Optim Medical Center-Tattnall CMS

ID
Description
Standard Charge
64415AN2
N BLOCK, INTERSCALINE
$500
64415ANS
N BLOCK, INFRACLAVICULAR
$500
64417ANS
N BLOCK, AXILLARY
$500
64418ANS
N BLOCK, SUPRASCAPULAR
$500
64445ANS
N BLOCK, POPLITEAL
$500
64447AN2
N BLOCK, SAPHENOUS
$500
64447ANS
N BLOCK, FEMORAL
$500
64450ANS
N BLOCK, ANKLE
$500
64450ANS2
ADDUCTOR CANAL BLOCK
$500
87015LAB
CONCENTRATE (FOR INFECTIOUS AGENTS)
$73.44
87040LAB
CULTURE, BLOOD
$113.52
87045LAB
CULTURE, STOOL
$103.76
87070L02
CULTURE, CATH
$94.72
87070L03
CULTURE, CSF
$94.72
87070L04
CULTURE, EAR
$94.72
87070L05
CULTURE, EYE
$94.72
87070L06
CULTURE, MISC
$94.72
87070L07
CULTURE, NASAL
$94.72
87070L08
CULTURE, SPUTUM
$94.72
87070L09
CULTURE, THROAT
$94.72
87070L10
CULTURE, VAGINAL (CERVIX)
$94.72
87070L11
CULTURE, WOUND
$94.72
87070LAB
CULTURE, BODY FLUID
$94.72
87073LAB
CULTURE, ANAEROBIC
$103.76
87077LAB
ORGANISM ID
$88.88
87081L03
MRSA - SELECT (NASAL)
$72.96
87086LAB
URINE COLONY COUNT
$88.8
87088LAB
CULTURE, URINE
$89.04
87102LAB
CULTURE, FUNGUS
$92.4
87116LAB
CULTURE, AFB
$79.92
87177LAB
OVA & PARASITES IDENTIFICATION (STOOL)
$97.84
87185L4
BETA LACTOMASE
$52.24
87186LAB
SENSITIVITY STUDIES
$95.04
87205L02
GRAM STAIN
$25.76
87205LAB
FECAL WBC
$25.76
87206LAB
AFB STAIN
$59.12
87209LAB
COMPLEX SPECIAL STAIN; TRICHROME
$197.68
87210L02
WET MOUNT
$46.96
87252LAB
CULTURE TISSUE
$243.2
87255LAB
HERPES SIMPLEX VIRUS CULTURE
$166.36
87272LAB
INFECTIOUS AGENT ANTIGEN DETECT; CRYPTOS
$131.92
87280LAB
RESPIRATORY SYNCYTIAL VIRUS RSU Ag
$131.92
87324LAB
C DIFFICILE TOXIN
$131.92
87328LAB
Cryptosporidium Antigen, EIA
$130.88
87329LAB
GIARDIA ANTIGEN
$131.92
87338LAB
H. PYLORI ANTIBODIES (STOOL)
$158.16
87389LAB
HIV 1/2 AG & AB 4TH GEN W REFLEX
$197.16
87449LAB
C DIFF ANTIGEN
$131.92
87493LAB
CLOSTRIDIUM DIFFICILE TOXIN B QUAL PCR
$214.16
87497LAB
CYTOMEGALOVINO QUANT
$288
87517LAB
HEPATITIS B DNA QUANT (PCR)
$235.62
87522L2
HEP C QUANT PCR w/REFLEX GENOTYPE LIPA
$233.76
87522LAB
HEPATITIS C qUANT
$235.52
87529LAB
HSV 1 & 2 DNA REAL TIME PCR
$264
87536LAB
HIV-1 RNA, QN REAL TIME PCR
$260
87590LAB
GONORRHEA DNA PROBE
$216.88
87660LAB
TRRCHOMONAS VAGINALIS
$176.88
87661LAB
TRICHOMONAS, MALES
$214.16
87799LAB
BK VIRUS DNA QUANT
$235.52
87804LAB
INFLUENZA A AND B
$131.92
87880LAB
RAPID STREP (QW)
$131.92
87902LAB
HEP C VIRAL RNA GENOTYPE
$479.52
36430L2
BLOOD ADMINISTRATION LEVEL 2
$592.7
36430L3
BLOOD ADMINISTRATION LEVEL 3
$792.7
36430L4
BLOOD ADMINISTRATION LEVEL 4
$992.7
36430LAB
BLOOD, ADMINISTRATION LEVEL 1
$392.7
86880LAB
COOMBS DIRECT
$59.12
86885LAB
COOMBS INDIRECT
$62.96
P9016LAB
RED BLOOD CELLS, LEUKOCYTES
$728
P9034LAB
PLATELET, PHERESIS
$785.4
80048LAB
BMP
$93.04
80051LAB
ELECTROLYTE PANEL
$77.12
80053LAB
CMP
$116.24
80061LAB
LIPID PROFILE
$147.36
80069LAB
RENAL FUNCTION PANEL
$95.52
80074LAB
HEPATITIS PANEL
$523.76
80076LAB
LIVER PROFILE (LFT)
$89.84
80100L2
URINE DRUG SCREEN
$56.95
80156LAB
TEGRETOL (CARBAMAZEPINE)
$160.16
80158LAB
CYCLOSPORIN
$65.44
80162LAB
DIGOXIN (LANOXIN)
$146
80164LAB
DEPAKENE (DEPAKOTE) (VALPORIC)
$149.04
80168LAB
ETHOSUXIMIDE
$179.76
80170LAB
GENTAMYCIN
$180.24
80175LAB
LAMICTAIL
$144.72
80178LAB
LITHIUM
$72.72
80184LAB
PHENOBARBITAL
$125.92
80185LAB
DILATIN (PHENYTION)
$145.76
80197LAB
TACROLIMUS (PROGRAF)
$150.96
80198LAB
THEOPHYLLINE
$155.6
80201LAB
TOPAMAX TOPIRAMATE
$131.12
80202LAB
VANCOMYCIN
$149.04
80307L4
DRUG SCREEN URINE
$303.36
80320LAB
ETHANOL
$118.8
80323LAB
ALKALOIDS, NOT OTHERWISE SPECIFIED
$193.86
80327LAB
DIHYDROTESTOSTERONE
$202.5
80329L2
ACETAMINOPHEN
$222.56
80329LAB
SALICYLATE
$78
80375LAB
TPMT ACTIVITY
$550.06
82009L02
URINE ACETONE
$49.68
82010LAB
BETA HYDROXYBUTYRATE
$89.2
82024LAB
ACTH
$212.4
82040LAB
ALBUMIN
$54.4
82043LAB
URINE MICRO ALBUMIN
$63.6
82085LAB
ALDOLASE
$106.72
82088LAB
ALDOSTERONE
$224.08
82103LAB
ALPHA-1-ANTITRYPSIN TOTAL
$147.76
82104LAB
ALPHA-1=ANTITRYPSIN PHENOTYPE
$157.84
82105LAB
ALPHA FETAL PROTEIN
$184.48
82140LAB
AMMONIA
$160.24
82150LAB
AMYLASE
$71.28
82164LAB
ANGIOTENSIN 1, (ACE)
$160.56
82172L2
APOLIPOPROTEIN B
$169.12
82175LAB
ARSENIC
$128.48
82247LAB
BILIRUBIN TOTAL
$55.2
82248LAB
BILIRUBIN DIRECT/INDIRECT
$55.2
82272LAB
OCCULT BLOOD (STOOL)
$35.84
82306L2
VITAMIN D 25 HYDOXY D2, D3
$242.4
82306LAB
VITAMIN D-25 HYDROXY
$325.6
82310LAB
CALCIUM
$56.72
82330LAB
CALCIUM, IONIZED
$150.32
82397LAB
ALPHA SUBUNIT
$157.48
82435LAB
CHLORIDE
$50.56
82436LAB
URINE CHLORIDE
$55.28
82465LAB
CHOLESTEROL
$47.84
82495LAB
CHROMIUM
$223.04
82507LAB
CITRIC ACID 24 URINE
$229.32
82523LAB
N-TELOPEPTICLE URINE
$205.52
82525LAB
COPPER
$136.48
82530L2
CORTISOL, FREE
$183.76
82533LAB
CORTISOL LEVEL
$179.28
82540LAB
24 URINE CREATINE
$50.96
82550LAB
CPK
$71.6
82552LAB
CREATINE KINASE ISOENZYME
$146.24
82553LAB
