunizationCharge 90717 $281.76TdNoCharge-ImmunizationCharge 90718 $0.01Pediarix90723-ImmunizationCharge 90723 $192.33PediarixNoCharge-ImmunizationCharge 90723 $0.01PediarixNoCharge-StateNoChargeImmunizations 90723 $0.0190732Pneumococcalpolysaccharidevaccine,23-valent,adultorimmunosuppressed2yrsor>,SCorIM 90732 $350.93Pneumovax90732-ImmunizationCharge 90732 $350.93PneumovaxNoCharge-ImmunizationCharge 90732 $0.01PneumovaxNoCharge-StateNoChargeImmunizations 90732 $0.01
00006-4739-00-pneumococcal23-valentvaccineInjSol2.5mL-00006-4739-00 90732 CallforPrice00006-4739-00-pneumococcal23-valentvaccineSoln 90732 CallforPrice00006-4943-00-pneumococcal23-valentvaccineInjSol0.5mL-00006-4943-00 90732 CallforPrice00006-4943-00-pneumococcal23-valentvaccineSoln 90732 CallforPriceMeningococcalpolysaccharide90733-ImmunizationCharge 90733 $296.9290734Meningococcalconjugatevaccine,serogroupsA,C,YandW-135(tetravalent),IM 90734 $485.13MCV4(Menactra21-55yrs)90734-ImmunizationCharge 90734 $485.13MCV4(Menactra)90734-ImmunizationCharge 90734 $485.13MCV4(Menactra)NoCharge-ImmunizationCharge 90734 $0.01MCV4(Menactra)NoCharge-StateNoChargeImmunizations 90734 $0.0190736Zoster(shingles)vaccine,live,forsubcutaneousinjection 90736 $475.92Zoster(65+yrs)90736-ImmunizationCharge 90736 $475.92Zoster(Zostavax)-ImmunizationCharge 90736 $475.92Zoster(Zostavax)NoCharge-StateNoChargeImmunizations 90736 $0.01ZosterNoCharge-ImmunizationCharge 90736 $0.01ZosterNoCharge-StateNoChargeImmunizations 90736 $0.0113533-0636-03-hepatitisBimmuneglobulin-Sol 90740 CallforPrice13533-0636-03-hepatitisBimmuneglobulinSoln 90740 CallforPrice13533-0636-05-hepatitisBimmuneglobulinIMSol5mL-13533-0636-05 90740 CallforPrice13533-0636-05-hepatitisBimmuneglobulinSoln 90740 CallforPrice58160-0821-01-hepatitisBvaccine20Susp 90740 CallforPrice58160-0821-11-hepatitisBvaccine20Susp 90740 CallforPrice58160-0821-46-hepatitisBvaccineadult20mcg/mLSus 90740 CallforPrice58160-0821-52-hepatitisBadultvaccine20mcg/mLSus 90740 CallforPrice90744HepatitisBvaccine,pediatric/adolescentdosage(3doseschedule),forintramuscularuse 90744 $167.58HepatitisB-adjuvanted(Heplisav-B)NoCharge-StateNoChargeImmunizations 90744 $0.01HepatitisB-pediatric90744-ImmunizationCharge 90744 $167.58HepatitisB-pediatricNoCharge-ImmunizationCharge 90744 $0.01HepatitisB-pediatricNoCharge-StateNoChargeImmunizations 90744 $0.0158160-0820-52-hepatitisBpediatricvaccine10mcg/0.5mLSus 90744 CallforPrice90746HepatitisBvaccine,adultdosage(3doseschedule),forintramuscularuse 90746 $244.00HepatitisB-adult90746-ImmunizationCharge 90746 $244.39HepatitisBandHaemophilusinfluenzaetypebvaccine(Hib-HepB),forintramuscularuse 90748 $0.01Zoster(Shingrix)-ImmunizationCharge 90750 $337.84Zoster(Shingrix)NoCharge-StateNoChargeImmunizations 90750 $0.01Zoster(Shingrix)vaccine(HZV),recombinant,subunit,adjuvanted,forintramuscularuse 90750 $337.8458160-0819-12-zostervaccine,inactivatedadjuvantedPow 90750 CallforPrice58160-0823-11-zostervaccine,inactivatedadjuvantedPow 90750 CallforPriceFluccIIV4MDV(Flucelvax)-FLUVaccineCharges 90756 $43.07PsyTxInteractivecomplexity(Listseparatelyinadditiontothecodeforprimaryprocedure) 90785 $55.91PsychiatricAssessment 90791 $219.88 $509.05PsychiatricDiagnosticEvaluation-GT 90791 $219.88 $509.05PsychiatricDiagnosticEvaluationwithmedicalservices 90792 $219.88 $567.31Indivpsychotherapy,interactive,inanofficeorOP,approx45to50minface-to-facew/patient 90812 $507.94IndivPsychotherapy30min 90832 $219.88 $253.61IndividualPsychotherapy-ClinicalServiceProvided 90832 $253.61IndividualPsychotherapy-Telemed-ClinicalServiceProvided 90832 $253.61Indivpsychotherapy,interactive,inanofficeorOP,approx20-30minw/medicaleval&mgmtsrvcs 90833 $260.62Psychotherapy,30minwithpatientwhenperformedw/anevalandmanagementservice 90833 $260.62IndividualPsychotherapy,45minutes 90834 $219.88 $338.01Psychotherapy,45minwithpatientwhenperformedw/anevalandmanagementservice 90836 $330.39IndivPsychotherapy60min 90837 $219.88 $507.94
Indivpsychotherapy,interactive,inofficeorOP,appox45-50minw/medicaleval&mgmtsrvcs 90838 $436.10Psychotherapy,60minwithpatientwhenperformedw/anevalandmanagementservice 90838 $436.10Psychotherapyforcrisis;first60minutes 90839 $219.88 $529.72Psychotherapyforcrisis;eaaddl30min(Listseparatelyinadditiontocodeforprimaryservice) 90840 $253.61Familypsychotherapy(withoutpatientpresent)30min 90846 $408.50Familypsychotherapy(withoutthepatientpresent) 90846 $408.50FamilyPsychotherapyw/oPatient 90846 $408.50FamilyPsychotherapyw/oPatient30min 90846 $408.50FamilyPsychotherapywithoutPatient-ClinicalServiceProvided 90846 $408.50Familypsychotherapy(conjointpsychotherapy)(withpatientpresent). 90847 $424.65Familypsychotherapy(conjointwithpatientpresent)30min 90847 $424.65FamilyPsychotherapywithPatient 90847 $424.65FamilyPsychotherapywithPatient30min 90847 $424.65FamilyPsychotherapywithPatient-ClinicalServiceProvided 90847 $424.65Multi-FamilyPsychotherapy-ClinicalServiceProvided 90849 $114.14Grouppsychotherapy(otherthanofamultiplefamilygrp)30min 90853 $101.27zzGrouppsychotherapy(otherthanofamultiple-familygroup). 90853 $101.27Grouppsychotherapy(otherthanofamultiple-familygroup).60min 90853 $101.27GroupPsychotherapy-ClinicalServiceProvided 90853 $101.27Consultationwithfamily 90887 $300.30Unlistedpsychiatricserviceorprocedure 90899 $39.88OTBiofeedbackCharge 90901 $216.74PTBiofeedbackTraininganyModalityCharge 90901 $216.7490901Biofeedbacktrainingbyanymodality 90901 $216.74PTBiofeedbackTrainingperi,rect,urethralCharge 90911 $395.98Yes-BiofeedbackChargePT 90911 $395.98BiofeedbackCharges 90911 $395.98Esophagealmotilitystudywithinterpretationandreport 91010 $2,147.60 $600.14Gastricmotility(manometric)studies 91020 $2,107.94 $786.21Esophagus,gastroesophagealrefluxtest;wnasalcatheterpHelectrode(s)place/record/interp 91034 $2,086.93 $626.39Esophagus,gastroesophagealrefluxtest;wmucosalattachedtelemetrypHelectrode,record&interpret 91035 $2,410.55 $1,566.93Gastrointestinaltractimaging,intraluminal,esophagusthroughileum,winterpretationandreport 91110 $3,624.17 $3,007.89Fibroscan(HepatitisClinic) 91200 $367.37 $125.19Opthalmologicalservices:medicalexam&evaluationwithinitiationofdiagnosticandtxprogram 92002 $219.88 $184.62Opthalmologicalservices:comprehensive,newpatient,1ormorevisits 92004 $219.88 $391.16Opthalmologicalsrvcs:medicalexam&evaluationw/initiationorcontinuationoftx,intrmedestpt 92012 $219.88 $224.70Opthalmologicalservices:comprehensive,establishedpt,1ormorevisits 92014 $219.88 $324.86Determinationofrefractivestate 92015 $65.69Gonioscopy(separateprocedure) 92020 $80.86Computerizedcornealtopography,unilateralorbilateral,withinterpretation&report 92025 $132.09CornealTopographyUnilateralorBilateral 92025 $132.0992060-Sensorimotorexmw/multmesrmnts 92060 $231.13SensorimotorExam 92060 $231.13Sensorimotorexaminationw/multiplemeasurementsofoculardeviationw/interpretationandreport 92060 $231.13Fittingofcontactlensfortxofocularsurfacedisease 92071 $128.81Fittingofcontactlensformanagementofkertoconus,initialfitting 92072 $398.15Visualfieldexamination,unilateralorbilateral,withinterpretation&report 92081 $117.86Visualfieldexamination,unilateralorbilateral,withinterpretation&report,intermediateexam 92082 $167.46VisualField-Threshhold 92083 $221.52Visualfieldexamination,unilateralorbilateral,withinterpretation&report,extendedexam 92083 $221.52SerialTonometry 92100 $131.05Serialtonometryw/measurementsofintraocularpressureoveranextendedtimeperiodw/interpretati 92100 $131.05
Scancomputerizedophthalmicdiagnosticimaging,antsegment,withinterpandreportunilatorbilat 92132 $108.96OCTOPTCNERVE 92133 $132.89OCTOpticNerve 92133 $132.89Scanningcompophthalmicdiagimaging,posteriorsegment,winterprandrpt,uniorbi;opticnerve 92133 $132.89OCTMacula 92134 $145.99Scanningcompophthalmicdiagimaging,posteriorsegment,winterprandrpt,uniorbi;retina 92134 $145.99EXTENDEDOPTHALMOSCOPY 92225 $82.37Ophthalmoscopy,extended,w/retinaldrawing(eg,forretinaldetachment,melanoma),w/interpretation 92225 $82.37Fundusphotographywithinterpretationandreport 92250 $222.08Colorvisionexamination,extended,eg,anomalscopeorequivalent 92283 $181.91ExternalOcularPhotography 92285 $66.90ExternalOcularPhotographyw/interpretationandreport 92285 $66.90Specialanteriorsegmentphotographywithinterpretationandreport 92285 $66.90ContactLensRe-fitting 92310 $297.50Prescription&fittingofcontactlens,withmedicalsupervisionofadaptation 92310 $297.50Otolaryngologicexaminationundergeneralanesthesia 92502 $2,904.55 $361.36Binocularmicroscopy 92504 $36.70Treatmentofspeech,language,voice,communication,and/orauditoryprocessingdisorder;individual 92507 $476.13Treatmentofspeech,language,voice,communication,and/orauditoryprocessingdisorder;ind(ILP) 92507 $476.13Yes-TRMTS,L,Voice&/orAudDisord 92507 $476.1392507Treatmentofspeech,lang,voice,communication,,orAPD;individual 92507 $476.13Yes-TRMTS,L,Voice&/orAudDisord 92507 $476.13Yes-Speech,Lang,orHearTher,Grp 92508 $229.03Nasopharyngoscopywithendoscope 92511 $536.51Yes-EvaluationSpeechFluency92521 92521 $481.51Evaluationofspeechsoundproduction 92522 $530.70Yes-EvaluationSpeechArticulation92522 92522 $530.70Evaluationofspeechsoundproduction;withevaloflanguagecomprehension&expression 92523 $545.31Yes-Evalspeechprodw/evalcomp,express92523 92523 $545.31Yes-NystagmusTestPositionalw/recording 92524 $375.02Behavioralandqualitativeanalysisofvoiceandresonance 92524 $403.42Yes-AnalysisVoiceResonance92524 92524 $403.42Yes-TRMTSwallowDysfunction 92526 $481.2992526Treatmentofswallowingdysfunctionand/ororalfunctionforfeeding 92526 $481.29Yes-TRMTSwallowDysfunction 92526 $481.2992541--Spontaneousnystagmustest(incl.gazeandfixation) 92541 $117.31Yes-NystagmusTestSpontw/recording 92541 $281.60Positionalnystagmustest,minimumof4positions,withrecording 92542 $93.8592542--Positionalnystagmustest(minimum4positions) 92542 $93.85Oscillatingtrackingtest,withrecording 92545 $313.93Tympanometryandreflexthresholdmeasurements 92550 $212.42Sceeningtest,puretone,aironly 92551 $45.7592551--Puretonescreening 92551 $45.75Puretoneaudiometry(threshold);aironly 92552 $147.5692552--Audiometry,air 92552 $147.56Puretoneaudiometry;Airandbone 92553 $321.2292553--Audiometry,airandbone 92553 $321.22Speechaudiometrythreshold 92555 $144.3692555--SRT/SAT 92555 $144.36Speechaudiometrythresholdwithspeechrecognition 92556 $191.6592556--Wordrecognitionw/SRT 92556 $191.65Comprehensiveaudiometrythresholdevaluationandspeechrecognition(92553and92556combined) 92557 $471.25
92557--Comprehensivehearingevaluation(incl.speechtesting) 92557 $471.25Stengertest,puretone 92565 $63.3592565--Stenger,puretone 92565 $63.35Tympanometry(impedancetesting) 92567 $170.2692567--Tympanometry(impedancetesting) 92567 $170.26Yes-Tympanometry 92567 $170.2692568--Acousticreflexthresholds 92568 $62.1792570--Immitancebattery(tymps,acousticreflexes,andreflexdecay) 92570 $254.38Visualreinforcementaudiometry(VRA) 92579 $109.1092579--Visualreinforcementaudiometry(VRA) 92579 $109.10Conditionalplayaudiometry 92582 $125.5292582--Conditionedplayaudiometry(CPA) 92582 $125.52Selectpictureaudiometry 92583 $84.4692583--Picturespondees 92583 $84.46Evokedotoacousticemissions;limited 92587 $248.6992587--DPOAEscreening(3-6frequencies) 92587 $248.69Yes-Otoacoustic,Limited 92587 $248.69Evokedotoacousticemissions;comprehensiveordiagnosticevaluation 92588 $326.1192588--DiagnosticOAEs(comprehensive--12frequenciesminimum) 92588 $326.11Hearingaidexaminationandselection;monaural 92590 $379.8592590--Hearingaideval(HAE)--monaural 92590 $379.85Hearingaidexaminationandselection;binaural 92591 $568.6692591--Hearingaideval(HAE)--binaural 92591 $568.66Hearingaidcheck;monaural 92592 $149.7192592--Hearingaidcheck(HAC)--listeningcheckandvisualinspection--monaural 92592 $149.71Hearingaidcheck;binaural 92593 $263.2092593--Hearingaidcheck(HAC)--listeningcheckandvisualinspection--binaural 92593 $263.20Electroacousticevaluationforhearingaid;monaural 92594 $97.0892594--EAA/REM--monaural 92594 $97.08Electroacousticevaluationforhearingaid;biaural 92595 $166.3192595--EAA/REM--binaural 92595 $166.3192596--Earprotectorattenuationmeasurements 92596 $88.82Yes-EvalOralSpeechDevice 92597 $518.7292602--SubsequentCIremapping(under7yrsold) 92602 $545.6092604--SubsequentCIremapping(7yrsandolder) 92604 $421.30Yes-RXSVCSpeechGenDev,Prog 92606 $333.93Yes-EvalRXSpeechDevice,Face;Fir 92607 $601.05Yes-RXEvalNonspeechAugment/Comm 92607 $601.05EvalRXSpeechDev,Face;EaAdd30min 92608 $260.40EvalRXSpeechDev,Face;EaAddunits 92608 $260.40Yes-TXSVSSpeechDeviceProg&Mod 92609 $397.83Evaloralandpharyngealswallowingfunction 92610 $593.26Yes-EvalOral/PharngealSwallowFU 92610 $593.26Yes-VideoSwallowEvalCharge(Motion) 92610 $593.26MotionFluoroEvalSwallowFU 92611 $508.20Motionfluroscopicevaluationofswallowingfunctionbycineorvideorecording 92611 $508.20Yes-FEESSwallowInterpretation/ReportCharge 92613 $130.81Yes-SwallowEvaluationCharge 92613 $130.81Yes-FEESLaryngealInterpretation/reportCharge 92615 $115.20Yes-FEESSW/LaryngealInterpretation/reportCharge 92617 $142.81Yes-EvaluationforNon-SpeechDevice 92618 $310.80CentralAuditoryFCNInit60m 92620 $163.05
CentralAuditoryFunctionea15min(92621) 92621 $35.16Cardiopulmonaryresuscitation(eg,incardiacarrest) 92950 $358.88 $325.33Code(WhiteorBlue)-RTResponsetoEmergentEvent 92950 $358.88Cardioversion,elective,electricalconversionofarrythmia,external 92960 $2,186.15 $422.13Electrocardiogram,routineECGwithatleast12leads 93000 $284.68 $59.3093005TCElectrocardiogram(ECG)Tracingw/ointerp&report 93005 $284.68Electrocardiogram 93005 $284.68Electrocardiogram,tracingonly,withoutinterpretationandreport 93005 $284.68EKG 93005 $284.68EKG 93005 $284.68EKG:12LeadTracingOnly 93005 $284.6812LeadEKG;Tracingonly(FAA)-RTMiscTreatments 93005 $284.68EKG-RTMiscTreatments 93005 $284.68Electrocardiogram,interpretationandreportonly 93010 $32.96ExerciseToleranceTest-withphysiciansupervision,withinterpretationandreport 93015 $268.33ExerciseToleranceTest-Physiciansupervisionwithoutinterpretationandreport 93016 $87.26Cardiovasclrstresstest;max/submaxtreadmill/bicycleexercise,cont.ECGmonitoring,and/orpharm 93017 $993.20PF-ExerciseToleranceTest 93018 $268.33EKG:1-3LeadTracingOnly 93041 $310.55PF-HolterMonitor24hr 93224 $308.15CVTHolterMonitor24Hour 93225 $525.20 $83.21HolterMonitor 93225 $525.20 $83.21HoltorMonitor24hr-RTMiscTreatments 93225 $525.20HolterMonitor24Hr-ScanningAnalysis 93226 $494.13 $118.87PFExternalelectrocardiographicrecupto48hrsbycontrhythmrecandstorage;scanninganalyw/r 93226 $118.87EKGupto30dayReviewwReport 93228 $268.63EKGUpto30dayTechSupport 93229 $117.31 $2,261.42ECGRecord,Review,Interpretation 93268 $2,529.11 $660.66CVTEventMonitor 93270 $457.43EventMonitorSet-up-RTMiscTreatments 93270 $457.43EventMonitor30days 93271 $793.88Programmingdeviceevaluationinpersonw/iterativetestandadj.dualleadpacemakersystem 93280 $212.25Programmingdeviceevaluationinpersonw/iterativetestandadj.multipleleadpacemakersystem 93281 $249.64Interrogationdeviceeval,includesconnection,recordinganddisconnection 93288 $133.68Interrogationdeviceeval,includesconnection,recordinganddisconnection,inc.analysisofheart 93289 $241.48Interrogationdeviceeval,incconnect/record/disconnect;implantablelooprecorderincheartrhythm 93291 $131.4493303TC-Transthoracicechocardiographyforcongenitalcardiacanomalies,complete 93303 $1,839.69 $793.4393304-FORCODINGTTECONGABN;LIMITED/F-UP 93304 $1,144.76 $506.94CVTEchocardiogramwithContrast 93306 $2,539.87 $766.68USEcho2DColorFlowwDoppler 93306 $2,539.87 $766.68EchocardiogramTransthoracic 93307 $1,575.47 $443.25CVTEchocardiogram,limited 93308 $1,144.05 $412.86CVTEchocardiogramTransesophageal 93312 $2,679.04 $860.80Transesophagealechocardiographyforcongenitalcardiacanomalies;includingprobeplacement,image 93315 $2,393.94TEEEchocardiographyforcongenitalcardiacanomalies;includingprobeplacement,imageacquisition, 93316 $107.14DopplerEcho,complete 93320 $769.61 $184.92CVTStressEchocardiogram 93350 $1,992.57 $811.92USEchoTransthoracicStress 93350 $1,992.57PF-StressEchocardiogramwithphysiciansupervision 93351 $2,899.81 $918.26CVT24HourBloodPressureMonitor 93784 $287.59 $182.99AmbulatoryBloodPressureMonitoring24+HRS,Utilizingmagnetictape/computerdisk,system 93788 $271.42 $275.73USCarotidDuplexBilateral 93880 $1,262.87
USCarotidDuplexBilateral-Report 93880 $666.18USCarotidDuplexLeft 93882 $1,060.23USCarotidDuplexLeft-Report 93882 $423.07USCarotidDuplexRight 93882 $1,060.23USCarotidDuplexRight-Report 93882 $423.07Noninvasivephysiologicstudiesofupperorlowerextremityarteries,singlelevel,bilateral 93922 $287.88AnkleBrachialIndex-Manual 93922 $789.86 $287.88UltrasoundCharge93925 93925 $1,244.33USLEArterialDuplexBilateral 93925 $1,244.33USLowerExtremityArteriesorArterialBypassGrafts-CompleteBilateral-Report 93925 $844.91UltrasoundCharge93926 93926 $743.50USLEArterialDuplexLeft 93926 $743.50USLEArterialDuplexLimitedBilateral 93926 $743.50USLEArterialDuplexRight 93926 $743.50USLowerExtremityArteriesorArterialBypassGrafts-UnilateralorLimitedLeft-Report 93926 $495.93USLowerExtremityArteriesorArterialBypassGrafts-UnilateralorLimitedRight-Report 93926 $495.93USLowerExtremityArteriesorArterialBypassGraftsLimitedBilateral-Report 93926 $495.93UltrasoundCharge93930 93930 $1,524.98USUEArterialDuplexBilateral 93930 $1,524.98PF-Arterialduplex,RTUpperExtremity 93931 $407.40UltrasoundCharge93931 93931 $915.43USUEArterialDuplexLeft 93931 $915.43USUEArterialDuplexLimitedBilateral 93931 $915.43USUEArterialDuplexRight 93931 $915.43USUpperExtremityArteriesorArterialBypassGrafts-UnilateralorLimitedLeft-Report 93931 $407.40USUpperExtremityArteriesorArterialBypassGrafts-UnilateralorLimitedRight-Report 93931 $407.40USUpperExtremityArteriesorArterialBypassGraftsLimitedBilateral-Report 93931 $407.40UltrasoundCharge93965 93965 $1,236.94UltrasoundCharge93970 93970 $1,387.91USLEVenousDuplexBilateral 93970 $1,387.91USLEVenousDuplexBilateral-Report 93970 $645.96USUEVenousDuplexBilateral 93970 $1,387.91USUEVenousDuplexBilateral-Report 93970 $645.96PF-Venousduplex,LTlowerextremity 93971 $962.92UltrasoundCharge93971 93971 $962.92USLEVenousDuplexLeft 93971 $962.92USLEVenousDuplexLeft-Report 93971 $394.87USLEVenousDuplexLimitedBilateral 93971 $962.92USLEVenousDuplexLimitedBilateral-Report 93971 $394.87USLEVenousDuplexRight 93971 $962.92USLEVenousDuplexRight-Report 93971 $394.87USUEVenousDuplexLeft 93971 $962.92USUEVenousDuplexLeft-Report 93971 $394.87USUEVenousDuplexLimitedBilateral 93971 $962.92USUEVenousDuplexLimitedBilateral-Report 93971 $394.87USUEVenousDuplexRight 93971 $962.92USUEVenousDuplexRight-Report 93971 $394.87USArtVeinAbdPelvisScrotalComplete 93975 $1,223.06USDopplerVascularAbdPelvicComplete-Report 93975 $929.76USArtVeinAbdPelvisScrotalLimited 93976 $766.77USDopplerVascularAbdPelvicLimited-Report 93976 $544.78AdultInitialDay-VentilatorBilling 94002 $2,376.73
AdultInitialDay-ERpriortoadmit-VentilatorBilling 94002 $2,376.73PediatricInitialDay-VentilatorBilling 94002 $2,376.73PediatricInitialDay-ERpriortoadmit-VentilatorBilling 94002 $2,376.73Ventilationassistandmanagement,initiationofpressureorvolumepresetventilatorsforassisted 94002 $2,376.73AdultSubsequentDay-VentilatorBilling 94003 $513.80PediatricSubsequentDay-VentilatorBilling 94003 $513.80Spirometryinclgraphcrecttltimedvitalcapexpirtryflowratemeasrmntw/w/omaxvolventlatn 94010 $419.59 $118.40Bronchodilationresponsiveness,spirometryasin94010,pre-andpost-bronchodilatoradministratin 94060 $849.09Spirometry(SMC) 94070 $1,312.71Bronchospasmprovocationeval,multiplespirometri 94070 $1,312.71Vitalcapacity,total(separateprocedure). 94150 $96.66FlowVolumeLoop-RTMiscTreatments 94375 $650.55Yes-INTRAPULMONARYSURFACTANTADMINISTRATION 94610 $258.206minutewalkdistance 94618 $212.65Pressurizedornonpressurizedinhalationtreatmentforacuteairwayobstructionorforsputuminduc 94640 $202.7894640-InhMediationAdministrationCharge 94640 $202.78NebulizerTreatment(addlafterinitial) 94640 $202.78Nebulizertreatment(single/each1) 94640 $202.78IPPB,Initial-AerosolDeliveryDevice 94640 $202.78IPPB,Subsequent-AerosolDeliveryDevice 94640 $163.96Metereddoseinhaler,Initial-AerosolDeliveryDevice 94640 $202.78Metereddoseinhaler,subsequent-AerosolDeliveryDevice 94640 $163.96Metereddoseinhaler-inline,initial-AerosolDeliveryDevice 94640 $202.78Metereddoseinhaler-inline,subsequent-AerosolDeliveryDevice 94640 $163.96Powderinhaler,initial-AerosolDeliveryDevice 94640 $202.78Powderinhaler,subsequent-AerosolDeliveryDevice 94640 $163.96Smallvolumenebulizer,Initial-AerosolDeliveryDevice 94640 $202.78Smallvolumenebulizer,subsequent-AerosolDeliveryDevice 94640 $163.96Ultrasonicnebulizer,initial-AerosolDeliveryDevice 94640 $202.78Ultrasonicnebulizer,subsequent-AerosolDeliveryDevice 94640 $163.96Continuousinhaltntrmt;1sthr 94644 $197.07Largevolumenebulizer,firsthour-AerosolDeliveryDevice 94644 $197.07Continuousinhtrmt;eaaddlhr 94645 $146.34Largevolumenebulizer,subsequenthour-AerosolDeliveryDevice 94645 $146.34AdultInitialDay-CPAP/BIPAPBilling 94660 $642.45AdultSubsequentDay-CPAP/BIPAPBilling 94660 $642.45PediatricInitialDay-CPAP/BIPAPBilling 94660 $642.45PediatricSubsequentDay-CPAP/BIPAPBilling 94660 $642.45Demoand/orevalofptutilizofaerosolgenerator,nebulizer,metereddoseinhalerorIPPBdevice 94664 $51.34Inhaler/SpacerTechnique 94664 $82.88InitialChestPhysiotherapy-ChestPhysiotherapyBillingMode 94667 $384.25SubsequentChestPhysiotherapy-ChestPhysiotherapyBillingMode 94668 $211.94PFTNitrogenWashOut 94726 $363.71ThoracicGasVolume 94727 $296.66DLCO 94729 $384.66Diffusingcapacity(Listseparatelyinadditiontocodeforprimaryprocedure) 94729 $384.66PulseOximetryforOxygenSaturation 94760 $148.95PulseOximetryforO2Saturation 94760 $148.95Multipledeterminations(eg,duringexercise) 94761 $14.08MultipleChecks-O2qualifying-SPO2StudyType 94761 $393.26NoninvasiveEar/PulseOximetryOvernightMonitor 94762 $537.67OvernightTrendRecording-SPO2StudyType 94762 $537.67
Professionalservicesforallergenimmunotherapynotincludingprovisionofallergenicextracts;sin 95115 $27.46InitialAdministration95115-AllergyInjectionAdministration 95115 $42.45Professionalservicesforallergenimmunotherapynotincludingprovisionofallergenicextracts;2o 95117 $31.93AdditionalAdministration95117-AllergyInjectionAdministration 95117 $56.23Ambulatorycontinuousglucose(sugar)monitoringforaminimumof72hours 95250 $489.11GLUCOSEMONITORINGCONT72+HRS,Subcu.sensor;placemnt,hook-up,calibrationofmonitor,pttrng,r 95250 $489.11Ambulatorycontinuousglucosemonitoringofinterstitialtissuefluid>=72hrs;interpret/rpt 95251 $139.87Yes-ManualMuscleTestEXT/Trunk 95831 $118.41Muscletesting,manual,w/rptextremity(exclhand)ortrunk 95831 $118.42Yes-RangeofMotionTestEXT/Trunk 95851 $113.79Yes-RangeofMotionTestHand 95851 $113.79Yes-EMG,oneextremityornonlimb 95860 $546.31Needleelectromyography;2extremitieswithorwithoutrelatedparaspinalareas 95861 $1,075.96 $759.64Needleelectromyography;2extremitieswithorwithoutrelatedparaspinalareas 95861 $1,075.96 $759.64Yes-NeedleEMG,TwoExemities 95861 $769.98Yes-NeedleEMG,ThreeExemities 95863 $794.32NeedleEMGLimited 95870 $308.34Needleelectromyography;1extremitywithorwithoutrelatedparaspinalareas 95886 $151.23 $319.41NeedleEMGComplete 95886 $151.23Yes-Nerveconduction3-4studies 95908 $788.91Yes-Nerveconduction5-6studies 95909 $496.14Yes-Nerveconduction7-8studies 95910 $541.09Yes-Nerveconduction9-10studies 95911 $1,874.66Yes-Nerveconduction11-12studies 95912 $2,309.25Yes-Nerveconduction13ormorestudies 95913 $1,067.00Electronicanalysisofimplantedneurostimulatorpulsegeneratorsystem,simpleorcomplex 95970 $304.53 $93.18Electronicanalysisofimplantedneurostimulatorgenerator1sthour 95971 $1,065.81 $158.55Canalithrepositioningprocedure(s),perday 95992 $145.72Yes-CanalithReposition/Epleyman95992 95992 $192.16MedicalGeneticCounselingServices 96040 $180.65 $57.96Psychologicaltestingper15minofclinicianstime,bothfacetoface&interpretingreport 96101 $407.75Psychologicaltestingperhroftheclinician'stime,bothface-to-face&interpretingreport 96101 $407.75Psychologicaltestingwithqualifiedhealthcareprofessionalinterpretationandreport,perhr 96102 $92.92AphasiaAssess.,Charges 96105 $485.26Assessmentofaphasiaw/interpretationandreportperhr 96105 $485.26Developmentaltesting;limited,withinterpretationandreport 96110 $32.71Yes-DevelopementalTestingLTD 96110 $123.18Yes-DevelTST,EXTw/I&R 96110 $123.18Yes-DevelTest,Limitedw/I&R 96111 $477.13Yes-DevelopementalTestingExtCharges 96112 $492.45TestNeurobehavioralCharges 96116 $511.43Neuropsychologicaltestingper15minofclinicianstime,bothfacetoface&interpretingreport 96118 $316.98Neuropsychologicaltesting,perhroftheclinician'stime,bothface-to-face&interpretingreport 96118 $316.98Yes-StandardizeCogPerformTesting 96125 $432.48Briefemotional/behavioralassessment 96127 $18.62Psychologicaltestingevaluation,firsthour 96130 $416.46Psychologicaltestingevaluation,eachadditionalhour 96131 $317.71Psychological/neuropsychologicaltestadministration&scoringof2or>testsbyQHCPfirst30mins 96136 $92.75Psychological/neuropsychologicaltestadministration&scoringof2or>testsbyQHCPeaadd30min 96137 $74.03Psychological/neuropsychologicaltestadministration&scoring,2or>tests,bytechfirst30mins 96138 $113.75Psychological/neuropsychologicaltestadministration&scoring,2or>tests,bytecheaaddl30min 96139 $113.75Health&behaviorassessment(egclinicalinterview,healthquestionnaires),ea15min 96150 $85.52
