Procedure Master # Procedure Record Name Revenue Code CPT Code Gross Charge BCBS Negotiated Fee Midlands Choice Negotiated Fee UHC Negotiated Fee Aetna Negotiated Fee 10000001 CJ SHORT-TERM RES - IC 1002 HCPCS H2013 461.00 414.90 447.17 437.95 442.56 11100001 R&B PRIVATE 111 " 1,232.00 " " 1,108.80 " " 1,195.04 " " 1,170.40 " "1,182.72" 11100002 R&B SNF PRIVATE 111 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 11100003 R&B ICF PRIVATE 111 570.00 513.00 552.90 541.50 547.2 12000001 R&B SEMI-PRIVATE 120 " 1,232.00 " " 1,108.80 " " 1,195.04 " " 1,170.40 " "1,182.72" 12000003 R&B IC SEMI-PRIVATE 120 " 1,290.00 " " 1,161.00 " " 1,251.30 " " 1,225.50 " "1,238.40" 12000004 Hc R&b Snf Semi-private 120 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 12000005 Hc R&b Icf Semi-private 120 570.00 513.00 552.90 541.50 547.2 12600001 R&B DETOX 126 " 1,800.00 " " 1,620.00 " " 1,746.00 " " 1,710.00 " "1,728.00" 17100001 R&B NEWBORN LEVEL I 171 665.00 598.50 645.05 631.75 638.4 20000001 R&B INTENSIVE CARE 200 " 2,605.00 " " 2,344.50 " " 2,526.85 " " 2,474.75 " "2,500.80" 26000005 NON-CHEMO IV PUSH 260 96374 199.00 179.10 193.03 189.05 191.04 27000170 SURG CAUTERY MACHINE 270 116.00 104.40 112.52 110.20 111.36 27000171 SURG MICROSCOPE WORKING 270 53.00 47.70 51.41 50.35 50.88 27000172 SURG USE OF TOURNIQUET 270 168.00 151.20 162.96 159.60 161.28 27000173 SURG VIDEO EQUIP-LIMITED 270 71.00 63.90 68.87 67.45 68.16 27000174 SURG VIDEO EQUIPMENT USE 270 172.00 154.80 166.84 163.40 165.12 27000175 OXYGEN/HR 270 17.00 15.30 16.49 16.15 16.32 27000176 OXYGEN PER DAY 270 416.00 374.40 403.52 395.20 399.36 27000177 APNEA MONITOR PER DAY 270 47.00 42.30 45.59 44.65 45.12 27000178 BLADDER SCANNER PER USE 270 64.00 57.60 62.08 60.80 61.44 27000179 BLOOD PRESSURE MACHINE 270 75.00 67.50 72.75 71.25 72 27000180 BLOOD WARMER 270 84.00 75.60 81.48 79.80 80.64 27000181 CAST-LONG ARM 270 117.00 105.30 113.49 111.15 112.32 27000182 CAST-LONG ARM PED 270 78.00 70.20 75.66 74.10 74.88 27000183 CAST-LONG LEG 270 150.00 135.00 145.50 142.50 144 27000184 CAST-LONG LEG PED 270 78.00 70.20 75.66 74.10 74.88 27000185 CAST-SHORT ARM 270 108.00 97.20 104.76 102.60 103.68 27000186 CAST-SHORT ARM PED 270 78.00 70.20 75.66 74.10 74.88 27000187 CAST-SHORT LEG 270 133.00 119.70 129.01 126.35 127.68 27000188 CAST-SHORT LEG PED 270 78.00 70.20 75.66 74.10 74.88 27000189 CAST-SPLINT/ALL SIZES 270 76.00 68.40 73.72 72.20 72.96 27000190 CAST-SPLINT SUGAR TONG 270 150.00 135.00 145.50 142.50 144 27000191 CAUTERY HYFROCATOR 270 96.00 86.40 93.12 91.20 92.16 27000192 CPM RENTAL PER DAY 270 34.00 30.60 32.98 32.30 32.64 27000193 EPI PUMP PER DAY 270 69.00 62.10 66.93 65.55 66.24 27000194 GOMCO EQUIPMENT/PER DAY 270 11.00 9.90 10.67 10.45 10.56 27000195 INFANT HEARING EQUIP/SUPP 270 129.00 116.10 125.13 122.55 123.84 27000196 IV SYRINGE PUMP/PER DAY 270 69.00 62.10 66.93 65.55 66.24 27000197 IV INFUSION PUMP/DAY 270 69.00 62.10 66.93 65.55 66.24 27000198 IV SOLUSET PUMP SET 270 28.00 25.20 27.16 26.60 26.88 27000199 K-PAD/UNIT PER USE 270 16.00 14.40 15.52 15.20 15.36 27000200 MONITOR-CARDIAC EQUIP/USE 270 45.00 40.50 43.65 42.75 43.2 27000201 NEO PUFF EQUIPMENT / DAIL 270 47.00 42.30 45.59 44.65 45.12 27000202 OXYGEN BLENDER PER HOUR 270 98.00 88.20 95.06 93.10 94.08 27000203 OXYHOOD PER HOUR 270 57.00 51.30 55.29 54.15 54.72 27000204 PCA PUMP PER DAY 270 69.00 62.10 66.93 65.55 66.24 27000205 PHOTOTHERAPY LITE PER DAY 270 175.00 157.50 169.75 166.25 168 27000209 PULMONARY FUNCTION EQUIP 270 56.00 50.40 54.32 53.20 53.76 27000210 SCD PUMP PER DAY 270 23.00 20.70 22.31 21.85 22.08 27000211 SUPPL NURSING SYSTEM STA 270 32.00 28.80 31.04 30.40 30.72 27000212 ENT SCOPE USE 270 58.00 52.20 56.26 55.10 55.68 27000213 SURG BONE INSTRUMENTS 270 160.00 144.00 155.20 152.00 153.6 27000214 SURG EGD EQUIPMENT 270 459.00 413.10 445.23 436.05 440.64 27000215 SURG GUIDE PIN - HIP 270 34.00 30.60 32.98 32.30 32.64 27000216 SURG LOANER INSTR HIP 270 350.00 315.00 339.50 332.50 336 27000217 TRAY-EAR 270 34.00 30.60 32.98 32.30 32.64 27000218 VAGINAL EXAM SUPPLIES 270 12.00 10.80 11.64 11.40 11.52 27000219 WOUND/ INFO VAC PER DAY 270 238.00 214.20 230.86 226.10 228.48 27000222 Hc Er Pack 270 26.00 23.40 25.22 24.70 24.96 27000223 Hc Splint-finger 270 7.00 6.30 6.79 6.65 6.72 27000224 Hc Tubigrip Per Foot 270 7.00 6.30 6.79 6.65 6.72 27100013 OXYGEN INITIAL 270 358.00 322.20 347.26 340.10 343.68 27100014 OXYGEN LIMITED 0 TO 4 HOURS 270 70.00 63.00 67.90 66.50 67.2 27100015 OXYGEN LIMITED 4 TO 12 HOURS 271 208.00 187.20 201.76 197.60 199.68 27100016 OXYGEN SUBSEQUENT Q8 270 48.00 43.20 46.56 45.60 46.08 27100018 ISOLETTE 270 186.00 167.40 180.42 176.70 178.56 27400021 Hc Elbow Wrist Hand Orthotic Rigid Wo Joints 274 HCPCS L3763 823.00 740.70 798.31 781.85 790.08 27400028 HAND FINGER ORTHOTIC 274 363.00 326.70 352.11 344.85 348.48 27400029 AIRPLANE SPLINT 274 HCPCS L3674 373.00 335.70 361.81 354.35 358.08 27400030 ELBOW ORTHOTIC W JOINT 274 HCPCS L3740 342.00 307.80 331.74 324.90 328.32 27400031 WRIST HAND FINGER ORTHOTIC 274 HCPCS L3808 158.00 142.20 153.26 150.10 151.68 27400032 WRIST HAND ORTHOSIS 274 HCPCS L3906 86.00 77.40 83.42 81.70 82.56 27400033 HAND ORTHOTIC 274 HCPCS L3919 158.00 142.20 153.26 150.10 151.68 27400034 ELBOW ORTHOTIC L3702 274 HCPCS L3702 350.00 315.00 339.50 332.50 336 27400035 CATHETER SUPP/PROSTHETIC 274 213.00 191.70 206.61 202.35 204.48 27400048 Hc Ostomy Belt With Peristomal Hernia Support 274 HCPCS A4396 65.00 58.50 63.05 61.75 62.4 27400050 Hc Wrist Finger Orthotic Wo Joints Custom 274 HCPCS L3913 395.00 355.50 383.15 375.25 379.2 27400052 Hc Finger Orthosis Wo Joints Custom 274 HCPCS L3933 282.00 253.80 273.54 267.90 270.72 30000001 COLLECTION BLOOD SPECIMEN 300 36415 31.00 27 30.07 29.45 29.76 30000002 LEGAL BLOOD COLLECTION 300 36415 100.00 27 97.00 95.00 96 30000003 COLLECT BLD CAPILLARY 300 36416 31.00 27.90 30.07 29.45 29.76 30000006 BASIC METABOLIC PANEL 300 80048 142.00 127.80 137.74 134.90 136.32 30000007 GENERAL HEALTH PANEL 300 80050 372.00 334.80 360.84 353.40 357.12 30000008 ELECTROLYTE PANEL 300 80051 107.00 96.30 103.79 101.65 102.72 30000009 COMPREHENSIVE METABOLIC PANEL 300 80053 152.00 125 147.44 144.40 145.92 30000010 OBSTETRIC PANEL 300 80055 266.00 239.40 258.02 252.70 255.36 30000011 LIPID PANEL 300 80061 113.00 101.70 109.61 107.35 108.48 30000012 RENAL FUNCTION PANEL 300 80069 142.00 127.80 137.74 134.90 136.32 30000013 HEPATITIS PANEL ACUTE W/REFLEX 300 80074 315.00 283.50 305.55 299.25 302.4 30000014 HEPATIC FUNCTION PANEL 300 80076 139.00 125.10 134.83 132.05 133.44 30000015 OBSTETRIC PANEL W/HIV1/2 300 80081 313.00 281.70 303.61 297.35 300.48 30000019 CARBAMAZEPINE TOTAL 300 80156 149.00 134.10 144.53 141.55 143.04 30000020 CARBAMAZEPINE TEGRETOL 300 80156 149.00 134.10 144.53 141.55 143.04 30000021 CARBAMAZEPINE FREE 300 80157 149.00 134.10 144.53 141.55 143.04 30000022 CYCLOSPORINE 300 80158 193.00 173.70 187.21 183.35 185.28 30000024 DIGOXIN 300 80162 128.00 115.20 124.16 121.60 122.88 30000025 VALPROIC ACID - DEPAKENE 300 80164 161.00 144.90 156.17 152.95 154.56 30000026 ETHOSUXIMIDE ZARONTIN 300 80168 170.00 153.00 164.90 161.50 163.2 30000027 GENTAMICIN 300 80170 159.00 143.10 154.23 151.05 152.64 30000028 GABAPENTIN/NEURONTIN QUANT 300 80171 99.00 89.10 96.03 94.05 95.04 30000029 HALOPERIDOL SERUM 300 80173 239.00 215.10 231.83 227.05 229.44 30000030 LAMOTRIGINE QUANT 300 80175 229.00 206.10 222.13 217.55 219.84 30000032 KEPPRA/LEVETIRACETAM QUANT 300 80177 229.00 206.10 222.13 217.55 219.84 30000033 LITHIUM SERUM 300 80178 103.00 92.70 99.91 97.85 98.88 30000035 TRILEPTAL/OXCARBAZEPINE QUANT 300 80183 149.00 134.10 144.53 141.55 143.04 30000036 PHENOBARBITOL 300 80184 155.00 139.50 150.35 147.25 148.8 30000037 ASSAY OF PHENOBARBITAL 300 80184 155.00 139.50 150.35 147.25 148.8 30000038 PHENOBARBITAL QUANT 300 80184 155.00 139.50 150.35 147.25 148.8 30000039 PHENYTOIN DILANTIN TOTAL 300 80185 139.00 125.10 134.83 132.05 133.44 30000040 PHENYTOIN TOTAL 300 80185 139.00 125.10 134.83 132.05 133.44 30000041 PHENYTOIN FREE 300 80186 150.00 135.00 145.50 142.50 144 30000043 PRIMIDONE 300 80188 137.00 123.30 132.89 130.15 131.52 30000044 PROCAINAMIDE & NAPA 300 80192 161.00 144.90 156.17 152.95 154.56 30000047 QUINIDINE 300 80194 137.00 123.30 132.89 130.15 131.52 30000048 RAPAMYCIN SIROLIMUS 300 80195 198.00 178.20 192.06 188.10 190.08 30000049 SIROLIMUS 300 80195 145.00 130.50 140.65 137.75 139.2 30000050 TACROLIMUS 300 80197 220.00 198.00 213.40 209.00 211.2 30000051 THEOPHYLLINE 300 80198 138.00 124.20 133.86 131.10 132.48 30000052 TOBRAMYCIN 300 80200 155.00 139.50 150.35 147.25 148.8 30000053 TOPIRAMATE 300 80201 268.00 241.20 259.96 254.60 257.28 30000054 TOPIRAMATE TOPAMAX 300 80201 268.00 241.20 259.96 254.60 257.28 30000055 VANCOMYCIN 300 80202 170.00 153.00 164.90 161.50 163.2 30000056 ZONISAMIDE 300 80203 136.00 122.40 131.92 129.20 130.56 30000058 QUANTITATION OF DRUG NES 300 80299 815.00 733.50 790.55 774.25 782.4 30000060 GABAPENTIN 300 80299 229.00 206.10 222.13 217.55 219.84 30000061 FELBAMATE 300 80299 229.00 206.10 222.13 217.55 219.84 30000062 5 FLUCYTOSINE 300 80299 229.00 206.10 222.13 217.55 219.84 30000063 VORICONAZOLE LEVEL 300 80285 229.00 206.10 222.13 217.55 219.84 30000064 AMIODARONE 300 80299 229.00 206.10 222.13 217.55 219.84 30000065 QUANT OF THERAPEUTIC DRUG NES 300 80230 196.00 176.40 190.12 186.20 188.16 30000066 METHOTREXATE 300 80299 229.00 206.10 222.13 217.55 219.84 30000067 TRAZODONE 300 80299 229.00 206.10 222.13 217.55 219.84 30000068 MEXILETINE 300 80299 229.00 206.10 222.13 217.55 219.84 30000069 LEVETIRACETAM KEPPRA 300 80299 229.00 206.10 222.13 217.55 219.84 30000070 LAMOTRIGINE 300 80299 229.00 206.10 222.13 217.55 219.84 30000071 OXCARBAZEPINE METABOLITE 300 80299 229.00 206.10 222.13 217.55 219.84 30000072 TIAGABINE 300 80299 229.00 206.10 222.13 217.55 219.84 30000073 TRILEPTAL LEVEL 300 80299 229.00 206.10 222.13 217.55 219.84 30000074 ITRACONAZOLE 300 80299 229.00 206.10 222.13 217.55 219.84 30000075 ZONISAMIDE 300 80299 229.00 206.10 222.13 217.55 219.84 30000076 STOOL FOR VIBRIO 300 80299 229.00 206.10 222.13 217.55 219.84 30000079 COMP DRUG SCREEN NONFOR URINE 300 80307 85.00 76.50 82.45 80.75 81.6 30000087 OPIATES 300 80307 33.00 29.70 32.01 31.35 31.68 30000093 SYNTHETIC CANNABINOIDS URINE 300 80307 314.00 282.60 304.58 298.30 301.44 30000094 ALCOHOL 300 80320 180.00 162.00 174.60 171.00 172.8 30000095 ETHYLENE GLYCOL 300 80320 180.00 162.00 174.60 171.00 172.8 30000096 VOLATILES SCREEN 300 80320 180.00 162.00 174.60 171.00 172.8 30000097 NICOTINE URINE 300 80323 137.00 123.30 132.89 130.15 131.52 30000098 AMPHETAMINES 1 OR 2 300 80324 62.00 55.80 60.14 58.90 59.52 30000101 FELBAMATE 300 80339 311.00 279.90 301.67 295.45 298.56 30000102 LACOSAMIDE ANTIEPILEPTICS 300 80235 311.00 279.90 301.67 295.45 298.56 30000103 METHSUXIMIDE 300 80339 311.00 279.90 301.67 295.45 298.56 30000104 THIOTHIXENE NAVENE 300 80342 266.00 239.40 258.02 252.70 255.36 30000106 LIBRIUM METABOLITE 300 80346 132.00 118.80 128.04 125.40 126.72 30000107 CANNABINOIDS NATURAL 300 80349 185.00 166.50 179.45 175.75 177.6 30000108 MDA MDEA MDMA 300 80359 77.00 69.30 74.69 73.15 73.92 30000109 COMPLIANCE DRUG SCREEN 300 80368 581.00 522.90 563.57 551.95 557.76 30000110 LASIX FUROSEMIDE 300 80375 124.00 111.60 120.28 117.80 119.04 30000111 CLINICAL PATH CONSULT WO 300 80500 237.00 213.30 229.89 225.15 227.52 30000112 URINALYSIS NONAUTO W SCOPE 300 81000 45.00 28 43.65 42.75 43.2 30000113 UA AUTO WITH MICROSCOPY 300 81001 56.00 28 54.32 53.20 53.76 30000114 PROTEIN URINE QUAL 300 81002 32.00 28.80 31.04 30.40 30.72 30000115 PH SCREEN URINE 300 81002 32.00 28.80 31.04 30.40 30.72 30000116 SPECIFIC GRAVITY UA 300 81002 32.00 28.80 31.04 30.40 30.72 30000117 GLUCOSE URINE QUAL 300 81002 32.00 28.80 31.04 30.40 30.72 30000118 UA WO MICRO NON AUTO 300 81002 32.00 28.80 31.04 30.40 30.72 30000119 KETONE URINE QUAL NON AUTO 300 81002 32.00 28.80 31.04 30.40 30.72 30000120 KETONES UR 300 81003 36.00 32.40 34.92 34.20 34.56 30000121 UA W/O MICRO AUTO 300 81003 36.00 32.40 34.92 34.20 34.56 30000122 URINALYSIS MICROSCOPIC ONLY 300 81015 26.00 23.40 25.22 24.70 24.96 30000123 HCG QUAL URINE PREG 300 81025 91.00 81.90 88.27 86.45 87.36 30000124 URINE MEASURE TIMED COLL 300 81050 28.00 25.20 27.16 26.60 26.88 30000125 BCR ABL 1 GENE MAJOR BP R 300 81206 376.00 338.40 364.72 357.20 360.96 30000126 Hc Bcr Abl 1 Gene Minor Bp R 300 81207 369.00 332.10 357.93 350.55 354.24 30000127 BCR ABL 1 GENE MAJOR BP R 300 81208 356.00 320.40 345.32 338.20 341.76 30000128 CFTR GENE ANALYSIS 300 81220 869.00 782.10 842.93 825.55 834.24 30000131 F2 GENE ANALYSIS 20210G 300 81240 193.00 173.70 187.21 183.35 185.28 30000132 F5 GENE ANALYSIS LEIDEN 300 81241 217.00 195.30 210.49 206.15 208.32 30000133 FMR1 ANALYSIS EVAL TO DET 300 81243 802.00 721.80 777.94 761.90 769.92 30000136 HFE GENE ANALYSIS 300 81256 448.00 403.20 434.56 425.60 430.08 30000137 JAK2 GENE ANALYSIS 300 81270 869.00 782.10 842.93 825.55 834.24 30000138 JAK2 GENE V617F MUTATION QUAL 300 81270 869.00 782.10 842.93 825.55 834.24 30000139 MTHFR GENE ANALYSIS 300 81291 5.00 4.50 4.85 4.75 4.8 30000141 PRADER-WILLI/ANGELMAN SYN 300 81331 946.00 851.40 917.62 898.70 908.16 30000142 SERPINA-1 GENE ANALYSIS COMMON VAR 300 81332 338.00 304.20 327.86 321.10 324.48 30000143 TRB REARRANGE ANAL AMP MET 300 81340 728.00 655.20 706.16 691.60 698.88 30000144 TRB REARRANGE ANAL AMP MET 300 81342 728.00 655.20 706.16 691.60 698.88 30000146 HLA TYPING 300 81381 311.00 279.90 301.67 295.45 298.56 30000148 MOLECULAR PATHOLOGY 300 81408 " 1,853.00 " " 1,667.70 " " 1,797.41 " " 1,760.35 " "1,778.88" 30000149 SEVERE COMB IMMUNE DEFICIENCY 300 81479 14.00 12.60 13.58 13.30 13.44 30000150 Hc Cebpa Gene Analysis 300 81218 289.00 260.10 280.33 274.55 277.44 30000151 QUAD SCREEN 2ND TRIMESTER 300 81511 118.00 106.20 114.46 112.10 113.28 30000152 ACETONE QUALITATIVE 300 82009 59.00 53.10 57.23 56.05 56.64 30000153 BETA-HYDROXYBUTYRATE 300 82010 78.00 70.20 75.66 74.10 74.88 30000154 BETA-HYDROXBUTYRIC ACID 300 82010 78.00 70.20 75.66 74.10 74.88 30000155 ACETONE SERUM QUANT 300 82010 78.00 70.20 75.66 74.10 74.88 30000156 ACYLCARNITINES QUANTITATIVE 300 82017 264.00 237.60 256.08 250.80 253.44 30000157 ACTH 300 82024 298.00 268.20 289.06 283.10 286.08 30000158 ADDL ALBUMIN 300 82040 45.00 40.50 43.65 42.75 43.2 30000159 ALBUMIN 300 82040 45.00 40.50 43.65 42.75 43.2 30000160 ALBUMIN URINE/OTHR QNT EA SPEC 300 82042 54.00 48.60 52.38 51.30 51.84 30000162 MICROALBUMIN URINE QUANTITATIVE 300 82043 101.00 90.90 97.97 95.95 96.96 30000163 MICROALBUMIN SEMIQUANT 300 82044 77.00 69.30 74.69 73.15 73.92 30000165 Hc Assay Of Breath Ethanol 300 82075 50.00 45.00 48.50 47.50 48 30000166 ALDOLASE 300 82085 97.00 87.30 94.09 92.15 93.12 30000167 ALDOSTERONE URINE 300 82088 348.00 313.20 337.56 330.60 334.08 30000168 ALDOSTERONE SERUM 300 82088 348.00 313.20 337.56 330.60 334.08 30000169 ALPHA-1 ANTITRYPSIN TOTAL 300 82103 165.00 148.50 160.05 156.75 158.4 30000170 ALPHA-1-ANTITRYPSIN 300 82103 165.00 148.50 160.05 156.75 158.4 30000171 Hc Alpha 1 Antitrypsin Phenotype 300 82104 118.00 106.20 114.46 112.10 113.28 30000173 ALPHA-FETOPROTEIN AFP 300 82105 114.00 102.60 110.58 108.30 109.44 30000174 ALPHA-FETOPROTEIN SERUM 300 82105 114.00 102.60 110.58 108.30 109.44 30000175 ALPHA-FETOPROTEIN AMNIO 300 82106 185.00 166.50 179.45 175.75 177.6 30000176 ALUMINUM 300 82108 170.00 153.00 164.90 161.50 163.2 30000177 AMINO ACIDS QUAL 300 82128 231.00 207.90 224.07 219.45 221.76 30000179 ALA AMINOLEV ACID 300 82135 288.00 259.20 279.36 273.60 276.48 30000180 AMINOLEVULINIC ACID ALA URINE 300 82135 288.00 259.20 279.36 273.60 276.48 30000181 AMINO ACIDS 6 OR MORE QUANT 300 82139 956.00 860.40 927.32 908.20 917.76 30000182 AMMONIA PLASMA 300 82140 144.00 129.60 139.68 136.80 138.24 30000184 Hc Amylase 300 82150 99.00 89.10 96.03 94.05 95.04 30000185 AMYLASE FLUID 300 82150 99.00 89.10 96.03 94.05 95.04 30000187 AMYLASE URINE RANDOM 300 82150 99.00 89.10 96.03 94.05 95.04 30000188 AMYLASE URINE TIMED 300 82150 99.00 89.10 96.03 94.05 95.04 30000189 ANDROSTENEDIONE 300 82157 237.00 213.30 229.89 225.15 227.52 30000190 ANGIOTENSIN CONVERTING ENZYME 300 82164 169.00 152.10 163.93 160.55 162.24 30000192 APOLIPOPROTEIN 300 82172 164.00 147.60 159.08 155.80 157.44 30000193 APOLIPOPROTEIN EACH 300 82172 118.00 106.20 114.46 112.10 113.28 30000195 ARSENIC 300 82175 159.00 143.10 154.23 151.05 152.64 30000196 ARSENIC BLOOD 300 82175 159.00 143.10 154.23 151.05 152.64 30000197 ARSENIC FRACTIONATED 300 82175 159.00 143.10 154.23 151.05 152.64 30000198 VITAMIN C ASCORBIC ACID 300 82180 97.00 87.30 94.09 92.15 93.12 30000199 BETA 2 MICROGLOBULIN 300 82232 143.00 128.70 138.71 135.85 137.28 30000200 BILE ACIDS TOTAL 300 82239 144.00 129.60 139.68 136.80 138.24 30000201 ADDL BILIRUBIN TOTAL 300 82247 61.00 54.90 59.17 57.95 58.56 30000202 BILIRUBIN TOTAL 300 82247 61.00 54.90 59.17 57.95 58.56 30000203 BILIRUBIN DIRECT 300 82248 56.00 50.40 54.32 53.20 53.76 30000204 ADDITIONAL BILIRUBIN DIRECT 300 82248 56.00 50.40 54.32 53.20 53.76 30000205 BIOTINIDASE 300 82261 59.00 53.10 57.23 56.05 56.64 30000206 BIOTINIDASE QUANT 300 82261 59.00 53.10 57.23 56.05 56.64 30000208 OCCULT BLOOD X3 SCREENING 300 82270 37.00 33.30 35.89 35.15 35.52 30000209 "Hc Occult Blood, Gastric" 300 82271 52.00 46.80 50.44 49.40 49.92 30000210 "Hc Occult Blood, Stool" 300 82272 39.00 35.10 37.83 37.05 37.44 30000211 CADMIUM 300 82300 85.00 76.50 82.45 80.75 81.6 30000212 VITAMIN D 25-HYDROXY CALCIFEDIOL 300 82306 217.00 195.30 210.49 206.15 208.32 30000213 CALCITONIN 300 82308 282.00 253.80 273.54 267.90 270.72 30000214 CALCIUM 300 82310 61.00 54.90 59.17 57.95 58.56 30000215 CALCIUM CSF 300 82310 61.00 54.90 59.17 57.95 58.56 30000216 ADDL CALCIUM 300 82310 61.00 54.90 59.17 57.95 58.56 30000217 CALCIUM URINE 300 82310 61.00 54.90 59.17 57.95 58.56 30000219 BEDSIDE CALC IONIZE 300 82330 113.00 101.70 109.61 107.35 108.48 30000220 BEDSIDE CA IONIZED 300 82330 113.00 101.70 109.61 107.35 108.48 30000221 CALCIUM IONIZED 300 82330 113.00 101.70 109.61 107.35 108.48 30000222 CALCIUM 24 HOUR URINE 300 82340 76.00 68.40 73.72 72.20 72.96 30000223 KIDNEY STONE ANALYSIS 300 82365 130.00 117.00 126.10 123.50 124.8 30000224 CARBON DIOXIDE 300 82374 47.00 42.30 45.59 44.65 45.12 30000225 ADDL CARBON DIOXIDE 300 82374 18.00 16.20 17.46 17.10 17.28 30000226 CARBON MONOXIDE QUANT BLD 300 82375 144.00 129.60 139.68 136.80 138.24 30000227 CARCINOEMBRYONIC AG CFA 300 82378 149.00 134.10 144.53 141.55 143.04 30000228 CARCINOEMBRYONIC ANTIGEN CEA 300 82378 149.00 134.10 144.53 141.55 143.04 30000230 CARNITINE SERUM 300 82379 267.00 240.30 258.99 253.65 256.32 30000231 CATECHOLAMINE FRACTIONATED 300 82384 236.00 212.40 228.92 224.20 226.56 30000232 CERULOPLASMIN 300 82390 113.00 101.70 109.61 107.35 108.48 30000233 CHEMILUMINESCENT ASSAY 300 82397 276.00 248.40 267.72 262.20 264.96 30000234 PTH RELATED PEPTIDE 300 82397 276.00 248.40 267.72 262.20 264.96 30000235 CHEMILUMINESCENT ASAY 300 82397 55.00 49.50 53.35 52.25 52.8 30000236 ADDL CHLORIDE BLOOD 300 82435 18.00 16.20 17.46 17.10 17.28 30000238 CHLORIDE BLOOD 300 82435 59.00 53.10 57.23 56.05 56.64 30000239 CHLORIDE URINE 300 82436 52.00 46.80 50.44 49.40 49.92 30000240 CHLORIDE FLUID 300 82438 119.00 107.10 115.43 113.05 114.24 30000244 CHOLESTEROL 300 82465 66.00 59.40 64.02 62.70 63.36 30000245 ADDL CHOLESTEROL 300 82465 69.00 62.10 66.93 65.55 66.24 30000246 PSEUDOCHOLINESTERASE 300 82480 111.00 99.90 107.67 105.45 106.56 30000254 COLLAGEN CROSS LINKS URINE 300 82523 284.00 255.60 275.48 269.80 272.64 30000255 ASSAY OF COPPER 300 82525 138.00 124.20 133.86 131.10 132.48 30000256 CORTISOL FREE 300 82530 166.00 149.40 161.02 157.70 159.36 30000257 CORTISOL TOTAL 300 82533 145.00 130.50 140.65 137.75 139.2 30000260 CHROMATO MASS SPEC QUANT 300 82542 162.00 145.80 157.14 153.90 155.52 30000261 HYDROCODONE FORENSIC 300 82542 162.00 145.80 157.14 153.90 155.52 30000262 COLUMN CHROMATOGRAPHY EACH SP 300 82542 521.00 468.90 505.37 494.95 500.16 30000263 CANNABINOIDS MECONIUM 300 82542 162.00 145.80 157.14 153.90 155.52 30000264 DIPHENHYDRAMINE BENADRYL 300 82542 162.00 145.80 157.14 153.90 155.52 30000265 DRUG CONFIRM GC MS BARB 300 82542 162.00 145.80 157.14 153.90 155.52 30000266 DRUG CONFIRM BENZO URINE 300 82542 162.00 145.80 157.14 153.90 155.52 30000267 DRUG CONFIRMATION EACH PR 300 82542 162.00 145.80 157.14 153.90 155.52 30000268 LACOSAMIDE VIMPAT 300 82542 162.00 145.80 157.14 153.90 155.52 30000269 MARIJUANA QUANT 300 82542 162.00 145.80 157.14 153.90 155.52 30000270 N METHYLHISTAMINE 24H URINE 300 82542 162.00 145.80 157.14 153.90 155.52 30000271 OPIATE CONF EXPND 300 82542 161.00 144.90 156.17 152.95 154.56 30000272 OXYCODONE CONFIRM 300 82542 162.00 145.80 157.14 153.90 155.52 30000274 TRAMADOL AND METABOLITE 300 82542 162.00 145.80 157.14 153.90 155.52 30000276 CREATINE PHOSPHOKINASE 300 82550 92.00 82.80 89.24 87.40 88.32 30000277 CK TOTAL 300 82550 92.00 82.80 89.24 87.40 88.32 30000279 CK ISOENZYMES 300 82552 153.00 137.70 148.41 145.35 146.88 30000280 CPK MB FRACTION 300 82553 180.00 162.00 174.60 171.00 172.8 30000281 BEDSIDE CREATININE 300 82565 61.00 54.90 59.17 57.95 58.56 30000282 ADDL CREATININE 300 82565 61.00 54.90 59.17 57.95 58.56 30000283 CREATININE URINE RANDOM 300 82570 71.00 63.90 68.87 67.45 68.16 30000284 URINE CREATININE TIMED 300 82570 71.00 63.90 68.87 67.45 68.16 30000285 URINE CREATININE 300 82570 71.00 63.90 68.87 67.45 68.16 30000286 CREATININE OTHER SOURCE 300 82570 71.00 63.90 68.87 67.45 68.16 30000287 CREATININE CLEARANCE 300 82575 113.00 101.70 109.61 107.35 108.48 30000288 CRYOFIBRINOGEN 300 82585 72.00 64.80 69.84 68.40 69.12 30000289 ASSAY OF CRYOGLOBULIN 300 82595 137.00 123.30 132.89 130.15 131.52 30000291 VITAMIN B-12 300 82607 150.00 135.00 145.50 142.50 144 30000292 DHEA 300 82626 212.00 190.80 205.64 201.40 203.52 30000293 DHEA SULFATE 300 82627 229.00 206.10 222.13 217.55 219.84 30000294 DEOXYCORTICOOSTERONE 300 82633 450.00 405.00 436.50 427.50 432 30000295 DEOXYCORTICOSTEROIDS 300 82634 215.00 193.50 208.55 204.25 206.4 30000296 DIBUCAINE INDEX 300 82638 111.00 99.90 107.67 105.45 106.56 30000297 VITAMIN D 1 25-DIHYDROXY 300 82652 355.00 319.50 344.35 337.25 340.8 30000298 ENZYME ACTIVITY EACH SPECIMEN 300 82657 684.00 615.60 663.48 649.80 656.64 30000299 ENZYME ACTIVITY IN BLOOD CELLS 300 82657 684.00 615.60 663.48 649.80 656.64 30000300 TPMT 300 82657 684.00 615.60 663.48 649.80 656.64 30000302 ELECTROPHORETIC TECHNIQUE 300 82664 287.00 258.30 278.39 272.65 275.52 30000304 ERYTHROPOIETIN 300 82668 207.00 186.30 200.79 196.65 198.72 30000305 ESTRADIOL 300 82670 175.00 157.50 169.75 166.25 168 30000306 ESTROGEN TOTAL 300 82672 343.00 308.70 332.71 325.85 329.28 30000307 ESTRIOL 300 82677 132.00 118.80 128.04 125.40 126.72 30000308 ESTRONE 300 82679 265.00 238.50 257.05 251.75 254.4 30000309 ETHYLENE GLYCOL SERUM 300 82693 293.00 263.70 284.21 278.35 281.28 30000310 FAT STOOL QUAL 300 82705 282.00 253.80 273.54 267.90 270.72 30000311 FECAL FAT QUANTITATIVE 300 82710 282.00 253.80 273.54 267.90 270.72 30000312 FERRITIN 300 82728 130.00 117.00 126.10 123.50 124.8 30000313 FETAL FIBRONECTIN SEMIQUANT 300 82731 506.00 455.40 490.82 480.70 485.76 30000314 FLUORIDE 300 82735 208.00 187.20 201.76 197.60 199.68 30000315 FOLIC ACID 300 82746 143.00 128.70 138.71 135.85 137.28 30000316 FOLATE RBC 300 82747 142.00 127.80 137.74 134.90 136.32 30000317 FRUCTOSE SEMEN 300 82757 341.00 306.90 330.77 323.95 327.36 30000318 GALACTOSE 300 82760 56.00 50.40 54.32 53.20 53.76 30000320 GALACTOSE-1-PHOS URIDYL TRANSF 300 82776 49.00 44.10 47.53 46.55 47.04 30000321 GAMMAGLOB IGA/IGG/IGM EACH 300 82784 105.00 94.50 101.85 99.75 100.8 30000322 IGG 300 82784 105.00 94.50 101.85 99.75 100.8 30000323 IGA 300 82784 105.00 94.50 101.85 99.75 100.8 30000324 IGM 300 82784 105.00 94.50 101.85 99.75 100.8 30000325 CELIAC DISEASE SEROLOGY C 300 82784 105.00 94.50 101.85 99.75 100.8 30000326 IGE 300 82785 136.00 122.40 131.92 129.20 130.56 30000327 IMMUNOGLOBULIN G SUBCLASS 300 82787 109.00 98.10 105.73 103.55 104.64 30000328 PH BLOOD 300 82800 92.00 82.80 89.24 87.40 88.32 30000329 BEDSIDE BLOOD GAS 300 82803 229.00 206.10 222.13 217.55 219.84 30000330 BEDSIDE BLOOD GASES 300 82803 229.00 206.10 222.13 217.55 219.84 30000331 BLOOD GASES PH PCO2 PO2 300 82803 229.00 206.10 222.13 217.55 219.84 30000334 PH AND PCO2 300 82803 229.00 206.10 222.13 217.55 219.84 30000336 GASTRIN 300 82941 193.00 173.70 187.21 183.35 185.28 30000337 GLUCOGON 300 82943 262.00 235.80 254.14 248.90 251.52 30000338 GLUCOSE URINE 300 82945 61.00 54.90 59.17 57.95 58.56 30000339 GLUCOSE 2 HR 300 82947 45.00 40.50 43.65 42.75 43.2 30000340 ADDL GLUCOSE QUANT 300 82947 45.00 40.50 43.65 42.75 43.2 30000341 REAGENT STRIP/BLOOD GLUCOSE 300 82948 50.00 45.00 48.50 47.50 48 30000342 GLUCOSE TOLERANCE/SPECI 300 82950 64.00 57.60 62.08 60.80 61.44 30000343 LACTOSE TOLERANCE 3 SPECIMENS 300 82951 165.00 148.50 160.05 156.75 158.4 30000344 TOL TEST - EA ADDL SPEC > 3 300 82952 55.00 49.50 53.35 52.25 52.8 30000345 GLUCOSE 6 PHOSPHATE DEHYDROGEN 300 82955 169.00 152.10 163.93 160.55 162.24 30000346 BEDSIDE GLUCOSE 300 82962 48.00 43.20 46.56 45.60 46.08 30000347 GGT 300 82977 68.00 61.20 65.96 64.60 65.28 30000348 GGT 300 82977 68.00 61.20 65.96 64.60 65.28 30000349 ADDL GGT GAMMA GLUTAMYL 300 82977 72.00 64.80 69.84 68.40 69.12 30000350 FRUCTOSAMINE 300 82985 150.00 135.00 145.50 142.50 144 30000351 GONADOTROPIN FOLL STIM HORMONE 300 83001 135.00 121.50 130.95 128.25 129.6 30000352 GONADOTROPIN LUTEINIZING HORM 300 83002 118.00 106.20 114.46 112.10 113.28 30000353 GROWTH HORMONE 300 83003 126.00 113.40 122.22 119.70 120.96 30000354 GROWTH HORMONE HUMAN 300 83003 124.00 111.60 120.28 117.80 119.04 30000355 HAPTOGLOBIN 300 83010 113.00 101.70 109.61 107.35 108.48 30000356 HAPTOGLOBIN QNT 300 83010 113.00 101.70 109.61 107.35 108.48 30000357 HELICOBACTER PLYORI BREATH TST 300 83013 393.00 353.70 381.21 373.35 377.28 30000360 HEMOGLOBIN FRACTION ELECTROPHO 300 83020 105.00 94.50 101.85 99.75 100.8 30000361 HEMOGLOBIN EVALUATION 300 83021 106.00 95.40 102.82 100.70 101.76 30000362 HGB FRACT CHROMATOGRAPHY 300 83021 106.00 95.40 102.82 100.70 101.76 30000363 HGB FRACTIONATION QUANT CHRO 300 83021 106.00 95.40 102.82 100.70 101.76 30000366 HGB A1C 300 83036 74.00 66.60 71.78 70.30 71.04 30000368 METHEMOGLOBIN QUANT 300 83050 85.00 76.50 82.45 80.75 81.6 30000369 PLASMA HEMOGLOBIN 300 83051 125.00 112.50 121.25 118.75 120 30000370 HEMOGLOBIN UNSTABLE SCREEN 300 83068 28.00 25.20 27.16 26.60 26.88 30000371 HEMOGLOBIN URINE 300 83069 114.00 102.60 110.58 108.30 109.44 30000372 HEMOSIDERIN 300 83070 55.00 49.50 53.35 52.25 52.8 30000373 HEMOSIDERIN QUAL URINE 300 83070 106.00 95.40 102.82 100.70 101.76 30000374 ASSAY HISTAMINE 300 83088 283.00 254.70 274.51 268.85 271.68 30000375 HOMOCYSTEINE TOTAL 300 83090 230.00 207.00 223.10 218.50 220.8 30000376 HOMOVANILLIC ACID HVA 300 83150 264.00 237.60 256.08 250.80 253.44 30000377 5 HIAA HYDROXYINDOLACETIC ACID 300 83497 155.00 139.50 150.35 147.25 148.8 30000378 17 HYDROXYPROGESTERONE 300 83498 149.00 134.10 144.53 141.55 143.04 30000379 CONGENTL ADREN HYPRPLSIC SCREN 300 83498 149.00 134.10 144.53 141.55 143.04 30000380 HYDROPROGESTERONE 17-D 300 83498 149.00 134.10 144.53 141.55 143.04 30000381 NEONATAL 17 OHP 300 83498 149.00 134.10 144.53 141.55 143.04 30000382 ANNA IGG BY IMMUNOBLOT 300 83516 244.00 219.60 236.68 231.80 234.24 30000383 CYSTIC FIBROSIS SCREEN 300 83516 171.00 153.90 165.87 162.45 164.16 30000384 DEAMINATED GLIADEN IGA OR IGG 300 83516 171.00 153.90 165.87 162.45 164.16 30000386 IMMUN FOR AN OTH INF AB OR AG 300 83516 171.00 153.90 165.87 162.45 164.16 30000388 IMMUNO QUANT RO SEMI QUANT OTH 300 83516 171.00 153.90 165.87 162.45 164.16 30000389 IMMUNOASSAY FOR PR3 AB 300 83516 171.00 153.90 165.87 162.45 164.16 30000390 IMMUNOASSAY MULT STEP 300 83516 171.00 153.90 165.87 162.45 164.16 30000391 IMMUNOASSAY QUANTITATIVE 300 83516 144.00 129.60 139.68 136.80 138.24 30000392 MYELOPEROXIDASE AB 300 83516 171.00 153.90 165.87 162.45 164.16 30000393 MYELOPEROXIDASE MPO 300 83516 171.00 153.90 165.87 162.45 164.16 30000395 RNA POLYMERASE III AB IGG 300 83516 171.00 153.90 165.87 162.45 164.16 30000396 TISSUE TRANSGLUT IGA OR IGG 300 83516 171.00 153.90 165.87 162.45 164.16 30000397 TITIN ANTIBODY 300 83516 244.00 219.60 236.68 231.80 234.24 30000399 CETROMERE AB IGG 300 83516 171.00 153.90 165.87 162.45 164.16 30000400 HISTONE ANTIBODY 300 83516 171.00 153.90 165.87 162.45 164.16 30000401 MITOCHONDRIAL ANTIBODIES 300 83516 171.00 153.90 165.87 162.45 164.16 30000402 PARIETAL CELL AB IGG 300 83516 171.00 153.90 165.87 162.45 164.16 30000403 IMMUNO NON-AB 300 83516 171.00 153.90 165.87 162.45 164.16 30000404 IMMUNOASSAY NON 300 83516 171.00 153.90 165.87 162.45 164.16 30000405 PANCREATIC ELASTASE STOOL 300 83516 171.00 153.90 165.87 162.45 164.16 30000406 ACETYLCHOLINE BINDING AB 300 83519 271.00 243.90 262.87 257.45 260.16 30000410 IMMUNO ANALYTE QUANT BY RIA 300 83519 236.00 212.40 228.92 224.20 226.56 30000411 IMMUNOASSAY QUANT BY RIA 300 83519 236.00 212.40 228.92 224.20 226.56 30000412 RIA FOR NON-INFECTIOUS