Facility Fees Charges

Sr. # CPT Codes Description Billing Charge Price

1

10060

INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE

$1,263.00

2

10061

INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE

$1,263.00

3

10080

INCISION & DRAINAGE PILONIDAL CYST SIMPLE

$1,263.00

4

10120

INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE

$1,263.00

5

10121

INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL

$1,260.00

6

10160

PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

$600.00

7

11000

DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF

$1,260.00

8

11042

DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<

$1,260.00

9

11719

TRIMMING NONDYSTROPHIC NAILS ANY NUMBER

$420.00

10

11730

AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1

$1,365.00

11

11740

EVACUATION SUBUNGUAL HEMATOMA

$648.00

12

11750

EXCISION NAIL MATRIX PERMANENT REMOVAL

$1,260.00

13

11982

REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

$1,362.00

14

12001

SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK

$738.00

15

12002

SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM

$738.00

16

12004

SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM

$714.00

17

12005

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM

$714.00

18

12011

SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<

$1,362.00

19

12013

SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM

$1,260.00

20

12014

SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM

$1,260.00

21

12015

SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM

$1,512.00

22

12032

REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM

$1,200.00

23

12041

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

$1,764.00

24

12042

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

$1,890.00

25

12044

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

$1,260.00

26

12051

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<

$1,764.00

27

12052

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM

$1,362.00

28

13120

REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM

$1,362.00

29

13152

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM

$1,362.00

30

15850

REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON

$1,026.00

31

16000

INITIAL TX 1ST DEGREE BURN LOCAL TX

$1,512.00

32

16020

DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL

$1,362.00

33

16030

DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE

$1,152.00

34

19000

PUNCTURE ASPIRATION CYST BREAST

$3,024.00

35

19100

BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX

$3,024.00

36

20550

INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

$1,020.00

37

20551

INJECTION SINGLE TENDON ORIGIN/INSERTION

$1,020.00

38

20552

INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

$1,020.00

39

20553

INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES

$1,020.00

40

20600

ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US

$1,200.00

41

20605

ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

$1,260.00

42

20610

ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

$1,260.00

43

20611

ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

$1,152.00

44

20612

ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ

$540.00

45

23550

OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC

$1,020.00

46

23650

CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

$1,260.00

47

23665

CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ

$1,512.00

48

24105

EXCISION OLECRANON BURSA

$1,140.00

49

24640

CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ

$1,260.00

50

25600

CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ

$1,152.00

51

25605

CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF

$1,152.00

52

26010

DRAINAGE FINGER ABSCESS SIMPLE

$1,260.00

53

26725

CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA

$1,260.00

54

27372

REMOVAL FOREIGN BODY DEEP THIGH/KNEE

$540.00

55

28190

REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS

$1,512.00

56

28192

REMOVAL FOREIGN BODY FOOT DEEP

$1,260.00

57

28470

CLOSED TX METATARSAL FRACTURE W/O MANIPULATION

$2,400.00

58

28490

CLTX FX GRT TOE PHLX/PHLG W/O MANJ

$1,152.00

59

29075

APPLICATION CAST ELBOW FINGER SHORT ARM

$1,098.00

60

29086

APPLICATION CAST FINGER

$1,062.00

61

29105

APPLICATION LONG ARM SPLINT SHOULDER HAND

$1,188.00

62

29125

APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC

$1,014.00

63

29126

APPLICATION SHORT ARM SPLINT DYNAMIC

$1,079.00

64

29130

APPLICATION FINGER SPLINT STATIC

$583.00

65

29131

APPLICATION FINGER SPLINT DYNAMIC

$655.00

66

29240

STRAPPING SHOULDER

$1,260.00

67

29280

STRAPPING HAND/FINGER

$1,260.00

68

29450

APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG

$1,260.00

69

29505

APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES

$941.00

70

29515

APPLICATION SHORT LEG SPLINT CALF FOOT

$1,019.00

71

29530

STRAPPING KNEE

$2,040.00

72

29540

STRAPPING ANKLE &/FOOT

$1,362.00

73

29550

STRAPPING TOES

$1,362.00

74

29700

REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST

$1,260.00

75

30300

REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE

$1,512.00

76

30901

CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE

$1,512.00

77

30903

CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX

$1,200.00

78

30905

CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST

$1,512.00

79

3120F

12-LEAD ECG PERFORMED

$276.00

80

31541

LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP

$1,200.00

81

33512

CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS

$3,024.00

82

36000

INTRODUCTION NEEDLE/INTRACATHETER VEIN

$204.00

83

36010

INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA

$684.00

84

36410

NON-ROUTINE BL DRAW 3/> YRS

$378.00

85

36415

ROUTINE VENIPUNCTURE

$456.00

86

36416

COLLECTION CAPILLARY BLOOD SPECIMEN

$684.00

87

36555

INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y

$900.00

88

36558

INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>

$1,500.00

89

36569

INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>

$1,152.00

90

36572

INSERTION PICC W/RS&I < 5 YR

$600.00

91

36600

ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX

$900.00

92

43752

NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE

$2,332.00

93

43753

GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE

$1,500.00

94

51702

INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE

$1,260.00

95

51703

INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED

$1,260.00

96

57415

REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL

$1,260.00

97

58301

REMOVAL INTRAUTERINE DEVICE IUD

$1,260.00

98

64450

INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH

$1,362.00

99

64451

Injection(s), anesthetic agent(s) and/or steroid;

