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CPT Code Description Charge Amount
0202U COVID-19 BioFire Respiratory Panel 2.1 (RP2.1) Testing $2,550.77
10060 INCISION/DRAINAGE ABSCESS $1,662.80
10061 INS/DRAIN ABSCESS COMPL $2,634.00
10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE $2,042.91
10081 I&D PILONIDAL CST COMP $6,514.99
10120 I & RMVL SUB-CUT SIMPLE $2,763.00
10121 I & RMVL FB, SUB-CUT,COMP $13,253.00
10140 I&D HEMATOMA SEROMA/FLUID COLLECTION $16,139.30
10160 PUNCTURE ASP OF ABSCESS $1,565.00
10180 Incision and drainage, complex, postoperative wound infecti… $13,429.00
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS $9,150.60
11042 DBRD SKN SUBQ TISSUE $5,214.02
11043 DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< $6,821.00
11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM $1,943.00
11200 RMVL SKIN TAGS $2,138.17
11730 AVULSION/1-NAIL PLATE $1,701.14
11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL $528.00
11740 EVAC SUBUNGUAL HEMATOMA $760.00
11750 EXC NAIL PART/COMP $6,767.00
11760 REPAIR NAIL BED $8,549.00
12001 LACERATION REPAIR $1,143.98
12002 REPAIR LAC SCALP 2.6-7.5 $1,150.81
12004 REPAIR LAC SCALP 7.6-12.5 $1,170.04
12005 REPAIR LAC,SCALP 12.6-20C $1,176.00
12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM $1,946.00
12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM $2,540.00
12011 REPAIR LAC FACE LESS THAN 2.5 CM $1,119.40
12013 REPAIR LAC FACE 2.6-5.0CM $1,151.40
12014 REPAIR LAC FACE 5.1-7.5CM $1,558.00
12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM $1,638.00
12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE $3,785.00
12031 LYR CLSR S/A/T/E 2.5CM $1,915.00
12032 REPAIR-INT SCALP 2.6-7.5 $2,273.00
12034 INTERM RPR SCLP/TRNK/EXTR $3,165.00
12035 REPAIR INTERM S/A/T/E 12. $3,932.00
12041 LAYER CLSR NECK/HAND 2.6 $1,456.64
12042 REPAIR LAC HAND/FOOT 2.6- $1,546.44
12044 LYR CLSR N/H/F/ETRNL GENT $2,725.00
12051 LAYER CLSR OF WND NCK/HND $1,868.08
12052 LYR CLSR WOUND 2.6-5.0FAC $1,915.00
12053 LYR CLSR F/E/E/N/L/M&/MUC $2,188.00
12054 REPAIR INTERMEDIATE F/E/E/N/L/M&MUC 7.6-12.5CM $2,621.00
13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM $11,504.00
13121 RPR CMPX SCALP ARM2.6-7.5 $4,622.00
13122 CMPLX RPR ADD 5 CM OR LES $1,846.73
13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM $2,831.00
13132 RPR CMPX FOREHEAD/CHECK/C $3,937.00
13133 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< $3,256.41
13151 CMPX RPR EYE NOSE 1.1-2.5 $4,087.00
13152 RPR CPLX E/N/E/L 2.6-7.5 $4,967.00
16000 BURN, INITIAL TREATMENT $1,631.80
16020 BURN, DRESSING/DBRDMNT-SM $1,510.00
16030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE $3,353.15
17250 UMBILICAL CAUTERIZATION $1,454.69
19020 MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP $15,871.14
20103 EXPLORATION PENETRATING WOUND SPX EXTREMITY $9,778.00
20520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE $6,102.00
20525 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP $14,267.00
20552 TRIGGER POINT INJ 1-2 MUS $7,891.00
20605 ARTHROCENTESIS, MED JOINT $4,695.00
20610 ARTHROCENTESIS, LG JOINT $5,568.00
20611 Arthrocentesis, aspiration and/or injection, major joint or… $3,964.00
21320 CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION $10,273.00
21480 CLDS TX TEMP DISLOCATION $1,842.00
21485 CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ $11,643.00
23600 CLTX PROX HUMRL FX WO MAN $2,165.12
23605 CLTX PRX HMRL FX MNPJ+-TRACT $6,012.00
23650 SHOULDER DISLOCATION TRMT $1,815.67
23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES $8,747.56
23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ $3,471.00
23931 INCISION&DRAINAGE UPPER ARM/ELBOW BURSA $7,329.00
24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ $5,048.00
24535 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ $8,585.00
24565 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ $7,263.00
24600 CLSD TX ELBOW DISLOCAT $1,342.06
24605 Treatment of closed elbow dislocation; requiring anesthesia $7,607.77
24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ $5,184.95
24640 RADIAL HEAD SUBLUX. CHILD $1,247.63
24650 CLTX RDL HEAD FX WO MANP $2,565.91
24655 CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION $6,529.00