AGENT 300 83519 847.00 762.30 821.59 804.65 813.12 30000413 PQ TYPE CALCIUM CHANNEL AB 300 83519 81.00 72.90 78.57 76.95 77.76 30000414 NEURONAL VGK CAUTO ANTIBODY 300 83519 81.00 72.90 78.57 76.95 77.76 30000416 ACLR GANGLIONIC NEURONAL AB 300 83519 81.00 72.90 78.57 76.95 77.76 30000417 Hc 21-hydroxylase Antibodies 300 83519 271.00 243.90 262.87 257.45 260.16 30000418 LEPTIN 300 83519 271.00 243.90 262.87 257.45 260.16 30000419 PANCREATIC POLYPEPTIDE 300 83519 271.00 243.90 262.87 257.45 260.16 30000420 IMMUNO NONANTIBO 300 83519 271.00 243.90 262.87 257.45 260.16 30000421 THYROTROPIN RECEPTOR AB 300 83519 271.00 243.90 262.87 257.45 260.16 30000422 IGF BINGING PROTEIN 1 M5 300 83519 271.00 243.90 262.87 257.45 260.16 30000423 CYTOKINE 300 83520 195.00 175.50 189.15 185.25 187.2 30000424 IMMUNO ANALYTE QUANT 300 83520 195.00 175.50 189.15 185.25 187.2 30000425 IMMUNOASSAY ANALYTE QUANT 300 83520 195.00 175.50 189.15 185.25 187.2 30000429 MANNOSE BINDING LECTIN 300 83520 195.00 175.50 189.15 185.25 187.2 30000430 NEURON-SPECIFIC ENOLASE 300 83520 195.00 175.50 189.15 185.25 187.2 30000431 PANCREATIC ELASTASE FECAL 300 83520 195.00 175.50 189.15 185.25 187.2 30000432 TRYPTASE 300 83520 195.00 175.50 189.15 185.25 187.2 30000433 ANTIMULLERIAN HORMANE AB 300 83520 277.00 249.30 268.69 263.15 265.92 30000434 ANTIMULLERIAN HORMONE AMH 300 83520 289.00 260.10 280.33 274.55 277.44 30000435 ANTI-SACCHAROMYCES IGA 300 83520 195.00 175.50 189.15 185.25 187.2 30000436 ANTI-SACCHAROMYCES IGG 300 83520 195.00 175.50 189.15 185.25 187.2 30000437 CENTROMERE ANTIBODIES 300 83520 195.00 175.50 189.15 185.25 187.2 30000439 GLOMERULAR BASE MEMBRANE 300 83520 195.00 175.50 189.15 185.25 187.2 30000440 HEMOGL CONFIRM NEWBORN UN 300 83520 195.00 175.50 189.15 185.25 187.2 30000441 HUMAN ANTI-MOUSE AB 300 83520 195.00 175.50 189.15 185.25 187.2 30000442 IA ANAL QUAN NOS 300 83520 195.00 175.50 189.15 185.25 187.2 30000443 IMMUNOASSAY RIA 300 83520 195.00 175.50 189.15 185.25 187.2 30000444 MAG ANTIBODY DUAL ELISA 300 83520 195.00 175.50 189.15 185.25 187.2 30000445 PHOSPATEID ANTIB 300 83520 195.00 175.50 189.15 185.25 187.2 30000446 PLASMINOGEN ACTIVATOR INH 300 83520 195.00 175.50 189.15 185.25 187.2 30000447 RIBOSOME P AB IGG 300 83520 195.00 175.50 189.15 185.25 187.2 30000448 SENSORIMOTOR NEURO PROFIL 300 83520 195.00 175.50 189.15 185.25 187.2 30000449 STRIATED MSC AB 300 83520 195.00 175.50 189.15 185.25 187.2 30000450 THYROTROPIN RECEPTOR AB 300 83520 180.00 162.00 174.60 171.00 172.8 30000451 X2 IMMUNO ASSAY 300 83520 195.00 175.50 189.15 185.25 187.2 30000452 INSULIN TOTAL 300 83525 164.00 147.60 159.08 155.80 157.44 30000453 IRON 300 83540 64.00 57.60 62.08 60.80 61.44 30000454 IRON BINDING CAPACITY 300 83550 82.00 73.80 79.54 77.90 78.72 30000455 LACTATE 300 83605 136.00 122.40 131.92 129.20 130.56 30000456 BEDSIDE LACTATE 300 83605 136.00 122.40 131.92 129.20 130.56 30000458 LACTIC DEHYDROGENAS FLUID 300 83615 72.00 64.80 69.84 68.40 69.12 30000459 LACTIC DEHYDROGENASE LD 300 83615 72.00 64.80 69.84 68.40 69.12 30000460 LD TOTAL 300 83615 72.00 64.80 69.84 68.40 69.12 30000461 LD ISOENZYMES 300 83625 126.00 113.40 122.22 119.70 120.96 30000462 LEAD 300 83655 93.00 83.70 90.21 88.35 89.28 30000463 FETAL LUNG MATURITY EVAL 300 83661 199.00 179.10 193.03 189.05 191.04 30000466 LIPASE 300 83690 114.00 102.60 110.58 108.30 109.44 30000467 LIPOPROTEIN A 300 83695 192.00 172.80 186.24 182.40 184.32 30000469 HDL 300 83718 76.00 68.40 73.72 72.20 72.96 30000470 LDL CHOLESTEROL DIRECT 300 83721 65.00 58.50 63.05 61.75 62.4 30000473 MAGNESIUM RANDOM URINE 300 83735 79.00 71.10 76.63 75.05 75.84 30000474 MAGNESIUM SERUM 300 83735 79.00 71.10 76.63 75.05 75.84 30000475 MAGNESIUM URINE TIMED 300 83735 79.00 71.10 76.63 75.05 75.84 30000476 MAGNESIUM STOOL 300 83735 79.00 71.10 76.63 75.05 75.84 30000480 CARNITINE TOTAL 300 83789 358.00 322.20 347.26 340.10 343.68 30000481 MASS AND TANDEM SPEC NES EACH 300 83789 358.00 322.20 347.26 340.10 343.68 30000482 PKU DIET SPOT MONITORING 300 84030 79.00 71.10 76.63 75.05 75.84 30000483 THIOPUR METHYLT TPMT-IMUR 300 83789 358.00 322.20 347.26 340.10 343.68 30000484 IODINE URINE 300 83789 358.00 322.20 347.26 340.10 343.68 30000485 MERCURY BLOOD 300 83825 156.00 140.40 151.32 148.20 149.76 30000487 MERCURY QUANT 300 83825 156.00 140.40 151.32 148.20 149.76 30000488 METANEPHRINES 300 83835 259.00 233.10 251.23 246.05 248.64 30000489 METANEPHRINES URINE FRACT 300 83835 259.00 233.10 251.23 246.05 248.64 30000491 MYELIN BASIC PROTEIN 300 83873 318.00 286.20 308.46 302.10 305.28 30000492 MYOGLOBIN 300 83874 159.00 143.10 154.23 151.05 152.64 30000493 MYELOPEROXIDASE AB MPO 300 83876 119.00 107.10 115.43 113.05 114.24 30000494 Hc Nt-probnp (brain Natriuretic Peptide) 300 83880 271.00 243.90 262.87 257.45 260.16 30000495 KAPPA/LAMBDA FREE LIGHT CHAIN 300 83883 185.00 166.50 179.45 175.75 177.6 30000496 NEPHELOMETRY 304 83883 185.00 166.50 179.45 175.75 177.6 30000497 NEPHELOMETRY ANALYTE 300 83883 185.00 166.50 179.45 175.75 177.6 30000498 NEPHELOMETRY EACH ANALYTE NES 300 83883 185.00 166.50 179.45 175.75 177.6 30000500 OLIGOCLONAL BANDS 300 83916 236.00 212.40 228.92 224.20 226.56 30000501 OLIGOCLONAL IMMUNE OLIG BANDS 300 83916 236.00 212.40 228.92 224.20 226.56 30000502 ORGANIC ACIDS TOTAL QUANT 300 83918 329.00 296.10 319.13 312.55 315.84 30000503 ORGANIC ACIDS SCN URINE 300 83919 338.00 304.20 327.86 321.10 324.48 30000504 METHYLMALONIC ACID SERUM 300 83921 338.00 304.20 327.86 321.10 324.48 30000506 OSMOLALITY BLOOD 300 83930 101.00 90.90 97.97 95.95 96.96 30000507 OSMOLALITY URINE 300 83935 101.00 90.90 97.97 95.95 96.96 30000510 PARATHORMONE PTH 300 83970 296.00 266.40 287.12 281.20 284.16 30000513 PH BODY FLUID 300 83986 152.00 136.80 147.44 144.40 145.92 30000514 PH SCREEN NOT URINE 300 83986 152.00 136.80 147.44 144.40 145.92 30000515 PHENCYCLIDINE CONFIRM URI 300 83992 261.00 234.90 253.17 247.95 250.56 30000516 CALPROTECTIN 300 83993 340.00 306.00 329.80 323.00 326.4 30000517 ASSAY OF BLOOD PKU 300 84030 79.00 71.10 76.63 75.05 75.84 30000518 ADDL ALKALINE PHOSPHATASE 300 84075 54.00 48.60 52.38 51.30 51.84 30000519 ALK PHOS-BONE SPECIFIC 300 84075 54.00 48.60 52.38 51.30 51.84 30000520 ALKP TOTAL 300 84075 54.00 48.60 52.38 51.30 51.84 30000521 PHOSPHATASE ALKALINE 300 84075 54.00 48.60 52.38 51.30 51.84 30000522 ALK PHOS ISOENZYMES 300 84080 119.00 107.10 115.43 113.05 114.24 30000523 ALKALINE PHOSPHATASE ISOENZYME 300 84080 119.00 107.10 115.43 113.05 114.24 30000524 AMNIOTIC FLUID-PG 300 84081 192.00 172.80 186.24 182.40 184.32 30000525 PHOSPHORUS 300 84100 59.00 53.10 57.23 56.05 56.64 30000526 ADDL PHOSPHORUS 300 84100 18.00 16.20 17.46 17.10 17.28 30000527 TIMED 300 84105 62.00 55.80 60.14 58.90 59.52 30000528 PBG URINE 300 84110 82.00 73.80 79.54 77.90 78.72 30000530 PORPHOBILINOGEN QUANT UR 300 84110 82.00 73.80 79.54 77.90 78.72 30000531 AMNIOTIC FLUID DETECTION 300 84112 185.00 166.50 179.45 175.75 177.6 30000532 PORPHYRINS URINE FRACTIONATED 300 84120 247.00 222.30 239.59 234.65 237.12 30000534 POTASSIUM SERUM 300 84132 54.00 48.60 52.38 51.30 51.84 30000537 ADDL POTASSIUM SERUM 300 84132 54.00 48.60 52.38 51.30 51.84 30000538 POTASSIUM URINE 300 84133 64.00 57.60 62.08 60.80 61.44 30000539 PREALBUMIN 300 84134 113.00 101.70 109.61 107.35 108.48 30000540 17-HYDROXYPREGNENOLONE M 300 84143 269.00 242.10 260.93 255.55 258.24 30000541 PROGESTERONE 300 84144 127.00 114.30 123.19 120.65 121.92 30000542 PROCALCITONIN 300 84145 216.00 194.40 209.52 205.20 207.36 30000543 PROLACTIN 300 84146 159.00 143.10 154.23 151.05 152.64 30000544 PROSTATE SPECIFIC ANTIGN TOTAL 300 84153 143.00 128.70 138.71 135.85 137.28 30000545 PSA TOTAL 300 84153 143.00 128.70 138.71 135.85 137.28 30000546 PSA FREE 300 84154 78.00 70.20 75.66 74.10 74.88 30000547 PROTEIN TOTAL SERUM 300 84155 58.00 52.20 56.26 55.10 55.68 30000548 ADDL PROTEIN TOTAL SERUM 300 84155 58.00 52.20 56.26 55.10 55.68 30000549 TOTAL PROTEIN URINE 300 84156 73.00 65.70 70.81 69.35 70.08 30000550 Hc Protein Total Other Source 300 84157 59.00 53.10 57.23 56.05 56.64 30000551 PROTEIN ELECTROPHORESIS CSF 300 84157 133.00 119.70 129.01 126.35 127.68 30000552 PROTEIN ELECTROPH FRACTION QNT 300 84165 127.00 114.30 123.19 120.65 121.92 30000553 PROTEIN ELECTRO OTHER FLUID 300 84166 151.00 135.90 146.47 143.45 144.96 30000554 ELCTR FRAC QUA OTH FLUID W CON 300 84166 129.00 116.10 125.13 122.55 123.84 30000555 MAGM WB 300 84181 260.00 234.00 252.20 247.00 249.6 30000558 AMPHIPHYSIN WESTERN BLOT 300 84182 428.00 385.20 415.16 406.60 410.88 30000560 WB W INTERP/REPORT 300 84182 428.00 385.20 415.16 406.60 410.88 30000561 BOTULINUM TOXIN TYPE A 300 84182 428.00 385.20 415.16 406.60 410.88 30000562 PROTOPORPHYRINS RBC 300 84202 266.00 239.40 258.02 252.70 255.36 30000563 PROINSULIN 300 84206 186.00 167.40 180.42 176.70 178.56 30000564 VITAMIN B6 300 84207 208.00 187.20 201.76 197.60 199.68 30000566 PYRUVATE 300 84210 353.00 317.70 342.41 335.35 338.88 30000568 ACETYLCHOLINE AB 300 84238 182.00 163.80 176.54 172.90 174.72 30000569 RENIN ACTIVITY 300 84244 267.00 240.30 258.99 253.65 256.32 30000570 SEROTONIN 300 84260 261.00 234.90 253.17 247.95 250.56 30000572 SEROTONIN SERUM 300 84260 297.00 267.30 288.09 282.15 285.12 30000573 SHBG 300 84270 163.00 146.70 158.11 154.85 156.48 30000574 SODIUM BLOOD 300 84295 49.00 44.10 47.53 46.55 47.04 30000577 ADDL SODIUM BLOOD 300 84295 49.00 44.10 47.53 46.55 47.04 30000578 SODIUM URINE 300 84300 61.00 54.90 59.17 57.95 58.56 30000580 SODIUM STOOL 300 84302 175.00 157.50 169.75 166.25 168 30000581 IGF-1 INSULIN-LIKE GROWTH I 300 84305 199.00 179.10 193.03 189.05 191.04 30000583 PORPHYRIN TOTAL 300 84311 210.00 189.00 203.70 199.50 201.6 30000584 POTASSIUM FECES 300 84311 210.00 189.00 203.70 199.50 201.6 30000586 SPEC GRAVITY EXCL URINE 300 84315 23.00 20.70 22.31 21.85 22.08 30000587 SUGARS SINGLE QUALITATIVE 300 84376 113.00 101.70 109.61 107.35 108.48 30000588 TESTOSTERONE FREE 300 84402 198.00 178.20 192.06 188.10 190.08 30000589 TESTOSTERONE TOTAL 300 84403 178.00 160.20 172.66 169.10 170.88 30000590 VITAMIN B1 PLASMA 300 84425 229.00 206.10 222.13 217.55 219.84 30000593 THYROGLOBULIN 300 84432 131.00 117.90 127.07 124.45 125.76 30000594 THYROGLOBULIN BY LC-MS/MS 300 84432 131.00 117.90 127.07 124.45 125.76 30000595 THYROXINE TOTAL 300 84436 81.00 72.90 78.57 76.95 77.76 30000596 THYROXINE TOTAL NEONATAL 300 84437 48.00 43.20 46.56 45.60 46.08 30000597 T-4 ASSAY FREE 300 84439 99.00 89.10 96.03 94.05 95.04 30000598 THYROXINE FREE 300 84439 99.00 89.10 96.03 94.05 95.04 30000600 THYROID STIMULATING HORMONE 300 84443 107.00 96.30 103.79 101.65 102.72 30000601 TSH TRIG FRM NEONATAL SCREEN 300 84443 107.00 96.30 103.79 101.65 102.72 30000602 THYROID STIMULATING IMM GLOBUL 300 84445 445.00 400.50 431.65 422.75 427.2 30000603 VITAMIN E 300 84446 202.00 181.80 195.94 191.90 193.92 30000604 AST SGOT 300 84450 73.00 65.70 70.81 69.35 70.08 30000605 ADDL SGOT AST 300 84450 73.00 65.70 70.81 69.35 70.08 30000606 ALT 300 84460 59.00 53.10 57.23 56.05 56.64 30000607 ADDITIONAL SGPT 300 84460 59.00 53.10 57.23 56.05 56.64 30000608 TRANSFERRIN 300 84466 108.00 97.20 104.76 102.60 103.68 30000609 TRIGLYCERIDES 300 84478 62.00 55.80 60.14 58.90 59.52 30000611 T3 UPTAKE 300 84479 88.00 79.20 85.36 83.60 84.48 30000612 TRIIODOTHYRONINE T3 TOTAL 300 84480 127.00 114.30 123.19 120.65 121.92 30000613 TRIIODOTHYRONINE T3 FREE 300 84481 211.00 189.90 204.67 200.45 202.56 30000614 T-3 REVERSE 300 84482 230.00 207.00 223.10 218.50 220.8 30000615 TROPONIN I 300 84484 204.00 183.60 197.88 193.80 195.84 30000616 UREA NITROGEN FLUID 300 84520 52.00 46.80 50.44 49.40 49.92 30000617 UREA NITROGEN BUN 300 84520 58.00 52.20 56.26 55.10 55.68 30000618 ADDL BUN 300 84520 18.00 16.20 17.46 17.10 17.28 30000619 UREA URINE 300 84540 59.00 53.10 57.23 56.05 56.64 30000620 UREA CLEARANCE 300 84545 85.00 76.50 82.45 80.75 81.6 30000621 URIC ACID BLOOD 300 84550 59.00 53.10 57.23 56.05 56.64 30000623 URIC ACID URINE 300 84560 76.00 68.40 73.72 72.20 72.96 30000624 VMA URINE 300 84585 164.00 147.60 159.08 155.80 157.44 30000625 VASOACTIVE INTEST POLYPEP 300 84586 425.00 382.50 412.25 403.75 408 30000626 ARGININE VASOPRESSIN 300 84588 116.00 104.40 112.52 110.20 111.36 30000627 VASOPRESSIN ADH 300 84588 116.00 104.40 112.52 110.20 111.36 30000628 VITAMIN A 300 84590 158.00 142.20 153.26 150.10 151.68 30000629 VITAMIN B3 300 84591 276.00 248.40 267.72 262.20 264.96 30000630 VITAMIN K1 SERUM 300 84597 151.00 135.90 146.47 143.45 144.96 30000633 VOLATILE SCREEN URINE 300 84600 219.00 197.10 212.43 208.05 210.24 30000634 ZINC 300 84630 105.00 94.50 101.85 99.75 100.8 30000635 C-PEPTIDE 300 84681 193.00 173.70 187.21 183.35 185.28 30000636 GONADOTROPIN CHORONC HCG QUANT 300 84702 133.00 119.70 129.01 126.35 127.68 30000637 HCG QUANT 300 84704 133.00 119.70 129.01 126.35 127.68 30000638 HCG TOTAL 300 84702 133.00 119.70 129.01 126.35 127.68 30000639 HCG QUAL SERUM PREG 300 84703 119.00 107.10 115.43 113.05 114.24 30000644 OSMOLALITY STOOL 300 84999 136.00 122.40 131.92 129.20 130.56 30000645 PCO2 BY ELECTRODE 300 84999 136.00 122.40 131.92 129.20 130.56 30000649 POTASSIUM STOOL 300 84999 136.00 122.40 131.92 129.20 130.56 30000650 BLEEDING TIME 300 85002 108.00 97.20 104.76 102.60 103.68 30000651 MANUAL DIFFERENTIAL 300 85007 62.00 55.80 60.14 58.90 59.52 30000653 BUFFY COAT PREP FOR DIFF 300 85009 58.00 52.20 56.26 55.10 55.68 30000654 HEMATOCRIT 300 85014 38.00 34.20 36.86 36.10 36.48 30000655 BEDSIDE-HEMATOCRIT 300 85014 38.00 34.20 36.86 36.10 36.48 30000656 HEMOGLOBIN 300 85018 38.00 34.20 36.86 36.10 36.48 30000657 CBC W/AUTO DIFF 300 85025 93.00 76 90.21 88.35 89.28 30000658 CBC WITHOUT AUTO DIFF 300 85027 81.00 72.90 78.57 76.95 77.76 30000659 PLATELET CT MANUAL 300 85032 30.00 27.00 29.10 28.50 28.8 30000660 RBC 300 85041 38.00 34.20 36.86 36.10 36.48 30000661 RETIC COUNT 300 85045 58.00 52.20 56.26 55.10 55.68 30000662 RETICULOCYTE AUTOMATED 300 85046 64.00 57.60 62.08 60.80 61.44 30000663 EOSINOPHIL ABSOLUT CT DIR 300 85048 49.00 44.10 47.53 46.55 47.04 30000664 WBC 300 85048 49.00 44.10 47.53 46.55 47.04 30000665 PLATELET COUNT AUTOMATED 300 85049 61.00 54.90 59.17 57.95 58.56 30000666 RETICULATED PLATELET ASSAY 300 85055 59.00 53.10 57.23 56.05 56.64 30000667 FACTOR II 300 85210 295.00 265.50 286.15 280.25 283.2 30000668 COAGULATION FACT V ACTIVI 300 85220 233.00 209.70 226.01 221.35 223.68 30000669 COAG FACTOR VII ACTIVE 300 85230 298.00 268.20 289.06 283.10 286.08 30000670 FACTOR VIII 300 85240 298.00 268.20 289.06 283.10 286.08 30000671 FACTOR VIII AHG ONE STAGE 300 85240 298.00 268.20 289.06 283.10 286.08 30000673 PLASMINOGEN 300 85240 298.00 268.20 289.06 283.10 286.08 30000674 RISTOCETIN COFACTOR 300 85245 249.00 224.10 241.53 236.55 239.04 30000675 VWF RISTOCETIN COFACTOR 300 85245 249.00 224.10 241.53 236.55 239.04 30000676 FACTOR VIII VW FACTOR AG 300 85246 249.00 224.10 241.53 236.55 239.04 30000677 VON WILLEBRAND FACTOR AG 300 85246 249.00 224.10 241.53 236.55 239.04 30000678 FACTOR VIII VW MULTIMERIC 300 85247 163.00 146.70 158.11 154.85 156.48 30000679 FACTOR IX PTC OR CHRISTMAS 300 85250 238.00 214.20 230.86 226.10 228.48 30000680 FACTOR X STUART-PROWER 300 85260 262.00 235.80 254.14 248.90 251.52 30000681 COAGULATION FACTOR XI ACT 300 85270 238.00 214.20 230.86 226.10 228.48 30000682 COAG FACTOR XII ACTIVITY 300 85280 238.00 214.20 230.86 226.10 228.48 30000684 CLTNG FACTOR XIII FIBRIN 300 85291 141.00 126.90 136.77 133.95 135.36 30000685 CLOT INHIBIT ANTITHROMB 3 ACTV 300 85300 172.00 154.80 166.84 163.40 165.12 30000686 ANTITHROMBIN III AG 300 85301 237.00 213.30 229.89 225.15 227.52 30000687 PROTEIN C TOTAL AG 300 85302 233.00 209.70 226.01 221.35 223.68 30000688 CLOT INHIB ANTICOAG PROTEIN C 300 85303 240.00 216.00 232.80 228.00 230.4 30000689 PROTEIN S TOTAL AG 300 85305 220.00 198.00 213.40 209.00 211.2 30000690 PROTEIN S FREE 300 85306 300.00 270.00 291.00 285.00 288 30000691 PROTEIN S FREE AG WITH REFLEX 300 85306 300.00 270.00 291.00 285.00 288 30000692 PROTEIN S FUNCTIONAL 300 85306 300.00 270.00 291.00 285.00 288 30000693 APC RESISTANCE PROFILE 300 85307 317.00 285.30 307.49 301.15 304.32 30000696 FIBRINOGEN DEGRAD PRODUCT 300 85362 100.00 90.00 97.00 95.00 96 30000697 FIBRIN DGRADJ SPLT PRODUX 300 85366 195.00 175.50 189.15 185.25 187.2 30000698 D-DIMER QUANT 300 85379 170.00 153.00 164.90 161.50 163.2 30000699 FIBRINOGEN LEV QUANT CLOT 300 85384 109.00 98.10 105.73 103.55 104.64 30000700 FIBRINOLYSIS 300 85390 159.00 143.10 154.23 151.05 152.64 30000702 CLOTTING FUNC ACTIVITY NOS EA ANALYT 300 85397 430.00 387.00 417.10 408.50 412.8 30000703 PLASMINOGEN FUNCTIONAL 300 85420 24.00 21.60 23.28 22.80 23.04 30000704 KLEIHAUER-BETKE TEST 300 85460 241.00 216.90 233.77 228.95 231.36 30000705 FETAL SCRN FET MAT BLD 300 85461 69.00 62.10 66.93 65.55 66.24 30000706 HEPARIN ANTI XA LOVENOX L 300 85520 358.00 322.20 347.26 340.10 343.68 30000708 HEPARIN NEUTRALIZATION 300 85525 55.00 49.50 53.35 52.25 52.8 30000709 LEUKOCYTE ALKALINE PHOSPHATASE 300 85540 185.00 166.50 179.45 175.75 177.6 30000710 LYSOZYME MURAMIDASE 300 85549 150.00 135.00 145.50 142.50 144 30000713 OSMOTIC FRAGILITY RBC M 300 85557 296.00 266.40 287.12 281.20 284.16 30000715 PLATELET AGGREGATION 300 85576 92.00 82.80 89.24 87.40 88.32 30000717 BILL PNP 300 85597 139.00 125.10 134.83 132.05 133.44 30000718 HEXAGONAL PHOSPHOLIPID 300 85598 350.00 315.00 339.50 332.50 336 30000720 PROTHROMBIN TIME 300 85610 55.00 29 53.35 52.25 52.8 30000721 PROTHROMBIN TIME -INR+SEC 300 85610 55.00 29 53.35 52.25 52.8 30000722 PT SUBSTITUTIONS 300 85611 198.00 178.20 192.06 188.10 190.08 30000723 DILUTE RUSSELL VIPER VENOM 300 85613 208.00 187.20 201.76 197.60 199.68 30000724 REPTILASE TEST 300 85635 73.00 65.70 70.81 69.35 70.08 30000725 SEDIMENTATION RATE ESR 300 85652 54.00 48.60 52.38 51.30 51.84 30000726 SICKLE CELL SCREEN 300 85660 73.00 65.70 70.81 69.35 70.08 30000727 SICKLING OF RBC REDUCTION 300 85660 73.00 65.70 70.81 69.35 70.08 30000728 SICKLING SOLUBILITY 300 85660 73.00 65.70 70.81 69.35 70.08 30000729 THROMBIN TIME 300 85670 126.00 113.40 122.22 119.70 120.96 30000731 THROMBIN TIME PLASMA 300 85670 82.00 73.80 79.54 77.90 78.72 30000732 THROMBIN TIME SINGLE 300 85670 82.00 73.80 79.54 77.90 78.72 30000733 PARTIAL THROMBOPLASTIN PTT 300 85730 91.00 81.90 88.27 86.45 87.36 30000734 PTT SUBSTITUTIONS 300 85732 105.00 94.50 101.85 99.75 100.8 30000735 VISCOSITY 300 85810 209.00 188.10 202.73 198.55 200.64 30000736 VISCOSITY SERUM 300 85810 209.00 188.10 202.73 198.55 200.64 30000738 ALLERGEN SPECIFIC - IGE 300 86003 57.00 51.30 55.29 54.15 54.72 30000739 ALLERGEN SPECIFIC IGE EACH 300 86003 64.00 57.60 62.08 60.80 61.44 30000740 ALLERGY LATEX RAST 300 86003 64.00 57.60 62.08 60.80 61.44 30000741 LATEX IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000742 RAST PER ALLERGEN 300 86003 64.00 57.60 62.08 60.80 61.44 30000743 RAST ADDL ALLERGEN 300 86003 64.00 57.60 62.08 60.80 61.44 30000744 CASEIN 300 86003 64.00 57.60 62.08 60.80 61.44 30000745 REGION 9 ALLERGY PANEL 300 86003 64.00 57.60 62.08 60.80 61.44 30000746 PEANUT IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000747 PECAN FOOD IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000748 ALMOND IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000749 WALNUT FOOD IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000750 BRAZIL NUT IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000751 CASHEW IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000752 ALLG SPEC IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000753 TREE PANEL #1 300 86003 64.00 57.60 62.08 60.80 61.44 30000754 GRASS PANEL #1 300 86003 64.00 57.60 62.08 60.80 61.44 30000755 SHORT RAGWEED IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000756 COCONUT IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000757 HALIBUT IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000758 SHRIMP IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000759 CODFISH IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000760 LOBSTER IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000761 CRAB IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000762 SOLE IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30000763 OYSTER 300 86003 64.00 57.60 62.08 60.80 61.44 30000764 WBC AB INDENT 300 86021 175.00 157.50 169.75 166.25 168 30000765 AB ID PLATELET ANTIBODIES 300 86022 341.00 306.90 330.77 323.95 327.36 30000766 PF4 ANTIBODIES BY ELISA 300 86022 341.00 306.90 330.77 323.95 327.36 30000770 PLATELET AB DIRECT 300 86023 299.00 269.10 290.03 284.05 287.04 30000771 ANA 300 86038 131.00 117.90 127.07 124.45 125.76 30000772 ANA AB REFLEX 300 86038 131.00 117.90 127.07 124.45 125.76 30000773 ANA TITER 300 86039 99.00 89.10 96.03 94.05 95.04 30000774 ANTI-STREPTOLYSIN ASO QUA 300 86060 95.00 85.50 92.15 90.25 91.2 30000775 C-REACTIVE PROTEIN-CRP 300 86140 103.00 92.70 99.91 97.85 98.88 30000776 CRP CARDIO 300 86141 114.00 102.60 110.58 108.30 109.44 30000777 BETA 2 GLYCOPROTEIN 1 AB 300 86146 417.00 375.30 404.49 396.15 400.32 30000778 CARDIOLIPIN AB EACH CLASS 300 86147 169.00 152.10 163.93 160.55 162.24 30000779 ANTIPHOSPHATIDYLSERINE AB 300 86148 143.00 128.70 138.71 135.85 137.28 30000781 CLD AGGLUT SCR 300 86156 77.00 69.30 74.69 73.15 73.92 30000782 COLD AGGLUTININ TITER 300 86157 77.00 69.30 74.69 73.15 73.92 30000783 COMPLEMNT ANTIGEN EA COMPONENT 300 86160 111.00 99.90 107.67 105.45 106.56 30000784 COMPLEMENT FUNCTIONAL ACTIVITY 300 86161 220.00 198.00 213.40 209.00 211.2 30000785 COMPLEMENT ACTIVITY TOTAL EIA 300 86162 202.00 181.80 195.94 191.90 193.92 30000786 IMMUNOASSAY PEPTIDE AB 300 86200 159.00 143.10 154.23 151.05 152.64 30000787 DNASE B ANTIBODY 300 86215 101.00 90.90 97.97 95.95 96.96 30000788 DNA ANTIBODY 300 86225 142.00 127.80 137.74 134.90 136.32 30000789 DOUBLE STRANDED DNA 300 86225 142.00 127.80 137.74 134.90 136.32 30000790 EXTRACTABLE NUCLEAR AG AB 300 86235 30.00 27.00 29.10 28.50 28.8 30000791 AMPHIPHYSIN AB 300 86255 61.00 54.90 59.17 57.95 58.56 30000792 ANCA 300 86255 165.00 148.50 160.05 156.75 158.4 30000793 CYTO NEUTRO A ANCA 300 86255 236.00 212.40 228.92 224.20 226.56 30000794 DNA DS AB CRITHIDIA IFA W/RFX 300 86255 235.00 211.50 227.95 223.25 225.6 30000795 ENDOMYSIAL AB IGA SCREEN 300 86255 235.00 211.50 227.95 223.25 225.6 30000796 FLUO NONINF AGE ANT SCR EA ANT 300 86255 94.00 84.60 91.18 89.30 90.24 30000797 FLUORESCENT NONINFECT AB SCRN 300 86255 236.00 212.40 228.92 224.20 226.56 30000798 NEURONAL NUCLEAR ANTIBODY 300 86255 61.00 54.90 59.17 57.95 58.56 30000799 NMO-AQP4-IGG-FACS 300 86255 236.00 212.40 228.92 224.20 226.56 30000800 PARANEOPLASTIC PANEL IFA 300 86255 95.00 85.50 92.15 90.25 91.2 30000801 PURKINJE CELL ANTIBODY 300 86255 61.00 54.90 59.17 57.95 58.56 30000802 RETICULIN ANTIBODIES 300 86255 236.00 212.40 228.92 224.20 226.56 30000803 SM MUSCLE AB SERUM 300 86255 236.00 212.40 228.92 224.20 226.56 30000806 ANTI-MITOCHONDRIAL AB TIT 300 86256 256.00 230.40 248.32 243.20 245.76 30000807 ANTI-SMOOTH MUSCLE AB TIT 300 86256 256.00 230.40 248.32 243.20 245.76 30000808 ENDOMYSIAL ANTIBODIES IGA 300 86256 256.00 230.40 248.32 243.20 245.76 30000810 FLUORESCENT NONINFECT AB TITER 300 86256 256.00 230.40 248.32 243.20 245.76 30000812 NMO-AQP4-FACS-TITER 300 86256 256.00 230.40 248.32 243.20 245.76 30000814 PURKINJE CELL TITER 300 86256 372.00 334.80 360.84 353.40 357.12 30000815 CANCER ANTIGEN BREAST CA15-3 300 86300 208.00 187.20 201.76 197.60 199.68 30000816 IMMUNOASSAY TUMOR ANTIGEN CA19-9 300 86301 240.00 216.00 232.80 228.00 230.4 30000817 IMMUNOASSAY TUMOR ANTIGEN CA 125 300 86304 181.00 162.90 175.57 171.95 173.76 30000818 MONONUCLEOSIS SCREEN 300 86308 83.00 74.70 80.51 78.85 79.68 30000819 IMMUNO FOR ANTIGEN QUANT 300 86316 186.00 167.40 180.42 176.70 178.56 30000821 HEPATITIS B SURFACE AB 300 86317 38.00 34.20 36.86 36.10 36.48 30000822 IMMUN FOR INF AGENT AB QU NOS 300 86317 149.00 134.10 144.53 141.55 143.04 30000823 IMMUNO INFECTIOUS ANTIBODY QNT 300 86317 207.00 186.30 200.79 196.65 198.72 30000824 IMMUNO INFECTIOUS QUANT AB 300 86317 71.00 63.90 68.87 67.45 68.16 30000825 IMMUNOA INFEC AGENT AB QUANT 300 86317 7.00 6.30 6.79 6.65 6.72 30000826 IMMUNOA INFECT AGENT AB QUANT 300 86317 71.00 63.90 68.87 67.45 68.16 30000828 STREP PNEUMO LGG AB 300 86317 71.00 63.90 68.87 67.45 68.16 30000829 TEICHOIC ABB IMMUNODIFFUSION 300 86329 79.00 71.10 76.63 75.05 75.84 30000830 IMMUNODIFFUSION GEL DIFF QUAL 300 86331 108.00 97.20 104.76 102.60 103.68 30000831 IMMUNE COMPLEX C1Q BIND 300 86332 275.00 247.50 266.75 261.25 264 30000832 IMMUNOFIXATION ELECTROPHORESIS 300 86334 233.00 209.70 226.01 221.35 223.68 30000833 IMMUNOFIXATION ELECTROPH SERUM 300 86334 233.00 209.70 226.01 221.35 223.68 30000834 IMMUNOFIX ELECTRO OTHER FLUID 300 86335 282.00 253.80 273.54 267.90 270.72 30000835 IMMUNOFIXATION ELECTROPH URINE 300 86335 282.00 253.80 273.54 267.90 270.72 30000836 INHIBIN A 300 86336 144.00 129.60 139.68 136.80 138.24 30000838 INSULIN ANTIBODY 300 86337 177.00 159.30 171.69 168.15 169.92 30000839 INTRINSIC FACTOR BLOCKING AB 300 86340 179.00 161.10 173.63 170.05 171.84 30000841 GLUTAMIC ACID 300 86341 288.00 259.20 279.36 273.60 276.48 30000842 ISLET CELL AB IGG 300 86341 288.00 259.20 279.36 273.60 276.48 30000843 ISLET CELL ANTIBODY 300 86341 288.00 259.20 279.36 273.60 276.48 30000844 LEUK HISTAMINE RELEASE TST LHR 300 86343 125.00 112.50 121.25 118.75 120 30000845 ASSAY CELLULAR FUNCTION 300 86352 375.00 337.50 363.75 356.25 360 30000847 LYMPHOCYTE TRANSFORMATION 300 86353 94.00 84.60 91.18 89.30 90.24 30000848 BCELL TOTAL COUNT 300 86355 139.00 125.10 134.83 132.05 133.44 30000849 MONONUC CELL AG QUANT NOS 300 86356 55.00 49.50 53.35 52.25 52.8 30000850 NK CELLS TOTAL COUNT 300 86357 142.00 127.80 137.74 134.90 136.32 30000851 TCELL TOTAL COUNT 300 86359 119.00 107.10 115.43 113.05 114.24 30000852 ABSOLUTE CD4/CD8 COUNT W/RATIO 300 86360 298.00 268.20 289.06 283.10 286.08 30000853 TCELL ABSOLUTE CD4 COUNT 300 86361 293.00 263.70 284.21 278.35 281.28 30000854 ANTITHYROID MICRO AB SERU 300 86376 144.00 129.60 139.68 136.80 138.24 30000855 LIVER KIDNEY MICROSOME-1AB IGG 300 86376 144.00 129.60 139.68 136.80 138.24 30000856 THYROID PEROXIDASE TPO AB 300 86376 144.00 129.60 139.68 136.80 138.24 30000857 POLIO VIRUS AB 300 86382 200.00 180.00 194.00 190.00 192 30000858 RABIES REFIT ENDPOINT 300 86382 200.00 180.00 194.00 190.00 192 30000859 CRYPTOCOCCOSIS ANTIGEN 300 86403 90.00 81.00 87.30 85.50 86.4 30000860 STREPTOZYME W/REFLEX TO TITER 300 86403 90.00 81.00 87.30 85.50 86.4 30000863 RHEUMATOID FACTOR QNT 300 86431 74.00 66.60 71.78 70.30 71.04 30000864 TB INTERFANTIGEN 300 86480 314.00 282.60 304.58 298.30 301.44 30000865 TSPOT TUBERCULOSIS TEST 300 86481 200.00 180.00 194.00 190.00 192 30000866 Hc Syphilis Test Qualitative 300 86592 62.00 55.80 60.14 58.90 59.52 30000867 VDRL CSF WITH REFLEX TO TITER 300 86592 62.00 55.80 60.14 58.90 59.52 30000868 BILL VDRLCS 300 86593 60.00 54.00 58.20 57.00 57.6 30000869 ADENOVIRUS ANTIBODY 300 86603 28.00 25.20 27.16 26.60 26.88 30000870 ASPERGILLUS ANTIBODY 300 86606 124.00 111.60 120.28 117.80 119.04 30000871 BARTONELLA AB 300 86611 95.00 85.50 92.15 90.25 91.2 30000872 BLASTOMYCOSIS 300 86612 233.00 209.70 226.01 221.35 223.68 30000873 BORDETELLA AB 300 86615 175.00 157.50 169.75 166.25 168 30000874 LYME CONFIRMATORY TEST 300 86617 143.00 128.70 138.71 135.85 137.28 30000875 LYME DISEASE AB 300 86618 181.00 162.90 175.57 171.95 173.76 30000876 BRUCELLA ANTIBODY 300 86622 125.00 112.50 121.25 118.75 120 30000880 CHLAMYDIA ANTIBODY 300 86631 131.00 117.90 127.07 124.45 125.76 30000881 CHLAMYDIA IGM ANTIBODY 300 86632 131.00 117.90 127.07 124.45 125.76 30000882 COCCIDIOIDES ANTIBODY 300 86635 208.00 187.20 201.76 197.60 199.68 30000883 Q-FEVER AB 300 86638 158.00 142.20 153.26 150.10 151.68 30000884 CMV ANTIBODY 300 86644 135.00 121.50 130.95 128.25 129.6 30000885 CYTOMEGALOVIRUS AB IGM 300 86645 212.00 190.80 205.64 201.40 203.52 30000886 DIPHTHERIA TOXOID IGD AB 300 86648 230.00 207.00 223.10 218.50 220.8 30000887 ENCEPHAL ANTIBODY CALIF 300 86651 137.00 123.30 132.89 130.15 131.52 30000888 ENCEPHAL ANTIBODY EAST 300 86652 137.00 123.30 132.89 130.15 131.52 30000889 ENCEPHAL ANTIBODY ST LOUIS 300 86653 137.00 123.30 132.89 130.15 131.52 30000890 ENTEROVIRUS ANTIBODY 300 86658 165.00 148.50 160.05 156.75 158.4 30000891 EBV IGG AB TO EARLY AG 300 86663 166.00 149.40 161.02 157.70 159.36 30000892 EBV AB TO NUCLEAR AG IGG 300 86664 135.00 121.50 130.95 128.25 129.6 30000893 EBV AB TO VIRAL CAPSID AG 300 86665 119.00 107.10 115.43 113.05 114.24 30000894 EHRLICHIA ANTIBODY 300 86666 208.00 187.20 201.76 197.60 199.68 30000895 FRANCISELLA TULARENSIS 300 86668 186.00 167.40 180.42 176.70 178.56 30000896 FRANCISELLA TULARENSIS AB 300 86668 186.00 167.40 180.42 176.70 178.56 30000897 FUNGUS AB 300 86671 64.00 57.60 62.08 60.80 61.44 30000899 HELICOBACTER PYLORI AB IGA 300 86677 165.00 148.50 160.05 156.75 158.4 30000900 HELICOBACTER PYLORI AB IGG 300 86677 165.00 148.50 160.05 156.75 158.4 30000901 HELICOBACTER PYLORI AB IGM 300 86677 165.00 148.50 160.05 156.75 158.4 30000902 HELMINTH AB 300 86682 93.00 83.70 90.21 88.35 89.28 30000904 HEM