3D RENDER W/O IMAGE POSTPROCESS … SOURCE HEPATITIS B AB $115.35 86706 BBP SOURCE HEPATITIS C AB...

Procedure Description Unit Price CPT(R)/HCPCS Code

3D RENDER W/O IMAGE POSTPROCESS $853.93 76376

3D RENDERING W/ IMAGE POSTPROCESS $1,269.02 76377

AB ID,PLATELET IMMUNOG.ASSAY $278.54 86023

ABBREV X-MATCH 86920 $285.11 86920

ABDOM,B-SCAN &/OR REAL TIME,COMPLE* $1,159.27 76700

ABDOMEN LIMITED $947.55 76705

ABDOMEN PARACENTESIS W/IMAGING $2,516.79 49083

ABLAT,OPEN,1+ LIVER TUMOR(S),PERCU* $6,115.36 47382

ABSCESS IMAGING, LTD AREA $2,977.54 78805

ABSCESS IMAGING, WHOLE BODY $3,392.23 78806

ACCESS BIL TREE TO SB NEW W R/GDE $5,442.78 47541

ACETONE OR KETONES-SERUM-QUANT $197.79 82010

ACT.PROTEIN C RESISTANCE ASSAY $282.47 85307

ACTH $465.06 82024

ACUTE GI BLOOD LOSS IMAGING $3,561.07 78278

ACUTE HEPATITIS PANEL $370.00 80074

AERO TX INLINE $182.00 94640

AFB CULTURE ISOLATION *r $80.00 87116

AGGLUTININS,FEBRILE,E.ANTIGEN $339.22 86000

AIRWAY INHALATION TREATMENT $33.53 94640

AIRWAY INHALATION TREATMENT SBQ $203.14 94640

ALBUMIN,SERUM $73.68 82040

ALDOLASE $154.71 82085

ALDOSTERONE $751.31 82088

ALKALINE PHOSPHATASE $198.87 84075

ALKALINE PHOSPHATASE $198.87 84075

ALLERGEN SPEC IGE QUAN SEMIQUAN REF $199.52 86003

ALPHA FETO PROTEIN $177.34 82105

ALPHA I ANTITRYPSIN $131.15 82103

AMMONIA $252.99 82140

AMNIOCENTESIS,DIAGNOSTIC $1,167.08 59000

AMPUTATION FINGER THUMB $4,230.41 26951

AMYLASE $166.63 82150

ANA (ANTI NUCLEAR ANTIBODY) $95.00 86038

ANESTH UPPR ARM PROCEDURE $73.00 1730

ANGIO AORTOBIFEMORAL W CATH $15,475.77 75630

ANGIO AORTOGRAM ABD SERIAL $16,017.49 75625

ANGIO AORTOGRAM THOR SERIAL $4,829.16 75605

ANGIO EA ADDNL SELECTV VESSEL $5,682.69 75774

ANGIO EXTERMITY BILAT $16,548.20 75716

ANGIO EXTREMITY UNILAT $17,242.14 75710

ANGIO PELVIS $17,137.47 75736

ANGIO VISCERAL SELECTV/SUBSELEC $4,249.98 75726

ANGIOGRAM,F/U STUDY,CATH THER/EMBO* $1,900.24 75898

ANGIOTENSIN I CONV ENZYME $145.73 82164

ANOSCOPY;DIAGNOSTIC-2ND PROCEDURE $141.01 46600

ANOSCOPY;WITH CONTROL OF BLEEDING $2,701.80 46614

ANOSCOPY;WITH CONTROL OF BLEEDING-2ND PROCEDURE $600.48 46614

ANOSCOPY;WITH CONTROL OF BLEEDINGOL OF BLEEDING $2,701.80 46614

ANTI THYROGLOBULIN $208.40 86800

ANTIBODY ID $388.71 86870

ANTIBODY ID PLATELET ANTIBODIES REF $349.19 86022

ANTIBODY MUMPS $104.22 86735

ANTIBODY SCREEN $265.91 86850

ANTIBODY, ASPERGILLUS $126.56 86606

ANTIBODY, VARICELLA-ZOSTER $201.58 86787

ANTIBODY,CANDIDA $81.83 86628

ANTIBODY,COCCIDIOIDES $113.66 86635

ANTIBODY,CYTOMEGALOVIRUS (CMV) $62.89 86644

ANTIBODY,CYTOMEGALOVIRUS,IGM $73.57 86645

ANTIBODY,HELMINTH,NOT ELSEWHRE $132.41 86682

ANTIBODY,HERPES SIMPLEX TYPE 1 $57.61 86695

ANTIBODY,HERPES SIMPLEX TYPE 2 $62.07 86696

ANTIBODY,HERPES SIMPLEX,NSTYPE $62.07 86694

ANTIBODY,LEGIONELLA $121.21 86713

ANTIBODY,PARVOVIRUS $115.22 86747

ANTIBODY,TOXOPLASMA,IGM $81.64 86778

ANTIBODY,TREPONEMA PALLIDUM $86.54 86780

ANTIBODY,VIRUS,NOS $246.85 86790

ANTI-CARDIOLIPIN AB *R $302.79 86147

ANTI-CENTROMERE AB *R $238.21 86255

ANTISTREPTOLYSIN O, TITER $134.60 86060

ANTITHROMBIN III,ACTIVITY $218.45 85300

APOLIPOPROTEIN A1 REF $67.69 82172

APP SKN GRAFT FNHFG<100 1ST25 $3,427.97 15275

APP SKN GRAFT FNHFG<100ADD25 $1,713.98 15276

APP SKN GRAFT FNHFG>100 1ST100 $3,427.97 15277

APP SKN GRAFT FNHFG>100ADD100 $1,713.98 15278

APP SKN GRAFT TAL<100CM 1ST25 $3,427.97 15271

APP SKN GRAFT TAL<100CM ADD25 $1,713.98 15272

APP SKN GRAFT TAL>100 1ST100 $5,651.15 15273

APP SKN GRAFT TAL>100 ADD100 $2,825.57 15274

APPLICATION OF CAST FIGURE OF EIGHT $235.31 29049

APPLICATION OF FINGER SPLINT DYNAMIC $336.27 29131

APPLICATION OF PASTE BOOT $283.94 29580

APPLICATION OF PASTE BOOT $283.94 29580

APPLICATION OF PASTE BOOT BILATERAL $567.88 29580

APPLY FOREARM SPLINT(FOREARM TO HAND)DYNAMIC $387.31 29126

APPLY MULTILAYER COMPRESSION SYSTEM LOWER LEG $286.80 29581

APPLY MULTILAYER COMPRESSION SYSTEM LOWER LEG BILATERAL $573.60 29581

AQUATIC THERAPY-M59 $110.00 97113

ARSENIC $117.86 82175

ARSENIC LEVEL *R $117.86 82175

ARTERIAL EXTREMITY W/STRESS $1,466.24 93924

ARTERIAL PUNCTURE FLOOR $176.46 36600

ARTERIAL PUNCTURE-BLOOD DX $176.46 36600

ARTHROGRAM OF ELBOW $1,820.42 73085

ARTHROGRAM OF HIP $1,297.52 73525

ARTHROGRAM OF KNEE JOINT $1,820.42 73580

ARTHROGRAM OF SHOULDER $1,820.42 73040

ARTHROGRAM OF WRIST $852.15 73115

ASPIRATE PLEURA W IMAGING $1,659.51 32555

ASPIRATION BLADDER INSERT SUPRAPUB* $4,105.72 51102

ASPIRATION OF BLADDER W/INSERTION OF SUPRAPUBIC CATHETER $4,105.72 51102

ASPIRATION OF BLADDER; BY NEEDLE $352.30 51100

ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER $199.19 51101

ASPIRATION PUNCTURE $682.16 10160

ASSESSMENT OF APHASIA PER HR $420.34 96105

AUTOLOGOUS BLOOD/COMPONENT-COLLECTION/STORAGE PREDEPOSIT $998.67 86890

AVULSION NAIL PLATE SINGLE $571.96 11730

B CELLS TOTAL COUNT $380.93 86355

B12 VITAMIN $227.77 82607

BALLOON DILAT URET W RAD/GDE $3,000.00 50706

BASIC METABOLIC PANEL $207.00 80048

BBP SOURCE HEPATITIS B AB $115.35 86706

BBP SOURCE HEPATITIS C AB $145.25 86803

BEHAVRAL QUALIT ANALYS VOICE $339.54 92524

BETA 2 GLYCOPROTEIN I AB,EACH $302.79 86146

BETA 2 MICROGLOBULIN $149.98 82232

BIL CATH EXT TO INT-EXT W RAD/GDE $5,442.78 47535

BIL CATH EX/ CV TO EXT W RAD/GDE $5,442.78 47536

BIL CATH REMOVAL REQ FLUORO GDE $1,207.08 47537

BILIRUBIN DIRECT LAB $44.94 82248

BILIRUBIN,TOTAL $113.56 82247

BIOPSY OF KIDNEY,PERCUTANEOUS $2,463.49 50200

BIOPSY OF LIVER,NEEDLE;PERCUTANEOUS $686.35 47000

BIOPSY OF LIVER,NEEDLE;PERCUTANEOUS-2ND PROCEDURE $572.63 47000

BIOPSY OF THYROID,PERCUT $1,061.70 60100

BIOPSY SOFT TISSUE NECK/CHEST $4,105.21 21550

BIOPSY SOFT TISSUE PELVIS&HIP AREA DEEP/SUBFSCAL $3,641.00 27041

BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL $2,178.00 27040

BLASTOMYCES AB LATE $126.56 86612

BLEEDING TIME $168.73 85002

BLEPHAROTOMY, DRAINAGE OF ABSCESS EYELID $998.30 67700

BLOOD 1ST HR UP TO 60 MIN. $800.00 36430

BLOOD COUNT,WBC,AUTOMATED $284.78 85048

BLOOD COUNT-HEMATOCRIT $43.29 85014

BLOOD COUNT-PLATELET-AUTOMATED $105.90 85049

BLOOD CULTURE $261.74 87040

BLOOD GASES $544.77 82803

BLOOD GLUCOSE $132.81 82947

BLOOD OCCULT PEROXIDASE SINGLE $85.77 82272

BLOOD TRANSFUSION > 1HR TO 4 HRS. $1,132.05 36430

BLOOD TRANSFUSION >1HR TO 4 HRS. $1,132.05 36430

BLOOD TRANSFUSION >1HR TO 4HRS $1,132.05 36430

BLOOD TRANSFUSION >8 HOURS $2,500.00 36430

BLOOD TRANSFUSION 1ST HOUR $800.00 36430

BLOOD TRANSFUSION 1ST HOUR $800.00 36430

BLOOD TRANSFUSION 4 TO 6 HOURS $1,500.00 36430

BLOOD TRANSFUSION 4 TO 6 HRS $1,500.00 36430

BLOOD TRANSFUSION 4-6 HRS. $1,500.00 36430



BLOOD TRANSFUSION 6 TO 8 HRS $2,000.00 36430

BLOOD TRANSFUSION 8 TO 10 HR $2,500.00 36430

BLOOD TRANSFUSION 8 TO 10 HR $2,500.00 36430

BLOOD TYPING ABO $89.69 86900

BLOOD TYPING AG REAGENT REF $245.64 86902

BLOOD TYPING ANTIGEN SCREEN $245.64 86902

BLOOD TYPING RH $94.78 86901

BONE BIOPSY,TROCAR/NEEDLE DEEP $2,050.84 20225

BONE BIOPSY,TROCAR/NEEDLE SUPERF $1,038.88 20220

BONE IMAGING (SPECT) $3,241.88 78320

BONE IMAGING, 3 PHASE $2,804.87 78315

BONE IMAGING, LIMITED AREA $2,111.99 78300

BONE IMAGING, MULTIPLE AREAS $3,136.86 78305

BONE IMAGING, WHOLE BODY $2,467.86 78306

BOWEL IMAGING $2,887.74 78290

BRAIN FLOW IMAGING ONLY $3,665.80 78610

BRAIN IMAGING < 4 STATIC VIEWS $3,665.80 78600

BRAIN IMAGING < 4 STATIC VIEWS W V FLOW $3,665.80 78601

BRAIN IMAGING MIN 4 STATIC VIEWS $3,665.80 78605

BRAIN IMAGING MIN 4 STATIC VIEWS W* $4,811.51 78606

BREATH ACTIVATED NEBULIZER INITIAL $459.21 94640

BRONCHOSCOPE/ALVEOLAR LAVAGE, INC FLUOROSCOPIC GUIDANCE $4,383.74 31624

BRONCHOSCOPE/BRUSH/DX,INCLUDING FLUOROSCOPIC GUIDANCE $1,781.47 31623

BRONCHOSCOPE/WASH/DX, INCLUDING FLUOROSCOPIC GUIDANCE $1,869.44 31622

BRONCHOSCOPY CLEAR AIRWAYS,INC FLUOROSCOPIC GUIDANCE $1,517.17 31645

BRONCHOSCOPY W/BIOPSY, INCLUDING FLUOROSCOPIC GUIDANCE $1,664.10 31625

BRONCHOSCOPY, RECLEAR AIRWAY,INC FLUOROSCOPIC GUIDANCE $1,676.34 31646

BRONCHOSCOPY/LUNG BX ADD'L, W/WO FLUOROSCOPIC GUIDANCE $775.70 31632

BX BREAST 1ST LESION STRTCTC $3,371.53 19081

BX BREAST 1ST LESION US IMAG $3,371.53 19083

BX BREAST ADD LESION STRTCTC $1,796.68 19082

BX BREAST ADD LESION US IMAG $1,796.68 19084

CA 125 $354.92 86304

CA 27.29 $150.00 86300

CALCIUM $90.40 82310

CALCIUM IONIZED $95.01 82330

CALCIUM URINE RANDOM $129.94 82340

CALCULUS SPECTROSCOPY $55.11 82365

CAMPYLOBACTER ANTIGEN DETECT $108.98 87899

CAPILLARY BLOOD SPECIMEN COLL. $37.89 36416

CARBAMAZEPINE TOTAL $254.52 80156

CARBON MONOXIDE EVAL $215.46 82375

CARCINOEMBRYONIC ANTIGEN $263.61 82378

CARDIAC DOPPLER EXAM(2ND) $600.24 93320

CARDIAC DOPPLER LIMITED $945.35 93321

CARDIAC MRI MORPHOLOGY & FUNCTION * $5,048.34 75557

CARDIAC MRI W/W/O CONTRAST & FURTH* $5,048.34 75561

CARDIO STRESS TEST $1,116.80 93017

CARDIOLIPIN ANTIBODY-EA IG CLS $302.79 86147

CARDIOPULMONARY RESUSCITATION $1,215.16 92950

CARDIOVASCULAR STRESS TEST $32.62 93016

Cardiovascular Stress Test $1,116.80 93017

CARDIOVERSION $1,802.82 92960

CARDIOVERSION EXTERNAL ELECTVE $1,802.82 92960

CAST REMOVAL FULL ARM/LEG $303.00 29705

CASTING/STRAPPING PROCEDURE $306.31 29799

CAT SCAN OF CHEST COMBO $3,400.00 71270

CAT SCAN OF CHEST CONTRAST $3,032.27 71260

CATECHOLAMIN*R $316.94 82382

CATH PLACE REN ART 1ST BILAT $4,829.16 36252

CATH PLACE REN ART 2ND+ BIL $4,829.16 36254

CATH PLACE REN ART 2ND+ UNILAT $3,863.31 36253

CATH/INJECT HYSTEROSALPINGOGRAM $236.91 58340

CBC, AUTO W/AUTOMATED DIFF $169.89 85025

CEFINASE-BETA LACTAMASE SENSIT $117.72 87185

CELL COUNT,MISC BODY FLUIDS $152.89 89050

CELL CT W/DIFF,MISC BODY FLUID $105.00 89051

CERULOPLASMIN $176.56 82390

CHANGE BLADDER TUBE $1,083.03 51705

CHANGE EXT TRANSNEPH URETER STENT * $3,371.58 50387

CHANGE GASTROSTOMY TUBE PERCUTANEO* $1,806.41 43760

CHANGE OF BLADDER TUBE $2,640.63 51710

CHANGE PERCUT TUBE/DRAIN CATH W CO* $1,486.02 75984

CHEMICAL CAUTERIZATION OF GRANULATION TISSUE-2ND PROCEDURE $150.12 17250

CHEMO ADMIN-IV INF-EA ADD HR $423.44 96415

CHEMO ADMIN-IV-1ST DRUG < 1 HR $695.30 96413

CHEMO ADMIN-IV-DIFF DRUG < 1HR $260.00 96417

CHEMO ADMIN-IV-PUSH 1ST DRUG $803.88 96409

CHEMO ADMIN-IV-PUSH ADDL DRUG $513.60 96411

CHEMO ADMIN-IV-W/PUMP > 8 HR $551.20 96416

CHEMO ADMIN-SQ/IM HORMONAL $230.00 96402

CHEMO ADMIN-SQ/IM NON HORMONAL $300.00 96401

CHEST PHYSIOTHERAPY-PEP-INIT $187.81 94667

CHEST PHYSIOTHERAPY-SUBSQ $139.62 94668

CHEST XRAY 2 VIEWS $455.71 71046

CHEST XRAY 3 VIEWS $529.46 71047

CHEST XRAY 4/MORE VIEWS $1,154.57 71048

CHEST XRAY SINGLE VIEW $381.96 71045

CHEST,REAL TIME $1,183.79 76604

CHLAMYDIA / GC DNA PROBE *R $85.55 87800

CHLAMYDIA AMP $262.09 87491

CHLAMYDIA GROUP AB $769.32 86631

CHLORIDE SERUM (CL) $284.78 82435

CHOLECYSTOSTOMY,PERCUT $5,261.40 47490

CHOLESTEROL $107.08 82465

CHOLESTEROL DIRECT LDL $129.25 83721

CISTERNAL/LAT (C1-C2) CERV PUNCTURE $1,519.05 61055

CK-MB $220.00 82553

CLEAR OUTER EAR CANAL $381.98 69200

CLOSED TREATMENT OF ANKLE DISLOCATION W/ANESTHESIA $2,689.43 27842

CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE W/O MAN $564.84 27786

CLOSED TREATMENT OF LUNATE DISLOCATION, W/MANIPULATION $3,744.36 25690

CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANI $4,611.50 21451

CLOSED TREATMENT OF SHOULDER DISLOCATION,WITH MANIPULATI $925.46 23675

CLOSED TX FINGER FX W/O MAN $499.91 26750

CLOSED TX FX OF LOWER LEG W/WO ANES W/O MANIPULATION $561.46 27824

CLOSED TX HUMERUS FX W/O MANIPULATION $668.04 24530

CLOSED TX KNEE FX W/O MANIPULATION $668.04 27530

CLOSED TX OF ANKLE FX W/O MANIPULATION $595.98 27760

CLOSED TX OF CARPAL SCAPHOID FRACTURE W/MANIPULATION $1,158.38 25624

CLOSED TX OF HUMERAL SHAFT FRACTURE; W/O MANIPULATION $641.70 24500

CLOSED TX OF MONTEGGIA TYPE OF FX DISLOCATION AT ELBOW $3,744.36 24620

CLOSED TX OF NASAL BONE FRACTURE W/O STABILIZATION $3,218.59 21315

CLOSED TX OF PROXIMAL FIBULA OR SHAFT FX W/O MAN $544.94 27780

CLOSED TX OF PROXIMAL FIBULA/SHAFT FX W/MANIPULATION $3,744.36 27781

CLOSED TX OF RADIAL SHAFT W/MANIPULATION $735.60 25505

CLOSED TX OF STERNOCLAVICULAR DISLOCATION W/MANIPULATION $1,158.38 23525

CLOSED TX OF THIGH FX W/O MAN $735.60 27500

CLOSED TX OF THIGH FX W/O MANIPULATION $761.11 27501

CLOSED TX OF THIGH FX W/O MANIPULATION MEDIAL OR LATERAL $668.04 27508

CLOSED TX OF TRIMALLEOLAR ANKLE FX W/O MANIPULATION $742.36 27816

CLOSED TX POST HIP ARTHROPLASTY DISLOCATION W/ANES $3,011.42 27266

CLOSED TX RADIUS FX W/O MANIPULATION $523.92 24650

CLOSED TX THIGH FX W/O MAN PROXIMAL END,NECK $628.37 27230

CLOSED TX TIBIAL SHAFT FX W&WO FIBULAR FX W/MANIPULATION $3,744.36 27752

CLOSED TX ULNAR FX WO MANIPULATION $551.28 24670

CLOSED TX WRIST BONE FX WO MANIPULATION $575.72 25622

CLOSED TX WRIST BONE FX WO MANIPULATION $430.10 25630

CLOSTRIDIUM DIFFICILE $265.84 87324

CLOSURE OF SPLIT WOUND SIMPLE $2,094.19 12020

CLOT INHIB-PROTEIN S,TOTAL $275.08 85305

CLSD TREATMNT GREATER TROCHANTERIC FRACTURE $587.00 27246

CO2 EXPIRED GAS DETERMINATION $301.61 94770

CO2/MEMBRANE DIFFUSE CAPACITY $511.00 94729

COGNITIVE FUNCTION INTERVENTION $120.00 97127

COGNITIVE TEST BY HC PRO $336.00 96125

COLD AGGLOTININ $123.49 86157

COLLAGEN CROSSLINKS,ANY METH. $171.00 82523

COLLECT BLOOD FROM PICC $232.48 36592

COLLECT BLOOD VENOUS DEVICE $232.48 36591

COLONOSCOPY STOMA W/BALLOON DILATION $1,973.88 44405

COLONOSCOPY STOMA W/BALLOON DILATION-2ND PROCEDURE $1,579.10 44405

COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION $1,973.88 44404

COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION-2ND PROCEDURE $1,579.10 44404

COLONOSCOPY THROUGH STOMA;DIAGNOSTIC $2,475.49 44388

COLONOSCOPY THROUGH STOMA;DIAGNOSTIC-2ND PROCEDURE $1,351.09 44388

COLONOSCOPY THROUGH STOMA;W/ BIOPSY SINGLE OR MULTIPLE-2ND PROCEDURE $1,050.85 44389

COLONOSCOPY THROUGH STOMA;WITH BIOPSY,SINGLE OR MULITPLE $2,528.65 44389

COLONOSCOPY THROUGH STOMA;WITH CONTROL OF BLEEDING $2,771.23 44391

COLONOSCOPY THROUGH STOMA;WITH CONTROL OF BLEEDING-2ND PROCEDURE $1,351.09 44391

COLONOSCOPY W/REMOVAL OF TUMOR,POLYP OR LESION-2ND PROCEDURE $1,660.94 45385

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DI-2ND PROCEDURE $1,254.82 45378

COLONOSCOPY,FLEXIBLE,PROXIMAL TO SPLENIC FLEXURE,DIAGNOS $4,565.65 45378

COLONOSCOPY,FLEXIBLE,PROXIMAL TO SPLENIC FLEXURE,DIAGNOS $4,565.65 45378

COLONOSCOPY,FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJ $3,841.01 45381

COLONOSCOPY,FLEXIBLE; WITH DIRECTEINGLE OR MULTIPLE $3,841.01 45381

COLONOSCOPY,FLEXIBLE;WITH BIOPSY,SIC FLEXURE,DIAGNOSTI $3,725.63 45380

COLONOSCOPY,FLEXIBLE;WITH BIOPSY,SINGLE OR MULTIPLE $3,725.63 45380

COLONOSCOPY,FLEXIBLE;WITH BIOPSY,SINGLE OR MULTIPLE-2ND PROCEDURE $1,398.49 45380

COLONOSCOPY,FLEXIBLE;WITH CONTROL SUBMUCOSAL INJ $2,715.68 45382

COLONOSCOPY,FLEXIBLE;WITH CONTROL OF BLEEDING $2,715.68 45382

COLONOSCOPY,FLEXIBLE;WITH CONTROL OF BLEEDING-2ND PROCEDURE $1,050.85 45382

COLONOSCOPY,FLEXIBLE;WITH DILATION BY BALLOON $2,702.18 45386

COLONOSCOPY,FLEXIBLE;WITH DILATION BY BALLOON-2ND PROCEDURE $1,200.97 45386

COLONOSCOPY,FLEXIBLE;WITH DIRECTED SUBMUCOSAL INJ-2ND PROCEDURE $1,351.09 45381

COLONOSCOPY,FLEXIBLE;WITH FOERIGN BODY REMOVAL-2ND PROCEDURE $1,351.09 45379

COLONOSCOPY,FLEXIBLE;WITH FOREIGN BODY REMOVAL $2,480.00 45379

COLONOSCOPY,WITH REMOVAL OF TUMOR,POLYP,OR LESION $4,475.20 45385

COLONY COUNT URINE $189.19 87086

COLPORRHAPHY,SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL) $3,970.47 57200

