Salem Health Prices

Number of proceedures: 4,285

Salem Health Outpatient Imaging

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3D RENDERING NOT REQUIRING WORKSTATIO
0350
76376
$721.00
ABLATION,RENAL TUMOR,PERC,UNILAT,CRYOTHERAPY
0360
50593
$6,464.00
ACT NEEDLE 18X11
0270
$129.00
ACT NEEDLE 18X15
0270
$133.00
ACT NEEDLE 18X20
0272
$146.00
ACT NEEDLE 20X11
0272
$141.00
ACT NEEDLE 20X15
0272
$155.00
ACT NEEDLE 20X20
0272
$166.00
AMNIOCENTESIS-DIAGNOSTIC
0360
59000
$684.00
ANGIOGRAPHY EXTREMITY UNILATERAL
0320
75710
$6,294.00
ARTHRO ASP/INJ INTERMED JT/BURSA W/O US GUID
0360
20605
$751.00
ARTHRO ASP/INJ INTERMED JT/BURSA W/US GUID W/PERM RECORD&REPORT
0360
20606
$890.00
ARTHRO ASP/INJ MAJOR JT/BURSA W/O US GUID
0360
20610
$703.00
ARTHRO ASP/INJ MAJOR JT/BURSA W/US GUID W/PERM RECORD&REPORT
0360
20611
$979.00
ARTHRO ASP/INJ SM JT/BURSA W/O US GUID
0360
20600
$586.00
ARTHRO ASP/INJ SM JT/BURSA W/US GUID W/PERM RECORD&REPORT
0360
20604
$603.00
ASPIRATION BLADDER W/INSERT OF SUPERA
0360
51102
$3,101.00
BIOPSY ABDOMINAL/RETROPERITONEAL,PERCUTANEOUS NEEDLE
0360
49180
$1,131.00
BIOPSY BONE TROCAR OR NEEDLE DEEP
0360
20225
$1,246.00
BIOPSY BONE TROCAR OR NEEDLE SUPERFICIAL
0360
20220
$2,207.00
BIOPSY MUSCLE PERCUTANEOUS NEEDLE
0360
20206
$760.00
BIOPSY OR EXCISION LYMPH NODE BY NEEDLE-SUPERFICIAL
0360
38505
$760.00
BIOPSY PLEURA PERCUT NEEDLE
0360
32400
$839.00
BONE AGE STUDY
0320
77072
$283.00
BONE DENSITY STUDY, AXIAL
0320
77080
$339.00
BONE LENGTH STUDY
0352
77073
$186.00
BONE MARROW SCAN W/B - NM
0341
78104
$863.00
BONE SCAN MULT VIEW W/FLOW-NM
0341
78315
$863.00
BONE SCAN MULTI VIEW-NM
0341
78305
$863.00
BONE SCAN WHOLE BODY-NM
0341
78306
$863.00
BREAST CORE NEEDLE (420582)
0272
$158.00
BREAST NEEDLE LOC (404322,404320,404319)
0272
$71.00
BX BREAST 1ST LESION MR IMAGING
0360
19085
$2,098.00
BX BREAST 1ST LESION STRTCTC
0360
19081
$2,098.00
BX BREAST 1ST LESION US IMAGING
0360
19083
$2,098.00
BX BREAST ADD LESION STRTCTC
0360
19082
$2,098.00
BX BREAST ADD LESION US IMAGING
0360
19084
$2,098.00
BX NEEDLE, CATH, OR SUPPLIES
0270
Variable
BX PANCREAS PERCUT NEEDLE
0360
48102
$1,519.00
CATH/INTRO SALINE OR CONTRAST
0360
58340
$163.00
CATHETER, DRAINAGE, PLEURA (9120)
0272
C1729
$1,547.00
CATHETER, SKATER PIGTAIL (435731)
0272
$284.00
CATHETER, SUPRAPUBIC/CYSTOSCOPY
0272
C2627
Variable
CHEMOTHERAPY ADMINISTRATION CNS/INTRATHECAL
0331
96450
$997.00
CHNG PRCUT DRAIN CATH W/CNTST
0320
75984
$355.00
CHOLANGIOGRAPHY SURGICAL
0320
74300
$198.00
CHOLANGIOGRAPHY SURGICAL ADDITIONAL VIEWS
0320
74301
$153.00
CISTERNOGRAPHY-NM
0341
78630
$1,118.00
CSF SHUNT PATENCY-NM
0341
78645
$1,118.00
CT ABD AND PELVIS W/CONTRAST
0350
74177
$991.00
CT ABD AND PELVIS W/O AND W/CONTRAST
0350
74178
$1,090.00
CT ABD AND PELVIS W/O CONTRAST (OR OR
0350
74176
$828.00
CT ABDO/RETROPERITONEAL BIOPSY
0360
49180
$1,131.00
CT ABDOMEN W/CONTRAST
0350
74160
$991.00
CT ABDOMEN W/O AND W/CONTRAST
0350
74170
$1,090.00
CT ABDOMEN W/O CONTRAST
0350
74150
$408.00
CT ANGIO ABD AND PELVIS W/CON,INCLUDING NON CONTRT
0352
74174
$953.00
CT ANGIO ABDOMEN W/CONTRAST
0352
74175
$953.00
CT ANGIO ABDOMEN W/RUNOFFS
0350
75635
$1,182.00
CT ANGIO CHEST W/CONTRAST
0352
71275
$953.00
CT ANGIO HEAD W/CONTRAST
0350
70496
$953.00
CT ANGIO HEART AND COR BYPASS (WHEN P
0350
75574
$953.00
CT ANGIO LOWER EXTREMITY W/CONTRAST
0350
73706
$953.00
CT ANGIO NECK W/CONTRAST
0350
70498
$953.00
CT ANGIO PELVIS W/CONTRAST
0352
72191
$953.00
CT ANGIO UPPER EXTREMITY W/O AND W/CO
0350
73206
$953.00
CT CERVICAL SPINE W/CONTRAST
0350
72126
$1,790.00
CT CERVICAL SPINE W/O AND W/CONTRAST
0350
72127
$1,686.00
CT CERVICAL SPINE W/O CONTRAST
0350
72125
$408.00
CT CHEST W/CONTRAST
0350
71260
$991.00
CT CHEST W/O AND W/CONTRAST
0350
71270
$1,090.00
CT CHEST W/O CONTRAST
0350
71250
$433.00
CT COLONOGRAPHY-DIAGNOSTIC
0350
74261
$408.00
CT COLONOGRAPHY-SCREENING
0350
74263
$1,241.00
CT GUIDANCE AND MONITORING FOR ABLATION,PARENCHYMAL TISSUE
0350
77013
$956.00
CT GUIDANCE FOR NEEDLE PLACEMENT
0350
77012
$750.00
CT HEAD OR BRAIN W/CONTRAST
0351
70460
$991.00
CT HEAD OR BRAIN W/O AND W/CONTRAST
0351
70470
$1,090.00
CT HEAD OR BRAIN W/O CONTRAST
0351
70450
$408.00
CT HEART STRUCTURE W/CONTRAST
0350
75572
$953.00
CT INJ,N BLOCK,CELIAC PLEXUS W/O OR W/RX MONITORING
0360
64530
$1,913.00
CT LIMITED F/U
0350
76380
$222.00
CT LOWER EXTREMITY W/CONTRAST
0350
73701
$991.00
CT LOWER EXTREMITY W/O AND W/CONTRST
0350
73702
$1,090.00
CT LOWER EXTREMITY W/O CONTRAST
0350
73700
$408.00
CT LUMBAR SPINE W-W/O CONTRAST
0350
72133
$1,686.00
CT LUMBAR SPINE W/CONTRAST
0350
72132
$1,790.00
CT LUMBAR SPINE W/O CONTRAST
0350
72131
$408.00
CT MAXILLOFACIAL W/CONTRAST
0350
70487
$991.00
CT MAXILLOFACIAL W/O AND W/CONTRAST
0350
70488
$1,090.00
CT MAXILLOFACIAL W/O CONTRAST
0350
70486
$408.00
CT NECK W/CONTRAST
0350
70491
$991.00
CT NECK W/O AND W/CONTRAST
0350
70492
$1,090.00
CT NECK W/O CONTRAST
0350
70490
$408.00
CT ORBIT OR SELLA W/CONTRAST
0350
70481
$991.00
CT ORBIT OR SELLA W/O AND W/CONTRAST
0350
70482
$1,090.00
CT ORBIT OR SELLA W/O CONTRAST
0350
70480
$408.00
CT PELVIS W/CONTRAST
0350
72193
$991.00
CT PELVIS W/O AND W/CONTRAST
0350
72194
$1,090.00
CT PELVIS W/O CONTRAST
0350
72192
$408.00
CT RENAL BIOPSY PERCUT
0360
50200
$888.00
CT THORACENTESIS FOR ASPIRATION W/IMAGING
0360
32555
$1,265.00
CT THORACIC SPINE W/CONTRAST
0350
72129
$991.00
CT THORACIC SPINE W/O CONTRAST
0350
72128
$408.00
CT UPPER EXTREMITY W/CONTRAST
0350
73201
$991.00
CT UPPER EXTREMITY W/O AND W/CONTRAST
0350
73202
$2,470.00
CT UPPER EXTREMITY W/O CONTRAST
0350
73200
$408.00
CYSTOGRAM
0320
74430
$486.00
CYSTOGRAM-VOIDING-DW
0320
74455
$574.00
DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
0360
38222
$3,639.00
DIAGNOSTIC BONE MARROW; BIOPSY(IES)
0360
38221
$1,563.00
DRAIN CHEST ATRIUM #3600 (6878)
0270
$95.00
DRAIN, 8FR FLEXI-FIRM PIGTAIL
0272
$237.00
DUPLEX SCAN ABDOMINAL,PELVIC,SCROTAL,RETROPERIONEAL-LIMITED STUD
0921
93976
$1,016.00
DUPLEX SCAN EXTRACRANIAL ARTERIES-COMPLETE BILATERAL STUDY
0921
93880
$735.00
DUPLEX SCAN EXTRACRANIAL ARTERIES-UNILATERAL OR LIMITED STUDY
0921
93882
$503.00
EACH ADDITIONAL CYST
0360
19001
$154.00
ECT BONE SCAN
0341
78320
$1,118.00
ECT BRAIN SCAN
0341
78607
$2,968.00
ERCP-DW
0320
74330
$493.00
ESOPHAGUS-DW
0320
74220
$351.00
EXCHANGE BILIARY DRAIN CATH W/IMG GID RS&I
0360
47536
$4,259.00
EXCHANGE DRAINAGE CATH
0360
49423
$3,344.00
EXT VENOUS DUPLEX BILATERAL UE/LE
0921
93970
$754.00
EXT VENOUS DUPLEX UNILATERAL UE/LE
0921
93971
$533.00
FINE NEEDLE ASPIRATION W/IMAGING GUIDANCE
0360
10022
$1,101.00
FLUORO CVC PLACE REPLAC REM
0320
77001
$278.00
FLUORO GUIDE NEEDLE PLCMNT
0320
77002
$423.00
FLUORO NEEDLE GUIDE, SPINAL
0320
77003
$348.00
FLUOROSCOPY UP TO 1 HOUR
0320
76000
$416.00
GALL BLADDER TUBE PLCMENT
0360
47490
$4,605.00
GASTRIC EMPTYING-NM
0341
78264
$863.00
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT W/FLOUROSCOPY
0320
49452
$1,690.00
GATED CARDIAC SCAN-NM
0341
78472
$863.00
GI BLOOD LOSS SCAN-NM
0341
78278
$863.00
GUIDANCE PERCUTANEOUS DRAIN W/CATH
0320
75989
$379.00
GUIDANCE PERCUTANEOUS DRAINAGE W/PLACEMENT OF CATHETER
0350
75989
$379.00
GUIDEWIRE
0272
C1769
Variable
HAWKINS-AKINS 18G NEEDLE
0272
$105.00
HCHRG FINE NEEDLE ASPIRATION W/IMAGING GUIDANCE
0360
10022
$1,101.00
HPYORI DRUG ADMINISTRATION
0300
83014
$32.00
HYSTEROSALPINGOGRAM-DW
0320
74740
$574.00
IDENTIFICATION SENTINEL NODE
0360
38792
$863.00
IMAGE GUIDE FLUID COLLECT CATH,PE/RETROPE/PERQ
0360
49406
$3,274.00
IMAGE GUIDE FLUID COLLECT CATH,SOFT TISSUE,PERQ
0360
10030
$2,832.00
IMAGE GUIDE FLUID COLLECT CATH,VISCERAL,PERQ
0360
49405
$2,866.00
INCISION AND DRAINAGE HEMATOMA SEROMA OR FLUID COLLECTION
0360
10140
$2,467.00
INCISION AND DRAINAGE PELVIS OR HIP-DEEP
0360
26990
$2,385.00
INCISION AND DRAINAGE-SIMPLE OR SINGLE
0360
10060
$308.00
INFECTION - LIMITED SCAN
0341
78805
$2,968.00
INFECTION - WHOLE BODY SCAN
0341
78806
$2,968.00
INJ ANTEGRDE NFROSGRM AND/OR URTRGRM IMG GUIDE RS&I; NEW ACCESS
0360
50430
$1,298.00
INJ ANTEGRDE NFROSGRM AND/OR URTRGRM IMGGUIDE RS&I; EXISTING
0360
50431
$1,298.00
INJ CHOLANGIO W/IMG INCLUDE IMG GUIDANCE RS&I; EXSISTING ACCESS
0360
47531
$871.00
INJ KNEE ARTHROGRAPHY
0360
27370
$203.00
INJ LUMB/SAC DX/TX SUBST INCL NEEDL OR CATH W/GUID
0350
62323
$1,328.00
INJ, INTERCOSTAL NERVES-MULTIPLE
0360
64421
$1,746.00
INJECT,EVAL EXIST GASTRO OR G/J TUBE
0360
49465
$513.00
INJECTION FOR EVAL OF EXISTING CENTRAL VENOUS ACCESS DEVICE
0360
36598
$490.00
INJECTION PROCEDURE LOOP O GRAM
0320
50690
$111.00
INJECTION PROCEDURE SACROILIAC JOINT ARTHROGRAPHY AND/OR ANESTHE
0360
27096
$551.00
INJECTION PROCEDURE-CYSTOGRAM
0320
51600
$140.00
INJECTION PROCEDURE-ELBOW ARTHROGRAM
0360
24220
$168.00
INJECTION PROCEDURE-HIP ARTHROGRAM
0360
27093
$358.00
INJECTION PROCEDURE-SHOULDER ARTHROGRAM
0360
23350
$682.00
INJECTION PROCEDURE-URETHROCYSTOGRAPHY
0360
51610
$175.00
INJECTION PROCEDURE-WRIST ARTHROGRAM
0360
25246
$251.00
INJECTION SINUS TRACT DIAGNOSTIC
0360
20501
$150.00
INJECTION SQ OR IM TX,DX,PROPH
0761
96372
$123.00
INSERT NON-TUN CV CATH,5YR OR OLDER
0360
36556
$2,711.00
JEJUNOSTOMY OR DUODENOSTOMY TUBE CHAN
0360
49451
$1,444.00
JOINT SURVEY 1 VIEW 2+ JOINTS
0320
77077
$283.00
LIVER BIOPSY PERCUT - US
0360
47000
$2,164.00
LIVER BIOPSY PERCUTANEOUS - CT
0360
47000
$2,164.00
LOOP O GRAM-DW
0320
74425
$666.00
LOW DOSE CT SCAN FOR LUNG CANCER SCREENING
0350
G0297
$275.00
LOWER GI COLON-DW
0320
74270
$351.00
LOWER GI/COLON W/AIR CONT-DW
0320
74280
$351.00
LUMBAR PUNCTURE THERAPEUTIC DRAINAGE
0360
62272
$1,293.00
LUNG BIOPSY-ANG
0360
32405
$839.00
LUNG SCAN (PERFUSION) - NM
0341
78580
$863.00
LYMPHOSCINTIGRAPHY
0341
78195
$1,118.00
MAMM-BREAST WIRE
0272
$68.00
MAMM-VACUUM CANISTER
0270
$71.00
MAMMOGRAPHY DIAGNOSTIC CAD BILATERAL
0401
77066
$291.00
MAMMOGRAPHY DIAGNOSTIC CAD UNILATERAL
0401
77065
$228.00
MAMMOGRAPHY SCREENING 2 VIEW CAD BILATERAL
0403
77067
$241.00
MAMMOGRAPHY-DIAGNOSTIC DIGITAL IMAGE BILATERAL
0401
G0204
$360.00
MAMMOGRAPHY-DIAGNOSTIC DIGITAL IMAGE UNILATERAL
0401
G0206
$281.00
MINI TRAY AND SET UP
0270
Variable
MINI TRAY AND SET UP-CT
0270
Variable
MODERATE SEDATION AGE 0-4 INITIAL 15MIN
0370
99151
$230.00
MODERATE SEDATION AGE 5+ 1ST 15MIN
0370
99152
$154.00
MODERATE SEDATION EACH ADDL 15MIN
0370
99153
$135.00
MRA ABDOMEN W/CONTRAST
0618
C8900
$991.00
MRA BRAIN W/3D RENDERING
0615
70544
$938.00
MRA BRAIN W/CONTRAST
0610
70545
$1,354.00
MRA BRAIN W/O AND W/CONTRAST
0615
70546
$1,861.00
MRA BRAIN W/O CONTRAST
0615
70544
$938.00
MRA CHEST W/CONTRAST
0618
C8909
$991.00
MRA LOWER EXTREMITY W/O CONTRAST
0610
C8913
$828.00
MRA NECK W/O AND W/CONTRAST
0615
70549
$1,703.00
MRA NECK W/O CONTRAST
0615
70547
$828.00
MRA-ABDOMEN W/3D REND
0610
C8900
$991.00
MRI ABDOMEN W/CONTRAST
0610
74182
$1,790.00
MRI ABDOMEN W/O AND W/CONTRAST
0610
74183
$1,969.00
MRI ABDOMEN W/O CONTRAST
0610
74181
$1,023.00
MRI BRAIN W/CONTRAST
0611
70552
$1,533.00
MRI BRAIN W/O AND W/CONTRAST
0611
70553
$1,969.00
MRI BRAIN W/O CONTRAST
0611
70551
$1,293.00
MRI BREAST BILAT W/O AND W/CONTRAST
0610
C8908
$1,969.00
MRI BREAST BILATERAL W/O CONTRAST
0610
C8907
$1,617.00
MRI BREAST UNILAT W/O AND W/CONTRAST
0610
C8905
$1,916.00
MRI CERVICAL SPINE W/CONTRAST
0612
72142
$1,790.00
MRI CERVICAL SPINE W/O AND W/CONTRAST
0612
72156
$2,059.00
MRI CERVICAL SPINE W/O CONTRAST
0612
72141
$1,010.00
MRI CHEST/HILUM/MED W/O AND W/CONTRAS
0610
71552
$1,969.00
MRI CHEST/HILUM/MED W/O CONTRAST
0610
71550
$828.00
MRI JOINT LOWER EXTREMITY W/CONTRAST
0610
73722
$2,674.00
MRI JOINT LOWER EXTREMITY W/O AND W/C
0610
73723
$2,598.00
MRI JOINT LOWER EXTREMITY W/O CONTRAS
0610
73721
$1,243.00
MRI JOINT UPPER EXTREMITY W/CONTRAST
0610
73222
$2,674.00
MRI JOINT UPPER EXTREMITY W/O AND W/C
0610
73223
$2,598.00
MRI JOINT UPPER EXTREMITY W/O CONTRAS
0610
73221
$1,132.00
MRI LOWER EXTREMITY W/O AND W/CONTRAS
0610
73720
$1,310.00
MRI LOWER EXTREMITY W/O CONTRAST
0610
73718
$1,205.00
MRI LUMBAR SPINE W/CONTRAST
0612
72149
$1,790.00
MRI LUMBAR SPINE W/O AND W/CONTRAST
0612
72158
$1,969.00
MRI LUMBAR SPINE W/O CONTRAST
0612
72148
$1,030.00
MRI ORBIT/FACE/NECK W/CONTRAST
0610
70542
$1,790.00
MRI ORBIT/FACE/NECK W/O AND W/CONTRAS
0610
70543
$1,969.00
MRI ORBIT/FACE/NECK W/O CONTRAST
0610
70540
$828.00
MRI PELVIS W/O AND W/CONTRAST
0610
72197
$1,916.00
MRI PELVIS W/O CONTRAST
0610
72195
$1,037.00
MRI TEMPOROMANDIBULAR JOINTS
0610
70336
$828.00
MRI THORACIC SPINE W/CONTRAST
0612
72147
$1,790.00
MRI THORACIC SPINE W/O AND W/CONTRAST
0612
72157
$1,969.00
MRI THORACIC SPINE W/O CONTRAST
0612
72146
$1,075.00
MRI UPPER EXTREMITY W AND W/O CONTRAS
0610
73220
$1,969.00
MRI UPPER EXTREMITY W/O CONTRAST
0610
73218
$1,433.00
MYELOGRAM/ARTHROGRAM TRAY-DW
0270
Variable
MYELOGRAPHY LUMBAR INJ RS&I 2+ REGIONS
0320
62305
$1,786.00
MYELOGRAPHY LUMBAR INJ RS&I CERVICAL
0320
62302
$1,786.00
MYELOGRAPHY LUMBAR INJ RS&I LUMBOSACRAL
0320
62304
$1,786.00
MYELOGRAPHY LUMBAR INJ RS&I THORACIC
0320
62303
$1,786.00
MYOCARDIAL PERFUSION IMAGING-MULTIPLE STUDIES
0341
78452
$2,968.00
MYOCARDIAL PERFUSION IMAGING-SINGLE STUDY
0341
78451
$2,968.00
NASO-ORO GASTRIC TUBE PLACEMENT
0360
43752
$744.00
NEEDLE, 21 GAUGE ACCUSTICK
0272
$190.00
NEPHROSTOMY,TUBE REM USING FLUORO
0360
50389
$2,019.00
NM BRAIN IMAGE W/FLOW 4 OR MORE VIEWS
0341
78606
$1,118.00
NM HEPATOBILIARY SYSTEM W/MEDICATION
0341
78227
$1,118.00
NM HEPATOBILIARY SYSTEM W/O MEDICATION
0341
78226
$863.00
NM INTRA-ARTERL PART TREATMENT
0342
79445
$448.00
NM IV TREATMENT
0342
79101
$448.00
NM MECKELS IMAGING
0341
78290
$863.00
NM PARATHYROID PLANAR IMAGING W/SPECT
0341
78071
$863.00
NM PARATHYROID PLANAR IMAGING W/SPECT AND CONCUR T
0341
78072
$1,118.00
NM PARATHYROID PLANAR ONLY IMAGING
0341
78070
$863.00
NM PULMONARY VENT AEROSOL OR GAS
0341
78579
$516.00
NM PULMONARY VENT/PERFUSION AEROSOL OR GAS
0341
78582
$1,118.00
NM QUANTITATIVE PULMONARY VENT/PERFUSION AEROSOL O
0341
78598
$1,118.00
NM THRYOID IMAGING W/UPTAKE-SINGLE OR MULTIPLE
0341
78014
$863.00
NM THYROID CARCINOMA IMAGING-WHOLE BO
0341
78018
$1,118.00
NM THYROID CARCINOMA UPTAKE
0341
78020
$171.00
NON INVASIVE OVERNIGHT OXIMETER
0460
94762
$265.00
ORTHO SUPPLY-
0274
Variable
ORTHOPANTOGRAM
0320
70355
$154.00
PANCREAS BIOPSY, PERC - CT
0360
48102
$1,519.00
PARACENTESIS
0360
49083
$1,098.00
PERCUTANEOUS DRAINAGE W/CATHETER AND FLUOROSCOPY
0320
75989
$379.00
PERQ DEVICE BREAST 1ST IMAGE
0360
19281
$2,883.00
PERQ DEVICE BREAST 1ST MR GUID
0360
19287
$2,883.00
PERQ DEVICE BREAST 1ST US IMAGING
0360
19285
$2,883.00
PERQ DEVICE BREAST ADD LESION US IMAGING
0360
19286
$2,883.00
PERQ EXCHANGE NEPHROSTOMY CATH INCLUDE IMG GUIDE RS&I
0360
50435
$3,941.00
PERQ PLMT BILIARY DRAIN CATH W/IMG GID RS&I EXTERNAL
0360
47533
$8,910.00
PERQ PLMT BILIARY DRAIN CATH W/IMG GID RS&I INTERNAL-EXTERNAL
0360
47534
$5,135.00
PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE
0360
10035
$1,820.00
PET - BRAIN METABOLISM
0404
78608
$3,616.00
PET-MYOCARDIAL METABOLIC
0404
78459
$2,968.00
PET-TUMOR SKULL-THIGH W/CT AC
0404
78815
$4,909.00
PET-TUMOR W/B W/CT AC
0404
78816
$4,909.00
PHARYNX-SPEECH PATHOLOGY-DW
0320
74230
$283.00
PLEURX CATHETER INSERTION
0360
32550
$3,185.00
PROBE, CRYOABLATION
0279
C2618
Variable
PUNCTURE ASPIRATION OF ABSCESS,HEMATOMA,BULLA,CYST
0360
10160
$598.00
PUNCTURE ASPIRTN CYST(BREAST)
0360
19000
$446.00
PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PROCEDURE
0360
61070
$1,265.00
RADIO PHARMA I-131 TX
0344
A9517
$28.00
RADIO:TC-99M EXAMETAZIME LBLD AUTOL WBC
0343
A9569
$2,387.00
RADIOLOGIC EXAM ABDOMEN 1 VIEW
0320
74018
$210.00
RADIOLOGIC EXAM ABDOMEN 2 VIEWS
0320
74019
$401.00
RADIOLOGIC EXAM CHEST 2 VIEWS
0320
71046
$200.00
RADIOLOGIC EXAM CHEST 3 VIEWS
0320
71047
$200.00
RADIOLOGIC EXAM CHEST 4+ VIEWS
0320
71048
$401.00
RADIOLOGIC EXAM CHEST SINGLE VIEW
0320
71045
$210.00
RADIOLOGICAL EXAM SURGICAL SPECIMEN
0400
76098
$1,201.00
RADIOPH: EXAMETAZINE/DOSE
0343
A9521
Variable
RADIOPH: INDIUM IN-111 PENTETREOTIDE
0343
A9572
$4,227.00
RADIOPH: MEDRONATE/DOSE
0343
A9503
$49.00
RADIOPH:GA-67/MCI
0343
A9556
$118.00
RADIOPH:I-123 DX/PER 100 UCI
0343
A9516
$168.00
RADIOPH:I-131 DX CAP/MCI
0343
A9528
$28.00
RADIOPH:IN-111 DTPA/0.5MCI
0343
A9548
$2,482.00
RADIOPH:MAA/UNIT DOSE
0343
A9540
$289.00
RADIOPH:MAA/VIAL
0343
A9540
$1,151.00
RADIOPH:MEBROFENIN/DOSE
0343
A9537
$70.00
RADIOPH:MERTIATIDE/DOSE
0343
A9562
$732.00
RADIOPH:MIBG/I-123
0343
A9582
$4,079.00
RADIOPH:RADIUM RA 223 DICHLORIDE,TX,PER MICROCURIE
0344
A9606
Variable
RADIOPH:RBC TAG/DOSE
0343
A9560
$222.00
RADIOPH:S COLLOID FILTERED TC99M-LYMPHO
0343
A9541
$473.00
RADIOPH:S COLLOID TC99M-DOSE
0343
A9541
$165.00
RADIOPH:S COLLOID TC99M-LYMPHO
0343
A9541
$543.00
RADIOPH:SESTAMIBI/DOSE
0343
A9500
$75.00
RADIOPH:XE-133/10 MCI
0343
A9558
$112.00
RADIOPHARM PROVIDED DURING HOSP INPT STAY
0342
C9898
$1.00
RADIOPHARM THERAPY ORAL ADMIN
0342
79005
$756.00
RADIOPHARM: FDG-18
0343
A9552
$611.00
RADIOPHARM: I-123 DATSCAN (PER DOSE UP TO 5MCI)
0343
A9584
$3,037.00
RADIOPHARM: TC-99M/MCI
0343
A9512
$2.00
REM OF TUNNELED PLEURAL CATH W/CUFF
0360
32552
$526.00
REMOVE/REPLACE EXT ACCESIBLE NEPHROURETERAL CATH/STENT
0360
50387
$3,799.00
RENAL FLOW FUNCTION
0341
78707
$1,118.00
RENAL FUNCTION W/MEDS-NM
0341
78708
$1,118.00
RF ABLATION-LIVER PERCUT
0360
47382
$9,445.00
SMALL BOWEL STUDY-DW
0320
74250
$283.00
SPINAL PUNCTURE LUMBAR DIAGNOSTIC
0360
62270
$1,167.00
STCB PROBE
0272
A4649
$859.00
STRESS TEST TRACING
0482
93017
$490.00
TISSUE MARKER-IMPLANTABLE
0278
A4648
$265.00
TISSUE MARKER/CLIP-IMPLANTABLE
0278
A4648
$265.00
TRAY THOROCENTESIS
0270
Variable
TUBE THORACOSTOMY-OPEN
0360
32551
$1,265.00
TUMOR LOC ECT
0341
78803
$1,118.00
TUMOR LOC LIMITED AREA
0341
78800
$720.00
TUMOR LOC WB - 1 DAY
0341
78802
$2,968.00
TUMOR LOC WB - MULT DAYS
0341
78804
$2,968.00
ULTRASOUND TRANSRECTAL
0402
76872
$425.00
UPPER GI W/AIR W/KUB-DR
0320
74247
$351.00
UPPER GI W/AIR W/O KUB-DR
0320
74246
$351.00
UPPER GI W/KUB - DR
0320
74241
$351.00
UPPER GI W/O KUB - DR
0320
74240
$351.00
UPPER GI W/SMALL BOWEL-DW
0320
74245
$574.00
URETHROCYSTOGRAM-DW
0320
74450
$574.00
URO IV W/NEPHROTOMOGRAPH-DW
0320
74415
$624.00
UROGRAPHY RETROGRADE-DW
0320
74420
$1,127.00
US ABDOMEN COMPLETE
0402
76700
$589.00
US ABDOMEN LIMITED
0402
76705
$437.00
US ABDOMINAL AORTA, RT W/IMAGE DOC, SCREENING FOR AAA
0402
76706
$425.00
US BREAST UNI REAL TIME W/IMAGE LIMITED
0402
76642
$362.00
US CHEST (INCLUDES MEDIASTINUM)
0402
76604
$336.00
US CHEST WALL BIOPSY
0360
21550
$3,819.00
US COMPLETE JOINT
0402
76881
$498.00
US FETAL MIDDLE CEREBRAL ARTERY DOPPL
0402
76821
$425.00
US FETAL UMBILICAL ARTERY DOPPLER
0402
76820
$425.00
US GUID PARENCHYMAL TISSUE ABLATION
0402
76940
$802.00
US GUIDANCE FOR AMNIOCENTESIS
0402
76946
$411.00
US GUIDANCE FOR NEEDLE PLACEMENT
0402
76942
$1,041.00
US GUIDANCE FOR VASCULAR ACCESS
0402
76937
$471.00
US GUIDANCE-INTRAOPERATIVE
0402
76998
$560.00
US HEAD/BRAIN
0402
76506
$366.00
US INFANT HIPS-DYNAMIC
0402
76885
$329.00
US LIMITED JOINT OR OTHER NONVASCULAR EXTREMITY
0402
76882
$366.00
US OBSTETRIC AFTER 14 WKS PREG-EA ADDSTER
0402
76810
$421.00
US OBSTETRIC AFTER 14 WKS PREG-SINGLE OR FIRST GESTATION
0402
76805
$624.00
US OBSTETRIC BPP W/O NON STRESS TEST
0402
76819
$425.00
US OBSTETRIC DETAILED EXAM-EA ADD GES
0402
76812
$453.00
US OBSTETRIC DETAILED EXAM-SINGLE OR FIRST GESTATION
0402
76811
$968.00
US OBSTETRIC NUCHAL TRANSLUCENCY-EA A
0402
76814
$392.00
US OBSTETRIC NUCHAL TRANSLUCENCY-SINGLE OR FIRST GESTATION
0402
76813
$631.00
US OBSTETRIC TRANSABDOMINAL F/U GROWTH-PER FETUS
0402
76816
$350.00
US OBSTETRIC TRANSVAGINAL
0402
76817
$455.00
US OBSTETRIC UP TO 14 WKS PREG-EA ADD
0402
76802
$226.00
US OBSTETRIC UP TO 14 WKS PREG-SINGLE OR FIRST GESTATION
0402
76801
$400.00
US PELVIS-COMPLETE
0402
76856
$492.00
US PELVIS-LIMITED OR F/U
0402
76857
$425.00
US PREGNANT UTERUS RT W/IMAGE DOCUMENT ONE OR MORE FETUSES
0402
76815
$425.00
US RENAL BIOPSY PERCUT
0360
50200
$888.00
US RENAL CYST ASP/INJ
0360
50390
$1,680.00
US RETROPERITONEAL COMPLETE
0402
76770
$510.00
US RETROPERITONEAL LIMITED
0402
76775
$425.00
US SCROTUM AND CONTENTS
0402
76870
$425.00
US SOFT TISSUES OF HEAD AND NECK
0402
76536
$425.00
US SPINAL CANAL AND CONTENTS
0402
76800
$366.00
US THORACENTESIS FOR ASPIRATION W/IMAGING
0360
32555
$1,265.00
US THORACENTESIS W/TUBE PLACEMENT W/IMAGING
0360
32557
$2,887.00
US TRANSPLANTED KIDNEY
0402
76776
$461.00
US TRANSVAGINAL
0402
76830
$455.00
WIRE, 80CM EXTRA STIFF AMPLATZ
0272
C1769
$108.00
XR ORBITS
0320
70200
$237.00
XR UGI W/AIR AND SBFT
0320
74249
$511.00
XRAY ABDOMEN W/CHEST COMPLETE
0320
74022
$283.00
XRAY ABSCESS FISTULA SINUS TRACT
0320
76080
$499.00
XRAY ACROMIOCLAVICULAR JOINTS BILATERAL
0320
73050
$154.00
XRAY ANKLE 2 VIEWS
0320
73600
$154.00
XRAY ANKLE 3+ VIEWS COMPLETE
0320
73610
$154.00
XRAY CERVICAL SPINE 4+ VIEWS
0320
72050
$283.00
XRAY CERVICAL SPINE 2-3 VIEWS
0320
72040
$154.00
XRAY CERVICAL SPINE COMPLETE
0320
72052
$283.00
XRAY CLAVICAL COMPLETE
0320
73000
$154.00
XRAY ELBOW 2 VIEWS
0320
73070
$154.00
XRAY ELBOW 3+ VIEWS
0320
73080
$154.00
XRAY EXAM ENTIRE SPINE 4 OR 5 VIEWS
0320
72083
$562.00
XRAY EXAM ENTIRE SPINE W/SKULL 1 VIEW
0320
72081
$154.00
XRAY EXAM ENTIRE SPINE W/SKULL 2-3 VIEWS
0320
72082
$283.00
XRAY EXAM HIP UNILATERAL 1 VIEW
0320
73501
$154.00
XRAY EXAM HIP UNILATERAL 2 OR 3 VIEWS
0320
73502
$154.00
XRAY EXAM HIPS BILATERAL 3 OR 4 VIEWS
0320
73522
$283.00
XRAY EXAM OF FEMUR 1 VIEW
0320
73551
$154.00
XRAY EXAM OF FEMUR 2 VIEWS MINIMUM
0320
73552
$154.00
XRAY FACIAL BONES 1-2 VIEWS
0320
70140
$154.00
XRAY FACIAL BONES 3+ VIEWS
0320
70150
$283.00
XRAY FOOT 2 VIEWS
0320
73620
$154.00
XRAY FOOT 3+ VIEWS COMPLETE
0320
73630
$154.00
XRAY FOR FOREIGN BODY-CHILD
0320
76010
$154.00
XRAY FOREARM 2 VIEWS
0320
73090
$154.00
XRAY HAND 2 VIEWS
0320
73120
$283.00
XRAY HAND 3+ VIEWS
0320
73130
$154.00
XRAY HEEL 2+ VIEWS
0320
73650
$154.00
XRAY HUMERUS 2+ VIEWS
0320
73060
$154.00
XRAY KNEE 1-2 VIEWS
0320
73560
$154.00
XRAY KNEE 3 VIEWS
0320
73562
$154.00
XRAY KNEE 4+ VIEWS COMPLETE
0320
73564
$283.00
XRAY LOWER EXTREMITY INFANT 2+ VIEWS
0320
73592
$154.00
XRAY LUMBAR SPINE BENDING 4+ VIEWS
0320
72120
$186.00
XRAY LUMBARSACRAL SPINE 2-3 VIEWS
0320
72100
$283.00
XRAY LUMBARSACRAL SPINE 4+ VIEWS
0320
72110
$283.00
XRAY LUMBARSACRAL SPINE COMPLETE
0320
72114
$283.00
XRAY MANDIBLE 4+ VIEWS
0320
70110
$283.00
XRAY NASAL BONES 3+ VIEWS
0320
70160
$154.00
XRAY NECK SOFT TISSUE
0320
70360
$154.00
XRAY OSSEOUS SURVEY COMPLETE
0320
77075
$283.00
XRAY OSSEOUS SURVEY-INFANT
0320
77076
$283.00
XRAY PELVIS 1-2 VIEWS
0320
72170
$283.00
XRAY RIBS BILATERAL 3 VIEWS
0320
71110
$283.00
XRAY RIBS BILATERAL 4 VIEWS
0320
71111
$283.00
XRAY RIBS UNILATERAL 2 VIEWS
0320
71100
$154.00
XRAY RIBS UNILATERAL 3 VIEWS
0320
71101
$283.00
XRAY SACROILIAC JOINTS 3+ VIEWS
0320
72202
$283.00
XRAY SACRUM/COCCYX 2+ VIEWS
0320
72220
$154.00
XRAY SCAPULA COMPLETE
0320
73010
$186.00
XRAY SHOULDER 1 VIEW
0320
73020
$154.00
XRAY SHOULDER 2+ VIEWS COMPLETE
0320
73030
$154.00
XRAY SINUSES 1-2 VIEWS
0320
70210
$154.00
XRAY SINUSES 3+ VIEWS
0320
70220
$154.00
XRAY SKULL 1-3 VIEWS
0320
70250
$283.00
XRAY SKULL 4+ VIEWS
0320
70260
$283.00
XRAY SPINE 1 VIEW
0320
72020
$154.00
XRAY STERNOCLAVICULAR JOINTS 3+ VIEWS
0320
71130
$154.00
XRAY STERNUM 2+ VIEWS
0320
71120
$154.00
XRAY SURGICAL SPECIMEN
0320
76098
$1,201.00
XRAY TEMPOROMANDIBULAR JOINTS BILATERAL
0320
70330
$154.00
XRAY THORACIC SPINE 2 VIEWS
0320
72070
$283.00
XRAY THORACIC SPINE 3 VIEWS
0320
72072
$283.00
XRAY THORACOLUMBAR JUNCTION 2 VIEWS MIN
0320
72080
$154.00
XRAY TIBIA/FIBULA 2 VIEWS
0320
73590
$154.00
XRAY UPPER EXTREMITY INFANT 2+ VIEWS
0320
73092
$283.00
XRAY WRIST 2 VIEWS
0320
73100
$154.00
XRAY WRIST 3+ VIEWS COMPLETE
0320
73110
$154.00
YUEH-CENTISIS CATH NEEDLE
0272
$61.00

Salem Health Outpatient Lab

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17 HYDROXYPROGESTERONE
301
83498
$89.00
2HR GLUCOSE TOLERANCE
301
82951
$48.00
3D RENDERING REQUIRING WORKSTATION
350
76377
$687.00
AB BARTONELLA
306
86611
$60.00
AB SCREEN
300
86850
$60.00
ABO TYPING
300
86900
$66.00
ACID FAST CULTURE
306
87116
$55.00
ACID FAST STAIN
306
87206
$24.00
ACTH
301
82024
$134.00
ACTIVATED PROTEIN C RESISTANCE RATION
300
85307
$78.00
ACUTE HEPATITIS PANEL
301
80074
$176.00
AEROBIC IDENTIFICATION
306
87077
$28.00
AFP TO SERUM TO ESOTERIX GENZYME
301
82105
$63.00
AG DETECT NOS EIA MULTI STEP EACH ORGANISM
306
87449
$58.00
ALBUMIN ASSAY
301
82042
$24.00
ALBUMIN, SERUM
301
82040
$20.00
ALCOHOL BIOMARKERS 1 OR 2 (ETHYL GLUCURONIDE)
301
80321
$124.00
ALDOLASE ASSAY
301
82085
$33.00
ALDOSTERONE ASSAY
301
82088
$102.00
ALKALINE PHOSPHATASE
301
84075
$24.00
ALKALINE PHOSPHATASE ISOENZYME
301
84080
$104.00
ALLERGEN SPECIFIC IGE, EACH
302
86003
$17.00
ALPHA 1 ANTITRYPSIN PHENOTYPE
301
82104
$48.00
ALPHA FETO PROTEIN
301
82105
$63.00
ALPHA FETOPROTEIN
301
82105
$63.00
ALPHA FETOPROTEIN, TUMOR MARKER
301
82105
$63.00
ALPHA-1-ANTITRYPSIN
301
82103
$56.00
ALPHA-FETOPROTEIN (AFP) AMNIO FLUID
301
82106
$109.00
AMMONIA
301
82140
$60.00
AMPHETAMINES; 1 OR 2
301
80324
$88.00
AMYLASE ASSAY
301
82150
$31.00
ANA BY IFA
301
86039
$44.00
ANAEROBE CULTURE SURGICAL SP
306
87075
$55.00
ANAEROBIC ID
306
87076
$31.00
ANGIOTENSIN CONVERT ENZ
301
82164
$42.00
ANTI MITOCHONDRIAL AB
301
83516
$49.00
ANTI NUCLEAR ANTIBODY SCREEN
301
86038
$45.00
ANTI-DNA DOUBLE STRAND
301
86225
$45.00
ANTI-STRIATED MUSCLE AB, IGG
301
86255
$60.00
ANTIBODY BRUCELLA
302
86622
$30.00
ANTIBODY DETECTION NOS, EACH ORGANISM
306
87299
$44.00
ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE
302
86651
$44.00
ANTIBODY ENCEPHALITIS EASTERN EQUINE
302
86652
$44.00
ANTIBODY ENCEPHALITIS ST. LOUIS
