FFC-MP

Sr. # Codes Description Charge Charge
1 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE 1052.9 1263
2 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE 1052.9 1263
3 10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE 1052.9 1263
4 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE 1052.9 1263
5 10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL 1050 1260
6 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST 500 600
7 11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF 1050 1260
8 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< 1050 1260
9 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER 350 420
10 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 1137.6 1365
11 11740 EVACUATION SUBUNGUAL HEMATOMA 540 648
12 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL 1050 1260
13 11982 REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT 1135 1362
14 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 615 738
15 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM 615 738
16 12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM 595 714
17 12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM 595 714
18 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< 1135 1362
19 12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM 1050 1260
20 12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM 1050 1260
21 12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM 1260 1512
22 12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM 1000 1200
23 12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< 1470 1764
24 12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM 1575 1890
25 12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM 1050 1260
26 12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< 1470 1764
27 12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM 1135 1362
28 13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM 1135 1362
29 13152 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM 1135 1362
30 15850 REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON 855 1026
31 16000 INITIAL TX 1ST DEGREE BURN LOCAL TX 1260 1512
32 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL 1135 1362
33 16030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE 960 1152
34 19000 PUNCTURE ASPIRATION CYST BREAST 2520 3024
35 19100 BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX 2520 3024
36 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS 850 1020
37 20551 INJECTION SINGLE TENDON ORIGIN/INSERTION 850 1020
38 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES 850 1020
39 20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES 850 1020
40 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 1000 1200
41 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 1050 1260
42 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 1050 1260
43 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 960 1152
44 20612 ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ 450 540
45 23550 OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC 850 1020
46 23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES 1050 1260
47 23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ 1260 1512
48 24105 EXCISION OLECRANON BURSA 950 1140
49 24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ 1050 1260
50 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ 960 1152
51 25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF 960 1152
52 26010 DRAINAGE FINGER ABSCESS SIMPLE 1050 1260
53 26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA 1050 1260
54 27372 REMOVAL FOREIGN BODY DEEP THIGH/KNEE 450 540
55 28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS 1260 1512
56 28192 REMOVAL FOREIGN BODY FOOT DEEP 1050 1260
57 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION 2000 2400
58 28490 CLTX FX GRT TOE PHLX/PHLG W/O MANJ 960 1152
59 29075 APPLICATION CAST ELBOW FINGER SHORT ARM 915 1098
60 29086 APPLICATION CAST FINGER 885 1062
61 29105 APPLICATION LONG ARM SPLINT SHOULDER HAND 990 1188
62 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC 845 1014
63 29126 APPLICATION SHORT ARM SPLINT DYNAMIC 899 1079
64 29130 APPLICATION FINGER SPLINT STATIC 486 583
65 29131 APPLICATION FINGER SPLINT DYNAMIC 546 655
66 29240 STRAPPING SHOULDER 1050 1260
67 29280 STRAPPING HAND/FINGER 1050 1260
68 29450 APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG 1050 1260
69 29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES 784 941
70 29515 APPLICATION SHORT LEG SPLINT CALF FOOT 849 1019
71 29530 STRAPPING KNEE 1700 2040
72 29540 STRAPPING ANKLE &/FOOT 1135 1362
73 29550 STRAPPING TOES 1135 1362
74 29700 REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST 1050 1260
75 30300 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE 1260 1512
76 30901 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 1260 1512
77 30903 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX 1000 1200
78 30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST 1260 1512
79 3120F 12-LEAD ECG PERFORMED 230 276
80 31541 LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP 1000 1200
81 33512 CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS 2520 3024
82 36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN 170 204
83 36010 INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA 570 684
84 36410 NON-ROUTINE BL DRAW 3/> YRS 315 378
85 36415 ROUTINE VENIPUNCTURE 380 456
86 36416 COLLECTION CAPILLARY BLOOD SPECIMEN 570 684
87 36555 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y 750 900
88 36558 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> 1250 1500
89 36569 INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/> 960 1152
90 36572 INSERTION PICC W/RS&I < 5 YR 500 600
91 36600 ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX 750 900
92 43752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE 1943 2332
93 43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE 1250 1500
94 51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE 1050 1260