COMMUNITY WORK REINTEGRATE15MN-M59 $97.86 97537

COMP METABOLIC PANEL $270.00 80053

COMPLEMENT ANTIGEN EA COMPONENT REF $212.06 86160

COMPLEMENT, TOTAL (CH50) $202.76 86162

COMPLEMENT,FUNCTIONAL ACTIVITY $62.12 86161

CON SEDATION/>5 YR 1ST 15 MIN $306.49 99152



CON SEDATION< 5 YR 1ST 15 MIN $152.60 99151

CON SEDATION< 5 YR 1ST 15 MIN $152.60 99151

CONCENTRATION FOR INF. AGENTS $52.08 87015

CONSULT & REPORT, REFERRED MATERIAL, REQ PREP OF SLIDES $67.08 88323

CONTINUOUS INHALATION TREATMENT W/MED EACH ADD HOUR $349.09 94645

CONTINUOUS INHALATION TREATMENT W/MEDS 1ST HOUR $425.11 94644

CONTINUOUS NEB < 1 HOUR $768.91 94640

CONTRAST BATHS EA 15 MIN $78.57 97034

CONTRAST INJ CENT VEN CATH, INC FL* $650.00 36598

CONTRAST INJECTION PERCUTANEOUOS R* $306.24 49465

CONTRAST XRAY THROAT/CERV ESOPHA $470.00 74210

CONTROL NOSE/THROAT BLEEDING SIMPLE $798.65 42970

CONTROL NOSEBLEED-INITIAL $542.38 30905

CONTROL OF NOSEBLEED $3,398.72 30915

CONTROL OF NOSEBLEED COMPLEX $539.51 30903

CONTROL OF NOSEBLEED SIMPLE $384.98 30901

CONTROL THROAT BLEEDING $3,512.83 42960

CONTROL THROAT BLEEDING W/2ND SURGICAL INTERVENTION $3,373.21 42962

CONV PERQ NEPH-URET CATH W RAD/GDE $1,311.20 50434

COPPER SERUM $65.58 82525

CORTISOL $182.41 82533

CORTISOL,FREE $308.22 82530

CPAP INITIATION/MANAGEMENT $1,075.41 94660

C-PEPTIDE LEVEL $220.18 84681

C-REACTIVE PROTEIN STANDARD LAB $125.57 86140

C-REACTIVE PROTEIN-HIGH SENS. $212.10 86141

CREATINE KINASE(CK)(CPK)-TOTAL $116.22 82550

CREATININE BLOOD $102.33 82565

CREATININE CLEARANCE $229.77 82575

CREATININE-OTHER SOURCE $84.58 82570

CROSS MATCH 86922 $224.00 86922

CRYOGLOBULINS $28.28 82595

CRYPTOCOCCAL ANTIGEN *R $67.36 87450

CRYPTOSPORIDIUM ANTIGEN $97.00 87328

CRYSTAL ID BY MICROSCOPY $213.33 89060

CSF FLUID SCAN CISTERNOGRAPHY $4,811.51 78630

CSF LEAKAGE DETECTION & LOCALIZATI* $2,199.50 78650

CT ANGIO AORTOBIFEMORAL, COMBO $4,936.24 75635

CT ANGIO HRT CORNRY ART/BYPASS GRF* $2,797.41 75574

CT ANGIO, ABD, COMBO,INCL IMAGE PR* $3,171.00 74175

CT ANGIO, CHEST (NON-CORON), COMBO* $3,243.19 71275

CT ANGIO, PELVIS, COMBO, INCL IMAG* $3,483.77 72191

CT ANGIO,LOWER EXTREM,COMBO,IMAGE * $4,127.58 73706

CT ANGIO,UPPER EXTREM,COMBO $2,693.00 73206

CT CHEST W/O LOW DOSE SCREEN $1,999.58 71250

CT GUIDANCE NEEDLE PLACEMENT $2,459.42 77012

CT HEAD W/ AND W/OUT $2,950.00 70470

CT HEAD WITH $2,800.00 70460

CT HEAD WITHOUT $2,127.00 70450

CT HEART CONTRAST EVAL CARDIAC STR* $2,797.41 75572

CT HEART CONTRAST EVAL CARDIAC STR* $2,797.41 75573

CT HEART W/O CONTRAST QUANT EVAL C* $468.87 75571

CT MAXILLOFAC W/,W/O $3,059.63 70488

CT MAXILLOFACIAL W/ $2,500.00 70487

CT MAXILLOFACIAL W/O $2,054.18 70486

CT NECK W/,W/O $3,665.80 70492

CT SCAN CERV SPINE CONTRAST $4,413.92 72126

CT SCAN DORSAL SP CONTRAST $3,303.03 72129

CT SCAN LUMBAR SP CONTRAST $3,303.03 72132

CT SCAN OF ABDOMEN COMBO $3,510.86 74170

CT SCAN OF ABDOMEN CONTRAST $2,959.24 74160

CT SCAN OF ARM COMBO $6,157.51 73202

CT SCAN OF ARM CONTRAST $4,493.76 73201

CT SCAN OF LEG COMBO $3,798.88 73702

CT SCAN OF LEG CONTRAST $3,655.88 73701

CT SCAN OF PELVIS COMBO $3,510.28 72194

CT SCAN OF PELVIS CONTRAST $2,913.24 72193

CT SCAN,ABD & PELVIS,W CONTRAST $3,100.00 74177

CT SCAN,ABD & PELVIS,W/O CONTRAST $2,700.00 74176

CT SCAN,ABDOMEN,W/O CONTRAST $2,108.61 74150

CT SCAN,CERVICAL SPINE,W/O CONTRAST $2,302.18 72125

CT SCAN,LIMITED/LOCALIZED F/U STUDY $1,157.08 76380

CT SCAN,LOWER EXTREMITY,W/O CONTRA* $2,890.03 73700

CT SCAN,LUMBAR SPINE,W/O CONTRAST $1,886.07 72131

CT SCAN,PELVIS,W/O CONTRAST $1,959.98 72192

CT SCAN,THORACIC SPINE,W/O CONTRAST $3,317.92 72128

CT SCAN,THORAX,W/O CONTRAST $1,999.58 71250

CT SCAN,UPPER EXTREMITY,W/O CONTRA* $3,949.00 73200

CT SOFT TISSUE NECK W/ $2,850.00 70491

CTA HEAD W/O,W,POST PROCESS $3,775.84 70496

CTA NECK W/O,W,POST PROCESS $3,775.84 70498

CULTURE & SENSITIVITY $281.57 87184

CULTURE ID, ANAEROBIC *R $120.00 87076

CULTURE ID/AEROBIC*R $227.95 87077

CULTURE MYCOPLASMA $221.70 87109

CULTURE SALM & SHIGELLA $130.00 87045

CULTURE SETUP YERSINIA/VIBRIO $137.51 87046

CULTURE, ANAEROBIC $190.22 87075

CULTURE-PRESUMPTIVE-SCREEN $130.16 87081

CVC TUNNEL WO PORT REMOVAL $2,219.21 36589

CVMC NEG PRESS WND TX <50 CM DME $300.00 97605

CVMC NEG PRESS WND TX >50 CM DME $324.25 97606

CYCLIC CITRULLINATED PEPTIDE $100.14 86200

CYCLOSPORIN (CYCLO) $342.04 80158

CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY $5,635.55 52315

CYTOLOGY CELLULAR ENHANCEMENT $300.32 88112

CYTOLOGY I $146.90 88104

CYTOPATH-EVALUATION OF FNA-IMM $155.53 88172

CYTOPATH-FNA EVAL INTERPRET. $490.54 88173

CYTOPATHOLOGY-CONCENTRATION $511.62 88108

CYTOPATH-PREPARATION $166.86 88161

CYTOPATH-SMEARS-OTHER SOURCE $294.07 88160

D-DIMER QUANTITATIVE $269.60 85379

DEBRIDE BONE ADD 20 SQ CM $2,687.72 11047

DEBRIDE BONE FIRST 20 SQ CM $2,687.74 11044

DEBRIDE INFECTED SKIN $1,810.72 11000

DEBRIDE INFECTED SKIN ADD-ON $293.60 11001

DEBRIDE MUSC/FASCIA ADD 20 SQ CM $1,810.72 11046

DEBRIDE MUSC/FASCIA FIRST 20 SQ CM $1,810.72 11043

DEBRIDE NAIL,ANY METHOD 1 TO 5 $242.07 11720

DEBRIDE NAIL,ANY METHOD 6/MORE $238.69 11721

DEBRIDE SUBQ TISSUE 20SQCM< $2,148.27 11042

DEBRIDE SUBQ TISSUE ADD 20 SQ CM $1,810.72 11045

DEBRIDE,FX,SKIN,TISSUE,MUSCLE FASCIA AND MUSCLE $2,389.42 11011

DECALCIFICATION PROCEDURE $194.52 88311

DECLOTTING OF VASCULAR DEVICE $726.41 36593

DEEP LINE INSERTION $1,341.34 36425

DHEA-S $150.00 82627

DIAGNOSTIC LARYNGOSCOPY-INDIRECT $466.64 31505

DIGOXIN $235.18 80162

DILANTIN (PHENYTOIN) $232.26 80185

DILATE URETHRA STRICTURE $1,385.62 53600

DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE $1,281.98 43450

DILUTED RUSSELL VIP VEN TIME $129.75 85613

DIRECT COOMBS 86880 $94.57 86880

DISCOGRAPHY LUMBAR SPINE $2,915.42 72295

DISKECTOMY,PERCUTANEOUS LUMBAR $10,151.25 62287

DISLOC ACROMIOCLAVICULAR CLSD $437.83 23540

DISLOC SHOULDER W/MANIP CLSD $1,014.03 23650

DISLOC STERNOCLAVICULAR CLSD $1,158.38 23520

DISLOC TX ELBOW W/O ANES CLSD $777.25 24600

DISLOC TX FINGER W/O ANES CLSD $720.13 26770

DISLOC TX KNEE W/O ANES CLSD $591.25 27550

DISLOC TX RADIUS/ULNA CLSD $1,989.88 25605

DNA AB SINGLE STRAND $87.52 86226

DNA ANTIBODY $95.00 86225

DRAIN BLOOD FROM UNDER NAIL $259.71 11740

DRAIN EXTERNAL EAR LESION $563.62 69000

DRAIN NECK/CHEST LESION $4,135.84 21501

DRAIN SKIN ABSCESS SIMPLE $618.42 10060

DRAINAGE CATHETER EXCHANGE $2,409.44 49423

DRAINAGE MOUTH ROOF LESION $433.84 42000

DRAINAGE OF ABSCESS; SUBMAXILLARY, EXTERNAL $623.09 42320

DRAINAGE OF BREAST LESION $662.49 19000

DRAINAGE OF FINGER ABSCESS $520.92 26010

DRAINAGE OF GUM LESION $651.63 41800

DRAINAGE OF HEMATOMA/FLUID $3,186.60 10140

DRAINAGE OF HEMATOMA/FLUID $3,186.60 10140

DRAINAGE OF MOUTH LESION $583.40 40800

DRAINAGE OF MOUTH LESION $2,346.39 41000

DRAINAGE OF NOSE LESION $2,828.28 30020

DRAINAGE OF PILONIDAL CYST; COMPLICATED $1,218.85 10081

DRAINAGE OF SCROTUM ABSCESS $2,315.77 55100

DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST $3,742.56 53060

DRAINAGE OF THROAT ABSCESS $3,248.40 42720

DRAINAGE OF TONSIL ABSCESS $707.08 42700

DRUG QUANTITATION-NOT SPECIFED $107.01 80299

DRUG TEST PRSMV CHEM ANLYZR LAB $370.00 80307

DRUG TEST PRSMV DIR OPT OBS LAB $370.43 80305

DUPLEX ABD/PEL VASC STUDY,COMPLETE $1,725.49 93975

DUPLEX EXTREM VENOUS,BILAT $1,565.06 93970

DUPLEX EXTREM VENOUS,UNI OR LTD $1,099.87 93971

DUPLEX HEMODIALYSIS ACCESS $894.72 93990

DUPLEX LARGE VESSEL(S),COMPLETE $2,584.50 93978

DUPLEX LARGE VESSEL(S),LIMITED $668.33 93979

DUPLEX LO EXTREM ART BILAT $1,152.12 93925

DUPLEX LO EXTREM ART UNILAT/LTD $1,071.93 93926

DUPLEX SCAN EXTRACRANIAL,BILAT $1,608.63 93880

DUPLEX UP EXTREM ART BILAT $2,584.50 93930

DUPLEX UP EXTREM ART UNILAT/LTD $1,060.91 93931

DX BONE MARROW ASPRATIONS $715.00 38220

DX BONE MARROW BIOPSIES $839.41 38221

DX MAMMO BILAT W/WO CAD $375.00 77066

DX MAMMO UNILATERAL W/WO CAD $275.00 77065

DXA BONE DENSITY STUDY $237.45 77085

DXA BONE DENSITY, AXIAL $288.51 77080

E HISTOLYTICA ANTIGEN $97.00 87337

EAR/PULSE OXIMETRY-MULTIPLE $76.26 94761

EAR/PULSE OXIMETRY-OVERNIGHT MONITOR $276.00 94762

EAR/PULSE OXIMETRY-SINGLE DETM $80.87 94760

ECG MONITOR/REPORT UP TO 48 HRS $390.00 93225

ECG RECORD/REVIEW $192.92 93268

ECG RECORDING (30 DAY) $440.74 93270

ECHO 2D COMP W/CF W/CONTRAST $1,426.28 93307

ECHO 2D W/CF COMP W/CONTRAST $2,364.65 93306

ECHO COMP W/ CONTRAST $2,364.65 93306

ECHO COMP W/O CONT W/O CF $1,426.28 93307

ECHO COMP W/O CONTRAST $2,364.65 93306

ECHO CONGENITAL COMP W/CONT $1,714.56 93303

ECHO DOPPLER EXAM COMP $600.24 93320

ECHO DOPPLER EXAM LIMITED $945.35 93321

ECHO LIMITED W/CONTRAST $1,267.82 93308

ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN $1,300.00 93355

ECHO TRANSESOPHAGEAL W/CONT $2,062.56 93312

ECHO,SCROTUM & CONTENTS $949.45 76870

ECHO,TRANSRECTAL $1,531.91 76872

ECHOCARDIOGRAM LTD W/O CONT $1,267.82 93308

ECHO-CNGNTL COMP W/ CONT $1,714.56 93303

ECHO-CNGNTL LTD W/ CONT $1,227.30 93304

ECHO-CONGENITAL COMP W/O CONT $1,714.56 93303

ECHO-CONGENITAL LTD W/O CONT $1,227.30 93304

ECHOCRDGRM LTD W/ CONT $1,267.82 93308

ECHOGRAPHY,TRANSVAGINAL $1,000.66 76830

EEG $757.00 95819

EEG AWAKE $684.00 95816

EEG CEREBRAL DEATH EVAL $819.00 95824

EEG EXTENDED MONITORING <1 HR $816.00 95812

EEG EXTENDED MONITORING >1 HR $1,054.00 95813

EEG SLEEP $785.00 95822

ELECTRIC STIMULATION THERAPY $80.00 97014

ELECTROCARDIOGRAM $278.29 93005

ELECTROLYTES, SERUM $146.27 80051

EMERGENCY ROOM CRITICAL CARE-30 TO 74 MINUTES $2,718.00 99291

EMERGENCY ROOM CRITICAL CARE-EA ADDL 30 MIN $1,363.00 99292

EMERGENCY ROOM LEVEL I BRIEF $258.00 99281

EMERGENCY ROOM LEVEL II LIMITED $503.00 99282

EMERGENCY ROOM LEVEL III INTERMEDIATE $753.00 99283

EMERGENCY ROOM LEVEL IV EXTENDED $1,428.00 99284

EMERGENCY ROOM LEVEL V COMPREHENSIVE $2,107.00 99285

ENDOLUMINAL BX PELVIS W RAD/GDE $3,000.00 50606

ENDOLUML BX(S) BIL TREE W RAD/GDE $3,500.00 47543

ENDOMYSIAL AB *R $224.30 83516

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPH - 2ND PROCEDURE $2,251.82 43262

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPH-2ND PROCEDURE $2,251.82 43264

EPSTEIN BARR VIRUS-CAPSID AG $83.38 86665

EPSTEIN BARR VIRUS-EARLY ANT $57.34 86663

EPSTEIN BARR VIRUS-NUC ANTIGEN $66.82 86664

ERYTHROPOIETIN $346.61 82668

ESOPHAGOSCOPY,RIGID OR FLEXIBLE,W/CONTROL OF BLEEDING-2ND PROCEDURE $1,050.85 43227

ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH BAND LIGATION $2,529.54 43205

ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH BAND LIGATION-2ND PROCEDURE $1,050.85 43205

ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH CONTROL OF BLEEDING $2,292.34 43227

ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH INJ OF SCLEROSIS-2ND PROCEDURE $1,200.97 43204