24675 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ $7,129.00
25505 CLSD TX RAD SHAFT W/MANIP $5,809.00
25520 CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT $7,090.00
25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE, WITH MANIPULATION $6,488.00
25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ $3,153.55
25600 CLSD TX DISTAL RAD FX WO $4,425.76
25605 CLSD TX DISTAL RAD FX $2,551.27
25607 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP $25,284.00
25652 OPEN TREATMENT ULNAR STYLOID FRACTURE $18,687.50
25675 CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ $3,542.20
26010 I & D FINGER ABSCESS,SIMP $1,022.78
26011 DRAINAGE FINGER ABSCESS COMPLICATED $7,507.16
26600 CLSD TX METACARPAL FX $1,843.74
26605 CLSD TX MEDICARPAL FX $2,841.00
26700 CLS TX MCP DISLOCATION $1,990.00
26725 CLTX PHLNGL FX PROX/MIDDL $2,191.26
26735 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA $25,284.00
26742 CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ $6,712.00
26746 OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA $16,463.00
26750 CLS TX FX FINGER/THUMB $1,552.20
26755 CLTX DSTL PHLNGL FX FNGR/ $2,085.52
26765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH $13,312.00
26770 TREAT FINGER DISLOC FINGE $1,535.83
26775 Closed treatment of interphalangeal joint dislocation, sing… $3,665.00
27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA $2,303.00
27560 CLTX PATELLAR DISLC W/O A $1,917.56
27750 Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation $4,062.50
27752 CLTX TIBL SFT FX W/MANP $8,065.00
27762 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ $7,043.00
27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ $3,198.93
27792 Open treatment of distal fibular fracture (lateral malleolu… $25,063.00
27810 CLTX BIMAL ANKLE FX W/POT $4,919.00
27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION $3,435.14
27840 CLOSED TX ANKLE DISLOCATI $3,642.60
27842 CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ $15,556.02
28190 RMVL FB BODY FOOT SUBQ $6,856.00
28192 RMVL FB FOOT DEEP $16,549.65
28495 CLTX FX GRT TOE PHLX/PHLG W/MANJ $2,652.67
28515 FX CARE PHALANX NOT GREAT $2,356.00
28660 CLSD TX PIP JNT DISLOCATI $1,636.18
29105 LONG ARM SPLINT $829.00
29125 SHORT ARM SPLINT $753.22
29126 SHORT ARM SPLINT DYNAMIC $1,071.00
29130 APPLICATION FINGER SPLINT $625.00
29240 STRPG SHO $797.00
29280 STRAPPING HAND/FINGER $646.00
29505 LONG LEG SPLINT $1,099.00
29515 SHORT LEG SPLINT $1,026.37
29530 STRAPPING KNEE $805.00
29550 STRAPPING TOES $836.00
30300 RMVL FOREIGN BODY NASAL $685.91
30901 NASAL PACKING $1,023.89
30903 CTRL NSL HEMRRG ANT CPLX $3,209.00
30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST $1,370.00
30906 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ $1,791.00
31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE $1,213.09
31502 TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT $1,942.00
32550 INSERTION INDWELLING TUNNELED PLEURAL CATHETER $20,534.31
32551 TUBE THORACOSTOMY INCLUDES WATER SEAL $3,465.00
32556 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING $8,060.39
36000 INTRODUCTION OF NEEDLE/IN $350.26
36005 NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH $4,393.00
36410 VENIPUNCTURE, 3 YRS OR OLDER $765.01
36415 VENIPUNCTURE $74.85
36416 COLL CAPILLARY BLG SPEC $82.50
36556 Insertion of non-tunneled centrally inserted central venous… $6,684.99
36558 INSERT TUNNELED CV CATH – INSJ TUN CTR CVC W/O SUBQ POR $13,386.49
36569 INSERTION PICC W/O IMG GDN 5 YR/> $8,161.08
36589 RMVL TUN CVC W/O SUBQ PORT/PMP $7,102.88
36591 COLLECT BLOOD FROM IMPLAN $735.89
36592 COLLECT BLOOD FROM CATHETER VENOUS NOS $702.84
36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION $1,091.83
40650 RPR LIP FULL THICKNESS $5,063.00
40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL $3,008.19
41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG $1,653.69
41800 DRNG ABSC DENTOALVEOLAR S $1,558.00
42700 I&D ABSC PRITONSILLAR $2,929.00
43752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE $2,787.02
43753 GASTRIC INTUBATION AND ASPIRATION THERAPUETIC, NECESSATING … $976.00
45915 RMVL FECAL IMPACTION/FB SPX UNDER ANES $9,348.00
46040 I&D ISCHIOR/PRIRC ABSC SP $12,172.00
46050 INC/DRAIN PERIANAL ABS SU $5,126.00
46083 INCISION THROM HEMORRHOID $1,571.00