INF B VAC RESP 300 86684 256.00 230.40 248.32 243.20 245.76 30000905 HTLVI/II 300 86687 150.00 135.00 145.50 142.50 144 30000906 HIV AB CONFIRMATION TEST 300 86689 298.00 268.20 289.06 283.10 286.08 30000907 HIV-1 AB CONFIRM WESTERN BLOT 300 86689 298.00 268.20 289.06 283.10 286.08 30000909 HSV NON SPECIFIC 300 86694 131.00 117.90 127.07 124.45 125.76 30000910 Hc Hsv Type 1 Glycoprotein G-specific Antibody Igg By Cia (reflex) 300 86695 132.00 118.80 128.04 125.40 126.72 30000911 Hc Hsv Type 2 Glycoprotein G-specific Antibody Igg By Cia (reflex) 300 86696 143.00 128.70 138.71 135.85 137.28 30000912 HISTOPLASMA ANTIBODY 300 86698 131.00 117.90 127.07 124.45 125.76 30000913 HIV 1 ANTIBODIES 300 86701 127.00 114.30 123.19 120.65 121.92 30000914 HIV-2 ANTIBODY 300 86702 128.00 115.20 124.16 121.60 122.88 30000915 HIV 1 AND HIV 2 SINGLE RESULT 300 86703 109.00 98.10 105.73 103.55 104.64 30000916 HIV-1 AND HIV-2 ANTIBODIES 300 86703 109.00 98.10 105.73 103.55 104.64 30000917 HEP B CORE AB - TOTAL 300 86704 139.00 125.10 134.83 132.05 133.44 30000918 HEPATITIS B CORE AB IGM 300 86705 105.00 94.50 101.85 99.75 100.8 30000919 HEP B SURFACE ANTIBODY HBSAB 300 86706 132.00 118.80 128.04 125.40 126.72 30000920 HEPATITIS BE ANTIBODY 300 86707 58.00 52.20 56.26 55.10 55.68 30000921 HEPATITIS A PANEL 300 86708 142.00 127.80 137.74 134.90 136.32 30000922 HEPATITIS A ANTIBODY IGM 300 86709 132.00 118.80 128.04 125.40 126.72 30000923 INFLUENZA A/B VIRUS AB IGG IGM 300 86710 124.00 111.60 120.28 117.80 119.04 30000925 STRAT JV AB WINDEX 300 86711 127.00 114.30 123.19 120.65 121.92 30000926 LEGIONELLA PNEUMOPHILA 1-6 IGG 300 86713 128.00 115.20 124.16 121.60 122.88 30000928 LYMPHOCYTIC CHORIOMENINGITIS 300 86727 62.00 55.80 60.14 58.90 59.52 30000929 MUMPS 300 86735 119.00 107.10 115.43 113.05 114.24 30000930 MYCOPLASMA PNEUMONIA AB 300 86738 141.00 126.90 136.77 133.95 135.36 30000931 PARVO VIRUS AB 300 86747 127.00 114.30 123.19 120.65 121.92 30000934 ENTAMOEBA HISTOLYTICA AB IGG 300 86753 114.00 102.60 110.58 108.30 109.44 30000935 RICKETTSIA AB PANEL 300 86757 443.00 398.70 429.71 420.85 425.28 30000936 ROCKY MTN SPOTTED FEVER AB 300 86757 145.00 130.50 140.65 137.75 139.2 30000937 TYPHUS FEVER AB 300 86757 305.00 274.50 295.85 289.75 292.8 30000938 ANTIBODY RUBELLA 300 86762 92.00 82.80 89.24 87.40 88.32 30000939 RUBELLA IGM 300 86762 92.00 82.80 89.24 87.40 88.32 30000940 RUBEOLA AB IGG 300 86765 118.00 106.20 114.46 112.10 113.28 30000941 TETANUS AB 300 86774 199.00 179.10 193.03 189.05 191.04 30000942 TOXOPLASMA AB 300 86777 138.00 124.20 133.86 131.10 132.48 30000943 TOXOPLASMA AB IGM 300 86778 145.00 130.50 140.65 137.75 139.2 30000944 TOXOPLASMA IGM 300 86778 81.00 72.90 78.57 76.95 77.76 30000946 TREPONEMA PALLIDUM 300 86780 127.00 114.30 123.19 120.65 121.92 30000947 VARICELLA ZOSTER AB 300 86787 142.00 127.80 137.74 134.90 136.32 30000948 WEST NILE VIRUS IGM AB 300 86788 131.00 117.90 127.07 124.45 125.76 30000949 WEST NILE VIRUS AB 300 86789 136.00 122.40 131.92 129.20 130.56 30000950 CHIKUNGUNYA IGM IGG AB 300 86790 418.00 376.20 405.46 397.10 401.28 30000952 HHV - 6 IGG 300 86790 139.00 125.10 134.83 132.05 133.44 30000955 WEST NILE IgG TITER CSF 300 86790 139.00 125.10 134.83 132.05 133.44 30000956 THYROGLOBULIN ANTIBODY 300 86800 130.00 117.00 126.10 123.50 124.8 30000957 HEP C AB WITH REFLEX TO RIBA 300 86803 137.00 123.30 132.89 130.15 131.52 30000958 HEPATITIS C AB 300 86803 137.00 123.30 132.89 130.15 131.52 30000961 HEPATITIS C RIBA CONF 300 86804 346.00 311.40 335.62 328.70 332.16 30000965 HLA-B27 300 86812 137.00 123.30 132.89 130.15 131.52 30000969 ANTIBODY SCREEN 300 86850 101.00 90.90 97.97 95.95 96.96 30000970 ANTIBODY ELUTION EACH 300 86860 172.00 154.80 166.84 163.40 165.12 30000971 ANTIBODY IDENTIFICATION 300 86870 192.00 172.80 186.24 182.40 184.32 30000972 MODIFIED ANTIBODY IDENT 300 86870 192.00 172.80 186.24 182.40 184.32 30000973 "DAT,ANTI IGG" 300 86880 71.00 63.90 68.87 67.45 68.16 30000974 ANTIBODY TITER 300 86886 288.00 259.20 279.36 273.60 276.48 30000975 Rh (D) PATIENT 300 86901 56.00 50.40 54.32 53.20 53.76 30000976 Hc Antigen Testing Each Unit 300 86902 76.00 68.40 73.72 72.20 72.96 30000977 SCREEN FOR COMPATIBLE UNITS 300 86904 69.00 62.10 66.93 65.55 66.24 30000978 RBC ANTIGENS OTHER THAN ABO Rh (D) 300 86905 55.00 49.50 53.35 52.25 52.8 30000979 "CROSSMATCH BLOOD, IS" 300 86920 165.00 148.50 160.05 156.75 158.4 30000980 "CROSSMATCH BLOOD, AHG" 300 86922 181.00 162.90 175.57 171.95 173.76 30000981 THAWING FFP SDP OR CRYO 300 86927 42.00 37.80 40.74 39.90 40.32 30000985 RBC PRETX INCUB W CHEMICAL 300 86970 159.00 143.10 154.23 151.05 152.64 30000986 AB NEUTRALIZATION STUDIES 300 86977 95.00 85.50 92.15 90.25 91.2 30000987 ANTIBODY ABSORPTION COLD 300 86978 163.00 146.70 158.11 154.85 156.48 30000989 PROCESSING BLOOD/PLATELETS 300 86999 49.00 44.10 47.53 46.55 47.04 30000990 CONCENTRATION ACID FAST 300 87015 41.00 36.90 39.77 38.95 39.36 30000991 CONCENTRATION FOR INFECT AGENT 300 87015 52.00 46.80 50.44 49.40 49.92 30000992 CULTURE BLOOD 300 87040 208.00 187.20 201.76 197.60 199.68 30000993 CULTURE STOOL SALM/SHIGELLA 300 87045 132.00 118.80 128.04 125.40 126.72 30000994 YERSINIA CULTURE 300 87046 82.00 73.80 79.54 77.90 78.72 30000995 CULTURE AEROBIC 300 87070 128.00 115.20 124.16 121.60 122.88 30000996 CULTURE CATH TIP 300 87070 128.00 115.20 124.16 121.60 122.88 30000997 CULTURE CONJUNCTIVAL 300 87070 128.00 115.20 124.16 121.60 122.88 30000998 CULTURE EAR 300 87070 128.00 115.20 124.16 121.60 122.88 30000999 CULTURE ENVIRONMENTAL 300 87070 128.00 115.20 124.16 121.60 122.88 30001000 CULTURE EYE 300 87070 128.00 115.20 124.16 121.60 122.88 30001001 CULTURE GENITAL 300 87070 128.00 115.20 124.16 121.60 122.88 30001002 CULTURE N GONORRHOEAE 300 87070 128.00 115.20 124.16 121.60 122.88 30001003 CULTURE NASOPHARYNGEAL 300 87070 128.00 115.20 124.16 121.60 122.88 30001004 CULTURE THROAT 300 87070 128.00 115.20 124.16 121.60 122.88 30001005 CULTURE WOUND SUPERFICIAL 300 87070 128.00 115.20 124.16 121.60 122.88 30001006 CULTURE ANAEROBIC 300 87075 126.00 113.40 122.22 119.70 120.96 30001007 ID BACTERIAL ANAEROBE 300 87076 105.00 94.50 101.85 99.75 100.8 30001009 AEROBIC ID 300 87077 78.00 70.20 75.66 74.10 74.88 30001012 CULTURE AEROBIC ISOLATE 300 87077 78.00 70.20 75.66 74.10 74.88 30001013 ID BACTERIAL 300 87077 78.00 70.20 75.66 74.10 74.88 30001014 BACILLUS ANTHRACIS SCREEN 300 87081 74.00 66.60 71.78 70.30 71.04 30001015 CULTURE SCREENING 300 87081 74.00 66.60 71.78 70.30 71.04 30001016 LEGIONELLA CULTURE 300 87081 74.00 66.60 71.78 70.30 71.04 30001017 CULTURE URINE QUANT COLONY CNT 300 87086 84.00 75.60 81.48 79.80 80.64 30001018 CULTURE FUNGUS SKIN/NAIL/HAIR 300 87101 155.00 139.50 150.35 147.25 148.8 30001019 CULTURE FUNGUS 300 87102 164.00 147.60 159.08 155.80 157.44 30001020 CULTURE FUNGUS BLOOD 300 87103 169.00 152.10 163.93 160.55 162.24 30001021 IDENTIFICATION FUNGAL YEAST 300 87106 142.00 127.80 137.74 134.90 136.32 30001022 IDENTIFICATION FUNGAL MOLD 300 87107 143.00 128.70 138.71 135.85 137.28 30001023 CULTURE MYCOPLASMA 300 87109 268.00 241.20 259.96 254.60 257.28 30001024 CHLAMYDIA CULTURE 300 87110 204.00 183.60 197.88 193.80 195.84 30001025 CULTURE ACID-FAST 300 87116 187.00 168.30 181.39 177.65 179.52 30001027 CULTURE MYCOBACT DEFINITIVE ID 300 87118 33.00 29.70 32.01 31.35 31.68 30001028 IDENT MYCOBACT BIOCHEM 300 87118 142.00 127.80 137.74 134.90 136.32 30001029 CULTURE TYPING 300 87140 118.00 106.20 114.46 112.10 113.28 30001031 SEROTYPING 300 87147 74.00 66.60 71.78 70.30 71.04 30001033 CULTURE TYPING ID NUCLEI PROBE 300 87149 232.00 208.80 225.04 220.40 222.72 30001035 ID MYCOBACT DNA PROBE 300 87149 232.00 208.80 225.04 220.40 222.72 30001036 ID OF EACH ORGANISM 300 87149 30.00 27.00 29.10 28.50 28.8 30001038 AEROBE ID SEQUENCING 300 87153 302.00 271.80 292.94 286.90 289.92 30001044 MYCOBATERIUM ID 300 87158 102.00 91.80 98.94 96.90 97.92 30001045 ANAEROBE ID SEQUENCING 300 87158 102.00 91.80 98.94 96.90 97.92 30001046 PINWORM PREP 300 87172 61.00 54.90 59.17 57.95 58.56 30001047 OVA AND PARASITES SMEARS 300 87177 103.00 92.70 99.91 97.85 98.88 30001048 SUSCEPTIBILITY STUDIES 300 87181 106.00 95.40 102.82 100.70 101.76 30001049 SENSITIVITY DISC 300 87184 104.00 93.60 100.88 98.80 99.84 30001050 SUSCEPTIBILITY BETA LACTAMASE 300 87185 49.00 44.10 47.53 46.55 47.04 30001051 BETA LACTAMASE 300 87185 54.00 48.60 52.38 51.30 51.84 30001052 ANTIMICRO SUSCEPTIB MICRODILUT 300 87186 104.00 93.60 100.88 98.80 99.84 30001054 MIC MIN INHIBITORY CONCEN 300 87186 104.00 93.60 100.88 98.80 99.84 30001055 MIC NOCARDIA 300 87186 104.00 93.60 100.88 98.80 99.84 30001057 SUSCEPT AFB NOCARDIA BY BROTH 300 87186 104.00 93.60 100.88 98.80 99.84 30001058 SUSCEPT ANAEROBE BY BROTH DIL 300 87186 104.00 93.60 100.88 98.80 99.84 30001059 SUSCEPTIBILITY MIC EACH 300 87186 104.00 93.60 100.88 98.80 99.84 30001060 SUSCEPTIBILITY STUDIES MIC 300 87186 104.00 93.60 100.88 98.80 99.84 30001061 SUSCEPTIBILITY GRAM NEG 300 87186 104.00 93.60 100.88 98.80 99.84 30001062 SUSCEPTIBILITY GRAM POS 300 87186 104.00 93.60 100.88 98.80 99.84 30001064 MYCOBACTERIUM SENSITIVITY 300 87188 90.00 81.00 87.30 85.50 86.4 30001065 MYCOBACTERIA SUSCEPTIBILITY 300 87190 78.00 70.20 75.66 74.10 74.88 30001066 GRAM STAIN SMEAR 300 87205 64.00 57.60 62.08 60.80 61.44 30001067 MYCOBACTERIUM STAIN 300 87206 90.00 81.00 87.30 85.50 86.4 30001068 CYCLOSPORA EXAMINATION 300 87207 125.00 112.50 121.25 118.75 120 30001069 GIEMSA STAIN 300 87207 125.00 112.50 121.25 118.75 120 30001070 GMS FUNGAL STAIN 300 87207 125.00 112.50 121.25 118.75 120 30001071 MALARIA SMEAR 300 87207 125.00 112.50 121.25 118.75 120 30001072 SPECIAL STAIN 300 87207 125.00 112.50 121.25 118.75 120 30001073 SPECIAL STAIN FOR INCLUSIONS 300 87207 72.00 64.80 69.84 68.40 69.12 30001074 SMEAR SPECIAL STAINS TRICHROME 300 87209 95.00 85.50 92.15 90.25 91.2 30001075 WET MOUNT 300 87210 78.00 70.20 75.66 74.10 74.88 30001076 FUNGUS DIRECT KOH 300 87220 64.00 57.60 62.08 60.80 61.44 30001077 TISS CULT INOC OBS PRESUM ID 300 87252 156.00 140.40 151.32 148.20 149.76 30001078 VIRUS ISOLATION TISSUE CULTURE 300 87252 156.00 140.40 151.32 148.20 149.76 30001079 IP STAIN 300 87253 39.00 35.10 37.83 37.05 37.44 30001080 TISS CULT DEFINITIVE ID 300 87253 39.00 35.10 37.83 37.05 37.44 30001081 VIRUS ISOLATION SHELL VIAL 300 87254 156.00 140.40 151.32 148.20 149.76 30001082 CULTURE HSV W/TYPING 300 87255 99.00 89.10 96.03 94.05 95.04 30001083 ADENOVIRUS 300 87260 52.00 46.80 50.44 49.40 49.92 30001084 CRYPTOSPORIDIUM AG DFA STOOL 300 87272 64.00 57.60 62.08 60.80 61.44 30001085 INFLUENZA B 300 87275 52.00 46.80 50.44 49.40 49.92 30001086 INFLUENZA A 300 87276 52.00 46.80 50.44 49.40 49.92 30001088 LEGIONELLA PNEUMOPHILA DFA 300 87278 203.00 182.70 196.91 192.85 194.88 30001089 PARAINFLUENZA 1 2 3 300 87279 52.00 46.80 50.44 49.40 49.92 30001090 RSV 300 87280 52.00 46.80 50.44 49.40 49.92 30001091 HUMAN METAPNEUMOVIRUS 300 87299 136.00 122.40 131.92 129.20 130.56 30001095 CLOSTRID DIFF TOXIN A & B 300 87324 188.00 169.20 182.36 178.60 180.48 30001096 CRYPTOCOCCUS AG SCREEN 300 87327 82.00 73.80 79.54 77.90 78.72 30001097 GIARDIA AG DFA STOOL 300 87329 138.00 124.20 133.86 131.10 132.48 30001098 E HISTOLYTICA AG 300 87337 300.00 270.00 291.00 285.00 288 30001099 HELICOBACTER PYLORI STOOL 300 87338 235.00 211.50 227.95 223.25 225.6 30001100 HEP B SURFACE ANTIGEN HBSAG 300 87340 107.00 96.30 103.79 101.65 102.72 30001101 HEP B SURF ANT HBSAG NEUTRAL 300 87341 65.00 58.50 63.05 61.75 62.4 30001102 HEPATITIS BE AG 300 87350 58.00 52.20 56.26 55.10 55.68 30001103 HISTOPLASMA AG ANY SOURCE 300 87385 268.00 241.20 259.96 254.60 257.28 30001104 HISTOPLASMA CAPSULATUM 300 87385 268.00 241.20 259.96 254.60 257.28 30001105 HIV-1 AGS W/HIV-1 HIV-2 ABS 300 87389 93.00 83.70 90.21 88.35 89.28 30001106 INFLUENZA A OR B EACH 300 87400 145.00 130.50 140.65 137.75 139.2 30001107 RSV DIRECT AG EIA 300 87420 109.00 98.10 105.73 103.55 104.64 30001108 ROTAVIRUS AG 300 87425 150.00 135.00 145.50 142.50 144 30001109 E COLI SHIGA TOXINS STOOL 300 87427 135.00 121.50 130.95 128.25 129.6 30001110 STREP GROUP A ANTIGEN 300 87430 81.00 72.90 78.57 76.95 77.76 30001111 FUNGITELL 1 & 3 BETA D GLUCAN 300 87449 358.00 322.20 347.26 340.10 343.68 30001114 LEGIONELLA ANTIGEN URINE 300 87450 244.00 219.60 236.68 231.80 234.24 30001115 BORRELIA BURGDORFERI AMP PROBE 300 87476 543.00 488.70 526.71 515.85 521.28 30001116 CHLAMYDIA PNEUMONIAE 300 87486 39.00 35.10 37.83 37.05 37.44 30001117 CHLAMYDIA BY AMPLIFIED PROBE 300 87491 150.00 135.00 145.50 142.50 144 30001118 CL DIFF TOXIN AMPLIFIED PROBE 300 87493 172.00 154.80 166.84 163.40 165.12 30001119 CMV AMPLIFIED PROBE 300 87496 491.00 441.90 476.27 466.45 471.36 30001120 CMV QUANT 300 87497 526.00 473.40 510.22 499.70 504.96 30001121 ENTEROVIRUS AMPLIFIED PROBE 300 87498 324.00 291.60 314.28 307.80 311.04 30001122 INFLUENZA A/B RFLX H1N0 300 87502 248.00 223.20 240.56 235.60 238.08 30001123 INFLUENZA A/B RFLX H1N1 300 87502 248.00 223.20 240.56 235.60 238.08 30001124 INFLUENZA A/B RFLX H1N2 300 87502 248.00 223.20 240.56 235.60 238.08 30001125 INFLUENZA A/B RFLX H1N3 300 87502 248.00 223.20 240.56 235.60 238.08 30001126 GASTRO INTSNL PATH PNL PCR PEC 300 87507 " 1,445.00 " " 1,300.50 " " 1,401.65 " " 1,372.75 " "1,387.20" 30001127 HEP B DNA 300 87517 595.00 535.50 577.15 565.25 571.2 30001128 HEP C AMPLIFIED PROBE 300 87521 583.00 524.70 565.51 553.85 559.68 30001129 Hc Hepatitis C Quantification 300 87522 633.00 569.70 614.01 601.35 607.68 30001131 HERPES AB TYPE 1&2 DNAPCR 300 87529 339.00 305.10 328.83 322.05 325.44 30001132 HERPES VIRUS 6 AMPLIFIED PROBE 300 87532 211.00 189.90 204.67 200.45 202.56 30001133 HIV-1 DNA/PCR QUAL 300 87535 589.00 530.10 571.33 559.55 565.44 30001134 HIV-1 QUANT 300 87536 752.00 676.80 729.44 714.40 721.92 30001135 HIV-1 RNA QUANT BY BDNA 300 87536 752.00 676.80 729.44 714.40 721.92 30001136 HIV-1 RNA QUANT PCR 300 87536 752.00 676.80 729.44 714.40 721.92 30001138 MYCOBACTERIA PCR CSF 300 87556 141.00 126.90 136.77 133.95 135.36 30001139 MYCOBACT TUBERCUL AMPLIF PROBE 300 87556 141.00 126.90 136.77 133.95 135.36 30001141 MYCOPLASMA PNEUMONIAE PCR 300 87581 39.00 35.10 37.83 37.05 37.44 30001142 N GONORRHOEAE AMPLIFIED PROBE 300 87591 143.00 128.70 138.71 135.85 137.28 30001145 INFLU A/B & RSV PCR M-FLUNP 300 87631 380.00 342.00 368.60 361.00 364.8 30001148 B PERTUSSIS PCR 300 87798 39.00 35.10 37.83 37.05 37.44 30001149 BARTONELLA PCR NLL 300 87798 199.00 179.10 193.03 189.05 191.04 30001150 H1N1 BY PCR 300 87798 199.00 179.10 193.03 189.05 191.04 30001151 H1N1 BY PCR 2 OF 2 300 87798 199.00 179.10 193.03 189.05 191.04 30001152 INFECTIOUS AGENT AMPLIF PROBE 300 87798 199.00 179.10 193.03 189.05 191.04 30001154 TROPHERYMA WHIPPLEI BY RA 300 87798 199.00 179.10 193.03 189.05 191.04 30001155 WEST NILE RAPID PCR 300 87798 199.00 179.10 193.03 189.05 191.04 30001156 WEST NILE VIRUS BY PCR CS 300 87798 199.00 179.10 193.03 189.05 191.04 30001157 INFECTIOUS AGENT QUANT 300 87799 631.00 567.90 612.07 599.45 605.76 30001158 BARTONELLA RAPID PCR BLOOD 300 87801 368.00 331.20 356.96 349.60 353.28 30001159 BORDETELLA PCR 300 87801 408.00 367.20 395.76 387.60 391.68 30001160 DETECT AGENT INFLUENZA 300 87804 105.00 94.50 101.85 99.75 100.8 30001161 HIV 1/2 AB/AG 4TH GENERATION 300 87806 150.00 135.00 145.50 142.50 144 30001162 GRP A STREP AG W/REFLEX 300 87880 91.00 81.90 88.27 86.45 87.36 30001163 INFECT AGENT DETECT BY IMMUN 300 87899 88.00 79.20 85.36 83.60 84.48 30001164 HIV-1 GENOTYPING-DRUG RESIST 300 87901 609.00 548.10 590.73 578.55 584.64 30001165 INFECT AGENT GENOTYPE DNA/RNA 300 87901 559.00 503.10 542.23 531.05 536.64 30001166 INFECT AGENT HEPATITIS C VIRUS 300 87902 641.00 576.90 621.77 608.95 615.36 30001167 FLOW CYTOMETRY RBC MARKER 1 300 88184 106.00 95.40 102.82 100.70 101.76 30001168 FLOW CYTOMETRY WBC MARKER 1 300 88184 106.00 95.40 102.82 100.70 101.76 30001169 CHROMOSOME ANALYSIS 5 CELLS 300 88261 520.00 468.00 504.40 494.00 499.2 30001170 CHROMOSOME ANALYSIS 15-20 CELL 300 88262 785.00 706.50 761.45 745.75 753.6 30001173 BILI TOTAL TRANSCUTANEOUS 300 88720 65.00 58.50 63.05 61.75 62.4 30001174 CELL CNT BODY FLD NOT BLD 300 89050 55.00 49.50 53.35 52.25 52.8 30001175 CSF CELL CT & ID 300 89051 127.00 114.30 123.19 120.65 121.92 30001176 LEUKOCYTES STOOL 300 89055 78.00 70.20 75.66 74.10 74.88 30001177 CRYSTAL ID SYNOVIAL FLUID 300 89060 74.00 66.60 71.78 70.30 71.04 30001179 EOSINOPHIL COUNT NASAL SMEAR 300 89190 59.00 53.10 57.23 56.05 56.64 30001180 SEMEN CT & MORPH 300 89310 150.00 135.00 145.50 142.50 144 30001181 SEMEN ANALYSIS COMPLETE 300 89320 166.00 149.40 161.02 157.70 159.36 30001182 SEMEN PRESENCE &/OR MOTIL 300 89321 88.00 79.20 85.36 83.60 84.48 30001183 DRUG COLL SCREEN 300 99001 28.00 25.20 27.16 26.60 26.88 30001184 TRANSP OUT OF TOWN 300 99082 235.00 211.50 227.95 223.25 225.6 30001186 TRAVEL ALLOW 1 DRAW 1 WAY 300 HCPCS P9604 24.00 21.60 23.28 22.80 23.04 30001187 TRAVEL ALLOW 2 DRAWS 1 WAY 300 HCPCS P9604 12.00 10.80 11.64 11.40 11.52 30001188 TRAVEL ALLOW 3 DRAWS 1 WAY 300 HCPCS P9604 10.00 9.00 9.70 9.50 9.6 30001189 BLOOD SMEAR EXAM 300 85008 32.00 28.80 31.04 30.40 30.72 30001191 CYTOPLASMIC NEUTROPHIL 300 86255 236.00 212.40 228.92 224.20 226.56 30001192 AG NA -1 300 86255 61.00 54.90 59.17 57.95 58.56 30001193 CRMP S IGG 300 86255 61.00 54.90 59.17 57.95 58.56 30001194 IODINE - SERUM 300 83018 146.00 131.40 141.62 138.70 140.16 30001195 ANTI-SM MUSCLE AB W REFLE 300 83516 171.00 153.90 165.87 162.45 164.16 30001196 PROTEINASE 3 AB 300 83516 171.00 153.90 165.87 162.45 164.16 30001197 TISSUE TRANSGLUINASE AB 300 83516 171.00 153.90 165.87 162.45 164.16 30001198 RSV ANTIGEN 300 87807 157.00 141.30 152.29 149.15 150.72 30001199 N-TYPE CALCIUM CHANNEL AB 300 83519 81.00 72.90 78.57 76.95 77.76 30001200 CAFFEINE SERUM 300 83520 195.00 175.50 189.15 185.25 187.2 30001201 NMO EVAL W REFLEX NMO IGG 300 83520 195.00 175.50 189.15 185.25 187.2 30001202 SULFATIDE AUTO ANTIBODY X2 300 83520 604.00 543.60 585.88 573.80 579.84 30001203 CLONAZEPAM SERUM 300 80346 300.00 270.00 291.00 285.00 288 30001204 BENZODIAZAPINE URINE CONFRMTRY 300 80346 230.00 207.00 223.10 218.50 220.8 30001205 FLOW CYTOMETRY EA ADDIT MARKER 300 88185 486.00 437.40 471.42 461.70 466.56 30001206 FLOW CYTOMETRY CELL SURF 300 88185 486.00 437.40 471.42 461.70 466.56 30001207 LEUK PHENO B CELL PANEL 300 88185 486.00 437.40 471.42 461.70 466.56 30001208 T CELLS ABS RATI 300 88185 298.00 268.20 289.06 283.10 286.08 30001209 ZAP 70 REFER 300 88185 486.00 437.40 471.42 461.70 466.56 30001210 VARICELLA ZOSTER PCR 300 87798 199.00 179.10 193.03 189.05 191.04 30001211 TREPONEMA PALLIDUM DNA PC 300 87798 199.00 179.10 193.03 189.05 191.04 30001212 NORTRIPTYLINE 300 80335 138.00 124.20 133.86 131.10 132.48 30001213 ENCEPHALITIS AB 300 86654 137.00 123.30 132.89 130.15 131.52 30001214 FLOUNDER IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30001215 PINAPPLE IGE 300 86003 64.00 57.60 62.08 60.80 61.44 30001216 IMMUNOASSAY TUMOR ANTIGEN QNT 300 86300 208.00 187.20 201.76 197.60 199.68 30001217 FLU AB RNA QL RT-PCR Q16086 300 87502 248.00 223.20 240.56 235.60 238.08 30001218 PANCREATIC ELASTASE 300 82656 210.00 189.00 203.70 199.50 201.6 30001220 AUTOLOGOUS UNIT HANDLING 300 86900 61.00 54.90 59.17 57.95 58.56 30001221 "ABO, PATIENT" 300 86900 62.00 55.80 60.14 58.90 59.52 30001222 MYCOBACTERIA CULTURE BLOOD 300 87116 187.00 168.30 181.39 177.65 179.52 30001223 HSV PCR 300 87529 339.00 305.10 328.83 322.05 325.44 30001224 STREPTOCOCCUS PNEUM ANTIGEN 300 87899 30.00 27.00 29.10 28.50 28.8 30001225 BLOOD CULTURE ORG ID PEDS 300 87150 268.00 241.20 259.96 254.60 257.28 30001227 HSV 1 AMPLIFIED PROBE 300 87529 105.00 94.50 101.85 99.75 100.8 30001228 HSV 2 AMPLIFIED PROBE 300 87529 105.00 94.50 101.85 99.75 100.8 30001230 RESP VIRAL PANEL BIOFIRE 300 87633 458.00 412.20 444.26 435.10 439.68 30001233 Hc Cbc Wo Plt Or Auto Diff 300 HCPCS G0307 98.00 88.20 95.06 93.10 94.08 30001235 COMPAZINE 300 HCPCS G0480 266.00 239.40 258.02 252.70 255.36 30001236 OPIATES 1 OR MORE 300 80361 359.00 323.10 348.23 341.05 344.64 30001237 CREATININE URINE 300 82570 81.00 72.90 78.57 76.95 77.76 30001241 FLOW CYTO INTERPRET 9-15 MRKS 300 88188 382.00 343.80 370.54 362.90 366.72 30001242 TISSUE CULTURE LYMPHOCYTE 300 88230 789.00 710.10 765.33 749.55 757.44 30001244 CHROM ANALY 5 COUNT 300 88261 520.00 468.00 504.40 494.00 499.2 30001246 CHROMO ANALY ADDL KARYOTYPES 300 88280 337.00 303.30 326.89 320.15 323.52 30001247 CYTOGENETICS INTERP & REPORT 300 88291 219.00 197.10 212.43 208.05 210.24 30001248 GROSS & MICRO LEVEL IV 300 88305 178.00 160.20 172.66 169.10 170.88 30001249 PSA TOTAL MC SCREENING 300 HCPCS G0103 134.00 120.60 129.98 127.30 128.64 30001253 URINE DRUG SCREEN 300 80305 123.00 110.70 119.31 116.85 118.08 30001254 SALICYLATE 300 80329 136.00 122.40 131.92 129.20 130.56 30001255 ACETOMINOPHEN QUANT 300 80330 258.00 232.20 250.26 245.10 247.68 30001256 PREP PKG MAIL SPEC 300 99001 36.00 32.40 34.92 34.20 34.56 30001257 DRUG SCREEN QUALITATIVE 300 80307 178.00 160.20 172.66 169.10 170.88 30001259 NICOTINE & COTININE 300 80307 97.00 87.30 94.09 92.15 93.12 30001260 DRUG SCR MULT DRUG CLASS 4 OR> 300 80307 85.00 76.50 82.45 80.75 81.6 30001261 ALCOHOL ETHYL BLOOD 300 80307 85.00 76.50 82.45 80.75 81.6 30001262 SALICYLATE 300 80307 85.00 76.50 82.45 80.75 81.6 30001263 ACETAMINOPHEN QUANT 300 80307 85.00 76.50 82.45 80.75 81.6 30001264 DRUG SCREEN MULTI DRUG 300 80307 196.00 176.40 190.12 186.20 188.16 30001267 IMMUNOGLOBULIN E 300 82785 136.00 122.40 131.92 129.20 130.56 30001268 HGB FRACTION & QUANT ELECTRO 300 83020 105.00 94.50 101.85 99.75 100.8 30001270 IMMUNO INFECTIOUS AGENT 300 83516 407.00 366.30 394.79 386.65 390.72 30001271 IMMUNOASSAY QUANT BY RIA 300 83519 236.00 212.40 228.92 224.20 226.56 30001273 CYTOKINE 300 83520 353.00 317.70 342.41 335.35 338.88 30001274 IMMUNOASSAY QUANT 300 83520 400.00 360.00 388.00 380.00 384 30001275 MERCURY QUANT 300 83825 156.00 140.40 151.32 148.20 149.76 30001277 THROMBOPLASTIN TIME PTT 300 85730 91.00 81.90 88.27 86.45 87.36 30001278 EXTRACTABLE NUCLEAR AG AB 300 86235 185.00 166.50 179.45 175.75 177.6 30001279 FLUO NONINF AGE ANT SCR EA ANT 300 86255 61.00 54.90 59.17 57.95 58.56 30001282 FLUOR NONINF AGENT TITER EA 300 86256 256.00 230.40 248.32 243.20 245.76 30001283 FLUORESCENT NONINFECT AB TITER 300 86256 256.00 230.40 248.32 243.20 245.76 30001288 ASPERGILLUS AB 300 86606 124.00 111.60 120.28 117.80 119.04 30001292 COCCIDIOIDES ANTIBODY 300 86635 208.00 187.20 201.76 197.60 199.68 30001293 Q-FEVER AB 300 86638 158.00 142.20 153.26 150.10 151.68 30001295 EHRLICHIA ANAPLASMA 300 86666 94.00 84.60 91.18 89.30 90.24 30001297 HISTOPLASMA ANTIBODY 300 86698 131.00 117.90 127.07 124.45 125.76 30001299 HIV-1 ANTIBODY 300 86701 127.00 114.30 123.19 120.65 121.92 30001300 HIV-2 ANTIBODY 300 86702 192.00 172.80 186.24 182.40 184.32 30001302 MUMPS 300 86735 119.00 107.10 115.43 113.05 114.24 30001303 TREPONEMA PALLIDUM 300 86780 88.00 79.20 85.36 83.60 84.48 30001304 THYROGLOBULIN AB 300 86800 130.00 117.00 126.10 123.50 124.8 30001307 MIC PANEL 300 87186 113.00 101.70 109.61 107.35 108.48 30001308 TISS CULT INOC OBS PRESUM ID 300 87252 156.00 140.40 151.32 148.20 149.76 30001309 SHELL VIAL 300 87254 202.00 181.80 195.94 191.90 193.92 30001310 INFECT AGENT DETECT RNA DNA 300 87798 199.00 179.10 193.03 189.05 191.04 30001311 INFECTIOUS AGENT BY AMPL PROBE 300 87798 199.00 179.10 193.03 189.05 191.04 30001312 INFECT AGENT DETECT AMP PROBE 300 87798 199.00 179.10 193.03 189.05 191.04 30001313 INFECTIOUS AGENT AMPLIF PROBE 300 87798 199.00 179.10 193.03 189.05 191.04 30001314 CHROMO ANALY ADDL KARYOTYPES 300 88280 337.00 303.30 326.89 320.15 323.52 30001315 CYTOGENETICS INTERP & REPORT 300 88291 219.00 197.10 212.43 208.05 210.24 30001317 COCCIDIOIDES ANTIBODIES 300 86635 208.00 187.20 201.76 197.60 199.68 30001318 CANDIDA DNA DIRECT PROBE 300 87480 102.00 91.80 98.94 96.90 97.92 30001319 GARDNER VAG DNA DIRECT PROBE 300 87510 102.00 91.80 98.94 96.90 97.92 30001320 TRICH VAG DNA DIRECT PROBE 300 87660 102.00 91.80 98.94 96.90 97.92 30001321 DRUG SCREEN SINGLE DRUG 300 80307 278.00 250.20 269.66 264.10 266.88 30001323 OXYCODONE 300 80365 200.00 180.00 194.00 190.00 192 30001324 CERULOPLASMIN 300 82390 113.00 101.70 109.61 107.35 108.48 30001325 DRUG TEST PRESUMPTIVE 300 80307 85.00 76.50 82.45 80.75 81.6 30001326 HIV-1 ANTIBODY 300 86701 127.00 114.30 123.19 120.65 121.92 30001328 "DAT,ANTI-C3B -C3D" 300 86880 71.00 63.90 68.87 67.45 68.16 30001331 GRP A STREP CULTURE THROAT 300 87081 67.00 60.30 64.99 63.65 64.32 30001334 ENTEROVIRUS PCR 300 87498 324.00 291.60 314.28 307.80 311.04 30001335 MYCOBACTERIA TB AMPLIF PROBE 300 87556 169.00 152.10 163.93 160.55 162.24 30001336 TOBRAMYCIN TROUGH 300 80200 155.00 139.50 150.35 147.25 148.8 30001337 TOBRAMYCIN KINETIC 300 80200 155.00 139.50 150.35 147.25 148.8 30001339 THROMBOPLASTIN INHIB TISSUE 300 85705 34.00 30.60 32.98 32.30 32.64 30001340 BARTONELLA DNA PCR 300 87471 517.00 465.30 501.49 491.15 496.32 30001341 MENING/ENCEPH PANEL BIOFIRE 300 87483 922.00 829.80 894.34 875.90 885.12 30001342 ALBUMIN SERUM PLASMA WB 300 82040 45.00 40.50 43.65 42.75 43.2 30001343 ALBUMIN URINE/OTHER QUANT EACH 300 82042 54.00 48.60 52.38 51.30 51.84 30001344 RHEUMATOID FACTOR QUANTITATIVE 300 86431 74.00 66.60 71.78 70.30 71.04 30001345 SPECTROPHOTOMETRY 300 84311 52.00 46.80 50.44 49.40 49.92 30001346 CRYPTOCOCCUS NEOFORMANS 300 87327 82.00 73.80 79.54 77.90 78.72 30001349 FLUORESCENT NONINFECT AGENT AB 300 86255 465.00 418.50 451.05 441.75 446.4 30001353 GI PANEL 300 87506 559.00 503.10 542.23 531.05 536.64 30001354 NOROVIRUS GI 300 87798 199.00 179.10 193.03 189.05 191.04 30001355 NOROVIRUS GII 300 87798 199.00 179.10 193.03 189.05 191.04 30001356 QUANT OF THERAPEUTIC DRUG 300 80299 196.00 176.40 190.12 186.20 188.16 30001357 NICOTINE METABOLITES URINE 300 80323 211.00 189.90 204.67 200.45 202.56 30001358 PLATELET ANTIBODIES 300 86022 341.00 306.90 330.77 323.95 327.36 30001359 CROSSMATCH ELECTRONIC 300 86923 197.00 177.30 191.09 187.15 189.12 30001360 LACTOSE TOLERANCE-3 SPEC 300 82951 165.00 148.50 160.05 156.75 158.4 30001363 CULTURE SCREENING GRP B 300 87081 74.00 66.60 71.78 70.30 71.04 30001365 FLUID CELL CT & ID 300 89051 127.00 114.30 123.19 120.65 121.92 30001366 SYNOVIAL FLUID CELL CT & ID 300 89051 127.00 114.30 123.19 120.65 121.92 30001367 Hc Glucose Body Fluid 300 82945 61.00 54.90 59.17 57.95 58.56 30001368 RSV BY PCR 300 87634 199.00 179.10 193.03 189.05 191.04 30001369 SIROLIMUS PAPAMUNE BLOOD 300 80195 202.00 181.80 195.94 191.90 193.92 30001370 HGB A1C SCRN LESS THAN 7.0 300 3044F 1.00 0.90 0.97 0.95 0.96 30001372 HGB A1C GREATER THAN 9 300 3046F 1.00 0.90 0.97 0.95 0.96 30001373 TRAZADONE URINE 300 80338 117.00 105.30 113.49 111.15 112.32 30001374 L PNEUMOPHILIA SEROGROUP 1 300 87449 251.00 225.90 243.47 238.45 240.96 30001375 LACTOFERIN FECAL QUANT 300 83631 108.00 97.20 104.76 102.60 103.68 30001377 Hc Glucose 300 82947 45.00 40.50 43.65 42.75 43.2 30001381 Hc Creatinine 300 82565 61.00 54.90 59.17 57.95 58.56 30001382 Hc C Difficile Toxins 300 87324 188.00 169.20 182.36 178.60 180.48 30001383 CYP2D6 GENOTYPING 300 81226 482.00 433.80 467.54 457.90 462.72 30001384 DEFINITIVE DRUG TESTS 1-7 CL 300 HCPCS G0480 214.00 192.60 207.58 203.30 205.44 30001385 Hc Cyp2c19 Genotyping 300 81225 375.00 337.50 363.75 356.25 360 30001386 Hc Calr Calreticulin Exon 9 Mut Analys 300 81219 321.00 288.90 311.37 304.95 308.16 30001387 Hc Mpl Codon 515 Mutation Detection Quant 300 81402 477.00 429.30 462.69 453.15 457.92 30001388 Hc Oprm1 300 81479 97.00 87.30 94.09 92.15 93.12 30001389 Hc Comt 300 81479 97.00 87.30 94.09 92.15 93.12 30001390 Hc Cyp3a4 300 81401 97.00 87.30 94.09 92.15 93.12 30001391 Hc Cyp3a5 300 81401 97.00 87.30 94.09 92.15 93.12 30001392 Hc Vkorc1 Genotyping 300 81355 5.00 4.50 4.85 4.75 4.8 30001396 Hc Ctfr Sequencing 300 81223 416.00 374.40 403.52 395.20 399.36 30001397 Hc Prss1 Sequencing 300 81404 523.00 470.70 507.31 496.85 502.08 30001398 Hc Ctrc Sequencing 300 81405 421.00 378.90 408.37 399.95 404.16 30001399 Hc Protein Total 300 84160 57.00 51.30 55.29 54.15 54.72 30001400 Hc Protein Electrophoretic Frac Quant 300 84165 127.00 114.30 123.19 120.65 121.92 30001401 Hc Immunofixation Electro Serum 300 86334 206.00 185.40 199.82 195.70 197.76 30001402 Hc Gammaglobulin Each 300 82784 93.00 83.70 90.21 88.35 89.28 30001403 Hc Nephelometry Each 300 83883 155.00 139.50 150.35 147.25 148.8 30001404 Hc Amphetamine 300 80325 75.00 67.50 72.75 71.25 72 30001408 Hc Hepatitis C Antibody 300 86803 113.00 101.70 109.61 107.35 108.48 30001409 Hc Spink1 Sequencing 300 81404 523.00 470.70 507.31 496.85 502.08 30001410 Hc Bcr Abl1 Major 300 81206 376.00 338.40 364.72 357.20 360.96 30001411 Hc Bcr Abl1 Minor 300 81207 369.00 332.10 357.93 350.55 354.24 30001412 Hc Molecular Pathology Proc Level 3 300 81402 477.00 429.30 462.69 453.15 457.92 30001413 Hc Myeloid Malignancy Panel 300 81455 " 2,009.00 " " 1,808.10 " " 1,948.73 " " 1,908.55 " "1,928.64" 30001414 Hc Jak2 Gene Analysis 300 81270 421.00 378.90 408.37 399.95 404.16 30001415 Hc Jak2 Sequencing 300 0027U 397.00 357.30 385.09 377.15 