ESOPHAGOSCOPY,RIGID OR FLEXIBLE;REMOVAL OF FOREIGN BOD-2ND PROCEDURE $1,200.97 43215

ESOPHAGRAM $855.34 74220

ESPHAGOSCOPY FLEX TRANSORAL-2ND PROCEDURE $1,047.50 43200

ESPHAGOSCOPY FLEXIBLE TRANSORAL $2,095.00 43200

ESTRADIOL (E2) $199.76 82670

ESTROGEN TOTAL SERUM $94.76 82672

EVAL SPEECH-GEN DEVICE 1ST HR $260.00 92607

EVALUATE SPEECH PRODUCTION $339.54 92522

EVALUATION OF SPEECH FLUENCY $339.54 92521

EVALUATION OF WHEEZING $150.30 94060

EXAM,SYNOVIAL FLUID CRYSTALS $213.33 89060

EXCHANGE PERQ NEPH CATH W RAD/GDE $1,311.20 50435

EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS $3,437.78 46230

EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL $3,605.16 46320

EXPIRED GAS COLLECTION $80.52 94250

EXPLORATION OF PENETRATING WOUND(SEPARATE PROCEDURE)NECK $1,191.40 20100

EXPLORE OF PENETRATIN WOUND EXTREMITY $1,832.98 20103

EXPLORE PENETRATING WOUND (SEPARATE PROCEDURE); CHEST $2,480.00 20101

EXPLORE PENETRATING WOUND; ABDOMEN/FLANK/BACK $3,599.90 20102

EXTRACTABLE NUCLEAR ANTIGEN,AB $110.00 86235

EYE SURGERY PROCEDURE $2,681.16 66999

FACTOR II GENOTYPE PANEL*REF $702.31 81240

FACTOR V GENOTYPE LEIDEN*REF $562.50 81241

FACTOR VIII VW MULTIMERIC $126.45 85247

FAT OR LIPIDS,FECES,QUAL. $75.50 82705

FERRITIN $201.50 82728

FETAL BIOPHYSICAL PROFILE WO NST $732.59 76819

FETAL FIBRONECTIN $560.84 82731

FETAL LUNG MATURITY,L/S RATIO $727.21 83661

FFP/CRYO THAW $127.05 86927

FIBRINOGEN QUANT $218.42 85384

FINE NEEDLE ASP;W/IMAGING GUIDANCE $646.98 10022

FLOURESCENT ANTIBODY TITER $253.78 86256

FLOW CYTOMETRY EA ADDL MARKER $55.24 88185

FLOW CYTOMETRY FIRST MARKER $218.08 88184

FLUORESCENT N.INF AGENT-SCREEN $238.21 86255

FLUORO GUIDE NEEDLE PLACEMENT $1,082.54 77002

FLUORO GUIDE SPINE INJECTION $1,163.66 77003

FLUORO GUIDE VENOUS ACCESS DEVICE $319.05 77001

FLUOROSCOPE EXAM >1 HR EXTENSIVE $1,251.72 76001

FLUOROSCOPE EXAMINATION $940.75 76000

FOLIC ACID,RBC $157.51 82747

FOLIC ACID,SERUM $200.23 82746

FREE T3 TRIIODOTHYRONINE $188.08 84481

FSH SERUM $279.38 83001

FUNDAL PHOTOGRAPHY $250.00 92250

FUNGAL CULTURE, SMEAR *R $60.41 87205

FUNGUS ISOLATION CULTURE*R $80.00 87102

G6PD *R $49.36 82960

GAIT TRAINING-M59 $95.00 97116

GAMMA GT $130.91 82977

GAMMAGLOBULIN (IMMUNOGLOBULIN);IGA,IGD,IGG,IGM,EACH *R $104.44 82784

GANGLIOSIDE GM-1 AB'S 1 *R $498.85 83520

GASTRIC EMPTY STUDY W SB MULTI DAY $1,103.40 78266

GASTRIC EMPTY STUDY W SB TRANSIT $831.63 78265

GASTRIC EMPTYING STUDY $2,328.39 78264

GASTRIC INTUBATION TREATMENT $650.25 43753

GASTRIN SERUM $109.73 82941

GASTROSTOMY TUBE CHANGE $1,806.41 43760

GATED HEART, PLANAR SINGLE $3,029.64 78472

GC CULTURE $150.68 87070

GC NUCLEIC AMP $254.81 87591

GENITAL SURGERY PROCEDURE $2,592.15 58999

GENTAMICIN $322.96 80170

GIARDIA AG, EIA $173.29 87329

GIARDIA ANTIBODIES *R $157.11 86674

GLIADIN IGG *R $189.50 83520

GLUCOSE 1HR GESTATIONAL LOAD $116.31 82950

GLUCOSE BLOOD TEST $53.31 82962

GLUCOSE TOLERANCE TEST (3 SP) $262.09 82951

GLUCOSE TOLERANCE TEST(EA ADD) $90.85 82952

GLUCOSE,BODY FLUID,NOT BLOOD $68.15 82945

GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP) $132.81 82947

GLYCOHEMOGLOBIN A1C $210.29 83036

GLYCOHEMOGLOBIN A1C $210.29 83036

GONADOTROPIN,CHORIONIC-QUANT. $238.47 84702

GRAM STAIN $60.41 87205

HAEMOPHILUS INFLUENZA AB $227.68 86684

HAPTOGLOBIN $211.12 83010

HCHG BLADDER SCAN PROCEDURE $244.98 51798

HCHG BMH CLOSED TX VERT FX W/O MANI $1,389.00 22310

HCHG BMH/CVMC ASPIRATE PLEURA W/O IMAGING $1,680.02 32554

HCHG BMH/CVMC IVP $2,469.80 74410

HCHG BMH/CVMC IVP W/TOMO $2,963.59 74415

HCHG BMH/CVMC NEEDLE ELECTROMYOGRAPHY 4 EXTREMITIES W/WO PARASPINAL $1,027.22 95864

HCHG BMH/CVMC NON-SELECTIVE CATH PLACE,THORACIC AORTA,W/ANGIOGRAPHY $8,930.91 36221

HCHG BMH/CVMC PLACE CATHETER SUBCLAVIAN OR INNOMINATE ARTERY, UNILATER $8,930.00 36225

HCHG BMH/CVMC SELECTIVE CATH PLACE,COMMON CAROTID/INNOMINATE ARTERY $8,930.91 36222

HCHG BMH/CVMC SELECTIVE CATH PLACEMENT, EXTERNAL CAROTID ARTERY, UNILA $3,628.12 36227

HCHG BMH/CVMC SELECTIVE CATH PLACEMENT,COMMON CAROTID/INNOMINATE ARTER $8,930.91 36223

HCHG BMH/CVMC SELECTIVE CATHETER PLACEMENT VERTEBRAL ARTERY UNILATERAL $14,606.00 36226

HCHG BMH/CVMC SELECTIVE CATHETER PLACEMENT, INTERNAL CAROTID ARTERY $14,606.00 36224

HCHG BMH/CVMC THORACENTESIS, NEEDLE OR CATHETER,W/IMAGING GUIDANCE $1,659.15 32555

HCHG BMH/CVMC TRANSCATH RETRIEVAL,PERCUT,INTRAVASCULAR FOREIGN BODY $8,963.82 37197

HCHG BMH/CVMC TRANSCATH THERAPY,ARTERIAL/VENOUS INF FOR THROMBOLYSIS $7,057.20 37213

HCHG BMH/CVMC TRANSCATH THERAPY,ARTERIAL/VENOUS INF FOR THROMBOLYSIS $7,057.20 37214

HCHG BMH/CVMC TRANSCATHETER THERAPY, VENOUS INFUSION FOR THROMBOLYSIS $3,162.60 37212

HCHG BX LESION SUBQ MUCOUS SINGLE $385.08 11100

HCHG CATH PLACE REN ART 1ST UNILAT $3,863.31 36251

HCHG CT SCAN CERV SP COMBO $3,658.87 72127

HCHG CT SCAN,ABD & PELVIS,COMBO $3,900.00 74178

HCHG CTA ABD/PEL W & W/O $3,600.00 74174

HCHG CVC, NON TUNNELED >AGE 5 $3,057.56 36556

HCHG CVMC ANAL/URINARY MUSCLE STUDY $708.52 51792

HCHG CVMC ANALYZE IMPLANTED NEUROSTIMULATOR, COMPLEX $1,265.24 95972

HCHG CVMC ANALYZE NEUROSTIM, WITH REPROGRAMMING $1,584.24 95971

HCHG CVMC ANALYZE NEUROSTIMULATOR ,W/O REPROGRAMMING $615.92 95970

HCHG CVMC ANOSCOPY REMOVE FOREIGN BODY $2,042.12 46608

HCHG CVMC AUDITOR EVOKE POTENTIALS, COMPREHENSIVE $683.92 92585

HCHG CVMC BLOOD TRANSFUSION HOUR $800.00 36430

HCHG CVMC BRONCHOSCOPE/ALVEOLAR LAVAGE, INC FLUOROSCOPIC GUIDANCE $4,383.74 31624

HCHG CVMC BRONCHOSCOPE/BRUSH/DX.INCLUDING FLUOROSCOPIC GUIDANCE $1,781.47 31623

HCHG CVMC BRONCHOSCOPE/WASH/DX, INCLUDING FLUOROSCOPIC GUIDANCE $1,869.44 31622

HCHG CVMC BRONCHOSCOPY CLEAR AIRWAYS, INC FLUOROSCOPIC GUIDANCE $1,517.17 31645

HCHG CVMC BRONCHOSCOPY W/BIOPSY, INCLUDING FLUOROSCOPIC GUIDANCE $1,664.10 31625

HCHG CVMC BRONCHOSCOPY, RECLEAR AIRWAY,INC FLUOROSCOPIC GUIDANCE $1,676.34 31646

HCHG CVMC BRONCHOSCOPY/LUNG BX ADD'L, W/WO FLUOROSCOPIC GUIDANCE $775.70 31632

HCHG CVMC CANALITH REPOSITIONING $95.00 95992

HCHG CVMC CENTAL MOTOR EVOKED POTENTIAL STUDY, LOWER LIMBS $773.48 95929

HCHG CVMC CENTRAL MOTOR EVOKED POTENTIAL STUDY, UPPER LIMBS $773.48 95928

HCHG CVMC CHANGE GASTROSTOMY TUBE $1,806.41 43760

HCHG CVMC EEG DURING SURGERY $1,190.73 95955

HCHG CVMC ELECTRODE STIM, BRAIN ADD-ON $847.92 95962

HCHG CVMC ELECTRODE STIMULATION,BRAIN $1,128.01 95961

HCHG CVMC ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH INJ OF SCLEROSIS $2,287.84 43204

HCHG CVMC GASTRIC OCCULT BLOOD $85.77 82271

HCHG CVMC MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT $4,727.73 19325

HCHG CVMC MASK CPAP/BIPAP SUBQ DAY $1,075.41 94660

HCHG CVMC MUSCLE TEST CRANIAL NERVE SUPPLIED MUSCLE(S) UNILATERAL $552.09 95867

HCHG CVMC MUSCLE TEST CRANIAL NERVE SUPPLIED MUSCLES BILATERAL $552.09 95868

HCHG CVMC MUSCLE TEST, 2 LIMBS $675.20 95861

HCHG CVMC MUSCLE TEST, 3 LIMBS $815.14 95863

HCHG CVMC MUSCLE TEST, NONPARASPINAL $269.08 95870

HCHG CVMC MUSCLE TEST, ONE LIMB $519.29 95860

HCHG CVMC NEUROMUSCULAR JUNCTION TEST $402.66 95937

HCHG CVMC PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS/SOLUTION INJ $2,714.80 62263

HCHG CVMC PHYSICAL PERFORMANCE TEST-PER 15 MIN $125.00 97750

HCHG CVMC PLACE GASTROSTOMY TUBE $4,197.16 43246

HCHG CVMC PSYCH DIAGNOSTIC EVALUATION $383.00 90791

HCHG CVMC PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES $383.00 90792

HCHG CVMC PSYCHOTHERAPY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEM $170.00 90832



HCHG CVMC REMOVE INTRAUTERINE DEVICE $388.00 58301

HCHG CVMC SENSITIVITY, MICROBIOLOGY $281.57 87186

HCHG CVMC SOMATOSENSORY TESTING,LOWER LIMBS $1,185.44 95926

HCHG CVMC SOMATOSENSORY TESTING,TRUNK/HEAD $1,185.44 95927

HCHG CVMC SOMATOSENSORY TESTING,UPPER LIMBS $1,185.44 95925

HCHG CVMC TRANSCATHETER BIOPSY $6,823.53 37200

HCHG CVMC X-RAY EXAM OF SALIVARY DUCT $818.00 70390

HCHG DEBRIDE REMOVAL FOREIGN MATERIAL FX $1,424.45 11010

HCHG DEBRIDE SKIN TISSUE MUSCLE BONE FX $1,599.69 11012

HCHG DISLOC TX ANKLE WO ANESTH CLSD $710.08 27840

HCHG DRAINAGE ABSCESS HEMATOMA NASAL $747.45 30000

HCHG DRAINAGE FINGER ABSCESS COMPLICATED $2,152.80 26011

HCHG DRAINAGE OF KIDNEY $3,792.05 50040

HCHG ENDOTRACHEAL INTUBATION $1,141.97 31500

HCHG ENDOVENOUS LASER VEIN ADDON $9,205.73 36479

HCHG ENDOVENOUS LASER, 1ST VEIN $9,205.73 36478

HCHG ESOPHAGOSCOPY FLEX REMOVAL FB $5,012.05 43215

HCHG FNA WITHOUT IMAGING GUIDANCE $750.61 10021

HCHG GENITAL MALE SURGERY PROCEDURE $3,057.97 55899

HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, 1ST LEVEL $5,044.32 64490

HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, 2ND LEVEL $1,790.58 64491

HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, ADD LEVEL $1,790.58 64492

HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 1ST LEVEL $5,044.32 64493

HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 2ND LEVEL $1,790.58 64494

HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, ADD LEVEL $1,790.58 64495