$600.00

100

65205

REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL

$1,512.00

101

65210

RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR

$1,260.00

102

65220

RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP

$1,362.00

103

65222

RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP

$1,512.00

104

65435

RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION

$1,362.00

105

69200

RMVL FB XTRNL AUDITORY CANAL W/O ANES

$1,362.00

106

69209

REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT

$1,362.00

107

69210

REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT

$1,512.00

108

70030

RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY

$2,190.00

109

70110

RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS

$2,538.00

110

70130

RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE

$1,824.00

111

70140

RADEX FACIAL BONES < 3 VIEWS

$2,394.00

112

70150

RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS

$2,394.00

113

70160

RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS

$3,024.00

114

70200

RADEX ORBITS COMPLETE MINIMUM 4 VIEWS

$3,024.00

115

70210

RADEX SINUSES PARANASAL <3 VIEWS

$3,024.00

116

70220

RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS

$3,024.00

117

70250

RADIOLOGIC EXAMINATION SKULL 4/> VIEWS

$2,724.00

118

70260

RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS

$2,724.00

119

70330

RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT

$3,024.00

120

70360

RADIOLOGIC EXAMINATION NECK SOFT TISSUE

$3,024.00

121

70450

CT HEAD/BRAIN W/O CONTRAST MATERIAL

$6,804.00

122

70460

CT HEAD/BRAIN W/CONTRAST MATERIAL

$6,804.00

123

70470

CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL

$6,804.00

124

70480

CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL

$6,804.00

125

70481

CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL

$6,804.00

126

70482

CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR

$6,804.00

127

70486

CT MAXILLOFACIAL W/O CONTRAST MATERIAL

$6,804.00

128

70487

CT MAXILLOFACIAL W/CONTRAST MATERIAL

$6,804.00

129

70488

CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL

$6,048.00

130

70490

CT SOFT TISSUE NECK W/O CONTRAST MATERIAL

$6,048.00

131

70491

CT SOFT TISSUE NECK W/CONTRAST MATERIAL

$6,804.00

132

70492

CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL

$6,048.00

133

70496

CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

$6,048.00

134

70498

CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

$6,048.00

135

71010

RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL

$2,724.00

136

71020

RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL

$2,724.00

137

71035

RADEX CHEST SPECIAL VIEWS

$3,024.00

138

71045

Radiologic examination, chest ; single view

$2,370.00

139

71046

Radiologic examination, chest ; 2 views

$3,024.00

140

71047

Radiologic examination, chest ; 3 views

$3,024.00

141

71048

(Radiologic examination, chest ; 4 or more

$3,024.00

142

71100

RADEX RIBS UNILATERAL 2 VIEWS

$2,274.00

143

71101

RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS

$2,634.00

144

71110

RADEX RIBS BILATERAL 3 VIEWS

$3,024.00

145

71111

RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS

$3,024.00

146

71120

RADEX STERNUM MINIMUM 2 VIEWS

$3,024.00

147

71250

CT THORAX W/O CONTRAST MATERIAL

$6,804.00

148

71260

CT THORAX W/CONTRAST MATERIAL

$6,804.00

149

71270

CT THORAX W/O & W/CONTRAST MATERIAL

$6,804.00

150

71275

CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

$6,804.00

151

72020

RADEX SPINE 1 VIEW SPECIFY LEVEL

$3,024.00

152

72040

RADEX SPINE CERVICAL 2 OR 3 VIEWS

$3,024.00

153

72050

RADEX SPINE CERVICAL 4 OR 5 VIEWS

$3,025.00

154

72052

RADEX SPINE CERVICAL 6 OR MORE VIEWS

$3,025.00

155

72070

RADEX SPINE THORACIC 2 VIEWS

$3,024.00

156

72072

RADEX SPINE THORACIC 3 VIEWS

$3,024.00

157

72074

RADEX SPINE THORACIC MINIMUM 4 VIEWS

$3,024.00

158

72080

RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS

$3,024.00

159

72082

RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW

$3,024.00

160

72100

RADEX SPINE LUMBOSACRAL 2/3 VIEWS

$3,258.00

161

72110

RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS

$3,571.00

162

72114

RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6

$3,024.00

163

72120

RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS

$3,024.00

164

72125

CT CERVICAL SPINE W/O CONTRAST MATERIAL

$6,804.00

165

72126

CT CERVICAL SPINE W/CONTRAST MATERIAL

$6,048.00

166

72127

CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL

$6,930.00

167

72128

CT THORACIC SPINE W/O CONTRAST MATERIAL

$6,804.00

168

72129

CT THORACIC SPINE W/CONTRAST MATERIAL

$6,048.00

169

72130

CT THORACIC SPINE W/O & W/CONTRAST MATERIAL

$6,804.00

170

72131

CT LUMBAR SPINE W/O CONTRAST MATERIAL

$6,804.00

171

72132

CT LUMBAR SPINE W/CONTRAST MATERIAL

$6,804.00

172

72133

CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL

$6,804.00

173

72170

RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS

$2,111.00

174

72190

RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS

$2,214.00

175

72192

CT PELVIS W/O CONTRAST MATERIAL

$6,804.00

176

72193

CT PELVIS W/CONTRAST MATERIAL

$6,827.00

177

72220

RADEX SACRUM & COCCYX MINIMUM 2 VIEWS

$3,024.00

178

72270

MYELOGRAPY 2/MORE REGIONS RS&I

$3,024.00

179

73000

RADEX CLAVICLE COMPLETE

$3,024.00

180

73010

RADEX SCAPULA COMPLETE

$3,024.00

181

73020

RADEX SHOULDER 1 VIEW

$2,279.00

182

73030

RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS

$3,235.00

183

73050

RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ

$3,024.00

184

73060

RADEX HUMERUS MINIMUM 2 VIEWS

$3,024.00

185

73070

RADEX ELBOW 2 VIEWS

$3,024.00

186

73080

RADEX ELBOW COMPLETE MINIMUM 3 VIEWS

$3,024.00

187

73090

RADEX FOREARM 2 VIEWS

$3,024.00

188

73100

RADEX WRIST 2 VIEWS

$3,024.00

189

73110

RADEX WRIST COMPLETE MINIMUM 3 VIEWS

$3,164.00

190

73120

RADEX HAND 2 VIEWS

$2,584.00

191

73130

RADEX HAND MINIMUM 3 VIEWS

$3,024.00

192

73140

RADEX FINGR MINIMUM 2 VIEWS

$2,274.00

193

73200

CT UPPER EXTREMITY W/O CONTRAST MATERIAL

$6,804.00

194

73201

CT UPPER EXTREMITY W/CONTRAST MATERIAL

$6,804.00

195

73202

CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL

$6,804.00

196

73501

RADEX HIP UNILATERAL WITH PELVIS 1 VIEW

$2,100.00

197

73502

RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS

$3,024.00

198

73503

RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS

$3,024.00

199

73510

X-RAY HIP UNILATERAL 2 VIEWS

$2,154.00

200

73522

RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS

$3,024.00

201

73551

RADIOLOGIC EXAMINATION FEMUR 1 VIEW

$1,320.00

202

73552

RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS

$2,382.00

203

73560

RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS

$2,016.00

204

73562

RADIOLOGIC EXAMINATION KNEE 3 VIEWS

$3,300.00

205

73564

RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS

$3,024.00

206

73565

RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST

$3,024.00

207

73590

RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS

$3,024.00

208

73592

RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS

$3,024.00

209

73600

RADIOLOGIC EXAMINATION ANKLE 2 VIEWS

$3,024.00

210

73610

RADEX ANKLE COMPLETE MINIMUM 3 VIEWS

$3,024.00

211

73620

RADIOLOGIC EXAMINATION FOOT 2 VIEWS

$2,538.00

212

73630

RADEX FOOT COMPLETE MINIMUM 3 VIEWS

$2,700.00

213

73650

RADEX CALCANEUS MINIMUM 2 VIEWS

$3,024.00

214

73660

RADEX TOE MINIMUM 2 VIEWS

$1,760.00

215

73700

CT LOWER EXTREMITY W/O CONTRAST MATERIAL

$8,004.00

216

73701

CT LOWER EXTREMITY W/CONTRAST MATERIAL

$7,770.00

217

73718

MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL

$7,814.00

218

74000

RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW

$3,024.00

219

74018

Radiologic examination, abdomen; 1 view

$2,142.00

220

74019

Radiologic examination, abdomen; 2 views

$2,058.00

221

74020

RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS

$3,024.00

222

74021

Radiologic examination, abdomen; 3 or more views

$2,389.00

223

74022

RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH

$2,275.00

224

74150

CT ABDOMEN W/O CONTRAST MATERIAL

$7,177.00

225

74160

CT ABDOMEN W/CONTRAST MATERIAL

$7,177.00

226

74174

CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG

$6,804.00

227

74175

CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST

$7,170.00

228

74176

CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL

$6,804.00

229

74177

CT ABDOMEN & PELVIS W/CONTRAST MATERIAL

$6,804.00

230

74178

CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE

$6,810.00

231

74190

PERITONEOGRAM RS&I

$3,024.00

232

74240

RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB

$3,024.00

233

74241

RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB

$3,024.00

234

74245

RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES

$3,024.00

235

74250

RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES

$3,024.00

236

74251

RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE

$3,024.00

237

74328

ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I

$4,282.00

238

74329

ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I

$3,024.00

239

74330

CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I

$3,286.00

240

74340

INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I

$1,500.00

241

74440

VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I

$3,024.00

242

76380

CT LIMITED/LOCALIZED FOLLOW UP STUDY

$6,804.00

243

76536

US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM

$3,024.00

244

76604

US CHEST REAL TIME W/IMAGE DOCUMENTATION

$2,724.00

245

76641

US BREAST UNI REAL TIME WITH IMAGE COMPLETE

$1,884.00

246

76642

US BREAST UNI REAL TIME WITH IMAGE LIMITED

$1,194.00

247

76700

US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION

$3,224.00

248

76705

US ABDOMINAL REAL TIME W/IMAGE LIMITED

$4,003.00

249

76770

US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE

$2,153.00

250

76775

US RETROPERITONEAL REAL TIME W/IMAGE LIMITED

$3,024.00

251

76801

US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT

$2,724.00

252

76802

US PREG UTERUS 14 WK TRANSABDL EACH GESTATION

$1,170.00

253

76805

US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION

$3,024.00

254

76810

US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO

$3,024.00

255

76816

US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS

$1,854.00

256

76817

US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG

$3,024.00

257

76830

US TRANSVAGINAL

$3,208.00

258

76856

US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE

$3,024.00

259

76857

US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U

$2,724.00

260

76870

US SCROTUM & CONTENTS

$3,654.00

261

76881

US EXTREMITY NON-VASC REAL-TIME IMG COMPL

$3,024.00

262

76882

US EXTREMITY NON-VASC REAL-TIME IMG LMTD

$1,380.00

263

80047

BASIC METABOLIC PANEL CALCIUM IONIZED

$1,554.00

264

80048

BASIC METABOLIC PANEL CALCIUM TOTAL

$1,430.00

265

80051

ELECTROLYTE PANEL

$540.00

266

80053

COMPREHENSIVE METABOLIC PANEL

$1,794.00

267

80061

LIPID PANEL

$1,512.00

268

80074

ACUTE HEPATITIS PANEL

$1,440.00

269

80076

HEPATIC FUNCTION PANEL

$1,458.00

270

80102

Drug confirmation, each procedure

$276.00

271

80299

QUANTITATION DRUG NOT ELSEWHERE SPECIFIED

$1,020.00

272

80305

DRUG TEST PRSMV QUAL DIR OPTICAL OBS PER DAY

$493.00

273

80307

DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS

$756.00

274

80320

DRUG SCREEN QUANTITATIVE ALCOHOLS

$684.00

275

80324

DRUG SCREEN QUANT AMPHETAMINES 1 OR 2

$756.00

276

80329

DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2

$684.00

277

80335

ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2

$276.00

278

80345

DRUG SCREENING BARBITURATES

$756.00

279

80346

DRUG SCREENING BENZODIAZEPINES 1-12

$756.00

280

80347

DRUG SCREENING BENZODIAZEPINES 13 OR MORE

$630.00

281

80348

DRUG SCREENING BUPRENORPHINE

$630.00

282

80349

DRUG SCREENING CANNABINOIDS NATURAL

$480.00

283

80351

DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6

$756.00

284

80352

DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE

$204.00

285

80353

DRUG SCREENING COCAINE

$756.00

286

80356

DRUG SCREENING HEROIN METABOLITE

$138.00

287

80358

DRUG SCREENING METHADONE

$756.00

288

80359

DRUG SCREENING METHYLENEDIOXYAMPHETAMINES

$756.00

289

80361

DRUG SCREENING OPIATES 1 OR MORE

$756.00

290

80362

DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2

$684.00

291

80365

DRUG SCREENING OXYCODONE

$756.00

292

80366

DRUG SCREENING PREGABALIN

$342.00

293

80367

DRUG SCREENING PROPOXYPHENE

$276.00

294

80373

DRUG SCREENING TRAMADOL

$684.00

295

80374

DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS

$684.00

296

81000

URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY

$510.00

297

81001

URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY

$690.00

298

81002

URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP

$300.00

299

81003

URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY

$545.00

300

81025

URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS

$684.00

301

82010

KETONE BODIES SERUM QUANTITATIVE

$382.00

302

82040

ALBUMIN SERUM PLASMA/WHOLE BLOOD

$204.00

303

82075

ASSAY OF ALCOHOL BREATH

$600.00

304

82140

ASSAY OF AMMONIA

$1,020.00

305

82150

ASSAY OF AMYLASE

$572.00

306

82247

BILIRUBIN TOTAL

$366.00

307

82248

BILIRUBIN DIRECT

$450.00

308

82270

BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER

$1,512.00

309

82272

BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC

$1,512.00

310

82310

CALCIUM TOTAL

$504.00

311

82330

CALCIUM IONIZED

$504.00

312

82374

CARBON DIOXIDE BICARBONATE

$360.00

313

82435

CHLORIDE BLD

$300.00

314

82465

CHOLESTEROL SERUM/WHOLE BLOOD TOTAL

$540.00

315

82533

CORTISOL TOTAL

$408.00

316

82550

CREATINE KINASE TOTAL

$468.00

317

82553

CREATINE KINASE MB FRACTION ONLY

$780.00

318

82565

CREATININE BLOOD

$468.00

319

82668

ASSAY OF ERYTHROPOIETIN

$780.00

320

82728

ASSAY OF FERRITIN

$660.00

321

82747

ASSAY OF FOLIC ACID RBC

$358.00

322

82784

ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH

$810.00

323

82803

BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3

$649.00

324

82945

GLUCOSE BODY FLUID OTHER THAN BLOOD

$474.00

325

82947

GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP

$276.00

326

82948

GLUCOSE BLOOD REAGENT STRIP

$684.00

327

82962

GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE

$276.00

328

82977

ASSAY OF GLUTAMYLTRASE GAMMA

$600.00

329

83009

HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE

$606.00

330

83013

HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE

$684.00

331

83036

HEMOGLOBIN GLYCOSYLATED A1C

$330.00

332

83525

ASSAY OF INSULIN TOTAL

$342.00

333

83605

ASSAY OF LACTATE

$570.00

334

83615

LACTATE DEHYDROGENASE LDH

$600.00

335

83690

ASSAY OF LIPASE

$556.00

336

83718

LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL

$420.00

337

83735

ASSAY OF MAGNESIUM

$600.00

338

83835

METANEPHRINES

$780.00

339

83874

MYOGLOBIN

$780.00

340

83880

NATRIURETIC PEPTIDE

$1,056.00

341

83992

ASSAY OF PHENCYCLIDINE

$540.00

342

84075

ASSAY OF PHOSPHATASE ALKALINE

$306.00

343

84100

ASSAY OF PHOSPHORUS INORGANIC

$292.00

344

84132

POTASSIUM SERUM PLASMA/WHOLE BLOOD

$300.00

345

84145

PROCALCITONIN (PCT)