381.12 30001416 Hc Creatinine Other Source 300 82570 81.00 72.90 78.57 76.95 77.76 30001418 Hc Bhb Beta - Hydroxybutyrate 300 82010 78.00 70.20 75.66 74.10 74.88 30001419 Hc Streptoccoccus Group B Probe 300 87653 180.00 162.00 174.60 171.00 172.8 30001420 Hc Fetal Congenital Abnormalities Biochem 4 Analytes 300 81511 206.00 185.40 199.82 195.70 197.76 30001422 Hc Inhibin A Ultrasensitive 300 86336 124.00 111.60 120.28 117.80 119.04 30001423 Hc Inhibin B 300 83520 236.00 212.40 228.92 224.20 226.56 30001424 Hc Interleukin-6 Serum 300 83520 225.00 202.50 218.25 213.75 216 30001429 Hc Zika Virus Igm (eua) 300 86794 225.00 202.50 218.25 213.75 216 30001430 Hc Zika Virus By Pcr Blood 300 87662 318.00 286.20 308.46 302.10 305.28 30001431 Hc Zika Virus By Pcr Urine 300 87662 318.00 286.20 308.46 302.10 305.28 30001432 Hc Free And Total Insulin (total) 300 83525 60.00 54.00 58.20 57.00 57.6 30001433 Hc Free And Total Insulin (free) 300 83527 60.00 54.00 58.20 57.00 57.6 30001434 Hc Infectious Agent Detection Dna/rna Chlamydia Pneumoniae Amplified Probe 300 87486 39.00 35.10 37.83 37.05 37.44 30001436 Hc Infectious Agent Detection Dna/rna Mpneumoniae Amplified Probe 300 87581 39.00 35.10 37.83 37.05 37.44 30001437 Hc Culture Typing Id By Dna/rna Probe Per Cultrue Or Isolate Ea Organism Probed 300 87150 268.00 241.20 259.96 254.60 257.28 30001439 Hc Infectious Agent Detection By Dna Or Rna Nos Amp Probe Ea Organism 300 87798 39.00 35.10 37.83 37.05 37.44 30001440 Hc Infectious Disease Chronic Hepatitis C Six Biochem Assays 300 81596 513.00 461.70 497.61 487.35 492.48 30001443 Hc Neuro Csf Prion Protein Qual 300 0035U 478.00 430.20 463.66 454.10 458.88 30001444 Hc Western Blot Test 300 84182 164.00 147.60 159.08 155.80 157.44 30001445 Hc Blood Occult Fecal Hgb Feces 1-3 Simult 300 82274 52.00 46.80 50.44 49.40 49.92 30001446 Hc Amines Vaginal Fluid Qualitative 300 82120 57.00 51.30 55.29 54.15 54.72 30001449 Hb Hgb A1c Srn Greater Or Equal To 7 And Less Than 8 300 3051F 1.00 0.90 0.97 0.95 0.96 30001450 Hb Hgb A1c Scrn Greater Than Or Equal To 8 And Less Than Or Equal To 9 300 3052F 1.00 0.90 0.97 0.95 0.96 30001451 Hc Resp Viral Panel Biofire 300 0097U 503.00 452.70 487.91 477.85 482.88 30001452 Hc Gi Panel 300 0100U 543.00 488.70 526.71 515.85 521.28 30001453 Hc Antipsychotics Not Otherwise Specified 1-3 300 80342 185.00 166.50 179.45 175.75 177.6 30001454 Hc Iadna Human Papillomavirus High-risk Types 300 87624 135.00 121.50 130.95 128.25 129.6 30001456 Hc M. Genitalium Amp Probe 300 87563 102.00 91.80 98.94 96.90 97.92 30001459 Hc Resp Viral Panel Biofire - Micro 300 0097U 503.00 452.70 487.91 477.85 482.88 30001460 Hc Bcr Abl1 Other Breakpoint 300 81208 356.00 320.40 345.32 338.20 341.76 30001463 Hc Citrate 300 82507 110.00 99.00 106.70 104.50 105.6 30001464 Hc Oxalate Urine 300 83945 100.00 90.00 97.00 95.00 96 30001465 Hc Calcium Urine Quant Timed 300 82340 75.00 67.50 72.75 71.25 72 30001468 Hc Alkaloids Not Otherwise Specified 300 80323 205.00 184.50 198.85 194.75 196.8 30001469 Hc Iadna Human Papillomavirus Types 16 & 18 Only 300 87625 275.00 247.50 266.75 261.25 264 30001470 Hc Sars-cov-2 By Pcr 300 87635 100.00 90.00 97.00 95.00 96 30001472 Hc Covid-19 Bryan 300 87635 100.00 90.00 97.00 95.00 96 30001473 Hc Sars-cov-2 Igg Ab 300 86769 107.00 96.30 103.79 101.65 102.72 30001474 Hc Specimen Collect Covid-19 300 HCPCS G2023 31.00 27.90 30.07 29.45 29.76 30001475 Hc Transcortin (cortisol Binding Globulin) 300 84449 150.00 135.00 145.50 142.50 144 30001477 "Hc Allergens, Food, Nuts" 300 86003 256.00 230.40 248.32 243.20 245.76 30001478 "Hc Allergens, Food, Fish Profile, Ige" 300 86003 192.00 172.80 186.24 182.40 184.32 30001479 "Hc Allergens, Food, Egg Components Ige" 300 86003 64.00 57.60 62.08 60.80 61.44 30001480 "Hc Allergens, Egg Components Ige" 300 86008 91.00 81.90 88.27 86.45 87.36 30001481 "Hc Allergens, Food, Shell Fish Profile" 300 86003 224.00 201.60 217.28 212.80 215.04 30001482 HC RESPIRATORY PATHOGEN PANEL WITH COVID 300 0202U 100.00 90.00 97.00 95.00 96 30001483 "HC SARS-COV-2 ANTIGEN, RAPID" 300 87426 136.00 122.40 131.92 129.20 130.56 30001487 HC HS TROPONIN T 300 84484 204.00 183.60 197.88 193.80 195.84 30001488 Hc Mlh1 300 81292 " 1,010.00 " 909.00 979.70 959.50 969.6 30001489 Hc Msh2 300 81295 570.00 513.00 552.90 541.50 547.2 30001490 Hc Msh6 300 81298 960.00 864.00 931.20 912.00 921.6 30001491 Hc Pms2 Full Sequence 300 81317 " 1,010.00 " 909.00 979.70 959.50 969.6 30001492 Hc Pms2 Dup/delet Variants 300 81319 305.00 274.50 295.85 289.75 292.8 30001493 Hc Tier 2 Molecular Pathology 300 81403 485.00 436.50 470.45 460.75 465.6 30001494 Hc Tier 1 Molecular Pathology 300 81228 " 1,350.00 " " 1,215.00 " " 1,309.50 " " 1,282.50 " "1,296.00" 30100001 BILIRUBIN TOTAL 301 82247 59.00 53.10 57.23 56.05 56.64 30200001 Hc Allergen Quant Semiquant Each 302 86008 91.00 81.90 88.27 86.45 87.36 30600001 HIV-I INTEGRASE GEROTYPE 306 87906 726.00 653.40 704.22 689.70 696.96 31000002 CYTO FLUID WASHING OR BRUSHING 310 88104 111.00 99.90 107.67 105.45 106.56 31000004 CYTO CONC SMEAR W INTERP 310 88108 132.00 118.80 128.04 125.40 126.72 31000005 CYTO SELECTIVE CELL ENHANCE 310 88112 61.00 54.90 59.17 57.95 58.56 31000009 REVIEW OF PAP SMEAR 311 88141 111.00 99.90 107.67 105.45 106.56 31000010 THIN LAYER PREP PAP SMEAR 311 88142 103.00 92.70 99.91 97.85 98.88 31000011 CYTO SMEARS OTHER SOURCE 310 88160 75.00 67.50 72.75 71.25 72 31000012 CYTO SMEARS PREP SCREEN INTERP 310 88161 108.00 97.20 104.76 102.60 103.68 31000013 CYTO SMEARS OVER 5 SLIDES 310 88162 185.00 166.50 179.45 175.75 177.6 31000014 PAP SMEAR 1 SLIDE 311 88164 68.00 61.20 65.96 64.60 65.28 31000015 PAP SMEAR 2 SLIDE 311 88164 76.00 68.40 73.72 72.20 72.96 31000016 CYTO FNA FIRST EVAL EACH SITE 310 88172 143.00 128.70 138.71 135.85 137.28 31000017 CYTO FNA INTERP AND REPORT 310 88173 130.00 117.00 126.10 123.50 124.8 31000019 CELL MARKER STUDY MARKER 1 300 88184 106.00 95.40 102.82 100.70 101.76 31000020 CELL MARKERS MARKER 1 311 88184 106.00 95.40 102.82 100.70 101.76 31000021 FLOW CYT CELL SURF MARKER 1 311 88184 106.00 95.40 102.82 100.70 101.76 31000022 FLOW CYT NUCLEAR MARKER 1 311 88184 106.00 95.40 102.82 100.70 101.76 31000024 LYMPH SUBSET PAN 4 MARKER 1 311 88184 106.00 95.40 102.82 100.70 101.76 31000025 T-CELL IMMUNODEFIC MARKER 1 300 88184 106.00 95.40 102.82 100.70 101.76 31000027 CELL MARKERS INTERP 16 OR MORE 311 88189 82.00 73.80 79.54 77.90 78.72 31000028 FISH PANEL FOR CLL 310 88217 47.00 42.30 45.59 44.65 45.12 31000029 TISSUE CULT NON-NEOPLASTIC 319 88230 530.00 477.00 514.10 503.50 508.8 31000031 CYTOGENETICS DNA 319 88271 42.00 37.80 40.74 39.90 40.32 31000032 MOLECULAR CYTOGEN DNA PROBE EA 319 88271 124.00 111.60 120.28 117.80 119.04 31000035 CYTOGENETICS 100-300 CELLS 319 88275 82.00 73.80 79.54 77.90 78.72 31000036 TISSUE CULTURE BONE MARROW/BLD 319 88237 489.00 440.10 474.33 464.55 469.44 31000038 SURGICAL PATH LEVEL I 310 88300 32.00 28.80 31.04 30.40 30.72 31000039 SURGICAL PATH LEVEL II 310 88302 65.00 58.50 63.05 61.75 62.4 31000040 SURGICAL PATH LEVEL III 310 88304 152.00 136.80 147.44 144.40 145.92 31000041 SURGICAL PATH LEVEL V 310 88307 350.00 315.00 339.50 332.50 336 31000042 SURGICAL PATH LEVEL VI 310 88309 204.00 183.60 197.88 193.80 195.84 31000043 DECALCIFICATION PROCEDURE 310 88311 11.00 9.90 10.67 10.45 10.56 31000044 SPECIAL STAINS GRP 1 MICROORG 310 88312 123.00 110.70 119.31 116.85 118.08 31000045 SPECIAL STAINS GRP 2 ALL OTHER 310 88313 73.00 65.70 70.81 69.35 70.08 31000049 PATH CONSLT FIRST TISSUE BLOCK 310 88331 155.00 139.50 150.35 147.25 148.8 31000050 PATH CONSLT ADD TISSUE BLOCK 310 88332 77.00 69.30 74.69 73.15 73.92 31000053 IMMUNOSTAIN ADDITIONAL 310 88341 155.00 139.50 150.35 147.25 148.8 31000054 IMMUNOSTAIN INITIAL 310 88342 152.00 136.80 147.44 144.40 145.92 31000061 MA TUMOR IMMUNOHISTOCHEM 310 88360 180.00 162.00 174.60 171.00 172.8 31000062 MA TUMOR IMMUNOHISTOCHEM AUTO 310 88361 171.00 153.90 165.87 162.45 164.16 31000064 IN SITU HYBRIDIZATION EACH 310 88365 505.00 454.50 489.85 479.75 484.8 31000073 CELL MARKER STUDY EACH ADDL 311 88185 30.00 27.00 29.10 28.50 28.8 31000074 FLOW CYT CELL SURF EACH ADDL 311 88185 486.00 437.40 471.42 461.70 466.56 31000077 TRANSFUSION RX INVESTIGAT 310 86078 79.00 71.10 76.63 75.05 75.84 31000078 THIN PREP W IMAGING 310 88175 111.00 99.90 107.67 105.45 106.56 31000080 FISH PANEL FOR CLL 310 88291 219.00 197.10 212.43 208.05 210.24 31000083 FLOW CYTOMETER 2-8 MARKERS 311 88187 182.00 163.80 176.54 172.90 174.72 31000088 TISSUE CULTURE; LYMPHOCYTE 319 88230 789.00 710.10 765.33 749.55 757.44 31000090 CHRM ANLY AMN FLD/CHOR VIL 15C 319 88267 760.00 684.00 737.20 722.00 729.6 31000091 FISH PANEL FOR CLL 310 88275 82.00 73.80 79.54 77.90 78.72 31000092 CHROMO ANALY ADDL KARYOTYPE 319 88280 337.00 303.30 326.89 320.15 323.52 31000095 SURGICAL PATH LEVEL IV 310 88305 178.00 160.20 172.66 169.10 170.88 31000096 CHROMOSOME COUNT ADDL 319 88285 108.00 97.20 104.76 102.60 103.68 31000098 FLOW CYT NUCLEAR MARKER 1 311 88184 106.00 95.40 102.82 100.70 101.76 31000099 CELL MARKER STUDY EACH ADDL 311 88185 30.00 27.00 29.10 28.50 28.8 31000100 CELL MARKER STUDY EACH ADDL 311 88185 32.00 28.80 31.04 30.40 30.72 31000101 CELL MARKER STUDY EACH ADDL 311 88185 30.00 27.00 29.10 28.50 28.8 31000104 Hc Path Consult In Surgery 310 88329 218.00 196.20 211.46 207.10 209.28 31000105 Hc Imhistochem Cytchm Ea Multiplex Antibody Slide 310 88344 211.00 189.90 204.67 200.45 202.56 31000106 Hc Blood Smear Interpretation 310 85060 72.00 64.80 69.84 68.40 69.12 31000107 Hc Microslide Consult 310 88321 513.00 461.70 497.61 487.35 492.48 32000003 PARACENTESIS WO GUIDANCE 761 49082 723.00 650.70 701.31 686.85 694.08 32000005 EYE FOREIGN BODY 320 70030 235.00 211.50 227.95 223.25 225.6 32000006 MANDIBLE 1-3 VIEWS 320 70100 289.00 260.10 280.33 274.55 277.44 32000007 MANDIBLE 4+ VIEWS 320 70110 400.00 360.00 388.00 380.00 384 32000008 MASTOIDS 1-2 VIEWS 320 70120 209.00 188.10 202.73 198.55 200.64 32000009 MASTOIDS 3 OR MORE VIEWS 320 70130 388.00 349.20 376.36 368.60 372.48 32000011 FACIAL BONES 1-2 VIEWS 320 70140 276.00 248.40 267.72 262.20 264.96 32000012 FACIAL BONES 3+ VIEWS 320 70150 390.00 351.00 378.30 370.50 374.4 32000013 NASAL BONES 320 70160 322.00 289.80 312.34 305.90 309.12 32000015 ORBITS 4+ VIEWS 320 70200 405.00 364.50 392.85 384.75 388.8 32000016 SINUS PARANASAL 1-2 VIEWS 320 70210 275.00 247.50 266.75 261.25 264 32000017 PARANASAL SINUS 3+ VIEWS 320 70220 418.00 376.20 405.46 397.10 401.28 32000019 SKULL 1-3 VIEWS 320 70250 296.00 266.40 287.12 281.20 284.16 32000020 SKULL COMPLETE 4+ VIEWS 320 70260 438.00 394.20 424.86 416.10 420.48 32000023 TMJ OPEN CLOSED UNI 320 70328 200.00 180.00 194.00 190.00 192 32000024 TMJ BILATERAL 320 70330 364.00 327.60 353.08 345.80 349.44 32000026 NECK SOFT TISSUE 320 70360 317.00 285.30 307.49 301.15 304.32 32000028 RIBS UNILATERAL 2 VIEW 320 71100 379.00 341.10 367.63 360.05 363.84 32000029 CHEST W/RIBS UNI 3 VIEW 320 71101 421.00 378.90 408.37 399.95 404.16 32000030 RIBS BIL 3 VIEWS 320 71110 421.00 378.90 408.37 399.95 404.16 32000031 CHEST W/RIBS BIL 4+ VIEWS 320 71111 531.00 477.90 515.07 504.45 509.76 32000032 STERNUM 320 71120 305.00 274.50 295.85 289.75 292.8 32000033 STERNOCLAVICULAR JOINT 320 71130 283.00 254.70 274.51 268.85 271.68 32000034 X-RAY SPINE ONE VIEW 320 72020 242.00 217.80 234.74 229.90 232.32 32000035 CERVICAL SPINE 2 OR 3 VIEWS 320 72040 320.00 288.00 310.40 304.00 307.2 32000036 SPINE CERVICAL 4 OR 5 VIEWS 320 72050 514.00 462.60 498.58 488.30 493.44 32000037 SPINE CERVICAL 6 OR MORE VIEWS 320 72052 640.00 576.00 620.80 608.00 614.4 32000038 SPINE THORACIC 2 VIEWS 320 72070 355.00 319.50 344.35 337.25 340.8 32000039 SPINE THORACIC 3 VIEWS 320 72072 464.00 417.60 450.08 440.80 445.44 32000041 SPINE T-L 2 VIEWS 320 72080 342.00 307.80 331.74 324.90 328.32 32000043 SPINE 2-3 VIEWS 320 72082 314.00 282.60 304.58 298.30 301.44 32000046 SPINE LUMBAR 2 OR 3 VIEWS 320 72100 385.00 346.50 373.45 365.75 369.6 32000047 SPINE LUMBAR 4+ VIEWS 320 72110 504.00 453.60 488.88 478.80 483.84 32000048 SPINE LUMB COMP W/BENDING 320 72114 514.00 462.60 498.58 488.30 493.44 32000049 SPINE LUMBAR BEND 2-3 VIEWS 320 72120 385.00 346.50 373.45 365.75 369.6 32000050 PELVIS 1 OR 2 VIEWS 320 72170 274.00 246.60 265.78 260.30 263.04 32000051 PELVIS COMPLETE 3+ VIEWS 320 72190 399.00 359.10 387.03 379.05 383.04 32000052 SACROILIAC JOINT 1-2 VIEW 320 72200 350.00 315.00 339.50 332.50 336 32000053 SACROILIAC JOINTS 3+ VIEW 320 72202 350.00 315.00 339.50 332.50 336 32000054 SACRUM/COCCYX 320 72220 283.00 254.70 274.51 268.85 271.68 32000055 MYELOGRAM CERV S & I 320 72240 859.00 773.10 833.23 816.05 824.64 32000057 MYELOGRAM LUMBOSACRAL S & I 320 72265 618.00 556.20 599.46 587.10 593.28 32000062 CLAVICLE COMPLETE 320 73000 280.00 252.00 271.60 266.00 268.8 32000063 SCAPULA COMPLETE 320 73010 305.00 274.50 295.85 289.75 292.8 32000064 SHOULDER 1 VIEW 320 73020 228.00 205.20 221.16 216.60 218.88 32000065 SHOULDER 2+ VIEWS 320 73030 333.00 299.70 323.01 316.35 319.68 32000066 AC JOINTS BILATERAL 320 73050 283.00 254.70 274.51 268.85 271.68 32000067 HUMERUS 320 73060 303.00 272.70 293.91 287.85 290.88 32000068 ELBOW 2 VIEWS 320 73070 262.00 235.80 254.14 248.90 251.52 32000069 ELBOW 3+ VIEWS 320 73080 308.00 277.20 298.76 292.60 295.68 32000070 FOREARM 2 VIEWS 320 73090 274.00 246.60 265.78 260.30 263.04 32000071 UPPER EXTREMITY INFANT 320 73092 234.00 210.60 226.98 222.30 224.64 32000072 WRIST 2 VIEWS 320 73100 228.00 205.20 221.16 216.60 218.88 32000073 WRIST 3+ VIEWS 320 73110 292.00 262.80 283.24 277.40 280.32 32000074 HAND 2 VIEWS 320 73120 239.00 215.10 231.83 227.05 229.44 32000075 HAND 3+ VIEWS 320 73130 308.00 277.20 298.76 292.60 295.68 32000076 FINGER(S) 2+ VIEWS 320 73140 217.00 195.30 210.49 206.15 208.32 32000077 HIP UNI W OR WO PEL 1 VIEW 320 73501 300.00 270.00 291.00 285.00 288 32000078 HIP UNI W OR WO PEL 2-3 VIEWS 320 73502 340.00 306.00 329.80 323.00 326.4 32000079 HIP UNI W OR WO PEL 4+ VIEWS 320 73503 356.00 320.40 345.32 338.20 341.76 32000082 HIP BIL W OR WO PEL 2 VIEWS 320 73521 415.00 373.50 402.55 394.25 398.4 32000083 HIP BIL W OR WO PEL 3-4 VIEWS 320 73522 485.00 436.50 470.45 460.75 465.6 32000084 HIP BIL W OR WO PEL 5+ VIEWS 320 73523 485.00 436.50 470.45 460.75 465.6 32000086 FEMUR 1 VIEW 320 73551 357.00 321.30 346.29 339.15 342.72 32000087 FEMUR 2 VIEWS 320 73552 340.00 306.00 329.80 323.00 326.4 32000088 KNEE 1-2 VIEWS 320 73560 290.00 261.00 281.30 275.50 278.4 32000089 KNEE 3 VIEWS 320 73562 314.00 282.60 304.58 298.30 301.44 32000090 KNEE COMPLETE 4+ VIEWS 320 73564 327.00 294.30 317.19 310.65 313.92 32000091 KNEES BOTH STANDING AP 320 73565 252.00 226.80 244.44 239.40 241.92 32000092 TIBIA/FIBULA 2 VIEWS 320 73590 298.00 268.20 289.06 283.10 286.08 32000093 LOWER EXTREMITY INFANT 320 73592 244.00 219.60 236.68 231.80 234.24 32000094 ANKLE 2 VIEWS 320 73600 246.00 221.40 238.62 233.70 236.16 32000095 ANKLE 3+ VIEWS 320 73610 307.00 276.30 297.79 291.65 294.72 32000096 FOOT 2 VIEWS 320 73620 253.00 227.70 245.41 240.35 242.88 32000097 FOOT 3+ VIEWS 320 73630 313.00 281.70 303.61 297.35 300.48 32000098 CALCANEUS 2+ VIEWS 320 73650 244.00 219.60 236.68 231.80 234.24 32000099 TOE(S) 2+ VIEWS 320 73660 235.00 211.50 227.95 223.25 225.6 32000103 ABD MULTIPLE VIEWS SERIES 320 74022 467.00 420.30 452.99 443.65 448.32 32000106 ESOPHAGUS 320 74220 628.00 565.20 609.16 596.60 602.88 32000107 SWALLOW FUNCTION W/VIDEO 320 74230 578.00 520.20 560.66 549.10 554.88 32000108 UPPER GI W/KUB 320 74241 626.00 563.40 607.22 594.70 600.96 32000109 UPPER GI/SM BOWEL SERIES 320 74245 907.00 816.30 879.79 861.65 870.72 32000110 UPPER GI AIR CONTRAST 320 74247 832.00 748.80 807.04 790.40 798.72 32000111 UPPER GI-SM BOWEL W/AIR 320 74249 " 1,077.00 " 969.30 " 1,044.69 " " 1,023.15 " "1,033.92" 32000112 SMALL BOWEL SERIES 320 74250 661.00 594.90 641.17 627.95 634.56 32000113 BARIUM ENEMA 320 74270 688.00 619.20 667.36 653.60 660.48 32000114 BE AIR CONTRAST 320 74280 986.00 887.40 956.42 936.70 946.56 32000116 CHOLANGIOGRAPHY OPER 320 74300 580.00 522.00 562.60 551.00 556.8 32000124 INTRAVENOUS PYELOGRAM 320 74400 600.00 540.00 582.00 570.00 576 32000126 IVP W/TOMA 320 74415 988.00 889.20 958.36 938.60 948.48 32000129 CYSTOGRAPHY 320 74430 439.00 395.10 425.83 417.05 421.44 32000133 URETHROCYSTOGRAM VOIDING 320 74455 456.00 410.40 442.32 433.20 437.76 32000137 HYSTEROSALPINOGRAPHY 320 74740 712.00 640.80 690.64 676.40 683.52 32000180 FLUOROSCOPY < 1 HOUR 320 76000 647.00 582.30 627.59 614.65 621.12 32000182 FOREIGN BODY EXAM-CHILD 320 76010 283.00 254.70 274.51 268.85 271.68 32000183 ABSCESSOGRAM/FISTULA/SINUS TRACT 320 76080 " 1,920.00 " " 1,728.00 " " 1,862.40 " " 1,824.00 " "1,843.20" 32000184 SURGICAL SPECIMEN 320 76098 175.00 157.50 169.75 166.25 168 32000187 FLUORO VENOUS ACCESS DEVICE 320 77001 712.00 640.80 690.64 676.40 683.52 32000188 FLUORO GUIDE NEEDLE PLACEMENT 320 77002 859.00 773.10 833.23 816.05 824.64 32000189 FLUORO GUIDANCE/LOCAL NDL 320 77003 859.00 773.10 833.23 816.05 824.64 32000190 DUCTOGRAM SINGLE 320 77053 464.00 417.60 450.08 440.80 445.44 32000192 BONE AGE STUDIES 320 77072 234.00 210.60 226.98 222.30 224.64 32000193 BONE LENGTH STUDY 320 77073 457.00 411.30 443.29 434.15 438.72 32000194 OSSEOUS SURVEY LIMITED 320 77074 471.00 423.90 456.87 447.45 452.16 32000195 OSSEOUS SURVEY COMPLETE 320 77075 779.00 701.10 755.63 740.05 747.84 32000196 OSSEOUS SURVEY-INFANT 320 77076 501.00 450.90 485.97 475.95 480.96 32000197 JOINT SINGLE VIEW 320 77077 262.00 235.80 254.14 248.90 251.52 32000198 DEXA AXIAL SKELETON STUDY 320 77080 482.00 433.80 467.54 457.90 462.72 32000216 ABDOMEN XRAY ONE VIEW 320 74018 283.00 254.70 274.51 268.85 271.68 32000217 ABDOMEN XRAY TWO VIEWS 320 74019 391.00 351.90 379.27 371.45 375.36 32000218 ABDOMEN XRAY THREE + VIEWS 320 74021 499.00 449.10 484.03 474.05 479.04 32000220 Hc Small Bowel Series Following Ugi 320 74248 877.50 789.75 851.18 833.63 842.4 32000221 Hc Upper Gi W Scout W Wo Delayed Images Double Contrast Agent 320 74246 637.20 573.48 618.08 605.34 611.71 32000222 Hc Upper Gi W Scout W Wo Delayed Images Single Contrast Agent 320 74240 590.00 531.00 572.30 560.50 566.4 32200001 ARTHROGRAPHY SHOULDER 322 73040 826.00 743.40 801.22 784.70 792.96 32200003 ARTHROGRAM WRIST 322 73115 646.00 581.40 626.62 613.70 620.16 32200004 ARTHROGRAM HIP 322 73525 826.00 743.40 801.22 784.70 792.96 32200005 ARTHROGRAPHY KNEE 322 73580 826.00 743.40 801.22 784.70 792.96 32400005 CHEST WITH FLUOROSCOPY 324 478.00 430.20 463.66 454.10 458.88 32400009 CHEST XRAY ONE VIEW 324 71045 255.00 229.50 247.35 242.25 244.8 32400010 CHEST XRAY TWO VIEWS 324 71046 324.00 291.60 314.28 307.80 311.04 32400012 CHEST XRAY THREE VIEWS 324 71047 394.00 354.60 382.18 374.30 378.24 32400013 CHEST DECUB/SPECIAL ONE VIEW 324 71045 369.00 332.10 357.93 350.55 354.24 32400014 CHEST XRAY FOUR + VIEWS 324 71048 512.00 460.80 496.64 486.40 491.52 32900002 Hc Fine Needle Asp W Us Guidance Initial Lesion 329 10005 624.00 561.60 605.28 592.80 599.04 32900005 ASP ABSCESS HEMATOMA CYST 329 10160 363.00 326.70 352.11 344.85 348.48 32900006 DEBRIDE SKIN & SUBQ 761 11042 270.00 243.00 261.90 256.50 259.2 32900007 "DEBRIDE SKIN, SUBQ & MUSCLE" 329 11043 999.00 899.10 969.03 949.05 959.04 32900008 BX SKIN SUBCU ONE LESION 761 11100 421.00 378.90 408.37 399.95 404.16 32900010 ASPIRATION BREAST CYST 329 19000 496.00 446.40 481.12 471.20 476.16 32900011 ASP BREAST CYST ADDTL 329 19001 258.00 232.20 250.26 245.10 247.68 32900012 INJ MAMMARY DUCTOGRAM 329 19030 917.00 825.30 889.49 871.15 880.32 32900015 BREAST NDL LOC MAMMO GUIDE 320 19281 628.00 565.20 609.16 596.60 602.88 32900016 BREAST NDL LOC MAMMO ADDTL 329 19282 650.00 585.00 630.50 617.50 624 32900020 PERC MUSCLE SFT TISSUE BX 761 20206 " 1,223.00 " " 1,100.70 " " 1,186.31 " " 1,161.85 " "1,174.08" 32900025 FOREIGN BODY REMOVAL 761 20520 " 1,514.00 " " 1,362.60 " " 1,468.58 " " 1,438.30 " "1,453.44" 32900026 INJ TRIGGER PT 1 OR 2 MUSCLE 761 20552 442.00 397.80 428.74 419.90 424.32 32900027 ARTHROCENTESIS SMALL JOINT 761 20600 166.00 149.40 161.02 157.70 159.36 32900028 DRAIN INJECT SM JOINT W US 761 20604 " 1,208.00 " " 1,087.20 " " 1,171.76 " " 1,147.60 " "1,159.68" 32900029 ARTHROCENTESIS INTERMED JNT 761 20605 300.00 270.00 291.00 285.00 288 32900030 DRAIN INJECT MED JOINT W US 761 20606 " 1,218.00 " " 1,096.20 " " 1,181.46 " " 1,157.10 " "1,169.28" 32900031 INJ MAJOR JOINT THERAPEUTIC 761 20610 224.00 201.60 217.28 212.80 215.04 32900032 DRAIN INJECT LRG JOINT W US 761 20611 " 1,092.00 " 982.80 " 1,059.24 " " 1,037.40 " "1,048.32" 32900042 INJECTION PROCEDURE SHOULDER 329 23350 401.00 360.90 388.97 380.95 384.96 32900045 INJECTION WRIST ARTHROGRAPHY 329 25246 401.00 360.90 388.97 380.95 384.96 32900048 INJECTION HIP ARTHROGRAM 329 27093 401.00 360.90 388.97 380.95 384.96 32900052 INJ PX FOR KNEE ARTH 329 27369 401.00 360.90 388.97 380.95 384.96 32900058 INSERT TUNNELED PLEURAL CATH 761 32550 " 2,217.00 " " 1,995.30 " " 2,150.49 " " 2,106.15 " "2,128.32" 32900061 THORACENTESIS WO GUIDANCE 761 32554 676.00 608.40 655.72 642.20 648.96 32900062 THORACENTESIS W GUIDANCE 761 32555 796.00 716.40 772.12 756.20 764.16 32900063 PLEURAL DRAIN PERC WO 761 32556 " 1,435.00 " " 1,291.50 " " 1,391.95 " " 1,363.25 " "1,377.60" 32900064 PLEURAL DRAIN PERC W GUIDE 761 32557 " 2,246.00 " " 2,021.40 " " 2,178.62 " " 2,133.70 " "2,156.16" 32900065 INJ FIBRIN AGENT PLEURAL CATH 761 32561 " 1,309.00 " " 1,178.10 " " 1,269.73 " " 1,243.55 " "1,256.64" 32900126 VCAD NT INSERT < 5 YR 761 36555 " 2,192.00 " " 1,972.80 " " 2,126.24 " " 2,082.40 " "2,104.32" 32900147 DECLOT THROMBOLYTIC AGENT 761 36593 390.00 351.00 378.30 370.50 374.4 32900151 INJECT CONTRAST W FLUORO 761 36598 690.00 621.00 669.30 655.50 662.4 32900198 BONE MARROW ASPIRATION ONLY 761 38220 " 1,329.00 " " 1,196.10 " " 1,289.13 " " 1,262.55 " "1,275.84" 32900199 BONE MARROW BX ONLY 761 38221 " 1,993.00 " " 1,793.70 " " 1,933.21 " " 1,893.35 " "1,913.28" 32900200 LYMPH NODE BIOPSY 329 38505 667.00 600.30 646.99 633.65 640.32 32900203 BIOPSY SALIVARY GLAND NDL 761 42400 " 1,196.00 " " 1,076.40 " " 1,160.12 " " 1,136.20 " "1,148.16" 32900206 CHANGE GASTROSTOMY TUBE 761 43762 584.00 525.60 566.48 554.80 560.64 32900207 REPOSITION GASTRIC TUBE 761 43761 " 1,074.00 " 966.60 " 1,041.78 " " 1,020.30 " "1,031.04" 32900211 INCISE DRAIN RECTAL ABSCESS 761 46040 " 2,884.00 " " 2,595.60 " " 2,797.48 " " 2,739.80 " "2,768.64" 32900212 NEEDLE BIOPSY LIVER 329 47000 " 3,336.00 " " 3,002.40 " " 3,235.92 " " 3,169.20 " "3,202.56" 32900235 PARACENTESIS W GUIDANCE 761 49083 " 1,293.00 " " 1,163.70 " " 1,254.21 " " 1,228.35 " "1,241.28" 32900239 DRAIN ABSC NONPERITONEAL RETRO 761 49405 579.00 521.10 561.63 550.05 555.84 32900240 DRAIN ABSC PERITONEAL RETRO 761 49406 " 4,208.00 " " 3,787.20 " " 4,081.76 " " 3,997.60 " "4,039.68" 32900244 CONTRAST INJ ABSCESS CYST 761 49424 770.00 693.00 746.90 731.50 739.2 32900252 INJ CONTRAST EVALUATE G-TUBE 329 49465 365.00 328.50 354.05 346.75 350.4 32900281 INJ HYSTEROSALPINGOGRAPHY 329 58340 401.00 360.90 388.97 380.95 384.96 32900285 THYROID BIOPSY PERC 329 60100 506.00 455.40 490.82 480.70 485.76 32900298 SPINAL PUNCTURE LUMBAR 761 62270 401.00 360.90 388.97 380.95 384.96 32900299 SPINAL PUNC THERAPEUTIC 329 62272 831.00 747.90 806.07 789.45 797.76 32900300 Hc Epidural Blood Patch 370 62273 " 1,033.00 " 929.70 " 1,002.01 " 981.35 991.68 32900303 MYELOGRAM INJECTION ONLY 329 62284 401.00 360.90 388.97 380.95 384.96 32900319 INJECT TRIGEMINAL NERVE BIL 761 64400 487.00 438.30 472.39 462.65 467.52 32900320 NERVE BLOCK OCCIPITAL 761 64405 919.00 827.10 891.43 873.05 882.24 32900325 VERTEBRA INJECTION SINGLE 761 64479 " 1,333.00 " " 1,199.70 " " 1,293.01 " " 1,266.35 " "1,279.68" 32900326 VERTEBRA INJECTION ADDL 761 64480 869.00 782.10 842.93 825.55 834.24 32900327 VERTEBRA INJECTION SINGLE 761 64483 932.00 838.80 904.04 885.40 894.72 32900328 VERTEBRA INJECTION ADDL 761 64484 375.00 337.50 363.75 356.25 360 32900332 INJ FACET LUMBAR SGL LEVEL 761 64493 " 1,403.00 " " 1,262.70 " " 1,360.91 " " 1,332.85 " "1,346.88" 32900333 INJ FACET LUMBAR 2ND LEVEL 761 64494 792.00 712.80 768.24 752.40 760.32 32900335 INJECT SPHENO GANGLION 761 64505 526.00 473.40 510.22 499.70 504.96 32900353 INJ SI JOINT THERAPEUTIC 761 27096 534.00 480.60 517.98 507.30 512.64 32900392 INJ EPIDURAL CERV THOR CT 761 62321 " 1,300.00 " " 1,170.00 " " 1,261.00 " " 1,235.00 " "1,248.00" 32900393 INJ EPIDURAL CERV THOR FL 761 62321 " 1,300.00 " " 1,170.00 " " 1,261.00 " " 1,235.00 " "1,248.00" 32900395 INJ EPIDURAL LUMB SACRAL FL 761 62323 " 1,500.00 " " 1,350.00 " " 1,455.00 " " 1,425.00 " "1,440.00" 32900396 ARTHROCENTESIS MAJOR JOINT 761 20610 401.00 360.90 388.97 380.95 384.96 33100002 CHEMO PLEURAL CAV W/THOR 331 96440 610.00 549.00 591.70 579.50 585.6 33100005 CHEMO IV PUSH 331 96409 310.00 279.00 300.70 294.50 297.6 33100008 CHEMO BLADDER INSTILL 761 51720 899.00 809.10 872.03 854.05 863.04 34100005 PARATHYROID PLANAR IMAGING 341 78070 " 1,286.00 " " 1,157.40 " " 1,247.42 " " 1,221.70 " "1,234.56" 34100008 LYMPHATIC GLAND IMAGING 341 78195 " 2,097.00 " " 1,887.30 " " 2,034.09 " " 1,992.15 " "2,013.12" 34100012 HEPATOBILIARY SYSTEM IMAGING 341 78226 " 1,726.00 " " 1,553.40 " " 1,674.22 " " 1,639.70 " "1,656.96" 34100013 NM GALLBLADDER PIPIDA W CCK 341 78227 " 1,726.00 " " 1,553.40 " " 1,674.22 " " 1,639.70 " "1,656.96" 34100014 NM SALIVARY GLAND 341 78230 596.00 536.40 578.12 566.20 572.16 34100015 GASTRIC EMPTYING STUDY 341 78264 " 1,681.00 " " 1,512.90 " " 1,630.57 " " 1,596.95 " "1,613.76" 34100017 BOWEL IMAGING 341 78290 " 1,349.00 " " 1,214.10 " " 1,308.53 " " 1,281.55 " "1,295.04" 34100018 BONE JOINT IMAGE LIMITED 341 78300 " 1,012.00 " 910.80 981.64 961.40 971.52 34100019 BONE JNT IMAGE WHOLE BODY 341 78306 " 1,801.00 " " 1,620.90 " " 1,746.97 " " 1,710.95 " "1,728.96" 34100020 BONE IMAGE 3 PHASE STUDY 341 78315 " 2,223.00 " " 2,000.70 " " 2,156.31 " " 2,111.85 " "2,134.08" 34100021 BONE JOINT TOMOGR SPECT 341 78320 " 2,163.00 " " 1,946.70 " " 2,098.11 " " 2,054.85 " "2,076.48" 34100023 CARDIAC SGI STUDY SPECT 341 78451 " 2,097.00 " " 1,887.30 " " 2,034.09 " " 1,992.15 " "2,013.12" 34100024 MYOCARD PERF SPECT MULT 341 78452 " 4,043.00 " "2,246.00" " 3,921.71 " " 3,840.85 " "3,881.28" 34100027 CARD BLD POOL IMAGE GATED 341 78472 " 2,097.00 " " 1,887.30 " " 2,034.09 " " 1,992.15 " "2,013.12" 34100038 KIDNEY W/VASC FLOW/FUNCT 341 78707 " 1,363.00 " " 1,226.70 " " 1,322.11 " " 1,294.85 " "1,308.48" 34100039 RENAL FUNCTION W/PHARM 341 78708 " 1,363.00 " " 1,226.70 " " 1,322.11 " " 1,294.85 " "1,308.48" 34100042 TUMOR LOCALIZ BY SPECT 341 78803 " 1,472.40 " " 1,325.16 " " 1,428.23 " " 1,398.78 " "1,413.50" 35000001 CT SFT TS NECK W/O CONT 350 70490 " 2,099.00 " " 1,889.10 " " 2,036.03 " " 1,994.05 " "2,015.04" 35000002 CT SFT TS NECK W/CONTRAST 350 70491 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35000003 CT SFT TS NECK W/WO CONT 350 70492 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35000004 CT ANGIO NECK W WO CONTRAST 350 70498 " 3,048.00 " " 2,743.20 " " 2,956.56 " " 2,895.60 " "2,926.08" 35000006 CT HEART W/O CONT CALC SCORE 350 75571 259.00 233.10 251.23 246.05 248.64 35000010 3D IMAGING W/O POST PROCESSING 350 76376 725.00 652.50 703.25 688.75 696 35000013 CT GUIDE NEEDLE PLACEMENT 350 77012 743.00 668.70 720.71 705.85 713.28 35000018 CT ANGIO CHEST W/WO CONTRAST 352 71275 " 3,048.00 " " 2,743.20 " " 2,956.56 " " 2,895.60 " "2,926.08" 35000019 SI-JOINT INJECTION BILAT 350 27096 504.00 453.60 488.88 478.80 483.84 35000020 SI-JOINT INJECTION 350 27096 528.00 475.20 512.16 501.60 506.88 35000024 CT LIMITED STUDY 350 76380 " 1,157.00 " " 1,041.30 " " 1,122.29 " " 1,099.15 " "1,110.72" 35000025 CTA CHEST W/WO CONT LMTD 350 71275 " 3,048.00 " " 2,743.20 " " 2,956.56 " " 2,895.60 " "2,926.08" 35000027 3-D IMAGING W/POST PROCESSING 350 76377 782.00 703.80 758.54 742.90 750.72 35000029 CT GUIDED BONE MARROW ASPIRATI 350 77012 491.00 441.90 476.27 466.45 471.36 35000030 CT GUIDED BONE MARROW BIOPSY 350 77012 " 1,900.00 " " 1,710.00 " " 1,843.00 " " 1,805.00 " "1,824.00" 35000031 FLUORO GUIDED SI JOINT INJECTION 350 27096 513.00 461.70 497.61 487.35 492.48 35000032 Hc Pet Imaging Skull Base To Mid-thigh 350 78812 " 5,945.00 " " 5,350.50 " " 5,766.65 " " 5,647.75 " "5,707.20" 35000033 Hc Ct Sft Ts Neck W/wo Cont 350 70492 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35000034 Hc Pet Imaging Whole Body 350 78813 " 6,449.00 " " 5,804.10 " " 6,255.53 " " 6,126.55 " "6,191.04" 35100002 CT HEAD W CONTRAST 351 70460 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35100003 CT HEAD W WO CONTRAST 351 70470 " 2,514.00 " "1,653.00" " 2,438.58 " " 2,388.30 " "2,413.44" 35100008 CT MAX FACIAL W CONTRAST 351 70487 " 2,099.00 " " 1,889.10 " " 2,036.03 " " 1,994.05 " "2,015.04" 35100009 CT MAX FACIAL W/WO CONT 351 70488 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35100010 CT ANGIO HEAD W/WO CONTRAST 351 70496 " 3,048.00 " " 2,743.20 " " 2,956.56 " " 2,895.60 " "2,926.08" 35100012 CT HEAD WO CONTRAST 351 70450 " 2,099.00 " "1,305.00" " 2,036.03 " " 1,994.05 " "2,015.04" 35100016 CT EARS WO CONTRAST 351 70480 " 2,099.00 " " 1,889.10 " " 2,036.03 " " 1,994.05 " "2,015.04" 35100017 CT ORBIT WO CONTRAST 351 70480 " 2,178.00 " " 1,960.20 " " 2,112.66 " " 2,069.10 " "2,090.88" 35100019 CT EARS W CONTRAST 351 70481 " 2,469.00 " " 2,222.10 " " 2,394.93 " " 2,345.55 " "2,370.24" 35100020 CT ORBIT W CONTRAST 351 70481 " 2,469.00 " " 2,222.10 " " 2,394.93 " " 2,345.55 " "2,370.24" 35100022 CT EARS W WO CONTRAST 351 70482 " 2,519.00 " " 2,267.10 " " 2,443.43 " " 2,393.05 " "2,418.24" 35100023 CT ORBIT W WO CONTRAST 351 70482 " 2,519.00 " " 2,267.10 " " 2,443.43 " " 2,393.05 " "2,418.24" 35100024 CT SELLA TURCICA W WO CONTRAST 351 70482 " 2,519.00 " " 2,267.10 " " 2,443.43 " " 2,393.05 " "2,418.24" 35100026 CT MAX FACIAL LTD 351 70486 " 1,896.00 " " 1,706.40 " " 1,839.12 " " 1,801.20 " "1,820.16" 35100027 CT MAX FACIAL WO CONTRAST 351 70486 " 1,896.00 " " 1,706.40 " " 1,839.12 " " 1,801.20 " "1,820.16" 35100030 Hc Ct Head W Wo Contrast 351 70470 " 2,514.00 " "1,653.00" " 2,438.58 " " 2,388.30 " "2,413.44" 35100031 Hc Ct Ears W Wo Contrast 351 70482 " 2,519.00 " " 2,267.10 " " 2,443.43 " " 2,393.05 " "2,418.24" 35100032 Hc Ct Orbit W Wo Contrast 351 70482 " 2,519.00 " " 2,267.10 " " 2,443.43 " " 2,393.05 " "2,418.24" 35100033 Hc Ct Sella Turcica W Wo Contrast 351 70482 " 2,519.00 " " 2,267.10 " " 2,443.43 " " 2,393.05 " "2,418.24" 35100034 Hc Ct Max Facial W/wo Cont 351 70488 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200002 CT THORAX W/CONTRAST 352 71260 " 2,514.00 " "1,405.00" " 2,438.58 " " 2,388.30 " "2,413.44" 35200003 CT THORAX W/WO CONTRAST 352 71270 " 2,783.00 " " 2,504.70 " " 2,699.51 " " 2,643.85 " "2,671.68" 35200004 CT LUNG WO CONT CANCER SCR 352 HCPCS G0297 " 1,800.00 " " 1,620.00 " " 1,746.00 " " 1,710.00 " "1,728.00" 35200005 CT SPINE CERVICAL WO CONT 352 72125 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200006 CT SPINE CERVICAL W CONT 352 72126 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200007 CT SP CERVICAL W/WO CONT 352 72127 " 2,760.00 " " 2,484.00 " " 2,677.20 " " 2,622.00 " "2,649.60" 35200008 CT SPINE THORACIC WO CONT 352 72128 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200009 CT SPINE THORACIC W CONT 352 72129 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200010 CT SPINE THORAC W/WO CONT 352 72130 " 2,578.00 " " 2,320.20 " " 2,500.66 " " 2,449.10 " "2,474.88" 35200011 CT SPINE LUMBAR W/O CONT 352 72131 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200012 CT SPINE LUMBAR W CONT 352 72132 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200013 CT LUMBAR SPINE W/WO CONT 352 72133 " 2,783.00 " " 2,504.70 " " 2,699.51 " " 2,643.85 " "2,671.68" 35200014 CT ANGIO PELVIS W/WO CONTRAST 352 72191 " 3,162.00 " " 2,845.80 " " 3,067.14 " " 3,003.90 " "3,035.52" 35200015 CT PELVIS W/O CONTRAST 352 72192 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200016 CT PELVIS W CONTRAST 352 72193 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200017 CT PELVIS W/WO CONTRAST 352 72194 " 2,717.00 " " 2,445.30 " " 2,635.49 " " 2,581.15 " "2,608.32" 35200018 CT UPPER EXT W/O CONTRAST 352 73200 " 2,099.00 " " 1,889.10 " " 2,036.03 " " 1,994.05 " "2,015.04" 35200019 CT UPPER EXT W/CONTRAST 352 73201 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200020 CT UPPER EXT W/WO CONTRAST 352 73202 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200022 CT LOWER EXT W/O CONTRAST 352 73700 " 2,121.00 " " 1,908.90 " " 2,057.37 " " 2,014.95 " "2,036.16" 35200023 CT LOWER EXT W CONTRAST 352 73701 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200024 CT LOWER EXT W/WO CONT 352 73702 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200026 CT ABDOMEN WO CONTRAST 352 74150 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200027 CT ABDOMEN W CONTRAST 352 74160 " 2,717.00 " " 2,445.30 " " 2,635.49 " " 2,581.15 " "2,608.32" 35200028 CT ABDOMEN W/WO CONTRAST 352 74170 " 2,926.00 " " 2,633.40 " " 2,838.22 " " 2,779.70 " "2,808.96" 35200029 CTA ABD & PELVIS 352 74174 " 4,100.00 " " 3,690.00 " " 3,977.00 " " 3,895.00 " "3,936.00" 35200030 CT ANGIO ABD W/WO CONTRAST 352 74175 " 3,048.00 " " 2,743.20 " " 2,956.56 " " 2,895.60 " "2,926.08" 35200031 CT ABD PEL W/O CONT 352 74176 " 4,117.00 " "2,111.00" " 3,993.49 " " 3,911.15 " "3,952.32" 35200032 CT ABD PEL WITH CONTRAST 352 74177 " 4,666.00 " "2,590.00" " 4,526.02 " " 4,432.70 " "4,479.36" 35200033 CT ABD PEL W AND WO CONTRAST 352 74178 " 5,372.00 " "2,898.00" " 5,210.84 " " 5,103.40 " "5,157.12" 35200039 ABDOMEN UPPER W WO CONTRA 352 74140 " 2,926.00 " " 2,633.40 " " 2,838.22 " " 2,779.70 " "2,808.96" 35200042 CT THORAX WO CONTRAST 352 71250 " 2,307.00 " " 2,076.30 " " 2,237.79 " " 2,191.65 " "2,214.72" 35200052 CT ABD W/O CONT LTD 352 74150 " 1,685.00 " " 1,516.50 " " 1,634.45 " " 1,600.75 " "1,617.60" 35200057 CT RENAL CALC W/O CONT 352 74176 " 3,317.00 " "2,111.00" " 3,217.49 " " 3,151.15 " "3,184.32" 35200059 CT RENAL CALC W AND W/O CONT 352 74178 " 5,372.00 " "2,898.00" " 5,210.84 " " 5,103.40 " "5,157.12" 35200060 CTA THORA/ABD AORTA W FEM RNFF 352 75635 " 3,516.00 " " 3,164.40 " " 3,410.52 " " 3,340.20 " "3,375.36" 35200061 Hc Ct Abdomen W/wo Contrast 352 74170 " 2,926.00 " " 2,633.40 " " 2,838.22 " " 2,779.70 " "2,808.96" 35200062 Hc Ct Thorax W/wo Contrast 352 71270 " 2,783.00 " " 2,504.70 " " 2,699.51 " " 2,643.85 " "2,671.68" 35200064 Hc Ct Lower Ext W/wo Cont 352 73702 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200065 Hc Ct Upper Ext W/wo Contrast 352 73202 " 2,514.00 " " 2,262.60 " " 2,438.58 " " 2,388.30 " "2,413.44" 35200066 Hc Ct Pelvis W/wo Contrast 352 72194 " 2,717.00 " " 2,445.30 " " 2,635.49 " " 2,581.15 " "2,608.32" 35200067 Hc Ct Renal Calc W And W/o Cont 352 74178 " 5,372.00 " "2,898.00" " 5,210.84 " " 5,103.40 " "5,157.12" 35200068 Hc Ct Abd Pel W And Wo Contrast 352 74178 " 5,372.00 " "2,898.00" " 5,210.84 " " 5,103.40 " "5,157.12" 36000001 CATARACT OR ROOM 360 " 3,525.00 " " 3,172.50 " " 3,419.25 " " 3,348.75 " "3,384.00" 36000003 OR 1 SCOPE 106-120 MINUTE 360 " 3,153.00 " " 2,837.70 " " 3,058.41 " " 2,995.35 " "3,026.88" 36000004 OR 1 SCOPE 1-15 MINUTES 360 " 1,021.00 " 918.90 990.37 969.95 980.16 36000005 OR 1 SCOPE 16-30 MINUTES 360 " 1,282.00 " " 1,153.80 " " 1,243.54 " " 1,217.90 " "1,230.72" 36000006 OR 1 SCOPE 31-45 MINUTES 360 " 2,055.00 " " 1,849.50 " " 1,993.35 " " 1,952.25 " "1,972.80" 36000007 OR 1 SCOPE 46-60 MINUTES 360 " 2,339.00 " " 2,105.10 " " 2,268.83 " " 2,222.05 " "2,245.44" 36000008 OR 1 SCOPE 61-75 MINUTES 360 " 2,584.00 " " 2,325.60 " " 2,506.48 " " 2,454.80 " "2,480.64" 36000009 OR 1 SCOPE 76-90 MINUTES 360 " 2,800.00 " " 2,520.00 " " 2,716.00 " " 2,660.00 " "2,688.00" 36000010 OR 1 SCOPE 91-105 MINUTES 360 " 2,975.00 " " 2,677.50 " " 2,885.75 " " 2,826.25 " "2,856.00" 36000011 OR 2 SCOPE 0-30 MINUTES 360 " 2,732.00 " " 2,458.80 " " 2,650.04 " " 2,595.40 " "2,622.72" 36000012 OR 2 SCOPE 106-120 MIN 360 " 4,376.00 " " 3,938.40 " " 4,244.72 " " 4,157.20 " "4,200.96" 36000013 OR 2 SCOPE 121-135 MIN 360 " 4,637.00 " " 4,173.30 " " 4,497.89 " " 4,405.15 " "4,451.52" 36000014 OR 2 SCOPE 136-150 MIN 360 " 4,897.00 " " 4,407.30 " " 4,750.09 " " 4,652.15 " "4,701.12" 36000015 OR 2 SCOPE 151-165 MIN 360 " 5,158.00 " " 4,642.20 " " 5,003.26 " " 4,900.10 " "4,951.68" 36000016 OR 2 SCOPE 166-180 MIN 360 " 5,417.00 " " 4,875.30 " " 5,254.49 " " 5,146.15 " "5,200.32" 36000017 OR 2 SCOPE 31-45 MINUTES 360 " 3,035.00 " " 2,731.50 " " 2,943.95 " " 2,883.25 " "2,913.60" 36000018 OR 2 SCOPE 46-60 MINUTES 360 " 3,333.00 " " 2,999.70 " " 3,233.01 " " 3,166.35 " "3,199.68" 36000019 OR 2 SCOPE 61-75 MINUTES 360 " 3,596.00 " " 3,236.40 " " 3,488.12 " " 3,416.20 " "3,452.16" 36000020 OR 2 SCOPE 76-90 MINUTES 360 " 3,857.00 " " 3,471.30 " " 3,741.29 " " 3,664.15 " "3,702.72" 36000021 OR 2 SCOPE 91-105 MINUTE 360 " 4,116.00 " " 3,704.40 " " 3,992.52 " " 3,910.20 " "3,951.36" 36000040 OR ROOM A 106-120 MINUTES 360 " 3,414.00 " " 3,072.60 " " 3,311.58 " " 3,243.30 " "3,277.44" 36000041 OR ROOM A 1-15 MINUTES 360 " 1,456.00 " " 1,310.40 " " 1,412.32 " " 1,383.20 " "1,397.76" 36000042 OR ROOM A 16-30 MINUTES 360 " 1,828.00 " " 1,645.20 " " 1,773.16 " " 1,736.60 " "1,754.88" 36000043 OR ROOM A 31-45 MINUTES 360 " 2,164.00 " " 1,947.60 " " 2,099.08 " " 2,055.80 " "2,077.44" 36000044 OR ROOM A 46-60 MINUTES 360 " 2,462.00 " " 2,215.80 " " 2,388.14 " " 2,338.90 " "2,363.52" 36000045 OR ROOM A 61-75 MINUTES 360 " 2,722.00 " " 2,449.80 " " 2,640.34 " " 2,585.90 " "2,613.12" 36000046 OR ROOM A 76-90 MINUTES 360 " 2,945.00 " " 2,650.50 " " 2,856.65 " " 2,797.75 " "2,827.20" 36000047 OR ROOM A 91-105 MINUTES 360 " 3,130.00 " " 2,817.00 " " 3,036.10 " " 2,973.50 " "3,004.80" 36000048 OR ROOM B 106-120 MINUTES 360 " 4,376.00 " " 3,938.40 " " 4,244.72 " " 4,157.20 " "4,200.96" 36000049 OR ROOM B 1-15 MINUTES 360 " 2,329.00 " " 2,096.10 " " 2,259.13 " " 2,212.55 " "2,235.84" 36000050 OR ROOM B 121-135 MINUTES 360 " 4,636.00 " " 4,172.40 " " 4,496.92 " " 4,404.20 " "4,450.56" 36000051 OR ROOM B 136-150 MIN 360 " 4,897.00 " " 4,407.30 " " 4,750.09 " " 4,652.15 " "4,701.12" 36000052 OR ROOM B 151-165 MIN 360 " 5,158.00 " " 4,642.20 " " 5,003.26 " " 4,900.10 " "4,951.68" 36000053 OR ROOM B 16-30 MINUTES 360 " 2,700.00 " " 2,430.00 " " 2,619.00 " " 2,565.00 " "2,592.00" 36000054 OR ROOM B 166-180 MIN 360 " 5,417.00 " " 4,875.30 " " 5,254.49 " " 5,146.15 " "5,200.32" 36000055 OR ROOM B 181-195 MIN 360 " 5,678.00 " " 5,110.20 " " 5,507.66 " " 5,394.10 " "5,450.88" 36000056 OR ROOM B 196-210 MIN 360 " 5,938.00 " " 5,344.20 " " 5,759.86 " " 5,641.10 " "5,700.48" 36000057 OR ROOM B 31-45 MINUTES 360 " 3,035.00 " " 2,731.50 " " 2,943.95 " " 2,883.25 " "2,913.60" 36000058 OR ROOM B 46-60 MINUTES 360 " 3,333.00 " " 2,999.70 " " 3,233.01 " " 3,166.35 " "3,199.68" 36000059 OR ROOM B 61-75 MINUTES 360 " 3,596.00 " " 3,236.40 " " 3,488.12 " " 3,416.20 " "3,452.16" 36000060 OR ROOM B 76-90 MINUTES 360 " 3,857.00 " " 3,471.30 " " 3,741.29 " " 3,664.15 " "3,702.72" 36000061 OR ROOM B 91-105 MINUTES 360 " 4,116.00 " " 3,704.40 " " 3,992.52 " " 3,910.20 " "3,951.36" 36000062 OR ROOM C 106-120 MINUTE 360 " 6,031.00 " " 5,427.90 " " 5,850.07 " " 5,729.45 " "5,789.76" 36000063 OR ROOM C 1-15 MINUTES 360 " 3,703.00 " " 3,332.70 " " 3,591.91 " " 3,517.85 " "3,554.88" 36000064 OR ROOM C 121-135 MINUTE 360 " 6,347.00 " " 5,712.30 " " 6,156.59 " " 6,029.65 " "6,093.12" 36000065 OR ROOM C 136-150 MINUTE 360 " 6,662.00 " " 5,995.80 " " 6,462.14 " " 6,328.90 " "6,395.52" 36000066 OR ROOM C 151-165 MINUTE 360 " 6,978.00 " " 6,280.20 " " 6,768.66 " " 6,629.10 " "6,698.88" 36000067 OR ROOM C 16 - 30 MINUTE 360 " 4,099.00 " " 3,689.10 " " 3,976.03 " " 3,894.05 " "3,935.04" 36000068 OR ROOM C 166-180 MINUTE 360 " 7,295.00 " " 6,565.50 " " 7,076.15 " " 6,930.25 " "7,003.20" 36000069 OR ROOM C 196-210 MINUTES 360 " 7,926.00 " " 7,133.40 " " 7,688.22 " " 7,529.70 " "7,608.96" 36000070 OR ROOM C 31 -45 MINUTES 360 " 4,456.00 " " 4,010.40 " " 4,322.32 " " 4,233.20 " "4,277.76" 36000071 OR ROOM C 46-60 MINUTES 360 " 4,768.00 " " 4,291.20 " " 4,624.96 " " 4,529.60 " "4,577.28" 36000072 OR ROOM C 61-75 MINUTES 360 " 5,082.00 " " 4,573.80 " " 4,929.54 " " 4,827.90 " "4,878.72" 36000073 OR ROOM C 76-90 MINUTES 360 " 5,399.00 " " 4,859.10 " " 5,237.03 " " 5,129.05 " "5,183.04" 36000074 OR ROOM C 91-105 MINUTES 360 " 5,718.00 " " 5,146.20 " " 5,546.46 " " 5,432.10 " "5,489.28" 36000075 OR ROOM D 106-120 MINUTES 360 " 8,201.00 " " 7,380.90 " " 7,954.97 " " 7,790.95 " "7,872.96" 36000076 OR ROOM D 1-15 MINUTES 360 " 5,820.00 " " 5,238.00 " " 5,645.40 " " 5,529.00 " "5,587.20" 36000077 OR ROOM D 121-135 MINTUES 360 " 8,536.00 " " 7,682.40 " " 8,279.92 " " 8,109.20 " "8,194.56" 36000078 OR ROOM D 136-150 MINUTES 360 " 8,873.00 " " 7,985.70 " " 8,606.81 " " 8,429.35 " "8,518.08" 36000079 OR ROOM D 151-165 MINUTES 360 " 9,205.00 " " 8,284.50 " " 8,928.85 " " 8,744.75 " "8,836.80" 36000080 OR ROOM D 16-30 MINUTES 360 " 6,191.00 " " 5,571.90 " " 6,005.27 " " 5,881.45 " "5,943.36" 36000081 OR ROOM D 166-180 MINUTES 360 " 9,543.00 " " 8,588.70 " " 9,256.71 " " 9,065.85 " "9,161.28" 36000082 OR ROOM D 181-195 MINUTES 360 " 9,878.00 " " 8,890.20 " " 9,581.66 " " 9,384.10 " "9,482.88" 36000083 OR ROOM D 196-210 MINUTES 360 " 10,209.00 " " 9,188.10 " " 9,902.73 " " 9,698.55 " "9,800.64" 36000084 OR ROOM D 211-225 MINUTES 360 " 10,619.00 " " 9,557.10 " " 10,300.43 " " 10,088.05 " "10,194.24" 36000085 OR ROOM D 241-255 MINUTES 360 " 11,957.00 " " 10,761.30 " " 11,598.29 " " 11,359.15 " "11,478.72" 36000086 OR ROOM D 286-300 MINUTES 360 " 13,964.00 " " 12,567.60 " " 13,545.08 " " 13,265.80 " "13,405.44" 36000087 OR ROOM D 31-45 MINUTES 360 " 6,527.00 " " 5,874.30 " " 6,331.19 " " 6,200.65 " "6,265.92" 36000088 OR ROOM D 331-345 MINUTES 360 " 16,125.00 " " 14,512.50 " " 15,641.25 " " 15,318.75 " "15,480.00" 36000089 OR ROOM D 346-360 MINUTES 360 " 15,306.00 " " 13,775.40 " " 14,846.82 " " 14,540.70 " "14,693.76" 36000090 OR ROOM D 46-60 MINUTES 360 " 6,861.00 " " 6,174.90 " " 6,655.17 " " 6,517.95 " "6,586.56" 36000091 OR ROOM D 61-75 MINUTES 360 " 7,197.00 " " 6,477.30 " " 6,981.09 " " 6,837.15 " "6,909.12" 36000092 OR ROOM D 76-90 MINUTES 360 " 7,534.00 " " 6,780.60 " " 7,307.98 " " 7,157.30 " "7,232.64" 36000093 OR ROOM D 91-105 MINUTES 360 " 7,867.00 " " 7,080.30 " " 7,630.99 " " 7,473.65 " "7,552.32" 36000097 PROCEDURE ROOM 106-120 MI 360 " 1,549.00 " " 1,394.10 " " 1,502.53 " " 1,471.55 " "1,487.04" 36000098 PROCEDURE ROOM 121-135 MI 360 " 1,747.00 " " 1,572.30 " " 1,694.59 " " 1,659.65 " "1,677.12" 36000099 PROCEDURE ROOM 1-30 MIN 360 488.00 439.20 473.36 463.60 468.48 36000100 PROCEDURE ROOM 31-45 MIN 360 587.00 528.30 569.39 557.65 563.52 36000101 PROCEDURE ROOM 46-60 MIN 360 " 1,004.00 " 903.60 973.88 953.80 963.84 36000102 PROCEDURE ROOM 61-75 MIN 360 " 1,219.00 " " 1,097.10 " " 1,182.43 " " 1,158.05 " "1,170.24" 36000103 PROCEDURE ROOM 76-90 MIN 360 " 1,345.00 " " 1,210.50 " " 1,304.65 " " 1,277.75 " "1,291.20" 36000104 PROCEDURE ROOM 91-105 MIN 360 " 1,456.00 " " 1,310.40 " " 1,412.32 " " 1,383.20 " "1,397.76" 36000105 PROCEDURE ROOM COLPOSCOPY 360 233.00 209.70 226.01 221.35 223.68 36000106 PROCEDURE ROOM CRYOTHERAP 360 233.00 209.70 226.01 221.35 223.68 36000107 PROCEDURE ROOM THORACENTE 360 233.00 209.70 226.01 221.35 223.68 36000112 INJCTN OF MJR JNT BURSA BILATL 360 20610 601.00 540.90 582.97 570.95 576.96 36000113 OR ROOM C 181-195 MINUTES 360 " 6,905.00 " " 6,214.50 " " 6,697.85 " " 6,559.75 " "6,628.80" 36000114 OR ROOM D 226-240 MINUTES 360 " 10,853.00 " " 9,767.70 " " 10,527.41 " " 10,310.35 " "10,418.88" 36000115 OR ROOM D 256-270 MINUTES 360 " 12,139.00 " " 10,925.10 " " 11,774.83 " " 11,532.05 " "11,653.44" 36000116 OR ROOM D 271-285 MINUTES 360 " 12,782.00 " " 11,503.80 " " 12,398.54 " " 12,142.90 " "12,270.72" 36000117 OR ROOM D 301-315 MINUTES 360 " 14,066.00 " " 12,659.40 " " 13,644.02 " " 13,362.70 " "13,503.36" 36000118 OR ROOM D 316-330 MINUTES 360 " 14,707.00 " " 13,236.30 " " 14,265.79 " " 13,971.65 " "14,118.72" 36000119 Hc Or Room A 121-135 Minutes 360 " 3,594.00 " " 3,234.60 " " 3,486.18 " " 3,414.30 " "3,450.24" 36000120 Hc Or Room A 136-150 Minutes 360 " 3,771.00 " " 3,393.90 " " 3,657.87 " " 3,582.45 " "3,620.16" 36000121 Hc Or Room A 151-165 Minutes 360 " 3,950.00 " " 3,555.00 " " 3,831.50 " " 3,752.50 " "3,792.00" 36000122 Hc Or Room A 166-180 Minutes 360 " 4,130.00 " " 3,717.00 " " 4,006.10 " " 3,923.50 " "3,964.80" 36000123 Hc Or Room A 181-195 Minutes 360 " 4,142.00 " " 3,727.80 " " 4,017.74 " " 3,934.90 " "3,976.32" 36000124 Hc Or Room A 196-210 Minutes 360 " 4,487.00 " " 4,038.30 " " 4,352.39 " " 4,262.65 " "4,307.52" 37000001 ANESTHESIA BLOCK 370 422.00 379.80 409.34 400.90 405.12 37000013 ANETH EQUIP/SUP 121-150 M 370 " 1,297.00 " " 1,167.30 " " 1,258.09 " " 1,232.15 " "1,245.12" 37000014 ANETH EQUIP/SUP 151-180 M 370 " 1,427.00 " " 1,284.30 " " 1,384.19 " " 1,355.65 " "1,369.92" 37000015 ANETH EQUIP/SUP 181-210 M 370 " 1,558.00 " " 1,402.20 " " 1,511.26 " " 1,480.10 " "1,495.68" 37000016 ANETH EQUIP/SUPP 1-30 MIN 370 645.00 580.50 625.65 612.75 619.2 37000017 ANETH EQUIP/SUPP 31-60 MI 370 863.00 776.70 837.11 819.85 828.48 37000018 ANETH EQUIP/SUPP 61-90 MI 370 " 1,037.00 " 933.30 " 1,005.89 " 985.15 995.52 37000019 ANETH EQUIP/SUPP 91-120 M 370 " 1,167.00 " " 1,050.30 " " 1,131.99 " " 1,108.65 " "1,120.32" 37000027 NITROUS OXIDE 370 26.00 23.40 25.22 24.70 24.96 37000028 ANESTH EQUIP/SUP 211-240 370 " 1,687.00 " " 1,518.30 " " 1,636.39 " " 1,602.65 " "1,619.52" 37000029 ANESTH EQUIP/SUP 241-270 370 " 1,818.00 " " 1,636.20 " " 1,763.46 " " 1,727.10 " "1,745.28" 37000030 ANESTH EQUIP/SUP 271-300 370 " 1,949.00 " " 1,754.10 " " 1,890.53 " " 1,851.55 " "1,871.04" 37000031 ANESTH EQUIP/SUP 301-330 370 " 2,079.00 " " 1,871.10 " " 2,016.63 " " 1,975.05 " "1,995.84" 37000032 ANESTH EQUIP/SUP 331-360 370 " 2,210.00 " " 1,989.00 " " 2,143.70 " " 2,099.50 " "2,121.60" 37100001 MODERATE SEDATION 371 215.00 193.50 208.55 204.25 206.4 37100002 MOD SEDATION INITIAL 15 MIN 371 99152 246.00 221.40 238.62 233.70 236.16 37100003 MOD SEDATION ADDT'L 15 MIN EA 371 99153 206.00 185.40 199.82 195.70 197.76 39000004 ANTIGEN TYPING ARC 390 86902 77.00 69.30 74.69 73.15 73.92 39000008 RED CELLS LR 390 HCPCS P9016 460.00 414.00 446.20 437.00 441.6 39000011 PLASMA FRESH FROZEN 390 HCPCS P9017 237.00 213.30 229.89 225.15 227.52 39000027 PLT APHERESIS LR IRR 390 HCPCS P9037 " 1,460.00 " " 1,314.00 " " 1,416.20 " " 1,387.00 " "1,401.60" 39000030 RED CELLS LR IRR 390 HCPCS P9040 625.00 562.50 606.25 593.75 600 39000044 "ABO, DONOR" 300 86900 59.00 53.10 57.23 56.05 56.64 39000050 AUTOLOGOUS BLOOD PROC FEE 390 577.00 519.30 559.69 548.15 553.92 39000051 "RD BL CELLS, LR PROC." 390 520.00 468.00 504.40 494.00 499.2 39000052 CMV ANTIBODY SCREEN 390 70.00 63.00 67.90 66.50 67.2 39000053 PHERESIS PLATELETS IRRADIATED 390 " 1,466.00 " " 1,319.40 " " 1,422.02 " " 1,392.70 " "1,407.36" 39000054 CRYOPRECIPITATE AHF 390 110.00 99.00 106.70 104.50 105.6 39000055 DIRECT DON BLD PRO FE LR 390 738.00 664.20 715.86 701.10 708.48 39000056 IRRADIATION FEE-ARC 390 120.00 108.00 116.40 114.00 115.2 39000057 FRESH FROZEN PLAS PRO FEE 390 156.00 140.40 151.32 148.20 149.76 39000058 PACKED CELLS IRRADIATED 390 625.00 562.50 606.25 593.75 600 39000059 PLAT PHER LR PROC FEE 390 " 1,358.00 " " 1,222.20 " " 1,317.26 " " 1,290.10 " "1,303.68" 39000060 IRRADIATION FEE-CBB 390 120.00 108.00 116.40 114.00 115.2 39000061 MISC RED CROSS FEE 390 251.00 225.90 243.47 238.45 240.96 39000066 PLT APHERESIS LR IRR VOL RED 390 HCPCS P9037 " 1,460.00 " " 1,314.00 " " 1,416.20 " " 1,387.00 " "1,401.60" 39100001 BLOOD PRODUCT ADMIN 391 36430 810.00 729.00 785.70 769.50 777.6 40100002 MAMMO DIAGNOSTIC UNI 3D 401 77061 100.00 90.00 97.00 95.00 96 40100003 MAMMO DIAGNOSTIC BIL 3D 401 77062 100.00 90.00 97.00 95.00 96 40100004 MAMMO DIAGNOSTIC BIL 3D 401 77066 406.00 365.40 393.82 385.70 389.76 40100005 MAMMO DIAGNOSTIC UNI 3D 401 77061 100.00 90.00 97.00 95.00 96 40100007 Hc Mammography Bil Diag 401 77066 406.00 365.40 393.82 385.70 389.76 40100008 MAMMOGRAPHY UNI DIAG 401 77065 330.00 297.00 320.10 313.50 316.8 40200002 BX BREAST US ADDTL 402 19084 " 2,827.00 " " 2,544.30 " " 2,742.19 " " 2,685.65 " "2,713.92" 40200003 BREAST NDL LOC US GUIDE 402 19285 " 1,990.00 " " 1,791.00 " " 1,930.30 " " 1,890.50 " "1,910.40" 40200004 BREAST NDL LOC US ADDTL 402 19286 " 1,990.00 " " 1,791.00 " " 1,930.30 " " 1,890.50 " "1,910.40" 40200007 US HEAD 402 76506 532.00 478.80 516.04 505.40 510.72 40200008 US THYROID/NECK 402 76536 565.00 508.50 548.05 536.75 542.4 40200009 US CHEST 402 76604 569.00 512.10 551.93 540.55 546.24 40200010 US BREAST UNI COMPLETE 402 76641 494.00 444.60 479.18 469.30 474.24 40200011 US BREAST LTD 402 76642 421.00 378.90 408.37 399.95 404.16 40200012 US ABDOMEN 402 76700 842.00 757.80 816.74 799.90 808.32 40200013 US ABDOMEN LTD 402 76705 654.00 588.60 634.38 621.30 627.84 40200014 US-ABD AORTA RENAL 402 76770 770.00 693.00 746.90 731.50 739.2 40200015 US RETROPERITONEAL LTD 402 76775 609.00 548.10 590.73 578.55 584.64 40200017 US SPINAL CANAL AND CONTENTS 402 76800 504.00 453.60 488.88 478.80 483.84 40200018 US OB < 14 WKS 0 DAYS 402 76801 567.00 510.30 549.99 538.65 544.32 40200019 EACH ADDTL GESTATION < 14 WKS 402 76802 270.00 243.00 261.90 256.50 259.2 40200024 US OB >= 14 WK SGL OR 1ST GEST 402 76805 805.00 724.50 780.85 764.75 772.8 40200025 EACH ADDTL GESTATION > 14 WKS 402 76810 588.00 529.20 570.36 558.60 564.48 40200028 US OB LTD 402 76815 463.00 416.70 449.11 439.85 444.48 40200029 US OB FOLLOW-UP 402 76816 388.00 349.20 376.36 368.60 372.48 40200030 US TRANSVAGINAL OBSTETRICAL 402 76817 524.00 471.60 508.28 497.80 503.04 40200031 US FETAL BIOPHYS W/O STRESS 402 76819 461.00 414.90 447.17 437.95 442.56 40200032 US TRNSVG NON OB LTD 402 76830 594.00 534.60 576.18 564.30 570.24 40200034 US PELVIC COMPLETE 402 76856 773.00 695.70 749.81 734.35 742.08 40200035 PELVIS LIMITED 402 76857 271.00 243.90 262.87 257.45 260.16 40200036 US SCROTUM 402 76870 621.00 558.90 602.37 589.95 596.16 40200039 US EXTREMITY NONVASC COMPLETE 402 76881 770.00 693.00 746.90 731.50 739.2 40200040 US EXTREMITY NONVASC LTD 402 76882 539.00 485.10 522.83 512.05 517.44 40200041 US INFANT HIPS W/MANIP 402 76885 539.00 485.10 522.83 512.05 517.44 40200047 US GUIDE NEEDLE PLACEMENT 402 76942 796.00 716.40 772.12 756.20 764.16 40200050 INTRA OPERATIVE US 402 76998 796.00 716.40 772.12 756.20 764.16 40200054 US AAA SCREENING CMS 402 76706 609.00 548.10 590.73 578.55 584.64 40200055 BX BREAST US GUIDE 402 19083 " 2,150.00 " " 1,935.00 " " 2,085.50 " " 2,042.50 " "2,064.00" 40200057 US THYROID / NECK LTD 402 76536 565.00 508.50 548.05 536.75 542.4 40200058 ABDOMINAL AORTA SCAN - LTD 402 76775 " 1,026.00 " 923.40 995.22 974.70 984.96 40200059 US ABDOMINAL AORTA LTD 402 76775 " 1,026.00 " 923.40 995.22 974.70 984.96 40200060 US KIDNEY TRANSPLANT LTD 402 76775 765.00 688.50 742.05 726.75 734.4 40200064 US TRANSVAGINAL NONOBSTETRIC 402 76830 594.00 534.60 576.18 564.30 570.24 40200067 US GUIDE VEN ACCESS DEV 402 76937 891.00 801.90 864.27 846.45 855.36 40200068 US GUIDED REGIONAL ANESTHESIA 402 76942 786.00 707.40 762.42 746.70 754.56 40300002 MAMMO SCREENING 3D VIEWS UNI 403 77063 87.00 78.30 84.39 82.65 83.52 40300003 MAMMOGRAPHY SCREENING BIL 2D 403 77067 378.00 225 366.66 359.10 362.88 40300004 MAMMO SCREENING BIL W 3D 403 77067 378.00 225 366.66 359.10 362.88 40300005 MAMMO SCREENING UNI W 3D 403 77067 333.00 225 323.01 316.35 319.68 40300006 MAMMOGRAPHY SCREEN UNI 2D 403 77067 333.00 225 323.01 316.35 319.68 40300007 MAMMO SCREENING 3D VIEWS BIL 403 77063 87.00 78.30 84.39 82.65 83.52 40400005 PET SCAN SKULL BASE MID-THIGH 404 78815 " 6,449.00 " " 5,804.10 " " 6,255.53 " " 6,126.55 " "6,191.04" 40400006 PET SCAN WHOLE BODY 404 78816 " 6,449.00 " " 5,804.10 " " 6,255.53 " " 6,126.55 " "6,191.04" 40400008 Hc Mopath Procedure Lvl 2 404 81401 311.00 279.90 301.67 295.45 298.56 41000001 ENDOTRACHEAL INTUBATION 761 31500 260.00 234.00 252.20 247.00 249.6 41000002 TRACH TUBE CHANGE 410 31502 48.00 43.20 46.56 45.60 46.08 41000004 VENTILATOR INITIAL 410 94002 908.00 817.20 880.76 862.60 871.68 41000005 VENTILATOR SUBSEQUENT 410 94003 456.00 410.40 442.32 433.20 437.76 41000007 AEROSOL THERAPY 410 94640 154.00 138.60 149.38 146.30 147.84 41000011 NON-INVASIVE CPAP INITIAL SIPAP 410 94660 " 1,025.00 " 922.50 994.25 973.75 984 41000013 OSCILLATORY PEP ACAPELLA 410 94667 204.00 183.60 197.88 193.80 195.84 41000016 PLETHYSMOGRAPHY FOR LV/AR 410 94726 447.00 402.30 433.59 424.65 429.12 41000020 MANUAL VENTILATION BVM 410 94799 235.00 211.50 227.95 223.25 225.6 41000027 COMPRESSED AIR-SUBSEQUENT 410 94799 415.00 373.50 402.55 394.25 398.4 41000033 INFANT AIRWAY MANAGEMENT 410 94002 908.00 817.20 880.76 862.60 871.68 41000037 PEAK FLOW PRE & POST TREATMENT 410 94010 137.00 123.30 132.89 130.15 131.52 41000038 AEROSOL TREATMENT 410 94640 154.00 138.60 149.38 146.30 147.84 41000039 AEROSOL THERAPY CONTINUOUS 410 94640 596.00 536.40 578.12 566.20 572.16 41000040 INCENTIVE BREATHING 410 94640 154.00 138.60 149.38 146.30 147.84 41000041 IPPB THERAPY 410 94640 186.00 167.40 180.42 176.70 178.56 41000042 MDI 410 94640 39.00 35.10 37.83 37.05 37.44 41000043 NON-INVASIVE CPAP SUBSEQUENT SIPAP 410 94660 586.00 527.40 568.42 556.70 562.56 41000044 NONINV BILEVEL VENT INITIAL 410 94660 " 2,202.00 " " 1,981.80 " " 2,135.94 " " 2,091.90 " "2,113.92" 41000045 NONINV BILEVEL VENT SUBS 410 94660 " 1,686.00 " " 1,517.40 " " 1,635.42 " " 1,601.70 " "1,618.56" 41000046 NONINV BILEVEL VENT LIMITED 410 94660 712.00 640.80 690.64 676.40 683.52 41000051 OSCILLATORY PEP MIE 410 94667 257.00 231.30 249.29 244.15 246.72 41000052 EZ-PAP 410 94667 122.00 109.80 118.34 115.90 117.12 41000053 IPV 410 94667 213.00 191.70 206.61 202.35 204.48 41000055 POSTURAL DRAINAGE 410 94667 270.00 243.00 261.90 256.50 259.2 41000065 NT SUCTIONING 410 31720 70.00 63.00 67.90 66.50 67.2 41000069 EZ-PAP AEROSOL TX-SUBSEQU 410 94640 154.00 138.60 149.38 146.30 147.84 41000073 AEROGEN AEROSOL 410 94640 171.00 153.90 165.87 162.45 164.16 42000006 PT TRACTION MECHANICAL 420 97012 71.00 63.90 68.87 67.45 68.16 42000007 PT ELECTRICAL STIM UNATTENDED 420 HCPCS G0283 70.00 63.00 67.90 66.50 67.2 42000008 PT VASOPNEUMATIC DEVICE APPL 420 97016 79.00 71.10 76.63 75.05 75.84 42000009 PT PARAFFIN BATH 420 97018 61.00 54.90 59.17 57.95 58.56 42000014 PT ELEC STIM ATTND EA 15M 420 97032 67.00 60.30 64.99 63.65 64.32 42000015 PT IONTOPHORESIS EA 15MIN 420 97033 109.00 98.10 105.73 103.55 104.64 42000016 PT CONTRAST BATH 420 97034 69.00 62.10 66.93 65.55 66.24 42000017 PT ULTRASOUND EA 15 MIN 420 97035 72.00 64.80 69.84 68.40 69.12 42000018 PT THERAPEUTIC EX EA 15M 420 97110 89.00 68 86.33 84.55 85.44 42000019 PT NEUROMUSC RE-ED EA 15M 420 97112 93.00 83.70 90.21 88.35 89.28 42000020 PT AQUA THER EXER EA 15M 420 97113 118.00 106.20 114.46 112.10 113.28 42000021 PT GAIT TRAINING EA 15 MIN 420 97116 84.00 75.60 81.48 79.80 80.64 42000023 PT MANUAL THERAPY EA 15M 420 97140 106.00 95.40 102.82 100.70 101.76 42000026 PT THER FUNCT ACT EA 15M 420 97530 92.00 82.80 89.24 87.40 88.32 42000027 PT COGNITIVE SKILLS 420 97127 89.00 80.10 86.33 84.55 85.44 42000028 PT SENSORY INTEGRATION 420 97533 94.00 84.60 91.18 89.30 90.24 42000029 PT SELF CARE MANAGEMENT EA 15M 420 97535 97.00 87.30 94.09 92.15 93.12 42000030 PT COMM WRK REINTEG-15M 420 97537 74.00 66.60 71.78 70.30 71.04 42000031 PT WHEELCHAIR MGMT TRN 15M 420 97542 87.00 78.30 84.39 82.65 83.52 42000034 PT WOUND DEBRID < OR 1ST 20CM 420 97597 201.00 180.90 194.97 190.95 192.96 42000035 PT WOUND DEBR EA ADD 20CM OR < 420 97598 307.00 276.30 297.79 291.65 294.72 42000040 PT PHYSICAL PERFORMANCE TEST 420 97750 101.00 90.90 97.97 95.95 96.96 42000041 PT ORTHO FIT TX INITL EA 15MN 420 97760 94.00 84.60 91.18 89.30 90.24 42000042 PT PROSTH TX INITIAL EA 15MIN 420 97761 89.00 80.10 86.33 84.55 85.44 42000044 PT ORTH PROTH TX SUBSEQ E 15MN 420 97763 83.00 74.70 80.51 78.85 79.68 42000064 PT VASOPNEUMATIC INITIAL 420 97016 266.00 239.40 258.02 252.70 255.36 42000078 PT PHYS CAP PROF 420 165.00 148.50 160.05 156.75 158.4 42000079 PT BACK ASSES 420 128.00 115.20 124.16 121.60 122.88 42400010 PT EVAL LOW COMPLEXITY 424 97161 150.00 135.00 145.50 142.50 144 42400011 PT EVAL MODERATE COMPLEXITY 424 97162 175.00 157.50 169.75 166.25 168 42400012 PT EVAL HIGH COMPLEXITY 424 97163 260.00 234.00 252.20 247.00 249.6 42400013 PT RE-EVAL 424 97164 101.00 90.90 97.97 95.95 96.96 43000002 OT ELECTRICAL STIM UNATTENDED 430 HCPCS G0283 70.00 63.00 67.90 66.50 67.2 43000003 OT PARAFFIN BATH 430 97018 61.00 54.90 59.17 57.95 58.56 43000005 OT ELEC STIM ATTND EA 15M 430 97032 67.00 60.30 64.99 63.65 64.32 43000006 OT IONTOPHORESIS EA 15MIN 430 97033 108.00 97.20 104.76 102.60 103.68 43000007 OT CONTRAST BATH EA 15M 430 97034 69.00 62.10 66.93 65.55 66.24 43000008 OT ULTRASOUND EA 15 MIN 430 97035 72.00 64.80 69.84 68.40 69.12 43000009 OT THERAPEUTIC EX EA 15M 430 97110 89.00 68 86.33 84.55 85.44 43000010 OT NEUROMUSC RE-ED EA 15M 430 97112 93.00 83.70 90.21 88.35 89.28 43000013 OT MANUAL THERAPY EA 15M 430 97140 106.00 95.40 102.82 100.70 101.76 43000014 OT THERAPEUTIC PROCEDURE GROUP 430 97150 90.00 81.00 87.30 85.50 86.4 43000015 OT THER FUNCT ACT EA 15M 430 97530 92.00 82.80 89.24 87.40 88.32 43000018 OT SELF CARE MANAGEMENT EA 15M 430 97535 97.00 87.30 94.09 92.15 93.12 43000020 OT WHELCHAIR MGMT TRN 15M 430 97542 87.00 78.30 84.39 82.65 83.52 43000021 OT WOUND DEBRID < OR 1ST 20CM 430 97597 201.00 180.90 194.97 190.95 192.96 43000022 OT WOUND DEBR EA ADD 20CM OR < 430 97598 307.00 276.30 297.79 291.65 294.72 43000023 OT ORTHO FIT TX INITL EA 15MN 430 97760 94.00 84.60 91.18 89.30 90.24 43000026 OT COG THER INT EA 15MIN 430 97129 90.00 81.00 87.30 85.50 86.4 43000057 OT ORTH PROTH TX SUBSEQ E 15MN 430 97763 83.00 74.70 80.51 78.85 79.68 43000058 OT VASOPHEUMATIC 430 97016 79.00 71.10 76.63 75.05 75.84 43000060 Hc Ot Asstv Technol Assmt Dir Cntct W/reprt Ea 15 Min 430 97755 101.00 90.90 97.97 95.95 96.96 43000062 Hc Ot Cog Ther Ivntj Ea Addl 15 Min 430 97130 90.00 81.00 87.30 85.50 86.4 43400012 OT EVAL LOW COMPLEXITY 434 97165 160.00 144.00 155.20 152.00 153.6 43400013 OT EVAL MODERATE COMPLEXITY 434 97166 190.00 171.00 184.30 180.50 182.4 43400014 OT EVAL HIGH COMPLEXITY 434 97167 230.00 207.00 223.10 218.50 220.8 43400015 OT