HCHG INJECT NERV BLCK,STELLATE GANGLION $2,328.44 64510

HCHG INSERT TUNNELED CV CATH $6,275.94 36563

HCHG LAP,ABLAT 1+ LIVER TUMOR(S),RADIOFREQ $13,605.32 47370

HCHG LARYNGOSCOPY FLEXIBLE FIBEROPTIC DX $613.07 31575

HCHG LUNG VENTILATION IMAGING $2,904.66 78579

HCHG MR ANGIO, NECK W/CONTRAST $3,750.00 70548

HCHG PF MOD SEDAT PHYS/QHP EA 15 MIN $73.00 99145

HCHG PHLEB VEINS - EXTREM - TO 20 $5,330.38 37765

HCHG PHLEB VEINS - EXTREM 20+ $7,201.10 37766

HCHG REM IMPACTED CERUMEN IRR/LVG UNILAT $139.85 69209

HCHG REMOVAL FB DEEP COMPLICATED $4,607.37 20525

HCHG REMOVAL IMPACTED CERUMEN INSTR UNILAT $418.63 69210

HCHG REPAIR COMPLEX WOUND 2.6-7.5CM $790.66 13152

HCHG REPAIR COMPLEX WOUND EA ADDL 5CM < $526.43 13153

HCHG REPLACE TUNNELED CV CATH $2,425.06 36578

HCHG REPLACE TUNNELED CV CATH $10,546.25 36583

HCHG TRANSVENOUS TEMP PACER SNGL CH $6,202.00 33210

HCHG VASCULAR SURGERY PROCEDURE UNLIST $3,482.97 37799

HCHG WEDGE EXCISION SKIN NAIL FOLD $630.51 11765

HCHG X-RAY SALIVARY GLAND $821.94 70380

HCHG-REVASCULARIZE FEM/POP ARTERY,* $13,230.63 37224

HEAD, REAL TIME $1,084.02 76506

HEAD/NECK TISSUES,REAL TIME $944.96 76536

HEART FIRST PASS ADD-ON $1,366.55 78496

HEART FIRST PASS SINGLE,PLANAR $3,059.82 78481

HEART IMAGE, SPECT $4,079.79 78494

HELICOBACTER AB SERUM $233.24 86677

HEMOCULT TEST-POINT OF SERVICE $49.43 82270

HEMOGLOBIN $42.57 85018

HEMOGLOBIN $42.57 85018

HEMOGLOBIN ELECTROPHORESIS-REF $72.57 83020

HEMOGRAM + PLTS $153.13 85027

HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS $4,372.37 46250

HEP B ANTIGEN $146.03 87340

HEP B E ANTIBODY (HBEAB) $143.17 86707

HEP B E ANTIGEN (HBEAG) $50.36 87350

HEP B S ANTIBODY (HBSAB) $115.35 86706

HEP.C RNA PCR QUALITIVE $625.78 87522

HEPATIC FUNCTION PANEL $156.59 80076

HEPATITIS A ANTIBODY,TOTAL $127.00 86708

HEPATITIS A IGM AB $202.03 86709

HEPATITIS B CORE AB $198.56 86704

HEPATITIS C AB $145.25 86803

HEPATITIS C ANTIBODY,CONFIRM $255.72 86804

HEPATITIS C DETECT-PROBE TECH. $625.78 87522

HEPATOBILIARY IMAGING $2,084.08 78226

HEPATOBILIARY WITH CCK $2,084.08 78227

HETEROPHILE SCREEN $153.50 86308

HIGH DENSITY LIPOPROTEIN (HDL) $313.47 83718

HISTOPLASMOSIS AB $196.80 86698

HIV VIRAL LOAD RNA QT $415.45 87536

HIV-1 AMPLIFIED PROBE $837.13 87535

HIV-1 ANTIBODY *R $118.20 86701

HIV-1/HIV-2 SINGLE RESULT $225.26 86703

HIV-WESTERN BLOT CONFIRM $124.94 86689

HLA TYPING DR/DR,MULT.ANTIGENS $618.44 86817

HLA-B27 $475.79 86812

HND HELD NEB INITIAL $203.14 94640

HOMOCYSTEINE, SERUM $358.57 83090

HUMAN GROWTH HORMONE $122.45 83003

HYDROXYINDOLACETIC ACID URINE $237.77 83497

I & D OF VULVA/PERINEUM $919.23 56405

ICG ANGIOGRAPHY $484.80 92240

IGG SUBCLASSES 1,2,3 OR 4,EACH $63.00 82787

ILEOSCOPY STOMA W/BALLOON DILATION $2,130.23 44381

ILEOSCOPY STOMA W/BALLOON DILATION-2ND PROCEDURE $1,065.11 44381

ILEOSCOPY,THROUGH STOMA,DIAGNOSTIC $5,544.84 44380

IMAGE CATH FLUID COLXN VISC $2,518.31 49405

IMAGE CATH FLUID PERI/RETRO $3,999.04 49406

IMAGE CATH FLUID TRNS/VGNL $4,910.50 49407

IMMUNIZATION ADMIN, EACH ADD $80.37 90472

IMMUNIZATION ADMINISTRATION $120.00 90471

IMMUNOASSAY FOR ANALYTE-NSMETH $498.85 83520

IMMUNOASSAY NONANTIBODY *R $129.10 83516

IMMUNOASSAY TUMOR ANT-CA 19-9 $270.30 86301

IMMUNOELEC*R $405.91 86320

IMMUNOGLOBULIN A $104.44 82784

IMMUNOGLOBULIN G (IGG) $104.44 82784

IMMUNOGLOBULIN IGE $167.22 82785

IN SITU HYBRIDIZATION (EG, FISH), EACH PROBE $123.82 88365

IN SITU HYBRIDIZATION, EACH PROBE; MANUAL $180.17 88368

INCISE FINGER TENDON SHEATH $3,331.11 26055

INCISION & DRAINAGE BELOW FACIA/FOOT/SINGE BURSAL SPACE $3,156.30 28002

INCISION AND DRAINAGE OF ANAL ABSCESS SUPERFICIAL $2,428.07 46050

INCISION AND DRAINAGE OF SCROTUM $4,226.29 54700

INCISION AND DRAINAGE OF UPPER ARM/ELBOW BURSA $3,076.39 23931

INCISION AND DRAINAGE, COMPLEX, POSTOP WOUND INFECTION $3,988.72 10180

INCISION DRAINAGE OF PILONIDAL CYST; SIMPLE $531.43 10080

INCISION HEMORRHOID EXTERNAL $691.68 46083

INCISION OF EYELID FOLD $2,810.65 67715

INCISION OF RETAL ABSCESS $3,237.37 46040

INCISION OF WINDPIPE EMERGENCY TRACHEOSTOMY $1,699.37 31603

INCISION WINDPIPE TRACH EMERGENCY $2,168.20 31605

INDIA INK PREP *R $46.87 87210

INF THERAPY-HYDRATION 31-60MIN $384.71 96360

INF THERAPY-HYDRATION EA ADDHR $109.80 96361

INF THERAPY-TH/DIAG-CONC < 1HR $171.08 96368

INF THERAPY-TH/DIAG-INIT < 1HR $535.00 96365

INF THERAPY-TH/DIAG-INIT ADDHR $190.07 96366

INF THERAPY-TH/DIAG-SEQ < 1HR $348.09 96367

INF.AGENT GENOTYPE ANAL-HIV-1 $1,124.63 87901

INF.AGENT-BY NUC-HEP B-QUANT. $427.18 87517

INF.AGENT-GENOTYPE ANAL-HEP C $1,124.63 87902

INFLUENZA ADMINISTRATION $120.00 90471

INFLUENZA B, EIA TEST $200.08 87400

INHALER INITIAL $239.66 94664

INIT PROSTHETIC TRAINING EA 15 MIN $154.05 97761

INITIAL ORTHOTIC TRAINING EA 15 MIN $173.00 97760

INJ ANES AGENT FACIAL NERVE $1,440.71 64402

INJ ANES GREATER OCCIPITAL NERVE $739.00 64405

INJ ANES SUPRASCAPULAR NERVE $1,074.00 64418

INJ PERQ CHOLANGIO EXIST W RAD/GDE $879.28 47531

INJ PERQ CHOLANGIO NEW W RAD/GDE $5,442.78 47532

INJ PROC SHOULDER ARTHROGRAPHY/CT/* $808.14 23350

INJ SACROILIAC JOINT,ARTHROGRAPHY OR ANESTHETIC/STEROID $1,306.69 27096

INJ SCLEROSANT MLT INCOMPETENT VEINS $145.78 36471

INJ SCLEROSANT SGL INCOMPETENT VEIN $145.78 36470

INJ THERAPUTIC/PROPHLACTIC/DX $179.55 96379

INJ THRU KIDNEY TUBE EXIST W RGDE $1,311.20 50431

INJ THRU KIDNEY TUBE NEW W RGDE $1,311.20 50430

INJ(S)-TRIGGER PT(S)-1/2MUSCULE $676.19 20552

INJ(S)-TRIGGER PT(S)-3/MORE MS $810.65 20553

INJ,EPI CERV/THOR SINGLE W IG $1,496.44 62321

INJ,EPI CERV/THOR SINGLE W/O IG $1,496.44 62320

INJ,EPI LUMB/SAC SINGLE W IG $1,405.82 62323

INJ,EPI LUMB/SAC SINGLE W/O IG $1,405.82 62322

INJ,FORAMEN C/T,1 LEVEL $2,743.11 64479

INJ,FORAMEN C/T,ADDL LEVELS $2,244.36 64480

INJ,FORAMEN,L/S,1 LEVEL $1,697.00 64483

INJ,FORAMEN,L/S,ADDL LEVELS $2,244.36 64484

INJ/ASPIR-INTERMED JT/BURSA W/O US GUIDE $955.26 20605

INJ/ASPIR-INTERMED JT/BURSA W/O US GUIDE $955.26 20605

INJ/ASPIR-LARGE JT/BURSA W/O US GUIDE $1,095.34 20610



INJ/ASPIR-LARGE JT/BURSA WITH US GUIDE $1,094.34 20611



INJ/ASPIR-SMALL JT/BURSA W/O US GUIDE $931.60 20600

INJ/ASPIR-SMALL JT/BURSA WITH US GUIDE $931.60 20604

INJ/ASPIR-SMALL JT/BURSA WITH US GUIDE $955.26 20606

INJ-ANES AGENT-CERVICAL PLEXUS $865.63 64413

INJ-ANES AGENT-OTHER PHER.NRVE $981.97 64450

INJ-ANES-TRIGEMINAL NERVE $1,382.86 64400

INJECT DISCOGRAM,LUMBAR,EA LEVEL $236.91 62290

INJECT FOR RETROGRADE URETHOCYSTO $236.91 51610

INJECT FOR SACROILIAC JOINT $1,306.69 27096

INJECT SINUS TRACT FOR DX W XRAY $236.91 20501

INJECT,MYELOGRAPHY &/OR CT SCAN,SP* $996.30 62284

INJECTION FOR ANKLE ARTHROGRAM $544.14 27648

INJECTION FOR BLADDER X-RAY $236.91 51600

INJECTION FOR ELBOW ARTHROGRAM $342.12 24220

INJECTION FOR KNEE ARTHROGRAM $560.58 27370

INJECTION FOR SALIVARY X-RAY $610.73 42550

INJECTION FOR WRIST ARTHROGRAM $544.08 25246

INJECTION HIP ARTHROGRAM $695.29 27093

INJECTION PROC,EXTREMITY,VENOGRAPHY $214.84 36005

INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE $1,003.57 64447

INJECTION-DIAG/THERAP-SQ/IM $160.63 96372

INJECTIONS SPIDER VEINS LIMB/TRUNK $145.78 36468

INJ-SNGL TENDON SHEATH/LIGAMNT $563.10 20550

INSERT ABDOM DRAIN/CATH,PERMAN $7,053.38 49421

INSERT BLADDER CATHETER COMPLEX $495.41 51703

INSERT CATH PLEURA W/IG $1,911.00 32557

INSERT DUODENOSTOMY/JEJUNOSTOMY TU* $5,012.05 49441

INSERT GASTROSTOMY TUBE PERCUTANEO* $7,217.34 49440

INSERT IVC FILTER WITH IG & SI $7,500.00 37191

INSERT NEEDLE BONE CAVITY FOR INTRAOSSEOUS INFUSION $397.15 36680

INSERT NON-TUNNEL CV CATH $3,057.56 36556

INSERT NON-TUNNEL CV CATH < 5 Y/O $1,500.48 36555

INSERT PICC W/ SUB-Q PORT <5 Y/O $14,432.31 36570

INSERT PICC W/O SUB-Q PORT <5 Y/O $2,064.83 36568

INSERT TRANSVEN INTRAHEP PORTOSYS * $25,395.69 37182

INSERT TUNNELED CV CATH $9,681.88 36561



INSERT TUNNELED CV CATH <5 Y/O $4,433.38 36557

INSERT TUNNELED CV CATH W/O PORT O* $4,093.26 36558

INSERT TUNNELED CV CATH WITH PORT * $6,820.15 36560

INSERTION CATHETER ARTERY FOR SAMPLING MONITOR TRANSFUSE $916.04 36625

INSERTION CATHETER ARTERY FOR SAMPLING MONITORING TRANSF $836.03 36620

INSERTION INDWELLING TUNNELED PLEU* $6,295.00 32550

INSERTION OF PICC; 5 YRS > $1,859.55 36569

INSULIN $91.77 83525

INTERCOSTAL INJECTION SINGLE $1,102.00 64420

INTRAOP CYTO PATH CONSULT, 1 $87.46 88333

INTRAOP CYTO PATH CONSULT, 2 $58.30 88334

INTRO NEEDLE CATH UE/LE ARTERY $1,296.38 36140

IONTOPHORESIS EA 15 MIN $95.00 97033

IOP FAMILY THERAPY W/O PT $266.00 90846

IOP GROUP THERAPY-CD $291.00 90853

IPPB RX $225.98 94640

IPPB TX INIT $225.98 94640

IRON $123.89 83540

IRON BINDING CAPACITY $129.09 83550

IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM $767.12 54220

IV START $167.36 36000

JOINT SURVEY, SINGLE VIEW $375.00 77077

KOH PREP $101.93 87220

LACTIC ACID $186.37 83605

LARYNGOSCOPY DIRECT W/WO TRACHEOSCOPY DX -NO NEWBORN $3,274.66 31525

LARYNGOSCOPY,DIRECT,OPERATIVE,WITH FOREIGN BODY REMOVAL $4,923.13 31530

LAVAGE A SUCTION $145.63 94799

LAYER CLOSE WOUND 12.6-20.0CM $788.13 12035

LAYER CLOSE WOUND 12.6-20.0CM FACE EARS EJYELID NOSE LIP $645.08 12055

LAYER CLOSSURE WOUND 7.6-12.5CM $671.04 12054

LAYER CLOSURE OF WOUND 2.5CM OR < $760.26 12041

LAYER CLOSURE OF WOUND 2.5CM OR < $849.34 12051

LAYER CLOSURE OF WOUND 5.1-7.5CM $609.34 12053

LAYER CLOSURE WOUND 2.6-7.5CM $795.05 12042

LAYER OF CLOSURE WOUND 2.6-5.0CM $783.08 12052

LAYER OF CLOSURE WOUND 7.6-12.5CM $805.87 12034

LDH $105.84 83615

LE ARTERIAL STRESS EXAM $1,466.24 93924

LEAD BLOOD $87.49 83655

LEAD LEVEL*R $87.49 83655

LEG/ANKLE SURGERY PROCEDURE $4,190.77 27899

LEGAL SPEC COLLECT $87.80 99001

LEUKOCYTE ALK P $52.39 85540

LEUKOCYTE ANTIBODY ID *R $404.93 86021

LEUKOCYTES STOOL $152.89 89055

LEVEL I SURG PATH GROSS ONLY $166.73 88300

LEVEL II S.PATH GROSS&MICRO $367.51 88302

LEVEL III S.PATH GROSS&MICRO $425.40 88304

LEVEL IV S.PATH GROSS&MICRO $986.66 88305

LEVEL V S.PATH GROSS&MICRO $689.29 88307

LEVEL VI S.PATH GROSS&MICRO $928.29 88309

LIPASE $180.00 83690

LIPID PANEL $234.31 80061

LIPOPROTEIN FRACTIONS $242.00 83701

LIPOPROTEINS A*R $203.50 83695

LITHIUM $166.37 80178

LIVER AND SPLEEN IMAGING $2,978.54 78215

LIVER IMAGING (SPECT) $3,802.20 78205

LUNG PERFUSION DIFFERENTIAL $3,052.34 78597

LUNG PERFUSION IMAGING $2,011.15 78580

LUNG VENT/PERF IMAGING $2,904.66 78582

LUPUS ANTICOAG*R $177.53 85705

LUTEINIZING HORMONE $282.13 83002

LYME DISEASE ANTIBODY $273.33 86618

LYMPHATICS & LYMPH GLANDS IMAGING $2,498.06 78195

LYMPHATICS INJ-SUBQUE/MUSCLE $2,064.03 38792

MAGNESIUM $134.92 83735

MAGNESIUM URINE $134.92 83735

MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA $9,017.43 27860

MANUAL THERAPY TECHNIQUE 15MIN $105.00 97140

MASSAGE $110.00 97124

MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP $2,684.68 19020