$1,020.00

346

84155

PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD

$347.00

347

84157

PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC

$425.00

348

84295

SODIUM SERUM PLASMA OR WHOLE BLOOD

$240.00

349

84436

ASSAY OF THYROXINE TOTAL

$438.00

350

84439

ASSAY OF FREE THYROXINE

$538.00

351

84443

ASSAY OF THYROID STIMULATING HORMONE TSH

$774.00

352

84450

TRANSFERASE ASPARTATE AMINO AST SGOT

$356.00

353

84460

TRANSFERASE ALANINE AMINO ALT SGPT

$300.00

354

84478

ASSAY OF TRIGLYCERIDES

$858.00

355

84479

THYROID HORM UPTK/THYROID HORMONE BINDING RATIO

$402.00

356

84480

ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3

$684.00

357

84481

ASSAY OF TRIIODOTHYRONINE T3 FREE

$570.00

358

84484

ASSAY OF TROPONIN QUANTITATIVE

$1,055.00

359

84512

ASSAY OF TROPONIN QUALITATIVE

$408.00

360

84520

ASSAY OF UREA NITROGEN QUANTITATIVE

$431.00

361

84550

ASSAY OF BLOOD/URIC ACID

$684.00

362

84702

GONADOTROPIN CHORIONIC QUANTITATIVE

$1,176.00

363

84703

GONADOTROPIN CHORIONIC QUALITATIVE

$1,020.00

364

85025

BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC

$1,512.00

365

85027

BLOOD COUNT COMPLETE AUTOMATED

$408.00

366

85379

FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE

$1,050.00

367

85610

PROTHROMBIN TIME

$934.00

368

85651

SEDIMENTATION RATE RBC NON-AUTOMATED

$684.00

369

85652

SEDIMENTATION RATE RBC AUTOMATED

$168.00

370

85730

THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD

$359.00

371

86038

ANTINUCLEAR ANTIBODIES ANA

$411.00

372

86039

ANTINUCLEAR ANTIBODIES ANA TITER

$521.00

373

86060

ANTISTREPTOLYSIN O TITER

$186.00

374

86140

C-REACTIVE PROTEIN

$504.00

375

86235

EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD

$684.00

376

86308

HETEROPHILE ANTIBODIES SCREEN

$524.00

377

86328

IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19

$360.00

378

86431

RHEUMATOID FACTOR QUANTITATIVE

$307.00

379

86592

SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL

$384.00

380

86593

SYPHILIS TEST QUANTITATIVE

$756.00

381

86677

ANTIBODY HELICOBACTER PYLORI

$684.00

382

86689

ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST

$465.00

383

86695

ANTIBODY HERPES SMPLX TYPE 1

$408.00

384

86696

ANTIBODY HERPES SMPLX TYPE 2

$480.00

385

86701

ANTIBODY HIV-1

$480.00

386

86735

ANTIBODY MUMPS

$720.00

387

86757

ANTIBODY RICKETTSIA

$1,020.00

388

86762

ANTIBODY RUBELLA

$480.00

389

86765

ANTIBODY RUBEOLA

$600.00

390

86769

SARS-COV-2 COVID-19 ANTIBODY

$1,020.00

391

86787

ANTIBODY VARICELLA-ZOSTER

$300.00

392

86900

BLOOD TYPING SEROLOGIC ABO

$1,020.00

393

86901

BLOOD TYPING SEROLOGIC RH (D)

$1,020.00

394

87015

CONCENTRATION INFECTIOUS AGENTS

$344.00

395

87040

CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES

$463.00

396

87045

CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL

$953.00

397

87070

CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL

$612.00

398

87071

CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL

$1,020.00

399

87075

CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID

$684.00

400

87076

CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL

$516.00

401

87077

CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL

$684.00

402

87081

CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ

$684.00

403

87086

CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE

$465.00

404

87088

CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE

$344.00

405

87106

CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST

$1,020.00

406

87184

SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD

$780.00

407

87205

SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL

$420.00

408

87210

SMR PRIM SRC WET MOUNT NFCT AGT

$1,020.00

409

87230

TOXIN/ANTITOXIN ASSAY TISSUE CULTURE

$1,140.00

410

87255

VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC

$480.00

411

87338

IAAD IA HPYLORI STOOL

$756.00

412

87389

IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE

$720.00

413

87420

IAAD IA RESPIRATORY SYNCTIAL VIRUS

$570.00

414

87426

SARSCOV CORONAVIRUS AG IA

$360.00

415

87428

IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B

$480.00

416

87486

IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ

$480.00

417

87491

IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ

$756.00

418

87493

INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE

$1,020.00

419

87529

IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ

$1,020.00

420

87581

IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ

$360.00

421

87591

IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ

$408.00

422

87631

IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS

$660.00

423

87633

IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET

$720.00

424

87635

SARS-COV-2 COVID-19 AMP PRB

$600.00

425

87637

SARSCOV2&INF A&B&RSV AMP PRB

$600.00

426

87640

IADNA S AUREUS AMPLIFIED PROBE TQ

$1,200.00

427

87651

IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ

$480.00

428

87653

IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ

$480.00

429

87660

IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ

$780.00

430

87661

Infectious agent detection by nucleic acid (DNA or RNA)

$480.00

431

87798

IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM

$480.00

432

87799

IADNA NOS QUANTIFICATION EACH ORGANISM

$720.00

433

87801

Infectious agent detection by nucleic acid (DNA or RNA)