95 51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED 1050 1260
96 57415 REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL 1050 1260
97 58301 REMOVAL INTRAUTERINE DEVICE IUD 1050 1260
98 64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH 1135 1362
99 64451 Injection(s), anesthetic agent(s) and/or steroid; 500 600
100 65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL 1260 1512
101 65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR 1050 1260
102 65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP 1135 1362
103 65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP 1260 1512
104 65435 RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION 1135 1362
105 69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES 1135 1362
106 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 1135 1362
107 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 1260 1512
108 70030 RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY 1825 2190
109 70110 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS 2115 2538
110 70130 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE 1520 1824
111 70140 RADEX FACIAL BONES < 3 VIEWS 1995 2394
112 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS 1995 2394
113 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS 2520 3024
114 70200 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS 2520 3024
115 70210 RADEX SINUSES PARANASAL <3 VIEWS 2520 3024
116 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS 2520 3024
117 70250 RADIOLOGIC EXAMINATION SKULL 4/> VIEWS 2270 2724
118 70260 RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS 2270 2724
119 70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT 2520 3024
120 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE 2520 3024
121 70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL 5670 6804
122 70460 CT HEAD/BRAIN W/CONTRAST MATERIAL 5670 6804
123 70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL 5670 6804
124 70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL 5670 6804
125 70481 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL 5670 6804
126 70482 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR 5670 6804
127 70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL 5670 6804
128 70487 CT MAXILLOFACIAL W/CONTRAST MATERIAL 5670 6804
129 70488 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL 5040 6048
130 70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL 5040 6048
131 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL 5670 6804
132 70492 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL 5040 6048
133 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST 5040 6048
134 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 5040 6048
135 71010 RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL 2270 2724
136 71020 RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL 2270 2724
137 71035 RADEX CHEST SPECIAL VIEWS 2520 3024
138 71045 Radiologic examination, chest ; single view 1975 2370
139 71046 Radiologic examination, chest ; 2 views 2520 3024
140 71047 Radiologic examination, chest ; 3 views 2520 3024
141 71048 (Radiologic examination, chest ; 4 or more 2520 3024
142 71100 RADEX RIBS UNILATERAL 2 VIEWS 1895 2274
143 71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS 2195 2634
144 71110 RADEX RIBS BILATERAL 3 VIEWS 2520 3024
145 71111 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS 2520 3024
146 71120 RADEX STERNUM MINIMUM 2 VIEWS 2520 3024
147 71250 CT THORAX W/O CONTRAST MATERIAL 5670 6804
148 71260 CT THORAX W/CONTRAST MATERIAL 5670 6804
149 71270 CT THORAX W/O & W/CONTRAST MATERIAL 5670 6804
150 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 5670 6804
151 72020 RADEX SPINE 1 VIEW SPECIFY LEVEL 2520 3024
152 72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS 2520 3024
153 72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS 2520.75 3025
154 72052 RADEX SPINE CERVICAL 6 OR MORE VIEWS 2520.75 3025
155 72070 RADEX SPINE THORACIC 2 VIEWS 2520 3024
156 72072 RADEX SPINE THORACIC 3 VIEWS 2520 3024
157 72074 RADEX SPINE THORACIC MINIMUM 4 VIEWS 2520 3024
158 72080 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS 2520 3024
159 72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW 2520 3024
160 72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS 2715.35 3258
161 72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS 2975.5 3571
162 72114 RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 2520 3024
163 72120 RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS 2520 3024
164 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL 5670 6804
165 72126 CT CERVICAL SPINE W/CONTRAST MATERIAL 5040 6048
166 72127 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL 5775 6930
167 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL 5670 6804
168 72129 CT THORACIC SPINE W/CONTRAST MATERIAL 5040 6048
169 72130 CT THORACIC SPINE W/O & W/CONTRAST MATERIAL 5670 6804
170 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL 5670 6804
171 72132 CT LUMBAR SPINE W/CONTRAST MATERIAL 5670 6804
172 72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL 5670 6804
173 72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS 1759.5 2111
174 72190 RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS 1845 2214
175 72192 CT PELVIS W/O CONTRAST MATERIAL 5670 6804
176 72193 CT PELVIS W/CONTRAST MATERIAL 5689 6827
177 72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS 2520 3024
178 72270 MYELOGRAPY 2/MORE REGIONS RS&I 2520 3024
179 73000 RADEX CLAVICLE COMPLETE 2520 3024
180 73010 RADEX SCAPULA COMPLETE 2520 3024
181 73020 RADEX SHOULDER 1 VIEW 1899.5 2279
182 73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS 2695.59 3235
183 73050 RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ 2520 3024
184 73060 RADEX HUMERUS MINIMUM 2 VIEWS 2520 3024
185 73070 RADEX ELBOW 2 VIEWS 2520 3024
186 73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS 2520 3024
187 73090 RADEX FOREARM 2 VIEWS 2520 3024
188 73100 RADEX WRIST 2 VIEWS 2520 3024