CKMB
$126.96
82565LAB
CREATININE
$56.32
82570LAB
URINE CREATININE
$56.88
82575LAB
24 HOUR CREATININE CLEARANCE
$103.92
82607LAB
VITAMIN B-12
$165.76
82608LAB
VITAMIN B12 BINDING CAPACITY
$156.32
82627LAB
DHEA SULFATE
$181.98
82652LAB
VITAMIN D, 1, 25 DIHYDROXY
$423.36
82656LAB
PANCREATIC ELASTASE
$116.64
82668LAB
ERYTHROPOIETIN
$206.72
82670LAB
ESTRADIOL
$307.28
82672LAB
ESTROGEN
$238.56
82705LAB
FECAL FAT QUAL
$55.92
82728LAB
FERRITIN
$149.84
82746LAB
FOLATE
$161.68
82747LAB
FELATE BBC
$190.48
82784L02
IGG
$102.24
82784L03
IGM
$102.24
82784LAB
IGA
$102.24
82785LAB
IGE
$181.12
82787L2
IgG SUBCLASS 2
$66.18
82787L3
IgG SUBCLASS 3
$66.18
82787L4
IgG SUBCLASS 4
$66.18
82787LAB
IgG SUBCLASS 1
$66.18
82945L02
SYNOVIAL FLUID GLUCOSE
$43.12
82945LAB
GLUCOSE CSF
$43.12
82947LAB
GLUCOSE
$43.12
82948LAB
REAGENT STRIP/BLOOD GLUCOSE
$34.8
82950LAB
GLUCOSE POSTPRANDIAL 1 HOUR
$52.24
82951LAB
GLUCOSE TOLERANCE TEST- 2HR
$141.52
82952LAB
GLUCOSE TOLERANCE TEST- 3HR
$43.12
82955LAB
GLUCOSE-6 PHOSPATE DEHYDROGENASE , QUANT
$85.76
82977LAB
GGT
$79.2
82985LAB
FRUTOSAMINE
$148.88
83001LAB
FOLLICE STIMULATING HORMONE (FSH)
$204.32
83002LAB
LUTEINIZING HORMONE
$203.68
83009LAB
H PYLORI; UREASE
$148.72
83010LAB
HAPTOGLOBIN
$40.96
83013LAB
H PYLORI BREATH TEST
$740.72
83018LAB
COBALT
$241.52
83021ALAB
HEMOGLOBINOPATHY
$66
83036LAB
GLYCOHEMOGLOBIN (A1C)
$106.72
83090LAB
HOMOCYSTEINE LEVEL
$185.52
83516L2
TRONSGLUTAMINASE ANTIBODIES AB(IGA)
$117.44
83516L3
TRANSGLUTAMINOSE AB (IGA)
$117.44
83516L4
ANTIPHOSPHOLIPID Ab IgG
$116.64
83516LAB
CENTROMERE
$117.52
83519L6
PTH RELATED PROTEIN
$147.12
83519L7
TRYPSIN
$147.44
83519LAB
ACETYLCHOLINE RECEPTOR BINDING ANTIBODY
$148.56
83520L6
ANTI IgE ANTIBODY
$210
83520LAB
GLOMERULAR BASEMENT MEMBRANCE
$120
83525LAB
INSULIN
$125.68
83540LAB
IRON
$71.2
83550LAB
IRON BINDING CAPACITY (TIBC)
$96.16
83605L2
LACTIC ACID
$80.16
83605LAB
LACTIC ACID
$117.44
83615LAB
LDH
$66.4
83655LAB
LEAD (BLOOD)
$133.12
83690LAB
LIPASE
$75.76
83695LAB
LIPOPROTEIN A
$142.4
83704LAB
DMR LIPOPROFILE
$173.44
83721LAB
LDL CHOLESTEROL
$104.88
83735LAB
MAGNESIUM (MG)
$73.68
83789LAB
TRILEPTAL (10-HYDROXYCARBAZEPINE)
$198.56
83825LAB
MERCURY
$108.8
83835LAB
24 HOUR METANEPHRINES
$186.32
83873LAB
MYELIN BOSIC PROKIN, CSF
$189.2
83874L2
Myoglobin Serum
$140.96
83874LAB
MYOGLOBIN URINE
$142
83880LAB
BNP B-TYPE NATRIURETIC PEPTIDE
$373.28
83883L2
FREE LAMBDA
$151.12
83916LAB
OLIGOCLONAL BANDS CSF
$219.44
83921LAB
METHYLMALONIC ACID
$179.6
83935LAB
OSMOLALITY URINE
$74.96
83945LAB
OXALIC ACID 24 URINE
$141.52
83970LAB
PARATHYROID HORMONE
$226.96
83993LAB
CALPROTECTIN, STOOL
$214.24
84080LAB
ALKALINE PHOSPHATASE ISOENZYMES
$56.48
84100LAB
PHOSPHORUS (PO4)
$52.16
84105LAB
PHOSPHATE 24 URINE
$56.88
84120LAB
PORPHYNNS URINE
$216.56
84132LAB
POTASSIUM (K+)
$50.56
84133LAB
URINE POTASSIUM (K+)
$47.28
84134LAB
PRE-ALBUMIN
$160.4
84140LAB
PREGNENOLONE
$170.52
84144LAB
PROGESTERONE
$224
84145LAB
PROCALCITONIN
$219.24
84146LAB
PROLACTIN
$213.12
84154LAB
PSA, FREE
$202.32
84156LAB
URINE TOTAL PROTEIN
$40.32
84157L02
SYNOVIAL FLUID PROTEIN
$40.32
84157LAB
CSF TOTAL PROTEIN
$40.32
84207LAB
VITAMIN B6 (pyridoxine)
$231.72
84244LAB
RENIN ACTIVITY PLASMA
$241.92
84270LAB
SEX HORMONE BLOCKING GLOBULIN
$179.22
84295LAB
SODIUM (NA+)
$52.96
84300L02
URINE SODIUM
$38
84305ALAB
INSULIN GROWTH IGF
$175.32
84311L2
CHYMOTRYPSIN
$69.04
84378LAB
GLYCOMARK
$126.72
84402LAB
TESTOSTERONE, FREE & TOTAL
$280
84403LAB
TESTOSTERONE
$283.92
84425LAB
THYAMIN, VITAMIN B1
$233.52
84432LAB
THYROGLOBULIN ANTIBODY
$176.64
84436LAB
T-4, TOTAL
$75.52
84439LAB
T-4, FREE
$99.2
84443LAB
TSH
$184.8
84446LAB
VITAMIN E (TOCOPHEROL)
$154.72
84450LAB
AST (SGOT)
$56.88
84460LAB
ALT (SGPT)
$58.16
84478LAB
TRIGLYCERIDES
$63.2
84479LAB
T-3, UPTAKE
$71.12
84480LAB
T-3, TOTAL
$140.24
84481LAB
T-3, FREE
$186.32
84482LAB
T 3 REVERSE
$173.36
84512LAB
TROPONIN I
$81.2
84520LAB
BUN
$43.44
84550LAB
URIC ACID
$49.68
84560L2
URIC ACID SYNOVIAL FLWD
$52.24
84630LAB
ZINC
$125.2
84681LAB
C-PEPTIDE
$174.8
84702LAB
HCG BETA QUANTATIVE
$70.56
84703LAB
SERUM PREGNANCY
$70.56
85303LAB
PROTEIN C ACTIVITY
$152.08
85306LAB
PROTEIN S ACTIVITY
$168.48
86300L02
CA 27-29
$228.88
86304LAB
CA 125
$228.88
86334LAB
IMMUNOFIXATION (SERUM)
$245.68
86480LAB
QUANTIFERON TB GOLD
$340.8
86705LAB
HEP B CORE IGM ANTIBODY
$129.44
86812LAB
B 27 (HLA)
$286.84
G0103LAB
PSA (TOTAL) SCREENING
$202.32
77012RAD
CT GUIDANCE FOR NEEDLE PLACEMENT
$307.75
71250RAD
CT THORAX W/O CONTRAST MATERIAL
$1364.02
71260RAD
CT THORAX W/CONTRAST MATERIAL
$1705.27
71270RAD
CT THORAX W/O &W/CONTRAST MATERIAL
$2063.74
71275RAD
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTR
$2622.48
72125RAD
CT CERVICAL SPINE W/O CONTRAST MATERIAL
$1395.17
72126RAD