MDI DOSE TITRATION $615.03 94640

MECH CHEST WALL OSCIL PER/SESSION $372.00 94669

MECH REMOV TUNNELED CV CATH $4,916.94 36595

MECH REMOV TUNNELED CV CATH $2,512.66 36596

MECHANICAL TRACTION $123.25 97012

MED NUT THERAPY INITIAL 15 MIN $50.00 97802

MED NUT THERAPY REASSMT 15 MIN $40.00 97803

MERCURY *R $71.04 83825

MERCURY LEVEL,QUANT $71.04 83825

METANEPHRINES TOTAL $312.39 83835

METHEMOGLOBIN *R $206.24 83050

MICRO, CULTURE COMAPYLOBACTER $137.51 87046

MICRO, CULTURE SETUP $130.16 87081

MICRO, ISOLATE ID $227.95 87077

MICROALBUMIN SEMIQUANT LAB $31.00 82044

MICROALBUMIN URINE QT $104.03 82043

MICROSLIDE CONSULTATION $82.37 88323

MICROSOMAL ANTIBODIES-EACH $200.45 86376

MR ANGIO UPPER EXTREMITY W/CONT $3,496.91 73225

MR ANGIO, HEAD $3,391.23 70544

MR ANGIO, HEAD W/CONTRAST $3,750.00 70545

MR ANGIO, HEAD, COMBO $3,975.00 70546

MR ANGIO, NECK $3,400.00 70547

MR ANGIO, NECK, W&WO CONTRAST $3,975.00 70549

MRA W/O CONT, ABD $3,975.00 74185

MRI BRAIN $2,575.00 70551

MRI BRAIN COMBO $3,975.00 70553

MRI BRAIN CONTRAST $2,975.00 70552

MRI CHEST WITH CONTRAST $3,495.00 71551

MRI LOWER EXTREM JT, W/O CONTRAST $2,975.00 73721

MRI UPPER EXTR, W/CONTRAST $3,975.00 73220

MRI W/CONT, BREAST, BI $4,744.08 77059

MRI, ABDOMEN (MRI) $3,388.57 74181

MRI, ABDOMEN, COMBO $3,975.00 74183

MRI, BONE MARROW $5,048.34 77084

MRI, CERV SPINE $2,575.00 72141

MRI, CERV SPINE COMBO $3,975.00 72156

MRI, CERV SPINE CONTRAST $3,750.00 72142

MRI, CHEST $2,975.00 71550

MRI, CHEST, COMBO $3,975.00 71552

MRI, DORSAL SPINE $3,537.76 72146

MRI, DORSAL SPINE COMBO $3,975.00 72157

MRI, DORSAL SPINE CONTRAST $3,750.00 72147

MRI, FACE, NECK $3,400.00 70540

MRI, FACE, NECK, COMBO $4,848.30 70543

MRI, JOINT OF LEG W/CONTRAST $3,334.75 73722

MRI, JOINT OF LEG. COMBO $3,975.00 73723

MRI, JOINT UPPER EXTREM $2,975.00 73221

MRI, JOINT UPPER EXTREM COMBO $3,975.00 73223

MRI, JOINT UPPER EXTREM W/CONTRAST $3,330.66 73222

MRI, LOWER EXTR, W/O CONTRAST F/U * $3,975.58 73720

MRI, LOWER EXTREM $3,029.48 73718

MRI, LOWER EXTREM W/CONTRAST $3,576.26 73719

MRI, LUMBAR SPINE $2,575.00 72148

MRI, LUMBAR SPINE COMBO $3,975.00 72158

MRI, LUMBAR SPINE CONTRAST $3,750.00 72149

MRI, PELVIS W/CONTRAST $3,750.00 72196

MRI, PELVIS, COMBO $3,975.00 72197

MRI, PELVIS, W/O CONTRAST $2,975.00 72195

MRI, TMJ $4,394.95 70336

MRI, UPPER EXTREM $2,975.00 73218

MRI, UPPER EXTREM W/CONTRAST $3,495.00 73219

MR-STAPH, DNA, AMP PROBE $326.89 87641

MSLT $3,358.57 95805

MUSCULOSKELETAL SURGERY $4,294.96 20999

MYCOPLASMA ANTIBODY $144.29 86738

MYELOGRAPHY CERV SPINE $2,446.84 72240

MYELOGRAPHY LUMBAR SPINE $4,167.45 72265

MYELOGRAPHY OF ENTIRE SPINE $3,191.98 72270

MYELOGRAPHY THORAX SPINE $4,167.45 72255

MYELOGRAPHY VIA LUMBAR IN 2+ REGIONS $1,535.10 62305

MYELOGRAPHY VIA LUMBAR IN LUMBOSACRAL $1,535.10 62304

MYELOGRAPHY VIA LUMBAR IN THORACIC $1,535.10 62303

MYELOGRAPHY VIA LUMBAR INJ CERVICAL $1,535.10 62302

MYOCARDIAL PERFUSION PLANAR 1 STUD* $8,055.86 78453

MYOCARDIAL SPECT MULTIPLE STUDIES $8,055.86 78452

MYOCARDIAL SPECT SINGLE STUDY AT R* $8,055.86 78451

MYOGLOBIN $254.52 83874

NASAL/OROGASTRIC TUBE PLACEMENT W/STENT $602.33 43752

NASO GASTRIC TUBE PLACEMENT $602.33 43752

NASOPHARYNGOSCOPY W ENDOSCOPE $438.36 92511

NATRIURETIC PEPTIDE (BNP) $493.12 83880

NEEDLE BIOPSY OF PANCREAS $3,127.15 48102

NEEDLE BIOPSY PLEURA $843.37 32400

NEEDLE BIOPSY, LYMPH NODE(S) $2,244.36 38505

NEEDLE BIOPSY,MUSCLE $922.20 20206

NEPHELOMETRY EA NOT SPEC REF $225.00 83883

NEUROMUSCULAR RE-EDUCATION-M59 $110.00 97112

NK CELL TOTAL COUNT *R $380.93 86357

NMR LIPO-PROFILE*R $276.80 83704

NON ROTUINE BL DRAW >3 YEARS $249.20 36410

NONINVASV EXTREM EXAM,1LEVEL,BILAT $679.10 93922

NONINVASV EXTREM EXAM,MULT,BILAT $1,279.05 93923

NON-ROUTINE BLOOD DRAW >3YRS $249.20 36410

NONSPEECH GEN DEVICE TREATMENT $289.57 92606

O&P CRYPTOSPORIDIUM *R $25.00 87207

O&P CYCLOSPORA *R $25.00 87207

OB < 14 WKS, ADD'L FETUS $927.69 76802

OB < 14 WKS, SINGLE FETUS $1,074.84 76801

OB >/= 14 WKS, ADDL FETUS $2,183.79 76810

OB >/= 14 WKS, SNGL FETUS $1,210.41 76805

OBSTRUCTIVE MATERIAL REMOVAL FROM * $1,399.47 49460

OCCULT BLOOD STOOL 3 SPECIMENS-CORE LABORATORY $74.41 82270

OFFICE VISIT ESTABLISHED PATIENT LEVEL 1 $115.00 99211





OFFICE VISIT NEW PATIENT LEVEL 1 $120.00 99201





OPEN/PERQ PLACE STENT 1ST $21,642.05 37236

OPEN/PERQ PLACE STENT EA ADD $10,821.02 37237

OPEN/PERQ PLACE STENT EA ADD $10,821.02 37239

OPEN/PERQ PLACE STENT SAME $21,642.05 37238

ORAL PHARYNGEAL EVALUATION $360.00 92610

ORGANIC ACID SINGLE QUANT REF $135.45 83921

OSMOLALITY $164.83 83930

OSMOLALITY URINE $164.83 83935

OT EVAL HIGH COMPLX 60 MIN $396.00 97167

OT EVAL LOW COMPLX 30 MIN $220.00 97165

OT EVAL MOD COMPLX 45 MIN $295.00 97166

OT RE-EVAL EST PLAN CARE $175.00 97168

OVA & PARASITES SMEARS REF $95.00 87177

PARACENTESIS, ABD WITH IMAGING $2,516.79 49083

PARAFFIN TREATMENT-M59 $99.65 97018

PARATHORMONE $518.85 83970

PARATHYROID NUCLEAR IMAGING $2,162.08 78070

PARTIAL THROMBO TIME $125.00 85730

PATH CONSULT DURING SURGERY $248.93 88329

PATH CONSULT-1ST TISSUE BLOCK $264.34 88331

PATH CONSULT-EA ADD TISSUE BLK $141.03 88332

PATH CYTO SMEAR>5 $141.03 88162

PERC RADIOFREQ ABLATE RENAL TUMOR $20,991.05 50592

PERCUT BIOPSY, ABDOMINAL MASS $1,397.78 49180

PERCUT BX, LUNG/MEDIASTINUM $1,000.00 32405

PERCUT DRAIN SPINAL CORD CYST $1,845.63 62268

PERCUT DRAIN/INJECT RENAL CYST $1,804.00 50390

PERCUT PORTAL VEIN CATH $4,918.70 36481

PERCUT XHEPATIC PORTO+DYNAMIC $3,309.97 75885

PERICARDIOCENTESIS,INITIAL $1,450.17 33010

PERICARDIOCENTESIS; SUBSEQUENT $833.17 33011

PERQ BIL CATH PLACE EXT W RAD/GDE $5,442.78 47533

PERQ BIL CATH PLACE INT-EXT W R/GDE $5,442.78 47534

PERQ BIL STENT PLACE EXIST W CATH $10,295.58 47540

PERQ BIL STENT PLACE EXIST W R/GDE $10,295.58 47538

PERQ BIL STENT PLACE EXIST WO CATH $10,295.58 47539

PERQ CERIVICOTHORACIC INJECT $6,700.00 22510

PERQ DEV BREAST 1ST STRTCTC $2,375.25 19283

PERQ DEV BREAST 1ST US IMAG $2,375.25 19285

PERQ DEV BREAST ADD STRTCTC $1,087.63 19284

PERQ DEV BREAST ADD US IMAG $1,087.63 19286

PERQ DEVICE BREAST 1ST IMAG $2,375.25 19281

PERQ DEVICE BREAST EA IMAG $1,087.63 19282

PERQ DILATION BIL DUCT W RAD/GDE $3,500.00 47542

PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGE $1,495.00 32556

PERQ LUMBOSACRAL INJECTION $6,700.00 22511

PERQ NEPH CATH NEW ACCESS W RAD/GDE $3,766.05 50432

PERQ SFT TISSUE DEV PLACE ADDL $800.00 10036

PERQ SFT TISSUE DEV PLACE FIRST $1,201.60 10035

PERQ URET CATH NEW ACCESS W RAD/GDE $3,766.05 50433

PERQ URTRL STENT EXIST W RAD/GDE $5,608.73 50693

PERQ URTRL STENT NEW W CATH W RGDE $5,608.73 50695

PERQ URTRL STENT NEW WO CATH W RGDE $5,608.73 50694

PERQ VERTEBRAL AUG EACH ADDL $9,000.00 22515

PERQ VERTEBRAL AUGMENT LUMBAR $14,900.00 22514

PERQ VERTEBRAL AUGMENT THORACIC $14,900.00 22513

PH,BODY FLUID,NOT SPECIFIED $94.65 83986

PHENOBARB $165.08 80184

PHENOBARBITAL $165.08 80184

PHLEBOTOMY,THERAPEUTIC $208.39 99195

PHOSPHATASE,ACID,TOTAL $33.67 84060

PHOSPHOLIPID ANTIBODY $189.71 86148

PHOSPHORUS $83.45 84100

PHOSPHORUS URINE $200.60 84105

PHP FAMILY THERAPY W/ PATIENT $290.00 90847

PICC EXCHANGE,COMPLETE $5,022.97 36584

PICC LINE PLACEMENT > AGE 5 $1,859.55 36569

PIN WORM $78.67 87172

PLACE CATH ADDN SUBSEL ART,ABD/PEL $559.76 36248

PLACE CATH AORTA $1,026.41 36200

PLACE CATH IN LT/RT PULM ART $1,243.55 36014

PLACE CATH IN VEIN,SELECT $214.92 36011

PLACE CATH IN VEIN,SUBSELECT $214.92 36012

PLACE CATH IN VEIN,SVC,IVC $2,506.34 36010

PLACE CATH SELECT ART,ABD/PEL $1,538.53 36245

PLACE CATH SELECTIVE ART,NECK $2,069.96 36215

PLACE CATH SUBSELECT ART,ABD/PEL $1,600.81 36246

PLACE CATH SUBSELECT ART,NECK $2,674.42 36216

PLACE CATH SUBSUBSELECT ART,ABD/PEL $1,894.27 36247

PLACE CATH SUBSUBSELECT ART,NECK $3,105.90 36217

PLACE GASTROSTOMY TUBE PERCUTANEOUG $7,217.34 49440

PLACE GASTROSTOMY TUBE PERCUTANEOUS $7,217.34 49440

PLACEMENT, BILE DUCT STENT $6,075.45 47801

PNEUMOCOCCAL ADMINISTRATION $120.00 90471

POC INFLUENZA ASSAY W/ OPTIC $209.80 87804

POLYSOM <6 YRS SLEEP STAGING 4> W/CPAP/BILVL $5,400.00 95783

POLYSOMNOGRAPHY <6 YRS SLEEP STAGING 4> $5,200.00 95782

POLYSOMNOGRAPHY, 4 OR MORE $4,639.55 95810

POLYSOMNOGRAPHY/CPAP $4,350.00 95811

PORPHOBILINOG, URINE *R $28.16 84106

PORPHYRINS, URINE *R $142.90 84119

PORTABLE PUMP REFILL & MAIN $329.83 96521

POST-FOSSA/EAR W/CONTRAST CT $2,800.00 70481

POSTFOSSA/EAR W/O CONTRAST CT $2,608.00 70480

POSTFOSSA-EAR W,W/O CONTRST CT $2,950.00 70482

POTASSIUM RANDOM URINE $118.32 84133

POTASSIUM,SERUM-PLASMA OR WB $96.23 84132

PPD-TB SKIN TEST $61.73 86580

PREALBUMIN $200.21 84134

PRENATAL PAN H $630.17 80055

PROCAINAMIDE*R $85.05 80190

PROCOLLAGEN 1 P1NP REF $810.00 83519

PROCTOSIGMIODOSCOPY,RIGID;WITH CONTROL OF BLEED-2ND PROCEDURE $1,050.85 45317

PROCTOSIGMOIDOSCOPY,RIGID;WITH CONTROL OF BLEEDING $2,823.78 45317

PROG&EST RC*R $907.72 84233

PROGESTERONE $269.39 84144

PROLACTIN $322.51 84146

PROSTATE SPECIFIC ANTIGEN-FREE $225.70 84154

PROTEIN C *R $295.66 85303

PROTEIN C ACTIVITY *R $295.66 85303

PROTEIN ELECTROPHORESIS $98.00 84165

PROTEIN ELP (URINE,CSF) $328.80 84166

PROTEIN S ACTIVITY *R $250.00 85306

PROTEIN,TOTAL EXCEPT REFRACT. $35.00 84155

PROTEIN,TOTAL,OTHER SOURCE $65.00 84157

PROTEIN,TOTAL,URINE $60.67 84156

PROTEINASE-9 AB (PAN-ANCA) *R $404.93 86021

PROTHROMBIN TIME (PT) $77.87 85610

PSA DIAGNOSTIC-TOTAL $234.19 84153

PSA SCREEN-TOTAL $234.19 84153

PSYCHIATRIC SERVICE/THERAPY $165.00 90899

PSYCHOTHERAPY FOR CRISIS 60 MIN $398.00 90839

PSYCHOTHERAPY FOR CRISIS ADDL 30 MIN $175.00 90840

PT EVAL HIGH COMPLEX 45 MIN $295.00 97163

PT EVAL LOW COMPLEX 20 MIN $136.00 97161

PT EVAL MOD COMPLEX 30 MIN $200.00 97162

PT RE-EVAL EST PLAN CARE $175.00 97164

PUCT/ASPIR BREAST CYST,EACH ADDN $1,197.02 19001

PULMONARY FUNCT TEST BY PLETHYSMOGRAPHY $311.32 94726

PULMONARY FUNCTION TEST BY GAS $511.00 94727

PULMONARY STRESS TEST $636.00 94618

PUNC/ASPIR BREAST CYST $662.49 19000

PURETONE AUDIOMETRY AIR ONLY $132.26 92552

QUANT DIFF LUNG PERF/VENT $3,052.34 78598

QUINIDINE $74.57 80194

RA TEST QUAL $136.34 86430

RAD GUIDED,PERCUT DRAINAGE,W/CATH * $1,662.20 75989

RAPID PLATLET FUNC ASSAY $276.77 85576

RECEPTOR ASSAY,NON-ENDOCRINE $159.76 84238

REM BIL CALCULI/DEBRIS W RAD/GDE $3,500.00 47544

REMOVAL DEVITALIZED TISSUE 20 CM /< $276.09 97597

REMOVAL DEVITALOZED TISSUE ADD'L 20 CM /< $276.09 97598

REMOVAL FB EYE $540.94 65205

REMOVAL FECAL IMPACTION/FOREIGN BODY UNDER ANESTHESIA $2,521.65 45915

REMOVAL OF CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION $2,739.31 65435

REMOVAL OF FOOT FOREIGN BODY $1,766.93 28190

REMOVAL OF FOOT FOREIGN BODY COMPLICATED $5,121.61 28193

REMOVAL OF FOOT FOREIGN BODY DEEP $4,931.47 28192

REMOVAL OF FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISSUE $3,533.85 27086

