BCBS Midlands Choice UHC Aetna Cigna Trustmark Tricare/Champ VA IP Tricare/Champ VA OP GEHA Allied Benefit Health Self Pay Procedure Master # Procedure Record Name Revenue Code CPT Code Gross Charge Payer 1 Negotiated Fee Payer 2 Negotiated Fee Payer 3 Negotiated Fee Payer 4 Negotiated Fee Payer 5 Negotiated Fee Payer 6 Negotiated Fee Payer 8 Negotiated Fee Payer 8 Negotiated Fee Payer 9 Negotiated Fee Payer 10 Negotiated Fee Payer 10 Negotiated Fee 11100001 HC R&B PRIVATE 111 " 1,281.00 " " 1,229.76 " " 1,229.76 " " 1,216.95 " " 1,191.33 " " 1,229.76 " " 1,191.33 " 891.96 601.17 " 1,216.95 " " 1,191.33 " 845.46 11100002 HC R&B SNF PRIVATE 111 " 1,087.00 " " 1,043.52 " " 1,043.52 " " 1,032.65 " " 1,010.91 " " 1,043.52 " " 1,010.91 " 756.88 510.13 " 1,032.65 " " 1,010.91 " 717.42 11100003 HC R&B ICF PRIVATE 111 593.00 569.28 569.28 563.35 551.49 569.28 551.49 412.91 278.29 563.35 551.49 391.38 12000001 HC R&B SEMI-PRIVATE 120 " 1,281.00 " " 1,229.76 " " 1,229.76 " " 1,216.95 " " 1,191.33 " " 1,229.76 " " 1,191.33 " 891.96 601.17 " 1,216.95 " " 1,191.33 " 845.46 12000004 HC R&B SNF SEMI-PRIVATE 120 " 1,087.00 " " 1,043.52 " " 1,043.52 " " 1,032.65 " " 1,010.91 " " 1,043.52 " " 1,010.91 " 756.88 510.13 " 1,032.65 " " 1,010.91 " 717.42 12000005 HC R&B ICF SEMI-PRIVATE 120 593.00 569.28 569.28 563.35 551.49 569.28 551.49 412.91 278.29 563.35 551.49 391.38 17100001 HC R&B NEWBORN LEVEL I 171 692.00 664.32 664.32 657.40 643.56 664.32 643.56 481.84 324.76 657.40 643.56 456.72 20000001 HC R&B INTENSIVE CARE 200 " 2,709.00 " " 2,600.64 " " 2,600.64 " " 2,573.55 " " 2,519.37 " " 2,600.64 " " 2,519.37 " " 1,886.28 " " 1,271.33 " " 2,573.55 " " 2,519.37 " " 1,787.94 " 26000005 HC NON-CHEMO IV PUSH 260 96374 199.00 191.04 191.04 189.05 185.07 191.04 185.07 138.56 93.39 189.05 185.07 131.34 27000170 HC SURG CAUTERY MACHINE 270 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 27000171 HC SURG MICROSCOPE WORKING 270 53.00 50.88 50.88 50.35 49.29 50.88 49.29 36.90 24.87 50.35 49.29 34.98 27000172 HC SURG USE OF TOURNIQUET 270 168.00 161.28 161.28 159.60 156.24 161.28 156.24 116.98 78.84 159.60 156.24 110.88 27000173 HC SURG VIDEO EQUIP-LIMITED 270 71.00 68.16 68.16 67.45 66.03 68.16 66.03 49.44 33.32 67.45 66.03 46.86 27000174 HC SURG VIDEO EQUIPMENT USE 270 172.00 165.12 165.12 163.40 159.96 165.12 159.96 119.76 80.72 163.40 159.96 113.52 27000175 HC OXYGEN/HR 270 17.00 16.32 16.32 16.15 15.81 16.32 15.81 11.84 7.98 16.15 15.81 11.22 27000176 HC OXYGEN PER DAY 270 416.00 399.36 399.36 395.20 386.88 399.36 386.88 289.66 195.23 395.20 386.88 274.56 27000177 HC APNEA MONITOR PER DAY 270 47.00 45.12 45.12 44.65 43.71 45.12 43.71 32.73 22.06 44.65 43.71 31.02 27000178 HC BLADDER SCANNER PER USE 270 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 27000179 HC BLOOD PRESSURE MACHINE 270 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 27000180 HC BLOOD WARMER 270 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 27000181 HC CAST-LONG ARM 270 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 27000182 HC CAST-LONG ARM PED 270 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 27000183 HC CAST-LONG LEG 270 150.00 144.00 144.00 142.50 139.50 144.00 139.50 104.45 70.40 142.50 139.50 99.00 27000184 HC CAST-LONG LEG PED 270 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 27000185 HC CAST-SHORT ARM 270 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 27000186 HC CAST-SHORT ARM PED 270 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 27000187 HC CAST-SHORT LEG 270 133.00 127.68 127.68 126.35 123.69 127.68 123.69 92.61 62.42 126.35 123.69 87.78 27000188 HC CAST-SHORT LEG PED 270 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 27000189 HC CAST-SPLINT/ALL SIZES 270 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 27000190 HC CAST-SPLINT SUGAR TONG 270 150.00 144.00 144.00 142.50 139.50 144.00 139.50 104.45 70.40 142.50 139.50 99.00 27000191 HC CAUTERY HYFROCATOR 270 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 27000192 HC CPM RENTAL PER DAY 270 34.00 32.64 32.64 32.30 31.62 32.64 31.62 23.67 15.96 32.30 31.62 22.44 27000193 HC EPI PUMP PER DAY 270 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 27000194 HC GOMCO EQUIPMENT/PER DAY 270 11.00 10.56 10.56 10.45 10.23 10.56 10.23 7.66 5.16 10.45 10.23 7.26 27000195 HC INFANT HEARING EQUIP/SUPP 270 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 27000196 HC IV SYRINGE PUMP/PER DAY 270 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 27000197 HC IV INFUSION PUMP/DAY 270 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 27000198 HC IV SOLUSET PUMP SET 270 28.00 26.88 26.88 26.60 26.04 26.88 26.04 19.50 13.14 26.60 26.04 18.48 27000199 HC K-PAD/UNIT PER USE 270 16.00 15.36 15.36 15.20 14.88 15.36 14.88 11.14 7.51 15.20 14.88 10.56 27000200 HC MONITOR-CARDIAC EQUIP/USE 270 45.00 43.20 43.20 42.75 41.85 43.20 41.85 31.33 21.12 42.75 41.85 29.70 27000201 HC NEO PUFF EQUIPMENT / DAIL 270 47.00 45.12 45.12 44.65 43.71 45.12 43.71 32.73 22.06 44.65 43.71 31.02 27000202 HC OXYGEN BLENDER PER HOUR 270 98.00 94.08 94.08 93.10 91.14 94.08 91.14 68.24 45.99 93.10 91.14 64.68 27000203 HC OXYHOOD PER HOUR 270 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 27000204 HC PCA PUMP PER DAY 270 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 27000205 HC PHOTOTHERAPY LITE PER DAY 270 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 27000209 HC PULMONARY FUNCTION EQUIP 270 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 27000210 HC SCD PUMP PER DAY 270 23.00 22.08 22.08 21.85 21.39 22.08 21.39 16.01 10.79 21.85 21.39 15.18 27000211 HC SUPPL NURSING SYSTEM STA 270 32.00 30.72 30.72 30.40 29.76 30.72 29.76 22.28 15.02 30.40 29.76 21.12 27000212 HC ENT SCOPE USE 270 58.00 55.68 55.68 55.10 53.94 55.68 53.94 40.39 27.22 55.10 53.94 38.28 27000213 HC SURG BONE INSTRUMENTS 270 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 27000214 HC SURG EGD EQUIPMENT 270 459.00 440.64 440.64 436.05 426.87 440.64 426.87 319.60 215.41 436.05 426.87 302.94 27000215 HC SURG GUIDE PIN - HIP 270 34.00 32.64 32.64 32.30 31.62 32.64 31.62 23.67 15.96 32.30 31.62 22.44 27000216 HC SURG LOANER INSTR HIP 270 350.00 336.00 336.00 332.50 325.50 336.00 325.50 243.71 164.26 332.50 325.50 231.00 27000217 HC TRAY-EAR 270 34.00 32.64 32.64 32.30 31.62 32.64 31.62 23.67 15.96 32.30 31.62 22.44 27000218 HC VAGINAL EXAM SUPPLIES 270 12.00 11.52 11.52 11.40 11.16 11.52 11.16 8.36 5.63 11.40 11.16 7.92 27000219 HC WOUND/ INFO VAC PER DAY 270 238.00 228.48 228.48 226.10 221.34 228.48 221.34 165.72 111.69 226.10 221.34 157.08 27000222 HC ER PACK 270 26.00 24.96 24.96 24.70 24.18 24.96 24.18 18.10 12.20 24.70 24.18 17.16 27000223 HC SPLINT-FINGER 270 7.00 6.72 6.72 6.65 6.51 6.72 6.51 4.87 3.29 6.65 6.51 4.62 27000224 HC TUBIGRIP PER FOOT 270 7.00 6.72 6.72 6.65 6.51 6.72 6.51 4.87 3.29 6.65 6.51 4.62 27100011 HC NON-INVASIVE VENT ASSEMBLY 271 924.00 887.04 887.04 877.80 859.32 887.04 859.32 643.38 433.63 877.80 859.32 609.84 27100013 HC OXYGEN INITIAL 271 358.00 343.68 343.68 340.10 332.94 343.68 332.94 249.28 168.01 340.10 332.94 236.28 27100014 HC OXYGEN LIMITED 0 TO 4 HOURS 271 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 27100015 HC OXYGEN LIMITED 4 TO 12 HOURS 271 208.00 199.68 199.68 197.60 193.44 199.68 193.44 144.83 97.61 197.60 193.44 137.28 27100016 HC OXYGEN SUBSEQUENT Q8 271 48.00 46.08 46.08 45.60 44.64 46.08 44.64 33.42 22.53 45.60 44.64 31.68 27100018 HC ISOLETTE 271 186.00 178.56 178.56 176.70 172.98 178.56 172.98 129.51 87.29 176.70 172.98 122.76 27400021 HC ELBOW WRIST HAND ORTHOTIC RIGID WO JOINTS 274 L3763 823.00 790.08 790.08 781.85 765.39 790.08 765.39 573.05 386.23 781.85 765.39 543.18 27400028 HC HAND FINGER ORTHOTIC 274 363.00 348.48 348.48 344.85 337.59 348.48 337.59 252.76 170.36 344.85 337.59 239.58 27400029 HC AIRPLANE SPLINT 274 L3674 373.00 358.08 358.08 354.35 346.89 358.08 346.89 259.72 175.05 354.35 346.89 246.18 27400030 HC ELBOW ORTHOTIC W JOINT 274 L3740 342.00 328.32 328.32 324.90 318.06 328.32 318.06 238.13 160.50 324.90 318.06 225.72 27400031 HC WRIST HAND FINGER ORTHOTIC 274 L3808 158.00 151.68 151.68 150.10 146.94 151.68 146.94 110.02 74.15 150.10 146.94 104.28 27400032 HC WRIST HAND ORTHOSIS 274 L3906 86.00 82.56 82.56 81.70 79.98 82.56 79.98 59.88 40.36 81.70 79.98 56.76 27400033 HC HAND ORTHOTIC 274 L3919 158.00 151.68 151.68 150.10 146.94 151.68 146.94 110.02 74.15 150.10 146.94 104.28 27400034 HC ELBOW ORTHOTIC L3702 274 L3702 350.00 336.00 336.00 332.50 325.50 336.00 325.50 243.71 164.26 332.50 325.50 231.00 27400035 HC CATHETER SUPP/PROSTHETIC 274 213.00 204.48 204.48 202.35 198.09 204.48 198.09 148.31 99.96 202.35 198.09 140.58 27400050 HC WRIST FINGER ORTHOTIC WO JOINTS CUSTOM 274 L3913 395.00 379.20 379.20 375.25 367.35 379.20 367.35 275.04 185.37 375.25 367.35 260.70 27400052 HC FINGER ORTHOSIS WO JOINTS CUSTOM 274 L3933 282.00 270.72 270.72 267.90 262.26 270.72 262.26 196.36 132.34 267.90 262.26 186.12 30000001 HC COLLECTION BLOOD SPECIMEN 300 36415 31.00 27.00 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 30000002 HC LEGAL BLOOD COLLECTION 300 36415 103.00 27.00 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30000003 HC COLLECT BLD CAPILLARY 300 36416 32.00 30.72 30.72 30.40 29.76 30.72 29.76 22.28 15.02 30.40 29.76 21.12 30000006 HC BASIC METABOLIC PANEL 300 80048 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000007 HC GENERAL HEALTH PANEL 300 80050 383.00 367.68 367.68 363.85 356.19 367.68 356.19 266.68 179.74 363.85 356.19 252.78 30000008 HC ELECTROLYTE PANEL 300 80051 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30000009 HC COMPREHENSIVE METABOLIC PANEL 300 80053 157.00 125.00 150.72 149.15 146.01 150.72 146.01 109.32 73.68 149.15 146.01 103.62 30000010 HC OBSTETRIC PANEL 300 80055 274.00 263.04 263.04 260.30 254.82 263.04 254.82 190.79 128.59 260.30 254.82 180.84 30000011 HC LIPID PANEL 300 80061 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000012 HC RENAL FUNCTION PANEL 300 80069 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000013 HC HEPATITIS PANEL ACUTE W/REFLEX 300 80074 324.00 311.04 311.04 307.80 301.32 311.04 301.32 225.60 152.05 307.80 301.32 213.84 30000014 HC HEPATIC FUNCTION PANEL 300 80076 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000015 HC OBSTETRIC PANEL W/HIV1/2 300 80081 322.00 309.12 309.12 305.90 299.46 309.12 299.46 224.21 151.11 305.90 299.46 212.52 30000019 HC CARBAMAZEPINE TOTAL 300 80156 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000020 HC CARBAMAZEPINE TEGRETOL 300 80156 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000021 HC CARBAMAZEPINE FREE 300 80157 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000022 HC CYCLOSPORINE 300 80158 199.00 191.04 191.04 189.05 185.07 191.04 185.07 138.56 93.39 189.05 185.07 131.34 30000023 HC CLOZAPINE/CLOZARIL QUANT 300 80159 165.00 158.40 158.40 156.75 153.45 158.40 153.45 114.89 77.43 156.75 153.45 108.90 30000024 HC DIGOXIN 300 80162 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000025 HC VALPROIC ACID - DEPAKENE 300 80164 166.00 159.36 159.36 157.70 154.38 159.36 154.38 115.59 77.90 157.70 154.38 109.56 30000026 HC ETHOSUXIMIDE ZARONTIN 300 80168 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 30000027 HC GENTAMICIN 300 80170 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000028 HC GABAPENTIN/NEURONTIN QUANT 300 80171 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000029 HC HALOPERIDOL SERUM 300 80173 246.00 236.16 236.16 233.70 228.78 236.16 228.78 171.29 115.45 233.70 228.78 162.36 30000030 HC LAMOTRIGINE QUANT 300 80175 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000032 HC KEPPRA/LEVETIRACETAM QUANT 300 80177 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000033 HC LITHIUM SERUM 300 80178 106.00 101.76 101.76 100.70 98.58 101.76 98.58 73.81 49.75 100.70 98.58 69.96 30000035 HC TRILEPTAL/OXCARBAZEPINE QUANT 300 80183 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000036 HC PHENOBARBITOL 300 80184 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30000037 HC ASSAY OF PHENOBARBITAL 300 80184 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30000038 HC PHENOBARBITAL QUANT 300 80184 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30000039 HC PHENYTOIN DILANTIN TOTAL 300 80185 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000040 HC PHENYTOIN TOTAL 300 80185 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000041 HC PHENYTOIN FREE 300 80186 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30000043 HC PRIMIDONE 300 80188 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000044 HC PROCAINAMIDE & NAPA 300 80192 166.00 159.36 159.36 157.70 154.38 159.36 154.38 115.59 77.90 157.70 154.38 109.56 30000047 HC QUINIDINE 300 80194 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000048 HC RAPAMYCIN SIROLIMUS 300 80195 204.00 195.84 195.84 193.80 189.72 195.84 189.72 142.05 95.74 193.80 189.72 134.64 30000049 HC SIROLIMUS 300 80195 149.00 143.04 143.04 141.55 138.57 143.04 138.57 103.75 69.93 141.55 138.57 98.34 30000050 HC TACROLIMUS 300 80197 227.00 217.92 217.92 215.65 211.11 217.92 211.11 158.06 106.53 215.65 211.11 149.82 30000051 HC THEOPHYLLINE 300 80198 142.00 136.32 136.32 134.90 132.06 136.32 132.06 98.87 66.64 134.90 132.06 93.72 30000052 HC TOBRAMYCIN 300 80200 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30000053 HC TOPIRAMATE 300 80201 276.00 264.96 264.96 262.20 256.68 264.96 256.68 192.18 129.53 262.20 256.68 182.16 30000054 HC TOPIRAMATE TOPAMAX 300 80201 276.00 264.96 264.96 262.20 256.68 264.96 256.68 192.18 129.53 262.20 256.68 182.16 30000055 HC VANCOMYCIN 300 80202 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 30000056 HC ZONISAMIDE 300 80203 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000058 HC QUANTITATION OF DRUG NES 300 80299 839.00 805.44 805.44 797.05 780.27 805.44 780.27 584.20 393.74 797.05 780.27 553.74 30000060 HC GABAPENTIN 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000061 HC FELBAMATE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000062 HC 5 FLUCYTOSINE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000063 HC DRUG ASSAY VORICONAZOLE 300 80285 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000064 HC AMIODARONE 300 80151 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000065 HC DRUG ASSAY INFLIXIMAB 300 80230 202.00 193.92 193.92 191.90 187.86 193.92 187.86 140.65 94.80 191.90 187.86 133.32 30000066 HC METHOTREXATE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000067 HC TRAZODONE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000068 HC MEXILETINE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000069 HC LEVETIRACETAM KEPPRA 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000070 HC LAMOTRIGINE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000071 HC OXCARBAZEPINE METABOLITE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000072 HC TIAGABINE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000073 HC TRILEPTAL LEVEL 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000074 HC ITRACONAZOLE 300 80189 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000075 HC ZONISAMIDE 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000076 HC STOOL FOR VIBRIO 300 80299 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000079 HC COMP DRUG SCREEN NONFOR URINE 300 80307 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000087 HC OPIATES 300 80307 34.00 32.64 32.64 32.30 31.62 32.64 31.62 23.67 15.96 32.30 31.62 22.44 30000093 HC SYNTHETIC CANNABINOIDS URINE 300 80307 323.00 310.08 310.08 306.85 300.39 310.08 300.39 224.90 151.58 306.85 300.39 213.18 30000094 HC ALCOHOL 300 80320 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 30000095 HC ETHYLENE GLYCOL 300 80320 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 30000096 HC VOLATILES SCREEN 300 80320 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 30000097 HC NICOTINE URINE 300 80323 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000098 HC AMPHETAMINES 1 OR 2 300 80324 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000101 HC FELBAMATE 300 80339 320.00 307.20 307.20 304.00 297.60 307.20 297.60 222.82 150.18 304.00 297.60 211.20 30000102 HC DRUG ASSAY LACOSAMIDE 300 80235 320.00 307.20 307.20 304.00 297.60 307.20 297.60 222.82 150.18 304.00 297.60 211.20 30000103 HC METHSUXIMIDE 300 80339 320.00 307.20 307.20 304.00 297.60 307.20 297.60 222.82 150.18 304.00 297.60 211.20 30000104 HC THIOTHIXENE NAVENE 300 80342 274.00 263.04 263.04 260.30 254.82 263.04 254.82 190.79 128.59 260.30 254.82 180.84 30000106 HC LIBRIUM METABOLITE 300 80346 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 30000107 HC CANNABINOIDS NATURAL 300 80349 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000108 HC MDA MDEA MDMA 300 80359 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 30000109 HC COMPLIANCE DRUG SCREEN 300 80368 598.00 574.08 574.08 568.10 556.14 574.08 556.14 416.39 280.64 568.10 556.14 394.68 30000110 HC LASIX FUROSEMIDE 300 80375 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 30000111 HC CLINICAL PATH CONSULT WO 300 80500 244.00 234.24 234.24 231.80 226.92 234.24 226.92 169.90 114.51 231.80 226.92 161.04 30000112 HC URINALYSIS NONAUTO W SCOPE 300 81000 46.00 28.00 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30000113 HC UA AUTO WITH MICROSCOPY 300 81001 58.00 28.00 55.68 55.10 53.94 55.68 53.94 40.39 27.22 55.10 53.94 38.28 30000114 HC PROTEIN URINE QUAL 300 81002 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30000115 HC PH SCREEN URINE 300 81002 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30000116 HC SPECIFIC GRAVITY UA 300 81002 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30000117 HC GLUCOSE URINE QUAL 300 81002 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30000118 HC UA WO MICRO NON AUTO 300 81002 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30000119 HC KETONE URINE QUAL NON AUTO 300 81002 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30000120 HC KETONES UR 300 81003 37.00 35.52 35.52 35.15 34.41 35.52 34.41 25.76 17.36 35.15 34.41 24.42 30000121 HC UA W/O MICRO AUTO 300 81003 37.00 35.52 35.52 35.15 34.41 35.52 34.41 25.76 17.36 35.15 34.41 24.42 30000122 HC URINALYSIS MICROSCOPIC ONLY 300 81015 27.00 25.92 25.92 25.65 25.11 25.92 25.11 18.80 12.67 25.65 25.11 17.82 30000123 HC HCG QUAL URINE PREG 300 81025 94.00 90.24 90.24 89.30 87.42 90.24 87.42 65.45 44.11 89.30 87.42 62.04 30000124 HC URINE MEASURE TIMED COLL 300 81050 29.00 27.84 27.84 27.55 26.97 27.84 26.97 20.19 13.61 27.55 26.97 19.14 30000125 HC BCR ABL 1 GENE MAJOR BP R 300 81206 387.00 371.52 371.52 367.65 359.91 371.52 359.91 269.47 181.62 367.65 359.91 255.42 30000126 HC BCR ABL 1 GENE MINOR BP R 300 81207 380.00 364.80 364.80 361.00 353.40 364.80 353.40 264.59 178.33 361.00 353.40 250.80 30000127 HC BCR ABL 1 GENE MAJOR BP R 300 81208 367.00 352.32 352.32 348.65 341.31 352.32 341.31 255.54 172.23 348.65 341.31 242.22 30000128 HC CFTR GENE ANALYSIS 300 81220 895.00 859.20 859.20 850.25 832.35 859.20 832.35 623.19 420.02 850.25 832.35 590.70 30000131 HC F2 GENE ANALYSIS 20210G 300 81240 199.00 191.04 191.04 189.05 185.07 191.04 185.07 138.56 93.39 189.05 185.07 131.34 30000132 HC F5 GENE ANALYSIS LEIDEN 300 81241 224.00 215.04 215.04 212.80 208.32 215.04 208.32 155.97 105.12 212.80 208.32 147.84 30000133 HC FMR1 ANALYSIS EVAL TO DET 300 81243 826.00 792.96 792.96 784.70 768.18 792.96 768.18 575.14 387.64 784.70 768.18 545.16 30000136 HC HFE GENE ANALYSIS 300 81256 461.00 442.56 442.56 437.95 428.73 442.56 428.73 320.99 216.35 437.95 428.73 304.26 30000137 HC JAK2 GENE ANALYSIS 300 81270 895.00 859.20 859.20 850.25 832.35 859.20 832.35 623.19 420.02 850.25 832.35 590.70 30000138 HC JAK2 GENE V617F MUTATION QUAL 300 81270 895.00 859.20 859.20 850.25 832.35 859.20 832.35 623.19 420.02 850.25 832.35 590.70 30000139 HC MTHFR GENE ANALYSIS 300 81291 5.00 4.80 4.80 4.75 4.65 4.80 4.65 3.48 2.35 4.75 4.65 3.30 30000141 HC PRADER-WILLI/ANGELMAN SYN 300 81331 974.00 935.04 935.04 925.30 905.82 935.04 905.82 678.20 457.10 925.30 905.82 642.84 30000142 HC SERPINA-1 GENE ANALYSIS COMMON VAR 300 81332 348.00 334.08 334.08 330.60 323.64 334.08 323.64 242.31 163.32 330.60 323.64 229.68 30000143 HC TRB REARRANGE ANAL AMP MET 300 81340 750.00 720.00 720.00 712.50 697.50 720.00 697.50 522.23 351.98 712.50 697.50 495.00 30000144 HC TRB REARRANGE ANAL AMP MET 300 81342 750.00 720.00 720.00 712.50 697.50 720.00 697.50 522.23 351.98 712.50 697.50 495.00 30000146 HC HLA TYPING 300 81381 320.00 307.20 307.20 304.00 297.60 307.20 297.60 222.82 150.18 304.00 297.60 211.20 30000148 HC MOLECULAR PATHOLOGY 300 81408 " 1,909.00 " " 1,832.64 " " 1,832.64 " " 1,813.55 " " 1,775.37 " " 1,832.64 " " 1,775.37 " " 1,329.24 " 895.89 " 1,813.55 " " 1,775.37 " " 1,259.94 " 30000149 HC SEVERE COMB IMMUNE DEFICIENCY 300 81479 14.00 13.44 13.44 13.30 13.02 13.44 13.02 9.75 6.57 13.30 13.02 9.24 30000150 HC CEBPA GENE ANALYSIS 300 81218 298.00 286.08 286.08 283.10 277.14 286.08 277.14 207.50 139.85 283.10 277.14 196.68 30000151 HC QUAD SCREEN 2ND TRIMESTER 300 81511 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 30000152 HC ACETONE QUALITATIVE 300 82009 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000153 HC BETA-HYDROXYBUTYRATE 300 82010 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30000154 HC BETA-HYDROXBUTYRIC ACID 300 82010 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30000155 HC ACETONE SERUM QUANT 300 82010 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30000156 HC ACYLCARNITINES QUANTITATIVE 300 82017 272.00 261.12 261.12 258.40 252.96 261.12 252.96 189.39 127.65 258.40 252.96 179.52 30000157 HC ACTH 300 82024 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000158 HC ADDL ALBUMIN 300 82040 46.00 44.16 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30000159 HC ALBUMIN 300 82040 46.00 44.16 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30000160 HC ALBUMIN URINE/OTHR QNT EA SPEC 300 82042 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000162 HC MICROALBUMIN URINE QUANTITATIVE 300 82043 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 30000163 HC MICROALBUMIN SEMIQUANT 300 82044 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 30000165 HC ASSAY OF BREATH ETHANOL 300 82075 52.00 49.92 49.92 49.40 48.36 49.92 48.36 36.21 24.40 49.40 48.36 34.32 30000166 HC ALDOLASE 300 82085 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30000167 HC ALDOSTERONE URINE 300 82088 358.00 343.68 343.68 340.10 332.94 343.68 332.94 249.28 168.01 340.10 332.94 236.28 30000168 HC ALDOSTERONE SERUM 300 82088 358.00 343.68 343.68 340.10 332.94 343.68 332.94 249.28 168.01 340.10 332.94 236.28 30000169 HC ALPHA-1 ANTITRYPSIN TOTAL 300 82103 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000170 HC ALPHA-1-ANTITRYPSIN 300 82103 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000171 HC ALPHA 1 ANTITRYPSIN PHENOTYPE 300 82104 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 30000173 HC ALPHA-FETOPROTEIN AFP 300 82105 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 30000174 HC ALPHA-FETOPROTEIN SERUM 300 82105 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 30000175 HC ALPHA-FETOPROTEIN AMNIO 300 82106 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000176 HC ALUMINUM 300 82108 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 30000177 HC AMINO ACIDS QUAL 300 82128 238.00 228.48 228.48 226.10 221.34 228.48 221.34 165.72 111.69 226.10 221.34 157.08 30000179 HC ALA AMINOLEV ACID 300 82135 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30000180 HC AMINOLEVULINIC ACID ALA URINE 300 82135 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30000181 HC AMINO ACIDS 6 OR MORE QUANT 300 82139 985.00 945.60 945.60 935.75 916.05 945.60 916.05 685.86 462.26 935.75 916.05 650.10 30000182 HC AMMONIA PLASMA 300 82140 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000184 HC AMYLASE 300 82150 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000185 HC AMYLASE FLUID 300 82150 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000187 HC AMYLASE URINE RANDOM 300 82150 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000188 HC AMYLASE URINE TIMED 300 82150 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000189 HC ANDROSTENEDIONE 300 82157 244.00 234.24 234.24 231.80 226.92 234.24 226.92 169.90 114.51 231.80 226.92 161.04 30000190 HC ANGIOTENSIN CONVERTING ENZYME 300 82164 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 30000192 HC APOLIPOPROTEIN 300 82172 169.00 162.24 162.24 160.55 157.17 162.24 157.17 117.67 79.31 160.55 157.17 111.54 30000193 HC APOLIPOPROTEIN EACH 300 82172 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 30000194 HC ASSAY OF APOLIPOPROTEIN 300 82172 169.00 162.24 162.24 160.55 157.17 162.24 157.17 117.67 79.31 160.55 157.17 111.54 30000195 HC ARSENIC 300 82175 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000196 HC ARSENIC BLOOD 300 82175 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000197 HC ARSENIC FRACTIONATED 300 82175 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000198 HC VITAMIN C ASCORBIC ACID 300 82180 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30000199 HC BETA 2 MICROGLOBULIN 300 82232 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000200 HC BILE ACIDS TOTAL 300 82239 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000201 HC ADDL BILIRUBIN TOTAL 300 82247 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000202 HC BILIRUBIN TOTAL 300 82247 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000203 HC BILIRUBIN DIRECT 300 82248 58.00 55.68 55.68 55.10 53.94 55.68 53.94 40.39 27.22 55.10 53.94 38.28 30000204 HC ADDITIONAL BILIRUBIN DIRECT 300 82248 58.00 55.68 55.68 55.10 53.94 55.68 53.94 40.39 27.22 55.10 53.94 38.28 30000205 HC BIOTINIDASE 300 82261 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000206 HC BIOTINIDASE QUANT 300 82261 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000208 HC OCCULT BLOOD X3 SCREENING 300 82270 38.00 36.48 36.48 36.10 35.34 36.48 35.34 26.46 17.83 36.10 35.34 25.08 30000209 "HC OCCULT BLOOD, GASTRIC" 300 82271 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30000210 "HC OCCULT BLOOD, STOOL" 300 82272 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30000211 HC CADMIUM 300 82300 88.00 84.48 84.48 83.60 81.84 84.48 81.84 61.27 41.30 83.60 81.84 58.08 30000212 HC VITAMIN D 25-HYDROXY CALCIFEDIOL 300 82306 224.00 215.04 215.04 212.80 208.32 215.04 208.32 155.97 105.12 212.80 208.32 147.84 30000213 HC CALCITONIN 300 82308 290.00 278.40 278.40 275.50 269.70 278.40 269.70 201.93 136.10 275.50 269.70 191.40 30000214 HC CALCIUM 300 82310 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000215 HC CALCIUM CSF 300 82310 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000216 HC ADDL CALCIUM 300 82310 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000217 HC CALCIUM URINE 300 82310 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000219 HC BEDSIDE CALC IONIZE 300 82330 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000220 HC BEDSIDE CA IONIZED 300 82330 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000221 HC CALCIUM IONIZED 300 82330 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000222 HC CALCIUM 24 HOUR URINE 300 82340 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 30000223 HC KIDNEY STONE ANALYSIS 300 82365 134.00 128.64 128.64 127.30 124.62 128.64 124.62 93.30 62.89 127.30 124.62 88.44 30000224 HC CARBON DIOXIDE 300 82374 48.00 46.08 46.08 45.60 44.64 46.08 44.64 33.42 22.53 45.60 44.64 31.68 30000225 HC ADDL CARBON DIOXIDE 300 82374 19.00 18.24 18.24 18.05 17.67 18.24 17.67 13.23 8.92 18.05 17.67 12.54 30000226 HC CARBON MONOXIDE QUANT BLD 300 82375 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000227 HC CARCINOEMBRYONIC AG CFA 300 82378 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000228 HC CARCINOEMBRYONIC ANTIGEN CEA 300 82378 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000230 HC CARNITINE SERUM 300 82379 275.00 264.00 264.00 261.25 255.75 264.00 255.75 191.48 129.06 261.25 255.75 181.50 30000231 HC CATECHOLAMINE FRACTIONATED 300 82384 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000232 HC CERULOPLASMIN 300 82390 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000233 HC CHEMILUMINESCENT ASSAY 300 82397 284.00 272.64 272.64 269.80 264.12 272.64 264.12 197.75 133.28 269.80 264.12 187.44 30000234 HC PTH RELATED PEPTIDE 300 82397 284.00 272.64 272.64 269.80 264.12 272.64 264.12 197.75 133.28 269.80 264.12 187.44 30000235 HC CHEMILUMINESCENT ASAY 300 82397 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000236 HC ADDL CHLORIDE BLOOD 300 82435 19.00 18.24 18.24 18.05 17.67 18.24 17.67 13.23 8.92 18.05 17.67 12.54 30000238 HC CHLORIDE BLOOD 300 82435 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000239 HC CHLORIDE URINE 300 82436 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30000240 HC CHLORIDE FLUID 300 82438 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000244 HC CHOLESTEROL 300 82465 68.00 65.28 65.28 64.60 63.24 65.28 63.24 47.35 31.91 64.60 63.24 44.88 30000245 HC ADDL CHOLESTEROL 300 82465 71.00 68.16 68.16 67.45 66.03 68.16 66.03 49.44 33.32 67.45 66.03 46.86 30000246 HC PSEUDOCHOLINESTERASE 300 82480 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 30000254 HC COLLAGEN CROSS LINKS URINE 300 82523 293.00 281.28 281.28 278.35 272.49 281.28 272.49 204.02 137.50 278.35 272.49 193.38 30000255 HC ASSAY OF COPPER 300 82525 142.00 136.32 136.32 134.90 132.06 136.32 132.06 98.87 66.64 134.90 132.06 93.72 30000256 HC CORTISOL FREE 300 82530 171.00 164.16 164.16 162.45 159.03 164.16 159.03 119.07 80.25 162.45 159.03 112.86 30000257 HC CORTISOL TOTAL 300 82533 149.00 143.04 143.04 141.55 138.57 143.04 138.57 103.75 69.93 141.55 138.57 98.34 30000259 HC 18 HYDROXYCORTICOSTERONE 300 82542 357.00 342.72 342.72 339.15 332.01 342.72 332.01 248.58 167.54 339.15 332.01 235.62 30000260 HC CHROMATO MASS SPEC QUANT 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000261 HC HYDROCODONE FORENSIC 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000262 HC COLUMN CHROMATOGRAPHY EACH SP 300 82542 537.00 515.52 515.52 510.15 499.41 515.52 499.41 373.91 252.01 510.15 499.41 354.42 30000263 HC CANNABINOIDS MECONIUM 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000264 HC DIPHENHYDRAMINE BENADRYL 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000265 HC DRUG CONFIRM GC MS BARB 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000266 HC DRUG CONFIRM BENZO URINE 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000267 HC DRUG CONFIRMATION EACH PR 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000268 HC LACOSAMIDE VIMPAT 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000269 HC MARIJUANA QUANT 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000270 HC N METHYLHISTAMINE 24H URINE 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000271 HC OPIATE CONF EXPND 300 82542 166.00 159.36 159.36 157.70 154.38 159.36 154.38 115.59 77.90 157.70 154.38 109.56 30000272 HC OXYCODONE CONFIRM 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000274 HC TRAMADOL AND METABOLITE 300 82542 167.00 160.32 160.32 158.65 155.31 160.32 155.31 116.28 78.37 158.65 155.31 110.22 30000276 HC CREATINE PHOSPHOKINASE 300 82550 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 30000277 HC CK TOTAL 300 82550 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 30000279 HC CK ISOENZYMES 300 82552 158.00 151.68 151.68 150.10 146.94 151.68 146.94 110.02 74.15 150.10 146.94 104.28 30000280 HC CPK MB FRACTION 300 82553 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 30000281 HC BEDSIDE CREATININE 300 82565 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000282 HC ADDL CREATININE 300 82565 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000283 HC CREATININE URINE RANDOM 300 82570 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000284 HC URINE CREATININE TIMED 300 82570 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000285 HC URINE CREATININE 300 82570 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000286 HC CREATININE OTHER SOURCE 300 82570 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000287 HC CREATININE CLEARANCE 300 82575 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000288 HC CRYOFIBRINOGEN 300 82585 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 30000289 HC ASSAY OF CRYOGLOBULIN 300 82595 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000291 HC VITAMIN B-12 300 82607 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30000292 HC DHEA 300 82626 218.00 209.28 209.28 207.10 202.74 209.28 202.74 151.79 102.31 207.10 202.74 143.88 30000293 HC DHEA SULFATE 300 82627 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000294 HC DEOXYCORTICOOSTERONE 300 82633 464.00 445.44 445.44 440.80 431.52 445.44 431.52 323.08 217.76 440.80 431.52 306.24 30000295 HC DEOXYCORTICOSTEROIDS 300 82634 221.00 212.16 212.16 209.95 205.53 212.16 205.53 153.88 103.72 209.95 205.53 145.86 30000296 HC DIBUCAINE INDEX 300 82638 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 30000297 HC VITAMIN D 1 25-DIHYDROXY 300 82652 366.00 351.36 351.36 347.70 340.38 351.36 340.38 254.85 171.76 347.70 340.38 241.56 30000298 HC ENZYME ACTIVITY EACH SPECIMEN 300 82657 705.00 676.80 676.80 669.75 655.65 676.80 655.65 490.89 330.86 669.75 655.65 465.30 30000299 HC ENZYME ACTIVITY IN BLOOD CELLS 300 82657 705.00 676.80 676.80 669.75 655.65 676.80 655.65 490.89 330.86 669.75 655.65 465.30 30000300 HC TPMT 300 82657 705.00 676.80 676.80 669.75 655.65 676.80 655.65 490.89 330.86 669.75 655.65 465.30 30000302 HC ELECTROPHORETIC TECHNIQUE 300 82664 296.00 284.16 284.16 281.20 275.28 284.16 275.28 206.10 138.91 281.20 275.28 195.36 30000304 HC ERYTHROPOIETIN 300 82668 213.00 204.48 204.48 202.35 198.09 204.48 198.09 148.31 99.96 202.35 198.09 140.58 30000305 HC ASSAY OF TOTAL ESTRADIOL 300 82670 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 30000306 HC ESTROGEN TOTAL 300 82672 353.00 338.88 338.88 335.35 328.29 338.88 328.29 245.79 165.66 335.35 328.29 232.98 30000307 HC ESTRIOL 300 82677 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 30000308 HC ESTRONE 300 82679 273.00 262.08 262.08 259.35 253.89 262.08 253.89 190.09 128.12 259.35 253.89 180.18 30000309 HC ETHYLENE GLYCOL SERUM 300 82693 302.00 289.92 289.92 286.90 280.86 289.92 280.86 210.28 141.73 286.90 280.86 199.32 30000310 HC FAT STOOL QUAL 300 82705 290.00 278.40 278.40 275.50 269.70 278.40 269.70 201.93 136.10 275.50 269.70 191.40 30000311 HC FECAL FAT QUANTITATIVE 300 82710 290.00 278.40 278.40 275.50 269.70 278.40 269.70 201.93 136.10 275.50 269.70 191.40 30000312 HC FERRITIN 300 82728 134.00 128.64 128.64 127.30 124.62 128.64 124.62 93.30 62.89 127.30 124.62 88.44 30000313 HC FETAL FIBRONECTIN SEMIQUANT 300 82731 521.00 500.16 500.16 494.95 484.53 500.16 484.53 362.77 244.51 494.95 484.53 343.86 30000314 HC FLUORIDE 300 82735 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000315 HC FOLIC ACID 300 82746 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000316 HC FOLATE RBC 300 82747 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000317 HC FRUCTOSE SEMEN 300 82757 351.00 336.96 336.96 333.45 326.43 336.96 326.43 244.40 164.72 333.45 326.43 231.66 30000318 HC GALACTOSE 300 82760 58.00 55.68 55.68 55.10 53.94 55.68 53.94 40.39 27.22 55.10 53.94 38.28 30000320 HC GALACTOSE-1-PHOS URIDYL TRANSF 300 82776 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30000321 HC GAMMAGLOB IGA/IGG/IGM EACH 300 82784 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000322 HC IGG 300 82784 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000323 HC IGA 300 82784 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000324 HC IGM 300 82784 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000325 HC CELIAC DISEASE SEROLOGY C 300 82784 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000326 HC IGE 300 82785 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000327 HC IMMUNOGLOBULIN G SUBCLASS 300 82787 112.00 107.52 107.52 106.40 104.16 107.52 104.16 77.99 52.56 106.40 104.16 73.92 30000328 HC PH BLOOD 300 82800 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 30000329 HC BEDSIDE BLOOD GAS 300 82803 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000330 HC BEDSIDE BLOOD GASES 300 82803 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000331 HC BLOOD GASES PH PCO2 PO2 300 82803 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000334 HC PH AND PCO2 300 82803 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000336 HC GASTRIN 300 82941 199.00 191.04 191.04 189.05 185.07 191.04 185.07 138.56 93.39 189.05 185.07 131.34 30000337 HC GLUCOGON 300 82943 270.00 259.20 259.20 256.50 251.10 259.20 251.10 188.00 126.71 256.50 251.10 178.20 30000338 HC GLUCOSE URINE 300 82945 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000339 HC GLUCOSE 2 HR 300 82947 46.00 44.16 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30000340 HC ADDL GLUCOSE QUANT 300 82947 46.00 44.16 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30000341 HC REAGENT STRIP/BLOOD GLUCOSE 300 82948 52.00 49.92 49.92 49.40 48.36 49.92 48.36 36.21 24.40 49.40 48.36 34.32 30000342 HC GLUCOSE TOLERANCE/SPECI 300 82950 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000343 HC LACTOSE TOLERANCE 3 SPECIMENS 300 82951 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000344 HC TOL TEST - EA ADDL SPEC > 3 300 82952 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000345 HC GLUCOSE 6 PHOSPHATE DEHYDROGEN 300 82955 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 30000346 HC BEDSIDE GLUCOSE 300 82962 49.00 47.04 47.04 46.55 45.57 47.04 45.57 34.12 23.00 46.55 45.57 32.34 30000347 HC GGT 300 82977 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 30000348 HC GGT 300 82977 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 30000349 HC ADDL GGT GAMMA GLUTAMYL 300 82977 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 30000350 HC FRUCTOSAMINE 300 82985 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30000351 HC GONADOTROPIN FOLL STIM HORMONE 300 83001 139.00 133.44 133.44 132.05 129.27 133.44 129.27 96.79 65.23 132.05 129.27 91.74 30000352 HC GONADOTROPIN LUTEINIZING HORM 300 83002 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 30000353 HC GROWTH HORMONE 300 83003 130.00 124.80 124.80 123.50 120.90 124.80 120.90 90.52 61.01 123.50 120.90 85.80 30000354 HC GROWTH HORMONE HUMAN 300 83003 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 30000355 HC HAPTOGLOBIN 300 83010 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000356 HC HAPTOGLOBIN QNT 300 83010 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000357 HC HELICOBACTER PLYORI BREATH TST 300 83013 405.00 388.80 388.80 384.75 376.65 388.80 376.65 282.00 190.07 384.75 376.65 267.30 30000360 HC HEMOGLOBIN FRACTION ELECTROPHO 300 83020 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000361 HC HEMOGLOBIN EVALUATION 300 83021 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30000362 HC HGB FRACT CHROMATOGRAPHY 300 83021 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30000363 HC HGB FRACTIONATION QUANT CHRO 300 83021 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30000366 HC HGB A1C 300 83036 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 30000368 HC METHEMOGLOBIN QUANT 300 83050 88.00 84.48 84.48 83.60 81.84 84.48 81.84 61.27 41.30 83.60 81.84 58.08 30000369 HC PLASMA HEMOGLOBIN 300 83051 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30000370 HC HEMOGLOBIN UNSTABLE SCREEN 300 83068 29.00 27.84 27.84 27.55 26.97 27.84 26.97 20.19 13.61 27.55 26.97 19.14 30000371 HC HEMOGLOBIN URINE 300 83069 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 30000372 HC HEMOSIDERIN 300 83070 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000373 HC HEMOSIDERIN QUAL URINE 300 83070 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30000374 HC ASSAY HISTAMINE 300 83088 291.00 279.36 279.36 276.45 270.63 279.36 270.63 202.62 136.57 276.45 270.63 192.06 30000375 HC HOMOCYSTEINE TOTAL 300 83090 237.00 227.52 227.52 225.15 220.41 227.52 220.41 165.02 111.22 225.15 220.41 156.42 30000376 HC HOMOVANILLIC ACID HVA 300 83150 272.00 261.12 261.12 258.40 252.96 261.12 252.96 189.39 127.65 258.40 252.96 179.52 30000377 HC 5 HIAA HYDROXYINDOLACETIC ACID 300 83497 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30000378 HC 17 HYDROXYPROGESTERONE 300 83498 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000379 HC CONGENTL ADREN HYPRPLSIC SCREN 300 83498 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000380 HC HYDROPROGESTERONE 17-D 300 83498 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000381 HC NEONATAL 17 OHP 300 83498 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000382 HC ANNA IGG BY IMMUNOBLOT 300 83516 251.00 240.96 240.96 238.45 233.43 240.96 233.43 174.77 117.79 238.45 233.43 165.66 30000383 HC CYSTIC FIBROSIS SCREEN 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000384 HC DEAMINATED GLIADEN IGA OR IGG 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000386 HC IMMUN FOR AN OTH INF AB OR AG 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000388 HC IMMUNO QUANT RO SEMI QUANT OTH 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000389 HC IMMUNOASSAY FOR PR3 AB 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000390 HC IMMUNOASSAY MULT STEP 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000391 HC IMMUNOASSAY QUANTITATIVE 300 83516 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000392 HC MYELOPEROXIDASE AB 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000393 HC MYELOPEROXIDASE MPO 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000395 HC RNA POLYMERASE III AB IGG 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000396 HC TISSUE TRANSGLUT IGA OR IGG 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000397 HC TITIN ANTIBODY 300 83516 251.00 240.96 240.96 238.45 233.43 240.96 233.43 174.77 117.79 238.45 233.43 165.66 30000399 HC CENTROMERE AB IGG 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000400 HC HISTONE ANTIBODY 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000401 HC MITOCHONDRIAL ANTIBODIES 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000402 HC PARIETAL CELL AB IGG 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000403 HC IMMUNO NON-AB 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000404 HC IMMUNOASSAY NON 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000405 HC PANCREATIC ELASTASE STOOL 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30000406 HC ACETYLCHOLINE BINDING AB 