CT CERVICAL SPINE W/CONTRAST MATERIAL
$1702.68
72127RAD
CT CERVICAL SPINE W/O &W/CONTRAST MATERI
$2033.22
72128RAD
CT THORACIC SPINE W/O CONTRAST MATERIAL
$1365.7
72129RAD
CT THORACIC SPINE W/CONTRAST MATERIAL
$1709.05
72130RAD
CT THORACIC SPINE W/O & W/CONTRAST MATER
$2043.93
72131RAD
CT LUMBAR SPINE W/O CONTRAST MATERIAL
$1361.43
72132RAD
CT LUMBAR SPINE W/CONTRAST MATERIAL
$1704.78
72133RAD
CT LUMBAR SPINE W/O & W/CONTRAST MATERIA
$2033.22
72192RAD
CT PELVIS W/O CONTRAST MATERIAL
$1134.77
72193RAD
CT PELVIS W/CONTRAST MATERIAL
$1776.04
72194RAD
CT PELVIS W/O & W/CONTRAST MATERIAL
$1989.26
73200RAD
CT UPPER EXTREMITY W/O CONTRAST MATERIAL
$1357.3
73201RAD
CT UPPER EXTREMITY WITH CONTRAST
$1664.88
73202RAD
CT UPPER EXTREMITY W/O & W/CONTRAST MATE
$2113.3
73700RAD
CT LOWER EXTREMITY W/O CONTRAST MATERIAL
$1361.57
73701RAD
CT LOWER EXTREMITY W/CONTRAST MATERIAL
$1688.4
74150RAD
CT ABDOMEN W/O CONTRAST MATERIAL
$1160.81
74160RAD
CT ABDOMEN W/CONTRAST MATERIAL
$1808.66
74170RAD
CT ABDOMEN W/O &W/CONTRAST MATERIAL
$2081.38
74174RAD
CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTR
$3241.14
74175RAD
CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCON
$2637.04
74176RAD
CT ABDOMEN & PELVIS W/O CONTRAST MATERIA
$1503.81
74177RAD
CT ABDOEN & PELVIS W/CONTRAST MATERIAL
$2243.57
74178RAD
CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY
$2624.72
75635RAD
CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POS
$2923.06
76376RAD
3D RENDERING W/INTERP CT/MRI/US/OTHER TO
$383.53
70450RAD
CT HEAD/BRAIN W/O CONTRAST MATERIAL
$1073.24
70460RAD
CT HEAD/BRAIN W/CONTRAST MATERIAL
$1407.35
70470RAD
CT HEAD/BRAIN W/O&W/CONTRAST MATERIAL
$1425.83
70486RAD
CT MAXILLOFACIAL W/O CONTRAST MATERIAL
$1482.46
70487RAD
CT MAXILLOFACIAL W/CONTRAST MATERIAL
$1783.74
70490RAD
CT SOFT TISSUE NECK W/O CONTRAST MATERIA
$1449.63
70491RAD
CT SOFT TISSUE NECK W/CONTRAST MATERIAL
$1742.93
70492RAD
CT SOFT TISSUE NECK W/O &W/CONTRAST MATE
$2076.2
70496RAD
CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRA
$3238.48
70498RAD
CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRA
$3347.54
76010RAD
RADEX FROM NOSE RECTUM FOREIGN BODY 1 VI
$253.9
95941OR
NEUROMONITORING INTRAOPERATIVE 8 UNITS
$1300
J0585OR
INJECTION ONABOTULINUMTOXIN, 1 UNIT
$303.36
20610RAD
ARTHROCENTESIS, ASP/INJ JOINT/BURSA (SHO
$680
70100RAD
MANDIBLE, LESS THAN 4 VIEWS
$196.38
70110RAD
MANDIBLE, COMPLETE, MIN 4 VIEWS
$225.3
70140RAD
RADEX FACIAL BONES < 3 VIEWS
$170.88
70150RAD
RADEX FACIAL BONES COMPLETE MINIMUM 3 VI
$242.04
70160RAD
RADEX NASAL BONES COMPLETE MINIMUM 3 VIE
$190.62
70200RAD
RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
$247.92
70210RAD
RADEX SINUSES PARANASAL < 3 VIEWS
$126.54
70220RAD
RADEX SINUSES PARANASAL COMPL MINIMUM 3
$221.64
70250RAD
RADIOLOGIC EXAMINATION SKULL < 4 VIEWS
$212.28
70260RAD
RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4
$267.54
70360RAD
RADIOLOGIC EXAMINATION NECK SOFT TISSUE
$157.62
71010RAD
RADIOLOGIC EXAMINATION CHEST SINGLE VIEW
$132.18
71020RAD
RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LA
$171.54
71021RAD
RADEX CH 2 VIEWS FRNT&LAT APICAL LORDOTI
$212.88
71045RAD
RADIOLOGIC EXAM CHEST SINGLE VIEW
$132.18
71046RAD
RADIOLOGIC EXAM CHEST 2 VIEWS FRONT & LA
$171.54
71047RAD
RADEX CHEST 3 VIEWS FRONT LA APIC LORDOT
$212.88
71100RAD
RADEX RIBS UNILATERAL 2 VIEWS
$184.38
71101RAD
RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3
$223.92
71110RAD
RADEX RIBS BILATERAL 3 VIEWS
$231.24
71111RAD
RADEX RIBS BI W/POSTEROANT CH MINIMUM 4
$332.46
71120RAD
RADEX STERNUM MINIMUM 2 VIEWS
$178.44
72040RAD
RADEX SPINE CERVICAL 2/3 VIEWS
$202.8
72050RAD
RADEX SPINE CERVICAL MINIMUM 4 VIEWS
$274.32
72052RAD
RADEX SPINE CRV COMPL W/OBLQ&FLEX&/XTN S
$352.38
72070RAD
RADEX SPINE THORACIC 2 VIEWS
$191.7
72072RAD
RADEX SPINE THORACIC 3 VIEWS
$210
72074RAD
RADEX SPINE THORACIC MINIMUM 4 VIEWS
$250.32
72080RAD
RADEX SPINE THORACOLUMBAR 2 VIEWS
$170.88
72081RAD
RADEX SPINE THORACOLMBR STANDING SCOLIOS
$216.18
72082RAD
RADEX SPINE SCOLIOS STUDY W/SUPINE&EREC
$344.76
72100RAD
RADEX SPINE LUMBOSACRAL 2/3 VIEWS
$204.66
72110RAD
RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
$277.98
72114RAD
RADEX SPINE LUMBSCRL COMPL W/BENDING VIE
$362.58
72170RAD
RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
$275.2
72190RAD
RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 V
$246.6
72200RAD
RADIOLOGIC EXAMINATION SACROILIAC JNTS <
$168.66
72202RAD
RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE
$196.56
72220RAD
RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
$165
72240RAD
MYELOGRAPY CERVICAL RS&I
$726.9
72255RAD
MYELOGRAPY THORACIC RS&I
$693.84
72265RAD
MYELOGRAPY LUMBOSACRAL RS&I
$712.38
72270RAD
MYELOGRAPY 2/MORE REGIONS RS&I