302
86653
$44.00
ANTIBODY ENCEPHALITIS WESTRN EQUINE
302
86654
$44.00
ANTIBODY ENTEROVIRUS
302
86658
$43.00
ANTIBODY FRANCISELLA TULARENSIS
302
86668
$38.00
ANTIBODY I.D. ELUATE
302
86860
$142.00
ANTIBODY ID
302
86870
$237.00
ANTIBODY LEPTOSPIRA
302
86720
$65.00
ANTIBODY PROTOZOA NES
302
86753
$47.00
ANTIBODY RICKETTSIA
302
86757
$65.00
ANTIBODY SALMONELLA
302
86768
$44.00
ANTIBODY TITER
300
86850
$60.00
ANTIBODY TRICHINELLA
306
86784
$42.00
ANTIBODY VIRUS NOT ELSEWHERE SPECIFIED
302
86790
$43.00
ANTIBODY; TREPONEMA PALLIDUM
306
86780
$40.00
ANTICARDIOLIPIN ABS, IGA, G OR M
301
86147
$70.00
ANTINEUTROPHIL CYTOPLASMIC AB
301
86021
$68.00
ANTITHROMBIN III ACTIV
302
85300
$109.00
ARSENIC ASSAY
301
82175
$99.00
ARTERIAL PUNCTURE
300
36600
$98.00
ASPERGILLUS AB, SERUM
302
86606
$51.00
ASPERGILLUS ANTIGEN DETECTION BY EIA
300
87305
$235.00
ASSAY OF ETHANOL
301
80320
$175.00
ASSAY OF MYOGLOBIN
301
83874
$66.00
ASSAY OF NICOTINE
301
80323
$104.00
ASSAY OF OPIATES
301
80361
$88.00
ASSAY OF PHENCYCLIDINE
301
83992
$60.00
ASSAY OF SEX HORMONE BINDING GLOBULIN
301
84270
$86.00
ASSAY TEST FOR BLOOD FECAL
300
82274
$57.00
BARBITURATES CONFIRMATION
301
80345
$88.00
BASIC METABOLIC PANEL
301
80048
$31.00
BASIC POWERGLIDE 18G X 10CM (435159)
278
C1751
$138.00
BCR ABL 1 GENE MAJOR BP
300
81206
$321.00
BCR ABL 1 GENE MINOR BP
300
81207
$585.00
BENZODIAZEPINES CONFIRMATION
301
80348
$88.00
BENZODIAZEPINES; 1-12
301
80346
$99.00
BETA 2 GLYCOPROTEIN AB, EA
302
86146
$59.00
BETA HCG
301
84702
$56.00
BETA HCG TUMOR MARKER
301
84702
$56.00
BETA HYDROXYBUTYRATE SERUM QUANT OTHER KETONE BODIES
301
82010
$52.00
BETA LACTAMASE TEST
306
87185
$29.00
BETA-2 MICROGLOBULIN, QUANTIT
301
82232
$63.00
BILIRUBIN TOTAL
301
82247
$26.00
BILIRUBIN,TOTAL,TRANCUTANEOUS
300
88720
$22.00
BLOOD TYPING,ANTIGEN TEST OF DONOR BL
309
86902
$237.00
BLOOD TYPING;RBC ANTIGENS,OTHER THAN
300
86905
$237.00
BNP
301
83880
$187.00
BODY FLUID HEMATOCRIT (SPUN)
305
85013
$45.00
BODY FLUID PH
301
83986
$11.00
BODY FLUID PROTEIN
301
84155
$14.00
BONE MARROW CHROMO/INTERP
305
88237
$213.00
BORRELIA SMEAR
306
87205
$18.00
BUFFY COAT DIFFERENTIAL
305
85009
$49.00
BUN
301
84520
$19.00
C DIFFICILE TOXIN A+B
306
87324
$44.00
C REACTIVE PROTEIN (CRP)
301
86140
$28.00
C-PEPTIDE
301
84681
$63.00
C4
300
86160
$43.00
CA 19-9
301
86301
$84.00
CA125 ASSAY
302
86304
$75.00
CALCITONIN ASSAY
301
82308
$98.00
CALCIUM ASSAY
301
82310
$22.00
CALCIUM ASSAY, URINE
301
82340
$22.00
CALCIUM, IONIZED
301
82330
$52.00
CALPROTECTIN FECAL
301
83993
$216.00
CANDIDA SPECIES DNA PROBE
306
87480
$64.00
CAPILLARY PUNCTURE
300
36416
$301.00
CARBOXYHEMOGLOBIN
301
82375
$43.00
CARNITINE, FREE AND TOTAL, SERUM
301
82379
$50.00
CATECHOLAMINES, UA FRACT
301
82384
$68.00
CBC (AUTOMATED)
305
85027
$27.00
CBC WITH AUTOMATED DIFF
305
85025
$30.00
CD4
301
86361
$51.00
CEA ASSAY
301
82378
$62.00
CELL CNT AND DIFFERENTIATION
305
89051
$40.00
CELL COUNT AND DIFF BODY FLUID
305
89051
$40.00
CELL COUNT CSF WITHOUT DIFF
301
89050
$25.00
CERULOPLASMIN
301
82390
$46.00
CHLAMYDIA PNEUMONIAE CULTURE
306
87110
$94.00
CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TECHNIQUE
306
87491
$98.00
CHLORIDE URINE
301
82436
$18.00
CHLORIDE, SERUM
301
82435
$23.00
CHOLESTEROL
301
82465
$20.00
CHROMIUM ASSAY
301
82495
$89.00
CHROMOGRANIN-A
301
86316
$90.00
CHROMOSOME ADDL KARYOTYPES
301
88280
$53.00
CHROMOSOME ANAL TISSUE CULT
301
88230
$156.00
CHROMOSOME ANALY AF OR CV 15 CELLS 1K WITH BANDING
300
88267
$368.00
CHROMOSOME ANALYSIS ANALYZE 20-25 CELLS
310
88264
$213.00
CHROMOSOME ANL; 15-20 CELLS, 2 KARYOTYPE, BANDING
301
88262
$636.00
CITRIC ACID, 24 HOUR URINE
301
82507
$97.00
CKMB
301
82553
$52.00
CLOTTING FUNCT ACTIVITY, NOS EA ANALYTE
305
85397
$185.00
CO2
301
82374
$48.00
COCAINE CONFIRMATION
301
80353
$88.00
COCCIDIOIDES AB IGG OR IGM
302
86635
$41.00
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
300
36415
$15.00
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
761
36415
$15.00
COLUMN CHROMATOGRAPHY NON DRUG NOS EA SPEC
301
82542
$256.00
COMPATABILITY TEST ANTIGLOBULIN
309
86922
$142.00
COMPATABILITY TEST IMMEDIATE SPIN
309
86920
$142.00
COMPATABILITY TEST INCUBATION PHASE
309
86921
$142.00
COMPLEMENT, TOTAL (CH-50)
301
86162
$78.00
COMPLEX STAIN FOR O AND P
306
87209
$50.00
COMPREHENSIVE MET PANEL
301
80053
$37.00
CONC FOR INFECTIOUS AGENT
306
87015
$22.00
COPPER
301
82525
$59.00
CORTISOL, SERUM
301
82533
$52.00
CORTISOL,FREE,24 HR URINE
301
82530
$31.00
COUNT 15-20 CELLS
305
88262
$636.00
COXIELLA BURNETII ANTIBODY (Q FEVER)
302
86638
$48.00
CPK
301
82550
$31.00
CREATININE CLEARANCE
301
82575
$46.00
CREATININE SERUM
301
82565
$22.00
CREATININE, URINE RANDOM
301
82570
$21.00
CRYO AHF PART OF POOL
390
P9012
$101.00
CRYOGLOBULINS QUAL OR SEMI QUANT
301
82595
$28.00
CRYPTOCOCCUS ANTIGEN
306
86403
$79.00
CRYPTOCOCCUS NEOFORM AG EIA
306
87327
$42.00
CRYPTOSPORIDIUM AG DETECTION BY EIA
306
87328
$51.00
CRYSTAL I.D
307
89060
$38.00
CSF VDRL
300
86592
$25.00
CULTURE AEROBIC
306
87070
$29.00
CULTURE BLOOD
306
87040
$49.00
CULTURE FUNGAL
306
87102
$50.00
CULTURE GRP B STREP ONLY
306
87081
$30.00
CULTURE STOOL
306
87045
$34.00
CULTURE STREP SCREEN ONLY
306
87081
$30.00
CULTURE TYPING BY RNA/DNA PROBE EA CULT/ISOLATE
306
87150
$129.00
CULTURE URINE
306
87086
$32.00
CULTURE, STOOL ADDT'L PATHOGENS
306
87046
$15.00
CULTURE, TYPING IMMUNOLOGIC METHOD, OTHER, PER ANTISERUM
306
87147
$29.00
CULTURE,PRESUMPTIVE,PATHOGENIC ORGANI
306
87081
$30.00
CYCLIC CITRUL PEPTIDE
301
86200
$56.00
CYCLOSPORINE ASSAY(SANDIMMUNE)
301
80158
$80.00
CYSTIC FIBROSIS GENE ANALYSIS
300
81220
$557.00
CYTOGENETIC AND MOLECULAR CYTOGENETICS INTERP & RPT
311
88291
$44.00
CYTOMEG, DNA OR RNA AMP PROBE
306
87496
$117.00
CYTOMEGALOVIRUS (CMV) QUANT (DNA OR RNA)
306
87497
$235.00
CYTOMEGALOVIRUS AB, IGM
302
86645
$49.00
CYTOMEGALOVIRUS, IGG
302
86644
$50.00
CYTOPATHOLOGY EVAL FOR ADEQUACY OF FINE NEEDLE ASP FIRST EVAL
311
88172
$224.00
CYTOPATHOLOGY FLUIDS WASHINGS OR BRUSHINGS SMEARS WITH INTERPRET
311
88104
$187.00
CYTOPATHOLOGY FNA INTERP/REPORT EVALUATION OF FINE NEEDLE ASP
311
88173
$168.00
CYTOPATHOLOGY SMEAR CONE CONCENTRATION TECHNIQUE SMEARS/INTERP
311
88108
$86.00
CYTOPATHOLOGY SMEARS SLIDES MADE PREP SCREENING AND INTERP
311
88161
$198.00
CYTOPATHOLOGY SMEARS SLIDES RECEIVED SCREENING/INTERPRETATION
311
88160
$137.00
CYTOPATHOLOGY THIN LAYER PAP CERVICAL/VAGINAL PREP AND MANUAL
311
88142
$68.00
D-DIMER, QUANT
305
85379
$98.00
DECALCIFICATION PROCEDURES LIST SEPARATE IN ADDITION TO CODE
312
88311
$43.00
DHEA (UNCONJUGATED)
301
82626
$46.00
DHEA SULFATE-SEND OUT TEST
301
82627
$59.00
DIAGNOSTIC BONE MARROW; ASPIRATION(S)
360
38220
$1,460.00
DIFFERENTIAL, MANUAL
305
85007
$15.00
DIGOXIN ASSAY
301
80162
$59.00
DILANTIN, TOTAL
301
80185
$56.00
DIRECT BILIRUBIN
301
82248
$23.00
DIRECT COOMBS
302
86880
$76.00
DRUG TEST(S) LC/MS OR GC/MS 1-7 DRUG CLASSES
301
G0480
$470.00
DRUG TESTS DEFINITIVE MULTI METHOD 15-21 CLASSES
301
G0482
$199.00
DRUG TESTS PRESUMPTIVE ANY NUMBER CLASSES, PER DATE OF SERVICE
300
80307
$252.00
DRUG TESTS PRESUMPTIVE ANY NUMBER CLASSES, PER DOS
300
80307
$252.00
DRUG TST PRESUMP INSTR ASSISTED DIR OPTICAL
300
80306
$222.00
DRUG(S) DEFINITIVE QUAL OR QUANT NOS 1-3
301
80375
$88.00
EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTIONS PATH CONSULT
312
88332
$121.00
ED LAB CHLORIDE
301
82435
$23.00
ELECTROLYTES, SERUM
301
80051
$29.00
ENZYME ACTIV BLD, CELLS OR TISSUE; NONRADIOACTIVE SUBSTRATE, EA
301
82657
$181.00
EPSTEIN BARR AB TO EARLY AG
302
86663
$70.00
EPSTEIN BARR AB TO NUCLEAR AG
302
86664
$84.00
EPSTEIN BARR AB VCA
302
86665
$58.00
EPSTEIN BARR AB VCA
306
86665
$58.00
ERYTHROPOIETIN ASSAY
301
82668
$71.00
ESTRADIOL
301
82670
$58.00
ESTROGEN FRACTIONATION
301
82671
$149.00
ETHOSUXIMIDE ASSAY (ZARONTIN)
301
80168
$56.00
ETHYLENE GLYCOL
301
82693
$202.00
EXTRACTABLE NUCLEAR ANTIGEN
300
86235
$42.00
F2 GENE ANALYSIS PT COAG FACTOR II
300
81240
$239.00
F5 GENE ANALYSIS LEIDEN VARIANT
300
81241
$217.00
FACTOR 8 RISTOCETIN COFACTOR
302
85245
$158.00
FACTOR IX ACTIVITY
302
85250
$147.00
FACTOR VIII ACTIVITY
302
85240
$105.00
FACTOR VIII RELATED ANTIGEN
302
85246
$159.00
FATS OR LIPIDS, FECES; QUALITATIVE
301
82705
$18.00
FECAL FAT 72 HR
301
82710
$105.00
FECAL LACTOFERRIN QUAL
301
83630
$46.00
FERRITIN
301
82728
$47.00
FETAL CGEN ABNOR FOUR ANALYTES
300
81511
$262.00
FETAL CGEN ABNOR TWO PROTEINS
300
81508
$116.00
FETAL FIBRONECTIN
301
82731
$321.00
FIBRINOGEN LEVEL
302
85384
$47.00
FIRST TISSUE BLOCK WITH FROZEN SECTIONS SINGLE SPECIMEN CONSULT
312
88331
$217.00
FLOW CYTO EA ADD MARKER
301
88185
$67.00
FLOW CYTO FIRST CELL MARKER
301
88184
$237.00
FLOW CYTOMETRY EACH ADDL
305
88185
$67.00
FLOW CYTOMETRY FIRST MARKER
301
88184
$237.00
FLUORESCENT NONINFECTIOUS AGENT ANTIB
301
86256
$54.00
FLUORESCENT NONINFECTIOUS AGENT, EACH ANTIBODY
301
86255
$60.00
FOLATE ASSAY
301
82746
$59.00
FSH
301
83001
$63.00
FUNGUS ANTIBODIES
302
86671
$57.00
GABAPENTIN QUANTITATIVE
301
80171
$95.00
GARDNERELLA DNA PROBE
306
87510
$64.00
GASES, BLOOD ARTERIAL OR VENOUS
301
82803
$70.00
GASTRIN, SERUM RIA
301
82941
$66.00
GASTROCCULT
307
82271
$17.00
GENERAL HEALTH PANEL
300
80050
$200.00
GENTAMICIN - RANDOM
301
80170
$68.00
GGT
301
82977
$26.00
GIARDIA ANTIGEN BY EIA
306
87329
$54.00
GLUCOSE 6 PD QUANTITATIVE
301
82955
$95.00
GLUCOSE ASSAY
301
82947
$19.00
GLUCOSE ASSAY, POST DOSE
301
82950
$23.00
GLUCOSE BODY FLUID
301
82945
$21.00
GLUCOSE TOL TEST, EACH ADDN
301
82952
$22.00
GLYCOSYLATED HEMOGLOBIN
301
83036
$40.00
GRAM STAIN
306
87205
$18.00
GROUP 1 GMS STAINS FOR MICROORGANISM
312
88312
$111.00
GROUP 1 PNEUMOCYSTIS FUNGAL STAINS FOR MICROORGANISM
312
88312
$111.00
GROUP 2 SPECIAL STAINS ALL OTHER
312
88313
$72.00
GROWTH HORMONE ASSAY
301
83003
$65.00
H PYLORI (C-13) BREATH ANALYSIS UREASE ACT NON-RADACT ISTOPE
300
83013
$225.00
H PYLORI ANTIGEN STOOL
306
87338
$91.00
HAPTOGLOBIN
301
83010
$73.00
HCG SCREEN
301
84703
$39.00
HCG, URINE
307
81025
$33.00
HCV GENOTYPE
301
87902
$627.00
HCV RNA QUANT BY PCR ULTRASEN
301
87522
$325.00
HELICOBACTER PYLORI IGG
306
86677
$72.00
HEMATOCRIT (AUTOMATED)
305
85014
$18.00
HEMOCHROMATOSIS GENE ANALYSIS
300
81256
$275.00
HEMOGLOBIN (AUTOMATED)
305
85018
$22.00
HEMOGLOBIN CHROMOTOGRAPHY
305
83021
$54.00
HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS
301
83020
$54.00
HEMOSIDERIN, URINE
305
83070
$108.00
HEPARIN ASSAY
305
85520
$141.00
HEPARIN NEUTRALIZATION
300
85525
$47.00
HEPARIN-PF4 ANTIBODY (HIT)
302
86022
$265.00
HEPATIC FUNCTION PANEL
301
80076
$35.00
HEPATITIS A ANTIBODY (IGM)
301
86709
$48.00
HEPATITIS A VIRUS AB, TOTAL
301
86708
$51.00
HEPATITIS B CORE AB (IGM)
301
86705
$53.00
HEPATITIS B CORE ANTIBODY, TOT
301
86704
$50.00
HEPATITIS B SURF AG
301
87340
$44.00
HEPATITIS B SURG AG NEUTRALIZATION
302
87341
$80.00
HEPATITIS B VIRAL DNA, PCR QUANT
306
87517
$261.00
HEPATITIS BE ANTIBODY
300
86707
$52.00
HEPATITIS BE ANTIGEN EIA
300
87350
$45.00
HEPATITIS C ANTIBODY
301
86803
$61.00
HEPATITIS DELTA AB
301
86692
$46.00
HEXAGONAL PHOS NEUT 85598
301
85598
$81.00
HIAA-5 24HR URINE
301
83497
$56.00
HIGH SENSITIVITY CRP
301
86141
$48.00
HISTOPLASMA YEAST
306
86698
$39.00
HIV 1 AND HIV 2 ANTIBODIES WITH HIV 1 ANTIGEN
302
87389
$129.00
HIV 1 ANTIBODY
302
86701
$158.00
HIV 2 ANTIBODY
302
86702
$64.00
HIV1 QUANT BY RNA OR DNA
306
87536
$366.00
HLA B27
300
86812
$105.00
HLA CLASS I&II ANTIBODY QUAL
300
86828
$117.00
HLA I TYPING 1 LOCUS LR
300
81373
$436.00
HLA II, HIGH RESOLUTION, 1 ALLELE OR ALLELE GROUP, EACH
310
81383
$452.00
HLA II, LOW RESOLUTION, 1 LOCUS, EACH
310
81376
$507.00
HOMOCYSTEINE
301
83090
$74.00
HOMOGENIZE TISSUE
306
87176
$39.00
HPYORI DRUG ADMINISTRATION
300
83014
$32.00
HSV TYPE 1 AND 2, IGM AB
306
86694
$54.00
HSV TYPE 1, IGG AB
302
86695
$47.00
HSV TYPE 2, IGG AB
302
86696
$54.00
IADNA DNA/RNA ZIKA VIRUS AMPLIFIED PROBE TQ
306
87662
$171.00
IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP
306
87498
$117.00
IADNA STREP A AMP PROBE TQ
306
87651
$131.00
IADNA STREPTOCOCCU GROUP B AMPLIFIED PROBE TQ
306
87653
$130.00
IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH
306
87661
$117.00
IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11
306
87506
$711.00
IMMATURE PLATELET FRACTION
305
85055
$73.00
IMMUNOASSAY FOR ANALYTE QUAL OR SEMIQUANT MULTI STEP
301
83516
$49.00
IMMUNOASSAY FOR ANALYTE QUANT BY RIA
301
83519
$125.00
IMMUNOASSAY FOR ANALYTE QUANTITATIVE
301
83520
$74.00
IMMUNOASSAY FOR INF AGENT QT,HEP B SU
301
86317
$29.00
IMMUNOASSAY TUMOR ANTIGEN QUANT 15-3 (27.29)
302
86300
$68.00
IMMUNOASSAY, EACH
301
83520
$74.00
IMMUNOFIXATION PROCEDURE
301
86334
$83.00
IMMUNOFIXATION URINE
301
86335
$97.00
IMMUNOGLOBULIN
301
82784
$38.00
IMMUNOGLOBULIN IGE
301
82785
$41.00
IMMUNOGLOBULIN SUBCLASSES 1 2 3 OR 4 EACH
301
82787
$42.00
IMMUNOHISTOCHEM PER SPEC EA ADDL SINGLE AB STAIN
312
88341
$242.00
IMMUNOHISTOCHEM PER SPEC EA MULTIPLEX AB STAIN
312
88344
$242.00
IMMUNOHISTOCHEM PER SPEC INITIAL AB STAIN
312
88342
$237.00
IMMUNOSAY INFECTIOUS AGENT AB OR AG QUAL OR SEMI QUAL
301
83516
$49.00
IN SITU HYBRIDIZATION EACH PROBE
310
88365
$178.00
INF AG DET BY DNA OR RNA NOS QUANT EA ORGANISM
306
87799
$296.00
INF AGENT BY DNA/RNA HSV AMP PROBE
306
87529
$130.00
INF AGENT DET NUCL ACID CLOSTRIDIUM AMP PROBE
306
87493
$133.00
INF AGENT DNA/RNA NOS AMP PROBE EA ORGANISM
306
87798
$202.00
INF AGENT GENOTYPE DNA/RNA HEP B VIRUS
300
87912
$465.00
INFECT AG BY NA CHLAMYDIA PNEUMONIAE AMP PROBE
306
87486
$138.00
INFECT AGENT DET BY NA RESP VIRUS 12 TO 25 TARGETS
306
87633
$1,095.00
INFECTIOUS AGENT AG IMMUNOASSAY;HISTOPLASMA
306
87385
$142.00
INFECTIOUS AGENT BY DNA/RNA STAPH AUREUS AMP PROBE
306
87640
$129.00
INFECTIOUS AGENT DETECT NUCLEIC ACID
306
87798
$202.00
INFLUENZA ANTIGEN A OR B, EACH
306
87400
$42.00
INHIBIN A
301
86336
$70.00
INSULIN, SERUM
301
83525
$47.00
INTERPRETATION/REPORT
310
88291
$63.00
IONIZED CALCIUM
301
82330
$52.00
IRON
301
83540
$29.00
IRON BINDING CAPACITY
300
83550
$52.00
IRON STAIN
305
85536
$91.00
ISLET CELL ANTIBODY
302
86341
$129.00
JAK2 GENE ANALYSIS
300
81270
$335.00
JO 1 ANTIBODY IGG
301
86235
$42.00
KLEIHAUER-BETKE (FETAL CELL)
305
85460
$115.00
KOH PREP
306
87210
$24.00
LAB HANDLING CHRG EXPANDED
301
99001
$19.00
LACTIC ACID ASSAY
301
83605
$49.00
LAMOTRIGINE QUANTITATIVE
301
80175
$76.00
LDH
301
83615
$27.00
LDL-CHOLESTEROL, DIRECT
301
83721
$52.00
LEAD ASSAY
301
83655
$52.00
LEGIONELLA DIRECT FLOURES AB
306
87278
$107.00
LEVEL 1 SURGICAL PATHOLOGY GROSS EXAMINATION ONLY
312
88300
$35.00
LEVEL 2 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88302
$83.00
LEVEL 3 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88304
$109.00
LEVEL 4 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88305
$156.00
LEVEL 5 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88307
$356.00
LEVEL 6 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88309
$594.00
LEVETIRACETAM (KEPPRA) QUANTITATIVE
301
80177
$162.00
LH
301
83002
$71.00
LIDOCAINE (XYLOCAINE)
301
80176
$111.00
LIPASE
301
83690
$31.00
LIPID SCREEN
301
80061
$51.00
LIPOPROT BLD QT OF LIPOPROT PARTICLE NOS & PARITCS
301
83704
$93.00
LIPOPROTEIN A
301
83695
$63.00
LIPOPROTEIN A
301
82172
$44.00
LITHIUM ASSAY
301
80178
$48.00
LYME DISEASE AB
306
86618
$73.00
LYME DISEASE AB WESTERN BLOT CONFIRMATORY TEST
302
86617
$35.00
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH
310
88377
$349.00
M/PHMTRC ALYS ISHQUANT/SEMIQ CPTR EACH
310
88374
$349.00
MAGNESIUM ASSAY
301
83735
$33.00
MALARIA SMEAR
305
87207
$33.00
MASS SPEC AND TANDEM MASS SPEC ANALYTE NOS QT EA
301
83789
$38.00
MERCURY BLOOD
301
83825
$89.00
METANEPHRINES
301
83835
$92.00
METANEPHRINES PLASMA FREE
301
83835
$92.00
METHADONE AND METABOLITE, SERUM OR PLASMA, QUANT
301
80358
$88.00
METHEMOGLOBIN
301
83050
$52.00
METHOTREXATE ASSAY
301
80299
$45.00
METHYLENEDIOXYAMPHETAMINES
301
80359
$149.00
METHYLMALONIC ACID
301
83921
$74.00
MICROALBUMIN
301
82043
$27.00
MICROSOMAL ANTIBODY, EA
302
86376
$56.00
MOLD ID
306
87107
$86.00
MOLECULAR CYTOGENETICS DNA PROBE EA (FISH)
300
88271
$46.00
MOLECULAR CYTOGENETICS INTERPHASE 100-300 CELLS
300
88275
$167.00
MOLECULAR PATH PROC LEVEL 2
300
81401
$222.00
MONO TEST
306
86308
$29.00
MONONUCLEAR CELL ANTIGEN QUANT NOS EA
300
86356
$89.00
MORPHOMETRIC ANALYSIS TUMOR IMMUNOHISTOCHEMISTRY QUANT OR SEMI
310
88360
$237.00
MRSA RAPID ASSAY
306
87641
$193.00
MTHFR GENE ANALYSIS COMMON VARIANTS
300
81291
$176.00
MUMPS AB,IGM
306
86735
$48.00
MYCOBACTERIA TUBERCULOSIS AMPLIFIED PROBE
306
87556
$141.00
MYCOPLASMA PNEUMONIAE AB, IGG
306
86738
$48.00
MYELIN BASIC PROTEIN, CSF
301
83873
$32.00
NASAL EOSINOPHIL SMEAR
305
89190
$45.00
NEISSERIA GONORRHOEAE AMPLIFIED PROBE TECHNIQUE
306
87591
$96.00
NEPHELOMETRY EACH ANALYTE NOT ELSEWHERE SPECIFIED
301
83883
$65.00
NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN
306
87505
$428.00
O2 SATURATION
301
82810
$47.00
OBSTETRIC PANEL WITH HIV
301
80081
$217.00
OCCULT BLOOD DIAGNOSTIC STOOL
307
82270
$19.00
OCCULT BLOOD SCREENING STOOL
307
82270
$21.00
OCCULT BLOOD-FECES1-3 SIMULT
300
82270
$19.00
OLIGOCLONAL IMMUNE (BANDS)
301
83916
$58.00
OSMOLALITY, SERUM
301
83930
$43.00
OSMOLALITY, URINE
301
83935
$44.00
OVA AND PARASITE EXAM
306
87177
$30.00
OXALATE, 24 HOUR URINE
301
83945
$63.00
OXCARBAZEPINE (TRILEPTAL) QUANTITATIVE
301
80183
$116.00
OXYCODONE
301
80365
$119.00
PAMG-1,CERVICOVAGINAL SECRETION,QUAL
301
84112
$238.00
PAPP-A FOR SEQUENTIAL SCREEN
301
84163
$56.00
PAPP-A SEQUENTIAL SCRN GENZYME
301
84163
$56.00
PARTIAL THROMBOPLASTIN
302
85730
$32.00
PARVOVIRUS B19 ABS IGG/IGM
306
86747
$67.00
PH BLOOD
301
82800
$78.00
PH URINE
307
81002
$19.00
PHENOBARBITOL ASSAY
301
80184
$55.00
PHENYTOIN FREE
301
80186
$36.00
PHLEBOTOMY, THERAPEUTIC
940
99195
$70.00
PHOSPHOLIPID NEUT PLT 85597
300
85597
$58.00
PHOSPHORUS
301
84100
$20.00
PHOSPHORUS ASSAY, URINE
301
84105
$24.00
PINWORM PREP
306
87172
$58.00
PLASMA, FRESH FROZEN
390
P9017
$109.00
PLASMA, FROZEN WITHIN 24 HOURS
390
P9059
$132.00
PLATELET ANTIBODY SCREEN
302
86022
$265.00
PLATELET COUNT
305
85049
$22.00
PLATELET CROSSMATCH SCREEN
300
86022
$265.00
PLATELET FUNCTION ASSAY, ADP
305
85576
$83.00
PLATELET RICH PLASMA, EACH UNIT
390
P9020
$333.00
PLATELETPHERESIS IRRAD LR
390
P9037
$940.00
PLATELETPHERESIS LEUKOREDUCED
390
P9035
$905.00
PLATELETS HLA MATCHED LR
390
P9052
$1,361.00
POC ACT CLOT TIME
302
85347
$58.00
POC FECAL OCCULT BLOOD
307
82270
$19.00
POC GASES, BLOOD ARTERIAL OR VENOUS
301
82805
$79.00
POC POTASSIUM
301
84132
$17.00
POC PT INR
305
85610
$27.00
PORPHOBILINGEN/PORPHRINS UR QT
305
84120
$103.00
PORPHOBILINOGEN, URINE
301
84110
$63.00
POTASSIUM
301
84132
$17.00
POTASSIUM ASSAY, SERUM
301
84132
$17.00
POTASSIUM ASSAY, URINE
301
84133
$18.00
POTASSIUM FLUID
301
84999
$322.00
PREALBUMIN
301
84134
$63.00
PRESUMPTIVE ID, URINE
306
87088
$38.00
PRIMIDONE
301
80188
$55.00
PRIMIDONE METABOLITE
301
80184
$55.00
PROCALCITONIN
301
84145
$146.00
PROGESTERONE SERUM
301
84144
$46.00
PROLACTIN
301
84146
$70.00
PROTEIN SERUM TOTAL
301
84155
$14.00
PROTEIN C ACTIVITY
302
85303
$174.00
PROTEIN ELECTROPHORESIS
301
84165
$45.00
PROTEIN ELECTROPHORESIS
301
84166
$77.00
PROTEIN S ACTIVITY
302
85306
$162.00
PROTEIN TOTAL REFRACTOMETRY ANY SRC
301
84160
$17.00
PROTEIN, CSF
301
84157
$23.00
PROTEIN, URINE
301
84156
$20.00
PROTIME
305
85610
$27.00
PSA
301
84153
$66.00
PSA SCREENING
300
G0103
$66.00
PSA, FREE
301
84154
$54.00
PTH (INTACT)
301
83970
$147.00
PTT
300
85730
$32.00
PTT PLASMA FRACTIONS, EACH
305
85732
$41.00
QUANTIFERON GOLD TB
301
86480
$168.00
QUANTITATION OF DRUG NES THERAPEUTIC DRUG ASSAY
301
80299
$45.00
QUANTITATIVE SCREEN METALS
301
83018
$87.00
RAPID HIV 1/2
301
86703
$50.00
RBC FOLATE
301
82747
$54.00
RBC SED RATE
305
85651
$19.00
RBC SED RATE (AUTOMATED)
305
85652
$21.00
RED BLOOD CELLS, EACH UNIT
390
P9021
$357.00
RED CELLS LEUKODEPL IRRADIATED
390
P9040
$508.00
RED CELLS, LEUKODEPLETE
390
P9016
$459.00
RENAL FUNCTION PANEL
301
80069
$35.00
RENIN ASSAY
301
84244
$81.00
REPTILASE TEST
305
85635
$39.00
RESPIRATORY VIRUS 3 TO 5 TARGETS
306
87631
$364.00
RESPIRATORY VIRUS PANEL BY PCR
300
87633
$1,095.00
RETIC COUNT (AUTOMATED)
305
85046
$34.00
RETICULOCYTE PROFILE, AUTOMATED
305
85046
$34.00
RH IG TESTING
302
85461
$62.00
RH TYPING
300
86901
$35.00
RH TYPING (WEAK DU)
300
86901
$35.00
RHEUMATOID FACTOR, QT
300
86431
$29.00
RNP ANTIBODY
300
86235
$42.00
ROTAVIRUS (ROTAZYME) AG
306
87425
$66.00
RPR
300
86592
$25.00
RPR QUANTITATION
302
86593
$21.00
RSV
301
87807
$67.00
RUBELLA AB IGG OR IGM
302
86762
$38.00
RUBELLA AB, IGG
301
86762
$38.00
RUBELLA AB, IGM
306
86762
$38.00
RUBEOLA ANTIBODY
301
86765
$63.00
RUSSELL VIPER VENOM TIME
301
85613
$127.00
SCL 70 AUTOANTIBODIES
301
86235
$42.00
SEMEN ANALYSIS
309
89322
$73.00
SENSITIVITY PER ORGANISM MIC
306
87186
$32.00
SENSITIVITY PER PLATE DISC
306
87184
$85.00
SEROTONIN
301
84260
$66.00
SGOT (AST)
301
84450
$23.00
SGPT (ALT)
301
84460
$25.00
SICKLE TESTING
305
85660
$44.00
SIROLIMUS (SACROLINUS)
301
80195
$100.00
SKIN TEST: TB
302
86580
$57.00
SODIUM
301
84295
$16.00
SODIUM OTHER SOURCE
301
84302
$32.00
SODIUM, LEVEL
301
84295
$16.00
SODIUM, URINE
301
84300
$18.00
SOMATOMEDIN C
301
84305
$106.00
SPECIFIC GRAVITY URINE
307
81002
$19.00
SPECTROPHOTOMETRY ANALYTE NES
301
84311
$15.00
SPERM CHECK
305
89310
$34.00
SS-A/RO ANTIBODIES
300
86235
$42.00
SS-B/LA ANTIBODIES
300
86235
$42.00
STONE ANALYSIS
301
82365
$64.00
STREP GRP A ANTIGEN DETECTION
306
87880
$39.00
STREPTOLYSIN O ANTIBODY (ASO)
302
86060
$44.00
SULFATE ASSAY, URINE
301
84392
$22.00
SURVEILLANCE CULTURE
306
87071
$70.00
T CELLS TOTAL COUNT CD3
302
86359
$57.00
T3 - TOTAL
301
84480
$61.00
T3 FREE
301
84481
$58.00
T3 REVERSE
301
84482
$63.00
T4 (THYROXINE)
301
84436
$25.00
T4, FREE
301
84439
$41.00
TACROLIMUS FK507
301
80197
$74.00
TB CELL MEDIATED ANTIGEN RESPONSE; GAMMA INTERFERON
302
86480
$230.00
TB INTRADERMAL TEST
302
86580
$45.00
TEGRETOL ASSAY (CARBAMAZEPIN)
301
80156
$60.00
TESTOSTERONE TOTAL SERUM
301
84403
$82.00
TESTOSTERONE, FREE
301
84402
$84.00
THC CANNABINOIDS CONFIRMATION
301
80349
$88.00
THEOPHYLLINE ASSAY
301
80198
$60.00
THROMBIN TIME
300
85670
$24.00
THYROGLOBULIN
301
84432
$55.00
THYROGLOBULIN ANTIBODY
302
86800
$57.00
THYROID HORMONE UPTAKE
301
84479
$23.00
THYROID STIM IMMUNOGLOBULIN
301
84445
$156.00
TISSUE CULTURE AMNIOTIC FLUID
300
88235
$182.00
TISSUE TRANSGLUTAMINASE AB IGA
301
83520
$74.00
TOBRAMYCIN - RANDOM
301
80200
$58.00
TOPIRAMATE (TOPAMAX)
301
80201
$80.00
TOTAL ALLERGEN IGE
301
82785
$41.00
TOXOPLASMA ANTIBODY, IGG
302
86777
$51.00
TOXOPLASMA ANTIBODY, IGM
302
86778
$49.00
TPMT GENE ANALAYSIS COMMON VARIANTS
310
81335
$472.00
TRANSFERRIN
301
84466
$51.00
TRICHOMONAS DNA PROBE
306
87660
$64.00
TRICYCLIC, ANTIDEPRESSANTS, QUANTITATIVE, URINE
301
80337
$93.00
TRIGLYCERIDE
301
84478
$26.00
TRIP FEE, 1 DRAW
300
P9604
$28.00
TRIP FEE, 10 DRAWS
300
P9604
$2.80
TRIP FEE, 11 DRAWS
300
P9604
$2.54
TRIP FEE, 12 DRAWS
300
P9604
$2.33
TRIP FEE, 14 DRAW
300
P9604
$2.00
TRIP FEE, 15 DRAW
300
P9604
$1.86
TRIP FEE, 2 DRAWS
300
P9604
$14.00
TRIP FEE, 3 DRAWS
300
P9604
$9.33
TRIP FEE, 4 DRAWS
300
P9604
$7.00
TRIP FEE, 5 DRAWS
300
P9604
$5.60
TRIP FEE, 6 DRAWS
300
P9604
$4.67
TRIP FEE, 7 DRAWS
300
P9604
$4.00
TRIP FEE, 8 DRAWS
300
P9604
$3.50
TRIP FEE, 9 DRAWS
300
P9604
$3.11
TROPONIN T
301
84484
$89.00
TSH
301
84443
$60.00
UNCONJUGATED ESTRIOL
301
82677
$36.00
UREA NITROGEN, URINE
301
84540
$18.00
URIC ACID
301
84550
$20.00
URIC ACID, URINE
301
84560
$22.00
URINALYSIS W/MICRO
307
81001
$20.00
URINALYSIS, COMPLETE
300
81000
$63.00
URINALYSIS, CULTURE IF INDICAT
307
81001
$20.00
URINE CHEMISTRY STRIP
307
81002
$19.00
URINE HEMOGLOBIN
307
83069
$26.00
URINE MACRO, C AND S IF INDICATED
307
81003
$10.00
URINE MACRO, MICROSCOPIC IF IND
307
81003
$10.00
URINE MICROSCOPIC
307
81015
$14.00
URINE MICROSCOPIC, CULT IF IND
307
81015
$14.00
URINE PROTEIN
301
84156
$20.00
VALPROIC ACID ASSAY
301
80164
$54.00
VANCOMYCIN - RANDOM
301
80202
$108.00
VARICELLA ZOSTER AB, IGG
301
86787
$61.00
VIRUS INOCULATION
306
87254
$111.00
VIRUS TISS CULTURE ADDL/EACH ISOLATE
306
87253
$75.00
VIRUS TISS CULTURE INOCULATION
306
87252
$108.00
VISCOSITY, SERUM
301
85810
$42.00
VITAMIN A, SERUM
301
84590
$62.00
VITAMIN B-12 ASSAY
301
82607
$61.00
VITAMIN B-6 ASSAY
301
84207
$76.00
VITAMIN B1 PYROPHOSPHATE (THIAMINE)
301
84425
$77.00
VITAMIN D 25-OH ASSAY
301
82306
$105.00
VITAMIN E
301
84446
$63.00
VMA 24HR URINE
301
84585
$39.00
VOLATILES, METHANOL, OR ISOPROPANOL
301
84600
$104.00
WBC (AUTOMATED)
305
85048
$25.00
WEST NILE VIRUS AB
302
86789
$64.00
X-MATCH 1 UNIT
309
86923
$142.00
YEAST ID
306
87106
$82.00
ZIKA VIRUS IGM ANTIBODY
302
86794
$56.00
ZINC LEVEL PLASMA
301
84630
$63.00
ZINC PROTOPORPHYRIN
301
84202
$57.00
ZONISAMIDE QUANTITATIVE
301
80203
$116.00

Salem Hospital

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17 HYDROXYPROGESTERONE
0301
83498
$93.00
2D TEE W OR W/O FOL W/CONTRAST
0483
C8925
$1,960.00
2D TTE W OR W/O FOL W/CONTRAST, FU
0483
C8924
$1,396.00
2HR GLUCOSE TOLERANCE
0301
82951
$132.00
2ND THROMB/LYSIS NON PRIM
0360
37186
$5,382.00
3D MAPPING, INTRACARDIAC EP
0480
93613
$6,889.00
3D RENDERING NOT REQUIRING WORKSTATIO
0350
76376
$721.00
3D RENDERING REQUIRING WORKSTATION
0350
76377
$768.00
3D TREATMENT PLANNING, INC DOSE-VOLUME HISTOGRAMS
0333
77295
$4,810.00
41FR BRONCHO CATH - LEFT (422040)
0270
$133.00
AB BARTONELLA
0306
86611
$72.00
AB SCREEN
0300
86850
$132.00
ABCESS/CYST CONTRAST INJECT
0360
49424
$340.00
ABDOM/PELVIC/LWR EXTRM ART 1ST
0360
36245
$1,406.00
ABDOM/PELVIC/LWR EXTRM ART 2ND
0360
36246
$1,570.00
ABDOM/PELVIC/LWR EXTRM ART 3RD
0360
36247
$1,874.00