$480.00

434

87804

IAADIADOO INFLUENZA

$575.00

435

87806

IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES

$1,260.00

436

87807

IAADIADOO RESPIRATORY SYNCTIAL VIRUS

$756.00

437

87880

IAADIADOO STREPTOCOCCUS GROUP A

$1,038.00

438

89051

CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT

$497.00

439

89055

LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE

$684.00

440

89240

UNLIS MISC

$246.00

441

90471

IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE

$303.00

442

90472

IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE

$420.00

443

90714

TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE

$806.00

444

90715

TDAP VACCINE 7 YRS/> IM

$756.00

445

93000

ECG ROUTINE ECG W/LEAST 12 LDS W/I&R

$756.00

446

93005

ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R

$960.00

447

93010

ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY

$240.00

448

93040

RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT

$960.00

449

93042

RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON

$756.00

450

93224

XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I

$1,212.00

451

93307

ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP

$2,880.00

452

93631

INTRAOP EPICAR& ENDOCAR PACG& MAPG

$912.00

453

93880

DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY

$2,461.00

454

93922

NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL

$2,921.00

455

93923

NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS

$3,024.00

456

93925

DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY

$3,570.00

457

93926

DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY

$2,724.00

458

93930

DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY

$3,280.00

459

93931

DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY

$2,976.00

460

93970

DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

$3,455.00

461

93971

DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

$3,024.00

462

93975

DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM

$3,815.00

463

93980

DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL

$2,080.00

464

94640

PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT

$347.00

465

94760

NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER

$457.00

466

94761

NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER

$408.00

467

94762

NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR

$684.00

468

96360

IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR

$1,512.00

469

96361

IV INFUSION HYDRATION EACH ADDITIONAL HOUR

$714.00

470

96365

IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR

$1,512.00

471

96366

IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR

$937.00

472

96367

IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR

$1,247.00

473

96368

IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS

$960.00

474

96372

THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM

$1,512.00

475

96374

THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG

$1,236.00

476

96375

THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG

$847.00

477

96376

THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC

$853.00

478

96377

APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION

$960.00

479

97010

APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS

$171.00

480

97116

THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR

$780.00

481

97542

WHEELCHAIR MGMT EA 15 MIN

$615.00

482

97597

DEBRIDEMENT OPEN WOUND 20 SQ CM/<

$1,195.00

483

98925

OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS

$240.00

484

99000

HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB

$1,020.00

485

99024

POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX

$912.00

486

99070

SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP

$300.00

487

99072

“Miscellaneous Medicine Services

$150.00

488

99151

MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

$630.00

489

99152

MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

$1,500.00

490

99173

SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT

$1,812.00

491

99217

OBSERVATION CARE DISCHARGE MANAGEMENT

$1,434.00

492

99218

INITIAL OBSERVATION CARE/DAY 30 MINUTES

$1,500.00

493

99219

INITIAL OBSERVATION CARE/DAY 50 MINUTES

$1,710.00

494

99220

INITIAL OBSERVATION CARE/DAY 70 MINUTES

$1,950.00

495

99224

SBSQ OBSERVATION CARE/DAY 15 MINUTES

$1,500.00

496

99225

SBSQ OBSERVATION CARE/DAY 25 MINUTES

$1,710.00

497

99226

SBSQ OBSERVATION CARE/DAY 35 MINUTES

$1,950.00

498

99234

OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES

$1,560.00

499

99235

OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES

$1,800.00

500

99236

OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES

$2,160.00

501

99281

EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB

$1,199.00

502

99282

EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY

$2,400.00

503

99283

EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY

$5,040.00

504

99283CP

EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY

$2,400.00

505

99284

EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY

$5,400.00

506

99285

EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ

$6,000.00

507

99291

CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN

$2,400.00

508

99292

CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN

$1,200.00

509

A0382

BASIC SUPPORT ROUTINE SUPPLS

$83.00

510

A0394

ALS IV DRUG THERAPY SUPPLIES

$83.00

511

A4206

1 CC STERILE SYRINGE&NEEDLE

$138.00

512

A4207

2 CC STERILE SYRINGE&NEEDLE

$99.00

513

A4208

STERILE SYRINGE&NEEDLE

$138.00

514

A4209

FIVE PLUS CC STERILE SYRINGE&NEEDLE

$138.00

515

A4210

NONNEEDLE INJECTION DEVICE

$138.00

516

A4211

SUPP FOR SELF-ADM INJECTIONS

$99.00

517

A4212

NON CORING NEEDLE OR STYLET

$138.00

518

A4213

20+ CC SYRINGE ONLY

$138.00

519

A4215

STERILE NEEDLE

$138.00

520

A4216

STERILE WATER/SALINE, 10 ML

$138.00

521

A4217

STERILE WATER/SALINE, 500 ML

$99.00

522

A4218

STERILE SALINE OR WATER

$138.00

523

A4221

SUPP NON-INSULIN INF CATH/WK

$138.00

524

A4224

SUPPLY INSULIN INF CATH/WK

$138.00

525

A4232

SYRINGE W/NEEDLE INSULIN 3CC

$99.00

526

A4244

ALCOHOL OR PEROXIDE PER PINT

$138.00

527

A4245

ALCOHOL WIPES PER BOX

$138.00

528

A4246

BETADINE/PHISOHEX SOLUTION

$138.00

529

A4247

BETADINE/IODINE SWABS/WIPES

$83.00

530

A4248

CHLORHEXIDINE ANTISEPT

$138.00

531

A4250

URINE REAGENT STRIPS/TABLETS

$138.00

532

A4253

BLOOD GLUCOSE/REAGENT STRIPS

$83.00

533

A4281

REPLACEMENT BREASTPUMP TUBE

$138.00

534

A4283

REPLACEMENT BREASTPUMP CAP

$138.00

535

A4300

CATH IMPL VASC ACCESS PORTAL

$99.00

536

A4310

INSERT TRAY W/O BAG/CATH

$138.00

537

A4311

CATHETER W/O BAG 2-WAY LATEX

$138.00

538

A4313

CATHETER W/BAG 3-WAY

$138.00

539

A4314

CATH W/DRAINAGE 2-WAY LATEX

$138.00

540

A4315

CATH W/DRAINAGE 2-WAY SILCNE

$99.00

541

A4322

IRRIGATION SYRINGE

$127.00

542

A4327

FEM URINARY COLLECT DEV CUP

$138.00

543

A4332

LUBE STERILE PACKET

$83.00

544

A4338

INDWELLING CATHETER LATEX

$127.00

545

A4352

COUDE TIP URINARY CATHETER

$99.00

546

A4353

INTERMITTENT URINARY CATH

$138.00

547

A4358

URINARY LEG OR ABDOMEN BAG

$138.00

548

A4369

SKIN BARRIER LIQUID PER OZ

$138.00

549

A4402

LUBRICANT PER OUNCE

$99.00

550

A4406

PECTIN BASED OSTOMY PASTE

$99.00

551

A4450

NON-WATERPROOF TAPE

$138.00

552

A4452

WATERPROOF TAPE

$138.00

553

A4458

REUSABLE ENEMA BAG

$127.00

554

A4461

SURGICL DRESS HOLD NON-REUSE

$138.00

555

A4465

NON-ELASTIC EXTREMITY BINDER

$99.00

556

A4470

GRAVLEE JET WASHER

$83.00

557

A4550

SURGICAL TRAYS

$138.00

558

A4554

DISPOSABLE UNDERPADS

$83.00

559

A4556

ELECTRODES, PAIR

$138.00

560

A4558

CONDUCTIVE GEL OR PASTE

$127.00

561

A4562

PESSARY, NON RUBBER,ANY TYPE

$99.00

562

A4565

SLINGS

$138.00

563

A4566

SHOULD SLING/VEST/ABRESTRAIN

$99.00

564

A4570

SPLINT

$413.00

565

A4580

CAST SUPPLIES (PLASTER)