Healthandbehaviorassessment(eg,health-focusedclinicalinterview,behavioralobservations,psyc 96151 $82.51Health&behaviorintervention,each15minutes,face-to-face 96152 $78.40Health&behaviorintervention,each15minutes,face-to-face 96152 $78.40Health/BehaviorIntervention,Group 96153 $16.87HealthandBehIntervention,Group 96153 $16.87Healthandbehaviorintervention,each15minutes,face-to-face;family(withthepatientpresent) 96154 $76.90Healthandbehaviorintervention,each15minutes,face-to-face;family(withoutpatientpresent) 96155 $79.77Intravenousinfusion,hydration,initial,31minto1hour 96360 $390.63 $187.08Intravenousinfusion,hydration;initial,31minutesto1hour 96360 $390.63 $187.08IVHydrationupto1hour96360-IVInfusionsInitialCharge 96360 $390.63 $187.08IVInfusion-Hydration,1st31-60min 96360 $390.63IVInfusion-Hydration,1st31-60min396360 96360 $390.63Initial31-60min96360-IVHydrationCharge 96360 $390.63Intravenousinfusion,hydration;eachadditionalhour(Listseparatelyinadditiontocodeforprima 96361 $164.23 $51.03IVInfusion-Hydration,eaaddlhr 96361 $164.23IVInfusion-Hydration,eaaddlhr396361 96361 $164.23Intravenousinfusion,fortherapy,prophylaxis,ordiagnosis;initial,upto1hour 96365 $445.77 $223.92IVinfusion,fortherapy,prophylaxis,ordiagnosis;initial,upto1hour 96365 $445.77 $223.92IVDrugInfusion-Other-1sthr 96365 $445.77IVDrugInfusion-Other-1sthr396365 96365 $445.77IVInfusionsupto1Hour96365-IVInfusionsInitialCharge 96365 $445.77 $223.92Eachadditionalhour,1hourinfusionthenevery30to60minsafterthat 96366 $205.29 $65.67Intravenousinfusion,fortherapy,prophylaxis,ordiagnosis;eachadditionalhour 96366 $205.29 $65.67Intravenousinfusion,fortherapy,prophylaxis,ordiagnosis;eachadditionalhour 96366 $205.29 $65.67IVInfusion-Other-eaaddlhr 96366 $205.29IVInfusion-Other-eaaddlhr396366 96366 $205.29Infusionsfrom151minutesto210minutes96366-IVInfusionsAdditionalTimeCharge 96366 $205.29 $65.67Infusionsfrom91minutesto150minutes96366-IVInfusionsAdditionalTimeCharge 96366 $205.29 $65.67Intravenousinfusion,fortherapy,prophylaxis,ordiagnosis;addlsequentialinfusion,upto1hour 96367 $294.44 $103.56IVInfusion-Sequential,upto1hr 96367 $294.44IVInfusion-Sequential,upto1hr396367 96367 $294.44SequentialIVInfusions96367-IVInfusionsInitialCharge 96367 $294.44 $103.56Concurrentinfusion(listinadditiontocodeforprimaryprocedure,onlyonceperencounter) 96368 $171.27 $70.86Intravenousinfusion,fortherapy,prophylaxis,ordiagnosis;concurrentinfusion 96368 $171.27 $70.86ConcurrentIVInfusions96368-IVInfusionsInitialCharge 96368 $171.27 $70.86IVInfusion,Concurrent(onepervisit) 96368 $171.27IVInfusion,Concurrent(onepervisit)396368 96368 $171.27SCTHERINFUSIONUPTO1HR 96369 $467.50InitialPumpIVInfusion-1sthr 96369 $445.77IVInfusionw/Pump-EaAddlHr 96370 $216.74Subcutaneousinfusionfortherapy/prophylaxis;additionalpumpset-upw/newSCinfusionsite(s). 96371 $263.02 $215.1196372InjMedicationAdministration 96372 $85.64 $86.47Therapeutic,prophylactic,ordiagnosticinjection(specifysubstanceordrug);SCorIM 96372 $85.64 $86.47Therapeutic,prophylactic;ordiagnosticinjection;subcutaneousorintramuscular 96372 $85.64 $86.47Therapeutic,prophylactic,ordiagnosticinjection;subcutaneousorintramuscular 96372 $85.64 $86.4796372-ImmuneGlobulinAdministrationCharge 96372 $85.64 $86.4796372-InjMedicationAdministrationCharge 96372 $85.64 $86.47IMorSubQInjection(any)Each 96372 $85.64InjectionCharge96372 96372 $85.64 $86.47InjectionCharge96372-InjectionCharge 96372 $85.64 $86.47InitialIVPush-96374-IVPAdministrationCharge 96374 $246.34Therapeutic,prophylactic,ordiagnosticinjection(specifysubstanceordrug);intravenouspush,si 96374 $246.34 $185.96
Therapeutic,prophylactic,ordiagnosticinjection;IVpush,singleorinitialsubstance/drug 96374 $246.34 $185.96IVPushInitialorSingle(upto15min) 96374 $246.34InitialAdministration96374-IVPushCharge 96374 $246.34AdditionalIVPush-96375-IVPAdministrationCharge 96375 $150.15Therapeutic,prophylactic,ordiagnosticinjection(specifysubstanceordrug):eachadditionalsequ 96375 $150.15 $73.71Therapeutic,prophylactic,ordiagnosticinjection;eachaddlsequentialIVpush-newsubstance/drug 96375 $150.15 $73.71IVP,EachAddlNewDrug/Substance 96375 $150.15AdditionalrepeatIVPush-96376-IVPAdministrationCharge 96376 $64.52Therapeutic,prophylactic,ordiagnosticinjection;eachaddlsequentialintravenouspushofthesam 96376 $64.52 $64.52Therapeutic,prophylactic,ordiagnosticinj;eaaddlsequentialIVpushofthesamesubstance/drug 96376 $64.52 $64.52IVP,EachAddlSameDrug/Substance 96376 $64.52Unlistedtherapeutic,prophylactic,ordiagnosticintravenousorintra-arterialinjection/infusion 96379 $64.52 $64.52Chemotherapyadmin,Subcutaneousorintramuscular,non-hormonalanti-neoplastic 96401 $312.04Chemotherapyadmin,subqorintramuscular,hormonalanti-neoplastic 96402 $170.09Chemotherapyadministration;intravenous,pushtech,singleorinitialsubstance/drug 96409 $465.00Chemotherapyadministration;intravenous,pushtechnique,eachadditionalsubstance/drug 96411 $333.41Chemotherapyadministration,intravenousinfusiontechnique;upto1hour,singleorinitialsusbtan 96413 $594.79Chemotherapyadministration,intravenousinfusiontechnique;eachadditionalhour 96415 $283.44Chemotherapyadministration,intravenousinfusiontechnique;initiationofprolongedchemotherapyin 96416 $805.00Chemotherapyadministration,intravenousinfusiontechnique;eachadditionalsequentialinfusion(di 96417 $345.11Refillingandmaintanenceofportablepump 96521 $495.00Irrigationofimplantedvenousaccesdevicefordrugdeliverysystems 96523 $115.88SalineFlush 96523 $115.88EvaluationOT 97003 $278.32Yes-OTRe-evaluationCharge 97004 $260.44Applicationofamodalityto1ormoreareas;hotorcoldpacks 97010 $79.46HotPack 97010 $79.46HotorColdPack 97010 $79.46Yes-HotorColdPack 97010 $79.46Applicationofamodalityto1ormoreareas;traction,mechanical 97012 $107.2597012-Mech.TractionProv 97012 $107.25MechanicalTraction97012 97012 $107.25MechanicalTractionProvided-MechanicalTractionProvided 97012 $107.25Yes-MechanicalTractionCharge 97012 $107.25SensoryStimulationCharge 97014 $68.15Yes-OTUnattendedElectricalTherapyCharge 97014 $68.15Applicationofamodalityto1ormoreareas;electricalstimulation(unattended) 97014 $68.15ElectricalStimUnattended-ElectricalStimUnattended 97014 $68.15VasopneumaticChargesOT 97016 $123.13VasopneumaticchargePT 97016 $123.13ParaffinBath 97018 $111.40Yes-OTParaffinBathCharge 97018 $111.40Applicationofamodalityto1ormoreareas;infrared 97026 $62.17Yes-PTApplicationModality1ormoreareas 97026 $62.17AttendedE-StimCharges 97032 $80.85ElectricalStimulation,AttendedCharges 97032 $80.85Applicationofamodalityto1ormoreareaselectrcalstimulation(manual),each15minutes 97032 $80.85ElectricalStimAttendedChargePT 97032 $80.85Yes-ElectricalStimAttended 97032 $80.85zzOTIontophoresisCharges 97033 $79.70IontophoresisChargesPT 97033 $79.70ContrastBathTherapyChargeOT 97034 $73.66
ContrastBathTherapyChargePT 97034 $73.66UltrasoundCharges 97035 $75.08UltrasoundChargesOT 97035 $75.08UltrasoundChargesPT 97035 $75.08Applicationofamodalityto1or>areas,ultrasound,ea15min 97035 $75.08Cupping 97039 $99.72ColdLaserApplicationCharges 97039 $99.72Yes 97110 $92.40THERAPEUTICEXERCISESEA15MI 97110 $92.40Therapeuticprocedure,1+areas,each15min;therapeuticexercisestodevelopstrengthandendurance 97110 $92.40TherapeuticExerciseChargeOT 97110 $92.4097110-ForCoders-ThpExeChrg 97110 $92.40TherapeuticExerciseChargesGQPT 97110 $92.40TherapeuticExerciseChargesGTPT 97110 $92.40TherapeuticExerciseChargesPT 97110 $92.40Yes-SLPTherapeuticExercises 97110 $92.40NEUROMUSCULARREEDUCATIONEA1 97112 $92.40NeuromuscularReeducationChargesOT 97112 $92.40NeuromuscularReeducationChargePT 97112 $92.40NeuromuscularReeducationGQPT 97112 $92.40NeuromuscularReeducationGTPT 97112 $92.40Yes-PTNeuromuscularReeducation 97112 $92.40Waterpooltherapywiththerapeuticexercisesto1ormoreareas,each15 97113 $63.52GAITTRAININGTHERAPYEA15MI 97116 $79.70GaitTrainingCharges 97116 $79.70GaitTrainingChargesGQ 97116 $79.70GaitTrainingChargesGT 97116 $79.70Therapeuticprocedure,1or>area,ea15min,gaittraining 97116 $79.70Therapeuticprocedure,1ormoreareas,each15minutes;massage,includingeffleurage,petrissagea 97124 $50.82MassageChargePT 97124 $50.82Therapeuticprocedure,1or>areas,ea15min,massage 97124 $50.82COGNITIVESKILLSDEVELOPMENTE 97127 $122.30CognitiveTrainingCharges 97127 $122.30Yes-DevelCogSkills,Direct 97127 $122.30DevelCogSkills,Directunits 97127 $122.30Manualtherapytechniques,1ormoreregions,each15minutes 97140 $86.62ManualTherapyChargeOT 97140 $86.62ManualTherapyChargePT 97140 $86.62Yes-JTMobilization,1ormorearea 97140 $86.62Yes-SoftTissueMobilization 97140 $86.62Yes-PTManualTherapyMassage 97140 $86.6297150-TherapeuticProcedures-Group 97150 $57.75Yes-PTGroupTherapyCharge 97150 $57.75OTGroupTherapyCharge 97150 $57.75OTTherapeuticProc(s)Group,2ormoreindividuals 97150 $57.75Yes-TherapeuticGroup 97150 $57.75GT:FacetoFaceVideoConferencing-PTLowComplexityEvaluation 97161 $142.10Yes-PTLowComplexityEvaluation 97161 $142.10Physicaltherapyevaluation:lowcomplexity.Typically,20minutesface-to-face. 97161 $142.10Yes-PTModerateComplexityEvaluation 97162 $213.15Physicaltherapyevaluation:moderatecomplexity.Typically,30minutesface-to-face. 97162 $213.15Yes-PTHighComplexityEvaluation 97163 $288.75
Physicaltherapyevaluation:highcomplexity.Typically,45minutesface-to-face. 97163 $288.75PhysicalTherapyRe-evaluation 97164 $196.35GT:FacetoFaceVideoConferencing-PTRe-evaluationCharge 97164 $196.35Yes-PTRe-evaluationCharge 97164 $196.35Yes-ReevaluationPhysicalTherapy 97164 $196.35Yes-OTLowComplexityEvaluation 97165 $151.19Occupationaltherapyevaluation,lowcomplexity.Typically,30minutesface-to-face. 97165 $151.19Yes-OTModerateComplexityEvaluation 97166 $226.79Occupationaltherapyevaluation,moderatecomplexity.Typically,45minutesface-to-face. 97166 $226.79Yes-OTHighComplexityEvaluation 97167 $294.83Occupationaltherapyevaluation,highcomplexity.Typically,60minutesface-to-face. 97167 $294.83Occupationaltherapyre-evaluation 97168 $197.75Yes-PTAthleticTrainingEvaluationLowComplexity 97169 $151.19Yes-PTAthleticTrainingEvalModerateComplexity 97170 $226.79Yes-PTAthleticTrainingEvalHighComplexity 97171 $293.93Yes-PTAthleticTrainingReevaluation 97172 $151.19Therapeuticactivities,direct(one-on-one)patientcontactbytheprovider,each15minutes. 97530 $82.00TherapeuticActivitiesChargeOT 97530 $82.00TherapeuticActivitiesChargePT 97530 $82.00SensoryIntegrativeTechniqueCharges 97533 $144.40SensoryIntegTech,DirEaCharges 97533 $144.40ADLTRAINING15MIN 97535 $92.40SelfCareHomeMGMTTrainingCharges 97535 $92.40ADLCharges 97535 $92.40Community/WorkReintegrationChargesOT 97537 $121.28WheelchairTrainingChargesPT 97542 $75.08Debridementopenwoundincltopicalapplication/s,wound/ssurfacearea;first20sqcmorless 97597 $394.96Yes-SelectiveDebridement;to20cm2 97597 $394.9697598-Debrid-SelectiveWoundCare;-EachAddtl.>20cm 97598 $157.38Rmvlofdevitalizedtissuefromwound(s)w/oanes;totalwound(s)surfaceareagreaterthan20sqcm 97598 $157.38Yes-SelectiveDebridementover20cm2Charge 97598 $157.38Removalofdevitaltissfromwndsnon-selectivedbrmt,woanesinclutopicalappswndassess 97602 $275.75Yes-WoundCareNon-SelectiveDebrideCharge 97602 $275.75Negativepressurewoundtherapy;totalwound(s)surfacearealessthanorequalto50squarecentime 97605 $285.61Negativepressurewoundtherapy;totalwound(s)surfaceareagreaterthan50squarecentimeters 97606 $549.00Negativepressurewoundtherapy,usingnon-DME,persession;area<or=to50squarecm 97607 $430.48Negativepressurewoundtherapy,usingnon-DME,persession;areagreaterthan50squarecm 97608 $584.72Negativepressurewoundtherapy,utilizingnon-DME,persession;areagreaterthan50squarecm 97608 $584.72Yes-WoundAssessmentw/USw/careinstruc97610 97610 $430.12Yes-MistTherapy 97610 $430.12PHYSICALPERFORMEA15M 97750 $92.4097750--SOP(each15min) 97750 $92.40PhysicalPerformanceTestchargeOT 97750 $92.40PhysicalPerformTestChargePT 97750 $92.40AssistTechniqueAssessmentCharges 97755 $163.17OrthoticsChargeOT 97760 $112.04OrthoticFitting/TrainingChargesPT 97760 $112.04OrthoticTrainingGQPT 97760 $112.04OrthoticTrainingGTPT 97760 $112.04Orthotic(s)managementandtraining,upperextremity(s),lowerextremity(s)and/ortrunk,each15mi 97760 $112.04Orthotic(s)managementandtraining,upper/lowerextremitiesand/ortrunk,ea15min 97760 $112.04ProstheticTrainingChargeOT 97761 $168.12
ProstheticTrainingChargesPT 97761 $168.12Subsequentprostheticmanagementtrainingofupperlowerextremitiesandtrunkea15minutes 97763 $78.54Orthotic/ProstheticCKGQPT 97763 $78.54Orthotic/ProstheticCKGTPT 97763 $78.54Orthotic/ProstheticCKPT 97763 $78.54Unlistedphysicalmedicine/rehabilitationserviceorprocedure 97799 $131.04Yes-DryNeedling 97799 $131.04Yes-PEDsParentEducation/HomeProgram 97799 $131.04Medicalnutritiontherapyinitialassessmntandinterventnindivface-to-facewiththeptea15m 97802 $219.88 $76.49Nutritiontherapy;initialassessment 97802 $219.88 $76.4997802MedicalNutritionTherapyUnits 97802 $219.88 $76.4997802MedicalNutritionTherapyVTCUnits 97802 $219.88 $76.49Medicalnutritiontherapy;re-assessmentandinterventionindivface-to-facew/patientea15mins 97803 $219.88 $62.41Nutritiontherapy;re-assessment 97803 $219.88 $62.4197803MedicalNutritionTherapyVTCunit 97803 $219.88 $62.41Medicalnutritiontherapy;initialassessmentandintervention,group 97804 $136.3097804MedicalNutritionTherapyUnits 97804 $136.3097804MedicalNutritionTherapyVTCunit 97804 $219.88 $136.30Acupuncture,1+needlesw/oelectricalstimulation,initial15minofpersonalone-on-onew/pt 97810 $93.42Acupuncture,1+needlesw/oelectricalstimulation,eachadd15minofpersonalone-on-onew/pt,w/re 97811 $93.42Acupuncture,one+needlesw/electricalstimulation,initial15minwpersonalcontactwpat 97813 $86.03Acupuncture,one+needles,w/electricalstimulation,Eaaddit15min/reinsertionofneedle 97814 $93.09Osteopathicmanipulativetreatment(OMT;1-2bodyreagionsinvolved) 98925 $75.24 $92.48Osteopathicmanipulativetreatment(OMT);3-4bodyregionsinvolved. 98926 $85.92 $139.70Osteopathicmanipulativetreatment(OMT);5-6bodyregionsinvolved. 98927 $86.03 $185.79Chiropracticmanipulativetreatment(CMT);spinal,1-2regions. 98940 $70.38Chiropracticmanipulativetreatment(CMT);spinal,3-4regions. 98941 $81.55Chiropracticmanipulativetreatment(CMT);spinal,5regions 98942 $92.73Chiropracticmanipulativetreatment(CMT);extraspinal,1ormoreregions 98943 $70.38Yes 98960 $130.37Ed/trainingself-mgmtbynonphysicianhealthcareprofface-to-faceeach30minindivpt 98960 $130.37Edu&trainingforptself-mgmtbynonphysicianhlthcareprofsslusingstdizedcurriculum,30min 98960 $107.92TelAssess/Mgmtbynonphysicianhealthcareprof5-10min 98966 $59.13TelAssess/Mgmtbynonphysicianhealthcareprof11-20min 98967 $75.41TelAssess/Mgmtbynonphysicianhealthcareprof21-30min 98968 $113.12Handlingand/orconveyanceofspecimenfortransferfromthephysician'sofficetoalaboratory 99000 $27.93Svcsprovidedinoffice@timesotherthannormalofficehours,inadditiontobasicservice 99050 $72.62AfterHoursVisit 99053 $137.95TESTIMONYPERHOUR 99075 $138.60Anesthesia,complicatedbyemergencyconditions(specify) 99140 $160.88Moderatesedationservicesbyphysician/QHPwithobserver;initial15min,pt<5yearsofage 99151 $92.12Moderatesedationservicesbyphysician/QHPwithobserver;initial15min,pt>/=5yearsofage 99152 $47.935+yrs:1st15minbyprimaryMD 99152 $172.54Moderatesedationservicesbyphysician/QHPwithobserver;eaadd15min 99153 $34.17eachadditional15minbyprimaryMD 99153 $122.97Moderatesedationservicesbyotherphysician/QHP;initial15minutes,patient<5yearsofage 99155 $360.18<5yrs:1st15minbysecondMD 99155 $331.61ModeratesedationbyphysotherthanthehealthcareprofessionalperformingtheDxortherapeutics 99156 $297.77Moderatesedationservicesbyotherphysician/QHP;initial15minutes,patient>/=5yearsofage 99156 $297.775+yrs:1st15minbysecondMD 99156 $172.54Moderatesedationservicesbyotherphysician/QHP;eaadd15minintraservicetime 99157 $225.88eachadditional15minbysecondMD 99157 $122.97
Screeningtestofvisualacuity,quantitative,bilateral 99173 $80.24Phlebotomy,therapeutic(separateprocedure) 99195 $289.75 $313.02TherapeuticPhlebotomy99195 99195 $289.75 $313.02Office/OutpatientVisitLevel1New 99201 $219.88 $105.76 $122.00TelemedicineOfficeVisitLevel1New 99201 $219.88 $105.76 $122.00Office/OutpatientVisitLevel2New 99202 $219.88 $158.81 $197.66TelemedicineOfficeVisitLevel2New 99202 $219.88 $158.81 $197.66Office/OutpatientVisitLevel3New 99203 $219.88 $206.85 $263.31Office/OutpatientVisitLevel4New 99204 $219.88 $333.71 $445.23Office/OutpatientVisitLevel5New 99205 $219.88 $396.32 $572.14FacilityVisitLevel1 99211 $109.61 $49.64Office/OutpatientVisitLevel1Established 99211 $109.61 $49.64TelemedicineOfficeVisitLevel1Estab 99211 $109.61 $49.64Yes-OfficeVisitLevel1 99211 $109.61Office/OutpatientVisitLevel2Established 99212 $219.88 $131.07 $98.51TelemedicineOfficeVisitLevel2Estab 99212 $219.88 $131.07 $98.51VTCOffice/OutpatientVisitLevel2 99212 $219.88 $131.07 $98.51Office/OutpatientVisitLevel3Established 99213 $219.88 $186.35 $169.04Office/OutpatientVisitLevel3EstablishedwithProcedure 99213 $219.88 $186.35 $169.04TelemedicineOfficeVisitLevel3Estab 99213 $219.88 $186.35 $169.04VTCOffice/OutpatientVisitLevel3 99213 $219.88 $186.35 $169.04Office/OutpatientVisitLevel4Established 99214 $219.88 $287.27 $271.97VTCOffice/OutpatientVisitLevel4 99214 $219.88 $287.27 $271.97FacilityVisitLevel5 99215 $219.88 $450.30 $390.88Office/OutpatientVisitLevel5Established 99215 $219.88 $450.30 $390.88VTCOffice/OutpatientVisitLevel5 99215 $219.88 $450.30 $390.88ObservationCareDischarge 99217 $346.70 $370.70InitialObservationCareLevel1 99218 $405.24 $459.39InitialObservationCareLevel2 99219 $559.11 $592.80InitialObservationCareLevel3 99220 $647.45 $843.61InitialHospitalCareLevel1 99221 $461.49InitialHospitalCareLevel2 99222 $625.92InitialHospitalCareLevel3 99223 $926.81SUBSEQUENTOBSERVATIONCARELVL1 99224 $169.61SubsequentObservationCareLvl2 99225 $377.44SubsequentObservationCareperday 99226 $607.81SubsequentHospitalCareLevel1 99231 $180.45SubsequentHospitalCareLevel2 99232 $330.97SubsequentHospitalCareLevel3 99233 $476.90Observation/SameDayInpatientCareLevel1 99234 $604.10Observation/SameDayInpatientCareLevel2 99235 $887.93Observation/SameDayInpatientCareLevel3 99236 $926.27HospitalDischargeDayManagement30minorLess 99238 $327.59HospitalDischargeDayManagementMoreThan30min 99239 $393.68OfficeConsultationLevel1 99241 $150.49TelemedicineConsultLevel1 99241 $276.84OfficeConsultationLevel2 99242 $296.05TelemedicineConsultLevel2 99242 $296.05OfficeConsultationLevel3 99243 $449.28TelemedicineConsultLevel3 99243 $449.28OfficeConsultationLevel4 99244 $586.53TelemedicineConsultLevel4 99244 $586.53
OfficeConsultationLevel5 99245 $880.73InpatientConsultationLevel1 99251 $227.64InpatientConsultationLevel2 99252 $346.75InpatientConsultationLevel3 99253 $531.26InpatientConsultationLevel4 99254 $771.80InpatientConsultationLevel5 99255 $931.81EmergencyDepartmentVisitLevel1 99281 $242.31 $239.6699281-Level1(2ndvisit)-LynxVisitLevel 99281 $242.31 $239.6699281-Level1(w/proc)-LynxVisitLevel 99281 $242.31 $239.6699281-Level1-LynxVisitLevel 99281 $242.31 $239.66EmergencyDepartmentVisitLevel2 99282 $380.65 $287.80EmergencyDepartmentVisitLevel3withProfeeProcedure 99282 $527.90 $472.7799282-Level2(2ndVisit)-LynxVisitLevel 99282 $380.65 $287.8099282-Level2(w/proc)-LynxVisitLevel 99282 $380.65 $287.8099282-Level2-LynxVisitLevel 99282 $380.65 $287.80EmergencyDepartmentVisitLevel3 99283 $527.90 $472.7799283-Level3(2ndVisit)-LynxVisitLevel 99283 $527.90 $472.7799283-Level3(w/proc)-LynxVisitLevel 99283 $527.90 $472.7799283-Level3-LynxVisitLevel 99283 $527.90 $472.77EmergencyDepartmentVisitLevel4 99284 $968.51 $839.8299284-Level4(2ndVisit)-LynxVisitLevel 99284 $968.51 $839.8299284-Level4(w/proc)-LynxVisitLevel 99284 $968.51 $839.8299284-Level4-LynxVisitLevel 99284 $968.51 $839.82EmergencyDepartmentVisitLevel5 99285 $3,863.93 $1,122.1099285-Level5(2ndVisit)-LynxVisitLevel 99285 $3,863.93 $1,122.1099285-Level5(w/proc)-LynxVisitLevel 99285 $3,863.93 $1,122.1099285-Level5-LynxVisitLevel 99285 $3,863.93 $1,122.10CriticalCareServicesEvaluationandTreatmentforFirst30-74Minutes 99291 $4,089.68 $1,284.0899291-CriticalCare(30-74mins)-LynxVisitLevel 99291 $4,089.68 $1,284.0899291-CriticalCare(w/proc)-LynxVisitLevel 99291 $4,089.68CriticalCareServicesEvaluationandTreatmentforEachAdditional30Minutes 99292 $918.52 $643.86Add'l30MinIncrementsCC>74 99292 $918.52Yes-30MinutesCriticalCare 99292 $918.52NursingFacilityLevel1New 99304 $219.88 $414.87NursingFacilityLevel2New 99305 $219.88 $591.26NursingFacilityLevel3New 99306 $219.88 $757.00NursingFacilityLevel1Established 99307 $219.88 $210.03NursingFacilityLevel2Established 99308 $219.88 $309.96NursingFacilityLevel3Established 99309 $219.88 $409.76NursingFacilityLevel4Established 99310 $219.88 $610.69NursingFacilityDischargeManagement30minorLess 99315 $219.88 $330.24NursingFacilityDischargeManagementMoreThan30min 99316 $219.88 $374.45NursingFacilityAnnualLowComplexity 99318 $219.88 $281.39RestHomeVisitLevel1New 99324 $219.88 $273.92RestHomeVisitLevel2New 99325 $219.88 $433.43RestHomeVisitLevel3New 99326 $219.88 $616.70RestHomeVisitLevel4New 99327 $219.88 $884.46RestHomeVisitLevel5New 99328 $754.45RestHomeVisitLevel1Established 99334 $219.88 $273.92RestHomeVisitLevel2Established 99335 $219.88 $433.43RestHomeVisitLevel3Established 99336 $219.88 $343.86RestHomeVisitLevel4Established 99337 $219.88 $884.46