$1109.76
73000RAD
RADEX CLAVICLE COMPLETE
$164.76
73010RAD
RADEX SCAPULA COMPLETE
$183.42
73020RAD
RADEX SHOULDER 1 VIEW
$135.24
73030RAD
RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
$176.28
73040RAD
RADEX SHOULDER ARTHROGRAPHY RS&I
$600
73050RAD
RADEX A-C JOINTS BI W/WO WEIGHTED DISTRC
$229.86
73060RAD
RADEX HUMERUS MINIMUM 2 VIEWS
$165
73070RAD
RADEX ELBOW 2 VIEWS
$162.72
73080RAD
RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
$190.62
73085RAD
RADEX ELBOW ARTHROGRAPHY RS&I
$577.92
73090RAD
RADEX FOREARM 2 VIEWS
$159.3
73092RAD
RADEX UPPER EXTREMITY INFANT MINIMUM 2 V
$184.92
73100RAD
RADEX WRIST 2 VIEWS
$183.24
73110RAD
RADEX WRIST COMPLETE MINIMUM 3 VIEWS
$214.5
73115RAD
RADEX WRIST ARTHROGRAPHY RS&I
$631.14
73120RAD
RADEX HAND 2 VIEWS
$157.44
73130RAD
RADEX HAND MINIMUM 3 VIEWS
$185.16
73140RAD
RADEX FINGR MINIMUM 2 VIEWS
$191.64
73501RAD
RADEX HIP UNILATERAL 1 VIEW
$164.22
73502RAD
RADEX HIP UNILATERAL COMPLETE MIN 2-3 VI
$224.58
73521RAD
RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST
$219.18
73522RAD
RADEX HIPS BILATERAL 3-4V WITH PELVIS
$270.9
73525RAD
RADEX HIP ARTHROGRAPHY RS&I
$598.14
73551RAD
RADIOLOGIC EXAMINATION FEMUR 1 VIEW
$154.14
73552RAD
RADIOLOGIC EXAMINATION FEMUR 2 VIEWS
$163.26
73560RAD
RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
$177.96
73562RAD
RADIOLOGIC EXAMINATION KNEE 3 VIEWS
$214.8
73564RAD
RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIE
$250.44
73565RAD
RADIOLOGIC EXAM BOTH KNEES STANDING ANTE
$250.44
73590RAD
RADIOLOGIC EXAMINATION TIBIA & FIBULA 2
$157.62
73600RAD
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
$164.76
73610RAD
RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
$190.62
73620RAD
RADIOLOGIC EXAMINATION FOOT 2 VIEWS
$157.44
73630RAD
RADEX FOOT COMPLETE MINIMUM 3 VIEWS
$179.64
73650RAD
RADEX CALCANEUS MINIMUM 2 VIEWS
$162.96
73660RAD
RADEX TOE MINIMUM 2 VIEWS
$173.34
74000RAD
RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW
$137.7
74018RAD
RADEX ABDOMEN 1 VIEW
$137.7
74019RAD
RADEX ABDOMEN 2 VIEWS
$229.38
74020RAD
RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS
$229.38
74022RAD
RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1
$276.24
74220RAD
RADEX ESOPHAGUS
$515.76
74247RAD
RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS
$748.92
74250RAD
RADEX SMALL INTESTINE W/MULTIPLE SERIAL
$574.2
75809RAD
SHUNTOGRAM INDWELLING NONVASCULAR
$460
77001RAD
FLUROGUIDE FOR VEIN DEVICE
$95.6
77002RAD
FLUORO GUIDANCE/BIOPSY/ASPIRATION/INJ
$529.68
77071RAD
MANUAL APPL STRESS PFRMD PHYS JOINT RADI
$291.3
77072RAD
BONE AGE STUDIES
$132.42
77073RAD
BONE LENGTH STUDIES
$218.58
77075RAD
RADIOLOGIC EXAMINATION OSSEOUS SURVEY CO
$533.94
78291RAD
SHUNT PATENCY TEST 3V
$394.4
93306RAD
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&
$1048.44
93000RES
ROUTINE ECG W/LEAST 12 LDS W/I&R
$172.5
93005RES
ELECTROCARDIOGRAM
$172.45
10060ER
INCISION & DRAINAGE ABSCESS SIMPLE/SINGL
$441.48
10061ER
INCISION&DRAINAGE ABSCESS COMPLICATED/MU
$783.16
10080ER
INCISION & DRAINAGE PILONIDAL CYST SIMPL
$683.8
10120ER
INCISION&REMOVAL FOREIGN BODY SUBQ TISS
$578.52
10121ER
INCISION&REMOVAL FOREIGN BODY SUBQ TISS
$1054.04
10140ER
I&D HEMATOMA SEROMA/FLUID COLLECTION
$620.36
11730ER
AVULSION NAIL PLATE PARTIAL/COMPLETE SIM
$373.68
11740ER
EVACUATION SUBUNGUAL HEMATOMA
$186.12
11750ER
EXCISION NAIL MATRIX PERMANENT REMOVAL
$849.52
11760ER
REPAIR NAIL BED
$887.72
11765ER
WEDGE RESECTION TOENAIL
$359.24
12001ER
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK
$344.64
12002ER
SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.
$418.68
12004ER
SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6
$492.72
12005ER
SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-
$638.52
12007ER
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK
$880.68
12011ER
SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
$421.36
12013ER
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0CM
$461.36
12014ER
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5CM
$541.04
12015ER
SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5CM
$660.68
12020ER
TX SUPERFICIAL WOUND DEHISCENCE SIMPLE C
$1073.92
12031ER
REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
$906.56
12032ER
REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
$1157.2
12034ER
REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
$1190.84
12035ER
REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
$1479.88
12036ER
REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM
$1619
12041ER
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5
$921.36
12042ER
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6
$1099.96
12045ER
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.