$127.00

566

A4606

OXYGEN PROBE USED W OXIMETER

$138.00

567

A4613

BATTERY CHARGER

$138.00

568

A4615

CANNULA NASAL

$138.00

569

A4616

TUBING (OXYGEN) PER FOOT

$99.00

570

A4619

FACE TENT

$138.00

571

A4620

VARIABLE CONCENTRATION MASK

$138.00

572

A4628

OROPHARYNGEAL SUCTION CATH

$138.00

573

A4629

TRACHEOSTOMY CARE KIT

$83.00

574

A4635

UNDERARM CRUTCH PAD

$550.00

575

A4649

SURGICAL SUPPLIES

$138.00

576

A4653

PD CATHETER ANCHOR BELT

$83.00

577

A4657

SYRINGE W/WO NEEDLE

$138.00

578

A4670

AUTOMATIC BP MONITOR, DIAL

$138.00

579

A4673

EXT LINE W EASY LOCK CONNECT

$138.00

580

A4750

ART OR VENOUS BLOOD TUBING

$83.00

581

A4770

BLOOD COLLECTION TUBE/VACUUM

$138.00

582

A4927

NON-STERILE GLOVES

$50.00

583

A4930

STERILE, GLOVES PER PAIR

$50.00

584

A5112

URINARY LEG BAG

$138.00

585

A5120

SKIN BARRIER, WIPE OR SWAB

$138.00

586

A5126

DISK/FOAM PAD +OR- ADHESIVE

$138.00

587

A6021

COLLAGEN DRESSING <=16 SQ IN

$127.00

588

A6196

ALGINATE DRESSING <=16 SQ IN

$138.00

589

A6203

COMPOSITE DRSG <= 16 SQ IN

$138.00

590

A6208

CONTACT LAYER > 48 SQ IN

$138.00

591

A6209

FOAM DRSG <=16 SQ IN W/O BDR

$138.00

592

A6212

FOAM DRG <=16 SQ IN W/BORDER

$99.00

593

A6216

NON-STERILE GAUZE<=16 SQ IN

$138.00

594

A6217

NON-STERILE GAUZE>16<=48 SQ

$138.00

595

A6218

NON-STERILE GAUZE > 48 SQ IN

$99.00

596

A6219

GAUZE <= 16 SQ IN W/BORDER

$99.00

597

A6220

GAUZE >16 <=48 SQ IN W/BORDR

$99.00

598

A6221

GAUZE > 48 SQ IN W/BORDER

$83.00

599

A6222

GAUZE <=16 IN NO W/SAL W/O B

$99.00

600

A6223

GAUZE >16<=48 NO W/SAL W/O B

$83.00

601

A6224

GAUZE > 48 IN NO W/SAL W/O B

$138.00

602

A6231

HYDROGEL DSG<=16 SQ IN

$138.00

603

A6233

HYDROGEL DRESSING >48 SQ IN

$138.00

604

A6235

HYDROCOLLD DRG >16<=48 W/O B

$83.00

605

A6238

HYDROCOLLD DRG >16<=48 W/BDR

$83.00

606

A6239

HYDROCOLLD DRG > 48 IN W/BDR

$99.00

607

A6246

HYDROGEL DRG >16<=48 IN W/B

$138.00

608

A6248

HYDROGEL DRSG GEL FILLER

$138.00

609

A6250

SKIN SEAL PROTECT MOISTURIZR

$138.00

610

A6251

ABSORPT DRG <=16 SQ IN W/O B

$138.00

611

A6252

ABSORPT DRG >16 <=48 W/O BDR

$138.00

612

A6253

ABSORPT DRG > 48 SQ IN W/O B

$138.00

613

A6254

ABSORPT DRG <=16 SQ IN W/BDR

$138.00

614

A6255

ABSORPT DRG >16<=48 IN W/BDR

$99.00

615

A6257

TRANSPARENT FILM <= 16 SQ IN

$138.00

616

A6258

TRANSPARENT FILM >16<=48 IN

$138.00

617

A6260

WOUND CLEANSER ANY TYPE/SIZE

$138.00

618

A6266

IMPREG GAUZE NO H20/SAL/YARD

$138.00

619

A6402

MEDICAL/SURGICAL SUPPLIES AND DEVICES (ALSO SEE 062X AN EXTENSION OF STE

$138.00

620

A6403

STERILE GAUZE>16 <= 48 SQ IN

$99.00

621

A6404

STERILE GAUZE > 48 SQ IN

$138.00

622

A6407

PACKING STRIPS, NON-IMPREG

$99.00

623

A6412

OCCLUSIVE EYE PATCH

$83.00

624

A6413

ADHESIVE BANDAGE, FIRST-AID

$138.00

625

A6441

PAD BAND W>=3 <5/YD

$99.00

626

A6442

CONFORM BAND N/S W<3/YD

$127.00

627

A6445

CONFORM BAND S W <3/YD

$138.00

628

A6446

CONFORM BAND S W>=3 <5/YD

$138.00

629

A6447

CONFORM BAND S W >=5/YD

$83.00

630

A6448

LT COMPRES BAND <3/YD

$138.00

631

A6449

LT COMPRES BAND >=3 <5/YD

$127.00

632

A6450

LT COMPRES BAND >=5/YD

$99.00

633

A6453

SELF-ADHER BAND W <3/YD

$138.00

634

A6454

SELF-ADHER BAND W>=3 <5/YD

$99.00

635

A6455

SELF-ADHER BAND >=5/YD

$138.00

636

A6456

ZINC PASTE BAND W >=3<5/YD

$138.00

637

A6457

TUBULAR DRESSING

$150.00

638

A6530

COMPRESSION STOCKING BK18-30

$90.00

639

A6545

GRAD COMP NON-ELASTIC BK

$108.00

640

A7000

DISPOSABLE CANISTER FOR PUMP

$150.00

641

A7001

NONDISPOSABLE PUMP CANISTER

$150.00

642

A7002

TUBING USED W SUCTION PUMP

$150.00

643

A7003

NEBULIZER ADMINISTRATION SET

$150.00

644

A7004

DISPOSABLE NEBULIZER SML VOL

$150.00

645

A7005

NONDISPOSABLE NEBULIZER SET

$150.00

646

A7006

FILTERED NEBULIZER ADMIN SET

$90.00

647

A7015

AEROSOL MASK USED W NEBULIZE

$108.00

648

A7030

CPAP FULL FACE MASK

$108.00

649

A7031

REPLACEMENT FACEMASK INTERFA

$150.00

650

A7046

REPL WATER CHAMBER, PAP DEV

$150.00

651

A7047

RESP SUCTION ORAL INTERFACE

$150.00

652

A9150

MISC/EXPER NON-PRESCRIPT DRU

$90.00

653

A9270

NON-COVERED ITEM OR SERVICE

$108.00

654

A9273

HOT/COLD H2OBOT/CAP/COL/WRAP

$150.00

655

A9281

REACHING/GRABBING DEVICE

$150.00

656

B4082

ENTERAL NG TUBING W/O STYLET

$300.00

657

C1722

AICD, SINGLE CHAMBER

$2,580.00

658

C1751

CATH, INF, PER/CENT/MIDLINE

$2,544.00

659

C1781

MESH (IMPLANTABLE)