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000409 HC IMMUNO ANALY QUANT RADRX TECH 300 83519 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000410 HC IMMUNO ANALYTE QUANT BY RIA 300 83519 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000411 HC IMMUNOASSAY QUANT BY RIA 300 83519 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000412 HC RIA FOR NON-INFECTIOUS AGENT 300 83519 872.00 837.12 837.12 828.40 810.96 837.12 810.96 607.17 409.23 828.40 810.96 575.52 30000413 HC PQ TYPE CALCIUM CHANNEL AB 300 83519 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30000414 HC NEURONAL VGK CAUTO ANTIBODY 300 83519 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30000416 HC ACLR GANGLIONIC NEURONAL AB 300 83519 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30000417 HC 21-HYDROXYLASE ANTIBODIES 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000418 HC LEPTIN 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000419 HC PANCREATIC POLYPEPTIDE 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000420 HC IMMUNO NONANTIBO 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000421 HC THYROTROPIN RECEPTOR AB 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000422 HC IGF BINGING PROTEIN 1 M5 300 83519 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000423 HC CYTOKINE 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000424 HC IMMUNO ANALYTE QUANT 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000425 HC IMMUNOASSAY ANALYTE QUANT 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000429 HC MANNOSE BINDING LECTIN 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000430 HC NEURON-SPECIFIC ENOLASE 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000431 HC PANCREATIC ELASTASE FECAL 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000432 HC TRYPTASE 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000433 HC ANTIMULLERIAN HORMANE AB 300 83520 285.00 273.60 273.60 270.75 265.05 273.60 265.05 198.45 133.75 270.75 265.05 188.10 30000434 HC ANTIMULLERIAN HORMONE AMH 300 83520 298.00 286.08 286.08 283.10 277.14 286.08 277.14 207.50 139.85 283.10 277.14 196.68 30000435 HC ANTI-SACCHAROMYCES IGA 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000436 HC ANTI-SACCHAROMYCES IGG 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000437 HC CENTROMERE ANTIBODIES 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000439 HC GLOMERULAR BASE MEMBRANE 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000440 HC HEMOGL CONFIRM NEWBORN UN 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000441 HC HUMAN ANTI-MOUSE AB 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000442 HC IA ANAL QUAN NOS 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000443 HC IMMUNOASSAY RIA 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000444 HC MAG ANTIBODY DUAL ELISA 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000445 HC PHOSPATEID ANTIB 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000446 HC PLASMINOGEN ACTIVATOR INH 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000447 HC RIBOSOME P AB IGG 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000448 HC SENSORIMOTOR NEURO PROFIL 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000449 HC STRIATED MSC AB 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000450 HC THYROTROPIN RECEPTOR AB 300 83520 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 30000451 HC X2 IMMUNO ASSAY 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000452 HC INSULIN TOTAL 300 83525 169.00 162.24 162.24 160.55 157.17 162.24 157.17 117.67 79.31 160.55 157.17 111.54 30000453 HC IRON 300 83540 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000454 HC IRON BINDING CAPACITY 300 83550 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30000455 HC LACTATE 300 83605 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000456 HC BEDSIDE LACTATE 300 83605 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000458 HC LACTIC DEHYDROGENAS FLUID 300 83615 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 30000459 HC LACTIC DEHYDROGENASE LD 300 83615 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 30000460 HC LD TOTAL 300 83615 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 30000461 HC LD ISOENZYMES 300 83625 130.00 124.80 124.80 123.50 120.90 124.80 120.90 90.52 61.01 123.50 120.90 85.80 30000462 HC LEAD 300 83655 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 30000463 HC FETAL LUNG MATURITY EVAL 300 83661 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30000466 HC LIPASE 300 83690 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 30000467 HC LIPOPROTEIN A 300 83695 198.00 190.08 190.08 188.10 184.14 190.08 184.14 137.87 92.92 188.10 184.14 130.68 30000469 HC HDL 300 83718 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 30000470 HC LDL CHOLESTEROL DIRECT 300 83721 67.00 64.32 64.32 63.65 62.31 64.32 62.31 46.65 31.44 63.65 62.31 44.22 30000473 HC MAGNESIUM RANDOM URINE 300 83735 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000474 HC MAGNESIUM SERUM 300 83735 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000475 HC MAGNESIUM URINE TIMED 300 83735 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000476 HC MAGNESIUM STOOL 300 83735 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000480 HC CARNITINE TOTAL 300 83789 369.00 354.24 354.24 350.55 343.17 354.24 343.17 256.93 173.17 350.55 343.17 243.54 30000481 HC MASS AND TANDEM SPEC NES EACH 300 83789 369.00 354.24 354.24 350.55 343.17 354.24 343.17 256.93 173.17 350.55 343.17 243.54 30000482 HC PKU DIET SPOT MONITORING 300 84030 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000483 HC THIOPUR METHYLT TPMT-IMUR 300 83789 369.00 354.24 354.24 350.55 343.17 354.24 343.17 256.93 173.17 350.55 343.17 243.54 30000484 HC IODINE URINE 300 83789 369.00 354.24 354.24 350.55 343.17 354.24 343.17 256.93 173.17 350.55 343.17 243.54 30000485 HC MERCURY BLOOD 300 83825 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30000487 HC MERCURY QUANT 300 83825 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30000488 HC METANEPHRINES 300 83835 267.00 256.32 256.32 253.65 248.31 256.32 248.31 185.91 125.30 253.65 248.31 176.22 30000489 HC METANEPHRINES URINE FRACT 300 83835 267.00 256.32 256.32 253.65 248.31 256.32 248.31 185.91 125.30 253.65 248.31 176.22 30000491 HC MYELIN BASIC PROTEIN 300 83873 328.00 314.88 314.88 311.60 305.04 314.88 305.04 228.39 153.93 311.60 305.04 216.48 30000492 HC MYOGLOBIN 300 83874 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000493 HC MYELOPEROXIDASE AB MPO 300 83876 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000494 HC NT-PROBNP (BRAIN NATRIURETIC PEPTIDE) 300 83880 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 30000495 HC KAPPA/LAMBDA FREE LIGHT CHAIN 300 83883 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000496 HC NEPHELOMETRY 300 83883 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000497 HC NEPHELOMETRY ANALYTE 300 83883 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000498 HC NEPHELOMETRY EACH ANALYTE NES 300 83883 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000500 HC OLIGOCLONAL BANDS 300 83916 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000501 HC OLIGOCLONAL IMMUNE OLIG BANDS 300 83916 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000502 HC ORGANIC ACIDS TOTAL QUANT 300 83918 339.00 325.44 325.44 322.05 315.27 325.44 315.27 236.05 159.09 322.05 315.27 223.74 30000503 HC ORGANIC ACIDS SCN URINE 300 83919 348.00 334.08 334.08 330.60 323.64 334.08 323.64 242.31 163.32 330.60 323.64 229.68 30000504 HC METHYLMALONIC ACID SERUM 300 83921 348.00 334.08 334.08 330.60 323.64 334.08 323.64 242.31 163.32 330.60 323.64 229.68 30000506 HC OSMOLALITY BLOOD 300 83930 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 30000507 HC OSMOLALITY URINE 300 83935 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 30000510 HC PARATHORMONE PTH 300 83970 305.00 292.80 292.80 289.75 283.65 292.80 283.65 212.37 143.14 289.75 283.65 201.30 30000513 HC PH BODY FLUID 300 83986 157.00 150.72 150.72 149.15 146.01 150.72 146.01 109.32 73.68 149.15 146.01 103.62 30000514 HC PH SCREEN NOT URINE 300 83986 157.00 150.72 150.72 149.15 146.01 150.72 146.01 109.32 73.68 149.15 146.01 103.62 30000515 HC PHENCYCLIDINE CONFIRM URI 300 83992 269.00 258.24 258.24 255.55 250.17 258.24 250.17 187.30 126.24 255.55 250.17 177.54 30000516 HC CALPROTECTIN 300 83993 350.00 336.00 336.00 332.50 325.50 336.00 325.50 243.71 164.26 332.50 325.50 231.00 30000517 HC ASSAY OF BLOOD PKU 300 84030 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000518 HC ADDL ALKALINE PHOSPHATASE 300 84075 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000519 HC ALK PHOS-BONE SPECIFIC 300 84075 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000520 HC ALKP TOTAL 300 84075 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000521 HC PHOSPHATASE ALKALINE 300 84075 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000522 HC ALK PHOS ISOENZYMES 300 84080 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000523 HC ALKALINE PHOSPHATASE ISOENZYME 300 84080 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000524 HC AMNIOTIC FLUID-PG 300 84081 198.00 190.08 190.08 188.10 184.14 190.08 184.14 137.87 92.92 188.10 184.14 130.68 30000525 HC PHOSPHORUS 300 84100 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000526 HC ADDL PHOSPHORUS 300 84100 19.00 18.24 18.24 18.05 17.67 18.24 17.67 13.23 8.92 18.05 17.67 12.54 30000527 HC TIMED 300 84105 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000528 HC PBG URINE 300 84110 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30000530 HC PORPHOBILINOGEN QUANT UR 300 84110 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30000531 HC AMNIOTIC FLUID DETECTION 300 84112 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000532 HC PORPHYRINS URINE FRACTIONATED 300 84120 254.00 243.84 243.84 241.30 236.22 243.84 236.22 176.86 119.20 241.30 236.22 167.64 30000534 HC POTASSIUM SERUM 300 84132 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000537 HC ADDL POTASSIUM SERUM 300 84132 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000538 HC POTASSIUM URINE 300 84133 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000539 HC PREALBUMIN 300 84134 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000540 HC 17-HYDROXYPREGNENOLONE M 300 84143 277.00 265.92 265.92 263.15 257.61 265.92 257.61 192.88 130.00 263.15 257.61 182.82 30000541 HC PROGESTERONE 300 84144 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000542 HC PROCALCITONIN 300 84145 222.00 213.12 213.12 210.90 206.46 213.12 206.46 154.58 104.18 210.90 206.46 146.52 30000543 HC PROLACTIN 300 84146 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000544 HC PROSTATE SPECIFIC ANTIGN TOTAL 300 84153 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000545 HC PSA TOTAL 300 84153 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000546 HC PSA FREE 300 84154 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30000547 HC PROTEIN TOTAL SERUM 300 84155 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30000548 HC ADDL PROTEIN TOTAL SERUM 300 84155 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30000549 HC TOTAL PROTEIN URINE 300 84156 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000550 HC PROTEIN TOTAL OTHER SOURCE 300 84157 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000551 HC PROTEIN ELECTROPHORESIS CSF 300 84157 137.00 131.52 131.52 130.15 127.41 131.52 127.41 95.39 64.29 130.15 127.41 90.42 30000552 HC PROTEIN ELECTROPH FRACTION QNT 300 84165 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000553 HC PROTEIN ELECTRO OTHER FLUID 300 84166 156.00 149.76 149.76 148.20 145.08 149.76 145.08 108.62 73.21 148.20 145.08 102.96 30000554 HC ELCTR FRAC QUA OTH FLUID W CON 300 84166 133.00 127.68 127.68 126.35 123.69 127.68 123.69 92.61 62.42 126.35 123.69 87.78 30000555 HC MAGM WB 300 84181 268.00 257.28 257.28 254.60 249.24 257.28 249.24 186.61 125.77 254.60 249.24 176.88 30000558 HC AMPHIPHYSIN WESTERN BLOT 300 84182 441.00 423.36 423.36 418.95 410.13 423.36 410.13 307.07 206.96 418.95 410.13 291.06 30000560 HC WB W INTERP/REPORT 300 84182 441.00 423.36 423.36 418.95 410.13 423.36 410.13 307.07 206.96 418.95 410.13 291.06 30000561 HC BOTULINUM TOXIN TYPE A 300 84182 441.00 423.36 423.36 418.95 410.13 423.36 410.13 307.07 206.96 418.95 410.13 291.06 30000562 HC PROTOPORPHYRINS RBC 300 84202 274.00 263.04 263.04 260.30 254.82 263.04 254.82 190.79 128.59 260.30 254.82 180.84 30000563 HC PROINSULIN 300 84206 192.00 184.32 184.32 182.40 178.56 184.32 178.56 133.69 90.11 182.40 178.56 126.72 30000564 HC VITAMIN B6 300 84207 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000566 HC PYRUVATE 300 84210 364.00 349.44 349.44 345.80 338.52 349.44 338.52 253.45 170.83 345.80 338.52 240.24 30000568 HC ACETYLCHOLINE AB 300 84238 187.00 179.52 179.52 177.65 173.91 179.52 173.91 130.21 87.76 177.65 173.91 123.42 30000569 HC RENIN ACTIVITY 300 84244 275.00 264.00 264.00 261.25 255.75 264.00 255.75 191.48 129.06 261.25 255.75 181.50 30000570 HC SEROTONIN 300 84260 269.00 258.24 258.24 255.55 250.17 258.24 250.17 187.30 126.24 255.55 250.17 177.54 30000572 HC SEROTONIN SERUM 300 84260 306.00 293.76 293.76 290.70 284.58 293.76 284.58 213.07 143.61 290.70 284.58 201.96 30000573 HC SHBG 300 84270 168.00 161.28 161.28 159.60 156.24 161.28 156.24 116.98 78.84 159.60 156.24 110.88 30000574 HC SODIUM BLOOD 300 84295 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30000577 HC ADDL SODIUM BLOOD 300 84295 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30000578 HC SODIUM URINE 300 84300 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000580 HC SODIUM STOOL 300 84302 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 30000581 HC IGF-1 INSULIN-LIKE GROWTH I 300 84305 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30000583 HC PORPHYRIN TOTAL 300 84311 216.00 207.36 207.36 205.20 200.88 207.36 200.88 150.40 101.37 205.20 200.88 142.56 30000584 HC POTASSIUM FECES 300 84311 216.00 207.36 207.36 205.20 200.88 207.36 200.88 150.40 101.37 205.20 200.88 142.56 30000586 HC SPEC GRAVITY EXCL URINE 300 84315 24.00 23.04 23.04 22.80 22.32 23.04 22.32 16.71 11.26 22.80 22.32 15.84 30000587 HC SUGARS SINGLE QUALITATIVE 300 84376 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30000588 HC TESTOSTERONE FREE 300 84402 204.00 195.84 195.84 193.80 189.72 195.84 189.72 142.05 95.74 193.80 189.72 134.64 30000589 HC TESTOSTERONE TOTAL 300 84403 183.00 175.68 175.68 173.85 170.19 175.68 170.19 127.42 85.88 173.85 170.19 120.78 30000590 HC VITAMIN B1 PLASMA 300 84425 236.00 226.56 226.56 224.20 219.48 226.56 219.48 164.33 110.75 224.20 219.48 155.76 30000593 HC THYROGLOBULIN 300 84432 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000594 HC THYROGLOBULIN BY LC-MS/MS 300 84432 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000595 HC THYROXINE TOTAL 300 84436 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30000596 HC THYROXINE TOTAL NEONATAL 300 84437 49.00 47.04 47.04 46.55 45.57 47.04 45.57 34.12 23.00 46.55 45.57 32.34 30000597 HC T-4 ASSAY FREE 300 84439 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000598 HC THYROXINE FREE 300 84439 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000600 HC THYROID STIMULATING HORMONE 300 84443 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 30000601 HC TSH TRIG FRM NEONATAL SCREEN 300 84443 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30000602 HC THYROID STIMULATING IMM GLOBUL 300 84445 458.00 439.68 439.68 435.10 425.94 439.68 425.94 318.91 214.94 435.10 425.94 302.28 30000603 HC VITAMIN E 300 84446 208.00 199.68 199.68 197.60 193.44 199.68 193.44 144.83 97.61 197.60 193.44 137.28 30000604 HC AST SGOT 300 84450 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000605 HC ADDL SGOT AST 300 84450 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000606 HC ALT 300 84460 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000607 HC ADDITIONAL SGPT 300 84460 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000608 HC TRANSFERRIN 300 84466 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 30000609 HC TRIGLYCERIDES 300 84478 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000611 HC T3 UPTAKE 300 84479 91.00 87.36 87.36 86.45 84.63 87.36 84.63 63.36 42.71 86.45 84.63 60.06 30000612 HC TRIIODOTHYRONINE T3 TOTAL 300 84480 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000613 HC TRIIODOTHYRONINE T3 FREE 300 84481 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 30000614 HC T-3 REVERSE 300 84482 237.00 227.52 227.52 225.15 220.41 227.52 220.41 165.02 111.22 225.15 220.41 156.42 30000615 HC TROPONIN I 300 84484 210.00 201.60 201.60 199.50 195.30 201.60 195.30 146.22 98.55 199.50 195.30 138.60 30000616 HC UREA NITROGEN FLUID 300 84520 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30000617 HC UREA NITROGEN BUN 300 84520 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30000618 HC ADDL BUN 300 84520 19.00 18.24 18.24 18.05 17.67 18.24 17.67 13.23 8.92 18.05 17.67 12.54 30000619 HC UREA URINE 300 84540 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000620 HC UREA CLEARANCE 300 84545 88.00 84.48 84.48 83.60 81.84 84.48 81.84 61.27 41.30 83.60 81.84 58.08 30000621 HC URIC ACID BLOOD 300 84550 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000623 HC URIC ACID URINE 300 84560 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 30000624 HC VMA URINE 300 84585 169.00 162.24 162.24 160.55 157.17 162.24 157.17 117.67 79.31 160.55 157.17 111.54 30000625 HC VASOACTIVE INTEST POLYPEP 300 84586 438.00 420.48 420.48 416.10 407.34 420.48 407.34 304.98 205.55 416.10 407.34 289.08 30000626 HC ARGININE VASOPRESSIN 300 84588 119.00 114.24 114.24 113.05 110.67 114.24 110.67 82.86 55.85 113.05 110.67 78.54 30000627 HC VASOPRESSIN ADH 300 84588 119.00 114.24 114.24 113.05 110.67 114.24 110.67 82.86 55.85 113.05 110.67 78.54 30000628 HC VITAMIN A 300 84590 163.00 156.48 156.48 154.85 151.59 156.48 151.59 113.50 76.50 154.85 151.59 107.58 30000629 HC VITAMIN B3 300 84591 284.00 272.64 272.64 269.80 264.12 272.64 264.12 197.75 133.28 269.80 264.12 187.44 30000630 HC VITAMIN K1 SERUM 300 84597 156.00 149.76 149.76 148.20 145.08 149.76 145.08 108.62 73.21 148.20 145.08 102.96 30000633 HC VOLATILE SCREEN URINE 300 84600 226.00 216.96 216.96 214.70 210.18 216.96 210.18 157.36 106.06 214.70 210.18 149.16 30000634 HC ZINC 300 84630 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000635 HC C-PEPTIDE 300 84681 199.00 191.04 191.04 189.05 185.07 191.04 185.07 138.56 93.39 189.05 185.07 131.34 30000636 HC GONADOTROPIN CHORONC HCG QUANT 300 84702 137.00 131.52 131.52 130.15 127.41 131.52 127.41 95.39 64.29 130.15 127.41 90.42 30000637 HC HCG QUANT 300 84704 137.00 131.52 131.52 130.15 127.41 131.52 127.41 95.39 64.29 130.15 127.41 90.42 30000638 HC HCG TOTAL 300 84702 137.00 131.52 131.52 130.15 127.41 131.52 127.41 95.39 64.29 130.15 127.41 90.42 30000639 HC HCG QUAL SERUM PREG 300 84703 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000644 HC OSMOLALITY STOOL 300 84999 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000645 HC PCO2 BY ELECTRODE 300 84999 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000649 HC POTASSIUM STOOL 300 84999 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000650 HC BLEEDING TIME 300 85002 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 30000651 HC MANUAL DIFFERENTIAL 300 85007 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000653 HC BUFFY COAT PREP FOR DIFF 300 85009 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30000654 HC HEMATOCRIT 300 85014 39.00 37.44 37.44 37.05 36.27 37.44 36.27 27.16 18.30 37.05 36.27 25.74 30000655 HC BEDSIDE-HEMATOCRIT 300 85014 39.00 37.44 37.44 37.05 36.27 37.44 36.27 27.16 18.30 37.05 36.27 25.74 30000656 HC HEMOGLOBIN 300 85018 39.00 37.44 37.44 37.05 36.27 37.44 36.27 27.16 18.30 37.05 36.27 25.74 30000657 HC CBC W/AUTO DIFF 300 85025 96.00 76.00 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 30000658 HC CBC WITHOUT AUTO DIFF 300 85027 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30000659 HC PLATELET CT MANUAL 300 85032 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 30000660 HC RBC 300 85041 39.00 37.44 37.44 37.05 36.27 37.44 36.27 27.16 18.30 37.05 36.27 25.74 30000661 HC RETIC COUNT 300 85045 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30000662 HC RETICULOCYTE AUTOMATED 300 85046 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000663 HC EOSINOPHIL ABSOLUT CT DIR 300 85048 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30000664 HC WBC 300 85048 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30000665 HC PLATELET COUNT AUTOMATED 300 85049 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000666 HC RETICULATED PLATELET ASSAY 300 85055 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30000667 HC FACTOR II 300 85210 304.00 291.84 291.84 288.80 282.72 291.84 282.72 211.68 142.67 288.80 282.72 200.64 30000668 HC COAGULATION FACT V ACTIVI 300 85220 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 30000669 HC COAG FACTOR VII ACTIVE 300 85230 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000670 HC FACTOR VIII 300 85240 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000671 HC FACTOR VIII AHG ONE STAGE 300 85240 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000673 HC PLASMINOGEN 300 85240 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000674 HC RISTOCETIN COFACTOR 300 85245 256.00 245.76 245.76 243.20 238.08 245.76 238.08 178.25 120.14 243.20 238.08 168.96 30000675 HC VWF RISTOCETIN COFACTOR 300 85245 256.00 245.76 245.76 243.20 238.08 245.76 238.08 178.25 120.14 243.20 238.08 168.96 30000676 HC FACTOR VIII VW FACTOR AG 300 85246 256.00 245.76 245.76 243.20 238.08 245.76 238.08 178.25 120.14 243.20 238.08 168.96 30000677 HC VON WILLEBRAND FACTOR AG 300 85246 256.00 245.76 245.76 243.20 238.08 245.76 238.08 178.25 120.14 243.20 238.08 168.96 30000678 HC FACTOR VIII VW MULTIMERIC 300 85247 168.00 161.28 161.28 159.60 156.24 161.28 156.24 116.98 78.84 159.60 156.24 110.88 30000679 HC FACTOR IX PTC OR CHRISTMAS 300 85250 245.00 235.20 235.20 232.75 227.85 235.20 227.85 170.59 114.98 232.75 227.85 161.70 30000680 HC FACTOR X STUART-PROWER 300 85260 270.00 259.20 259.20 256.50 251.10 259.20 251.10 188.00 126.71 256.50 251.10 178.20 30000681 HC COAGULATION FACTOR XI ACT 300 85270 245.00 235.20 235.20 232.75 227.85 235.20 227.85 170.59 114.98 232.75 227.85 161.70 30000682 HC COAG FACTOR XII ACTIVITY 300 85280 245.00 235.20 235.20 232.75 227.85 235.20 227.85 170.59 114.98 232.75 227.85 161.70 30000684 HC CLTNG FACTOR XIII FIBRIN 300 85291 145.00 139.20 139.20 137.75 134.85 139.20 134.85 100.96 68.05 137.75 134.85 95.70 30000685 HC CLOT INHIBIT ANTITHROMB 3 ACTV 300 85300 177.00 169.92 169.92 168.15 164.61 169.92 164.61 123.25 83.07 168.15 164.61 116.82 30000686 HC ANTITHROMBIN III AG 300 85301 244.00 234.24 234.24 231.80 226.92 234.24 226.92 169.90 114.51 231.80 226.92 161.04 30000687 HC PROTEIN C TOTAL AG 300 85302 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 30000688 HC CLOT INHIB ANTICOAG PROTEIN C 300 85303 247.00 237.12 237.12 234.65 229.71 237.12 229.71 171.99 115.92 234.65 229.71 163.02 30000689 HC PROTEIN S TOTAL AG 300 85305 227.00 217.92 217.92 215.65 211.11 217.92 211.11 158.06 106.53 215.65 211.11 149.82 30000690 HC PROTEIN S FREE 300 85306 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 30000691 HC PROTEIN S FREE AG WITH REFLEX 300 85306 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 30000692 HC PROTEIN S FUNCTIONAL 300 85306 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 30000693 HC APC RESISTANCE PROFILE 300 85307 327.00 313.92 313.92 310.65 304.11 313.92 304.11 227.69 153.46 310.65 304.11 215.82 30000696 HC FIBRINOGEN DEGRAD PRODUCT 300 85362 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30000697 HC FIBRIN DGRADJ SPLT PRODUX 300 85366 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30000698 HC D-DIMER QUANT 300 85379 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 30000699 HC FIBRINOGEN LEV QUANT CLOT 300 85384 112.00 107.52 107.52 106.40 104.16 107.52 104.16 77.99 52.56 106.40 104.16 73.92 30000700 HC FIBRINOLYSIS 300 85390 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000702 HC CLOTTING FUNC ACTIVITY NOS EA ANALYT 300 85397 443.00 425.28 425.28 420.85 411.99 425.28 411.99 308.46 207.90 420.85 411.99 292.38 30000703 HC PLASMINOGEN FUNCTIONAL 300 85420 25.00 24.00 24.00 23.75 23.25 24.00 23.25 17.41 11.73 23.75 23.25 16.50 30000704 HC KLEIHAUER-BETKE TEST 300 85460 248.00 238.08 238.08 235.60 230.64 238.08 230.64 172.68 116.39 235.60 230.64 163.68 30000705 HC FETAL SCRN FET MAT BLD 300 85461 71.00 68.16 68.16 67.45 66.03 68.16 66.03 49.44 33.32 67.45 66.03 46.86 30000706 HC HEPARIN ANTI XA LOVENOX L 300 85520 369.00 354.24 354.24 350.55 343.17 354.24 343.17 256.93 173.17 350.55 343.17 243.54 30000708 HC HEPARIN NEUTRALIZATION 300 85525 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000709 HC LEUKOCYTE ALKALINE PHOSPHATASE 300 85540 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30000710 HC LYSOZYME MURAMIDASE 300 85549 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30000713 HC OSMOTIC FRAGILITY RBC M 300 85557 305.00 292.80 292.80 289.75 283.65 292.80 283.65 212.37 143.14 289.75 283.65 201.30 30000715 HC PLATELET AGGREGATION 300 85576 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 30000717 HC BILL PNP 300 85597 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000718 HC HEXAGONAL PHOSPHOLIPID 300 85598 361.00 346.56 346.56 342.95 335.73 346.56 335.73 251.36 169.42 342.95 335.73 238.26 30000720 HC PROTHROMBIN TIME 300 85610 57.00 29.00 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000721 HC PROTHROMBIN TIME -INR+SEC 300 85610 57.00 29.00 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000722 HC PT SUBSTITUTIONS 300 85611 204.00 195.84 195.84 193.80 189.72 195.84 189.72 142.05 95.74 193.80 189.72 134.64 30000723 HC DILUTE RUSSELL VIPER VENOM 300 85613 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000724 HC REPTILASE TEST 300 85635 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000725 HC SEDIMENTATION RATE ESR 300 85652 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30000726 HC SICKLE CELL SCREEN 300 85660 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000727 HC SICKLING OF RBC REDUCTION 300 85660 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000728 HC SICKLING SOLUBILITY 300 85660 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 30000729 HC THROMBIN TIME 300 85670 130.00 124.80 124.80 123.50 120.90 124.80 120.90 90.52 61.01 123.50 120.90 85.80 30000731 HC THROMBIN TIME PLASMA 300 85670 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30000732 HC THROMBIN TIME SINGLE 300 85670 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30000733 HC PARTIAL THROMBOPLASTIN PTT 300 85730 94.00 90.24 90.24 89.30 87.42 90.24 87.42 65.45 44.11 89.30 87.42 62.04 30000734 HC PTT SUBSTITUTIONS 300 85732 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000735 HC VISCOSITY 300 85810 215.00 206.40 206.40 204.25 199.95 206.40 199.95 149.70 100.90 204.25 199.95 141.90 30000736 HC VISCOSITY SERUM 300 85810 215.00 206.40 206.40 204.25 199.95 206.40 199.95 149.70 100.90 204.25 199.95 141.90 30000738 HC ALLERGEN SPECIFIC - IGE 300 86003 59.00 56.64 56.64 56.05 54.87 56.64 54.87 41.08 27.69 56.05 54.87 38.94 30000739 HC ALLERGEN SPECIFIC IGE EACH 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000740 HC ALLERGY LATEX RAST 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000741 HC LATEX IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000742 HC RAST PER ALLERGEN 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000743 HC RAST ADDL ALLERGEN 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000744 HC CASEIN 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000745 HC REGION 9 ALLERGY PANEL 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000746 HC PEANUT IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000747 HC PECAN FOOD IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000748 HC ALMOND IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000749 HC WALNUT FOOD IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000750 HC BRAZIL NUT IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000751 HC CASHEW IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000752 HC ALLG SPEC IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000753 HC TREE PANEL #1 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000754 HC GRASS PANEL #1 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000755 HC SHORT RAGWEED IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000756 HC COCONUT IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000757 HC HALIBUT IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000758 HC SHRIMP IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000759 HC CODFISH IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000760 HC LOBSTER IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000761 HC CRAB IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000762 HC SOLE IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000763 HC OYSTER 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000764 HC WBC AB INDENT 300 86021 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 30000765 HC AB ID PLATELET ANTIBODIES 300 86022 351.00 336.96 336.96 333.45 326.43 336.96 326.43 244.40 164.72 333.45 326.43 231.66 30000766 HC PF4 ANTIBODIES BY ELISA 300 86022 351.00 336.96 336.96 333.45 326.43 336.96 326.43 244.40 164.72 333.45 326.43 231.66 30000770 HC PLATELET AB DIRECT 300 86023 308.00 295.68 295.68 292.60 286.44 295.68 286.44 214.46 144.54 292.60 286.44 203.28 30000771 HC ANA 300 86038 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000772 HC ANA AB REFLEX 300 86038 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000773 HC ANA TITER 300 86039 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30000774 HC ANTI-STREPTOLYSIN ASO QUA 300 86060 98.00 94.08 94.08 93.10 91.14 94.08 91.14 68.24 45.99 93.10 91.14 64.68 30000775 HC C-REACTIVE PROTEIN-CRP 300 86140 106.00 101.76 101.76 100.70 98.58 101.76 98.58 73.81 49.75 100.70 98.58 69.96 30000776 HC CRP CARDIO 300 86141 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 30000777 HC BETA 2 GLYCOPROTEIN 1 AB 300 86146 430.00 412.80 412.80 408.50 399.90 412.80 399.90 299.41 201.80 408.50 399.90 283.80 30000778 HC CARDIOLIPIN AB EACH CLASS 300 86147 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 30000779 HC ANTIPHOSPHATIDYLSERINE AB 300 86148 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000781 HC CLD AGGLUT SCR 300 86156 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 30000782 HC COLD AGGLUTININ TITER 300 86157 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 30000783 HC COMPLEMNT ANTIGEN EA COMPONENT 300 86160 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 30000784 HC COMPLEMENT FUNCTIONAL ACTIVITY 300 86161 227.00 217.92 217.92 215.65 211.11 217.92 211.11 158.06 106.53 215.65 211.11 149.82 30000785 HC COMPLEMENT ACTIVITY TOTAL EIA 300 86162 208.00 199.68 199.68 197.60 193.44 199.68 193.44 144.83 97.61 197.60 193.44 137.28 30000786 HC IMMUNOASSAY PEPTIDE AB 300 86200 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000787 HC DNASE B ANTIBODY 300 86215 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 30000788 HC DNA ANTIBODY 300 86225 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000789 HC DOUBLE STRANDED DNA 300 86225 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000790 HC EXTRACTABLE NUCLEAR AG AB 300 86235 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 30000791 HC AMPHIPHYSIN AB 300 86255 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000792 HC ANCA 300 86255 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000793 HC CYTO NEUTRO A ANCA 300 86255 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000794 HC DNA DS AB CRITHIDIA IFA W/RFX 300 86255 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 30000795 HC ENDOMYSIAL AB IGA SCREEN 300 86255 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 30000796 HC FLUO NONINF AGE ANT SCR EA ANT 300 86255 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 30000797 HC FLUORESCENT NONINFECT AB SCRN 300 86255 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000798 HC NEURONAL NUCLEAR ANTIBODY 300 86255 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000799 HC NMO-AQP4-IGG-FACS 300 86255 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000800 HC PARANEOPLASTIC PANEL IFA 300 86255 98.00 94.08 94.08 93.10 91.14 94.08 91.14 68.24 45.99 93.10 91.14 64.68 30000801 HC PURKINJE CELL ANTIBODY 300 86255 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30000802 HC RETICULIN ANTIBODIES 300 86255 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000803 HC SM MUSCLE AB SERUM 300 86255 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30000806 HC ANTI-MITOCHONDRIAL AB TIT 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000807 HC ANTI-SMOOTH MUSCLE AB TIT 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000808 HC ENDOMYSIAL ANTIBODIES IGA 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000809 HC FLUOR NONINF AGENT TITER EA 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000810 HC FLUORESCENT NONINFECT AB TITER 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000812 HC NMO-AQP4-FACS-TITER 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000814 HC PURKINJE CELL TITER 300 86256 383.00 367.68 367.68 363.85 356.19 367.68 356.19 266.68 179.74 363.85 356.19 252.78 30000815 HC CANCER ANTIGEN BREAST CA15-3 300 86300 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000816 HC IMMUNOASSAY TUMOR ANTIGEN CA19-9 300 86301 247.00 237.12 237.12 234.65 229.71 237.12 229.71 171.99 115.92 234.65 229.71 163.02 30000817 HC IMMUNOASSAY TUMOR ANTIGEN CA 125 300 86304 186.00 178.56 178.56 176.70 172.98 178.56 172.98 129.51 87.29 176.70 172.98 122.76 30000818 HC MONONUCLEOSIS SCREEN 300 86308 85.00 81.60 81.60 80.75 79.05 81.60 79.05 59.19 39.89 80.75 79.05 56.10 30000819 HC IMMUNO FOR ANTIGEN QUANT 300 86316 192.00 184.32 184.32 182.40 178.56 184.32 178.56 133.69 90.11 182.40 178.56 126.72 30000821 HC HEPATITIS B SURFACE AB 300 86317 39.00 37.44 37.44 37.05 36.27 37.44 36.27 27.16 18.30 37.05 36.27 25.74 30000822 HC IMMUN FOR INF AGENT AB QU NOS 300 86317 153.00 146.88 146.88 145.35 142.29 146.88 142.29 106.53 71.80 145.35 142.29 100.98 30000823 HC IMMUNO INFECTIOUS ANTIBODY QNT 300 86317 213.00 204.48 204.48 202.35 198.09 204.48 198.09 148.31 99.96 202.35 198.09 140.58 30000824 HC IMMUNO INFECTIOUS QUANT AB 300 86317 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000825 HC IMMUNOA INFEC AGENT AB QUANT 300 86317 7.00 6.72 6.72 6.65 6.51 6.72 6.51 4.87 3.29 6.65 6.51 4.62 30000826 HC IMMUNOA INFECT AGENT AB QUANT 300 86317 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000828 HC STREP PNEUMO LGG AB 300 86317 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000829 HC TEICHOIC ABB IMMUNODIFFUSION 300 86329 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 30000830 HC IMMUNODIFFUSION GEL DIFF QUAL 300 86331 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 30000831 HC IMMUNE COMPLEX C1Q BIND 300 86332 283.00 271.68 271.68 268.85 263.19 271.68 263.19 197.05 132.81 268.85 263.19 186.78 30000832 HC IMMUNOFIXATION ELECTROPHORESIS 300 86334 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 30000833 HC IMMUNOFIXATION ELECTROPH SERUM 300 86334 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 30000834 HC IMMUNOFIX ELECTRO OTHER FLUID 300 86335 290.00 278.40 278.40 275.50 269.70 278.40 269.70 201.93 136.10 275.50 269.70 191.40 30000835 HC IMMUNOFIXATION ELECTROPH URINE 300 86335 290.00 278.40 278.40 275.50 269.70 278.40 269.70 201.93 136.10 275.50 269.70 191.40 30000836 HC INHIBIN A 300 86336 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000838 HC INSULIN ANTIBODY 300 86337 182.00 174.72 174.72 172.90 169.26 174.72 169.26 126.73 85.41 172.90 169.26 120.12 30000839 HC INTRINSIC FACTOR BLOCKING AB 300 86340 184.00 176.64 176.64 174.80 171.12 176.64 171.12 128.12 86.35 174.80 171.12 121.44 30000841 HC GLUTAMIC ACID 300 86341 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30000842 HC ISLET CELL AB IGG 300 86341 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30000843 HC ISLET CELL ANTIBODY 300 86341 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30000844 HC LEUK HISTAMINE RELEASE TST LHR 300 86343 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30000845 HC ASSAY CELLULAR FUNCTION 300 86352 386.00 370.56 370.56 366.70 358.98 370.56 358.98 268.77 181.15 366.70 358.98 254.76 30000847 HC LYMPHOCYTE TRANSFORMATION 300 86353 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 30000848 HC BCELL TOTAL COUNT 300 86355 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000849 HC MONONUC CELL AG QUANT NOS 300 86356 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000850 HC NK CELLS TOTAL COUNT 300 86357 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000851 HC TCELL TOTAL COUNT 300 86359 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000852 HC ABSOLUTE CD4/CD8 COUNT W/RATIO 300 86360 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000853 HC TCELL ABSOLUTE CD4 COUNT 300 86361 302.00 289.92 289.92 286.90 280.86 289.92 280.86 210.28 141.73 286.90 280.86 199.32 30000854 HC ANTITHYROID MICRO AB SERU 300 86376 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000855 HC LIVER KIDNEY MICROSOME-1AB IGG 300 86376 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000856 HC THYROID PEROXIDASE TPO AB 300 86376 148.00 142.08 142.08 140.60 137.64 142.08 137.64 103.05 69.46 140.60 137.64 97.68 30000857 HC POLIO VIRUS AB 300 86382 206.00 197.76 197.76 195.70 191.58 197.76 191.58 143.44 96.68 195.70 191.58 135.96 30000858 HC RABIES REFIT ENDPOINT 300 86382 206.00 197.76 197.76 195.70 191.58 197.76 191.58 143.44 96.68 195.70 191.58 135.96 30000859 HC CRYPTOCOCCOSIS ANTIGEN 300 86403 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 30000860 HC STREPTOZYME W/REFLEX TO TITER 300 86403 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 30000863 HC RHEUMATOID FACTOR QNT 300 86431 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30000864 HC TB INTERFANTIGEN 300 86480 323.00 310.08 310.08 306.85 300.39 310.08 300.39 224.90 151.58 306.85 300.39 213.18 30000865 HC TSPOT TUBERCULOSIS TEST 300 86481 206.00 197.76 197.76 195.70 191.58 197.76 191.58 143.44 96.68 195.70 191.58 135.96 30000866 HC SYPHILIS TEST QUALITATIVE 300 86592 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000867 HC VDRL CSF WITH REFLEX TO TITER 300 86592 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000868 HC BILL VDRLCS 300 86593 62.00 59.52 59.52 58.90 57.66 59.52 57.66 43.17 29.10 58.90 57.66 40.92 30000869 HC ADENOVIRUS ANTIBODY 300 86603 29.00 27.84 27.84 27.55 26.97 27.84 26.97 20.19 13.61 27.55 26.97 19.14 30000870 HC ASPERGILLUS ANTIBODY 300 86606 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 30000871 HC BARTONELLA AB 300 86611 98.00 94.08 94.08 93.10 91.14 94.08 91.14 68.24 45.99 93.10 91.14 64.68 30000872 HC BLASTOMYCOSIS 300 86612 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 30000873 HC BORDETELLA AB 300 86615 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 30000874 HC LYME CONFIRMATORY TEST 300 86617 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000875 HC LYME DISEASE AB 300 86618 186.00 178.56 178.56 176.70 172.98 178.56 172.98 129.51 87.29 176.70 172.98 122.76 30000876 HC BRUCELLA ANTIBODY 300 86622 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30000880 HC CHLAMYDIA ANTIBODY 300 86631 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000881 HC CHLAMYDIA IGM ANTIBODY 300 86632 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000882 HC COCCIDIOIDES ANTIBODY 300 86635 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000883 HC Q-FEVER AB 300 86638 163.00 156.48 156.48 154.85 151.59 156.48 151.59 113.50 76.50 154.85 151.59 107.58 30000884 HC CMV ANTIBODY 300 86644 139.00 133.44 133.44 132.05 129.27 133.44 129.27 96.79 65.23 132.05 129.27 91.74 30000885 HC CYTOMEGALOVIRUS AB IGM 300 86645 218.00 209.28 209.28 207.10 202.74 209.28 202.74 151.79 102.31 207.10 202.74 143.88 30000886 HC DIPHTHERIA TOXOID IGD AB 300 86648 237.00 227.52 227.52 225.15 220.41 227.52 220.41 165.02 111.22 225.15 220.41 156.42 30000887 HC ENCEPHAL ANTIBODY CALIF 300 86651 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000888 HC ENCEPHAL ANTIBODY EAST 300 86652 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000889 HC ENCEPHAL ANTIBODY ST LOUIS 300 86653 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000890 HC ENTEROVIRUS ANTIBODY 300 86658 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000891 HC EBV IGG AB TO EARLY AG 300 86663 171.00 164.16 164.16 162.45 159.03 164.16 159.03 119.07 80.25 162.45 159.03 112.86 30000892 HC EBV AB TO NUCLEAR AG IGG 300 86664 139.00 133.44 133.44 132.05 129.27 133.44 129.27 96.79 65.23 132.05 129.27 91.74 30000893 HC EBV AB TO VIRAL CAPSID AG 300 86665 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000894 HC EHRLICHIA ANTIBODY 300 86666 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000895 HC FRANCISELLA TULARENSIS 300 86668 192.00 184.32 184.32 182.40 178.56 184.32 178.56 133.69 90.11 182.40 178.56 126.72 30000896 HC FRANCISELLA TULARENSIS AB 300 86668 192.00 184.32 184.32 182.40 178.56 184.32 178.56 133.69 90.11 182.40 178.56 126.72 30000897 HC FUNGUS AB 300 86671 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30000899 HC HELICOBACTER PYLORI AB IGA 300 86677 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000900 HC HELICOBACTER PYLORI AB IGG 300 86677 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000901 HC HELICOBACTER PYLORI AB IGM 300 86677 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000902 HC HELMINTH AB 300 86682 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 30000904 HC HEM INF B VAC RESP 300 86684 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30000905 HC HTLVI/II 300 86687 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30000906 HC HIV AB CONFIRMATION TEST 300 86689 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000907 HC HIV-1 AB CONFIRM WESTERN BLOT 300 86689 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30000909 HC HSV NON SPECIFIC 300 86694 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000910 HC HSV TYPE 1 GLYCOPROTEIN G-SPECIFIC ANTIBODY IGG BY CIA (REFLEX) 300 86695 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 30000911 HC HSV TYPE 2 