REMOVAL OF FOREIGN BODY SIMPLE $2,854.60 20520

REMOVAL OF SUPPORT IMPLANT $5,172.02 20680

REMOVAL TUNNELED CV CATH $2,219.21 36589

REMOVAL TUNNELED CV CATH $2,892.00 36590

REMOVE EYELID FOREIGN BODY $983.89 67938

REMOVE FOREIGN BODY FROM EYE $510.41 65210



REMOVE FOREIGN BODY FROM EYE $3,563.88 65235

REMOVE NAIL BED/FINGER TIP $3,883.63 11752

REMOVE NASAL FOREIGN BODY $337.77 30300

REMOVE PERM CANNULA/CATHETER $5,338.31 49422

REMOVE PHARYNX FOREIGN BODY $511.17 42809

REMOVE VAGINAL FOREIGN BODY $4,488.62 57415

RENAL IMAGING, MORPH W/ FLOW $2,574.53 78701

RENAL IMAGING, MORPH W/ FLOW/FUNC $2,884.84 78707

RENAL IMAGING, MORPH W/ FLOW/FUNC,* $3,930.14 78708

RENAL IMAGING, MORPH W/ FLOW/FUNC,* $2,942.63 78709

RENAL IMAGING, MORPHOLOGY $2,805.19 78700

RENAL IMAGING, MORPHOLOGY, TOPO $3,371.53 78710

RENAL PANEL $151.60 80069

RENIN $405.58 84244

REPAIR BLOOD VESSEL LESION $2,638.01 35226

REPAIR BLOOD VESSEL LESION DIRECT/NECK $5,104.66 35201

REPAIR BLOOD VESSEL LESION/UPPER EXTREMITY $4,600.53 35206

REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER $4,609.76 35207

REPAIR COMPLEX FOREHEAD CHEEK CHIN MOUTH NECK ADD<5CM $579.46 13133

REPAIR COMPLEX TRUNK 1.1-2.5 CM $1,529.86 13100

REPAIR LIP $2,145.22 40652

REPAIR LIP COMPLEX $2,498.01 40654

REPAIR LIP-VERMILLION ONLY $1,693.86 40650

REPAIR MOUTH LACERATION 2.5 OR < $514.91 40830

REPAIR MOUTH LACERATION>2.5CM $899.23 40831

REPAIR OF FOOT TENDON PRIMARY OR SECONDARY EACH TENDON $4,206.23 28208

REPAIR OF NAIL BED $1,082.40 11760

REPAIR SUPERFICIAL WOUND >30.0CM SCALP NECK AXILLAE $596.91 12007

REPAIR SUPERFICIAL WOUND 12.6-20.0CM FACE EAR EYELID LIP $579.46 12016

REPAIR SUPERFICIAL WOUND 20.1-30.0CM SCALP NECK AXILLAE $639.51 12006

REPAIR SUPERFICIAL WOUND 7.6-12.5CM $546.44 12015

REPAIR TONGUE LACERATION 2.5CM OR < $453.11 41250

REPAIR TONGUE LACERATION>2.6CM $1,034.58 41252

REPAIR TUNNELED CV CATH W/O PORT $2,425.06 36575

REPAIR TUNNELED CV CATH W/PORT $3,490.54 36576

REPAIR WOUND 12.6-20.0 SIMPLE $588.48 12005

REPAIR WOUND 7.6-12.5CM SIMPLE $805.87 12004

REPAIR WOUND/LESION 1.1-2.5CM COMPLEX SCALP ARM LEG $829.48 13120

REPAIR WOUND/LESION 2.6-7.5CM $951.77 13132

REPAIR WOUND/LESION 2.6-7.5CM COMPLEX SCALP ARM LEG $918.10 13121

REPAIR WOUND/LESION 2.6-7.5CM COMPLEX TRUNK $1,507.19 13101

REPAIR WOUND/LESION ADD-ON 5 CM OR LESS $559.89 13102

REPAIR WOUND/LESION ADD-ON 5CM OR< COMPLEX SCALP,ARM,LEG $589.98 13122

REPAIR WOUND/LESION1.1-2.5CM COMPLEX EYELID,NOSE,EAR,LIP $987.61 13151

REPAIR WOUND/LESION1.1-2.5CM COMPLEX FOREHEAD,CHEEK,CHIN $791.78 13131

REPAIR, INTERMEDIATE, WOUNDS 12.6 CM-20.0 CM $604.78 12045

REPAIR, INTERMEDIATE, WOUNDS 20.1 CM-30.0 CM $1,235.95 12046


REPAIR, INTERMEDIATE, WOUNDS 30.0 CM $1,541.59 12037


REPAIR, INTERMEDIATE, WOUNDS OVER 30.0 CM $1,057.08 12047

REPAIR, INTERMEDIATE, WOUNDS OVER 30.0 CM $648.45 12057

REPAIR, INTMD, WOUNDS 20.1-30.0 CM $793.63 12036

REPAIR, OPEN OR PERCUT RUPTURED ACHILLES TENDON $7,911.00 27650

REPEAT CONTROL OF NOSEBLEED ANY METHOD SUBSEQUENT $494.34 30906

REPLACE DUODENOSTOMY/JEJUNOSTOMY T* $2,662.11 49451

REPLACE TUNNELED CV CATH $6,297.88 36580





REPLACEMENT OF GASTROSTOMY OR CECOSTOMY TUBE $865.93 49450

REPOSITION VENOUS CATHETER $2,425.06 36597

REPOSITION,NASO/GASTRIC TUBE $1,092.88 43761

RESET DISLOCATED JAW CLOSED TX INITIAL OR SUBSEQUENT $609.49 21480

RETICULOCYTE COUNT $69.54 85045

RETROPERITNL ABD, LTD $839.18 76775

REVIS TRANSVEN INTRAHEP PORTOSYS S* $16,366.74 37183

REVISE/RMV PN/GASTR STIMUL $7,578.72 64595

RH TITRE/COOMBS TEST, INDIRECT, TITER $215.46 86886

RHYTHM ECG 93041 $156.97 93041

ROTAVIRIS ANTIGEN $221.22 87425

ROUTINE VENIPUNCTURE $37.89 36415

RSV $262.28 87807

RUBELLA IMMUNITY SC $114.72 86762

RUBELLA TITR $114.72 86762

RUBEOLA IMMUNITY SC $56.30 86765

RUSSELL VIPER VENOM DILUTED *R $129.75 85613

SCREENING MAMMO BILAT W/WO CAD $295.00 77067

SED RATE,ERYTHROCYTE-NONAUTO $74.74 85651

SELENIUM $111.51 84255

SELF CARE ADL TRAINING 15 MIN-M59 $95.00 97535

SELF CARE MNGMENT TRAINING $95.00 97535

SEMEN ANAL SPERM DETECTION LAB $157.28 89300

SEMEN-COMPLETE $309.42 89320

SENSITIVITY MICROSCAN $281.57 87186

SENSORY INT TCHNQS 15 MIN $95.00 97533

SEROTONIN BLOOD $428.44 84260

SICKLE CELL PREP $164.83 85660

SIGMOIDOSCOPY W/BALLOON DILATION $2,698.57 45340

SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJ $1,948.77 45335

SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJ-2ND PROCEDURE $974.39 45335