ABDOMINAL AORTOGRAM - ANG
0320
75625
$6,294.00
ABDOMINAL AORTOGRAM W/RUN OFF
0320
75630
$6,294.00
ABLATE ARRHYTHMIA ADD ON
0481
93655
$7,283.00
ABLATION AV NODE +/- TEMP PACE
0480
93650
$6,839.00
ABLATION,RENAL TUMOR,PERC,UNILAT,CRYOTHERAPY
0360
50593
$6,464.00
ABO TYPING
0300
86900
$109.00
ACCUCATH 20G 1.25 BASIC (AC0201250)
0272
$61.00
ACCUCATH 20G 2.26 BASIC (AC0202250)
0272
$116.00
ACID FAST CULTURE
0306
87116
$152.00
ACID FAST STAIN
0306
87206
$78.00
ACT NEEDLE 18X11
0270
$129.00
ACT NEEDLE 18X15
0270
$133.00
ACT NEEDLE 18X20
0272
$146.00
ACT NEEDLE 20X11
0272
$141.00
ACT NEEDLE 20X15
0272
$155.00
ACT NEEDLE 20X20
0272
$166.00
ACTH
0301
82024
$134.00
ACTIVATED PROTEIN C RESISTANCE RATION
0300
85307
$92.00
ACUTE HEMODIALYSIS
0800
G0257
$1,282.00
ACUTE HEPATITIS PANEL
0301
80074
$369.00
ADDL 2ND,3RD ORDER +INVAS FMLY
0360
36218
$309.00
ADDL ABDOM/PLVC/LWR EXTRM ART
0360
36248
$286.00
ADMIN VACCINE-IMMUNIZATION-ONE VACCINE
0771
G0008
$97.00
AEROBIC IDENTIFICATION
0306
87077
$56.00
AFP TO SERUM TO ESOTERIX GENZYME
0301
82105
$65.00
AG DETECT NOS EIA MULTI STEP EACH ORGANISM
0306
87449
$139.00
AIGIS-DEFIBRILLATOR
0272
Variable
AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY
0460
94728
$577.00
ALBUMIN ASSAY
0301
82042
$25.00
ALBUMIN, SERUM
0301
82040
$25.00
ALCOHOL BIOMARKERS 1 OR 2 (ETHYL GLUCURONIDE)
0301
80321
$124.00
ALDOLASE ASSAY
0301
82085
$70.00
ALDOSTERONE ASSAY
0301
82088
$136.00
ALKALINE PHOSPHATASE
0301
84075
$27.00
ALKALINE PHOSPHATASE ISOENZYME
0301
84080
$104.00
ALLERGEN SPECIFIC IGE, EACH
0302
86003
$20.00
ALPHA 1 ANTITRYPSIN PHENOTYPE
0301
82104
$48.00
ALPHA FETO PROTEIN
0301
82105
$65.00
ALPHA FETOPROTEIN
0301
82105
$65.00
ALPHA FETOPROTEIN, TUMOR MARKER
0301
82105
$65.00
ALPHA-1-ANTITRYPSIN
0301
82103
$73.00
ALPHA-FETOPROTEIN (AFP) AMNIO FLUID
0301
82106
$109.00
ALSIUS CATH STARTER KIT (424164)
0272
$967.00
ALSIUS FEMORAL CATH 38CM (424163)
0272
$1,863.00
ALSIUS SUBCLAVAN CATH 22CM (424178)
0272
$1,451.00
AMBULATING OXIMETRY
0460
94761
$303.00
AMMONIA
0301
82140
$62.00
AMNIOCENTESIS-DIAGNOSTIC
0360
59000
$684.00
AMPHETAMINES; 1 OR 2
0301
80324
$88.00
AMYLASE ASSAY
0301
82150
$84.00
ANA BY IFA
0301
86039
$154.00
ANAEROBE CULTURE SURGICAL SP
0306
87075
$74.00
ANAEROBIC ID
0306
87076
$72.00
ANCHOR/SCREW FOR OPPOSING BONE TO BON
0278
C1713
Variable
ANESTHESIA INHALATION OR IV ADDL MINUTE
0370
$8.05
ANESTHESIA INHALATION OR IV FIRST 15 MINUTES
0370
$380.00
ANGIO CATH/GUIDEWIRE-CARDIAC
0272
Variable
ANGIOGRAPHY EXTREMITY UNILATERAL
0320
75710
$6,294.00
ANGIOTENSIN CONVERT ENZ
0301
82164
$62.00
ANTI MITOCHONDRIAL AB
0301
83516
$73.00
ANTI NUCLEAR ANTIBODY SCREEN
0301
86038
$126.00
ANTI-DNA DOUBLE STRAND
0301
86225
$90.00
ANTI-STRIATED MUSCLE AB, IGG
0301
86255
$72.00
ANTIBODY BRUCELLA
0302
86622
$30.00
ANTIBODY DETECTION NOS, EACH ORGANISM
0306
87299
$44.00
ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE
0302
86651
$44.00
ANTIBODY ENCEPHALITIS EASTERN EQUINE
0302
86652
$44.00
ANTIBODY ENCEPHALITIS ST. LOUIS
0302
86653
$44.00
ANTIBODY ENCEPHALITIS WESTRN EQUINE
0302
86654
$44.00
ANTIBODY ENTEROVIRUS
0302
86658
$43.00
ANTIBODY FRANCISELLA TULARENSIS
0302
86668
$38.00
ANTIBODY I.D. ELUATE
0302
86860
$382.00
ANTIBODY ID
0302
86870
$638.00
ANTIBODY LEPTOSPIRA
0302
86720
$65.00
ANTIBODY PROTOZOA NES
0302
86753
$56.00
ANTIBODY RICKETTSIA
0302
86757
$65.00
ANTIBODY SALMONELLA
0302
86768
$44.00
ANTIBODY TITER
0300
86850
$132.00
ANTIBODY TRICHINELLA
0306
86784
$42.00
ANTIBODY VIRUS NOT ELSEWHERE SPECIFIED
0302
86790
$43.00
ANTIBODY; TREPONEMA PALLIDUM
0306
86780
$65.00
ANTICARDIOLIPIN ABS, IGA, G OR M
0301
86147
$94.00
ANTINEUTROPHIL CYTOPLASMIC AB
0301
86021
$120.00
ANTITHROMBIN III ACTIV
0302
85300
$145.00
AORTA CATH (FEMORAL/AXILLARY)
0360
36200
$900.00
AORTIC ROOT-AORTOGRAPHY-ANG
0480
93567
$2,038.00
AORTOILIAC/IVC-ILIAC/GRAFT DUPLEX
0921
93978
$690.00
AORTOILIAC/IVC-ILIAC/GRAFT DUPLEX LTD
0921
93979
$621.00
APHASIA TESTING 1 HR
0440
$331.00
APHASIA TESTING 1 HR
0440
96105
$331.00
APILGRAF, PER SQ CENTIMETER
0278
Q4101
Variable
APP OF MULTI-LAYER VENOUS WOUND COMP BELOW KNEE-BILATERAL
0510
29581
$356.00
APP OF MULTI-LAYER VENOUS WOUND COMP BELOW KNEE-LT
0510
29581
$356.00
APP OF MULTI-LAYER VENOUS WOUND COMP BELOW KNEE-RT
0510
29581
$356.00
APP SKIN SUB GRAFT FIRST 25 SQ CM OR LESS TRUNK/ARM/LEG
0510
15271
$4,080.00
APP SKIN SUB GRAFT FIRST 25 SQCM OR LESS FACE/NECK/HF/G
0510
15275
$4,080.00
APPL MOD 1+ AREAS ELEC STIM MAN EA 15 MIN
0430
97032
$104.00
APPL MOD 1+ AREAS ULTRASOUND EACH 15 MINUTES
0420
97035
$74.00
APPL MODALITY 1+ AREAS ELECT STIM MANUAL EA 15 MIN
0420
97032
$104.00
APPL OF MOD 1+ AREAS ULTRASOUND EACH 15 MINUTES
0430
97035
$74.00
APPL OF MODALITY TO 1+ AREAS ELEC STIM UNATTENDED
0430
97014
$56.00
APPL OF MODALITY TO 1+ AREAS ELECTRICAL STIM UNATTENDED
0420
97014
$56.00
APPL OF MODALITY TO 1+ AREAS PARAFFIN BATH
0430
97018
$51.00
APPL OF MODALITY TO 1+ AREAS WHIRLPOOL
0430
97022
$131.00
APPL OF MODALITY TO ONE OR MORE AREAS WHIRLPOOL
0420
97022
$131.00
APPLICATION OF MODALITY TO 1+ AREAS IONTOPHORESIS EACH 15 MINUTE
0420
97033
$83.00
APPLICATION OF MODALITY TO 1+ AREAS IONTOPHORESIS EACH 15 MINUTE
0430
97033
$83.00
APPLICATION OF MODALITY TO 1+ AREAS TRACTION MECHANICAL
0420
97012
$83.00
APPLICATION OF RIGID TOTAL CONTACT LEG CAST
0510
29445
$760.00
APPLICATION OF TENS SURFACE TRANSCUTANEOUS NEUROSTIMULATOR
0420
64550
$149.00
ARROW DUAL LUMEN SLICK (7627)
0270
$87.00
ARSENIC ASSAY
0301
82175
$99.00
ARTERIAL DUPLEX BILATERAL LE
0921
93925
$917.00
ARTERIAL DUPLEX BILATERAL UE
0921
93930
$743.00
ARTERIAL DUPLEX UNILATERAL UE
0921
93931
$533.00
ARTERIAL LINE (451928)
0270
$69.00
ARTERIAL LINE (N/A)
0270
Variable
ARTERIAL PUNCTURE
0300
36600
$158.00
ARTHRO ASP/INJ INTERMED JT/BURSA W/O US GUID
0360
20605
$751.00
ARTHRO ASP/INJ INTERMED JT/BURSA W/US GUID W/PERM RECORD&REPORT
0360
20606
$890.00
ARTHRO ASP/INJ MAJOR JT/BURSA W/O US GUID
0360
20610
$703.00
ARTHRO ASP/INJ MAJOR JT/BURSA W/US GUID W/PERM RECORD&REPORT
0360
20611
$979.00
ARTHRO ASP/INJ SM JT/BURSA W/O US GUID
0360
20600
$586.00
ARTHRO ASP/INJ SM JT/BURSA W/US GUID W/PERM RECORD&REPORT
0360
20604
$603.00
ARTHROGRAM KNEE-DW
0320
73580
$488.00
ASPERGILLUS AB, SERUM
0302
86606
$61.00
ASPERGILLUS ANTIGEN DETECTION BY EIA
0300
87305
$270.00
ASPIRATION BLADDER W/INSERT OF SUPERA
0360
51102
$3,101.00
ASSAY OF ETHANOL
0301
80320
$175.00
ASSAY OF MYOGLOBIN
0301
83874
$66.00
ASSAY OF NICOTINE
0301
80323
$104.00
ASSAY OF OPIATES
0301
80361
$88.00
ASSAY OF PHENCYCLIDINE
0301
83992
$60.00
ASSAY OF SEX HORMONE BINDING GLOBULIN
0301
84270
$86.00
ASSAY TEST FOR BLOOD FECAL
0300
82274
$59.00
ATTENDANCE AT DELIVERY INITIAL STABILIZATION
0410
99464
$310.00
ATTENTION CURRENT STATUS
0430
G9165
$0.01
ATTENTION CURRENT STATUS
0440
G9165
$0.01
ATTENTION DISCHARGE STATUS
0440
G9167
$0.01
ATTENTION GOAL STATUS
0430
G9166
$0.01
ATTENTION GOAL STATUS
0440
G9166
$0.01
AUDITORY EVOKED RESPONSE AUDIOMETRY TESTING CENTRAL NERVOUS
0470
92585
$347.00
BAG BELMONT UNIVERSAL (7648)
0270
$362.00
BAG COLLECTION DRAINAGE (9069)
0270
$117.00
BAG DRAINAGE BECKER EDMS (9123)
0270
$117.00
BAG DRAINAGE LIMITORR (7769)
0270
$112.00
BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EA DUCT
0360
47542
$678.00
BALLOON DILAT URETERAL STRICT W/IMG GID RS&I
0360
50706
$3,531.00
BARBITURATES CONFIRMATION
0301
80345
$88.00
BASIC METABOLIC PANEL
0301
80048
$88.00
BASIC POWERGLIDE 18G X 10CM (435159)
0278
C1751
$138.00
BASIC POWERGLIDE 18G X 8CM (435157)
0278
C1751
$138.00
BASIC POWERGLIDE 20G X 10CM (435155)
0278
C1751
$138.00
BASIC POWERGLIDE 20G X 8CM (435153)
0278
C1751
$138.00
BCR ABL 1 GENE MAJOR BP
0300
81206
$547.00
BCR ABL 1 GENE MINOR BP
0300
81207
$702.00
BEHAVIORAL AND QUALITATIVE ANALYSIS VOICE/RESONANC
0440
$403.00
BEHAVIORAL AND QUALITATIVE ANALYSIS VOICE/RESONANC
0440
92524
$403.00
BENZODIAZEPINES CONFIRMATION
0301
80348
$88.00
BENZODIAZEPINES; 1-12
0301
80346
$99.00
BETA 2 GLYCOPROTEIN AB, EA
0302
86146
$85.00
BETA HCG
0301
84702
$56.00
BETA HCG TUMOR MARKER
0301
84702
$56.00
BETA HYDROXYBUTYRATE SERUM QUANT OTHER KETONE BODIES
0301
82010
$52.00
BETA LACTAMASE TEST
0306
87185
$33.00
BETA-2 MICROGLOBULIN, QUANTIT
0301
82232
$74.00
BILIRUBIN TOTAL
0301
82247
$35.00
BILIRUBIN,TOTAL,TRANCUTANEOUS
0300
88720
$25.00
BIOFEEDBACK TRAINING BY ANY MODALITY
0430
90901
$111.00
BIOFEEDBACK TRAINING PERINEAL MUSCLES ANORECTAL OR URETHRAL SPHI
0420
90911
$222.00
BIOPSY ABDOMINAL/RETROPERITONEAL,PERCUTANEOUS NEEDLE
0360
49180
$1,131.00
BIOPSY BONE TROCAR OR NEEDLE DEEP
0360
20225
$1,246.00
BIOPSY BONE TROCAR OR NEEDLE SUPERFICIAL
0360
20220
$2,207.00
BIOPSY MUSCLE PERCUTANEOUS NEEDLE
0360
20206
$760.00
BIOPSY OR EXCISION LYMPH NODE BY NEEDLE-SUPERFICIAL
0360
38505
$760.00
BIOPSY PLEURA PERCUT NEEDLE
0360
32400
$839.00
BIOPSY SKIN SUBCUTANEIOUS AND OR MUCOUS MEMBRANE 1 LESION
0510
11100
$591.00
BLADDER INSTILL OF ANTICARCINOGENIC AGENT (INC RETENTION TIME)
0761
51720
$650.00
BLEDSOE BRACE AK-100-22/4/6/8
0270
Variable
BLOOD DRAW-CENTRAL/PERIPHERAL LINE
0510
36592
$126.00
BLOOD DRAW-COMPLETE IMPLANTABLE VAD
0510
36591
$104.00
BLOOD TYPING,ANTIGEN TEST OF DONOR BL
0309
86902
$638.00
BLOOD TYPING;RBC ANTIGENS,OTHER THAN
0300
86905
$638.00
BNP
0301
83880
$261.00
BODY FLUID HEMATOCRIT (SPUN)
0305
85013
$45.00
BODY FLUID PH
0301
83986
$50.00
BODY FLUID PROTEIN
0301
84155
$27.00
BODY POSITION CURRENT STATUS
0420
G8981
$0.01
BODY POSITION CURRENT STATUS
0430
G8981
$0.01
BODY POSITION DISCHARGE STATUS
0420
G8983
$0.01
BODY POSITION DISCHARGE STATUS
0430
G8983
$0.01
BODY POSITION GOAL STATUS
0420
G8982
$0.01
BODY POSITION GOAL STATUS
0430
G8982
$0.01
BONE AGE STUDY
0320
77072
$425.00
BONE DENSITY STUDY, AXIAL
0320
77080
$508.00
BONE LENGTH STUDY
0352
77073
$279.00
BONE MARROW CHROMO/INTERP
0305
88237
$421.00
BONE MARROW SCAN W/B - NM
0341
78104
$1,295.00
BONE SCAN MULT VIEW W/FLOW-NM
0341
78315
$1,295.00
BONE SCAN MULTI VIEW-NM
0341
78305
$1,295.00
BONE SCAN WHOLE BODY-NM
0341
78306
$1,295.00
BOOT ROOKE HFS (7770)
0270
$289.00
BOOT TRUVUE (7257)
0270
$150.00
BORRELIA SMEAR
0306
87205
$53.00
BRACHY SOURCE HD IR 192
0278
C1717
$1,613.00
BRACHYTHERAPY CATHETERS
0272
C1728
$291.00
BRACHYTHERAPY SOURCE, NON STRANDED, YTTRIUM-90, PER SOURCE
0278
C2616
Variable
BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
0333
77316
$1,277.00
BREAST CORE NEEDLE (420582)
0272
$158.00
BREAST IMPLANTS
0278
C1789
Variable
BREAST NEEDLE LOC (404322,404320,404319)
0272
$71.00
BRIDLE NASAL TUBE RETAINING SYSTEM 12FR (E4-4112)
0272
$257.00
BRONCH BLOCKER 7FRX65CM (ARNDT) (422832)
0270
$506.00
BRONCH FORCEP (424905)
0272
$167.00
BRONCHO CATH - 28FR LEFT (95890) (30115)
0270
$140.00
BRONCHO CATH - 35FR LEFT (125035) (30113)
0270
$140.00
BRONCHO CATH - 37FR LEFT (95893) (30636)
0270
$140.00
BRONCHO CATH - 39FR LEFT (125039) (30111)
0270
$140.00
BRONCHOPROVOCATION
0460
94070
$803.00
BRONCHOSCOPY
0360
$2,685.00
BRONCHOSCOPY WITH BRONCHIAL THERMOSPLASTY
0360
$13,829.00
BS/MT CUTTING BALLOON
0272
C1725
$7,634.00
BUFFY COAT DIFFERENTIAL
0305
85009
$49.00
BUN
0301
84520
$27.00
BURR HOLE FOR CATH/RESERVOIR/PRESSUR
0360
61210
$2,593.00
BX BREAST 1ST LESION MR IMAGING
0360
19085
$2,098.00
BX BREAST 1ST LESION STRTCTC
0360
19081
$2,098.00
BX BREAST 1ST LESION US IMAGING
0360
19083
$2,098.00
BX BREAST ADD LESION STRTCTC
0360
19082
$2,098.00
BX BREAST ADD LESION US IMAGING
0360
19084
$2,098.00
BX NEEDLE, CATH, OR SUPPLIES
0270
Variable
BX PANCREAS PERCUT NEEDLE
0360
48102
$1,519.00
C DIFFICILE TOXIN A+B
0306
87324
$140.00
C REACTIVE PROTEIN (CRP)
0301
86140
$115.00
C-PEPTIDE
0301
84681
$70.00
C4
0300
86160
$98.00
CA 19-9
0301
86301
$101.00
CA125 ASSAY
0302
86304
$156.00
CALCITONIN ASSAY
0301
82308
$98.00
CALCIUM ASSAY
0301
82310
$27.00
CALCIUM ASSAY, URINE
0301
82340
$54.00
CALCIUM, IONIZED
0301
82330
$60.00
CALPROTECTIN FECAL
0301
83993
$216.00
CANALITH REPOSITION EPLEY MANEUVER SEMONT MAN PER DAY
0420
$129.00
CANALITH REPOSITION EPLEY MANEUVER SEMONT MAN PER DAY
0420
95992
$129.00
CANDIDA SPECIES DNA PROBE
0306
87480
$74.00
CANISTER 1000ML (7465)
0270
$190.00
CAPD TREATMENT
0800
G0257
$1,536.00
CAR SEAT/BED TESTING 60 MINUTES
0410
94780
$217.00
CAR SEAT/BED TESTING EA ADDL 30 MINUTES
0410
94781
$109.00
CARBOXYHEMOGLOBIN
0301
82375
$56.00
CARDIAC DOPPLER/NO INTERP
0480
93320
$336.00
CARDIAC REHAB W/O ECG MONITORING
0943
93797
$147.00
CARDIOPULMONARY RESUSCITATION
0480
92950
$632.00
CARDIOVERSION
0480
92960
$1,054.00
CARNITINE, FREE AND TOTAL, SERUM
0301
82379
$75.00
CAROTID STENT
0278
C1876
Variable
CARRY CURRENT STATUS
0420
G8984
$0.01
CARRY CURRENT STATUS
0430
G8984
$0.01
CARRY DISCHARGE STATUS
0420
G8986
$0.01
CARRY DISCHARGE STATUS
0430
G8986
$0.01
CARRY GOAL STATUS
0420
G8985
$0.01
CARRY GOAL STATUS
0430
G8985
$0.01
CASSETTE VERALINK (8057)
0272
$162.00
CATECHOLAMINES, UA FRACT
0301
82384
$111.00
CATH CVC 9FRX10CM DUAL (ARROW) (7454)
0270
$359.00
CATH CVP 16G 30 CM ONE LUMEN (2898)
0270
$66.00
CATH CVP 16GX20CM SINGLE (ARROW) (2906)
0270
$220.00
CATH CVP 4FR 13CM 2 L(PED) (9118)
0270
$97.00
CATH CVP 7FR 20CM 3 L (1637)
0270
$174.00
CATH CVP 7FRX20CM TRIPLE (ARROW) (1637)
0270
$188.00
CATH CVP 8.5FRX16CM 4 LUMEN (7629)
0272
$388.00
CATH CVP 8.5FRX20CM 4 LUMEN (7628)
0272
$388.00
CATH DOUBLE LUMEN CV KIT (7454)
0270
$334.00
CATH FEMORAL ARTERIAL LINE (7381)
0270
$94.00
CATH FOLEY TRAY 16FR TEMP SENS (7626)
0272
$115.00
CATH FOLEY TRAY W/
0270
Variable
CATH HEMODIALYSIS/PERITONEAL,LONG TER
0278
C1750
Variable
CATH INTRODUCER PERCU ARR 8.5 (6831)
0272
$147.00
CATH PIGTAIL (149594)
0270
$238.00
CATH PLACEMENT TO MEASURE TRANSPULM PRESSURES
0410
94799
$422.00
CATH PLC 2ND OR MORE SLCT BRCH
0360
36012
$5,335.00
CATH SUPPLY - ANGIO
0272
Variable
CATH SUPRAPUBIC 14FR 23CM (6287)
0270
$138.00
CATH SWAN CHANGE (NONE)
0272
$219.00
CATH SWAN GANZ (6978)
0272
$132.00
CATH SWAN-GANZ VIP 7.5FR (COOK) (6978)
0270
$131.00
CATH THORACIC KIT 28FR (3215)
0270
$92.00
CATH UMBILICAL 3.5 DUAL (7354 OR 434354)
0270
$112.00
CATH UMBILICAL 5.0 DUAL (7321)
0270
$94.00
CATH VENOUS PORT A (9029)
0270
$817.00
CATH VENT THORACIC TRUE (7175)
0272
$705.00
CATH, BALLOON
0272
C1726
Variable
CATH, OCCLUSION
0272
C2628
Variable
CATH, THROMBECTOMY/EMBOLECTOMY
0272
C1757
Variable
CATH,HEMODIALYSIS/PERITONEAL SHORT TE
0278
C1752
Variable
CATH/INTRO SALINE OR CONTRAST
0360
58340
$244.00
CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL
0410
31720
$425.00
CATHETER BRONCHO SIZE 35 RIGHT (30635)
0270
$165.00
CATHETER SET ON-Q OVER THE NEEDLE NOSTIM (439426)
0270
$78.00
CATHETER SET ON-Q OVER THE NEEDLE STIM (439428)
0270
$89.00
CATHETER SET ON-Q OVER THE NEEDLE STIM (439780)
0270
$94.00
CATHETER TRIALYSIS 15CM (7785)
0278
C1752
$593.00
CATHETER TRIALYSIS 20CM (7786)
0278
C1752
$593.00
CATHETER, DRAINAGE, PLEURA (9120)
0272
C1729
$1,547.00
CATHETER, EXTRAVASCULAR TISSUE ABLATION, ANY MODALITY
0272
C1886
Variable
CATHETER, GUIDING
0272
C1887
Variable
CATHETER, SKATER PIGTAIL (435731)
0272
$284.00
CATHETER, SUPRAPUBIC/CYSTOSCOPY
0272
C2627
Variable
CATHETER, TRANSLUMINAL ANGIOPLASTY, LASER
0272
C1885
Variable
CATHETER, URETERAL
0272
C1758
Variable
CATHETER,TRANSLUMINAL ANGIO,DRUG COATED,NON LASER
0272
C2623
Variable
CATHETER,TRANSLUMINAL ANGIO,NON LASER
0272
C1725
Variable
CBC (AUTOMATED)
0305
85027
$58.00
CBC WITH AUTOMATED DIFF
0305
85025
$81.00
CD4
0301
86361
$164.00
CEA ASSAY
0301
82378
$94.00
CELL CNT AND DIFFERENTIATION
0305
89051
$98.00
CELL COUNT AND DIFF BODY FLUID
0305
89051
$98.00
CELL COUNT CSF WITHOUT DIFF
0301
89050
$98.00
CERULOPLASMIN
0301
82390
$57.00
CERVICAL RIPENING BALLOON W/STYLET (434894)
0272
$129.00
CHANGE URETEROSTOMY TUBE OR EXTERNALL
0360
50688
$3,912.00
CHECKOUT ORTHO PROSTH USE EST PT EACH 15 MINUTES
0420
$105.00
CHECKOUT ORTHO PROSTH USE EST PT EACH 15 MINUTES
0420
97762
$105.00
CHEMICAL CAUT. OF GRAN. TISSUE
0510
17250
$308.00
CHEMO ADMIN,SQ OR IM, HORMONAL ANTI-NEOPLASTIC
0280
96402
$207.00
CHEMO ADMIN,SQ OR IM, NON-HORMONAL ANTI-NEOPLASTIC
0280
96401
$207.00
CHEMO IV INF 1ST HR SINGLE OR 1ST DRU
0280
96413
$633.00
CHEMO IV INF ADDT'L DRUG SEQ
0280
96417
$323.00
CHEMO IV INF ADDT'L HRS
0280
96415
$143.00
CHEMO IV PUSH EACH ADDT'L DRUG
0280
96411
$290.00
CHEMO IV PUSH SINGLE OR 1ST DRUG
0331
96409
$420.00
CHEMOTHERAPY ADMIN INTRA ARTERIAL PUSH TECHNIQUE
0331
96420
$341.00
CHEMOTHERAPY ADMINISTRATION CNS/INTRATHECAL
0331
96450
$997.00
CHEST PT AND PD
0410
94668
$184.00
CHLAMYDIA PNEUMONIAE CULTURE
0306
87110
$108.00
CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TECHNIQUE
0306
87491
$191.00
CHLORIDE URINE
0301
82436
$48.00
CHLORIDE, SERUM
0301
82435
$27.00
CHNG PRCUT DRAIN CATH W/CNTST
0320
75984
$355.00
CHOLANGIOGRAPHY SURGICAL
0320
74300
$298.00
CHOLANGIOGRAPHY SURGICAL ADDITIONAL VIEWS
0320
74301
$229.00
CHOLESTEROL
0301
82465
$27.00
CHROMIUM ASSAY
0301
82495
$168.00
CHROMOGRANIN-A
0301
86316
$138.00
CHROMOSOME ADDL KARYOTYPES
0301
88280
$93.00
CHROMOSOME ANAL TISSUE CULT
0301
88230
$388.00
CHROMOSOME ANALY AF OR CV 15 CELLS 1K WITH BANDING
0300
88267
$666.00
CHROMOSOME ANALYSIS ANALYZE 20-25 CELLS
0310
88264
$415.00
CHROMOSOME ANL; 15-20 CELLS, 2 KARYOTYPE, BANDING
0301
88262
$763.00
CISTERNOGRAPHY-NM
0341
78630
$1,677.00
CITRIC ACID, 24 HOUR URINE
0301
82507
$97.00
CKMB
0301
82553
$75.00
CLOG ZAPPER FEED TUBE (7081)
0270
$72.00
CLOSURE DEVICE VASCULAR
0272
C1760
$1,867.00
CLOTTING FUNCT ACTIVITY, NOS EA ANALYTE
0305
85397
$185.00
CO2
0301
82374
$48.00
COCAINE CONFIRMATION
0301
80353
$88.00
COCCIDIOIDES AB IGG OR IGM
0302
86635
$64.00
COGNITIVE SKILLS DEVELOPMENT
0430
$106.00
COGNITIVE SKILLS DEVELOPMENT
0430
G0515
$106.00
COGNITIVE SKILLS DEVELOPMENT
0440
G0515
$106.00
COLLAR VISTA UNIVERSAL (7853)
0270
$213.00
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
0300
36415
$28.00
COLONOSCOPY - SIMPLE
0360
$2,465.00
COLONOSCOPY FLX W/ EUS LIMITED STRUCTURES
0360
$3,130.00
COLONOSCOPY FLX W/ REMOVAL FOREIGN BODY(S)
0360
$3,130.00
COLONOSCOPY FLX W/COLL SPEC WHEN PFRMD
0360
$2,465.00
COLONOSCOPY FLX W/DECOMPRESSION
0360
$3,130.00
COLONOSCOPY FLX W/ENDOSCOPIC STENT PLACEMENT
0360
$3,130.00
COLONOSCOPY FLX W/SUBMUCOSAL INJECTION(S) ANY SUB
0360
$3,130.00
COLONOSCOPY FLX W/TRANSENDOSCOPIC BALLOON DILATION
0360
$3,130.00
COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION
0360
$3,130.00
COLOR FLOW DOPPLER
0480
93325
$538.00
COLUMN CHROMATOGRAPHY NON DRUG NOS EA SPEC
0301
82542
$256.00
COMMUNITY WORK REINTEGRATION TRAIN 15 MIN DIRECT 1/1
0420
97537
$87.00
COMMUNITY WORK REINTEGRATION TRAIN 15 MIN DIRECT 1/1
0430
97537
$87.00
COMP EPS W INDUCT
0480
93620
$8,226.00
COMPATABILITY TEST ANTIGLOBULIN
0309
86922
$382.00
COMPATABILITY TEST IMMEDIATE SPIN
0309
86920
$382.00
COMPATABILITY TEST INCUBATION PHASE
0309
86921
$382.00
COMPLEMENT, TOTAL (CH-50)
0301
86162
$102.00
COMPLEX STAIN FOR O AND P
0306
87209
$60.00
COMPREHENSIVE MET PANEL
0301
80053
$126.00
CONC FOR INFECTIOUS AGENT
0306
87015
$85.00
CONNECTIVE TISSUE, HUMAN (INCLUDES FA
0278
C1762
Variable
CONNECTIVE TISSUE,NON HUMAN
0278
C1763
Variable
CONTINUING MEDICAL PHYSICS
0333
77336
$481.00
CONTINUOUS NEBULIZER
0410
94645
$142.00
CONTINUOUS NEBULIZER 1ST HOUR
0410
94644
$142.00
CONTRAST C02
0636
A9698
$1.00
CONVERT PERQ NEPHROSTOMY CATH TO NEPHROURTRL CATH RS&I
0360
50434
$2,622.00
COPPER
0301
82525
$59.00
COR ARTERY(S) ONLY,INCL INJ/S&I
0480
93454
$8,931.00
COR ARTERY(S) ONLY,INCL INJ/S&I
0480
93456
$10,497.00
COR ARTERY(S) ONLY,W/GRAFTS,INCL INJ
0480
93457
$11,639.00
COR ARTERY(S),ONLY,W/GRAFTS,INCL INJ
0480
93455
$8,112.00
COR DOPPLER/PRESSURE EA ADDL
0480
93572
$428.00
COR DOPPLER/PRESSURE INI VESS
0480
93571
$1,001.00
COR PAK TUBE (166280)
0272
$106.00
CORONARY THROMBECTOMY
0480
92973
$7,159.00
CORTISOL, SERUM
0301
82533
$96.00
CORTISOL,FREE,24 HR URINE
0301
82530
$62.00
COUNT 15-20 CELLS
0305
88262
$763.00
COXIELLA BURNETII ANTIBODY (Q FEVER)
0302
86638
$58.00
CPAP ACUTE
0410
94660
$789.00
CPAP CHRONIC
0410
94660
$302.00
CPK
0301
82550
$64.00
CREATININE CLEARANCE
0301
82575
$76.00
CREATININE SERUM
0301
82565
$27.00
CREATININE, URINE RANDOM
0301
82570
$45.00
CRITICAL CARE 30-74 MINUTES
0450
99291
$2,641.00
CRITICAL CARE EACH ADDTNL 30 MIN
0450
99292
$773.00
CRYO AHF PART OF POOL
0390
P9012
$143.00
CRYOGLOBULINS QUAL OR SEMI QUANT
0301
82595
$39.00
CRYPTOCOCCUS ANTIGEN
0306
86403
$96.00
CRYPTOCOCCUS NEOFORM AG EIA
0306
87327
$48.00
CRYPTOSPORIDIUM AG DETECTION BY EIA
0306
87328
$59.00
CRYSTAL I.D
0307
89060
$86.00
CSF SHUNT PATENCY-NM
0341
78645
$1,677.00
CSF VDRL
0300
86592
$48.00
CT ABD AND PELVIS W/CONTRAST
0350
74177
$1,667.00
CT ABD AND PELVIS W/O AND W/CONTRAST
0350
74178
$1,834.00
CT ABD AND PELVIS W/O CONTRAST (OR OR
0350
74176
$1,421.00
CT ABDO/RETROPERITONEAL BIOPSY
0360
49180
$1,131.00
CT ABDOMEN W/CONTRAST
0350
74160
$1,667.00
CT ABDOMEN W/O AND W/CONTRAST
0350
74170
$1,834.00
CT ABDOMEN W/O CONTRAST
0350
74150
$709.00
CT ANGIO ABD AND PELVIS W/CON,INCLUDING NON CONTRT
0352
74174
$1,667.00
CT ANGIO ABDOMEN W/CONTRAST
0352
74175
$1,667.00
CT ANGIO ABDOMEN W/RUNOFFS
0350
75635
$2,068.00
CT ANGIO CHEST W/CONTRAST
0352
71275
$1,667.00
CT ANGIO HEAD W/CONTRAST
0350
70496
$1,667.00
CT ANGIO HEART AND COR BYPASS (WHEN P
0350
75574
$1,667.00
CT ANGIO LOWER EXTREMITY W/CONTRAST
0350
73706
$1,667.00
CT ANGIO NECK W/CONTRAST
0350
70498
$1,667.00
CT ANGIO PELVIS W/CONTRAST
0352
72191
$1,667.00
CT ANGIO UPPER EXTREMITY W/O AND W/CO
0350
73206
$1,667.00
CT CERVICAL SPINE W/CONTRAST
0350
72126
$2,685.00
CT CERVICAL SPINE W/O AND W/CONTRAST
0350
72127
$2,952.00
CT CERVICAL SPINE W/O CONTRAST
0350
72125
$709.00
CT CHEST W/CONTRAST
0350
71260
$1,667.00
CT CHEST W/O AND W/CONTRAST
0350
71270
$1,834.00
CT CHEST W/O CONTRAST
0350
71250
$758.00
CT COLONOGRAPHY-DIAGNOSTIC
0350
74261
$709.00
CT COLONOGRAPHY-SCREENING
0350
74263
$2,173.00
CT GUIDANCE AND MONITORING FOR ABLATION,PARENCHYMAL TISSUE
0350
77013
$1,673.00
CT GUIDANCE FOR NEEDLE PLACEMENT
0350
77012
$1,314.00
CT HEAD OR BRAIN W/CONTRAST
0351
70460
$1,667.00
CT HEAD OR BRAIN W/O AND W/CONTRAST
0351
70470
$1,834.00
CT HEAD OR BRAIN W/O CONTRAST
0351
70450
$709.00
CT HEART STRUCTURE W/CONTRAST
0350
75572
$1,667.00
CT INJ,N BLOCK,CELIAC PLEXUS W/O OR W/RX MONITORING
0360
64530
$1,913.00
CT LIMITED F/U
0350
76380
$377.00
CT LOWER EXTREMITY W/CONTRAST
0350
73701
$1,667.00
CT LOWER EXTREMITY W/O AND W/CONTRST
0350
73702
$1,834.00
CT LOWER EXTREMITY W/O CONTRAST
0350
73700
$709.00
CT LUMBAR SPINE W-W/O CONTRAST
0350
72133
$2,952.00
CT LUMBAR SPINE W/CONTRAST
0350
72132
$2,685.00
CT LUMBAR SPINE W/O CONTRAST
0350
72131
$709.00
CT MAXILLOFACIAL W/CONTRAST
0350
70487
$1,667.00
CT MAXILLOFACIAL W/O AND W/CONTRAST
0350
70488
$1,834.00
CT MAXILLOFACIAL W/O CONTRAST
0350
70486
$709.00
CT NECK W/CONTRAST
0350
70491
$1,667.00
CT NECK W/O AND W/CONTRAST
0350
70492
$1,834.00
CT NECK W/O CONTRAST
0350
70490
$709.00
CT ORBIT OR SELLA W/CONTRAST
0350
70481
$1,667.00
CT ORBIT OR SELLA W/O AND W/CONTRAST
0350
70482
$1,834.00
CT ORBIT OR SELLA W/O CONTRAST
0350
70480
$709.00
CT PELVIS W/CONTRAST
0350
72193
$1,667.00
CT PELVIS W/O AND W/CONTRAST
0350
72194
$1,834.00
CT PELVIS W/O CONTRAST
0350
72192
$709.00
CT RENAL BIOPSY PERCUT
0360
50200
$888.00
CT SIMULATION
0350
77014
$793.00
CT THORACENTESIS FOR ASPIRATION W/IMAGING
0360
32555
$1,265.00
CT THORACIC SPINE W/CONTRAST
0350
72129
$1,667.00
CT THORACIC SPINE W/O CONTRAST
0350
72128
$709.00
CT UPPER EXTREMITY W/CONTRAST
0350
73201
$1,667.00
CT UPPER EXTREMITY W/O AND W/CONTRAST
0350
73202
$2,470.00
CT UPPER EXTREMITY W/O CONTRAST
0350
73200
$709.00
CULTURE AEROBIC
0306
87070
$118.00
CULTURE BLOOD
0306
87040
$171.00
CULTURE FUNGAL
0306
87102
$156.00
CULTURE GRP B STREP ONLY
0306
87081
$92.00
CULTURE STOOL
0306
87045
$127.00
CULTURE STREP SCREEN ONLY
0306
87081
$92.00
CULTURE TYPING BY RNA/DNA PROBE EA CULT/ISOLATE
0306
87150
$130.00
CULTURE URINE
0306
87086
$78.00
CULTURE, STOOL ADDT'L PATHOGENS
0306
87046
$32.00
CULTURE, TYPING IMMUNOLOGIC METHOD, OTHER, PER ANTISERUM
0306
87147
$33.00
CULTURE,PRESUMPTIVE,PATHOGENIC ORGANI
0306
87081
$92.00
CUSTOM DELIVERY PACK (159654)
0272
Variable
CVVH CRRT TREATMENT
0800
G0257
$3,031.00
CYCLIC CITRUL PEPTIDE
0301
86200
$78.00
CYCLOSPORINE ASSAY(SANDIMMUNE)
0301
80158
$100.00
CYSTIC FIBROSIS GENE ANALYSIS
0300
81220
$1,503.00
CYSTOGRAM
0320
74430
$486.00
CYSTOGRAM-VOIDING-DW
0320
74455
$861.00
CYSTOURETHROSCOPY
0360
52000
$830.00
CYTOGENETIC AND MOLECULAR CYTOGENETICS INTERP & RPT
0311
88291
$53.00
CYTOMEG, DNA OR RNA AMP PROBE
0306
87496
$117.00
CYTOMEGALOVIRUS (CMV) QUANT (DNA OR RNA)
0306
87497
$364.00
CYTOMEGALOVIRUS AB, IGM
0302
86645
$72.00
CYTOMEGALOVIRUS, IGG
0302
86644
$65.00
CYTOPATHOLOGY EVAL FOR ADEQUACY OF FINE NEEDLE ASP FIRST EVAL
0311
88172
$382.00
CYTOPATHOLOGY FLUIDS WASHINGS OR BRUSHINGS SMEARS WITH INTERPRET
0311
88104
$224.00
CYTOPATHOLOGY FNA INTERP/REPORT EVALUATION OF FINE NEEDLE ASP
0311
88173
$202.00
CYTOPATHOLOGY SMEAR CONE CONCENTRATION TECHNIQUE SMEARS/INTERP
0311
88108
$138.00
CYTOPATHOLOGY SMEARS SLIDES MADE PREP SCREENING AND INTERP
0311
88161
$238.00
CYTOPATHOLOGY SMEARS SLIDES RECEIVED SCREENING/INTERPRETATION
0311
88160
$164.00
CYTOPATHOLOGY THIN LAYER PAP CERVICAL/VAGINAL PREP AND MANUAL
0311
88142
$82.00
D-DIMER, QUANT
0305
85379
$98.00
D-STAT DRY PATCH
0271
$165.00
DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<
0510
11044
$2,815.00
DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<
0510
11043
$1,122.00
DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
0510
11046
$964.00
DEBRIDEMENT OPEN WOUND 20 SQ CM/<
0510
97597
$497.00
DEBRIDEMENT OPEN WOUND EACH ADDL 20 SQ CM
0510
97598
$497.00
DEBRIDEMENT SQ, EA ADDTNL 20 SQ CM
0510
11045
$964.00
DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<