189 73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS 2637 3164
190 73120 RADEX HAND 2 VIEWS 2153 2584
191 73130 RADEX HAND MINIMUM 3 VIEWS 2520 3024
192 73140 RADEX FINGR MINIMUM 2 VIEWS 1895 2274
193 73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL 5670 6804
194 73201 CT UPPER EXTREMITY W/CONTRAST MATERIAL 5670 6804
195 73202 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL 5670 6804
196 73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW 1750 2100
197 73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS 2520 3024
198 73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS 2520 3024
199 73510 X-RAY HIP UNILATERAL 2 VIEWS 1795 2154
200 73522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS 2520 3024
201 73551 RADIOLOGIC EXAMINATION FEMUR 1 VIEW 1100 1320
202 73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS 1985 2382
203 73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS 1680 2016
204 73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS 2750 3300
205 73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS 2520 3024
206 73565 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST 2520 3024
207 73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS 2520 3024
208 73592 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS 2520 3024
209 73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS 2520 3024
210 73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS 2520 3024
211 73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS 2115 2538
212 73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS 2250 2700
213 73650 RADEX CALCANEUS MINIMUM 2 VIEWS 2520 3024
214 73660 RADEX TOE MINIMUM 2 VIEWS 1466.95 1760
215 73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL 6670 8004
216 73701 CT LOWER EXTREMITY W/CONTRAST MATERIAL 6475 7770
217 73718 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL 6511.35 7814
218 74000 RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW 2520 3024
219 74018 Radiologic examination, abdomen; 1 view 1785 2142
220 74019 Radiologic examination, abdomen; 2 views 1715 2058
221 74020 RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS 2520 3024
222 74021 Radiologic examination, abdomen; 3 or more views 1990.5 2389
223 74022 RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH 1895.5 2275
224 74150 CT ABDOMEN W/O CONTRAST MATERIAL 5980.8 7177
225 74160 CT ABDOMEN W/CONTRAST MATERIAL 5980.8 7177
226 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG 5670 6804
227 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST 5975 7170
228 74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL 5670 6804
229 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL 5670 6804
230 74178 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE 5675 6810
231 74190 PERITONEOGRAM RS&I 2520 3024
232 74240 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB 2520 3024
233 74241 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB 2520 3024
234 74245 RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES 2520 3024
235 74250 RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES 2520 3024
236 74251 RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE 2520 3024
237 74328 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I 3568 4282
238 74329 ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I 2520 3024
239 74330 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I 2738 3286
240 74340 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I 1250 1500
241 74440 VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I 2520 3024
242 76380 CT LIMITED/LOCALIZED FOLLOW UP STUDY 5670 6804
243 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM 2520 3024
244 76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION 2270 2724
245 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE 1570 1884
246 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED 995 1194
247 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION 2686.67 3224
248 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED 3335.5 4003
249 76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE 1794 2153
250 76775 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED 2520 3024
251 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT 2270 2724
252 76802 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION 975 1170
253 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION 2520 3024
254 76810 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO 2520 3024
255 76816 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS 1545 1854
256 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG 2520 3024
257 76830 US TRANSVAGINAL 2673.5 3208
258 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE 2520 3024
259 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U 2270 2724
260 76870 US SCROTUM & CONTENTS 3045 3654
261 76881 US EXTREMITY NON-VASC REAL-TIME IMG COMPL 2520 3024
262 76882 US EXTREMITY NON-VASC REAL-TIME IMG LMTD 1150 1380
263 80047 BASIC METABOLIC PANEL CALCIUM IONIZED 1295 1554
264 80048 BASIC METABOLIC PANEL CALCIUM TOTAL 1192 1430
265 80051 ELECTROLYTE PANEL 450 540
266 80053 COMPREHENSIVE METABOLIC PANEL 1495 1794
267 80061 LIPID PANEL 1260 1512
268 80074 ACUTE HEPATITIS PANEL 1200 1440
269 80076 HEPATIC FUNCTION PANEL 1215 1458
270 80102 Drug confirmation, each procedure 230 276
271 80299 QUANTITATION DRUG NOT ELSEWHERE SPECIFIED 850 1020
272 80305 DRUG TEST PRSMV QUAL DIR OPTICAL OBS PER DAY 411 493
273 80307 DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS 630 756
274 80320 DRUG SCREEN QUANTITATIVE ALCOHOLS 570 684
275 80324 DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 630 756
276 80329 DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 570 684
277 80335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 230 276
278 80345 DRUG SCREENING BARBITURATES 630 756
279 80346 DRUG SCREENING BENZODIAZEPINES 1-12 630 756
280 80347 DRUG SCREENING BENZODIAZEPINES 13 OR MORE 525 630
281 80348 DRUG SCREENING BUPRENORPHINE 525 630
282 80349 DRUG SCREENING CANNABINOIDS NATURAL 400 480