49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE $6,502.68
49505 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE $25,524.60
51700 BLDR IRR SMPL LVG&/INSTLJ $1,902.92
51701 INSR NONDWELLING BLDR CAT $680.91
51702 INSERTION BLADDER CATH $664.00
51703 INSERT BLADDER CATH COMPL $844.76
54220 IRRIGATION CORPORA CAVERNOSA PRIAPISM $2,403.92
54235 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT $1,419.87
54437 REPAIR OF TRAUMATIC CORPOREAL TEAR(S) $25,072.78
54450 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING $4,025.00
55100 DRAINAGE SCROTAL WALL ABSCESS $6,504.55
56405 INC/DRAIN VULVA/PERINEAL $2,036.47
56420 I & D BARTHOLIN ABSCESS $1,694.00
57410 PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL $13,698.75
58301 REMOVAL INTRAUTERINE DEVICE IUD $14,504.00
59025 FTL NON-STRS TST $1,670.13
62270 SPINAL PUNCTURE,LUMBAR $3,147.32
62272 THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF $3,759.11
64400 NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH $2,474.37
64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE $4,308.53
64450 INJ ANESTHETIC AGENT $2,131.06
65205 REMOVAL FB EYE-SUPERFCL $1,275.00
65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR $2,119.65
65220 RMVL FB EYE W/O SLIT LAMP $1,561.00
65222 RMVL FB EYE $1,681.00
67700 I&D ABSCESS EYELID $1,658.00
69000 Drainage external ear $3,343.00
69200 RMVL FOREIGN BODY EAR $826.00
69205 RMVL FB XTRNL AUD CANAL A $9,924.00
69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL $766.00
69210 RMVL IMPACTED CERUMEN $671.70
70100 XRAY MANDIBLE LESS THAN 4 VIEWS $1,716.86
70110 XRAY MANDIBLE MIN 4 VIEWS $1,709.01
70130 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE $1,335.29
70140 XRAY FACIAL BONES LESS THAN 3 VIEW $1,838.76
70150 XRAY FACIAL BONES GREATER THAN 3 VIEW $1,699.89
70160 Radiologic examination, nasal bones, complete, minimum of 3… $1,286.15
70200 RAD EXAM ORBIT COMP. $2,352.18
70210 RADEX SINUSES PARANASAL <3 VIEWS $1,100.47
70220 RAD EXAM SINUS COMPLETE $1,324.00
70250 SKULL LESS THAN 4 VIEWS $1,542.89
70260 RAD EXAM SKULL COMPLETE $1,988.00
70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT $1,415.89
70360 RAD EXAM NECK,SOFT TISSUE $986.98
70450 COMPUTED TOMOGRAPHY HD/BR $6,000.35
70460 TOMOGRAPHY HEAD/BRAIN WIT $6,473.78
70470 COMPUTED TOMOGRAPHY HEAD/ $7,290.89
70480 CT ORBIT SELLA/POST FOSSA $5,449.04
70481 CT ORBIT SELLA/POST FOSSA $6,918.53
70482 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR $8,800.75
70486 CT MAXLFCL AREA C-MATRL $6,491.00
70487 CT MAXLFCL AREA C+ MATRL $8,034.29
70488 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL $7,129.51
70490 CT NECK WO CONTRAST $5,581.92
70491 CT SOFT TISS NCK C+MATRL $6,970.56
70492 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL $6,402.00
70496 CTA HEAD C-/C+ $6,569.35
70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST $6,650.72
71045 Radiologic examination, chest ; single view $1,119.00
71046 CHEST XRAY 2 VIEWS $1,410.15
71047 Radiologic examination, chest ; 3 views $1,428.00
71100 RIBS UNILATERAL 2 VIEWS $1,689.49
71101 RIB UNILATERAL W CHEST $1,643.78
71110 RIBS BILATERAL 3 VIEWS $2,887.49
71111 RIBS BILATERAL W/CHEST $3,412.26
71120 Radiologic examination; sternum, minimum of 2 views $1,314.73
71250 CT CHEST W/O CONTRAST $5,793.47
71260 CT THORAX W/CONTRAST $7,325.61
71270 CT THORAX WO CONTRAST $8,569.40
71275 CT ANGIOGRAPHY $7,192.43
72020 Radiologic examination, spine, single view, specify level $714.00
72040 SPINE, CERVICAL 2/3 VIEWS $1,387.03
72050 SPINE, CERVICAL MIN 4VIEW $2,298.95
72052 SPINE CERV. COMP FLEX/EXT $2,879.53
72070 SPINE THORACIC 2 VIEWS $1,864.83
72072 SPINE THORACIC 3 VIEWS $2,042.75
72074 RAD EXAN SPINE THROAC 4 V $1,605.93
72080 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS $1,490.51
72082 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW $2,390.99
72100 SPINE LUMBO. MIN 4 VIEWS $1,655.93
72110 LUMBAR X-RAY 4 VIEWS RADEX SPI LUMBOSAC MINIMUM 4 VIEWS $2,484.48
72125 COMPUTED TOMOGRAPHY CERVI $5,904.47
72126 CT CRV SPI C+MATRL $7,249.92
72127 CT CRV SPI C-/C+ $8,780.00
72128 CT THRC SPI C-MATRL $7,830.72
72129 CT THRC SPI C+ MATRL $7,320.41
72131 CT L SPINE WO CONTRST $7,131.83
72132 CT LMBR SPI C+ MATRL $7,215.83
72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL $7,493.00