$985.84
12051ER
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 C
$1120.68
12052ER
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5
$784.6
12053ER
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7
$1320.72
12054ER
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-1
$1411.2
13121ER
REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5
$1628.44
13122ER
REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 C
$511.12
13131ER
REPAIR COMPLEX FOREHEAD 1.1-2.5 CM
$975.08
13132ER
REPAIR COMPLEX FOREHEAD 2.6*--7.5 CM
$1225.04
16020ER
DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SM
$309.68
16025ER
DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ ME
$564.28
20103ER
EXPLORATION PENETRATING WOUND SPX EXTREM
$2232.76
20520ER
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEAT
$220.92
20552ER
INJECTION SINGLE/MLT TRIGGER POINT 1/2 M
$209.88
20600ER
ARTHROCENTESIS ASPIR&/INJECTION SMALL JT
$179.32
20605ER
ARTHROCENTESIS ASPIR&/INJECTION INTERM J
$249.96
20610ER
ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT
$229
23650ER
CLSD TX SHOULDER DISLC W/MANIPULATION W/
$1210.04
23655ER
CLSD TX SHOULDER DISLC W/MANIPULATION RE
$1530.08
24200ER
REMOVE ELBOW/UPPPER ARM FB SIMPLE W/INC
$537.04
24201ER
REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEE
$2136.84
24605ER
TREATMENT CLOSED ELBOW DISLOCATION REQ A
$1918.24
24640ER
CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELB
$545
25259ER
MANIPULATION WRIST UNDER ANESTHESIA
$7268
25605ER
FX CARE DISTAL RADIUS W/MANIPULATION
$1977.88
25660ER
CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W
$1569.88
26700ER
DISLOCATION METACARPOPHALANGEAL EA W/O
$1172.52
26750ER
CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ E
$705.84
26770ER
CLTX IPHAL JT DISLC W/MANJ W/O ANES
$1063.96
27250ER
CLTX HIP DISLOCATION TRAUMATIC W/O ANEST
$712.04
27252ER
CLTX HIP DISLOCATION TRAUMATIC REQ ANEST
$2916.48
27762ER
FX CARE MEDIAL MALLEOLUS W MANIPULATION
$1682.76
27810ER
FX CARE BIMALLEOLAR ANKLE W/MANIPULATION
$1488.04
27842ER
CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL
$1903.32
28190ER
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
$990.52
28515ER
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
$549.12
28630ER
DISLOCATION RED METASAL PHALANGEALW/OANE
$430.36
28660ER
CLTX INTERPHALANGEAL JOINT DISLOCATION W
$451.2
29105ER
APPLICATION LONG ARM SPLINT SHOULDER HAN
$337.72
29125ER
APPLICATION SHORT ARM SPLINT FOREARM-HAN
$249.24
29126ER
APP OF SHORT ARM CAST; DYNAMIC
$295.84
29130ER
APPLICATION FINGER SPLINT STATIC
$157.56
29131ER
APPL OF FINGER SPLINT; DYNAMIC
$199.84
29240ER
STRAPPING; SHOULDER
$220.28
29345ER
APPLICATION LONG LEG CAST THIGH-TOE
$525.28
29405ER
APPLICATION SHORT LEG CAST BELOW KNEE-TO
$313.4
29505ER
APPLICATION LONG LEG SPLINT THIGH ANKLE/
$193.36
29515ER
APPLICATION SHORT LEG SPLINT CALF FOOT
$276.96
30300ER
REMOVAL FOREIGN BODY FROM NOSE
$481.12
30901ER
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
$369.12
30905ER
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY
$391.52
31500ER
INTUBATION ENDOTRACHEAL-ER
$460.96
32405ER
PNEUMOCENTESIS PUNCTURE LUNG ASPIRATION
$444.95
32551ER
TUBE THORACOSTOMY INCLUDES WATER SEAL
$687.8
36556ER
INSJ NON-TUNNELED CENTRAL VENOUS CATH AG
$901.24
36569ER
INSERTION OF PICC LINE
$697.14
36589ER
RMVL TUN CVC W/O SUBW PORT/ PMP
$1262.4
36680ER
EZ I O Intraosseus Venous Access Device
$240.72
40654ER
REPAIR LIP FULL THICKNESS > HALF VERT/HG
$1658.2
43760ER
CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O
$1923.22
46040ER
I & D ISCHORECTAL AND PERIRECTAL ABSCESS
$3033.6
46050ER
I&D PERIANAL ABSCESS SUPERFICIAL
$783.24
46083ER
INCISION THROMBOSED HEMORRHOID EXTERNAL
$679.84
51701ER
INSERT STRAIGHT CATH
$109.12
51702ER
FOLEY CATHETER
$118.16
51798ER
BLADDER SCAN
$68.28
56405ER
I&D VULVA/PERINEAL ABSCESS
$425.04
56420ER
I&D OF BARTHOLINS GLAND ABSCESS
$470.72
59409ER
VAGINAL DELIVERY
$3303.76
64400ER
BLOCK PAIN - DENTAL OR TMJ/PERIPHERAL
$271.52
64402ER
INJECTION ANESTHETIC AGENT FACIAL NERVE
$466.6
64450ER
DIGITAL BLOCK (INJ PERIPHERAL NVE BR)
$179.76
65205ER
REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
$218.04
69200ER
RMVL FB XTRNL AUDITORY CANAL W/O ANES
$476.72
69209ER
REMOVAL IMPACTED CERUMEN UNILATERAL
$28.98
69210ER
RMVL IMPACTED CERUMEN SPX 1/BOTH EARS
$199.4
90471ER
IMMUNIZATION ADMIINISTRATION (FIRST)
$92.64
90714ER
TETANUS/DIPTHERIA TOXOIDS ABSORBED
$167.28
90715ER
TETANUS/DIPTHERIA/PERTUSSIS TOXOIDS ABSO
$296.8
92950ER
CPR
$740.08
99151ER
MODERATE SEDATION SAME PHY/ QHP INITIAL
$214.8
99152ER
MOD SED SAME PHY/ QHP INITIAL 15 MINS
$112.56
99195ER
PHLEBOTOMY, THERAPEUTIC
$369.28
99281ER
ER LEVEL 1
$196.1
99282ER
ER LEVEL 2
$221.1
99283ER
ER LEVEL 3
$319.55
99284ER
ER LEVEL 4
$475.2
99285ER
ER LEVEL 5
$820.6
99291ER
ER CRITICAL CARE LEVEL 1ST HOUR
$1041.52
99292ER
ER CRITICAL CARE EACH ADD'L 30 MINUTES
$465.8
97001PT
PHYSICAL THERAPY EVALUATION