283 80351 DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6 630 756
284 80352 DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE 170 204
285 80353 DRUG SCREENING COCAINE 630 756
286 80356 DRUG SCREENING HEROIN METABOLITE 115 138
287 80358 DRUG SCREENING METHADONE 630 756
288 80359 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES 630 756
289 80361 DRUG SCREENING OPIATES 1 OR MORE 630 756
290 80362 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 570 684
291 80365 DRUG SCREENING OXYCODONE 630 756
292 80366 DRUG SCREENING PREGABALIN 285 342
293 80367 DRUG SCREENING PROPOXYPHENE 230 276
294 80373 DRUG SCREENING TRAMADOL 570 684
295 80374 DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS 570 684
296 81000 URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY 425 510
297 81001 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY 575 690
298 81002 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP 250 300
299 81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY 454 545
300 81025 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS 570 684
301 82010 KETONE BODIES SERUM QUANTITATIVE 318 382
302 82040 ALBUMIN SERUM PLASMA/WHOLE BLOOD 170 204
303 82075 ASSAY OF ALCOHOL BREATH 500 600
304 82140 ASSAY OF AMMONIA 850 1020
305 82150 ASSAY OF AMYLASE 477 572
306 82247 BILIRUBIN TOTAL 305 366
307 82248 BILIRUBIN DIRECT 375 450
308 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 1260 1512
309 82272 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC 1260 1512
310 82310 CALCIUM TOTAL 420 504
311 82330 CALCIUM IONIZED 420 504
312 82374 CARBON DIOXIDE BICARBONATE 300 360
313 82435 CHLORIDE BLD 250 300
314 82465 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL 450 540
315 82533 CORTISOL TOTAL 340 408
316 82550 CREATINE KINASE TOTAL 390 468
317 82553 CREATINE KINASE MB FRACTION ONLY 650 780
318 82565 CREATININE BLOOD 390 468
319 82668 ASSAY OF ERYTHROPOIETIN 650 780
320 82728 ASSAY OF FERRITIN 550 660
321 82747 ASSAY OF FOLIC ACID RBC 298.5 358
322 82784 ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH 675 810
323 82803 BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 541 649
324 82945 GLUCOSE BODY FLUID OTHER THAN BLOOD 395 474
325 82947 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP 230 276
326 82948 GLUCOSE BLOOD REAGENT STRIP 570 684
327 82962 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE 230 276
328 82977 ASSAY OF GLUTAMYLTRASE GAMMA 500 600
329 83009 HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE 505 606
330 83013 HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE 570 684
331 83036 HEMOGLOBIN GLYCOSYLATED A1C 275 330
332 83525 ASSAY OF INSULIN TOTAL 285 342
333 83605 ASSAY OF LACTATE 475 570
334 83615 LACTATE DEHYDROGENASE LDH 500 600
335 83690 ASSAY OF LIPASE 463 556
336 83718 LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL 350 420
337 83735 ASSAY OF MAGNESIUM 500 600
338 83835 METANEPHRINES 650 780
339 83874 MYOGLOBIN 650 780
340 83880 NATRIURETIC PEPTIDE 880 1056
341 83992 ASSAY OF PHENCYCLIDINE 450 540
342 84075 ASSAY OF PHOSPHATASE ALKALINE 255 306
343 84100 ASSAY OF PHOSPHORUS INORGANIC 243 292
344 84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD 250 300
345 84145 PROCALCITONIN (PCT) 850 1020
346 84155 PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD 289 347
347 84157 PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC 354 425
348 84295 SODIUM SERUM PLASMA OR WHOLE BLOOD 200 240
349 84436 ASSAY OF THYROXINE TOTAL 365 438
350 84439 ASSAY OF FREE THYROXINE 448 538
351 84443 ASSAY OF THYROID STIMULATING HORMONE TSH 645 774
352 84450 TRANSFERASE ASPARTATE AMINO AST SGOT 297 356
353 84460 TRANSFERASE ALANINE AMINO ALT SGPT 250 300
354 84478 ASSAY OF TRIGLYCERIDES 715 858
355 84479 THYROID HORM UPTK/THYROID HORMONE BINDING RATIO 335 402
356 84480 ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 570 684
357 84481 ASSAY OF TRIIODOTHYRONINE T3 FREE 475 570
358 84484 ASSAY OF TROPONIN QUANTITATIVE 879 1055
359 84512 ASSAY OF TROPONIN QUALITATIVE 340 408
360 84520 ASSAY OF UREA NITROGEN QUANTITATIVE 359 431
361 84550 ASSAY OF BLOOD/URIC ACID 570 684
362 84702 GONADOTROPIN CHORIONIC QUANTITATIVE 980 1176
363 84703 GONADOTROPIN CHORIONIC QUALITATIVE 850 1020
364 85025 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC 1260 1512
365 85027 BLOOD COUNT COMPLETE AUTOMATED 340 408
366 85379 FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE 875 1050
367 85610 PROTHROMBIN TIME 778.4 934
368 85651 SEDIMENTATION RATE RBC NON-AUTOMATED 570 684
369 85652 SEDIMENTATION RATE RBC AUTOMATED 140 168
370 85730 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD 299 359
371 86038 ANTINUCLEAR ANTIBODIES ANA 342.5 411
372 86039 ANTINUCLEAR ANTIBODIES ANA TITER 434 521
373 86060 ANTISTREPTOLYSIN O TITER 155 186
374 86140 C-REACTIVE PROTEIN 420 504
375 86235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD 570 684
376 86308 HETEROPHILE ANTIBODIES SCREEN 436.85 524
377 86328 IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19 300 360
378 86431 RHEUMATOID FACTOR QUANTITATIVE 256 307
379 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 320 384
380 86593 SYPHILIS TEST QUANTITATIVE 630 756
381 86677 ANTIBODY HELICOBACTER PYLORI 570 684
382 86689 ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST 387.75 465
383 86695 ANTIBODY HERPES SMPLX TYPE 1 340 408
384 86696 ANTIBODY HERPES SMPLX TYPE 2 400 480
385 86701 ANTIBODY HIV-1 400 480
386 86735 ANTIBODY MUMPS 600 720
387 86757 ANTIBODY RICKETTSIA 850 1020
388 86762 ANTIBODY RUBELLA 400 480
389 86765 ANTIBODY RUBEOLA 500 600
390 86769 SARS-COV-2 COVID-19 ANTIBODY 850 1020
391 86787 ANTIBODY VARICELLA-ZOSTER 250 300
392 86900 BLOOD TYPING SEROLOGIC ABO 850 1020
393 86901 BLOOD TYPING SEROLOGIC RH (D) 850 1020
394 87015 CONCENTRATION INFECTIOUS AGENTS 286.75 344
395 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 385.79 463
396 87045 CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL 794 953
397 87070 CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL 510 612