0510
11042
$591.00
DECALCIFICATION PROCEDURES LIST SEPARATE IN ADDITION TO CODE
0312
88311
$54.00
DECLOT OF ACCESS DEVICE/CATH
0761
36593
$523.00
DECLOTTING BY THROMB AGENT-IMPL VAD
0510
36593
$523.00
DEFIB PAD (4230)
0270
Variable
DELIVERY BIRTHING ROOM RESUCITATION
0410
99465
$562.00
DHEA (UNCONJUGATED)
0301
82626
$84.00
DHEA SULFATE-SEND OUT TEST
0301
82627
$90.00
DIABETES O/P SELF MGMT TRAIN GRP 2+ PER 30 MIN
0942
G0109
$44.00
DIABETES O/P SELF MGMT TRAINING SERVICES INDIV PER 30 MIN
0942
G0108
$101.00
DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
0360
38222
$3,639.00
DIAGNOSTIC BONE MARROW; ASPIRATION(S)
0360
38220
$1,770.00
DIAGNOSTIC BONE MARROW; BIOPSY(IES)
0360
38221
$1,563.00
DIALYSIS CATH IMPLANTABLE
0278
C1750
Variable
DIALYSIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
0360
36909
$19,899.00
DIALYSIS GRAFT DUPLEX
0921
93990
$526.00
DIAMONDBACK-ROTATIONAL
0272
C1724
Variable
DIFFERENTIAL, MANUAL
0305
85007
$35.00
DIFFUSION STUDY
0460
94729
$175.00
DIGOXIN ASSAY
0301
80162
$136.00
DILANTIN, TOTAL
0301
80185
$58.00
DILATE NEPH/URETER/URETHERA
0320
74485
$3,593.00
DILATE-NEPHROSTOMY TRACT-ANG
0360
50395
$4,562.00
DIRECT BILIRUBIN
0301
82248
$39.00
DIRECT COOMBS
0302
86880
$94.00
DONJOY ULTRASLING 11
0270
Variable
DONJOY ULTRASLING AB
0270
Variable
DOPPLER LIMITED OR F/U
0483
93321
$131.00
DOSIMETRY CALC-BASIC-GAP-NSO
0333
77300
$417.00
DRAIN ATRIUM HEART (6879)
0270
$119.00
DRAIN CHEST ATRIUM #3600 (6878)
0270
$95.00
DRAIN CHEST ATRIUM MINI 500 EX (7750)
0270
$191.00
DRAIN PLEUX BOTTLE (9121)
0270
$184.00
DRAIN VENTRICULAR (9122)
0270
$531.00
DRAIN, 8FR FLEXI-FIRM PIGTAIL
0272
$237.00
DRAINAGE CATHETER
0272
C1729
Variable
DRESS FERRIS POLYMEM (7392)
0270
$73.00
DRESSING AND OR DEBRIDEMENT PRTL-THKNS BURNS MEDIUM
0510
16025
$591.00
DRESSING PROMOGRAN PRISMA MATRIX
0272
$69.00
DRESSING VERAFLO (8056)
0272
$339.00
DRESSING VERAFLO CLEANSE WHITE MEDIUM (8119)
0272
$375.00
DRIVING OCCUPATIONAL THERAPY EVALUATION
0430
$232.00
DRUG TEST(S) LC/MS OR GC/MS 1-7 DRUG CLASSES
0301
G0480
$564.00
DRUG TESTS DEFINITIVE MULTI METHOD 15-21 CLASSES
0301
G0482
$537.00
DRUG TESTS PRESUMPTIVE ANY NUMBER CLASSES, PER DATE OF SERVICE
0300
80307
$302.00
DRUG TESTS PRESUMPTIVE ANY NUMBER CLASSES, PER DOS
0300
80307
$302.00
DRUG(S) DEFINITIVE QUAL OR QUANT NOS 1-3
0301
80375
$88.00
DUPLEX SCAN ABDOMINAL,PELVIC,SCROTAL,RETROPERIONEAL-LIMITED STUD
0921
93976
$1,016.00
DUPLEX SCAN EXTRACRANIAL ARTERIES-COMPLETE BILATERAL STUDY
0921
93880
$735.00
DUPLEX SCAN EXTRACRANIAL ARTERIES-UNILATERAL OR LIMITED STUDY
0921
93882
$503.00
DUPLEX SCAN LOWER EXTREMITY,ARTERIAL/GRAFT-UNILATERAL OR LIMITED
0920
93926
$634.00
EACH ADDITIONAL CYST
0360
19001
$154.00
EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTIONS PATH CONSULT
0312
88332
$145.00
EBUS
0360
$2,139.00
ECG 12 LEAD
0730
93005
$155.00
ECT BONE SCAN
0341
78320
$1,677.00
ECT BRAIN SCAN
0341
78607
$4,452.00
ED FACILITY FEE CLASS 1
0450
99281
$278.00
ED FACILITY FEE CLASS 2
0450
99282
$590.00
ED FACILITY FEE CLASS 3
0450
99283
$862.00
ED FACILITY FEE CLASS 4
0450
99284
$1,394.00
ED FACILITY FEE CLASS 5
0450
99285
$1,955.00
ED LAB CHLORIDE
0301
82435
$27.00
ED PROCEDURE LEVEL 1
0450
$245.00
ED PROCEDURE LEVEL 2
0450
$375.00
ED PROCEDURE LEVEL 3
0450
$767.00
ED PROCEDURE LEVEL 4
0450
$905.00
ED PROCEDURE LEVEL 5
0450
$1,440.00
EEG AWAKE AND ASLEEP 20-40 MIN
0740
95819
$968.00
EEG AWAKE AND DROWSY 20-40 MIN
0740
95816
$635.00
EEG EXTENDED, 41-60 MIN
0740
95812
$1,181.00
EEG EXTENDED, GREATER THAN 60 MIN
0740
95813
$1,393.00
EEG, AMBULATORY OR LONG TERM, 24 HRS
0740
95953
$1,703.00
EEG, VIDEO FOR SEIZURES, 24 HRS
0740
95951
$2,346.00
ELBOW ORTHOSIS W/O JOINTS CUSTOM FABRICATED
0274
L3702
$403.00
ELBOW ORTHOSIS WITH ADJ LOCK JNT PREFABRICATED W/ EXPERTISE
0274
L3760
$697.00
ELECTROLYTES, SERUM
0301
80051
$44.00
ELECTRONS, TELETHERAPY PLAN
0333
77321
$1,152.00
EMBOLIZATION COILS/PARTICLES
0278
Variable
EMBOLIZATION PROTECTIVE DEVICE
0272
C1884
Variable
ENDOLUMINAL BX BILIARY TREE PERQ ANY METH SINGLE/MULTI
0360
47543
$5,520.00
ENDOLUMINAL CORONARY IVUS OCT I&R EA ADDL VESSEL
0480
92979
$513.00
ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
0480
92978
$1,001.00
ENDOTRACH INTUBATION
0360
31500
$1,097.00
ENT NASOPHARYNGOSCOPE
0510
92511
$257.00
ENZYME ACTIV BLD, CELLS OR TISSUE; NONRADIOACTIVE SUBSTRATE, EA
0301
82657
$181.00
EP & ABLATE SUPRAVENT ARRHYT
0481
93653
$24,388.00
EP & ABLATE VENTRIC TACHY
0481
93654
$26,062.00
EP ABLATION 3D/VECTOR (CT)
0272
C1732
Variable
EP ABLATION 3D/VECTOR (NON CT)
0272
C1733
Variable
EP ABLATION NON 3D/VECTOR (CT)
0272
C2630
Variable
EP CATH NON 3D-20 OR MORE ELECTRODES
0272
C1731
Variable
EP CATH NON-3D 19 OR LESS ELECT
0272
C1730
Variable
EP EVAL + TEST ICD; INI OR REP
0480
93641
$5,748.00
EP MAPPING OF TACHYCARDIA
0480
93609
$571.00
EP SHEATH FIXED NON PEEL-AWAY
0272
C1893
Variable
EP SHEATH FIXED PEEL-AWAY
0272
C1892
Variable
EP SHEATH STEERABLE NON-PEEL
0272
C1766
Variable
EPIDURAL BLOCK ADDL MINUTE
0370
$4.55
EPIDURAL BLOCK FIRST 15 MINUTES
0370
$284.00
EPIDURAL TRAY (4222)
0270
Variable
EPIFIX, PER SQ CENTIMETER
0278
Q4131
Variable
EPSTEIN BARR AB TO EARLY AG
0302
86663
$84.00
EPSTEIN BARR AB TO NUCLEAR AG
0302
86664
$101.00
EPSTEIN BARR AB VCA
0302
86665
$70.00
EPSTEIN BARR AB VCA
0306
86665
$70.00
ERCP
0360
$4,512.00
ERCP-DW
0320
74330
$739.00
ERYTHROPOIETIN ASSAY
0301
82668
$77.00
ESOPHAGEAL MOTILITY
0750
91010
$2,145.00
ESOPHAGOGASTRODUODENOSCOPY W/INJ SCLEROSIS ESOPH/GASTRIC VARICES
0360
43243
$632.00
ESOPHAGOSCOPY
0360
$1,449.00
ESOPHAGUS-DW
0320
74220
$526.00
ESTRADIOL
0301
82670
$146.00
ESTROGEN FRACTIONATION
0301
82671
$182.00
ETHOSUXIMIDE ASSAY (ZARONTIN)
0301
80168
$56.00
ETHYLENE GLYCOL
0301
82693
$202.00
EVAL FOR SPEECH DEVICE RX EACH ADDL 30 MIN
0444
92608
$235.00
EVAL NON SPEECH GEN AUGMENT ALTERNATIVE COMM DEVICE 1ST HR
0440
92605
$235.00
EVAL NON SPEECH GEN AUGMENT ALTERNATIVE COMM DEVICE 1ST HR
0440
$235.00
EVAL OF PT NEBULIZER
0410
94664
$161.00
EVAL OF SPEECH FLUENCY
0440
92521
$235.00
EVAL OF SPEECH PRODUCTION
0440
$235.00
EVAL OF SPEECH PRODUCTION
0440
92522
$235.00
EVAL OF SPEECH PRODUCTION W/LANG COMP & EXPRESSION
0440
$235.00
EVAL OF SPEECH PRODUCTION W/LANG COMP & EXPRESSION
0440
92523
$235.00
EVAL PACG CVDFB PROGRM/REPROGRM PARAMETERS
0480
93642
$1,601.00
EVAL PRESCRIPT SPEECH GENERAT AUG DEVICE FACE TO FACE 1ST HR
0440
92607
$235.00
EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION
0440
$235.00
EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION
0440
92610
$235.00
EVASC PLMT ILIAC ART OCCLS DEVICE
0360
34808
$230.00
EVASC PLMT PROX XTN PRSTH DESC THORAC AORTA RS&I
0320
75958
$3,568.00
EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
0320
75957
$3,568.00
EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
0320
75956
$3,568.00
EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
0360
34705
$35,004.00
EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
0360
34703
$35,004.00
EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
0360
33880
$20,524.00
EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
0360
33881
$20,524.00
EVENT MONITOR HOOK UP
0731
93270
$302.00
EVENT RECORDER CARDIAC
0278
C1764
Variable
EWHO RIGID W/O JOINTS CUSTOM FABRICATED
0274
L3763
$1,092.00
EXCHANGE BILIARY DRAIN CATH W/IMG GID RS&I
0360
47536
$4,259.00
EXCHANGE DRAINAGE CATH
0360
49423
$3,344.00
EXPLORATORY LAP W/WO BIOPSY
0360
49000
$2,622.00
EXPORT ASPIRATION CATHETER
0272
C1757
$5,769.00
EXT VENOUS DUPLEX BILATERAL UE/LE
0921
93970
$754.00
EXT VENOUS DUPLEX UNILATERAL UE/LE
0921
93971
$533.00
EXTERNAL CEPHALIC VERSION WITH OR WITHOUT TUCOLYSIS
0761
59412
$2,042.00
EXTRACTABLE NUCLEAR ANTIGEN
0300
86235
$74.00
EXTREMITY BILATERAL-ANG
0320
75716
$6,294.00
EXTREMITY VENOGRAPHY-BILATERAL
0320
75822
$2,030.00
EXTREMITY VENOGRAPHY-UNILATERAL
0320
75820
$2,030.00
EZ-IO INTRAOSSEOUS NEEDLE
0272
$359.00
F2 GENE ANALYSIS PT COAG FACTOR II
0300
81240
$352.00
F5 GENE ANALYSIS LEIDEN VARIANT
0300
81241
$322.00
FACTOR 8 RISTOCETIN COFACTOR
0302
85245
$158.00
FACTOR IX ACTIVITY
0302
85250
$147.00
FACTOR VIII ACTIVITY
0302
85240
$105.00
FACTOR VIII RELATED ANTIGEN
0302
85246
$182.00
FATS OR LIPIDS, FECES; QUALITATIVE
0301
82705
$18.00
FECAL FAT 72 HR
0301
82710
$105.00
FECAL LACTOFERRIN QUAL
0301
83630
$77.00
FEMSTOP COMPRESSION ARCH (9057)
0270
$247.00
FERRITIN
0301
82728
$123.00
FETAL CGEN ABNOR FOUR ANALYTES
0300
81511
$384.00
FETAL CGEN ABNOR TWO PROTEINS
0300
81508
$243.00
FETAL FIBRONECTIN
0301
82731
$458.00
FETAL NON STRESS TEST
0920
59025
$441.00
FIBRINOGEN LEVEL
0302
85384
$74.00
FILTER VAPOR CLEAN (433939)
0270
$219.00
FINE NEEDLE ASP W/O GUIDANCE
0360
10021
$591.00
FINE NEEDLE ASPIRATION W/IMAGING GUIDANCE
0360
10022
$1,101.00
FINGER OTHOSIS W/O JOINTS CUSTOM FABRICATED
0274
L3933
$298.00
FIRST TISSUE BLOCK WITH FROZEN SECTIONS SINGLE SPECIMEN CONSULT
0312
88331
$382.00
FLEXIBLE ENDO EVAL SWALLOW C/V RECORDING
0440
92612
$235.00
FLEXIBLE ENDO EVAL SWALLOW C/V RECORDING
0440
$235.00
FLEXIBLOCK ECHO CATH 17GA X 9CM (442077)
0270
$97.00
FLOW CYTO EA ADD MARKER
0301
88185
$136.00
FLOW CYTO FIRST CELL MARKER
0301
88184
$638.00
FLOW CYTOMETRY EACH ADDL
0305
88185
$88.00
FLOW CYTOMETRY FIRST MARKER
0301
88184
$638.00
FLUIDOTHERAPY
0420
97039
$66.00
FLUIDOTHERAPY
0430
97039
$66.00
FLUORESCENT NONINFECTIOUS AGENT ANTIB
0301
86256
$77.00
FLUORESCENT NONINFECTIOUS AGENT, EACH ANTIBODY
0301
86255
$72.00
FLUORO CVC PLACE REPLAC REM
0320
77001
$278.00
FLUORO GUIDE NEEDLE PLCMNT
0320
77002
$423.00
FLUORO NEEDLE GUIDE, SPINAL
0320
77003
$348.00
FLUOROSCOPY UP TO 1 HOUR
0320
76000
$416.00
FO PIP/DIP W/O JNT/SPR EXT/FLEX PREFABRICATED
0274
L3927
$48.00
FO PIP/DIP WITH NONTORS JNT/SPRING PREFABRICATED
0274
L3925
$91.00
FOLATE ASSAY
0301
82746
$92.00
FSH
0301
83001
$113.00
FUHRMAN DRAINAGE TUBE
0272
C1729
$308.00
FULL POWERGLIDE 18G X 10CM (435160)
0278
C1751
$246.00
FULL POWERGLIDE 18G X 8CM (435158)
0278
C1751
$246.00
FULL POWERGLIDE 20G X 10CM (435156)
0278
C1751
$226.00
FULL POWERGLIDE 20G X 8CM (435154)
0278
C1751
$226.00
FUNGUS ANTIBODIES
0302
86671
$68.00
G TUBE 24FR (420098)
0272
$88.00
G/J TUBE CHANGE W/FLUORO
0360
49452
$2,535.00
GABAPENTIN QUANTITATIVE
0301
80171
$95.00
GALL BLADDER TUBE PLCMENT
0360
47490
$4,605.00
GARDNERELLA DNA PROBE
0306
87510
$74.00
GASES, BLOOD ARTERIAL OR VENOUS
0301
82803
$182.00
GASTRIC EMPTYING-NM
0341
78264
$1,295.00
GASTRIC LAP BAND ADJUSTMENT
0510
43999
$95.00
GASTRIN, SERUM RIA
0301
82941
$73.00
GASTRO TUBE CHANGE/REPOSITION
0360
9018479
$886.00
GASTRO-JEJUNOSTOMY TUBE REPLACEMENT W/FLOUROSCOPY
0320
49452
$2,535.00
GASTROCCULT
0307
82271
$26.00
GASTROESOPH RFLX TST (PH)
0750
91034
$926.00
GASTROSCOPY - SIMPLE
0360
$1,875.00
GASTROSTOMY TUBE CHANGE W/FLUORO
0360
49450
$1,963.00
GATED CARDIAC SCAN-NM
0341
78472
$1,295.00
GENERAL HEALTH PANEL
0300
80050
$267.00
GENERATOR, NEUROSTIM (IMPLANT), HIGH FREQ, W/RECHA
0278
C1822
Variable
GENERATOR,NEUROSTIM (IMPLANT),W/RECHA
0278
C1820
Variable
GENERATOR,NEUROSTIMULATOR (IMPLANTABL
0278
C1767
Variable
GENTAMICIN - RANDOM
0301
80170
$126.00
GGT
0301
82977
$32.00
GI BLOOD LOSS SCAN-NM
0341
78278
$1,295.00
GIARDIA ANTIGEN BY EIA
0306
87329
$75.00
GLUCOSE 6 PD QUANTITATIVE
0301
82955
$95.00
GLUCOSE ASSAY
0301
82947
$27.00
GLUCOSE ASSAY, POST DOSE
0301
82950
$73.00
GLUCOSE BODY FLUID
0301
82945
$39.00
GLUCOSE TOL TEST, EACH ADDN
0301
82952
$35.00
GLYCOSYLATED HEMOGLOBIN
0301
83036
$73.00
GRAFTJACKET
0278
Q4107
Variable
GRAM STAIN
0306
87205
$53.00
GROSHONG CATHETER
0278
C1751
Variable
GROUP 1 GMS STAINS FOR MICROORGANISM
0312
88312
$301.00
GROUP 1 PNEUMOCYSTIS FUNGAL STAINS FOR MICROORGANISM
0312
88312
$301.00
GROUP 2 SPECIAL STAINS ALL OTHER
0312
88313
$145.00
GROWTH HORMONE ASSAY
0301
83003
$87.00
GTUBE REMOVE/CHECK
0761
99211
$174.00
GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR
0333
77387
$320.00
GUIDANCE PERCUTANEOUS DRAIN W/CATH
0320
75989
$568.00
GUIDANCE PERCUTANEOUS DRAINAGE W/PLACEMENT OF CATHETER
0350
75989
$568.00
GUIDE CATHETER
0272
C1887
Variable
GUIDE WIRE
0272
C1769
Variable
GUIDEWIRE
0272
C1769
Variable
H PYLORI (C-13) BREATH ANALYSIS UREASE ACT NON-RADACT ISTOPE
0300
83013
$225.00
H PYLORI ANTIGEN STOOL
0306
87338
$124.00
HAND FINGER ORTHOSIS W/O JNTS PREFABRICATED OTS
0274
L3924
$110.00
HAND FINGER ORTHOSIS W/O JNTS PREFABRICATED W/ EXPERTISE
0274
L3923
$138.00
HAND FINGER ORTHOSIS W/O JOINTS CUSTOM FABRICATED
0274
L3913
$378.00
HAPTOGLOBIN
0301
83010
$73.00
HAWKINS-AKINS 18G NEEDLE
0272
$105.00
HCG SCREEN
0301
84703
$67.00
HCG, URINE
0307
81025
$48.00
HCHRG AMNIOCENTESIS-DIAGNOSTIC
0360
59000
$684.00
HCHRG FINE NEEDLE ASPIRATION W/IMAGING GUIDANCE
0360
10022
$1,101.00
HCV GENOTYPE
0301
87902
$858.00
HCV RNA QUANT BY PCR ULTRASEN
0301
87522
$437.00
HDR ELECTRONIC BRACHYTHERAPY SKIN
0333
0394T
$1,049.00
HEART VALVE
0278
Variable
HEEL WEDGE
0274
L3350
$35.00
HELICOBACTER PYLORI IGG
0306
86677
$86.00
HELIUM/OXYGEN DAILY
0271
$361.00
HEMATOCRIT (AUTOMATED)
0305
85014
$26.00
HEMOCHROMATOSIS GENE ANALYSIS
0300
81256
$365.00
HEMOGLOBIN (AUTOMATED)
0305
85018
$26.00
HEMOGLOBIN CHROMOTOGRAPHY
0305
83021
$64.00
HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS
0301
83020
$54.00
HEMOSIDERIN, URINE
0305
83070
$108.00
HEPARIN ASSAY
0305
85520
$146.00
HEPARIN NEUTRALIZATION
0300
85525
$47.00
HEPARIN-PF4 ANTIBODY (HIT)
0302
86022
$318.00
HEPATIC FUNCTION PANEL
0301
80076
$101.00
HEPATITIS A ANTIBODY (IGM)
0301
86709
$64.00
HEPATITIS A VIRUS AB, TOTAL
0301
86708
$80.00
HEPATITIS B CORE AB (IGM)
0301
86705
$94.00
HEPATITIS B CORE ANTIBODY, TOT
0301
86704
$163.00
HEPATITIS B SURF AG
0301
87340
$74.00
HEPATITIS B SURG AG NEUTRALIZATION
0302
87341
$92.00
HEPATITIS B VIRAL DNA, PCR QUANT
0306
87517
$300.00
HEPATITIS BE ANTIBODY
0300
86707
$62.00
HEPATITIS BE ANTIGEN EIA
0300
87350
$52.00
HEPATITIS C ANTIBODY
0301
86803
$125.00
HERNIA MESH
0278
C1781
Variable
HEXAGONAL PHOS NEUT 85598
0301
85598
$81.00
HFO WITH 1 OR MORE NONTORSION JNTS CUSTOM FABRICATED
0274
L3921
$448.00
HIAA-5 24HR URINE
0301
83497
$76.00
HIGH FLOW THERAPY (432406)
0270
$304.00
HIGH SENSITIVITY CRP
0301
86141
$115.00
HIP ABDUCTION PILLOW 1916S/M/L
0270
Variable
HISTOPLASMA YEAST
0306
86698
$47.00
HIV 1 AND HIV 2 ANTIBODIES WITH HIV 1 ANTIGEN
0302
87389
$148.00
HIV 1 ANTIBODY
0302
86701
$190.00
HIV 2 ANTIBODY
0302
86702
$77.00
HIV1 QUANT BY RNA OR DNA
0306
87536
$421.00
HLA B27
0300
86812
$126.00
HLA CLASS I&II ANTIBODY QUAL
0300
86828
$173.00
HLA I TYPING 1 LOCUS LR
0300
81373
$523.00
HLA II, HIGH RESOLUTION, 1 ALLELE OR ALLELE GROUP, EACH
0310
81383
$452.00
HLA II, LOW RESOLUTION, 1 LOCUS, EACH
0310
81376
$507.00
HLTH & BEHAVIOR ASSMT EA 15 MIN W/PT, INITIAL
0900
96150
$129.00
HLTH & BEHAVIOR INTERVENTION EA 15 MIN W/PT
0900
96152
$129.00
HOLTER MONITOR UP TO 48 HR-HOOKUP
0731
93225
$366.00
HOLTER MONITOR UP TO 48 HR-W/REPORT
0731
93226
$612.00
HOMOCYSTEINE
0301
83090
$101.00
HOMOGENIZE TISSUE
0306
87176
$46.00
HOT ICE PAD (7345)
0270
$150.00
HOVER MAT DISP (7652)
0270
$213.00
HPYORI DRUG ADMINISTRATION
0300
83014
$32.00
HSV TYPE 1 AND 2, IGM AB
0306
86694
$65.00
HSV TYPE 1, IGG AB
0302
86695
$56.00
HSV TYPE 2, IGG AB
0302
86696
$67.00
HYSTEROSALPINGOGRAM-DW
0320
74740
$861.00
I & D ABSCESS COMPLICATED/MULTIPLE
0510
10061
$598.00
I & D ABSCESS SIMPLE/SINGLE
0510
10060
$308.00
IADNA DNA/RNA ZIKA VIRUS AMPLIFIED PROBE TQ
0306
87662
$171.00
IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP
0306
87498
$117.00
IADNA STREPTOCOCCU GROUP B AMPLIFIED PROBE TQ
0306
87653
$130.00
IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH
0306
87661
$117.00
IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11
0306
87506
$711.00
ICD GENERATOR BI-V
0275
C1882
Variable
ICD GENERATOR DUAL CH
0275
C1721
Variable
ICD GENERATOR SINGLE CH
0275
C1722
Variable
IDENTIFICATION SENTINEL NODE
0360
38792
$1,295.00
ILEOSCOPY/JEJUNOSCOPY
0360
$3,377.00
IMAGE GUIDE FLUID COLLECT CATH,PE/RETROPE/PERQ
0360
49406
$3,274.00
IMAGE GUIDE FLUID COLLECT CATH,SOFT TISSUE,PERQ
0360
10030
$2,832.00
IMAGE GUIDE FLUID COLLECT CATH,VISCERAL,PERQ
0360
49405
$2,866.00
IMMATURE PLATELET FRACTION
0305
85055
$136.00
IMMUNIZATION ADMIN-ONE VACCINE
0771
90471
$97.00
IMMUNIZATION: EA ADDL VACC
0771
90472
$57.00
IMMUNOASSAY FOR ANALYTE QUAL OR SEMIQUANT MULTI STEP
0301
83516
$73.00
IMMUNOASSAY FOR ANALYTE QUANT BY RIA
0301
83519
$125.00
IMMUNOASSAY FOR ANALYTE QUANTITATIVE
0301
83520
$74.00
IMMUNOASSAY FOR INF AGENT QT,HEP B SU
0301
86317
$82.00
IMMUNOASSAY TUMOR ANTIGEN QUANT 15-3 (27.29)
0302
86300
$89.00
IMMUNOASSAY, EACH
0301
83520
$74.00
IMMUNOFIXATION PROCEDURE
0301
86334
$266.00
IMMUNOFIXATION URINE
0301
86335
$266.00
IMMUNOGLOBULIN
0301
82784
$104.00
IMMUNOGLOBULIN IGE
0301
82785
$64.00
IMMUNOGLOBULIN SUBCLASSES 1 2 3 OR 4 EACH
0301
82787
$42.00
IMMUNOHISTOCHEM PER SPEC EA ADDL SINGLE AB STAIN
0312
88341
$290.00
IMMUNOHISTOCHEM PER SPEC EA MULTIPLEX AB STAIN
0312
88344
$638.00
IMMUNOHISTOCHEM PER SPEC INITIAL AB STAIN
0312
88342
$638.00
IMMUNOSAY INFECTIOUS AGENT AB OR AG QUAL OR SEMI QUAL
0301
83516
$73.00
IMPELLA 2.5
0275
Variable
IMPLANT, INFUSION PORT
0278
C1788
Variable
IMPLANTED VENOUS ACCESS DEVICE IRRIGA
0510
96523
$78.00
IMPLATABLE WIRELESS PULM ARTERY PRESSURE SENSOR W/ CATH
0278
C2624
Variable
IMPLT PT-ACT CARD EVENT REC
0360
33282
$10,880.00
IN SITU HYBRIDIZATION EACH PROBE
0310
88365
$382.00
INCISION AND DRAINAGE HEMATOMA SEROMA OR FLUID COLLECTION
0360
10140
$2,467.00
INCISION AND DRAINAGE PELVIS OR HIP-DEEP
0360
26990
$2,385.00
INCISION AND DRAINAGE-SIMPLE OR SINGLE
0360
10060
$308.00
INEXSUFFLATOR TREATMENT
0410
Variable
INF AG DET BY DNA OR RNA NOS QUANT EA ORGANISM
0306
87799
$396.00
INF AGENT BY DNA/RNA HSV AMP PROBE
0306
87529
$150.00
INF AGENT DET NUCL ACID CLOSTRIDIUM AMP PROBE
0306
87493
$223.00
INF AGENT DNA/RNA NOS AMP PROBE EA ORGANISM
0306
87798
$232.00
INF AGENT GENOTYPE DNA/RNA HEP B VIRUS
0300
87912
$858.00
INFECT AG BY NA CHLAMYDIA PNEUMONIAE AMP PROBE
0306
87486
$159.00
INFECT AGENT DET BY NA RESP VIRUS 12 TO 25 TARGETS
0306
87633
$1,389.00
INFECTION - LIMITED SCAN
0341
78805
$4,452.00
INFECTION - WHOLE BODY SCAN
0341
78806
$4,452.00
INFECTIOUS AGENT AG IMMUNOASSAY;HISTOPLASMA
0306
87385
$163.00
INFECTIOUS AGENT BY DNA/RNA STAPH AUREUS AMP PROBE
0306
87640
$148.00
INFECTIOUS AGENT DETECT NUCLEIC ACID
0306
87798
$232.00
INFLATION DEVICE (ELECT)
0272
$460.00
INFLUENZA ANTIGEN A OR B, EACH
0306
87400
$129.00
INFUSION CATHETER
0272
C1751
Variable
INHALATION TREATMENT
0410
94640
$161.00
INHIBIN A
0301
86336
$110.00
INITIAL ORTHO MGMT TRAIN UP LOW EXTR OR TRUNK EA 15 MIN
0430
$113.00
INITIAL ORTHO MGMT TRAIN UPPER LOWER EXTREMITY OR TRUNK EA 15 MIN
0430
97760
$113.00
INITIAL ORTHO MGMT TRAINING UPPER/LOWER EXTREM AND OR TRUNK EA 15 MIN
0420
$113.00
INITIAL ORTHO MGMT TRAINING UPPER/LOWER EXTREM AND OR TRUNK EA 15 MIN
0420
97760
$113.00
INITIAL PROSTHETIC TRAINING 15 MIN
0420
97761
$81.00
INITIAL PROSTHETIC TRAINING 15 MIN
0430
97761
$81.00
INJ ANESTHETIC AGENT OTHER PERIPHERAL NERVE BLOCK
0360
64450
$735.00
INJ ANTEGRDE NFROSGRM AND/OR URTRGRM IMG GUIDE RS&I; NEW ACCESS
0360
50430
$1,298.00
INJ ANTEGRDE NFROSGRM AND/OR URTRGRM IMGGUIDE RS&I; EXISTING
0360
50431
$1,298.00
INJ CHOLANGIO W/IMG INCLUDE IMG GUIDANCE RS&I; EXSISTING ACCESS
0360
47531
$871.00
INJ CHOLANGIO W/IMG INCLUDE IMG GUIDANCE RS&I; NEW ACCESS
0360
$445.00
INJ EVAL OF PREVIOUSLY PLACED PERITONEAL-VENOUS SH
0360
49427
$583.00
INJ KNEE ARTHROGRAPHY
0360
27370
$305.00
INJ LUMB/SAC DX/TX SUBST INCL NEEDL OR CATH W/GUID
0350
62323
$1,328.00
INJ PROC CONTRAST VENOGRAM
0360
36005
$2,314.00
INJ SELECTIVE LT VENTRICAL OR ART ANGIOGRAPHY
0480
93565
$1,383.00
INJ, INTERCOSTAL NERVES-MULTIPLE
0360
64421
$1,746.00
INJ, INTERCOSTAL NERVES-SINGLE
0360
64420
$1,995.00
INJ,ANES AGENT,FEMORAL,SINGLE
0360
64447
$1,328.00
INJ,ANES AGENT,INTERSCALENE,SINGLE
0360
64415
$1,274.00
INJECT,EVAL EXIST GASTRO OR G/J TUBE
0360
49465
$513.00
INJECTION EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W/GUIDANCE
0360
64483
$1,888.00
INJECTION EPIDURAL OF BLOOD OR CLOT PATCH
0360
62273
$786.00
INJECTION FOR EVAL OF EXISTING CENTRAL VENOUS ACCESS DEVICE
0360
36598
$490.00
INJECTION PROCEDURE LOOP O GRAM
0320
50690
$111.00
INJECTION PROCEDURE SACROILIAC JOINT ARTHROGRAPHY AND/OR ANESTHE
0360
27096
$826.00
INJECTION PROCEDURE-CYSTOGRAM
0320
51600
$140.00
INJECTION PROCEDURE-ELBOW ARTHROGRAM
0360
24220
$251.00
INJECTION PROCEDURE-HIP ARTHROGRAM
0360
27093
$536.00
INJECTION PROCEDURE-SHOULDER ARTHROGRAM
0360
23350
$1,022.00
INJECTION PROCEDURE-URETHROCYSTOGRAPHY
0360
51610
$263.00
INJECTION PROCEDURE-WRIST ARTHROGRAM
0360
25246
$376.00
INJECTION SINUS TRACT DIAGNOSTIC
0360
20501
$225.00
INJECTION SQ OR IM TX,DX,PROPH
0761
96372
$123.00
INS/REP PERM CVDFB TRNSVEN LEADS 1/2 CHAMBER
0480
33249
$36,245.00
INS/REPL PERM PCMKR ART/VENT
0360
33208
$16,523.00
INS/REPL PERM PCMKR ATRIAL
0360
33206
$19,083.00
INS/REPL PERM PCMKR VENT
0360
33207
$13,512.00
INS/REPL PULSE GEN 1 CH A/V
0360
33212
$13,112.00
INS/REPLACE PERM SUBQ IMPLNT EFB W/SUBQ ELTRODE
0481
33270
$30,449.00
INSERT 1 TRANSVNS ELECTRODE PERM PM OR CVDFB
0360
33216
$11,787.00
INSERT 2 TRANSVNS ELECTRODE PERM PM OR CVDFB
0360
33217
$8,696.00
INSERT ELECTRODE CAR VEN SYS ATTCH PM/CVDFB PLS GEN
0360
33224
$18,295.00
INSERT ELECTRODE CAR VEN SYS TM INS PM/CVDFB PLS GEN
0360
33225
$19,406.00
INSERT HEPATIC SHUNT (TIPS)
0360
37182
$4,989.00
INSERT IAB ASSIST DEV PRQ
0480
33967
$1,459.00
INSERT INTRAVASCULAR VENA CAVA FILTER
0480
37191
$10,282.00
INSERT NON-TUN CV CATH,5YR OR OLDER
0360
36556
$2,711.00
INSERT TEMPORARY INDWELLING BLADDER CATHETER, SIMPLE (EG, FOLEY)
0450
51702
$302.00
INSERT TEMPORARY PACER
0480
92953
$1,232.00
INSERT TUNNEL CVC W/O PORT/PUMP >5YRS
0360
36558
$5,424.00
INSERT UTERINE TANDEMS OVOIDS
0333
57155
$4,437.00
INSERT VAD ARTERY ACCESS
0481
33990
$2,749.00
INSERTION FLOW DIRECTED CATH FOR MONITORING EG,SWAN-GANZ
0480
93503
$4,202.00
INSERTION OF DRUG DELIVERY IMPLANT
0761
11981
$275.00
INSERTION OF NON-INDWELLING BLADDER CATHETER
0761
51701
Variable
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER SIMPLE
0360
51702
Variable
INSTILLATION, AGENT FOR FIBRINOLYSIS; INITIAL DAY
0761
32561
$1,761.00
INSTILLATION, AGENT FOR FIBRINOLYSIS; SUBSEQUENT DAY
0761
32562
$1,761.00
INSTILLATION, AGENT FOR PLEURODESIS
0761
32560
$1,761.00
INSULIN, SERUM
0301
83525
$68.00
INTENSITY MODULATED RADIATION TX DLVR COMPLEX
0333
77386
$1,865.00
INTENSITY MODULATED RADIATION TX DLVR SIMPLE
0333
77385
$1,865.00
INTERCEED 4350
0272
Variable
INTERJECT GI SCLERO NEEDLE (421514)
0272
$164.00
INTERPRETATION/REPORT
0310
88291
$93.00
INTERVENTN ABLATION (ARGON)
0360
$1,800.00
INTERVENTN BAND LIGATION
0360
$1,965.00
INTERVENTN BRUSHING/WASHING
0360
$133.00
INTERVENTN BX
0360
$548.00
INTERVENTN CONTROL OF BLEEDING
0360
$1,710.00
INTERVENTN CRYOTHERAPY
0360
$1,576.00
INTERVENTN DECOMPRESSION
0360
$1,277.00
INTERVENTN DIL BALLOON/GUIDE
0360
$262.00
INTERVENTN DIL NON BALLOON
0360
$377.00
INTERVENTN ENDOSCOPIC US
0360
$1,710.00
INTERVENTN FINE NEEDLE ASP
0360
$980.00
INTERVENTN INSERT / REVISE TUBE
0360
$947.00
INTERVENTN POLYP REMOVAL
0360
$1,452.00
INTERVENTN REMOVE FB/STENT
0360
$870.00
INTERVENTN REMOVE STONE
0360
$2,165.00
INTERVENTN RFLX TST W BRAVO
0750
91035
$5,570.00
INTERVENTN SCLEROSIS INJ
0360
$1,123.00
INTERVENTN SPHINCTER OF ODDI
0360
$1,200.00
INTRA UTERINE PRESSURE CATHETER
0272
$112.00
INTRACARDIAC ECHO/NO INTERP
0480
93662
$4,135.00
INTRAOSSEOUS NEEDLE PLACEMENT
0360
36680
$233.00
INTRAVASCULAR US NONCORONARY RS&I 1ST VESSEL
0481
37252
$1,039.00
INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
0481
37253
$515.00
INTRO CATH DIALYSYS CIRCUIT DX ANGRAPH FLUOR S&I
0360
36901
$1,378.00
INTRO CATH DIALYSYS CIRCUIT W/TCAT PLMT IV STENT
0360
36903
$19,651.00
INTRO CATH DIALYSYS CIRCUIT W/TRLUML BALO ANGRIOP
0360
36902
$9,723.00
INTRO INTRACATH EXTRMTY ARTERY
0360
36140
$591.00
INTRO OF LONG GI TUBE
0321
74340
$386.00
INTRO OF LONG GI TUBE (NG,NJ)
0360
44500
$2,072.00
INTRODUCER NEEDLE (7324)
0272
$82.00
INTRODUCER PERCU SHEATH KIT 9FR (6831)
0270
$161.00
INTRODUCER SET (218005)
0270
$62.00
INTRODUCER/SHEATH
0272
C1894
Variable
INTRODUCER/SHEATH,GUIDING,INTRACARDIA
0272
C1892
Variable
IONIZED CALCIUM
0301
82330
$60.00
IRON
0301
83540
$29.00
IRON STAIN
0305
85536
$91.00
ISLET CELL ANTIBODY
0302
86341
$155.00
IUD INSERTION
0761
58300
$504.00
IV INF HYDRATION ADDL HRS
0761
96361
$126.00
IV INF HYDRATION INITIAL 31 MIN TO 1 HR
0761
96360
$420.00
IV INF TX,DX,PROPH 1ST HR,1ST DRUG
0761
96365
$454.00
IV INF TX,DX,PROPH ADDL DRUG CCUR
0761
96368
$211.00
IV INF TX,DX,PROPH ADDL DRUG SEQ
0761
96367
$285.00
IV INF TX,DX,PROPH ADDL HRS
0761
96366
$132.00
IV PUSH TX,DX,PROPH EA ADDL NEW DRUG
0761
96375
$173.00
IV PUSH TX,DX,PROPH REPEAT SEQ DRUG
0761
96376
$125.00
IV PUSH TX,DX,PROPH SINGLE OR INITIAL
0761
96374
$243.00
IVUS CATHETER RADIOLOGY
0272
C1753
Variable
JAK2 GENE ANALYSIS
0300
81270
$475.00
JEJUNOSTOMY OR DUODENOSTOMY TUBE CHAN
0360
49451
$1,444.00
JO 1 ANTIBODY IGG
0301
86235
$74.00
JOINT DEVICE (IMPLANTABLE)
0278
C1776
Variable
JOINT SURVEY 1 VIEW 2+ JOINTS
0320
77077
$425.00
KIT FECAL MGMT SYSTEM FLEXISE (7606)
0270
$706.00
KIT PERICARDIOCENTESIS (9067)
0270
$398.00
KIWI OMNI EXTRACTOR (429990)
0270
$88.00
KIWI PRO EXTRACTOR (429989)
0270
$88.00
KLEIHAUER-BETKE (FETAL CELL)
0305
85460
$115.00
KNEE IMMOBILIZER CUSTOM 19
0270
Variable
KNEE IMMOBILIZER CUSTOM 24
0270
Variable
KOH PREP
0306
87210
$51.00
KOOL KIT 900
0272
$968.00
L AND D EPID BLOCK ADDL MIN
0370
$4.80
L AND D EPID BLOCK FIRST 15 MIN
0370
$284.00
L AND D REGI BLOCK ADDL MIN