$214.29
97161PT
PT EVAL LOW COMPLEXITY
$156.46
97162PT
PT EVAL MODERATE COMPLEXITY
$156.46
97163PT
PT EVAL HIGH COMPLEXITY
$156.46
97164PT
PT RE-EVAL CODE 2017
$105.9
PRIVATE
PRIVATE
$3000
RBPRIVATE
PRIVATE
$3000
85002LAB
BLEEDING TIME
$49.52
85007LAB
BLOOD COUNT, DIFFERENTIAL
$37.84
85014LAB
HCT
$26.08
85018LAB
HEMOGLOBIN
$26.08
85025LAB
CBC/AUTO DIFF
$85.52
85027LAB
CBC (NO AUTO DIFF)
$71.12
85041LAB
RBC
$48
85044LAB
Retic
$47.28
85048LAB
WBC
$27.92
85049LAB
PLATELET COUNT
$49.2
85060LAB
PATHOLOGY SMEAR REVIEW
$58.3
85220LAB
FACTOR V
$194.08
85301LAB
ANTITHROMBIN III ANTIGEN
$118.88
85302LAB
PROTEIN C ANTIGEN
$132.16
85305LAB
PROTEIN S ANTIGEN
$127.6
85307LAB
ACT PROTEIN C RESIST W/REFLEX FACTOR C
$167.28
85379LAB
D-DIMER
$111.92
85384LAB
FIBINOGEN
$93.44
85610LAB
PROTIME (PT)
$43.2
85613L2
LUPUS ANTICOAGULANT EVALUATION
$105.28
85651LAB
SED RATE (ESR)
$39.04
85730LAB
PTT (APTT)
$66
85999LAB
EOSINOPHIL COUNT URINE
$46.96
93225RES
HOLTER RECORDING
$220.55
93226RES
HOLTER SCANNING
$555.25
80177LAB
LEVETIRACETAM
$150.64
80299L02
LEVETIRACETAM (KEPPRA)
$150.64
80299LAB
LAMOTRIGINE (LAMICTAIL)
$150.64
81381LAB
HLA B5701 TYPING
$339.8
82009LAB
ACETONE (SERUM)
$36.16
82271LAB
GASTRIC OCCULT
$35.84
82378LAB
CEA
$208.64
82390LAB
CERULOPLASMIN
$118.08
84300LAB
24 HOUR SODIUM (NA+)
$53.52
85660LAB
SICKLE CELL
$60.72
86003L10
LIVE OAK Ige
$20.56
86003L12
DOG Ige
$20.56
86003L13
PECAN TREE IGE
$57.36
86003L22
ASPERGILLUS FUMIGATUS
$20.56
86003L23
BERMUDA GRASS
$20.56
86003L24
BIRCH
$20.56
86003L25
CIADOSPORIUM HERBARUM
$20.56
86003L26
COCROACH
$20.56
86003L27
DERMATOPHOGOIDES FARINAE
$20.56
86003L28
ELM
$20.56
86003L29
MAPLE
$20.56
86003L30
MOUNTAIN CEDAR
$20.56
86003L31
NETTLE
$20.56
86003L32
PENICILLIUM NOTATUM
$20.56
86003L33
SHEEP SORREL
$20.56
86003L34
TIMOTHY GRASS
$20.56
86003L35
ROUGH PIGWEED IgE
$56.96
86003L36
DERMATOPHAGOIDES PTERONYSSINUS IgE
$56.96
86003L7
BAHIA GRASS Ige
$20.56
86003L8
ALTERNARIA Ige
$20.56
86003L9
RAGWEED Ige
$20.56
86003LAB
CAT Ige
$20.56
86021
MYELOPEROXIDASE Ab (Anca-c)
$50
86038LAB
ANA
$132.96
86039LAB
ANA TITER
$122.8
86060LAB
ASO TITER
$76.88
86140LAB
C REACTIVE PROTEIN
$56.88
86141LAB
HS-CRP
$140
86147LAB
CARDIOLIPIN Ab (IgG)
$209.82
86160L02
C4
$132
86160LAB
C3
$132
86161LAB
CI INHIBITOR
$32.76
86162LAB
CH50
$223.44
86200LAB
CYCLIC CITRULLINE PEPTIDE (CCP)
$142.4
86235L02
SMOOTH MUSCLE RNP ANTIBODY
$197.2
86235L03
SJOGREN'S ANTIBODY A; SS-A
$197.2
86235L04
SJOGREN'S ANTIBODY B; SS-B
$197.2
86235LAB
ANTI SMOOTH MUSCLE
$218.65
86255L02
MILOCHONDRIAL Ab
$132.56
86255L3
SMOOTH MUSCLE Ab
$131.52
86255LAB
PARIETAL CELL AB
$132.56
86301
CA19-9
$228.88
86308LAB
MONO TEST
$56.88
86317L27
HEPATITIS B SURFACE AB QUANT
$132
86335LAB
IMMUNOFIXATION URINE
$187.36
86337LAB
GAD-65
$235.44
86340LAB
INTRIOSIC FACTOR BLOCKING AB
$165.76
86341L2
INSULIN AUTOANTIBODY
$217.6
86341LAB
IA-2
$217.6
86360LAB
LYMPHOCYTE SUBSET PANEL 4
$258.36
86361LAB
LYMPHOCYTE SUBSET PANEL 5
$215.34
86376LAB
THYROID PEROXIDOSE ANTIBODY
$159.92
86403LAB
CRYPTOCOCCAL Ag CSF
$112.08
86430LAB
RA LATEX
$62.4
86431L02
QUANTITATIVE TITER
$62.4
86431LAB
RA LATEX (TITER)
$62.4
86592L2
VDRL CSF
$46.96
86592LAB
RPR
$46.96
86606LAB
ASPERGILLUS, FUMIGATUS
$41.08
86609L2
PIGEON SERUM
$35.16
86609LAB
MICROPOLYSPORA FAENI
$35.16
86611L2
BARTONELLA HENSELAE
$111.12
86617L1
LYME DISEASE Ab IgM
$170.4
86617LAB
LYME DISEASE Ab IgG
$170.4
86618LAB
LYME DISEASE Ab WITH REFLEX TO BLOT, EIA
$187.28
86644LAB
CYTOMEGAIOVIRUS Ab IgG
$128
86664LAB
EPSTEIN BARR VIRUS AB
$168.24
86671L02
ASCA (IgA)
$134.8
86671LAB
ASCA (IgG)
$134.8
86677LAB
H. PYLORI ANTIBODIES
$170.4
86689LAB
HIV Ab, WESTERN BLOCK
$212.8
86695LAB
HERPES ANTIBODY 1
$145.04
86696LAB
HERPES ANITBODY 2
$212.8
86703LAB
HIV
$150.8
86704LAB
HEP B CORE TOTAL
$132.56
86706LAB
HEPATITIS B SURF ANTIBODY HBSAB
$118.08
86708LAB
HEP A ANTIBODY
$136.24
86709LAB
HEPATITIS A IgM ANTIBODY
$122.88
86735L2
MUMPS ANTIBODY
$142.4
86757LAB
RICKETTSIA
$212.81
86762L2
RUBELLA IMMUNE STATUS
$128
86762LAB
RUBELLA
$128
86765LAB
MEASLES ANTIBODY
$140.64
86774LAB
TETANUS ANTITOXOID
$162.72
86777LAB
TOXOPLASMA Ab IgG
$128
86787LAB
VARICEIN ZOSTER Ab(IgG)
$141.68
86800LAB
THYROGLUBLIN Ab
$174.88
86803LAB
HEPATITIS C ANTIBODY
$156.96
86850LAB
ANTIBODY SCREEN
$140
86900LAB
ABO
$32.8
86901LAB
RH
$32.8
86905LAB
PATIENT RBC TYPING PER AG
$41.76
86922LAB
CROSSMATCH
$121
87210LAB
KOH
$46.96
87340LAB
HEP B SURGACE ANTIGEN
$113.6
87380LAB
HEP B ANTIGEN
$180.48
IMP32555
ALCON LENS SA6AT4 14.0
$576
96360ER
INTRAVENOUS HYDRATION INIT 31MIN-1 HOUR
$212.68
96361ER
IV INFUS HYDRATION EACH ADDTL HOUR
$56.28
96365ER
IV INFUSION FOR THERAPY; INTL TO 1HR
$274.36
96366ER
IV INFUSION, THERAPY, EACH ADDTL HR
$80.76
96367ER
ADDTL SEQ INFUS OF NEW DRUG TO 1 HR
$117.56
96368ER
CONCURRENT INFUSION
$69.6
96370ER
SUBCUT INFUSION EACH ADDTL HR
$64.88
96372ER
INJECTION; SUBCUT OR INTRAMUSCULAR
$95.28
96374ER
INJECTION INTRAVEN PUSH SNG OR INITIAL