SIGMOIDOSCOPY,FLEXIBLE;DIAGNOSTIC $2,011.03 45330

SIGMOIDOSCOPY,FLEXIBLE;DIAGNOSTIC-2ND PROCEDURE $600.48 45330

SIGMOIDOSCOPY,FLEXIBLE;W/REMOVAL OF TUMOR,POLYP,LESION $2,274.34 45338

SIGMOIDOSCOPY,FLEXIBLE;W/REMOVAL OF TUMOR,POLYP,LESION-2ND PROCEDURE $1,050.85 45338

SIGMOIDOSCOPY,FLEXIBLE;WITH BIOPSY,SINGLE OR MULTIPLE $2,497.03 45331

SIGMOIDOSCOPY,FLEXIBLE;WITH BIOPSY,SINGLE OR MULTIPLE-2ND PROCEDURE $600.48 45331

SIGMOIDOSCOPY,FLEXIBLE;WITH CONTROL OF BLEEDING $2,519.03 45334

SIGMOIDOSCOPY,FLEXIBLE;WITH CONTROL OF BLEEDING-2ND PROCEDURE $1,050.85 45334

SIMPLE REPAIR SUPERFICIAL WND > 30CM $247.29 12018

SIMPLE REPAIR SUPERFICIAL WOUND 20.1 CM-30.0 CM $537.51 12017

SKIN TISSUE PROCEDURE $2,777.48 17999

SLEEP STUDY UNATND W/ANALYSIS $636.75 95801

SLEEP STUDY UNATT & RESP EFFT $880.00 95806

SMALL BOWEL ENDOSCOPY BRUSH/WASH $2,955.80 44360

SMALL BOWEL ENDOSCOPY J TUBE PLACE $3,559.95 44372

SMALL INTESTINAL ENDOSCOPY $2,911.60 44366

SMALL INTESTINAL ENDOSCOPY $3,535.49 44378

SMALL INTESTINAL ENDOSCOPY-2ND PROCEDURE $1,351.09 44366

SMALL INTESTINAL ENDOSCOPY-2ND PROCEDURE $1,351.09 44378

SMALL INTESTIONAL ENDOSCOPY WITH BIOPSY-2ND PROCEDURE $1,351.09 44361

SMALL INTESTIONAL ENDOSCOPY WITH BIPOSY $2,467.99 44361

SMEAR COMPLEX STAIN REF $50.00 87209

SMEAR FOR EOSINOPHILS $284.78 89190

SMEAR,ACID FAST STAIN $50.00 87206

SMOKING COUNSELING VISIT > 10 MIN $90.07 99407

SODIUM RANDOM URINE $118.84 84300

SODIUM,SERUM-PLASMA OR WB $43.06 84295

SOFT TISSUE NECK W/O $2,600.00 70490

SPECIAL STAINS,GROUP 1,EACH $655.80 88312

SPECIAL STAINS,GROUP 2,EACH $233.57 88313

SPECIFIC GRAVITY NON-URINE $46.21 84315

SPEECH GEN DEVICE TREATMENT $209.54 92609

SPEECH LANG TX-INDIVIDUAL $230.04 92507

SPEECH LANGUAGE TX-GROUP $143.53 92508

SPEECH SOUND LANG COMPREHEN $339.54 92523

SPINAL BLOOD PATCH INJECTION $1,500.00 62273

SPINAL CANAL & CONTENTS $1,436.39 76800

SPINAL PUNCTURE,DIAGNOSTIC $927.09 62270

SPINAL PUNCTURE,LUMBAR,DIAG. $927.09 62270

SPINAL PUNCTURE,THERA,DRAINAGE OF CEREBROSPINAL FLUID $973.50 62272

SPIRO PRE & POST $690.12 94060

SPIROMETRY W/ GRAPHIC RCD (NO PROF* $460.16 94010

SPLINT APPLICATION FINGER $235.57 29130

SPLINT APPLICATION LONG ARM $248.95 29105

SPLINT APPLICATION LONG LEG $524.19 29505

SPLINT APPLICATION SHORT ARM $260.00 29125

SPLINT APPLICATION SHORT LEG $369.11 29515

SPUTUM INDUCTION $171.09 89220

STERILE WHIRLPOOL-M59 $265.25 97022

STOMACH SURGERY PROCEDURE $2,604.60 43999

STRAPPING OF ANKLE AND/OR FOOT $248.95 29540

STRAPPING OF CHEST $266.01 29200

STRAPPING OF ELBOW OR WRIST $285.24 29260

STRAPPING OF HAND OR FINGER $274.72 29280

STRAPPING OF KNEE $248.95 29530

STRAPPING OF SHOULDER $248.95 29240

STRAPPING OF TOES $264.45 29550

STREP A ASSAY W/ OPTIC $209.80 87880

STREP, PYOGENES, AB SCREEN $44.53 86403

STREPTCOCCUS TYPING $99.73 87147

STREPTOCCUS GROUP A $168.36 87430

SUBSQ PROS/ORTHO TRAINING EA 15 MIN $91.90 97763

SUGARS, SINGLE, QUAL $104.48 84376

SUTURE OF RECENT WOUND EYELID $3,977.86 67935

SWALLOWING DYSFUNCTION TREATMT $240.00 92526

SWALLOWING FCN,W/CINE &/OR VIDEO $920.42 74230

SWAN LINE INSERTION $3,563.88 93503

SYPHILIS TEST,NON-TREP,QUAL $70.00 86592

T CELLS,ABSOLUTE CD4/CD8 COUNT $380.92 86360

T CELLS,TOTAL COUNT $380.92 86359

T3 (TRIIODOTHYRONINE) $237.23 84480

T4 (THYROXINE) $164.35 84436

TACROLIMUS $120.00 80197

TB TEST CELL IMM MEASURE AG $227.00 86480

TEAT THUMB DISLOCATION W/MANIPULATION $644.47 26641

TEE-CONGENITAL W/ CONT $2,431.96 93315

TEE-CONGENITAL W/O CONTRAST $2,431.96 93315

TEMPORARY TRANSCUTANEOUS PACING $968.28 92953

TESTOSTERONE BIOAVAILABLE REF $182.00 84410

TESTOSTERONE BLOOD $221.14 84403

TESTOSTERONE BLOOD $221.14 84403

TESTOSTERONE,FREE $221.14 84402

THEOPHYLLINE (AMINOPHYLLINE) $245.72 80198

THERAPEUTIC ACTIVITIES 15 MIN-M59 $105.00 97530

THERAPEUTIC EXERCISE EA 15 MIN-M59 $105.00 97110

THORACENTESIS WITH IMAGING GUIDANCE $1,659.15 32555

THROMBIN TIME (TT) REF $35.93 85670

THROMBOLYTIC THERAPY(CORONARY) $1,144.68 92977

THYROGLOBULIN $230.82 84432

THYROID IMAGING W/BLOOD FLOW $603.66 78013

THYROID IMAGING W/BLOOD FLOW W/UPTAKE $937.17 78014

THYROID UPTAKE MEASUREMENT $458.76 78012

THYROXINE FREE $155.18 84439

TOBRAMYCIN $446.36 80200

TOXOPLASMA ANTIBODY $81.65 86777

TRACHEOTOMY TUBE CHANGE $808.70 31502

TRANS THPY ART CORO/INTRAC DAY 1 $3,162.60 37211

TRANSCATHETER BIOPSY $6,823.53 37200

TRANSCATHETER RX EMBOLIZATN $9,386.44 75894

TRANSESOPHAGEAL ECHO W/O CONT $2,062.56 93312

TRANSESPHGL ECHO W/ CONT $2,062.56 93312

TRANSFERASE ALANINE AMINO SGPT $81.36 84460

TRANSFERASE,ASPART. AMINO SGOT $116.49 84450

TRANSFERRIN $86.27 84466

TRANSGLUTAMINASE IGA *R $129.10 83516

TREAT BIG TOE FRACTURE W/O MANIPULATION $424.58 28490

TREAT BIG TOE FRACTURE WITH MANIPULATION $480.39 28495

TREAT CLAVICLE DISLOCATION CLOSED W/MANIPULATION $875.20 23545

TREAT CLAVICLE FRACTURE CLOSED $1,225.55 23505

TREAT CLAVICLE FX W/O MANIPULATION $510.41 23500

TREAT DENTAL RIDGE FRACTURE $4,664.49 21440

TREAT DISLOCATION/FRACTURE W/MANIPULATION $1,365.66 23665

TREAT ELBOW DISLOCATION W/ANE $9,017.43 24605

TREAT FINGER FRACTURE EACH CLOSED W/MANIPULATION $659.03 26742

TREAT FINGER FX EACH W/MANIPULATION $618.71 26755

TREAT FINGER FX EACH W/O MANIPULATION $538.06 26720

TREAT FOOT DISLOCATION W/O ANESTHESIA $426.34 28540

TREAT FOOT DISLOCATION W/O ANESTHESIA $1,158.38 28570

TREAT FOOT DISLOCATION W/O ANESTHESIA $301.05 28600

TREAT FRACTURE OF ULNA WITH MANIPULATION $648.03 25535

TREAT FX RADIUS/ULNA W/MANIPULATION $3,561.17 25565

TREAT FX RADIUS/ULNA W/O MANIPULATION $609.49 25560

TREAT FX W/O MANIPULATION $607.99 25600

TREAT HIP DISLOCATION W/O ANES $804.65 27250

TREAT HIP DISLOCATION W/O ANES $925.46 27265

TREAT HUMERUS FRACTURE $4,501.06 23605

TREAT HUMERUS FRACTURE CLOSED MEDIAL/LATERAL W/MAN $1,238.50 24577

TREAT HUMERUS FRACTURE CLOSED W/MANIPULATION $1,510.21 24535

TREAT HUMERUS FRACTURE W/O MAN $546.44 23620

TREAT HUMERUS FRACTURE W/WO SKELETAL TRACTION $1,238.50 24505

TREAT HUMERUS FX W/O MANIPULATION $556.95 23600

TREAT KNEECAP DISLOCATION W/O ANESTHESIA $609.49 27560

TREAT LOWER LEG FRACTURE W/WO ANES $3,744.36 27825

TREAT METACARPAL FRACTURE W/MANIPULATION EACH BONE $3,745.97 26607

TREAT METACARPAL FX W/MANIPULATION $1,148.52 26605

TREAT METACARPAL FX W/O MANIPULATION $462.37 26600

TREAT METATARSAL FRACTURE W/O MANIPULATION $551.70 28470

TREAT MIDFOOT FX EACH W/O MANIPULATION $471.38 28450

TREAT RADIUS FX W/MANIPULATION $908.23 24655

TREAT SHOULDER BLADE FX $1,158.38 23575

TREAT SHOULDER BLADE FX W/O MANI $513.41 23570

TREAT SHOULDER DISLOCATION $2,134.72 23655

TREAT THUMB FRACTURE CLOSED W/MANIPULATION $885.72 26645

TREAT TOE DISLOCATION W/O ANES $507.41 28660

TREAT TOE DISLOCATION W/O ANESTHESIA $480.08 28630

TREAT WRIST BONE FRACTURE CLOSED/ULNAR STYLOID $600.48 25650

TREAT WRIST DISLOCATION CLOSED W/MANIPULATION $925.46 25675

TREATMENT OF ANKLE FRACTURE $1,426.16 28435

TREATMENT OF ANKLE FRACTURE W/MANIPULATION $3,561.17 27818

TREATMENT OF HEEL FX W/O MANIPULATION $506.13 28400

TREATMENT OF NASAL BONE FRACTURE W/O MANIPULATION $915.04 21310

TREATMENT OF NOSE FRACTURE $4,233.22 21320

TREATMENT OF THIGH FRACTURE W/MANIPULATION $2,950.05 27503

TREATMENT OF TOE FX-W/O MANIPULATION $446.62 28510

TREATMENT,MISSED AB,ANY TRI. $4,203.39 59812

TRICHOMONAS MT 87211 $46.87 87210

TRIGLYCERIDES $100.14 84478

TRIGLYCERIDES $100.14 84478

TROPONIN,QUANTITIVE $220.00 84484

TSH $279.90 84443

TUBE THORACOSTOMY INCLUDES WATER S* $1,278.11 32551

TUBE THORACOSTOMY WITH/WITH OUT WATER SEAL $1,278.11 32551

TUMOR IMAGING SPECT $2,977.54 78803

TUMOR IMAGING, LIMITED AREA $2,977.54 78800

TUMOR IMAGING, MULT AREAS $2,588.50 78801

TUMOR IMAGING, WHOLE BODY $2,977.54 78802

TUMOR IMAGING, WHOLE BODY, 2 OR MO* $5,393.94 78804

TUMOR, IMMUNOHISTOCHEMICAL/MANUAL $81.06 88360

TUMOR, IMMUNOHISTOCHEMISTRY/COMPUTER ASSISTED TECHNOLOGY $109.44 88361

TX ELBOW CHILD W/MANIP CLSD $668.01 24640

TX FINGER FX EACH W/O MANIPULATION $423.34 26740

TX FINGER FX-W MANIPULATION $699.34 26725

TX FRACTURE OF RADIUS W/O MANIPULATION $547.94 25500

TX FX OF ULNA W/O MANIPULATION $480.39 25530

TX HAND DISLOCATION W/MANIPULATION W/O ANES $454.12 26670

TX HUMERUS FX-W MANIPULATION $653.92 24565

TX KNUCKLE DISLOCATION W/MANIPULATION W/O ANES $556.31 26700

TX OF ANKLE FX W/MANIPULATION $957.29 27788

TX OF ANKLE FX W/MANIPULATION $947.55 27810

TX OF ANKLE FX-W/O MANIPULATION $565.96 27808

TX OF CARPAL BONE FX W/MANIPULATION $950.27 25635

TX OF MISSED ABORTION COMPLETED SURGICALLY 2ND TRIMESTER $3,727.67 59821

TX OF TIBIA FX W/O MANIPULATION $669.54 27750

TX OF TOE FX W/MANIPULATION $543.91 28515

TX ULNAR FX W/MANIPULATION $1,711.38 24675

TX-PRO-DX IV PSH SAME DRG $156.99 96376

TX-PRO-DX IV PUSH NEW DRG $163.65 96375

TX-PRO-DX IV PUSH SNGL/INITIAL $209.02 96374