Individualphysiciansupvofapatient(patientnotpresent)inhome,domiciliaryorresthome 99339 $291.20HomeVisitLevel1New 99341 $219.88 $250.23HomeVisitLevel2New 99342 $219.88 $363.18HomeVisitLevel3New 99343 $219.88 $597.46HomeVisitLevel4New 99344 $219.88 $829.99HomeVisitLevel1Established 99347 $219.88 $251.07HomeVisitLevel2Established 99348 $219.88 $383.19HomeVisitLevel3Established 99349 $219.88 $581.87HomeVisitLevel4Established 99350 $219.88 $809.31ProlongedPhysicianServiceOutpatientwithDirectPatientContactFirstHour 99354 $371.28ProlongedPhysicianServiceOutpatientwithDirectPatientContactEachAddl30Minutes 99355 $392.13ProlongedPhysicianServiceInpatientwithDirectPatientContactFirstHour 99356 $908.28Prolongedserviceintheinpatientorobservsetting,requnit/flrtimebeyondtheusualsvc;1sthr 99356 $908.28ProlongedPhysicianServiceInpatientwithDirectPatientContactEachAdditional30Minutes 99357 $416.84ProlongedPhysicianServiceWithoutDirectPatientContactFirstHour 99358 $499.82ProlongedPhysicianServiceWithoutDirectPatientContactEachAdditional30Minutes 99359 $240.94MedicalTeamConferenceDirect30min 99366 $193.05Yes-RehabTeamConfw/pt 99366 $297.17MedicalTeamConferenceWithoutDirectContact30min 99367 $259.78MedicalTeamConferencewithoutDirectContactbyNonphysician30Min 99368 $137.25Yes-RehabTeamConfw/opt 99368 $137.25CarePlanOversightSvcsPhysSupervisionPtUnderCareofHomeHealthorEquiv15-29Min 99374 $259.78CarePlanOversightSvcsPhysSupervisionPtUnderCareofHomeHealthorEquiv>30Min 99375 $407.62CarePlanOversightServicesPhysicianSupervisionHospicePatient15-29Minutes 99377 $259.78CarePlanOversightServicesPhysicianSupervisionHospicePatient>30Minutes 99378 $407.62CarePlanOversightServicesPhysicianSupervisionNursingFacilityPatient15-29Minutes 99379 $259.78CarePlanOversightServicesPhysicianSupervisionNursingFacilityPatient>30Minutes 99380 $407.62InitialComprehensivePreventiveMedicine<1yearNew 99381 $257.80 $332.15InitialComprehensivePreventiveMedicine1-4yearsNew 99382 $232.93 $376.72InitialComprehensivePreventiveMedicine5-11yearsNew 99383 $247.88 $400.89InitialComprehensivePreventiveMedicine12-17yearsNew 99384 $291.36 $471.20InitialComprehensivePreventiveMedicine18-39yearsNew 99385 $245.78 $451.96InitialComprehensivePreventiveMedicine40-64yearsNew 99386 $281.54 $549.63InitialComprehensivePreventiveMedicine65+yearsNew 99387 $245.78 $590.35PeriodicComprehensivePreventiveMedicine<1yearEstablished 99391 $186.35 $247.81PeriodicComprehensivePreventiveMedicine1-4yearsEstablished 99392 $172.60 $269.51PeriodicComprehensivePreventiveMedicine5-11yearsEstablished 99393 $172.60 $276.38PeriodicComprehensivePreventiveMedicine12-17yearsEstablished 99394 $195.79 $342.29PeriodicComprehensivePreventiveMedicine18-39yearsEstablished 99395 $186.35 $372.19PeriodicComprehensivePreventiveMedicine40-64yearsEstablished 99396 $222.01 $355.27PeriodicComprehensivePreventiveMedicine65+yearsEstablished 99397 $227.77 $471.20RiskFactorCounseling15min 99401 $177.69 $112.75RiskFactorCounseling30min 99402 $251.93 $230.70RiskFactorCounseling45min 99403 $233.50 $344.88RiskFactorCounseling60min 99404 $321.75 $460.91Minimal(<3min) 99406 $69.52Smokingandtobaccousecessationcounselingvisit(3-10minutes) 99406 $219.88 $45.49Brief(<3min) 99407 $119.05Smokingandtobaccousecessationcounselingvisit(greaterthan10minutes) 99407 $219.88 $97.20Alcoholand/orsubstanceabusestructuredscreening(15-30minutes)(SBIRT) 99408 $103.23Alcoholand/orsubstanceabusestructuredscreening(greaterthan30minutes) 99409 $175.96PreventiveMedicine,GroupCounselingApproximately60Minutes 99412 $59.13
Prolongedclinicalstaffserviceduringaneval,directpatientcontactw/physician;firsthour 99415 $32.75Prolongedclinicalstaffserviceduringaneval,directpatientcontactw/physician;eachadd30mi 99416 $18.13TelephoneE/MEstablishedPatient(5-10minutes) 99441 $59.13TelephoneE/MEstablishedPatient(11-20minutes) 99442 $117.78TelephoneE/MEstablishedPatient(21-30minutes) 99443 $176.94LifeInsurancePhysical 99450 $94.96CDLPhysical 99455 $333.90WorkRelatedorMedicalDisabilityInsuranceEvaluationbyTreatingProvider 99455 $355.27WorkRelatedorMedicalDisabilityInsuranceEvaluationbyOtherThanTreatingProvider 99456 $355.27InitialHospital-BirthingCenterCarePerDay 99460 $446.20InitialCareNormalNewbornnotinHospital-BirthingCenter 99461 $258.07SubsequentHospCareNormalNewbornPerDay 99462 $193.99InitialHosp-BirthingCenterCareNormalNewbornAdmittedandDischargedonSameDay 99463 $540.17AttendanceatDeliveryandInitialStabilazationofNewborn 99464 $333.86Delivery-BirthingRoomResuscitation,PositivePressureVentorChestCompression 99465 $701.73DeliveryRoomCPR-RTResponsetoEmergentEvent 99465 $1,565.50CaremanagementservicesforBHconditions,=/>20minutesofclinicalstafftime,percalendarmont 99484 $111.15ComplexChronCareSvrcs1sthrnoface-to-facevisit,staff/phys/qualhlthcareprofpercalmon 99487 $326.16ComplexChronCareeaadd30minclinicalstaffdirectbyaphys/o/qualhlthcareprofsl,percalmo 99489 $163.09Chroniccaremanagement,permonth;comprehensivecareplanestablish,implement,revise,ormonitor 99490 $153.42ChroniccaremanagementservicesbyQHCPatleast30minutespercalendarmonth 99491 $314.16Transitionalcaremanagementserviceswithmoderatemedicaldecisioncomplexity(face-to-facevisit 99495 $219.88 $426.32Transitionalcaremanagementserviceswithmoderatemedicaldecisioncomplexity(face-to-facevisit 99496 $219.88 $618.01Sports/SummercisePhysical 99499 $98.51School/SportsPhysical 99499 $98.51Charge-Miscellaneous 99999 $0.01DOTLicExamPhys 99999 $222.33SCREWLOCKING3.5X12MM_614612 614612 $312.50SCREWLOCKING3.5X14MM_614614 614614 $312.50SCREWLOCKING3.5X16MM_614616 614616 $312.50SCREW2.7X14MM 614714 $161.53ScrewSTRYBoneT102.7x16mm614716 614716 $161.53SCREW3.5X8MM 614808 $161.53SCREW3.5X12MM 614812 $161.53SCREW3.5X14MM 614814 $161.53SCREW3.5X16MM 614816 $161.53SCREWBONET103.5X18MM614818 614818 $161.53PLATESUPERIORDECREASED8HLT 628008 $1,666.34PLATESUPERIORDECREASED7HRT 628027 $1,500.05PLATEANTERIORMIDSHAFT6H 628306 $1,666.34DRILLTWISTCANN2.7MM 702449 $579.61GuideWireASNISIII1.4x150mm702459 702459 $146.76WIREGUIDETHREADED3.2X300MM 702462 $91.85DRILLTWISTCANN6.5MM 702601 $759.19DRILLCANNFITTING6.5MM 702603 $849.46DRILLBIT3.2X300MM 702626 $275.56DrillSTRY2.0x122mmWL50MMAO-Shaft703701 703701 $277.67DRILLBIT2.6X220MM 703824 $300.90SRHC_ARTHROSCOPYKNEEIIPACK 60100672 $166.14SRHC_TIBIGA-SCOPEPACK 60100673 $253.62SRHC_TOMCATCUTTER4.0MM 60100674 $252.38SRHC_KNEEANDBODYSTRAP 60100677 $20.95
SRHC_TOURNIQUETCUFF-DISPOSABLE 60100678 $81.48SRHC_SERFASENERGY90-S 60100679 $660.26SRHC_FLUFFS 60100680 $42.90Annualwellnessvisit;includesapersonalizedpreventionplanofservice(pps),initialvisit $385.43 $747.78MedicareSubsequentAnnualWellVstG0439 $256.96 $251.94Smokingandtobaccousecessationcounselingvisit;intensive,greaterthan10minutes $219.88 $97.20 $118.65Injection,hydroxyprogesteronecaproate,1mg $12.32Injection,hydroxyprogesteronecaproate,1mg $12.3290837-Psychotherapy,60minuteswithpatientand/orfamily $219.88 $507.94Indivpsychotherapy,insightoriented,inofficeorOP,appox45-50minw/medicaleval&mgmtsrvcs $328.16Indivpsychotherapy,interactive,inanofficeorOP,approx20to30minface-to-facew/patient $253.61IndividualPsychotherapy30MIN $219.88 $253.61IndividualPsychotherapy-GT30MIN $219.88 $253.61IndividualPsychotherapy-GT60MIN $219.88 $507.94Individualpsychotherapy,insightoriented,behaviormodifying,inoffice,appox45-50min $219.88 $338.01Medicalnutritiontherapyinitialassesmentinterventionindividualfacetofacew/patient $219.88 $76.49Medicalnutritiontherapyre-assessment&interventionindividualfacetofacew/theptea15m $219.88 $62.41Medicalnutritiontherapy;initialassessmentandintervention,individual,face-to-facewiththepa $219.88 $76.49Medicalnutritiontherapy;re-assessmentandintervention,individual,face-to-facew/pt,each15min $219.88 $62.41PPPSInitialVisit $385.43 $747.78PPPSsubseqvisit $256.96Psychotherapy,30minutesw/patient $219.88 $253.61Psychotherapy,45minuteswithpatient $219.88 $338.01Psychotherapy,60minuteswithpatient $219.88 $507.94Rmvlofdevitalizedtissuefromwound(s)w/oanes;totalwound(s)surfacearealessthanorequalto $554.13Externalelectrocardiographicrecordingformorethan48hoursupto21daysbycontinuousrhythmre $443.64AnticoagulantManagementforOutpatientEachSubsequent90DaysofTherapy $306.24 $42.57AnticoagulantManagementforOutpatientInitial90DaysofTherapy $306.24 $42.57PharmacyAnticoagulationEducation $306.24 $42.57MorphologyDifferential $77.09MycobacteriaIdentification $0.01Anesthesia,obturatorneurectomy;extrapelvic $159.60Anesthesia,obturatorneurectomy;intrapelvic $159.60Biopsyofskin,subcutaneoustissueand/ormucousmembraneunlessotherwiselistedsinglelesion $128.62Psychiatricdiagnosticeval $219.88 $389.90Psychotherapy,30minuteswithpatientand/orfamilymember $219.88 $253.61Psychotherapy,60minuteswithpatientand/orfamilymember $219.88 $507.94TransCareMgmntSrvcsw/infollowingelements:Commw/ptorcaregiversw/in14caldaysdischarge $219.88 $426.32TransCareMgmntSrvcsw/infollowingelements:Commw/ptorcaregiversw/in7dayspostdischarge $219.88 $618.01<5yrs:1st15minbyprimaryMD $331.61PatientOwnMed-MedicationSource $0.01ROOM/BED:1:1Care $3,686.76ROOM/BED:1:2Care $3,686.76ROOM/BED:Hold-ApplyCharge $1,389.80ROOM/BED:Hostel $1,389.80ROOM/BED:IntermediateCare $3,686.76ROOM/BED:Isolation $3,686.76ROOM/BED:LeaveofAbsenceSocial $1,389.80ROOM/BED:LeaveofAbsenceTherapeutic $1,389.80ROOM/BED:Level1 $3,686.76ROOM/BED:Level1W/ISO $4,357.08ROOM/BED:Level2 $3,686.76
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10370-0101-03-buPROPion150mg/24hoursTab CallforPrice10370-0101-50-buPROPion150mgERTab-10370-0101-50 CallforPrice10370-0102-03-buPROPion300mg/24hoursTab CallforPrice10370-0190-01-glipiZIDE5mgERTab-10370-0190-01 CallforPrice10370-0745-01-glipiZIDE5mgTab CallforPrice10370-0829-09-dilTIAZem120mg/24hoursCap-10370-0829-09 CallforPrice10370-0832-11-dilTIAZem300mgERCap-10370-0832-11 CallforPrice10370-0832-11-dilTIAZem300mg/24hoursCap CallforPrice10481-0112-08-ferricsubsulfatetopical-Sol CallforPrice10599-0003-01-mometasonenasal1350mcgImp CallforPrice10631-0407-01-hydrocortisonetopical2.5%Cre CallforPrice10702-0003-01-promethazine25mgTab-10702-0003-01 CallforPrice10702-0003-10-promethazine25mgTab-10702-0003-10 CallforPrice10702-0007-05-cyclobenzaprine10mgTab CallforPrice10702-0007-10-cyclobenzaprine10mgTab-10702-0007-10 CallforPrice10702-0007-50-cyclobenzaprine10mgTab CallforPrice10702-0018-01-oxyCODONE5mgTab-10702-0018-01 CallforPrice10702-0025-01-phentermine37.5mgTab CallforPrice10702-0100-01-methylphenidate5mgTab-10702-0100-01 CallforPrice10939-0810-44-melatonin5mgTab CallforPrice11098-0510-02-physostigmine1mg/mLInjSol2mL-11098-0510-02 CallforPrice11523-1159-01-oxymetazolinenasal0.05%Spr CallforPrice11523-1159-01-oxymetazolinenasal0.05%Spr15mL-11523-1159-01 CallforPrice11523-7197-01-loratadine5mg/5mLOralSol120mL-11523-7197-01 CallforPrice11534-0165-03-folicacid1mgTab CallforPrice11534-0165-03-folicacid1mgTab-11534-0165-03 CallforPrice11980-0011-05-sulfacetamidesodiumophthalmic10%Sol CallforPrice11980-0174-05-prednisoLONEophthalmicacetate0.12%Sus CallforPrice12496-1283-02-buprenorphine-naloxone2mg-0.5mgTab-12496-1283-02 CallforPrice12547-0150-20-witchhazeltopical50%Pad CallforPrice12843-0132-31-aspirin81mgChewTab-12843-0132-31 CallforPrice12843-0132-31-aspirin81mgTab CallforPrice12870-0001-02-silvernitrateTopStick-12870-0001-02 CallforPrice13107-0003-34-mirtazapine30mgTab-13107-0003-34 CallforPrice13107-0014-01-glycopyrrolate1mgTab CallforPrice13107-0035-01-dextroamphetamine5mgTab-13107-0035-01 CallforPrice13107-0055-01-oxyCODONE5mgTab-13107-0055-01 CallforPrice13107-0056-01-oxyCODONE15mgTab-13107-0056-01 CallforPrice13107-0068-01-amphetamine-dextroamphetamine5mgTab CallforPrice13107-0070-01-amphetamine-dextroamphetamine10mgTab CallforPrice13107-0155-30-PARoxetine20mgTab CallforPrice13107-0155-99-PARoxetine20mgTab CallforPrice13107-0155-99-PARoxetine20mgTab-13107-0155-99 CallforPrice13107-0196-30-losartan50mgTab CallforPrice13517-0107-16-PHENobarbital20mg/5mLEli CallforPrice13517-0107-16-PHENobarbital20mg/5mLOralElixer473mL-13517-0107-16 CallforPrice13517-0111-01-PHENobarbital32.4mgTab CallforPrice13517-0111-01-PHENobarbital32.4mgTab-13517-0111-01 CallforPrice13517-0112-01-PHENobarbital64.8mgTab CallforPrice13517-0112-01-PHENobarbital64.8mgTab-13517-0112-01 CallforPrice13517-0113-01-PHENobarbital97.2mgTab CallforPrice13517-0113-01-PHENobarbital97.2mgTab-13517-0113-01 CallforPrice
13533-0318-01-rabiesimmuneglobulin,human300intlunits/mLSol CallforPrice13533-0318-05-rabiesimmuneglobulin,human300intlunits/mLSol CallforPrice13533-0618-02-rabiesimmuneglobulin,human150intlunits/mLSol CallforPrice13533-0618-10-rabiesimmuneglobulin,human150intlunits/mLIMSol10mL-13533-0618-10 CallforPrice13533-0618-10-rabiesimmuneglobulin,human150intlunits/mLSol CallforPrice13533-0631-02-RHo(D)immuneglobulin1500intlunitsSol CallforPrice13533-0634-02-tetanusimmuneglobulin250unitsSol CallforPrice13533-0661-06-RHo(D)immuneglobulin250intlunitsSol CallforPrice13533-0703-10-alpha1-proteinaseinhibitor1unit(s)Powder-Inj CallforPrice13533-0705-01-alpha1-proteinaseinhibitor-Soln-IV CallforPrice13533-0800-40-immuneglobulinintravenousandsubcutaneous10%Sol CallforPrice13668-0037-05-risperiDONE1mgTab-13668-0037-05 CallforPrice13668-0091-90-pramipexole0.125mgTab CallforPrice13668-0093-90-pramipexole0.5mgTab CallforPrice13668-0094-90-pramipexole1mgTab-13668-0094-90 CallforPrice13668-0103-30-donepezil10mgTab CallforPrice13668-0186-30-sildenafil25mgTab-13668-0186-30 CallforPrice13668-0189-30-tolterodine2mgERCap-13668-0189-30 CallforPrice13668-0189-90-tolterodine2mgCap-13668-0189-90 CallforPrice13668-0190-05-tolterodine4mgERCap-13668-0190-05 CallforPrice13668-0190-30-tolterodine4mgCap-13668-0190-30 CallforPrice13668-0217-30-ARIPiprazole5mgTab-13668-0217-30 CallforPrice13668-0218-30-ARIPiprazole10mgTab-13668-0218-30 CallforPrice13668-0219-30-ARIPiprazole15mgTab-13668-0219-30 CallforPrice13668-0220-30-ARIPiprazole20mgTab-13668-0220-30 CallforPrice13668-0409-30-losartan50mgTab CallforPrice13668-0453-01-anagrelide0.5mgCap-13668-0453-01 CallforPrice13668-0482-01-minocycline50mgCap CallforPrice13811-0678-30-leflunomide20mgTab CallforPrice13811-0714-90-venlafaxine150mgTab CallforPrice13925-0504-30-dapsone25mgTab-13925-0504-30 CallforPrice13925-0505-30-dapsone100mgTab CallforPrice13925-0505-30-dapsone100mgTab-13925-0505-30 CallforPrice14539-0674-01-hydrOXYzinepamoate25mgCap-14539-0674-01 CallforPrice14789-0011-01-isoproterenol0.2mg/mLSol CallforPrice14789-0012-02-sodiumnitroprusside25mg/mLSol CallforPrice14789-0014-01-ephedrine50mg/mLSoln-Inj CallforPrice16500-0535-02-calcium-vitaminD200mg-250intlunitsTab CallforPrice16571-0120-50-ciprofloxacinophthalmic0.3%Sol CallforPrice16571-0120-50-ciprofloxacinophthalmic0.3%Sol5mL-16571-0120-50 CallforPrice16571-0160-10-trihexyphenidyl2mgTab-16571-0160-10 CallforPrice16571-0161-10-trihexyphenidyl5mgTab-16571-0161-10 CallforPrice16571-0330-16-PHENobarbital20mg/5mLElixer-16751-0330-16 CallforPrice16714-0042-10-allopurinol300mgTab-16714-0042-10 CallforPrice16714-0042-11-allopurinol300mgTab CallforPrice16714-0072-04-baclofen20mgTab CallforPrice16714-0081-10-hydrOXYzinehydrochloride10mgTab CallforPrice16714-0101-02-gemfibrozil600mgTab-16714-0101-02 CallforPrice16714-0101-05-gemfibrozil600mgTab CallforPrice16714-0101-05-gemfibrozil600mgTab-16714-0101-05 CallforPrice16714-0234-01-penicillinVpotassium250mgTab CallforPrice16714-0234-01-penicillinVpotassium250mgTab-16714-0234-01 CallforPrice
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47781-0470-13-oseltamivir75mgUDCap-47781-0470-13 CallforPrice47781-0544-01-minocycline50mgCap CallforPrice47781-0553-01-labetalol200mgTab-47781-0553-01 CallforPrice47781-0553-05-labetalol200mgTab-47781-0553-05 CallforPrice47781-0554-01-labetalol300mgTab CallforPrice47781-0569-26-fluocinonideTop0.05%Oint60gm-47781-0569-26 CallforPrice47781-0577-01-methenaminehippurate1gmTab-47781-0577-01 CallforPrice47781-0578-07-dexrazoxane500mgPow CallforPrice47781-0584-68-ketorolac30mg/mLSol CallforPrice47781-0585-68-ketorolac30mg/mLInjSol2mL-47781-0585-68 CallforPrice47781-0586-29-labetalol5mg/mLSol CallforPrice47781-0587-17-metoprolol1mg/mLSol CallforPrice47781-0588-68-midazolam1mg/mLSol CallforPrice47781-0589-91-midazolam5mg/mLSol CallforPrice47781-0597-91-vancomycin1gPow CallforPrice47781-0598-91-vancomycin500mgPow CallforPrice47781-0601-91-tranexamicacid100mg/mLSol CallforPrice47781-0607-30-disulfiram250mgTab CallforPrice47781-0607-30-disulfiram250mgTab-47781-0607-30 CallforPrice47781-0729-50-vancomycin125mgCap CallforPrice47781-0729-50-vancomycin125mgCap-47781-0729-50 CallforPrice48433-0104-01-cholecalciferol1000intlunitsTab CallforPrice48433-0202-30-mineraloil100%Liq CallforPrice48433-0230-15-iodine-potassiumiodide5%-10%Sol CallforPrice49281-0190-20-rabiesimmuneglobulin,human150intlunits/mLSol CallforPrice49281-0215-15-tetanus-diphthtoxoids(Td)adult/adol5units-2units/0.5mLPFSusp5mL-49281-02 CallforPrice49281-0250-51-rabiesvaccine,humandiploidcell2.5intlunitsPow CallforPrice49281-0278-10-diphtheria-tetanustoxoids(DT)5units-6.7units/0.5mLpediatricInjSusp-49281- CallforPrice49281-0291-10-tetanus-diphtheriatoxoids5units-2units/0.5mLSusp CallforPrice49281-0400-15-tetanus/diphth/pertuss(Tdap)adult/adol5units-2units-15.5mcg/0.5mLSus CallforPrice49281-0400-20-tetanus/diphth/pertuss(Tdap)adult/adol5units-2units-15.5mcg/0.5mLSus CallforPrice49281-0405-65-influenzavirusvaccine,inactivatedhigh-dosepreservative-freetrivalentSus CallforPrice49281-0419-50-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus CallforPrice49281-0489-01-meningococcalpolysaccharidevaccinesingledosePow CallforPrice49281-0515-25-influenzavirusvaccinequadrivalentPF6-35mo,inactivatedpresrvative-freequadri CallforPrice49281-0519-25-influenzavirusvaccine,inactivatedpreservative-freepediatricquadrivalentSus CallforPrice49281-0589-05-meningococcalconjugatevaccine4mcg/0.5mLIMSol-49281-0589-05 CallforPrice49281-0589-05-meningococcalconjugatevaccineSoln CallforPrice49281-0631-15-influenzavirusvaccine,inactivatedquadrivalentSus CallforPrice49281-0719-10-influenzavirusvaccine,inactivatedrecombinanthemagglutininquadrivalentSol CallforPrice49281-0752-21-tuberculinpurifiedproteinderivative50Soln CallforPrice49281-0752-21-tuberculinpurifiedproteinderivative5TU/0.1mLIDSol1mL-49281-0752-21 CallforPrice49281-0752-22-tuberculinpurifiedproteinderivative5TU/0.1mLIDSol5mL-49281-0752-22 CallforPrice49281-0752-22-tuberculinpurifiedproteinderivative5tuberculinunits/0.1mLSol CallforPrice49281-0790-20-typhoidvaccine,inactivated-Sol CallforPrice49281-0860-10-poliovirusvaccine,inactivatedSQSusp5mL-49281-0860-10 CallforPrice49281-0860-10-poliovirusvaccine,inactivatedSusp CallforPrice49281-0915-01-yellowfevervaccine-Pow CallforPrice49348-0011-34-calamine-zincoxidetopical8%-8%Lot CallforPrice49348-0013-10-docusate-senna50mg-8.6mgTab CallforPrice49348-0016-36-castoroil100%Liq CallforPrice49348-0019-39-Alhydroxide/Mghydroxide/simethicone200mg-200mg-20mg/5mLOralSusp355mL-49 CallforPrice
49348-0028-27-oxymetazolinenasal0.05%Spr CallforPrice49348-0037-29-tetrahydrozolineophthalmic0.05%Sol CallforPrice49348-0045-34-diphenhydrAMINE12.5mg/5mLLiq-49348-0045-34 CallforPrice49348-0076-44-phenazopyridine95mgTab CallforPrice49348-0153-39-Alhydroxide/Mghydroxide/simethicone200mg/200mg/20mgSusp-Oral CallforPrice49348-0154-72-bacitracintopicalzinc500units/gOin CallforPrice49348-0179-37-hydrogenperoxidetopical3%Sol CallforPrice49348-0179-38-hydrogenperoxideTop3%Sol473mL-49348-0179-38 CallforPrice49348-0179-38-hydrogenperoxidetopical3%Sol CallforPrice49348-0185-20-mineraloil100%Ene CallforPrice49348-0185-20-mineraloil100%RectalEnema133mL-49348-0185-20 CallforPrice49348-0188-10-simethicone80mgTab CallforPrice49348-0191-07-aspirin81mgChewTab-49348-0191-07 CallforPrice49348-0191-07-aspirin81mgTab CallforPrice49348-0197-27-phenylephrinenasal1%Soln CallforPrice49348-0237-87-permethrintopical0.5%Spr CallforPrice49348-0356-25-sodiumchloridenasal0.65%Spr CallforPrice49348-0379-54-clotrimazoletopical2%Cre CallforPrice49348-0398-96-camphor/eucalyptus/mentholtopical4.8%-1.2%-2.6%Oin CallforPrice49348-0504-49-magnesiumcitrate1.745g/30mLOralLiq296mL-49348-0504-49 CallforPrice49348-0622-37-povidoneiodinetopical10%Sol CallforPrice49348-0622-38-povidoneiodinetopical10%Sol CallforPrice49348-0740-27-simethicone40mg/0.6mLLiq CallforPrice49348-0793-76-clotrimazole1%VagCrmw/Appl45gm-49348-0793-76 CallforPrice49348-0793-76-clotrimazoletopical1%Cre CallforPrice49348-0853-16-nicotine4mgLoz CallforPrice49348-0872-77-miconazoletopical2%Cre CallforPrice49348-0953-44-bismuthsubsalicylate262mgChewTab-49348-0953-44 CallforPrice49348-0953-44-bismuthsubsalicylate262mgTab CallforPrice49348-0973-16-acetaminophen325mgTab-49348-0973-16 CallforPrice49348-0980-15-aspirin81mgECTab-49348-0980-15 CallforPrice49348-0980-23-aspirin81mgTab CallforPrice49348-0980-53-aspirin81mgTab-49348-0980-53 CallforPrice49348-0981-15-aspirin81mgOralECTab-49348-0981-15 CallforPrice49348-0981-15-aspirin81mgTab CallforPrice49348-0990-44-mentholtopical5.4mgLozenge CallforPrice49471-0001-05-benzylpenicilloyl-polylysine-Sol CallforPrice49483-0481-12-aspirin81mgTab CallforPrice49483-0481-12-aspirin81mgTab-49483-0481-12 CallforPrice49502-0101-02-EPINEPHrine0.15mgSoln-Inj CallforPrice49502-0102-02-EPINEPHrine0.3mgKit CallforPrice49502-0102-02-EPINEPHrine0.3mgSoln-Inj CallforPrice49702-0242-13-dolutegravir-rilpivirine50mg-25mgTab CallforPrice49884-0009-01-isosorbidedinitrate30mgTab CallforPrice49884-0055-01-imipramine25mgTab CallforPrice49884-0056-01-imipramine50mgTab-49884-0056-01 CallforPrice49884-0076-01-fluPHENAZine5mgTab-49884-0076-01 CallforPrice49884-0122-05-labetalol100mgTab CallforPrice49884-0122-05-labetalol100mgTab-49884-0122-05 CallforPrice49884-0161-11-calcitonin200intlunits/inh3.7mL-49884-0161-11 CallforPrice49884-0161-11-calcitonin200intlunits/inhSpr CallforPrice49884-0290-05-megestrol40mgTab CallforPrice
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50268-0858-15-pyridoxine50mgTab CallforPrice50268-0860-15-ascorbicacid250mgTab CallforPrice50383-0025-05-ofloxacinotic0.3%Sol CallforPrice50383-0042-24-prednisoLONE15mg/5mLSyr CallforPrice50383-0042-48-prednisoLONE15mg/5mLSyr CallforPrice50383-0050-08-cimetidine300mg/5mLLiq CallforPrice50383-0063-06-guaiFENesin100mg/5mLLiq CallforPrice50383-0087-04-codeine-guaifenesin10mg-100mg/5mLOralSyrup118mL-50383-0087-04 CallforPrice50383-0087-04-codeine-guaifenesin10mg-100mg/5mLSyr CallforPrice50383-0087-16-codeine-guaiFENesin10mg-100mg/5mLOralSyrup473mL-50383-0087-16 CallforPrice50383-0241-16-levETIRAcetam100mg/mLOralSol50383-0241-16 CallforPrice50383-0667-30-lidocaine-prilocainetopical2.5%-2.5%Cre CallforPrice50383-0705-30-LORazepam2mg/mLCon CallforPrice50383-0740-16-albuterol2mg/5mLSyr CallforPrice50383-0775-04-lidocainetopical2%Sol CallforPrice50383-0779-16-lactulose10g/15mLOralSyrup-50383-0779-16 CallforPrice50383-0779-16-lactulose10g/15mLSyr CallforPrice50383-0779-32-lactulose10g/15mLSyr CallforPrice50383-0779-33-lactulose10g/15mLSyr CallforPrice50383-0792-07-valproicacid250mg/5mLSyr CallforPrice50383-0792-16-valproicacid250mg/5mLOralSyrup473mL-50383-0792-16 CallforPrice50383-0801-16-promethazine6.25mg/5mLOralSyrup473mL-50383-0801-16 CallforPrice50383-0801-16-promethazine6.25mg/5mLSyr CallforPrice50383-0901-10-aceticacid-hydrocortisoneOticSol-50383-0901-10 CallforPrice50458-0140-30-canagliflozin100mgTab CallforPrice50458-0141-30-canagliflozin300mgTab CallforPrice50458-0561-01-paliperidone78mg/0.5mLSus CallforPrice50458-0564-01-paliperidone234mg/1.5mLSus CallforPrice50458-0579-10-rivaroxaban20mgTab CallforPrice50458-0590-50-risperiDONE0.25mgTab CallforPrice50458-0592-60-risperiDONE1mgTab CallforPrice50458-0593-60-risperiDONE2mgTab CallforPrice50458-0594-50-risperiDONE3mgTab CallforPrice50458-0594-50-risperiDONE3mgTab-50458-0594-50 CallforPrice50458-0595-60-risperiDONE4mgTab CallforPrice50458-0606-01-paliperidone273mg/0.875mLSus CallforPrice50458-0607-01-paliperidone410mg/1.315mLSus CallforPrice50458-0608-01-paliperidone546mg/1.75mLSus CallforPrice50458-0609-01-paliperidone819mg/2.625mLSus CallforPrice50474-0370-66-brivaracetam10mgTab CallforPrice50474-0470-66-brivaracetam25mgTab CallforPrice50474-0570-66-brivaracetam50mgTab CallforPrice50474-0670-66-brivaracetam75mgTab CallforPrice50474-0710-79-certolizumab200mg/mLKit CallforPrice50474-0770-66-brivaracetam100mgTab CallforPrice50474-0870-15-brivaracetam10mg/mLLiq CallforPrice50474-0970-75-brivaracetam10mg/mLSol CallforPrice50580-0534-04-diphenhydrAMINE12.5mg/5mLLiq CallforPrice50580-0534-04-diphenhydrAMINE12.5mg/5mLOralLiq118mL-50580-0534-04 CallforPrice50580-0535-01-diphenhydrAMINE12.5mg/5mLLiq CallforPrice50580-0535-01-diphenhydrAMINE12.5mg/5mLOralLiq118mL-50580-0535-01 CallforPrice50580-0600-02-acetaminophen325mgTab CallforPrice