72170 RAD EXAM PELVIS 1/2 VEIW $1,155.29
72190 RADEX PELVIS COMPL MIN 3 $1,417.68
72192 CT PELVIS WO CONTRAST $6,238.31
72193 TOMOGRAPHY PELVIS WCONTRS $7,003.32
72220 XRAY COCCYX/SACRUM $1,341.14
73000 XRAY CLAVICLE 2 VIEWS $1,342.35
73010 SCAPULA COMPLETE $1,508.15
73020 RADEX SHO 1 VIEW $1,044.62
73030 SHOULDR COMPLETE 2 VIEWS $1,605.00
73060 XRAY HUMERUS MIN 2 VIEWS $1,305.02
73070 XRAY ELBOW 2 VIEWS $1,451.65
73080 XRAY ELBOW GREATER THAN 3 VIEWS-COMP $1,505.02
73090 XRAY FOREARM AP & LAT $1,232.77
73092 Radiologic examination; upper extremity, infant, minimum of… $997.00
73100 XRAY WRIST AP & LAT VIEW $1,236.77
73110 XRAY WRIST/COMP MIN 3 VIE $1,514.00
73120 XRAY HAND AP & LAT $1,236.00
73130 XRAY HAND MIN 3 VIEWS $1,421.75
73140 XRAY FINGER MIN 2 VIEWS $1,096.72
73200 CT UPPR EXTR WO CNTRS $6,051.50
73201 CT UPPER EXTREMITY W/CONTRAST MATERIAL $6,125.59
73202 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL $8,139.25
73501 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW $899.68
73502 RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN P… $1,331.50
73503 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS $3,029.65
73521 Radiologic examination, hips, bilateral, with pelvis when p… $2,996.00
73522 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS $2,699.97
73523 Radiologic examination, hips, bilateral, with pelvis when p… $3,139.00
73551 RADIOLOGIC EXAMINATION FEMUR 1 VIEW $1,650.00
73552 FEMUR; MIN 2 VIEWS $1,720.31
73560 XRAY KNEE, SUNRISE VIEW $1,151.00
73562 XRAY KNEE MIN 3 VIEWS $1,668.26
73564 RAD EXAM KNEE 4 OR MORE $2,035.51
73590 XRAY TIBIA/FIBULA AP/LAT $1,407.38
73592 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS $1,182.06
73600 XRAY ANKLE 2 VIEWS $1,177.62
73610 XRAY ANKLE 3 VIEWS/COMPLE $1,412.56
73620 XRAY FOOT MIN 2 VIEWS $1,321.00
73630 XRAY FOOT MIN 3 VIEWS $1,883.00
73650 RAD EXAN HEEL MIN 2 VIEWS $1,057.85
73660 XRAY TOES, MIN 2 VIEWS $1,088.51
73700 CT LWR EXTR WO CONTRAST $5,608.28
73701 CT LWR EXT W CONT $7,054.52
73702 CT LXTR C-/C+ $7,201.81
73706 CT ANGIOGRAPHY LOWER EXTREMITY $13,771.00
74018 Radiologic examination, abdomen; 1 view $1,063.05
74019 Radiologic examination, abdomen; 2 views $1,484.30
74021 Radiologic examination, abdomen; 3 or more views $1,639.76
74022 RAD EXAM COMPLETE ABD $1,705.16
74150 COMPUTED TOMOGRAPHY ABD $7,791.41
74160 TOMOGRAPHY ABD W/CONTRAST $8,410.50
74170 TOMOGRAPHY ABD W/OCONTRAS $9,068.43
74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG $15,775.03
74175 CT ANGIO ABDOMEN W/CONTRA $9,171.00
74176 COMP TOMOG AB/PEL W/O CON $9,914.62
74177 COMP TOMO AB/PELV W/OCONT $10,986.69
74178 CT ABD & PELVIS 1 PLUS SECTION/REGNS $13,343.04
74220 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY $2,001.14
74240 RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB $3,088.48
74246 Radiologic examination, gastrointestinal tract, upper, air … $2,527.30
74250 RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES $2,411.38
74328 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I $2,853.66
74330 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I $5,004.85
74340 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I $2,242.00
75574 CT CORONARY $6,053.46
75635 CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP $7,566.54
76010 RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD $979.00
76376 3D RNDR I&R CT MRI US/OTH $1,871.83
76536 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK $2,623.06
76604 US CHEST REAL TIME W/IMAGE DOCUMENTATION $1,716.51
76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE $2,739.00
76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED $2,766.31
76700 US ABDOMINAL R-T W/IMAGE $3,749.11
76705 US ABDOMINAL $2,913.68
76770 US RETROPERITONEAL R-T W/ $3,104.40
76775 US RPR B-SCAN&/R-T IMG LMTD $2,902.50
76801 ULTRASOUND 14 WK TABDL 1/1ST GESTATION $2,905.05
76802 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION $1,469.12
76805 US PG UTER F&MAT AFTER 1S $3,004.33
76810 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO $2,164.13
76815 ULTRASND PG UTER $2,534.91
76816 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS $2,425.15
76817 UT PG UTER R-T IMG TRVG $2,833.44
76830 TRANSVAGINAL ULTRASOUND $2,491.27
76856 US PELVIC NONOB REAL-TIME $3,110.49