$209.16
96375ER
EH ADDLT PUSH OF NEW DRUG
$82.08
96376ER
IV PUSH EACH ADD'TNAL SEQUENTIAL
$61.59
36415LAB
VENIPUNCTURE
$24
81256LAB
HFE HEREDITARY, HEMOCHROMATOSIS GENE ANA
$358.64
82340LAB
24 HR URINE CALCIUM
$66.32
82803RES
ABG
$200
83630LAB
FECAL LACTOFERRIN
$213.68
84153LAB
PSA (TOTAL) DIAGNOSTIC
$202.32
84165LAB
PROTEIN ELECTROPHORESIS SERUM
$118.08
84166L2
24 HR URINE PROTEN ELECTROPHORESIS
$196.16
84166LAB
URINE PROTEIN ELECTROPHORESES SERUM
$196.16
84466LAB
TRANSFERRIN
$140.4
85549LAB
LYSOZYME, SERUM
$185.2
86063LAB
ASO
$63.44
86225LAB
DNA DS ANTIBODY
$151.04
86707LAB
HEP B ANTIBODY
$127.2
86870LAB
ANTIBODY IDENTIFICATION
$246.4
86904LAB
ANTIGEN SCREEN
$104.56
87169LAB
PARASITE IDENTIFICATION
$42.16
87185L2
CATALASE ENZYME TEST
$52.24
87491LAB
CHLAMYDIA AMPLIFIED PROBE
$245.76
87521LAB
HEPATITIS C VIRAL RNA QUALITATIVE
$214.16
87591LAB
GONORRHOEAE AMPLIFIED PROBE
$215.76
89051L02
SYNOVIAL CELL COUNT WITH DIFF
$19.44
89051LAB
CSF CELL COUNT WITH DIFF
$19.44
CB00001
LEGAL DRUG COLLECTION
$27.75
CB0004
LABCORP VENI
$15
89220RES
SPUTUM COLLECTION
$97.9
81001LAB
URINALYSIS W MICROSOPIC
$34.8
81003LAB
URINALYSIS W/O MICROSCOPIC
$24.72
81025LAB
URINE PREGNANCY
$69.6
MM2207
IS VOLUMETRIC EXCERSISES
$97.32
MM32652
STOCKINGS EMS THIGH HIGH XXL 6PR/BOX
$37.02
MM32654
STOCKING EMS KNEE HIGH XXXL 12PR/BX
$29.76
RES0001
OXYGEN X 1 HOUR
$21.2
RES0003
INCENTIVE SPIROMETRY INSTRUCTION
$39.6
TELEM-INPT
TELEMETRY INPT
$3280.88
SWINGBED
SWINGBED
$2105
SWINGBEDSC
SWINGBED
$2105
70551MRI
MRI BRAIN BRAIN STEM W/O CONTRAST MATERI
$2784.81
70553MRI
MRI BRAIN BRAIN STEM W/O &W/CONTRAST MAT
$2878.75
23350MRI
INJECTION SHOULDER ARTHROGRAPHY/CT/MRI
$315.78
70543MRI
MRI ORBIT FACE & NCK W/O &W/CONTRAST MAT
$2949.31
70544MRI
MRA HEAD W/O CONTRST MATERIAL
$2568.65
70547MRI
MRA NECK W/O CONTRST MATERIAL
$2575.23
71550MRI
MRI CHEST W/O CONTRAST MATERIAL
$2562.21
72141MRI
MRI SPINAL CANAL CERVICAL W/O CONTRAST M
$1946.28
72146MRI
MRI SPINAL CANAL THORACIC W/O CONTRAST M
$1950.55
72147MRI
MRI SPINAL CANAL THORACIC W/CONTRAST MAT
$2181.55
72148MRI
MRI SPINAL CANAL LUMBAR W/O CONTRAST MAT
$1948.38
72156MRI
MRI SPINAL CANAL CERVICAL W/O & W/CONTR
$2814.56
72157MRI
MRI SPINAL CANAL THORACIC W/O & W/CONTR
$2560.11
72158MRI
MRI SPINAL CANAL LUMBAR W/O &W/CONTR MAT
$2797.48
72195MRI
MRI PELVIS W/O CONTRAST MATERIAL
$2752.4
72197MRI
MRI PELVIS W/O & W/CONTRAST MATERIAL
$3000.62
73218MRI
MRI UPPER EXTREMITY OTH THAN JT W/O CONT
$2260.65
73219MRI
MRI UPPER EXTREMITY OTH THAN JT W/CONTR
$2470.23
73220MRI
MRI UPPER EXTREM OTHER THAN JT W/O & W/C
$3002.79
73221MRI
MRI ANY JT UPPER EXTREMITY W/O CONTRAST
$1806.56
73222MRI
MRI ANY JT UPPER EXTREMITY W/CONTRAST MA
$2288.44
73223MRI
MRI ANY JT UPPER EXTREMITY W/O & W/CONTR
$2793.21
73718MRI
MRI LOWER EXTREM OTH/THN JT W/O CONTR MA
$2243.57
73720MRI
MRI LOWER EXTREM OTH/THN JT W/O & W/CONT
$3028.48
73721MRI
MRI ANY JT LOWER EXTREM W/O CONTRAST MAT
$1353.87
73722MRI
MRI ANY JT LOWER EXTREM W/CONTRAST MATER
$2324.84
73723MRI
MRI ANY JT LOWER EXTREM W/O & W/CONTRAST
$2791.04
74181MRI
MRI ABDOMEN W/O CONTRAST MATERIAL
$1963.36
74183MRI
MRI ABDOMEN W/O &W/CONTRAST MATERIAL
$3013.5
95860EMG
NDL EMG 1 XTR W/WO RELATED PARASPINAL AR
$500
95885EMG
NEEDLE EMG EA EXTREMITY W/PARASPINL AREA
$500
95886EMG
NEEDLE EMG EA EXTREMTY W/PARASPINL AREA
$500
95908EMG
NVR CNDJ TST 3-4 STUDIES
$79.53
95909EMG
NVR CNDJ TST 5-6 STUDIES
$167.88
95910EMG
NVR CNDJ TST 7-8 STUDIES
$216.51
95911EMG
NVT CNDJ TST 9-10 STUDIES
$251.4
95912EMG
NVR CODJ TST 11-12 STUDIES
$284.43
95913EMG
NVR CNDJ TST 13- MORE STUDIES
$318.39
97003OT
OCCUPATIONAL THERAPY EVALUATION
$266.75
97004OT
OCCUPATIONAL THERAPY RE-EVALUATION
$266.75
97014OT
APPL MODALITY 1/> AREAS ELEC STIMJ UNATT
$106
97018OT
APPL MODALITY 1/> AREAS PARAFFIN BATH
$107
97022OT
APPLICATION MODALITY 1/> AREAS WHIRLPOOL
$129.55
97032OT
APPL MODALITY 1/> AREAS ELEC STIMJ EA 15
$107
97033OT
APPL MODALITY 1/> AREAS IONTOPHORESIS EA
$129.55
97035OT
APPL MODALITY 1/> AREAS ULTRASOUND EA 15
$91.85
97110OT
THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXE
$90.87
97112OT
THER PX 1/> AREAS EACH 15 MIN NEUROMUSC
$129.55
97140OT
MANUAL THERAPY TQS 1/> REGIONS EACH 15 M
$149
97161OT
OT EVAL LOW COMPLEXITY
$156.46
97165OT
OT EVAL LOW COMPLEXITY
$151.96
97166OT
OT EVAL MODERATE COMPLEXITY
$151.96
97167OT
OT EVAL HIGH COMPLEXITY
$151.96
97168OT
OT RE-EVAL
$100.04
97530OT
THER ACTV DIR PT CONTACT BY PROVIDER EAC
$144.65
97535OT
SELF-CARE/HOME MGMT TRAINING EACH 15 MIN
$85.25
97545OT
work hardening/ conditioning. CA workers
$363
97597OT
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
$159.8
97598OT
REMOVAL DEVITALIZED TISSUE >20 CM
$402
97750OT
PHYSICAL PERFORMANCE TEST/MEAS W/REPRT E
$165
97760OT
ORTHO MGMT&TRAINJ LXTR&/TRNK EA INITIAL
$182
97763OT
ORTHO/PROST MNGMNT- SUBSEQUENT ENC
$182
G0283OT
APPL MODALITY 1/> AREAS ELEC STIMJ UNAT
$106
L3702OT
EO STATIC CUSTOM ELBOW (WRIST NOT INCL)
$526
L3763OT