398 87071 CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL 850 1020
399 87075 CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID 570 684
400 87076 CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL 430 516
401 87077 CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL 570 684
402 87081 CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ 570 684
403 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 387.5 465
404 87088 CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE 286.89 344
405 87106 CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST 850 1020
406 87184 SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD 650 780
407 87205 SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL 349.75 420
408 87210 SMR PRIM SRC WET MOUNT NFCT AGT 850 1020
409 87230 TOXIN/ANTITOXIN ASSAY TISSUE CULTURE 950 1140
410 87255 VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC 400 480
411 87338 IAAD IA HPYLORI STOOL 630 756
412 87389 IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE 600 720
413 87420 IAAD IA RESPIRATORY SYNCTIAL VIRUS 475 570
414 87426 SARSCOV CORONAVIRUS AG IA 300 360
415 87428 IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B 400 480
416 87486 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ 400 480
417 87491 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ 630 756
418 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 850 1020
419 87529 IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ 850 1020
420 87581 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ 300 360
421 87591 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ 340 408
422 87631 IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS 550 660
423 87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET 600 720
424 87635 SARS-COV-2 COVID-19 AMP PRB 500 600
425 87637 SARSCOV2&INF A&B&RSV AMP PRB 500 600
426 87640 IADNA S AUREUS AMPLIFIED PROBE TQ 1000 1200
427 87651 IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ 400 480
428 87653 IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ 400 480
429 87660 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ 650 780
430 87661 Infectious agent detection by nucleic acid (DNA or RNA) 400 480
431 87798 IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM 400 480
432 87799 IADNA NOS QUANTIFICATION EACH ORGANISM 600 720
433 87801 Infectious agent detection by nucleic acid (DNA or RNA) 400 480
434 87804 IAADIADOO INFLUENZA 478.8 575
435 87806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES 1050 1260
436 87807 IAADIADOO RESPIRATORY SYNCTIAL VIRUS 630 756
437 87880 IAADIADOO STREPTOCOCCUS GROUP A 865.2 1038
438 89051 CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT 414.4 497
439 89055 LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE 570 684
440 89240 UNLIS MISC 204.95 246
441 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE 252.75 303
442 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE 350 420
443 90714 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE 672 806
444 90715 TDAP VACCINE 7 YRS/> IM 630 756
445 93000 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R 630 756
446 93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R 800 960
447 93010 ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY 200 240
448 93040 RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT 800 960
449 93042 RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON 630 756
450 93224 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I 1010 1212
451 93307 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP 2400 2880
452 93631 INTRAOP EPICAR& ENDOCAR PACG& MAPG 760 912
453 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY 2051 2461
454 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL 2434.15 2921
455 93923 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS 2520 3024
456 93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY 2975.33 3570
457 93926 DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY 2270 2724
458 93930 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY 2733 3280
459 93931 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY 2479.85 2976
460 93970 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY 2879.55 3455
461 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY 2520 3024
462 93975 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM 3179.5 3815
463 93980 DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL 1733.2 2080
464 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 289 347
465 94760 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER 380.8 457
466 94761 NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER 340 408
467 94762 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR 570 684
468 96360 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR 1260 1512
469 96361 IV INFUSION HYDRATION EACH ADDITIONAL HOUR 595 714
470 96365 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 1260 1512
471 96366 IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR 781.2 937
472 96367 IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR 1038.8 1247
473 96368 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS 800 960
474 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM 1260 1512
475 96374 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG 1030.4 1236
476 96375 THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG 705.6 847
477 96376 THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC 711.2 853
478 96377 APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION 800 960
479 97010 APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS 142.8 171
480 97116 THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR 649.6 780
481 97542 WHEELCHAIR MGMT EA 15 MIN 512.4 615
482 97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/< 995.75 1195
483 98925 OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS 200 240
484 99000 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB 850 1020
485 99024 POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX 760 912