GLYCOPROTEIN G-SPECIFIC ANTIBODY IGG BY CIA (REFLEX) 300 86696 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30000912 HC HISTOPLASMA ANTIBODY 300 86698 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000913 HC HIV 1 ANTIBODIES 300 86701 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000914 HC HIV-2 ANTIBODY 300 86702 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000915 HC HIV 1 AND HIV 2 SINGLE RESULT 300 86703 112.00 107.52 107.52 106.40 104.16 107.52 104.16 77.99 52.56 106.40 104.16 73.92 30000916 HC HIV-1 AND HIV-2 ANTIBODIES 300 86703 112.00 107.52 107.52 106.40 104.16 107.52 104.16 77.99 52.56 106.40 104.16 73.92 30000917 HC HEP B CORE AB - TOTAL 300 86704 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000918 HC HEPATITIS B CORE AB IGM 300 86705 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30000919 HC HEP B SURFACE ANTIBODY HBSAB 300 86706 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 30000920 HC HEPATITIS BE ANTIBODY 300 86707 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30000921 HC HEPATITIS A PANEL 300 86708 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000922 HC HEPATITIS A ANTIBODY IGM 300 86709 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 30000923 HC INFLUENZA A/B VIRUS AB IGG IGM 300 86710 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 30000925 HC STRAT JV AB WINDEX 300 86711 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000926 HC LEGIONELLA PNEUMOPHILA 1-6 IGG 300 86713 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000928 HC LYMPHOCYTIC CHORIOMENINGITIS 300 86727 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30000929 HC MUMPS 300 86735 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30000930 HC MYCOPLASMA PNEUMONIA AB 300 86738 145.00 139.20 139.20 137.75 134.85 139.20 134.85 100.96 68.05 137.75 134.85 95.70 30000931 HC PARVO VIRUS AB 300 86747 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000934 HC ENTAMOEBA HISTOLYTICA AB IGG 300 86753 117.00 112.32 112.32 111.15 108.81 112.32 108.81 81.47 54.91 111.15 108.81 77.22 30000935 HC RICKETTSIA AB PANEL 300 86757 456.00 437.76 437.76 433.20 424.08 437.76 424.08 317.51 214.00 433.20 424.08 300.96 30000936 HC ROCKY MTN SPOTTED FEVER AB 300 86757 149.00 143.04 143.04 141.55 138.57 143.04 138.57 103.75 69.93 141.55 138.57 98.34 30000937 HC TYPHUS FEVER AB 300 86757 314.00 301.44 301.44 298.30 292.02 301.44 292.02 218.64 147.36 298.30 292.02 207.24 30000938 HC ANTIBODY RUBELLA 300 86762 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 30000939 HC RUBELLA IGM 300 86762 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 30000940 HC RUBEOLA AB IGG 300 86765 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 30000941 HC TETANUS AB 300 86774 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30000942 HC TOXOPLASMA AB 300 86777 142.00 136.32 136.32 134.90 132.06 136.32 132.06 98.87 66.64 134.90 132.06 93.72 30000943 HC TOXOPLASMA AB IGM 300 86778 149.00 143.04 143.04 141.55 138.57 143.04 138.57 103.75 69.93 141.55 138.57 98.34 30000944 HC TOXOPLASMA IGM 300 86778 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30000946 HC TREPONEMA PALLIDUM 300 86780 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30000947 HC VARICELLA ZOSTER AB 300 86787 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30000948 HC WEST NILE VIRUS IGM AB 300 86788 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30000949 HC WEST NILE VIRUS AB 300 86789 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30000950 HC CHIKUNGUNYA IGM IGG AB 300 86790 431.00 413.76 413.76 409.45 400.83 413.76 400.83 300.11 202.27 409.45 400.83 284.46 30000952 HC HHV - 6 IGG 300 86790 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000955 HC WEST NILE IGG TITER CSF 300 86790 143.00 137.28 137.28 135.85 132.99 137.28 132.99 99.57 67.11 135.85 132.99 94.38 30000956 HC THYROGLOBULIN ANTIBODY 300 86800 134.00 128.64 128.64 127.30 124.62 128.64 124.62 93.30 62.89 127.30 124.62 88.44 30000957 HC HEP C AB WITH REFLEX TO RIBA 300 86803 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000958 HC HEPATITIS C AB 300 86803 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000961 HC HEPATITIS C RIBA CONF 300 86804 356.00 341.76 341.76 338.20 331.08 341.76 331.08 247.88 167.07 338.20 331.08 234.96 30000965 HC HLA-B27 300 86812 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30000969 HC ANTIBODY SCREEN 300 86850 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 30000970 HC ANTIBODY ELUTION EACH 300 86860 177.00 169.92 169.92 168.15 164.61 169.92 164.61 123.25 83.07 168.15 164.61 116.82 30000971 HC ANTIBODY IDENTIFICATION 300 86870 198.00 190.08 190.08 188.10 184.14 190.08 184.14 137.87 92.92 188.10 184.14 130.68 30000972 HC MODIFIED ANTIBODY IDENT 300 86870 198.00 190.08 190.08 188.10 184.14 190.08 184.14 137.87 92.92 188.10 184.14 130.68 30000973 "HC DAT,ANTI IGG" 300 86880 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30000974 HC ANTIBODY TITER 300 86886 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30000975 HC RH (D) PATIENT 300 86901 58.00 55.68 55.68 55.10 53.94 55.68 53.94 40.39 27.22 55.10 53.94 38.28 30000976 HC ANTIGEN TESTING EACH UNIT 300 86902 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 30000977 HC SCREEN FOR COMPATIBLE UNITS 300 86904 71.00 68.16 68.16 67.45 66.03 68.16 66.03 49.44 33.32 67.45 66.03 46.86 30000978 HC RBC ANTIGENS OTHER THAN ABO RH (D) 300 86905 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30000979 "HC CROSSMATCH BLOOD, IS" 300 86920 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30000980 "HC CROSSMATCH BLOOD, AHG" 300 86922 186.00 178.56 178.56 176.70 172.98 178.56 172.98 129.51 87.29 176.70 172.98 122.76 30000981 HC THAWING FFP SDP OR CRYO 300 86927 43.00 41.28 41.28 40.85 39.99 41.28 39.99 29.94 20.18 40.85 39.99 28.38 30000985 HC RBC PRETX INCUB W CHEMICAL 300 86970 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 30000986 HC AB NEUTRALIZATION STUDIES 300 86977 98.00 94.08 94.08 93.10 91.14 94.08 91.14 68.24 45.99 93.10 91.14 64.68 30000987 HC ANTIBODY ABSORPTION COLD 300 86978 168.00 161.28 161.28 159.60 156.24 161.28 156.24 116.98 78.84 159.60 156.24 110.88 30000989 HC PROCESSING BLOOD/PLATELETS 300 86999 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30000990 HC CONCENTRATION ACID FAST 300 87015 42.00 40.32 40.32 39.90 39.06 40.32 39.06 29.24 19.71 39.90 39.06 27.72 30000991 HC CONCENTRATION FOR INFECT AGENT 300 87015 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30000992 HC CULTURE BLOOD 300 87040 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30000993 HC CULTURE STOOL SALM/SHIGELLA 300 87045 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 30000994 HC YERSINIA CULTURE 300 87046 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30000995 HC CULTURE AEROBIC 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000996 HC CULTURE CATH TIP 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000997 HC CULTURE CONJUNCTIVAL 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000998 HC CULTURE EAR 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30000999 HC CULTURE ENVIRONMENTAL 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001000 HC CULTURE EYE 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001001 HC CULTURE GENITAL 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001002 HC CULTURE N GONORRHOEAE 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001003 HC CULTURE NASOPHARYNGEAL 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001004 HC CULTURE THROAT 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001005 HC CULTURE WOUND SUPERFICIAL 300 87070 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 30001006 HC CULTURE ANAEROBIC 300 87075 130.00 124.80 124.80 123.50 120.90 124.80 120.90 90.52 61.01 123.50 120.90 85.80 30001007 HC ID BACTERIAL ANAEROBE 300 87076 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30001009 HC AEROBIC ID 300 87077 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001012 HC CULTURE AEROBIC ISOLATE 300 87077 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001013 HC ID BACTERIAL 300 87077 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001014 HC BACILLUS ANTHRACIS SCREEN 300 87081 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001015 HC CULTURE SCREENING 300 87081 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001016 HC LEGIONELLA CULTURE 300 87081 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001017 HC CULTURE URINE QUANT COLONY CNT 300 87086 88.00 84.48 84.48 83.60 81.84 84.48 81.84 61.27 41.30 83.60 81.84 58.08 30001018 HC CULTURE FUNGUS SKIN/NAIL/HAIR 300 87101 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30001019 HC CULTURE FUNGUS 300 87102 169.00 162.24 162.24 160.55 157.17 162.24 157.17 117.67 79.31 160.55 157.17 111.54 30001020 HC CULTURE FUNGUS BLOOD 300 87103 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 30001021 HC IDENTIFICATION FUNGAL YEAST 300 87106 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30001022 HC IDENTIFICATION FUNGAL MOLD 300 87107 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30001023 HC CULTURE MYCOPLASMA 300 87109 276.00 264.96 264.96 262.20 256.68 264.96 256.68 192.18 129.53 262.20 256.68 182.16 30001024 HC CHLAMYDIA CULTURE 300 87110 210.00 201.60 201.60 199.50 195.30 201.60 195.30 146.22 98.55 199.50 195.30 138.60 30001025 HC CULTURE ACID-FAST 300 87116 193.00 185.28 185.28 183.35 179.49 185.28 179.49 134.39 90.57 183.35 179.49 127.38 30001026 HC BILL ID BY MALDI-TOF MS AFB 300 87118 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 30001027 HC CULTURE MYCOBACT DEFINITIVE ID 300 87118 34.00 32.64 32.64 32.30 31.62 32.64 31.62 23.67 15.96 32.30 31.62 22.44 30001028 HC IDENT MYCOBACT BIOCHEM 300 87118 146.00 140.16 140.16 138.70 135.78 140.16 135.78 101.66 68.52 138.70 135.78 96.36 30001029 HC CULTURE TYPING 300 87140 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 30001031 HC SEROTYPING 300 87147 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001033 HC CULTURE TYPING ID NUCLEI PROBE 300 87149 239.00 229.44 229.44 227.05 222.27 229.44 222.27 166.42 112.16 227.05 222.27 157.74 30001035 HC ID MYCOBACT DNA PROBE 300 87149 239.00 229.44 229.44 227.05 222.27 229.44 222.27 166.42 112.16 227.05 222.27 157.74 30001036 HC ID OF EACH ORGANISM 300 87149 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 30001038 HC AEROBE ID SEQUENCING 300 87153 311.00 298.56 298.56 295.45 289.23 298.56 289.23 216.55 145.95 295.45 289.23 205.26 30001044 HC MYCOBATERIUM ID 300 87158 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 30001045 HC ANAEROBE ID SEQUENCING 300 87158 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 30001046 HC PINWORM PREP 300 87172 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001047 HC OVA AND PARASITES SMEARS 300 87177 106.00 101.76 101.76 100.70 98.58 101.76 98.58 73.81 49.75 100.70 98.58 69.96 30001048 HC SUSCEPTIBILITY STUDIES 300 87181 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30001049 HC SENSITIVITY DISC 300 87184 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001050 HC SUSCEPTIBILITY BETA LACTAMASE 300 87185 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30001051 HC BETA LACTAMASE 300 87185 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30001052 HC ANTIMICRO SUSCEPTIB MICRODILUT 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001054 HC MIC MIN INHIBITORY CONCEN 300 87186 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30001055 HC MIC NOCARDIA 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001057 HC SUSCEPT AFB NOCARDIA BY BROTH 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001058 HC SUSCEPT ANAEROBE BY BROTH DIL 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001059 HC SUSCEPTIBILITY MIC EACH 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001060 HC SUSCEPTIBILITY STUDIES MIC 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001061 HC SUSCEPTIBILITY GRAM NEG 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001062 HC SUSCEPTIBILITY GRAM POS 300 87186 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001064 HC MYCOBACTERIUM SENSITIVITY 300 87188 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 30001065 HC MYCOBACTERIA SUSCEPTIBILITY 300 87190 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001066 HC GRAM STAIN SMEAR 300 87205 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30001067 HC MYCOBACTERIUM STAIN 300 87206 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 30001068 HC CYCLOSPORA EXAMINATION 300 87207 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30001069 HC GIEMSA STAIN 300 87207 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30001070 HC GMS FUNGAL STAIN 300 87207 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30001071 HC MALARIA SMEAR 300 87207 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30001072 HC SPECIAL STAIN 300 87207 129.00 123.84 123.84 122.55 119.97 123.84 119.97 89.82 60.54 122.55 119.97 85.14 30001073 HC SPECIAL STAIN FOR INCLUSIONS 300 87207 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 30001074 HC SMEAR SPECIAL STAINS TRICHROME 300 87209 98.00 94.08 94.08 93.10 91.14 94.08 91.14 68.24 45.99 93.10 91.14 64.68 30001075 HC WET MOUNT 300 87210 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001076 HC FUNGUS DIRECT KOH 300 87220 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30001077 HC TISS CULT INOC OBS PRESUM ID 300 87252 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30001078 HC VIRUS ISOLATION TISSUE CULTURE 300 87252 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30001079 HC IP STAIN 300 87253 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30001080 HC TISS CULT DEFINITIVE ID 300 87253 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30001081 HC VIRUS ISOLATION SHELL VIAL 300 87254 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30001082 HC CULTURE HSV W/TYPING 300 87255 102.00 97.92 97.92 96.90 94.86 97.92 94.86 71.02 47.87 96.90 94.86 67.32 30001083 HC ADENOVIRUS 300 87260 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001084 HC CRYPTOSPORIDIUM AG DFA STOOL 300 87272 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30001085 HC INFLUENZA B 300 87275 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001086 HC INFLUENZA A 300 87276 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001088 HC LEGIONELLA PNEUMOPHILA DFA 300 87278 209.00 200.64 200.64 198.55 194.37 200.64 194.37 145.53 98.08 198.55 194.37 137.94 30001089 HC PARAINFLUENZA 1 2 3 300 87279 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001090 HC RSV 300 87280 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001091 HC HUMAN METAPNEUMOVIRUS 300 87299 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30001095 HC CLOSTRID DIFF TOXIN A & B 300 87324 194.00 186.24 186.24 184.30 180.42 186.24 180.42 135.08 91.04 184.30 180.42 128.04 30001096 HC CRYPTOCOCCUS AG SCREEN 300 87327 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30001097 HC GIARDIA AG DFA STOOL 300 87329 142.00 136.32 136.32 134.90 132.06 136.32 132.06 98.87 66.64 134.90 132.06 93.72 30001098 HC E HISTOLYTICA AG 300 87337 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 30001099 HC HELICOBACTER PYLORI STOOL 300 87338 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 30001100 HC HEP B SURFACE ANTIGEN HBSAG 300 87340 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30001101 HC HEP B SURF ANT HBSAG NEUTRAL 300 87341 67.00 64.32 64.32 63.65 62.31 64.32 62.31 46.65 31.44 63.65 62.31 44.22 30001102 HC HEPATITIS BE AG 300 87350 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 30001103 HC HISTOPLASMA AG ANY SOURCE 300 87385 276.00 264.96 264.96 262.20 256.68 264.96 256.68 192.18 129.53 262.20 256.68 182.16 30001104 HC HISTOPLASMA CAPSULATUM 300 87385 276.00 264.96 264.96 262.20 256.68 264.96 256.68 192.18 129.53 262.20 256.68 182.16 30001105 HC HIV-1 AGS W/HIV-1 HIV-2 ABS 300 87389 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 30001106 HC INFLUENZA A OR B EACH 300 87400 149.00 143.04 143.04 141.55 138.57 143.04 138.57 103.75 69.93 141.55 138.57 98.34 30001107 HC RSV DIRECT AG EIA 300 87420 112.00 107.52 107.52 106.40 104.16 107.52 104.16 77.99 52.56 106.40 104.16 73.92 30001108 HC ROTAVIRUS AG 300 87425 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30001109 HC E COLI SHIGA TOXINS STOOL 300 87427 139.00 133.44 133.44 132.05 129.27 133.44 129.27 96.79 65.23 132.05 129.27 91.74 30001110 HC STREP GROUP A ANTIGEN 300 87430 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30001111 HC FUNGITELL 1 & 3 BETA D GLUCAN 300 87449 369.00 354.24 354.24 350.55 343.17 354.24 343.17 256.93 173.17 350.55 343.17 243.54 30001113 HC INFECTIOUS AGENT AG DETECTION 300 87449 259.00 248.64 248.64 246.05 240.87 248.64 240.87 180.34 121.55 246.05 240.87 170.94 30001114 HC LEGIONELLA ANTIGEN URINE 300 87899 251.00 240.96 240.96 238.45 233.43 240.96 233.43 174.77 117.79 238.45 233.43 165.66 30001115 HC BORRELIA BURGDORFERI AMP PROBE 300 87476 559.00 536.64 536.64 531.05 519.87 536.64 519.87 389.23 262.34 531.05 519.87 368.94 30001116 HC CHLAMYDIA PNEUMONIAE 300 87486 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001117 HC CHLAMYDIA BY AMPLIFIED PROBE 300 87491 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30001118 HC CL DIFF TOXIN AMPLIFIED PROBE 300 87493 177.00 169.92 169.92 168.15 164.61 169.92 164.61 123.25 83.07 168.15 164.61 116.82 30001119 HC CMV AMPLIFIED PROBE 300 87496 506.00 485.76 485.76 480.70 470.58 485.76 470.58 352.33 237.47 480.70 470.58 333.96 30001120 HC CMV QUANT 300 87497 542.00 520.32 520.32 514.90 504.06 520.32 504.06 377.39 254.36 514.90 504.06 357.72 30001121 HC ENTEROVIRUS AMPLIFIED PROBE 300 87498 334.00 320.64 320.64 317.30 310.62 320.64 310.62 232.56 156.75 317.30 310.62 220.44 30001122 HC INFLUENZA A/B RFLX H1N0 300 87502 255.00 244.80 244.80 242.25 237.15 244.80 237.15 177.56 119.67 242.25 237.15 168.30 30001123 HC INFLUENZA A/B RFLX H1N1 300 87502 255.00 244.80 244.80 242.25 237.15 244.80 237.15 177.56 119.67 242.25 237.15 168.30 30001124 HC INFLUENZA A/B RFLX H1N2 300 87502 255.00 244.80 244.80 242.25 237.15 244.80 237.15 177.56 119.67 242.25 237.15 168.30 30001125 HC INFLUENZA A/B RFLX H1N3 300 87502 255.00 244.80 244.80 242.25 237.15 244.80 237.15 177.56 119.67 242.25 237.15 168.30 30001126 HC GASTRO INTSNL PATH PNL PCR PEC 300 87507 " 1,488.00 " " 1,428.48 " " 1,428.48 " " 1,413.60 " " 1,383.84 " " 1,428.48 " " 1,383.84 " " 1,036.09 " 698.32 " 1,413.60 " " 1,383.84 " 982.08 30001127 HC HEP B DNA 300 87517 613.00 588.48 588.48 582.35 570.09 588.48 570.09 426.83 287.68 582.35 570.09 404.58 30001128 HC HEP C AMPLIFIED PROBE 300 87521 600.00 576.00 576.00 570.00 558.00 576.00 558.00 417.78 281.58 570.00 558.00 396.00 30001129 HC HEPATITIS C QUANTIFICATION 300 87522 652.00 625.92 625.92 619.40 606.36 625.92 606.36 453.99 305.98 619.40 606.36 430.32 30001131 HC HERPES AB TYPE 1&2 DNAPCR 300 87529 349.00 335.04 335.04 331.55 324.57 335.04 324.57 243.01 163.79 331.55 324.57 230.34 30001132 HC HERPES VIRUS 6 AMPLIFIED PROBE 300 87532 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 30001133 HC HIV-1 DNA/PCR QUAL 300 87535 607.00 582.72 582.72 576.65 564.51 582.72 564.51 422.65 284.87 576.65 564.51 400.62 30001134 HC HIV-1 QUANT 300 87536 775.00 744.00 744.00 736.25 720.75 744.00 720.75 539.63 363.71 736.25 720.75 511.50 30001135 HC HIV-1 RNA QUANT BY BDNA 300 87536 775.00 744.00 744.00 736.25 720.75 744.00 720.75 539.63 363.71 736.25 720.75 511.50 30001136 HC HIV-1 RNA QUANT PCR 300 87536 775.00 744.00 744.00 736.25 720.75 744.00 720.75 539.63 363.71 736.25 720.75 511.50 30001138 HC MYCOBACTERIA PCR CSF 300 87556 145.00 139.20 139.20 137.75 134.85 139.20 134.85 100.96 68.05 137.75 134.85 95.70 30001139 HC MYCOBACT TUBERCUL AMPLIF PROBE 300 87556 145.00 139.20 139.20 137.75 134.85 139.20 134.85 100.96 68.05 137.75 134.85 95.70 30001141 HC MYCOPLASMA PNEUMONIAE PCR 300 87581 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30001142 HC N GONORRHOEAE AMPLIFIED PROBE 300 87591 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 30001145 HC INFLU A/B & RSV PCR M-FLUNP 300 87631 391.00 375.36 375.36 371.45 363.63 375.36 363.63 272.25 183.50 371.45 363.63 258.06 30001148 HC B PERTUSSIS PCR 300 87798 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30001149 HC BARTONELLA PCR NLL 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001150 HC H1N1 BY PCR 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001151 HC H1N1 BY PCR 2 OF 2 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001152 HC INFECTIOUS AGENT AMPLIF PROBE 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001154 HC TROPHERYMA WHIPPLEI BY RA 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001155 HC WEST NILE RAPID PCR 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001156 HC WEST NILE VIRUS BY PCR CS 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001157 HC INFECTIOUS AGENT QUANT 300 87799 650.00 624.00 624.00 617.50 604.50 624.00 604.50 452.60 305.05 617.50 604.50 429.00 30001158 HC BARTONELLA RAPID PCR BLOOD 300 87801 379.00 363.84 363.84 360.05 352.47 363.84 352.47 263.90 177.86 360.05 352.47 250.14 30001159 HC BORDETELLA PCR 300 87801 420.00 403.20 403.20 399.00 390.60 403.20 390.60 292.45 197.11 399.00 390.60 277.20 30001160 HC DETECT AGENT INFLUENZA 300 87804 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30001161 HC HIV 1/2 AB/AG 4TH GENERATION 300 87806 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30001162 HC GRP A STREP AG W/REFLEX 300 87880 94.00 90.24 90.24 89.30 87.42 90.24 87.42 65.45 44.11 89.30 87.42 62.04 30001163 HC INFECT AGENT DETECT BY IMMUN 300 87899 91.00 87.36 87.36 86.45 84.63 87.36 84.63 63.36 42.71 86.45 84.63 60.06 30001164 HC HIV-1 GENOTYPING-DRUG RESIST 300 87901 627.00 601.92 601.92 595.65 583.11 601.92 583.11 436.58 294.25 595.65 583.11 413.82 30001165 HC INFECT AGENT GENOTYPE DNA/RNA 300 87901 576.00 552.96 552.96 547.20 535.68 552.96 535.68 401.07 270.32 547.20 535.68 380.16 30001166 HC INFECT AGENT HEPATITIS C VIRUS 300 87902 660.00 633.60 633.60 627.00 613.80 633.60 613.80 459.56 309.74 627.00 613.80 435.60 30001167 HC FLOW CYTOMETRY RBC MARKER 1 300 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30001168 HC FLOW CYTOMETRY WBC MARKER 1 300 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 30001169 HC CHROMOSOME ANALYSIS 5 CELLS 300 88261 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 30001170 HC CHROMOSOME ANALYSIS 15-20 CELL 300 88262 809.00 776.64 776.64 768.55 752.37 776.64 752.37 563.31 379.66 768.55 752.37 533.94 30001173 HC BILI TOTAL TRANSCUTANEOUS 300 88720 67.00 64.32 64.32 63.65 62.31 64.32 62.31 46.65 31.44 63.65 62.31 44.22 30001174 HC CELL CNT BODY FLD NOT BLD 300 89050 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 30001175 HC CSF CELL CT & ID 300 89051 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30001176 HC LEUKOCYTES STOOL 300 89055 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001177 HC CRYSTAL ID SYNOVIAL FLUID 300 89060 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001179 HC EOSINOPHIL COUNT NASAL SMEAR 300 89190 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30001180 HC SEMEN CT & MORPH 300 89310 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30001181 HC SEMEN ANALYSIS COMPLETE 300 89320 171.00 164.16 164.16 162.45 159.03 164.16 159.03 119.07 80.25 162.45 159.03 112.86 30001182 HC SEMEN PRESENCE &/OR MOTIL 300 89321 91.00 87.36 87.36 86.45 84.63 87.36 84.63 63.36 42.71 86.45 84.63 60.06 30001183 HC DRUG COLL SCREEN 300 99001 29.00 27.84 27.84 27.55 26.97 27.84 26.97 20.19 13.61 27.55 26.97 19.14 30001184 HC TRANSP OUT OF TOWN 300 99082 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 30001186 HC TRAVEL ALLOW 1 DRAW 1 WAY 300 P9604 25.00 24.00 24.00 23.75 23.25 24.00 23.25 17.41 11.73 23.75 23.25 16.50 30001187 HC TRAVEL ALLOW 2 DRAWS 1 WAY 300 P9604 12.00 11.52 11.52 11.40 11.16 11.52 11.16 8.36 5.63 11.40 11.16 7.92 30001188 HC TRAVEL ALLOW 3 DRAWS 1 WAY 300 P9604 10.00 9.60 9.60 9.50 9.30 9.60 9.30 6.96 4.69 9.50 9.30 6.60 30001189 HC BLOOD SMEAR EXAM 300 85008 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 30001191 HC CYTOPLASMIC NEUTROPHIL 300 86255 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30001192 HC AG NA -1 300 86255 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001193 HC CRMP S IGG 300 86255 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001194 HC IODINE - SERUM 300 83018 150.00 144.00 144.00 142.50 139.50 144.00 139.50 104.45 70.40 142.50 139.50 99.00 30001195 HC ANTI-SM MUSCLE AB W REFLE 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30001196 HC PROTEINASE 3 AB 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30001197 HC TISSUE TRANSGLUINASE AB 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30001198 HC RSV ANTIGEN 300 87807 162.00 155.52 155.52 153.90 150.66 155.52 150.66 112.80 76.03 153.90 150.66 106.92 30001199 HC N-TYPE CALCIUM CHANNEL AB 300 83519 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30001200 HC CAFFEINE SERUM 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30001201 HC NMO EVAL W REFLEX NMO IGG 300 83520 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 30001202 HC SULFATIDE AUTO ANTIBODY X2 300 83520 622.00 597.12 597.12 590.90 578.46 597.12 578.46 433.10 291.90 590.90 578.46 410.52 30001203 HC CLONAZEPAM SERUM 300 80346 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 30001204 HC BENZODIAZAPINE URINE CONFRMTRY 300 80346 237.00 227.52 227.52 225.15 220.41 227.52 220.41 165.02 111.22 225.15 220.41 156.42 30001205 HC FLOW CYTOMETRY EA ADDIT MARKER 300 88185 501.00 480.96 480.96 475.95 465.93 480.96 465.93 348.85 235.12 475.95 465.93 330.66 30001206 HC FLOW CYTOMETRY CELL SURF 300 88185 501.00 480.96 480.96 475.95 465.93 480.96 465.93 348.85 235.12 475.95 465.93 330.66 30001207 HC LEUK PHENO B CELL PANEL 300 88185 501.00 480.96 480.96 475.95 465.93 480.96 465.93 348.85 235.12 475.95 465.93 330.66 30001208 HC T CELLS ABS RATI 300 88185 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 30001209 HC ZAP 70 REFER 300 88185 501.00 480.96 480.96 475.95 465.93 480.96 465.93 348.85 235.12 475.95 465.93 330.66 30001210 HC VARICELLA ZOSTER PCR 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001211 HC TREPONEMA PALLIDUM DNA PC 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001212 HC NORTRIPTYLINE 300 80335 142.00 136.32 136.32 134.90 132.06 136.32 132.06 98.87 66.64 134.90 132.06 93.72 30001213 HC ENCEPHALITIS AB 300 86654 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 30001214 HC FLOUNDER IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30001215 HC PINAPPLE IGE 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30001216 HC IMMUNOASSAY TUMOR ANTIGEN QNT 300 86300 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30001217 HC FLU AB RNA QL RT-PCR Q16086 300 87502 255.00 244.80 244.80 242.25 237.15 244.80 237.15 177.56 119.67 242.25 237.15 168.30 30001218 HC PANCREATIC ELASTASE 300 82656 216.00 207.36 207.36 205.20 200.88 207.36 200.88 150.40 101.37 205.20 200.88 142.56 30001220 HC AUTOLOGOUS UNIT HANDLING 300 86900 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001221 "HC ABO, PATIENT" 300 86900 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 30001222 HC MYCOBACTERIA CULTURE BLOOD 300 87116 193.00 185.28 185.28 183.35 179.49 185.28 179.49 134.39 90.57 183.35 179.49 127.38 30001223 HC HSV PCR 300 87529 349.00 335.04 335.04 331.55 324.57 335.04 324.57 243.01 163.79 331.55 324.57 230.34 30001224 HC STREPTOCOCCUS PNEUM ANTIGEN 300 87899 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 30001225 HC BLOOD CULTURE ORG ID PEDS 300 87150 250.00 240.00 240.00 237.50 232.50 240.00 232.50 174.08 117.33 237.50 232.50 165.00 30001227 HC HSV 1 AMPLIFIED PROBE 300 87529 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30001228 HC HSV 2 AMPLIFIED PROBE 300 87529 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30001230 HC RESP VIRAL PANEL BIOFIRE 300 87633 472.00 453.12 453.12 448.40 438.96 453.12 438.96 328.65 221.51 448.40 438.96 311.52 30001233 HC CBC WO PLT OR AUTO DIFF 300 G0307 101.00 96.96 96.96 95.95 93.93 96.96 93.93 70.33 47.40 95.95 93.93 66.66 30001235 HC COMPAZINE 300 G0480 274.00 263.04 263.04 260.30 254.82 263.04 254.82 190.79 128.59 260.30 254.82 180.84 30001236 HC OPIATES 1 OR MORE 300 80361 370.00 355.20 355.20 351.50 344.10 355.20 344.10 257.63 173.64 351.50 344.10 244.20 30001237 HC CREATININE URINE 300 82570 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30001241 HC FLOW CYTO INTERPRET 9-15 MRKS 300 88188 393.00 377.28 377.28 373.35 365.49 377.28 365.49 273.65 184.43 373.35 365.49 259.38 30001242 HC TISSUE CULTURE LYMPHOCYTE 300 88230 813.00 780.48 780.48 772.35 756.09 780.48 756.09 566.09 381.54 772.35 756.09 536.58 30001244 HC CHROM ANALY 5 COUNT 300 88261 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 30001246 HC CHROMO ANALY ADDL KARYOTYPES 300 88280 347.00 333.12 333.12 329.65 322.71 333.12 322.71 241.62 162.85 329.65 322.71 229.02 30001247 HC CYTOGENETICS INTERP & REPORT 300 88291 226.00 216.96 216.96 214.70 210.18 216.96 210.18 157.36 106.06 214.70 210.18 149.16 30001248 HC GROSS & MICRO LEVEL IV 300 88305 183.00 175.68 175.68 173.85 170.19 175.68 170.19 127.42 85.88 173.85 170.19 120.78 30001249 HC PSA TOTAL MC SCREENING 300 G0103 138.00 132.48 132.48 131.10 128.34 132.48 128.34 96.09 64.76 131.10 128.34 91.08 30001253 HC URINE DRUG SCREEN 300 80305 127.00 121.92 121.92 120.65 118.11 121.92 118.11 88.43 59.60 120.65 118.11 83.82 30001254 HC SALICYLATE 300 80329 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30001255 HC ACETOMINOPHEN QUANT 300 80330 266.00 255.36 255.36 252.70 247.38 255.36 247.38 185.22 124.83 252.70 247.38 175.56 30001256 HC PREP PKG MAIL SPEC 300 99001 37.00 35.52 35.52 35.15 34.41 35.52 34.41 25.76 17.36 35.15 34.41 24.42 30001257 HC DRUG SCREEN QUALITATIVE 300 80307 183.00 175.68 175.68 173.85 170.19 175.68 170.19 127.42 85.88 173.85 170.19 120.78 30001259 HC NICOTINE & COTININE 300 80307 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30001260 HC DRUG SCR MULT DRUG CLASS 4 OR> 300 80307 230.00 220.80 220.80 218.50 213.90 220.80 213.90 160.15 107.94 218.50 213.90 151.80 30001261 HC ALCOHOL ETHYL BLOOD 300 80307 230.00 220.80 220.80 218.50 213.90 220.80 213.90 160.15 107.94 218.50 213.90 151.80 30001262 HC SALICYLATE 300 80307 230.00 220.80 220.80 218.50 213.90 220.80 213.90 160.15 107.94 218.50 213.90 151.80 30001263 HC ACETAMINOPHEN QUANT 300 80307 230.00 220.80 220.80 218.50 213.90 220.80 213.90 160.15 107.94 218.50 213.90 151.80 30001264 HC DRUG SCREEN MULTI DRUG 300 80307 202.00 193.92 193.92 191.90 187.86 193.92 187.86 140.65 94.80 191.90 187.86 133.32 30001267 HC IMMUNOGLOBULIN E 300 82785 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30001268 HC HGB FRACTION & QUANT ELECTRO 300 83020 108.00 103.68 103.68 102.60 100.44 103.68 100.44 75.20 50.68 102.60 100.44 71.28 30001270 HC IMMUNO INFECTIOUS AGENT 300 83516 419.00 402.24 402.24 398.05 389.67 402.24 389.67 291.75 196.64 398.05 389.67 276.54 30001271 HC IMMUNOASSAY QUANT BY RIA 300 83519 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30001273 HC CYTOKINE 300 83520 364.00 349.44 349.44 345.80 338.52 349.44 338.52 253.45 170.83 345.80 338.52 240.24 30001274 HC IMMUNOASSAY QUANT 300 83520 412.00 395.52 395.52 391.40 383.16 395.52 383.16 286.88 193.35 391.40 383.16 271.92 30001275 HC MERCURY QUANT 300 83825 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30001277 HC THROMBOPLASTIN TIME PTT 300 85730 94.00 90.24 90.24 89.30 87.42 90.24 87.42 65.45 44.11 89.30 87.42 62.04 30001278 HC EXTRACTABLE NUCLEAR AG AB 300 86235 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30001279 HC FLUO NONINF AGE ANT SCR EA ANT 300 86255 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001282 HC FLUOR NONINF AGENT TITER EA 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30001283 HC FLUORESCENT NONINFECT AB TITER 300 86256 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30001288 HC ASPERGILLUS AB 300 86606 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 30001292 HC COCCIDIOIDES ANTIBODY 300 86635 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30001293 HC Q-FEVER AB 300 86638 163.00 156.48 156.48 154.85 151.59 156.48 151.59 113.50 76.50 154.85 151.59 107.58 30001295 HC EHRLICHIA ANAPLASMA 300 86666 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 30001297 HC HISTOPLASMA ANTIBODY 300 86698 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30001299 HC HIV-1 ANTIBODY 300 86701 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30001300 HC HIV-2 ANTIBODY 300 86702 198.00 190.08 190.08 188.10 184.14 190.08 184.14 137.87 92.92 188.10 184.14 130.68 30001301 HC LEPTOSPIRA AB 300 86720 145.00 139.20 139.20 137.75 134.85 139.20 134.85 100.96 68.05 137.75 134.85 95.70 30001302 HC MUMPS 300 86735 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30001303 HC TREPONEMA PALLIDUM 300 86780 91.00 87.36 87.36 86.45 84.63 87.36 84.63 63.36 42.71 86.45 84.63 60.06 30001304 HC THYROGLOBULIN AB 300 86800 134.00 128.64 128.64 127.30 124.62 128.64 124.62 93.30 62.89 127.30 124.62 88.44 30001307 HC MIC PANEL 300 87186 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30001308 HC TISS CULT INOC OBS PRESUM ID 300 87252 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 30001309 HC SHELL VIAL 300 87254 208.00 199.68 199.68 197.60 193.44 199.68 193.44 144.83 97.61 197.60 193.44 137.28 30001310 HC INFECT AGENT DETECT RNA DNA 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001311 HC INFECTIOUS AGENT BY AMPL PROBE 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001312 HC INFECT AGENT DETECT AMP PROBE 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001313 HC INFECTIOUS AGENT AMPLIF PROBE 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001314 HC CHROMO ANALY ADDL KARYOTYPES 300 88280 347.00 333.12 333.12 329.65 322.71 333.12 322.71 241.62 162.85 329.65 322.71 229.02 30001315 HC CYTOGENETICS INTERP & REPORT 300 88291 226.00 216.96 216.96 214.70 210.18 216.96 210.18 157.36 106.06 214.70 210.18 149.16 30001317 HC COCCIDIOIDES ANTIBODIES 300 86635 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 30001318 HC CANDIDA DNA DIRECT PROBE 300 87480 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30001319 HC GARDNER VAG DNA DIRECT PROBE 300 87510 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30001320 HC TRICH VAG DNA DIRECT PROBE 300 87660 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30001321 HC DRUG SCREEN SINGLE DRUG 300 80307 286.00 274.56 274.56 271.70 265.98 274.56 265.98 199.14 134.22 271.70 265.98 188.76 30001323 HC OXYCODONE 300 80365 206.00 197.76 197.76 195.70 191.58 197.76 191.58 143.44 96.68 195.70 191.58 135.96 30001324 HC CERULOPLASMIN 300 82390 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30001325 HC DRUG TEST PRESUMPTIVE 300 80307 123.00 118.08 118.08 116.85 114.39 118.08 114.39 85.64 57.72 116.85 114.39 81.18 30001326 HC HIV-1 ANTIBODY 300 86701 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30001328 "HC DAT,ANTI-C3B -C3D" 300 86880 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 30001331 HC GRP A STREP CULTURE THROAT 300 87081 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 30001334 HC ENTEROVIRUS PCR 300 87498 334.00 320.64 320.64 317.30 310.62 320.64 310.62 232.56 156.75 317.30 310.62 220.44 30001335 HC MYCOBACTERIA TB AMPLIF PROBE 300 87556 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 30001336 HC TOBRAMYCIN TROUGH 300 80200 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30001337 HC TOBRAMYCIN KINETIC 300 80200 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30001339 HC THROMBOPLASTIN INHIB TISSUE 300 85705 35.00 33.60 33.60 33.25 32.55 33.60 32.55 24.37 16.43 33.25 32.55 23.10 30001340 HC BARTONELLA DNA PCR 300 87471 533.00 511.68 511.68 506.35 495.69 511.68 495.69 371.13 250.14 506.35 495.69 351.78 30001341 HC MENING/ENCEPH PANEL BIOFIRE 300 87483 950.00 912.00 912.00 902.50 883.50 912.00 883.50 661.49 445.84 902.50 883.50 627.00 30001342 HC ALBUMIN SERUM PLASMA WB 300 82040 46.00 44.16 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30001343 HC ALBUMIN URINE/OTHER QUANT EACH 300 82042 56.00 53.76 53.76 53.20 52.08 53.76 52.08 38.99 26.28 53.20 52.08 36.96 30001344 HC RHEUMATOID FACTOR QUANTITATIVE 300 86431 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001345 HC SPECTROPHOTOMETRY 300 84311 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001346 HC CRYPTOCOCCUS NEOFORMANS 300 87327 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 30001349 HC FLUORESCENT NONINFECT AGENT AB 300 86255 479.00 459.84 459.84 455.05 445.47 459.84 445.47 333.53 224.79 455.05 445.47 316.14 30001353 HC GI PANEL 300 87506 576.00 552.96 552.96 547.20 535.68 552.96 535.68 401.07 270.32 547.20 535.68 380.16 30001354 HC NOROVIRUS GI 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001355 HC NOROVIRUS GII 300 87798 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001356 HC QUANT OF THERAPEUTIC DRUG 300 80193 202.00 193.92 193.92 191.90 187.86 193.92 187.86 140.65 94.80 191.90 187.86 133.32 30001357 HC NICOTINE METABOLITES URINE 300 80323 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 30001358 HC PLATELET ANTIBODIES 300 86022 351.00 336.96 336.96 333.45 326.43 336.96 326.43 244.40 164.72 333.45 326.43 231.66 30001359 HC CROSSMATCH ELECTRONIC 300 86923 203.00 194.88 194.88 192.85 188.79 194.88 188.79 141.35 95.27 192.85 188.79 133.98 30001360 HC LACTOSE TOLERANCE-3 SPEC 300 82951 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 30001361 HC CONCENTRATION CYCLOSPORA 300 87015 42.00 40.32 40.32 39.90 39.06 40.32 39.06 29.24 19.71 39.90 39.06 27.72 30001363 HC CULTURE SCREENING GRP B 300 87081 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 30001365 HC FLUID CELL CT & ID 300 89051 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30001366 HC SYNOVIAL FLUID CELL CT & ID 300 89051 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30001367 HC GLUCOSE BODY FLUID 300 82945 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001368 HC RSV BY PCR 300 87634 205.00 196.80 196.80 194.75 190.65 196.80 190.65 142.74 96.21 194.75 190.65 135.30 30001369 HC SIROLIMUS PAPAMUNE BLOOD 300 80195 208.00 199.68 199.68 197.60 193.44 199.68 193.44 144.83 97.61 197.60 193.44 137.28 30001370 HC HGB A1C SCRN LESS THAN 7.0 300 3044F 1.00 0.96 0.96 0.95 0.93 0.96 0.93 0.70 0.47 0.95 0.93 0.66 30001372 HC HGB A1C GREATER THAN 9 300 3046F 1.00 0.96 0.96 0.95 0.93 0.96 0.93 0.70 0.47 0.95 0.93 0.66 30001373 HC TRAZADONE URINE 300 80338 121.00 116.16 116.16 114.95 112.53 116.16 112.53 84.25 56.79 114.95 112.53 79.86 30001374 HC L PNEUMOPHILIA SEROGROUP 1 300 87449 259.00 248.64 248.64 246.05 240.87 248.64 240.87 180.34 121.55 246.05 240.87 170.94 30001375 HC LACTOFERIN FECAL QUANT 300 83631 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 30001377 HC GLUCOSE 300 82947 46.00 44.16 44.16 43.70 42.78 44.16 42.78 32.03 21.59 43.70 42.78 30.36 30001381 HC CREATININE 300 82565 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 30001382 HC C DIFFICILE TOXINS 300 87324 194.00 186.24 186.24 184.30 180.42 186.24 180.42 135.08 91.04 184.30 180.42 128.04 30001383 HC CYP2D6 GENOTYPING 300 81226 496.00 476.16 476.16 471.20 461.28 476.16 461.28 345.36 232.77 471.20 461.28 327.36 30001384 HC DEFINITIVE DRUG TESTS 1-7 CL 300 G0480 220.00 211.20 211.20 209.00 204.60 211.20 204.60 153.19 103.25 209.00 204.60 145.20 30001385 HC CYP2C19 GENOTYPING 300 81225 386.00 370.56 370.56 366.70 358.98 370.56 358.98 268.77 181.15 366.70 358.98 254.76 30001386 HC CALR CALRETICULIN EXON 9 MUT ANALYS 300 81219 331.00 317.76 317.76 314.45 307.83 317.76 307.83 230.48 155.34 314.45 307.83 218.46 30001387 HC MOPATH PROCEDURE LEVEL 3 300 81402 491.00 471.36 471.36 466.45 456.63 471.36 456.63 341.88 230.43 466.45 456.63 324.06 30001388 HC OPRM1 300 81479 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30001389 HC COMT 300 81479 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30001390 HC MOPATH PROCEDURE LEVEL 2 300 81401 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30001391 HC MOPATH PROCEDURE LEVEL 2 300 81401 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 30001392 HC VKORC1 GENOTYPING 300 81355 5.00 4.80 4.80 4.75 4.65 4.80 4.65 3.48 2.35 4.75 4.65 3.30 30001396 HC CTFR SEQUENCING 300 81223 428.00 410.88 410.88 406.60 398.04 410.88 398.04 298.02 200.86 406.60 398.04 282.48 30001397 HC MOPATH PROCEDURE LEVEL 5 300 81404 539.00 517.44 517.44 512.05 501.27 517.44 501.27 375.31 252.95 512.05 501.27 355.74 30001398 HC MOPATH PROCEDURE LEVEL 6 300 81405 434.00 416.64 416.64 412.30 403.62 416.64 403.62 302.19 203.68 412.30 403.62 286.44 30001399 HC PROTEIN TOTAL 300 84160 59.00 56.64 56.64 56.05 54.87 56.64 54.87 41.08 27.69 56.05 54.87 38.94 30001400 HC PROTEIN ELECTROPHORETIC FRAC QUANT 300 84165 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 30001401 HC IMMUNOFIXATION ELECTRO SERUM 300 86334 212.00 203.52 203.52 201.40 197.16 203.52 197.16 147.62 99.49 201.40 197.16 139.92 30001402 HC GAMMAGLOBULIN EACH 300 82784 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 30001403 HC NEPHELOMETRY EACH 300 83883 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30001404 HC AMPHETAMINE 300 80325 77.00 73.92 73.92 73.15 71.61 73.92 71.61 53.62 36.14 73.15 71.61 50.82 30001408 HC HEPATITIS C ANTIBODY 300 86803 116.00 111.36 111.36 110.20 107.88 111.36 107.88 80.77 54.44 110.20 107.88 76.56 30001409 HC MOPATH PROCEDURE LEVEL 5 300 81404 539.00 517.44 517.44 512.05 501.27 517.44 501.27 375.31 252.95 512.05 501.27 355.74 30001410 HC BCR ABL1 MAJOR 300 81206 387.00 371.52 371.52 367.65 359.91 371.52 359.91 269.47 181.62 367.65 359.91 255.42 30001411 HC BCR ABL1 MINOR 300 81207 380.00 364.80 364.80 361.00 353.40 364.80 353.40 264.59 178.33 361.00 353.40 250.80 30001412 HC MOPATH PROCEDURE LEVEL 3 300 81338 491.00 471.36 471.36 466.45 456.63 471.36 456.63 341.88 230.43 466.45 456.63 324.06 30001413 HC MYELOID MALIGNANCY PANEL 300 81455 " 2,069.00 " " 1,986.24 " " 1,986.24 " " 1,965.55 " " 1,924.17 " " 1,986.24 " " 1,924.17 " " 1,440.64 " 970.98 " 1,965.55 " " 1,924.17 " " 1,365.54 " 30001414 HC JAK2 GENE ANALYSIS 300 81270 434.00 416.64 416.64 412.30 403.62 416.64 403.62 302.19 203.68 412.30 403.62 286.44 30001415 HC JAK2 SEQUENCING 300 0027U 409.00 392.64 392.64 388.55 380.37 392.64 380.37 284.79 191.94 388.55 380.37 269.94 30001416 HC CREATININE OTHER SOURCE 300 82570 83.00 79.68 79.68 78.85 77.19 79.68 77.19 57.79 38.95 78.85 77.19 54.78 30001418 HC BHB BETA - HYDROXYBUTYRATE 300 82010 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001419 HC STREPTOCCOCCUS GROUP B PROBE 300 87653 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 30001420 HC FETAL CONGENITAL ABNORMALITIES