76857 PEL NONOB B-SCAN&/R-T IMG LMTD/F-UP+C97 $2,144.27
76870 US SCROTUM&CNTS $2,692.89
76881 US EXTREMITY NON-VASC REAL-TIME IMG COMPL $2,977.21
76882 ULTRASOUND, EXTREMITY, NON VASCULAR $2,783.68
76937 Us guide vascular access $2,026.00
76942 ULTRASONIC GUIDANCE FOR NEEDLE PLCMNT, IMGNG SUPERVSN AND I… $3,311.72
78315 B1&/JT IMG 3 PHASE STD $5,640.00
80047 BASIC METABOLIC PANEL CALCIUM IONIZED $417.90
80048 METABOLIC PANEL BASIC $839.17
80051 ELECTROLYTE PANEL $781.42
80053 METABOLIC COMPRE PANEL $1,187.55
80061 LIPID PROFILE III $798.10
80074 HEPATITIS PANEL $1,262.45
80076 HEPATIC FUNCTION PANEL $792.48
80143 Acetaminophen $616.04
80175 DRUG SCREEN QUANTITATIVE LAMOTRIGINE $116.22
80177 DRUG SCREEN QUANTITATIVE LEVETIRACETAM $351.00
80178 LITHIUM $330.30
80197 TACROLIMUS $754.71
80202 VANCOMYCIN PEAK $408.10
80305 DRUG TEST, PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUM… $728.58
80307 DRUG TEST PRSMV INSTRMNT CHEMISTRY ANALYZERS $935.00
80320 DRUG SCREEN $526.91
80329 DRUG SCREEN $356.69
80349 DRUG SCREENING CANNABINOIDS NATURAL $853.71
80353 DRUG SCREENING COCAINE $853.71
80361 DRUG SCREENING OPIATES 1 OR MORE $853.71
81001 U/A DIP STICK $485.32
81003 U/A W/O MICRO DIPSTICK $255.32
81005 Urinalysis; qualitative or semiquantitative, except immunoa… $65.67
81025 PREG.TST URINE VISUAL $491.11
81240 F2 GENE ANALYSIS 20210G >A VARIANT $786.05
82010 KETONE BODIES SERUM QUANTITATIVE $288.04
82040 ALBUMIN; SERUM $201.28
82075 ALCOHOL BREATH TEST $262.92
82140 Ammonia $365.00
82150 AMYLASE $523.51
82247 BILIRUBIN TOTAL $256.60
82248 BILIRUBIN DIRECT $306.65
82270 OCCULT BLOOD $240.31
82271 BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES $148.87
82272 BLD OCLT PEROXIDASE ACTV $114.93
82310 CALCIUM $212.00
82330 CALCIUM IONIZED $339.21
82374 CARBON DIOXIDE BICARBONATE $199.00
82375 Under Chemistry Procedures $455.11
82435 CHLORIDE BLD $168.82
82465 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL $175.12
82533 CORTISOL TOTAL $454.90
82550 CREATINE CK-TOTAL $343.57
82553 CREATINE CKMB $541.53
82565 CREATININE $314.93
82607 VITAMIN B-12 $268.08
82728 ASSAY OF FERRITIN $555.00
82746 ASSAY OF FOLIC ACID SERUM $294.42
82747 ASSAY OF FOLIC ACID RBC $470.56
82784 IGC IMMUNOGLOBULIN $433.13
82785 GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE $262.68
82800 GASES BLD PH ONLY $163.18
82803 BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 $659.49
82805 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (… $824.41
82945 GLUCOSE BODY FLUID OTHER THAN BLOOD $311.95
82947 GLUCOSE $284.83
82948 GLUCOSE BLOOD REAGET STR $203.32
82977 GLUTAMYLTRANSFERASE-GTT $216.42
83036 HEMOGLOBIN GLYCOSYLATED A1C $291.00
83050 Under Chemistry Procedures $550.24
83520 IMMUNOASSAY ANALYTE QUANTITIATIVE NOS $461.34
83525 ASSAY OF INSULIN TOTAL $360.19
83540 IRON-TOTAL $241.98
83550 IRON BINDING CAPACITY $356.00
83605 ASSAY OF LACTATE $259.81
83615 Lactate dehydrogenase (LD), (LDH); $293.00
83690 LIPASE $469.00
83735 MAGNESIUM $340.00
83874 MYOGLOBIN $309.47
83880 B-TYPE NATRIURETIC $542.32
83992 ASSAY OF PHENCYCLIDINE $459.69
84075 ALK PHOS/PROFILE OR PANEL $270.00
84100 ASSAY OF PHOSPHORUS INORGANIC $239.00
84132 POTASSIUM SERUM PLASMA/WHOLE BLOOD $298.00
84153 Prostate specific antigen (PSA); total $368.00
84155 PROTEIN,TOTAL,EXCEPT REFR $223.80
84157 PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC $256.54
84165 PROTEIN ELECTROPHORESIS $468.95
84295 SODIUM; SERUM $153.00
84403 Testosterone; total $560.52
84436 THYRIXINE TOTAL $278.07
84439 THYROXINE-FREE $389.05
84443 Thyroid stimulating hormone (TSH) $440.69
84450 Transferase; aspartate amino (AST) (SGOT) $343.09
84460 ALT-TRANSFERASE;ALANINE $355.77
84478 ASSAY OF TRIGLYCERIDES $287.37
84479 THYROID HORMONE $541.28
84480 T3 TOTAL $482.60
84481 ASSAY OF TRIIODOTHYRONINE T3 FREE $618.77
84484 TROPONIN I $583.78
84520 Urea nitrogen; quantitative $233.22
84550 URIC ACID $343.51
84560 URIC ACID OTH SRC $248.16
84702 HCG QUANTATIVE $554.98
84703 PREGNANCY TEST BLOOD $527.57
85014 HEMATOCRIT $121.51
85018 HEMOGLOBIN $116.93
85025 Blood count; complete (CBC) $361.01
85027 CBC W/O DIFF $258.71
85044 RETICULOCYTE COUNT $71.64
85347 COAGJ TM ACTIVATED $326.63
85379 D-DIMER $593.59
85384 FIBRINOGEN ACTIVITY $412.13