0370
$4.30
L AND D REGI BLOCK FIRST 15 MIN
0370
$245.00
L AND D SUR LVL 2 ADDL MIN
0360
$91.00
L AND D SUR LVL 2 FIRST 15 MIN
0360
$2,405.00
L AND D SUR LVL 3 ADDL MIN
0360
$118.00
L AND D SUR LVL 3 FIRST 15 MIN
0360
$3,126.00
L AND D SURG ANESTHESIA ADDL MIN
0370
$8.60
L AND D SURG ANESTHESIA FIRST 15 MIN
0370
$380.00
LAB HANDLING CHRG EXPANDED
0301
99001
$56.00
LACTATION EST 30 MIN
0761
99212
$284.00
LACTATION EST 45 MIN
0761
99213
$326.00
LACTATION EST 60 MIN
0761
99214
$459.00
LACTATION EST 75 MIN
0761
99215
$534.00
LACTATION NEW 15 MIN
0761
99201
$175.00
LACTATION NEW 30 MIN
0761
99202
$302.00
LACTATION NEW 45 MIN
0761
99203
$428.00
LACTATION NEW 60 MIN
0761
99204
$546.00
LACTATION NEW 75 MIN
0761
99205
$687.00
LACTIC ACID ASSAY
0301
83605
$81.00
LAMOTRIGINE QUANTITATIVE
0301
80175
$76.00
LANG COMP CURRENT STATUS
0440
G9159
$0.01
LANG COMP DISCHARGE STATUS
0440
G9161
$0.01
LANG COMP GOAL STATUS
0440
G9160
$0.01
LANG EXPRESS CURRENT STATUS
0440
G9162
$0.01
LANG EXPRESS DISCHARGE STATUS
0440
G9164
$0.01
LANG EXPRESS GOAL STATUS
0440
G9163
$0.01
LASER SHEATH II
0272
C2629
$3,157.00
LDH
0301
83615
$27.00
LDL-CHOLESTEROL, DIRECT
0301
83721
$67.00
LEAD LV REPOSITIONING
0360
33226
$3,769.00
LEAD ASSAY
0301
83655
$94.00
LEAD ENDOCARDIAL PACEMAKER
0275
C1898
Variable
LEAD ENDOCARDIAL PACEMKR C1898
0275
C1898
Variable
LEAD ICD,ENDO SINGLE COIL
0278
C1777
Variable
LEAD LEFT VENT COR VEN SYSTEM
0275
C1900
Variable
LEAD, ICD, ENDOCARD DUAL COIL
0275
C1895
Variable
LEAD, PACER/ICD
0275
C1899
Variable
LEAD,CARD-DEFIB,OTHER THAN ENDOCARD,SINGLE/DUAL
0278
C1896
Variable
LEAD,NEUROSTIMULATOR (IMPLANTABLE)
0278
C1778
Variable
LEGIONELLA DIRECT FLOURES AB
0306
87278
$123.00
LENS INTRAOCULAR
0276
C1780
Variable
LEVEL 1 EST PT EVAL AND MGMT
0510
99211
$174.00
LEVEL 1 EST PT EVAL AND MGMT
0761
99211
$174.00
LEVEL 1 NEW PT EVAL AND MGMT
0761
99201
$175.00
LEVEL 1 NEW PT OP VISIT
0510
99201
$175.00
LEVEL 1 SURGICAL PATHOLOGY GROSS EXAMINATION ONLY
0312
88300
$85.00
LEVEL 2 EST PT EVAL AND MGMT
0510
99212
$284.00
LEVEL 2 EST PT EVAL AND MGMT
0761
99212
$284.00
LEVEL 2 NEW PT EVAL AND MGMT
0510
99202
$302.00
LEVEL 2 NEW PT EVAL AND MGMT
0761
99202
$302.00
LEVEL 2 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
0312
88302
$102.00
LEVEL 3 EST PT EVAL AND MGMT
0510
99213
$326.00
LEVEL 3 EST PT EVAL AND MGMT
0761
99213
$336.00
LEVEL 3 EST PT EVAL AND MGMT
0761
99213
$326.00
LEVEL 3 NEW OP VISIT
0510
99203
$428.00
LEVEL 3 NEW PT EVAL AND MGMT
0510
99203
$428.00
LEVEL 3 NEW PT EVAL AND MGMT
0761
99203
$428.00
LEVEL 3 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
0312
88304
$162.00
LEVEL 4 EST PT EVAL AND MGMT
0510
99214
$459.00
LEVEL 4 EST PT EVAL AND MGMT
0761
99214
$459.00
LEVEL 4 NEW OP VISIT
0510
99204
$546.00
LEVEL 4 NEW PT EVAL AND MGMT
0761
99204
$546.00
LEVEL 4 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
0312
88305
$221.00
LEVEL 5 EST PT EVAL AND MGMT
0510
99215
$534.00
LEVEL 5 EST PT EVAL AND MGMT
0761
99215
$534.00
LEVEL 5 NEW OP VISIT
0510
99205
$687.00
LEVEL 5 NEW PT EVAL AND MGMT
0761
99205
$687.00
LEVEL 5 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
0312
88307
$638.00
LEVEL 6 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
0312
88309
$1,602.00
LEVETIRACETAM (KEPPRA) QUANTITATIVE
0301
80177
$162.00
LH
0301
83002
$116.00
LHC BY TRANSSEPTAL PUNCTURE
0480
93462
$5,714.00
LHC/LV/COR ARTERY(S) W/GRAFTS,INCL IN
0480
93459
$10,468.00
LHC/LV/COR ARTERY(S),INCL INJ/S&I
0480
93458
$10,218.00
LIDOCAINE (XYLOCAINE)
0301
80176
$111.00
LIPASE
0301
83690
$64.00
LIPID SCREEN
0301
80061
$179.00
LIPOPROT BLD QT OF LIPOPROT PARTICLE NOS & PARITCS
0301
83704
$105.00
LIPOPROTEIN A
0301
83695
$63.00
LIPOPROTEIN A
0301
82172
$57.00
LIQUID PULMONARY SEALANT
0278
C2615
Variable
LITHIUM ASSAY
0301
80178
$63.00
LIVER BIOPSY PERCUT - US
0360
47000
$2,164.00
LIVER BIOPSY PERCUTANEOUS - CT
0360
47000
$2,164.00
LOOP O GRAM-DW
0320
74425
$666.00
LOW DOSE CT SCAN FOR LUNG CANCER SCREENING
0350
G0297
$481.00
LOWER BALLOON ENTEROSCOPY
0360
$3,378.00
LOWER GI COLON-DW
0320
74270
$526.00
LOWER GI/COLON W/AIR CONT-DW
0320
74280
$526.00
LUMBAR PUNCTURE THERAPEUTIC DRAINAGE
0360
62272
$1,293.00
LUNG BIOPSY-ANG
0360
32405
$839.00
LUNG SCAN (PERFUSION) - NM
0341
78580
$1,295.00
LUNG VOLUMES
0460
94727
$145.00
LYME DISEASE AB
0306
86618
$88.00
LYME DISEASE AB WESTERN BLOT CONFIRMATORY TEST
0302
86617
$52.00
LYMPHOSCINTIGRAPHY
0341
78195
$1,677.00
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH
0310
88377
$382.00
M/PHMTRC ALYS ISHQUANT/SEMIQ CPTR EACH
0310
88374
$382.00
MAGNESIUM ASSAY
0301
83735
$33.00
MALARIA SMEAR
0305
87207
$101.00
MAMM-BREAST WIRE
0272
$68.00
MAMM-VACUUM CANISTER
0270
$71.00
MAMMOGRAPHY DIAGNOSTIC CAD BILATERAL
0401
77066
$437.00
MAMMOGRAPHY DIAGNOSTIC CAD UNILATERAL
0401
77065
$342.00
MAMMOGRAPHY SCREENING 2 VIEW CAD BILATERAL
0403
77067
$362.00
MAMMOGRAPHY-DIAGNOSTIC DIGITAL IMAGE BILATERAL
0401
G0204
$540.00
MAMMOGRAPHY-DIAGNOSTIC DIGITAL IMAGE UNILATERAL
0401
G0206
$421.00
MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
0360
27570
$3,276.00
MANUAL THERAPY TECHNIQUES 1+ REGIONS EA 15 MINUTES
0420
$118.00
MANUAL THERAPY TECHNIQUES 1+ REGIONS EA 15 MINUTES
0420
97140
$118.00
MANUAL THERAPY TECHNIQUES 1+ REGIONS EA 15 MINUTES
0430
$118.00
MANUAL THERAPY TECHNIQUES 1+ REGIONS EA 15 MINUTES
0430
97140
$118.00
MASS SPEC AND TANDEM MASS SPEC ANALYTE NOS QT EA
0301
83789
$269.00
MDI INSTRUCT
0410
94664
$161.00
MEAS POST VOID RESIDUAL URINE AND/OR BLADDER CAP NON IMAGING
0761
51798
$389.00
MECH REMV INTRA OBSTR MAT CV
0321
75902
$211.00
MECH REMV INTRA OBSTR MAT CV
0360
36596
$1,784.00
MED NUTRITION THERAPY INITIAL ASSESS INDIV 1/1 EA 15 MIN
0942
97802
$56.00
MED NUTRITION THERAPY REASSESS INDIV 1/1 EA 15 MIN
0942
97803
$56.00
MEDICAL NUTRITION THERAPY GROUP TWO+ INDIVIDUALS EACH 30 MIN
0942
97804
$47.00
MEDICAL NUTRITION THERAPY INITIAL ASSESS 1/1 EA 15 MIN
0942
97802
$56.00
MEDICAL NUTRITION THERAPY REASSESS INTERVEN IND 1/1 EA 15 MIN
0942
97803
$56.00
MEDICAL TEAM CONFERENCE WITH PT AND/OR FAMILY 3O MIN
0420
$153.00
MEDICAL TEAM CONFERENCE WITH PT AND/OR FAMILY 3O MIN
0420
99366
$153.00
MEDICAL TEAM CONFERENCE WITH PT AND/OR FAMILY 3O+ MIN
0430
$153.00
MEDICAL TEAM CONFERENCE WITH PT AND/OR FAMILY 3O+ MIN
0430
99366
$153.00
MEDTRONIC ANALYSIS W/ REPROGRAMMING
0510
62368
$819.00
MEDTRONIC ANALYSIS W/ REPROGRAMMING AND REFILL
0510
62369
$991.00
MEDTRONIC REFILL SPINAL(INTRATHECAL,EPIDURAL)OR BRAIN(INTRAVENTR
0510
95990
$419.00
MEMORY CURRENT STATUS
0420
G9168
$0.01
MEMORY CURRENT STATUS
0430
G9168
$0.01
MEMORY DISCHARGE STATUS
0430
G9170
$0.01
MEMORY DISCHARGE STATUS
0440
G9170
$0.01
MEMORY GOAL STATUS
0420
G9169
$0.01
MEMORY GOAL STATUS
0430
G9169
$0.01
MEMORY GOAL STATUS
0440
G9169
$0.01
MEMORY STATUS CURRENT
0440
G9168
$0.01
MERCURY BLOOD
0301
83825
$89.00
MESH (IMPLANTABLE)
0278
C1781
Variable
METANEPHRINES
0301
83835
$119.00
METANEPHRINES PLASMA FREE
0301
83835
$119.00
METHADONE AND METABOLITE, SERUM OR PLASMA, QUANT
0301
80358
$88.00
METHEMOGLOBIN
0301
83050
$52.00
METHOTREXATE ASSAY
0301
80299
$84.00
METHYLENEDIOXYAMPHETAMINES
0301
80359
$149.00
METHYLMALONIC ACID
0301
83921
$75.00
MIC GASTROSTOMY TUBE (KC) 20FR (6270)
0272
$92.00
MICRO INTRODCUER GUIDEWIRE (430471)
0270
$114.00
MICROALBUMIN
0301
82043
$32.00
MICROSOMAL ANTIBODY, EA
0302
86376
$67.00
MINI TRAY AND SET UP
0270
Variable
MINI TRAY AND SET UP-CT
0270
Variable
MISC PROCEDURE
9000005
Variable
MITYVAC VACUUM EXTRACTOR (420422)
0270
$91.00
MLC DEVICE FOR IMRT, PLAN
0333
77338
$844.00
MOBILITY CURRENT STATUS
0420
G8978
$0.01
MOBILITY CURRENT STATUS
0430
G8978
$0.01
MOBILITY DISCHARGE STATUS
0420
G8980
$0.01
MOBILITY GOAL STATUS
0420
G8979
$0.01
MODERATE SEDATION 5+ 1ST 15MIN
0370
99152
$154.00
MODERATE SEDATION AGE 0-4 INITIAL 15MIN
0370
99151
$230.00
MODERATE SEDATION AGE 5+ 1ST 15MIN
0370
99152
$154.00
MODERATE SEDATION EACH ADDL 15MIN
0370
99153
$135.00
MOLD ID
0306
87107
$99.00
MOLECULAR CYTOGENETICS DNA PROBE EA (FISH)
0300
88271
$71.00
MOLECULAR CYTOGENETICS INTERPHASE 100-300 CELLS
0300
88275
$167.00
MOLECULAR PATH PROC LEVEL 2
0300
81401
$532.00
MONITOR ANESTHESIA ADDL MINUTE
0370
$4.05
MONITOR ANESTHESIA FIRST 15 MINUTES
0370
$253.00
MONO TEST
0306
86308
$68.00
MONONUCLEAR CELL ANTIGEN QUANT NOS EA
0300
86356
$89.00
MORGAN LENS
0270
$72.00
MORPHOMETRIC ANALYSIS TUMOR IMMUNOHISTOCHEMISTRY QUANT OR SEMI
0310
88360
$638.00
MOTION FLUOROSCOPIC EVAL OF SWALLOWING FUNCT BY CINE OR VIDEO
0440
$235.00
MOTION FLUOROSCOPIC EVAL OF SWALLOWING FUNCT BY CINE OR VIDEO
0440
92611
$235.00
MOTOR SPEECH CURRENT STATUS
0440
G8999
$0.01
MOTOR SPEECH DISCHARGE STATUS
0440
G9158
$0.01
MOTOR SPEECH GOAL STATUS
0440
G9186
$0.01
MRA ABDOMEN W/CONTRAST
0618
C8900
$1,667.00
MRA BRAIN W/3D RENDERING
0615
70544
$1,642.00
MRA BRAIN W/CONTRAST
0610
70545
$2,370.00
MRA BRAIN W/O AND W/CONTRAST
0615
70546
$2,954.00
MRA BRAIN W/O CONTRAST
0615
70544
$1,642.00
MRA CHEST W/CONTRAST
0618
C8909
$1,667.00
MRA LOWER EXTREMITY W/O CONTRAST
0610
C8913
$1,421.00
MRA NECK W/O AND W/CONTRAST
0615
70549
$2,954.00
MRA NECK W/O CONTRAST
0615
70547
$1,421.00
MRA-ABDOMEN W/3D REND
0610
C8900
$1,667.00
MRI ABDOMEN W/CONTRAST
0610
74182
$2,685.00
MRI ABDOMEN W/O AND W/CONTRAST
0610
74183
$2,954.00
MRI ABDOMEN W/O CONTRAST
0610
74181
$1,790.00
MRI BRAIN W/CONTRAST
0611
70552
$2,684.00
MRI BRAIN W/O AND W/CONTRAST
0611
70553
$2,954.00
MRI BRAIN W/O CONTRAST
0611
70551
$2,263.00
MRI BREAST BILAT W/O AND W/CONTRAST
0610
C8908
$2,954.00
MRI BREAST BILATERAL W/O CONTRAST
0610
C8907
$2,829.00
MRI BREAST UNILAT W/O AND W/CONTRAST
0610
C8905
$2,954.00
MRI CERVICAL SPINE W/CONTRAST
0612
72142
$2,685.00
MRI CERVICAL SPINE W/O AND W/CONTRAST
0612
72156
$3,603.00
MRI CERVICAL SPINE W/O CONTRAST
0612
72141
$1,767.00
MRI CHEST/HILUM/MED W/O AND W/CONTRAS
0610
71552
$3,436.00
MRI CHEST/HILUM/MED W/O CONTRAST
0610
71550
$1,421.00
MRI JOINT LOWER EXTREMITY W/CONTRAST
0610
73722
$4,133.00
MRI JOINT LOWER EXTREMITY W/O AND W/C
0610
73723
$4,546.00
MRI JOINT LOWER EXTREMITY W/O CONTRAS
0610
73721
$2,176.00
MRI JOINT UPPER EXTREMITY W/CONTRAST
0610
73222
$4,133.00
MRI JOINT UPPER EXTREMITY W/O AND W/C
0610
73223
$4,546.00
MRI JOINT UPPER EXTREMITY W/O CONTRAS
0610
73221
$1,981.00
MRI LOWER EXTREMITY W/O AND W/CONTRAS
0610
73720
$2,293.00
MRI LOWER EXTREMITY W/O CONTRAST
0610
73718
$2,110.00
MRI LUMBAR SPINE W/CONTRAST
0612
72149
$2,685.00
MRI LUMBAR SPINE W/O AND W/CONTRAST
0612
72158
$3,215.00
MRI LUMBAR SPINE W/O CONTRAST
0612
72148
$1,803.00
MRI ORBIT/FACE/NECK W/CONTRAST
0610
70542
$2,685.00
MRI ORBIT/FACE/NECK W/O AND W/CONTRAS
0610
70543
$2,954.00
MRI ORBIT/FACE/NECK W/O CONTRAST
0610
70540
$1,421.00
MRI PELVIS W/O AND W/CONTRAST
0610
72197
$2,954.00
MRI PELVIS W/O CONTRAST
0610
72195
$1,815.00
MRI TEMPOROMANDIBULAR JOINTS
0610
70336
$1,421.00
MRI THORACIC SPINE W/CONTRAST
0612
72147
$2,685.00
MRI THORACIC SPINE W/O AND W/CONTRAST
0612
72157
$2,954.00
MRI THORACIC SPINE W/O CONTRAST
0612
72146
$1,882.00
MRI UPPER EXTREMITY W AND W/O CONTRAS
0610
73220
$2,954.00
MRI UPPER EXTREMITY W/O CONTRAST
0610
73218
$2,508.00
MRSA RAPID ASSAY
0306
87641
$291.00
MTHFR GENE ANALYSIS COMMON VARIANTS
0300
81291
$176.00
MULTIPLE SLEEP LATENCY/MAINT OF WAKEF
0740
95805
$2,365.00
MUMPS AB,IGM
0306
86735
$58.00
MYCOBACTERIA TUBERCULOSIS AMPLIFIED PROBE
0306
87556
$162.00
MYCOPLASMA PNEUMONIAE AB, IGG
0306
86738
$58.00
MYELIN BASIC PROTEIN, CSF
0301
83873
$67.00
MYELOGRAM/ARTHROGRAM TRAY-DW
0270
Variable
MYELOGRAPHY LUMBAR INJ RS&I 2+ REGIONS
0320
62305
$1,786.00
MYELOGRAPHY LUMBAR INJ RS&I CERVICAL
0320
62302
$1,786.00
MYELOGRAPHY LUMBAR INJ RS&I LUMBOSACRAL
0320
62304
$1,786.00
MYELOGRAPHY LUMBAR INJ RS&I THORACIC
0320
62303
$1,786.00
MYOCARDIAL PERFUSION IMAGING-MULTIPLE STUDIES
0341
78452
$4,452.00
MYOCARDIAL PERFUSION IMAGING-SINGLE STUDY
0341
78451
$4,452.00
N BLOCK INJ HYPOGAS PLXS
0360
64517
$3,411.00
NASAL EOSINOPHIL SMEAR
0305
89190
$54.00
NASO-ORO GASTRIC TUBE PLACEMENT
0360
43752
$744.00
NAVIGATIONAL BRONCHOSCOPY
0360
$5,573.00
NEEDLE ELECTRODE
0272
$80.00
NEEDLE, 21 GAUGE ACCUSTICK
0272
$190.00
NEISSERIA GONORRHOEAE AMPLIFIED PROBE TECHNIQUE
0306
87591
$191.00
NEPHELOMETRY EACH ANALYTE NOT ELSEWHERE SPECIFIED
0301
83883
$110.00
NEPHROSTOMY,TUBE REM USING FLUORO
0360
50389
$2,019.00
NEPHROURETERAL STENT
0278
C2617
Variable
NERVE BLOCK INJECTION, AXILLARY
0360
64417
$1,328.00
NERVE BLOCK SET (ARROW) (428925)
0270
$202.00
NEURO IMPLANT
0278
C1713
Variable
NEUROPSYCHOLOGICAL TESTING BY COMPUTER
0900
96120
$270.00
NEUROPSYCHOLOGICAL TESTING PER HR OF PSYCHOLOGISTS OR PHYS TIME
0900
96118
$376.00
NEWBORN SERVICES-MED/SURG
0170
$1,400.00
NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN
0306
87505
$428.00
NITRICOXIDE HOURLY
0271
$617.00
NM BRAIN IMAGE W/FLOW 4 OR MORE VIEWS
0341
78606
$1,677.00
NM HEPATOBILIARY SYSTEM W/MEDICATION
0341
78227
$1,677.00
NM HEPATOBILIARY SYSTEM W/O MEDICATION
0341
78226
$1,295.00
NM INTRA-ARTERL PART TREATMENT
0342
79445
$448.00
NM IV TREATMENT
0342
79101
$448.00
NM MECKELS IMAGING
0341
78290
$1,295.00
NM PARATHYROID PLANAR IMAGING W/SPECT
0341
78071
$1,295.00
NM PARATHYROID PLANAR IMAGING W/SPECT AND CONCUR T
0341
78072
$1,677.00
NM PARATHYROID PLANAR ONLY IMAGING
0341
78070
$1,295.00
NM PULMONARY VENT AEROSOL OR GAS
0341
78579
$516.00
NM PULMONARY VENT/PERFUSION AEROSOL OR GAS
0341
78582
$1,677.00
NM QUANTITATIVE PULMONARY VENT/PERFUSION AEROSOL O
0341
78598
$1,677.00
NM THRYOID IMAGING W/UPTAKE-SINGLE OR MULTIPLE
0341
78014
$1,295.00
NM THYROID CARCINOMA IMAGING-WHOLE BO
0341
78018
$1,677.00
NM THYROID CARCINOMA UPTAKE
0341
78020
$256.00
NON HEPARIN 5FR SWAN-GANZ CATHETER (435164)
0270
$117.00
NON INVASIVE OVERNIGHT OXIMETER
0460
94762
$265.00
NON LATEX 7FR SWAN-GANZ CATHETER (435163)
0270
$1,418.00
O2 SATURATION
0301
82810
$47.00
OBSERVATION DIRECT ADMIT
0762
G0379
$708.00
OBSTETRIC PANEL WITH HIV
0301
80081
$380.00
OCCLUSION CATHETER
0272
C2628
Variable
OCCULT BLOOD DIAGNOSTIC STOOL
0307
82270
$32.00
OCULAR PHOTOSCREENING INTERPRETATION AND REPORT BILATERAL
0920
99174
$251.00
OFFICE VISIT NEW LEVEL 5
0510
99205
$687.00
OLIGOCLONAL IMMUNE (BANDS)
0301
83916
$87.00
OPEN/PERQ PLACE STENT EA ADD ARTERY
0481
37237
$21,588.00
OPEN/PERQ PLACE STENT EA ADD VEIN
0481
37239
$13,748.00
OPEN/PERQ PLACE STENT,INITIAL ARTERY
0481
37236
$15,700.00
OPEN/PERQ PLACE STENT,INITIAL VEIN
0481
37238
$15,504.00
ORTHC/PROSTC MGMT SBSQ ENC
0420
$105.00
ORTHC/PROSTC MGMT SBSQ ENC
0420
97763
$105.00
ORTHC/PROSTC MGMT SBSQ ENC
0430
97763
$105.00
ORTHO SUPPLY-
0274
Variable
ORTHOPANTOGRAM
0320
70355
$231.00
ORTHOPEDIC IMPLANT
0278
C1713
Variable
OSCILLATORY VENT CIRCUIT
0272
$435.00
OSMOLALITY, SERUM
0301
83930
$72.00
OSMOLALITY, URINE
0301
83935
$60.00
OSTOMY GEL IODOSORB 40G (7603)
0272
$98.00
OT EVAL HIGH COMPLEX
0434
$210.00
OT EVAL HIGH COMPLEX
0434
97167
$210.00
OT EVAL LOW COMPLEX
0434
$125.00
OT EVAL LOW COMPLEX
0434
97165
$125.00
OT EVAL MOD COMPLEX
0434
$200.00
OT EVAL MOD COMPLEX
0434
97166
$200.00
OT RE-EVAL EST PLAN CARE
0434
$125.00
OT RE-EVAL EST PLAN CARE
0434
97168
$125.00
OTHER IMPLANTABLE
0278
Variable
OTHER OT CURRENT STATUS
0430
G8990
$0.01
OTHER OT DISCHARGE STATUS
0430
G8992
$0.01
OTHER OT GOAL STATUS
0430
G8991
$0.01
OTHER PT CURRENT STATUS
0420
G8990
$0.01
OTHER PT DISCHARGE STATUS
0420
G8992
$0.01
OTHER PT GOAL STATUS
0420
G8991
$0.01
OVA AND PARASITE EXAM
0306
87177
$140.00
OXALATE, 24 HOUR URINE
0301
83945
$63.00
OXCARBAZEPINE (TRILEPTAL) QUANTITATIVE
0301
80183
$116.00
OXYCODONE
0301
80365
$119.00
PACE/RECORD LA/COR SINUS
0480
93621
$5,157.00
PACE/RECORD LV
0480
93622
$2,336.00
PACEMAKER DUAL RATE
0275
C1785
Variable
PACEMAKER SINGLE RATE
0275
C1786
Variable
PACEMAKER BRADY DUAL RAT C1785
0275
C1785
Variable
PACEMKR, OTHER THAN SNGLE/DUAL
0275
C2621
Variable
PAD GEO MATT (9025)
0270
$129.00
PAD HEMOSTATIC D-STAT (7612)
0272
$127.00
PAD HYPOTHERMIA LRG (5745)
0270
Variable
PAMG-1,CERVICOVAGINAL SECRETION,QUAL
0301
84112
$265.00
PANCREAS BIOPSY, PERC - CT
0360
48102
$1,519.00
PAPP-A FOR SEQUENTIAL SCREEN
0301
84163
$56.00
PAPP-A SEQUENTIAL SCRN GENZYME
0301
84163
$56.00
PARACENTESIS
0360
49083
$1,098.00
PARAVERTEBRAL BLOCK, THORACIC, BY CONT CATH W/IMG GUIDE
0360
64463
$1,562.00
PARTIAL THROMBOPLASTIN
0302
85730
$58.00
PARVOVIRUS B19 ABS IGG/IGM
0306
86747
$80.00
PATIENT PROGRAMMER, NEUROSTIMULATOR
0278
C1787
Variable
PEG KIT 20-24F (424878)
0272
$220.00
PELVIC SELECT/SUPRASELECT
0320
75736
$6,294.00
PENILE PROSTHESIS
0278
C1813
Variable
PERC CONV GASTRO TUBE TO GASTO-JEJUNO
0360
49446
$1,357.00
PERC DRUG EL CORONARY STENT ATHERECTOMY SINGLE
0481
C9602
$19,605.00
PERC DRUG EL CORONARY STENT BRANCH
0481
C9601
$16,633.00
PERC DRUG EL CORONARY STENT SINGLE
0481
C9600
$17,710.00
PERC DRUG EL REVASC CHRO SINGLE
0481
C9607
$14,476.00
PERC DRUG EL REVASC T CABG BRANCH
0481
C9605
$17,387.00
PERC DRUG EL REVASC T CABG SINGLE
0481
C9604
$17,732.00
PERC DRUG EL REVASC W/AMI SINGLE
0481
C9606
$9,763.00
PERC PLACEMENT OF JEJUNOSTOMY OR DEOD
0360
49441
$5,277.00
PERCUT GAST TB PLACE
0360
49440
$2,391.00
PERCUT GAST TB PLACE
0360
$1,723.00
PERCUTANEOUS DRAINAGE W/CATHETER AND FLUOROSCOPY
0320
75989
$568.00
PERI PROCEDURAL DEVICE EVAL-PACEMAKER
0480
93286
$84.00
PERI-PX EVAL & PROG CARDIOV/DEFIB
0480
93287
$95.00
PERICARDIOCENTESIS, INITIAL
0360
33010
$1,299.00
PERQ ACCESS & CLSR FEM ART
0360
34713
$359.00
PERQ DEVICE BREAST 1ST IMAGE
0360
19281
$2,883.00
PERQ DEVICE BREAST 1ST MR GUID
0360
19287
$2,883.00
PERQ DEVICE BREAST 1ST US IMAGING
0360
19285
$2,883.00
PERQ DEVICE BREAST ADD LESION
0360
19282
$2,883.00
PERQ DEVICE BREAST ADD LESION US IMAGING
0360
19286
$2,883.00
PERQ EXCHANGE NEPHROSTOMY CATH INCLUDE IMG GUIDE RS&I
0360
50435
$3,941.00
PERQ PLMT BILIARY DRAIN CATH W/IMG GID RS&I EXTERNAL
0360
47533
$8,910.00
PERQ PLMT BILIARY DRAIN CATH W/IMG GID RS&I INTERNAL-EXTERNAL
0360
47534
$5,135.00
PERQ PLMT NEPHROSTOMY CATH AND OR URTRGRM INCLUDE IMG GUIDE RS&I
0360
50432
$4,897.00
PERQ PLMT NEPHROURETERAL CATH INCLUDE IMG GUIDE RS&I; NEW ACCESS
0360
50433
$4,358.00
PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE
0360
10035
$1,820.00
PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
0360
36906
$29,785.00
PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGRP
0360
36905
$19,651.00
PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
0360
36904
$9,723.00
PERQ VERT AUGMNT CAVITY CRTJ UNI/BI CANNULATION
0360
22513
$13,650.00
PERQ VERT AUGMNT CAVITY CRTJ UNI/BI CANNULATION EA
0360
22515
$10,083.00
PERQ VERT AUGMNT CAVITY CRTJ UNI/BI CANNULATION LUMBAR
0360
22514
$13,538.00
PET - BRAIN METABOLISM
0404
78608
$5,424.00
PET-MYOCARDIAL METABOLIC
0404
78459
$4,452.00
PET-TUMOR LTD AREA W/CT AC
0404
78814
$5,158.00
PET-TUMOR SKULL-THIGH W/CT AC
0404
78815
$8,315.00
PET-TUMOR W/B W/CT AC
0404
78816
$8,315.00
PFO-ACUNAV ICE CATH
0272
C1759
Variable
PH URINE
0307
81002
$35.00
PHARMACY CHG REV 250
0250
Variable
PHARMACY CHG REV 258
0258
Variable
PHARMACY CHG REV 635
0635
Variable
PHARMACY CHG REV 636
0250
Variable
PHARMACY CHG REV 637
0250
Variable
PHARMACY SUPPLY REV 272
0272
Variable
PHARYNX-SPEECH PATHOLOGY-DW
0320
74230
$425.00
PHENOBARBITOL ASSAY
0301
80184
$87.00
PHENYTOIN FREE
0301
80186
$72.00
PHLEBOTOMY, THERAPEUTIC
0940
99195
$98.00
PHOSPHOLIPID NEUT PLT 85597
0300
85597
$60.00
PHOSPHORUS
0301
84100
$27.00
PHOSPHORUS ASSAY, URINE
0301
84105
$53.00
PHYSICAL PERFORM TEST OR MEASURE W/REPORT EA 15 MIN
0420
$59.00
PHYSICAL PERFORM TEST OR MEASURE W/REPORT EA 15 MIN
0420
97750
$59.00
PHYSICAL PERFORM TEST OR MEASURE W/REPORT EA 15 MIN
0430
97750
$59.00
PHYSICIAN SERV O/P CARDIAC REHAB CONT ECG MONITORING P/SESSION
0943
93798
$173.00
PHYSIOLOGIC MULTI LEVEL UE/LE
0921
93923
$404.00
PHYSIOLOGIC SINGLE LEVEL UE/LE
0921
93922
$260.00
PICC INSERTION OVER 5 YRS TO ADULT
0761
36569
$2,414.00
PICC INSERTION UNDER 5 YRS
0761
36568
$2,076.00
PICC KIT
0272
$273.00
PICC LINE REPAIR
0761
36575
$1,190.00
PICC REPLACEMENT OVER CATH
0761
36584
$4,697.00
PICC TRAY SI
0278
C1751
$790.00
PILLOW HIP ABDUCTION LG (7262)
0270
$111.00
PILLOW HIP ABDUCTION MD (7261)
0270
$111.00
PILLOW HIP ABDUCTION SM (7263)
0270
$111.00
PINWORM PREP
0306
87172
$67.00
PKU COLLECTION
0270
$169.00
PLACE CATH COMMON CAROTID/INOM ART EXTRACRANIAL
0481
36222
$6,294.00
PLACE CATH COMMON CAROTID/INOM ART INTRACRANIAL
0481
36223
$6,294.00
PLACE CATH SUBCLAVAN/INOM ART UNILATERAL
0481
36225
$6,294.00
PLACE CATH THORACIC AORTA
0481
36221
$6,294.00
PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR
0360
34709
$20,524.00
PLASMA, FRESH FROZEN
0390
P9017
$199.00
PLASMA, FROZEN WITHIN 24 HOURS
0390
P9059
$200.00
PLASMAPHERESIS TREATMENT
0361
36514
$1,908.00
PLATELET ANTIBODY SCREEN
0302
86022
$318.00
PLATELET COUNT
0305
85049
$35.00
PLATELET CROSSMATCH SCREEN
0300
86022
$318.00
PLATELET FUNCTION ASSAY, ADP
0305
85576
$95.00
PLATELET RICH PLASMA, EACH UNIT
0390
P9020
$333.00
PLATELETPHERESIS IRRAD LR
0390
P9037
$1,748.00
PLATELETPHERESIS LEUKOREDUCED
0390
P9035
$1,350.00
PLATELETS HLA MATCHED LR
0390
P9052
$2,077.00
PLETHYSMOGRAPHY FOR DET OF LUNG VOL INC AIRWAY RESIST
0460
94726
$577.00
PLEURX CATHETER INSERTION
0360
32550
$3,185.00
PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
0360
33883
$9,925.00
PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN
0360
33884
$20,524.00
PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH
0360
50695
$7,244.00
PLMT URTRL STENT PRQ NEW W/O SEP NFROS CATH
0360
50694
$4,878.00
PLMT URTRL STENT PRQ PRE-EXST NEPH TRACT
0360
50693
$7,413.00
POC ACT CLOT TIME
0302
85347
$58.00
POC FECAL OCCULT BLOOD
0307
82270
$32.00
POC GASES, BLOOD ARTERIAL OR VENOUS
0301
82805
$213.00
POC POTASSIUM
0301
84132
$19.00
POC PT INR
0305
85610
$49.00
PORPHOBILINGEN/PORPHRINS UR QT
0305
84120
$103.00
PORPHOBILINOGEN, URINE
0301
84110
$64.00
PORT INDWELLING (IMPLANTABLE)
0278
C1788
Variable
PORTABLE MATTRESS WARMER
0272
$85.00
POTASSIUM
0301
84132
$19.00
POTASSIUM ASSAY, SERUM
0301
84132
$19.00
POTASSIUM ASSAY, URINE
0301
84133
$58.00
POTASSIUM FLUID
0301
84999
$322.00
POWER PICC TRAY
0278
C1751
$790.00
PREALBUMIN
0301
84134
$112.00
PRESUMPTIVE ID, URINE
0306
87088
$74.00
PRIMIDONE
0301
80188
$59.00
PRIMIDONE METABOLITE
0301
80184
$87.00
PRO RIT BASIC POWERGLIDE 18G X 10CM
0278
C1751
$195.00
PRO RIT BASIC POWERGLIDE 18G X 8CM
0278
C1751
$195.00
PRO RIT BASIC POWERGLIDE 20G X 10CM
0278
C1751
$195.00
PRO RIT BASIC POWERGLIDE 20G X 8CM
0278
C1751
$195.00
PRO RIT FULL POWERGLIDE 18G X 10CM
0278
C1751
$315.00
PRO RIT FULL POWERGLIDE 18G X 8CM
0278
C1751
$315.00
PRO RIT FULL POWERGLIDE 20G X 10CM
0278
C1751
$315.00
PRO RIT FULL POWERGLIDE 20G X 8CM
0278
C1751
$315.00
PROBE, CRYOABLATION
0279
C2618
Variable
PROCALCITONIN
0301
84145
$146.00
PROCEDURE OVERRIDE (OML)
0301
4288963
Variable
PROCEDURE OVERRIDE (OML)
0301
4289963
Variable
PROG STIM/PACE AFTER MEDS
0480
93623
$3,897.00
PROGESTERONE SERUM
0301
84144
$111.00
PROLACTIN
0301
84146
$137.00
PROSTHETIC IMPLANT,NOT OTHERWISE SPEC
0278
L8699
Variable
PROTEIN SERUM TOTAL
0301
84155
$27.00
PROTEIN C ACTIVITY
0302
85303
$215.00
PROTEIN ELECTROPHORESIS
0301
84165
$122.00
PROTEIN ELECTROPHORESIS
0301
84166
$193.00
PROTEIN S ACTIVITY
0302
85306
$215.00
PROTEIN TOTAL REFRACTOMETRY ANY SRC
0301
84160
$17.00
PROTEIN, CSF
0301
84157
$63.00
PROTEIN, URINE
0301
84156
$73.00
PROTIME
0305
85610
$49.00
PRQ CARD ANGIO/ATHRECT 1 ARTERY
0481
92924
$17,830.00
PRQ CARD REVASC CHRONIC 1 VESSEL
0481
92943
$10,474.00
PRQ CARD REVASC MI 1 VESSEL
0481
92941
$14,110.00
PRQ CARD STENT W/ANGIO 1 VESSEL
0481
92928
$13,602.00
PRQ CARD STENT W/ANGIO VESSEL ADD ON
0481
92929
$14,110.00
PRQ CARDIAC ANGIOPLASTY 1 ARTERY
0481
92920
$9,787.00
PRQ CARDIAC ANGIOPLASTY ARTERY ADD ON
0481
92921
$9,983.00
PRQ REVASC BYP GRAFT 1 VESSEL
0481
92937
$18,166.00
PSA
0301
84153
$108.00
PSA SCREENING
0300
G0103
$130.00
PSA, FREE
0301
84154
$136.00
PSYCH COMPUTER TEST BATTERY
0900
96103
$284.00
PSYCH TESTING PER HR OF PSYCHOLOGISTS OR PHYS TIME
0900
96101
$376.00
PSYCH TREATMENT PROGRAM
0919
$661.00
PSYCHIATRIC DIAGNOSTIC EVALUATION
0900
90791
$406.00
PSYCHOTHERAPY 30 MIN WITH PATIENT
0900
90832
$186.00
PSYCHOTHERAPY 45 MIN WITH PATIENT
0900
90834
$327.00
PSYCHOTHERAPY 60 OR MORE MIN WITH PATIENT
0900
90837
$415.00
PT EVAL HIGH COMPLEX
0424
$210.00
PT EVAL HIGH COMPLEX
0424
97163
$210.00
PT EVAL LOW COMPLEX
0424
$125.00
PT EVAL LOW COMPLEX
0424
97161
$125.00
PT EVAL MOD COMPLEX
0424
$200.00
PT EVAL MOD COMPLEX
0424
97162
$200.00
PT RE-EVAL EST PLAN CARE
0424
$125.00
PT RE-EVAL EST PLAN CARE
0424
97164
$125.00
PTH (INTACT)
0301
83970
$157.00
PTT
0300
85730
$58.00
PTT PLASMA FRACTIONS, EACH
0305
85732
$41.00
PULMONARY BILATERAL SELECTIVE
0320
75743
$6,294.00
PULMONARY REHAB INC EXERCISE INC MONITOR PER HOUR PER SESSION
0948
G0424
$200.00
PULMONARY STRESS TESTING
0460
94618
$275.00
PULMONARY UNILATERAL SELECTIVE
0320
75741
$6,294.00
PUMP BREAST DOUBLE KIT (6292)
0270
$85.00
PUNCTURE ASPIRATION OF ABSCESS,HEMATOMA,BULLA,CYST
0360
10160
$598.00
PUNCTURE ASPIRTN CYST(BREAST)
0360
19000
$446.00
PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PROCEDURE
0360
61070
$1,265.00
QUANTIFERON GOLD TB
0301
86480
$230.00
QUANTITATION OF DRUG NES THERAPEUTIC DRUG ASSAY
0301
80299
$84.00
QUANTITATIVE SCREEN METALS
0301
83018
$139.00
RAD TX DEL, =1 MEV; COMPLEX
0333
77412
$599.00
RAD TX DEL, =1 MEV; INTERMEDIATE
0333
77407
$353.00
RAD TX DEL, =1 MEV; SIMPLE
0333
77402
$372.00
RADIATION PHYSICS CONSULT
0333
77370
$860.00
RADIATION PHYSICS, DOSIMETRY & TREAMENT, SPECIAL SERVICES
0333
77399
$328.00
RADIO PHARMA I-131 TX
0344
A9517
$28.00
RADIO:TC-99M EXAMETAZIME LBLD AUTOL WBC
0343
A9569