BIOCHEM 4 ANALYTES 300 81511 212.00 203.52 203.52 201.40 197.16 203.52 197.16 147.62 99.49 201.40 197.16 139.92 30001421 HC HERPES SIMPLEX VIRUS TYPE 1-2 ABS IGG W REFLEX TYPE 1-2 GLYCOPROTEIN G-SPECIFIC AB IGG 300 86694 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 30001422 HC INHIBIN A ULTRASENSITIVE 300 86336 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 30001423 HC INHIBIN B 300 83520 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30001424 HC INTERLEUKIN-6 SERUM 300 83520 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 30001429 HC ZIKA VIRUS IGM (EUA) 300 86794 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 30001430 HC ZIKA VIRUS BY PCR BLOOD 300 87662 328.00 314.88 314.88 311.60 305.04 314.88 305.04 228.39 153.93 311.60 305.04 216.48 30001431 HC ZIKA VIRUS BY PCR URINE 300 87662 328.00 314.88 314.88 311.60 305.04 314.88 305.04 228.39 153.93 311.60 305.04 216.48 30001432 HC FREE AND TOTAL INSULIN (TOTAL) 300 83525 62.00 59.52 59.52 58.90 57.66 59.52 57.66 43.17 29.10 58.90 57.66 40.92 30001433 HC FREE AND TOTAL INSULIN (FREE) 300 83527 62.00 59.52 59.52 58.90 57.66 59.52 57.66 43.17 29.10 58.90 57.66 40.92 30001434 HC INFECTIOUS AGENT DETECTION DNA/RNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE 300 87486 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001436 HC INFECTIOUS AGENT DETECTION DNA/RNA MPNEUMONIAE AMPLIFIED PROBE 300 87581 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30001437 HC CULTURE TYPING ID BY DNA/RNA PROBE PER CULTRUE OR ISOLATE EA ORGANISM PROBED 300 87150 250.00 240.00 240.00 237.50 232.50 240.00 232.50 174.08 117.33 237.50 232.50 165.00 30001439 HC INFECTIOUS AGENT DETECTION BY DNA OR RNA NOS AMP PROBE EA ORGANISM 300 87798 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 30001440 HC INFECTIOUS DISEASE CHRONIC HEPATITIS C SIX BIOCHEM ASSAYS 300 81596 528.00 506.88 506.88 501.60 491.04 506.88 491.04 367.65 247.79 501.60 491.04 348.48 30001443 HC NEURO CSF PRION PROTEIN QUAL 300 0035U 492.00 472.32 472.32 467.40 457.56 472.32 457.56 342.58 230.90 467.40 457.56 324.72 30001444 HC WESTERN BLOT TEST 300 84182 169.00 162.24 162.24 160.55 157.17 162.24 157.17 117.67 79.31 160.55 157.17 111.54 30001445 HC BLOOD OCCULT FECAL HGB FECES 1-3 SIMULT 300 82274 54.00 51.84 51.84 51.30 50.22 51.84 50.22 37.60 25.34 51.30 50.22 35.64 30001446 HC AMINES VAGINAL FLUID QUALITATIVE 300 82120 59.00 56.64 56.64 56.05 54.87 56.64 54.87 41.08 27.69 56.05 54.87 38.94 30001449 HB HGB A1C SRN GREATER OR EQUAL TO 7 AND LESS THAN 8 300 3051F 1.00 0.96 0.96 0.95 0.93 0.96 0.93 0.70 0.47 0.95 0.93 0.66 30001450 HB HGB A1C SCRN GREATER THAN OR EQUAL TO 8 AND LESS THAN OR EQUAL TO 9 300 3052F 1.00 0.96 0.96 0.95 0.93 0.96 0.93 0.70 0.47 0.95 0.93 0.66 30001451 HC RESP VIRAL PANEL BIOFIRE 300 0097U 518.00 497.28 497.28 492.10 481.74 497.28 481.74 360.68 243.10 492.10 481.74 341.88 30001452 HC GI PANEL 300 0100U 559.00 536.64 536.64 531.05 519.87 536.64 519.87 389.23 262.34 531.05 519.87 368.94 30001453 HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 300 80342 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 30001454 HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 300 87624 139.00 133.44 133.44 132.05 129.27 133.44 129.27 96.79 65.23 132.05 129.27 91.74 30001455 HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH 300 87661 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001456 HC M. GENITALIUM AMP PROBE 300 87563 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 30001459 HC RESP VIRAL PANEL BIOFIRE - MICRO 300 0097U 518.00 497.28 497.28 492.10 481.74 497.28 481.74 360.68 243.10 492.10 481.74 341.88 30001460 HC BCR ABL1 OTHER BREAKPOINT 300 81208 367.00 352.32 352.32 348.65 341.31 352.32 341.31 255.54 172.23 348.65 341.31 242.22 30001463 HC CITRATE 300 82507 113.00 108.48 108.48 107.35 105.09 108.48 105.09 78.68 53.03 107.35 105.09 74.58 30001464 HC OXALATE URINE 300 83945 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001465 HC CALCIUM URINE QUANT TIMED 300 82340 77.00 73.92 73.92 73.15 71.61 73.92 71.61 53.62 36.14 73.15 71.61 50.82 30001468 HC ALKALOIDS NOT OTHERWISE SPECIFIED 300 80323 211.00 202.56 202.56 200.45 196.23 202.56 196.23 146.92 99.02 200.45 196.23 139.26 30001469 HC IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY 300 87625 283.00 271.68 271.68 268.85 263.19 271.68 263.19 197.05 132.81 268.85 263.19 186.78 30001470 HC SARS-COV-2 BY PCR 300 87635 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001471 HC COVID-19-RPS 300 U0003 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001472 HC COVID-19 BRYAN 300 87635 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001473 HC SARS-COV-2 IGG AB 300 86769 110.00 105.60 105.60 104.50 102.30 105.60 102.30 76.59 51.62 104.50 102.30 72.60 30001474 HC SPECIMEN COLLECT COVID-19 300 G2023 32.00 30.72 30.72 30.40 29.76 30.72 29.76 22.28 15.02 30.40 29.76 21.12 30001475 HC TRANSCORTIN (CORTISOL BINDING GLOBULIN) 300 84449 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 30001476 HC SARS-COV-2 TOTAL AB 300 86769 107.00 102.72 102.72 101.65 99.51 102.72 99.51 74.50 50.22 101.65 99.51 70.62 30001477 "HC ALLERGENS, FOOD, NUTS" 300 86003 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 30001478 "HC ALLERGENS, FOOD, FISH PROFILE, IGE" 300 86003 198.00 190.08 190.08 188.10 184.14 190.08 184.14 137.87 92.92 188.10 184.14 130.68 30001479 "HC ALLERGENS, FOOD, EGG COMPONENTS IGE" 300 86003 66.00 63.36 63.36 62.70 61.38 63.36 61.38 45.96 30.97 62.70 61.38 43.56 30001480 "HC ALLERGENS, EGG COMPONENTS IGE" 300 86008 94.00 90.24 90.24 89.30 87.42 90.24 87.42 65.45 44.11 89.30 87.42 62.04 30001481 "HC ALLERGENS, FOOD, SHELL FISH PROFILE" 300 86003 231.00 221.76 221.76 219.45 214.83 221.76 214.83 160.85 108.41 219.45 214.83 152.46 30001482 HC RESPIRATORY PATHOGEN PANEL WITH COVID 300 0202U 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001483 "HC SARS-COV-2 ANTIGEN, RAPID" 300 87426 140.00 134.40 134.40 133.00 130.20 134.40 130.20 97.48 65.70 133.00 130.20 92.40 30001487 HC HS TROPONIN T 300 84484 210.00 201.60 201.60 199.50 195.30 201.60 195.30 146.22 98.55 199.50 195.30 138.60 30001488 HC MLH1 300 81292 " 1,040.00 " 998.40 998.40 988.00 967.20 998.40 967.20 724.15 488.07 988.00 967.20 686.40 30001489 HC MSH2 300 81295 587.00 563.52 563.52 557.65 545.91 563.52 545.91 408.73 275.48 557.65 545.91 387.42 30001490 HC MSH6 300 81298 989.00 949.44 949.44 939.55 919.77 949.44 919.77 688.64 464.14 939.55 919.77 652.74 30001491 HC PMS2 FULL SEQUENCE 300 81317 " 1,040.00 " 998.40 998.40 988.00 967.20 998.40 967.20 724.15 488.07 988.00 967.20 686.40 30001492 HC PMS2 DUP/DELET VARIANTS 300 81319 314.00 301.44 301.44 298.30 292.02 301.44 292.02 218.64 147.36 298.30 292.02 207.24 30001493 HC TIER 2 MOLECULAR PATHOLOGY 300 81403 500.00 480.00 480.00 475.00 465.00 480.00 465.00 348.15 234.65 475.00 465.00 330.00 30001494 HC TIER 1 MOLECULAR PATHOLOGY 300 81228 " 1,391.00 " " 1,335.36 " " 1,335.36 " " 1,321.45 " " 1,293.63 " " 1,335.36 " " 1,293.63 " 968.55 652.80 " 1,321.45 " " 1,293.63 " 918.06 30001495 HC SPINAL MUSCULAR ATROPHY 300 81401 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 30001496 HC MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS 300 81299 618.00 593.28 593.28 587.10 574.74 593.28 574.74 430.31 290.03 587.10 574.74 407.88 30001497 HC NFCT DS RNA 3 TARGETS UPPER RESPIRATORY SPECIMEN 300 0240U 380.00 364.80 364.80 361.00 353.40 364.80 353.40 264.59 178.33 361.00 353.40 250.80 30001498 HC NFCT DS RNA 4 TARGETS UPPER RESPIRATORY SPECIMEN 300 0241U 380.00 364.80 364.80 361.00 353.40 364.80 353.40 264.59 178.33 361.00 353.40 250.80 30001499 "HC NASH FIBRO TEST, NSFIB" 300 0003M 755.00 724.80 724.80 717.25 702.15 724.80 702.15 525.71 354.32 717.25 702.15 498.30 30001500 HC ACETAMINOPHEN 300 80143 258.00 247.68 247.68 245.10 239.94 247.68 239.94 179.65 121.08 245.10 239.94 170.28 30001501 HC JAK2 GENE TRGT SEQUENCE ANALYS 300 81279 427.00 409.92 409.92 405.65 397.11 409.92 397.11 297.32 200.39 405.65 397.11 281.82 30001502 HC ALCOHOL (ETHANOL) NON URINE/BR 300 82077 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 30001503 HC ESTRADIOL FREE DIRECT MEASURE 300 82681 165.00 158.40 158.40 156.75 153.45 158.40 153.45 114.89 77.43 156.75 153.45 108.90 30001504 HC MPL GENE COMMON VARIANTS 300 81338 477.00 457.92 457.92 453.15 443.61 457.92 443.61 332.14 223.86 453.15 443.61 314.82 30001505 HC MPL GENE SEQ ALYS EXON 10 300 81339 477.00 457.92 457.92 453.15 443.61 457.92 443.61 332.14 223.86 453.15 443.61 314.82 30001506 HC INF DISEASE BACT VAGINOSIS RNA 300 81513 584.00 560.64 560.64 554.80 543.12 560.64 543.12 406.64 274.07 554.80 543.12 385.44 30001507 HC INF DISEASE BACT VAGINOSIS DNA 300 81514 584.00 560.64 560.64 554.80 543.12 560.64 543.12 406.64 274.07 554.80 543.12 385.44 30001508 HC AMIODARONE 300 80151 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 30001509 HC CARBAMAZEPINE -10 11-EPOXIDE 300 80161 184.00 176.64 176.64 174.80 171.12 176.64 171.12 128.12 86.35 174.80 171.12 121.44 30001510 HC FELBAMATE 300 80167 284.00 272.64 272.64 269.80 264.12 272.64 264.12 197.75 133.28 269.80 264.12 187.44 30001511 HC SALICYLATE 300 80179 188.00 180.48 180.48 178.60 174.84 180.48 174.84 130.90 88.23 178.60 174.84 124.08 30001512 HC ITRACONAZOLE 300 80189 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 30001513 HC METHOTREXATE 300 80204 229.00 219.84 219.84 217.55 212.97 219.84 212.97 159.45 107.47 217.55 212.97 151.14 30001515 HC COVID-19 INFEC AGEN DETEC AMPLI PROBE 300 U0005 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 30001516 HC HS TROPONIN I 300 84484 18.00 17.28 17.28 17.10 16.74 17.28 16.74 12.53 8.45 17.10 16.74 11.88 30001520 HC FLUO NONINF AG ANT SCREEN EA ANT 300 86255 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 30001521 HC IMMUNO ANALYTE QUANT NOS 300 83520 165.00 158.40 158.40 156.75 153.45 158.40 153.45 114.89 77.43 156.75 153.45 108.90 30001522 HC IMMUNOASSAY ANALY QUAL MUTLI STEP 300 83516 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 30001523 HC IMMUNOASSAY ANALY QUANT BY RIA 300 83519 243.00 233.28 233.28 230.85 225.99 233.28 225.99 169.20 114.04 230.85 225.99 160.38 30001524 HC ISLET CELL AB 300 86341 297.00 285.12 285.12 282.15 276.21 285.12 276.21 206.80 139.38 282.15 276.21 196.02 30001525 HC NUCLEAR ANTIG ANTIBODY 300 86235 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 30001526 HC CYCLIC CIRULLINATED PEPTIDE AB 300 86200 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 30100001 HC BILIRUBIN TOTAL 301 82247 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 30200001 HC ALLERGEN QUANT SEMIQUANT EACH 302 86008 94.00 90.24 90.24 89.30 87.42 90.24 87.42 65.45 44.11 89.30 87.42 62.04 30600001 HC HIV-I INTEGRASE GEROTYPE 306 87906 748.00 718.08 718.08 710.60 695.64 718.08 695.64 520.83 351.04 710.60 695.64 493.68 31000002 HC CYTO FLUID WASHING OR BRUSHING 310 88104 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 31000004 HC CYTO CONC SMEAR W INTERP 310 88108 136.00 130.56 130.56 129.20 126.48 130.56 126.48 94.70 63.82 129.20 126.48 89.76 31000005 HC CYTO SELECTIVE CELL ENHANCE 310 88112 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 31000009 HC REVIEW OF PAP SMEAR 310 88141 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 31000010 HC THIN LAYER PREP PAP SMEAR 310 88142 106.00 101.76 101.76 100.70 98.58 101.76 98.58 73.81 49.75 100.70 98.58 69.96 31000011 HC CYTO SMEARS OTHER SOURCE 310 88160 77.00 73.92 73.92 73.15 71.61 73.92 71.61 53.62 36.14 73.15 71.61 50.82 31000012 HC CYTO SMEARS PREP SCREEN INTERP 310 88161 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 31000013 HC CYTO SMEARS OVER 5 SLIDES 310 88162 191.00 183.36 183.36 181.45 177.63 183.36 177.63 132.99 89.64 181.45 177.63 126.06 31000014 HC PAP SMEAR 1 SLIDE 310 88164 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 31000015 HC PAP SMEAR 2 SLIDE 310 88164 78.00 74.88 74.88 74.10 72.54 74.88 72.54 54.31 36.61 74.10 72.54 51.48 31000016 HC CYTO FNA FIRST EVAL EACH SITE 310 88172 147.00 141.12 141.12 139.65 136.71 141.12 136.71 102.36 68.99 139.65 136.71 97.02 31000017 HC CYTO FNA INTERP AND REPORT 310 88173 134.00 128.64 128.64 127.30 124.62 128.64 124.62 93.30 62.89 127.30 124.62 88.44 31000019 HC CELL MARKER STUDY MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000020 HC CELL MARKERS MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000021 HC FLOW CYT CELL SURF MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000022 HC FLOW CYT NUCLEAR MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000024 HC LYMPH SUBSET PAN 4 MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000025 HC T-CELL IMMUNODEFIC MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000027 HC CELL MARKERS INTERP 16 OR MORE 310 88189 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 31000028 HC FISH PANEL FOR CLL 310 88217 48.00 46.08 46.08 45.60 44.64 46.08 44.64 33.42 22.53 45.60 44.64 31.68 31000029 HC TISSUE CULT NON-NEOPLASTIC 310 88230 546.00 524.16 524.16 518.70 507.78 524.16 507.78 380.18 256.24 518.70 507.78 360.36 31000031 HC CYTOGENETICS DNA 310 88271 43.00 41.28 41.28 40.85 39.99 41.28 39.99 29.94 20.18 40.85 39.99 28.38 31000032 HC MOLECULAR CYTOGEN DNA PROBE EA 310 88271 128.00 122.88 122.88 121.60 119.04 122.88 119.04 89.13 60.07 121.60 119.04 84.48 31000035 HC CYTOGENETICS 100-300 CELLS 310 88275 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 31000036 HC TISSUE CULTURE BONE MARROW/BLD 310 88237 504.00 483.84 483.84 478.80 468.72 483.84 468.72 350.94 236.53 478.80 468.72 332.64 31000038 HC SURGICAL PATH LEVEL I 310 88300 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 31000039 HC SURGICAL PATH LEVEL II 310 88302 67.00 64.32 64.32 63.65 62.31 64.32 62.31 46.65 31.44 63.65 62.31 44.22 31000040 HC SURGICAL PATH LEVEL III 310 88304 157.00 150.72 150.72 149.15 146.01 150.72 146.01 109.32 73.68 149.15 146.01 103.62 31000041 HC SURGICAL PATH LEVEL V 310 88307 361.00 346.56 346.56 342.95 335.73 346.56 335.73 251.36 169.42 342.95 335.73 238.26 31000042 HC SURGICAL PATH LEVEL VI 310 88309 210.00 201.60 201.60 199.50 195.30 201.60 195.30 146.22 98.55 199.50 195.30 138.60 31000043 HC DECALCIFICATION PROCEDURE 310 88311 11.00 10.56 10.56 10.45 10.23 10.56 10.23 7.66 5.16 10.45 10.23 7.26 31000044 HC SPECIAL STAINS GRP 1 MICROORG 310 88312 127.00 121.92 121.92 120.65 118.11 121.92 118.11 88.43 59.60 120.65 118.11 83.82 31000045 HC SPECIAL STAINS GRP 2 ALL OTHER 310 88313 75.00 72.00 72.00 71.25 69.75 72.00 69.75 52.22 35.20 71.25 69.75 49.50 31000049 HC PATH CONSLT FIRST TISSUE BLOCK 310 88331 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 31000050 HC PATH CONSLT ADD TISSUE BLOCK 310 88332 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 31000053 HC IMMUNOSTAIN ADDITIONAL 310 88341 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 31000054 HC IMMUNOSTAIN INITIAL 310 88342 157.00 150.72 150.72 149.15 146.01 150.72 146.01 109.32 73.68 149.15 146.01 103.62 31000055 HC IMMUNOFLUOR AB DIRECT 310 88346 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 31000061 HC MA TUMOR IMMUNOHISTOCHEM 310 88360 185.00 177.60 177.60 175.75 172.05 177.60 172.05 128.82 86.82 175.75 172.05 122.10 31000062 HC MA TUMOR IMMUNOHISTOCHEM AUTO 310 88361 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 31000064 HC IN SITU HYBRIDIZATION EACH 310 88365 520.00 499.20 499.20 494.00 483.60 499.20 483.60 362.08 244.04 494.00 483.60 343.20 31000073 HC CELL MARKER STUDY EACH ADDL 310 88185 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 31000074 HC FLOW CYT CELL SURF EACH ADDL 310 88185 501.00 480.96 480.96 475.95 465.93 480.96 465.93 348.85 235.12 475.95 465.93 330.66 31000077 HC TRANSFUSION RX INVESTIGAT 310 86078 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 31000078 HC THIN PREP W IMAGING 310 88175 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 31000080 HC FISH PANEL FOR CLL 310 88291 226.00 216.96 216.96 214.70 210.18 216.96 210.18 157.36 106.06 214.70 210.18 149.16 31000083 HC FLOW CYTOMETER 2-8 MARKERS 310 88187 187.00 179.52 179.52 177.65 173.91 179.52 173.91 130.21 87.76 177.65 173.91 123.42 31000088 HC TISSUE CULTURE; LYMPHOCYTE 310 88230 813.00 780.48 780.48 772.35 756.09 780.48 756.09 566.09 381.54 772.35 756.09 536.58 31000090 HC CHRM ANLY AMN FLD/CHOR VIL 15C 310 88267 783.00 751.68 751.68 743.85 728.19 751.68 728.19 545.20 367.46 743.85 728.19 516.78 31000091 HC FISH PANEL FOR CLL 310 88275 84.00 80.64 80.64 79.80 78.12 80.64 78.12 58.49 39.42 79.80 78.12 55.44 31000092 HC CHROMO ANALY ADDL KARYOTYPE 310 88280 347.00 333.12 333.12 329.65 322.71 333.12 322.71 241.62 162.85 329.65 322.71 229.02 31000095 HC SURGICAL PATH LEVEL IV 310 88305 183.00 175.68 175.68 173.85 170.19 175.68 170.19 127.42 85.88 173.85 170.19 120.78 31000096 HC CHROMOSOME COUNT ADDL 310 88285 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 31000098 HC FLOW CYT NUCLEAR MARKER 1 310 88184 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 31000099 HC CELL MARKER STUDY EACH ADDL 310 88185 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 31000100 HC CELL MARKER STUDY EACH ADDL 310 88185 33.00 31.68 31.68 31.35 30.69 31.68 30.69 22.98 15.49 31.35 30.69 21.78 31000101 HC CELL MARKER STUDY EACH ADDL 310 88185 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 31000102 HC CELL MARKER STUDY EACH ADDL 310 88185 31.00 29.76 29.76 29.45 28.83 29.76 28.83 21.59 14.55 29.45 28.83 20.46 31000104 HC PATH CONSULT IN SURGERY 310 88329 225.00 216.00 216.00 213.75 209.25 216.00 209.25 156.67 105.59 213.75 209.25 148.50 31000105 HC IMHISTOCHEM CYTCHM EA MULTIPLEX ANTIBODY SLIDE 310 88344 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 31000106 HC BLOOD SMEAR INTERPRETATION 310 85060 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 31000107 HC MICROSLIDE CONSULT 310 88321 528.00 506.88 506.88 501.60 491.04 506.88 491.04 367.65 247.79 501.60 491.04 348.48 31000108 HC JAK2 GENE TRGT SEQUENCE ANALYS 310 81279 402.00 385.92 385.92 381.90 373.86 385.92 373.86 279.91 188.66 381.90 373.86 265.32 31000109 HC MPL GENE COMMON VARIANTS 310 81338 583.00 559.68 559.68 553.85 542.19 559.68 542.19 405.94 273.60 553.85 542.19 384.78 31000110 HC MPL GENE SEQ ALYS EXON 10 310 81339 583.00 559.68 559.68 553.85 542.19 559.68 542.19 405.94 273.60 553.85 542.19 384.78 31000111 HC INF DISEASE BACT VAGINOSIS RNA 310 81513 90.00 86.40 86.40 85.50 83.70 86.40 83.70 62.67 42.24 85.50 83.70 59.40 31000112 HC INF DISEASE BACT VAGINOSIS DNA 310 81514 90.00 86.40 86.40 85.50 83.70 86.40 83.70 62.67 42.24 85.50 83.70 59.40 31000113 HC IMMUNOFLUOR PER SPEC ADD SINGLE 310 88350 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 32000003 HC PARACENTESIS WO GUIDANCE 320 49082 745.00 715.20 715.20 707.75 692.85 715.20 692.85 518.74 349.63 707.75 692.85 491.70 32000005 HC EYE FOREIGN BODY 320 70030 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 32000006 HC MANDIBLE 1-3 VIEWS 320 70100 298.00 286.08 286.08 283.10 277.14 286.08 277.14 207.50 139.85 283.10 277.14 196.68 32000007 HC MANDIBLE 4+ VIEWS 320 70110 412.00 395.52 395.52 391.40 383.16 395.52 383.16 286.88 193.35 391.40 383.16 271.92 32000008 HC MASTOIDS 1-2 VIEWS 320 70120 215.00 206.40 206.40 204.25 199.95 206.40 199.95 149.70 100.90 204.25 199.95 141.90 32000009 HC MASTOIDS 3 OR MORE VIEWS 320 70130 400.00 384.00 384.00 380.00 372.00 384.00 372.00 278.52 187.72 380.00 372.00 264.00 32000011 HC FACIAL BONES 1-2 VIEWS 320 70140 284.00 272.64 272.64 269.80 264.12 272.64 264.12 197.75 133.28 269.80 264.12 187.44 32000012 HC FACIAL BONES 3+ VIEWS 320 70150 402.00 385.92 385.92 381.90 373.86 385.92 373.86 279.91 188.66 381.90 373.86 265.32 32000013 HC NASAL BONES 320 70160 332.00 318.72 318.72 315.40 308.76 318.72 308.76 231.17 155.81 315.40 308.76 219.12 32000015 HC ORBITS 4+ VIEWS 320 70200 417.00 400.32 400.32 396.15 387.81 400.32 387.81 290.36 195.70 396.15 387.81 275.22 32000016 HC SINUS PARANASAL 1-2 VIEWS 320 70210 283.00 271.68 271.68 268.85 263.19 271.68 263.19 197.05 132.81 268.85 263.19 186.78 32000017 HC PARANASAL SINUS 3+ VIEWS 320 70220 431.00 413.76 413.76 409.45 400.83 413.76 400.83 300.11 202.27 409.45 400.83 284.46 32000019 HC SKULL 1-3 VIEWS 320 70250 305.00 292.80 292.80 289.75 283.65 292.80 283.65 212.37 143.14 289.75 283.65 201.30 32000020 HC SKULL COMPLETE 4+ VIEWS 320 70260 451.00 432.96 432.96 428.45 419.43 432.96 419.43 314.03 211.65 428.45 419.43 297.66 32000023 HC TMJ OPEN CLOSED UNI 320 70328 206.00 197.76 197.76 195.70 191.58 197.76 191.58 143.44 96.68 195.70 191.58 135.96 32000024 HC TMJ BILATERAL 320 70330 375.00 360.00 360.00 356.25 348.75 360.00 348.75 261.11 175.99 356.25 348.75 247.50 32000026 HC NECK SOFT TISSUE 320 70360 327.00 313.92 313.92 310.65 304.11 313.92 304.11 227.69 153.46 310.65 304.11 215.82 32000028 HC RIBS UNILATERAL 2 VIEW 320 71100 390.00 374.40 374.40 370.50 362.70 374.40 362.70 271.56 183.03 370.50 362.70 257.40 32000029 HC CHEST W/RIBS UNI 3 VIEW 320 71101 434.00 416.64 416.64 412.30 403.62 416.64 403.62 302.19 203.68 412.30 403.62 286.44 32000030 HC RIBS BIL 3 VIEWS 320 71110 434.00 416.64 416.64 412.30 403.62 416.64 403.62 302.19 203.68 412.30 403.62 286.44 32000031 HC CHEST W/RIBS BIL 4+ VIEWS 320 71111 547.00 525.12 525.12 519.65 508.71 525.12 508.71 380.88 256.71 519.65 508.71 361.02 32000032 HC STERNUM 320 71120 314.00 301.44 301.44 298.30 292.02 301.44 292.02 218.64 147.36 298.30 292.02 207.24 32000033 HC STERNOCLAVICULAR JOINT 320 71130 291.00 279.36 279.36 276.45 270.63 279.36 270.63 202.62 136.57 276.45 270.63 192.06 32000034 HC X-RAY SPINE ONE VIEW 320 72020 249.00 239.04 239.04 236.55 231.57 239.04 231.57 173.38 116.86 236.55 231.57 164.34 32000035 HC CERVICAL SPINE 2 OR 3 VIEWS 320 72040 330.00 316.80 316.80 313.50 306.90 316.80 306.90 229.78 154.87 313.50 306.90 217.80 32000036 HC SPINE CERVICAL 4 OR 5 VIEWS 320 72050 529.00 507.84 507.84 502.55 491.97 507.84 491.97 368.34 248.26 502.55 491.97 349.14 32000037 HC SPINE CERVICAL 6 OR MORE VIEWS 320 72052 659.00 632.64 632.64 626.05 612.87 632.64 612.87 458.86 309.27 626.05 612.87 434.94 32000038 HC SPINE THORACIC 2 VIEWS 320 72070 366.00 351.36 351.36 347.70 340.38 351.36 340.38 254.85 171.76 347.70 340.38 241.56 32000039 HC SPINE THORACIC 3 VIEWS 320 72072 478.00 458.88 458.88 454.10 444.54 458.88 444.54 332.83 224.33 454.10 444.54 315.48 32000041 HC SPINE T-L 2 VIEWS 320 72080 352.00 337.92 337.92 334.40 327.36 337.92 327.36 245.10 165.19 334.40 327.36 232.32 32000042 HC SPINE ONE VIEW 320 72081 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 32000043 HC SPINE 2-3 VIEWS 320 72082 323.00 310.08 310.08 306.85 300.39 310.08 300.39 224.90 151.58 306.85 300.39 213.18 32000046 HC SPINE LUMBAR 2 OR 3 VIEWS 320 72100 397.00 381.12 381.12 377.15 369.21 381.12 369.21 276.43 186.31 377.15 369.21 262.02 32000047 HC SPINE LUMBAR 4+ VIEWS 320 72110 519.00 498.24 498.24 493.05 482.67 498.24 482.67 361.38 243.57 493.05 482.67 342.54 32000048 HC SPINE LUMB COMP W/BENDING 320 72114 529.00 507.84 507.84 502.55 491.97 507.84 491.97 368.34 248.26 502.55 491.97 349.14 32000049 HC SPINE LUMBAR BEND 2-3 VIEWS 320 72120 397.00 381.12 381.12 377.15 369.21 381.12 369.21 276.43 186.31 377.15 369.21 262.02 32000050 HC PELVIS 1 OR 2 VIEWS 320 72170 282.00 270.72 270.72 267.90 262.26 270.72 262.26 196.36 132.34 267.90 262.26 186.12 32000051 HC PELVIS COMPLETE 3+ VIEWS 320 72190 411.00 394.56 394.56 390.45 382.23 394.56 382.23 286.18 192.88 390.45 382.23 271.26 32000052 HC SACROILIAC JOINT 1-2 VIEW 320 72200 361.00 346.56 346.56 342.95 335.73 346.56 335.73 251.36 169.42 342.95 335.73 238.26 32000053 HC SACROILIAC JOINTS 3+ VIEW 320 72202 361.00 346.56 346.56 342.95 335.73 346.56 335.73 251.36 169.42 342.95 335.73 238.26 32000054 HC SACRUM/COCCYX 320 72220 291.00 279.36 279.36 276.45 270.63 279.36 270.63 202.62 136.57 276.45 270.63 192.06 32000055 HC MYELOGRAM CERV S & I 320 72240 885.00 849.60 849.60 840.75 823.05 849.60 823.05 616.23 415.33 840.75 823.05 584.10 32000057 HC MYELOGRAM LUMBOSACRAL S & I 320 72265 637.00 611.52 611.52 605.15 592.41 611.52 592.41 443.54 298.94 605.15 592.41 420.42 32000062 HC CLAVICLE COMPLETE 320 73000 288.00 276.48 276.48 273.60 267.84 276.48 267.84 200.53 135.16 273.60 267.84 190.08 32000063 HC SCAPULA COMPLETE 320 73010 314.00 301.44 301.44 298.30 292.02 301.44 292.02 218.64 147.36 298.30 292.02 207.24 32000064 HC SHOULDER 1 VIEW 320 73020 235.00 225.60 225.60 223.25 218.55 225.60 218.55 163.63 110.29 223.25 218.55 155.10 32000065 HC SHOULDER 2+ VIEWS 320 73030 343.00 329.28 329.28 325.85 318.99 329.28 318.99 238.83 160.97 325.85 318.99 226.38 32000066 HC AC JOINTS BILATERAL 320 73050 291.00 279.36 279.36 276.45 270.63 279.36 270.63 202.62 136.57 276.45 270.63 192.06 32000067 HC HUMERUS 320 73060 312.00 299.52 299.52 296.40 290.16 299.52 290.16 217.25 146.42 296.40 290.16 205.92 32000068 HC ELBOW 2 VIEWS 320 73070 270.00 259.20 259.20 256.50 251.10 259.20 251.10 188.00 126.71 256.50 251.10 178.20 32000069 HC ELBOW 3+ VIEWS 320 73080 317.00 304.32 304.32 301.15 294.81 304.32 294.81 220.73 148.77 301.15 294.81 209.22 32000070 HC FOREARM 2 VIEWS 320 73090 282.00 270.72 270.72 267.90 262.26 270.72 262.26 196.36 132.34 267.90 262.26 186.12 32000071 HC UPPER EXTREMITY INFANT 320 73092 241.00 231.36 231.36 228.95 224.13 231.36 224.13 167.81 113.10 228.95 224.13 159.06 32000072 HC WRIST 2 VIEWS 320 73100 235.00 225.60 225.60 223.25 218.55 225.60 218.55 163.63 110.29 223.25 218.55 155.10 32000073 HC WRIST 3+ VIEWS 320 73110 301.00 288.96 288.96 285.95 279.93 288.96 279.93 209.59 141.26 285.95 279.93 198.66 32000074 HC HAND 2 VIEWS 320 73120 246.00 236.16 236.16 233.70 228.78 236.16 228.78 171.29 115.45 233.70 228.78 162.36 32000075 HC HAND 3+ VIEWS 320 73130 317.00 304.32 304.32 301.15 294.81 304.32 294.81 220.73 148.77 301.15 294.81 209.22 32000076 HC FINGER(S) 2+ VIEWS 320 73140 224.00 215.04 215.04 212.80 208.32 215.04 208.32 155.97 105.12 212.80 208.32 147.84 32000077 HC HIP UNI W OR WO PEL 1 VIEW 320 73501 280.00 268.80 268.80 266.00 260.40 268.80 260.40 194.96 131.40 266.00 260.40 184.80 32000078 HC HIP UNI W OR WO PEL 2-3 VIEWS 320 73502 320.00 307.20 307.20 304.00 297.60 307.20 297.60 222.82 150.18 304.00 297.60 211.20 32000079 HC HIP UNI W OR WO PEL 4+ VIEWS 320 73503 350.00 336.00 336.00 332.50 325.50 336.00 325.50 243.71 164.26 332.50 325.50 231.00 32000082 HC HIP BIL W OR WO PEL 2 VIEWS 320 73521 427.00 409.92 409.92 405.65 397.11 409.92 397.11 297.32 200.39 405.65 397.11 281.82 32000083 HC HIP BIL W OR WO PEL 3-4 VIEWS 320 73522 500.00 480.00 480.00 475.00 465.00 480.00 465.00 348.15 234.65 475.00 465.00 330.00 32000084 HC HIP BIL W OR WO PEL 5+ VIEWS 320 73523 500.00 480.00 480.00 475.00 465.00 480.00 465.00 348.15 234.65 475.00 465.00 330.00 32000086 HC FEMUR 1 VIEW 320 73551 368.00 353.28 353.28 349.60 342.24 353.28 342.24 256.24 172.70 349.60 342.24 242.88 32000087 HC FEMUR 2 VIEWS 320 73552 350.00 336.00 336.00 332.50 325.50 336.00 325.50 243.71 164.26 332.50 325.50 231.00 32000088 HC KNEE 1-2 VIEWS 320 73560 299.00 287.04 287.04 284.05 278.07 287.04 278.07 208.19 140.32 284.05 278.07 197.34 32000089 HC KNEE 3 VIEWS 320 73562 323.00 310.08 310.08 306.85 300.39 310.08 300.39 224.90 151.58 306.85 300.39 213.18 32000090 HC KNEE COMPLETE 4+ VIEWS 320 73564 337.00 323.52 323.52 320.15 313.41 323.52 313.41 234.65 158.15 320.15 313.41 222.42 32000091 HC KNEES BOTH STANDING AP 320 73565 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 32000092 HC TIBIA/FIBULA 2 VIEWS 320 73590 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 32000093 HC LOWER EXTREMITY INFANT 320 73592 251.00 240.96 240.96 238.45 233.43 240.96 233.43 174.77 117.79 238.45 233.43 165.66 32000094 HC ANKLE 2 VIEWS 320 73600 253.00 242.88 242.88 240.35 235.29 242.88 235.29 176.16 118.73 240.35 235.29 166.98 32000095 HC ANKLE 3+ VIEWS 320 73610 316.00 303.36 303.36 300.20 293.88 303.36 293.88 220.03 148.30 300.20 293.88 208.56 32000096 HC FOOT 2 VIEWS 320 73620 261.00 250.56 250.56 247.95 242.73 250.56 242.73 181.73 122.49 247.95 242.73 172.26 32000097 HC FOOT 3+ VIEWS 320 73630 322.00 309.12 309.12 305.90 299.46 309.12 299.46 224.21 151.11 305.90 299.46 212.52 32000098 HC CALCANEUS 2+ VIEWS 320 73650 251.00 240.96 240.96 238.45 233.43 240.96 233.43 174.77 117.79 238.45 233.43 165.66 32000099 HC TOE(S) 2+ VIEWS 320 73660 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 32000103 HC ABD 2+ VIEWS INCLUDING SINGLE CHEST XRAY 320 74022 481.00 461.76 461.76 456.95 447.33 461.76 447.33 334.92 225.73 456.95 447.33 317.46 32000106 HC ESOPHAGUS SINGLE CONTRAST AGENT 320 74220 647.00 621.12 621.12 614.65 601.71 621.12 601.71 450.51 303.64 614.65 601.71 427.02 32000107 HC SWALLOW FUNCTION W VIDEO 320 74230 595.00 571.20 571.20 565.25 553.35 571.20 553.35 414.30 279.23 565.25 553.35 392.70 32000108 HC UPPER GI W/KUB 320 74241 645.00 619.20 619.20 612.75 599.85 619.20 599.85 449.11 302.70 612.75 599.85 425.70 32000110 HC UPPER GI AIR CONTRAST 320 74247 857.00 822.72 822.72 814.15 797.01 822.72 797.01 596.73 402.19 814.15 797.01 565.62 32000111 HC UPPER GI-SM BOWEL W/AIR 320 74249 " 1,109.00 " " 1,064.64 " " 1,064.64 " " 1,053.55 " " 1,031.37 " " 1,064.64 " " 1,031.37 " 772.20 520.45 " 1,053.55 " " 1,031.37 " 731.94 32000112 HC SMALL BOWEL SERIES SINGLE CONTRAST AGENT 320 74250 681.00 653.76 653.76 646.95 633.33 653.76 633.33 474.18 319.59 646.95 633.33 449.46 32000113 HC BARIUM ENEMA SINGLE CONTRAST AGENT 320 74270 709.00 680.64 680.64 673.55 659.37 680.64 659.37 493.68 332.73 673.55 659.37 467.94 32000114 HC BE AIR CONTRAST DOUBLE AGENT 320 74280 " 1,016.00 " 975.36 975.36 965.20 944.88 975.36 944.88 707.44 476.81 965.20 944.88 670.56 32000116 HC CHOLANGIOGRAPHY OPER 320 74300 597.00 573.12 573.12 567.15 555.21 573.12 555.21 415.69 280.17 567.15 555.21 394.02 32000124 HC INTRAVENOUS PYELOGRAM 320 74400 618.00 593.28 593.28 587.10 574.74 593.28 574.74 430.31 290.03 587.10 574.74 407.88 32000126 HC IVP W/TOMA 320 74415 " 1,018.00 " 977.28 977.28 967.10 946.74 977.28 946.74 708.83 477.75 967.10 946.74 671.88 32000129 HC CYSTOGRAPHY 320 74430 452.00 433.92 433.92 429.40 420.36 433.92 420.36 314.73 212.12 429.40 420.36 298.32 32000133 HC URETHROCYSTOGRAM VOIDING 320 74455 470.00 451.20 451.20 446.50 437.10 451.20 437.10 327.26 220.57 446.50 437.10 310.20 32000137 HC HYSTEROSALPINOGRAPHY 320 74740 733.00 703.68 703.68 696.35 681.69 703.68 681.69 510.39 344.00 696.35 681.69 483.78 32000180 HC FLUOROSCOPY < 1 HOUR 320 76000 666.00 639.36 639.36 632.70 619.38 639.36 619.38 463.74 312.55 632.70 619.38 439.56 32000182 HC FOREIGN BODY EXAM-CHILD 320 76010 291.00 279.36 279.36 276.45 270.63 279.36 270.63 202.62 136.57 276.45 270.63 192.06 32000183 HC ABSCESSOGRAM/FISTULA/SINUS TRACT 320 76080 " 1,978.00 " " 1,898.88 " " 1,898.88 " " 1,879.10 " " 1,839.54 " " 1,898.88 " " 1,839.54 " " 1,377.28 " 928.28 " 1,879.10 " " 1,839.54 " " 1,305.48 " 32000184 HC SURGICAL SPECIMEN 320 76098 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 32000187 HC FLUORO VENOUS ACCESS DEVICE 320 77001 733.00 703.68 703.68 696.35 681.69 703.68 681.69 510.39 344.00 696.35 681.69 483.78 32000188 HC FLUORO GUIDE NEEDLE PLACEMENT 320 77002 885.00 849.60 849.60 840.75 823.05 849.60 823.05 616.23 415.33 840.75 823.05 584.10 32000189 HC FLUORO GUIDANCE/LOCAL NDL 320 77003 885.00 849.60 849.60 840.75 823.05 849.60 823.05 616.23 415.33 840.75 823.05 584.10 32000190 HC DUCTOGRAM SINGLE 320 77053 478.00 458.88 458.88 454.10 444.54 458.88 444.54 332.83 224.33 454.10 444.54 315.48 32000192 HC BONE AGE STUDIES 320 77072 241.00 231.36 231.36 228.95 224.13 231.36 224.13 167.81 113.10 228.95 224.13 159.06 32000193 HC BONE LENGTH STUDY 320 77073 471.00 452.16 452.16 447.45 438.03 452.16 438.03 327.96 221.04 447.45 438.03 310.86 32000194 HC OSSEOUS SURVEY LIMITED 320 77074 485.00 465.60 465.60 460.75 451.05 465.60 451.05 337.71 227.61 460.75 451.05 320.10 32000195 HC OSSEOUS SURVEY COMPLETE 320 77075 802.00 769.92 769.92 761.90 745.86 769.92 745.86 558.43 376.38 761.90 745.86 529.32 32000196 HC OSSEOUS SURVEY-INFANT 320 77076 516.00 495.36 495.36 490.20 479.88 495.36 479.88 359.29 242.16 490.20 479.88 340.56 32000197 HC JOINT SINGLE VIEW 320 77077 270.00 259.20 259.20 256.50 251.10 259.20 251.10 188.00 126.71 256.50 251.10 178.20 32000198 HC DEXA AXIAL SKELETON STUDY 320 77080 496.00 476.16 476.16 471.20 461.28 476.16 461.28 345.36 232.77 471.20 461.28 327.36 32000216 HC ABDOMEN XRAY ONE VIEW 320 74018 291.00 279.36 279.36 276.45 270.63 279.36 270.63 202.62 136.57 276.45 270.63 192.06 32000217 HC ABDOMEN XRAY TWO VIEWS 320 74019 403.00 386.88 386.88 382.85 374.79 386.88 374.79 280.61 189.13 382.85 374.79 265.98 32000218 HC ABDOMEN XRAY THREE + VIEWS 320 74021 514.00 493.44 493.44 488.30 478.02 493.44 478.02 357.90 241.22 488.30 478.02 339.24 32000220 HC SMALL BOWEL SERIES FOLLOWING UGI 320 74248 904.00 867.84 867.84 858.80 840.72 867.84 840.72 629.46 424.25 858.80 840.72 596.64 32000221 HC UPPER GI W SCOUT W WO DELAYED IMAGES DOUBLE CONTRAST AGENT 320 74246 656.00 629.76 629.76 623.20 610.08 629.76 610.08 456.77 307.86 623.20 610.08 432.96 32000222 HC UPPER GI W SCOUT W WO DELAYED IMAGES SINGLE CONTRAST AGENT 320 74240 608.00 583.68 583.68 577.60 565.44 583.68 565.44 423.35 285.33 577.60 565.44 401.28 32200001 HC ARTHROGRAPHY SHOULDER 322 73040 851.00 816.96 816.96 808.45 791.43 816.96 791.43 592.55 399.37 808.45 791.43 561.66 32200003 HC ARTHROGRAM WRIST 322 73115 665.00 638.40 638.40 631.75 618.45 638.40 618.45 463.04 312.08 631.75 618.45 438.90 32200004 HC ARTHROGRAM HIP 322 73525 851.00 816.96 816.96 808.45 791.43 816.96 791.43 592.55 399.37 808.45 791.43 561.66 32200005 HC ARTHROGRAPHY KNEE 322 73580 851.00 816.96 816.96 808.45 791.43 816.96 791.43 592.55 399.37 808.45 791.43 561.66 32400005 HC CHEST WITH FLUOROSCOPY 324 492.00 472.32 472.32 467.40 457.56 472.32 457.56 342.58 230.90 467.40 457.56 324.72 32400009 HC CHEST XRAY ONE VIEW 324 71045 263.00 252.48 252.48 249.85 244.59 252.48 244.59 183.13 123.43 249.85 244.59 173.58 32400010 HC CHEST XRAY TWO VIEWS 324 71046 334.00 320.64 320.64 317.30 310.62 320.64 310.62 232.56 156.75 317.30 310.62 220.44 32400012 HC CHEST XRAY THREE VIEWS 324 71047 406.00 389.76 389.76 385.70 377.58 389.76 377.58 282.70 190.54 385.70 377.58 267.96 32400013 HC CHEST DECUB/SPECIAL ONE VIEW 324 71045 380.00 364.80 364.80 361.00 353.40 364.80 353.40 264.59 178.33 361.00 353.40 250.80 32400014 HC CHEST XRAY FOUR + VIEWS 324 71048 527.00 505.92 505.92 500.65 490.11 505.92 490.11 366.95 247.32 500.65 490.11 347.82 32900002 HC FINE NEEDLE ASP W US GUIDANCE INITIAL LESION 329 10005 643.00 617.28 617.28 610.85 597.99 617.28 597.99 447.72 301.76 610.85 597.99 424.38 32900004 HC INCISE DRAIN HEMATOMA 329 10140 " 2,800.00 " " 2,688.00 " " 2,688.00 " " 2,660.00 " " 2,604.00 " " 2,688.00 " " 2,604.00 " " 1,949.64 " " 1,314.04 " " 2,660.00 " " 2,604.00 " " 1,848.00 " 32900005 HC ASP ABSCESS HEMATOMA CYST 329 10160 374.00 359.04 359.04 355.30 347.82 359.04 347.82 260.42 175.52 355.30 347.82 246.84 32900006 HC DEBRIDE SKIN & SUBQ 329 11042 278.00 266.88 266.88 264.10 258.54 266.88 258.54 193.57 130.47 264.10 258.54 183.48 32900010 HC ASPIRATION BREAST CYST 329 19000 511.00 490.56 490.56 485.45 475.23 490.56 475.23 355.81 239.81 485.45 475.23 337.26 32900011 HC ASP BREAST CYST ADDTL 329 19001 266.00 255.36 255.36 252.70 247.38 255.36 247.38 185.22 124.83 252.70 247.38 175.56 32900012 HC INJ MAMMARY DUCTOGRAM 329 19030 945.00 907.20 907.20 897.75 878.85 907.20 878.85 658.00 443.49 897.75 878.85 623.70 32900015 HC BREAST NDL LOC MAMMO GUIDE 329 19281 647.00 621.12 621.12 614.65 601.71 621.12 601.71 450.51 303.64 614.65 601.71 427.02 32900016 HC BREAST NDL LOC MAMMO ADDTL 329 19282 670.00 643.20 643.20 636.50 623.10 643.20 623.10 466.52 314.43 636.50 623.10 442.20 32900020 HC PERC MUSCLE SFT TISSUE BX 329 20206 " 1,260.00 " " 1,209.60 " " 1,209.60 " " 1,197.00 " " 1,171.80 " " 1,209.60 " " 1,171.80 " 877.34 591.32 " 1,197.00 " " 1,171.80 " 831.60 32900025 HC FOREIGN BODY REMOVAL 329 20520 " 1,559.00 " " 1,496.64 " " 1,496.64 " " 1,481.05 " " 1,449.87 " " 1,496.64 " " 1,449.87 " " 1,085.53 " 731.64 " 1,481.05 " " 1,449.87 " " 1,028.94 " 32900026 HC INJ TRIGGER PT 1 OR 2 MUSCLE 329 20552 455.00 436.80 436.80 432.25 423.15 436.80 423.15 316.82 213.53 432.25 423.15 300.30 32900027 HC ARTHROCENTESIS SMALL JOINT 329 20600 171.00 164.16 164.16 162.45 159.03 164.16 159.03 119.07 80.25 162.45 159.03 112.86 32900028 HC DRAIN INJECT SM JOINT W US 329 20604 " 1,244.00 " " 1,194.24 " " 1,194.24 " " 1,181.80 " " 1,156.92 " " 1,194.24 " " 1,156.92 " 866.20 583.81 " 1,181.80 " " 1,156.92 " 821.04 32900029 HC ARTHROCENTESIS INTERMED JNT 329 20605 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 32900030 HC DRAIN INJECT MED JOINT W US 329 20606 " 1,255.00 " " 1,204.80 " " 1,204.80 " " 1,192.25 " " 1,167.15 " " 1,204.80 " " 1,167.15 " 873.86 588.97 " 1,192.25 " " 1,167.15 " 828.30 32900031 HC INJ MAJOR JOINT THERAPEUTIC 329 20610 231.00 221.76 221.76 219.45 214.83 221.76 214.83 160.85 108.41 219.45 214.83 152.46 32900032 HC DRAIN INJECT LRG JOINT W US 329 20611 " 1,125.00 " " 1,080.00 " " 1,080.00 " " 1,068.75 " " 1,046.25 " " 1,080.00 " " 1,046.25 " 783.34 527.96 " 1,068.75 " " 1,046.25 " 742.50 32900042 HC INJECTION PROCEDURE SHOULDER 329 23350 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900045 HC INJECTION WRIST ARTHROGRAPHY 329 25246 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900048 HC INJECTION HIP ARTHROGRAM 329 27093 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900052 HC INJ PX FOR KNEE ARTH 329 27369 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900058 HC INSERT TUNNELED PLEURAL CATH 329 32550 " 2,284.00 " " 2,192.64 " " 2,192.64 " " 2,169.80 " " 2,124.12 " " 2,192.64 " " 2,124.12 " " 1,590.35 " " 1,071.88 " " 2,169.80 " " 2,124.12 " " 1,507.44 " 32900061 HC THORACENTESIS WO GUIDANCE 329 32554 696.00 668.16 668.16 661.20 647.28 668.16 647.28 484.62 326.63 661.20 647.28 459.36 32900062 HC THORACENTESIS W GUIDANCE 329 32555 820.00 787.20 787.20 779.00 762.60 787.20 762.60 570.97 384.83 779.00 762.60 541.20 32900063 HC PLEURAL DRAIN PERC WO 329 32556 " 1,478.00 " " 1,418.88 " " 1,418.88 " " 1,404.10 " " 1,374.54 " " 1,418.88 " " 1,374.54 " " 1,029.13 " 693.63 " 1,404.10 " " 1,374.54 " 975.48 32900064 HC PLEURAL DRAIN PERC W GUIDE 329 32557 " 2,313.00 " " 2,220.48 " " 2,220.48 " " 2,197.35 " " 2,151.09 " " 2,220.48 " " 2,151.09 " " 1,610.54 " " 1,085.49 " " 2,197.35 " " 2,151.09 " " 1,526.58 " 32900147 HC DECLOT THROMBOLYTIC AGENT 329 36593 402.00 385.92 385.92 381.90 373.86 385.92 373.86 279.91 188.66 381.90 373.86 265.32 32900151 HC INJECT CONTRAST W FLUORO 329 36598 711.00 682.56 682.56 675.45 661.23 682.56 661.23 495.07 333.67 675.45 661.23 469.26 32900198 HC BONE MARROW ASPIRATION ONLY 329 38220 " 1,369.00 " " 1,314.24 " " 1,314.24 " " 1,300.55 " " 1,273.17 " " 1,314.24 " " 1,273.17 " 953.23 642.47 " 1,300.55 " " 1,273.17 " 903.54 32900199 HC BONE MARROW BX ONLY 329 38221 " 2,053.00 " " 1,970.88 " " 1,970.88 " " 1,950.35 " " 1,909.29 " " 1,970.88 " " 1,909.29 " " 1,429.50 " 963.47 " 1,950.35 " " 1,909.29 " " 1,354.98 " 32900200 HC LYMPH NODE BIOPSY 329 38505 687.00 659.52 659.52 652.65 638.91 659.52 638.91 478.36 322.41 652.65 638.91 453.42 32900203 HC BIOPSY SALIVARY GLAND NDL 329 42400 " 1,232.00 " " 1,182.72 " " 1,182.72 " " 1,170.40 " " 1,145.76 " " 1,182.72 " " 1,145.76 " 857.84 578.18 " 1,170.40 " " 1,145.76 " 813.12 32900206 HC CHANGE GASTROSTOMY TUBE 329 43762 602.00 577.92 577.92 571.90 559.86 577.92 559.86 419.17 282.52 571.90 559.86 397.32 32900207 HC REPOSITION GASTRIC TUBE 329 43761 " 1,106.00 " " 1,061.76 " " 1,061.76 " " 1,050.70 " " 1,028.58 " " 1,061.76 " " 1,028.58 " 770.11 519.05 " 1,050.70 " " 1,028.58 " 729.96 32900211 HC INCISE DRAIN RECTAL ABSCESS 329 46040 " 2,971.00 " " 2,852.16 " " 2,852.16 " " 2,822.45 " " 2,763.03 " " 2,852.16 " " 2,763.03 " " 2,068.71 " " 1,394.29 " " 2,822.45 " " 2,763.03 " " 1,960.86 " 32900212 HC NEEDLE BIOPSY LIVER 329 47000 " 3,436.00 " " 3,298.56 " " 3,298.56 " " 3,264.20 " " 3,195.48 " " 3,298.56 " " 3,195.48 " " 2,392.49 " " 1,612.51 " " 3,264.20 " " 3,195.48 " " 2,267.76 " 32900235 HC PARACENTESIS W GUIDANCE 329 49083 " 1,332.00 " " 1,278.72 " " 1,278.72 " " 1,265.40 " " 1,238.76 " " 1,278.72 " " 1,238.76 " 927.47 625.11 " 1,265.40 " " 1,238.76 " 879.12 32900239 HC DRAIN ABSC NONPERITONEAL RETRO 329 49405 596.00 572.16 572.16 566.20 554.28 572.16 554.28 414.99 279.70 566.20 554.28 393.36 32900240 HC DRAIN ABSC PERITONEAL RETRO 329 49406 " 4,334.00 " " 4,160.64 " " 4,160.64 " " 4,117.30 " " 4,030.62 " " 4,160.64 " " 4,030.62 " " 3,017.76 " " 2,033.95 " " 4,117.30 " " 4,030.62 " " 2,860.44 " 32900244 HC CONTRAST INJ ABSCESS CYST 329 49424 793.00 761.28 761.28 753.35 737.49 761.28 737.49 552.17 372.15 753.35 737.49 523.38 32900252 HC INJ CONTRAST EVALUATE G-TUBE 329 49465 376.00 360.96 360.96 357.20 349.68 360.96 349.68 261.81 176.46 357.20 349.68 248.16 32900280 HC PROSTATE NEEDLE BIOPSY 329 55700 " 1,850.00 " " 1,776.00 " " 1,776.00 " " 1,757.50 " " 1,720.50 " " 1,776.00 " " 1,720.50 " " 1,288.16 " 868.21 " 1,757.50 " " 1,720.50 " " 1,221.00 " 32900281 HC INJ HYSTEROSALPINGOGRAPHY 329 58340 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900285 HC THYROID BIOPSY PERC 329 60100 521.00 500.16 500.16 494.95 484.53 500.16 484.53 362.77 244.51 494.95 484.53 343.86 32900298 HC SPINAL PUNCTURE LUMBAR 329 62270 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900299 HC SPINAL PUNC THERAPEUTIC 329 62272 856.00 821.76 821.76 813.20 796.08 821.76 796.08 596.03 401.72 813.20 796.08 564.96 32900300 HC EPIDURAL BLOOD PATCH 329 62273 " 1,064.00 " " 1,021.44 " " 1,021.44 " " 1,010.80 " 989.52 " 1,021.44 " 989.52 740.86 499.34 " 1,010.80 " 989.52 702.24 32900303 HC MYELOGRAM INJECTION ONLY 329 62284 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 32900319 HC INJECT TRIGEMINAL NERVE COMPLETE 329 64400 502.00 481.92 481.92 476.90 466.86 481.92 466.86 349.54 235.59 476.90 466.86 331.32 32900325 HC VERTEBRA INJECTION SINGLE 329 64479 " 1,373.00 " " 1,318.08 " " 1,318.08 " " 1,304.35 " " 1,276.89 " " 1,318.08 " " 1,276.89 " 956.02 644.35 " 1,304.35 " " 1,276.89 " 906.18 32900326 HC VERTEBRA INJECTION ADDL 329 64480 895.00 859.20 859.20 850.25 832.35 859.20 832.35 623.19 420.02 850.25 832.35 590.70 32900327 HC VERTEBRA INJECTION SINGLE 329 64483 960.00 921.60 921.60 912.00 892.80 921.60 892.80 668.45 450.53 912.00 892.80 633.60 32900328 HC VERTEBRA INJECTION ADDL 329 64484 386.00 370.56 370.56 366.70 358.98 370.56 358.98 268.77 181.15 366.70 358.98 254.76 32900332 HC INJ FACET LUMBAR SGL LEVEL 329 64493 " 1,445.00 " " 1,387.20 " " 1,387.20 " " 1,372.75 " " 1,343.85 " " 1,387.20 " " 1,343.85 " " 1,006.15 " 678.14 " 1,372.75 " " 1,343.85 " 953.70 32900333 HC INJ FACET LUMBAR 2ND LEVEL 329 64494 816.00 783.36 783.36 775.20 758.88 783.36 758.88 