486 99070 SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP 250 300
487 99072 Miscellaneous Medicine Services 125 150
488 99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 525 630
489 99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 1250 1500
490 99173 SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT 1510 1812
491 99217 OBSERVATION CARE DISCHARGE MANAGEMENT 1195 1434
492 99218 INITIAL OBSERVATION CARE/DAY 30 MINUTES 1250 1500
493 99219 INITIAL OBSERVATION CARE/DAY 50 MINUTES 1425 1710
494 99220 INITIAL OBSERVATION CARE/DAY 70 MINUTES 1625 1950
495 99224 SBSQ OBSERVATION CARE/DAY 15 MINUTES 1250 1500
496 99225 SBSQ OBSERVATION CARE/DAY 25 MINUTES 1425 1710
497 99226 SBSQ OBSERVATION CARE/DAY 35 MINUTES 1625 1950
498 99234 OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES 1300 1560
499 99235 OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES 1500 1800
500 99236 OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES 1800 2160
501 99281 EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB 999.01 1199
502 99282 EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY 2000 2400
503 99283 EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY 4200 5040
504 99283CP EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY 2000 2400
505 99284 EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 4500 5400
506 99285 EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ 5000 6000
507 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN 2000 2400
508 99292 CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN 1000 1200
509 A0382 BASIC SUPPORT ROUTINE SUPPLS 75 83
510 A0394 ALS IV DRUG THERAPY SUPPLIES 75 83
511 A4206 1 CC STERILE SYRINGE&NEEDLE 125 138
512 A4207 2 CC STERILE SYRINGE&NEEDLE 90 99
513 A4208 STERILE SYRINGE&NEEDLE 125 138
514 A4209 FIVE PLUS CC STERILE SYRINGE&NEEDLE 125 138
515 A4210 NONNEEDLE INJECTION DEVICE 125 138
516 A4211 SUPP FOR SELF-ADM INJECTIONS 90 99
517 A4212 NON CORING NEEDLE OR STYLET 125 138
518 A4213 20+ CC SYRINGE ONLY 125 138
519 A4215 STERILE NEEDLE 125 138
520 A4216 STERILE WATER/SALINE, 10 ML 125 138
521 A4217 STERILE WATER/SALINE, 500 ML 90 99
522 A4218 STERILE SALINE OR WATER 125 138
523 A4221 SUPP NON-INSULIN INF CATH/WK 125 138
524 A4224 SUPPLY INSULIN INF CATH/WK 125 138
525 A4232 SYRINGE W/NEEDLE INSULIN 3CC 90 99
526 A4244 ALCOHOL OR PEROXIDE PER PINT 125 138
527 A4245 ALCOHOL WIPES PER BOX 125 138
528 A4246 BETADINE/PHISOHEX SOLUTION 125 138
529 A4247 BETADINE/IODINE SWABS/WIPES 75 83
530 A4248 CHLORHEXIDINE ANTISEPT 125 138
531 A4250 URINE REAGENT STRIPS/TABLETS 125 138
532 A4253 BLOOD GLUCOSE/REAGENT STRIPS 75 83
533 A4281 REPLACEMENT BREASTPUMP TUBE 125 138
534 A4283 REPLACEMENT BREASTPUMP CAP 125 138
535 A4300 CATH IMPL VASC ACCESS PORTAL 90 99
536 A4310 INSERT TRAY W/O BAG/CATH 125 138
537 A4311 CATHETER W/O BAG 2-WAY LATEX 125 138
538 A4313 CATHETER W/BAG 3-WAY 125 138
539 A4314 CATH W/DRAINAGE 2-WAY LATEX 125 138
540 A4315 CATH W/DRAINAGE 2-WAY SILCNE 90 99
541 A4322 IRRIGATION SYRINGE 115 127
542 A4327 FEM URINARY COLLECT DEV CUP 125 138
543 A4332 LUBE STERILE PACKET 75 83
544 A4338 INDWELLING CATHETER LATEX 115 127
545 A4352 COUDE TIP URINARY CATHETER 90 99
546 A4353 INTERMITTENT URINARY CATH 125 138
547 A4358 URINARY LEG OR ABDOMEN BAG 125 138
548 A4369 SKIN BARRIER LIQUID PER OZ 125 138
549 A4402 LUBRICANT PER OUNCE 90 99
550 A4406 PECTIN BASED OSTOMY PASTE 90 99
551 A4450 NON-WATERPROOF TAPE 125 138
552 A4452 WATERPROOF TAPE 125 138
553 A4458 REUSABLE ENEMA BAG 115 127
554 A4461 SURGICL DRESS HOLD NON-REUSE 125 138
555 A4465 NON-ELASTIC EXTREMITY BINDER 90 99
556 A4470 GRAVLEE JET WASHER 75 83
557 A4550 SURGICAL TRAYS 125 138
558 A4554 DISPOSABLE UNDERPADS 75 83
559 A4556 ELECTRODES, PAIR 125 138
560 A4558 CONDUCTIVE GEL OR PASTE 115 127
561 A4562 PESSARY, NON RUBBER,ANY TYPE 90 99
562 A4565 SLINGS 125 138
563 A4566 SHOULD SLING/VEST/ABRESTRAIN 90 99
564 A4570 SPLINT 375 413
565 A4580 CAST SUPPLIES (PLASTER) 115 127
566 A4606 OXYGEN PROBE USED W OXIMETER 125 138
567 A4613 BATTERY CHARGER 125 138
568 A4615 CANNULA NASAL 125 138
569 A4616 TUBING (OXYGEN) PER FOOT 90 99
570 A4619 FACE TENT 125 138
571 A4620 VARIABLE CONCENTRATION MASK 125 138
572 A4628 OROPHARYNGEAL SUCTION CATH 125 138
573 A4629 TRACHEOSTOMY CARE KIT 75 83
574 A4635 UNDERARM CRUTCH PAD 500 550
575 A4649 SURGICAL SUPPLIES 125 138
576 A4653 PD CATHETER ANCHOR BELT 75 83
577 A4657 SYRINGE W/WO NEEDLE 125 138
578 A4670 AUTOMATIC BP MONITOR, DIAL 125 138
579 A4673 EXT LINE W EASY LOCK CONNECT 125 138
580 A4750 ART OR VENOUS BLOOD TUBING 75 83
581 A4770 BLOOD COLLECTION TUBE/VACUUM 125 138
582 A4927 NON-STERILE GLOVES 45 50
583 A4930 STERILE, GLOVES PER PAIR 45 50
584 A5112 URINARY LEG BAG 125 138
585 A5120 SKIN BARRIER, WIPE OR SWAB 125 138
586 A5126 DISK/FOAM PAD +OR- ADHESIVE 125 138
587 A6021 COLLAGEN DRESSING <=16 SQ IN 115 127
588 A6196 ALGINATE DRESSING <=16 SQ IN 125 138
589 A6203 COMPOSITE DRSG <= 16 SQ IN 125 138
590 A6208 CONTACT LAYER > 48 SQ IN 125 138
591 A6209 FOAM DRSG <=16 SQ IN W/O BDR 125 138
592 A6212 FOAM DRG <=16 SQ IN W/BORDER 90 99
593 A6216 NON-STERILE GAUZE<=16 SQ IN 125 138
594 A6217 NON-STERILE GAUZE>16<=48 SQ 125 138
595 A6218 NON-STERILE GAUZE > 48 SQ IN 90 99
596 A6219 GAUZE <= 16 SQ IN W/BORDER 90 99
597 A6220 GAUZE >16 <=48 SQ IN W/BORDR 90 99
598 A6221 GAUZE > 48 SQ IN W/BORDER 75 83
599 A6222 GAUZE <=16 IN NO W/SAL W/O B 90 99
600 A6223 GAUZE >16<=48 NO W/SAL W/O B 75 83
601 A6224 GAUZE > 48 IN NO W/SAL W/O B 125 138
602 A6231 HYDROGEL DSG<=16 SQ IN 125 138
603 A6233 HYDROGEL DRESSING >48 SQ IN 125 138
604 A6235 HYDROCOLLD DRG >16<=48 W/O B 75 83
605 A6238 HYDROCOLLD DRG >16<=48 W/BDR 75 83
606 A6239 HYDROCOLLD DRG > 48 IN W/BDR 90 99
607 A6246 HYDROGEL DRG >16<=48 IN W/B 125 138
608 A6248 HYDROGEL DRSG GEL FILLER 125 138
609 A6250 SKIN SEAL PROTECT MOISTURIZR 125 138
610 A6251 ABSORPT DRG <=16 SQ IN W/O B 125 138
611 A6252 ABSORPT DRG >16 <=48 W/O BDR 125 138
612 A6253 ABSORPT DRG > 48 SQ IN W/O B 125 138
613 A6254 ABSORPT DRG <=16 SQ IN W/BDR 125 138