$2,387.00
RADIOLOGIC EXAM ABDOMEN 1 VIEW
0320
74018
$210.00
RADIOLOGIC EXAM ABDOMEN 2 VIEWS
0320
74019
$401.00
RADIOLOGIC EXAM CHEST 2 VIEWS
0320
71046
$200.00
RADIOLOGIC EXAM CHEST 3 VIEWS
0320
71047
$200.00
RADIOLOGIC EXAM CHEST 4+ VIEWS
0320
71048
$401.00
RADIOLOGIC EXAM CHEST SINGLE VIEW
0320
71045
$210.00
RADIOLOGICAL EXAM SURGICAL SPECIMEN
0400
76098
$1,802.00
RADIOPH: EXAMETAZINE/DOSE
0343
A9521
Variable
RADIOPH: INDIUM IN-111 PENTETREOTIDE
0343
A9572
$4,227.00
RADIOPH: MEDRONATE/DOSE
0343
A9503
$49.00
RADIOPH:GA-67/MCI
0343
A9556
$118.00
RADIOPH:I-123 DX/PER 100 UCI
0343
A9516
$168.00
RADIOPH:I-131 DX CAP/MCI
0343
A9528
$28.00
RADIOPH:IN-111 DTPA/0.5MCI
0343
A9548
$2,482.00
RADIOPH:MAA/UNIT DOSE
0343
A9540
$289.00
RADIOPH:MAA/VIAL
0343
A9540
$1,151.00
RADIOPH:MEBROFENIN/DOSE
0343
A9537
$70.00
RADIOPH:MERTIATIDE/DOSE
0343
A9562
$732.00
RADIOPH:MIBG/I-123
0343
A9582
$4,079.00
RADIOPH:RADIUM RA 223 DICHLORIDE,TX,PER MICROCURIE
0344
A9606
Variable
RADIOPH:RBC TAG/DOSE
0343
A9560
$222.00
RADIOPH:S COLLOID FILTERED TC99M-LYMPHO
0343
A9541
$473.00
RADIOPH:S COLLOID TC99M-DOSE
0343
A9541
$165.00
RADIOPH:S COLLOID TC99M-LYMPHO
0343
A9541
$543.00
RADIOPH:SESTAMIBI/DOSE
0343
A9500
$75.00
RADIOPH:XE-133/10 MCI
0343
A9558
$112.00
RADIOPHARM PROVIDED DURING HOSP INPT STAY
0342
C9898
$1.00
RADIOPHARM THERAPY ORAL ADMIN
0342
79005
$756.00
RADIOPHARM: FDG-18
0343
A9552
$611.00
RADIOPHARM: I-123 DATSCAN (PER DOSE UP TO 5MCI)
0343
A9584
$3,037.00
RADIOPHARM: TC-99M/MCI
0343
A9512
$2.00
RAPID HIV 1/2
0301
86703
$206.00
RBC FOLATE
0301
82747
$60.00
RBC SED RATE (AUTOMATED)
0305
85652
$43.00
RCH W/IMPLANT OF WIRELESS PRESSURE SENSOR PULM ARTERY
0483
C9741
$7,450.00
RE-OPEN LAP
0360
49002
$2,983.00
REC L AND D STAGE 1 LVL 1 ADDL MIN
0710
$17.00
REC L AND D STAGE 1 LVL 1 FIRST 15 MIN
0710
$665.00
REC L AND D STAGE 1 LVL 2 ADDL MIN
0710
$26.00
REC L AND D STAGE 1 LVL 2 FIRST 15 M
0710
$869.00
REC L AND D STAGE 1 LVL 3 ADDL MIN
0710
$32.00
REC L AND D STAGE 1 LVL 3 FIRST 15 MIN
0710
$1,130.00
REC L AND D STAGE 1 LVL 4 ADDL MIN
0710
$35.00
REC L AND D STAGE 1 LVL 4 FIRST 15 MIN
0710
$1,306.00
RECOVERY MAIN STAGE 1 LVL 1 ADDL MIN
0710
$17.00
RECOVERY MAIN STAGE 1 LVL 1 FIRST 15MS
0710
$666.00
RECOVERY MAIN STAGE 1 LVL 2 ADDL MIN
0710
$25.00
RECOVERY MAIN STAGE 1 LVL 2 FIRST 15MS
0710
$868.00
RECOVERY MAIN STAGE 1 LVL 3 ADDL MINS
0710
$31.00
RECOVERY MAIN STAGE 1 LVL 3 FIRST 15
0710
$1,130.00
RECOVERY MAIN STAGE 1 LVL 4 ADDL MIN
0710
$41.00
RECOVERY MAIN STAGE 1 LVL 4 FIRST 15 S
0710
$1,514.00
RECOVERY MAIN STAGE 2 ADDL MIN
0710
$11.35
RECOVERY MAIN STAGE 2 FIRST 15 MIN
0710
$245.00
RECOVERY STAGE 2 ADDL MIN
0710
$11.35
RECOVERY STAGE 2 FIRST 15 MIN
0710
$245.00
RED BLOOD CELLS, EACH UNIT
0390
P9021
$428.00
RED CELLS LEUKODEPL IRRADIATED
0390
P9040
$719.00
RED CELLS, LEUKODEPLETE
0390
P9016
$551.00
REGIONAL BLOCK ADDL MINUTE
0370
$4.05
REGIONAL BLOCK FIRST 15 MINUTES
0370
$253.00
RELOCATE SKIN POCKET FOR PACEMAKER
0360
33222
$2,682.00
REM 1/2 CHMBR PACG CVDFB ELTRD TRANSVNS XTR
0360
33244
$8,290.00
REM IMP PT-ACT CARD EVENT REC
0360
33284
$2,713.00
REM OF TUNNELED PLEURAL CATH W/CUFF
0360
32552
$526.00
REM PAC CVDFB PLS GEN & REPL PLS GEN DUAL LEAD
0360
33263
$44,274.00
REM PAC CVDFB PLS GEN & REPL PLS GEN MULTI LEAD
0360
33264
$33,496.00
REM PAC CVDFB PLS GEN & REPL PLS GEN SNGL LEAD
0360
33262
$31,852.00
REMOTE AFTLD INTERSTITIAL OR INTRACAV BRACHY 1 CHANNEL
0333
77770
$1,858.00
REMOTE AFTLD INTERSTITIAL OR INTRACAV BRACHY 2-12 CHANNEL
0333
77771
$1,858.00
REMOVAL DEVITALIZED TISS FR WOUND NON SELECT DEBRIDE ONGOING
0430
97602
$166.00
REMOVAL FB, FOREARM/WRIST - US
0360
25248
$1,563.00
REMOVAL TUNNELED CVAD
0360
36590
$1,978.00
REMOVAL TUNNELED CVC
0360
36589
$1,464.00
REMOVE IABP
0480
33968
$312.00
REMOVE PAC CVDFB PLS GEN ONLY
0360
33241
$12,454.00
REMOVE PCMKR PULSE GEN W/REPL-DUAL LEAD
0360
33228
$16,016.00
REMOVE PCMKR PULSE GEN W/REPL-MULTIPLE LEAD
0360
33229
$19,070.00
REMOVE PCMKR PULSE GEN W/REPL-SINGLE LEAD
0360
33227
$16,029.00
REMOVE PCMKR PULSE GENERATOR
0360
33233
$9,114.00
REMOVE TRANSCAT PERCUT OF INTRAVASCULAR FB
0481
37197
$6,162.00
REMOVE TVP ELECT 1 LEAD A OR V
0360
33234
$3,715.00
REMOVE TVP ELECT 2 LEAD A OR V
0360
33235
$6,953.00
REMOVE VAD
0481
33992
$2,667.00
REMOVE/REPLACE EXT ACCESIBLE NEPHROURETERAL CATH/STENT
0360
50387
$3,799.00
RENAL CYST/PELV ASP OR INJT-CT
0360
50390
$1,680.00
RENAL FLOW FUNCTION
0341
78707
$1,677.00
RENAL FUNCTION PANEL
0301
80069
$81.00
RENAL FUNCTION W/MEDS-NM
0341
78708
$1,677.00
RENAL SELECTIVE UNILATERAL
0480
36251
$6,294.00
RENAL SUPERSELECTIVE UNILATERAL
0480
36253
$6,294.00
RENAL/MESENTERIC/PORTAL(TIPS)DUPLEX
0921
93975
$1,695.00
RENAL/MESENTERIC/PORTAL(TIPS)LTD
0921
93976
$986.00
RENIN ASSAY
0301
84244
$81.00
REPAIR CVAD W/PORT,PUMP CENTRL,PERIPH
0360
36576
$2,076.00
REPLACE AORTIC VALVE OPEN FEMORAL ARTERY APPROACH
0360
33362
$23,143.00
REPLACE TUNNELED CNTRL CVC
0360
36581
$4,654.00
REPLACE,COMPLETE,TUNNELED CVC W/PORT
0360
36582
$8,265.00
REPO G-TUBE THRU DUODENUM
0360
43761
$1,646.00
REPO PREV IMPLNT PM/CVDFB RA/RV ELECTRODE
0360
33215
$3,501.00
REPOSITION VENOUS CATHETER
0360
36597
$1,252.00
REPTILASE TEST
0305
85635
$39.00
RESPIRATOR MOTION MGMT SIMUL
0333
77293
$317.00
RESPIRATORY VIRUS 3 TO 5 TARGETS
0306
87631
$475.00
RESPIRATORY VIRUS PANEL BY PCR
0300
87633
$1,389.00
RETIC COUNT (AUTOMATED)
0305
85046
$48.00
RETICULOCYTE PROFILE, AUTOMATED
0305
85046
$48.00
RETRIEVAL DEVICE(S)
0272
C1773
Variable
RETRIEVAL INTRAVASCULAR VENA CAVA FILTER
0480
37193
$7,772.00
REVASC FEM-POP,UNILAT W/PTA
0360
37224
$10,239.00
REVASC FEM-POP,UNILAT,STENT,INCL PTA
0360
37226
$20,498.00
REVASC FEM-POP,UNILAT,STENT/ATH,INCL
0360
37227
$33,311.00
REVASC FEMP-POP,UNILAT,ATH,INCL PTA S
0360
37225
$22,492.00
REVASC ILIAC,UNILAT EA ADD IPSILAT VE
0360
37222
$8,178.00
REVASC ILIAC,UNILAT EA ADD IPSILAT VE
0360
37223
$10,483.00
REVASC ILIAC,UNILAT INT VES W/PTA
0360
37220
$11,444.00
REVASC ILIAC,UNILAT INT VES,STENT,INC
0360
37221
$20,719.00
REVASC ILIAC,UNILAT,ATH,INCLUDES PTA
0360
0238T
$27,500.00
REVASC TIBIOPERONEAL UNILAT EA ADD VE
0360
37232
$9,114.00
REVASC TIBIOPERONEAL UNILAT EA ADD VE
0360
37233
$16,816.00
REVASC TIBIOPERONEAL UNILAT EA ADD VE
0360
37234
$1,374.00
REVASC TIBIOPERONEAL UNILAT INTL VES
0360
37228
$11,931.00
REVASC TIBIOPERONEAL UNILAT,ATH,INCLU
0360
37229
$24,193.00
REVASC TIBIOPERONEAL UNILAT,STENT,INC
0360
37230
$23,910.00
REVISION OF AORTIC VALVE
0481
92986
$8,468.00
REVISION OF HEPATIC SHUNT (TIPS)
0360
37183
$14,683.00
REVSE SKIN POCKET FOR CARDIOVERT-DEFIB
0360
33223
$4,660.00
RF ABLATION-LIVER PERCUT
0360
47382
$9,445.00
RH IG TESTING
0302
85461
$62.00
RH TYPING
0300
86901
$94.00
RH TYPING (WEAK DU)
0300
86901
$94.00
RHEUMATOID FACTOR, QT
0300
86431
$53.00
RNP ANTIBODY
0300
86235
$74.00
ROOM AND BOARD HOURLY OBS FIRST 48
0762
G0378
Variable
ROOM AND BOARD HOURLY OBS OVER 48
0762
G0378
Variable
ROOM AND BOARD-HOURLY OBS-MED/SURG
0762
G0378
$83.00
ROOM AND BOARD-INTENSIVE
0200
$5,683.00
ROOM AND BOARD-INTERMEDIATE
0206
$3,745.00
ROOM AND BOARD-MED/SURG
0120
$2,230.00
ROOM AND BOARD-MED/SURG-W/TELEMETRY
0120
$2,896.00
ROOM AND BOARD-NURSERY
0171
$1,829.00
ROOM AND BOARD-NURSERY-LEVEL I
0171
$3,676.00
ROOM AND BOARD-NURSERY-LEVEL II
0172
$5,020.00
ROOM AND BOARD-NURSERY-LEVEL III
0173
$6,224.00
ROOM AND BOARD-NURSERY-LEVEL IV
0174
$7,498.00
ROOM AND BOARD-PSYCHIATRIC UNIT
0124
$2,370.00
ROOM AND BOARD-REHABILITATION
0128
$2,520.00
ROTAVIRUS (ROTAZYME) AG
0306
87425
$94.00
RPR
0300
86592
$48.00
RPR QUANTITATION
0302
86593
$32.00
RSV
0301
87807
$77.00
RT AND LEFT HEART CATH
0480
93453
$8,638.00
RT AND LT HEART CATH W/LV,INCL INJ/S&
0480
93460
$10,981.00
RT AND LT HEART CATH W/LV,W/GRAFTS,IN
0480
93461
$11,187.00
RT HEART CATH-ANG
0480
93451
$8,536.00
RT TECHT BEDSIDE PROCEDURE
0410
Variable
RT TECHT CONSCIOUS SEDATION
0410
Variable
RT TECHT DELIVERY
0410
Variable
RT TECHT ED TRAUMA
0410
Variable
RT TECHT INTUBATION
0410
Variable
RT TECHT OTHER
0410
Variable
RT TECHT RETAPE
0410
Variable
RT TECHT ROAD TRIP
0410
Variable
RT TECHT RRT RESPONSE
0410
Variable
RT TECHT SWALLOW EVAL
0410
Variable
RUBELLA AB IGG OR IGM
0302
86762
$68.00
RUBELLA AB, IGG
0301
86762
$68.00
RUBELLA AB, IGM
0306
86762
$68.00
RUBEOLA ANTIBODY
0301
86765
$106.00
RUSSELL VIPER VENOM TIME
0301
85613
$127.00
SBRT DELIVERY,PER FRACTION TO 1 OR MORE LESIONS
0333
77373
$5,727.00
SCL 70 AUTOANTIBODIES
0301
86235
$74.00
SELCT EA ADD VES AFTR BSIC EXM
0320
75774
$2,385.00
SELCT PLC RT/LT PULM ARTERY
0360
36014
$1,368.00
SELECT CATH PLACE PULM ARTERY
0360
36015
$1,721.00
SELF CARE CURRENT STATUS
0420
G8987
$0.01
SELF CARE CURRENT STATUS
0430
G8987
$0.01
SELF CARE DISCHARGE STATUS
0420
G8989
$0.01
SELF CARE DISCHARGE STATUS
0430
G8989
$0.01
SELF CARE GOAL STATUS
0420
G8988
$0.01
SELF CARE GOAL STATUS
0430
G8988
$0.01
SELFCARE HOME MGMT 1/1 BY PROVIDER EA 15 MINUTES
0430
$87.00
SELFCARE HOME MGMT 1/1 BY PROVIDER EA 15 MINUTES
0430
97535
$87.00
SELFCARE HOME MGMT TRAIN DIRECT 1/1 BY PROVIDER EA 15 MIN
0420
97535
$87.00
SELFCARE HOME MGMT TRAIN DIRECT 1/1 BY PROVIDER EA 15 MIN
0420
$87.00
SEMEN ANALYSIS
0309
89322
$88.00
SENSITIVITY PER ORGANISM MIC
0306
87186
$114.00
SENSITIVITY PER PLATE DISC
0306
87184
$98.00
SENSORY INTEGRATIVE TECHNIQUES SENSORY PROC EA 15 MIN
0430
$109.00
SENSORY INTEGRATIVE TECHNIQUES SENSORY PROC EA 15 MIN
0430
97533
$109.00
SEPRAFILM ADHESION BARRIER
0278
Variable
SEROTONIN
0301
84260
$103.00
SET PNEUMOTHORAX (9079)
0270
$481.00
SGMDSC FLX DECOMPRESSION VOLVULUS ANY METHOD
0360
$3,278.00
SGOT (AST)
0301
84450
$27.00
SGPT (ALT)
0301
84460
$30.00
SHUNTOGRAM OF PREVPLACE INDWELLING NONVASCULAR
0481
75809
$225.00
SICKLE TESTING
0305
85660
$44.00
SIGMOIDOSCOPY
0360
$585.00
SIGMOIDOSCOPY FLX CONTROL BLEEDING
0360
$3,278.00
SIGMOIDOSCOPY FLX SNARE TUMOR POLYP OTH LESION
0360
$3,278.00
SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
0360
$3,278.00
SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)
0360
$3,278.00
SIMPLE REPAIR SUPERFICIAL WOUNDS 2.6 CM TO 7.5 CM
0510
12002
$308.00
SIMPLE REPAIR SUPERFICIAL WOUNDS 7.6 CM TO 12.5 CM
0510
12004
$308.00
SIMULATION-COMPLEX
0333
77290
$1,106.00
SIMULATION-SIMPLE
0333
77280
$481.00
SIO FLEX PELVI-SACRAL PREFAB (SI BELT)
0274
L0621
$187.00
SIROLIMUS (SACROLINUS)
0301
80195
$123.00
SKIN SUBST,ALLODERM,PER SQ CM
0278
Q4116
Variable
SKIN SUBSTITUTE, AMNIOEXCEL, PER SQ CM
0278
Q4137
Variable
SKIN SUBSTITUTE, NOT OTHERWISE SPECIF
0278
Q4100
Variable
SKIN SUBSTITUTE, STRATTICE TM, PER SQ CM
0278
Q4130
Variable
SKIN SUBSTITUTE,SURGIMEND,PER 0.5SQ C
0278
C9358
Variable
SKIN TEST: TB
0302
86580
$76.00
SLCT CATH PLC 1ST ORDR, VENOUS
0360
36011
$4,096.00
SLEEP DISORDER STUDY
0740
95810
$3,125.00
SLEEP STUDY W/CPAP
0740
95811
$3,629.00
SLEEP STUDY, AMBULATORY
0510
G0399
$1,063.00
SMALL BOWEL STUDY-DW
0320
74250
$425.00
SMOKING CESS OVER 10 MIN
0942
99407
$108.00
SMOKING CESS UP TO 10 MIN
0942
99406
$58.00
SNARE SMALL/MEDIUM (424967)
0272
$65.00
SODIUM
0301
84295
$27.00
SODIUM OTHER SOURCE
0301
84302
$32.00
SODIUM, LEVEL
0301
84295
$27.00
SODIUM, URINE
0301
84300
$40.00
SOMATOMEDIN C
0301
84305
$106.00
SPECIAL TX PROCEDURE
0333
77470
$1,426.00
SPECIFIC GRAVITY URINE
0307
81002
$35.00
SPECTROPHOTOMETRY ANALYTE NES
0301
84311
$26.00
SPEECH LANG CURRENT STATUS
0440
G9174
$0.01
SPEECH LANG DISCHARGE STATUS
0440
G9176
$0.01
SPEECH LANG GOAL STATUS
0440
G9175
$0.01
SPEECH LANGUAGE GROUP 2 OR MORE INDIVIDUALS
0440
92508
$184.00
SPERM CHECK
0305
89310
$41.00
SPHINCTER URINARY (C1815)
0278
C1815
Variable
SPINAL ANESTHESIA TRAY (1320)
0270
Variable
SPINAL BLOCK EACH ADDL MIN
0370
$4.30
SPINAL BLOCK FIRST 15 MIN
0370
$253.00
SPINAL BLOCK FIRST 15 MINUTES
0370
$253.00
SPINAL BLOCK FIRST ADDL MINUTE
0370
$4.05
SPINAL PUNCTURE LUMBAR DIAGNOSTIC
0360
62270
$1,167.00
SPIROMETRY
0460
94010
$140.00
SPIROMETRY PRE AND POST ADMIN
0460
94060
$252.00
SPLINT FAB. 1ST 30 MIN
0430
$166.00
SPLINT FAB. EA. 15 MIN'S.
0430
$69.00
SRS LINEAR BASED,COMPLETE COURSE CRANIAL LESION 1
0333
77372
$10,705.00
SS-A/RO ANTIBODIES
0300
86235
$74.00
SS-B/LA ANTIBODIES
0300
86235
$74.00
STANDARD COGNITIVE PERF TEST PER HR
0430
$270.00
STANDARD COGNITIVE PERF TEST PER HR
0430
96125
$270.00
STANDARD COGNITIVE PERF TEST PER HR
0440
$270.00
STANDARD COGNITIVE PERF TEST PER HR
0440
96125
$270.00
STANDARD DELIVERY
0720
$4,830.00
STCB PROBE
0272
A4649
$859.00
STENT BARE CORONARY (DEVICE)
0278
C1876
$8,773.00
STENT DRUG CORONARY (DEVICE)
0278
C1874
$23,072.00
STENT ANGIO PERIPHERAL
0278
C1876
Variable
STENT COATED NON-COR (DEVICE)
0278
C1874
Variable
STENT GRAFT
0278
C1874
Variable
STENT INSERT/CHANGE
0360
$1,088.00
STENT, COATED/COVERED, WITH DELIVERY
0278
C1874
Variable
STENT, NON CORONARY, TEMPORARY
0278
C2625
Variable
STENT, URETERAL
0278
C2617
Variable
STENT,NON-COATED/NON-COVERED W/DELIVE
0278
C1876
Variable
STONE ANALYSIS
0301
82365
$81.00
STREP GRP A ANTIGEN DETECTION
0306
87880
$71.00
STREPTOLYSIN O ANTIBODY (ASO)
0302
86060
$59.00
STRESS ECHO
0483
93350
$953.00
STRESS TEST TRACING
0482
93017
$490.00
STRESS TTE COMPLETE
0483
93351
$1,693.00
STRESS TTE W OR W/O CONTRAST CONT ECG
0483
C8930
$1,960.00
STRYKER QUICK STICK 0295-002
0270
$190.00
SUBFASCIAL SLING
0278
C1771
Variable
SULFATE ASSAY, URINE
0301
84392
$75.00
SUPERIOR/INFERIOR VENA CAVA
0360
36010
$729.00
SUPPLIES PROCEDURE
0272
Variable
SURGERY LEVEL 1 ADD MINUTES
0360
$71.00
SURGERY LEVEL 1 FIRST 15 MIN
0360
$1,477.00
SURGERY LEVEL 2 ADD MINUTES
0360
$90.00
SURGERY LEVEL 2 FIRST 15 MIN
0360
$1,923.00
SURGERY LEVEL 3 ADD MINUTES
0360
$118.00
SURGERY LEVEL 3 FIRST 15 MIN
0360
$2,500.00
SURGERY LEVEL 4 ADD MINUTES
0360
$151.00
SURGERY LEVEL 4 FIRST 15 MIN
0360
$3,253.00
SURGERY LEVEL 5 ADD MINUTES
0360
$190.00
SURGERY LEVEL 5 FIRST 15 MIN
0360
$4,229.00
SURGIFLO HEMOSTATIC MATRIX KIT (2994)
0278
Variable
SURVEILLANCE CULTURE
0306
87071
$80.00
SWALLOW CURRENT STATUS
0440
G8996
$0.01
SWALLOW DISCHARGE STATUS
0440
G8998
$0.01
SWALLOW GOAL STATUS
0440
G8997
$0.01
T CELLS TOTAL COUNT CD3
0302
86359
$126.00
T3 - TOTAL
0301
84480
$70.00
T3 FREE
0301
84481
$91.00
T3 REVERSE
0301
84482
$63.00
T4 (THYROXINE)
0301
84436
$73.00
T4, FREE
0301
84439
$41.00
TACROLIMUS FK507
0301
80197
$121.00
TAP BLOCK BILATERAL BY INJECTION(S)
0360
64488
$195.00
TAVR HEART VALVE
0272
Variable
TB CELL MEDIATED ANTIGEN RESPONSE; GAMMA INTERFERON
0302
86480
$230.00
TCAT IV STENT CRV CRTD ART EMBOLIC PROTEC
0360
37215
$4,530.00
TCAT PLMT IV STENT CTR DIALYSIS SEG W/IMG S&I
0360
36908
$19,651.00
TEE OR CONTINUOUS
0483
93318
$1,325.00
TEGRETOL ASSAY (CARBAMAZEPIN)
0301
80156
$87.00
TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
0333
77307
$1,376.00
TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
0333
77306
$959.00
TEMP TRANSVENOUS PACEMAKER
0360
33210
$10,238.00
TESTOSTERONE TOTAL SERUM
0301
84403
$136.00
TESTOSTERONE, FREE
0301
84402
$88.00
THC CANNABINOIDS CONFIRMATION
0301
80349
$88.00
THEAPEUTIC PROCEDURES GROUP TWO OR MORE INDIVIDUALS
0430
97150
$62.00
THEOPHYLLINE ASSAY
0301
80198
$109.00
THERA PROC 1+ AREAS EA 15 MIN AQUATIC THERA EXCERCISES
0430
97113
$117.00
THERA PROC 1+ AREAS EA 15 MIN GAIT TRAIN INC STAIR CLIMBING
0420
$81.00
THERA PROC 1+ AREAS EA 15 MIN GAIT TRAIN INC STAIR CLIMBING
0420
97116
$81.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSC REEDUCATION
0430
$121.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSC REEDUCATION
0430
97112
$121.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSCULAR REEDUCATION
0420
$121.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSCULAR REEDUCATION
0420
97112
$121.00
THERAPEUT DYNAMIC ACT IMPROVE FUNCT PERF 1/1 EA 15 MIN
0420
$100.00
THERAPEUT DYNAMIC ACT IMPROVE FUNCT PERF 1/1 EA 15 MIN
0420
97530
$100.00
THERAPEUT PROC 1+ AREAS EA 15 MIN AQUATIC EXCERCISES
0420
97113
$117.00
THERAPEUTIC DYN ACTIV IMPROVE FUNCT PERF 1/1 EA 15 MINUTES
0430
$100.00
THERAPEUTIC DYN ACTIV IMPROVE FUNCT PERF 1/1 EA 15 MINUTES
0430
97530
$100.00
THERAPEUTIC IVNTJ W/FOCUS ON COGNITIVE FUNCTION
0440
97127
$106.00
THERAPEUTIC IVNTJ W/FOCUS ON CONGNITIVE FUNCTION
0430
$106.00
THERAPEUTIC IVNTJ W/FOCUS ON CONGNITIVE FUNCTION
0430
97127
$106.00
THERAPEUTIC IVNTJ W/FOCUS ON CONGNITIVE FUNCTION
0440
97127
$106.00
THERAPEUTIC PROC 1+ AREAS EACH 15 MIN MASSAGE INCL EFF/PET
0420
$95.00
THERAPEUTIC PROC 1+ AREAS EACH 15 MIN MASSAGE INCL EFF/PET
0430
97124
$95.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXCERCISES
0430
$105.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXCERCISES
0430
97110
$105.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXERCISES
0420
$105.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXERCISES
0420
97110
$105.00
THERAPEUTIC PROCEDURES GROUP TWO OR MORE INDIVIDUALS
0420
97150
$62.00
THERAPEUTIC PROCEDURES GROUP TWO OR MORE INDIVIDUALS
0420
$62.00
THERAPEUTIC PROCEDURES GROUP TWO OR MORE INDIVIDUALS
0440
97150
$62.00
THERAPEUTIC PROCEDURES INCR STRENGTH END RESP MUSCLES GROUP 2+
0460
G0239
$52.00
THERAPEUTIC SERV NON SPEECH GEN DEVICE INCL PROGRAM AND MOD
0440
92606
$176.00
THORACIC/BRACHIOCEPHALIC 1ST
0323
36215
$1,374.00
THORACIC/BRACHIOCEPHALIC 2ND
0360
36216
$1,570.00
THORACIC/BRACHIOCEPHALIC 3RD
0360
36217
$1,874.00
THROMB/LYSIS ART ADDL VESL
0360
37185
$7,184.00
THROMB/LYSIS ART PRIM 1ST VESL
0360
37184
$6,511.00
THROMB/LYSIS VEIN REPEAT TREAT
0360
37188
$7,184.00
THROMB/LYSIS VEIN(S)
0360
37187
$7,353.00
THROMBIN INJECT FOR PSEUDOANEURYSM
0360
36002
$606.00
THROMBIN TIME
0300
85670
$24.00
THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
0450
37195
$779.00
THROMBOLYSIS, CORONARY, BY INTRAVENOUS INFUSION
0450
92977
$779.00
THROMBOLYTIC ART OR VEN TX-SUB W/CESSATION OF TX
0481
37214
$4,065.00
THROMBOLYTIC ART OR VENOUS THERAPY-SUBSEQUENT DAY
0481
37213
$4,065.00
THROMBOLYTIC ART THERAPY-INITIAL DAY
0481
37211
$5,437.00
THROMBOLYTIC VENOUS THERAPY-INITIAL DAY
0481
37212
$1,768.00
THYROGLOBULIN
0301
84432
$55.00
THYROGLOBULIN ANTIBODY
0302
86800
$68.00
THYROID HORMONE UPTAKE
0301
84479
$73.00
THYROID STIM IMMUNOGLOBULIN
0301
84445
$170.00
TISSUE CULTURE AMNIOTIC FLUID
0300
88235
$491.00
TISSUE MARKER-IMPLANTABLE
0278
A4648
$265.00
TISSUE MARKER/CLIP-IMPLANTABLE
0278
A4648
$265.00
TISSUE TRANSGLUTAMINASE AB IGA
0301
83520
$74.00
TOBRAMYCIN - RANDOM
0301
80200
$121.00
TOPIRAMATE (TOPAMAX)
0301
80201
$109.00
TOTAL ALLERGEN IGE
0301
82785
$64.00
TOXOPLASMA ANTIBODY, IGG
0302
86777
$74.00
TOXOPLASMA ANTIBODY, IGM
0302
86778
$80.00
TPMT GENE ANALAYSIS COMMON VARIANTS
0310
81335
$472.00
TRACH 4 CFS SHILEY (9097)
0270
$121.00
TRACH 4 DCT SHILEY (9090)
0270
$110.00
TRACH 5.0 PORTEX (9007)
0270
$71.00
TRACH 6 CFN SHILEY (9088)
0270
$121.00
TRACH 6 CFS SHILEY (9096)
0270
$113.00
TRACH 6 DCT SHILEY (9091)
0270
$110.00
TRACH 6 EXL CUFF (NS)(7642)
0270
$194.00
TRACH 6 EXL CUFFLESS (NS) (7641)
0270
$194.00
TRACH 7 EXL CUFF SHILEY (7440)
0270
$194.00
TRACH 7.0 UNCUF PORTEX (9106)
0270
$71.00
TRACH 8 CFN SHILEY (9089)
0270
$121.00
TRACH 8 CUST 129 CUFF SHILEY (7428)
0270
$178.00
TRACH 8 DCT SHILEY (9092)
0270
$110.00
TRACH 8 EXL CUFF SHILEY (7428)
0270
$194.00
TRACH 8 EXL CUFLS SHILEY (7427)
0272
$188.00
TRACH 8 FEN SHILEY (9087)
0270
$130.00
TRACH BUTTON OLYMPIC 10X27 (7514)
0270
$547.00
TRACH CHANGE
0360
$854.00
TRACH CUFFD 6MM PORTEX (4514)
0270
$81.00
TRACH CUFFD 7MM PORTEX (5979)
0270
$81.00
TRACH CUFFD 8MM PORTEX (4515)
0270
$81.00
TRACH CUFLS 6MM PORTEX (4505)
0270
$71.00
TRACH PORT 7 CUFF FEN (7539)
0272
$85.00
TRACH SPEAKING VALVE
0274
$232.00
TRAIN IN USE OF SPEECH DEVICE
0440
92609
$349.00
TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR
0481
0387T
$29,269.00
TRANSCATH/BRUSH/BX-ANG
0320
75970
$2,045.00
TRANSCATHETER BIOPSY
0360
37200
$5,411.00
TRANSCRANIAL DOPPLER
0921
93886
$1,168.00
TRANSCRANIAL DOPPLER INTRACRANIAL ARTERIES-LIMITED STUDY
0921
93888
$760.00
TRANSESOPHAGEAL ECHOCARDIO
0480
93312
$1,121.00
TRANSFERRIN
0301
84466
$67.00
TRANSFUSION BLOOD OR BLOOD COMPONENTS
0391
36430
$877.00
TRAUMA ACTIVATION FULL
0682
G0390
$3,727.00
TRAUMA ACTIVATION FULL W/UNDER 30 MIN CC
0682
$3,727.00
TRAUMA ACTIVATION MOD W/UNDER 30 MIN CC
0682
$2,855.00
TRAUMA ACTIVATION MODIFIED
0682
G0390
$2,855.00
TRAUMA CRITICAL CARE 30-74 MINUTES
0450
99291
$4,215.00
TRAUMA CRITICAL CARE LESS THAN 30 MIN
0450
99285
$1,955.00
TRAUMA-MODIFIED W/O ACTIVATION
0450
99285
$2,345.00
TRAY THORACENTESIS 17G 6" (1323)
0270
Variable
TRAY THORACENTESIS 18G (7560)
0272
Variable
TRAY THOROCENTESIS
0270
Variable
TREATMENT DEVICES-COMPLEX
0333
77334
$843.00
TREATMENT DEVICES-INTERMED
0333
77333
$686.00
TREATMENT DEVICES-SIMPLE
0333
77332
$843.00
TREATMENT OF SPEECH LANGUAGE VOICE COMMUNICATION AUDITORY PROCES
0440
$317.00
TREATMENT OF SPEECH LANGUAGE VOICE COMMUNICATION AUDITORY PROCES
0440
92507
$317.00
TREATMENT PORT IMAGE(S) VERIFI
0333
77417
$244.00
TREATMENT SWALLOWING DYSFUNCTION AND OR ORAL FUNCTION FOR FEEDING
0440
92526
$247.00
TRICHOMONAS DNA PROBE
0306
87660
$74.00
TRICYCLIC, ANTIDEPRESSANTS, QUANTITATIVE, URINE
0301
80337
$93.00
TRIGLYCERIDE
0301
84478
$26.00
TRIP FEE, 1 DRAW
0300
P9604
$28.00
TRIP FEE, 10 DRAWS
0300
P9604
$2.80
TRIP FEE, 11 DRAWS
0300
P9604
$2.54
TRIP FEE, 12 DRAWS
0300
P9604
$2.33
TRIP FEE, 14 DRAW
0300
P9604
$2.00
TRIP FEE, 15 DRAW
0300
P9604
$1.86
TRIP FEE, 2 DRAWS
0300
P9604
$14.00
TRIP FEE, 3 DRAWS
0300
P9604
$9.33
TRIP FEE, 4 DRAWS
0300
P9604
$7.00
TRIP FEE, 5 DRAWS
0300
P9604
$5.60
TRIP FEE, 6 DRAWS
0300
P9604
$4.67
TRIP FEE, 7 DRAWS
0300
P9604
$4.00
TRIP FEE, 8 DRAWS
0300
P9604
$3.50
TRIP FEE, 9 DRAWS
0300
P9604
$3.11
TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART
0481
37246
$9,723.00
TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN
0481
37248
$9,723.00
TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN
0481
37249
$4,702.00
TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I
0360
36907
$9,723.00
TROPONIN T
0301
84484
$132.00
TSH
0301
84443
$147.00
TTE LIMITED OR F/U
0480
93308
$823.00
TTE W OR W/O FOL W/CONTRAST, DOPPLER
0483
C8929
$1,960.00
TTE WITH DOPPLER AND COLOR FLOW
0483
93306
$1,696.00
TTE-CHD
0483
93303
$815.00
TTE-CHD LIMITED OR F/U
0483
93304
$504.00
TTMT SWLLOWING DYSFUNCTION AND OR ORAL FCTN FOR FEEDING
0440
$247.00
TUBE CHEST THALQIK (9114)
0270
$409.00
TUBE EXHANGER (433587)
0270
$177.00
TUBE MIC GASTROSTOMY 20FR (6270)
0270
$95.00
TUBE THORACOSTOMY INCLUDES WATER SEAL
0360
32551
$1,408.00
TUBE THORACOSTOMY-OPEN
0360
32551
$1,265.00
TUMOR LOC ECT
0341
78803
$1,677.00
TUMOR LOC LIMITED AREA
0341
78800
$720.00
TUMOR LOC WB - 1 DAY
0341
78802
$4,452.00
TUMOR LOC WB - MULT DAYS
0341
78804
$4,452.00
TUNNELED CVAD W/PORT AGE +5
0360
36561
$7,023.00
TX ATRIAL FIB PULM VEIN ISOL
0481
93656
$21,022.00
TX L/R ATRIAL FIB ADD ON
0481
93657
$13,999.00
TX PLANNING IMRT
0333
77301
$4,553.00
ULTRASOUND TRANSRECTAL
0402
76872
$425.00
UMBILICAL ARTERY CATH, NEWBORN
0761
36660
$1,059.00
UMBILICAL VENOUS CATH, NEWBORN
0761
36510
$1,059.00
UNCONJUGATED ESTRIOL
0301
82677
$81.00
UNNA BOOT APPLICATION - BILATERAL
0510
29580
$240.00
UNNA BOOT APPLICATION - LEFT
0510
29580
$240.00
UNNA BOOT APPLICATION - RIGHT
0510
29580
$240.00
UPPER BALLOON ENTERSCOPY
0360
$3,378.00
UPPER GI W/AIR W/KUB-DR
0320
74247
$526.00
UPPER GI W/AIR W/O KUB-DR
0320
74246
$526.00
UPPER GI W/KUB - DR
0320
74241
$526.00
UPPER GI W/O KUB - DR
0320
74240
$526.00
UPPER GI W/SMALL BOWEL-DW
0320
74245
$861.00
UPR GI NDSC REMOVAL LESION/POLYP/TUMOR BY HOT BX
0360
$4,220.00
UREA NITROGEN, URINE
0301
84540
$44.00
URETERAL STENT
0272
Variable
URETHROCYSTOGRAM-DW
0320
74450
$861.00
URIC ACID
0301
84550
$27.00
URIC ACID, URINE
0301
84560
$75.00
URINALYSIS W/MICRO
0307
81001
$48.00
URINALYSIS, CULTURE IF INDICAT
0307
81001
$48.00
URINE CHEMISTRY STRIP
0307
81002
$35.00
URINE HEMOGLOBIN
0307
83069
$27.00
URINE MACRO, C AND S IF INDICATED
0307
81003
$21.00
URINE MACRO, MICROSCOPIC IF IND
0307
81003
$21.00
URINE MICROSCOPIC
0307
81015
$29.00
URINE MICROSCOPIC, CULT IF IND
0307
81015
$29.00
URINE PROTEIN
0301
84156
$73.00
URO IV W/NEPHROTOMOGRAPH-DW
0320
74415
$936.00
UROGRAPHY RETROGRADE-DW
0320
74420
$1,691.00
US ABDOMEN COMPLETE
0402
76700
$589.00
US ABDOMEN LIMITED
0402
76705
$437.00
US ABDOMINAL AORTA, RT W/IMAGE DOC, SCREENING FOR AAA
0402
76706
$425.00
US BREAST UNI REAL TIME W/IMAGE LIMITED
0402
76642
$362.00
US CHEST (INCLUDES MEDIASTINUM)
0402
76604
$336.00
US CHEST WALL BIOPSY
0360
21550
$3,819.00
US COMPLETE JOINT
0402
76881
$498.00
US FETAL MIDDLE CEREBRAL ARTERY DOPPL
0402
76821
$425.00
US FETAL UMBILICAL ARTERY DOPPLER
0402
76820
$425.00
US GUID PARENCHYMAL TISSUE ABLATION
0402
76940
$802.00
US GUIDANCE FOR AMNIOCENTESIS
0402
76946
$411.00
US GUIDANCE FOR NEEDLE PLACEMENT
0402
76942
$1,041.00
US GUIDANCE FOR PERICARDIOCENTESIS
0402
76930
$335.00
US GUIDANCE FOR VASCULAR ACCESS
0402
76937
$471.00
US GUIDANCE-INTRAOPERATIVE
0402
76998
$560.00
US GUIDED PERICARDIOCENTESIS
0761
76930
$335.00
US HEAD/BRAIN
0402
76506
$366.00
US INFANT HIPS-DYNAMIC
0402
76885
$329.00
US LIMITED JOINT OR OTHER NONVASCULAR EXTREMITY
0402
76882
$366.00
US OBSTETRIC AFTER 14 WKS PREG-EA ADDSTER
0402
76810
$421.00
US OBSTETRIC AFTER 14 WKS PREG-SINGLE OR FIRST GESTATION
0402
76805
$624.00
US OBSTETRIC BPP W/O NON STRESS TEST
0402
76819
$425.00
US OBSTETRIC DETAILED EXAM-EA ADD GES
0402
76812
$453.00
US OBSTETRIC DETAILED EXAM-SINGLE OR FIRST GESTATION
0402
76811
$968.00
US OBSTETRIC NUCHAL TRANSLUCENCY-EA A
0402
76814
$392.00
US OBSTETRIC NUCHAL TRANSLUCENCY-SINGLE OR FIRST GESTATION
0402
76813
$631.00
US OBSTETRIC TRANSABDOMINAL F/U GROWTH-PER FETUS
0402
76816
$350.00
US OBSTETRIC TRANSVAGINAL
0402
76817
$455.00
US OBSTETRIC UP TO 14 WKS PREG-EA ADD
0402
76802
$226.00