568.18 382.95 775.20 758.88 538.56 32900335 HC INJECT SPHENO GANGLION 329 64505 542.00 520.32 520.32 514.90 504.06 520.32 504.06 377.39 254.36 514.90 504.06 357.72 32900353 HC INJ SI JOINT THERAPEUTIC 329 27096 550.00 528.00 528.00 522.50 511.50 528.00 511.50 382.97 258.12 522.50 511.50 363.00 32900392 HC INJ EPIDURAL CERV THOR CT 329 62321 " 1,339.00 " " 1,285.44 " " 1,285.44 " " 1,272.05 " " 1,245.27 " " 1,285.44 " " 1,245.27 " 932.35 628.39 " 1,272.05 " " 1,245.27 " 883.74 32900393 HC INJ EPIDURAL CERV THOR FL 329 62321 " 1,339.00 " " 1,285.44 " " 1,285.44 " " 1,272.05 " " 1,245.27 " " 1,285.44 " " 1,245.27 " 932.35 628.39 " 1,272.05 " " 1,245.27 " 883.74 32900395 HC INJ EPIDURAL LUMB SACRAL FL 329 62323 " 1,545.00 " " 1,483.20 " " 1,483.20 " " 1,467.75 " " 1,436.85 " " 1,483.20 " " 1,436.85 " " 1,075.78 " 725.07 " 1,467.75 " " 1,436.85 " " 1,019.70 " 32900396 HC ARTHROCENTESIS MAJOR JOINT 329 20610 413.00 396.48 396.48 392.35 384.09 396.48 384.09 287.57 193.82 392.35 384.09 272.58 33100005 HC CHEMO IV PUSH 331 96409 322.00 309.12 309.12 305.90 299.46 309.12 299.46 224.21 151.11 305.90 299.46 212.52 34100005 HC PARATHYROID PLANAR IMAGING 341 78070 " 1,325.00 " " 1,272.00 " " 1,272.00 " " 1,258.75 " " 1,232.25 " " 1,272.00 " " 1,232.25 " 922.60 621.82 " 1,258.75 " " 1,232.25 " 874.50 34100008 HC LYMPHATIC GLAND IMAGING 341 78195 " 2,160.00 " " 2,073.60 " " 2,073.60 " " 2,052.00 " " 2,008.80 " " 2,073.60 " " 2,008.80 " " 1,504.01 " " 1,013.69 " " 2,052.00 " " 2,008.80 " " 1,425.60 " 34100012 HC HEPATOBILIARY SYSTEM IMAGING 341 78226 " 1,778.00 " " 1,706.88 " " 1,706.88 " " 1,689.10 " " 1,653.54 " " 1,706.88 " " 1,653.54 " " 1,238.02 " 834.42 " 1,689.10 " " 1,653.54 " " 1,173.48 " 34100013 HC NM GALLBLADDER PIPIDA W CCK 341 78227 " 1,778.00 " " 1,706.88 " " 1,706.88 " " 1,689.10 " " 1,653.54 " " 1,706.88 " " 1,653.54 " " 1,238.02 " 834.42 " 1,689.10 " " 1,653.54 " " 1,173.48 " 34100014 HC NM SALIVARY GLAND 341 78230 614.00 589.44 589.44 583.30 571.02 589.44 571.02 427.53 288.15 583.30 571.02 405.24 34100015 HC GASTRIC EMPTYING STUDY 341 78264 " 1,731.00 " " 1,661.76 " " 1,661.76 " " 1,644.45 " " 1,609.83 " " 1,661.76 " " 1,609.83 " " 1,205.30 " 812.36 " 1,644.45 " " 1,609.83 " " 1,142.46 " 34100017 HC BOWEL IMAGING 341 78290 " 1,389.00 " " 1,333.44 " " 1,333.44 " " 1,319.55 " " 1,291.77 " " 1,333.44 " " 1,291.77 " 967.16 651.86 " 1,319.55 " " 1,291.77 " 916.74 34100018 HC BONE JOINT IMAGE LIMITED 341 78300 " 1,042.00 " " 1,000.32 " " 1,000.32 " 989.90 969.06 " 1,000.32 " 969.06 725.54 489.01 989.90 969.06 687.72 34100019 HC BONE JNT IMAGE WHOLE BODY 341 78306 " 1,855.00 " " 1,780.80 " " 1,780.80 " " 1,762.25 " " 1,725.15 " " 1,780.80 " " 1,725.15 " " 1,291.64 " 870.55 " 1,762.25 " " 1,725.15 " " 1,224.30 " 34100020 HC BONE IMAGE 3 PHASE STUDY 341 78315 " 2,290.00 " " 2,198.40 " " 2,198.40 " " 2,175.50 " " 2,129.70 " " 2,198.40 " " 2,129.70 " " 1,594.53 " " 1,074.70 " " 2,175.50 " " 2,129.70 " " 1,511.40 " 34100021 HC BONE JOINT TOMOGR SPECT 341 78320 " 2,228.00 " " 2,138.88 " " 2,138.88 " " 2,116.60 " " 2,072.04 " " 2,138.88 " " 2,072.04 " " 1,551.36 " " 1,045.60 " " 2,116.60 " " 2,072.04 " " 1,470.48 " 34100023 HC CARDIAC SGI STUDY SPECT 341 78451 " 2,160.00 " " 2,073.60 " " 2,073.60 " " 2,052.00 " " 2,008.80 " " 2,073.60 " " 2,008.80 " " 1,504.01 " " 1,013.69 " " 2,052.00 " " 2,008.80 " " 1,425.60 " 34100024 HC MYOCARD PERF SPECT MULT 341 78452 " 4,164.00 " " 2,246.00 " " 3,997.44 " " 3,955.80 " " 3,872.52 " " 3,997.44 " " 3,872.52 " " 2,899.39 " " 1,954.17 " " 3,955.80 " " 3,872.52 " " 2,748.24 " 34100027 HC CARD BLD POOL IMAGE GATED 341 78472 " 2,160.00 " " 2,073.60 " " 2,073.60 " " 2,052.00 " " 2,008.80 " " 2,073.60 " " 2,008.80 " " 1,504.01 " " 1,013.69 " " 2,052.00 " " 2,008.80 " " 1,425.60 " 34100038 HC KIDNEY W/VASC FLOW/FUNCT 341 78707 " 1,404.00 " " 1,347.84 " " 1,347.84 " " 1,333.80 " " 1,305.72 " " 1,347.84 " " 1,305.72 " 977.61 658.90 " 1,333.80 " " 1,305.72 " 926.64 34100039 HC RENAL FUNCTION W/PHARM 341 78708 " 1,404.00 " " 1,347.84 " " 1,347.84 " " 1,333.80 " " 1,305.72 " " 1,347.84 " " 1,305.72 " 977.61 658.90 " 1,333.80 " " 1,305.72 " 926.64 34100042 HC TUMOR IMAGING SPECT SINGLE AREA SINGLE DAY IMAGING 341 78803 " 1,517.00 " " 1,456.32 " " 1,456.32 " " 1,441.15 " " 1,410.81 " " 1,456.32 " " 1,410.81 " " 1,056.29 " 711.93 " 1,441.15 " " 1,410.81 " " 1,001.22 " 35000001 HC CT SFT TS NECK W/O CONT 350 70490 " 2,141.00 " " 2,055.36 " " 2,055.36 " " 2,033.95 " " 1,991.13 " " 2,055.36 " " 1,991.13 " " 1,490.78 " " 1,004.77 " " 2,033.95 " " 1,991.13 " " 1,413.06 " 35000002 HC CT SFT TS NECK W/CONTRAST 350 70491 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35000003 HC CT SFT TS NECK W/WO CONT 350 70492 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35000004 HC CT ANGIO NECK W WO CONTRAST 350 70498 " 3,109.00 " " 2,984.64 " " 2,984.64 " " 2,953.55 " " 2,891.37 " " 2,984.64 " " 2,891.37 " " 2,164.80 " " 1,459.05 " " 2,953.55 " " 2,891.37 " " 2,051.94 " 35000006 HC CT HEART W/O CONT CALC SCORE 350 75571 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 35000010 HC 3D IMAGING W/O POST PROCESSING 350 76376 740.00 710.40 710.40 703.00 688.20 710.40 688.20 515.26 347.28 703.00 688.20 488.40 35000013 HC CT GUIDE NEEDLE PLACEMENT 350 77012 758.00 727.68 727.68 720.10 704.94 727.68 704.94 527.80 355.73 720.10 704.94 500.28 35000018 HC CT ANGIO CHEST W/WO CONTRAST 350 71275 " 3,109.00 " " 2,984.64 " " 2,984.64 " " 2,953.55 " " 2,891.37 " " 2,984.64 " " 2,891.37 " " 2,164.80 " " 1,459.05 " " 2,953.55 " " 2,891.37 " " 2,051.94 " 35000019 HC SI-JOINT INJECTION BILAT 350 27096 514.00 493.44 493.44 488.30 478.02 493.44 478.02 357.90 241.22 488.30 478.02 339.24 35000020 HC SI-JOINT INJECTION 350 27096 539.00 517.44 517.44 512.05 501.27 517.44 501.27 375.31 252.95 512.05 501.27 355.74 35000024 HC CT LIMITED STUDY 350 76380 " 1,180.00 " " 1,132.80 " " 1,132.80 " " 1,121.00 " " 1,097.40 " " 1,132.80 " " 1,097.40 " 821.63 553.77 " 1,121.00 " " 1,097.40 " 778.80 35000025 HC CTA CHEST W/WO CONT LMTD 350 71275 " 3,109.00 " " 2,984.64 " " 2,984.64 " " 2,953.55 " " 2,891.37 " " 2,984.64 " " 2,891.37 " " 2,164.80 " " 1,459.05 " " 2,953.55 " " 2,891.37 " " 2,051.94 " 35000027 HC 3-D IMAGING W/POST PROCESSING 350 76377 798.00 766.08 766.08 758.10 742.14 766.08 742.14 555.65 374.50 758.10 742.14 526.68 35000029 HC CT GUIDED BONE MARROW ASPIRATI 350 77012 501.00 480.96 480.96 475.95 465.93 480.96 465.93 348.85 235.12 475.95 465.93 330.66 35000030 HC CT GUIDED BONE MARROW BIOPSY 350 77012 " 1,938.00 " " 1,860.48 " " 1,860.48 " " 1,841.10 " " 1,802.34 " " 1,860.48 " " 1,802.34 " " 1,349.43 " 909.50 " 1,841.10 " " 1,802.34 " " 1,279.08 " 35000031 HC FLUORO GUIDED SI JOINT INJECTION 350 27096 523.00 502.08 502.08 496.85 486.39 502.08 486.39 364.16 245.44 496.85 486.39 345.18 35000032 HC PET IMAGING SKULL BASE TO MID-THIGH 350 78812 " 6,064.00 " " 5,821.44 " " 5,821.44 " " 5,760.80 " " 5,639.52 " " 5,821.44 " " 5,639.52 " " 4,222.36 " " 2,845.84 " " 5,760.80 " " 5,639.52 " " 4,002.24 " 35000033 HC CT SFT TS NECK W/WO CONT 350 70492 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35000034 HC PET IMAGING WHOLE BODY 350 78813 " 6,578.00 " " 6,314.88 " " 6,314.88 " " 6,249.10 " " 6,117.54 " " 6,314.88 " " 6,117.54 " " 4,580.26 " " 3,087.06 " " 6,249.10 " " 6,117.54 " " 4,341.48 " 35100002 HC CT HEAD W CONTRAST 351 70460 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35100003 HC CT HEAD W WO CONTRAST 351 70470 " 2,564.00 " " 1,653.00 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35100008 HC CT MAX FACIAL W CONTRAST 351 70487 " 2,141.00 " " 2,055.36 " " 2,055.36 " " 2,033.95 " " 1,991.13 " " 2,055.36 " " 1,991.13 " " 1,490.78 " " 1,004.77 " " 2,033.95 " " 1,991.13 " " 1,413.06 " 35100009 HC CT MAX FACIAL W/WO CONT 351 70488 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35100010 HC CT ANGIO HEAD W/WO CONTRAST 351 70496 " 3,109.00 " " 2,984.64 " " 2,984.64 " " 2,953.55 " " 2,891.37 " " 2,984.64 " " 2,891.37 " " 2,164.80 " " 1,459.05 " " 2,953.55 " " 2,891.37 " " 2,051.94 " 35100012 HC CT HEAD WO CONTRAST 351 70450 " 2,141.00 " " 1,305.00 " " 2,055.36 " " 2,033.95 " " 1,991.13 " " 2,055.36 " " 1,991.13 " " 1,490.78 " " 1,004.77 " " 2,033.95 " " 1,991.13 " " 1,413.06 " 35100016 HC CT EARS WO CONTRAST 351 70480 " 2,141.00 " " 2,055.36 " " 2,055.36 " " 2,033.95 " " 1,991.13 " " 2,055.36 " " 1,991.13 " " 1,490.78 " " 1,004.77 " " 2,033.95 " " 1,991.13 " " 1,413.06 " 35100017 HC CT ORBIT WO CONTRAST 351 70480 " 2,222.00 " " 2,133.12 " " 2,133.12 " " 2,110.90 " " 2,066.46 " " 2,133.12 " " 2,066.46 " " 1,547.18 " " 1,042.78 " " 2,110.90 " " 2,066.46 " " 1,466.52 " 35100019 HC CT EARS W CONTRAST 351 70481 " 2,518.00 " " 2,417.28 " " 2,417.28 " " 2,392.10 " " 2,341.74 " " 2,417.28 " " 2,341.74 " " 1,753.28 " " 1,181.70 " " 2,392.10 " " 2,341.74 " " 1,661.88 " 35100020 HC CT ORBIT W CONTRAST 351 70481 " 2,518.00 " " 2,417.28 " " 2,417.28 " " 2,392.10 " " 2,341.74 " " 2,417.28 " " 2,341.74 " " 1,753.28 " " 1,181.70 " " 2,392.10 " " 2,341.74 " " 1,661.88 " 35100022 HC CT EARS W WO CONTRAST 351 70482 " 2,569.00 " " 2,466.24 " " 2,466.24 " " 2,440.55 " " 2,389.17 " " 2,466.24 " " 2,389.17 " " 1,788.79 " " 1,205.63 " " 2,440.55 " " 2,389.17 " " 1,695.54 " 35100023 HC CT ORBIT W WO CONTRAST 351 70482 " 2,569.00 " " 2,466.24 " " 2,466.24 " " 2,440.55 " " 2,389.17 " " 2,466.24 " " 2,389.17 " " 1,788.79 " " 1,205.63 " " 2,440.55 " " 2,389.17 " " 1,695.54 " 35100024 HC CT SELLA TURCICA W WO CONTRAST 351 70482 " 2,569.00 " " 2,466.24 " " 2,466.24 " " 2,440.55 " " 2,389.17 " " 2,466.24 " " 2,389.17 " " 1,788.79 " " 1,205.63 " " 2,440.55 " " 2,389.17 " " 1,695.54 " 35100026 HC CT MAX FACIAL LTD 351 70486 " 1,934.00 " " 1,856.64 " " 1,856.64 " " 1,837.30 " " 1,798.62 " " 1,856.64 " " 1,798.62 " " 1,346.64 " 907.63 " 1,837.30 " " 1,798.62 " " 1,276.44 " 35100027 HC CT MAX FACIAL WO CONTRAST 351 70486 " 1,934.00 " " 1,856.64 " " 1,856.64 " " 1,837.30 " " 1,798.62 " " 1,856.64 " " 1,798.62 " " 1,346.64 " 907.63 " 1,837.30 " " 1,798.62 " " 1,276.44 " 35100030 HC CT HEAD W WO CONTRAST 351 70470 " 2,564.00 " " 1,653.00 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35100031 HC CT EARS W WO CONTRAST 351 70482 " 2,569.00 " " 2,466.24 " " 2,466.24 " " 2,440.55 " " 2,389.17 " " 2,466.24 " " 2,389.17 " " 1,788.79 " " 1,205.63 " " 2,440.55 " " 2,389.17 " " 1,695.54 " 35100032 HC CT ORBIT W WO CONTRAST 351 70482 " 2,569.00 " " 2,466.24 " " 2,466.24 " " 2,440.55 " " 2,389.17 " " 2,466.24 " " 2,389.17 " " 1,788.79 " " 1,205.63 " " 2,440.55 " " 2,389.17 " " 1,695.54 " 35100033 HC CT SELLA TURCICA W WO CONTRAST 351 70482 " 2,569.00 " " 2,466.24 " " 2,466.24 " " 2,440.55 " " 2,389.17 " " 2,466.24 " " 2,389.17 " " 1,788.79 " " 1,205.63 " " 2,440.55 " " 2,389.17 " " 1,695.54 " 35100034 HC CT MAX FACIAL W/WO CONT 351 70488 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200002 HC CT THORAX W/CONTRAST 352 71260 " 2,564.00 " " 1,405.00 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200003 HC CT THORAX W/WO CONTRAST 352 71270 " 2,839.00 " " 2,725.44 " " 2,725.44 " " 2,697.05 " " 2,640.27 " " 2,725.44 " " 2,640.27 " " 1,976.80 " " 1,332.34 " " 2,697.05 " " 2,640.27 " " 1,873.74 " 35200004 HC CT LUNG WO CONT CANCER SCR 352 71271 " 1,836.00 " " 1,762.56 " " 1,762.56 " " 1,744.20 " " 1,707.48 " " 1,762.56 " " 1,707.48 " " 1,278.41 " 861.63 " 1,744.20 " " 1,707.48 " " 1,211.76 " 35200005 HC CT SPINE CERVICAL WO CONT 352 72125 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200006 HC CT SPINE CERVICAL W CONT 352 72126 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200007 HC CT SP CERVICAL W/WO CONT 352 72127 " 2,815.00 " " 2,702.40 " " 2,702.40 " " 2,674.25 " " 2,617.95 " " 2,702.40 " " 2,617.95 " " 1,960.08 " " 1,321.08 " " 2,674.25 " " 2,617.95 " " 1,857.90 " 35200008 HC CT SPINE THORACIC WO CONT 352 72128 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200009 HC CT SPINE THORACIC W CONT 352 72129 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200010 HC CT SPINE THORAC W/WO CONT 352 72130 " 2,630.00 " " 2,524.80 " " 2,524.80 " " 2,498.50 " " 2,445.90 " " 2,524.80 " " 2,445.90 " " 1,831.27 " " 1,234.26 " " 2,498.50 " " 2,445.90 " " 1,735.80 " 35200011 HC CT SPINE LUMBAR W/O CONT 352 72131 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200012 HC CT SPINE LUMBAR W CONT 352 72132 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200013 HC CT LUMBAR SPINE W/WO CONT 352 72133 " 2,839.00 " " 2,725.44 " " 2,725.44 " " 2,697.05 " " 2,640.27 " " 2,725.44 " " 2,640.27 " " 1,976.80 " " 1,332.34 " " 2,697.05 " " 2,640.27 " " 1,873.74 " 35200014 HC CT ANGIO PELVIS W/WO CONTRAST 352 72191 " 3,225.00 " " 3,096.00 " " 3,096.00 " " 3,063.75 " " 2,999.25 " " 3,096.00 " " 2,999.25 " " 2,245.57 " " 1,513.49 " " 3,063.75 " " 2,999.25 " " 2,128.50 " 35200015 HC CT PELVIS W/O CONTRAST 352 72192 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200016 HC CT PELVIS W CONTRAST 352 72193 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200017 HC CT PELVIS W/WO CONTRAST 352 72194 " 2,771.00 " " 2,660.16 " " 2,660.16 " " 2,632.45 " " 2,577.03 " " 2,660.16 " " 2,577.03 " " 1,929.45 " " 1,300.43 " " 2,632.45 " " 2,577.03 " " 1,828.86 " 35200018 HC CT UPPER EXT W/O CONTRAST 352 73200 " 2,141.00 " " 2,055.36 " " 2,055.36 " " 2,033.95 " " 1,991.13 " " 2,055.36 " " 1,991.13 " " 1,490.78 " " 1,004.77 " " 2,033.95 " " 1,991.13 " " 1,413.06 " 35200019 HC CT UPPER EXT W/CONTRAST 352 73201 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200020 HC CT UPPER EXT W/WO CONTRAST 352 73202 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200022 HC CT LOWER EXT W/O CONTRAST 352 73700 " 2,163.00 " " 2,076.48 " " 2,076.48 " " 2,054.85 " " 2,011.59 " " 2,076.48 " " 2,011.59 " " 1,506.10 " " 1,015.10 " " 2,054.85 " " 2,011.59 " " 1,427.58 " 35200023 HC CT LOWER EXT W CONTRAST 352 73701 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200024 HC CT LOWER EXT W/WO CONT 352 73702 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200026 HC CT ABDOMEN WO CONTRAST 352 74150 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200027 HC CT ABDOMEN W CONTRAST 352 74160 " 2,771.00 " " 2,660.16 " " 2,660.16 " " 2,632.45 " " 2,577.03 " " 2,660.16 " " 2,577.03 " " 1,929.45 " " 1,300.43 " " 2,632.45 " " 2,577.03 " " 1,828.86 " 35200028 HC CT ABDOMEN W/WO CONTRAST 352 74170 " 2,985.00 " " 2,865.60 " " 2,865.60 " " 2,835.75 " " 2,776.05 " " 2,865.60 " " 2,776.05 " " 2,078.46 " " 1,400.86 " " 2,835.75 " " 2,776.05 " " 1,970.10 " 35200029 HC CTA ABD & PELVIS 352 74174 " 4,182.00 " " 4,014.72 " " 4,014.72 " " 3,972.90 " " 3,889.26 " " 4,014.72 " " 3,889.26 " " 2,911.93 " " 1,962.61 " " 3,972.90 " " 3,889.26 " " 2,760.12 " 35200030 HC CT ANGIO ABD W/WO CONTRAST 352 74175 " 3,109.00 " " 2,984.64 " " 2,984.64 " " 2,953.55 " " 2,891.37 " " 2,984.64 " " 2,891.37 " " 2,164.80 " " 1,459.05 " " 2,953.55 " " 2,891.37 " " 2,051.94 " 35200031 HC CT ABD PEL W/O CONT 352 74176 " 4,199.00 " " 2,111.00 " " 4,031.04 " " 3,989.05 " " 3,905.07 " " 4,031.04 " " 3,905.07 " " 2,923.76 " " 1,970.59 " " 3,989.05 " " 3,905.07 " " 2,771.34 " 35200032 HC CT ABD PEL WITH CONTRAST 352 74177 " 4,759.00 " " 2,590.00 " " 4,568.64 " " 4,521.05 " " 4,425.87 " " 4,568.64 " " 4,425.87 " " 3,313.69 " " 2,233.40 " " 4,521.05 " " 4,425.87 " " 3,140.94 " 35200033 HC CT ABD PEL W AND WO CONTRAST 352 74178 " 5,479.00 " " 2,898.00 " " 5,259.84 " " 5,205.05 " " 5,095.47 " " 5,259.84 " " 5,095.47 " " 3,815.03 " " 2,571.29 " " 5,205.05 " " 5,095.47 " " 3,616.14 " 35200039 HC ABDOMEN UPPER W WO CONTRA 352 74140 " 2,985.00 " " 2,865.60 " " 2,865.60 " " 2,835.75 " " 2,776.05 " " 2,865.60 " " 2,776.05 " " 2,078.46 " " 1,400.86 " " 2,835.75 " " 2,776.05 " " 1,970.10 " 35200042 HC CT THORAX WO CONTRAST 352 71250 " 2,353.00 " " 2,258.88 " " 2,258.88 " " 2,235.35 " " 2,188.29 " " 2,258.88 " " 2,188.29 " " 1,638.39 " " 1,104.26 " " 2,235.35 " " 2,188.29 " " 1,552.98 " 35200052 HC CT ABD W/O CONT LTD 352 74150 " 1,719.00 " " 1,650.24 " " 1,650.24 " " 1,633.05 " " 1,598.67 " " 1,650.24 " " 1,598.67 " " 1,196.94 " 806.73 " 1,633.05 " " 1,598.67 " " 1,134.54 " 35200057 HC CT RENAL CALC W/O CONT 352 74176 " 3,383.00 " " 2,111.00 " " 3,247.68 " " 3,213.85 " " 3,146.19 " " 3,247.68 " " 3,146.19 " " 2,355.58 " " 1,587.64 " " 3,213.85 " " 3,146.19 " " 2,232.78 " 35200059 HC CT RENAL CALC W AND W/O CONT 352 74178 " 5,479.00 " " 2,898.00 " " 5,259.84 " " 5,205.05 " " 5,095.47 " " 5,259.84 " " 5,095.47 " " 3,815.03 " " 2,571.29 " " 5,205.05 " " 5,095.47 " " 3,616.14 " 35200060 HC CTA THORA/ABD AORTA W FEM RNFF 352 75635 " 3,586.00 " " 3,442.56 " " 3,442.56 " " 3,406.70 " " 3,334.98 " " 3,442.56 " " 3,334.98 " " 2,496.93 " " 1,682.91 " " 3,406.70 " " 3,334.98 " " 2,366.76 " 35200061 HC CT ABDOMEN W/WO CONTRAST 352 74170 " 2,985.00 " " 2,865.60 " " 2,865.60 " " 2,835.75 " " 2,776.05 " " 2,865.60 " " 2,776.05 " " 2,078.46 " " 1,400.86 " " 2,835.75 " " 2,776.05 " " 1,970.10 " 35200062 HC CT THORAX W/WO CONTRAST 352 71270 " 2,839.00 " " 2,725.44 " " 2,725.44 " " 2,697.05 " " 2,640.27 " " 2,725.44 " " 2,640.27 " " 1,976.80 " " 1,332.34 " " 2,697.05 " " 2,640.27 " " 1,873.74 " 35200064 HC CT LOWER EXT W/WO CONT 352 73702 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200065 HC CT UPPER EXT W/WO CONTRAST 352 73202 " 2,564.00 " " 2,461.44 " " 2,461.44 " " 2,435.80 " " 2,384.52 " " 2,461.44 " " 2,384.52 " " 1,785.31 " " 1,203.29 " " 2,435.80 " " 2,384.52 " " 1,692.24 " 35200066 HC CT PELVIS W/WO CONTRAST 352 72194 " 2,771.00 " " 2,660.16 " " 2,660.16 " " 2,632.45 " " 2,577.03 " " 2,660.16 " " 2,577.03 " " 1,929.45 " " 1,300.43 " " 2,632.45 " " 2,577.03 " " 1,828.86 " 35200067 HC CT RENAL CALC W AND W/O CONT 352 74178 " 5,479.00 " " 2,898.00 " " 5,259.84 " " 5,205.05 " " 5,095.47 " " 5,259.84 " " 5,095.47 " " 3,815.03 " " 2,571.29 " " 5,205.05 " " 5,095.47 " " 3,616.14 " 35200068 HC CT ABD PEL W AND WO CONTRAST 352 74178 " 5,479.00 " " 2,898.00 " " 5,259.84 " " 5,205.05 " " 5,095.47 " " 5,259.84 " " 5,095.47 " " 3,815.03 " " 2,571.29 " " 5,205.05 " " 5,095.47 " " 3,616.14 " 36000001 HC CATARACT OR ROOM 360 " 3,666.00 " " 3,519.36 " " 3,519.36 " " 3,482.70 " " 3,409.38 " " 3,519.36 " " 3,409.38 " " 2,552.64 " " 1,720.45 " " 3,482.70 " " 3,409.38 " " 2,419.56 " 36000003 HC OR 1 SCOPE 106-120 MINUTE 360 " 3,279.00 " " 3,147.84 " " 3,147.84 " " 3,115.05 " " 3,049.47 " " 3,147.84 " " 3,049.47 " " 2,283.17 " " 1,538.83 " " 3,115.05 " " 3,049.47 " " 2,164.14 " 36000004 HC OR 1 SCOPE 1-15 MINUTES 360 " 1,062.00 " " 1,019.52 " " 1,019.52 " " 1,008.90 " 987.66 " 1,019.52 " 987.66 739.47 498.40 " 1,008.90 " 987.66 700.92 36000005 HC OR 1 SCOPE 16-30 MINUTES 360 " 1,333.00 " " 1,279.68 " " 1,279.68 " " 1,266.35 " " 1,239.69 " " 1,279.68 " " 1,239.69 " 928.17 625.58 " 1,266.35 " " 1,239.69 " 879.78 36000006 HC OR 1 SCOPE 31-45 MINUTES 360 " 2,137.00 " " 2,051.52 " " 2,051.52 " " 2,030.15 " " 1,987.41 " " 2,051.52 " " 1,987.41 " " 1,487.99 " " 1,002.89 " " 2,030.15 " " 1,987.41 " " 1,410.42 " 36000007 HC OR 1 SCOPE 46-60 MINUTES 360 " 2,433.00 " " 2,335.68 " " 2,335.68 " " 2,311.35 " " 2,262.69 " " 2,335.68 " " 2,262.69 " " 1,694.10 " " 1,141.81 " " 2,311.35 " " 2,262.69 " " 1,605.78 " 36000008 HC OR 1 SCOPE 61-75 MINUTES 360 " 2,687.00 " " 2,579.52 " " 2,579.52 " " 2,552.65 " " 2,498.91 " " 2,579.52 " " 2,498.91 " " 1,870.96 " " 1,261.01 " " 2,552.65 " " 2,498.91 " " 1,773.42 " 36000009 HC OR 1 SCOPE 76-90 MINUTES 360 " 2,912.00 " " 2,795.52 " " 2,795.52 " " 2,766.40 " " 2,708.16 " " 2,795.52 " " 2,708.16 " " 2,027.63 " " 1,366.60 " " 2,766.40 " " 2,708.16 " " 1,921.92 " 36000010 HC OR 1 SCOPE 91-105 MINUTES 360 " 3,094.00 " " 2,970.24 " " 2,970.24 " " 2,939.30 " " 2,877.42 " " 2,970.24 " " 2,877.42 " " 2,154.35 " " 1,452.01 " " 2,939.30 " " 2,877.42 " " 2,042.04 " 36000011 HC OR 2 SCOPE 0-30 MINUTES 360 " 2,841.00 " " 2,727.36 " " 2,727.36 " " 2,698.95 " " 2,642.13 " " 2,727.36 " " 2,642.13 " " 1,978.19 " " 1,333.28 " " 2,698.95 " " 2,642.13 " " 1,875.06 " 36000012 HC OR 2 SCOPE 106-120 MIN 360 " 4,551.00 " " 4,368.96 " " 4,368.96 " " 4,323.45 " " 4,232.43 " " 4,368.96 " " 4,232.43 " " 3,168.86 " " 2,135.78 " " 4,323.45 " " 4,232.43 " " 3,003.66 " 36000013 HC OR 2 SCOPE 121-135 MIN 360 " 4,822.00 " " 4,629.12 " " 4,629.12 " " 4,580.90 " " 4,484.46 " " 4,629.12 " " 4,484.46 " " 3,357.56 " " 2,262.96 " " 4,580.90 " " 4,484.46 " " 3,182.52 " 36000014 HC OR 2 SCOPE 136-150 MIN 360 " 5,093.00 " " 4,889.28 " " 4,889.28 " " 4,838.35 " " 4,736.49 " " 4,889.28 " " 4,736.49 " " 3,546.26 " " 2,390.14 " " 4,838.35 " " 4,736.49 " " 3,361.38 " 36000015 HC OR 2 SCOPE 151-165 MIN 360 " 5,364.00 " " 5,149.44 " " 5,149.44 " " 5,095.80 " " 4,988.52 " " 5,149.44 " " 4,988.52 " " 3,734.95 " " 2,517.33 " " 5,095.80 " " 4,988.52 " " 3,540.24 " 36000016 HC OR 2 SCOPE 166-180 MIN 360 " 5,634.00 " " 5,408.64 " " 5,408.64 " " 5,352.30 " " 5,239.62 " " 5,408.64 " " 5,239.62 " " 3,922.95 " " 2,644.04 " " 5,352.30 " " 5,239.62 " " 3,718.44 " 36000017 HC OR 2 SCOPE 31-45 MINUTES 360 " 3,156.00 " " 3,029.76 " " 3,029.76 " " 2,998.20 " " 2,935.08 " " 3,029.76 " " 2,935.08 " " 2,197.52 " " 1,481.11 " " 2,998.20 " " 2,935.08 " " 2,082.96 " 36000018 HC OR 2 SCOPE 46-60 MINUTES 360 " 3,466.00 " " 3,327.36 " " 3,327.36 " " 3,292.70 " " 3,223.38 " " 3,327.36 " " 3,223.38 " " 2,413.38 " " 1,626.59 " " 3,292.70 " " 3,223.38 " " 2,287.56 " 36000019 HC OR 2 SCOPE 61-75 MINUTES 360 " 3,740.00 " " 3,590.40 " " 3,590.40 " " 3,553.00 " " 3,478.20 " " 3,590.40 " " 3,478.20 " " 2,604.16 " " 1,755.18 " " 3,553.00 " " 3,478.20 " " 2,468.40 " 36000020 HC OR 2 SCOPE 76-90 MINUTES 360 " 4,011.00 " " 3,850.56 " " 3,850.56 " " 3,810.45 " " 3,730.23 " " 3,850.56 " " 3,730.23 " " 2,792.86 " " 1,882.36 " " 3,810.45 " " 3,730.23 " " 2,647.26 " 36000021 HC OR 2 SCOPE 91-105 MINUTE 360 " 4,281.00 " " 4,109.76 " " 4,109.76 " " 4,066.95 " " 3,981.33 " " 4,109.76 " " 3,981.33 " " 2,980.86 " " 2,009.07 " " 4,066.95 " " 3,981.33 " " 2,825.46 " 36000040 HC OR ROOM A 106-120 MINUTES 360 " 3,551.00 " " 3,408.96 " " 3,408.96 " " 3,373.45 " " 3,302.43 " " 3,408.96 " " 3,302.43 " " 2,472.56 " " 1,666.48 " " 3,373.45 " " 3,302.43 " " 2,343.66 " 36000041 HC OR ROOM A 1-15 MINUTES 360 " 1,514.00 " " 1,453.44 " " 1,453.44 " " 1,438.30 " " 1,408.02 " " 1,453.44 " " 1,408.02 " " 1,054.20 " 710.52 " 1,438.30 " " 1,408.02 " 999.24 36000042 HC OR ROOM A 16-30 MINUTES 360 " 1,901.00 " " 1,824.96 " " 1,824.96 " " 1,805.95 " " 1,767.93 " " 1,824.96 " " 1,767.93 " " 1,323.67 " 892.14 " 1,805.95 " " 1,767.93 " " 1,254.66 " 36000043 HC OR ROOM A 31-45 MINUTES 360 " 2,251.00 " " 2,160.96 " " 2,160.96 " " 2,138.45 " " 2,093.43 " " 2,160.96 " " 2,093.43 " " 1,567.37 " " 1,056.39 " " 2,138.45 " " 2,093.43 " " 1,485.66 " 36000044 HC OR ROOM A 46-60 MINUTES 360 " 2,560.00 " " 2,457.60 " " 2,457.60 " " 2,432.00 " " 2,380.80 " " 2,457.60 " " 2,380.80 " " 1,782.53 " " 1,201.41 " " 2,432.00 " " 2,380.80 " " 1,689.60 " 36000045 HC OR ROOM A 61-75 MINUTES 360 " 2,831.00 " " 2,717.76 " " 2,717.76 " " 2,689.45 " " 2,632.83 " " 2,717.76 " " 2,632.83 " " 1,971.23 " " 1,328.59 " " 2,689.45 " " 2,632.83 " " 1,868.46 " 36000046 HC OR ROOM A 76-90 MINUTES 360 " 3,063.00 " " 2,940.48 " " 2,940.48 " " 2,909.85 " " 2,848.59 " " 2,940.48 " " 2,848.59 " " 2,132.77 " " 1,437.47 " " 2,909.85 " " 2,848.59 " " 2,021.58 " 36000047 HC OR ROOM A 91-105 MINUTES 360 " 3,255.00 " " 3,124.80 " " 3,124.80 " " 3,092.25 " " 3,027.15 " " 3,124.80 " " 3,027.15 " " 2,266.46 " " 1,527.57 " " 3,092.25 " " 3,027.15 " " 2,148.30 " 36000048 HC OR ROOM B 106-120 MINUTES 360 " 4,551.00 " " 4,368.96 " " 4,368.96 " " 4,323.45 " " 4,232.43 " " 4,368.96 " " 4,232.43 " " 3,168.86 " " 2,135.78 " " 4,323.45 " " 4,232.43 " " 3,003.66 " 36000049 HC OR ROOM B 1-15 MINUTES 360 " 2,422.00 " " 2,325.12 " " 2,325.12 " " 2,300.90 " " 2,252.46 " " 2,325.12 " " 2,252.46 " " 1,686.44 " " 1,136.64 " " 2,300.90 " " 2,252.46 " " 1,598.52 " 36000050 HC OR ROOM B 121-135 MINUTES 360 " 4,821.00 " " 4,628.16 " " 4,628.16 " " 4,579.95 " " 4,483.53 " " 4,628.16 " " 4,483.53 " " 3,356.86 " " 2,262.50 " " 4,579.95 " " 4,483.53 " " 3,181.86 " 36000051 HC OR ROOM B 136-150 MIN 360 " 5,093.00 " " 4,889.28 " " 4,889.28 " " 4,838.35 " " 4,736.49 " " 4,889.28 " " 4,736.49 " " 3,546.26 " " 2,390.14 " " 4,838.35 " " 4,736.49 " " 3,361.38 " 36000052 HC OR ROOM B 151-165 MIN 360 " 5,364.00 " " 5,149.44 " " 5,149.44 " " 5,095.80 " " 4,988.52 " " 5,149.44 " " 4,988.52 " " 3,734.95 " " 2,517.33 " " 5,095.80 " " 4,988.52 " " 3,540.24 " 36000053 HC OR ROOM B 16-30 MINUTES 360 " 2,808.00 " " 2,695.68 " " 2,695.68 " " 2,667.60 " " 2,611.44 " " 2,695.68 " " 2,611.44 " " 1,955.21 " " 1,317.79 " " 2,667.60 " " 2,611.44 " " 1,853.28 " 36000054 HC OR ROOM B 166-180 MIN 360 " 5,634.00 " " 5,408.64 " " 5,408.64 " " 5,352.30 " " 5,239.62 " " 5,408.64 " " 5,239.62 " " 3,922.95 " " 2,644.04 " " 5,352.30 " " 5,239.62 " " 3,718.44 " 36000055 HC OR ROOM B 181-195 MIN 360 " 5,905.00 " " 5,668.80 " " 5,668.80 " " 5,609.75 " " 5,491.65 " " 5,668.80 " " 5,491.65 " " 4,111.65 " " 2,771.22 " " 5,609.75 " " 5,491.65 " " 3,897.30 " 36000056 HC OR ROOM B 196-210 MIN 360 " 6,176.00 " " 5,928.96 " " 5,928.96 " " 5,867.20 " " 5,743.68 " " 5,928.96 " " 5,743.68 " " 4,300.35 " " 2,898.40 " " 5,867.20 " " 5,743.68 " " 4,076.16 " 36000057 HC OR ROOM B 31-45 MINUTES 360 " 3,156.00 " " 3,029.76 " " 3,029.76 " " 2,998.20 " " 2,935.08 " " 3,029.76 " " 2,935.08 " " 2,197.52 " " 1,481.11 " " 2,998.20 " " 2,935.08 " " 2,082.96 " 36000058 HC OR ROOM B 46-60 MINUTES 360 " 3,466.00 " " 3,327.36 " " 3,327.36 " " 3,292.70 " " 3,223.38 " " 3,327.36 " " 3,223.38 " " 2,413.38 " " 1,626.59 " " 3,292.70 " " 3,223.38 " " 2,287.56 " 36000059 HC OR ROOM B 61-75 MINUTES 360 " 3,740.00 " " 3,590.40 " " 3,590.40 " " 3,553.00 " " 3,478.20 " " 3,590.40 " " 3,478.20 " " 2,604.16 " " 1,755.18 " " 3,553.00 " " 3,478.20 " " 2,468.40 " 36000060 HC OR ROOM B 76-90 MINUTES 360 " 4,011.00 " " 3,850.56 " " 3,850.56 " " 3,810.45 " " 3,730.23 " " 3,850.56 " " 3,730.23 " " 2,792.86 " " 1,882.36 " " 3,810.45 " " 3,730.23 " " 2,647.26 " 36000061 HC OR ROOM B 91-105 MINUTES 360 " 4,281.00 " " 4,109.76 " " 4,109.76 " " 4,066.95 " " 3,981.33 " " 4,109.76 " " 3,981.33 " " 2,980.86 " " 2,009.07 " " 4,066.95 " " 3,981.33 " " 2,825.46 " 36000062 HC OR ROOM C 106-120 MINUTE 360 " 6,272.00 " " 6,021.12 " " 6,021.12 " " 5,958.40 " " 5,832.96 " " 6,021.12 " " 5,832.96 " " 4,367.19 " " 2,943.45 " " 5,958.40 " " 5,832.96 " " 4,139.52 " 36000063 HC OR ROOM C 1-15 MINUTES 360 " 3,851.00 " " 3,696.96 " " 3,696.96 " " 3,658.45 " " 3,581.43 " " 3,696.96 " " 3,581.43 " " 2,681.45 " " 1,807.27 " " 3,658.45 " " 3,581.43 " " 2,541.66 " 36000064 HC OR ROOM C 121-135 MINUTE 360 " 6,601.00 " " 6,336.96 " " 6,336.96 " " 6,270.95 " " 6,138.93 " " 6,336.96 " " 6,138.93 " " 4,596.28 " " 3,097.85 " " 6,270.95 " " 6,138.93 " " 4,356.66 " 36000065 HC OR ROOM C 136-150 MINUTE 360 " 6,928.00 " " 6,650.88 " " 6,650.88 " " 6,581.60 " " 6,443.04 " " 6,650.88 " " 6,443.04 " " 4,823.97 " " 3,251.31 " " 6,581.60 " " 6,443.04 " " 4,572.48 " 36000066 HC OR ROOM C 151-165 MINUTE 360 " 7,257.00 " " 6,966.72 " " 6,966.72 " " 6,894.15 " " 6,749.01 " " 6,966.72 " " 6,749.01 " " 5,053.05 " " 3,405.71 " " 6,894.15 " " 6,749.01 " " 4,789.62 " 36000067 HC OR ROOM C 16 - 30 MINUTE 360 " 4,263.00 " " 4,092.48 " " 4,092.48 " " 4,049.85 " " 3,964.59 " " 4,092.48 " " 3,964.59 " " 2,968.33 " " 2,000.63 " " 4,049.85 " " 3,964.59 " " 2,813.58 " 36000068 HC OR ROOM C 166-180 MINUTE 360 " 7,587.00 " " 7,283.52 " " 7,283.52 " " 7,207.65 " " 7,055.91 " " 7,283.52 " " 7,055.91 " " 5,282.83 " " 3,560.58 " " 7,207.65 " " 7,055.91 " " 5,007.42 " 36000069 HC OR ROOM C 196-210 MINUTES 360 " 8,243.00 " " 7,913.28 " " 7,913.28 " " 7,830.85 " " 7,665.99 " " 7,913.28 " " 7,665.99 " " 5,739.60 " " 3,868.44 " " 7,830.85 " " 7,665.99 " " 5,440.38 " 36000070 HC OR ROOM C 31 -45 MINUTES 360 " 4,634.00 " " 4,448.64 " " 4,448.64 " " 4,402.30 " " 4,309.62 " " 4,448.64 " " 4,309.62 " " 3,226.65 " " 2,174.74 " " 4,402.30 " " 4,309.62 " " 3,058.44 " 36000071 HC OR ROOM C 46-60 MINUTES 360 " 4,959.00 " " 4,760.64 " " 4,760.64 " " 4,711.05 " " 4,611.87 " " 4,760.64 " " 4,611.87 " " 3,452.95 " " 2,327.26 " " 4,711.05 " " 4,611.87 " " 3,272.94 " 36000072 HC OR ROOM C 61-75 MINUTES 360 " 5,285.00 " " 5,073.60 " " 5,073.60 " " 5,020.75 " " 4,915.05 " " 5,073.60 " " 4,915.05 " " 3,679.95 " " 2,480.25 " " 5,020.75 " " 4,915.05 " " 3,488.10 " 36000073 HC OR ROOM C 76-90 MINUTES 360 " 5,615.00 " " 5,390.40 " " 5,390.40 " " 5,334.25 " " 5,221.95 " " 5,390.40 " " 5,221.95 " " 3,909.72 " " 2,635.12 " " 5,334.25 " " 5,221.95 " " 3,705.90 " 36000074 HC OR ROOM C 91-105 MINUTES 360 " 5,947.00 " " 5,709.12 " " 5,709.12 " " 5,649.65 " " 5,530.71 " " 5,709.12 " " 5,530.71 " " 4,140.90 " " 2,790.93 " " 5,649.65 " " 5,530.71 " " 3,925.02 " 36000075 HC OR ROOM D 106-120 MINUTES 360 " 8,529.00 " " 8,187.84 " " 8,187.84 " " 8,102.55 " " 7,931.97 " " 8,187.84 " " 7,931.97 " " 5,938.74 " " 4,002.66 " " 8,102.55 " " 7,931.97 " " 5,629.14 " 36000076 HC OR ROOM D 1-15 MINUTES 360 " 6,053.00 " " 5,810.88 " " 5,810.88 " " 5,750.35 " " 5,629.29 " " 5,810.88 " " 5,629.29 " " 4,214.70 " " 2,840.67 " " 5,750.35 " " 5,629.29 " " 3,994.98 " 36000077 HC OR ROOM D 121-135 MINTUES 360 " 8,877.00 " " 8,521.92 " " 8,521.92 " " 8,433.15 " " 8,255.61 " " 8,521.92 " " 8,255.61 " " 6,181.06 " " 4,165.98 " " 8,433.15 " " 8,255.61 " " 5,858.82 " 36000078 HC OR ROOM D 136-150 MINUTES 360 " 9,228.00 " " 8,858.88 " " 8,858.88 " " 8,766.60 " " 8,582.04 " " 8,858.88 " " 8,582.04 " " 6,425.46 " " 4,330.70 " " 8,766.60 " " 8,582.04 " " 6,090.48 " 36000079 HC OR ROOM D 151-165 MINUTES 360 " 9,573.00 " " 9,190.08 " " 9,190.08 " " 9,094.35 " " 8,902.89 " " 9,190.08 " " 8,902.89 " " 6,665.68 " " 4,492.61 " " 9,094.35 " " 8,902.89 " " 6,318.18 " 36000080 HC OR ROOM D 16-30 MINUTES 360 " 6,439.00 " " 6,181.44 " " 6,181.44 " " 6,117.05 " " 5,988.27 " " 6,181.44 " " 5,988.27 " " 4,483.48 " " 3,021.82 " " 6,117.05 " " 5,988.27 " " 4,249.74 " 36000081 HC OR ROOM D 166-180 MINUTES 360 " 9,925.00 " " 9,528.00 " " 9,528.00 " " 9,428.75 " " 9,230.25 " " 9,528.00 " " 9,230.25 " " 6,910.78 " " 4,657.80 " " 9,428.75 " " 9,230.25 " " 6,550.50 " 36000082 HC OR ROOM D 181-195 MINUTES 360 " 10,273.00 " " 9,862.08 " " 9,862.08 " " 9,759.35 " " 9,553.89 " " 9,862.08 " " 9,553.89 " " 7,153.09 " " 4,821.12 " " 9,759.35 " " 9,553.89 " " 6,780.18 " 36000083 HC OR ROOM D 196-210 MINUTES 360 " 10,617.00 " " 10,192.32 " " 10,192.32 " " 10,086.15 " " 9,873.81 " " 10,192.32 " " 9,873.81 " " 7,392.62 " " 4,982.56 " " 10,086.15 " " 9,873.81 " " 7,007.22 " 36000084 HC OR ROOM D 211-225 MINUTES 360 " 11,044.00 " " 10,602.24 " " 10,602.24 " " 10,491.80 " " 10,270.92 " " 10,602.24 " " 10,270.92 " " 7,689.94 " " 5,182.95 " " 10,491.80 " " 10,270.92 " " 7,289.04 " 36000085 HC OR ROOM D 241-255 MINUTES 360 " 12,435.00 " " 11,937.60 " " 11,937.60 " " 11,813.25 " " 11,564.55 " " 11,937.60 " " 11,564.55 " " 8,658.49 " " 5,835.75 " " 11,813.25 " " 11,564.55 " " 8,207.10 " 36000086 HC OR ROOM D 286-300 MINUTES 360 " 14,523.00 " " 13,942.08 " " 13,942.08 " " 13,796.85 " " 13,506.39 " " 13,942.08 " " 13,506.39 " " 10,112.36 " " 6,815.64 " " 13,796.85 " " 13,506.39 " " 9,585.18 " 36000087 HC OR ROOM D 31-45 MINUTES 360 " 6,788.00 " " 6,516.48 " " 6,516.48 " " 6,448.60 " " 6,312.84 " " 6,516.48 " " 6,312.84 " " 4,726.48 " " 3,185.61 " " 6,448.60 " " 6,312.84 " " 4,480.08 " 36000088 HC OR ROOM D 331-345 MINUTES 360 " 16,770.00 " " 16,099.20 " " 16,099.20 " " 15,931.50 " " 15,596.10 " " 16,099.20 " " 15,596.10 " " 11,676.95 " " 7,870.16 " " 15,931.50 " " 15,596.10 " " 11,068.20 " 36000089 HC OR ROOM D 346-360 MINUTES 360 " 15,918.00 " " 15,281.28 " " 15,281.28 " " 15,122.10 " " 14,803.74 " " 15,281.28 " " 14,803.74 " " 11,083.70 " " 7,470.32 " " 15,122.10 " " 14,803.74 " " 10,505.88 " 36000090 HC OR ROOM D 46-60 MINUTES 360 " 7,135.00 " " 6,849.60 " " 6,849.60 " " 6,778.25 " " 6,635.55 " " 6,849.60 " " 6,635.55 " " 4,968.10 " " 3,348.46 " " 6,778.25 " " 6,635.55 " " 4,709.10 " 36000091 HC OR ROOM D 61-75 MINUTES 360 " 7,485.00 " " 7,185.60 " " 7,185.60 " " 7,110.75 " " 6,961.05 " " 7,185.60 " " 6,961.05 " " 5,211.81 " " 3,512.71 " " 7,110.75 " " 6,961.05 " " 4,940.10 " 36000092 HC OR ROOM D 76-90 MINUTES 360 " 7,835.00 " " 7,521.60 " " 7,521.60 " " 7,443.25 " " 7,286.55 " " 7,521.60 " " 7,286.55 " " 5,455.51 " " 3,676.97 " " 7,443.25 " " 7,286.55 " " 5,171.10 " 36000093 HC OR ROOM D 91-105 MINUTES 360 " 8,182.00 " " 7,854.72 " " 7,854.72 " " 7,772.90 " " 7,609.26 " " 7,854.72 " " 7,609.26 " " 5,697.13 " " 3,839.81 " " 7,772.90 " " 7,609.26 " " 5,400.12 " 36000097 HC PROCEDURE ROOM 106-120 MI 360 " 1,611.00 " " 1,546.56 " " 1,546.56 " " 1,530.45 " " 1,498.23 " " 1,546.56 " " 1,498.23 " " 1,121.74 " 756.04 " 1,530.45 " " 1,498.23 " " 1,063.26 " 36000098 HC PROCEDURE ROOM 121-135 MI 360 " 1,817.00 " " 1,744.32 " " 1,744.32 " " 1,726.15 " " 1,689.81 " " 1,744.32 " " 1,689.81 " " 1,265.18 " 852.72 " 1,726.15 " " 1,689.81 " " 1,199.22 " 36000099 HC PROCEDURE ROOM 1-30 MIN 360 508.00 487.68 487.68 482.60 472.44 487.68 472.44 353.72 238.40 482.60 472.44 335.28 36000100 HC PROCEDURE ROOM 31-45 MIN 360 610.00 585.60 585.60 579.50 567.30 585.60 567.30 424.74 286.27 579.50 567.30 402.60 36000101 HC PROCEDURE ROOM 46-60 MIN 360 " 1,044.00 " " 1,002.24 " " 1,002.24 " 991.80 970.92 " 1,002.24 " 970.92 726.94 489.95 991.80 970.92 689.04 36000102 HC PROCEDURE ROOM 61-75 MIN 360 " 1,268.00 " " 1,217.28 " " 1,217.28 " " 1,204.60 " " 1,179.24 " " 1,217.28 " " 1,179.24 " 882.91 595.07 " 1,204.60 " " 1,179.24 " 836.88 36000103 HC PROCEDURE ROOM 76-90 MIN 360 " 1,399.00 " " 1,343.04 " " 1,343.04 " " 1,329.05 " " 1,301.07 " " 1,343.04 " " 1,301.07 " 974.12 656.55 " 1,329.05 " " 1,301.07 " 923.34 36000104 HC PROCEDURE ROOM 91-105 MIN 360 " 1,514.00 " " 1,453.44 " " 1,453.44 " " 1,438.30 " " 1,408.02 " " 1,453.44 " " 1,408.02 " " 1,054.20 " 710.52 " 1,438.30 " " 1,408.02 " 999.24 36000105 HC PROCEDURE ROOM COLPOSCOPY 360 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 36000106 HC PROCEDURE ROOM CRYOTHERAP 360 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 36000107 HC PROCEDURE ROOM THORACENTE 360 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 36000112 HC INJCTN OF MJR JNT BURSA BILATL 360 20610 625.00 600.00 600.00 593.75 581.25 600.00 581.25 435.19 293.31 593.75 581.25 412.50 36000113 HC OR ROOM C 181-195 MINUTES 360 " 7,181.00 " " 6,893.76 " " 6,893.76 " " 6,821.95 " " 6,678.33 " " 6,893.76 " " 6,678.33 " " 5,000.13 " " 3,370.04 " " 6,821.95 " " 6,678.33 " " 4,739.46 " 36000114 HC OR ROOM D 226-240 MINUTES 360 " 11,287.00 " " 10,835.52 " " 10,835.52 " " 10,722.65 " " 10,496.91 " " 10,835.52 " " 10,496.91 " " 7,859.14 " " 5,296.99 " " 10,722.65 " " 10,496.91 " " 7,449.42 " 36000115 HC OR ROOM D 256-270 MINUTES 360 " 12,625.00 " " 12,120.00 " " 12,120.00 " " 11,993.75 " " 11,741.25 " " 12,120.00 " " 11,741.25 " " 8,790.79 " " 5,924.91 " " 11,993.75 " " 11,741.25 " " 8,332.50 " 36000116 HC OR ROOM D 271-285 MINUTES 360 " 13,293.00 " " 12,761.28 " " 12,761.28 " " 12,628.35 " " 12,362.49 " " 12,761.28 " " 12,362.49 " " 9,255.92 " " 6,238.40 " " 12,628.35 " " 12,362.49 " " 8,773.38 " 36000117 HC OR ROOM D 301-315 MINUTES 360 " 14,629.00 " " 14,043.84 " " 14,043.84 " " 13,897.55 " " 13,604.97 " " 14,043.84 " " 13,604.97 " " 10,186.17 " " 6,865.39 " " 13,897.55 " " 13,604.97 " " 9,655.14 " 36000118 HC OR ROOM D 316-330 MINUTES 360 " 15,295.00 " " 14,683.20 " " 14,683.20 " " 14,530.25 " " 14,224.35 " " 14,683.20 " " 14,224.35 " " 10,649.91 " " 7,177.94 " " 14,530.25 " " 14,224.35 " " 10,094.70 " 36000119 HC OR ROOM A 121-135 MINUTES 360 " 3,738.00 " " 3,588.48 " " 3,588.48 " " 3,551.10 " " 3,476.34 " " 3,588.48 " " 3,476.34 " " 2,602.77 " " 1,754.24 " " 3,551.10 " " 3,476.34 " " 2,467.08 " 36000120 HC OR ROOM A 136-150 MINUTES 360 " 3,922.00 " " 3,765.12 " " 3,765.12 " " 3,725.90 " " 3,647.46 " " 3,765.12 " " 3,647.46 " " 2,730.89 " " 1,840.59 " " 3,725.90 " " 3,647.46 " " 2,588.52 " 36000121 HC OR ROOM A 151-165 MINUTES 360 " 4,108.00 " " 3,943.68 " " 3,943.68 " " 3,902.60 " " 3,820.44 " " 3,943.68 " " 3,820.44 " " 2,860.40 " " 1,927.88 " " 3,902.60 " " 3,820.44 " " 2,711.28 " 36000122 HC OR ROOM A 166-180 MINUTES 360 " 4,295.00 " " 4,123.20 " " 4,123.20 " " 4,080.25 " " 3,994.35 " " 4,123.20 " " 3,994.35 " " 2,990.61 " " 2,015.64 " " 4,080.25 " " 3,994.35 " " 2,834.70 " 36000123 HC OR ROOM A 181-195 MINUTES 360 " 4,308.00 " " 4,135.68 " " 4,135.68 " " 4,092.60 " " 4,006.44 " " 4,135.68 " " 4,006.44 " " 2,999.66 " " 2,021.74 " " 4,092.60 " " 4,006.44 " " 2,843.28 " 36000124 HC OR ROOM A 196-210 MINUTES 360 " 4,666.00 " " 4,479.36 " " 4,479.36 " " 4,432.70 " " 4,339.38 " " 4,479.36 " " 4,339.38 " " 3,248.94 " " 2,189.75 " " 4,432.70 " " 4,339.38 " " 3,079.56 " 37000001 HC ANESTHESIA BLOCK 370 439.00 421.44 421.44 417.05 408.27 421.44 408.27 305.68 206.02 417.05 408.27 289.74 37000013 HC ANETH EQUIP/SUP 121-150 M 370 " 1,297.00 " " 1,245.12 " " 1,245.12 " " 1,232.15 " " 1,206.21 " " 1,245.12 " " 1,206.21 " 903.10 608.68 " 1,232.15 " " 1,206.21 " 856.02 37000014 HC ANETH EQUIP/SUP 151-180 M 370 " 1,427.00 " " 1,369.92 " " 1,369.92 " " 1,355.65 " " 1,327.11 " " 1,369.92 " " 1,327.11 " 993.62 669.69 " 1,355.65 " " 1,327.11 " 941.82 37000015 HC ANETH EQUIP/SUP 181-210 M 370 " 1,558.00 " " 1,495.68 " " 1,495.68 " " 1,480.10 " " 1,448.94 " " 1,495.68 " " 1,448.94 " " 1,084.84 " 731.17 " 1,480.10 " " 1,448.94 " " 1,028.28 " 37000016 HC ANETH EQUIP/SUPP 1-30 MIN 370 645.00 619.20 619.20 612.75 599.85 619.20 599.85 449.11 302.70 612.75 599.85 425.70 37000017 HC ANETH EQUIP/SUPP 31-60 MI 370 863.00 828.48 828.48 819.85 802.59 828.48 802.59 600.91 405.01 819.85 802.59 569.58 37000018 HC ANETH EQUIP/SUPP 61-90 MI 370 " 1,037.00 " 995.52 995.52 985.15 964.41 995.52 964.41 722.06 486.66 985.15 964.41 684.42 37000019 HC ANETH EQUIP/SUPP 91-120 M 370 " 1,167.00 " " 1,120.32 " " 1,120.32 " " 1,108.65 " " 1,085.31 " " 1,120.32 " " 1,085.31 " 812.58 547.67 " 1,108.65 " " 1,085.31 " 770.22 37000027 HC NITROUS OXIDE 370 26.00 24.96 24.96 24.70 24.18 24.96 24.18 18.10 12.20 24.70 24.18 17.16 37000028 HC ANESTH EQUIP/SUP 211-240 370 " 1,687.00 " " 1,619.52 " " 1,619.52 " " 1,602.65 " " 1,568.91 " " 1,619.52 " " 1,568.91 " " 1,174.66 " 791.71 " 1,602.65 " " 1,568.91 " " 1,113.42 " 37000029 HC ANESTH EQUIP/SUP 241-270 370 " 1,818.00 " " 1,745.28 " " 1,745.28 " " 1,727.10 " " 1,690.74 " " 1,745.28 " " 1,690.74 " " 1,265.87 " 853.19 " 1,727.10 " " 1,690.74 " " 1,199.88 " 37000030 HC ANESTH EQUIP/SUP 271-300 370 " 1,949.00 " " 1,871.04 " " 1,871.04 " " 1,851.55 " " 1,812.57 " " 1,871.04 " " 1,812.57 " " 1,357.09 " 914.67 " 1,851.55 " " 1,812.57 " " 1,286.34 " 37000031 HC ANESTH EQUIP/SUP 301-330 370 " 2,079.00 " " 1,995.84 " " 1,995.84 " " 1,975.05 " " 1,933.47 " " 1,995.84 " " 1,933.47 " " 1,447.61 " 975.67 " 1,975.05 " " 1,933.47 " " 1,372.14 " 37000032 HC ANESTH EQUIP/SUP 331-360 370 " 2,210.00 " " 2,121.60 " " 2,121.60 " " 2,099.50 " " 2,055.30 " " 2,121.60 " " 2,055.30 " " 1,538.82 " " 1,037.15 " " 2,099.50 " " 2,055.30 " " 1,458.60 " 37100001 HC MODERATE SEDATION 371 224.00 215.04 215.04 212.80 208.32 215.04 208.32 155.97 105.12 212.80 208.32 147.84 37100002 HC MOD SEDATION INITIAL 15 MIN 371 99152 256.00 245.76 245.76 243.20 238.08 245.76 238.08 178.25 120.14 243.20 238.08 168.96 37100003 HC MOD SEDATION ADDT'L 15 MIN EA 371 99153 214.00 205.44 205.44 203.30 199.02 205.44 199.02 149.01 100.43 203.30 199.02 141.24 39000004 HC ANTIGEN TYPING ARC 390 86902 79.00 75.84 75.84 75.05 73.47 75.84 73.47 55.01 37.07 75.05 73.47 52.14 39000008 HC RED CELLS LR 390 P9016 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 39000011 HC PLASMA FRESH FROZEN 390 P9017 244.00 234.24 234.24 231.80 226.92 234.24 226.92 169.90 114.51 231.80 226.92 161.04 39000027 HC PLT APHERESIS LR IRR 390 P9037 " 1,504.00 " " 1,443.84 " " 1,443.84 " " 1,428.80 " " 1,398.72 " " 1,443.84 " " 1,398.72 " " 1,047.24 " 705.83 " 1,428.80 " " 1,398.72 " 992.64 39000030 HC RED CELLS LR IRRADIATED 390 P9040 644.00 618.24 618.24 611.80 598.92 618.24 598.92 448.42 302.23 611.80 598.92 425.04 39000044 "HC ABO, DONOR" 390 86900 61.00 58.56 58.56 57.95 56.73 58.56 56.73 42.47 28.63 57.95 56.73 40.26 39000050 HC AUTOLOGOUS BLOOD PROC FEE 390 594.00 570.24 570.24 564.30 552.42 570.24 552.42 413.60 278.76 564.30 552.42 392.04 39000051 "HC RD BL CELLS, LR PROC." 390 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 39000052 HC CMV ANTIBODY SCREEN 390 72.00 69.12 69.12 68.40 66.96 69.12 66.96 50.13 33.79 68.40 66.96 47.52 39000053 HC PHERESIS PLATELETS IRRADIATED 390 " 1,510.00 " " 1,449.60 " " 1,449.60 " " 1,434.50 " " 1,404.30 " " 1,449.60 " " 1,404.30 " " 1,051.41 " 708.64 " 1,434.50 " " 1,404.30 " 996.60 39000054 HC CRYOPRECIPITATE AHF 390 113.00 108.48 108.48 107.35 105.09 108.48 105.09 78.68 53.03 107.35 105.09 74.58 39000055 HC DIRECT DON BLD PRO FE LR 390 760.00 729.60 729.60 722.00 706.80 729.60 706.80 529.19 356.67 722.00 706.80 501.60 39000056 HC IRRADIATION FEE-ARC 390 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 39000057 HC FRESH FROZEN PLAS PRO FEE 390 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 39000058 HC PACKED CELLS IRRADIATED 390 644.00 618.24 618.24 611.80 598.92 618.24 598.92 448.42 302.23 611.80 598.92 425.04 39000059 HC PLAT PHER LR PROC FEE 390 " 1,399.00 " " 1,343.04 " " 1,343.04 " " 1,329.05 " " 1,301.07 " " 1,343.04 " " 1,301.07 " 974.12 656.55 " 1,329.05 " " 1,301.07 " 923.34 39000060 HC IRRADIATION FEE-CBB 390 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 39000061 HC MISC RED CROSS FEE 390 259.00 248.64 248.64 246.05 240.87 248.64 240.87 180.34 121.55 246.05 240.87 170.94 39000066 HC PLT APHERESIS LR IRR VOL RED 390 P9037 " 1,504.00 " " 1,443.84 " " 1,443.84 " " 1,428.80 " " 1,398.72 " " 1,443.84 " " 1,398.72 " " 1,047.24 " 705.83 " 1,428.80 " " 1,398.72 " 992.64 39100001 HC BLOOD PRODUCT ADMIN 391 36430 834.00 800.64 800.64 792.30 775.62 800.64 775.62 580.71 391.40 792.30 775.62 550.44 40100002 HC MAMMO DIAGNOSTIC UNI 3D 401 77061 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 40100003 HC MAMMO DIAGNOSTIC BIL 3D 401 77062 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 40100004 HC MAMMO DIAGNOSTIC BIL 3D 401 77066 418.00 401.28 401.28 397.10 388.74 401.28 388.74 291.05 196.17 397.10 388.74 275.88 40100005 HC MAMMO DIAGNOSTIC UNI 3D 401 77061 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 40100007 HC MAMMOGRAPHY BIL DIAG 401 77066 418.00 401.28 401.28 397.10 388.74 401.28 388.74 291.05 196.17 397.10 388.74 275.88 40100008 HC MAMMOGRAPHY UNI DIAG 401 77065 340.00 326.40 326.40 323.00 316.20 326.40 316.20 236.74 159.56 323.00 316.20 224.40 40200002 HC BX BREAST US ADDTL 402 19084 " 2,912.00 " " 2,795.52 " " 2,795.52 " " 2,766.40 " " 2,708.16 " " 2,795.52 " " 2,708.16 " " 2,027.63 " " 1,366.60 " " 2,766.40 " " 2,708.16 " " 1,921.92 " 40200003 HC BREAST NDL LOC US GUIDE 