614 A6255 ABSORPT DRG >16<=48 IN W/BDR 90 99
615 A6257 TRANSPARENT FILM <= 16 SQ IN 125 138
616 A6258 TRANSPARENT FILM >16<=48 IN 125 138
617 A6260 WOUND CLEANSER ANY TYPE/SIZE 125 138
618 A6266 IMPREG GAUZE NO H20/SAL/YARD 125 138
619 A6402 MEDICAL/SURGICAL SUPPLIES AND DEVICES (ALSO SEE 062X AN EXTENSION OF STE 125 138
620 A6403 STERILE GAUZE>16 <= 48 SQ IN 90 99
621 A6404 STERILE GAUZE > 48 SQ IN 125 138
622 A6407 PACKING STRIPS, NON-IMPREG 90 99
623 A6412 OCCLUSIVE EYE PATCH 75 83
624 A6413 ADHESIVE BANDAGE, FIRST-AID 125 138
625 A6441 PAD BAND W>=3 <5/YD 90 99
626 A6442 CONFORM BAND N/S W<3/YD 115 127
627 A6445 CONFORM BAND S W <3/YD 125 138
628 A6446 CONFORM BAND S W>=3 <5/YD 125 138
629 A6447 CONFORM BAND S W >=5/YD 75 83
630 A6448 LT COMPRES BAND <3/YD 125 138
631 A6449 LT COMPRES BAND >=3 <5/YD 115 127
632 A6450 LT COMPRES BAND >=5/YD 90 99
633 A6453 SELF-ADHER BAND W <3/YD 125 138
634 A6454 SELF-ADHER BAND W>=3 <5/YD 90 99
635 A6455 SELF-ADHER BAND >=5/YD 125 138
636 A6456 ZINC PASTE BAND W >=3<5/YD 125 138
637 A6457 TUBULAR DRESSING 125 150
638 A6530 COMPRESSION STOCKING BK18-30 75 90
639 A6545 GRAD COMP NON-ELASTIC BK 90 108
640 A7000 DISPOSABLE CANISTER FOR PUMP 125 150
641 A7001 NONDISPOSABLE PUMP CANISTER 125 150
642 A7002 TUBING USED W SUCTION PUMP 125 150
643 A7003 NEBULIZER ADMINISTRATION SET 125 150
644 A7004 DISPOSABLE NEBULIZER SML VOL 125 150
645 A7005 NONDISPOSABLE NEBULIZER SET 125 150
646 A7006 FILTERED NEBULIZER ADMIN SET 75 90
647 A7015 AEROSOL MASK USED W NEBULIZE 90 108
648 A7030 CPAP FULL FACE MASK 90 108
649 A7031 REPLACEMENT FACEMASK INTERFA 125 150
650 A7046 REPL WATER CHAMBER, PAP DEV 125 150
651 A7047 RESP SUCTION ORAL INTERFACE 125 150
652 A9150 MISC/EXPER NON-PRESCRIPT DRU 75 90
653 A9270 NON-COVERED ITEM OR SERVICE 90 108
654 A9273 HOT/COLD H2OBOT/CAP/COL/WRAP 125 150
655 A9281 REACHING/GRABBING DEVICE 125 150
656 B4082 ENTERAL NG TUBING W/O STYLET 250 300
657 C1722 AICD, SINGLE CHAMBER 2150 2580
658 C1751 CATH, INF, PER/CENT/MIDLINE 2120 2544
659 C1781 MESH (IMPLANTABLE) 1541 1849
660 C2618 PROBE/NEEDLE, CRYO 340 408
661 C9285 PATCH, LIDOCAINE/TETRACAINE 85 102
662 E0110 CRUTCH FOREARM PAIR 699.75 840
663 E0114 CRUTCH UNDERARM PAIR NO WOOD 795.8 955
664 E0116 CRUTCH UNDERARM EACH NO WOOD 599.75 720
665 E0168 HEAVYDUTY/WIDE COMMODE CHAIR 380 456
666 E0240 BATH/SHOWER CHAIR 115 138
667 E0275 BED PAN STANDARD 230 276
668 E0325 URINAL MALE JUG-TYPE 145 174
669 E0326 URINAL FEMALE JUG-TYPE 145 174
670 E0487 ELECTRONIC SPIROMETER 350 420
671 E0570 NEBULIZER WITH COMPRESSION 910 1092
672 E0607 BLOOD GLUCOSE MONITOR HOME 570 684
673 E0625 PATIENT LIFT BATHROOM OR TOI 455 546
674 G0168 WOUND CLOSURE BY ADHESIVE 380 456
675 G0378 HOSPITAL OBSERVATION PER HR 2520 3024
676 G0402 INITIAL PREVENTIVE EXAM 2100 2520
677 G0481 DRUG TEST DEF 8-14 CLASSES 500 600
678 G6058 Drug confirmation, each procedure 570 684
679 G8598 ASA/ANTIPLAT THER USED 60 72
680 G8601 NO ELIG TPA INIT W/IN 3 HRS 1135 1362
681 G8602 NO TPA INIT W/IN 3 HRS 1135 1362
682 J0120 TETRACYCLIN INJECTION 190 228
683 J0129 ABATACEPT INJECTION 190 228
684 J0131 ACETAMINOPHEN INJECTION 30 36
685 J0153 ADENOSINE INJ 1MG 115 138
686 J0171 ADRENALIN EPINEPHRINE INJECT 190 228
687 J0282 AMIODARONE HCL 115 138
688 J0290 AMPICILLIN 500 MG INJ 50 60
689 J0295 AMPICILLIN SODIUM PER 1.5 GM 250 300
690 J0360 HYDRALAZINE HCL INJECTION 190 228
691 J0456 AZITHROMYCIN 190 228
692 J0461 ATROPINE SULFATE INJECTION 60 72
693 J0500 DICYCLOMINE INJECTION 225.85 271
694 J0561 PENICILLIN G BENZATHINE INJ 190 228
695 J0610 CALCIUM GLUCONATE INJECTION 30 36
696 J0690 CEFAZOLIN SODIUM INJECTION 190 228
697 J0696 CEFTRIAXONE SODIUM INJECTION 190 228
698 J0697 STERILE CEFUROXIME INJECTION 115 138
699 J0735 CLONIDINE HYDROCHLORIDE 115 138
700 J0744 CIPROFLOXACIN IV 190 228
701 J0780 PROCHLORPERAZINE INJECTION 190 228
702 J1020 METHYLPREDNISOLONE 20 MG INJ 90 108
703 J1030 METHYLPREDNISOLONE 40 MG INJ 100 120
704 J1040 METHYLPREDNISOLONE 80 MG INJ 100 120
705 J1100 DEXAMETHASONE SODIUM PHOS 20 24
706 J1170 HYDROMORPHONE INJECTION 190 228
707 J1200 DIPHENHYDRAMINE HCL INJECTIO 50 60
708 J1265 DOPAMINE INJECTION 40 48
709 J1550 Injection, gamma globulin, intramuscular, 10 cc 30 36
710 J1610 GLUCAGON HYDROCHLORIDE/1 MG 491 589
711 J1631 HALOPERIDOL DECANOATE INJ 315 378
712 J1642 INJ HEPARIN SODIUM PER 10 U 29 35
713 J1644 INJ HEPARIN SODIUM PER 1000U 190 228
714 J1650 INJ ENOXAPARIN SODIUM 142 170
715 J1741 IBUPROFEN INJECTION 115 138
716 J1810 DROPERIDOL/FENTANYL INJ 115 138
717 J1815 INSULIN INJECTION 50 60
718 J1817 INSULIN FOR INSULIN PUMP USE 115 138
719 J1885 KETOROLAC TROMETHAMINE INJ 95 114
720 J1930 LANREOTIDE INJECTION 290.53 349
721 J1940 FUROSEMIDE INJECTION 165 198
722 J1956 LEVOFLOXACIN INJECTION 190 228
723 J2001 Injection, lidocaine hcl for intravenous infusion 129 155
724 J2060 LORAZEPAM INJECTION 190 228
725 J2175 MEPERIDINE HYDROCHL /100 MG 115 138
726 J2250 INJ MIDAZOLAM HYDROCHLORIDE 190 228
727 J2270 MORPHINE SULFATE INJECTION 190 228
728 J2274 IN MORPHINE PRESERVATIV FREE 190 228
729 J2360 ORPHENADRINE INJECTION 190 228
730 J2405 ONDANSETRON HCL INJECTION 20 24
731 J2410 OXYMORPHONE HCL INJECTION 115 138
732 J2425 PALIFERMIN INJECTION 115 138
733 J2504 PEGADEMASE BOVINE, 25 IU 115 138
734 J2543 PIPERACILLIN/TAZOBACTAM 190 228
735 J2550 PROMETHAZINE HCL INJECTION 144 173
736 J2704 INJ, PROPOFOL, 10 MG 115 138
737 J2765 METOCLOPRAMIDE HCL INJECTION 190 228
738 J2780 RANITIDINE HYDROCHLORIDE INJ 115 138
739 J2800 METHOCARBAMOL INJECTION 385 462
740 J2920 METHYLPREDNISOLONE INJECTION 137.5 165
741 J2930 METHYLPREDNISOLONE INJECTION 190 228
742 J3010 FENTANYL CITRATE INJECITON 190 228
743 J3030 SUMATRIPTAN SUCCINATE / 6 MG 315 378
744 J3260 TOBRAMYCIN SULFATE INJECTION 440 528
745 J3301 TRIAMCINOLONE ACET INJ NOS 50 60
746 J3360 DIAZEPAM INJECTION 153 184
747 J3370 VANCOMYCIN HCL INJECTION 190 228
748 J3430 VITAMIN K PHYTONADIONE INJ 299 359
749 J3475 INJ MAGNESIUM SULFATE 115 138
750 J3480 INJ POTASSIUM CHLORIDE 125 150
751 J3490 DRUGS UNCLASSIFIED INJECTION 30 36