85397 Coagulation and fibrinolysis, functional activity, not othe… $777.10
85610 PROTHROMBIN TIME $306.02
85651 SEDIMENTATION RATE NONAUT $202.85
85652 SED RATE ERYTHROCYTE NON $215.19
85730 THROMBOPLASTIN TIME PART $317.85
86038 ANTINUCLEAR AB $410.17
86039 ANTINUCLEAR AB TITER $616.32
86060 ANTISTREPTOLYSIN O TITER $373.13
86140 C REACTIVE PROTEIN $259.98
86235 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD $472.85
86256 SMOOTH MUSCLE AB TITER $568.46
86308 MONO,HETEROPHILE ANTIBODI $342.87
86328 COVID-19 RAPID ANTIBODY TEST SINGLE METHOD $100.00
86360 T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO $1,301.46
86376 Microsomal antibodies (eg, thyroid or liver-kidney), each $325.78
86403 MONO SPOT $362.35
86430 RHEUMATOID FACTOR $157.87
86431 RHEUMATOID FACTOR QUANTITATIVE $376.55
86592 Syphilis test, non-treponemal antibody; qualitative (eg, VD… $290.05
86593 Syphilis test, non-treponemal antibody; quantitative $276.11
86617 Antibody; Borrelia burgdorferi (Lyme disease) confirmatory … $546.00
86631 ANTB CHLAMYDIA $183.00
86644 ANTIBODY CYTOMEGALOVIRUS CMV $501.81
86645 ANTIBODY CYTOMEGALOVIRUS CMV IGM $613.92
86664 EPSTEIN-BARR VIRUS EBNA $350.11
86677 ANTIBODY HELICOBACTER PYLORI $387.83
86689 ANTB HTLV/HIV ANTB CONFIRMATION TST $593.00
86695 Antibody; herpes simplex, type 1 $347.98
86696 Antibody; herpes simplex, type 2 $408.32
86701 HIV SERUM $767.00
86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL $529.00
86705 HEPATITIS B CORE IGM $306.46
86706 HEPATITIS B SURF ANTIBODY HBSAB $447.00
86708 HEPATITIS A ANTIBODY HAAB $312.00
86709 HEPATITIS ANTIBODY HAAB IGM ANTIBODY $323.87
86757 ANTIBODY RICKETTSIA $288.05
86769 COVID-19 RAPID ANTIBODY TEST MULTIPLE STEP METHOD $100.00
86780 TP-Under Qualitative or Semi quantitative Immunologists- $187.31
86803 HEPATITIS C ANTIBODY $439.00
86850 ANTB SCR RBC EA SERUM TQ $315.78
86900 Blood typing, serologic; ABO $310.13
86901 RH FACTOR-BLOOD $236.89
87015 CONCENTRATION INFECTIOUS AGENTS $162.82
87040 BLOOD CULTURE $631.00
87045 CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL $570.47
87046 Culture, bacterial; stool, aerobic, additional pathogens, i… $377.36
87070 CULTURE BODY FLUID $467.00
87075 CULTURE ANAEROBIC $701.00
87076 CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL $393.03
87077 CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL $326.00
87081 CULTURE, BACTERIAL-SCREEN $357.89
87086 URINE CULTURE $449.32
87088 CULTURE BCT ISOL&PRSMPTV $505.99
87106 CUL FNGI DEFINITIVE ID EA ORGANISM YEAST $302.06
87110 CHLAMYDIA CULTURE $562.00
87140 Culture, typing; immunofluorescent method, each antiserum $194.00
87177 Ova and parasites, direct smears, concentration and identif… $498.48
87186 Susceptibility studies, antimicrobial agent $307.46
87205 SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL $282.00
87207 SMR PRIM SRC SPEC STAIN $310.44
87209 SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS $468.89
87210 WET SMEAR $263.25
87252 VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT $359.53
87255 Herpes Simplex Virus Culture with Reflex Typing $689.85
87324 IAAD IA CLOSTRIDIUM DIFFICILE TOXIN $274.91
87338 IAAD IA HPYLORI STOOL $302.04
87340 IAAD IA HEPATITIS B SURFACE ANTIGEN $451.00
87341 IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION $476.27
87389 infection agent etc $279.65
87400 INFLUENZA A&B $405.86
87420 IAAD IA RESPIRATORY SYNCTIAL VIRUS $522.54
87425 IAAD IA ROTAVIRUS $491.75
87426 COVID-19 RAPID ANTIGEN TESTING $446.62
87430 INF AGT IMMUNO STREP A $221.00
87486 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ $285.00
87491 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ $477.19
87493 INF AGENT DET NUC ACID CLOSTRIDIUM AMP PROBE $556.31
87506 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 $1,498.51
87507 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 $3,160.95
87522 Infectious agent detection by nucleic acid (DNA or RNA); he… $1,416.35
87529 IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ $1,150.41
87581 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ $1,665.64
87591 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ $447.57
87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET $3,757.00
87635 Infectious agent detection by nucleic acid (DNA or RNA); se… $275.00