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57894-0054-27-ustekinumab5mg/mLSol CallforPrice57894-0502-05-daratumumab20mg/mLSol CallforPrice57894-0502-20-daratumumab20mg/mLSol CallforPrice57896-0101-01-acetaminophen325mgTab-57896-0101-01 CallforPrice57896-0101-10-acetaminophen325mgTab-57896-0101-10 CallforPrice57896-0102-10-acetaminophen325mgTab-57896-0102-10 CallforPrice57896-0339-05-carbamideperoxideotic6.5%Sol CallforPrice57896-0339-05-carbamideperoxideotic6.5%Sol CallforPrice57896-0408-03-docusatesodium100mgCap-57896-0408-03 CallforPrice57896-0444-05-bisacodyl10mgSupp CallforPrice57896-0791-01-simethicone80mgTab CallforPrice57896-0911-36-aspirin81mgChewTab-57896-0911-36 CallforPrice57896-0921-10-aspirin325mgTab CallforPrice57896-0921-10-aspirin325mgTab-57896-0921-10 CallforPrice57902-0249-01-asparaginaseErwiniachrysanthemi10000intlunitsPow CallforPrice58160-0810-01-diphtheria/tetanus/pertussis,acel(DTaP)25units-10units-58mcg/Susp-Inj CallforPrice58160-0810-11-diphtheria/tetanus/pertussis(DTaP)ped25units-10units-58mcg/0.5mLSus CallforPrice58160-0810-11-diphtheria/tetanus/pertussis,acel(DTaP)25units-10units-58mcg/0.5mLIMSusp0. CallforPrice58160-0811-01-diphtheria/hepB/pertussis,acel/polio/tetanus0.5mLSusp-Inj CallforPrice58160-0811-11-diphtheria/hepB/pertussis,acel/polio/tetanusSusp CallforPrice58160-0811-11-diphtheria/hepB/pertussis,acel/polio/tetanusIMSusp0.5mL-58160-0811-11 CallforPrice58160-0811-43-diphtheria/hepB/pertussis,acel/polio/tetanus-Susp-Inj CallforPrice58160-0811-46-diphtheria/hepB/pertussis,acel/polio/tetanus-Sus CallforPrice58160-0811-46-diphtheria/hepB/pertussis,acel/polio/tetanusIMSusp0.5mL-58160-0811-46 CallforPrice58160-0811-52-diphtheria/hepB/pertussis,acel/polio/tetanusIMSusp0.5mL-58160-0811-52 CallforPrice58160-0811-52-diphtheria/hepB/pertussis,acel/polio/tetanus-Sus CallforPrice58160-0812-01-diphtheria/pertussis,acel/tetanus/polio-Susp-Inj CallforPrice58160-0812-11-diphtheria/pertussis,acel/tetanus/polio-Sus CallforPrice58160-0812-52-diphtheria/pertussis,acel/tetanus/polio-Sus CallforPrice58160-0818-11-haemophilusbconjugate(PRP-T)vaccine-Pow CallforPrice58160-0825-01-hepatitisApediatricvaccine720Susp CallforPrice58160-0825-11-hepatitisApediatricvaccine720Susp CallforPrice58160-0825-11-hepatitisApediatricvaccine720units/0.5mLPFIMSusp-58160-0825-11 CallforPrice58160-0825-52-hepatitisApediatricvaccine720units/0.5mLpreservativefreeSus CallforPrice58160-0826-01-hepatitisAadultvaccine1mLSusp-Inj CallforPrice58160-0826-11-hepatitisAadultvaccine1440Susp CallforPrice58160-0826-11-hepatitisAadultvaccine1440units/mLPFIMSusp1mL-58160-0826-11 CallforPrice58160-0826-46-hepatitisAadultvaccine1440units/mLpreservativefreeSus CallforPrice58160-0826-46-hepatitisAadultvaccine1440units/mLPFIMSusp1mL-58160-0826-46 CallforPrice58160-0826-52-hepatitisAadultvaccine1440units/mLPFIMSusp1mL-58160-0826-52 CallforPrice58160-0826-52-hepatitisAadultvaccine1440units/mLpreservativefreeSus CallforPrice58160-0840-11-diphtheria/tetanus/pertussis,acel(DTaP)25units-10units-58mcg/0.5mLIMSusp0. CallforPrice58160-0842-11-tetanus/diphtheria/pertussis,acel(Tdap)5units-2.5units-18.5mcg/0.5mLIMSusp CallforPrice58160-0842-46-tetanus/diphtheria/pertussis,acel(Tdap)5units-2.5units-18.5mcg/0.5mLSus CallforPrice58160-0842-46-tetanus/diphtheria/pertussis,acel(Tdap)5units-2.5units-18.5mcg/0.5mLIMSusp CallforPrice58160-0842-52-tetanus/diphtheria/pertussis,acel(Tdap)5units-2.5units-18.5mcg/0.5mLIMSusp CallforPrice58160-0896-52-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus CallforPrice58160-0964-12-rabiesvaccine,purifiedchickembryocell2.5intlunitsPow CallforPrice58160-0964-12-rabiesvaccine,purifiedchickembryocell2.5intlunitsIMInj1mL-58160-0964-1 CallforPrice58160-0976-06-meningococcalgroupBvaccinerecombinant,OMV,adjuvantedSus CallforPrice58160-0976-20-meningococcalgroupBvaccinerecombinant,OMV,adjuvantedSus CallforPrice58181-3041-05-lomustine40mgCap CallforPrice
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69097-0846-15-cyclobenzaprine10mgTab CallforPrice69097-0861-07-zonisamide100mgCap-69097-0861-07 CallforPrice69097-0867-07-nadolol20mgTab CallforPrice69097-0867-07-nadolol20mgTab-69097-0867-07 CallforPrice69097-0927-35-palonosetron0.25mg/5mLSol CallforPrice69097-0946-15-atorvastatin40mgTab-69097-0946-15 CallforPrice69238-1051-01-phytonadione5mgTab CallforPrice69238-1154-03-ezetimibe10mgTab-69238-1154-03 CallforPrice69238-1264-01-oseltamivir30mgCap CallforPrice69238-1266-01-oseltamivir75mgCap CallforPrice69238-1266-01-oseltamivir75mgUDCap-69238-1266-01 CallforPrice69238-1605-08-methylergonovine0.2mgTab-69238-1605-08 CallforPrice69238-1831-01-levothyroxine50mcg(0.05mg)Tab CallforPrice69251-0201-01-ciprofloxacinotic6%Sus CallforPrice69292-0722-25-flurbiprofen0.03%Soln-Ophth CallforPrice69292-0722-25-flurbiprofenOphth0.03%Sol2.5mL-69292-0722-25 CallforPrice69315-0116-01-furosemide20mgTab-69315-0116-01 CallforPrice69315-0116-10-furosemide20mgTab-69315-0116-10 CallforPrice69315-0117-01-furosemide40mgTab-69315-0117-01 CallforPrice69315-0117-10-furosemide40mgTab-69315-0117-10 CallforPrice69315-0127-01-folicacid1mgTab CallforPrice69315-0137-01-benztropine1mgTab CallforPrice69315-0138-01-benztropine2mgTab-69315-0138-01 CallforPrice69315-0210-01-methenaminehippurate1gTab CallforPrice69315-0210-01-methenaminehippurate1gTab-69315-0210-01 CallforPrice69315-0211-01-NIFEdipine10mgCap CallforPrice69315-0211-01-NIFEdipine10mgCap-69315-0211-01 CallforPrice69315-0308-05-ciprofloxacin0.30%Soln-Ophth CallforPrice69315-0904-01-LORazepam0.5mgTab CallforPrice69315-0904-01-LORazepam0.5mgTab-69315-0904-01 CallforPrice69315-0905-01-LORazepam1mgTab CallforPrice69315-0905-01-LORazepam1mgTab-69315-0905-01 CallforPrice69339-0135-01-cyproheptadine4mgTab-69339-0135-01 CallforPrice69339-0138-17-chlorhexidinetopical0.12%Liq CallforPrice69339-0138-19-chlorhexidinetopical0.12%Liq CallforPrice69401-0000-01-typhoidvaccine,live-Cap CallforPrice69452-0105-19-montelukast10mgTab-69452-0105-19 CallforPrice69452-0106-19-montelukast4mgTab CallforPrice69452-0107-19-montelukast5mgChewTab-69452-0107-19 CallforPrice69452-0151-20-ergocalciferol50,000intlunitsCap CallforPrice69452-0151-20-ergocalciferol50,000intlunitsCap-69452-0151-20 CallforPrice69452-0155-20-tacrolimus5mgCap-69452-0155-20 CallforPrice69452-0209-20-niMODipine30mgCap CallforPrice69452-0241-20-trihexyphenidyl2mgTab-69452-0241-20 CallforPrice69536-0050-15-phenylephrinenasal0.5%Spr CallforPrice69536-0100-15-phenylephrinenasal1%Spr CallforPrice69536-0162-88-levonorgestrel1.5mgTab CallforPrice69543-0131-12-alendronate70mgTab CallforPrice69543-0131-12-alendronate70mgTab-69543-0131-12 CallforPrice69543-0140-11-losartan25mgTab CallforPrice69543-0151-30-dapsone100mgTab-69543-0151-30 CallforPrice69543-0234-60-ergocalciferol8000intlunits/mLSol CallforPrice
69543-0252-04-codeine-guaiFENesin10mg-100mg/5mLSyr CallforPrice69543-0252-16-codeine-guaiFENesin10mg-100mg/5mLOralSyrup473mL-69543-0252-16 CallforPrice69543-0374-10-progesterone100mgCap CallforPrice69543-0374-10-progesterone100mgCap-69543-0374-10 CallforPrice69543-0375-10-progesterone200mgCap-69543-0375-10 CallforPrice69543-0379-10-potassiumchloride20mEqPow CallforPrice69543-0379-10-potassiumchloride20mEqPwdr-69543-0379-10 CallforPrice69543-0379-30-potassiumchloride20mEqPow CallforPrice69543-0379-30-potassiumchloride20mEqPowder-Pkt-69543-0379-30 CallforPrice69543-0380-90-OLANZapine2.5mgTab-69543-0380-90 CallforPrice69543-0381-90-OLANZapine5mgTab-69543-0381-90 CallforPrice69543-0383-90-OLANZapine10mgTab-69543-0383-90 CallforPrice69543-0384-90-OLANZapine15mgTab-69543-0384-90 CallforPrice69543-0385-30-OLANZapine20mgTab-69543-0385-30 CallforPrice69543-0385-90-OLANZapine20mgTab-69543-0385-90 CallforPrice69543-0386-25-ketorolac30mg/mLInjSol1mL-69543-0386-25 CallforPrice69618-0032-06-simethicone125mgTab CallforPrice69618-0046-10-aspirin81mgOralECTab-69618-0046-10 CallforPrice69656-0103-90-niraparib100mgCap CallforPrice69784-0180-14-polyethyleneglycol3350-Pow CallforPrice69918-0101-01-desmopressin0.1mgTab CallforPrice69918-0201-01-desmopressin0.2mgTab CallforPrice69918-0301-30-tranexamicacid650mgTab CallforPrice69918-0700-25-succinylcholine20mg/mLSol CallforPrice69968-0063-01-naphazoline-pheniramineophthalmic0.025%-0.3%Sol CallforPrice70003-0300-20-nitroglycerin0.4mgSpray CallforPrice70003-0300-20-nitroglycerin0.4mgSublSpray12gm-70003-0300-20 CallforPrice70003-0300-65-nitroglycerin0.4mgSubLSpray4.9gm-70003-0300-65 CallforPrice70010-0043-01-methylphenidate20mg/8hrTab CallforPrice70010-0491-05-metFORMIN500mgERTab-70010-0491-05 CallforPrice70010-0491-10-metFORMIN500mgERTab-70010-0491-10 CallforPrice70010-0754-01-methocarbamol500mgTab CallforPrice70010-0754-05-methocarbamol500mgTab CallforPrice70010-0770-01-methocarbamol750mgTab-70010-0770-01 CallforPrice70121-1168-01-triamcinoloneacetonide40mg/mLSus CallforPrice70347-0025-02-metoprolol25mgER-70347-0025-02 CallforPrice70347-0025-03-MetoprololSuccinate25mgTab-70347-0025-03 CallforPrice70347-0050-02-metoprolol50mgTab CallforPrice70347-0050-02-metoprolol50mgTab-ER CallforPrice70347-0050-03-metoprolol50mgERTab-70347-0050-03 CallforPrice70347-0100-02-metoprolol100mgTab CallforPrice70347-0100-02-metoprolol100mgTab-70347-0100-02 CallforPrice70347-0100-03-metoprolol100mgTab CallforPrice70347-0100-03-metoprolol100mgTab-70347-0100-03 CallforPrice70347-0200-02-metoprolol200mgERTab-70347-0200-02 CallforPrice70370-1040-01-valbenazine40mgCap CallforPrice70370-1080-01-valbenazine80mgCap CallforPrice70377-0008-12-rosuvastatin20mgTab CallforPrice70408-0239-32-nitrofurantoin25mg/5mLSus CallforPrice70408-0239-32-nitrofurantoin25mg/5mLSus-70408-0239-32 CallforPrice70436-0092-05-aspirin-dipyridamole25mg-200mgCap-70436-0092-05 CallforPrice70437-0240-18-neratinib40mgTab CallforPrice
70461-0019-03-influenzavirusvaccine,inactivatedadjuvantedpreservative-freetrivalentSus CallforPrice70461-0319-03-influenzavirusvaccine,inactivatedpreservative-freemdckcellderivedquadrivalen CallforPrice70461-0419-10-influenzavirusvaccine,inactivatedmdckcellderivedquadrivalentSus CallforPrice70501-0092-00-coaltartopical0.5%Sha CallforPrice70504-0126-02-varicellazosterimmuneglobulin125intlunits/1.2mLSol CallforPrice70504-3100-02-RHo(D)immuneglobulin5000intlunits/4.4mLSol CallforPrice70515-0260-10-digoxin250mcg/mL(0.25mg/mL)InjSol2mL-70515-0260-10 CallforPrice70515-0610-01-omeprazole10mgPow CallforPrice70594-0026-02-bacitracin50,000unit(s)Powder-Inj CallforPrice70594-0049-01-polymyxinBsulfate500000unitsPow CallforPrice70655-0002-10-fluconazole200mg/100mL-0.9%Soln-IV CallforPrice70677-0041-01-senna8.6mgTab CallforPrice70677-0051-01-magnesiumcitrate1.745g/30mLOralLiq296mL-70677-0051-01 CallforPrice70710-1021-08-albendazole200mgTab-70710-1021-08 CallforPrice70710-1110-01-cyproheptadine4mgTab-70710-1110-01 CallforPrice70710-1138-03-fluconazole100mgTab-70710-1138-03 CallforPrice70710-1478-01-fomepizole1g/mLSol CallforPrice70860-0103-10-polymyxinBsulfate500000unitsPow CallforPrice70860-0115-26-ampicillin2gPow CallforPrice70860-0451-10-levothyroxine100mcgPowder-Inj CallforPrice70860-0601-10-midazolam5mg/mLSol CallforPrice70860-0605-03-dexmedetomidine100mcg/mLSol CallforPrice70954-0135-20-dapsone25mgTab-70954-0135-20 CallforPrice71019-0019-04-bupivacaine0.2%Soln-IV CallforPrice71019-0095-03-calciumgluconate1gm/100mLSoln-IV CallforPrice71019-0097-02-calciumgluconate2gm/100mLSoln-IV CallforPrice71019-0121-02-heparin30units/mL-NaCl0.9%Soln-IV CallforPrice71019-0138-24-bupivacaine0.25%Soln-Inj CallforPrice71019-0138-53-bupivacaine0.25%Sol-Inj CallforPrice71019-0141-12-bupivacaine0.5%Soln-Inj CallforPrice71019-0175-13-lidocaine-sodiumbicarbonate1%-8.4%Soln-Inj CallforPrice71019-0181-01-magnesiumsulfate10gminLR250mLSoln-IV CallforPrice71019-0183-03-magnesiumsulfate2gm/100mLSoln-IV CallforPrice71019-0192-03-magnesiumsulfate4gmSoln-IV CallforPrice71019-0201-01-magnesiumsulfate120mg/mL-D5%Sol CallforPrice71019-0254-01-oxytocin30units/500mL-5%Sol CallforPrice71019-0263-15-phenylephrine1mg/10mL-NaCl0.9%Soln-IV CallforPrice71019-0321-07-rocuronium10mg/mLSoln-IV CallforPrice71019-0341-15-succinylcholine20mg/mLSoln-Inj CallforPrice71288-0005-20-ampicillin-sulbactam1.5gmPowder-Inj CallforPrice71288-0006-30-ampicillin-sulbactam2gm-1gmPowder-Inj CallforPrice71288-0007-75-ampicillin-sulbactam15gmPowder-Inj CallforPrice71288-0008-15-cefepime1gmPowder-Inj CallforPrice71288-0009-20-cefepime2gPowder-Inj CallforPrice71456-0001-01-sodiumbicarbonate8.4%Soln-Inj CallforPrice71740-0112-30-potassiumiodide1g/mLOralSol30mL-71740-0112-30 CallforPrice71740-0112-30-potassiumiodide1g/mLSol CallforPrice72205-0007-92-capecitabine500mgTab-72205-0007-92 CallforPrice74300-0005-30-methylsalicylatetopical-Cre CallforPrice74300-0008-03-tetrahydrozolineophthalmic0.05%Sol CallforPrice74312-0013-80-cyanocobalamin1000mcgTab CallforPrice75137-0004-95-acetaminophen-diphenhydramine325mg-12.5mgTab CallforPrice
75137-0585-07-salicylicacidtopical17%Gel CallforPrice75834-0124-01-acyclovir200mgCap-75834-0124-01 CallforPrice75834-0170-01-zincoxide20%Ointment CallforPrice75987-0090-11-caffeine-ergotamine100mg-2mgSup CallforPrice76045-0006-10-morphine5mg/mLpreservative-freeSol CallforPrice76045-0009-05-HYDROmorphone0.5mg/0.5mLSol CallforPrice76045-0009-10-HYDROmorphone1mg/mLSol CallforPrice76045-0103-20-ondansetron2mg/mLInjSol2mL-76045-0103-20 CallforPrice76045-0104-10-ketorolac30mg/mLInjSol1mL-76045-0104-10 CallforPrice76045-0105-20-ketorolac30mg/mLInjSol2mL-76045-0105-20 CallforPrice76282-0045-30-ARIPiprazole5mgTab CallforPrice76282-0045-30-ARIPiprazole5mgTab-76282-0045-30 CallforPrice76282-0046-30-ARIPiprazole10mgTab CallforPrice76282-0046-30-ARIPiprazole10mgTab-76282-0046-30 CallforPrice76282-0047-30-ARIPiprazole15mgTab-76282-0047-30 CallforPrice76282-0048-30-ARIPIPRazole20mgTab-76282-0048-30 CallforPrice76282-0049-30-ARIPiprazole30mgTab CallforPrice76282-0049-30-ARIPiprazole30mgTab-76282-0049-30 CallforPrice76282-0206-10-citalopram10mgTab CallforPrice76282-0208-10-citalopram40mgTab CallforPrice76282-0212-05-sertraline25mgTab CallforPrice76282-0213-30-sertraline50mgTab-76282-0213-30 CallforPrice76282-0214-18-sertraline100mgTab-76282-0214-18 CallforPrice76282-0214-90-sertraline100mgTab CallforPrice76282-0214-90-sertraline100mgTab-76282-0214-90 CallforPrice76282-0249-10-escitalopram5mgTab CallforPrice76282-0250-10-escitalopram10mgTab CallforPrice76282-0251-10-escitalopram20mgTab CallforPrice76282-0309-01-hydrALAZINE10mgTab CallforPrice76282-0310-01-hydrALAZINE25mgTab CallforPrice76282-0310-10-hydrALAZINE25mgTab-76282-0310-10 CallforPrice76282-0323-05-gabapentin400mgCap-76282-0323-05 CallforPrice76282-0332-10-warfarin5mgTab CallforPrice76282-0340-01-naproxen250mgTab-76282-0340-01 CallforPrice76282-0342-01-naproxen500mgTab-76282-0342-01 CallforPrice76282-0405-05-gabapentin600mgTab CallforPrice76282-0406-90-gabapentin800mgTab CallforPrice76282-0417-01-lisinopril2.5mgTab CallforPrice76282-0418-01-lisinopril5mgTab CallforPrice76282-0419-01-lisinopril10mgTab CallforPrice76282-0419-90-lisinopril10mgTab-76282-0419-90 CallforPrice76282-0420-10-lisinopril20mgTab CallforPrice76282-0422-01-lisinopril40mgTab-76282-0422-01 CallforPrice76282-0422-18-lisinopril40mgTab-76282-0422-18 CallforPrice76282-0422-45-lisinopril40mgTab CallforPrice76282-0422-45-lisinopril40mgTab-76282-0422-45 CallforPrice76282-0481-30-buPROPion300mgERTab CallforPrice76282-0627-05-gabapentin300mgCap-76282-0627-05 CallforPrice76282-0628-10-citalopram10mgTab CallforPrice76282-0629-10-citalopram20mgTab CallforPrice76282-0629-10-citalopram20mgTab-76282-0629-10 CallforPrice76297-0001-01-sodiumchloride0.9%0.9%Soln-IV CallforPrice
76329-3304-01-calciumchloride100mg/mLSol CallforPrice76329-3390-01-lidocaine2%PFInjSol5mL-76329-3390-01 CallforPrice76329-3390-01-lidocaine2%preservative-freeSol CallforPrice76385-0104-01-benztropine1mgTab CallforPrice76385-0114-01-sotalol80mgTab-76385-0114-01 CallforPrice76385-0124-01-methocarbamol750mgTab CallforPrice76385-0124-50-methocarbamol750mgTab-76385-0124-50 CallforPrice76388-0635-25-chlorambucil2mgTab-76388-0635-25 CallforPrice76388-0880-25-thioguanine40mgTab CallforPrice76439-0309-10-hyoscyamine0.125mgTab CallforPrice77333-0934-10-thiamine100mgTab CallforPrice77333-0937-10-cyanocobalamin500mcgTab CallforPrice77333-0940-10-pyridoxine50mgTab CallforPrice77333-0983-10-zincsulfate220mgCap CallforPrice79854-0050-24-cholecalciferol1000intlunitsTab CallforPrice79854-0200-10-thiamine100mgTab-79854-0200-10 CallforPrice81421-0020-02-bisacodyl5mgTab CallforPrice84009-3101-37-cyanocobalamin1,000mcgTab CallforPrice87541-0300-91-sodiumhyaluronate10mg/mLSol CallforPrice89116-0000-22-hypochlorousacid-sodiumhypochlorite0.01%Spray-Top CallforPrice92771-0590-02-lanolintopical-Cre CallforPrice92771-0600-02-emollients,topical-Cream CallforPrice99999-0064-20-magnesiumsulfate10gminNS250mLSoln-IV CallforPrice99999-0105-01-hydroxyprogesterone250mg/mLSoln-Inj CallforPrice99999-2267-04-labetalol5mg/mLSoln-Inj CallforPrice99999-2344-01-DOBUTamine2mg/mLSoln-IV CallforPrice99999-4297-10-furosemide10mgTab CallforPrice99999-9999-07-vancomycin25mg/mLOphthSolnCmpd25mg/mLSoln-Ophth CallforPrice99999-9999-65-dextrose-lidocaine50%-2%Soln-Inj CallforPrice99999-9999-66-bacitracin-sodiumchloride500,000unit(s)Soln-IRR CallforPrice99999-9999-68-enalapril1mg/mLSusp-Oral CallforPrice99999-9999-69-GICocktail-Susp-Oral CallforPrice99999-9999-72-penicillinGpotassium10,000unit(s)/mLSoln-Inj CallforPrice99999-9999-90-ropivacaine0.2%Soln-IV CallforPrice99999-9999-91-ethambutol50mg/mLSusp-Oral CallforPrice99999-9999-92-clonidine0.01mg/mLSusp-Oral CallforPrice99999-9999-93-metoprolol10mg/mLSusp-Oral CallforPrice99999-9999-94-Voriconazole0.5mg/mLOphthSolm-CMPD CallforPriceA00186-0230-03-lidocaine1%10mg/mLSoln-Inj CallforPriceA77777-7777-19-acetaminophen10mg/mLSoln-IV CallforPriceCPAPMaskFullFace $63.4577012-ChargeServicesReport $2,330.76 $433.14DigitalMammogram-LTdiagnostic,unilateral $551.61 $365.39DigitalMammogram-RTdiagnostic,unilateral $551.61 $365.39G0204MammogramDiagnosticBilateral $721.71 $228.34NeedleBxCoreMonopty14Gx10cmSRHC $173.21NeedleSpinal22Gx31/2in $6.92NeedleSpinal25Gx31/2in $7.21DRILLBIT2.0X102WL50mmSHAFT $204.81DRILLBIT2.0X122WL70mmSHAFT $240.71DRILLBIT2.8X102MMWL70MMFIT $226.99DRILLBIT4.2X340MM $332.57
DRILLOVER2.7DAI $277.67DRILLSHAFT2.6X122MMWL70MM $277.67DRILLSHAFT2X122MMWL50MM $277.67SRHC_BLADEMYRINGOTOMY $137.74SRHC_BLADELESSTROCAR5MM $71.22SRHC_OPTIVIEWTROCAR12MM $94.25SRHC_PACKCSECTION $88.41SRHC_SCDSLEEVESKNEEHIGHREG $55.02SRHC_SuctionIrrigator $263.37SRHC_URINEMETERFOLEYTRAY16FR $33.64SRHC_VACUUMDELIVERYKIT60MMREG $29.77SRHC_VACUUMDELIVERYKIT65MM $29.77AdductorCanalBlock $167.58AirwayBlock $167.58AnkleBlock $167.58AxillaryBlock $167.58BierBlock $167.58BrachialPlexusBlock $167.58CaudalBlock $167.58CeliacPlexusBlock $167.58CentralNerveBlock $167.58CervicalPlexusBlock $167.58DigitalBlock $167.58Epidural $167.58FemoralNerveBlock $167.58General $167.58InfraclavicularBlock $167.58IntercostalBlock $167.58InterscaleneBlock $167.58Local $167.58LumbarPlexus/PsoasBlock $167.58MAC $167.58MedianNerveBlock $167.58None $167.58ObturatorBlock $167.58PoplitealBlock $167.58RadialNerveBlock $167.58SaphenousBlock $167.58SciaticBlockBolus $167.58SciaticBlockInfusion $167.58Spinal $167.58StellateGanglionBlock $167.58SupraclavicularBlock $167.58TAPIlioinguinal/iliohypogastricblock $167.58TAPbilateralbyinjection $167.58TAPotherperipheralnerve/branchblock $167.58TAPunilateralbyinjection $167.58Topical $167.58UlnarNerveBlock $167.58WristBlock $167.58Level1 $167.58Level2 $167.58
Level3 $167.58Level4 $167.58Level5 $167.58None $0.01PACU-SMOR CallforPricePACU-SPROC CallforPricePostOpPhase1-ENDO CallforPricePostOpPhase1-MOR CallforPricePostOpPhase1-SENDO CallforPricePostOpPhase1-SOR CallforPricePostOpPhase2-ENDO CallforPricePostOpPhase2-MOR CallforPricePostOpPhase2-SENDO CallforPricePostOpPhase2-SOR CallforPriceSRHC_SHAFTHALL450MM 0227-3000S $553.210296TRecording(includesconnectionandinitialrecording) 0296T $397.10STEMEXETERV4037.5MMNO2 0580-1-372 $2,825.01SRHC_K-WIRE3.2X450MM 1210-6450S $242.82STEMSECURFITADVANCESIZE8 1601-08127 $4,360.89STEMSECURFITADVANCESIZE9 1601-09132 $4,360.89STEMSECURFITADVANCESIZE11 1601-11132 $4,360.89GUIDEWIRESTRYBALL3.0X800MM1806-0080S 1806-0080S $350.51SRHC_GUIDEWIREBALLTIP3X1000 1806-0085S $366.34DRILLBITSTRY4.2X340MM1806-4260S 1806-4260S $332.57SRHC_DRILLBIT4.2X180MM 1806-4270S $356.84SRHC_SCREWLOCKING5MMX45MM 1896-5045S $342.07SRHC_SCREWLOCKING5MMX52.5MM 1896-5052S $342.07SCREWSTRYT2LCK5X55MM1896-5055S 1896-5055S $342.07SCREWBONECANCELLOUS16MM 2030-6516-1 $207.80SCREWBONECANCELLOUS20MM 2030-6520-1 $207.80SCREW6.5CANCELLOUSBONE25MM2030-6525-1 2030-6525-1 $207.80ScrewCancellousBone2030-6535-1 2030-6535-1 $207.80PLUGACETABULARDOMEHOLE 2060-0000-1 $207.80SCREWLAG10.5X85MM 3060-0085S $928.33SCREWLAG10.5X90MM 3060-0090S $928.33NAILKIT11X18MMX125 3125-1180S $2,106.24SCREWCANNULATED4X30MM 325030S $318.83SCREWCANNULATED4X38MM 325038S $318.83SCREWCANNULATED4X40MM 325040S $318.83SCREWCANNULATED6.5X70MM 326070S $506.76SCREWCANNULATED6.5X75MM 326075S $506.76SCREWCANNULATED8X90MM 326690S $506.76SCREWCANNULATED8X100MM 326700S $506.76PLATELONGBROADSTRAIGHT 40-15043 $1,083.20PLATEDISTALLATERALFIBULA5H 40-20905 $1,034.74SCREWBONE2.7X12MM_40-27012 40-27012 $138.31SCREWBONE2.7X16MM 40-27016 $138.31SCREWBONE2.7X18MM 40-27018 $138.31SCREWBONE2.7X20MM 40-27020 $138.31SCREWBONE2.7X30MM 40-27030 $138.31SCREWBONE3.5X12MM 40-35012 $153.09SCREWBONE3.5X14MM 40-35014 $153.09
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49401-0102-01-belimumab400mgPow J0490 CallforPrice58914-0080-52-dicyclomine10mg/mLSol J0500 CallforPrice00143-9729-05-benztropine1mg/mLSol J0515 CallforPrice00517-0785-05-benztropine1mg/mLInjSol2mL-00517-0785-05 J0515 CallforPrice17478-0012-02-benztropine1mg/mLInjSol2mL-17478-0012-02 J0515 CallforPrice17478-0012-02-benztropine1mg/mLSol J0515 CallforPrice67386-0611-52-benztropine1mg/mLInjSol2mL-67386-0611-52 J0515 CallforPrice67386-0611-52-benztropine2Soln J0515 CallforPrice68382-0860-10-benztropine1mg/mLSol J0515 CallforPriceBicillinLAInjection1.2millionunits/2mLJ0561-InjMedicationCharge J0561 $100.51BicillinLAInjection1.2millionunits/mL J0561 $53.98BicillinLAInjection600,000units/mLJ0561-InjMedicationCharge J0561 $53.98Injection,penicillinGbenzathine,100,000units J0561 $45.80Injection,penicillingbenzathine,100,000units J0561 $45.8060793-0700-01-penicillin600000Susp J0561 CallforPrice60793-0700-10-penicillin600000Susp J0561 CallforPrice60793-0700-10-penicillinGbenzathine600,000units/mLIMSusp1mL-60793-0700-10 J0561 CallforPrice60793-0701-02-penicillinGbenzathine1,200,000unit(s)Susp-Inj J0561 CallforPrice60793-0701-10-penicillinGbenzathine1,200,000units/2mLIMSusp2mL-60793-0701-10 J0561 CallforPrice60793-0701-10-penicillinGbenzathine1,200,000units/2mLSus J0561 CallforPrice65293-0001-01-bivalirudin250mgPow J0583 CallforPriceJ0585Injection,onabotulinumtoxinA,1unit J0585 $34.37J0585,Injection,100unitsonabotulinumtoxinA00259-1610-01 J0585 $34.3700023-1145-01-botulinumtoxintypeA100unitsPow-Inpatient-00023-1145-01 J0585 CallforPrice00023-1145-01-onabotulinumtoxinA100unitsPow J0585 CallforPrice00259-1605-01-incobotulinumtoxinA50unitsPow J0588 CallforPrice00259-1605-01-incobotulinumtoxinA50unitsPow-00259-1605-01 J0588 CallforPrice00259-1610-01-incobotulinumtoxinA100unitsPow J0588 CallforPrice00259-1610-01-incobotulinumtoxinA100unitsPow-00259-1610-01 J0588 CallforPrice00409-1623-01-butorphanol1mg/mLSol J0595 CallforPrice00409-1626-01-butorphanol2Soln J0595 CallforPrice00409-1626-02-butorphanol2mg/mLSol J0595 CallforPrice00409-1626-02-butorphanol2mg/mLSol J0595 CallforPrice55390-0184-00-butorphanol2mg/mLSoln-Inj J0595 CallforPrice55390-0184-01-butorphanol2mg/mLSol J0595 CallforPrice61553-0051-48-calciumgluconate2gm/100mLSoln-IV J0610 CallforPrice61553-0053-48-calciumgluconate1gm/100mLSoln-IV J0610 CallforPrice63323-0311-10-calciumgluconate100mg/mLInjSol10mL-63323-0311-10 J0610 CallforPrice63323-0311-10-calciumgluconate1000Soln J0610 CallforPrice63323-0311-19-calciumgluconate100mg/mLSol J0610 CallforPrice63323-0311-50-calciumgluconate5000Soln J0610 CallforPrice63323-0311-61-calciumgluconate10000Soln J0610 CallforPrice63323-0311-66-calciumgluconate100mg/mLSol J0610 CallforPrice63323-0360-19-calciumgluconate100mg/mLSol J0610 CallforPrice88888-8888-10-calciumgluconate0.465mEq/mLSoln-Inj J0610 CallforPriceA63323-0311-10-calciumgluconate100mg/mLSoln-IV J0610 CallforPriceInjection,calciumglycerophosphateandcalciumlactate,per10ml J0620 $10.6200078-0149-23-calcitonin200intlunits/mL2mL J0630 CallforPrice54766-0149-23-calcitonin200unit(s)/mLSoln-Inj J0630 CallforPrice17478-0931-01-calcitriol1mcg/mLSol J0636 CallforPrice00006-3822-10-caspofungin50mgRECInjection J0637 CallforPrice00006-3823-10-caspofungin70mgPow J0637 CallforPrice