EWHO STATIC CUSTOM ELBOW WRIST HAND
$1446
L3806OT
WHFO DYNAMIC CUST ORTHOSIS WR,HND,FINGER
$828
L3808OT
WHFO STATIC WRIST HAND FINGER ORTHOSIS
$830
L3906OT
WHO STATIC WRIST HAND ORTHOSIS
$769
L3913OT
HFO STATIC CUSTOM HAND, FINGER ORTHOSIS
$494
L3919OT
HO HAND ORTHOSIS (MC FX OR COLDITZ)
$494
L3921OT
HFO DYNAMIC CUSTOM HAND, FINGER ORTHOSIS
$585
L3925OT
FO DYNAMIC PREFAB FINGER (LMB)
$110
L3933OT
FO STATIC CUSTOM FINGER ORTHOSIS
$389
81241LAB
FACTOR V LEIDEN
$160
82310L2
CALCIUM RANDOM URINE
$56.72
87807LAB
RSV IMMUNOASSAY
$131.92
88104TC
CYTOPATHOLOGY
$68
88302TC
LEVEL II
$68
88304TC
LEVEL I I I
$147.28
88305TC
LEVEL IV
$229.08
88307TC
LEVEL V
$229.08
88311TC
DECALCIFICATION PROCEDURE
$20.56
88312TC
SPECIAL STAIN
$68.18
89060LAB
SYNOVIAL FLUID CRYSTALS
$78.64
93880RAD
US CAROTID
$1329
93923RAD
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY
$797.94
93925RAD
DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STU
$1401.24
93926RAD
DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STU
$806.46
93970RAD
DUP-SCAN XTR VEINS COMPLETE BILATERAL ST
$1058.16
93971RAD
DUP-SCAN XTR VEINS UNILATERAL/LIMITED ST
$640.26
97010PT
APPLICATION MODALITY 1/> AREAS HOT/COLD
$36.3
97012PT
APPL MODALITY 1/> AREAS TRACTION MECHANI
$45.72
97014PT
APPL MODALITY 1/> AREAS ELEC STIMJ UNATT
$106
97016PT
VASOPNEUMATIC
$73.44
97018PT
APPL MODALITY 1/> AREAS PARAFFIN BATH
$107
97022PT
APPLICATION MODALITY 1/= AREA WHIRLPOOL
$129.55
97032PT
APPL MODALITY 1/> AREAS ELEC STIMJ EA 15
$107
97033PT
APPL MODALITY 1/> AREAS IONTOPHORESIS EA
$129.55
97035PT
APPL MODALITY 1/> AREAS ULTRASOUND EA 15
$91.85
97110PT
THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXE
$90.87
97112PT
THER PX 1/> AREAS EACH 15 MIN NEUROMUSC
$129.55
97116PT
THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ
$80.28
97140PT
MANUAL THERAPY TQS 1/> REGIONS EACH 15 M
$149
97166PT
PT EVAL MODERATE COMPLEXITY
$151.96
97530PT
THER ACTV DIR PT CONTACT BY PROVIDER EAC
$144.65
97535PT
SELF CARE HOME MANAGEMENT
$126
97545PT
work hardening/ conditioning. CA workers
$363
97750PT
PHYSICAL PERFORMANCE TEST/MEAS W/REPRT E
$165
G0283PT
APPL MODALITY 1/> AREAS ELEC STIMJ UNAT
$106
M243239
ENDO, GI w/BIOPSY
$870
M243246
PLACEMENT PERCUTANEOUS G-TUBE
$744
M245378
COLONSCOPY, FLEXIBLE
$637
M245380
COLONOSCOPY, w/BIOPSY
$2167
94010RES
SPIROMETRY W/WO MVV
$78.65
94060RES
BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILA
$141.35
94640R02
AEROSOL SUBSEQUENT
$69.72
94640R05
MDI TREATMENT
$47.05
94640RES
INITIAL AEROSOL
$133.16
94727RES
GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB
$218.5
94729RES
CO DIFFUSING CAPACITY
$317.05
94762RES
NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT
$291.5
31500RES
INTUBATION ENDOTRACHEAL
$583.55
36600RES
PUNCTURE ARTERIAL
$118.25
92950RES
CPR
$1014.5
94002RES
VENTILATION ASSIST & MGMT INPATIENT 1ST
$392.7
94003RES
VENTILATION ASSIST & MGMT INPATIENT EA S
$270.68
94660RES
CPAP VENTILATION CPAP INITIATION & MGMT
$188.95
94667R02
CHEST PERCUSSION/POST DRAIN INIT
$78.65
94667RES
PEP INITIAL DEMONSTRATION AND/OR EVAL
$234.05
94668R02
CHEST PERCUSSION/POST DRAIN SUBSEQUENT
$78.65
94668RES
PEP SUBSEQUENT
$47.6
94760RES
NONINVASIVE EAR/PULSE OXIMETRY SINGLE DE
$15.35
SEMIPRIV
SEMI-PRIVATE
$3000
97022ST
WHIRPOOL
$72
97110ST
THERAPEUTIC EXERCISE
$121
97140ST
MANUAL THERAPY TECH
$112
97530ST
THERAPEUTIC ACTIVITIES
$126
97750ST
PHYSICAL PERF TEST/ MEASUREMEN
$124
94620RES
PULMONARY STRESS TESTING SIMPLE(six min)
$288.2
99406RES
TOBACCO USE CESSATION INTERMEDIATE 3-10
$47.72
36569PR
INSERTION PICC LINE
$697.14
96360OP
INTRAVENOUS HYDRATION INIT 31 MIN-1 HOUR
$212.68
96361OP
IV INFUS HYDRATION EACH ADDITL HOUR
$56.28
96365OP
IV INFUSION FOR THERAPY, INTL TO 1 HR
$274.36
96366OP
IV INFUSION THERAPY, EA ADDTL HR
$80.76
96367OP
ADDTL SEQ INFUS OF NEW DRUG TO 1 HOUR
$117.56
96372OP
INJECTION SUBCUT OR INTRAMUSCULAR
$95.28
96374OP
INJECTION INTRAVEN PUSH SNG OR INITIAL
$209.16
96376OP
IV PUSH EACH ADD'TNAL SEQ
$61.59
99211ER
OFFICE OUTPATIENT VISIT 5 MINUTES
$75.88
99211OP
OUTPATIENT VISIT 5 MINUTES
$75.88
76536RAD
US SOFT TISSUE HEAD & NECK REAL TIME IMG
$684.66
76604RAD
US CHEST REAL TIME W/IMAGE DOCUMENTATION
$495.66
76700RAD
US ABDOMINAL REAL TIME W/IMAGE DOCUMENTA
$788.94
76705RAD
ULTRASOUND ABDOMINAL REAL TIME W/IMAGE L
$606.48
76770RAD
US RETROPERITONEAL REAL TIME W/IMAGE COM
$743.46
76801RAD
US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST
$715.62
76805RAD
US PREG UTERUS AFTER 1ST TRIMEST 1/1ST G
$832.92
76817RAD
US PREG UTERUS REAL TIME W/IMAGE DCMTN T
$576.78
76830RAD
ULTRASOUND TRANSVAGINAL
$425.22
76856RAD
US PELVIC NONOBSTETRIC REAL-TIME IMAGE C
$698.4
76857RAD
US PELVIC NONOBSTETRIC IMAGE DCMTN LIMIT
$532.44
76870RAD
ULTRASOUND SCROTUM & CONTENTS
$697.38
76881RAD
US EXTREMITY NON-VASC REAL-TIME IMG COMP
$684.36
76882RAD
US EXTREMITY NON-VASC REAL-TIME IMG LMTD
$201.18
76942RAD
US GUIDANCE NEEDLE PLACEMENT RS&I
$1137.96