402 19285 " 2,050.00 " " 1,968.00 " " 1,968.00 " " 1,947.50 " " 1,906.50 " " 1,968.00 " " 1,906.50 " " 1,427.42 " 962.07 " 1,947.50 " " 1,906.50 " " 1,353.00 " 40200004 HC BREAST NDL LOC US ADDTL 402 19286 " 2,050.00 " " 1,968.00 " " 1,968.00 " " 1,947.50 " " 1,906.50 " " 1,968.00 " " 1,906.50 " " 1,427.42 " 962.07 " 1,947.50 " " 1,906.50 " " 1,353.00 " 40200007 HC US HEAD 402 76506 548.00 526.08 526.08 520.60 509.64 526.08 509.64 381.57 257.18 520.60 509.64 361.68 40200008 HC US THYROID/NECK 402 76536 582.00 558.72 558.72 552.90 541.26 558.72 541.26 405.25 273.13 552.90 541.26 384.12 40200009 HC US CHEST 402 76604 586.00 562.56 562.56 556.70 544.98 562.56 544.98 408.03 275.01 556.70 544.98 386.76 40200010 HC US BREAST UNI COMPLETE 402 76641 509.00 488.64 488.64 483.55 473.37 488.64 473.37 354.42 238.87 483.55 473.37 335.94 40200011 HC US BREAST LTD 402 76642 434.00 416.64 416.64 412.30 403.62 416.64 403.62 302.19 203.68 412.30 403.62 286.44 40200012 HC US ABDOMEN 402 76700 867.00 832.32 832.32 823.65 806.31 832.32 806.31 603.69 406.88 823.65 806.31 572.22 40200013 HC US ABDOMEN LTD 402 76705 674.00 647.04 647.04 640.30 626.82 647.04 626.82 469.31 316.31 640.30 626.82 444.84 40200014 HC US-ABD AORTA RENAL 402 76770 793.00 761.28 761.28 753.35 737.49 761.28 737.49 552.17 372.15 753.35 737.49 523.38 40200015 HC US RETROPERITONEAL LTD 402 76775 627.00 601.92 601.92 595.65 583.11 601.92 583.11 436.58 294.25 595.65 583.11 413.82 40200017 HC US SPINAL CANAL AND CONTENTS 402 76800 519.00 498.24 498.24 493.05 482.67 498.24 482.67 361.38 243.57 493.05 482.67 342.54 40200018 HC US OB < 14 WKS 0 DAYS 402 76801 584.00 560.64 560.64 554.80 543.12 560.64 543.12 406.64 274.07 554.80 543.12 385.44 40200019 HC EACH ADDTL GESTATION < 14 WKS 402 76802 278.00 266.88 266.88 264.10 258.54 266.88 258.54 193.57 130.47 264.10 258.54 183.48 40200024 HC US OB >= 14 WK SGL OR 1ST GEST 402 76805 829.00 795.84 795.84 787.55 770.97 795.84 770.97 577.23 389.05 787.55 770.97 547.14 40200025 HC EACH ADDTL GESTATION > 14 WKS 402 76810 606.00 581.76 581.76 575.70 563.58 581.76 563.58 421.96 284.40 575.70 563.58 399.96 40200028 HC US OB LTD 402 76815 477.00 457.92 457.92 453.15 443.61 457.92 443.61 332.14 223.86 453.15 443.61 314.82 40200029 HC US OB FOLLOW-UP 402 76816 400.00 384.00 384.00 380.00 372.00 384.00 372.00 278.52 187.72 380.00 372.00 264.00 40200030 HC US TRANSVAGINAL OBSTETRICAL 402 76817 540.00 518.40 518.40 513.00 502.20 518.40 502.20 376.00 253.42 513.00 502.20 356.40 40200031 HC US FETAL BIOPHYS W/O STRESS 402 76819 475.00 456.00 456.00 451.25 441.75 456.00 441.75 330.74 222.92 451.25 441.75 313.50 40200032 HC US TRNSVG NON OB LTD 402 76830 612.00 587.52 587.52 581.40 569.16 587.52 569.16 426.14 287.21 581.40 569.16 403.92 40200034 HC US PELVIC COMPLETE 402 76856 796.00 764.16 764.16 756.20 740.28 764.16 740.28 554.25 373.56 756.20 740.28 525.36 40200035 HC PELVIS LIMITED 402 76857 279.00 267.84 267.84 265.05 259.47 267.84 259.47 194.27 130.93 265.05 259.47 184.14 40200036 HC US SCROTUM 402 76870 640.00 614.40 614.40 608.00 595.20 614.40 595.20 445.63 300.35 608.00 595.20 422.40 40200039 HC US EXTREMITY NONVASC COMPLETE 402 76881 793.00 761.28 761.28 753.35 737.49 761.28 737.49 552.17 372.15 753.35 737.49 523.38 40200040 HC US EXTREMITY NONVASC LTD 402 76882 555.00 532.80 532.80 527.25 516.15 532.80 516.15 386.45 260.46 527.25 516.15 366.30 40200041 HC US INFANT HIPS W/MANIP 402 76885 555.00 532.80 532.80 527.25 516.15 532.80 516.15 386.45 260.46 527.25 516.15 366.30 40200047 HC US GUIDE NEEDLE PLACEMENT 402 76942 820.00 787.20 787.20 779.00 762.60 787.20 762.60 570.97 384.83 779.00 762.60 541.20 40200050 HC INTRA OPERATIVE US 402 76998 820.00 787.20 787.20 779.00 762.60 787.20 762.60 570.97 384.83 779.00 762.60 541.20 40200054 HC US AAA SCREENING CMS 402 76706 627.00 601.92 601.92 595.65 583.11 601.92 583.11 436.58 294.25 595.65 583.11 413.82 40200055 HC BX BREAST US GUIDE 402 19083 " 2,215.00 " " 2,126.40 " " 2,126.40 " " 2,104.25 " " 2,059.95 " " 2,126.40 " " 2,059.95 " " 1,542.30 " " 1,039.50 " " 2,104.25 " " 2,059.95 " " 1,461.90 " 40200057 HC US THYROID / NECK LTD 402 76536 582.00 558.72 558.72 552.90 541.26 558.72 541.26 405.25 273.13 552.90 541.26 384.12 40200058 HC ABDOMINAL AORTA SCAN - LTD 402 76775 " 1,057.00 " " 1,014.72 " " 1,014.72 " " 1,004.15 " 983.01 " 1,014.72 " 983.01 735.99 496.05 " 1,004.15 " 983.01 697.62 40200059 HC US ABDOMINAL AORTA LTD 402 76775 " 1,057.00 " " 1,014.72 " " 1,014.72 " " 1,004.15 " 983.01 " 1,014.72 " 983.01 735.99 496.05 " 1,004.15 " 983.01 697.62 40200060 HC US KIDNEY TRANSPLANT LTD 402 76775 788.00 756.48 756.48 748.60 732.84 756.48 732.84 548.68 369.81 748.60 732.84 520.08 40200064 HC US TRANSVAGINAL NONOBSTETRIC 402 76830 612.00 587.52 587.52 581.40 569.16 587.52 569.16 426.14 287.21 581.40 569.16 403.92 40200067 HC US GUIDE VEN ACCESS DEV 402 76937 918.00 881.28 881.28 872.10 853.74 881.28 853.74 639.20 430.82 872.10 853.74 605.88 40200068 HC US GUIDED REGIONAL ANESTHESIA 402 76942 810.00 777.60 777.60 769.50 753.30 777.60 753.30 564.00 380.13 769.50 753.30 534.60 40300002 HC MAMMO SCREENING 3D VIEWS UNI 403 77063 90.00 86.40 86.40 85.50 83.70 86.40 83.70 62.67 42.24 85.50 83.70 59.40 40300003 HC MAMMOGRAPHY SCREENING BIL 2D 403 77067 389.00 225.00 373.44 369.55 361.77 373.44 361.77 270.86 182.56 369.55 361.77 256.74 40300004 HC MAMMO SCREENING BIL W 3D 403 77067 389.00 225.00 373.44 369.55 361.77 373.44 361.77 270.86 182.56 369.55 361.77 256.74 40300005 HC MAMMO SCREENING UNI W 3D 403 77067 343.00 225.00 329.28 325.85 318.99 329.28 318.99 238.83 160.97 325.85 318.99 226.38 40300006 HC MAMMOGRAPHY SCREEN UNI 2D 403 77067 343.00 225.00 329.28 325.85 318.99 329.28 318.99 238.83 160.97 325.85 318.99 226.38 40300007 HC MAMMO SCREENING 3D VIEWS BIL 403 77063 90.00 86.40 86.40 85.50 83.70 86.40 83.70 62.67 42.24 85.50 83.70 59.40 40400005 HC PET SCAN SKULL BASE MID-THIGH 404 78815 " 6,642.00 " " 6,376.32 " " 6,376.32 " " 6,309.90 " " 6,177.06 " " 6,376.32 " " 6,177.06 " " 4,624.82 " " 3,117.09 " " 6,309.90 " " 6,177.06 " " 4,383.72 " 40400006 HC PET SCAN WHOLE BODY 404 78816 " 6,642.00 " " 6,376.32 " " 6,376.32 " " 6,309.90 " " 6,177.06 " " 6,376.32 " " 6,177.06 " " 4,624.82 " " 3,117.09 " " 6,309.90 " " 6,177.06 " " 4,383.72 " 40400008 HC MOPATH PROCEDURE LEVEL 2 404 81401 320.00 307.20 307.20 304.00 297.60 307.20 297.60 222.82 150.18 304.00 297.60 211.20 41000001 HC ENDOTRACHEAL INTUBATION 410 31500 268.00 257.28 257.28 254.60 249.24 257.28 249.24 186.61 125.77 254.60 249.24 176.88 41000002 HC TRACH TUBE CHANGE 410 31502 49.00 47.04 47.04 46.55 45.57 47.04 45.57 34.12 23.00 46.55 45.57 32.34 41000004 HC VENTILATOR INITIAL 410 94002 935.00 897.60 897.60 888.25 869.55 897.60 869.55 651.04 438.80 888.25 869.55 617.10 41000005 HC VENTILATOR SUBSEQUENT 410 94003 470.00 451.20 451.20 446.50 437.10 451.20 437.10 327.26 220.57 446.50 437.10 310.20 41000007 HC AEROSOL THERAPY 410 94640 159.00 152.64 152.64 151.05 147.87 152.64 147.87 110.71 74.62 151.05 147.87 104.94 41000011 HC NON-INVASIVE CPAP INITIAL SIPAP 410 94660 " 1,056.00 " " 1,013.76 " " 1,013.76 " " 1,003.20 " 982.08 " 1,013.76 " 982.08 735.29 495.58 " 1,003.20 " 982.08 696.96 41000013 HC OSCILLATORY PEP ACAPELLA 410 94667 210.00 201.60 201.60 199.50 195.30 201.60 195.30 146.22 98.55 199.50 195.30 138.60 41000016 HC PLETHYSMOGRAPHY FOR LV/AR 410 94726 460.00 441.60 441.60 437.00 427.80 441.60 427.80 320.30 215.88 437.00 427.80 303.60 41000020 HC MANUAL VENTILATION BVM 410 94799 242.00 232.32 232.32 229.90 225.06 232.32 225.06 168.50 113.57 229.90 225.06 159.72 41000027 HC COMPRESSED AIR-SUBSEQUENT 410 94799 427.00 409.92 409.92 405.65 397.11 409.92 397.11 297.32 200.39 405.65 397.11 281.82 41000033 HC INFANT AIRWAY MANAGEMENT 410 94002 935.00 897.60 897.60 888.25 869.55 897.60 869.55 651.04 438.80 888.25 869.55 617.10 41000037 HC PEAK FLOW PRE & POST TREATMENT 410 94010 141.00 135.36 135.36 133.95 131.13 135.36 131.13 98.18 66.17 133.95 131.13 93.06 41000038 HC AEROSOL TREATMENT 410 94640 159.00 152.64 152.64 151.05 147.87 152.64 147.87 110.71 74.62 151.05 147.87 104.94 41000039 HC AEROSOL THERAPY CONTINUOUS 410 94640 614.00 589.44 589.44 583.30 571.02 589.44 571.02 427.53 288.15 583.30 571.02 405.24 41000040 HC INCENTIVE BREATHING 410 94640 159.00 152.64 152.64 151.05 147.87 152.64 147.87 110.71 74.62 151.05 147.87 104.94 41000041 HC IPPB THERAPY 410 94640 192.00 184.32 184.32 182.40 178.56 184.32 178.56 133.69 90.11 182.40 178.56 126.72 41000042 HC MDI 410 94640 40.00 38.40 38.40 38.00 37.20 38.40 37.20 27.85 18.77 38.00 37.20 26.40 41000043 HC NON-INVASIVE CPAP SUBSEQUENT SIPAP 410 94660 604.00 579.84 579.84 573.80 561.72 579.84 561.72 420.57 283.46 573.80 561.72 398.64 41000044 HC NONINV BILEVEL VENT INITIAL 410 94660 " 2,268.00 " " 2,177.28 " " 2,177.28 " " 2,154.60 " " 2,109.24 " " 2,177.28 " " 2,109.24 " " 1,579.21 " " 1,064.37 " " 2,154.60 " " 2,109.24 " " 1,496.88 " 41000045 HC NONINV BILEVEL VENT SUBS 410 94660 " 1,737.00 " " 1,667.52 " " 1,667.52 " " 1,650.15 " " 1,615.41 " " 1,667.52 " " 1,615.41 " " 1,209.47 " 815.17 " 1,650.15 " " 1,615.41 " " 1,146.42 " 41000046 HC NONINV BILEVEL VENT LIMITED 410 94660 733.00 703.68 703.68 696.35 681.69 703.68 681.69 510.39 344.00 696.35 681.69 483.78 41000051 HC OSCILLATORY PEP MIE 410 94667 265.00 254.40 254.40 251.75 246.45 254.40 246.45 184.52 124.36 251.75 246.45 174.90 41000052 HC EZ-PAP 410 94667 126.00 120.96 120.96 119.70 117.18 120.96 117.18 87.73 59.13 119.70 117.18 83.16 41000053 HC IPV 410 94667 219.00 210.24 210.24 208.05 203.67 210.24 203.67 152.49 102.78 208.05 203.67 144.54 41000055 HC POSTURAL DRAINAGE 410 94667 278.00 266.88 266.88 264.10 258.54 266.88 258.54 193.57 130.47 264.10 258.54 183.48 41000065 HC NT SUCTIONING 410 31720 72.00 69.12 69.12 68.40 66.96 69.12 66.96 50.13 33.79 68.40 66.96 47.52 41000069 HC EZ-PAP AEROSOL TX-SUBSEQU 410 94640 159.00 152.64 152.64 151.05 147.87 152.64 147.87 110.71 74.62 151.05 147.87 104.94 41000073 HC AEROGEN AEROSOL 410 94640 176.00 168.96 168.96 167.20 163.68 168.96 163.68 122.55 82.60 167.20 163.68 116.16 42000006 HC PT TRACTION MECHANICAL 420 97012 73.00 70.08 70.08 69.35 67.89 70.08 67.89 50.83 34.26 69.35 67.89 48.18 42000007 HC PT ELECTRICAL STIM UNATTENDED 420 G0283 72.00 69.12 69.12 68.40 66.96 69.12 66.96 50.13 33.79 68.40 66.96 47.52 42000008 HC PT VASOPNEUMATIC DEVICE APPL 420 97016 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 42000009 HC PT PARAFFIN BATH 420 97018 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 42000014 HC PT ELEC STIM ATTND EA 15M 420 97032 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 42000015 HC PT IONTOPHORESIS EA 15MIN 420 97033 112.00 107.52 107.52 106.40 104.16 107.52 104.16 77.99 52.56 106.40 104.16 73.92 42000016 HC PT CONTRAST BATH 420 97034 71.00 68.16 68.16 67.45 66.03 68.16 66.03 49.44 33.32 67.45 66.03 46.86 42000017 HC PT ULTRASOUND EA 15 MIN 420 97035 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 42000018 HC PT THERAPEUTIC EX EA 15M 420 97110 92.00 68.00 88.32 87.40 85.56 88.32 85.56 64.06 43.18 87.40 85.56 60.72 42000019 HC PT NEUROMUSC RE-ED EA 15M 420 97112 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 42000020 HC PT AQUA THER EXER EA 15M 420 97113 122.00 117.12 117.12 115.90 113.46 117.12 113.46 84.95 57.25 115.90 113.46 80.52 42000021 HC PT GAIT TRAINING EA 15 MIN 420 97116 87.00 83.52 83.52 82.65 80.91 83.52 80.91 60.58 40.83 82.65 80.91 57.42 42000023 HC PT MANUAL THERAPY EA 15M 420 97140 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 42000026 HC PT THER FUNCT ACT EA 15M 420 97530 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 42000027 HC PT COGNITIVE SKILLS 420 97127 92.00 88.32 88.32 87.40 85.56 88.32 85.56 64.06 43.18 87.40 85.56 60.72 42000028 HC PT SENSORY INTEGRATION 420 97533 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 42000029 HC PT SELF CARE MANAGEMENT EA 15M 420 97535 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 42000030 HC PT COMM WRK REINTEG-15M 420 97537 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 42000031 HC PT WHEELCHAIR MGMT TRN 15M 420 97542 90.00 86.40 86.40 85.50 83.70 86.40 83.70 62.67 42.24 85.50 83.70 59.40 42000034 HC PT WOUND DEBRID < OR 1ST 20CM 420 97597 207.00 198.72 198.72 196.65 192.51 198.72 192.51 144.13 97.15 196.65 192.51 136.62 42000035 HC PT WOUND DEBR EA ADD 20CM OR < 420 97598 316.00 303.36 303.36 300.20 293.88 303.36 293.88 220.03 148.30 300.20 293.88 208.56 42000040 HC PT PHYSICAL PERFORMANCE TEST 420 97750 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 42000041 HC PT ORTHO FIT TX INITL EA 15MN 420 97760 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 42000042 HC PT PROSTH TX INITIAL EA 15MIN 420 97761 92.00 88.32 88.32 87.40 85.56 88.32 85.56 64.06 43.18 87.40 85.56 60.72 42000044 HC PT ORTH PROTH TX SUBSEQ E 15MN 420 97763 85.00 81.60 81.60 80.75 79.05 81.60 79.05 59.19 39.89 80.75 79.05 56.10 42000064 HC PT VASOPNEUMATIC INITIAL 420 97016 274.00 263.04 263.04 260.30 254.82 263.04 254.82 190.79 128.59 260.30 254.82 180.84 42000078 HC PT PHYS CAP PROF 420 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 42000079 HC PT BACK ASSES 420 132.00 126.72 126.72 125.40 122.76 126.72 122.76 91.91 61.95 125.40 122.76 87.12 42400010 HC PT EVAL LOW COMPLEXITY 424 97161 155.00 148.80 148.80 147.25 144.15 148.80 144.15 107.93 72.74 147.25 144.15 102.30 42400011 HC PT EVAL MODERATE COMPLEXITY 424 97162 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 42400012 HC PT EVAL HIGH COMPLEXITY 424 97163 268.00 257.28 257.28 254.60 249.24 257.28 249.24 186.61 125.77 254.60 249.24 176.88 42400013 HC PT RE-EVAL 424 97164 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 43000002 HC OT ELECTRICAL STIM UNATTENDED 430 G0283 72.00 69.12 69.12 68.40 66.96 69.12 66.96 50.13 33.79 68.40 66.96 47.52 43000003 HC OT PARAFFIN BATH 430 97018 63.00 60.48 60.48 59.85 58.59 60.48 58.59 43.87 29.57 59.85 58.59 41.58 43000005 HC OT ELEC STIM ATTND EA 15M 430 97032 69.00 66.24 66.24 65.55 64.17 66.24 64.17 48.04 32.38 65.55 64.17 45.54 43000006 HC OT IONTOPHORESIS EA 15MIN 430 97033 111.00 106.56 106.56 105.45 103.23 106.56 103.23 77.29 52.09 105.45 103.23 73.26 43000007 HC OT CONTRAST BATH EA 15M 430 97034 71.00 68.16 68.16 67.45 66.03 68.16 66.03 49.44 33.32 67.45 66.03 46.86 43000008 HC OT ULTRASOUND EA 15 MIN 430 97035 74.00 71.04 71.04 70.30 68.82 71.04 68.82 51.53 34.73 70.30 68.82 48.84 43000009 HC OT THERAPEUTIC EX EA 15M 430 97110 92.00 68.00 88.32 87.40 85.56 88.32 85.56 64.06 43.18 87.40 85.56 60.72 43000010 HC OT NEUROMUSC RE-ED EA 15M 430 97112 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 43000013 HC OT MANUAL THERAPY EA 15M 430 97140 109.00 104.64 104.64 103.55 101.37 104.64 101.37 75.90 51.15 103.55 101.37 71.94 43000014 HC OT THERAPEUTIC PROCEDURE GROUP 430 97150 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 43000015 HC OT THER FUNCT ACT EA 15M 430 97530 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 43000018 HC OT SELF CARE MANAGEMENT EA 15M 430 97535 100.00 96.00 96.00 95.00 93.00 96.00 93.00 69.63 46.93 95.00 93.00 66.00 43000020 HC OT WHELCHAIR MGMT TRN 15M 430 97542 90.00 86.40 86.40 85.50 83.70 86.40 83.70 62.67 42.24 85.50 83.70 59.40 43000021 HC OT WOUND DEBRID < OR 1ST 20CM 430 97597 207.00 198.72 198.72 196.65 192.51 198.72 192.51 144.13 97.15 196.65 192.51 136.62 43000022 HC OT WOUND DEBR EA ADD 20CM OR < 430 97598 316.00 303.36 303.36 300.20 293.88 303.36 293.88 220.03 148.30 300.20 293.88 208.56 43000023 HC OT ORTHO FIT TX INITL EA 15MN 430 97760 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 43000026 HC OT THER IVNTJ 1ST 15 MIN 430 97129 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 43000057 HC OT ORTH PROTH TX SUBSEQ E 15MN 430 97763 85.00 81.60 81.60 80.75 79.05 81.60 79.05 59.19 39.89 80.75 79.05 56.10 43000058 HC OT VASOPHEUMATIC 430 97016 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 43000060 HC OT ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN 430 97755 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 43000062 HC OT COG THER IVNTJ EA ADDL 15 MIN 430 97130 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 43400012 HC OT EVAL LOW COMPLEXITY 434 97165 165.00 158.40 158.40 156.75 153.45 158.40 153.45 114.89 77.43 156.75 153.45 108.90 43400013 HC OT EVAL MODERATE COMPLEXITY 434 97166 196.00 188.16 188.16 186.20 182.28 188.16 182.28 136.47 91.98 186.20 182.28 129.36 43400014 HC OT EVAL HIGH COMPLEXITY 434 97167 237.00 227.52 227.52 225.15 220.41 227.52 220.41 165.02 111.22 225.15 220.41 156.42 43400015 HC OT RE-EVAL 434 97168 104.00 99.84 99.84 98.80 96.72 99.84 96.72 72.42 48.81 98.80 96.72 68.64 44000005 HC EVAL SWALLOW BARIUM 440 92611 492.00 472.32 472.32 467.40 457.56 472.32 457.56 342.58 230.90 467.40 457.56 324.72 44000009 HC ST SENSORY INTERGAT EA 15M 440 97533 97.00 93.12 93.12 92.15 90.21 93.12 90.21 67.54 45.52 92.15 90.21 64.02 44000012 HC ST COG THER IVNTJ EA ADDL 15 MIN 440 97130 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 44000037 HC ST THERAPEUTIC ACTIV PER 15 440 97530 95.00 91.20 91.20 90.25 88.35 91.20 88.35 66.15 44.58 90.25 88.35 62.70 44000038 HC SLP TRMT 440 92507 255.00 244.80 244.80 242.25 237.15 244.80 237.15 177.56 119.67 242.25 237.15 168.30 44000040 HC SLP TRMT 45 440 92507 227.00 217.92 217.92 215.65 211.11 217.92 211.11 158.06 106.53 215.65 211.11 149.82 44000041 HC SLP TRMT 60 440 92507 299.00 287.04 287.04 284.05 278.07 287.04 278.07 208.19 140.32 284.05 278.07 197.34 44000047 HC DYSPHAGIA TRMT 440 92526 290.00 278.40 278.40 275.50 269.70 278.40 269.70 201.93 136.10 275.50 269.70 191.40 44000048 HC DYSPHAGIA TRMT 30 440 92526 288.00 276.48 276.48 273.60 267.84 276.48 267.84 200.53 135.16 273.60 267.84 190.08 44000049 HC DYSPHAGIA TRMT 45 440 92526 388.00 372.48 372.48 368.60 360.84 372.48 360.84 270.16 182.09 368.60 360.84 256.08 44000050 HC DYSPHAGIA TRMT 60 440 92526 515.00 494.40 494.40 489.25 478.95 494.40 478.95 358.59 241.69 489.25 478.95 339.90 44000059 HC ST THER IVNTJ 1ST 15 MIN 440 97129 93.00 89.28 89.28 88.35 86.49 89.28 86.49 64.76 43.64 88.35 86.49 61.38 44000060 HC ST SPEECH THERAPY RE-EVAL 440 S9152 149.00 143.04 143.04 141.55 138.57 143.04 138.57 103.75 69.93 141.55 138.57 98.34 44400015 HC SLP FLUENCY EVAL 60 444 92521 296.00 284.16 284.16 281.20 275.28 284.16 275.28 206.10 138.91 281.20 275.28 195.36 44400019 HC SLP ARTICULATION EVAL 60 444 92522 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 44400023 HC SLP LANGUAGE EVAL 60 444 92523 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 44400025 HC SLP VOICE EVAL 30 444 92524 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 44400029 HC DYSPHAGIA EVAL 30 444 92610 366.00 351.36 351.36 347.70 340.38 351.36 340.38 254.85 171.76 347.70 340.38 241.56 44400035 HC COGN TEST BY HC PROF 444 96125 307.00 294.72 294.72 291.65 285.51 294.72 285.51 213.76 144.08 291.65 285.51 202.62 45000001 HC BLADDER SCAN 450 51798 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 45000003 HC EMERGENCY ROOM I 450 99281 221.00 212.16 212.16 209.95 205.53 212.16 205.53 153.88 103.72 209.95 205.53 145.86 45000004 HC EMERGENCY ROOM II 450 99282 338.00 324.48 324.48 321.10 314.34 324.48 314.34 235.35 158.62 321.10 314.34 223.08 45000005 HC EMERGENCY ROOM III 450 99283 521.00 500.16 500.16 494.95 484.53 500.16 484.53 362.77 244.51 494.95 484.53 343.86 45000006 HC EMERGENCY ROOM IV 450 99284 767.00 736.32 736.32 728.65 713.31 736.32 713.31 534.06 359.95 728.65 713.31 506.22 45000007 HC EMERGENCY ROOM V 450 99285 " 1,155.00 " " 1,108.80 " " 1,108.80 " " 1,097.25 " " 1,074.15 " " 1,108.80 " " 1,074.15 " 804.23 542.04 " 1,097.25 " " 1,074.15 " 762.30 45000008 HC EMERGENCY ROOM VI 450 99291 " 1,691.00 " " 1,623.36 " " 1,623.36 " " 1,606.45 " " 1,572.63 " " 1,623.36 " " 1,572.63 " " 1,177.44 " 793.59 " 1,606.45 " " 1,572.63 " " 1,116.06 " 45000023 HC OCL LONG LEG BONE SPLINT 450 29505 137.00 131.52 131.52 130.15 127.41 131.52 127.41 95.39 64.29 130.15 127.41 90.42 45000028 HC ED MISC PROCEDURE 450 11.00 10.56 10.56 10.45 10.23 10.56 10.23 7.66 5.16 10.45 10.23 7.26 45000029 HC REMOVE FOREIGN BODY SIMPLE 450 10120 602.00 577.92 577.92 571.90 559.86 577.92 559.86 419.17 282.52 571.90 559.86 397.32 45000030 HC REMOVE FOREIGN BODY COMPLIC 450 10121 " 2,612.00 " " 2,507.52 " " 2,507.52 " " 2,481.40 " " 2,429.16 " " 2,507.52 " " 2,429.16 " " 1,818.74 " " 1,225.81 " " 2,481.40 " " 2,429.16 " " 1,723.92 " 45000032 HC REMOVAL OF NAIL PLATE 450 11730 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 45000033 HC REMOVE ADDITIONAL NAIL PLATE 450 11732 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 45000034 HC REMOVAL OF NAIL BED 450 11750 639.00 613.44 613.44 607.05 594.27 613.44 594.27 444.94 299.88 607.05 594.27 421.74 45000035 HC RECONSTRUC OF NAIL BED 450 11760 922.00 885.12 885.12 875.90 857.46 885.12 857.46 641.99 432.69 875.90 857.46 608.52 45000036 HC EXCISION OF NAIL FOLD TOE 450 11765 685.00 657.60 657.60 650.75 637.05 657.60 637.05 476.97 321.47 650.75 637.05 452.10 45000037 HC RESUPERF WND BODY <2.5CM 450 12001 372.00 357.12 357.12 353.40 345.96 357.12 345.96 259.02 174.58 353.40 345.96 245.52 45000038 HC RESUP NPTERF WND BODY 2.6-7.5CM 450 12002 386.00 370.56 370.56 366.70 358.98 370.56 358.98 268.77 181.15 366.70 358.98 254.76 45000039 HC RESUPERF WND BODY 7.6-12.5CM 450 12004 477.00 457.92 457.92 453.15 443.61 457.92 443.61 332.14 223.86 453.15 443.61 314.82 45000040 HC RESUPERF WND BODY 12.6-20CM 450 12005 492.00 472.32 472.32 467.40 457.56 472.32 457.56 342.58 230.90 467.40 457.56 324.72 45000041 HC RESUPERF WND BODY 20.1-30CM 450 12006 621.00 596.16 596.16 589.95 577.53 596.16 577.53 432.40 291.44 589.95 577.53 409.86 45000043 HC RESUPERF WND FACE <2.5CM 450 12011 376.00 360.96 360.96 357.20 349.68 360.96 349.68 261.81 176.46 357.20 349.68 248.16 45000044 HC RESUPERF WND FACE 2.6-5CM 450 12013 422.00 405.12 405.12 400.90 392.46 405.12 392.46 293.84 198.04 400.90 392.46 278.52 45000045 HC RESUPERF WND FACE 5.1-7.5CM 450 12014 519.00 498.24 498.24 493.05 482.67 498.24 482.67 361.38 243.57 493.05 482.67 342.54 45000046 HC RESUPERF WND FACE 7.6-12.5CM 450 12015 679.00 651.84 651.84 645.05 631.47 651.84 631.47 472.79 318.65 645.05 631.47 448.14 45000050 HC LAYR CLOS WND TRUNK ARM LEG <2.5CM 450 12031 579.00 555.84 555.84 550.05 538.47 555.84 538.47 403.16 271.72 550.05 538.47 382.14 45000051 HC LAYR CLOS WND TRUNK ARM LEG 2.6-7.5CM 450 12032 832.00 798.72 798.72 790.40 773.76 798.72 773.76 579.32 390.46 790.40 773.76 549.12 45000052 HC LAYR CLOS WND TRUNK ARM LEG 7.6-12.5CM 450 12034 615.00 590.40 590.40 584.25 571.95 590.40 571.95 428.22 288.62 584.25 571.95 405.90 45000053 HC LAYR CLOS WND TRUNK ARM LEG 12.6-20CM 450 12035 " 1,100.00 " " 1,056.00 " " 1,056.00 " " 1,045.00 " " 1,023.00 " " 1,056.00 " " 1,023.00 " 765.93 516.23 " 1,045.00 " " 1,023.00 " 726.00 45000056 HC LAYR CLOS WND REST BODY <2.5CM 450 12041 600.00 576.00 576.00 570.00 558.00 576.00 558.00 417.78 281.58 570.00 558.00 396.00 45000057 HC LAYR CLOS WND REST BODY 2.6-7.5CM 450 12042 713.00 684.48 684.48 677.35 663.09 684.48 663.09 496.46 334.61 677.35 663.09 470.58 45000058 HC LAYR CLOS WND REST BODY 7.6-12.5CM 450 12044 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000059 HC LAYR CLOS WND REST BODY 12.6-20CM 450 12045 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000062 HC LAYR CLOS WND FACE FACIAL <2.5CM 450 12051 422.00 405.12 405.12 400.90 392.46 405.12 392.46 293.84 198.04 400.90 392.46 278.52 45000063 HC LAYR CLOS WND FACE FACIAL 2.5-5CM 450 12052 397.00 381.12 381.12 377.15 369.21 381.12 369.21 276.43 186.31 377.15 369.21 262.02 45000064 HC LAYR CLOS WND FACE FACIAL 5.1-7.5CM 450 12053 477.00 457.92 457.92 453.15 443.61 457.92 443.61 332.14 223.86 453.15 443.61 314.82 45000065 HC LAYR CLOS WND FACE FACIAL 7.6-12.5CM 450 12054 590.00 566.40 566.40 560.50 548.70 566.40 548.70 410.82 276.89 560.50 548.70 389.40 45000066 HC LAYR CLOS WND FACE FACIAL 12.6-20CM 450 12055 685.00 657.60 657.60 650.75 637.05 657.60 637.05 476.97 321.47 650.75 637.05 452.10 45000069 HC RECMPL WND TRUNK 1.1-2.5CM 450 13100 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000070 HC RECMPL WND TRUNK 2.6-7.5CM 450 13101 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000071 HC REP SKIN TRUNKCMPLX +5CM/< 450 13102 965.00 926.40 926.40 916.75 897.45 926.40 897.45 671.93 452.87 916.75 897.45 636.90 45000072 HC RECMPL WND SCALP EXTR 1.1-2.5CM 450 13120 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000073 HC RECMPL WND SCALP EXTR 2.6-7.5CM 450 13121 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000074 HC REP SKIN SCALP/EXTREM+5CM/< 450 13122 " 1,589.00 " " 1,525.44 " " 1,525.44 " " 1,509.55 " " 1,477.77 " " 1,525.44 " " 1,477.77 " " 1,106.42 " 745.72 " 1,509.55 " " 1,477.77 " " 1,048.74 " 45000075 HC RECMPL WND HEAD FAC HAND 1.1-2.5CM 450 13131 685.00 657.60 657.60 650.75 637.05 657.60 637.05 476.97 321.47 650.75 637.05 452.10 45000076 HC RECMPL WND HEAD FAC HAND 2.6-7.5CM 450 13132 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000077 HC REPR FACE GENITAL HAND FT+5CM/< 450 13133 " 1,249.00 " " 1,199.04 " " 1,199.04 " " 1,186.55 " " 1,161.57 " " 1,199.04 " " 1,161.57 " 869.68 586.16 " 1,186.55 " " 1,161.57 " 824.34 45000078 HC RECMPL WND LID NOS EAR 1.1-2.5CM 450 13151 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000079 HC RECMPL WND LID NOS EAR 2.5-7.5CM 450 13152 " 1,076.00 " " 1,032.96 " " 1,032.96 " " 1,022.20 " " 1,000.68 " " 1,032.96 " " 1,000.68 " 749.22 504.97 " 1,022.20 " " 1,000.68 " 710.16 45000080 HC REPR EYELID NOSE EAR LIP+5CM 450 13153 " 1,363.00 " " 1,308.48 " " 1,308.48 " " 1,294.85 " " 1,267.59 " " 1,308.48 " " 1,267.59 " 949.06 639.66 " 1,294.85 " " 1,267.59 " 899.58 45000081 HC INITIAL RX BURN(S) 1ST DEGREE 450 16000 372.00 357.12 357.12 353.40 345.96 357.12 345.96 259.02 174.58 353.40 345.96 245.52 45000082 HC DRESS/DEBRID SMALL BURN NO ANES 450 16020 372.00 357.12 357.12 353.40 345.96 357.12 345.96 259.02 174.58 353.40 345.96 245.52 45000091 HC CLOSED RX NOSE FRACTURE W/O MANIPULATION 450 21310 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000092 HC CLOSED RX NOSE FRACTURE W/O STABILIZATION 450 21315 " 2,509.00 " " 2,408.64 " " 2,408.64 " " 2,383.55 " " 2,333.37 " " 2,408.64 " " 2,333.37 " " 1,747.02 " " 1,177.47 " " 2,383.55 " " 2,333.37 " " 1,655.94 " 45000103 HC REDUCE TEMPOROMANDIBL DISLOC 450 21480 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000111 HC CLOSED RX CLAVICLE FRACTURE 450 23500 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000116 HC CLOSED RX A-C JT DISLOC MANIPULATN 450 23545 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000119 HC CLOSED RX PROX HUMERUS FRACTURE 450 23600 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000121 HC CLOSED RX GR TUBEROSITY HUM FX 450 23620 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000123 HC CLOSED RX SHLDR DISLOCATION 450 23650 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000124 HC CLOSED RX SHLDR DISLOC ANESTHESIA 450 23655 " 1,736.00 " " 1,666.56 " " 1,666.56 " " 1,649.20 " " 1,614.48 " " 1,666.56 " " 1,614.48 " " 1,208.78 " 814.70 " 1,649.20 " " 1,614.48 " " 1,145.76 " 45000129 HC CLOSED RX MID HUMERUS FRACTURE 450 24500 410.00 393.60 393.60 389.50 381.30 393.60 381.30 285.48 192.41 389.50 381.30 270.60 45000130 HC CLOSED RX MID HUMERUS FX MANIPULATN 450 24505 560.00 537.60 537.60 532.00 520.80 537.60 520.80 389.93 262.81 532.00 520.80 369.60 45000137 HC CLOSED RX ELBOW DISLOCATION 450 24600 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000138 HC CLOSED RX ELBOW DISLOCATN ANESTHESIA 450 24605 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000140 HC CLOSED RX RADIAL HEAD DISLOC CHILD 450 24640 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000141 HC CLOSED RX RADIAL HEAD/NECK FX 450 24650 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000143 HC CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE 450 24670 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000144 HC CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION 450 24675 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000148 HC CLOSED RX RADIAL SHAFT FX 450 25500 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000149 HC CLOSED RX RADIAL SHAFT FX MANIPULATN 450 25505 " 3,092.00 " " 2,968.32 " " 2,968.32 " " 2,937.40 " " 2,875.56 " " 2,968.32 " " 2,875.56 " " 2,152.96 " " 1,451.08 " " 2,937.40 " " 2,875.56 " " 2,040.72 " 45000151 HC CLOSED RX ULNA SHAFT FX 450 25530 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000152 HC CLOSED RX ULNA SHAFT FX MANIPULATN 450 25535 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000153 HC CLOSED RX RAD/ULNA SHAFT FX 450 25560 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000154 HC CLOSED RX RAD/ULNA SHAFT FX MANIP 450 25565 " 1,368.00 " " 1,313.28 " " 1,313.28 " " 1,299.60 " " 1,272.24 " " 1,313.28 " " 1,272.24 " 952.54 642.00 " 1,299.60 " " 1,272.24 " 902.88 45000155 HC CLOSED RX DIST RAD/ULNA FX 450 25600 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000156 HC CLOSED RX DIST RAD/ULNA FX MANIPUL 450 25605 " 1,875.00 " " 1,800.00 " " 1,800.00 " " 1,781.25 " " 1,743.75 " " 1,800.00 " " 1,743.75 " " 1,305.56 " 879.94 " 1,781.25 " " 1,743.75 " " 1,237.50 " 45000157 HC CLOSED RX NAVICULAR FX 450 25622 412.00 395.52 395.52 391.40 383.16 395.52 383.16 286.88 193.35 391.40 383.16 271.92 45000161 HC CLOSED RX ULNA STYLOID FX 450 25650 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000163 HC CLOSED RX RADIO-ULNA DISLOCATION 450 25675 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000167 HC CLOSED RX METACARPAL FX 450 26600 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000168 HC CLOSED RX METACARPAL FX MANIP 450 26605 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000169 HC TREAT THUMB DISLOC MANIPULATN 450 26641 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000170 HC TREAT THUMB FX/DISLOC MANIP 450 26645 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000171 HC CLOSED RX CARPOMETACAR DISLOC NON-THUMB 450 26670 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000173 HC CLOSED RX MC-P DISLOC 450 26700 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000175 HC CLOSE RX PROX/MID FING SHFT FX 450 26720 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000176 HC CLOSE RX PROX/MID FING SHFT FX MANIP 450 26725 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000177 HC CLOSE RX FINGR ARTICULAR FX 450 26740 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000178 HC CLOSE RX FINGR ARTICULAR FX MANIP 450 26742 " 2,839.00 " " 2,725.44 " " 2,725.44 " " 2,697.05 " " 2,640.27 " " 2,725.44 " " 2,640.27 " " 1,976.80 " " 1,332.34 " " 2,697.05 " " 2,640.27 " " 1,873.74 " 45000179 HC CLOSE RX DIST FINGR FX 450 26750 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000180 HC CLOSE RX DIST FINGR FX MANIPULATN 450 26755 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000181 HC CLOSED RX IP JT DISLOCATION 450 26770 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000182 HC CLOSED RX IP JT DISLOCATION ANESTH 450 26775 523.00 502.08 502.08 496.85 486.39 502.08 486.39 364.16 245.44 496.85 486.39 345.18 45000195 HC CLOSED RX TRAUMATIC HIP DISLOCATN 450 27250 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000196 HC CLOSED RX TRAUMA HIP DISLOC ANESTH 450 27252 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000197 HC CLOSED RX SPONTANEOUS HIP DISLOC 450 27256 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000198 HC CLOSED RX SPONT HIP DISLOC ANESTH 450 27257 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000199 HC CLOSED RX POST HIP ARTHRPLAS DISLOC 450 27265 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000200 HC CLOSED RX POST HIP FIX DISLOC ANESTH 450 27266 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000213 HC CLOSED RX KNEE DISLOCATN 450 27550 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000214 HC CLOSED RX KNEE DISLOC+ANESTH 450 27552 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000215 HC CLOSED RX KNEECAP DISLOCATN 450 27560 402.00 385.92 385.92 381.90 373.86 385.92 373.86 279.91 188.66 381.90 373.86 265.32 45000217 HC CLOSED RX TIBIA SHAFT FX 450 27750 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000218 "HC CLOSED RX TIBIA SHAFT FX,MANIPULATN" 450 27752 " 2,977.00 " " 2,857.92 " " 2,857.92 " " 2,828.15 " " 2,768.61 " " 2,857.92 " " 2,768.61 " " 2,072.89 " " 1,397.11 " " 2,828.15 " " 2,768.61 " " 1,964.82 " 45000219 HC CLOSED RX MED MALLEOLUS FX 450 27760 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000221 HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP 450 27767 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000223 HC CLOSED RX PROX/SHAFT FIBULA FX 450 27780 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000225 HC CLOSED RX DIST FIBULA FX 450 27786 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000227 HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 450 27808 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000229 HC CLOSED RX TRIMALLEOLAR FX 450 27816 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000230 "HC CLOSED RX TRIMALLEOLAR FX,MANIP" 450 27818 " 2,566.00 " " 2,463.36 " " 2,463.36 " " 2,437.70 " " 2,386.38 " " 2,463.36 " " 2,386.38 " " 1,786.71 " " 1,204.22 " " 2,437.70 " " 2,386.38 " " 1,693.56 " 45000235 HC CLOSED RX ANKLE DISLOCATN 450 27840 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000237 "HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS" 450 28190 " 1,262.00 " " 1,211.52 " " 1,211.52 " " 1,198.90 " " 1,173.66 " " 1,211.52 " " 1,173.66 " 878.73 592.26 " 1,198.90 " " 1,173.66 " 832.92 45000246 HC CLOSED RX METATARSAL FX 450 28470 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000248 HC CLOSED RX BIG TOE FRACTURE 450 28490 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000250 HC CLOSED RX TOE FX 450 28510 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000251 HC CLOSED RX TOE FX MANIPULATN 450 28515 404.00 387.84 387.84 383.80 375.72 387.84 375.72 281.31 189.60 383.80 375.72 266.64 45000256 HC CLOSED RX TALOTARSAL DISLOC ANESTH 450 28575 " 5,831.00 " " 5,597.76 " " 5,597.76 " " 5,539.45 " " 5,422.83 " " 5,597.76 " " 5,422.83 " " 4,060.13 " " 2,736.49 " " 5,539.45 " " 5,422.83 " " 3,848.46 " 45000261 HC CLOSED RX I-P JT TOE DISLOCATION 450 28660 474.00 455.04 455.04 450.30 440.82 455.04 440.82 330.05 222.45 450.30 440.82 312.84 45000262 HC CLOSED RX I-P JT TOE DISLOC ANESTH 450 28665 523.00 502.08 502.08 496.85 486.39 502.08 486.39 364.16 245.44 496.85 486.39 345.18 45000263 HC APPLY LONG ARM CAST 450 29065 522.00 501.12 501.12 495.90 485.46 501.12 485.46 363.47 244.97 495.90 485.46 344.52 45000264 HC APPLY FOREARM CAST 450 29075 302.00 289.92 289.92 286.90 280.86 289.92 280.86 210.28 141.73 286.90 280.86 199.32 45000265 HC APPLY HAND/WRIST CAST 450 29085 302.00 289.92 289.92 286.90 280.86 289.92 280.86 210.28 141.73 286.90 280.86 199.32 45000267 HC APPLY LONG ARM SPLINT 450 29105 299.00 287.04 287.04 284.05 278.07 287.04 278.07 208.19 140.32 284.05 278.07 197.34 45000268 HC APPLY FOREARM SPLINT STATIC 450 29125 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000269 HC APPLY FOREARM SPLINT DYNAMIC 450 29126 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000270 HC APPLY FINGER SPLINT STATIC 450 29130 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 45000271 HC APPLY FINGER SPLINT DYNAMIC 450 29131 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 45000272 HC STRAPPING OF SHOULDER 450 29240 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000273 HC STRAPPING OF ELBOW OR WRIST 450 29260 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 45000274 HC STRAPPING OF HAND OR FINGER 450 29280 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 45000275 HC APPLY LONG LEG CAST 450 29345 432.00 414.72 414.72 410.40 401.76 414.72 401.76 300.80 202.74 410.40 401.76 285.12 45000276 HC APPLY LONG LEG CAST WALKER 450 29355 522.00 501.12 501.12 495.90 485.46 501.12 485.46 363.47 244.97 495.90 485.46 344.52 45000277 HC APPLY SHORT LEG CAST 450 29405 302.00 289.92 289.92 286.90 280.86 289.92 280.86 210.28 141.73 286.90 280.86 199.32 45000278 HC APPLY SHORT LEG CAST WALKER 450 29425 302.00 289.92 289.92 286.90 280.86 289.92 280.86 210.28 141.73 286.90 280.86 199.32 45000279 HC APPLY LOWER LEG SPLINT 450 29515 299.00 287.04 287.04 284.05 278.07 287.04 278.07 208.19 140.32 284.05 278.07 197.34 45000280 HC STRAPPING OF KNEE 450 29530 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000281 HC STRAPPING ANKLE &/OR FOOT 450 29540 299.00 287.04 287.04 284.05 278.07 287.04 278.07 208.19 140.32 284.05 278.07 197.34 45000282 HC STRAPPING OF TOES 450 29550 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 45000283 HC STRAPPING UNNA BOOT 450 29580 299.00 287.04 287.04 284.05 278.07 287.04 278.07 208.19 140.32 284.05 278.07 197.34 45000284 HC REMOVE NASAL FOREIGN BODY 450 30300 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000289 HC REPAIR LIP FULL THICK VERMILION 450 40650 " 1,015.00 " 974.40 974.40 964.25 943.95 974.40 943.95 706.74 476.34 964.25 943.95 669.90 45000290 HC REPAIR LIP <1/2 VERT HEIGHT 450 40652 " 1,015.00 " 974.40 974.40 964.25 943.95 974.40 943.95 706.74 476.34 964.25 943.95 669.90 45000291 HC REPAIR LIP >1/2 VERT HEIGHT 450 40654 " 2,509.00 " " 2,408.64 " " 2,408.64 " " 2,383.55 " " 2,333.37 " " 2,408.64 " " 2,333.37 " " 1,747.02 " " 1,177.47 " " 2,383.55 " " 2,333.37 " " 1,655.94 " 45000292 HC REMOVAL FOREIGN BODY MOUTH SIMPLE 450 40804 " 1,640.00 " " 1,574.40 " " 1,574.40 " " 1,558.00 " " 1,525.20 " " 1,574.40 " " 1,525.20 " " 1,141.93 " 769.65 " 1,558.00 " " 1,525.20 " " 1,082.40 " 45000294 HC REPAIR MOUTH LACERATION <2.5 CM 450 40830 394.00 378.24 378.24 374.30 366.42 378.24 366.42 274.34 184.90 374.30 366.42 260.04 45000295 HC REPAIR MOUTH LACERATION >2.5 CM 450 40831 " 1,015.00 " 974.40 974.40 964.25 943.95 974.40 943.95 706.74 476.34 964.25 943.95 669.90 45000308 HC INC/DRAIN PERITONSIL ABSCESS 450 42700 394.00 378.24 378.24 374.30 366.42 378.24 366.42 274.34 184.90 374.30 366.42 260.04 45000309 HC REMOVE PHARYNX FOREIGN BODY 450 42809 728.00 698.88 698.88 691.60 677.04 698.88 677.04 506.91 341.65 691.60 677.04 480.48 45000313 HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY 450 45332 " 2,064.00 " " 1,981.44 " " 1,981.44 " " 1,960.80 " " 1,919.52 " " 1,981.44 " " 1,919.52 " " 1,437.16 " 968.64 " 1,960.80 " " 1,919.52 " " 1,362.24 " 45000316 HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD 450 46600 197.00 189.12 189.12 187.15 183.21 189.12 183.21 137.17 92.45 187.15 183.21 130.02 45000318 HC CHANGE OF BLADDER TUBE SIMPLE 450 51705 300.00 288.00 288.00 285.00 279.00 288.00 279.00 208.89 140.79 285.00 279.00 198.00 45000319 HC CHANGE OF BLADDER TUBE COMPLICATED 450 51710 600.00 576.00 576.00 570.00 558.00 576.00 558.00 417.78 281.58 570.00 558.00 396.00 45000322 HC MARSUP BARTHOLIN GLAND CYST 450 56440 " 5,011.00 " " 4,810.56 " " 4,810.56 " " 4,760.45 " " 4,660.23 " " 4,810.56 " " 4,660.23 " " 3,489.16 " " 2,351.66 " " 4,760.45 " " 4,660.23 " " 3,307.26 " 45000325 HC REMV FB EYE SUPERF CONJUNC 450 65205 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000326 HC REMV FB EYE EMBED CONJUNC 450 65210 728.00 698.88 698.88 691.60 677.04 698.88 677.04 506.91 341.65 691.60 677.04 480.48 45000327 HC REMV FB EYE CORNEA NO SLIT 450 65220 728.00 698.88 698.88 691.60 677.04 698.88 677.04 506.91 341.65 691.60 677.04 480.48 45000328 HC REMV FB EYE CORNEA SLIT LAMP 450 65222 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000330 HC SUTURE EYELID WOUND PARTIAL THICK 450 67930 " 3,993.00 " " 3,833.28 " " 3,833.28 " " 3,793.35 " " 3,713.49 " " 3,833.28 " " 3,713.49 " " 2,780.33 " " 1,873.91 " " 3,793.35 " " 3,713.49 " " 2,635.38 " 45000331 HC SUTURE EYELID WOUND FULL THICK 450 67935 " 3,993.00 " " 3,833.28 " " 3,833.28 " " 3,793.35 " " 3,713.49 " " 3,833.28 " " 3,713.49 " " 2,780.33 " " 1,873.91 " " 3,793.35 " " 3,713.49 " " 2,635.38 " 45000334 HC REMV EXT CANAL FOREIGN BODY 450 69200 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 45000336 HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 450 99151 227.00 217.92 217.92 215.65 211.11 217.92 211.11 158.06 106.53 215.65 211.11 149.82 45000337 HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS 450 99155 227.00 217.92 217.92 215.65 211.11 217.92 211.11 158.06 106.53 215.65 211.11 149.82 45000338 HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS 450 99156 454.00 435.84 435.84 431.30 422.22 435.84 422.22 316.12 213.06 431.30 422.22 299.64 45000339 HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS 450 99157 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 45000340 HC CRITICAL CARE ADDL 30 MIN 450 99292 " 1,022.00 " 981.12 981.12 970.90 950.46 981.12 950.46 711.62 479.62 970.90 950.46 674.52 45000344 HC INJECT NERV BLCK FACIAL NERV 450 64999 466.00 447.36 447.36 442.70 433.38 447.36 433.38 324.48 218.69 442.70 433.38 307.56 45000345 HC EXCISION BENIGN LESION INCL MARGINS T/A/L 450 11402 " 1,391.00 " " 1,335.36 " " 1,335.36 " " 1,321.45 " " 1,293.63 " " 1,335.36 " " 1,293.63 " 968.55 652.80 " 1,321.45 " " 1,293.63 " 918.06 46000001 HC SPIROMETRY 460 94010 336.00 322.56 322.56 319.20 312.48 322.56 312.48 233.96 157.68 319.20 312.48 221.76 46000002 HC BRONCHODILATION RESPONSIVENESS 460 94060 623.00 598.08 598.08 591.85 579.39 598.08 579.39 433.79 292.37 591.85 579.39 411.18 46000010 HC DIFFUSION CAPACITY 460 94729 534.00 512.64 512.64 507.30 496.62 512.64 496.62 371.82 250.61 507.30 496.62 352.44 46000011 HC OXIMETRY SINGLE DETERMINATION 460 94760 88.00 84.48 84.48 83.60 81.84 84.48 81.84 61.27 41.30 83.60 81.84 58.08 46000012 HC AMBULATORY OXIMETRY 460 94761 288.00 276.48 276.48 273.60 267.84 276.48 267.84 200.53 135.16 273.60 267.84 190.08 46000013 HC OVERNIGHT OXIMETRY MONITORING 460 94762 411.00 394.56 394.56 390.45 382.23 394.56 382.23 286.18 192.88 390.45 382.23 271.26 46000022 HC OXIMETRY CONTINUOUS 460 94761 288.00 276.48 276.48 273.60 267.84 276.48 267.84 200.53 135.16 273.60 267.84 190.08 46000025 HC RESPIRATORY PARAMETERS 460 94150 55.00 52.80 52.80 52.25 51.15 52.80 51.15 38.30 25.81 52.25 51.15 36.30 46000028 HC PULMONARY STRESS TESTING 460 94618 353.00 338.88 338.88 335.35 328.29 338.88 328.29 245.79 165.66 335.35 328.29 232.98 46000029 HC SIX MINUTE WALK TEST 460 94618 353.00 338.88 338.88 335.35 328.29 338.88 328.29 245.79 165.66 335.35 328.29 232.98 47100002 HC NEWBORN AUDITORY PROCESS EVAL 60 MIN 471 92620 264.00 253.44 253.44 250.80 245.52 253.44 245.52 183.82 123.90 250.80 245.52 174.24 47100003 HC NEWBORN AUDITORY PROCESS EVAL EACH ADDL 15 MIN 471 92621 67.00 64.32 64.32 63.65 62.31 64.32 62.31 46.65 31.44 63.65 62.31 44.22 48000021 HC CARDIOVERSION EXTERNAL 480 92960 " 2,200.00 " " 2,112.00 " " 2,112.00 " " 2,090.00 " " 2,046.00 " " 2,112.00 " " 2,046.00 " " 1,531.86 " " 1,032.46 " " 2,090.00 " " 2,046.00 " " 1,452.00 " 48000028 HC ECHO COMPLETE 480 93306 " 2,152.00 " " 2,065.92 " " 2,065.92 " " 2,044.40 " " 2,001.36 " " 2,065.92 " " 2,001.36 " " 1,498.44 " " 1,009.93 " " 2,044.40 " " 2,001.36 " " 1,420.32 " 48000030 HC ECHO 2D LIMITED 480 93308 867.00 832.32 832.32 823.65 806.31 832.32 806.31 603.69 406.88 823.65 806.31 572.22 48000032 HC CARDIAC DOPPLER EXAM 480 93320 423.00 406.08 406.08 401.85 393.39 406.08 393.39 294.53 198.51 401.85 393.39 279.18 48000033 HC CARDIAC DOPPLER - COLOR 480 93325 475.00 456.00 456.00 451.25 441.75 456.00 441.75 330.74 222.92 451.25 441.75 313.50 48000073 HC ECHO W/CONTRAST 480 C8929 " 2,152.00 " " 2,065.92 " " 2,065.92 " " 2,044.40 " " 2,001.36 " " 2,065.92 " " 2,001.36 " " 1,498.44 " " 1,009.93 " " 2,044.40 " " 2,001.36 " " 1,420.32 " 48000077 HC NON MONITORED CARDIAC REHAB 480 93797 213.00 204.48 204.48 202.35 198.09 204.48 198.09 148.31 99.96 202.35 198.09 140.58 48000078 HC PHASE IV 1/2 MONTH 480 93797 44.00 42.24 42.24 41.80 40.92 42.24 40.92 30.64 20.65 41.80 40.92 29.04 48000079 HC PHASE IV 1/4 MONTH 480 93797 26.00 24.96 24.96 24.70 24.18 24.96 24.18 18.10 12.20 24.70 24.18 17.16 48000080 HC PHASE IV 3/4 MONTH 480 93797 67.00 64.32 64.32 63.65 62.31 64.32 62.31 46.65 31.44 63.65 62.31 44.22 48000081 HC PHASE IV PER VISIT 480 93797 16.00 15.36 15.36 15.20 14.88 15.36 14.88 11.14 7.51 15.20 14.88 10.56 48000082 HC PHASE I 480 93798 89.00 85.44 85.44 84.55 82.77 85.44 82.77 61.97 41.77 84.55 82.77 58.74 48000083 HC PHASE II 480 93798 246.00 236.16 236.16 233.70 228.78 236.16 228.78 171.29 115.45 233.70 228.78 162.36 48000084 HC PHASE III PER VISIT 480 93798 44.00 42.24 42.24 41.80 40.92 42.24 40.92 30.64 20.65 41.80 40.92 29.04 48200001 HC GXT CORPORATE STRESS TEST 482 93015 401.00 384.96 384.96 380.95 372.93 384.96 372.93 279.22 188.19 380.95 372.93 264.66 48200002 HC CARDIAC STRESS TEST 482 93017 " 1,067.00 " " 1,024.32 " " 1,024.32 " " 1,013.65 " 992.31 " 1,024.32 " 992.31 742.95 500.74 " 1,013.65 " 992.31 704.22 48300001 HC ECHO W/BUBBLE STUDY 483 93306 " 2,111.00 " " 2,026.56 " " 2,026.56 " " 2,005.45 " " 1,963.23 " " 2,026.56 " " 1,963.23 " " 1,469.89 " 990.69 " 2,005.45 " " 1,963.23 " " 1,393.26 " 48300002 HC CARDIAC DOPPLER LIMITED 483 93321 249.00 239.04 239.04 236.55 231.57 239.04 231.57 173.38 116.86 236.55 231.57 164.34 48300004 HC ECHO W CONTRAST LTD 483 C8924 " 2,152.00 " " 2,065.92 " " 2,065.92 " " 2,044.40 " " 2,001.36 " " 2,065.92 " " 2,001.36 " " 1,498.44 " " 1,009.93 " " 2,044.40 " " 2,001.36 " " 1,420.32 " 51000001 HC PROCEDURE ROOM 106-120 MI 510 " 1,549.00 " " 1,487.04 " " 1,487.04 " " 1,471.55 " " 1,440.57 " " 1,487.04 " " 1,440.57 " " 1,078.57 " 726.95 " 1,471.55 " " 1,440.57 " " 1,022.34 " 51000002 HC PROCEDURE ROOM 121-135 MI 510 " 1,747.00 " " 1,677.12 " " 1,677.12 " " 1,659.65 " " 1,624.71 " " 1,677.12 " " 1,624.71 " " 1,216.44 " 819.87 " 1,659.65 " " 1,624.71 " " 1,153.02 " 51000003 HC PROCEDURE ROOM 1-30 MINS 510 488.00 468.48 468.48 463.60 453.84 468.48 453.84 339.79 229.02 463.60 453.84 322.08 51000004 HC PROCEDURE ROOM 31-45 MINS 510 587.00 563.52 563.52 557.65 545.91 563.52 545.91 408.73 275.48 557.65 545.91 387.42 51000005 HC PROCEDURE ROOM 46-60 MINS 510 " 1,004.00 " 963.84 963.84 953.80 933.72 963.84 933.72 699.09 471.18 953.80 933.72 662.64 51000006 HC PROCEDURE ROOM 61-75 MINS 510 " 1,219.00 " " 1,170.24 " " 1,170.24 " " 1,158.05 " " 1,133.67 " " 1,170.24 " " 1,133.67 " 848.79 572.08 " 1,158.05 " " 1,133.67 " 804.54 51000007 HC PROCEDURE ROOM 76-90 MINS 510 " 1,345.00 " " 1,291.20 " " 1,291.20 " " 1,277.75 " " 1,250.85 " " 1,291.20 " " 1,250.85 " 936.52 631.21 " 1,277.75 " " 1,250.85 " 887.70 51000008 HC PROCEDURE ROOM 91-105 MIN 510 " 1,456.00 " " 1,397.76 " " 1,397.76 " " 1,383.20 " " 1,354.08 " " 1,397.76 " " 1,354.08 " " 1,013.81 " 683.30 " 1,383.20 " " 1,354.08 " 960.96 51000013 HC CIRCUMCISION W/REGIONL BLOC 510 54150 696.00 668.16 668.16 661.20 647.28 668.16 647.28 484.62 326.63 661.20 647.28 459.36 51000014 HC CIRCUMCISION NEONATE 510 54160 330.00 316.80 316.80 313.50 306.90 316.80 306.90 229.78 154.87 313.50 306.90 217.80 51000015 HC CIRCUM 28 DAYS OR OLDER 510 54161 188.00 180.48 180.48 178.60 174.84 180.48 174.84 130.90 88.23 178.60 174.84 124.08 51000022 HC EXC SKIN BENIG >4 CM TRUNK ARM LEG 510 11406 " 1,900.00 " " 1,824.00 " " 1,824.00 " " 1,805.00 " " 1,767.00 " " 1,824.00 " " 1,767.00 " " 1,322.97 " 891.67 " 1,805.00 " " 1,767.00 " " 1,254.00 " 51000023 HC EXC SKIN BENIG 2.1-3CM T/A/L 510 11403 " 1,450.00 " " 1,392.00 " " 1,392.00 " " 1,377.50 " " 1,348.50 " " 1,392.00 " " 1,348.50 " " 1,009.64 " 680.49 " 1,377.50 " " 1,348.50 " 957.00 51000024 HC EXC SKIN BENIG 3.1-4CM T/A/L 510 11404 " 1,550.00 " " 1,488.00 " " 1,488.00 " " 1,472.50 " " 1,441.50 " " 1,488.00 " " 1,441.50 " " 1,079.27 " 727.42 " 1,472.50 " " 1,441.50 " " 1,023.00 " 51000025 HC TELEHEALTH FACILITY FEE 510 Q3014 60.00 27.00 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 51000028 HC EXC SKIN BENIG 3.1-4 CM REMAINDR BODY 510 11424 390.00 374.40 374.40 370.50 362.70 374.40 362.70 271.56 183.03 370.50 362.70 257.40 51000029 HC INJECT CARPAL TUNNEL 510 20526 200.00 192.00 192.00 190.00 186.00 192.00 186.00 139.26 93.86 190.00 186.00 132.00 51000030 HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY 510 11422 295.00 283.20 283.20 280.25 274.35 283.20 274.35 205.41 138.44 280.25 274.35 194.70 51000031 HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 510 21932 " 2,000.00 " " 1,920.00 " " 1,920.00 " " 1,900.00 " " 1,860.00 " " 1,920.00 " " 1,860.00 " " 1,392.60 " 938.60 " 1,900.00 " " 1,860.00 " " 1,320.00 " 51000032 "HC TENOTOMY,UNI HAMSTR,KNEE-THIGH,MULTI" 510 27391 " 2,200.00 " " 2,112.00 " " 2,112.00 " " 2,090.00 " " 2,046.00 " " 2,112.00 " " 2,046.00 " " 1,531.86 " " 1,032.46 " " 2,090.00 " " 2,046.00 " " 1,452.00 " 51000033 "HC INJECTION INTO SKIN LESIONS, UP TO 7" 510 11900 200.00 192.00 192.00 190.00 186.00 192.00 186.00 139.26 93.86 190.00 186.00 132.00 51000034 HC LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 510 31575 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 51000035 HC NASAL ENDOSCOPY DX 510 31231 175.00 168.00 168.00 166.25 162.75 168.00 162.75 121.85 82.13 166.25 162.75 115.50 51000036 HC BIOPSY OF MOUTH LESION 510 40808 665.00 638.40 638.40 631.75 618.45 638.40 618.45 463.04 312.08 631.75 618.45 438.90 51000037 HC BIOPSY TONGUE ANTER 2/3 510 41100 680.00 652.80 652.80 646.00 632.40 652.80 632.40 473.48 319.12 646.00 632.40 448.80 51000038 HC NASOPHARYNGOSCOPY 510 92511 250.00 240.00 240.00 237.50 232.50 240.00 232.50 174.08 117.33 237.50 232.50 165.00 51000039 HC PROSTATE INCISIONAL BIOPSY 510 55705 " 3,100.00 " " 2,976.00 " " 2,976.00 " " 2,945.00 " " 2,883.00 " " 2,976.00 " " 2,883.00 " " 2,158.53 " " 1,454.83 " " 2,945.00 " " 2,883.00 " " 2,046.00 " 51000040 HC VASECTOMY 510 55250 " 1,850.00 " " 1,776.00 " " 1,776.00 " " 1,757.50 " " 1,720.50 " " 1,776.00 " " 1,720.50 " " 1,288.16 " 868.21 " 1,757.50 " " 1,720.50 " " 1,221.00 " 51000041 HC CYSTOSCOPY 510 52000 " 1,100.00 " " 1,056.00 " " 1,056.00 " " 1,045.00 " " 1,023.00 " " 1,056.00 " " 1,023.00 " 765.93 516.23 " 1,045.00 " " 1,023.00 " 726.00 51000042 HC CYSTO - STENT REMOVAL 510 52310 " 1,850.00 " " 1,776.00 " " 1,776.00 " " 1,757.50 " " 1,720.50 " " 1,776.00 " " 1,720.50 " " 1,288.16 " 868.21 " 1,757.50 " " 1,720.50 " " 1,221.00 " 51000043 HC INJECT TENDON ORIGIN/INSERT 510 20551 455.00 436.80 436.80 432.25 423.15 436.80 423.15 316.82 213.53 432.25 423.15 300.30 54200001 HC PARAMEDIC SVC/15 MIN 542 8.00 7.68 7.68 7.60 7.44 7.68 7.44 5.57 3.75 7.60 7.44 5.28 54200002 HC PARMEDIC ON-CALL/MTH 542 " 1,886.00 " " 1,810.56 " " 1,810.56 " " 1,791.70 " " 1,753.98 " " 1,810.56 " " 1,753.98 " " 1,313.22 " 885.10 " 1,791.70 " " 1,753.98 " " 1,244.76 " 54200003 HC ALS INTERCEPT - TIER 1 542 324.00 311.04 311.04 307.80 301.32 311.04 301.32 225.60 152.05 307.80 301.32 213.84 54200004 HC ALS INTERCEPT - TIER 2 542 162.00 155.52 155.52 153.90 150.66 155.52 150.66 112.80 76.03 153.90 150.66 106.92 61000006 HC MRI ORBIT FACE NECK WO CONTR 610 70540 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61000007 HC MRI ORBIT/FACE/NECK W/CONTRAST 610 70542 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61000008 HC MRI ORBIT/FACE/NECK W/WO CONTR 610 70543 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61000009 HC MRA HEAD WO CONTRAST 610 70544 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61000012 HC MRA NECK W/O CONTRAST 610 70547 " 3,025.00 " " 2,904.00 " " 2,904.00 " " 2,873.75 " " 2,813.25 " " 2,904.00 " " 2,813.25 " " 2,106.31 " " 1,419.63 " " 2,873.75 " " 2,813.25 " " 1,996.50 " 61000014 HC MRA NECK W/WO CONTRAST 610 70549 " 3,632.00 " " 3,486.72 " " 3,486.72 " " 3,450.40 " " 3,377.76 " " 3,486.72 " " 3,377.76 " " 2,528.96 " " 1,704.50 " " 3,450.40 " " 3,377.76 " " 2,397.12 " 61000015 HC MRI CHEST W/O CONTRAST 610 71550 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61000016 HC MRI CHEST W/CONTRAST 610 71551 " 3,893.00 " " 3,737.28 " " 3,737.28 " " 3,698.35 " " 3,620.49 " " 3,737.28 " " 3,620.49 " " 2,710.70 " " 1,826.98 " " 3,698.35 " " 3,620.49 " " 2,569.38 " 61000017 HC MRI CHEST W/WO CONTRAST 610 71552 " 4,279.00 " " 4,107.84 " " 4,107.84 " " 4,065.05 " " 3,979.47 " " 4,107.84 " " 3,979.47 " " 2,979.47 " " 2,008.13 " " 4,065.05 " " 3,979.47 " " 2,824.14 " 61000019 HC MRI PELVIS WO CONTRAST 610 72195 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61000020 HC MRI PELVIS W CONTRAST 610 72196 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61000021 HC MRI PELVIS W WO CONTRAST 610 72197 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61000023 HC MRI UPPER EXT WO CONTRAST 610 73218 " 2,593.00 " " 2,489.28 " " 2,489.28 " " 2,463.35 " " 2,411.49 " " 2,489.28 " " 2,411.49 " " 1,805.51 " " 1,216.89 " " 2,463.35 " " 2,411.49 " " 1,711.38 " 61000024 HC MRI UPPER EXT W/CONTRAST 610 73219 " 2,845.00 " " 2,731.20 " " 2,731.20 " " 2,702.75 " " 2,645.85 " " 2,731.20 " " 2,645.85 " " 1,980.97 " " 1,335.16 " " 2,702.75 " " 2,645.85 " " 1,877.70 " 61000025 HC MRI UPPER EXT W/WO CONTRAST 610 73220 " 3,200.00 " " 3,072.00 " " 3,072.00 " " 3,040.00 " " 2,976.00 " " 3,072.00 " " 2,976.00 " " 2,228.16 " " 1,501.76 " " 3,040.00 " " 2,976.00 " " 2,112.00 " 61000026 HC MRI JT UPPER EXT W/O CONTRAST 610 73221 " 2,593.00 " " 2,489.28 " " 2,489.28 " " 2,463.35 " " 2,411.49 " " 2,489.28 " " 2,411.49 " " 1,805.51 " " 1,216.89 " " 2,463.35 " " 2,411.49 " " 1,711.38 " 61000027 HC MRI JOINT UPPER EXT W/CONTRAST 610 73222 " 2,899.00 " " 2,783.04 " " 2,783.04 " " 2,754.05 " " 2,696.07 " " 2,783.04 " " 2,696.07 " " 2,018.57 " " 1,360.50 " " 2,754.05 " " 2,696.07 " " 1,913.34 " 61000028 HC MRI JOINT UPPER EXT W/WO CONTRAST 610 73223 " 3,200.00 " " 3,072.00 " " 3,072.00 " " 3,040.00 " " 2,976.00 " " 3,072.00 " " 2,976.00 " " 2,228.16 " " 1,501.76 " " 3,040.00 " " 2,976.00 " " 2,112.00 " 61000029 HC MRA UPPER EXT W & W/O CONTRAST 610 73225 " 2,767.00 " " 2,656.32 " " 2,656.32 " " 2,628.65 " " 2,573.31 " " 2,656.32 " " 2,573.31 " " 1,926.66 " " 1,298.55 " " 2,628.65 " " 2,573.31 " " 1,826.22 " 61000030 HC MRI LOW EXT W/O CONTRAST 610 73718 " 2,593.00 " " 2,489.28 " " 2,489.28 " " 2,463.35 " " 2,411.49 " " 2,489.28 " " 2,411.49 " " 1,805.51 " " 1,216.89 " " 2,463.35 " " 2,411.49 " " 1,711.38 " 61000031 HC MRI LOW EXT W/CONTRAST 610 73719 " 3,580.00 " " 3,436.80 " " 3,436.80 " " 3,401.00 " " 3,329.40 " " 3,436.80 " " 3,329.40 " " 2,492.75 " " 1,680.09 " " 3,401.00 " " 3,329.40 " " 2,362.80 " 61000032 HC MRI LOWER EXT W/WO CONTRAST 610 73720 " 3,200.00 " " 3,072.00 " " 3,072.00 " " 3,040.00 " " 2,976.00 " " 3,072.00 " " 2,976.00 " " 2,228.16 " " 1,501.76 " " 3,040.00 " " 2,976.00 " " 2,112.00 " 61000033 HC MRI JT LOWER EXT W/O CONTRAST 610 73721 " 2,593.00 " " 1,413.00 " " 2,489.28 " " 2,463.35 " " 2,411.49 " " 2,489.28 " " 2,411.49 " " 1,805.51 " " 1,216.89 " " 2,463.35 " " 2,411.49 " " 1,711.38 " 61000034 HC MRI JT LOWER EXT W CONTRAST 610 73722 " 2,735.00 " " 2,625.60 " " 2,625.60 " " 2,598.25 " " 2,543.55 " " 2,625.60 " " 2,543.55 " " 1,904.38 " " 1,283.54 " " 2,598.25 " " 2,543.55 " " 1,805.10 " 61000035 HC MRI JT LOWER EXT W/WO CONTRAST 610 73723 " 3,200.00 " " 3,072.00 " " 3,072.00 " " 3,040.00 " " 2,976.00 " " 3,072.00 " " 2,976.00 " " 2,228.16 " " 1,501.76 " " 3,040.00 " " 2,976.00 " " 2,112.00 " 61000036 HC MRA LOWER EXTREMITY W/CONTRAST 610 73725 " 3,200.00 " " 3,072.00 " " 3,072.00 " " 3,040.00 " " 2,976.00 " " 3,072.00 " " 2,976.00 " " 2,228.16 " " 1,501.76 " " 3,040.00 " " 2,976.00 " " 2,112.00 " 61000037 HC MRI ABDOMEN W/O CONTRAST 610 74181 " 3,677.00 " " 3,529.92 " " 3,529.92 " " 3,493.15 " " 3,419.61 " " 3,529.92 " " 3,419.61 " " 2,560.30 " " 1,725.62 " " 3,493.15 " " 3,419.61 " " 2,426.82 " 61000038 HC MRI ABD W/CONTRAST 610 74182 " 3,729.00 " " 3,579.84 " " 3,579.84 " " 3,542.55 " " 3,467.97 " " 3,579.84 " " 3,467.97 " " 2,596.50 " " 1,750.02 " " 3,542.55 " " 3,467.97 " " 2,461.14 " 61000039 HC MRI ABD W/WO CONTRAST 610 74183 " 4,279.00 " " 4,107.84 " " 4,107.84 " " 4,065.05 " " 3,979.47 " " 4,107.84 " " 3,979.47 " " 2,979.47 " " 2,008.13 " " 4,065.05 " " 3,979.47 " " 2,824.14 " 61000040 HC MRA ABDOMEN W & W/O CONTRAST 610 74185 " 4,279.00 " " 4,107.84 " " 4,107.84 " " 4,065.05 " " 3,979.47 " " 4,107.84 " " 3,979.47 " " 2,979.47 " " 2,008.13 " " 4,065.05 " " 3,979.47 " " 2,824.14 " 61000058 HC MRI TMJ BILATERAL 610 70336 " 2,923.00 " " 2,806.08 " " 2,806.08 " " 2,776.85 " " 2,718.39 " " 2,806.08 " " 2,718.39 " " 2,035.28 " " 1,371.76 " " 2,776.85 " " 2,718.39 " " 1,929.18 " 61000059 HC MRI TMJ UNILATERAL 610 70336 " 2,508.00 " " 2,407.68 " " 2,407.68 " " 2,382.60 " " 2,332.44 " " 2,407.68 " " 2,332.44 " " 1,746.32 " " 1,177.00 " " 2,382.60 " " 2,332.44 " " 1,655.28 " 61000062 HC MRI ORBITS ONLY WO CONT 610 70540 " 1,811.00 " " 1,738.56 " " 1,738.56 " " 1,720.45 " " 1,684.23 " " 1,738.56 " " 1,684.23 " " 1,261.00 " 849.90 " 1,720.45 " " 1,684.23 " " 1,195.26 " 61000065 HC MRI ORBITS ONLY WITH CONTRAST 610 70542 " 1,897.00 " " 1,821.12 " " 1,821.12 " " 1,802.15 " " 1,764.21 " " 1,821.12 " " 1,764.21 " " 1,320.88 " 890.26 " 1,802.15 " " 1,764.21 " " 1,252.02 " 61000068 HC MRI ORBITS ONLY W/WO CONTRAST 610 70543 " 2,185.00 " " 2,097.60 " " 2,097.60 " " 2,075.75 " " 2,032.05 " " 2,097.60 " " 2,032.05 " " 1,521.42 " " 1,025.42 " " 2,075.75 " " 2,032.05 " " 1,442.10 " 61000073 HC MRV HEAD W/O CONTRAST 610 70544 " 3,344.00 " " 3,210.24 " " 3,210.24 " " 3,176.80 " " 3,109.92 " " 3,210.24 " " 3,109.92 " " 2,328.43 " " 1,569.34 " " 3,176.80 " " 3,109.92 " " 2,207.04 " 61000077 HC MRA HEAD W/CONTRAST 610 70545 " 3,907.00 " " 3,750.72 " " 3,750.72 " " 3,711.65 " " 3,633.51 " " 3,750.72 " " 3,633.51 " " 2,720.44 " " 1,833.56 " " 3,711.65 " " 3,633.51 " " 2,578.62 " 61000078 HC MRV HEAD W/CONTRAST 610 70545 " 4,341.00 " " 4,167.36 " " 4,167.36 " " 4,123.95 " " 4,037.13 " " 4,167.36 " " 4,037.13 " " 3,022.64 " " 2,037.23 " " 4,123.95 " " 4,037.13 " " 2,865.06 " 61000081 HC MRA & MRV HEAD W/WO CONTRAST 610 70546 " 4,899.00 " " 4,703.04 " " 4,703.04 " " 4,654.05 " " 4,556.07 " " 4,703.04 " " 4,556.07 " " 3,411.17 " " 2,299.10 " " 4,654.05 " " 4,556.07 " " 3,233.34 " 61000082 HC MRA HEAD W/WO CONTRAST 610 70546 " 4,418.00 " " 4,241.28 " " 4,241.28 " " 4,197.10 " " 4,108.74 " " 4,241.28 " " 4,108.74 " " 3,076.25 " " 2,073.37 " " 4,197.10 " " 4,108.74 " " 2,915.88 " 61000083 HC MRV HEAD W/WO CONTRAST 610 70546 " 4,418.00 " " 4,241.28 " " 4,241.28 " " 4,197.10 " " 4,108.74 " " 4,241.28 " " 4,108.74 " " 3,076.25 " " 2,073.37 " " 4,197.10 " " 4,108.74 " " 2,915.88 " 61000087 HC MRA & MRV NECK W/O CONTRAST 610 70547 " 2,719.00 " " 2,610.24 " " 2,610.24 " " 2,583.05 " " 2,528.67 " " 2,610.24 " " 2,528.67 " " 1,893.24 " " 1,276.03 " " 2,583.05 " " 2,528.67 " " 1,794.54 " 61000088 HC MRV NECK W/O CONTRAST 610 70547 " 2,408.00 " " 2,311.68 " " 2,311.68 " " 2,287.60 " " 2,239.44 " " 2,311.68 " " 2,239.44 " " 1,676.69 " " 1,130.07 " " 2,287.60 " " 2,239.44 " " 1,589.28 " 61000091 HC MRA & MRV NECK W/CONTRAST 610 70548 " 3,397.00 " " 3,261.12 " " 3,261.12 " " 3,227.15 " " 3,159.21 " " 3,261.12 " " 3,159.21 " " 2,365.33 " " 1,594.21 " " 3,227.15 " " 3,159.21 " " 2,242.02 " 61000093 HC MRV NECK W/CONTRAST 610 70548 " 2,972.00 " " 2,853.12 " " 2,853.12 " " 2,823.40 " " 2,763.96 " " 2,853.12 " " 2,763.96 " " 2,069.40 " " 1,394.76 " " 2,823.40 " " 2,763.96 " " 1,961.52 " 61000097 HC MRA & MRV NECK W/WO CONTRAST 610 70549 " 3,795.00 " " 3,643.20 " " 3,643.20 " " 3,605.25 " " 3,529.35 " " 3,643.20 " " 3,529.35 " " 2,642.46 " " 1,780.99 " " 3,605.25 " " 3,529.35 " " 2,504.70 " 61000098 HC MRV NECK W/WO CONTRAST 610 70549 " 3,286.00 " " 3,154.56 " " 3,154.56 " " 3,121.70 " " 3,055.98 " " 3,154.56 " " 3,055.98 " " 2,288.04 " " 1,542.12 " " 3,121.70 " " 3,055.98 " " 2,168.76 " 61000118 HC MRI SACRUM COCCYX WO CONTRAST 610 72195 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61000121 HC MRI SACRUM COCCYX W CONTRAST 610 72196 " 2,804.00 " " 2,691.84 " " 2,691.84 " " 2,663.80 " " 2,607.72 " " 2,691.84 " " 2,607.72 " " 1,952.43 " " 1,315.92 " " 2,663.80 " " 2,607.72 " " 1,850.64 " 61000124 HC MRI SACRUM COCCYX W WO 610 72197 " 3,510.00 " " 3,369.60 " " 3,369.60 " " 3,334.50 " " 3,264.30 " " 3,369.60 " " 3,264.30 " " 2,444.01 " " 1,647.24 " " 3,334.50 " " 3,264.30 " " 2,316.60 " 61100001 HC MRI BRAIN WO CONTRAST 611 70551 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61100002 HC MRI BRAIN W/CONTRAST 611 70552 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61100015 HC MRI BRAIN W IACS WO CONT 611 70551 " 3,508.00 " " 3,367.68 " " 3,367.68 " " 3,332.60 " " 3,262.44 " " 3,367.68 " " 3,262.44 " " 2,442.62 " " 1,646.30 " " 3,332.60 " " 3,262.44 " " 2,315.28 " 61100020 HC MRI PITUITARY W/O CONTRAST 611 70551 " 2,611.00 " " 2,506.56 " " 2,506.56 " " 2,480.45 " " 2,428.23 " " 2,506.56 " " 2,428.23 " " 1,818.04 " " 1,225.34 " " 2,480.45 " " 2,428.23 " " 1,723.26 " 61100026 HC MRI BRAIN/PIT W/CONTRAST 611 70552 " 3,476.00 " " 3,336.96 " " 3,336.96 " " 3,302.20 " " 3,232.68 " " 3,336.96 " " 3,232.68 " " 2,420.34 " " 1,631.29 " " 3,302.20 " " 3,232.68 " " 2,294.16 " 61100027 HC MRI PITUITARY W/CONTRAST 611 70552 " 2,927.00 " " 2,809.92 " " 2,809.92 " " 2,780.65 " " 2,722.11 " " 2,809.92 " " 2,722.11 " " 2,038.07 " " 1,373.64 " " 2,780.65 " " 2,722.11 " " 1,931.82 " 61100032 HC MRI BRAIN W IACS W WO CONT 611 70553 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61100033 HC MRI BRAIN W/PITUITRY W/WO CONT 611 70553 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61100034 HC MRI BRAIN W/WO CONTRAST 611 70553 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61100035 HC MRI PITUITARY W/WO CONTRAST 611 70553 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61200001 HC MRI SPINAL CANAL CERV W/O CONTRAST 612 72141 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61200002 HC MRI SPINAL CNL CERV W/CONTRAST 612 72142 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61200003 HC MRI SPINAL CANAL THOR W/O CONTRAST 612 72146 " 3,458.00 " " 3,319.68 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61200004 HC MRI SPINL CNL THOR W/CONTRAST 612 72147 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61200005 HC MRI SPINAL CNL LUMBAR WO CONTRAST 612 72148 " 3,458.00 " " 1,860.00 " " 3,319.68 " " 3,285.10 " " 3,215.94 " " 3,319.68 " " 3,215.94 " " 2,407.81 " " 1,622.84 " " 3,285.10 " " 3,215.94 " " 2,282.28 " 61200006 HC MRI SPINAL CNL LUMB W/CONTRAST 612 72149 " 3,762.00 " " 3,611.52 " " 3,611.52 " " 3,573.90 " " 3,498.66 " " 3,611.52 " " 3,498.66 " " 2,619.48 " " 1,765.51 " " 3,573.90 " " 3,498.66 " " 2,482.92 " 61200007 HC MRI SPINAL CNL CERV W/WO 612 72156 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61200008 HC MRI SPINAL CNL THOR W/WO 612 72157 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61200009 HC MRI SPINAL CNL LUMB W/WO 612 72158 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 61200025 HC MRA SPNL CNL CONTENT W WO 612 72159 " 4,065.00 " " 3,902.40 " " 3,902.40 " " 3,861.75 " " 3,780.45 " " 3,902.40 " " 3,780.45 " " 2,830.46 " " 1,907.70 " " 3,861.75 " " 3,780.45 " " 2,682.90 " 68400001 HC TRAUMA ACTIVATION <30 MIN 684 446.00 428.16 428.16 423.70 414.78 428.16 414.78 310.55 209.31 423.70 414.78 294.36 68400002 HC TRAUMA ACTIVATION >30 MIN 684 G0390 743.00 713.28 713.28 705.85 690.99 713.28 690.99 517.35 348.69 705.85 690.99 490.38 71000011 HC RECOVERY ROOM 1-30 MIN 710 491.00 471.36 471.36 466.45 456.63 471.36 456.63 341.88 230.43 466.45 456.63 324.06 71000012 HC RECOVERY ROOM 31-60 MIN 710 729.00 699.84 699.84 692.55 677.97 699.84 677.97 507.60 342.12 692.55 677.97 481.14 71000013 HC RECOVERY ROOM 61-90 MIN 710 828.00 794.88 794.88 786.60 770.04 794.88 770.04 576.54 388.58 786.60 770.04 546.48 71000014 HC RECOVERY ROOM 91-120 MIN 710 914.00 877.44 877.44 868.30 850.02 877.44 850.02 636.42 428.94 868.30 850.02 603.24 72000001 HC BIRTHING SERVICE 720 " 1,909.00 " " 1,832.64 " " 1,832.64 " " 1,813.55 " " 1,775.37 " " 1,832.64 " " 1,775.37 " " 1,329.24 " 895.89 " 1,813.55 " " 1,775.37 " " 1,259.94 " 72100002 HC LABOR SERVICE 721 874.00 839.04 839.04 830.30 812.82 839.04 812.82 608.57 410.17 830.30 812.82 576.84 72100003 HC OB OUTPATIENT ROOM PER HR 721 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 72200001 HC EXTERNAL CEPHALIC VERSION W WO TOCOLYSIS 722 59412 " 2,758.00 " " 2,647.68 " " 2,647.68 " " 2,620.10 " " 2,564.94 " " 2,647.68 " " 2,564.94 " " 1,920.40 " " 1,294.33 " " 2,620.10 " " 2,564.94 " " 1,820.28 " 73000001 HC EKG TRACING ONLY 730 93005 303.00 160.00 290.88 287.85 281.79 290.88 281.79 210.98 142.20 287.85 281.79 199.98 73000001 HC EKG TRACING ONLY 730 93005 17.00 160.00 16.32 16.15 15.81 16.32 15.81 11.84 7.98 16.15 15.81 11.22 73100001 HC HOLTER MONITOR APPLICATION 731 93225 515.00 494.40 494.40 489.25 478.95 494.40 478.95 358.59 241.69 489.25 478.95 339.90 73100002 HC HOLTER 12 HOUR RECORDING 731 93226 664.00 637.44 637.44 630.80 617.52 637.44 617.52 462.34 311.62 630.80 617.52 438.24 73100003 HC EVENT MONITOR APPLICATION 731 93270 358.00 343.68 343.68 340.10 332.94 343.68 332.94 249.28 168.01 340.10 332.94 236.28 73100004 HC EVENT MONITOR SERVICE 731 93271 " 1,040.00 " 998.40 998.40 988.00 967.20 998.40 967.20 724.15 488.07 988.00 967.20 686.40 73100006 HC HOLTER 24 HOUR RECORDING 731 93226 664.00 637.44 637.44 630.80 617.52 637.44 617.52 462.34 311.62 630.80 617.52 438.24 73100007 HC HOLTER 48 HOUR RECORDING 731 93226 " 1,325.00 " " 1,272.00 " " 1,272.00 " " 1,258.75 " " 1,232.25 " " 1,272.00 " " 1,232.25 " 922.60 621.82 " 1,258.75 " " 1,232.25 " 874.50 73100010 "HC EXT ECG >48 HR-7 DAYS, ANALYSIS W/REPORT" 731 93243 850.00 816.00 816.00 807.50 790.50 816.00 790.50 591.86 398.91 807.50 790.50 561.00 73100011 "HC EXT ECG 7-15 DAYS, ANALYSIS W/REPORT" 731 93247 " 1,050.00 " " 1,008.00 " " 1,008.00 " 997.50 976.50 " 1,008.00 " 976.50 731.12 492.77 997.50 976.50 693.00 73100012 "HC EXTERNAL HOLTER RECORDING, 7 TO 15 DAYS" 731 93246 650.00 624.00 624.00 617.50 604.50 624.00 604.50 452.60 305.05 617.50 604.50 429.00 73100013 "HC EXTERNAL HOLTER RECORDING, UP TO 7 DAYS" 731 93242 450.00 432.00 432.00 427.50 418.50 432.00 418.50 313.34 211.19 427.50 418.50 297.00 76000001 HC EXTENDED RECOVERY TO 1 HR 760 183.00 175.68 175.68 173.85 170.19 175.68 170.19 127.42 85.88 173.85 170.19 120.78 76000002 HC EXTENDED RECOVERY TO 2 HR 760 362.00 347.52 347.52 343.90 336.66 347.52 336.66 252.06 169.89 343.90 336.66 238.92 76000003 HC EXTENDED RECOVERY TO 3 HR 760 548.00 526.08 526.08 520.60 509.64 526.08 509.64 381.57 257.18 520.60 509.64 361.68 76000004 HC EXTENDED RECOVERY TO 4 HR 760 727.00 697.92 697.92 690.65 676.11 697.92 676.11 506.21 341.18 690.65 676.11 479.82 76000005 HC EXTENDED RECOVERY TO 5 HR 760 908.00 871.68 871.68 862.60 844.44 871.68 844.44 632.24 426.12 862.60 844.44 599.28 76000006 HC EXTENDED RECOVERY TO 6 HR 760 " 1,086.00 " " 1,042.56 " " 1,042.56 " " 1,031.70 " " 1,009.98 " " 1,042.56 " " 1,009.98 " 756.18 509.66 " 1,031.70 " " 1,009.98 " 716.76 76100001 HC DEBRIDEMENT OF NAIL 1-5 761 11720 76.00 72.96 72.96 72.20 70.68 72.96 70.68 52.92 35.67 72.20 70.68 50.16 76100002 HC DEBRIDEMENT OF NAIL >5 761 11721 86.00 82.56 82.56 81.70 79.98 82.56 79.98 59.88 40.36 81.70 79.98 56.76 76100004 HC INSERT STRAIGHT CATH 761 51701 170.00 163.20 163.20 161.50 158.10 163.20 158.10 118.37 79.78 161.50 158.10 112.20 76100005 HC INSERT SIMPLE CATH 761 51702 180.00 172.80 172.80 171.00 167.40 172.80 167.40 125.33 84.47 171.00 167.40 118.80 76100006 HC INSERT COMPLEX CATH 761 51703 275.00 264.00 264.00 261.25 255.75 264.00 255.75 191.48 129.06 261.25 255.75 181.50 76100007 HC IMPLANT LOC DEV PROST IRRAD 761 55876 " 1,350.00 " " 1,296.00 " " 1,296.00 " " 1,282.50 " " 1,255.50 " " 1,296.00 " " 1,255.50 " 940.01 633.56 " 1,282.50 " " 1,255.50 " 891.00 76100008 HC IMMUNIZATION ADMIN 761 90471 130.00 124.80 124.80 123.50 120.90 124.80 120.90 90.52 61.01 123.50 120.90 85.80 76100009 HC IMMUNIZATION ADMIN ADDL 761 90472 70.00 67.20 67.20 66.50 65.10 67.20 65.10 48.74 32.85 66.50 65.10 46.20 76100014 HC TX RM IV THER 31-1HR HYDR 761 96360 348.00 334.08 334.08 330.60 323.64 334.08 323.64 242.31 163.32 330.60 323.64 229.68 76100015 HC TX RM IV THER 1STHR NON-H 761 96365 348.00 334.08 334.08 330.60 323.64 334.08 323.64 242.31 163.32 330.60 323.64 229.68 76100016 HC TX RM IV ADL HR SAME DRG 761 96366 106.00 101.76 101.76 100.70 98.58 101.76 98.58 73.81 49.75 100.70 98.58 69.96 76100017 HC TX RM IV THER ADL INFUS 761 96367 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 76100018 HC TX RM IV THER CONCUR INF 761 96368 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 76100019 HC TX RM INJECT NON CHEMO 761 96372 130.00 124.80 124.80 123.50 120.90 124.80 120.90 90.52 61.01 123.50 120.90 85.80 76100021 HC TX RM IV PUSH DIFF DRUG 761 96375 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 76100022 HC SUBS IV PUSH OF SAME DRUG 761 96376 164.00 157.44 157.44 155.80 152.52 157.44 152.52 114.19 76.97 155.80 152.52 108.24 76100023 HC TX RM CHEMO INJECT NON-H 761 96401 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 76100024 HC TX RM CHEMO INJ-HORMONAL 761 96402 210.00 201.60 201.60 199.50 195.30 201.60 195.30 146.22 98.55 199.50 195.30 138.60 76100025 HC TX RM CHEMO IV PUSH-ADL 761 96411 174.00 167.04 167.04 165.30 161.82 167.04 161.82 121.16 81.66 165.30 161.82 114.84 76100026 HC TX RM CHEMO IV 1ST HOUR 761 96413 562.00 539.52 539.52 533.90 522.66 539.52 522.66 391.32 263.75 533.90 522.66 370.92 76100027 HC TX RM CHEMO ADL HR SM DRG 761 96415 114.00 109.44 109.44 108.30 106.02 109.44 106.02 79.38 53.50 108.30 106.02 75.24 76100028 HC CHEMO IV PUMP INITIATION 761 96416 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 76100029 HC TX RM CHEMO IV ADL INFUS 761 96417 160.00 153.60 153.60 152.00 148.80 153.60 148.80 111.41 75.09 152.00 148.80 105.60 76100030 HC TX RM IRRG OF IMPL DEVICE 761 96523 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 76100036 HC OFFICE OUTPATIENT ESTABLISHED VISIT LEVEL 1 761 99211 57.00 54.72 54.72 54.15 53.01 54.72 53.01 39.69 26.75 54.15 53.01 37.62 76100041 HC PICC INSERTION <5 YRS 761 36568 " 1,682.00 " " 1,614.72 " " 1,614.72 " " 1,597.90 " " 1,564.26 " " 1,614.72 " " 1,564.26 " " 1,171.18 " 789.36 " 1,597.90 " " 1,564.26 " " 1,110.12 " 76100042 HC PICC INSERTION 5+ YRS 761 36569 " 2,020.00 " " 1,939.20 " " 1,939.20 " " 1,919.00 " " 1,878.60 " " 1,939.20 " " 1,878.60 " " 1,406.53 " 947.99 " 1,919.00 " " 1,878.60 " " 1,333.20 " 76100045 HC BLOOD DRAW VIA PICC/PORT ACCESS 761 36592 25.00 24.00 24.00 23.75 23.25 24.00 23.25 17.41 11.73 23.75 23.25 16.50 76100046 HC TX RM IV THER ADL HR HYD 761 96361 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 76100055 HC TX ROOM <2 HRS 761 156.00 149.76 149.76 148.20 145.08 149.76 145.08 108.62 73.21 148.20 145.08 102.96 76100056 HC TX ROOM >2 HRS 761 222.00 213.12 213.12 210.90 206.46 213.12 206.46 154.58 104.18 210.90 206.46 146.52 76100067 HC MIDLINE INSERT 3 + YRS OLD 761 36410 " 1,221.00 " " 1,172.16 " " 1,172.16 " " 1,159.95 " " 1,135.53 " " 1,172.16 " " 1,135.53 " 850.18 573.02 " 1,159.95 " " 1,135.53 " 805.86 76100071 HC BLOOD DRAW FROM COMPLETELY IMPLANTABLE DEVICE OR A FISTULA DEVICE 761 36591 135.00 129.60 129.60 128.25 125.55 129.60 125.55 94.00 63.36 128.25 125.55 89.10 76100078 HC BONE MARROW BX W ASP SAME SITE 761 38222 " 1,996.00 " " 1,916.16 " " 1,916.16 " " 1,896.20 " " 1,856.28 " " 1,916.16 " " 1,856.28 " " 1,389.81 " 936.72 " 1,896.20 " " 1,856.28 " " 1,317.36 " 76100079 HC TB INTRADERMAL TEST 761 86580 28.00 26.88 26.88 26.60 26.04 26.88 26.04 19.50 13.14 26.60 26.04 18.48 76100086 HC DEBRIDE OPEN WOUND 20 SQ CM< 761 97597 270.00 259.20 259.20 256.50 251.10 259.20 251.10 188.00 126.71 256.50 251.10 178.20 76100092 HC INJECT NERV BLCK OTHR PERIPH NERV 761 64450 838.00 804.48 804.48 796.10 779.34 804.48 779.34 583.50 393.27 796.10 779.34 553.08 76100093 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 761 69209 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 76100094 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 761 69210 124.00 119.04 119.04 117.80 115.32 119.04 115.32 86.34 58.19 117.80 115.32 81.84 76100095 HC CTRL NOSEBLEED ANTER SIMPLE 761 30901 304.00 291.84 291.84 288.80 282.72 291.84 282.72 211.68 142.67 288.80 282.72 200.64 76100096 HC CTRL NOSEBLEED ANTER COMPLEX 761 30903 304.00 291.84 291.84 288.80 282.72 291.84 282.72 211.68 142.67 288.80 282.72 200.64 76100097 HC CTRL NOSEBLEED POST W/PACKS &/OR CAUT 761 30905 304.00 291.84 291.84 288.80 282.72 291.84 282.72 211.68 142.67 288.80 282.72 200.64 76100098 HC REPEAT CONTROL OF NOSEBLEED 761 30906 281.00 269.76 269.76 266.95 261.33 269.76 261.33 195.66 131.87 266.95 261.33 185.46 76100100 HC DRAIN SKIN ABSCESS SIMPLE 761 10060 360.00 345.60 345.60 342.00 334.80 345.60 334.80 250.67 168.95 342.00 334.80 237.60 76100101 HC DRAIN SKIN ABSCESS COMPLIC 761 10061 721.00 692.16 692.16 684.95 670.53 692.16 670.53 502.03 338.37 684.95 670.53 475.86 76100102 HC DRAIN PILONIDAL CYST SIMPL 761 10080 " 1,351.00 " " 1,296.96 " " 1,296.96 " " 1,283.45 " " 1,256.43 " " 1,296.96 " " 1,256.43 " 940.70 634.02 " 1,283.45 " " 1,256.43 " 891.66 76100104 HC DRAINAGE OF HEMATOMA/FLUID 761 10140 " 3,599.00 " " 3,455.04 " " 3,455.04 " " 3,419.05 " " 3,347.07 " " 3,455.04 " " 3,347.07 " " 2,505.98 " " 1,689.01 " " 3,419.05 " " 3,347.07 " " 2,375.34 " 76100106 HC DRAIN BLOOD FROM UNDER NAIL 761 11740 168.00 161.28 161.28 159.60 156.24 161.28 156.24 116.98 78.84 159.60 156.24 110.88 76100107 HC I&D DEEP ABSC/HEMATOMA NECK/CHEST 761 21501 " 4,399.00 " " 4,223.04 " " 4,223.04 " " 4,179.05 " " 4,091.07 " " 4,223.04 " " 4,091.07 " " 3,063.02 " " 2,064.45 " " 4,179.05 " " 4,091.07 " " 2,903.34 " 76100113 HC DRAIN FINGER ABSCESS SIMPLE 761 26010 360.00 345.60 345.60 342.00 334.80 345.60 334.80 250.67 168.95 342.00 334.80 237.60 76100114 HC DRAIN FINGER ABSCESS COMPLICATED 761 26011 " 1,462.00 " " 1,403.52 " " 1,403.52 " " 1,388.90 " " 1,359.66 " " 1,403.52 " " 1,359.66 " " 1,017.99 " 686.12 " 1,388.90 " " 1,359.66 " 964.92 76100119 HC DRAIN ABSCESS/HEMATOMA NASAL 761 30000 395.00 379.20 379.20 375.25 367.35 379.20 367.35 275.04 185.37 375.25 367.35 260.70 76100121 HC DRAIN MOUTH ABSC/CYST/HEMATOMA SIMPL 761 40800 " 1,350.00 " " 1,296.00 " " 1,296.00 " " 1,282.50 " " 1,255.50 " " 1,296.00 " " 1,255.50 " 940.01 633.56 " 1,282.50 " " 1,255.50 " 891.00 76100123 HC DRAINAGE OF GUM LESION 761 41800 360.00 345.60 345.60 342.00 334.80 345.60 334.80 250.67 168.95 342.00 334.80 237.60 76100125 HC I&D PERIANAL ABSCESS SUPERFICIAL 761 46050 " 1,687.00 " " 1,619.52 " " 1,619.52 " " 1,602.65 " " 1,568.91 " " 1,619.52 " " 1,568.91 " " 1,174.66 " 791.71 " 1,602.65 " " 1,568.91 " " 1,113.42 " 76100126 HC INCISE EXTERNAL HEMORRHOID 761 46083 506.00 485.76 485.76 480.70 470.58 485.76 470.58 352.33 237.47 480.70 470.58 333.96 76100128 HC I&D OF VULVA/PERINEUM ABSCESS 761 56405 598.00 574.08 574.08 568.10 556.14 574.08 556.14 416.39 280.64 568.10 556.14 394.68 76100129 HC I&D BARTHOLIN GLAND ABSCESS 761 56420 360.00 345.60 345.60 342.00 334.80 345.60 334.80 250.67 168.95 342.00 334.80 237.60 76100131 HC DRAIN EXT EAR ABSC/BLOOD SIMPLE 761 69000 832.00 798.72 798.72 790.40 773.76 798.72 773.76 579.32 390.46 790.40 773.76 549.12 76100134 HC INSERT NEEDLE INTRAOSSEOUS INFUSN 761 36680 779.00 747.84 747.84 740.05 724.47 747.84 724.47 542.42 365.58 740.05 724.47 514.14 76100148 HC CARDIOPULMONARY RESUSCITATION 761 92950 971.00 932.16 932.16 922.45 903.03 932.16 903.03 676.11 455.69 922.45 903.03 640.86 76100199 HC INCAL BX SKN SINGLE LES 761 11106 476.00 456.96 456.96 452.20 442.68 456.96 442.68 331.44 223.39 452.20 442.68 314.16 76100217 HC TANGENTIAL BIOPSY SKIN SINGLE LESION 761 11102 476.00 456.96 456.96 452.20 442.68 456.96 442.68 331.44 223.39 452.20 442.68 314.16 76100218 HC PUNCH BIOPSY SKIN SINGLE LESION 761 11104 476.00 456.96 456.96 452.20 442.68 456.96 442.68 331.44 223.39 452.20 442.68 314.16 76100219 HC INJECT TENDON SHEATH/LIGAMENT 761 20550 238.00 228.48 228.48 226.10 221.34 228.48 221.34 165.72 111.69 226.10 221.34 157.08 76100220 HC THROMBOLYSIS CEREBRAL BY INTRAVENOUS INFUSION 761 37195 855.00 820.80 820.80 812.25 795.15 820.80 795.15 595.34 401.25 812.25 795.15 564.30 76100243 HC RADIO FREQUENCY ABLATION NERVE OF SI JOINT 761 64625 " 1,531.00 " " 1,469.76 " " 1,469.76 " " 1,454.45 " " 1,423.83 " " 1,469.76 " " 1,423.83 " " 1,066.04 " 718.50 " 1,454.45 " " 1,423.83 " " 1,010.46 " 76100244 HC DESTRUCTION GENICULAR NERVE NEUROLYTIC AGENT COMPLETE 761 64624 " 1,685.00 " " 1,617.60 " " 1,617.60 " " 1,600.75 " " 1,567.05 " " 1,617.60 " " 1,567.05 " " 1,173.27 " 790.77 " 1,600.75 " " 1,567.05 " " 1,112.10 " 76100245 HC INJECT GENICULAR NERVE COMPLETE 761 64454 " 1,685.00 " " 1,617.60 " " 1,617.60 " " 1,600.75 " " 1,567.05 " " 1,617.60 " " 1,567.05 " " 1,173.27 " 790.77 " 1,600.75 " " 1,567.05 " " 1,112.10 " 76100246 HC INJECT NERVE OF SI JOINT 761 64451 784.00 752.64 752.64 744.80 729.12 752.64 729.12 545.90 367.93 744.80 729.12 517.44 76100247 HC SPINAL PUNCTURE THERAPEUTIC W FLUORO GUIDANCE 761 62329 " 1,381.00 " " 1,325.76 " " 1,325.76 " " 1,311.95 " " 1,284.33 " " 1,325.76 " " 1,284.33 " 961.59 648.10 " 1,311.95 " " 1,284.33 " 911.46 76100248 HC SPINAL PUNCTURE THERAPEUTIC W CT GUIDANCE 761 62329 " 1,597.00 " " 1,533.12 " " 1,533.12 " " 1,517.15 " " 1,485.21 " " 1,533.12 " " 1,485.21 " " 1,111.99 " 749.47 " 1,517.15 " " 1,485.21 " " 1,054.02 " 76100249 HC SPINAL PUNCTURE LUMBAR DX W FLUORO GUIDANCE 761 62328 " 2,567.00 " " 2,464.32 " " 2,464.32 " " 2,438.65 " " 2,387.31 " " 2,464.32 " " 2,387.31 " " 1,787.40 " " 1,204.69 " " 2,438.65 " " 2,387.31 " " 1,694.22 " 76100250 HC SPINAL PUNCTURE LUMBAR DX W CT GUIDANCE 761 62328 " 1,597.00 " " 1,533.12 " " 1,533.12 " " 1,517.15 " " 1,485.21 " " 1,533.12 " " 1,485.21 " " 1,111.99 " 749.47 " 1,517.15 " " 1,485.21 " " 1,054.02 " 76100252 HC MNT INITIAL EACH 15 MIN 761 97802 47.00 45.12 45.12 44.65 43.71 45.12 43.71 32.73 22.06 44.65 43.71 31.02 76100253 HC MNT FOLLOW-UP EACH 15 MIN 761 97803 44.00 42.24 42.24 41.80 40.92 42.24 40.92 30.64 20.65 41.80 40.92 29.04 76200001 HC OBSERVATION 762 G0378 53.00 50.88 50.88 50.35 49.29 50.88 49.29 36.90 24.87 50.35 49.29 34.98 77100001 HC ADMINISTRATION FEE -- INFLUENZA 771 90471 21.00 20.16 20.16 19.95 19.53 20.16 19.53 14.62 9.86 19.95 19.53 13.86 77100002 HC ADMINISTRATION FEE -- PNEUMOCOCCAL 771 90471 21.00 20.16 20.16 19.95 19.53 20.16 19.53 14.62 9.86 19.95 19.53 13.86 77100003 HC VACCINE ADMINISTRATION 771 90471 21.00 20.16 20.16 19.95 19.53 20.16 19.53 14.62 9.86 19.95 19.53 13.86 77100004 HC ADMINISTRATION FEE -- HEPATITIS B 771 90471 21.00 20.16 20.16 19.95 19.53 20.16 19.53 14.62 9.86 19.95 19.53 13.86 77100005 HC IMMUNIZATION ADMINISTRATION EA ADDL 771 90472 21.00 20.16 20.16 19.95 19.53 20.16 19.53 14.62 9.86 19.95 19.53 13.86 77100006 HC IMMUNIZATION ADMINISTRATION PFIZER-NIONTECH COVID-19 VACCINE - FIRST DOSE 771 0001A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 77100007 HC IMMUNIZATION ADMINISTRATION PFIZER-NIONTECH COVID-19 VACCINE -SECOND DOSE 771 0002A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 77100008 HC IMMUNIZATION ADMINISTRATION MODERNA COVID-19 VACCINE - FIRST DOSE 771 0011A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 77100009 HC IMMUNIZATION ADMINISTRATION MODERNA COVID-19 VACCINE - SECOND DOSE 771 0012A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 77100010 HC IMMUNIZATION ADMINISTRATION ASTRAZENECA COVID-19 VACCINE - FIRST DOSE 771 0021A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 77100011 HC IMMUNIZATION ADMINISTRATION ASTRAZENECA COVID-19 VACCINE - SECOND DOSE 771 0022A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 77100012 HC IMMUNIZATION ADMINISTRATION JANSEN-COVID-19 VACCINE 771 0031A 60.00 57.60 57.60 57.00 55.80 57.60 55.80 41.78 28.16 57.00 55.80 39.60 90000006 HC SW DX INTERVIEW EXAM 900 90791 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 91400059 HC SW IND THERAPY 16-37 914 90832 240.00 230.40 230.40 228.00 223.20 230.40 223.20 167.11 112.63 228.00 223.20 158.40 91400060 HC SW IND THERAPY 38-52 914 90834 250.00 240.00 240.00 237.50 232.50 240.00 232.50 174.08 117.33 237.50 232.50 165.00 91400061 HC SW IND THERAPY 53+ 914 90837 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 91400062 HC FAMILY WITHOUT THE PATIENT 50 MINUTES 914 90846 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 91400063 HC FAMILY WITH THE PATIENT 50 MINUTES 914 90847 260.00 249.60 249.60 247.00 241.80 249.60 241.80 181.04 122.02 247.00 241.80 171.60 92000002 HC ARTERIAL PHLEBOTOMY 920 36600 99.00 95.04 95.04 94.05 92.07 95.04 92.07 68.93 46.46 94.05 92.07 65.34 92000004 HC FETAL MONITORING 920 59025 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 92000011 HC MULTICHNL SLEEP STUDY UNATTEND 920 95806 " 1,050.00 " " 1,008.00 " " 1,008.00 " 997.50 976.50 " 1,008.00 " 976.50 731.12 492.77 997.50 976.50 693.00 92000013 HC POLYSOMNOGRAPHY 920 95810 " 3,778.00 " " 3,626.88 " " 3,626.88 " " 3,589.10 " " 3,513.54 " " 3,626.88 " " 3,513.54 " " 2,630.62 " " 1,773.02 " " 3,589.10 " " 3,513.54 " " 2,493.48 " 92000014 HC NASAL CPAP STUDY 920 95811 " 4,296.00 " " 4,124.16 " " 4,124.16 " " 4,081.20 " " 3,995.28 " " 4,124.16 " " 3,995.28 " " 2,991.30 " " 2,016.11 " " 4,081.20 " " 3,995.28 " " 2,835.36 " 92000015 HC HOME SLEEP TEST/TYPE 3 PORTA 920 G0399 " 1,050.00 " " 1,008.00 " " 1,008.00 " 997.50 976.50 " 1,008.00 " 976.50 731.12 492.77 997.50 976.50 693.00 92000024 HC POLYSOMNOGRAPHY SPLIT 920 95811 " 4,296.00 " " 4,124.16 " " 4,124.16 " " 4,081.20 " " 3,995.28 " " 4,124.16 " " 3,995.28 " " 2,991.30 " " 2,016.11 " " 4,081.20 " " 3,995.28 " " 2,835.36 " 92000025 HC NON-STRESS TEST 920 59025 333.00 319.68 319.68 316.35 309.69 319.68 309.69 231.87 156.28 316.35 309.69 219.78 92100016 HC CAROTID DUPLEX BILATERAL 921 93880 " 1,408.00 " " 1,351.68 " " 1,351.68 " " 1,337.60 " " 1,309.44 " " 1,351.68 " " 1,309.44 " 980.39 660.77 " 1,337.60 " " 1,309.44 " 929.28 92100017 HC CAROTID DUPLEX LMT OR UNI 921 93882 " 1,148.00 " " 1,102.08 " " 1,102.08 " " 1,090.60 " " 1,067.64 " " 1,102.08 " " 1,067.64 " 799.35 538.76 " 1,090.60 " " 1,067.64 " 757.68 92100020 HC ARTERIAL ANKLE ARM INDEX 921 93922 554.00 531.84 531.84 526.30 515.22 531.84 515.22 385.75 259.99 526.30 515.22 365.64 92100021 HC ART SEG STUDY & REAC HYPEREMIA 921 93923 824.00 791.04 791.04 782.80 766.32 791.04 766.32 573.75 386.70 782.80 766.32 543.84 92100022 HC ART SEG STUDY & EXERCISE LOWER 921 93924 965.00 926.40 926.40 916.75 897.45 926.40 897.45 671.93 452.87 916.75 897.45 636.90 92100023 HC ARTERIAL SCAN LOWER BIL 921 93925 " 1,140.00 " " 1,094.40 " " 1,094.40 " " 1,083.00 " " 1,060.20 " " 1,094.40 " " 1,060.20 " 793.78 535.00 " 1,083.00 " " 1,060.20 " 752.40 92100024 HC ART DUPLEX SCAN LOWER LTD 921 93926 911.00 874.56 874.56 865.45 847.23 874.56 847.23 634.33 427.53 865.45 847.23 601.26 92100025 HC ARTERIAL DUPLEX SCAN BIL UPPER 921 93930 " 1,114.00 " " 1,069.44 " " 1,069.44 " " 1,058.30 " " 1,036.02 " " 1,069.44 " " 1,036.02 " 775.68 522.80 " 1,058.30 " " 1,036.02 " 735.24 92100026 HC ART DUPLEX SCAN UPPER LTD 921 93931 898.00 862.08 862.08 853.10 835.14 862.08 835.14 625.28 421.43 853.10 835.14 592.68 92100028 HC DOPPLER - EXT VENOUS LTD 921 93971 966.00 927.36 927.36 917.70 898.38 927.36 898.38 672.63 453.34 917.70 898.38 637.56 92100029 HC RENAL ARTERY DUPLEX COMPLETE 921 93975 " 1,044.00 " " 1,002.24 " " 1,002.24 " 991.80 970.92 " 1,002.24 " 970.92 726.94 489.95 991.80 970.92 689.04 92100031 HC AORTA IVC ILIAC DUPLEX 921 93978 991.00 951.36 951.36 941.45 921.63 951.36 921.63 690.03 465.08 941.45 921.63 654.06 92100032 HC DUPLEX OF HEMODIALYSIS ACCESS 921 93990 640.00 614.40 614.40 608.00 595.20 614.40 595.20 445.63 300.35 608.00 595.20 422.40 92100034 HC ARTERIAL SEGMENTAL UPPER/LOWER 921 93923 824.00 791.04 791.04 782.80 766.32 791.04 766.32 573.75 386.70 782.80 766.32 543.84 92100037 HC ERIAL ANKLE ARM INDEX EXER 921 93924 965.00 926.40 926.40 916.75 897.45 926.40 897.45 671.93 452.87 916.75 897.45 636.90 92100038 HC ARTERIAL SCAN LOWER LTD 921 93926 911.00 874.56 874.56 865.45 847.23 874.56 847.23 634.33 427.53 865.45 847.23 601.26 92100039 HC VENOUS DUPLEX SCAN BILATERAL 921 93970 " 1,329.00 " " 1,275.84 " " 1,275.84 " " 1,262.55 " " 1,235.97 " " 1,275.84 " " 1,235.97 " 925.38 623.70 " 1,262.55 " " 1,235.97 " 877.14 92100042 HC VENOUS DUPLEX SCAN UNI LTD 921 93971 993.00 953.28 953.28 943.35 923.49 953.28 923.49 691.43 466.01 943.35 923.49 655.38 92100043 HC VENOUS MAPPING LTD 921 93971 993.00 953.28 953.28 943.35 923.49 953.28 923.49 691.43 466.01 943.35 923.49 655.38 92100044 HC US DOPP ABD PEL SCROT RET 921 93975 764.00 733.44 733.44 725.80 710.52 733.44 710.52 531.97 358.55 725.80 710.52 504.24 92100045 HC DOPP AB PEL SCROT RET LTD 921 93976 602.00 577.92 577.92 571.90 559.86 577.92 559.86 419.17 282.52 571.90 559.86 397.32 92200008 HC EMG WITH NERVE CONDUCTION 922 95885 103.00 98.88 98.88 97.85 95.79 98.88 95.79 71.72 48.34 97.85 95.79 67.98 92200009 HC EMG 5+ MUSCLES 922 95886 161.00 154.56 154.56 152.95 149.73 154.56 149.73 112.10 75.56 152.95 149.73 106.26 92200010 HC EMG NON EXTREMITY 922 95887 142.00 136.32 136.32 134.90 132.06 136.32 132.06 98.87 66.64 134.90 132.06 93.72 92200012 HC NERVE CONDUCTION STUDIES 1-2 922 95907 85.00 81.60 81.60 80.75 79.05 81.60 79.05 59.19 39.89 80.75 79.05 56.10 92200013 HC NERVE CONDUCTION STUDIES 5-6 922 95909 131.00 125.76 125.76 124.45 121.83 125.76 121.83 91.22 61.48 124.45 121.83 86.46 92200014 HC NERVE CONDUCTION STUDIES 7-8 922 95910 173.00 166.08 166.08 164.35 160.89 166.08 160.89 120.46 81.19 164.35 160.89 114.18 92200015 HC NERVE CONDUCTION STUDIES 9-10 922 95911 200.00 192.00 192.00 190.00 186.00 192.00 186.00 139.26 93.86 190.00 186.00 132.00 92200016 HC NERVE CONDUCTION STUDIES 13 > 922 95913 222.00 213.12 213.12 210.90 206.46 213.12 206.46 154.58 104.18 210.90 206.46 146.52 92200024 HC NERVE CONDUCTION STUDIES 3-4 922 