87660 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ $471.63
87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH $486.92
87798 IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM $672.62
87804 INFLUENZA IMMUNOASSAY OPT $378.23
87807 INF AGT DET IMNAS OPT RSV $348.97
87880 RAPID STREP-BETA STREP $335.45
88305 PATH SURG LEVEL IV $1,222.55
89050 CELL COUNT MISCELLANEOUS BODY FLUIDS $445.15
89051 CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT $527.00
89055 LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE $295.32
89060 CRYSTAL INDENTIFICATION $267.06
90471 IMMUN ADM 1 VAC $356.68
90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE $154.56
90714 TETANUS DIPHTHERIA TOXOID $638.00
90715 TDAP VACCINE $547.02
92950 Cardiopulmonary resuscitation (eg, in cardiac arrest) $2,738.00
92960 CARDIOVERSION ELECTIVE ARRHYT XTRNL $4,586.90
93005 Electrocardiogram, routine ECG with at least 12 leads; trac… $1,011.32
93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY $4,759.05
93041 RHYTHEM ECG 1-3 LDS $503.64
93303 COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY $6,128.85
93306 ECHO TEST $7,760.32
93307 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP $5,627.00
93308 ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD $2,277.11
93320 DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY $2,469.25
93325 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING $1,508.77
93351 ECHO TTHRC R-T 2D-+M-MODE REST&STRS CONT ECG $8,973.75
93880 DUP-SCAN XTRC ART COMPL B $3,894.94
93882 DUP-SCAN XTRC ART UNI/LMTD STD $2,806.00
93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL $6,328.44
93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY $3,347.82
93926 DOPPLER-DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STD $2,425.62
93930 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY $3,525.00
93931 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STD $2,203.43
93970 DUP-SCAN XTR VEINS COMPL $4,238.00
93971 DPLX SCN EXTRM VEINS $2,961.51
93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABD, P… $4,816.86
93976 DUPLEX SCAN- LIMITED $2,686.00
94010 SPIROMETRY W/RECORD $1,742.74
94150 Vital capacity test $1,031.74
94640 NEBULIZER TREATMENT $762.00
94644 INHALATION TREATMENT – CONTINUOUS 1ST HR $757.25
94660 CPAP VENTILATION CPAP INITIATION&MGMT $1,855.11
94664 DEMO&/EVAL OF PT UTILIZ $351.62
94760 EAR OR PULSE OXIMETRY $249.04
94761 N-INVAS EAR/PLS OXIMTRY F $501.00
94762 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR $1,171.95
96360 IV INFUS INIT 31 MIN 1 HR $1,464.84
96361 IV INFUS HYDR EA ADD’T HR $597.33
96365 IV INFUSION THERAPY/PROPH $1,467.74
96366 IV INFUS THER PROPH/DX EA $688.00
96367 IV NFS THER PROPH/DX ADDL $1,486.18
96368 IV NFS TX PROPHYLAXIS/DX $1,128.35
96372 THERAPEUTIC PROPHYLACTIC/ $583.04
96374 THER PROPH/DX NJX IV PUSH $753.31
96375 THER PROPH/DX NJX EA SEQL $621.20
96376 SUB INFU EA ADD IV PUSH $471.15
97116 THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR $330.24
97140 MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES $450.45
97166 OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS $1,062.60
97597 DEBRIDEMENT OPEN WOUND 20 SQ CM/< $1,053.00
99000 SPECIMEN HANDLING $53.00
99001 COC COLLECITON ONLY $142.88
99070 SUPPLIES&MATERIALS ABOVE or BEYOND PROV BY PHYS or QHP $117.03
99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS $1,099.00
99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS $2,852.00
99153 Moderate sedation services provided by the same physician o… $286.59
99156 MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS $756.60
99157 MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS $186.00
99173 SCREENING TEST OF VISION $761.53
99281 E/M VISIT LEVEL 1 TECH COMP $1,000.00
99282 E/M VISIT LEVEL 2 TECH COMP $1,965.24
99283 E/M VISIT LEVEL 3 TECH COMP $3,485.69
99284 E/M VISIT LEVEL 4 TECH COMP $5,681.64
99285 E/M VISIT LEVEL 5 TECH COMP $7,635.21
99291 CRITICAL CARE 30-74 MIN $10,658.97
99292 CRITICAL CARE ADD 30 MIN $2,865.36
G0378 HOSPITAL OBSERVATION SERVICES PER HOUR $2,500.00
J0131 INJECTION, ACETAMINOPHEN, 10 MG $48.13
J0153 ADENOSINE INJ 1MG $50.30
J0171 ADRENALIN EPINEPHRINE INJECT $50.30
J0282 INJ AMIODARONE HYDROCHLOR $32.59
J0290 AMPICILLIN 500 MG INJ $79.00
J0295 INJ AMPCLLN SODIUM/SULBA $64.62