752 J7030 NORMAL SALINE SOLUTION INFUS 246.4 296
753 J7040 NORMAL SALINE SOLUTION INFUS 221 265
754 J7042 5% DEXTROSE/NORMAL SALINE 260.4 312
755 J7050 NORMAL SALINE SOLUTION INFUS 250 300
756 J7060 5% DEXTROSE/WATER 250 300
757 J7070 D5W INFUSION 115 138
758 J7120 RINGERS LACTATE INFUSION 250 300
759 J7121 5% DEXTROSE IN LAC RINGERS 250 300
760 J7131 HYPERTONIC SALINE SOL 115 138
761 J7192 FACTOR VIII RECOMBINANT NOS 115 138
762 J7313 FLUOCINOL ACET INTRAVIT IMP 115 138
763 J7510 PREDNISOLONE ORAL PER 5 MG 10 12
764 J7611 ALBUTEROL NON-COMP CON 190 228
765 J7613 ALBUTEROL NON-COMP UNIT 190 228
766 J7614 LEVALBUTEROL NON-COMP UNIT 190 228
767 J7615 LEVALBUTEROL COMP UNIT 190 228
768 J7620 ALBUTEROL IPRATROP NON-COMP 190 228
769 J7631 CROMOLYN SODIUM NONCOMP UNIT 115 138
770 J7637 DEXAMETHASONE COMP CON 115 138
771 J7644 IPRATROPIUM BROMIDE NON-COMP 190 228
772 J7682 TOBRAMYCIN NON-COMP UNIT 115 138
773 J7699 INHALATION SOLUTION FOR DME 115 138
774 J8498 ANTIEMETIC RECTAL/SUPP NOS 115 138
775 J8499 ORAL PRESCRIP DRUG NON CHEMO 115 138
776 J9206 IRINOTECAN INJECTION 115 138
777 L0112 CRANIAL CERVICAL ORTHOSIS 1135 1362
778 L0120 CERV FLEX N/ADJ FOAM PRE OTS 645 774
779 L0150 CERV SEMI-RIG ADJ MOLDED CHN 150 180
780 L0170 CERVICAL COLLAR MOLDED TO PT 350 420
781 L0172 CERV COL SR FOAM 2PC PRE OTS 150 180
782 L0174 CERV SR 2PC THOR EXT PRE OTS 1260 1512
783 L0625 LO FLEX L1-BELOW L5 PRE OTS 650 780
784 L1810 KO ELASTIC WITH JOINTS 1560 1872
785 L1830 KO IMMOB CANVAS LONG PRE OTS 529.5 635
786 L1902 AFO ANKLE GAUNTLET PRE OTS 65 78
787 L1906 AFO MULTILIG ANK SUP PRE OTS 350 420
788 L2360 EXTENDED STEEL SHANK 469.75 564
789 L3031 FOOT LAMIN/PREPREG COMPOSITE 575 690
790 L3201 OXFORD W SUPINAT/PRONAT INF 425 510
791 L3209 SURGICAL BOOT EACH CHILD 425 510
792 L3250 CUSTOM MOLD SHOE REMOV PROST 575 690
793 L3260 AMBULATORY SURGICAL BOOT EAC 650 780
794 L3310 SHOE LIFT ELEV HEEL/SOLE NEO 415 498
795 L3334 SHOE LIFTS ELEVATION HEEL /I 50 60
796 L3500 ORTHO SHOE ADD LEATHER INSOL 390 468
797 L3540 ORTHO SHOE ADD FULL SOLE 575 690
798 L3650 SO 8 ABD RESTRAINT PRE OTS 125 150
799 L3660 SO 8 AB RSTR CAN/WEB PRE OTS 575 690
800 L3670 SO ACRO/CLAV CAN WEB PRE OTS 672.5 807
801 L3720 FOREARM/ARM CUFFS FREE MOTIO 975 1170
802 L3807 WHFO W/O JOINTS PRE CST 500 600
803 L3808 WHFO, RIGID W/O JOINTS 1890 2268
804 L3809 WHFO W/O JOINTS PRE OTS 1890 2268
805 L3905 WHO W/NONTORSION JNT(S) CF 1890 2268
806 L3906 WHO W/O JOINTS CF 1890 2268
807 L3908 WHO COCK-UP NONMOLDE PRE OTS 195 234
808 L4350 ANKLE CONTROL ORTHO PRE OTS 265 318
809 L4360 PNEUMAT WALKING BOOT PRE CST 275 330
810 L4361 PNEUMA/VAC WALK BOOT PRE OTS 275 330
811 L4386 NON-PNEUM WALK BOOT PRE CST 275 330
812 L4387 NON-PNEUM WALK BOOT PRE OTS 275 330
813 L4398 FOOT DROP SPLINT PRE OTS 153 184
814 L4631 AFO, WALK BOOT TYPE, CUS FAB 275 330
815 M0243 CASIRIVI AND IMDEVI INJ 1260 1512
816 P9612 CATHETERIZE FOR URINE SPEC 115 138
817 Q0144 AZITHROMYCIN DIHYDRATE, ORAL 57 68
818 Q0169 PROMETHAZINE HCL 12.5MG ORAL 25 30
819 Q4001 CAST SUP BODY CAST PLASTER 1010 1212
820 Q4006 CAST SUP LONG ARM ADULT FBRG 1010 1212
821 Q4018 CAST SUP LNG ARM SPLINT FBRG 340 408
822 Q4019 CAST SUP LNG ARM SPLNT PED P 800 960
823 Q4020 CAST SUP LNG ARM SPLNT PED F 680 816
824 Q4021 CAST SUP SHT ARM SPLINT PLST 735 882
825 Q4022 CAST SUP SHT ARM SPLINT FBRG 570 684
826 Q4023 CAST SUP SHT ARM SPLNT PED P 570 684
827 Q4024 CAST SUP SHT ARM SPLNT PED F 570 684
828 Q4042 CAST SUP LNG LEG SPLNT FBRGL 1010 1212
829 Q4046 CAST SUP SHT LEG SPLNT FBRGL 1010 1212
830 Q4049 FINGER SPLINT, STATIC 112.5 135
831 Q9962 HOCM 300-349MG/ML IODINE,1ML 570 684
832 Q9963 HOCM 350-399MG/ML IODINE,1ML 230 276
833 Q9967 LOCM 300-399MG/ML IODINE,1ML 15 18
834 S0020 INJECTION, BUPIVICAINE HYDRO 175 210
835 S0028 INJECTION, FAMOTIDINE, 20 MG 125 150
836 S0030 INJECTION, METRONIDAZOLE 125 150
837 S0077 INJECTION, CLINDAMYCIN PHOSP 125 150
838 S0164 INJECTION PANTROPRAZOLE 125 150
839 S0630 REMOVAL OF SUTURES 340 408
840 S1015 IV TUBING EXTENSION SET 75 90
841 S8100 SPACER WITHOUT MASK 125 138
842 S8101 SPACER WITH MASK 125 138
843 S8430 PADDING FOR COMPRSSN BDG 75 83
844 S8431 COMPRESSION BANDAGE 95 105
845 S8451 SPLINT WRIST OR ANKLE 125 138
846 U0001 Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel 250 300
847 U0002 COVID-19 LAB TEST NON-CDC 300 360
848 U0003 COV-19 AMP PRB HGH THRUPUT 400 480
849 U0004 COV-19 TEST NON-CDC HGH THRU 500 600

 

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COVID-19 TESTING UPDATE:

The Exceptional Emergency Room staff and physicians care about you and your loved ones. We are here 24/7 for all your emergency care needs.

  1. If you are experiencing fever, shortness of breath, chest pain, dizziness, weakness, numbness, sensory loss, or any other emergent medical problems, please call 911 or seek medical care immediately at your nearest Emergency Room.
  2. To provide the highest quality emergency medical care to our communities, we are directing all routine COVID testing to outpatient community resources.
  3. Testing through local resources, including your primary care doctor, urgent care, walk-in clinic, or local health department, is appropriate under the following circumstances:
    1. If you have been exposed to a person known to have COVID, and you do not have symptoms, we recommend that you self-quarantine at home and seek testing 4-5 days after exposure. It often takes this long for the infection to be detected by routine lab testing.
    2. If you have no symptoms or very mild symptoms, outpatient testing is also typically appropriate.
    3. Please follow this link for local COVID testing resources.
  4. If you have tested negative, you should still self-quarantine for 14 days from the day of suspected exposure as it can take anywhere from 2-14 days to come down with symptoms of this infection.
  5. Please kindly limit your phone time with our Emergency Rooms as the phone lines are needed to communicate with other health care entities and to provide patients their test results. Thank you for your understanding during this trying time.