RE-EVAL 434 97168 101.00 90.90 97.97 95.95 96.96 44000005 EVAL SWALLOW BARIUM 444 92611 478.00 430.20 463.66 454.10 458.88 44000009 ST SENSORY INTERGAT EA 15M 440 97533 94.00 84.60 91.18 89.30 90.24 44000012 SLP COG THER EA 15MIN 440 97130 90.00 81.00 87.30 85.50 86.4 44000037 ST THERAPEUTIC ACTIV PER 15 440 97530 92.00 82.80 89.24 87.40 88.32 44000040 SLP TRMT 45 440 92507 220.00 198.00 213.40 209.00 211.2 44000041 SLP TRMT 60 440 92507 290.00 261.00 281.30 275.50 278.4 44000048 DYSPHAGIA TRMT 30 440 92526 280.00 252.00 271.60 266.00 268.8 44000049 DYSPHAGIA TRMT 45 440 92526 377.00 339.30 365.69 358.15 361.92 44000050 DYSPHAGIA TRMT 60 440 92526 500.00 450.00 485.00 475.00 480 44000059 Hc St Ther Ivntj 1st 15 Min 440 97129 90.00 81.00 87.30 85.50 86.4 44000060 Hc St Speech Therapy Re-eval 440 HCPCS S9152 145.00 130.50 140.65 137.75 139.2 44400015 SLP FLUENCY EVAL 60 440 92521 287.00 258.30 278.39 272.65 275.52 44400019 SLP ARTICULATION EVAL 60 440 92522 298.00 268.20 289.06 283.10 286.08 44400023 SLP LANGUAGE EVAL 60 440 92523 298.00 268.20 289.06 283.10 286.08 44400025 SLP VOICE EVAL 30 444 92524 298.00 268.20 289.06 283.10 286.08 44400029 DYSPHAGIA EVAL 30 444 92610 355.00 319.50 344.35 337.25 340.8 44400035 COGN TEST BY HC PROF 444 96125 298.00 268.20 289.06 283.10 286.08 45000001 BLADDER SCAN 761 51798 175.00 157.50 169.75 166.25 168 45000003 EMERGENCY ROOM I 450 99281 215.00 193.50 208.55 204.25 206.4 45000004 EMERGENCY ROOM II 450 99282 328.00 295.20 318.16 311.60 314.88 45000005 EMERGENCY ROOM III 450 99283 506.00 455.40 490.82 480.70 485.76 45000006 EMERGENCY ROOM IV 450 99284 745.00 670.50 722.65 707.75 715.2 45000007 EMERGENCY ROOM V 450 99285 " 1,121.00 " " 1,008.90 " " 1,087.37 " " 1,064.95 " "1,076.16" 45000008 EMERGENCY ROOM VI 450 99291 " 1,642.00 " " 1,477.80 " " 1,592.74 " " 1,559.90 " "1,576.32" 45000020 LACERATION REPAIR 450 42.00 37.80 40.74 39.90 40.32 45000023 OCL LONG LEG BONE SPLINT 450 29505 133.00 119.70 129.01 126.35 127.68 45000028 Hc Ed Misc Procedure 450 11.00 9.90 10.67 10.45 10.56 45000029 Hc Remove Foreign Body Simple 450 10120 584.00 525.60 566.48 554.80 560.64 45000030 Hc Remove Foreign Body Complic 450 10121 " 2,536.00 " " 2,282.40 " " 2,459.92 " " 2,409.20 " "2,434.56" 45000031 Hc Trim Nondystrophic Nails Any Number 450 11719 114.00 102.60 110.58 108.30 109.44 45000032 Hc Removal Of Nail Plate 450 11730 165.00 148.50 160.05 156.75 158.4 45000033 Hc Remove Additional Nail Plate 450 11732 100.00 90.00 97.00 95.00 96 45000034 Hc Removal Of Nail Bed 450 11750 620.00 558.00 601.40 589.00 595.2 45000035 Hc Reconstruc Of Nail Bed 450 11760 895.00 805.50 868.15 850.25 859.2 45000036 Hc Excision Of Nail Fold Toe 450 11765 665.00 598.50 645.05 631.75 638.4 45000037 Hc Resuperf Wnd Body <2.5cm 450 12001 361.00 324.90 350.17 342.95 346.56 45000038 Hc Resup Npterf Wnd Body 2.6-7.5cm 450 12002 375.00 337.50 363.75 356.25 360 45000039 Hc Resuperf Wnd Body 7.6-12.5cm 450 12004 463.00 416.70 449.11 439.85 444.48 45000040 Hc Resuperf Wnd Body 12.6-20cm 450 12005 478.00 430.20 463.66 454.10 458.88 45000041 Hc Resuperf Wnd Body 20.1-30cm 450 12006 603.00 542.70 584.91 572.85 578.88 45000043 Hc Resuperf Wnd Face <2.5cm 450 12011 365.00 328.50 354.05 346.75 350.4 45000044 Hc Resuperf Wnd Face 2.6-5cm 450 12013 410.00 369.00 397.70 389.50 393.6 45000045 Hc Resuperf Wnd Face 5.1-7.5cm 450 12014 504.00 453.60 488.88 478.80 483.84 45000046 Hc Resuperf Wnd Face 7.6-12.5cm 450 12015 659.00 593.10 639.23 626.05 632.64 45000050 Hc Layr Clos Wnd Trunk Arm Leg <2.5cm 450 12031 562.00 505.80 545.14 533.90 539.52 45000051 Hc Layr Clos Wnd Trunk Arm Leg 2.6-7.5cm 450 12032 808.00 727.20 783.76 767.60 775.68 45000052 Hc Layr Clos Wnd Trunk Arm Leg 7.6-12.5cm 450 12034 597.00 537.30 579.09 567.15 573.12 45000053 Hc Layr Clos Wnd Trunk Arm Leg 12.6-20cm 450 12035 " 1,068.00 " 961.20 " 1,035.96 " " 1,014.60 " "1,025.28" 45000056 Hc Layr Clos Wnd Rest Body <2.5cm 450 12041 583.00 524.70 565.51 553.85 559.68 45000057 Hc Layr Clos Wnd Rest Body 2.6-7.5cm 450 12042 692.00 622.80 671.24 657.40 664.32 45000058 Hc Layr Clos Wnd Rest Body 7.6-12.5cm 450 12044 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000059 Hc Layr Clos Wnd Rest Body 12.6-20cm 450 12045 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000062 Hc Layr Clos Wnd Face Facial <2.5cm 450 12051 410.00 369.00 397.70 389.50 393.6 45000063 Hc Layr Clos Wnd Face Facial 2.5-5cm 450 12052 385.00 346.50 373.45 365.75 369.6 45000064 Hc Layr Clos Wnd Face Facial 5.1-7.5cm 450 12053 463.00 416.70 449.11 439.85 444.48 45000065 Hc Layr Clos Wnd Face Facial 7.6-12.5cm 450 12054 573.00 515.70 555.81 544.35 550.08 45000066 Hc Layr Clos Wnd Face Facial 12.6-20cm 450 12055 665.00 598.50 645.05 631.75 638.4 45000069 HC RECMPL WND TRUNK 1.1-2.5CM 450 13100 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000070 Hc Recmpl Wnd Trunk 2.6-7.5cm 450 13101 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000071 Hc Rep Skin Trunkcmplx +5cm/< 450 13102 937.00 843.30 908.89 890.15 899.52 45000072 Hc Recmpl Wnd Scalp Extr 1.1-2.5cm 450 13120 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000073 Hc Recmpl Wnd Scalp Extr 2.6-7.5cm 450 13121 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000074 Hc Rep Skin Scalp/extrem+5cm/< 450 13122 " 1,543.00 " " 1,388.70 " " 1,496.71 " " 1,465.85 " "1,481.28" 45000075 Hc Recmpl Wnd Head Fac Hand 1.1-2.5cm 450 13131 665.00 598.50 645.05 631.75 638.4 45000076 Hc Recmpl Wnd Head Fac Hand 2.6-7.5cm 450 13132 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000077 Hc Repr Face Genital Hand Ft+5cm/< 450 13133 " 1,213.00 " " 1,091.70 " " 1,176.61 " " 1,152.35 " "1,164.48" 45000078 Hc Recmpl Wnd Lid Nos Ear 1.1-2.5cm 450 13151 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000079 Hc Recmpl Wnd Lid Nos Ear 2.5-7.5cm 450 13152 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 45000080 Hc Repr Eyelid Nose Ear Lip+5cm 450 13153 " 1,323.00 " " 1,190.70 " " 1,283.31 " " 1,256.85 " "1,270.08" 45000081 Hc Initial Rx Burn(s) 1st Degree 450 16000 361.00 324.90 350.17 342.95 346.56 45000082 Hc Dress/debrid Small Burn No Anes 450 16020 361.00 324.90 350.17 342.95 346.56 45000091 Hc Closed Rx Nose Fracture W/o Manipulation 450 21310 460.00 414.00 446.20 437.00 441.6 45000092 Hc Closed Rx Nose Fracture W/o Stabilization 450 21315 " 2,436.00 " " 2,192.40 " " 2,362.92 " " 2,314.20 " "2,338.56" 45000103 Hc Reduce Temporomandibl Disloc 450 21480 460.00 414.00 446.20 437.00 441.6 45000111 Hc Closed Rx Clavicle Fracture 450 23500 460.00 414.00 446.20 437.00 441.6 45000112 Hc Closed Rx Clavicle Fx Manipulatn 450 23505 " 2,739.00 " " 2,465.10 " " 2,656.83 " " 2,602.05 " "2,629.44" 45000116 Hc Closed Rx A-c Jt Disloc Manipulatn 450 23545 460.00 414.00 446.20 437.00 441.6 45000119 Hc Closed Rx Prox Humerus Fracture 450 23600 460.00 414.00 446.20 437.00 441.6 45000121 Hc Closed Rx Gr Tuberosity Hum Fx 450 23620 460.00 414.00 446.20 437.00 441.6 45000123 Hc Closed Rx Shldr Dislocation 450 23650 460.00 414.00 446.20 437.00 441.6 45000124 Hc Closed Rx Shldr Disloc Anesthesia 450 23655 " 1,685.00 " " 1,516.50 " " 1,634.45 " " 1,600.75 " "1,617.60" 45000129 Hc Closed Rx Mid Humerus Fracture 450 24500 398.00 358.20 386.06 378.10 382.08 45000137 Hc Closed Rx Elbow Dislocation 450 24600 460.00 414.00 446.20 437.00 441.6 45000138 Hc Closed Rx Elbow Dislocatn Anesthesia 450 24605 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000140 Hc Closed Rx Radial Head Disloc Child 450 24640 460.00 414.00 446.20 437.00 441.6 45000141 Hc Closed Rx Radial Head/neck Fx 450 24650 460.00 414.00 446.20 437.00 441.6 45000143 Hc Closed Tx Ulnar Fracture Prox End W/o Manipulate 450 24670 460.00 414.00 446.20 437.00 441.6 45000144 Hc Closed Tx Ulnar Fracture Prox End W Manipulation 450 24675 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000148 Hc Closed Rx Radial Shaft Fx 450 25500 460.00 414.00 446.20 437.00 441.6 45000149 Hc Closed Rx Radial Shaft Fx Manipulatn 450 25505 " 3,002.00 " " 2,701.80 " " 2,911.94 " " 2,851.90 " "2,881.92" 45000151 Hc Closed Rx Ulna Shaft Fx 450 25530 460.00 414.00 446.20 437.00 441.6 45000152 Hc Closed Rx Ulna Shaft Fx Manipulatn 450 25535 460.00 414.00 446.20 437.00 441.6 45000153 Hc Closed Rx Rad/ulna Shaft Fx 450 25560 460.00 414.00 446.20 437.00 441.6 45000154 Hc Closed Rx Rad/ulna Shaft Fx Manip 450 25565 " 1,328.00 " " 1,195.20 " " 1,288.16 " " 1,261.60 " "1,274.88" 45000155 Hc Closed Rx Dist Rad/ulna Fx 450 25600 460.00 414.00 446.20 437.00 441.6 45000156 Hc Closed Rx Dist Rad/ulna Fx Manipul 450 25605 " 1,820.00 " " 1,638.00 " " 1,765.40 " " 1,729.00 " "1,747.20" 45000161 Hc Closed Rx Ulna Styloid Fx 450 25650 460.00 414.00 446.20 437.00 441.6 45000163 Hc Closed Rx Radio-ulna Dislocation 450 25675 460.00 414.00 446.20 437.00 441.6 45000167 Hc Closed Rx Metacarpal Fx 450 26600 460.00 414.00 446.20 437.00 441.6 45000168 Hc Closed Rx Metacarpal Fx Manip 450 26605 460.00 414.00 446.20 437.00 441.6 45000169 Hc Treat Thumb Disloc Manipulatn 450 26641 460.00 414.00 446.20 437.00 441.6 45000170 Hc Treat Thumb Fx/disloc Manip 450 26645 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000171 Hc Closed Rx Carpometacar Disloc Non-thumb 450 26670 460.00 414.00 446.20 437.00 441.6 45000173 Hc Closed Rx Mc-p Disloc 450 26700 460.00 414.00 446.20 437.00 441.6 45000175 Hc Close Rx Prox/mid Fing Shft Fx 450 26720 460.00 414.00 446.20 437.00 441.6 45000176 Hc Close Rx Prox/mid Fing Shft Fx Manip 450 26725 460.00 414.00 446.20 437.00 441.6 45000177 Hc Close Rx Fingr Articular Fx 450 26740 460.00 414.00 446.20 437.00 441.6 45000178 Hc Close Rx Fingr Articular Fx Manip 450 26742 " 2,756.00 " " 2,480.40 " " 2,673.32 " " 2,618.20 " "2,645.76" 45000179 Hc Close Rx Dist Fingr Fx 450 26750 460.00 414.00 446.20 437.00 441.6 45000180 Hc Close Rx Dist Fingr Fx Manipulatn 450 26755 460.00 414.00 446.20 437.00 441.6 45000181 Hc Closed Rx Ip Jt Dislocation 450 26770 460.00 414.00 446.20 437.00 441.6 45000182 Hc Closed Rx Ip Jt Dislocation Anesth 450 26775 508.00 457.20 492.76 482.60 487.68 45000195 Hc Closed Rx Traumatic Hip Dislocatn 450 27250 460.00 414.00 446.20 437.00 441.6 45000196 Hc Closed Rx Trauma Hip Disloc Anesth 450 27252 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000197 Hc Closed Rx Spontaneous Hip Disloc 450 27256 460.00 414.00 446.20 437.00 441.6 45000198 Hc Closed Rx Spont Hip Disloc Anesth 450 27257 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000199 Hc Closed Rx Post Hip Arthrplas Disloc 450 27265 460.00 414.00 446.20 437.00 441.6 45000200 Hc Closed Rx Post Hip Fix Disloc Anesth 450 27266 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000213 Hc Closed Rx Knee Dislocatn 450 27550 460.00 414.00 446.20 437.00 441.6 45000214 Hc Closed Rx Knee Disloc+anesth 450 27552 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000215 Hc Closed Rx Kneecap Dislocatn 450 27560 390.00 351.00 378.30 370.50 374.4 45000217 Hc Closed Rx Tibia Shaft Fx 450 27750 460.00 414.00 446.20 437.00 441.6 45000218 "Hc Closed Rx Tibia Shaft Fx,manipulatn" 450 27752 " 2,890.00 " " 2,601.00 " " 2,803.30 " " 2,745.50 " "2,774.40" 45000219 Hc Closed Rx Med Malleolus Fx 450 27760 460.00 414.00 446.20 437.00 441.6 45000221 Hc Closed Treatment Pst Malleolus Fracture W/o Manip 450 27767 460.00 414.00 446.20 437.00 441.6 45000223 Hc Closed Rx Prox/shaft Fibula Fx 450 27780 460.00 414.00 446.20 437.00 441.6 45000225 Hc Closed Rx Dist Fibula Fx 450 27786 460.00 414.00 446.20 437.00 441.6 45000227 Hc Closed Tx Bimalleolar Ankle Fracture W/o Manip 450 27808 460.00 414.00 446.20 437.00 441.6 45000229 Hc Closed Rx Trimalleolar Fx 450 27816 460.00 414.00 446.20 437.00 441.6 45000230 "Hc Closed Rx Trimalleolar Fx,manip" 450 27818 " 2,491.00 " " 2,241.90 " " 2,416.27 " " 2,366.45 " "2,391.36" 45000235 Hc Closed Rx Ankle Dislocatn 450 27840 460.00 414.00 446.20 437.00 441.6 45000237 "Hc Remv Foot Foreign Body,subcutaneous" 450 28190 " 1,225.00 " " 1,102.50 " " 1,188.25 " " 1,163.75 " "1,176.00" 45000246 Hc Closed Rx Metatarsal Fx 450 28470 460.00 414.00 446.20 437.00 441.6 45000248 Hc Closed Rx Big Toe Fracture 450 28490 460.00 414.00 446.20 437.00 441.6 45000250 Hc Closed Rx Toe Fx 450 28510 460.00 414.00 446.20 437.00 441.6 45000251 Hc Closed Rx Toe Fx Manipulatn 450 28515 392.00 352.80 380.24 372.40 376.32 45000256 Hc Closed Rx Talotarsal Disloc Anesth 450 28575 " 5,661.00 " " 5,094.90 " " 5,491.17 " " 5,377.95 " "5,434.56" 45000261 Hc Closed Rx I-p Jt Toe Dislocation 450 28660 460.00 414.00 446.20 437.00 441.6 45000262 Hc Closed Rx I-p Jt Toe Disloc Anesth 450 28665 508.00 457.20 492.76 482.60 487.68 45000263 Hc Apply Long Arm Cast 450 29065 507.00 456.30 491.79 481.65 486.72 45000264 Hc Apply Forearm Cast 450 29075 293.00 263.70 284.21 278.35 281.28 45000265 Hc Apply Hand/wrist Cast 450 29085 293.00 263.70 284.21 278.35 281.28 45000266 Hc Apply Cast Finger (contracture) 450 29086 209.00 188.10 202.73 198.55 200.64 45000267 Hc Apply Long Arm Splint 450 29105 290.00 261.00 281.30 275.50 278.4 45000268 Hc Apply Forearm Splint Static 450 29125 225.00 202.50 218.25 213.75 216 45000269 Hc Apply Forearm Splint Dynamic 450 29126 225.00 202.50 218.25 213.75 216 45000270 Hc Apply Finger Splint Static 450 29130 120.00 108.00 116.40 114.00 115.2 45000271 Hc Apply Finger Splint Dynamic 450 29131 120.00 108.00 116.40 114.00 115.2 45000272 Hc Strapping Of Shoulder 450 29240 225.00 202.50 218.25 213.75 216 45000273 Hc Strapping Of Elbow Or Wrist 450 29260 68.00 61.20 65.96 64.60 65.28 45000274 Hc Strapping Of Hand Or Finger 450 29280 68.00 61.20 65.96 64.60 65.28 45000275 Hc Apply Long Leg Cast 450 29345 419.00 377.10 406.43 398.05 402.24 45000276 Hc Apply Long Leg Cast Walker 450 29355 507.00 456.30 491.79 481.65 486.72 45000277 Hc Apply Short Leg Cast 450 29405 293.00 263.70 284.21 278.35 281.28 45000278 Hc Apply Short Leg Cast Walker 450 29425 293.00 263.70 284.21 278.35 281.28 45000279 Hc Apply Lower Leg Splint 450 29515 290.00 261.00 281.30 275.50 278.4 45000280 Hc Strapping Of Knee 450 29530 225.00 202.50 218.25 213.75 216 45000281 Hc Strapping Ankle &/or Foot 450 29540 290.00 261.00 281.30 275.50 278.4 45000282 Hc Strapping Of Toes 450 29550 120.00 108.00 116.40 114.00 115.2 45000283 Hc Strapping Unna Boot 450 29580 290.00 261.00 281.30 275.50 278.4 45000284 Hc Remove Nasal Foreign Body 450 30300 225.00 202.50 218.25 213.75 216 45000289 Hc Repair Lip Full Thick Vermilion 450 40650 985.00 886.50 955.45 935.75 945.6 45000290 Hc Repair Lip <1/2 Vert Height 450 40652 985.00 886.50 955.45 935.75 945.6 45000291 Hc Repair Lip >1/2 Vert Height 450 40654 " 2,436.00 " " 2,192.40 " " 2,362.92 " " 2,314.20 " "2,338.56" 45000292 Hc Removal Foreign Body Mouth Simple 450 40804 " 1,592.00 " " 1,432.80 " " 1,544.24 " " 1,512.40 " "1,528.32" 45000294 Hc Repair Mouth Laceration <2.5 Cm 450 40830 383.00 344.70 371.51 363.85 367.68 45000295 Hc Repair Mouth Laceration >2.5 Cm 450 40831 985.00 886.50 955.45 935.75 945.6 45000308 Hc Inc/drain Peritonsil Abscess 450 42700 383.00 344.70 371.51 363.85 367.68 45000309 Hc Remove Pharynx Foreign Body 450 42809 707.00 636.30 685.79 671.65 678.72 45000313 Hc Sigmoidoscopy Flx W/rmvl Foreign Body 450 45332 " 2,004.00 " " 1,803.60 " " 1,943.88 " " 1,903.80 " "1,923.84" 45000316 Hc Anoscopy Dx W/collj Spec Br/wa Spx When Prfrmd 450 46600 191.00 171.90 185.27 181.45 183.36 45000318 "Hc Change Of Bladder Tube,simple" 450 51705 492.00 442.80 477.24 467.40 472.32 45000322 Hc Marsup Bartholin Gland Cyst 450 56440 " 4,865.00 " " 4,378.50 " " 4,719.05 " " 4,621.75 " "4,670.40" 45000325 Hc Remv Fb Eye Superf Conjunc 450 65205 225.00 202.50 218.25 213.75 216 45000326 Hc Remv Fb Eye Embed Conjunc 450 65210 707.00 636.30 685.79 671.65 678.72 45000327 Hc Remv Fb Eye Cornea No Slit 450 65220 707.00 636.30 685.79 671.65 678.72 45000328 Hc Remv Fb Eye Cornea Slit Lamp 450 65222 225.00 202.50 218.25 213.75 216 45000330 Hc Suture Eyelid Wound Partial Thick 450 67930 " 3,877.00 " " 3,489.30 " " 3,760.69 " " 3,683.15 " "3,721.92" 45000331 Hc Suture Eyelid Wound Full Thick 450 67935 " 3,877.00 " " 3,489.30 " " 3,760.69 " " 3,683.15 " "3,721.92" 45000334 Hc Remv Ext Canal Foreign Body 450 69200 225.00 202.50 218.25 213.75 216 45000336 Hc Mod Sed Same Phys/qhp Initial 15 Mins <5 Yrs 450 99151 220.00 198.00 213.40 209.00 211.2 45000337 Hc Mod Sed Other Phys/qhp Initial 15 Mins <5 Yrs 450 99155 220.00 198.00 213.40 209.00 211.2 45000338 Hc Mod Sed Other Phys/qhp Initial 15 Mins 5/> Yrs 450 99156 441.00 396.90 427.77 418.95 423.36 45000339 Hc Mod Sed Other Phys/qhp Each Addl 15 Mins 450 99157 165.00 148.50 160.05 156.75 158.4 45000340 Hc Critical Care Addl 30 Min 450 99292 992.00 892.80 962.24 942.40 952.32 45000344 Hc Inject Nerv Blck Facial Nerv 450 64999 452.00 406.80 438.44 429.40 433.92 45000345 Hc Excision Benign Lesion Incl Margins T/a/l 450 11402 " 1,350.00 " " 1,215.00 " " 1,309.50 " " 1,282.50 " "1,296.00" 46000001 SPIROMETRY 460 94010 326.00 293.40 316.22 309.70 312.96 46000002 BRONCHODILATION RESPONSIVENESS 460 94060 605.00 544.50 586.85 574.75 580.8 46000010 DIFFUSION CAPACITY 460 94729 518.00 466.20 502.46 492.10 497.28 46000011 OXIMETRY SINGLE DETERMINATION 460 94760 85.00 76.50 82.45 80.75 81.6 46000012 AMBULATORY OXIMETRY 460 94761 280.00 252.00 271.60 266.00 268.8 46000013 OVERNIGHT OXIMETRY MONITORING 460 94762 399.00 359.10 387.03 379.05 383.04 46000022 OXIMETRY CONTINUOUS 460 94761 280.00 252.00 271.60 266.00 268.8 46000025 RESPIRATORY PARAMETERS 460 94150 53.00 47.70 51.41 50.35 50.88 46000028 PULMONARY STRESS TESTING 460 94618 343.00 308.70 332.71 325.85 329.28 46000029 Hc Six Minute Walk Test 460 94618 343.00 308.70 332.71 325.85 329.28 48000021 CARDIOVERSION EXTERNAL 480 92960 " 2,115.00 " " 1,903.50 " " 2,051.55 " " 2,009.25 " "2,030.40" 48000028 ECHO COMPLETE 480 93306 " 2,069.00 " " 1,862.10 " " 2,006.93 " " 1,965.55 " "1,986.24" 48000030 ECHO 2D LIMITED 480 93308 834.00 750.60 808.98 792.30 800.64 48000032 CARDIAC DOPPLER EXAM 480 93320 407.00 366.30 394.79 386.65 390.72 48000033 CARDIAC DOPPLER - COLOR 480 93325 457.00 411.30 443.29 434.15 438.72 48000073 ECHO W/CONTRAST 480 HCPCS C8929 " 2,069.00 " " 1,862.10 " " 2,006.93 " " 1,965.55 " "1,986.24" 48000077 NON MONITORED CARDIAC REHAB 943 93797 205.00 184.50 198.85 194.75 196.8 48000078 PHASE IV 1/2 MONTH 943 93797 42.00 37.80 40.74 39.90 40.32 48000079 PHASE IV 1/4 MONTH 943 93797 25.00 22.50 24.25 23.75 24 48000080 PHASE IV 3/4 MONTH 943 93797 64.00 57.60 62.08 60.80 61.44 48000081 PHASE IV PER VISIT 943 93797 15.00 13.50 14.55 14.25 14.4 48000082 PHASE I 943 93798 86.00 77.40 83.42 81.70 82.56 48000083 PHASE II 943 93798 237.00 213.30 229.89 225.15 227.52 48000084 PHASE III PER VISIT 943 93798 42.00 37.80 40.74 39.90 40.32 48200001 GXT CORPORATE STRESS TEST 482 93015 386.00 347.40 374.42 366.70 370.56 48200002 CARDIAC STRESS TEST 482 93017 " 1,026.00 " 923.40 995.22 974.70 984.96 48300001 ECHO W/BUBBLE STUDY 483 93306 " 2,030.00 " " 1,827.00 " " 1,969.10 " " 1,928.50 " "1,948.80" 48300002 CARDIAC DOPPLER LIMITED 483 93321 239.00 215.10 231.83 227.05 229.44 51000001 PROCEDURE ROOM 106-120 MI 510 " 1,549.00 " " 1,394.10 " " 1,502.53 " " 1,471.55 " "1,487.04" 51000002 PROCEDURE ROOM 121-135 MI 510 " 1,747.00 " " 1,572.30 " " 1,694.59 " " 1,659.65 " "1,677.12" 51000003 PROCEDURE ROOM 1-30 MINS 510 488.00 439.20 473.36 463.60 468.48 51000004 PROCEDURE ROOM 31-45 MINS 510 587.00 528.30 569.39 557.65 563.52 51000005 PROCEDURE ROOM 46-60 MINS 510 " 1,004.00 " 903.60 973.88 953.80 963.84 51000006 PROCEDURE ROOM 61-75 MINS 510 " 1,219.00 " " 1,097.10 " " 1,182.43 " " 1,158.05 " "1,170.24" 51000007 PROCEDURE ROOM 76-90 MINS 510 " 1,345.00 " " 1,210.50 " " 1,304.65 " " 1,277.75 " "1,291.20" 51000008 PROCEDURE ROOM 91-105 MIN 510 " 1,456.00 " " 1,310.40 " " 1,412.32 " " 1,383.20 " "1,397.76" 51000009 Hc Paracentesis Ant Chamb Eye Aspir Aqueous Spx 510 65800 " 4,175.00 " " 3,757.50 " " 4,049.75 " " 3,966.25 " "4,008.00" 51000010 Hc Drain Ant Chmbr Remv Blood 510 65815 " 4,186.00 " " 3,767.40 " " 4,060.42 " " 3,976.70 " "4,018.56" 51000011 Hc Drain Ant Chmbr Remv Vitreous 510 65810 " 4,186.00 " " 3,767.40 " " 4,060.42 " " 3,976.70 " "4,018.56" 51000012 Hc Fetal Fluid Drainage W Us 510 59074 670.00 603.00 649.90 636.50 643.2 51000013 Hc Circumcision W/regionl Bloc 723 54150 575.00 517.50 557.75 546.25 552 51000019 Hc Immunotx Not Including Provision Of Allergenic Extracts Single Inj 510 95115 52.00 46.80 50.44 49.40 49.92 51000020 Hc Immunotx Not Including Provision Of Allergenic Extracts 2+ Inj 510 95117 52.00 46.80 50.44 49.40 49.92 51000021 Hc Unlisted Procedure Small Intestine 510 44799 941.00 846.90 912.77 893.95 903.36 51000022 Hc Exc Skin Benig >4 Cm Trunk Arm Leg 510 11406 " 1,900.00 " " 1,710.00 " " 1,843.00 " " 1,805.00 " "1,824.00" 51000023 Hc Exc Skin Benig 2.1-3cm T/a/l 510 11403 " 1,450.00 " " 1,305.00 " " 1,406.50 " " 1,377.50 " "1,392.00" 51000024 Hc Exc Skin Benig 3.1-4cm T/a/l 510 11404 " 1,550.00 " " 1,395.00 " " 1,503.50 " " 1,472.50 " "1,488.00" 51000025 Hc Telehealth Facility Fee 510 HCPCS Q3014 60.00 27 58.20 57.00 57.6 51000026 Hc Incision & Removal Foreign Body Subq Tiss Simple 510 10120 945.00 850.50 916.65 897.75 907.2 51000028 Hc Exc Skin Benig 3.1-4 Cm Remaindr Body 510 11424 390.00 351.00 378.30 370.50 374.4 51000029 Hc Inject Carpal Tunnel 510 20526 200.00 180.00 194.00 190.00 192 51000030 Hc Exc Skin Benig 1.1-2 Cm Remaindr Body 510 11422 295.00 265.50 286.15 280.25 283.2 51000031 HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 510 21932 " 2,000.00 " " 1,800.00 " " 1,940.00 " " 1,900.00 " "1,920.00" 51000032 "HC TENOTOMY,UNI HAMSTR,KNEE-THIGH,MULTI" 510 27391 " 2,200.00 " " 1,980.00 " " 2,134.00 " " 2,090.00 " "2,112.00" 51000033 "Hc Injection Into Skin Lesions, Up To 7" 510 11900 200.00 180.00 194.00 190.00 192 54200001 PARAMEDIC SVC/15 MIN 542 8.00 7.20 7.76 7.60 7.68 54200002 PARMEDIC ON-CALL/MTH 542 " 1,886.00 " " 1,697.40 " " 1,829.42 " " 1,791.70 " "1,810.56" 54200003 ALS INTERCEPT - TIER 1 542 324.00 291.60 314.28 307.80 311.04 54200004 ALS INTERCEPT - TIER 2 542 162.00 145.80 157.14 153.90 155.52 61000006 MRI ORBIT FACE NECK WO CONTR 610 70540 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61000007 MRI ORBIT/FACE/NECK W/CONTRAST 610 70542 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61000008 MRI ORBIT/FACE/NECK W/WO CONTR 610 70543 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61000009 MRA HEAD WO CONTRAST 610 70544 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61000012 MRA NECK W/O CONTRAST 610 70547 " 2,966.00 " " 2,669.40 " " 2,877.02 " " 2,817.70 " "2,847.36" 61000014 MRA NECK W/WO CONTRAST 610 70549 " 3,561.00 " " 3,204.90 " " 3,454.17 " " 3,382.95 " "3,418.56" 61000015 MRI CHEST W/O CONTRAST 610 71550 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61000016 MRI CHEST W/CONTRAST 610 71551 " 3,817.00 " " 3,435.30 " " 3,702.49 " " 3,626.15 " "3,664.32" 61000017 MRI CHEST W/WO CONTRAST 610 71552 " 4,195.00 " " 3,775.50 " " 4,069.15 " " 3,985.25 " "4,027.20" 61000019 MRI PELVIS WO CONTRAST 610 72195 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61000020 MRI PELVIS W CONTRAST 610 72196 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61000021 MRI PELVIS W WO CONTRAST 610 72197 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61000023 MRI UPPER EXT WO CONTRAST 610 73218 " 2,542.00 " " 2,287.80 " " 2,465.74 " " 2,414.90 " "2,440.32" 61000024 MRI UPPER EXT W/CONTRAST 610 73219 " 2,789.00 " " 2,510.10 " " 2,705.33 " " 2,649.55 " "2,677.44" 61000025 MRI UPPER EXT W/WO CONTRAST 610 73220 " 3,137.00 " " 2,823.30 " " 3,042.89 " " 2,980.15 " "3,011.52" 61000026 MRI JT UPPER EXT W/O CONTRAST 610 73221 " 2,542.00 " " 2,287.80 " " 2,465.74 " " 2,414.90 " "2,440.32" 61000027 MRI JOINT UPPER EXT W/CONTRAST 610 73222 " 2,842.00 " " 2,557.80 " " 2,756.74 " " 2,699.90 " "2,728.32" 61000028 MRI JOINT UPPER EXT W/WO CONTRAST 610 73223 " 3,137.00 " " 2,823.30 " " 3,042.89 " " 2,980.15 " "3,011.52" 61000029 MRA UPPER EXT W & W/O CONTRAST 610 73225 " 2,713.00 " " 2,441.70 " " 2,631.61 " " 2,577.35 " "2,604.48" 61000030 MRI LOW EXT W/O CONTRAST 610 73718 " 2,542.00 " " 2,287.80 " " 2,465.74 " " 2,414.90 " "2,440.32" 61000031 MRI LOW EXT W/CONTRAST 610 73719 " 3,510.00 " " 3,159.00 " " 3,404.70 " " 3,334.50 " "3,369.60" 61000032 MRI LOWER EXT W/WO CONTRAST 610 73720 " 3,137.00 " " 2,823.30 " " 3,042.89 " " 2,980.15 " "3,011.52" 61000033 MRI JT LOWER EXT W/O CONTRAST 610 73721 " 2,542.00 " "1,413.00" " 2,465.74 " " 2,414.90 " "2,440.32" 61000034 MRI JT LOWER EXT W CONTRAST 610 73722 " 2,681.00 " " 2,412.90 " " 2,600.57 " " 2,546.95 " "2,573.76" 61000035 MRI JT LOWER EXT W/WO CONTRAST 610 73723 " 3,137.00 " " 2,823.30 " " 3,042.89 " " 2,980.15 " "3,011.52" 61000036 MRA LOWER EXTREMITY W/CONTRAST 610 73725 " 3,137.00 " " 2,823.30 " " 3,042.89 " " 2,980.15 " "3,011.52" 61000037 MRI ABDOMEN W/O CONTRAST 610 74181 " 3,605.00 " " 3,244.50 " " 3,496.85 " " 3,424.75 " "3,460.80" 61000038 MRI ABD W/CONTRAST 610 74182 " 3,656.00 " " 3,290.40 " " 3,546.32 " " 3,473.20 " "3,509.76" 61000039 MRI ABD W/WO CONTRAST 610 74183 " 4,195.00 " " 3,775.50 " " 4,069.15 " " 3,985.25 " "4,027.20" 61000040 MRA ABDOMEN W & W/O CONTRAST 610 74185 " 4,195.00 " " 3,775.50 " " 4,069.15 " " 3,985.25 " "4,027.20" 61000058 MRI TMJ BILATERAL 610 70336 " 2,866.00 " " 2,579.40 " " 2,780.02 " " 2,722.70 " "2,751.36" 61000059 MRI TMJ UNILATERAL 610 70336 " 2,459.00 " " 2,213.10 " " 2,385.23 " " 2,336.05 " "2,360.64" 61000062 MRI ORBITS ONLY WO CONT 610 70540 " 1,775.00 " " 1,597.50 " " 1,721.75 " " 1,686.25 " "1,704.00" 61000065 MRI ORBITS ONLY WITH CONTRAST 610 70542 " 1,860.00 " " 1,674.00 " " 1,804.20 " " 1,767.00 " "1,785.60" 61000068 MRI ORBITS ONLY W/WO CONTRAST 610 70543 " 2,142.00 " " 1,927.80 " " 2,077.74 " " 2,034.90 " "2,056.32" 61000073 MRV HEAD W/O CONTRAST 610 70544 " 3,278.00 " " 2,950.20 " " 3,179.66 " " 3,114.10 " "3,146.88" 61000077 MRA HEAD W/CONTRAST 610 70545 " 3,830.00 " " 3,447.00 " " 3,715.10 " " 3,638.50 " "3,676.80" 61000078 MRV HEAD W/CONTRAST 610 70545 " 4,256.00 " " 3,830.40 " " 4,128.32 " " 4,043.20 " "4,085.76" 61000081 MRA & MRV HEAD W/WO CONTRAST 610 70546 " 4,803.00 " " 4,322.70 " " 4,658.91 " " 4,562.85 " "4,610.88" 61000082 MRA HEAD W/WO CONTRAST 610 70546 " 4,331.00 " " 3,897.90 " " 4,201.07 " " 4,114.45 " "4,157.76" 61000083 MRV HEAD W/WO CONTRAST 610 70546 " 4,331.00 " " 3,897.90 " " 4,201.07 " " 4,114.45 " "4,157.76" 61000087 MRA & MRV NECK W/O CONTRAST 610 70547 " 2,666.00 " " 2,399.40 " " 2,586.02 " " 2,532.70 " "2,559.36" 61000088 MRV NECK W/O CONTRAST 610 70547 " 2,361.00 " " 2,124.90 " " 2,290.17 " " 2,242.95 " "2,266.56" 61000091 MRA & MRV NECK W/CONTRAST 610 70548 " 3,330.00 " " 2,997.00 " " 3,230.10 " " 3,163.50 " "3,196.80" 61000093 MRV NECK W/CONTRAST 610 70548 " 2,914.00 " " 2,622.60 " " 2,826.58 " " 2,768.30 " "2,797.44" 61000097 MRA & MRV NECK W/WO CONTRAST 610 70549 " 3,721.00 " " 3,348.90 " " 3,609.37 " " 3,534.95 " "3,572.16" 61000098 MRV NECK W/WO CONTRAST 610 70549 " 3,222.00 " " 2,899.80 " " 3,125.34 " " 3,060.90 " "3,093.12" 61000118 MRI SACRUM COCCYX WO CONTRAST 610 72195 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61000121 MRI SACRUM COCCYX W CONTRAST 610 72196 " 2,749.00 " " 2,474.10 " " 2,666.53 " " 2,611.55 " "2,639.04" 61000124 MRI SACRUM COCCYX W WO 610 72197 " 3,441.00 " " 3,096.90 " " 3,337.77 " " 3,268.95 " "3,303.36" 61100001 MRI BRAIN WO CONTRAST 611 70551 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61100002 MRI BRAIN W/CONTRAST 611 70552 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61100015 MRI BRAIN W IACS WO CONT 611 70551 " 3,439.00 " " 3,095.10 " " 3,335.83 " " 3,267.05 " "3,301.44" 61100020 MRI PITUITARY W/O CONTRAST 611 70551 " 2,560.00 " " 2,304.00 " " 2,483.20 " " 2,432.00 " "2,457.60" 61100026 MRI BRAIN/PIT W/CONTRAST 611 70552 " 3,408.00 " " 3,067.20 " " 3,305.76 " " 3,237.60 " "3,271.68" 61100027 MRI PITUITARY W/CONTRAST 611 70552 " 2,870.00 " " 2,583.00 " " 2,783.90 " " 2,726.50 " "2,755.20" 61100032 MRI BRAIN W IACS W WO CONT 611 70553 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61100033 MRI BRAIN W/PITUITRY W/WO CONT 611 70553 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61100034 MRI BRAIN W/WO CONTRAST 611 70553 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61100035 MRI PITUITARY W/WO CONTRAST 611 70553 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61200001 MRI SPINAL CANAL CERV W/O CONTRAST 612 72141 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61200002 MRI SPINAL CNL CERV W/CONTRAST 612 72142 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61200003 MRI SPINAL CANAL THOR W/O CONTRAST 612 72146 " 3,390.00 " " 3,051.00 " " 3,288.30 " " 3,220.50 " "3,254.40" 61200004 MRI SPINL CNL THOR W/CONTRAST 612 72147 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61200005 MRI SPINAL CNL LUMBAR WO CONTRAST 612 72148 " 3,390.00 " "1,860.00" " 3,288.30 " " 3,220.50 " "3,254.40" 61200006 MRI SPINAL CNL LUMB W/CONTRAST 612 72149 " 3,688.00 " " 3,319.20 " " 3,577.36 " " 3,503.60 " "3,540.48" 61200007 MRI SPINAL CNL CERV W/WO 612 72156 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61200008 MRI SPINAL CNL THOR W/WO 612 72157 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61200009 MRI SPINAL CNL LUMB W/WO 612 72158 