00703-2793-01-leucovorin10mg/mLSol J0640 CallforPrice00703-5145-01-leucovorin350mgRECInjection J0640 CallforPrice25021-0814-30-leucovorin100mgPow J0640 CallforPrice25021-0816-30-leucovorin350mgPow J0640 CallforPrice55390-0051-10-leucovorin50mgPow J0640 CallforPrice55390-0052-10-leucovorin100mgRECInjection J0640 CallforPrice55390-0054-01-leucovorin350mgPow J0640 CallforPrice63323-0710-50-leucovorin200mgPow J0640 CallforPriceAncef(Cefazolin)2gmIVPB-InjMedicationCharge J0690 $78.20Ancef(Cefazolin)Injection1gmJ0690-InjMedicationCharge J0690 $39.10Cefazolin500mgIM-InjMedicationCharge J0690 $19.5500143-9924-90-cefazolin1gmInj-00143-9924-90 J0690 CallforPrice00143-9924-90-cefazolin1gmRECInjection J0690 CallforPrice00143-9983-03-cefazolin10gPow J0690 CallforPrice00264-3103-11-cefazolin1Soln J0690 CallforPrice00264-3103-11-cefazolin1gm/50mLIVSolduplex-00264-3103-11 J0690 CallforPrice00264-3105-11-cefazolin2gmSoln-Inj J0690 CallforPrice00338-3503-41-cefazolin1g/50mLSol J0690 CallforPrice00338-3503-41cefazolin1g/50mLSol J0690 CallforPrice00409-0805-01-ceFAZolin1gPow J0690 CallforPrice00781-3451-96-ceFAZolin1gPow J0690 CallforPrice00781-3451-96-cefazolin1gmInj-00781-3451-96 J0690 CallforPrice25021-0101-10-ceFAZolin1gPow J0690 CallforPrice25021-0102-99-ceFAZolin10gPow J0690 CallforPrice44567-0707-25-ceFAZolin1gPow J0690 CallforPrice60505-0749-05-cefazolin1gPow J0690 CallforPrice60505-0749-05-cefazolin1gmInj-60505-0749-05 J0690 CallforPrice60505-0769-00-ceFAZolin10gPow J0690 CallforPrice63323-0237-10-cefazolin1gPow J0690 CallforPrice63323-0237-10-cefazolin1gmInj-63323-0237-10 J0690 CallforPrice63323-0238-61-cefazolin10gPow J0690 CallforPrice63323-0238-61-cefazolin10gmRECInjection J0690 CallforPrice66860-0002-03-cefazolin1gPow J0690 CallforPrice66860-0002-03-cefazolin1gmInj-66860-0002-03 J0690 CallforPrice66860-0003-02-cefazolin10gPow J0690 CallforPriceA00143-9924-90-cefazolin1gmShampoo J0690 CallforPriceB00143-9924-90-cefazolin2gmSoln-Inj J0690 CallforPriceCefazolin1gm(Ancef) J0690 $38.3800409-0219-01-cefepime1gPow J0692 CallforPrice25021-0121-20-cefepime1gPow J0692 CallforPrice25021-0122-50-cefepime2gPow J0692 CallforPrice60505-0681-00-cefepime2gPow J0692 CallforPrice63323-0326-20-cefepime1gPow J0692 CallforPrice63323-0340-20-cefepime2gPow J0692 CallforPriceA63323-0326-20-cefepime1gmSoln-Inj J0692 CallforPriceCefoxitin1gmInjJ0694-InjMedicationCharge J0694 $14.4800143-9877-25-cefOXitin2gPow J0694 CallforPrice00264-3123-11-cefOXitin1g/50mLSol J0694 CallforPrice25021-0109-10-cefoxitin1gPow J0694 CallforPrice25021-0110-20-cefoxitin2gPow J0694 CallforPrice44567-0245-25-cefOXitin1gPow J0694 CallforPrice60505-0759-05-cefOXitin1gPow J0694 CallforPrice
60505-0760-05-cefoxitin2gPow J0694 CallforPrice60505-6026-05-cefoxitin2gPow J0694 CallforPrice63323-0341-20-cefoxitin1gmRECInjection J0694 CallforPrice63323-0341-25-cefOXitin1gPow J0694 CallforPrice63323-0342-20-cefoxitin2gmRECInjection J0694 CallforPrice63323-0342-25-cefoxitin2gmInjection J0694 CallforPriceA63323-0341-20-cefoxitin1gmSoln-Inj J0694 CallforPriceCeftriaxone1gmIVPB-IVMedicationCharge J0696 $5.23Ceftriaxone2gmInj-InjMedicationCharge J0696 $6.49Ceftriaxone2gmIVPB-IVMedicationCharge J0696 $5.23Injection,ceftriaxonesodium,per250mg J0696 $50.64Injection,ceftriaxonesodium,per250mg(Rocephin-1QCF) J0696 $50.64Injection,ceftriaxonesodium,per250mg,(Rosephin-4QCF) J0696 $50.64J0696-RocephinInjection250mg J0696 $50.64RocephinInjection1gmJ0696-InjMedicationCharge J0696 $5.23RocephinInjection250mgJ0696-InjMedicationCharge J0696 $9.9400264-3153-11-ceftriaxone1Soln J0696 CallforPrice00264-3153-11-ceftriaxone1gm/50mLIVSolduplex-00264-3153-11 J0696 CallforPrice00264-3155-11-cefTRIAXone2g/50mLSol J0696 CallforPrice00264-3155-11-ceftriaxone2Soln J0696 CallforPrice00338-5002-41-ceftriaxone1g/50mLSol J0696 CallforPrice00338-5002-41-ceftriaxone1g/50mLSol J0696 CallforPrice00338-5003-41-ceftriaxone2g/50mLSol J0696 CallforPrice00338-5003-41-ceftriaxone2g/50mLSol J0696 CallforPrice00409-7332-01-ceftriaxone1gPow J0696 CallforPrice00409-7332-01-ceftriaxone1gmInj-00409-7332-01 J0696 CallforPrice00409-7334-10-ceftriaxone10gPow J0696 CallforPrice00409-7334-10-ceftriaxone10gmRECInjection J0696 CallforPrice00409-7335-03-cefTRIAXone2gPow J0696 CallforPrice00409-7337-01-cefTRIAXone250mgInj-00409-7337-01 J0696 CallforPrice00409-7337-01-cefTRIAXone250mgPow J0696 CallforPrice00409-7338-01-ceftriaxone500mgPow J0696 CallforPrice00517-8711-10-ceftriaxone1gmInj-00517-8711-10 J0696 CallforPrice00517-8711-10-ceftriaxone1gmRECInjection J0696 CallforPrice00517-8725-10-ceftriaxone250mgInj-00517-8725-10 J0696 CallforPrice00517-8725-10-ceftriaxone250mgRECInjection J0696 CallforPrice00781-3206-85-ceftriaxone250mgPow J0696 CallforPrice00781-3206-95-ceftriaxone250mgInj-00781-3206-95 J0696 CallforPrice00781-3206-95-ceftriaxone250mgPow J0696 CallforPrice00781-3208-95-ceftriaxone1gPow J0696 CallforPrice00781-3209-95-cefTRIAXone2gPow J0696 CallforPrice10019-0685-01-ceftriaxone250mgInj-10019-0685-01 J0696 CallforPrice10019-0685-01-ceftriaxone250mgPow J0696 CallforPrice10019-0689-05-ceftriaxone10gPow J0696 CallforPrice25021-0106-10-cefTRIAXone1gmInj-25021-0106-10 J0696 CallforPrice25021-0108-99-ceftriaxone10gPow J0696 CallforPrice25021-0108-99-ceftriaxone10gPow J0696 CallforPrice54569-1802-01-ceftriaxone1gPow J0696 CallforPrice55390-0309-10-ceftriaxone250mgInj-55390-0309-10 J0696 CallforPrice55390-0309-10-ceftriaxone250mgPow J0696 CallforPrice55390-0311-10-ceftriaxone1gPow J0696 CallforPrice55390-0311-10-ceftriaxone1gmInj-55390-0311-10 J0696 CallforPrice
60505-0750-00-cefTRIAXone250mgPow J0696 CallforPrice60505-0750-04-cefTRIAXone250mgPow J0696 CallforPrice60505-0752-04-cefTRIAXone1gPow J0696 CallforPrice63323-0346-10-ceftriaxone1gPow J0696 CallforPrice63323-0346-10-ceftriaxone1gmInj-63323-0346-10 J0696 CallforPrice66860-0073-02-ceftriaxone1gPow J0696 CallforPriceA00781-3209-95-cefTRIAXone2gmSoln-Inj J0696 CallforPrice00039-0018-01-cefotaxime1gPowder-Inj J0698 CallforPrice00039-0018-10-cefotaxime1gmInj-00039-0018-10 J0698 CallforPrice00039-0018-10-cefotaxime1gmRECInjection J0698 CallforPrice00039-0019-10-cefotaxime2gmRECInjection J0698 CallforPrice00143-9931-22-cefotaxime1gPow J0698 CallforPrice00143-9931-22-cefotaxime1gmInj-00143-9931-22 J0698 CallforPrice00143-9931-25-cefotaxime1gPow J0698 CallforPrice00143-9931-91-cefotaxime1gPowder-Inj J0698 CallforPrice00143-9933-22-cefotaxime2gPow J0698 CallforPrice00143-9933-22-cefotaxime2gmPow J0698 CallforPriceJ0702Injection,betamethasoneacetate3mg&betamethasonesodiumphosp3mg J0702 $9.0300085-0566-01-betamethasone6mg/mLSusp-Inj J0702 CallforPrice00085-0566-05-betamethasoneSusp J0702 CallforPrice00085-0566-05-betamethasoneacetate-betamethasonesodiumphosphate3mg-3mgInjSusp5mL-00085 J0702 CallforPrice00517-0720-01-betamethasone6mg/mLSus J0702 CallforPrice00517-0720-01-betamethasoneacetate-betamethasonesodiumphosphate3mg-3mgInjSusp5mL-00517 J0702 CallforPrice25021-0602-03-caffeinecitrate20mg/mLLiq J0706 CallforPrice47335-0289-40-caffeinecitrate20mg/mLSol J0706 CallforPrice47335-0289-44-caffeinecitrate20mg/mLSoln-Inj J0706 CallforPrice55390-0357-03-caffeine60Soln J0706 CallforPrice55390-0358-03-caffeine60Liquid J0706 CallforPrice55390-0358-03-caffeinecitrate20mg/mLOralLiq3mL-55390-0358-03 J0706 CallforPrice63323-0407-03-caffeinecitrate20mg/mLSol J0706 CallforPrice00456-0600-10-ceftaroline600mgPow J0712 CallforPrice00173-0378-10-ceftazidime1gmRECInjection J0713 CallforPrice00173-0379-34-ceftazidime2gmRECInjection J0713 CallforPrice00173-0382-37-ceftazidime6gmRECInjection J0713 CallforPrice00264-3143-11-ceftazidime1gmSoln-IV J0713 CallforPrice00264-3145-11-ceftazidime2gmSoln-IV J0713 CallforPrice00409-5082-16-ceftazidime1gPow J0713 CallforPrice00409-5084-11-cefTAZidime2gPow J0713 CallforPrice00409-5086-11-ceftazidime6gPow J0713 CallforPrice24987-0379-34-cefTAZidime2gPow J0713 CallforPrice25021-0128-50-cefTAZidime2gPow J0713 CallforPrice44567-0235-25-cefTAZidime1gPow J0713 CallforPrice44567-0236-10-cefTAZidime2gPow J0713 CallforPrice60505-0679-05-ceftriaxone10gPow J0713 CallforPrice00052-0315-10-chorionicgonadotropin(HCG)10,000unitsIMInj-00052-0315-10 J0725 CallforPrice55566-1501-01-chorionicgonadotropin(HCG)10,000unitsIMInj-55566-1501-01 J0725 CallforPrice23155-0216-31-cidofovir75mg/mLSol J0740 CallforPrice61958-0101-01-cidofovir75mg/mLSol J0740 CallforPrice67457-0210-05-cidofovir75mg/mLSol J0740 CallforPrice00006-3516-59-imipenem-cilastatin500mg-500mgPow J0743 CallforPrice00409-3507-01-imipenem-cilastatin500mg-500mgPow J0743 CallforPriceInjection,ciprofloxacinforintravenousinfusion,200mg J0744 $6.03
00085-1762-01-ciprofloxacin400mg/200mL-5%Sol J0744 CallforPrice00085-1763-03-ciprofloxacin10mg/mLSol J0744 CallforPrice00409-4765-86-ciprofloxacin10mg/mLSol J0744 CallforPrice00409-4777-02-ciprofloxacin400mg/200mL-5%Sol J0744 CallforPrice00703-0956-03-ciprofloxacin200Soln J0744 CallforPrice00703-0958-01-ciprofloxacin10mg/mLSoln-IV J0744 CallforPrice00703-0958-03-ciprofloxacin400Soln J0744 CallforPrice00703-0960-36-ciprofloxacin400mg/200mL-5%Sol J0744 CallforPrice25021-0114-87-ciprofloxacin400Soln J0744 CallforPrice36000-0009-24-ciprofloxacin400mg/200mL-5%Sol J0744 CallforPriceA25021-0114-87-ciprofloxacin400mgSoln-IV J0744 CallforPrice42023-0107-06-colistimethate150mg(colistinbase)Pow J0770 CallforPrice63323-0393-06-colistimethate150mgPow J0770 CallforPrice66887-0003-01-collagenaseclostridiumhistolyticum0.9mgPow J0775 CallforPriceInjection,prochlorperazine,upto10mgIMIV J0780 $82.4423155-0294-42-prochlorperazine5mg/mLInjSol2mL-23155-0294-42 J0780 CallforPrice23155-0294-42-prochlorperazine5mg/mLSol J0780 CallforPrice55390-0077-10-prochlorperazine10Soln J0780 CallforPrice55390-0077-10-prochlorperazine5mg/mLInjSol2mL-55390-0077-10 J0780 CallforPriceCortrosynInjection0.25mgJ0834-InjMedicationCharge J0834 $571.55J0834Injection,cosyntropin(Cortrosyn),0.25mg J0834 $571.5500548-5900-00-cosyntropin0mgRECInjection J0834 CallforPrice00548-5900-00-cosyntropin0.25mgInj-00548-5900-00 J0834 CallforPrice44206-0532-11-cytomegalovirusimmuneglobulin50mg/mLSol J0850 CallforPrice67919-0011-01-daptomycin500mgRECInjection J0878 CallforPrice55513-0028-01-darbepoetin200mcg/0.4mLInjSyringe-55513-0028-01 J0881 CallforPrice55513-0028-01-darbepoetinalfa200Soln J0881 CallforPrice55513-0111-01-darbepoetin300mcg/0.6mLInjSyringe-55513-0111-01 J0881 CallforPrice55513-0111-01-darbepoetinalfa300Soln J0881 CallforPrice55513-0003-04-darbepoetin40mcg/mL1mLInj-55513-0003-04 J0882 CallforPrice55513-0004-04-darbepoetin60mcg/mL1mLInj-55513-0004-04 J0882 CallforPrice55513-0006-01-darbepoetin200mcg/mL1mLInj-55513-0006-01 J0882 CallforPrice55513-0025-04-darbepoetin100mcg/0.5mLInjSyringe-55513-0025-04 J0882 CallforPrice55513-0057-04-darbepoetin25mcg/0.4mLInjSyringe-55513-0057-04 J0882 CallforPriceBCEepoetinalfa,(fornon-esrduse),1000units J0885 $62.08Epoetin20,000unitsSQInj-InjMedicationCharge J0885 $4,618.0859676-0302-00-epoetinalfa2,000unit(s)/1mLSoln-Inj J0885 CallforPrice59676-0302-01-epoetinalfa2000Soln J0885 CallforPrice59676-0302-01-epoetinalfa2000units/mLInjSol1mL-59676-0302-01 J0885 CallforPrice59676-0303-00-epoetinalfa3000Soln J0885 CallforPrice59676-0303-01-epoetinalfa3000Soln J0885 CallforPrice59676-0303-01-epoetinalfa3000units/mLInjSol1mL-59676-0303-01 J0885 CallforPrice59676-0304-01-epoetinalfa4000Soln J0885 CallforPrice59676-0304-01-epoetinalfa4000units/mLInjSol1mL-59676-0304-01 J0885 CallforPrice59676-0310-00-epoetinalfa10,000unit(s)Soln-Inj J0885 CallforPrice59676-0310-01-epoetinalfa10,000units/mLInjSol1mL-59676-0310-01 J0885 CallforPrice59676-0310-01-epoetinalfa10000Soln J0885 CallforPrice59676-0320-00-epoetinalfa20,000unit(s)/1mLSoln-Inj J0885 CallforPrice59676-0320-04-epoetinalfa20,000units/mLInjSol1mL-59676-0320-04 J0885 CallforPrice59676-0320-04-epoetinalfa20000Soln J0885 CallforPrice59676-0340-00-epoetinalfa40,000unit(s)/1mLSoln-Inj J0885 CallforPrice59676-0340-01-epoetinalfa40,000units/mLInjSol1mL-59676-0340-01 J0885 CallforPrice
59676-0340-01-epoetinalfa40000Soln J0885 CallforPrice00409-2336-10-deferoxamine500mgPow J0895 CallforPrice00591-3974-04-deferoxamine500mgInj-00591-3974-04 J0895 CallforPrice00591-3974-04-deferoxamine500mgRECInjection J0895 CallforPrice00591-3974-06-deferoxamine500mgPowder-Inj J0895 CallforPrice63323-0599-30-deferoxamine2gPow J0895 CallforPriceDenosumab1mgSCJ0897 J0897 $70.4655513-0710-01-denosumab60mg/mLSol J0897 CallforPrice55513-0730-01-denosumab120mg/1.7mLSol J0897 CallforPrice55513-0730-01-denosumab120mg/1.7mLSol J0897 CallforPriceInjection,methylprednisoloneacetate,20mg J1020 $36.96DepoMedrol(40mg)J1030-InjMedicationCharge J1030 $12.95Depo-MedrolInjection40mg-OtherInjMedicationCharge J1030 $105.99Injection,methylprednisoloneacetate,40mg J1030 $71.6400009-3073-01-methylPREDNISoloneacetate40mg/mLInjSusp1mL-00009-3073-01 J1030 CallforPrice00009-3073-03-methylPREDNISolone40mg/mLSus J1030 CallforPrice00009-3073-03-methylPREDNISoloneacetate40mg/mLInjSusp1mL-00009-3073-03 J1030 CallforPriceDepoMedrol(80mg)J1040-InjMedicationCharge J1040 $105.84Depo-MedrolInjection80mg/mLJ1040-InjMedicationCharge J1040 $105.84Injection,depomedrolmethylprednisoloneacetate,80mg J1040 $105.84Injection,methylprednisoloneacetate,80mg J1040 $105.8400009-3475-01-methylPREDNISolone80mgSusp J1040 CallforPrice00009-3475-01-methylPREDNISoloneacetate80mg/mLInjSusp1mL-00009-3475-01 J1040 CallforPrice00009-3475-03-methylPREDNISolone80mg/mLSus J1040 CallforPrice00009-3475-03-methylPREDNISoloneacetate80mg/mLInjSusp1mL-00009-3475-03 J1040 CallforPriceA00009-3475-03-methylPREDNISoloneacetate80mg/mLSusp-Inj J1040 CallforPriceJ1050Injection,medroxyprogesteroneacetate,150mg J1050 $162.55Depo-ProveraInjection150mg/mLJ1050-InjMedicationCharge J1050 $162.55Injection,medroxyprogesteroneacetate,1mg J1050 $1.0800009-0746-30-medroxyPROGESTERone150mg/mLIMSusp1mL-00009-0746-30 J1050 CallforPrice00009-0746-30-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00009-0746-35-medroxyPROGESTERone150mg/mLIMSusp1mL-00009-0746-35 J1050 CallforPrice00009-0746-35-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00009-7376-04-medroxyPROGESTERone150mg/mLIMSusp1mL-00009-7376-04 J1050 CallforPrice00009-7376-04-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00009-7376-07-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00009-7376-07-medroxyPROGESTERone150mg/mLSusp-Inj J1050 CallforPrice00009-7376-11-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00009-7376-11-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00703-6801-01-medroxyPROGESTERone150mg/mLIMSusp1mL-00703-6801-01 J1050 CallforPrice00703-6801-04-medroxyPROGESTERone150mg/mLIMSusp1mL-00703-6801-04 J1050 CallforPrice00703-6801-04-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice59762-4537-01-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice59762-4537-01-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice59762-4538-01-medroxyPROGESTERone150mg/mLIMSusp1mL-59762-4538-01 J1050 CallforPrice59762-4538-02-medroxyPROGESTERone150mg/mLIMSusp1mL-59762-4538-02 J1050 CallforPrice59762-4538-09-medroxyPROGESTERone150mg/mLIMSusp1mL-59762-4538-09 J1050 CallforPrice59762-4538-09-medroxyPROGESTERone150mg/mLSus J1050 CallforPrice00703-6801-01-medroxyPROGESTERone150Susp J1055 CallforPriceJ1071Injection,testosteronecypionate,1mg J1071 $0.52TestosteroneCypionateInjection200mg/mL1mL-InjMedicationCharge J1071 $105.0200009-0417-01-testosterone200Soln J1071 CallforPrice
00574-0820-01-testosteronecypionate200mg/mLIMSol1mL-00574-0820-01 J1071 CallforPrice00574-0820-01-testosteronecypionate200mg/mLSol J1071 CallforPrice00703-6121-01-testosteronecypionate200mg/mLIMSol1mL-00703-6121-01 J1071 CallforPrice00703-6121-01-testosteronecypionate200mg/mLSol J1071 CallforPriceDecadronInjection4mg/mLJ1100-InjMedicationCharge J1094 $11.22Dexamethasoneacetate1mg J1094 $11.22DecadronInjection10mg/mLJ1100-InjMedicationCharge J1100 $8.24Injection,dexamethasonesodiumphosphate,1mg J1100 $5.3000517-4901-25-dexamethasone4Soln J1100 CallforPrice00517-4901-25-dexamethasone4mg/mLInjSol1mL-00517-4901-25 J1100 CallforPrice00641-0367-21-dexamethasone10Soln J1100 CallforPrice00641-0367-21-dexamethasone10mg/mLInjSol1mL-00641-0367-21 J1100 CallforPrice00641-0367-25-dexamethasone10mg/mLInjSol1mL-00641-0367-25 J1100 CallforPrice00641-0367-25-dexamethasone10mg/mLSol J1100 CallforPrice55390-0060-02-dexrazoxane500mgPow J1100 CallforPrice63323-0165-01-dexamethasone4mg/mLSol J1100 CallforPrice63323-0165-01-dexamethasone4mg/mLSol-63323-0165-01 J1100 CallforPrice63323-0165-05-dexamethasone4mg/mLSol J1100 CallforPrice63323-0165-30-dexamethasone4mg/mLSol J1100 CallforPrice63323-0506-01-dexamethasone10mg/mLPFInjSol1mL-63323-0506-01 J1100 CallforPrice63323-0506-01-dexamethasone10mg/mLpreservative-freeSol J1100 CallforPrice63323-0516-10-dexamethasone10mg/mLSol J1100 CallforPrice63323-0516-10-dexamethasone10mg/mLSol J1100 CallforPriceA00517-4901-25-dexamethasone4mg/mLSoln-Inj J1100 CallforPriceA77777-7777-18-dexamethasone4mg/mLSoln-Inj J1100 CallforPriceDHEInjection1mg/mLJ1110-InjMedicationCharge J1110 $176.10Injection,dihydroergotaminemesylate,per1mg J1110 $316.9700574-0850-05-dihydroergotamine1Soln J1110 CallforPrice00574-0850-05-dihydroergotamine1mg/mLInjSol1mL-00574-0850-05 J1110 CallforPrice55390-0013-10-dihydroergotamine1mg/mLInjSol1mL-55390-0013-10 J1110 CallforPrice66490-0041-01-dihydroergotamine1mg/mLSol J1110 CallforPrice39822-0190-01-acetaZOLAMIDE500mgPow J1120 CallforPrice55390-0460-01-acetaZOLAMIDE500mgRECInjection J1120 CallforPrice00173-0260-01-digoxin250mcg/mL(0.25mg/mL)Soln-Inj J1160 CallforPrice00173-0260-10-digoxin250mcg/mL(0.25mg/mL)InjSol2mL-00173-0260-10 J1160 CallforPrice00173-0260-10-digoxin500Soln J1160 CallforPrice00173-0262-10-digoxin100Soln J1160 CallforPrice00641-1410-31-digoxin250mcg/mL(0.25mg/mL)Sol J1160 CallforPrice00641-1410-35-digoxin250mcg/mL(0.25mg/mL)Sol J1160 CallforPrice00641-1410-35-digoxin250mcg/mL(0.25mg/mL)Sol J1160 CallforPrice24987-0260-10-digoxin250mcg/mL(0.25mg/mL)InjSol-24987-0260-10 J1160 CallforPrice24987-0260-10-digoxin250mcg/mL(0.25mg/mL)Sol J1160 CallforPrice70515-0260-10-digoxin250mcg/mL(0.25mg/mL)Sol J1160 CallforPrice00173-0230-44-digoxinimmuneFAB38mgRECInjection J1162 CallforPrice50633-0120-11-digoxinimmuneFAB40mgPow J1162 CallforPrice00641-2555-41-phenytoin50mg/mLSoln-Inj J1165 CallforPrice00641-2555-45-phenytoin250Soln J1165 CallforPrice39822-4050-03-phenytoin50mg/mLSol J1165 CallforPrice39822-4050-06-phenytoin50mg/mLSol J1165 CallforPriceHydromorphoneInjection2mg/mL-ExtraMedicationCharge J1170 $6.62Injection,hydromorphone,upto4mg J1170 $5.8100000-2341-01-HYDROmorphone2mg/mLSoln-Inj J1170 CallforPrice
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00548-5603-00-enoxaparin60mg/0.6mLSQSol-00548-5603-00 J1650 CallforPrice00548-5603-00-enoxaparin60mg/0.6mLSol J1650 CallforPrice00548-5604-00-enoxaparin80mg/0.8mLSoln-Inj J1650 CallforPrice00548-5605-00-enoxaparin100mg/1mLSoln-Inj J1650 CallforPrice00548-5605-00-enoxaparin100mg/mLSQSol1mL-00548-5605-00 J1650 CallforPrice00548-5606-00-enoxaparin120mg/0.8mLSoln-Inj J1650 CallforPrice00548-5606-00-enoxaparin120mg/0.8mLSQSol-00548-5606-00 J1650 CallforPrice00548-5607-00-enoxaparin150mg/mLSol J1650 CallforPrice00703-8530-23-enoxaparin30mg/0.3mLSol J1650 CallforPrice00781-3356-66-enoxaparin60mg/0.6mLSQSol-00781-3356-66 J1650 CallforPrice00781-3356-66-enoxaparin60mg/0.6mLSol J1650 CallforPrice00781-3428-68-enoxaparin80mg/0.8mLSQSol-00781-3428-68 J1650 CallforPrice00781-3428-68-enoxaparin80mg/0.8mLSol J1650 CallforPrice00781-3500-69-enoxaparin100mg/mLSQSol-00781-3500-69 J1650 CallforPrice00781-3500-69-enoxaparin100mg/mLSol J1650 CallforPrice00781-3612-68-enoxaparin120mg/0.8mLSQSol-00781-3612-68 J1650 CallforPrice00781-3612-68-enoxaparin120mg/0.8mLSol J1650 CallforPrice00955-1003-10-enoxaparin30mg/0.3mLSQSol-00955-1003-10 J1650 CallforPrice00955-1003-10-enoxaparin30mg/0.3mLSol J1650 CallforPrice00955-1004-10-enoxaparin40mg/0.4mLSQSol-00955-1004-10 J1650 CallforPrice00955-1004-10-enoxaparin40mg/0.4mLSol J1650 CallforPrice00955-1006-10-enoxaparin60mg/0.6mLSQSol-00955-1006-10 J1650 CallforPrice00955-1006-10-enoxaparin60mg/0.6mLSol J1650 CallforPrice00955-1008-10-enoxaparin80mg/0.8mLSQSol-00955-1008-10 J1650 CallforPrice00955-1008-10-enoxaparin80mg/0.8mLSol J1650 CallforPrice00955-1010-10-enoxaparin100mg/mLSQSol-00955-1010-10 J1650 CallforPrice00955-1010-10-enoxaparin100mg/mLSol J1650 CallforPrice00955-1012-10-enoxaparin120mg/0.8mLSQSol-00955-1012-10 J1650 CallforPrice00955-1012-10-enoxaparin120mg/0.8mLSol J1650 CallforPrice00955-1016-01-enoxaparin300mg/3mLSol J1650 CallforPrice62037-0866-20-enoxaparin150mg/mLSol J1650 CallforPrice63323-0568-87-enoxaparin40mg/0.4mLSol J1650 CallforPrice00007-3230-01-fondaparinux2.5mg/0.5mLSoln-Inj J1652 CallforPrice00007-3230-11-fondaparinux2Soln J1652 CallforPrice00007-3230-11-fondaparinux2.5mg/0.5mLSQSol-00007-3230-11 J1652 CallforPrice00007-3232-01-fondaparinux5mg/0.4mLSoln-Inj J1652 CallforPrice00007-3232-11-fondaparinux5Soln J1652 CallforPrice00007-3234-01-fondaparinux7.5mg/0.6mLSoln-Inj J1652 CallforPrice00007-3234-02-fondaparinux7.5mg/0.6mLSol J1652 CallforPrice00007-3234-11-fondaparinux1Soln J1652 CallforPrice00007-3234-11-fondaparinux7.5mg/0.6mLInjSol-00007-3234-11 J1652 CallforPrice00007-3236-01-fondaparinux10mgSoln-Inj J1652 CallforPrice00007-3236-02-fondaparinux10mg/0.8mLSol J1652 CallforPrice00007-3236-11-fondaparinux10Soln J1652 CallforPrice00007-3236-11-fondaparinux10mg/0.8mLSQSol-00007-3236-11 J1652 CallforPrice55111-0678-02-fondaparinux2.5mg/0.5mLSol J1652 CallforPrice55111-0679-02-fondaparinux5mg/0.4mLSQSol-55111-0679-02 J1652 CallforPrice55111-0679-02-fondaparinux5mg/0.4mLSol J1652 CallforPrice60505-6078-04-fondaparinux2.5mg/0.5mLSol J1652 CallforPrice60505-6079-04-fondaparinux5mg/0.4mLSol J1652 CallforPrice60505-6080-04-fondaparinux7.5mg/0.6mLSol J1652 CallforPrice67457-0582-10-fondaparinux2.5mg/0.5mLSol J1652 CallforPrice
