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 |