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 61200025 MRA SPNL CNL CONTENT W WO 612 72159 " 3,985.00 " " 3,586.50 " " 3,865.45 " " 3,785.75 " "3,825.60" 63600003 EPIFIX PER SQ CM 636 HCPCS Q4186 691.00 621.90 670.27 656.45 663.36 63600006 Hc Oasis Ultra 7x10cm Tri-layer 636 HCPCS Q4124 48.67 43.80 47.21 46.24 46.72 63600007 Hc Oasis Ultra 7x20cm Tri-layer 636 HCPCS Q4124 48.67 43.80 47.21 46.24 46.72 63600008 Hc Oasis Ultra 5x7cm Tri-layer 636 HCPCS Q4124 36.50 32.85 35.41 34.68 35.04 63600009 Hc Oasis Ultra 3x3.5cm Tri-layer 636 HCPCS Q4124 61.45 55.31 59.61 58.38 58.99 63600010 Hc Oasis Ultra 3x7cm Tri-layer 636 HCPCS Q4124 55.30 49.77 53.64 52.54 53.09 63600011 Hc Oasis Fenestrated 3x3.5cm 636 HCPCS Q4102 43.95 39.56 42.63 41.75 42.19 63600012 Hc Oasis Fenestrated 3x7cm 636 HCPCS Q4102 43.91 39.52 42.59 41.71 42.15 63600013 HC RESTRATA WOUND MATRIX PER SQ CM 278 HCPCS C1849 175.00 157.50 169.75 166.25 168 68400001 TRAUMA ACTIVATION <30 MIN 684 433.00 389.70 420.01 411.35 415.68 68400002 TRAUMA ACTIVATION >30 MIN 684 HCPCS G0390 721.00 648.90 699.37 684.95 692.16 71000011 RECOVERY ROOM 1-30 MIN 710 472.00 424.80 457.84 448.40 453.12 71000012 RECOVERY ROOM 31-60 MIN 710 701.00 630.90 679.97 665.95 672.96 71000013 RECOVERY ROOM 61-90 MIN 710 796.00 716.40 772.12 756.20 764.16 71000014 RECOVERY ROOM 91-120 MIN 710 879.00 791.10 852.63 835.05 843.84 72000001 BIRTHING SERVICE 720 " 1,836.00 " " 1,652.40 " " 1,780.92 " " 1,744.20 " "1,762.56" 72100002 LABOR SERVICE 721 840.00 756.00 814.80 798.00 806.4 72100003 OB OUTPATIENT ROOM PER HR 721 58.00 52.20 56.26 55.10 55.68 72200001 Hc External Cephalic Version W Wo Tocolysis 722 59412 " 2,652.00 " " 2,386.80 " " 2,572.44 " " 2,519.40 " "2,545.92" 73000001 EKG TRACING ONLY 730 93005 291.00 160 282.27 276.45 279.36 73100001 HOLTER MONITOR APPLICATION 731 93225 495.00 445.50 480.15 470.25 475.2 73100002 HOLTER 12 HOUR RECORDING 731 93226 638.00 574.20 618.86 606.10 612.48 73100003 EVENT MONITOR APPLICATION 731 93270 344.00 309.60 333.68 326.80 330.24 73100004 EVENT MONITOR SERVICE 731 93271 " 1,000.00 " 900.00 970.00 950.00 960 73100005 Hc Zio Patch Recording 731 0296T 378.00 340.20 366.66 359.10 362.88 73100006 HOLTER 24 HOUR RECORDING 731 93226 638.00 574.20 618.86 606.10 612.48 73100007 HOLTER 48 HOUR RECORDING 731 93226 " 1,274.00 " " 1,146.60 " " 1,235.78 " " 1,210.30 " "1,223.04" 76000001 EXTENDED RECOVERY TO 1 HR 760 176.00 158.40 170.72 167.20 168.96 76000002 EXTENDED RECOVERY TO 2 HR 760 348.00 313.20 337.56 330.60 334.08 76000003 EXTENDED RECOVERY TO 3 HR 760 527.00 474.30 511.19 500.65 505.92 76000004 EXTENDED RECOVERY TO 4 HR 760 699.00 629.10 678.03 664.05 671.04 76000005 EXTENDED RECOVERY TO 5 HR 760 873.00 785.70 846.81 829.35 838.08 76000006 EXTENDED RECOVERY TO 6 HR 760 " 1,044.00 " 939.60 " 1,012.68 " 991.80 "1,002.24" 76100001 DEBRIDEMENT OF NAIL 1-5 761 11720 73.00 65.70 70.81 69.35 70.08 76100002 DEBRIDEMENT OF NAIL >5 761 11721 83.00 74.70 80.51 78.85 79.68 76100004 INSERT STRAIGHT CATH 761 51701 170.00 153.00 164.90 161.50 163.2 76100005 INSERT SIMPLE CATH 761 51702 170.00 153.00 164.90 161.50 163.2 76100006 INSERT COMPLEX CATH 761 51703 317.00 285.30 307.49 301.15 304.32 76100008 IMMUNIZATION ADMIN 761 90471 125.00 112.50 121.25 118.75 120 76100009 IMMUNIZATION ADMIN ADDL 761 90472 67.00 60.30 64.99 63.65 64.32 76100014 TX RM IV THER 31-1HR HYDR 260 96360 335.00 301.50 324.95 318.25 321.6 76100015 TX RM IV THER 1STHR NON-H 260 96365 335.00 301.50 324.95 318.25 321.6 76100016 TX RM IV ADL HR SAME DRG 260 96366 102.00 91.80 98.94 96.90 97.92 76100017 TX RM IV THER ADL INFUS 260 96367 167.00 150.30 161.99 158.65 160.32 76100018 "TX RM IV THER, CONCUR INF" 260 96368 101.00 90.90 97.97 95.95 96.96 76100019 TX RM INJECT NON CHEMO 260 96372 125.00 112.50 121.25 118.75 120 76100020 ATTEMPT PICC INSERTION 5+ YRS 761 36569 " 1,227.00 " " 1,104.30 " " 1,190.19 " " 1,165.65 " "1,177.92" 76100021 TX RM IV PUSH DIFF DRUG 260 96375 164.00 147.60 159.08 155.80 157.44 76100022 SUBS IV PUSH OF SAME DRUG 260 96376 164.00 147.60 159.08 155.80 157.44 76100023 TX RM CHEMO INJECT NON-H 331 96401 250.00 225.00 242.50 237.50 240 76100024 TX RM CHEMO INJ-HORMONAL 331 96402 202.00 181.80 195.94 191.90 193.92 76100025 TX RM CHEMO IV PUSH-ADL 331 96411 167.00 150.30 161.99 158.65 160.32 76100026 TX RM CHEMO IV 1ST HOUR 335 96413 540.00 486.00 523.80 513.00 518.4 76100027 TX RM CHEMO ADL HR SM DRG 335 96415 110.00 99.00 106.70 104.50 105.6 76100028 CHEMO IV PUMP INITIATION 761 96416 154.00 138.60 149.38 146.30 147.84 76100029 TX RM CHEMO IV ADL INFUS 331 96417 154.00 138.60 149.38 146.30 147.84 76100030 TX RM IRRG OF IMPL DEVICE 761 96523 126.00 113.40 122.22 119.70 120.96 76100036 OFFICE OUTPATIENT VISIT LEVEL 1 761 99211 55.00 49.50 53.35 52.25 52.8 76100041 PICC INSERTION <5 YRS 761 36568 " 1,617.00 " " 1,455.30 " " 1,568.49 " " 1,536.15 " "1,552.32" 76100042 PICC INSERTION 5+ YRS 761 36569 " 1,942.00 " " 1,747.80 " " 1,883.74 " " 1,844.90 " "1,864.32" 76100045 Hc Blood Draw Via Picc/port Access 761 36592 24.00 21.60 23.28 22.80 23.04 76100046 TX RM IV THER ADL HR HYD 260 96361 101.00 90.90 97.97 95.95 96.96 76100047 MNT NON DM/NON RENAL 30M 761 99201 50.00 45.00 48.50 47.50 48 76100048 MNT NON DM/NON RENAL 60M 761 99201 70.00 63.00 67.90 66.50 67.2 76100050 OFFICE OUTPATIENT VISIT LEVEL 2 761 99212 228.00 205.20 221.16 216.60 218.88 76100051 OFFICE OUTPATIENT VISIT LEVEL 3 761 99213 331.00 297.90 321.07 314.45 317.76 76100052 OFFICE OUTPATIENT VISIT LEVEL 4 761 99214 436.00 392.40 422.92 414.20 418.56 76100053 OFFICE OUTPATIENT VISIT LEVEL 5 761 99215 521.00 468.90 505.37 494.95 500.16 76100055 TX ROOM <2 HRS 761 150.00 135.00 145.50 142.50 144 76100056 TX ROOM >2 HRS 761 213.00 191.70 206.61 202.35 204.48 76100063 SPINAL PUNCTURE LUMBAR 761 62270 969.00 872.10 939.93 920.55 930.24 76100064 THORACENTESIS 761 712.00 640.80 690.64 676.40 683.52 76100066 PICC GROSHONG REPAIR 761 36575 " 1,009.00 " 908.10 978.73 958.55 968.64 76100067 MIDLINE INSERT 3 + YRS OLD 761 36410 " 1,174.00 " " 1,056.60 " " 1,138.78 " " 1,115.30 " "1,127.04" 76100071 Hc Blood Draw From Completely Implantable Device Or A Fistula Device 761 36591 130.00 117.00 126.10 123.50 124.8 76100078 BONE MARROW BX W ASP SAME SITE 761 38222 " 1,919.00 " " 1,727.10 " " 1,861.43 " " 1,823.05 " "1,842.24" 76100079 Hc Tb Intradermal Test 761 86580 27.00 24.30 26.19 25.65 25.92 76100080 Hc Inject Trigger Points > 3 761 20553 821.00 738.90 796.37 779.95 788.16 76100081 Hc Ext Cannula Declott Wo Balloon Cath 761 36860 " 1,045.00 " 940.50 " 1,013.65 " 992.75 "1,003.20" 76100084 Hc App Skn Sub Grft T/a/l Area/<100scm /<1st 25 Scm 761 15271 " 1,096.00 " 986.40 " 1,063.12 " " 1,041.20 " "1,052.16" 76100085 Hc App Skn Sub Grft T/a/l Area/<100scm Ea Adl 25scm 761 15272 261.00 234.90 253.17 247.95 250.56 76100086 Hc Debride Open Wound 20 Sq Cm< 761 97597 260.00 234.00 252.20 247.00 249.6 76100087 Hc Debride Open Wound Ea Addl 20 Sq Cm 761 97598 209.00 188.10 202.73 198.55 200.64 76100088 Hc Removal Devitalized Tissue Per Session 761 97602 219.00 197.10 212.43 208.05 210.24 76100090 Hc Bladder Irrigation 761 51700 439.00 395.10 425.83 417.05 421.44 76100091 Hc Tube Thoracostomy Includes Water Seal 761 32551 " 2,299.00 " " 2,069.10 " " 2,230.03 " " 2,184.05 " "2,207.04" 76100092 Hc Inject Nerv Blck Othr Periph Nerv 761 64450 806.00 725.40 781.82 765.70 773.76 76100093 Hc Removal Impacted Cerumen Irrigation/lvg Unilat 761 69209 119.00 107.10 115.43 113.05 114.24 76100094 Hc Removal Impacted Cerumen Instrumentation Unilat 450 69210 119.00 107.10 115.43 113.05 114.24 76100095 Hc Ctrl Nosebleed Anter Simple 761 30901 292.00 262.80 283.24 277.40 280.32 76100096 Hc Ctrl Nosebleed Anter Complex 761 30903 292.00 262.80 283.24 277.40 280.32 76100097 Hc Ctrl Nosebleed Post W/packs &/or Caut 761 30905 292.00 262.80 283.24 277.40 280.32 76100098 Hc Repeat Control Of Nosebleed 761 30906 270.00 243.00 261.90 256.50 259.2 76100100 Hc Drain Skin Abscess Simple 761 10060 346.00 311.40 335.62 328.70 332.16 76100101 Hc Drain Skin Abscess Complic 761 10061 693.00 623.70 672.21 658.35 665.28 76100102 Hc Drain Pilonidal Cyst Simpl 761 10080 " 1,299.00 " " 1,169.10 " " 1,260.03 " " 1,234.05 " "1,247.04" 76100104 Hc Drainage Of Hematoma/fluid 761 10140 " 3,461.00 " " 3,114.90 " " 3,357.17 " " 3,287.95 " "3,322.56" 76100106 Hc Drain Blood From Under Nail 761 11740 162.00 145.80 157.14 153.90 155.52 76100107 Hc I&d Deep Absc/hematoma Neck/chest 761 21501 " 4,230.00 " " 3,807.00 " " 4,103.10 " " 4,018.50 " "4,060.80" 76100113 Hc Drain Finger Abscess Simple 761 26010 346.00 311.40 335.62 328.70 332.16 76100114 Hc Drain Finger Abscess Complicated 761 26011 " 1,406.00 " " 1,265.40 " " 1,363.82 " " 1,335.70 " "1,349.76" 76100119 Hc Drain Abscess/hematoma Nasal 761 30000 380.00 342.00 368.60 361.00 364.8 76100121 Hc Drain Mouth Absc/cyst/hematoma Simpl 761 40800 " 1,298.00 " " 1,168.20 " " 1,259.06 " " 1,233.10 " "1,246.08" 76100123 Hc Drainage Of Gum Lesion 761 41800 346.00 311.40 335.62 328.70 332.16 76100125 Hc I&d Perianal Abscess Superficial 761 46050 " 1,622.00 " " 1,459.80 " " 1,573.34 " " 1,540.90 " "1,557.12" 76100126 Hc Incise External Hemorrhoid 761 46083 487.00 438.30 472.39 462.65 467.52 76100128 Hc I&d Of Vulva/perineum Abscess 761 56405 575.00 517.50 557.75 546.25 552 76100129 Hc I&d Bartholin Gland Abscess 761 56420 346.00 311.40 335.62 328.70 332.16 76100131 Hc Drain Ext Ear Absc/blood Simple 761 69000 800.00 720.00 776.00 760.00 768 76100134 Hc Insert Needle Intraosseous Infusn 761 36680 749.00 674.10 726.53 711.55 719.04 76100148 Hc Cardiopulmonary Resuscitation 410 92950 934.00 840.60 905.98 887.30 896.64 76100149 Hc Apply Cast Shoulder Spica 761 29055 277.00 249.30 268.69 263.15 265.92 76100150 Hc Apply Cast Plaster Velpeau 761 29058 277.00 249.30 268.69 263.15 265.92 76100151 Hc Apply Cast Figure Eight 761 29049 277.00 249.30 268.69 263.15 265.92 76100152 Hc Apply Cast Shoulder To Hips 761 29035 481.00 432.90 466.57 456.95 461.76 76100153 Hc Apply Cast Shoulder To Hips Head Minerva 761 29040 575.00 517.50 557.75 546.25 552 76100154 Hc Apply Cast Shoulder To Hips Both Thighs 761 29046 575.00 517.50 557.75 546.25 552 76100155 Hc Apply Cast Shoulder To Hips One Thigh 761 29044 481.00 432.90 466.57 456.95 461.76 76100156 Hc Apply Cylinder Cast Thigh To Ankle 761 29365 397.00 357.30 385.09 377.15 381.12 76100157 Hc Apply Long Leg Cast Brace 761 29358 397.00 357.30 385.09 377.15 381.12 76100158 Hc Apply Hip Spica Cast One Leg 761 29305 397.00 357.30 385.09 377.15 381.12 76100159 Hc Apply Rigid Total Contact Leg Cast 761 29445 416.00 374.40 403.52 395.20 399.36 76100160 Hc Apply Patellar Tendon Bearing Cast 761 29435 277.00 249.30 268.69 263.15 265.92 76100161 Hc Apply Hip 1.5 Spica Or Both Legs 761 29325 575.00 517.50 557.75 546.25 552 76100162 Hc Debride Bone 1st 20 Sqcm< 761 11044 " 2,116.00 " " 1,904.40 " " 2,052.52 " " 2,010.20 " "2,031.36" 76100163 Hc Debride Subq Tissue Ea Addl 20 Sqcm 761 11045 767.00 690.30 743.99 728.65 736.32 76100164 Hc Debride Muscle/fascial Ea Addl 20 Sqcm 761 11046 921.00 828.90 893.37 874.95 884.16 76100165 Hc Debride Bone Ea Addl 20 Sqcm 761 11047 862.00 775.80 836.14 818.90 827.52 76100166 Hc Appl Skin Graft To T/a/l 1st 100 Sqcm 761 15273 " 1,463.00 " " 1,316.70 " " 1,419.11 " " 1,389.85 " "1,404.48" 76100167 Hc Appl Skin Graft T/a/l Ea Addl 100 Sqcm 761 15274 523.00 470.70 507.31 496.85 502.08 76100168 Hc Appl Skin Graft Face Scalp Genital Hands Ft 1st 25 Sqcm 761 15275 384.00 345.60 372.48 364.80 368.64 76100169 Hc Appl Skin Graft Face Scalp Genital Hands Ft Ea Addl 25 Sqcm 761 15276 209.00 188.10 202.73 198.55 200.64 76100170 Hc Appl Skin Graft Face Scalp Genital Hands Ft 1st 100 Sqcm 761 15277 " 1,463.00 " " 1,316.70 " " 1,419.11 " " 1,389.85 " "1,404.48" 76100171 Hc Appl Skin Graft Face Scalp Genital Hands Ft Ea Addl 100 Sqcm 761 15278 523.00 470.70 507.31 496.85 502.08 76100172 Hc Chemical Cauterize Granulation Tissue 761 17250 329.00 296.10 319.13 312.55 315.84 76100173 Hc Appl Multi-layer Compression Sys Leg Below Knee 761 29581 438.00 394.20 424.86 416.10 420.48 76100174 Hc Neg Press Wound Therapy <= 50 Sqcm 761 97607 416.00 374.40 403.52 395.20 399.36 76100175 Hc Neg Press Wound Therapy > 50 Sqcm 761 97608 742.00 667.80 719.74 704.90 712.32 76100177 Hc Periotoneal Lavage W Wo Imaging Guidance 761 49084 " 1,593.00 " " 1,433.70 " " 1,545.21 " " 1,513.35 " "1,529.28" 76100178 Hc Neg Press Wound Tx < 50cm 761 97605 394.00 354.60 382.18 374.30 378.24 76100179 Hc Neg Press Wound Tx > 50cm 761 97606 394.00 354.60 382.18 374.30 378.24 76100180 Hc Trim Hyperkeratotic Skin Lesion One 761 11055 268.00 241.20 259.96 254.60 257.28 76100181 Hc Trim Benign Hyperkeratotic Skin Lesion 2-4 761 11056 127.00 114.30 123.19 120.65 121.92 76100182 Hc Incision & Drainage Simple 761 575.00 517.50 557.75 546.25 552 76100183 Hc Incision & Drainage Complicated 761 982.00 883.80 952.54 932.90 942.72 76100184 Hc Closed Reduction Of Fracture 761 488.00 439.20 473.36 463.60 468.48 76100186 Hc Unlisted Chemotherapy Procedure 761 96549 75.00 67.50 72.75 71.25 72 76100187 Hc Electronic Analysis Intrathecal/epidural Drug Infusion 761 62369 846.00 761.40 820.62 803.70 812.16 76100188 Hc Colposcopy Entire Vagina 761 57420 533.00 479.70 517.01 506.35 511.68 76100189 Hc Chemodenervation Parotid Submandibular Salivary Glands Bilateral 761 64611 549.00 494.10 532.53 521.55 527.04 76100198 Hc Punch Bx Skin Ea Sep Addl 761 11105 236.00 212.40 228.92 224.20 226.56 76100199 Hc Incal Bx Skn Single Les 761 11106 458.00 412.20 444.26 435.10 439.68 76100200 Hc Incal Bx Skn Ea Sep Addl 761 11107 235.00 211.50 227.95 223.25 225.6 76100204 Hc Colposc Cervix W Adj Vag W Bx & Curretag 761 57454 366.00 329.40 355.02 347.70 351.36 76100205 Hc Colposcopy Entire Vagina W Biopsy(s) 761 57421 784.00 705.60 760.48 744.80 752.64 76100206 Hc Colposcopy Cervix W Adj Vagina Curettag 761 57456 366.00 329.40 355.02 347.70 351.36 76100207 Hc Endometrial Sampl W/wo Endocerv Sampl Wo Cerv Dilation Any Method 761 58100 230.00 207.00 223.10 218.50 220.8 76100209 Hc Appl Low Cost Skin Sub (t/a/l) 1st 25 Sq Cm 761 HCPCS C5271 982.00 883.80 952.54 932.90 942.72 76100210 Hc Appl Low Cost Skin Sub (t/a/l) Ea Addl 25 Sq Cm 761 HCPCS C5272 982.00 883.80 952.54 932.90 942.72 76100211 Hc Appl Low Cost Skin Sub (t/a/l) 1st 100 Sq Cm 761 HCPCS C5273 " 3,177.00 " " 2,859.30 " " 3,081.69 " " 3,018.15 " "3,049.92" 76100212 Hc Appl Low Cost Skin Sub (t/a/l) Ea Addl 100 Sq Cm 761 HCPCS C5274 982.00 883.80 952.54 932.90 942.72 76100213 Hc Appl Low Cost Skin Sub (face/scalp/eye/mouth/neck/orb) 1st 25 Sq Cm 761 HCPCS C5275 982.00 883.80 952.54 932.90 942.72 76100214 Hc Appl Low Cost Skin Sub (face/scalp/eye/mouth/neck) Ea Addl 25 Sq Cm 761 HCPCS C5276 982.00 883.80 952.54 932.90 942.72 76100215 Hc Appl Low Cost Skin Sub (face/scalp/eye/mouth/neck) 1st 100 Sq Cm 761 HCPCS C5277 982.00 883.80 952.54 932.90 942.72 76100216 Hc Appl Low Cost Skin Sub (face/scalp/eye/mouth/neck) Ea Adl 100 Sq Cm 761 HCPCS C5278 982.00 883.80 952.54 932.90 942.72 76100217 Hc Tangential Biopsy Skin Single Lesion 761 11102 458.00 412.20 444.26 435.10 439.68 76100218 Hc Punch Biopsy Skin Single Lesion 761 11104 458.00 412.20 444.26 435.10 439.68 76100219 Hc Inject Tendon Sheath/ligament 761 20550 229.00 206.10 222.13 217.55 219.84 76100220 Hc Thrombolysis Cerebral By Intravenous Infusion 761 37195 822.00 739.80 797.34 780.90 789.12 76100221 Hc Epidrm Autogrft Trnk/arm/leg <100 Sqcm 761 15110 " 4,441.00 " " 3,996.90 " " 4,307.77 " " 4,218.95 " "4,263.36" 76100222 "Hc Epidrm Autogrft Trnk/arm/leg, Each 100 Sqcm" 761 15111 " 2,090.00 " " 1,881.00 " " 2,027.30 " " 1,985.50 " "2,006.40" 76100223 Hc Epi Autogrft Face/nck/hnd/ft/gen <100 Sqcm 761 15115 " 3,135.00 " " 2,821.50 " " 3,040.95 " " 2,978.25 " "3,009.60" 76100224 "Hc Epi Autogrft Face/nck/hnd/ft/gen , Ea 100 Sqcm" 761 15116 " 1,568.00 " " 1,411.20 " " 1,520.96 " " 1,489.60 " "1,505.28" 76100225 Hc Obtaining Screen Pap Smear 761 HCPCS Q0091 47.00 42.30 45.59 44.65 45.12 76100226 Hc Chemodenerv Musc Neck Dyston 761 64616 637.00 573.30 617.89 605.15 611.52 76100232 Hc Unlisted Px Skin Muc Membrane & Subq Tissue 761 17999 397.00 357.30 385.09 377.15 381.12 76100233 Hc Insertion Intrauterine Device Iud 761 58300 314.00 282.60 304.58 298.30 301.44 76100234 Hc Removal Superficial Implant 761 20670 " 3,031.00 " " 2,727.90 " " 2,940.07 " " 2,879.45 " "2,909.76" 76100236 Hc Comp Ext Fixate Strut Change 761 20697 " 2,853.00 " " 2,567.70 " " 2,767.41 " " 2,710.35 " "2,738.88" 76100237 Hc Tenotomy Open Tendon Flexor Foot Single Or Multiple 761 28230 " 2,675.00 " " 2,407.50 " " 2,594.75 " " 2,541.25 " "2,568.00" 76100238 Hc Destruction Benign Lesions Up To 14 761 17110 444.00 399.60 430.68 421.80 426.24 76100239 Hc Closure Of Split Wound 761 12020 " 1,024.00 " 921.60 993.28 972.80 983.04 76100243 Hc Radio Frequency Ablation Nerve Of Si Joint 761 64625 " 1,472.40 " " 1,325.16 " " 1,428.23 " " 1,398.78 " "1,413.50" 76100244 Hc Destruction Genicular Nerve Neurolytic Agent Complete 761 64624 " 1,620.00 " " 1,458.00 " " 1,571.40 " " 1,539.00 " "1,555.20" 76100245 Hc Inject Genicular Nerve Complete 761 64454 " 1,620.00 " " 1,458.00 " " 1,571.40 " " 1,539.00 " "1,555.20" 76100246 Hc Inject Nerve Of Si Joint 761 64451 754.20 678.78 731.57 716.49 724.03 76100247 Hc Spinal Puncture Therapeutic W Fluoro Guidance 761 62329 " 1,327.50 " " 1,194.75 " " 1,287.68 " " 1,261.13 " "1,274.40" 76100248 Hc Spinal Puncture Therapeutic W Ct Guidance 761 62329 " 1,535.40 " " 1,381.86 " " 1,489.34 " " 1,458.63 " "1,473.98" 76100249 Hc Spinal Puncture Lumbar Dx W Fluoro Guidance 761 62328 " 2,467.80 " " 2,221.02 " " 2,393.77 " " 2,344.41 " "2,369.09" 76100250 Hc Spinal Puncture Lumbar Dx W Ct Guidance 761 62328 " 1,535.40 " " 1,381.86 " " 1,489.34 " " 1,458.63 " "1,473.98" 76100252 HC MNT INITIAL EACH 15 MIN 761 97802 45.00 40.50 43.65 42.75 43.2 76100253 HC MNT FOLLOW-UP EACH 15 MIN 761 97803 42.00 37.80 40.74 39.90 40.32 76100254 Hc Injection Epidural Cervical Or Thoracic Without Imaging Guidance 761 62320 " 1,926.00 " " 1,733.40 " " 1,868.22 " " 1,829.70 " "1,848.96" 76100255 Hc Secondary Closure Of Surgical Wound Or Dehiscence Extensive Or Complicated 761 13160 " 6,200.00 " " 5,580.00 " " 6,014.00 " " 5,890.00 " "5,952.00" 76100256 Hc Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/o Img Gdn 761 62322 " 1,957.00 " " 1,761.30 " " 1,898.29 " " 1,859.15 " "1,878.72" 76100257 Hc Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/img Gdn 761 62323 " 2,110.00 " " 1,899.00 " " 2,046.70 " " 2,004.50 " "2,025.60" 76100258 Hc Remove Intrauterine Device 761 58301 479.00 431.10 464.63 455.05 459.84 76100261 HC INSERT PESSARY/OTHER DEVICE 761 57160 415.00 373.50 402.55 394.25 398.4 76200001 OBSERVATION 762 HCPCS G0378 51.00 45.90 49.47 48.45 48.96 76900001 IC ROOM & BOARD RES 769 100.00 90.00 97.00 95.00 96 77000001 Hc Prev Visit Est Age 40-64 770 99396 157.00 141.30 152.29 149.15 150.72 77100001 ADMINISTRATION FEE -- INFLUENZA 771 90471 21.00 18.90 20.37 19.95 20.16 77100002 ADMINISTRATION FEE -- PNEUMOCOCCAL 771 90471 21.00 18.90 20.37 19.95 20.16 77100003 VACCINE ADMINISTRATION 771 90471 21.00 18.90 20.37 19.95 20.16 77100004 ADMINISTRATION FEE -- HEPATITIS B 771 90471 21.00 18.90 20.37 19.95 20.16 77100005 INFLUENZA ADMINISTRATION 771 90472 21.00 18.90 20.37 19.95 20.16 90000002 INTERVENTION CONSULT 900 90791 120.00 108.00 116.40 114.00 115.2 90000003 SCREEN INTERVENTION - RN 900 90791 190.00 171.00 184.30 180.50 182.4 90000005 EVALUATION 900 90791 220.00 198.00 213.40 209.00 211.2 90000010 SCREEN COUNSELOR 45(38-52)MIN 900 90834 190.00 171.00 184.30 180.50 182.4 90000011 INTERVENTION VISIT RN 900 90832 50.00 45.00 48.50 47.50 48 90000012 Hc Cj Evaluation 900 90791 216.00 194.40 209.52 205.20 207.36 90000013 Hc Evaluation For Telehealth 900 90791 220.00 198.00 213.40 209.00 211.2 90000014 Hc Cj Evaluation For Telehealth 900 90791 216.00 194.40 209.52 205.20 207.36 90600001 SKILLS TRAINING IOP - 15 MIN 906 HCPCS H2014 10.00 9.00 9.70 9.50 9.6 90600002 IOP (PC) 3 HRS AM OR PM 906 90853 246.00 221.40 238.62 233.70 236.16 90700001 SKILL TRAINING DAY TX - 15 MIN 907 HCPCS H2027 15.00 13.50 14.55 14.25 14.4 91200001 IOP WKND/HLDYS 912 246.00 221.40 238.62 233.70 236.16 91200002 SHORT-TERM RES - IC WKEND 912 346.00 311.40 335.62 328.70 332.16 91200006 HALF DAY PARTIAL-UHC MILITARY 912 246.00 221.40 238.62 233.70 236.16 91300001 PARTIAL CARE 6-8 HRS 913 90853 525.00 472.50 509.25 498.75 504 91300002 SHORT-TERM RES - IC 913 625.00 562.50 606.25 593.75 600 91400008 ALCOHL/DRUG ASSESS15-30MINS BC 914 HCPCS G0396 119.00 107.10 115.43 113.05 114.24 91400009 ALCOHOL/DRUG ASSESS>30MINS BC 914 HCPCS G0397 220.00 198.00 213.40 209.00 211.2 91400016 IOP IND THERAPY 30(16-37)MIN 914 90832 60.00 54.00 58.20 57.00 57.6 91400017 DAY TX IND THERAPY 30(16-37) 914 90832 60.00 54.00 58.20 57.00 57.6 91400018 CJ IND THERAPY 30(16-37)MIN 914 90832 122.00 109.80 118.34 115.90 117.12 91400024 CJ IND THERAPY 45(38-52)MIN 914 90834 122.00 109.80 118.34 115.90 117.12 91400026 IOP IND THERAPY 45(38-52)MIN 914 90834 115.00 103.50 111.55 109.25 110.4 91400027 DAY TX IND THERAPY 45(38-52) 914 90834 115.00 103.50 111.55 109.25 110.4 91400029 INDIV THERAPY 45(38-52)MIN 914 90834 115.00 103.50 111.55 109.25 110.4 91400043 Hc Indiv Therapy 30(16-37)min 914 90832 60.00 54.00 58.20 57.00 57.6 91400048 Hc Indiv Therapy 60 Min 914 90837 125.00 112.50 121.25 118.75 120 91400049 Hc Cj Ind Therapy 60 Min 914 90837 122.00 109.80 118.34 115.90 117.12 91400050 Hc Day Tx Ind Therapy 60 Min 914 90837 125.00 112.50 121.25 118.75 120 91400051 Hc Iop Ind Therapy 60 Min 914 90837 125.00 112.50 121.25 118.75 120 91400053 Hc Individual Therapy For Telehealth 30 (16-37) Min 914 90832 60.00 54.00 58.20 57.00 57.6 91400054 Hc Individual Therapy For Telehealth 45 (38-52) Min 914 90834 115.00 103.50 111.55 109.25 110.4 91400055 Hc Individual Therapy For Telehealth 60 Min 914 90837 125.00 112.50 121.25 118.75 120 91400056 Hc Cj Individual Therapy For Telehealth 30 (16-37) Min 914 90832 122.00 109.80 118.34 115.90 117.12 91400057 Hc Cj Individual Therapy For Telehealth 45 (38-52) Min 914 90834 122.00 109.80 118.34 115.90 117.12 91400058 Hc Cj Individual Therapy For Telehealth 60 Min 914 90837 122.00 109.80 118.34 115.90 117.12 91500002 CJ IOP GROUP THERAPY 60 MIN 915 90853 31.00 27.90 30.07 29.45 29.76 91500003 CJ IOP LECTURE DIDACTIC 915 90853 27.00 24.30 26.19 25.65 25.92 91500004 CJ IOP LECTURE INTERACTIV GRP 915 90853 31.00 27.90 30.07 29.45 29.76 91500005 CJ IOP GROUP THERAPY 90 MIN 915 90853 31.00 27.90 30.07 29.45 29.76 91500006 CJ DAY TX GRP THERAPY 60 MIN 915 90853 31.00 27.90 30.07 29.45 29.76 91500007 CJ DAY TX LECTURE DIDACTIC 915 90853 42.00 37.80 40.74 39.90 40.32 91500008 CJ DAY TX LECT INTERACTIV GRP 915 90853 42.00 37.80 40.74 39.90 40.32 91500009 LECTURE DIDACTIC 915 90853 55.00 49.50 53.35 52.25 52.8 91500010 Hc Day Tx Lecture Didactic Partial Care 915 90853 55.00 49.50 53.35 52.25 52.8 91500011 IOP LECTURE DIDACTIC 915 90853 55.00 49.50 53.35 52.25 52.8 91500012 CJ DAY TX GRP THERAPY 90 MIN 915 90853 31.00 27.90 30.07 29.45 29.76 91500013 GROUP THERAPY 60 MIN 915 90853 65.00 58.50 63.05 61.75 62.4 91500015 Hc Day Tx Group Therapy 60 Min-partial Care 915 90853 65.00 58.50 63.05 61.75 62.4 91500016 CJ GROUP THERAPY 60 MIN 915 90853 52.00 46.80 50.44 49.40 49.92 91500017 GROUP THERAPY 90 MIN 915 90853 105.00 94.50 101.85 99.75 100.8 91500018 LECTURE INTERACTIVE GROUP 915 90853 105.00 94.50 101.85 99.75 100.8 91500019 Hc Day Tx Group Therapy 90 Min-partial Care 915 90853 105.00 94.50 101.85 99.75 100.8 91500020 IOP GROUP THERAPY 90 MIN 915 90853 105.00 94.50 101.85 99.75 100.8 91500021 Hc Day Tx Lecture Interactive Grp-partial Care 915 90853 105.00 94.50 101.85 99.75 100.8 91500022 IOP LECTURE INTERACTIVE GRP 915 90853 105.00 94.50 101.85 99.75 100.8 91500029 Hc Group Therapy For Telehealth 60 Min 915 90853 65.00 58.50 63.05 61.75 62.4 91600005 FAMILY CONFERENCE 30 MIN 916 90847 75.00 67.50 72.75 71.25 72 91600006 CJ FAMILY CONFERENCE 60 MIN 916 90847 122.00 109.80 118.34 115.90 117.12 91600007 FAMILY CONFERENCE 60 MIN 916 90847 135.00 121.50 130.95 128.25 129.6 91600009 IOP FAMILY CONFERENCE 30 MIN 916 90847 75.00 67.50 72.75 71.25 72 91600017 IOP FAMILY CONFERENCE 60 MIN 916 90847 135.00 121.50 130.95 128.25 129.6 91600018 DAY TX FAMILY CONFERENCE 30MIN 916 90847 75.00 67.50 72.75 71.25 72 91600019 DAY TX FAMILY CONFERENCE 60MIN 916 90847 135.00 121.50 130.95 128.25 129.6 91600020 Hc Family Therapy For Telehealth 30 Min 916 90847 75.00 67.50 72.75 71.25 72 91600021 Hc Family Therapy For Telehealth 60 Min 916 90847 135.00 121.50 130.95 128.25 129.6 91800024 Hc Chrnc Care Mgmt Svc 30 Min 918 99491 249.00 224.10 241.53 236.55 239.04 92000002 ARTERIAL PHLEBOTOMY 920 36600 95.00 85.50 92.15 90.25 91.2 92000004 FETAL MONITORING 920 59025 62.00 55.80 60.14 58.90 59.52 92000011 MULTICHNL SLEEP STUDY UNATTEND 920 95806 " 1,010.00 " 909.00 979.70 959.50 969.6 92000013 POLYSOMNOGRAPHY 920 95810 " 3,633.00 " " 3,269.70 " " 3,524.01 " " 3,451.35 " "3,487.68" 92000014 NASAL CPAP STUDY 920 95811 " 4,131.00 " " 3,717.90 " " 4,007.07 " " 3,924.45 " "3,965.76" 92000015 HOME SLEEP TEST/TYPE 3 PORTA 920 HCPCS G0399 " 1,010.00 " 909.00 979.70 959.50 969.6 92000024 POLYSOMNOGRAPHY SPLIT 920 95811 " 4,131.00 " " 3,717.90 " " 4,007.07 " " 3,924.45 " "3,965.76" 92000025 NON-STRESS TEST 920 59025 320.00 288.00 310.40 304.00 307.2 92100016 CAROTID DUPLEX BILATERAL 921 93880 " 1,367.00 " " 1,230.30 " " 1,325.99 " " 1,298.65 " "1,312.32" 92100017 CAROTID DUPLEX LMT OR UNI 921 93882 " 1,115.00 " " 1,003.50 " " 1,081.55 " " 1,059.25 " "1,070.40" 92100020 ARTERIAL ANKLE ARM INDEX 921 93922 538.00 484.20 521.86 511.10 516.48 92100021 ART SEG STUDY & REAC HYPEREMIA 921 93923 800.00 720.00 776.00 760.00 768 92100022 ART SEG STUDY & EXERCISE LOWER 921 93924 937.00 843.30 908.89 890.15 899.52 92100023 ARTERIAL SCAN LOWER BIL 921 93925 " 1,107.00 " 996.30 " 1,073.79 " " 1,051.65 " "1,062.72" 92100024 ART DUPLEX SCAN LOWER LTD 921 93926 884.00 795.60 857.48 839.80 848.64 92100025 ARTERIAL DUPLEX SCAN BIL UPPER 921 93930 " 1,082.00 " 973.80 " 1,049.54 " " 1,027.90 " "1,038.72" 92100026 ART DUPLEX SCAN UPPER LTD 921 93931 872.00 784.80 845.84 828.40 837.12 92100028 DOPPLER - EXT VENOUS LTD 921 93971 938.00 844.20 909.86 891.10 900.48 92100029 RENAL ARTERY DUPLEX COMPLETE 921 93975 " 1,014.00 " 912.60 983.58 963.30 973.44 92100031 AORTA IVC ILIAC DUPLEX 921 93978 962.00 865.80 933.14 913.90 923.52 92100032 DUPLEX OF HEMODIALYSIS ACCESS 921 93990 621.00 558.90 602.37 589.95 596.16 92100034 ARTERIAL SEGMENTAL UPPER/LOWER 921 93923 800.00 720.00 776.00 760.00 768 92100037 ERIAL ANKLE ARM INDEX EXER 921 93924 937.00 843.30 908.89 890.15 899.52 92100038 ARTERIAL SCAN LOWER LTD 921 93926 884.00 795.60 857.48 839.80 848.64 92100039 VENOUS DUPLEX SCAN BILATERAL 921 93970 " 1,290.00 " " 1,161.00 " " 1,251.30 " " 1,225.50 " "1,238.40" 92100042 VENOUS DUPLEX SCAN UNI LTD 921 93971 964.00 867.60 935.08 915.80 925.44 92100043 VENOUS MAPPING LTD 921 93971 964.00 867.60 935.08 915.80 925.44 92100044 US DOPP ABD PEL SCROT RET 921 93975 742.00 667.80 719.74 704.90 712.32 92100045 DOPP AB PEL SCROT RET LTD 921 93976 584.00 525.60 566.48 554.80 560.64 92200008 Hc Emg With Nerve Conduction 922 95885 100.00 90.00 97.00 95.00 96 92200009 EMG 5+ MUSCLES 922 95886 156.00 140.40 151.32 148.20 149.76 92200010 EMG NON EXTREMITY 922 95887 138.00 124.20 133.86 131.10 132.48 92200012 NERVE CONDUCTION STUDIES 1-2 922 95907 83.00 74.70 80.51 78.85 79.68 92200013 NERVE CONDUCTION STUDIES 5-6 922 95909 127.00 114.30 123.19 120.65 121.92 92200014 NERVE CONDUCTION STUDIES 7-8 922 95910 168.00 151.20 162.96 159.60 161.28 92200015 NERVE CONDUCTION STUDIES 9-10 922 95911 194.00 174.60 188.18 184.30 186.24 92200016 NERVE CONDUCTION STUDIES 13 > 922 95913 216.00 194.40 209.52 205.20 207.36 92200024 NERVE CONDUCTION STUDIES 3-4 922 95908 102.00 91.80 98.94 96.90 97.92 92200025 NERVE CONDUCTION STUDIES 11-12 922 95912 200.00 180.00 194.00 190.00 192 94000001 THERAPEUTIC PHLEBOTOMY 940 99195 195.00 175.50 189.15 185.25 187.2 94000004 Hc Us Wound Assessment Per Day 940 97610 416.00 374.40 403.52 395.20 399.36 94200001 Hc Nutr Ther Initial Dm Ea 15m 942 97802 77.00 69.30 74.69 73.15 73.92 94200002 Hc Nutr Ther Dm Reas 15m 942 97803 42.00 37.80 40.74 39.90 40.32 94200006 IND COMP DM ED/30M 942 HCPCS G0108 48.00 43.20 46.56 45.60 46.08 94200007 GRP COMP DM ED/30M 942 HCPCS G0109 77.00 69.30 74.69 73.15 73.92 94200030 NUTR COUNSEL 30 MIN 761 99201 48.00 43.20 46.56 45.60 46.08 94300001 PHASE IV MONTHLY 943 81.00 72.90 78.57 76.95 77.76 94300002 HEALTHY LIFESTYLES FT MON 943 42.00 37.80 40.74 39.90 40.32 94300003 HEALTHY LIFESTYLES PT MON 943 21.00 18.90 20.37 19.95 20.16 94300004 HEALTHY LIFESTYLES INIT V 943 17.00 15.30 16.49 16.15 16.32 94700002 BED CLINITRON PER DAY 947 275.00 247.50 266.75 261.25 264 94800001 PULM REHAB NON-COPD 948 94799 225.00 202.50 218.25 213.75 216 94800002 PULM REHAB COPD 948 HCPCS G0424 225.00 202.50 218.25 213.75 216 96400002 Hc Crna Insert Emergency Endotrach Airway 964 31500 210.00 189.00 203.70 199.50 201.6 96400003 Hc Crna Vnpnxr <3 Years Phy/qhp Skill Femral/juglar View 964 36400 62.00 55.80 60.14 58.90 59.52 96400004 Hc Crna Vnpnxr 