$1,849.00

660

C2618

PROBE/NEEDLE, CRYO

$408.00

661

C9285

PATCH, LIDOCAINE/TETRACAINE

$102.00

662

E0110

CRUTCH FOREARM PAIR

$840.00

663

E0114

CRUTCH UNDERARM PAIR NO WOOD

$955.00

664

E0116

CRUTCH UNDERARM EACH NO WOOD

$720.00

665

E0168

HEAVYDUTY/WIDE COMMODE CHAIR

$456.00

666

E0240

BATH/SHOWER CHAIR

$138.00

667

E0275

BED PAN STANDARD

$276.00

668

E0325

URINAL MALE JUG-TYPE

$174.00

669

E0326

URINAL FEMALE JUG-TYPE

$174.00

670

E0487

ELECTRONIC SPIROMETER

$420.00

671

E0570

NEBULIZER WITH COMPRESSION

$1,092.00

672

E0607

BLOOD GLUCOSE MONITOR HOME

$684.00

673

E0625

PATIENT LIFT BATHROOM OR TOI

$546.00

674

G0168

WOUND CLOSURE BY ADHESIVE

$456.00

675

G0378

HOSPITAL OBSERVATION PER HR

$3,024.00

676

G0402

INITIAL PREVENTIVE EXAM

$2,520.00

677

G0481

DRUG TEST DEF 8-14 CLASSES

$600.00

678

G6058

Drug confirmation, each procedure

$684.00

679

G8598

ASA/ANTIPLAT THER USED

$72.00

680

G8601

NO ELIG TPA INIT W/IN 3 HRS

$1,362.00

681

G8602

NO TPA INIT W/IN 3 HRS

$1,362.00

682

J0120

TETRACYCLIN INJECTION

$228.00

683

J0129

ABATACEPT INJECTION

$228.00

684

J0131

ACETAMINOPHEN INJECTION

$36.00

685

J0153

ADENOSINE INJ 1MG

$138.00

686

J0171

ADRENALIN EPINEPHRINE INJECT

$228.00

687

J0282

AMIODARONE HCL

$138.00

688

J0290

AMPICILLIN 500 MG INJ

$60.00

689

J0295

AMPICILLIN SODIUM PER 1.5 GM

$300.00

690

J0360

HYDRALAZINE HCL INJECTION

$228.00

691

J0456

AZITHROMYCIN

$228.00

692

J0461

ATROPINE SULFATE INJECTION

$72.00

693

J0500

DICYCLOMINE INJECTION

$271.00

694

J0561

PENICILLIN G BENZATHINE INJ

$228.00

695

J0610

CALCIUM GLUCONATE INJECTION

$36.00

696

J0690

CEFAZOLIN SODIUM INJECTION

$228.00

697

J0696

CEFTRIAXONE SODIUM INJECTION

$228.00

698

J0697

STERILE CEFUROXIME INJECTION

$138.00

699

J0735

CLONIDINE HYDROCHLORIDE

$138.00

700

J0744

CIPROFLOXACIN IV

$228.00

701

J0780

PROCHLORPERAZINE INJECTION

$228.00

702

J1020

METHYLPREDNISOLONE 20 MG INJ

$108.00

703

J1030

METHYLPREDNISOLONE 40 MG INJ

$120.00

704

J1040

METHYLPREDNISOLONE 80 MG INJ

$120.00

705

J1100

DEXAMETHASONE SODIUM PHOS

$24.00

706

J1170

HYDROMORPHONE INJECTION

$228.00

707

J1200

DIPHENHYDRAMINE HCL INJECTIO

$60.00

708

J1265

DOPAMINE INJECTION

$48.00

709

J1550

Injection, gamma globulin, intramuscular, 10 cc

$36.00

710

J1610

GLUCAGON HYDROCHLORIDE/1 MG

$589.00

711

J1631

HALOPERIDOL DECANOATE INJ

$378.00

712

J1642

INJ HEPARIN SODIUM PER 10 U

$35.00

713

J1644

INJ HEPARIN SODIUM PER 1000U

$228.00

714

J1650

INJ ENOXAPARIN SODIUM

$170.00

715

J1741

IBUPROFEN INJECTION

$138.00

716

J1810

DROPERIDOL/FENTANYL INJ

$138.00

717

J1815

INSULIN INJECTION

$60.00

718

J1817

INSULIN FOR INSULIN PUMP USE

$138.00

719

J1885

KETOROLAC TROMETHAMINE INJ

$114.00

720

J1930

LANREOTIDE INJECTION

$349.00

721

J1940

FUROSEMIDE INJECTION

$198.00

722

J1956

LEVOFLOXACIN INJECTION

$228.00

723

J2001

Injection, lidocaine hcl for intravenous infusion

$155.00

724

J2060

LORAZEPAM INJECTION

$228.00

725

J2175

MEPERIDINE HYDROCHL /100 MG

$138.00

726

J2250

INJ MIDAZOLAM HYDROCHLORIDE

$228.00

727

J2270

MORPHINE SULFATE INJECTION

$228.00

728

J2274

IN MORPHINE PRESERVATIV FREE

$228.00

729

J2360

ORPHENADRINE INJECTION

$228.00

730

J2405

ONDANSETRON HCL INJECTION

$24.00

731

J2410

OXYMORPHONE HCL INJECTION

$138.00

732

J2425

PALIFERMIN INJECTION

$138.00

733

J2504

PEGADEMASE BOVINE, 25 IU

$138.00

734

J2543

PIPERACILLIN/TAZOBACTAM

$228.00

735

J2550

PROMETHAZINE HCL INJECTION

$173.00

736

J2704

INJ, PROPOFOL, 10 MG

$138.00

737

J2765

METOCLOPRAMIDE HCL INJECTION

$228.00

738

J2780

RANITIDINE HYDROCHLORIDE INJ

$138.00

739

J2800

METHOCARBAMOL INJECTION

$462.00

740

J2920

METHYLPREDNISOLONE INJECTION

$165.00

741

J2930

METHYLPREDNISOLONE INJECTION

$228.00

742

J3010

FENTANYL CITRATE INJECITON

$228.00

743

J3030

SUMATRIPTAN SUCCINATE / 6 MG

$378.00

744

J3260

TOBRAMYCIN SULFATE INJECTION

$528.00

745

J3301

TRIAMCINOLONE ACET INJ NOS

$60.00

746

J3360

DIAZEPAM INJECTION

$184.00

747

J3370

VANCOMYCIN HCL INJECTION

$228.00

748

J3430

VITAMIN K PHYTONADIONE INJ

$359.00

749

J3475

INJ MAGNESIUM SULFATE

$138.00

750

J3480

INJ POTASSIUM CHLORIDE

$150.00

751

J3490

DRUGS UNCLASSIFIED INJECTION

$36.00

752

J7030

NORMAL SALINE SOLUTION INFUS

$296.00

753

J7040

NORMAL SALINE SOLUTION INFUS

$265.00

754

J7042

5% DEXTROSE/NORMAL SALINE

$312.00

755

J7050

NORMAL SALINE SOLUTION INFUS

$300.00

756

J7060

5% DEXTROSE/WATER

$300.00

757

J7070

D5W INFUSION

$138.00