US OBSTETRIC UP TO 14 WKS PREG-SINGLE OR FIRST GESTATION
0402
76801
$400.00
US PELVIS-COMPLETE
0402
76856
$492.00
US PELVIS-LIMITED OR F/U
0402
76857
$425.00
US PREGNANT UTERUS RT W/IMAGE DOCUMENT ONE OR MORE FETUSES
0402
76815
$382.00
US PREGNANT UTERUS RT W/IMAGE DOCUMENT ONE OR MORE FETUSES
0402
76815
$425.00
US RENAL BIOPSY PERCUT
0360
50200
$888.00
US RENAL CYST ASP/INJ
0360
50390
$1,680.00
US RETROPERITONEAL COMPLETE
0402
76770
$510.00
US RETROPERITONEAL LIMITED
0402
76775
$425.00
US SCROTUM AND CONTENTS
0402
76870
$425.00
US SOFT TISSUES OF HEAD AND NECK
0402
76536
$425.00
US SPINAL CANAL AND CONTENTS
0402
76800
$366.00
US THORACENTESIS FOR ASPIRATION W/IMAGING
0360
32555
$1,265.00
US THORACENTESIS W/TUBE PLACEMENT W/IMAGING
0360
32557
$2,887.00
US TRANSPLANTED KIDNEY
0402
76776
$461.00
US TRANSVAGINAL
0402
76830
$455.00
VAC CANISTER 500ML (7464)
0270
$117.00
VAC DRESS SM (7468)
0272
$110.00
VAC DRESS X-LARGE (7460)
0270
$346.00
VAC DRESSING ABD ABTHERA (7744)
0272
$1,152.00
VAC DRESSING LG (7462)
0272
$168.00
VAC DRESSING LG WHITE (7461)
0270
Variable
VAC DRESSING MED (7466)
0272
$146.00
VAC DRESSING MED SILVER (7583)
0270
$219.00
VAC DRESSING MED WHITE (7469)
0270
$177.00
VAC DRESSING SM WHITE (7470)
0270
$168.00
VAGINAL INSERTION FOR CYLINDERS
0333
57156
$598.00
VALPROIC ACID ASSAY
0301
80164
$87.00
VANCOMYCIN - RANDOM
0301
80202
$108.00
VARICELLA ZOSTER AB, IGG
0301
86787
$86.00
VASC EMBOLIZE/OCCLUDE ARTERY
0481
37242
$16,087.00
VASC EMBOLIZE/OCCLUDE BLEED
0481
37244
$17,278.00
VASC EMBOLIZE/OCCLUDE ORGAN
0481
37243
$17,112.00
VASC EMBOLIZE/OCCLUDE VENOUS
0481
37241
$19,195.00
VASCULAR GRAFTS
0278
C1768
Variable
VEN HEPATIC W/HEMODYNAMIC EVAL
0320
75889
$6,294.00
VEN HEPATIC W/O HEMODYNMC EVAL
0320
75891
$6,294.00
VENA CAVA FILTER
0278
C1880
Variable
VENO CAVA/INFERIOR W/SERIAL
0320
75825
$6,294.00
VENO CAVAL/SUPERIOR W/SERIAL
0320
75827
$2,030.00
VENO RENAL UNILAT SELECT-ANG
0320
75831
$6,294.00
VENTILATOR CHRONIC
0410
94003
$2,743.00
VENTILATOR CIRCUIT
0272
Variable
VENTILATOR MANAGEMENT
0410
94003
$2,743.00
VIRUS INOCULATION
0306
87254
$128.00
VIRUS TISS CULTURE ADDL/EACH ISOLATE
0306
87253
$75.00
VIRUS TISS CULTURE INOCULATION
0306
87252
$124.00
VISCER & INFRARENAL ABDOM AORTA 2 PROSTHESIS
0360
34846
$20,524.00
VISCERL SUPRA/SELECT W/WO AORT
0320
75726
$6,294.00
VISCOSITY, SERUM
0301
85810
$53.00
VITAL CAPACITY
0460
94150
$140.00
VITAMIN A, SERUM
0301
84590
$62.00
VITAMIN B-12 ASSAY
0301
82607
$92.00
VITAMIN B-6 ASSAY
0301
84207
$94.00
VITAMIN B1 PYROPHOSPHATE (THIAMINE)
0301
84425
$77.00
VITAMIN D 25-OH ASSAY
0301
82306
$108.00
VITAMIN E
0301
84446
$63.00
VMA 24HR URINE
0301
84585
$70.00
VOICE CURRENT STATUS
0440
G9171
$0.01
VOICE DISCHARGE STATUS
0440
G9173
$0.01
VOICE GOAL STATUS
0440
G9172
$0.01
VOLATILES, METHANOL, OR ISOPROPANOL
0301
84600
$165.00
WBC (AUTOMATED)
0305
85048
$25.00
WC PHYS CAP EVAL - LEVEL 1
0429
99196
$300.00
WC PHYS CAP EVAL - LEVEL II
0429
99197
$616.00
WC PHYS CAP EVAL ADD'L 15 MIN
0429
99193
$78.00
WC WORK CAPACITY EVAL
0429
99198
$1,230.00
WEST NILE VIRUS AB
0302
86789
$77.00
WHEELCHAIR MANAGEMENT ASSESSMENT FITTING TRAINING EA 15 MIN
0420
$97.00
WHEELCHAIR MANAGEMENT ASSESSMENT FITTING TRAINING EA 15 MIN
0420
97542
$97.00
WHFO CF INCL 1 OR MORE NONTORSION JNTS
0274
L3806
$673.00
WHFO RIGID W/O JNTS CUSTOM FABRICATED
0274
L3808
$533.00
WHFO W/O JNTS PREFABRICATED OTS
0274
L3809
$279.00
WHFO W/O JNTS PREFABRICATED W/ EXPERTISE
0274
L3807
$349.00
WHO INCL 1 OR MORE NONTORSION JNTS CUSTOM FABRICATED
0274
L3905
$1,381.00
WHO INCL 1 OR MORE NT JNTS PREFABRICATED W/ EXPERTISE
0274
L3915
$220.00
WHO W/O JNTS CUSTOM FABRICATED
0274
L3906
$631.00
WHO WRST EXT CONTROL COCK UP NON MOLDED PREFABRICATED
0274
L3908
$195.00
WIRE, 80CM EXTRA STIFF AMPLATZ
0272
C1769
$108.00
WORK HARDENING CONDITIONING INITIAL TWO HOURS
0429
97545
$242.00
WOUND DEBRIDE, 1ST 20 SQ CM
0420
97597
$512.00
WOUND DEBRIDE, 1ST 20 SQ CM
0430
97597
$512.00
WOUND VAC DAY RENTAL KCI (N/A)
0270
Variable
WOUND VAC DRESS WHITE SMALL (7470)
0270
$152.00
WOUND VAC-NEG PRESS GREATER THAN 50 SQ CM
0510
97606
$501.00
WOUND VAC-NEG PRESS UP THRU 50 SQ CM
0510
97605
$285.00
X-MATCH 1 UNIT
0309
86923
$382.00
XR UGI W/AIR AND SBFT
0320
74249
$511.00
XRAY ABDOMEN W/CHEST COMPLETE
0320
74022
$425.00
XRAY ABSCESS FISTULA SINUS TRACT
0320
76080
$499.00
XRAY ACROMIOCLAVICULAR JOINTS BILATERAL
0320
73050
$231.00
XRAY ANKLE 2 VIEWS
0320
73600
$231.00
XRAY ANKLE 3+ VIEWS COMPLETE
0320
73610
$231.00
XRAY CERVICAL SPINE 4+ VIEWS
0320
72050
$425.00
XRAY CERVICAL SPINE 2-3 VIEWS
0320
72040
$231.00
XRAY CERVICAL SPINE COMPLETE
0320
72052
$425.00
XRAY CLAVICAL COMPLETE
0320
73000
$231.00
XRAY ELBOW 2 VIEWS
0320
73070
$231.00
XRAY ELBOW 3+ VIEWS
0320
73080
$231.00
XRAY EXAM ENTIRE SPINE 4 OR 5 VIEWS
0320
72083
$843.00
XRAY EXAM ENTIRE SPINE W/SKULL 1 VIEW
0320
72081
$231.00
XRAY EXAM ENTIRE SPINE W/SKULL 2-3 VIEWS
0320
72082
$425.00
XRAY EXAM HIP UNILATERAL 1 VIEW
0320
73501
$231.00
XRAY EXAM HIP UNILATERAL 2 OR 3 VIEWS
0320
73502
$231.00
XRAY EXAM HIPS BILATERAL 3 OR 4 VIEWS
0320
73522
$425.00
XRAY EXAM OF FEMUR 1 VIEW
0320
73551
$231.00
XRAY EXAM OF FEMUR 2 VIEWS MINIMUM
0320
73552
$231.00
XRAY FACIAL BONES 1-2 VIEWS
0320
70140
$231.00
XRAY FACIAL BONES 3+ VIEWS
0320
70150
$425.00
XRAY FOOT 2 VIEWS
0320
73620
$231.00
XRAY FOOT 3+ VIEWS COMPLETE
0320
73630
$231.00
XRAY FOR FOREIGN BODY-CHILD
0320
76010
$231.00
XRAY FOREARM 2 VIEWS
0320
73090
$231.00
XRAY HAND 2 VIEWS
0320
73120
$425.00
XRAY HAND 3+ VIEWS
0320
73130
$231.00
XRAY HEEL 2+ VIEWS
0320
73650
$231.00
XRAY HUMERUS 2+ VIEWS
0320
73060
$231.00
XRAY KNEE 1-2 VIEWS
0320
73560
$231.00
XRAY KNEE 3 VIEWS
0320
73562
$231.00
XRAY KNEE 4+ VIEWS COMPLETE
0320
73564
$425.00
XRAY LOWER EXTREMITY INFANT 2+ VIEWS
0320
73592
$231.00
XRAY LUMBAR SPINE BENDING 4+ VIEWS
0320
72120
$279.00
XRAY LUMBARSACRAL SPINE 2-3 VIEWS
0320
72100
$425.00
XRAY LUMBARSACRAL SPINE 4+ VIEWS
0320
72110
$425.00
XRAY LUMBARSACRAL SPINE COMPLETE
0320
72114
$425.00
XRAY MANDIBLE 4+ VIEWS
0320
70110
$425.00
XRAY NASAL BONES 3+ VIEWS
0320
70160
$231.00
XRAY NECK SOFT TISSUE
0320
70360
$231.00
XRAY OSSEOUS SURVEY COMPLETE
0320
77075
$425.00
XRAY OSSEOUS SURVEY-INFANT
0320
77076
$425.00
XRAY PELVIS 1-2 VIEWS
0320
72170
$425.00
XRAY RIBS BILATERAL 3 VIEWS
0320
71110
$425.00
XRAY RIBS BILATERAL 4 VIEWS
0320
71111
$425.00
XRAY RIBS UNILATERAL 2 VIEWS
0320
71100
$231.00
XRAY RIBS UNILATERAL 3 VIEWS
0320
71101
$425.00
XRAY SACROILIAC JOINTS 3+ VIEWS
0320
72202
$425.00
XRAY SACRUM/COCCYX 2+ VIEWS
0320
72220
$231.00
XRAY SCAPULA COMPLETE
0320
73010
$279.00
XRAY SHOULDER 1 VIEW
0320
73020
$231.00
XRAY SHOULDER 2+ VIEWS COMPLETE
0320
73030
$231.00
XRAY SINUSES 1-2 VIEWS
0320
70210
$231.00
XRAY SINUSES 3+ VIEWS
0320
70220
$231.00
XRAY SKULL 1-3 VIEWS
0320
70250
$425.00
XRAY SKULL 4+ VIEWS
0320
70260
$425.00
XRAY SPINE 1 VIEW
0320
72020
$231.00
XRAY STERNOCLAVICULAR JOINTS 3+ VIEWS
0320
71130
$231.00
XRAY STERNUM 2+ VIEWS
0320
71120
$231.00
XRAY SURGICAL SPECIMEN
0320
76098
$1,802.00
XRAY TEMPOROMANDIBULAR JOINTS BILATERAL
0320
70330
$231.00
XRAY THORACIC SPINE 2 VIEWS
0320
72070
$425.00
XRAY THORACIC SPINE 3 VIEWS
0320
72072
$425.00
XRAY THORACOLUMBAR JUNCTION 2 VIEWS MIN
0320
72080
$231.00
XRAY TIBIA/FIBULA 2 VIEWS
0320
73590
$231.00
XRAY UPPER EXTREMITY INFANT 2+ VIEWS
0320
73092
$425.00
XRAY WRIST 2 VIEWS
0320
73100
$231.00
XRAY WRIST 3+ VIEWS COMPLETE
0320
73110
$231.00
YEAST ID
0306
87106
$94.00
YUEH-CENTISIS CATH NEEDLE
0272
$61.00
ZIKA VIRUS IGM ANTIBODY
0302
86794
$56.00
ZINC LEVEL PLASMA
0301
84630
$63.00
ZINC PROTOPORPHYRIN
0301
84202
$57.00
ZIO 48HRS UP TO 21DAYS-HOOK UP
0731
0296T
$366.00
ZONISAMIDE QUANTITATIVE
0301
80203
$116.00

West Valley Hospital

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17 HYDROXYPROGESTERONE
301
83498
$93.00
2HR GLUCOSE TOLERANCE
301
82951
$132.00
3D RENDERING REQUIRING WORKSTATION
350
76377
$768.00
AB BARTONELLA
306
86611
$72.00
AB SCREEN
300
86850
$132.00
ABO TYPING
300
86900
$109.00
ACID FAST CULTURE
306
87116
$152.00
ACID FAST STAIN
306
87206
$78.00
ACTH
301
82024
$134.00
ACTIVATED PROTEIN C RESISTANCE RATION
300
85307
$92.00
ACUTE HEPATITIS PANEL
301
80074
$369.00
ADMIN OF HEPATITIS B VACCINE
771
G0010
$62.00
ADMIN OF INFLUENZA VACCINE
771
G0008
$62.00
ADMIN OF PNEUMOCOCCAL VACCINE
771
G0009
$62.00
ADMIN VACCINE-IMMUNIZATION-ONE VACCINE
771
G0008
$97.00
AEROBIC IDENTIFICATION
306
87077
$56.00
AFP TO SERUM TO ESOTERIX GENZYME
301
82105
$65.00
AG DETECT NOS EIA MULTI STEP EACH ORGANISM
306
87449
$139.00
AIRWAY INHALATION TREATMENT
410
94640
$45.00
ALBUMIN ASSAY
301
82042
$25.00
ALCOHOL BIOMARKERS 1 OR 2 (ETHYL GLUCURONIDE)
301
80321
$124.00
ALDOLASE ASSAY
301
82085
$70.00
ALDOSTERONE ASSAY
301
82088
$136.00
ALKALINE PHOSPHATASE
301
84075
$27.00
ALKALINE PHOSPHATASE ISOENZYME
301
84080
$104.00
ALLERGEN SPECIFIC IGE, EACH
302
86003
$20.00
ALPHA 1 ANTITRYPSIN PHENOTYPE
301
82104
$48.00
ALPHA FETOPROTEIN, TUMOR MARKER
301
82105
$65.00
ALPHA-1-ANTITRYPSIN
301
82103
$73.00
AMMONIA
301
82140
$62.00
AMPHETAMINES; 1 OR 2
301
80324
$88.00
AMYLASE ASSAY
301
82150
$84.00
ANA BY IFA
301
86039
$154.00
ANAEROBE CULTURE SURGICAL SP
306
87075
$74.00
ANAEROBIC ID
306
87076
$72.00
ANCHOR/SCREW FOR OPPOSING BONE TO BON
278
C1713
Variable
ANESTHESIA INHALATION OR IV ADDL MINUTE
370
$8.05
ANESTHESIA INHALATION OR IV FIRST 15 MINUTES
370
$380.00
ANGIOTENSIN CONVERT ENZ
301
82164
$62.00
ANTI MITOCHONDRIAL AB
301
83516
$73.00
ANTI NUCLEAR ANTIBODY SCREEN
301
86038
$126.00
ANTI-DNA DOUBLE STRAND
301
86225
$90.00
ANTI-STRIATED MUSCLE AB, IGG
301
86255
$72.00
ANTIBODY ENTEROVIRUS
302
86658
$43.00
ANTIBODY I.D. ELUATE
302
86860
$382.00
ANTIBODY ID
302
86870
$638.00
ANTIBODY TITER
300
86850
$132.00
ANTIBODY VIRUS NOT ELSEWHERE SPECIFIED
302
86790
$43.00
ANTIBODY; TREPONEMA PALLIDUM
306
86780
$65.00
ANTICARDIOLIPIN ABS, IGA, G OR M
301
86147
$94.00
ANTINEUTROPHIL CYTOPLASMIC AB
301
86021
$120.00
ANTITHROMBIN III ACTIV
302
85300
$145.00
APP OF MULTI-LAYER VENOUS WOUND COMP BELOW KNEE-BILATERAL
510
29581
$356.00
APP OF MULTI-LAYER VENOUS WOUND COMP BELOW KNEE-LT
510
29581
$356.00
APP OF MULTI-LAYER VENOUS WOUND COMP BELOW KNEE-RT
510
29581
$356.00
APPL MOD 1+ AREAS ELEC STIM MAN EA 15 MIN
430
97032
$104.00
APPL MOD 1+ AREAS ULTRASOUND EACH 15 MINUTES
420
97035
$74.00
APPL OF MOD 1+ AREAS ULTRASOUND EACH 15 MINUTES
430
97035
$74.00
APPL OF MODALITY TO 1+ AREAS ELECTRICAL STIM UNATTENDED
420
97014
$56.00
APPL OF MODALITY TO 1+ AREAS PARAFFIN BATH
430
97018
$51.00
APPLICATION OF MODALITY TO 1+ AREAS IONTOPHORESIS EACH 15 MINUTE
420
97033
$83.00
APPLICATION OF MODALITY TO 1+ AREAS IONTOPHORESIS EACH 15 MINUTE
430
97033
$83.00
APPLICATION OF MODALITY TO 1+ AREAS TRACTION MECHANICAL
420
97012
$83.00
ARSENIC ASSAY
301
82175
$99.00
ARTERIAL PUNCTURE
300
36600
$158.00
ASSAY OF ETHANOL
301
80320
$175.00
ASSAY OF MYOGLOBIN
301
83874
$66.00
ASSAY OF NICOTINE
301
80323
$104.00
ASSAY OF PHENCYCLIDINE
301
83992
$60.00
ASSAY OF SEX HORMONE BINDING GLOBULIN
301
84270
$86.00
ASSAY TEST FOR BLOOD FECAL
300
82274
$59.00
ATTENTION CURRENT STATUS
440
G9165
$0.01
ATTENTION DISCHARGE STATUS
440
G9167
$0.01
ATTENTION GOAL STATUS
440
G9166
$0.01
BARBITURATES CONFIRMATION
301
80345
$88.00
BASIC METABOLIC PANEL
301
80048
$88.00
BCR ABL 1 GENE MAJOR BP
300
81206
$547.00
BCR ABL 1 GENE MINOR BP
300
81207
$702.00
BENZODIAZEPINES; 1-12
301
80346
$99.00
BETA 2 GLYCOPROTEIN AB, EA
302
86146
$85.00
BETA HCG
301
84702
$56.00
BETA HYDROXYBUTYRATE SERUM QUANT OTHER KETONE BODIES
301
82010
$52.00
BETA LACTAMASE TEST
306
87185
$33.00
BETA-2 MICROGLOBULIN, QUANTIT
301
82232
$74.00
BILIRUBIN TOTAL
301
82247
$35.00
BIOPSY OR EXCISION LYMPH NODE BY NEEDLE-SUPERFICIAL
360
38505
$760.00
BLOOD DRAW-CENTRAL/PERIPHERAL LINE
510
36592
$126.00
BLOOD DRAW-COMPLETE IMPLANTABLE VAD
510
36591
$104.00
BLOOD TYPING;RBC ANTIGENS,OTHER THAN
300
86905
$638.00
BNP
301
83880
$261.00
BODY FLUID PH
301
83986
$50.00
BODY FLUID PROTEIN
301
84155
$27.00
BODY POSITION CURRENT STATUS
420
G8981
$0.01
BODY POSITION CURRENT STATUS
430
G8981
$0.01
BODY POSITION DISCHARGE STATUS
420
G8983
$0.01
BODY POSITION DISCHARGE STATUS
430
G8983
$0.01
BODY POSITION GOAL STATUS
420
G8982
$0.01
BODY POSITION GOAL STATUS
430
G8982
$0.01
BONE AGE STUDY
320
77072
$425.00
BONE DENSITY STUDY, AXIAL
320
77080
$508.00
BREAST CORE NEEDLE (420582)
272
$158.00
BREAST NEEDLE LOC (404322,404320,404319)
272
$71.00
BRONCHOSCOPY
360
$2,685.00
BUN
301
84520
$27.00
BX BREAST 1ST LESION US IMAGING
360
19083
$2,098.00
C DIFFICILE TOXIN A+B
306
87324
$140.00
C REACTIVE PROTEIN (CRP)
301
86140
$115.00
C-PEPTIDE
301
84681
$70.00
C4
300
86160
$98.00
CA 19-9
301
86301
$101.00
CA125 ASSAY
302
86304
$156.00
CALCITONIN ASSAY
301
82308
$98.00
CALCIUM ASSAY
301
82310
$27.00
CALCIUM ASSAY, URINE
301
82340
$54.00
CALCIUM, IONIZED
301
82330
$60.00
CALPROTECTIN FECAL
301
83993
$216.00
CANALITH REPOSITION EPLEY MANEUVER SEMONT MAN PER DAY
420
95992
$129.00
CANDIDA SPECIES DNA PROBE
306
87480
$74.00
CAPILLARY PUNCTURE
300
36416
$301.00
CARBOXYHEMOGLOBIN
301
82375
$56.00
CARDIAC DOPPLER/NO INTERP
480
93320
$336.00
CARDIOPULMONARY RESUSCITATION
480
92950
$632.00
CARDIOVERSION
480
92960
$1,054.00
CARNITINE, FREE AND TOTAL, SERUM
301
82379
$75.00
CARRY CURRENT STATUS
420
G8984
$0.01
CARRY CURRENT STATUS
430
G8984
$0.01
CARRY DISCHARGE STATUS
420
G8986
$0.01
CARRY DISCHARGE STATUS
430
G8986
$0.01
CARRY GOAL STATUS
420
G8985
$0.01
CARRY GOAL STATUS
430
G8985
$0.01
CATARACT REMOVAL W/INSERT INTRAOCULAR LENS 1 STAGE
360
66984
$5,889.00
CATECHOLAMINES, UA FRACT
301
82384
$111.00
CATH FOLEY TRAY 16FR TEMP SENS (7626)
272
Variable
CATH, BALLOON
272
C1726
Variable
CATHETER, URETERAL
272
C1758
Variable
CBC (AUTOMATED)
305
85027
$58.00
CBC WITH AUTOMATED DIFF
305
85025
$81.00
CD4
301
86361
$164.00
CEA ASSAY
301
82378
$94.00
CELL COUNT AND DIFF BODY FLUID
305
89051
$98.00
CELL COUNT CSF WITHOUT DIFF
301
89050
$98.00
CERULOPLASMIN
301
82390
$57.00
CHEMO IV INF 1ST HR SINGLE OR 1ST DRU
280
96413
$633.00
CHEMO IV INF ADDT'L HRS
280
96415
$143.00
CHEST PT AND PD
410
94668
$184.00
CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TECHNIQUE
306
87491
$191.00
CHLORIDE URINE
301
82436
$48.00
CHLORIDE, SERUM
301
82435
$27.00
CHOLANGIOGRAPHY SURGICAL
320
74300
$298.00
CHOLESTEROL
301
82465
$27.00
CHROMIUM ASSAY
301
82495
$168.00
CHROMOGRANIN-A
301
86316
$138.00
CITRIC ACID, 24 HOUR URINE
301
82507
$97.00
CKMB
301
82553
$75.00
COCCIDIOIDES AB IGG OR IGM
302
86635
$64.00
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
300
36415
$20.00
COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE
761
36415
$28.00
COLONOSCOPY - SIMPLE
360
$2,465.00
COLOR FLOW DOPPLER
480
93325
$538.00
COLUMN CHROMATOGRAPHY NON DRUG NOS EA SPEC
301
82542
$256.00
COMBINED VACCINE,MMR+VARICELLA,SQ
636
90710
Variable
COMPATABILITY TEST ANTIGLOBULIN
309
86922
$382.00
COMPATABILITY TEST IMMEDIATE SPIN
309
86920
$382.00
COMPATABILITY TEST INCUBATION PHASE
309
86921
$382.00
COMPLEMENT, TOTAL (CH-50)
301
86162
$102.00
COMPLEX STAIN FOR O AND P
306
87209
$60.00
COMPREHENSIVE MET PANEL
301
80053
$126.00
CONC FOR INFECTIOUS AGENT
306
87015
$85.00
CONNECTIVE TISSUE, HUMAN (INCLUDES FA
278
C1762
Variable
CONTINUOUS NEBULIZER 1ST HOUR
410
94644
$142.00
COPPER
301
82525
$59.00
CORTISOL, SERUM
301
82533
$96.00
CORTISOL,FREE,24 HR URINE
301
82530
$62.00
CPAP ACUTE
410
94660
$789.00
CPAP CHRONIC
410
94660
$302.00
CPK
301
82550
$64.00
CREATININE CLEARANCE
301
82575
$76.00
CREATININE SERUM
301
82565
$27.00
CREATININE, URINE RANDOM
301
82570
$45.00
CRITICAL CARE 30-74 MINUTES
450
99291
$2,641.00
CRITICAL CARE EACH ADDTNL 30 MIN
450
99292
$773.00
CRYOGLOBULINS QUAL OR SEMI QUANT
301
82595
$39.00
CRYPTOSPORIDIUM AG DETECTION BY EIA
306
87328
$59.00
CRYSTAL I.D
307
89060
$86.00
CT ABD AND PELVIS W/CONTRAST
350
74177
$1,667.00
CT ABD AND PELVIS W/O AND W/CONTRAST
350
74178
$1,834.00
CT ABD AND PELVIS W/O CONTRAST (OR OR
350
74176
$1,421.00
CT ABDOMEN W/CONTRAST
350
74160
$1,667.00
CT ABDOMEN W/O AND W/CONTRAST
350
74170
$1,834.00
CT ABDOMEN W/O CONTRAST
350
74150
$709.00
CT ANGIO ABD AND PELVIS W/CON,INCLUDING NON CONTRT
352
74174
$1,667.00
CT ANGIO ABDOMEN W/CONTRAST
352
74175
$1,667.00
CT ANGIO ABDOMEN W/RUNOFFS
350
75635
$2,068.00
CT ANGIO CHEST W/CONTRAST
352
71275
$1,667.00
CT ANGIO HEAD W/CONTRAST
350
70496
$1,667.00
CT ANGIO LOWER EXTREMITY W/CONTRAST
350
73706
$1,667.00
CT ANGIO NECK W/CONTRAST
350
70498
$1,667.00
CT CERVICAL SPINE W/CONTRAST
350
72126
$1,614.00
CT CERVICAL SPINE W/O CONTRAST
350
72125
$709.00
CT CHEST W/CONTRAST
350
71260
$1,667.00
CT CHEST W/O AND W/CONTRAST
350
71270
$1,834.00
CT CHEST W/O CONTRAST
350
71250
$758.00
CT HEAD OR BRAIN W/CONTRAST
351
70460
$1,667.00
CT HEAD OR BRAIN W/O AND W/CONTRAST
351
70470
$1,834.00
CT HEAD OR BRAIN W/O CONTRAST
351
70450
$709.00
CT LOWER EXTREMITY W/CONTRAST
350
73701
$1,667.00
CT LOWER EXTREMITY W/O CONTRAST
350
73700
$709.00
CT LUMBAR SPINE W/CONTRAST
350
72132
$2,685.00
CT LUMBAR SPINE W/O CONTRAST
350
72131
$709.00
CT MAXILLOFACIAL W/CONTRAST
350
70487
$1,667.00
CT MAXILLOFACIAL W/O CONTRAST
350
70486
$709.00
CT NECK W/CONTRAST
350
70491
$1,667.00
CT NECK W/O CONTRAST
350
70490
$709.00
CT ORBIT OR SELLA W/CONTRAST
350
70481
$1,667.00
CT ORBIT OR SELLA W/O CONTRAST
350
70480
$709.00
CT PELVIS W/CONTRAST
350
72193
$1,667.00
CT PELVIS W/O AND W/CONTRAST
350
72194
$1,834.00
CT PELVIS W/O CONTRAST
350
72192
$709.00
CT THORACIC SPINE W/CONTRAST
350
72129
$1,667.00
CT THORACIC SPINE W/O CONTRAST
350
72128
$709.00
CT UPPER EXTREMITY W/CONTRAST
350
73201
$1,667.00
CT UPPER EXTREMITY W/O CONTRAST
350
73200
$709.00
CULTURE AEROBIC
306
87070
$118.00
CULTURE BLOOD
306
87040
$171.00
CULTURE FUNGAL
306
87102
$156.00
CULTURE STOOL
306
87045
$127.00
CULTURE STREP SCREEN ONLY
306
87081
$92.00
CULTURE TYPING BY RNA/DNA PROBE EA CULT/ISOLATE
306
87150
$130.00
CULTURE URINE
306
87086
$78.00
CULTURE, STOOL ADDT'L PATHOGENS
306
87046
$32.00
CULTURE, TYPING IMMUNOLOGIC METHOD, OTHER, PER ANTISERUM
306
87147
$33.00
CULTURE,PRESUMPTIVE,PATHOGENIC ORGANI
306
87081
$92.00
CYCLIC CITRUL PEPTIDE
301
86200
$78.00
CYCLOSPORINE ASSAY(SANDIMMUNE)
301
80158
$100.00
CYSTIC FIBROSIS GENE ANALYSIS
300
81220
$1,503.00
CYSTOGRAM-VOIDING-DW
320
74455
$861.00
CYTOMEG, DNA OR RNA AMP PROBE
306
87496
$117.00
CYTOMEGALOVIRUS (CMV) QUANT (DNA OR RNA)
306
87497
$364.00
CYTOMEGALOVIRUS AB, IGM
302
86645
$72.00
CYTOMEGALOVIRUS, IGG
302
86644
$65.00
CYTOPATHOLOGY SMEAR CONE CONCENTRATION TECHNIQUE SMEARS/INTERP
311
88108
$138.00
CYTOPATHOLOGY THIN LAYER PAP CERVICAL/VAGINAL PREP AND MANUAL
311
88142
$82.00
D-DIMER, QUANT
305
85379
$98.00
DECLOTTING BY THROMB AGENT-IMPL VAD
510
36593
$523.00
DHEA (UNCONJUGATED)
301
82626
$84.00
DHEA SULFATE-SEND OUT TEST
301
82627
$90.00
DIFFERENTIAL, MANUAL
305
85007
$35.00
DIGOXIN ASSAY
301
80162
$136.00
DILANTIN, TOTAL
301
80185
$58.00
DIP-TET-PERTUSS VACCINE UNDER 7 YRS
636
90700
$54.00
DIRECT BILIRUBIN
301
82248
$39.00
DIRECT COOMBS
302
86880
$94.00
DOPPLER LIMITED OR F/U
483
93321
$131.00
DRIVING OCCUPATIONAL THERAPY EVALUATION
430
$232.00
DRUG TEST(S) LC/MS OR GC/MS 1-7 DRUG CLASSES
301
G0480
$564.00
DRUG TESTS PRESUMPTIVE ANY NUMBER CLASSES, PER DATE OF SERVICE
300
80307
$302.00
DRUG TESTS PRESUMPTIVE ANY NUMBER CLASSES, PER DOS
300
80307
$302.00
DRUG TST PRESUMP INSTR ASSISTED DIR OPTICAL
300
80306
$222.00
DRUG(S) DEFINITIVE QUAL OR QUANT NOS 1-3
301
80375
$88.00
DTAP-HIB-IP VACCINE, IM
636
90698
Variable
DTAP-IPV 4-6 YRS
636
90696
Variable
DTAP/HEPB/IPV VACCINE,IM
636
90723
$91.00
DUPLEX SCAN ABDOMINAL,PELVIC,SCROTAL,RETROPERIONEAL-LIMITED STUD
921
93976
$1,016.00
DUPLEX SCAN EXTRACRANIAL ARTERIES-COMPLETE BILATERAL STUDY
921
93880
$735.00
DUPLEX SCAN EXTRACRANIAL ARTERIES-UNILATERAL OR LIMITED STUDY
921
93882
$503.00
ECG 12 LEAD
730
93005
$155.00
ED FACILITY FEE CLASS 1
450
99281
$278.00
ED FACILITY FEE CLASS 2
450
99282
$590.00
ED FACILITY FEE CLASS 3
450
99283
$862.00
ED FACILITY FEE CLASS 4
450
99284
$1,394.00
ED FACILITY FEE CLASS 5
450
99285
$1,916.00
ED FACILITY FEE CLASS 5
450
99285
$1,955.00
ED PROCEDURE LEVEL 1
450
$245.00
ED PROCEDURE LEVEL 2
450
$375.00
ED PROCEDURE LEVEL 3
450
$767.00
ED PROCEDURE LEVEL 4
450
$905.00
ED PROCEDURE LEVEL 5
450
$1,440.00
ELBOW ORTHOSIS WITH ADJ LOCK JNT PREFABRICATED W/ EXPERTISE
274
L3760
$697.00
ELECTROLYTES, SERUM
301
80051
$44.00
ENDOTRACH INTUBATION
360
31500
$1,097.00
ENZYME ACTIV BLD, CELLS OR TISSUE; NONRADIOACTIVE SUBSTRATE, EA
301
82657
$181.00
EPSTEIN BARR AB TO EARLY AG
302
86663
$84.00
EPSTEIN BARR AB TO NUCLEAR AG
302
86664
$101.00
EPSTEIN BARR AB VCA
302
86665
$70.00
EPSTEIN BARR AB VCA
306
86665
$70.00
ERYTHROPOIETIN ASSAY
301
82668
$77.00
ESOPHAGUS-DW
320
74220
$526.00
ESTRADIOL
301
82670
$146.00
ESTROGEN FRACTIONATION
301
82671
$182.00
ETHOSUXIMIDE ASSAY (ZARONTIN)
301
80168
$56.00
EVAL OF SPEECH PRODUCTION
440
92522
$235.00
EVAL OF SPEECH PRODUCTION W/LANG COMP & EXPRESSION
440
92523
$235.00
EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION
440
92610
$235.00
EVENT MONITOR HOOK UP
731
93270
$302.00
EXT VENOUS DUPLEX BILATERAL UE/LE
921
93970
$754.00
EXT VENOUS DUPLEX UNILATERAL UE/LE
921
93971
$533.00
EXTRACTABLE NUCLEAR ANTIGEN
300
86235
$74.00
EZ-IO INTRAOSSEOUS NEEDLE
272
$359.00
F2 GENE ANALYSIS PT COAG FACTOR II
300
81240
$352.00
F5 GENE ANALYSIS LEIDEN VARIANT
300
81241
$322.00
FACTOR 8 RISTOCETIN COFACTOR
302
85245
$158.00
FACTOR VIII ACTIVITY
302
85240
$105.00
FACTOR VIII RELATED ANTIGEN
302
85246
$182.00
FATS OR LIPIDS, FECES; QUALITATIVE
301
82705
$18.00
FECAL FAT 72 HR
301
82710
$105.00
FECAL LACTOFERRIN QUAL
301
83630
$77.00
FERRITIN
301
82728
$123.00
FETAL CGEN ABNOR FOUR ANALYTES
300
81511
$384.00
FIBRINOGEN LEVEL
302
85384
$74.00
FINGER OTHOSIS W/O JOINTS CUSTOM FABRICATED
274
L3933
$298.00
FIRST TISSUE BLOCK WITH FROZEN SECTIONS SINGLE SPECIMEN CONSULT
312
88331
$382.00
FLU VACCINE INACTIVATED IIV SUBUNIT ADJUVANTED FOR IM
636
90653
$54.83
FLU VACCINE, 0.5ML DOSAGE, IM, NO PRESERVATIVE
636
90656
$14.00
FLUORESCENT NONINFECTIOUS AGENT ANTIB
301
86256
$77.00
FLUORESCENT NONINFECTIOUS AGENT, EACH ANTIBODY
301
86255
$72.00
FLUORO NEEDLE GUIDE, SPINAL
320
77003
$348.00
FLUOROSCOPY UP TO 1 HOUR
320
76000
$416.00
FO PIP/DIP W/O JNT/SPR EXT/FLEX PREFABRICATED
274
L3927
$48.00
FOLATE ASSAY
301
82746
$92.00
FOOT INSERT REMOVABLE FORMED TO LEFT FOOT
274
L3030
$190.00
FOOT INSERT REMOVABLE FORMED TO RIGHT FOOT
274
L3030
$190.00
FSH
301
83001
$113.00
FUNGUS ANTIBODIES
302
86671
$68.00
GARDNERELLA DNA PROBE
306
87510
$74.00
GASES, BLOOD ARTERIAL OR VENOUS
301
82803
$182.00
GASTRIN, SERUM RIA
301
82941
$73.00
GASTROCCULT
307
82271
$26.00
GASTROSCOPY - SIMPLE
360
$1,875.00
GENERAL HEALTH PANEL
300
80050
$267.00
GENTAMICIN - RANDOM
301
80170
$126.00
GGT
301
82977
$32.00
GIARDIA ANTIGEN BY EIA
306
87329
$75.00
GLUCOSE 6 PD QUANTITATIVE
301
82955
$95.00
GLUCOSE ASSAY
301
82947
$27.00
GLUCOSE ASSAY, POST DOSE
301
82950
$73.00
GLUCOSE BODY FLUID
301
82945
$39.00
GLUCOSE TOL TEST, EACH ADDN
301
82952
$35.00
GLYCOSYLATED HEMOGLOBIN
301
83036
$73.00
GRAM STAIN
306
87205
$53.00
GROUP 1 GMS STAINS FOR MICROORGANISM
312
88312
$301.00
GROUP 1 PNEUMOCYSTIS FUNGAL STAINS FOR MICROORGANISM
312
88312
$301.00
GROWTH HORMONE ASSAY
301
83003
$87.00
GUIDE WIRE
272
C1769
Variable
H PYLORI (C-13) BREATH ANALYSIS UREASE ACT NON-RADACT ISTOPE
300
83013
$225.00
H PYLORI ANTIGEN STOOL
306
87338
$124.00
HAND FINGER ORTHOSIS W/O JNTS PREFABRICATED OTS
274
L3924
$110.00
HAND FINGER ORTHOSIS W/O JNTS PREFABRICATED W/ EXPERTISE
274
L3923
$138.00
HAND FINGER ORTHOSIS W/O JOINTS CUSTOM FABRICATED
274
L3913
$378.00
HAPTOGLOBIN
301
83010
$73.00
HCG SCREEN
301
84703
$67.00
HCG, URINE
307
81025
$48.00
HCV GENOTYPE
301
87902
$858.00
HCV RNA QUANT BY PCR ULTRASEN
301
87522
$437.00
HELICOBACTER PYLORI IGG
306
86677
$86.00
HEMATOCRIT (AUTOMATED)
305
85014
$26.00
HEMOCHROMATOSIS GENE ANALYSIS
300
81256
$365.00
HEMOGLOBIN
300
85018
$26.00
HEMOGLOBIN (AUTOMATED)
305
85018
$26.00
HEMOGLOBIN CHROMOTOGRAPHY
305
83021
$64.00
HEP B VACC PED/ADOL 3 DOSE
636
90744
$36.00
HEP B VACCINE
636
90746
$36.00
HEPATIC FUNCTION PANEL
301
80076
$101.00
HEPATITIS A ANTIBODY (IGM)
301
86709
$64.00
HEPATITIS A PED 2 DOSE
636
90633
$36.00
HEPATITIS A VACC ADULT IM
636
90632
$78.00
HEPATITIS A VIRUS AB, TOTAL
301
86708
$80.00
HEPATITIS B CORE AB (IGM)
301
86705
$94.00
HEPATITIS B CORE ANTIBODY, TOT
301
86704
$163.00
HEPATITIS B SURF AG
301
87340
$74.00
HEPATITIS B SURG AG NEUTRALIZATION
302
87341
$92.00
HEPATITIS B VIRAL DNA, PCR QUANT
306
87517
$300.00
HEPATITIS BE ANTIBODY
300
86707
$62.00
HEPATITIS BE ANTIGEN EIA
300
87350
$52.00
HEPATITIS C ANTIBODY
301
86803
$125.00
HEPATITIS DELTA AB
301
86692
$43.00
HEXAGONAL PHOS NEUT 85598
301
85598
$59.00
HIAA-5 24HR URINE
301
83497
$76.00
HIB VACCINE, PRP-T, IM
636
90648
$69.00
HIGH SENSITIVITY CRP
301
86141
$115.00
HISTOPLASMA YEAST
306
86698
$47.00
HIV 1 AND HIV 2 ANTIBODIES WITH HIV 1 ANTIGEN
302
87389
$148.00
HIV 1 ANTIBODY
302
86701
$190.00
HIV 2 ANTIBODY
302
86702
$77.00
HIV1 QUANT BY RNA OR DNA
306
87536
$421.00
HLA B27
300
86812
$126.00
HLA II, HIGH RESOLUTION, 1 ALLELE OR ALLELE GROUP, EACH
310
81383
$452.00
HLA II, LOW RESOLUTION, 1 LOCUS, EACH
310
81376
$507.00
HOLTER MONITOR UP TO 48 HR-HOOKUP
731
93225
$366.00
HOLTER MONITOR UP TO 48 HR-W/REPORT
731
93226
$612.00
HOMOCYSTEINE
301
83090
$101.00
HPV 9-VALENT VACCINE (GARDASIL-9)
636
90651
$24.00
HSV TYPE 1 AND 2, IGM AB
306
86694
$65.00
HSV TYPE 1, IGG AB
302
86695
$56.00
HSV TYPE 2, IGG AB
302
86696
$67.00
HUMIDIFIER-DISP
270
Variable
HZV VACC RECOMBINANT IM NJX
636
90750
$185.00
IADNA STREP A AMP PROBE TQ