3 Years/> Phys/qhp Skill 964 36410 42.00 37.80 40.74 39.90 40.32 96400005 Hc Crna Withdrawal Of Arterial Blood 964 36600 92.00 82.80 89.24 87.40 88.32 96400006 Hc Crna Spinal Puncture Lumbar Diagnostic 964 62270 297.00 267.30 288.09 282.15 285.12 96400007 Hc Crna Inj Lumb Epidur Blood/clot Patch 964 62273 411.00 369.90 398.67 390.45 394.56 96400008 Hc Crna Njx Dx/ther Sbst Intrlmnr Crv/thrc W/o Img Gdn 964 62320 364.00 327.60 353.08 345.80 349.44 96400009 Hc Crna Njx Dx/ther Sbst Intrlmnr Crv/thrc W/img Gdn 964 62321 515.00 463.50 499.55 489.25 494.4 96400010 Hc Crna Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/o Img Gdn 964 62322 364.00 327.60 353.08 345.80 349.44 96400011 Hc Crna Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/img Gdn 964 62323 515.00 463.50 499.55 489.25 494.4 96400012 Hc Crna Njx Dx/ther Sbst Intrlmnr Crv/thrc W/o Img Gdn 964 62324 364.00 327.60 353.08 345.80 349.44 96400013 Hc Crna Njx Dx/ther Sbst Intrlmnr Crv/thrc W/img Gdn 964 62325 515.00 463.50 499.55 489.25 494.4 96400014 Hc Crna Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/o Img Gdn 964 62326 364.00 327.60 353.08 345.80 349.44 96400015 Hc Crna Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/img Gdn 964 62327 515.00 463.50 499.55 489.25 494.4 96400016 Hc Crna Inj Anes Agent Brachial Plexus Single 964 64415 987.00 888.30 957.39 937.65 947.52 96400017 Hc Crna Inj Anes Agent Sciatic Nerve Single 964 64445 987.00 888.30 957.39 937.65 947.52 96400018 Hc Crna Inj Anes Agent Femoral Nerve Single 964 64447 987.00 888.30 957.39 937.65 947.52 96400019 Hc Anest# Non-timed 964 101.00 90.90 97.97 95.95 96.96 96400020 Hc Crna Us Guide Vascular Access 964 76937 857.00 771.30 831.29 814.15 822.72 98100001 Hc Drain Skin Abscess Simple 981 10060 220.00 198.00 213.40 209.00 211.2 98100002 Hc Drain Skin Abscess Complex 981 10061 382.00 343.80 370.54 362.90 366.72 98100003 Hc Drain Pilonidal Cyst Simple 981 10080 338.00 304.20 327.86 321.10 324.48 98100004 Hc Remove Foreign Body Simple 981 10120 281.00 252.90 272.57 266.95 269.76 98100005 Hc Remove Foreign Body Complex 981 10121 502.00 451.80 486.94 476.90 481.92 98100006 Hc Puncture Drainage Of Lesion 981 10160 240.00 216.00 232.80 228.00 230.4 98100007 Hc Debridement Skin Sub-q Tissue=<20 Sq Cm 981 11042 225.00 202.50 218.25 213.75 216 98100008 Hc Removal Of Skin Tags Up To 15 981 11200 163.00 146.70 158.11 154.85 156.48 98100009 Hc Exc Skin Benig 0.6-1 Cm Remaindr Body 981 11421 291.00 261.90 282.27 276.45 279.36 98100010 Hc Debridement Of Nail(s) 1-5 981 11720 62.00 55.80 60.14 58.90 59.52 98100011 Hc Removal Of Nail Plate 981 11730 203.00 182.70 196.91 192.85 194.88 98100012 Hc Remove Additional Nail Plate 981 11732 61.00 54.90 59.17 57.95 58.56 98100013 Hc Drain Blood From Under Nail 981 11740 95.00 85.50 92.15 90.25 91.2 98100014 Hc Reconstruc Of Nail Bed 981 11760 355.00 319.50 344.35 337.25 340.8 98100015 Hc Excision Of Nail Fold Toe 981 11765 314.00 282.60 304.58 298.30 301.44 98100016 Hc Resuperf Wnd Body <2.5cm 981 12001 164.00 147.60 159.08 155.80 157.44 98100017 Hc Resup Npterf Wnd Body 2.6-7.5 Cm 981 12002 200.00 180.00 194.00 190.00 192 98100018 Hc Resuperf Wnd Body 7.6-12.5 Cm 981 12004 234.00 210.60 226.98 222.30 224.64 98100019 Hc Resuperf Wnd Body 12.6-20 Cm 981 12005 304.00 273.60 294.88 288.80 291.84 98100020 Hc Resuperf Wnd Body 20.1-30 Cm 981 12006 358.00 322.20 347.26 340.10 343.68 98100021 Hc Resuperf Wnd Face <2.5 Cm 981 12011 200.00 180.00 194.00 190.00 192 98100022 Hc Resuperf Wnd Face 2.6-5 Cm 981 12013 209.00 188.10 202.73 198.55 200.64 98100023 Hc Resuperf Wnd Face 5.1-7.5 Cm 981 12014 251.00 225.90 243.47 238.45 240.96 98100024 Hc Resuperf Wnd Face 7.6-12.5 Cm 981 12015 304.00 273.60 294.88 288.80 291.84 98100025 Hc Resuperf Wnd Face 12.6-20 Cm 981 12016 383.00 344.70 371.51 363.85 367.68 98100026 Hc Resuperf Wnd Face 20.1-30 Cm 981 12017 282.00 253.80 273.54 267.90 270.72 98100027 Hc Resuperf Wnd Face >30 Cm 981 12018 319.00 287.10 309.43 303.05 306.24 98100028 Hc Closure Superf Wnd Dehis Simple 981 12020 527.00 474.30 511.19 500.65 505.92 98100029 Hc Layr Clos Wnd Trunk Arm Leg <2.5 Cm 981 12031 450.00 405.00 436.50 427.50 432 98100030 Hc Layr Clos Wnd Trunk Arm Leg 2.6-7.5 Cm 981 12032 558.00 502.20 541.26 530.10 535.68 98100031 Hc Layr Clos Wnd Trunk Arm Leg 7.6-12.5 Cm 981 12034 585.00 526.50 567.45 555.75 561.6 98100032 Hc Layr Clos Wnd Trunk Arm Leg 12.6-20 Cm 981 12035 703.00 632.70 681.91 667.85 674.88 98100033 Hc Layr Clos Wnd Rest Body <2.5 Cm 981 12041 451.00 405.90 437.47 428.45 432.96 98100034 Hc Layr Clos Wnd Rest Body 2.6-7.5 Cm 981 12042 543.00 488.70 526.71 515.85 521.28 98100035 Hc Layr Clos Wnd Face Facial <2.5 Cm 981 12051 487.00 438.30 472.39 462.65 467.52 98100036 Hc Layr Clos Wnd Face Facial 2.5-5 Cm 981 12052 552.00 496.80 535.44 524.40 529.92 98100037 Hc Layr Clos Wnd Face Facial 5.1-7.5 Cm 981 12053 646.00 581.40 626.62 613.70 620.16 98100038 Hc Layr Clos Wnd Face Facial 12.6-20 Cm 981 12055 875.00 787.50 848.75 831.25 840 98100039 Hc Recmpl Wnd Scalp Extr 1.1-2.5 Cm 981 13120 651.00 585.90 631.47 618.45 624.96 98100040 Hc Recmpl Wnd Scalp Extr 2.6-7.5 Cm 981 13121 792.00 712.80 768.24 752.40 760.32 98100041 Hc Rep Skin Scalp/extrem+5 Cm/< 981 13122 243.00 218.70 235.71 230.85 233.28 98100042 Hc Recmpl Wnd Head Fac Hand 2.6-7.5 Cm 981 13132 882.00 793.80 855.54 837.90 846.72 98100043 Hc Repr Face Genital Hand Ft+5 Cmcm/< 981 13133 326.00 293.40 316.22 309.70 312.96 98100044 Hc Recmpl Wnd Lid Nos Ear 2.5-7.5 Cm 981 13152 935.00 841.50 906.95 888.25 897.6 98100045 Hc Initial Rx Burn(s) 1st Degree 981 16000 130.00 117.00 126.10 123.50 124.8 98100046 Hc Dress/debrid Small Burn No Anes 981 16020 150.00 135.00 145.50 142.50 144 98100047 Hc Dress/debrid Large Burn No Anesth 981 16030 347.00 312.30 336.59 329.65 333.12 98100048 Hc Inject Trigger Point 1 Or 2 981 20552 103.00 92.70 99.91 97.85 98.88 98100049 Hc Inject Trigger Points > 3 981 20553 118.00 106.20 114.46 112.10 113.28 98100050 Hc Arthrocentesis Aspir&/inj Small Jt/bursa W/o Us 981 20600 90.00 81.00 87.30 85.50 86.4 98100051 Hc Arthrocentesis Aspir&/inj Interm Jt/burs W/o Us 981 20605 94.00 84.60 91.18 89.30 90.24 98100052 Hc Arthrocentesis Aspir&/inj Major Jt/bursa W/o Us 981 20610 110.00 99.00 106.70 104.50 105.6 98100053 Hc Closed Rx Mandible Fx+manipulatn 981 21451 " 1,399.00 " " 1,259.10 " " 1,357.03 " " 1,329.05 " "1,343.04" 98100054 Hc Closed Rx Clavicle Fracture 981 23500 401.00 360.90 388.97 380.95 384.96 98100055 Hc Closed Rx Scapula Fx Manipulatn 981 23575 738.00 664.20 715.86 701.10 708.48 98100056 Hc Closed Rx Prox Humerus Fracture 981 23600 601.00 540.90 582.97 570.95 576.96 98100057 Hc Closed Rx Gr Tuberosity Hum Fx 981 23620 491.00 441.90 476.27 466.45 471.36 98100058 Hc Closed Rx Shldr Dislocation 981 23650 587.00 528.30 569.39 557.65 563.52 98100059 Hc Closed Rx Shldr Disloc Anesthesia 981 23655 739.00 665.10 716.83 702.05 709.44 98100060 Hc Incis/drain Arm/elbow Infect Bursa 981 23931 527.00 474.30 511.19 500.65 505.92 98100061 Hc Closed Rx Elbow Dislocation 981 24600 681.00 612.90 660.57 646.95 653.76 98100062 Hc Closed Rx Elbow Dislocatn Anesthesia 981 24605 866.00 779.40 840.02 822.70 831.36 98100063 Hc Closed Rx Radial Head Disloc Child 981 24640 189.00 170.10 183.33 179.55 181.44 98100064 Hc Closed Rx Radial Head/neck Fx 981 24650 479.00 431.10 464.63 455.05 459.84 98100065 Hc Closed Rx Rad/ulna Shaft Fx Manip 981 25565 945.00 850.50 916.65 897.75 907.2 98100066 Hc Closed Rx Dist Rad/ulna Fx 981 25600 604.00 543.60 585.88 573.80 579.84 98100067 Hc Closed Rx Dist Rad/ulna Fx Manipul 981 25605 991.00 891.90 961.27 941.45 951.36 98100068 Hc Drain Finger Abscess Simple 981 26010 500.00 450.00 485.00 475.00 480 98100069 Hc Repair Exten Tendon Dorsum Hand Ea 981 26410 " 1,018.00 " 916.20 987.46 967.10 977.28 98100070 Hc Closed Rx Metacarpal Fx Manip 981 26605 593.00 533.70 575.21 563.35 569.28 98100071 Hc Treat Thumb Disloc Manipulatn 981 26641 694.00 624.60 673.18 659.30 666.24 98100072 Hc Closed Rx Carpometacar Disloc Non-thumb 981 26670 636.00 572.40 616.92 604.20 610.56 98100073 Hc Closed Rx Mc-p Disloc 981 26700 606.00 545.40 587.82 575.70 581.76 98100074 Hc Close Rx Prox/mid Fing Shft Fx 981 26720 362.00 325.80 351.14 343.90 347.52 98100075 "Hc Close Rx Prox/mid Fing Shft Fx,manip" 981 26725 621.00 558.90 602.37 589.95 596.16 98100076 Hc Close Rx Fingr Articular Fx 981 26740 421.00 378.90 408.37 399.95 404.16 98100077 Hc Close Rx Dist Fingr Fx 981 26750 339.00 305.10 328.83 322.05 325.44 98100078 Hc Close Rx Dist Fingr Fx Manipulatn 981 26755 579.00 521.10 561.63 550.05 555.84 98100079 Hc Closed Rx Ip Jt Dislocation 981 26770 514.00 462.60 498.58 488.30 493.44 98100080 Hc Closed Rx Ip Jt Dislocation Anesth 981 26775 706.00 635.40 684.82 670.70 677.76 98100081 Hc Closed Rx Traumatic Hip Dislocatn 981 27250 334.00 300.60 323.98 317.30 320.64 98100082 Hc Closed Rx Post Hip Arthrplas Disloc 981 27265 742.00 667.80 719.74 704.90 712.32 98100083 Hc Closed Tx Bimalleolar Ankle Fracture W/o Manip 981 27808 612.00 550.80 593.64 581.40 587.52 98100084 Hc Closed Rx Trimalleolar Fx Manip 981 27818 894.00 804.60 867.18 849.30 858.24 98100085 Hc Remv Foot Foreign Body Subcutaneous 981 28190 479.00 431.10 464.63 455.05 459.84 98100086 Hc Closed Rx Talus Fx Manipulatn 981 28435 666.00 599.40 646.02 632.70 639.36 98100087 Hc Closed Rx Big Toe Fracture 981 28490 267.00 240.30 258.99 253.65 256.32 98100088 Hc Closed Rx Toe Fx 981 28510 228.00 205.20 221.16 216.60 218.88 98100089 Hc Apply Long Arm Cast 981 29065 175.00 157.50 169.75 166.25 168 98100090 Hc Apply Forearm Cast 981 29075 158.00 142.20 153.26 150.10 151.68 98100091 Hc Apply Hand/wrist Cast 981 29085 174.00 156.60 168.78 165.30 167.04 98100092 Hc Apply Long Arm Splint 981 29105 151.00 135.90 146.47 143.45 144.96 98100093 Hc Apply Forearm Splint Static 981 29125 118.00 106.20 114.46 112.10 113.28 98100094 Hc Apply Finger Splint Static 981 29130 76.00 68.40 73.72 72.20 72.96 98100095 Hc Strapping Of Shoulder 981 29240 58.00 52.20 56.26 55.10 55.68 98100096 Hc Strapping Of Elbow Or Wrist 981 29260 56.00 50.40 54.32 53.20 53.76 98100097 Hc Strapping Of Hand Or Finger 981 29280 57.00 51.30 55.29 54.15 54.72 98100098 Hc Apply Long Leg Cast 981 29345 247.00 222.30 239.59 234.65 237.12 98100099 Hc Apply Long Leg Cast Walker 981 29355 258.00 232.20 250.26 245.10 247.68 98100100 Hc Apply Short Leg Cast 981 29405 148.00 133.20 143.56 140.60 142.08 98100101 Hc Addition Of Walker To Cast 981 29440 82.00 73.80 79.54 77.90 78.72 98100102 Hc Apply Long Leg Splint 981 29505 157.00 141.30 152.29 149.15 150.72 98100103 Hc Apply Lower Leg Splint 981 29515 132.00 118.80 128.04 125.40 126.72 98100104 Hc Remove Nasal Foreign Body 981 30300 340.00 306.00 329.80 323.00 326.4 98100105 Hc Ctrl Nosebleed Anter Simple 981 30901 253.00 227.70 245.41 240.35 242.88 98100106 Hc Ctrl Nosebleed Anter Complex 981 30903 398.00 358.20 386.06 378.10 382.08 98100107 Hc Insert Emergency Endotrach Airway 981 31500 267.00 240.30 258.99 253.65 256.32 98100108 Hc Rmvl Tun Ctr Vad W/subq Port/pmp Ctr/prph Insj 981 36590 407.00 366.30 394.79 386.65 390.72 98100109 Hc Insert Needle Intraosseous Infusn 981 36680 109.00 98.10 105.73 103.55 104.64 98100110 Hc Repair Lip Full Thick Vermilion 981 40650 841.00 756.90 815.77 798.95 807.36 98100111 Hc Drain Mouth Absc/cyst/hematoma Simpl 981 40800 392.00 352.80 380.24 372.40 376.32 98100112 Hc Perq Replacement Gtube Not Req Revj Gstrst Trc 981 43762 407.00 366.30 394.79 386.65 390.72 98100113 Hc Drainage Of Deep Rectal Abscess 981 45020 " 1,048.00 " 943.20 " 1,016.56 " 995.60 "1,006.08" 98100114 Hc I&d Perirectal Abscess 981 46040 987.00 888.30 957.39 937.65 947.52 98100115 Hc I&d Perianal Abscess Superficial 981 46050 384.00 345.60 372.48 364.80 368.64 98100116 Hc Incise External Hemorrhoid 981 46083 337.00 303.30 326.89 320.15 323.52 98100117 Hc Abdom Paracentesis Dx/ther W Imaging Guidance 981 49083 550.00 495.00 533.50 522.50 528 98100118 Hc Insert Non-indwelling Bladder Catheter 981 51701 83.00 74.70 80.51 78.85 79.68 98100119 Hc Insert Temp Indwelling Blad Cath Simple 981 51702 115.00 103.50 111.55 109.25 110.4 98100120 Hc Meas Post-void Res Us Non-imaging 981 51798 23.00 20.70 22.31 21.85 22.08 98100121 Hc Obstetrical Care Vag Deliv Only 981 59409 " 1,457.00 " " 1,311.30 " " 1,413.29 " " 1,384.15 " "1,398.72" 98100122 Hc Deliver Placenta 981 59414 164.00 147.60 159.08 155.80 157.44 98100123 Hc Spinal Puncture Lumbar Diagnostic 981 62270 273.00 245.70 264.81 259.35 262.08 98100124 Hc Inject Nerv Blck Trigeminal 981 64400 247.00 222.30 239.59 234.65 237.12 98100125 Hc Inject Nerv Blck Othr Periph Nerv 981 64450 143.00 128.70 138.71 135.85 137.28 98100126 Hc Remv F.b. Eye Superf Conjunc 981 65205 86.00 77.40 83.42 81.70 82.56 98100127 Hc Remv F.b. Eye Cornea No Slit 981 65220 110.00 99.00 106.70 104.50 105.6 98100128 Hc Remove Eyelid Foreign Body Embedded 981 67938 469.00 422.10 454.93 445.55 450.24 98100129 Hc Remv Ext Canal Foreign Body 981 69200 150.00 135.00 145.50 142.50 144 98100130 Hc Removal Impacted Cerumen Instrumentation Unilat 981 69210 87.00 78.30 84.39 82.65 83.52 98100131 Hc Heart/lung Resuscitation (cpr) 981 92950 586.00 527.40 568.42 556.70 562.56 98100132 Hc Debridement Open Wound 20 Sq Cm< 981 97597 165.00 148.50 160.05 156.75 158.4 98100133 Hc Emergency Department Visit Limited/minor Prob 981 99281 40.00 36.00 38.80 38.00 38.4 98100134 Hc Emergency Department Visit Low/moder Severity 981 99282 78.00 70.20 75.66 74.10 74.88 98100135 Hc Emergency Department Visit Moderate Severity 981 99283 116.00 104.40 112.52 110.20 111.36 98100136 Hc Emergency Department Visit High/urgent Severity 981 99284 221.00 198.90 214.37 209.95 212.16 98100137 Hc Emergency Dept Visit High Severity&threat Func 981 99285 325.00 292.50 315.25 308.75 312 98100138 Hc Critical Care E/m 30-74 Minutes 981 99291 517.00 465.30 501.49 491.15 496.32 98100139 Hc Critical Care Addl 30 Min 981 99292 229.00 206.10 222.13 217.55 219.84 98100140 Hc Drainage Of Hematoma/fluid 981 10140 309.00 278.10 299.73 293.55 296.64 98100141 Hc Exc Skin Benig 1.1-2 Cm Trunk Arm Leg 981 11402 308.00 277.20 298.76 292.60 295.68 98100142 Hc Removal Of Nail Bed 981 11750 290.00 261.00 281.30 275.50 278.4 98100143 Hc Layr Clos Wnd Rest Body 7.6-12.5 Cm 981 12044 672.00 604.80 651.84 638.40 645.12 98100144 Hc Layr Clos Wnd Rest Body 12.6-20 Cm 981 12045 739.00 665.10 716.83 702.05 709.44 98100145 Hc Layr Clos Wnd Face Facial 7.6-12.5 Cm 981 12054 675.00 607.50 654.75 641.25 648 98100146 Hc Recmpl Wnd Trunk 1.1-2.5 Cm 981 13100 624.00 561.60 605.28 592.80 599.04 98100147 Hc Recmpl Wnd Trunk 2.6-7.5 Cm 981 13101 735.00 661.50 712.95 698.25 705.6 98100148 Hc Rep Skin Trunk Cmplx +5 Cm/< 981 13102 222.00 199.80 215.34 210.90 213.12 98100149 Hc Recmpl Wnd Head Fac Hand 1.1-2.5 Cm 981 13131 716.00 644.40 694.52 680.20 687.36 98100150 Hc Recmpl Wnd Lid Nos Ear 1.1-2.5 Cm 981 13151 783.00 704.70 759.51 743.85 751.68 98100151 Hc Repr Eyelid Nose Ear Lip+5 Cm 981 13153 354.00 318.60 343.38 336.30 339.84 98100152 Hc Removal Of Foreign Body 981 20520 380.00 342.00 368.60 361.00 364.8 98100153 Hc Arthrocnt Aspir&/inj Small Jt/bursa W Us Rec Rprt 981 20604 137.00 123.30 132.89 130.15 131.52 98100154 Hc Arthrocentesis Aspir&/inj Interm Jt/burs W Us 981 20606 151.00 135.90 146.47 143.45 144.96 98100155 Hc Arthrocentesis Aspir&/inj Major Jt/bursa W Us 981 20611 169.00 152.10 163.93 160.55 162.24 98100156 Hc Closed Rx Nose Fracture Wo Manipulation 981 21310 243.00 218.70 235.71 230.85 233.28 98100157 Hc Closed Rx Nose Fracture Wo Stabilization 981 21315 506.00 455.40 490.82 480.70 485.76 98100158 Hc Reduce Temporomandibl Disloc 981 21480 198.00 178.20 192.06 188.10 190.08 98100159 Hc Closed Rx A-c Jt Disloc Manipulatn 981 23545 639.00 575.10 619.83 607.05 613.44 98100160 Hc Closed Rx Mid Humerus Fracture 981 24500 655.00 589.50 635.35 622.25 628.8 98100161 Hc Closed Tx Ulnar Fracture Prox End Wo Manipulate 981 24670 532.00 478.80 516.04 505.40 510.72 98100162 Hc Closed Tx Ulnar Fracture Prox End W Manipulation 981 24675 839.00 755.10 813.83 797.05 805.44 98100163 Hc Closed Rx Radial Shaft Fx 981 25500 507.00 456.30 491.79 481.65 486.72 98100164 Hc Closed Rx Radial Shaft Fx Manipulatn 981 25505 919.00 827.10 891.43 873.05 882.24 98100165 Hc Closed Rx Ulna Shaft Fx 981 25530 479.00 431.10 464.63 455.05 459.84 98100166 Hc Closed Rx Ulna Shaft Fx Manipulatn 981 25535 897.00 807.30 870.09 852.15 861.12 98100167 Hc Closed Rx Rad/ulna Shaft Fx 981 25560 517.00 465.30 501.49 491.15 496.32 98100168 Hc Closed Rx Ulna Styloid Fx 981 25650 592.00 532.80 574.24 562.40 568.32 98100169 Hc Closed Rx Radio-ulna Dislocation 981 25675 808.00 727.20 783.76 767.60 775.68 98100170 Hc Drain Finger Abscess Complicated 981 26011 739.00 665.10 716.83 702.05 709.44 98100171 Hc Closed Rx Metacarpal Fx 981 26600 540.00 486.00 523.80 513.00 518.4 98100172 Hc Treat Thumb Fx/disloc Manip 981 26645 785.00 706.50 761.45 745.75 753.6 98100173 Hc Close Rx Fingr Articular Fx Manip 981 26742 682.00 613.80 661.54 647.90 654.72 98100174 Hc Closed Rx Trauma Hip Disloc Anesth 981 27252 " 1,387.00 " " 1,248.30 " " 1,345.39 " " 1,317.65 " "1,331.52" 98100175 Hc Closed Rx Spontaneous Hip Disloc 981 27256 562.00 505.80 545.14 533.90 539.52 98100176 Hc Closed Rx Spont Hip Disloc Anesth 981 27257 664.00 597.60 644.08 630.80 637.44 98100177 Hc Closed Rx Post Hip Fix Disloc Anesth 981 27266 " 1,065.00 " 958.50 " 1,033.05 " " 1,011.75 " "1,022.40" 98100178 Hc Closed Rx Knee Dislocatn 981 27550 952.00 856.80 923.44 904.40 913.92 98100179 Hc Closed Rx Knee Disloc+anesth 981 27552 " 1,150.00 " " 1,035.00 " " 1,115.50 " " 1,092.50 " "1,104.00" 98100180 Hc Closed Rx Tibia Shaft Fx 981 27750 633.00 569.70 614.01 601.35 607.68 98100181 Hc Closed Rx Tibia Shaft Fx Manipulatn 981 27752 981.00 882.90 951.57 931.95 941.76 98100182 Hc Closed Rx Med Malleolus Fx 981 27760 612.00 550.80 593.64 581.40 587.52 98100183 Hc Closed Treatment Pst Malleolus Fracture Wo Manip 981 27767 519.00 467.10 503.43 493.05 498.24 98100184 Hc Closed Rx Prox/shaft Fibula Fx 981 27780 560.00 504.00 543.20 532.00 537.6 98100185 Hc Closed Rx Dist Fibula Fx 981 27786 577.00 519.30 559.69 548.15 553.92 98100186 Hc Closed Rx Trimalleolar Fx 981 27816 596.00 536.40 578.12 566.20 572.16 98100187 Hc Closed Rx Ankle Dislocatn 981 27840 691.00 621.90 670.27 656.45 663.36 98100188 Hc Closed Rx Metatarsal Fx 981 28470 405.00 364.50 392.85 384.75 388.8 98100189 Hc Closed Rx Talotarsal Disloc Anesth 981 28575 676.00 608.40 655.72 642.20 648.96 98100190 Hc Closed Rx I-p Jt Toe Dislocation 981 28660 220.00 198.00 213.40 209.00 211.2 98100191 Hc Closed Rx I-p Jt Toe Disloc Anesth 981 28665 291.00 261.90 282.27 276.45 279.36 98100192 Hc Apply Forearm Splint Dynamic 981 29126 142.00 127.80 137.74 134.90 136.32 98100193 Hc Apply Finger Splint Dynamic 981 29131 95.00 85.50 92.15 90.25 91.2 98100194 Hc Apply Short Leg Cast Walker 981 29425 143.00 128.70 138.71 135.85 137.28 98100195 Hc Strapping Of Knee 981 29530 57.00 51.30 55.29 54.15 54.72 98100196 Hc Strapping Ankle And Or Foot 981 29540 54.00 48.60 52.38 51.30 51.84 98100197 Hc Strapping Of Toes 981 29550 36.00 32.40 34.92 34.20 34.56 98100198 Hc Strapping Unna Boot 981 29580 115.00 103.50 111.55 109.25 110.4 98100199 Hc Drain Abscess/hematoma Nasal 981 30000 441.00 396.90 427.77 418.95 423.36 98100200 Hc Ctrl Nosebleed Post W Packs And Or Caut 981 30905 605.00 544.50 586.85 574.75 580.8 98100201 Hc Repeat Control Of Nosebleed 981 30906 633.00 569.70 614.01 601.35 607.68 98100202 Hc Thoracentesis Needle/cath Pleura Wo Imaging 981 32554 391.00 351.90 379.27 371.45 375.36 98100203 Hc Thoracentesis Needle/cath Pleura Wimaging 981 32555 556.00 500.40 539.32 528.20 533.76 98100204 Hc Perq Drainage Pleura Insert Cath Wo Imaging 981 32556 " 1,127.00 " " 1,014.30 " " 1,093.19 " " 1,070.65 " "1,081.92" 98100205 Hc Repair Lip <1/2 Vert Height 981 40652 920.00 828.00 892.40 874.00 883.2 98100206 Hc Repair Lip >1/2 Vert Height 981 40654 " 1,062.00 " 955.80 " 1,030.14 " " 1,008.90 " "1,019.52" 98100207 Hc Removal Foreign Body Mouth Simple 981 40804 354.00 318.60 343.38 336.30 339.84 98100208 Hc Repair Mouth Laceration <2.5 Cm 981 40830 503.00 452.70 487.91 477.85 482.88 98100209 Hc Repair Mouth Laceration >2.5 Cm 981 40831 642.00 577.80 622.74 609.90 616.32 98100210 Hc Drainage Of Gum Lesion 981 41800 536.00 482.40 519.92 509.20 514.56 98100211 Hc Inc/drain Peritonsil Abscess 981 42700 351.00 315.90 340.47 333.45 336.96 98100212 Hc Remove Pharynx Foreign Body 981 42809 372.00 334.80 360.84 353.40 357.12 98100213 Hc Reposition Gastric Feeding Tube Thru Duodenum 981 43761 224.00 201.60 217.28 212.80 215.04 98100214 Hc Sigmoidoscopy Flx W Rmvl Foreign Body 981 45332 475.00 427.50 460.75 451.25 456 98100215 Hc Abdom Paracentesis Dx/ther Wo Imaging Guidance 981 49082 367.00 330.30 355.99 348.65 352.32 98100216 Hc Anoscopy Dx W Collj Spec Br/wa Spx When Prfrmd 981 46600 175.00 157.50 169.75 166.25 168 98100217 Hc Change Of Bladder Tube Simple 981 51705 174.00 156.60 168.78 165.30 167.04 98100218 Hc I&d Bartholin Gland Abscess 981 56420 251.00 225.90 243.47 238.45 240.96 98100219 Hc Marsup Bartholin Gland Cyst 981 56440 336.00 302.40 325.92 319.20 322.56 98100220 Hc Inject Nerv Blck Facial Nerv 981 64402 270.00 243.00 261.90 256.50 259.2 98100221 Hc Inject Anes/steroid Foramen Cerv/thoracic W Img Guide 1 Level 981 64479 455.00 409.50 441.35 432.25 436.8 98100222 Hc Inject Anes/steroid Foramen Lumbar/sacral W Img Guide 1 Level 981 64483 421.00 378.90 408.37 399.95 404.16 98100223 Hc Remv Fb Eye Embed Conjunc 981 65210 105.00 94.50 101.85 99.75 100.8 98100224 Hc Remv Fb Eye Cornea Slit Lamp 981 65222 128.00 115.20 124.16 121.60 122.88 98100225 Hc Suture Eyelid Wound Partial Thick 981 67930 684.00 615.60 663.48 649.80 656.64 98100226 Hc Suture Eyelid Wound Full Thick 981 67935 " 1,111.00 " 999.90 " 1,077.67 " " 1,055.45 " "1,066.56" 98100227 Hc Removal Impacted Cerumen Irrigation/lvg Unilat 981 69209 25.00 22.50 24.25 23.75 24 98100228 Hc Cardioversion Elective Arrhythmia External 981 92960 298.00 268.20 289.06 283.10 286.08 98100229 Hc Ambulatory Eeg Monitoring 981 95950 539.00 485.10 522.83 512.05 517.44 98100230 Hc Mod Sed Same Phys/qhp Initial 15 Mins 5/> Yrs 981 99152 94.00 84.60 91.18 89.30 90.24 98100231 Hc Wound Closure By Adhesive 981 HCPCS G0168 144.00 129.60 139.68 136.80 138.24 98100232 Hc Nervous System Surgery Unlisted 981 64999 250.00 225.00 242.50 237.50 240 98200001 Hc Esophagogastroduodenoscopy Transoral Diagnostic 982 43235 493.00 443.70 478.21 468.35 473.28 98200002 Hc Egd Transoral Biopsy Single/multiple 982 43239 659.00 593.10 639.23 626.05 632.64 98200003 Hc Sigmoidoscopy Flx Dx W/collj Spec Br/wa If Pfrmd 982 45330 315.00 283.50 305.55 299.25 302.4 98200004 Hc Sigmoidoscopy Biopsy 982 45331 491.00 441.90 476.27 466.45 471.36 98200005 Hc Sigmoidoscopy Flx W Rmvl Tumor By Hot Bx Forceps 982 45333 559.00 503.10 542.23 531.05 536.64 98200006 Hc Colonoscopy Flx Dx W Collj Spec When Pfrmd 982 45378 594.00 534.60 576.18 564.30 570.24 98200007 Hc Colonoscopy W Biopsy Single/multiple 982 45380 764.00 687.60 741.08 725.80 733.44 98200008 Hc Colsc Flx W Removal Lesion By Hot Bx Forceps 982 45384 847.00 762.30 821.59 804.65 813.12 98200009 Hc Colsc Flx W Rmvl Of Tumor Polyp Lesion Snare Tq 982 45385 802.00 721.80 777.94 761.90 769.92 98200010 Hc Anoscopy Dx W Collj Spec Br/wa Spx When Prfrmd 982 46600 175.00 157.50 169.75 166.25 168 98200011 Hc Anoscopy Remove Lesn Forceps/cauter 982 46610 442.00 397.80 428.74 419.90 424.32 98200012 Hc Anoscopy Remove Lesn Snare 982 46611 350.00 315.00 339.50 332.50 336 98200013 Hc Anoscopy Remove Lesions 982 46612 535.00 481.50 518.95 508.25 513.6 98200014 Hc Removal Of Sperm Duct(s) 982 55250 693.00 623.70 672.21 658.35 665.28 98200015 Hc Colposcopy Entire Vagina 982 57420 222.00 199.80 215.34 210.90 213.12 98200016 Hc Colposcopy Entire Vagina W Biopsy(s) 982 57421 298.00 268.20 289.06 283.10 286.08 98200017 Hc Colposcopy Cervix W Adj Vagina 982 57452 210.00 189.00 203.70 199.50 201.6 98200018 Hc Colposc Cervix W Adj Vag W Bx And Curretag 982 57454 291.00 261.90 282.27 276.45 279.36 98200019 Hc Colposcopy Cervix W Adj Vagina W Bx 982 57455 273.00 245.70 264.81 259.35 262.08 98200020 Hc Colposcopy Cervix W Adj Vagina Curettag 982 57456 257.00 231.30 249.29 244.15 246.72 98200021 Hc Hysteroscopy Dx Sep Proc 982 58555 545.00 490.50 528.65 517.75 523.2 98200022 Hc Hysteroscopy W Endo Bx 982 58558 " 2,513.00 " " 2,261.70 " " 2,437.61 " " 2,387.35 " "2,412.48" 98200023 Hc Obstetrical Care Vag Deliv Only 982 59409 " 1,457.00 " " 1,311.30 " " 1,413.29 " " 1,384.15 " "1,398.72" 98200024 Hc Surg Rx Incomplete Abortn 982 59812 585.00 526.50 567.45 555.75 561.6 98200025 Hc Surg Rx Missed Abortn 1st Tri 982 59820 704.00 633.60 682.88 668.80 675.84 98200026 Hc Surg Rx Missed Abortn 2nd Tri 982 59821 704.00 633.60 682.88 668.80 675.84 98200027 Hc Evacuate Mole Of Uterus 982 59870 878.00 790.20 851.66 834.10 842.88 98200028 Hc Colorectal Scrn Hi Risk Ind 982 HCPCS G0105 594.00 534.60 576.18 564.30 570.24 98200029 Hc Colon Ca Scrn Not Hi Rsk Ind 982 HCPCS G0121 594.00 534.60 576.18 564.30 570.24 98200030 Hc Cv Strs Tst Xers&/or Rx Cont Ecg W/o I&r 982 93016 43.00 38.70 41.71 40.85 41.28 98300001 Hc Puncture Drainage Of Lesion 983 10160 240.00 216.00 232.80 228.00 230.4 98300002 Hc Exc Skin Benig 1.1-2 Cm Remaindr Body 983 11422 327.00 294.30 317.19 310.65 313.92 98300003 Hc Inject Tendon Sheath/ligament 983 20550 98.00 88.20 95.06 93.10 94.08 98300004 Hc Inject Tendon Origin/insert 983 20551 100.00 90.00 97.00 95.00 96 98300005 Hc Inject Trigger Point 1 Or 2 983 20552 103.00 92.70 99.91 97.85 98.88 98300006 Hc Inject Trigger Points > 3 983 20553 118.00 106.20 114.46 112.10 113.28 98300007 Hc Arthrocentesis Aspir&/inj Small Jt/bursa W/o Us 983 20600 90.00 81.00 87.30 85.50 86.4 98300008 Hc Arthrocnt Aspir&/inj Small Jt/bursaw/us Rec Rprt 983 20604 137.00 123.30 132.89 130.15 131.52 98300009 Hc Arthrocentesis Aspir&/inj Interm Jt/burs W/o Us 983 20605 94.00 84.60 91.18 89.30 90.24 98300010 Hc Arthrocentesis Aspir&/inj Interm Jt/burs W/us 983 20606 151.00 135.90 146.47 143.45 144.96 98300011 Hc Arthrocentesis Aspir&/inj Major Jt/bursa W/o Us 983 20610 110.00 99.00 106.70 104.50 105.6 98300012 Hc Arthrocentesis Aspir&/inj Major Jt/bursa W/us 983 20611 169.00 152.10 163.93 160.55 162.24 98300013 Hc Aspirat/injection Ganglion Cyst(s) 983 20612 111.00 99.90 107.67 105.45 106.56 98300014 Hc Injection Sacroiliac Joint 983 27096 299.00 269.10 290.03 284.05 287.04 98300015 Hc Inject Anes/steroid Plantar Common Digital Nerve 983 64455 90.00 81.00 87.30 85.50 86.4 98300016 Hc Us Lmtd Joint/oth Nonvasc Xtr Strux R-t W/img 983 76882 104.00 93.60 100.88 98.80 99.84 98300017 Hc Sono Guide Needle Biopsy 983 76942 105.00 94.50 101.85 99.75 100.8 98300018 Hc Office Outpatient New 10 Minutes 983 99201 84.00 75.60 81.48 79.80 80.64 98300019 Hc Office Outpatient New 20 Minutes 983 99202 141.00 126.90 136.77 133.95 135.36 98300020 Hc Office Outpatient New 30 Minutes 983 99203 200.00 180.00 194.00 190.00 192 98300021 Hc Office Outpatient New 45 Minutes 983 99204 305.00 274.50 295.85 289.75 292.8 98300022 Hc Office Outpatient New 60 Minutes 983 99205 384.00 345.60 372.48 364.80 368.64 98300023 Hc Office Outpatient Visit 5 Minutes 983 99211 42.00 37.80 40.74 39.90 40.32 98300024 Hc Office Outpatient Visit 10 Minutes 983 99212 83.00 74.70 80.51 78.85 79.68 98300025 Hc Office Outpatient Visit 15 Minutes 983 99213 138.00 124.20 133.86 131.10 132.48 98300026 Hc Office Outpatient Visit 25 Minutes 983 99214 203.00 182.70 196.91 192.85 194.88 98300027 Hc Office Outpatient Visit 40 Minutes 983 99215 272.00 244.80 263.84 258.40 261.12 98300028 Hc Inject Carpal Tunnel 983 20526 141.00 126.90 136.77 133.95 135.36 98300030 HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 983 21932 " 1,201.00 " " 1,080.90 " " 1,164.97 " " 1,140.95 " "1,152.96" 98300031 HC RECMPL WND TRUNK 1.1-2.5 CM 983 13100 624.00 561.60 605.28 592.80 599.04 98500001 Hc Electrocardiogram Report 985 93010 16.00 14.40 15.52 15.20 15.36 98700001 Hc Observation Care Discharge Management 987 99217 137.00 123.30 132.89 130.15 131.52 98700002 Hc Initial Observation Care/day 30 Minutes 987 HCPCS 99218 187.00 168.30 181.39 177.65 179.52 98700003 Hc Initial Observation Care/day 50 Minutes 987 99219 256.00 230.40 248.32 243.20 245.76 98700007 Hc Sbsq Observation Care/day 25 Minutes 987 99225 138.00 124.20 133.86 131.10 132.48 98700008 Hc Sbsq Observation Care/day 35 Minutes 987 99226 198.00 178.20 192.06 188.10 190.08 98700011 Hc Observation/inpatient Hospital Care 50 Minutes 987 99235 319.00 287.10 309.43 303.05 306.24 98700014 Hc Initial Observation Care/day 70 Minutes 987 99220 350.00 315.00 339.50 332.50 336 98700015 Hc Sbsq Observation Care/day 15 Minutes 987 99224 75.00 67.50 72.75 71.25 72 98700016 Hc Observation/inpatient Hospital Care 40 Minutes 987 99234 250.00 225.00 242.50 237.50 240 98700017 Hc Observation/inpatient Hospital Care 55 Minutes 987 99236 411.00 369.90 398.67 390.45 394.56 98700018 Hc Thoracentesis Needle/cath Pleura Wo Imaging 987 32554 391.00 351.90 379.27 371.45 375.36 98700019 Hc Thoracentesis Needle/cath Pleura W Imaging 987 32555 556.00 500.40 539.32 528.20 533.76