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63323-0162-01-ketorolac30mg/mLSol J1885 CallforPrice64679-0758-01-ketorolac30mg/mLSol J1885 CallforPrice64679-0758-02-ketorolac30mg/mLSol J1885 CallforPrice64679-0758-06-ketorolac30mg/mLInjSol2mL-64679-0758-06 J1885 CallforPrice64679-0758-06-ketorolac30mg/mLSol J1885 CallforPrice69543-0386-25-ketorolac30mg/mLSol J1885 CallforPrice76045-0104-10-ketorolac30mg/mLSol J1885 CallforPriceA00409-3795-01-ketorolac30mg/mLSoln-Inj J1885 CallforPrice15054-0060-01-lanreotide60mg/0.2mLSol J1930 CallforPrice15054-0090-01-lanreotide90mg/0.3mLSol J1930 CallforPrice15054-0120-01-lanreotide120mg/0.5mLSol J1930 CallforPriceFurosemide10mg/mLInj4mL-InjMedicationCharge J1940 $6.98J1940Injection,furosemide,upto20mg J1940 $5.75FurosemideinjJ1940-MiscMedicationCharges J1940 $9.3500409-6102-02-furosemide10mg/mLInjSol2mL-00409-6102-02 J1940 CallforPrice00409-6102-02-furosemide10mg/mLSol J1940 CallforPrice00409-6102-02-furosemide10mg/mLSol J1940 CallforPrice00409-6102-10-furosemide10mg/mLInjSol10mL-00409-6102-10 J1940 CallforPrice00409-6102-10-furosemide100Soln J1940 CallforPrice00517-5702-25-furosemide10mg/mLInjSol2mL-00517-5702-25 J1940 CallforPrice00517-5702-25-furosemide10mg/mLInjSol2mL-00517-5702-25 J1940 CallforPrice00517-5702-25-furosemide20Soln J1940 CallforPrice00517-5710-25-furosemide10mg/mLSol J1940 CallforPrice36000-0284-25-furosemide10mg/mLSol J1940 CallforPrice63323-0280-02-furosemide10mg/mLSol J1940 CallforPrice63323-0280-04-furosemide10mg/mLSol J1940 CallforPriceA00409-6102-02-furosemide10mg/mLSoln-Inj J1940 CallforPrice50419-0150-01-lepirudin50mgSoln-Inj J1945 CallforPrice50419-0150-57-lepirudin50mgRECInjection J1945 CallforPriceJ1950Injection,leuprolideacetate(fordepotsuspension),per3.75mg J1950 $3,028.86J1950Leuprolideacetate(forDepotSuspension)3.75MGIM J1950 $3,028.86Leuprolide11.25mgIMInj-InjMedicationCharge J1950 $8,102.81Leuprolide22.5mgIMInj-InjMedicationCharge J1950 $9,655.64Leuprolide3.75mgIMInj-InjMedicationCharge J1950 $2,700.89Leuprolide30mgIMInj-InjMedicationCharge J1950 $12,476.08Leuprolide7.5mgIMInj-InjMedicationCharge J1950 $3,217.5400074-2282-03-leuprolide11.25mg/monthIMInj,ER-00074-2282-03 J1950 CallforPrice00074-3641-03-leuprolide3.75mg/monthIMInj,ER-00074-3641-03 J1950 CallforPrice00074-3641-03-leuprolide3.75mg/monthPWD J1950 CallforPrice00074-3663-03-leuprolide11.25mg/3monthsIMInj,ER-00074-3663-03 J1950 CallforPrice00074-3663-03-leuprolide11.25mg/3monthsPWD J1950 CallforPrice00300-3641-01-leuprolide3.75mg/monthIMInj,ER-00300-3641-01 J1950 CallforPrice00300-3663-01-leuprolide11.25mg/3monthsIMInj,ER-00300-3663-01 J1950 CallforPrice00409-6102-04-furosemide10mg/mLSol J1950 CallforPrice00143-9673-10-levETIRAcetam100mg/mLSol J1953 CallforPrice00409-1886-02-levETIRAcetam100mg/mLSol J1953 CallforPrice39822-4000-01-levETIRAcetam100mg/mLInj5mL-39822-4000-01 J1953 CallforPrice50474-0002-63-levetiracetam100mg/mLInj5mL-50474-0002-63 J1953 CallforPrice62756-0513-44-levetiracetam100mg/mLSol J1953 CallforPrice63323-0400-09-levETIRAcetam100mg/mLSol J1953 CallforPrice54482-0145-08-levocarnitine100mg/mLOralSol118mL-54482-0145-08 J1955 CallforPrice54482-0145-08-levocarnitine11800Soln J1955 CallforPrice
54482-0147-01-levocarnitine1000Soln J1955 CallforPriceLevofloxacin250mgIVPB-IVMedicationCharge J1956 $15.88Levofloxacin500mgIVPB100mL-IVMedicationCharge J1956 $26.5400045-0066-01-levofloxacin750Soln J1956 CallforPrice00045-0066-01-levofloxacin750mg/150mLIVSol-00045-0066-01 J1956 CallforPrice00045-0067-01-levofloxacin250Soln J1956 CallforPrice00045-0068-01-levofloxacin500Soln J1956 CallforPrice00045-0068-01-levofloxacin500mg/100mLIVSol100mL-00045-0068-01 J1956 CallforPrice00143-9721-01-levofloxacin500mg/100mLSol J1956 CallforPrice00781-3342-09-levofloxacin500mg/100mLSol J1956 CallforPrice00781-3342-46-levofloxacin750mg/150mLInjection J1956 CallforPrice00781-3343-09-levofloxacin750mg/150mLSol J1956 CallforPrice17478-0107-20-levofloxacin25mg/mLSol J1956 CallforPrice25021-0132-81-levofloxacin250mgSoln-IV J1956 CallforPrice25021-0132-82-levofloxacin500mg/100mLSol J1956 CallforPrice25021-0132-83-levofloxacin750mg/150mLSol J1956 CallforPrice50458-0164-20-levofloxacin500Soln J1956 CallforPrice50458-0166-01-levofloxacin750mg/150mLIVSol-50458-0166-01 J1956 CallforPrice50458-0166-01-levofloxacin750mg/150mLSol J1956 CallforPrice50458-0167-01-levofloxacin250mg/50mLSol J1956 CallforPrice50458-0168-01-levofloxacin500mg/100mLIVSol1mL-50458-0168-01 J1956 CallforPrice50458-0168-01-levofloxacin500mg/100mLIVSol100mL-50458-0168-01 J1956 CallforPrice50458-0168-01-levofloxacin500mg/100mLSol J1956 CallforPrice63323-0355-50-levofloxacin250mg/50mLSol J1956 CallforPrice63323-0355-65-levofloxacin500mg/100mLSol J1956 CallforPriceA50458-0168-01-levofloxacin500mgSoln-IV J1956 CallforPriceInjection,chlordiazepoxidehcl,upto100mg J1990 $4.81Injection,lidocaineHCLforintravenousinfusion,10mg J2001 $10.2500264-9594-10-lidocaine5%-0.4%Sol J2001 CallforPrice00338-0409-03-lidocaine0.4%-D5%Soln J2001 CallforPrice00338-0409-03-lidocaine0.4%-D5WInjSol500mL-00338-0409-03 J2001 CallforPrice63323-0486-27-lidocaine20mg/mLInjection J2001 CallforPrice63323-0491-50-lidocaine0.5%preservative-freeSol J2001 CallforPriceA00338-0409-03-lidocaine0.4%Soln-IV J2001 CallforPriceA00409-4903-34-lidocaine2%Soln-IV J2001 CallforPrice00009-5140-01-linezolid600Soln J2020 CallforPriceInjection,lorazepam,2mg J2060 $53.88Injection,lorazepam,2mg J2060 $53.88LorazepamInjection2mg/mL-ExtraMedicationCharge J2060 $54.6100409-1539-31-lorazepam4Soln J2060 CallforPrice00409-1985-05-lorazepam2mg/mLInjSol1mL-00409-1985-05 J2060 CallforPrice00409-1985-05-lorazepam2mg/mLSol J2060 CallforPrice00409-1985-30-lorazepam2Soln J2060 CallforPrice00409-1985-30-lorazepam2mg/mLInjSol1mL-00409-1985-30 J2060 CallforPrice00409-6778-02-lorazepam2mg/mLInjSol1mL-00409-6778-02 J2060 CallforPrice00409-6778-02-lorazepam2mg/mLSol J2060 CallforPrice00409-6780-02-LORazepam2mg/mLSol J2060 CallforPrice00641-6000-01-lorazepam2mg/mLSoln-Inj J2060 CallforPrice00641-6000-10-LORazepam2mg/mLSol J2060 CallforPrice00641-6001-25-LORazepam2mg/mLInjSol1mL-00641-6001-25 J2060 CallforPrice00641-6001-25-LORazepam2mg/mLSol J2060 CallforPrice00641-6046-01-lorazepam2mg/mLInjection J2060 CallforPrice
00641-6046-10-LORazepam2mg/mLSol J2060 CallforPrice10019-0102-10-lorazepam20Soln J2060 CallforPrice10019-0102-37-lorazepam2mg/mLSoln-Inj J2060 CallforPrice10019-0102-39-lorazepam2mg/mLSoln-Inj J2060 CallforPrice17478-0040-01-lorazepam2mg/mLInjSol1mL-17478-0040-01 J2060 CallforPrice17478-0040-01-lorazepam2mg/mLSol J2060 CallforPrice60977-0112-01-lorazepam2mg/mLInjSol1mL-60977-0112-01 J2060 CallforPrice60977-0112-01-lorazepam2mg/mLSol J2060 CallforPrice60977-0112-02-lorazepam2mg/mLSol J2060 CallforPrice60977-0112-81-lorazepam2mg/mLSol J2060 CallforPrice60977-0113-81-lorazepam4mg/mLSol J2060 CallforPrice61553-0411-39-lorazepam1mg/mLSoln-IV J2060 CallforPrice76329-8261-00-lorazepam2mg/mLSoln-Inj J2060 CallforPrice76329-8261-01-LORazepam2mg/mLSol J2060 CallforPriceA00409-6778-02-lorazepam2mg/mLSoln-Inj J2060 CallforPrice00409-4031-01-mannitol25%Sol J2150 CallforPrice00517-4050-25-mannitol25%IVSolPF50mL-00517-4050-25 J2150 CallforPrice00517-4050-25-mannitol25%Soln J2150 CallforPrice63323-0024-25-mannitol25%IVSolPF50mL-63323-0024-25 J2150 CallforPrice63323-0024-25-mannitol25%Sol J2150 CallforPriceDemerolInjection100mg/mLJ2175-InjMedicationCharge J2175 $18.04DemerolInjection25mg/mLJ2175-InjMedicationCharge J2175 $18.15DemerolInjection50mg/mLJ2175-InjMedicationCharge J2175 $20.11Injection,meperidinehydrochloride,per100mg J2175 $55.44Injection,meperidinehydrochloride,per100mg J2175 $55.4400409-1176-30-meperidine25Soln J2175 CallforPrice00409-1176-30-meperidine25mg/mLInjSol1mL-00409-1176-30 J2175 CallforPrice00409-1178-30-meperidine50Soln J2175 CallforPrice00409-1178-30-meperidine50mg/mLInjSol1mL-00409-1178-30 J2175 CallforPrice00409-1179-30-meperidine75Soln J2175 CallforPrice00409-1179-30-meperidine75mg/mLInjSol1mL-00409-1179-30 J2175 CallforPrice00409-1180-69-meperidine100Soln J2175 CallforPrice00409-1180-69-meperidine100mg/mLInjSol1mL-00409-1180-69 J2175 CallforPrice00409-6030-04-meperidine300Soln J2175 CallforPriceA00409-1176-30-meperidine25mg/mLSoln-Inj J2175 CallforPrice00310-0321-30-meropenem1gmRECInjection J2185 CallforPrice00310-0325-20-meropenem500mgRECInjection J2185 CallforPrice63323-0507-20-meropenem500mgPow J2185 CallforPrice63323-0508-30-meropenem1000mgPow J2185 CallforPriceMethylergonovine0.2mgInj1mL-InjMedicationCharge J2210 $17.2500078-0053-03-methylergonovine0Soln J2210 CallforPrice00078-0053-03-methylergonovine0.2mg/mLInjSol1mL-00078-0053-03 J2210 CallforPrice00078-0053-61-methylergonovine0Soln J2210 CallforPrice00517-0740-01-methylergonovine0.2mg/mLInjection J2210 CallforPrice00517-0740-20-methylergonovine0.2mg/mLInjSol1mL-00517-0740-20 J2210 CallforPrice00517-0740-20-methylergonovine0.2mg/mLSol J2210 CallforPrice17478-0501-01-methylergonovine0.2mg/mLInjSol1mL-17478-0501-01 J2210 CallforPrice17478-0501-01-methylergonovine0.2mg/mLSol J2210 CallforPrice51991-0144-17-methylergonovine0.2mg/mLInjSol1mL J2210 CallforPriceA00078-0053-03-methylergonovine0.2mg/mLSoln-Inj J2210 CallforPrice65649-0551-02-methylnaltrexone12mg/0.6mLSCSol-65649-0551-02 J2212 CallforPrice65649-0551-02-methylnaltrexone12mg/0.6mLSol J2212 CallforPrice
65649-0551-03-methylnaltrexone12mg/0.6mLSCSol-65649-0551-03 J2212 CallforPrice65649-0551-03-methylnaltrexone12mg/0.6mLSol J2212 CallforPrice65649-0551-07-methylnaltrexone12mg/0.6mLSCSol-65649-0551-07 J2212 CallforPrice65649-0551-07-methylnaltrexone12mg/0.6mLSol J2212 CallforPrice00469-3250-10-micafungin50mgPow J2248 CallforPriceMidazolam5mg/mLInj2mL-InjMedicationCharge J2250 $10.89MidazolamInjection2mg/2mL-ExtraMedicationCharge J2250 $2.2400409-2305-02-midazolam1mg/mLpreservative-freeInjSol2mL-00409-2305-02 J2250 CallforPrice00409-2305-02-midazolam1mg/mLpreservative-freeSol J2250 CallforPrice00409-2305-05-midazolam1mg/mLPFInjSol5mL-00409-2305-05 J2250 CallforPrice00409-2305-17-midazolam1mg/mLpreservative-freeInjSol2mL-00409-2305-17 J2250 CallforPrice00409-2305-17-midazolam1mg/mLpreservative-freeSol J2250 CallforPrice00409-2308-01-midazolam5mg/mLPFInjSol-00409-2308-01 J2250 CallforPrice00409-2308-01-midazolam5mg/mLpreservative-freeSol J2250 CallforPrice00409-2596-05-midazolam5mg/mLSol J2250 CallforPrice00641-6057-01-midazolam1mg/mLSoln-Inj J2250 CallforPrice00641-6057-10-midazolam1mg/mLInjSol2mL-00641-6057-10 J2250 CallforPrice00641-6057-10-midazolam1mg/mLSol J2250 CallforPrice00641-6057-25-midazolam1mg/mLInjSol2mL-00641-6057-25 J2250 CallforPrice00641-6057-25-midazolam1mg/mLSoln-IV J2250 CallforPrice00641-6059-10-midazolam1mg/mLInjSol5mL-00641-6059-10 J2250 CallforPrice00641-6059-10-midazolam1mg/mLSol J2250 CallforPrice00641-6060-10-midazolam5mg/mLSol J2250 CallforPrice00641-6061-10-midazolam5mg/mLInjSol1mL-00641-6061-10 J2250 CallforPrice00641-6063-10-midazolam5mg/mLSoln-Inj J2250 CallforPrice00641-6063-25-midazolam5mg/mLSol J2250 CallforPrice00641-6063-25-midazolam5mg/mLSoln-Inj J2250 CallforPrice10019-0027-01-midazolam5Soln J2250 CallforPrice10019-0027-06-midazolam5mg/mLInjSol1mL-10019-0027-06 J2250 CallforPrice10019-0027-06-midazolam5mg/mLSol J2250 CallforPrice10019-0027-08-midazolam5mg/mLSol J2250 CallforPrice10019-0027-10-midazolam50Soln J2250 CallforPrice10019-0027-39-midazolam5Soln J2250 CallforPrice10019-0027-39-midazolam5mg/mLSoln-Inj J2250 CallforPrice10019-0027-59-midazolam5mg/mLSoln-Inj J2250 CallforPrice10019-0028-03-midazolam1mg/mLInjSol2mL-10019-0028-03 J2250 CallforPrice55390-0126-05-midazolam25Soln J2250 CallforPrice55390-0126-10-midazolam5mg/mLSol J2250 CallforPrice55390-0137-02-midazolam1mg/mLpreservative-freeInjSol2mL-55390-0137-02 J2250 CallforPrice55390-0137-02-midazolam2Soln J2250 CallforPrice55390-0137-05-midazolam1mg/mLpreservative-freeInjSol5mL-55390-0137-05 J2250 CallforPrice55390-0137-05-midazolam1mg/mLpreservative-freeSol J2250 CallforPrice55390-0138-02-midazolam10Soln J2250 CallforPrice61553-0100-96-midazolam0.5mg/mLSoln-IV J2250 CallforPrice61553-0292-02-midazolam1mg/mLSoln-IV J2250 CallforPrice63323-0411-12-midazolam1mg/mLSol J2250 CallforPrice63323-0412-02-midazolam10Soln J2250 CallforPrice63323-0412-10-midazolam5mg/mLSol J2250 CallforPrice68094-0716-59-midazolam2mg/mLSyr J2250 CallforPrice99999-9999-64-midazolam0.5mg/mLSoln-IV J2250 CallforPriceA63323-0411-12-midazolam1mg/mLSoln-Inj J2250 CallforPrice00143-9708-01-milrinone1mg/mLSol J2260 CallforPrice
00143-9719-10-milrinone200mcg/mL-D5%Sol J2260 CallforPrice00338-6010-48-milrinone200mcg/mL-D5%Sol J2260 CallforPrice00409-2776-23-milrinone20mg/100mL-D5%20Soln J2260 CallforPrice10019-0070-02-milrinone20Soln J2260 CallforPrice55390-0019-10-milrinone10Soln J2260 CallforPrice55390-0078-01-milrinone200mcg/mL-D5%Sol J2260 CallforPriceInjection,morphinesulfate,upto10mg J2270 $50.27Injection,morphinesulfate,upto10mg J2270 $50.27Morphine10mg/1mLIVP-IVPMedicationCharge J2270 $50.27Morphine4mgIMInj-InjMedicationCharge J2270 $4.55MorphineInjection10mg/mLJ2270-InjMedicationCharge J2270 $50.27MorphineInjection2mg/mLJ2270-InjMedicationCharge J2270 $50.2700409-1134-03-morphine1000Soln J2270 CallforPrice00409-1134-05-morphine2500Soln J2270 CallforPrice00409-1135-02-morphine25mg/mLpreservative-freeSol J2270 CallforPrice00409-1258-30-morphine4Soln J2270 CallforPrice00409-1258-30-morphine4mg/mLInjSol1mL-00409-1258-30 J2270 CallforPrice00409-1261-30-morphine10Soln J2270 CallforPrice00409-1261-30-morphine10mg/mLInjSol1mL-00409-1261-30 J2270 CallforPrice00409-1762-30-morphine2Soln J2270 CallforPrice00409-1762-30-morphine2mg/mLInjSol1mL-00409-1762-30 J2270 CallforPrice00409-1890-01-morphine2mg/mLInjSol1mL-00409-1890-01 J2270 CallforPrice00409-1890-01-morphine2mg/mLSol J2270 CallforPrice00409-1891-01-morphine4mg/mLInjSol1mL-00409-1891-01 J2270 CallforPrice00409-1891-01-morphine4mg/mLSol J2270 CallforPrice00409-1893-01-morphine10mg/mLInjSol1mL-00409-1893-01 J2270 CallforPrice00409-1893-01-morphine10mg/mLSol J2270 CallforPrice00409-2029-02-morphine30Soln J2270 CallforPrice00641-6070-25-morphine10mg/mLInjSol1mL-00641-6070-25 J2270 CallforPrice00641-6070-25-morphine10mg/mLInjection J2270 CallforPrice00641-6073-25-morphine5mg/mLSol J2270 CallforPrice00641-6125-25-morphine4mg/mLpreservative-freeSol J2270 CallforPrice00641-6127-25-morphine10mg/mLSoln-Inj J2270 CallforPrice00641-6127-25-morphine10mg/mLSoln-Inj J2270 CallforPrice10019-0178-36-morphine10mg/mLSoln-Inj J2270 CallforPrice10019-0178-39-morphine10mg/mLSoln-Inj J2270 CallforPrice10019-0178-44-morphine10mg/mLInjSol1mL-10019-0178-44 J2270 CallforPrice10019-0178-44-morphine10mg/mLSol J2270 CallforPrice10019-0178-62-morphine100Soln J2270 CallforPrice60977-0017-73-morphine10Soln J2270 CallforPrice61553-0648-44-morphine2mg/mL-NaCl0.9%Sol J2270 CallforPrice68094-0001-62-morphine10mg/5mLSol J2270 CallforPrice76045-0004-10-morphine2mg/mLpreservative-freeSol J2270 CallforPrice76045-0005-10-morphine4mg/mLpreservative-freeSol J2270 CallforPrice76045-0008-10-morphine10mg/mLpreservative-freeSol J2270 CallforPriceA60977-0017-01-morphine1mg/mLSoln-Inj J2270 CallforPrice00409-3814-12-morphine0.5mg/mLpreservative-freeSol J2274 CallforPrice00641-6019-10-morphine1mg/mLpreservative-freeSol J2274 CallforPrice00641-6020-10-morphine0.5mg/mLpreservative-freeSol J2274 CallforPrice00641-6040-01-morphine25mg/mLpreservative-freeSol J2274 CallforPrice60977-0017-01-morphine10Soln J2274 CallforPrice60977-0115-74-morphine25mg/mLpreservative-freeSol J2274 CallforPrice
63323-0292-80-morphine1mg/mLPFInjSol2mL J2274 CallforPrice00085-1737-01-moxifloxacin400mg/250mLSol J2280 CallforPrice00409-1463-01-nalbuphine10Soln J2300 CallforPriceA00409-1463-01-nalbuphine10mg/mLSoln-Inj J2300 CallforPriceInjection,naloxonehydrochloride,per1mg J2310 $35.86NarcanInjection0.4mg/mlJ2310-InjMedicationCharge J2310 $31.37NarcanInjection1mg/mlJ2310-InjMedicationCharge J2310 $78.4200409-1212-01-naloxone0Soln J2310 CallforPrice00409-1212-01-naloxone0.4mg/mLInjSol1mL-00409-1212-01 J2310 CallforPrice00409-1215-01-naloxone0.4mg/mLInjSol1mL-00409-1215-01 J2310 CallforPrice00409-1215-01-naloxone0.4mg/mLSol J2310 CallforPrice00548-1469-00-naloxone1mg/mLInjSol2mL-00548-1469-00 J2310 CallforPrice00548-1469-00-naloxone1mg/mLSol J2310 CallforPrice00548-3369-00-naloxone1mg/mLInjSol2mL-00548-3369-00 J2310 CallforPrice00548-3369-00-naloxone2Soln J2310 CallforPrice67457-0292-02-naloxone0.4mg/mLInjSol1mL-67457-0292-02 J2310 CallforPrice67457-0292-02-naloxone0.4mg/mLSol J2310 CallforPrice76329-1469-01-naloxone1mg/mLInjSol2mL-76329-1469-01 J2310 CallforPrice76329-1469-05-naloxone1mg/mLInjSol-76329-1469-05 J2310 CallforPrice76329-3369-01-naloxone1mg/mLInjSol2mL-76329-3369-01 J2310 CallforPrice76329-3369-01-naloxone1mg/mLSol J2310 CallforPriceA00409-1215-01-naloxone0.4mg/mLSoln-Inj J2310 CallforPriceBCEnaltrexone380mgPWD J2315 $4.65J2315-Naltrexone J2315 $4.61Naltrexone380mgIMInj-InjMedicationCharge J2315 $1,766.07naltrexoneInj380mg J2315 $1,754.90naltrexoneInj380mg J2315 $1,754.9065757-0300-01-naltrexone380mgPWD J2315 CallforPrice65757-0300-01-naltrexone380mg/mL1mLERInj-65757-0300-01 J2315 CallforPrice59075-0730-15-natalizumab300Conc J2323 CallforPrice64406-0008-01-natalizumab300mg/15mLSoln-IV J2323 CallforPrice65847-0205-25-nesiritide2mgRECInjection J2325 CallforPrice50242-0150-01-ocrelizumab300mg/10mLSol J2350 CallforPrice00078-0341-61-octreotide20mgIMInj-00078-0341-61 J2353 CallforPrice00078-0341-61-octreotide20mgRECInjection J2353 CallforPrice00078-0342-61-octreotide30mgRECInjection J2353 CallforPrice00078-0818-81-octreotide20mgIMInj-00078-0818-81 J2353 CallforPrice00078-0825-81-octreotide30mgPow J2353 CallforPrice25021-0452-01-octreotide100mcg/mLSol J2353 CallforPrice00078-0181-01-octreotide100mcg/mLSol J2354 CallforPrice00078-0183-25-octreotide200mcg/mLSol J2354 CallforPrice25021-0453-01-octreotide500mcg/mLSol J2354 CallforPrice25021-0454-05-octreotide200mcg/mLSol J2354 CallforPrice55390-0162-10-octreotide500mcg/mLSol J2354 CallforPrice55390-0163-01-octreotide1000Soln J2354 CallforPrice55390-0163-01-octreotide200mcg/mLInjSol5mL-55390-0163-01 J2354 CallforPrice62756-0349-44-octreotide100Soln J2354 CallforPrice62756-0350-40-octreotide200mcg/mLSol J2354 CallforPrice63323-0378-05-octreotide200mcg/mLInjSol5mL-63323-0378-05 J2354 CallforPrice63323-0378-05-octreotide200mcg/mLSoln J2354 CallforPriceInjection,omalizumab,5mg J2357 $132.3750242-0040-62-omalizumab150mgRECInjection J2357 CallforPrice
50242-0040-62-omalizumab150mgSQInj-50242-0040-62 J2357 CallforPrice00002-7597-01-OLANZapine10mgPow J2358 CallforPrice00517-0405-25-phenylephrine10mg/mLSol J2370 CallforPrice00641-6142-01-phenylephrine10mg/mLSoln-Inj J2370 CallforPrice00641-6142-25-phenylephrine10mg/mLInjSol-00641-6142-25 J2370 CallforPrice00641-6142-25-phenylephrine10mg/mLSol J2370 CallforPrice00703-1631-04-phenylephrine10mg/mLInjSol1mL-00703-1631-04 J2370 CallforPrice00703-1631-04-phenylephrine10mg/mLSol J2370 CallforPrice10019-0163-01-phenylephrine50Soln J2370 CallforPrice10019-0163-02-phenylephrine50Soln J2370 CallforPrice10019-0163-05-phenylephrine10mg/mLSoln-Inj J2370 CallforPrice10019-0163-05-phenylephrine10mg/mLSoln-Inj J2370 CallforPrice10019-0163-12-phenylephrine10Soln J2370 CallforPrice10019-0163-12-phenylephrine10mg/mLInjSol1mL-10019-0163-12 J2370 CallforPrice10019-0163-39-phenylephrine10mg/mLSoln-Inj J2370 CallforPrice61553-0307-72-Phenylephrine1mg/10mL-NaCl0.9%Sol-UDINJ J2370 CallforPrice66758-0016-03-phenylephrine10mg/mLSoln-Inj J2370 CallforPrice63323-0478-20-chloroprocaineSoln J2400 CallforPrice63323-0478-27-chloroprocaine3%preservative-freeSol J2400 CallforPriceInjection,ondansetronhydrochloride,per1mg J2405 $19.23ZofranInjection2mg/mlJ2405-InjMedicationCharge J2405 $9.0400143-9891-05-ondansetron2mg/mLInjSol2mL-00143-9891-05 J2405 CallforPrice00143-9891-05-ondansetron2mg/mLSol J2405 CallforPrice00409-1120-62-ondansetron2mg/mLInjSol2mL-00409-1120-62 J2405 CallforPrice00409-1120-62-ondansetron2mg/mLSol J2405 CallforPrice00409-4755-03-ondansetron2mg/mLInjSol2mL-00409-4755-03 J2405 CallforPrice00409-4755-03-ondansetron2mg/mLSol J2405 CallforPrice00641-6078-25-ondansetron2mg/mLSol J2405 CallforPrice00703-7221-04-ondansetron2mg/mLSol J2405 CallforPrice00781-3010-95-ondansetron2mg/mLSol J2405 CallforPrice23155-0196-42-ondansetron2mg/mLSol J2405 CallforPrice23155-0196-42-ondansetron2mg/mLSol J2405 CallforPrice23155-0196-43-ondansetron2mg/mLInjSol2mL-23155-0196-43 J2405 CallforPrice23155-0196-43-ondansetron4mgSoln-Inj J2405 CallforPrice23155-0547-41-Ondansetron2mg/mLInjSol-23155-0547-41 J2405 CallforPrice36000-0012-25-ondansetron2mg/mLSol J2405 CallforPrice55150-0125-02-ondansetron2mg/mLSol J2405 CallforPrice60505-6130-05-ondansetron2mg/mLSol J2405 CallforPrice63323-0373-02-ondansetron2mg/mLInjSol2mL-63323-0373-02 J2405 CallforPrice63323-0373-02-ondansetron4Soln J2405 CallforPrice64679-0726-01-ondansetron2mg/mLSol J2405 CallforPrice76045-0103-20-ondansetron2mg/mLSol J2405 CallforPriceA63323-0373-02-ondansetron2mg/mLSoln-Inj J2405 CallforPrice50458-0562-01-paliperidone117mg/0.75mLSus J2426 CallforPrice50458-0563-01-paliperidone156mg/mLSus J2426 CallforPrice50458-0563-01-paliperidone156mg/mLSus J2426 CallforPrice25021-0803-10-pamidronate9mg/mLSol J2430 CallforPrice55390-0129-01-pamidronate90mgRECInjection J2430 CallforPrice61703-0326-18-pamidronate9mg/mLSol J2430 CallforPrice63323-0735-10-pamidronate9mg/mLSol J2430 CallforPrice00517-4002-25-papaverine30mg/mLSol J2440 CallforPrice00517-4010-01-papaverine300Soln J2440 CallforPrice
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00641-1495-35-promethazine25mg/mLInjSol-00641-1495-35 J2550 CallforPrice00641-1495-35-promethazine25mg/mLSol J2550 CallforPrice00703-2191-04-promethazine25mg/mLInjSol-00703-2191-04 J2550 CallforPrice00703-2191-04-promethazine25mg/mLSol J2550 CallforPrice39822-5500-03-promethazine25mg/mLInjSol1mL39822-5500-03 J2550 CallforPrice00409-2349-31-phenobarbital130mg/mLInjSol1mL-00409-2349-31 J2560 CallforPrice00409-2349-31-phenobarbital130mg/mLSol J2560 CallforPrice00641-0476-21-phenobarbital65Soln J2560 CallforPrice00641-0476-25-phenobarbital65Soln J2560 CallforPrice00641-0477-21-phenobarbital130Soln J2560 CallforPrice00641-0477-25-phenobarbital130mg/mLInjSol1mL-00641-0477-25 J2560 CallforPrice00641-0477-25-phenobarbital130mg/mLSol J2560 CallforPrice42023-0116-25-oxytocin10intlunits/mLInjSol1mL-42023-0116-25 J2590 CallforPrice61553-0735-03-oxytocin30Soln J2590 CallforPrice63323-0012-01-oxytocin10intlunits/mLInjSol1mL J2590 CallforPrice63323-0012-01-oxytocin10intlunits/mLInjSol1mL-63323-0012-01 J2590 CallforPrice63323-0012-10-oxytocin10units/mLSol J2590 CallforPrice71019-0253-01-oxytocin30units/500mL-0.9%Soln-IV J2590 CallforPrice00075-2451-01-desmopressin4mcg/mLIVSol1ml-00075-2451-01 J2597 CallforPrice00075-2451-01-desmopressin4mcg/mLSol J2597 CallforPrice00409-2265-01-desmopressin4Soln J2597 CallforPrice00409-2265-01-desmopressin4mcg/mLIVSol1ml-00409-2265-01 J2597 CallforPrice55566-2200-00-desmopressin4mcg/mLInjection J2597 CallforPrice55566-2200-00-desmopressin4mcg/mLSoln-Inj J2597 CallforPrice55566-5030-00-desmopressin4mcg/mLSoln-Inj J2597 CallforPrice55566-5030-01-desmopressin4mcg/mLIVSol1ml-55566-5030-01 J2597 CallforPrice55566-5030-01-desmopressin4mcg/mLSol J2597 CallforPrice55566-5040-01-desmopressin4mcg/mLSol J2597 CallforPriceFluphenazineDecanoate25mg/mLInj5mL-InjMedicationCharge J2680 $41.55Injection,fluphenazinedecanoate,upto25mg J2680 $65.0442023-0129-01-fluPHENAZinedecanoate25mg/mLInjSol5mL-42023-0129-01 J2680 CallforPrice63323-0272-05-fluphenazine125Soln J2680 CallforPrice63323-0272-05-fluphenazinedecanoate25mg/mLInjSol5mL-63323-0272-05 J2680 CallforPrice00409-1902-01-procainamide100mg/mLInjSol10mL-00409-1902-01 J2690 CallforPrice00409-1902-01-procainamide1000Soln J2690 CallforPriceA00409-1902-01-procainamide100mg/mLSoln-IV J2690 CallforPrice00000-0269-10-propofol10mg/mLEmulsion J2704 CallforPrice00409-4699-24-propofol10mg/mLEmu J2704 CallforPrice00409-4699-24-propofol10mg/mLIVEmul100mL-00409-4699-24 J2704 CallforPrice00703-2859-03-propofol10mg/mLEmu J2704 CallforPrice00703-2859-03-propofol10mg/mLIVEmul100mL-00703-2859-03 J2704 CallforPrice25021-0608-20-propofol10mg/mLEmu J2704 CallforPrice63323-0269-20-propofol10mg/mLEmu J2704 CallforPrice63323-0269-29-propofol10mg/mLIVEmul20mL-63323-0269-29 J2704 CallforPrice63323-0269-29-propofol10mg/mLInjection J2704 CallforPrice63323-0269-50-propofol500Emulsion J2704 CallforPrice63323-0269-65-propofol10mg/mLIVEmul100mL-63323-0269-65 J2704 CallforPrice63323-0269-65-propofol1000Emulsion J2704 CallforPrice63323-0270-25-propofol10mg/mLIVEmul20mL-63323-0270-25 J2704 CallforPrice63323-0270-65-propofol10mg/mLEmu J2704 CallforPrice63323-0270-65-propofol10mg/mLEmu J2704 CallforPriceA63323-0269-20-propofol10mg/mLInjection J2704 CallforPrice