758

J7120

RINGERS LACTATE INFUSION

$300.00

759

J7121

5% DEXTROSE IN LAC RINGERS

$300.00

760

J7131

HYPERTONIC SALINE SOL

$138.00

761

J7192

FACTOR VIII RECOMBINANT NOS

$138.00

762

J7313

FLUOCINOL ACET INTRAVIT IMP

$138.00

763

J7510

PREDNISOLONE ORAL PER 5 MG

$12.00

764

J7611

ALBUTEROL NON-COMP CON

$228.00

765

J7613

ALBUTEROL NON-COMP UNIT

$228.00

766

J7614

LEVALBUTEROL NON-COMP UNIT

$228.00

767

J7615

LEVALBUTEROL COMP UNIT

$228.00

768

J7620

ALBUTEROL IPRATROP NON-COMP

$228.00

769

J7631

CROMOLYN SODIUM NONCOMP UNIT

$138.00

770

J7637

DEXAMETHASONE COMP CON

$138.00

771

J7644

IPRATROPIUM BROMIDE NON-COMP

$228.00

772

J7682

TOBRAMYCIN NON-COMP UNIT

$138.00

773

J7699

INHALATION SOLUTION FOR DME

$138.00

774

J8498

ANTIEMETIC RECTAL/SUPP NOS

$138.00

775

J8499

ORAL PRESCRIP DRUG NON CHEMO

$138.00

776

J9206

IRINOTECAN INJECTION

$138.00

777

L0112

CRANIAL CERVICAL ORTHOSIS

$1,362.00

778

L0120

CERV FLEX N/ADJ FOAM PRE OTS

$774.00

779

L0150

CERV SEMI-RIG ADJ MOLDED CHN

$180.00

780

L0170

CERVICAL COLLAR MOLDED TO PT

$420.00

781

L0172

CERV COL SR FOAM 2PC PRE OTS

$180.00

782

L0174

CERV SR 2PC THOR EXT PRE OTS

$1,512.00

783

L0625

LO FLEX L1-BELOW L5 PRE OTS

$780.00

784

L1810

KO ELASTIC WITH JOINTS

$1,872.00

785

L1830

KO IMMOB CANVAS LONG PRE OTS

$635.00

786

L1902

AFO ANKLE GAUNTLET PRE OTS

$78.00

787

L1906

AFO MULTILIG ANK SUP PRE OTS

$420.00

788

L2360

EXTENDED STEEL SHANK

$564.00

789

L3031

FOOT LAMIN/PREPREG COMPOSITE

$690.00

790

L3201

OXFORD W SUPINAT/PRONAT INF

$510.00

791

L3209

SURGICAL BOOT EACH CHILD

$510.00

792

L3250

CUSTOM MOLD SHOE REMOV PROST

$690.00

793

L3260

AMBULATORY SURGICAL BOOT EAC

$780.00

794

L3310

SHOE LIFT ELEV HEEL/SOLE NEO

$498.00

795

L3334

SHOE LIFTS ELEVATION HEEL /I

$60.00

796

L3500

ORTHO SHOE ADD LEATHER INSOL

$468.00

797

L3540

ORTHO SHOE ADD FULL SOLE

$690.00

798

L3650

SO 8 ABD RESTRAINT PRE OTS

$150.00

799

L3660

SO 8 AB RSTR CAN/WEB PRE OTS

$690.00

800

L3670

SO ACRO/CLAV CAN WEB PRE OTS

$807.00

801

L3720

FOREARM/ARM CUFFS FREE MOTIO

$1,170.00

802

L3807

WHFO W/O JOINTS PRE CST

$600.00

803

L3808

WHFO, RIGID W/O JOINTS

$2,268.00

804

L3809

WHFO W/O JOINTS PRE OTS

$2,268.00

805

L3905

WHO W/NONTORSION JNT(S) CF

$2,268.00

806

L3906

WHO W/O JOINTS CF

$2,268.00

807

L3908

WHO COCK-UP NONMOLDE PRE OTS

$234.00

808

L4350

ANKLE CONTROL ORTHO PRE OTS

$318.00

809

L4360

PNEUMAT WALKING BOOT PRE CST

$330.00

810

L4361

PNEUMA/VAC WALK BOOT PRE OTS

$330.00

811

L4386

NON-PNEUM WALK BOOT PRE CST

$330.00

812

L4387

NON-PNEUM WALK BOOT PRE OTS

$330.00

813

L4398

FOOT DROP SPLINT PRE OTS

$184.00

814

L4631

AFO, WALK BOOT TYPE, CUS FAB

$330.00

815

M0243

CASIRIVI AND IMDEVI INJ

$1,512.00

816

P9612

CATHETERIZE FOR URINE SPEC

$138.00

817

Q0144

AZITHROMYCIN DIHYDRATE, ORAL

$68.00

818

Q0169

PROMETHAZINE HCL 12.5MG ORAL

$30.00

819

Q4001

CAST SUP BODY CAST PLASTER

$1,212.00

820

Q4006

CAST SUP LONG ARM ADULT FBRG

$1,212.00

821

Q4018

CAST SUP LNG ARM SPLINT FBRG

$408.00

822

Q4019

CAST SUP LNG ARM SPLNT PED P

$960.00

823

Q4020

CAST SUP LNG ARM SPLNT PED F

$816.00

824

Q4021

CAST SUP SHT ARM SPLINT PLST

$882.00

825

Q4022

CAST SUP SHT ARM SPLINT FBRG

$684.00

826

Q4023

CAST SUP SHT ARM SPLNT PED P

$684.00

827

Q4024

CAST SUP SHT ARM SPLNT PED F

$684.00

828

Q4042

CAST SUP LNG LEG SPLNT FBRGL

$1,212.00

829

Q4046

CAST SUP SHT LEG SPLNT FBRGL

$1,212.00

830

Q4049

FINGER SPLINT, STATIC

$135.00

831

Q9962

HOCM 300-349MG/ML IODINE,1ML

$684.00

832

Q9963

HOCM 350-399MG/ML IODINE,1ML

$276.00

833

Q9967

LOCM 300-399MG/ML IODINE,1ML

$18.00

834

S0020

INJECTION, BUPIVICAINE HYDRO

$210.00

835

S0028

INJECTION, FAMOTIDINE, 20 MG

$150.00

836

S0030

INJECTION, METRONIDAZOLE

$150.00

837

S0077

INJECTION, CLINDAMYCIN PHOSP

$150.00

838

S0164

INJECTION PANTROPRAZOLE

$150.00

839

S0630

REMOVAL OF SUTURES

$408.00

840

S1015

IV TUBING EXTENSION SET

$90.00

841

S8100

SPACER WITHOUT MASK

$138.00

842

S8101

SPACER WITH MASK

$138.00

843

S8430

PADDING FOR COMPRSSN BDG

$83.00

844

S8431

COMPRESSION BANDAGE

$105.00

845

S8451

SPLINT WRIST OR ANKLE

$138.00

846

U0001

Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel

$300.00

847

U0002

COVID-19 LAB TEST NON-CDC

$360.00

848

U0003

COV-19 AMP PRB HGH THRUPUT

$480.00

849

U0004

COV-19 TEST NON-CDC HGH THRU

$600.00

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Exceptional ER Logo

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.