ULTRASOUND BREAST COMPLETE $573.71 76641

ULTRASOUND BREAST LIMITED $265.90 76642

ULTRASOUND PER 15 MIN $80.00 97035

UPPER GASTROINTESTINAL ENDOSCOPY INC ESOPHAGUS,STOMACH $3,702.94 43235

UPPER GASTROINTESTINAL ENDOSCOPY INC ESOPHAGUS,STOMACH-2ND PROCEDURE $1,521.47 43235

UPPER GASTROINTESTINAL ENDOSCOPY W FOREIGN BODY REMOVAL $7,471.85 43247

UPPER GASTROINTESTINAL ENDOSCOPY W/ INJECT SCLEROSIS-2ND PROCEDURE $1,200.97 43243

UPPER GASTROINTESTINAL ENDOSCOPY W/BALLOON DILATION-2ND PROCEDURE $1,600.00 43249

UPPER GASTROINTESTINAL ENDOSCOPY W/CONTROL OF BLEEDING $4,768.27 43255

UPPER GASTROINTESTINAL ENDOSCOPY W/CONTROL OF BLEEDING-2ND PROCEDURE $1,050.85 43255

UPPER GASTROINTESTINAL ENDOSCOPY W/DIALTION OF GASTRIC $3,432.92 43245

UPPER GASTROINTESTINAL ENDOSCOPY W/DILATION OF GASTRIC-2ND PROCEDURE $971.45 43245

UPPER GASTROINTESTINAL ENDOSCOPY W/INJECTION SCLEROSIS $2,585.27 43243

UPPER GASTROINTESTINAL ENDOSCOPY W/SUBMUCOSAL INJ $2,287.84 43236

UPPER GASTROINTESTINAL ENDOSCOPY WITH BIOPSY $3,200.00 43239

UPPER GASTROINTESTINAL ENDOSCOPY WITH BIOPSY-2ND PROCEDURE $1,600.00 43239

UPPER GASTROINTESTINAL ENDOSCOPY WITH INSERT GUIDE WIRE $3,093.26 43248

UPPER GASTROINTESTINAL ENDOSCOPY WITH SUBMUCOSAL INJ-2ND PROCEDURE $1,200.97 43236

UPPER GASTROINTESTIONAL ENDOSCOPY W/BALLOON DILATION $3,200.00 43249

UPPER GI ENDOSCOPY W/PLACEMENT OF GASTROSTOMY TUBE $4,197.16 43246

UPPER GI ENDOSCOPY W/PLACEMENT OF GASTROSTOMY TUBE-2ND PROCEDURE $1,200.97 43246

UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION $5,012.05 43250

UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION $2,287.84 43251

UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION-2ND PROCEDURE $1,200.97 43250

UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION-2ND PROCEDURE $1,200.97 43251

UPPER GI ENDOSCOPY W/TRANSENDOSCOPIC INTRALUMINAL TUBE $2,292.34 43241

UPPER GI ENDOSCOPY W/TRANSENDOSCOPIC INTRALUMINAL TUBE-2ND PROCEDURE $1,050.85 43241

UPPER GI ENDOSCOPY/LIGATION $3,136.63 43244

UPPER GI ENDOSCOPY/LIGATION-2ND PROCEDURE $1,351.09 43244

UPPR GASTROINTESTINAL ENDOSCOPY W FOREIGN BODY REMOVAL-2ND PROCEDURE $3,037.45 43247

UPPR GASTROINTESTINAL ENDOSCOPY WITH INSERT GUIDE WIRE-2ND PROCEDURE $900.73 43248

UREA NITROGEN,QUANTITIVE $107.77 84520

URETERAL EMB/OCCL W RAD/GDE $3,000.00 50705

URIC ACID $89.69 84550

URIC ACID-OTHER SOURCE $87.51 84560

URINALYSIS, AUTO, W/O SCOPE-POINT OF SERVICE $62.84 81003

URINALYSIS, NONAUTO W/SCOPE $63.22 81000

URINALYSIS,AUTO W/O MICRO-CORE LABORATORY $51.86 81003

URINE PREGNANCY TEST-COLORCOMP $276.95 81025

URINE VOL.MEASURE,TIMED COLL. $18.69 81050

US ABDOMINAL AORTA SCREEN AAA $340.12 76706

US COMPL JOINT RT W/IMAGE DOC $964.35 76881

US GUIDANCE FOR NEEDLE PLACEMENT $806.71 76942

US GUIDANCE FOR NEEDLE PLACEMENT $788.01 76946

US GUIDANCE FOR VASCULAR ACCESS $585.20 76937

US GUIDANCE INTRAOPERATIVE $1,772.55 76998

US LTD JOINT RT W/IMAGE DOC $557.00 76882

US,PELVIC (NONOBSTETRIC),REAL TIME* $942.96 76856

US,PELVIC (NONOBSTETRIC),REAL TIME* $706.53 76857

US,PREG UTER,FET & MAT,+ DETL FET * $2,194.50 76811

US,PREG UTER,FET & MAT,+ DETL FET,* $1,436.39 76812

US,PREGNANT UTERUS,LIMITED, 1/> FE* $927.69 76815

US,PREGNANT UTERUS,TRANSVAGINAL $927.69 76817

US,RETROPERIT,REAL TIME,COMPLETE $1,027.97 76770

VAGINAL DELIVERY $3,741.00 59409

VALPROIC ACID (DEPAKANE) $242.17 80164

VANCOMYCIN LEVEL $226.10 80202

VANILLYLMANDELIC ACID URINE $131.94 84585

VASC EMBOLIZE/OCCLUDE ARTERY $7,259.40 37242

VASC EMBOLIZE/OCCLUDE BLEED $7,259.40 37244

VASC EMBOLIZE/OCCLUDE ORGAN $7,259.40 37243

VASC EMBOLIZE/OCCLUDE VENOUS $7,259.40 37241

VASCULAR BIOPSY $7,008.23 75970

VASOPNEUMATIC PUMP THERAPY $117.44 97016

VEIN ACCESS CUTDOWN <1 YEAR VENIPUNCTURE $1,341.34 36420

VENOGRAM EXTREM BILAT $2,610.67 75822

VENOGRAM EXTREM UNILAT $2,152.59 75820

VENOGRAM HEPATIC W HEMODYNAMICS $8,367.85 75889

VENOGRAM INFER VENA CAVA $3,896.95 75825

VENOGRAM SUPER VENA CAVA $5,986.69 75827

VENOUS SAMPLING BY CATHETER $3,309.97 75893

VENTILATION(BIPAP)-FIRST DAY $3,100.00 94002

VENTILATION(BIPAP)-SUBSQ DAY $1,966.42 94003

VERTEBRAL FRACTURE ASSESSMENT VIA DXA $148.35 77086

VERTEBROPLASTY ADDL INJECT $6,700.00 22512

VIDEOFLUOROSCOPIC EVALUATION $500.00 92611

VIRAL CULTURE*R $480.58 87252

VISCOSITY $55.35 85810

VITAL CAPACITY $190.00 94150

VITAMIN A $213.78 84590

VITAMIN B1 THIAMINE REF $102.83 84425

VITAMIN D,25 HYDROXY $227.69 82306

VITAMIN E $77.57 84446

VLDL *R $107.73 83719

WET MOUNT FOR INFECTIOUS AGENT $46.87 87210

WHEELCHAIR MAN/PROP TRNG 15MIN-M59 $154.71 97542

WITHDRAWAL OF ARTERIAL BLOOD $176.46 36600

XR SPINE ENTIRE L/T 2/3 VW $251.73 72082

XR SPINE ENTIRE L/T 4/5 VW $479.93 72083

XR SPINE ENTIRE L/T 6/MORE VW $479.93 72084

XR SPINE ENTIRE L/T ONE VW $152.00 72081

XRAY ABDOMEN 1 VIEW $421.71 74018

XRAY ABDOMEN 2 VIEWS $433.43 74019

XRAY ABDOMEN 3/MORE VIEWS $1,082.80 74021

X-RAY ABDOMEN,COMP ACUTE SERIES $781.65 74022

X-RAY AC JTS $634.91 73050

X-RAY ANKLE 2 VW $375.00 73600

X-RAY ANKLE 3+ VW $464.08 73610

X-RAY ARM, INFANT $232.00 73092

X-RAY BILE/PANCREAS ENDOSCOPY $2,593.23 74330

X-RAY CERV SPINE 2 VW $496.47 72040



X-RAY CLAVICLE $452.63 73000

X-RAY COLON AIR CONTRAST $1,558.04 74280

X-RAY COLON CONTRAST $2,321.42 74270

X-RAY CYSTOGRAM, MIN 3 VIEW $1,428.42 74430

X-RAY ELBOW 2 VW $380.37 73070

X-RAY ELBOW 3+ VW $438.88 73080

X-RAY EXAM OF FINGER(S) $386.24 73140

X-RAY EXAM, BREAST SPECIMEN $378.31 76098

X-RAY FACIAL BONES <3 VW $677.31 70140

X-RAY FACIAL BONES 3+ VW $677.31 70150

XRAY FEMUR 1 VW $152.00 73551

XRAY FEMUR 2+ VW $152.00 73552

X-RAY FISTULA,ABSCESS,SINUS TRACT $2,258.84 76080

X-RAY FOOT 2 VW $320.00 73620

X-RAY FOOT 3+ VW $370.00 73630

X-RAY FOREARM 2 VW $421.08 73090

X-RAY GUIDE ENTEROCLYSIS TUBE $651.86 74355

X-RAY HAND 2 VW $325.00 73120

X-RAY HAND 3+ VW $350.00 73130

X-RAY HEEL $493.40 73650

XRAY HIP BIL W/WO PELVIS 2 VW $251.73 73521

XRAY HIP BIL W/WO PELVIS 3-4 VW $251.73 73522

XRAY HIP BIL W/WO PELVIS 5+ VW $479.93 73523

XRAY HIP UNI W/WO PELVIS 1 VW $152.00 73501

XRAY HIP UNI W/WO PELVIS 2-3 VW $152.00 73502

XRAY HIP UNI W/WO PELVIS 4+ VW $251.73 73503

X-RAY HUMERUS $458.74 73060

X-RAY HYSTEROSALPINGOGRAM $2,142.63 74740

X-RAY JAW <4 VW $748.63 70100

X-RAY JAW 4+ VW $1,653.10 70110

X-RAY KNEE 1 OR 2 VIEW $403.80 73560

X-RAY KNEE 3 VIEW $412.94 73562

X-RAY KNEE 4+ VIEW $491.98 73564

X-RAY KNEE BILAT STANDING $396.38 73565

X-RAY LEG, INFANT $298.00 73592

X-RAY LUMBAR SPINE 2/3 VW $466.49 72100

X-RAY LUMBAR SPINE 4 VW $715.59 72110

X-RAY LUMBAR SPINE 6+ VW $1,050.96 72114

X-RAY LUMBAR SPINE FLEX/EXTEN $797.73 72120

X-RAY MIDDLE EAR $1,358.59 70134

X-RAY NASAL BONES $546.06 70160

X-RAY NECK SOFT TISSUE $431.34 70360

X-RAY OPER CHOLANGIO ADDNL SET $238.89 74301

X-RAY OPER CHOLANGIOGRAM $1,857.58 74300

X-RAY OPTIC FORAMEN $777.81 70190

X-RAY ORBITS $1,499.99 70200

X-RAY PELVIS 1/2 VW $416.02 72170

X-RAY PELVIS 3+ VW $633.25 72190

X-RAY RETROGRADE PYELOGRAM $2,192.52 74420

X-RAY RIBS 2 VW UNILAT $431.61 71100

X-RAY RIBS, CHEST 3+ VW $426.41 71101

X-RAY RIBS, CHEST 4+ VW $921.47 71111

X-RAY SACROILIAC JTS 3+ VW $573.35 72202

X-RAY SACRUM/COCCYX 2+ VW $555.14 72220

X-RAY SCAPULA $620.87 73010

X-RAY SHOULDER 1 VW $494.26 73020

X-RAY SHOULDER 2+ VW $460.34 73030

X-RAY SIALOGRAM $818.00 70390

X-RAY SINUSES <3 VW $564.43 70210

X-RAY SINUSES 3+ VW $728.06 70220

X-RAY SKULL <4 VW $620.87 70250

X-RAY SKULL 4+ VW $939.95 70260

X-RAY SMALL BOWEL ENTEROCLYSIS $2,134.63 74251

X-RAY SPINE ONE VIEW $574.79 72020

X-RAY STERNO-CLAVICLUAR JT $685.79 71130

X-RAY STERNUM 2+ VW $620.87 71120

X-RAY THORACIC SPINE 2 VW $521.65 72070

X-RAY THORACIC SPINE 4 VW $1,004.99 72074

X-RAY THORACIC SPINE+SWIM 3 VW $453.83 72072

X-RAY THOR-LUMB SP 2 VW $620.69 72080

X-RAY TIB + FIB, 2VW $522.80 73590

X-RAY TMJ BILAT $564.43 70330

X-RAY TOE(S) $421.94 73660

XRAY UPPER GI AIR CONTRAST+KUB $939.40 74247

XRAY UPPER GI TRACT + KUB $1,677.02 74241

XRAY UPPER GI TRACT,W/SMALL INTEST* $2,777.76 74245

X-RAY URETHROCYSTOGRAM $1,469.05 74450

X-RAY URETHROCYSTOGRAM+VOIDING S&I $2,197.10 74455

X-RAY WRIST 2 VW $350.00 73100

X-RAY WRIST 3+ VW $375.00 73110

X-RAY,SMALL BOWEL,W/MULT SERIAL FI* $1,055.90 74250

X-RAY,UPPER GI TRACT W/CONT,SMALL * $1,718.14 74249

X-RAYS FOR BONE AGE $516.94 77072

X-RAYS, BONE LENGTH STUDIES $564.43 77073

X-RAYS, BONE SURVEY COMPLETE $1,757.84 77075

X-RAYS, BONE SURVEY, INFANT $1,426.64 77076

ZINC PROTOPORPHYRINS $98.50 84202

ZINC SERUM $80.00 84630

3D RENDER W/O IMAGE POSTPROCESS … SOURCE HEPATITIS B AB $115.35 86706 BBP SOURCE HEPATITIS C AB...

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Transcript of 3D RENDER W/O IMAGE POSTPROCESS … SOURCE HEPATITIS B AB $115.35 86706 BBP SOURCE HEPATITIS C AB...