00641-6077-01-neostigmine1mg/mLSoln-Inj J2710 CallforPrice10019-0270-39-neostigmine1mg/mLSoln-Inj J2710 CallforPrice63323-0383-10-neostigmine1mg/mLSol J2710 CallforPrice76014-0003-10-neostigmine1mg/mLSoln-Inj J2710 CallforPrice63323-0229-05-protamine50Soln J2720 CallforPrice63323-0229-30-protamine250Soln J2720 CallforPriceA63323-0229-05-protamine10mg/mLSoln-IV J2720 CallforPrice60977-0141-01-pralidoxime1gmIVInj-60977-0141-01 J2730 CallforPrice60977-0141-01-pralidoxime1gmRECInjection J2730 CallforPrice60977-0141-27-pralidoxime1gPow J2730 CallforPrice55390-0113-01-phentolamine5mgRECInjection J2760 CallforPriceInjection,metoclopramidehcl,upto10mg J2765 $2.50Reglan10mgtab-POMedicationCharge J2765 $44.90ReglanInjection5mg/mLJ2765-InjMedicationCharge J2765 $44.9000409-3414-01-metoclopramide10Soln J2765 CallforPrice00409-3414-01-metoclopramide5mg/mLInjSol2mL-00409-3414-01 J2765 CallforPrice00703-4502-04-metoclopramide5mg/mLSol J2765 CallforPrice10019-0450-02-metoclopramide5mg/mLInjSol2mL-10019-0450-02 J2765 CallforPrice10019-0450-02-metoclopramide5mg/mLSol J2765 CallforPrice10019-0450-39-metoclopramide5mg/mLSoln-Inj J2765 CallforPriceA00409-3414-01-metoclopramide5mg/mLSoln-Inj J2765 CallforPriceInjection,ranitidinehydrochloride,25mg J2780 $32.5700173-0362-38-ranitidine25mg/mLSol J2780 CallforPrice00173-0363-00-ranitidine25mg/mLSol J2780 CallforPrice00173-0441-00-ranitidine1mg/mLIVSol50mL-00173-0441-00 J2780 CallforPrice00173-0441-00-ranitidine50Soln J2780 CallforPrice24987-0362-10-ranitidine25mg/mLSol J2780 CallforPrice55390-0616-01-ranitidine150Soln J2780 CallforPrice55390-0616-10-ranitidine50Soln J2780 CallforPrice55390-0618-01-ranitidine25mg/mLSol J2780 CallforPrice68382-0422-02-ranitidine25mg/mLSol J2780 CallforPrice68382-0423-06-ranitidine25mg/mLSol J2780 CallforPrice00024-5150-10-rasburicase1.5mgPow J2783 CallforPrice00024-5151-75-rasburicase7.5mgPow J2783 CallforPriceRHo(D)ImmuneGlobulinInjection300mcg-InjMedicationCharge J2790 $505.1300562-7805-01-RHo(D)immuneglobulin300mcgInjSol(1500IU)Syringe-00562-7805-01 J2790 CallforPrice00562-7805-01-RHo(D)immuneglobulin300mcg/mLSol J2790 CallforPrice00562-7805-05-RHo(D)immuneglobulin300mcgSol J2790 CallforPrice00944-2967-05-RHo(D)immuneglobulin5000intlunits J2792 CallforPrice13533-0631-06-RHo(D)immuneglobulin250intlunitsSol J2792 CallforPrice53270-3100-01-RHo(D)immuneglobulin5000intlunits/4.4mLSol J2792 CallforPriceRisperidoneERInj50mg-InjMedicationCharge J2794 $1,094.2750458-0306-11-risperiDONE25mg/2mLUDINJ J2794 CallforPrice50458-0306-11-risperidone25mg/2weeksIMInj,ER-50458-0306-11 J2794 CallforPrice50458-0307-11-risperiDONE37.5mg/2weeksPWD J2794 CallforPrice50458-0307-11-risperidone37.5mg/2weeksIMInj,ER-50458-0307-11 J2794 CallforPrice50458-0308-11-risperiDONE50mg/2weeksPWD J2794 CallforPrice50458-0308-11-risperidone50mg/2weeksIMInj,ER-50458-0308-11 J2794 CallforPrice25021-0652-31-ropivacaine0.5%Sol J2795 CallforPrice63323-0285-64-ropivacaine0.2%Sol J2795 CallforPrice63323-0286-23-ropivacaine0.5%Sol J2795 CallforPrice63323-0286-30-ropivacaine0.5%Sol J2795 CallforPrice
63323-0286-31-ropivacaine0.5%Sol J2795 CallforPriceA63323-0286-23-ropivacaine0.5%Soln-Inj J2795 CallforPrice55513-0221-01-romiPLOStim250mcgPow J2796 CallforPrice55513-0222-01-romiPLOStim500mcgPow J2796 CallforPrice00641-6103-25-methocarbamol100mg/mLSol J2800 CallforPrice60977-0150-01-methocarbamol1000Soln J2800 CallforPrice67457-0273-10-methocarbamol100mg/mLSol J2800 CallforPrice00270-0556-15-sincalide5mcgRECInjection J2805 CallforPrice00264-9954-10-theophylline400mgSoln-IV J2810 CallforPriceInjection,methylprednisolonesodiumsuccinate,upto40mg J2920 $14.52Solu-MedrolInjection40mg-OtherInjMedicationCharge J2920 $54.0900009-0039-28-methylPREDNISolone40mgRECInjection J2920 CallforPrice00009-0039-28-methylPREDNISolonesodiumsuccinate40mgInj-00009-0039-28 J2920 CallforPrice00009-0039-30-methylPREDNISolone40mgPowder-Inj J2920 CallforPrice00009-0113-19-methylPREDNISolone40mgPow J2920 CallforPrice00009-0113-19-methylPREDNISolonesodiumsuccinate40mgInj-00009-0113-19 J2920 CallforPriceInjection,methylprednisolonesodiumsuccinate,upto125mg J2930 $59.27MethylprednisoloneSodiumSuccinate1gmIVPB-IVMedicationCharge J2930 $68.04Solu-MedrolInjection125mg-InjMedicationCharge J2930 $23.38Solu-MedrolInjection125mg-OtherInjMedicationCharge J2930 $59.2700009-0047-22-methylPREDNISolone125mgpreservative-freePow J2930 CallforPrice00009-0047-22-methylPREDNISolonesodiumsuccinate125mgPFInj J2930 CallforPrice00009-0047-25-methylPREDNISolone125mgpreservative-freePowder-Inj J2930 CallforPrice00009-0190-16-methylPREDNISolone125mgInj-00009-0190-16 J2930 CallforPrice00009-0190-16-methylPREDNISolone125mgRECInjection J2930 CallforPrice00009-0698-01-methylPREDNISolone1gmRECInjection J2930 CallforPrice00009-0758-01-methylPREDNISolone500mgRECInjection J2930 CallforPrice00009-0796-01-methylPREDNISolone2gmRECInjection J2930 CallforPrice00009-0796-01-methylPREDNISolonesodiumsuccinate2gmInj-00009-0796-01 J2930 CallforPrice50242-0022-20-somatropin10Soln J2941 CallforPrice50242-0022-20-somatropin5mg/mLInjSol2mL-50242-0022-20 J2941 CallforPrice50242-0074-01-somatropin5mg/mLInjSol2mL-50242-0074-01 J2941 CallforPriceActivaseInjection2mg-OtherInjMedicationCharge J2997 $337.93Injection,alteplaserecombinant,1mg J2997 $337.9350242-0041-63-alteplase2mgPow J2997 CallforPrice50242-0041-64-alteplase2mgIVInj-50242-0041-64 J2997 CallforPrice50242-0041-64-alteplase2mgRECInjection J2997 CallforPrice50242-0085-25-alteplase100mgPowder-Inj J2997 CallforPrice50242-0085-27-alteplase100mgPow J2997 CallforPrice50242-0085-27-alteplase100mgRECInjection J2997 CallforPrice39822-0706-01-streptomycin1gPow J3000 CallforPrice39822-0706-02-streptomycin1gmRECInjection J3000 CallforPriceFentanylIVP50mcg-ExtraMedicationCharge J3010 $42.65Injection,fentanylcitrate,0.1mg J3010 $4.6300000-9094-01-fentanyl50mcg/mLSoln-Inj J3010 CallforPrice00409-1276-32-fentanyl50mcg/mLSol J3010 CallforPrice00409-1276-32-fentanyl50mcg/mL(0.05mg/ml)InjSol2mL-00409-1276-32 J3010 CallforPrice00409-9093-32-fentanyl50mcg/mL(0.05mg/mL)InjSol2mL-00409-9093-32 J3010 CallforPrice00409-9093-32-fentanyl50mcg/mLSol J3010 CallforPrice00409-9094-22-fentanyl0Soln J3010 CallforPrice00409-9094-22-fentanyl50mcg/mL(0.05mg/ml)InjSol2mL-00409-9094-22 J3010 CallforPrice00409-9094-25-fentanyl0Soln J3010 CallforPrice
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49884-0501-01-budesonide3mgERCap-49884-0501-01 J3490 CallforPrice49884-0600-36-silversulfADIAZINEtopical1%Cre J3490 CallforPrice49884-0600-40-silversulfADIAZINETop1%Crm400gm-49884-0600-40 J3490 CallforPrice49884-0600-40-silversulfADIAZINEtopical1%Cream J3490 CallforPrice49884-0724-01-hydroxyurea500mgCap-49884-0724-01 J3490 CallforPrice49884-0831-11-diltiazem240mgERCap-49884-0831-11 J3490 CallforPrice49884-0832-11-diltiazem300mg/24hoursCap J3490 CallforPrice49884-0959-01-chlordiazepoxide10mgCap J3490 CallforPrice49884-0959-01-chlordiazepoxide10mgCap-49884-0959-01 J3490 CallforPrice49884-0960-01-chlordiazepoxide25mgCap J3490 CallforPrice49884-0960-01-chlordiazepoxide25mgCap-49884-0960-01 J3490 CallforPrice50111-0307-02-hydrOXYzinehydrochloride10mgTab J3490 CallforPrice50111-0647-01-fluoxetine10mgCap J3490 CallforPrice50111-0647-01-fluoxetine10mgCap-50111-0647-01 J3490 CallforPrice50111-0647-03-fluoxetine10mgCap-50111-0647-03 J3490 CallforPrice50111-0648-01-FLUoxetine20mgCap J3490 CallforPrice50111-0648-01-FLUoxetine20mgCap-50111-0648-01 J3490 CallforPrice50111-0648-02-FLUoxetine20mgCap-50111-0648-02 J3490 CallforPrice50111-0648-03-FLUoxetine20mgCap-50111-0648-03 J3490 CallforPrice50111-0852-01-valproicacid250mgCap J3490 CallforPrice50111-0852-01-valproicacid250mgCap-50111-0852-01 J3490 CallforPrice50111-0901-01-ethosuximide250mgCap-50111-0901-01 J3490 CallforPrice50111-0990-01-ergocalciferol50,000intlunitsCap-50111-0990-01 J3490 CallforPrice50111-0990-01-ergocalciferol50000unit(s)Cap J3490 CallforPrice50222-0260-06-calcipotrieneTop0.005%Crm60gm-50222-0260-06 J3490 CallforPrice50222-0260-06-calcipotrienetopical0.005%Cre J3490 CallforPrice50222-0260-12-calcipotrieneTop0.005%Crm120gm-50222-0260-12 J3490 CallforPrice50242-0044-13-alteplase50mgPow J3490 CallforPrice50242-0074-01-somatropin10mg/2mLSol J3490 CallforPrice50242-0075-01-somatropin5mg/2mLSol J3490 CallforPrice50242-0138-01-tocilizumab162mg/0.9mLSol J3490 CallforPrice50268-0060-15-acyclovir200mgCap J3490 CallforPrice50268-0796-15-ursodiol300mgCap J3490 CallforPrice50268-0816-15-zonisamide100mgCap J3490 CallforPrice50383-0062-07-dextromethorphan-guaiFENesin10mg-100mg/5mLLiq J3490 CallforPrice50383-0079-16-acetaminophen-codeine120mg-12mg/5mLLiq J3490 CallforPrice50383-0087-07-codeine-guaiFENesin10mg-100mg/5mLSyr J3490 CallforPrice50383-0171-04-levocarnitine100mg/mLSol J3490 CallforPrice50383-0232-10-dorzolamideOpth2%Sol10mL-50383-0232-10 J3490 CallforPrice50383-0232-10-dorzolamideophthalmic2%Sol J3490 CallforPrice50383-0233-10-dorzolamide-timololophthalmic2%-0.5%Sol J3490 CallforPrice50383-0233-10-dorzolamide-timololophthalmic2%-0.5%Sol J3490 CallforPrice50383-0241-16-levETIRAcetam100mg/mLSol J3490 CallforPrice50383-0266-50-clobetasoltopical0.05%Sol J3490 CallforPrice50383-0267-15-clobetasolTop0.05%Crm15gm-50383-0267-15 J3490 CallforPrice50383-0267-30-clobetasolTop0.05%Crm30gm-50383-0267-30 J3490 CallforPrice50383-0268-30-clobetasoltopical0.05%Oint30gm-50383-0268-30 J3490 CallforPrice50383-0286-04-levofloxacin25mg/mLSol J3490 CallforPrice50383-0286-16-levoFLOXacin25mg/mLSol J3490 CallforPrice50383-0311-47-gabapentin250mg/5mLOralSol470mL-50383-0311-47 J3490 CallforPrice50383-0311-47-gabapentin250mg/5mLSol J3490 CallforPrice50383-0587-16-nystatin100000units/mLOralSusp-50383-0587-16 J3490 CallforPrice
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51284-0620-22-chlorhexidinetopical0.12%Liq J3490 CallforPrice51285-0063-90-estradiol-norgestimatebiphasicTab J3490 CallforPrice51285-0088-90-estradiol-norgestimatebiphasicTab J3490 CallforPrice51285-0204-01-copper-Dev J3490 CallforPrice51285-0445-23-erythromycin-sulfiSOXAZOLE200mg-600mg/5mLGra J3490 CallforPrice51285-0754-02-acetaZOLAMIDE500mgCap-ER-51285-0754-02 J3490 CallforPrice51285-0754-02-acetaZOLAMIDE500mgCap-ER J3490 CallforPrice51479-0041-15-aztreonam1gmRECInjection J3490 CallforPrice51479-0042-15-aztreonam2gmRECInjection J3490 CallforPrice51525-0294-03-azelastinenasal137mcg/inhSpr J3490 CallforPrice51552-0051-06-aceticacidTop3%Soln-51552-0051-06 J3490 CallforPrice51552-0051-06-aceticacidtopical3%Sol J3490 CallforPrice51552-0106-05-lidocaine100gmPowder J3490 CallforPrice51552-0106-05-lidocainepowder100gm-51552-0106-05 J3490 CallforPrice51552-0194-04-iodine-potassiumiodide5%-10%Sol J3490 CallforPrice51552-0357-05-ferricsubsulfatetopical-Soln-Top J3490 CallforPrice51672-1253-02-fluocinonidetopical0.05%Cre J3490 CallforPrice51672-1253-03-fluocinonideTop0.05%Crm60gm-51672-1253-03 J3490 CallforPrice51672-1253-03-fluocinonidetopical0.05%Cream J3490 CallforPrice51672-1258-01-clobetasolTop0.05%Crm15gm-51672-1258-01 J3490 CallforPrice51672-1258-02-clobetasolTop0.05%Crm30gm-51672-1258-02 J3490 CallforPrice51672-1258-02-clobetasoltopical0.05%Cream J3490 CallforPrice51672-1258-03-clobetasoltopical0.05%Cre J3490 CallforPrice51672-1259-01-clobetasolTop0.05%Oint15gm-51672-1259-01 J3490 CallforPrice51672-1259-01-clobetasoltopical0.05%Oin J3490 CallforPrice51672-1259-02-clobetasolTop0.05%Oint30gm-51672-1259-02 J3490 CallforPrice51672-1259-02-clobetasoltopical0.05%Ointment J3490 CallforPrice51672-1259-03-clobetasoltopical0.05%Oin J3490 CallforPrice51672-1263-01-nystatin-triamcinoloneTopCrm15gm-51672-1263-01 J3490 CallforPrice51672-1263-01-nystatin-triamcinolonetopical100000units/g-0.1%Cre J3490 CallforPrice51672-1263-02-nystatin-triamcinoloneTopCrm30gm-51672-1263-02 J3490 CallforPrice51672-1263-02-nystatin-triamcinolonetopical100000units/g-0.1%Cre J3490 CallforPrice51672-1263-03-nystatin-triamcinolonetopical100000units/g-0.1%Cream J3490 CallforPrice51672-1264-01-fluocinonidetopical0.05%Oin J3490 CallforPrice51672-1264-02-fluocinonidetopical0.05%Oin J3490 CallforPrice51672-1264-03-fluocinonideTop0.05%Oint60gm-51672-1264-03 J3490 CallforPrice51672-1264-03-fluocinonidetopical0.05%Ointment J3490 CallforPrice51672-1267-05-triamcinoloneTop0.1%Paste5gm-51672-1267-05 J3490 CallforPrice51672-1267-05-triamcinolonetopical0.1%Paste J3490 CallforPrice51672-1272-01-nystatin-triamcinolone100000units/gm-0.1%TopOint15gm-51672-1272-01 J3490 CallforPrice51672-1272-01-nystatin-triamcinolonetopical100000units/g-0.1%Ointment J3490 CallforPrice51672-1272-02-nystatin-triamcinolonetopical100000units/g-0.1%Oin J3490 CallforPrice51672-1282-02-triamcinoloneTop0.1%Crm30gm-51672-1282-02 J3490 CallforPrice51672-1282-02-triamcinolonetopical0.1%Cre J3490 CallforPrice51672-1284-01-triamcinoloneTop0.1%Oint15gm-51672-1284-01 J3490 CallforPrice51672-1284-01-triamcinolonetopical0.1%Oin J3490 CallforPrice51672-1284-08-triamcinolonetopical0.1%Oin J3490 CallforPrice51672-1284-08-triamcinolonetopical0.1%Oint80gm-51672-1284-08 J3490 CallforPrice51672-1289-01-nystatinTop100,000units/gCrm15gm-51672-1289-01 J3490 CallforPrice51672-1289-01-nystatintopicalCream J3490 CallforPrice51672-1289-02-nystatinTop100,000units/gCrm30gm-51672-1289-02 J3490 CallforPrice51672-1293-02-clobetasolTop0.05%Sol25mL-51672-1293-02 J3490 CallforPrice
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61958-0501-01-adefovir10mgTab-61958-0501-01 J8499 CallforPrice61958-0601-01-emtricitabine200mgCap J8499 CallforPrice61958-0601-01-emtricitabine200mgCap-61958-0601-01 J8499 CallforPrice61958-0602-01-emtricitabine10mg/mLoralSol170ml-61958-0602-01 J8499 CallforPrice61958-0602-01-emtricitabine1700Soln J8499 CallforPrice61958-0701-01-emtricitabine-tenofovir200mg-300mgTab J8499 CallforPrice61958-0701-01-emtricitabine-tenofovir200mg-300mgTab-61958-0701-01 J8499 CallforPrice61958-0801-01-ambrisentan5mgTab J8499 CallforPrice61958-0901-01-aztreonam75mgPow J8499 CallforPrice61958-1001-01-ranolazine500mgTab J8499 CallforPrice61958-1001-01-ranolazine500mgoralERTab-61958-1001-01 J8499 CallforPrice61958-1003-01-ranolazine500mgTab J8499 CallforPrice61958-1003-01-ranolazine500mgoralERTab-61958-1003-01 J8499 CallforPrice61958-1101-01-emtrTab200mg/25mg/300 J8499 CallforPrice61958-1101-01-emtricitabine/rilpivirine/tenofovir200mg-25mg-300mgTab-61958-1101-01 J8499 CallforPrice61958-1201-01-cobicistat/elvitegravir/emtricitabine/tenofov150mg-150mg-200mg-300mgTab J8499 CallforPrice61958-1201-01-cobicistat/elvitegravir/emtricitabine/tenofov150mg-150mg-200mg-300mgTab J8499 CallforPrice61958-1501-01-sofosbuvir400mgTab J8499 CallforPrice61958-1701-01-idelalisib100mgTab J8499 CallforPrice61958-1701-01-idelalisib100mgTab J8499 CallforPrice61958-1702-01-idelalisib150mgTab J8499 CallforPrice61958-1801-01-ledipasvir-sofosbuvir90mg-400mgTab J8499 CallforPrice61958-1901-01-cobicistat/elvitegravir/emtricitabine/tenofov150mg-150mg-200mg-10mgTab J8499 CallforPrice61958-2002-01-emtricitabine-tenofoviralafenamide200mg-25mgTab J8499 CallforPrice61958-2101-01-emtricitabine-rilpivirine-tenofovir200mg-25mg-25mgTab J8499 CallforPrice61958-2201-01-sofosbuvir-velpatasvir100mg-400mgTab J8499 CallforPrice62037-0560-05-potassiumchloride10mEqCap J8499 CallforPrice62037-0571-01-metformin500mgERTab-62037-0571-01 J8499 CallforPrice62037-0571-01-metformin500mgTab J8499 CallforPrice62037-0571-10-metformin500mgERTab-62037-0571-10 J8499 CallforPrice62037-0597-05-diltiazem120mgERCap-62037-0597-05 J8499 CallforPrice62037-0597-90-diltiazem120mgERCap-62037-0597-90 J8499 CallforPrice62037-0597-90-diltiazem120mg/24hoursCap J8499 CallforPrice62037-0598-05-diltiazem180mgERCap-62037-0598-05 J8499 CallforPrice62037-0598-90-diltiaZEM180mg/24hoursCap J8499 CallforPrice62037-0598-90-diltiazem180mgERCap-62037-0598-90 J8499 CallforPrice62037-0599-05-diltiazem240mgERCap-62037-0599-05 J8499 CallforPrice62037-0599-90-diltiazem240mgERCap-62037-0599-90 J8499 CallforPrice62037-0599-90-diltiazem240mg/24hoursCap J8499 CallforPrice62037-0600-05-diltiazem300mgERCap-62037-0600-05 J8499 CallforPrice62037-0600-90-diltiaZEM300mg/24hoursCap J8499 CallforPrice62037-0600-90-diltiazem300mgERCap-62037-0600-90 J8499 CallforPrice62037-0696-30-diltiazem120mg/24hoursCap J8499 CallforPrice62037-0696-90-diltiazem120mgERCap-62037-0696-90 J8499 CallforPrice62037-0696-90-diltiazem120mg/24hoursCap J8499 CallforPrice62037-0697-30-diltiazem180mg/24hoursCap J8499 CallforPrice62037-0697-90-diltiazem180mgERCap-62037-0697-90 J8499 CallforPrice62037-0697-90-diltiazem180mg/24hoursCap J8499 CallforPrice62037-0698-90-diltiazem240mgERCap-62037-0698-90 J8499 CallforPrice62037-0698-90-diltiazem240mg/24hoursCap J8499 CallforPrice62037-0699-90-diltiazem300mg/24hoursCap J8499 CallforPrice62037-0700-30-diltiazem360mg/24hoursCap J8499 CallforPrice
62037-0700-90-diltiazem360mgERCap-62037-0700-90 J8499 CallforPrice62037-0700-90-diltiazem360mg/24hoursCap J8499 CallforPrice62037-0830-01-metoprolol25mgERTab-62037-0830-01 J8499 CallforPrice62037-0830-01-metoprolol25mgTab J8499 CallforPrice62037-0830-10-metoprolol25mgERTab-62037-0830-10 J8499 CallforPrice62037-0830-10-metoprolol25mgTab J8499 CallforPrice62037-0831-01-metoprolol50mgERTab-62037-0831-01 J8499 CallforPrice62037-0831-01-metoprolol50mgTab J8499 CallforPrice62037-0831-10-metoprolol50mgERTab-62037-0831-10 J8499 CallforPrice62037-0831-10-metoprolol50mgTab J8499 CallforPrice62037-0832-01-metoprolol100mgERTab-62037-0832-01 J8499 CallforPrice62037-0832-01-metoprolol100mgTab J8499 CallforPrice62037-0832-10-metoprolol100mgERTab-62037-0832-10 J8499 CallforPrice62037-0832-10-metoprolol100mgTab J8499 CallforPrice62037-0833-01-metoprolol200mgERTab-62037-0833-01 J8499 CallforPrice62037-0999-01-potassiumchloride20mEqERTab-62037-0999-01 J8499 CallforPrice62037-0999-05-potassiumchloride20mEqERTab-62037-0999-05 J8499 CallforPrice62037-0999-10-potassiumchloride20mEqERTab-62037-0999-10 J8499 CallforPrice62175-0114-32-omeprazole10mgCap J8499 CallforPrice62175-0114-32-omeprazole10mgOralECCap-62175-0114-32 J8499 CallforPrice62175-0118-32-omeprazole20mgOralDRCap-62175-0118-32 J8499 CallforPrice62175-0118-37-omeprazole20mgCap-62175-0118-37 J8499 CallforPrice62175-0118-43-omeprazole20mgCap J8499 CallforPrice62175-0118-43-omeprazole20mgOralDRCap-62175-0118-43 J8499 CallforPrice62175-0119-37-isosorbidemononitrate60mgTab J8499 CallforPrice62175-0128-37-isosorbidemononitrate30mgTab J8499 CallforPrice62175-0180-46-pantoprazole20mgTab J8499 CallforPrice62175-0181-43-pantoprazole40mgECTab-62175-0181-43 J8499 CallforPrice62175-0181-46-pantoprazole40mgECTab-62175-0181-46 J8499 CallforPrice62175-0262-37-NIFEdipine90mgERTab-62175-0262-37 J8499 CallforPrice62175-0262-37-NIFEdipine90mgTab J8499 CallforPrice62175-0270-37-oxybutynin5mg/24hoursTab J8499 CallforPrice62175-0271-37-oxybutynin10mg/24hrTab J8499 CallforPrice62175-0442-15-polyethyleneglycol3350OralPwdrforRecon255gm-62175-0442-15 J8499 CallforPrice62175-0490-64-chlorpheniramine-HYDROcodone8mg-10mg/5mLSus J8499 CallforPrice62175-0581-37-verapamil180mgCap-ER J8499 CallforPrice62175-0617-43-pantoprazole40mgECTab-62175-0617-43 J8499 CallforPrice62175-0617-43-pantoprazole40mgTab J8499 CallforPrice62175-0617-46-pantoprazole40mgTab J8499 CallforPrice62175-0617-46-pantoprazole40mgTab-62175-0617-46 J8499 CallforPrice62332-0025-31-theophylline300mgTab-62332-0025-31 J8499 CallforPrice62332-0095-31-lamoTRIgine5mgChewTab-62332-0095-31 J8499 CallforPrice62332-0096-31-lamoTRIgine25mgTab J8499 CallforPrice62332-0096-31-lamoTRIgine25mgTab-62332-0096-31 J8499 CallforPrice62559-0111-07-hydrocortisone100mg/60mLSusp J8499 CallforPrice62559-0111-07-hydrocortisone100mg/60mLSusp J8499 CallforPrice62559-0138-07-hydrocortisone100mg/60mLRectalSusp-62559-0138-07 J8499 CallforPrice62559-0138-07-hydrocortisone100mg/60mLSus J8499 CallforPrice62559-0149-01-esterifiedestrogens-methylTESTOSTERone1.25mg-2.5mgTab-62559-0149-01 J8499 CallforPrice62559-0149-01-esterifiedestrogens-methylTESTOSTERone1.25mg-2.5mgTab J8499 CallforPrice62559-0150-01-esterifiedestrogens-methylTESTOSTERone0.625mg-1.25mgTab-62559-0150-01 J8499 CallforPrice62559-0153-04-opium10%(equivalenttomorphine10mg/mL)Tin J8499 CallforPrice
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76439-0141-90-losartan50mgTab J8499 CallforPrice76439-0308-10-hyoscyamine0.125mgTab J8499 CallforPrice76439-0308-10-hyoscyamine0.125mgTab-76439-0308-10 J8499 CallforPrice76439-0343-10-potassiumchloride20mEqPow J8499 CallforPrice85122-8000-06-cholecalciferol400unit(s)/dropSoln-Oral J8499 CallforPrice92771-0590-07-lanolintopical-Cre J8499 CallforPrice99999-9999-18-azathioprine50mg/mLoralsusp50mg/mLSusp-Oral J8499 CallforPrice99999-9999-19-tacrolimus0.5mg/mLoralsusp0.5mg/mLSusp-Oral J8499 CallforPriceA00409-4276-01-lidocaine1%1%Soln-Inj J8499 CallforPriceA00517-0405-25-phenylephrine10mg/mLSoln-Inj J8499 CallforPriceA17478-0711-10-lidocainetopical2%2%Gauze J8499 CallforPriceTemplate/Non-Formulary(Medication) J8499 CallforPricecarvedilol J8499 CallforPricemethyleneblue J8499 CallforPricepotassiumchloride J8499 CallforPriceBariumE-ZPaqueThinBottleSRHC J8499 $9.46BariumPolibarPlusBESRHC J8499 $55.31BariumThick J8499 $13.94BariumThinE-ZPaque12ozBottle J8499 $9.46BariumVoLumenCTSRHC J8499 $14.79E-ZDiskTablet(pertablet) J8499 $5.51E-ZGas(perpacket) J8499 $5.55Lidocaine2%Viscous J8499 $11.88Charge-Maaloxsusp J8499 $4.0516729-0035-15-anastrozole1mgTab J8999 CallforPrice00069-3030-20-DOXOrubicin2mg/mLSol J9000 CallforPrice00069-3032-20-DOXOrubicin2mg/mLSol J9000 CallforPrice55390-0233-01-DOXOrubicin50mgPow J9000 CallforPrice55390-0235-10-DOXOrubicin2mgSoln J9000 CallforPrice55390-0237-01-DOXOrubicin2mgSoln J9000 CallforPrice55390-0238-01-DOXOrubicin2mg/mLSol J9000 CallforPrice63323-0883-05-DOXOrubicin2mg/mLSol J9000 CallforPrice63323-0883-10-DOXOrubicin2mg/mLSol J9000 CallforPrice63323-0883-30-DOXOrubicin2mg/mLSol J9000 CallforPrice00078-0495-61-aldesleukin22MIntUnits/1.2mlInj J9015 CallforPrice63459-0600-10-arsenictrioxide10Soln J9017 CallforPrice59572-0102-01-azacitidine100mgRECInjection J9025 CallforPrice67211-0102-01-azacitidine100mgPow J9025 CallforPrice00052-0602-02-BCG50mg/1mLPow-UDINJ J9031 CallforPrice63459-0390-08-bendamustine25mgPow J9033 CallforPrice63459-0391-20-bendamustine100mgPow J9033 CallforPrice63459-0395-02-bendamustine90mg/mLSol J9033 CallforPrice63459-0396-02-bendamustine90mg/mLSol J9033 CallforPrice50242-0060-01-bevacizumab100Soln J9035 CallforPrice50242-0061-01-bevacizumab400Soln J9035 CallforPrice00703-3154-01-bleomycin15unitsPow J9040 CallforPrice00703-3155-01-bleomycin30unitsPow J9040 CallforPrice61703-0323-22-bleomycin30unit(s)RECInjection J9040 CallforPrice61703-0332-18-bleomycin15unitsPow J9040 CallforPrice63323-0136-10-bleomycin15unitsPow J9040 CallforPrice63323-0137-20-bleomycin30unitsPow J9040 CallforPrice63020-0049-01-bortezomib4mgRECInjection J9041 CallforPrice