306
87651
$131.00
IDENTIFICATION SENTINEL NODE
360
38792
$1,295.00
IMMUNIZATION ADMIN EACH ADDITIONAL
771
90472
$31.00
IMMUNIZATION ADMIN INITIAL VACCINE
771
90471
$63.00
IMMUNIZATION ADMIN ORAL/NASAL INITIAL VACCINE
771
90473
$63.00
IMMUNIZATION ADMIN-ONE VACCINE
771
90471
$97.00
IMMUNIZATION ANY METH EA ADD UP TO 18
771
90461
$31.00
IMMUNIZATION ANY METHOD UP TO AGE 18
771
90460
$63.00
IMMUNIZATION: EA ADDL VACC
771
90472
$57.00
IMMUNOASSAY FOR ANALYTE QUAL OR SEMIQUANT MULTI STEP
301
83516
$73.00
IMMUNOASSAY FOR ANALYTE QUANT BY RIA
301
83519
$125.00
IMMUNOASSAY FOR ANALYTE QUANTITATIVE
301
83520
$74.00
IMMUNOASSAY FOR INF AGENT QT,HEP B SU
301
86317
$82.00
IMMUNOASSAY, EACH
301
83520
$74.00
IMMUNOFIXATION PROCEDURE
301
86334
$266.00
IMMUNOFIXATION URINE
301
86335
$266.00
IMMUNOGLOBULIN
301
82784
$104.00
IMMUNOGLOBULIN SUBCLASSES 1 2 3 OR 4 EACH
301
82787
$42.00
IMMUNOHISTOCHEM PER SPEC EA ADDL SINGLE AB STAIN
312
88341
$290.00
IMMUNOHISTOCHEM PER SPEC INITIAL AB STAIN
312
88342
$638.00
IMMUNOSAY INFECTIOUS AGENT AB OR AG QUAL OR SEMI QUAL
301
83516
$73.00
IMPLANTED VENOUS ACCESS DEVICE IRRIGA
510
96523
$78.00
INF AG DET BY DNA OR RNA NOS QUANT EA ORGANISM
306
87799
$396.00
INF AGENT BY DNA/RNA HSV AMP PROBE
306
87529
$150.00
INF AGENT DET NUCL ACID CLOSTRIDIUM AMP PROBE
306
87493
$223.00
INF AGENT DNA/RNA NOS AMP PROBE EA ORGANISM
306
87798
$232.00
INF AGENT GENOTYPE DNA/RNA HEP B VIRUS
300
87912
$858.00
INFECT AGENT DET BY NA RESP VIRUS 12 TO 25 TARGETS
306
87633
$1,389.00
INFECTIOUS AGENT AG IMMUNOASSAY;HISTOPLASMA
306
87385
$163.00
INFECTIOUS AGENT BY DNA/RNA STAPH AUREUS AMP PROBE
306
87640
$148.00
INFLUENZA ANTIGEN A OR B, EACH
306
87400
$129.00
INHALATION TREATMENT
410
94640
$161.00
INHIBIN A
301
86336
$110.00
INITIAL ORTHO MGMT TRAIN UPPER LOWER EXTREMITY OR TRUNK EA 15 MIN
430
97760
$113.00
INITIAL ORTHO MGMT TRAINING UPPER/LOWER EXTREM AND OR TRUNK EA 15 MIN
420
97760
$113.00
INJ,ANES AGENT,FEMORAL,SINGLE
360
64447
$1,328.00
INJ,ANES AGENT,INTERSCALENE,SINGLE
360
64415
$1,274.00
INJECTION PROCEDURE-CYSTOGRAM
320
51600
$140.00
INJECTION PROCEDURE-URETHROCYSTOGRAPHY
360
51610
$263.00
INJECTION SQ OR IM TX,DX,PROPH
761
96372
$123.00
INSERT TEMPORARY INDWELLING BLADDER CATHETER, SIMPLE (EG, FOLEY)
450
51702
$302.00
INSULIN, SERUM
301
83525
$68.00
INTERVENTN BAND LIGATION
360
$1,965.00
INTERVENTN BX
360
$548.00
INTERVENTN DIL NON BALLOON
360
$377.00
INTERVENTN POLYP REMOVAL
360
$1,452.00
INTERVENTN SCLEROSIS INJ
360
$1,123.00
INTRODUCER/SHEATH
272
C1894
Variable
IRON
301
83540
$29.00
IRON BINDING CAPACITY
300
83550
$52.00
ISLET CELL ANTIBODY
302
86341
$155.00
IV INF HYDRATION ADDL HRS
761
96361
$126.00
IV INF HYDRATION INITIAL 31 MIN TO 1 HR
761
96360
$420.00
IV INF TX,DX,PROPH 1ST HR,1ST DRUG
761
96365
$454.00
IV INF TX,DX,PROPH ADDL DRUG CCUR
761
96368
$211.00
IV INF TX,DX,PROPH ADDL DRUG SEQ
761
96367
$285.00
IV INF TX,DX,PROPH ADDL HRS
761
96366
$132.00
IV PUSH TX,DX,PROPH EA ADDL NEW DRUG
761
96375
$173.00
IV PUSH TX,DX,PROPH REPEAT SEQ DRUG
761
96376
$125.00
IV PUSH TX,DX,PROPH SINGLE OR INITIAL
761
96374
$243.00
JAK2 GENE ANALYSIS
300
81270
$475.00
JO 1 ANTIBODY IGG
301
86235
$74.00
KOH PREP
306
87210
$51.00
LACTIC ACID ASSAY
301
83605
$81.00
LAMOTRIGINE QUANTITATIVE
301
80175
$76.00
LANG COMP CURRENT STATUS
440
G9159
$0.01
LANG COMP GOAL STATUS
440
G9160
$0.01
LANG EXPRESS CURRENT STATUS
440
G9162
$0.01
LANG EXPRESS DISCHARGE STATUS
440
G9164
$0.01
LANG EXPRESS GOAL STATUS
440
G9163
$0.01
LDH
301
83615
$27.00
LDL-CHOLESTEROL, DIRECT
301
83721
$67.00
LEAD ASSAY
301
83655
$94.00
LENS INTRAOCULAR
276
C1780
$471.00
LEVEL 1 EST PT EVAL AND MGMT
510
99211
$174.00
LEVEL 1 SURGICAL PATHOLOGY GROSS EXAMINATION ONLY
312
88300
$85.00
LEVEL 2 EST PT EVAL AND MGMT
510
99212
$284.00
LEVEL 2 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88302
$102.00
LEVEL 3 EST PT EVAL AND MGMT
510
99213
$326.00
LEVEL 3 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88304
$162.00
LEVEL 4 EST PT EVAL AND MGMT
510
99214
$459.00
LEVEL 4 NEW PT EVAL AND MGMT
761
99204
$546.00
LEVEL 4 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88305
$221.00
LEVEL 5 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88307
$638.00
LEVEL 6 SURGICAL PATHOLOGY GROSS AND MICROSCOPIC EXAMINATION
312
88309
$1,602.00
LEVETIRACETAM (KEPPRA) QUANTITATIVE
301
80177
$162.00
LH
301
83002
$116.00
LIPASE
301
83690
$64.00
LIPID SCREEN
301
80061
$179.00
LIPOPROT BLD QT OF LIPOPROT PARTICLE NOS & PARITCS
301
83704
$105.00
LIPOPROTEIN A
301
83695
$63.00
LITHIUM ASSAY
301
80178
$63.00
LOWER GI COLON-DW
320
74270
$526.00
LOWER GI/COLON W/AIR CONT-DW
320
74280
$526.00
LUMBAR PUNCTURE THERAPEUTIC DRAINAGE
360
62272
Variable
LYME DISEASE AB
306
86618
$88.00
LYME DISEASE AB WESTERN BLOT CONFIRMATORY TEST
302
86617
$52.00
MAGNESIUM ASSAY
301
83735
$33.00
MAMM-BREAST WIRE
272
$68.00
MAMMOGRAPHY DIAGNOSTIC CAD BILATERAL
401
77066
$437.00
MAMMOGRAPHY DIAGNOSTIC CAD UNILATERAL
401
77065
$342.00
MAMMOGRAPHY SCREENING 2 VIEW CAD BILATERAL
403
77067
$356.00
MAMMOGRAPHY-DIAGNOSTIC DIGITAL IMAGE BILATERAL
401
G0204
$540.00
MAMMOGRAPHY-DIAGNOSTIC DIGITAL IMAGE UNILATERAL
401
G0206
$421.00
MANUAL THERAPY TECHNIQUES 1+ REGIONS EA 15 MINUTES
420
97140
$118.00
MANUAL THERAPY TECHNIQUES 1+ REGIONS EA 15 MINUTES
430
97140
$118.00
MASS SPEC AND TANDEM MASS SPEC ANALYTE NOS QT EA
301
83789
$269.00
MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM
636
90734
$257.00
MDI INSTRUCT
410
94664
$161.00
MEAS POST VOID RESIDUAL URINE AND/OR BLADDER CAP NON IMAGING
761
51798
$389.00
MED NUTRITION THERAPY INITIAL ASSESS INDIV 1/1 EA 15 MIN
942
97802
$56.00
MED NUTRITION THERAPY REASSESS INDIV 1/1 EA 15 MIN
942
97803
$56.00
MEMORY DISCHARGE STATUS
440
G9170
$0.01
MEMORY GOAL STATUS
440
G9169
$0.01
MEMORY STATUS CURRENT
440
G9168
$0.01
MENB RP W/OMV VACCINE IM
636
90620
$217.00
MERCURY BLOOD
301
83825
$89.00
MESH (IMPLANTABLE)
278
C1781
Variable
METANEPHRINES
301
83835
$119.00
METANEPHRINES PLASMA FREE
301
83835
$119.00
METHADONE AND METABOLITE, SERUM OR PLASMA, QUANT
301
80358
$88.00
METHYLENEDIOXYAMPHETAMINES
301
80359
$149.00
METHYLMALONIC ACID
301
83921
$75.00
MICROALBUMIN
301
82043
$32.00
MICROSOMAL ANTIBODY, EA
302
86376
$67.00
MISC PROCEDURE
9000005
Variable
MMR VACC LIVE SC INJ
636
90707
$65.00
MOBILITY CURRENT STATUS
420
G8978
$0.01
MOBILITY CURRENT STATUS
430
G8978
$0.01
MOBILITY DISCHARGE STATUS
420
G8980
$0.01
MOBILITY DISCHARGE STATUS
430
G8980
$0.01
MOBILITY GOAL STATUS
420
G8979
$0.01
MODERATE SEDATION AGE 0-4 INITIAL 15MIN
370
99151
$230.00
MODERATE SEDATION AGE 5+ 1ST 15MIN
370
99152
$154.00
MODERATE SEDATION EACH ADDL 15MIN
370
99153
$135.00
MONITOR ANESTHESIA ADDL MINUTE
370
$4.05
MONITOR ANESTHESIA FIRST 15 MINUTES
370
$253.00
MONO TEST
306
86308
$68.00
MONONUCLEAR CELL ANTIGEN QUANT NOS EA
300
86356
$89.00
MORPHOMETRIC ANALYSIS TUMOR IMMUNOHISTOCHEMISTRY QUANT OR SEMI
310
88360
$638.00
MOTION FLUOROSCOPIC EVAL OF SWALLOWING FUNCT BY CINE OR VIDEO
440
92611
$235.00
MOTOR SPEECH CURRENT STATUS
440
G8999
$0.01
MOTOR SPEECH GOAL STATUS
440
G9186
$0.01
MRA BRAIN W/3D RENDERING
615
70544
$1,642.00
MRA BRAIN W/O CONTRAST
615
70544
$1,642.00
MRA NECK W/O AND W/CONTRAST
615
70549
$2,954.00
MRA NECK W/O CONTRAST
615
70547
$1,421.00
MRI ABDOMEN W/O AND W/CONTRAST
610
74183
$2,954.00
MRI ABDOMEN W/O CONTRAST
610
74181
$1,790.00
MRI BRAIN W/CONTRAST
611
70552
$2,684.00
MRI BRAIN W/O AND W/CONTRAST
611
70553
$2,954.00
MRI BRAIN W/O CONTRAST
611
70551
$2,263.00
MRI CERVICAL SPINE W/O AND W/CONTRAST
612
72156
$3,603.00
MRI CERVICAL SPINE W/O CONTRAST
612
72141
$1,767.00
MRI JOINT LOWER EXTREMITY W/CONTRAST
610
73722
$4,133.00
MRI JOINT LOWER EXTREMITY W/O AND W/C
610
73723
$4,546.00
MRI JOINT LOWER EXTREMITY W/O CONTRAS
610
73721
$2,176.00
MRI JOINT UPPER EXTREMITY W/O AND W/C
610
73223
$4,546.00
MRI JOINT UPPER EXTREMITY W/O CONTRAS
610
73221
$1,981.00
MRI LOWER EXTREMITY W/O AND W/CONTRAS
610
73720
$2,293.00
MRI LOWER EXTREMITY W/O CONTRAST
610
73718
$2,110.00
MRI LUMBAR SPINE W/O AND W/CONTRAST
612
72158
$3,215.00
MRI LUMBAR SPINE W/O CONTRAST
612
72148
$1,803.00
MRI ORBIT/FACE/NECK W/O AND W/CONTRAS
610
70543
$2,954.00
MRI PELVIS W/O AND W/CONTRAST
610
72197
$2,954.00
MRI PELVIS W/O CONTRAST
610
72195
$1,815.00
MRI THORACIC SPINE W/O AND W/CONTRAST
612
72157
$2,954.00
MRI THORACIC SPINE W/O CONTRAST
612
72146
$1,882.00
MRI UPPER EXTREMITY W AND W/O CONTRAS
610
73220
$2,954.00
MRI UPPER EXTREMITY W/O CONTRAST
610
73218
$2,508.00
MRSA RAPID ASSAY
306
87641
$291.00
MTHFR GENE ANALYSIS COMMON VARIANTS
300
81291
$176.00
MUMPS AB,IGM
306
86735
$58.00
NEISSERIA GONORRHOEAE AMPLIFIED PROBE TECHNIQUE
306
87591
$191.00
NEPHELOMETRY EACH ANALYTE NOT ELSEWHERE SPECIFIED
301
83883
$110.00
NON INVASIVE OVERNIGHT OXIMETER
460
94762
$265.00
NON INVASIVE OXIMETRY SINGLE DETERM
460
94760
Variable
OBSERVATION DIRECT ADMIT
762
G0379
$708.00
OCCULT BLOOD DIAGNOSTIC STOOL
307
82270
$32.00
OCCULT BLOOD SCREENING STOOL
307
82270
$36.00
OCCULT BLOOD-FECES1-3 SIMULT
300
82270
$19.00
ORTHC/PROSTC MGMT SBSQ ENC
420
97763
$105.00
ORTHC/PROSTC MGMT SBSQ ENC
430
97763
$105.00
ORTHO SUPPLY-
274
Variable
ORTHOPEDIC IMPLANT
278
C1713
Variable
OSMOLALITY, SERUM
301
83930
$72.00
OSMOLALITY, URINE
301
83935
$60.00
OT EVAL HIGH COMPLEX
434
97167
$210.00
OT EVAL LOW COMPLEX
434
97165
$125.00
OT EVAL MOD COMPLEX
434
97166
$200.00
OT RE-EVAL EST PLAN CARE
434
97168
$125.00
OTHER IMPLANTABLE
278
Variable
OTHER PT CURRENT STATUS
420
G8990
$0.01
OTHER PT DISCHARGE STATUS
420
G8992
$0.01
OTHER PT GOAL STATUS
420
G8991
$0.01
OVA AND PARASITE EXAM
306
87177
$140.00
OXALATE, 24 HOUR URINE
301
83945
$63.00
OXCARBAZEPINE (TRILEPTAL) QUANTITATIVE
301
80183
$116.00
OXYCODONE
301
80365
$119.00
OXYSENSOR-ALL SIZE (6183,6182,6181)
270
Variable
PARACENTESIS
360
49083
$1,098.00
PARTIAL THROMBOPLASTIN
302
85730
$58.00
PERQ DEVICE BREAST 1ST IMAGE
360
19281
$2,883.00
PERQ DEVICE BREAST 1ST US IMAGING
360
19285
$2,883.00
PH BLOOD
301
82800
$78.00
PHARMACY CHG REV 250
250
Variable
PHARMACY CHG REV 258
258
Variable
PHARMACY CHG REV 635
635
Variable
PHARMACY CHG REV 636
250
Variable
PHARMACY CHG REV 637
250
Variable
PHARMACY SUPPLY REV 272
272
Variable
PHARYNX-SPEECH PATHOLOGY-DW
320
74230
$425.00
PHENOBARBITOL ASSAY
301
80184
$87.00
PHENYTOIN FREE
301
80186
$72.00
PHLEBOTOMY, THERAPEUTIC
940
99195
$98.00
PHOSPHOLIPID NEUT PLT 85597
300
85597
$60.00
PHOSPHORUS
301
84100
$27.00
PHOSPHORUS ASSAY, URINE
301
84105
$53.00
PHYSICAL PERFORM TEST OR MEASURE W/REPORT EA 15 MIN
420
97750
$59.00
PINWORM PREP
306
87172
$67.00
PLATELET COUNT
305
85049
$35.00
PLATELET FUNCTION ASSAY, ADP
305
85576
$95.00
PLATELETPHERESIS IRRAD LR
390
P9037
$1,748.00
PLATELETS HLA MATCHED LR
390
P9052
$2,077.00
PNEUMOCOCCAL VACC 23V INJ
636
90732
$77.00
POC FECAL OCCULT BLOOD
307
82270
$32.00
POC PT INR
305
85610
$49.00
POLIOVIRUS VACC 0.5ML SYR
636
90713
$35.00
POTASSIUM ASSAY, SERUM
301
84132
$19.00
POTASSIUM ASSAY, URINE
301
84133
$58.00
PR INFLUENZA VAC 4 VALENT PRSRV FREE 0.5 ML DOSAGE IM
636
90686
$23.34
PR INFLUENZA VAC QUADRIVALENT PRSRV FREE 0.25 ML DOSAGE IM
636
90685
$23.82
PR PNEUML VACC 13 VALENT IM
636
90670
$155.00
PREALBUMIN
301
84134
$112.00
PRESUMPTIVE ID, URINE
306
87088
$74.00
PRIMIDONE
301
80188
$59.00
PRIMIDONE METABOLITE
301
80184
$87.00
PROCALCITONIN
301
84145
$146.00
PROCEDURE OVERRIDE (OML)
301
4288963
Variable
PROCEDURE OVERRIDE (OML)
301
4289963
Variable
PROGESTERONE SERUM
301
84144
$111.00
PROLACTIN
301
84146
$137.00
PROTEIN SERUM TOTAL
301
84155
$27.00
PROTEIN C ACTIVITY
302
85303
$215.00
PROTEIN ELECTROPHORESIS
301
84165
$122.00
PROTEIN ELECTROPHORESIS
301
84166
$193.00
PROTEIN S ACTIVITY
302
85306
$215.00
PROTEIN TOTAL REFRACTOMETRY ANY SRC
301
84160
$17.00
PROTEIN, CSF
301
84157
$63.00
PROTEIN, URINE
301
84156
$73.00
PROTIME
305
85610
$49.00
PSA
301
84153
$108.00
PSA SCREENING
300
G0103
$130.00
PSA, FREE
301
84154
$136.00
PT EVAL HIGH COMPLEX
424
97163
$210.00
PT EVAL LOW COMPLEX
424
97161
$125.00
PT EVAL MOD COMPLEX
424
97162
$200.00
PT RE-EVAL EST PLAN CARE
424
97164
$125.00
PTH (INTACT)
301
83970
$157.00
PTT
300
85730
$58.00
PTT PLASMA FRACTIONS, EACH
305
85732
$30.00
PUNCTURE ASPIRTN CYST(BREAST)
360
19000
$446.00
QUANTIFERON GOLD TB
301
86480
$230.00
QUANTITATIVE SCREEN METALS
301
83018
$139.00
RADIOLOGIC EXAM ABDOMEN 1 VIEW
320
74018
$168.00
RADIOLOGIC EXAM ABDOMEN 2 VIEWS
320
74019
$321.00
RADIOLOGIC EXAM CHEST 2 VIEWS
320
71046
$168.00
RADIOLOGIC EXAM CHEST 3 VIEWS
320
71047
$168.00
RADIOLOGIC EXAM CHEST 4+ VIEWS
320
71048
$401.00
RADIOLOGIC EXAM CHEST SINGLE VIEW
320
71045
$168.00
RADIOPH:S COLLOID TC99M-DOSE
343
A9541
$165.00
RAPID HIV 1/2
301
86703
$206.00
RAPID STREP, GROUP A
300
87880
$39.00
RBC FOLATE
301
82747
$60.00
RBC SED RATE
305
85651
$43.00
RBC SED RATE (AUTOMATED)
305
85652
$43.00
RECOVERY MAIN STAGE 1 LVL 1 ADDL MIN
710
$17.00
RECOVERY MAIN STAGE 1 LVL 1 FIRST 15MS
710
$666.00
RECOVERY MAIN STAGE 1 LVL 2 ADDL MIN
710
$25.00
RECOVERY MAIN STAGE 1 LVL 2 FIRST 15MS
710
$868.00
RECOVERY MAIN STAGE 2 ADDL MIN
710
$11.35
RECOVERY MAIN STAGE 2 FIRST 15 MIN
710
$245.00
RED CELLS LEUKODEPL IRRADIATED
390
P9040
$719.00
RED CELLS, LEUKODEPLETE
390
P9016
$551.00
RENAL FUNCTION PANEL
301
80069
$81.00
RENIN ASSAY
301
84244
$81.00
RESPIRATORY VIRUS 3 TO 5 TARGETS
306
87631
$475.00
RETICULOCYTE PROFILE, AUTOMATED
305
85046
$48.00
RH TYPING
300
86901
$94.00
RHEUMATOID FACTOR, QT
300
86431
$53.00
RNP ANTIBODY
300
86235
$74.00
ROOM AND BOARD HOURLY OBS FIRST 48
762
G0378
Variable
ROOM AND BOARD HOURLY OBS OVER 48
762
G0378
Variable
ROOM AND BOARD-HOURLY OBS-MED/SURG
762
G0378
$83.00
ROOM AND BOARD-MED/SURG
120
$2,156.00
ROOM AND BOARD-MED/SURG-W/TELEMETRY
120
$2,896.00
ROOM AND BOARD-SNF
120
$923.00
ROTAVIRUS (ROTAZYME) AG
306
87425
$94.00
ROTAVIRUS VACCINE, ATTENUATED
636
90681
$92.00
ROTOVIRUS VACCINE, ORAL
636
90680
$92.00
RPR
300
86592
$48.00
RPR QUANTITATION
302
86593
$32.00
RSV
301
87807
$77.00
RT TECHT CONSCIOUS SEDATION
410
Variable
RT TECHT ED TRAUMA
410
Variable
RUBELLA AB, IGG
301
86762
$68.00
RUBELLA AB, IGM
306
86762
$68.00
RUBEOLA ANTIBODY
301
86765
$106.00
RUSSELL VIPER VENOM TIME
301
85613
$127.00
SCL 70 AUTOANTIBODIES
301
86235
$74.00
SELF CARE CURRENT STATUS
420
G8987
$0.01
SELF CARE CURRENT STATUS
430
G8987
$0.01
SELF CARE DISCHARGE STATUS
420
G8989
$0.01
SELF CARE DISCHARGE STATUS
430
G8989
$0.01
SELF CARE GOAL STATUS
420
G8988
$0.01
SELF CARE GOAL STATUS
430
G8988
$0.01
SELFCARE HOME MGMT 1/1 BY PROVIDER EA 15 MINUTES
430
$87.00
SELFCARE HOME MGMT 1/1 BY PROVIDER EA 15 MINUTES
430
97535
$87.00
SENSITIVITY PER ORGANISM MIC
306
87186
$114.00
SEROTONIN
301
84260
$103.00
SGOT (AST)
301
84450
$27.00
SGPT (ALT)
301
84460
$30.00
SIGMOIDOSCOPY
360
$433.00
SIROLIMUS (SACROLINUS)
301
80195
$123.00
SKIN TEST: TB
302
86580
$76.00
SMALL BOWEL STUDY-DW
320
74250
$425.00
SODIUM, LEVEL
301
84295
$27.00
SODIUM, URINE
301
84300
$40.00
SOMATOMEDIN C
301
84305
$106.00
SPECIFIC GRAVITY URINE
307
81002
$35.00
SPERM CHECK
305
89310
$41.00
SPINAL PUNCTURE LUMBAR DIAGNOSTIC
360
62270
$1,167.00
SPIROMETRY PRE AND POST ADMIN
460
94060
$252.00
SQ OR IM INJ-TX,DX,PROPH
940
96372
$63.00
SS-A/RO ANTIBODIES
300
86235
$74.00
SS-B/LA ANTIBODIES
300
86235
$74.00
STANDARD COGNITIVE PERF TEST PER HR
440
96125
$270.00
STENT, URETERAL
278
C2617
Variable
STONE ANALYSIS
301
82365
$81.00
STREP GRP A ANTIGEN DETECTION
306
87880
$71.00
STREPTOLYSIN O ANTIBODY (ASO)
302
86060
$59.00
SULFATE ASSAY, URINE
301
84392
$75.00
SUPPLIES PROCEDURE
272
Variable
SURGERY LEVEL 1 ADD MINUTES
360
$71.00
SURGERY LEVEL 1 FIRST 15 MIN
360
$1,477.00
SURGERY LEVEL 2 ADD MINUTES
360
$90.00
SURGERY LEVEL 2 FIRST 15 MIN
360
$1,923.00
SURGERY LEVEL 3 ADD MINUTES
360
$118.00
SURGERY LEVEL 3 FIRST 15 MIN
360
$2,500.00
SURGERY LEVEL 4 ADD MINUTES
360
$99.80
SURGERY LEVEL 4 FIRST 15 MIN
360
$2,141.03
SURVEILLANCE CULTURE
306
87071
$80.00
SWALLOW CURRENT STATUS
440
G8996
$0.01
SWALLOW DISCHARGE STATUS
440
G8998
$0.01
SWALLOW GOAL STATUS
440
G8997
$0.01
T CELLS TOTAL COUNT CD3
302
86359
$126.00
T3 - TOTAL
301
84480
$70.00
T3 FREE
301
84481
$91.00
T3 REVERSE
301
84482
$63.00
T4 (THYROXINE)
301
84436
$73.00
T4, FREE
301
84439
$41.00
TACROLIMUS FK507
301
80197
$121.00
TB CELL MEDIATED ANTIGEN RESPONSE; GAMMA INTERFERON
302
86480
$230.00
TB INTRADERMAL TEST
302
86580
$20.00
TDAP VACCINE
636
90715
$96.00
TEGRETOL ASSAY (CARBAMAZEPIN)
301
80156
$87.00
TESTOSTERONE TOTAL SERUM
301
84403
$136.00
TESTOSTERONE, FREE
301
84402
$88.00
THC CANNABINOIDS CONFIRMATION
301
80349
$88.00
THEOPHYLLINE ASSAY
301
80198
$109.00
THERA PROC 1+ AREAS EA 15 MIN GAIT TRAIN INC STAIR CLIMBING
420
97116
$81.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSC REEDUCATION
430
$121.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSC REEDUCATION
430
97112
$121.00
THERA PROC 1+ AREAS EA 15 MIN NEUROMUSCULAR REEDUCATION
420
97112
$121.00
THERAPEUT DYNAMIC ACT IMPROVE FUNCT PERF 1/1 EA 15 MIN
420
97530
$100.00
THERAPEUT PROC 1+ AREAS EA 15 MIN AQUATIC EXCERCISES
420
97113
$117.00
THERAPEUTIC DYN ACTIV IMPROVE FUNCT PERF 1/1 EA 15 MINUTES
430
97530
$100.00
THERAPEUTIC PROC 1+ AREAS EACH 15 MIN MASSAGE INCL EFF/PET
420
97124
$95.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXCERCISES
430
$105.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXCERCISES
430
97110
$105.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXERCISES
420
$105.00
THERAPEUTIC PROCEDURES 1+ AREAS EA 15 MIN THERA EXERCISES
420
97110
$105.00
THROMBIN TIME
300
85670
$24.00
THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
450
37195
$779.00
THYROGLOBULIN
301
84432
$55.00
THYROGLOBULIN ANTIBODY
302
86800
$68.00
THYROID HORMONE UPTAKE
301
84479
$73.00
THYROID STIM IMMUNOGLOBULIN
301
84445
$170.00
TISSUE MARKER-IMPLANTABLE
278
A4648
$265.00
TISSUE MARKER/CLIP-IMPLANTABLE
278
A4648
$265.00
TISSUE TRANSGLUTAMINASE AB IGA
301
83520
$74.00
TOPIRAMATE (TOPAMAX)
301
80201
$109.00
TOTAL ALLERGEN IGE
301
82785
$64.00
TPMT GENE ANALAYSIS COMMON VARIANTS
310
81335
$472.00
TRANSFERRIN
301
84466
$67.00
TRANSFUSION BLOOD OR BLOOD COMPONENTS
391
36430
$877.00
TRAUMA CRITICAL CARE 30-74 MINUTES
450
99291
$4,215.00
TRAUMA CRITICAL CARE LESS THAN 30 MIN
450
99285
$1,955.00
TREATMENT OF SPEECH LANGUAGE VOICE COMMUNICATION AUDITORY PROCES
440
92507
$317.00
TREATMENT SWALLOWING DYSFUNCTION AND OR ORAL FUNCTION FOR FEEDING
440
92526
$247.00
TRICHOMONAS DNA PROBE
306
87660
$74.00
TRICYCLIC, ANTIDEPRESSANTS, QUANTITATIVE, URINE
301
80337
$93.00
TRIGLYCERIDE
301
84478
$26.00
TRIP FEE, 1 DRAW
300
P9604
$28.00
TRIP FEE, 10 DRAWS
300
P9604
$2.80
TRIP FEE, 11 DRAWS
300
P9604
$2.54
TRIP FEE, 12 DRAWS
300
P9604
$2.33
TRIP FEE, 2 DRAWS
300
P9604
$14.00
TRIP FEE, 3 DRAWS
300
P9604
$9.33
TRIP FEE, 4 DRAWS
300
P9604
$7.00
TRIP FEE, 5 DRAWS
300
P9604
$5.60
TRIP FEE, 6 DRAWS
300
P9604
$4.67
TRIP FEE, 7 DRAWS
300
P9604
$4.00
TRIP FEE, 8 DRAWS
300
P9604
$3.50
TRIP FEE, 9 DRAWS
300
P9604
$3.11
TROPONIN T
301
84484
$132.00
TSH
301
84443
$147.00
TTE LIMITED OR F/U
480
93308
$823.00
TTE W OR W/O FOL W/CONTRAST, DOPPLER
483
C8929
$1,960.00
TTE WITH DOPPLER AND COLOR FLOW
483
93306
$1,696.00
TTE-CHD
483
93303
$815.00
UNCONJUGATED ESTRIOL
301
82677
$81.00
UNNA BOOT APPLICATION - BILATERAL
510
29580
$240.00
UNNA BOOT APPLICATION - LEFT
510
29580
$240.00
UNNA BOOT APPLICATION - RIGHT
510
29580
$240.00
UPPER GI W/AIR W/KUB-DR
320
74247
$526.00
UPPER GI W/AIR W/O KUB-DR
320
74246
$526.00
UPPER GI W/O KUB - DR
320
74240
$526.00
UPPER GI W/SMALL BOWEL-DW
320
74245
$861.00
UREA NITROGEN, URINE
301
84540
$44.00
URETHROCYSTOGRAM-DW
320
74450
$861.00
URIC ACID
301
84550
$27.00
URIC ACID, URINE
301
84560
$75.00
URINALYSIS W/MICRO
307
81001
$48.00
URINALYSIS, COMPLETE
300
81000
$63.00
URINALYSIS, CULTURE IF INDICAT
307
81001
$48.00
URINALYSIS, DIP STICK ONLY
300
81002
$19.00
URINE CHEMISTRY STRIP
307
81002
$35.00
URINE MACRO, C AND S IF INDICATED
307
81003
$21.00
URINE MACRO, MICROSCOPIC IF IND
307
81003
$21.00
URINE MACROSCOPIC, AUTO
300
81003
$10.00
URINE MICROSCOPIC
307
81015
$29.00
URINE MICROSCOPIC, CULT IF IND
307
81015
$29.00
URINE PREGNANCY TEST
307
81025
$33.00
URINE PROTEIN
301
84156
$73.00
UROGRAPHY RETROGRADE-DW
320
74420
$1,691.00
US ABDOMEN COMPLETE
402
76700
$589.00
US ABDOMEN LIMITED
402
76705
$437.00
US ABDOMINAL AORTA, RT W/IMAGE DOC, SCREENING FOR AAA
402
76706
$425.00
US BREAST UNI REAL TIME W/IMAGE LIMITED
402
76642
$362.00
US CHEST (INCLUDES MEDIASTINUM)
402
76604
$336.00
US GUIDANCE FOR NEEDLE PLACEMENT
402
76942
$1,041.00
US LIMITED JOINT OR OTHER NONVASCULAR EXTREMITY
402
76882
$366.00
US OBSTETRIC AFTER 14 WKS PREG-EA ADDSTER
402
76810
$421.00
US OBSTETRIC AFTER 14 WKS PREG-SINGLE OR FIRST GESTATION
402
76805
$624.00
US OBSTETRIC BPP W/O NON STRESS TEST
402
76819
$425.00
US OBSTETRIC TRANSABDOMINAL F/U GROWTH-PER FETUS
402
76816
$350.00
US OBSTETRIC TRANSVAGINAL
402
76817
$455.00
US OBSTETRIC UP TO 14 WKS PREG-EA ADD
402
76802
$226.00
US OBSTETRIC UP TO 14 WKS PREG-SINGLE OR FIRST GESTATION
402
76801
$400.00
US PELVIS-COMPLETE
402
76856
$492.00
US PELVIS-LIMITED OR F/U
402
76857
$425.00
US PREGNANT UTERUS RT W/IMAGE DOCUMENT ONE OR MORE FETUSES
402
76815
$425.00
US RETROPERITONEAL COMPLETE
402
76770
$510.00
US RETROPERITONEAL LIMITED
402
76775
$425.00
US SCROTUM AND CONTENTS
402
76870
$425.00
US SOFT TISSUES OF HEAD AND NECK
402
76536
$425.00
US THORACENTESIS FOR ASPIRATION W/IMAGING
360
32555
$1,265.00
US TRANSPLANTED KIDNEY
402
76776
$461.00
US TRANSVAGINAL
402
76830
$455.00
VALPROIC ACID ASSAY
301
80164
$87.00
VANCOMYCIN - RANDOM
301
80202
$108.00
VARICELLA VIRUS VACC LIVE SC
636
90716
$98.00
VARICELLA ZOSTER AB, IGG
301
86787
$86.00
VIRUS TISS CULTURE ADDL/EACH ISOLATE
306
87253
$75.00
VIRUS TISS CULTURE INOCULATION
306
87252
$124.00
VISCOSITY, SERUM
301
85810
$53.00
VITAMIN A, SERUM
301
84590
$62.00
VITAMIN B-12 ASSAY
301
82607
$92.00
VITAMIN B-6 ASSAY
301
84207
$94.00
VITAMIN B1 PYROPHOSPHATE (THIAMINE)
301
84425
$77.00
VITAMIN D 25-OH ASSAY
301
82306
$108.00
VITAMIN E
301
84446
$63.00
VMA 24HR URINE
301
84585
$70.00
WHFO CF INCL 1 OR MORE NONTORSION JNTS
274
L3806
$616.00
WHFO RIGID W/O JNTS CUSTOM FABRICATED
274
L3808
$488.00
WHFO W/O JNTS PREFABRICATED OTS
274
L3809
$279.00
WHFO W/O JNTS PREFABRICATED W/ EXPERTISE
274
L3807
$349.00
WHO W/O JNTS CUSTOM FABRICATED
274
L3906
$578.00
WHO WRST EXT CONTROL COCK UP NON MOLDED PREFABRICATED
274
L3908
$112.00
WOUND VAC-NEG PRESS GREATER THAN 50 SQ CM
510
97606
$501.00
WOUND VAC-NEG PRESS UP THRU 50 SQ CM
510
97605
$285.00
X-MATCH 1 UNIT
309
86923
$382.00
XR ORBITS
320
70200
$237.00
XRAY ABDOMEN W/CHEST COMPLETE
320
74022
$425.00
XRAY ACROMIOCLAVICULAR JOINTS BILATERAL
320
73050
$231.00
XRAY ANKLE 2 VIEWS
320
73600
$231.00
XRAY ANKLE 3+ VIEWS COMPLETE
320
73610
$231.00
XRAY CERVICAL SPINE 4+ VIEWS
320
72050
$425.00
XRAY CERVICAL SPINE 2-3 VIEWS
320
72040
$231.00
XRAY CERVICAL SPINE COMPLETE
320
72052
$425.00
XRAY CLAVICAL COMPLETE
320
73000
$231.00
XRAY ELBOW 2 VIEWS
320
73070
$231.00
XRAY ELBOW 3+ VIEWS
320
73080
$231.00
XRAY EXAM ENTIRE SPINE 4 OR 5 VIEWS
320
72083
$843.00
XRAY EXAM ENTIRE SPINE W/SKULL 1 VIEW
320
72081
$231.00
XRAY EXAM ENTIRE SPINE W/SKULL 2-3 VIEWS
320
72082
$425.00
XRAY EXAM HIP UNILATERAL 1 VIEW
320
73501
$231.00
XRAY EXAM HIP UNILATERAL 2 OR 3 VIEWS
320
73502
$231.00
XRAY EXAM HIPS BILATERAL 3 OR 4 VIEWS
320
73522
$425.00
XRAY EXAM OF FEMUR 2 VIEWS MINIMUM
320
73552
$231.00
XRAY FACIAL BONES 1-2 VIEWS
320
70140
$231.00
XRAY FACIAL BONES 3+ VIEWS
320
70150
$425.00
XRAY FOOT 2 VIEWS
320
73620
$231.00
XRAY FOOT 3+ VIEWS COMPLETE
320
73630
$231.00
XRAY FOR FOREIGN BODY-CHILD
320
76010
$231.00
XRAY FOREARM 2 VIEWS
320
73090
$231.00
XRAY HAND 2 VIEWS
320
73120
$425.00
XRAY HAND 3+ VIEWS
320
73130
$231.00
XRAY HEEL 2+ VIEWS
320
73650
$231.00
XRAY HUMERUS 2+ VIEWS
320
73060
$231.00
XRAY KNEE 1-2 VIEWS
320
73560
$231.00
XRAY KNEE 3 VIEWS
320
73562
$231.00
XRAY KNEE 4+ VIEWS COMPLETE
320
73564
$425.00
XRAY LOWER EXTREMITY INFANT 2+ VIEWS
320
73592
$231.00
XRAY LUMBAR SPINE BENDING 4+ VIEWS
320
72120
$279.00
XRAY LUMBARSACRAL SPINE 2-3 VIEWS
320
72100
$425.00
XRAY LUMBARSACRAL SPINE 4+ VIEWS
320
72110
$425.00
XRAY LUMBARSACRAL SPINE COMPLETE
320
72114
$425.00
XRAY MANDIBLE 4+ VIEWS
320
70110
$425.00
XRAY NASAL BONES 3+ VIEWS
320
70160
$231.00
XRAY NECK SOFT TISSUE
320
70360
$231.00
XRAY OSSEOUS SURVEY COMPLETE
320
77075
$425.00
XRAY PELVIS 1-2 VIEWS
320
72170
$425.00
XRAY RIBS BILATERAL 3 VIEWS
320
71110
$425.00
XRAY RIBS BILATERAL 4 VIEWS
320
71111
$425.00
XRAY RIBS UNILATERAL 2 VIEWS
320
71100
$231.00
XRAY RIBS UNILATERAL 3 VIEWS
320
71101
$425.00
XRAY SACROILIAC JOINTS 3+ VIEWS
320
72202
$425.00
XRAY SACRUM/COCCYX 2+ VIEWS
320
72220
$231.00
XRAY SCAPULA COMPLETE
320
73010
$279.00
XRAY SHOULDER 1 VIEW
320
73020
$231.00
XRAY SHOULDER 2+ VIEWS COMPLETE
320
73030
$231.00
XRAY SINUSES 1-2 VIEWS
320
70210
$231.00
XRAY SINUSES 3+ VIEWS
320
70220
$231.00
XRAY SKULL 1-3 VIEWS
320
70250
$425.00
XRAY SKULL 4+ VIEWS
320
70260
$425.00
XRAY SPINE 1 VIEW
320
72020
$231.00
XRAY STERNUM 2+ VIEWS
320
71120
$231.00
XRAY SURGICAL SPECIMEN
320
76098
$1,802.00
XRAY TEMPOROMANDIBULAR JOINTS BILATERAL
320
70330
$231.00
XRAY THORACIC SPINE 2 VIEWS
320
72070
$425.00
XRAY THORACIC SPINE 3 VIEWS
320
72072
$425.00
XRAY THORACOLUMBAR JUNCTION 2 VIEWS MIN
320
72080
$231.00
XRAY TIBIA/FIBULA 2 VIEWS
320
73590
$231.00
XRAY UPPER EXTREMITY INFANT 2+ VIEWS
320
73092
$425.00
XRAY WRIST 2 VIEWS
320
73100
$231.00
XRAY WRIST 3+ VIEWS COMPLETE
320
73110
$231.00
YEAST ID
306
87106
$94.00
YUEH-CENTISIS CATH NEEDLE
272
$61.00
ZINC LEVEL PLASMA
301
84630
$63.00
ZONISAMIDE QUANTITATIVE
301
80203
$116.00