95908 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 92200025 HC NERVE CONDUCTION STUDIES 11-12 922 95912 206.00 197.76 197.76 195.70 191.58 197.76 191.58 143.44 96.68 195.70 191.58 135.96 94000001 HC THERAPEUTIC PHLEBOTOMY 940 99195 201.00 192.96 192.96 190.95 186.93 192.96 186.93 139.96 94.33 190.95 186.93 132.66 94200001 HC NUTR THER INITIAL DM EA 15M 942 97802 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 94200002 HC NUTR THER DM REAS 15M 942 97803 44.00 42.24 42.24 41.80 40.92 42.24 40.92 30.64 20.65 41.80 40.92 29.04 94200006 HC IND COMP DM ED/30M 942 G0108 50.00 48.00 48.00 47.50 46.50 48.00 46.50 34.82 23.47 47.50 46.50 33.00 94200007 HC GRP COMP DM ED/30M 942 G0109 80.00 76.80 76.80 76.00 74.40 76.80 74.40 55.70 37.54 76.00 74.40 52.80 94300001 HC PHASE IV MONTHLY 943 81.00 77.76 77.76 76.95 75.33 77.76 75.33 56.40 38.01 76.95 75.33 53.46 94300002 HC HEALTHY LIFESTYLES FT MON 943 42.00 40.32 40.32 39.90 39.06 40.32 39.06 29.24 19.71 39.90 39.06 27.72 94300003 HC HEALTHY LIFESTYLES PT MON 943 21.00 20.16 20.16 19.95 19.53 20.16 19.53 14.62 9.86 19.95 19.53 13.86 94300004 HC HEALTHY LIFESTYLES INIT V 943 17.00 16.32 16.32 16.15 15.81 16.32 15.81 11.84 7.98 16.15 15.81 11.22 94700002 HC BED CLINITRON PER DAY 947 275.00 264.00 264.00 261.25 255.75 264.00 255.75 191.48 129.06 261.25 255.75 181.50 94800001 HC PULM REHAB NON-COPD 948 94799 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 94800002 HC PULM REHAB COPD 948 G0424 232.00 222.72 222.72 220.40 215.76 222.72 215.76 161.54 108.88 220.40 215.76 153.12 96400001 HC ANEST # 964 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 96400002 HC CRNA INSERT EMERGENCY ENDOTRACH AIRWAY 964 31500 218.00 209.28 209.28 207.10 202.74 209.28 202.74 151.79 102.31 207.10 202.74 143.88 96400003 HC CRNA VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VIEW 964 36400 64.00 61.44 61.44 60.80 59.52 61.44 59.52 44.56 30.04 60.80 59.52 42.24 96400004 HC CRNA VNPNXR 3 YEARS/> PHYS/QHP SKILL 964 36410 44.00 42.24 42.24 41.80 40.92 42.24 40.92 30.64 20.65 41.80 40.92 29.04 96400005 HC CRNA WITHDRAWAL OF ARTERIAL BLOOD 964 36600 96.00 92.16 92.16 91.20 89.28 92.16 89.28 66.84 45.05 91.20 89.28 63.36 96400006 HC CRNA SPINAL PUNCTURE LUMBAR DIAGNOSTIC 964 62270 309.00 296.64 296.64 293.55 287.37 296.64 287.37 215.16 145.01 293.55 287.37 203.94 96400007 HC CRNA INJ LUMB EPIDUR BLOOD/CLOT PATCH 964 62273 427.00 409.92 409.92 405.65 397.11 409.92 397.11 297.32 200.39 405.65 397.11 281.82 96400008 HC CRNA NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN 964 62320 379.00 363.84 363.84 360.05 352.47 363.84 352.47 263.90 177.86 360.05 352.47 250.14 96400009 HC CRNA NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 964 62321 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 96400010 HC CRNA NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN 964 62322 379.00 363.84 363.84 360.05 352.47 363.84 352.47 263.90 177.86 360.05 352.47 250.14 96400011 HC CRNA NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN 964 62323 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 96400012 HC CRNA NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN 964 62324 379.00 363.84 363.84 360.05 352.47 363.84 352.47 263.90 177.86 360.05 352.47 250.14 96400013 HC CRNA NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 964 62325 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 96400014 HC CRNA NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN 964 62326 379.00 363.84 363.84 360.05 352.47 363.84 352.47 263.90 177.86 360.05 352.47 250.14 96400015 HC CRNA NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN 964 62327 536.00 514.56 514.56 509.20 498.48 514.56 498.48 373.22 251.54 509.20 498.48 353.76 96400016 HC CRNA INJ ANES AGENT BRACHIAL PLEXUS SINGLE 964 64415 " 1,026.00 " 984.96 984.96 974.70 954.18 984.96 954.18 714.40 481.50 974.70 954.18 677.16 96400017 HC CRNA INJ ANES AGENT SCIATIC NERVE SINGLE 964 64445 " 1,026.00 " 984.96 984.96 974.70 954.18 984.96 954.18 714.40 481.50 974.70 954.18 677.16 96400018 HC CRNA INJ ANES AGENT FEMORAL NERVE SINGLE 964 64447 " 1,026.00 " 984.96 984.96 974.70 954.18 984.96 954.18 714.40 481.50 974.70 954.18 677.16 96400019 HC ANEST# NON-TIMED 964 105.00 100.80 100.80 99.75 97.65 100.80 97.65 73.11 49.28 99.75 97.65 69.30 96400020 HC CRNA US GUIDE VASCULAR ACCESS 964 76937 891.00 855.36 855.36 846.45 828.63 855.36 828.63 620.40 418.15 846.45 828.63 588.06 97500001 HC BIOPSY OF PROSTATE NEEDLE/PUNCH 975 55700 464.00 445.44 445.44 440.80 431.52 445.44 431.52 323.08 217.76 440.80 431.52 306.24 97500002 HC BIOPSY OF PROSTATE INCISIONAL 975 55705 504.00 483.84 483.84 478.80 468.72 483.84 468.72 350.94 236.53 478.80 468.72 332.64 97500003 HC CYSTOURETHROSCOPY W/IRRIG & EVAC CLOTS 975 52001 740.00 710.40 710.40 703.00 688.20 710.40 688.20 515.26 347.28 703.00 688.20 488.40 97500004 HC CYSTOURETHROSCOPY BIOPSY 975 52204 702.00 673.92 673.92 666.90 652.86 673.92 652.86 488.80 329.45 666.90 652.86 463.32 97500005 HC CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER 975 52287 628.00 602.88 602.88 596.60 584.04 602.88 584.04 437.28 294.72 596.60 584.04 414.48 97500006 HC CYSTOURETHROSCOPY FULGUR <0.5 CM LESN 975 52224 " 1,356.00 " " 1,301.76 " " 1,301.76 " " 1,288.20 " " 1,261.08 " " 1,301.76 " " 1,261.08 " 944.18 636.37 " 1,288.20 " " 1,261.08 " 894.96 97500007 HC CYSTOURETHROSCOPY FULGUR 0.5-2 CM LESN 975 52234 467.00 448.32 448.32 443.65 434.31 448.32 434.31 325.17 219.16 443.65 434.31 308.22 97500008 HC CYSTOURETHROSCOPY FULGUR 2-5 CM LESN 975 52235 548.00 526.08 526.08 520.60 509.64 526.08 509.64 381.57 257.18 520.60 509.64 361.68 97500009 HC CYSTOURETHROSCOPY FULGUR >5 CM LESN 975 52240 745.00 715.20 715.20 707.75 692.85 715.20 692.85 518.74 349.63 707.75 692.85 491.70 97500010 HC CYSTOSCOPY DIR VIS INT URETHROTOMY 975 52276 502.00 481.92 481.92 476.90 466.86 481.92 466.86 349.54 235.59 476.90 466.86 331.32 97500011 HC CYSTOSCOPY INSERT URETERAL STENT 975 52332 877.00 841.92 841.92 833.15 815.61 841.92 815.61 610.66 411.58 833.15 815.61 578.82 97500012 HC CYSTO/URETERO/PYELOSCOPY DX 975 52351 575.00 552.00 552.00 546.25 534.75 552.00 534.75 400.37 269.85 546.25 534.75 379.50 97500013 HC CYSTO/URETERO/PYELOSCOPY W/LITHOTRIPSY 975 52353 745.00 715.20 715.20 707.75 692.85 715.20 692.85 518.74 349.63 707.75 692.85 491.70 97500014 HC FRAGMENT KIDNEY STONE/ ESWL 975 50590 " 1,372.00 " " 1,317.12 " " 1,317.12 " " 1,303.40 " " 1,275.96 " " 1,317.12 " " 1,275.96 " 955.32 643.88 " 1,303.40 " " 1,275.96 " 905.52 97500015 HC CYSTO/URETERO W/LITHOTRIPSY & INDWELL STENT INSRT 975 52356 791.00 759.36 759.36 751.45 735.63 759.36 735.63 550.77 371.22 751.45 735.63 522.06 97500016 HC CYSTOSCOPY DIL URETHRAL STRICTURE 975 52281 555.00 532.80 532.80 527.25 516.15 532.80 516.15 386.45 260.46 527.25 516.15 366.30 97500017 HC DRAINAGE OF HYDROCELE TUNICA 975 55000 217.00 208.32 208.32 206.15 201.81 208.32 201.81 151.10 101.84 206.15 201.81 143.22 97500018 HC REMOVAL OF HYDROCELE TUNICA UNILAT 975 55040 638.00 612.48 612.48 606.10 593.34 612.48 593.34 444.24 299.41 606.10 593.34 421.08 97500019 HC LYSIS/EXCIS PENILE POSTCIRCUM ADHESIONS 975 54162 484.00 464.64 464.64 459.80 450.12 464.64 450.12 337.01 227.14 459.80 450.12 319.44 98100001 HC DRAIN SKIN ABSCESS SIMPLE 981 10060 220.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100002 HC DRAIN SKIN ABSCESS COMPLEX 981 10061 382.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100003 HC DRAIN PILONIDAL CYST SIMPLE 981 10080 338.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100004 HC REMOVE FOREIGN BODY SIMPLE 981 10120 281.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100005 HC REMOVE FOREIGN BODY COMPLEX 981 10121 502.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100006 HC PUNCTURE DRAINAGE OF LESION 981 10160 240.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100007 HC DEBRIDEMENT SKIN SUB-Q TISSUE=<20 SQ CM 981 11042 225.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100008 HC REMOVAL OF SKIN TAGS UP TO 15 981 11200 163.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100009 HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY 981 11421 291.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100010 HC DEBRIDEMENT OF NAIL(S) 1-5 981 11720 62.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100011 HC REMOVAL OF NAIL PLATE 981 11730 203.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100012 HC REMOVE ADDITIONAL NAIL PLATE 981 11732 61.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100013 HC DRAIN BLOOD FROM UNDER NAIL 981 11740 95.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100014 HC RECONSTRUC OF NAIL BED 981 11760 355.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100015 HC EXCISION OF NAIL FOLD TOE 981 11765 314.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100016 HC RESUPERF WND BODY <2.5CM 981 12001 164.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100017 HC RESUP NPTERF WND BODY 2.6-7.5 CM 981 12002 200.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100018 HC RESUPERF WND BODY 7.6-12.5 CM 981 12004 234.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100019 HC RESUPERF WND BODY 12.6-20 CM 981 12005 304.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100020 HC RESUPERF WND BODY 20.1-30 CM 981 12006 358.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100021 HC RESUPERF WND FACE <2.5 CM 981 12011 200.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100022 HC RESUPERF WND FACE 2.6-5 CM 981 12013 209.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100023 HC RESUPERF WND FACE 5.1-7.5 CM 981 12014 251.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100024 HC RESUPERF WND FACE 7.6-12.5 CM 981 12015 304.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100025 HC RESUPERF WND FACE 12.6-20 CM 981 12016 383.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100026 HC RESUPERF WND FACE 20.1-30 CM 981 12017 282.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100027 HC RESUPERF WND FACE >30 CM 981 12018 319.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100028 HC CLOSURE SUPERF WND DEHIS SIMPLE 981 12020 527.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100029 HC LAYR CLOS WND TRUNK ARM LEG <2.5 CM 981 12031 450.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100030 HC LAYR CLOS WND TRUNK ARM LEG 2.6-7.5 CM 981 12032 558.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100031 HC LAYR CLOS WND TRUNK ARM LEG 7.6-12.5 CM 981 12034 585.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100032 HC LAYR CLOS WND TRUNK ARM LEG 12.6-20 CM 981 12035 703.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100033 HC LAYR CLOS WND REST BODY <2.5 CM 981 12041 451.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100034 HC LAYR CLOS WND REST BODY 2.6-7.5 CM 981 12042 543.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100035 HC LAYR CLOS WND FACE FACIAL <2.5 CM 981 12051 487.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100036 HC LAYR CLOS WND FACE FACIAL 2.5-5 CM 981 12052 552.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100037 HC LAYR CLOS WND FACE FACIAL 5.1-7.5 CM 981 12053 646.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100038 HC LAYR CLOS WND FACE FACIAL 12.6-20 CM 981 12055 875.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100039 HC RECMPL WND SCALP EXTR 1.1-2.5 CM 981 13120 651.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100040 HC RECMPL WND SCALP EXTR 2.6-7.5 CM 981 13121 792.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100041 HC REP SKIN SCALP/EXTREM+5 CM/< 981 13122 243.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100042 HC RECMPL WND HEAD FAC HAND 2.6-7.5 CM 981 13132 882.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100043 HC REPR FACE GENITAL HAND FT+5 CMCM/< 981 13133 326.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100044 HC RECMPL WND LID NOS EAR 2.5-7.5 CM 981 13152 935.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100045 HC INITIAL RX BURN(S) 1ST DEGREE 981 16000 130.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100046 HC DRESS/DEBRID SMALL BURN NO ANES 981 16020 150.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100047 HC DRESS/DEBRID LARGE BURN NO ANESTH 981 16030 347.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100048 HC INJECT TRIGGER POINT 1 OR 2 981 20552 103.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100049 HC INJECT TRIGGER POINTS > 3 981 20553 118.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100050 HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 981 20600 90.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100051 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 981 20605 94.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100052 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 981 20610 110.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100053 HC CLOSED RX MANDIBLE FX+MANIPULATN 981 21451 " 1,399.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100054 HC CLOSED RX CLAVICLE FRACTURE 981 23500 401.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100055 HC CLOSED RX SCAPULA FX MANIPULATN 981 23575 738.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100056 HC CLOSED RX PROX HUMERUS FRACTURE 981 23600 601.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100057 HC CLOSED RX GR TUBEROSITY HUM FX 981 23620 491.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100058 HC CLOSED RX SHLDR DISLOCATION 981 23650 587.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100059 HC CLOSED RX SHLDR DISLOC ANESTHESIA 981 23655 739.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100060 HC INCIS/DRAIN ARM/ELBOW INFECT BURSA 981 23931 527.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100061 HC CLOSED RX ELBOW DISLOCATION 981 24600 681.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100062 HC CLOSED RX ELBOW DISLOCATN ANESTHESIA 981 24605 866.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100063 HC CLOSED RX RADIAL HEAD DISLOC CHILD 981 24640 189.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100064 HC CLOSED RX RADIAL HEAD/NECK FX 981 24650 479.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100065 HC CLOSED RX RAD/ULNA SHAFT FX MANIP 981 25565 945.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100066 HC CLOSED RX DIST RAD/ULNA FX 981 25600 604.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100067 HC CLOSED RX DIST RAD/ULNA FX MANIPUL 981 25605 991.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100068 HC DRAIN FINGER ABSCESS SIMPLE 981 26010 500.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100069 HC REPAIR EXTEN TENDON DORSUM HAND EA 981 26410 " 1,018.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100070 HC CLOSED RX METACARPAL FX MANIP 981 26605 593.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100071 HC TREAT THUMB DISLOC MANIPULATN 981 26641 694.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100072 HC CLOSED RX CARPOMETACAR DISLOC NON-THUMB 981 26670 636.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100073 HC CLOSED RX MC-P DISLOC 981 26700 606.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100074 HC CLOSE RX PROX/MID FING SHFT FX 981 26720 362.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100075 "HC CLOSE RX PROX/MID FING SHFT FX,MANIP" 981 26725 621.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100076 HC CLOSE RX FINGR ARTICULAR FX 981 26740 421.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100077 HC CLOSE RX DIST FINGR FX 981 26750 339.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100078 HC CLOSE RX DIST FINGR FX MANIPULATN 981 26755 579.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100079 HC CLOSED RX IP JT DISLOCATION 981 26770 514.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100080 HC CLOSED RX IP JT DISLOCATION ANESTH 981 26775 706.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100081 HC CLOSED RX TRAUMATIC HIP DISLOCATN 981 27250 334.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100082 HC CLOSED RX POST HIP ARTHRPLAS DISLOC 981 27265 742.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100083 HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 981 27808 612.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100084 HC CLOSED RX TRIMALLEOLAR FX MANIP 981 27818 894.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100085 HC REMV FOOT FOREIGN BODY SUBCUTANEOUS 981 28190 479.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100086 HC CLOSED RX TALUS FX MANIPULATN 981 28435 666.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100087 HC CLOSED RX BIG TOE FRACTURE 981 28490 267.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100088 HC CLOSED RX TOE FX 981 28510 228.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100089 HC APPLY LONG ARM CAST 981 29065 175.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100090 HC APPLY FOREARM CAST 981 29075 158.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100091 HC APPLY HAND/WRIST CAST 981 29085 174.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100092 HC APPLY LONG ARM SPLINT 981 29105 151.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100093 HC APPLY FOREARM SPLINT STATIC 981 29125 118.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100094 HC APPLY FINGER SPLINT STATIC 981 29130 76.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100095 HC STRAPPING OF SHOULDER 981 29240 58.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100096 HC STRAPPING OF ELBOW OR WRIST 981 29260 56.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100097 HC STRAPPING OF HAND OR FINGER 981 29280 57.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100098 HC APPLY LONG LEG CAST 981 29345 247.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100099 HC APPLY LONG LEG CAST WALKER 981 29355 258.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100100 HC APPLY SHORT LEG CAST 981 29405 148.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100101 HC ADDITION OF WALKER TO CAST 981 29440 82.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100102 HC APPLY LONG LEG SPLINT 981 29505 157.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100103 HC APPLY LOWER LEG SPLINT 981 29515 132.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100104 HC REMOVE NASAL FOREIGN BODY 981 30300 340.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100105 HC CTRL NOSEBLEED ANTER SIMPLE 981 30901 253.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100106 HC CTRL NOSEBLEED ANTER COMPLEX 981 30903 398.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100107 HC INSERT EMERGENCY ENDOTRACH AIRWAY 981 31500 267.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100108 HC RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 981 36590 407.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100109 HC INSERT NEEDLE INTRAOSSEOUS INFUSN 981 36680 109.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100110 HC REPAIR LIP FULL THICK VERMILION 981 40650 841.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100111 HC DRAIN MOUTH ABSC/CYST/HEMATOMA SIMPL 981 40800 392.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100112 HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 981 43762 407.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100113 HC DRAINAGE OF DEEP RECTAL ABSCESS 981 45020 " 1,048.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100114 HC I&D PERIRECTAL ABSCESS 981 46040 987.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100115 HC I&D PERIANAL ABSCESS SUPERFICIAL 981 46050 384.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100116 HC INCISE EXTERNAL HEMORRHOID 981 46083 337.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100117 HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE 981 49083 550.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100118 HC INSERT NON-INDWELLING BLADDER CATHETER 981 51701 83.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100119 HC INSERT TEMP INDWELLING BLAD CATH SIMPLE 981 51702 115.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100120 HC MEAS POST-VOID RES US NON-IMAGING 981 51798 23.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100121 HC OBSTETRICAL CARE VAG DELIV ONLY 981 59409 " 1,457.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100122 HC DELIVER PLACENTA 981 59414 164.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100123 HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC 981 62270 273.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100124 HC INJECT NERV BLCK TRIGEMINAL 981 64400 247.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100125 HC INJECT NERV BLCK OTHR PERIPH NERV 981 64450 143.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100126 HC REMV F.B. EYE SUPERF CONJUNC 981 65205 86.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100127 HC REMV F.B. EYE CORNEA NO SLIT 981 65220 110.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100128 HC REMOVE EYELID FOREIGN BODY EMBEDDED 981 67938 469.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100129 HC REMV EXT CANAL FOREIGN BODY 981 69200 150.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100130 HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 981 69210 87.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100131 HC HEART/LUNG RESUSCITATION (CPR) 981 92950 586.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100132 HC DEBRIDEMENT OPEN WOUND 20 SQ CM< 981 97597 165.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100133 HC EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB 981 99281 40.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100134 HC EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY 981 99282 78.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100135 HC EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY 981 99283 116.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100136 HC EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 981 99284 221.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100137 HC EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNC 981 99285 325.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100138 HC CRITICAL CARE E/M 30-74 MINUTES 981 99291 517.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100139 HC CRITICAL CARE ADDL 30 MIN 981 99292 229.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100140 HC DRAINAGE OF HEMATOMA/FLUID 981 10140 309.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100141 HC EXC SKIN BENIG 1.1-2 CM TRUNK ARM LEG 981 11402 308.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100142 HC REMOVAL OF NAIL BED 981 11750 290.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100143 HC LAYR CLOS WND REST BODY 7.6-12.5 CM 981 12044 672.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100144 HC LAYR CLOS WND REST BODY 12.6-20 CM 981 12045 739.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100145 HC LAYR CLOS WND FACE FACIAL 7.6-12.5 CM 981 12054 675.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100146 HC RECMPL WND TRUNK 1.1-2.5 CM 981 13100 624.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100147 HC RECMPL WND TRUNK 2.6-7.5 CM 981 13101 735.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100148 HC REP SKIN TRUNK CMPLX +5 CM/< 981 13102 222.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100149 HC RECMPL WND HEAD FAC HAND 1.1-2.5 CM 981 13131 716.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100150 HC RECMPL WND LID NOS EAR 1.1-2.5 CM 981 13151 783.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100151 HC REPR EYELID NOSE EAR LIP+5 CM 981 13153 354.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100152 HC REMOVAL OF FOREIGN BODY 981 20520 380.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100153 HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSA W US REC RPRT 981 20604 137.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100154 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W US 981 20606 151.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100155 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W US 981 20611 169.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100156 HC CLOSED RX NOSE FRACTURE WO MANIPULATION 981 21310 243.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100157 HC CLOSED RX NOSE FRACTURE WO STABILIZATION 981 21315 506.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100158 HC REDUCE TEMPOROMANDIBL DISLOC 981 21480 198.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100159 HC CLOSED RX A-C JT DISLOC MANIPULATN 981 23545 639.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100160 HC CLOSED RX MID HUMERUS FRACTURE 981 24500 655.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100161 HC CLOSED TX ULNAR FRACTURE PROX END WO MANIPULATE 981 24670 532.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100162 HC CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION 981 24675 839.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100163 HC CLOSED RX RADIAL SHAFT FX 981 25500 507.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100164 HC CLOSED RX RADIAL SHAFT FX MANIPULATN 981 25505 919.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100165 HC CLOSED RX ULNA SHAFT FX 981 25530 479.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100166 HC CLOSED RX ULNA SHAFT FX MANIPULATN 981 25535 897.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100167 HC CLOSED RX RAD/ULNA SHAFT FX 981 25560 517.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100168 HC CLOSED RX ULNA STYLOID FX 981 25650 592.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100169 HC CLOSED RX RADIO-ULNA DISLOCATION 981 25675 808.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100170 HC DRAIN FINGER ABSCESS COMPLICATED 981 26011 739.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100171 HC CLOSED RX METACARPAL FX 981 26600 540.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100172 HC TREAT THUMB FX/DISLOC MANIP 981 26645 785.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100173 HC CLOSE RX FINGR ARTICULAR FX MANIP 981 26742 682.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100174 HC CLOSED RX TRAUMA HIP DISLOC ANESTH 981 27252 " 1,387.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100175 HC CLOSED RX SPONTANEOUS HIP DISLOC 981 27256 562.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100176 HC CLOSED RX SPONT HIP DISLOC ANESTH 981 27257 664.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100177 HC CLOSED RX POST HIP FIX DISLOC ANESTH 981 27266 " 1,065.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100178 HC CLOSED RX KNEE DISLOCATN 981 27550 952.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100179 HC CLOSED RX KNEE DISLOC+ANESTH 981 27552 " 1,150.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100180 HC CLOSED RX TIBIA SHAFT FX 981 27750 633.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100181 HC CLOSED RX TIBIA SHAFT FX MANIPULATN 981 27752 981.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100182 HC CLOSED RX MED MALLEOLUS FX 981 27760 612.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100183 HC CLOSED TREATMENT PST MALLEOLUS FRACTURE WO MANIP 981 27767 519.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100184 HC CLOSED RX PROX/SHAFT FIBULA FX 981 27780 560.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100185 HC CLOSED RX DIST FIBULA FX 981 27786 577.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100186 HC CLOSED RX TRIMALLEOLAR FX 981 27816 596.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100187 HC CLOSED RX ANKLE DISLOCATN 981 27840 691.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100188 HC CLOSED RX METATARSAL FX 981 28470 405.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100189 HC CLOSED RX TALOTARSAL DISLOC ANESTH 981 28575 676.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100190 HC CLOSED RX I-P JT TOE DISLOCATION 981 28660 220.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100191 HC CLOSED RX I-P JT TOE DISLOC ANESTH 981 28665 291.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100192 HC APPLY FOREARM SPLINT DYNAMIC 981 29126 142.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100193 HC APPLY FINGER SPLINT DYNAMIC 981 29131 95.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100194 HC APPLY SHORT LEG CAST WALKER 981 29425 143.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100195 HC STRAPPING OF KNEE 981 29530 57.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100196 HC STRAPPING ANKLE AND OR FOOT 981 29540 54.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100197 HC STRAPPING OF TOES 981 29550 36.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100198 HC STRAPPING UNNA BOOT 981 29580 115.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100199 HC DRAIN ABSCESS/HEMATOMA NASAL 981 30000 441.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100200 HC CTRL NOSEBLEED POST W PACKS AND OR CAUT 981 30905 605.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100201 HC REPEAT CONTROL OF NOSEBLEED 981 30906 633.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100202 HC THORACENTESIS NEEDLE/CATH PLEURA WO IMAGING 981 32554 391.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100203 HC THORACENTESIS NEEDLE/CATH PLEURA WIMAGING 981 32555 556.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100204 HC PERQ DRAINAGE PLEURA INSERT CATH WO IMAGING 981 32556 " 1,127.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100205 HC REPAIR LIP <1/2 VERT HEIGHT 981 40652 920.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100206 HC REPAIR LIP >1/2 VERT HEIGHT 981 40654 " 1,062.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100207 HC REMOVAL FOREIGN BODY MOUTH SIMPLE 981 40804 354.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100208 HC REPAIR MOUTH LACERATION <2.5 CM 981 40830 503.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100209 HC REPAIR MOUTH LACERATION >2.5 CM 981 40831 642.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100210 HC DRAINAGE OF GUM LESION 981 41800 536.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100211 HC INC/DRAIN PERITONSIL ABSCESS 981 42700 351.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100212 HC REMOVE PHARYNX FOREIGN BODY 981 42809 372.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100213 HC REPOSITION GASTRIC FEEDING TUBE THRU DUODENUM 981 43761 224.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100214 HC SIGMOIDOSCOPY FLX W RMVL FOREIGN BODY 981 45332 475.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100215 HC ABDOM PARACENTESIS DX/THER WO IMAGING GUIDANCE 981 49082 367.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100216 HC ANOSCOPY DX W COLLJ SPEC BR/WA SPX WHEN PRFRMD 981 46600 175.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100217 HC CHANGE OF BLADDER TUBE SIMPLE 981 51705 174.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100218 HC I&D BARTHOLIN GLAND ABSCESS 981 56420 251.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100219 HC MARSUP BARTHOLIN GLAND CYST 981 56440 336.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100220 HC INJECT NERV BLCK FACIAL NERV 981 64402 270.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100221 HC NJX AA&/STRD TFRM EPI C/T 1 981 64479 455.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100222 HC NJX AA&/STRD TFRM EPI L/S 1 981 64483 421.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100223 HC REMV FB EYE EMBED CONJUNC 981 65210 105.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100224 HC REMV FB EYE CORNEA SLIT LAMP 981 65222 128.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100225 HC SUTURE EYELID WOUND PARTIAL THICK 981 67930 684.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100226 HC SUTURE EYELID WOUND FULL THICK 981 67935 " 1,111.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100227 HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 981 69209 25.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100228 HC CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL 981 92960 298.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100229 HC AMBULATORY EEG MONITORING 981 95950 539.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100230 HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 981 99152 94.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100231 HC WOUND CLOSURE BY ADHESIVE 981 G0168 144.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100232 HC NERVOUS SYSTEM SURGERY UNLISTED 981 64999 250.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98100233 HC CLOSED RX MID HUMERUS FX MANIPULATN 981 24505 913.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200001 HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC 982 43235 493.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200002 HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE 982 43239 659.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200003 HC SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD 982 45330 315.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200004 HC SIGMOIDOSCOPY BIOPSY 982 45331 491.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200005 HC SIGMOIDOSCOPY FLX W RMVL TUMOR BY HOT BX FORCEPS 982 45333 559.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200006 HC COLONOSCOPY FLX DX W COLLJ SPEC WHEN PFRMD 982 45378 594.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200007 HC COLONOSCOPY W BIOPSY SINGLE/MULTIPLE 982 45380 764.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200008 HC COLSC FLX W REMOVAL LESION BY HOT BX FORCEPS 982 45384 847.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200009 HC COLSC FLX W RMVL OF TUMOR POLYP LESION SNARE TQ 982 45385 802.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200010 HC ANOSCOPY DX W COLLJ SPEC BR/WA SPX WHEN PRFRMD 982 46600 175.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200011 HC ANOSCOPY REMOVE LESN FORCEPS/CAUTER 982 46610 442.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200012 HC ANOSCOPY REMOVE LESN SNARE 982 46611 350.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200013 HC ANOSCOPY REMOVE LESIONS 982 46612 535.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200014 HC REMOVAL OF SPERM DUCT(S) 982 55250 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200015 HC COLPOSCOPY ENTIRE VAGINA 982 57420 222.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200016 HC COLPOSCOPY ENTIRE VAGINA W BIOPSY(S) 982 57421 298.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200017 HC COLPOSCOPY CERVIX W ADJ VAGINA 982 57452 210.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200018 HC COLPOSC CERVIX W ADJ VAG W BX AND CURRETAG 982 57454 291.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200019 HC COLPOSCOPY CERVIX W ADJ VAGINA W BX 982 57455 273.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200020 HC COLPOSCOPY CERVIX W ADJ VAGINA CURETTAG 982 57456 257.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200021 HC HYSTEROSCOPY DX SEP PROC 982 58555 545.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200022 HC HYSTEROSCOPY W ENDO BX 982 58558 " 2,513.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200023 HC OBSTETRICAL CARE VAG DELIV ONLY 982 59409 " 1,457.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200024 HC SURG RX INCOMPLETE ABORTN 982 59812 585.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200025 HC SURG RX MISSED ABORTN 1ST TRI 982 59820 704.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200026 HC SURG RX MISSED ABORTN 2ND TRI 982 59821 704.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200027 HC EVACUATE MOLE OF UTERUS 982 59870 878.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200028 HC COLORECTAL SCRN HI RISK IND 982 G0105 594.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200029 HC COLON CA SCRN NOT HI RSK IND 982 G0121 594.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98200030 HC CV STRS TST XERS&/OR RX CONT ECG W/O I&R 982 93016 43.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300001 HC PUNCTURE DRAINAGE OF LESION 983 10160 240.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300002 HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY 983 11422 327.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300003 HC INJECT TENDON SHEATH/LIGAMENT 983 20550 98.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300004 HC INJECT TENDON ORIGIN/INSERT 983 20551 100.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300005 HC INJECT TRIGGER POINT 1 OR 2 983 20552 103.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300006 HC INJECT TRIGGER POINTS > 3 983 20553 118.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300007 HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 983 20600 90.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300008 HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT 983 20604 137.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300009 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 983 20605 94.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300010 HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US 983 20606 151.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300011 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 983 20610 110.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300012 HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 983 20611 169.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300013 HC ASPIRAT/INJECTION GANGLION CYST(S) 983 20612 111.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300014 HC INJECTION SACROILIAC JOINT 983 27096 299.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300015 HC INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE 983 64455 90.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300016 HC US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG 983 76882 104.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300017 HC SONO GUIDE NEEDLE BIOPSY 983 76942 105.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300019 HC OFFICE OUTPATIENT NEW 15-29 MINUTES 983 99202 141.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300020 HC OFFICE OUTPATIENT NEW/NUTR COUNSEL 30-44 MINUTES 983 99203 200.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300021 HC OFFICE OUTPATIENT NEW 45-59 MINUTES 983 99204 305.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300022 HC OFFICE OUTPATIENT NEW 60-74 MINUTES 983 99205 384.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300023 HC OFFICE OUTPATIENT VISIT 5 MINUTES 983 99211 42.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300024 HC OFFICE OUTPATIENT VISIT 10-19 MINUTES 983 99212 83.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300025 HC OFFICE OUTPATIENT VISIT 20-25 MINUTES 983 99213 138.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300026 HC OFFICE OUTPATIENT VISIT 30-39 MINUTES 983 99214 203.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300027 HC OFFICE OUTPATIENT VISIT 40-54 MINUTES 983 99215 272.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300028 HC INJECT CARPAL TUNNEL 983 20526 141.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300029 HC INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG 983 64451 396.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300030 HC EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 983 21932 " 1,201.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300031 HC RECMPL WND TRUNK 1.1-2.5 CM 983 13100 624.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300032 HC BIOPSY OF MOUTH LESION 983 40808 346.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300033 HC BIOPSY TONGUE ANTER 2/3 983 41100 319.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300034 HC PLACE RADIOTHER DEVICE/MARKER PROSTATE 983 55876 265.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300035 HC BIOPSY OF PROSTATE NEEDLE/PUNCH 983 55700 464.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300036 HC BIOPSY OF PROSTATE INCISIONAL 983 55705 504.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300037 HC REMOVAL OF SPERM DUCT(S) 983 55250 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300038 HC INSERT NON-INDWELLING BLADDER CATHETER 983 51701 83.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300039 HC INSERT TEMP INDWELLING BLAD CATH SIMPLE 983 51702 115.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300040 HC INSERT TEMP INDWELLING BLAD CATH COMP 983 51703 247.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300041 HC CYSTOURETHROSCOPY 983 52000 350.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300042 HC CYSTOSCOPY REMV CALCULUS SIMPLE 983 52310 500.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300043 HC MEAS POST-VOID RES US NON-IMAGING 983 51798 23.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300044 HC CHANGE OF BLADDER TUBE SIMPLE 983 51705 174.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98300045 HC CHANGE OF BLADDER TUBE COMPLICATED 983 51710 240.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98500001 HC ELECTROCARDIOGRAM REPORT 985 93010 16.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700001 HC OBSERVATION CARE DISCHARGE MANAGEMENT 987 99217 137.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700002 HC INITIAL OBSERVATION CARE/DAY 30 MINUTES 987 99218 187.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700003 HC INITIAL OBSERVATION CARE/DAY 50 MINUTES 987 99219 256.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700007 HC SBSQ OBSERVATION CARE/DAY 25 MINUTES 987 99225 138.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700008 HC SBSQ OBSERVATION CARE/DAY 35 MINUTES 987 99226 198.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700011 HC OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES 987 99235 319.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700014 HC INITIAL OBSERVATION CARE/DAY 70 MINUTES 987 99220 350.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700015 HC SBSQ OBSERVATION CARE/DAY 15 MINUTES 987 99224 75.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700016 HC OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES 987 99234 250.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700017 HC OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES 987 99236 411.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700018 HC THORACENTESIS NEEDLE/CATH PLEURA WO IMAGING 987 32554 391.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 98700019 HC THORACENTESIS NEEDLE/CATH PLEURA W IMAGING 987 32555 556.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A