00024-5824-11-cabazitaxel60mg/1.5mLSol J9043 CallforPrice00703-4248-01-CARBOplatin10mg/mLSol J9045 CallforPrice55390-0155-01-carboplatin10mg/mLSol J9045 CallforPrice61703-0339-18-carboplatin50Soln J9045 CallforPrice61703-0339-22-CARBOplatin10mg/mLSol J9045 CallforPrice61703-0339-50-carboplatin450Soln J9045 CallforPrice63323-0172-15-CARBOplatin10mg/mLSol J9045 CallforPrice63323-0172-45-carboplatin10mg/mLSol J9045 CallforPrice66758-0047-03-carboplatin10mg/mLSol J9045 CallforPrice76075-0101-01-carfilzomib60mgPow J9047 CallforPrice66733-0958-23-cetuximab200Soln J9055 CallforPrice00703-5747-11-cisplatin1mg/mLSol J9060 CallforPrice00703-5748-11-cisplatin1mg/mLSol J9060 CallforPrice63323-0103-51-cisplatin1mg/mLSol J9060 CallforPrice63323-0103-64-cisplatin1mg/mLSol J9060 CallforPrice63323-0103-65-cisplatin100Soln J9060 CallforPrice67457-0424-10-CISplatin1mg/mLSol J9060 CallforPrice00781-3233-94-cyclophosphamide500mgPow J9070 CallforPrice00781-3244-94-cyclophosphamide1gPow J9070 CallforPrice10019-0955-01-cyclophosphamide500mgRECInjection J9070 CallforPrice00069-0155-01-cytarabine100mg/mLSol J9100 CallforPrice55390-0132-10-cytarabine500mgRECInjection J9100 CallforPrice55390-0133-01-cytarabine1gmRECInjection J9100 CallforPrice55390-0134-01-cytarabine2gmRECInjection J9100 CallforPrice61703-0303-46-cytarabine20mg/mLSol J9100 CallforPrice61703-0319-22-cytarabine100mg/mLSol J9100 CallforPrice63323-0120-20-cytarabine100mg/mLSol J9100 CallforPrice67457-0452-20-cytarabine100mg/mLSol J9100 CallforPrice67457-0454-50-cytarabine20mg/mLSol J9100 CallforPrice55292-0811-55-DACTINomycin0.5mgPow J9120 CallforPrice67386-0811-55-dactinomycin0mgRECInjection J9120 CallforPrice55390-0090-10-dacarbazine200mgRECInjection J9130 CallforPrice61703-0327-22-dacarbazine200mgPow J9130 CallforPrice63323-0128-20-dacarbazine200mgPow J9130 CallforPrice00703-5233-11-DAUNOrubicin5mg/mLSoln-Inj J9150 CallforPrice00703-5233-13-DAUNOrubicin5mg/mLSol J9150 CallforPrice55390-0281-10-DAUNOrubicin20mgPow J9150 CallforPrice55566-8401-01-degarelix120mgPow J9155 CallforPrice55566-8401-01-degarelix120mgSQInj-55566-8401-01 J9155 CallforPrice00075-8001-20-docetaxel20Soln J9171 CallforPrice00075-8001-80-docetaxel80Soln J9171 CallforPrice00075-8003-01-docetaxel20mg/mLSol1mL J9171 CallforPrice00075-8004-04-docetaxel20mg/mLSol4mL J9171 CallforPrice00075-8004-04-docetaxel20mg/mLSol4mL J9171 CallforPrice00955-1020-01-DOCEtaxel20mg/mLSol J9171 CallforPrice00955-1021-04-DOCEtaxel20mg/mLSol J9171 CallforPrice25021-0222-04-DOCEtaxel20mg/mLSol J9171 CallforPrice45963-0734-52-DOCEtaxel20mg/mLSol J9171 CallforPrice00009-5091-01-epirubicin2mg/mLSol J9178 CallforPrice10518-0104-10-epirubicin2mg/mLSol J9178 CallforPrice25021-0203-25-epirubicin2mg/mLSol J9178 CallforPrice55390-0207-01-epirubicin2mg/mLSol J9178 CallforPrice
59762-5091-01-epirubicin2mg/mLSol J9178 CallforPrice61703-0347-35-epirubicin50mgRECInjection J9178 CallforPrice61703-0359-93-epirubicin2mg/mLSol J9178 CallforPrice63323-0151-25-epirubicin50Soln J9178 CallforPrice66758-0042-01-epirubicin2mg/mLSol J9178 CallforPrice62856-0389-01-eribulin1mg/2mLSol J9179 CallforPrice00703-5653-01-etoposide20mg/mLSol J9181 CallforPrice16729-0114-31-etoposide20mg/mLSol J9181 CallforPrice55390-0291-01-etoposide100Soln J9181 CallforPrice63323-0104-05-etoposide20mg/mLSol J9181 CallforPrice00703-5854-01-fludarabine50mgRECInjection J9185 CallforPrice25021-0205-05-fludarabine50mgPow J9185 CallforPrice25021-0237-06-fludarabine50mgPow J9185 CallforPrice61703-0344-18-fludarabine50mgPow J9185 CallforPrice63323-0192-02-fludarabine25mg/mLSol J9185 CallforPrice10139-0063-10-fluorouracil50mg/mLSoln-Inj J9190 CallforPrice10139-0063-11-fluorouracil50mg/mLSol J9190 CallforPrice63323-0117-10-fluorouracil50mg/mLSol J9190 CallforPrice66758-0044-01-fluorouracil500Soln J9190 CallforPrice00002-7501-01-gemcitabine200mgRECInjection J9201 CallforPrice00002-7502-01-gemcitabine1gmRECInjection J9201 CallforPrice00069-3858-10-gemcitabine1gPow J9201 CallforPrice00409-0181-01-gemcitabine38mg/mLSol J9201 CallforPrice00409-0183-01-gemcitabine38mg/mLSol J9201 CallforPrice00781-3282-75-gemcitabine200mgPow J9201 CallforPrice25021-0208-10-gemcitabine200mgPow J9201 CallforPrice25021-0209-50-gemcitabine1gPow J9201 CallforPrice25021-0234-10-gemcitabine200mgPow J9201 CallforPrice25021-0235-50-gemcitabine1gPow J9201 CallforPrice47335-0154-40-gemcitabine1gPow J9201 CallforPrice55111-0687-25-gemcitabine1gPow J9201 CallforPrice63323-0102-10-gemcitabine200mgPow J9201 CallforPrice63323-0102-13-gemcitabine200mgPowder-Inj J9201 CallforPrice63323-0125-50-gemcitabine1gPow J9201 CallforPrice00009-7529-01-irinotecan20mg/mLSol J9206 CallforPrice00009-7529-02-irinotecan20mg/mLSol J9206 CallforPrice00009-7529-03-irinotecan20mg/mLSol J9206 CallforPrice00009-7529-04-irinotecan20mg/mLSol J9206 CallforPrice00703-4434-11-irinotecan20mg/mLSol J9206 CallforPrice55390-0296-01-irinotecan20mg/mLSol J9206 CallforPrice61703-0349-09-irinotecan100Soln J9206 CallforPrice61703-0349-36-irinotecan20mg/mLSol J9206 CallforPrice00015-1910-12-ixabepilone15mgPow J9207 CallforPrice00015-1911-13-ixabepilone45mgPow J9207 CallforPrice00069-4496-22-ifosfamide50mg/mLSol J9208 CallforPrice00338-3991-01-ifosfamide1gPow J9208 CallforPrice00338-3993-01-ifosfamide3gmRECInjection J9208 CallforPrice00703-3429-11-ifosfamide3000Soln J9208 CallforPrice10019-0925-01-ifosfamide1gPow J9208 CallforPrice10019-0926-02-ifosfamide3gPow J9208 CallforPrice63323-0142-10-ifosfamide1gPow J9208 CallforPrice63323-0174-60-ifosfamide50mg/mLSol J9208 CallforPrice
67457-0443-60-ifosfamide50mg/mLSol J9208 CallforPrice00338-1305-03-mesna100mg/mLSol J9209 CallforPrice10019-0953-01-mesna100mg/mLSol J9209 CallforPrice10019-0953-02-mesna100mg/mLSol J9209 CallforPrice25021-0201-10-mesna100mg/mLSol J9209 CallforPrice55390-0045-01-mesna1000Soln J9209 CallforPrice63323-0733-11-mesna100mg/mLSol J9209 CallforPrice00013-2576-91-IDArubicin1mg/mLSol J9211 CallforPrice00703-4154-11-idarubicin5Soln J9211 CallforPrice55390-0215-01-idarubicin1mg/mLSol J9211 CallforPrice55390-0217-01-idarubicin20Soln J9211 CallforPrice00085-1242-01-interferonalpha-2brecombinant3MIU J9214 CallforPriceLeuprolideacetate(fordepotsuspension),7.5mg J9217 $3,217.5400024-0605-45-leuprolide45mg/6monthsSCPwdrforInj,ER-00024-0605-45 J9217 CallforPrice00074-3346-03-leuprolide22.5mg/3monthsIMInj,ER-00074-3346-03 J9217 CallforPrice00074-3346-03-leuprolide22.5mg/3monthsPWD J9217 CallforPrice00074-3642-03-Leuprolide7.5mg/WDInj J9217 CallforPrice00074-3642-03-leuprolide7.5mg/monthIMInj,ER-00074-3642-03 J9217 CallforPrice00074-3683-03-leuprolide30mg/4monthsIMInj,ER-00074-3683-03 J9217 CallforPrice00300-2440-01-leuprolide15mg/monthPediatricIMInj,ER-00300-2440-01 J9217 CallforPrice00300-3346-01-leuprolide22.5mg/3monthsIMInj,ER-00300-3346-01 J9217 CallforPrice00300-3642-01-leuprolide7.5mg/monthIMInj,ER-00300-3642-01 J9217 CallforPrice62935-0452-45-leuprolide45mg/6monthsSCPwdrforInj,ER-62935-0452-45 J9217 CallforPrice62935-0453-45-leuprolide45mg/6monthsPowder-Inj J9217 CallforPrice00781-4003-32-leuprolide1mg/0.2mLKit J9218 CallforPrice41616-0936-40-leuprolide1mg/0.2mLKit J9218 CallforPrice67979-0002-01-histrelin50mg/1UD/Implnt J9225 CallforPrice67979-0002-01-histrelin50mgImp J9226 CallforPrice00003-2328-22-ipilimumab5mg/mLSol J9228 CallforPriceMethotrexatesodium,5mg J9250 $1.6500069-0146-01-methotrexate25mg/mLSoln-Inj J9250 CallforPrice00069-0146-02-methotrexate25mg/mLSol J9250 CallforPrice00069-0146-02-methotrexate25mg/mLSol J9250 CallforPrice00703-3671-03-methotrexate25mg/mLPFInjSol2mL-00703-3671-03 J9250 CallforPrice00703-3671-03-methotrexate25mg/mLpreservative-freeSol J9250 CallforPrice10139-0062-02-methotrexate25mg/mLPFInjSol2mL-10139-0062-02 J9250 CallforPrice10139-0062-02-methotrexate25mg/mLpreservative-freeSol J9250 CallforPrice10139-0062-10-methotrexate25mg/mLPFInj10mL-10139-0062-10 J9250 CallforPrice10139-0062-10-methotrexate25mg/mLpreservative-freeSol J9250 CallforPrice16729-0277-30-methotrexate25mg/mLPFInjSol2mL-16729-0277-30 J9250 CallforPrice16729-0277-35-methotrexate25mg/mLpreservative-freeSol J9250 CallforPrice55390-0031-10-methotrexate25mg/mLPFInjSol2mL-55390-0031-10 J9250 CallforPrice61703-0350-38-methotrexate25mg/mLInjSol2mL-61703-0350-38 J9250 CallforPrice61703-0350-38-methotrexate50Soln J9250 CallforPrice61703-0408-41-methotrexate25mg/mLpreservative-freeSol J9250 CallforPrice67457-0221-02-methotrexate25mg/mLPFInjSol2mL-67457-0221-02 J9250 CallforPrice67457-0221-02-methotrexate25mg/mLpreservative-freeSol J9250 CallforPriceMethotrexateInjection25mg/mL-InjMedicationCharge J9260 $9.1800069-0149-01-methotrexate25mg/mLSol J9260 CallforPrice55390-0031-10-methotrexate50Soln J9260 CallforPrice00024-0590-10-oxaliplatin5mg/mLSol J9263 CallforPrice00024-0591-20-oxaliplatin5mg/mLIVSol20mL-00024-0591-20 J9263 CallforPrice
00024-0591-20-oxaliplatin5mg/mLSol J9263 CallforPrice00069-0067-01-oxaliplatin50mgPowder-Inj J9263 CallforPrice00703-3985-01-oxaliplatin5mg/mLSol J9263 CallforPrice00703-3986-01-oxaliplatin5mg/mLSol J9263 CallforPrice25021-0212-50-oxaliplatin100mgPow J9263 CallforPrice47335-0176-40-oxaliplatin50mgPow J9263 CallforPrice47335-0178-40-oxaliplatin100mgPow J9263 CallforPrice61703-0363-18-oxaliplatin50Soln J9263 CallforPrice61703-0363-22-oxaliplatin100Soln J9263 CallforPriceInj-oxaliplatin50mgPow/NDC25021-0211-20-J9263 J9263 CallforPrice68817-0134-50-PACLitaxelprotein-bound100mgPow J9264 CallforPrice00069-0076-01-PACLitaxel6mg/mLSol J9267 CallforPrice00069-0079-01-PACLitaxel6mg/mLSol J9267 CallforPrice00703-4764-01-paclitaxel6mg/mLSol J9267 CallforPrice00703-4766-01-paclitaxel6mg/mLSol J9267 CallforPrice00703-4767-01-PACLitaxel6mg/mLSol J9267 CallforPrice00703-4768-01-paclitaxel6mg/mLSol J9267 CallforPrice25021-0213-50-PACLitaxel6mg/mLSol J9267 CallforPrice55390-0114-50-paclitaxel6mg/mLSol J9267 CallforPrice61703-0342-09-PACLitaxel6mg/mLSol J9267 CallforPrice61703-0342-22-paclitaxel6mg/mLSol J9267 CallforPrice61703-0342-50-PACLitaxel6mg/mLSol J9267 CallforPrice63323-0763-05-PACLitaxel6mg/mLSol J9267 CallforPrice66758-0043-01-paclitaxel30Soln J9267 CallforPrice66758-0043-02-paclitaxel100Soln J9267 CallforPrice66758-0043-03-paclitaxel300Soln J9267 CallforPrice00409-0801-01-pentostatin10mgPow J9268 CallforPrice00006-3026-02-pembrolizumab25mg/mLSol J9271 CallforPrice00006-3029-02-pembrolizumab50mgPowder-Inj J9271 CallforPrice16729-0108-11-mitomycin20mgPow J9280 CallforPrice16729-0115-05-mitomycin5mgPow J9280 CallforPrice55390-0251-01-mitomycin5mgRECInjection J9280 CallforPrice61703-0343-18-mitoXANTRONE2mg/mLSol J9293 CallforPrice63323-0132-10-mitoxantrone20Soln J9293 CallforPrice00003-3772-11-nivolumab40mg/mLSoln-Inj J9299 CallforPrice00003-3774-12-nivolumab100mg/mLSoln-Inj J9299 CallforPrice00003-3774-12-nivolumab40mg/4mLSoln-Inj J9299 CallforPrice00173-0821-01-ofatumumab20mg/mLSol J9302 CallforPrice00173-0821-33-ofatumumab20mg/mLSol J9302 CallforPrice55513-0954-01-panitumumab100Soln J9303 CallforPrice55513-0956-01-panitumumab20mg/mLIVSol20mL J9303 CallforPrice55513-0956-01-panitumumab20mg/mLIVSol20mL J9303 CallforPrice00002-7623-01-pemetrexed500mgRECInjection J9305 CallforPrice00002-7640-01-pemetrexedRECInjection J9305 CallforPrice50242-0145-01-pertuzumab420mg/14mLSol J9306 CallforPrice48818-0001-01-pralatrexate20mg/mLSol J9307 CallforPrice48818-0001-02-pralatrexate20mg/mLSol J9307 CallforPrice00002-7669-01-ramucirumab10mg/mLSol J9308 CallforPrice00002-7678-01-ramucirumab10mg/mLSol J9308 CallforPrice50242-0051-21-rituximab100Soln J9310 CallforPrice50242-0053-06-rituximab500Soln J9310 CallforPrice46026-0983-01-romiDEPsin10mgPow J9315 CallforPrice
59572-0983-01-romiDEPsin10mgPowder-Inj J9315 CallforPrice00008-1179-01-temsirolimus25mg/mLSol J9330 CallforPrice00007-4201-01-topotecan4mgPow J9351 CallforPrice00007-4201-05-topotecan4mgRECInjection J9351 CallforPrice00409-0302-01-topotecan1mg/mLSol J9351 CallforPrice25021-0206-06-topotecan4mgPow J9351 CallforPrice63323-0762-10-topotecan4mgPow J9351 CallforPrice63323-0762-17-topotecan4mgPow J9351 CallforPrice50242-0087-01-ado-trastuzumabemtansine160mgPow J9354 CallforPrice50242-0088-01-ado-trastuzumabemtansine100mgPowder-Inj J9354 CallforPrice50242-0134-68-trastuzumab440mgKit J9355 CallforPrice55390-0091-10-vinBLAStine10mgPow J9360 CallforPrice55390-0091-10-vinBLAStine10mgPow J9360 CallforPrice63323-0278-10-vinBLAStine10Soln J9360 CallforPrice00703-4402-11-vinCRIStine1mg/mLSol J9370 CallforPrice00703-4402-11-vinCRIStine1mg/mLSol J9370 CallforPrice61703-0309-06-vinCRIStine1mg/mLSol J9370 CallforPrice61703-0309-16-vinCRIStine2Soln J9370 CallforPrice00069-0099-01-vinorelbine10mg/mLSol J9390 CallforPrice25021-0204-01-vinorelbine10mg/mLSol J9390 CallforPrice25021-0204-05-vinorelbine10mg/mLSol J9390 CallforPrice55390-0070-01-vinorelbine10mg/mLSol J9390 CallforPrice64370-0532-01-vinorelbine10mg/mLSol J9390 CallforPrice64370-0532-02-vinorelbine10mg/mLSol J9390 CallforPrice66758-0045-02-vinorelbine50Soln J9390 CallforPrice00310-0720-10-fulvestrant50mg/mLSol J9395 CallforPrice00310-0720-10-fulvestrant50mg/mLSol J9395 CallforPriceKneeorthosis,elasticwithjoints,customized L1810 $1.11L1820KneeSupport L1820 $14.52Wristhandfingerorthosis,w/ojoint(s),customized L3808 $459.69L3908WristSupport L3908 $102.66Handfingerorthosis,w/ojoints, L3924 $107.71Hand/fingerorthosis,w/ojoints,customized L3933 $272.58Walkingbootpneumaticprefabricatedcustomizedtofitaspecificptbyanindividualwithexpertise L4360 $327.18L4386WalkingBoot L4386 $165.97Prolotherapy M0076 $85.64 $86.47REDCELLSLEUKOREDUCED(PROCESSING) P9016 $774.06FreshFrozenPlasma P9017 $343.42REDBLOODCELLS,EACHUNIT P9021 $826.73PLATELETS,PHERESIS,LEUKOREDUCED,IRRADIATED P9031 $651.75PlateletPheresis P9034 $1,948.40PLATELETS,PHERESIS P9035 $3,079.2300944-0491-01-albuminhuman5%Sol P9041 CallforPrice13533-0685-20-albuminhuman5%Soln P9041 CallforPrice13533-0690-20-albuminhuman5%Sol P9041 CallforPrice13533-0690-25-albuminhuman5%Sol P9041 CallforPrice68516-5214-01-albuminhuman5%Sol P9041 CallforPrice68516-5214-02-albuminhuman5%Sol P9041 CallforPrice76125-0785-25-albuminhuman5%Sol P9041 CallforPrice13533-0685-20-albuminhuman5%IVSol50mL-13533-0685-20 P9045 CallforPrice13533-0685-25-albuminhuman5%IVSol250mL-13533-0685-25 P9045 CallforPrice13533-0685-25-albuminhuman5%Sol250mL-13533-0685-25 P9045 CallforPrice
13533-0685-25-albuminhuman5%Soln P9045 CallforPrice68209-0623-02-albuminhuman5%Sol P9045 CallforPrice00944-0490-02-albuminhuman25%Sol P9046 CallforPrice13533-0684-72-albuminhuman25%Soln P9046 CallforPrice13533-0692-20-albuminhuman25%Sol P9046 CallforPrice13533-0692-71-albuminhuman25%Sol P9046 CallforPrice67467-0643-02-albuminhuman25%IVSol100mL-67467-0643-02 P9046 CallforPrice68982-0643-02-albuminhuman25%Sol P9046 CallforPrice76125-0784-10-albuminhuman25%Sol P9046 CallforPrice13533-0684-20-albuminhuman25%IVSol50mL-13533-0684-20 P9047 CallforPrice13533-0684-20-albuminhuman25%Sol P9047 CallforPrice13533-0684-71-albuminhuman25%IVSol100mL-13533-0684-71 P9047 CallforPrice13533-0684-71-albuminhuman25%Sol100mL P9047 CallforPrice13533-0684-71-albuminhuman25%Sol100mL-13533-0684-71 P9047 CallforPrice13533-0684-71-albuminhuman25%Soln P9047 CallforPrice67467-0643-01-albuminhuman25%IVSol50mL-67467-0643-01 P9047 CallforPrice67467-0643-01-albuminhuman25%Soln P9047 CallforPrice67467-0643-02-albuminhuman25%Sol P9047 CallforPrice68516-5216-01-albuminhuman25%Sol P9047 CallforPrice68516-5216-02-albuminhuman25%Sol P9047 CallforPriceFreshFrozenPlasmaUnit1 P9059 $303.21FreshFrozenPlasmaUnit2 P9059 $303.21FreshFrozenPlasmaUnit3 P9059 $303.21FreshFrozenPlasmaUnit4 P9059 $303.21FreshFrozenPlasmaUnit5 P9059 $303.21FreshFrozenPlasmaUnit6 P9059 $303.21Catheterizationforcollectionofspecimensingleptallplacesofservice P9612 $81.11Catheterizationforcollnofspecimen,sglpt,allplacesofsvc P9612 $80.44ScreeningPapanicolaousmear;obtaining,prepandconveyanceofcervicalorvaginalsmeartolab Q0091 $219.88 $78.20 $90.20Wetmounts,includingpreparationsofvaginal,cervicalorskinspecimens Q0111 $101.10Ferntest. Q0114 $78.3859338-0775-10-ferumoxytol30mg/mLSol Q0138 CallforPriceQ0144Zithromax250mgTab00781-1496-69 Q0144 $86.03Zithromax250mgTab-POMedicationCharge Q0144 $86.0300069-1340-05-ondansetron2mg/mLSoln-Inj Q0162 CallforPrice00069-1340-16-ondansetron2mg/mLSol-69134016 Q0162 CallforPrice00781-3010-72-ondansetron2mg/mLSol Q0162 CallforPriceDiphenhydramine50mgCapsule-POMedicationCharge Q0163 $1.1100069-6001-21-fosphenytoin(PE)500mg/10mLInjSol-00069-6001-21 Q2009 CallforPrice00071-4007-05-fosphenytoin100Soln Q2009 CallforPrice00071-4008-10-fosphenytoin(PE)500mg/10mLInjSol-00071-4008-10 Q2009 CallforPrice00071-4008-10-fosphenytoin500mgPE/10mLSol Q2009 CallforPrice00143-9782-10-fosphenytoin500mgPE/10mLSol Q2009 CallforPrice00409-4857-10-fosphenytoin500mgPE/10mLSol Q2009 CallforPrice63323-0403-02-fosphenytoin(PE)100mg/2mLInjSol-63323-0403-02 Q2009 CallforPrice63323-0403-02-fosphenytoin100mgPE/2mLSol Q2009 CallforPrice63323-0403-10-fosphenytoin(PE)500mg/10mLInjSol-63323-0403-10 Q2009 CallforPrice63323-0403-10-fosphenytoin500Soln Q2009 CallforPriceInfluenzavirusvaccine,splitvirus,administeredto3yrsandolder,forIMuse(flulaval) Q2036 $62.1942874-0016-10-influenzavirusvaccine,inactivatedrecombinanthemagglutinintrivalentSol Q2037 CallforPrice49281-0399-65-influenzavirusvaccine,high-dosePFSusp0.5mL-49281-0399-65 Q2037 CallforPrice49281-0399-65-influenzavirusvaccine,high-dosePFhigh-dosepreservative-frSusp-Inj Q2037 CallforPrice
49281-0401-65-influenzavirusvaccine,inactivatedhigh-dosepreservative-freetrivalentSus Q2037 CallforPrice49281-0416-50-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus Q2037 CallforPrice49281-0516-25-influenzavirusvaccine,inactivatedpreservative-freepediatricquadrivalentSus Q2037 CallforPrice58160-0905-52-influenzavirusvaccine,inactivatedpreservative-freequadrivalentSus Q2037 CallforPriceInfluenzavirusvaccine,nototherwisespecified Q2039 $97.2047335-0049-40-DOXOrubicinliposomal2mg/mLDev Q2050 CallforPrice47335-0050-40-DOXOrubicinliposomal2mg/mLDev Q2050 CallforPrice47335-0082-50-DOXOrubicin2mg/mLSoln-IV Q2050 CallforPrice47335-0082-50-DOXOrubicinliposomal2mg/mLSoln-IV Q2050 CallforPrice47335-0083-50-DOXOrubicin2mg/mLSoln-IV Q2050 CallforPrice47335-0083-50-DOXOrubicinliposomal2mg/mLSoln-IV Q2050 CallforPriceTelehealthoriginatingsitefacilityfee Q3014 $102.65 $102.65Telehealthoriginatingsitefee Q3014 $102.65 $102.65FacilitationofTelemedicine-ClinicalServiceProvided Q3014 $102.65 $102.6559627-0002-05-interferonbeta-1a30mcg/0.5mLIMkit-59627-0002-05 Q3027 CallforPriceInjection,perflutrenlipidmicrospheres,perml Q9957 $445.77Cysto-ConrayII17.2%250ml Q9959 $55.5000019-4816-04-diatrizoate66%-10%Sol Q9963 CallforPrice00270-0445-35-diatrizoate66%-10%Sol Q9963 CallforPriceGastrografin30mlSRHC Q9963 $58.34ContrastOmnipaque18010mL Q9965 $7.70IsovueM-20041%20mlvial Q9966 $6.1100407-1413-59-iohexol300mg/mLSol Q9967 CallforPrice00407-1414-53-iohexol350mg/mLSol Q9967 CallforPriceIsovue300100mlSRHC Q9967 $212.36Isovue30061%50ml Q9967 $212.56Omnipaque30050mlSRHC Q9967 $22.83Omnipaque300SingleDose30ml Q9967 $104.83Omnipaque350100ml(percc) Q9967 $1.34Optiray350100mlSRHC Q9967 $229.25SRHCUltravist30050ml Q9967 $47.63Visopaque320150ml Q9967 $22.83ContrastOmnipaque300mgPlusPak30mLBottles Q9967 $1.3400517-0301-10-methyleneblue10mg/mLSol Q9968 CallforPrice00517-0310-10-methyleneblue10mg/mLInjSol10mL-00517-0310-10 Q9968 CallforPrice00517-0310-10-methyleneblue100Soln Q9968 CallforPrice17478-0504-01-methyleneblue10mg/mLSol Q9968 CallforPriceGICocktailOralLiqCmpd(Donnatal/Lidocaine/Mintox)1:1:1-POMedicationCharge Q9977 $8.28AMOXICILLINCAP500MG-SRHC Q9999 $5.59AMOXICILLIN/CLAV400mg/5ML-SRHC Q9999 $96.25AMOXICILLIN/CLAV875/125mgTAB-SRHC Q9999 $5.25AZITHROMYCINO/S200MG/5ML-SRHC Q9999 $233.86AZITHROMYCINTAB250MG-SRHC Q9999 $5.59AlbuterolHFAMDIW/COUNTER8.5GM-SRHC Q9999 $99.82Amoxicillin250mg-SRHC Q9999 $5.59Amoxicillin400mg/5mL100mLSRHC Q9999 $13.70CEFDINIRCAP300MG-SRHC Q9999 $5.59CEFDINIROralSoln125/5ML-SRHC Q9999 $112.80CEPHALEXINCAP250MG-SRHC Q9999 $5.59CEPHALEXINCAP500MG-SRHC Q9999 $5.59CEPHALEXINOralSoln250MG/5ML-SRHC Q9999 $71.57CIPROFLOXACINOPHTSOLN0.3%-SRHC Q9999 $131.89
CIPROFLOXACINTAB500MG-SRHC Q9999 $5.59CLINDAMYCINCAP150MG-SRHC Q9999 $5.59CLINDAMYCINCAP300MG-SRHC Q9999 $5.59DOXYCYCLINEHYCTAB100MG-SRHC Q9999 $5.59Glucosegel-SRHC Q9999 $5.59Levonorgestrel0.75mgTab(PlanB)-SRHC Q9999 $54.46METHYLPREDTAB4MG(MedrolDosepak)-SRHC Q9999 $41.92METRONIDAZOLE250mgtab-SRHC Q9999 $5.59MUPIROCINOINT2%-SRHC Q9999 $15.71NITROFURANTOINCAP100MG-SRHC Q9999 $5.59OFLOXACINOPH0.3%-SRHC Q9999 $29.23ONDANSETRONODTAB4MG-SRHC Q9999 $5.59PENICILLINVPOTTAB250MG-SRHC Q9999 $5.59PENICILLINVPOTTAB500MG-SRHC Q9999 $5.59PENICILLIN-VKOralSoln.250MG/5ml-SRHC Q9999 $14.30PHENAZOPYRIDINETAB100MG-SRHC Q9999 $5.59PREDNISONETAB5MG-SRHC Q9999 $5.59PROMETHAZINEHCLTAB25MG-SRHC Q9999 $5.59SULFACETOPHSOL0.3%-SRHC Q9999 $77.71SULFAMETH-TMP200/40/5mlSOLN-SRHC Q9999 $33.33TRIMETH+SUL+POLYOPH-SRHC Q9999 $24.32ibuprofensusp100/5ml-SRHC Q9999 $5.5900409-1159-02-bupivacaine0.25%PFInjSol30mL-00409-1159-02 S0020 CallforPrice00409-1162-02-bupivacaine0.5%PFInjSol30mL-00409-1162-02 S0020 CallforPrice61553-0171-37-bupivacaine0.2%Soln-IV S0020 CallforPrice99999-9999-63-bupivacaine0.2%Soln-IV S0020 CallforPriceFamotidine20mgIVPB-IVMedicationCharge S0028 $2.16Injection,famotidine,20mg S0028 $5.10Injection,metronidazole,500mg S0030 $3.10Metronidazole500mgIVPB100mL-IVMedicationCharge S0030 $5.5300338-1055-48-metronidazole500mg/100mLIVSol-00338-1055-48 S0030 CallforPrice00338-1055-48-metronidazole500mg/100mLSol S0030 CallforPrice00409-7811-24-metronidazole500mg/100mLIVSol-00409-7811-24 S0030 CallforPrice63323-0386-20-cefotetan2gmInj-63323-0386-20 S0074 CallforPriceClindamycin600mgIVPB-IVMedicationCharge S0077 $5.30Clindamycin900mgIVPB-IVMedicationCharge S0077 $5.3000009-0902-18-clindamycin150mg/mLIVSol6mL-00009-0902-18 S0077 CallforPrice00009-3375-01-clindamycin600mg/50mL-D5%600Soln S0077 CallforPrice00009-3375-02-clindamycin600mg/50mL-D5WIVSol-00009-3375-02 S0077 CallforPrice00009-3382-01-clindamycin900mg/50mL-D5%900Soln S0077 CallforPrice00009-3382-02-clindamycin900mg/50mL-D5WIVSol-00009-3382-02 S0077 CallforPrice00338-9549-24-clindamycin600mg/50mL-NaCl0.9%Sol S0077 CallforPrice00409-4052-01-clindamycin150mg/mLIVSol6mL-00409-4052-01 S0077 CallforPriceOndansetron,oral,4mg S0119 $44.6657237-0077-10-ondansetron4mgTab S0119 CallforPrice00087-6632-41-didanosine10mg/mLPow S0137 CallforPriceInjection,pantoprazolesodium,40mg S0164 $12.06Pantoprazole40mgIVPB-IVMedicationCharge S0164 $12.0600008-0923-51-pantoprazole40mgIVInj-00008-0923-51 S0164 CallforPrice00008-0923-51-pantoprazole40mgRECInjection S0164 CallforPrice00008-0923-55-pantoprazole40mgIVInj-00008-0923-55 S0164 CallforPrice00008-0923-60-pantoprazole40mgIVInj-00008-0923-60 S0164 CallforPrice
00143-9284-10-pantoprazole40mgPow S0164 CallforPrice55150-0202-10-pantoprazole40mgPow S0164 CallforPrice00641-6008-01-bumetanide0.25mg/mLInjection S0171 CallforPrice00641-6008-10-bumetanide0.25mg/mLSol S0171 CallforPriceRoutinefootcare/visit S0390 $68.0700536-3112-01-nicotine2mgOraltransmucosalGum-00536-3112-01 S4995 CallforPriceDextrose5%with0.45%NaClIV-MiscMedicationCharges S5010 $26.54Yes-MaintenanceTherapySLP S8990 $61.42ConsulttoDieticianAdult S9470 $76.49Crisisinterventionmentalhealthservices,per15min S9484 $39.68Crisisinterventionmentalhealthservices,perhour S9484 $158.82zzCrisisinterventionmentalhealthservices,per15min S9484 $39.68Crisisinterventionmentalhealthservices,each15min S9484 $39.70Crisisinterventionmentalhealthservices,eachhour S9484 $158.82Crisisinterventionservice,per15minutes S9484 $39.70CrisisIntervention-InterventionorStabilization S9484 $39.68Alcoholand/orsubstanceabuseservices,skillsdevelopment T1012 $39.88Casemanagement,each15minutes T1016 $37.54Casemanagement,per15minutes T1016 $37.54CaseManagement-ClinicalServiceProvided T1016 $37.54AlaskaScreeningTool-GT T1023 $82.11Screeningforparticipation,perencounter T1023 $82.11BHAlaskaScreeningToolv2010 T1023 $82.11Fitting/orientation/checkingofhearingaid V5011 $223.44HearingAidRepair-Other V5014 $268.13HearingAidRepair12mos(V5014) V5014 $268.13Hearingaidrepair6mos(V5014) V5014 $268.13Repair/modificationofahearingaid V5014 $268.13Earimpression,each V5275 $62.56SPEECHSCREENING V5362 $67.03Yes-SpeechScreeningArtic-MCD V5362 $67.03LANGUAGESCREENING V5363 $100.55Yes-LanguageScreening V5363 $100.55DYSPHAGIASCREENING V5364 $130.81Yes-DyphagiaScreening V5364 $130.81