J0330 SUCCINYLCHOLINE CHLO 20MG $121.80
J0360 HYDRALAZINE HCL INJ UP TO 20MG $162.55
J0456 INJ AZITHROMYCIN 500MG $106.99
J0461 INJ ATROPINE SULFATE 0.01 $22.13
J0500 DICYCLOMINE HCL 20MG $557.51
J0515 Injection, benztropine mesylate, per 1 mg $390.46
J0561 INJECTION PENICILLIN G BENZATHINE 100,000 UNITS $215.93
J0595 STADOL $65.00
J0690 KEFZOL 1 GR VIAL $34.00
J0692 INJ CEFEPIME HCI 500MG $62.78
J0696 ROCEPHIN 250 MG $49.21
J0735 CLONIDINE 1MG $177.31
J0744 CIPRO 200MG $85.77
J0780 COMPAZINE 10 MG $156.16
J1030 DEPO MEDROL 40 MG/ML $68.63
J1040 METHYLPREDNISOLONE 80MG $119.76
J1100 DECADRON 4 MG VIAL $21.98
J1110 dihydroergotamine mesylate $1,259.92
J1165 DILANTIN 100 MG VIAL $20.45
J1170 DILAUDID 4 MG $61.48
J1200 BENADRYL 50MG $40.82
J1335 ERTAPENEM INJECTION $605.36
J1580 GARAMYCIN,GENTAMICIN 80MG $61.96
J1610 GLUCOGAN 1 MG VIAL $1,555.50
J1630 HALOPERIDOL INJECTION $63.94
J1642 HEPARIN SODIUM PER 10 UNI $12.11
J1644 INJ HEPARIN SOD PER 1000 $78.18
J1650 ENOXAPARIN SODIUM 10MG $159.24
J1670 TETANUS INJECTION $4,732.95
J1815 INJ INSULIN PER 5 UNITS $23.74
J1885 TORADOL INJ 15 MG $45.64
J1940 LASIX 40 MG IV VIAL $46.86
J1956 LEVOFLOXACIN 250 MG $78.35
J2001 LIDOCAINE HCI 10MG $19.77
J2060 ATIVAN 2ML SYRUP $51.89
J2150 MANNITOL INJECTION $45.38
J2175 DEMEROL 50 MG SYRINGE $59.82
J2250 MIDAZOLAM HCI PER 1 MG $19.19
J2270 INJ MORPHINE SULFATE 10 M $46.30
J2274 INJ MORPHINE PF EPID ITHC $80.50
J2300 NUBAIN 10MG AMP $102.25
J2310 INJ NALOXONE HCL 1MG $210.81
J2360 ORPHENADRINE CITRATE 60MG $140.03
J2370 NEO-SYNEPHRINE UP TO 1 ML $96.16
J2405 ONDANSETRON HCI, PER MG $18.94
J2543 ZOSYN – PIPERACILLIN/TAZOBACTAM $75.76
J2550 PHENERGAN 50 MG $49.68
J2704 INJ, PROPOFOL, 10 MG $25.40
J2765 METOCLOPRAMIDE HCL 10MG $34.76
J2770 Quinupristin/dalfopristin $1,656.91
J2790 RHOGAM INJECTION $339.05
J2800 METHOCARBAMOL INJECTION $344.59
J2920 SOLU-MEDROL 40MG $122.10
J2930 SOLU-MEDROL 125 MG $110.69
J3010 INJ FENTANYL CITRATE .1MG $22.78
J3030 IMITREX 6MG VIAL $167.37
J3105 INJECTION, TREBUTALINE SULFATE, UP TO 1 MG $72.76
J3230 THOROZINE 50 MG $347.06
J3360 VALIUM INJ 5 MG $157.22
J3370 VANCOMYCIN HCI INJ 500MG $198.77
J3410 VISTERIL INJ 50 MG $74.46
J3411 INJ THIAMINE 100 MG $89.60
J3430 INJECTION, (PHYTONADIONE) VITAMIN K, PER 1 MG $101.43
J3475 MAGNESIUM SULFATE 2CC AMP $50.15
J3480 POTASSIUM CHLORIDE 2 MG $35.12
J3486 GEODON – ZIPRASIDONE MESYLATE 10MG $272.18
J3490 UNCLASSIFIED DRUGS $458.39
J7030 INFUS NORM SALINE 1000CC $104.54
J7040 INFUS NORM SALINE 500ML $92.06
J7042 5% DEXTROSE $74.31
J7050 INFS NORM SALINE 250CC $97.51
J7060 INFUSION D5W 250ML $93.48
J7070 INFUSION D5W 1000ML $62.50
J7120 RINGER’S LACTATE INFUS $188.27
J7121 5% DEXTROSE IN LAC RINGERS $242.92
J7510 PREDNISOLONE ORAL 5 MG $7.72
J7512 PREDNISONE 5 MG $6.62
J7607 LEVALBUTEROL COMP CON $27.71
J7613 ALBUT INHAL NON-CP 1MG $36.89
J7614 ALBUTEROL ALL FOMULATIONS $27.52
J7620 ALBUTEROL 2.5 MG ATROVENT $36.89
J7644 IPRATROPIUM BROMIDE INHAL $53.75
J7699 NOC DRUGS INHAL SOL ADMIN $38.19
J8499 NONCHEMOTHERAPEUTIC ORAL $73.09
J8540 DEXAMETHASONE, ORAL .25MG $14.82
L0120 CERVICAL FLEX NONADJ COLL $244.41
L0150 CERV SEMI-RIG ADJ MOLDED CHN $368.00
L0464 TLSO 4MOD SACRO-SCAP PRE $9,421.00
L1600 Hip orthosis (HO), abduction control of hip joints, flexible, Frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise $234.82
L1830 KNEE IMMOBOLIZER $224.00
L3260 SURGICAL BOOT/SHOE $228.41
L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing $359.00
L3650 SO FIGURE EIGHT ABDUCTION $654.91
L3660 SO 8 AB RSTR CAN/WEB PRE OTS $686.43
L3908 WRIST EXTN CONTROL COCKUP $228.41
L3913 Hand-finger orthosis (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment $733.00
L4350 AIR SPLINT $888.41
L8501 Tracheostomy speaking valve $762.17
M0243 Intravenous infusion, casirivimab and imdevimab, includes i… $1,200.00
M0245 Intravenous infusion, bamlanivimab and etesevimab, includes… $1,200.00
Q9966 LOCM 200-299MG ML IODINE, 1ML $12.63
Q9967 LOW OSMOLAR CNTRS MAT $13.00
S0028 INJECT FAMOTIDINE 20 MG $62.06
S0119 ZOFRAN, 4MG, ORAL $161.73
S0164 PROTONIX PANTROPRAZOLE 40MG $256.01
S5000 PRESCRIPTION DRUG GENERIC $14.15
S5001 PRESCRIPTION DRUG BAND NM $17.93
S8451 SPLINT WRIST OR ANKLE $169.68
U0002 SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple ty… $150.00